It is ridiculous to think that a health institution can expand from Baltimore across the state all over the US and then overseas using all the money generated as profit and still call itself NON-PROFIT. All that needs be done is elect progressive labor and justice candidates that will then force a state's comptroller and Secretary of State charged with these illegal non-profit status designations to
DO THE RIGHT THING AND DECLARE CORPORATIONS HIDING AS NON-PROFITS CORPORATIONS THAT PAY TAXES AND THIS INCLUDES MANY RELIGIOUS INSTITUTIONS BEYOND THE CHURCH STRUCTURE.
MedStar in the Baltimore region is taking over every aspect of public health. They have become our community public health clinics----they are located in every sector of Baltimore----they are senior care-----rehabilitation care centers. This is an example of consolidated and captured corporate health care. They want to pretend MedStar is a local health corporation but you can follow MedStar's expansion from the West complete with MediVAC helicopter ambulance service. Look below to see how revenue in the billions has jumped significantly last year after the installation of the Affordable Care Act allowed MedStar to stop taking patients including uninsured and Medicaid. It also has installed the kind of patient staging that has patients out fast and not allowed to come back. This allows for the expensive hospital procedure to be billed and then off you go to all of the home health care services.
MEDSTAR IS A CORPORATION THAT EARNS PROFIT AND NEEDS TO PAY TAXES.
I spoke of my own personal experiences with MedStar and people are made fearful for their lives in this system that does indeed maximize profits. Please glance through a long article to get the feel of this consolidation and profiteering. Having institutions growing to what will be hundreds of billions in revenue vs a public hospital that got only what it needed to provide safe and broad service to a community. THE AMOUNT OF MONEY SPENT FOR THESE EXPANSIONS IS TREMENDOUS.
MedStar Health and the art of upheaval
Jun 19, 2015, 6:00am EDT Updated Jun 19, 2015, 5:38pm EDT
The 20-something had tried to schedule a doctor’s appointment over the phone, only to be put on hold for several minutes, a clear faux pas in the world of millennials.
“Dad, I don’t mean disrespect,” Samet recalls her saying, “but do you really run your business that way all the time? Why can’t I go online and make my appointment?”
He had an epiphany.
“I thought, ‘Even I use OpenTable,’” he said, referring to the online restaurant reservation service.
The executive got behind a proposed 18-month exclusive regional deal with ZocDoc in January 2014, allowing patients to book appointments with MedStar online for the first time. It was good for patients. But it also ended up being pretty good for business, too, as last-minute cancellations were filled.
It’s an example of a massive movement at Columbia-based MedStar, which is changing the way patients access care at a magnitude and pace unmatched elsewhere in the region. The system began implementing its MedStar 2020 strategy in 2009, at least a year before Democrats approved President Barack Obama’s Affordable Care Act. Obamacare, as the act is commonly referred to, embraces many of the same elements being instituted at MedStar: incentivizing health systems to push patients from hospital to outpatient care, emphasizing preventative measures and using technology to better coordinate care and improve its costs.
“We are disrupting the largest health care system in the region. This is not a little experiment,” Samet said. “It’s serious enough, we’re willing to disrupt our own business model.”
For MedStar — with $4.6 billion in revenue in its 10 hospitals and more than 250 outpatient access points — the experiment has begun paying off, with the health system reporting its strongest financial results in the last two years even as health systems around the U.S. have faced serious financial challenges. As it adapts to a new business model itself, MedStar says it could ultimately help the region’s employers rein in ever-escalating health care costs by leading the shifts brought on by health reform.
Getting ahead of Obamacare
Samet began working on the new strategy soon after being appointed CEO of the system in 2008.
He knew health care would undergo radical changes in the coming decade, driven by unsustainable growth in utilization and cost. The system, even with its sizable hospital assets, could no longer focus on episodic acute care in an emergency room.
Key to that 2020 strategy was shaking up what was widely considered a successful regional hospital network, whose holdings include MedStar Washington Hospital Center, which has 769 beds and its cardiovascular institute, and MedStar Georgetown University Hospital, with 396 beds and a National Cancer Institute-designated cancer center. Even as it grew a research agenda and one of the largest medical education programs in the country, MedStar began aggressively pursuing a distributed model of community-based facilities. That included primary and specialty care physician offices, to family care centers, multispecialty care centers, urgent care centers and large-scale “hospitals without beds” — connecting them all electronically.
Another key: Samet recognized he may have to spend — or lose — money in the short term to achieve long-term success. “There’s no question the CFO could come in here and say, ‘Ken, it cost you X dollars for that,’” said Samet, who ran Washington Hospital Center for 13 years before becoming chief operating officer and then CEO of the entire system.
The way Samet tells it, MedStar quietly got way ahead of health reform by swallowing costs and pushing its business outside of traditionally more lucrative hospital care before there was a financial incentive — i.e., Obamacare — to do so. Before health reform, hospitals got more money for admitting a patient to the hospital than for offering a wellness visit to keep them out of one. Health care reform overturns that, paying health systems based on patient outcomes, not volumes.
