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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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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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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President Obama - Do Something That Could Work!

Stanley Feld M.D.,FACP,MACE

The solution to repairing the healthcare system is simple. The healthcare system must be consumer driven. If consumers were in control of their healthcare dollars and were responsible for their health and their healthcare choices the cost of the healthcare system would decrease to manageable levels.

My ideal Medical Savings Account puts the consumer in charge. Its success is totally dependent on real transparency by all stakeholders including healthcare insurance companies, hospital systems and physicians. 

A Health Savings Account does not give consumers enough of an incentive to shop for price and quality with the present lack of transparency. In a transparent healthcare system Medical Saving Accounts would provide more incentive than Health Savings Accounts.  

Presently President Obama is trying to eliminate Health Savings Accounts. HSAs are the single greatest threat to his goal for a single party payer system. They are also the fastest growing healthcare insurance product.

The lack of transparency for hospitals, healthcare insurance companies, drug companies and physicians must be eliminated. The public must demand that the healthcare insurance industry make their expenses transparent so that its exorbitant salaries and profits can be clearly understood.   

There is no reason that this one stakeholder receives 40% of every premium dollar spent either by private corporations or the government. The medical loss ratio as it is presently constructed by the Obama administration provides 20% for expenses. The other 20% of the $40% is in the direct patient care column.

The government should help consumers understand these prices and understand the measurement of quality. Consumers of healthcare must be turned into Prosumers of healthcare (Productive Consumers.)

When this happens the consumers can become independent intelligent consumers. Consumers will become independent of government and its bureaucracy.

The Obama administration wants consumers to be more dependent on government not less dependent.

Intelligent independent Consumers will force the other stakeholders to be competitive. Competition will drive healthcare costs down.

Government cost controls will not drive prices down. They will simply distort prices and cause more spending.

Private sources such as Angie’s list help consumers decide on which plumber to hire. It is important and creates competition and price lowering. However the defect in Angie’s list is that it is based on other consumers’ opinions.

It is not based on specific costs or origins of the cost to the plumber or the measurement of the plumber’s skill. It only deals with price and consumer satisfaction. Angie’s list does make plumbers competitive.

Competition for consumers will bring down the cost of healthcare.  By forcing consolidation of doctors and hospitals Obamacare will decrease competition and increase prices.

 Healthcare policy wonks dismiss this concept because they believe consumers are not smart enough or interested enough in learning to be intelligent healthcare consumers. They are wrong.

Their thnking is correct if a system exists where consumers are spending other people’s money. Obamacare is such a system. It will drive costs up just as the private first dollar coverage system has driven healthcare prices up.

There is no financial incentive for healthcare consumers to try to save money and preserve their health.

Obamacare is a huge entitlement with an overwhelming budget that will be impossible to execute. We have seen that to be true with ever increasing waivers and the most recent delay in the mandate until 2015.  There will be delays in other critical portions of Obamacare in the near future. It could be delayed forever because it cannot be executed.

In my last blog I forgot to mention the delay in forming and activating the Independent Physician Advisory Board.

Last year I wrote about the Obama administration’s infatuation with the Canadian Healthcare System. I reviewed the 2011 Fraser report explaining that the Canadian Healthcare System is unsustainable.

I also wrote about Canadian consumers’ healthcare experiences in two provinces I visited.  The fact is the system doesn’t work well and is unsustainable.

The Fraser Institute in a 2011 report concluded that Canada’s health care system is spending money at an unsustainable rate. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the institute.

“In 2011, health care spending consumed 50 percent of revenues in Canada’s two largest provinces, Ontario and Quebec.

By 2017, four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick — will spend half of their revenues on health care, according to the institute.

Total federal, provincial and territorial government health spending has grown by 8.1 percent annually. Canada’s GDP increased by 6.7 percent during the same period. The math is obvious. The Canadian healthcare entitlement system is not working.

“In response to the rapidly rising costs, provincial governments have raised taxes and rationed care, increasing patient wait times. Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief,” Fraser Institute Senior Fellow Nadeem Esmail told The Daily Caller News Foundation in an email.”

Only 20% of the people utilize the healthcare system at any on time. If consumers know they are entitled to healthcare and the healthcare system will fix them if they get sick, consumers of healthcare feel protected. The feelings of eighty percent of consumers who are not sick believe the system is great until they have to interact with the system. In this system of entitlement consumers have a tendency to not take care of their health.  This makes them more likely to interact with the system in the future when they are very sick. The result is increasing healthcare costs.

Once an entitlement is created it is almost impossible to eliminate it even though it has proved ineffective and costly.

England’s NHS has shown this to be true. The NHS is struggling right now to modify the NHS so it works better for physicians and patients. However, the new reform rules have been contaminated with so many amendments that I suspect no progress will be made.

Consumers are realizing that Obamacare is much too complicated and impossible to execute. Rather than demanding repeal and eliminating the concept of instituting an entitlement program, the New York Times is publishing letters from readers that are demanding a single party payer system to simplify the system.

Let us stop making the same mistakes over and over again.

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

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Where Is The Intellectual Integrity?

Stanley Feld M.D, FACP, MACE

Paul Krugman did it again. He demonstrated his bias for Obamacare by ignoring or misrepresenting the facts.

 “As long as someone with Krugman’s professional status gets his facts wrong in column after column, and does so in an arrogant and pompous manner, attacking the integrity and hurling insults at all who disagree with him…well, there will always be a market for a writer who is able to show that the scourge of sensible people everywhere has written one more erroneous editorial. “

This is a perfect description of Paul Krugman’s methodology. His opening sentences demonstrate the arrogance and pompous manner in which he attacks the integrity of his opponents and hurls insults at them.

“The Affordable Care Act, a k a Obamacare, goes fully into effect at the beginning of next year, and predictions of disaster are being heard far and wide. There will be an administrative “train wreck,” we’re told; consumers will face a terrible shock. Republicans, one hears, are already counting on the law’s troubles to give them a big electoral advantage.”

He uses misleading and false evidence to undermine his critics’ opinion.

“Yet important new evidence — especially from California, the law’s most important test case — suggests that the real Obamacare shock will be one of unexpected success.”

The LA Times told part of the story to unmask Paul Krugman’s disinformation.

California's health insurance rates for some companies with some physician networks for the new state-run marketplace (health insurance exchange) did come in lower than expected.

However, there are certain downsides for many consumers that Paul Krugman ignores.

There will be far fewer doctors and hospitals to choose from in Covered California.  Covered California is California’s version of Obamacare’s health insurance exchange.

Consumers who want UCLA Medical Center and its doctors in their health plan network next year will have only one choice in California's exchange. Anthem Blue Cross is the only carrier.

Additionally, Blue Shield of California said its exchange customers will be restricted to 36% of its regular physician networks statewide.

These two insurers are decreasing physician reimbursement.  Physicians and their networks are refusing to participate.

Cedars-Sinai Medical Center, one of Southern California’s most prestigious and expensive hospital systems and physician networks said it’s not included in any exchange plans at the moment because physicians and the hospital system will not accept the reduced reimbursement.

There is a problem with Paul Krugman’s statement because he does not define  the real cost of healthcare to the state.

The California health insurance exchange (Covered California) is trying to make consumers believe they are getting more for less.

The facts are, when you get in the weeds, Californians are getting less for more.

The health insurance exchange must be analyzed within the context of each individual patient. The insurance industry is excited about Obamacare because they believe young patients will be forced into the marketplace.

A hypothetical healthy 25 year old in San Francisco earning $46,000 a year in 2013 can buy a PPO plan from a major insurer with a $5,000 deductible and a 30% coinsurance plus a $10 copay for generic drugs and a total $7,000 out of pocket expense for $177 per month.

“Covered California, a “Bronze” plan from the exchange with nearly the same benefits, including a slightly lower out-of-pocket maximum of $6,350, will cost him between $245 and $270 a month.”

The cost of coverage under Covered California is 38% higher than comparable coverage in the present overpriced private sector for someone whose chances of being sick are small.

Paul Krugman is talking about a fudged figure when he quotes a 29% reduction using the health insurance exchange.

“The rates submitted to Covered California for the 2014 individual market,” the state said in a press release, “ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions.”

This sentence led Paul Krugman’s triumphant commentary.

“This is a home run for consumers in every region of California,” exulted the head of Covered California.”

Obamacare will drive premiums up by between 100 and 123 percent for a typical nonsmoking 25-year-old earning $45,000 per year.

It will also drive them out of the market for healthcare insurance. They will buy healthcare insurance from the health insurance exchange only in case of an emergency or if they develop a chronic illness.

This is exactly what President Obama wants to happen. He wants to drive everyone into health insurance exchanges and then stick the bill to the states.

The traditional media represented by Paul Krugman is spinning the story and the American public isn’t buying it.

The problem is they aren’t feeling the pain yet. When Americans start feeling the pain there will be an uproar.

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

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The Anatomy of Healthcare Billing

Stanley Feld M.D.,FACP,MACE

The start of exposing the real cause of healthcare inflation has begun.  The billing and reimbursement system is finally being questioned.

I hope the debate creates an uproar among consumers who are the most important and most disadvantaged stakeholders in the debate. My hope is consumers will realize they are pawns in the complex billing and reimbursement system created.

Consumers must also realize they have the power to demand control over their healthcare dollars and not hope the government will protect them.

Steven Brill’s article in TIME magazine started the debate. The demand for transparent pricing has started.  Steve Brill’s numbers are far from accurate.  However,the pricing information is close enough to get consumers mad as hell.

The Centers for Medicare and Medicaid Services finally released its massive database containing what 3,000 hospitals charge for 100 of the most common medical procedures.

The database compares the hospital “chargemaster” to the prices Medicare actually paid.

The reimbursement to hospitals is based on the hospital system’s estimates of the actual hospital costs plus hospital administrative overhead. These estimates are an error. The calculation should be the actual costs and not an estimate of the actual cost.

The database only covers 100 of the most common illnesses.

I have written about hospital administrators’ salaries being in excess of 1 million dollars a year with many being up to 15 million dollars a year. These salaries are included in the overhead covered by Medicare payment.

I have questioned the appropriateness of these massive salaries. In Boston there seems to be a contest between hospital systems for which CEO gets a bigger salary.

Another important question is how many hospital administrators in a hospital system get an excessive salary for the value they add to medical treatment.

Who is worth more, a physician or a hospital administrator?

 In many cases the reimbursement by Medicare to some hospitals is 10% of the hospital’s billing.  In other hospitals the difference is 20-40%.

The payment gap between hospital charges for procedures and Medicare payments is also stunning. The average difference between hospital charges for the 100 procedures tracked and what Medicare’s average actually payment is a difference of 72%.

A good metric is to beware of the man that quotes average percentages if you want to understand the actual difference.

The best example I have seen to visualize the variation of these prices in simple terms is as follows.

 

“Imagine a banana in a supermarket. It costs $1 for those paying with Visa, $3 for those paying with MasterCard, and $32 for those paying with cash.

You can't sign up for Visa until you're 65, and you can only get a MasterCard if you have a nice employer or a decent income.

Worse, customers have no idea that such price discrepancy exists. They don't even know how much they'll pay for the banana until long after they've eaten it.”

