Tuesday, June 26, 2007
Killing the Frankenstein veto
Harsdorf's constitutional amendment would continue to allow governors to stitch together bits and pieces of an appropriation bill to create laws that the Legislature did not approve or authorize. It would expressly prohibit one way governors do that, but still leave plenty of room for mischief.
The proposed amendment says governors "may not create a new sentence by combining parts of two or more sentences of the enrolled bill." That means a governor could still delete one or more parts of a single sentence, such as the word "not," and stitch together the remnants to create a law with the opposite meaning of the one approved by the Legislature. A governor also would continue to be permitted to delete whole sentences or paragraphs or sections or subsections of bills and piece together what remains to fashion new laws that the Legislature did not approve, as long as care is taken not to create a new sentence by combining parts of two or more sentences.
The proposed amendment to our state constitution would not have prevented Governor Doyle from stitching together the remnants of a single sentence to increase the state's bonding authority for major highway projects from $140 million to $1 billion without the approval of the Legislature. That Frankenstein veto can be found in Section 683d of 2003 Wisconsin Act 33.
If the proposed amendment had been in effect during Tommy Thompson's tenure in office, it would not have prevented Governor Thompson from vetoing parts of a single sentence to spend $319 million per year that the Legislature did not authorize. This veto appears in Section 2135t of 1991 Wisconsin Act 39 and resulted in $1.2 billion in spending over four years for a school tax credit that the Legislature had decided to eliminate and replace with a different form of property tax relief.
The proposed amendment also would not have prevented Governor Thompson from vetoing parts of a single sentence to repeal the Property Tax Rent Credit. This little beauty in Section 2m of 1999 Wisconsin Act 10 cost taxpayers $234 million in higher income taxes before the tax credit was eventually restored.
Another time, Governor Thompson unilaterally increased the amount of sales tax collections that retailers were required to pay by using Frankenstein vetoes to reduce the amounts that could be deducted as "administration expenses" in Section 510 of 1991 Wisconsin Act 269. That veto increased revenues by something on the order of $25 million to $35 million. Harsdorf's amendment wouldn't have stopped that one either.
Governor Doyle used the same stitching technique that Thompson employed to unilaterally increase an agricultural chemical cleanup surcharge from 38 cents per ton to 83 cents per ton, while the Legislature had approved an increase to only 63 cents per ton. That veto can be found in Section 1745 of 2003 Wisconsin Act 33. Again, the proposed constitutional amendment would allow this Frankenstein to live.
Neither side – not those who oppose fixing the problem just because they belong to the same political party as the current governor who now wields this monstrous veto authority and not even those who support the proposed constitutional amendment that is advertised as a remedy – gets it. Neither group of legislators is doing what's best for the Legislature and the people its members represent or what's right for democracy.
Friday, April 20, 2007
Pandemic flu prep goes grassroots
Governmental plans for an influenza pandemic are missing an important opportunity to improve US preparedness, according to two new reports: They are not reaching out to communities and grass-roots groups that could refine plan details and increase public support.
Meanwhile, ad hoc communities and preparedness alliances are forming—in the real world and online—with minimal input from government planners. And, confirming the reports' concerns, some members of those communities say they have networks and resources to offer to official efforts, but are frustrated by their inability to make themselves heard.
The first report, "Community Engagement: Leadership Tool for Catastrophic Health Events," was published Apr 4 by the Center for Biosecurity at the University of Pittsburgh Medical Center (UPMC). The report, which sums up the findings of a 27-member panel convened by the center during 2006, asserts that official planning incorrectly assumes the public will panic and create a "secondary disaster."
"The civic infrastructure—comprised of the public's collective wisdom and capability to solve problems; voluntary associations (both virtual and face-to-face) that arise from shared interests or a public good; and social service organizations that look out for the well-being of various groups—is essential to managing a mass health emergency," the report says.
"US homeland security and health emergency policies, however, do not adequately reflect the civic infrastructure's proven contributions in catastrophes. Nor have most top officials yet realized the potential value for local and national communities—and for themselves—of preparing knowledgeable, trained networks of constituents who can mobilize in a crisis." ...
The second report, "Citizen Engagement in Emergency Planning for a Flu Pandemic," was published Apr 13 by the National Academies Press and sums up the findings of an Institute of Medicine workshop held Oct 23, 2006. It says that seeking community input about policy decisions and setting up channels through which residents can talk back to government has been critical to the success of recent environmental-action and public-health campaigns and should be folded into pandemic planning as well.
