Dr. TonyMag

In the first week of May 2013, Gov. Huckabee felt that because of the administration's reaction to the Benghazi attack on our consulate in Libya, President Obama will have to resign before his second term expires. Let's review some of the facts that are known about the Benghazi attack on September 11, 2012.
First, for many months preceding the September 11,2012 attack, it is known that there were several attacks on both the British on June 11,2012 and the International Red Cross on May 22,2012 in Benghazi that were initiated by Islamic extremists and those who claim to be part of Al Qaeda. Therefore, Benghazi, Libya was not a safe place for foreigners.
Second, it is also known that for many months preceding the September 11, 2012 Benghazi attack,  there were multiple requests for added security; in terms of the number of the American security forces protecting the government officials in both Benghazi and Tripoli,Libya.
Third, it is also now known that on the night of the attack when Ambassador Stevens and three other Americans were killed, a high-ranking official either in the administration or military made a decision not to send any military personnel to help quell the assault on Americans in Benghazi by Islamic extremists with Al Qaeda.
Fourth, it is also now known that the administration and members of the State Department made at least 11 revisions of the CIA talking points regarding the assault on Benghazi by Islamic terrorists. This resulted in UN Amb. Susan Rice going on five TV shows on the Sunday following the attacks and claiming that these attacks were caused by an anti-Muslim video. We now know that this is completely false and were fabricated by the administration in an attempt to show that the Obama administration was successful in getting rid of the threat of Al Qaeda in the world. This was obviously done in order to portray Pres. Obama as strong on foreign affairs and therefore make it more likely for him to be reelected.
Fifth, it is now known that the Obama administration and the State Department under Sec. Hillary Clinton were involved in covering up this deception claiming the attack on the consulate in Benghazi was caused by a video.
Lastly, it is now known that anybody who did not want to go along with this cover-up, were either instructed to be quiet, threatened with demotion and/or intimidated.
 Now, note that it was just 15 years ago when President Clinton was felt innocent by the press until DNA evidence on a dress was found which proved President Clinton lied to the American people and under oath. This resulted in Pres. Clinton being impeached by the house and for political reasons was then not impeached by the Senate. Also, Pres. Nixon had to resign because of his lying to the American people about his knowledge of a burglary (Watergate) and then subsequent cover-up.

So, when a Republican president lies and covers up, he resigns. When a Democratic president lies and covers up he's able to finish his term. Therefore the standards for a Republican are obviously different than that for a Democrat.
This then leads us to the question of how the Benghazi assault will affect Pres. Obama. It is obvious to anybody with common sense and honesty that Pres. Obama and Hillary Clinton and many others in his administration have lied and engaged in a cover-up for political gain. It is sad that American lives were sacrificed for the political gain of the Obama administration and for Hillary Clinton's potential future run for presidency in 2016. But, from their perspective the ends justify any means. Also they are comforted by knowing that the press will do anything they can to help the cover-up. The press, since Pres. Obama has been in the White House, has acted as a fourth branch of government protecting this Pres. Unfortunately, the press is not protecting the interests of the American citizen but is rather protecting the interests of a political candidate and that candidate’s ideology.
In the future, there will be further evidence that Pres. Obama and Sec. Hillary Clinton lied about what happened in Benghazi and about how inadequately prepared they were for potential assaults on the anniversary of 9/11. It is apparent to me that Pres. Obama will never admit that he had any wrongdoing in the Benghazi assault and cover up and he also will not resign over this issue. It is my belief that they will not be any impeachment hearings unless other impeachable offenses occur during his administration. As we know there's now a question of who ordered the IRS to investigate tea party members and those political adversaries of the Obama administration. So there may be many more impeachable offenses arising in the near future in the Obama administration.
As far as the effect on Sec. Clinton, I still believe that there is a 50-50 chance that she will be the Democratic nominee for the presidency in 2016. In 2008, she was a favorite to win her party's nomination and was overcome by a then unknown Sen. Obama. In Hillary Clinton's mind, she does not believe she has done anything wrong and she believes she is a very honest person, which like her husband is untrue and dangerous for Americans.
Gov. Huckabee is too optimistic that the Benghazi hearings will result in Pres. Obama resigning from the presidency. However, there are positives that result from the hearings.
1. These hearings will definitely result in some of the press and some more Americans distrusting this Pres. This will result in an inability for him to push his agenda through without significant resistance. Therefore there will be less social reform and entitlements during the remainder of his presidency.
2. Hillary Clinton will also have some issues of trust and this may enable another candidate to defeat her either in the primary or general election in 2016.

