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January 17th, 2014

1/17/2014

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SO FAR IT HAS BEEN BERNIE SANDERS AND RUSS FEINGOLD THAT HAVE SHOUTED FOR STRONG BANK REFORM AND JUSTICE IN THESE MASSIVE FRAUDS....SO LET'S GET THEM TO RUN FOR PRESIDENT/VICE-PRESIDENT IN 2016!!!



Did you hear the corporate NPR introduction of Obama's next Wall Street appointment to an agency supposedly protecting the public from economic instability and work for high employment?  What a stellar appointment of a good all-round guy!!!  We all love him!  Now, if you look at the US Federal Reserve as the center of global corporate tribunal rule acting to place massive corporate fraud on steroids and installing policy that keeps the public caught in boom and bust crony and criminal markets losing all their wealth and causing ever-growing levels of unemployment.....ALL MAXIMIZING WEALTH FOR THE FEW---- you see from where this promotion comes. Indeed, Fischer is in fact THAT good ole' boy.  In the days of TPP there is no public sector or US citizens to consider for goodness sake!

For those who know better you'll see below how the Fischer/Bernake/Draghi fit goes with the TROIKA mess that has hold of the US and Europe.  You can follow the money to see his place in the pecking order of moving massive wealth.  Again, we want to thank Anonymous and those hackers that are doing civil disobedience and not stealing people's pin numbers.....hacking to download banking information that is allowing International Journalists to follow the money to off-shore accounts to the tune so far of $35 trillion dollars.  We are getting a great picture of who has the money and where it is so when Rule of Law is reinstated the people of Europe and US will be able to recover the loot and reverse wealth inequity.  THIS IS WHERE FISCHER COMES INTO THE PICTURE.

We all remember when Obama placed Greenspan's deputy and Geithner to head Financial agencies needed by the public to hold banks accountable.  These two where of course in the forefront of allowing the massive frauds to go forward while everyone was shouting MASSIVE AND SYSTEMIC MORTGAGE AND FINANCIAL FRAUD throughout the 2000s.  This is now round two of 'IT'S ABOUT THE GLOBAL TRIBUNAL AS WORLD RULER' politics.
  Yellen has stated she supports all of what Bernanke did so she will be status quo for the US economy and wealth inequity.


For those liking to follow the financial fraud this is the next connection of dots in the revolving door of cronyism.  It is important because as more people see how corrupt this system is, the more people will move to revolution.  Fischer is MIT material tied to Summers and Italy's Draghi.  Draghi is now head of the European ECB.  We all know Summers as Clinton's global market king and MIT is of course farm team for Wall Street.  Fischer's connection with the BAnk of Israel coincides with the exact time Wall Street was moving massive amounts of money off-shore and guess where the top off-shore location was according to International Investigative Journalists using WIKILEAKS hacking download of Wall Street banks showing the movement of $35 trillion dollars?????  ISRAEL WAS ONE TO THE TOP LOCATIONS.  Know why Pope Benedict retired suddenly...Draghi's Italy used the Vatican Bank to move money from NYC through the Vatican.  See the crony?  It is all illegal and it is all documented by International Justice groups!!!!



Obama to nominate Stanley Fischer, 2 others to Federal Reserve seats

By Jim Puzzanghera January 10, 2014, 8:35 a.m. Los Angeles Times



WASHINGTON -- President Obama will nominate Stanley Fischer, the former head of the Bank of Israel, to be vice chair of the Federal Reserve, and also tapped two other people for seats on the central bank's Board of Governors, the White House said Friday.

Lael Brainard, who recently stepped down as Treasury undersecretary for international affairs, was chosen to fill one of the vacant seats on the seven-member Fed board.

And Jerome H. Powell, a former Treasury official and investment banker who has served on the Fed board since 2012, will be renominated. Powell was confirmed to an unexpired term that expires on Jan. 31.

PHOTOS: Federal Reserve chairs through the years

"These three distinguished individuals have the proven experience, judgment and deep knowledge of the financial system to serve at the Federal Reserve during this important time for our economy," Obama said.

The nominations, which had been expected, add to the major changes coming at the Fed as it tries to pull back on its aggressive stimulus efforts without damaging the economic recovery.

Current Vice Chair Janet L. Yellen was confirmed this week to replace Ben S. Bernanke, whose second four-year term as central bank chair expires on Jan. 31. She will lead a different, and potentially more fractious Fed policy-making team.

This month, four new regional Federal Reserve Bank presidents will rotate into the 12 voting positions on the Federal Open Market Committee, or FOMC, which sets monetary policy. All seven Fed governors are voting members.

Friday's disappointing government report showing the economy created just 74,000 net new jobs in December highlighted the difficulties for Fed policymakers. They must decide if the economy is strong enough to continue the reduction started last month in the Fed's bond-buying stimulus program, when most data pointed to an improving labor market.

Fischer, who was governor of the Bank of Israel from 2005-13, is a legendary economist who brings a wealth of experience to the Fed board.

He has worked at the World Bank, the International Monetary Fund and was vice chairman of Citigroup Inc. from 2002-05.

Fischer was the PhD advisor for outgoing Fed Chair Ben S. Bernanke at the Massachusetts Institute of Technology. Fischer also taught European Central Bank President Mario Draghi and former Treasury Secretary Lawrence H. Summers.

If confirmed by the Senate, Fischer would replace Yellen as the Fed's No. 2 official.

"He is widely acknowledged as one of the world’s leading and most experienced economic policy minds and I’m grateful he has agreed to take on this new role and I am confident that he and Janet Yellen will make a great team," Obama said.

Brainard also brings international experience to the Fed. And she helps close a pending gender gap on the central bank's board. Elizabeth Duke stepped down last year and Sarah Bloom Raskin is awaiting confirmation as deputy Treasury secretary.

If Raskin departs as expected, Yellen would be the only woman remaining on the board.

Obama said Brainard's "knowledge of international monetary and economic issues will be an important addition to the Fed."

Powell served as an assistant secretary and under secretary at the Treasury Department under President George H.W. Bush.

Fed governors have 14-year terms but rarely serve all of it. Powell is nominated to a full 14-year term. Fischer would fill a term expiring in 2020 and Brainard one expiring in 2026.


_______________________________________________________________________
Below you see nothing has been done with the Financial Reform Bill.  Volcker demanded long ago that his name be taken off of what neo-liberals are pretending are rules that will safeguard the banking system.  NO ONE BELIEVES THAT.  I'v spoken as to the importance of bank capitalization and the fact that most financial experts wanted this to be at least 20%...below you see the TROIKA as will the FED move away from any accountability.  Remember, QE and 0% recapitalized the banks by taking all the most toxic subprime mortgages off the banks accounting and move them to the FED in the trillions of dollars.  THIS IS WHAT CORPORATE NPR CALLS 'THE BANKS/CORPORATIONS ARE HEALTHY NOW'.

Somehow we are getting bank warnings that requiring capital will hurt lending that has yet to happen as they roll in profit and will not happen as the goal is to consolidate all small and regional businesses into these global corporations.


The two issues in financial reform were banks having enough capital to cover leverage and the Glass Steagall separation of bank's money from its consumers....the Volcker Rule was advanced for this. So, capitalization many thought needed to be 20% as it had historically been 70%. When the financial reform debate was hot we were told we would get 8-10% which was a start, but now we see below they are back where it was before the crash....3%. NOT ONE CHANGE HAS BEEN MADE....NOT ONE BIT OF ACCOUNTABILITY.....AND THIS IS BECAUSE WE HAVE A NEO-LIBERAL PRESIDENT AND CONGRESS.

KEEP IN MIND THAT IT IS THE FEDERAL RESERVE WRITING MANY  OF THESE LAWS AND CHOOSES TO ENFORCE REGULATIONS OR NOT.  SINCE NEO-LIBERALS CONSIDER TPP A DONE DEAL.....ALL THE POLICY IS ABOUT WHAT MAXIMIZES PROFIT....MORE NAKED CAPITALISM.

What the American people want is a President that appoints people that want the opposite.....more capitalization, more regulation, and more downsizing by recovering tens of trillions of dollars in fraud still owed. 


SO FAR IT HAS BEEN BERNIE SANDERS AND RUSS FEINGOLD THAT HAVE SHOUTED FOR STRONG BANK REFORM AND JUSTICE IN THESE MASSIVE FRAUDS....SO LET'S GET THEM TO RUN FOR PRESIDENT/VICE-PRESIDENT IN 2016!!!

Debt Rule Faces Dilution as Regulators Heed Bank Warnings

By Jim Brunsden Jan 10, 2014 8:05 AM ET

Lenders are poised to win concessions from central bank chiefs and global regulators over a debt limit they criticized as a blunt instrument that would penalize low-risk activities and curtail lending.

A revised leverage-ratio plan is set to be laxer than a draft published last year by the Basel Committee on Banking Supervision, said a person familiar with the scope of a Jan. 12 meeting of the group’s oversight body at which the measure will be discussed.

Leverage ratios are designed to curb banks’ reliance on debt by setting a minimum standard for how much capital they must hold as a percentage of all assets on their books. A quarter of large global lenders would have failed to meet the draft version of the leverage limit had it been in force at the end of 2012, according to data published by the committee in September.

“I expect considerable change in the rule to defer to applicable national accounting systems,” Karen Shaw Petrou, managing partner of Washington-based research firm Federal Financial Analytics Inc., said in an e-mail. “If the rule in fact doesn’t do this, it will wreak tremendous havoc in securities financing, repo, and other capital-market activities and send them over to the shadows.”

Photographer: Chris Ratcliffe/Bloomberg Bank of England Governor Mark Carney said, “My personal view, is that a leverage ratio... Read More

Some supervisors have called for greater use of leverage ratios instead of standard Basel capital requirements, which are measured as a ratio of banks’ equity against risk-weighted assets, because banks are inconsistent in the way they calculate these standards.

Asset Size The draft leverage rule published last year would have required banks to hold capital equivalent to at least 3 percent of their assets, without any possibility to take into account the riskiness of their investments. Stefan Ingves, the Basel committee’s chairman, has said that discussions in the group have focused on calibrating how banks should calculate the size of their assets, as opposed to reopening talks on the 3 percent figure.

“In our view, the final leverage rule will be significantly moderated to avoid it becoming a binding constraint on bank lending activity,” research firm Capital Alpha Partners LLC wrote in a note to clients yesterday.

The “most likely adjustments will be to allow for greater netting for derivatives and securities financing transactions,” according to the note. There is also “a good chance” that regulators will scale back rules on how banks must calculate the size of some off balance sheet commitments, it said.

Stated Intentions The Basel committee declined to comment on the leverage ratio talks.

“Overall and in contrast to publicly stated intentions, a binding leverage ratio may actually encourage increased risk-taking by European banks while at the same time forcing them to cut back on low-risk exposures” such as derivatives used to hedge risk, Jan Schildbach, senior economist at Deutsche Bank Research, said in an e-mail. This would potentially hurt “their clients and the European economy as a whole.”

Global regulators have met for almost 40 years in Basel, Switzerland, to negotiate common standards for supervising the banking system.

The Jan. 12 meeting will be of the Group of Governors and Heads of Supervision, or GHOS, which oversees the committee’s work and is comprised of central bank and regulatory chiefs. The GHOS is led by Mario Draghi, the president of the European Central Bank.

Bank Strength Relying on leverage ratios to assess a bank’s strength wouldn’t be sensible as the measure can easily be influenced and is hard to compare between lenders under different reporting standards, Rabobank Groep Chief Financial Officer Bert Bruggink said in an interview this week.

“For banks reporting under European accounting rules, a leverage ratio of 3 percent or 4 percent is very well defendable,” Bruggink said. “Requiring higher numbers, especially if that’s done with reference to U.S. banks, would be wrong and harmful to the economy.”

Main Item The leverage measure is the main item on the agenda for the GHOS talks, according to two other people familiar with the talks. All three asked not to be identified because the discussions are private.

Under the published Basel timetable, banks will be expected to publicly disclose how well they measure up to the standard from 2015, with the rule to become a binding minimum standard in 2018.

Banks such as BNP Paribas SA (BNP), Bank of America Corp. and Citigroup Inc. (C) have called for a rewrite of the draft leverage rule published in June, saying it would adversely affect economic growth and job creation, make it more expensive for governments to sell their debt and give banks incentives to invest in riskier assets.

“The leverage ratio instrument sets the wrong incentives by discriminating against low-risk business, which also accounts for a larger share of European banks’ operations than for U.S. institutions,” Schildbach said. “In addition, in the U.S., a compulsory leverage ratio has been in place for many years already, whereas the Europeans are used to align their business models to a system of risk-weighted capital ratios.”

More Scope Banks have called on the committee to alter the rule by giving lenders more scope to carry out netting, which would allow them to reduce the size of the pool of assets used to calculate the leverage ratio.

Netting is an accounting term describing the process of banks offsetting the value of different assets and liabilities they have taken on with a single counterparty.

Lenders have argued that they should be allowed to net the collateral received on derivatives trades because otherwise the protection they gain wouldn’t be taken into account by the leverage ratio. They have also called for more scope to use netting on securities financing transactions such as repurchase agreements, or repos.

Other requests from banks have included that assets perceived to bear little risk of loss, such as high quality mortgage debt, should be exempted or partially exempted from the leverage ratio calculation.

Playing Field Knowing how the international leverage ratio is defined “is important domestically for a level playing field,” Bank of England Governor Mark Carney told U.K. lawmakers in November, according to a public record of the proceedings.

“My personal view, is that a leverage ratio is an integral part of the capital framework of banks, so it is absolutely necessary,” Carney said.

There is no chance that all high quality assets will be removed from the calculations, Simon Hills, executive director at the British Bankers’ Association, said in a telephone interview.

“The most we can probably hope for on scope is a little movement,” he said. “Our priority is that cash held with central banks should be excluded from the leverage ratio calculations, as well as gilt purchases made as part of central bank monetary policy operations. We think that merits another look.”



__________________________________________________
As corporate NPR and local WYPR pretend they do not know the economy is ready to implode with the same conditions as last time only instead of subprime mortgage fraud in the trillions it will be sovereign and muncipal bond debt that took Europe last crash.  We are over the $600 trillion leverage mark now!

This is why Fischer and Yellen are so important for the global tribunal because they both will use the same system of bailout and coverup that Bernanke and Geithner did in 2007-2008.



Derivatives: The $600 Trillion Time Bomb That's Set to Explode
  • By Keith Fitz-Gerald, Chief Investment Strategist, Money Map Report  ·   October 12, 2011  ·   Print  |   Email
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Keith Fitz-Gerald Do you want to know the real reason banks aren't lending and the PIIGS have control of the barnyard in Europe?

It's because risk in the $600 trillion derivatives market isn't evening out. To the contrary, it's growing increasingly concentrated among a select few banks, especially here in the United States.

In 2009, five banks held 80% of derivatives in America. Now, just four banks hold a staggering 95.9% of U.S. derivatives, according to a recent report from the Office of the Currency Comptroller.

The four banks in question: JPMorgan Chase & Co. (NYSE: JPM), Citigroup Inc. (NYSE: C), Bank of America Corp. (NYSE: BAC) and Goldman Sachs Group Inc. (NYSE: GS).

Derivatives played a crucial role in bringing down the global economy, so you would think that the world's top policymakers would have reined these things in by now - but they haven't.

Instead of attacking the problem, regulators have let it spiral out of control, and the result is a $600 trillion time bomb called the derivatives market.

Think I'm exaggerating?

The notional value of the world's derivatives actually is estimated at more than $600 trillion. Notional value, of course, is the total value of a leveraged position's assets. This distinction is necessary because when you're talking about leveraged assets like options and derivatives, a little bit of money can control a disproportionately large position that may be as much as 5, 10, 30, or, in extreme cases, 100 times greater than investments that could be funded only in cash instruments.

The world's gross domestic product (GDP) is only about $65 trillion, or roughly 10.83% of the worldwide value of the global derivatives market, according to The Economist. So there is literally not enough money on the planet to backstop the banks trading these things if they run into trouble.

Compounding the problem is the fact that nobody even knows if the $600 trillion figure is accurate, because specialized derivatives vehicles like the credit default swaps that are now roiling Europe remain largely unregulated and unaccounted for.

Tick...Tick...Tick To be fair, the Bank for International Settlements (BIS) estimated the net notional value of uncollateralized derivatives risks is between $2 trillion and $8 trillion, which is still a staggering amount of money and well beyond the billions being talked about in Europe.

Imagine the fallout from a $600 trillion explosion if several banks went down at once. It would eclipse the collapse of Lehman Brothers in no uncertain terms.

A governmental default would panic already anxious investors, causing a run on several major European banks in an effort to recover their deposits. That would, in turn, cause several banks to literally run out of money and declare bankruptcy.

Short-term borrowing costs would skyrocket and liquidity would evaporate. That would cause a ricochet across the Atlantic as the institutions themselves then panic and try to recover their own capital by withdrawing liquidity by any means possible.

And that's why banks are hoarding cash instead of lending it.

The major banks know there is no way they can collateralize the potential daisy chain failure that Greece represents. So they're doing everything they can to stockpile cash and keep their trading under wraps and away from public scrutiny.

What really scares me, though, is that the banks

think this is an acceptable risk because the odds of a default are allegedly smaller than one in 10,000.

But haven't we heard that before?

Although American banks have limited their exposure to Greece, they have loaned hundreds of billions of dollars to European banks and European governments that may not be capable of paying them back.

According to the Bank of International Settlements, U.S. banks have loaned only $60.5 billion to banks in Greece, Ireland, Portugal, Spain and Italy - the countries most at risk of default. But they've lent $275.8 billion to French and German banks.

And undoubtedly bet trillions on the same debt.

There are three key takeaways here:

  • There is not enough capital on hand to cover the possible losses associated with the default of a single counterparty - JPMorgan Chase & Co. (NYSE: JPM), BNP Paribas SA (PINK: BNPQY) or the National Bank of Greece (NYSE ADR: NBG) for example - let alone multiple failures.
  • That means banks with large derivatives exposure have to risk even more money to generate the incremental returns needed to cover the bets they've already made.
  • And the fact that Wall Street believes it has the risks under control practically guarantees that it doesn't.
Seems to me that the world's central bankers and politicians should be less concerned about stimulating "demand" and more concerned about fixing derivatives before this $600 trillion time bomb goes off.


__________________________________________________
Corporate NPR/APM likes to tell us that the world's economy is getting better now that looted money has made it to offshore accounts and austerity in Europe and US has the public filling the $17 trillion whole in the national deficit caused by the massive frauds.  The free money and QE has moved most of the US real estate into the hands of these huge investment firms now controlling development and soaking people with rents and slum-landlording.  YES, THIS IS INDEED THE NEW ECONOMY!!!

So, as Americans pray the TPP nations that signed the treaty can bring down their governments to end the TPP......and as we pray that the Atlantic Trade deal will fall because of loss of trust created by the NSA exposure and Europe's farm/environment issues that will not bend to US naked capitalism.....this we know:

Europeans are not all rosy and cheerily agreeing to austerity and TROIKA rule and the dismantling of their social programs and labor unions contracts.  In fact the move for dismantling the Euro is far stronger and Wall Street knows that the shock from this default will be traumatic to the world and US economy.  What is happening in Spain, Wall Street's favorite nation following TROIKA orders as you see below is a return of Fascism to Spain.  Global corporate tribunals will be totalitarianism and while Americans have not known this personally and this is why we are slow to fight.....

EUROPEANS HAVE ALL OF THIS AUTOCRACY IN RECENT MEMORY AND THEY WILL NOT ALLOW IT TO CREEP!  That's why the NSA scandal was so important, it is why attempts to pass laws limiting protest and political speech happening in the US will not fly in Europe.  Remember, it was Germany/DeutscheBank and Wall Street/Goldman Sachs that started this full fledged attack on social governments over the decade and it started with fraudulent financial instruments hiding sovereign debt and then loading these countries with tremendous municipal debt.  Europeans know this dynamic and will not join a European union with Germany leading the TROIKA and the UK fat on massive financial fraud on top!  As we see the PIIGS nations have been made IMF developing world wards with this massive fraud and attack on their sovereignty!

What does that mean to you and me?  It means that all the US pensions and municipal bonds that are now propping up these European nations under attack by the TROIKA will default and just as with these same US pensions./municipal bonds sent into the stock market to prop up the Wall Street banks in 2007 losing 1/2 their value to fraud.....it is about to happen big time sometime soon and your politician, your pension fund manager knows this!  With the amount of debt Wall Street has....$600 trillion in leveraged debt, the FED has several trillion in leveraged debt, the US Federal debt of $17 trillion, and local credit bond and municipal debt soaking local budgets-----


THIS WILL BE A DEPRESSION-MAKER JUST AS WE HEAD INTO 2014 ELECTION YEAR.  REMEMBER OBAMA ELECTED JUST AS THE LAST CRASH HIT?  WE WILL HEAR ALL POLICY AGAIN SURROUNDING BAILING OUT THE ECONOMY.

This is where Obama's Federal Reserve appointments come into play as the same system of bailouts and protection from fraud happen all over!!

The EU is a new form of colonialism – it’s time to break free

Posted by revoltingeurope ⋅ January 14, 2014 ⋅ 


Spain has a future but it means breaking with the Eurozone and EU institutions, argue Hector Illueca and Adoración Guamán

The economic crisis affecting our country and the austerity policies imposed by the troika (European Commission, European Central Bank and International Monetary Fund) are leading to an increasingly evident social fracture. Astonished citizens observe the degradation of everyday life and the tolerance of abuses of power by the most privileged in the country. The deterioration of the material conditions of an increasingly wide social majority comes accompanied by grave corruption scandals that have infected the political and economic elites, shining a light on a society in which injustice and inequality are ever more entrenched.

In this context, the dream of European integration has become a nightmare of a brutal present and a bleak future. Citizens have been quite deliberately served up a false, ideological and idyllic image of the European Union, with the media projecting a mythical vision quite removed from reality: the truth is that the European Union completely alien to the principles of cohesion and solidarity collaborative solidarity and has become a sort of German hunting ground where strong economies exploit their economic and commercial advantages to crush the weak economies. This is a European Union governed by the law of the jungle .


However, the severity of the economic situation and declining well-being has cast aside the veil and the inhabitants of the periphery are starting to understand that they are victims of a new settlement. It is increasingly difficult to hide that the introduction of the euro has led to a centre-periphery relationship within the European Union, where the North dominates the South. It is no longer possible to deny that the single currency has benefited Germany and the other rich countries of Europe, strengthening their position in the European scheme as net exporters of capital goods and consumption, and net importers of overall demand.

To put it plainly and simply: economic and monetary union has allowed the core countries, especially Germany, to accumulate growing trade surpluses in Europe, blocking any possibility of competitive devaluation and fuelling a radical redistribution of work to the detriment of the less powerful economies of the Mediterranean basin. Strong core countries such as Germany, the Netherlands and Finland, increase their competitiveness, retain their national sovereignty and finance their welfare states due to loss of competitiveness and the destruction of sovereignty and welfare in the European periphery.

The new European division of labour

Spanish workers, along with workers in other peripheral economies, have become a reservoir of low cost labour. As noted by others, the process of European integration has created a new international division of labour, fuelling colonialist dynamics characterized by German hegemony and the subordination of peripheral [1 ] economies. This is what explains why state control over the market and the protection of social rights are being dismantled according to the dictates of economic and monetary union.

When this process clashes with state provisions in social policy, peripheral states adapt their welfare systems, always, to be clear, reducing the protection of labour and social rights. Social dumping has not only not been challenged, but it has been fostered, placing labour regulation as a competitive factor and triggering a fierce regulatory Darwinism to reduce labour standards and social protection.

SOUND FAMILIAR?????  SAME THING HAPPENING IN THE US!!!

The new European division of labour explains and promotes the progressive destruction of state -sponsored social models desired by the Troika and which is immediately apparent in two key areas: the flexibility of labour markets (in particular, lowering the protection for stabile employment and cutting the cost of labour) and the reduction of welfare, in particular social security systems (reducing pensions, health care reforms, etc. . ) .

Its influence is also evident in the education reform in Spain pursued by Minister Wert, reforms which are also sponsored by European institutions, which guide the educational system towards the formation of cheap labour and providing the knowledge needed to deal appropriately with the garbage that characterizes the labour market in underdeveloped countries. The dependent and peripheral position of our economy in the European scheme is radically incompatible with the existence of public pensions, education and public health and a fair and decent job market.

By accepting the dictates of the Troika, the ruling classes of the peripheral countries show their inability to take an independent path for their respective countries and seal a relationship of subordination and dependence similar to that which occurs in the process of classic colonization, characterized by the systematic dispossession of peripheral economies and the exploitation of its workers. We must not forget that they are the ruling classes of the Member States which have built and paid for this European Union model, under whose untouchable legitimacy the most unpopular and tough reforms have sheltered. The undermining of the bargaining position of the unions is the price of the treacherous collusion of the elites of the deficit countries in forging a strong and stable alliance with the German bourgeoisie to impose a new political and social order throughout Europe.

More Europe?

In this context, it is surprising that certain sectors of the Spanish and European left insist on reforming the eurozone as a solution to the current social and economic emergency. With something of a Panglossian air, they invoke the need for “more Europe” , denounce the fragmentation of fiscal policy and the criticise the ECB for providing ample liquidity to banks while abandoning indebted member states to face speculative attacks.

They propose the abolition of the Stability Pact, the creation of a fiscal authority and amendments to the statutes of the ECB to enable loans to governments experiencing difficulties. In a burst of ingenuity, they even speak of a “good euro” in which one could establish a European minimum wage to reduce the competitiveness differentials between countries.

This is an illusion that for decades has paralyzed much of the left and the labour movement and blocked the construction of an alternative at the service of the masses of our country. The euro area lacks a single European state and there is no expectation that one will be created in the near future. The unification of fiscal policy would mean a complete restructuring of sovereignty throughout the European Union, constructed from a strict hierarchy of states and a careful calculation of national interests, and would require a consensus that will not occur.

Any possible reform would follow the existing hierarchy of power, characterized by the dominance of the countries of the centre and especially Germany. To be exact, the euro has been the means to build the hegemony of German capital, which has inexorably imposed itself on the European stage and prevents the possibility of implementing a programme that meets the needs of the social majority.

Time for a break

In our opinion, any political agenda that seeks to actually break with neoliberalism, even in a reformist direction, should seriously consider euro exit. As noted by Costas Lapavitsas [2 ] , the only progressive answer for our people is to leave the euro zone and regain control of sovereignty in the context of a radical shift in economic and social power to labour.


This strategy must start with the default on sovereign debt and extends to a euro exit to allow our country to escape the cataclysm of internal devaluation imposed by the European Union. Our country has a future, but a decent future will necessarily mean breaking with this Europe and the European institutions.
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January 15th, 2014

1/15/2014

0 Comments

 
Regarding more leaks on TPP:

PROFIT OVER PEOPLE WILL ALWAYS ELIMINATE ENVIRONMENTAL JUSTICE!!!!!! THIS IS WHAT THE TPP WILL PLACE ON STEROIDS!!!!!


TPP is all about law written in a way that policy always leads to maximize corporate profits and as the US becomes a third world wasteland with raw energy resources killing the environment right here in the US,.....we know that neo-liberals working with corporations to write these treaties have no intention of allowing environmental justice into the picture. Yet, neo-liberals like O'Malley always claim they are an environmental candidate!!!! See that progressive bone being tossed?

