Tag Archives: Fact-Checking

Driving Your Doctor Out Of Business

It began almost as a footnote. 

Five months after Obamacare was passed, members of the Obama administration quietly published an article in The Annals of Internal Medicine describing the law’s planned impact on physicians.  

Shortly thereafter, the piece disappeared and was replaced with a more benign one, with the obvious cooperation of the journal. 

You won’t be able to find the original. It’s been wiped from the internet. 

(And no, not “like with a cloth or something.”)

What was so controversial about the article?

The admission that the law aimed to eliminate private medical practices — and drive physicians into the arms of hospital bureaucrats and huge medical groups. 

From the original:

“The economic forces put in motion by [the ACA] are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups … Physician practices that accept the challenge will be rewarded in the future payment system.”

The article’s authors were Nancy-Ann DeParle, JD, Office of Health Reform director, Robert Kocher, MD, formerly from the Obama National Economic Council — and the now rather infamous Ezekiel Emanuel, MD, Obamacare architect and a really special kind of bad guy.

What’s “vertical organization?”

In Medscape Medical News coverage of the piece, the writer likened “vertical organization” to the military and the federal government.

“This business catchphrase refers to enterprises
with a hierarchal structure and centralized management.
An integrated delivery system that owns hospitals,
medical practices, and other healthcare services is a prime example.”

Wow. Sure sounds like single payer, doesn’t it?

And the Obamacare masterminds have been largely successful in moving the medical community in this direction. Journalist Keith Speight observed in 2013 that:

“While the shift away from private practices was already under way prior to Obamacare, the legislation definitely threw gasoline on the fire.”

In its 2014 survey, the Physician’s Foundation found that “only 35% of physicians describe themselves as independent practice owners, down from 49% in 2012 and 62% in 2008.” In contrast, 53 percent of the survey respondents described themselves as hospital or medical group employees, increasing from 38 percent in 2008 and 44 percent in 2012.

Many of the physicians remaining in small practices have already been heroically laboring to comply with ACA and other federal requirements, spending evenings and weekends transmitting patient data through expensive electronic health record systems. 

The newest iteration of health reform,
MACRA (the Medicare Access and CHIP Reauthorization Act),
will break their backs.

MACRA (previously covered here) restructures physician pay by rewarding more patient data-gathering and obedience to government-dictated clinical and electronic activities.

The Centers for Medicare & Medicaid Services, the agency fleshing out the MACRA regulations, admits that its new rules will penalize 87 percent of solo practitioners  and 69.9 percent of practices with 2 to 9 doctors. Over time, many small practices will lose up to nine percent of their Medicare reimbursements. Meanwhile, only 18.7 percent of clinicians in groups of 100 or more will be penalized.

Tom LaGrelius, MD, president of the American College of Private Physicians, explains that “small organizations cannot possibly comply” with MACRA’s complex data-reporting requirements and will be unable to absorb the MACRA penalties. “Such practices are already running on very narrow margins with 70 percent-plus overheads.” 

The Physician’s Foundation reported that even pre-MACRA Medicare reimbursement has risen only 3.6 percent since 2001, while overhead expenses “have increased well over 20 percent.”

Orthopedic surgeon Tony Francis believes “compliance will be difficult or impossible” for small groups.

“Just reading a 962-page proposed rule would be daunting enough.
Comprehending the meaning of it is something else.
That would take a full team of lawyers and CPAs.
What small practice has that kind of resources?”

Why force independent physicians into hospital jobs? Physician and health policy expert Scott Gottlieb explains:

“It will be easier for Medicare to gain
more direct leverage over their clinical decisions.”

And you know what that means.