Stating that our current president governs is risky since many believe that Obama does not govern but constantly campaigning. He is successful in campaigning because it is easier to demonize your opponent with falsehoods to win an argument than to debate honestly with actual accomplishments as a basis for your argument. President Obama put forth little effort in passing Obamacare (The Affordable Care Act) since he had a supermajority of Democrats in both the Senate and the House after his election in 2008.This Act was advertised as a piece of legislation that would lower health care costs while keeping our current level of quality care and also insuring 30 million additional Americans. If that indeed was the objective, it failed miserably.



Instead, Obamacare was a progressive maneuver to increase the size of government by controlling another 1/6 of the economy. This is the main focus and goal of the Obama Administration and influences how he governs. His administration is never concerned about unintended consequences. That is, these programs will result in costs that are astronomical and unsustainable. Quality of health care will diminish due to fewer providers, longer waits for care and massive government regulations. Also, the number of those insured will not significantly change since more Americans will be unemployed or no longer even looking for work and more employers will not cover health care for their employees. Additionally, the health care exchanges, originally meant to help the working poor obtain health care, will be postponed. Even when these exchanges are operational in several years, government involvement and control of these exchanges will result in more costly care, by restricting access to care due to fewer providers, and because of increased bureaucracy and regulations.
Let’s review the playbook of this administration’s methods of how to govern using Obamacare as the example.·         Sell the public on a concept based on hope, but not based on any facts or history of success; therefore unrealistic expectations. All Americans hope that everyone can have affordable healthcare and that this will not adversely affect the quality of care, access to care, and not   bankrupt the country in the process. Of course those hopes only occur in a fairy tale world. The Obama administration, along with the mainstream media and many misinformed voters allow this hope to materialize into law.

·         Pass the legislation by any means possible. Obamacare was not going to be passed when Massachusetts, a liberal state, elected a republican, Scott Brown, for Senator in November 2009 mainly as a referendum against Obamacare. But when one door closed, the Democrats circumvented the process of passing legislation in Congress by using reconciliation and allowing the Senate bill from 2009 to be voted on in March 2010; even though it should have returned to the house of Representatives for changes and approval prior to a final vote (especially when the revenue for the bill is considered a “tax”).

 Other examples of circumventing the legislative process is executive orders and accusing Republicans of being racists, bigots, uncaring to children and the elderly as well as homophobic. In these ways, the Obama administration can carry out their agenda to make Government as big as possible in order to reach the point of no return. This is where there are more Americans benefiting from Big Government through government employment, self-serving interests with unions, political allies and entitlement recipients than there are citizens working in the private sector. The Americans who benefit from Big Government will then vote for the Democrats who benefit their lives and the cycle of dependency becomes even worse. This is already so very apparent in Europe.

 This is the model for governing for the Obama administration over the last 4 years and will continue for 4 more.  There will be more empty promises and distortions in order to pass more laws and regulations that will not help Americans improve their lives and standard of living. But rather, will increase the size of Big Government, which results in the government having control over the individual.  Remember that as the government gets BIGGER, the citizen gets SMALLER.

Health savings accounts are one of the many types of health insurance plans available for Americans. These accounts are owned by the individual and contributions to health savings accounts (HSAs) are paid on a pretax basis. Therefore, they are tax free medical saving accounts. Now, there are yearly limits imposed by the federal government on the amount of pretax dollars that can be deposited into a health savings account ($3,250 for an individual and $6,450 for a family in 2013). What makes them attractive is when there are leftover funds at the end of the year; the funds can roll over and be used at any time in the future. So, if you are relatively healthy and are mandated under Obamacare to purchase healthcare insurance, having a health savings account makes a lot of sense.