RUN AND VOTE FOR LABOR AND JUSTICE IN ALL PRIMARIES!

Administration Is Seen as Retreating on Environment in Talks on Pacific Trade Pact

By CORAL DAVENPORTJAN. 15, 2014

WASHINGTON — The Obama administration is retreating from previous demands of strong international environmental protections in order to reach agreement on a sweeping Pacific trade deal that is a pillar of President Obama’s strategic shift to Asia, according to documents obtained by WikiLeaks, environmentalists and people close to the contentious trade talks.

The negotiations over the Trans-Pacific Partnership, which would be one of the world’s biggest trade agreements, have exposed deep rifts over environmental policy between the United States and 11 other Pacific Rim nations. As it stands now, the documents, viewed by The New York Times, show that the disputes could undo key global environmental protections.

The environmental chapter of the trade deal has been among the most highly disputed elements of negotiations in the pact. Participants in the talks, which have dragged on for three years, had hoped to complete the deal by the end of 2013.

Environmentalists said that the draft appears to signal that the United States will retreat on a variety of environmental protections — including legally binding pollution control requirements and logging regulations and a ban on harvesting sharks’ fins — to advance a trade deal that is a top priority for Mr. Obama.

Launch media viewer Michael Froman, the United States trade representative, said, “We’re pushing hard.” Stephen Crowley/The New York Times Ilana Solomon, the director of the Sierra Club’s Responsible Trade Program, said the draft omits crucial language ensuring that increased trade will not lead to further environmental destruction.

“It rolls back key standards set by Congress to ensure that the environment chapters are legally enforceable, in the same way the commercial parts of free-trade agreements are,” Ms. Solomon said. The Sierra Club, the Natural Resources Defense Council and the World Wildlife Fund have been following the negotiations closely and are expected to release a report on Wednesday criticizing the draft.

American officials countered that they had put forward strong environmental proposals in the pact.

“It is an uphill battle, but we’re pushing hard,” said Michael Froman, the United States trade representative. “We have worked closely with the environmental community from the start and have made our commitment clear.” Mr. Froman said he continued to pursue a robust, enforceable environmental standard that he said would be stronger than those in previous free-trade agreements.

The draft documents are dated Nov. 24 and there has been one meeting since then.

The documents consist of the environmental chapter as well as a “Report from the Chairs,” which offers an unusual behind-the-scenes look into the divisive trade negotiations, until now shrouded in secrecy. The report indicates that the United States has been pushing for tough environmental provisions, particularly legally binding language that would provide for sanctions against participating countries for environmental violations. The United States is also insisting that the nations follow existing global environmental treaties.

But many of those proposals are opposed by most or all of the other Pacific Rim nations working on the deal, including Australia, New Zealand, Canada, Mexico, Chile, Japan, Singapore, Malaysia, Brunei, Vietnam and Peru. Developing Asian countries, in particular, have long resisted outside efforts to enforce strong environmental controls, arguing that they could hurt their growing economies.

The report appears to indicate that the United States is losing many of those fights, and bluntly notes the rifts: “While the chair sought to accommodate all the concerns and red lines that were identified by parties regarding the issues in the text, many of the red lines for some parties were in direct opposition to the red lines expressed by other parties.”

As of now, the draft environmental chapter does not require the nations to follow legally binding environmental provisions or other global environmental treaties. The text notes only, for example, that pollution controls could vary depending on a country’s “domestic circumstances and capabilities.”

In addition, the draft does not contain clear requirements for a ban on shark finning, which is the practice of capturing sharks and cutting off their fins — commonly used in shark-fin soup — and throwing back the sharks to die. The dish is a delicacy in many of the Asian negotiating countries. At this point the draft says that the countries “may include” bans “as appropriate” on such practices.

Earlier pacts like the North American Free Trade Agreement included only appendices, which called for cooperation on environmental issues but not legally binding terms or requirements. Environmentalists derided them as “green window dressing.”

But in May 2007, President George W. Bush struck an environmental deal with Democrats in the Senate and the House as he sought to move a free-trade agreement with Peru through Congress. In what became known as the May 10 Agreement, Democrats got Mr. Bush to agree that all American free-trade deals would include a chapter with environmental provisions, phrased in the same legally binding language as chapters on labor, agriculture and intellectual property. The Democrats also insisted that the chapter require nations to recognize existing global environmental treaties.

Since then, every American free-trade deal has included that strong language, although all have been between the United States and only one other country. It appears to be much tougher to negotiate environmental provisions in a 12-nation agreement.

“Bilateral negotiations are a very different thing,” said Jennifer Haverkamp, the former head of the United States trade representative’s environmental office. “Here, if the U.S. is the only one pushing for this, it’s a real uphill battle to get others to agree if they don’t like it.”

But business groups say the deal may need to ease up. “There are some governments with developing economies that will need more time and leeway,” said Cal Cohen, president of the Emergency Committee for American Trade, a group of about 100 executives and trade associations that lobbies the United States trade negotiator on the deal. “When you think about the evolution of labor provisions, you realize how many centuries the development of high standards took.”

Since the trade talks began, lawmakers and advocacy groups have assailed the negotiators for keeping the process secret, and WikiLeaks has been among the most critical voices. The environment chapter is the third in a series of Trans-Pacific Partnership documents released by WikiLeaks. In November, the group posted the draft chapter on intellectual property. In December, the site posted documents detailing disagreements between the negotiating parties on other issues. The site is expected to release more documents as the negotiations unfold.

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This shows how corrupt Maryland is .......it is unbelivable.  Here is a corporation wanting to build a natural gas terminal being given a tax credit and a green light.  Also, here we see again, labor is backing this deal because they are desperate for jobs probably not knowing how much it will impact their members as the price of natural gas soars and their communities are open as fair game for fracking sites that kill these communities.


So, we have a neo-liberal working to build fracking and natural gas as a global exporting market for the US because to save it for domestic use only depresses the price and profit for natural gas corporations.  As with gas at the pump that goes sky-high and is deliberately being pushed higher in price so fewer people drive.....as with BGE/Exelon merger that has a rate increase that will double the rates for electricity as Exelon has a billion dollar a year profit-margin....labor leaders are pushing to move natural gas into the same money-soaking category for the citizens of Maryland all because it will create some jobs for a few years.

Now, I am not blaming labor as much as the neo-liberals because neo-liberals are deliberately making the job market so tight that people are desperate and give up all their rights and benefits to work.  THAT IS THE REASON MARYLAND IS THE MOST CORPORATE OF STATES AND THE HIGHEST IN INCOME INEQUITY.


Board OKs tax credit pact with Dominion Prince Frederick, MD - 11/6/2013



By Marty Madden

  Janet Ashby opted to spend her remaining allotted time in meditation during a public hearing when the county commissioners declined to answer her question


While their presence at a previous public hearing affecting the Dominion Cove Point Liquefied Natural Gas (LNG) Plant’s expansion plan was mainly as observers, several members of local labor unions stepped up to the plate Tuesday, Nov. 5 to voice support for the project. The public hearing issue this time was a proposal from the Calvert County Commissioners to grant a tax credit and accept a payment in lieu of taxes (PILOT) from the utility.

In addition to labor’s backing, the plan to add a LNG export component to the Lusby plant received the endorsement of three state lawmakers—two verbally and another via letter.

“We have hundreds of carpenters living in Calvert County,” said labor representative Hank Sorenson, who added the workers “want and need” a major project in their home county.

Electrical workers union representative Steve Zimmerman of Owings said the monetary windfall is needed both by laborers and county government. “We can’t afford to keep losing this money, this revenue,” said Zimmerman.

“There are people hurting,” said Delegate Mark N. Fisher [R-District 27B]. “We have a golden opportunity.”

Both Fisher and Delegate Anthony J. “Tony” O’Donnell [R-District 29C] encouraged the commissioners to not earmark the additional revenue generated by the Cove Point expansion project for new initiatives but rather toward tax breaks for local businesses and property owners.

Earlier in the hearing, County Attorney John Norris read into the record a letter of support from Maryland Senate President Thomas V. Mike Miller Jr. [D-District 27]. “This is a tremendous opportunity for the county,” stated Miller, who observed the Cove Point expansion project would be a larger construction effort than the new Woodrow Wilson Bridge or the Ravens Stadium in Baltimore.

“We have been given due diligence to this project for a long, long time,” said O’Donnell. “Left and right, Rs and Ds, there’s some merit here. This is going to be a big benefit to future generations.”

As they did a week earlier, project opponents also weighed in and again leveled criticism on the county commissioners for their support of Dominion’s plan. County resident Ken Pritchard said the board was about to approve “a sizable welfare check to corporate giant Dominion.

Cove Point Beach resident June Sevilla said the deal with Dominion came with “no re-numeration to citizens for toxic air and water pollution.” Sevilla accused Dominion of dumping chemicals into the Cove Point Marsh and added the liquefaction process “is a lot more toxic. The safety issue and the homeland security issue are real.”

“The Calvert County Commissioners have truly become Santa Claus for Dominion and Scrooges to the rest of us,” said Cove of Calvert resident Jean Marie Neal. She labeled the proceedings “a tax giveaway hearing. Dominion should pay its full tax responsibility just as we do.”

Another project opponent, Janet Ashby, asked the commissioners “what’s the rush?” When Commissioners President Pat Nutter [R] explained the public hearing was not a time for the board to answer questions, Ashby said she would use her remaining time to meditate. The room fell silent until Ashby’s time expired.

When the testimony was over, the county commissioners were ready to have their say.

“Dominion has proven itself to be a good neighbor,” said Commissioner Evan K. Slaughenhoupt Jr. [R]. “In the end it [project] is going to benefit all citizens of Calvert County.”

Noting the clamor among project skeptics to impel the Federal Energy Regulatory Commission (FERC) to conduct an environmental impact study instead of an environmental assessment, Commissioner Susan Shaw [R] recalled Dominion’s pipeline expansion project during the latter part of the last decade. “FERC took it extremely seriously,” said Shaw. “A complete environmental impact study was done. The environmental assessment is an update of the environmental impact study.”

Shaw said the PILOT and tax credit proposal “is a significant tax benefit because it takes the pressure off the homeowners. We got the best deal from Dominion we could get.”

“I support this project 100 percent,” said Commissioner Gerald W. “Jerry” Clark [R], who conceded the three-year construction project at the plant was likely to pose “an inconvenience” for some county residents. “We will minimize the traffic, environmental and health impacts.”

Commissioner Steven R. Weems [R] suggested the board consider establishing an “expansion advisory committee” to discuss the construction project’s challenges.

The commissioners subsequently voted unanimously to approve the ordinance amendment implementing the tax credit and PILOT authority. According to a county government memo, highlights of the pact are:

1. In fiscal year 2018 the county will receive $25 million before the new equipment is taxable. This represents consideration for entering into the agreement.

2. Dominion Cove Point LLC will begin making payments on the expansion equipment when placed in service pursuant to a PILOT agreement. The PILOT will be five years in duration.

3. The PILOT locks in existing equipment value at $15.1 million for the duration of the PILOT; the value of the existing equipment was projected to decline.

4. The tax credit would begin upon expiration of the PILOT, providing a 42-percent tax credit, versus the requested 50 percent requested by the Company, on new and repurposed equipment for the next nine years.

”We think it’s our fair share of taxes,” said Dominion spokesman Dan Donovan following the hearing. Donovan also indicated Dominion would be involved in improvements to Cove Point Road.

The proposed project is still in the permit obtainment stage. When the final permit is issued Dominion will then need to submit an implementation plan to FERC.

Contact Marty Madden at marty.madden@thebaynet.com


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I am pleading with labor unions and justice organizations working for jobs to not allow neo-liberals making it hard to find jobs press you into these policies that are very, very, very very bad for you and your families in the longer run.  Fracking is the worst for communities, for family health, for exploding the cost of natural gas.

NEO-LIBERALS ARE USING LABOR TO PUSH BAD LEGISLATION!!!!!





Battles Escalate Over Community Efforts to Ban Fracking Obama's trip to fracking territory underscores the controversy. Protesters converged on Dimock, Pennsylvania, in 2011 over the effects of fracking on residents' water. Now an increasing number of communities are seeking to ban fracking outright, sparking court battles.

Photograph by Nina Berman/NOOR/Redux

Joe Eaton

For National Geographic

Published August 22, 2013

As President Obama visits upstate New York and northeastern Pennsylvania this week to discuss his education agenda, a separate issue looms large in the background: fracking, a practice that has transformed Pennsylvania's economy and divided New York, where a moratorium is in place.



Protesters on both sides of the issue are expected to greet the President. And while his trip highlights many unresolved issues related to America's new wealth of natural gas and oil, a growing number of communities are taking matters into their own hands. (Vote: "How Has Fracking Changed Our Future?")

From New York to New Mexico, more than 100 municipalities have passed fracking bans or temporary moratoriums, according to FracTracker, a nonprofit organization that compiles data on the oil and gas industry. The bans often put communities in direct conflict with states over the right to regulate the oil and gas industry. (See related story: "Health Questions Key to New York Fracking Decision, but Answers Scarce.")

A Far-Reaching Debate

At first glance, New Mexico's Mora County seems an unlikely battleground in the fight over fracking, which involves injecting wells with millions of gallons of water and chemicals to release trapped oil and gas.

Located in a rural northern part of the state, the county has fewer than 5,000 citizens, vast tracts of open land, and an unemployment rate nearly twice the national average. Still, despite its need for jobs and economic development, Mora County in May became perhaps the first county in the United States to ban fracking on its land. (See related quiz: "What You Don't Know About Natural Gas.")

John Olivas, chairman of the Mora County Commission, said the ban stems from fear that fracking might harm water wells, which have flowed despite several recent summers of severe drought. "When you talk about an industry affecting our water, that is really all we have," Olivas said.

Many states across the country are in the midst of an energy boom propelled in large part by advanced drilling technologies, which allow companies to access oil and gas that could not be reached in the past. As drillers move into new frontiers, communities concerned over the health, safety, and environmental impact of fracking are passing strict regulations, moratoria, and outright bans, which often wind up in court. It's a trend experts expect will escalate. (See related story: "Natural Gas Nation: EIA Sees U.S. Future Shaped by Fracking.")

"I think we will see more municipalities and communities trying to ban fracking," said Sorrell Negro, a land use attorney in Connecticut who wrote an influential 2012 paper on the topic. In the past, drilling took place mainly on rural land, Negro said, but new technologies and recent shale discoveries have brought drilling into more densely populated areas.

"You are having places like the city of Dallas that have to decide if they are going to allow it in the city boundaries," Negro said. "These issues just have not come up before."

The trend of community bans has the oil and gas industry on edge. "This is an industry that operates on certainty," said Reid Porter, a spokesman for the American Petroleum Institute. "When you are looking at the planning necessary to make these investments in communities, it's necessary to know what the regulations are."

Industry representatives say drilling takes years of planning and millions of dollars of investment before the trucks arrive. If a local government has authority to ban drilling or enact regulations that make it too costly or cumbersome, drillers say it puts that investment at risk.

"The ability [of municipal governments] to change policy quickly would not elicit any sort of confidence," said Steve Forde, vice president of the Marcellus Shale Coalition, a trade association that represents energy companies targeting natural gas deposits in the 48,000-square-mile shale formation underneath New York, Pennsylvania, Maryland, Virginia, Ohio, and West Virginia. The Marcellus shale contains by far the largest known deposits of natural gas in the United States, and has turned the states where it is located into test cases for local control over fracking. (See related blog post: "In Virginia, a Tug of War Persists Over a National Forest Atop Shale Gas Reserves.")

What's unclear is how far energy companies are willing to go to protect their interests. Industry giants ExxonMobil and BP declined to comment on the issue, referring calls to industry trade associations. Shaun Goho, a lecturer and environmental law expert at Harvard Law School, said he expects industry will continue to push states to limit municipal regulation of fracking. "They want the states to handle it as much as possible," Goho said, "not local governments, and not the federal government."

Legal Uncertainty

State laws vary on the authority of local governments to regulate oil and gas development. In 2012, the Pennsylvania General Assembly passed statewide standards for oil and gas zoning, preempting the rights of municipalities to ban drilling or regulate where wells are sited. A handful of towns challenged the law and won in lower courts. The issue is currently before the Pennsylvania Supreme Court. (See related series: "The Great Shale Gas Rush.")

Since 2008, New York has enforced a statewide fracking moratorium while it prepares state regulations. In the meantime, several municipalities have passed bans and moratoria. In May, a mid-level New York appeals court ruled in favor of Dryden and Middlefield, two small upstate New York towns that banned fracking, affirming lower court decisions. Norse Energy, which has since filed for bankruptcy, had sued Dryden over its fracking ban.

Tom West, an Albany attorney who represents Norse Energy in the case, asked the state's high court to review the ruling. West said communities that ban drilling after energy companies buy leases will likely face further legal challenges. "Municipalities will have to think long and hard about that," West said, adding that he would recommend both that landowners and companies sue to protect the value of their mineral rights.

Deborah Goldberg, an attorney with Earthjustice, a nonprofit public interest environmental law firm that represents Dryden, said the case tests the rights of communities in the state to determine their future. "They are asking for the right to develop a well anywhere," Goldberg said of Norse Energy. "If they want to go in next to a school, they go in next to a school. If they want to go in next to a hospital, they go in next to a hospital, regardless of what the zoning says."

Battles over fracking are also brewing far from the Marcellus Shale, in western states including Colorado. In December, the Colorado Oil and Gas Association filed a lawsuit that seeks to overturn a fracking ban passed by voters in Longmont, a city of 85,000 northeast of Boulder. Colorado Governor John Hickenlooper's administration joined the lawsuit on the side of the drillers. In May, the Fort Collins City Council overturned its fracking ban, reportedly over concern over possible industry legal action, according to the Boulder Journal.

Stan Dempsey, president of the Colorado Petroleum Association, said in most cases Colorado fracking bans are little more than symbolic gestures in communities that have little or no energy development. In Longmont, for example, Dempsey said there was only one drilling operator. Nonetheless, Dempsey said, the industry spent $500,000 to influence the vote in Longmont and will continue to take cases to court.

"All of these communities are going to be sued for taking someone's mineral interests from them," Dempsey said. "I think it's a bit hypocritical for communities saying 'not in my backyard,' but we want the energy in our tanks and we want natural gas to heat our homes. I think so much of the opposition  [to hydraulic fracturing] is really about opposing the development of fossil fuels. They don't want any more fossil fuel development, period."

As new technologies allow energy companies to target shale they were unable to drill in the past, experts say the legal challenges over fracking might be only beginning. The next battlefield may be in California, where drillers are eyeing the massive Monterey shale. The 1,750-square-mile formation in central and southern California is believe to contain double the oil of the Bakken shale, which made North Dakota into the second largest producer of oil behind Texas. (See related story: "Monterey Shale Shakes up California's Energy Future")

Because of the unique geology of the Monterey shale, it is unclear whether hydraulic fracturing would be an effective tool for oil production. After several recent legislative bills to halt fracking in California failed, activists started petition drives to block drilling in several cities and counties. If the activism leads to bans, industry watchers expect they will be tested in state courts.

This story is part of a special series that explores energy issues. For more, visit The Great Energy Challenge.





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As an American being forced to watch US media show images of water on fire from methane, ground water made brackish and undrinkable, earthquakes, and devastating pipeline oil spills all involving natural gas drilling......ARE WE STILL LIVING IN A FIRST WORLD COUNTRY? A SECOND WORLD COUNTRY? HOW ABOUT A THIRD WORLD COUNTRY? That's where we are with neo-liberals. You see, when a country resorts to being an energy exporter allowing all kinds of environmental damage all for profits.....your have reached third world Nigerian status.

THIS IS WHAT TPP INTENDS TO PLACE ON STEROIDS AND IS WHY ALL ENVIRONMENTAL LAW DISAPPEARS AND SOME ACADEMIC RESEARCH HIDES THE FACTS.

Look at how a first world country approaches the raping of its environment for profit! Maryland Governor O'Malley and Maryland Assembly leaders are big backers of Maryland as an export terminal knowing exporting places fracking on steroids.



France upholds ban on fracking over fears of environmental damage, despite country's huge shale gas reserves
By Peter Allen

PUBLISHED: 06:47 EST, 11 October 2013 | UPDATED: 06:55 EST, 11 October 2013



France today upheld its nationwide ban on fracking due to fears the process may cause long-term environmental damage.

The move follows a number of high-profile protests against the practice in Britain, where energy firms have been allowed to undergo exploratory drilling.

Fracking involves injecting a mixture of water, sand and chemicals into the ground at high pressure to crack shale rock holding oil and gas reserves deep underground.


Anti-fracking campaigners stage a protest at Balcombe, West Sussex, due to fears over an exploratory oil drilling plant



But despite efforts by US company Scheupbach Energy (SE) to start drilling into France's plentiful reserves, the country's Constitutional Court today upheld a 2011 moratorium on the process.

Socialist president Francois Hollande is opposed to fracking, based on the legal concept of ‘precaution’.

He supports environmentalists who link the practice with a range of problems, including pollution and minor earthquakes.

 
Marc Fornacciari, SE’s barrister, told the Paris court that ‘there is not a single study showing that fracking presents the slightest risk.’


The Dallas-based company tried to convince the Constitutional Court that the 2011 ban was discriminatory. But Thierry-Xavier Girardot, for the French government, argued the environmental dangers of fracking were ‘sufficiently acknowledged’ to justify a ban.


SE's permit to explore shale reserves in Aveyron and Ardeche in the south of France have been revoked, and the new ruling confirms this.


Police officers escort a vehicle past anti fracking protestors at Balcombe in Sussex



Anti-fracking protesters set up a camp near Balcombe, West Sussex, over the summer as energy firm Cuadrilla drilled for oil.


Cuadrilla has now submitted new plans to carry out 'flow tests' to determine the rate of extraction at the well after test-drilling found oil in rock samples.

Fracking has revolutionised the energy industry in the USA, despite the huge amounts of water that have to be transported to a fracking site, at huge environmental cost.


There are also fears that potentially carcinogenic chemicals can escape and contaminate groundwater around the fracking site. Two small earthquakes of 1.5 and 2.2 magnitude hit the Blackpool area in 2011 following fracking.

A test drilling site for shale gas near Banks on the outskirts of Southport, Lancashire, UK



Environmental campaigners further argue that fracking is preventing energy firms and governments from investing in renewable sources of energy, and encouraging continued reliance on fossil fuels.


Friends of the Earth energy campaigner Tony Bosworth said: ‘We need a 21st century energy revolution based on efficiency and renewables, not more fossil fuels that will add to climate change.’

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January 14th, 2014

1/14/2014

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The ancient playwright Sophocles could not have written a political satire more robust than Maryland's current comedy/tragedy politics.  Maryland's 1% say-----this is no failure----we moved hundreds of millions of dollars to the connected people we chose!



THERE IS GOOD NEWS FROM THE FAILURE OF MARYLAND HEALTH SYSTEM DESIGNED TO END FEDERAL PROGRAMS MEDICARE, MEDICAID, AND PUBLIC SECTOR HEALTH PLANS.....PEOPLE HAVE TIME TO SEE THE DAMAGE AFFORDABLE CARE ACT DOES TO THE AMERICAN PEOPLE AND THEY ALL NOW WANT EXPANDED AND IMPROVED MEDICARE FOR ALL!

Do you hear your political pundit, labor and justice organization,or incumbent shouting out all of what I have been  saying about the Affordable CAre Act for 4 years?  Well, they knew what I knew and they were not working for you and me!

As I have said there are well-developed plans already developed for Expanded and Improved Medicare for All.  Any politician could run for Governor of Maryland and simply use existing policy and planning to implement.  Do not allow neo-liberals to tell you it can't be done because simply building oversight into Medicare health system will end 1/2 of expenditures just by ending fraud and profiteering!  This neo-liberals have wasted hundreds of billions of dollars developing this private system simply to make health care a global profit-maximizing industry and WE WILL TAKE IT BACK!!!!


I would like to end this session on health care reform with a reminder of how the State of Maryland moves to Expanded and Improved Medicare for All.


Still think the plan was not to end Medicare and Medicaid as Federal programs by sending them all to state health systems that dismantle all Federal protections for public health?

Private health plans have no intention of coming into these exchanges because they are well on their way to going global with the deregulation of the Affordable Care Act they will be just as unaccountable as Wall Street and just as criminal and corrupt.  What you see are private companies being created under the guise of private non-profits like EVERGREEN owned and run by Johns Hopkins under Beilenson.  So, these private non-profits will end up with all of Medicare, Medicaid, and public sector health plans ending these Federal programs and with deregulations and not public health protections....health care for most will become charity work if these people have their way.


ALL ACROSS THE  COUNTRY THE MOST HEALTH ACCOUNTS BEING CREATED ARE FOR MEDICAID....AS IN MARYLAND.



Tue, Jan 14, 2014, 8:28 AM EST -

63 percent of RI insurance sign-ups for Medicaid 63 percent of insurance sign-ups during first 3 months of HealthSource RI were for Medicaid

By Erika Niedowski, Associated Press 16 hours ago

HealthSource RI said that 11,770 individuals enrolled in commercial plans between Oct. 1, when the marketplace opened, and Jan. 4. The state Health and Human Services office said 19,941 enrolled in Medicaid during the same period.

Of those who enrolled for private coverage, 9,902 have paid and had coverage begin this month, according to HealthSource RI.

The marketplace, sometimes known as an exchange, also released new demographic data that show who is using it and what type of coverage they are choosing.

One-third of individual private-plan enrollees are 55 and older; 23 percent are 18 to 34. The overwhelming majority of those who signed up chose a Blue Cross & Blue Shield of Rhode Island plan. Fifty-six percent chose a "silver" plan over bronze, gold and platinum.

Eighty-seven percent are receiving some kind of subsidies for the coverage.

It's not clear how many of those who enrolled in private plans were previously uninsured.

Most Americans are now required to have health insurance under the federal Affordable Care Act, or pay a penalty. There are more than 120,000 uninsured in Rhode Island in a population of just over 1 million.

The state has not publicly released enrollment targets for the first sign-up period, but the U.S. Centers for Medicaid and Medicare Services set a goal of 5,640 enrollments in Rhode Island by Dec. 31 and 12,000 by March 31.

HealthSource RI also reported Monday that 75 small businesses have enrolled, representing 530 employees. The state is putting a lot of emphasis on getting small businesses to sign up.

The marketplace is offering 12 individual plans and 16 small-group plans in 2014.

The deadline to pay for coverage beginning Jan. 1 already passed, but open enrollment is continuing through March 31. The next deadline to select and pay for a plan is Jan. 23.

________________________________________

Did you know that HUMANA is a private health plan that seeks to draw seniors out of the public Medicare by front-loading these plans with perks but in the longer term will undermine this strong Federal program and it is deliberate?

If people understand what Maryland's Medicare exemption from Federal oversight means you will see why Hopkins is tied with a private senior health care corporation.  Hopkins' goal in health policy is to maximize health profits and when they requests these exemptions from Medicare they are telling us they are making Medicare more cost effective.  What they are doing is creating the tiered system of payments to Medicare patients and procedures that has systematically made Maryland's hospitals the worst in the nation as far as quality care and performance.  Just finished surgery on you leg under anesthesia and still haven't fully woken from this procedure after a few hours?