“It’s a particularly interesting and challenging time from a financial standpoint to run health care organizations like MedStar because it’s running an organization in both a today and a tomorrow world,” Samet said. “We have to believe we’re doing the right thing for the long-term benefit.”
MedStar is already touching more patients, has increased its scale and purchasing power, and is on track to make $5 billion in revenue this year, a 9 percent increase from $4.6 billion the previous year. That’s significantly better than the national average — Moody’s Investors Service reported last fall that operating revenue growth among nonprofit hospitals dropped from 5.1 percent in 2012 to 3.9 percent in 2013.
Moody’s also has given MedStar an A2 rating, a prime rating that indicates the health system has a strong ability to repay short-term debt obligations. Moody’s said MedStar has positioned itself well in the market with its growing network, allowing it to evolve with the nation’s health care system, praising its leadership for proactive planning for potential future challenges.
That’s not by coincidence. While other hospital systems in the region have promoted major investments in research — see Inova Health System CEO Knox Singleton’s major push into precision medicine in Northern Virginia— Samet has placed more emphasis on the business side.
“Knox wants to be remembered for genomics,” said Jay Shiver, a former D.C.-area health care administrator who now teaches health care administration at George Mason University. “Kenny’s a much more grounded person. He’s thinking the business of health care. And right now, this is where it’s going.”
Follow the Starbucks
In a Mitchellville strip mall with a grocery store and a McDonald’s, a MedStar multispecialty clinic appears packed one recent weekday morning. Patients in the Prince George’s County center are there for everything from X-rays to primary care appointments and follow-ups with cancer or surgical specialists.
Since 2009, MedStar has poured $186 million dollars into building out a network of more than 250 such outpatient access points, many in or near shopping centers, to attract patients across the region. Eight years ago, it had 95.
MedStar looked for established retailers like Starbucks nearby as it chose sites to build what it calls the “distributed care” model. Following the success of CVS’ retail Minute Clinics, MedStar created 10 of its own stand-alone urgent care centers called MedStar PromptCare around Greater Washington. It plans on having about 20 within the next 18 months. All are connected electronically when it comes to patient records.
The outpatient sites tie back to the health system. For instance, a third of all patients who come into urgent care don’t have a primary care physician yet and receive referrals.
“It becomes another front door to the system,” Samet said.
MedStar is going so far as to make some clinics “big-box” or “hospital without beds” multispecialty locations. That includes the planned downtown D.C. location at Lafayette Center, a 92,000-square-foot clinic that will offer six floors of primary care and specialty services, including surgical care and sports medicine. It is meant to be a more accessible way for patients to receive care they might typically receive at multiple locations throughout the city without the inconvenience of having to book multiple appointments. The center, which boasts a large parking structure, is blocks from the George Washington University Medical Faculty Associates, an independent physician group with more than 750 providers and 51 specialties.
Strength in (insured) patients
The health system’s new distributed network has made it a target for criticism, however, that it’s cherry-picked commercially insured patients.
After MedStar opens outpatient centers nearby, the D.C. Primary Care Association has complained that smaller nonprofits get fewer numbers of insured patients who help make their own clinics viable for caring for the uninsured. In August, MedStar looked to shed that reputation as it established a memorandum of understanding with DCPCA to help get uninsured patients improved access to MedStar specialists and improve coordination with primary care providers outside its system, said Jackie Bowens, CEO of the D.C. Primary Care Association.
DCPCA wasn’t the only one. MedStar also entered into a similar MOU with Mary’s Center, a regional network of clinics to help low-income residents.
“Being [that] MedStar is a well-capitalized health center, Mary’s Center didn’t have a choice but to enter into an MOU,” David Tatro, chief operating officer at Mary’s Center, said when it was signed last August. “But we seem to be making progress toward ensuring the community has better access.”
For MedStar, the investments solidified its strength across the region as its outpatient visits dominated its business and drove market growth. Last year, the health system counted 4 million outpatient visits, compared with 160,000 inpatient admissions. For the 10 months of this fiscal year that ends June 30, the system’s outpatient revenue growth, pegged at 7 percent, is outpacing its 1.2 percent rise in inpatient revenue in that time.
Year over year, MedStar steadily increased its market share in D.C., growing 3.7 percentage points from just shy of 18 percent in 2007 to more than 21.7 percent in fiscal 2013, according to D.C. Hospital Association data.
“They are coming together as an increasingly sophisticated health care system,” said Dr. Toby Cosgrove, CEO of Cleveland Clinic, which has partnered with MedStar’s tech transfer program, as well as its cardiovascular program. Cosgrove, himself a 40-year veteran at Cleveland Clinic, calls Samet “aggressive.”
MedStar has a long way to go before it ever has the national reputation of a Johns Hopkins, but Cosgrove praised its growing regional clout even as more nationally renowned institutions struggle with their research-based budgets.
“Increasingly,” he said, “what you’re getting paid for is the efficient delivery of care.”
Investments in innovation
Samet initially planned to pursue a career in medicine at Old Dominion University. He excelled more in business ventures and, in one instance, organized a group of fraternity brothers to help sell souvenirs where he worked as a concessions manager for the local convention center.
