Category: Medicaremedicaid

August 29th, 2014

8/29/2014

THE INSURANCE INDUSTRY IS THE NEXT VEHICLE FOR PREDATORY FRAUD AND GUTTING OF PUBLIC WEALTH. FOR OVER A DECADE CONGRESS HAS LOOSENED POLICY TO ALLOW INSURANCE CORPORATIONS TO OPERATE LIKE BANKS WITH THE MONEY THEY COLLECT. THEY ARE NOW USING THEM WITH LEVERAGING SCHEMES AND COMPLETE DISREGARD TO THE SAFETY OF YOUR FUNDS. A CRASH IS COMING THAT WILL CAUSE THESE CORPORATIONS TO GO INTO BANKRUPTCY JUST AS AIG INSURANCE DID IN 2008. PLEASE CONSIDER THAT PLACING YOUR MONEY IN THESE POLICIES WILL RESULT IN THE SAME FRAUD AND USE OF FUNDS AS FODDER AS HAS HAPPENED WITH OUR PENSIONS.

IFAwebnews.com > National >

P&C industry enjoys portfolio boost from soaring stocks in 2013

P&C industry enjoys portfolio boost from soaring stocks in 2013
By IFAwebnews Staff Posted: May 30, 2014

When Republican pols say they are going to rebuild oversight and accountability they mean they are going to stop all that Food Stamp or pension fraud by employees faking injury. They do not mean they are going to stop the billions of dollars in corporate fraud from corporate fleecing of consumers and policy holders. Neo-liberals simply say nothing and let it all continue because their goal is to empty government coffers to restructure for Trans Pacific Trade Pact and global tribunal rule.

I have shown so much data that shows the billions of dollars in corporate fraud and yet this corporation working for the insurance industry states that 90% of insurance fraud is by the consumers or 'non-professional' fraudsters. That's the 99% for you and me. Given that most Americans were pushed into poverty with last decade's massive corporate fraud, no doubt some average Americans are looking for ways to survive the stagnant jobless economy. Insurance corporations might want to join the fight to get rid of neo-liberals and neo-cons so we can rebuild a domestic economy and citizens have jobs to and consume.

Insurers continue to count the cost of soaring fraud

July 2012 Experian Identity and Fraud

'The vast majority of fraud – more than 90 per cent - is being carried out by consumers or ‘non-professional’ fraudsters, so-called first-party fraud'.

Below you see what is really happening----insurance corporations are creating reasons to get rid of all consumer protections regarding policies that create some level of cost protection.
You will notice that this article refers to pushing the cost of business onto Medicaid and the public as does health care reform. Yet another move to send most Americans to Medicaid-level of care for all health care.

Is insurance fraud causing auto No-Fault premiums to rise, or are insurance companies price-gouging and trying to hide the truth?

February 20, 2012 by Steven Gursten

Insurance lawyer says truth is not what the insurance industry would like public to believe

There is a lie being spread by the auto No-Fault insurance industry in Michigan -- a lie that our auto insurance premiums are more expensive due to insurance fraud.

This from an insurance industry that is making record-breaking profits– and on the heels of a $1 billion raise. The insurance industry would love to divert attention away from its own profits and find something – anything – to blame the cost of our premiums on.

In a recent press release from the Property Casualty Insurers Association of America (PCI), the group stated that fraud is “forcing” drivers into paying more for their auto insurance, especially in states like Michigan:

Soaring medical bills, high attorney fees and rampant fraud and abuse are forcing drivers in (several of the nation’s largest states including Michigan) to pay significantly more for auto insurance than they should,” said Paul Blume, senior vice president of state government relations for PCI. “Over the last several years, fraud rings and abuses of the system have cost consumers over $1.6 billion in New York and Florida alone. This amounts to a “fraud tax” on hardworking citizens and the cost trends in these states are unsustainable.”

This fraud and abuse argument couldn’t be farther from the truth. The insurance industry always lumps Michigan into its paint-with-a-broad brush approach. Yet the insurance industry has not produced actual cases of No-Fault insurance fraud in Michigan.

Yes, there have been widely publicized abuses occurring in other states. Yes, I will be the first to say there are some No-Fault insurance lawyers who are too aggressive today, and from time to time I blog about these excesses as well.

But unlike what is happening in some states, in Michigan the insurance companies are making record-breaking profits. In other words, the real cost driver of auto insurance remains an insurance industry that is almost entirely unregulated in what it can charge Michigan drivers who are forced by law to purchase No-Fault insurance.

Want to really curb insurance fraud? I’d start with empowering our insurance commissioner to regulate clearly excessive premiums that insurance companies charge here in Michigan. And then watch the cost of No-Fault insurance premiums plummet.

There is no reason why insurance companies should make more money off the backs of Michigan drivers in this state than they do in any other state in the US.

And fraud goes two ways. If we are really serious about fraud, then why not start tackling the insurance company IME industry of cut-off doctors that find nothing wrong with anyone, and that always deny people their PIP benefits, no matter how serious the injuries? THAT'S WHAT WE ARE TALKING ABOUT!

There will always be accusations by the insurance industry’s spin doctors, but so far these accusations have been without any factual support. In fact, this report from the National Crime Insurance Bureau puts Michigan at the lower end of questionable claims.

Let’s control excessive insurance industry profits before we pass No-Fault “reform” Meanwhile, this same insurance industry wants to increase profits even more. There is a huge push by the insurance industry for No-Fault “reform” that would eliminate vital insurance protections. In exchange for the suggestion of lower premiums (they refuse to promise), drivers would be able to choose lower amounts of PIP insurance coverage that provide limited No-Fault (PIP) benefits – including levels clearly insufficient if someone is seriously injured in a car accident, truck accident or motorcycle accident.

These auto accident victims would simply be pushed onto Medicaid. And taxpayers will be stuck footing the bill.

So while the deep-pocketed insurance industry is aiming to take away our most important insurance protections – touted by the insurance industry itself as the best No-Fault system in the nation — I’d look to the insurance industry first as the reason why our No-Fault insurance premiums are so expensive.

It’s not because there’s rampant insurance fraud in Michigan. And it is not because of the cost of medical care or No-Fault attorney fees, as the insurance industry spin-doctors would like us to believe.

It is because, again, Michigan is one of the only states that does not allow our insurance commissioner the power to regulate excessive profit-gouging by our own auto insurance companies. To put it simply, our insurance is high because the insurance industry makes it that way, in order to charge more and make higher profits in Michigan than in any other state in the country!

- Steve Gursten is one of the nation’s top insurance attorneys handling auto accident lawsuits. He is head of Michigan Auto Law and president of the Motor Vehicle Trial Lawyers Association. Steve frequently writes about Michigan auto insurance and insurance company abuse, and is available for comment.

Related Information:

Help save Michigan No-Fault: Write your representatives

Charade over “savings” from Michigan No-Fault “reform” has finally stopped

Michigan No-Fault insurance resource center

Michigan Auto Law is the largest law firm exclusively handling car accident, truck accident and motorcycle accident cases throughout the entire state. We have offices in Farmington Hills, Detroit, Ann Arbor, Grand Rapids and Sterling Heights to better serve you. Call (888) 996-0279 for a free consultation with one of our Michigan insurance attorneys.
__________________________________________

This is a great article written last decade by New York's Attorney General Spitzer known to be actually fighting for corporate responsibility at the time. This shows the degree of fraud and corruption that existed before the economic crash of 2008------everyone knew AIG insurance corporation was loading itself with fraudulent debt----and it shows what exists today as no attempts to change this environment have happened. In fact, neo-liberals Obama and Congress are making it worse.

So, when insurance corporations paint consumers as driving fraud in order to hide profiteering and fraud by these very corporations-----you have a free-for-all as regards Rule of Law and accountability. The American people are being required by law to buy these No Fault Insurance plans-----or with Affordable Care Act----the Catastrophic Care policies with rates that just keep rising. You cannot escape them unless you opt out of driving and/or accessing health care.......WHICH IS THE POINT.

I actually cried when Spitzer was brought down with prostitution charges. You can believe these charges came to light to get rid of him although his behavior was unexcusable. The point now is that this corporate fraud is going to soar with Trans Pacific Trade Pact seeking to end all US Constitutional rights of WE THE PEOPLE.

This is only a partial post of this article----you should check out the whole article.

State Attorney Generals And Other Agencies ?Investigate? Insurance Industry "Widespread Fraud And Corruption" Charges

Extent Of Government Agencies Insurance Industry Investigations, Results
[Notes: the "Headlines" lists (below) tell the extent of the investigations for each agency.
"Articles Library" following the headlines lists (farther below) includes the articles full text.]

Introduction - AGs Investigations, Results (various states)

On October 14, 2004,

NY Attorney General Eliot Spitzer Announced A Lawsuit Brought Against Marsh & McLennan Companies, "The Nation's Leading Insurance Brokerage Firm", For "Fraud, Bid-rigging and Antitrust Violations". The following Major Insurance Companies AIG, Hartford, ACE, and Munich American Risk Partners" were named in the Complaint as Participants." AG Spitzer said, "The insurance industry needs to take a long, hard look at itself." "If the practices identified in our suit are as widespread as they appear to be, then the industry's fundamental business model needs major corrective action and reform." "There is simply no responsible argument for a system that rigs bids, stifles competition and cheats customers," he added, "alleging that it steered unsuspecting clients to insurers with whom it had lucrative payoff agreements, and that the firm solicited rigged bids for insurance contracts." "The Attorney General's office has uncovered extensive evidence showing that it distorts and corrupts the insurance marketplace and cheats insurance customers." "Marsh, at times, solicited fake bids" "even as it claimed in public statements that its "guiding principle" was to always consider its client's best interests." The "immediate victims of the illegal practices were ... mainly large corporations seeking property and casualty coverage, but also small and mid-size businesses, municipal governments, school districts and some individuals." In a press conference, Attorney General Spitzer indicated, as referenced by the title of his Press Release, "Investigation Reveals Widespread Corruption In Insurance Industry", that as the investigation continues, it could proceed further into property & casualty, expand into auto, health and other areas of insurance. "Trust me," Spitzer said upon filing his complaint against Marsh, "this is Day 1".

