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August 08th, 2014

8/8/2014

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'The TPP will re-regulate the pharmaceutical and medical device industry patent protections, eroding the affordability of life saving medicines.  Generic drugs will become less available. EVERGREENING drug patents will extend patents ensuring a never ending upward cost spiral sacrificing affordability for the many to the profit making on medicines exorbitantly priced for the few.  Surgical Techniques, laboratory tests and medical treatments can be patented restricting availability to people in need'.

There has also been concern about the problem of patent ‘ever greening’ — that the TPP will impose low patent standards ‘likely to lead to a proliferation of secondary patents being granted … preventing fair competition for long periods’. This would be an undesirable outcome, creating excessive opportunities for the extension of monopoly protections.

In Maryland it was Johns Hopkins that wrote the policies of Trans Pacific Trade Pact in health care and the structures being implemented by neo-liberals and neo-cons in the Maryland Assembly with Governor O'Malley.  It is the Hopkins private non-profit Maryland Health Care for All that pushed Affordable Care Act to deregulate and consolidate the health industry preparing for TPP.  Below you see Hopkins' associate Beilenson building the structure that will capture most Marylanders not able to access health care and it is the model of third world clinic care.  Above you see the term 'evergreening' meaning privatization and profiteering in TPP trade policies that create the conditions of dismantling public health.  Below you see Johns Hopkins and their use of the term as the name of the so-called private non-profits that will manage the masses not able to access health care in Maryland.
   The very institutions guilty of making the US health system the worst in the world are now writing policy to take the US health system third world.


At Evergreen Health we put your health first.


Evergreen Health is a new health insurance company in Maryland created to give you a better health care experience.

We were founded by local doctors who imagined a health care system that puts a patient’s health first – not corporate profits. Evergreen Health offers quality, affordable health insurance plans  for individuals and families in Maryland.  We also offer group plans for employees of your business who work in Maryland.


______________________________________________

The reason Beilenson thinks Evergreen is well-positioned is that if Affordable Care Act is implemented more and more people will be forced into these non-profit plans.  Evergreen will be the health structure people are forced to as Medicare, Medicaid, and people's corporate plans disappear.  As with evergreening in TPP-----it will move the American people to a third world platform of health care.  Beilenson is Johns Hopkins and Johns Hopkins is third world health care.  Baltimore doesn't have citizens dying 30 years too early because of good policy!

OH WELL------IT'S ONLY THE POOR!  WELL, IN THIRD WORLD NATIONS DOCTORS, LAWYERS, AND INDIAN CHIEFS ARE POOR.


Why do we need a private non-profit co-op to bring prices down when Medicare and Medicaid does just that?
  As Beilenson knows------he is there to replace these Federal programs and will not have to meet any Federal guidelines of care-----they are staged to downgrade a public health structure in Medicare that has served wonderfully for decades.  All we need to keep Medicare is to stop the health industry fraud by institutions like Johns Hopkins.

OH, LET'S CREATE PRIVATE NON-PROFITS TO TAKE OVER PUBLIC HEALTH PROGRAMS LIKE MEDICARE AND MEDICAID THAT ALREADY WORK TO KEEP PRICES DOWN----
  if 1/2 of entitlement spending wasn't lost to corporate fraud.


In the land of neo-liberalism/neo-cons,  ending all Federal agencies that come with public protections is a must in order to allow global corporations to do anything they want in the US and to American citizens.

Evergreen faces challenges in delivering health insurance

Small businesses may be the future of health insurance co-op in MarylandOctober 29, 2013|By Meredith Cohn, The Baltimore Sun

Four weeks since it began selling health insurance on the state's new marketplace for the uninsured, Evergreen Health Cooperative Inc. has signed up only five people.

That's a long way from the nonprofit health insurance provider's first-year goal of 15,000 people, so Evergreen is already shifting focus.

Technical problems making it difficult for people to register for the state exchange culminated last week for Evergreen when its plans disappeared from the exchange offerings. The plans were restored after a short time.

Statewide, more than 3,100 people have signed up for health coverage on the exchange, according to the latest numbers released by the Maryland Health Connection. There are about 800,000 uninsured Marylanders.

Evergreen isn't waiting for the exchange to start working properly. For now, the co-op has switched focus from individuals buying its insurance on the exchange to small businesses buying plans directly from Evergreen, said Dr. Peter Beilenson, the former city health commissioner who started it. (The state's small-business exchange has been delayed until Jan. 1.)

"We obviously were predicating most of our business on the exchange market, which is not bearing fruit right now," Beilenson said. "That was a problem for us in two ways: financially in terms of generating enough members and for our mission. We did this for the middle class who would qualify for subsidies."

But the co-op was new and nimble enough to switch "almost overnight to small businesses," he said. "We think it will provide us with enough members to get through until the exchange is running smoothly."

Evergreen's small group rates were approved Oct. 25, so no group has enrolled yet, but the prices are below average and attracting attention from businesses and brokers, Beilenson said. The co-op will depend on enrollment to survive — members' premiums will pay to run the co-op and cover startup costs. Any profits would be returned to the plans.

The co-op's small-group rates are at the lower end of the spectrum, with an average premium of about $368 per insured, according to data from the Maryland Insurance Administration.

The lower rates may reflect Evergreen's model. The co-op employs its own doctors, who work in one of four centers for a salary rather than fee-for-service. The idea is to focus on prevention while managing multiple chronic conditions and staving off costly emergency visits and hospital stays.

Evergreen also offers a traditional plan using a network of doctors.

It's cost that matters most to small businesses, and a competitive premium will serve Evergreen well, said Karen Davis, a professor in the Johns Hopkins University's department of health policy and management. There is a "fair amount of evidence" that shows Evergreen's patient-centered model cuts costs, she said.

But insurance tends to be dominated by large insurance companies, so it remains unclear whether Evergreen and co-ops in other states can slice off enough business.

"The major challenge is size and scale," Davis said. "But the advantage Evergreen has is that its model of care is more effective. … I think they're in a better position than most of the co-ops."

Nationwide, 24 co-ops received federal funding as part of the Affordable Care Act. Evergreen got $65 million in federal loans, but all but about $13 million will go to a required reserve fund

Others wanted to start co-ops in Maryland, seeing the potential to compete with traditional insurance companies and bring down prices. One was MedChi, the state medical society, which planned to start a co-op largely on the Eastern Shore but was stymied when Congress cut startup funding.

"We're very supportive of the idea of co-ops and think they can work really well," said Gene Ransom, MedChi's CEO. "I don't think they have an easy task ahead. We are rooting for Evergreen because more competition is good for the marketplace."

Beilenson said Evergreen has made other adjustments to survive. It has hired some staff from the insurance industry to serve as a balance with those employees who know more about public health. It has raised $5 million in startup money from private foundations and another $1 million from other private sources for marketing, including a new TV ad (federal law prohibits explicit marketing with government money).

"I think we're well-positioned," Beilenson said. "We think we know what we're doing. And we think we have a really good product."
_____________________________________________



One of the elements in Affordable Care Act is the connection of generic drugs to Medicare.  Obama and neo-liberals in Congress told the American people that because massive health industry fraud of our Medicare Trust occurred over these few decades they would have to reduce our health benefits to cover the money stolen.  In the case of health care this means Medicare and Medicaid enrollees limited to what medications they can access.  Common drugs will no longer be available to 80% of Americans because of this ACA clause pushing people to generic drugs only.  IT SAVES MONEY AND LOWERS THE NATIONAL DEBT!  As the statement at the top shows this ACA policy corresponds to the TPP health policies making generic drugs less common and harder to get.  Neo-liberals and neo-cons are sending people to generics at the same time they are pushing TPP limiting access to generics.  It's the same policy as pushing NAFTA and global markets knowing it will cause massive unemployment and poverty at the same time ending Welfare as a safety net-----creating the deepest poverty in US history.  These are all Republican policies written for wealth and profit being installed by Clinton neo-liberals.  Republican voters who are shouting against lost US Constitutional rights and dismantling of Rule of Law------lost access to health care need to remember these are all Republican policies.  Don't vote Republican to fix this-----rebuild the Democratic Party at the national, state, and local level.


Below you see from what the Affordable Care Act is modeled......third world clinic care.  Baltimore has had this system in place for a few decades but the model is being expanded because of the huge number of citizens falling into poverty.  Only 1/2 of taxpayer money sent for social services are spent on the people meant to be served.....the rest has been funneled to Johns Hopkins and/or University of Maryland as profit.  This is why the poor in Baltimore have life spans equal to third world countries.  Neo-liberalism = third world poverty so 90% of Americans will be pushed into this system.   Below you see a neo-liberal solution to our exploding health care costs fueled by health industry fraud and profiteering------third world clinic care and using college students to replace the public sector health care and social services employees.  Health care outcomes in the US are at second and third world levels because of the dismantling of public health systems.  College students are not prepared to be the backbone of public/social services-----they need practical experience of working with public professionals.  Making volunteers and students the backbone of public health is a third world structure. 


The US is now on par with countries like Hungary and Slovenia because Reagan/Clinton neo-liberalism dismantles all first world structures the protect and serve the public and all taxpayer money is looted in corporate fraud and subsidy.  Simply rebuilding these oversight and accountability structures returns the US to first world status.


DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL IN YOUR STATE TO KEEP OUR FEDERAL MEDICARE PROGRAM STRONG AND EVERYONE COVERED!  PUBLIC HEALTH IS WHAT KEEPS COSTS DOWN.  WE SIMPLY NEED TO REBUILD OVERSIGHT TO ELIMINATE 1/2 OF HEALTH SPENDING AS FRAUD.


Doctor and Patient What We Can Learn From Third-World Health Care

By PAULINE W. CHEN, M.D. July 26, 2012 12:01 amJuly 26, 2012 11:16 pm  New York Times


The young doctor had just returned from a month working in a country in Africa, familiar to the rest of us only through pictures of its impoverished population and news reports of recurring natural disasters and political upheavals. “You must feel exhausted but great,” a senior colleague commented. “You went in there and you really helped those people.”

Doctor and PatientDr. Pauline Chen on medical care.

But my younger colleague felt neither exhausted nor relieved to be back home, she confided when the older doctor had left the room. She had cared for dozens of patients with abscesses and broken bones, tumors and arrow wounds, relying on nothing more than a single rickety X-ray machine, a handful of battered surgical instruments and the aid of one well-connected local nurse.

“We could get so much done with so little over there,” she said. “It’s like we’re not doing something right over here.”


Put another way, the American health care system has become the great international paradox, spending more but getting less.

With all the most advanced technology and equipment, spending far more on health care than any other nation — a whopping $2.6 trillion annually, or over 17 percent of our gross domestic product — the United States consistently underperforms on some of the most important health indicators. Our infant mortality rates, for example, are worse than those in countries like Hungary, Cuba and Slovenia. Our life expectancy rates are not much better; in global rankings, we sit within spitting distance of Cuba, Chile and Libya.

This quality conundrum dogs us, even as our best and brightest have tried to imagine a more cost-efficient system. Some have pursued the carrot-and-stick route, linking quality measures to reimbursement. Others have attempted to reduce quality to its most basic parts, creating checklists and to-do lists. And still others have rearranged networks of hospitals, clinics, physician practices and payments, conjuring up a breathtaking array of combinations, permutations and bundles of care in order to create more cost-efficient systems.

But, according to an essay published this summer in The Stanford Social Innovation Review, we might have saved ourselves the huge effort, the expenses and the disappointments of only marginally successful initiatives, if we had first looked to countries traditionally viewed as needing our aid and learned from their successes in facing challenges similar to our own.

In the essay, Rebecca D. Onie, a founder and the chief executive of Health Leads, a domestic health care organization; Dr. Paul Farmer, a founder of Partners in Health, a Boston-based medical nonprofit group; and Dr. Heidi Behforouz, medical and executive director of the Prevention and Access to Care and Treatment project, a community-based health care initiative in the United States that is part of Partners in Health, argue eloquently for “reverse innovation.” They contend that for decades, several nongovernmental and nonprofit medical organizations have delivered high-quality care in some of the most challenging circumstances possible. Applying the solutions these medical organizations have already discovered could allow us to bypass or at least foreshorten what has become an interminable trial-and-error search for the answers to our country’s health care woes.

Their own organizations offer several models of success. For nearly three decades, Partners in Health, for example, has delivered consistently high-quality care to more than 2.5 million people in a dozen countries like Haiti, Rwanda and Peru, places with widespread poverty, scarce numbers of providers and no health care infrastructure. But they have managed to achieve, among other successes, the highest rate of cure of multidrug-resistant tuberculosis in the world and better rates of adherence to treatment regimens and follow-up than in much of the United States.

The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.

Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid.

Health Leads has stretched these definitions even further, giving the terms “provider” and “care” a millennial twist. Each year, Health Leads trains a selected group of technology-savvy and tenacious college students to staff “resource desks” in primary care and prenatal clinics in cities like New York, Baltimore, Boston and Chicago. With these Health Leads volunteers in place, doctors can, for example, “prescribe” housing assistance for a family whose child’s severe asthma has been exacerbated by a cockroach infestation, healthy foods and nutrition resources for a man suffering from obesity, or transportation to a drugstore for an elderly woman who needs diabetes medications. At the resource desk, a Health Leads volunteer then “fills” these prescriptions by finding the best solutions for the problems at hand, whether that means tracking down the appropriate agency, navigating complicated online application processes or providing support as the patient makes the calls. In clinics where a single social worker may be responsible for as many as 25,000 patients, Health Leads volunteers have more than doubled the services provided.

The successes of PACT and Health Leads are no secret. But what does remain mysterious as our health care system threatens to implode is why more of us haven’t done the same and rushed to apply the lessons learned and proved elsewhere.

“We keep trying to reinvent the wheel,” Ms. Onie observed. “The humbling reality is that we are trying to recreate innovations that have been robustly developed in the developing world.”

In other words, we have yet to deploy what could prove to be the most powerful weapon in the fight to contain costs and improve the quality of health care: our own humility.

$200- 400 BILLION DOLLARS EVERY YEAR ARE LOST TO MEDICARE AND MEDICAID TO HEALTH INDUSTRY FRAUD.  THAT IS WHERE THE HUMILITY NEEDS TO BE FELT!


___________________________________________
People must understand the neo-liberal jargon---- when they say they work for the middle-class they see the middle-class in the US as people earning $250,000 as a family.  They see Medicare and making it last longer for those 10% of people.  Needless to say the working and current middle-class are the only ones having paid payroll taxes into this Medicare Trust so the very people that should be getting full benefit are the ones being pushed out with the ACA.  That 'donut hole' will do no one any good if you cannot access or afford the kinds of PHARMA you need.  I already have friends having bad health effects because of being forced to use a generic that does not work for a chronic condition. 

THIS IS SERIOUS FOLKS.  THE SAME PEOPLE TRYING TO KILL PUBLIC HEALTH WORLD-WIDE WITH TRANS PACIFIC TRADE PACT ARE WRITING THESE HEALTH POLICIES.

Remember, the answer is not to vote Republican because the Affordable Care Act is Republican policy.  The solution is getting rid of neo-liberals in the Democratic Party.
  Do you hear your labor and justice leaders shouting out against neo-liberals?

In Maryland, Brown, Gansler, and Mizeur all supported these policies----while Cindy Walsh did not.

THE KING AND QUEEN OF NEO-LIBERALISM, BILL AND HILLARY CLINTON TAKING THE US FROM FIRST WORLD STATUS TO THIRD WORLD STATUS.


Which tier will your family fall?  In the US almost 70% of Americans are at poverty line meaning they will fall into the lowest 2 tiers.
  Don't forget that TPP will keep generic drug availability at a minimum and when they do come available they will be very outdated.  That's what the masses get say the neo-liberals and neo-cons.   Someone has to replace the trillions of dollars in health industry fraud from our Medicare and Medicaid programs....

ACA 5-Tier Drug List

For Individual PPO and Small Group HMO, POS, and PPO plans (including Marketplace/QHP plans) with ACA-compliant coverage becoming effective on or after January 1, 2014

About tiers

Most covered prescription drugs will be categorized into one of five tiers. The cost of drugs varies widely, even though several different medications may be used to treat the same condition. What you pay for the prescription depends upon what tier the drug is listed in. Health First offers many benefit plans that can vary in coverage for each tier. Details about your specific benefit for each tier are included in the Health First Summary of Benefits.

•Tier 1 — Preferred Generic Drugs •

Tier 2 — Non-Preferred Generic Drugs •

Tier 3 — Preferred Brand Name Drugs and some generics

•Tier 4 — Non-Preferred Brand Name Drugs and some generics (limited to a 30-day supply)

•Tier 5 — Specialty Drugs (limited to a 30-day supply, must obtain from Health First Family Pharmacy)


Generic drugs are prescription drugs that are identified by their chemical name. When the patent has expired on a brand name drug, the FDA permits new manufacturers to create an equivalent of the brand name drug and make it available to the public. Generally, more than one manufacturer will create generic versions, although often the same pharmaceutical firm that produces the brand name drug also makes the generic version. This prompts competitive pricing of the generic version and usually results in a less expensive drug. The Drug List is subject to change In order to continue to offer a safe and cost effective selection of prescription drugs, Health First periodically makes changes to the Drug List. These changes may include removing medications, adding restrictions, and/or covering a drug at a higher tier. The following list represents some of the most common scenarios in which changes to drug coverage will occur: •Throughout the year, new medications are approved by the FDA. It is the policy of Health First that new drugs will be excluded for 6 months from the date of FDA approval, during which time the Health First Pharmacy and Therapeutics Committee can review the drug for safety and efficacy. •The Drug List may change when a medication is withdrawn from the market due to safety reasons or if it becomes available over-the-counter (OTC). At the time that a medication on the Health First Drug List becomes available OTC, it may be excluded from coverage from that point forward. •When a brand-name prescription drug loses its patent and the equivalent generic form is added to the Drug List, the brand-name drug may be moved to the highest non-specialty drug tier, which is generally Tier 4 or removed from the formulary.

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July 10th, 2014

7/10/2014

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IT IS WOMEN AND CHILDREN THAT MAKE UP THE BULK OF FAMILIES FACING THE DISMANTLING OF OUR DEMOCRACY AND PUBLIC PROGRAMS AND SERVICES.  IT IS NEO-LIBERAL POLITICIANS WORKING WITH NEO-CONS DOING IT!

I want to continue one more day on private non-profits and commissions and health care in Maryland.  Remember, large sectors of Marylanders are not accessing health care----having a longevity 30 years less than affluent communities shows this.  Having the worse VA system in the nation shows this. The clinic care system built to keep Marylanders out of hospitals offer almost no access to basic medical procedures.

IT IS A DISASTER AND IT IS BECAUSE PEOPLE HAVING NO MORALITY OR ETHICS ARE CREATING THESE POLICIES ONLY AIMED AT MAKING A FEW EVER MORE RICH.

The average citizen working for these organizations are not bad people----they just want jobs.  Each time you create a private non-profit or commission for health care you have eliminated the public sector employees that would do that job.  You eliminate the public's ability to see what is happening and the accountability tasked to our government to serve and protect. 

DO YOU HEAR YOUR POLITICIANS SHOUTING THIS?  IF NOT, THEY ARE NEO-LIBERALS WORKING FOR WEALTH AND PROFIT AND NOT YOU AND I!


Yesterday we saw the commissions filled with the health executives writing the law and regulating themselves.  Let's look at the front lines where the health care is delivered----or, in Maryland, not delivered.  This is where the fraud and corruption fills the system.  Again, it is not the average staff doing this---they are being told to do this.  I spoke at length about the dismantling of the VA to private non-profits and showed they were receiving the money and doing nothing.  Medicaid and Medicare is handled just the same.  Remember, in Maryland Medicaid and Medicare is handled the same as private insurance so none of the requirements of coverage or accountability have occurred for a few decades.  Billions of dollars are lost as fewer Medicare patients enter the hospital but Medicare bills per patient climb.....THAT IS FRAUD CAUSING THOSE BILLS TO CLIMB.


Below you see the private non-profit that took over yet another duty of public health and it has been at it for 15 years---the very years that gave Baltimore the 30 year longevity difference.  If you look today health access has never been worse so we know this organization is not doing its job!  Remember, the people affected are not only black and brown or unemployed and impoverished or working poor.  Middle-class families with expenses that take money that would go for health care are included in these stats. 

DO NOT ALLOW PREJUDICE OF CLASS OR RACE SKEW YOUR THOUGHTS ON HEALTH ACCESS----THIS AFFECTS EVERYONE.


Our Organization Enroll In Benefits

HealthCare Access Maryland (HCAM)

is a nonprofit agency that plays a critical role in strengthening Maryland’s health care delivery system. Working with both government and private-sector support, HCAM helps residents enroll in public health care coverage, navigate the complex health care system and connect to educational and other resources.

HCAM was established in 1997 as Baltimore HealthCare Access to initially assist with the Medicaid transition to managed care. What began as a small organization with 40 employees, a $3 million budget and two core grants has grown steadily.

  • Funding has grown to $23 million and the agency has earned more than 30 major grants, including a $7.9 million grant from the Maryland Health Benefit Exchange (MHBE) as part of the State’s efforts to implement health care reform in Maryland and help uninsured residents gain access to affordable health care.
  • The number of programs offered has grown from the original two to 19, allowing HCAM’s 200 employees to help connect over 125,000 clients each year to health insurance and care and to vital community resources through a variety of programs serving the uninsured, under-insured and vulnerable populations of the state.
As a 501(C)3 not-for-profit organization, HCAM is overseen by a committed board of directors and supported by public and private sector grants, as well as corporate and individual donations. This unique funding allows us to provide a variety of specialized services for the residents of Maryland in four areas of expertise:

  • Eligibility and enrollment
  • Navigation of the health care system
  • Care coordination
  • Education and advocacy
HCAM’s expertise in these areas led the agency to broaden its reach and help provide services to people throughout the state. To signify this expanded focus, the organization changed its name in 2011 from Baltimore HealthCare Access to HealthCare Access Maryland.

The agency’s ability to help people live healthier lives has been recognized by others in our field. The agency is the proud recipient of Maryland Nonprofits’ Seal of Excellence, a designation that recognizes HCAM’s reputation for delivering high-quality programs and services in a fiscally responsible way.

Although HCAM specializes in health care access, we continue to serve the needs of our clients beyond just helping them obtain an insurance card. We serve children, pregnant women, parents, childless adults and youth in foster care, as well as those with addiction issues, immigrants, individuals recently released from jail and the homeless.

HCAM’s work to implement health care reform in Maryland

Throughout its 15-year history, HCAM has become a critical player in strengthening Maryland’s health care delivery system, earning a spot as a public health leader in the state and working with policymakers, nonprofit organizations and elected officials on innovative approaches to improving the health of all Marylanders.

In the Spring of 2013, HealthCare Access Maryland (HCAM) received a $7.9 million grant from the Maryland Health Benefit Exchange (MHBE) as part of the State’s consumer assistance program to implement the Affordable Care Act and help uninsured residents learn about, apply for and enroll in health insurance. HCAM was selected as the State’s Central Region Connector, serving Baltimore City, Baltimore County and Anne Arundel County.

As the Central Region Connector, HCAM will organize services across the region and has partnered with 17 organizations to provide outreach, education and eligibility determinations and to facilitate enrollment of the nearly 217,000 uninsured residents in the region into Medicaid, the Maryland Children’s Health Program (MCHP) and subsidized and non-subsidized qualified health plans.


__________________________________________

Baltimore is ground zero for Medicaid and Medicare spending and as we know the money is not getting to the people.  Johns Hopkins and University of Maryland Medical Center are handling many of these groups so that is where you start your search.  Since Johns Hopkins has captured all public policy and creates all the private non-profits that are then funded to work in these low-income communities----that is who is charged with overseeing this distribution only THERE IS NO OVERSIGHT!  THERE IS THE PROBLEM.  If we had a public health department filled with employees whose job it is dispensing money and providing oversight and reporting to the citizens of Baltimore----this would not be happening.

If you have followed me these few years you know I do not like Sharfstein and Barbot.  They were appointed to dismantle all public health and build more of these private non-profits and

THEY HAVE BEEN VERY BUSY!  NO WONDER SHARFSTEIN COULDN'T ROLL OUT THE STATE HEALTH EXCHANGE----HE'S TOO BUSY MAKING SURE MARYLAND HAS NO PUBLIC HEALTH.  Slander you say----no, all you have to do is look at who is doing the work of public health and you see nothing but private non-profits.  The people supposedly served all complaining they cannot access care.
  The money is flowing but not where its supposed to------

DID YOU KNOW THAT JOHNS HOPKINS BUILT A GLOBAL CORPORATE EMPIRE THESE FEW DECADES THAT MEDICARE AND MEDICAID FRAUD WAS THE WORSE-----just saying there's likely a link!


This should anger everyone as this looted Medicare Trust is now being addressed by limiting more access to most people....you and I!



Tuesday, May 10, 2011

Healthy Baltimore 2015 Last month, the Robert Wood Johnson Foundation issued the second annual County Health Rankings. As it did last year, Baltimore City ranked last in the state. 

One statistic in particular stuck out: 14,887. That’s the number of years of potential life lost before the age of 75.  Put simply, far too many Baltimore City residents are dying before their time.
Statistics like these give great urgency to the work we do to improve the health of our city, our neighborhoods and our residents.  It also makes clear that traditional medical or public health approaches aren’t working and it’s time to try something different.
That conversation starts today with the release of Healthy Baltimore 2015.
This comprehensive health policy agenda highlights 10 priority areas that account for the greatest morbidity and mortality in Baltimore.  These areas were chosen because there are evidence-based interventions proven to make a difference.  The plan looks at the relevance of where we live, work and play on health outcomes, as oftentimes they play as significant a role in making us sick as they do in keeping us healthy.
The city has set ambitious, yet reachable, improvement goals for the following priority areas:
1. Promote access to quality health care for all. 
2. Be tobacco free. 
3. Redesign Communities to Prevent Obesity.
4. Promote Heart Health.
5. Stop the spread of HIV and other STIs. 
6. Recognize and Treat Mental Health Disorders. 
7. Reduce Drug Use and Alcohol Abuse.
8. Encourage early detection of cancer.
9. Promote Healthy Children and Adolescents.   
10. Create Health Promoting Neighborhoods. 


For more information on the specific indicators we will use to measure progress in these areas, please view the full Healthy Baltimore 2015 report.
As you can see, there is much work to be done. Healthy Baltimore 2015 makes clear that we all play a role in improving the health of our city.
Over the course of the next several weeks to months, we will work with partners throughout the city to flesh out a 3-pronged approach to moving the needle for each of the leading indicators, including policy development; prevention, quality, and access; and community engagement.  Later this spring, senior leaders within the department will visit communities around the city to share this plan and the updated neighborhood health profiles.  We hope communities will put this information to use in designing new strategies and interventions for tackling the top priorities they identify for creating health promoting environments.
Let me be clear: the health department alone cannot successfully execute Healthy Baltimore 2015.  We welcome all motivated neighborhood leaders, individual citizens, aca­demic institutions, community-based organizations, business owners and the media to join us in this effort as partners in health. 
Partners can contribute to the success of Healthy Baltimore 2015 in many ways. These varying levels of engagement include, but are not limited to:
  • Communication – displaying or distributing health information materials within each of the ten priority areas.
  • Facilitation – actively participating in interventions such as incorporating wellness at work programs into the business day.
  • Integration – actively considering the potential health impacts of pending business or policy decisions.
To become a partner, please email me at health.commissioner@baltimorecity.gov. Together, we can reshape the landscape to make Baltimore City a place where all residents realize their full health potential.  Posted by Oxiris Barbot, M.D. at 8:37 AM

_________________________________________

Using Maryland for the divide between wealthier counties and poor counties we need to be clear-----while the poorest were excluded from accessing health in Maryland these last decades it is now coming higher up the economic scale....The Affordable Care Act is designed to make preventative care the only care 80% of Americans can afford and percentage is rising soon to 90%.  We will see with these forced re-negotiations of corporate and public sector health benefits that the middle-class will now be the ones forced out of care because they cannot afford co-pays and deductibles or once they pay the health insurance premiums they have no money for the health care itself.  THAT IS THE GOAL....

