The document discusses how the US healthcare delivery system has failed and who controls healthcare. It provides a brief history of how health insurance companies became involved with unions and the government, leading to rising costs and loss of individual control over healthcare decisions. The author argues that healthcare should be controlled by individuals and their doctors rather than insurance companies, drug companies, or the government, and that the Affordable Care Act will reduce individual choice and control.

1. Health Care
Delivery System
in America has
Failed
By
Andy Edley
JE Health Care Solutions
http://jehealthcaresolutions.com
http://jehealthcaresolutions.blogspot.com
Independent Rep. For: Renco Direct
contact
jehealthcaresolutions@gmail.com
865-357-3379

2. ALL RIGHTS RESERVED
If you find this report is helpful to you and it could help others, please
feel free to pass it on to your friends and family.
DISCLAIMER AND/OR LEGAL NOTICES
The information presented herein represents the views of the author
as of the date of publication. Because of the rate with which
conditions change, the author reserves the right to alter and update
his opinions based on the new conditions. This report is for
informational purposes only and the author does not accept any
responsibility for any liability resulting from the use of this
information. While every attempt has been made to verify the
information provided here, the author cannot assume any
responsibility for errors, inaccuracies or omissions. Any slights of
people or organizations are unintentional.
Copyright © Andy Edley (September 2011)
The purpose of this e-book is to give you information and resources
you can use to decide who is going to Control your Healthcare; you, or
someone else? The Insurance Companies or the Government? I hope
it will also help you understand and learn ways to control your cost.

3. TABLE OF CONTENTS
Preface: How We Got Here
Page 8) Chapter One: How Cost Of Health
Insurance Has Risen
Page 10) Chapter Two: Do We Need Our Health
Care Delivered?
Page 12) Chapter Three: Who Controls Your
Health Care?
Page 14) Chapter Four: Who Takes Your Health
Care Dollar And Why?
Page 18 ) Chapter Five: Affordable Healthcare
Act (Obamacare) How It
Effects Your Healthcare
Page 23 )Chapter Six: Get Out While You Still
Can “A Solution”

4. How We Got Here
I want to start by giving you a little history lesson on How the Health Care Delivery
System started. I will be using BCBS as the example since they were the first one and
you can find this information at: http://www.bcbs.com/about/history
I would like you to pay close attention to a few of the time line dates. The first one is
1935, the next one is 1950, then 959, 965, 973, 997, and of course. 2010. the year of
Obamacare. You will notice as the years go by, the Insurance industry, Labor Unions,
and Government got closer and closer. This is why the insurance companies like
Obamacare; it forces everyone into a third -party payer system, which is what a Health
Care Delivery System is all about. Remember, by controlling your health care, they
control you.
1929: The prototype prepaid hospital plan, upon which Blue Cross Plans were later
based, is created at Baylor University in Dallas, Texas, established by Justin Ford
Kimball. In just 10 years, enrollment in Blue health Plans will grow from just more than
1,300 covered lives to 3 million.
On December 27, 1933, America's first "Blue Cross Baby" was born in Durham, North
Carolina. The entire cost of her delivery and her mother's 10-day hospital stay totaled
$60. This birth was the first in America to be covered by a health insurance family
certificate that included maternity benefits.
1935: The Social Security Act is passed, omitting health insurance. The National Labor
Relations Act, requiring management to bargain with labor over "wages and conditions"
is enacted and will become a catalyst for employer-based health benefits.
1944 : Unemployment drops to 1.2 percent. Under normal conditions, employers would
have lured workers from competitors with higher wages. However, during the World War
II years, price and wage controls were strictly enforced. To compete for workers,
employers began to offer health insurance benefits, giving rise to the employer-based
system -- still largely in place today.
1949: The Inter-Plan Service Benefit Bank is created as a coordinating mechanism to
provide coverage for subscribers who were hospitalized away from home.
1950: The groundbreaking "U.S. Steel Agreement" went into effect between United
States Steel Corporation, the Carnegie Pension Fund, and Blue Cross of Western
Pennsylvania. The role played by the Pittsburgh-based Plan -- the "control Plan" that
coordinated administration of benefits by local "participating Plans" -- becomes the
linchpin of the Blue System's ability to serve large national accounts.
NOTE: This is where the insurance companies got involved with the unions and third
party payer took off.

