Bad Influence: The 100 Most Influential People in Healthcare

Leave it to the healthcare establishment to snub its own heroes—physicians, nurses, and other providers of care—real heroes who go above and beyond and save countless lives, all in a day’s work. Leave it to the healthcare establishment to overlook its own in favor of the government and Wall Street fat cats who are trying to put them out of business.

It’s called propaganda. And whether you realize it or not, it surrounds you.

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Modern Healthcare is a leading publication and research institution serving America’s healthcare providers and healthcare systems. Every year, they publish a list of the “100 Most Influential People in Healthcare.” They just published their 2016 list. And it’s a doozy.

Some of the entries, while dismaying, are not surprising.

The Politicians

For the third straight year, Barack Obama has been named the number one most influential person in healthcare. Go figure. If by “influential” you mean the most destructive, I suppose Obama’s placement at the top of the list makes sense. More on that in a moment.

Obama is in good political company on the list, which is slightly more surprising.

Joining Obama at the top of the list are the anticipated individuals who gave you Obamacare. These include at number 5 Silvia Mathews Burwell, Secretary of the United States Department of Health and Human Services (HHS) and, at number 9, Marilyn Tavenner, disgraced former administrator of the United States Centers for Medicare and Medicaid Services (CMS). Tavenner currently serves as President and CEO of America’s Health Insurance Plans. Go figure. It seems no one in Washington actually loses their job these days.

Burwell and Tavenner are joined by Andy Slavitt, the current acting administrator for CMS (#10), Patrick Conway, Deputy Administrator and Chief Medical Officer for CMS (#26), Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC) (#28), and Karen DeSalvo, acting Assistant Secretary of Health for HHS (#31). Next up is Francis Collins, Director of the National Institutes of Health (NIH) (#53), Robert Califf, Commisioner of the U.S. Food and Drug Adminstration (FDA) (#61), and Mark Chassin, President and CEO of the Joint Commission, the body that accredits and certifies American hospitals and clinics (#65).

Finally, there is Vivek Murthy, Obama’s controversial (and largely publicly absent) Surgeon General. Murthy, an Indian American physician born in Great Britain, is married to a Chinese American physician. Together they run a national physicians’ organization dedicated to liberal progressive healthcare reform. Murthy publicly declared gun violence a threat to public health, leading many to conclude that he would like to see gun control shoved in through the Obamacare back door. That almost cost him his appointment to the Surgeon General’s post. Even so, Murthy came in a surprisingly low 73rd. I guess he was a little too absent from the Obamacare debate, when he could have done so much for the liberal progressive cause. Oh, well.

Whew! But wait! We’re not done with the politicians yet!

I know what you’re thinking: But the list is only 100 entries long! Why so many politicians?

Which is exactly my point. But I digress . . .


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Then there is the group of politicians—and politicians posing as non-politicians—who are slightly more surprising given that they have done absolutely nothing of record for the sake of health care—unless, of course, you consider opposing those seeking to inject a modicum of sanity into an increasingly insane system to be “influencing healthcare.” Those include U.S. Attorney General Loretta Lynch (at a surprisingly high #11), Speaker of the House Paul Ryan (an equally surprisingly high #13), and Senate Majority Leader Mitch McConnell (#32). Rounding out the group from the other side of the aisle (or wherever it is that he hails from these days) is U.S. Senator, longtime Independent, and former Democratic presidential candidate Bernie Sanders (#15). Then there are the political outliers, including John Edwards, Governor of Louisiana (#35), joined by Kentucky Governor Matt Bevin (#89).

Finally, there are the non-political politicians whose inclusion should make every decent and informed American scratch his or her head: At number 19 is the Honorable John Roberts, Chief Justice of the U.S. Supreme Court, who virtually single-handedly secured the survival of the inaptly named Affordable Care Act (ACA). Roberts is joined at number 54 by his colleague on the High Bench, the Honorable Anthony Kennedy, the High Court’s notorious “swing vote” who dutifully swung in Roberts’—and Obama’s—direction when it came to the ACA. No coincidence there, I’m sure.

Nor is it any coincidence that not a single justiUS Supreme Court - supremecourt - CROPPEDce who opposed the constitutionality of the ACA—even for reasons espousing a firm understanding of the American healthcare delivery system—is included in the list. To the contrary, the most vocal among them, the Honorable Antonin Scalia, the ACA’s most outspoken critic, died alone in a remote part of Texas, was pronounced deceased of natural causes by an individual who did not know him, never met him, did not travel to the location, and in fact never examined, much less investigated, anything. After refusing to conduct any inquiry whatsoever (or even, apparently, send any federal officers to the scene), arrangements were quickly made to cremate Scalia. As if that weren’t enough, the ever-self-absorbed Barack Obama again treated us to a disgraceful show of disrespect by refusing, oh-so-publicly, to attend Scalia’s Funeral Mass on a lovely Saturday a few days later during which Obama had nothing better to do. Again, I’m sure there is no connection. None at all. Nothing to see here.

Altogether, 20 of the 100 individuals honored are politicians, the heads of federal government healthcare bureaucracies, or idologues masquerading as objective jurists. So 20% of the list is made up of the D.C. powers that be. Got it.

What about the other 80%? That is even more dismaying.

Health Insurance and Wall Street Fat Cats 

Man Holding Money 01 - 47536562To make a painfully long story short, 65 out of 100 spots went to the healthcare insurance and Wall Street fat cats. That’s right: The guys who have already made themselves rich at the expense of your health, including those who just grabbed the money and ran—away from the Obamacare exchanges that they convinced you to adopt. This group includes the CEOs of most of the country’s largest and most profitable insurance companies, healthcare systems, healthcare federations, associations of healthcare professionals, and healthcare managers. Also included in the list are the well-heeled heads of ancillary providers such as Big Pharma. Also included are some of nation’s largest healthcare technology giants—who, like their corporate colleagues on the list, publicly supported Obamacare, with its onerous technological mandates, in exchange for promised—and now delivered—wealth and control beyond what we regular Americans can even fathom.

Okay. So between the politicians and the industry fat cats, we’re up to 85.

Yikes! We’re running out of spots!

Quasi-governmental Agency Leaders

Just wait: With only 15 spots remaining, guess who garnered 13 of them? Why, the illustrious heads of quasi-governmental agencies and foundations that also lent their public support to Obamacare while cashing in behind closed doors. These include the presidents of such quasi-political, quasi-professional membership associations as the American Medical Association (AMA), the American Nurses Association (ANA), the National League for Nursing, the American College of Healthcare Executives, and the American Association of Nurse Practitioners. Joining them are the executive directors of the union National Nurses United and the American Public Health Association. Also joining them are countless  heads of other ideologically motivated so-called “professional organizations” that serve everyone except their real, working members.

With only two spots left, the editorial board of Modern Healthcare had to be discriminating.

The Final Two

Coming in at number 41, the 98th spot went to Atul Gawande. Gawande, a professor, author, and speaker from the Harvard Medical School, has spent most of his career criticizing his own profession and devising overly simplistic “checklists” that, according to Gawande, will prevent medical errors. Only they don’t. But that’s another blog post for another day.

Drumroll, please . . .

The last and final place of honor on the Modern Healthcare list of the 100 Most Influential People in Healthcare for 2016 goes to . . .

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Cecile Richards, President of the Planned Parenthood Federation. You know—the national organization started by a confirmed racist and eugenicist that today trades in free abortions for poor minority women and the auctioning off of the partially formed body parts of their aborted fetuses. You know—the same organization that is now using the Zika crisis to advocate, yet again, for unrestricted access to free late-term abortions.

