Image by Getty Images via @daylife

Don’t these people ever learn?

There’s a heartbreaking piece in today’s New York Times that chronicles how at least half of these United States, grappling with underfunded budgets, are cutting back on home-care services for the elderly and disabled. First — and second, and third — of all, that’s unconscionably cruel. But fourth of all, it’s fiscally irresponsible.

As the article lays out, it costs one heck of a lot less to care for someone in their home than to maintain them in a nursing or assisted living facility. And it certainly costs less than to care for them in a hospital, after they fell, or became malnourished, or didn’t take their meds. In Oregon — once an exemplar of how to effectively care for people at home, now one of the state’s cutting back — nursing homes cost an average of $5,900 a month. Home and community based services cost $1,500 — about 25%!

The problem, as usual, is boneheaded law. States are required to provide nursing home care to receive federal Medicaid money. They aren’t required to provide home care. So, home care is the only place they can conceivably cut back with impunity.

The piece’s kicker grafs say it better than I ever could:

For states, having to cut the Medicaid programs is a double loss, because they come with matching dollars from the federal government. This creates state jobs and much-needed revenue.

Without these, said James A. Davis, a gerontologist at Marylhurst University and executive director of United Seniors of Oregon, “it really is a death spiral.”

“So often the programs to go are the early interventions that save money and keep people healthy,” Professor Davis said. “That comes back to bite you.”

The timing on this, of course, is pathetically ironic. I mean, part of Obamacare — which I still heartily endorse — calls for removing copayments for preventive medicine, things like well-baby checkups and such. Everyone knows the cost of that will be way less than the cost of caring for people who ignored their health. The economic principles behind providing home care are the same. What’s wrong with these people???!!!

On a different (you’ll see the connection) but more heartening note, the Times has an editorial applauding the growing number of states who are recognizing the stupidity of barring ex-cons from municipal jobs. Some progressive cities — the Times cites Boston, Chicago and San Francisco — long ago abandoned that rule. And now, Connecticut, New Mexico and Minnesota have passed laws protecting the employment rights of former offenders.

The Times suggests other states follow. I heartily concur. If you don’t do it on humane grounds, then do it on economic ones — if these folks can’t get jobs, the chances they’ll go back to crime are huge. And the crimes themselves will be a cost to society — as, of course, will be the cost of incarcerating them yet again.

Noone is suggesting that we put convicted pedophiles in day care centers, or burglars as home care attendants. But there are plenty of “safe” jobs to offer these folks. I’ll give the Times the final word:

Confining people with criminal convictions to the very margins of society is unfair and self-defeating. These sensible new laws recognize that.

Image by Getty Images via @daylife

If this weren’t such a deadly serious issue — and one fraught with such danger down the road — I’d be getting a huge giggle out of the way mandatory health care is twisting on the spit of hairsplitting definitions.

Apparently, our Constitution, as interpreted by opponents to health care reform, prohibits our government from requiring that everyone, sick or healthy, young or old, have health insurance — or pay a penalty if they don’t. That interferes with commerce, the naysayers insist, and thus is a no-no for the federal government to do.

Ah, but what if we say that everyone must buy health insurance or pay an extra tax instead? That’s perfectly okay, federal government certainly has the right to tax.

What’s so irritating about this is that of course it’s not a tax. Who ever heard of selective taxation on people who refuse to buy a product? Allowing the government to so thoroughly broaden the definition of a tax — and thus, broaden its ability to levy more of them — opens a ghastly can of worms.

But allowing young, healthy people to go without insurance opens an even larger can of even uglier wrigglers. This is one of the few issues on which I side with the insurance industry: If we are going to force them to insure everyone, despite preexisting conditions, they have got to be able to bring their costs down by insuring a pool of folks whose health care needs won’t exceed their premiums. That’s simple economics.

So yeah, if we have to call it a tax to get it passed, then do it. But I don’t have to like it.

Republicans are seizing on White House press secretary Robert Gibbs’s admission Sunday that Democrats could lose their House majority to send an unambiguous message to Washington’s lobbyist community: The train is leaving the station, and it’s time to get on board.

…

[Rep. Greg] Walden emphasized that he wasn’t issuing any threats to corporations and trade groups — “the legislation coming out of this Congress is threat enough,” he said — but he wasn’t shy about suggesting that business-oriented political action committees ought not wait until after Election Day to cut their checks to GOP candidates who stand a good chance of being elected.

“I know they don’t want to be caught by surprise,” the Republican said of access-minded lobbyists. “They have to answer to their clients.”

He added: “Everybody wants to look like they saw it coming, and it’s our job to help them look smart.”

It’s remarkable how blase Republicans can be about declaring themselves the party of the every person in one minute and turning around and pandering to precisely the special interests that an overwhelming number of Americans are frustrated about controlling their government in the next.

Much of Republicans’ excitement is apparently vindicated in an ABC-Washington Post poll showing that support for the President is at all-time lows, which seems to translate into clear mathematical opportunities for Republicans to seize the House. However, whatever opportunities towards which the poll points, they are not due to some sudden ground swell of confidence in Republican Members of Congress.

The same poll notes,

Lack of confidence in the Republicans, plus their stubbornly low allegiance numbers since the Bush presidency went bad, indicate that they’re not benefiting from affirmative support for their own plans, but rather from dissatisfaction with Obama and the Democratic-led Congress.

In fact, the trend on confidence in Congressional Republicans since the President’s inauguration has been a net reduction of 3%, from 29% to 26%. And currently both the President (43%) and Democrats (32%) hold a greater share of the public’s confidence, both of which have seen substantial drops since inauguration day. And registered voters are, “overall divide almost exactly evenly in their party preference for House candidates.”

What the poll really demonstrates, though, is that Americans are frustrated right now, with a full 62% wanting to look around for someone new rather than re-electing their current Member of Congress. Also notable is the degree to which President Obama’s approval ratings mirror Reagan’s for the same time period of the former’s presidency,

The president’s solace may be his comparison to Ronald Reagan – the last president to take office in the midst of a recessionary gale. In an ABC/Post poll at about his year and a half mark, and with unemployment then at 9.8 percent, Reagan’s approval rating was 49-47 percent – almost precisely the same as Obama’s now.

It’s nothing new: These two presidents’ approval ratings have correlated at a remarkable .9 (1 is a perfect fit).

Which seems to suggest that economic factors that are largely beyond Obama’s control are, to perhaps a more remarkable degree than acknowledged, driving his approval rating. If that is indeed the case, then it strikes me that there is an even further case to be made about lost opportunities under the Obama administration in its first year and a half of  operations.

Ostensibly, the timidity that is currently driving so many liberal critics of the administration crazy right now was at least in part about not coming off as too liberal for a majority of voters. Hence only tepid efforts on reform in health care and a concerted effort towards dialing back financial reform.

But all of those efforts are for not in an economic situation where a prolonged period of suffering is destined to push frustration regardless of what the administration did. So by some lights, all the moderating has been an exercise in squandering the super majority that Democrats were handed.