TOO BAD BECAUSE YOUR TIME IS UP AND YOU ARE OUT THE DOOR.  WHAT???  NO ONE AT HOME TO MAKE SURE YOU HAVE NO ILL EFFECTS FROM THE SURGERY?  HIRE A HOME HEALTH PERSON TO COME SIT WITH YOU ---YOUR TIME IS UP HERE IN MEDSTAR!!!!


We had surgery and implanted a steel plate for your broken bone that once simply had a cast placed on it because the bone had a fracture that needed support.  The patient asks to see the X-RAY and straining his eyes looking for a fracture because there is none is told by the doctor-----IT'S THERE!

Need a doctor that handles Medicare?????  There is a compound for senior care on the outskirts of the city with national health chains.....GO THERE! 


This is how Hopkins has made Maryland's health businesses the most profitable in the nation and these new approaches are what the Affordable Care Act is based upon.  It is diabolical!!!!

I DO NOT HAVE TO TELL BALTIMORE CITIZENS THAT PEOPLE ARE FEARFUL OF ENTERING JOHNS HOPKINS AND CALL MEDSTAR A DEATH TRAP BECAUSE OF WHAT THESE LONG-TERM HEALTH POLICIES HAVE DONE TO MARYLAND'S HEALTH SYSTEM....SO, AS HOPKINS TOUTS ITSELF OVER AND AGAIN AS THE BEST IN THE WORLD IN EVERYTHING....KNOW THAT THEY ARE NO DOUBT BUYING THEIR RANKING FROM THE LIKES OF US NEWS AND WOLD REPORT!




HUMANA AND JOHNS HOPKINS TEAM UP WITH MANAGED-CARE NETWORK



BALTIMORE, Dec. 1 /PRNewswire/ --


Humana Inc., one of the nation's largest health maintenance organizations, and Johns Hopkins, one of the premier medical centers in the country, are teaming up to form physician networks throughout the state of Maryland.

Humana members also will be able to use Johns Hopkins hospitals and facilities in the state.

"This strategic affiliation is the first of its kind for Johns Hopkins," Health System President and CEO James A. Block, M.D., said. "We are tremendously pleased to be able to work with Humana, not least because of its experience nationwide in serving a managed-care population covered by Medicare."

The affiliation is between Johns Hopkins HealthCare LLC, led by John D. Stobo, M.D., which represents The Johns Hopkins Health System and The Johns Hopkins University School of Medicine, and Human Group Health Plan, Inc. of Washington, D.C., a wholly-owned subsidiary of Humana Inc.

Humana will use primary and specialty physician networks being formed by Johns Hopkins, such as the Wilmer Eye Network and networks in cardiology and pediatrics, and work with Johns Hopkins to develop a full complement of other networks in the state.

"This relationship with a medical center that has an international reputation for quality and innovation is terrific news for Humana and its members," said Humana Senior Vice President Phil Garmon, who also noted that Johns Hopkins Hospital has been rated best in the country for five consecutive years by "U.S. News & World Report" and more faculty physicians from its school of medicine than any other have been listed in the book, "Best Doctors in America." "It should be a mutually beneficial relationship for both parties. Humana obtains access to networks of quality physicians and high caliber medical facilities in Maryland and Johns Hopkins can utilize our many years of experience in managed care to develop and expand its networks."

Michael E. Johns, M.D., dean of the School of Medicine, added that, "As Humana's enrollment grows in central Maryland, this agreement will serve to heighten access to the faculty practice at Hopkins. This is another vote of confidence from a leading managed-care organization for the way in which we are responding to the changing health-care marketplace."

Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly-owned HMO companies with more than 3.8 million members in 22 states and the District of Columbia. Humana offers quality and affordable coordinated care in the form of HMOs, preferred provider organizations, point-of-service organizations, along with administrative-only services. In addition, Humana is one of the nation's largest providers of "HMO-style" health care to seniors through its federally approved Medicare products. -0- 12/1/95

____________________________________________
As I have said there are well-developed plans already developed for Expanded and Improved Medicare for All.  Any politician could run for Governor of Maryland and simply use existing policy and planning to implement.  Do not allow neo-liberals to tell you it can't be done because simply building oversight into Medicare health system will end 1/2 of expenditures just by ending fraud and profiteering!  This neo-liberals have wasted hundreds of billions of dollars developing this private system simply to make health care a global profit-maximizing industry and WE WILL TAKE IT BACK!!!!

National Physicians has a well-researched plan that will reverse this Wall Street takeover.  I want to acknowledge that while I believe these physicians are working for all of us....I do want to make sure that this is universal and equal and addresses massive health industry fraud and profiteering and is not only funded by more taxes on the public!  When I read that Vermont's will include Tort reform as a way to lower cost I know that the reasons Doctor's Malpractice insurance is so high is that the American Medical Association does not police or hold accountable the doctors repeatedly performing badly....it is just like these other white collar crimes that get hidden and moved around. 


TORT REFORM SHOULD NOT HAPPEN UNTIL THE AMA HAS PROVEN THAT IT IS POLICING THE MEDICAL PROFESSIONALS AND ARE TRANSPARENT TO THE PUBLIC!!!!!

Please take time to read the entire article below!


A National Health Program for the United States: A Physicians' Proposal
Reprinted from the New England Journal of Medicine 320:102-108 (January 12), 1989

Abstract:

Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians' services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capital basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform. (N Engl J Med 1989; 320: 102-8.)


_____________________________________________

The problems with MD's health exchange are not isolated,......all of MD public policy is a disaster because none of it is written by public advocates.....it is entirely written by the corporate 1% that make policy simply to move profit to the top....ergo, people are not placed in charge because of talent but because of having the 3 monkey syndrome.....SEE NO EVIL, HEAR NOT EVIL, SPEAK NO EVIL....public policy in policing, education, development are all failures and hundreds of billions of the state's revenue have been lost just during O'Malley's tenure as Mayor of Baltimore and now Governor of Maryland.

Remember, the goal with these state health systems is to end Medicare and Medicaid as Federal programs and dismantle them through state policy!  We want to be shouting for Expanded and Improved Medicare for All!!

Also, please know it is not the democratic party bringing these republican policies forward.....it is neo-liberals that have control of the democratic party.  We simply need to rebuild the democratic party by running labor and justice to reverse all of this attack on public health!


Also note that it is Beilenson  leading with a so-called private non-profit EVERGREEN that is designed to catch all of what was public sector Medicare, Medicaid, and public sector health plans.....AND HE IS JOHNS HOPKINS.

Below is what is happening with all of Maryland policy----the connected are throwing together businesses to capture all the wealth from taxpayer money building something we do not even need as Medicare already has a system!


'Both had expanded rapidly to build the Maryland site, expecting it could give them a foothold in the potentially lucrative health-exchange market'.


Maryland officials were warned for a year of problems with online health-insurance site


By Aaron C. Davis and Mary Pat Flaherty, Published: January 11   Washington Post

More than a year before Maryland launched its health insurance exchange, senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1.

Over the following months, as political leaders continued to proclaim that the state’s exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project “was a disaster waiting to happen.”

Timeline

A timeline of events and related documents tied to the Maryland health care exchange.


The Democratic gubernatorial hopeful is the only female candidate at the top of a ticket.


The repeated warnings culminated days before the launch, with one from contractors testing the Web site that said it was “extremely unstable” and another from an outside consultant that urged state officials not to let residents enroll in health plans because there was “no clear picture” of what would happen when the exchange would turn on.

Within moments of its launch at noon Oct. 1, the Web site crashed in a calamitous debut that was supposed to be a crowning moment for Maryland officials who had embraced President Obama’s Affordable Care Act and pledged to build a state-run exchange that would be unparalleled.

Instead, by the next morning only four people had signed up using the Web site — and amazed that anyone had gotten through the system successfully, state officials contacted each of them to make sure they were real. The site’s problems continue to prevent Marylanders from signing up for health insurance. As of Friday, 20,358 people had selected private plans, and state officials have said they do not expect to come close to their initial goal of 150,000 by the end of March.

This report is based on a Washington Post review of thousands of pages of previously undisclosed documents, including e-mails, internal reports, audits and court records, along with interviews with dozens of current and former contractors, state officials and others. The review shows that the creation of the exchange was dysfunctional from the start and that there were repeated missteps at almost every level.

On the morning of Oct. 1, shortly after Obama had proclaimed that Maryland would lead the charge in signing up residents for new health-care plans, the director of the state’s health exchange was repeatedly rejected by the network before she became the first to log on, with the help of her IT staff.

Since then, an unknown number of Marylanders have experienced the same frustration with the Web site and have been prevented from signing up for health insurance.

As the state continues to try to fix the site, Gov. Martin O’Malley (D) and state lawmakers are working to enact emergency legislation to spend millions to help insure those who could not sign up and had to begin the year with no coverage.

With many Marylanders still facing frozen computer screens and error codes when they attempt to select insurance, O’Malley is expected this coming week to decline an offer by the Obama administration to temporarily take over parts of the troubled site, despite the urging of some state Democrats to embrace the move. This past week, O’Malley acknowledged that the rollout “did not meet our expectations” but said that many things have been fixed and the state’s site is improving.

It’s a situation far different than what O’Malley predicted on a sunny morning in March 2010, less than 24 hours after Obama signed the Affordable Care Act. O’Malley called reporters to the entrance of an Anne Arundel County emergency room to announce that Maryland would begin drafting plans to “immediately begin the work to ensure our state leads the nation.”

‘There is a risk . . .’

Of the 14 states that opted to build and run their own health-insurance marketplaces, Maryland was among the earliest and most enthusiastic supporters of what became known as “Obamacare.” And it became the second state, trailing California, to enact legislation creating an exchange.

Lt. Gov. Anthony G. Brown (D), the highest-ranking elected official charged with implementing the law, was invited to speak across the country about the state’s early success. The Obama administration began depositing tens of millions of dollars in state accounts to pay for development, thinking Maryland’s exchange might be built so early that other states could copy it.

But out of public view, reports of trouble started arriving.

The first came in the fall of 2012, just over a year before the exchange was to launch. Auditors from the Portland, Maine-based firm of BerryDunn found that exchange officials were missing early deadlines to begin building the IT backbone for the public Web site, known as the Maryland Health Connection. The exchange was supposed to have signed agreements with state agencies that would allow them to link data from sources such as Medicaid and the Department of Motor Vehicles to the nascent site. But most agencies had not heard from the exchange or were unaware that the work was even overdue. The findings were summarized in a Nov. 1, 2012, letter to the president of the Maryland Senate and the speaker of the House of Delegates.

Almost $9 million in federal money was set aside to pay BerryDunn to be the watchdog for the high-profile project, with the expectation that Maryland officials would use the assessments to correct course as needed. The Post obtained copies of the confidential documents.

At the exchange’s temporary offices in north Baltimore during the fall of 2012, no one could produce for BerryDunn standard project plans showing a timeline and checklist for how the main IT contractor, from Fargo, N.D., would get the job done. The exchange’s staff, then just seven full-time state employees and borrowed ones from other agencies, “may not be sufficient to complete the work,” BerryDunn said in a PowerPoint presentation delivered to senior state officials in December. Five of the presentation’s slides began with: “There is a risk . . .”

One proved particularly prescient: Maryland might build all of the components of its health-insurance exchange and then put them together and find out they do not work, the presenters said. It was a serious risk, because the state also did not appear to be leaving itself with enough time to “complete, verify and test all system components before go-live.”

The 10 months that remained before the launch would go by quickly, the consultant warned, but corrective action could get the project back on track.

Two of O’Malley’s Cabinet members, his senior IT advisers and leaders of the exchange received copies of the confidential monthly reports, according to distribution lists. The first was also summarized in the technically worded letter to lawmakers. Aides to the legislative leaders said that the significance of the warning was not clear at the time and that they never knew the outside audits continued.

Late in 2012, the consultant’s reports focused increasingly on warnings that no one seemed to be in charge. Maryland Health Secretary Joshua Sharfstein; Human Resources Secretary Ted Dallas, the Cabinet member in charge of Medicaid; and Rebecca Pearce, the exchange leader, tried to make decisions together. It was a “three-headed-monster. . . . The next meeting could overrule the last. It was classic, you know, nothing was moving,” said one official who spoke on the condition of anonymity for fear of reprisal.

Within the exchange, Pearce, who had been lured away from a top job at Kaiser Permanente to run the system, was jostling with her own project manager for day-to-day control. Sunny Raheja was a state contractor who preceded Pearce on the exchange and would go to Sharfstein for decisions, according to documents as well as exchange officials who witnessed the dysfunction.

Ultimately, Raheja, who declined to comment, was replaced, and Pearce brought in a Medicaid IT specialist to run the technical side.

As Pearce’s new project manager began, the outside auditor said there was still no dis­cern­ible plan for building the exchange, no oversight by the state and poor communication among the contractors hired to build the online site.

“There is also no overall Master Project Plan and schedule that is being utilized to manage the milestones and activities necessary for the entire program effort,” BerryDunn warned in a Feb. 25 report.

The consultant broke the project into 11 categories and began labeling them as red, yellow or green — seven were in red, four were in yellow.

“From our perspective, agreement on a consolidated work plan will need input from all . . . so that there is a common understanding of what needs to occur between now and Oct. 1, 2013.”

In e-mails, Pearce’s new project manager said the situation appeared untenable. He resigned after a month, and the third project manager in three months took over in April — with six months to go before the site would launch.

“I think the wheels came off very early on,” said Amir Segev, who was deputy IT director for the exchange from February to May.

Segev said he left after only a few months “because it was a disaster waiting to happen.”

Contractors at odds

By May, the Obama administration was deciding which states would be allowed to proceed with building their own exchanges and which ones it would force to use the federal exchange. The team gave Maryland a deadline of June 1 to prove a core task: Its rudimentary software would have to communicate with a data hub the federal government was building to let states check whether health-care enrollees were eligible for subsidies.

The month of May became a sprint to make the deadline.

On one of the last days before the deadline, a federal team arrived at the Maryland IT contractor’s office in Linthicum, south of Baltimore, and sat in the front row of the briefing room with computers at each desk and a projection screen on the wall.

One part of the screen showed a fake enrollee’s information being sent from Maryland; the other showed the response from the federal hub. The two connected, and Maryland passed. Despite the internal turmoil and negative audits, the state seemed to finally be on the right path.

Sharfstein, the state health secretary, and Pearce called together the production team. Pearce put her foot on a chair and thanked everyone with a deep sense of relief evident in her voice.

News of the success also passed quickly to Brown and O’Malley, who began touting it in public appearances.

But as they celebrated, feuding between the two contractors in charge of doing much of the technical work to get the Web site running was getting worse.

Shortly after it had won Maryland’s initial $50 million contract, Noridian Healthcare Solutions, a company that grew out of Medicare claims processing, hired a Florida company — run by a former executive of Noridian’s parent firm — that renamed itself EngagePoint.

Noridian and EngagePoint agreed to share profits for development of the exchange, according to court documents filed by the companies — a move that state officials said they were made aware of only much later.

But within months of joining forces, the two were fighting over costs.

By July, according to court documents, infighting had brought work to a near-standstill.

Meanwhile, the software used successfully to pass the June test had to be replaced with newer and untested versions needed to meet federal security requirements.

In an interview, Sharfstein said the dispute had become a major distraction by then.

“For a while, we tried to play marriage counselor, but it was clear these were two companies that couldn’t work together well,” he said.

And another federal test was looming.

On Aug. 26, five weeks before the launch date, Maryland faced its final major test with federal overseers, a more thorough demonstration of how each part of its system would work.

This one did not go as well.

When the test got to the part of having a fictitious person choose a health plan, the Web site crashed. It also could not fully send enrollment data to insurers or e-mail Marylanders when they successfully selected a plan — something it still cannot do.

BerryDunn, the consultant, said the state must “hold Noridian to scheduled” deadlines and make 65 other changes. The state, it warned, also needed to start focusing on contingencies, knowing some parts of the site were bound to fail.

On a weekend in early September, Sharfstein logged on to measure the problems for himself. “You don’t want to know what he thought,” Pearce relayed in a message to her team, according to a testing report.

Pearce would soon send an e-mail titled “12 days out,” pleading with contractors to finish the job after she visited their Linthicum office on the evening of Sept. 18 and found it nearly empty.

“There’s a management methodology that has 4 aspects: pamper/pull/push/pummel. I think I have tried all of them at some point during this process,” she wrote at 11:24 p.m. “Tonight I am begging . . . we have got to make this reality.”

The success of the exchange was also becoming freighted with political implications as Brown launched his campaign for governor. In an early-morning e-mail on Sept. 23, Sharfstein wrote to Pearce, under a subject line “from today’s [Baltimore] Sun.”

He pasted in a line from U.S. Sen. Barbara Mikulski’s endorsement of the lieutenant governor the day before: “While we’re fighting to save Obamacare, we know that in Maryland we have a health exchange that’s ready to go because of Anthony Brown,” the Maryland Democrat said.

Pearce forwarded the e-mail to the heads of Noridian and EngagePoint, adding one line: “It’s time to get this right. Now. Period.”

Noridian chief executive Tom McGraw responded with military sparseness: “Understood.”

Testers filed their final report on Sept. 13, calling the last version of the software they could review “extremely unstable.” Internal testing of one aspect of the site found 449 defects, almost half of which would probably trouble the final release.

‘What’s wrong?’

On a conference call at the start of the final week of September, senior aides gave O’Malley a high-level summary of expected troubles with the exchange.

The Web site would not allow some people to check for subsidies or to select plans, but everyone should at least be able to log on, he was told, according to several aides.

The governor ended the call, said John Griffin, his chief of staff, saying the state should “move forward.”

But two days later, Griffin requested that a roomful of aides to the governor and Brown vote on whether to proceed. Most gave the Oct. 1 launch a green light. The next day, O’Malley smiled as Obama visited Prince George’s County and praised state leaders for being ready to roll.

Just after midnight on Oct. 1, programmers in the Linthicum office listened through a speaker phone to the anxiety growing in Pearce’s voice as she tried to log on, according to several people on the call. The site was not yet viewable publicly, but it should have allowed her to sign on. If there was one part of the site everyone agreed would work, it was this.

They waited for a second try and then a third as she reentered her name and address. Everything was correct. “What’s wrong?” she demanded.

No one was sure. Someone noticed that Pearce had left blank a box for the four-digit extension of her Zip code. Maybe the computer code required every single data field to be filled in to proceed. Try adding that, one manager said.

Pearce did not know the extension to her Zip code. They listened as she Googled it and attempted a fourth sign-on.

Click. She was in.

At 8 a.m., the exchange was supposed to launch simultaneously with other states, but it froze. The exchange posted a message online asking residents to come back in four hours.

Finally, at noon, officials watched from a command center in Baltimore as about 10,000 people logged on to the site, pinging servers in Fargo.

Screens showed blank graphs that should fill with enrollees moving through each phase of the system: creating accounts, checking for subsidies, shopping for plans, purchasing.

The stroke of noon came and went. No one logged on. No one bought health care.

The next morning was scarcely better. In the subject line of an e-mail to fellow contractors at 6:53 a.m., Noridian’s McGraw typed “Maryland is Down,” and wrote,“We cannot get through.”

More than 24 hours after the launch, there were just four people who had selected plans and eight more who appeared to have logged on.

An IT contractor wrote to state officials on Oct. 2 wondering if the four were “legitimate,” since contractors could not even access the site. She questioned if they might be fictitious accounts from prior phases of testing.

But later that day, the exchange’s chief information officer responded with good news: “The team has researched the 4 records and have determined these are for real customers. 3 applicants and 1 dependent. Applications have been processed albeit very slowly and sporadically.”

Pearce, who resigned under pressure in December, declined to comment on many aspects of the exchange’s development but said the wholesale failure on Oct. 1 “was a complete surprise to all of us.”

“We didn’t know it would be broken when we turned it on,” she said.

The day after the failed launch, Pearce sent an e-mail to the heads of Noridian and EngagePoint demanding answers.

“Gentlemen,” she wrote. “As the executives in charge of this program I would like to understand from you exactly what is happening with the project, and what you are doing to address our issues.”

But by the end of the first week of October, relations between the two companies were so strained that Pearce and Sharfstein acted as go-betweens. After more weeks of fighting, EngagePoint, the subcontractor, made a bold proposal to state officials, urging them to allow it to take over the project entirely. Days later, Noridian instead fired EngagePoint, whose programmers packed up their laptops and left, leaving some of the software in Ukraine, where EngagePoint had hired programmers.

It was now up to Noridian to fix the site — with few employees certain of where to begin. It began making offers to hire back fired EngagePoint workers it said were key to fixing the site.

EngagePoint chief executive Pradeep Goel was aghast. “We are not going to respond to ridiculous emails from Noridian demanding our team members show up for work after being escorted out of the office,” Goel wrote to McGraw and Noridian’s attorneys on Oct. 26. “Are you people on crack cocaine?”

EngagePoint persuaded a judge to sign a restraining order that blocked Noridian from hiring back workers to fix the site. Noridian countersued, and the state entered the fray, siding with Noridian for the sake of Marylanders who needed a functioning site.

Through its attorney, Daniel Graham, Noridian declined to discuss its work with EngagePoint, citing the ongoing litigation. In a statement, the company said that “the complexity of this project has led to a number of major issues beyond what was anticipated.” But the company believes that recent improvements have made the system easier to use and said it “will continue to work with the State” to improve it further.

Karen See, a spokeswoman for EngagePoint, said the firm would not discuss its work, also citing the lawsuits.

The full effect of the failed project on the two companies remains unclear. Both had expanded rapidly to build the Maryland site, expecting it could give them a foothold in the potentially lucrative health-exchange market.

Before the launch, the state had allocated about $100 million in federal money for the construction of its exchange, and, according to one estimate, it has spent tens of millions more since Oct. 1. It is unclear how much of the added costs federal officials will agree to cover. But the bigger question is how many people the state can sign up. 
IT'S THE MARYLAND APPROACH TO PUBLIC WORKS.....

Maryland’s next deadline is March 31, the date by which it expected 150,000 people to have used the site to select health insurance, excluding Medicaid. Officials have said the state will not meet that goal.

“It’s a problem for the people of Maryland, a problem for the people that Obamacare was supposed to help,” said Peter Beilenson, chief executive of the Evergreen Health Co-Op, a new Maryland insurer that launched its business on a bet that it could compete with the state’s bigger insurers on a smooth-running Maryland exchange.

The company had a waiting list of more than 1,000 people who were expected to sign up with it when the exchange turned on.

For months, however, it could barely sign up one. On its best day in recent weeks, its staff helped 10 people navigate Maryland’s site. Evergreen still has more than 1,000 people waiting to buy insurance.





Jennifer Jenkins, Jenna Johnson and Amy Goldstein contributed to this report.


0 Comments

January 13th, 2014

1/13/2014

0 Comments

 
The hype with the Affordable Care Act is that it moves to preventative care and it moves people from group living in senior centers to staying in their homes.  Sounds OK if you do not see how it actually works.  As I showed last time, Obama and the ACA is privatizing Medicare and Medicaid into these state health systems, something republicans have been trying to do for years and it is the neo-liberals doing it!  The idea is that to save Medicare for the upper middle-class you have to cull off the middle and working class to do it because after all 1/2 of Medicare spending has been stolen in health institution fraud and/or spent building the NSA spy network.

I wanted to focus on just a few issues in detail to show how detrimental the ACA is not only to all citizens but especially seniors.

THE ORGANIZATIONS SHOUTING OUT FOR ACA KNEW THESE ISSUES EXISTED BUT DELIBERATELY HID THEM FROM THE PEOPLE THEY PRETENDED TO SUPPORT!

So, seniors will stay in their homes as public retirement communities and public senior buildings close.  Don't worry they say, we are training tons of home health care people to come to your home to care for you.  OH, REALLY????

What is actually happening is that the ACA funding for this is not there.....kind of like NO CHILD LEFT BEHIND being an unfunded mandate.  So, all the public health support for seniors are being closed and handed to hedge funds to operate with no money coming to make sure quality care will occur.  WE ARE BEING GHETTOIZED.  Now, seniors were hard hit with fraud from this decade of massive corporate fraud-----savings, pensions, COLA increases eliminated for Social Security-----

A DELIBERATE ATTACK BY WALL STREET ON THE WEALTH GAINED BY BABY BOOMERS WITH OBAMA AND NEO-LIBERALS MAKING SURE WE CAN NOT GET JUSTICE!  ONLY, WHEN A GOVERNMENT SUSPENDS RULE OF LAW IT SUSPENDS STATUTES OF LIMITATION...

Seniors have been deliberately left without the retirement money they worked for and as we see below, the Medicare program that had strong support services for seniors are being dismantled as public health is handed to corporations for profit.  A senior in a senior care facility run by hedge funds as is the case in Baltimore with ManorCare?  Think Charles Dickens level of care for the elderly.  One imagines they will be forced to work with the disabled on menial labor to pay their way....which by the way seniors prepaid through payroll taxes.


ALL OF MEDICARE HAS BEEN PAID BECAUSE REAGAN TRIPLED PAYROLL TAXES IN THE 1980s JUST SO THERE WOULD BE PLENTY FOR BABY BOOMERS.  BUT DID THESE CORPORATIONS PAY THEIR SHARE OF THE PAYROLL TAX?  WE KNOW THAT PAYROLL FRAUD HAS BEEN RAMPANT.

We are not against immigrants coming to America to work and we are not against vocational tracking of students into health care.  What we are against is the outrageously inadequate level of training and knowledge people being sent to homes actually have.  This is serious.  People with chronic illness, people with psychological malady......these are serious and complicated health matters that these people being trained as home health workers have not a clue.  The people doing the job are not bad.....they are often not able to do the job or not trained right.  THAT DOES NOT MATTER....THE GOAL IS GETTING THE CHEAPEST MODEL IN PLACE TO MAXIMIZE PROFIT AND LOWER MEDICARE COSTS SINCE THERE IS NO MONEY IN THE TRUST.

Who is going to age into this mess?  Well, me no doubt as I am a regular middle-class professional with average means.  Remember, neo-liberals see the middle-class right now as give and take $200,000.  These are the wage earners that will be able to afford private senior care or the private insurance that allows it.  Right now that is less than 5% of US population.  It is the working/middle class that paid the most into these Trusts and it is these same people getting axed out of care with the ACA.

One thing you see throughout the Affordable Care Act is that there will be nurses and/or nurse practitioner involved in these health businesses taking over public health....including home health care.  As the commenter above pointed out in his review of one global corporation covering senior home health.....THERE WAS NOT A NURSE IN SIGHT.  HE HAD NO MEDICAL SUPERVISOR WITH WHOM TO TALK AND I HEAR THIS IN ALL CASES OF THESE HEALTH BUSINESSES.

You can see the same with education reform by privatization ------school boards filled with business people with no education background.  IT IS DELIBERATE AND IT WILL BREAK DOWN ALL PUBLIC HEALTH PROTECTIONS AND ALL STRUCTURES DESIGNED TO PROVIDE QUALITY CONTROL AND ACCOUNTABILITY.......which is the point of the ACA.....complete deregulation of the health care industry!





