Response Letter to Humana- My options: violate my code of ethics, break the law, or terminate agreement.

August 31, 2015

Dear Mr. Buss,

Thank you for your response regarding my concerns over Humana’s ICD-10 conversion. Yes, I know that HIPAA requires all HIPAA covered entities convert to use of ICD-10 effective October 1, 2015. In fact, I worked with a group that was instrumental in achieving the initial delays and that worked toward another delay- until special interest groups, such as specialty hospitals and IT, lobbied and won (bought) the votes of their favorite Congressmen in DC. Imagine if all the money and resources spent on ICD-10 conversion were instead spent on actual patient care.

As I stated in prior correspondence, I will only comply with and implement policies and procedures that 1.) serve the patient first and 2.) are the best utilization of precious medical resources, including time and money. Implementation of ICD-10 does not serve the patient first and is not the best utilization of resources. If I convert to ICD-10, it will only be a stop gap measure until the next required by law mandate comes along that does not best serve the patient and is not the best utilization of resources. What will the next required by law mandate be? One can only imagine. Accordingly, I will not convert to ICD-10. Therefore, because I do not want to break the law, I am forced to not be a “HIPAA covered entity.” I guess I am a conscientious objector in some sort of strange new government-run, “war on private Hippocratic medicine” way.

I have enjoyed my relationship with Humana up until this point; however, it seems your company has done little to resist, and in fact facilitates, the complete government takeover of medicine. By now, you should have received a letter of termination from me. I caution you regarding the advisement you are planning to give my patients, your members, in this regard.

In your letter you state, “If your contracts are terminated, Humana will need to advise your patients who are Humana members that continuing with your practice once you are a non-Participating Provider will result in greater personal out of pocket expense under their benefit plan and Humana will assist those members who choose to do so, to move to another Humana Participating Provider where they will not experience the added out of pocket expense.” In fact, my new transparent fee schedule may result in many instances where the cost will be less to the patient to stay in my care than through their Humana plan which shifts them to another doctor under Humana’s fee schedule. It is a sad state of affairs that a fleeting membership with an insurance company trumps the longstanding relationship with the chosen doctor. That my patients, your members, are shuffled from doctor to doctor each year results in a serious waste of time and resources and results in worse continuity and quality of care. Do not mislead my patients of, in many cases, twenty-plus years saying that staying in my care will cost them more in every instance. Humana has clearly transformed from providing health insurance to providing prepaid medical care, including selection of the patient’s doctor. This destroys the patient-physician relationship, the foundation of Hippocratic medicine. This is not without risk to the patient, and Humana will ultimately be held accountable.

Imagine how much better it would have been for private insurance to collaborate with the doctors and patients instead of the federal government in effecting health care reform. Going forward, is there any person or part of Humana that would be willing to work with third party free medical practices to offer low cost, high deductible, major medical indemnity plans in a paradigm-shifting alternate model of health insurance? The number of physicians practicing third party free has increased from less than 1% in 2008 to 7.2% in 2014 with 13.3% transitioning to third party free practices in the future. It appears that United Healthcare will become the single-payer for the feds. Maybe Humana would be interested in forging a new path with those of us who are creating new models of health care delivery. I believe we will succeed in providing state of the art care directly to patients at a fraction of the cost. I would love to discuss this with anyone at Humana that has any interest in peeking outside the box and the beltway.

Sincerely,

Kristin S. Held, M.D.

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Dear 3rd party player! I’ve had it, and I’m not taking it sitting down anymore! Appeal this!