After taking a course taught by the chief financial offer at a local hospital, he was hooked on a new plan: the business of health.
After graduate school, he began an administrative residency at the Washington Hospital Center in 1982 and has been connected with the hospital ever since.
“My hands aren’t going to touch a patient, thankfully,” Samet said. “But I feel like my contribution can be in creating and organizing and turning loose the energy and the creativity and the passion of our people.”
His new strategy did just that. In 2009, he set aside $2 million to establish the MedStar Institute for Innovation, called MI2. The institute now has an annual budget of $10 million.
Many health systems say they have innovative cultures, but new ideas can easily get buried in bureaucracy, said Mark Smith, MedStar’s chief innovation officer. That hasn’t happened at MedStar, Smith said, because Samet was clear the institute would report directly to him.
Six years later, Samet is still vague about why he created it. “If I actually knew what it was going to do, it wasn’t very innovative,” he tells anyone who asks.
What we know is this: It was an infrastructure for innovation, Smith said, by offering a safe space for employees to pursue ideas that could impact health care.
The innovation center launched the Global Healthcare Innovations Alliance with Cleveland Clinic in 2011 — essentially outsourcing its work to commercialize ideas.
That partnership has resulted in 255 ideas, including 33 this year. It has also resulted in 13 patent applications, an app on the Apple App Store, five technologies in license negotiation and three proof of concept studies. Most recently, a physician invented an implantable device that could help patients with pulmonary failure live independently. MedStar is moving that product to market.
MI2 eventually led to the formation of the Center for Digital Health & Data Science, which is designed to incubate ideas, for instance, in personal health and telemedicine. The center also serves as a portal to the outside world for both established and early-stage companies, becoming a founding partner of D.C. startup incubator 1776.
MI2 is working with six startups on remote monitoring systems, informatics, telemedicine and other digital health solutions to change health care delivery. In exchange, MedStar has the first rights to use any innovations within its own delivery system.
Most large integrated health systems have begun developing innovation programs, but the overall breadth of MedStar’s program is unique, said Dr. Molly Coye, the entrepreneur-in-residence at the Network for Excellence in Innovation, a health policy institute not affiliated with MedStar.
“MedStar was an early entrant in this,” said Coye, who served on the American Hospital Association board with Samet.
She said MedStar’s focus on combining internal ideas with outside resources makes sense.
“Some health systems insist they want to exclusively do their own innovations or approaches,” she said. “But because MedStar uses this approach, the chances they’ll produce something useful is quite high.”
One of MedStar’s creations was its National Center for Human Factors in Healthcare, which looks to capture safety and quality lessons from such industries as aviation and manufacturing. The name of the center itself is enough to make many health administrators squeamish by virtue of the implicit connection to the mistakes that can happen when humans run a health system. But it put the health system in the company of more established institutions, such as John Hopkins, which has a leading patient safety and quality institute of its own.
Too often, changes in health care are being attempted from the top down, said Dr. Peter Pronovost, a nationally recognized leader in patient safety who heads Johns Hopkins Armstrong Institute for Patient Safety and Quality. “Evidence shows that pay-for-quality has motivated hospital executives, but what about the care provider on the night shift?” Pronovost said. “That’s why innovation is so important because it can inspire and motivate. Fundamentally, you’ve got to engage your employees.”
Indeed, “a lot of innovations are created by medical nerds like scientists,” Coye said. “But human factors engineering means you’re really studying the patients, their families, the nurses at the bedside and really trying to understand them.”
How do you measure success?
Whatever Samet and MedStar are doing, they should brace for some serious competition. Other health systems, such as Tenet Health, are doing this on a much larger scale, said Venson Wallin, a managing director in BDO Consulting LLC’s health care advisory practice.
“From a regional perspective and a general strategy perspective, they are ahead of the game,” Wallin said. “But they won’t be on their own for much longer. That’s where the focus on health care is going.” Instead, Wallin believes MedStar could be more of an example to similarly sized systems that can’t measure up to Tenet’s scale. “If they are able to cut costs by getting people into the community rather than the hospital, as a result, the costs from employers’ and employees’ perspective are hopefully reined in,” Wallin said.
To be sure, the Supreme Court’s decision on whether to uphold the Affordable Care Act, due out by the end of the month, has the potential to create massive ripples across health care if millions of patients across the country were to suddenly lose health insurance. It was the health reform law that helped incentivize much of the momentum happening in the industry.
And while health executives have said it’s unlikely they’ll roll back the steps they’ve taken toward value-based care, it could create some serious financial hurdles and slow progress.
“The region needs us to be successful,” Samet said. “There’s no replacement strategy for the activities and the services that get provided.”
How will Samet and MedStar know if they are successful in the long term?
Samet said he’ll know if MedStar continues to grow even while inpatient revenue makes up less than 40 percent of the health system’s total revenue in five years. But ultimately, he said, success will mean the health system built a value equation recognized nationally as a key to solving the quality, safety and ultimately cost of health care.