“That would be absurd. No one would put up with it.

But it's how our health care system works.”

Why should healthcare consumers in America put up with it? Isn’t it the government’s job to protect us from this abuse and not have a system that encourages it? Obamacare claims to stop the abuse as it has been going on its merry way to encourage it.

This is not the entire grizzly story.

The average prices by states shows massive discrepancies. In California, the average hospital charges $101,844 to treat respiratory infections. In Maryland the average price for the same respiratory infection is $18,144. The difference is 82% for the same disease in two different states. The government is the same payer for both states.

 New Jersey hospitals bill an average for $72,084 for "simple pneumonia," while Massachusetts’ hospitals charges an average of $20,722. Neither of the state’s hospitals receives that much reimbursement for treating these infections from Medicare. However, New Jersey hospitals receive more.

Uninsured patients and the indigent without insurance are getting the shaft. These people will have to pay retail hospital prices or get sued by the hospital system.

None of the hospital prices are transparent. A patient cannot even beg the hospital system to get a price.

Many treatments can be administered as an outpatient. The government pays at least three times more for chemotherapy in a hospital setting or a hospital outpatient clinic as it would to a freestanding private outpatient oncology clinic.

 What’s the deal? The government doesn’t trust physicians. It is afraid physicians will overcharge.

What does the government think the hospital systems are doing?

I have also written about primary care physicians’ salary being about $100,000- $120,000 a year. Surveys of physician salaries have shown salaries varying between $100,000 to $600,000 per year. Surgical subspecialists receive more than primary care physicians.

Let us assume the average physician’s salary is $300,000 per year. There are approximately 600,000 practicing physicians in the U.S.

The total physician reimbursement is $180 billion dollars a year in a $2.7 trillion dollar industry. This is less than 10% of the total dollars spent. Even if you doubled physicians’ salaries to include an overhead of 50% physicians receive 13.2% of the healthcare dollars spent.

A major question is where is the remaining 2.5 trillion dollars going?

The healthcare insurance companies take 40% off the top of all care delivered including Medicare and Medicaid and other government programs. They do all the government administrative services and hide the fees through deductions that should go to expenses but with the government’s permission go to direct patient care.

The most important metrics are never discussed and inaccurately measured.  They are clinical outcomes and quality of procedures performed with respect to financial outcomes.

The reason this measurement is not done is because there is no accurate definition or measurement of these metrics. Clinical outcomes as it relates to cost of care has to be included in the measurement of quality of care.  No one knows how to do this.

How does all this get fixed?

Consumers must drive the healthcare system. My ideal medical saving account would go a long way in dis-intermediating the healthcare insurance industry.

An easy to use web site should be constructed using the Travelocity, Expedia or the Orbitz formula.

All hospital and physicians’ prices should be online. All insurance and government reimbursement should be published on this web site, plus insurance premiums and their justifications. The real government overhead should also be available to consumers. 

A government web based educational program to make consumers smart medical consumers would decrease healthcare costs immediately.

All of the above would be a good start.

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

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Surprises For Physicians Coming With In Health Insurance Exchanges

Stanley Feld M.D.,FACP, MACE

 Two important components of Obamacare are Accountable Care Organizations (ACOs) and Health Insurance Exchanges (HIEs).

The adoption of both by medical communities and the states has been slow for good reason.

I have discussed the difficulties of setting up and the executing effective Accountable Care Organizations.

Some hospital systems are trying to set up ACO’s. These hospital systems are buying up physicians’ practices and trying to develop integrated care organizations.

The hospital systems are buying the physicians’ intellectual property and surgical skills sets. It will not work once physicians realize what happened.

The relationship between community hospital systems and practicing physicians had always been tense. Physicians do not trust hospitals and hospitals do not trust physicians.

Some physician groups are trying to develop their own ACOs. They are trying to convert hospital systems from being providers of patient care to vendors for their physician ACO.

If there are two hospitals in a community or town the hospital systems might become competitive.

The huge problem for physicians is the assuming of risk. If healthcare insurance companies cannot manage risk, why would physicians think they can manage risk?

 A variable that cannot be controlled in managing risk are patients. With all the obesity and the increase in diabetes mellitus it seems patients do not have the incentives to manage their own risks.

 Patients and physicians must be provided with appropriate financial incentives if there is the slightest chance of managing risk and decreasing the cost of healthcare.

 The adoption of ACOs has been slower than the Obama administration has anticipated.   

 Adoption of the Health Insurance Exchanges has been slow by states. Some states recognize the financial risk the Obama administration is trying to force on them.

This risk is ever present even if the federal government is going to pay the entire bill for the first three years.

As soon as physicians realize the risk the Health Insurance Exchanges are going to impose on them, they will not be willing participate.

These risks become more apparent will each succeeding release of regulation.

Kathleen Sebelius said it two weeks ago when she said there would be plenty of surprises ahead for physicians.

“Health and Human Services Secretary Kathleen Sebelius, who told a gathering a few weeks ago at the Harvard School of Public Health that she has been "surprised" by the political wrangling caused so far by Obamacare, there are likely to be plenty of surprises ahead.”

Physicians could face dramatic financial challenges for treating patients who receive health coverage through the Affordable Care Act's (ACA) Health Insurance Exchanges starting next year.

“ Insurance companies will not process claims on patients who haven't paid their premiums in 3 months, leaving doctors on the hook to recoup payment directly from the patients.”

Obamacare provides a 3-month grace period to individuals who haven't paid their premiums for insurance purchased through the Health Insurance Exchanges.

This provision will prove to be a problem for physicians.

In Obamacare patients who fail to pay their premium are free to sign up for another plan provided by the Health Insurance Exchange.  

They can also start seeing another physician without the insurance company or new physicians being aware of the patient’s delinquent premium record.

"Why would a doctor sign up to treat these patients] if they're going to be completely at risk and have to collect from the patient directly for their care?"  "This is a really bad provision in the bill, and we've got to get it fixed."

Under traditional insurance provided by employers, the plan is still liable for paying doctors even if the patient or employer hasn't paid their premiums,

Under the health insurance exchange the individual is responsible for their monthly premium. If the patients discontinue payment of their premium the healthcare insurer is not obligated to pay the physician for the care provided.

Most of the time patients have stopped paying premiums because they cannot afford them. Patients buying healthcare insurance from the Health Insurance Exchanges are lower income producing patients. 

 The expected annual, out-of-pocket cost for an individual is estimated to be around $6,400 and $12,800 for a family. This is not an insignificant expense for low wage earners.

Recent premium estimates indicate that the premium will be higher. This could be one of the surprises Kathleen Sibelius is referring to.

Another potential shortcoming of the Health Insurance Exchange is the reimbursement rates provided to physicians. The Obama administration believes Medicaid rates are sufficient.

I wonder if any of President Obama’s healthcare policy wonks ever questioned why so many physicians do not accept Medicaid.

The answer is simple. The reimbursement rate is less than the physicians fixed overhead to see the patient.

Medicaid physicians are driven to see many patients a day to try to make a living.

It would be difficult maintaining a physician patient relationship and a high quality of care seeing over 100 patients a day.

When their overproduction is discovered these physicians are investigated for fraudulent practices.

 The rates the healthcare insurance industry will pay physicians will not be set until late summer.

The big provider groups are negotiating with plans on their payments. Small groups will only get a "take it or leave it" contract from the health plans.

It seems obvious that fewer physicians will sign up to accept patients receiving coverage through the Health Insurance Exchanges once physicians understand what Obamacare is doing.

 This will result in a further physician shortage.

 The simple question is what is Obamacare trying to do to the healthcare system?

 Is Obamacare trying to destroy the healthcare system?

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

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Facts and Misuse Of Facts

 

Stanley Feld M.D.,FACP,MACE

All of us try to understand the facts and make logical decisions by synthesizing the facts.

There is a lot of misinformation and disinformation being printed. This misinformation and disinformation leads to the wrong conclusions because the facts are inaccurate.

 A master purveyor of this misinformation and disinformation is Paul Krugman.

I believe his misuse of facts is icreasing as he is subconsciously realizing his ideology is incorrect.

Here are a few examples of disinformation or misinformation in Paul Krugman’s most recent article “Mooching off of Medicaid” 

“For there is a lot of price-gouging in health care — a fact long known to health care economists but documented especially graphically in a recent article in Time magazine. “

This is true. The margins on hospital systems retail prices are outrageous. The margins on some discounted hospital system prices are equally outrageous.

 There is a continuous price war between hospital systems and payers (government and healthcare insurance companies).

 The uninsured and under insured primary stakeholders (consumers) are stuck with these outrageous prices.

"As Steven Brill, the article’s author, points out, individuals seeking health care can face incredible costs, and even large private insurance companies have limited ability to control profiteering by providers."

 This statement is not quite true. Most people have healthcare insurance. The healthcare insurance industry and government have negotiated discounted prices that are as low as 10% of the retail prices published in Steven Brill’s article.

In the struggle to retain providers, private insurance companies offer slightly higher prices than the government.

The healthcare insurance industry knows the government’s exact reimbursement prices. The private insurance companies provide the administrative services for the government’s healthcare plans.

Individuals not under the umbrella of these discounted prices are liable for these high prices. As insurance premiums increase, employers are reducing insurance coverage for employees.

The deductibles and co-pays are increasing to unaffordable levels for everyone as an increasing numbers of employees are becoming under insured.  

 “For there is a lot of price-gouging in health care —"

 Price gouging is the result of a lack of transparency and special deals the government and the healthcare insurance industry makes with certain hospital systems   

“Medicare does much better at preventing price gouging , and although Mr. Brill doesn’t point this out, Medicaid — which has greater ability to say no — seems to do better still”.

 This is false. There are fewer physicians seeing Medicaid patients because reimbursement is very low. In fact, in most cases physician reimbursement is lower than physician overhead. The result is access to care for a Medicaid patient is restricted. The access to care for private insured patients is not.

Hospitals receive a bonus for seeing Medicaid patients. This fact is not transparent and known by few.

 “And despite some feeble claims to the contrary, privatizing Medicaid will end up requiring more, not less, government spending”,

Paul Krugman makes declarative statements as if they are unequivocal evidence. 

 “because there’s overwhelming evidence that Medicaid is much cheaper than private insurance.”

The evidence in Paul Krugman’s quoted study is not that overwhelming.

I reviewed this 2008 study. The demographic difference of the Medicaid group compared to the privately insured group is different. The difference can reveal alternate conclusions.

 

 

Note the demographic differences of the Medicaid vs. Private insurance patients.

 

Heath status good      53.5% vs 41.2%

Mental health             17.4 % vs  6.4%

Hispanic                     23.4% vs 16.9%

African American        27.5% vs 16.4%

White                          49% vs 66%

Employed                   48% vs 74.6%

No hi school degree   36.7% vs 17.2%

Married                        33.6% vs 51.7%

Income less than poverty 62.3% vs 22.2%

 

An alternate conclusion could be that it is too difficult for Medicaid patients to find a physician. Medicaid patients are more poorly educated. The do not seek physicians’ help compared to the privately insured group. Medicaid patients cannot afford the minimal out of pocket expenses.

