Below you see a great policy analysis showing myRA being used simply as a way to collect money from citizens to fullfill debt obligations created from corporate fraud. Notice the FED's QE debt is equal to our Social Security Trust Fund and it indeed will take this SS Trust fund. QE was the FED's policy for moving all of the toxic subprime loan debt from Wall Street bank accounts to 'recapitalize' the banks and then shift that fraudulent debt over to the taxpayers----BYE BYE SOCIAL SECURITY TRUST. I cannot post this data so Google this to see they are openly planning to simply end Social Security and use the privatized myRA as a new revenue source to raid. It is really breath-taking at how bold these Clinton and Bush global corporate pols are in literally stealing all public wealth.
Social Security and my RA
Antony Davies Duquesne University www.antonydavies.org George Mason University
How much money does the government owe?
Borrowed from Social Security$5 trillion
Borrowed from people and foreign governments$12 trillion
Total debt$17 trillion
Problem: How to raise the 5 Trillion-----
About $5 trillion in private 401(k) and IRA accounts.
•Encourage people to loan their retirement savings to the Federal government.
•Next step is to make myRA mandatory.
•Last step is to confiscate people’s savings.
Clinton neo-liberals always act as though they are supporting progressive issues when these issues are tied to the very act of looting the American people. Federal payroll taxes cover SS, Medicare, and Disability----but State's have done the same in payroll tax deductions. So, neo-liberals are doing their own myRA at the state level-----as you see with Maryland's 'progressive' Clinton neo-liberal Heather Mizeur having on her platform the same policy as Obama's myRA. She wants to installl the same privatized 'savings account' for people as an end to Social Security. It has nothing to do with helping the poor save money or be able to 'invest' in 401Ks----Heather and Obama are simply building the Republican policy to end Social Security knowing this money will be used to cover Wall Street debt. This policy was sold over and over as helping the poor save their money as if someone in poverty has money to set aside. These people are really sociopaths! I can't copy her plan because she has coded her page so that you do not get words----you only get code.
Read Heather's plan to create a state-run retirement savings fund.
Then there is Medicare and Medicaid and the Affordable Care Act. As you see below, the goal is simply to create a subsidized corporate health structure that is deregulated and consolidated to global health systems----they are making Wall Street banks of our health system. Nothing says NO MORE HIPPOCRATIC OATH AND DO NO HARM like a profit-driven health system.
I have outlined Obama's and Congressional neo-liberal's use of Federal stimulus to send hundreds of billions of dollars to build corporate university research structures. Johns Hopkins has its patent-pushing research structure in East Baltimore. Corporations merely 'donate' for a tax write-off money to what is now a corporate research center. They pay Hopkins to use students and university facilities to develop their research and then buy the patent the university claims.
THIS IS CORPORATE R & D DONE BY STUDENTS AND PAID FOR WITH TAXPAYER GRANTS AND STUDENT TUITION.
The terms 'Affordable Care' and 'Value-Added' have nothing to do with costs or quality to patients---it is strictly market-based terminology for maximizing health industry profit by subpriming health care. What can a health system do to bring the most profit? This is directed at labor and justice as usual---justice being access to health care.
Below you see the US is unique in developed nations for health costs because of systemic fraud and profiteering. This IS THE REASON HEALTH COSTS ARE HIGH. Below as well you see that a small proportion of health costs are created by 5% of Americans....so there is no need for 'efficiencies' for all Americans. There is no problem with Value-Added if it addressed these problems first. They don't even look at fraud and profiteering as the same corporations committing the fraud and profiteering are writing these health policies.
Why 5% of Patients Create 50% of Health Care Costs -
Jan 09, 2013 · ... bought and sold various health care and health ... the costs of health care, ... attempts to scare people about any change in health care.
NY Medicaid Fraud May Reach Billions -
The New York Times www.nytimes.com/2005/07/18/nyregion/18medicaid.htmlJul 17, 2005 · New York Medicaid Fraud May Reach ... ago to provide health care for the ... billions of dollars annually because of fraud, waste and profiteering.