Social Security and Medicare taxes

Federal Insurance Contributions Act tax Federal social insurance taxes are imposed on employers[15] and employees,[16] ordinarily consisting of a tax of 6.2% of wages up to an annual wage maximum ($110,100 in 2012) for Social Security and a tax of 1.45% of all wages for Medicare.[17] For the years 2011 and 2012, the employee's contribution had been temporarily reduced to 4.2%, while the employer's portion remained at 6.2%,[18] but Congress allowed the rate to return to 6.2% for the individual in 2013. [19] To the extent an employee's portion of the 6.2% tax exceeded the maximum by reason of multiple employers, the employee is entitled to a refundable tax credit upon filing an income tax return for the year.[20]



You know what ACA does to Medicare access? It sends most care for seniors and Medicaid to home health care corporations....guess what? Cuts take even that access away!  Actually what Medicare is set to become for most will be the same as Medicaid......MEDICAID FOR ALL SAY THE AFFORDABLE CARE ACT PEOPLE! 

Below you see an industry political piece that tries to scare people into voting against democrats because this ACA policy will gut health care.   This article is truthful as to the effect cuts in funding will have on these private health businesses for home health but as someone that does not want these businesses getting all this Medicare funding.....I do not have sympathy for money lost to this industry.  As reformers cutting cost always say to the health industry-------figure out how to do it cheaper without losing your profits.  AND SO, THE LYING, CHEATING, AND STEALING BEGINS BECAUSE THEY ARE NOW REQUIRED TO FAKE THE NUMBER OF PATIENTS AND WHAT PROCEDURES THEY RECEIVE IN ORDER TO PAD PROFITS. 

Home Health Leaders: Unprecedented Medicare Cut Endangers Millions of Seniors' Access to Home Healthcare
November 25, 2013 2:22 PM PR NewsWire



Final Rule disregards input from lawmakers, seniors' advocates, and home health community –

CMS concedes that "approximately 40 percent of providers will have negative margins in CY 2017"(1)

WASHINGTON, Nov. 25, 2013 /PRNewswire-USNewswire/ -- Home health leaders warned that the Home Health Prospective Payment System (HHPPS) Final Rule, released Friday by the Obama Administration's Centers for Medicare and Medicaid Services (CMS), will directly impact the homebound seniors and disabled Americans who are the Medicare program's most vulnerable beneficiaries and will limit their access to the clinically advanced, cost effective home health care they need.

The HHPPS proposed rule initially included a 3.5 percent annual rebasing cut to Medicare home health funding – the maximum allowable under the Affordable Care Act (ACA) – which was calculated using an incorrect base year.  While the Final Rule now uses the correct base year (2010), it maintains the maximum annual rebasing cut of 3.5 percent, thereby imposing an unprecedented total rebasing cut of 14 percent over 4 years.

"From start to finish, this is a patient care issue," said Chairman Billy Tauzin, Senior Counsel to the Partnership. "The stated purpose of the Obamacare legislation was to expand Americans' access to healthcare, but this Obamacare regulation will do the exact opposite.  Despite pleas by lawmakers, seniors and stakeholders, CMS has decided to impose unprecedented cuts to the home health services on which the nation's most vulnerable Medicare population depends.  These cuts directly impact homebound seniors in rural, minority, and underserved communities who are among the Medicare program's oldest, sickest, and poorest beneficiaries."

"Despite the concerns expressed by more than 200 bipartisan Members of Congress, leading senior advocacy organizations, and dozens of other stakeholders, CMS chose to cut Medicare home health payments to the fullest extent allowed by the ACA," added Eric Berger, CEO of the Partnership.  "On a technical basis, this rule is also deeply flawed in that required analyses were never conducted on its impact over the full 4 years in which its cuts will go into effect or on the thousands of small businesses and their employees who will be impacted by it." 

"Just as troubling, the actual nature of this Final Rule has not been accurately disclosed," continued Mr. Berger.  "Although CMS releases seem to suggest that the Final Rule provides rebasing relief, the reality is that the cut in the Final Rule is the maximum allowable under the law.  The ACA authorized the Secretary to impose an annual rebasing cut of not more than 3.5 percent of the 2010 Medicare home health standardized payment rate.  The proposed rule exceeded the law in that it incorrectly applied the 3.5 percent cut to 2013 payment rates.  By contrast, the Final Rule applies the maximum allowable 3.5 percent annual cut to 2010.  As a result, all that can be said of the Final Rule is that, by properly replacing 2013 with 2010 as the base year, it no longer exceeds the law."


                               Base Year: 2013         Base Year: 2010

Proposed Rule       3.5%              EQUALS          4.5%

Final Rule                 2.7%              EQUALS           3.5%

"While there are so many people across the country whose health care will be adversely affected by this Final Rule, we are deeply thankful to the many lawmakers who devoted so much of their time and energy in an effort to protect Medicare home health beneficiaries," Mr. Berger added.  "They and the vulnerable Medicare beneficiaries they valiantly serve deserve better than this regulation."

Since the proposed rule was released, tens of thousands of patients, family members, providers, advocates, and state associations have cautioned the Administration that these cuts go too far and will have severe implications on the delivery of skilled home healthcare.  Extensive action was undertaken, including data and policy analyses, grassroots engagement, and extensive direct dialogue.  In addition, letters were filed by leading advocates including AARP, the American Hospital Association (AHA), the National Association of Home Care and Hospice (NAHC), the Visiting Nurses Association of America (VNAA) and many other stakeholders, all of whom expressed concern that the proposed cuts would negatively impact homebound seniors who depend on home health.

"The extraordinary cuts announced on Friday are alarming, especially in light of the deep cuts that Medicare home health has already suffered in recent years," added Senator John Breaux, Senior Counsel to the Partnership.  "Even before these latest cuts, funding for Medicare home health services had been reduced by more than $72 billion since 2009.  When factoring in these additional cuts, two of the nation's leading health care consulting firms – Avalere Health and Dobson|DaVanzo Associates – project that the home health delivery systems in nearly every State will experience net losses by 2017, which greatly jeopardizes seniors' access to high-quality, low-cost home healthcare.  In fact, even CMS concedes – on page 117 of the HHPPS Final Rule – that 'approximately 40 percent of providers will have negative margins in CY 2017' and that more than 8-in-10 of these providers are already experiencing negative margins as a result of pre-existing cuts!  For these reasons, we strongly urge decision makers to protect homebound seniors from this regulation and any further cuts in the weeks and months ahead."

"The fact that this extreme regulation is a result of Obamacare means it cannot help but have political in addition to access implications," concluded Chairman Tauzin.  "The Medicare cuts in the 2010 Obamacare bill angered seniors so much that voters over age 65 helped give Republicans control of the U.S. House in the President's first midterm elections.  These newest Medicare cuts, coming right out of Obamacare, could now put the Democrats' Senate majority in jeopardy when senior voters cast their ballots next November.  Both Democratic and Republican leaders tried to stop the White House from issuing this unprecedented cut, and both were ignored.  Three and a half million seniors depend on home health, they vote, and they are not likely to take these cuts lying down." 


With an estimated 10,000 American seniors entering the Medicare program every day, the Medicare home health benefit is widely recognized as a clinically advanced, cost-effective and patient preferred means for meeting the post-acute and long-term care needs of this rapidly growing patient population. Medicare home health services are delivered to approximately 3.5 million Medicare beneficiaries, who are documented as being more likely to be poor, old, sick, and minority than the Medicare beneficiary population as whole.  In light of its importance to millions of seniors and their families, the Medicare home health sector has been one of the nation's leading creators of new jobs according to the Bureau of Labor Statistics.


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As we see below a decade ago it was revealed that this growing industry was not functioning properly, had no oversight, and no public transparency.  Now, Baltimore and Maryland are 10 times worse than California in all these regards so one can imagine what this industry looks like in Maryland.  We have had our entire public sector health dismantled and handed to private non-profits run by health corporations.

As you see below this business system mirrors the lack of oversight, the fraud and corruption as all US business sectors only now it is public health.  I want to emphasize that because Maryland has no media reporting or investigation in all of this it is safe to conclude that what is happening here is happening in Maryland only more than likely worse.  Remember, Maryland has a waver from Medicare in oversight and that compounds the abuse.  See why Maryland has reduced Medicare spending?

------PEOPLE ARE DYING FROM NAKED CAPITALISM

I want to emphasize that these problems have not been addressed....they are worse!

Publicize Home Care Problems, Critics Say / Complaints about health providers hard to dig out

Janet Wells, Chronicle Staff Writer Published 4:00 am, Wednesday, May 24, 2000



In the wake of revelations about problems at Kaiser Oakland's home health program, consumer advocates are decrying the failure of state and federal agencies to inform the public about serious deficiencies among home health care providers.

The state Department of Health Services performs scores of investigations each year that reveal numerous problems. Yet the agency has no mechanism or requirement for public disclosure of its findings.

Such is the case even when violations are serious enough to put patients in "immediate jeopardy," as the state recently found was occurring at Kaiser.

"The fact is we have these problems, and there's no venue for reporting them," said Celi Adams, founder of Home Care Companions, a San Francisco-based group that trains people to provide home care for seriously ill relatives and friends.

"Nobody has the responsibility to put it out there, and it absolutely would be helpful to publish once a year what the complaints were, or the 10 worst home health agencies in the state."

Daniel Zingale, the interim head of the state's new Department of Managed Care, which will oversee health maintenance organizations starting July 1, agrees. He plans to issue a report on managed care with "easily accessible" information about state violations.

"There's definitely a need for more and better information being made available to the public," said Zingale, whose department is scheduled to take over much of the health care oversight responsibility of the Department of Corporations.

"Shining a spotlight on the strength and failings of managed care plans may be the best tool we have to ensure the quality of care they deliver," he said.

In Kaiser's case, the state investigation revealed problems so serious that they contributed to the death of one elderly patient from malnutrition, septic shock and deeply infected bed sores. Kaiser was given 23 days to fix the worst problems; it is now in compliance.

Although state reports on home health care providers are public record, it takes determination to dig one out.


The state performed almost 100 full surveys of the 944 home care providers last year, in addition to documenting investigations into 400 complaints.

A consumer seeking information about a particular home health agency must first determine which of the 13 state licensing and certification districts investigated it and then go to the district office in person to request the documentation.

But before the survey or complaint investigation is public record, the home health agency has up to several months to file a plan of correction and implement improvements.

After a brief follow-up visit by state evaluators to verify that changes are in place, the home health agency is left to monitor its own progress.

"It's all handled internally," Adams noted. "The public is not informed, and then it's a done deal. As a consumer, I want to know what's going on."


The idea is not to punish home health agencies, said Department of Health Services spokeswoman Lea Brooks. "You try to do everything you can to get the operator to comply."

Home health agencies have been sorely squeezed in recent years, facing severe staffing shortages, increased regulatory requirements and, since 1997, a 45 percent cut in reimbursement from Medicare, which pays for almost 80 percent of home health visits in California, according to state records.

Almost 300 agencies in California have closed in the last three years, mostly due to the deep cuts in Medicare reimbursement, said Connie Little, senior vice president of the California Association for Health Services at Home, an industry group representing 500 agencies.

Little pointed out that consumers have access to information on home health agencies from the Joint Commission on Accreditation of Healthcare Organizations, whose Web site is www.jcaho.org. The Illinois-based group has accredited 6,000 home health agencies nationwide, but participation in the accreditation survey process is voluntary and does not have the same focus -- or impact -- as a regulatory agency survey.

Little questioned whether consumers would benefit from public disclosure requirements in the home heath care industry. "If you're going for a regulatory fix, you get more regulations," she said. "I don't know if it increases the quality of care."


_____________________________________________
Below you see a good description of what conditions have to be met before you can qualify for home health care.  Time and again I hear from people who need the service desperately they cannot qualify for Medicare help and the cost is prohibitive.  So, if the only option for seniors needing a support system to age into is home health and they have written the laws so that getting that help is not easily available what happens to seniors?

They fall prey to the worst of private companies that act as the 'safety net' that once were public run institutions.  Mind you, state run senior care has always been the pits......but being a public institutions there was the ability to hold the institution accountable for public interest.  In this reform, people will be tracked into these private care facilities given no oversight and transparency and making it hard for families to get justice for bad care.

THIS IS WHAT NAKED CAPITALISM AND HEALTH CARE LOOK LIKE AND IT WILL NOT BE PRETTY!



When the Medicare home health benefit pays for home health care

Section IV.g. Home Health Care Benefit (Part A and B)Question 1 of 10 (use "Last" or "Next" buttons to see more) Return to referring page

Medicare will help pay for your home care if all four of the following are true:

1. You are considered homebound. Medicare considers you homebound if you meet the following criteria:  

  • You need the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home or your doctor believes that leaving your home would be harmful to your health; and
  • It is difficult for you to leave your home and you typically cannot do so.
2. You need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means you need care little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services. Skilled therapy services can be physical, speech or occupational therapy;*

3. Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare. 

  • As part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you related to the main reason you need home care within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.
  • The face-to-face encounter can also be done through telehealth. In certain areas, Medicare will cover examinations done for you in specific places (doctors offices, hospitals, health clinics, skilled nursing facilities) through the use of telecommunications (such as video conferencing). 
4. You receive your care from a Medicare-certified home health agency (HHA).

*If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. Even when your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you continue to need it.

If you have questions about billing issues for home health care you should contact 800-MEDICARE.

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A GLOBAL FRANCHISE CARING FOR OUR SENIORS.....HOW SPECIAL!!!!  Carlyle hedge fund has Baltimore's ManorCare!

A global leader in non-medical in-home senior care, the Home Instead Senior Care Network® has more than 900 international franchise businesses in operation, with key Home Instead Master Franchise markets still available worldwide.

Instead of worry, there's Home Instead®

The 85-and-older population is expected to more than triple between 2008 and 2050 in the United States alone. This staggering statistic not only proves the growing need for elderly home care, but also the fact that thousands of families are facing the same critical decision as you. You are absolutely not alone.

Since 1994, the Home Instead Senior Care® franchise network has been devoted to providing the highest-quality senior home care. Compassionate Home Instead CAREGiversSM are an invaluable resource in helping families eliminate worry, reduce stress and reestablish personal freedom. From Alzheimer's and dementia support to respite care and companionship, our more than 900 locally owned and operated offices are ready to help you through this difficult time.


Below you see a review written by a former employee.  Not surprising he recommends using smaller, local care as there is no consumer interest in this global corporate home health chain.  Sound familiar?  If you think this is bad for a cell phone business wait until it becomes life and death!

THAT'S THE WAY NEO-LIBERALS ROLL!!!

Exploiting health care workers and giving no attention to consumer communications----

Consumer Affairs
Consumer Complaints & Reviews


sally of St Paul, MN on Dec. 31, 2013

Satisfaction Rating1/5I worked at H. I. and also at another agency (where I am very happy). Home Instead doesn't pay well, but I really enjoyed my clients and have a much larger appreciation for seniors after working for them...I have reservations about them:

First, Home Instead doesn't have any nurses on staff just a million managers and supervisors who I have NEVER met who are constantly calling and emailing me. It's run very business-like not AT ALL personal. They are very micro managerial which is why I've wanted to leave and why I already have another job. They are over, over, overstaffed by people to over yet under manage the caregivers. When there is a problem, there is NO ONE to help- the "on call supervisor" is a joke- has never ever met the clients and is paid to basically answer the phone (I'm sure she calls in her hours on time which is probably why she's still there) but if you make a mistake 5 people you've never met to pound on you and tell you what you should have done...very corporate, over managed and under effective. Never met the owner.

The other company however, I have met the owner, nurses and the few staff. They are effective and staff manage themselves and know who to contact and know things will be handled promptly and effectively. The nurses actually are familiar with the clients, their meds, home, etc and are a phone call away. The small staff actually work TOGETHER cooperatively as an actual CARE TEAM (medical model) instead of destructively at each other (corporate model). I'd recommend a small independently run non-chain agency over an indifferent corporate business. As a CNA, almost-nurse and caregiver I feel for better care for your family go with a small, independent medically minded agency. It's better for both the client and caregiver. I also think that clients' family want a caregiver that is treated well.

__________________________________________
One thing you see throughout the Affordable Care Act is that there will be nurses and/or nurse practitioner involved in these health businesses taking over public health....including home health care.  As the commenter above pointed out in his review of one global corporation covering senior home health.....THERE WAS NOT A NURSE IN SIGHT.  HE HAD NO MEDICAL SUPERVISOR WITH WHOM TO TALK AND I HEAR THIS IN ALL CASES OF THESE HEALTH BUSINESSES.

You can see the same with education reform by privatization ------school boards filled with business people with no education background.  IT IS DELIBERATE AND IT WILL BREAK DOWN ALL PUBLIC HEALTH PROTECTIONS AND ALL STRUCTURES DESIGNED TO PROVIDE QUALITY CONTROL AND ACCOUNTABILITY.......which is the point of the ACA.....complete deregulation of the health care industry!


BELOW IS A REALLY, REALLY LONG REAL ACADEMIC STUDY THAT ADDRESSES THE NEED FOR NURSES IN SENIOR CARE CENTERS.  IT CLEARLY SHOWS THAT TAKING THESE NURSES OUT....ESPECIALLY COMPLETELY WILL BE HARMFUL.


Health Serv Res. 2004 April; 39(2): 225–250. doi:  10.1111/j.1475-6773.2004.00225.xPMCID: PMC1361005

Relationship of Nursing Home Staffing to Quality of Care

John F Schnelle, Sandra F Simmons, Charlene Harrington, Mary Cadogan, Emily Garcia, and Barbara M Bates-Jensen

To compare nursing homes (NHs) that report different staffing statistics on quality of care.

Data SourcesStaffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes.

Study DesignTwo groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures.

Data CollectionDirect observation, resident and staff interview, and chart abstraction methods.

Principal FindingsStaff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes.

ConclusionThe highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes.

Keywords: Staffing, quality of careNursing home (NH) staffing resources necessary to provide care consistent with regulatory guidelines are the subject of national debate due to emerging evidence that existing staffing resources may not be adequate (U.S. Department of Health and Human Services 2000b). One recent study for the Centers for Medicare and Medicaid Services (CMS) reported that 4.1 mean total (nursing aides [NAs] plus licensed nurses) direct care hours per resident per day (hprd) and 1.3 licensed nurse hprd (.75 for registered nurses [RNs] and .55 for licensed vocational nurses [LVNs]) were the minimum staffing levels associated with a lower probability of poor resident outcomes, such as weight loss and pressure ulcers (Kramer and Fish 2001). This study is supported by other correlational data documenting a relationship between staffing (particularly RNs) and a variety of outcomes, including: lower death rates, higher rates of discharges to home, improved functional outcomes, fewer pressure ulcers, fewer urinary tract infections, lower urinary catheter use, and less antibiotic use (Linn, Gurel, and Linn 1977; Nyman 1988; Munroe 1990; Cherry 1991; Spector and Takada 1991; Aaronson, Zinn, and Rosko 1994; Bliesmer et al. 1998; Harrington et al. 2000; U.S. Department of Health and Human Services 2000b). Few studies have specifically examined the relationship between staffing and the implementation of daily care processes, but inadequate staffing has been associated with inadequate feeding assistance during meals, poor skin care, lower activity participation, and less toileting assistance (Spector and Takada 1991; Kayser-Jones 1996, 1997; Kayser-Jones and Schell 1997). The results of these correlational studies led two Institute of Medicine committees to recommend higher nurse staffing in nursing facilities, including 24-hour registered nursing care (Wunderlich, Sloan, and Davis 1996; Wunderlich and Kohler 2001;). An expert panel recommended even higher minimum staffing levels (4.55 hprd including 1.85 licensed nurse hprd) (Harrington et al. 2000). However, neither the correlational studies nor the CMS study directly measured specific care processes that may be better implemented in higher staffed homes and that could explain the effects on resident outcomes.

A second study conducted for CMS focused on this care process implementation issue (Schnelle, Simmons, and Cretin 2001). This study used staff time estimates in computerized simulations to predict the nursing assistant (NA) staffing ratios necessary to provide care recommended in regulatory guidelines. Care processes related to incontinence care, feeding assistance, exercise, and activities of daily living (ADL) independence enhancement (e.g., dressing), all of which are typically implemented by NAs, were included in the simulation. The results of this study showed that 2.8 to 3.2 NA hprd, depending on the acuity level of the NH population, were necessary to consistently provide all of these daily care processes. The NA staffing levels reported in this process-focused study are similar to those recommended by one expert consensus panel who also attempted to identify the labor requirements to implement key care processes, such as feeding assistance (Harrington, Kovner et al. 2000). Unfortunately, 92 percent of the nation's NHs report staffing levels below the staffing minimums identified by the expert panel as well as the two recent CMS studies, and more than 50 percent of NHs would have to double current staffing levels to meet these minimums (U.S. Department of Health and Human Services 2000a).

The fact that so many NHs report staffing levels below this minimum has led to recent efforts to develop staffing indicators so that long-term care consumers can make informed judgements about the adequacy of NH staffing within a facility. However, neither the simulated staffing predictions nor the expert consensus recommendations have been subjected to a field test evaluation. Based on the simulation predictions, one would hypothesize that higher staffed NHs would be better able to provide labor-intense daily care activities, such as feeding assistance, toileting assistance, repositioning, and exercise care. More specifically, it would be predicted that homes that report 2.8 to 3.2 NA hprd would perform significantly better than all other homes in the implementation of these daily care processes. The purpose of this study was to address this issue by describing the relationship between staffing levels in 21 NHs and directly measured processes of care that are both labor intense and recommended in NH regulatory guidelines. The primary question addressed in this study was: Is there a relationship between staffing, as separately reported by NH administrators and NAs, and the implementation of daily care processes that reflect quality of care?

Go to:MethodsSubjects and SettingRecruitment of homes was accomplished in two phases (Figure 1). In phase one, 175 homes were identified in the southern California region as being in the upper 75th percentile or lower 25th percentile according to staffing data reported by NH administrators in 1999 to the State of California (California Office of Statewide Health Planning and Development 2002). Mean total direct hprd was used to determine each home's percentile rank. Thirty homes agreed to participate (15 in each of the extreme quartiles). However, only 17 of the 30 homes remained in the same quartile according to state staffing data reported in the year 2000 (9 lower quartile; 8 upper quartile). In addition, six of the eight homes in the upper quartile in both years (stable homes) reported a decrease in staffing in 2000 (4.0 hours to 3.4 hours) with all six homes clustered at 3.4 direct care hprd. The two remaining homes in the upper quartile were more stable and reported 3.7 and 5.1 direct care hprd in 2000. Furthermore, NAs in these two higher staffed homes also reported significantly lower resident care loads on interview in the year 2001 when compared to homes in the remaining upper quartile, as will be reported later. Thus, homes were initially divided into the following three categories for analytical comparisons: nine homes that reported an average of 2.7 hprd in both 1999 and 2000 (Group 1: lower quartile homes), six homes that reported 3.4 hprd in both 1999 and 2000 (Group 2: upper quartile homes), and two homes that reported an average of 4.9 hprd in both 1999 and 2000 (Group 3: upper-decile homes).

Figure 1Flow of Participants through TrialBecause of the potential importance of the upper-decile homes, Phase 2 was initiated to recruit additional homes in the 91st to 100th percentile (upper decile) following the completion of data analyses for Phase 1 homes. Research staff was blind to the staffing percentile ranking for each home during the data collection and analyses for Phase 1 but not in Phase 2 (see Figure 1). In Phase 2, 47 homes in the Southern California region were identified as being in the upper decile according to 2000 state staffing data. These homes also had small (<10 percent) Medicare populations because large Medicare populations can inflate staffing levels for the long-term care portion of the NH. Four homes were recruited that reported staffing levels above 3.8 total hprd in the year 2000 (upper decile) for a predominantly long-term care population.

Thus, a total of 21 homes were studied across the two phases. Residents who were long stay (not covered by Medicare) were eligible for participation, and resident recruitment occurred over two weeks within each home. The number of participants and consent rates are illustrated in Figure 1. Onsite data collection both to assess quality of care and to confirm state staffing reports with NH staff interviews occurred over three consecutive days and were conducted from June 2001 to September 2002. State cost report staffing data were not available for the year 2001.

Staff Interviews: Accuracy of State Staffing Reports To check the accuracy of year 2000 staffing statistics reported by NH administrators to the state and also to update these statistics, research staff conducted interviews with 118 NAs who worked on the 7 a.m. to 3 p.m. and 3 p.m. to 11 p.m. shifts during onsite data collection in 2001–2002. The NAs were asked “How many residents are you responsible for today?” and “Are you working ‘short’?” Administrators were also asked to report the number of NAs, LVNs, and RNs that were usually scheduled during the time period that onsite data collection was being completed. These data were converted into staffing hours per resident day by assuming that a full-time staff member worked 7.5 hours and dividing staffing hours by the number of occupied beds in the facility. Even though these staffing data were not collected according to the same specific definitions used for the state reporting system, it does represent a more current staffing estimate. Independent checks of time cards to validate staffing statistics were not possible because it would have required consent from each NH staff member in the facility. The onsite staffing reports were not regarded as more or less accurate than the state staffing reports, only more timely. The agreement between the different staffing data sources was considered an important estimate of data accuracy.

Measurement DomainsSixteen care processes typically implemented by NAs were measured by research staff using standardized direct observation and resident interview protocols during three consecutive 12-hour weekdays in each NH. The care process measures relevant to NA job performance can be divided into four major domains: out of bed/social engagement; feeding assistance; incontinence care; exercise and repositioning. Each of these NA care process measures can be defended as representing “good practice” and should be sensitive to differential NA staffing between homes because most of these care processes are also labor intense to implement.

All participants were observed with at least one of three different observational protocols (described below), but subgroups of participants were selected for interview. Participants with an MDS recall score of two or greater were asked questions about the occurrence of specific care processes (e.g., How often do you receive walking or toileting assistance?) because a recent study showed that residents who meet this interview selection criterion are able to accurately describe the care they receive (Simmons and Schnelle 2001). However, all participants were asked more general questions about the quality of assistance (e.g., Do you have to wait too long?) because there is evidence that residents who are capable of completing an interview can provide stable responses to these types of questions. Eleven care process measures related primarily to licensed nurse staff performance (e.g., pressure ulcer risk assessment) were evaluated based primarily on medical record review, with the exception of two resident interview measures, using standardized protocols.

Out of Bed and Engagement: Observations To assess participants' time spent in bed and social engagement during the day research staff observed participants for one 12-hour day (7 a.m. to 7 p.m.). The time-sampling protocol involved locating each participant every hour between 7 a.m. and 7 p.m. and observing the resident for up to one minute. Engagement was defined as interaction with either a staff member, a resident, or another person; an organized group activity; or with an object (e.g., television, reading, sewing). These two measures (out-of-bed time and engagement) are related to staffing levels, because assisting residents out of bed is labor intense since it occurs during the morning or evening periods when there are numerous competing activities (e.g., breakfast) and the resident must be dressed or groomed at the same time. There is evidence that NH residents spend excessive times in bed (Schnelle et al. 1998). It was also hypothesized that staff in high-staffed homes would have more time either to interact with or encourage residents to participate in activities during the day. Social interaction with and prompting residents to participate in activities are not necessarily labor intensive but are optional care activities that may not occur if staff are rushed to provide more mandatory physical care (e.g., providing feeding assistance to residents).