IT'S LIKE AUTO INSURANCE....YOU PAY AND PAY FOR COVERAGE AND IF YOU USE IT, THEY HIKE YOUR RATES OR CANCEL YOUR POLICY.

That is what is coming.  Below you see the other factor that will keep most people out of basic medical care----the need for a primary care doctor to access specialists and their care.  Activists have tried for decades to have medical school training be made free.  Get rid of the medical grads high tuition debt and you get lots of people in doctoring less motivated to earn $500,000 or more.  THIS ONE POLICY HAS CREATED THIS SHORTAGE AND AGAIN---IT IS DONE DELIBERATELY.  If corporations and the rich are paying no taxes and receive all revenue that is collected as corporate subsidy----where does all that free money for medical schools come from?  No, say corporations its better to simply exclude most people from health care access to maximize corporate profits.

FREE MEDICAL SCHOOL PAID FOR BY SIMPLY RECOVERING TRILLIONS OF DOLLARS IN HEALTH INDUSTRY FRAUD AND STOPPING IT IN THE FUTURE FLOODS THE MARKET WITH PRIMARY CARE DOCTORS.


But then say health corporations we cannot pretend to need to bring third world doctors to the US that are used to high levels of fraud and corruption and not bothering with the Hippocratic Oath and HIPAA regulations and who have no rights as citizens so as to be exploited by these growing US  global health systems!

What is being said here is nothing new----we have been shouting it for decades----they simply are pretending they are working on this solution as they dismantle all the avenues to address this.

Primary care access a key to health disparities among counties ■ An annual ranking of counties based on health status found that gaps between the healthiest and unhealthiest regions of states are wide — and getting wider.

By Jennifer Lubell — Posted April 1, 2013 AMED NEWS.com

Washington If you're a resident of Howard County, Md., chances are fairly high that you have insurance, enjoy good health and have relatively easy access to a primary care physician. Take a short car ride to Baltimore, however, and the situation for residents is much more grim.

In Howard County, ranked as Maryland's healthiest in the most recent County Health Rankings and Roadmaps survey, only 9% of residents are uninsured, and just 8% are considered in poor health. There's one primary care physician for every 577 patients. In Baltimore City, the unhealthiest county in the state, the uninsured rate is nearly twice as high, and there's only one primary care doctor for every 985 patients — a combination that means a significant access-to-care problem.

The comparison underscores a key finding in the 2013 survey: Gaps between the healthiest and unhealthiest counties in individual states are large and continue to grow. The survey highlighted the fact that residents in the healthiest counties are 1.4 times more likely to have access to a primary care physician than those in the least healthy counties. Unhealthy areas also had higher rates when it came to a host of other negative indicators of overall health, including child poverty, teen pregnancy and premature death.

This is the fourth year that the Robert Wood Johnson Foundation and the University of Wisconsin School of Medicine and Public Health have surveyed the health of every county in the U.S., ranking them on a state-by-state basis to gauge the factors determining the health of residents. All survey measures use figures or percentages that take population into account so that a county such as Howard, with a population of less than 300,000, can be compared with Baltimore City's population of more than 600,000.

The rankings are set up so that every state has a healthiest and unhealthiest county despite the overall health of the state. But health outcomes can vary widely within a state, said Patrick Remington, MD, MPH, professor and associate dean at the University of Wisconsin School of Medicine and Public Health, during a teleconference to discuss the 2013 rankings. Louisiana and Mississippi are two states that often rank last in the nation on overall health. But when researchers dig into each state, they find as much variability among individual counties in Louisiana and Mississippi as they do in Vermont, a state that ranks relatively high nationally on patient health outcomes, he said.

Competition drives improvement Dr. Remington said promoting the results of county rankings has made a difference, “sparking action all over the country as people from all sectors join forces to create new possibilities in health — county by county.”

One of those areas is New Orleans, which has been trying to rebuild its infrastructure after Hurricane Katrina in 2005, said Karen B. DeSalvo, MD, New Orleans health commissioner and senior health policy adviser to the city's mayor. Orleans Parish typically has ranked in the 60-62 range in a state that has 64 counties, Dr. DeSalvo said. “So we've been at the bottom of the pack in one of the more unhealthy states in the country. What we're excited about this year is we've jumped up to number 48, so that's a big leap.”

In addition to overhauling its education system and making improvements to parks and playgrounds, the city has spent seven years on an initiative to develop its primary care infrastructure.

“We had essentially no neighborhood-based primary care before Katrina. People were reliant upon hospital-based services, especially those who were uninsured and underinsured,” Dr. DeSalvo said.

Since then, the city has responded by working with 25 organizations, ranging from small clinics to large hospital systems, to build access to primary care and outpatient mental care, with a particular focus on patient-centered medical homes and health information technology. The initiative has received financial support from philanthropic sources as well as some federal demonstration program funding to expand access to primary care rapidly. “This is a true public-private partnership,” she said.

Dr. DeSalvo said the renewed focus on building strong primary and preventive care at the neighborhood level probably has reduced unnecessary hospitalizations and led to improvements in screening rates for such conditions as diabetes and breast cancer.

Improving patient-reported measures and clinical outcomes is one of the strategic goals recently adopted by the American Medical Association. The AMA is focusing on promoting quality and safety, reducing unwarranted variation in care, and fostering appropriate use of limited health care resources.

Other factors leading to poor health The fact that fewer physicians and dentists practice in certain communities obviously contributes to poorer health in those areas, said Bridget B. Catlin, PhD. She's a senior scientist at the University of Wisconsin Population Health Institute and director of the County Health Rankings and Roadmaps survey. But, as she and other health care observers pointed out, lack of access is just one of many problems that go hand in hand with poor health among residents. In addition to measuring clinical care outcomes, the survey analyzes health behaviors, social and economic statistics, morbidity, and such physical environment elements as air and water quality.

“Other key factors that influence the health of a community are education, employment, income, and whether people smoke or have access to healthy foods and places to exercise. Some of these factors probably also influence physicians' decisions about where to practice,” Catlin said. “In particular, there is a widespread need for health care providers in rural areas.”

At least in Maryland, the health gap between the highest- and lowest-ranking counties largely comes down to socioeconomic conditions, said Brian Avin, MD, a neurologist and the president of MedChi, the Maryland State Medical Society. Howard County, a suburb of Washington, is one of the most affluent areas of the nation, “so whatever social factors you want to create, Howard is going to be the highest and Baltimore City is going to be the lowest,” he said. There's much more poverty and unemployment in Baltimore, as well as more people on Medicaid or going without insurance, generating more uncompensated care cases. “Obesity, smoking, any individual feature you're going to look at is going to be worse when you're not getting basic care.”

Howard County also has been trying to get all of its population insured, whereas no such strategic initiative exists in Baltimore City, Dr. Avin said.
___________________________________________


Baltimore has a policy of replacing school athletic courts and community center athletic courts with 'greening' development moving all of this to private non-profits like YMCA located too far for most to reach.  I literally had to fight for an athletic court for an elementary school of 300 students----Johns Hopkins Homewood wanted to make it a park. Parks and playgrounds across the city have been neglected as the city dismantled its Parks department and handed the funding to a private non-profit.  So school grounds have grass up to your knees, broken glass all because the city does not collect revenue from corporations and the rich and any that is collected go to projects connected to the same.   Baltimore City schools often have no recess and most schools have no athletic teams.  The tiered funding leaving these low-income schools run as businesses make it impossible to address these disparities so NOTHING is being done to actually address health issues ------they simply say they are doing so.

Private wellness non-profits are going into poor neighborhoods telling people to eat better and scolding when people explain that living in poverty places survival over preparing a good meal or even having a living space that allows it.  So, we are seeing these national private non-profits coming in to talk the talk of better health to communities now being kept from accessing any health care but preventative care.


There are some good programs-----Food stamps being used at Farmers Markets is a good thing.  If you are creating an environment of deeper and wider poverty as neo-liberals and neo-cons are doing today----none of this will end in data having better results and THEY KNOW THIS.

EXPANDED AND IMPROVED MEDICARE FOR ALL SIMPLY ALLOWS EVERYONE TO GET ALL THE CARE THEY NEED AND THAT IS THE BEST PREVENTATIVE MEDICINE AND YOU PAY FOR IT BY ENDING HEALTH INDUSTRY FRAUD AND PROFITEERING.


Below you see the vestige of a city no caring for families and with that goes health.  Day care is where children receive healthy exposure and access is critical to a family working and having low-incomes.  So, if you do not provide a system of day care-----and you are closing and defunding parks and playgrounds-----YOU DO NOT CARE ABOUT WELLNESS.
None of this information is new and Johns Hopkins is behind the redirecting of money and the lack of oversight and accountability and is the one charged now with the most responsibility in these Maryland health care reforms....THE OPPOSITE OF WHAT IS NEEDED FOR REAL CHANGE.


Below you see middle-class families saying OMG!!!!!  and it is all centered on the corporations/ rich taking all the revenue through fraud and corruption in the City of Baltimore and this expands across the State of Maryland.

Day care shortage frustrates parents in Baltimore.  Costs can top tuition at University of Maryland, College Park

The Children's Choice Learning Center, housed in the… (Karen Jackson, BALTIMORE…)July 14, 2013|By Tricia Bishop, The Baltimore Sun

In five months, the downtown Baltimore day care attended by Celine Plachez's youngest son is slated to close, yet she's not looking for a backup. She can't stomach it.

She searched before he was born, calling about a dozen places, some of which said they wouldn't have an opening in the foreseeable future. Others were so expensive, they cost more than tuition at the University of Maryland, College Park. And a handful were just plain unacceptable in terms of quality.

So she's devoting her energy to finding a way to keep open the Children's Choice Learning Center, housed in the Social Security Administration building on North Greene Street.

"Call me crazy — I refuse to look. I want to fight," said Plachez, a scientist who lives in Federal Hill. "We can make it happen. It's not impossible, it's not unrealistic."

Plachez's response to the center's planned closure highlights a frustrating reality: At a time when the city is trying to attract and retain families — and more women work than ever before — there's a lack of high-quality, affordable, regulated child care in Baltimore.

The shortage is particularly pronounced for children younger than 2, like Plachez's son, who require a higher, 3-1 ratio of children to staff under state law, making their care cost-prohibitive for many facilities.

For some who live or work in the city, the situation has significant consequences.

Rachel Winer Sticklin of Canton is postponing having a second child until the first is out of day care because her family can't afford to pay for two at once.

Judy O'Brien of Otterbein started looking for a spot two years before her newborn needs it, knowing she faced long waiting lists at many places.

And Jana Gauvey of Federal Hill brings her kids to Baltimore County, where she works in marketing, for their care.

"There weren't that many options close to our home," Gauvey said.

Others, particularly those with low incomes, are putting their kids in informal, unregulated city settings — often in the homes of neighbors operating babysitting businesses — in the hope that the financial savings won't equate to inadequate care.

Not enough spaces

Roughly 13,300 Baltimore children younger than 2 have mothers who work, and many of them need some kind of child care, from relatives, hired sitters or centers, according to a Baltimore Sun analysis of state data. Licensed facilities can accommodate at most 20 percent of them.

The surrounding counties face a similar issue, though only Anne Arundel County's case is as severe. In Howard County, for example, licensed facilities can handle up to 35 percent of the children under 2 who might need care; in Baltimore County up to 27 percent can be accommodated.

The quality of care is also thought to be less variable in the counties. A greater percentage of children enter kindergarten fully prepared in the counties than in Baltimore.

"In most cities, there is always a shortage of infant and toddler care, mainly because it's expensive to do it right," and Baltimore is no exception, said David W. Andrews, dean of the Johns Hopkins University School of Education. "The ratios of adults to children [here] just don't make it a very profitable scenario unless you're able to charge upward of 17, 18, 19 thousand per kid."

There are also a "number of consequences associated with" doing it wrong, Andrews said.

Studies increasingly show that the early years are crucial to a person's development. Ninety percent of brain growth happens before age 5, and the first three years of life are particularly important. Young children and infants are primed for learning, educators said, and their environment has a lasting impact.

Studies show that while parents have a strong influence on young children, day care effects can linger. Children in the highest-quality programs — where kids feel comfortable, stimulated and cared for by a stable staff — do the best years later in terms of social and academic development, and even health and economic prospects. Those who receive poor care are more likely to wind up in the criminal justice system, act out or drop out of school.

Yet early childhood education in the United States receives the least public investment of any schooling, leaving parents to bear much of the financial burden.

The average cost of full-time infant care at a Baltimore center, as opposed to a home-based site, is about $11,560, according to data from the Maryland Family Network, a private nonprofit that advocates for children and families.

That figure, which factors in the highest- and lowest-quality care options, is 40 percent higher than the average cost of tuition and fees at a state university — $8,220 in 2012. And it's roughly 30 percent of the median household income in the city before taxes.

"It's a real struggle for most parents," said Steve Rohde, the network's deputy director of child care resource and referral services.

____________________________________________
This article shows the mechanism that creates all this disparity and dysfunction.  A Baltimore global corporation headquartered in the Enterprise Zones that allow corporations to pay no taxes starve Baltimore's coffers for a few decades causing all of the crumbling of infrastructure and closing of facilities geared towards keeping citizens healthy.  All money is directed to boosting profits for this global corporation that adds almost nothing to the economy of Baltimore. 

IT IS A HUGE SUCKING MACHINE AND CORPORATE SUBSIDY IS ITS BEST ACHIEVEMENT.

So, here we have our Baltimore media giving this global corporation recognition for 'donating' a playground so it can write the costs of donation from any taxes that might be left to pay again starving government coffers.  Rather than consistently paying taxes so general funds can be distributed equitably across the city-----we have corporation simply selecting where they want their tax deduction to go.


THIS IS JOHNS HOPKINS DRIVING THESE POLICIES AND HOPKINS IS NEO-CONSERVATIVE WORKING FOR GLOBAL CORPORATE WEALTH WITH POLITICIANS RUNNING AS DEMOCRATS CREATING ALL THESE POLICIES.

The point is this-----the structures in place that have the public sector dismantled and complete control of policy given to corporations will never end with health policy that does what they say it will do.  They will simply create private non-profits that for the most part pretend to be doing something.  Remember, more and more people are falling into this abyss so we need the middle-class to WAKE UP and care about where these policies lead.

The taxes this corporation should have paid for a decade or so would have built dozens of playgrounds across the city.

If city employees were being paid to build this playground they could afford to live more healthily!

press release

June 10, 2014, 7:13 p.m. EDT

Baltimore-Based Global Education Company Builds New Playground for Local School

BALTIMORE, June 10, 2014 /PRNewswire/ -- Laureate Education, Inc., the world's largest higher education network, today built and donated a playground at The Historic Samuel Coleridge-Taylor Elementary School in Baltimore. Nearly 300 of Laureate's most senior executives from around the world came to Baltimore to build the playground. Laureate, formerly known as Sylvan Learning Systems, relocated its global headquarters to Baltimore in 1996, the first company to do so in more than twenty years. Laureate was the first company in the Harbor East neighborhood, a key part of Baltimore's federally designated empowerment zone. In the 18 years since moving to Baltimore, the company has grown from employing 300 people at the headquarters to more than 2,700.

More than 100 local volunteers joined Laureate executives and students to build the playground, in partnership with KaBOOM!. The playground will be accessible to nearby residents.

"It's a great honor to give back to the community that has given me -- and Laureate Education -- so much," said Douglas L. Becker, Laureate's founder, chief executive officer, and a Baltimore native. "We are committed to doing work that is here for good in every community in which we operate."

"The Historic Samuel Coleridge-Taylor Elementary School really is the center of this community and this new playground will help foster that sense of community that we cherish," said the school's principal, Dr. Harold A. Barber.

"Congratulations to Baltimore's own Doug Becker and Laureate Education on their 15th anniversary," said Mayor Stephanie Rawlings-Blake. "I'm so grateful that this Baltimore-based global company continues to invest in the local community in ways that benefit the people of this great city. The students of the historic Samuel-Coleridge Taylor Elementary School and members of the neighboring community will truly enjoy the new playground more than you will ever know. Thank you."
















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April 14th, 2014

4/14/2014

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PLEASE CHECK MY SUNDAY POST!


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!


We are listening today on corporate NPR/APM and WYPR our local politician Elijiah Cummings heap praise on departing Kathleen Sebelius of Department of Health fame.  Here is a politician from the most conservative republican state in the country-----Kansas given the job of developing and implementing a health care reform, the ACA that ends public health and hands the American people over to health institutions writing health law to maximize corporate profit.  Kathleen was a state insurance commissioner in a state where politicians work for the industries they regulate-----you know like Wall Street regulatory agencies.  Yet, this dye-in-the-wool conservative republican state pol was selected by Obama and praised by Cummings for her work in privatizing all public health and both Obama and Cummings run as democrats.

WHEN A POLITICIAN RUNS AS A PROGRESSIVE LABOR AND JUSTICE CANDIDATE AND THEN APPOINTS AND PRAISES POLS FROM THE MOST CONSERVATIVE OF STATES
-----THEY ARE NOT DEMOCRATS!


Kathleen Sebelius

Kansas House of Representatives (1987–1995)
Kansas Insurance Commissioner (1995–2003)Governor of Kansas (2003–2009)



Political Pundits: Is Kansas The Most Conservative State?

By Stephen Steigman & Steve Kraske

If there was any doubt about the hold of the political right in the Heartland then wonder no more.  A recent survey shows Kansas has the most conservative congressional delegation in the nation.


WHY IS THAT?  IT IS BECAUSE OBAMA AND CUMMINGS ARE GLOBAL CORPORATE POLS WORKING FOR WEALTH AN PROFIT JUST AS REPUBLICANS DO----THEY ARE NOT DEMOCRATS!

GANSLER, BROWN, AND MIZEUR ALL SUPPORT AND WILL CONTINUE THE DISMANTLING OF OUR PUBLIC HEALTH BECAUSE THEY ARE ALL GLOBAL CORPORATE POLS.


Remember, the Federal program Medicare has decades of health data that can easily show how much each medical procedure costs all over the nation, can assess what the best cost would be in balance of patient access and corporate profit and yet, none of this factors as corporate democrats hand this health reform to corporations to write and patient access and health care labor are of course the losers.  When you listen to corporate NPR/APM you are listening to republicans and corporate neo-liberals both working for the same goal----they represent 5% of the nation as even republican voters hate global corporate pols.




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!  These 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!!!!


How does the State of Maryland move 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 de-regulation and no 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.


Below you see where advocates of Medicare out Medicare Part D as the start of privatization and Affordable Care Act heavily funds Medicare Part D making it the plan seniors must go to to get medication they can afford.  Creating state health systems
sets the stage for Medicare and Medicaid programs to end at the Federal level and become what is looking like Medicaid for All.  Only, Medicaid was gutted at Federal and State level and does not exist as a Federal program.......while most people in the US are falling into this category.




The Privatization of Medicare
V I E W P O I N T


Medicare is the federal health insurance program that provides coverage to 43 million Americans who are age 65 and older or who are younger than 65 and receiving Social Security disability payments. Traditional Medicare consists of hospital insurance, Part A, and supplementary medical insurance, Part B. Every Medicare beneficiary has the same cost-sharing amounts and benefit structure under both Parts A and B. Premiums were originally uniform, but Part B premiums have been increased for higher-income beneficiaries.

The Medicare Part D prescription drug benefit, established by the Medicare Modernization Act of 2003 (MMA), differs dramatically from traditional Medicare. The MMA allows only private companies to participate in Medicare Part D, thus privatizing prescription drug coverage for America's seniors and eroding the social insurance nature of the Medicare program. Because of this privatized structure, beneficiaries pay different premiums and must choose between a very large number of plans with varying drug coverage and cost sharing amounts.

Despite the success and popularity of the traditional fee-for-service Medicare program, and the failure of past privatization efforts such as Medicare+Choice, the MMA greatly expanded the role of the private sector in Medicare. In addition to the prescription drug benefit that is delivered only by private stand-alone prescription drug plans or private Medicare Advantage (MA) plans, the law threatens traditional Medicare by overpaying private health insurance companies, means-testing the Part B premium, imposing a completely arbitrary 45 percent cap on general revenue financing of the Medicare program, and establishing a "premium support" demonstration to compare costs between fee-for-service Medicare and subsidized private plans.

NATIONAL COMMITTEE POSITION

Create a Medicare-operated prescription drug benefit with the government required to negotiate drug prices

Seniors should have the option of a Medicare prescription drug benefit rather than having to sort through countless private plans in order to receive prescription drug coverage. Seniors face too many plan choices with various premiums, deductibles and other cost-sharing amounts. A Medicare-operated drug benefit would offer the dual benefit of simplifying and standardizing the coverage provided by the program, and it could provide a more comprehensive formulary at uniform prices. Furthermore, unlike private companies, a government plan would not need to increase prices and change formularies throughout the year to maximize profits. Overall, traditional Medicare achieves administrative efficiencies not matched by private plans. Extending this efficiency to the Part D program will save taxpayer dollars.

Require the federal government to negotiate drug prices

The federal government should be required to use leverage through negotiating in bulk to negotiate lower drugs prices for the Part D program. States currently use this leverage to negotiate lower prices for their health care programs, as does the Department of Veterans Affairs. It would be easiest to achieve effective price negotiation under a Medicare-operated drug benefit, but there are a number of alternatives by which CMS could effectively achieve lower prices for private plans as well.

Level the playing field between traditional Medicare and private Medicare Advantage plans

Private plans should be paid at the same rate that the traditional Medicare program is paid for covering beneficiaries. However, due to provisions of the Medicare Modernization Act of 2003 (MMA), private Medicare Advantage plans are now paid an average of 14 percent more than traditional Medicare. Inflated payments to Medicare Advantage plans, which amount to $15 billion a year, are funded by all taxpayers and all Medicare beneficiaries, not just the 20 percent of Medicare beneficiaries enrolled in private plans. Equalizing Medicare payments would save about $169 billion over ten years, reduce Medicare Part B premiums by $3.00 a month per beneficiary and bring an additional 18 months of solvency to the Medicare hospital trust fund. Better uses of the money would be to improve the Part D benefit by reducing costs to seniors, including filling-in the so-called "donut hole" that requires beneficiaries to pay 100% of the cost of their prescription drugs while continuing to pay full premiums to private plans; and enhancing benefits in traditional Medicare.

Repeal the means-testing of Part B premiums


Medicare beneficiaries with incomes above certain levels are paying higher Part B premiums due to passage of the Medicare Modernization Act of 2003 (MMA). Prior to 2007, all Medicare beneficiaries paid premiums equal to about 25 percent of the Part B program's average cost per beneficiary. Today, higher-income seniors are paying premiums ranging from 35 to 80 percent of the average per beneficiary cost which translates into premiums that are double or triple the standard premium amount.

Means-testing undermines the social insurance nature of the Medicare program and could lead to increased costs for middle- and lower-income seniors if higher-income seniors, who are often younger and healthier, are driven away by increased cost-sharing. It also raises premiums for those who have paid the most into the program through Medicare payroll taxes, harms seniors and their families regardless of their financial obligations, and puts the burden on seniors to demonstrate that their premiums should not be increased if their income is reduced.

Repeal the 45 percent cap on general revenue funding for Medicare

The Medicare Modernization Act imposed a completely arbitrary cap of 45 percent on general revenue financing of the Medicare program. When the Medicare Trustees project, for two consecutive years, that 45 percent of Medicare funding will come from general revenues at a set future date, the President is required to present a plan to Congress to reduce general revenue funding. This approach would prevent consideration of all potential solutions to the program's long-term shortfall. Further, it ignores Medicare's financing structure, which is designed to include substantial contributions from general revenues to fund Medicare Parts B and D, as well as the need to address Medicare's future in the context of U. S. health policy as a whole. The National Committee supports the House of Representatives' decision to suspend the 45 percent rule for the 111th Congress and urges its permanent repeal.

Prevent implementation of the 2010 comparative cost adjustment demonstration

The "comparative cost adjustment demonstration project" - also known as "premium support" - established in the Medicare Modernization Act requires traditional fee-for-service Medicare to compete with private Medicare Advantage plans in selected regions beginning in 2010. Seniors will receive the equivalent of a voucher in an amount reflecting the average per beneficiary cost of private plans and traditional Medicare for their region. If they enroll in a less expensive plan, either a private plan or traditional Medicare, they can keep a portion of the savings; if their plans' premiums or the traditional Medicare Part B costs are higher, they will pay the difference out-of-pocket.

Proponents of the comparative costs adjustment demonstration project claim that this competition will result in better benefits to seniors at lower cost. Healthier seniors who enroll in subsidized Medicare Advantage plans, which are overpaid compared to the traditional Medicare program, may do better in such a system for a time. Older, sicker seniors are more likely to remain in traditional Medicare where they are certain of the benefits it provides and they can continue seeing the doctors they know. However, because the risk of insuring these seniors would be spread among many fewer people, it is inevitable that they will end up paying higher Part B premiums than beneficiaries who are not in comparative cost adjustment areas. At the same time, they are subsidizing the private companies that drain healthier retirees from their risk pool and further increase their costs. This privatization experiment would likely move Medicare beneficiaries out of traditional Medicare and into private health plans thus further eroding the social insurance nature of Medicare.

CONCLUSION

Forty years after its enactment, Medicare, along with Social Security, remain our most popular and essential federal social insurance programs. Any changes in Medicare must not alter the fundamental social insurance principle that has made Medicare such a popular and effective program.

The National Committee to Preserve Social Security and Medicare will continue to advocate for expanding traditional fee-for-service Medicare to include a prescription drug benefit with the government negotiating drug prices. The National Committee is also dedicated to leveling the playing field between traditional fee-for-service Medicare and private Medicare Advantage plans in order to enhance benefits for all Medicare beneficiaries and to make the best use of all Medicare expenditures. In addition, the National Committee will continue to oppose initiatives such as means-testing premiums and the "premium support demonstration" that likely could result in a two-tiered Medicare program based on income and health status.


 

Government Relations and Policy, March 2009



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We are hearing all across the country that most people are being pushed into Medicaid level plans that will only offer preventative care.  As corporations shed their health plans and as Medicare and public sector pensions are ended and thrown into these private health systems, most people will fall into these Medicaid/Bronze level health plans with only preventative access.

If this is allowed to continue life expectancy in the US will drop dramatically in just one generation.  IT IS A CATASTROPHE FOR A DEVELOPED WORLD TO PUSH 80% OF ITS CITIZENS INTO THIRD WORLD LEVELS OF HEALTH CARE AS THE AFFORDABLE CARE ACT PLANS TO DO!






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.

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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

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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!  These 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.)

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KEEP IN MIND MARYLAND'S PRIVATE HEALTH EXCHANGE IS THE MOST CORPORATE AND PROFIT-DRIVEN IN THE NATION AND THIS IS WHY OBAMA FRONT-LOADED CORPORATE DEMOCRATS IN MARYLAND WITH MONEY TO DEVELOP THE 'MODEL' FOR THE COUNTRY----JOHNS HOPKINS WROTE MUCH OF THE STATE'S POLICY.


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.”

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.