5. 1955: The spread of health insurance coverage-- from less than 10 percent of the
population having coverage in 1940 grows to nearly 70 percent in 1955.
1959: Congress enacted the Federal Employees Health Benefits Act and the first FEP
open enrollment period was held a year later. Today, FEP covers more than 4.8 million
federal employees, retirees, and their families.
NOTE: This is where insurance got involved with Politicians. This was a bad idea
because politics and health care should never be mixed.
1960: Associated Medical Care Plans is renamed Association of Blue Shield Plans.
1965: The Medicare and Medicaid programs are created. Launching a massive program
like Medicare would have been prohibitive without the established Blue Cross and Blue
Shield infrastructure. In the five years following Medicare's inception, Blue Cross
processed 63.4 million claims, totaling approximately $19.2 billion. In 2001, the Blue
System continued to process the overwhelming majority of Medicare.
NOTE: Just a personal note here, my mother, who was an RN at the time, said that this
would end up destroying health care in this country. She said that having the
government involved in health care would never work. I think she was right.
1973: The Health Maintenance Organization Act provided federal grant and loan money
to help HMO's get off the ground and contained broad language about benefits that had
to be provided.
NOTE: More government involvement using tax money to support what should have
been a private business function.
1996: Blue Cross and Blue Shield Plans, PPO, POS and HMO, enrollment reaches 37.5
million, surpassing the 30.4 million members in traditional coverage.
1997: The Balanced Budget Act is enacted, which added the Medicare+ Choice
program allowing beneficiaries to choose additional types of health plans.
NOTE: This is more government involvement.
2001: Blue System processes the majority of Medicare claims at a total of $163 billion.
2003: Blue Cross and Blue Shield system-wide enrollment reaches all-time high. More
than 88 million Americans - nearly one-in-three – have BCBS coverage.
2005: Blue Cross and Blue Shield system-wide enrollment reaches 93 million
Americans. Nearly one-in-three have BCBS coverage.
2006: The BlueCard® Program processed more than 194 million claim transactions, up
from 182 million in 2005.

6. 2009: Blue Cross and Blue Shield system-wide enrollment reaches more than 100
million Americans.
NOTE: I hope this has given you a little background information on how the insurance
companies developed their third-party payer system. This is also why they backed
Obamacare; because it meant everyone would have to buy health care insurance. It is
strange that these same insurance companies got Obamacare waivers from something
they thought was such a great thing for the rest of us.
CPT CODES
Now I want to give you some history on the CPT Codes. These are the 5 digit numbers
you see on the form the doctor fills out when you go for a visit. You also see them on
the paperwork you get from your insurance company when you have a claim. The AMA
owns the Copyright to these codes.
CPT was first developed and published by the AMA in 1966.
The purpose of the system was to standardize the categorization of the types of
services provided by physicians.
In 1983, HCFA, now CMS, mandated CPT for Medicare billing
**CPT (Current Procedural Terminology) codes are numbers assigned to every task and
service a medical practitioner may provide to a patient, including medical, surgical, and
diagnostic services. They are then used by insurers to determine the amount of
reimbursement that a practitioner will receive by an insurer. Since everyone uses the
same codes to mean the same thing, they ensure uniformity.
CPT codes are developed, maintained, and copyrighted by the AMA (American Medical
Association.) As the practice of health care changes, new codes are developed for new
services, current codes may be revised, and old, unused codes are discarded.
Thousands of codes are in use and they are updated annually. Development and
maintenance of these codes is overseen by editorial boards at the AMA and the
publications of all the software, books, and manuals needed by those who use them,
brings millions in income (*see note below) to the AMA each year.
Examples of CPT Codes:
 99214 may be used for a physical
 90658 indicates a flu shot
 90716 may be used for chicken pox vaccine (varicella)
 12002 may be used to stitch up a one-inch cut on a patient's arm
If you use Medicare, you'll see CPT codes, but used a bit differently. Medicare uses
HCPCS codes (Healthcare Common Procedure Coding System.)