Feeding Assistance: Observation and Interview Measures Seven measures related to the quality of feeding assistance care were measured using direct, continuous (not time-sampled) observations during meals in which one staff member observed six to eight participants. All feeding assistance measures were assessed regardless of dining location (dining room versus room), with the exception of social interaction and verbal prompting during meals. The percent of social interaction or verbal prompts during meals was designed to assess the quality of feeding assistance, and interaction was counted if at least one minute of social interaction or verbal prompting occurred between the resident and the NH staff. Social interaction during meals has been related to increased food intake, and even the most cognitively impaired resident should receive some verbal prompts and social interaction during meals as opposed to physical assistance rendered in silence. The development, rationale, and scoring rules for all feeding assistance care process measures have been described elsewhere (Simmons et al. 2002). Brief descriptions of a few measures are provided here. Two measures were related to determining if a resident who is at risk for weight loss due to either low oral food and fluid intake or physical dependency on staff for eating, received at least a minimal amount of staff assistance during meals. Participants were considered to “pass” the first care process measure if they ate less than 50 percent of their meal but still received more than one minute of staff assistance. The logic of this indicator is that residents with intake below 50 percent are at risk for weight loss, and staff should try to provide assistance to these residents. If a resident ate less than 50 percent and received less than one minute of staff attention, it is not possible to separate poor assistance from other explanations for the poor eating. Participants were considered to pass the second care process measure if they were rated as physically dependent on the MDS and received more than five minutes of assistance. A measure relating to the accuracy of NH staff documentation of residents' oral food and fluid intake during meals and, thus, the ability of staff to identify residents with potentially problematic intake was also assessed. A participant passed this care process measure if he or she was observed by research staff to eat less than 50 percent of their meal and NH staff recorded less than 60 percent. Low intake is associated with weight loss and accurately identifying this problem is a logical prerequisite for prevention. Participants who had an MDS recall score of two or greater were also asked one interview question related to the NH food service, “If you don't like the food served at a particular meal, can you get something else?”

It was hypothesized that feeding assistance would be significantly associated with staffing levels because it is labor intense to provide this daily care process for all residents who need it. Both the simulation predictions conducted for the CMS study and one expert consensus panel predicted that a NA staffing ratio of two to five residents per NA is necessary to provide adequate feeding assistance care (Harrington, Kovner et al. 2000; Schnelle, Simmons, and Cretin 2001).

Incontinence Care: Interview Measures Incontinent participants, according to the most recent MDS assessment, with MDS recall scores of two or greater were asked how often they received toileting assistance, and all incontinent residents who responded to the interview questions were asked the more general question, “Do you have to wait too long for assistance?”

Exercise and Repositioning: Observation and Interview Measures Observational data relevant to participants' physical movements were obtained from a wireless monitor worn on the thigh that measures horizontal and vertical orientation every four seconds. Preliminary research showed that repositioning movements in bed were characterized by the monitor recording a minimum 40° move in the horizontal position followed by maintenance of at least a 20° change in the horizontal position and at least two 40° vertical changes when repositioning occurred in a chair. The monitor also enabled the detection of physical activities that involved sustained participant movement for at least six minutes and, thus, could possibly reflect an episode of exercise care. Because exercise (e.g., walking assistance) could not be discriminated from care processes that involved movement for other reasons (e.g., incontinence care), all participant movements that were sustained for at least six minutes were characterized as “activity episodes” possibly related to exercise. The thigh monitor was used because preliminary data indicated that any observational schedule feasible for a human observer to implement with more than three residents would underestimate the frequency of care episodes, such as walking and repositioning, that occur less than every two hours and are relatively brief in duration.

Two movement measures were calculated from thigh monitor data. First, the number of repositioning episodes per hour was calculated for participants who were noted in the medical record as being on a two-hour repositioning program and who could not reposition themselves independently according to a performance test conducted by research staff. In this test, participants who were unable to move from side to side unless they received physical assistance were considered dependent on staff for repositioning. Next, the number of activity episodes per hour was calculated for each of the above participants to determine whether there were differences between high- and low-staffed homes in the provision of care processes that could be interpreted as exercise.

Finally, all participants with MDS recall scores of two or greater and who were in need of walking assistance were asked how many walking assists they received per day. The participants' need for walking assistance was determined during a performance test conducted by research staff in which participants were asked to stand and walk and provided graduated levels of assistance to do so. Participants who were unable to stand and bear weight, even if provided full physical assistance by research staff, were excluded from this analysis. It was hypothesized that higher-staffed homes would be more likely to consistently provide exercise, repositioning, and walking assistance to participants because all of these care processes are labor intensive.

Medical Record Review: Licensed Nurse Measures Descriptive information for all participants was collected from the medical record and the most recent MDS or the annual assessment for some items. A trained physician or geriatric nurse practitioner conducted medical record reviews to assess care processes related to licensed nurse activities. It was hypothesized that licensed nurses in homes with higher staffing would perform better at assessment of conditions typically managed by nurses, as opposed to primary care providers, than licensed nurses in homes with lower staffing.

Eight of the licensed nurse care process measures used in this study are derived from the RAND Assessing the Care of Vulnerable Elderly (ACOVE) project. The quality indicators in the ACOVE project were operationalized with specific scoring rules and data sources identified for rating each indicator. The methodology used to develop the ACOVE indicators and the evidence that supports their validity has been reported elsewhere (Wenger and Shekelle 2001; Shekelle et al. 2001; Saliba and Schnelle 2002). Eight care processes from the set of ACOVE quality indicators most relevant to licensed nurse performance were identified by a geriatric nurse practitioner and clinical nurse specialist who covered three care areas: pressure ulcer, incontinence assessment, and pain. In addition, three care processes that were not specific ACOVE indicators were identified that evaluated how well nurses either assessed pain or provided medications to residents with chronic pain.

The ACOVE indicators are relatively self-explanatory even though it should be noted that liberal scoring rules were used to determine if a participant's medical record documentation met the pass criteria for each indicator. For example, in regard to incontinence Indicator 5, a medical record was considered to have fulfilled the intent of this indicator if documentation was provided for just two of the three conditions (e.g., skin health, genital system examination, fecal impaction assessment). The measures used to assess how well nurses were detecting and treating pain requires more explanation.

Three interview measures were used to evaluate licensed nurse performance relevant to pain. Research staff attempted to interview all participants with MDS recall scores of two or above with a set of six questions about pain. Two questions were related to communication between the licensed nurse and the resident regarding pain, “Do you tell the nurse about your pain?” and “Does the nurse ask you about pain?” We report data on the latter question and hypothesized that licensed nurses in higher-staffed homes would ask participants about pain more frequently than nurses in lower-staffed homes. Directly taking a proactive approach and asking residents about pain was considered better care than the more passive approach of simply reacting when a resident spontaneously complains of pain.

The four remaining pain questions were used to identify participants with chronic pain symptoms. Participants were asked: “Do you have pain every day?”; “Does pain ever keep you from doing things you enjoy (like social activities, walking)?”; “Does pain ever keep you from sleeping at night?”; and “Do you have pain right now?” Participants were judged as endorsing chronic pain if they responded “yes” to the question, “Do you have pain everyday?” or if they responded “yes” to all three remaining pain questions. To assess how well licensed nurses were detecting pain we determined the percent of participants who were judged as having chronic pain according to research staff interview who also had licensed nurse documentation of pain on the most recent MDS assessment. We also assessed licensed nurse performance relevant to management of chronic pain. First, we identified a subgroup of participants who had chronic pain according to research staff interviews. Then we determined the percent of this subgroup of participants who were offered pain medication by the licensed nurse at least 50 percent of the days in the previous month. We believed that licensed nurses in higher staffed homes would both detect chronic pain symptoms and offer as needed pain medication more frequently than licensed nurses in lower staffed homes.

Reliability and Stability Interrater reliability for time in bed and engagement observational measures was statistically significant for both measures but high only for the in-bed measures (measures 1 and 2, Table 3; kappa values .65 and .29; p<.001). A subset of 272 participants was observed for a second day on these measures to evaluate stability. The Pearson correlation was .79 for in-bed and .47 for engagement (p<.05). Interrater reliability for all observational-based feeding assistance care process measures shown in Table 3 (measures 3 to 10) ranged from .92 to 1.0; n=55 to 199; p<.001. Mealtime observations were repeated on a second day for all participants and correlations between the two days were significant on all variables (range .22 to .75; p<.05) with social interaction and verbal prompting measures showing the lowest but still significant correlations. The low correlation for this social interaction variable was due to the relatively low frequency that this behavior was observed. Correlations for all the other nutritional measures were above .60. Correlation between a resident's reported having received toileting assistance on two separate days (measure 11, Table 3) was .62; p<.01. The interrater agreement for the interpretation of thigh monitor data necessary to calculate exercise care process measures (measures 13, 14, 15) produced kappa statistics of .61 for repositioning movements, .82 for activity episodes while in a chair, and .75 for activity episodes while in bed. The correlation of a participant's report of walking assistance (measure 16) between two days was calculated for 38 residents (day 1 number of assists reported versus day 2 number of assists reported; r=.35, p<.05).

Table 3Observation and Interview Measurement DomainsGo to:ResultsCharacteristics of Participants in Key Comparison GroupsTable 1 shows the demographic characteristics of the participants in each group of homes. There were significant differences between participants in all three groups (Table 1). In particular, participants in the upper-decile homes were significantly more likely to be female, older, private pay, and Caucasian when compared to participants in all the other homes; while participants in the lower quartile homes were significantly more likely to be minority and MediCal. In terms of participant acuity, participants in the lower quartile homes (Group 1) tended to be more independent for transfer and feeding assistance and had better cognitive functioning (MDS recall scores) when compared to participants in both the 75th to 90th percentile (Group 2) and upper-decile homes (Group 3). There was no difference on five MDS based acuity measures (recall, transfer and eating dependency, incontinence, pressure ulcer RAP triggered) when comparisons were made between residents in the highest-staffed homes (upper decile) and those in the two lower-staffed homes (combined Groups 1 and 2 versus Group 3).

Table 1Facility and Demographic Characteristics of Participants in Sample Nursing HomesTo address generalizability issues, efforts were made to determine if differences existed between 9 highest-staffed and 45 lower-staffed homes that declined participation in this project and the 6 highest-staffed and 15 lower-staffed homes that participated. The homes that declined participation and the homes that participated were compared on MDS-derived measures of prevalence of weight loss, physical restraint use, and residents' need for assistance with transfer, eating, and toileting characteristics, all of which are available from a new public reporting system in California (http://www.calnhs.org). In addition, data were available describing homes' profit status, total nursing staff hours, nursing staff turnover, total federal deficiencies cited for 2001–2002, and expenditures for direct resident care per resident day. The only difference between participating lower-staffed homes and nonparticipating lower-staffed homes was on the expenditures per resident per day ($59 versus $68, respectively; t=2.115, p=.04). The only difference between participating and nonparticipating highest-staffed homes was on for-profit status of the home (33 percent versus 100 percent, χ2=8.182, p=.004). These results should be cautiously interpreted but in general suggest that the homes participating in this project comprise a relatively typical sample.

Sample Characteristics: Staffing DataTable 2 illustrates the staffing data for the three groups of NHs. The first eight rows alternatively illustrate state staffing statistics for the year 2000 and onsite staffing data reported by administrators. There were large differences between high-decile homes and all remaining homes on all staffing variables except RN hours according to 2000 state staffing data. These differences are most dramatic for total staffing hours and aide staffing hours. In regard to total hours, high decile homes reported an average of 4.88 hours compared to lower quartile and 75th to 90th percentile homes that reported 2.7 and 3.4 hrpd, respectively. There were also significant but less dramatic differences between homes in the lower quartile and the 75th to 90th percentile on most staffing variables. However, interview data collected in 2001–2002 while the research team was onsite suggested that there were no longer differences between lower quartile homes and those in the 75th to 90th percentile on any staffing variable. Lower-quartile home administrators reported an increase in total staffing from 2.7 in 2000 to 3.2 in 2001–2002 and the 75th to 90th percentile homes reported a staffing decrease from 3.4 to 3.0. Administrator reports of staffing and NA reports of workload continued to show a significant difference for Group 3 (upper decile) homes compared to the remaining homes. Administrators reported a total of 4.5 hrpd in 2001–2002 in the upper-decile homes. Both administrators and NAs in the upper-decile homes reported a ratio of residents to NAs on the 7 a.m. to 3 p.m. and 3 p.m. to 11 p.m. shifts combined that were very close (7.1 to 7.6 residents to NAs, respectively). These reports were significantly different from the NA workload reports in other homes (e.g., nine to 10 residents per aide, see Table 2, rows 9, 10). These data suggest that there are two distinct groups of homes based on staffing statistics. The difference in staffing between Group 1 and Group 2 homes is not only small and unstable, but also well below those minimums thought to indicate better care according to both expert panels and recent CMS studies. Alternatively, the homes in the upper decile were not only dramatically higher on staffing measures when compared to all other homes but also staffed at those levels thought to be necessary to provide good care (Harrington, Kovner et al. 2000; Schnelle, Simmons, Cretin 2001; Kramer and Fish 2001). For these reasons, the primary comparisons on all care process measures were conducted between homes in the upper decile (Group 3) and the remaining sample (Groups 1+2 combined).

Table 2Staffing Characteristics of Sample Nursing HomesNA Care Process Measures: Do Homes That Report the Highest NA Staffing (Group 3 Upper Decile) Provide Different Care Than the Remainder of the Homes (Groups 1 and 2 Combined)Table 3 illustrates that upper-decile homes (Group 3) were significantly different in the same direction on 13 of 16 different care process measures; and, in eight cases significance levels exceeded p<.001. The probability that 13 out of 16 comparisons would be significant at the .05 level by chance is less than .00001. The pattern of significant differences was consistent across all care areas listed in Table 1, but the care process differences were most compelling for feeding assistance and least compelling for exercise and repositioning. In general, participants in the upper-decile homes spent more time out of bed during the day; were engaged more frequently; received better feeding and toileting assistance; were repositioned more frequently; and showed more physical movement patterns during the day that could reflect exercise. However, even participants in these highest-staffed facilities did not receive repositioning at the rate of once every two hours during the day or night and only received potential exercise activities at the rate of approximately one episode every four hours. In addition, there were no differences between the groups of homes in repositioning frequency at night; walking assistance frequency during the day as reported by the participants; or the amount of social interaction observed between residents and staff during meals.

Social interaction during meals could only be measured in the dining room, and participants in the upper-decile homes were observed significantly more often in the dining room than those in the remaining homes. If one assumes that there are very low or zero levels of social interaction between residents and staff if residents eat in their rooms, which is a reasonable assumption, then there would be significant overall differences in the amount of social interaction that participants in upper-decile homes received during meals as compared to participants in all remaining homes.

There were no differences on five MDS-based acuity measures that could explain why more residents ate in their rooms more often in the lower-staffed homes (Groups 1 and 2 combined versus those in the highest-staffed NHs—see Table 1). The significant higher age of residents in the highest-staffed home would seem predictive of these residents spending more time in bed as opposed to less time as was observed. However, none of the demographic characteristics including age were correlated with in-bed or feeding assistance measures across all homes. A multiple regression analysis using staffing as a categorical variable (upper decile versus all others) and MDS acuity scores that were correlated with in-bed time (transfer and feeding assistance, recall scores, and prevalence of UI and pressure ulcer RAP triggered) revealed that staffing remained the only significant predictor of in-bed time (standardized beta=−.28, standard error=8.8, p<.003).

Licensed Nurse Performance MeasuresTable 4 presents the licensed nurse comparisons between the three groups of homes. Unlike the NA care process comparisons, there were no licensed nurse performance measures that favored the upper-decile homes. In fact, licensed nurses in the lower-staffed homes performed better on 2 of the 11 indicators when compared to the upper-decile homes (Group 3). This difference was primarily due to Group 1 homes' nurses scoring significantly better on two pressure ulcer indicators. In addition to the low pass rates for higher-staffed homes on licensed nurse measures, there was also relatively poor performance on some indicators across all homes. Specifically, no group of homes performed well on the indicators assessing licensed nurse management of chronic pain by offering “as needed” pain medication on at least 50 percent of the days in the prior month to those residents with chronic pain symptoms. Less than 10 percent of participants who had chronic pain symptoms and who also had a physician's order for pain medication “as needed” were offered the pain medication on at least 50 percent of the days in the prior month across all homes. Furthermore, licensed nurses failed to identify many residents with chronic pain because less than 50 percent of participants who had chronic pain also had documentation of pain on their most recent MDS assessment. The kappa statistic agreement for residents with chronic pain on two different interviews was .65 (p<.01), indicating high stability. Finally, licensed nurses in all homes also performed poorly on several of the incontinence indicators. Most notably, no incontinent participants had documentation of a three-to-five day toileting assistance trial, which is the most valid method of determining if a resident should receive a scheduled toileting program.

Table 4Measures of Licensed Nurse Care ProcessesGo to:DiscussionNursing home self-reported staffing statistics do reflect differences in quality between homes that report the highest staffing level (upper decile) and all remaining homes. There were few differences between homes that report staffing levels below the 90th percentile and the staffing levels in these homes were unstable across the different staffing measures. There appears to be a two-tiered staffing system with only the homes reporting the highest level of staffing showing both stability and significantly better care on most measures.

The most dramatic differences between the homes were reported for NA hours and the most dramatic quality improvement occurred for homes that reported a total staffing hrpd average from 4.8 (state data) to 4.5 (onsite interview data). There was also a significant improvement in these upper-decile homes for multiple care processes delivered by NAs even though residents in the upper-decile homes needed as much care according to multiple functional measures as residents in the lower-staffed homes.

There were smaller differences between homes in reported licensed nurse hours and particularly RN hours and there were also fewer differences between homes on licensed nurse performance measures. The differences that did exist favored the lower-staffed homes for two pressure ulcer assessment indicators derived from medical record data. In contrast, observation and resident interview measures related to pressure ulcer care actually received by residents (e.g., toileting assistance, repositioning care) favored the upper-decile homes. This finding highlights an important discrepancy between quality conclusions about NH care process implementation derived from different data sources (medical record versus observation and resident interview).

Despite this discrepancy, it is still surprising that the medical record documentation provided by licensed nurses in higher-staffed facilities was not better since other studies have reported a relationship between licensed nurses' hours and some quality measures (Kramer and Fish 2001). There are two potential explanations for this finding. First, it is possible that none of the homes in this study had adequate licensed nurses, particularly RNs, to improve care quality. Furthermore, RN hours failed to reach the minimum level recommended by a recent CMS study (.75 hours) in all homes, and RN hours were much less in all homes than that recommended by an expert panel (1.15 hours) (Harrington, Kovner et al. 2000). Second, licensed nurses in all facilities simply may be unaware of some care processes that define good quality (e.g., no homes documented a trial of toileting assistance for incontinent residents and all homes did poorly on all pain-related measures). This possibility reinforces arguments that licensed nurses who practice in NHs should receive more specialized training focused on the NH population.

It is also important to note that some care processes were poorly implemented in even the highest-staffed facilities, despite the fact that these facilities had sufficient numbers of NAs to potentially provide 100 percent of care to all residents. One plausible explanation for this finding is that all homes lacked management mechanisms necessary to assure that care was provided on a daily basis, in particular, for care processes that are difficult to measure and manage. For example, the fewest differences occurred between homes on care processes related to repositioning and walking exercise, both of which are difficult to measure when compared to more visible types of care (e.g., resident out of bed). In addition, even though the highest-staffed facilities provided better feeding assistance than other homes, there were still problems that could be traced to measurement issues. For example, even staff in the highest-staffed facilities did not accurately record that 48 percent of the residents were eating less than 50 percent of the food offered and that 54 percent of these low-intake residents were provided less than one minute of feeding assistance during meals. Both of these problems in higher-staffed homes could reflect the absence of a quality assessment technology to accurately measure and monitor these care processes.

We should also note that the differences in the care for the highest-staffing homes (Group 3, upper decile) and all lower-staffed homes were significantly greater than the differences in quality measured for homes that differed on MDS clinical quality indicators. This finding, as reported in other studies, suggests that staffing data may be the best information to give consumers (Bates-Jensen et al. 2003; Simmons et al. 2003; Schnelle, Cadogan et al. 2003; Cadogan et al. 2003; Schnelle et al. 2004).

The conclusions are limited to the relatively small regional sample and our inability to check staffing accuracy with time card records even though time card accuracy checks can also be problematic (Hurd, White, and Feuerberg 2001). Fortunately, the reports by aides of their workloads appears to be a measure that is both associated with other workload reports and discriminative of care quality. This fact suggests that consumers might want to monitor the adequacy of staffing in NHs by asking aides how many people they are working with.

It is also possible that NH characteristics correlated with staffing may have mediated some of the effects reported in this study. For example, higher wages and benefits and lower staff turnover have been linked to better quality and we did not measure these variables. Future studies should expand the number of NH homes (particularly high-staffed homes) and variables studied in an effort to more comprehensively delineate the effects of staffing on quality. The low number of high-staffed homes in this study prevented statistical controls for potentially important facility variables that differentiated these homes, such as size and proportion of Medicaid residents. In addition, we did not measure all resident acuity variables that may have explained why residents in low-staffed homes spent so much time in bed. Direct measures of a resident's sickness severity are particularly important for this purpose.

The standardized measurement technology described in this paper represents a major strength of this study. The measurement protocols are clearly defined, can be replicated, and meet scientific measurement criteria related to reliability and stability. Even though one can argue about the importance of some of the measures for assessing quality, the specificity of the measures allows for this argument to be evidence-based.

Despite the limitations of this study, an excellent case can be made that the highest-staffed homes provided better care. Furthermore, NA staffing levels reported by only the highest-staffed homes exceeded those levels that were identified in two recent CMS reports as associated with higher care quality. This finding provides some verification that NA staffing above 2.8 hours per resident per day is associated with better quality.

Go to:FootnotesSupported by a grant from the California HealthCare Foundation. The views expressed in this paper are those of the authors and may not reflect those of the Foundation. The California HealthCare Foundation, based in Oakland, California, is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of the people of California. This research was also supported by grant AG10415 from the National Institute on Aging, UCLA Claude D. Pepper Older Americans Independence Center.






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January 10th, 2014

1/10/2014

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AS NEO-LIBERAL ECONOMISTS LIKE REICH AND KRUGMAN SHOUT OUT AGAINST THE WEALTH INEQUITY OF TODAY WITHOUT EVER ACKNOWLEDGING THAT IT ISN'T INEQUITY-----IT WAS A VISIGOTH LOOTING OF THE AMERICAN SOCIETY BY MASSIVE CORPORATE FRAUD------WE SAY, A GOVERNMENT THAT SUSPENDS RULE OF LAW SUSPENDS STATUTES OF LIMITATION!

I see in Baltimore all these middle-class homeowners that were able to keep their homes in hard times and I am shouting----financial analysts are warning to get rid of houses as this coming economic crash will bring a depression so you may be next!  Gentrification will go up the income scale!



I spoke last time about how Obama and neo-liberals played this entire crisis like a playbook written by Wall Street.  We saw how these main street bailouts were deliberately written so that only the affluent homeowners would access help and the FHA, a vital agency with a long service to families was targeted to be shut out.  Neo-liberals are working just as hard as republicans to end all War on Poverty and New Deal programs and fair housing goes!!!!  So, the middle-class  holding on to jobs and their homes now had better buckle-up because financial analysts are calling for people owning homes to get rid of them as the next, more powerful economic collapse comes soon......

THIS IS OBAMA'S LEGACY AND ALL OF MARYLAND'S DEMOCRATS ARE NEO-LIBERALS AND ALL EQUALLY RESPONSIBLE. 


SHAME AND DISGRACE FOR MARYLAND NEO-LIBERALS WATCHING SILENTLY AS THIS UNFOLDED.

What could we do, they say?  When 50 states attorney general shout out in 2005 that the mortgage industry is systemically criminal--------

YOU SHOUT OUT TO MARYLAND CITIZENS NOT TO GET INVOLVED IN THESE LOANS.  THEN, YOU SHOUT OUT OVER AND OVER THAT JUSTICE HAS NOT OCCURRED!

That is what a democrat would do!


Below you see the housing program that Obama and neo-liberals pretended was the bailout of main street and help in curbing foreclosures.  It was a ruse of course as they fumbled the roll-out long enough for most people that could have gotten help went under trying to get it!  Mind you....some people were helped.  The percentage I see over and again is 10% of foreclosures were saved.

 I sit and watch the same banks and mortgage corporations that created the massive subprime mortgage fraud now connected with HARP, earning more money from fees attached to yet another mortgage refinance.  From Quickens Loans to  Wells Fargo and Bank of America.....they are earning billions on HARP.

HARP Program Requirements In order to participate in HARP you need to meet the following requirements:

  • Your mortgage must be owned or guaranteed by Fannie Mae or Freddie Mac
  • You must be current on your mortgage, and cannot have made a payment more than 30 days late in the past year.
  • You must have negative home equity (you owe more on your mortgage than your home is worth), but your mortgage cannot exceed 125% of the value of your home.
  • Refinancing must help the affordability or stability of your mortgage.
  • You must have the ability to continue making payments
  • Mortgage owned or guaranteed by the FHA, VA, or USDA are not eligible for HARP.
  • Your property must be 1-4 units.
  • Your property must also be your primary residence. 2nd homes are not eligible for refinancing under HARP.
________________________________________________
As you see, HARP deliberately excludes FHA and the other government mortgages from this 'stimulus' and these loans are for those needing the help the most.  See why tens of millions of people went into foreclosure?  They were the ones most affected by the massive frauds and simple Rule of Law would have kept those homes with those families.

The reason Obama and neo-liberals in Congress chose Freddie and Fannie for this stimulus is that these loans were private mortgages and they wanted bank mortgages to be stabilized with the higher end prices and they are trying to end FHA and low-income homeownership. Neo-liberals work with republicans to end all War on Poverty and New Deal programs!

Obama and neo-liberals called these homeowners 'responsible' because they were able to weather years of recession.


Remember, they wanted everyone out of property ownership and into rentals because Pottersville landlords can keep people poor with high rents and control where they live!  Neo-liberals are socially engineering this return to Medieval society with the serfs outside the castle gates....into what is suburbia.  What about equal housing and access?  THE BILL OF RIGHTS GOES WITH TPP YOU KNOW!  In Maryland, the ACLU is actually helping with this even as it is unconstitutional.


The FHA was a successful program for decades causing very little cost for taxpayers.  So, the only reason to get rid of it is that it took away profit for banks wanting the mortgage business. 





Fannie Mae and Freddie Mac purchase mortgages from financial institutions, providing a way for those financial institutions to have more cash to continue to lend money for additional mortgages. Congress enacted a statutory mission for these GSEs to bring "liquidity, stability and affordability to the U.S. housing and mortgage markets."


FHA mortgages were created by the United States government to give borrowers with low credit scores and down payments who could not qualify for a Freddie Mac mortgage the opportunity to buy a home.


_____________________________________________


When Obama chose to suspend Rule of Law and allow all this mortgage fraud go without justice it was the old, women, and children who were hit the hardest.  Seniors taking home equity loans thinking they would be able to address them over time did not know massive corporate fraud was being allowed to go unabated.  These were the 'irresponsible' homeowners Obama and neo-liberals allowed to be taken under.

Now, Wall Street wanted all real estate back into the hands of the banks so if you watch TV you are familiar with the REVERSE MORTGAGE DEALS THAT HAND HOMES TO THE BANKS AFTER SENIORS DIE.  This is handy for families with seniors struggling to survive, but it was yet another device to move homeownership away from average people as these families who would normally have inherited these homes now had no inheritance.  Meanwhile, the estate taxes are being eliminated slowly but surely for the wealthy.


THE FIRST THING A DEMOCRATIC SOCIETY DOES IS PROTECT THE OLD AND YOUNG....NOT NEO-LIBERALS!

