Please check my last blog under Social Security to see that neo-liberals are now building the structures to end Social Security as the Social Security and Medicare Trusts have been looted to build the Homeland Security/NSA network.  The American people have plenty of money----it simply needs Rule of Law reinstated and the fraud recovered.

IF YOU DO NOT HEAR YOUR INCUMBENT SHOUTING FOR JUSTICE FROM MASSIVE CORPORATE FRAUD.....IF THEY ARE PRETENDING AMERICANS ARE POOR......IF THEY ARE FIGHTING FOR UNEMPLOYMENT BENEFITS AND NOT THE HUNDREDS OF THOUSANDS OF DOLLARS EACH CITIZEN IS OWED FROM CORPORATE FRAUD-----THEY ARE WORKING FOR GLOBAL CORPORATIONS.  ALL MARYLAND POLS ARE GLOBAL CORPORATE POLS.

The next few days I want to look at the health care reform----Affordable Care Act.  By now people understand it is bad for the American people and has nothing to do with making health costs for citizens more affordable or increasing access to care for the poor.  That is just the progressive bones corporate neo-liberals throw when working for wealth and profit.  I want to look first at the mental health issue and how Medicare and Medicaid are continually under attack from fraud and corruption.  There is something more important than losing health coverage in the Affordable Care Act------there is the opening for yet more loss of civil liberties that take the US to autocratic policies of third world countries.  Again, it is being pushed under the guise of progressive bones and none of it is progressive.

EXPANDED AND IMPROVED MEDICARE FOR ALL IS THE ONLY SOLUTION TO HEALTH CARE COSTS AND QUALITY HEALTH CARE AND ACCESS FOR ALL!

Regarding the race for Governor of MD and health care reform:

In Maryland, citizens get an up-close look at what elections look like in third world countries. You have candidates running for governor with absolutely no administrative experience and two in the democratic primary, Brown and Gansler, with proven failures in office in administration on just a smaller scale. Cindy Walsh for Governor of Maryland has 3 decades of management/administrative experience and training on top of knowing more about the political issues of the day than my opponents who just repeat political talking points over and over.
So, the neo-liberal plan was to pass a republican health care policy getting all of its base mad and then fill the airwaves with propaganda on this issue that has no relevance to people's lives. Neo-liberals in Congress and Obama push a state run health insurance system with consolidation and deregulation and then VOILA----republicans have control of Congress and Hillary is elected and 'forced' to create the conditions for the predatory and profit-driven health systems to become Wall Street banks as she and Bill did their last terms. What? The Trans Pacific Trade Pact (TPP) has the US forcing public health all over the globe to end in order to maximize profits, drug costs soar because Bill Gates is now in the PHARMA business?

WELL, HILLARY WILL SIMPLY HAVE TO PUSH AND PASS TPP BECAUSE IT IS ALL THE REPUBLICANS FAULT.

This is the political scenario silenced by the constant talk of failed health system roll-outs. Doug Gansler has his face on buses telling the underserved communities he will fight for health insurance for the poor and yet, 1/2 of Medicare and Medicaid funding has been stolen under his watch as Maryland Attorney General. Anthony Brown is not worried about having no talent in administering public policy because the goal of this health care reform was setting up these private health systems that will end public health and send Medicare and Medicaid to states, ending these Federal programs. So, who cares as hundreds of millions of dollars are blown on roll-out-----the policies of health care privatization and ending entitlements is being installed under O'Malley/Brown. OPERATION SUCCESS SAY NEO-LIBERALS AND THEIR GLOBAL CORPORATE HANDLERS. His campaign ads have him FIGHTING FOR HEALTH JUSTICE at every turn. Let's look at the reality of this 'health justice' neo-liberals are planning for the citizens of Maryland.

First, let's look at mental health.....you know, the mantra of gun control pols pretending to be hard on policy and then not funding these policies they pretend to support. Mental health is a huge issue in America because since the Reagan/Clinton years this public sector has been defunded and is now a skeleton crew. Much of Medicaid spending goes to mental health and we know the entire system is full of fraud and corruption and people actually struggling with mental health issues almost always cannot get help. The system is set up to get mental health clients into a clinic with just enough time to give him/her medications to bill to Medicaid and then send them on their way with little followup. The current conditions having most of these people either failing to take medication, selling it, or having it stolen. That does not matter because the goal is MAXIMIZING PROFITS FOR PHARMA AND THE MORE THAT GOES OUT THE DOOR THE BETTER. Depression, bi-polar, and hyper-activity meds have our nation dosed out of what often is normal behavior.

I showed earlier that Bill Gates is now the owner of Prozac and many other mental health PHARMA soaring in profits from these policies. Abuse, fraud, and corruption drives these profits and it can all stop with rebuilding public oversight and accountability. These medications are not all bad it is just the way the system administers these mental health programs that make it a disaster for the Medicare/Medicaid Trusts, taxpayers, and these patient clients.

We know Affordable Care Act was written deliberately giving the health institutions the power to decide how to operate with less money from Medicare and Medicaid and the first thing that happens is these programs become worse and the emphasis on getting the drugs out the door increases.

INCREASE IN MASS SHOOTINGS TIED TO THE DISMANTLING OF THE MENTAL HEALTH SECTOR------YOU BETCHA!!!!!

THIS HEALTH REFORM ADDRESSING MENTAL HEALTH CRISIS------OH, REALLY??????

Features » April 1, 2014

The ACA Could Be the Death Knell for Chicago’s Public Mental Health Clinics

In 2012, Mayor Emanuel’s budget forced half the city’s public mental health clinics to close; now the remaining six are in danger, too.

BY Kari Lydersen

Mental health and labor advocates ... fear that city officials are trying to divert insured clients from the remaining clinics because they ultimately want to close them. They suspect reducing the client population and the number of employees at the clinics is a way to lay the groundwork for shuttering them altogether.

Thanks to the Affordable Care Act's expansion of Medicaid, many more Chicagoans will have access to mental health care in the near future. But ironically, the increased availability of health insurance could starve Chicago’s six remaining public mental health clinics of resources—and cause havoc for the city residents who depend on them.

In addition to serving those without insurance, the clinics have long provided care to locals with insurance who could have gone elsewhere, but saw the facilities as their most accessible and supportive option.

Over the past year, however, city officials reportedly started directing people with existing insurance to private or county mental health providers instead. And as formerly uninsured Chicagoans get new coverage from the Affordable Care Act, some say they, too, are being discouraged from attending the city clinics. While they theoretically could get care elsewhere, mental health advocates say that in reality, many are likely to fall through the cracks rather than moving to a provider they don’t trust.

Members of the grassroots coalition Mental Health Movement say that starting in 2013, public clinic staff members began pressuring uninsured clients to enroll in CountyCare, part of the state’s expanded Medicaid program. In turn, the clients say they’ve been told that once they have CountyCare or other insurance coverage, they will no longer be able to receive care at the public clinics.

A March 14 memo, obtained by In These Times and sent from Chicago Department of Public Health deputy commissioner Edie Bamberger, says that people with insurance and mental health needs “will be educated” about the “benefits of accessing integrated health care services through their insurance network,” which would not include the city clinics. If the client wants to attend a city clinic, the memo directs, public health staff should consult the clinic director; such requests will be considered on a case-by-case basis. People already attending a city clinic will be allowed to continue attending the clinic once they get insured, it continues, but the clinic director “must be made aware of this request.”

In other words, insured people who are already clients won’t be expressly prohibited from attending the city clinics, but staff are supposed to make an effort to divert them to other providers. And new insured clients won’t be expressly prohibited from the public clinics, but their attendance will have to be specifically approved. Previously, the DPH had a more strident ban on insured people obtaining services from the clinics; the shift in policy apparently came after the department faced a wave of criticism.

On April 2, aldermen who are part of the Chicago City Council’s Progressive Caucus will introduce a resolution calling for public hearings before the Council’s Health and Environmental Protection Committee on the state of mental health care in the city. At a press conference at City Hall on March 27, Aldermen Robert Fioretti and Scott Waguespack explained that the issue of whether and to what extent the public clinics will accept clients with insurance would be a central talking point at those hearings.

Chicago resident and Mental Health Movement member Horace Howard, who attended the press conference, says he has been receiving services from the public Greater Grand Boulevard clinic on the South Side since the Woodlawn clinic closed in 2012; he was part of the high-profile occupation at Woodlawn in April of that year. He claims that after several months going to Greater Grand, he still hasn’t been able to get an appointment with a doctor. (Clients at the public clinics typically meet with therapists on a regular basis and have less frequent meetings with psychiatrists.) But Howard still feels at home at the public clinics and doesn’t want to switch to another provider.

“We’re being kicked out because of managed care,” says Howard, 56, sporting a T-shirt bearing a portrait of Helen Morley, the Mental Health Movement member who died in 2012 of heart complications after famously telling Mayor Rahm Emanuel, “If you close my clinic, I will die.” Howard says the city should reopen the Woodlawn clinic “in memorial to Helen.”

Mental Health Movement member Ronald “Cowboy” Jackson says he knows several former clients of public clinics who were told since obtaining CountyCare coverage that they should go to the county hospital in Chicago instead. But people have had trouble getting appointments at the over-crowded county system, Jackson says; as a consequence, they have grown frustrated and stopped trying to get care.

Alderman Fioretti argues the changes to the system are only making it harder for Chicagoans in need. “They’re creating confusion out there,” he says. “For years, people have been going to these clinics. Now they’re being told they can’t … it’s adding more confusion, more disorientation for people in need of care.”

Because the Chicago Department of Public Health has so far not joined a healthcare provider network, including CountyCare, the public mental health clinics cannot be reimbursed under Medicaid as the state switches to managed care in coming weeks, meaning their funding will be put in danger. Just why the city hasn’t joined a network yet, however, remains unclear. (The department did not respond to an interview request for this story.) The March 14 memo claims that the department is encouraging insured people to go elsewhere because it “remains focused on preserving our limited capacity to serve uninsured residents with more limited options.”

A fact sheet handed out at the press conference rebuts that statement, though. It reads:

Turning away people with insurance means turning away money—revenue that could help strengthen the city clinics for everybody. Turning away that revenue will lower the number of people at the city clinics, lower the funding coming into them and likely end up causing more of them to close.

Mental health and labor advocates—including AFSCME, the union representing public clinic staff—fear that city officials are trying to divert insured clients from the remaining clinics because they ultimately want to close them. They suspect that reducing the client population and the number of employees at the clinics is a way to lay the groundwork for shuttering them altogether.

“Once you have no one going to the clinic because they don’t accept insurance, then you can justify closing it because you have an empty building,” says N’Dana Carter, a leader of the Mental Health Movement.

Fioretti said that in closing and sidelining the clinics, Chicago’s leaders “throw our hands up and say we’re not going to do this service anymore.”

He and other aldermen have apologized for voting in 2011 for Mayor Emanuel’s 2012 budget, which closed six of the city’s 12 mental health clinics. “We made a big mistake,” he says.

Though Emanuel initially claimed the clinic’s closures would lead to an estimated $2.3 million in savings, Fioretti and his fellow progressive aldermen argue that this number “failed to account for the additional costs of increased emergency room visits, hospitalizations, police interventions and incarcerations.”

Alderman Waguespack says he has been disappointed by the city’s misplaced spending priorities. “You look at an $8 billion budget, and we can’t find $2.3 million?” he scoffs. “The city says we’re going to take away the safety net for such a small [savings]?”

Jackson, meanwhile, points to the mid-March standoff along Lake Shore Drive as an example of how unaddressed mental health crises can cause widespread trauma and cost taxpayers millions down the line. In that incident, a man with a history of mental illness who was suspected of killing his wife engaged police in an eight-hour showdown, closing off the major city thoroughfare along with nearby businesses.

“There’s a real effect on families and communities and schools” when people lack mental health care, Jackson says.

At a March 31 seminar on incarceration called “The $2 Billion Question” sponsored by the Chicago Community Trust and other groups, various speakers agreed that unavailable resources can have an enormously detrimental impact on individuals and their networks. They described, for instance, how a lack of mental health care can lead to the imprisonment of people who really need treatment, not punishment.

“We have a growing mentally ill population, both at the county and state level, that we’re struggling with how to deal with,” says Cook County Sheriff’s senior advisor Cara Smith.

At the seminar, she gave one example of the type of situations that land people with mental health issues in jail: A man grabbed a set of sheets or towels from a North Side Walgreens, walked out the door and told the clerk to “charge it.”

“$29.99 was the value of the item that he did not successfully steal,” Smith recounts. “And he was with us [in jail] for quite a long time … He had a very significant criminal history, mostly committing crimes of what I would call ‘survival’—criminal trespassing, retail theft—things to get shelter.”

“Because of the lack of services in the community, I can sit here and say many people are better off in the jail when they have severe mental illness because they’re getting care,” Smith continues. “Which is an awful thing to have to say.”