You know—the organization that engages in the abject practice of genocide, all the while claiming to champion “women’s rights.” (Except, of course, the rights of women not to have their children murdered and their tiny bodies sold off like so much meat. Or the rights of baby girls who will never even be given a chance at life, much less an opportunity to exercise their feminist rights. Or the rights of the scared young women whom they dupe into believing that they are exercising a personal freedom, all the while knowing that it is only later in life that those same women, upon becoming mothers, will likely be traumatized by the magnitude of what they did out of desperation, fear, manipulation, and ignorance of their options—which are many, happy, and life-saving.)

That Cecile Richards. Right. Let’s honor her. What a feminist and healthcare hero.

The Final Tally

So there you have it:

In a list of 1Hippocrates - With Hippocratic Oath 01 - hippocrates200 supposed “movers and shakers” in healthcare, we have: (1) one U.S. President taking the number 1 honor for the third year running, who ran roughshod over his own Congress and the American public that elected him in enacting and defending the very law that will increase our suffering and hasten our death; (2) 19 other politicians who have done . . . what, exactly, for healthcare in America? Anyone? Anyone?; (3) 65 of the heads of the country’s wealthiest insurance, pharmaceutical, health care administration, technology, and other corporate conglomerates who sold out the American people by publicly supporting Obamacare even as they arranged—and collected—their own bailouts behind closed doors; (4) 13 equally well-heeled heads of quasi-governmental bodies that likewise supported Obamacare publicly while polishing their golden parachutes in private; (5) a Harvard academic who has spent the better part of his career criticizing and oversimplifying what his colleagues—unlike him—still actually do for a living in an increasingly hostile healthcare environment; and (6) the President of Planned Parenthood, which trades in free, on-demand abortions and the selling of fetal body parts.

These are the “most influential people in healthcare?” Seriously?

What in the world do you suppose Hippocrates would have to say about this list?

A Matter of Definition

I guess it depends upon how you define “influential.” If by “influential” you mean the 100 people who did the most to destroy the American healthcare system, then the list is pretty darned accurate. On the other hand, if by “influential” you mean the heroes of healthcare, not so much.


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Where did all the doctors go?

There is one very large and diverse group that was left completely off of the list. Not one entry. Not one out of 100.

That is practicing physicians, nurses, and other healthcare providers. You know—the ones who get up most days weary from the day before, put on scrubs and a white coat, and take care of folks in need. The ones who have not traded in their stethoscope for a Rolex and their dingy call room for an oceanfront vacation home. The ones who you hope are working when illness or injury strikes you.Young Doctor Studying at Table 01 - 8617738979_98826c79fe_o - RESIZED

Healthcare’s Real Heroes

Since Modern Healthcare won’t do it, I will tell you who the heroes of healthcare are:

They are the young medical resident working his 18th, or 24th, or 30th hour in a row without sleep, food, or a moment to himself so that your needs are met no matter the hour.

They are the local ER physician who misses sleep, food, and major events in his own and his family’s lives so that when illness or tragedy strike, he will be there for you.

They are the beaming obstetrician who Medical Resident with Newborn Baby 01 - 20150618_0371 - CROPPED AND RESIZEDbreathes a sign of relief, smiles broadly, and discreetly wipes away a tear as she completes her 1,000th delivery of a healthy baby, who was prepared to pull out all the stops and cry tears of frustration and pain had things not gone so well—which happens more often than she would like, but thankfully far less often than the joyous deliveries.

They are the dedicated cancer doctor who specializes in not only eradicating that most dreaded of diseases, but also in holding the hands of the suffering as they bravely battle their way toward certain death.

They are the dedicated family physician who, in the middle of the night, trades his warm bed and comfortable pajamas for a snow-covered car and a pair of mismatched scrubs as he heads, for the third time in 24 hours, back to the hospital across town because a patient needs his help or simply wants to hold his hand.

They are the idealistic young doctors and nurses who fly to faraway lands to care for those without the benefit of hospitals, doctors, and medications in an efforSalvation Army Clinic 01 - c8811cbb-3a9f-47e4-a54d-a02c0a81faa5_Picture31t to make not only our great nation, but also the entire world a better, happier, healthier, safer place to live.

They are the nurses, midlevel providers, therapists, and other clinicians who work alongside the nation’s physicians to care for those in need. They are the ones who specialize in heartbreakingly human maladies that know nothing of the rising and setting of the sun, family vacations, and other personal luxuries.

They are the doctor who will one day be there for you to pull you back from the brink—of pain and despair, if not death. They are the doctor, like me, who will be there for you just because you ask.

Just Between YouHome Health Nurse with Patient - 2a99f6_d49f5166d1e2424fb07533215c65f4f0 and Me

Because in that moment, there will be no discussion of politics, or money, or your “right” to care. There will be no consideration of what is right for society if that is not also what is right for you.

In that moment, there will be only you and me. Neither of us will be rich. Both of us are likely to be tired, and overwhelmed, and afraid. That, however, will not matter, for we will have something far more important than money, or rest, or nerves of steel.

In that most private of moments, despite the bustling activity around us, we will have a quiet connection. A real, human connection. We will care. We will be there for each other. We will trust each other. And we will get the job done, the government and Wall Street be damned.

We will have no choice—for unlike them, we have no boardroom to which to retreat. Nor do we have a golden parachute to transport us to safety.

When the going gets tough, unlike them, we will get going. Together we will stare down the beast, come what may. Together we will see you to safety, whether in this life or the next.

Because that is what we do. We do it not for fame, or weath, or recognition. We do it for each other.

Modern Healthcare can have its list. I’ll take holding your hand any day of the week.

Those are my thoughts. Please let me know yours.



Another Failed Obamacare Promise: The Continuing “Job Lock” Problem

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Oops! It seems Barack Obama did it again. He made another healthcare promise he didn’t keep.

I know: You’re shocked. Am I? Not at all.

Healing the Economy Through Health Care—or Not

Remember way back in 2009 when Obama was pushing health care reform while the country languished through its worst financial crisis in years? Obama sold the country on socialized medicine—the last thing a country teetering on the edge of bankruptcy needs—by arguing that health care reform was economic reform. He promised that the Affordable Care Act would “build a new foundation for lasting and sustained growth.” One of the ways that health care reform would give a much-needed boost to the economy, Obama promised, was by ending what is known as “job lock.”


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Job Lock

First, a little background: Why do economists worry about job lock, anyway? More importantly, what is job lock?

I’m glad you asked.

Job lock is the phenomenon whereby individuals who receive their health insurance through their employers are afraid to leave their jobs out of fear of losing their health insurance. Those employees are literally “locked in” their jobs by their health insurance needs. Where employees are afraid to leave dead-end jobs for better jobs or, more importantly, to start their own businesses, they are less productive than they could otherwise be.

Growth in American productivity, in turn, is widely assumed to be necessary in order for American workers, as a whole, to see their wages rise. Indeed, this lack of productivity growth is one of the fundamental problems keeping the United States economy stagnant. For that reason, insurance-related job lock is seen as a major impediment to American economic prosperity—so much so that it is acknowledged as a pressing concern by politicians on both sides of the aisle.


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Unkept Promises

In 2009, the newly elected President Obama campaigned for the Affordable Care Act before a skeptical American public. In his characteristic eloquent style, Obama stood confidently before hopeful crowds flush with the promise of exceptional but free care. He spoke eloquently of health care as a human right, not a privilege. He told the stories of ostensible victims of the vicious healthcare system that routinely brought attendees to tears. He told of the horrors of the insurance industry, drug manufacturers, physicians like me, . . . everyone except the government—his government.

In an attempt to appear to reach across the aisle while doing nothing of the sort, Obama made a show of good will for his recently vanquished presidential opponent, Republican Senator John McCain. Obama magnanimously cited research from the conservative Heritage Foundation praising McCain’s 2008 health reform plan and its proposed ability to solve the job lock problem by offering tax credits to employees so they could afford to buy health insurance on the private market. While the details under Obamacare differed (and who has time for details?), Obama confidently promised the same outcome. As a result, Obama argued, American workers would feel free to leave unfulfilling and unproductive jobs, because they would “own” their health insurance coverage and could take it with them to a new, more fulfilling, and more productive job.