THIS WAS MASSIVE FRAUD AND THE ECONOMY WAS DAMAGED BY THIS FRAUD.  ALL OF THE AID BY CONGRESS SHOULD HAVE COME TO MAIN STREET.  RULE OF LAW DEMANDS IT SO------WHEN GOVERNMENT SUSPENDS RULE OF LAW THEY SUSPEND STATUTES OF LIMITATIONS!

Senior Citizens Worst Hit By Foreclosures in America
Filed Under Repo Homes

It is the senior citizens that have been worst hit by the foreclosure crisis in America. About 28% of those boiling in the foreclosure cauldron are aged above 50. A recent study by AARP has questioned the validity of the hitherto popular surmise that the seniors have escaped the crisis because of they had built up sufficient equity on their houses.

The research done by AARP show that 684,000 persons aged 50 are in foreclosure during the last six months of 2007. Those who were above 50 comprised of 28% of all those who were in the foreclosure soup. Of these 684,000 senior borrowers, 50,000 were in foreclosures and lost their houses.

At the close of 2007 the rate among senior citizens of America who were in foreclosure was 0.24%. This was half of those who were aged less than 50 and have less equity than their elders.

Susan Reinhard of Public Policy Institute said that the seniors of America are dependent on their houses both as a shelter and an asset when retirement knocks. She said, “Losing a home jeopardizes long-term financial security with limited time to recover.”

The report also highlights the effects of the sub-prime mortgage crisis on those who were aged 50 and above. This group was 17 times more likely to be caught by foreclosure than those with prime mortgages. The states with high repo home rates among the seniors are California, Nevada, Colorado and Michigan.

Older Americans had made use of the equity on their houses for making repairs to their property and financing the higher education of their children. But seniors with fixed income are facing problems making mortgage payments. The sluggish economy with inflation is making the going even tougher for those with advancing age. Fall in the real estate market has affected all age groups.

Daniel Alpert of Westwood Capital that both young and old who had siphoned off the equity on their houses are now rocking on the same boat of foreclosure Many seniors like the juniors contracted teaser loans thanks to the aggressive peddling of the same by agents. The mortgage forms were also difficult to comprehend. The call of the hour is simplified mortgages. So it was a question of sales talk and trust that were misused for disastrous consequences for all – the lender, the borrower and the community together with the hapless individual whether young or old.




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Below you see an article from Fall 2011 talking about how very few on main street were able to access HARP from the time it rolled out with the bank bailout.  This was supposedly main street's bailout but between the long-term unemployment creating the environment of missed payments and the banks constantly 'losing paperwork' that basically caused most people applying to fail to be considered. 

ALL OF THIS WAS DELIBERATE AS THIS ENTIRE MORTGAGE FRAUD WAS ABOUT GETTING MAIN STREET OUT OF THEIR HOMES SO THE GOAL WAS TO GET AS MANY HOMEOWNERS AS POSSIBLE INTO FORECLOSURE. 

Here in Maryland advocates for people heading to foreclosure shouted even into 2012 that  the money intended to augment people heading to foreclosure from the $25 billion mortgage fraud settlement was not getting to people.  So, just think, people who we all know were struggling from the economic downturn were left from 2009-2012 mostly unable to get the help they needed with this HARP policy. 

Flash forward to 2013 and we see Obama shouting that those funds set aside for HARP be used.  By now, most people of average means have lost their homes to foreclosure.


The Home Affordable Refinance Program (HARP): What you need to know

By Hayley Tsukayama, Published: October 24, 2011

On Monday, the federal government announced that it would revise the Home Affordable Refinance Program (HARP), implementing changes that The Washington Post’s Zachary A. Goldfarb reported would “allow many more struggling borrowers to refinance their mortgages at today’s ultra-low rates, reducing monthly payments for some homeowners and potentially providing a modest boost to the economy.”

The HARP program, which was rolled out in 2009, is designed to help. Those who are “underwater” on their homes and owe more than the homes are worth. So far, The Post reported, it has reached less than one-tenth of the 5 million borrowers it was designed to help. Here’s a quick breakdown of what you need to know about the changes.

Video

Oct. 24 (Bloomberg) -- Edward J. DeMarco, acting director of the Federal Housing Finance Agency, talks about the regulator's mortgage relief program that will expand to allow homeowners to refinance regardless of how much their houses have dropped in value.

Gallery

  Flashback: Last year, some mortgage lenders and government officials took action after discovering that many mortgage documents were mishandled.


What was announced? The enhancements will allow some homeowners who are not currently eligible to refinance to do so under HARP. The changes cut fees for borrowers who want to refinance into short-term mortgages and some other borrowers. They also eliminate a cap that prevented “underwater” borrowers who owe more than 125 percent of what their property is worth from accessing the program.

Am I eligible? To be eligible, you must have a mortgage owned or guaranteed by Fannie Mae or Freddie Mac, sold to those agencies on or before May 31, 2009. The current loan-to-value ratio on the mortgage must be greater than 80 percent. Having a mortgage that was previously refinanced under the program disqualifies you from the program. Borrowers cannot not have missed any mortgage payments in the past six months and cannot have had more than one missed payment in the past 12 months.

How do I take advantage of HARP? According to the Federal Housing Finance Agency, the first step borrowers should take is to see whether their mortgages are owned by Fannie Mae or Freddie Mac. If so, borrowers should contact lenders that offer HARP refinances.

When do the changes go into effect? The FHFA is expected to publish final changes in November. According to a fact sheet on the program, the timing will vary by lender.



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I speak quite often about the targeted families in urban centers because of what is happening in Baltimore.  The black middle-class was hit hardest as their wealth was often tied to these urban areas hit with mortgage fraud and as we know the US Justice Department has failed to give any justice to people of color in these urban centers.  City Hall is not only allowing the subprime loan fraud go without justice......I have spoken about how City Hall is actually preying on these citizens with home seizures from faulty utility bills or small amounts of back taxes.

THIS IS NOT A DONE DEAL AS ALL OF THIS HAS YET TO SEE JUSTICE AND RULE OF LAW WILL HAVE LOW-INCOME HOUSING FOR VICTIMS OF FRAUD IN THE CITY CENTER!


The Great Eviction: Black America and the Toll of the Foreclosure Crisis From predatory loans to evictions at gunpoint, neighborhoods are hosting bitter conflicts between activists and market forces—By Laura Gottesdiener

| Thu Aug. 1, 2013 1:04 PM


We cautiously ascend the staircase, the pitch black of the boarded-up house pierced only by my companion's tiny circle of light. At the top of the landing, the flashlight beam dances in a corner as Quafin, who offered only her first name, points out the furnace. She is giddy; this house—unlike most of the other bank-owned buildings on the block—isn't completely uninhabitable.

It had been vacated, sealed, and winterized in June 2010, according to a notice on the wall posted by BAC Field Services Corporation, a division of Bank of America. It warned: "entry by unauthorized persons is strictly prohibited." But Bank of America has clearly forgotten about the house and its requirement to provide the "maintenance and security" that would ensure the property could soon be reoccupied. The basement door is ajar, the plumbing has been torn out of the walls, and the carpet is stained with water. The last family to live here bought the home for $175,000 in 2002; eight years later, the bank claimed an improbable $286,100 in past-due balances and repossessed it.

It's May 2012 and we're in Woodlawn, a largely African American neighborhood on the South Side of Chicago. The crew Quafin is a part of dubbed themselves the HIT Squad, short for Housing Identification and Target. Their goal is to map blighted, bank-owned homes with overdue property taxes and neighbors angry enough about the destruction of their neighborhood to consider supporting a plan to repossess on the repossessors.

"Anything I can do," one woman tells the group after being briefed on its plan to rehab bank-owned homes and move in families without houses. She points across the street to a sagging, boarded-up place adorned with a worn banner—"Grandma's House Child Care: Register Now!"—and a disconnected number. There are 20 banked-owned homes like it in a five-block radius. Records showed that at least five of them were years past due on their property taxes.

Where exterior walls once were, some houses sport charred holes from fires lit by people trying to stay warm. In 2011, two Chicago firefighters died trying to extinguish such a fire at a vacant foreclosed building. Now, houses across the South Side are pockmarked with red Xs, indicating places the fire department believes to be structurally unsound. In other states--Wisconsin, Minnesota, and New York, to name recent examples—foreclosed houses have taken to exploding after bank contractors forgot to turn off the gas.

Most of the occupied homes in the neighborhood we're visiting display small signs: "Don't shoot," they read in lettering superimposed on a child's face, "I want to grow up." On the bank-owned houses, such signs have been replaced by heavy-duty steel window guards. ("We work with all types of servicers, receivers, property management, and bank asset managers, enabling you to quickly and easily secure your building so you can move on," boasts Door and Window Guard Systems, a leading company in the burgeoning "building security industry.")

The dangerous houses are the ones left unsecured, littered with trash and empty Cobra vodka bottles. We approach one that reeks of rancid tuna fish and attempt to push open the basement door, held closed only by a flimsy wire. The next-door neighbor, returning home, asks: "Did you know they killed someone in that backyard just this morning?"

The Equivalent of the Population of Michigan Foreclosed
Since 2007, the foreclosure crisis has displaced at least 10 million people from more than four million homes across the country. Families have been evicted from colonials and bungalows, A-frames and two-family brownstones, trailers and ranches, apartment buildings and the prefabricated cookie-cutters that sprang up after World War II. The displaced are young and old, rich and poor, and of every race, ethnicity, and religion. They add up to approximately the entire population of Michigan.

However, African American neighborhoods were targeted more aggressively than others for the sort of predatory loans that led to mass evictions after the economic meltdown of 2007-2008. At the height of the rapacious lending boom, nearly 50% of all loans given to African American families were deemed "subprime." The New York Times described these contracts as "a financial time-bomb."

Over the last year and a half, I traveled through many of these neighborhoods, reporting on the grassroots movements of resistance to foreclosure and displacement that have been springing up in the wake of the explosion. These community efforts have proven creative, inspiring, and often effective—but in too many cities and towns, the landscape that forms the backdrop to such a movement of hope is one of almost overwhelming destruction. Lots filled with "Cheap Bank-Owned!" trailers line highways. Cities hire contractors dubbed "Blackwater Bailiffs" to keep pace with the dizzying eviction rate.

In recent years, the foreclosure crisis has been turning many African American communities into conflict zones, torn between a market hell-bent on commodifying life itself and communities organizing to protect their neighborhoods. The more I ventured into such areas, the more I came to realize that the clash of values going on isn't just theoretical or metaphorical.

"Internal displacement causes conflict," explained J.R. Fleming, the chairman of the Chicago Anti-Eviction Campaign. "And there's no other country in the world that would force so much internal displacement and pretend that it's something else."

Evictions at Gunpoint
It was three in the morning when at least a dozen police cruisers pulled up to the single-story, green-shuttered house in the African American Atlanta suburb where Christine Frazer and her family lived. The precise number of sheriffs and deputies who arrived is disputed; the local radio station reported 25, while Frazer recalled seeing between 40 and 50.

A locksmith drilled off the home's locks and dozens of officers burst into the house with flashlights and handguns.

"Who's in the house?" they shouted. Aside from Frazer, a widow with a vocal devotion to the Man Above, there were three other residents: her 85-year-old mother, her adult daughter, and her four-year-old grandson. Things began to happen fast. Animal control rounded up the pets. Officers told the women to get dressed. Could she take a shower? Frazer asked. Imagine there's a fire in your house, the officer replied.

"They came to my home like I was a drug dealer," she told reporters later. Over the next seven hours, the officers hauled out the entire contents of her home and cordoned off the street to prevent friends from helping her retrieve her things.

"I have no idea where some of my jewelry is, stuff I bought when I was 30 years old," said Frazer. "I am sixty-three. They just threw everything everywhere, helter-skelter on the front lawn in the dark."

The eviction-turned-raid sparked controversy across Atlanta when it occurred in the spring of 2012, in part because Frazer had a motion pending in federal court that should have stayed the eviction, and in part because she was an active participant of Occupy Homes Atlanta. But this type of militarized reaction is often the outcome when communities—especially those of color—organize to resist eviction.

When Nicole Shelton attempted to move back into her repossessed home in a picket-fence subdivision in North Carolina, the Raleigh police department sent in more than a dozen police officers and an eight-person SWAT team. Officers were equipped with M5 submachine guns. A helicopter roared overhead. In Boston, one organizer with the community group City Life/Vida Urbana remembers the police acting so aggressively at an eviction blockade in a Haitian neighborhood that the grandmother of the family had a heart attack right in the driveway.

And sometimes it doesn't require resistance at all. On the South Side of Chicago, explained Toussaint Losier, a community organizer completing his Ph.D. at the University of Chicago, "They bust in the door, and it's at the point of a gun that you get evicted."

Exiles in America
There have been widespread foreclosures—and some organized resistance—in predominately white communities, too. Kevin Kirkman, captain of the civil division of the Lee County sheriff's office, explained, "I get so many [eviction] papers in here, it's unbelievable."

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More than 75% of the residents in North Carolina's Lee County are whites. But Kirkman still sees the ripple effects of mass foreclosure here. "You're talking about a mudslide where a lot of things are affected. You're talking about taxes, about retail sales if people move, about food services, about gasoline. You see what I'm talking about? When you lose a family in the community? Some people leave the community. I have seen people leave the state of North Carolina."

He added, "I'm going be honest with you, my feeling is that I would not do these evictions."


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I wanted to end with this main stream shout out that the subprime mortgage loan fraud is recognized by all and the amount of these frauds are in the trillions of dollars and as of now we have gotten maybe a trillion in subprime loan settlement and most of that has been sent right back to banks as developers......WE ALL KNOW THIS!

Op-Ed Columnist The Mortgage Fraud Fraud

By JOE NOCERA Published: June 1, 2012 

I got an e-mail the other day from Richard Engle telling me that his son Charlie would be getting out of prison this month. I was happy to hear it.

Charlie’s ordeal isn’t over yet, of course. When he leaves prison on June 20, Charlie, 49, will move temporarily to a halfway house, after which he will be on probation for another five years. And unless he can get the verdict overturned, he will have to spend the rest of his life with a felony on his record.

Perhaps you remember Charlie Engle. I wrote about him not long after he entered a minimum-security facility in Beaver, W.Va., 16 months ago. He’s the poor guy who went to jail for lying on a liar loan during the housing bubble.

There were two things about Charlie’s prosecution that really bothered me. First, he’d clearly been targeted by an agent of the Internal Revenue Service who seemed offended that Charlie was an ultramarathoner without a steady day job. The I.R.S. conducted “Dumpster dives” into his garbage and put a wire on a female undercover agent hoping to find some dirt on him. Unable to unearth any wrongdoing on his tax returns, the I.R.S. discovered he had taken out several subprime mortgages that didn’t require income verification. His income on one of them was wildly inflated. They don’t call them liar loans for nothing.

Charlie has always insisted that he never filled out the loan document — his mortgage broker did it, and he was actually a victim of mortgage fraud. (The broker later pleaded guilty to another mortgage fraud.) Indeed, according to a recent court filing by Charlie’s lawyer, the government failed to turn over exculpatory evidence that could have helped Charlie prove his innocence. For whatever inexplicable reason, prosecutors really wanted to nail Charlie Engle. And they did.

Second, though, it seemed incredible to me that with all the fraud that took place during the housing bubble, the Justice Department was focusing not on the banks that had issued the fraudulent loans, but rather on those who had taken out the loans, which invariably went sour when housing prices fell.

As I would later learn, Charlie Engle was no aberration. The current meme — argued most recently by Charles Ferguson, in his new book “Predator Nation” — is that not a single top executive at any of the firms that nearly brought down the financial system has spent so much as a day in jail. And that is true enough.

But what is also true, and which is every bit as corrosive to our belief in the rule of law, is that the Justice Department has instead taken after the smallest of small fry — and then trumpeted those prosecutions as proof of how tough it is on mortgage fraud. It is a shameful way for the government to act.

“These people thought they were pursuing the American dream,” says Mark Pennington, a lawyer in Des Moines who regularly defends home buyers being prosecuted by the local United States attorney. “Right here in Des Moines,” he said, “there was a big subprime outfit, Wells Fargo Financial. No one there has been prosecuted. They are only going after people who lost their homes after the bubble burst. It’s a scandal.”

The Justice Department has had a tough run recently. Last week, Eric Schneiderman, the New York attorney general — who was recently given a role by President Obama to investigate the mortgage-backed securities issued during the bubble — complained publicly that he wasn’t getting the resources he needed from the Justice Department. And, of course, on Thursday, a federal judge declared a mistrial on five charges of campaign finance fraud and conspiracy in the trial of the former presidential candidate John Edwards.

In the Edwards case, the Justice Department spent tens of millions of dollars, and trotted out novel legal theories, to prosecute a man who was essentially trying to keep people from discovering that he had had a mistress and an out-of-wedlock child. Salacious though it was, the case has zero public import. Yet this same Justice Department isn’t willing to use similar resources — and perhaps even trot out some novel legal theories — to go after the pervasive corporate wrongdoing that gave us the financial crisis and the Great Recession. (I should note that the Justice Department claims that it “will not hesitate” to prosecute any “institution where there is evidence of a crime.”)

Think back to the last time the federal government went after corporate crooks. It was after the Internet bubble. Jeffrey Skilling and Kenneth Lay of Enron were prosecuted and found guilty. Bernard Ebbers, the former chief executive of WorldCom, went to jail. Dennis Kozlowski of Tyco was prosecuted and given a lengthy prison sentence. Now recall which Justice Department prosecuted those men.

Amazing, isn’t it? George W. Bush has turned out to be tougher on corporate crooks than Barack Obama.






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January 07th, 2014

1/7/2014

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DID YOU KNOW THAT MARYLAND IS ONE OF THE STATES NOT COVERING AUTISM AND THAT IS THE MOST DIAGNOSED NEUROLOGICAL  DISEASES TODAY BECAUSE OF DAMAGES FROM CHEMICAL EXPOSURES FOR ONE!  THE DEVIL IS IN THE DETAILS!

IN MARYLAND, WHAT DOES THIS SAY ABOUT JOHNS HOPKINS PUBLIC HEALTH? YOU KNOW IT RUNS ALL OF BALTIMORE AND MUCH OF MARYLAND PUBLIC HEALTH----AND IT IS A CORPORATION FOR GOODNESS SAKE!

PLEASE BE AWARE THAT THE FAILURE OF ACA AS A HEALTH REFORM IS NOT BECAUSE OF DEMOCRATS, IT IS BECAUSE OF NEO-LIBERALS.  IT IS A REPUBLICAN PLAN SIMPLY MEANT TO DISMANTLE PUBLIC HEALTH AND MAXIMIZE PROFIT.  SO, DON'T VOTE REPUBLICAN BECAUSE YOU ARE MAD AT NEO-LIBERALS.....RUN AND VOTE FOR LABOR AND JUSTICE!

YOUR POLITICIAN KNEW THIS WOULD BE THE RESULT!



Michael Riseup Stowell
I figured Obamacare was designed as a bailout for the insurance industry, and so I expected it to be disappointing - this journalist explains how: "Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.

Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance...


Everyone knows I've been shouting for four years that this would be the result and your political pundit, media, and national labor union/justice leaders knew it too!  Labor no doubt backed this to save union rights but there is a point at which saving the bathwater and throwing out the baby comes into play.  Union members feel betrayed and citizens see the unions as working against their interests. 

CITIZENS HAVE TO COME OUT AND SHOUT AS OUR UNIONS ARE BETWEEN A ROCK AND A HARD PLACE.  STRENGTHEN UNIONS BY FIGHTING FOR THE BENEFITS PROMISED!



YOU CANNOT WAIT TO SHOUT OUT AND DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL AND DO NOT VOTE FOR ANY POLITICIAN THAT DOES NOT SHOUT THIS!


The article below is harsh on supposed progressive people backing what people in the know knew was bad for Americans.  The process of reform was built on making labor and justice desperate and divided and that is what happened.  I went to a progressive symposium four years ago in Washington with all the leading 'progressive' voices and shouted at that packed symposium that this would be the result and there was silence. 
If your incumbent chose silence then


THE SILENCE IS DUPLICITY.

January 06, 2014

Single-Payer is the Only Real Option The Left After the Failure of Obamacare by SHAMUS

COOKE it’s satisfying to watch rats flee a sinking ship.  This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end.  A collective sense of relief is a natural response.

The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group’s resources—and integrity— to sell a crappy product to the American people.

Those in the deepest denial went “all in” for Obamacare— such as some unions and groups like Moveon.org— while the more conniving groups and individuals—like Michael Moore— playacted “critical” of Obamacare, while nevertheless declaring it “progressive”, in effect adding crucial political support to a project that deserved none.

But of course Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction— into the pockets of the insurance mega corporations.    A couple progressive patches on the sails won’t keep her afloat.  It’s shipbuilding time.

It was painful to watch otherwise intelligent people lend support to something that’s such an obviously bad idea.  So it’s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare’s Titanic failure.   Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.

The inevitable failure of Obamacare is not due to a bad website, but deeper issues.   The hammering of the nails in the coffin has begun:  millions of young people are suddenly realizing that Obamacare does not offer affordable health care.  It’s a lie, and they aren’t buying it, literally.

The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population.    Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.

Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance”.   Many of the cheapest plans—the obvious choice for most young people— have $5,000 deductibles before the insurance will pay for anything.   For poor young people this is no insurance at all, but a form of extortion.

At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the “Cadillac” tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.

Lower paid union workers will suffer as well.  Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get.   This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member’s dollars propping it up.

Ultimately, the American working class will collectively cheer Obamacare’s demise.   They just need labor and other lefties to cheer lead its destruction a little more fiercely.

Surprisingly, most of the rats are still clinging to Obama’s hopeless vessel, frantically bailing water.  Sure they’ve put on their life preservers and anxiously eyeing the lifeboats, but they’re also preaching about how to re-align the deckchairs.

For example, in his “critical” New York Times op-ed piece, Michael Moore called Obamacare “awful”, but also called it a “godsend”, singing his same tired tune.   Part of Moore’s solution for Obamacare—which was cheered on in the Daily Kos— is equally ludicrous, and follows his consistently flawed logic that Obamacare is worth saving, since its “progress” that we can build on.   Moore writes:

“Those who live in red [Republican dominated] states need the benefit of Medicaid expansion [a provision of Obamacare]…. In blue [Democrat dominated] states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer.”

This is Moore at his absolute worst.  He’s neck deep in the flooded hull of the U.S.S Obamacare and giving us advice on how to tread water.

Of course Moore doesn’t criticize the heart of Obamacare, the individual mandate, the most hated component.

Moore also relies on the trump card argument of the pro-Obamacare liberals: there are progressive aspects to the scheme—such as the expansion of Medicaid— and therefore the whole system is worth saving.

Of course it’s untrue that we need Obamacare to expand Medicaid.  In fact, the expansion of Medicaid acted more as a Trojan horse to introduce the pro-corporate heart of the system; a horse that Moore and other liberals nauseatingly continue to ride on.

But Moore’s sneakiest argument is his advice to blue states to  “…lobby for a public option on the insurance exchange…”

Again, Moore implies that it’s ok if we are “mandated” to buy health insurance, so long is there is a public option.  But that aside, the deeper scheme here is that Moore wants us to further waste our energy “reforming” Obamacare, rather than driving it to the bottom of the sea.

Moore surely knows that very few people are going to march in the streets demanding a public option at this point; he therefore knows that even this tiny reform of the system is unachievable. He’s wasting our time.  Real change only happens in politics when there is a surge of energy among large sections of the population, and it’s extremely unlikely that more than a handful of people are going to be active towards “fixing” Obamacare— they want to drown it.

Moore’s attempt to funnel people’s outrage at Obamacare towards a “public option” falls laughably short, and this is likely his intention, since his ongoing piecemeal “criticisms” of the system have only served to salvage a sunken ship.

Instead of wasting energy trying to pry Obamacare out of the grip of the corporations, Moore would be better served to focus exclusive energy towards expanding the movement for Medicare For All, which he claims that he also supports, while maintaining that somehow Obamacare will evolve into Single Payer system. 

IT WILL......MEDICAID FOR ALL!

Most developed nations have achieved universal health care through a single payer system, which in the United States can be easily achieved by expanding Medicare to everybody.  Once the realities of Obamacare directly affect the majority of the population and exacerbates the crisis of U.S. healthcare, people will inevitably choose to support the movement of Medicare for All, the only real option for a sane health care system.

Shamus Cooke is a social service worker, trade unionist, and writer for Workers Action (www.workerscompass.org).  He can be reached at shamuscooke@gmail.com


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Cutting a trillion from Medicare and then allowing health corporations decide how those cuts will be made.....by limiting patient access of course. THAT'S A NEO-LIBERAL FOR YOU!

As the American people are now calling for Expanded and Improved Medicare for All you see neo-liberals and Obama are busy dismantling that as a public health program.  First you make it too expensive to access and then you pass TPP which does not allow policy that prevents private profits in health care!

So, this isn't just the poor and working class losing their access, it is the seniors and disabled as well.  Those upper-middle class still affording to buy private insurance------about 5% of Americans!

Medicare reimbursement cuts threaten access to care

Published on March 29, 2013 at 1:26 PM ·News Medical

Physicians and patients alike are feeling the impact of Medicare reimbursement cuts that went into effect on January 1, 2013. With an additional 2% sequestration cut to roll out on April 1, it's likely that physicians who treat Medicare patients will be faced with difficult decisions as operating margins continue to shrink.

The the 2% cuts may seem modest, but they come on the heels of much larger cuts to reimbursement for nerve conduction studies (NCSs) of 40-70% for Medicare beneficiaries. These cuts were announced November 1, 2012, and went into effect on January 1, 2013, allowing providers little time to prepare.

While all Medicare providers are feeling the squeeze, private practices are likely to experience the most impact. "These cuts may force private practice physicians to choose between seeing Medicare patients and keeping their practice open," said Catherine French, AANEM senior analyst of medical economic affairs. French is concerned that the sequestration cuts will be adopted by private insurers, too. "It is possible that private insurers will follow suit and reduce reimbursement by 2% because most model their payment rates on Medicare."

Cuts Threaten Access to Care
According to Kristi Snihurowych, MD, a spine interventionalist in Salt Lake City, UT, the cuts pose a serious risk to access to care. Snihurowych has decided to discontinue EMG and NCS testing, which previously made up an eighth of her total practice. "Given the cuts, it's no longer feasible to perform these tests in-house. The problem is, I cannot find anyone to do them for me," said Snihurowych. "It seems everyone has had to give them up, and not just for Medicare patients. Providers anticipate that other payers will soon follow suit, so many have stopped offering EMGs all together."

Snihurowych suspects unnecessary and costly procedures will be among the cuts' ripple effects. "I am seeing patients go to surgery without a definitive diagnosis of, for example, carpal tunnel syndrome because the surgeons cannot get confirmation by an EMG or NCS test."

Utah-based physiatrist Faisel M. Zaman, MD, PC, agreed, "People will pay with their health. Of course there will be financial costs associated with unnecessary surgeries, but the biggest cost will be to the patients with scars and pain from procedures they didn't need."

Zaman is a spine specialist who has had several cases where an EMG has prevented patients from undergoing major surgery. In one case, a healthy and active 70-year-old male patient was referred by a vascular surgeon who thought the patient was experiencing symptoms of peripheral vascular disease. But the surgeon wanted to rule out spinal problems before he did a major bypass operation. Following EMG testing, the man was diagnosed with spinal stenosis.