Introduction - National Association of Insurance Commissioners (NAIC) and States Departments Of Insurance (DOIs) Investigations, Results (if any) [also includes other related state and federal agencies as may be applicable].

It Is Proven Extremely Doubtful For Most DOIs, If Any, To Investigate Or Take Real Criminal Action Against Insurance Companies That They Are Supposed To Regulate, Which Historically They Have Had A Warm And Cozy Relationship With For 150 Years. If Ever, There Has To Be A Legal Action Taken And/Or Criminal Conviction First Before DOIs Might Take Any Meaningful Action, If Any, ... And That Is To Justify Their Reason For Being. Instead state DOIs' do occasional "Market Conduct Examinations" which is no more than fluff for the Press and to deceptively show state citizens that they are supposedly doing their jobs and to justify their Agency's reason for being and to protect their jobs. EXPECT the usual politically correct announcements of alleged cooperation with state Attorney General Probes, an alleged task force set-up to investigate that we will never hear from again ... and then, even after Attorney General investigations and criminal prosecutions take place, expect no actions from the state DOIs and NAIC. This section nonetheless will cover their deceptions and announcements of their intent to cooperate with state Attorney General probes (esp. as they have all of the state insureds complaints, etc.) even though they won't share these files or information or ultimately will not cooperate with their state Attorney General's investigation ... this section also includes comments, studies and reports from FBIC and outside industry experts.

Unfortunately, based on decades of industry knowledge and experience, one should not expect any meaningful new investigative or prosecutorial results from the NAIC or state DOIs with exception of a token prosecution from a few states DOIs … who know in cases that if they don't prosecute, NY Attorney General Spitzer's office will. Otherwise, expect "the usual deception, cover-up, well disguised lack of 'real' and 'meaningful' cooperation or actions in most if not all cases. Expect their appearances of going through the exercises to satisfy the media, possibly a few meaningless fines from insurance companies which usually each state DOI gets to keep, along with a meaningless company warning or reprimand and/or temporary suspension of an employee (with pay) ... But in the whole grand scheme of things, any actions will be meaningless and have no measurable effect or contribution toward reform and the final results ... in fact expect just the opposite and maintenance of the status quo.

The truth of the matter is the NAIC’s and state DOIs’ historical record of duplicitous rhetoric, consistently staunch, pro-insurer allegiance and secretive anti-consumer positions being well disguised to the contrary for decades as they deceptively continue to portray themselves as champions of the consumer and protectionists of the people. This deception has been well maintained under a strict industry non-transparent cloak of secrecy tightly hidden behind a wall of silence made possible by decades of successful industry legislative lobbying affording them unnecessary special laws and an exemption from federal laws that are exclusive only to the insurance industry. Regardless, in the interest of objectivity, FBIC will look to report the announcements along with outcomes and results of the NAIC and state DOI investigations and cooperation with state Attorney General offices which NONE are expected ... and then let you be the judge. The investigations are indicated as of this writing and date have just begun ...

The NAIC's and individual states DOIs' past three decades actions and track record strongly indicates a strong biased favoring of insurers versus a near total lack of actions in the protection of consumers from the unscrupulous and unlawful actions by many of the country's largest and most powerful national interstate insurers which are indicated as bad faith insurers. From research, experience and input from the many thousands of Americans, FBIC knows not to expect any meaningful actions or any real cooperation by the NAIC or individual states DOI commissioners and the Departments they oversee. Instead, FBIC expects the usual politically correct press releases from them espousing the same rhetoric and hyperboles in the past, indicating the alleged actions they are supposedly taking to investigate the insurers related criminal activities. According to their alleged usual routine, they will issue these periodic press releases to the media which espouse and give the implication that investigations are underway, active, and ongoing. As usual they hope their press releases will be adequate enough to stave off the persistence of the Press looking for interviews and more specific details. Their preferred modus operandi in between press releases is the exact opposite, that is to run and hide quietly behind their vaulted tightly closed doors and remain as quiet as possible. But when given no choice by a persistent reporter for the Press, their canned routine is to comment only on their last press release, no more and no less. When cornered and really pressured into a corner for comment, the occasional use of the "we never comment on ongoing investigations" appears to be most suitable.

_______________________________________

Below is a stat that has a broad range.....actually most government watchdogs place the amount at $400 billion a year and rising. This amount is staggering and it is why neo-liberals and neo-cons are claiming that the Medicare Trusts will be empty in just a decade. IT WAS LOOTED BY THE HEALTH INDUSTRY AND FRAUDULENT INSURANCE CLAIMS. Then, neo-liberals allowed these same health institutions write the Affordable Care Act privatizing all public health and deregulating and making global corporations of our health care.

Please stop allowing neo-liberals to control the Democratic Party. The people's party is the one that should put protecting public wealth first.

Industry Execs Targeted for Health Fraud
Posted in Health Insurance , Medicaid , Medicare

June 1st, 2011

Health care fraud, especially in the areas of Medicare and Medicaid, is known to be costly. In fact, the government is said to lose between $60 billion and $2 trillion to fraud every year.

We Must Stop the Rampant Fraud in the Health Care Industry

www.huffingtonpost.com/rep-bernie-sanders/we-must-stop...

Jun 29, 2009 · What we have seen over the last several decades is the systemic fraud perpetrated by private insurance companies, private drug companies, and private for ...
_______________________________________

I am shouting about this corporate fraud because it is expanding into insurance industries like LIFE INSURANCE. If you watch free TV the commercials are on Life Insurance corporation after another. They are using the decline in American people's wealth as the scare tactic behind buying LIFE INSURANCE.....you don't want to leave your family with your expense. This is the same industry that used AIG to bring down the economy and take millions of people's homes through the subprime mortgage fraud. We got your house, now come to us to protect you after you die......OH REALLY?????

What they are doing is setting the stage for the exact economic collapse that took AIG into bankruptcy unable to pay its debt and having US taxpayers paying 100% of insurance bets on subprime mortgage loans. Only this time, it will be Life Insurance. They are taking all that equity you and I are paying each month and using it to leverage 1,000 times what they can afford and guess what? AN ECONOMIC COLLAPSE IN THE BOND MARKET IS JUST AROUND THE CORNER. They will be taken into bankruptcy with your equity disappearing.

NEO-LIBERALS IN CONGRESS ACTUALLY PASSED LEGISLATION ALLOWING INSURANCE CORPORATIONS TO ACT AS BANKS WITH THE POLICY INSTALLMENTS----LEVERAGING BEYOND WHAT CAN BE COVERED.

ALL OF MARYLAND'S POLS ARE NEO-LIBERALS AND NEO-CONS.

This is a partial clip of a great look at how the insurance industry is being allowed to become as entwined and leveraged as the financial industry creating the same conditions of too-big-to-fail and propensity to collapse.

Systemic Risk and the U.S. Insurance Sector

By J. David Cummins and Mary A. Weiss
Temple University

Systemic Risk and the U.S. Insurance Sector

Abstract

This paper examines the potential for the U.S. insurance industry to cause systemic risk events that spill over to other segments of the economy. We examine primary indicators that determine whether institutions are systemically risky as well as contributing factors that exacerbate vulnerability to systemic events. Evaluation of systemic risk is based on a detailed financial analysis of the insurance industry, its role in the economy, and the interconnectedness of insurers. The primary conclusion is that the core activities of the U.S. insurers do not pose systemic risk. However, life insurers are vulnerable to intra-sector crises because of leverage and liquidity risk; and both life and property-casualty insurers are vulnerable to reinsurance crises arising from counterparty credit exposure. Non-core activities such as derivatives trading have the potential to cause systemic risk, and most global insurance organizations have exposure to derivatives markets. To reduce systemic risk from non-core activities, regulators need to develop better mechanisms for insurance group supervision.

By way of preview, the analysis suggests that the core activities of insurers are not a major source of systemic risk. However, there are several sources of exposure to intra-sector crises, which could potentially spill over into the broader economy if sufficiently severe. For example, a substantial proportion of insurers have very high exposure to one or a few reinsurance counterparties, suggesting the possibility of a reinsurance spiral that could lead to substantial financial deterioration. In the life insurance industry, the high leverage of the life insurers, exposure of surplus to reinsurance defaults, and insurer investment in mortgage backed securities raise concerns about sectoral stability.

MEANWHILE-----

While they are leveraging themselves to the point of collapse-----they have a new revenue source-----SELLING YOUR PERSONAL INSURANCE DATA....a profit bonanza. So, too-big-to-fail and emergency bailouts with bankruptcy clearing all that need to pay consumer LIFE INSURANCE policies and VOILA-----you have AIG all over again.

THAT'S WHERE NEO-LIBERALS AND NEO-CONS ARE TAKING US!

All of that data you send in that is supposed to be confidential? FORGET ABOUT IT-----IT IS EARNING INSURANCE INDUSTRIES BILLIONS OF DOLLARS AS A PRODUCT.

How the Insurance Industry Should Leverage Big Data

Posted February 27, 2014

The Insurance Industry generates vast amounts of data, from legacy systems, call centre dialogues to customer records and it is multiplying rapidly. It is time for the insurance companies to start getting access to all this available data and start analysing it. In this video, Laura Hay – National Leader Insurance KPMG, talks about the massive potential of Big Data, Mobile and Predictive Analytics for the Insurance industry.