The American public could almost hear the cha-ching-punctuated purring of a humming, happy economy.

Curing job lock was the first step to economic utopia. Upon that both parties agreed. Obama had a point. The problem was, he had no power to deliver on his grand promise. To the contrary, the Affordable Care Act promised not relief, but exacerbation of the problem of job lock. And the American public was supremely uninterested in the boring details. And so they fell for Obama’s empty promises—as they say, hook, line, and syringe. Or something like that.



The Final Analysis

Now, over seven years later, as Obama prepares to leave the White House, we can chalk Obama’s pledge to end job lock up as another promise eloquently made but not kept.

According to a new study by the nonpartisan National Bureau of Economic Research (NBER), Obamacare has done nothing to solve the problem of job lock.

NBER economists recently studied states that expanded their Medicaid programs under the ACA. They found no evidence that there was a reduction in job lock in those states as a result.

What they did find was something completely predictable—and damning to Obamacare:

New Medicaid enrollees exceeded expectations. That is a problem, because those individuals require taxpayer subsidies, some to the tune of 100% of their Obamacare premiums. And they are likely—make that certain—to require continuing subsidies in the future. To make matters worse, many of them are the sickest of the sick and already need long-postponed—and very expensive—care. And Obamacare says they can have it, after the fact, for free.

It gets worse: While the number of new Medicaid enrollees exceeded expectations, the enrollment of middle-class, working, taxpaying Americans fell far short of expectations—according to one recent study, by more than one-half.

Economic Death Spiral

Obamacare, it seems, suffers from the most devastating economic malady of all: one-way cash flow. All of the Obamacare cash—heck, all of the healthcare cash—is destined to flow out to those who contribute nothing. At the same time, those who do contribute get nothing for their good deeds. And so they opt out. And the money stops flowing in. And there is nothing that Obama or anyone else can do to revive the dying patient.

As it turns out, you don’t have to have a degree in economics—or even be that interested in the boring details—to understand that this represents an economic death spiral.

The insurance industry’s reaction has been equally predictable: One by one, they are throwing in the towel and exiting the Obamacare exchanges. Despite the fact that they supported the law and were instrumental to its passage. Despite the fact that they knew these very losses would occur, and why. Despite the fact that they have already received their cash bailout, which was baked into the Obamacare pie.

So much for ending job lock. Now, we have both job lock and “disease lock.” Because the chances of your navigating these choppy waters without subjugating your interests to those of the federal government, and the Wall Street and insurance fat cats with whom they share both a bed and a lifeboat, are slim to none—nonexistent, really.

Welcome to Obamacare. I’m sure you’re going to hate it.

Those are my thoughts. Please let me know yours.




Cash for Care: The Obamacare Discount Club

No Free Lunch—or Free Health Care

It is now official:  Health care costs have skyrocketed under Obamacare. It seems the old saying is true: There is no free lunch—or free health care. In fact, costs governed by Obamacare have risen disproportionately to all other markers of economic growth. They have also outstripped by far the few aspects of health care that, for now, have remained under private control.

Go figure. Government interference results in higher prices. Who knew?

And there’s more bad news where that came from:  It seems that consumers are punished for having insurance. That’s right: You are punished, in terms of pricing, for having insurance. Those without insurance who are willing to pay using cash or credit are getting steep discounts on routine healthcare screenings.

This makes sense. After all, who wouldn’t discount their prices in order to avoid the red tape, delay, risk, and uncertainty of reimbursement through the bureaucratic jungle of not only gargantuan insurance companies, but also the federal government? After all, providers are merely passing their savings on to their customers. What could be wrong with that?

A lot, actually. Because their doing so means that you are actually worse off for having insurance. It seems that the old saying is true: No good deed goes unpunished.

Medical Price Wars

Don’t get me wrong: This is not a new development. Historically, as insurance companies reduced the percentage of billed charges paid, providers responded by raising prices. After all, 40% of a lot is more than 40% of a little. Likewise, 20% of a lot is more than 20% of a little. And 40% of a little equals 20% of a lot. You get my drift.

In response, the insurance industry lowered its reimbursements even more, and providers again raised their prices. And so on and on and on. It was a vicious cycle that resulted in a hospital-administered tablet of Tylenol costing $100 and a CT scan coming with a price tag of $1,500 or more.

So, why did we never address this issue? Seems it didn’t matter that much, that’s why.

While that back and forth pricing duel between the insurance industry  and providers was not good, it didn’t actually matter to insured health care consumers, who were going to pay little to none of the inflated prices charged. Nor did it matter to the insurance companies or the federal government, both of which have the clout to tell individual providers to take a hike if their reimbursement isn’t enough.

Of course, this is all ancient history. This was way back when deductibles were in the hundreds rather than the thousands and premiums, too, were in the hundreds and not thousands per year. You know: Way, way back. Six years or so. In other words, before Obamacare intentionally destroyed both the insurance market and the health care system.

Here are some examples from my own experience:

The $1,700 CT that Costs $350—or Less

A friend of mine recently commented to me that her daughter didn’t know what to do. When I asked what was going on, I got an earful. It seems her daughter and son-in-law had gotten caught in the dreaded upward spiral of employer-sponsored healthcare insurance premiums. Their monthly premiums, which they paid through their employer, had gone from just over $200 per month to over $450 per month.

Recently, my friend’s daughter experienced excruciating abdominal pain. When she made an appointment to see her doctor, she was told that under her insurance plan,”her part” of the bill for the office visit was $159. How much, she inquired, was a visit for someone without insurance? $89, she was told. For the very same visit.

After a few more visits, the young woman was finally told that she needed to have her gallbladder removed. Before surgery could be performed, she would have to have a CT, or “cat,” scan of her abdomen. The cost under her insurance policy? A cool $1,700 copay. In cash. Before the scan could be performed. In light of the $1,700 designated as “her part” of the charges, she inquired as to the total amount being charged for the scan. The answer shocked her: Over $4,000.

My friend lamented that her daughter and son-in-law, though insured through a major insurance company, simply could not afford to seek treatment. And so her daughter remained in pain.

A few days later, my friend was decidedly more upbeat. It seems that her daughter, by then desperate, complained to the insurance company that she could not afford a $1,700 CT. A representative of the company referred her to a private radiology group. The same exact CT, under her insurance policy, would cost $450—total. The cost if she paid cash and did not use her insurance? $350.

So . . . a $1,700 CT actually costs less than $350 to perform. Most likely far less.

In fact, I can confirm that the real price is most likely far less.

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$1,500 or $150 for an MRI? That depends . . .

As I shared with my friend, long before she told me about her daughter’s dilemma, I personally became curious about the pricing of routine scans. So I went to a medical imaging center. I asked how much a routine MRI would cost. The answer was $1,500 for an insured patient. I then asked how much it would cost for an uninsured patient paying with cash, check, or a credit card. The answer was $750. I then asked how much it would be if the patient hesitated on price. The answer was $350. I then asked what the bottom line price was if, say, the patient started to leave and their machine was not being used. Their answer? $150.

So in a free market system, that $1,500 scan just became a $150 scan – with immediate, no-wait service, no less.

Thus, we could get things like CTs and MRIs for 10% of their current price – or 90% off – if we could get the big insurers and the government out of the way. Unfortunately, self-serving politicians have convinced the American public that free market, cash-based medicine is “medicine for rich people.” Who, I ask you, can possibly pay $1,500 for a routine MRI that may or may not result in any pertinent findings? That’s right: Rich people. And who can pay the $150 that the same scan would cost in a free market system? That’s right: You and me.