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

Kari Lydersen

Kari Lydersen, an In These Times contributing editor, is a Chicago-based journalist and instructor who currently works at Northwestern University. Her work has appeared in the New York Times, the Washington Post, the Chicago Reader and The Progressive, among other publications. Her most recent book is Mayor 1%: Rahm Emanuel and the Rise of Chicago's 99 Percent. She is also the co-author of Shoot an Iraqi: Art, Life and Resistance Under the Gun and the author of Revolt on Goose Island: The Chicago Factory Takeover, and What it Says About the Economic Crisis. Look for an updated reissue of Revolt on Goose Island in 2014. In 2011, she was awarded a Studs Terkel Community Media Award for her work. She can be reached at kari.lydersen@gmail.com.
______________________________________

Keep in mind that the federal government and states gutted Medicaid funding these few years to pay for the massive corporate fraud of tens of trillions of dollars. So, when your pol acts as though they are adding funding to mental health after this huge gutting of funds-----THEY ARE LYING TO YOU! What is surfacing is a huge attack on all civil liberties and a further move towards totalitarianism. Can you imagine a government having the ability to force people to take drugs they do not want in the confines of their homes because the entire public health system with group living situations are being dismantled?

IT IS CRAZY AND YOUR NEO-LIBERAL IS MOVING THAT WAY EVEN IF THEY ARE NOT OPENLY SUPPORTING THIS BECAUSE WHEN PEOPLE ARE LEFT WITH ONLY HOME CARE AND LAWS ARE BROAD FOR THESE KINDS OF TREATMENTS THERE WILL BE ABUSE AND YOUR POLS KNOW THIS.

Remember, the problem with mass shootings by people with severe mental illness is that these people cannot access the kind of care and facilities they need to control these illnesses. We can effectively treat these diseases but that costs money and neo-liberals and neo-cons do not see any money coming for public services and programs. So, they easiest solution------forced medication with home care people overseeing what are catatonic conditions. Think of conditions for mental health institutions without proper oversight and then place individuals in their homes with only national chains providing barely trained home care employees. THIS IS DICKENSIAN.

I will add that US citizens are being assaulted by police acting outside of Constitutional policing -----imagine these officers having the power to determine people's mental health status. We are already going to jail because police are using illegal tactics for jailing protesters and killing citizens. Police need to remain out of the diagnostic loop for mental illness.

HAVE YOU SEEN PEOPLE PLACED ON THESE SCHIZO PHARMA? THEY ARE OFTEN CATATONIC AND HELPLESS.

Why are we reforming our mental health guidelines written at a time when all people had civil rights and liberties when the problem was funding and access to quality care?

'And its backing of the expanded use of involuntary outpatient treatment has drawn opposition from some advocacy groups'.

Mental Health Groups Split on Bill to Overhaul Care

By BENEDICT CAREY  APRIL 2, 2014

Lawmakers, patient advocates and the millions of Americans living with a psychiatric diagnosis agree that the nation’s mental health care system is broken, and on Thursday, Congress will hear testimony on the most ambitious overhaul plan in decades, a bill that has already stirred longstanding divisions in mental health circles.

The prospects for the bill, proposed by Representative Tim Murphy, Republican of Pennsylvania, are uncertain, experts say, given partisanship in both the House and the Senate and the sheer complexity of the mental health system. And its backing of the expanded use of involuntary outpatient treatment has drawn opposition from some advocacy groups.

But the bill, the Helping Families in Mental Health Crisis Act, does have more than a dozen Democratic co-sponsors in the House, and several mental health organizations are supporting it. Last week, both houses of Congress adopted one of its central provisions, expanding funding for outpatient treatment programs through other legislation. On Thursday, the House Energy and Commerce health subcommittee is scheduled to hear testimony on the entire bill, which includes more than two dozen measures.

“It’s the most comprehensive mental health bill we’ve seen in a long, long time, and that in itself is an accomplishment,” said Keris Myrick, chief executive of the Project Return Peer Support Network and president of the board of the National Alliance on Mental Illness, which supports some parts of the bill. “I think almost everyone sees things in the bill that are long overdue, but also things they’re very concerned about.”

Among those opposing the bill because of its involuntary treatment provisions is the Bazelon Center for Mental Health Law, whose president, Robert Bernstein, said, “Many serious organizations seem to have an ‘any port in the storm’ mentality, supporting this bill even though it includes dangerous provisions.”

Mr. Murphy, a clinical psychologist from Pittsburgh, put together the legislation at the behest of House Republican leaders after the massacre at Sandy Hook Elementary School in Newtown, Conn., in 2012. He spent a year hearing testimony about the current system, a patchwork of community clinics and state hospitals chronically short of funding that leaves millions of people with mental illness without treatment, often homeless or in prison.

“It’s a broken system, and we’re not going to fix it by throwing a little money here or there,” Mr. Murphy said in an interview. “We know that when people get care, they get better, but there are simply not many options: Clinics are reducing services, there are not enough psychiatrists or psychologists to go around — we found all sorts of barriers to care.”

Widely backed provisions of the bill include streamlining payment for services under the Medicaid program, and providing funds for clinics that meet standards for rigorous, scientifically supported care.

The bill also provides money for suicide prevention programs and for so-called telepsychiatry, or remote video therapy, which is seen as especially crucial in rural areas.

Provisions calling for increased training for police officers and emergency medical workers in how to identify and treat people with mental disorders are also widely approved. The police and paramedics often act as ad hoc social workers, dealing with people with mental problems when they are hurt or break the law.

About 350,000 Americans with a diagnosis of a severe mental illness like schizophrenia or bipolar disorder are in state jails and prisons, while the number of psychiatric beds available has shrunk to 35,000, according to a coming analysis by the Treatment Advocacy Center, a nonprofit group that favors expanded access to treatment.

“The situation has been getting progressively worse for 50 years, to the point where we now have 10 times more people with severe mental illness in prisons and jails than in mental hospitals,” said Dr. E. Fuller Torrey, of the Stanley Medical Research Institute, a nonprofit organization supporting research in schizophrenia and bipolar disorder, and a strong supporter of the bill.

But the bill’s backing for involuntary treatment is highly contentious. It would provide state grants for so-called assisted outpatient treatment programs under which certain mentally ill people with a history of legal or other problems get court-ordered therapy, which in most cases means trying to ensure they take their medication.

The result: more people treated earlier, and more treated against their will.

“This becomes a civil rights issue quickly, and it can drive people away from seeking services when they fear treatment will be forced on them or they’ll be locked up,” said Gina Nikkel, president and chief executive of the Foundation for Excellence in Mental Health Care, which advocates a more holistic, less medication-oriented approach to recovery.

In the last two decades, 45 states have adopted laws allowing compelled treatment in some cases, with varying requirements and levels of enforcement. Kendra’s Law, passed in New York in 1999, is one that researchers have monitored closely. One recent analysis, led by investigators at Duke University, found that since the law was passed, patients were much less likely to land back in the hospital or be arrested. Mental health and Medicaid costs for them dropped by about half.

But involuntary treatment programs have led thousands of former psychiatric patients to become fierce critics of the mental health system.

Dr. Bernstein of the Bazelon Center and Dr. Nikkel said that extending such programs would “eviscerate civil right protections” and further erode trust between patient and provider.

The Murphy bill also proposes amending federal medical privacy protections — the now-familiar Hipaa laws — to allow parents or other caregivers access to a patient’s medical information. Under current law, those records are private once a person becomes an adult, and as a result, caregivers are often effectively cut out of treatment decisions. The bill seeks to bring them back in, with a provision that will also generate strong political resistance, experts said.

Finally, the bill proposes to sharply scale back many of the programs funded by the Substance Abuse and Mental Health Services Administration. This agency, with a $3.6 billion budget, has long financed programs that critics say are not backed by good evidence.

“When something has been funded for a long time, it’s tough to let it go,” Mr. Murphy said. “What we’re saying is that if a program works, then show us the evidence that it does, and we’ll keep it. If the evidence is not there, then the taxpayers shouldn’t pay for it.”

______________________________________________

Citizens of Maryland have a front seat to neo-conservative public policy because much of public policy pushed by Maryland neo-liberals is written by Johns Hopkins----the most neo-conservative institution in the world. You can see why Maryland has no democratic party when they all work for Johns Hopkins. Maryland's gun control policy mirrors this mental health policy-----it writes law that looks at mental illness very broadly making it possible to take gun ownership rights away for the most common of mental health issues. Now, gun control advocates may think this is good----but it will be used to end people's civil liberties and this extends to mental health diagnosis and treatment.

When everyone knows the problem with gun violence has little to do with mental health issues needing new laws.....why are are we allowing a government controlled by neo-liberals and neo-cons write laws at a time of NSA and totalitarianian suspension of Rule of Law and mass fraud and corruption. The worst of totalitarian regimes use these issues to throw people into jail and losing our public justice and Bill of Rights set this tone.

MARYLAND IS IN THE CATEGORY OF DEFUNDING AND DISMANTLING ALL PUBLIC HEALTH WHILE TRYING TO PASS LAW THAT TAKES CIVIL RIGHTS AWAY. THIS IS VERY, VERY, VERY BAD.

In Gun Debate, a Misguided Focus on Mental Illness

By RICHARD A. FRIEDMAN, M.D.
Published: December 17, 2012

In the wake of the terrible shooting at an elementary school in Newtown, Conn., national attention has turned again to the complex links between violence, mental illness and gun control.

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffrey Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence? ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

How the TPP Would Impact Public Health
How the Trans-Pacific Partnership
exposethetpp.org

REMEMBER, THE GOAL OF NEO-LIBERALISM IS TAKING THE US FROM A FIRST WORLD SOCIAL DEMOCRACY TO A THIRD WORLD AUTOCRATIC PLUTOCRACY.  THAT MEANS INSTEAD OF MODERN DAY AMERICA THEY LOOK TO MEDIEVAL EUROPE----THE DARK AGES ----FOR THEIR SOCIAL MODEL.  THE MASSES IMPOVERISHED, HEAVILY TAXED WAITING FOR THE GENTRY TO SPONSOR PUBLIC PROJECTS WHILE THE CHURCH HANDLES THE POOR---AND NOT SO WELL!

Today's blog looks at billionaires as benevolent philanthropist.

This is indeed where neo-liberals are going.  The next phase after -'we have all the money and will do as we please' - is building the image of billionaire as benevolent philanthropist----you know----THE MEDICIs.  You could feel sorry for the delusions of grandeur from a moneyed-class equal to mafia-cartels, but this is life and death and fighting for democracy in America.  We are seeing in US media a build-up of image of billionaires for social good.  As they starve public coffers by fraud and tax evasion they are being allowed to 'donate' for the common good and corporate tax deductions.

Meanwhile, you and I have moved back to the vision of the US as first world social democracy. HMMMMM...did I see 900,000 registered democrats in Maryland?  Do you really think they want to go with neo-liberalism and Medicis?

I DON'T THINK SO!!!  SEE WHY IT IS SO IMPORTANT TO KEEP CINDY WALSH FOR GOVERNOR OF MARYLAND OUT OF ELECTION COVERAGE AND OFF THE CAMPAIGN TRAIL!

What I am seeing and hoping to build with my candidacy is a structure around crony democratic politics in Maryland and the US.  We do not need party machines and media money for campaigns.  We need labor unions and justice organizations, churches and university political groups to network for the candidate working for labor and justice.  Simple community networking and education about the need to ignore the onslaught of media campaign advertising by neo-liberal candidates with corporate war chests.

ALL OF MARYLAND CANDIDATES FOR GOVERNOR ARE NEO-LIBERALS EXCEPT CINDY WALSH.  SHAKE THE BUGS FROM THE RUG------GET RID OF CORPORATE CONTROL OF THE DEMOCRATIC PARTY.

Regarding Basu's singing of praises for US billionaires and funding of basic research:

NEO-LIBERALS MAKING BILLIONAIRES LOOK WARM AND FUZZY AS THEY PUSH AMERICAN CITIZENS TO CHARITY!  

Who doesn't like a billionaire made rich from the massive corporate frauds of last decade exploding shareholder wealth from looting the US Treasury and American people.  A billionaire that parks hundreds of billions of dollars in revenue off-shore to avoid paying taxes and who is guilty of more hundreds of billions of dollars in tax fraud and tax evasion.  A billionaire that backs basic research that will earn his corporation trillions of dollars in profit at the expense of public health and interest.  God bless those billionaires say Basu and corporate public media.  Who needs those trillions of dollars stolen from the public that funded basic research in public universities and gave the development benefits to the public rather than private patenting to soak the public as consumer.  WHAT AMERICAN PATRIOTS THESE BILLIONAIRES ARE!  Sound like the North Korean Great Leader propaganda?  YOU BETCHA!

