In The Republic, Plato writes about the “Noble Lie”: “It is the business of the rulers of the city to tell lies, deceiving both its enemies and its own citizens for the benefit of the city.”
Bob Woodward, on the Nov 18 Chris Wallace Show, commented that Obama was trying to do something good—providing insurance for 30 million uninsured. Woodward seemed to be forgiving a “Noble Lie,” thought Stanley Feld, M.D.—the only problem being its disastrous implementation.
Plato’s justification was that the Philosopher King knows that the people are too ignorant to see the truth about their city’s problems and how to fix them. It is only through a lie that he can get them to cooperate with his agenda.
Feld cites Arthur Herman’s book The Cave and the Light: Plato Versus Aristotle, and the Struggle for the Soul of Western Civilization: “Thomas Jefferson once confessed to John Adams that he had been rereading Plato’s Republic” and “laid it down often to ask myself how it could have been that the world should have so long consented to give reputation to such nonsense as this,” including the notion of the Noble Lie.
Good Intentions: “President Obama fooled many people with his intentions, including me,” writes Feld on his “Repairing the Healthcare System” blog (Nov 3). “I think President Obama wants the healthcare system to fail. He wants to prove that the free market cannot succeed.” In fact, the dysfunction in the not-so-free system is “the result of all the stakeholders trying to adjust to ever changing government regulations during the last 48 years.” Obama ignores this, and ObamaCare just makes it worse.
Easily Fixed Computer “Glitches”: The White House issued a non-bid contract for $634 million to CGI Federal, whose software had already failed in three Canadian provinces (Feld, Nov 7). Its senior vice president Toni Townes-Whitley is Michelle Obama’s Princeton classmate (Feld, Oct 28).
One reason for designing the site to demand an extraordinary amount of personal information before allowing access to prices was the Administration’s desire that people see only the subsidized price (Grace-Marie Turner, Forbes 10/14 /13).
Between 30% and 40%—or possibly 60% to 70%—of the Exchange software has yet to be built, according to CMS deputy chief information officer Henry Chao. That includes the payment system (Avik Roy, Forbes 11/19/13). And you are not enrolled until the insurer has been paid. Possibly, there are zero enrollees.
Though the Administration insisted that reports of problems were the work of “partisan saboteurs,” CMS was well aware that a year of testing (not 5 days) was needed (Forbes 10/24/13).
“You Can Keep Your Health Plan”: In 1965, nearly half of seniors had private medical insurance (http://jpands.org/vol8no1/annis.pdf). It was illegal to cancel any person’s policy; however, it was fine to cancel all the policies, and that is what Lyndon Johnson bullied insurers into doing, to assure the success of “his” wonderful, “popular” program. Déjà vu all over again: whole books of insurance are being cancelled, leaving some subscribers marooned in the middle of a course of cancer therapy.
Obama’s obviously scripted, oft-repeated assurance was “more than a garden variety lie. It perfectly encapsulated the progressive method of civilizational betrayal,” writes Daren Jonescu (American Thinker 11/26/13). The chaos of people losing the plans they relied on was predictable, and intended. Obama’s “non-fix fix” will only accelerate it. The insurance industry cannot, in 4 weeks, reactivate policies that were purged from the system because they were (and are) illegal under HHS rules (Feld, Nov 18; Forbes 11/15/13).
Obama officials knew, in 2010, that 93 million Americans would be unable to keep their plans (Forbes 10/31/13). In Newspeak, the cancellations mean “transitioning people into better plans,” writes Bob Barr (Townhall.com 11/6/13).
No New Middle-Class Taxes: Only about 30% of the $1 trillion in new taxes imposed by the Affordable Care Act (ACA) by 2022 are specifically targeted to the “rich” (Chris Conover, Forbes 10/21/13). ACA will cost the average taxpayer as much as $6,000 by next year. The Administration has already given the IRS an extra $500 million to enforce the rules and regulations of Obamacare.
“It’s the Law”: ObamaCare “is not actually a law. It’s the name of a law. By invoking this name, Obama does anything he likes. He just calls a press conference, and ‘presto’ the law is changed” (Art Robinson, Access to Energy, November 2013).
Overloading Medicaid: the Cloward & Piven Strategy
Overwhelmingly, people enrolling through state exchanges are being signed up for Medicaid (CBS News 10/25/13). Those who are eligible have no choice, even if they want to buy their own insurance (WSJ 11/20/13).
Taught to political science students at Columbia University in the 1980s, when Obama was said to be a student there, the strategy devised by former professors Cloward and Piven was to destroy America from within by overwhelming the system with debt, welfare, and entitlements (Wayne Allyn Root, Human Events 4/14/13).