"EMG was critical in this case," said Zaman. "It turns out that he is a great candidate for nonvascular treatments that will improve his condition. Without the lower-extremity EMG, he would have undergone major surgery. It's scary to think of the consequences to patients if the availability of EMG testing becomes more limited. Ultimately, it would hurt patients the most."

Claire Wolfe, MD, AANEM past president, has similar concerns regarding access to care. Nearing retirement and working part-time, she is the only physician performing EDX studies for an office of 23 physicians, as well as some outside referrals. Before the cuts, two other physiatrists in her office performed EMGs.

"There will be greater uncertainty around diagnoses of upper and lower limb pain/numbness; neck surgeries rather than carpal tunnel releases and vice-versa; delayed diagnoses of motor unit diseases; and delayed recognition of folks with metabolic disorders like diabetes if patients don't have access to an electrodiagnostic study that may catch peripheral neuropathy changes before the diagnosis of the underlying disorder is made," Wolfe said.

Unfortunately, the impact of the cuts may be long-lasting. "These cuts will significantly impact Medicare beneficiary access to appropriate management of their disabling neurologic disorders, limit further the number of neurologists who are currently seeing Medicare patients, and discourage budding physicians from the field of neurology," said Mohammed Zafar, MD, in response to an AANEM survey about the Medicare reimbursement cuts for EDX procedures.

Looking Forward
With the cuts to Medicare reimbursement, AANEM members are asking what can be done to protect their practices and to ensure access to care for patients into the future.




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As this article shows big PHARMA drives TPP and it will basically end a nation's ability to lower prices either with restrictions to generic brands or collective purchasing power as is sought in the US in the case of Medicare.  As you hear neo-liberals saying good-bye doughnut hole/co-pays for PHARMA.....they are working to be sure you won't be able to afford it.

Who is PHARMA?  Well, Bill Gates is PHARMA in his funding of research for drugs to prevent disease in Asian and African nations.  Was he really being philanthropic or just getting the jump on global PHARMA markets?  Johns Hopkins is now attached to its BIO-TECH branch that will market its patents coming from taxpayer funded research.  IT IS NOW PHARMA.

WE NEED TO BE ELECTING POLITICIANS SHOUTING FOR EXPANDED AND IMPROVED MEDICARE FOR ALL AND GETTING RID OF THE GLOBAL CORPORATE AFFORDABLE CARE ACT SUPPORTERS!

Notice this article was written in 2011----everyone in power has known this was coming that long-----DO NOT BELIEVE YOUR POL WAS KEPT IN THE DARK!


Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

The TPP chapter may be best seen as a significant step toward the pharmaceutical industry’s ultimate goal, which is a binding international agreement on drug pricing that would restrain the ability of governments to use collective purchasing power to demand prices below “market” levels.



  For immediate release.


By Sean Flynn, sflynn@wcl.american.edu

Lima, Peru. on October 22, 2011

Among the US Trans Pacific Partnership (TPP) proposals leaked today was a proposed chapter on “Transparency and Procedural Fairness for Healthcare Technologies,” more widely known as the Pharmaceutical Pricing Chapter.

All countries negotiating the Trans Pacific Partnership agreement should reject this proposal, the primary goal of which is to regulate pharmaceutical reimbursement programs. This is an extreme proposal that has no place in a trade negotiation, particularly one with some of the poorest countries in the world.



Although the provisions are styled as “transparency” provisions, in fact they regulate the substance of drug pricing programs. The heart of the proposal would require that countries establish new administrative and judicial appeal systems to contest whether public drug reimbursement rates “appropriately recognize the value” of pharmaceutical patents. Similar provisions have led to higher drug prices and more challenges by pharmaceutical companies in the one country to implement similar provisions – Australia.[1]

At the core of this proposal is a false distinction between government reimbursement prices and “market” prices. Government reimbursement prices ARE market prices. Suppliers can refuse to supply to governments, just as they can with any private purchaser demanding a better deal. The fact that governments obtain better prices than atomized consumers does not make their roles as purchasers anti-market. Drug price restraint is a natural, inevitable and beneficial result of public health expenditure or any other form of pooled purchasing. Large purchasers in free markets obtain better prices; governments obtain better prices when they pool consumers and negotiate as a volume purchaser.

Raising drug prices is, of course, the goal of pharmaceutical companies pushing for these provisions. This point was explained by President Bush’s Ambassador to Poland in a recently released cable. He explained:

While pharmaceuticals companies often assert that they would be happy with a transparent process, even if it led to decisions not to fund their drugs, in practice they seem to resent all government measures aimed at cost containment, as these also inevitably limit drug companies’ sales.[2]

This proposal is contrary to the demands of democracy, is bad for the development interests of poorer countries, and represents an affront to best practices in evidence-based health policy, including such practices in the US.

  • Pharmaceutical price regulation is an inappropriate subject for closed door trade negotiations. The proposed pharmaceutical chapter regulates public health policy, not trade. This is perhaps most notable in the fact that the provisions apply to policies regardless of any trade distorting or discriminatory effect of the given policy. Using secretive trade negotiation processes to set minimum requirements for domestic health policy like this is democratically illegitimate. Enactment of reimbursement policies to advance public health outcomes lies in the core of domestic sovereignty. These policies do not affect a limited range of companies, justifying closed door processes where only those companies are meaningfully consulted. Public health policies affect all citizens and a wide variety of stakeholders that deserve to be included in policy making processes. Indeed, access to decision making processes that impact public health programs is an internationally recognized human right.
  • Pharmaceutical price regulation is an inappropriate subject for agreements with developing countries. This would be the first-ever international agreement regulating the efficacy of pharmaceutical price regulations in developing countries. The ability to regulate the prices of patented products directly is one of the most important TRIPS flexibilities. Without some kind of price control, patents on pharmaceuticals demonstratively and predictably lead to excessive pricing of medicines in developing countries with very high income inequality. This is because the most profitable behavior of an unregulated essential service monopolist in high inequality countries will be to price to the richest tier of the population. [3] All of the developing countries negotiating the TPP (Peru, Malaysia, Vietnam, and Chile) have been identified as having high medicine prices given their development level. [4] The case of Vietnam is particularly egregious – with local prices of patented medicines 46 times higher than international referents.[5]
  • The U.S. proposal would require bad public policy contrary to best practices in the US itself. Ironically and ominously, US drug pricing programs do not comply with the standards that the US is proposing. In particular, the operation of preferred drug lists by the Federal Medicaid program would violate the terms of the agreement, including because they do not provide appeals for pharmaceutical companies on whether the prices achieved adequately value patents. Previous FTAs with Australia and Korea carefully exempted all U.S. programs from their coverage, including through a footnote defining the federal Medicaid program as a “regional,” rather than “central,” level government program. That footnote has been removed from the draft TPP proposal. This may indicate that the US has not decided whether to propose exempting Medicaid from the TPP requirements or to give in to demands of other countries for full reciprocity in the agreement.
SECTION BY SECTION ANALYSIS

X.1: Agreed Principles. The agreed principles are verbatim restatements from the KORUS agreement. As in KORUS, they understate the role and importance of promoting affordability through pharmaceutical reimbursement policies. The provisions mainly discuss the promotion of “access” and “availability” of pharmaceuticals. The concept of affordability is mentioned only once. USTR’s recent white paper on TPP and medicines also defines “access” without reference to affordability concerns. One of the key purposes of drug reimbursement programs must be to promote affordable access to pharmaceuticals, not mere availability of the products themselves. This concern applies throughout the proposal.

X.2: Transparency Related to Healthcare Technologies. The provision creates a vague requirement that “all measures” related to pharmaceutical reimbursement be administered in an “objective” manner. This concept of “objective” administration of the law is not a current US legal requirement and is not defined in the agreement. What it means in this context is unclear, which may open opportunities for pharmaceutical companies to attempt to define it through litigation. What is a non-objective administration of the law? Would public interest standards violate the test? What about the choosing of drugs for a formulary based on a multitude of factors including price and availability decisions?

X.3: Procedural Fairness Related to Healthcare Technologies. This is the core section forcing countries to use formal rulemaking processes rather than market negotiations to determine reimbursement prices. International law should not determine this important policy choice. Countries must be free to use reimbursement programs as a player in the market rather than as its regulator.

X.3(a): The term “reasonable period” has no definition in the agreement or in US or international law. It invites litigation.

X.3(b): The requirement to disclose all methodologies used to negotiate drug prices is one of many rules forcing the government to operate as a price regulator rather than market participant. Private companies do not disclose such information to their suppliers.

X.3(c): The requirement to give notice and comment opportunities during reimbursement decisions prevents health authorities from using negotiation rather regulation to set drug prices. Private entities do not invite public comments on their negotiations with suppliers.

X.3(d): This is one of the most worrisome provisions in the text. The provision has two parts:

  • The first part encourages countries to abandon any economy of scale benefits from pooled purchasing through government and instead reimburse pharmaceutical companies at rates “consisting of competitive market-driven prices in the Party’s territory.” The restriction to “in the Party’s territory” was not included in previous agreements and is designed to restrict countries from the common practice of using international reference prices to determine reasonable reimbursement rates. This rule is not followed in the US. Medicaid programs receive discounts of up to 50% off the list price for pharmaceuticals due to their increased purchasing power. The provision is also practically unworkable since other large private purchasers in the market will not be under any obligation to disclose their “market-driven” prices.
  • The second part of this section, read with paragraph (i), provides that if countries do not set reimbursement prices at the “competitive market-driven” price, then they must provide companies with appeals of whether reimbursement prices “appropriately recognize the value” of patents. There is no objective measure of the “value” of a patent. Economists normally define value as a function of market price. But in a monopoly market for an essential good, particularly in countries with high income inequality, this market price will be excessively high absent government regulation. It is impossible to know how this provision would be implemented. It invites litigation and promotes uncertainty.
X.3(e): This provision mandates that countries allow companies to “apply for an increased amount” in reimbursement based on evidence of “superior safety, efficacy or quality.” This provision is potentially beneficial in embracing the idea that prices should be set based on efficacy rather than market value. Nonetheless, affordability concerns must also be an integral part of reimbursement decisions, but are not mentioned.

X.3(f): This provision mandates that governments allow companies to “apply” for reimbursements for additional medical indications for products. The provision has no requirement that the additional indications applied for first be approved by the government’s medical registration authorities. It rather suggests that the safety and efficacy information would be submitted directly to the reimbursement entity, side stepping regulatory authorities.

X.3(g, h, i): These provisions require that governments provide written reasons for every decision [(g) and (h)] and then provide an “independent appeal” of any reimbursement decision (i), presumably based on the substantive restrictions on reimbursement programs defined in X.2(d). These provisions will likely increase pharmaceutical company negotiating power to exact higher prices from governments through litigation threats.

X.3(k): This provision requires that all members of reimbursement committees be made public, presumably to enable targeted lobbying from pharmaceutical companies. Such lobbying can be detrimental to public decision making, especially when linked to unethical gift giving that has plagued pharmaceutical marketing in the US and elsewhere.

X.4: Dissemination of Information to Health Professionals and Consumers. This provision attempts to set drug marketing policy through trade agreements. It would mandate that countries allow certain kinds of direct-to-consumer and direct-to-physician marketing efforts over the internet. This is a subject currently subject to regulatory investigations in the US and would be contrary to the drug marketing laws of many countries. The provision would appear to make illegal a proposal by Representative Waxman that companies not be allowed to engage in certain kinds of direct to consumer promotion in the first three years of a drug’s time on the market.

X.5: Ethical business practices [no text]. As in other areas of the TPP, provisions protecting corporate concerns are well developed and those potentially protecting consumers are absent. This section should consider standards that would ban gift giving and other pecuniary relationships between pharmaceutical companies and prescribers or government health officials. It should ban off-label marketing of drugs. It should mandate private and public rights of action against fraudulent and misleading marketing practices.

X.6: Cooperation. As in the agreed principles, this provision appears tailored to promote a conception of “availability” that does not include affordability. The key concern of countries in the region, and in particular the US, should be on sharing information on how best to ensure the affordability of medicines in the context of the ongoing economic crisis.

X.7: Definitions. Few of the key terms in the agreement are defined, including “access,” “value,” “reimbursement” and “health care programs” as applied to the scope of coverage, “transparent,” “verifiable,” “objective,” “competitive-market derived,” “independent” as related to “appeal or review.”

X.7 fn 2. (US carve out?). In previous agreements with the US including pharmaceutical chapters, the US has claimed that they have no application to programs in the US. The KORUS agreement included a footnote stating: “For greater certainty, Medicaid is a regional level of government health care program in the United States, not a central level of government program.” This footnote has been criticized in the US for potentially leaving vulnerable other US programs that control prices on drugs in government programs, including through Medicare and the so-called 340b program. TPP removes this footnote form the proposed text and substitutes a bracketed place holder for clarification of the scope of application. This should be concerning to US health advocates and officials. A letter from several senior members of the US Congress, released during the Chicago round of negotiations, instructed that “TPP should not undermine either U.S. or other member countries’ current or prospective, non-discriminatory drug reimbursement policies and programs (e.g. Medicare, Medicaid, the VA, and other programs).” Vermont Governor Peter Shumlin wrote President Obama with respect to a possible TPP pharmaceutical chapter:

Even if a chapter was proposed that did include a Medicaid carve-out, state leaders believe it is inappropriate for U.S. trade policy to advance restrictions on pharmaceutical pricing programs that U.S. programs do not meet but for technical carve outs.[6]

Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

The TPP chapter may be best seen as a significant step toward the pharmaceutical industry’s ultimate goal, which is a binding international agreement on drug pricing that would restrain the ability of governments to use collective purchasing power to demand prices below “market” levels.[7] This is a radical proposal that would move trade agreements completely beyond any pretense to regulate trade and instead directly regulate domestic regulation itself. If such an agreement is desired by countries, it should be negotiated in an open forum where public health experts and advocates are well represented, e..g the World Health Organization. This is a completely inappropriate subject for closed door trade negotiations.





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Selling this policy as helping to insure groups not previously covered is a ploy to hide the real mission and that is to end public health and programs that protect the public on health issues.  Does it matter if you have subsidized insurance coverage if you cannot pay to access it?  Of course not.  The ACA makes it sound as if people will gain access when in fact they are losing it!

Review of U.S. Health Care Law from a Human Rights Perspective

DGH Supports Medicare for All


Many misconceptions exist, both in the U.S. and abroad, about the health care reform law recently passed in the U.S. The Patient Protection and Affordable Care Act (PPACA) implements a series of health care and insurance related provisions to take effect over years -- most by 2014.

A recent report by the National Economic and Social Rights Initiative (NESRI) has published several documents that point out where this law has failed women, immigrants, and people of color.  

To briefly explain, the PPACA will extend health insurance to 32 million more Americans. Many will get insurance through Medicaid, a federal social insurance program for the poor, which will be expanded to cover all citizens and some legal residents up to 133% of the federal poverty level. The PPACA will subsidize insurance premiums for lower income individuals and families, and give financial incentives to businesses to provide health care benefits to employees. It initiates consumer protections from certain insurance company abuses such as being cut off (“rescission”) and discrimination against those with pre-existing conditions.  It will mandate that all legally residing U.S. residents obtain medical insurance, and state-based insurance “exchanges” will be established. It will establish a non-profit Patient-Centered Outcomes Research Institute to assess the relative outcomes, effectiveness and appropriateness of various treatments. Funding for community health centers and payments for primary care services will increase substantially. Cost sharing for preventive care will be eliminated, and it will also eliminate co-pays for prescription drugs for those with Medicare.

Although more people will obtain insurance once the law is fully in effect in 2014, this actually insures that more public and private funds will flow to pharmaceutical, insurance, hospital and other health care industry corporations. An estimated $447 billion in taxpayer money from the new law will go directly to the health insurance industry alone. While the PPACA creates some important consumer protections and will expand health care coverage for millions, it continues to strengthen a profit-driven and fractured approach to health in the U.S. It is far from a comprehensive system of health care for all.

Impact of the PPACA on marginalized and vulnerable groups

Under the new law, an estimated 23 million Americans will remain uninsured.  This translates to 23,000 unnecessary deaths annually, and preventable and unnecessary suffering for those who remain without access to healthcare. In addition, many previously uninsured will be mandated to spend a significant portion of their income on health care from private insurers and still may not have comprehensive coverage. On average, poor people will spend 10% of their income to cover 70% of health care expenses, with co-pays and fees still unaffordable for many  Medicaid expansion will largely be outsourced by the federal government to private insurance companies, raising concerns over for-profit abuse of Medicaaid. Federal payments to hospitals with a large proportion of uninsured and low-income patients will be lowered, limiting much needed services.

Under the new law, the health rights of women have been undermined.  Gender-based higher insurance rates for women will remain legal until at least 2017, and large employer based insurance programs will be exempt from the new PPACA provision on gender rating prohibition. Women’s reproductive rights have been eroded, as the law seriously restricts access to abortion by requiring segregation of federal insurance funds for abortion from all other medical services. This means that government funds to finance insurance programs in the PPACA cannot be used for abortion services except in cases of rape, incest, or if a woman’s life is in danger. Contraception is currently not considered a “preventive” service, so women may continue to pay for this out of pocket, despite the PPACA law that eliminates fees and co-pays for preventive services. 

Under the new law, documented immigrants are subject to the health insurance mandate upon entry to the U.S., but still face waiting periods of 5 or more years to qualify for government social services such as Medicaid. This means the large expansion of Medicaid under the new law excludes all recent immigrants. Undocumented immigrants will be unable to access state exchanges to purchase their own insurance. Nor will Medicaid (except in cases of medical emergency) or other social services be open to them. This continues a dire and inhumane practice for asylum seekers and undocumented immigrants that denies them essential health care. In addition, overly strict verification requirements for the exchanges may lead to an exclusion of many eligible applicants. 

Again, please share this information. The struggle is not over for fair, equitable, and comprehensive health care for all in the U.S.


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As we see below, the ACA was simply a policy preparing the US market for these TPP treaties.....and as you see the US is criss-crossing the world pressuring other nations to shed their public health because, after all, the US now sees health care as purely market driven.....as it does education.  GOOD BYE PUBLIC HEALTH !

If Obama and neo-liberals are working so hard overseas to end public health and create these TPP treaties that super-size corporate control of all public policy especially health care......DO YOU REALLY THINK THEY ARE SITTING ON CAPITOL HILL FIGHTING REPUBLICANS IN OUR BEHALF?????

REALLY?????




Public Health Advocates Must Derail the TranPacific Partnership

December 29, 2013


Kris Alman, Assistant Secretary of Health for Data Privacy

Without public input, fast-track passage of this treaty could jeopardize their important work with the threat of costly lawsuits that put profits over people.

The mainstream media should be ashamed of its minimal attempts at informing the American people about the TranPacific Partnership (TPP). Negotiated in secret, the TPP is NAFTA on steroids. It’s urgent we demand that Congress oppose a “fast track” of this treaty.

You may be muttering, “Why pay attention to this irrelevant issue?” After all, we’re too busy working long hours to buy cheap Nike shoes, iPads and apparel from retailers like Walmart to celebrate the Christmas® holidays.

Indeed, we are so busy buying stuff destined for landfills that we don’t realize we are disposable too. The wizards behind the curtain of the TPP are 600 corporate “advisors” for rich multi-national corporations that don’t care about public health, the environment and human rights. They care about profits—period.

Over the weekend, the New York Times published a front-page story, “Tobacco Firms’ Strategy Limits Poorer Nations’ Smoking Laws.” While the Times pointed out that the U.S. is among twelve Pacific Rim Countries completing talks on a major new trade treaty that will be a “model for the rules of international commerce,” they made no mention of the TPP. “Fast tracking” the TPP requires a complicit mainstream media—one that eliminates enough dots so citizens can’t connect them.

The Oregonian is no different. As a scribe for Nike, the Oregonian reports that the TPP would eliminate tariffs on sneakers (outsourced to manufacturers who pay low wages overseas) and magically, we'll have more high-paying jobs here! Money needs to circulate for a society to thrive. Since the 2008 recession, we’ve learned that money is heading in just one direction: upwards. Global trade agreements will further concentrate money and power when corporate boardrooms reward their executives—including Nike CEO Mark Parker.

A Nixon innovation, fast track limits Congress to a no-amendments, no-filibuster, simple majority vote on complex trade agreements—even though the rare Congressman or Senator has read the TPP. Fast track expired in 2007. A midterm election compels the most do-nothing Congress to make amends to their corporate donors. Passing fast track in early 2014 is a bipartisan agenda.

The TPP is much more than tariffs. There are twenty-nine chapters and only five chapters deal with traditional trade issues. In mid-November, Wikileaks released draft text of the TPP Intelligential Property Rights chapter. This text includes an investor-state protection clause that gives multi-national corporations the right to sue communities, states and nations enacting laws that might compromise future profits.

The TPP singles out tobacco as a health concern, but the Chamber of Commerce says this “would leave the door open for other products, like soda or sugar, to be heavily regulated in other countries.” The Chamber of Commerce sent a letter to U.S. Trade Representative Michael Froman, opposing the “last-minute inclusion of a product-specific reference to tobacco or any other product.” They claimed “the TPP nor any prior U.S. trade agreement prevents American officials from regulating in the public interest—period. Trade agreements only require that such measures be based in sound science…”

Like the “sound science” performed by Monsanto that “proves” GMOs are safe and labeling is a costly regulatory burden?  One of the lobbyists that co-signed the letter is the Grocery Manufacturers Association. The Grocery Manufacturers Association amassed $7.2 million (of over $22 million in the opposition coffers) to successfully oppose GMO labeling in Washington State. PepsiCo, Nestle USA and Coca-Cola each donated over $1 million to that Grocery Manufacturers Association slush fund.

Corporations are tribal when they collectively fight public health campaigns because it’s costly for corporations to also fight “sin taxes.” In 2010, these same corporations helped to raise over $16 million to pass Initiative 1107 which repealed a tax on candy and soda in Washington. This discouraged Upstream Health, a nonprofit in Oregon, to mount a similar campaign to tax sugary sodas in 2013, especially since they couldn’t get a hearing for the same bill in 2011. Yet there is no question that sugar-sweetened beverages promote obesity.

Since the mainstream media protects corporate interests, WikiLeaks came to the rescue in publishing the Intellectual Property chapter of the TPP. If you can't stomach Julian Assange, turn to Joseph Stiglitz, (Columbia professor and winner of the Nobel Prize for Economic Science in 2001), who wrote an open letter to the TPP negotiators. Sadly, we must look to blogs for this publication. Stiglitz concludes, "The investor state dispute resolution mechanisms should not be shrouded in mystery to the general public, while the same provisions are routinely discussed with advisors to big corporations.

The invisible hand of “free” market forces is what Milton Friedman calls “the possibility of cooperation without coercion.” In the current era of mass communication and micro-targeted advertising, corporations have the upper hand when they defend their ability to obfuscate harms, laying blame on people that should take “personal responsibility” for their consumer choices.

More than three-quarters of the world’s smokers now live in the developing world, too poor to fight corporate lawsuits that might arise if they try to place limits on advertising, packaging and sale of tobacco products. With deep pockets, corporations squelch the voice of public health advocates while they belittle consumer protections as the “nanny state.”

The TPP subordinates public health, the environment and human rights to corporate profits. As global citizens, we must take time to learn more about the TPP. Call Congress and demand NO FAST TRACK.

~ Kris Alman serves as Assistant Secretary of Health for Data Privacy in the General Welfare Branch of the Green Shadow Cabinet.




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Here you see an article written last year.  This information was available to all politicians and pundits that pushed the ACA as hard as they could.....knowing it simply prepared US policy for these TPP deals.

Know who shouted loudly and who was silent------silence in these cases is duplicity and in Maryland----all democrats are silent and neo-liberals have to go!


IF YOUR LABOR AND JUSTICE ORGANIZATIONS ARE NOT RUNNING CANDIDATES IN ALL PRIMARIES AGAINST NEO-LIBERALS -----THEY ARE NOT WORKING FOR YOU AND ME!

TPP’s Investment Rules Harm Public Health
27/06/2012
Trade officials from nine Pacific Rim nations—Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, the U.S. and Vietnam— are in intensive, closed- door negotiations to sign a Trans-Pacific Partnership (TPP) free trade agreement in 2012. Every Pacific Rim nation from China and Russia to Indonesia and Japan could eventually be included. There are draft texts for many of this pact’s 26 chapters, most of which have nothing to do with trade, but rather impose limits on domestic food safety, health, environmental, and other policies. The governments won’t release the texts to the public. But over 600 U.S. corpo rate “trade advisors” have full access. America’s worst job-offshoring corporations, global banks, agribusiness, and pharmaceutical giants want this deal to be another corporate power tool like NAFTA (North American Free Trade Agreement.) Consumer, labor, environmental, and other public interest advocates want transparen- cy in the process and a “Fair Deal or No Deal.”

A major goal of U.S. multinational corporations for the TPP is to impose on more countries a set of extreme foreign investor privileges and rights and their private enforcement through the notorious “investor-state” system. This system allows foreign corporations to challenge before international tribunals national health, consumer safety, environmental, and other laws and regulations that apply to domestic and foreign firms alike. Outrageously, this regime elevates individual corporations and investors to equal standing with each TPP signatory country’s government – and above all of us citizens. This regime would empower corporations to skirt national courts and sue our governments before tribunals of private sector lawyers operating under UN and World Bank rules to demand taxpayer compensation for domestic regulatory policies that investors believe diminish their “expected future profits.” These regulatory policies can be anything from health and environmental protection to financial regulation. Indeed, under this regime, corporations can launch attacks on changes in government regulation surrounding patents and other intellectual property rights – something that can cast a chill on efforts to improve access to safe and affordable generics.

If a corporation “wins”, the taxpayers of the “losing” country must foot the bill. Over $350 million in compensation has already been paid out to corporations in a series of investor-state cases under NAFTA-style deals alone. This includes attacks on toxics bans, natural resource policies, health and safety measures, and more. In fact, of the over $12.5 billion in the 17 claims now pending under NAFTA-style deals, all relate to public health, environmental, and transportation policy – not traditional trade issues. Even when governments win, they waste scarce budgetary resources defending national policies against these corporate attacks.

A review of just some of the outrageous cases brought under this system highlights the extreme peril of these extreme investor privileges and their investor-state private enforcement being included in a TPP: 

Investor-state attack on cigarette plain packaging policies:

In the mid-2000s, countries from around the world signed onto the World Health Organization’s Frame- work Convention on Tobacco Control, which aims “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke…”

In 2008, Uruguay began implementing its obligations under this framework, including through legislation to enhance tobacco warning labels and require plain packaging. In 2010, Australia followed suit. But before the ink was even dry on these efforts, Philip Morris launched investor-state attacks against both countries. While the company is widely considered a U.S. company, the U.S.-Australia Free Trade Agreement doesn’t have investor-state arbitration, thanks to the push-back of legislators in both countries at the time of negotiation. So Philip Morris used its Swiss and Hong Kong subsidiaries to launch the attacks, using Bilateral Investment Treaties. The company is requesting investor-state tribunals to block the Uruguayan and Australian legislation from going into effect, and to have taxpayers of these nations compensate the company.  

Justice for children poisoned by smelter imperiled by investor-state:

Citizens in La Oroya, Peru suffer from the toxic emissions from a metal smelter owned by Ira Rennert, one of the richest men in the United States.  