It didn’t really matter whether Democrats passed financial reform that included a public option or not. The public, reacting to forces that have nothing to do with health care, were bound to wind up generally dissatisfied, just as they had with Reagan in the same set of conditions.

So all Democrats managed to do was blunt the achievements of their own agenda for an outcome that would have been the same regardless of what they’d done.

The question was not whether or not Democrats, through a better or worse show of scrupulous self-policing, could have succeeded in stemming public feelings of dissatisfaction. Rather, the question was given a high likelihood of public dissatisfaction due to factors largely beyond their control, would Democrats rather come out further ahead on their agenda with things like a public option and strong financial reform or not?

The perception of bipartisan efforts and pragmatic moderation towards which the administration has been striving were, in the end, red herrings. And given that Obama’s predecessor, Bill Clinton, defined his presidency by an appeal to centrist sensibilities, a bolder approach may well have thrown off the mantle of “business as usual” that seems to have stuck to Democrats and seems to be driving the tectonic electoral shifts that have Republicans in such a tizzy.

These numbers may well vindicate the liberal critique that you just don’t run on a hope and change platform without a willingness to deliver.

The correlation of Obama’s presidency to Reagan’s is doubly ironic in that despite Obama’s open admiration of Reagan during the election, he has failed to live up to the realigning qualities of Reagan’s example at almost every turn.

Hindsight, as they say, is 20/20, I suppose.

To illustrate the point, one need only examine the organization’s complete and utter ineptitude at handling the most important issue facing American physicians – the ever present axe that hangs over their heads as they attempt to fight off the 21% reduction in Medicare payments payable to doctors willing to treat the nation’s elderly.

It’s not like they haven’t had their chances.

The first misstep came with the AMA’s willingness to accept and support the Obama healthcare plan without gaining anything in return. Surely, a promise to deliver on a repeal of the law that is producing the threatened cuts – or at least a commitment to table the cuts for a meaningful period of time – could have been accomplished in exchange for AMA support of the health care reform bill.

But then, when it comes to politics, one must ask before one can expect to receive. And when asking politely doesn’t work,  one must be prepared to threaten with the checkbook.

But not so the AMA.

The AMA says it endorsed reform because the law would help doctors and patients by expanding coverage, adding it never took part in a quid pro quo to support the bill.

“We make no apologies for our strong, principled advocacy on behalf of patients and physicians,” Cecil B. Wilson, president of the AMA, said in a statement to POLITICO. “We have been vocal advocates for covering the uninsured since before the last presidential election — before the issue became divisive and politicized.”
Via Politico

I suppose I can respect such a noble and principled approach. But then, I’m not a physician struggling to keep my office open while accepting elderly patients on what little Medicare already pays, let alone trying to do it with a further 21% cut in pay.

Having let the moment pass them by at the outset of reform, the AMA determined not to make the same mistake twice. Last month, they went full force for a complete repeal of the threatened cuts – a repeal that would cost  the national treasury some $240 billion. Once again, a noble objective. But in an election year where Democrats are already getting their heads handed to them for ballooning deficits, it doesn’t take a strategic genius to understand that such an approach is not going to succeed and that an unwillingness to compromise is just plain stupid – especially when Congress offers a reasonable compromise.

And that is precisely what Congress did.

Unable to push through an expensive repeal of the law, for all the obvious reasons, Congress suggested a five-year fix that would have given the docs a little breathing room while we see how reform develops. But the AMA refused. Instead, they launched a multimillion – dollar television campaign attacking the U.S. Senate for walking away from the problem.

What did the AMA win for their efforts? Rather than the five- year deal they had within their grasp, they achieved only a one-month reprieve. That’s right – having turned down a five-year deal, they spent millions of dollars only to end up with just 30 days until the ugly problem raises its head once again. Does it get any more embarrassing for a political lobbying group? Is it any wonder that membership in the AMA has dwindled to a mere fraction of what it once was?

For those physicians who continue to belong, I can only hope that they show better judgment when cutting us open than they do when it comes to political decision making. While taking a principled, all-or-nothing approach may be admirable – it is usually the province of interest groups who seek only to be heard in the press and on cable TV rather than those who actually mean to accomplish something in Congress. Our collective health demands much more. Medicine in America is very much about politics. And if the physicians can’t handle it, you and I will pay the price.

It is worth keeping in mind that the AMA is the very same organization that has managed to get its way on healthcare policy since first taking on Teddy Roosevelt to defeat a national health insurance program. Indeed, they have defeated every single president they’ve taken on when it comes to healthcare proposals that did not meet with their approval.

But those days are over.  The time has come to pronounce the AMA dead and hope that the nation’s physicians will respond by creating an organization with the requisite skill and courage required to represent their interests.

Why do we care? Because while you may have gripes about how much money physicians earn (and I hear them all the time), I assure you that the interests of America’s physicians are very much tied to our own. You simply cannot have a health care system without the doctors who diagnose the illnesses, dispense the treatments, work the cures and alleviate our pain. This is not an abstract proposition. Should you or a member of your family become ill, it won’t be politics or disgust over how much the other guy earns that is on your mind. You’re going to want a doctor and you’d better hope there is a competent one available to provide what you need.

The AMA has given a whole meaning to the adage, “Physician, heal thyself.” The nation’s doctors would be wise to take the advice and get themselves properly organized before it’s too late- if it isn’t too late already.

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There’s so much rotten news about corporations these days — lax safety practices at BP leading to environmental disaster, out-of-control risk and compensation packages on Wall Street bringing down the economy, the once-hallowed Toyota guilty of shoddy workmanship — that we sometimes tend to forget that industry does some things really right.

When it comes to process efficiency, manufacturers the world over have made tremendous strides. And now some of the techniques they’ve honed are being put to use in hospitals, with excellent results. According to the New York Times, a growing number of hospitals are applying “continuous performance improvement” — a cross between Six Sigma and kaizen and Total Quality Management, all programs that have spread like wildfire through the corporate world. And guess what? They work.

Here’s how one hospital made out:

The program, called “continuous performance improvement,” or C.P.I., examines every aspect of patients’ stays at the hospital, from the time they arrive in the parking lot until they are discharged, to see what could work better for them and their families.

Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million, Mr. Hagan says. And as patient demand has grown in the last six years, he estimates that the hospital avoided spending $180 million on capital projects by using its facilities more efficiently. It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.

Apparently, so many hospitals are interested that Seattle Children’s has put together a training program to teach them. Reminds me a lot of the old days, when Toyota used to graciously let GM and others come in to learn its vaunted quality methods (yeah, I know, maybe it needs to re-teach itself). And it reminds me of a trip I took to GE Health Care (back then it was called GE Medical Systems, or Gems) more than a decade ago, to see first hand how they applied Design for Six Sigma. They used it to create a new CAT Scanner, one that was lightyears ahead of existing machines in terms of performance and reliability, yet much less expensive to make.