Let's look at the tax policies at the Federal, state, and local level that that allow this fleecing of the US Treasury beyond an IRS that has been gutted of employees to keep from doing investigations of hundreds of billions of dollars in corporate tax fraud that when recovered will make state and local universities flush with cash in education Trusts and grants and public research funding.

YOU SEE, IT IS THE MONEY THAT MADE THESE BILLIONAIRES RICH THAT IS NOW MISSING FROM THE ECONOMY BRINGING DEBT AND DISMANTLING OF PUBLIC SECTOR SERVICES AND PROGRAMS.  UNIVERSITY TUITION TOO HIGH----BLAME THAT BILLIONAIRE.

Do you get a sick feeling in the pit of your stomach when a corporate CEO from the likes Starbucks receives all kinds of media coverage for 'donating' to veterans charities because he is upset with the conditions for veterans at VA hospitals around the country?  Let's see how Starbucks evades paying corporate taxes and bring that back to fund all the public VA hospitals.


Starbucks wakes up and smells the stench of tax avoidance controversy


Cafe chain executive to face questions from MPs, while protesters plan to turn branches into creches and refuges

    Simon Neville and Shiv Malik    
    The Guardian, Sunday 11 November 2012    

Starbucks
Police protect a Starbucks branch during an anti-cuts march last month after the company's low tax bill was revealed. Photograph: Suzanne Plunkett/Reuters

On an average day its outlets are a hive of social activity, hosting everything from business meetings to reading groups looking for that all-important appointment with a morning caffeine rush, approvingly overlooked by a branded community bulletin board. But Starbucks should be careful what it wishes for.

The direct action group UK Uncut plans to turn dozens of the coffee empire's UK branches into creches, refuges and homeless shelters to highlight the chain's tax avoidance tactics.

The announcement of the action comes on the day a Starbucks executive faces questions from the House of Commons public accounts committee over why the company paid no corporation tax in the UK during the past three years, despite senior US management trumpeting the company's profitable operations in Britain.

MPs will also question management representatives from Google and Amazon, both of which have faced criticism for basing their European operations in countries that have lower tax rates such as Ireland and Luxembourg.

In his appearance before the committee, Starbucks' chief financial officer, Troy Alstead, will attempt to repair the company's reputation, which, according to research by YouGov, continues to suffer because of the controversy.

In a similar session last week, MPs accused HM Revenue & Customs (HMRC) officials of having cosy relationships with big businesses. Speaking about the arrangements with Starbucks, the Conservative MP Richard Bacon said: "It smells – and it doesn't smell of coffee. It smells bad."

UK Uncut has said it will start targeting Starbucks on the Saturday following the autumn statement by the chancellor, George Osborne, on 8 December. The campaign group is attempting to draw a link between government cuts, in particular those that affect women, and tax avoidance by multinational businesses.

Sarah Greene, a UK Uncut activist, said funding for refuges and rape crisis centres faced cuts unless companies paid their fair share of tax. HMRC estimates around £32bn was lost to tax avoidance last year.

Greene said the government could easily bring in billions that could fund vital services by clamping down on tax avoidance, but was instead "making cuts that are forcing women to choose between motherhood and work, and trapping them in abusive relationships".

The group, which rose to prominence after staging a sit-in at Vodafone stores, Sir Philip Green's Topshop and Fortnum & Mason, turned its attentions to Starbucks last month after an investigation by Reuters discovered the company had paid only £8.6m in corporation tax since launching in the UK 14 years ago, despite cumulative sales of £3bn.

Longstanding Uncut campaigner Anna Walker said the group wanted to "galvanise the anger" that women were feeling: "We've chosen to really highlight the impact of the cuts on women this time. So there is going to be a real focus on transforming Starbucks into those services that are being cut by the government … [such as] refuges and creches," she said.

Walker said the campaign group had been in touch with women's groups across the country in the lead-up to the direct action event and believed that, along with a pre-established network of activists, dozens of the company's coffee shops were likely to be targeted.

"Starbucks is a really great target because it is on every high street across the country and that's what UK Uncut finds really important: people can take action in their local areas," she said. "We're really hoping that women who are impacted by the cuts, who are seeing their Sure Start centres where their kids go being reduced in services, and people who use refuges, [will] be involved."

Several international organisations have faced criticism over their UK accounts, with Amazon, eBay, Facebook, Google and Ikea all paying little or no corporation tax despite large British operations.

However, according to pollsters at YouGov's BrandIndex, Starbucks has suffered the deepest damage to its image.

The organisation, which records the strength of companies' brand identities, revealed Starbucks' cachet plummeted following the tax revelations and continues to languish at near-record lows.

Its "buzz" score, which measures the number of negative and positive comments customers have heard, hit -16.7. That is only slightly higher than the lowest levels it hit during the most heated point of the controversy last month, at -28.6. A year ago its rating was at +3.1.

By comparison, Google and Amazon – both due at the select committee – have seen their ratings seemingly unaffected.

UK BrandIndex director Sarah Murphy said: "A brand's buzz score typically recovers quite quickly following a spate of bad press, but we aren't seeing that with Starbucks, which is quite unusual. Its scores started to level out around the end of last month, but whatever modest recovery Starbucks has made could well be in jeopardy if this story flares up again in the media."

The coffee store chain insists it pays the correct level of taxes. The group chief executive, Howard Schultz, has said in a statement: "Starbucks has always paid taxes in the UK despite recent suggestions to the contrary.

"Over the last three years alone, our company has paid more than £160m in various taxes, including national insurance contributions, VAT and business rates."

However, MPs will no doubt point out that VAT is paid by the customers at point of sale and collected by Starbucks.

Margaret Hodge, who chairs the public accounts committee, told parliament last month that Apple, eBay, Facebook, Google and Starbucks had avoided nearly £900m of tax. The prime minister, David Cameron responded to the claim by saying: "I'm not happy with the current situation. I think [HMRC] needs to look at it very carefully. We do need to make sure we are encouraging these businesses to invest in our country as they are but they should be paying fair taxes as well."

A spokeswoman for Starbucks said on Sunday: "While the subject of tax law can be extremely complex, Starbucks respects and complies with tax laws and accounting rules" in each of the 61 countries where we do business, including the UK – a market that we remain committed to for the long term. We've posted the facts about our tax practices in the UK on our website .

"Starbucks' economic impact in the UK spans far beyond our stores and partners (employees). We spend hundreds of millions of pounds with local suppliers on milk, cakes and sandwiches, and on store design and renovations. When you take into account the indirect employment created by Starbucks' investments in the UK, the company's extended economic impact to the UK economy exceeds £80m annually.

"We hope that UK Uncut will respect the wellbeing of our partners and customers, and recognise the value that we add to the economy, creating jobs and apprenticeships, as well as paying our fair share of taxes in the UK."
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How does a US global corporation go from being called a tax cheat and immoral in overseas press.....which is far more free and fair than a US state-run corporate media......to being the good guys in America donating all that money for tax write-offs instead of paying US taxes that would flood government coffers with revenue?

 NEO-LIBERALS AND NEO-CONS CONTROL US MEDIA AND HAVE MADE IT US CHAMBER OF COMMERCE ALL THE TIME.  THE US MEDIA IS NOW EQUAL TO ROMANIA AS FREE PRESS.  ERGO, BASU'S LOVEFEST.

We all know that as all US commerce becomes consolidated and owned by the same few people at the top we will not be able to police US global corporations overseas and while they stagnate our US economy for growing profits overseas, all that wealth generated overseas does nothing for US yet we have the global headquarters ruling over all government and public policies and taxpayers subsidizing corporate wealth.  The article above on the state of US corporations doing business in the UK paying no taxes is mirrored in America.  The difference, the American people are electing the very neo-liberals turning their heads to this massive fraud and allowing media to ignore all of this.

EUROPE IS SEEING MORE ACCOUNTABILITY BECAUSE ITS CITIZENS HIT THE STREETS AND VOTE BAD POLS OUT OF OFFICE.



Starbucks, Google, Amazon accused of 'immoral' tax avoidance ...


www.csmonitor.com/.../1203/Starbucks...immoral-tax-avoidance   

Starbucks, Google, and Amazon were among the major multinational corporations accused by lawyers of exploiting British tax laws to move UK-made profits ...
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Sending money stolen through tax fraud and shareholder wealth created by massive corporate fraud of US Treasury to charity just to write the donation off future taxes-----WHAT A GUY-----HOWARD SCHULTZ!  Mind you, I have a history of Starbucks and its beginning in Seattle even having a Starbuck's green Jeep in my enthusiasm for fair trade coffee.  THOSE DAYS ARE LONG GONE.

Do you know the entire GI Bill would be flush with money if Starbucks paid its corporate taxes and shouted to end massive corporate fraud?

THE LEVEL OF DISGRACE IN PUSHING AMERICAN VETERANS TO HAWKING FOR CHARITY IS UNMEASURABLE.


Starbucks CEO To Donate $30 Million To Support PTSD Research For Veterans


The Huffington Post  | by  Melissa McGlensey

Posted: 03/21/2014 6:18 pm EDT Updated: 03/21/2014 6:59 pm EDT

Starbucks Starbucks Coffee Howard Schultz Charity Military Veterans Veterans Video Impact News

Starbucks CEO Howard Schultz is making a large donation to help U.S. veterans.

Schultz spoke to CBS Evening News on Wednesday and announced his plan to allocate most of the $30 million donation toward researching solutions to brain trauma and post-traumatic stress disorder.

PTSD affects between 11 and 20 percent of military members who served in the Iraq and Afghanistan wars, according to the Department of Veterans Affairs.

Schultz told CBS that veterans often don't get the treatment or understanding they need and deserve.

"The truth of the matter is, and I say this with respect, more often than not, the government does a very -- a much better job of sending people to war than they do bringing them home, " he stated. "They're coming home to an American public that really doesn't understand and never embraced, what these people have done."

Schultz has shown support for troops in the past. Last year, Starbucks announced its initiative to hire 10,000 veterans and spouses of active military in five years.

The unemployment rate among post-9/11 veterans dropped to 9.0 percent last year, down from 9.9 percent the year before, according to the Bureau of Labor Statistics. This number is about 1.6 percentage points above the civilian population.
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Bill Gates was given the 'good billionaire' logo by neo-liberals trying to push the Buffett 'billionaires need to pay what their secretary pays in taxes' at a time when the US needs billionaires to pay what they paid before the Reagan/Clinton era-----60-70% tax rate -----to bring back the massive frauds and swing the pendulum back to flush government coffers and a first world society.  This is not targeted tax policy-----

IT IS SIMPLY RULE OF LAW AND JUSTICE BRINGING TENS OF TRILLIONS OF DOLLARS IN CORPORATE FRAUD BACK TO US TREASURY AND PUBLIC TRUSTS.

As Basu pretends that Bill Gates created the Gates Global Health Initiative for the good of mankind the first thing that comes to mind is that African and Asian PHARMA developed and patented by the Gates foundation has Bill Gates, Obama, and Clinton lobbying hardest this past decade to dismantle all of public health and protections of generic manufacturing and subsidy of PHARMA around the world with the Trans Pacific Trade Pact.  It is Bill Gates building a PHARMA corporation that seeks to maximize profits by gutting all public health protections for medicine around the world.  WHAT A GUY-----BILL GATES THAT GOOD BILLIONAIRE!

While in Washington State I attended Microsoft shareholder meetings that had stockholders angry that Bill was moving all Microsoft money to a trust that was then spending billions of dollars in Pharma and health care products in Africa and Asia.  Warren Buffett moved his billions to this new economy as well.  WHILE BEING TOUTED AS PHILANTHROPISTS THEY WERE SIMPLY GUARDING MONEY FROM TAXATION UNDER THE GUISE OF PRIVATE NON-PROFITS WHILE THEY BUILT WHAT THEY KNEW WAS THE NEXT ECONOMIC ENGINE-----HEALTH AND EDUCATION.  This was at the end of Reagan and the beginning of Clinton when the transition to privatization of public health and education to create the next Wall Street markets were made.

RAISE YOUR HAND IF YOU THINK A BILLIONAIRE USING PRIVATE NON-PROFITS AND THE GUISE OF PUBLIC HEALTH TO SHIELD MONEY FROM TAXATION ALL TO CREATE AND PATENT PHARMA TARGETING A DEVELOPING WORLD THEY WANT TO MAKE A MARKET IS A GOOD GUY------NO ONE!!!!

Bill Gates is the face of Race to the Top and education privatization for the same reason-----creating private education businesses centered online and developed by Microsoft and other tech institutions.  The Industrial Philanthropists built the public structures of public universities, libraries, and K-12 and Bill Gates Foundation seeks to tear them down for profit.  WHAT A GUY-----BILL GATES!

Keep in mind that all these excuses of republicans defunding the IRS or Wall Street regulatory agencies made by neo-liberals are a farce.  Look to neo-liberal Maryland where fraud and corruption is king to see a dismantled and unfunded oversight.

