Buck Naked Politics

Health Care Fraud Last Week: More Tax Dollars Wasted

  by D. Cupples |  The fraudulent billing of us taxpayers for health care costs is so widespread that one might call it a sport. 

Below are merely a few of the cases that the Justice Department mentioned just over the last week.  They're small-timers, but it all adds up.  And it all adds to our nation's staggering, aggregate health care expenditures.

 The El Centro Regional Medical Center (Imperial County, California) agreed to pay  $2.2 million to settle allegations that it defrauded Medicare.  The Justice Department states:

"The government alleges that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program.   The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient “observation” basis or as emergency room visits."

Note that private contractors often try to settle False Claims Act cases because if a contractor is found guilty the contractor could be barred from getting future contracts. 

Two New Orleans area doctors-- Dahlia Kirpatrick and Emmanuel Komandu pleaded guilty to conspiracy to commit health-care fraud.  The Justice Department states:

 

Does the FDA Even Try to Keep our Food & Drugs Safe?

by D. Cupples |  We pay the U.S. Food and Drug Administration (FDA) billions each year.  In exchange, the FDA is supposed to protect us consumer-taxpayers from unsafe food, drugs, cosmetics, etc.

I didn't dream that up: the duty is stated on the FDA's Website.  

Despite that clearly articulated duty, the FDA's performance has been spotty for years--some would say due to over-friendliness with drug companies.

Maybe I'm putting it too nicely.  I'll try again.  For some years, the FDA seems to have promoted drug companies' interests over our interests.  

Still too watered down?  Okay.  Last try: evidence suggests that some of FDA's decision-makers have been downright corrupt.  

This month's Time Magazine has an article entitled, After Avandia: Does the FDA Have a Drug Problem?

In May 2007, we at Buck Naked Politics did a blog post entitled The FDA's Latest Pharma-Friendly Sins.  It addressed the FDA's highly questionable actions regarding the drugs Avandia, Vioxx, Ketek, and Viagra.

The FDA approved Ketek for public sale despite allegedly knowing that clinical-study results were fraudulent.  Despite studies linking Vioxx to heart attacks, the FDA waited two years before requiring a stronger warning label. 

Then there's the wildly popular Viagra, which was linked to a strange form of blindness: the FDA waited a whole year to require a stronger warning label.

Then there was our blog post in November 2008, which cited a Washington Post article stating that the FDA had learned about traces of melamine and cyanuric acid ( toxic chemicals) in baby food, yet the FDA inexplicably delayed informing the baby-feeding public about it.

I'm glad that after three-plus years, major media is again spotlighting the FDA's questionable reliability.  The health and safety of us consumer-taxpayers is, after all, in the FDA's hands.

Why This Moment Matters

posted by Bill: Here's an excerpt from James Fallows at his Atlantic blog the other day— that I thought summed up nicely why, beyond all the caveats about how Health Care Reform, as presently constituted, falls far short of the mark, it matters:

...the significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials)... TOWARD a system in which people can assume they will have health-care coverage. Period.

The Healthcare Debate and Beyond

by Bill Kavanagh: The House of Representatives finally passed the Senate's Christmas Eve version of Healthcare Reform, 219-212. This time, the legislation will go to the President and the Senate will take up a package of changes negotiated between the House and Senate. No doubt after some promised Republican Senatorial-haggling-over-parliamentary-procedure-to-come, the legislation will be signed into law. Healthcare reform, after a century of debate, will be enacted.

The floor debate in the House last night followed the tone of the argument in the country at large. On the Democratic side, there was a general pride in reaching out, finally, to the millions of Americans left uncovered by the current health system. There were members recalling civil rights struggles of the past to include all Americans in the franchise of voting and connecting health care as a right for all to stand alongside other basic freedoms we hold dear. On the Republican side, there were many exhortations about the end of liberty; members warned of losing a battle against tyranny and decried totalitarian tactics.