Republicans called it 'death panels' ----that term is not far from being right. Rather than everyone having access to basic medical care insurance corporations will decide what they pay for and how much. Think about auto insurance where you pay for ten years and then have an accident---they give you the blue book value of the car and jack up your rates so they incur no loses---only profit. That is what the Affordable Care Act does to health care. I have shown where 80% and more of Americans will only be allowed to access PREVENTATIVE HEALTH CARE through Medicaid or Bronze health plans. Health insurance rates will soar as these corporations go global. Americans will indeed die from simply not being able to access cancer or heart treatment---diabetes or chronic disease treatment. That's why Republicans use the term 'death panel'. They are posing for their own Republican voters because all of this policy is Republican policy simply designed for maximized corporate profit.
At the state level you have Clinton neo-liberals pressing the same policies----greater commercialization of universities say Heather Mizeur playing right into Hopkins' corporate patent machine all as a non-profit university.
Read Heather's plan to facilitate greater commercialization of academic research, and capitalize on nanotechnology, cyber security, and the arts.
'Achieving high value for patients'------OH REALLY?????
Below you see the justification of placing all the emphasis on health outcomes towards preventative care----it is cheaper to have people come in for lab tests and required blood level tracking than to operate down the road. So, we send 80% of Americans to preventative care and eliminate most access to medical procedures and VOILA----health savings. All done while maximizing profits with soaring fraud and profiteering.
The article below is long so please glance to the next article.
What Is Value in Health Care?
Michael E. Porter, Ph.D.
N Engl J Med 2010; 363:2477-2481December 23, 2010DOI: 10.1056/NEJMp1011024
Two framework papers that develop the concepts outlined in this article, “Value in Health Care” and “Measuring Health Outcomes,” are available as Supplementary Appendixes.
In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In health care, however, stakeholders have myriad, often conflicting goals, including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction. Lack of clarity about goals has led to divergent approaches, gaming of the system, and slow progress in performance improvement.
Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent.1 This goal is what matters for patients and unites the interests of all actors in the system. If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.
Value — neither an abstract ideal nor a code word for cost reduction — should define the framework for performance improvement in health care. Rigorous, disciplined measurement and improvement of value is the best way to drive system progress. Yet value in health care remains largely unmeasured and misunderstood.
Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system. Since value depends on results, not inputs, value in health care is measured by the outcomes achieved, not the volume of services delivered, and shifting focus from volume to value is a central challenge. Nor is value measured by the process of care used; process measurement and improvement are important tactics but are no substitutes for measuring outcomes and costs.
Since value is defined as outcomes relative to costs, it encompasses efficiency. Cost reduction without regard to the outcomes achieved is dangerous and self-defeating, leading to false “savings” and potentially limiting effective care.
Outcomes, the numerator of the value equation, are inherently condition-specific and multidimensional. For any medical condition, no single outcome captures the results of care. Cost, the equation's denominator, refers to the total costs of the full cycle of care for the patient's medical condition, not the cost of individual services. To reduce cost, the best approach is often to spend more on some services to reduce the need for others.
Health care delivery involves numerous organizational units, ranging from hospitals to physicians' practices to units providing single services, but none of these reflect the boundaries within which value is truly created. The proper unit for measuring value should encompass all services or activities that jointly determine success in meeting a set of patient needs. These needs are determined by the patient's medical condition, defined as an interrelated set of medical circumstances that are best addressed in an integrated way. The definition of a medical condition includes the most common associated conditions — meaning that care for diabetes, for example, must integrate care for conditions such as hypertension, renal disease, retinal disease, and vascular disease and that value should be measured for everything included in that care.1
For primary and preventive care, value should be measured for defined patient groups with similar needs. Patient populations requiring different bundles of primary and preventive care services might include, for example, healthy children, healthy adults, patients with a single chronic disease, frail elderly people, and patients with multiple chronic conditions.
Care for a medical condition (or a patient population) usually involves multiple specialties and numerous interventions. Value for the patient is created by providers' combined efforts over the full cycle of care. The benefits of any one intervention for ultimate outcomes will depend on the effectiveness of other interventions throughout the care cycle.
Accountability for value should be shared among the providers involved. Thus, rather than “focused factories” concentrating on narrow groups of interventions, we need integrated practice units that are accountable for the total care for a medical condition and its complications.