The system, whether applied at GE or Toyota or Seattle Children’s, is deceptively simple. It involves studying how employees, be they riveters or doctors, do their jobs — and putting needed tools and information at fingertip reach. It also means studying how customers — patients and their families — consume services and products, and streamlining accordingly. In a hospital it means standardizing instrument carts in operating rooms so surgeons always have the right scalpel at hand, organizing supply shelves and automating supply reorder methods so nurses can always find needed tubing and bandages. It means recognizing that recovery rooms are overcrowded on Tuesdays and empty on Fridays, and reskedding surgeries to even out the usage flow. Sounds so simple you can’t figure out why it hasn’t been done all along — except we flawed humans aren’t logical (admit it — are your closets and kitchen drawers optimally organized?)

There’s of course a danger in this. It could too easily devolve into the classic Time/Motion studies, where experts decide that a certain task should take 2 minutes, and workers who take 2.5 minutes are penalized. So much for spending that added time to calm a patient, say, or take a more thorough history. And, of course, if the hospitals use the new efficiencies as an excuse to lay off workers, all you’ll have accomplished is a smaller but resentful, overworked and underperforming staff.

But if the systems are applied humanely, and without total rigidity, they really, really work. And if this type of thinking is built in from the getgo — i.e., when a new hospital is going up — it can create efficiencies from day one. I’ll end with the same hopeful anecdote that ended the Times piece:

Medical buildings often have standard benchmarks — basing the number of examination rooms, for example, on the expected volume of patients. Ms. Brandenberg and her team instead used C.P.I. to map out common paths that patients, staff members, supplies and information would flow through. They worked in an empty office building, using cardboard mock-ups of surgical sites, recovery rooms, anesthesia areas and waiting rooms. Fifty staff members then play-acted various scenarios to test the design’s effectiveness.

The final design reduces walking distances and waiting times for patients by grouping related facilities together and creating rooms that can be used for more than one purpose. The hospital was able to shave 30,000 square feet and $20 million off of the new building, which is to open July 20.

I was busy at work when I received a phone call from my health insurance company, Aetna Blue Cross of California. The insurer, best known for attempting to raise premium rates into the stratosphere and a history of seeking to deny coverage to those often in the greatest need, was phoning to invite me to participate in a program they are offering to their customers with chronic health conditions – such as diabetes and heart disease.

Sadly, such a program very much includes me.

The offer included a weekly phone call from one of their health care aides along with 24/7 access to their nurses, pharmacists and nutrition experts. And…get this… all at no charge to me whatsoever.

While I tend to stay very much on top of my chronic conditions and have a pretty healthy knowledge and understanding of how to properly care for my “issues”, I decided to play along. After all, I’ve been arguing that this sort of program is precisely the sort of thing that will, in the long run, save health insurers a lot of money, improve the health of their customers and, as a result, bring down premium costs for payers everywhere.

I could hardly turn them down.

The conversation took awhile. After a preliminary discussion with the individual who made the initial contact, I was turned over to a health specialist who presented me with a long list of questions designed to work out where I could use a little help or motivation to keep the blood sugar under control and the coronary arteries from suffering any further damage.

The questions were relevant and on point. They knew what they were asking and why.

Based on my answers, the consultant suggested a few things that I was welcomed to accept or pass on. For example, I agreed to the weekly phone call from one of their nurses, mainly because I want to see how well the program functions. I passed on the opportunity to speak with the nutritionist, taking the opportunity to relay the tale of how I was forced to see a hospital nutritionist prior to being discharged from my triple bypass surgery adventure only to find that the nutritionist was a three hundred pound woman who clearly was not prepared to practice what she preached. Despite Aetna’s assurances that their nutritionists were all committed to healthy eating, I really do know enough to understand when I’m eating poorly so I decided to save their nutritionist’s time for someone who could better benefit from the service.

Kudos to Aetna Blue Cross of California.

While these programs may be baby steps in the direction of getting the cost curve under control, they are important steps just the same and should be encouraged.

I’ll report back on this subject after my first telephone conference with the insurance company’s nurse.

Indeed, conservative pols were up in arms about the President’s latest act of treason. As reported by  Senatus, Senator Pat Roberts was, “deeply disappointed.” Minority Leader Mitch McConnell called the appointment, “truly outrageous.” And Senator John Barraso said the President’s decision was, “an insult to the American people.”

Even Democrat Max Baucus described himself as, “troubled,” over the appointment . But how controversial is the President’s decision?

Well, for Republicans it is potentially very controversial. If Berwick is successful in getting Medicare and Medicaid costs under control while avoiding compromises in quality — an exercise for which he is a significantly qualified expert as I noted a few weeks ago — it will take much of the wind out of Republican sails given their focus on health care reform as a vote determining issue in November. The potential political losses involved with Berwick’s success might have more to do with Republican intransigence than anything else.

For the rest of us? You might not like the idea of a recess appointment in principle, but in practice it is not nearly as controversial Republicans would have you believe.

According to ABC’s Jake Tapper, the Berwick appointment brings President Obama to a total of 18 recess appointments. That’s a rate of almost exactly one (1) appointment per month in office. If the President maintains that rate, he will rack up 48 appoints over a four (4) year term, 96 if he wins re-election in 2012.

According to the Associated Press; however, President George W. Bush, “made more than 170 such appointments in his two-term presidency.” And President Bill Clinton made, “nearly 140”. Those are rates of roughly 1.77 appointments per month and 1.46 appointments per months respectively for the two previous Presidents.

And neither former President was a wall flower about all of their appointments,

President George W. Bush placed several judges on U.S. courts of appeals via recess appointments when Senate Democrats filibustered their confirmation proceedings. In one controversial case, Judge Charles Pickering, appointed to the Fifth Circuit U.S. Court of Appeals, chose to withdraw his name from consideration for re-nomination when his recess appointment expired. President Bush also appointed Judge William H. Pryor, Jr. to the bench of the Eleventh Circuit Court during a recess, after the Senate repeatedly failed to vote on Pryor’s nomination.

President Bill Clinton was harshly criticized for his recess appointment of Bill Lan Lee as assistant attorney general for civil rights, when it became clear that Lee’s strong support of affirmative action would lead to Senate opposition.

Which is to say that not only is President Obama’s rate of appointment lower than his predecessors, but his appointment of Berwick to a politically sensitive position is relatively unremarkable, as well.

I’m not such a fan of the idea that executives can go ahead and side step the elected bodies designated as their checks and balances at will. But if we’re going to judge President Obama on this decision fairly, we ought at least to be comparing apples to apples.

Twenty-nine states have informed the federal government that they will operate their own program with the assistance of federal money. Twenty–one states have opted to allow the federal government to operate a high risk pool on their behalf. The remaining states, including California and New York, are expected to have their programs up and running by the end of the summer.

The high-risk insurance policies will be available to those who have been uninsured for six months and can show proof that they have been denied health coverage due to a pre-existing condition. For those who may desire to gain coverage from the program, note that you are not obligated to prove that you have been turned down by every insurance company on the market. You need only prove – by presenting a written letter of rejection – that one such company has denied coverage.

