Category: Healthcare

Could Someone Please Hang this Guy from a Lamp Post?*

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Don’t You Want to Slap That Smile From His Face

It turns out that Martin Shkreli, he of the rapacious drug price hike infamy donated a few thousand dollars to the Bernie Sanders campaign and demanded an audience.

Sanders donated the money to a medical clinic and told him to piss off:

It must be strange, if you’re the kind of person who generally believes he can wave his wallet in the direction of something he wants and make it — poof! — appear, when that magic trick doesn’t work. When a drunken demand for mac and cheese goes unheeded. Or when a pharmaceutical company CEO gets turned down by a politician. Sorry, Martin Shkreli!

Just last month, Shkreli earned the disgust of a good portion of the Internet — as well as Democratic hopefuls Hillary Clinton and Bernie Sanders — when it was revealed his company, Turing Pharmaceuticals, had raised the price of toxoplasmosis drug Daraprim from $13.50 a pill to $750 overnight. Sanders even wrote a letter to Shkreli, asking for an explanation. But though Shrkreli quickly vowed that “I think that it makes sense to lower the price in response to the anger that was felt by people,” no change has been forthcoming. He now says that “Until we figure out demand, we won’t lower the price. We have to find a safe price to lower it to.” Seems like something he’d want to get on, soon.

Shkreli has, however, meanwhile managed to find the time to troll journalists and retweet photos of cats rolling around in money. He also, according to the Boston Globe, “says he has donated to presidential candidate Bernie Sanders — who has been bashing Big Pharma on the campaign trail — to try to get a meeting so the two can talk it out.” It did not work out that way.

Shkreli claims he recently donated $2,700 — the maximum individual contribution — to Sanders’ campaign. He told the Boston Globe he had hoped for a private meeting with Sanders to explain the rationale of drug company pricing. But on Thursday, the Sanders campaign said they were giving the money to the Whitman-Walker health clinic in Washington, adding, “We are not keeping the money from this poster boy for drug company greed.”

And Shrkreli now says he’s “furious” over the snub. “I think it’s cheap to use one person’s action as a platform without kind of talking to that person,” he says. “He’ll take my money, but he won’t engage with me for five minutes to understand this issue better.” And he continues, “I’d ask him, what role does innovation play in health care? Is he willing to sort of accept that there is a tradeoff, that to take risks for innovation, companies have to invest lots of money and they need some kind of return for that, and what does he think that should look like?” I guess you can’t always get what you want. Meetings with senators, your toxoplasmosis drug returned to a reasonable cost, that sort of thing.

Seriously, Mr. Shrkreli, how about you make the world a better place, and just drop dead.

*From his testicles, not his neck.  Death by rope is too quick,†
†OK, in a perfect world, there would also be some pinata play as well.‡
‡And fire ants, definitely fire ants

A Very Good Point on Obamacare

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The folks at Naked Capitalism have never been big fans of the PPACA, because they feel that it has far too many sops to the evildoers in the US healthcare system, in particular the insurance companies. (I agree)

Now Lambert Strether makes what is an obvious point, that the “Cadillac Tax” on high value healthcare plans are pretty clearly a tactic developed to union bust:


I haven’t written about much about ObamaCare’s “Cadillac Tax” mostly because it seemed (as we shall see) such an obvious union-busting measure that there wouldn’t be much of interest to say. However, a recent Kaiser briefing on how many employers will be affected by it has generated a lot of coverage, and, as it turns out, the Cadillac tax — not that anybody could have predicted this — turns out to be insanely complex, based on a crazypants neo-liberal economic assumption, and will screw over a lot more working people than originally thought. (There’s actually some pressure on the Hill for reform or repeal, and not just by the usual suspects, but I won’t cover the politics of it here).