This morning I operated on my patients; this afternoon I’m fighting the denials from their insurance companies for their care. I am exasperated, but when the patients and I just get fed up and give in (the patient just pays for it or the physician writes off the bill), the insurance companies win, profit, and redouble their efforts. I am looking forward to 10/01/2015 when I am liberated from this government-run, third party-controlled healthcare mess and practice under a new alternate model where my patients and I freely engage in a patient-doctor relationship, and I serve them first to the best of my ability with state of the art care, compassion, confidentiality , and dignity for a fair, reasonable, transparent fee. Until then, I’m not giving up the fight. The companies are ripping patients off- huge premiums, huge deductibles, huge co-pays- and for what? Delays, denials, narrow networks, and restriction of care. Here is today’s letter to a company denying coverage for a drug that works beautifully for my patient. I bet I’ll hear nothing back. Typically we’re stonewalled- the patients and doctors nothing but an annoying inconvenience in the big government/big business $3T dollar a year healthcare bonanza.

Dear third party entity that is denying coverage for a prescription drug I have written for my patient,

In the current healthcare environment, government mandates that patients buy health insurance from insurance companies such as yours that have subsequently developed and implemented major strategies which primarily delay and deny care to these patients but secondarily increase your bottom line. The three most common delay tactics for medications are 1.) requiring preauthorization, 2.) establishing quantity limits, and 3.) requiring step edits. These tactics are harmful to patients and waste incredible resources such as the time I have spent talking to my patient and staff about this and now writing to you. I could have been caring for other patients at this time when physician shortages are resulting in limited access to care, and physicians are living a bureaucratic nightmare.

When my patients seek my care, I thoroughly evaluate, diagnose, and treat them. When indicated, I write a prescription for a medication that will alleviate their symptoms or cure their condition. I write the prescription, because I want them to be treated with that particular drug. When possible I will authorize that a generic may be dispensed if adequately safe and efficacious. A prescription I write for my patient is not a request for you to pontificate. You are interfering in the patient-doctor relationship and effectively practicing medicine without a license. You are causing increased suffering, morbidity, and potential mortality for patients whose care you are delaying and denying.

In this particular case, you have denied filling the prescription for Restasis I wrote for a patient who has a long history of severe dry eyes dating back to March 10, 2003, when I became her physician more than twelve years ago. Her condition is well documented in her confidential medical record and supported by ancillary testing, as is her excellent response both symptomatically and clinically to her use of Restasis for the past few years.

I received a “prior authorization request denial” stating the information submitted does not indicate a trial of the formulary alternative: steroid eye drops. I am stunned on many levels. A steroid alternative is not an appropriate or equivalent alternative for Restasis. Steroid eye drops can cause cataracts and glaucoma, which Restasis does not. Steroids and Restasis are not even in the same class of drugs. Will your company bear the blame when a new generation of patients presents with iatrogenic premature cataracts and glaucoma which will then require increased expense treating those conditions and in some cases will result in permanent visual loss?

Someone must advocate for the patients. It is ethically wrong that your company is choosing to act not as a provider of health insurance but as a provider of health care, for which you are not qualified. Worse is that in this perverse system your clients are forced to buy what you promise to provide, and you profit by denying them what you promised to provide. No longer will I play this game nor allow you to take advantage of my patients in this deplorable fashion.

Your letter states: “If you wish to file an appeal please contact PARx Solutions at 866-725-7279 to review the appeals process.” My response to you is: 1.)fill the prescription I wrote which is indicated for my patient who pays you to provide access to care not to delay and deny it, and 2.) do not tell me to use an alternative therapy that is wrong and potentially harmful, if not blinding, to my patient. That is my appeal. I will copy my patient on this letter, and I expect you to honor your commitment to her by covering the prescription I wrote.

Sincerely,

Kristin S. Held, MD

Letter to private insurance.

In 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid with the promise that the federal government would not interfere in any way with the practice of medicine whatsoever including compensation, administration, or operation of any institution, agency, or person per Title XVII SEC.1801. Government has broken its promise not to interfere with the practice of medicine. Politicians, starting with the President of the United States, have lied to us to get laws passed that allow them to fundamentally transform the USA, and now, in spite of what they promised, if you like your plan, you CAN’T keep your plan, and  if you like your doctor, you CAN’T keep you doctor.

