Tag: Healthcare

If You Are Suggesting that John McCain is Playing 3D Chess, You are an Imbecile

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Let’s be clear: McCain is neither intelligent enough to come up with this, and he is far to vain and chatty to keep his mouth shut for the requisite 24 hours of so to make it work.

He did this, because he was upset that people were calling him out on the “straight shooter” myth that he has cultivated his entire political career, and I believe that acted in this manner because of his own self regard.

But in the interest fairness, I will quote the theory: (%$# mine)

I’m not sure if it’s really being appreciated just how comprehensively the Republicans were just f%$#ed over.

See, the Republicans have been trying to pass these godawful healthcare bills through a process called budget reconciliation, which, among other things, protects the bill from being filibustered in the Senate and only requires a simple majority of 50 votes (rather than 60, which the Republicans don’t have).

The thing is, the Senate can only consider one budget reconciliation bill per topic per year. Of course, if the bill dies in committee and never comes to an official vote, it doesn’t count- which is why they’ve been able to keep hammering away at the issue.

This bill, though, was allowed to come to the Senate floor, because the Republicans thought they’d secured the votes. Collins, Murkowski and the Democrats would vote no, everyone else would vote yes, and Pence would break the tie. And then McCain completely f%$#ed them. And it was almost certainly a calculated move; he voted to allow the bill to come to the floor. Had McCain allowed it to die in committee, McConnell could have come back with yet another repeal bill; but he let it come to a vote, and now they can’t consider another budget reconciliation bill for the rest of the fiscal year. The Senate needs 60 votes to pass any kind of healthcare reform now.

So now they’re caught between a rock and a hard place. Either they concede defeat on the issue and try again later (causing a big, unpopular stink that could damage elections if they try it before the midterms, or risking losing the slim majority they already have if they wait) or they actually sit down with the democrats like adults and write a halfway decent healthcare bill.

This is amazing.

While I admit that his actions MAY have had the stated effect, I think that was a happy accident.

Simply put, this is not how John McCain plays the game.

Also, the idea that McConnell gives a flying f%$# about Senate procedure, and won’t wreck 200+ years of dysfunction tradition to get his way is simply delusional.

H/t DC at the Stellar Parthenon BBS.

Ahhh ……… The Glories of the Free Market

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Hospitals have had problems with staffing their emergency rooms, and have taken to contracting with a company called EmCare.

The result has been exorbitant fees charged by out of network doctors:

Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

“The billing scenario, that was the real fiasco and caught us off guard,” said Tom Wilbur, the chief executive of Newport Hospital. “Hindsight being 20/20, we never would have done that.” Faced with angry patients, the hospital took back control of its coding and billing.

Newport’s experience with EmCare, now one of the nation’s largest physician-staffing companies for emergency rooms, is part of a pattern. A study released Monday by researchers at Yale found that the rate of out-of-network doctor’s bills for customers of one large insurer jumped when EmCare entered a hospital. The rates of tests ordered and patients admitted from the E.R. into a hospital also rose, though not as much. The use of the highest billing code increased.

………

In the study, the researchers examined nearly nine million visits made to emergency rooms run by a variety of companies between 2011 and 2015, using data from a single insurance company that does business in every state. In exchange for access, the researchers agreed not to identify the insurer. Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to, and the national trends in surprise billing detected by the Yale team are consistent with a broader study by government researchers.

The new data suggests that EmCare, part of publicly traded Envision Healthcare, did not sign contracts with the insurance company and was able to charge higher prices.

Fiona Scott Morton, a professor at the Yale School of Management and a co-author of the paper, described the strategy as a “kind of ambushing of patients.” A patient who goes to the emergency room can look for a hospital that takes her insurance, but she almost never gets to choose the doctor who treats her.

This actually highlights a flaw in Obamacare:  Whatever protection you have goes away when you get out of network services.

The larger picture is that for-profit healthcare is inefficient and morally bankrupt.

I’m Surprised. He Is So Considerate of Women

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Blake Farenthold (R-TX)

Blake Farenthold is upset that Republican women Senators have concerns about the latest incarnation of Trumpcare, so wants to shoot them:

Texas Representative Blake Farenthold wants to take some female Republican senators out back and shoot them for not repealing the Affordable Care Act and killing thousands of their fellow citizens.

 Farenthold says it’s “absolutely repugnant” that the GOP-led Senate hasn’t acted on repealing the health care law, singling out “some female senators from the Northeast.”