There are several advantages to having a health savings account. First, they will reduce your tax bill because taxable income will be deposited into this tax free HSA. Second, the HSA money that you do not use for your health care will grow with tax free earnings and can be utilized in the future for your healthcare needs. Also, these HSA plans tend to have lower premiums and usually avoid the high increase in rate hikes seen in other traditional healthcare plans. The costs of these premiums can be lowered further by using higher deductible insurance plans. Another advantage is that many of these HSAs with high deductibles represent a maximum out-of-pocket limit for both the individual and family coverage plan. Therefore, the out-of-pocket cost may be the $5,000-$10,000 deductible in the HSA account because after the deductible is met, the insurance then pays 100%. So, for catastrophic care such an unexpected accident or illness, an individual will not go bankrupt trying to pay for an illness/accident.
The main advantage is that the individual and family who have this account will have more control over both their healthcare decisions and their healthcare costs. This will have the effect of decreasing the overall cost of healthcare in our nation because the individuals who have this health savings account will be more informed about healthcare issues and will be more cost conscious, since the money comes from their own savings and they are dipping into it when they use the healthcare system. Naturally, they will be more selective on spending their money.
Since health savings accounts are not dependent on government control but under an individual citizen's control, the current administration is not in favor of HSA’s and Obamacare’s regulations will have a major negative effect on these accounts. Only the federal government, through its infinite wisdom, tries to destroy an insurance plan where the individuals are more informed about their health and more informed about the actual cost of healthcare services.
Obamacare has also made it difficult for over 11 million senior citizens with Medicare Advantage (a plan similar to HSA’s) by eliminating federal subsidies for the insurance companies that utilize the Medicare Advantage plan. This also doesn't make any sense since the major amount of money spent on healthcare is in the last few years of an individual’s life.  Especially with the Medicare population, it is important that they be informed and knowledgeable of all the costs involved in their care. If we could promote the concept of HSAs for those purchasing health insurance and for those on Medicare; that would be a step in the right direction and result in decreasing the overall healthcare costs in our nation. There should also be an incentive that these health savings accounts become part of an individual's estate so that it can be passed on to their heirs.
A Health savings account is a health insurance strategy that should not be discouraged by our government but rather encouraged. This is an effective way to decrease the healthcare costs by creating an incentive for saving money for the individual and being able to utilize the money they pay for health care in the future for their own needs or to pass it to their heirs as an inheritance. Therefore, health savings accounts are one of the solutions to healthcare reform which makes sense from both an economical point of view and a quality of life point of view.

 Due to the passage of the Affordable Care Act, also known as Obamacare, a decision to accept federal funding for Medicaid expansion has to be made by mid-year 2013. This is done so that facilities needed to accommodate the 33-38% increase in Medicaid enrollment can be operational by early 2014. Several of the Republican Governors have also opted to utilize health insurance exchanges. As of the end of February 2013, there are 8 states with Republican Governors accepting Medicaid expansion.They are Ohio, Michigan, New Mexico, Nevada, Arizona, Florida, New Jersey and North Dakota. All these states except for North Dakota and Arizona were carried by Obama in 2012. Therefore, it appears that these Governors are caving in on this Medicaid expansion in order to help their political aspirations in the short-term.