Flu Wiki is prominently featured both in the article and in the academic papers:
"The central cyber-site for pandemic planning is the FluWiki, a sprawling collection of thousands of collectively assembled posts that has garnered 1.5 million visits in its 22 months."
but the important concept is the use of interactive blogs and wikis (aka Web 2.0) to influence and be part of the dialogue. To the extent that the public participates, existing institutions are strengthened. To the extent that the public is ignored, institutions are likely to make wrong choices unaccepted by the 'stakeholders' (i.e., we the people). Public health institutions at the highest level are beginning to sign on to the idea.
It's no different than what we've learned here about politics. Citizen participation is what makes politics work, and the web is a powerful tool to engage citizens. And there's little about Web 2.0 that you do not already experience.
It's nice to see the reality we know be accepted by the institutions we are trying to influence. That sort of dialog can only be good for America (and everywhere else these principles are adopted). Oh, and in case you didn't know, there's more to bird flu risk assessment and preparation than what you see on cable TV. If our public health infrastructure can be rebuilt to prepare for that, it should serve us well for everything else that comes (and I include mental health and health care as part of public health). Those issues will resonate in 2008. But that, of course, is another story for another day. For now, check out the American Red Cross's panflu prep page.
- Family Preparedness Guide Fact Sheet - Available in
English and Español - Preparing for a Flu Pandemic Pandemic: Coping and Emotional Well-being
- Pandemic Flu: Self-study presentation
Why is the Red Cross interested in this? They were there in 1918, and they haven't forgotten.
Labels: flu, preparedness
Thursday, January 11, 2007
One reason there's no money for health care?
31,709 Earmarks Later, Bush Decides Pork Is A Problem In 2006, Congress allocated a record $71.77 billion “to 15,832 special projects, more than double the $29.11 billion spent on 4,155 pork-barrel projects in 1994.” In 2005, Congress inserted 15,877 pork projects into spending bills. In his weekend radio address, President Bush called on Congress to reform this earmarking process:
[O]ne of the best ways we can impose more discipline on federal spending is by addressing the problem of earmarks. … My administration will soon lay out a series of reforms that will help make earmarks more transparent, that will hold the members who propose earmarks more accountable, and that will help reduce the number of earmarks inserted into large spending bills.
Pork is a problem. But Bush should also address reform in his own administration. Bush’s earmarks are much tougher to find, often appearing “only in closely held supplements separate from the public budget books. … [A]s head of the executive branch, the president often doesn’t need earmarks: Once federal agencies get funding from Congress, his appointees are fairly free to steer sums to places, programs and vendors as the administration decides.” A few examples of Bush’s bacon:
– “While the Education Department’s budget would be cut, Mr. Bush propose[d] a 16% increase to $204 million for teaching sexual abstinence in high schools, a popular cause for social conservatives.”
– Rep. Anne Northup (R-KY), “a target of Democrats in this year’s midterm elections,” secured “a $3.5 million research grant for a local surgical team. The funds came not from congressional earmarks but from Pentagon accounts, according to the report.”
– Bush requested “$10 million for Preserve America grants for communities’ historic preservation efforts and $50 million for the Helping America’s Youth Initiative — also among programs championed by Mrs. Bush.”
Bush may say he’s against pork, but in his six years as President, Bush has never once vetoed any of Congress’s pork-laden spending bills.
Labels: federal funding, medicare, waste
Big Pharma fails
Labels: drug companies, pharmaceuticals
When they cut Medicaid $$, remember this...
Rep. Keith Ellison (D-MN) blogs on the “myth of scarcity.”
In America today, we are encouraged to believe in the myth of scarcity - that there just isn’t enough - of anything. But in the story of the miracle of the loaves and fishes, Jesus, who the Muslims call Isa, found himself preaching to 5000 (not including the women by the way) at dinner time, and there didn’t appear to be enough food. The disciples said that there were only five barley loaves and two fish. We just have to send them away hungry. We simply don’t have enough. But Jesus took the loaves and the fish and started sharing food. There was enough for everyone. There was more than enough. What was perceived as scarcity was illusory as long as there was sharing, and not hoarding. … If scarcity is a myth, then poverty is not necessary. America need not have 37 million Americans living below the poverty line. It is a choice. Hunger is a choice. Exclusion of the stranger, the immigrant, or the darker other is a choice.
Labels: Medicaid
Community rating for health insurance
Kevin Drum writes: One of the arguments in favor of limited universal health care proposals -- like the one Arnold Schwarzenegger unveiled on Tuesday for California -- is that it's the best we can realistically hope for. Sure, an honest-to-goodness single-payer system might be superior, but special interests will never allow it to happen. Better to mollify the special interests and take what we can get.