………

And if the unions can’t deliver wages, and now they can’t deliver benefits — or prevent existing benefits from being taken away — what exactly do they deliver? So who is to determine what is “generous”? Workers, or pencil-necked< neo-liberal economists? Who never mention whether CEO health insurance — or top 20% health insurance, for that matter — is “too generous”? That said, let’s turn to the crapification. From the Kaiser briefing:

The potential of facing an HCPT assessment as soon as 2018 is encouraging employers to assess their current health benefits and consider cost reductions to avoid triggering the tax. Some employers announced that they made changes in 2014 in anticipation of the HCPT, and more are likely to do so as the implementation date gets closer. By making modifications now, employers can phase-in changes to avoid a bigger disruption later on.

………

So, a race to the bottom that starts out affecting “overly generous” health insurance, and ends up affecting more and more of the rest of us. Typical. I doubt this can be fixed by Congress this year or next, since the Democrats will not be able to admit that Obama has ever made a mistake in any aspect of his sorry administration, and Republicans have no choice but to throw red meat to their base by trying to repeal it all together. Pass the popcorn.

This is not a bug.  It’s a feature.

If you were come up with a way to get the truth for any people behind Obamacare, whether Obama, Gruber, or whoever, they all would say that they want to eliminate employer sponsored health insurance by making various claims about how having open insurance markets and “skin in the game” will make healthcare more efficient.  (All the available evidence shows otherwise)

Obama has been (at best) lukewarm on unions, with no effort to push card-check, his hiring of union-busting heiress Penny Pritzker, his aggressive support of union-busting mayor Rahm Emanuel, his tepid opposition to “Right to Work” legislation proposals put forward in many states, etc.

There are way too many people among Obama’s “Chicago School” policy advisers who see an Ayn Rand inspired dystopia as a model for a good society.  (As an aside, it turned out that even Ayn Rand could not live in the world which she hoped to create.)

Our country is looking more and more like the USSR circa 1987.

Today’s Must Read, from Paul Krugman

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Paul Krugman makes an interesting observation in the case of the lion killing dentist from Minnesota, and it has nothing to do with the ethics of killing things for your personal amusement, and everything to do with the fact that “Skin in the Game” does not work to control healthcare costs:

Wonkblog has a post inspired by the dentist who paid a lot of money to shoot Cecil the lion, asking why he — and dentists in general — make so much money. Interesting stuff; I’ve never really thought about the economics of dental care.

But once you do focus on that issue, it turns out to have an important implication — namely, that the ruling theory behind conservative notions of health reform is completely wrong.

For many years conservatives have insisted that the problem with health costs is that we don’t treat health care like an ordinary consumer good; people have insurance, which means that they don’t have “skin in the game” that gives them an incentive to watch costs. So what we need is “consumer-driven” health care, in which insurers no longer pay for routine expenses like visits to the doctor’s office, and in which everyone shops around for the best deals.

………

But what if even the underlying premise, that individual choice will hold down costs, is all wrong?

As it turns out, many fewer people have dental insurance than have general medical insurance; even where there is insurance, it typically leaves a lot of skin in the game. But dental costs have risen just as fast as overall health spending, and it may be that the reduced role of insurers actually raises those costs. According to the post,

In the rest of medicine, insurers have an important function in limiting costs and promoting quality. The market power of Medicare and major national insurance companies allows them to insist on better rates for their customers when they negotiate with doctors and hospitals.

“There’s been less presence from all kinds of insurance payers in the dental sector,” explained Andy Snyder, who is in charge of oral health at the nonpartisan National Academy for State Health Policy. “Medicare does not cover routine dental services, and private dental coverage is far less common than private medical coverage. So, the dental industry has faced less of the cost containment and quality improvement pressures that the rest of the health care sector’s experienced over the last couple of decades.”

So more skin in the game is not just useless but actually counterproductive.

Bazinga!

Has John Thune Been Dining on Lead Paint?

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It is amazing just how much stupid can be jammed into just 140 characters:

Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people.

— Senator John Thune (@SenJohnThune) June 8, 2015

I am not a big fan of Obamacare, but to claim that Obamacare might be responsible for ending the subsidies that it created is a level of stupid that buggers the mind.

Good Governance from ……… Nigeria?!?!?!?!?!

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I’m actually serious here.