0 Comments

August 08th, 2014

8/8/2014

0 Comments

'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.

0 Comments

July 15th, 2014

7/15/2014

0 Comments

I spend time talking about labor and unions in a State of Maryland that is not union-friendly because whether Republican or Democratic voter-----it is unions that will be able to counter the power of global corporations. Republican Party used to be a supporter of unions and needs to come back to this. I qualify my support with the fact that we need to rebuild our union leadership and models as they are currently often tying themselves to what neo-liberal politicians tell them to do.

PLEASE TAKE THE TIME TO CONSIDER THESE LABOR ISSUES NO MATTER THE SUPPORT OF UNIONS. CITIZENS CAN SUPPORT UNIONS WITHOUT BEING A UNION MEMBER AS THE WORKPLACE LAWS WON BY THE UNIONS OF LAST CENTURY BENEFIT ALL!

Check out this Facebook page: the movement is growing!

US Uncut
June 30 ·

The Trans-Pacific Partnership is a corporate trade deal that places profits over everything and would affect half of humanity, but the mainstream media refuses to cover it at all.

Share to break corporate media's censorship.

I want to make clear, it is not only the working class and poor being driven deeper into poverty. The middle-class employee is feeling it as well. I spoke of public universities now filled with part-time adjuncts and we are watching as nursing staff and other medical employees with strong middle-class salaries feeling the cuts of Affordable Care Act reform. Post Office employees were strongly middle-class as were MTA bus drivers and all are under attack from privatization. Doctors know they are next as their profession becomes a cog in a profit-driven system. The problem is global corporations having complete control of our US and state economies. Ending that power is the solution to protecting all US workers AND IT CAN BE DONE!

WE NEED EVERYONE ENGAGED IN POLITICS----RUN OR ADVOCATE!

It is a bad sign for democracy when US universities attack the very professors who for centuries were the ones charged with holding power accountable. Taking away tenure and making professors predominately adjunct was meant to kill political activism on US university campuses.....and is why there is silence today. I am glad to see the movement below.

Wednesday, Feb 19, 2014, 3:10 pm
UIC Faculty Rekindle Fight for Public Education With Historic Strike

BY Rebecca Burns
University of Illinois----Chicago

As a tenured professor at the University of Illinois-Chicago (UIC), Josh Radinsky never expected to participate in a strike—or to see so many of his colleagues ready to do the same. “I’ve never seen anything like it. It’s like a ghost town today,” Radinsky marveled as he and a group of colleagues picketed outside an empty academic building yesterday morning.

Tuesday marked the start of an unprecedented two-day walkout staged by UIC United Faculty (UICUF), the union that represents more than 1,100 tenure-track and non-tenure-track faculty members at the state university. Strikes by university professors are a rare occurrence: The first of its kind at UIC, the faculty strike is also one of only a handful at U.S. colleges and universities during the past five years. Since gaining recognition in 2012, though, UICUF has been locked in a stalemate with university administrators over its first contract. In December, faculty members voted overwhelmingly to authorize a strike if progress wasn’t made at the negotiating table.

This week, the union made good on its threat: Faculty members walked out of their offices on Tuesday morning, fanning out into picket lines across campus.

Though the sight of picketing professors may be novel, it’s become increasingly evident to many that the union and administration were coming to loggerheads. As Radinsky, who’s taught for 14 years in the university’s College of Education, says about the strike, “This needed to happen—I think it’s about time.”

As it’s geared up for a strike, UICUF’s central contention has been that the university is not as cash-strapped as it claims to be. The union argues, based on reports of auditors and bond ratings, that UIC has more than $500 million in unrestricted reserves. And during the past five years, according to UICUF, even while the school has deferred faculty raises and withheld other benefits in the name of tough fiscal times, it has also increased the number of administrators by 10 percent.

Though the union says that some progress has been made during negotiations on non-economic issues such as academic freedom, the two sides are still sorely at odds about pay and benefits. Specifically, UICUF has put the penurious conditions of non-tenure-track (NTT) faculty at the center of its struggle: NTT faculty members currently make a minimum of $30,000 annually, and the union is demanding a $45,000 wage floor. Though the university offered $36,000 in its most recent counter-proposal, union negotiators say this does not constitute a good-faith negotiation.

“We don’t see that as an actual compromise,” says John Casey, a non-tenure-track lecturer who is a member of the union’s bargaining team. Casey teaches a freshman writing course and says his low wages impact his ability to give his students the attention they deserve. He says he’s had to take a string of outside jobs, including a recent one as a bicycle tour guide, to make ends meet while teaching at UIC.

For its part, UIC maintains the union’s proposals for tenure-track faculty would lead to a 23 percent hike in costs for the university; its proposals for non-tenure-track faculty would increase costs by 27 percent. “A work stoppage or strike is not in the best interest of the faculty, the University, or our students,” the university said in a statement issued last week on its website. “However, under Illinois law, educational employees in a bargaining unit without an applicable no-strike clause in a contract have a right to strike. Each professor or instructor has the right to strike, or to work.”

The UIC strike represents a new height of coordination between tenured and non-tenure-track faculty, who often bargain contracts separately and sometimes see their interests as divergent. As I’ve reported previously, UICUF has found a unique way to maintain solidarity between the two groups. In 2011, the university successfully blocked tenure-track and NTT faculty members from forming a single bargaining unit—a move union activists say was an attempt to “divide and conquer.” But the two groups have maintained the same core demands and the same bargaining team, operating as a unified group even though they must ultimately bargain two separate contracts.

Though the last major wave of faculty unionization took place in the 1970s, labor organizing in the academy is on the rise again. A surge of organizing among adjunct professors during the past year has won new, adjunct-only unions at several private universities, including Tufts University in Massachusetts. This resurgence is “a direct outgrowth of the large increase in the use of low-paid contingent faculty,” says William A. Herbert, a distinguished lecturer at CUNY and executive director of the National Center for the Study of Collective Bargaining in Higher Education and the Professions.

However, he notes that the labor action at UIC is fairly unique because of the “apparent [tenure-track and NTT] faculty unity and prioritization for improving the working conditions of contingent faculty.”

Casey, who was an adjunct activist even before UIC unionized, tells In These Times that he was initially uncertain whether working with tenured professors would be the best path to improvements in his own conditions.

“I was skeptical when we first started about how the relationship would work,” says Casey. “[But] our tenure-track faculty have been amazing allies.” Among the benefits of working in conjunction with tenured faculty, he says, is that the most vulnerable faculty members may be shielded from retaliation. “I mean, my boss was out here today on the picket line,” Casey notes. “That’s pretty remarkable.” (Department heads at UIC are not included in the union, but many have expressed support for the strike.)

Many labor activists are hailing today’s walkout as a historic development whose impact could extend beyond Chicago. For example, faculty members at the University of Illinois Urbana-Champaign (UIUC), the flagship campus in the state system, are currently in the midst of their own union drive. And many of those professors have their eyes on UIC as a bellwether for the rest of the state.

Given the expanding ranks of NTT faculty at Urbana-Champaign, UICUF’s ability to secure a higher wage floor for equivalent positions at UIC “would be a huge boost for us here,” Susan Davis, a professor in the Department of Communication at Urbana-Champaign and a member of the pro-union Campus Faculty Association, tells In These Times via e-mail.

Davis also points out UIC higher-ups could be taking a hard line in contract negotiations with UICUF in an attempt to stem the tide toward faculty unionization at other campuses. “We think the administration is playing hardball with UICUF in part because they could set a dramatic precedent for the University of Illinois as a whole,” she continues.

Spokespeople for UICUF estimate more than 1,000 faculty members participated in the first day of the strike and that about half of all classes were cancelled. More than 200 people, including students, attended a midday rally on Tuesday. The group chanted, “Chop from the Top!” and “No Contract, No Peace!” while many marched with distinctly professorial picket signs, such as “I Teach, Therefore I Am (Exploited)” and “The Inductive Method: No Contract, No Work!”

Campus service and maintenance workers represented by SEIU Local 73, who are in the midst of their own contentious contract negotiations and could strike in March, also came out to demonstrate solidarity.

“We’re hoping that this will show us a way towards a stronger contract,” says Michael Schmitt, a member of the union’s bargaining team, who says the $13 to $17 an hour wages in Campus Parking Services aren’t enough for him and his co-workers to make ends meet. Though other campus unions have clauses in their contracts that prohibit them from striking in solidarity with faculty, many still attended pickets during their free time on Tuesday.

Faculty strikes are distinct from those at other workplaces in that they don’t actually cut into the university’s bottom line—though they can disrupt day-to-day business on campus, students have already paid tuition for the classes being cancelled. Therefore, faculty strikes are most often a short-term, symbolic tactic aimed at gaining public attention and support, says Herbert.

UIC faculty members insist, however, that their two-day walkout is a warning to the university before bargaining sessions resume again on Friday. “We’re out here today to show urgency,” says Casey. “If we don’t see any progress ... we will go out on indefinite strike.”

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

Wednesday, Apr 30, 2014, 8:10 pm

College Adjuncts Union Scores Victory at Maryland Institute College of Art

BY Bruce Vail Email Print MICA adjuncts celebrate after filing their petition to unionize. (SEIU 500)

BALTIMORE—Part-time college faculty members at the historic Maryland Institute College of Art (MICA) scored an impressive win on Tuesday when they voted overwhelmingly to bring a labor union on campus for the first time since MICA’s opening in 1826.