 

To my amazement the unadjusted annual per person Medicaid spending was higher in this article for the Medicaid insured group than the privately insured group by $1000.  

Paul Krugman states Medicare and Medicaid have lower administrative costs.

“Partly this reflects lower administrative costs, because Medicaid neither advertises nor spends money trying to avoid covering people”.

 He goes on to say.

 “But a lot of it reflects the government’s bargaining power, its ability to prevent price gouging by hospitals, drug companies and other parts of the medical-industrial complex.”

The government does have bargaining power. However reimbursement to physicians is so low that it is difficult for Medicaid patients to find a physician.

This could be a reason Medicaid costs are lower than privately insured patients with a high school education and a job.

Acute care hospitals have a 10% Medicaid threshold. They can also be eligible for incentive pay.

 “In addition, to be eligible to receive a Medicaid EHR incentive payment, acute care hospitals must also meet a 10 percent Medicaid patient volume threshold.”

Paul Krugman and others conclude,

“Our nation cannot control runaway medical spending without fundamentally changing how physicians are paid.”

Physicians receive only 9% of healthcare dollars spent. The real facts are physicians write orders for the inflated services of the hospital systems without receiving financial benefit. In fact, the government restricts physician participation. Physicians’ reimbursement decreases yearly.

It is very easy to draw the wrong conclusions when relying on inaccurate facts from so called experts.

The real challenge is to dig down and get the correct facts.

This is not done because ideology, non-transparency and bias stand in the way. This contributes to the healthcare system becoming more dysfunctional and costly each year.

 Healthcare policy errors are made because policy is made using incorrect facts.

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



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The Destruction of Private Healthcare Insurance

Stanley Feld M.D., FACP, MACE

One of these days Americans are going to pay attention to how President Obama is destroying private healthcare in America.

Many people will fine this hard to believe because he is such a nice guy and many people like him.

He is making the healthcare insurance industry destroy itself by forcing them to increase healthcare insurance rates.

The destruction is so well designed that the public cannot take notice. The healthcare system will not be more affordable or accessible to anyone in the nation.

The changes will provide President Obama with another tool to redistribute wealth and increase the individual’s dependence on the federal government. This defines President Obama’s goal in affecting all areas of our life.

Americans are on the Road To Serfdom.

I remember Barney Frank and John Kerry saying that healthcare reform would not work without a “Public Option.” I also remember President Obama saying we can make it work without a “Public Option.”

President Obama’s original plan was to eliminate private insurance. Americans would have no choice but a “Public Option.”  (National Health Plan)

 

 Kathleen Sebelius, the secretary of health and human services said, she “retains authority to make the final decision” on insurance rates if she finds that a state acted in an arbitrary or capricious way in denying a rate increase sought by a nationwide health plan.

 

This is the first time I have seen President Obama’s administration use the words “National Health Plan.”

It was obvious President Obama was not truthful when he said “if you like your physician you can keep him” and “if you like your healthcare insurance you can keep it.”

Congress made a gigantic while passing Obamacare and transferring all healthcare policy decision making power to the executive branch of government.

President Obama’s goal is to have complete control over the healthcare system. He wants to force the private healthcare insurance industry out of business. He wants to socialize the entire medical care industry into a single party payer system.  The government will be the single party payer.

Healthcare will then be a ubiquitous entitlement program that the government cannot afford unless it increases taxes entire population according to the taxpayers means.

This is the pattern behind many of the articles written in isolation by the traditional media.

The unintended consequences resulting from each policy change will be overwhelming.

I have been fascinated by President Obama’s negotiating strategy.  

Americans are going to wake up to the fact that President Obama has increased taxes for the funding of Obamacare by $1 trillion dollars over the next ten years aside from the tax hikes effective January 1^st.

Americans are going to wake up and feel deceived by President Obama when they realize they are getting little for their increased taxes except government control over their freedoms.

I predict President Obama’s plans will blow up in his face.

Consumers will protest when they recognize the impact these multiple new taxes will have on their discretionary income. President Obama will not get the funding he needs from congress.  

His physician workforce will not cooperate. Hospitals are starting to wake up and are seeing they were deceived. They thought they would do better because they have bought physician practices.

Recently they automatically received cuts in reimbursement while the doctor fix was extended for another year. Physician reimbursement will be cut and the physician workforce will dwindle.

On Friday afternoon November 30^th 2012 the Obama administration pulled a stunt on the healthcare insurance industry.

“The Obama administration said Friday that it would charge insurance companies for the privilege of selling health insurance to millions of Americans in new online markets run by the federal government.”

The cost of these “user fees” can be passed on to consumers. The proposed fees could add 3.5 percent to premiums for private health plans sold in insurance exchanges operated by the federal government.

The "user fees" are another tax to consumers.

The government is disregarding the fact that healthcare insurance premiums are too high for employers to provide healthcare insurance for employees now.

Employers are opting to drop healthcare insurance coverage and pay the government penalty. Some are dropping healthcare insurance and avoiding the penalty by decreasing the number of employees to under 50 employees or decreasing employees work hours to under 30 hours per week.

This will increase, not decrease the tax burden on the consumer.

The exact effect of the health insurance exchange on the healthcare industry is muddled.

It looks as if President Obama is rapidly moving toward a “Public Option.”

Consumer advocates, insurers, and some state officials had expressed concern about delays in publication of the rules for this new proposal.

President Obama has used this is the same tactic before. Consumers and agencies must accept the changes before the rules are published.

Consumers and state governments do not trust President Obama. They are afraid to say yes when they do not know what they are saying yes to. In the end it  looks like the state governments and the consumers will get stuck with the bill and the federal government will have complete control over the healthcare system.

CMS said. “These plans will be offered by private insurance companies under contract with the United States Office of Personnel Management. The agency already provides insurance to eight million federal employees, retirees and dependents.”

The scary part is the administration said, “It (the government) retains authority to make the final decision” on rates if it finds that a state acted in an arbitrary or capricious way in denying a rate increase sought by a nationwide health plan.”

The term “Nationwide Health Plan” and “final authority” sounds as if the government is taking over.

The federal government will also have control over physicians and hospital fees.  It will also control access to care and the rationing of care.

It is almost too late for consumers to wake up.

No one can say President Obama didn’t tell us.

It can only be said the plan was so obfuscated, final rules so delayed and unsubstantiated promises made and not publicized on a Friday afternoon the week after Thanksgiving that the public did not understand what was going on and could not express an opinion.

The games President Obama and his administration play are dizzying. The irresponsibility of our elected congressional officials who are supposed to be our surrogates is unconscionable.

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



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Price Competition for Medical Care

Stanley Feld M.D.,FACP,MACE

Thank goodness many physicians are starting to recognize the problems of abuse and waste in government run healthcare programs.  The run up in cost is secondary to the healthcare insurance industry taking 40% of the healthcare dollars off the top as patient care dollars and the hospital systems over inflating the costs to patients because of inflated operating expenses and administrative salaries.

Physicians realize that an efficient free market system will reduce the cost of care. Physicians are tired for being blamed for the entire healthcare systems problems. They do not deny being part of the problem.

Many physicians have decided to move forward and develop consumer driven free market systems of care. 

One example is Nextera Health in Longmont Colorado. I have discussed this previously.

Nextera Healthcare is a new model for delivering primary care at an affordable price. It follows many of the principles embodied in my ideal medical savings account model.  Nextera delivers compassionate care at an affordable cost and encourages patients to be responsible for their health.

Nextera Healthcare services all of a families needs at an affordable monthly cost. It is combined with a high deductible healthcare insurance plan to cover costly illness.  

The reason I am so high on Nextera Healthcare is that it closely fits a model of healthcare delivery that will work to decrease the cost of medical care. It will increase the quality of medical care and permit primary care to be a viable specialty. 

Nextera Healthcare has the potential to permit the patient to be responsible for managing their health and their healthcare dollars.

Nextera Healthcare has the potential to reduce healthcare cost to individuals, employer sponsored self insured plans, associations and even government funded healthcare plans while permitting consumers to make their own healthcare decisions.

Surgeons are developing their own innovative systems.  In free standing surgery centers they are developing surgical procedures that cost at least 70% less than Medicare is paying hospitals for the same procedure.   

 Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, took an initiative that would only be considered radical in the health care industry.

Dr. Smith posted a list of prices online for 112 common surgical procedures. Dr. Smith ,an anesthesiologists, became disillusioned about how patients were treated and charged at St. Anthony Hospital in Oklahoma City.  

Dr. Smith’s goal was to create a for-profit facility that could deliver first-rate care at a fraction of what traditional hospitals charge. The goal was to eliminate the hospital and healthcare insurance industry as the middlemen while decreasing the cost of surgical care without decreasing the quality of care.

He wanted to create a system in which consumers and their employers could receive surgical value at an affordable price. In the existing healthcare system patients have no incentive to look for dollar value.

A healthcare system in which consumers buy goods or services from a physician, surgeon or hospital systems all being paid for by the healthcare insurance industry or government does not constituent incentive for consumers to seek value and quality.

The lack of patient responsibility and value hunting is one of the major causes of exploding U.S. heath care costs.

Physician owned transparent Surgery Centers are becoming increasingly common as Americans look for alternatives to the traditional health care market which is unaffordable and out of reach.

Consumer-driven models are appearing as fewer people have healthcare coverage from their employers and are on their own

The unintended consequences of Obamacare are creating more uninsured not less. The Medicaid insurance coverage that Obamacare is offering is unappealing.

Patients may have no choice but to look outside the traditional health care industry in the face of higher costs and reduced access to doctors and hospitals. It is only going to get worse as we get deeper into Obamacare.

The Oklahoma Surgery Center demonstrates that it’s possible to offer high quality care at low prices. Surgeons can do twice as many surgeries in an outpatient surgery center than they can in a traditional hospital surgical suite.

Most industries try to improve efficiency. However, simple efficiencies have not occurred in most traditional hospitals. Surgeons spend half their time waiting for the patients to come to the operating room or for the availability of operating rooms and equipment.

The Surgery centers have solved these efficiency problems. They can service surgeons’ needs at less than half the cost without the wasted time.

A key reason is there are not multiple administrators creating multiple regulations and collecting multiple $500,000 to $3 million dollar a year salaries. Surgical centers have one head nurse responsible for everything and zero administrators.

The cost of a “complex bilateral sinus procedure” at the Surgery Center was an all-inclusive $5,885. The traditional hospital bill totaled $33,505 without the surgeon’s and anesthesiologist’s bill included.

It was discovered at the time of the nasal surgery that the hospital charged $360 for a dexamethasone injection. A dexamethasone injection cost the hospital $.75.

 A fentanyl shot which is a pain-killer cost the hospital system $1.50 but the bill to the insurance company was $630.00 dollars. Everyone has heard of the $45.00 hospital aspirin   

A traditional hospital discounted non-inclusive bill to the healthcare insurance industry for a carpel-tunnel release would be $7,452. The fee for the procedure pre-op is not be available. The same procedure done for the all-inclusive transparent cost at the Surgery Center was $2,775.

More tragic was that the patient would have had to pay $5,299 out-of-pocket  to cover her deductible and co-pay for the hospital bill before she even received the bills for physicians’ services. 