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April 09th, 2014

4/9/2014

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Raise your hands if you think giving the government authority to force American citizens to take PHARMA under the guise of mental illness is a good idea-------NO ONE!!!!!!  Remember, your incumbent in Maryland voted for the NDAA national security law that allows the government to hold American citizens without charge for as long as they want.

  This is what they do in Iran and China to dissidents. 


What we are seeing is yet another money vehicle to build corporate infrastructure with taxpayer money that will end up helping almost none of the people it is directed to help.  Longevity in the US will drop in one generation from lack of access to health care for 80% of Americans.


Today, I'd like to speak to Medicare and health industry fraud that is already soaring with deregulated/consolidated health markets.  There will be no controlling global health industry just as our government says it cannot control banks.


Remember when we were told the idea of state health exchanges were to give consumers more access to information and that would increase competition? SURPRISE----THAT WAS NOT THE GOAL AT ALL.

MANDATING INSURANCE AND CONSOLIDATION AND DEREGULATION ARE THE GOALS OF ACA-----THAT'S A CORPORATE POL FOR YOU-----ALWAYS WORKING FOR WEALTH AND PROFIT.

As we watch Dr. Sharfstein of Maryland's health exchange debacle testify to Congress about the mess that is Maryland's health exchange please remember that throughout this process Sharfstein was arrogant in making the process behind closed doors......NO TRANSPARENCY ....and came out of public meetings conducted behind closed doors to tell those gathered that the details of how health institutions would be monitored for meeting Federal requirements and for oversight of the entire process would be developed at a later time.  He did not look to care about the descriptions of the tiered plans.  As the article below shows, Maryland is ranked again at the bottom in transparency in its health exchange.  Sharfstein told me-----THERE IS NO FRAUD IN HEALTH CARE.

With Medicare being folded into this Maryland private health system
as if this Federal program did not exist-------THIS IS CRITICAL FOR SENIORS.  We have lost 1/2 of Medicare/Medicaid spending for these few decades and this pace will soar under these Affordable Care Act conditions.

MARYLAND DOES NOT RECOGNIZE MEDICARE AS A PROGRAM....IT HAS INTEGRATED IT INTO THE TIERED ACCESS GIVEN ALL MARYLAND CITIZENS.





Below you see a good report on the state of transparency in health system exchanges.  Please Google it.  Remember, we were told the point of these exchanges was transparency for the consumer......MARYLAND AS ALWAYS IS SHOWN WITH AN 'F'.

States Fail the Grade on Health Care Price

Transparencywww.governing.com

Despite the growing number of laws that require publicly available health care pricing for consumers, most states fail the test of transparency, according to a new report from the Health Care..


______________________________________________

Seniors know the most expensive costs to health care can be PHARMA and as I showed in my last blog neo-liberals and Obama are pushing hard to make sure PHARMA maximizes profits all over the world, so you can bet here in America citizens will not be able to access ordinary drugs with the Affordable Care Act.  Medicare Part D was created by George Bush to end the Federal program  Medicare by making Americans have to leave the Federal program in order to afford PHARMA.  Policies like Medicare Advantage are private health plans designed to end Medicare.  You can bet once they get most people onto these private PHARMA plans----these plans will disappear.

MEDICARE ADVANTAGE AND MEDICARE PART D ARE ONLY MEANT TO END THE FEDERAL PROGRAM MEDICARE.

This is why neo-liberals doubled-down on funding Medicare Part D as they work hard to make PHARMA as expensive as possible.  This is bad for you and me, not good.


Don't worry that Maryland politicians and the people they appoint to manage Maryland Department of Health cannot see entitlement fraud -----CHINA IS DOING THIS FOR THE WORLD.

T
HIS IS HOW RIDICULOUS THE LEVEL OF FRAUD AND CORRUPTION IN AMERICAN CORPORATIONS HAS GOTTEN.  THE CITIZENS OF AMERICA ARE REDUCED TO BEING PROTECTED BY ONE NATION WANTING TO CORNER PROFIT OVER ANOTHER.



All of the candidates for Governor of Maryland will continue to work for this global corporate mess except CINDY WALSH FOR GOVERNOR OF MARYLAND.

I WILL REBUILD ALL WHITE COLLAR CRIMINAL AGENCIES IN MARYLAND AND SHOUT FOR THE FEDERAL JUSTICE AGENCIES TO DO THE SAME!

You know if US corporations are acting this fraudulently overseas.....and importing their products from overseas.....WE THE PEOPLE IN THE US ARE VICTIMS OF ABSOLUTELY NO OVERSIGHT!



Investing 7/29/2013 @ 4:13PM   Forbes

Is Big Pharma Addicted To Fraud?


Recent news out of China raises the question once again of whether any aspect of the pharmaceutical business can be trusted.

First, Chinese authorities announced they were investigating GlaxoSmithKline GSK +1.24% and other pharma companies for bribing doctors, hospitals and government officials to buy and prescribe their drugs. Glaxo is accused of using a Shanghai travel agency to funnel at least $489 million in bribes.

Then the New York Times revealed last week the alarming news that an internal Glaxo audit found serious problems with the way research was conducted at the company’s Shanghai research and development center.

Last year Glaxo paid $3 billion to resolve civil and criminal allegations of, among other things, marketing widely used prescription drugs for unapproved treatments and using kickbacks to promote sales.

And in 2009, Glaxo paid $750 million to resolve civil and criminal charges that quality failures led to serious contamination of drug products at its manufacturing operations in Puerto Rico.

Glaxo is a leader in pharma fraud and wrongdoing, with other industry heavyweights close behind. Over the past decade, whistleblowers and government investigations in the US have exposed a never-ending series of problems by numerous pharma companies in all facets of the industry, starting with fraudulent “research” papers used to bolster marketing and continuing through to the manufacture of contaminated and defective products, the marketing of drugs for unapproved and life-threatening uses and the mispricing of prescription drugs.

But the combination of pharma’s noncompliant corporate culture and the prevalence of corrupt business practices in China and other emerging economies could have a lethal impact on many more consumers as pharma shifts more research and development functions, manufacturing operations and marketing efforts to those growing markets.

In China, Glaxo allegedly used the travel agency to hand out inducements by claiming the payments were for travel and meeting expenses. Glaxo issued a statement by Abbas Hussain, Glaxo’s president international, that acknowledged some of its executives may have “acted outside of our processes and controls which breaches Chinese law.”

Chinese officials say they are investigating other foreign companies for similar charges. Merck & Co MRK -0.27%., Roche Holding and Sanofi SNY +1.31% SA confirm they used the same travel agency as Glaxo, but they haven’t been accused of wrongdoing.

Meanwhile, AstraZeneca AZN -0.86% — which previously reported that it is under investigation by the Securities and Exchange Commission and the Justice Department — said last week that police in Shanghai questioned two company sales managers, but “we have no reason to believe it is related to the other investigations.”

If the bribery accusations are true, the pharma companies could face charges in the US for violating the US Foreign Corrupt Practices Act, an anti-bribery law, as well as charges by Chinese authorities. Last year, Pfizer paid $60.2 million and Eli Lilly & Co. paid $29.4 million to the US to settle allegations they had bribed government officials, including hospital administrators and government doctors, in China and other countries to approve and prescribe their products.

But having to deal with a new cop on the bribery beat – China – should scare all pharma companies and their employees who have engaged in bribery. Four Chinese-born senior executives in China were originally detained, and last week Chinese media reported that police have detained 18 more Glaxo employees and some medical personnel. A British consultant to Glaxo in China also reportedly is being held. Chinese authorities may hold all of them in custody as long as the police feels it’s necessary – putting additional pressure on Glaxo and other pharma companies to resolve this matter.

Though Big Pharma’s practices in China are grabbing headlines, not much about them is truly new. Those tactics – the use of payments disguised as speaking and consulting fees, luxury travel, sex and numerous other inducements to expand sales of prescription drugs — are marketing techniques homegrown in the U.S.  They simply have been exported to emerging markets.

Now it’s China’s turn to express the same outrage that U.S. prosecutors did when faced with a recalcitrant industry that uses illegal inducements as a core business strategy for selling its prescription drugs.

“I need to remind foreign pharmaceutical companies that, because they occupy a leading position in the industry and reap huge amounts of commercial profits, they should also bear a great responsibility to society and the public,” Gao Feng, a Public Security Ministry official said at a July 15 briefing. “While we don’t expect them to set a moral example, we expect them to obey the law.”

That may be too much to expect from pharma, which has paid more than $30.2 billion in civil and criminal penalties to the US and state governments and continues to face more allegations of wrongdoing.

Big pharma’s woes in China underscore that the industry – despite huge penalties and a long string of public mea culpas – has a fraud habit that is just too profitable to kick. Finding a cure should be a top priority of regulators worldwide.

___________________________________


As corporate NPR/APM was proud to state, no worries about fraud and penalties because these fines are so low that fraud settlements are simply worked into operational costs for US corporations now.  They are so low because neo-liberals in Congress and Maryland pass laws that cap awards and eliminate damage awards.  Remember, this is your Medicare Trust being eaten with fraud and then they tell you there are not enough funds in these Trusts.

NEO-LIBERALS IN CONGRESS AND MARYLAND WORK TO PASS LAWS THAT PROTECT CORPORATIONS FROM PUBLIC JUSTICE.


If you wonder why Maryland is never in the news for the same problems I describe across the country it is because Maryland does not have a public sector health department -----all has been privatized to non-profits like Johns Hopkins which in turn are the source of much of the malfeasance.  Add to that a captured media that does no investigations to hold power accountable and you have no news in Maryland.  Autocratic societies do not allow bad press to escape, only propaganda.

MARYLAND IS RANKED AT THE BOTTOM IN THE NATION FOR FRAUD, CORRUPTION, AND LACK OF TRANSPARENCY SO YOU KNOW THAT WHAT HAPPENS ACROSS AMERICA IS SOARING IN MARYLAND.


Below is just an isolated picture of what happens in specialties throughout health care.  It happens because there is no oversight and no public justice so all these health institutions assume they will get away with it.  It is fraud and profiteering that creates high costs in US health care and the Affordable Care Act does nothing for this.  Simply rebuilding oversight structures in Medicare and Medicaid cuts costs in half.  Why is Maryland not doing this??????

IF YOUR CANDIDATE IS NOT SHOUTING TO REBUILD RULE OF LAW IN YOUR STATE AND IN AMERICA----THEY ARE A NEO-LIBERAL WORKING FOR WEALTH AND PROFIT.


If you watch TV you are seeing more and more advertizing of trial lawyers and class action lawsuits for medical procedures, PHARMA, and devices placed onto market without proper clinical study using you and I as test subjects.  WHOOPS, THAT DIDN'T WORK THEY SAY.
  Neo-liberal answer to this increasing legal environment------END CLASS ACTION LAWSUITS.


'Even the most jaded experts in fraud enforcement see a new level of callousness as some in the healthcare industry forget basic right and wrong in their quest for profits at any cost, including human suffering'.

Investing 9/12/2013 @ 4:36PM

Medicare Blood Money: The Healthcare Industry's Misalignment of Profits and Humane Medical Treatment Recent stories out of Chicago and Detroit give an unusually cruel meaning to “for-profit” medicine.

Authorities say a doctor at Sacred Heart Hospital in Chicago directed that his patients be heavily sedated, so that it was difficult for them to breathe. Then he would perform tracheotomies, cutting holes in their necks and windpipes, so they could breathe more easily.

The cost to Medicare for each tracheotomy: $160,000.


The cost to the patients – needless suffering. In some cases, death.

A Detroit oncologist is said to have administered unnecessary chemotherapy to patients who were in remission and ordered chemotherapy for end-of-life patients, rather than let the patients die in peace. The government said he even gave chemotherapy to people who didn’t have cancer. He allegedly made those treatment decisions simply to increase his Medicare payments.

Chemotherapy drugs are among the most toxic. Side effects from chemotherapy include nausea and vomiting, hair loss, diarrhea, extreme fatigue, swelling and pain.

Payments by Medicare to Michigan Hematology Oncology Clinics, the chain of clinics owned by the oncologist: $35 million over two years, $25 million of which was attributable to the oncologist, Dr. Farid Fata, according to the US Department of Justice.

The price patients paid: needless and extensive suffering up to their deaths.

In April, the government arrested the owner of Sacred Heart Hospital – where the tracheotomies were performed – as well as a senior executive at the hospital and four physicians affiliated with the hospital and charged them with conspiring to pay and receive illegal kickbacks in return for referring Medicare and Medicaid patients to the hospital. The Justice Department also said it was investigating alleged Medicare and Medicaid fraud schemes involving unnecessary sedation, intubation and tracheotomy procedures.

Meanwhile, the Detroit doctor, who entered a not guilty plea, is being held on $9 million bond.

These appalling allegations, if proven, remind us that Medicare fraud is not just about money; it often is about human life and dignity.
It is blindingly obvious that no one should have to endure a tracheotomy, unnecessary intubation or chemotherapy unless it is absolutely necessary. Unfortunately, horrifying conduct by medical providers is not limited to individual physicians.

Big hospital chains (such as Tenet Healthcare ) have been accused of padding their bottom lines with money made from subjecting patients to unnecessary cardiology procedures.
Big pharma has been known to sell vulnerable patients drugs contaminated with impurities, such as bacteria, glass and other substances (as happened with some GlaxoSmithKline and Ranbaxy Pharmaceuticals drugs). Medical device companies (most recently Johnson & Johnson ) continued to sell hip implant devices despite thousands of complaints about pain, metal debris from the devices and the need for additional surgery.

Even the most jaded experts in fraud enforcement see a new level of callousness as some in the healthcare industry forget basic right and wrong in their quest for profits at any cost, including human suffering.

An oncologist who worked for Dr. Fata told the FBI that he had been “living with this hell” by working for the Detroit doctor, according to the criminal complaint.

At least the doctor lived through his hell.  Unfortunately, the same can’t be said for many of these patients.

____________________________________________
Citizens of Maryland know neo-liberals are using Maryland as a model for opting out of the Federal Medicare program.  Johns Hopkins has partnered with Humana in their consolidation scheme and if you want to go to Hopkins for treatment you must join this insurer.  Humana is Medicare Advantage....a private Medicare insurer.  So, the system is being built such that a hospital can partner with insurers that will force you off of Federal programs and into private.  Do you really think the next step will not be to have these private Medicare plans in these state health systems?

THE ENTIRE AFFORDABLE CARE ACT CAME FROM THE SAME CONSERVATIVE THINK TANKS AS PAUL RYAN USES TO CREATE THE POLICY BELOW!!!!  THIS IS THE PLAN FOR ENDING MEDICARE.


As you see below Ryan's plan is what Maryland is moving to do now.  Neo-liberals and neo-cons will not leave any public asset or service in this race to send all wealth to the top.
 

Do you really think Medicare and Medicaid Trusts are really going bust if trillions of dollars in entitlement fraud is recovered and future fraud and profiteering is stopped?  SHOUT OUT FOR NEO-LIBERALS TO STOP THE FRAUD.


Aug 2012 •


Paul Ryan's "Medicare Exchange"  

Paul Ryan is Romney's choice. Conservatives remember with glee how Ryan shredded Obamacare at the President's health care summit. Ryan said the bill was "full of smoke and mirrors." He looked right into the President's eyes. Six minutes later, Obama could barely respond.   Ryan's Medicare proposal now takes center stage. In March, Paul Ryan created shock waves with the Medicare reform proposed in his 2013 budget called "The Path to Prosperity."  His bold step changed the debate forever. Mr. Ryan's Medicare proposal "begins with a commitment to keep the promises made to those who now are in or near retirement. Consequently, for those 55 and older, the Medicare program and its benefits will remain as they are, without change." Thus he acknowledges the dependent situation of some of the elderly.    I'd like to report that Mr. Ryan, who brings all his Midwestern niceness into seemingly every encounter, proposes to completely obliterate Obamacare-like policies and give Americans a non-Medicare option in their sunset years. However, here are a few details:   First, I'm pleased to tell you that Ryan's plan repeals Obamacare (p. 94). But then his plan "would set up a carefully monitored exchange for Medicare plans" (p. 97), which would act much like the ACA's federal Exchange, with the government deciding which plans are available to seniors. He would also extend it to "non-retirees by giving certain employers the option to offer their employees a free choice option, smoothing the transition from their working years to when seniors become Medicare-eligible" (p. 97). This portends the possibility of the Medicare Exchange becoming a National Exchange.   Mr. Ryan's plan does move Medicare to a defined contribution program which he calls "premium support" (p. 96). However, it's not a voucher given to the individual, and just like the ACA, these government subsidies would be directly distributed to health plans through the Exchange (p. 97).    Also, like the ACA, a cap on the growth rate of spending would be implemented (p. 53). And finally, like the ACA, his plan includes "risk adjustment," which is done through profiling of patients. Higher payments go to health plans that enroll high-risk recipients (p. 219). Means-testing of seniors would also be required (p. 98), the age of eligibility would increase in 2023 (p. 97), and medical liability lawsuits would be limited (p. 98). Thus, Medicare would stay in place with various government intrusions and controls on choice, access and price.   Will Ryan's plan end Medicare as we know it? Medicare-as-we-know-it is already ending. The $38 trillion unfunded liability is three times the national debt, with bankruptcy possible as early as 2016. Medicare can't be saved in its present form. This is what scares politicians of all stripes who could soon be in the line of fire from 77 million babyboomers whose "retirement security" program is going bust.

  While Paul Ryan's current plan contains some troubling provisions and does not create a needed escape hatch for seniors, it does recognize the crisis ahead and begin the critical "What next?" discussion.

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March 20th, 2014

3/20/2014

0 Comments

 
IF YOU ARE NOT READING INTO THESE POLICIES THE VISION OF SANITARIUMS FROM THE DAYS OF CHARLES DICKENS------YOU DO NOT UNDERSTAND HEALTH CARE REFORM WRITTEN BY HEDGE FUNDS...THE AFFORDABLE CARE ACT.

THIS IS A LONG BLOG.....PLEASE GLANCE THROUGH ALL ARTICLES!

Regarding corporate commentators Fraser Smith and Basu on private non-profits and health care reform in Maryland:

FRASER SMITH AND BASU HIT IT ON THE HEAD.....JOHNS HOPKINS UNIVERSITY CREATED THE PRIVATE NON-PROFIT MARYLAND HEALTHCARE FOR ALL TO CAPTURE THE POLICY ISSUE OF UNIVERSAL CARE AND MADE SURE IT WENT WITH AFFORDABLE CARE ACT-----PRIVATIZATION FOR PROFIT AT THE EXPENSE OF ACCESS TO HEALTH CARE-------AND SO THE POLICY WOULD NOT GO TOWARDS EXPANDED AND IMPROVED MEDICARE FOR ALL, THE REAL UNIVERSAL CARE POLICY.

So, a corporation created its own private non-profit to push it own policy agenda using taxpayer money and private donations to make sure policy went towards maximizing profit for Johns Hopkins. That is indeed what this proliferation of corporate private non-profits is about.

SO, WHAT ABOUT THIS LADY FRASER MADE TO SOUND THANKFUL TO HAVE THIRD WORLD HEALTH CARE WITH TODAY'S MEDICAID AFTER LOSING A FIRST WORLD QUALITY HEALTH PLAN?

We hear time and again that this Affordable Care Health Reform is a Republican idea pulled together first by Reagan and implemented by Romney in Massachusetts. It is indeed a Republican plan. Affordable Care does not mean affordable for people, it means affordable for corporations and profit-maximizing.....Third Way corporate neo-liberals in Mass passed this plan just as they are now in Maryland. What we are seeing is the requirement to have health insurance partnered with health access that is window-dressing. When Massachusetts says it has almost universal coverage it isn't telling you that the coverage that many people have is just the preventative public health level we are seeing hitting Maryland. Who are those falling into this Medicaid level care? The article below written in 2010 looks at immigrant and low-income care but makes clear that the window is opening as to who will receive this level of care.


Massachusetts health care plan “dangerously restricts access” to primary care

Published August 9th, 2010 iHealthBulletin News!

The first health care plan from a for-profit insurance company approved to offer government-subsidized coverage under Massachusetts’ health care reform has dangerously restricted access to primary care, according to data reported on August 5, 2010 in the New England Journal of Medicine. Researchers say the findings raise troubling concerns about the Obama administration’s new health law, which is modeled after the Massachusetts plan.

Three Harvard-affiliated physicians report that out of a list of 326 doctors identified as members of the provider network of CeltiCare, a for-profit insurer contracted by the state of Massachusetts to take over coverage of about 30,000 legal immigrants (and, more recently, low-income citizens), only 217 were non-duplicate adult primary care providers. Of these 217 doctors, 25 percent could not be reached by telephone.

Of those primary care doctors who were reachable by telephone, only 37 percent, or 60 providers, said they were accepting new CeltiCare patients. In those cases, the average wait time for an appointment was 33 days, even though the patient was described as having a chronic illness like diabetes or hypertension.


Moreover, although many of the patients who had been forced into the CeltiCare plan don’t speak English, only 38 of the doctors who were accepting new patients had any form of translation services.

The plan’s failure to provide adequate access to doctors for its members raises grave concerns not only about Massachusetts’ reform, but also about the recently enacted national reform, the researchers say. The national plan closely mirrors Massachusetts’ reform, but relies far more heavily on for-profit insurers.

The report points out that even when patients have insurance, profit-driven plans may discourage them from getting the care they need by “rationing by inconvenience.”

The data appears in a letter titled “Immigrants’ experience with publicly funded private health insurance” in the August 5, 2010 print edition of the journal. It was written by two resident physicians at the Harvard-affiliated Cambridge Health Alliance and a Harvard Medical School faculty adviser, and is based on the work of a group of interns, residents and medical students from several Boston-area hospitals and medical schools.

These doctors-in-training carried out the research after they became worried when some of their sickest patients – patients with cancer, diabetes and other severe health problems – were forced from their existing insurance plan into the CeltiCare plan. They then were told that they could no longer be treated at many of their previous health clinics, forcing them to find new doctors.

The researchers identified doctors available to the CeltiCare patients using the plan’s “Find a Provider” website. They called each of the doctors’ offices within a 5-mile radius of their hospital, identifying themselves as relatives of a chronically ill, older adult who needed an appointment soon. If an appointment was offered, the researcher asked about the availability of translators.

“Trying to get an appointment was even more daunting than these numbers suggest,” said Dr. Cassie Frank, a co-author of the article. “Many clinics forced me to call several times to get an appointment. One said they only open up appointments on Monday morning, and that to have a chance of getting any appointment slot I’d have to show up an hour before the clinic opened to be first in line.”


Dr. Malgorzata Dawiskiba, another co-author, said: “The state suddenly shifted thousands of sick patients to a cut-rate plan. But instead of getting a bargain, the patients were left stranded – insured, but unable to find a doctor who could care for them. These were people whom we knew. We and our supervisors had been their doctors, sometimes for many years, and overnight they were told ‘you can’t come here anymore.’”

Dr. Ruth Hertzman-Miller, an instructor at Harvard Medical School and study co-author, commented: “The problems faced by CeltiCare’s patients may soon become much more widespread. Our legislative leaders want to require every insurer in Massachusetts to offer a plan with a restricted list of doctors and a lower price tag. But that kind of restricted coverage may be little more than a worthless piece of paper” (Courtesy of Eurekalert).


_________________________________________________
What we are seeing in Maryland already is an inability of low-income people or inadequately insured people to get the normal treatment for common diseases. When you have to co-pay a $100,000 treatment, how does that affect your future access? YOU WON'T HAVE ANY. Baby boomers are told they will not be affected, but at age 55 I know that when I start having major health issues in a decade or so, all of this reform will not protect my Medicare coverage.

OTHER COUNTRIES DO UNIVERSAL CARE WITH SATISFACTORY SERVICE......DO YOU HEAR THE ENGLISH, CANADIAN, OR FRENCH SHOUTING OUT AGAINST THEIR HEALTH SYSTEMS? DO YOU HEAR OF THE POOR CLIMBING INTO THE BACKS OF VANS FOR HEALTH CARE WHILE THE RICH HAVE HEALTH BOUTIQUES IN THESE COUNTRIES?

VOTE YOUR NEO-LIBERAL INCUMBENT OUT OF OFFICE!!


Making all of health care about profit moves drugs to market-based operations.  So, if a drug is not used much it will be made expensive or will not be manufactured.  We already are seeing shortfalls in availability of common drugs because of market-based health policy.  IT WILL GET WORSE IF LEFT TO CONTINUE.

No Health Insurance Dims Cancer Fate Cancer Outcomes Worse for People With No Health Insurance or Inadequate Health Insurance

By Miranda Hitti
WebMD Health News Reviewed by Louise Chang, MD

Dec. 20, 2007 -- Cancer patients without adequate health insurance tend to face grimmer odds than those with good health insurance, says the American Cancer Society.

The American Cancer Society today released a new report on health insurance and cancer.

The report shows that people with no health insurance or inadequate health insurance face four main challenges when it comes to cancer:

They're less likely to get screened for cancer.
They're less likely to get counseled about cancer prevention.
They're more likely to get diagnosed late, when their cancer is harder to treat.
They're more likely to die from cancer than people with adequate health insurance.


Take breast cancer, for instance. The report shows that women with private health insurance are more likely to get mammograms, get diagnosed earlier, and have better survival rates than uninsured women.

The same is true for colorectal cancer. The report shows that among adults aged 50-65, about half of those with private health insurance had gotten screened for colorectal cancer in the past decade, compared with almost 40% of those with Medicaid insurance and about 19% of uninsured people.

Noting that some new cancer treatments cost more than $100,000 per year, the American Cancer Society's report asks, "To what extent will availability and type of insurance coverage, as well as individual financial resources, determine who has access to the most effective therapies?"

Health insurance isn't the only gap in cancer care. Racial and ethnic disparities also affect cancer outcomes.

The American Cancer Society based its report on information from the CDC and from the National Cancer Data Base.

The findings appear in CA: A Cancer Journal for Clinicians.

_____________________________________________________

CHECK OUT THE DESCRIPTIONS OF THESE HEALTH HOMES THEY PLAN FOR MEDICAID/MEDICARE PEOPLE. THEY ARE SIMPLY COMPOUNDS OF CARE WE ALREADY KNOW WILL BE RUN BY HUGE HEDGE FUND-SIZED CORPORATIONS THAT HAVE NO INTENTION BUILDING A CARING/QUALITY ENVIRONMENT.

What is the difference between the retirement communities and state nursing homes we have today and what ACA is calling community-centered health homes? First, retirement communities and state nursing homes were run by private non-profits like religious communities and the government having the public's interest at heart. What ACA if creating is a national system of corporate businesses often owned by hedge funds and run with only thoughts of profit and raiding entitlement Trusts with fraud. We already had the kinds of facilities ACA is creating only they were not structured for profit.

THINK HOW A HEDGE FUND WILL OPERATE A COMMUNITY HEALTH HOME.

Community homes for seniors and the poor with chronic health conditions.....sound a little like the sanitariums of hundreds of years ago? YOU BETCHA!!!!! Think who will age or fall into poverty in this downward spiral of neo-liberalism------ALMOST EVERYONE. HOW MEDIEVAL OF NEO-LIBERALS!!!




MEDICAL HOMES-----for the poor that means isolated health care focusing on containing communicable diseases and mental health issues. It is third world speak for containing disease vectors as cheaply as possible. As I mention above, the old practice of SANITARIUMS is the model. It will become a Dickens' nightmare as public health is dismantled and no public oversight allows a level of neglect we do not want to allow.

You notice that ACA sends billions of dollars to fund the building of these structures and this is happening as more and more people lose private health insurance or public health plans are getting ready to be thrown into these state health systems relegating most people to the status of Medicaid.