To ultimately achieve single-payer, government-run healthcare, government cut deals with big private health insurance corporations and mandated we buy government designed insurance products from these companies “or else.” These companies follow government marching orders lockstep in order to stay on the take.

While their mission statements say they care for us, the patients, truth is, big insurance companies care more about their bottom line, the profit, and they will do whatever it takes to enhance it. So, when government sold out to hospitals and IT and required physicians adopt the nonsensical, wasteful ICD-10, a World Health Organization based coding system, insurance followed suit. Alas, if physicians don’t do what government and insurance companies say, we can’t even bill patients for our services. We’re out of luck.

America’s physicians are trapped; we’re afraid of losing our patients, our autonomy and ability to practice medicine, and our livelihoods if we don’t implement and comply with big government/big insurance commands. Problem is, I’m not willing to sell my soul. I stand by my patients and the Hippocratic Oath.

Accordingly, on October 1st, I will be forced out of Medicare and private insurance because I will not adopt ICD-10. Though I have already severed ties with most insurance companies, I sent this letter to the remaining ones with whom I have an agreement. In typical fashion, I’ve heard nothing back. The insurance companies don’t even have the decency to respond. The doctors are clearly nothing in this perverse food chain. Where does that leave patients?

Big insurance is colluding with big government at the expense of patients and doctors. Please read my letter and understand why I will be unable to bill for services for any private insurance patient as of October first.July 28,2015.

I pray my patients will choose to stay in my care. I promise to care for you to the best of my ability with privacy and dignity, with transparent, low cost fees, and with the best, innovative, state of the art technology available in the world. While government and insurance compel and control you, I will care for you. Let’s stand together.

I wonder if I’ll ever even get a response to my letter.  If big insurance treats patients in this fashion, the consequences will be grave.

July 28, 2015
Dear Private Health Insurance Company (Blue Cross/Blue Shield, Cigna, and Humana),

Many of my patients purchase medical insurance from your company. My steadfast commitment is to my patients, the patient-physician relationship, and the Hippocratic oath. I will continue to serve my patients to the best of my ability undeterred by third party interference in the patient-physician relationship, and I will only comply with and implement policies or procedures that 1.) serve the patient first and 2.) are the best utilization of precious medical resources, including time and money.

On October 1, 2015, ICD-10 codes are required to bill CMS for services provided to Medicare patients. I am not implementing ICD-10, because doing so does not serve the patient first and is not the best utilization of resources. Your health insurance company is a private company, not a CMS entity, but apparently, many private insurers are voluntarily converting to ICD-10 lockstep with CMS.

I will continue to see my patients in spite of my non-adoption of ICD10, because the preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by orders of great magnitude. Patient care trumps company coding.

Nothing in my agreement with your company compels me to do what is not in my patients’ best interests and is not the best utilization of resources.

A significant proportion of physicians across the US agree with me. How are you planning to pay for your customers’ services when their physicians do not use ICD-10? Will you continue to use ICD-9 codes simultaneously? Will you use actual diagnoses in standard medical terminology using actual written words, such as, cataract right eye and corneal laceration left eye? Will you have your customer pay the physician directly and then reimburse them for the benefits they are paying you to provide? Will you refund or reduce your customers’ premiums, because you have implemented company policy with which their promised physicians cannot comply? Have you quantified the potential impact of physician ICD-10 non-conversion on your customers, America’s patients? What is it you sell, if you have no doctors?

Your customers pay you to facilitate their access to medical care, not to prohibit them from seeing their doctors. I want to know what you plan to do on October 1st when I provide services to my patients of 20 plus years who happen to have been your customers for perhaps a fiscal year or two, and I do not provide you with an ICD-10 code.

This is just sixty days away. Stonewalling is not an option. I await your timely response.

Sincerely,

Kristin S. Held, M.D.