“I’m proud of our organization that we had the courage to start this journey before all of that,” Samet said, referring to the health reform legislation. “But I also know it’s a good thing we did.”
I am highlighting MedStar because it has a growing control in our Baltimore regional market. This article shows how Medicaid patients are indeed being kept from these profit-driven hospitals and as it says-----MedStar is building the preventative care only clinics in underserved communities to keep patients out. At the same time, the funding for Medicaid is being fleeced in greater amounts as the access to care for what is becoming most Americans falls. MedStar is pleased to be at the forefront of tiered access to health care and using Federal funding from our Medicare and Medicaid Trusts to maximize profits---that is Wall Street driven private health care.
Now, if you think it is good news that close to 50% of Americans are moving to these Federal programs as they are being dismantled and privatized----with the coming economic crash taking out private and public pensions and health plans boosting this number above 70%.......you don't know what life without access to any health care but preventative care will look like. The plan for Medicare will be that it will look just like Medicaid for anyone earning under a few hundred thousand dollars a year.
Single Payer: Centers for Medicare and Medicaid Will Provide 43% of All Health Insurance in 2014
By Terence P. Jeffrey | November 1, 2013 | 9:46 AM EDT 247SharesFacebookTwitterMore President Barack Obama (AP Photo/Carolyn Kaster)
(CNSNews.com) - The Centers for Medicare and Medicaid Services--the federal agency that created and is operating the Obamacare exchanges--says in a budget document provided to the congressional appropriations committees that the Medicare, Medicaid and Children’s Health Insurance Program (CHIP) will cover almost 116,000,000 Americans in 2014.
MedStar Health expands Medicaid business in D.C.
Aug 3, 2012, 6:00am EDT
Ben Fischer Staff Reporter Washington Business Journal Enlarge Wagner
MedStar Health is expanding its Medicaid insurance plan to the Washington region, where executives believe they can make money with a counterintuitive goal: Keep patients out of their growing network of local hospitals.
The Columbia, Md.-based hospital system recently won a D.C. contract to begin competing in the city’s Medicaid program Oct. 1, a victory that comes as it also expands into the Maryland suburbs after a decade in Baltimore. In both jurisdictions, the insurance arm makes money by spending less on beneficiaries’ health care needs than it receives in fees from the government.
For now the plan, dubbed MedStar Family Choice, is a small play, about 3 percent of MedStar’s $4 billion in annual revenue. But the system is positioned to be an even bigger insurance force in D.C., where the current Medicaid contracting market is in flux. Dominant player D.C. Chartered Health Plan Inc. is seeking a buyer, and officials say it likely will not receive a new contract as long as embattled political donor Jeffrey Thompson owns the company. Both Chartered and second-tier UnitedHealthcare Community Plan have reported losses recently, and UnitedHealthcare has not committed to seeking a new contract.
Typically, Medicaid insurance plans build market share slowly, because they are prohibited from directly soliciting business and incumbent plans usually retain members. But the turnover could allow MedStar to be an exception, said Wayne Turnage, director of the D.C. Health Care Finance Department.
You hear absolutely no discussion as to what these laws in Affordable Care Act mean and below you see what will become the largest culling of American people from accessing Medicare in history-----losing Medigap insurance option as seniors try to pay the 20% of costs Medicare does not cover. As you see below, a large percentage of seniors use Medigap----you can be upper-middle class and need Medigap to meet that 20%. What Obama and Clinton neo-liberals did was use this to keep a majority of seniors from accessing much of health care. This is called----BRINGING DOWN THE COSTS OF MEDICARE. So, this consolidation and deregulation of health care creating global health corporations will make health costs soar at the same time seniors are made to pay the 20% with no avenue for Medigap to help. This means one health incident and you are medically bankrupt and no longer able to access ordinary health procedures.
THIS WILL PUSH SENIORS THAT WOULD HAVE GOTTEN MEDICARE ONTO MEDICAID----THAT GUTTED OF FUNDING PREVENTATIVE CARE FOR ALL.
Republicans have always wanted to end Medicare and Medicaid----but they did not force Obama and Clinton neo-liberals----it was what Affordable Care Act had as a goal.
You see how installing Expanded and Improved Medicare for All takes care of all this. It covers the 20% seniors had to pay----as a result bringing some of that massive fraud against all of our wealth assets back with full coverage for life. It does not matter if the poor have this access folks----simply ending corporate fraud and profiteering leaves plenty of revenue -----along with taxing corporations.
Medigap Most Medicare enrollees have some type of coverage that limits the program's cost-sharing requirements. According to the Kaiser Family Foundation (KFF), 23% of all Medicare enrollees buy private Medigap policies; 35% have employer- or union-sponsored supplemental coverage; and Medicaid augments Medicare coverage for low-income seniors (19% of all enrollees).
Under the doc-fix law, Medigap plans will no longer cover the annual Part B deductible for new enrollees ($147 this year). That will mean changes for Medigap "C" and "F" plans, the two most popular plan choices and the only ones that cover Part B deductibles. Starting in 2020, seniors would have to pay it themselves. Current Medigap policyholders and new enrollees up to 2020 would be protected. First-dollar coverage from employers and Medicaid are unaffected.