For those who live in a guarantee issue state where insurers are not permitted to deny coverage, providing proof that the premium charge you would be obligated to pay is well above the charge from the high-risk pool will qualify you for entry.

Applicants who get their paperwork in by July 15th will begin to receive coverage as early as August 1st.

While the launch program will come as truly welcome news to many of our uninsured, there remains great concern that the funding available to operate the program – totaling $5 billion – will not be nearly enough to provide insurance coverage to everyone in need. While the Secretary of HHS has the right to cap the program at any time, the government is currently accepting all applicants. Accordingly, those who wish to take advantage of the program would be wise to get their applications in as soon as possible.

You can get all the information required –for both state and federally operated programs – at http://www.healthcare.gov which goes on-line today.

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Back when both the public option and New York’s St. Vincent’s Hospital were both still battling for their lives (R.I.P. to both, more’s the pity), I raised what I thought was a good question: wouldn’t government-run hospitals be a better idea than government-run insurance?

Why shouldn’t the government operate hospitals that serve poor communities, or people without insurance, without a thought to profit? There are city-run hospitals, sure, but I’m talking about a federal network of hospitals.

We don’t expect the welfare system to turn a profit, we don’t expect unemployment insurance or food stamp programs to turn a profit. Health care really is as essential as food and shelter, and it should be part of the safety net — but directly, not indirectly through subsidized insurance.

Well, we’re no closer to that federal network I envision. But something heartening has just happened in New York City. This from the New York Times:

Barely two months after the closing of St. Vincent’s Hospital in Greenwich Village, North General Hospital, a potent symbol of the city’s political and philanthropic commitment to Harlem, announced Monday that it was declaring bankruptcy.

The 200-bed North General will close by next week, hospital officials said. But while St. Vincent’s closed abruptly with only the distant promise of an urgent care clinic in its place, the North General building will immediately be occupied by a large government-subsidized walk-in clinic for Harlem residents, state and North General officials said.

The city’s public hospital system will also move two of its facilities, a nursing home and a 200-bed long-term rehabilitation center, to the North General site from Roosevelt Island, officials said.
<…>
As a so-called federally qualified health care center, the new clinic will receive Medicaid money and other grants to provide primary care, mental health care, dental care and school-based care to 80,000 patients a year, state officials said. Its doctors will also be available to privately insured patients, officials said.

Like St. Vincent’s, North General was losing barrels of money. Unlike St. Vincent’s, which was not located in a poverty-stricken area, it really was a safety net for locals.

Of course, the plan already has its detractors. The hospital’s main union is filing an unfair labor practices suit because not every single one of its members will have jobs at the new institution. I feel for them, but not a lot — hey, guys, what part of bankruptcy and crippling debt do you not understand? If there’s no money to meet payroll, being kept on payroll doesn’t do you much good, does it?

I’m not generally a fan of nationalizing private institutions. But when the choice is, lose a needed institution entirely, or let the government run it — even at a loss — to me it’s a no-brainer. Repeating myself: health care is up there with education and police protection, it has to be part of a safety net. It’s a use of my tax dollars that I heartily endorse.

There are many interesting aspects to this new report, but this chart tells you most of what you need to know.

By far the dominant theme of the media narrative revolved around “politics and strategy,” that is, the day to day horse race coverage that also dominates all modern political campaigns.  There is some value to understanding how the bill existed and was changed as it wound its way through the Congress, but that type of coverage falls squarely in the separate realm of “legislative process.”  “Politics and strategy” is about buzz words, and how effective they are, and whether this theatrical display or that will resonate with the public, etc.

Analyzing how that coverage was manifested shows just how superficial our media outlets are, and how incapable they are of performing any task save amplifying the latest scandal du jour.  I think Igor Volsky at The Wonk Room is correct when he writes:

The media covered the politics of health care — the death panels and ‘government takeover’ memes — because they were more sensationalistic and popular than the boring complexities of how the public option could compete with private plans or whether the individual mandate penalty should be structured as a percentage or a flat fee.

That’s true, but it doesn’t tell the whole story.  Those memes are important and deserve to be covered, but even more important is the need to analyze those memes, and inform your readership when they’re being lied to; that is the basic role of the journalist.  Simply repeating focus-grouped buzz words politicians cynically employ to frighten the masses allows charlatans to dictate the terms of the debate, which is exactly what happened.  The conclusion the report reaches is that “opponents” of health care reform won the message war:

A study of the concepts and rhetoric that found their way into the media narrative from June 2009 through March 2010 revealed that the opponents’ leading terms appeared almost twice as frequently (about 18,000 times) as the supporters’ top terms (about 11,000 times.) Boiled down to its essence, the opponents’ attack on big government resonated more in the media than the supporters’ attack on greedy insurance firms.

That last sentence speaks volumes: opponents’ attack on big government resonated more in the media than the supporters’ attack on greedy insurance firms.  Our media landscape, at its core, is a verbal battleground in which truth claims aren’t subjected to rigorous fact checking and verification.  Objective truth has no place in American journalism, whose practitioners serve as little more than stenographers to the powerful, and whose self-identified role is to repeat claims that “resonate” with the outlet’s readership.  Write down what both sides say, and if one side makes their claims louder and more emotionally than the other, well, then they win the war.  Does it matter if one side is completely unhinged and delusional?  Not in the least.  Look at what terms “won” the media war for health care opponents.

In addition to the three memes listed in the chart, the researchers found 2,500 instances of the term “death panels” showing up in the media, which is to say about a 1/3 less than “insuring pre-existing conditions” showed up.  That is really quite astounding.  On the one hand you have a complete, utter fabrication that gained an incredible amount of traction and in fact dominated the health care debate in the awful month of August; on the other, you have the basic faith that government can and should provide care for its citizens.  The gap in coverage between those ideas should be greater than the gap in coverage between my college punk band and Lady Gaga, yet, relatively speaking, my college punk band was featured on the cover of Rolling Stone.

As far as the other 3 dominant conservative memes go, “rationing care” is the most obviously obscene.  Our current system rations care in the most brutal of ways by denying it to those who need help the most.  The idea that we don’t ration care now is insulting and disgusting — ask the people who waited in line for days to receive basic medical care.  Or talk to Wendell Potter, the insurance executive turned whistle-blower, about how companies conspired to deny care to those who were previously covered.  Literally, every time a right-wing politician uttered the phrase “rationed care,” a journalist should’ve written “Well, here’s the thing about that.  We already do.”  That’s not bias.  That’s reporting.

The “more taxes” and “more government” memes are equally absurd, though it’s less surprising that they took hold, as it would be slightly more difficult to debunk those myths.  Providing context and explanation is anathema to attracting eyeballs, apparently.  As far as “more taxes” goes, the CBO ruled the bill deficit neutral, and although I never supported the bill whole-heartedly, without any reform costs would have bankrupted the country.  Our citizens are getting older, and unless we want to eat them, we need to figure out how to pay for their care.  As far as the “more government” meme goes, well, people love Medicare and, when polled, over 50% said the bill should include a public option.  It’s very easy to scare people by screaming SOCIALISM — that doesn’t mean that people hate social programs.  Again, when people don’t understand the policy, bludgeoning them to death with the blunt instrument of “THE GOVERNMENT’S COMING” might be effective.  That’s where, you know, journalists and editors come in to clear things up.