7. Matching CPT Codes to the Services They Represent
As patients, our interest in these codes is usually related to our doctor's and insurance
billings. Until recently, it was difficult to find out what certain CPT codes meant without
contacting your insurance company or doctor's office.
You won't find a freely-available, comprehensive list of CPT codes because the AMA
controls their publication. Groups that have tried to make them available for free to the
public have been cited for violations, fined by the AMA, and have been forced to remove
them from the Internet. Since the AMA developed and copyrights the system, it has a
right to make sure access to these lists is paid for. It licenses CPT code lists to groups
who wish to publish the codes to make them available to others. Those groups then
charge a fee for access, too.
We patients don't have the large sums of money needed to subscribe to websites or
purchase publications that list CPT codes. To make them more accessible to us, the
AMA does provide on its website a means for looking up the individual CPT codes you
might find on your doctor's bills or EOB's (Estimates of Benefits).
Learn more about where to find CPT codes, what they look like, and find the links to
look them up for free.
*(Note about the AMA's income from CPT codes: The amount the AMA makes from
CPT codes each year is in dispute.)
** Information found at About.com patient empowerment by: Trisha Torrey

8. CHAPTER 1
How Cost Of Health Insurance Has Risen
This information is from the Kaiser Report (EMPLOYER HEALTH BENEFITS 2010
REPORT) You can get the full report HERE.
The key findings from the 2010 survey, conducted from January through May 2010,
include increases in the average single and family premium, as well as in the amount
workers pay for coverage. About a quarter (27%) of covered workers have a deductible
of at least $1,000 for single coverage and a greater proportion of workers are enrolled in
high-deductible health plans with a savings option (HDHP/SO) than in 2009. Firms
responded that they increased cost-sharing, or reduced the scope of coverage, or
increased the amount workers pay for insurance as a result of the economic downturn.
The 2010 survey continues to track the percentage of firms offering wellness benefits or
health risk assessments and also included questions on health plan quality indicators
and benefit changes made as a result of the Mental Health Parity and Addiction Equity
Act.
The average annual premiums for employer-sponsored health insurance in 2010 are
$5,049 for single coverage and $13,770 for family coverage. Compared to 2009,
premiums for single coverage are 5% higher ($4,824) and premiums for family coverage
are 3% higher ($13,375). Since 2000, average premiums for family coverage have
increased 114%. Average premiums for family coverage are lower for workers in small
firms (3–199 workers) than for workers in large firms (200 or more workers), ($13,250
vs. $14,038). Average premiums for high-deductible health plans with a savings option
(HDHP/SOs) are lower than the overall average for all plan types for both single and
family coverage. For PPO's, the most common plan type, the average family premium
topped $14,000 annually in 2010.
As a result of factors such as benefit differences and geographical cost differences,
there is significant variation around the average annual premium. Twenty percent of
covered workers are in plans with an annual total premium for family coverage of at
least $16,524 (120% of the average premium), while 19% of covered workers are in
plans where the family premium is less than $11,016 (80% of the average premium).
In 2010, covered workers contributed a greater share of the total premium, a notable
change from the steady share workers have paid on average over the last decade.
Covered workers on average contribute 19% of the total premium for single coverage
(up from 17% in 2009) and 30% for family coverage (up from 27% in 2009). As with total

9. premiums, the premium shares contributed by workers vary considerably around these
averages. For single coverage, 28% of workers pay more than 25% of the total premium
while 16% make no contribution.
Fifty-one percent of workers with family coverage pay more than 25% of the total
premium; only 5% make no contribution. Looking at dollar amounts, the average annual
worker contributions are $899 for single coverage and $3,997 for family coverage, up
from $779 and $3,515 respectively in 2009. Workers in small firms (3–199 workers)
contribute about the same amount for single coverage as workers in large firms (200 or
more workers), ($865 vs. $917), but they contribute significantly more for family
coverage, ($4,665 vs. $3,652).
NOTE: There was another 10% increase in cost in January 2011. There is no sign that
these increased costs are going to slow down anytime soon. Individual plans have
followed suit in cost increases.