Below are some examples of the differences in costs for procedures.

 
A list of the surgical fee for the Oklahoma Surgery Center is on its web site. http://www.surgerycenterok.com/pricing.php

How do hospital systems get away with this?

The more the hospital bills the more the insurance company puts in reserve. The reserves are in the medical costs column and include the non-discounted costs. The result is greater profit for the insurance company.

President Obama does not want physicians to be innovative in this way. He wants physicians to be dependent employees of hospital systems. His goal is to control physicians and dictate their medical care.

President Obama has provided some non-transparent favors to hospital systems that are forcing physicians to be employed by hospitals. 

"A new provision buried in Obamacare effectively prohibits doctors from starting their own hospitals or expanding the hospitals they already own, which has been widely interpreted as a give-away to the American Hospital Association."

Hospital systems claim they must charge more to cover their overhead and bureaucratic inefficiencies. So fix your system. Surgery centers have.

Dr. Smith says: "Everyone can see what the prices are at the Surgery Center, and that affordable health care is possible. So the jig is up.”

Dr. Smith believes that despite the obstacles being put in the way by Obamacare, market-driven facilities like his will thrive and proliferate as consumers catch on to costly collusion between big government and big health care.

I totally agree. As Obamacare’s unintended consequences proliferate consumers and captured physicians (hospital employed) will pay more attention to physician innovation. The jig for big government and big healthcare will certainly be up.

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

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What Is The Insurance Value Of Medicare?

Stanley Feld M.D.,FACP,MACE

 

Healthcare insurance is great if you do not need it.

The wonderful thing about Medicare is private insurance is not available to seniors.  

Healthcare insurance companies are not interested in covering consumers with health risks or preexisting illnesses.

In fact private individual healthcare insurance policies are not available to an unemployed 55 year old person with mild obesity and hypertension.

If you are employed and over 65 years old with mild obesity and hypertension the healthcare insurance industry is required to insure you under your employer healthcare plan.

The employed person receives healthcare coverage with pre-tax dollars.

 A person who might be eligible to purchase individual healthcare insurance must pay with after-tax dollars.

This is unfair but easily corrected.

The pre-tax/post tax issue could be solved if the state insurance boards required the healthcare insurance companies, wanting to sell private insurance in that state, cover everyone applying for insurance. The insurance company should be required to set the premiums based on community rating.

Everyone should pay premiums with pre-tax dollars.

Medicare, through government inefficiency, has become very expensive. If it were efficient insurance it would be less expensive to both consumers and the government.

Most working people have no idea of Medicare’s cost to them during their working years.

Medicare’s yearly tax withholding is 1.45% of salary. A worker earning $100,000 a year pays $1450 yearly to the Medicare Trust Fund. In 40 years that person would pay $58,000 into the Trust Fund.

When they became eligible for;

 Medicare Part B the yearly premium in 2012 was means tested.

 

If your yearly income in 2010 was		You pay (in 2012)
File individual tax return	File joint tax return
$85,000 or less	$170,000 or less	$99.90
above $85,000 up to $107,000	above $170,000 up to $214,000	$139.90
above $107,000 up to $160,000	above $214,000 up to $320,000	$199.80
above $160,000 up to $214,000	above $320,000 up to $428,000	$259.70

 

In 2013 the Medicare Part B premiums are going to increase.
If your yearly income in 2011 was				You pay (in 2013)
File individual tax return	File joint tax return
$85,000 or less	$170,000 or less			$104.90
above $85,000 up to $107,000	above $170,000 up to $214,000			$146.90
above $107,000 up to $160,000	above $214,000 up to $320,000			$209.80
above $160,000 up to $214,000	above $320,000 up to $428,000			$272.70
above $214,000	above $428,000			$335.70

 

Income is defined as income from all sources such as capital gains, interest, pension annuities, social security and all earned income.

Further premium increases have been announced for 2014 but have not been published.

Medicare premiums are taken out of each Social Security check.

The Medicare Part B insurance has deductible and co-pay rules. Medicare Part B deductibles apply for each hospital stay, ER visits and physician office visits.

For each benefit period you pay:

• A total of $1,156 for each hospital admission of 1-60 days.
• $289 per day for days 61-90 of a hospital stay.
• $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days.
•  

Skilled Nursing Facility Coinsurance

• $144.50 per day for days 21 through 100 each benefit period. Days 1-20 are free.
•  

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)

 

The deductible for the first $140 dollars worth of services plus 20% of any physicians and hospital bill can add up as one gets older. It becomes unaffordable for many seniors.

 

Medicare Part B’s deductibles and copays’ costs makes Medicare gap coverage   essential.

Premiums For Medicare Part F   

Policy Summary

Monthly Premium:
$84 - $302  depending on age and benefits

Estimated Annual Cost: $6,050.00

Benefits

• Basic Benefits Medigap Basic Benefits definition[?] - Opens in a new window
• Skilled Nursing Facilities Skilled Nursing Facility definition[?] - Opens in a new window

• Part A Deductible Part A (Hospital Insurance) definition[?] - Opens in a new window
• Part B Deductible Part B (Medical Insurance) definition[?] - Opens in a new window
• Part B Excess Charges (100%)

• Foreign Travel Emergency
• Preventive Services

 Medicare Part D is the drug benefit plan. Medicare Part D helps reduce the cost of medications.

Medicare Part D is also means tested. There are multiple plans to pick. Some include complete payment for brand named drugs and some cover the donut. The price can range from $40 to $120 per month per senior depending on the coverage a senior picks. The additional means tested fees are below.

The brand named drugs are expensive. Most drug chains have followed Wal-Mart’s lead and charge $4.00 for generic drugs. This forces seniors to purchase generic drugs

Medicare Part D is expensive and unfair for seniors needing brand named drugs.

The Means Testing Formula For Medicare Part D 2012

 If your yearly income in 2010 was

		You pay
File individual tax return	File joint tax return
$85,000 or less	$170,000 or less	Your plan premium
above $85,000 up to $107,000	above $170,000 up to $214,000	$11.60 + your plan premium
above $107,000 up to $160,000	above $214,000 up to $320,000	$29.90 + your plan premium
above $160,000 up to $214,000	above $320,000 up to $428,000	$48.10+ your plan premium
above $214,000	above $428,000	$66.40 + your plan premium

 http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 Medigap fees and Medicare Part D fees are paid with post tax dollars.

These costs are in addition to seniors having contributed $58,000 to the Medicare Trust Fund during their working years.

“The reason we have health insurance at all is not that health care is expensive, but rather that there is great uncertainty about who will need very expensive and potentially lifesaving care and when they will need it. Medicare should give beneficiaries not just access to medical care, but also protection from the risk of catastrophic spending.” 

Medicare coverage is not cheap. President Obama’s Obamacare is going to make it more expensive with less access to care.

 Why is Medicare Part B,F,D  so expensive when the average person on Medicare spends only $6,600 dollar per year?

This is the major question. The government should focus on the answer. It should not be spending time and money on a system that is punitive to patients and physicians and has little chance of being successful.

The money creating the Medicare deficit is going somewhere. Where?

The cost to Medicare beneficiaries is high. The protection against economic ruin is limited. The basic benefit lacks a cap on out-of-pocket spending, so beneficiaries are exposed to the risk of open-ended cost sharing that can generate substantial financial strain (or deplete assets for surviving spouses).1 

Moreover, the odds of facing a catastrophic expense mount over time. Almost 50% of beneficiaries are hospitalized at least once over a 4-year period.2 

If we are going protect our seniors from financial strain or ruin Medicare must reassess it premises and reduce its administrative waste. It must be completely transparent. If the government did it correctly it would provide an affordable healthcare insurance plan for seniors.

“Everyone knows the dice is loaded.” Leonard Cohen.

  

http://youtu.be/GUfS8LyeUyM

 

At the moment seniors do not have another choice. It is the only game in town.

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

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Business Model For Medical Care 2020. The Ideal Future State

Stanley Feld M.D.,FACP,MACE

 

Please click on all the links to study the references to each spoke. It will help you visualize the power of the business model.

The ideal future state business model for the healthcare system must include the execution of ideas in the specific spokes outlined below.. These spokes will serve to align all of the stakeholders’ interests.

The business model must contain appropriate rules for a consumer driven healthcare system, an ideal electronic medial record, and an ideal medical savings account.

The ideal medical saving accounts can work optimally when there is significant tort reform and patients take full responsibility for their health and healthcare dollars.

Consumer education is critical to the business model of the future. Educational modules can be available to consumers 24/7 via the Internet. These educational modules must be an extension of consumers physicians’ care in order to be effective. The education can become available using a series of social networks.

Chronic disease self-management education can be achieved by the use of interactive online teaching programs. Patients can be linked to share their disease experience through private social networks.

Most believe that the healthcare system must have greater integration of care. This integration of care can be done virtually through a series of private integrated networks.

Effective integration can be achieved without disruption of the entire healthcare system. Obamacare has been disruptive to the entire healthcare system.

Obamacare is forced integration by the government will be slow, costly and unsuccessful.

Physicians must be compensated for the presently uncompensated time necessary to execute each one of the spokes of the wheel.

Each spoke is necessary to convert the healthcare system into a system that once more makes the physician patient relationship paramount.

The future business plan removes control of the healthcare system from the government. It permits the patient to have the freedom to choose his own healthcare course.   

Tort reform is vital to the 2020 business model. It will decrease costly over-testing to avoid frivolous malpractice suits. There are many ways to set up a tort reform system that truly protects patients from real harm while eliminating over-testing. It limits the malpractice litigation system. Punitive damages must be lowered. Losers in lawsuits must pay all fees. These two provisions will decrease lawyers’ incentive to sue.

 

Consumer driven healthcare will create a system that promotes personal responsibility by the consumers’ for their health and health care dollars.

 

The major spoke necessary to successfully accomplish a consumer driven healthcare system is my ideal medical saving accounts.

 

 

The ideal medical savings accounts would provide the financial incentive for consumers to drive the healthcare system. It would dis-intermediate the healthcare insurance industry’s grasp on first dollar coverage and profits. The insurance industry would realize that its profit margin would increase under this system.

In order for consumers to be in a position to lower the cost of healthcare they must be taught to understand how to self manage their disease and be responsible for the decisions they make in their choices for medical care.

In order to decrease patients’ dependency on the government and increase  being responsible for themselves, a system of education using information technology as an extension of their physicians’ care has to be developed and put into place.

Social networking is in its infancy at present. It must be developed and used as an educational tool between physicians, patients and physicians, and patients and patients.

All the social networking must be an extension of the physicians’ medical care to their patients. Social networking must be developed to enhance and promote the physician/patient relationship because this relationship is critical, at its core, to successful medical treatment.

Social networking and information technology can extend physician educational resources for patient care.

Systems of care for the self-management of chronic disease as an extension of their physicians care have already been developed. The unsuccessful chronic disease self-management systems are the programs that are not an extension of physicians’ care. The reason these third party systems are unsuccessful is because they undermine the patient physician relationship.

President Obama has done pilot studies using those third party self-management companies to prove that chronic disease self-management systems work. They have all failed to reduce the cost of care.