The point here is not to cheer lead for the health care bill.  See this fantastic post by FireDogLake’s Jon Walker for the progressive case against it.  The point is that criticisms of the bill should be based in fact — not in base appeals to people emotions.  If the press abdicates their responsibility, then polls the public, then regurgitates the public’s understandable lack of knowledge, well, that just leaves us all covered in vomit.

This study illustrates as clearly as possible how absurd the myth of the liberal media is.  Whether or not editorial boards across the country endorse Democrats or Republicans, the “objective reporting” shapes the narrative, and if that reporting reduces itself to lazily repeating obscene and demonstrably false talking points over and over again like a magical incantation designed to kill the most at risk, well, they need to be treated like the pathetic servants they are.  A good journalist performs a function as necessary to society as a fire fighter; a bad journalist is a PR man with a serious case of denial.

We now have a case in point that proves the point.

Geisinger Health System operates clinics, hospitals and primary practice physician’s offices in northeast and central Pennsylvania. They also offer a health insurance plan that covers about 250,000 people, most of whom get their health care from Geisinger’s network of care providers.

Following the logic that expensive hospital care can be avoided if patients – particularly those with chronic illnesses – are treated more effectively in the doctor’s office, Geisinger’s insurance company began experimenting with the medical home concept whereby more attention is paid to patients at the time when something can still be done to control these illnesses.

The idea is simple. Using diabetics as an example, we know that when diabetes is not effectively treated it will often lead to heart attacks and other serious complications requiring expensive hospitalization – an experience potentially lethal to the patient and dramatically more expensive to the insurance company who will pick up the tab.   Geisinger suspected that providing care designed to head off hospitalizations at the ‘front end’ could save a lot of money and produce happier and healthier patients in the long run.

Of course, merely desiring to focus more on patient health at the primary care stage is easier said than done . Primary care physicians are already forced to see huge numbers of patients each day just to keep their doors open and earn a living.  Their schedule typically allows only 15 minutes for a patient visit and leaves no time at all for follow-up and ongoing communication with chronically ill patients.

Enter the nurses.

Recognizing that physician office nurses could play a major role in solving the problem, Geisinger’s insurance operation went out and hired the additional nurses and paid for their employment. Not only did Geisinger Insurance pay for the added nursing staff’s at the physician offices they own, they also did it for physician’s offices that, while not owned by Geisinger, accepted Geisinger insurance.

The nurses would get into the mix with a patient during the patient’s physician visit. From there, the  nurses stayed in touch with patients on a weekly basis, checking in to see how medicines were working, how patient’s were feeling, monitoring changes in condition, diets, etc.

The results have been interesting, to say the least.

Not only are patients staying healthier due to the reach-out efforts by the nurses, they are also finding that they are more comfortable calling the doctor’s office when they fear something is wrong, heading off more dramatic illnesses before they require hospitalization.

Rose Ann Cox, 69 years old, began working a few years ago with a Geisinger-paid nurse, Karen Thomas, to control her diabetes, talking by phone at least once a week. Ms. Cox had gone to the emergency room when her blood sugars were too low, but she has not been in the hospital for about three years now.
“You don’t always think you should call the doctor,” Ms. Cox said. But she has no qualms about reaching out to the nurse.
Via New York Times

Here’s the payoff.

In an unpublished review of 2008 data, Geisinger experienced an 18 percent drop in hospital admissions; overall medical expenses fell 7 percent.

In the world of health care, these numbers are huge. Who wouldn’t like to see their health care insurance premiums actually fall by 7% as a result of just this one, simple change in the system? The notion that our chances of hospitalization could fall by nearly 20% is not such a bad bonus either.

The idea is beginning to catch on as the big, for-profit health insurance companies are now experimenting with the “nurse fix”.

While the experiment of a small, Pennsylvania based health insurance company may not seem like much, the reality is that this is a very serious step forward in bending the curve of health care costs. It did not take an act of Congress or become fodder for cable television talking heads. Nobody was screaming about it at town hall meetings of hanging elected officials in effigy. No politician is going to get votes as a result of the effort.

All that happened here is that patients were cared for with greater success and a dramatically lowered price.

Health care costs are local. The sooner we recognize this, the sooner we can begin to gets our costs under control.

Unfortunately, Klein misses the mark by revealing his complete lack of understanding of the legal process. He writes -

Late last night, the Obama Department of Justice filed a motion to dismiss the Florida-based lawsuit against the health care law, arguing that the court lacks jurisdiction and that the State of Florida and fellow plaintiffs haven’t presented a claim for which the court can grant relief. To bolster its case, the DOJ cited the Anti-Injunction Act, which restricts courts from interfering with the government’s ability to collect taxes…. But this is a characterization that Democrats, and specifically Obama, angrily denounced during the health care debate. Most prominently, in an interview with ABC’s George Stephanopoulos, Obama argued that the mandate was “absolutely not a tax increase,” and he dug into his view even after being confronted with a dictionary definition”
The American Spectator

First of all, I think Mr. Klein intended to reference the Tax Anti-Injunction Act of 1867 and not the “Anti-Injunction Act” which was passed in 1783. The Tax Anti-Injunction Act says that – with a few exceptions not relevant to this case- a federal tax cannot be challenged in any court (not just state court). This law was further flushed out in the landmark case of Flora vs. The United States, 357 U. S. 63, reaffirmed. Pp. 362 U. S. 146-177 (1960), where the Supremes held that, with the exception of personal income taxes, a taxpayer must first pay the tax amount in dispute and then appeal in an administrative hearing before the Internal Revenue Service. The exception is in the case of a personal income tax complaint where a taxpayer may file in the United States Tax Court before paying the tax and receive a ruling as to whether or not the tax is owed.

No such exception would be applicable in the matter before the Florida court. For starters, the suggested tax or penalty has not yet been paid by anyone as the law has not yet taken effect. Further, the case is not being heard by the United States Tax Court.

Of course, Mr. Klein would respond by pointing out that by invoking the restrictions of the Tax Anti-Injunction Act, the federal government is acknowledging that the health insurance mandate is, indeed, a tax – despite the Administration’s arguments to the contrary in the political arena.

Klein could stand to bone up a bit on how the legal system works.

In responding to a complaint such as this, it would be incumbent upon the government to assert any and all possible claims to accomplish their objective – in this case that objective being dismissal of the cause of action.

Thus, it would only make sense for the government to argue that this is a tax or a penalty which should be treated as a tax since the IRS would collect either. Were the court to buy the argument, the case would then likely be dismissed based on the very law Klein incorrectly cites, and the mission would be accomplished.