With the average income in Baltimore at $45,000====everyone will be on Medicaid. See how you make the single-payer Medicaid for All!
Pressure for Entitlement Cuts Is on Medicare, Medicaid
by Jim RowleyHeidi Przybyla November 28, 2012 — 12:17 PM EST
Democrats willingness to change Medicare and Medicaid will determine how far Republicans can go to meet President Obama’s demand for $1.6 trillion in more revenue. (Bloomberg)
-- Democrats say Social Security is off the table. So if Republicans are successful in pushing for changes to entitlement programs in U.S. budget talks, the pressure for cuts will be on Medicare and Medicaid.
Republicans propose raising the Medicare eligibility age. Other options for squeezing money out of the health care program for the elderly include additional co-payments and an increase in premiums paid by high-income recipients. In February, President Barack Obama proposed saving about $70 billion over 10 years by revising the formula for federal matching of state Medicaid expenditures, along with other changes.
“There are things that we can do with entitlements that don’t hurt beneficiaries,” Senate Majority Leader Harry Reid, a Nevada Democrat, told reporters in Washington yesterday without giving specifics.
Democrats, buoyed by victories in the Nov. 6 election, say they won’t touch Social Security during talks over averting the so-called fiscal cliff. Their willingness to make changes to Medicare and Medicaid -- which together cost $720 billion a year, about one-fifth of the U.S. budget -- may determine how far Republicans will go to meet Obama’s demand for $1.6 trillion in new revenue over the next decade.
Financial Structure House Speaker John Boehner, an Ohio Republican, has said he wants “real changes to the financial structure” of entitlements before he’ll agree to more tax revenue.
Lawmakers are trying to avert $607 billion in tax increases and automatic spending cuts scheduled to begin in January. They are also aiming for a longer-term plan to reduce the U.S. budget deficit, which has topped $1 trillion for four consecutive years.
Today, Boehner said he was “optimistic” all sides will continue to work toward an agreement. A day earlier, Reid said the parties had made “little progress” in budget talks since a Nov. 16 meeting at the White House.
Stocks were little changed today. The Standard & Poor’s 500 Index rose less than 0.1 percent to 1,399.03 at 11:27 a.m. in New York, erasing a decline of as much as 1 percent. The Dow Jones Industrial Average added 28.15 points, or 0.2 percent, to 12,906.28.
One alternative sought by Republicans is increasing the eligibility age for Medicare, now 65. Gradually raising that to 67 for future recipients would save $148 billion through 2021, the Congressional Budget Office has estimated.
Starting Point The Democrats’ starting point for Medicare and Medicaid cuts is what Obama proposed to trim from the programs in his 2013 budget. CBO estimated those cuts would total $351 billion over 10 years.
Republican Representative Tom Cole of Oklahoma dismissed Obama’s proposals for entitlement cuts as “mostly nips and tucks around the edges.” To curb the projected long-term growth of entitlement spending “you’ve got to go deeper,” he told reporters. “I haven’t seen anything that suggests” that Obama “is willing to do real structural reform.”
Obama and his advisers “surely look at the same numbers we do and they know they can’t” cut deficits without dealing with entitlements, Cole said. After endorsing a plan to partially privatize Medicare, House Republicans survived the “fire of an election,” he said. “That tells me the American people are willing to accept some honest talk and some tough decisions.”
Drug Rebates The biggest savings in Obama’s budget proposal would be $137 billion from requiring drugmakers to give Medicare the same rebates for medicines for low-income recipients that are allowed for Medicaid’s purchase of prescription drugs, according to the CBO estimate.
More than $45 billion in savings would come from cutting reimbursements for providers of some post-acute care, such as rehabilitation services and home-health care. Almost $24 billion would be saved by reducing the government’s coverage of bad debts that hospitals incur from patients who don’t pay their bills.
For Medicaid, the health-care system for low-income Americans, Obama’s budget would revise the formula for payments to states and make other changes for a 10-year savings of about $70 billion, according to CBO. Republicans have proposed making Medicaid a block grant-style program and turning it over to the states.
Some Democrats say they favor an increase in the payroll withholding tax for Medicare. It would hit lower-income wage earners harder because it’s based on a percentage of income.
‘Tiny Fraction’ Still, an increase of just “a tiny fraction would generate a fair amount of money,” said Democratic Representative Earl Blumenauer of Oregon.
These sorts of changes probably won’t provide enough savings for Republicans to accept in return for increasing taxes for high earners, said G. William Hoagland, a former Republican staff director for the Senate Budget Committee. He’s now a vice president at the Bipartisan Policy Center in Washington, which studies ways to cut the deficit.
Even if Democrats are willing to make fundamental changes to Medicare they “don’t generate savings very quickly,” Hoagland said. Republicans want to “see spending savings quickly,” he said.
The election effectively killed the Republican proposal to offer future Medicare recipients a chance to buy private health insurance with money provided by the government, Hoagland said.