Not only did the Nigerian parliament pass a ban on female genital mutilation, but it was done in a way in which the successor politicians get political cover to enforce the law:

Nigerian President Goodluck Jonathan signed a bill this week that criminalizes female genital mutilation or cutting, a practice that a staggering 19.9 million Nigerian women are thought to have undergone. The landmark legislation is being hailed as an important step for Africa’s most populous country but also one that experts hope will have a potential ripple effect on the 26 other African nations that have significant populations of women who undergo the practice.

Nigeria’s decision to outlaw female genital mutilation (FGM) sends “a powerful signal not only within Nigeria but across Africa,” according to J. Peter Pham, the director of the Africa Center at the Atlantic Council. “Nigeria, just because of the sheer size of its population, has one of the highest absolute number of cases of FGM in the world,” he said, adding that the bill now effectively criminalizes a significant percentage of FGM on the African continent. “One cannot overestimate the impact of any decision by Nigeria [on the continent].”

Here is the important bit:

In this regard, the timing of Nigeria’s decision to outlaw the procedure is no coincidence. While advocates have campaigned for this legislation for over a decade, it was only passed this week, in the final days of the Jonathan presidency. “There’s a price to be paid by bucking norms that are widely observed,” said Pham. “It took a lame duck president and lame duck legislators who don’t have to face voters to undertake something that goes that much against the cultural norms or practices.”

Indeed, Pham argued that Jonathan has even done a favor for his successor, President-elect Muhammadu Buhari, who will now not have to face future voter backlash by legislating the controversial issue. “It’s already signed and Buhari can say he’s simply enforcing the laws,” he said.

This last bit is remarkable, particularly for a country whose political system is a dysfunctional as Nigeria’s.

Normally, one would expect a defeated President to do whatever they could to plant policy land mines for his predecessor, much as GHW Bush did with Clinton on Somalia in 1992.

Props to the soon to be former President of Nigeria, Goodluck Jonathan, for doing the right thing in the right way in the most unlikely of places.

Alan Grayson Was Right! They Want You To ‘Die Quickly’*

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Michael R. “Andromeda” Strain. a resident “scholar” for the American Enterprise Institute, penned an OP/ED, and the moral pygmy that is Washington Post editorial editor Fred Hiatt, published a work titled, “End Obamacare, and people could die. That’s okay.”

He wants the death penalty for poverty.

What’s more, he tacitly admits that Obamacare saves lives.

 Seriously, the Washington Post has the 2nd worst opinion pages in the nation.

*This is not my bon mot, it is courtesy of Crooks and Liars.

F%$# Me! I Agree With a Fox News Doctor!

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He’s right, you know

Fox Doc Marc Siegel has condemned the anti-vaxxer movement over the Measels outbreak in Disney Land:

Fox News medical correspondent Marc Siegel lashed out on Thursday at parents who refused to give their kids vaccines for putting everyone else at risk.

Reports this week said that at least 70 cases of measles had been confirmed at Disney theme parks, with 62 of those cases occurring where the anti-vaccination movement is thriving in Orange Country, California.

During his Thursday appearance on Fox News, Siegel, who is an associate professor of medicine at NYU Langone Medical Center, wasted no time in blaming anti-vaxxers for the outbreak.

“Let me be clear on this, I see no debate whatsoever. Period,” Siegel said. “This is the greatest vaccine that has ever been created in the history of vaccines.”

The doctor pointed out that “measles is the most contagious virus known to man.”

Your mouth to God’s ear, Doctor Siegel.

I cannot believe that I am posting a Fox News clip with approval.

American Healthcare in a Nutshell

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Author, and Canadian, Douglas Coupland describes his experience with the American healthcare system.

The short version is that he had a cold that became bronchitis, and he went to a clinic, and got a prescription for an antibiotics and oxycodone(!) as a cough suppressant.

I do understand that opiods are effective cough suppressants, codeine used to be in half the cough syrups out there, but it does seem to me like hunting for an elephant with a microscope.