Over at TNR, Jonathan Cohn suggests that it's not that simple. In fact, his guess is that special interests will fight just as hard to kill any plan, no matter what we do to try to get them on board:
This is one reason that, paradoxically, plans like Schwarzenegger's -- which seek to graft universal coverage onto the existing private insurance system, rather than create a single-payer plan that would supplant private insurance altogether -- may actually be as hard, if not harder, to accomplish politically. Any plan for universal health care is bound to offend at least some special interests. And these special interests will fight hard. So while trying to soften their opposition with a less radical plan helps, it may be more important to craft an alternative that captures voters' imaginations and rallies support behind it -- even if that means proposing even more sweeping changes.
The same thing is true nationally. Although Schwarzenegger would surely resist the comparison, his plan has more than a few elements in common with the Clinton health-care plan. The architects of that scheme tried very hard to come up with something that would please various stakeholders. That's a big reason that they, like Schwarzenegger, rejected calls for a single-payer system and settled instead on a proposal in which most people would continue to get insurance through the private sector. Yet, to their dismay, few of those stakeholders became enthusiastic supporters of the Clinton health-care plan. In fact, quite a few attacked it, pretty much sealing its defeat. It's easy to imagine a similar scenario playing out here.
This is the reason I swing back and forth on whether it's worth supporting half-hearted plans like Schwarzenegger's.
On the pro side: (1) It's better than nothing. If it helps people even a little bit, that's better than letting them suffer while we all wait for nirvana. (2) Liberals have gotten burned more times than I can count by not accepting half measures when they were offered. Inevitably, a decade later, we wish we'd accepted the compromise and then worked to improve it. (3) It might work. Stranger things have happened.
On the con side: (1) Cohn is right. You need public support to overcome special interest inertia, and the only way to get that is with a simple plan that people understand. Compromises just don't generate the requisite enthusiasm. (2) Compromise plans sometimes lock weird incentives into place forever. Just take a look at how the United States ended up with employer-based health care in the first place. (3) One of the whole points of single-payer health care is that it saves a lot of money by reducing administrative costs. Compromise plans don't. Without the cost savings, it's possible that we'll end up with a system that's even worse than what we have now.
In the end, the reason I support Schwarzenegger's plan is because it includes insurance company regulation, and in particular because it enforces community rating (i.e., a requirement that insurers accept all comers at the same price, regardless of age, occupation, or medical history). And while I can't back this up with a solid argument, my gut tells me that community rating will eventually put private health care insurers out of business. Even with universal coverage, there are just too many contradictions in trying to run a profit-making insurance company while being forced to insure even people that you know for an absolute fact you're going to lose money on.
I might be wrong about that. Insurance company managers are clever folks, after all, and might very well figure out how to game the system just well enough to stay around. But there's at least a chance that Schwarzenegger's plan will lead to their eventual demise, and thence to a more efficient, more rational health care system. For now, that prospect is enough to get me on board.
Paying investors when you're sick
You want reform? Then the time has come to drive a stake through the heart of the for-profit insurance industry and replace this merciless, cruel and anti-American beast with a taxpayer funded single-payer system.
And if you don't believe me, maybe you'd like to take a look at what Paul Krugman has to say about our imploding system.
Go to the link I've provided and you can read his entire column for free.
Universal health care, much as we need it, won’t happen until there’s a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
Officially, of course, it was the Medicare Modernization Act. But as we learned during the debate over Social Security, in Bushspeak "modernize" is a synonym for "privatize." And one of the main features of the legislation was an effort to bring private-sector fragmentation and inefficiency to one of America’s most important public programs.
http://www.dohiyimir.org/...
His reference to the private-sector is a polite euphemism for the for-profit U.S. insurance industry. The for-profit insurance industry is the crown jewel of the U.S. health care system. And never forget that every dollar they spend on your health care goes against their corporate bottom line.
Let me explain again that paying your health care bills is bad, very bad indeed for the financial health of the insurance industry. And therein lies the blood curdling reality.
Back to Krugman.
The process actually started in the 1990s, when Medicare began allowing recipients to replace traditional Medicare — in which the government pays doctors and hospitals — with private managed-care plans, in which the government pays a fee to an H.M.O. The magic of the marketplace was supposed to cut Medicare’s costs.
The plan backfired. H.M.O.’s received fees reflecting the medical costs of the average Medicare recipient, but to maximize profits they selectively enrolled only healthier seniors, leaving sicker, more expensive people in traditional Medicare. Once Medicare became aware of this cream-skimming and started adjusting payments to reflect beneficiaries’ health, the H.M.O.’s began dropping out: their extra layer of bureaucracy meant that they had higher costs than traditional Medicare and couldn’t compete on a financially fair basis.