Letter To My Patients Regarding My Opt-Out of Medicare, Non-adoption of ICD-10, and Plea to Stand With Me

Dear Cherished Patient,

I most humbly request you take a few minutes to read my heartfelt letter to you. Whether I have cared for you for the past 20 years or you are new to the practice, I want you to understand that I value our relationship most highly and regard my service to you as your physician and surgeon as a privilege and a blessing. I honor the Hippocratic Oath and will treat you individually to the very best of my ability with dignity and privacy.

In 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid with the promise that the federal government would not interfere in any way with the practice of medicine whatsoever including compensation, administration, or operation of any institution, agency, or person per Title XVIII SEC.1801.

Tragically, over the past 50 years, the government’s pledge to not interfere with the practice of medicine has been broken. The law has been unheeded and continuously altered, such that the practice of medicine in the United States has been fundamentally transformed, commandeered, and all but lost.

October 1, 2015, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services of the Executive Branch of the United States federal government requires implementation of ICD-10, the 10th revision of the International Classification of Diseases and Related Health Problems, a medical cataloging system of the World Health Organization that includes 141,000 diagnosis and procedure codes including W56.22 Struck by Orca, initial encounter, V91.07 Burn due to water-skis on fire, Y92.146 Swimming pool of prison as the place of occurrence of the external cause, V97.33 Sucked into jet engine, X52 Prolonged stay in weightless environment, V95.40 Unspecified Spacecraft accident injuring occupant, and even VO6.00xA for when Grandma gets run over by a reindeer. The costs of ICD-10 implementation are staggering, far outweigh any perceived benefit, and are a vital factor separating financial sustainability from bankruptcy for private medical practices going forward. ICD-10 implementation was fought vehemently and delayed a year, but ultimately, money from lobbyists representing hospitals, IT, and other special interests bought votes and trumped the best interests of America’s patients and physicians.

Government is now virtually extorting physicians in unprecedented fashion. If physicians do not precisely follow government rubrics and implement and comply with everything the Secretary of Health and Human Services says, we are penalized. I am not implementing ICD-10, because it is nonsensical and doing so does not serve my patients first and is not the best utilization of resources. If I implement this nonsensical, wasteful system, what won’t I do? This is my line in the sand. Therefore, as of October 1st, I will be unable to submit claims to CMS for my services to you. I will be forced to opt out of Medicare.

Just as government has broken its pledge not to interfere with the practice of medicine, it has broken its promise to you, our nation’s seniors. On April 16,2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and soon government will be means testing you and charging you increasingly higher monthly premiums for your Part B Medicare.

Government has betrayed us, but we must not betray one another. The preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by great orders of magnitude. I am asking you to continue in my care. I will provide you with a transparent fee schedule that is fair and reasonable. I will put you and your well-being first, in place of nonsensical, if not harmful, government rubrics that serve the collective good and political ruling class at your expense. I will not violate my pledge to you. Please, stand with me.

If you chose to see me, government requires you sign an affidavit stating that you understand I have opted-out of Medicare and that you will not submit a claim for my services except for emergency or urgent care services.

I cannot continue to enable this perverse, wasteful, dysfunctional system. This is the ultimate in tough love. I pray you will work with me in a new paradigm-shifting, alternate universe where you have an actual doctor and actual medical care in lieu of government-mandated “insurance” that comes with neither. I appreciate your time and consideration of this critical matter.

Warmest Regards,

Kristin S. Held, MD

Running out of Patients: Reflection on Reflections of a Physician Patient-Who Was Right!

 I wrote this over two years ago, and I was right about the government takeover of medicine, the loss of physician autonomy, and progression toward single-payer set forth in Obamacare. October 1,2015, I will no longer be able to submit bills for my services to my patients to private insurance companies or Medicare, because I refuse to implement and comply with their insane, nonsensical, requirements that 1.) do not serve the patient first and 2.) are not the best utilization of resources. I will continue to serve my patients as long as I can through a new, alternate model of direct patient care, free of 3rd party waste and nonsense, via a fair, transparent fee schedule, and direct access to me, the doctor. I hope and pray enough of my patients will choose to stay with me instead of following their insurance company du jour, where you see a new doctor every time you go in. Imagine coming home to a new family every few months or yearly. I thank God and my amazing doctors for the gift of life- that I am still alive to repost and write this new preamble 3 years later. I pray I will be able to keep my practice alive under this new model, so I will be there for my patients in the next three years. I pray I will still have patients in 3 years.