But here is the kicker, and it shows just how corrupting the profit motive is:

………

 My doctor vanished for a few minutes and I looked around. The clinic was pleasant enough, as were both the staff and my doctor, who returned a few minutes later with some filled-out prescription forms. “I’m going to give you a course of antibiotics. Take one a day in the morning with food. Just one.” [emphasis mine]

“OK.”

 “And here’s a prescription for oxycodone. Take two a day.”

 “Oxycodone?” It felt weirdly glamorous to be getting some oxy for the first time.

 “Yes. It’s a terrific cough suppressant.”

 “OK.” In my head I was thinking, “Oxy — woohoo!” . . . but in my body I was thinking, “But I also really would like to stop coughing up jelly-like deep-sea creatures into my dinner napkins.” So I walked three minutes to the pharmacist and picked up my antibiotics, and then my oxy. My pharmacist looked at me gravely: “You know, you’re very lucky your doctor gave me this discount coupon on your oxycodone prescription.”

 “Oh — why’s that?”

 “This drug [use drug name; get sued] is $900 a pop.”

 “What?!”

 “Yes, but for you, with a coupon this first time, it’s $90.”

 “For a cough suppressant?”

 “Not just any cough suppressant. This is oxycodone.”

 “I suppose so.”

 “And there’s a bit of decongestant added to it as well.”

 “Hard to argue with that.”

Well, the bronchitis does not clear up, and it turns into pneumonia, and our fearless protagonist finds that he has developed a physiological dependence on the Oxy.

He then gets back to his doctor in Canada:

So I stopped. [the Oxy] And I returned to Canada, where my doctor looked at my prescriptions, puzzled. First, my antibiotic: “Your Florida doctor prescribed you this? [Name drug; get lawsuit.] We used to give this to two-year-olds and, even then, for your body weight, this ought to have been at least three times a day at quadruple strength.” [emphasis mine]

 “OK, but what about oxycodone? You have to admit, it did stop me from coughing.”

 “Yes, but you also almost became addicted to a $900-a-pop drug.”

 “True.”

 “And just to be clear, you were deliberately underprescribed antibiotics to keep you from getting well so as to ensure that you’d keep going back for more visits and repeat oxy prescriptions. And your doctor was obviously in on some kind of racket with the pharmacist — all that coupon nonsense.” [emphasis mine]

 “All true.”

 Within 48 hours, my pneumonia essentially vanished thanks to two azithromycin tablets. But it took almost a week for The Hand to permanently unclasp itself from my skull. [Oxycodone dependency] Now that the experience is over, I feel as if I’d driven through a speed trap in a small Ozark town and had been at the mercy of the local Boss Hogg. All of this because of bronchitis. What if I’d had something bigger than mere bronchitis? What bigger and scarier speed traps would await me or you or anyone else down the US medical road?

The system does not just prey on Canadians, you know, it preys on all of us.

What’s more, my guess is that there was no (illegal) kickback arrangement, but rather that the pharmacy was either owned in whole or part by the doctor, or operating as a part of the clinic (my money is on the latter), so there were no illegal payments per se, just business.

To paraphrase Sal Tessio, “It’s nothing personal it’s only business.”

Yes, the Goal is the Eimination of Employer Supplied Health Plans

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Remember when I said that I thought that one of the hidden goals of Obamacare was the elimination of employer sponsored healthcare plans?

Well, pretty much:

In a 2011 conversation about the Affordable Care Act, MIT economist Jonathan Gruber, one of the architects of the law more commonly known as Obamacare, talked about how the bill would get rid of all tax credits for employer-based health insurance through “mislabeling” what the tax is and who it would hit.

 In recent days, the past comments of Gruber — who in a 2010 speech noted that he “helped write the federal bill” and “was a paid consultant to the Obama administration to help develop the technical details as well” — have been given renewed attention.

 ………

 The issue at hand in this sixth video is known as the “Cadillac tax,” which was represented as a tax on employers’ expensive health insurance plans. While employers do not currently have to pay taxes on health insurance plans they provide employees, starting in 2018, companies that provide health insurance that costs more than $10,200 for an individual or $27,500 for a family will have to pay a 40 percent tax.