Now if you're wondering why your mother, father, grandmother or grandfather was shoehorned into a plan which is cynically named Medicare Advantage, it's because the scum Congress which passed the vile Medicare D legislation (of which Tommy Thompson says he's so darn proud) made certain that there were big bucks for the for-profit insurance industry. Here's what Krugman has to say.
That should have been the end of the story. But for the Bush administration and its Congressional allies, privatization isn’t a way to deliver better government services — it’s an end in itself. So the 2003 legislation increased payments to Medicare-supported H.M.O.’s, which were renamed Medicare Advantage plans. These plans are now heavily subsidized.
According to the Medicare Payment Advisory Commission, an independent federal body that advises Congress on Medicare issues, Medicare Advantage now costs 11 percent more per beneficiary than traditional Medicare. According to the Commonwealth Fund, which has a similar estimate of the excess cost, the subsidy to private H.M.O.’s cost Medicare $5.4 billion in 2005.
Enough on Medicare D.
Let's move onto the health care reform being championed by the Republican governor of California. Again, don't take my word for anything. Take a look at this brave and brilliant op-ed which was in the Los Angeles Times yesterday.
WHEN Gov. Arnold Schwarzenegger, on crutches, unveils his expected grand redesign of the state's health insurance system Monday, he must tackle the biggest obstacle to insuring the uninsured: insurance companies.
The governor said recently that California's high number of uninsured residents — about one in five — acts as a hidden tax on the insured by forcing them to pay higher premiums, deductibles and co-pays. He has strongly hinted that he favors a system requiring individuals to buy health insurance, as well as assuring coverage for all children in the state (who constitute about 12% of the uninsured).But he's said nothing about reforming insurance companies or HMOs.
This is the truth you must understand. Everywhere you look, all you see when the subject of health care reform is discussed is, in reality, more of the same. It's all about maintaining the status quo of the for-profit insurance industry. And what does this mean for you and me? More of the same too, delay, deny and deceive.
Delay and deny us lifesaving health care, delay and deny us and our health care providers payment for services rendered. Deceive us about everything: Trial lawyers are responsible for spiraling health care costs (Wrong!); Health savings accounts are good for you and me (Wrong!)
The money paragraph from the L.A. Times.Schwarzenegger's experience with health insurers is not your average citizen's. Anyone as rich as he is doesn't have to worry about medical expenses. He and his surgeon surely didn't have to seek permission for treatment. They didn't have to argue with a cost-control center demanding something cheaper — such as outpatient surgery. The governor won't fear that his insurer will retroactively cancel his policy or double his premiums because of the surgery.
Not only is Schwarzenegger immune to most people's struggles with insurers, he's also enjoyed nearly $1 million in direct political contributions from them, according to public contribution reports.
It is this political relationship that should worry Californians hoping for real health care reform. Insurance companies, after all, will spend whatever it takes and call in every favor they're owed to stop reforms that restrict their profits, curb their extravagant overhead or limit what they can pay their chief executives.
California insurers won't like these proposals, and won't be shy in reminding the governor and Legislature about favors owed. Whether our elected officials respond to the desires of insurers or the needs of California will determine everything about health care reform.
Will Democrats stand up for the American people or their insuance industry patrons?
It's become almost oxymoronic. As the guy said: "I don't mind paying a doctor, but I don't understand why I have to pay an investor every time I get sick."
Labels: insurance
The human cost of the "market"
Lisa Girion, continuing her wonderful work exposing atrocious insurer practices in the LA Times, has a great piece detailing yet another tragic absurdity: In California, insurers will simply refuse to provide individual coverage to applicants from certain occupations. So if you're a roofer, or an athlete, or a dockworker, or a firefighter, and you apply for coverage, you'll be turned down, sight unseen. And even if you're not in one of these "risky" professions, if you've taken such medications as Celebrex, Lipitor, or eight of the Top 20 bestselling prescriptions in the United States, you can still be blackballed from all coverage.
This is the world traversed by the unfortunate souls condemned to seek coverage on the individual -- non-employer provided -- market. One of those souls was Maria Leavey, a luminous, unceasingly generous progressive who decided to make her life and living doing the organizing and social capital building and advising and bridging that no one else seemed capable of. Last week, at the age of 52, her heart failed her. A congenital defect, much like the one that killed her father, had lain undetected over the years, and it struck over the holidays. Maria had no health insurance.