RECOVERING CORPORATE FRAUD PAYS FOR ITSELF, NO REPUBLICANS OR TAXPAYER MONEY NEEDED.  THAT FIRST BILLION IN RECOVERY PAYS FOR THE NEXT TRILLION DOLLARS IN RECOVERY!



Microsoft, HP skirted taxes via offshore units: U.S. Senate panel

By Kim Dixon

WASHINGTON Thu Sep 20, 2012 7:12pm EDT


A variety of logos hover above the Microsoft booth on the opening day of the International Consumer Electronics Show (CES) in Las Vegas January 10, 2012. REUTERS/Rick Wilking

A variety of logos hover above the Microsoft booth on the opening day of the International Consumer Electronics Show (CES) in Las Vegas January 10, 2012.




(Reuters) - Microsoft Corp and Hewlett-Packard Co pushed back against claims by a U.S. Senate panel on Thursday that they used offshore units and loopholes to shield billions of dollars in profits from U.S. taxes.

Calling tax avoidance rampant in the technology sector, the Senate's Permanent Subcommittee on Investigations said tech companies used intellectual property, royalties and license fees in overseas tax havens to skirt taxes.

The panel subpoenaed internal documents from the companies and interviewed Microsoft and HP officials to compile its report, which uses the companies as case studies.

"The tax practices and gimmicks range from egregious to dubious validity," Democratic Senator Carl Levin, chairman of the panel, said at a news conference.

Officials at HP and Microsoft strongly denied any wrongdoing, noted tax officials had not objected to the structures and said there were valid reasons for tax planning.

Senator Tom Coburn, the top Republican on the panel, signed onto the new report but blamed Congress.

"Tax avoidance is not illegal. Congress has created this situation," Coburn said, criticizing the complex tax code and the 35 percent corporate tax rate, among of the world's highest, though few companies pay that statutory rate.

The subcommittee said that from 2009 to 2011, Microsoft shifted $21 billion offshore, almost half its U.S. retail sales revenue, saving up to $4.5 billion in taxes on goods sold in the United States.

This was accomplished, the report said, by aggressive transfer pricing, where companies value intra-company movement of assets. Corporate units must use a fair market price to value transfers, but critics say they are manipulated to minimize tax.

The report also said the software giant shifts royalty revenue to units in low-tax nations, such as Singapore and Ireland, avoiding billions of dollars of U.S. tax.

Levin said one Microsoft Singapore unit was legally headquartered in Bermuda and had no employees. Levin asked Microsoft's tax vice president, William Sample, if the reason was to cut its tax bill. "Yes, that is correct," Sample said.

Sample also said several offshore units employ hundreds of workers, which Levin noted was a tiny fraction of its workforce.

IRS CITES CHALLENGE

Internal Revenue Service officials are not allowed to comment on specific taxpayers, but Chief Counsel William Wilkins said enforcing transfer pricing law "has been the IRS's most significant international enforcement challenge."

U.S. companies have at least $1.5 trillion in profits sitting offshore. Most say they are keeping them there to avoid U.S. tax. Of the top 10 companies with the biggest offshore cash balances, five are in the technology sector.

"The high-tech industry is probably the No. 1 user of these offshore entities to transfer intellectual property," Levin said.

The panel said Hewlett-Packard funded U.S. operations with a stream of intra-company loans, using an exception in the law for short-term loans, to avoid billions of dollars in taxes.

Levin said more than 90 percent of HP's cash was sitting offshore, as opposed to about 65 percent of revenue coming from countries outside the United States.

An HP spokesman said in a statement that the hearing was a politically motivated attack.

"We are disappointed to see what appears to be a politically motivated attack on one of America's largest employers," HP spokesman Michael Thacker said before the hearing.

Lester Ezrati, an HP tax vice president, said HP used cash faster in the United States for valid reasons including that certain payments like pensions must be made with U.S. cash.

"HP has an overall strategy to minimize expenses and that is what generates where the cash is located," and "one of those expenses is taxes," Ezrati said.

REPATRIATED PROFITS TAXABLE

Under tax law, foreign profits are subject to U.S. tax when they are "repatriated," or brought into the United States, usually in the form of a dividend.

One internal document released by the panel suggested that HP routinely brought money into the U.S. without paying U.S. tax. An HP presentation noted that "without planning, repatriation of foreign earnings could lead to tax payments."

Loans by the foreign units to a related U.S. entity are considered a dividend for tax purposes but there is an exception for loans that are repaid within 30 days, according to the committee's tax experts.

HP set up a complicated series of short-term loans starting in 2008 to these businesses that were continuous without gaps, to get around that provision, the panel found.

Big companies have lobbied for a tax holiday to let them bring offshore profits into the United States at a reduced tax rate, arguing that the profits are trapped offshore. That effort has fallen flat amid reports suggesting such a program would cost the government significant revenue and not produce U.S. jobs.

The report on transfer pricing "mocks the notion that profits of U.S. multinationals are 'locked-up' or 'trapped' offshore," Levin said.

The subcommittee also criticized accounting giant Ernst & Young for blessing HP's practices.

Ernst & Young partner Beth Carr said that the firm stands firmly behind its auditing for HP.
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Below you see from 2002-2005 Bill Gates was positioning himself for the coming Affordable Care Act health legislation and privatization and making of global health corporations.  Keep in mind that mental health pharma was just given a boost in rewriting the Psychiatric definition of what constitutes depression. increasing government subsidy of more depression PHARMA as Gates moves to Prozac.  Medicare and Medicaid will now pay for depression medicine for what we all know is common sadness.

Bill Gates was simply moving his wealth to what he knew would be the new markets created by privatization of public health and education-----AFFORDABLE CARE ACT AND RACE TO THE TOP.

ALWAYS WORKING FOR THE PUBLIC'S INTERESTS THOSE GOOD BILLIONAIRES!  NEO-LIBERALS----WORKING FOR WEALTH AND PROFIT AND THIRD WORLD QUALITY OF LIFE.  HOW DO THEY RUN AS DEMOCRATS?

Below you see a blogger that obviously attended the same Microsoft shareholder meetings I did.

created 04/07/2005 - 07:35, updated 31/08/2006 - 14:01 by cybe


Bill Gates is [alledgedly] giving 95% of his wealth for africa ......

I wonder if he is diversifying his investments and has bought shares in the pharmaceutical industry so he is just transferring his money into a new business venture whilst "looking" as though he is giving it away.

The Real Way to Health is a completely different one:- "Healing in His Wings"

Three articles below:

Bill Gates sells MSFT, takes Prozac
Bill Gates and Big Pharma
Bush's bogus AIDS offer, and why Bill Gates is making it worse.
The Gates And Buffet Foundation Shell Game

 


Bill Gates sells MSFT, takes Prozac

By Andrew Orlowski in San Francisco
http://forms.theregister.co.uk/mail_author/?story_url=/2002/09/09/bill_gates_sells_msft_takes/

Published Monday 9th September 2002 19:48 GMT

Bill Gates has sold almost half a billion dollar's worth of Microsoft stock this year, and begun to invest heavily in big pharma. In the second half of this year he bought 2.5 million shares in Eli Lilly, manufacturer of Prozac, and also made major investments in Merck and Pfizer, notes /Information Week/.

The 9 million shares Gates relinquished represent only a tiny proportion of Chairman Bill's MSFT holdings, or about 1.36 per cent.

Eli Lily's patent on Prozac expired a year ago, but the company has sought to widen its appeal, combining its with other drugs and marketing it as a kind of MSG of anti-depressants.

"Companies are getting a lot more creative in ways to sustain the product lifespan of drugs," a J.P. Morgan told The Street.

In sickness and in wealth, big pharma remains the most profitable industry in America. No doubt Gates took comfort in the Bush administration's indulgent attitude towards the inflated prices charged by the pharmaceutical industry. Although nine out of ten drugs fail clinical tests, the industry - which argues that high prices are needed to justify R&D - spends two and half times as much on marketing than on research, according to Families USA .

(I'll defer to our very own Thomas C Greene, who covered the industry in detail).

A crack about anxiety-inducing computer software would simply be too cheap, so we won't dream of making it here.


_______________________________________________
We must be very careful to follow where these last few years of US global corporation has led under Obama and neo-liberals in Congress.  Remember, between the FED policy and trillions in fake job stimulus money that was just used to expand US global corporations overseas, the US has allowed global corporations to create a global network of empire that looks just like this one below.  IT IS HORRENDOUS.

So, as Basu tells us on corporate 'public' media WYPR that billionaires are doing good in their bequests to basic research, the entire world knows what kind of empire Bill Gates is building!


'Blackwater, Monsanto and Gates are three sides of the same figure: the war machine on the planet and most people who inhabit it, are peasants, indigenous communities, people who want to share information and knowledge or any other who does not want to be in the aegis of profit and the destructiveness of capitalism'.

A Link Between Monsanto, Blackwater & Bill Gates?

By majestic on January 3, 2011 in News

There’s an unlikely story circulating on various underground news sites claiming that the controversial biotech company Monsanto has acquired infamous mercenary outfit Blackwater (now trading as Xe Services). The report apparently first appeared in La Jornada, one of Mexico City’s leading daily newspapers, described by Noam Chomsky as “the one independent newspaper in the whole hemisphere.” Pravda has translated the original Spanish text written by Silvia Ribeiro into English. From my reading of the Jeremy Scahill article that seems to form the basis of the report, the most you can deduce is that Monsanto hired the creeps at Blackwater to do dirty work for them, but the rumor keeps circulating, so could there be a grain of truth somewhere in this story?:

A report by Jeremy Scahill in The Nation (Blackwater’s Black Ops, 9/15/2010) revealed that the largest mercenary army in the world, Blackwater (now called Xe Services) clandestine intelligence services was sold to the multinational Monsanto. Blackwater was renamed in 2009 after becoming famous in the world with numerous reports of abuses in Iraq, including massacres of civilians. It remains the largest private contractor of the U.S. Department of State “security services,” that practices state terrorism by giving the government the opportunity to deny it.

Many military and former CIA officers work for Blackwater or related companies created to divert attention from their bad reputation and make more profit selling their nefarious services-ranging from information and intelligence to infiltration, political lobbying and paramilitary training – for other governments, banks and multinational corporations. According to Scahill, business with multinationals, like Monsanto, Chevron, and financial giants such as Barclays and Deutsche Bank, are channeled through two companies owned by Erik Prince, owner of Blackwater: Total Intelligence Solutions and Terrorism Research Center. These officers and directors share Blackwater.

One of them, Cofer Black, known for his brutality as one of the directors of the CIA, was the one who made contact with Monsanto in 2008 as director of Total Intelligence, entering into the contract with the company to spy on and infiltrate organizations of animal rights activists, anti-GM and other dirty activities of the biotech giant.

Contacted by Scahill, the Monsanto executive Kevin Wilson declined to comment, but later confirmed to The Nation that they had hired Total Intelligence in 2008 and 2009, according to Monsanto only to keep track of “public disclosure” of its opponents. He also said that Total Intelligence was a “totally separate entity from Blackwater.”

However, Scahill has copies of emails from Cofer Black after the meeting with Wilson for Monsanto, where he explains to other former CIA agents, using their Blackwater e-mails, that the discussion with Wilson was that Total Intelligence had become “Monsanto’s intelligence arm,” spying on activists and other actions, including “our people to legally integrate these groups.” Total Intelligence Monsanto paid $ 127,000 in 2008 and $ 105,000 in 2009.

No wonder that a company engaged in the “science of death” as Monsanto, which has been dedicated from the outset to produce toxic poisons spilling from Agent Orange to PCBs (polychlorinated biphenyls), pesticides, hormones and genetically modified seeds, is associated with another company of thugs.

Almost simultaneously with the publication of this article in The Nation, the Via Campesina reported the purchase of 500,000 shares of Monsanto, for more than $23 million by the Bill and Melinda Gates Foundation, which with this action completed the outing of the mask of “philanthropy.” Another association that is not surprising.

It is a marriage between the two most brutal monopolies in the history of industrialism: Bill Gates controls more than 90 percent of the market share of proprietary computing and Monsanto about 90 percent of the global transgenic seed market and most global commercial seed. There does not exist in any other industrial sector monopolies so vast, whose very existence is a negation of the vaunted principle of “market competition” of capitalism. Both Gates and Monsanto are very aggressive in defending their ill-gotten monopolies.

Although Bill Gates might try to say that the Foundation is not linked to his business, all it proves is the opposite: most of their donations end up favoring the commercial investments of the tycoon, not really “donating” anything, but instead of paying taxes to the state coffers, he invests his profits in where it is favorable to him economically, including propaganda from their supposed good intentions. On the contrary, their “donations” finance projects as destructive as geoengineering or replacement of natural community medicines for high-tech patented medicines in the poorest areas of the world. What a coincidence, former Secretary of Health Julio Frenk and Ernesto Zedillo are advisers of the Foundation.

