Forbes column: CBO Blesses Violation of Separation of Powers - gmlevinmd@gmail.com - Gmail

Forbes column: CBO Blesses Violation of Separation of Powers - gmlevinmd@gmail.com - Gmail

'Micro-hospitals' offer alternative to urgent care model | FierceHealthcare

A revolution is taking place in the delivery of health care

Bedless hospitals. 

Consumers like the convenience and accessibility of urgent care clinics. But hospitals may have found another model that better meets the needs of patients: the “micro-hospital.”

While the state of Colorado prefers to call them "community hospitals," these licensed facilities offer emergency medical care, inpatient care, surgery, laboratory and radiology services, Michael Slubowski, president of CEO of SCL Health told Hospital & Health Networks. SCL, which is based in Denver, plans to open four locations in neighborhood settings with it's partner Emerus. The facilities are priced higher than urgent care centers, but less than a full-service hospital, and can treat a wider range of conditions because they have inpatient beds, he said. 

Most micro-hospitals operate 24 hours a day, seven days a week and usually have eight to 10 inpatient  beds for observation and short-stays, according to the Advisory Board. "No two micro-hospitals are exactly the same in their design or service mix, but one trend is becoming clear. Most health systems are using them as entry points into markets where demand would not be able to support a full-scale hospital," the Advisory Board noted in a recent report. 

"Micro-hospitals like this are more suited for large urban and suburban metro areas," he told the publication. "This model would probably be too large and complex for a rural market. It definitely is a trend, among many trends occurring in healthcare, to create more accessible, cost-effective access points and alternative delivery models." Driving this experiment is the desire to have highly efficient operations and specialized care giving. Industry is finding bigger is not always better and cost containment may more easily be achieved in smaller facilities.

Telehealth

FTC, DOJ back Teladoc in battle with the Texas Medical Board  

Teladoc is getting support from the Federal Trade Commission and the Department of Justice in its lengthy battle with the Texas Medical Board (TMB) over the latter’s face-to-face appointment requirement before a physician can prescribe medications via telemedicine.

Teladoc says that such a requirement limits and hinders use of telemedicine services within the state.

Last December, TMB was denied a motion to dismiss Teladoc’s 2011 antitrust lawsuit--the board then appealed that decision in January.

In an amici curiae brief, filed in the Fifth Circuit Court, the FTC and DOJ call that appeal an attempt to “evade the substance of federal antitrust law," and add that, basically, the court doesn't have jurisdiction over the appeal. 

The brief goes on to say that if the court does feel it has a right to jurisdiction over the appeal, "it should hold that the state action doctrine does not shield the TMB’s rules from federal antitrust scrutiny because the TMB did not carry its burden to show active supervision."

"There is no evidence that any disinterested state official reviewed the TMB rules at issue to determine whether they promote state regulatory policy rather than TMB doctors’ private interests in excluding telehealth--and its lower prices--from the Texas market," the brief says.

In conclusion, DOJ and FTC say that the appeal should be dismissed "for lack of appellate jurisdiction."

The FTC has shown support for telemedicine before, backing a telemedicine provisionpresented in March as part of legislation working its way through the Alaska Senate.

Remote televideo visits and screening

This ability will decrease non compliance for non ambulatory and/or non compliant patients. It provides a means of communication visually, with a nurse practitioner or medical assistant. Some insurance companies already reimburse for diabetic retinopathy screening at home for non compliant patients. The socioeconomic benefit has already been demonstrated. 1


'Micro-hospitals' offer alternative to urgent care model | FierceHealthcare

Help Preserve Our Privacy-Data Selling for Profit Epidemic |

It is your data, but are you sharing the profit ?


Each time I check my mail or bank statement I do not see any deposits coming from my health insurance company or hospital for the moneys they earned from selling my data, anonymized or not. This information is becoming more commonly known.