It's impossible to know if coverage would've averted her death. I've no idea if she ever felt chest pains, and decided to wait, or was recommended for a precautionary ECG, but preferred to put her money into rent. But the very possibility smears our society's illusions of justice and fairness. Beyond her extraordinary personal and moral qualities, Maria was following the American Dream -- the very one politicians so often extol. She was a political entrepreneur, creating an occupation and pathway that hadn't existed before she conceived of it. She could've worked corporate had she so chose, or entered the bureaucracy at some larger institution. She was on a first-name basis with everyone from Howard Dean to Harry Reid -- a perch in a communications shop somewhere wouldn't have eluded her for long. Her sin was, instead, to take the road less traveled, to create something new and add as much value as her talents and vision allowed. That isn't a life course that comes with health insurance, Indeed, it's entirely possible that she applied, and had taken a painkiller at some point, or had a surgery, and was simply turned away. She never went corporate, and so she didn't deserve coverage.
Maria Leavey died last week. And maybe health insurance wouldn't have saved her. But maybe it would've. And what sort of society do we inhabit where we allow that question to linger?
Labels: insurance
Dems Expected to Produce Health Care Reform
Across the country there are unmistakable signs that the gridlock and confusion sustaining our sadly outdated system are coming to an end and that real reform may finally emerge...Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.
Dems who want to get up to speed on public opinion on health care reform will find no better place to go than Ruy Teixeira's article "What the Public Really Wants on health Care" at The Century Foundation. As Teixera notes:
The public desire for change in the health care arena is so strong that policy-makers would be well-advised to start concentrating on the issue now, rather than face the wrath of a frustrated public in the next election cycle.
Teixeira cites opinion data showing that nearly twice as many Americans are more worried about health care costs than unemployment and nearly three in ten say someone in their household has not had needed medical care or medicine during the last year because of cost. Teixeira also shows overwhelming majorities in favor of universal coverage and concludes that "The public is ready for change and the next election cycle is likely to punish those who stand in the way."
Democrats in congress will have to decide whether "big package" health care reform is now tactically as feasible as a step-by-step approach. But when November '08 rolls around, it is critical for Dems that a significantly higher percentage of Americans feel their health security has improved.
Wednesday, December 06, 2006
Lies, damn lies and health insurance
Transparency in Health Care Insurance
By Kip Sullivan (a friend of mine; cross-posted from Z Magazine Online)
printer friendly version
Comedian Jon Lovitz used to do a skit for “Saturday Night Live” in which he played Tommy Flanagan, the pathological liar. Lovitz’s character was always telling tall tales that made him look good. When a tale would become so outrageous even he suspected he was about to be exposed, Flanagan would stop for a moment, then, with a huge grin, he would blurt out a new fib and proclaim, “Yeah, that’s the ticket.”
The health insurance industry is proving to be a master at the Jon Lovitz routine. For a quarter-century the industry and its apologists in business, politics, and academia told the public managed care would solve the health care crisis. When even diehard defenders of the industry realized in the late 1990s that managed care had flopped, the industry came up with a new excuse to justify its existence and to distract public attention from real health care reform. Of the several names bestowed on the new excuse, the most faddish is transparency in health care. “Yeah, transparency, that’s the ticket.”
Like “health maintenance organization” and “consumer-driven health plan” (to name two other misnomers coined by the insurance industry and their hangers-on), “transparency in health care” is terribly misleading. The phrase evokes glorious visions of a world in which:
- Data on the quality of doctors and hospitals and other health care providers are published in great quantities (by whom is unclear)
- This cornucopia of data forces providers to improve quality
- The improved quality leads to lower costs
Second, despite Bush’s talk about “you and your doctor,” there is no information about individual doctors on the CMP report card. Grades are available only for entire “provider networks”—groups of clinics and hospitals, some with dozens of clinics and hospitals in them. Common sense and research indicate that to the extent patients want information on medical quality, they want it for particular health care professionals, not for entire clinic-hospital chains. The reason data on individual doctors is not offered is that the CMP is not collecting data on enough patients to make a statistical analysis of individual doctors possible. In other words, if the total number of patients in CMP’s current database were broken down by doctor instead of by provider network, the sample sizes for the vast majority of doctors would be too small to permit rigorous analysis. Collecting data on many more patients means, obviously, greater expense. Wednesday, November 15, 2006
Once a hack, always a hack?
I've known this guy for years and he's been a Republican party operative since long before I knew him. He wasn't just a hired gun, he was a true believer, so his sideline of lobbying intrigued me. Overlooking the obvious question (Might not his clients' interests conflict with his employer's interests, and might there not be ethical issues involved in accepting payment from both? Just askin'.), I wondered whether he would be able to remove the far-rightwing blinders he'd been wearing for so long and enable himself to see -- and represent -- the missions, causes and goals of those clients that did not fall on his side of the political spectrum. The answer was quick in coming.