Like Monsanto, Gates is also engaged in trying to destroy rural farming worldwide, mainly through the “Alliance for a Green Revolution in Africa” (AGRA). It works as a Trojan horse to deprive poor African farmers of their traditional seeds, replacing them with the seeds of their companies first, finally by genetically modified (GM). To this end, the Foundation hired Robert Horsch in 2006, the director of Monsanto. Now Gates, airing major profits, went straight to the source.

Blackwater, Monsanto and Gates are three sides of the same figure: the war machine on the planet and most people who inhabit it, are peasants, indigenous communities, people who want to share information and knowledge or any other who does not want to be in the aegis of profit and the destructiveness of capitalism.

* The author is a researcher at ETC Group


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I watched a TV commercial that had UnderArmour CEO standing on an African mountaintop stating that he wants to use his billions to help the poor worldwide.  This is the same CEO who demands his UnderArmour headquarters in Baltimore be given tax-free status starving Baltimore City government coffers of money that would go to underserved communities and public schools.  

IF THAT ISN'T OBSCENE ENOUGH-----UNDERARMOUR USES THE FACT THAT THE VETERANS ADMINISTRATION HAS BEEN DISMANTLED AND NEO-LIBERALS ARE PUSHING VET CHARITY TO SUPPORT VETS.

So, rather than paying taxes that would support a strong, public supported VA, he is making profits off of his athletic brand and 'donating' money to vet charities for corporate tax write-offs.  WHAT A GUY-------BILLIONAIRE PROFITS OFF OF VETS FORCED TO SEEK CHARITY IN LIEU OF VETERAN'S BENEFITS!

Below you see yet another corporation that is ground zero for making the American people impoverished and yet finding time to 'donate' to help the poor.

THIS IS NEO-LIBERALISM WHERE WEALTH AND PROFIT CREATE AN AUTOCRATIC SYSTEM MODELED ON MEDIEVAL EUROPE-----THEY CALLED IT THE DARK AGES.



UNDERARMOUR---GlassDoor

 “Employee survey results were poor”
Director (Former Employee)
Baltimore, MD

I worked at Under Armour full-time for more than 3 years

Pros – Successful brand w/ currently valuable stock

Cons – Don't just go by these anonymous reviews. In a recent survey of all employees, findings were that an overwhelming majority feel "disengaged", "overworked" , "underpaid", and "under appreciated". What was the founder's response when he pulled Directors into a room? Instead of saying "here's what we're going to do", he said "it's your problem. You fix it." Needless to say there's extremely high turnover. Those that do stay wish they were somewhere else.

Advice to Senior Management – Listen to employee issues and do something about. Currently you're doing neither.

No, I would not recommend this company to a friend – I'm not optimistic about the outlook for this company

__________________________________________

TAX CREDITS FOR HIRING VETS IS LIKE ENTERPRISE ZONE TAX CREDITS FOR HIRING THE UNDERSERVED ------AS IN BALTIMORE'S INNER HARBOR THESE CONTRACTS ARE ALL IGNORED AND THE JOBS ARE FILLED WITH FRAUD AND WORKPLACE ABUSE.

All across the country veterans are being hired into the worst of jobs and working conditions as corporations get tax credits for simply hiring.  Those fighting to keep public military positions are being harassed and denied civil liberties and workplace safety.  Remember, the Bush Administration made military service contracts NULL and VOID requiring national guard and military to serve extended service tours knowing these troops would be battle weary and did while dismantling Va facilities.  AS Obama does the same, O'Malley travels overseas to recruit Veterans to substandard online degrees and career colleges.



UNDERARMOUR
Shop the Wounded Warrior project

Between August 2012 and December 2014, Under Armour® will make a donation of over $1 Million to Wounded Warrior Project™ benefitting injured service members and their families.
__________________________________________

The neo-liberals spent all last decade shouting against the abuses of the US troops by neo-conservatives and now neo-conservatives are blaming neo-liberals for the outrageous move to dismantle all that is public veterans administration.

TAG TEAM OF GLOBAL CORPORATE POLS----STOP ALLOWING A NEO-LIBERAL DEMOCRATIC LEADERSHIP CHOOSE YOUR CANDIDATES---RUN LABOR AND JUSTICE IN ALL PRIMARIES!

Below you see the same labor and justice conditions that existed under Bush are now super-sized under Obama and neo-liberals in Congress.  Do you hear your incumbent shouting out against the deliberate attack of public sector workers in order to get them to quit and be replaced by private contractors and to protect yet more people breaking the US laws from prosecution?

General News 3/1/2014 at 17:57:53
    
Veterans Speak Out Against a Debilitating Federal Workplace Harming the Health of America's Returning Military

By Ward Jordan

opednews.com


(WASHINGTON, DC)   --  In a recently released statement veterans, members of The Coalition For Change, Inc. (C4C), called for the U.S. Congress and the Obama administration to stop the political power play and to mandate that federal supervisory and management officials face discipline for willfully breaking civil rights and whistleblower-protection laws.

"The unrestrained retaliatory actions the VA supervisors take against subordinate employees cripples the agency's healthcare system and stifles many employees from exposing unfair customs, unsafe conditions and unlawful practices," said Oliver Mitchell, a U.S. Marine Corps veteran and a former employee with the Veterans Affairs' Greater West Los Angeles Medical Center Imaging Service, Radiology Section. While serving as a Patient Services Assistant, Mitchell received "excellent" performance ratings.   "Things changed rapidly after I refused an order to purge patient documents," Mitchell explained.   "The harassment started and VA officials detailed me repeatedly after I filed a whistleblower complaint with the Office of Special Counsel (OSC)."

According to Mitchell, both the VA's Office of Inspector General and the OSC failed to properly pursue the matter even after hearing Mitchell's submitted audio tape of employees discussing how to destroy veteran patients' records.   "Although I declined to purge patient records, VA officials hired another employee to delete valid MRI requests from the system as a means of reducing the backlog," said Mitchell, now homeless after being constructively removed from the U.S. Veterans Affairs pursuant to terms put in a settlement agreement.

"The constructive discharge is a popular tactic used in discharging complaining parties," said Janel Smith, a disabled Air Force veteran and the Vice President of the Coalition For Change, Inc. (C4C).

Ralph Saunders, a U.S. Marine Corps veteran and a former employee with the VA's New Orleans Medical Center, agreed that reprisal against employees who file complaints is a daunting problem.   According to Saunders, VA personnel once destroyed his medical documents and subjected him to endless reprisal after he filed an Equal Employment Opportunity (EEO) complaint against a manager who had denied him requested time off from work to accommodate his wife's heart-surgery operation. Saunders prevailed in his discrimination complaint (Saunders v Shinseki, Case Number 200L-0629-2004-100828).

Unequivocally, the Equal Employment Opportunity Commission (EEOC) found managers (Cassandra Holiday, Jeanette Butler, and Linda Cosey) guilty of "abusing the rules" and "retaliating against Saunders for his protected EEO activity."   The EEOC also found "evidence that officials retaliated against other employees who filed EEO complaints."   Saunders, who had worked sixteen years with the VA before officials targeted him for removal from federal service, is presently challenging the VA on a settlement-breach issue.

"Retaliation by rogue VA managers is destroying the lives of men and women who served honorably on active duty in the U.S. Armed Forces," said Isaac Decatur, a U.S. Navy veteran, who after eighteen years with the department was fired from Veterans Affairs' Durham, North Carolina, office after filing an EEO complaint (Decatur v Shinseki, 0120073404).

"I wrote to President Obama about the VA's failure to take discipline against the supervisors who engaged in the blacklisting of employees and who the EEOC found guilty of discrimination," said Decatur. "My letter to the President spurred a reply letter from the EEOC in which the federal agency, charged with enforcing federal laws prohibiting employment discrimination, openly asserted: While EEOC orders agencies to consider; we have no authority to issue discipline."

"Some of these VA managers need to face conspiracy criminal charges for destroying veterans' records and engaging in various illegal activities," said Chauncey L. Robinson, who served in the Persian Gulf War. Robinson reported that he has been waiting twenty-one years for the VA to process his claim for Post-Traumatic Stress Disorder (PTSD) and a heart condition. "VA officials destroyed my records," said Robinson, who joined other veterans in a class-action lawsuit that asserts the VA has been systematically violating veterans' due process for decades (Gary Kendall v Eric A. Shinseki, Secretary of Veterans Affairs Case No. CV07-103-S-EJL).

"The ill-treatment of VA's workforce harms the well-being of VA's employees as well as the veterans deserving of timely health care and benefits," said Al Hunt, III, a Gulf War veteran and a former VA supervisor with the New Orleans Medical Center. Hunt explained that he was forced to resign from the VA due to discriminatory practices and harassment. "I refused to be complicit in a managerial scheme to write-up and fire black veterans who bravely served our country solely because they had exposed civil rights abuses in the VA workplace," Hunt said.

"Internal federal workplace dysfunction will continue to adversely impact public programs and services until supervisors and managers are held accountable for violating civil rights and whistleblower-protection laws."  said Tanya Ward Jordan, the President and Founder of the volunteer support and advocacy group, C4C.

-------------------------------------------------------
About The Coalition For Change, Inc. (C4C)
The Coalition For Change, Inc. (C4C) is a Washington, DC-based volunteer organization comprised of present and former federal employees who have been injured or ill-treated due to workplace race discrimination and /or reprisal.  C4C recently produced a YouTube video to expose how an internal broken workplace system harms the public. The video is entitled -- Veterans Affairs Dishonoring America's Veterans and Civil Servants.

__________________________________________________



Below is possibly more than you want to know about Bill Gates as US corporate lobby to end public health and capture health patents and curb generics but it is one of the best overviews.  Keep in mind this was written in 2011 and we now know TPP is worse than this article shows.

Bill Gates and Warren Buffett placed hundreds of billions of dollars into trusts under the guise of private non-profits and health care that are now these very patents and intellectual rights protections sought for the PHARMA and health industry.  So, rather than paying taxes and allowing the public do the research to produce these PHARMA results as it always has, these billionaires privatized the research and seeks patents and protections on what would be a trillion-dollar PHARMA industry in developing worlds.

AS BILL GATES SAID AT THE 1990s SHAREHOLDER MEETING QUESTIONING HIS MOVING OF ALL THAT MONEY INTO TRUSTS RATHER THAN REINVESTING IT IN TECH INNOVATION-----'WE ARE MOVING TO AFRICA AS THE NEXT MARKET AND WE HAVE TO MAKE IT LIVABLE FOR US EMPLOYEES BEING SENT THERE TO WORK.  Meanwhile, all of the African citizens that were helped by these research and development activities are now seeing funding disappear and are not feeling to advantages of all that patented research.  



Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011


How the Trans-Pacific Partnership Agreement Threatens Access to Medicines


The eighth round of closed-door negotiations for the Trans-Pacific Partnership (TPP) agreement will be held in
Chicago from September 6-15, 2011. Negotiations during this round are expected to be substantial, as the
current nine negotiating countries, Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, the United
States and Vietnam, plan to present the outlines of an agreement at the Asia Pacific Economic Cooperation
(APEC) Leaders’ meeting in Honolulu, November 8-13 2011.1
According to the United States Trade Representative (USTR), “U.S. involvement in the TPP is predicated on the
expansion of the agreement to include more economies across the Asia-Pacific region,”2 and should “set the
standard for 21st-century trade agreements going forward.”3 It is therefore expected that the norms that emerge
from these negotiations will serve as a baseline for future trade agreements, potentially impacting a much wider
group of countries, including developing countries where MSF has medical operations and beyond. For
example, Japan and South Korea are reportedly currently considering joining the TPP.
TPP negotiating parties are under no obligation to subject their negotiating positions to public scrutiny; only the
final agreed-upon text will be made publicly available. However, a leaked draft of the U.S. position, now
available to the public,4 indicates that the U.S. is demanding aggressive intellectual property provisions that go
beyond what international trade law requires. Furthermore, the U.S. position represents a major retreat from
previous U.S. commitments to global health, including the 2007 bipartisan New Trade Policy, in which
Congress and the Bush administration agreed to abide by important public health safeguards in future trade
agreements.


1. INTELLECTUAL PROPERTY AND ACCESS TO MEDICINES
Vital Importance of Affordable Medicines
Affordable, quality generic medicines are a critical component of treatment programs. About 80% of the HIV
medicines that MSF uses are generics, and MSF routinely relies on generic drugs to treat TB, malaria, and a
wide range of infectious diseases. In fact, all the major donors and leading international treatment providers,
including the Global Fund to Fight AIDS, Tuberculosis and Malaria, The U.S. President's Emergency Plan for
AIDS Relief (PEPFAR), UNITAID and UNICEF, rely on quality affordable generic drugs for the programs they
support. PEPFAR, which purchases 80-90 percent of its ARVs drugs from generic suppliers, has reported
significant savings through the purchase of generic medicines.5
The first generation of HIV drugs have come down in price by 99 percent over the last decade, from
U.S.$10,000 per person per year in 2000 to roughly $60 today, thanks to generic production in India, Brazil and
Thailand, where these drugs were not patented. This dramatic price drop has been instrumental in helping scale
up HIV/AIDS treatment for more than six million people in developing countries. About 80 percent of donorfunded
anti-AIDS drugs and 92 percent of drugs to treat children with AIDS across the developing world comes
from generic manufacturers.