 “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance,” Gruber said at the Pioneer Institute for public policy research in Boston. The subsidy is “terrible policy,” Gruber said.

 “It turns out politically it’s really hard to get rid of,” Gruber said. “And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people when we all know it’s a tax on people who hold those insurance plans.”

 ………

 The issue at hand in this sixth video is known as the “Cadillac tax,” which was represented as a tax on employers’ expensive health insurance plans. While employers do not currently have to pay taxes on health insurance plans they provide employees, starting in 2018, companies that provide health insurance that costs more than $10,200 for an individual or $27,500 for a family will have to pay a 40 percent tax.

 “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance,” Gruber said at the Pioneer Institute for public policy research in Boston. The subsidy is “terrible policy,” Gruber said.

 “It turns out politically it’s really hard to get rid of,” Gruber said. “And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people when we all know it’s a tax on people who hold those insurance plans.”

Seriously, Obama, and the people who advise him, make Ronald Reagan look like a f%$#ing socialist.

Obamacare is chock full of manifestations of the unholy glee that Obama and His Evil Minions™ take in neoliberal free market ideology and the financial industry.

The most depressing thing is that the next president is probably going to be a lot worse.

This is the Best Idea that I have Heard all Day

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The canvassing board in Michigan has just certified the language for a petition to prevent hospitals to overcharge the uninsured:

The Board of State Canvassers on Monday unanimously approved the form a statewide ballot initiative petition that aims to prohibit a health care provider from charging a higher price to some for medical goods or services.

A group called Stop Overcharging is backing the “citizen initiated” legislation, which would limit a hospital or provider to charging somebody any more than 150 percent of the lowest amount the provider had accepted as payment in full.

The example they give is if somebody was charged $2,000 for an MRI but the provider accepted $600 as payment in full, the provider couldn’t force an uninsured person or auto accident victim to pay more than $900.

It’s something that has come up in the discussion of no-fault reforms. The petition is designed to incite action from the state legislature on that topic.

“We would hope that they would, we would wish that they would, but we’re preparing if they wouldn’t,” said Rocky Raczkowski, a former state lawmaker who is heading up the petition drive.

………

The Board of State Canvassers unanimously approved the petition as to form, meaning it meets state guidelines and can be circulated.

The group can start collecting signatures after the Nov. 4 election, and Raczkowski said they plan to move quickly. Asked if paid circulators would be circulating the petitions, he said the group was still examining its options.

There is some political baggage along with this, it seems to be associated with insurance “Reforms” that favor the auto insurance industry, but the idea that part of the healthcare delivery problem in the USA is the price of healthcare appears to be gaining currency, and this is a good thing.

The idea that, for example, the cost of an identical service can vary by over an order of magnitude at the same hospital in the is much, if not most of the problem here.

The New York Times revealed something very similar recently, when it discovered that many hospitals employed ER physicians who were out of network, who then price gouged patients, since they were not covered by any agreement with insurance carriers:

When Jennifer Hopper raced to the emergency room after her husband, Craig, took a baseball in the face, she made sure they went to a hospital in their insurance network in Texas. So when they got a $937 bill from the emergency room doctor, she called the insurer, assuming it was in error.

But the bill was correct: UnitedHealthcare, the insurance company, had paid its customary fee of $151.02 and expected the Hoppers to pay the remaining $785.98, because the doctor at Seton Northwest Hospital in Austin did not participate in their network.

“It never occurred to me that the first line of defense, the person you have to see in an in-network emergency room, could be out of the network,” said Ms. Hopper, who has spent months fighting the bill. “In-network means we just get the building? I thought the doctor came with the E.R.”

Patients have no choice about which physician they see when they go to an emergency room, even if they have the presence of mind to visit a hospital that is in their insurance network. In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network.

Note that this sort of shenanigans is why ER doctors income has gone up in recent years.

ER’s are going Wall Street, and the only people who win in this game are the worst among us.

Obamacare Follies

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It turns out that large employers, particularly ones with large numbers of low paid employees, can issue complying plans that do not cover hospitalization>:

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.