SEE WHY NEO-LIBERALS ARE PUSHING EXPANDED MEDICAID RATHER THAN FIGHTING TO RECOVER TRILLIONS OF DOLLARS LOST FROM ENTITLEMENT TRUSTS FROM CORPORATE FRAUD.

We simply need to rebuild white collar criminal agencies and stop the massive fleecing of Medicare and Medicaid, recover funds lost to fraud, and we will be flush with money to fund a first world quality of health care for all.



HMMMMMMM.....MEDICAL ENTERPRISE ZONES SEEM TO BE THE FEDERAL MONEY BUILDING THIS SYSTEM

Community-Centered Health Homes

Community-Centered Health Homes Bridging the gap between health services and community prevention ...practices, including the patient-centered medical home,

aswww.ravenswoodfhc.org/images/pdf/community-centered...

Transforming Community Health Centers into Patient-Centered Medical Homes: The Role of Payment Reform

September 28, 2011

Authors: Leighton Ku, Ph.D., M.P.H., Peter Shin, Ph.D., M.P.H., Emily Jones, M.P.P., Brian Bruen, M.S.
Contact: Leighton Ku, Ph.D., M.P.H., Director, Center for Health Policy Research in the Department of Health Policy, George Washington University leighton.ku@gwumc.edu
Editor: Deborah Lorber

"FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes."

Overview This report examines how changes in the way federally qualified health centers (FQHCs) are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Through surveys and interviews, the authors explore the current landscape of health center involvement in medical home initiatives, adoption of medical home standards, and receipt of payment incentives. Based on their findings, the authors make preliminary recommendations to encourage health centers to serve as patient- and community-centered medical homes. These include: establishing recommended standards for patient- and community-centered medical homes that apply to FQHCs; structuring payment incentives to promote medical homes; including FQHCs in state Medicaid medical or health home projects; adapting payment approaches, including adding monthly case management fees; and encouraging the Health Resources and Services Administration to use quality-of-care measures in making funding decisions.

Executive Summary

The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) significantly altered the landscape of American health care policy. In addition to expanding coverage to millions of uninsured and increasing funding to expand community health centers, the Affordable Care Act initiates efforts to change how health care is paid for and delivered in the United States. For example, the law encourages state Medicaid programs to develop medical homes, also known as "health homes," for Medicaid patients with chronic diseases. More broadly, the law calls on federal and state governments to consider other methods to transform health care delivery, including strategies such as creating accountable care organizations and bundling episodes of care. The large increases in the number of people with health insurance, including Medicaid patients, after the implementation of health reform will require the nation and the states to consider strategies to strengthen primary care services as part of a high performance health system.

This report examines how changes in the way federally qualified health centers are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Federally qualified health centers (FQHCs), also known as community health centers or clinics, are nonprofit facilities that provide comprehensive primary medical care—and often dental, vision, and behavioral health services—to low-income patients in medically underserved areas, regardless of a person's ability to pay.

In late 2009, we conducted a survey of state primary care associations, which represent community health centers in their states. We followed up this survey with interviews of selected health center, state agency, and managed care staff about medical home and quality initiatives in their states. In the majority of states, health centers receive payments to serve as primary care providers or medical homes, generally under Medicaid, and more recently have begun to serve as patient-centered medical homes. There was great diversity in the nature of medical home programs, medical home criteria, and stages of development. In some cases, private physicians are eligible for medical home payments, but health centers are not.

FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes. Nonetheless, many FQHCs have demonstrated interest in attaining formal recognition as a medical home.

Preliminary data from a George Washington University survey of FQHCs, conducted from 2010 to 2011, indicate that about 6 percent of centers have attained National Committee for Quality Assurance–Patient Centered Medical Home (NCQA–PCMH) recognition, another 12 percent have a pending application, and 40 percent expect to seek recognition in the next 18 months. Some (12%) have received or applied for recognition from a state medical home program and 11 percent are considering another national recognition program. One reason some centers do not consider applying is there is no financial reward for attaining recognition, as some states do not have medical home incentive programs for FQHCs.

We present several financing recommendations to increase the incentives for FQHCs to transform themselves into high-performing medical homes:

Establish recommended standards for patient- and community-centered medical homes that apply to FQHCs. A variety of national and state recognition programs exist for medical or health homes, but they generally focus only on patient-centered medical care. Health centers also seek to provide community-centered services, such as offering access to patients regardless of ability to pay; providing nonmedical services like behavioral, dental, or enabling services (like case management, health education, and translation); and conducting community needs assessments and other prevention-oriented projects. It may be relevant to establish standards that emphasize these broader community-oriented service components.
States should include FQHCs in Medicaid health home projects. Under the Affordable Care Act, state Medicaid programs may establish health home projects for those with chronic health conditions. In the past, some state medical home programs excluded FQHCs because they are paid differently than physician practices. Since FQHCs provide primary care to a substantial and growing number of Medicaid patients, they should be included in all state Medicaid health home projects.
Clarify that states may pay FQHCs more than the levels prescribed by the prospective payment system. Although federal Medicaid policy that governs health center payments does not prevent states from paying FQHCs more than the prospective payment system (PPS) level, which is based on historical Medicaid costs and then updated, some states appear to interpret the statute as constituting a cap on FQHC payment levels.
If states adopt medical or health home incentives, providing monthly case management fees per Medicaid patient is a reasonable approach. States considering this option could add a monthly medical home case management fee, in addition to regular FQHC reimbursements, as an appropriate way to create a payment incentive for medical home status. This is already used in many states and is the method planned for the Medicare FQHC Advanced Primary Care Practice demonstration project.
Clarify how states may increase FQHC payment levels under Medicaid. Under current federal rules, states may change PPS payments to individual health centers when the centers demonstrate a change in the scope of Medicaid services. However, there is no specific provision for changing the PPS
payments when a health center increases the quality or intensity of services it provides.
Maintain the all-inclusive per-visit payment rates in Medicaid. Under federal law, Medicaid payments to FQHCs are paid on a flat, all-inclusive, per-visit (or per encounter) basis. To change the system would require substantially changing all FQHC payment rates, which would take years to develop. Given current state budget problems, in which state Medicaid programs have often trimmed provider payment rates, opening all FQHC payment rates to recalculation could place them at substantial risk of unanticipated reductions.
The Centers for Medicare and Medicaid Services (CMS) should ensure that Medicare policies are consistent with medical home goals. CMS has announced two Medicare advanced primary care medical home demonstration projects, one for FQHCs and one that permits multipayer projects in several states. CMS should continue to develop these projects. CMS is also actively developing policies in related areas, such as those related to Medicare accountable care organizations, and should ensure that the objectives of those policies are ultimately supportive of medical home policies as well.
The Health Resources and Services Administration has long encouraged quality of care for FQHCs and supports Section 330 grantees as NCQA–PCMHs, but could consider additional efforts. The Health Resources and Services Administration (HRSA) seeks to build on the already strong quality of care delivered by health centers by focusing on quality improvements and ways that payment reforms could affect health centers. HRSA provides grants to subsidize the cost of NCQA–PCHM applications for FQHCs that receive federal Section 330 grants. In allocating funds to grantees, HRSA has not traditionally used quality of care in funding decisions. HRSA is improving information collected about the quality of care at Section 330 grantees under its Uniform Data System. In the future, HRSA could develop incentives to improve the quality of care at health centers or performance as medical homes. It could develop further efforts to help integrate health center coordination in medical home, health home, and advanced primary care projects, working with Medicare, Medicaid, and the Children's Health Insurance Program—and eventually the health insurance exchanges.

As the concept of a medical home and other paradigms to strengthen the health care infrastructure are implemented, FQHCs will serve as laboratories for innovation to test new care models. Adequate and appropriately structured financial incentives are critical to the success of any model of health care delivery, and the medical home is no exception. In addition to changes to the reimbursement system that would better align incentives, other supports for providers such as training and technical assistance are necessary to bolster and support the infrastructure.
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This is what happens when health care becomes about maximizing profits. Staff are not always to blame. People are being sent to do jobs for which they are not prepared. Standardization of care misses lots of individual symptoms and history. Having hedge funds operating medical care can only be a spiraling disaster for health care. SHOUT FOR EXPANDED AND IMPROVED MEDICARE FOR ALL.

This article is a good look at what has happened as health care moves from hospital to nursing facilities, but it doesn't address the gorilla in the room------home health care skilled and non-skilled. If you know nursing homes and community care facilities are rife with bad care you know this booming national health chains of home health care businesses are really, really bad. THEY ARE. This is what all of these private for-profit career job training schools are releasing on the public and it is not pretty. The students graduating are not at fault most times....they are being steered into programs that do not prepare them for the jobs they will do and these health businesses for which they are hired are not monitored or operating legally in many cases.

THIS IS WHAT ACA DOES IN TANDEM WITH PRIVATIZATION OF EDUCATION....IT DEVELOPS A SYSTEM WHERE EDUCATION FEEDS BUSINESSES AND IT IS ALL PROFIT-DRIVEN.

So, Americans are being told they will be serviced at home at the same time academics are seeing the lowest quality of training for students entering these fields. I want to qualify that home health care businesses have been around for decades and many offer strong, quality care and staffing. What we are seeing from ACA is a flooding of the market with national chains simply there to make a buck anyway they can. This article below has a Hopkins professional reporting these shortfalls as Baltimore is ground zero in the worst health care in these kinds of facilities and Hopkins is public health in Baltimore. It's like interviewing the fox about how best to stop foxes from raiding the hen house.

DO YOU SEE HEDGE FUNDS AND GLOBAL CORPORATIONS RISING TO THE CALL TO IMPROVE QUALITY OF CARE?


'About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve'.

He said,

“They are dangerous, dangerous places”.



Keep in mind with this article below that in Maryland, where Medicare is being dismantled by privatization with no Federal oversight, has the goal to end all Federal oversight of Medicare. 1/2 of Medicare spending is lost to fraud and you see Federal spending by Medicare is sent to building these skilled nursing businesses. When the Federal Medicare program is privatized to these state systems, there will be no public oversight as described in this article.

One Third of Skilled Nursing Patients Harmed in Treatment

March 16th, 2014

Special Report from ProPublica

by Marshall Allen, ProPublica

One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released recently that underscores the widespread nature of the country’s patient harm problem.

Follow up:

Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable. More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied — about 2 percent of Medicare’s total inpatient spending.

Patient safety experts told ProPublica they were alarmed because the frequency of people harmed under skilled nursing care exceeds that of hospitals, where medical errors receive the most attention.

Dr. Marty Makary, a physician at Johns Hopkins Medicine in Baltimore who researches health care quality, said -

“(The report) tells us what many of us have suspected ­­– there are vast areas of health care where the field of patient safety has not matured”.

The study by the inspector general of the U.S. Department of Health and Human Services (HHS) focused on skilled nursing care – treatment in nursing homes for up to 35 days after a patient was discharged from an acute care hospital. Doctors working with the inspector general’s office reviewed medical records of 653 randomly selected Medicare patients from more than 600 facilities.

The doctors found that 22 percent of patients suffered events that caused lasting harm, and another 11 percent were temporarily harmed. In 1.5 percent of cases the patient died because of poor care, the report said. Though many who died had multiple illnesses, they had been expected to survive.

The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure.

One patient suffered an undiagnosed lung collapse because caregivers failed to recognize symptoms. The patient later had a reaction to medication and a blood clot and had to be transferred to a hospital.

Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled.

Medicare patients “deserve better,” said Sen. Bill Nelson, D-Fla., chairman of the U.S. Senate Special Committee on Aging. Nelson said he would push for better inspections of the facilities. He said,


“This report paints a troubling picture of the care that’s being provided in some of our nation’s nursing homes”.

The report said it is possible to reduce the number of patients being harmed. It calls on the federal Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services (CMS) to promote patient safety efforts in nursing homes as they have done in hospitals.

The authors also suggest that CMS instruct the state agencies that inspect nursing homes to review what they are doing to identify and reduce adverse events.

In its response to the report, CMS agreed with the findings and noted that the Affordable Care Act requires nursing homes to develop Quality Assurance and Performance Improvement programs. The agency’s quality improvement work includes a website for nursing homes that was launched in 2013.

A “skilled nursing” facility provides specialized care and rehabilitation services to patients following a hospital stay of three days or more. There are more than 15,000 skilled nursing facilities nationwide, and about 90 percent of them are also certified as nursing homes, which provide longer-term care.

As hospitals have moved to shorten patient stays, skilled nursing care has grown dramatically. Medicare spending on skilled nursing facilities more than doubled to $26 billion between 2000 and 2010. About one-in-five Medicare patients who were hospitalized in 2011 spent time in a skilled nursing facility.

John Sheridan, a member of the American College of Health Care Administrators, which represents nursing home executives, called the report valuable but noted that it sampled only a small number of patients. He questioned whether the findings apply broadly to skilled nursing facilities.

Sheridan also strongly disagreed with the report’s observation that there’s less known about patient safety in skilled nursing facilities compared to hospitals. He said Medicare has robust inspections of nursing homes it certifies – they take place annually or when there are complaints and are usually conducted by state contractors. Medicare also keeps detailed data on the violations, he said. (ProPublica’s Nursing Home Inspect makes it easy to search and view Medicare inspection reports.)

Sheridan agreed that skilled nursing facilities could improve, but said the caregivers face a daunting task and work diligently despite low reimbursements Medicare pays to the facilities.

Sheridan said of the providers that -

“They don’t go to work every day to cause an adverse event. They do it to care for the residents there. They do it with sacrifice and love.”

Dr. Jonathan Evans, president of the American Medical Directors Association, a group focused on nursing home care, said while he doesn’t dispute the estimates in the inspector general’s report, they are typical of problems that exist throughout the health care sector.

Evans said that patients receiving skilled nursing care are leaving hospitals sooner and that many are not medically stable and have more intensive needs. Nursing homes, originally designed for long-term patients who did not need intensive care, and have been slow to adapt, Evans added.

He said,

“You have a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for them and commitment from those sending them from one facility to another haven’t kept pace.”


Evans called the study significant and said he hopes it raises awareness and sparks improvements.

Makary, the Johns Hopkins’ doctor, said the patient safety movement has been more focused on problems at hospitals than in nursing homes.

A 2010 report by the HHS inspector general estimated that 180,000 patients a year die from bad hospital care, and other estimates have been higher. The patient safety research community has focused on reducing bloodstream infections and surgical errors at hospitals but has done less to address issues specific to nursing homes, Makary said.

Developing metrics to track improvement would be more effective than annual inspections, which don’t do a good job of capturing a facility’s everyday performance, Makary said.

Patient advocates said the study verifies what they’ve heard from skilled nursing patients and their families. Richard Mollot, executive director of New York’s Long Term Care Community Coalition, said he was “flabbergasted” by medication errors, bedsores and falls that were identified in the report.

They are prominent problems that nursing homes should be “well versed” to address, he said.

Mollot said the report should have more forcefully called for better enforcement of the existing standards in nursing homes.

States inspect nursing homes on behalf of Medicare every year and when there are complaints, he said, but some inspectors are tougher than others. Medicare’s current standards of care are good, he said, and “if they were enforced we wouldn’t have these widespread problems.”

About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve.

He said,

“They are dangerous, dangerous places”.

_____________________________________________

This article show too where things will go in the US if neo-liberals remain in charge. Spain has been taken by the worst of TROIKA politicians and the public sector is being gutted and a strong public health care system and quality wages and staffing dismantled. Remember, Trans Pacific Trade Pact (TPP) and its Atlantic Trade deal pushes the dismantling of public health all over the world so US private health systems will maximize profits. Here is a former first world country moving to third world in one fell swoop. This is the goal of TPP---to take formerly first world nations to the level of developing countries under the guise of needing to be competitive globally.

THAT'S A NEO-LIBERAL FOR YOU----ALL MARYLAND POLS ARE NEO-LIBERALS!


Outrage as nurses are appointed at less than €4 per hour

by TPN/ Lusa, in News · 05-07-2012

Portugal’s national nurses register publicly announced on Monday that it considered it “scandalous” for nursing professionals to be placed on contracts earning less than four euros per hour and appealed for those who could “not to accept” the proposals.
Outrage as nurses are appointed at less than €4 per hour


This is a scandal for Portugal, for a first world country, that is offering highly qualified professionals at a price per hour that is incompatible with their profession and their dignity," said Germano Couto from the national nurses register Ordem dos Enfermeiros, adding that he had received "a series of denunciations" from "tens of nurses who have contracts at €3.96 per hour."


Mr. Couto spoke in reaction to news published in Diário de Noticias that nurses hired by temping agencies for the health centres of Lisbon and the Tagus Valley region who started work on Monday will receive less than four euros per hour.

He guaranteed that the news piece "is real" and "there are facts and evidence", although he added that he hoped it "isn’t more than a series of intentions" and so "may be reverted by the Lisbon and Tagus Valley regional health authority and the Ministry of Health."

Mr. Couto added that the government may be "paying more to these companies" for them to "obtain their profit" but highlighted that it is necessary to check whether these companies are fulfilling the contract conditions, as the €3.96 per hour the nurses will earn equates to €300 in their pockets at the end of the month, which doesn’t even qualify as minimum wage.

Currently, the average wage deemed acceptable for nurses in Portugal is around €1,020 per month, which is around seven euros per hour and that value "should be the yardstick the government should use."

Following the news of the reduced wages for new nursing contracts in the Lisbon area, the national nurses register has "appealed to nurses not to accept these contracts if they are able," adding that they do however understand if some go ahead "so as not to lose their status."

Mr. Couto considers that many health professionals prefer to move abroad rather than end up unemployed or lose their status, criticising that Portugal is "training nurses for export" at a time when there is need in the country.

In response to the news, the Lisbon and the Tagus Valley health authority (ARSLVT) announced that the nursing contracts were put to tender at prices per hour varying between €4.77 and €5.19 and declined any responsibility of wages being paid below four euros per hour.

The price per hour "results from the public tender whereby the companies involved presented their proposals," ARSLVT said in a statement.

The health authority said it had launched a public tender for the acquisition of nurses with a base value of €8.50 per hour, which corresponds to the average price on the market for this type of service.

"The values presented by firms that responded to the public tender were substantially lower than the base value, and all those 50 percent below it were excluded from the public tender because of the legal reason that they were abnormally low values," said the statement.


ARSLVT added that "the majority of firms presented values much reduced compared to that proposed by ARSLVT, with a price being fixed between €4.77 and €5.19" in the end.

"Negotiation of salaries and conditions is the exclusive responsibility of the firms that responded to the public tender and their staff," the regional health authority concluded.
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March 11th, 2014

3/11/2014

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New Push for Single Payer Healthcare for All

The cause of universal healthcare is alive and well. Not only is the state of Vermont moving toward a single-payer system, but Vermont's U.S. Senator Bernie Sanders has introduced a bill and is holding a hearing this week on the benefits other countries enjoy from a single-payer system that would benefit everyone except the profiteering middlemen who've rigged the current system.

ALL OF MARYLAND'S CANDIDATES FOR GOVERNOR WILL CONTINUE THIS AFFORDABLE CARE ACT PRIVATIZATION OF PUBLIC HEALTH-----CINDY WALSH SUPPORTS EXPANDED AND IMPROVED MEDICARE FOR ALL!


As citizens of Maryland listen to the failures of implementing its private health insurance system WE THE PEOPLE have decided to move forward with Expanded and Improved Medicare for All.  Neo-liberals think they can simply run as progressives in elections and then implement republican policies that end all public programs and services but citizens have figured out this game.

Privatizing public health with Affordable Care Act is more than losing access to basic health procedures and care.  It is about losing our public health agencies structured to oversee the data collected on the health of the nation, the agencies that hold the health industry accountable for quality and malpractice, and the agencies tasked with public justice in regards to health outcomes.  In other words, it creates the same conditions of deregulation that gave us Wall Street banks and their unaccountability.  In addition to preying on people for profits, the public will not know that the data provided in approving medical products and techniques are true and if what is being given as treatment is dangerous.  The public now faces a litany of drugs hitting the market that have not gone through clinical trial and the practice of using the general public as the source of knowledge of medical efficacy for products is becoming more common.  If you have universities as corporations that patent research you have lost pure academic study that provides facts in public interest.
  If you lose your public health agencies that provide data collection that is honest, you lose your ability to hold health industries accountable.


THIS IS HUGE FOLKS!  DISMANTLING PUBLIC HEALTH WILL HAVE ALL CITIZENS DISTRUSTING HEALTH PROFESSIONALS AS WE DISTRUST OUR BANKS!


Below you see where this is going.  Payers are health insurance agencies and providers are the doctors and hospitals.  This article shows the intent to end public health data collection and analysis in overseeing the health care industry from research, to hospital care, to outcomes.

Remember, the Centers for Medicare and Medicaid have decades of public health data stored in its database that show all of the information needed to assess the cost benefit of procedures, the outcomes from procedures, the average prices paid for every procedure.  WE ALREADY HAVE ALL OF THE DATA NEEDED TO DEVELOP A MEANINGFUL APPROACH FOR COST EFFECTIVE HEALTH CARE.  What neo-liberals are doing is handing all of the development of cost models to the very people creating the inflated costs by health fraud and profiteering.  This article says------we do not need public funding of data exchanges because with public funding comes public oversight and transparency.  Can you imagine corporations paying for the data collection for medical procedures and products they develop?



The Affordable Care Act is about ending public health and deregulating the health industry just as Clinton did the banking industry.  It ends all public ability to oversee, to hold accountable, and to collect data that can be reliably used to protect public interest.  Maximizing profits means corporations will write the policies that end public health.




Payers, Providers Question Value of Public Health Data Exchanges

Tuesday, January 28, 2014 TOPIC ALERT:
  • Health Data Exchange
Click on topic to receive periodic emails. The majority of payers and providers believe that the business model of publicly funded health information exchanges is flawed, according to a Black Book survey, Health Data Management reports.

Survey Details, Findings For the survey, Black Book polled 1,550 providers and 794 payers.

According to the survey, 95% of payers, 83% of hospitals and 70% of physicians said HIEs funded by federal grants have flawed business models and do not assist with meaningful connectivity (Goedert, Health Data Management, 1/27).

In addition, 94% of surveyed payers said they did not see "value proposition" in public HIEs (Sullivan, Government Health IT, 1/27).

Less than 33% of surveyed providers said they participate in public HIEs, while 86% said they have rejected paying the annual fees for public HIEs (Health Data Management, 1/27).

More than 80% of the 220 operating public HIEs in the U.S. are stalling as federal grants supporting many of those HIEs ends, according to Government Health IT (Government Health IT, 1/27).

Seventy-two percent of survey respondents predict that there may be only 10 public HIEs left after federal grant money for them expires in 2017.

More than 80% of respondents concluded that a national operational public HIE is more than a decade away (Walsh, Clinical Innovation & Technology, 1/28).

Meanwhile, the report also found that many payers have been investing more heavily in private HIEs, rather than public exchanges.

Doug Brown, managing partner of Black Book, said, "Payers are looking for [return on investment] that the majority of public HIEs aren't even close to delivering, [s]o it was inevitable the private HIE market got so hot" (Government Health IT, 1/27).

___________________________________________

Here in Baltimore, all of public health has and is being privatized to private corporate non-profits that write health policy, that implement all that policy in communities, and that are the source of all data that comes to the public.  All is done under the restrictions of the public to transparency protections given private non-profits.  We have little access as the public to any of the policy-writing, any of the use of Federal and State funding on behalf of health services, any sense of oversight of the data being presented to the public on the state of public health.

We know that Medicare and Medicaid fraud is rampant and as much as 1/2 of spending on entitlements are lost to fraud.  This in turn affects the health programs implemented and it affects the result data we receive. 

RAISE YOUR HAND IF YOU UNDERSTAND THAT CORPORATIONS PROVIDING A SERVICE WILL HAVE THE INCENTIVE TO SKEW DATA TOWARDS THEIR BENEFIT AND NOT THE PUBLIC INTEREST?  THAT IS WHY THE US HAS A PUBLIC SECTOR-----TO SERVE THE PUBLIC INTEREST.

Neo-liberals work in the corporate interest and push these policies of privatization so that corporations have all the control.




What Is the Public Health System?

The public health system once was thought of as comprising only official government public health agencies, but now is understood to include both other public-sector agencies (such as schools, Medicaid and environmental protection agencies, and land-use agencies) and private-sector organizations whose actions have significant consequences for the health of the public. The public health system includes the following four main components:

  • Mission – The mission of the public health system includes its goals at any point in time and how, at the conceptual level, these goals are operationalized. At the beginning of the 21st century, the mission of public health is to ensure conditions in which people can be healthy.2
  • Structure – The structural capacity of the public health system is the cumulative resources and relationships necessary to carry out the important processes of public health. Structural capacity includes the following elements: information resources, organizational resources, physical resources, human resources, and fiscal resources. 2
  • Process – The practice of public health can be thought of in terms of the key processes through which practitioners seek to identify, address, and prioritize community or population-wide health problems and resources and the outputs of these more fundamental processes, public health’s interventions, policies, regulations, programs, and services.The processes of public health are those that identify and address health problems as well as the programs and services consistent with mandates and community priorities. 2
  • Outcome – The immediate and long-term changes experienced by individuals, families, communities, providers, and populations are the system’s outcomes, the cumulative result of the interaction of the public health system’s structural capacity and processes, given the macro context and the system’s mission and purpose. Outcomes can be used to provide information about the system’s overall performance, including its efficiency, effectiveness, and ability to achieve equity between populations.
    _______________________________________

    If you look at the leaked documents for the Trans Pacific Trade Pact you will see it involves ending public subsidy of health and indeed, Obama Administration is actively lobbying nations around the world to end generous public health subsidy as part of these trade deals.  NEO-LIBERALS ARE TRYING TO FORCE NATIONS AROUND THE WORLD TO END PUBLIC HEALTH AND THEY ARE DOING THAT IN THE US WITH THE AFFORDABLE CARE ACT.

    Building state health systems is a republican policy to end Federal public health programs.  They have tried for decades to do this and it is Obama and neo-liberals passing the laws to do it.  They want as much as republicans to downsize the public sector and health care is the largest sector left to privatize.  Private health systems are designed to give the health industry control of writing all of the policies in this reform and they are writing them to the industry's benefit and to the public detriment.





  • FOR IMMEDIATE RELEASE
    July 24, 2013
    4:27 PM

    CONTACT: US PIRG

    Phone: (202) 546-9707

    Congress Mulls Dismantling America’s Public Health and Consumer Protections WASHINGTON - July 24 - “The Regulatory Accountability Act (H.R. XX) and the Regulatory Flexibility and Improvement Act (H.R. 2542)  would threaten the health and safety of the American people, by disarming standards like the ones that keep children safe from faulty cribs and toxic toys. These bills would block enforcement of critical laws by creating new bureaucratic hurdles and impossibly short timelines for approval of public health rules.

    “The Regulatory Accountability Act would add layers of new bureaucratic processes before even simple public health rules could be enforced, and empower special interests to use the courts to delay protections that have been years in the making.   For example, in 2011 after a 10 year fight, Congress authorized and the Consumer Product Safety Commission developed new safe crib standards.  Parents finally received protection against collapsing cribs that injured and killed far too many infants. The RAA Act would make it easier for special interests to contest the new crib standards in court, delaying these critical protections.

    “The Regulatory Flexibility Improvements Act, by adding new layers of red tape and bureaucracy,will potentially jeopardize straightforward proposals. This could hurt the ability to create important new tools such as the www.SaferProducts.gov website, which provides parents with information on dangerous and toxic toys and children’s products.

    “As a nation, we have made significant progress toward ensuring a safe and healthy marketplace for consumers.  Congress should continue in that proud tradition and oppose these bills, to protect the health and safety of the American people.”