What happens in the ensuing chaos? Falsehood always brings violence in its wake, Aleksandr Solzhenitsyn tells us.
Currency Debasement and Health
The Rome of 100 A.D. had better paved streets, sewage disposal, water supplies, and fire protection than the capitals of civilized Europe in 1800 A.D., writes Richard Maybury (Early Warning Report, November/December 2013). Then Rome began debasing the denarius to pay for welfare and war. The western empire devolved, and living standards regressed by 10 centuries. While destruction of the currency and hence of reliable price signals was not the only cause of the Dark Ages, it was so serious that our Founding Fathers created the Coinage Act of 1782. The very first death penalty enacted by the U.S. was for debasing the dollar.
Had it not been for the destruction of industry and civilization in the western Roman empire, medicine might be several centuries ahead of where it is now, Maybury suggests.
He believes that our rate of decline is faster than Rome’s, and violent upheaval is likely. (See chart of U.S. monetary base, from the Federal Reserve Bank of St. Louis at http://www.chaostan.com.)
R. Lowell Campbell, M.D.: R.I.P.
Former president of AAPS and its long-time treasurer, Dr. R. Lowell Campbell died at age 87 on Oct 19. He practiced general medicine from 1954-2002 and served in the U.S. Air Force Reserve from 1983-1991. For 41 years he was a delegate to the Texas Medical Association, where he was known as the “conscience of the House” for his unwavering principles.
ACTION OF THE MONTH
Take our survey at http://www.aapsonline.org/obamacaresurvey.
We will share with media and Congress.
Beware of entering private data in ObamaCare sites.
ACA: an Insurance Company Bailout?
ACA could never have passed without the health insurance lobby’s support of the individual mandate—“a guarantee of perpetual business on the government dole,” but it’s not an unmixed benefit, writes Larry Bell in “Insurers Who Slept in the White House Must Now Make Their Own Beds” (Forbes 11/19/13).
Ten giant insurers got HHS waivers allowing them to cap benefits to their own employees. AARP, which spent $212 million on an advertising campaign to pass ACA, got an HHS waiver from oversight rules on “Medigap” policies, and its biggest competitor, Medicare Advantage plans, took a $313 billion hit.
Those pesky “medical loss ratio” (MLR) rules require insurers to spend 80% of premium dollars on direct medical expenditures, or refund subscribers’ money. The industry, however, defines “direct medical care” to include many typical business expenses plus an added-on profit. “This is the way the…industry takes 40-60% of each premium off the top” (Feld, Oct 24).
The “tax credits” to people who don’t owe taxes, Feld writes, are really subsidies, which constitute tax-free income to insurers. But since the subsidies are affected by sequestration, they may not cover increased costs (Scott Gottlieb, Forbes 10/21/13).
In addition to problems on the “front end” of HealthCare.gov, where people shop for policies, are “back end” problems, where insurers are supposed to process applications.
“Like the Bush Administration in Iraq, the White House seems to have invaded the health insurance marketplace with woefully inadequate postinvasion planning, and let the occupation turn into a disaster of hack work and incompetence,” writes Ross Douthat (NYT 10/19/13). Communication with payers via “form 834” is not functioning properly, and insurers may need to process applications on paper (Modern Healthcare 10/22/13).
The White House is blaming the insurance industry for problems, such as cancellation of policies that don’t meet HHS rules, and pressuring insurers to keep silent (Bell, op. cit.).
But insurers have an ace in the hole: the risk corridors in § 1342 of ACA: a taxpayer bailout of health insurers, no action by Congress needed (Marco Rubio, WSJ 11/19/13).
People who erroneously think they have coverage, when they really don’t, may face IRS penalties as well as doctor bills they thought the insurer would pay. Of course, physicians may be working without pay for patients who are delinquent on their premiums, or who can’t afford the high deductibles and copayments on top of hefty premiums.
As with all Faustian bargains, there will eventually be hell to pay. It is possible that, along with physicians, patients, and taxpayers, responsible special interests and politicians will share the pain.
Jan 31-Feb 1, 2014. Workshop, board meeting, Louisville.
May 9-10, 2014. Workshop, board meeting, Minneapolis/St. Paul.
Sept. 2-6, 2014. 71st annual meeting, Charleston, SC.