Healthcare Reform- The Tea Party Viewpoint

by Bill Kavanagh: It's likely that today will finally be the decisive vote on healthcare reform. Over thirty million Americans currently lack health coverage and a good many more are losing insurance along with their jobs. Beyond this, lots of people who pay for health coverage find their insurance won't compensate them when they need it most, either through rescission or because their illnesses are categorized as pre-existing conditions. The reform bill will address these conditions.

While healthcare reform could have done more to lower costs and provide an affordable public option, the moderate provisions that remain in the bill are still intensely controversial. The resistance to reform has engendered a backlash on the right that has taken to the streets. Erick Stoll and Chase Whiteside, two students at Wright State University, produced this terrific coverage of the last Tea Party gathering against healthcare reform in Washington this past week. It's worth a few minutes to check out the sort of sloganeering that's passed for argument in opposition to any serious reform of the system.

If you value Stoll and Whiteside's coverage, support their work here.

(Kavanagh cross-posts at Bill's Big Diamond .)

Reform in the Balance

by Bill Kavanagh: Paul Krugman sums up the situation on health care reform nicely in his column today. It's decision-time. A few months back, we almost had an imperfect, but enormously significant reform which had passed both houses of Congress. Now, we might just get almost the same package passed, finally. It's up to a few members of Congress to step up.

The alternative, as Krugman points out, is more of the same bone-crunching cruelty that is health insurance today in America. People get thrown off the rolls when they become ill, are undercovered or not covered at all when they are well (or at least think they are), and are paying premiums without knowing whether they'll be honored when it counts.

This weekend should finally tell whether the United States joins the ranks of every other developed nation in providing for reasonably universal coverage, whether imperfectly or not.

One way or another, the fate of health care reform is going to be decided in the next few days. If House Democratic leaders find 216 votes, reform will almost immediately become the law of the land. If they don’t, reform may well be put off for many years — possibly a decade or more.

(Kavanagh cross-posts at Bill's Big Diamond.)

Capping Insurance Rate Hikes: is it a Real Effort?

by Deb Cupples |  Via Memeorandum, the New York Times reports:

"President Obama will propose on Monday giving the federal government new power to block excessive rate increases by health insurance companies, as he rolls out comprehensive legislation to revamp the nation’s health care system, White House officials said Sunday.

The president’s legislation aims to bridge differences between the bills adopted by the House and Senate late last year, and to frame his debate with Republicans over health policy at a televised meeting on Thursday.

By focusing on the effort to tighten regulation of insurance costs, a new element not included in either the House or Senate bills, Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent announced by Anthem Blue Cross of California and moving to portray the Democrats’ health overhaul as a way to protect Americans from profiteering insurers.

"Congressional Republicans have long denounced the Democrats’ legislation as a “government takeover” of health care. And while they are likely to resist any expansion of federal authority over existing state regulators, they will face a tough balancing act at the meeting with the president to avoid appearing as if they are willing to allow steep premium increases like those by Anthem."

First, insurance-friendly Republicans will have no trouble stir ring up gullible Tea-baggers or 20-percenters against Obama's purported proposal.  Said elite Republicans will do what they always do: cloud the issue by speciously squawking about "freedom" -- probably something about how if the federal government can cap insurance-company rate hikes, than government can limit how much money ordinary folks can make.

Second, I have to wonder if this new proposal is anything more than mere posturing to get credit for trying.

Insurance Rates Go up, along with Profits: What gives?

by Deb Cupples |  Last week, The Los Angeles Times reported:

"The parent of beleaguered Anthem Blue Cross offered a spirited defense Thursday of large premium increases for customers with individual health insurance policies in California, but critics -- including the Obama administration -- voiced skepticism.

"In a letter to the administration, health insurance giant WellPoint Inc. of Indianapolis said that increases of as much as 39%, set to take effect March 1, reflect soaring medical costs and an exodus of healthy consumers from its ranks."

Right: healthy customers are dropping their insurance, which means that WellPoint's administrative costs should decrease -- so, why the price hike?

