Category Archives: Healthcare

New York City Has a Fiscal Crisis…Right Now!


We often hear about out of control unfunded pension liabilities, but NYC government employee’s health insurance is also a ticking time bomb.

The Citizens Budget Committee estimates the current and future retirees now have an unfunded health insurance liability of $95 billion.  And, this figure will grow at an unprecedented rate per year, generating an unfunded liability of $175 billion in ten years.

Let’s put that in perspective.  This year’s total budget is estimated at $87 billion, so unfunded health care alone in ten years will be equal to 200% of this year’s total city budget.

And, we can add the pension liability of an estimated $100 billion, and you have unfunded pension and health insurance liabilities that in ten years will be more than three times this year’s total budget.  This will require a budget in 2027 of equal to 400% of our current budget to fully fund these liabilities.

New York City provides its employees the most generous pension and health plans than any other major city in the United States.

Mayor de Blasio doesn’t seem to be worried.  He is campaigning with Bernie Sanders later today.  Perhaps he believes Bernie’s “Medicare for All” will become law and bail out the city….but who will pay the bill?  We think you know who will be stuck with the tab.

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Filed under Governance of the Government, Healthcare, New York City

ACA-Obamacare Review

The ACA (Obamacare) was designed to provide health insurance to many of the estimated 40 to 60 million uninsured Americans. Has it succeeded? At the risk of sounding like a politician instead of a health care provider, the answer is “yes and no”.

Yes, many previously uninsured Americans now have insurance.   But the offering has fallen far short of expectations of enrollment and more importantly in the benefits it provides.

For the lower income Americans, they can now access an affordable health insurance plan. They can then receive a physical examination as a determination of their current health status along with recommendations to get or stay healthy. The issue is the plans. The deductibles are so high, most insured’s cannot afford ongoing treatment.

Often the deductibles range from $2,000 to $5000 per year. Rarely does a patient incur those levels of charges to satisfy the deductible. Therefore, after their physical, they basically do not have any health insurance unless they suffer a catastrophic event such as hospitalization.   We believe this type of high limit deductible coverage is still important to financially safeguard the patients against those significant health events. Many others believe ongoing routine health care is simply out of reach.

The New York Times covered this important disparity in detail. You can read their excellent analysis and in depth reporting at New York Times

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Filed under Governance of the Government, Healthcare

The Challenges facing Obama Care Increase!

Many of us breathed a sigh of relief with last week’s Supreme Court decision.  The consensus opinion was the challenges were over and we can now smooth out the edges of the ACA and enjoy the benefits of health care for all.  In a word….Hardly!

The universal plan was needed, but designed by committee in order to get it passed.  And yes, we need Congress to clean up the rough edges, but there are more extraordinary issues that will be apparent soon enough that will call for more dramatic action.  For example:

  • The individual deductibles are at draconian levels.  Often $2500, $5000 or even $10,000 per year.  The good news have health insurance and it will be affordable.   The bad news is in the absence of a serious illness or hospitalization; it won’t be of much use.  We need to get the deductibles down and that will cost money, lots of money;
  • The outrage of employers has not yet been felt. It will be and it will be loud.  An employers requirement to provide coverage will undoubtedly be paid for by deferring employee raises, or new hiring and probably both;
  • The hidden federal cost covering insurance company losses will come home to roost.  This first payment is $7.9 billion that Uncle Sam will reimburse insurance companies for their losses when underwriting the ACA.  There is much more to come;
  • Finally, insurers are already announcing some enormous rate increases that recognize their losses and the fact that government back reimbursements are not forever.

So what needs to happen?  First Congress must act to smooth out the inconsistencies and make structural changes so implementation can work smoother, better, cheaper.  Secondly, government must understand that cost savings or cost containment, whatever they want to call it does not mean simple ratcheting down the providers reimbursement rate.  They are already embarrassingly low and more and more providers are refusing to accept Medicare and the networks for the ACA are tiny and difficult to access.  And finally, allow the free market to react and innovate some workable affordable solutions for high deductibles, affordable plan changes, etc.


Our conclusion is there will be more pain before we have a viable and affordable structure for all of America.

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Filed under Healthcare, Politics

Congressional Dysfunction Threatens Seniors Health Care…..Yet Again

Most seniors have never heard of the acronym SGR that in healthcare parlance means Sustainable Growth Rate.

The wisdom of congress passed this particular piece of legislation in 1997.  Its purpose was to control the cost of Medicare through a complex formula that controlled escalating costs.

The problem is simple; it doesn’t work and has really never worked.  Congress however, has never been able to come to grips with it and continues to pass “kick the can down the road” legislation rather than fixing it.  In 2010 alone, the proverbial can was kicked five times.

We now find ourselves staring down the barrel of a gun once again.  If congress doesn’t act by the end of March, Medicare reimbursements to doctors will be cut by 21%.