And lest you think this problem is new, consider this:

The Case of the $5,000 Colonoscopy

Years ago when I was in medical residency, I was due for a routine colonoscopy due to a family history of colon cancer. Because I was a medical resident, I had my health insurance through my employer (that is, my medical residency program and the attached hospital system in which I worked). One of the gastroenterologists (GI doctors), a friend of mine, agreed to waive his fees for performing the colonoscopy. (This is a common courtesy among physicians.) So the only costs I would incur were the charges of the hospital.

So far, so good – especially for a medical resident on a steady diet of ramen noodles and peanut butter. I scheduled the colonoscopy.

Weeks later, after a day of prep (which if you have ever had a colonoscopy, you know is not fun), I showed up for the procedure. When I signed in, I was told that my copay was $1,300. I wrote them a personal check on the spot.

At the time, the standard, going price (total) for a colonoscopy was between $900 and $1,200. So charging me $1,300 cash up front was high – particularly given that the hospital would collect on my insurance as well. Even so, I did as they asked.

Thankfully, the colonoscopy was routine and without complications. One small polyp was removed and sent to the lab. That was negative for disease. There were no other findings. I was in the procedure for less than 10 minutes total.

Several weeks later, I received a bill from the hospital – my employer – for over $4,000! With the $1,300 that I had already paid, that meant that they were charging well over $5,000 for a routine, 10-minute procedure with a market value of $900 to $1,200. And that was years ago. With no physician’s fee included.

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The Losers in the Health Care Price Wars: You and Me

This price inflation is what government over-regulation, insurance interference, and profit-mongering do to health care.

Let’s face it: We blew our chance to improve the American healthcare system. And it will only get worse from here. Better hang on.

Welcome to the Obamacare price wars. You’d better bring your Discount Club membership card. And your wallet. You’re going to need it.

Oh, and welcome to Obamacare. I’m sure you’re going to hate it.

Those are my thoughts. Please let me know yours



Another One Bites the Dust: Aetna Joins Humana, UnitedHealth, Others Leaving the Obamacare Exchanges

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Let’s face it: The American health insurance industry is officially dead.

Before you reach for the tissues and plan the funeral, know this: Theirs was a self-inflicted wound. It was also a calculated endgame.

Its victims? You and me, that’s who.

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Aetna Bows Out

Earlier today, Aetna reported that it is all but exiting the Obamacare exchanges starting in 2017. The company is slashing its involvement in the exchanges by 70%, from an initial participation in over two dozen states down to a mere four states for 2017. No doubt, that number will reach zero by 2018.

The only folks surprised by Aetna’s exit are those who haven’t been paying attention. In fact, all Aetna did today was join a growing list of major insurance conglomerates to leave the Obamacare exchanges. Just yesterday, I posted a blog about the equally abrupt exit of UnitedHealth (“Growing Profit by Bleeding Loss: The New Accounting of Obamacare”). And then there is Humana.

The community of Obamacare expats is growing by the day.

It is worth remembering that a mere two years ago, Aetna served as one of the biggest—and most influential—proponents of the Obamacare exchanges. Almost from inception, Aetna joined the exchanges in over two dozen states, eagerly jumping behind the Obamacare podium and preaching a sermon of free lunches and healthcare for all. At little to no cost to you. Coming to a hospital near you.

The only problem was, the sermon was  a lie. As they pounded the podium and wiped their furrowed brows, asking for donations and support—not to mention your trust—they knew that the sermon was a lie. You were the only one who didn’t know. Even back then, I tried to warn anyone who would listen; but no one wanted to hear my message.

Let’s try this again.

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Golden Parachutes and Beachfront Real Estate

They lied to you, and now they are leaving you with the consequences of their misdeeds.

Oh, and one more thing: They are getting rich in the process, and leaving you poorer than ever. And sicker than ever.

Welcome to Obamacare. Welcome to government-run healthcare designed by Wall Street and insurance fat cats and administered by liberal Democrats intent upon both controlling and rationing the care that you receive.

In yesterday’s blog referenced above, I discussed the fact that Obamacare specifically included a “risk corridor” that was intended to bail out the insurance industry. Everyone knew from the beginning that the nation’s insurance companies would lose massive amounts of money. And they have. Aetna lost over $200 million in the second quarter of this year alone. So did UnitedHealth, which has reported overall losses of some $1.3 billion in 2015 and 2016.

And yet to a company, they all came out in rousing support of the Obamacare mandate.

What gives?

They were promised money. Like most of American politics, money talked—or convinced them to keep their mouths shut, as it were, regarding what Obamacare would really do to the health care that you receive.

Okay. So in exchange for the insurance behemoths’ agreement to stand dutifully at the Obamacare podium—and thereby (as I mentioned yesterday) help forge the instrument of their own demise—they got a bailout. A nice, big, fat wad of government cash, guaranteed. Their CEOs dreamed of golden parachutes and sunset years on sun-drenched beaches.

Today, those same insurance executives are preparing to cash in, and are now looking at oceanfront real estate. But there is a catch, and it’s a big one: As with every government bailout, it now seems that there isn’t enough money to go around. After all, beachfront real estate is expensive—very expensive. And the list of those seeking to cash in is growing.

Forgive me for not weeping openly for their plight.

Bottom Lines and Bad DealsWorried Young Woman 01 - untitled

Earlier today, Aetna Chairman and CEO Marc Bertolini issued a statement identifying as the problem that Obamacare plan members tend to incur high medical costs, while the federal risk adjustment program (the so-called “risk corridor”) meant to offset insurance company losses has not been adequate. As a result, Aetna, as many insurers, is losing money in the exchanges.

If you haven’t yet read it, you should read my post from yesterday that is referenced above. I said just that.

In other words, Aetna made a bad deal. So did UnitedHealth. And Humana. And now they want out. And the federal government—the same federal government that shoved this entire mess down the throats of good Americans—says that is just fine. Seems they never thought, before handing out the bailout cash, to require that the insurance companies stick around for the ride. And so that ride just got a lot bumpier—for you and me.

So . . . What is going on?

Here is the truth:

You are being hosed by the same fat cats this administration encouraged you to hate. My former law school classmate Barack Obama—assisted by generations of liberal progressive Democrats, free-lunch politicians, and medical establishment and educational elites—convinced you that they were the good guys. At the same time, they made you hate the insurance industry. They made you hate them, while blaming them for healthcare’s enduring plagues: high cost and inadequate access.

Having done that, they fed you a line that somehow the federal government would put the insurance companies in their place. They put them in their place, all right: right beside them in the bed that they share, and have always shared.

For their part, the insurance companies were happy to go along for the ride. After all, public vilification is nothing new to them. Everyone already hated them. All that was needed was a little reinforcement and the acquiescence of the insurers themselves. And that came at a price—a very high price, indeed. And, we now learn, with no strings attached. It was a typical government deal in which we, the American taxpayers and the only folks with no seat at the table, get hosed.

In the meantime, the politicians, policymakers, and government bureaucrats encouraged you to hate the insurance industry. They publicly blamed the nation’s insurers for most of the shortcomings of the American healthcare system. But here’s the kicker: They did all that with a wink and a nod in the insurance industry’s direction. Theirs was a fake conflict manufactured to lead you down the path to the destruction of not them, but you. Only you could not see that.

With the exits of Aetna, Humana, and UnitedHealth—not to mention the long list of insurers who will join them at the exit door—millions of Americans will be left with few to no viable options for both insurance coverage and care.

It was the classic bait-and-switch. And we are the catch of the day.

Even worse, the void will be filled—by the same federal government that orchestrated this entire charade. Acting as though they are benevolently bailing us out this time, they will offer what they intended for us all along: universal, single payer health care. Health care by the government, for the benefit of the chosen, in accordance with the social good. Socialized medicine.