_______________________________________________

When I speak of shareholder class this article does a good job showing what this means. You and I may have pension funds but with boom and bust of bubbles lose most of what we gain every five years. This is not really being a shareholder. Neo-liberals and neo-cons work for the shareholder class and that is at most 5% of the US population. Also, you can see how the people controlling these global corporations are increasingly becoming the same 1% and-----the banks.

So, labor has to fight across industry and not only for one corporation. I shout out that we do not want labor unions taking the structure of global corporations as they expand overseas to organize and that is what we are seeing. Demand your labor union works locally and remains controlled locally. It is this International status of unions like the AFL-CIO and SEIU that has them paired to neo-liberal pols.

UPS, FedEx owned by most of the same monopoly banks

Highlights the need for industry-wide organizing, unionizing FedEx workers
By Dave Schneider and Dustin Ponder

Jacksonville, FL – Despite ‘competing’ as the world's two largest parcel delivery and shipping companies, UPS and FedEx are owned by many of the same banks. According to NASDAQ's ownership summary of both companies, 12 of the top 20 owners of UPS and FedEx are the same banks, investment groups and financial institutions.

Both multi-billion dollar corporations are under 'institutional ownership', which means that a majority of their shares are owned by financial institutions, banks and other large monopoly corporations. According to NASDAQ's ownership summary of UPS on April 11, nearly 71% of UPS shares are owned by institutions. FedEx, a smaller company than UPS, actually had greater institutional ownership, with 83.94% of the company's shares owned by institutions, according to NASDAQ.

However, most of the largest institutional owners of both UPS and FedEx have substantial interests in both companies. For instance, Vanguard Group Inc., a Pennsylvania-based investment bank that manages nearly $2 trillion in assets, is the single-largest owner of UPS and the third largest owner of FedEx. Vanguard Group is a massive financial institution that boasts the largest ownership in many other large, well-known corporations including Apple, Exxon Mobil and Microsoft.

Primecap Management Company, based in Pasadena, California, is the largest owner of FedEx, holding nearly 19 million shares of the shipping company, according to NASDAQ. However, Primecap is also the 16th largest owner of UPS stock, holding more than 6.3 million shares, also according to NASDAQ.

In all, 60% of the top 20 owners of both UPS and FedEx are the same banks, investment groups and financial institutions.

Institutional ownership is incredibly common among the largest 500 publicly traded companies.

Despite this fact, companies like UPS stress to workers the need to “compete” against rival workers in their industry, like those at FedEx. UPS's collective bargaining agreement includes an entire article on competition that states: “The Union recognizes that the Employer is in direct competition with…other firms engaging in the distribution of express letter, parcel express, parcel delivery, and freight, both air and surface.”

The company leverages this poison pill of competition to justify subcontracting union work and undermining union standards. It creates an adversarial relationship between workers of UPS and FedEx, when in reality the owners at the top are united in extracting the most profit possible from workers at both companies. When the owners of UPS and FedEx are one in the same, ‘competition’ means which management team can exploit their workers the most and extract the most profit for the banks that own the whole industry.

A prominent argument used by UPS claims that workers must accept concessionary contracts to remain ‘competitive.’ They argue that employing tried-and-true militant tactics, like striking as the Teamsters did successfully in 1997, will result in FedEx stealing UPS’s customers. Historically, the union movement addressed this by organizing entire industries, instead of single worksites or employers. This meant one industry, one union, and at times - one contract. At its best, this method of organizing and bargaining takes wages out of competition and sets industry-wide standards to prevent subcontracting and a race to the bottom through ‘competition.’ Tactically, if the 1% owners of both brands are united, then to combat them and win, workers across the entire industry must also unite.

The attempts of the International Brotherhood of Teamsters to organize FedEx have been foiled by U.S. labor law, which misclassifies workers and stifles their ability to unionize. FedEx Ground drivers are misclassified as independent contractors and are legally barred from union representation, even though in practice, they are effectively workers directly employed by the company. FedEx Express drivers are also misclassified under the Railway Labor Act (RLA), as opposed to the National Labor Relations Act. The company claims their employees are ‘airline’ workers, and thus would need to unionize nationally all at once. The RLA also places many more restrictions on workers’ rights, including the ability to strike. It also forces the workers into binding arbitration, which often serve the interest of the boss instead of the workers.

The banks and financial institutions that own both UPS and FedEx are united in their push for lower wages, part-time poverty jobs, fewer benefits and weaker contracts. To effectively fight their race to the bottom, union workers at UPS must organize FedEx workers, regardless of the legal fictions created by politicians in Washington.

Dave Schneider and Dustin Ponder are both rank-and-file Teamsters and members of Part-Time Power at UPS, which is a national group for UPS part-timers.

______________________________________________
All across the nation nurses have been out protesting the most of any union. They are on the front-lines of the Affordable Care Act and the Obama/neo-liberal cuts of almost $1 trillion from Medicare. We all know those cuts were allowed to be designed by health corporations and hit the patient access and health industry labor.....nurses for one. If health industry and education industry are going to be drivers of the 21st century economy then driving these groups to poverty is not a solution for a healthy economy or quality health service. It's not meant to be say neo-liberals----it's all about the corporate profits!

Did you know there is actually growing unemployment for nursing after decades of being told there were shortages? So much for this 'growth' industry. It is a combination of staff layoffs and importing immigrant labor to work in the health field that has this strong middle-class employment under attack.

In Baltimore, it is Johns Hopkins who makes a living recruiting foreign health care workers to the US to replace US workers and they do it to exploit these immigrant workers. I have a friend who works in Hopkins' research labs from the Middle East who says she is simply used to do the most mundane of lab work-----the assembly line of lab research and has no chance of anything better. She will leave to return home after being assured a good life in America. Meanwhile, Baltimore has 50% unemployment in the black community and 36% in the general community. It is these policies that have to go and these situations permeate the health industry.

We thank the nurses unions for shouting out for patients rights and fighting for labor justice!

Private equity firms are being handed all public health especially in Maryland and not coincidentally fraud and corruption is soaring!

Using the excuse of Medicare budget cuts was the plan for dismissing staff and creating a structure for maximizing profits. Remember, the Medicare Trust is low because these same health institutions spent a few decades robbing it through fraud.

' at a time when more health care is shifting from in-patient to outpatient services'.

The Affordable Care Act is about denying most people the ability to access the most basic of medical procedures and private equity firms say----get used to it because people will be getting the only care they can afford at home.

Nurses walk out at Quincy Medical Center

By Robert Weisman and Jessica Bartlett | Globe Staff and Globe Correspondent April 12, 2013

QUINCY — Hundreds of nurses marched in a drizzly chill Thursday, carrying signs, waving union flags, and drumming on plastic bins in a 24-hour strike to dramatize their complaints about staffing levels they say compromise patient safety at Quincy Medical Center.

They called in big political guns, notably US Representative Stephen F. Lynch, the South Boston Democrat who is running for US Senate, at a noon rally. They even rolled out an inflatable Cerberus, the three-headed dog that guards the gates of the underworld. The private equity firm that owns the hospital’s parent, Steward Health Care System, is named after the mythical creature.

“The dog came out of retirement,” said David Schildmeier, spokesman for the Massachusetts Nurses Association, who said the hellhound’s only previous appearance was at a protest last year outside the New York headquarters of Cerberus Capital Management, which formed the Steward hospital and doctors group in 2010.

Inside the hospital, doctors and administrators said it was largely business as usual — except that they canceled elective surgeries for the day and brought in about 60 replacement nurses. They also hired trucks with billboards proclaiming the union was living in the past. Nurses stood in the street trying to block the trucks and attach their own signs to the vehicles.

“In today’s economy, nurses sitting by empty beds making $52 an hour is not feasible,” said Daniel Knell, who took over in 2011 as president of Quincy Medical Center.

Barry Chin/Globe Staff

Dr. Nissage Cadet (left) and hospital president Daniel Knell discussed the strike.

At the end of the day, nothing was resolved. Nurses were set to return to their jobs Friday morning without a contract. And there was no agreement between the two sides on the basic facts of what prompted the unusual one-day strike. While the nurses cited inadequate staffing, management insisted the union was pushing for higher wages and benefits.

The walkout took place against a backdrop of looming cuts in government funding for Medicare and Medicaid, the public insurance programs for older and low-income people.

“There is a lot of pressure being put on the hospitals,” Lynch told more than 200 nurses and their supporters. “The reimbursement rates are not there. They are being put under pressure to reduce costs, and they are looking at making nurses work longer hours with fewer nurses on staff. That’s not the way we need to be going.”

The strike got underway at 6 a.m., when unionized nurses walked out of the hospital to join nurses from Norwood Hospital, Morton Hospital in Taunton, and other Steward-owned and nonprofit hospitals who came to show their support.

“We need to bring it to the community to support the issues,” said Paula Ryan, a recovery room nurse at Quincy Medical who chairs the union local. “It’s been a long time coming. It’s been a struggle every day, nurses trying to provide the better care.”

Regulators from the state Department of Public Health showed up before dawn to make sure replacement nurses were certified and had been trained by hospital officials. A contingent of Quincy police officers — paid for by Steward — kept watch at the protest. “The financial impact for today alone is exceptional,” Knell said. He warned the hospital could be hurt further if patients chose to go to competing hospitals in Boston, Milton, or Weymouth because of what he said were false charges of safety problems.

“If the community doesn’t support the facility because of the rhetoric, it could do financial damage to us,” Knell said.

Nurses authorized the strike last month after their negotiators failed to reach agreement with Steward on a new contract. Their last contract expired before Steward acquired the bankrupt hospital in October 2011. Through an understanding between labor and management, they have been working under the terms of a separate Steward contract with union nurses at Steward-owned Carney Hospital in Dorchester.