    ________________________________
    Below you see a democratic state struggling with simple public health issues that ACA force into the reform category.  It is not only republican states that will use this move to state control of health policy-----neo-liberal states are dismantling services under the guise of lack of state budget for public health.

    Below you see policy that looks a lot like the policies working to implode the US Post Office.  Regulations that hit public health hardest will force the public sector out of business and private sector simply absorbs the cost until it takes control of once public sector services.  Look at what conservative states are doing to Planned Parenthood to end abortions.  The use of targeted regulations makes the cost to public health too expensive just to put them out of business.

    If you talk with doctors in the public health field they will tell you that decades of massive entitlement fraud pushed the need to commit fraud to stay in business onto public health agencies. 

    WE WATCHED AS THESE SAME PRACTICES BLEW UP OUR PUBLIC HOUSING AGENCY AND OUR PUBLIC EDUCATION AGENCY.  THEY ARE NOW COMING FOR PUBLIC HEALTH.

  • REMEMBER, THE US HAS THE HIGHEST COST IN HEALTH CARE BECAUSE OF MASSIVE FRAUD AND CORRUPTION IN THE INDUSTRY-----NOT BECAUSE PATIENT COSTS ARE HIGH.  GOVERNMENT COFFERS ARE EMPTY BECAUSE CORPORATIONS ARE PAYING NO TAXES.  THESE ARE THE PROBLEMS.  NEO-LIBERALS ARE MAKING THE PUBLIC PAY THE SHORTFALLS.



  • New CDC Regulations Threaten to Dismantle Vaccines for Children Program

    The policy changes would affect how providers store and replenish vaccines and have a severe impact on rural clinicians. Jeff McDonaldSignificant federal policy changes could force many providers to opt out of Oregon’s well-established immunization program, potentially leaving kids around the state unvaccinated and with a higher risk of disease, state health care leaders and providers say.

    New policies from the Centers for Disease Control and Prevention (CDC), set to take effect as early as Feb. 1, could dismantle the state’s successful Vaccines for Children (VFC) program, which includes about 600 clinics and serves about 52 percent of the state’s children in the state.

    Among the new requirements is the separation of public and private inventory with public stock including VFC and state purchased vaccines. Public stock includes VFC and state-funded Children's Health Insurance Program (CHIP) doses, while the state’s Billable Project provides immunizations to children with private insurance.

    “The purpose of this requirement is to assure VFC vaccine is not administered to non-VFC eligible children,” wrote Melinda Wharton, CDC’s deputy director, in a Sept. 5 memo. “This has been identified through various program integrity reviews as a critical risk. For this reason, we must require that VFC vaccine be stored separately in providers’ offices.”

    CDC has introduced the policy changes in response to an audit of the federal VFC program by the Office of Inspector General, which found unacceptable accounting and vaccine storage and handling practices in several states around the country.

    Oregon was not among those states cited in the audit and has already found a way to work around a portion of the CDC’s policy changes for the Advance Credit Model, which took effect Oct. 1.

    Last week, the Oregon Health Authority (OHA) announced it would pay up to $7.5 million in advance for the cost of vaccines for both CHIP and Billable programs. Those costs have been in arrears quarterly by the state under the old model after the CDC had provided the vaccines in advance.

    But other parts of the new regulations could prove more onerous and lead to private clinics dropping out of the VFC program, said Mimi Luther, VFC manager with the Oregon Health Authority’s Public Health Division.

    “The risk is that we will have kids who don’t have access to vaccines,” she said.

    Oregon’s VFC program, which started as part of a federal program in 1995, relies upon a system of provider accountability for waste and a vaccine tracking method that is one of the most established in the country, Luther said.

    The new policies, which have been in flux since they were announced in August, would change how providers store and replenish vaccines and ultimately lead to lower vaccination rates and greater vulnerability in an outbreak, Luther said.

    Under the current regulations, when providers run out of doses marked for VFC kids, they can borrow from their supply of Billable doses and replenish the supply through reordering. Roughly 43 percent of providers borrow vaccines that are intended for different eligibility groups or from other providers, she said.

    That practice would no longer be allowed under the new regulations.

    One exception to this rule would occur in times of outbreak, but would require providers to get written permission from the state’s Public Health Officer, who would need written permission from the CDC, Luther said.

    “That is just absurd,” she said. “Can you imagine being a pediatrician during an outbreak and saying, ‘sorry, I can’t immunize your kid today? It is crazy.”

    Storage guidelines also would change, potentially costing up to thousands of dollars for larger clinics.

    Another new requirement is that providers organize and stock their vaccines in separate refrigeration bins for different eligibility classes, including VFC, CHIP, Billables, and Section 317 clients, according to OHA. Many providers would need to purchase new refrigerators and increase their staffing and electricity costs to meet those requirements.

    Additionally, the new regulations would dismantle the state’s successful buying program, which requires providers to pay for any doses that are wasted or expired.

    “Oregon always has required providers to pay for waste because we think it’s a good stewardship of public dollars,” Luther said.

    The system has proven successful with only a 2 percent rate of waste, she said.

    But under new CDC regulations, providers would be required to buy replacement doses on the private market.

    The costs would increase dramatically in most cases.

    Using the state’s bulk buying power, the cost of a single dose of measles, mumps and rubella (MMR) vaccine would cost $19.75 through the state and $56.14 through the private market.

    “The state has huge purchasing power and contracts in place,” she said. “What I pay for a vaccine is much less than anybody would pay for on the private market.”

    Exemplifying this point, Luther priced Hepatitis A vaccine at $15.25 for a single dose from the state and $30.40 on the private market. Polio vaccine would cost $12.42 and $27.44, respectively.

    That is ordering a single dose. Most private insurers sell vaccines in packs of 10, so while an HPV vaccine would cost $107.16 from the state, a provider would end up paying about $1,350 from private insurers for a 10-pack, according to Luther.

    “I am hopeful that Oregon is going to find a way to not require the separate inventories,” Luther said. “I am sure in my heart that if we fail at that we are going to lose many providers.”

    The new policy guidelines could have the most impact on rural clinicians, who would need to follow a new set of storage and handling guidelines that would increase costs and potentially leave some clinics short of vaccines at critical times.

    “They’re trying to fix something that isn’t broken in our state,” said Michael Sheets, a family nurse practitioner and owner of The Merrill Clinic and The Bonanza Clinic in rural Southern Oregon. “Potentially what could happen is that some of the centers may opt not to do immunizations instead of meeting these requirements.”

    The value of the VFC program in rural areas cannot be overstated, said Sheets, who drives 23 miles between his two private clinics and spends a half-day at each.

    The private clinics fill in a 96-mile stretch between the Public Health Department in Klamath Falls and the next closest public facility in Lakeview.

    “Basically, we’re not making any money on this,” Sheets said. “Providers are trying to help the kids because otherwise the working poor couldn’t afford to get their shots.”

    At his two clinics, Sheets administers a variety of shots for kids in the VFC and CHIP programs, including influenza, chicken pox, diphtheria and polio.

    Since the program began in the mid-1990s, ear, sinus and respiratory infections have dropped dramatically because of the shots, he said.

    “The kids that have these shots, don’t end up having those problems,” he said. “The value cannot be overstated in terms of reduced illness. It is a marriage of the public and private sector that works. We should have more of that, not less.”

    Vaccines are currently stored and marked according to eligibility classes in a single refrigerator unit close to exam rooms, Sheets said. Under the proposed CDC rules, providers could end up needing additional storage space and temperature monitoring equipment to meet the CDC regulations, he said.

    Additional refrigeration unit in each of his clinics would cost $400 to $500. The units would need to be moved further away from the patients due to lack of space, he said.

    Clinicians could opt out of the system altogether, forcing rural families to travel further distances to get to the closest clinic, Sheets said. Or patients could potentially be turned away, he said.

    “The new regulations are not in the best interests of anyone,” he said. “Somebody who is sitting in Atlanta or D.C. has written the regulations and doesn’t know how clinics work.”


    The next steps for Oregon’s medical community include asking CDC for an exemption to the new requirements or a delay in their implementation until December, 2014, OHA’s Luther said.

    The state would like the opportunity to problem solve the new regulations with the CDC, she said.

    Otherwise, the changes would shift the burden onto already cash-strapped county health departments, said Karen Vian, immunization program manager for Douglas County Public Health.

    Vian is one of many members of the health community who have shared their story with the state, and her experiences could help shape national policy, Luther said.

    “These policy changes don’t work for the private sector and they don’t work for the public sector,” Vian said. “Public health departments are going to be unable to meet these policy changes.”



    _______________________________________

The Affordable Care Act seeks savings for Medicare and Medicaid by requiring the use of generic drugs.  Yet, as we see below, the US is pushing policies that make it harder to create generics and limit generic sales.  So, how do you think that will ultimately effect seniors and the poor in the US?

That's right.  People already have cases where the generic form of a drug is not as effective so if TPP passes this will grow in frequency.



  • The TPP’s Threats to Public Health

  • The Trans-Pacific Partnership (TPP) is an international trade and investment pact currently under negotiation between the United States, Australia, Brunei Darussalam, Canada, Chile, Malaysia, Mexico, New Zealand, Peru, Singapore and Vietnam. It is also specifically intended as a “docking agreement”that other countries would join over time, with Japan, Korea, China and others already expressing some interest. U.S. negotiators are pushing to complete the TPP as soon as possible.NEGOTIATIONS ARE HEADED IN THE WRONG DIRECTION ON PUBLIC HEALTH  A roll back from the Bush administration.Leaked U.S. proposals for several chapters in the Trans-Pacific Partnership reveal that U.S. trade negotiators have reversed hard-won reforms designed to enhance access to affordable medicines that were made during the George W. Bush administration. In addition to pushing for increased monopoly rights for drug companies, the U.S. is also demanding new rights for pharmaceutical firms to challenge pricing and other drug formulary policies used by many countries to keep down health care costs.PACT WOULD REDUCE ACCESS TO GENERIC MEDICATION BY EXTENDING DRUG PATENTS
    Access to generic medicine is critical to saving lives. The first generation of HIV drugs has come down in price from roughly $10,000 per patient per year to just $120 thanks to increased access to generic medications. This reduction in price has helped to dramatically scale up the number of people throughout the world who are now receiving treatment. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Emergency Plan for AIDS Relief, UNITAID and UNICEF all rely heavily on access to quality generic medications. For millions of people throughout the globe, delaying access to generic medications means delaying access to treatment. The U.S. proposal would grant new monopoly patent rights, reducing access to generic medicine. If finalized and implemented, the leaked U.S. intellectual property proposal would roll back access to generic medicine for people in developing countries and throughout the world. Specifically, the U.S. proposal would broaden the scope of patentability by making it easier for pharmaceutical companies to patent new uses and minor variations of old medicines; slow the production of new generics when patents expire by expanding “data exclusivity” over clinical trials forcing either the timely and costly replication of such trials or an additional three-year delay (beyond the current five) before such “exclusivity” ends;constrict safeguards against patent abuse by makingit harder for public health advocates to challenge unjustified new patents; require new forms of drug patent policing;and mandate that countries allow patents on plants, animals Trade Policy & Access to Medicine!

  • _____________________________________


    What neo-liberals intend to do as they privatize public health goes beyond actual access to health care.  The public sector is the last labor unions holding on to middle-class income and as we already see with handing health policy-writing to states developing private health systems as in Maryland------it is staff and labor costs cut under the guise of making health care cost effective.  Women are the ones being hit by this attack on the public sector with public private partnerships and the ending of public health.

    DO YOU HEAR NEO-LIBERALS SHOUTING THEY ARE THE PROTECTORS OF WOMEN, CHILDREN, AND THE MIDDLE-CLASS?  DO YOU SEE THE STATE OF MARYLAND ADOPTING ALL THAT IS PRIVATIZATION OF PUBLIC SERVICES, PROGRAMS, AND ASSETS?

    MARYLAND ADOPTED A STATE PRIVATE HEALTH SYSTEM BECAUSE IT IS RUN BY NEO-LIBERAL POLITICIANS WORKING FOR JOHNS HOPKINS AND THE HEALTH INDUSTRY!


  • Roosevelt House Faculty Forum
    Triple Jeopardy: Dismantling of the Public Sector and the War on Women

    Mimi Abramovitz Bertha Capen Reynolds Professor of Social Policy at the Silberman School of Social Work at Hunter College, and a Roosevelt House Faculty Associate; Faculty of the CUNY Graduate Center and the Murphy Institute for Worker Education and Labor Studies. Posted on January 13, 2014

    The current effort to dismantle the public sector is the latest round in the rancorous debate about the role of so-called “big government” that has shaped public policy since the mid-1970s. There has been much buzz in recent news surrounding the widening inequality gap, the long-term effectiveness of President Johnson’s Great Society programs in combating poverty, and President Obama’s call to increase the federal minimum wage.  While these issues are extremely important, it has been surprising to see the lack of a gender lens in these dialogues, a perspective that is absolutely critical in evaluating potential policy changes.

    Since the onset of the economic crisis in the mid-1970s, U.S. leaders have pursued a neoliberal agenda designed to downsize the government, and redistribute income upwards. Its familiar tactics include tax cuts, retrenchment, privatization, and deregulation, among others.  To win public support for these unpopular ideas, neoliberal advocates have resorted to what Naomi Klein called the “shock doctrine”: the creation and manipulation of a crisis to impose policies that the public would not otherwise stand for. Discounting evidence and evoking the shock doctrine, government foes targeted programs for the poor but also popular entitlement programs—once regarded as the “third rail” of politics. Unlikely to pass Congress intact their proposals which fall heavily on women –will set the agenda for months to come.

    The current effort to dismantle the public sector is the latest round in the rancorous debate about the role of so-called “big government” that has shaped public policy since the mid-1970s. Initially targeted at program users, the attack subsequently took aim at public sector employees and union members. Since most scholars and activists focus on one group or another, they miss the strategy’s wider impact. Lacking the gender lens needed to bring women into view, they also miss that women comprise the majority in each group. Until the 2012 presidential campaign turned the women’s vote into a hot political issue, few officials paid much attention to women’s issues or did much to end the decades-long “war on women”

    Given that women make up the majority of government service users, employees and union members, the cuts constitute a “war on women.”
    Many of the programs now on the chopping block address the basic needs of women and their families over the life span. Current House budgets proposed to to cut child care, Head Start, job training, Pell Grants, housing, and more by $1.2 trillion over the next 10 years.

    Less spending by Washington translates into reduced federal aid to states and cities. To balance their budgets, states spent $75 billion less in 2012 than in 2011, and 31 states projected a $55 billion shortfall in state budgets for the 2012 fiscal year.  In total, states governments have had to close more than $540 billion in shortfalls over the past four years due to cutbacks on the federal level.  In addition, the right has taken aim on women’s reproductive health services, demanding ever more drastic cutbacks.  In 2012, The Guttmacher Institute reported that legislators in 46 states introduced 944 provisions to limit women’s reproductive health and rights including massive cuts to Planned Parenthood.

    Fewer services also mean more unpaid care work. Employed or not, women are the majority of the nation’s sixty-seven million informal caregivers; they pick up the slack when services disappear. From 1935 to 1970, the services provided by an expanding public sector helped women balance work and family life. Since the mid-1970s, neoliberal budget cuts shifted the costs and responsibility of care work back to women in the home. So does the growing practice of moving the elderly and the disabled from publicly-funded residential centers to home-based care, and discharging hospital patients still in need of medical monitoring and nursing services.

    The anti-government strategy also decreased women’s access to the public sector jobs. After World War II, as social movements pressed for an expanded welfare state, these jobs became an important source of upward mobility for white women and people of color excluded from gainful private sector employment. In January 2012, women comprised 57 percent of all government workers.  According to the latest available data, women comprise 43 percent of federal, 51.7 percent of state and 61.4 percent of local government employees. Women filled these jobs because society assigned care work to women, their families needed two earners to make ends meet, and social welfare programs benefited from cheap female labor. The public sector also became the single most important employer for blacks, who are 30% more likely than other workers to hold public sector jobs. More than 14% of all public sector workers are black. In most other sectors, they comprise only 10% of the workforce.

    The Great Recession and the slow recovery have decimated public sector employment. During the early stages of the recession, men suffered more than 70% of total job loss because “male” jobs (construction, manufacturing, etc.) are particularly sensitive to cyclical downturns. The current “recovery,” by contrast, has been tougher on women, who comprised over half of the public workforce. From June 2009 to May 2012 as the public sector lost 2.6% of its jobs women suffered 61% of the job losses (348,000 out of 573,000). They gained only 22.5% of 2.5 million net jobs added to the overall economy. In 2012, the poverty rate among women climbed to an astounding 14.5%.

    Total union membership plummeted from a peak of 35% of the civilian labor force in 1954 to just 11.3% in 2012 — the lowest percentage of union workers since the Great Depression. Private-sector unionization dropped to 6.6 %. Despite the loss of thousands of government jobs, public unions withstood the onslaught, maintaining an average membership rate of more than 35%. It helped that the majority of public sector work cannot be outsourced or automated.

    Seeking to weaken the remaining unions, foes of labor and government turned against the public sector –labor’s last stronghold. Some governors demonized government workers as the new privileged elite to convince the public that collective bargaining rather than tax cuts is the enemy of balanced budgets. When governors strip teachers and nurses of their collective bargaining rights but spare police and firefighters, they hit women especially hard: 61% of unionized women but only 38% of unionized men work in the public sector. The loss of union protection sets women back economically. Unionized women of all races in both public and private jobs earn nearly one-third more per week than non-union women, although white women earn more than women of color. Trade union women face a smaller gender wage gap and are more likely to have employer-provided health insurance and pension plans than their non-union sisters.

    Public sector unions historically pressed for high-quality services, dependable benefits, and fair procedures for themselves and for others. In the 1920s, the teacher’s union stood up for greater school funding and smaller class sizes. In the 1960s, unionized social workers fought for fair hearings and due process for welfare recipients. In the 1980s and 1990s, home care workers sought more sustained care for their clients. The loss of union power will cost public sector program users, workers, and union members a strong advocate. Unions remain one of the few institutions with the capacity to represent the middle and working classes and check corporate power inside and outside government.

    The attack on the public sector puts women in triple jeopardy.
    As the majority of public sector program users, workers, and union members, they face fewer services, fewer jobs, and less union protection. In state after state, thousands of government workers and community supporters have raised up against these cuts, unwilling to take the assault on their well being, dignity, and rights lying down. As the National Economic & Social Rights Initiative reminds us, the current agenda amounts to “attacks on public responsibility, the notion of the public good, and the ability of government to secure economic and social rights for all.”  These cuts pose as fundamental threats to the stability and health of both our country’s economy and our democracy.  We must stand together to demand stronger social policies that support women and their families.

    This OpEd was adapted from the longer article, “Feminization of Austerity,” New Labor Forum, Winter  21(1) 2012: 32-41.






0 Comments

February 12th, 2014

2/12/2014

0 Comments

 
Regarding Ruppersberger and Fort Meade policy:

Here we go down the rabbit hole with Alice in Wonderland as MR NSA HIMSELF.....MR. PRIVATIZE ALL MILITARY AND END PUBLIC MILITARY FACILITIES TO THE DETRIMENT OF ALL MILITARY PERSONNEL......cries foul over legislation designed to protect American civil liberties and end DEATH TO AMERICA chanting as the NSA and Wall Street enrage the world with its illegal activities that undermine sovereignty including the US.  Nothing makes the US more prone to attack from enemies than the actions of Wall Street and their NSA!

Here we are with republicans being the protector of US Constitutional rights and public justice. Meanwhile, it is MD neo-liberals making the Ft Meade NSA central. Remember, it was George Bush and neo-liberals who started this and are the face of the hedge funds running it. So, this is a neo-con/neo-liberal problem.

DO NOT ALLOW REPUBLICANS SHOUT THAT DEMOCRATS ARE THE PROBLEM.....NEO-LIBERALS ARE NOT DEMOCRATS!



BREAKING: Maryland Legislators Move To Kill NSA Headquarters
benswann.com
ANNAPOLIS, Md., February 10, 2014-- It's lights our for the National Security Agency (NSA). State lawmakers in Maryland have filed...


____________________________________

As Dutch Ruppersberger knows the US lost trillions of dollars over just a few decades to defense industry fraud, billions each year.  Much of it is used to bribe, used to promote fraudulent development abroad, to buy alliances that later fall apart and amount to nothing.  Profiteering in the defense industry is rampant and it is public malfeasance and duplicity when politicians charged with serving the public allow all of this to happen without public justice.  What Ruppersberger supports is an NSA run by Wall Street and not a system designed to oversee Wall Street and stop the fleecing of American taxpayers with defense industry fraud.

Dutch doesn't want to stop there.....he wants to privatize all that is public support of Veterans at bases like Fort Meade and reduce the Veteran's Administration to private corporate non-profits with no oversight and known not to be doing the business of aiding Vets.  

NOTICE ALL THE CHARITY ORGANIZATIONS CREATED TO BEG FOR MONEY FOR VETERANS?  THAT IS WHAT RUPPERSBERGER HAS WORKED TO DO FOR VETERANS BY PRIVATIZING ALL PUBLIC SERVICES FOR VETS!  WHAT A GUY!!!!!!!

But wait, Dutch is fighting against cuts to veterans benefits you say!!!  Recovering defense industry fraud would pay off much of the national debt and remove this fake deficit and debt!  DO YOU HEAR DUTCH SHOUTING FOR THIS??????  No, Dutch is busy passing laws that allow the US military to expand its mercenary military to non-citizens overseas because we have to protect US global corporate interests while these corporations are fleecing Americans and ignoring all Rule of Law.  HOW DOES RUPPERSBERGER KEEP GETTING RE-ELECTED YOU SAY!  

RUN AND VOTE FOR LABOR AND JUSTICE IN ALL PRIMARIES TO SHAKE THE NEO-LIBERAL BUGS FROM THE RUG!!!!!

 Do you know that Manning downloaded and gave to Wikileaks defense industry data on just these defense industry expenditures just so international investigative journalists could do the research that shows where all this defense industry fraud is and where it is going?  See why Manning was tried as aiding the enemy------WHO ARE OBVIOUSLY YOU AND I!




Encyclopedia of White-Collar & Corporate Crime


Lawrence M. Salinger, Ph.D.

Pub. date: 2005 | Online Pub. Date: September 15, 2007 | DOI:http://dx.doi.org/10.4135/9781412914260 | Print ISBN: 9780761930044 | Online ISBN: 9781412914260 | Publisher:SAGE Publications, Inc.

Defense Industry Fraud

John Walsh Ph.D.

THE DEFENSE INDUSTRY comprises the development, production and sale of weapons and weapons-support systems. In some cases, components or substances that are not themselves weapons may be classified as being part of the defense industry if it is believed that they may be used in the creation of weapons. The defense industry is characterized by oligopolistic conditions, in which a small number of large firms compete for a small number of orders from governments. Success in the industry relies upon, to a considerable extent, economies of scale from research and development departments, large-scale production facilities and good network contacts with relevant government officials, both domestically and internationally. Many overseas sales are characterized by corruption and bribery and Transparency International has listed defense, along with the public works and construction industry, as being the sectors in which bribery is most rife. The very high value of products also provides an incentive ...

________________________________________________
There's Bernie Sanders shouting loudly to use defense industry fraud to pay down the national debt.  The trillions recovered from a few decades of fraud would end all cuts to public services and programs tied to the military.  

As Bernie says......IT IS THE PRIVATIZATION OF PUBLIC MILITARY WORK THAT MAKES GOVERNMENT COFFERS FEEDING TROUGHS FOR CORPORATE FRAUD!  You won't hear Dutch shouting this!




Lawmakers push Defense fraud, waste report to influence supercommittee cuts

By John T. Bennett - 10/23/11 06:53 PM EDT  The Hill Blog

Liberal lawmakers will soon send the congressional deficit panel the details of a Pentagon report that shows defense firms over the last decade ripped off the military to the tune of $1.1 trillion, Democratic sources told The Hill.

Pro-military lawmakers from both parties have warned the supercommittee to avoid Pentagon spending cuts beyond the $350 billion ordered by the August debt deal.

But several Senate Democrats want the panel to keep in mind that dollars sent to the Pentagon are often lost to fraud and waste, even as some conservatives raise the possibility of retroactively exempting the Pentagon from the $600 billion cut that will be triggered if the supercommittee fails.


Sen. Bernie Sanders (I-Vt.) last week highlighted what he called a “shocking” internal Pentagon report that concluded defense companies defrauded the military by $1.1 trillion.

“The ugly truth is that virtually all of the major defense contractors in this country for years have been engaged in systemic fraudulent behavior, while receiving hundreds of billions of dollars of taxpayer money,” Sanders said in a statement. “With the country running a nearly $15 trillion national debt, my goal is to provide as much transparency as possible about what is happening with taxpayer money.”

More than $250 million “went to 54 contractors convicted of hard-core criminal fraud in the same period,” Sanders said, summarizing tables included with the DoD report. “Of that total, $33 million was paid to companies after they were convicted of crimes.”

The Pentagon revealed defense behemoth Lockheed Martin paid $10.5 million in 2008 to settle fraud charges related to the Titan IV rocket program. Northrop Grumman paid $62 million three years prior to settle allegations it was involved in a fraud scheme.

And the list of contractors linked to waste goes on, the DoD tables show, ranging from the other largest defense firms to smaller companies.

Yet most continued to receive massive contracts.

And that does not sit well with Sanders and several other liberal lawmakers, Democratic sources say.

Sanders “believes numbers like these are very relevant for the supercommittee when some are talking about cutting social programs,” an aide to the Vermont liberal told The Hill on Friday.

“The supercommittee also should see the extent to which these companies committed fraud on behalf of the government,” the Sanders aide said. “We will get this to the supercommittee, at least at the staff level.”

Another Democratic aide said his boss intends to highlight the DoD fraud report as the special panel ramps up its search for $1.5 trillion in federal cuts. It must finish its work by Nov. 23 or automatic triggers will be enacted, including $600 billion in cuts to security spending.

“As debate goes forward, I’m sure you’ll see a number of Democrats on the left use that report and others like it. There’s a movement on the right to go back and exempt defense spending from the trigger if the supercommittee fails,” the Democratic aide said Friday. “That’s going to be unacceptable to [liberals who are] likely to use reports like this as proof that there is room to cut Defense spending without harming security.”

The Aerospace Industries Association, a leading defense industrial lobbying organization, declined to comment on the report.

But one prominent defense analyst and industry consultant blasted the Pentagon’s findings.

“Sen. Sanders is correct in stating the report is shocking — it's shockingly wrong. The report confuses isolated cases of wrongdoing with the dominant culture in the defense industry, which is the most heavily regulated and audited industry in the nation,” said Loren Thompson of the Lexington Institute.

“Critics of Defense spending like Sen. Sanders routinely make sweeping allegations of malfeasance in military contracting while ignoring far worse behavior in major entitlement programs like Medicaid,” he said.

What’s more, the yearly waste within the military largely comes from “decisions by legislators and policymakers that disburse funds to unnecessary projects” and mandate “superfluous tests, reports and contracting procedures,” Thompson told The Hill. “That's where the real waste occurs in military contracting, but Sen. Sanders would prefer to focus on the handful of cases of malfeasance that more closely match his ideological leanings.”

But one government watchdog group called the findings “mind-boggling.”

“The amount of money given to these companies is staggering, but what is really mind-boggling is the willingness of the DoD to provide additional taxpayer dollars to the same bad actors again and again,” Scott Amey, general counsel for the Project on Government Oversight (POGO) said in a Friday statement.

“Despite the report’s findings, the DoD’s over-reliance on contractors may hinder reform,” Amey said. “Taxpayers are unlikely to see any changes until DoD holds contractors more accountable, especially those defrauding the government.”