The larger question is it  still your data if your identifying information has been removed? Apparently so,  as this challenge has been rebuffed by powerful corporate interests. Profiteering from a sick or well person's data is now acceptable business practice.

This story is curated from an article by Barbara Duck in You Caring

The Story

I am an active consumer advocate and write about our data being sold frequently and we don't know to who, what kind of data they sell, and how it will impact us. We need a law to require all who sells data in the US to buy a license and disclose what they sell and to whom. Here's the reason why...(Think Anthem Breach)

This call was different as the caller proceeded to tell me that their records indicate that I am one who takes blood thinners.  They also had my name and address information which they disclosed at the beginning of the call.  So what's the problem here?

I don't take blood thinners, never been prescribed any and have not taken any in my life!  

Where did this information come from?  It was derived by the data sellers on the internet piecing together information they mine and some algorithm determined with making this match that "I take blood thinners"!  This is enough to make anyone mad as hell!  It made me mad as I used to be a data base person that did this kind of work too.  I have a pretty good idea on the data mechanics here.  

Now we hear that the hackers of Anthem came from China, do you want your records sold all over China and the US?  That's why they hacked to get data to sell, period.  Hackers can repackage our data, hide the original formats and bingo they have a money maker.  When this happens and being there's no licensing attached to identify origins, well companies will end up buying stolen data at some point, why we need licensing!!  Here's the rest of what happened to me..

Long and short of this, my data has been sold and I have been repackaged and who knows how many other places have this "flawed data" about me on file?  I'm not one who has ever taken blood thinners and I have no way to fix this.

I have no way to find who did this to get it corrected and remember this is all on my own dime and time too!  The data sellers don't care as flawed data gets the same price as good data, so I'm screwed and can't remove this and I don't know where and when it will appear again and I'm mad.  My hands are completely tied and I can't fix this.  This is why we need an index for this.

I have no way to find who did this to get it corrected and remember this is all on my own dime and time too!  The data sellers don't care as flawed data gets the same price as good data, so I'm screwed and can't remove this and I don't know where and when it will appear again and I'm mad.  My hands are completely tied and I can't fix this.  This is why we need an index for this.

Who in the hell are all these data sellers?  

Now when people do research about me to find what's on the web, I have no clue when this will pop up again and it will at some point, depends how many bought this information about me.  So I go apply for a loan as an example and guess what "I'm a person that takes blood thinners" shows up.  

With all the extensive data searching we do today, this person who could be the one approving the loan will see this!  What could be their next move?  Easy, look and purchase more data about me, like get an actuary report from another data seller that shows the risk of how long they think I will live!!  This happens folks and this an example with me here but it happens.  

So depending on what comes back if my risk of not living long enough has impact, well guess what, I get no loan.

More about other matters:

Here's some additional reference and information with more details about how this works against us with privacy and no transparency....

Did you know you are "secretly" scored? What is a score? Well think back to school if you will and remember how you were graded, and this is happening all the time today, but it's not a test you are taking to get scored, companies and buying and selling your data and you don't even know it. Worse yet, when there are errors, guess what, the score is wrong, but you have no way to even know you have a flawed score out there that people are using to make some kind of decision. 

Did you know that when you call most insurance call centers they are "scoring" your voice?When you hear "this call may be recorded..." what's really occurring is that millions of computer algorithms are listening to you and determining what your current state of mind is. You can read more here about how that occurs and the software used. 

Do you know that health insurers are buying your Visa and Master Card records? They sure are and those too are analyzed and used along with other data they may have on file about you. This is becoming more common practice all the time. They could be doing that, but they have a lot more than just clothes purchases and could be looking at anything including your grocery bill, and so on.  

Do you want your health insurer to know everything you buy and scrutinize it? You can read more here about how that works. 

There really are few ways to track your information once it  goes into a  server either cloud based or in your office. The cost of insuring your privacy is considerable and is another addition to health care costs.

The over-riding weakness of the system is that all of the data resides in one place (or more) It is not compartmentalized and a simple breach can result in massive data exposure.