 

Reflections of a physician patient facing government-run medicine and cancer at a crossroad

5 May 2013 at 14:39

I am a physician and surgeon home today recovering from my third operation for breast cancer. I am blessed to live in the United States where we enjoy the earliest detection and highest survival rate for breast cancer in the world…at least for now. Tragically, government has taken over the practice of medicine in the U.S. via the unwanted and corruptly passed, without-having-been-read, paradoxically-named Patient Protection and Affordable Care Act (ACA). The US Preventive Task Force born of the ACA has already trumped our established guidelines for breast cancer screening to save money over lives- not a single breast cancer specialist was on the committee. Committee members picked and chose which studies they would include and which they would disregard- in the same fashion that this self-serving political ruling class picks winners and losers and now picks who lives and who dies. I am thankful for my physicians, surgeons, and their teams who carried me through this ordeal to a cure and good physical result. I was able to select my doctors, my treatment, and I only missed two weeks of work last year and 2 days this year. You see, as a physician and small business owner, my patients and my employees need me to be at work. There is no room in the business model for the doctor to be out. My overhead is tremendous, and when I am out the lost income is nothing compared to the uncovered operating expenses. I love my patients, my employees and the privilege of practicing medicine, but sadly I fear that at some point it is just too risky, if not stupid, to continue in this oppressive, punitive, stifling environment.

Government first got its claws on medicine when it froze wages on workers allowing employers to instead offer health insurance as a benefit to attract employees. Health insurance as an employee benefit has evolved into a government mandate, now called a tax. Then in 1965, the federal government’s grip on medicine was tightened to a chokehold with implementation of Medicare and Medicaid, massive entitlement programs that have bloated to beyond what experts fathomed to the point that they are fiscally unsustainable and will soon throw our economy into fiscal ruin. Rather than reforming these broken, bankrupting components of healthcare, the federal government has expanded them and seeks to place everyone on them. There is no understanding the irrationality of the process other than to accept that this is nothing about the health of the American patient but is all about keeping power and money in the hands of the political ruling class, whose intent is to fundamentally change our country to accepting the socialized medicine of a dictatorial state in complete disregard for the Constitution.

As an eye surgeon, most of my patients are seniors on Medicare. Cataract surgery is a minor miracle for patients who are able to continue enjoying the highest quality of life with restored vision. Having performed nearly 10,000 cataract operations over the past twenty-some years, I have become a highly skilled surgeon able to achieve successful outcomes in even the most difficult cases. With technological advances and an experienced surgeon, the operation can be performed quickly. Trust me, there are surgeons who take much longer and achieve poorer outcomes. Government, because it has no concept of how to practice medicine, judges quality of care based on time taken and pays physicians based on a convoluted communist based system of relative value units. So, ironically, as the surgeon and technology gets better, our pay gets lowered. Medicare now pays $629.91 for cataract surgery including 3 months post op care, and United Healthcare pays $526.08. Most believe the goal of this administration is to ultimately have a single-payer system (socialized medicine) to be administered by United Healthcare, the largest provider in the US and worldwide. Because of its world market, it will be able to undercut all other carriers long enough to remain the sole survivor.