Therefore the administration has reached the conclusions that self-management of chronic disease does not work. Nothing could be further from the truth. The government simply does not understand the magic of the physician-patient relationship.

In order to decrease the cost of medical care, medical care must be integrated. At present, primary care physicians recommend specialists. The primary care physicians know whether the specialists are doing a good job by the specialists’ treatment results with their patients.

Most of the time physicians do not know their specialists’ fees. These fees must be totally transparent to primary care physicians and their patients. The primary care physicians can then be in a position to help their patients choose appropriate specialists.

It will also reduce the specialists’ prices because they will be forced to become competitive by the patients in a consumer driven system.

Hospital fees must also be transparent. One of the reasons I am opposed to hospital systems hiring physicians and paying them a salary is the hospital systems would then be able to develop a monopoly in a town or area of town. This would permit the hospital system to raise prices without informing patients or physicians.

Hospital systems could erase physicians’ choices and hindered patients from having the freedom to choose a hospital or specialist of their choice with their primary care physicians. It devalues the patient physician relationship.  

 

The way President Obama is going about developing a universally functioning electronic medical record is foolish and costly. Most physicians cannot afford a fully functional electronic medical record. This fact is being used to drive physicians into being employees of hospital systems. The problem is hospital systems are paying hundreds of millions of dollars for electronic medical records that are not fully functional.

Many of these records are hard to use and provide inflexible data. The inflexible data leads to healthcare policy decisions that are wrong. The data is also used to commoditize medical care.

Commoditized medical care is not the best quality of medical care.  

If the government is so smart it should develop a fully functional electronic medical record and provide it to all hospital systems and practices for free.

The EMR should be put in the cloud. Providers should be charged by the click. The government can service and upgrade the EMR in one place and improve the quality of data collected. The data should be used for educational purposes only and be owned by the patients and physicians. It should not be used for punitive purposes. The inaccurate data is now used for punitive purposes. The result has been a lack of physician cooperation.

 

The healthcare journey to an ideal future state must begin in an orderly way. The principle goal is to be consumer centric. It must be consumer driven and force the secondary stakeholders to be transparent and competitive.

This journey will wring the excess costs out of the healthcare system. It will create a democratic system affordable to all.

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

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Healthcare Insurance Industry’s’ New Business Model Is Wrong.

Stanley Feld M.D.,FACP,MACE

One percent of the people spend 25% of the healthcare dollars. Twenty percent of the people spend 80% of the healthcare dollars.

It would be important to know why this is true. Then figure out what could be done about it Stakeholders need to agree on a course of action.

It would be a good idea to understand what physicians think should be done. 

“One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.”

The 1% and the 20% are suffering from complications of a chronic disease.

The incidence of chronic diseases is on the rise in the United States. A major precipitating factor for this is obesity.

The incidence of Type 2 Diabetes Mellitus is increasing in both adults and young children, as the incidence of obesity is increasing.

The incidence of complications of Diabetes Mellitus will increase in the future. The result will be an increase in the cost of medical care.

President Obama’s healthcare reform act will expand healthcare coverage to 32 million uninsured in 2014. Obamacare is forcing the healthcare insurance industry to change its business model in order in order to remain profitable.

Premiums are out of the reach of most businesses and individuals. Premium increases are not an option.

High-risk individuals are denied healthcare insurance coverage. High-risk patients automatically get coverage in corporate healthcare plans. The healthcare insurance industry simply raises premiums on corporate groups in order to maintain its profits.

Something must be done to decrease the increase in chronic disease and its complications. 

The government cannot afford to insure its present patient obligations much less the 32 million uninsured.

“As the new federal health care law aims to expand care and control costs, the people in the medical 1 percent are getting more attention from the nation’s health insurers.”

Twenty percent of the population not 1% should be getting the attention of the healthcare insurance industry.

“Studies have already shown that Medicare spending is concentrated on a small group of individuals who are seriously ill.

An analysis by the IMS Institute for Healthcare Informatics, the research arm of IMS Health, a health information company in Danbury, Conn., provides a rare glimpse into the medical problems of people with private health insurance that are under 65.

About three-quarters of them suffer from at least one chronic condition that could spiral out of control without proper care.”

Most of these people were obese.

The healthcare insurance industry cannot avoid these patients after 2014.

“Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent.”

The healthcare insurance industry realizes it must fundamentally change its business model.

The healthcare insurance industry has a problem developing a new business model that would work. The industry does not want to lose control over patients, their physicians and the monies paid into the healthcare system.

The healthcare industry does not have a clue about how to actually repair the healthcare system. It is focused on its own bottom line rather than looking at business models that will be beneficial to everyone and align all the stakeholders’ incentives.

The healthcare insurance industry is planning on instituting programs that will tinker with the edges. It will not fix the problems.

The new business models will increase the percentage of money the insurance industry receives for direct patient care maintaining a Medical-Loss ratio of 15%. There is no interest in providing patients with financial incentives and a choice.

The net result will be higher costs and system failure. The weird thing is most of the healthcare insurance industry executives know it.

“The reality is if we don’t figure out how to get to the patients, we’re not going to get where they need to be,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

The reality is that the system must be consumer driven with consumers in charge of their healthcare and their healthcare dollars.

At the moment patients have no incentive to decrease the cost of care. Hundreds of patients have told me that they go to the doctor to fix their illness. Medicare or their insurance pays. The patients have no idea of the costs they incur nor do they care. They have no interest in controlling their disease.

My ideal medical saving accounts would give the patients incentive to learn about their disease. They would be interested in self-managing their disease with the physician and his medical care team being the coach.

“The next challenge, say insurers, is to figure out how best to work with a person’s doctor. Because many of these patients seem to be seeing many doctors and taking many medications, there may be no one who is accountable for the patients’ overall health.” 

Physicians have figured out what services get paid by the healthcare insurance industry. They do not get paid for educating patients about their disease.

The healthcare insurance industry and the government have developed a punitive bureaucracy.   

An attempt is being made to penalize or reward physicians for medical outcomes. Pay for Performance (P4P) is a punitive payment system. It will fail. 

Patients are responsible in large part for the onset of their medical problems and in controlling their medical outcomes. Physicians cannot be responsible for patients’ outcomes. It is the responsibility of the patient.

“Insurers are also still grappling with their understanding of human nature — why some people simply don’t take care of themselves or take their medicine or go to the doctor, even when it is clear that they should.”

Patient outcomes have nothing to do with human nature. It has everything to do with financial incentive and effective education.

Spokes 5 and 6 of my future state business model has everything to do with patients’ responsibility for caring for their disease and the physicians’ responsibility to the patients. It has nothing to do with physicians’ and patients’ responsibility to the healthcare insurance industry or government.

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

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I Left My Job: What Do I Do Now For Healthcare Insurance Coverage?

Stanley Feld M.D.,FACP,MACE

“Dear Dr. Feld

My wife and I are 43 years old. We have a 7 year old daughter. All three of us are in excellent health. We have minimal medical bills and yearly checkups. 

I just left an executive position in a company that had excellent healthcare insurance.

 I am in the process of hunting for a new executive position. I am currently uninsured. I have the option to buy COBRA insurance for the next 18 months or until I get a job with good healthcare benefits.

The COBRA premium quoted to me to be $1600 per month or $19,200 per year. My former employer told me he was paying $15,000 for the same insurance.

I cannot afford $19,200 per year. Neither can I afford not to have healthcare insurance coverage for my family in case of catastrophic illness. I searched the Internet for the best option.

There were at least 97 healthcare insurance policies offered for individual coverage. After I got through understanding the fifth policy I was exhausted. None seemed to be a good deal.

I have been a reader of your blog and always say to myself thank God I do not have to deal with the dysfunction you describe. I could not believe I would be in this situation.

You seem to understand the problems in the healthcare system. What do I do next?

Thank you in advance for any help you can offer.

Sincerely

H”

I have received other letters of disbelief from young people. They did not appreciate how unfair, non transparent and truly dysfunctional the healthcare system was until they encountered the problems.

The future belongs to the 20 -50 year old age group not seniors. They are all consumers and potential patients. They are are going to need a viable healthcare system at some point in their life.

This age group must take an interest in developing an understanding of and take responsibility for getting involved in fixing the dysfunctional healthcare system now.

In general 20-50 year olds are not sick. Only 20% of the population is involved in dealing with the healthcare industry at one time.  Eighty percent of the population does not interact with the healthcare system. When they do they realize how dysfunctional it is.

100% of the consumers must demand, simultaneously, the healthcare system become transparent and equitable.

The structure of Present Obama’s healthcare reform plan has not yet delivered nor does it have a chance to deliver is promises. In fact, it has made the healthcare system more dysfunctional and unfair.   

Change in the system has to be consumer driven in order to force the government to reform the system so it is affordable and accessible to all. This means honestly eliminating waste at all levels.

President Obama’s waivers to favored groups and concession to vested interests political pressures will not improve the system.  

I totally understand that when dysfunction affects the other guy, young busy unaffected consumers have no interest in being involved in actively changing the system. However, they are going to be the other guy at some point.

In answer to the reader’s question “What do I do?”

He could sign up for COBRA. The COBRA system is a flawed system. It is a dishonest promise.  COBRA was accepted by congress and consumers without understanding its underlying consequences.  

“The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. “

Nothing in the Department of Labor’s document covers how the premiums are determined by the healthcare insurance industry.

A consumer electing to take COBRA is charged the calculated premium for an individual healthcare plan. The premium is very high.  

Actuarial calculation is designed to the benefit of the healthcare insurance industry. The calculation is not transparent. I suspect the government does not oversee the calculation.

COBRA is about the only option good for a 50 year old obese male with hypertension and hyperlipidemia who has a wife and a 7 year old child. He would be rejected for all private insurance plans.

The individual state’s “high risk pools’” premiums are even higher than COBRA’s premium. The high risk insurance coverage is less inclusive because it excludes any possible risk from underlying conditions.  

I felt compelled to help this reader.

He needed coverage in case of a catastrophic illness in his family until he obtained a new position. At his age and health history he should not have any trouble getting accepted for a high deductible policy.

I told him to check which insurance company his family’s physicians accept. It was UnitedHealth.

The 8^th plan down the list of UnitedHealth options for high deductible was a $10,000 called Plan 100. The premium would be $318.82 a month. The deductible was $10,000. The plan provides full first dollar coverage after the $10,000 deductible is met up to 1 million dollars.

UnitedHealth Plan 100 underwritten by Golden Rule also had a $7,500 deductible for $417.

I thought this was the plan for this family. Their routine healthcare costs were less than $1000 year. The premium for the $7,500 deductible is $5004 per year. Total savings vs. COBRA is $19,200-$6004= $13,196.

If there was a catastrophic illness in his family and it cost more than $7,500 his total cost would be $7500 plus $5004 for his premium for a total cost of $12,504. He would still save $6,696 (19,200 for COBRA vs. $12,504= $6,696).

The big disadvantage is his premium costs are not tax deductible as it would be for an employer. At a 30% tax rate this consumer would have to earn $27,429 in order to pay $19,200. 