Help Preserve Our Privacy-Data Selling for Profit Epidemic | Other - YouCaring

This Homemade Mosquito Spray will Protect you from the Zika Virus —

Home made Mosquito Repellant

The Zika virus spreads via vector transmission. Individuals infected with Zika do not display signs and symptoms of infection. In some cases, the following signs and symptoms are reported:

• general feeling of discomfort
• rash and muscle pain
• mild fever
• red eyes

The incubation period, that which is the time from exposure to the manifestation of symptoms, is still unknown, but is likely to be a few days to a week.

The most adverse effect of the Zika virus is microcephaly, a condition characterized by fatal congenital condition that is common among infants. This happens when a pregnant woman is exposed to the Zika virus. There have been new cases of the virus from UK to Brazil, exposing many newborns to congenital anomalies.

Based on research conducted so far, the virus does not spread from person to person like, a cold, but through vector transmission- a mosquito biting an infected person and then on to another individual who then contracts the virus.

To date, there is no known vaccine to prevent or medication to treat the Zika virus infection. One effective measure of avoiding infection is by avoiding mosquito bites altogether in places where cases of Zika virus have been reported.

Homemade Essential Oil Mosquito Spray Repellent

Instead of applying harsh mosquito spray ion the skin, use a homemade essential oil spray to avoid mosquito bites altogether. Here are the ingredients to make an all-natural essential oil repellent:

What you need:

2 tsp lemongrass essential oil

2 tsp eucalyptus essential oil

2 tsp citronella essential oil

13 ounces witch hazel

How to make:

1. Combine the ingredients and shake well.
2. Pour the essential oil mixture into spray bottles
3. This essential oil preparation can last for a month or two. Make sure to store the mixture in glass spray bottles.

This Homemade Mosquito Spray will Protect your from the Zika Virus 

Obamacare should have been named Emanuel Care

Ezekiel Emanuel's part in formulating the Affordable Care Act was overshadowed as it became known by President Obamas campaigning for it's passage. The bill was passed by the Republicans refusal to compromise on some important values to all Americans. The democrats won a political victory by expediency.  The clock was ticking and the moment was at hand.  Rather than passing an intelligent, logicall and well thought out law the ACA was passed with an end goal in mind, not the liklihood that it would work.

A major goal was to insure 40 million Amercans that were then uninsured.  The goal was not achieved, however missing it by tens of millions, leaving those still uninsured. Affordability is open to question.

I thought it would be a good time to republish my thoughts of November 2013,  

What They Said Before the Train Wreck: The Top 10 Worst Quotes Pushing ObamaCare

Patient-Centered Care? Not for This Patient

And not for how many more?

Any situation such as the one described here sometimes defies any algorithm or ven diagram designed to assure continuity and totality of patient management.

The term seems to have evolved to assuage patient concerns that our health system is in run-away mode driven by self interest of providers, specialists, primary care physicians, insurance companies, pharma, and our government. Each has it's own self-interest.

Now in the era of 'big data' and analytics another powerful force is taking over. " the patient experience'.  Surveys present the opportunity to serve up how well providers, hospitals and insurers meet standards of compliance. In a world of check boxes rankings depend upon documented compliance with an arbitrary bar, and without looking deeper into the evaluation.

Given the task of measurement by managers the statistician becomes a 'king maker' with his numbers. At first glance knowing the numbers seems to be objective and factual. Most highly educated professionals know that statistics often lie, and are only probabilities. Statistics do not solve problems, they are merely one of the tools for managers, providers and others to support ideas and proposals for change-making.

Credits: Patient-Centered Care? Not for This Patient | Medpage Today

President Obama, in the Rose Garden, signed the so-called doc-fix bill, which permanently ended automatic Medicare payment cuts to doctors.

The 20 year war by physicians to rescind the SGR (sustained growth rate)  which had been designed to decrease the inflation of health cost has been placed. The result was a trade-off for MACRA and MIPS.