“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”

Timothy Jost is pretty sure the whole thing was a mistake.

“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.

………

Companies considering such plans include a restaurant chain with 1,000 workers, a trucking firm with 500 employees and dependents, a delicatessen, a fur farm and firms working the oil boom in upper Midwest, Flunker said.

Employer interest in the plans “is definitely picking up pretty quickly,” said Kevin Schlotman, director of benefits at Benovation, an Ohio firm that designs and administers health coverage. “These are organizations that are facing a significant increase in expenses. They’re trying to do their best.”

I rather imagine that WalMart is working to set up something like this.

Evil is as evil does.

This is what happens when you decide that the source of the problem must be “partners” in a solution.

The free market aspects of  American healthcare are what cause the high prices and opacity and poor outcomes. 

Expecting that stapling a few regulations on this system would fix it was delusional.

My Feelings on Scottish Secession

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After thinking about it, and analyzing my feelings on this matter, I support the secession referendum.

Basically, I think that the current political situation in the UK, where the Neoliberal consensus and the banksters in the City of London rule will continue to control the political discussion in England, and hence in the UK as a whole.

What this means is that, when in power, the Tories will continue to engage their efforts to do things like gradually privatize the social contract in Britain, and when the “new” (Blairite) Labour is will simply accept the new status quo, and so the policies will ratchet to a Dickensian society, particularly with the cross-party support of things like the Transatlantic Trade and Investment Partnership (TTIP), which largely makes privatization irreversible.

The path England has taken is pretty clearly toward continued deindustrialization and further finanacialization, at least until the Vampire Squid finishes sucking what remains out their society, and moves on.

The Tories are pushing inexorably in that direction, and Labor never moves the needle back, they just slow the deterioration for a few years.

In the process, it is clear that the National Health Service (NHS) will move to something very much like the American model for healthcare.

I would consider inflicting our system of healthcare on anyone else to be tantamount to a crime against humanity, and crimes against humanity are a justification for secession.

Soldiers, Is That Our Answer to Everything?

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Obama is sending 3000 soldiers to Africa to deal with the Ebola outbreak in Africa.

Am I the only one who thinks that it might be a better idea to send doctors, nurses, lab technicians, and construction workers?

The Obama administration is ramping up its response to west Africa’s Ebola crisis, preparing to assign 3,000 US military personnel to the afflicted region to supply medical and logistical support to overwhelmed local healthcare systems and to boost the number of beds needed to isolate and treat victims of the epidemic.

Seriously? We need to send in the military to deal with an epidemic?

I am coming to believe that no one in Washington believes that any agency but the Pentagon can do anything, ever!

DC Circuit Will Hear Obamacare Subsidy Case En Banc

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After a three judge panel of the U.S. Court of Appeals for the District of Columbia Circuit, in which Federalist type Neander-Conservative were the majority, ruled against subsidies for states that used the federal insurance exchanges, the DoJ asked for a hearing from the full court, an en banc hearing.

Well the court has agreed to this hearing, and they have stayed the decision of the original panel:

A vital part of the federal health care law will get a new review before the full bench of the U.S. Court of Appeals for the District of Columbia Circuit. In a two-page order released Thursday, a majority of the eleven-member court granted the Obama administration’s request to consider en banc the legality of subsidies being given to consumers to help them afford health care insurance, if they shop for it at a federal marketplace (“exchange”). Such exchanges exist in thirty-four states, and nearly five million consumers have already received subsidies.

By granting further review of the controversy, the en banc court wiped out a three-judge panel’s two-to-one ruling on July 22 finding that such subsidies under the Affordable Care Act can only be provided to those who seek insurance on an exchange directly operated by a state government — a potentially crippling blow to the new law. Only sixteen states have set up exchanges.

By granting further review, the D.C. Circuit has raised the chances that the administration will win in that court, as it did previously in the U.S. Court of Appeals for the Fourth Circuit. If there is then no conflict among appeals courts on the question, that could reduce the chances that the Supreme Court would feel a need to step in. However, the issue is pending in other lower courts, so a conflict remains a possibility.