 Farenthold, in a radio interview with 1440 Keys, said the Senate has failed to show the courage to repeal Obamacare. The Senate is expected to vote Tuesday on whether to move ahead on legislation they haven’t even released for review by the Senators voting on it.

 Still, the fact that Farenthold doesn’t know what is or isn’t in the legislation didn’t stop him from blaming the female Senators, who actually may have a problem with the wanton murder of thousands of Americans by robbing them of access to affordable health care.

 “If it was a guy from south Texas, I might ask him to step outside and settle this Aaron Burr-style,” he blustered.

What a lovely fellow.

His mother should have drowned him at birth.

Oh, Snap!

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In the Senate there is something known as the Byrd Rule.

Basically, it states that only items that effect the deficit can be placed in the budget resolution.

This is significant because the budget resolution is not subject to the filibuster.

Well, the Senate Parliamentarian has ruled that the most recent budget resolution, which includes Trumpcare, includes provisions that run afoul of the Byrd Rule:

The Senate Republican bill to dismantle the Affordable Care Act encountered huge new problems on Friday night after the Senate parliamentarian challenged key provisions that are needed to win conservative votes and to make the health bill workable.

The provisions appear to violate Senate rules, the parliamentarian said, giving Democrats grounds to challenge them as the Senate prepares for a battle next week over the future of the Affordable Care Act.

One provision questioned by the parliamentarian, Elizabeth MacDonough, and cherished by conservatives would cut off federal funds for Planned Parenthood for one year. Another would prohibit use of federal subsidies to buy insurance that includes coverage for abortions.

A third provision would penalize people who go without health insurance by requiring them to wait six months before their coverage could begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year.

If formally challenged, the provisions could survive only with 60 votes, a near-impossibility in the partisan, narrowly divided Senate. The abortion-related provisions are important to many conservatives, not just in the Senate but also in the House.

………

The waiting period provision is fundamental to the working of the bill. Because the legislation would end the Affordable Care Act’s mandate that most Americans have health insurance, the waiting period was designed to ensure that people could not simply wait to get sick before they purchased a policy.

………

The parliamentarian also objected to a narrowly written provision that would shift Medicaid costs from New York’s counties to its state government. This provision, tagged by opponents as the “Buffalo Bailout,” was included in a repeal bill passed by the House in May to secure the votes of Republican House members from upstate New York.

The Senate Democratic leader, Chuck Schumer of New York, suggested that other provisions written specifically for different states could also be at risk.

“This will greatly tie the majority leader’s hands as he tries to win over reluctant Republicans with state-specific provisions,” Mr. Schumer said. “We will challenge every one of them.”

Heh.

Fail

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Mitch McConnell and his merry band of psychopaths have failed even worse on their 2nd try to repeal Obamacare:

Senate Majority leader Mitch McConnell, Republican of Kentucky, announced Tuesday morning on the Senate floor that the Republicans’ effort to repeal and replace Obamacare had failed.

This turn of events marks a stunning defeat for President Trump, who has made a “repeal and replace” of the Affordable Care Act (ACA) one of his central policy goals. Although he has issued executive orders on immigration, deregulation, and taken other reactionary initiatives, no major legislation has been moved through Congress for him to sign.

McConnell was unable to bring the latest version of Senate Republicans’ Better Care Reconciliation Act (BCRA) to a vote after two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition to the bill, leaving the Senate leadership at least two votes short of the number needed to begin debate on the measure.

Two other Republicans, Senators Rand Paul of Kentucky and Susan Collins of Maine, had already signaled their opposition. With a slim 52-48 majority in the Senate, the measure could only lose the support of two Republicans, with Vice President Mike Pence brought in to break a tie.

Senate Republicans then pivoted to “Plan B,” described by McConnell as legislation that would include a “repeal of Obamacare combined with a stable two-year transition period.” This measure was scuttled almost as soon as it was advanced, as three Republican senators indicated that they would not vote to bring it to the Senate floor.

I  believe that the source of Republican problems is that, as Stephen Colbert noted, “Reality has a well-known liberal bias.”

This interferes with Republican attempts to impoverish and inmiserate the American public.

FAIL

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Two more Republicans have come out against the Senate version of Trumpcare, which means that even with the tie breaking vote of Mike Pence, they are two votes short to passing their healthcare clusterf%$#:

Two more Senate Republicans have declared their opposition to the latest plan to overhaul the nation’s health-care system, potentially ending a months-long effort to make good on a GOP promise that has defined the party for nearly a decade and been a top priority for President Trump.

Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements declaring that they would not vote for the revamped measure. The sudden breaks by Lee, a staunch conservative, and Moran, an ally of Senate Majority Leader Mitch McConnell (R-Ky.), rocked the GOP leadership and effectively closed what already had been an increasingly narrow path to passage for the bill.

They joined Sens. Rand Paul (Ky.) and Susan Collins (Maine), who also oppose it. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the Affordable Care Act. All 46 Democrats and two independents are expected to vote against it.

Republicans, who have made rallying cries against President Barack Obama’s 2010 health-care law a pillar of the party’s identity, may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.

They are running into a classic problem from history:  Invading barbarians tear things down, but then find that they can neither build nor maintain things, and so they cannot maintain control.

The Republicans are constrained by their philosophy, they have come to believe that government is an unalloyed evil, and as such they cannot propose something that might be seen as an improvement by all but the most delusional right wingers.

Unfortunately, those, “Most delusional right wingers,” have large enough numbers within the party to swing a primary, but there aren’t enough to swing a general election. (They already vote ‘Phant in the general now)

Mitch McConnell, meet the Kobayashi Maru.

Call Your Congressmen and Senators, and Tell Them No

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In rather unsurprising news there are some Democratic Senators looking to cut a deal with Republicans on healthcare.

At the top of the list, of course, is Democrat in Name Only (DINO), and father of the price gouging CEO of Mylan Pharmaceuticals, Joe Manchin will give a bipartisan gloss to something aweful.  Primary him, and failing that vote republican

With Senate Republicans struggling to cobble together the votes needed to pass an Obamacare replacement measure, bipartisan talks on health care legislation have picked up pace on Capitol Hill.

Multiple lawmakers and high-level congressional aides have told The Daily Beast that moderates from each party have begun taking the temperature of the other side for a more modest approach to reforming the health care system. Aides and lawmakers insist that these talks are in their nascent stages. Sen. Joe Manchin (D-WV), in an interview, odescribed them as both informal and ephemeral.

Any Republican plan will kill tens of thousands of people a year, and engaging in some narcissistic strutting to polish your bipartisan street cred is intellectually, morally, and politically bankrupt.

Obamacare sucks, but any Republican plan will make it far worse.

Barring anything that directly moves a public healthcare solution, like adding a public option, the response to Republicans has to be no.

But of Course………

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You know that clusterf%$# of a healthcare bill that Mitch McConnell is trying to push through the Senate?

It turns out that it exempts the US Senate from their “reforms”. Funny that, huh?

Senate Republicans included a provision that exempts members of Congress and their staff from part of their latest health care plan.

This exemption could have the effect of ensuring that members of Congress have coverage for a wider array of benefits than other Americans who purchase their own coverage.

A Senate Republican aide confirmed that the exemption existed but was unable to comment as to the specific effect it would have. The aide said it was included to ensure that the bill hewed to the chamber’s strict reconciliation rules that limit the policies this health bill can include.

The exemption is similar to the one that existed in the House health bill. After Vox reported on its existence, the House voted to close the loophole — and the Senate aide expected their chamber to follow the same path.

The revised Senate health bill draft released Thursday lets health insurers offer plans that do not cover the Affordable Care Act’s essential health benefits, which requires insurers to include a wide array of benefits such as maternity care and mental health services.

Insurers can offer plans without these benefits — unless they’re selling coverage to members of Congress and their staff, who are required to buy coverage on the health law marketplaces. The exemption says this part of the law still applies to any plans sold to Congress.

So not a surprise.

Dried Out School Marm Cancels Recess

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By “School Marm”, I mean Mitch McConnell, and by “recess”, I mean that he is delaying the Senate recess in an attempt to pass some variant of TrumpCare.

I understand where he is coming from, Republican politicians are getting savaged at their public meetings by their constituents, and one of the things that goes on when the Congress is on recess is meetings with the public.

McConnell is clearly trying to minimize opportunities for members of his caucus to interact with the public before they vote on the bill, because being screamed at by the mother of a profoundly disabled child who would lose coverage tends to make politicians skittish.

If this weren’t literally a matter of life and death, I would be amused at the Republican discomfort at their current situation.

California is F%$#ed Up and Sh%$

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We’ve all heard that the head of the California State Assembly killed the single payer bill.

While you are condemning lobbyists and timid Democrats, it should be noted that the bill had no funding mechanism, and because of California’s out of control initiative petition system, which passes bills with all the sophistication of the saying in fortune cookies, every dollar of benefits would require two dollars in taxes:

In the days since California Assembly Speaker Anthony Rendon shelved for the year SB562, which intends to establish a state single-payer health care system, he’s been subject to mass protests and even death threats. The bill’s chief backers, including the California Nurses Association and the Bernie Sanders-affiliated Our Revolution, angrily point to Rendon as the main roadblock to truly universal health care.