Administratively MACRA and MIPA are highly complex and require significant and expensive reorganization.  Will it save money? That is a good question. Has anyone seen a financial analysis of these requirements?

Agate Resources insiders made $34 million on sale of company that used public funds to provide health care to low-income Oregonians | Local | Eugene, Oregon

Is this a legal transaction ?

Is this an ethical transaction?

A small group of insiders in a private Eugene company that managed medical services for low-income Lane County residents made about $34 million when the company sold last year to a large out-of-state buyer, documents obtained by The Register-­Guard show.

For-profit Agate Resources owned and ran Trillium Community Health Plan, which oversees the Oregon Health Plan in Lane County, using federal and state government money to provide health care for about 94,000 low-income residents in Lane County and 2,000 in Douglas County.

The sale has been controversial because of concern that Agate held onto government Medicaid money to make itself attractive to a buyer, instead of spending more aggressively to provide doctors and medical services for Oregon Health Plan patients.

Early last year, 13,000 Lane County OHP patients did not have a primary care doctor. The problem wasn’t fully resolved until a year later.

Centene reported in its latest annual report that it bought Agate in September for $109 million. Agate shareholders divvied up that cash, according to the sale plan documents obtained by The Register-Guard.

Eleven Agate executives and directors became millionaires over night, the documents show. They include Chief Executive Officer Terry Coplin, who received the biggest single sale payout, of about $5.7 million, and Chief Financial Officer David Cole, who received about $4.2 million, the sale documents show.

Agate Resources insiders made $34 million on sale of company that used public funds to provide health care to low-income Oregonians | Local | Eugene, Oregon

Medicare's second-highest paid doc accepts three-year exclusion

One of the country’s highest paid physicians agreed to a three-year exclusion to settle claims that he billed Medicare for medically unnecessary cardiac procedures, according tothe Department of Justice.

Last year, the DOJ joined two whistleblower lawsuits against Asad Qamar, who owned the Institute of Cardiovascular Excellence in Ocala, Florida. The lawsuits alleged that he regularly billed for unnecessary procedures and violated the Anti-Kickback Statute by waiving Medicare copayments. Months later, the Centers for Medicare & Medicaid Services banned Qamar from the Medicare program, prompting support from a Super PAC of former patients who were “disgusted and distressed” by the government’s portrayal of Qamar.

In addition to a three-year exclusion from Medicare, Qamar will pay $2 million and forgo an additional $5.3 million in suspended claims.

One thing to remember is that these occurences are rare. The real question is how medicare waits so long to act on these suspicious billings. The claims should be suspended pending adequate analysis.  The system needs to be proactive to avoid fraud and theft from the public tillers.

Fraud such as this is inexcusable, and the alleged perpetrator should have his medical license suspended  pending further analysis.  With this volume of surgery  his records also should be thoroughly examined. No doubt he owned his own surgery center and had no peer review. Were the procedures even indicated ?

These issues brought forth by the DOJ on behalf of CMS are difficult to analyze at times. There were a number of providers in this group and it may be that all were included under his billing identifications. No other providers were named in the action.

Here is the doctors letter of response to his patients. Bottom line...pay a fine, make retitution and you are still in business...all about money for the feds....not a real moral or ethical issue for them. Was he guilty.  I present.... you decide.  

Patients are easily fooled, especially if complication rates are low. Examine the Facebook pages of grateful happy patients. PR and marketing can be clever camouflage for deception and fraud

WebMD reports multiple physicians in this group. Dr Qamar may have been the only interventional cardiologists receiving referrals from the other cardiologists. The devil is in the details. It is a standard practice for cardiologists, and other interventional providers who no longer operate to see and diagnose patients with serious cardiac problems and refer them to someone who performs PCCT. It is also a proven fact that 'high volume' surgeons have fewer complications... We do not know all of the details which become murky and obscured by what is published by others. Either that or the doctor is a sociopath. Case closed.

