Monday, August 22, 2016


Another factor that is making the ACA an economic failure is the hospital providers who have figured out how to game the system.

To begin they have attempted to create monopolies by aggressive absorption of other institutions into their own system,

An example is RWJBarnabas Health: the most comprehensive health care delivery system in New Jersey, The system includes eleven acute care hospitals –three acute care children’s hospitals and a leading pediatric rehabilitation hospital (Children’s Specialized Hospital), plus a freestanding 100-bed behavioral health center, ambulatory care centers, geriatric centers, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy

Nearby is the smaller Atlantic Health Systems that includes among others Overlook, and Morristown Hospitals.

All these hospitals maintain in hospital medical staffs or affiliated groups including physicians based in local offices but who have a guaranteed income from the parent system who do the billing including the coding.

The doctor’s office has become an outpatient facility of the hospital and a visit to the doctor includes a charge for using an outpatient facility, something that traditionally was included in the office visit charge but is now additional.

The system also includes a mandatory use laboratory for its affiliated practices.

Once again the government bureaucracy has made the private practice complicated and costly which has had the impetus for doctors to become affiliated with a hospital system group.

I will not go into the mandatory Electronic Records with costly systems to install and templates to fill out by check marks. The systems may not talk to another physician’s office and in some cases to the hospital’s compute

The extra office personnel needed to comply has increased the doctor’s operating cost which has to recoup in the bill for services. Since not only Medicare and Medicaid reimbursement is low balled as well as that of the insurance carriers who form networks of providers who will accept the lowest possible fees.

Physicians who will not accept the Insurance Carries fee scheduled are frozen out by the use of restricted networks.

All this has changed American health care so that almost 60% of physicians are on salary from a hospital or its affiliated networks. That alone has increased the cost of care.

Today’s health care is not patient friendly. Besides the fact that the doctor is too often spending his allotted five minutes entering data into his computer but the patient’s exam and care is done by a NP or PA. This of course impacts on quality no matter how experienced that individual

There are other stupid regulations that impact on the patient’s ease of care; such as the Medicare one that only one office procedure at a visit will be paid. Two examples; if one has an office visit with an Orthopedist one cannot have PT the same day at that office. Or, as happened to me, I had an ingrown toe nail treated by my podiatrist but although I was scheduled to have my nails could not have my nails cut within a weeks’ time had to comeback because Medicare would not pay for both procedures the same visit.

It is an unforeseen effect of the ACA that has made the one on one relationship between patient and doctor a lost art which was a major factor in having good health results.


Among the many reasons that Obama Care should and will fail is it is basically fiscal unstable. Universal health insurance/ care has to deliver care at a cost which reimburses all providers or participants fairly.

Among the villains are the Insurance carriers who believed that they had a golden cow since the government was backing their policies. Many carriers low balled their initial premiums and can no longer afford to provide insurance at that rate.

Disregarding a “what the traffic could bear” reimbursement a fee schedule based on available funds will result in providers opting out of the system. The alternative is strictly limiting services provided, or denying costly procedures. That is rationing!

Federal control means bureaucracy with multiple regulations which increase the cost of service for providers be they physicians or facilities such as hospitals or long term care, or outpatient clinics and ERs.

The Exchanges with a no one can be denied insurance have resulted in major insurances dropping out of the market because of loss. This has been due to the fact that there has been an influx of people with chronic diseases that had not been able to receive insurance. There has also been many who were independently insured to the cheaper Exchange policies.

The government has subsided the carriers in the exchanges to make up for some of the expected loss for the first few years but that subsidy is being discontinued.

Since such subside has to be paid by the government it can done either by increasing tax income, or by the politician's  favorite, increasing the debt to a point that would result in defaulting on bonds.

In their rush to tap into this goldmine many of the carriers grossly underestimated the risks. Now they are attempting to compensate by either dropping out of the exchange insurance or raising the premiums by double digits of anywhere from 15 to 43 percent.

The theory was that all uninsured would now get insurance. However to day there still are about 26 million not insured. Many are the young age group who were supposed to balance the carriers cost by not using resources. They have opt to not be insured despite the so called penalties as being less expensive. They will take their chances of not having a catastrophic medical crisis.

The other factor affecting the carriers balance is that there was a large increase of heavy service users who had private insurance are buying the cheaper Exchange insurances.

Others who no longer have a major health problem drop their insurance ASAP.

Insurance companies usually charge different premiums depending on risk including such factors as sex, occupation, income level and age. Under the ACA the only variable can be age, and that is a restricted one.

In many locations instead of competition for the Exchange customers there is only one carrier and the premiums reflect that monopoly.

Saturday, August 20, 2016


For those  who can remember the past 50 years, how things have changed,
1966: Long hair
2016: Longing for hair 

1966: KEG
2016: EKG 

1966: Acid rock
2016: Acid reflux 

1966: Moving to California because it's cool
2016: Moving to Arizona because it's warm 

1966: Trying to look like Marlon Brando or Liz Taylor
2016: Trying NOT to look like Marlon Brando or Liz Taylor 

1966: Seeds and stems
2016: Roughage 

1966: Hoping for a BMW
2016: Hoping for a BM 

1966: Going to a new, hip joint
2016: Receiving a new hip joint 

1966: Rolling Stones
2016: Kidney Stones 

1966: Screw the system
2016: Upgrade the system 

1966: Disco
2016: Costco 

1966: Parents begging you to get your hair cut
2016: Children begging you to get their heads shaved

1966: Passing the drivers' test
2016: Passing the vision test 

1966: Whatever 
2016: Depends