10. CHAPTER 2
Do We Need Our Care Delivered?
Or Do We What Quality Health Care?
Before we get into this chapter I would like you to take a little quiz and test your
knowledge of the healthcare delivery system we now have. Click here to take the
quiz.
Now that you have taken the quiz, how did you do. If you did not do well then you are in
the majority because most people have know idea how the system works. What I am
trying to do is help you forget the health insurance company, AMA, drug company,
media and government propaganda we have been fed for the last 50 or so years and
begin to uncover the truth. This not your fault because we have all been sold a bill of
goods and now the system is broke, and they are trying to tell us more healthcare
delivery will fix the problem.
So What is health care delivery? The best way to describe health care delivery is
health insurance companies gone rogue. Instead of being and doing what insurance is
supposed to be and do, they have become the source for all health care. Instead of
providing a safety net for large hospital expenses, they have picked our doctors, our
drugs, our hospitals, our diseases and our eventual demise - all because of money.
Don't get me wrong, I am a capitalist and an entrepreneur. I believe in making money,
profit, doing well and most importantly doing good. The health insurance companies
long ago ceased doing good.
The problem comes when it's all about the money and not doing the right thing. When
through coercion, deception and corruption an entity or a group of entities becomes so
obsessed with making money that human life and the quality of life become a distant
second or even a third or fourth priority.
Instead of being there to pay for large bills, like any other kind of insurance, the health
insurance companies have taken it upon themselves to run every portion of our health
care from picking our doctors all the way to ending our lives once the cost of keeping us
alive becomes too steep.
And now we have the Government wanting to do the same thing with their panel of 15
un-elected government worker bees deciding what treatment you can have and what
treatments are the least expensive, rather than which are best for you. They also want
to control what your doctor gets paid, and when to just knock you out with drugs it you
start needing to much care. This is what Obamacare does for you.

11. This is what healthcare delivery is, someone else making medical decisions for you,
instead of you and your doctor. I for one want to make my own decisions with my
doctor and nobody else. HOW ABOUT YOU.

12. Chapter 3
Who Controls Your Health Care?
Who Should Control Your Health Care?
Where do I start, I seems everybody but you is in control of your health
care.
There are four groups controlling your health care and the cost.
1. Insurance companies
2. Drug Companies
3. AMA
4. Government
For over 50 years the insurance companies have been working to control your health
care by convincing us that you have to have health care insurance. They have done
this by working with unions, Governments (Local, State and Federal) and thru
commercials on radio and TV. By convincing us that a “third party payer system” well
offer the people the best health care possible at the lowest cost. Well we know now
that this is not true. What has happen is we now have a health care delivery system
controlled by the insurance companies and others and no control by the patient or the
doctor. I am sure you have noticed how people from other countries come to the US for
medical treatment at least those that can afford it, because they can get the best
treatment in the world here. The difference is they pay cash for their treatment. So
when some political figure says our health care is not good here in America they are
lying to you, because we have the best medical care available in the world. What is not
working is the health care delivery system we have. Our health care should never be
controlled by anyone but ourselves and our doctor’s.
Drug companies are also helping in controlling your health care. Have you
noticed all the commercials on TV and ever where else about this or that new
wonder drug. So people self diagnose themselves and go to their doctor and
want a prescription for this wonder drug that is going to cure what ever. The
problem is they don’t cure the problem they treat the symptoms an cause new
problems. Half of these commercials are used to explain all the side effects they
may cause. Did you know for a new drug to get FDA approval it must be toxic to
the body?
So when you go to the doctor for your new wonder drug guess who makes
money? It is now you! The cycle starts all over again the doctor files an
insurance claim the drug store files a claim and the insurance company makes

13. more money off of you. Remember for every dollar you pay for health care
insurance you get 25 cents worth of service and the insurance companies and
drug companies and others get a part of the other 75 cents.
Have you noticed no one talks about curing a problem? All we here is lets treat
the problem with this drug or that drug. Drug companies send billions of dollars
pushing their drugs to doctors and the public. When you are at your doctors
office how many drug companies reps. Are there waiting for their turn to show the
doctors the latest and greatest drug out. This process starts while the doctors
are still in medical school and this is how they are taught, this is how the system
is suppose to work. There is no profit in curing someone only in treatment.
After the billions that the American Tax payer has poured into this research group
or that research group you would think they could come up with a CURE for
something. Don’t get me wrong we need to do research, but should we not whole
someone responsible to produce something that is a CURE, not just another
treatment that cost some outrages amount of money. Have you noticed doctors
always say we can treat this with this drug or this drug but never say we can cure
the problem. CURE is the dirty four letter word to the health care delivery system.
The AMA controls your health because they control all the Medical schools and
how or doctors are trained. Our Doctors are taught from the beginning the way to
build a practice is sign up with as many insurance companies as they can and
see as many patients as they can. This is why your doctor spends so little time
with their patients because to be able to keep their practice open they have to see
as many patients as they can do to how they get paid by the insurance
companies. They are also have to deal with the Drug Company reps. On a regular
basic while the are still in medical school.
Also remember the AMA owns the copyright to all the CPT codes that I talked
about in the preface, so they make money every time you go to see your doctor
are get a prescription filled, or go to the hospital.
Now for the fourth group that has a hand in controlling our health care. The
Government. This all started back in 1959 when Congress enacted the Federal
Employees Health Benefits Act and the first FEP open enrollment period was held
a year later. Today, FEP covers more than 4.8 million federal employees, retirees,
and their families. It got worst in 1965 when The Medicare and Medicaid
programs were created. Launching a massive program like Medicare would have
been prohibitive without the established Blue Cross and Blue Shield
infrastructure. In the five years following Medicare's inception, Blue Cross
processed 63.4 million claims, totaling approximately $19.2 billion. In 2001, the
Blue System continued to process the overwhelming majority of Medicare claims.
2010 Now we have the healthcare reform law (Obamacare). This is the complete
take over of the healthcare delivery system. Who is going to benefit from this the