RATIONING

The inevitable results of the proposed MACRA regulations are these:

  • We can expect an increase in the “silent exodus” of physicians from clinical care, either through retirement or career change. Even health IT whiz John Halamka, MD, finds the MACRA proposals to be “so overwhelmingly complex that no mere human will be able to understand them… as a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.
  • Some will no doubt surrender their positions as “the knuckle-draggers who just won’t get with the Managed Care 2.0 program,” and join corporate medicine, a move that didn’t turn out well in the 1990’s, and will certainly devalue the medical care Americans have enjoyed in the past. 
  • Others will decide to opt out of the Medicare program and treat Medicare patients through private contracts.
  • Wisely realizing that private insurance companies (the Aetnas and UnitedHealths of the world) will eventually make these very same data-collection demands, many physicians will terminate all insurance contracts, offering private individually-tailored care only through direct-pay or concierge arrangements.

If the MACRA regulations are finalized, not only will independent practices suffer, but so will Medicare beneficiaries. Small physician-owned practices are already known to result in fewer preventable hospital admissions than hospital-owned practices. As the Physicians Foundation points out, while mega-health systems “can handle government rules and regulations,” they simply cannot provide “the personalized care found in the offices of private practices.”

Patients, physicians, and other stakeholders can voice their opinions about the destruction of our physicians’ small businesses at http://bit.ly/macracomment.

Your opportunity to comment will close on June 27, 2016.

Ezra Klein, Please Don’t Fire Sarah Kliff

For months, Vox’s Sarah Kliff has complained about the declining value of workers’ health insurance coverage and in particular rising deductibles

Kliff has also written about Obamacare’s Cadillac Tax.

And we called her out on her failure to connect the two. Twice

“Three articles on increased worker cost-sharing 
and yet NO mention of the Cadillac Tax?” 

So did The Tax Foundation.

It appears that Sarah has now awakened to the fact that the Cadillac Tax is driving down the value of company plans — and increasing employee costs — and her discovery has not made her happy.

NOW she’s skeptical. NOW she wonders if workers will really experience pay hikes as their health plans lose value. It took a long time and some hard cogitating to get Kliff to this point, but we congratulate her for discovering what we revealed in June.

One may wonder how her enlightenment is sitting with Vox boss and alleged wunderkind and intellectual giant Ezra Klein. Klein was a HUGE fan of the Cadillac Tax when disgraced Obamacare architect Jonathan Gruber promoted it in 2009 and 2010. In fact, Klein and Gruber had a mutual Cadillac Tax love-fest, and Klein frequently wrote in support of the tax and its wage growth promise.

In 2009:

Earlier in the day, I’d been talking to MIT economist Jon Gruber about this issue. “There are a few things economists believe in our souls so strongly that we have a hard time actually explaining them,” he said. “One is that free trade is good and another is that health-care costs come out of wages.” To put it another way: Economists are pretty united on this point. A firm’s compensation for its workers is pretty static, and if relatively more goes to health-care costs, relatively less will go to wages, and vice-versa. But this isn’t just a matter of theory. 

In 2010:

Unions will respond by “rebalancing compensation away from expensive insurance plans and towards higher wages, which is exactly what the tax is supposed to.”

And again:

[T]he excise tax is small change. It won’t hurt many people. It won’t hurt folks badly. 

But should workers suffer, Klein was all in:

When a policy bumps up against the tax, a couple of different things could happen. One is that the employer just passes along the tax, either increasing premiums for the employee or taking it out of wages. The other is that the employer chooses a plan that’s beneath the threshold. That plan might have a higher deductible, or more co-pays, or tighter networks, or less coverage for brand-name drugs. It will, in other words, be more like the managed care of the 1990s, which brought down spending and didn’t hurt health outcomes, but which people really didn’t like. “Managed care worked,” says Gruber, “but workers didn’t know it. They didn’t see the benefit. We’ve got to make them feel the pain of not reforming and enjoy the benefits of reforming.” In this case, the pain will be the excise tax.

In what can only be called economic incest, Gruber used a chart Klein created from Gruber’s numbers as evidence that his premises were valid. 