What does this mean?  Docs won’t be happy, in fact they have about had it with Medicare as evidenced by a growing group of them who will no longer accept Medicare.

A colleague of ours voiced his thoughts recently.  It went something like this….”I began to accept Medicare even though I felt their reimbursement rate was low and didn’t properly compensate me for my time and expenses.  However, they paid promptly and didn’t harass me with a million questions about why I used one treatment versus another” He has since changed his mind.  His comments now complain that reimbursement, which was never fair, has been reduced.  He now receives letters from Medicare questioning his judgment, and he is facing not just another cut, but a long delay in receiving anything.  He has had it and will not longer accept Medicare patients.

If congress fails to act (again) by March 31st, doctor’s treating Medicare patients will face a 21% reduction in their reimbursement rate.  Could you afford a 21% pay cut.

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Filed under Governance of the Government, Healthcare, Politics

Is the ACA (Obamacare) working….yes, a little.

This blog has previously indicated the ACA will not solve the decades old problem of the 30 to 50 million uninsured Americans…and I maintain that position. However, it has made some inroads and offers a glimmer of hope.

Data is still extremely elusive with this White House and we generally get the cherry picked good news pieces rather than the full Monty. These selective data releases would indicate a modest inroad into the uninsured base of perhaps 15%…that’s a start. My question is at what cost? And no, I’m not talking money.

If there is any such person as a typical uninsured, he or she would probably be a low income individual who has a low paying or part time job which doesn’t offer insurance. This class will also include the previously employed, but now displaced workers. This allows them to enroll in an ACA plan and perhaps receive a substantial subsidy from the government to reduce the premium. Stories abound with monthly premiums of $100 or so per month for “full coverage”. The problem is defining “full coverage” or any coverage at all.

A look at a community I’m familiar with has approximately 250 doctors. I can only identify 8-10 primary care docs in this population who accept the predominate ACA plan in our area. The specialist community is even more restrictive, with no availability at all for some specialties and very little for others.

If we couple this extremely small network of physicians accepting the most prevalent plans, and the plans deductibles ranging from $500 to $7500 we have a problem….people with insurance coverage but none or few available doctors to treat them and deductibles that are not affordable, posing another roadblock to health care for them.

We need ACA amended, to make it more responsive to patients, insurance companies to be more responsible when dealing with physicians and more companies offering plans to foster competition. These changes will help reduce the vast number of uninsured Americans, a very noble and worthwhile undertaking, but will also give rise to a new issue…yet another tier of patient care…but that’s for another day.

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Filed under Healthcare, Politics

No Solutions for Uninsured Americans

We have predicted before that the ACA will not solve the problem of the 40 to 60 uninsured American’s.  In fact, it doesn’t even begin to address the problem.

It appears we have 6.0 million to 7.0 million now enrolled in ACA.  Many of these (a number unknown because no one seems to want to tell us) were already covered in a plan that was canceled, or were on Medicaid, etc.  Only a small portion of these insureds were uninsured before their enrollment.

Check out this blog:

This blogger is one of the better informed on the subject.


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Filed under Healthcare, Politics

One of Your Most Dangerous Medical Risks Will Surprise You

We believe a visit to the hospital can be loosely interpreted as one of those to avoid.  We give full credit and recognize the important contribution our local hospitals provide, but simply stated, no matter what hospital in the country you may have to visit, they can be a threat.  The threat takes many forms, the simplest being bacteria and disease that exists within the hospitals walls, beds, operating and treatment rooms.  The threat continues when considering the possibility of the wrong or conflicting medications or dosage being administered, and at the extreme, would include a surgeon operating on the wrong person or body part. Just how threatening can a visit to the hospital really be… can be downright frightening.  Here are some facts.

1.   Each year it is estimated as many as 100,000 Americans die in hospitals from preventable medical mistakes;

2.  An estimated 86% of medical mistakes are not reported;

3.  HHS Study reveals one in seven Medicare patients suffered serious or long-term injuries or died as a result of hospital care, and 44% of these problems were preventable.

These are staggering statistics, but there are positive steps being taken.  And, while these are national averages, we know many local hospitals perform at a very high level of safety thus do not incur these types of percentages.  Medical Checklists are becoming commonplace and remove or reduce many surgical risks.  Patient safety advocates have been able to increase awareness and eliminate risks.

Another and perhaps the most important method of avoidance of hospital risks is “Wellness”.  That’s right, simply stated, stay well and stay out of the hospital.

Emphasizes wellness with such basics as an extensive annual physical exam and a flu shot, to reviewing your proclivity for disease from your heredity and then taking appropriate steps to avoid illness or disease and thus remove the risk from hospitalization.

“Practice” wellness and you will not need to treat illness.