Digital Health Space neither agrees or disagrees with any stipulated legal settlement between Dr Assad Qamar with CMS and/or HHS.  This is only opinion..

Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times

 In its quest to remake the nation’s health care system, the Obama administration has urged doctors and hospitals to band together to improve care and cut costs, using a model devised by researchers atDartmouth College.

But Dartmouth itself, facing mounting financial losses in the federal program, has dropped out, raising questions about the future of the new entities known as accountable care organizations, created under the Affordable Care Act.

The entities are in the vanguard of efforts under the health law to moveMedicare away from a disjointed fee-for-service system to a new model that rewards doctors who collaborate and coordinate care.

Medicare now has more than 400 accountable care organizations, serving eight million of the 57 million Medicare beneficiaries. Obama administration officials say the new entities are saving money while improving care, but some independent experts have questioned those claims.

“There’s little in the way of analysis or data about how A.C.O.s did in 2015,” said Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. “The results have not been a home run.”

In addition, he said, “there is little reason to think that A.C.O.s will bend the cost curve in a meaningful way” unless they bear more financial risk, sharing losses as well as savings with the government.

An evaluation for the federal government found that Dartmouth’s accountable care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.

“We were cutting costs and saving money and then paying a penalty on top of that,” said Dr. Robert A. Greene, an executive vice president of the Dartmouth-Hitchcock health system. “We would have loved to stay in the federal program, but it was just not sustainable.”

Dr. Elliott S. Fisher, the director of the Dartmouth Institute for Health Policy and Clinical Practice, said: “It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. I helped design the model of accountable care organizations. So it’s sad that we could not make it work here.”

The idea of accountable care organizations and the name are generally traced back to a paper in 2006 by Dr. Fisher and colleagues at Dartmouth and its medical school. Writing in the journal Health Affairs, they reported that Medicare beneficiaries received most of their care from doctors who were directly or indirectly affiliated with a local hospital.

Rather than trying to measure the performance of individual doctors, they said, Medicare should assess the hospital and the doctors together and hold them jointly accountable for the cost and quality of care provided to a defined group of Medicare patients.

In effect, this was an effort to overcome the fragmented nature of most American health care and to replicate some of the benefits of managed care while still allowing Medicare patients to visit any doctors they wanted.

The new entities, unlike health maintenance organizations, “can’t tell you which health care providers to see” and “can’t limit your Medicare benefits,” the Obama administration tells beneficiaries. But, it says, doctors and hospitals working together in an accountable care organization can share information, including test results and prescription drug data, so it is easier for them to coordinate care for patients.

This result is the outcome of muddled thinking. True cost savings and reductions in fees would not be known for some time.  They also exclude the organizational costs and information technology (software development) to administer the new organization.

Accountable care organizations are one of many demonstration projects being conducted by the Center for Medicare and Medicaid Innovation, an office created by the Affordable Care Act to test new ways of financing and delivering care. Under the law, the secretary of health and human services has sweeping power to expand such projects nationwide if she finds that they would reduce Medicare spending without harming the quality of care.

The center is testing new ways to pay for prescription drugs, medical devices, cancer care, hip replacement surgery and many other services.

The Congressional Budget Office predicts that the center’s activities will save $34 billion over the next 10 years, although it does not know which projects will save money.

Bottom line:

We want you to reorganize to save money, and we will penalize you if you don't or cannot.  (CMS Center for Innovation)

Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times

8 Tips for Healthier Eyes

Report: Hungry Teens Often Feel Responsibility To Help Feed The Family | California Healthline

A report today from the California Healthline reveals a disturbing fact. Many adolescents are required to help feed their families.  Many are not aware of public assistance programs such as Cal or Medicaid programs.