The federal government is promising to pay 100% of the expenses of newly eligible Medicaid beneficiaries for 3 years and then 90% in the fourth year. So, the Governors are justifying this decision to accept Medicaid expansion because of increased inflow of federal tax money into the state. In the short term, this could make sense if Medicaid spending was run efficiently and was effective in improving quality care. But as we know, this is not the case. For hospitals and physicians, there is a financial loss when caring for Medicaid patients. Medicaid cost per person has risen way over their projections for more than 3 decades. Therefore, to increase a program that is ineffective and costly and not improving quality care just doesn't make any sense.
I believe that the Governors are also caving to special interest groups such as those that benefit from increasing the Medicaid amount provided to the state from the federal government. These special interest groups include the state bureaucracy, suppliers of medical equipment and those in healthcare who actually benefit from accepting Medicaid. The other special self-interest is a better chance for this particular governor to be reelected. I believe this to be a selfish motive and one that may benefit that particular politician but does not benefit the best interests of the citizens of his or her state.
Obamacare is a very poor piece of legislation.  The stated goals of curbing the increasing costs of healthcare and insuring more Americans will not be achieved. As we know, the costs are going up by about 10% a year which is much higher than predicted or expected. Also, because the mandate portion of Obamacare was upheld by the Supreme Court last summer, many citizens who chose not to have or purchase health care in the past are now forced to do so. These citizens now forced or mandated to have health insurance may increase the number of insured Americans in healthcare by several millions, but they will be offset by many more Americans who will lose healthcare coverage because of increasing unemployment and an employer’s inability to cover their employees because of the increased costs and increased regulations.
Since the stated goals of Obamacare will not be achieved; what can we actually expect to result from implementing Obamacare? We can expect that Obamacare along with its many taxes, regulations, penalties, Medicaid expansion and Health Insurance Exchanges will result in a bankrupting of our healthcare system (both financially and with respect to quality of care). The real purpose of Obamacare was to lead to the destruction of the private sector component of healthcare in this country. By doing so, a single payer Government controlled system results by default. Government programs always tend to be more costly and less efficient than a private market system and one where there is freedom of choice. These Governors, by accepting Medicaid expansion, have chosen to abandon the principles that make healthcare in this country better than all other countries. They have also abandoned the principles of smaller government and a government that has less control over its citizens.
On the next blog, some of the solutions will be discussed such as health savings accounts and a free market based system.

On the last blog, we addressed the issue of smoking and health care insurance premiums. There are some simple solutions to this problem which are as follows:
 
1.         Private Health insurance companies should be allowed to increase their premiums for smokers. The amount of increase in premiums for these smokers should be based on the actual increase in health care costs. This number is probably over 20% but not as high as 50%. This recommendation will not apply for those on government programs such as Medicare and Medicaid (read further for explanation). The same type of proposal can be made for those that are overweight with high BMIs, except when caused by a pre-existing medical condition such as hypothyroidism or chronic steroid use, etc.
2.       For those on Medicare, higher premiums should not be applied to smokers but should be applied to increasing age. The last year of life is the most expensive year of Medicare cost for an individual. Most of these costs are due to unrealistic expectations by the patient and the family which can be corrected by further education on this matter. Also there are extensive costs due to highly technical services and intensive care services in a Hospital. Therefore, I propose that since the average person lives to about 82 years of age, that Medicare coverage is decreased from 80% down to 70% beginning at the age of 85. That is, at age 85, Medicare coverage would be 78% and at age 90 it would reduce to 70%. The remaining 20-30% would be picked up by either Medicaid or private insurer depending on the patient's financial status. More importantly, there needs to be health savings accounts especially in this Medicare population. Health savings accounts are utilized by those who are more informed about health insurance. The individual will have more control over his/her health care costs. If there is money left over in the health savings account when that person passes away, it can be inherited by surviving family members. This would definitely influence both the individual and family members in spending their money more wisely at the end of life. Unfortunately, Obamacare tries to eliminate health savings accounts through its policies and taxes. This needs to be changed if there is any meaningful attempt to reign in end-of-life health care costs.
3.       For those on Medicaid, that smoke or are obese, higher copayments will need to be paid. Right now, if people are paying $3 for the copayment, they should be paying $4.50 if they have a BMI over 35 or smoke. If the BMI is over 30 and less than 35 their copayment could be $3.75. Let me state that I believe that $3 is too low a copayment to pay for Medicaid and that needs to be readjusted so that even the indigent can make some  responsible healthcare choices or pay  because they have some “skin in the game”.
4.      For all types of insurance plans, there should be discounts for both employers and employees that utilize programs that encourage smoking cessation and weight loss. There should be incentives for individuals who make healthier choices and more economic choices with healthcare expenses.
Other behavioral choices that can be measured should be looked at such as diet and type 2 diabetes, etc. Healthcare premiums could be increased appropriately for these conditions depending on their increased cost to healthcare.
More comprehensive measures will be necessary to address the healthcare issues facing us in this country. The most important point is that we as citizens cannot allow the government to control us.  If one wishes to smoke or eat poorly, that is up to the individual. They may have to pay higher premiums but that should be their choice to make, not government's choice to control. They can try to influence behavior with higher premiums and through incentives. But, the individual should have the final say and control over their choices.
Also, health savings accounts should be encouraged and promoted since most people who utilize it are better informed and make better healthcare decisions , resulting in lower overall costs to the healthcare system. These health savings accounts should be available for all those with private insurance and with Medicare. We should also explore a way to utilize it within the Medicaid system. This one concept will decrease health care costs by a significant degree.
There are solutions to the rising healthcare costs. What is lacking is the political will to legislate it for the benefit of all Americans.

