The view from here

I received a letter this week from a fellow association executive in Wisconsin, annoucing that he and one of his association staff members are running a lobbying firm on the side and wondering whether WHO would like to hire their services.

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.

Critics debate whether our health system is actually on the verge of collapse, or just facing bad publicity from well-publicized but anomalous problems. But if you look at the facts squarely, there's no question that the system is close to failing, says John Abramson, a clinical instructor at Harvard Medical School. In fact, we spend far more on health care than other Western countries, and get worse results, he contends. Column

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

It's not often that you see a hospital CEO walk away from the lucrative, high-profile job to take on the backbreaking work of nursing. But that's just what former respiratory therapist and Milton Hospital CEO George Geary did. At age 56, he went to nursing school, and now, at age 59, is working overnight shifts at a Boston-area hospital as a green recruit. It's not that Geary failed at being a CEO--Milton Hospital has run in the black for 14 years--it's because he wants to be closer to patients. Article

Labels: nursing

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

Most current health care policy--and health plan benefit structure--is based on the assumption that consumers will over-utilize health care services if there's no financial penalty for doing so. Economists call this notion the theory of "moral hazard." But New Yorker columnist Malcolm Gladwell disputes this conclusion strenuously, arguing that you can't apply this theory to health care demand. What happens when patients are forced to carry a larger share of costs, in reality, is that rather than cutting wasteful utilization, it encourages patients to neglect serious conditions like diabetes and high blood pressure. "When it comes to health care, many of the things we do only because we have insurance--like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care--are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health care system a good deal of money," he writes. Column

Labels: insurance

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