14. most, the insurance companies, drug companies and the AMA. That is why they
backed Obamacare. But like the Congress they did not read the bill before it was
passed and now they are getting waivers so they don't have to deal with it. Also
the unions are getting waivers and they backed this disaster as well. I guess the
old saying be careful what you wish for is still true. The only real answer is to get
educated and take control of your own healthcare.
This is what happens when you have third-party payer system like we have in this
country. It is also why a third-party system does not work well. To many people
look at it as a way to make money instead of delivery of the best health care
controlled by the patient and their doctor.
All of this information is out there you just have to take the time to find it. A good
place to start is Care Liberty and I strongly urge you to get educated on what is
really going on with our health care system. Both for yourself and your family’s
health.

15. Chapter 4
Who Takes Your Health Care Dollar And Why?
Did you know that for every dollar you pay for healthcare insurance on average you get
about 25 cents worth of actual patient care. Yes there are exceptions to this but this is
what the average is. That means 75 cents is going to somebody else. So, whose else
as their hand out for their part of this 75 cents? Well to answer that question lets look at
what happens to your healthcare dollar.
The following data is extrapolated from Mutual of Omaha's Annual report on Healthcare
utilization & cost.
ABC co. inc. insures 100 employees. The national Average for a single person is
$5000 per year. Cost to the company is $500,000.00 for the 100 employees. On
average 90 employees will get about $450.00 annual benefit, 3 employees will get
about $5000.00 annual benefits and 7 employees will need be hospitalized.
Average cost for a hospital stay is $30,000.00 of which the insurance co. will pay an
average of $10,000.00 after they take there provider network discount. So company
wide average benefit paid out is $125,000.00 annually. This means only $.25 of each
dollar paid out in premiums goes to your actual healthcare.
Health Insurance premiums have increased over 100% since 2004, yet Doctors
reimbursements have decreased 40%, hospitals reimbursement have kept pace with
inflation. So if the doctors and hospitals aren't getting it where does it go.
Most people want to blame the insurance companies, and then the politicians start a
push for more laws. The real truth is there are to many laws already. Insurance
companies are so regulated already there is no way they can operate in a free market.
So what happens we get Obamacare which means now the government and insurance
companies now will control your health care. They now decide which doctors you can
see, what hospitals you can use, what treatment you can have and which drugs you can
have. Add to that the 15 person UN-elected panel and you have a health care system
that puts cost before patient care. They now are telling the insurance companies what
they have to cover at no cost to the patient. What do you think is going to happen to
healthcare insurance rates? Someone is going to have to pay for all of these new
programs.
The fact is quality health care is not free. Doctors deserve to be paid
what they are worth and need to be free to treat their patients with out interference from
outside. This is what they spent 8 or more years of their lives in school for. Hospitals
need to be paid fairly as well, are they will have to close their doors.