______________________________________
George Bush sent trillions in profit to all of Cheney's Halliburton and hedge funds became Blackwater USA as our public troops were ghettoized with the super-sized wages these private military contractors paid private employees with the same US taxpayer money.  The intent was to move the best public troops over to private contractors as the public military structures were dismantled.  On came Obama and Hillary who as neo-liberals placed this process on steroids with the movement of troops and war to Afghanistan.  Now, government watchdogs say that over 70% of US military is private contractors and the fraud and corruption is rampant.  US private military behave so illegally that nations do not want them in their countries.  Human rights abuse is systemic.

What we are seeing in the build-up of the US police state is the coming home of these private military contractors and employees to become city and state police.  We in Baltimore know what this police state will look like.  Police here act with impunity here just as they do overseas.  SEE WHY PEOPLE AROUND THE WORLD ARE SHOUTING 'DEATH TO AMERICA"?

DO YOU HEAR MARYLAND POLS TALKING ABOUT THIS?????  THEY ARE NEO-LIBERALS WORKING FOR WEALTH AND PROFITS!



Christian Science Monitor
Opinion

A lesson from Iraq war: How to outsource war to private contractors

During the Iraq war, private defense contractors providing security and support outnumbered troops on the ground at points. Contractors can enhance US military capacity but also entail risks. US experience with private security contractors holds several key lessons.

By Molly Dunigan / March 19, 2013

A helicopter owned by Blackwater USA, a private security contractor, flies over central Baghdad, Iraq, Feb. 7, 2007. Op-ed contributor Molly Dunigan says 'the United States must protect its interests and ensure that the contractors it employs are carefully vetted and well trained. It should also continue to work toward a commonly accepted means of holding contractors accountable for their behavior.'

Ten years after it began, the Iraq war might best be remembered as America’s most privatized military engagement to date, with contractors hired by the Pentagon actually outnumbering troops on the ground at various points.

This might come as a surprise to many, since the sheer number of contractors used in Iraq was often overshadowed by events. By 2008, the US Department of Defense employed 155,826 private contractors in Iraq – and 152,275 troops. This degree of privatization is unprecedented in modern warfare.

One of the most important lessons of the Iraq war is that this military privatization is likely to continue in future conflicts. This could be a good thing, as contractors can enhance US military capacity. But any large-scale use of private military contractors also entails risks. Recent US experience with private security contractors, in particular, holds several critical lessons for the future.

OPINION: After US withdrawal from Iraq, a tallying of the balance sheet

Of course, private contractors are not new to war zones. They supported all the major US conflicts of the late 20th century, including in Vietnam, the Balkans, and Operation Desert Storm in Iraq. But in these cases, they mainly provided logistical and base support.

Now, the US military has developed a growing dependence on private contractors – and for a wide range of functions traditionally handled by military personnel. The Army spent roughly $815 million ($163 million per year, or about $200 million per year in 2012 dollars) to employ contractors under its Logistics Civil Augmentation Program between 1992 and 1997. But between 2001 and 2010, that expenditure grew to nearly $5 billion per year. Of course, this latter cost coincides with US involvement in Afghanistan as well as Iraq.

A more pertinent question – and what truly sets the Iraq war apart – concerns the role of these private civilian contractors. Throughout the war, the majority (61 percent) of contracted jobs continued to be base-support functions. The next-largest group (18 percent) of Department of Defense contractors were security contractors. They provided security services, such as guarding installations, protecting convoys, or acting as bodyguards.

Moreover, this outsourcing trend continued in Afghanistan, where there were 94,413 contractors in 2010, compared with 91,600 US troops.

Military outsourcing in this vein developed as a result of an increased supply of private military services combined with increased demand. The boom in supply was borne out of larger privatization trends in both the US and Britain in the 1980s and 1990s, which spread over into the military arena. The increased demand was due to the strains that the wars in Iraq and Afghanistan placed on the US military.

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As I wrote before....Maryland was sighted as having the worse VA services with a failing grade for the Baltimore VA center because all of it has been privatized to private non-profits taking the taxpayer money under the guise of running programs that VETs will tell you are not happening.  Indeed, talk was to get rid of the VA building itself.  THAT'S DUTCH FOR YOU.....WORKING FOR DEFENSE INDUSTRY AND CORPORATE PROFITS AT THE EXPENSE OF THE CITIZENS WHO VOTE FOR HIM!!!

SHAKE THE NEO-LIBERAL BUGS FROM THE RUG BY RUNNING AND VOTING FOR LABOR AND JUSTICE IN ALL PRIMARIES!



    
Friday, January 28th, 2011 | Posted by Dale R. Suiter


VA / Privatization = Loss for Vets

Don't give up on these guys!
New folks in the House of Representatives say they are looking to “cut spending” and reduce the size of government. There is a movement to repeal the Affordable Care Act.

There is mention to of privatizing some government health care services. What’s all this mean for Vets?

If you love what Halliburton did for the trrops, yuo’ll love what privatization will do for veterans.

October 15, 2010 (rushlimbaugh.com) then candidate Sharron Angle was critical of Senator Reid. Senator Reid reportedly said: “She (Ms. Angle) wants to privatize the Veterans Administration.” Mr. Linbaugh continues: “What’s wrong with privatizing the VA…? Somebody tell me where its working. Somebody tell me where anything the federal government is running is working… Privatize the Veterans Administration.!”

Including the military:
1. 10th mountain Division – great outfit
2. 1 Bn 119th FA MIARNG – excellent – well trained cannoneers
3. United States Marine Corp (especially 3/9 and 1/3)*
4. United States Air Force
5. United States Army
6. United States Coast Guard
7. Centers for Disease Control and Prevention
8. Departments of Motor Vehicles in 50 states and all the territories
9. Local, state and federal judicial systems – that due process item we kinda like and wanna keep
10. Open meeting acts around the country

Privatization come with a heavy price tag. Many traditional military mainenance and support roles have been privatized. Many line grunts report few hot meals “… at the front …” (O.K. no hot food up front is as old as warfare). Military units are challgenged to repair and maintain vehicles, equipment, aircraft and weapons systems. (In one case – an Army 88M’s Dad – sent his son a needed tool kit so he and his truck partner could repair the trucks they were assigned to. Also as old as the history of warfare. Key point is the troops could not get the support they needed in theater.)

FACT SHEET
GAO Issues Report on Hlliburton Troops Support Contract In Iraq (Minority Staff Committe On Government Reform U.S. House of Representatives Juy 21, 2004)

This GAO report documented serious shortfalls with the government contract with Halliburton. Problems included:
* Planning for troops delayed until “Afther the Fall of Baghadad.”
* Planning for Support Services “Ineffective”
* Halliburton’s uncontrolled costs (Halliburton costs grew from $5.8 billion to $8.6 billion between September 2003 and January 2004.)

The report “higlights a pattern of contractor management problems. Including:
* Inadequate cost control
* Difficulties meeting schedules – Halliburton did not provide some services required, including “water production”
* Inadequate control over purchases
* Inadequate control over subcontractors

The report notes too inadequate control and oversight of Halliburton as follows: “… essentially military officials do not understand their role … regarding their roles and responsibilities.”

Dana Hedgpath, Washington Post (3011098) wrote: “KBR Faulted on Water Provided to Soldiers”. The article includes: “U.S. Soldiers at a military base in Iraq … provided with … untested water for … two years by KBR … and may have suffered health problems … KBR inappropriately distributed chlorinated wastewater to 5,000 U.S. troops at Camp Q-West … north of Baghdad… KBR disagreed with the report.”

Many Vets depend on the VA. Privatizing it will turn Vets worlds upside down. One thing our government can not do well is track massive contracts with private industry and contractors. There many examples of troops running into wall after wall after wall trying to get day to day military tasks completed – and being frustrated with civilians who do not respond to the military. The so called reduction of the military dating from the 1990′s is a myth. The funds and tasks have been redirected into private industry – at a loss to the military and increased danger to our troops. Privatization of the VA would be another disaster.

Regards

Dale R. Suiter

* Corp as in Marine Corp – the Corp is pronounced – core – folks. Often mispronounced by those who have not had the honor of Marine Corp service.

Note: Author does not support or approve of the Affordable Care Act. It is (my opinion) of something the government can not do well. Read the act and determine for yourself the many implications for the VA.
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This is what neo-liberals have reduced all public services to....charity.  Rather than have Medicare and Medicaid or VET health programs.....we will see if corporations and other will donate to charities for even more tax write-offs rather than simply pay taxes!

DUTCH------I DO NOT HEAR YOU SHOUTING AGAINST ALL OF THIS....BUT YOU LOVE YOUR NSA COMPLEX DON'T YOU?????



Veterans Charities Ratings


The American Institute of Philanthropy recently released a report rating various veterans charities on how well they support the causes they were created to support.

We were surprised at some of the ratings in this report; not at others. Before you donate your hard-earned dollars to any charitable organization, check it out to see how much of its revenues actually go to support its charitable purpose, and how much goes to administrative expenses, salaries, and fundraising. You may be surprised!

Letter grades were based largely on the charities' fundraising costs and the percentage of money raised that was spent on its charitable activities.

The charities that received failing grades are in red type.

The charities that received grades of A or better are in bold blue type.

Here are the December 2007 veterans charities ratings, by the AIP:


Veterans Charities Ratings

Air Force Aid Society (A+)

American Ex-Prisoners of War Service Foundation (F)

American Veterans Coalition (F)

American Veterans Relief Foundation (F)

AMVETS National Service Foundation (F)

Armed Services YMCA of the USA (A-)

Army Emergency Relief (A+)

Blinded Veterans Association (D)

Coalition to Support America's Heroes (F)

Disabled American Veterans (D)

Disabled Veterans Association (F)
Notice the similarity of the name to Disabled American Veterans

Fisher House Foundation (A+)

Freedom Alliance (F)

Help Hospitalized Veterans/Coalition to Salute America's Heroes (F)

Intrepid Fallen Heroes Fund (A+)

Military Order of the Purple Heart Service Foundation (F)

National Military Family Association (A)

National Veterans Services Fund (F)

National Vietnam Veterans Committee (D)

Navy-Marine Corps Relief Society (A+)

NCOA National Defense Foundation (F)

Paralyzed Veterans of America (F)

Soldiers' Angels (D)

United Spinal Association's Wounded Warrior Project (D)*
     * See update on Wounded Warrior Project

USO (United Service Organization) (C+)

Veterans of Foreign Wars and Foundation (C-)

Veterans of the Vietnam War & the Veterans Coalition (D)

Vietnam Veterans Memorial Fund (D)

VietNow National Headquarters (F)

World War II Veterans Committee (D)


Read the complete AIP veterans charity watchdog report and veterans charities ratings.

Do you have questions about specific veterans charities?

First, check the list of veterans charities reviewed by Military-Money-Matters.com. If the charity you're interested in is not listed there, then check the references listed below the stars & stripes bar to look up information.

If you can't find the answer to your question in any of those sources, ask your questions about specific veterans charities. For ease of answering your questions, please make a separate submission for each different charity you wish to inquire about, and make the title of your submission the name of the charity. Thanks.

0 Comments

February 07th, 2014

2/7/2014

0 Comments

 
Regarding Maryland's ending of public health and Health Enterprise Zones:

MARYLAND CITIZENS ARE SHOUTING FOR EXPANDED AND IMPROVED MEDICARE FOR ALL IN A STATE DISMANTLING PUBLIC HEALTH AND MEDICARE SYSTEM.

If you read my blog on Maryland Education Reform where when people shout out against Common Core the answer is to change the name.......same goes for health care reform.

WE ARE PLOWING AHEAD WITH THESE RACE TO THE TOP AND AFFORDABLE CARE ACT REFORMS EVEN AS THE NATION AND CITIZENS OF MARYLAND DECRY BOTH!

The reason is of course Maryland is ground zero for TPP and the 21st Century 'New' Economy....you know, global tribunal rule.

Let's look at the these Health Enterprise Zones and what purpose they serve in the scheme of ending Medicare and Medicaid as Federal programs and pushing everyone into this tiered system that has very few able to afford even the most basic of medical procedures. THE SUBSIDY THE SUBSIDY cry neo-liberals.....OH THAT IS COMFORTING. Remember, the problems with health care costs is massive health industry fraud and profiteering, not how much people access health care. Almost a trillion dollars was cut from Medicare over 10 years because the Medicare Trust has been raided of $3 trillion in payroll taxes to pay for the NSA surveillance system.

As I said, I attended the Brookings Institute health care reform forum where I watched doctors being told by the 1% reformers that ACOs would be implemented within a few years with the doctors decrying it can't be done and the damage to the health system will be huge. Brookings is of course the neo-liberal think tank devoted to ending public health and maximizing the health industry profit while growing the industry globally. That right there screams.....RUNNNNNNNNN. Unfortunately for Maryland citizens all of the Maryland Assembly and Baltimore City Hall and O'Malley and Rawlings-Blake work for global corporations like Johns Hopkins which is the face of these policies.

So, Health Enterprise Zones are designated as such because once again Federal and state tax money will be used to build the infrastructure for what will be ACO's.....if you are a senior seeking health care in Maryland you are already seeing your primary care doctors tied to profit-driven hospitals failing to answer your calls if your conditions prove to be costly. What happens when doctors do not take Medicare patients? THEY ARE PUSHED TO THESE ACOs where quality of care will be determined by how much you can pay.


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An accountable care organization (ACO)
is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers forms an ACO, which then provides care to a group of patients. The ACO may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it."[1]

THE TPP REQUIRES THAT PUBLIC SUBSIDY BE CURTAILED AND PHARMA IS THE BIG WINNER AS GENERICS HAVE A HARDER TIME AND INSTEAD OF USING MEDICARE TO NEGOTIATE LOWER PRICES WE ARE SEEING THE EXISTING STRUCTURES TO LOWER COST TAKEN AWAY.......TO MAXIMIZE PROFIT WITH THE LOSS OF ACCESS TO PATIENTS. Think what an ACO working to lower costs and keep profits will do with medicines that are expensive.....and costs will soar with global health systems.


Obama Administration Proposes Removing 'Protected' Status for Some Medicare Drugs

January 10, 2014

In a move that some fear could compromise care for Medicare recipients, the Obama administration is proposing to remove special protections that guarantee seniors access to a wide selection of three types of drugs.

The three classes of drugs — widely used antidepressants, antipsychotics and drugs that suppress the immune system to prevent the rejection of a transplanted organ — have enjoyed special "protected" status since the launch of the Medicare prescription benefit in 2006.

That has meant that the private insurance plans that deliver prescription benefits to seniors and disabled beneficiaries must cover "all or substantially all" medications in the class, allowing the broadest possible access. The plans can charge more for costlier drugs, but they can't just close their lists of approved drugs, or formularies, to protected medications.


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Keep in mind that other countries that have universal care do it by making sure there is not massive fraud and profiteering and by having corporations and the wealthy pay a fair amount of taxes. Obama and neo-liberals allowed the Bush Tax cuts to stay as is (the mico-increase on the top earners will be ignored and not paid) and took corporate taxes down to 17% for most and nothing for others.

IF YOU ADD THE RAIDING OF THESE TRUSTS BY FRAUD TO THE LOSS OF TAXATION AT THE TOP.....YOU GET PEOPLE WHO WILL DIE FROM LACK OF ORDINARY CARE.

Preventative care is really NOTHING. It is blood tests to monitor levels, wellness spas that make you exercise and clinic care that will set a bone.


In Baltimore where a majority of people are on Medicaid or earn too little to qualify for Medicaid....you see how they will not receive any of what is advertised as positives for low-income.  IT WAS DELIBERATELY MEANT TO DECEIVE THE POOR WHO NOW WILL HAVE FAR LESS ACCESS TO CARE.

ALL OF MARYLAND'S POLS KNEW THIS AND VOTED FOR IT BECAUSE THEY ARE NEO-LIBERALS!


Medicaid Programs Vary in Coverage of Preventive Care, Report Says

Released: 7/3/2013 9:00 AM EDT
Embargo expired: 7/8/2013 4:00 PM EDT


Source Newsroom: George Washington University more news from this source Contact Information Available for logged-in reporters only

Citations Health Affairs Newswise — WASHINGTON, DC--Existing Medicaid beneficiaries have largely been left out of the health reform movement when it comes to preventive services that can ward off cancer, heart disease and other potentially deadly diseases, according to a new study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The study, which appears in the July issue of Health Affairs, notes that under the Affordable Care Act most private insurance plans, Medicare and Medicaid expansion programs are required by law to cover a full range of crucial preventive services such as screening tests for colorectal cancer, high blood cholesterol, HIV infection, and diet counseling that can prevent obesity. But state Medicaid plans are not required to cover such care for adults already enrolled in Medicaid—and this report suggests that those adults will not have access to the full range of preventive services.

“Preventive services save lives by detecting diseases before they can progress,” says lead author Sara Wilensky, PhD, JD, special services faculty for undergraduate education in the Department of Health Policy at SPHHS. “Why should some Medicaid beneficiaries be left out when it comes to coverage for this kind of care?” Screening mammograms, colonoscopies, cholesterol screenings and other preventive services are aimed at staving off health problems early on rather than trying to provide costly health care for established and hard-to-treat disorders, she said.

Wilensky and her co-author Elizabeth Gray, JD, a research associate at SPHHS, reviewed Medicaid policies in all 50 states and the District of Columbia from June 2012 through November 2012. The initial review looked at all publically available information on coverage of preventive services. After that first review, the researchers then contacted state Medicaid officials to fill in any missing information about coverage for this population.

The researchers found that most states do not cover all of the preventive services recommended by the U.S. Preventive Services Task Force, an independent panel that looks at preventive care and offers guidelines for health plans and providers. In addition, it was often difficult to discern exactly which services were covered by Medicaid programs based on the vague language used by many programs. The report highlighted some serious gaps in coverage. For example, while most states provided coverage for screening mammograms, not all Medicaid programs offered such care to existing beneficiaries. In fact, three states don’t cover preventive mammograms for this population at all—a shortfall that could mean low-income women will go without the test, the authors said.

The analysis also says that states appear to rarely cover other types of preventive care for breast cancer for those at high risk. Only 11 state Medicaid programs, for example, make it clear that they will pay for breast cancer susceptibility testing for the BRCA1 gene that increases the risk of breast and ovarian cancer. And just three states explicitly cover chemoprevention for such beneficiaries. This medication can be used to lower the risk of breast cancer, a disease that kills about 40,000 American women every year.

"The Affordable Care Act guarantees millions of low-income Americans access to mammograms, colonoscopies and other lifesaving preventive services, but that assurance does not extend to people who currently have Medicaid coverage," said Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society and one funder of the study. "States have a responsibility to ensure that all people in Medicaid have access to preventive care for a life-threatening disease such as cancer."

The authors of the study also say there is wide variation in coverage of tests for sexually transmitted diseases (STD) and the test for the HIV virus that causes AIDS. And in some states STD screening is limited to family planning visits, a restriction that means people visiting the doctor for some other reason or those who are not eligible for family planning services may not have coverage. Going without this screen, increases the risk that an infected person will not receive treatment and could unknowingly spread a disease to others, Wilensky said.

Many of the preventive services evaluated by the study, such as screenings for early signs of heart disease, depression or diabetes, were either not covered or it was unclear if they would be paid for by Medicaid. In some cases, state Medicaid officers said that the preventive services would be paid for only if deemed “medically necessary.” But Wilensky says that these terms should not be used together because medically necessary tests are for instances when a provider has a reason to suspect an established health problem, while preventive tests are crucial in detecting an emerging problem in an otherwise healthy, asymptomatic person.

Such confusion could leave providers wondering if preventive services will be covered by Medicaid, says the report. In the end, providers may simply fail to provide care if they are uncertain about Medicaid coverage and/or payment for their services, the authors said.

“By lowering risk factors such as high blood pressure and cholesterol, Americans can reduce their risk of heart disease or stroke by as much as 80 percent,” said Nancy Brown, CEO of the American Heart Association, which also helped fund the study. “Evidence-based screenings play an essential role in identifying and reducing these factors. Without Medicaid coverage of preventative screenings and services, we could fall behind in the battle against the nation’s No. 1 and No. 4 killers.”

The authors conclude that there are many opportunities to increase the coverage of preventive services for this population. For example, managed care plans could choose to cover services that end up saving lives even if not required by state Medicaid programs. In states that do not clearly spell out covered preventive services or require providers to follow a specific standard of care, providers could choose to follow the guidelines of the U.S. Preventive Services Task Force. Alternatively, Congress could step in and give existing Medicaid beneficiaries the same coverage of preventive services as most other Americans enjoy under health reform, the authors point out.

The Health Affairs study, “Existing Medicaid Beneficiaries Left Off the Affordable Care Act’s Prevention Bandwagon,” was funded by the American Cancer Society, the American Cancer Society Cancer Action Network, the American Heart Association and the National Colorectal Cancer Roundtable.

The full report, “Coverage of Medicaid Preventive Services for Adults—A National Review,” includes state-specific data and additional information about this topic. To access the report click here.

About the George Washington University School of Public Health and Health Services:
Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education and is now the only school of public health in the nation’s capital. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health.


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The doctors on this Brookings panel were decrying these policies of health care reform because they are written by the same corporations having stolen all the health care spending in fraud and so, the goal will be profit for those at the top while doctors become employees told to cut costs in treating patients to maximize profit and REAL DOCTORS do not want to do this. It is true that doctors have gamed the system and are part of the fraud that emptied our health Trusts with fee-for-service. They are part of the problem. Is fee-for service the culprit being played by reformers?

THE PROBLEM WITH FEE-FOR-SERVICE WAS THAT MEDICARE HAD NO OVERSIGHT AND THIS IS A WELCOME SIGN FOR FRAUD....IT WAS LEFT WITHOUT PROTECTION ON PURPOSE.

If Medicare builds in white collar fraud protections then fraud and profiteering is caught and VOILA.....right away 1/2 of the losses to health care are gone and the US health care system looks more like the rest of the developed world. YES, THE US SPENDS THE MOST WITH THE LEAST RESULTS IN HEALTH STATUS BECAUSE OF ALL THE FRAUD. Also, if one wants to compare costs for procedures one goes to Medicare for decades of cost analysis for millions of people for each procedure. WE HAVE A READY DATABASE TO DEVISE COSTS PER PROCEDURE. What Affordable Care Act does is give all of this calculating to the health industry where they figure out how to keep profits when payments fall and the answer is ACOs that will provide care according to what you can pay now. Remember, all of the people aging into health care needs have already paid for full health care through payroll taxes and income taxes that funded all the research for medical procedures these health institutions now want to profit from. So, you do not need to pay premiums if you are a senior.....but when Maryland dismantles the public health system and Medicare as has happened over a decade......that is what happens to people aging into Medicare; they are treated by what they can pay.

When you have a consolidation of health institutions into one system.......you are now limited to where you can go. So, if Johns Hopkins partners with Humana Advantage....they are saying if you want to come to Hopkins you will leave the Federal Medicare and go to private Humana.

Humana sees only 202,000 insurance exchange enrollees

By Virgil Dickson
Posted: February 5, 2014 - 6:15 pm ET




Humana reports that it's only gotten 202,000 enrollees from the state and federal insurance exchanges as of Jan. 31. This accounts for less than 7% of the 3 million people who have acquired private insurance coverage under the Patient Protection and Affordable Care Act through the end of January....


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They are working to end Medicare as a Federal program. This is what each hospital chain is doing. It is partnering with a health insurance corporation, a PHARMA corporation, etc. You as the patient will not have a choice even as they pretend you do. If you cannot pay for private insurance you will not go to these hospitals where you used to go anywhere. When you see the news reports of CVS, the pharmacy stopping the sales of cigarettes losing billions in revenue....it is because CVS is partnering with a health system where profits will soar because of patients with critical and costly conditions will be unable to access care.



Walgreen approved for 3 Medicare accountable care organizations

Entities' goal is to improve quality, coordination of patient care while lowering costs

January 11, 2013|By Peter Frost, Chicago Tribune reporter

Drugstore chain Walgreen Co. took another step Thursday in its transformation into a front-line health care provider when three so-called accountable care organizations it created were approved by the federal government.

Physician groups in Texas, Florida and New Jersey agreed to team with Deerfield-based Walgreen, the nation's largest pharmacy chain, to coordinate health care for patients covered by Medicare, the federal health insurance program for the elderly.


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BUT OBAMA AND NEO-LIBERALS SAID THOSE UNABLE TO GET HEALTH INSURANCE BECAUSE OF PRE-EXISTING CONDITIONS WILL NOW BE ABLE TO GET HEALTH INSURANCE YOU SAY........having health insurance and accessing health care are two different things to a corporate wealth and profit pol like a neo-liberal. You will pay an insurance premium and have insurance that is basically a catastrophic health plan that will bankrupt you after one health emergency. Paying thousands in premiums and thousands in co-pays and deductibles will make it impossible to access most care.

Consolidating health institutions is like consolidating banks. Look how that turned out. When a health system contains all the health options in one place.....you have no choices and they have a monopoly. You have no protection and they have free market naked capitalism to send profits soaring. Hopkins has a global health tourism business catering to the world's richest paying lots of money.....you have these Health Enterprise ACOs make up of national health chains known for fraud, corruption, and patient abuse. Sending a loved one with special needs to a health space where care is regimented and standardized.....IS A FRIGHTENING EXPERIENCE.

SO, WHAT HAPPENS WHEN MEDICARE SENDS A SET AMOUNT TO AN ACO FOR CARE AND COSTS PRODUCE PROFITS? THAT HEALTH SYSTEM EXPANDS UNTIL IT IS GLOBAL. WHAT CREATES THESE PROFITS? HEALTH CARE STAFF ARE STIFFED OF PAY AND PATIENTS ARE STIFFED OF QUALITY.

In Baltimore, most of the staff working in these ACOs are immigrants and when I ask them what they are paid and the work conditions....you see how Wall Street intends to make the profit. Remember, if these ACOs are paid more for coding you healthier than you are.....YOU WILL BE CODED HEALTHIER THAN YOU ARE.



Medicare Shared Savings ACOs
Map: 2012 Medicare ACOs
November 20, 2012

The big question for Medicare ACOs is how they will distribute the savings. According to Robert Williams, national medical director at Deloitte Life Sciences-Healthcare Consulting, based in McLean, Va., "many organizations that are in this process still haven't defined how they're going to do the distribution of savings."

Read more: Medicare Shared Savings ACOs - FierceHealthcare

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THIS IS WHAT DOCTORS WITH A CONSCIENCE DO NOT LIKE ABOUT ACOs. THEY WILL BE REQUIRED TO END THE HIPPOCRATIC OATH.......AND JUST FOLLOW ORDERS. PEOPLE WILL DIE FROM SIMPLE LACK OF CARE SO FORGET PUBLIC JUSTICE AND SUING FOR MALPRACTICE....THE ENTIRE SYSTEM WILL BE DESIGNED TO FAIL MOST PEOPLE.

What these state health systems are meant to be is basically single-payer Medicaid for All. If you look at businesses ending health policies and pushing costs on the worker.....we all know most people will fall into the Medicaid level of care. Think of all the state and city public sector plans being thrown into this system and where those employees will fall. An ACO handling these Medicaid-level patients will be preventative care only and clinic procedures very basic. Anything else will not be addressed by these Maryland hospitals now tied to ACOs requiring private health plans.

All these Federal and state funds going to these Health Enterprise Zones are simply Balkanizing the very people who paid all of those payroll taxes for decades just so they could have quality care. The upper-middle class who will be able to pay for private plans at least for the near-term......are the ones having paid a very small percentage of these payroll taxes. YOUR MEDICARE IS BEING TAKEN TO SUBSIDIZE CORPORATE PROFIT AND EXPANSION OF THE SYSTEM.