In the en banc hearing, unlike the original hearing, will not be stacked with partisan hacks, so it’s pretty much certain that they rule as the 4th Circuit.

The question now is whether the Supreme Court is going to hear this case.

So, How is that Whole Efficiency of the Whole Profit Driven Market Based Thing Working In Healthcare?

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It turns out as more and more for-profit hospices are entering the market, more and more of hospice patients are leaving those hospices under their own power, largely because the for-profit hospices are taking non-terminal patients, and driving out expensive terminal ones, in order to maximize their bottom line:

At hundreds of U.S. hospices, more than one in three patients are dropping the service before dying, new research shows, a sign of trouble in an industry supposed to care for patients until death.

 When that many patients are leaving a hospice alive, experts said, the agencies are likely to be either driving them away with inadequate care or enrolling patients who aren’t really dying in order to pad their profits.

 It is normal for a hospice to release a small portion of patients before death — about 15 percent has been typical, often because a patient’s health unexpectedly improves.

 But researchers found that at some hospices, and particularly at new, for-profit companies, the rate of patients leaving hospice care alive is double that level or more.

 The number of “hospice survivors” was especially high in two states: in Mississippi, where 41 percent of hospice patients were discharged alive, and Alabama, where 35 percent were.

 “When you have a live discharge rate that is as high as 30 percent, you have to wonder whether a hospice program is living up to the vision and morality of the founders of hospice,” said Joan Teno, a Brown University hospice doctor and researcher and the lead author of the article published in the Journal of Palliative Medicine. “One part of the reason is some of the new hospice providers may not have the same values — they may be more concerned with profit margins than compassionate care.”

(emphasis mine)

When people call for “Market Based Solutions,” this is what you get.

Grifting from the Rick Scotts* of the world.

*While head of Columbia/HCA, the current governor of governor’s company engaged in activities leading to their having to pay nearly a billion dollars to the government for Medicare fraud.

Ummmm……… Isn’t This Straight Out Bribery?

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The Republicans in the Virginia State Senate bought off state Senator Phillip Puckett with the offer of a 6-figure job and a permanent judgeship for his wife, which threw control of the chamber back to the Republicans:

Republicans appear to have outmaneuvered Gov. Terry McAuliffe in a state budget standoff by persuading a Democratic senator to resign his seat, at least temporarily giving the GOP control of the chamber and possibly dooming the governor’s push to expand Medicaid under the Affordable Care Act.

Sen. Phillip P. Puckett (D-Russell) will announce his resignation Monday, effective immediately, paving the way to appoint his daughter to a judgeship and Puckett to the job of deputy director of the state tobacco commission, three people familiar with the plan said Sunday. They spoke on the condition of anonymity because they were not authorized to discuss the matter.

The news prompted outrage among Democrats — and accusations that Republicans were trying to buy the Senate with job offers in order to thwart McAuliffe’s proposal to expand health coverage to 400,000 low-income Virginians.

Del. Scott A. Surovell (D-Fairfax) said Republicans were unable to win the policy argument about Medicaid expansion, so they have resorted to other means.

“It’s astounding to me. The House Republican caucus will do anything and everything to prevent low-income Virginians from getting health care. . . . They figure the only way they could win was to give a job to a state senator,” Surovell said. “At least they can’t offer Terry McAuliffe a job. I hope Terry continues to stand up to these bullies.”

Puckett, a senator since 1998, did not respond to calls seeking comment. Other Republicans denied that Puckett was offered the jobs in exchange for his resignation.

Yeah, sure.

Here is a note to governor McAuliffe:  Now is a time to enforce party discipline:  If you can block Puckett’s getting a do-nothing job on the tobacco commission, do it.  If you can block the appointment of his daughter to a judgeship, do it.

Use the veto pen.  It is all fruit of a poisoned tree.

This Comes as No Surprise

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Maryland is dumping its healthcare exchange, and replacing it with Connecticut’s technology:

Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.