Because care activities are interdependent, value for patients is often revealed only over time and is manifested in longer-term outcomes such as sustainable recovery, need for ongoing interventions, or occurrences of treatment-induced illnesses.2 The only way to accurately measure value, then, is to track patient outcomes and costs longitudinally.
For patients with multiple medical conditions, value should be measured for each condition, with the presence of the other conditions used for risk adjustment. This approach allows for relevant comparisons among patients' results, including comparisons of providers' ability to care for patients with complex conditions.
The current organizational structure and information systems of health care delivery make it challenging to measure (and deliver) value. Thus, most providers fail to do so. Providers tend to measure only what they directly control in a particular intervention and what is easily measured, rather than what matters for outcomes. For example, current measures cover a single department (too narrow to be relevant to patients) or outcomes for a whole hospital, such as infection rates (too broad to be relevant to patients). Or they measure what is billed, even though current reimbursement practices are misaligned with value. Similarly, costs are measured for departments or billing units rather than for the full care cycle over which value is determined. Faulty organizational structure also helps explain why physicians fail to accept joint responsibility for outcomes, blaming lack of control over “outside” actors involved in care (even those in the same hospital) and patients' compliance.
The concept of quality has itself become a source of confusion. In practice, quality usually means adherence to evidence-based guidelines, and quality measurement focuses overwhelmingly on care processes. For example, of the 78 Healthcare Effectiveness Data and Information Set (HEDIS) measures for 2010, the most widely used quality-measurement system, all but 5 are clearly process measures, and none are true outcomes.3 Process measurement, though a useful internal strategy for health care institutions, is not a substitute for measuring outcomes. In any complex system, attempting to control behavior without measuring results will limit progress to incremental improvement. There is no substitute for measuring actual outcomes, whose principal purpose is not comparing providers but enabling innovations in care. Without such a feedback loop, providers lack the requisite information for learning and improving. (Further details about measuring value are contained in a framework paper, “Value in Health Care,” in Supplementary Appendix 1, available with the full text of this article at NEJM.org.)
Measuring, reporting, and comparing outcomes are perhaps the most important steps toward rapidly improving outcomes and making good choices about reducing costs.4 Systematic, rigorous outcome measurement remains rare, but a growing number of examples of comprehensive outcome measurement provide evidence of its feasibility and impact.
Determining the group of relevant outcomes to measure for any medical condition (or patient population in the context of primary care) should follow several principles. Outcomes should include the health circumstances most relevant to patients. They should cover both near-term and longer-term health, addressing a period long enough to encompass the ultimate results of care. And outcome measurement should include sufficient measurement of risk factors or initial conditions to allow for risk adjustment.
For any condition or population, multiple outcomes collectively define success. The complexity of medicine means that competing outcomes (e.g., near-term safety versus long-term functionality) must often be weighed against each other.
The outcomes for any medical condition can be arrayed in a three-tiered hierarchy (see Figure 1Figure 1The Outcome Measures Hierarchy.), in which the top tier is generally the most important and lower-tier outcomes involve a progression of results contingent on success at the higher tiers. Each tier of the framework contains two levels, each involving one or more distinct outcome dimensions. For each dimension, success is measured with the use of one or more specific metrics.
Tier 1 is the health status that is achieved or, for patients with some degenerative conditions, retained. The first level, survival, is of overriding importance to most patients and can be measured over various periods appropriate to the medical condition; for cancer, 1-year and 5-year survival are common metrics. Maximizing the duration of survival may not be the most important outcome, however, especially for older patients who may weight other outcomes more heavily. The second level in Tier 1 is the degree of health or recovery achieved or retained at the peak or steady state, which normally includes dimensions such as freedom from disease and relevant aspects of functional status.
Tier 2 outcomes are related to the recovery process. The first level is the time required to achieve recovery and return to normal or best attainable function, which can be divided into the time needed to complete various phases of care. Cycle time is a critical outcome for patients — not a secondary process measure, as some believe. Delays in diagnosis or formulation of treatment plans can cause unnecessary anxiety. Reducing the cycle time (e.g., time to reperfusion after myocardial infarction) can improve functionality and reduce complications. The second level in Tier 2 is the disutility of the care or treatment process in terms of discomfort, retreatment, short-term complications, and errors and their consequences.