A Democratic proposal to raise premiums paid by higher-income Medicare beneficiaries is potentially “the big one for real savings quickly,” Hoagland said.
Higher Premiums Individuals with annual incomes of more than $85,000 and married couples with incomes of more than $170,000 already pay higher premiums. That amounts to 5 percent of all Medicare recipients.
As an alternative to raising taxes, “this is a back-door way, particularly for the elderly rich,” Hoagland said. Higher premiums for individuals with incomes of more than $200,000 or married couples with incomes of more than $250,000 would be “fair game” for “soaking the rich,” he said.
Obama’s plan would freeze the income thresholds until 25 percent of Medicare recipients pay premiums based on income testing. That provision would save $30 billion over the next decade, according to the CBO.
Means-testing is “much more controversial” among Democrats who don’t want Medicare and Social Security to be equated with welfare programs, said Paul Van de Water, a health-care economist at the Center for Budget and Policy Priorities, a Democratic-aligned budget policy research group.
‘A Stake’ “It’s important that everyone feel they have a stake,” Van de Water said. “Income-tested premiums represent a breach in that principle.”
With sluggish progress in budget negotiations, Democratic-aligned interest groups are starting a media and grassroots campaign to urge Obama not to accept benefit cuts. Congressional Republicans are seeking to rally public support for their positions on taxes and entitlements.
Goldman Sachs Group Inc. Chief Executive Officer Lloyd Blankfein is among executives scheduled to meet today with Obama, and later with Boehner, to press for a solution to the fiscal-cliff standoff.
About 200 local labor union members led by the AFL-CIO and the Service Employees International Union plan to visit Washington today to lobby lawmakers.
The disagreement over entitlements may be a bigger hurdle to a budget deal than Republicans’ opposition to higher taxes, said Steve Bell, a former Republican Senate Budget Committee aide.
“I do not believe that taxes will be the main stumbling block to these negotiations,” Bell said. “Any fundamental change in Medicare and Medicaid will be the stumbling block.”
When thinking of all these reforms with the Affordable Care Act we need to know that these politicians know a massive bond market crash will implode the government with so much debt as to have them saying----SORRY---NO MONEY FOR PUBLIC TRUSTS. That was the goal of super-heating the bond market. So, all of this is about creating the structures to move almost all of Americans into what will be a gutted Medicaid for All----this is the single-payer model Maryland has been developing these few decades.....and it is what will play out very quickly for baby boomers losing all pensions, retirements, and now health insurance. This would happen as soon as 2020----and that is why Obama and Clinton neo-liberals chose 2020 to end MediGap.
The Coming Bond Market Collapse: 3 Ways To Escape The Damage
Apr. 27, 2013 8:29 AM ET
Just when you've finally gotten over the stock market crash from four years ago, there's a new threat that could potentially hit your portfolio. Even worse, it's in an area that many people think of as being safer than stocks: the bond market.
We're on a collision course with the worst bond market collapse in decades and the warning signs are as clear as day. There's still time to dodge the damage - and even to profit - if you know what to look for.
But the time to make your move is now…
Three Facilitators for a "Total Bond Market Collapse"U.S. Treasury bond yields have been falling steadily since the beginning of 2011, with the 10-year Treasury yield falling from 3.54% to its current yield of 1.78%.
Investors have piled into bond investments over the past several years, accepting lousy guaranteed returns in exchange for the near-certainty that they won't lose any principal. Various levered (NYSEARCA:UBT) and inverse levered long Treasury bond funds (TBT,TMV, TTT), will continue to generate activity and interest. With Treasury bond volatility now roughly equivalent to the trailing volatility of the S&P 500 (NYSEARCA:SPY), this market will continue to be a place for traders to tactically position with the hopes of short-term gains, but for how long?
While this example only represents a moderate decline in bond prices, take heed: That gentle slope leads directly to the precipice of a bottomless pit - a total bond market collapse.
There are three key factors that will cause - and even hasten - the coming bond market collapse. These catalysts are easy to spot - indeed, they're in the headlines virtually every day.
I'm talking, of course, about monetary policy, inflation and the federal deficit. Let's take a detailed look at each of these potential bond-market-collapse catalysts:
The Monetary Policy BluesU.S. Federal Reserve Chairman Ben S. Bernanke has kept interest rates virtually at zero (0.00%) for 54 months, with inflation jumping .4% in March. At the latest FOMC meeting, Bernanke has announced the Fed's plan to continue buying $85 billion per month of U.S. Treasury debt and mortgage-backed securities. He's not going to raise interest rates anytime soon, which means inflation could potentially accelerate, mostly through commodity prices. And when he stops buying Treasuries, where will that leave the investors?
The Inflation ConflagrationInflation had been running very low ever since the recession, but in the last six months, the producer price index (PPI) has risen at an annual rate of 12%. That will feed into the consumer price index (CPI) over the next few months, which already experienced the largest over-the-year increase in February - the largest increase since the 2.9-percent advance in March 2012.
(click to enlarge)
At some point, bond buyers will realize inflation is back and panic. After all, even though inflation never got above 14% in the 1970s and 1980s, long-term bond yields got to 15%. For bond yields to move that high from here, bond prices would have to fall an awfully long way.