The adjudication of claims is simple. The physicians send the bill to UnitedHealth. UnitedHealth allows physicians their negotiated fee. The consumer is then sent an explanation of benefits for allowable fees.

Since the consumer has not reached the deductible, he is required to pay the physician’s allowable fee. This fee is credited toward his $7,500 deductible.

When the deductible is reached the full allowable amount for services is paid. This is the best deal under the present healthcare insurance options for this family of three.

He bought the high deductible Plus 100 insurance. He also complained about the confusing array of options and prices, the lack of transparency about these options, and difficulty in easily understanding the options.

He said he is a pretty smart fellow. He had difficulty in figuring out what to do and was ready to pay for COBRA coverage.

He asked, “How could people of average intelligence figure it out?

It would be easy if there were a questionnaire that would automatically determine consumers’ healthcare policy needs and direct them toward healthcare insurance policies that would fix their needs.

I told him the game is rigged. The insurance industry does not want you to figure out what policy is best for you. It wants you to buy the most expensive policy that might not address your needs.

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

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The Second Spoke Of The Wheel: The Ideal Medical Savings Account

Stanley Feld

"Dear Dr. Feld

If your ideal Medical Savings Account is such a good idea why has it not become more popular?"

The reason is simple. The Ideal Medical Savings Account does not exist as a healthcare insurance option. The healthcare insurance industry has obfuscated the purpose of creating financial incentives for consumers with the offer of Health Savings Accounts.

The Health Savings Accounts keep premium dollars in the healthcare insurance industry’s control at the end of the year. Consumers are able to use unspent money on healthcare deductible in the future.

The Ideal Medical Saving Account puts the money not spent in a separate tax-free trust for consumers’ retirement. The logic is to reward consumers for good health financially and to encourage consumers to be responsible for their health and healthcare choices.

The goal is not to reward the healthcare insurance company it is to reward consumers. The healthcare insurance industry is controlling the consumer’s money for its own profit.

Despite its faults HSA’s are becoming very popular. It is the fastest growing healthcare insurance product in America.

President Obama wants to eliminate HSAs. His goal is to increase government control over consumers’ healthcare choices. He does not want consumers to control their healthcare dollars. He wants to control consumers.

The healthcare insurance industry’s goal is to maximize its profit. It is not concerned about the consumer’s health. The more consumers in the healthcare system the more premium dollars the healthcare insurance industry controls. 

 Using the power of lobbying and the influence of lobbyists it has been able to rig the game against the consumer.

    "Wendell Potter, former senior executive^[1] at Cigna turned whistle-blower, has written that the insurance industry has worked to kill "any reform that might interfere with insurers' ability to increase profits" by engaging in extensive and well funded, anti-reform campaigns."

"This is nothing new. However, as consumers (patients in all three categories) the Internet and social networking can empower us to have more influence over the politicians than lobbyists."

"After all, we are the people who give them their jobs. Some might say this is a naïve view. However, recent events have shown the effect of People Power and its ability to disrupt the establishment and its lobbyists.

The industry, however, "goes to great lengths to keep its involvement in these campaigns hidden from public view," including the use of "front groups." Indeed, in a 1998 effort to successfully kill the Patient Bill of Rights at that time, “the insurers formed a front group called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights.

While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion’s share of its funding and guidance from the big insurance companies and their trade associations."

The question is why would the National Federation of Independent Business or the U.S. Chamber of Commerce do this? They either don’t understand the healthcare insurance industry’s motives or they received grant money from the healthcare insurance industry. Both groups are working against the benefit of it own people.

"Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington’s biggest P.R. firms. The P.R. firm provided all the staff work for the Coalition. The tactics worked. Industry allies in Congress made sure the Patients’ Bill of Rights would not become law."^[2]" 

Obamacare and the Democratic congress have also yielded to the demands of the healthcare insurance industry. President Obama’s goal is to control all medical decisions for patients to keep healthcare costs down. Most advocates of Obamacare overlook this fact.

President Obama’s individual mandated purchase of healthcare insurance would increase the number healthcare industry’s customers. Its profits would increase. 

Medicare and Medicaid are totally dependent on the healthcare insurance industry for administrative services. This results in keeping the healthcare insurance industry in control of healthcare spending. The 2.5% overhead for Medicare and Medicaid continuosly repeated by government officials is completely bogus.

The healthcare insurance industry receives at least 30% of every Medicare and Medicaid dollar spent.

The administrative services costs are supposed to be no more than 15%. However, large sums of administrative costs are applied to direct patient care. Each administrative cost has a profit center attached to it.

These profits center increases the healthcare industry’s profits. In turn the salaries of the executives increase.

The Ideal Medical Savings Account eliminates all these layers of bureaucracy, profits and abuses.

It is a perfect opportunity for “People Power” to demand through social networks that the Ideal Medical Saving Account be added to healthcare insurance choices.

The Ideal Medical Savings Account puts the power back in consumers’ hands.

Neither traditional insurance plans or Medicare or Medicaid provide financial incentives for patient to be responsible for their disease nor their healthcare needs.

 

 

Financial incentive for all categories of patients (consumers) can serve to increase adherence to physician’s treatment instructions.

Financial incentives can stimulate consumers to be educated consumers of both healthcare and medical care.

Financial incentives can serve to incentivize patients to become professors of their chronic disease. Self-management can avoid many emergency room visits and hospitalizations.

Instant adjudication of claims can decrease many of the excessive administrative costs.

The Ideal Medical Savings Account is simple and transparent to consumers.

IMSAs revives the patient physician relationship. It drives the government and the healthcare insurance industry to the edge of the medical care transaction. It disrupts the hairball and will instantly disrupt the food chain that is failing under the weight of healthcare costs.

The Ideal Medical Savings Account is a perfect healthcare insurance product if deployed properly. Social networks must be formed to demand its availability in order to permit consumers’ (patients) to drive the healthcare system.

Social networks on other levels can force physicians to be more competitive.

The result would be a reduction in the healthcare system’s cost while eliminating administrative abuse, waste and fraud.

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

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Some Innovative Software Opportunities In Medicine.

Stanley Feld M.D.,FACP,MACE

I have pointed out that all the stakeholders are to blame for the dysfunction of the healthcare system.

 I have also explained the difference between the healthcare system and the medical care system.

In the past two weeks I have explained that both the medial care system and the healthcare system are ripe for disintermediation with innovative software just as the publishing system was dis-intermediated with amazon.com, the music industry with ITunes and the movie industry with Neflix.  

John Goodman has recently written a series of articles on how physicians are trapped by the current healthcare system.

 The core problem has developed over the last 40 years. The government and the healthcare insurance industry have created a huge payment hairball between patients and physicians.

ICD and CPT coding has created complications beyond belief for patients and physicians. The ICD 10 is more confusing that ICD 9.

ICD 9 contained 15,000 codes. ICD 10 contains 68000 codes.

Instead of closing the window for fraud and abuse it has opened it further.

The problems with coding can be dis-intermediated by innovative software with its focus on patients and physicians.

A retired physician wrote the following note to me after reading my posts about innovative software and the destruction of the patient-physician relationship. His narrative was in response to the WSJ article “Should Physicians Use Email to Communicate With Patients?”

The writer is a retired physician with 40 years of private practice experience. He has lived through the development of the dysfunction in the healthcare system.

 “Stan 

 This observation has been on my mind for a long time. The health issues in the 4th section of the WSJ today January

23,2011 caused me to put the ideas down on paper. 

 D”

 “In doctors’ offices all across the country, a scenario like this is being played out as I write these comments.

 The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

 This is an excellent description of the disconnect between the care of patients by physicians. Patients and physicians should have a relationship where patients are at the center of the physicians’ healthcare team. The physicians are coaches. The physicians’ team is the assistant coaches helping physicians treat patients. 

 “What happens next is where I’d like to spend a little time in this essay.

 The written prescription/s may be hand-carried to the pharmacy, the doctor may telephone the prescription/s to the pharmacy, or more commonly these days, the prescriptions may be sent on line or by fax, with the doctor’s assistant doing the sending.

The government is now paying an incentive bonus to the physicians for e-prescriptions. Unfortunately 60% of physicians’ offices cannot afford the software.

 This is a place for a fully functional ideal electronic medical record in the cloud.

 “Now here is where the situation can get dicey. Up to 20% of all those prescriptions are never picked up by the patient. After an interval, they are returned to stock in the pharmacy. It is unlikely that the doctor will be made aware that this has happened.”

 The e-prescription must be a two way street. The physician should be notified electronically by the pharmacy if a patient does not pick up a prescription.

 The physician’s office should automatically contact the patient and explain the importance of the medication.

Other results can also happen. The patient picks up some, but not all of the prescriptions because of the cost versus what he/she can afford.

In the fully functioning EMR software can be included to enable the pharmacy to inform the physician.

Or the patient picks up all of the medications ordered. Once at home, the patient may or may not take the medications as prescribed.

 The instructions from the doctor may be recalled incompletely or inaccurately.

The healthcare team can electronically reinforce instructions and goals for the medication using the Internet sites picked by the physician.

 The physician’s healthcare team must be an extension of the physician’s care.

Freestanding organizations will fail if they are not an extension of physicians’ care.

The CBO recently revealed that President Obama’s pilot studies using freestanding chronic disease management organizations have failed to lower the cost of care.

My fear is that President Obama and his healthcare administrators will conclude that chronic disease management does not lower healthcare costs.

Effective chronic disease management of diabetes can lower the complication rate by at least 50%. Decreasing complications can lower the cost of care by 80%

The medications may not be tolerated by the patient, and as a consequence, he/she may elect to discontinue one or more of them, or may elect to take them in some manner other than as directed by the doctor.

The patient may not notify his physician of his difficulty taking the medication.

Social networking between physicians and patients and patients in that physicians practice could solve this problem.  

Patients understand that most cognitive physicians are reimbursed for coded procedures. Advice over the telephone or email is not reimbursed. A mechanism for reimbursement must be developed for using social networking.

The medications may prove effective in alleviating the problem that caused the patient to see their physician in the first place, or they may not.

Most of the events described will not be known to the patient’s physician until the patient is next seen in the office, and maybe not even then.

E-mail could have malpractice liability in the current malpractice environment. This is one more reason Tort reform is essential.

In a perfect world, a lot of the issues raised above could be made better by a few simple moves. The pharmacy could make the physician’s office aware that the prescriptions were never picked up.

Someone in the physician’s office could call or email the patient 3-4 days after the visit, and inquire whether the patient is taking the medication,

Reinforcing the physician’s instructions, and inquiring whether the medications are helping the patient, asking if there have been any problems arising from the use of the medication, and passing what is learned back to the physician.

 The reinforcement of the instructions can be very helpful, and the awareness of issues relating to the medication can lead to more timely resolution of problems the patient is experiencing.

It has always seemed to this writer that the doctor-patient relationship would be well served if we all started to use what I call “The Doctor Phil Question”, which goes like this: “How’s that working out for you?” 

It is all about patients’ responsibility for their healthcare and their healthcare dollar. It is about consumer driven healthcare and the patient physician relationship. 

 As long as the government and the healthcare insurance industry continues to drive a wedge between the patient and physician the cost of healthcare will continue to rise.