The available evidence clearly illustrates that there is essentially a one to one offset between employer insurance spending and wages. There are a number of economics studies that support this conclusion. But it is perhaps most vividly illustrated by simply comparing the growth rate of health insurance costs to the growth rate of wages, a task recently undertaken by Ezra Klein…when health care costs moderate, wages rise.” 

In other words, Gruber fed Klein his numbers, Klein sold them to America, and Gruber quoted Klein as evidence for his wage growth hypothesis. 

So Kliff now concludes that “the evidence is thinthat Klein’s Cadillac Tax sales job was honorable.

Let’s hope he doesn’t punish her for actually thinking this through herself, even as it took her years.

UPDATE: Who could have anticipated this? Klein admits Gruber’s “wage growth” hypothesis was bogus all along.

You have some ‘splaining to do, Mr. Klein.

Sarah Kliff Unloads Yet Another Awful Voxplanation

Is “awful” too harsh an adjective for Vox.com, the faux-educational ‘splainer site run by alleged wunderkind and intellectual giant Ezra Klein? One Twitter user, after reading our last piece on health beat reporter Sarah Kliff, didn’t think so.

Vox has also been called “terrible” and “a joke.” The staff has been referred to as “complete idiots” and likened to “sleazy mob lawyers.”  David Harsanyi of The Federalist writes that “Vox makes us stupid.”

Let’s agree to call them awful. Because they really are. Say it like Donald Trump would. 

NEW YORK, NY - MARCH 09:  Donald Trump and Melania Knauss-Trump attend the Comedy Central Roast Of Donald Trump at the Hammerstein Ballroom on March 9, 2011 in New York City.  (Photo by Andrew H. Walker/Getty Images)   Original Filename: GYI0063876060.jpg

“Vox is awwwwwwful!”

In her latest awful health care ‘splainer, Kliff tells us “Why your health bills are getting higher, in one chart.” And Kliff, who is now rather famous for producing pieces that cover only part of the story, once again fails to disappoint her reader(s)!

Let’s be clear: she really doesn’t explain “Why your health bills are getting higher, in one chart.” She only informs the reader that one component — the deductible — is on the rise. As if we hadn’t noticed.

She must believe Americans open bills from their doctors or hospitals and think, “Whaa?? How did this happen to me? I sure hope Sarah Kliff can ‘splain this!”

But see, she doesn’t. She just calmly ’splains that “This is your new deductible. On steroids.”

Actually, middle-class Americans already realize that Obamacare has made everything related to health care — not just deductibles — awfully expensive. Copayments and coinsurance are rapidly increasing. So are pharmaceutical and medical device costs, narrow networks (“if you have a doctor you like, you will be able to keep your doctor”) and insurers’ “medical necessity” audits and preauthorization requirements.

Why, oh why, is this happening, dear Sarah?

She’ll never admit this, of course, but it’s by design, courtesy of Obamacare architects like Jonathan Gruber, Zeke Emanuel, John Kerry, and The Won. You’re supposed to embrace this financial pain. It’s supposed to be awfully good for you. It’ll force you to reconsider scheduling that physician visit (as if you relished such appointments before) and filling your prescription order.

Never mind that it’s causing people to avoid care. (Shush!)

And never mind that you weren’t told of this plan before you voted in 2010 and beyond.

Kliff would have you believe these cost increases are occurring because “bosses are mean and stingy.” That is her implication in this, the latest of three articles in which she’s complained about deductibles and NOT mentioned the source of this pain: Obamacare’s Cadillac Tax on company health plans. 

(You can read all about the forty percent excise tax here and here.)

Kliff is merely taking a page from her progressive elders’ script: blaming company owners — for rising health care expenses and dropped policies — was the plan all along. 

Emanuel advanced this move in an interview with FOX news anchor Chris Wallace:

The president — look, the law does not say “Sears, drop coverage.” Sears decides what’s good for Sears… When the private companies decide that they’re going to drop people or put them in the exchange, you blame President Obama. He is not responsible for that.