Partners promises a new model for health care Tells US investors that expansion will cut costs, improve coverage

By Robert Weisman | Boston Globe Staff January 14, 2014

“It may be a little more interesting and a little more dynamic than elsewhere because the government has intervened for an extended period of time,” said Partners CEO Gary Gottlieb on the Massachusetts market.

SAN FRANCISCO — Facing challenges in their home state, top executives of Boston-based Partners HealthCare System told a national audience of investors Monday that they will create a bold “new medical model” by integrating hospitals and their medical services with insurance products and by drawing patients from across the country.

Speaking at the J.P. Morgan Healthcare Conference, Partners’ chief executive, Gary L. Gottlieb, said his organization, which owns Harvard-affiliated Massachusetts General and Brigham and Women’s hospitals in Boston, plans to improve medical care and lower costs by further expanding its network of community hospitals and primary care physicians in Eastern Massachusetts.

“We need to control our own destiny,” Gottlieb said before a standing-room-only crowd at the Westin St. Francis Hotel, during the industry’s largest global gathering of health care leaders and deal makers.

Among other moves, Gottlieb and chief financial officer Peter K. Markell hope to expand on a strategy to shift more routine health care to community clinics and hospitals, while marketing higher-priced specialty care at Mass. General and Brigham and Women’s to patients around the region and nationally.

They offered no timetable for this plan.

Partners, which also owns seven community hospitals and other facilities in Massachusetts, rang up revenue of $10.3 billion last year, making it the largest health care provider in New England. It attracted about $1.5 billion in outside research funding, including about $800 million from the federal government.

The Partners presentation in San Francisco came days after the massive hospital and doctors system disclosed it will sell $425 million worth of bonds to finance new construction and other expansion initiatives.

As Partners has grown, so has scrutiny of its market dominance, with critics saying the system’s size contributes to more expensive medical care.

The Massachusetts Health Policy Commission wants Attorney General Martha Coakley’s office to reject the organization’s latest attempt to grow, with the proposed acquisition of South Shore Hospital in Weymouth. A review by the watchdog agency concluded the merger could drive up costs and restrict competition for health care services south of Boston.

Later this week, Partners is expected to issue a rebuttal.

Coakley’s office is nearing completion of a four-year investigation, conducted with the US Department of Justice, into allegedly anticompetitive practices by Partners. Partners officials have said that expansion moves on the North and South shores will make it easier for them to integrate services, control costs, and treat more patients in community settings rather than in Boston.

Meanwhile, former Boston Mayor Thomas M. Menino last month lambasted Partners, the city’s largest private employer, for passing up land in Roxbury and deciding instead to consolidate administrative operations — and about 4,500 nonhospital employees — in a giant office complex being built at Somerville’s Assembly Row. Partners said the move to Somerville would be less expensive and afford easier commutes for its employees.

Partners executives did not discuss either issue Monday, but Markell noted the proposed acquisitions of South Shore Hospital and Hallmark Health System, which owns two hospitals north of Boston, are “going through the regulatory process.”

Gottlieb, for his part, made a veiled reference to the regulatory oversight.

“Like elsewhere, the Massachusetts marketplace is interesting and it’s dynamic,” he said. “It may be a little more interesting and a little more dynamic than elsewhere because the government has intervened for an extended period of time. That has intensified and exaggerated some downward cautionary pressures.”

To meet demands of patients, employers, and government officials for more-affordable health care, Partners executives said, they have contracted with insurers that reward doctors and hospitals for keeping patients healthy. Between patients covered by such contracts and those signed up by Neighborhood Health Plan — a Medicaid-managed care insurer Partners acquired in 2012 — it now has about 750,000 “lives under management,” Gottlieb said.

Partners may use that experience to offer its own commercial health insurance products to customers, executives said. Such products, if tailored as limited-network policies, could keep patients within the Partners system.

“We are working real hard to combine our insurance expertise with our provider expertise to create a new medical model,” Markell said.

He said Partners’ bond issue will help it finance ongoing capital improvement projects, such as renovations and new construction at Brigham and Women’s in Boston and elsewhere, as well as initiatives such as an information technology system that will improve efficiency by better managing patients’ records and data.

“Anyone who wants to step up to the plate and buy the bonds right now . . . we’ll take the orders,” Markell told investors.

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Think about what working for these ACOs will do to the hippocratic oath.

What's missing from the Hippocratic oath
August 31, 2012 | By Alicia Caramenico

As FierceHealthcare reported yesterday, some teaching hospitals want the Hippocratic oath to require physicians to abstain from inflicting financial harm on patients and the overall healthcare system.

Medical bills are the biggest factor sending people into bankruptcy, as the article notes, which makes "do no financial harm" a great addition to the oath.

Whether you look at the classical or the modern version, the Hippocratic oath seems a little lacking in today's rapidly evolving healthcare environment.
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In this webinar, we will examine this trend and discuss options for providers who are entering this market. We will review technology, systems and delivery models. What are the risks/rewards of such a model, and how does it differ from the provider models of the past? What are the factors that will drive an organization to success? Register Now!
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What else should doctors and other healthcare professionals swear to before entering the profession? I can think of a few oaths I'd like my own physician to take:

"Provide informed consent"

With recent research finding that doctors don't disclose all the possible risks associated with certain treatments to their patients, pledging to give patients complete and accurate information will help them make informed choices about healthcare.

Such an oath also could motivate doctors to acknowledge that all risks warrant a discussion with patients, even if a specific risk is extremely rare.

Improving the way clinicians and patients communicate about treatment not only can improve care, but also can protect hospitals from lawsuits if something goes wrong. On top that, better informed patients are good for a hospital's bottom line, as providing patients with more information about their conditions and medication management can reduce readmissions.

"Wash my hands"

The industry is well aware that hand-washing compliance across hospitals is routinely dismal. But even with hand-washing stations and hand sanitizer dispensers, providers play a vital role in keeping hospitals clean.

While the Hippocratic oath already requires providers keep patients safe, it could benefit from an added emphasis on better hand hygiene. More doctors and nurses tapping on iPads and other mobile devices at work, for example, is just one of many reasons for a hand-hygiene pledge.

"Maintain my own health and wellness"

Physicians should be counseling patients on healthy diet and physical activity, but advice can be hard to follow when it comes from someone who's not exactly a model for healthy behaviors.

In fact, research indicates hospital employees have higher healthcare costs than the general population and are less healthy. And they're more likely to be diagnosed with chronic medical conditions like asthma and diabetes.

Moreover, a survey last month found that almost half of U.S. physicians suffer from burnout, which can lead to patient safety errors, poor staff morale and greater physician turnover.

It's not surprising, given providers usually work long hours in a high-stress setting--not to mention easy access to vending machines and greasy food in hospital cafeterias.

To honor a vow to promote their own health and well-being, providers need to make non-work a priority. A better work/life balance, whether through mindful living, engaging in fun and fulfilling activities, or setting clear, achievable goals, will keep providers healthy--something that could rub off on their patients.

"Speak up about medical errors and bad behavior"
To help ensure patient safety, providers need to be vigilant about reporting medical errors. Yet most health professionals remain reluctant to speak up, fearing their mistakes and event reports will be held against them.


Some hospitals may not have a blame-free culture, but providers should still be advocates of transparency and patient safety and vow to reduce rather than ignore medical errors.

Unfortunately, some healthcare workers are still hesitant to speak up when their colleagues make mistakes or take dangerous shortcuts. To prevent potential hazards to patients, they must share concerns with the person involved, go higher up the chain of command or report it to the hopsitals' incident reporting system when appropriate.

Read more: What's missing from the Hippocratic oath - FierceHealthcare
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January 25th, 2014

1/25/2014

0 Comments

 
I'm making up for snow days with this blog......

DO YOU KNOW THAT WE HAVE ONLY 25 DAYS TO FILE AS A CANDIDATE FOR STATE-WIDE ELECTION IN MARYLAND AND NO ONE IS CHALLENGING NEO-LIBERALS WHO INTEND TO MOVE ALL THESE POLICIES FORWARD!!!!!!! 

As I rant about having all health care decisions now placed in the hands of corporations I want to be clear.....corporate wellness/ACOs are not across-the-board bad.....just as charter schools, individual programs can be innovative.  But, as with charter chain businesses.....when the whole process becomes market-driven none of what is done is done for the good of people.  Remember as well, as these health systems go global they will behave just as Wall Street banks do.....they will be predatory and unaccountable.


Looking towards health care policy I am glad to have been able to share with friends across the country that  Maryland is ground zero for ending Medicare and Medicaid as Federal programs by sending them to these state health systems and having people simply treated as they are with the tiered system being built.  So, working/middle class......you paid all the payroll taxes and income taxes that allowed this first class health care system to exist.....but, at best, only upper middle-class will have a Medicare we have always been used to.  Who are those upper/middle class-----give or take $250,000.  You see, disposible income is hard to find in a society that has the middle-class preyed upon from the top and bottom income groups!

Raise your hands if you understand that the ACA reforms make hospitals profitable and therefor they are not private non-profits. Look, they are being rated for profitability for goodness sake.....

TAX THEM AND USE THAT TAX TO BUILD AND RUN PUBLIC HOSPITALS!

We are now to believe that once these hospitals take steps to become more cost-effective and profitable.....that they will still be private non-profits.  After all, even though they use that extra money earned to expand globally....they are not handing out dividends-----OH REALLY?????  Below you see Wall Street modelling these corporations and you see how these corporations are planning and investing all those PROFITS.  As I show below that.....the UMMS health care union shouts loudly and strongly how what is in Maryland a quasi-governmental state university hospital.....see how far they go not to say corporation.....uses Wall Street investments of what should be public money to the detriment of staff and patients all to boost profit and expansion.

THESE ARE NOT NON-PROFITS AND NEED TO EITHER GO BACK TO BEING PUBLIC HOSPITALS OR PAY TAXES AS CORPORATIONS.

33 Statistics on Nonprofit Hospital Operating Margin by Credit Rating

Written by Bob Herman (Twitter | Google+)  | January 17, 2014 BEcker's Hospital Review

  Healthcare CFOs and other top finance leaders view operating margin as one of the most important metrics to gauge the sustainability of their organizations.

In 2012, the median operating margin at most nonprofit hospitals and health systems varied, depending on credit rating and other factors, but generally it fell between 1 and 4 percent.

Here are 33 statistics on nonprofit hospital and health system operating margins, separated by credit rating categories from the three major rating agencies. Note: All data are medians and reflect audited 2012 financial statements.

Fitch Ratings

Hospital credit rating

Median operating margin (2012)


10 Priorities for Nonprofit Hospital Investment Committees

 Written by Bob Herman (
Twitter | Google+)  | January 16, 2014 

Given the large-scale changes in the healthcare sector today, investment strategy has become more important.

As the calendar flips to a new year, prudent hospital and health system executives are looking at their investment strategies from 2013 and evaluating what worked — and what didn't. A report from consulting firm Mercer identified 10 priorities that investment committees at nonprofit hospitals and health systems should consider as 2014 gets underway.

1. Assess whether risk tolerance in the investment portfolio has changed, given a challenging operating environment.

2. Review the fixed income allocation in both a low and a rising interest rate environment.

3. Consider whether a delegated investment approach could offer time and cost savings for your organization.

4. Evaluate whether investment strategy should take into account a pending or potential strategic action, such as a merger, acquisition or joint venture.

5. In a post-merger situation, conduct an investment policy survey to facilitate successful integration of investment assets.

6. Develop a strategy for getting a defined benefit pension plan fully funded.

7. Recognize the growing importance of the defined contribution pension plan.

8. Consider how best to meet the fiduciary obligations of defined contribution plan governance.

9. If you are considering moving a captive insurance company offshore, understand the governance, reporting and regulatory requirements.

10. Assess the balance sheet implications of taking on capitation or insurance risk.

Here you have real patient advocates in the UMMS Code Red union shouting that 'IF AN INSTITUTION WALKS LIKE A DUCK AND TALKS LIKE A DUCK, IT IS A CORPORATION FOR GOODNESS SAKE AND NOT A NON-PROFIT.

Let's be clear......we all know a health system based on privatized corporate policies will be purely profit-driven and bad for patients and their employees!


UMMS is seeking $155 million for the Upper Chesapeake Health System even as the system’s debts mount from the purchase of St. Joseph Hospital and even though UMMS has failed to build a promised hospital on the Eastern Shore. All the while, UMMS is laying off frontline caregivers.


UMMS Code Red December 17, 2013 In Maryland, private hospitals fall under the National Labor Relations Act and public hospitals fall under the Maryland Labor Relations Act. The University of Maryland Medical Center, based in Baltimore, is governed by neither. UMMC is the only hospital in the state where workers do not have basic labor protections.

The issues at stake at UMMS are the same issues at stake nationally. An ethos has developed in this country in which executives, even those of taxpayer supported nonprofits, are lavished with high pay, perks and bonuses while their employees struggle to make ends meet, and risky financial schemes by CEOs are given a pass. Will we continue to live in a society where executives can squander taxpayer dollars at will? http://ummscodered.org/


Between 2008 and 2012, pay jumped 75 percent for the top four UMMS executives, who received more than $21 million during that time, and that’s not including perks like exclusive health club memberships, each for worth thousands of dollars. www.ummscodered.org

Why should a "non-profit" hospital, which gets more than 58 percent of its funding from tax dollars, sic "nasty" lawyers on anyone or push patients into bankruptcy? If you are also looking at patient issues, fiscal problems or other types of mismanagement at UMMS, write us at info@UMMSCodeRed.org or call our hotline: 877-434-1011.
________________________________________________


Raise your hand if you understand that something with the title of corporation and headed by a CEO is not public!!!!!!!!! EVERYONE.

This is what public private looks like and it does not work for you and me.....it works to maximize profits for the health industry. So, the first thing a real progressive would do is dismantle the private from the public!

Dr. Ramanathan Raju Named President of New York Health and Hospitals Corporation

Written by Akanksha Jayanthi
January 21, 2014   Becker Hospital Review

 New York City Mayor Bill de Blasio has
selected Ramanathan Raju, MD, as president of New York Health and Hospitals Corporation, the largest public hospital system in the country.

Dr. Raju currently serves as CEO of Cook County Health and Hospitals Systems in Chicago, the third largest public hospital system in the country.

He previously served as CMO, corporate COO and executive vice president of New York City HHC.

Dr. Raju has also served as director of surgery, director of medical education and senior vice president of Lutheran Medical Center and COO and CMO of Coney Island Hospital, both in Brooklyn, N.Y.

_________________________________________________________

'In other words, if you are high maintenance because you don’t do what your doctor says (and remember, “non-compliant” includes people who don’t follow orders because they think the cookie-cutter approach isn’t right for them) or want higher service or per the example of the pediatrician Patricia’s 40 minute case, have a complicated set of ailments, you’ll be shunted. The brave new world of corporate medicine will eject you'.


WOW......JUST AS I SAID FOUR YEARS AGO.....It's almost like I knew the goal of ACA was to consolidate the health industry into Wall Street sized global health systems that would maximize profits by excluding most people from coverage.  All labor and justice leaders knew this too------leaders shouting loudly for ACA knew you would lose access to health care and Medicare and Medicaid would be ended as a Federal program.

We are watching as corporations are now being given rights to force their employees to behave a certain way regarding health care and health conditions are else be without health coverage and perhaps a job.  These preventative plans are simply a way of having people tied to blood tests that show high levels of sugar, cholesterol, fats, for example and expect that employee to use a wellness program to bring levels into range.......it will be a boot camp and this is all supposed to bring wellness.  It will be more about having all that data on you in a database and sold for profit and it will be used to discriminate in employment and how much you pay for health insurance premiums.
  PERIOD!!!!!

Remember, many health risks are hereditary and cannot simply be wellnessed away.  Many health problems like obesity are now linked to chemicals placed in common foods that are impossible to avoid.  There is no way that preventative care will stop much of what most people experience in illness......cancers, diabetes, heart disease..... but these neo-liberals are going to deny access to these ordinary treatments using these arbitrary prevention schemes.  I had my doctor tell me I am obese.  This places me in an insurance premium and preventative care regime that I do not need
BECAUSE I AM NOT OBESE FOR GOODNESS SAKE.....I AM SIMPLY A MID-AGED WOMAN!

This is not a good thing.  It follows  the idea of a totalitarian society where everything you do is guided by corporations and this health policy is truly regressive.  Here in Maryland it comes from Johns Hopkins.

THE PROBLEM WITH COST IN HEALTH CARE IS HEALTH FRAUD AND PROFITEERING NOT PATIENT ABUSE OF THE SYSTEM!!!!!

Obamacare penalties spawn 'skinny' plans

The law is nearly silent on what employers need to include in their health plans. | Reuters

By
BRETT NORMAN | 7/16/13 4:59 AM EDT

Employers heaved a sigh of relief when the Obama administration announced it would not enforce Obamacare’s mandate that large companies provide insurance to their workers next year.

But some companies plan to offer “skinny plans” designed to duck the biggest penalties anyway, according to industry consultants. And the Obama administration has extended its blessing to this limited coverage, even though it would not protect individuals from medical bills that could cause financial ruin in the case of severe injury or illness.

The health law spells out in detail the comprehensive coverage that insurers have to provide on the new insurance marketplaces or exchanges. But it’s nearly silent about what the employers who provide insurance to a majority of Americans need to include in their health plans.



“There are no rules on how good that coverage has to be,” said Gretchen Young, senior vice president of health policy at the ERISA Industry Committee.

About 95 percent of large employers already offer health insurance. Most of them offer fairly comprehensive coverage, as good or better than the typical plans that will be offered on the exchanges.

That’s not the case for many retailers, restaurant chains and the hospitality industry, which often rely on low-wage, part-time workers and offer few or no health benefits.

And those are the businesses that were most seriously affected by the employer mandate.

“There are particular employers in particular industries for whom the Affordable Care Act is a disaster,” said Andy Anderson, who leads the health division at the law firm Morgan, Lewis & Bockius in Chicago. The Congressional Budget Office estimates the penalties would bring in $3.7 billion per year.



The health care law required employers with the equivalent of 50 or more full-time workers to provide health insurance or else pay a $2,000 per employee fine, starting in 2014. After intense lobbying from the business community, the Treasury Department announced earlier this month that the mandate won’t take effect until 2015.

The penalty is a fraction of the roughly $8,000 it costs to provide an employee with comprehensive health insurance. But it would be a major new expense for large employers that don’t pay for coverage now.

A firm with 2,500 employees would pay about $5 million in penalties each year.

But there’s a second penalty that gets less attention. Large employers that don’t provide robust, affordable insurance to their workers will pay a $3,000 penalty for each employee who gets taxpayer-funded subsidies on an exchange.

And there is a new type of insurance plan that is designed to protect employers from the first penalty and lower their exposure to the second. They are the skinny plans, a descendant of limited benefit — or “mini-med” — plans that are set to be phased out at the end of this year.

“Skinny alternatives are an attempt to manage liability for ACA penalties,” said Neil Trautwein, employee benefits policy counsel at the National Retail Federation.
__________________________________________________

The mantra with the Affordable Care Act people is that these reforms give access to health care to more people and boosts the number insured for health care.  Before all of this the poor had clinics that gave them all the care they needed and they were able to go to the emergency rooms for more serious conditions.  So, the poor were far better off then now.  Now, they are excluded from most hospitals for many kinds of care.....they are eligible for less preventative care, rather than more.   It will be a debacle for the poor as regards access to ordinary medical procedures.

The expanded Medicare takes in what used to be people with strong workplace health policies that were lost or will be shed in this reform as businesses stop health plan coverage for low-income workers.  It is simply an step down to basic Medicaid and will encompass 80% of Americans.  So, the ACA is indeed a type of single-payer.......Medicaid for All.

This is a good article showing what basic procedures that save lives will not fall under the venue of ACA......and how lots of people will not be in the window of Medicaid.

THAT'S A NEO-LIBERAL FOR YOU.....MAXIMIZING PROFITS BY ENDING PUBLIC SERVICES AND PROGRAMS.

We already see the number of poor and low-income who try to access dental care for instance is extremely low because these people are getting such poor care and/or abused by these caretakers to which they are referred....they are not using it.....WHICH I FEEL IS DELIBERATE.

Sen. Grassley Investigating Abuse at Corporate Dental Chains

July 2, 2012, 1:23 pm ET by David Heath Center for Public Integrity

a joint investigation by FRONTLINE and the Center for Public Integrity. Sen. Charles Grassley (R-Iowa) says that 
his investigators have found evidence of abuses by corporate dental chains treating children on Medicaid.

For months now, Grassley’s staff has been asking questions of three dental chains serving poor children on Medicaid. Each is owned by a private-equity firm. The chains are Kool Smiles, Small Smiles and ReachOut HealthCare America.




Medicaid Programs Vary in Coverage of Preventive Care, Report Says

 Released: 7/3/2013 9:00 AM EDT
Embargo expired: 7/8/2013 4:00 PM EDT
Source Newsroom:
George Washington University more news from this source Contact Information Available for logged-in reporters only

CitationsHealth Affairs

Newswise — WASHINGTON, DC—Existing Medicaid beneficiaries have largely been left out of the health reform movement when it comes to preventive services that can ward off cancer, heart disease and other potentially deadly diseases, according to a new study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The study, which appears in the July issue of Health Affairs, notes that under the Affordable Care Act most private insurance plans, Medicare and Medicaid expansion programs are required by law to cover a full range of crucial preventive services such as screening tests for colorectal cancer, high blood cholesterol, HIV infection, and diet counseling that can prevent obesity. But state Medicaid plans are not required to cover such care for adults already enrolled in Medicaid—and this report suggests that those adults will not have access to the full range of preventive services.

“Preventive services save lives by detecting diseases before they can progress,” says lead author Sara Wilensky, PhD, JD, special services faculty for undergraduate education in the Department of Health Policy at SPHHS. “Why should some Medicaid beneficiaries be left out when it comes to coverage for this kind of care?” Screening mammograms, colonoscopies, cholesterol screenings and other preventive services are aimed at staving off health problems early on rather than trying to provide costly health care for established and hard-to-treat disorders, she said.

Wilensky and her co-author Elizabeth Gray, JD, a research associate at SPHHS, reviewed Medicaid policies in all 50 states and the District of Columbia from June 2012 through November 2012. The initial review looked at all publically available information on coverage of preventive services. After that first review, the researchers then contacted state Medicaid officials to fill in any missing information about coverage for this population.

The researchers found that most states do not cover all of the preventive services recommended by the U.S. Preventive Services Task Force, an independent panel that looks at preventive care and offers guidelines for health plans and providers. In addition, it was often difficult to discern exactly which services were covered by Medicaid programs based on the vague language used by many programs. The report highlighted some serious gaps in coverage. For example, while most states provided coverage for screening mammograms, not all Medicaid programs offered such care to existing beneficiaries. In fact, three states don’t cover preventive mammograms for this population at all—a shortfall that could mean low-income women will go without the test, the authors said.

The analysis also says that states appear to rarely cover other types of preventive care for breast cancer for those at high risk. Only 11 state Medicaid programs, for example, make it clear that they will pay for breast cancer susceptibility testing for the BRCA1 gene that increases the risk of breast and ovarian cancer. And just three states explicitly cover chemoprevention for such beneficiaries. This medication can be used to lower the risk of breast cancer, a disease that kills about 40,000 American women every year.

"The Affordable Care Act guarantees millions of low-income Americans access to mammograms, colonoscopies and other lifesaving preventive services, but that assurance does not extend to people who currently have Medicaid coverage," said Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society and one funder of the study. "States have a responsibility to ensure that all people in Medicaid have access to preventive care for a life-threatening disease such as cancer."

The authors of the study also say there is wide variation in coverage of tests for sexually transmitted diseases (STD) and the test for the HIV virus that causes AIDS. And in some states STD screening is limited to family planning visits, a restriction that means people visiting the doctor for some other reason or those who are not eligible for family planning services may not have coverage. Going without this screen, increases the risk that an infected person will not receive treatment and could unknowingly spread a disease to others, Wilensky said.

Many of the preventive services evaluated by the study, such as screenings for early signs of heart disease, depression or diabetes, were either not covered or it was unclear if they would be paid for by Medicaid. In some cases, state Medicaid officers said that the preventive services would be paid for only if deemed “medically necessary.” But Wilensky says that these terms should not be used together because medically necessary tests are for instances when a provider has a reason to suspect an established health problem, while preventive tests are crucial in detecting an emerging problem in an otherwise healthy, asymptomatic person.

Such confusion could leave providers wondering if preventive services will be covered by Medicaid, says the report. In the end, providers may simply fail to provide care if they are uncertain about Medicaid coverage and/or payment for their services, the authors said.

“By lowering risk factors such as high blood pressure and cholesterol, Americans can reduce their risk of heart disease or stroke by as much as 80 percent,” said Nancy Brown, CEO of the American Heart Association, which also helped fund the study. “Evidence-based screenings play an essential role in identifying and reducing these factors. Without Medicaid coverage of preventative screenings and services, we could fall behind in the battle against the nation’s No. 1 and No. 4 killers.”

The authors conclude that there are many opportunities to increase the coverage of preventive services for this population. For example, managed care plans could choose to cover services that end up saving lives even if not required by state Medicaid programs. In states that do not clearly spell out covered preventive services or require providers to follow a specific standard of care, providers could choose to follow the guidelines of the U.S. Preventive Services Task Force. Alternatively, Congress could step in and give existing Medicaid beneficiaries the same coverage of preventive services as most other Americans enjoy under health reform, the authors point out.

The Health Affairs study, “Existing Medicaid Beneficiaries Left Off the Affordable Care Act’s Prevention Bandwagon,” was funded by the American Cancer Society, the American Cancer Society Cancer Action Network, the American Heart Association and the National Colorectal Cancer Roundtable.

The full report, “Coverage of Medicaid Preventive Services for Adults—A National Review,” includes state-specific data and additional information about this topic. To access the report
click here.

About the George Washington University School of Public Health and Health Services:
Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education and is now the only school of public health in the nation’s capital. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health.
http://sphhs.gwu.edu/







0 Comments

January 11th, 2014

1/11/2014

0 Comments

 
IF YOU ARE SHOUTING AT CONGRESS AND OBAMA TO SAVE MEDICARE AND MEDICAID......THEY ARE ALREADY PRIVATIZING IT AND SENDING IT TO THE STATES GUTTED OF FUNDING AND CREATING TIERED ACCESS FOR GOODNESS SAKE.


Medicare Advantage was a George Bush attempt to privatize as much of Medicare as possible and as this article states it has pulled 1/4 of seniors off the public program simply by boosting coverage for popular health access issues that Medicare does not offer like dental and vision....or giving a good price on heavily used health item while loading costs on others. So, Expanded and Improved Medicare for All would not want these private plans drawing from the Trust funds.....it would want Medicare to cover all of those health issues for everyone. This article is good in two respects.....it shows that the Affordable Care Act is having a negative impact on these private Medicare Advantage plans but it shows as well why.......the Affordable Care Act deliberately seeks to create a tiered funding of Medicare just as with these state systems. As I have said, the plan is to throw Medicare, Medicaid, and public sector health plans into these systems and it will come out as Medicare looking more like Medicaid for most people. Again, it will be 80% of people unable to access the quality care of Medicare that has always been available to all seniors. The lower-income seniors are the more costly and they are the ones targeted to be pushed from the system. THAT IS HOW OBAMA PLANS TO CUT COSTS OF MEDICARE. Obama is a tiered kind of guy......a perfect republican!!!!