The Federal-Deficit Follies:The real cost of the $787 billion "stimulus" of 2009 is the $1.12 trillion deficit we are now struggling with. The United States has never run a deficit of anywhere near this magnitude, and it's becoming obvious that near- trillion-dollar-plus deficits are here until 2015. That's another reason for the bond markets to panic - and is another reason to fear a bond market collapse.
Worse Than the 70sCombine those three factors, and you're looking at the potential for a truly epic bond market collapse, worse than anything that we saw in the 1970s. If you ask me to bet, I would say the bond market disaster will start in the third quarter - even CPI inflation figures are likely to be looking pretty creepy by then. Before then, you will probably see a continuing creep upwards in bond yields, perhaps reaching 4% on 10-year Treasuries by early June.
How to protect yourself? Well, obviously gold and silver are part of the solution, at least until the Fed starts fighting inflation properly, which I don't expect to happen before next year.
In fact, I would recommend you have at least 15% to 20% of your portfolio in gold and silver, the traditional inflation hedges.
Of course, the short story is that both metals have exchange-traded funds that track their price fluctuations - namely the SPDR Gold Trust (NYSEARCA:GLD) and the iShares Silver Trust (NYSEARCA:SLV).
The other solution is to bet on the bond market collapse itself. To do that, I'd recommend a look at the ProShares UltraShort Barclays 20+ Year Treasury Exchange Traded Fund (NYSEARCA:TBT), which aims to rise by twice the amount that long-term Treasuries decline. Like all leveraged inverse funds, this accumulates tracking error if you hold it too long. However, I don't think we'll have to hold it for more than a few months this time, so the tracking error should be modest.
People have been predicting a sharp rise in bond yields for a few years now, and they have been wrong. However, I think those predictions of a bond market collapse are likely to come true within the next few months, and when they do, they'll come true with a bang.
Investors are looking at a bond market collapse, and it could start in the third quarter. But don't wait until then to adopt defensive investments. Start positioning yourself now.
The U.S. Federal Reserve's loose monetary policy and the inability of our elected representatives in Congress to rein in the U.S. debt load have undermined both the U.S. dollar and the nation's economic recovery.
There is no safe place to hide, but owning gold and other precious metals such as silver could go a long way toward preserving your wealth - at least until the Fed starts fighting inflation properly, which I don't expect to happen before next year.
Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.
Below you see a well-researched paper on health fraud. Notice that the amount of fraud back in 1998 was $250 billion a year.....THAT WAS BEFORE CORPORATE FRAUD WENT ON STEROIDS. This is an example of what was probably one of the last of university research that held power accountable and told the truth about this massive fraud of our Medicare and Medicaid Trusts. I have this paper on my website under Healthcare.
Today you see estimates of $90 billion ------I contacted the Center for Public Integrity reporter who used this number and he qualified it as the sum of just one kind of fraud-----billing fraud and all media, pols, and pundits use that low-ball number. We know if in 1998 before the complete dismantling of FEderal oversight and accountability allowed the Bush and Obama years to go wild with fraud----that health care frauds were already in the hundreds of billions.
My point is recovery of this money to our trusts are never mentioned and will never be mentioned by Clinton neo-liberals-----they will simply use 'austerity' to pay for that corporate fraud.
STOP ALLOWING THEM TO DO THIS-----WE PAID FOR DECADES A HIGH PAYROLL TAX JUST TO RECEIVE FIRST WORLD QUALITY CARE AS SENIORS.
Expanded and Improved Medicare for All not only keeps our Federal Medicare strong----it gives all Americans the opportunity when they need it most to walk in to get any healthcare they need.
'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'
An Undergraduate Honors Thesis by
Professor Nicole C. Quon
Wednesday, April 20, 2011
Mass "For Profit" Medicine Creates Economic Incentives for Medicare Fraud and Medicaid Fraud
Medicare Fraud Lawsuit, Systematic Medicare Fraud Lawsuit, Medicare Recipient Whistleblower Lawsuit, Medicare Fraud Whistleblower Lawsuit, Systematic Medicaid Fraud Lawsuit, and Medicare Compliance Fraud Lawsuit Information
by Texas Medicare Fraud Lawyer Jason S. Coomer
Medicare fraud and Medicaid fraud are becoming one of the fastest growing and most lucrative crimes in the United States. It is estimated that Medicare fraud and Medicaid fraud costs tax payers between $70 Billion and $230 Billion each year. One of the reasons for the rapid growth of Medicare Fraud and Medicaid Fraud is that many large "for profit" medical services including hospitals and medical systems have moved to assembly line mass production of medical services that value maximizing profits over the individual needs of the patients. This maximization of profits can easily turn into systematic Medicare fraud or systematic Medicaid fraud.