Barry Chin/Globe Staff

A nurse from another Steward hospital waved a sign outside Quincy Medical Center to drum up support.

The union was notified in February that the hospital will close a 40-bed medical surgical floor and lay off 30 nurses who worked there along with 40 technicians, orderlies, and laborers, though the cuts have yet to take effect. Union officials contend that will aggravate already overcrowded conditions, but hospital officials insist there are often empty beds.

Steward and Cerberus executives are more interested in making money from their for-profit community hospitals than caring for patients, union members said. But hospital officials said the Quincy strike was part of a national union effort to inflate wages and keep staffing unnecessarily high at a time when more health care is shifting from in-patient to outpatient services.

“I consider nurses as our colleagues, and I value the work they do for patients,” said Dr. Nissage Cadet, chief of surgery at Quincy Medical Center. “But health care is changing, and that’s the right thing for patients. Steward came in and bailed out a hospital that was about to close in months. The quality of the institution has never been this good.”

On the picket line, however, nurses said conditions have gotten so bad that patients are being “boarded” in the emergency department for long periods while waiting to see a doctor. Department nurse Kathleen LeBretton said such episodes happen two to three times a week.

Hospital officials insisted they only board psychiatric patients in a section of the emergency room while they await transfer to other hospitals because Quincy Medical does not have psychiatric beds.

The nurses were supported by Dr. Robert Noonan, a private practice physician who sometimes works with Quincy Medical Center. “There was a patient last month who was a patient of mine in her 80s,” he said. “The closed surgical floor was full, and she was boarded in the emergency room for 18 hours.”

Hospital officials contended the nurses and their backers were making false claims in an effort to get more money.

“I’ve been a nurse myself,” Knell said. “And when I took my oath to take care of my patients, I meant it. I don’t know that I would ever walk away from the bedside of my patient for financial reasons.”

________________________________________________

These agreements are often small gains for the union members but what is most important is the citizens of the state and communities coming out to say enough is enough. The workers cannot bear any more of the cuts designed to save money to be sent to corporate subsidy rather than people's paychecks.

For those not liking unions we need to remember everyone benefited from the policies built on union activism. It is the only organized group which advocates for workers and I would suggest that what most people do not like about unions has more to do with bad union leaders and not the mission. We need strong labor policy and law enforcement to reverse this wealth inequity and rebuild a healthy economy so everyone should be fighting for these issues.

We do need to see these unions fighting for the losses of the economic crash and fraud----we do not want to simply pretend we are starting again in the 1960s as union members lose these decades of accumulated wealth to corporate fraud and public malfeasance. It is not public sector benefits and wages emptying government coffers---it is the corporate fraud and government corruption.

PROTECTING UNION MEMBER'S WEALTH IS AS IMPORTANT.

Maryland is privatizing its Maryland Transportation Authority piece by piece and are now handing buses to VEOLA----busting wages, benefits and unions themselves all under neo-liberal control of government.

Friday, Apr 11, 2014, 1:01 pm

With Solidarity in Spades, Vermont Bus Drivers’ 18-Day Strike Results in Big Win

BY Jonathan Leavitt

An outpouring of students, community members and allies from other unions turned out to support the strike. (All photographs by Jonathan Leavitt.)

At 6am on March 17, St. Patrick’s Day, 40 bus drivers and a dozen community members defied negative-10-degree weather to picket outside the Chittenden County Transportation Authority (CCTA) bus garage in Burlington, Vt. The action marked the beginning of nearly three-week-long transit strike over concessionary contract demands that would capture the imagination of much of Vermont and culminate in victory.

“Management misjudged us,” said CCTA driver Jim Fouts, speaking to In These Times from the impromptu victory rally on April 3. “We don’t drive together, we don’t have a lunch room to eat together,” said Fouts. But on the picket line, he says, “we turned into icicles together and we started to get to know one another.”

Traven Leyshon of the Vermont AFL-CIO leading Teamsters 597 members and supporters in chants on a negative 10 degree picket line. (Full disclosure: The author was part of the strike's solidarity committee and is a member of the Vermont Workers' Center, which supported the strike.)

After months of failed negotiations and working without a contract since June 30 of last year, drivers voted 54-0 on March 12th to reject CCTA management’s final contract offer. Drivers could not stomach monitoring disciplinary procedures that they saw as “abusive," such as being tailed by supervisors, reviewed via bus videotapes, and suspensions of as long as a month. The added demand that drivers work eight hours over the course of an exhausting 13.5-hour “split shift,” which could be extended through forced overtime to 15 hours, sparked concerns among bus drivers and community members that CCTA management’s demands risked “community safety.”

A new generation of strikers St. Patrick’s Day fell on a Monday, a school day, and the temperature was negative 5 degrees, but at 7a.m., a steady stream of parents dropped off their students to march the picket line. Seventy-one Burlington High School (BHS) students walked the proverbial mile in another’s shoes, shoulder to shoulder with their bus drivers in a show of solidarity that harkens back to a much older, bolder labor movement. The students accompanied the bus drivers every foot of the circuitous 2.3-mile bus route from the Cherry Street picket line to the front office of the high school, where administrators greeted the students with applause and excused absences. The handmade signs students carried would paper the lobby for the duration of the strike.

“This is Vermont, and even record cold temperatures cannot keep us away from supporting the workers of our state,” says Sabine Rogers, a senior at BHS. “Students showed how much they support fair working conditions and how much they support the work that you bus drivers do each and every day.”

“As we started to walk, we went from a fairly quiet group to chanting with a bullhorn and really getting into it,” says BHS senior Henry Prine. “One quiet student told me he doesn’t like loud noises or large crowd, but it was such an incredible experience. He fell in love with organizing in that moment.”

BHS Students on the picket line beside their CCTA drivers.

Prine detailed the prefigurative movement-building BHS students did before the strike. Through his student delegate position on the school board, Prine convinced the body to pass a resolution stating the school district would not hire scab bus drivers to cross picket lines. Prine says that as negotiations broke down and a strike appeared imminent, he began talking with other seniors ("and underclassmen too") about ways BHS students could take an even more powerful public stand. The students drafted a petition calling on CCTA management to meet the drivers’ demands, and Mayor Weinberger and the Burlington City Council to support the bus drivers.” According to Prine, the petition drew more than 500 signatures in one day’s time. “That’s more signatures than people get to keep the hockey program,” he says.

This petition would be presented to Democratic Mayor Miro Weinberger in a March 10 City Council meeting by ten BHS student organizers. Weinberger and his City Council allies had earned a reputation as anti-labor for gutting Burlington’s Livable Wage Ordinance despite popular support for policies to reduce the growing disparity of wealth.

Rogers, motivated by her experience on the strike line, would build out a student carpool in solidarity with drivers, using some dusty ward maps to collectivize students’ overlapping routes to school. In the strike’s final week, students organized teachers to host bus drivers in their classes. Striking drivers presented labor history and origin story of their job action to 80 students in four classes in the three days leading up to the strike settlement.

Rogers believes the experience transformed a culture of alienation at her school. “The solidarity and community and sense of activism that has been such a big player in this whole past few weeks—I definitely see that continuing as part of the atmosphere at BHS,” she says.

‘This is the movement of the people’ Nine days into the strike, the drivers would face a massively heavy lift. With the backing of Mayor Weinberger, eight of the 14 members of Burlington's City Council co-sponsored a resolution calling for the contract negotiations to enter “binding arbitration.”

According to a statement in responde to the resolution by the Vermont Federation of Nurses and Healthcare Professionals (a local of AFT Vermont), binding arbitration decreases the likelihood of a favorable outcome for workers and communities by placing “all decision-making in the hands of a third party, someone with no relationship to the workplace or community directly affected by his or her decision” and who is not accountable for the results.

To speak against binding arbitration, 150 drivers and supporters marched upon the City Council's March 26 meeting, chanting “We are the union, the mighty, mighty union!" After they filed into the chamber, City Council President Joan Shannon informed the crowd that the customary public comment period at the beginning of the meeting would be delayed by a special executive session. At that point, the entire driver solidarity march assembled outside the chamber door and unleashed perhaps the most boisterous rally City Hall has ever seen.

Bus drivers, other unions and community solidarity activists lead a speak-out in Burlington City Hall on March 26.

The hallway and steps leading to City Hall’s second floor and the Mayor’s office were suffused with swelling throng of students, members of United Electric (UE), the Vermont Workers’ Center, the Vermont State Employees Association, Vermont National Education Assocaition (Vermont NEA), the newly formed Vermont Homecare United (a local of ASFCME) and many bus drivers. Loud applause and chants of "What do we want? Fair Contract! When do we want it? Now!" resounded in hallway’s marble and into the City Council chamber in a scene many would compare to the 2011 occupation of the Wisconsin Capitol by pro-union protesters.

"Where is the freedom? Where is the chance?” bus driver Noor Ibrahim, an immigrant from Somalia, asked the impromptu rally. “I was told there is a chance here in this country. Where is the right of the poor people? [CCTA management] are misusing the money of the taxpayers. From now on we have this strike as experience, we don’t need to back down.”

Noor detailed how three years ago his wife was pregnant and “the doctor said the baby wasn’t moving.” He set up an appointment on his day off so he could support his wife, even filling out the vacation paperwork as an extra precaution. Less than 24 hours before the appointment, he said, CCTA’s management told him he would have to work. “When I asked them, they said ‘We don’t care about you, we don’t care about your family all we care about is the bus moving,’ " said Noor.