While physician fees have plummeted (because we are motivated to care for our patients first as opposed to fighting for pay), payments to hospitals and pharma have skyrocketed. There is a convoluted billing game that goes on between government, hospitals (represented by the-American Hospital Association lobbyists), big insurance, and big pharma. These interest groups all colluded behind closed doors with big federal government to cut deals in the ACA. Physicians were excluded, demonized, denigrated, and lied about-especially by President Obama who famously said doctors are immediately paid “30,40, or $50,000 to cut off a foot”, when in reality a below knee amputation fee to physician is around $700 including 3 months post op care. He further accused surgeons of taking out tonsils for cash instead of prescribing antibiotics, which is not only a lie, but in reality the surgeon’s fee is around $200 while the cost of antibiotics may exceed that. The final blow was when Obama declared “we will let doctors know, and your mom know, that you know what, maybe it’s better to take the painkiller instead of having the surgery.” Government is now arrogantly practicing medicine without a license, and sadly this government puts the collective good ahead of the individual patient and family.

While I am now paid $500 for performing intricate, vision saving but potentially blinding eye surgery, the government will further reduce my pay if my patients don’t achieve a perfect outcome. So, if I operate on patients with coexistent disease, like macular degeneration, who will be greatly benefited but will not achieve 20/20, I will be penalized. Surgeons will stop operating on complex patients. My fee will be reduced further if I do not implement meaningful use electronic medical record reporting, quality reporting and data collecting, and I will not be paid at all if I do not adopt the absurd ICD10 codes by October 2014. Further, any HIPAA violation subjects me to a $1.5 million dollar fine, and a dictation error can land me in jail, as exemplified by Dr. Natale this past year. Government is doing random unauthorized audits on physicians looking for fraud; the physician is presumed guilty until proven innocent, and bounty hunters are offered a percent of what they can dig up. The government is seeking to link the license to practice medicine with forced-taking of government insurance and forcing doctors to spend thousands of dollars and hours on “Maintenance of Certification” and “Maintenance of Licensure” scams that ultimately line the pockets of our specialty societies, which like the AMA have become nothing more than partners in crime with the feds. All this, while patient expectation and sense of entitlement escalate…patients are unhappy, if not angry, if they have to come out of pocket a dime and if they don’t get 20/20 vision without glasses. Doctors are then subject to lawsuit. No tort reform was enacted in the ACA, because the trial lawyers’ desires exceeded the doctors’ need for protection. So, is the risk of jail, lawsuit, audit, $1.5 million dollar HIPAA fine, patient and government harassment, oppression, and demonization and MOC and MOL demands worth the $500, when I can’t even cover my expenses? Is your eyeball worth more than your Iphone? At some point it becomes too risky and flat out stupid to continue to operate in this environment.

When the doctor in me wants to throw in the towel, the patient in me says “stay in the ring”. I would not be here if my surgeons had quit. What we must do as physicians is refuse to play this game any longer. We must stand against government for the sake of our patients, profession, and future of our country. When Government says grab your ankles, physicians must say NO! Government can’t do this without us. Are we complicit, compliant pawns doing government bidding, or are we men and women of the mind serving the sick, honoring the tradition and advancing the field? The only way not to lose is not to play. Physicians must refuse to participate in this destructive, abusive, wasteful system. We must practice our trade outside the stranglehold of government. We have actual workable plans founded on the sacred doctor–patient relationship that will drastically cut costs and vastly improve quality of care. Will we stand? Will our patients stand with us?

ObamaFare: When our Health Plan evolves to our Meal Plan

As the multitude of private U.S. health insurance companies consolidate into three, en route to one, we must understand what happened to our medical care to better prepare for what’s next on the D.C. Prix Fixe dinner menu.

Amidst the perfect storm of single party control of a big central government machine fueled by special interest and unthrottled by lack of term limits, we were told the country would be fundamentally transformed, starting with centralized control of our health. We were told we have a right to healthcare. The government’s self-anointed central planners grant us our rightful healthcare in the form of a mandate to purchase government-stipulated “health insurance,” or else. What’s next?

If we have a right, AKA mandate, to buy government sanctioned health insurance, don’t we logically we have a right, AKA mandate, to buy government sanctioned food? As of January 2015, 46.5 million people receive government support to buy food via the Supplemental Nutrition Assistance Program (SNAP), but many people don’t have access to SNAP. It’s just not fair. Everyone needs SNAP! Have no fear; ObamaFare will no doubt soon be here.