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

Please send the blog to a friend

 

The Healthcare System vs. The Medical Care System

Stanley Feld M.D.,FACP,MACE

The difference between the healthcare system and the medical care system is very clear to me. The stakeholders in the healthcare system are patients, physicians, government, hospital systems, pharmaceutical companies, pharmacies, pharmacy middlemen, and healthcare insurance companies. 

 Government, hospital systems, pharmaceutical companies, pharmacies, pharmacy middlemen, and healthcare insurance companies are secondary stakeholders in the healthcare system.

 The primary stakeholders are patients and physicians. They also comprise the medical care system. Without the primary stakeholders there would be no need for a healthcare system.

 The secondary stakeholders have long ago taken over the healthcare system. All businesses and the government deal with the hand they are dealt using their best judgment. The people running the business or government pursue their vested interest. The difference between businesses and government is businesses work to make as big a profit as possible. Government, depending on the political party in power, pursues fulfillment of its ideology.  

 Since 1942 and the Economic Stabilization Act of President Roosevelt the market place for medical care has been distorted. In 1946 healthcare insurance was introduced. At that time the interaction between the primary stakeholders, physicians and patients, started to be destroyed by secondary stakeholders.

The cost of healthcare has progressively increased since the government passed the Medicare and Medicaid in 1965. Costs increased further in 1980 when the government said we couldn’t keep paying these increasing costs and instituted price controls for Medicare and Medicaid.

This led to cost shifting of the difference to the private healthcare insurance sector.  Businesses providing healthcare insurance for their employees accepted the resulting premiums associated with cost shifting until 1985. At that time they said, “stop.”

The healthcare insurance industry asked corporations what percentage of your gross revenue could you afford for healthcare insurance benefits. The healthcare premiums were 18% of gross revenue.

 The corporate answer was they could afford up to 12% of gross revenue. The healthcare insurance industry’s response was, no problem.

HMO pricing became the most economical option for corporate employers. HMO fixed healthcare cost for corporations and healthcare insurers.

HMOs shifted the risk to physicians and hospitals. HMOs failed because physicians and hospital did not know how to assess risk. They accepted risk initially because they were afraid to lose patients.

 Hillarycare failed to become law because of the potential for patient abuse, restrictions of access to care, rationing of care and loss of freedom of choice. Patients did not want the government to dictate their medical decisions.

 Obamacare was passed by a Democrat controlled congress with a very liberal ideology.

  Many congressmen did not read the entire document or debate the potential unintended consequences.

  The difference in ideology between liberal and conservative is easy to understand.

 “Liberals believe that health care is treated as a market commodity today but should not be, and conservatives think that health care is not treated as a market commodity but should be.”

 The healthcare system is not a true marketplace. The healthcare marketplace has been continuously distorted by government regulations and adjusted regulations since Medicare passage in 1965.

 All the stakeholders have distorted the market even further by adjusting to government regulations in order to purse their vested interest.

If real repair of the healthcare system is to occur a real marketplace has to be created. Obamacare is another adjustment in an already distorted marketplace. Obamacare is accelerating the dysfunction in the healthcare system until it implodes and results in increasing costs not savings.  

 The healthcare insurance industry controls costs. Many Democratic healthcare policy experts have ignored the facts. The healthcare insurance industry’s goal is to maximize its profit. It takes 30% of the healthcare dollars off the top.

The healthcare insurance industry should not be in control of the economics of the healthcare system.

 Consumers should be in control of their medical care decisions and the money they spend for those decisions.

Personal medical care decisions should not be left to the munificence of the government. The government has never done anything efficiently.  

 Private and Medicare insurance has kept control of medical decisions out of consumers’ hands.  Consumers purchase healthcare insurance individually or from Medicare. Consumers also can receive healthcare insurance from their employers as a job benefit.

 The healthcare insurer directs consumers to use physicians and hospital in its network. The insurer negotiates reimbursement rates for the insured with hospitals and physicians.

Consumers are given little or no information about the comparative cost or quality of any particular doctor or hospital.  Consumers go to a doctor in their network.

Physicians do a history and physical exam and order tests and procedures on patients’ behalf.  When the test and procedures come back physicians prescribe the appropriate medication after a follow-up visit.

The healthcare insurance company reimburses physicians.

  Patients receive a copy of the bill from the insurer with patient portion of the co-pay. The explanations of benefits are impossible to interpret.

This is not a marketplace transaction. Patients have no control over the reimbursement. Patients and physicians have little incentive to restrain overuse of the healthcare system. They have no incentive to even scrutinize the bill. Patients’ have no incentive to control costs.

The use of healthcare services is divorced from marketplace forces that constantly assess cost benefit ratios.  Neither physicians nor patients have incentive to get the best care at the lowest price with the best quality.

As healthcare costs increase each year the source of the increase remains opaque. The increasing costs are made to appear to be the result of patients’ and physicians’ overuse of the healthcare system.

The increase in cost could be the result of the healthcare insurance industry and the pharmaceutical industry’s increased profits.

All stakeholders pursue their vested interests. The only way to align vested interests is to have consumers be responsible for thei health and healthcare dollars.

Only then will a true market place exist. Entitlements and price controls do not work. The cost of healthcare will skyrocket with Obamacare and create a larger budget deficit.

 

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

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Hospital System Monopolies And ACOs

Stanley Feld M.D.,FACP,MACE

I have been a constant critic of Accountable Care Organizations. I have said they cannot work to the benefit of patients and physicians because of the difficulty of organizing them and the subsequent unintended consequences. ACOs will increase the costs to the government and healthcare insurance industry to provide the administrative services.

Government has proven over and over again its ability to make complicated mistakes. These mistakes result from bloated bureaucracies and conflicting bureaucratic missions.

Additionally the government outsources administrative services to the healthcare insurance industry. Administrative services fees are constantly increasing because of waste, inefficiency, and mark-ups.

Hospital systems have been merging for 15 years. In the process they are attempting to buy physicians practice and provide a salary for physicians.

 Hospitals are brick and mortar structures. They are not the future of medical care. Hospitals, now hospital systems, had to change their business plan because more and more patients are being treated out of the hospital.

Outpatient clinics, diagnostic imaging centers, chemistry laboratories and ambulatory surgical centers have shifted income from hospitals to physician owned outpatient clinics.

Hospital systems goal has been to buy physicians’ practices and ancillary care facilities. Hospital systems’ consultants have concluded that they would be in a better position to negotiate price if they owned the physicians infrastructure regardless of the cost and pay physicians a salary.

The published reason given for this action is to provide better and integrated medical care within their hospital system. The real reason is to capture the revenue lost to outpatient facilities and profit from physicians’ productivity. Physicians are realizing they are being taken advantage of and are demanding their fair share of their own productivity.

 The Federal Trade Commission is supposed to have the authority to challenge monopolistic hospital mergers to protect consumers.

 

In 1996, the FTC amended its policies on health care mergers. The new policy encouraged hospital systems to merge by providing safe harbor to competing hospital systems when the hospital system could prove their hospital could achieve sufficient clinical integration.

 

The definition of sufficient integration was very loose and ill defined. The government thought it could save money by having all the fees under one roof. The FTC encouraged healthcare system monopolies in order to achieve more efficient and integrated care. It did not realize it would bite them in the leg someday.

It has always been a mystery to me how the government came to this conclusion. Suddenly the government has realized that the monopolies have turned on it and are in a position to demand more reimbursement. 

J. Frank Rosch the FTC Commissioner said,

 “I thought that the 1996 amendments…were the biggest loophole in the antitrust laws I had seen,”

 “Subsequent Advisory Opinions issued by Commission staff…were about as clear as mud.” 

Dr. Donald Berwick and President Obama claim that Accountable Care Organizations are the cure to our rising healthcare costs. A gigantic and expensive bureaucratic system has been constructed by CMS to regulate these new ACOs.  ACO’s promote further consolidation and mergers of physicians and hospital systems.

“The net result” of ACOs, says Rosch, “may therefore be higher costs and lower quality health care—precisely the opposite of its goal.”

Remember the government outsources all of the administrative services to the healthcare insurance industry. I have shown how the healthcare insurance industry has taken 30 to 50% of every Medicare healthcare dollar to the disadvantage of the taxpayer and seniors. 

Large merged hospital systems have in turn taken advantage of their size to take advantage of the healthcare insurance industry.

The healthcare insurance industry has taken advantage of the government in pricing administrative services.

Finally, the government has taken advantage of seniors by increasing Medicare premiums, increasing deductibles and decreasing benefits..

“ The final ACO guidelines, says Rosch, are “extraordinarily generous to providers,” and will constrain the FTC’s ability to block exploitative provider mergers.”

The Congressional Budget Office, much to the dismay of Obamacare’s advocates, did not think ACO’s would save much money in ten years.

 The CBO projected that the Medicare ACO initiative would save $5.3 billion over ten years.

 “In other words,” Rosch points out, “the savings to Medicare from the ACO program are no more than a rounding error. Yet even the CBO’s modest cost savings projections are likely overstated.”

 This supposed savings amounts to eight-hundredths of one percent of Medicare’s spending over the projected ten years.

People have a tendency not to do the arithmetic when present with what sounds like a big number.              

 “Against the very meager prospects for cost savings,” Rosch concludes, “there is a very real risk that some ACOs will be formed with an eye toward creating or exercising market power.

Middle-class Americans are already struggling with the burdens of the rising cost of health insurance. The potential ACO policy blunder is not to be taken lightly.

 Obamacare’s failure will skyrocket our federal debt. The lack of consideration of the dysfunctional dynamics of the healthcare system will result in unintended consequences that will create greater dysfunction and higher costs.  

Obamacare and ACOs will end up making health care even less affordable and accessible.

Maybe that is President Obama’s goal.

 

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

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Infringement On Privacy Keeps Popping Up With Obamacare

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Stanley Feld M.D.,FACP,MACE

 I suggest those of you who enjoy reading the Federal Register to read the proposed rule: “ Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment, Volume 76, page 41930. Proposed rule docket ID is HHS-OS-2011-0022”

http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/pdf/2011-17609.pdf)

  President Obama’s healthcare reform act is proposing to collect healthcare claims data on all Americans. The federal government already owns the claims data on Medicare and Medicaid recipients.

Now President Obama wants the claims data on all private insured and non-insured consumers. His reason is to stratify risk for the healthcare insurance industry.

Every consumer would pay the same healthcare insurance premium through the state exchanges whether he was a high risk or low risk patient.

If patients incurred high healthcare costs because they were a high-risk patients, the government would subsidize the healthcare insurance company if the cost was greater than the fixed premium.

 Presumably the government would subsidize the healthcare insurance company so it would not lose money. It would also tighten the government’s control over the healthcare insurance industry and its profits. These regulations have not been written yet.

What is wrong with that? Consumers are again left out of the loop. An unelected bureaucrat is making our healthcare decisions. If the potential consequences were followed to the end, private insurance and a freedom of choice to have no insurance coverage would be eliminated.

 Everyone would be required to have to have healthcare insurance through the state healthcare insurance exchanges.  In reality it is a backdoor mandate.