Welcome to the VA Health System on steroids. Get comfortable. You’re going to be here for a while.


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Let’s face it: We allowed them to brainwash us into screwing up our own health care.

And now they are all bailing out, leaving us without care. Because make no mistake: single payer health care is the closest thing to no care that you will ever have the misfortune of experiencing.

Welcome to Obamacare. I’m sure you’re going to hate it.

Those are my thoughts. Please let me know yours.




Growing Profit by Bleeding Loss: The New Accounting of Obamacare




It’s all UnitedHealth’s fault. Sort of.

Modern Healthcare is a leading publication of the healthcare industry. Recently, Modern Healthcare published an article entitled “UnitedHealth posts major gains despite $200 million of additional ACA losses.”

Needless to say, the article caught my attention.

As bad as the headline is, the details in the article are even worse.

According to the author:

  • “UnitedHealth Group . . . grew revenue by more than 28%, even though the conglomerate continued to bleed money from the Affordable Care Act’s exchanges.”
  • “UnitedHealth’s profit increased 11% in the second quarter to $1.75 billion” despite “an additional $200 million of losses from the ACA’s public exchanges.”
  • UnitedHealth “has now lost approximately $1.3 billion in 2015 and 2016 from the new marketplaces.”
  • “Despite those losses, UnitedHealth raised premium prices and controlled costs in other areas to solidify its fundamental business.”
  • “Earnings from UnitedHealth’s operations totaled $3.2 billion in the quarter and $6.2 billion in the first half of this year.”
  • Finally, having made its excess profit despite record losses, “UnitedHealth has pulled out of most of the exchanges for 2017.”

Keep in mind that UnitedHealth currently insures almost 48 million Americans.

And yet they are pulling out of the Obamacare exchanges. After making record profits from the confusion and insurance industry . . . um, flexibility (I’m being nice) it created.

It gets worse.Worried Woman 01 - 131568-566x848r1-ExcessiveWorry

A spokesman for UnitedHealth recently opined—out loud, and in public—that the only way the Obamacare exchanges will survive is with “a massive new infusion” of taxpayer money.

Keep in mind that Obamacare and its regulations already established a so-called “risk corridor” to subsidize insurance behemoths, like UnitedHealth, that lost money in the exchanges (as everyone knew they would). It was the only way to get the politically powerful insurance industry on board as supporting the passage and implementation of the very law that would destroy their industry. Tricky business, that: getting smart folks to help forge the instrument of their own death.

Everyone knew that the Obamacare exchanges would fail. And so, in exchange for their public support, the country’s largest—and most profitable—insurance companies demanded a bailout. It was classic quid pro quo. It was also the classic pay to play scheme. Only this time, the payer is you. And you don’t even get to play.

Welcome to health insurance administered by the federal government.

Needless to say, the insurance industry got just what it asked for in the risk corridor.

Only like all bailouts, now it seems what they got was not enough. Now they want more—of your money. And the federal government has signaled that it is more than willing to oblige. And remember that this time around, they have the power of the federal Internal Revenue Service and Department of Justice on their side. You will pay—dearly—for their . . . um, miscalculation (again, I am being nice, which isn’t easy).


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How can this be?

How, you may ask, can one of the nation’s largest insurance conglomerates support the passage of Obamacare over the wishes of its insureds, intentionally lose billions of dollars in the exchanges as a result, yet still make record profits?

And how can they legitimately make up for those losses—all of which were of their own doing—by increasing premiums paid by, and decreasing coverage provided to, those they insure?

And having cashed in on the legislated risk corridor, what right do they have to return to the well and demand even more taxpayer dollars to subsidize their mistake if not their misconduct?

Finally, having done all that, how can they simply exit the system, leaving some 48 million Americans with few options other than substandard Obamacare offered through an obscure and unaccountable middleman, if not the federal government itself?

Do those 48 million Americans have any idea where they will go? Does UnitedHealth even care?

I think we know the answer to both questions:  No.

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Welcome to the future.

Welcome to government-controlled healthcare administered by nameless, faceless, and unaccountable bureaucrats, working in concert with equally unaccountable insurance and Wall Street fat cats, none of whom cares about you or your care.

None of what is about to happen will make sense to good folks like you and me. None of it will be right, or fair. None of it will improve your health—quite the opposite.

And there is not one thing that you or your doctor can do about it.

And who do you think footed the bill for UnitedHealth’s “major gains” despite their record losses under Obamacare?

That’s right: You and me, that’s who.

And who do you think will provide the “massive new infusion” of cash that UnitedHealth now demands?

That’s right: You and me, that’s who.

Welcome to Obamacare. I’m sure you’re going to hate it.

Those are my thoughts. Please let me know yours.





Increasing Spending by Lowering Cost: Obamacare and the Upward Death Spiral

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It appears that the Obamacare narrative continues to run headlong into the unforgiving brick wall of reality.

Pesky things, facts.

The latest: 

Healthcare costs are skyrocketing under Obamacare.

In 2015, the United States healthcare system spent $3.2 trillion—that’s trillion with a “t”—or almost $10,000 for every person. This is the highest rate of spending—and the greatest increase over 2014 spending—seen thus far under Obamacare. It also outpaces by a significant stretch all pre-Obamacare healthcare spending.

With a whopping 5.5% annual growth rate, healthcare spending goes up by $176 billion every year. That same 5.5% annual growth rate also ensures that healthcare spending outstrips by a significant margin the growths of gross domestic product (GDP), tax revenue, and wages. In other words, healthcare spending is outgrowing every other marker of American productivity and wealth. That is concerning.

Under Obamacare, the percentage of the United States economy devoted to healthcare spending has grown.

Remember when proponents of Obamacare relied upon the supposedly unprecedented percentage of the U.S. economy devoted to healthcare spending—16% at the time—to promise a remedy?

Outrageous!” they exclaimed, with a righteous indignation that was visible and, for many, compelling.

Well, under Obamacare, that percentage has increased—to 17.8%, to be exact. So in less than six years of Obamacare, that number has increased by some 1.8%, or just over 11%. That’s almost 2% per year. With overall spending of $3.2 trillion, that’s a lot of money—almost $60 billion—that’s billion, with a “b”— per year, to be exact. And that’s just the annual increase in the percentage of the economy devoted to healthcare spending under Obamacare. Yikes.

Even worse, Barack Obama’s own Centers for Medicare & Medicaid Services (CMS) estimates that by 2025, healthcare spending will comprise 20.1% of the U.S. economy. That, of course, leaves precious little money for defense, education, transportation, infrastructure, disaster preparedness and relief . . . You know: the other necessities.

Healthcare spending will not slow down anytime soon.

Between the Obamacare-mandated expansion of Medicaid and industry responses that have increased prices while limiting consumer choice, healthcare spending is poised to continue its upward death spiral. As they say, few things are as certain as death, taxes, and increased healthcare spending. Okay, so they don’t add that last part. But they should.

Obamacare has done nothing measurable to lower healthcare spending.

When recently pressed, even Obamacare-friendly CMS economists “could not definitively say” whether the law’s payment and delivery reforms have done anything to lower healthcare spending.

You know what that means: They have not.

One area alone has continued to grow at a historically low rate of 0.8%—private sector price inflation.

Tellingly, that is the one part of the healthcare spending equation that remains, for the most part and thanks to an aggressive lobbying effort, in the private sector—for now. You should hope that continues. If not, and if the federal government takes over, expect dramatic increases in the prices of everything related to your health.


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Relentless, Obamacare-driven job growth in the healthcare sector will further exacerbate the problem.

All new jobs are not created equal.

According to healthcare economists, the current healthcare hiring pace will put the industry at 900,000 added jobs in 2015 and 2016 alone.

Job creation is a good thing, right? Not necessarily.