An in-depth scientific study of the site – deemed among the top 10 most polluted worldwide – noted that sulfur dioxide concentrations at La Oroya greatly exceed international standards, noting that the chemical “damages the respiratory system, aggravates existing respiratory illnesses (especially bronchitis), and diminishes the capacity of the lungs to expel foreign particles such as heavy metals. It leads to a higher mortality rate, particularly when combined with the presence of elevated levels of particulate material.” The study found that sulfur dioxide levels doubled in the years after Rennert’s acquisition of the complex. When Rennert’s company bought the smelter, it agreed to construct a sulfur plant by 2006, which  would help with environmental remediation. But the company did not, and requested – and was granted extensions in 2006 and 2009.  That same year, the company presented a proposal to the Peruvian authorities to restart the smelter if the environmental commitments were loosened. The Peruvian government refused, and by the end of the year, Rennert had launched an attack under the U.S.-Peru FTA, claiming at least $800 million in damages. Among other claims, the company argues Peru’s failure to grant additional extensions constitutes an FTA violation. Unfortunately, past tribunals have found that countries can violate FTAs by disappointing investors’ expectations. Rennert’s efforts seem to have succeeded in casting a chill on the Peruvian government, which is slated to loosen the environmental requirements that the company must meet.  

Canada reverses ban on toxic gasoline additive after investor-state attack, pays $13 million.

Ethyl Corporation was a Virginia-based chemical company with a long and controversial history. In the 1950s, Ethyl Corporation developed a new gasoline additive called methylcyclopentadienyl manganese tricarbonyl (MMT). MMT, an anti-knocking agent used to improve engine performance, contains manganese – a known human neurotoxin. MMT was banned from use in unleaded gasoline by California, which has its own clean air law, and by the U.S. Environmental Protection Agency, due to environmental and public health concerns. Against this background, the Canadian Parliament imposed a ban on the import and interprovincial transport of MMT in April 1997. 

Although the potential hazards to human health were not fully-known, Canada acted in a precautionary manner until more information was available, as had the state of California and the U.S. EPA. But on September 10, 1996, while the prospective ban was being debated in the Canadian Parliament, Ethyl Corporation notified the government of Canada that it would sue for compensation under NAFTA’s investment chapter if restrictions were placed on MMT. The Parliament withstood these threats and passed the ban a year later in April 1997. That same month, Ethyl filed a NAFTA investor-state claim against the Canadian government. Initially, Canada objected to the NAFTA suit. On June 24, 1998, however, the NAFTA panel rejected Canada’s claims, clearing the way for the case to move forward. Shortly after this initial ruling, the government of Canada decided to settle with Ethyl.  

On July 20, 1998, Canada reversed its ban on MMT, paid $13 million in legal fees and damages to the Ethyl Corporation, and issued a statement for Ethyl’s use in advertising declaring that “current scientific information” did not demonstrate MMT's toxicity or that MMT impairs functioning of automotive diagnostic systems. This case shows how investor-state rules can cast a chill on public interest regulation. 


Growing resistance.

The investor-state system is so extreme that it is losing whatever small political support it ever had. Australia has said it will not include investor-state in its trade deals, and the Korean opposition parties are promising to derail the pending Korea-U.S. trade deal unless investor-state is removed. Latin American countries are pulling out of various arbitration agreements that provide venues for these private corporate attacks. President Obama even campaigned against this system! But career bureaucrats and big business want to stay the course, no matter the cost.





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Johns Hopkins has used a trillion dollars in public taxpayer money to build its global health corporation.....a few billion in Baltimore alone as the city crumbles from lack of government revenues.  When questioned about paying corporate taxes since it is now a global corporation Hopkins stated 'we will not pay taxes'.  It now controls the entire City of Baltimore development and policies are all neo-con.

This is what the ACA is all about.  It is a mirror of the Clinton banking deregulation and consolidation and is only meant to create global health corporations like these.  Hopkins declared health institutions have never been more profitable as quality of care/access has plummeted. 


8 Health Systems That Created International Partnerships in 2013

Written by Bob Herman  | December 26, 2013 Becker's Hospital Review


Globalization is a major part of the business sector, and several U.S. health systems have also grown their roles internationally.

Several providers expanded their work and ideas into other countries. Here are eight hospitals and health systems that created some of the most significant international partnerships in the past year, starting with the most recent.

1. Irving, Texas-based Christus Health finalized a joint venture with Pontificia Universidad Católica de Chile, a Chilean university in Santiago. Under the agreement, the two will become equity partners in a Santiago, Chile-based health network called Red Salud UC. 

2. Brentwood, Tenn.-based RegionalCare Hospital Partners partnered with Nashville, Tenn.-based nonprofit LiveBeyond to open a hospital in Thomazeau, Haiti.

3. Sioux Falls, S.D.-based Sanford Health partnered with YMCI Calmette Medical Investment & Management Company, a state-owned health system in China's Yunnan province. Sanford launched its World Clinics initiative in 2007 to develop a series of pediatric clinics in the U.S. and around the world in areas lacking sufficient primary care services. It has since expanded the scope of the initiative to provide care for entire families.

4. Baltimore-based Johns Hopkins Medicine International signed an affiliation agreement with Hospital Moinhos de Vento of Porto Alegre in Brazil. 


DOES 'MEDICINE INTERNATIONAL' SOUND LIKE A CORPORATION AND NOT A NON-PROFIT?  YOU BETCHA, BUT THEY ARE STILL CATEGORIZED AS NON-PROFIT AS IS MEDSTAR, A NATIONAL HOSPITAL CHAIN!

5. University of Rochester (N.Y.) Medical Center and Chennai, India-based Apollo Hospitals discussed a potential affiliation. Apollo is one of the largest private hospital networks in its region, with 50 hospitals located across India and eight other countries in South Asia, the Middle East and Africa.

6. A July agreement between Kazakhstan's Nazarbayev University and Pittsburgh-based UPMC's Pitt School of Medicine will help NU open its first medical school

7. Winston-Salem, N.C.-based Wake Forest Baptist Medical Center announced its commercialization arm, Wake Forest Innovations, signed a memorandum of understanding with CHA Health Systems, based in Seoul, South Korea.

8. Cleveland Clinic signed a contract with an academic medical center in Beijing, where Cleveland Clinic physicians will consult on the opening of a new brain health facility.






__________________________________________________

I showed recently that 80% of Americans have now been driven to the poverty line so will not be able to afford the premium payments much less the co-pays and deductibles.  THAT IS THE POINT! 

What they are doing is setting up a system of 'preventative care' that fills the entitlement system with the same kinds of health care that most of the health fraud exists.  OK, you get preventative care checkups that find you have HIV....how do you afford the treatment?  YOU DO NOT.  You do get placed in the database as having this illness and these lists will be available to corporations who then will not hire you.  You have no job, no access to basic health care for HIV and you die prematurely.  This same scenario plays for any of the chronic illnesses that require long-term treatment and we know most people will not afford treatment beyond the first level of care.  It systematically kills most Americans.


Why are they doing this?  Because these few decades health industry has been stealing hundreds of billions of dollars each year from Medicare and Medicaid so these Trusts are gutted by fraud.  Then, they dismantled all of the oversight in Medicare agencies and allowed profiteering with super-sized pricing that drained these Trusts----WE PAID FOR THE MEDICAL ADVANCES AND WE WILL HAVE ACCESS TO THEM!

FRAUD AND PROFITEERING IS THE PROBLEM AND OBAMA AND NEO-LIBERALS MADE THE AFFORDABLE CARE ACT ABOUT ELIMINATING ACCESS TO GET RID OF COSTS THAT CUT INTO PROFIT.

Everyone understands that simply having a few health incidents a year will end a family's ability to access more care!

Obamacare: Is a $2,000 deductible 'affordable?'

By Tami Luhby  @Luhby June 13, 2013: 6:23 AM ET


Participants may have different views on whether Obamacare plans are affordable.

NEW YORK (CNNMoney) Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges. But what will enrollees actually get for that monthly charge?

States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs.

Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.

For some, this will be great news since it will allow them to see the doctor without breaking the bank. But others may not want to shell out a few thousand bucks in addition to a monthly premium.

"The hardest question is will it be a good deal and will consumers be able to afford it," said Marian Mulkey, director of the health reform initiative at the California Healthcare Foundation. "The jury is still out. It depends on their circumstances."

A quick refresher on Obamacare: People who don't have affordable health insurance through their employers will be able to sign up for coverage through state-based exchanges. Enrollment is set to begin in October, with coverage taking effect in January. You must have some form of coverage next year, or you will face annual penalties of $95 or 1% of family income (whichever is greater) initially and more in subsequent years.

Each state will offer four levels of coverage: platinum, gold, silver and bronze. Platinum plans come with the highest premiums, but lowest out-of-pocket expenses, while bronze plans carry lower monthly charges but require more cost-sharing. Gold and silver fall in the middle.

The federal government will offer premium subsidies to those with incomes of up to four times the federal poverty level. This year, that's $45,960 for an individual or $94,200 for a family of four. There will be additional help to cover out-of-pocket expenses for those earning less than 250% of the poverty line: $28,725 for a single person and $58,875 for a family of four. The subsidies are tied to the cost of the state's silver level plans.


California offers insight into how much participants will actually have to pay under Obamacare. The state, unlike most others, is requiring insurers to offer a standard set of benefits and charges in each plan level. The only variables are monthly premiums, doctor networks and carriers in your area.

For those in need of frequent medical care, the platinum or gold plans would reduce out-of-pocket costs for treatment. These plans have no deductible, and doctors' visits and medication are cheaper. But the trade-off is that they have higher monthly premiums. California has not yet released the premium range for these tiers.

On the flip side, a young man who never visits the doctor and wants to minimize his monthly charge could opt for a bronze plan. A 40-year-old enrolling in this plan could pay as little as $219 a month. But, if he did get sick, he'd get socked with a $5,000 deductible, $60 co-pays for primary care visits and a $300 emergency room charge.

Obamacare provides protection for those who need a lot of care by placing a cap on out-of-pocket expenses. The maximum a person in an individual platinum plan will spend a year is $4,000, while those in the other tiers will shell out no more than $6,400.

"Insurance is expensive. It's hard for anyone who isn't well off to afford it," said Gary Claxton, director of the health care marketplace project at the Kaiser Family Foundation. "But it is good enough that you can afford to get sick without bankrupting yourself."

Whether potential enrollees find these plans affordable will depend on how healthy they are and whether they are currently insured.

Many individual insurance offerings currently available come with much higher deductibles, cover fewer expenses and limits on how much they'll pay out in a year. Plans on the exchange, on the other hand, are required to cover a variety of "essential benefits," including maternity care, mental health services and medication.

"In many cases, depending on the plan, the coverage will be more comprehensive than what the enrollee currently has," said Anne Gonzalez, a spokeswoman with Covered California, which is running the state's exchange.





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January 06th, 2014

1/6/2014

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IT MATTERS FOLKS WHERE WE GET THESE POLLING NUMBERS AND NOW THAT WE HAVE A WHOLESALE DISREGARD TO OVERSIGHT AND ACCOUNTABILITY BOTH NATIONALLY AS WELL AS STATE AND LOCAL DATA......WE NEED TO MOVE AWAY FROM RELYING ON THESE POLLING DATA.  THE POLLING CORPORATIONS ARE NOW OPERATING JUST AS THE WALL STREET RATING AGENCIES S & P AND MOODY'S......

THEY GIVE THE RESULTS THE 1% WANT TO SEE!




Do your own research and vote by that------do not be sheeple!!!!

This is a top election issue .....if your politician or justice organizations are not shouting that the integrity of polling especially for elections and political issues is now propaganda and not scientific polling......THEY ARE NOT WORKING FOR YOU AND ME!


Regarding the loss of integrity in US stats and polls:

By now everyone knows the poverty data Basu gave are not real.....but it is important to look at why he gives these stats and how this embracing of propaganda in US media affects world opinion.

Below we see why he is doing it.  First, it keeps citizens from knowing the reality of the severity of conditions and second to keep protests at bay and second, it reflects the attitude of the 1% that people falling into poverty no longer count---LITERALLY!


The goal of the last few decades was moving US wealth to the top and creating a level of poverty in the US that mirrors third world countries. This is how 5% of a population keeps the other 95% suppressed----poverty. 80% is getting to that goal....just wait for the massive crash of the economy next year. That will do it!

ALL THAT NEED BE DONE IS TO RUN LABOR AND JUSTICE IN ALL PRIMARIES AGAINST NEO-LIBERALS TO REVERSE THIS-----REINSTATING RULE OF LAW TO RECOVER MASSIVE CORPORATE FRAUD IS ALL THAT IS NEEDED!


When this article says 80% are near poverty.....we know that with a Living Wage at $15 an hour and poverty stats by US use 1960s cost of living to tally its figures.


*************************

In the U.S. 49.7 Million Are Now Poor, and 80% of the Total Population Is Near Poverty

 Posted by PBSpot Admin      06 November 2013   

If you live in the United States, there is a good chance that you are now living in poverty or near poverty. Nearly 50 million Americans, (49.7 Million), are living below the poverty line, with 80% of the entire U.S. population living near poverty or below it.

_________________________________________________

More interesting on corporate NPR was the report of US exporting its polling around the world with Gallup trying to get into the Afghanistan elections.  LOL!!!!  Gallup was shown to have released skewed data and polls in our US elections so we hear people around the world shouting RUN FROM US DATA AND POLLING!

I showed you the Gallup poll that had Obama and Hillary as the most admired in the US.....winning with just over 1,000 polled.  We all know a cohort this size with a 4% error is absolutely useless and yet it made every mainstream news media in the US.  No doubt they did this because they could only find 1,000 people in the US to say they admired Obama and Hillary or they simply polled the White House staff.  We have the same in Maryland as Gonzales and other agencies used for polling always seems to poll support for the governor's policies with a cohort of a few hundred.....again, probably the State House staff.

Raise your hands if you understand that sampling 403 Maryland citizens out of .......Maryland voter registration has 1,944,620 are registered as Democrats in 2010.......MEANS NOTHING!  EVERYONE.

Raise your hands if you know 3-5% margin of error means not statistically valid!!!!!!!!  EVERYONE.

Below you see the Maryland polling agency used the most and all of Maryland media repeat whatever is said.  Finding 400 democratic voters in Maryland who say they still have faith in Obama's performance.....who still believe the statistics put forward by O'Malley making him look like he did a good job.....and now want his protege Brown to win.....YES, IT LOOKS LIKE THE COHORT CAME FROM THE STATE HOUSE!


As a scientist I understand means testing and know that the margin of error needs to be extremely low to be acceptable for scientific research.  We do not need to be that low in these societal pollings, but we do know that once you go above 3% you lose any reliability in data.



Comparing percentages


In a plurality voting system, where the winner is the candidate with the most votes, it is important to know who is ahead.

Given the observed percentage difference p − q (2% or 0.02) and the standard error of the difference calculated above (.03), any statistical calculator may be used to calculate the probability that a sample from a normal distribution with mean 0.02 and standard deviation 0.03 is greater than 0.



 Embargo: 12:01 am Thursday, October 17, 2013
 
Gonzales Research & Marketing Strategies, Inc.
Methodology


This survey also includes an oversampling of 403 registered Democrats who indicated they were likely to vote in the June 2014 primary election. A cross-section of interviews was conducted in each jurisdiction within the state to reflect Democratic primary election voting patterns. The margin of error on this group is plus or minus 5 percentage points.


 President Barack Obama Job Approval
Among Maryland voters, 58% approve of the job Barack Obama is doing as president

Statewide, 48% of voters
approve of the job O’Malley
is doing as governor

 Democratic Primary
Forty percent of Maryland Democratic primary voters have a favorable opinion of Anthony
Brown  


***********************************
As the interviewee stated in this report, these polls will only be used as propaganda in Afghan elections as they are now in the US.  Look below to see again, Gallup is taking 1,000 polling samples within each nation polled.....1,000!!!!!! 

THIS IS HOW YOU KNOW THE POLL IS ONLY ABOUT PROPAGANDA BECAUSE IT MEANS NOTHING!

Will Afghan Polling Data Help Alleviate Election Fraud?

by Sean Carberry
January 06, 2014 5:07 AM



The U.S. Embassy in Kabul has commissioned a series of polls to see who Afghans favor in the April election. But between security challenges and "social desirability" biases, it can be difficult to impossible to get a clear read of the Afghan people.


*********************************

'Gallup conducts surveys in 160 countries and is committed to doing so for the entire century. The Gallup World Poll provides a scientific window into the thoughts and behaviors of 98% of the world's residents through nationally representative samples. It is the only global study of its kind in existence'.


Global Gallup Poll: US Voted Greatest Threat to World Peace

The polling agency Gallup recently asked about 1,000 people in each of 68 different countries which country they believed was the biggest threat to world peace.


**************************************
Below you see an analysis that shows how a major US polling organization, Gallup has been wrong over and again by wide margins and these sample sizes are part of the reason.  More importantly is the movement of polls to being propaganda rather than true stats with integrity and honesty of reporting as the goal.  You see, when the people behind them are part of the lying, cheating, stealing group....THE STATS BECOME IRRELEVANT.  

MARYLAND KNOWS THAT BETTER THAN MOST STATES AS ALL DATA BY STATE IS SKEWED.


******************
Look below at my last article on reliability in research design and how polling data used to be the realm of public universities who took integrity and broad information collection seriously.  Then think about what Gallup, Gonzalez and all other mainstream polling agencies are giving us.  We need to go back to strong public universities working in the public interest and this includes the value of polling!


 'To be clear, I would not recommend disregarding the Gallup poll. You should consider it — but in context.

The context is that its most recent results differ substantially from the dozens of other state and national polls about the campaign. It’s much more likely that Gallup is wrong and everyone else is right than the other way around'.


In National Polling, It’s Gallup vs. the Rest



By NATE SILVER
Published: October 19, 2012

   

The Gallup national tracking poll now shows a very strong lead for Mitt Romney. As of Friday, he was ahead by six points among likely voters, having led by seven points on Thursday.

However, the poll’s results are deeply inconsistent with the results that other polling firms are showing in the presidential race, and the Gallup poll has a history of performing very poorly when that is the case.

Other national polls now show a very slight lead for President Obama on average, while state polls continue to indicate a narrow advantage for the president in tipping-point states like Ohio. The FiveThirtyEight forecast has Mr. Obama as a modest favorite in the election largely on the basis of the state polls.

The Gallup poll is accounted for in the forecast model, along with all other state and national surveys.

There are two major pieces of information that we’re looking to extract from each poll. One is simply the raw number — who is ahead or behind? The other is the trend it shows in the race — which candidate is gaining or losing ground?

Different types of polls are relatively more or less useful for these purposes. Because national tracking polls like Gallup are published every day, they are useful for the trend part of the calculation.

There are six national tracking polls published most days. The others are from Rasmussen Reports, Ipsos, the RAND Corporation, Investors’ Business Daily and United Press International. (A seventh daily tracking poll, from Public Policy Polling, made its debut on Thursday.)

But of the daily tracking polls, the Gallup survey receives the largest weight in the model’s trendline calculation. It uses a larger sample size than most other polls, and its methodology includes calls to cellphone voters.

On the other hand, our pollster ratings are also based in part on past accuracy, and Gallup’s performance is middling in that department.

The Gallup poll seems to have an outsize influence on the subjective perception of where the presidential race stands, however — especially when the poll seems to diverge from the consensus.

This simply isn’t rational, in my view. Usually, when a poll is an outlier relative to the consensus, its results turn out badly.

You do not need to look any further than Gallup’s track record over the past few election cycles to see this.

In 2008, the Gallup poll put Mr. Obama 11 points ahead of John McCain on the eve of that November’s election. The average of the 15 or so national polls released just before the election put Mr. Obama up by about seven points.

The average did a good job; Mr. Obama won the popular vote by seven points. The Gallup poll had a four-point miss, however.

In 2010, Gallup put Republicans ahead by 15 points on the national Congressional ballot, higher than other polling firms, which put Republicans an average of 8 or 9 points ahead. In fact, Republicans won the popular vote for the House of Representatives by about seven percentage points — fairly close to the average of polls, but representing another big miss for Gallup.

The Gallup poll also has often found implausibly large swings within a race. In 2000, for example, Gallup had George W. Bush 16 points ahead of Al Gore among likely voters in polling it conducted in early August. By Sept. 20, about six weeks later, the firm had Mr. Gore up by 10 points instead: a 26-point swing over the course of a month and a half. No other polling firm showed a swing remotely that large.

Then in October 2000, Gallup showed a 14-point swing toward Mr. Bush over a few days, and had him ahead by 13 points on Oct. 27 — just 10 days before an election that ended in a virtual tie.

After the Republican convention in 2008, Gallup had Mr. McCain leading Mr. Obama by as many as 10 points among likely voters. Although some other polls also had Mr. McCain pulling ahead in the race, no other polling firm ever gave him more than a four-point lead.

It’s not clear what causes such large swings, although Gallup’s likely voter model may have something to do with it.

Even their registered voter numbers can be volatile, however. In early September of this year, after the Democratic conventions, they had Mr. Obama’s lead among registered voters going from seven points to zero points over the course of a week — and then reverting to six points just as quickly. Most other polling firms showed a roughly steady race during this time period.

Because Gallup’s polls usually take large sample sizes, statistical variance alone probably cannot account for these sorts of shifts. It seems to be an endemic issue with their methodology.

To be clear, I would not recommend disregarding the Gallup poll. You should consider it — but in context.

The context is that its most recent results differ substantially from the dozens of other state and national polls about the campaign. It’s much more likely that Gallup is wrong and everyone else is right than the other way around. 



__________________________________________
What we are seeing with US polling is a direct attempt to frame all US political issues under the guise of polling.  The way polling questions are asked or not asked and who is in the cohort overs the American public nothing but mis-information.

When a poll asks a general question like DO YOU SUPPORT THE IMMIGRATION BILL rather than having a question that offers categories important to the immigration policy found in that bill.....you skew the results.  They know it and so do we.  It is also how they kill any approach to getting all political views on an issue aired.

POLLING HAS NOW BECOME THE MEANS TO CAPTURE ALL POLITICAL TALK ON ALL ISSUES!


Polling used to be done by public universities for the most part and involved extensive attention to integrity and detail just as if it were a scientific data activity.  Academics did due diligence to collecting the data needed for polling because they used those stats for public research.  Now, public universities have been made into corporate branches and you see very little time placed by universities in this because it is not cost-effective!  Meanwhile, the corporations allowed to dominate the polling arena now find the costs of real polling not necessary and give us these useless data collected as cheaply as possible....


THAT'S NAKED CAPITALISM FOR YOU!!!!



Reliability in Research Design

January 3, 20092By ActiveCampaign

When I think of reliability I imagine always knowing what to expect.  If a person is able to produce the same quality work consistently then they are considered reliable.  You see it in sports all the time. Certain players have a knack for coming through in key situations no matter how late in the season or how worn down they are.   However, I can imagine few jobs that require more reliability than a surgeon.  Having an off day for them could prove disastrous. For a measure to be reliable it must demonstrate consistency as well as repeatability.  When carrying out research our results should be accurate across a range of measurements.  In surveys you would like to think that you would get the same response no matter what mood your respondent is in but that is not always the case.   A surgeon must deal with difficult situations while showing the same precision and reliability.  That is a quality to be admired but you can not always expect everyone to act like a surgeon at all times.  It’s also possible that your respondent won’t know what you mean when you ask them a certain question resulting in an answer that is entirely different from what you are attempting to measure.



Test-retest Reliability

If your survey respondent had to take your survey again would they answer the same questions the same way?  Test-retest reliability measures reliability over time.  A number of factors can affect reliability over time such as a person’s mood, time of the day, where the questions are placed in the survey (context effect), circumstantial events, vagueness, etc.  A good test will take into account factors that may influence survey results over time and minimize them so that results show little variation. If a test is unreliable then any one of a number of factors can lead to varying results depending on when the question is asked.  In general the more time a person takes between retesting the more variation you can expect in the responses.

If you ask Joe Q what he thinks about Candidate X on Tuesday he may view him favorably because X gave a really good speech on Monday.   Say Candidate X is indited later in the week in a corruption scandal.  Joe previously indicated that a candidate’s integrity is very important.  Last week he said that he was leaning toward Candidate X.  Now that Candidate X has been exposed you may think he is likely to give you a different response if you asked Joe the same question next Tuesday.   The reliability of opinion polls can be doubtful depending on the questions we ask because opinions tend to fluctuate over time.  What does Joe Q mean when he rates integrity as very important?  Perhaps Joe Q considers anyone that shares his ideology to have integrity.  Its possible that Joe Q would vote for Candidate X no matter what he thought of him personally because they share the same ideology.  Probing Joe’s past voting record would be more indicative of voter preference than asking a subjective question about integrity.  Asking him more objective questions that would not fluctuate from week to week would have higher test-retest reliability.

Parallel Forms Reliability

Another challenge reliability faces is in knowing what the best questions to ask are.  What does Joe Q mean when he rates integrity as very important?  Could we come up with better questions to predict how voters like Joe Q would vote? Another way to improve the reliability of a survey is to ensure that it is representative of the data you are trying to collect.   To do this increase the sample size.  If you are gathering research to find out whether voters like Joe Q are likely to vote for Candidate X then you need to find more people like Joe and ask them different questions or question sets based on the same construct.

You come up with a large set of questions to ask in your survey.  The construct that you are measuring is voter preference. The large question set is split in half and you administer each set to half of the targeted population.  You can then take a look at which questions are better indicators of voter preference. This combines what is known as a split test method with parallel form evaluation.

You can use parallel forms to measure a construct for people that are not like Joe Q.  Here you would divide a population that is representative of all likely voters in two.  Develop a large question set that measures a particular construct and then administer to each half of your representative population.  Now you can learn which questions are better indicators for voter preference for a representative population.

Inter-rater Reliability

This is necessary if you are conducting your survey using an interview process.   If  multiple people are interviewing Joe Q to ask what his opinion on politics is then inter-rater reliability measures the degree to which the observers agree.  This is the best way to measure reliability if you are using observation for your research.

Internal Consistency Reliability

The purpose of asking questions in surveys is to assess a particular construct or idea.  Therefore different questions that measure the same construct should yield similar results.  Reliability is determined on the basis of whether results are consistent for different items that measure the same construct.  For example, you could check for reliability on your survey by asking a respondent two similar questions meant to measure the same thing.

  • Average Inter-Item Correlation – when we ask a respondent two similar questions to measure the same construct.  This compares correlations between this and any other paired questions to measure the same construct by calculating the mean of all paired comparisons.
  • Average Itemtotal Correlation – where you take the average inter-item correlation and calculate a total score for each item.
  • Split-half Correlation – you divide items that measure the same construct into two tests,  apply them to the same group of people, and calculate the correlation between the two scores.
  • Cronbach’s Alpha – when we calculate the average split half estimates from a sample population.
In order to draw conclusions, formulate theories, or make generalizations about your research you need to ensure the reliability of the data you collect.  In general reliability is threatened when assessments are taken over time, rely on different standards of judgment, or assessments are highly subjective.  You can improve reliability by ensuring that your surveys are written clearly and without ambiguity.  You should construct your response options so that they are appropriate and meaningful.

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    Cindy Walsh is a lifelong political activist and academic living in Baltimore, Maryland.

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