1 http://www.ustr.gov/tpp
2 http://www.ustr.gov/about-us/press-office/press-releases/2010/june/ustr-ron-kirk-comments-trans-pacific-partnership-talk
3 http://www.ustr.gov/about-us/press-office/press-releases/2009/november/ustr-news-kirk-comments-trans-pacific-partnership
4 Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
5 http://jama.ama-assn.org/content/304/3/313.short



Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011

Public Health Safeguards Threatened
Since the creation of the World Trade Organization (WTO) and the conclusion of the Agreement on Trade
Related Aspects of Intellectual Property Rights (TRIPS) in 1995, the most comprehensive multilateral
agreement on intellectual property to date, developing countries have struggled to strike a balance between
protecting public health and making their patent laws TRIPS compliant. Patents and other intellectual property
(IP) regulations pose significant barriers to access to life-saving medicines, and flexibilities in patent systems are
recognized as important public policy tools in the fight to protect public health interests. Even developed
countries like the U.S. have utilized TRIPS-compliant legal flexibilities to protect public health and other
national interests.
The WTO 2001 Doha Declaration on TRIPS and Public Health was signed to reaffirm that the TRIPS
Agreement does not and should not prevent members from taking measures to protect public health, and that it
can and should be interpreted and implemented in a manner supportive of WTO members' right to protect public
health and, in particular, to promote access to medicines for all.

 These commitments were reaffirmed and
strengthened in the 2008 World Health Organization (WHO) Global Strategy and Plan of Action on Public
Health, Innovation and Intellectual Property.
However, over the last decade, many developing countries have come under pressure in trade negotiations not to
use TRIPS flexibilities and to implement even tougher rules than those set out in TRIPS – these are known as
“TRIPS plus.” The U.S. and the European Union routinely use bilateral and regional trade agreements to limit
or circumvent developing countries’ abilities to implement the Doha Declaration and safeguard public health.
The U.S. and the E.U. both have large pharmaceutical industries lobbying for stricter patent regulations, and
these interests not only tip the balance away from public health protections and threaten access to medicines, but
also work to counter the efforts of global health programs.


In fact, studies have shown that U.S. bilateral and regional free trade agreements (FTAs) have already
undermined access to medicines in developing countries. For example, Oxfam found in a 2007 study6 that
during the five-year period since Jordan implemented TRIPS plus measures included in the U.S.-Jordan FTA,
medicines prices rose 20 percent, without any corresponding benefit in terms of domestic innovation or access
to new products. In addition, the Center for Policy Analysis on Trade and Health (CPATH) found in a 2009
study7 that once Guatemala enacted data exclusivity, on the basis of the Dominican Republic-Central America-
United States (CAFTA-DR) FTA, prices for some medicines rose significantly – even though just a handful of
medicines were under patent protection.
Recognizing the damaging effects that trade agreements have had on public health, the Bush administration and
the U.S. Congress signed a bipartisan agreement on May 10th, 2007, known as the 2007 New Trade Policy to
scale-back the harshest IP protections in order to strike a better balance between protection of IP and public
health needs. The agreement specifies that the USTR should modify its intellectual property demands in trade
agreement negotiations so that important public health safeguards are included. Yet in several meetings with
U.S. civil society, the USTR has stated on the record that they are considering options in the TPP that would
shift U.S. policy away from the 2007 New Trade Policy.
MSF is concerned that the U.S. demands for the TPP negotiations threaten to roll back vitally important public
health safeguards in developing countries, creating a fundamental contradiction between U.S. trade policy and
U.S. commitments and priorities on global health.
Medical Innovation Threatened
MSF is also concerned about the effects that intellectual property norms have on innovation for essential
medical technologies. The USTR presents its efforts to demand stronger regimes for intellectual property
protection in developing countries as a tool to protect innovation. MSF recognizes the importance of innovation

6 http://www.oxfam.org/en/policy/bp102_jordan_us_fta
7 http://www.cpath.org/sitebuildercontent/sitebuilderfiles/cpathhaonline8-25-09.pdf
8 http://waysandmeans.house.gov/media/enewsletter/5-11-07/07%2005%2010%20New%20Trade%20Policy%20Outline.pdf


Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011

and the need to finance research and development. We are a humanitarian medical organization that needs and
welcomes biomedical innovation to better treat our patients. However, the reality is that intellectual property
protection in the medical field keeps prices high and limits access to treatment, and furthermore does not
stimulate innovation for many of the diseases affecting people in developing countries, where patients have
limited purchasing power. By seeking greater and higher intellectual property norms in developing countries,
the U.S. government is perpetuating a failed business model that links innovation costs to high prices, and does
not address the innovation needs of developing countries.


2. THE TRANS-PACIFIC PARTNERSHIP AND ACCESS TO MEDICINES

The TPP negotiations are being conducted in secret, so MSF other interested stakeholders don’t have access to
the U.S. or other countries’ demands. However, according to a leaked draft of the U.S. position, now available
to the public at http://keionline.org/node/1091, as well as correspondence and discussions between Congress and
the USTR, the U.S. is expected to demand the following TRIPS plus measures to be included in the

Intellectual Property Chapter of the TPP:


a) Broadening the scope of patentability: the U.S. wants to make it easier to patent new forms of old
medicines that offer no added therapeutic efficacy for patients
The TRIPS agreement includes important flexibilities for governments to decide what type of “innovation”
deserves to be protected by patents in a given country. Essential terms such as ‘novelty,’ ‘inventive step,’ and
‘industrial applicability’ are left undefined as standards to be best determined by individual governments within
the context of existing national legislation and circumstances.
However, the U.S. is seeking to erode this flexibility by requesting that TPP partners introduce new rules that
would severely limit the ability of each country to define what is ‘patentable.’

For example, the U.S. proposal for the TPP requests the patenting of a “new form, use, or method of using” an
existing product - even if there is no increase in efficacy. This technique, known as “evergreening,” allows
pharmaceutical companies to obtain or extend monopoly protection for old drugs simply by making minor
modifications to existing formulas. Evergreening significantly delays the arrival of more affordable generic
medicines onto the market.
Novartis has been battling the Indian government on its implementation of this flexibility since 2006, when its
patent for the cancer drug imatinib mesylate (Gleevec) was rejected on the grounds it was based on a drug
compound that already existed. Having lost its case in 2007 and the patent appeal in 2009, Novartis is now
attempting to ensure the words ‘therapeutic efficacy’ are interpreted in a way that allows even small changes to
an old medicine – such as imatinib mesylate – to be patentable10.
Additionally, the US seeks to require that parties make patents available on plants and animals, as well as
diagnostic, therapeutic and surgical methods for the treatment of humans or animals despite the fact that Article
27 of the TRIPS Agreement explicitly allows for the exclusion of these inventions from patent protection11.
Aside from the serious ethical concerns for surgeons performing procedures on patients, this text is not even
compatible with the U.S. policy not to enforce patents against medical professionals.

b) Restrictions on pre-grant patent oppositions: the U.S. wants to make it harder to challenge unjustified
patents
The TRIPS agreement allows countries and third parties (including generic companies and civil society organizations such as patient groups) to file an opposition to the granting of a patent - either before it has been


 Article 8.1, Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
http://www.msfaccess.org/about-us/media-room/press-releases/drug-company-novartis-tries-weaken-indian-patent-law-protects
 Article 8.2, Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
 http://keionline.org/node/1216


Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011

granted (pre-grant opposition) or after (post-grant opposition). Patent opposition procedures have been
successfully used in several countries to prevent patents being granted undeservedly.
For example, in June 2008 the Indian patent office rejected a patent for the hemihydrate (syrup) form of
Nevirapine (NVP), a widely-used antiretroviral (ARV) treatment, based on pre-grant oppositions by civil society
groups. The price of NVP has decreased dramatically over the past years as a result of generic competition.
Similarly, the Indian patent office rejected the patent application for Tenofovir Disoproxil Fumarate (TDF), an
important HIV drug highly recommended by the World Health Organization (WHO), and Darunavir (DRV), a
third-line ARV, based on pre-grant oppositions.
Patent oppositions are an essential public health safeguard that can accelerate the entry of generic competition,
improve the patent system through public participation, and help reduce over-patenting.
However, the U.S. government is now seeking to clamp down on this flexibility and prevent pre-grant oppositions in TPP partner countries,13 making it more costly and cumbersome to oppose a patent. In addition, patent offices will not have the benefit of the expertise of opponents/competitors to the applicant who may be
able to identify inaccuracies in the application before a patent is approved.


c) Imposing new forms of IP enforcement: the U.S. wants to allow customs officials to seize shipments of drugs on mere suspicion of IP infringement and to increase damages for IP infringement
The TRIPS agreement allows for governments to have a great amount of flexibility when designing the mechanisms that the country will allow for the enforcement of IP rights. However, the U.S., through the TPP and other tools (e.g. ACTA14), is demanding that countries enforce IP rights with new forms of enforcement beyond what TRIPS requires.
For example, the U.S. is requesting that TPP countries grant customs officials the ex officio right to detain
shipments of medicines at the border, even in transit, if the goods are suspected of being counterfeits or if they
are considered “confusingly similar” to trademarked goods.
Under TRIPS, “counterfeit” products are defined as those resulting from criminal – and not civil – trademark
infringement, which occurs knowingly and on a commercial scale. The U.S.’s proposed TPP IP chapter allows border officials to rely on a different, more lenient standard - “confusingly similar” – in order to seize consignments. This standard conflates pure commercial trademark disputes, which do not represent a threat to
public health or patent rights, with criminal offenses, such as production of counterfeit, falsified or substandard
medicines.

In fact, customs and border officials are often not fully trained or equipped to make accurate assessments with
regard to intellectual property infringement and may be overzealous in the protection of brand name companies.
For example, during 2008 and 2009, at least 19 shipments of generic medicines from India to other countries
were impounded while in transit in Europe on grounds that the shipments were suspected of infringing patent
rights. In one instance, German customs authorities wrongfully seized a drug shipment of “Amoxicillin” on the
suspicion that it infringed the brand name “Amoxil” – the cargo was detained for four weeks while further
investigation took place, eventually revealing that there was no trademark infringement. In another instance,
the Dutch customs authorities seized a shipment of the AIDS drug abacavir sulfate while it was en route (via
Europe) from India to a Clinton Foundation project in Nigeria.

 Article 8.7, Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
The Anti-Counterfeiting Trade Agreement (ACTA) would impose limits on price-reducing generic competition and jeopardize the free flow of legitimate medicines across borders.


 Article 14.4, Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
16 http://www.doctorswithoutborders.org/publications/reports/2011/2011Special301MSF_Final.pdf
17 http://www.doctorswithoutborders.org/publications/reports/2011/2011Special301MSF_Final.pdf
18 http://www.bmj.com/content/340/bmj.c2672.extract
19 http://www.twnside.org.sg/title2/IPR/pdf/ipr13.pdf
20 http://www.safemedicines.org/nigeriabound-hivaids-drugs-seized-in-netherlands.html


Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011

In addition, under the U.S.’s proposed TPP regulations, shipments that are legitimate in the country of origin
and the country of ultimate destination would still be subject to detention in the transit country. Unwarranted
interception of legitimate in-transit pharmaceutical supplies can undermine legitimate trade in generic
medicines.

Furthermore, the U.S. is requesting TPP countries to mandate that judicial authorities consider valuing damages
based on “the suggested retail price or other legitimate measure of value submitted by the right holder” in cases
of infringement of intellectual property rights,” a mechanism that strongly favors the rights holder and
increases damage amounts. Each country should have the flexibility to individually determine the appropriate
measure for damages for IP infringement.

d) Expanding data exclusivity: the U.S. is seeking to expand a backdoor way to grant monopoly status
Data exclusivity is a TRIPS plus provision that restricts access to essential clinical trial data pertaining to the
safety and efficacy of drugs. Data exclusivity measures prevent generic manufacturers from using existing
clinical research to gain regulatory approval of their medicines, forcing them to perform duplicate clinical trials
or wait for the “data monopoly” period to end.
In the absence of data exclusivity measures, when a generic manufacturer applies to register and sell a version of
a previously-registered medicine, they only have to provide data showing that their product is equivalent to the
original. The drug regulatory authority relies on the clinical trial data provided by the original manufacturer to
evaluate the safety and efficacy of the generic drug.
The introduction of data exclusivity provisions essentially creates a new system for granting monopolies by
blocking registration of generic medicines until the data exclusivity period ends, even if the patent monopoly
has already ended or been overcome, for example with the use of a compulsory license. Under these terms,
generic competition is stifled not only for old medicines no longer under patent protection, but also for new
medicines that don’t warrant patent protection.
Data exclusivity prevents the registration of generic versions of a medicine for many years (the U.S. is asking
for up to 12 years of data exclusivity for some classes of drugs), unless the generic manufacturer repeats the
necessary clinical trials. This is not only extremely costly, but also arguably unethical, as it forces duplication
of clinical trials for patients and animals in order to prove something that is already known.
In addition, while there are clear methods and procedures by which patents can be challenged and overcome –
such as patent oppositions and compulsory licenses – rules governing data exclusivity for pharmaceutical test
data do not always provide the same public health safeguards.
Although it is not yet clear what the U.S. demands for data exclusivity will be for the TPP, the U.S. has
traditionally pressed for a minimum term of five years, similar to U.S. law for certain products. However,
Pharmaceutical Research and Manufacturers of America (PhRMA) has been aggressively lobbying for the TPP
to require 12 years of data exclusivity for a subset of pharmaceutical drugs, called biologic (also called
biosimilar or biopharmaceutical) drugs.