ObamaCare actually sets the stage for ObamaFare, deeming our diet a pillar of our health and setting forth a multitude of policies, rules, and regulations to control what we eat. ObamaCare requires food suppliers, restaurants, and even vending machines to list calories of every item served, and central planners, including our First Lady, lead initiatives that target what we eat and even what our children are fed in our public schools. If the government applies the way it grants us our right to health to granting us our right to food, get ready for this.

Applying the ObamaCare model, government bureaucrats will decide what and how much we should eat. We will be required to buy an ObamaFare meal plan from a government approved list of qualified grocery stores, restaurants, or vending machines, called “qualified food entities.” These “qualified food entities” must sell us what the government deems “minimal essential food.” We must buy all the “minimal essential food” even if we don’t want it. We will pay huge and ever increasing amounts of money monthly for the food, whether we eat it or not. This is our monthly “food premium.” If any of us want or need to buy different or more food than is on the government’s essential food menu, we must pay a second huge lump sum of money to buy it for ourselves before ObamaFare benefits chip in, this is called our “food deductible.” On top of the monthly food premiums and food deductible, there is a food-sharing expense too. Every time we actually go to the restaurant, grocery store, or vending machine, we must pay an additional flat fee on top of the monthly food premium called a food co-pay, sharing the cost of buying the food with our qualified food entity. If our qualified food entity does not approve of the food we want, they will not pay for it whatsoever and won’t apply what we spend on it to our food deductible. In that case, we must pay for it ourselves on top of our food premiums, food deductibles, and food co-pays.

If we say, “This is a rip-off, I’m going to grow my own food or go directly to restaurants, grocery stores, and vending machines that cost less, sell me the food I actually like, and aren’t working for the government as a qualified food entity,” and if we then don’t buy the ObamaFare meal plan, we will be penalized by government- fined in the form of tax penalties for not buying the government mandated food plan. By the way, the cost of the food plan is not tax deductible, it is taxed, so the government forces us to buy the meal plan and rakes in billions of dollars in additional tax revenue by making us buy it and taxing us more if we don’t.

They’ll make it sound really good at first- “If you like your grocery store, you can shop at your grocery store.” “If you like your restaurant, you can go to your restaurant.” “If you like your vending machine, you can use your vending machine.” “If you like hamburgers and fries, you can eat hamburgers and fries.” “And, you will save $2500.00 a year using the ObamaFare meal plan.”

They will delay and change things on a whim for a while to appease us. Then, the ObamaFare reality will set in. We will have 3 mega qualified food entities to buy our food plans from. The menus will all be the same. The prices will be high. We can’t go to the grocery stores, restaurants, or vending machines we like- only the “qualified “ ones. We can’t eat what we want. And, it costs thousands more, not thousands less, to eat. In fact, the qualified food entities are paid by us and subsidized by the government. The entities collect the money, and in a perverse system, they keep more of the money if they dole less food out to us. Food entities are businesses first and must show a profit to their investors. They are business savvy and concoct ways to delay and restrict our food to increase their bottom line. They do things like-requiring preauthorization of the food we want to eat, establishing quantity limits on how much we can eat, and offer us a very limited menu from which to order- the bare minimum.

Odds are, because they are required to be essentially the same, the three mega food entities will eventually merge into one under the government umbrella. The menu soon evolves to consist of only the government’s minimal essential foods. It is soon proven cheaper to just offer us a limited number of qualified essential food cubes, dispensed only at qualified restaurants, grocery stores, or vending machines (that have lobbied and struck deals with politicians to sell the cubes) by eligible food professionals (who precisely and unquestioningly follow the Secretary of FFS’s marching orders). No matter how old we are, how big we are, how active we are, or what our individual dietary restrictions or needs may be, we will all get the same number of tasteless, food cubes that have been chosen for us by the Secretary of Food and Food Services in consultation with crony food consultants who get government grants and profit on the side from the advice they give her. The Secretary of Food and Food Services is not a dietician or chef, but a life long, executive branch political crony who majored in government, philosophy, and economics.