And it's not as though the company can't cover its costs despite decreased revenue, given that it enjoyed $2.7 billion in profits just in the last quarter of 2009.  Note that profits are calculated after all executives, managers, and salespeople take their bonuses and or commissions.

Are we surprised?  Private insurance companies have been robbing us consumers for years and coming up with flimsy rationalization.  And our state and federal governments have allowed it.

True, medical costs are high (partly because for-profit hospitals and medical offices tend to be as profit-minded as insurance companies).  It's a fact of our system -- as it currently is.

But premium dollars are paying for things other than medical costs: every dollar that goes toward toward executive compensation or shareholder profits is one less dollar to pay for actual health care services.  Most of those dollars that end up funneled into execs' personal pockets come from us premium payers. 

A health care report from last year stated:

"Profits at 10 of the country’s largest publicly-traded health insurance companies
rose 428 percent from 2000 to 2007, from $2.4 billion to $12.9 billion, according to U.S.
Securities and exchange Commission filings.

"In 2007 alone the chief executive officers at these companies collected combined total
compensation of $118.6 million—an average of $11.9 million each. That is 468 times more than the $25,434 an average American worker made that year." (HCAN report)

For a few specific examples of executive compensation, see "Public Option Needed Because Private Insurers are Robbing Us" 

And does it matter that the Obama administration is voicing skepticism?  Would it matter if our politicians were trumpeting outrage?  Sticks and stones, right?

Last year, members of Congress publicly chastised bank executives for taking huge bonuses (i.e., looting their companies) after taking our hard-earned tax dollars via TARP (the bailouts).

Did it change anything?  Apparently not.  Bank execs took huge bonuses again this year. 

In practical terms, I have no idea what the solution to any of this is.

The Good News and the Bad

by Deb Cupples |   The good news: house foreclosures were down nearly 10% in January, compared to December.  The bad news: more than 315,000 homeowners got foreclosure-related notices in January.

The good news: the nation's unemployment rate fell about one-third of 1%.  The bad news: the unemployment rate is still 9.7%, and more than 14 million people are out of work.

The good news: a recent Washington Post/ABC poll indicates that 71% of Americans see Sarah Palin as not fit to be president.  The bad news: ABC and the Washington Post are still doin polls about Ms. Palin.

Obama at Year One

by Bill Kavanagh: There are few politicians who could have inspired the sort of hope that Barack Obama did coming into office, arriving in the wake of a near collapse of the American financial system a year ago. His inaugural address raised the nation's expectations. We hoped, we looked for change, we thought perhaps we'd crossed some significant barriers in the country's history. Mostly, we looked for leadership in a time of great anxiety.

Then came a search for consensus. For reasons that have more to do with Obama's nature than with empirical evidence, the new President looked for bipartisanship in addressing the nation's dire financial straits. He took a massive stimulus bill that most economists said would be the minimum necessary to get the country moving again and split it down the middle. Obama designated slightly more than half towards job creation, largely in infrastructure; the rest he saved for tax cuts, hoping the huge giveaway might bring Republicans and conservatives into the big stimulus tent he was creating. It didn't.

Instead, Republicans voted, to the last, against the stimulus plan and lambasted the President as a socialist. They sat on their hands and dared President Obama to pass his recovery plans without them. So, without pulling the $400 billion tax cut, he did. Without offering any plan of their own, the Republican Party had succeeded in paring off almost half of the stimulus funding towards tax relief. Obama had reached across the aisle and had been rejected, even while still siphoning off a huge percentage of the job creating effect of the stimulus bill.

Did the President Fib About the Public Option?

by Deb Cupples |   The Washington Post's Ezra Klein reports that President Obama recently claimed (and quite publicly) that Obama had not campaigned on the public option as part of his health-care reform plans.  I remember it differently.

So does Mr. Klein, who basically says that Obama certainly did campaign on the public option.  Klein also links to a pdf that serves as evidence to support Klein's claim.

As I remember it (and my memory may be a bit rickety), back in December 2007, Mr. Obama was not leaning toward a public option: instead, he was talking about what amounted to major subsidies for insurance companies -- which is precisely what we may be getting.