The third and fourth sentences of his introductory letter read as follows: "There are many new faces in the Wisconsin legislature. New people with BIG ideas for our state, such as taxing medicaid (sic) funding or new regulations that can drive up the cost of your business." (You'll have to forgive that his fourth sentence was incomplete and failed to properly capitalize a proprer noun.) While all our ears perk up at the threat of new regulations, I call your attention to the earlier clause in this sentence fragment, in which he not only paints increased Medicaid funding as a threat in need of fighting, he blithely assumes that WHO -- and you -- will agree with this portrait.
Set aside for a moment the data that shows Medicaid funding is great for Wisconsin's business climate, let's take a look that moral implications of his assumption -- an assumption that is dripping with far-right political thinking. And let's be clear: It is not Republican thinking, it's "fringe" thinking.
He's assuming that everyone who runs a business is so fixated on increasing their own material wealth that they're willing to short-change funding for the health and well-being of our neediest citizens (including children), our disabled and our frail elderly. In short, he's assuming that our greed is so strong it's twisted us into a perverse caricature of human beings. Beyond being amused by that level of stupidity in a marketing letter sent to WHO, I take offense to the assumption about the state of your soul and mine.
Christmas is just around the corner and one of our best loved seasonal stories, "A Christmas Carol," contains an applicable and rather pointed scene between two main characters:
Marley's Ghost, explaining his chains, was despairing over "life's opportunities misused."
Scrooge, trembling with fear and beginning to share in Marley's guilt, said: "But you were always a good man of business, Jacob."
The ghost cried out in anguish and anger: "Business! Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence, were all my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!"
These words stand as an eloquent expression of our grand human purpose. It is our inner thoughts and feelings, our motives, our priorities, which contribute to making our lives an emptiness or a fullness. What we are in our whole being is so much grander than anything we can measure by surface values. In Goethe's words, "We are shaped and fashioned by what we love."
We can see what has shaped the soul of this hack, but what is shaping us? Let us neither sink to our lowest nature, not be swayed by those who appeal to our owest nature. The notion that running a business, making a living and taking care of our needy are mutually exclusive, or even contradictory, is unsupported by data, archaic and immoral. If we can't kill it off, let's at least ignore those who sell it.
Monday, November 13, 2006
Health system in need of hospice care?
Somehow, I'm skeptical of this HMO report
New research suggests that hospital visits decrease as the level of cost the patient bears go up. While this might be worrisome--we don't want people to avoid hospital trips and end up sicker--the study also found that the higher co-pays actually didn't have a negative effect on patient health. In fact, they saw no increase in negative clinical events such hospitalization, intensive care admission or deaths. To gather their data, researchers followed more than two million commercially insured patients and 250,000 Medicare insured patients.
OK, that's a large number of patients, but color me skeptical. I'd like to know how forcing poorer patients to decide on their own how sick they are could possibly have no impact on outcomes. Maybe the fact that Dr. Hsu is affiliated with Kaiser Permanente--a health plan which stands to make money if visits go down--has something to do with the result? Hey, I'm just asking...
For more background on the research:
- read this Medical News Today article
I like this guy!
Labels: nursing
More fun with our HMO friends
It's not just about William McGuire (photo) anymore. Now it appears that stock options drama will have a much greater impact, forcing the company to restate earnings all the way back to 1994. True, the outgoing UnitedHealth CEO agreed to reprice his personal stock options, cutting about $200 million in value from his staggering $1.78 billion haul. Incoming CEO Stephen Hemsley has agreed to forfeit $190 million on options he holds, as well. In a recent release commenting on the repricing, McGuire's attorneys bragged that the company had grown 8400 percent during his tenure, which apparently makes the stock option skulduggery OK. I don't know about you, but I think McGuire's management track record has little to do with whether his options were improperly backdated, or what--if anything--should be done to punish him. But then again, I'm not on his payroll.
UnitedHealth had previously estimated that stock option-related charges would cut $286 million from reported earnings for 2003 through 2005. Now, executives say that that losses will be "significantly higher," though they haven't yet named a figure. In an apparent response to these ongoing troubles, the company's CFO has been moved out of his job into as-yet-unspecified new duties.
To get the latest details on the options scandal:
- check out this Wall Street Journal piece (sub. req.)