High Crimes and Misdemeanors
The concept of “high crimes and misdemeanors” originated in England in the 1300s, observes Joseph M. Scherzer, M.D., of Scottsdale, Ariz., and was adopted by our Founding Fathers. Officials were accused of offenses as varied as misappropriating government funds, appointing unfit subordinates, not prosecuting cases, not spending money allocated by Parliament, promoting themselves ahead of more deserving candidates, threatening a grand jury, disobeying an order from Parliament, arresting a man to keep him from running for Parliament, losing a ship by neglecting to moor it, helping “suppress petitions to the King to call a Parliament,” granting warrants without cause, and bribery.
What would happen to a CEO in the private sector who promised people that they could keep their current plans under his proposal—which he knew was designed to destroy those plans, asks Andrew C. McCarthy, senior fellow at the National Review Institute. He believes that Obama is guilty of serial fraud that is orders of magnitude more serious than offenses that his Dept. of Justice routinely prosecutes, and that are punished by decades in prison (NRO 11/9/13).
Even as Obama was repeating his promise, based on the “grandfathering” provision, his Dept. of Justice was telling a federal court that a “majority of group health plans” would likely have lost their grandfathered status by the end of 2013. That affects close to all consumers, not the mere “5%” in the individual market that Obama referred to in his apology. (The individual market actually insures 8% or 25 million, about the same number who lack insurance owing to poverty or pre-existing conditions, a key argument for nationalizing one-sixth of the economy.)
McCarthy also notes that HealthCare.gov runs afoul of numerous consumer protection laws.
Offenses do not need to be indictable to be a basis of impeachment for high crimes and misdemeanors.
“No Reasonable Expectation of Privacy”
Source code on the ObamaCare exchange website, which is hidden from the user, reads: “You have no reasonable expectation of privacy regarding any communication or data transmitting or stored on this information system.”
In an Oct 24 hearing before the House Energy and Commerce Committee, Rep. Henry Barton (R-Tex.) asked Cheryl Campbell of CGI Federal about this code. She acknowledged that the contractor was aware of it, but declined to answer whether she thought it violated the HIPAA Privacy Rule. CGI was just following CMS orders, she said. Nor could she name the person responsible for making the call (CNSNews.com). Summaries of E&C hearings are on the AAPS website; this one is here: http://bit.ly/1eNEp4j.
Henry Chao told the House Oversight Committee that he allowed the website launch to go forward, believing that there “were no high findings of security issues.” He said that he never saw a key security report that stated: “The threat and risk potential is limitless” from a redacted security issue, and that “non-compliance with…CMS Minimum Security Requirements (CMSR) without continuous monitoring presents an unacceptable risk.”
“It’s astounding that Marilyn Tavenner—who promised in Congressional testimony that ‘we will have the highest degree of security and privacy protection’—would sign off on a website that is vulnerable to identity theft and hacking. But that appears to be what she did,” writes Avik Roy (Forbes 11/12/13).
Tip of the Month: The top five signs of a phony patient and a possible entrapment in order to prosecute a physician: (1) Dialog that would sound improper if recorded, such as a patient claiming he gives his medication to his girlfriend for sex. (2) Requests to meet the physician outside the office. (3) Attempts to pay the physician by handing him cash directly, rather than through the receptionist. (4) Showing up for an office visit with a “friend.” (5) A canned story by the patient about why he has no medical records (and no referral by another familiar physician).
More Reasons to Opt Out
Many physicians are reluctant to cut the cord to third-party payments, fearing that patients will not pay them. Increasingly, there is concern that third parties will not pay either.
If patients game the system by paying their premiums intermittently, physicians may find themselves working without pay during the “grace period.”
Patients who are covered may have much higher deductibles and copayments than they are accustomed to, and it may be difficult to extract payment, especially as they are burdened by much higher insurance premiums. Under Cover Oregon, for example, families with income between 200% and 399% of poverty will have out-of-pocket spending maximums between $8,500 and $12,700, writes Greg Scandlen.
“The ACA is…expected to cause a ‘seismic shift’ in [high-deductible health plan] enrollment,” write J. Frank Wharam, et al., of Harvard (NEJM 10/17/13). These authors “express none of the hysteria that went along with the roll-out of [heath savings accounts], even though HSA deductibles were quite modest compared to ObamaCare deductibles,” Scandlen writes. And there are no HSAs. “ObamaCare just throws people in the deep end of the pool without any support. It is cruel and mean-spirited.”
Physicians are also expected to take on huge additional expenses: in addition to ObamaCare, there is ICD-10 coding. All HIPAA-covered entities are required to convert by Oct 1, 2014. Expert coders in one study came up with the correct code only two-thirds of the time; imprecise medical documentation was blamed. The cost of conversion for a small practice (3 physicians, 2 staff) was estimated to be $83,000, including $19,500 in cash-flow disruption and $44,000 in increased documentation. All payers are expected to require the new codes, even for paper claims; non-compliant claims will not be processed.