No doubt, this acceleration in hiring is in response to the added burdens placed on providers by Obamacare and its regulations. The problem is, these are jobs that are now required to do the same work that was previously done by fewer people. Just because the workplace is more crowded, that doesn’t necessarily mean that more, additional, or better care is provided.

Nor is more profit being generated. Rather, thanks to Obamacare and its regulatory complexity and technological mandates, the new jobs are required just to maintain the status quo. Obviously, where employment costs rise and profits do not, that equals a net loss. In such a scenario, the more new healthcare jobs are created, the more healthcare spending increases, while profits remain stagnant.

And so the upward death spiral continues.

Americans are paying more out of pocket for the health care that they receive.

In 2015, a record 10.6% of national health expenditures came directly from consumers. With $3.2 trillion in total healthcare spending, that equals almost $340 billion—that’s billion, with a “b”—per year that comes out of individual Americans’ pockets. As those consumers are increasingly pushed toward high-deductible health plans, that upward trajectory of individual costs is expected to continue, reaching historic highs over the next few years.

It is only a matter of time before average Americans like you and me are priced out of not only the health insurance market, but the health care delivery market as well. That is when things will get really painful—literally.

Because of the personal costs involved, more and more Americans are postponing both seeking and receiving care, leading to higher costs and worse outcomes.

Individual responsibility for costs associated with healthcare services reduces spending in the short term as healthcare consumers forgo routine and non-emergent care. However, that same postponement leads to more long-term spending and worse outcomes. Because individuals wait longer to seek care, they are sicker when they do, with the result that their care is both more expensive and less effective.



Having “skin in the game” does not a better healthcare consumer make.

Obamacare’s proponents extol the cost savings associated with giving healthcare consumers “skin in the game” by making them pay more out of pocket for their care. Economists disagree. They report that when it come to healthcare, high deductibles and copays have the opposite effect. Increasing out of pocket expenditures—particularly in a time of economic recession and record unemployment and wage stagnation—results in higher overall healthcare spending. This is because for every healthcare consumer who forgoes low-value/high-cost care, another forgoes low cost/high value care like preventive care and disease screenings. Again, costs rise and outcomes worsen as a result.


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Per-person healthcare spending increases with federal government involvement. 

In 2015, private health insurance companies spent an average of $5,380 per insured individual. That same year, Medicare spent almost $12,000 per enrollee—not including enrollees’ out of pocket expenditures. Of course, since Medicare is used almost exclusively by the elderly and those with serious health conditions, that is understandable. They are a self-selected group inclined toward healthcare spending. Less understandable is the fact that that same year, Medicaid programs—which presumably represent the same wide variety of individuals as the private health insurance industry—spent nearly $8,000 per member.

All of this is a direct result of the passage and implementation of Obamacare.

Even the Obamacare-friendly CMS admits that these are direct effects of, and responses to, Obamacare’s expansion of Medicaid and its resulting disruption of both the health insurance market and the healthcare delivery system. On that we all agree.

So why, exactly, are we continuing down the Obamacare road? That’s a good question.

The Bottom Line

Who, exactly, is surprised by any of this? Certainly not the nation’s physicians. But no one asked us. Certainly not my former law school classmate, Barack Obama. Go figure.

Just wait until the rationing of care begins in earnest starting in 2017. If you think rising insurance deductibles and copays are concerning, just wait until you cannot get the care that you need regardless of price and your ability and willingness to pay.

Unfortunately, that day is fast approaching. Its arrival will be hastened in the event Hillary Clinton wins the presidency this fall. She has actually promised as much.

Higher costs. Less care. Worse outcomes. Government control. Bureaucratic interference. Rationed care. Death panels.

This is the real face of Obamacare.

Is this progress? Because it looks and feels a lot like failure to me.

Welcome to Obamacare. I’m sure you’re going to hate it.

Those are my thoughts. Please let me know yours.





Obamacare Gets an F: Physicians Give the Law a Failing Grade

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Grades Matter

Grades matter. They are also telling. Obamacare has just been put to the test, and the results are not good. Obamacare has failed—miserably.

Late last month, while the nation recovered from the Republican and Democratic National Conventions and continued to obsess over every new investigation of Hillary Clinton and every regrettable utterance by Donald Trump, the results of a stunning survey were released.

While the nation slept, one of its scariest boogeymen looked it straight in the eye; and the American public did not even blink.


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Surveying America’s Physicians

Medical Economics is a leading journal of the medical profession. Recently, the magazine’s editorial board surveyed hundreds of practicing physicians across the nation. With the help of healthcare industry experts, including healthcare policy analysts and policymakers and physician advisors, the magazine’s editorial board devised a list of eight major policy initiatives of Obamacare. Items listed were among the largest, most sweeping promises used to sell Obamacare to physicians and healthcare consumers—you know, you and me as the individuals with the power to make or break the new law—and vote politicians into, and out of, office.

Physicians surveyed were engaged in the day-to-day practice of medicine. They were asked to grade each Obamacare promise based upon whether that promise had been kept, whether the stated goal had been achieved, and whether that element of Obamacare assisted them in their day-to-day work as a physician. They were asked to grade each element between a low of 0 (not at all) to a high of 10 (very much).

In the cover article of the magazine’s July 25, 2016 issue, pictured above, the magazine’s editorial board revealed the results of that survey.

They were dismaying, but not surprising.

That’s Obamacare with an “F”

It is now official: Six long years in, America’s physicians give each element of Obamacare an F.   medicare-frustrated-doctor

It is worth noting that practicing physicians do not give each element of Obamacare an F as in, say, a 64, 60, or even 55 sort of F—in other words, the sort of F that says, “If you had just tried harder, everything would have been okay; so better luck next time.”

No. They gave each element of Obamacare an F that is in the 20s or 30s—you know, the kind of F that in school would have caused you to be held back, grounded by your parents, or most likely both. In other words, each element of Obamacare examined received a “you-didn’t-even-try-so-there-won’t-be-a-next-time” sort of F.

Even more telling, as the article’s authors note, individual survey respondents did not differ much in their evaluations—or their grades. Indeed, the physician respondents were uniform to a physician in their perceptions of the massive failures of Obamacare.

Again, the results are disappointing but not surprising to those of us who have struggled under Obamacare’s false promises and egregious mandates for six years now.

Results Rundown

Since most of you have no reason or desire to subscribe to, much less read, Medical Economics Magazine, here is a rundown of the specific Obamacare promises considered, their respective grades (both number and letter), and verbatim quotes from physician respondents:

1.   Medicare bonus for primary care services  

     The Obamacare promise: Obamacare-mandated Medicare bonuses for primary care services will more fairly compensate primary care physicians by closing the gap between reimbursement for primary care services and payment for specialist services, which have historically be compensated at much higher rates despite a relative equality of services, training, and education. This would have amounted to an effective raise for primary care physicians while leaving medical specialists’ payments intact. It was proposed as a win-win for all physicians as well as their patients.

     PHYSICIAN GRADE: 33 = F  

Physician comments:

      “It is totally meaningless.”                                                 

      “It was a silly Band-Aid.”

2.   Medicaid-Medicare parity

       The Obamacare promise: Obamacare-mandated payments to primary care physicians providing services under Medicaid will be reimbursed at the same rate as the same services under Medicare. This would have amounted to an effective raise for physicians caring for the Medicaid population while keeping Medicare reimbursements stable. Again, it was proposed as a win-win for everyone. 


Physician comment:

       “Once again a short-term fix for long-term problems which mandates one and then walks away to  leave someone else holding the bag.”

3.   Increased coverage through healthcare insurance exchanges 

      The Obamacare promise: Under Obamacare, more Americans will be provided health insurance coverage thanks to the healthcare insurance exchanges.


Physician comments:

      “Coverage is shockingly bad, and at a high price.

      “[M]ore coverage does not equal more access.”