Yeah, that’s right. The Preezy didn’t write an executive order commanding Sears to trim or drop company plans. He and his fellow Obamacare masterminds just made it a whole lot harder for Sears to keep its doors open. Paying a forty percent excise tax on health policies would put many firms out of business; employers simply have no choice but to skimp on or terminate company insurance.

We’re not alone in noticing Kliff’s awful omissions. The Tax Foundation also offered commentary on her latest skewed article:

Vox today covered the issue of rising deductibles in the U.S. health care market. As with their past coverage of the issue, there is a curious omission from the piece: the Cadillac tax…A number of outlets have linked this industry trend of higher deductibles to the Cadillac Tax. If Vox is to live up to its tagline and “explain the news,” it should perhaps give some consideration to the possible explanation offered by reports from Kaiser Family Foundation and Mercer, both of which link the Cadillac Tax to higher cost-sharing or consumer-directed health plans (CDHPs). This explanation for the news, for example, was considered by journalists at Bloomberg, the New York Times, the Wall Street Journal, and the Los Angeles Times, in today’s papers alone. It may behoove Vox to give it a look.

Kliff has a documented history of recycling information, but this is getting ridiculous — and, yes, awful! — for a former Washington Post writer.

Three articles on increased worker cost-sharing and yet NO mention of the Cadillac Tax? 

While some may have previously believed Sarah Kliff was just goofy, inattentive, and lazy, there’s no reason to think she wants her reader(s) to be anything but ignorant.

Shame on you, Sarah Kliff. Like your boss, you’re nothing but a progressive propagandist.

How awful of you!

H/T Citizen researcher Kathy in Alabama

Kliff’s Clunker Coverage of the Cadillac Tax

There’s no doubt about it: the faux-educational website Vox had a very unfortunate week.

First, alleged wunderkind and intellectual giant Ezra Klein nixed an essay an editor commissioned because the topic might challenge its reader(s) to think different thoughts. “The concern is that people will misinterpret it as implying opposition to abortion rights and birth control.”  Can’t have free discussion of ideas, huh?

Steven Hayward eviscerated Klein, concluding that he is a “a petty and small-souled human being.” 

Ouch.

Then someone at the outlet, apparently thinking the National Rifle Association produced chocolate products, confused the organization’s image with FDR’s National Recovery Administration. Twitchy, T. Becket Adams, and The Daily Caller ridiculed the site until Vox deleted the tweet and the image

Finally, our favorite Vox writer, Sarah Kliffafter more than a month of teasing us — offered her ‘splainer of Obamacare’s Cadillac Tax, the excise tax on employer plans designed to deliver a sucker punch to workers. 

First let’s note that Kliff wrote two previous articles complaining that those nasty little business owners are offering “crummier” insurance plans.

In neither article did she mention the Cadillac Tax as the reason. And it IS the reason. 

In her piece on the excise tax, Kliff only tells part of the story. Worse yet, she implies Republicans support it (this is not true).

She first admits this:

The point of the Cadillac tax isn’t to tax health insurance. It’s to change health insurance.

Do you remember being told you could keep your health insurance? Kliff fails to mention the 2013 Lie of the Year.

And do you remember this pie chart

Oh, yes, during all the outrage over cancelled plans in late 2013, Jonathan Gruber, who helped design the Cadillac Tax, claimed that worker plans wouldn’t be touched. And then someone made a pie chart for us.

Go ahead and peek at it. That big blue area representing the “unaffected” 80 percent of Americans?

“Largely people who keep their current employer plan.” 

Kliff apparently doesn’t remember any of this when she confesses that your job-based insurance is, after all, required to change. 