Tier 3 is the sustainability of health. The first level is recurrences of the original disease or longer-term complications. The second level captures new health problems created as a consequence of treatment. When recurrences or new illnesses occur, all outcomes must be remeasured.
With some conditions, such as metastatic cancers, providers may have a limited effect on survival or other Tier 1 outcomes, but they can differentiate themselves in Tiers 2 and 3 by making care more timely, reducing discomfort, and minimizing recurrence.
Each medical condition (or population of primary care patients) will have its own outcome measures. Measurement efforts should begin with at least one outcome dimension at each tier, and ideally one at each level. As experience and available data infrastructure grow, the number of dimensions (and measures) can be expanded.
Improving one outcome dimension can benefit others. For example, more timely treatment can improve recovery. However, measurement can also make explicit the tradeoffs among outcome dimensions. For example, achieving more complete recovery may require more arduous treatment or confer a higher risk of complications. Mapping these tradeoffs, and seeking ways to reduce them, is an essential part of the care-innovation process.
The most important users of outcome measurement are providers, for whom comprehensive measurement can lead to substantial improvement.5 Outcomes need not be reported publicly to benefit patients and providers, and public reporting must be phased in carefully enough to win providers' confidence. Progression to public reporting, however, will accelerate innovation by motivating providers to improve relative to their peers and permitting all stakeholders to benefit fully from outcome information.
Current cost-measurement approaches have also obscured value in health care and led to cost-containment efforts that are incremental, ineffective, and sometimes even counterproductive. Today, health care organizations measure and accumulate costs around departments, physician specialties, discrete service areas, and line items such as drugs and supplies — a reflection of the organization and financing of care. Costs, like outcomes, should instead be measured around the patient. Measuring the total costs over a patient's entire care cycle and weighing them against outcomes will enable truly structural cost reduction, through steps such as reallocation of spending among types of services, elimination of non–value-adding services, better use of capacity, shortening of cycle time, provision of services in the appropriate settings, and so on.
Much of the total cost of caring for a patient involves shared resources, such as physicians, staff, facilities, and equipment. To measure true costs, shared resource costs must be attributed to individual patients on the basis of actual resource use for their care, not averages. The large cost differences among medical conditions, and among patients with the same medical condition, reveal additional opportunities for cost reduction. (Further aspects of cost measurement and reduction are discussed in the framework paper “Value in Health Care.”)
The failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians' practices, which imposes substantial costs of its own. Measuring value will also permit reform of the reimbursement system so that it rewards value by providing bundled payments covering the full care cycle or, for chronic conditions, covering periods of a year or more. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.
The biggest push for cost savings is to make sure the sickest cannot access health care and then to convince them they are better off ending it all. If 80% of Americans are not going to be able to access basic medical procedures like cancer or heart treatment there will be pain and suffering. Remember, most people will fall right into medical bankruptcy after only one major health event and then from then on----they will be worried to death about incurring health costs. THIS IS HOW YOU INSTALL COST SAVINGS IN HEALTH CARE.
Patient advocacy groups are already pointing to spouse abuse and pressuring by family to end a life because of health costs. Patients are now being made to feel guilty for pursuing health treatment for survival----you sign a Living Will every time you enter a Maryland hospital saying you do not want extra efforts to protect your life. Remember, the last decades of medical research were geared towards saving and extending life. They are saying -----ONLY IF YOU CAN PAY FOR IT. That is value-added.
All of the medical research of these several decades were paid for with the taxes of baby boomers as payroll taxes created a health savings account. So, baby boomers have paid for all of the access to care they need-----only, Clinton neo-liberals and Bush neo-cons say----sorry----this is a profit-maximizing health system now! Assisted Suicide was much different when people could access all the care they needed but decided they didn't want to.....what we are going to see is people feeling forced to end their lives because they cannot access the care they need.
So, we are seeing Clinton neo-liberals pressing Living Wills and Assisted Suicide to move people along who no longer can access ordinary health care.
Read Heather's plan for Death with Dignity -----Assisted Suicide--------