In August 2011, several members of the House of Representatives,
led by Rep. Henry Waxman, urged president Obama to refrain from negotiating any provisions on exclusivity
for biologics in the TPP, noting that a 12-year exclusivity period would impede the ability of Congress to
achieve the administration's proposal that the exclusivity period for biologics be reduced to seven years, as
reflected in the FY2012 budget proposal, without running afoul of U.S. trade obligations. It is also unclear if
the U.S will allow the public health safeguards for data exclusivity specified in the 2007 New Trade Policy.


 Article 12.3 (b), Leaked TPP IPR chapter (http://keionline.org/sites/default/files/tpp-10feb2011-us-text-ipr-chapter.pdf)
 http://www.who.int/medicines/services/expertcommittees/pharmprep/QAS04_093Rev4_final.pdf
 http://www.pharmalot.com/2011/05/phrma-wants-12-years-data-protection-in-tpp-talks
 http://www.waxman.house.gov/UploadedFiles/TPP_Biologics_Letter_08-04-11.pdf
Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011


e) Requesting patent term extensions: the U.S. is seeking to keep generic competitors out of the market,
for longer
The TRIPS Agreement requires patents to last 20 years. Although it is not yet clear what the U.S. demands for
patent term extensions in the TPP will be, the U.S. is expected to seek to extend the monopoly patent period in
order to compensate for administrative delays in the regulatory process, even though the 2007 New Trade Policy
made patent extensions optional for countries negotiating trade agreements with the U.S. Such extensions delay
the entry of generic medicines, punishing patients for bureaucratic delays.

f) Requesting patent linkage: the U.S. is seeking to turn drug regulatory authorities into ‘patent police’
Patent linkage provisions prevent drug regulatory authorities from approving new drugs if they could potentially
infringe existing patents. Such provisions effectively require drug regulatory authorities, which are responsible
for evaluating the safety, quality, and efficacy of medicines, to take on the responsibility of policing patents, an
area normally under the purview of separate patent authorities. Linking drug registration and patent status can
delay generic entry into the market and is an aggressive TRIPS plus measure.
The 2007 New Trade Policy made patent linkage optional for countries negotiating trade agreements with the
U.S. Most countries in Europe do not impose linkage between patent status and drug registration. If a linkage
obligation is included in the TPP, it will impose on developing countries more restrictive conditions for the
registration of generic medicines than are found in Europe3. OBAMA ADMINISTRATION BACKTRACKING ON U.S. COMMITMENTS TO ACCESS TO
MEDICINES

The TPP is the first trade agreement negotiated under the Obama administration. Leaked U.S. positions and
correspondence and discussions between Congress and the USTR indicate that the U.S. is prepared to walk
away from its previous public health commitments, including the 2007 New Trade Policy.


The bipartisan May 10th, 2007 New Trade Policy,25 signed by the Bush administration and U.S. Congress,
specified that the USTR should modify its intellectual property demands in trade agreement negotiations so that
important public health safeguards are included. The 2007 New Trade Policy aims to scale-back the harshest IP
protections for developing countries in order to strike a better balance between protection of IP and public health
needs. Although it did not go far enough, it was a step in the right direction. In particular:26
 Patent linkage provisions were made voluntary (whereas they had been mandatory in previous US trade
agreements).
 Patent term extension provisions were made voluntary (whereas they had been mandatory in previous
US trade agreements).
 Data exclusivity was limited to five years for new chemical entities; concurrent periods of exclusivity
were mandated, and public health exceptions were allowed to ensure governments could still implement
public health safeguards such as compulsory licenses.
When the 2007 New Trade Policy was announced, the House Ways and Means Committee called it “a
fundamental shift in U.S. trade policy.”27 However, the U.S. pharmaceutical industry has been aggressively
lobbying against the 2007 New Trade Policy being applied to the TPP negotiation countries.

USTR has stated
that they are considering options in the TPP that would shift U.S. policy away from the 2007 New Trade Policy
and toward greater protection of intellectual property rights for brand-name pharmaceutical companies in the
25 http://waysandmeans.house.gov/media/enewsletter/5-11-07/07%2005%2010%20New%20Trade%20Policy%20Outline.pdf
26

 For an analysis of the May 10 agreement, see: Fabiana Jorge. New U.S. trade policy: A turning point?. Journal of Generic Medicines
(2007) 5, 5–8. doi:10.1057/palgrave.jgm.4950093. Available at: http://www.palgrave-journals.com/jgm/journal/v5/n1/abs/4950093a.html
27 http://waysandmeans.house.gov/media/enewsletter/5-11-07/07%2005%2010%20New%20Trade%20Policy%20Outline.pdf

Doctors Without Borders/Médecins Sans Frontières (MSF) Campaign for Access to Essential Medicines
TPP Issue Brief - September 2011


Several Members of US Congress have also warned against this possibility and written to the
Obama administration to demand that it uphold the 2007 New Trade Policy28.

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

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

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

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

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

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

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

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

Published August 9th, 2010 iHealthBulletin News!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

VOTE YOUR NEO-LIBERAL INCUMBENT OUT OF OFFICE!!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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


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

Community-Centered Health Homes

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

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

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

September 28, 2011

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

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

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

Executive Summary

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

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

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

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

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

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

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

As the concept of a medical home and other paradigms to strengthen the health care infrastructure are implemented, FQHCs will serve as laboratories for innovation to test new care models. Adequate and appropriately structured financial incentives are critical to the success of any model of health care delivery, and the medical home is no exception. In addition to changes to the reimbursement system that would better align incentives, other supports for providers such as training and technical assistance are necessary to bolster and support the infrastructure.
________________________________________________

This is what happens when health care becomes about maximizing profits. Staff are not always to blame. People are being sent to do jobs for which they are not prepared. Standardization of care misses lots of individual symptoms and history. Having hedge funds operating medical care can only be a spiraling disaster for health care. SHOUT FOR EXPANDED AND IMPROVED MEDICARE FOR ALL.

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

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

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

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

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

He said,

“They are dangerous, dangerous places”.


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

One Third of Skilled Nursing Patients Harmed in Treatment

March 16th, 2014

Special Report from ProPublica

by Marshall Allen, ProPublica

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

Follow up:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sheridan said of the providers that -

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

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

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

He said,

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

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

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

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

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

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

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

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

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

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

He said,

“They are dangerous, dangerous places”.
_____________________________________________

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

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

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

by TPN/ Lusa, in News · 05-07-2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Regarding Ruppersberger and Fort Meade policy:

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

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

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


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

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

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

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

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

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

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



Encyclopedia of White-Collar & Corporate Crime

Lawrence M. Salinger, Ph.D.

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

Defense Industry Fraud

John Walsh Ph.D.

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

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



Lawmakers push Defense fraud, waste report to influence supercommittee cuts

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

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

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

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


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

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

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

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

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

Yet most continued to receive massive contracts.

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

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

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

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

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

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

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

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

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

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

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

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

“Despite the report’s findings, the DoD’s over-reliance on contractors may hinder reform,” Amey said. “Taxpayers are unlikely to see any changes until DoD holds contractors more accountable, especially those defrauding the government.”
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George Bush sent trillions in profit to all of Cheney's Halliburton and hedge funds became Blackwater USA as our public troops were ghettoized with the super-sized wages these private military contractors paid private employees with the same US taxpayer money.  The intent was to move the best public troops over to private contractors as the public military structures were dismantled.  On came Obama and Hillary who as neo-liberals placed this process on steroids with the movement of troops and war to Afghanistan.  Now, government watchdogs say that over 70% of US military is private contractors and the fraud and corruption is rampant.  US private military behave so illegally that nations do not want them in their countries.  Human rights abuse is systemic.

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

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


Christian Science Monitor
Opinion

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

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

By Molly Dunigan / March 19, 2013

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

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

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

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

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

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

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

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

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

Military outsourcing in this vein developed as a result of an increased supply of private military services combined with increased demand. The boom in supply was borne out of larger privatization trends in both the US and Britain in the 1980s and 1990s, which spread over into the military arena. The increased demand was due to the strains that the wars in Iraq and Afghanistan placed on the US military.
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As I wrote before....Maryland was sighted as having the worse VA services with a failing grade for the Baltimore VA center because all of it has been privatized to private non-profits taking the taxpayer money under the guise of running programs that VETs will tell you are not happening.  Indeed, talk was to get rid of the VA building itself.  THAT'S DUTCH FOR YOU.....WORKING FOR DEFENSE INDUSTRY AND CORPORATE PROFITS AT THE EXPENSE OF THE CITIZENS WHO VOTE FOR HIM!!!

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


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


VA / Privatization = Loss for Vets

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

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

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

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

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

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

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

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

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

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

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

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

Regards

Dale R. Suiter

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

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

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


Veterans Charities Ratings


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

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

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

The charities that received failing grades are in red type.

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

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


Veterans Charities Ratings

Air Force Aid Society (A+)

American Ex-Prisoners of War Service Foundation (F)

American Veterans Coalition (F)

American Veterans Relief Foundation (F)

AMVETS National Service Foundation (F)

Armed Services YMCA of the USA (A-)

Army Emergency Relief (A+)

Blinded Veterans Association (D)

Coalition to Support America's Heroes (F)

Disabled American Veterans (D)

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

Fisher House Foundation (A+)

Freedom Alliance (F)

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

Intrepid Fallen Heroes Fund (A+)

Military Order of the Purple Heart Service Foundation (F)

National Military Family Association (A)

National Veterans Services Fund (F)

National Vietnam Veterans Committee (D)

Navy-Marine Corps Relief Society (A+)

NCOA National Defense Foundation (F)

Paralyzed Veterans of America (F)

Soldiers' Angels (D)

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

USO (United Service Organization) (C+)

Veterans of Foreign Wars and Foundation (C-)

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

Vietnam Veterans Memorial Fund (D)

VietNow National Headquarters (F)

World War II Veterans Committee (D)


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

Do you have questions about specific veterans charities?

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

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

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

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

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

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

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

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

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

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

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

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

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

January 10, 2014

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

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

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

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

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

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

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

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

Medicaid Programs Vary in Coverage of Preventive Care, Report Says

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Humana sees only 202,000 insurance exchange enrollees

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



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

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


Walgreen approved for 3 Medicare accountable care organizations

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

By Robert Weisman | Boston Globe Staff January 14, 2014

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

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

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

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

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

They offered no timetable for this plan.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Anyone who wants to step up to the plate and buy the bonds right now . . . we’ll take the orders,” Markell told investors.
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Think about what working for these ACOs will do to the hippocratic oath.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more: What's missing from the Hippocratic oath - FierceHealthcare

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


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


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

Pharma & Healthcare | 1/06/2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

RECENT REPORTS:

• A study by the actuarial firm Milliman found that Medicare pays $6,500 more per beneficiary annualized when chemotherapy is given in outpatient hospital facilities versus community cancer clinics, and each senior patient pays $650 more in out-of-pocket costs.
• A recent study by The Moran Company reveals that Medicare cancer patients receive more chemotherapy treatments with more expensive chemotherapy drugs in hospitals compared to community oncology clinics, resulting in chemotherapy costs that are as much as 47% higher.
• COA reported earlier this year that 469 community cancer clinics had merged into or affiliated with hospital systems and 288 cancer treatment facilities had actually closed over the past 6 years, especially in rural areas. This creates access problems when patients, particularly seniors, have to travel for cancer care.

As has been widely reported, the sequester cut to the underlying cost of cancer drugs has forced cancer clinics to send Medicare patients elsewhere for treatment or merge with large health systems.  This drives up costs to Medicare and patients — the exact opposite intent of sequestration. The budget deal just passed by Congress extended the Medicare sequester and further increases the magnitude of the payment cuts just issued by CMS.