She is correct when she says people of all political stripes hate what’s called “the tax exclusion” allowing workers to receive benefits tax-free. But as Duke University research scholar Chris Conover points out, there’s a BIG difference between limiting the exclusion, as various policy analysts have suggested, and wiping it out through the highly regressive Cadillac Tax:

In short, whereas capping the tax exclusion even-handedly eliminates the tax subsidy for all workers above a certain premium dollar threshold, the Cadillac tax is far more pernicious–imposing a far heavier burden on low-wage workers than high-wage workers. That is, instead of merely reducing the low-wage worker’s tax subsidy to zero, the Cadillac tax goes overboard by using the tax code to actually penalize the provision of employer-provided health benefits to low wage workers. In contrast, while it obviously reduces the magnitude of the subsidy for high wage workers, it nevertheless leaves in place a net taxpayer subsidy for the identical health coverage for which a low-wage worker would face a tax penalty! Leave aside fairness: does that make any policy sense to you?

So when Jon McDonough told her the Cadillac Tax is “working just as Republicans wanted,” he either lied or is wildly uninformed about the law he helped write. 

And Kliff swallowed it whole.

Furthermore, Kliff writes that Economists think the Cadillac tax will give Americans a raise. Let’s put aside the proposition that A TAX can increase your take-home pay and proclaim that this is almost true. 

Some economists — like Gruber — have maintained for years that Americans are going to see pay raises as the tax forces companies to dilute the value of health plans they offer. (See Obamacare’s Wage Growth Hoax for more detail.) But other economists, health policy experts and even some Congress members find this doubtful. 

Linking to only one study, Kliff writes, “There’s a vast body of economics research that shows workers bear the cost of more expensive health plans with lower wages. These papers suggest there’s a lump sum amount that companies spend compensating workers. It goes into either wages or benefits.”

A lump sum, huh? Employers have no other options for savings they reap? What about distributing dividends or cutting the price of products they market? What about hiring more workers, say in Human Relations, to comply with Obamacare reporting requirements?

Have Gruber or Kliff ever run a business?

Keep in mind that at the time the tax was being debated, Megan McArdle demonstrated that she’d actually put some thought into the proposition:

What if employers just cut their costs and don’t raise their employees wages? What if employers just cut their costs and don’t raise their employees wages, because they’re in a dying unionized industry? What if they shift workers to other forms of tax-deferred compensation, like 401(k) matching or HSAs?

Indeed. What if this doesn’t work? What if employees suffer both higher health care costs and no pay raises?

After reading Kliff’s article, Gruber researcher Rich Weinstein tweeted:

And he’s right. Here’s what she omitted:

  • In his ’08 campaign the President swore his health reform plan wouldn’t tax worker benefits. He spent $100 million hammering John McCain for proposing a cap on the employer exclusion. 
  • And because they all understood the tax would be a political nightmare, John Kerry, to quote Gruber, “had a very clever idea. He said, ‘Let’s call it instead a tax on insurance companies and not a tax on insurance plans.’…Now, you and I know, economists know, that that will just get passed on in the price of insurance.”
  • Three days later, Obama said this to his Shaker Heights, Ohio, audience:

First of all, in terms of taxing benefits, I said I oppose the taxing of health care benefits that people are already receiving, so that’s not a proposal that I’m supportive of…But what I said and I’ve taken off the table would be the idea that you just described, which would be that you would actually provide — you would eliminate the tax deduction that employers get for providing you with health insurance, because, frankly, a lot of employers then would stop providing health care, and we’d probably see more people lose their health insurance than currently have it. And that’s not, obviously, our objective in reform. OK?

But that was the objective. Bye-bye, employer-sponsored coverage. “Everybody, into the exchanges!” As analyst Patrick Garry writes:

Obamacare was sold as supporting the employer-based system, not eroding it. But at its core, Obamacare is designed to do precisely that: to eventually force every American with employer-based coverage onto the Obamacare exchanges, whether they like it or not.

So there’s your ‘splainer, Vox. You’re welcome. Feel free to update your article with this material. 

We would have made corrections in your comments section instead of writing a long and embarrassing blog post, but you don’t allow comments on your articles.