16. So who is taking your healthcare dollars.
When you or your employer pay the insurance premium to the insurance company your
dollars are no longer yours but belongs to the insurance company. So how is it spent?
So lets see what happens to your insurance dollar after you or your employer pays the
insurance premium.
1. The Insurance Company now as control of your insurance dollar.
2. Risk Group: ( Employer Group) These are the people in your group that are
sick, because it is a guarantee issue group policy.
3. Government: This all the laws, regulations, political contributions. Taxes, fees
etc.
4. Labor: Because of labor unions in hospitals, cost or driven up. Labor union
demands for high cost insurance plans drive up cost.
Things like low co-pay, low cost prescriptions, etc.
5. Government Programs: Medicare, Medicaid reimbursements from your policy
have to go to help cover the under payment from these programs.
6. Big Disease: These are non-profit and puts mandates on
every ones policies. Things like cancer, heart disease, COPD, etc. Your
premiums reflect these cost because all of these have to be covered for
everyone.
7. Drug Companies: The drug companies have put themselves between you
and your healthcare dollar by marketing directly to you with adds for the
next miracle drug so you will self diagnose and run to your doctor and ask
for their drug by name.
8. Attorney's: These are the tort attorney's that are waiting for your doctor to
make a mistake. Malpractice insurance is built into your doctor's cost of
doing business, but this forces them to do Unnecessary test just to cover
themselves against the attorney's.
9. Billings and Collections: This would not be need if it weren't for insurance
companies. Billing is needed to handle the paper work involved with filing
insurance companies. Collections are needed because remember the
insurance company can deny your claim and they have to collect from
you.
All of these entries are between you and your doctor thus your healthcare.

17. Now let's look at hospitalization and what else is between you and your healthcare
dollar. Remember this all of the above as well.
1. Claims: A lot of claims are denied or delayed. The claims job is to
save the insurance companies money by denial or delaying claims.
2. Case Manager: The case manager's job is to approve the lease
expensive treatment and the doctor with the lowest bid.
So where is all the savings going it is not going to you or me remember or premiums
have increased 100% since 2004 and the doctors are being paid 40% less and the
hospitals are barely keeping up with the rate of inflation. The truth is this money is
going everywhere but where it should, OUR HEALTHCARE. Now we get Affordable
Healthcare Act (Obamacare). This will allow the government to take control of this
of the complete health care delivery system. Chapter 5 will go in-depth on this. There
is a solution that we will go in-depth about in chapter 6.

18. Chapter 5
Affordable Healthcare Act (Obamacare)
How It Effects Your Healthcare
and Medicare
In this Chapter we will look at how the Affordable Healthcare Act will effect your
healthcare and Medicare both in cost and quality of care. I must admit that I am totally
against the government being involved in our health care in any way. All you have to do
is look at the history of the government involvement in health care and you see total
failure, both in keeping cost down and improving quality of care. Anytime you mix
politics with healthcare you are going to end up with what we have now. It is bad
enough having insurance companies deciding what treatment they will pay for or not,
now we are going to have a panel of 15 people appointed by the president making
those decisions for you. I know the politicians say this will control cost but it is not their
job or right to make medical decisions for you are your family. That needs be left to you
and your doctor and know body else. What I will be giving you is a lot of reference
information from people a lot smarter then I am, this way you can reach your own
decisions about this law.
For those interested in reading the Affordable Healthcare Act passed by congress, Click
Here to get a PDF copy. It is 906 pages long.
How this law well effect healthcare delivery is just now starting to show up and so far it
is not good. Cost have already risen from $12,680 in 2008 to $13,770 in 2010 for family
coverage according to the Kaiser Foundation 2010 Report.
Phil Galewitz covers Medicaid, Medicare, long‐term care, hospitals and various state
health issues. He has covered the health beat for nearly two decades. He is a board
member of the Association of Health Care Journalists and Health News Florida, a
nonprofit news service. In 2004‐05, he was a Kaiser Media Fellow and wrote about
community solutions to the uninsured. Before coming to KHN, he was at The Palm
Beach Post and was a national health industry writer for the Associated Press and The
Patriot‐ News in Harrisburg, Pa. He has a BA in health planning and administration and
a master's in public administration with an emphasis in health policy. | Contact:
PGalewitz@kff.org
I highly recommend you go to his site by clicking on his name below. He has a lot of
articles on healthcare that I think are worth reading.
Article by: By Phil Galewitz Nation’s Health Care Bill To Nearly Double By 2020