They’re completely wrong. What’s more, they know they’re wrong. They’re perfectly aware that SB562 is a shell bill that cannot become law without a ballot measure approved by voters. Rather than committing to raising the millions of dollars that would be needed to overcome special interests and pass that initiative, they would, apparently, rather deceive their supporters, hiding the realities of California’s woeful political structure in favor of a morality play designed to advance careers and aggrandize power.

………

It’s because you can’t do the funding without help from the voters, because of California’s fatal addiction to its perverse form of direct democracy. The blame, in other words, lies with ourselves.

To figure this out, you need only turn to the actual legislative analysis of the Senate bill, which passed in early June. It states very clearly what Rendon alluded to in his announcement shelving SB562: “There are several provisions of the state constitution that would prevent the Legislature from creating the single-payer system envisioned in the bill without voter approval.”

To cut through the clutter, let’s focus on the biggest constitutional hurdle, known as Proposition 98. Passed in 1988, Prop 98 requires that roughly 40 percent of all general fund revenues — money the state receives in taxes — must go to K-12 education. If you include community college spending, it must exceed 50 percent.

Prop 98 was itself a reaction to the notorious Prop 13, which sharply limited state property taxes. It was intended to ensure that education received its fair share of funding. But it also created a budgetary straitjacket that affects virtually anything that costs California money.

………

Substituting a centralized state program for the skyrocketing premiums people pay today would actually be relatively affordable. But if half the money has to be siphoned off to education, that rationale becomes harder to sell.

Self-appointed experts have countered that the state can suspend Prop 98 with a two-thirds vote of the legislature. This has been done twice in the past, during downturns in the economy. But the suspension can last for only a single year; it would have to be renewed annually to keep single payer going. More important, as the California Budget and Policy Center explains, after any suspension, “the state must increase Prop 98 funding over time to the level that it would have reached absent the suspension.”

So legislators would have to vote year after year to suspend Prop 98, but add more money back to cover it in subsequent years. That backfill would grow with every budget, and over time lawmakers would need to vote for ever-increasing giant tax hikes. If this didn’t return Republicans to power in Sacramento within a few years, some enterprising lawyer would sue the legislature for violating the spirit of Prop 98. Suspension is not politically, legally, or financially sustainable.

Until California fixes the network of stupid and dysfunctional initiative petitions that have completely f%$#ed up state government, the best that they can expect is the, “Same Sh%$ Different Day.”

FAIL

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So, Mitch McConnell has put off a vote on the Senate version of Trumpcare because he doesn’t have the votes.

I am amused, though unlike some people, I don’t think that this is the beginning of the complete unraveling of the Republican party, even though they have been promising to kill the ACA for 8 years.

Never underestimate the capacity of Republicans for self-delusion.  In comparison, Trotskyites look like steel eyed realists.

Yeah, It’s a Sh%$ Show. Anyone Surprised?

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After developing the bill in secret, Senate Republicans has revealed their proposal for Trump Care, and it ain’t pretty:

The health-care proposal unveiled by Senate Majority Leader Mitch McConnell on Thursday came under immediate attack from conservative and centrist Republican senators as well as industry officials, casting the bill’s viability into doubt even as GOP leaders plan to bring it to a final vote next week.

 The 142-page bill, which McConnell (R-Ky.) released after weeks of drafting it in secrecy, drew swift criticism from hard-right senators who argued it does not go far enough in undoing Barack Obama’s signature health-care law, the Affordable Care Act. It also prompted an outcry from centrist senators and medical organizations worried that it takes on the law, known as Obamacare, too aggressively and would lead to millions losing their health care or receiving fewer benefits.

These critics effectively delivered their opening bids in what is expected to be a contentious week of negotiations. McConnell is trying to pass the bill before the July 4 recess, with Republican leaders seeking to quickly learn whether they will be able to fulfill years of promises to roll back the law or whether it’s time to turn to other items on their legislative agenda, such as overhauling the tax code.

The plan here is to get a vote on the bill before anyone has a chance to read it.

The reports that I have read is that the McConnell’s version is worse than the house version, (it basically destroys Medicaid, for example) but a bit more back loaded, so as to push the outrage past the next election.

This isn’t surprising:  The political calculus here makes it essential to repeal Obamacare and cut taxes for the rich, but actually keeping people from dying is irrelevant.