NEO-LIBERALS RUN AS PROGRESSIVE DEMOCRATS AND THEN SERVE LIKE RIGHT WING REPUBLICANS

Pharma & Healthcare | 1/06/2014

More Cuts In Store For Medicare Plans -- Here Are The Options That Will Shrink Most For Seniors

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

The privately run Medicare plans known as “Medicare Advantage” have been in the political crosshairs of the Obama White House. Even after facing steep cuts under Obamacare, the Advantage plans are now slated to take a brand new round of reductions in 2015. These new cuts will cause the private Medicare option to shrink further in the next few years, and pressure the insurance companies that offer them.

The latest cuts are the consequence of a slowdown in the overall growth of Medicare spending — some of it owing to reduced utilization of medical services as a result of the slack economy. The Medicare program recently told the private plans that, since per capita costs are trending lower than prior estimates, the feds are now assuming that Medicare Advantage will take another cut in 2015, on top of existing reductions.

This means that in 2015, the rates that the feds pay these plans is slated to go from an earlier 1.7 percent increase to a new, -2.0 percent decrease. This is on top of other cuts that have already been announced or implemented. Combined with these other cuts mandated by Obamacare, the Medicare Advantage plans are looking at significant reductions when they had been expecting small increases.

The slower rate of growth in overall Medicare spending will come as welcome news. Yet basing Medicare Advantage rates off this metric was always flawed. The translation between Medicare’s per-capita costs and beneficiary costs in the Medicare Advantage program was never precise. They don’t track each other well, as the Advantage plans often implement reforms and realize savings in ways that are detached from trends underway in the broader medical marketplace.

These 2015 rate adjustments will affect the investment decisions that the advantage plans make. Now that anticipated increases are turning into cuts, more health plans are likely to skinny down the options that they offer.

Hardest hit are going to be the health plans that have made the biggest investments in Medicare Advantage. At the top of this list is Humana.

Humana has about 2.5 million Medicare Advantage members and 3.3 million participants in Medicare Part D drug plans. The company’s Medicare business accounts for 70 percent of its revenue. So watch the plan as a bellwether for the impacts of these policy trends.

Humana has been making aggressive investments in the way it delivers care to seniors and integrates their medical services. It’s part of a broader effort to improve medical outcomes, and save money on medical costs. But these are long term investments that might not pay off in time to offset the near term cuts. That’s the problem with the way Washington budgets around healthcare. The year-to-year budget adjustments don’t provide enough opportunity for insurers to realize the savings from making longer-term investments in healthcare. If Humana’s Medicare business starts to shrink, or benefits get trimmed in noticeable ways, it will be a reflection of the recent cuts.

All of this begs the question why the private Medicare plans remain a target?

The original gripe that the Obama team had was that the MA plans were being paid more for each beneficiary that they covered than what the government spent on an average senior enrolled in traditional fee-for-service Medicare.

The math on this costs per-beneficiary estimate was always fuzzy. It baked in a lot of fungible assumptions. Nonetheless, Obamacare sanded away any perceived discrepancy, cutting more than $150 billion from these plans.

The net effect of all of these cuts is already expected to shrink the program. The Obama Administration is disproportionately shifting these cuts onto so-called Medicare “special needs” plans. These are Medicare Advantage plans that are specifically designed to enroll patients with certain serious and costly chronic illnesses like diabetes and heart disease. Many of these patients are low income, and dually eligible for both Medicare and Medicaid.

These SNP plans are paid more to effectively siphon these less healthy patients away from other Medicare schemes like Medicare’s fee-for-service program. The idea is that these specialized Medicare Advantage plans will be able to more closely manage these patients, reducing morbidity associated with chronic ailments, and in turn lowering costs to the Medicare program. There is evidence that this kind of focused health plan works to improve clinical outcomes, and reduce costs.

More than 1.5 million seniors were covered by about 500 of these plans in 2013. Avalere Health, a Washington-based health policy firm estimates that at least 13% of these plans will be eliminated as a result of the cuts.

The targeting of SNPs is illustrative of the incongruous nature of the President’s policies when it comes to Medicare Advantage. The White House has been using a “demonstration” project authorized under Obamacare to forcibly turn many of these same patients over to state-run healthcare programs. The states, in turn, are typically enrolling these seniors into the HMOs used by their Medicaid programs. It’s going to be hard to argue that low-income seniors with chronic medical problems will be better off in state-run Medicaid HMOs (getting the equivalent of a Medicaid benefit) than they were in the private Medicare SNPs.

The Obama demonstration program aims to improve the medical management of these seniors. But the SNPs were already doing the same thing that the states are now trying to figure out. And the SNPs are using managed care plans tailored to seniors, and not designed to serve state Medicaid programs. The effort to turn these seniors over to the states always looked like it was more about politics than sound healthcare — a backdoor scheme to cross subsidize state Medicaid programs with money from Medicare.

It can’t help but seem like the real aim of the successive cuts is to shrink the advantage program. Yet more than a quarter of Medicare beneficiaries enroll in the private Medicare Advantage plans. Many of these are low-income seniors who choose these options because they can’t afford the Medigap policies that richer seniors use to plug the increasing gaps in traditional, fee-for-service Medicare. The private Medicare Advantage plans typically have fewer out-of-pockets costs than traditional Medicare, eliminating the need to buy a costly, supplemental health plan.

The Obama team has made a warm embrace of managed care options when it comes to Obamacare and Medicaid. But for Medicare, they want to deny low-income seniors these options. All of the administration’s old arguments on why they resisted these private Medicare plans have been largely mooted, or never materialized. Only one possible reason remains prominent. It’s a Bush era program that sought to privatize aspects of this public program. And it will continue to be opposed largely on those grounds.



______________________________________________
For those not knowing that the Affordable Care Act is about huge cuts in health access for most people in order to make the health industry more profitable, the roll-out is showing people what they are losing. Medicare is being taken to the same tiered level of care you see on these state health exchanges and as we can see, Medicare and Medicaid will end as Federal programs and simply become part of these state systems of tiered access. Seniors needing care the most will now not be able to access important care if they cannot pay for the right health plan.

Obama Administration Issues New Rounds Of Cancer Care Cuts Amidst Healthcare Reform Chaos

Community Oncology Alliance gravely concerned over severe cuts to cancer care
Community Oncology Alliance December 18, 2013 12:29 PM



  • WASHINGTON, Dec. 18, 2013 /PRNewswire/ --
  • The Community Oncology Alliance (COA) issued a plea today to Congress to immediately stop the latest round of payment cuts the Obama Administration will make effective January 2014 to providing chemotherapy and other life-saving drugs to seniors with cancer.  Additionally, COA called on Congress to stop the sequester cut to cancer drugs by passing the Cancer Patient Protection Act (H.R. 1416), a bill authored by Rep. Renee Ellmers (R-N.C.) and cosponsored by 109 representatives

The Centers for Medicare & Medicaid Services (CMS) recently announced Medicare fees for 2014, which include severe cuts to essential cancer care services. CMS will arbitrarily cut by 7.4% chemotherapy services payments to physician-run community cancer clinics — where close to 70% of the nation's cancer patients are treated — without any cost-based justification. At the same time, CMS will increase payment to hospitals by 29.9%. This is in direct opposition to the Medicare Payment Advisory Commission's recommendation in their June 2013 Report to Congress that CMS should be achieving payment parity for identical services, regardless of where those services are delivered.

"Our government has consistently and increasingly jeopardized this country's cancer care delivery system," said Dr. Mark Thompson, COA president and an oncologist at the Mark H. Zangmeister Center in Columbus, Ohio. "These latest payment cuts are bad medicine for cancer patients and taxpayers. They will further consolidate cancer care into large corporate medical systems and, in the process, inhibit patient access while increasing costs to patients and taxpayers."

RECENT REPORTS:

  • A study by the actuarial firm Milliman found that Medicare pays $6,500 more per beneficiary annualized when chemotherapy is given in outpatient hospital facilities versus community cancer clinics, and each senior patient pays $650 more in out-of-pocket costs.
  • A recent study by The Moran Company reveals that Medicare cancer patients receive more chemotherapy treatments with more expensive chemotherapy drugs in hospitals compared to community oncology clinics, resulting in chemotherapy costs that are as much as 47% higher.
  • COA reported earlier this year that 469 community cancer clinics had merged into or affiliated with hospital systems and 288 cancer treatment facilities had actually closed over the past 6 years, especially in rural areas. This creates access problems when patients, particularly seniors, have to travel for cancer care.
As has been widely reported, the sequester cut to the underlying cost of cancer drugs has forced cancer clinics to send Medicare patients elsewhere for treatment or merge with large health systems.  This drives up costs to Medicare and patients — the exact opposite intent of sequestration. The budget deal just passed by Congress extended the Medicare sequester and further increases the magnitude of the payment cuts just issued by CMS.

"The sequester cut to cancer drugs is a wrecking ball to our cancer care delivery system," said Ted Okon, COA executive director. "To make matters worse, oncologists are being hit by insurers who are cutting them out of Obamacare exchange and Medicare Advantage networks, which recently happened en masse to 170 cancer care providers in Florida. In the midst of this chaos, CMS will reduce cancer care payments even further, with no rationale justification, and is simply driving up costs for Medicare and seniors. It doesn't make sense."

COA's official comment letter to CMS on the agency's 2014 fee schedule for cancer care services can be obtained here: http://www.communityoncology.org/COA-Comment-Letter.pdf

About Community Oncology Alliance (COA)
Community Oncology Alliance (COA) is a non-profit organization dedicated solely to community cancer care, where four out of five Americans with cancer are treated. Since its formation over a decade ago, COA has helped community cancer clinics navigate an increasingly turbulent environment by working together to become more efficient, advocating for their patients, and proactively providing solutions to Congress and policy makers. COA members have testified before both chambers of Congress, authored cancer care demonstration projects, and been instrumental in the passage of oral cancer drug parity legislation, among many other initiatives.

COA also leads a multi-stakeholder group that is developing and implementing an Oncology Medical Home (OMH) cancer care model and is advancing payment reform for cancer care. More information can be found at www.CommunityOncology.org. 

The COA Patient Advocacy Network (CPAN) was created in 2010 to advocate for access to local affordable care for all cancer patients. More information can be found at www.COAadvocacy.org.



_________________________________________________
WE ALL HEARD THAT THE ONLY PEOPLE THAT WENT TO JAIL FOR THE MASSIVE SUBPRIME MORTGAGE FRAUD WERE THE SMALL FRIES AT THE BOTTOM OF THIS SCAM......WELL, THIS PRIVATE CONTRACTING CORPORATIONS WILL DO THE SAME WITH ENTITLEMENT FRAUD....

We all want fraud and waste in the health care system be addressed as we have lost 1/2 of entitlement spending to fraud over a few decades.....trillions of dollars needing to come back. What Obama is doing is outsourcing Medicare now....private firms are creating these websites, below you see private contractors looking for fraud, and as Obama places Medicare on tiered levels of access, these ACOs will be in control of how Medicare funds are spent. No standard payment for all. This will of course create the same disparities as with any corporate operation and consumer service. The search for fraud for example will focus on individuals/mafia types of fraud and completely ignore the hundreds of billions being stolen by health institutions. I read an article on Medicaid fraud that had one of these private contractors saying they do not see much fraud when we know it is rampant. No doubt what these agencies will do is monitor doctors adherence to restricted levels of health care to deter any hippocratic oath caretakers.

ALL OF THIS IS REALLY , REALLY, REALLY BAD. REMEMBER, ALL THESE STRUCTURES BEING BUILT ARE ABOUT CONTAINING COSTS TO MAXIMIZE PROFITS. THEY ARE NOT ABOUT SAVING MEDICARE TRUSTS FROM BEING RAIDED BY CORPORATE FRAUD.


Sat, Jan 11, 2014, 11:31AM EST -
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Tommy G. Thompson, Former U.S. Secretary of Health and Human Services, Appointed Chairman of HealthcarePays, Inc. Board of Directors Thompson: Time is Now to Tackle Healthcare Fraud, Inefficiency, and Improve Transparency


HealthcarePays, Inc.
December 18, 2013 12:04 PM

  • RICHMOND, Va., Dec. 18, 2013 /PRNewswire/ -- HealthcarePays (HCP) (@HealthcarePays), an industry-owned "payment network" designed to cut healthcare costs by effectively reducing waste and fraud, announces Tommy G. Thompson as a member of its board and its chairman.



HCP employs an industry-owned network for healthcare payment authorization and processing that is proprietary, standardized and compliant with the Affordable Care Act (ACA) and all state and federal laws. Employers, providers and insurance companies are joining HCP to combat waste and fraud, create efficiencies of healthcare payment processing and access industry-wide data cube analytics. 

Thompson says he's joining HealthcarePays to combat the lack of cost transparency and rampant waste and fraud that are draining the U.S. healthcare system of hundreds of billions each year.

"There is little doubt that the future financial well-being of both the federal and state governments depends in, large part, on controlling healthcare payment inefficiencies," said Thompson.  "It makes little sense that the U.S. has no overarching healthcare industry payment network to check for fraud and authorize payments by examining all the payments in the system, similar to what is in place in our financial services sector.  I'm joining HealthcarePays to establish the first industry-owned network of this kind.  The leaders in the areas of employers, health plans and governments are encouraged to join us in this unique opportunity to create healthcare accountability through payment automation."

Key healthcare accountability challenges include:

  • The National Healthcare Anti-Fraud Association (NHCAA), a watchdog group, cites information from the FBI that anywhere between $70 billion and $234 billion is lost annually to healthcare fraud. (Source: Reuters/Huff Post Health News http://www.huffingtonpost.com/2011/04/13/health-care-fraud_n_848691.html)
  • PricewaterhouseCoopers research found that wasteful spending in the health system has been calculated at more than half of all health spending. (Source: PricewaterhouseCoopers http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml)
  • Only 10 percent of all healthcare claim payments are made electronically, in an industry that represents more than $2.7 trillion in annual healthcare spend, or 17.9 percent of the Gross Domestic Product (GDP). (Source: http://www.ushealthcareindex.org/resources/USHEINationalProgressReport.pdf and Source: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html) 
"HealthcarePays offers a singular solution to one of the biggest problems facing healthcare – lack of cost transparency in the healthcare system," said Thompson. "The time is now to tackle issues of transparency, inefficiency, and waste and fraud head on, HealthcarePays and its industry members are working to be part of a real solution to our healthcare crisis. I'm looking forward to providing leadership to the board as HealthcarePays continues to build out the first national payment network for the healthcare industry."

HCP interacts with all existing healthcare industry organizations including employers, hospital systems, physician groups, insurance companies, government payers such as Medicaid and Medicare, intermediaries, clearinghouses and banks.

As Secretary of Health and Human Services and Governor of Wisconsin, Thompson became a champion for welfare and Medicare reform, and had a reputation for fighting for the federal funding needed to improve public health.

"Tommy is a visionary and has a long track record of accomplishments in health services," said HealthcarePays Chief Executive Officer Dave Adams. "He's been advocating for healthcare reform throughout his impressive career in public and private service. We are fortunate to have him as a leader and an evangelist for our cause to reduce healthcare costs in the U.S."

About Tommy G. Thompson

Tommy G. Thompson was the 42nd and longest serving Governor of the State of Wisconsin from 1987 to 2001.  Thompson also served from 2001 to 2005 as the United States Secretary of Health and Human Services (HHS).  Thompson has held numerous important posts including as Chairman of AMTRAK, Independent Chairman of the Deloitte Center for Health Solutions and served on the boards of various other publicly and privately held entities.  Thompson has been called a "pioneer" for two landmark initiatives, the Wisconsin Works welfare reform and school voucher programs.  During his time as HHS Secretary, Thompson provided key leadership in the post 9-11 environment, reorganizing HHS, increasing funding to the National Institutes of Health, increased the responsiveness of the Centers of Medicare and Medicaid and working through the backlog of waiver requests thereby providing health insurance to 1.8 million low income Americans.

About HealthcarePays

HealthcarePays (HCP) is an industry-owned "payment network" designed to cut healthcare costs. HCP, headquartered in Richmond, Virginia, with its technology group based in Carlsbad, California, provides a fast, secure, electronic network that simplifies and improves the healthcare payment system. HCP streamlines the movement of healthcare payments and filters such payments among providers, health plans, self-insured employers, government payers, intermediaries, clearinghouses and banks in the U.S. The secure network is highly efficient, cost effective and fully compliant with the Affordable Care Act and other state and federal laws.







______________________________________________
Headlines in all media says 'Good news, health costs going down'.  Now, the public was led to believe that the ACA was about controlling health costs for the public, but as we are seeing controlling costs means limiting access to most people so health institutions are more profitable.  Below we see the biggest winners Health Insurance Corporations and Big PHARMA.  People now pay for insurance and then are kept from using it with co-pays and deductibles.

Insurance has no where to go but up as with all health care institutions because the ACA is about consolidation into global health systems and as we know when consumers come from all over the world.....only the affluent of the world will be able to afford most private insurance.   While 80% of US citizens will be on Medicaid and Bronze plans both allowing mostly preventative care, when these insurance corporations expand overseas.....and that will happen fast.....the percentage not accessing much of health care will go to 90%.  So, Affordable means that almost all Americans will be getting preventative care that is the cheapest health care to be had!

This is why Obama and neo-liberals put the policy of buying out of purchasing insurance so low initially and tying that penalty to the lowest cost of Bronze level insurance soon after....IT WILL TAKE ALL THE DISPOSABLE INCOME MOST PEOPLE HAVE JUST TO BUY THIS INSURANCE! 

SCORE WALL STREET!!!! 


Wall Street wouldn't be able to do all this without your neo-liberal incumbent!


Pharma & Healthcare


New Survey of Health Insurance Brokers: Private Health Plan Premiums Are Spiking. Now, Even The Fed Is Watching These Trends  Get ready for even higher healthcare costs.

A new survey of health insurance brokers shows that commercial insurance rates are going to rise “significantly” in 2014.

The research team at investment bank Morgan Stanley surveyed 131 brokers, finding that December 2013 rates are rising in excess of 6% in the small group market, and 9% in the individual market.

The spike in the quarterly-reported rates for annual premiums on new or renewing contracts is being attributed to the continued implementation of Obamacare rules, as well as new Obamacare taxes and fees that are being assessed on plans this year.

The December 2013 rate hikes are the largest reported since Morgan Stanley’s research team first started conducting the quarterly surveys of brokers in 2010. In prior quarters, the average quarterly reported rate increases never rose above 3% over the preceding period.

On top of this, health plans are also predicting higher cost trends in 2014, after years of stabilization (much of it attributable to the economic downturn, which reduced medical utilization rates). These higher cost trends were also among the reasons health plans cited for their December rate increases.

According to the survey, Aetna and United are increasing insurance rates in excess of 10%. Commercial carriers such as United are already on record attributing the bulk of their increased healthcare costs to new, Obamacare-related provisions.

Among the states seeing the highest annualized rate hikes (for the full 2013 year) in the individual market are Connecticut, which is averaging a 37% increase; Florida (42%); Illinois (33%); Michigan (39%); and Minnesota (35%).

Among the states with the biggest annualized spike in the small group rates are Delaware, which is averaging a 35% increase; Michigan (30%); and Minnesota (50%).

These rate increases have broad implications. Federal Reserve Board Member Jeffrey Lacker said today that the Fed has its eye on these costs.

Lacker said that he expects a “lot of turmoil” in the healthcare industry, and that the Fed will be watching how Obamacare unfolds.

In a speech to the Greater Raleigh Chamber of Commerce this afternoon he said “I think the Affordable Care Act is something that we are watching very closely because it’s something that could well have a substantial economic impact.”

In other words: You can’t tap the average family by $2,000 or $3,000 in additional healthcare costs and not expect some macro impacts.



_______________________________________________
Those people backing this reform often are the ones who are afraid that the coming baby boomer boom will implode the Medicare Trust and so think limiting access of low-income is a good idea.  You had better look at how extreme these reforms will be in removing regulations and protections and handing all control to Wall Street in how health care is dished out.   EVEN THOSE UPPER MIDDLE CLASS SHOULD BE OUTRAGED.

PUSH FOR EXPANDED AND IMPROVED MEDICARE FOR ALL AT NATIONAL AND STATE LEVEL!!!


While Obamacare Enrollment Continues to Lag, Labor Builds Support for Expanded and Improved Medicare for All

Posted: 12/30/2013 10:25 am

The 113th Congress will likely be remembered as the most unproductive in our history, and with an overall approval rating of 9 perent, it is safe to say that most Americans do not consider this bunch to be a noble group of public servants engaged in good works for the people of this country. It is rare that any member of Congress is honored on any level these days, but one truly worthy exception is Rep. John Conyers (D-MI), who early in December was honored with a breakfast celebration attended by some 40 union representatives at a restaurant on East 29th Street in New York City.

Those present included leaders from Actors Equity, The International Alliance of Theatrical Stage Employees (IATSE) and the New York City Central Labor Council (NYCCLC), whose President, Vincent Alvarez, declared his support for Mr. Conyers' bill HR 676, The Expanded and Improved Medicare for All Act, and promised to deliver their 1.3 million members to back this cause. This is a very significant development, as the 300 unions under the umbrella of the NYCCLC are made up of truck drivers, teachers, nurses, operating engineers, construction workers, janitors, train operators, electricians, fire fighters, retail workers and many more hardworking Americans who, along with everyone else in our nation, would benefit greatly from this revolutionary healthcare plan. They are the face of American labor today, and Mr. Alvarez spoke of the need for labor and the general public to unite and work together for this imperative cause: providing affordable, quality healthcare to all Americans.

We might recall that it was labor that gave us the middle class during the post World War II years as they worked to indeed lift all boats in that time of unprecedented prosperity. Can they lead our nation once again in this time of unprecedented need? They have been taking quite a beating, and have been decimated in several states by the lackeys of the 1 percent. But their values are America's values, and it is critical that they remain a vibrant force for change in this country.

Mr. Conyers was introduced by his longtime friend, TV talk show host Phil Donahue, and other speakers that morning included Robert Score, Recording-Corresponding Secretary of Local 1 of IATSE, and Stephen Shaff, speaking on behalf of Progressive Democrats of America. Mr. Conyers himself noted that it took him 15 years to move Congress to declare a national holiday for Dr. Martin Luther King, so he is prepared for a long haul to achieve Medicare For All. He has reintroduced HR 676 in every Congress since 2003, and has now garnered support from 54 other House members, along with an impressive 609 union organizations, including 146 Central Labor Councils/Area Federations and 44 State AFL/CIO's. Obamacare's failure to address the Taft Hartley Plans and the operating procedures under which they work could create even more union support for the Single Payer movement. The president must address this issue.

Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.

Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! -- as well as some doctors -- to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care -- including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs -- what's not to like? And if you like your doctor, you actually could keep him or her -- did you hear that, Mr. President? You can also pick any doctor you like -- no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a "provider" or "vendor," and we could become patients again, ending our dehumanizing role as a "consumer" or "customer."

Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama's second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.

Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) -- who is also a doctor -- have both introduced Single Payer bills. Bernie's bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.

Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can't the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott's home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.

In the Greider article in this month's The Nation, entitled "Reviving The Fight For Single Payer," he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that "...the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies." Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: "In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We're not making refrigerators. We're dealing with human beings, who are way more complicated than refrigerators on an assembly line."

Rep. McDermott - an advocate for Single Payer for decades - further wondered if hospitals will become "too big to fail" as they continue to merge and buy up private practices, and continue hiring younger doctors as salaried employees. Mr. Greider also made the following revelation: "An AMA survey in 2012 found the majority of doctors under 40 are salaried employees." Rep. McDermott sees the troubling direction of this trend, noting that many new doctors "...will simply be serfs working for the system," and Mr. Greider referred to another key point in the AMA research, noting that "...hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines." Mr. Greider added further insight from Rep. McDermott: "Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures." Even so, Rep. McDermott remains optimistic that stronger health care systems resembling Single Payer will spring up moving forward.

The New York Daily News offered a scathing editorial on December 24th entitled "Can This Patient Be Saved?" in which we were given a blow-by-blow analysis of the devastatingly mishandled rollout of the Obamacare exchanges and the problems millions of Americans have been having signing up for them. The situation was so bad that the deadline was extended until Christmas Eve for those to sign up who wanted their insurance to kick in on January 1, 2014. The CBO projects seven million will sign up in 2014, in addition to the about 1.1 million this year -- well below the Administration's projections. Meanwhile, millions will be losing their current plans due to the mandate. The question of more people losing their insurance than gaining it as a result of the president remaking the "healthcare economy" was also raised in this Op Ed piece.

Key provisions of the bill have already been waived in the past three years since its passage, and an additional postponement of the requirement for companies with fifty or more employees to offer health insurance or pay a tax penalty has now been postponed until 2015.

The individual mandate requiring most Americans to find coverage by April is also waiving penalties for those who had insurance and lost it this year. Most glaring in this critical article is the fact that there is "little reliable" information on who is getting what as far as coverage is concerned, and at what cost. The even larger question is, will those younger and healthier people opt in at all? If not, financially this boondoggle will sink. Obamacare is counting on them.

As the tinkering continues on the ACA, a major architect of this mess has just been rewarded by the president with an ambassadorship offer to China. Senator Baucus, do you not know the meaning of the word "retire?"




_________________________________________
This says it simply.  National Physicians tries to be diplomatic with ACA by stating a few helpful issues addressed, but if you look closely they are not even really addressed.  Shout out to your national pols and your local ones.....ALL OF MARYLAND POLS VOTED FOR THIS PRIVATIZED NIGHTMARE.  Maryland has some Expanded and Improved Medicare for All groups to join!


Medicare for All



We Demand: Medicare for All. Pass H.R. 676, the Expanded and Improved Medicare for All Act.



Whether healthcare is a “right” is a meaningless abstraction. It is an urgent necessity, for lack of which many Americans suffer and die needlessly. Public health insurance must be expanded and made available to all Americans, regardless of age, income or health.

The debate over “Obamacare” (The Affordable Care Act) has been misrepresented on both sides. Supporters claim it makes coverage universal, failing to mention its failures to contain costs or protect Medicare. Critics call it “rationed care,” failing to justify the more egregious rationing by private insurers.

Obamacare does contain several components which are highly valuable to the American people – including the mandate to insure without prejudice those with pre-existing conditions, and the new insurance exchanges. Wall Street and the GOP are eager to destroy the act on this basis alone. Anything that is good for the American people is bad for Wall Street.

However, Obamacare represents a continued bailout of the private insurance industry. Rather than expanding public programs, it offers  public subsidy for private insurance, forces uninsured individuals to buy private insurance, and fails to control costs or defend Medicare, America's only truly public insurance program.

What we demand is not mere “universal coverage,” but a system that is affordable and available to all, without regard for the profit motive of the private insurance industry. The only system that fits the bill is to expand and improve Medicare for all Americans.

Quick facts*
  • Administrative costs – including underwriting, advertising and executive/shareholder compensation – consume 31% of US health spending.
  • Simply eliminating these costs (over $350 billion annually) would create enough revenue to cover all uninsured Americans.
  • “Single-payer” systems like that in Canada operate at far lower costs per capita, and provide better access to health care and better health outcomes than in the US.
  • Taxes already pay for over 60% of US health spending, with business paying less than 20%.
*From Physicians for a National Health Program

Our Demand
  • Medicare for All. Pass H.R. 676, the Expanded and Improved Medicare for All Act.
  • Universal, comprehensive coverage
  • A single national insurance plan with regional administration
  • Free choice of providers
  • No out-of-pocket payments
  • Funding will come from a modest, progressive payroll tax, supplemented by revenue from a 1% Wall Street Sales Tax
- See more at: http://www.taxwallstreetparty.org/program/medicare-all#sthash.e7xdbiCw.dpnB9uTE.dpuf
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    Cindy Walsh is a lifelong political activist and academic living in Baltimore, Maryland.

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