The central planners and their bureaucrats don’t have to buy the ObamaFare meal plan. They can go to whatever restaurant, grocery store, or vending machine they want and eat whatever they want using special cards we buy for them.

The government controllers and food entities will only pay the food providers if they do exactly what the central planners say. All food providers, from chefs to dishwashers, will be classified as eligible food professionals and will all be paid the same. A new generation of food professionals will be cultivated who will willingly follow government food guidelines and dispense only what the food (cube) government algorithms say. The eligible food professionals will be paid and graded for how well they follow the Secretary of Food and Food Services rules for making the cubes, passing them out, and keeping a computerized record of everyone’s cube consumption using a special cube coding system. If they do not use the nonsensical cube code and transmit each individual’s personal cube consumption data to government, they will not be paid.

Cubes are limited. Eligible food professionals will get paid to talk to older people about not eating as many cubes, so younger, more productive people can have more cubes. This is considered heroic. More heroic is when the food providers give older or sicker people the “little red cubes.” The older and sicker people can eat the little red cubes whenever they choose, when they just want to die…as heroes. And then there are the “teeny-tiny red cubes” that women can take if they inadvertently get pregnant and don’t want to share their cube allotment. The teeny-tiny cubes just dissolve the prospective, potential cube-consuming baby tissue, leaving more cubes for the already burgeoning populace. Oh, and if we have a moral objection to any of this, or can’t eat a certain food, let’s say pork, due to a religious belief, too bad- we all have to buy the same meal plans that pay for these foods and cubes that are morally wrong for us, so that others can have them.

If an eligible food professional for some reason does not want to comply with this perverse system of food cube allocation, but instead wants to prepare the most nutritious, delicious foods for others, he or she must break free and take a big risk. He or she will face potential bankruptcy, because few people will have any money left over to buy the food they sell after having paid the usurious monthly food premiums. The resisting food professional will also face public humiliation on the Secretary of FFS’s website, because she posts a composite performance score of 0-100 for each eligible food provider based on how well they do her bidding. Not complying with her scoring rubric results in a 0. But, if a few brave souls will resist, break away from the government monopoly, and create an alternate food system, people will have a choice to go to the new and different restaurants and grocery stores operated by these innovative food professionals.

The problem is, the ObamaFare mandated meal plan is so expensive and the penalties for not buying it so high, that the poorest will have no money left to buy anything else; they will be forced to live on government cubes forever. A two-tier food system will result… unless a massive number of food patrons refuse to buy the expensive, restrictive ObamaFare meal plans and instead use the money saved by not buying the meal plan to directly buy the delicious, nutritious food from the innovators. The pleasant surprise is that these foods cost 80 to 90% less than the government foods, because they are not subject to the burden of the government’s bureaucratic regulatory redundancy and waste.

The Food and Food Services Secretary will try to make it impossible for the rebel chefs and grocers to even create and cook at all. Their very existence threatens the central planners’ plan for everyone to have the same government cubes- in their quest for food justice.

God wiling, brave, innovative food professionals will resist and will create an alternate world where people can eat as much as they want, of what they want, when and where they want it, and brave patrons will refuse to buy the lousy ObamaFare meal plans choosing instead to buy their food from innovators outside the government-food entity cartel.

The tasteless, little red, and teeny-tiny red cubes will be replaced by delicious, nutritious meals of each individual’s choosing, sprinkled freely with the spice of life.

Yes, as a people and as a nation, we are living through our leaders’ promised fundamental transformation, brought to us warp speed via ObamaCare. As the morals, virtues, and beliefs of our leaders evolve, so does ObamaCare. This piece is just a little glimpse forward to ObamaFare- when your health plan evolves to your meal plan. Is this the fundamental transformation we seek? Or do we hunger for something more?