“In a proposed rule from Secretary Kathleen Sebelius and the Department of Health and Human Services (HHS), the federal government is demanding insurance companies submit detailed health care information about their patients.”

The healthcare insurance industry is being asked to provide proprietary information to government. The healthcare industry claims that providing this information will undermine its competitiveness.

It forces the healthcare insurance industry to become more transparent while the proposal claims to protect the healthcare insurance industry from risk.

“Obama and Sebelius made such a big deal about Americans being able to keep the coverage they have under ObamaCare; with these provisions, such private insurance may cease to exist if insurers are required to divulge their business models.”

There are several obvious dangers of this action. The first danger is from the healthcare insurance industry’s point of view. Another danger is from the healthcare system’s point of view. The third danger is from the consumer’s point of view.

The federal government is not capable of providing the administrative services necessary for healthcare coverage. The government outsources the administrative services for Medicare and Medicaid.

Those administrative service fees are in the 20-30% range to the federal government presently. Those hidden fees are creating unsustainable healthcare costs for the federal government.   

If the government tried to lower those fees, the healthcare insurance industry would walk away from the healthcare system. The healthcare system would collapse.

 The Federal Register includes three proposals for collecting the claims data on every American.

1. A “centralized approach” wherein insurers’ data go directly to Washington.
2. An “intermediate state-level approach” in which insurers give the information to the 50 states.
3. A “distributed approach” in which health insurance companies crunch the numbers according to federal bureaucrat edict.

 “ There are major problems with any one of these three “options.” First is the obvious breach of patient confidentiality. The federal government does not exactly have a stellar track record when it comes to managing private information about its citizens.”

“Why should we trust that the federal government would somehow keep all patient records confidential?”

Each option provides government bureaucrats access to the health records of every American. 

President Obama’s trap for consumers is obvious. If a business loses or gives up or sells confidential data a victim can fire or sue a health insurance company. The power of the market can also punish a private sector provider.

If a government bureaucrat losses or gives up your confidential information to another federal agency or other private individuals, the individuals affected could not get the unionized bureaucrat fired even if they could find out who was responsible bureaucrat providing the information.

Imagine a Wikileaks-sized disclosure of every American’s health histories. The results could be devastating - embarrassing - even Orwellian.

With its extensive rule-making decrees, ObamaCare has been an exercise in creating authority out of thin air at the expense of individuals’ rights, freedoms, and liberties.

Providing the federal government the ability to spy on, review, and approve individuals’ private patient-doctor interactions is an abuse of power and a challenge to every American’s liberty Where is the ACLU on this issue?

In an attempt to do the right thing, President Obama and HHS ends up restricting our freedoms, individual rights and liberty.

I hate to be cynical. Perhaps President Obama’s goal is the have centralized control over Americans and restrict our freedoms, individual rights and liberty. .

Obamacare is looking more and more like this is the goal.

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

The Healthcare Insurance Industry Is Not Interested in Being Price Transparent.

Stanley Feld M.D.,FACP,MACE

Truthful information (Price Transparency) is a huge issue in the healthcare system. Hospital systems, physicians, drug companies, pharmacies, the healthcare insurance industry and the government hide behind the opacity of information.

There is a mutual distrust among stakeholders.

This mutual distrust must be overcome and price transparency achieved before any progress can occur in Repairing The Healthcare System.

In order to achieve Pareto efficiency in the healthcare system all the stakeholders must agree to price transparency. The advantage of Pareto efficiency is that all the stakeholders will be better off in the long term while some might have to yield to some issues in the short term.

Lodi Hurwicz introduced the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design mechanism in which everyone does best for himself or herself. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

 The lack of interest in price transparency by the healthcare insurance industry was demonstrated in New York State in the last few weeks.

Major health insurance companies seeking steep premium increases in New York have submitted memos to state officials to justify the higher rates. Now they are fighting to keep the memos from the public, saying they include trade secrets that competitors could use against them.

 Benjamin M. Lawsky, the state superintendent of financial services, whose new agency oversees the state insurance division said,

 “How these companies are setting these rates is vital for the public to know, and should not be treated like a state secret,” “Transparency will promote healthy competition and enable the public to rigorously comment on proposed rates, two goals that all of us should favor.”

 The state insurance division issues permits to healthcare insurance companies to sell insurance in the state. If a healthcare insurance company does not want the state to publish the reasons for its insurance premium increases they should not be issued a permit to sell healthcare insurance in that state.

Mr. Lawsky has ordered that the memos be made public. His decision will go into effect by the end of November unless the companies obtain a court injunction.

The healthcare insurance industry has held the advantage over consumers in the past under the long-standing “trade secret” exemption.  The state legislature should have the courage to eliminate that exemption.

The decision followed a battle by a consumer advocacy coalition, Health Care for All New York, which had first sought information for a policyholder in Queens who faced a 76 percent increase in his family’s Emblem Healthpremium. (The fee was later raised by 270 percent.)

State Insurance Department has received hundreds of consumer protests over proposed premium increases, many of them double-digit percentages without justification except that it must be done. The State Insurance Department now has the power to reject proposed rate increases. The question remains as to whether they have the courage to reject the increases.

Aetna and others are making outrageous profits selling healthcare insurance and paying its executives many millions of dollars a year in salary.

Aetna, like other carriers, has said premium increases are driven by the actual cost of health care. But consumer advocates dispute such assertions, while complaining that it is hard to challenge the increases without access to the company filings.

United Health/Oxford wrote, “This matter is of critical importance to us.” It called the information “proprietary.”

 Aetna wrote,  “Public disclosure in this format will provide ready and easy access to comprehensive pricing, product and marketing strategies,” and warned of “substantial and irreparable injury to Aetna.”

Independent Health said, “It had spent “well over $700,000 developing the trade secret documents” and estimated that the value of keeping them confidential was much higher.

It sounds as if both Aetna and Independent Health are threating the state with legal action. If they do not like the state rule they should move on and not sell insurance in that state.  

The state’s obligation is to protect its consumers from abuse. The state should simply deny permits to the healthcare insurance company to sell healthcare insurance in the state.

Moreover, other companies argued, the filings are too technical to be understood by consumers.

“Several of the exhibits to the rate application as well as the actuarial memorandum contain not only trade secrets as noted above, but esoteric actuarial pricing precepts best understood by fellow actuaries and health plan competitors,” Sean M. Doolan, a lawyer representing Excellus, Empire, Connecticut General, and Capital District Physicians’ Health Plan wrote to state officials.

 “These documents, often speaking of concepts such as morbidity and anti-selection, could cause not only confusion, but also unnecessary alarm to the layman policyholder.”

These are excuses. They are lame and patronizing. Consumers are not as dumb as the insurance industry thinks.

 Elisabeth Benjamin is vice president for health initiatives at the Community Service Society of New York and a founder of Health Care for All New York, a coalition of 100 groups working for more affordable medical care. She said the group has hired its own actuaries.

“The only way the public will find out whether these outlandish price hikes are justified is if we can see the underpinnings,” she said. “They would like to have us ignorant. What they are saying to us, by opposing the disclosure of why they think their rate increases are justified, is that they want to keep us uninformed consumers.”

They sure do want to keep consumers ignorant. I hope the state officials are not intimidated by the healthcare insurance companies. I hope the state officials are supported by New York’s governor. Consumers are starting to understand their power. They need to drive the healthcare system. This issue is a good place to start.

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

 

Nation’s Health Care Bill Predicted To Double By 2020

 Stanley Feld M.D.,FACP,MACE

Massachusetts has experienced a sixty percent increase in healthcare costs since “Romneycare” was enacted in 2006.  The total cost of medical care in 2005 was $350,100,000. In 2009 the total cost of care had risen to $587,900,000. This represents an annual growth rate of 13.7% per year.

The Medicare Office of the Actuary reported it expects healthcare costs to increase from the $2.6 trillion dollars in 2011 to $4.6 trillion dollars by 2020 under President Obama’s Healthcare Reform Act.

“The Medicare Office of the Actuary estimated that health spending will grow by an average of 5.8 percent a year through 2020, compared to 5.7 percent without the health care overhaul. With that growth, the nation is expected to spend $4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year.

I believe the Medicare Office of the Actuary growth rate estimate of healthcare costs is low. Obamacare is about expanding healthcare coverage for the uninsured. It is actually about driving the entire population into a “Public Option” which will be subsidized by the federal government. President Obama’s goal is to have total government control over the healthcare system.

The total rate of growth of healthcare costs will be greater than 5.8% per year. President Obama is not going to be able to decrease costs by insuring at least 30 million more people. Obamacare has done nothing to restrain the healthcare industry’s billing policies. The healthcare industry’s profit will escalate even further as the federal deficit escalates.

President Obama declared that Accountable Care Organizations, Pay4Performance and Electronic Medical Records would reign in costs. I believe this is a pipe dream.  These programs are in the developmental stages and have an excellent chance of failing as the entitlement expands.

President Obama has continued to ignore an important healthcare cost generator.  Defensive medicine generates between $300 billion and $700 billion dollars a year in costs. Tort Reform if done correctly could decrease the cost of defensive medicine to the healthcare system markedly.

“The federal health law, which will expand coverage to 30 million currently uninsured Americans, will have little effect on the nation's rising health spending in the next decade, a government report said today.’

I hope the American people do not let President Obama trick them again with his demagogary. Last week he told us he was going to decrease the federal deficit by 4 trillion dollars in ten years. It is not true because he is going to increase the federal debt by 9 trillion dollars or 4 trillion less than he had planned. Deficit spending continues unabated.

 Everyone has to watch closely. He is bankrupting the country.

 White House Deputy Chief of Staff Nancy-Ann DeParle tells us not to worry. "The bottom line from the report is clear: more Americans will get coverage and save money and health expenditure growth will remain virtually the same,"

 

She stated that the new programs that administration officials said they hope to implement would change the way Medicare and Medicaid pay doctors and hospitals. (ACOs, Pay4Peformance and EMRs). Doctor’s and hospitals are only part of the problem. A bigger part of the problem is the administrative service providers (healthcare insurance industry) expenses, the cost of government bureaucracy, and the increase in defensive medicine

“Meredith Rosenthal, a health economist at Harvard School of Public Health, said it is difficult to predict what impact the health law will have on slowing national health spending.  "Many of the components of the law that are intended to control costs are still in draft form,"

The key to President Obama’s deception to the American people is to distract Americans from connecting the dots. Fifty per cent of employers will drop employer sponsored insurance programs and pay the penalty. Employees will buy insurance through the state insurance exchanges. States are refusing to participate in the insurance exchanges. The federal government is picking the ball up for the states and will have total control over the insurance exchanges.

Baby Boomers are joining the Medicare roles in increasing numbers by the minute. The cost of Medicare will escalate. Seniors are not going to be able to find physicians who accept Medicare because President Obama is going to decrease reimbursement by thirty percent January 1, 2012.

President Obama believes physicians are the problem. He refuses to believe the reality of the dysfunctional healthcare system. All the stakeholders are the problem. Some stakeholders donate more to his reelection than others. He has a strong record of playing favoritism to those that support him.

Americans are waking up to his tricks. The healthcare system has to be reformed. He has the wrong approach. I hope the electorate does not fall for his charm again. 

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