As drivers continued telling personal stories like these and the raucous rally spilled over into public comment, two of the eight resolution sponsors, Karen Paul and Tom Ayers, pulled their names off. Councilor Paul was evidently moved by the driver’s stories; she introduced a successful amendment to “remove the resolution from the agenda” entirely, adding, “I’ve learned a great deal tonight. If we go forward with the agenda, I’ll remove my name from the resolution.” By the council meeting’s denouement, the focus had shifted from binding arbitration to a discussion led by progressive councilors of whether or not to sanction CCTA management.

“This is the movement of the people,” Nigerian CCTA driver Ade Fajobi told In These Times. “The voice of everybody changed the votes of City Council.”

‘Every step you take on your picket line is our step’ On Saturday, March 29, the 12th day of the strike, an all-night, 18-hour negotiation session broke down, yet again, over CCTA management’s demand to increase drivers’ split-shifts 12.5 to 13.5 hours. “They basically tossed the same pile of dung back in our faces,” said Jim Fouts. In response, hundreds of supporters gathered at Burlington City Hall, beneath a 12-foot wide bright blue banner reading “Work With Dignity” and “Fair Contract Now.” A massive University of Vermont (UVM) feeder march and brass band joined, and Vermont residents lent their voices to the drivers’ cause.

A brass band joins the picket line on the second day of the strike.

“By using your right to strike, you're creating a stronger movement of workers,” said Amy Lester, a member of Vermont NEA and the vice-president of the Vermont Workers’ Center. “Your strength is our strength. Your courage is our courage. Your momentum is our momentum. Every step you take on your picket line is our step. We all have your back, keep fighting and don’t give up.”

To loud applause, FaRied Munarsyah, a Workers’ Center member and 20-year CCTA rider, called for “temporary replacement managers.” Michelle Gałecki of UVM’s Student Climate Culture said, “Livable jobs and public transportation is a green issue, but it’s also a human rights issue.”

“We have been swallowing this pain for the last ten years,” said Noor Ibrahim, from the steps of City Hall, with dozens of CCTA bus drivers behind him. “We cannot live in this hostile environment. We deserve respect.”

Chief Steward Mike Walker, driver Noor Ibrahim, and many more drivers leading the March 29 march.

Just days later, after threatening picket line-crossing scab drivers, CCTA management would finally capitulate. CCTA agreed to a contract with language limiting monitoring and discipline, reducing "forced overtime" to 13.5 hours a day instead of 15, and maintaining drivers’ split shifts at the current 12.5 hours. Though drivers conceded an increase from 13 to 15 part-time drivers, the union was able to win language preventing CCTA from using retirement or termination to reduce the entire bargaining unit slowly to part-time status. On April 3, inside the local VFW’s Eddie Laplant ballroom, drivers voted 53-6 to adopt the new contract.

A growing movement for work with dignity According to James Haslam, director of the Vermont Workers Center, "In the current context of the attack on public transit, the public sector and the labor movement nationally, this is a tremendous victory for work with dignity that benefits all working people in the long haul.”

Indeed, the solidarity unionism that blossomed in Vermont’s late-winter snow could be—like the Chicago Teachers Union, Portland Teachers Union or Boeing Machinists—another harbinger of rebirth for rank-and-file reform movements buttressed by community solidarity.

The successful 18-day job action “really shows what happens when a few people speak out and continue to speak out towards a common goal of having a strong union,” said driver Jim Fouts in the bus terminal, in the afterglow of the victory celebration. “When I first came here the union was weak, because it was a business-as-usual union. Then some activists started saying, ‘This is wrong. We can vote on things. This is supposed to be a democracy.’ And really it was a bottom up movement to change our union.”

According to former drivers Chuck Norris-Brown and Scott Ranney, a reform caucus with the local solidified over breakfasts in local restaurants in the spring of 2009, around a petition circulated amongst drivers that helped win stewards elected by drivers, not merely appointed by Teamsters higher-ups. The caucus, nicknamed the Sunday Breakfast Club, soon began coordinating with Teamsters for a Democratic Union (TDU), a national, independent rank-and-file movement within the Teamsters. In 2011 contract negotiations, Breakfast Club members did the shopfloor organizing and the local outreach to community members and other unions to build public support. "A seed was sown which kept the Teamster Local to the grindstone, and almost all of the community action that resulted in major support for the recent drivers strike was based on earlier Sunday Breakfast Club contacts and strategies," says Ranney, who also believes the caucus empowered rank-and-file members and paved the way for the unanimous rejection of the concessionary contract.

Tearing up, Fouts describes how Local 597 followed the advice of a Labor Notes organizer Ellen David Freidman, to build power and beat back concessions: “ ‘Turn enemies into neutrals, you turn neutrals into activists and you turn activists into leaders,’ ” he quotes. “That’s what we did.”

"We won this fair contract because of our unity and the tremendous support from our community,” says Rob Slingerland, CCTA bus driver and spokesperson for the drivers.

Many drivers, even in the midst of the victory party, said they’d already begun reciprocating the solidarity unionism they experienced from other unions during their strikes. “We were talking about solidarity with other unions before we even went over our contract today,” says Slingerland. He says that drivers have already volunteered to join marches on the boss at Vermont's HowardCenter, a counseling and medical-services center where workers are in the process of unionizing with AFSCME. “We got the help and now we’ve got to give the help," he says. "Vermont is so small, but this movement is so big."

Slingerland described an “umbrella of fear,” his co-workers used to work under and how the victorious strike changed workplace power relations and gave drivers a sense of dignity. “A lot of drivers have discovered the power that they have within as a person,” said Slingerland, “you put that together as a group and you end where we are today, with a victory.”

AFSCME is a sponsor of In These Times. Sponsors have no role in editorial content.

Striking bus drivers lead the March 29th community solidarity march with hundreds of supporters. .

0 Comments

July 08th, 2014

7/8/2014

0 Comments

CORPORATIONS ARE USING PRIVATE NON-PROFITS TO CONTROL PUBLIC POLICY. THEY CAPTURE AN ISSUE AND PROMOTE POLICY THAT WORKS TO THE ADVANTAGE OF CORPORATIONS. IN MARYLAND THE PUBLIC SECTOR HAS BEEN DISMANTLED AND IS REPLACED BY THESE PRIVATE NON-PROFITS. IT IS WHY THERE IS NO PUBLIC VOICE OR CONTROL OF POLICY IN MARYLAND. A DEMOCRAT WOULD NOT ALLOW THIS TO HAPPEN....NE0-LIBERALS AND NEO-CONS ARE DOING THIS!

I have spoken about Maryland's capture of politics centered in the movement away from a strong public sector which has been replaced by private non-profits controlled by corporations that simply place someone as head of the organization that makes sure public policy goes the way the corporations want. In Maryland we have AGAB serving that goal. Johns Hopkins creates and controls most non-profits in Baltimore and in doing so captures all public policy. What we see less of in Maryland and Baltimore are real citizens coming out and organizing and controlling their own non-profits. My non-profit, Citizens Oversight Maryland speaks freely because there is no corporate connection. If you see a non-profit that is silent on all of the issues I address here-----they are being controlled by a corporation. We have great groups doing good work in Baltimore but very few of them will shout against the power structures -----Johns Hopkins and Baltimore Development or identify the fact that all of Baltimore's politicians work for these institutions and not the citizens of Baltimore. I told you about the anti-fracking environmental group that ran when I asked them to educate about Trans Pacific Trade Pact and the fact that it allows all environmental laws to be ignored. Now, if an environmental non-profit is not talking about this----it is headed by a corporation. This is why TPP is not even mentioned in Maryland.....corporations control all of our private non-profits.

PLEASE WAKE UP AND ENGAGE IN POLITICS FOLKS! THE MIDDLE CLASS CANNOT WATCH AS THE POOR ARE BRUTALIZED BECAUSE WE KNOW THE GOAL OF NEO-LIBERALISM IS TO GET RID OF ALL MIDDLE-CLASS. YOU OR YOUR CHILDREN/GRANDCHILDREN WILL BE THE POOR. YOU CANNOT BE SILENT FOR FEAR OF YOUR JOB BECAUSE LOSING DEMOCRACY AND YOUR RIGHTS AS CITIZENS IS MORE IMPORTANT.

Maryland and especially Baltimore is now running just a global corporations do overseas----Non-governmental organizations NGOs control our state and local governments as a 'quasi-governmental agency' and corporations 'donate' rather than pay taxes to private non-profits that then do what that 'donor' wants. No doubt national non-profits have always been this way but now they are controlling all policy at state and local levels as well. This is the capture we are feeling in Maryland. The neo-liberals and neo-cons work to establish these private non-profits and then make sure that these groups are the ones heard in policy discussion. This is why many community associations in Baltimore are silent to politicians pushing neo-conservative/neo-liberal policies that are killing the residents living in these communities. They instead are the ones backing these same pols dismantling our democratic structures. The heads of these organizations sound to be supporting the community when in fact they are working to push corporate policy.

As you see below you must have politicians in office that want the public engaged in public policy. They build the structures to make sure to stimulate participation. In Maryland all policy is written behind closed doors and the public is pulled from public meetings if they try to speak on the most important issues. Go to Baltimore City Hall and you look at pols that are simply sitting there----they are no more connected to the people speaking than a man on the moon. They are simply meeting a charter requirement to have hearings.

IT IS THE DISMANTLING OF ALL OF THE PUBLIC STRUCTURES OF CIVIC ENGAGEMENT THAT HAS PRODUCED THE LACK OF PARTICIPATION AND IT HAS BEEN REPLACED BY THESE PRIVATE NON-PROFITS.

The Citizens Most Vocal in Local Government

View detailed demographic data from a national survey about the most and least likely people to speak up. by Mike Maciag | July 2014 Flickr/Kelby Carr

In his first few months in office, Park City, Utah, Mayor Jack Thomas has heard from quite a few constituents. His office phone rings off the hook. Going out for lunch takes about twice as long as before, too, as he constantly fields concerns from residents who walk up. “If you want a quiet moment,” he jokes, “you’ve got to leave town.”