Clearly, the Problem Is Not Enough Markets

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Drug rehabilitation clinics are paying brokers to get bodies in the door:

Days after he relapsed on heroin last summer, Patrick Graney received an offer that was too good to turn down.

How would he like to get treatment in a beach town with a hipster vibe in South Florida — with all expenses paid, including airfare from his Massachusetts home? Graney didn’t have to think long. He was on a flight south the next day. Two months later he was dead.

The arrangement — according to interviews with Graney’s mother and girlfriend and saved Facebook messages he sent — was brokered by Daniel Cleggett, a flamboyant figure, and some would say a pillar, in the Boston-area drug recovery community. A former addict who has spent nearly a quarter of his life in jail, Cleggett has turned entrepreneur in the burgeoning treatment industry for people addicted to opioids such as heroin and prescription painkillers.

He presides over an expanding empire of treatment facilities in Massachusetts, but he has also helped recruit addicted young people from Massachusetts for drug rehab centers in South Florida, according to the patients’ families and others who know Cleggett and are familiar with the arrangements. Two of these young men, including Graney, died from overdoses in hotel rooms in the oceanside resort communities where they were sent for treatment.

………

Patient brokers can earn up to tens of thousands of dollars a year by wooing vulnerable addicts for treatment centers that often provide few services and sometimes are run by disreputable operators with no training or expertise in drug treatment, according to Florida law enforcement officials and two individuals who worked as brokers in Massachusetts. Cleggett refused to say whether he was paid to find customers for Florida treatment centers.

The facilities are tapping into a flood of dollars made available to combat the opioid epidemic and exploiting a shortage of treatment beds in many states. As center owners and brokers profit, many patients get substandard treatment and relapse.

The role of patient brokers in steering addicts to out-of-state treatment centers is now coming under scrutiny from law enforcement, including Massachusetts Attorney General Maura Healey, according to a spokeswoman for her office. “These recruitment operations take advantage of the desperation of people struggling with addiction to refer them to treatment centers not based on their best interest, but in order to get a commission,” Healey said in a statement. “Patients need to access safe and effective recovery options instead of being treated like paychecks.”

Such arrangements can be illegal in some cases under federal and Massachusetts law if facilities pay brokers to bring them patients and if patients are given inducements, such as free travel or insurance, to enroll in a particular treatment center.

(emphasis mine)

It seems that the only growth industry in the United States these days is parasitism.

This Business Will Get out of Control. It Will Get out of Control and We’ll Be Lucky to Live through It.

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A Tennessee woman hated that her congressman voted for the controversial Republican health-care bill in the House of Representatives, authorities said.

So Wendi L. Wright tried to run Rep. David Kustoff (R-Tenn.) off the road after he visited the University of Tennessee at Martin, they said.

The Weakley County Sheriff’s Department said Wright tailed the car carrying Kustoff. At some point, the congressman and his aide became afraid and worried that Wright wanted to force them off the road.

They then turned into a driveway and stopped. That’s where Wright got out, screamed at the congressman and struck the windows of his vehicle, even reaching inside the car, the sheriff’s department said.

Authorities said Wright then stood in front of the vehicle to try to keep Kustoff from leaving. At some point, someone called 911, but Wright left before authorities arrived.

The incident happened on May 8, four days after House Republicans narrowly passed a bill to overhaul the country’s health-care system.

Wright, 35, has been charged with felony reckless endangerment and was released after posting a $1,000 bond. Authorities say they found her after she posted details of the encounter with Kustoff on Facebook.

I think that characterizing this as an attempt to run the Congressman off the road is a bit much. It’s more of a stalking and a rant.

Still, this is major league crazy sh%$, and it is a profoundly unproductive course of action.

The Balloon Has Gone Up

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The House of Representatives just passed the latest version of Trumpcare:

The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage.

The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement.

The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch.

This is going to be a complete clusterf%$#.

The only question is whether the Democrats have sufficient solidarity to make political hay from it.

Ironic Headline of the Day

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Former Obama Aide Who Helped Kill Single-Payer in the ACA Solicits Donations for Sick Friend’s GoFundMe Page

The former Barack Obama, and Max Baucus, aide is Jim Messina, who played a pivotal role in close lining even the remotest possibility of single payer or a public option, as well as steering the negotiations towards Baucus, who made a complete hash of the negotiations, and made the bill far worse as a result.

I am not suggesting that you not donate to Will Leaverton, who is having a very rough time dealing with pancreatitis, I am suggesting that you might want to find a way make Messina feel as badly about his role in the current state of affairs as is possible.