And it’s pretty clear why.

Obamacare Scorecard: Takers Taking, Makers Breaking

When market research company J.D. Power released its 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) Study last Thursday, progressive health care reporters rushed to their laptops to declare Obama’s remarkable achievement:

Wowie!
Obamacare customers
are more satisfied
than people with job-based plans!

Vox’s Sarah Kliff offered her ‘splainer of the study, which was based on data collected from December 9, 2014, through February 24, 2015. 

People who had coverage through Obamacare had an average satisfaction score of 696 in 2014, thinking back to their last year of coverage. During that same year, people in mostly employer-based plans had a satisfaction rating of 679 — 17 points lower.

So did Sarah Ferris at The Hill:

People who bought coverage through ObamaCare are generally more satisfied than those with other types of insurance, according to a new national survey. ObamaCare customers rated their satisfaction over the last year as 696 out of 1,000, compared to the 679-point rating by customers with employer-based plans, according to a large survey by the consumer research firm J.D. Power.

And let’s not forget young Jonathan Cohn, who wrote a Huffington Post piece titled Obamacare News That Should Make Conservatives Happy, But Won’t:

J.D. Power uses a numerical index, from zero (low) to 1,000 (high), to measure consumer satisfaction. The figure for Affordable Care Act consumers was 696. To put that in perspective, the figure for people with employer-sponsored insurance — the source of coverage for most working-age Americans — was 670 [sic].

Here’s a question for Kliff, Ferris, and Cohn:

Are you really surprised that getting free stuff is popular?

…especially since J.D. Power found that “cost is the most influential attribute driving satisfaction among Marketplace plan members?”

Reporters of all stripes ought to know why Obamacare customers are happier than those in employer plans.

  • Obamacare enrollees enjoy the taxpayer’s helping hand with their premiums: in 2014, 90 percent received premium subsidies, and 69 percent paid $100 or less per month. 
  • Those in job-based plans are being increasingly hammered by rising out-of-pocket costs, as employers reduce benefits to avoid Obamacare’s Cadillac Tax. 

The New York Times provides one example of the excise tax’s impact on workers.

Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

Remember: Obamacare enrollees don’t have to pay the Cadillac Tax; only those with company plans suffer that burden.

The real story in the J.D. Power release, though, is not found in comparisons of people with different types of coverage: it’s found when one examines the insurance satisfaction index over time.

In 2009, the year before Obamacare was passed, that number was 712 out of 1000. In 2010, it plummeted to 701. And now, for those with employer-provided insurance, that number is 679 — and 696 for those in the individual market.

In their reports, the research firm (strangely) never mentions the sampling errors and confidence intervals that would allow for meaningful year-by-year comparisons. However, they do say they consider a ten-point change to be significant.

So overall, Americans are vastly less satisfied with their health insurance since Obamacare started monkeying around with it. That’s the story.

But our progressive health care journos didn’t write about that tidbit, did they? 

Instead, they put a happy face on the numbers, gleefully announcing that those getting freebies are happy with their free provisions, and those subsidizing those freebies are much less so. 

Duh. They must think their readers were educated at the Jonathan Gruber School of Stupid.

[Sigh] It’s all fun and games until we “run out of other people’s money.”

Meet Jeffrey Young, HuffPo’s Medicare Donut Hole

On April 17, Huffington Post’s Jeffrey Young admitted he doesn’t know squat about Obamacare. 

Referring to a Bloomberg article on Obamacare polling, he asked his Twitter followers to enlighten him as to one woman’s claims.

And then he revealed that he has no idea whatsoever as to Obamacare’s impact on Medicare.

“Eventually” deducing that she’s “almost certainly on Medicare,” not Obamacare, he writes off her report as nonsense.

Why, it’s as if Medicare and Obamacare are two distinct and unrelated programs! 