Later, as Hillary Clinton's and John Edward's health-care plans gained public support, Mr. Obama started editing his plan so that it looked a bit more like Hillary's and John's.  Eventually, Mr. Obama certainly did seem to support a public option. 

That's just how I remember it.

What Part of "Health Care Reform" Means Funneling More Money to Insurance Companies?

by Deb Cupples |  As a former small-business person, I learned at least one thing: money comes in and money goes out.  One way to reduce the amount of money going out is to cut out hyper-expensive, non-essential "middle men."

Most people understand this simple concept.  Keep that in mind as you read the following paragraphs from an editorial by Rep. Louise Slaughter about the Senate's health care "reform" bill:

Half a Loaf

by Bill Kavanagh: Like many of you, I'm sick to death of the slow-motion evisceration of the healthcare 'reform' bill winding its way through the Senate. As we inch toward the decade's end, it seems that each day brings a new Senator out of the woodwork to take his or her rightful fifteen minutes of infamy. As each dim Senatorial light insists on stripping out another element of reform, in order either to please a lobbyist or to insure against anyone who might later claim they were a progressive for voting "Yes," I have to wonder whether what's left in this legislation is worth fighting for.

But there is a wealth of experience out there, starting with the missed health insurance opportunity offered during the Nixon years, to remind us that passing on significant reform in order to drive home our revulsion at the way Washington works will delay any healthcare progress, however slight, for at least another presidential administration. That's at least four more years of millions of uninsured Americans staying outside the system, getting sicker and dying faster.

Apparently, GOP Senators Do Not Want Ordinary Americans to Have Good Health Care

 by Deb Cupples |  The Hill reports: "Sen. Jim DeMint said Thursday he is prepared to use every procedural tool to delay a vote on the Democratic healthcare legislation."

The Washington Post tells us:

"Senate Republicans said Thursday that they would try to filibuster a massive Pentagon bill that funds the wars in Iraq and Afghanistan, an unusual move that several acknowledged was an effort to delay President Obama's health-care legislation."

How intriguing!  Some of the same politicians who spent years trumpeting in favor of beefing up national security are now plotting to hold our nation's security hostage, all for the sake of blocking political opponents' efforts to make health care affordable for us ordinary Americans.

Fortunately for those elite members of Congress, U.S. senators reportedly have phenomenal health-care coverage -- paid for, in part, by us ordinary taxpayers.  Memeorandum has commentary.

"Compromise" on Public Option a Win-Win?

by Deb Cupples |   The New York Times reports:

"The Senate majority leader, Harry Reid, said Tuesday night that he and a group of 10 Democratic senators had reached “a broad agreement” to resolve a dispute over a proposed government-run health insurance plan, which has posed the biggest obstacle to passage of sweeping health care legislation....

"Under the agreement, people ages 55 to 64 could “buy in” to Medicare. And a federal agency, the Office of Personnel Management, would negotiate with insurance companies to offer national health benefit plans, similar to those offered to federal employees, including members of Congress."

If one overlooks the millions of people who are younger than 55 and lack adequate health-care coverage, this "compromise" certainly seems to be a win-win.

First, our elected officials would be able to grab headlines and trumpet on the campaign trail about having achieved something in terms of health-care reform.

Keeping Faith

by Bill Kavanagh: Today, with our spirit beaten down by two long wars, an economic collapse, and a seemingly paralyzed political process; we wait for the President’s speech on Afghanistan. We’ve become restless and fearful now, still waiting, but less hopeful for the big changes we thought would be coming after we threw off the chains of our former right wing leaders. Many of us are out of work; many are underwater in our homes.

Despite the trepidation we feel about the future, there are reasons to hope that yes, we can, in fact, make a better America and a better world for our children. The first one is remembering that we did elect someone because he inspired hope. Whether or not he lives up to our high expectations, Barack Obama is in the White House because he embraced hope and change. His campaign succeeded largely on the premise that this democratic experiment in the United States still had the potential to be reinvigorated by our participation in it. Across racial, age and economic boundaries, Americans responded to that premise, with the belief that yes, we could make a more progressive and vital America.