The small resort community is home to some of the nation’s more vocal residents. In a recent survey, 28 percent of city residents reported contacting elected officials to express their opinions and 37 percent said they had attended a local public meeting over a 12-month period.

Nationwide, though, citizen participation in local government remains abysmally low. The National Research Center (NRC), a firm that conducts citizen surveys for more than 200 communities, compiled data for Governing shedding light on the types of residents who are most active. Overall, only 19 percent of Americans recently surveyed contacted their local elected officials over a 12-month period, while about a quarter reported attending a public meeting.

In many city halls, extremists on either side of an issue dominate public hearings. Those who do show up at the sparsely attended meetings are often the same cast of characters week after week. But some public officials have found ways to reach a much wider segment of residents.

Park City’s Mayor Thomas said he’ll go door-to-door along the town’s main corridor to gauge resident sentiment about everything from new development projects to air quality and garbage pickup. “If you want to have a government that’s rooted in the community, you better start that way,” Thomas said. “It’s all about trust.”

NRC survey data identifies types of residents who are the most active or, in some cases, the least vocal. Individuals living in a community for more than 10 years, for example, are about three times more likely to attend public meetings and contact elected officials than new residents. Among racial groups, Asians tend to have the lowest participation rates. Low-income residents also aren’t as active as those earning six-figure incomes.

In general, residents often aren’t compelled to weigh in on an issue unless it negatively affects them, said Cheryl Hilvert of the International City/County Management Association. It’s for this reason that much of the citizen engagement in communities is confined to typical hot-button issues, such as planning and zoning meetings.

Many residents don’t think they have time to participate. Others, particularly newer residents with lower participation rates, may not know where or how to get involved, Hilvert said.

Survey data further suggests that younger residents aren’t inclined to speak up. Those under the age of 35 attend meetings and contact elected officials at far lower rates than those over 35. Hilvert suspects their busy lifestyles may have something to do with it, especially if they have children.

Connecting with these groups of residents requires stepping outside of city hall and meeting residents on their own turf. Park City officials say they’ve held meetings in school lunch rooms, performing arts centers and with local homeowners’ associations.

“To truly engage the community,” Hilvert said, “managers have to think broader about it than in the past.”

Some localities employ unconventional approaches to raise the level of citizen engagement. When the city of Rancho Cordova, Calif., debated permitting more residents to raise chickens on their properties last year, it launched an online Open Town Hall. More than 500 residents visited the interactive forum to make or review public statements. “It is noisy and smelly enough with pigeons, turkeys, feral cats, and untended dogs without adding chickens to the mix,” wrote one resident. The city drafted an ordinance reflecting citizen input, then emailed it to forum subscribers.

Outreach efforts through local media or civic organizations help further community involvement. Some residents also form Facebook groups or online petitions to promote their causes.

The city of Chanhassen, Minn., relied heavily on social media to connect with citizens when it confronted an issue that’s about as contentious as any local government can face: a proposal to build a new Walmart. The city posted regular updates on its Facebook page and uploaded all documents online. Laurie Hokkanen, the city’s assistant city manager, said residents continued hearing rumors even after the city rejected the company’s rezoning proposal. As a result, staff kept lines of communication open.

“A vote by the city council does not end the issue for residents who are invested in it,” Hokkanen said. “It’s important to tell people you appreciate their input.”

Citizen Survey Data Across much of the country, citizens rarely voice their opinion to local governments. The National Research Center provided survey results from local jurisdictions throughout the country participating in the National Citizen Survey, collected between 2012 and earlier this year.

Two questions on the survey assessed how vocal citizens were in government. Survey respondents were asked if they had done the following in the last 12 months:

1) "Contacted [locality name] elected officials (in-person, phone, email or web) to express your opinion?"

Yes: 19 percent
No: 81 percent

2) "Attended a local public meeting?"

Two times a week or more: 1 percent
Two to four times a month: 1 percent
Once a month or less: 22 percent
Not at all: 76 percent

___________________________________________
We all know the quasi nature of Baltimore Development and the University of Maryland Medical Center but let's look at AGAB and how corporations 'donate' for tax write-offs and then simply write the public policy tied to that non-profit.

If you could look at what this organization does------and the details are very private-----you will see that corporations and the rich simply choose a category to contribute and then are allowed to write what that 'donation' will create. So, greening as a category can channel money to paying for corporate parks that simply subsidize the costs of a corporation's headquarters. Why pay to landscape your property when you can get a tax write-off as 'donation' to greening and have the city contribute a chunk for example. A corporation wanting to 'donate' to eduction would direct that money to a national education non-profit controlled by corporations to go into schools and tell parents, teachers, and students just what 'wellness' will look like in the schools. In Baltimore parents asking for recess for their children may not be discussed in these 'wellness' groups in many schools.

This entire system allows corporations not paying taxes in Baltimore and Maryland to instead 'donate' money and then control the public policy in whatever area they choose. This is how the citizens of Maryland have lost their voices in their own communities. When I first moved to Baltimore I had the nerve as a citizen to try to organize for an athletic field on a vacant lot in my community and the response-----JOHNS HOPKINS HOMEWOOD DEVELOPMENT WILL DECIDE WHAT WILL GO THERE----ARE YOU CRAZY? As a resident of a community you must go to that development corporation for community grants to do anything and that allows that development corporation to decide what they want-----

AND ALL OF THIS IS THE CORPORATION THAT IS JOHNS HOPKINS AND BALTIMORE DEVELOPMENT.

This is what happens when the public sector is dismantled-----all money is funneled through private non-profits that have no transparency and whose membership becomes ever more exclusive.

GET RID OF THE NEO-LIBERALS AND NEO-CONS ALLOWING THIS DISMANTLING OF OUR PUBLIC SECTOR----REMEMBER, IF YOU THINK GOVERNMENT HAS TOO MUCH CONTROL----CORPORATE CONTROL IS MUCH WORSE AS REGARDS DEMOCRATIC FREEDOMS.

About The Association of Baltimore Area Grantmakers (ABAG)

ABAG's mission is to maximize the impact of philanthropic giving on community life through a growing network of diverse, informed and effective grantmakers.

The Association of Baltimore Area Grantmakers is the region’s premier resource on philanthropy, dedicated to informing grantmakers and improving our community. ABAG was founded in 1983 to provide a forum in which colleagues could address common problems, approaches and interests.

Our members include more than 145 private and community foundations, donor advised funds, and corporations with strategic grantmaking programs - representing the vast majority of institutional giving in our area.

ABAG is …

The Resource on Grantmaking

ABAG provides critical information and services to the philanthropic and nonprofit communities.

The Network for Givers

ABAG convenes grantmakers and others to address issues and create lasting solutions.

The Voice for Philanthropy

ABAG represents the philanthropic sector to key audiences, including the media, legislators, and national organizations, raising public awareness and understanding about the role and impact of philanthropy on our society.

_________________________________________

Maryand Health Care for All and Baltimore Education Coalition are two examples of many. Maryland Health Care for All is a Johns Hopkins non-profit created to make sure the Affordable Care Act was the health reform that moved forward in Maryland and not REAL health care for all like Expanded and Improved Medicare for All. People see that the ACA is not about access----it is about building structures that will deregulate and consolidate the health industry killing oversight and accountability and denying most people most access to care. Maryland has already disconnected from Medicare by receiving exemptions from the Federal government. All of this makes Maryland have one of the worst health environments in the nation. The poor have a life span 30 years less than affluent, people are fearful when going to the hospital because of poor quality and staff work in some of the most difficult conditions. Now, the state health reform is creating a tiered health system that has most people only able to connect to clinic care. We see this breakdown in health care in Maryland best if we look at the dismantled Veteran's Administration with Baltimore having the worst in the nation. All of the doctors in this system were moved out and into private health systems that now cater to the world's rich------HEALTH TOURISM. THIS IS JOHNS HOPKINS SPECIALTY NOW.

Below you see two Hopkins grads placed in charge of controlling the health care policy. Bill and Hillary tried to do to health care what Obama has done with ACA at the same time they created the conditions for global banks---so this group in 1999 had the goal of moving health policy in that direction. This is why Maryland sought the exemption from Medicare----to create the private health systems that are tied to the Maryland state health exchange. Medicare and Medicaid fraud is rampant in Maryland because the oversight and accountability of the public sector was long ago dismantled.

The leaders advocating for the Affordable Care Act knew the goal was maximizing corporate profits and building global health corporations and not REAL health care for all. The groups joining this coalition often did not. They assumed they were actually working for health care for all. This is an example of corporate capture of a policy. Maryland spent this time from 1999 dismantling the public programs Medicare and Medicaid---and the Veteran's Administration and creating a tiered level of coverage that denied basic access by allowing health institutions to create the most profitable definition of care.

While neo-liberals claimed to be building the most cost-effective health delivery system------patient outcomes in Maryland worsened and longevity declined. So much for health care for all. Johns Hopkins was able to build a global corporate empire with all that Medicare and Medicaid----not to mention Federal, state, and local grants and public funding.

A GLOBAL HEALTH EMPIRE BUILT ON PUBLIC MONEY----THAT IS A SUCCESSFUL PRIVATE NON-PROFIT.

The people attached to Maryland Health Care for All really seeking this goal now need to join Expanded and Improved Medicare for All in Maryland to actually get health care for all. We need to replace the most private and profit-driven health system in the nation that is Maryland health exchange with this public structure that keeps Medicare strong.

The Founder of the Initiative is Peter Beilenson, MD, MPH, and the President is Vincent DeMarco, MA, JD.