At the same time it is heartening that young people are devoted to their family and attempt to remain independent from government programs.  What would be good would be a public employment (part time) for youth who could be active in rebuilding community, such as improvements in housing, or neighborhood cleanup programs.  Rather than having a rather meaningless job at a fast food restaurant, or worse, dealing in controlled substances they would contribute a real need for their community, and  gain self esteem.  By using unemployed needy youth it could offset increasing public budgets for community services. The effort should be coordinated with official agencies for public service as to optimize the program(s) without unduly effecting the job market.

Teenagers as young as 13  often play an active role in feeding their families,  taking jobs when they can or selling their possessions to help raise money for food, researchers found in a detailed look at hunger among adolescents.

In extreme cases, teens resorted to crime and sexual favors in exchange for nourishment.

Yet, according to the research, many cringed at the thought of using a local food bank.

“I will go without a meal if that’s the case,” said one girl in Chicago. “As long as my two young siblings is good, that’s all that really matters to me.”

The report, published Monday, is from the Urban Institute, an economic and social policy research group, and Feeding America, a national network of food banks. It is based on interviews of 193 teenagers in 20 focus groups across the country.

Researchers asked teens how they coped with hunger in their communities and what barriers prevented them from accessing food assistance programs. They discovered many teens shrink from seeking help for fear of being stigmatized.

Susan Popkin, senior fellow at the Urban Institute and co-author of the report, said teens engaging in risky behavior are often treated with disdain instead of being recognized as victims of sexual exploitation and the cycle of hunger.

“We need to be thinking about getting assistance to families with teens,” she said. We need to stop thinking about teens as the problem and start helping them.”

The federal Department of Agriculture last week released the latest government estimate of household hunger, finding 13 million children and 29 million adults did not have sufficient food at some point in 2015. That is nearly 13 percent of the U.S. population.

In 13 of the 20 focus groups, participants in the Urban Institute study mentioned “selling their body” or “sex for money” as a viable strategy. While participants in nearly every focus group preferred finding a job to make ends meet, many had trouble finding work and school commitments made working more difficult, the teens noted.

Others simply went hungry so their siblings could eat.

The report also found teens didn’t know many of the resources available to them. In addition to feeling stigma, some participants perceived local food pantries as inaccessible and believed summer programs targeted small children, not adolescents.

Despite that progress, teens reported that Supplemental Nutrition Assistance Program SNAP benefits — federal food assistance —do not provide enough food for the month

Teachers and other program directors for adolescent programs should learn to evaluate adolescent behavior stemming from hunger....irritability,  lethargy, depression, stealing food, or money, selling personal possessions or other family items.

Publc schools should display articles about adolescent and child hunger on their bulletin boards. PTAs should discuss these needs with parents.

Other sources of information can be found:

Foods Available
Feed The Children
Facebook Feed the Children
Twitter Feed the Children

Report: Hungry Teens Often Feel Responsibility To Help Feed The Family | California Healthline

Under Obamacare, Health Care Costs Unlikely to Ever Drop - Opportunity Lives

As reported extensively at Opportunity Lives, the cost of health care is skyrocketing nationwide, with insurance companies raising premiums or even pulling out of the Obamacare exchanges due to enormous profit losses over the past few years.  Liberals have long argued this was merely a temporary hiccup as insurers adjusted to the new regulations and mandates of President Obama’s signature law. But experts are now warning that the problems associated with Obamacare are only compounding and show no hope for improvement.

In an ideal world, President Obama would recognize the pain American families are feeling under the rule of his law and collaborate with Republicans, several of whom are physicians, to put together a plan that works for the country. But that seems unlikely in a hyper-politicized environment.

According to Megan McArdle of Bloomberg, the Obama administration has found itself in a difficult position. Regulators, who place significant controls on premium prices, have an interest in keeping costs low for policyholders. But with insurers posting record losses, these bureaucrats don’t want to drive them out of the exchange program, either, and thus, must permit rates that allow them to yield a modest profit.

“They are not going to approve rates they believe will cause insurers to lose large sums of money,” McArdle explained.