       “High deductibles appears to me to be a by-product of insurance companies protecting their assets.” 

       “Why would selling an insurance policy with a large deductible help someone who can’t even afford the premiums? They can’t pay the deductible, so they still can’t afford care. Who made out? Insurance companies. Who lost? Private practice doctors who had to deal with patients who stiffed them for the deductibles on policies. Thanks Obama!

       “[Physicians] have been the ones who have to explain that the patient does have to pay their exorbitant copays—usually we end up with zero and an angry patient.

4.   Physician networks                                           

       The Obamacare promise: Under Obamacare, Americans will enjoy access to a wide range of care from a physician of their choosing. (“If you like your doctor, you can keep your doctor.”) (“If you like your plan, you can keep your plan.”)


Physician comments:

      “[Obama said] ‘If you like your plan, you can keep your plan.’ The result? Reduced choice.”

     “Insurance companies are prohibited from cherry picking healthy patients, so they cherry pick physicians who treat healthy patients.”

      “The network delineations in our area are so arbitrary and inappropriate that all they do is impede care.”

      “If I can’t send my patients to specialists within a reasonable travel time, the patient simply can’t go. This is particularly true in rural areas. 

5.   Accountable care organizations  

      The Obamacare promise: Through Obamacare-mandated Accountable Care Organizations (ACOs), Medicare patients will enjoy high-quality, coordinated care.

      PHYSICIAN GRADE: 29 = F 

Physician comments:                                      

      “This is managed care reintroduced under another name. There will be temporary savings then rapidly increasing costs again as the market becomes controlled.”

      “ACOs add layers of work for physicians, reducing our ability to spend time with our patients and adding unnecessary burdens to our already busy schedules. And all of this with marginal if not negligible benefit.”

6.   Outcomes-based reimbursement   

       The Obamacare Promise: Obamacare-mandated initiatives, including outcomes-based provider reimbursement, will ensure patients a higher quality of care.

       PHYSICIAN GRADE: 28 = F 

Physician comments:

      “Let’s start paying lawyers and politicians using a similar grading system.” 

      “Unintended consequence of this in a long run will be that no one will be willing to take care of sick patients, because they will cost the doctor money in reimbursement.”

      “This is a very dangerous game that the government is playing with physician reimbursement and it will be the death of the small practice.”

      “Ultimately could just be a complicated way to cut reimbursement.”

      “The emphasis has moved from the patient to the process.”

      “The problem is that this law does not reward good medicine, it only rewards good recordkeeping.”

7.   Physician ratings via the Physician Compare website

       The Obamacare promise: Obamacare-mandated physician compare websites will allow patients to make more informed choices of providers, at the same time incentivizing physicians to provide the highest quality care possible.


Physician comments    

      “We need a site for insurance companies and congressmen as well.”

      “This website constitutes CMS’s engagement in cyberbullying practicing physicians.”

      “[The site is] horribly inaccurate.”

      “It appears to be at random and not vetted at all.”

      “Not all that is important can be measured, and not all that is measurable is important.”

8.   Expansion of health IT

       The Obamacare promise: Obamacare-mandated electronic health records (EHRs) will improve patient care and physician communication.


Physician comments:

      “The EHR is the single worst thing among many to happen to medical practice in the past 15 years.”

      “This is the single most detrimental hurdle to practicing.” 

       “Nothing ruins a patient’s experience faster than a computer in the exam room.” 

       “[EHRs] just opened doors to lots of IT vendors who are overcharging because they can!” 

       “[E]verything involved in patient care takes longer.” 

       “I spend a large amount of time as a clerk. Thank you 9th grade typing teacher!



Obamacare’s Failing Grade

The results are in. They also speak for themselves.

Obamacare’s average? Exactly 30. That’s a dangerously long way from 100—or even the passing mark of 65, for that matter. In fact, it is less than half of passing. Hardly commendable. Not even acceptable.

Imagine what would have happened to you in school were you to take such a dismal report card home.

Obamacare should be held back. Or grounded. Or suspended until improved.

Obamacare is a failure—a massive failure.

In case you wondered what your physician thinks of Obamacare, well, you have your answer.

That is bad news for us physicians, and even worse news for you, our patients.

Welcome to Obamacare. You’re going to hate it. Heck, you might not even survive it.

Please let me know your thoughts.




Cruz Control


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Though predictable overall, the recent Republican and Democratic National Conventions did deliver some notable drama–particularly of the Ted Cruz variety. If it was drama you sought, the first-term Texas Senator and previous GOP presidential hopeful did not disappoint.

Before we get into this, I should admit: I was once a Ted Cruz fan. Not anymore.

Drama at the RNC

You know what I’m talking about: Cruz’s infamous non-endorsement speech at the RNC. Watching Cruz speak that Wednesday evening was like watching a train go off the tracks in slow motion. At first, the ride was fun and the view lovely. Cruz was telling us what we wanted to hear. And then we went through a tunnel. Those present on the floor began—softly at first—to chant for Cruz to do the right thing and endorse Donald Trump, the GOP nominee. Cruz refused to do so. Those of us watching at home became uneasy. We shifted in our seats, suddenly uncomfortable. Surely Cruz, the ultimate politician, would not refuse to endorse Trump; would he? Surely he would not be so obstinate in a prime time speech with much of America watching; would he?

And then he did. The train emerged from the tunnel only to careen down a steep incline and over a cliff that few of us saw coming. In a matter of moments, the audience went from adoring, to respectful, to guarded, to suspicious, to demanding, to angry, to furious. Through it all, Cruz remained unyielding, defiant. He was a man on a mission to . . . what? Stand on principle? Hurt Trump? Destroy his own carefully crafted and constantly nurtured political career?

There is a silver lining, however: Those events lead me to conclude that presidential primary seasons, while challenging, tiresome, and expensive, do work, after all. Their purpose is to vet, hone the skills of, test the mettle of, and rally increasing support behind the deserving while weeding out the unacceptable, the undeserving, the incapable, and those of impure purpose.

True Colors

Cruz’s RNC speech was a stunning moment that is destined to take its place in the archives of presidential politics as one of the most dramatic convention moments in modern history.

Drama, it turns out, is rapidly becoming the hallmark of Ted Cruz. And that is a problem.

In that stunning moment that we will discuss for years to come, Ted Cruz failed to reach the mark. He also showed his true colors.

Ted Cruz is in it for Ted Cruz. Like a petulant child who did not get his way, Cruz stood defiantly before the American people, figurative arms crossed tightly across his chest and lower lip protruding, and unapologetically refused to do what he pledged he would do: support the party’s nominee. Despite having just delivered a rousing speech that would make any constitutional scholar proud, for that very public transgression, Cruz was literally booed off the stage. At that very moment, Trump appeared in the wings, with his thumb jutted firmly into the air, in a signature gesture. Trump’s message was clear: “It’s all good. I’m bigger than this. I’m better than this. We’re better than this.” The no doubt contrived optics worked for Trump, as Cruz silently slunk from the stage. It was a very presidential moment—for Trump. Yet again, the career politician had been outmaneuvered by the political newcomer.

It was not Cruz at his most splendid. It did not make him look remotely presidential. To the contrary, it made him look small, petty, mean, jealous, and self-serving. It made him look entitled. Moments later, Cruz’s wife Heidi was hurriedly escorted out of the convention hall by security as angry delegates yelled the intended insult, “Goldman Sachs!” at her.

The Wall

Cruz’s evening went downhill from there. As he walked past, shocked, disappointed and furious Republicans averted their eyes. It was too soon. One gentleman had to be restrained. Cruz proceeded to the suite of Las Vegas casino magnate and GOP mega donor Sheldon Adelson, having previously been invited to do so. That invitation, however, was rescinded the moment Cruz refused to endorse Trump. Cruz was stopped at the door to the lavish suite, where he was denied entrance. Later, a senior aide to Adelson tweeted out a picture of Adelson and his wife posing with Trump, “their choice for President!”