The Maryland Citizens’ Health Initiative Education Fund (“MCHI”) is a 501(c)(3) non-profit advocacy organization that was created in 1999 with a mission to educate all Marylanders about sound ways to achieve quality, affordable health care for all. In order to create a comprehensive, economically sound health care for all plan, MCHI organized the state’s largest coalition and solicited input from coalition members and thousands of Maryland citizens in town hall meetings. National experts at the Johns Hopkins University Bloomberg School of Public Health and the University of Maryland Law School then worked to incorporate this community input into MCHI’s Health Care for All! Plan. In 2002, MCHI released its first plan and conducted a statewide campaign to educate people about how the plan would guarantee health care security for all Marylanders. A revised version of the plan was released in 2008 by the same set of experts that created the original following another round of public stakeholder meetings. The updated plan includes similar components as the Patient Protection and Affordable Care Act (2010) and is being used to guide analysis and planning for state and local implementation of the federal health reform law.

Over 1,200 faith, labor, business, health, and community organizations have joined the Health Care for All! Coalition to support enactment of MCHI’s plan. This is the largest coalition ever created in Maryland and certainly one of the largest health care consumer coalitions in the country.

The Coalition successfully advocated for a number of laws that will increase access to care and prescription drugs. In addition, MCHI continues to work with key state leaders to educate members of our broad coalition about how they can access health care programs now in existence. In the years ahead, MCHI will continue to educate and activate its powerful coalition to increase health care access in Maryland.

___________________________________________

Baltimore Education Coalition is the Michelle Rhee of privatization groups again created by Johns Hopkins this time with the goal of capturing education policy and making sure reforms go the way of corporate control-----just as did Maryland Health Care for All. In both cases the leaders knew the goal but the people joining often think they are really working towards the goal of health care for all or quality public education. It is not until all of the bad policy the BEC unrolls that many people in these coalitions find they did not get what they bargained for. Good people wanting to work for good public policy captured by joining private non-profits that exist to make sure that does not happen.

This is why activism in Baltimore and Maryland is so low----people trying to organize have to fight these corporate non-profits !

Please stop allowing corporate non-profits to control all public policy in Maryland. Know what the policies these groups are advocating and know that they actually have a goal that works for the people and not only for maximizing corporate profit.

This is a prime example of why getting rid of neo-liberals and neo-cons is so important. It is not only how they vote in City Hall or the Maryland Assembly. It is the environment they allow to exist in public community organizations ------where is the public discussion-----is it open and inclusive? Neither Maryland Health Care for All nor Baltimore Education Coalition would allow Cindy Walsh to come in to educate and/or speak against these policies. If they do not allow open dialog----they are hiding something and that is that what they are doing is not in the public interest!

Baltimore Education Coalition

We are public schools – traditional and charter. We are after-school programs and neighborhood associations. We are education policy organizations, religious institutions, broad-based organizations, and schools. We are policy analysts, teachers, students, parents, community members, grandparents, and Baltimoreans working together to organize, mobilize, and energize the City of Baltimore to achieve our mission that all Baltimore students receive an excellent education. We focus on the issues that impact our students and families the most. Together, we have stopped over $100 million dollars in proposed funding cuts to city schools. In the face of potential harmful cuts to School Based Health Centers the BEC responded and advocated to successfully keep this important resource in the budget. We have also worked together to address the deplorable facility conditions in Baltimore City including winning the bottle tax in Baltimore City to support the successful campaign to pass state legislation to provide an unprecedented financing plan providing up to $1 billion to rebuild or renovate schools in Baltimore City. This effort was successful due to the dedication and perseverance of the more than 3,000 parents, students, teachers, administrators, and community leaders who came to Annapolis and City Hall to make their voices heard for Baltimore City’s 85,000 students and their communities.

0 Comments

January 14th, 2014

1/14/2014

0 Comments

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

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

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

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

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

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

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

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

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

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

By Erika Niedowski, Associated Press 16 hours ago
HealthSource RI said that 11,770 individuals enrolled in commercial plans between Oct. 1, when the marketplace opened, and Jan. 4. The state Health and Human Services office said 19,941 enrolled in Medicaid during the same period.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HUMANA AND JOHNS HOPKINS TEAM UP WITH MANAGED-CARE NETWORK

BALTIMORE, Dec. 1 /PRNewswire/ --

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

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

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

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

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

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

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

Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly-owned HMO companies with more than 3.8 million members in 22 states and the District of Columbia. Humana offers quality and affordable coordinated care in the form of HMOs, preferred provider organizations, point-of-service organizations, along with administrative-only services. In addition, Humana is one of the nation's largest providers of "HMO-style" health care to seniors through its federally approved Medicare products. -0- 12/1/95
____________________________________________
As I have said there are well-developed plans already developed for Expanded and Improved Medicare for All. Any politician could run for Governor of Maryland and simply use existing policy and planning to implement. Do not allow neo-liberals to tell you it can't be done because simply building oversight into Medicare health system will end 1/2 of expenditures just by ending fraud and profiteering! This neo-liberals have wasted hundreds of billions of dollars developing this private system simply to make health care a global profit-maximizing industry and WE WILL TAKE IT BACK!!!!

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

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

Please take time to read the entire article below!

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

Abstract:

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

_____________________________________________

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

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

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

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

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

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

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

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

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

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

Timeline

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

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

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

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

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

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

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

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

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

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

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

‘There is a risk . . .’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contractors at odds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And another federal test was looming.

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

This one did not go as well.

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

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

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

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

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

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

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

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

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

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

‘What’s wrong?’

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

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

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

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

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

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

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

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

Click. She was in.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

0 Comments

January 13th, 2014

1/13/2014

0 Comments

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

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

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

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

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

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

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

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

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

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

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

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

Social Security and Medicare taxes

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

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

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

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

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

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

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

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

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

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

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

                               Base Year: 2013         Base Year: 2010

Proposed Rule       3.5%              EQUALS          4.5%

Final Rule                 2.7%              EQUALS           3.5%

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When the Medicare home health benefit pays for home health care

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

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

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

You need the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home or your doctor believes that leaving your home would be harmful to your health; and
It is difficult for you to leave your home and you typically cannot do so.

2. You need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means you need care little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services. Skilled therapy services can be physical, speech or occupational therapy;*

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

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

4. You receive your care from a Medicare-certified home health agency (HHA).

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

If you have questions about billing issues for home health care you should contact 800-MEDICARE.
____________________________________________
A GLOBAL FRANCHISE CARING FOR OUR SENIORS.....HOW SPECIAL!!!! Carlyle hedge fund has Baltimore's ManorCare!

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

Instead of worry, there's Home Instead®

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

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

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

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

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

Consumer Affairs
Consumer Complaints & Reviews

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

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

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

The other company however, I have met the owner, nurses and the few staff. They are effective and staff manage themselves and know who to contact and know things will be handled promptly and effectively. The nurses actually are familiar with the clients, their meds, home, etc and are a phone call away. The small staff actually work TOGETHER cooperatively as an actual CARE TEAM (medical model) instead of destructively at each other (corporate model). I'd recommend a small independently run non-chain agency over an indifferent corporate business. As a CNA, almost-nurse and caregiver I feel for better care for your family go with a small, independent medically minded agency. It's better for both the client and caregiver. I also think that clients' family want a caregiver that is treated well.
__________________________________________
One thing you see throughout the Affordable Care Act is that there will be nurses and/or nurse practitioner involved in these health businesses taking over public health....including home health care. As the commenter above pointed out in his review of one global corporation covering senior home health.....THERE WAS NOT A NURSE IN SIGHT. HE HAD NO MEDICAL SUPERVISOR WITH WHOM TO TALK AND I HEAR THIS IN ALL CASES OF THESE HEALTH BUSINESSES.

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

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

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

Relationship of Nursing Home Staffing to Quality of Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

0 Comments

January 07th, 2014

1/7/2014

0 Comments

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

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

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

YOUR POLITICIAN KNEW THIS WOULD BE THE RESULT!

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

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

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

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

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

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

THE SILENCE IS DUPLICITY.

January 06, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

__________________________________________________

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

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

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

Medicare reimbursement cuts threaten access to care

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

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

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

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

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

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

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

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

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

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

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

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

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

___________________________________________________

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

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

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

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

Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

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

For immediate release.

By Sean Flynn, sflynn@wcl.american.edu

Lima, Peru. on October 22, 2011

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

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

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

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

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

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

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

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

SECTION BY SECTION ANALYSIS

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

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

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

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

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

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

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

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

X.3(e): This provision mandates that countries allow companies to “apply for an increased amount” in reimbursement based on evidence of “superior safety, efficacy or quality.” This provision is potentially beneficial in embracing the idea that prices should be set based on efficacy rather than market value. Nonetheless, affordability concerns must also be an integral part of reimbursement decisions, but are not mentioned.

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

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

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

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

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

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

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

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

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

Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

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

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

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

DGH Supports Medicare for All

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

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

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

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

Impact of the PPACA on marginalized and vulnerable groups

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

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

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

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

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

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

REALLY?????

Public Health Advocates Must Derail the TranPacific Partnership

December 29, 2013

Kris Alman, Assistant Secretary of Health for Data Privacy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Investor-state attack on cigarette plain packaging policies:

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

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

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

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

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

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

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

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

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

Growing resistance.

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

_____________________________________________________

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

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

8 Health Systems That Created International Partnerships in 2013

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

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

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

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

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

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

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

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

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

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

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

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

__________________________________________________

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

0 Comments

August 29th, 2014

August 08th, 2014

July 15th, 2014

July 08th, 2014

January 14th, 2014

January 13th, 2014

January 07th, 2014

Author

Archives

Categories