“A BIG PART OF IT IS SIMPLY THAT THE INSURERS CANNOT MAKE A PROFIT AT CURRENT PRICES”

Insurers are hemorrhaging money because Obamacare requires the guaranteed issue of policies, even when patients pose extreme financial risks to the provider. Further, Obamacare mandates that insurers cover a bevy of new procedures and treatments, tacking on additional costs to doing business for these companies.

These goals are all well and good, but intentions often go astray when market forces are not understood.  

Obamacare attempts to camouflage an insurance company by calling it  a health plan. The obvious point about insurers using risk to appraise premiums has been totally ignored.

“THEY ARE NOT GOING TO APPROVE RATES THEY BELIEVE WILL CAUSE INSURERS TO LOSE LARGE SUMS OF MONEY”

To compensate for the financial strain imposed by Obamacare, insurers have raised rates. For millions of Americans, this means premiums and out-of-pocket expenses doubling, tripling or even quadrupling. As a result, healthier patients, many of whom are young and pose virtually no risk to insurers, have opted to drop their coverage, pay out of pocket for medical costs they incur and endure a tax penalty for their failure to maintain insurance. The plans based their income on the number of young and healthy patients who have little medical expenses. Most of these people did not carry health insurance in the first place. The sudden impact of paying $200 dollars a month did not compute, especially when their out of pocket and deductible expenses would also add to their monthly costs.  Why pay a premium when the $ 200 premium could go directly to direct payment expense?   Well, the HSA or MSA was invented. Patients could place money in a tax deductible savings account, before taxes.  It is all about cash flow. Most of these young people do not have discretionary income to save $ 200.00 each month

This is because of the aforementioned healthy-sick ratio of patients, nicknamed the adverse-selection death spiral. As prices go up to compensate for the rising number of sick Americans covered, healthy consumers are forced out of the market, exacerbating the risk insurers already face in covering those who cost more to insure.

As typical of most government programs it does not happen. It was an illusion foisted upon all of  us.  Perhaps for older adults and those with substantial income it might be work.

Obamacare advocates insist that this is a temporary problem, but as McArdle points out, the problems are far more systemic than the law’s defenders like to admit.

The worse news, McArdle writes, is that, “unbeknownst to most people, the subsidies are actually capped at a little over 0.5 percent of gross domestic product. We’re nowhere near that level yet — the Congressional Budget Office expects us to spend about $43 billion in 2017 on premium tax credits, while 0.5 percent of GDP would be a hair over $90 billion — but it doesn’t take too many years of 10 percent increases to get there.”

Perhaps the most realistic view, cynical though it may be, is that the impending death spiral was always the point of Obamacare. Conservatives are accused of engaging in hyperbole for even bringing up the accusation, but all evidence points to this being the actual motivation.  

Liberals have always desired a government-run health care system. They knew the public would never accept it. So they concocted a scheme they knew would succeed by failing. With the collapse of Obamacare, they figured, most Americans would have no choice but to embrace some amped-up iteration of Medicaid or a single-payer system that puts most private insurers out of business. Private coverage would remain only for the affluent who could purchase it to supplement their state-sponsored care, just as it’s done in many European countries — the same countries whose “universal” health care systems have been lauded by Democrats but left patients with long lines and little hope.

At the worst it looks like a conspiracy. At the least it was a stupid bungling. Our government is so disorganized it would be hard pressed to conjure up this plan. Nevertheless, it may happen.  I have always suspected as much. Make the system so chaotic and  unworkable that we all give up and sue for a single payer system. "Just go away"

In an ideal world, President Obama would recognize the pain American families are feeling under the rule of his law and collaborate with Republicans, several of whom are physicians, to put together a plan that works for the country. But that seems unlikely in a hyper-politicized environment.

Ellen Carmichael is a senior writer for Opportunity Lives. Follow her on Twitter @ellencarmichael.

Under Obamacare, Health Care Costs Unlikely to Ever Drop - Opportunity Lives