Many Large "For Profit" Health Care Providers Become Medical Assembly Lines for Patients, Provide Mass One Size Fits All Medical Services for Patients Regardless of Individual Medical Need, and Commit Systematic Medicare Fraud and/or Medicaid Fraud
by Texas Medicare Fraud Lawyer Jason S. Coomer
In the modern age of medicine, large "for profit" health care providers have turned traditional medical practices where doctors knew their patients and were able to spend significant time with their patients into large "for profit" billing machines where many patients are run through an assembly line and the patient is lucky to spend 10 or 15 minutes with a doctor. These "for profit" patient mills often tend to provide one size fits all services despite the individual needs of the patient. In many of these large "for profit" medical systems, patients are nothing more than a number or a Medicare number that can be billed.
The large "for profit" hospitals and health care systems, often view patients through their billing departments as ways to make a profit by billing for expensive and unnecessary services as long as the services can be billed to the person's Medicare number. Regardless of the patient's actual needs, the ability to bill Medicare for services becomes a driving force as to how the person is treated in the medical system. By maximizing the amount that can be billed to Medicare or other third party payers, the large health care provider is able to maximize their revenue and profits regardless of what the patient actually needs. The patient's needs often become secondary to the need to maximize profits.
The need to overcome economic incentives that could turn medical providers away from the best interests of patients was understood and the basis in passing the Stark Laws and Anti-kickback Laws. Hopefully, new whistleblower protections and expanded False Claims Act laws may also help curb negative economic incentives and profit driven health care providers that are placing profits over the needs of patients.
In situations where the health care provider is driven by profit instead of a patient's needs, the traditional doctor patient relationship is violated. The patient's trust in the health care provider can then often be misplaced. Where the traditional expert advice of a medical doctor was once in the patient's best interest, the "for profit" health care provider can now be working against a patient's best interest and to only be maximizing profits.
Further, many "for profit" health care providers have separate billing departments, accountants, and administrators whose jobs are to maximize the hospital or health care system's profits. These billing departments, accountants, and administrators, can sometimes determine that by making systematic changes including upcoding, phantom billing, or other Medicare fraud, that the hospital's or health care system's monthly, quarterly, or annual profits can be increased. By slowly and continually making these systematic Medicare fraud changes, the hospital can continue to increase profits and the incremental changes can be extremely hard to detect.
Hospital Medicare Fraud Whistleblower Lawyer, Nursing Home Medicare Fraud Whistleblower Lawyer, Physician Medicare Fraud Whistleblower Lawyer, Hospice Fraud Whistleblower Lawyer, and Home Health Care Medicare Fraud Whistleblower Lawyer
(Medicare Fraud Whistleblower Law Suits)
If you are a hospital administrator, nursing home administrator, physician, nurse, respiratory therapist, coder, accountant, dentist, health care coordinator, coding specialist, or other health care professional that is aware of Medicare fraud, it is important that you report the Medicare fraud. As a Medicare fraud whistleblower you not only can recover a portion of the recovery if the fraud is properly reported, but it can help avoid potential criminal liability. Medicare fraud lawyer, Jason S. Coomer helps whistleblowers that are aware of systematic Medicare fraud including health care providers that are committing upcoding, illegal kickbacks, charging for unnecessary services and procedures, charging for services not provided, double billing, or bill padding.
Through Health Care System Medicare Fraud Whistleblower Lawsuits, Hospital Medicare Fraud Whistleblower Lawsuits, and other Health Care Fraud Lawsuits, billions of dollars have been recovered from individuals and organizations that have committed health care fraud and stolen large amounts of money from the government. It is extremely important that Hospital Administrator Whistleblowers, Health Care System Whistleblowers, and other Medicare Fraud Whistleblowers continue to expose fraud schemes including off-label marketing schemes, illegal kickbacks, fraudulent billing practices, hospice fraud, nursing home fraud, dentist Medicaid fraud, and other Medicare Fraud that cost hundreds of billions of dollars.
Feel free to clicking on the following link for more information on Hospital Systematic Medicare Fraud Lawsuits and Health Care System Medicare Fraud Lawsuits: Hospital Systematic Medicare Fraud Lawsuit and Health Care System Medicare Fraud Lawsuit Information.
Medicare Fraud Lawsuit, Systematic Medicare Fraud Lawsuit, Medicare Recipient Whistleblower Lawsuit, Medicare Fraud Whistleblower Lawsuit, Systematic Medicaid Fraud Lawsuit, and Medicare Compliance Fraud Lawsuit Information
by Texas Medicare Fraud Lawyer Jason S. Coomer
Medicare fraud and Medicaid fraud scams are costing the United States hundreds of billions of dollars and are threatening the Medicare benefits and Medicaid benefits of millions of Americans. The cost of systematic Medicare fraud and systematic Medicaid fraud includes nursing home Medicare fraud, home health care service Medicare fraud, hospital Medicare fraud, therapist Medicare fraud, dentist Medicare fraud , and other health care provider Medicare fraud that systematically and knowingly commits upcoding Medicare fraud schemes, double billing Medicare fraud schemes, unnecessary service Medicare Fraud schemes, and other fraudulent Medicare billing schemes. By billing for services not provided or needed, many fraudulent health care providers have found it extremely profitable to exploit the current Medicare and Medicaid system.