Muddying the Health Care Bill Could Be a Win-Win (for Some Politicians)

by Deb Cupples |  Apparently, most Americans want the freedom to choose to pay less for health insurance through a publicoption (as opposed to being forced to pay skyrocketing premiums to private insurance companies).  A poll released in July by the Employee Benefit Research Institute indicates that "between 68 percent and 88 percent of Americans either strongly or somewhat support health reform ideas such as national health plans, a public plan option...."

Over the summer, some media outlets, pollsters and interest groups tried to create the impression that most Americans didn't want the freedom to choose to pay less for health insurance.  Some outfits even fudged their polling data by changing survey questions yet comparing new polling results to older polling results based on surveys in which questions were phrased differently.

Whatever data-manipulation may or may not have occurred, an ABC-Washington Post poll released in late October indicates that 57% of Americans favor a public-insurance option  [likely because a public option would be cheaper for us ordinary folks.]

Given that a majority of Americans seem to support a public option, congressional Democrats likely feel pressure to at least appear to support a public option. 

At the same time, many Dem politicians (along with their Republican siblings) also feel pressure from the insurance industry (and other health-related industries) to make sure that a truly effective public option doesn't get passed by Congress.

Talk about a "rock and a hard place" -- the horns of a dilemma.

Historic Vote

posted by Bill: Finally, the historic vote came as healthcare reform passed in the House last night. Rep. Jim McGovern lauded Speaker Pelosi for "threading the needle" in pulling through a 220-215 margin for a truly significant change in American healthcare. Letting the abortion battle play out first seems to have been the necessary prelude to sorting out priorities in the Democratic Caucus and getting the votes needed in the "Yes" column.

As depressing as all our financial news is, this is a ray of sunshine in American political life. It's the first step towards truly important progress in an era when we seem too often to be merely rearranging the deck chairs on the Titanic.

On to the Senate!

One Way to Poison Health Care Reform

 by Deb Cupples |  I'm just starting to catch up.  Apparently, Rep. Bart Stupak proposed an amendment to the health care reform bill that would essentially prevent many insurance companies from covering abortions -- not that I've ever seen an insurance executive cry over not having to cover something.

The Hill reports:

"House Democratic leaders will allow an up-or-down vote on an amendment blocking any money in its healthcare overhaul from funding abortions, risking the votes of members who support abortion rights."

Good strategy, whoever thought of it!  That's one way to get a bunch of Dems who support personal freedoms to vote against a health-care reform bill.  Booman commented:

"So, it turns out that the price of passing health care reform in the House is selling women down the river."

To some of the people running our nation, public policy seems to be a game -- often a cash-laden game.   I am downright disgusted by the lack of genuine concern for the well being of so many ordinary Americans.  It's no wonder that so many U.S. House members are under ethics probes (for all the good it'll do)

Where Does the White House Really Stand re: the Public Option?

by Deb Cupples |  Last week, President Obama bluntly called out the insurance industry essentially for price gouging, profiteering, and deceptive advertising.  Yesterday, Talking Points Memo stated:

"Senate Majority Leader Harry Reid is very close to rounding up 60 members in support of a public option with an opt out clause, and are continuing to push skeptical members. But they also say that the White House is pushing back against the idea, in a bid to retain the support of Sen. Olympia Snowe (R-ME)."

Frankly, I'm not sure what the "opt out clause" is, but it doesn't sound good.  Here's what Marc Ambinder says:

"The White House is denying reports that officials are pressuring Sen. Harry Reid to scale back the scope of the 'public option' that'll be attached to the Senate health insurance bill.  Talking Points Memo reported, based on unnamed sources close to the negotiations, that the White House is 'skeptical' of a public option that includes a state opt-out choice, preferring -- and advocating for -- a public option that would kick in only if the private exchange failed to lower costs."

Why are our elected officials making this so complicated?  The way I see it, it's pretty simple.