- read this Associated Press article
- see Dr. McGuire's statement
Related Articles:
UnitedHealth CEO ousted. Report
UnitedHealth CEO denies actions hurt patients. Report
Labels: insurance
Moral hazard theory debunked
Labels: insurance
Uninsured man dies while we all stand by
It's one of those tragic stories that makes one absolutely certain that our health care system is broken (if you had any doubt). Middle-class, employed Delbert Davis incurred hundreds of thousands of dollars in medical debts, declared bankruptcy and ultimately died because he wasn't able to get insurance or self-pay for a liver transplant. Delbert, who was in the printing business, lost his health insurance in late 2004. Not long after, he was diagnosed with cirrhosis of the liver but told that his liver could regenerate if he took care of himself. Meanwhile, though he worked part-time and his wife full-time, neither was able to get health insurance again. When his liver failed to regenerate, doctors told him that he needed a transplant, but without insurance, the region's transplant centers wouldn't place him on the candidate list. Besides, there was no way the two could have come up with the $120,000 to $500,000 needed to pay for the procedure. With the couple's income barring them from Medicaid coverage and other programs, Davis didn't get the transplant and died only three years after the couple married. While I realize that the hospitals involved needed to make hard, cold financial decisions here, I wonder why nobody other than his wife seems to have fought hard for Delbert. It's a sickening spectacle.
To read the whole story of Delbert Davis' death:
- read this piece in the Austin American Statesman
Labels: uninsured
Thursday, October 19, 2006
Insurers hit record profits (what's in YOUR wallet?)
The story goes that insurers, especially medical malpractice insurers, are charging increasingly higher rates because of too many lawsuits and too many fraudulent claims. Well, as is pointed out in this post, one has to ask themselves if insurance companies are being so squeezed by lawsuits that they have to increase rates simply to stay afloat and are not just choosing to do so to make more money, shouldn't they be making far less money than they used to? The recent statistics on property and auto insurance company profits, even after Hurricane Katrina, do not fit well into this narrative.
Insurance industry profits hit record highs in 2005, despite Hurricane Katrina.
* The property-casualty insurance industry's after-tax net income for 2005 was the highest ever, a record-breaking $44.8 billion!
* 2005 profits are up 18.7% over last year's profit of 38.7 billion; 2004 had been the record until 2005.
* The property/casualty industry's surplus also is at the highest level ever, rising by more than 7% to nearly $427 billion.
(link to full Center for Justice and Democracy piece)
Even in light of these astounding post-Katrina numbers, insurance companies still argued that they need more support from the state and will need to premium raise rates.
They said that even with the increase, insurers face deep problems that can be fixed only by substantial premium hikes, a scaling back of commitments by several firms to the most disaster-prone portions of the country and, according to some, a greatly expanded role for the state and federal governments in insuring individuals against the largest of catastrophes.
"Unless insurers can get relief, you're going to see a pullback by the private industry," warned Robert P. Hartwig, chief economist of the industry-funded Insurance Information Institute.
"We're not being good stewards of our investors' capital or our policyholders' surplus if we keep doing business where we can't make money." (link to Los Angeles Times Article)
This perspective is already kind of hard to swallow, but it almost gets worse.
As explained by Peter G. Gosselin, of the Los Angeles Times, these insurance companies are doing fine because they have over time pulled back their coverage and (beleive it or not) gotten their own insurance for their insurance policy losses. In short, they have slowly shifted financial risks to be increasingly "borne by individuals:"But the industry's remarkable performance also reflects a dozen-year effort by insurers to insulate themselves from the most extreme financial consequences of catastrophe by, among other things, shifting risks previously borne by companies to policyholders and the public.
The effort started after the last big batch of natural disasters in the early 1990s, among them Hurricane Andrew in Florida in 1992, and the Oakland hills firestorm in 1991 and Northridge earthquake in 1994 in California.
The effort has included industry adoption of increasingly sophisticated techniques for analyzing catastrophic risk, as well as self-imposed limits on how much firms will cover and where. It also has included successful campaigns to get states or state-created entities to shoulder such dangers as earthquakes in California and wind in Florida, Texas, Hawaii and elsewhere. And it has involved tightening policy language -- by, for example, narrowing the definition of "replacement cost" for homes -- in ways that leave individuals bearing more of the burden of putting their material lives back together after trouble strikes.
While premiums for homeowners insurance have increased by more than half since the early 1990s, coverage, especially in disasters, has shrunk. Historically, insurers covered a little more than 60% of total losses in disasters, according to Hartwig, the industry economist. During the 2004 hurricanes in Florida, they covered less than 50%, according to Hartwig's numbers. During Katrina, he said, they covered about 30%, due in part to the high flood damage.
In making these changes, the insurance industry has been part of a trend that has picked up steam as the U.S. economy has grown more competitive in recent decades -- a shift of financial risks from business and often government to individual households.
"If last year's hurricane season had occurred 10 years ago, it would have been devastating for the company," said Allstate Vice President Fred F. Cripe in an interview. "Last year, it was merely disappointing."
(link to Los Angeles Times Article)
See Justinian'stelling post and chart on this issue.