If the court rejects the argument, because it neither sees the mandate as a tax or a penalty sufficiently resembling a tax, then the government would, no doubt, rely upon a variety of its other arguments put forward, such as the legality of the mandate under the Commerce Clause of the Constitution along with any and all other arguments the government has at its disposal.

This is how it works. The government’s lawyers are responsible to suggest all possible theories to accomplish their objective of dismissal. The court’s job is to determine if any of the theories are appropriate and rule accordingly.

As for pointing out that the legal argument is at odds with the political argument, so what? Lawyers are to defend the interest of their client – in this case, that client being the United States of America. And, in the opinion of the Justice Department, it is in the interest of the client to have the case tossed out of the Florida court.

While confusing the role of judicial proceedings with the machinations of everyday politics might serve as a ‘gotcha’ moment for Mr. Klein and the American Spectator, it is indeed the American Spectator that has been ‘got’ as I believe its readers expect something a bit deeper in the analysis of important matters such as the case under discussion.

Mr. Klein and friends might also wish to take into consideration that a review of Justice Department arguments and legal positions taken in past cases – such as those made during the Bush Administration that fly smack in the face of the conservative values held so dear by the American Spectator-would further undermine the credibility of the Spectator when it comes to in-depth reporting. Even I, as one who expects very little from the American Spectator, would think that Mr. Klein could provide his readers with a more accurate and deeper accounting of what is actually transpiring in the case and leave the silly, irrelevant gotcha stuff to the cable TV networks.

The object of their ire this time is Obama’s proposed nominee for the administrator of the Centers for Medicare and Medicaid — a post that has been vacant for four years — Donald Berwick.

Berwick’s grievous sin? He openly admires Britain’s National Health Service,

Berwick has called Britain’s National Health Service “one of the greatest health care institutions in human history” and “a global treasure.” He once said it sets an “example” for the United States to follow. And his decade-long efforts to improve the NHS were so well-regarded that Queen Elizabeth granted him an honorary knighthood in 2005.

Responding, Sen. John Cornyn describes Berwick as, “bad news” and seems to be gearing Senate Republicans up for a fight to challenge Berwick’s nomination, as Politico describes it, “just in time to resurrect the brutal yearlong health reform battle ahead of the midterm elections.”

Quoth the Church Lady, how convenient.

Of course, Cornyn and the Republicans probably won’t mention that Berwick has tempered his admiration with a recognition of the problems inherent in Britain’s NHS,

“I fell in love with the NHS,” Berwick said in a 2008 speech of the system that he had worked on since the 1990s. “To an American observer, the NHS is such a seductress. … Like any lover, it took me a while to see the blemishes of my beloved, though I soon had help from people quite willing to point out the warts.”

And in that same speech (available in full only to members, sadly), Berwick lists ten ways that the NHS could be improved. In a shorter article on the topic, Berwick, along with Sheila Leatherman, offers some suggestions that should be music to conservatives ears (italics mine),

The increase of 30% in funding the NHS over the next five years should provide the needed capital to modernise undercapitalised facilities and fund investment in information systems. Adding more capacity is critical in a system widely recognised as understaffed. But we caution NHS planners not to overshoot. Oversupply has been shown to correlate with higher rates of hospitalisation and procedures in health care that are clinically unexplained.

Specific performance improvements should be targeted and pursued system wide. We believe that national aims—such as improving cancer outcomes, improving care for heart disease, and improving mental health interventions in crisis—are helpful in establishing focus and coordinating national resources. We suggest developing centralised “big picture” aims, while nurturing innovative and pluralistic local initiatives to realise gains “on the ground.” The NHS wastes its most promising resource—the talent of its people—when it discourages clinicians and managers from initiatives that would improve care locally.

Emphasise learning over regulation as the linchpin strategy for improving care. The NHS Plan calls for increased levels of measurement and accountability throughout the NHS. These are important. But more important for the long haul is the NHS’s capacity to learn from its own best practices and innovations and spread those good ideas throughout the nation. That requires the system to develop and maintain world class educational and training opportunities for its staff and clinicians.

Depoliticise the NHS as much as possible. A side effect of nationalised health care is that it becomes interwoven with national politics. This can garner resources and propel change, but it can also confound constancy of purpose. Reform fatigue and scepticism are real dangers in the NHS, particularly when too many people start to believe that the political agenda is driving the health agenda. Britain’s political and health care leaders need to maintain the long term view and the discipline to assure that NHS modernisation will be shaped by the simple and abiding values of equity, efficiency, and effectiveness.

At the end of the day, though, Berwick’s admiration and support for the NHS is a re herring. The real reason that Berwick’s nomination is so important is that he has expertise that speak directly to the biggest problem facing US halth care: cost.

Again from Politico,

Berwick, a physician with three Harvard degrees, founded the nonprofit Institute for Healthcare Improvement in 1991. In this capacity, Berwick has traveled the country and the world, pressing his theory that doctors and hospitals can boost care and reduce medical errors while saving money. Admirers — a group that includes a few Republicans who headed CMS — have described his work as “revolutionary.”

From the Institute’s website,

We aim to improve the lives of patients, the health of communities, and the joy of the health care workforce by focusing on an ambitious set of goals adapted from the Institute of Medicine’s six improvement aims for the health care system: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. We call this the “No Needless List”:

No needless deaths
No needless pain or suffering
No helplessness in those served or serving
No unwanted waiting
No waste
No one left out

IHI works with health professionals throughout the world to accelerate the measurable and continual progress of health care systems toward these bold objectives, leading to breakthrough improvements that are truly meaningful in the lives of patients.

We will be a recognized and generous leader, a trustworthy partner, and the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health care profoundly for the better.

As Kevin Drum noted back on May 27, with massive rate hikes looming, cost is where conservatives and Republicans really need to train their lasers,

If conservatives want to avoid the specter of federally funded single-payer healthcare in the United States, this is what they need to come to terms with. Canada provides high quality healthcare for everyone — including small businesses and the elderly — for a cost per person of about $4,000 per year. Ditto for France and the Netherlands. Britain and Japan do it for about $3,000. Ann Terranova is being asked to pay more than $6,000 per person — and that’s for three working-age employees.

One way or another we have to deal with this. This year’s healthcare reform bill takes some small strides toward reining in costs, but they’re not nearly enough. We need to do far more, and if the private market won’t do it then eventually public opinion will force us to adopt a European-style system. If conservatives really understood this, they’d take the problem more seriously. But they don’t seem to.

In this regard, Berwick’s nomination holds the potential to tap someone who has a wealth of experience from all around the world in containing costs, while at the same time maintaining and improving quality of care. And that is the key point to bear in mind vis-a-vis President Obama’s nomination of Berwick.

Berwick stands to address the fundamental issues facing American health care. Republicans; however, are poised to offer opposition to Berwick’s nomination on the grounds that it could score them a quick political buck while striking yet another blow for the unsustainable corporate status quo they worked so hard with industry lobbiest to maintain over the past year.

Ultimately, this latest move by Republicans serves as further evidence that they care more about their own political fortunes than a system of health care that benefits the country as a whole. In other words, nothing much has changed.