Obamacare, also known as The Affordable Care Act, will allow health insurers to increase individual policies by up to 50% for those who smoke. This could raise the premiums by almost $5000 a year more for smokers. Is that fair?  When an individual is purchasing a life insurance policy or car insurance, their past behavior or record is taken into consideration when determining a premium. Anyone who obtains life insurance realizes that if they are older, have poor health or engage in risky behavior (such as sky diving) they will have higher premiums. Also, if you have caused accidents while driving, your car insurance premium will be higher. The same should apply for health care insurance. When you engage in behavior like smoking that increases your chances for health care issues and costs, it is only fair that the premiums be higher.

But what is a fair increase in premiums for smokers? Life insurance can calculate when smokers are more likely to die and then adjust the life insurance premium accordingly. It is much more difficult to calculate the actual health care costs caused by smoking because of many other factors affecting the cost of healthcare such as diabetes, obesity, heart disease and age. For example, a Dutch study in 2008 concluded that smokers had lower national healthcare costs than obese or healthy individuals mainly because they lived a shorter amount of time. Smokers on the average lived to 77 years of age, obese individuals lived to an average of 80 and healthy non obese, non-smokers lived until the average age of 84. Therefore, living longer costs society more in overall healthcare costs than a behavior which causes them to live 4 or 7 less years.   

Now, our healthcare system is not a national healthcare system like the Dutch and therefore, it cannot be public policy to hope that individuals die sooner so the costs of their overall healthcare are lower.     Our founding fathers’ principles stated that we are a nation of individuals who determine how we are governed and that the individual’s freedom and liberty will be the dominant force not the government’s view of what is best for society. So, there should be no exclusion to obtaining health care insurance, but more costly behavior such as smoking and overeating should have higher premiums, at least until one is on Medicare. When one is receiving Medicare benefits, age becomes the most important factor in determining premiums, since most (over  75%) of healthcare costs in one’s lifetime is in their last year of life. It is difficult to predict when the last year of life will be, but we know that that the average age expectancy in the US is now close to 78 years; so premiums should be higher after that age.

Therefore, it is fair to increase premiums for smokers until they are Medicare eligible? 50% higher premiums are too high. A study should be done to determine more precisely how much more smokers and other controllable risk factors (those that are modifiable by one’s behavior) cost the health care system and then adjust the premiums accordingly. Most likely it will be closer to 20% than 50%, but we need more data to determine fairer numbers for insurance premium hikes.    A  better strategy  is to  incentivize individuals to take smoking cessation measures to maintain lower premiums and to give tax benefits to employers who incentivize their employees by lowering their health care deductibles when they do not smoke, keep a BMI under 30, maintain their BP under 140/80 and their LDL Cholesterol under 130. These incentives for positive behavior changes are a more effective long term strategy for decreasing the healthcare costs in our nation than solely relying on punitive measures by raising premiums.

There are some simple measures in order to try to keep our nation healthier and keep down the costs of healthcare in our nation. It needs to be a multifaceted approach with strategies to both penalize bad behavior with increased premiums and incentivize good behavior with tax breaks and lower costs. But, we can no longer afford to ignore the real costs of healthcare involving the care of an individual in the last year of their life. There are practical solutions to this issue which I will address in the next blog.