19. QUOTE:
The federal health law, which will expand coverage to 30 million currently uninsured
Americans, will have little effect on the nation's rising health spending in the next
decade, a government report said today.
The report by the Medicare Office of the Actuary estimated that health spending will
grow by an average of 5.8 percent a year through 2020, compared to 5.7 percent
without the health overhaul. With that growth, the nation is expected to spend $4.6
trillion on health care in 2020, nearly double the $2.6 trillion spent last year.
Article by: By Merrill Goozner, The Fiscal Times: Rising Health Care Curve Won’t
Bend, Even for Obama
QUOTE:
A forthcoming report from the Congressional Budget Office shows that more than
two dozen demonstrations projects launched by Medicare and Medicaid over the
past decade have failed to stop the upward march of health care costs, CBO
director Doug Elmendorf said Tuesday. But health care policy experts say the
findings paint too gloomy a picture.
The CBO pronouncement will heighten pressure on politicians from both political
parties to come up with new health care cost savings beyond those contained in
the health care reform bill, whether as part of the current debt ceiling talks or in
separate legislation. Federal spending on Medicare and Medicaid totaled $739
billion in 2010, making health care the single largest budget item in the federal
budget. Those costs are expected to nearly double in the next decade.
The article below is another reason why Government and Healthcare should
never be mixed. Based on the Law insurance companies can raise their rates
9.9% per year without having to justify the rate increase. What will the cost be to
you it this happens each year.
Written By: Edmund F. Haislmaier
Published In: Health Care News > August 2011
Publication date: 07/08/2011
Publisher: The Heartland Institute

20. Defund Obamacare’s Insurance Rate Reviews
The recently published U.S. Department of Health and Human Services regulations for
implementing Obamacare’s health insurance rate reviews, effective September 1, are
another instance of the arbitrary and politically manipulated regulations that inevitably
result when Congress enacts vague, subjective, and aspirational legislation rather than
clear, objective, and specific statutes.
Political Pressure on Premiums
These rate-review provisions were an entirely political exercise from the start. They
were only added to Obamacare in the fall of 2009—after the health-insurance industry
had the temerity to point out other provisions of the legislation would drive up premiums
—in order to give HHS authority to review so-called “unreasonable” premium increases
(but not the authority to block those increases, nor did it provide a definition of
“unreasonable”). Blame for Obamacare’s inevitable cost increases could thereby be
deflected onto insurers.
These provisions have negative practical implications. For example, the proposed rule
setting an arbitrary 10 percent price-increase threshold could cause insurers to target
rate increases to just below the limit. One well-documented effect of price controls is
that sellers respond to the imposition of price “ceilings” by turning them into price
“floors.” The less competitive the market on which price controls are imposed, the
sooner that phenomenon occurs.
Guaranteed Inflation
Under these regulations, any rate increase of 9.9 percent or less will not trigger a
burdensome, publicized federal rate review, so why should an insurer limit a rate
increase to, say, 6 or 7 percent? Theoretically, competitive pricing pressure might
discourage such behavior. But these and other Obamacare insurance regulations will
reduce competition by driving smaller carriers out of the market, and after 2014 the
remaining insurers will be selling to customers who are required to buy their products.
Thus, the perfectly rational response will be for the remaining insurers to have 9.9
percent annual premium increases ad infinitude.
Ignores Insurer Solvency
These regulations are contrary to even the legitimate purpose of insurance-rate
supervision, which is to make sure carriers charge high enough premiums to cover their