It may be unfair, given opponents who decided on an unprecedented strategy of unyielding resistance.  They have shamelessly sabotaged almost any progress or possible success for this administration.

But how do they get away with it? Shouldn’t effective politicians be able to roll over those in the other side of the partisan blockades?

It may also be that the Obama communications team does a lousy job of, uh, communicating.  The message about what accomplishments there have been has been drowned out by the loud braying of opportunistic politicians and commentators on the Right sidelines.

How is it that Press Secretary Robert Gibbs looks so much like he has his hands tied at the very same time he swings wildly at any questioner?  That can’t be possible.  Can it?

But forget about surrogates, isn’t it ultimately the Chief Executive,  who should speak softly and carry a big fly swatter?

Unfortunately, this President only seems to have gotten the “speak softly” part down. It’s hard to be “No Drama Obama” in such a theatre of the absurd.

No matter how many times his handlers feed pliant reporters some story about how he glowered behind closed doors or snapped “Plug the damned hole” in a snitty moment, it still seems like just a moment…that this is a man who doesn’t instill fear when he needs to.

So every time, he clenches his jaw and makes another “No More Mr. Nice Guy” speech everyone yawns and says, “Yeah, whatever”. As a result, in spite of the promise of “Change you can believe in”, it looks like things are basically UNchanged.

The oil companies still are in control even when apparent sloppy greediness by one of them results in massive destruction. The bankers and investment chiefs whose inept avarice caused a worldwide economic collapse not only go unpunished but they’re getting huge raises while everyone else struggles to stay afloat.

The insurance companies used all the tried and true tricks to finesse  attempts at meaningful health care reform, leaving a hollow shell.

Speaking of reform, those who came in promising a new way of life in Washington wallow around in the same-old-same-old with their Chicago-machine like patronage, where government jobs are offered as favors.

This list doesn’t even address the grandiose declarations about more enlightened ways to handle terrorism and terrorists, and detainees and national security and civil liberties. Enemies still thumb their noses, as do the critics at home.

Here are some fair questions:  In today’s world of instant communication and blatant demagoguery is an effective Presidency even possible?

If so is it premature to judge this one less than 17 months in?  Perhaps.  Except when will the impression of Barack Obama’s audacious hopefulness be consumed by one of timid haplessness? And when will it have slipped too far in the public mind for this Presidency to recover?

Sad to say it’s hard to refute one of their main propaganda points:  Regulation doesn’t work. It doesn’t but it should.  We don’t need to look very far to see the mortal danger of uninhibited commerce. We can compile a long list of examples from the news…a list of companies where  any concern for the lives and welfare of everyone else has been overridden by careless and shameless greed..

It includes, of course, British Petroleum, Toyota, Johnson and Johnson, and it’s subsidiary that makes CHILDREN’S health care products.

Let’s not forget the bankers and other money changers, the health insurance companies, at least one coal company.

They are all regulated to some degree, at least theoretically.  The problem is that in practice, the agencies that are supposed to oversee them have been often paralyzed, compromised by a culture that condones slothfulness and even corruption.  We can easily come up with a list here with initials: MMS, which stands for Minerals Management Service, but we know its real MISmanagement.
NHTSA…the National Highway Transportation Safety Administration, where the “T” obviously did NOT mean “Toyota” safety.

They are easy marks for the industries that want to avoid any controls, particularly when their bought-and-paid-for politicians create laws with loopholes big enough for an 80 year old running back.

Those who contend regulation is ineffective are often right on the money.  Unfortunately, it’s our money.

What do we do?  Boycott the miscreants?  That would be worth considering but it won’t work.  There are so many of them we wouldn’t be able to buy what’s necessary to live in today’s world. They have metastasized through our entire system.

There is only one solution.  We need to get smarter.  We must reject all the shop worn arguments that reasonable protections by government are un-American in one way or another.  It’s important that we pay attention to who’s doing what in all those back room deals and demand a full and public accounting by our public officials.

We must constantly monitor those  we pay to monitor and be responsible for industry.  It’s not too much to insist they are competent and do their job.  We can’t let them get so burrowed into their workforce they can’t be pried out or shielded by impenetrable walls of bureaucracy.

And we have to pass laws that truly punish those who steal from us.  Unfortunately, dangerous and negligent fraud is not always a crime. It should be.

Contrary to the apologists, the unfetteredly free markets they defend with their platitudes is anything but free.  We are paying a  huge price.

Image via Wikipedia

The New York Times has a fascinating piece on a fast growing medical specialty: hospitalists. They are a modern day hybrid, part administrator and part caregiver.

They spend quality time with patients that family doctors, making hasty morning rounds, barely visit. They coordinate medications, double-check diagnoses, make sure that patients and their families fully understand what they must do upon discharge so that the patient doesn’t end up readmitted a week later.

But perhaps even more important in the long run, they are also trained computer geeks, adept at designing systems that contain costs, coordinate treatment, and manage workflow so that a minimum of staff can provide a maximum of care.

The name hospitalist, at least to me, conjures up a stodgy bureaucrat, someone who pushes pencils, loves saying no, and finds ways to benefit the hospital at the patient’s expense. But forget the name, these folks are the mirror image of that. They are proactive. They do not seek ways to cover the hospital’s tush if the readmission rate is too high; they seek systems to bring it down.

In 65 participating hospitals around the country, the Society of Hospital Medicine identifies patients at high risk for readmission, provides staff mentoring, and designs user-friendly discharge forms listing follow-up appointments, potential signs of trouble and phone numbers for the hospital team. Peer-reviewed research on the reforms in the system is expected in a year or two.

Even experts who were initially skeptical agree that the hospitalists’ skill set is timely. They are young and thus not entrenched in the current order. They enjoy working in teams, when older doctors tend to be hierarchical.
<…>
At meetings with her fellow hospitalists, phrases seldom spoken by most doctors, like “cost-effective delivery of care,” and “preventable adverse events,” flow off everyone’s tongue: The language of health care reform.

That last sentence is probably the most important. The health care reform bill will be a bear to enforce. But think how much easier it will be with a new cadre of doctors on hand, who have no good old days to mourn, no vested interest in prescribing unnecessary tests, equal allegiance to patient and hospital. but none to insurance companies.

It is a true reason for hope.

Five major insurers in California’s small-business market are raising rates 12% to 23% for firms with fewer than 50 employees, according to a survey by The Times.

….”We don’t have that money,” said Ann Terranova, a San Francisco financial planner who is dropping Blue Shield for herself and two employees after learning that their annual premium would jump to more than $19,000 a year from $11,000. 

….California insurers defend their rate hikes as sound and fair, saying they struggle to balance affordable rates with the need to remain competitive and turn a modest profit. Blue Shield, for example, said hospital charges rose nearly 20% last year, while physician costs and pharmaceutical fees increased almost as much. Anthem Blue Cross also cited the cost of medical care in explaining its average rate hikes of 13% this year.

You can look forward to a similar fate no matter where you live in the United States, meaning people will keep losing coverage or finding themselves paying ever higher premiums for less coverage.