CMS did not finalize 2014 Medicare payment rates until Nov 27, and has extended the deadline for making a decision on participation to Dec 31. Nonparticipants can opt out at any time. CMS also no longer requires non-enrolled physicians to obtain an NPI in order to opt out (CMS Transmittal 160), although non-enrolled physicians might prefer not to change that status.
No, You Can’t Keep Your Doctor. Insurance companies have initiated a “disenrollment program” to terminate doctors who treat patients who are sicker than average (and thus cost the insurer more money) from Medicare Advantage networks. They are also apparently terminating physicians who treat only a small number of Medicare patients. Sam Unterricht, M.D., president of the Medical Society of the State of New York, writes: “We suspect that this also represents economic credentialing of physicians whereby insurers want to shift care to large groups where they can control cost and data (MSSNY eNews 10/25/13).
Some patients are being told that they can no longer see their doctor even before the doctor is told that he is being terminated. One nursing home physician will either have retire or see his patients free of charge. Continuity of care doesn’t matter.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
“Unacceptable.” Obama’s signature statement, as for the “fumbled” ObamaCare rollout, seems to be: “This is unacceptable, and we will get to the bottom of this.” He also used it for the Benghazi, NSA, IRS, and Fast and Furious scandals. There is never any follow-up. The public never learns who was responsible for the debacle. No one ever gets fired, and the traditional media carries on. The public soon forgets about the nonresolved scandal.
Stanley Feld, M.D., Dallas, TX
Successful Enrollments. So far, the score is: ObamaCare 36,000; one-way trip to Mars 202,586, according to Millward Brown Digital and Mars One Foundation.
William K. Summers, M.D., Albuquerque, NM
Workaround. It was reported that with 5 million lines of new code, the ObamaCare website might function. Obama announced that all you have to do is install 35 floppy disks on your computer and you can bypass the system.
Dave Janda, M.D., Ann Arbor, MI
The Goal. ObamaCare has already wrecked the individual insurance market with guaranteed issue and community rating. We know that the Democrats are pushing for single payer. ObamaCare is taking the Switzerland route. Contrary to currently received wisdom, the Swiss system doesn’t work well unless one likes doctor unions, strikes, poor resource allocation, denying care to the elderly, and shortages. Eliminating private medicine is next on the leftist equality-over-all agenda.
Linda Gorman, Ph.D., Independent Institute, Golden, CO
We Must Act. The whole recent trend in government is disinformation directed at those who should know better but refuse to stand for what is right. We need to take widespread action against tyranny. My ten-year-old understands this when she asks, “Do people really think they get anything free?” We need to quit the system : Opt out, decline insurance completely, serve your patients alone, do not submit to EHR private data theft. Refuse to do MOC, OCC, or any other letter combination that costs time and money to prove nothing except how to fund more bureaucratic nonsense and pay ridiculous salaries to those who keep you from doing what you are uniquely educated to do. Yes, I did that in 2009. It cost money, but now I sleep well.
Charles Smutny III, D.O., Centerport, NY
How Much Is Covered? According to a notice from Univera Healthcare of Buffalo, N.Y., it will not pay the 80% of an 80%/20% Gold plan in each instance; this is the average for all policyholders. The consumer will never know the amount that will be paid; he might be responsible for 30%, 40%, or any amount.
Stephen Welk, M.D., Holland, NY
Can-Do Americans Fix Problem. Working evenings and week-ends, three 20-year-old programmers built http://HealthSherpa.com. By inputting ZIP code, age, and smoking status, a user can find all the health plans available in his location, and contact information for the insurer so he can enroll. The government “got it completely backwards in terms of what people want up front,” said Ning Liang. “They want prices and benefits.” There was no thought of making money this time: the men saw it as a problem they could easily solve.
Jim Vanne, Aurora, IL
Is AMA Changing on ObamaCare? Austin Hill writes that the AMA may be changing its support for ObamaCare because of confusion (Townhall.com 9/29/13). No, they are posturing to preserve membership—as in the “show” votes by RINOs to appeal to their conservative constituencies. They talk about the “big tent” and let the vipers into the tent hoping they’ll be the last to be bitten.
John Dale Dunn, M.D., J.D., Brownwood, TX
The Uninsured. The biggest failure of ObamaCare will occur in the next 6 to 9 months. We’ll discover that the number of uninsured has doubled just in time for the 2014 elections. And we will have destroyed the infrastructure that worked well for 86%.
Greg Scandlen, Consumers for Health Care Choices