Ideas for fixing what's wrong
When we take a long view on improving health, we usually find reasons to celebrate. In the last century, for example, infant mortality dropped by 90% and maternal mortality decreased 99%. Yet today, despite scientific advances, we face the fact that we are not a healthy nation:
– Our children’s life expectancy may be shorter than our own.
– About 70 % of deaths and health costs in the U.S. are now attributable to chronic diseases (e.g., cardiovascular disease, cancer) — many of which are preventable.
– More people die from obesity or tobacco than from homicide.
Our health care system has gravitated toward quick fixes rather than the persistent actions with lifetime rewards. Proven clinical and community preventive services go unused. Two out of three adults fail to get a flu vaccine or recommended colorectal screening. Millions of lives are lost needlessly. As a nation, we dedicate only three percent of our health dollars on health promotion — but over 20% of costs to the last year of life.
A new approach is needed. As part of its overall plan to fix the fundamentally flawed health system, the Center for American Progress proposes a Wellness Trust. The Wellness Trust would:
– Deliver prevention outside of the bounds of the health system by paying for services wherever they are delivered, in pharmacies or supermarkets, workplaces or senior centers.
– Use its pooled financing to create incentives for providers, employers, schools and individuals to prioritize prevention.
– Operate independently like Social Security, with expert Trustees.
The premise of the Wellness Trust is that disease prevention is more like homeland security than health insurance: everyone needs it, no one notices if it works, and it depends on persistent, strong leadership and systems. While change will come at a cost, this cost would be dwarfed by the lost lives, productivity, and public resources that will result from a failure to act.
Health care opinion survey results
Kaiser, ABC, and USA Today just released a pretty expansive poll documenting the country's opinions on health care. The nickel version is that your countrymen are mostly liberal, deeply confused, and more likely to loathe the status quo than clearly conceptualize potential alternatives. Respondents said it was the third most important issue in the country, behind Iraq and the economy, but before immigration, gas prices, or terrorism. That's probably because opinions toward the system are so overwhelmingly negative: 80% are dissatisfied with the cost of health care in the country, and 54% are dissatisfied with the quality. So the system starts out with few friends.
From there, things get more complicated. Nearly 90% are satisfied with the quality of care they received. Nearly 60% are satisfied with their costs. In other words, Americans believe everyone else's health care system costs too much and delivers too little. Their own system rocks. Meanwhile, a full 25% reported that they or someone in their household had problems paying for medical bill in the last 12 months, and 28% put off medical treatment due to cost. Of that 28%, 70% admitted that the delayed treatment was "serious." And remember, this is all in the last year.
Individual fears become more acute when asked about the future: 60% fear affording insurance "over the next few years" and 56% fear losing their coverage if they lose their job.
As for what's driving all these high costs, the reported culprits, in descending order, are excess profits of drug and insurance companies, medical malpractice lawsuits, fraud and waste, overpaid doctors, administrative costs, unnecessary treatments, unhealthy lifestyles, expensive new treatments, the aging population, and better medical care.
So, in sum: The health care system sucks, but nearly every American's health care is great. That would suggest the opportunities for reform are minor, unless directed at the loathed elements (like insurance or Pharma). Folks don't like the high costs and fear they'll soon be overtaken by bills, but they blame all manner of minor and moderate contributors for the problem, not their own health choices, overtreatment, or new technologies. Universal care is heavily desired, but only if it doesn't cost anything or demand any sacrifices. In other words, the appetite for reform outpaces the realism of would-be reformers. The tradeoffs of the current system seem poorly understood, and attitudes towards its desirability are contradictory. Not a whole lot of hope in here for anyone.
Managed care: We're trying to LOOK like we care
Blue Cross of California has settled a group of more than 70 lawsuits and claims filed by patients who alleged that the health plan canceled their insurance after they got sick. The settlement comes in response to pressure from state regulators, which already fined the health plan $200,000 for canceling one California woman's policy, according to the Los Angeles Times. While the dollar amount was not disclosed, the patients received a substantial cash settlement and are "pleased" with the outcome, according to one plaintiff's attorney. Five other suits, including one filed against Blue Shield of California, are currently pending, according to the Times.
The suits accused Blue Cross of exploiting a state law allowing health plans to cancel individual policies if the insured lied on their application. They contended that the insurer intentionally designed the forms to be misleading, generating innocent mistakes that could be used against them as evidence of deceit. Blue Cross only checked over the forms when a patient filed a claim for treatment of a chronic condition or costly care, the plaintiffs said.
Find out more about the suit: Read this article from the Los Angeles Times
Meanwhile, Blue Cross of California has been working to position itself as a good corporate citizen (bwahaahaahaa), funding rural and urban health care initiatives across the state. Article