Kevin writes:

Canada provides high quality healthcare for everyone — including small businesses and the elderly — for a cost per person of about $4,000 per year. Ditto for France and the Netherlands. Britain and Japan do it for about $3,000. Ann Terranova is being asked to pay more than $6,000 per person — and that’s for three working-age employees.

One way or another we have to deal with this. This year’s healthcare reform bill takes some small strides toward reining in costs, but they’re not nearly enough. We need to do far more, and if the private market won’t do it then eventually public opinion will force us to adopt a European-style system. If conservatives really understood this, they’d take the problem more seriously. But they don’t seem to.

I’m not sure it should really be left up to conservatives at this point. Liberals like Oregon’s Ron Wyden had the best ideas for healthcare reform that included market mechanisms to keep down costs. We don’t need the free market as a stand alone solution to healthcare reform (as many libertarians and conservatives suggest) any more than we need to nationalize healthcare, or even single-payer. Right now the ball is in the Democrats’ court, and they should seriously think about incorporating more of Wyden’s ideas into their new healthcare law as they tinker with the thing in coming years.

We should also talk about catastrophic coverage vouchers going out to the uninsured right now, and finding out some way to tie Medicaid to unemployment so that nobody goes without healthcare coverage between jobs.

Image by Getty Images via @daylife

The Times has an editorial today that pretty much rings the opening bell on the maneuvers the insurance industry is undertaking to outwit health care reform. They’ve admitted defeat on trying to fend off a rule that they spend at least 80% of their premiums on — gasp! — health care, leaving a meager 20% for advertising, lobbying, and let’s not forget bonuses. So now they’re trying to redefine the concept of what constitutes health care.

They argue that much of the cost of setting up networks of providers should count as quality improvement, because they check the credentials and disciplinary records of doctors. They want to include programs to root out fraud or overbilling because they probably weed out some bad doctors as well. And they would include the cost of programs, including precertification, that judge whether care is covered and appropriate. All these look like activities whose primary purpose is to reduce costs for the insurer with quality at best a secondary issue.

Ya think? I’d argue that quality isn’t a secondary issue at all, it’s nowhere near the table.

The editorial notes that insurers are already reclassifying some of their administrative costs as medical expenses to make it look as though they are in fact spending a high percentage of premiums on care. What scares me is that, when it comes time to actually implement the bill, regulators — out of laziness or overwork or political considerations — will actually let them grandfather the costs in.

Don’t let them!

Granted, some “administrative” costs really do promote better health care. But many don’t. I agree with the Times’ examples:

Health information technology that improves patient care by preventing drug interactions should clearly count, but technology that primarily streamlines business operations should not. Programs that help manage and coordinate the care given chronically ill patients should count, but programs that review whether doctor-recommended services are covered should not.

If I were running an insurance company right now, I’d probably try to advertise all the things I was doing to actually promote health care. I’d try to compete on service, with the expectation that my reputation for honesty and service would help me win any number of new clients, now that so many uninsured folks are being pulled into the fold.

But that would entail being proactive rather than malevolently reactive — not exactly a stance the insurance industry is known for.

Image by Getty Images via Daylife

I just read a piece in today’s New York Times about the health insurance industry’s lobbying push to keep from having to use too much money for actual patient care. I mean, after all, that money could go to far better purposes, like paying executive bonuses or buying back stock.

Okay, I’ll stop with the silly sarcasm, the target’s too easy. And I wouldn’t even be commenting on this thoroughly-expected lobbying activity if it weren’t for the very last line of the Times piece:

Under the new law, insurers in the large group market are generally supposed to spend 85 percent of customers’ premiums on “clinical services” and quality-enhancing activities. The minimum is 80 percent for coverage sold to individuals and small groups.

Insurers and insurance regulators say that some companies will be unable or unwilling to meet the new standards.

Unwilling? UNWILLING???!!!

Every time I think business can’t shock me, it proves me wrong. What if Toyota were “unwilling” to recall defective cars? What if Coca Cola is “unwilling” to post nutritional information on its bottles? We then change the law to accommodate them? Or we put them out of business, and encourage consumers to buy Hondas and Pepsis?

My point, of course, is that if Blue Cross is unwilling, let Oxford take its customers. If both are unwilling, let’s reopen the public option concept (I hate the fact that it’s gone — I’ll go for any excuse to bring it back)

But I do have to say here, I hope the regulators don’t go too nuts in defining what activities qualify as customer-centric expenses. Maybe the industry should be allowed to count research studies aimed at, say, reducing hospital infections as part of that 85%/80% payout. Maybe the industry should help hospitals and doctors digitize records, and that cost should count too.

My way of saying, I’m willing to throw a few bones to the companies that come to the negotiating table in good faith. But those that are “unwilling”? Let them disappear. Now.

Image via Wikipedia

Every now and then, our government actually comes through for us.

Last week, Reuters reported that Wellpoint – the nation’s largest private health insurance company – was employing a computer algorithm that automatically targeted policyholders recently diagnosed with breast cancer. Once ‘kicked out’ of the computer, the policyholders’ applications were targeted for ‘aggressive investigation with intent to cancel their policies.’

Mistakes or omissions in applications – such as failing to report an illness while a child – were used by the insurance company to cancel the policies of tens of thousands of people at the worst possible moment for those affected.

While the new health care legislation is set to outlaw this kind of behavior, many have been concerned that the law lacks sufficient ‘teeth’ to adequately enforce the ban on rescissions.

Enter “Di-Fi.”

For those of you who do not hail from California, I’m referring to Senator Dianne Feinstein who was clearly not amused upon hearing of Wellpoint’s coldhearted computer scheme.

We have a duty to protect the American people from the corporate greed of these for-profit, publically traded health insurance companies. If a CEO thinks it is okay to deprive women of their health coverage when they become seriously ill with breast cancer, we can’t trust them to do the right thing, period. Left to their own devices, companies like WellPoint will throw paying customers to the sharks for the sake of profit.”
Via East County Magazine

Following up on Feinstein’s anger, House Democrats representing three different committees wrote to health insurance executives urging them to immediately stop the practice while crafting a special letter, signed by 57 Democrats, which was sent directly to WellPoint.
.
Apparently, that did the trick.

This afternoon, Wellpoint announced that, effective May 1, they would stop dropping health care coverage for customers once they get sick.

That’s a big deal and a very good day’s work for the United States Congress.

Wellpoint CEO, Angela Braly, issued the following statement:

There have been a lot of misrepresentations and inaccuracies in recent days that have caused confusion among our members and among the public generally about our policies in this area. We think today’s announcement will go a long way toward bringing greater clarity.

While I doubt that anyone will be buying the whole ‘misrepresentations and inaccuracies” thing, if that’s what it takes for Braly to end one of the most cruel and inhuman practices in the health insurance industry, it’s fine by me.

In the meantime, let all insurance companies who would cut off a cancer patient from the treatment they need hear the word –

Don’t mess with Dianne Feinstein!