His reasoning? On the one hand, some poor schlubs lost their plans and had to sign up for lousy coverage in the exchanges. On the other, there’s Medicare, the insurance plan for the elderly and disabled. And never the twain shall meet, right?

WRONG, Mr. Young.  And Ms. Stone isn’t a befuddled octogenarian who doesn’t know the difference. 

Ms. Stone was treated at physicians’ offices through Russell Medical Center, which has partnered with the University of Alabama at Birmingham Health System (UAB) since August, 2012. At the time, RMC agreed to a plan of “working together to solve problems in health care delivery.”  In September, 2013, UAB embraced Obamacare’s ambition to reduce health care costs.

Ms. Stone has never had heart problems, but during a routine blood draw, her triglycerides tested at 600, almost 10 times her usual result. Her internist put her on multiple medications and referred her to one of RMC’s cardiologists. 

She then became a cardiac patient. 

With three master’s degrees and two specialty degrees, including one in psychometry, Ms. Stone was no fool. “I knew the lab was wrong.” But she couldn’t convince her doctors to retest her.

“They told me I couldn’t get another test for three months and that I’d need to take all of these medicines in the meantime. They said Obamacare was the reason.”

And they explained how Obamacare is influencing patient care: “The doctors are very dissatisfied, and many of them are not able to give their patients the attention that they feel that they need because they can’t have too many appointments, too many tests.”

The unaware and uninterested Jeffrey Young, HuffPo’s Obamacare expert, admits he’s “puzzled” by this. And this revelation is surprising since he’s written about the donut hole repair, Medicare costs, and the increasing out-of-pocket costs Americans are enduring. He even weighed in on King v. Burwell. One could fairly assume he’s researched the law in its entirety. 

Did he stop reading Obamacare when it came to its reforms of Medicare? Did he get sleepy?

As a national health care reporter, Mr. Young ought to know that no other group is as affected by Obamacare as are seniors on Medicare. The law created a variety of pay-for-performance experiments in Medicare, including the following:

Section 3001: Hospital Value-Based Purchasing Program
Section 3002: Improvements to Medicare’s Physician Quality and Reporting System (PQRS)

Section 3003: Expansion of Medicare’s Physician Feedback Program 
Section 3007: Application of Medicare’s Value-Based Physician Payment Modifier (VBPM) to Physicians Payments 
Section 3022: Medicare’s Shared Savings Program for Accountable Care Organizations
Section 3023: Bundled Payment Pilot 

The goals of these experiments are to reduce costs (in large part by limiting tests and procedures) and to improve the quality of care by “rewarding value” rather than the number of services delivered. 

The problem? Federal government bureaucrats, not health care professionals, are the ones defining quality treatment. And when health care providers don’t attest to their compliance with government-approved standards, they’re penalized.

This is what ophthalmologist and Obamacare rebel Kris Held means when she refers to the law’s perverse incentives that shift focus away from what’s best for the patient to what’s best in the eyes of The System’s cost-cutters.

As physician editor of The Hospitalist Danielle Scheurer cautioned last year, “there is a legitimate concern that physicians will be overwhelmingly motivated to play to the test, so that their efforts to perform exceedingly well at a few metrics will crowd out and hinder their performance on unmeasured metrics. This tendency can result in lower-value care in the sum total, even if the metrics show stellar performance.” 

And lower-value care is just what Dell Stone received, thanks to bureaucratic interference with her treatment. When her triglyceride levels tested alarmingly high, her physician clicked the boxes in his electronic health record and prescribed heart medications, including a potentially dangerous statin drug. And due to the drive to keep testing expenses low, a second lipid panel had to wait.

Thankfully, when Ms. Stone returned to her cardiologist two weeks ago, her three-month wait paid off and she was granted a retest. This time her triglyceride reading was 67.

So, yes, Mr. Young, Obamacare did cause harm to this senior — and is in the process of harming countless others. 

When The System begins experimenting with your grandmother’s care, Mr. Young, will you bother to research Obamacare a bit more?