The board of the Maryland exchange plans to vote on the change Tuesday, the day after the end of the first enrollment period for the state’s residents under the 2010 Affordable Care Act.

Marylanders will be able to use the exchange even as it is being overhauled. The first enrollment period opened Oct. 1 and closes Monday for insurance coverage that kicks in this year. A second open enrollment period starts Nov. 15.

Like Maryland, Connecticut was one of the first and most enthusiastic states to embrace the idea of building its own insurance exchange rather than using a federal site to implement the law’s sweeping changes in health-care coverage.

But unlike Maryland, where the system crashed within moments of launching and has limped along ever since, Connecticut’s exchange has worked as smoothly as any in the country.

I do think that this means that I have to reevaluate my assessment of O’Malley as the front-runner in the “Not Hillary” presidential primary.

Still, the fact that Maryland has decided to end its attempt and move to a working system, and that it did so before Oregon, Minnesota and Hawaii, all of whom have similar problems, was the right thing to do.

I Add My First Canadian to my List of People I Do Not Want to Piss Off

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This is truly EPIC ownage of Senator Richard Burr by Dr. Danielle Martin, vice president at the Women’s College Hospital in Toronto, Canada.

While I understand that in some ways, this is shooting fish in a barrel, Burr is a clueless ignorant tool on pretty much everything he touches, but still, her exquisitely polite (She is Canadian, Eh?) response shows demolishes his delusional objections.

The nickel tour of the exchange, as rendered by rage comics: (Video follows) (Updated comic. I put in a draft my mistake)

H/t Salon.

Obamacare Is a Subterfuge

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When one looks at Obama, and the neoliberal free market mousketeers who surround him, one has to to wonder just how much Obama, who actually taught at the University of Chicago, is in thrall to Chicago School economic theory.

While I do think part of the motivation for putting forward what became the PPACA was an attempt to “fix” the thoroughly dysfunctional healthcare delivery system in the United States, I also think that there has been an unspoken agenda, which is to sever the relationship between employers and their employees insurance.

If you talk to most economists, and all of the conservative “freshwater” economists, they will vehemently maintain that employer provided healthcare is economically unjustified, and so should be abolished.

When you look at the implementation of healthcare reform, it seems that one constant is that the employer mandate has been repeatedly delayed and weakened.

And today, they did it again:

For the second time in a year, the Obama administration is giving certain employers extra time before they must offer health insurance to almost all their full-time workers.

Under new rules announced Monday by Treasury Department officials, employers with 50 to 99 workers will be given until 2016 — two years longer than originally envisioned under the Affordable Care Act — before they risk a federal penalty for not complying.

Companies with 100 workers or more are getting a different kind of one-year grace period. Instead of being required in 2015 to offer coverage to 95 percent of full-time workers, these bigger employers can avoid a fine by offering insurance to 70 percent of them next year.

How the administration would define employer requirements has been one of the biggest remaining questions about the way the 2010 health-care law will work in practice — and has sparked considerable lobbying. By providing the dual phase-ins for employers of different sizes, administration officials have sought to lighten the burden on the small share of affected employers that have not offered insurance in the past.

As word of the delays spread Monday, many across the ideological spectrum viewed them as an effort by the White House to defuse another health-care controversy before the fall midterm elections. The new postponements won over part, but not all, of the business community. And they caught consumer advocates, usually reliable White House allies, by surprise, particularly because administration officials had already announced in July that the employer requirements would be postponed from this year until 2015.

Congressional Republicans seized on the announcement as the latest justification for scrapping the health-care law. In particular, they renewed their opposition to the law’s requirement that most Americans have insurance, saying it is unfair to delay rules for businesses and not for individuals.

Of course it’s unfair.

That’s a feature not a bug.

It is my belief that the goal of these actions is to create a space which will allow the minimization, and eventual elimination, of employer provided healthcare, because ……… freedumb and free markets.

This also explains why Obama has been so eager to cut a “grand bargan” with the ‘phants, and why he is so enthusiastic about trade deals like the TPP where freedumb and free markets trump democracy, labor rights, and environmental protections.