21. claims costs. In a competitive insurance market, regulators don’t have to worry much
about possible “price-gouging,” since competition checks such behavior. However,
regulators do need to be concerned about insurers trying to attract more business by
under-pricing coverage while complacently underestimating their future losses—the
actuarial equivalent of “rosy scenarios.”
The danger is that if premium income isn’t sufficient to cover claims costs, an insurer
risks becoming insolvent. That harms everyone, including policyholders or taxpayers
who can be left liable for claims the insurer can’t pay.
Thus any rate-regulation regime that focuses only on holding down rates while ignoring
insurer solvency is inherently dangerous. HHS admits this is a serious flaw in the
statute: “We acknowledge that inadequate rate increases can be problematic,” but it
blithely dismisses those concerns, arguing the statute “does not identify adequacy
among the criteria to be considered when determining unreasonableness.”
Case for Defunding
Fortunately, this bad idea is one of many in Obamacare that can be defunded. Included
in Obamacare’s $105 billion of advanced appropriations was $250 million for HHS to
distribute in grants to state insurance regulators to implement stricter rate regulation.
The purpose of those grants is to bribe state insurance departments into enforcing
Obamacare’s new federal price controls.
Last summer, HHS distributed $46 million of that $250 million to 45 states and the
District of Columbia ($1 million to each) in the first round of rate-review grants. HHS
says it intends to award a second round of grants in the fall. Congressional
appropriators should intervene and rescind at least the remaining $204 million
earmarked for rate-review grants.
The five states that did not apply for the first round of grants (Alaska, Georgia, Iowa,
Minnesota, and Wyoming) should continue to refrain from doing so, and states that
received the initial funding should follow the lead of Oklahoma’s Insurance Department
and return the money. Doing so is in the interests of state lawmakers, who should want
to preserve the independence and integrity of their state insurance departments in light
of the inherent conflicts that will arise between the new federal rate regulations and
existing state insurer-solvency laws.
Edmund F. Haislmaier (ed.haislmaier@heritage.org) is a senior research fellow in the
Heritage Foundation’s Center for Health Policy Studies. Article reprinted with
permission from heritage.org.
See more articles by Edmund F. Haislmaier
These are just a few articles about Obamacare and what they show is that a one size
fits all government answer will not work and that as long as the insurance companies
and politicians are involved with each other there are going to be major problems. What

22. we need is a free market program where patients drive our health care, both in cost and
quality.
Now I what to look at the State insurance exchanges that this Law set up. We don't
know yet exactly how they will work but I do have an example from one State that has
exchanges set up. A Client in Utah had to buy through their exchange. She is paying
$500 per month for a policy that has a $5000 deductible per year and does not pay
anything until she has paid that $5000 on her health care. That means It is costing her
$6000 a year plus the $5000 deductible or $11,000 before the insurance pays anything.
If this is an example of the exchanges then we are all in for lot of out of pocket expense
for healthcare. The Insurance wants these exchanges because it will help them not to
have to pay commissions to the insurance agents that sell health care insurance. So
you have another group that will be hurt by this Law.
You may say I have employer-based healthcare insurance, Well I am now seeing
reports that as many as 30% of business are saying they will drop their group plans
because of the high cost. It will save them on their overhead to pay the fine rather then
continue to pay the high cost of insurance. This will force more people into the
exchanges which will put a larger burden on the government, other words more cost to
the taxpayer. If you work for a company that has less then 50 employees than they are
exempt from this regulation, and don't have to offer health-insurance.
The main point here is that we all need to become better informed when it comes to our
healthcare. Another words we need to take responsibility for our own healthcare and
quite relying on a third party to do this for us.

23. Chapter Six
Get Out While You Still Can
A Solution
In Chapter 4 I showed what happens to your health insurance premium dollars, now I
want to show you a better way to have complete control of your health care dollars, as
well as your health care.
So what do we do to solve this problem?
Find a program that lets you pay cash for your doctor visits at an affordable price.
That is where Renco Direct comes in. With this program you become a member
of Renco and this will allow you to pay the same PPO Allowable rate that the
insurance companies have been paying for over 50 years. This works both for
you and your Doctor. You pay the PPO allowable at the time of your visit and the
Doctor does not have to file a insurance claim and wait for his money. This is a
win win situation for both you and your doctor. Also medical decisions are based
on your medical needs and not what an outside agency be it government or
insurance company decides is best for you or your family. Because this program
is a non insurance plan no one is turned down due to pre-existing conditions, and
no one is going to deny or delay your treatment. Since you are not filing
insurance claims your medical care is you and your doctor's business and
nobody else.
The Renco Direct also concludes many more savings programs
such as Prescription discounts, Vision, Dental, Consult a Doctor, Chiropractic
Care, and more.
The Renco Direct program works well if you have existing healthcare insurance policy
that you like and want to keep if you could get your rate lower. By increasing your
deductible to say $7500 or even $10,000 which will reduce your cost, and using Renco
for your regular office visits and having the health insurance policy to take care of the
major problems. Another option is to combine Renco with an accident or critical care
policy which are much less expensive.
For more information on how JE Health Care Solutions can help you with answers
tailored to your family or business needs please contact us a
jehealthcaresolutions@gmail.com or call 865-357-3379.
I hope the information I have given you in the e-book will help you in getting answers
that make sense in your health care decisions.
Andy Edley