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ACA Can Be Very “Painful”

The issue of replacing health insurance coverage that many liked and used with an ACA “acceptable” plan continues to be painful for many. They often lose doctors they have used for years, and the new plan often becomes more costly. See this excellent article in the New York

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Affordable Care Act… the Real Problem


We have estimated 40 to 60 million uninsured Americans for the last several decades.  The last available estimate in 2012 was 47.0 million.  It is commonly believed this group has not received routine health care, and has swarmed hospital emergency rooms and overwhelmed the system with acute health care needs.  This is all true… to a very small degree, and most importantly this main objective of the ACA remains unresolved.


The numbers coming in for the ACA enrollment clearly reflect a shift of previously insured parties to new insurance plans in the ACA.  This shift does nothing to resolve the uninsured problem; and won’t in the near or far term unless the plan is dramatically altered.


The almost accidental positives of ACA include no limit health care, removing pre-existing conditions, offering guaranteed issue to all, and extending coverage for aging dependent children.  The guaranteed issue comes with the cost of the myriad of extremely confusing state and federal plans.  There were far easier ways of accomplishing these offerings, none of which were used because of the administrations unilateral approach to the legislation.


The vast majority of participants in the new plans come from previous individual policy insured’s who were forced to change because their policy was canceled; or from Medicaid eligible individuals.  It is now clear the previous multi-millions of uninsured have not flocked to the new plans and probably will not do so.  Yes, the 47 million uninsured will be reduced, but probably only by a small percentage.  We will be left with some 30+ million uninsured and a revised health care financing system that will take years to sort out and modify in order to get it to run smoothly.


And, one of the dirty little truths is this large and hardly changed uninsured group will continue to visit ER’s but for an entirely different reason than once believed.


If you are sick and need to see a doctor and you don’t have a primary care physician, I would challenge you to A)  Fine one, and more importantly B) Find one that will see you right now to treat your acute medical issue, not in four or six weeks.  Studies are reflecting the fact that sick people seek medical care in the ER because they cannot see a doctor without waiting days or often times weeks…far too long for someone who is sick and hurting.

And, Medicaid is simply not the answer.  In fact, the Annals of Emergency Medicine published a survey that reflects this startling fact…61% of Medicaid patients visited the ER in the previous year.


Even those Medicaid patients who have primary care physicians — and that is less likely than for people with private insurance — report significant barriers to seeing their doctor.” senior study author Dr. Adit Ginde, of the University of Colorado School of Medicine, said in a journal news release.


“Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall,” Ginde added. “But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all.”


“The efforts by some states to keep Medicaid patients out of the ER do not take this lack of access to primary care into account,” Dr. David Seaberg, president of the American College of Emergency Physicians, said in the news release. “It puts both patients and providers into an impossible position that will only get worse as more people enroll in Medicaid.”


The real problem with healthcare in the U.S. is a drastic lack of primary care health providers and the ACA does absolutely nothing to help resolve this issue.  Further, it does almost nothing to reduce costs in this fee for service industry.


We can offer many suggestions on how the ACA should have been structured, but that won’t be constructive.  But, here are a few suggestions for reforming the ACA and making it more viable:


  • Immediately launch new educational programs outside the purview of the AMA for educating and training new primary care physicians.  Federally fund it by expanding the National Health Service Corps program to include urban areas.
  • Pass federal legislation empowering Physician Assistants and Nurse Practitioners to provide the basic functions of the primary care physician unfettered from the overly protective AMA guidelines and various state legislatures.  This will free up many primary care doctors to handle the more complex levels of treatment needed.
  • Federalize Medicaid and simply make it a part of Medicare…which would remove the hurdles to care and the stigma of being poor or unemployed.
  • Fund the Medicare system so healthcare providers at all levels will accept it and earn a well-deserved living for their many years of education and training they have invested;
  • Accomplish what has been threatened by every Congress since LBJ. REALLY get rid of fraud and waste without the accompanying silliness that drives providers crazy, wastes their time and doesn’t reduce costs or improve the system.
  • And yes, pass tort reform to protect both the patient and the system;


The problem of reform is extremely difficult if not impossible in the current political environment.  The unilateral approach to passing the initial legislation has led to the most cantankerous atmosphere not seen before in politics.  There is virtually no hope of cleaning up the ACA at the moment.  Perhaps our “best shot” is a one party takeover of the congress and their best effort to “save” health care by making some the much needed and obvious changes.   I honestly believe if either party had complete power, they would make the necessary changes, but the current split will simply not allow it.


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Musings of a Politically Independent Healthcare Consultant

Welcome to my Blog.

I created this blog to offer my opinion on a variety of subjects.  My areas of interest include politics, healthcare, New York City, fairness, diversity and a desire to help the needy and protect our children.  I do have opinions. I will express them, some will agree and others will not.  My purpose is two-fold:  express myself and instigate a dialogue.  I hope you enjoy my comments even though you may not agree.

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Filed under Children, Diversity, General, Healthcare, New York City, Politics