Trump and his supporters were building their first wall—to keep Cruz out of the upcoming general election process.


Ted Cruz with RNC Texas Delegation - cruz+rnc+texas+delegation

This is personal.

Even so, mere hours after being booed from the convention stage, an astoundingly tone-deaf Cruz on Thursday morning told an angry group of Texas constituents that he refuses to be a “servile puppy dog” to the party’s nominee. Did I miss something? Trump gave the man a prime time speaking slot—and an opportunity to address the nation—despite the fact that he refused to endorse Trump. What about that indicates the servility of anyone, much less Cruz?

Cruz also admitted that despite his lofty speech the night before, steeped as it was in soaring constitutional rhetoric and concluding with a call for those listening to “vote their conscience,” his beef with Trump was, it turns out, quite personal. When some members of the Texas delegation voiced their displeasure with his actions, Cruz defiantly stated that his refusal to endorse Trump was “not about politics” but was, rather, “personal.”

It seems that Cruz was mad because of TTed Cruz Pointing Finger - ted-cruz-acuse-pointing-ap-640x480rump’s perceived attacks against Cruz’s wife Heidi and his father Rafael. With regard to Heidi, the Cruz campaign created an ad portraying Donald Trump’s wife, former supermodel Melania Trump, scantily clad and in a distinctly immodest pose—which it then plastered across the notoriously conservative and religious state of Utah just prior to the Utah primaries. The Trump campaign hit back with an unflattering photo of Heidi Cruz. With regard to Cruz’s father Rafael, the National Enquirer published a photo of what appeared to be the elder Cruz with Lee Harvey Oswald handing out pro-Castro pamphlets in New Orleans in 1963. The implication was that the elder Cruz was linked to the assassin of President John F. Kennedy. Though he was not responsible for its publication, Trump publicly referenced the National Enquirer photo.

That is it. Even so, facing his constituents Thursday morning, Cruz angrily pointed his finger and doubled down, declaring that “right and wrong matter.” Needless to say, Cruz’s morning-after righteous indignation fell as flat as his speech the night before.

After all, this was pretty surprising stuff coming from the guy who just publicly broke a formal pledge because, well, he got mad. And how could he have known, in taking the pledge so many months before, that he would become mad at Trump . . . because Trump hit back . . . when Cruz hit him first. Oh, that’s right: Cruz could have saved himself this dilemma by simply never taking the pledge. After all, that would have been the honest, upstanding thing to have done. And as we all now know, Ted Cruz is all about standing up for what it right. As it was, he did—take the pledge, that is. And he should have kept it.

Punch and Counterpunch

The back-and-forth between the Cruz and Trump camps is the classic political punch and counterpunch. It is the dirty underbelly of politics. It is the stuff of tough primary contests, where politics don’t differ all that much and distinctions must be drawn among individuals candidates as individuals. It is the part that makes good, decent Americans everywhere wince in discomfort and embarrassment that our politics should sink so low—on both sides of the aisle.

Were these among America’s proudest moments? No. Were they too personal for comfort? You bet. Were they surprisingly juvenile and mean-spirited for a presidential contest? Of course. Were they completely unexpected given the rough-and-tumble world of presidential politics? Of course not.

Most importantly, were the majority of the so-called “personal attacks” started by Ted Cruz? Yes, they were. Whatever you may think of Donald Trump, he was hitting back. That is very different from dealing the first blow.

Every playground bully knows this: Think twice about throwing the first punch if you can’t knock the other guy out. Whatever you do, don’t throw the first punch if you can’t take the counterpunch.

Cruzing to Obscurity

In the days since, things have not improved for Cruz. His favorability ratings have dropped precipitously. A recent CNN/ORC poll indicates that Cruz’s likability, at least among Republicans, dropped by 50 percent as a result of his actions at the RNC. Before the convention, two-thirds of Republicans viewed Cruz positively. After his RNC performance, that number dropped to one-third. That represents a precipitous decline, and is not what a 2020 presidential hopeful wants to see.

The ever astute Fox News contributor Charles Krauthammer put it best in observing that “what Cruz delivered was the longest suicide note in American political history.”

Cruz’s gamble—taking a solitary stand against Trump as the GOP nominee—appears, for the time being, to have backfired. While that is bad for Ted Cruz, it is probably a good thing for the rest of us.

As it turns out, taking dramatic stands based on principle rather than practicality for the purpose of serving his own needs is somewhat of a Cruz characteristic.

Green Eggs and HamTed Cruz - Senate Filibuster - Early Shot - 90

Cruz’s RNC performance was reminiscent of his much publicized 2013 quasi-filibuster in the United States Senate in protest of the Affordable Care Act, also known as Obamacare. For 21 hours, we watched Cruz talk. We watched him read bedtime stories to his young daughters, including Dr. Seuss’ Green Eggs and Ham. Cruz even provided two versions of his family’s recipe for the literature-inspired dish. All the while, Cruz kept talking, and talking, and talking. It was dramatic, yes. Perhaps even slightly touching—in an odd, uncomfortable, too-public way. It was silly, and pointless.Ted Cruz - Senate Filibuster - Late Shot - abc_pol_cruz_130925_ducks_wb

Ultimately, it was Ted Cruz grandstanding. Cruz was making a name for himself while strategically positioning himself as a “Washington outsider” ostensibly opposing “the Washington establishment”—the same Washington establishment of which he was unquestionably a part. Cruz was positioning himself to run for the presidency in an election cycle characterized by unprecedented voter mistrust of and anger at career politicians—career politicians like Cruz. As far as the Obamacare question, Cruz’s mission was doomed from the start. It would have no effect or consequence. It was, we now know, mere political theater. It was also typical Ted Cruz.

Ted Cruz - Standing at Door - Ted-Cruz-on-Deck-MSNBC-Cliff-OwenAP-640x480

Fall From Grace

The RNC marked what I predict will be the beginning of Ted Cruz’s stunning fall from political—and certainly the GOP’s—grace. Though it is still early, that fall promises to assume Shakespearean proportions—or at least I hope it does. Because at the RNC, Ted Cruz showed that he is not fit to lead—now or ever. Despots and Manchurian candidates from the right are every bit as frightening—and destructive—as those hailing from the left. So are those who feel personally entitled to hold political office. Regardless of party affiliation, a leader who is in it for himself is no leader; he’s a tyrant. So is a leader who is convinced of his own entitlement to lead. He, above all, is dangerous to the nation he feels entitled to dominate.

It may just be that we dodged a bullet in Ted Cruz. Time will tell.

Out-Politicking the Politician

It is ironic that in the contest between a businessman with no political experience and a career politician, it turns out that the career politician is the one who can’t take the heat in the boiling kitchen of a messy and overcrowded primary contest. Go figure. One would almost think that Trump—as the founder, owner, and main force behind one of the largest real estate development companies in the country, if not the world—has himself battled a storm or two. Go figure. But I digress.

Someone should send Ted Cruz a memo. This is not about Heidi or Rafael Cruz. It is not about Melania Trump. It is not about Ted Cruz or even Donald Trump. This is no longer even about politics. This is about the future of our country. This is about stopping the bleeding of the last eight years. This is about stopping a train headed full-bore toward our self-destruction. This is about saving us from the suicide that we are in the process of committing. This is about saving us from the dire predictions of none other than Thomas Jefferson and Alexis de Toqueville. This is about saving our own lives.

Just as we conservatives will reject the Clinton/Obama 3.0 ticket this fall, so also should Texas voters reject Ted Cruz when he comes up for re-election in 2018.

Cruz needs to go. Let’s face it: He’s just no good at the politics of politics.

Please let me know your thoughts.