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

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

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

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

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


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

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

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


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


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

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

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

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

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

Key healthcare accountability challenges include:

• The National Healthcare Anti-Fraud Association (NHCAA), a watchdog group, cites information from the FBI that anywhere between $70 billion and $234 billion is lost annually to healthcare fraud. (Source: Reuters/Huff Post Health News http://www.huffingtonpost.com/2011/04/13/health-care-fraud_n_848691.html)
• PricewaterhouseCoopers research found that wasteful spending in the health system has been calculated at more than half of all health spending. (Source: PricewaterhouseCoopers http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml)
• Only 10 percent of all healthcare claim payments are made electronically, in an industry that represents more than $2.7 trillion in annual healthcare spend, or 17.9 percent of the Gross Domestic Product (GDP). (Source: http://www.ushealthcareindex.org/resources/USHEINationalProgressReport.pdf and Source: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html) 

"HealthcarePays offers a singular solution to one of the biggest problems facing healthcare – lack of cost transparency in the healthcare system," said Thompson. "The time is now to tackle issues of transparency, inefficiency, and waste and fraud head on, HealthcarePays and its industry members are working to be part of a real solution to our healthcare crisis. I'm looking forward to providing leadership to the board as HealthcarePays continues to build out the first national payment network for the healthcare industry."

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

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

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

About Tommy G. Thompson

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

About HealthcarePays

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






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

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

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

SCORE WALL STREET!!!! 

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

Pharma & Healthcare


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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

Posted: 12/30/2013 10:25 am

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

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

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

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

Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.

Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! -- as well as some doctors -- to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care -- including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs -- what's not to like? And if you like your doctor, you actually could keep him or her -- did you hear that, Mr. President? You can also pick any doctor you like -- no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a "provider" or "vendor," and we could become patients again, ending our dehumanizing role as a "consumer" or "customer."

Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama's second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.

Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) -- who is also a doctor -- have both introduced Single Payer bills. Bernie's bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.

Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can't the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott's home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.

In the Greider article in this month's The Nation, entitled "Reviving The Fight For Single Payer," he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that "...the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies." Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: "In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We're not making refrigerators. We're dealing with human beings, who are way more complicated than refrigerators on an assembly line."

Rep. McDermott - an advocate for Single Payer for decades - further wondered if hospitals will become "too big to fail" as they continue to merge and buy up private practices, and continue hiring younger doctors as salaried employees. Mr. Greider also made the following revelation: "An AMA survey in 2012 found the majority of doctors under 40 are salaried employees." Rep. McDermott sees the troubling direction of this trend, noting that many new doctors "...will simply be serfs working for the system," and Mr. Greider referred to another key point in the AMA research, noting that "...hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines." Mr. Greider added further insight from Rep. McDermott: "Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures." Even so, Rep. McDermott remains optimistic that stronger health care systems resembling Single Payer will spring up moving forward.

The New York Daily News offered a scathing editorial on December 24th entitled "Can This Patient Be Saved?" in which we were given a blow-by-blow analysis of the devastatingly mishandled rollout of the Obamacare exchanges and the problems millions of Americans have been having signing up for them. The situation was so bad that the deadline was extended until Christmas Eve for those to sign up who wanted their insurance to kick in on January 1, 2014. The CBO projects seven million will sign up in 2014, in addition to the about 1.1 million this year -- well below the Administration's projections. Meanwhile, millions will be losing their current plans due to the mandate. The question of more people losing their insurance than gaining it as a result of the president remaking the "healthcare economy" was also raised in this Op Ed piece.

Key provisions of the bill have already been waived in the past three years since its passage, and an additional postponement of the requirement for companies with fifty or more employees to offer health insurance or pay a tax penalty has now been postponed until 2015.

The individual mandate requiring most Americans to find coverage by April is also waiving penalties for those who had insurance and lost it this year. Most glaring in this critical article is the fact that there is "little reliable" information on who is getting what as far as coverage is concerned, and at what cost. The even larger question is, will those younger and healthier people opt in at all? If not, financially this boondoggle will sink. Obamacare is counting on them.

As the tinkering continues on the ACA, a major architect of this mess has just been rewarded by the president with an ambassadorship offer to China. Senator Baucus, do you not know the meaning of the word "retire?"



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This says it simply.  National Physicians tries to be diplomatic with ACA by stating a few helpful issues addressed, but if you look closely they are not even really addressed.  Shout out to your national pols and your local ones.....ALL OF MARYLAND POLS VOTED FOR THIS PRIVATIZED NIGHTMARE.  Maryland has some Expanded and Improved Medicare for All groups to join!


Medicare for All



We Demand: Medicare for All. Pass H.R. 676, the Expanded and Improved Medicare for All Act.



Whether healthcare is a “right” is a meaningless abstraction. It is an urgent necessity, for lack of which many Americans suffer and die needlessly. Public health insurance must be expanded and made available to all Americans, regardless of age, income or health.

The debate over “Obamacare” (The Affordable Care Act) has been misrepresented on both sides. Supporters claim it makes coverage universal, failing to mention its failures to contain costs or protect Medicare. Critics call it “rationed care,” failing to justify the more egregious rationing by private insurers.

Obamacare does contain several components which are highly valuable to the American people – including the mandate to insure without prejudice those with pre-existing conditions, and the new insurance exchanges. Wall Street and the GOP are eager to destroy the act on this basis alone. Anything that is good for the American people is bad for Wall Street.

However, Obamacare represents a continued bailout of the private insurance industry. Rather than expanding public programs, it offers  public subsidy for private insurance, forces uninsured individuals to buy private insurance, and fails to control costs or defend Medicare, America's only truly public insurance program.

What we demand is not mere “universal coverage,” but a system that is affordable and available to all, without regard for the profit motive of the private insurance industry. The only system that fits the bill is to expand and improve Medicare for all Americans.

Quick facts*

• Administrative costs – including underwriting, advertising and executive/shareholder compensation – consume 31% of US health spending.
• Simply eliminating these costs (over $350 billion annually) would create enough revenue to cover all uninsured Americans.
• “Single-payer” systems like that in Canada operate at far lower costs per capita, and provide better access to health care and better health outcomes than in the US.
• Taxes already pay for over 60% of US health spending, with business paying less than 20%.

*From Physicians for a National Health Program

Our Demand

• Medicare for All. Pass H.R. 676, the Expanded and Improved Medicare for All Act.
• Universal, comprehensive coverage
• A single national insurance plan with regional administration
• Free choice of providers
• No out-of-pocket payments
• Funding will come from a modest, progressive payroll tax, supplemented by revenue from a 1% Wall Street Sales Tax

- See more at: http://www.taxwallstreetparty.org/program/medicare-all#sthash.e7xdbiCw.dpnB9uTE.dpuf

AS OBAMA DOES HIS USUAL DOUBLE-SPEAK SAYING THAT TPP WILL CREATE MORE JOBS AND THAT HE IS WORKING TO STRENGTHEN SAFETY NETS------HE IS ACTUALLY DOING THE OPPOSITE.  HE THINKS THAT CUTTING ACCESS TO SOCIAL SECURITY AND MEDICARE IS STRENGTHENING THESE TRUSTS.  TAKING FROM THE PEOPLE RATHER THAN RECOVERING THE MONEY RAIDED FROM THESE TRUSTS BY CORPORATE FRAUD.

THIS IS SERIOUS FOLKS.....THEY HAVE GUTTED EVERY RETIREMENT AND SAVINGS PEOPLE HAVE AND NOW THEY ARE COMING FOR FEDERAL TRUSTS-----SOCIAL SECURITY AND MEDICARE. 


It is Obama who gave no COLA for a few years and now only 1%....the largest loss of money for payments in Social Security ever. We all know inflation is higher than the 1-2% the FED says. Obama has never acknowledged as well that Reagan tripled payroll taxes in 1980s so baby boomers would not have shortfalls in these Trusts.

THERE IS NO SHORTFALL.....JUST AN ATTEMPT TO TAKE THESE RETIREMENT FUNDS AS WELL!!

The FED artificially keeps inflation near 0%....this has never before been done.....and no one thinks it is really at 1-2%. So, Obama chooses Bernanke who states inflation is at 0% even as everyone pays more for most consumption. If Obama questioned that inflation number, the FED would not get away with giving this inflation number.

Isn't it odd that since the 1970s an average of 4% COLA each year....that is a great big difference.


WASHINGTON – Social Security recipients will get a raise in January -- their first increase in benefits since 2009. It's expected to be about 3.5 percent.

Congress adopted the measure in the 1970s, and since then it has resulted in annual benefit increases averaging 4.2 percent. But there was no COLA in 2010 or 2011 because inflation was too low. That was small comfort to the millions of retirees and disabled people who have seen retirement accounts dwindle and home values drop during the period of economic weakness, said David Certner, legislative policy director for the AARP.

More simply said is that I am almost sure that the FED is fixing that inflation rate and Obama is not outing him on behalf of the people losing lots of money!  WE NEED TO GET THAT LOST INCREASE BACK WITH HIGHER MONTHLY PAYMENTS FROM HIGHER COLAs.  We are hearing the right approach from some REAL progressive pols.....since the American people have had their retirements gutted from fraud and lost to manipulated corporate bankruptcies, we now need Social Security to be increased so as to provide the quality of life intended from our retirements. We need Social Security to be EXPANDED AND IMPROVED TO SERVE AS INTENDED!

Let's be clear about the idea that eliminating the cap on Social Security taxes would make this a redistribution of wealth and not an insurance program------

WE HAVE HAD TENS OF TRILLIONS OF DOLLARS IN CORPORATE FRAUD OVER THIS PAST DECADE AND HAVING THE AFFLUENT PAY MORE IS NOT A REDISTRIBUTION OF WEALTH----IT IS JUSTICE!


Wednesday, Jul 24, 2013 12:12 PM EDT

Growing consensus on Social Security: Expand it After staving off Obama's plan to cut benefits, progressives are fighting to boost checks to seniors

Alex Seitz-Wald  SALON

Thanks in part to their effort, along with Republican recalcitrance and changing economic realities, Democrats have abandoned any plans to mess with the social safety net, at least for the moment. The federal deficit has fallen precipitously this year  – Treasury actually ran a surplus in June — and with it, the impetus for a “grand bargain” trading safety net cuts for increased tax revenue has evaporated. (This may have been the White House’s plan all along.)

Now, as Obama prepares to deliver a major speech on the economy today, the scrappy activists who were until recently playing defense against cuts are turning around and pushing to increase Social Security benefits.

“Social Security is the most effective anti-poverty program in history. Forget cutting it — we need to double down on success and make it even stronger,” Jim Dean, the chair of Democracy for America, will say in an email to supporters today.

The coalition of leading progressive groups, including the Progressive Change Campaign Committee, Democracy for America, Credo Action, MoveOn.org, Progressives United and Social Security Works, are joining together to back a plan introduced by Democratic Sens. Tom Harkin and Mark Begich to boost benefits and shore up Social Security’s finances for the better part of the next century.


These kinds of economic justice issues are Harkin’s bread and butter, but Begich, who is up for reelection this year in deep-red Alaska, is an interesting addition. In May, he made a splash by breaking with Obama on Social Security cuts. His leadership on this issue suggests he thinks expanding the social safety net will not only not hurt him, but actually help him politically, even in one of the most Republican states in the union.

And there’s reason to believe he’s right — Social Security is overwhelmingly popular. A new PPP poll commissioned by DFA and the PCCC found that 51 percent of Kentucky voters support the Harkin-Begich framework, which would boost benefits for 75-year-old workers by $452 per year and by $807 per year for 85-year-olds. Twenty-four percent said they didn’t support the plan, and another 24 said they weren’t sure.

Obama’s budget called for changing the way inflation is calculated for Social Security by switching to the “chained CPI” (consumer price index) formula, which would have the effect of reducing benefits. Begich and Harkin have each introduced slightly different plans, but both would also change the inflation formula. Their change, however, to the “CPI-E,” better accounts for the fact that seniors spend disproportionate amounts of their income on health care, the price of which grows faster than the price of goods overall.

To pay for this expansion, and to ensure the solvency of all of Social Security for decades into the future, the plan would eliminate the income cap on Social Security FICA taxes. Currently, income above $113,700 is exempt from the tax, meaning someone who makes $1 million a year pays the tax on only about a tenth of their income. The new poll commissioned by the groups found that 62 percent of Kentuckians support removing the cap, while 20 percent oppose it and another 18 percent are unsure.

Some liberals have criticized the idea of removing the cap, arguing that it would undermine the political strength of Social Security by making the plan more of a redistributional welfare system than a social insurance scheme. But others point out that the cap means the current Social Security tax is regressive, charging poor and middle-class Americans a larger portion of their income than millionaires and billionaires.




I'm not a Krugman fan because he is the good cop of global capitalism so never talks of downsizing global corporations as a solution to unaccountability and predatory and criminal culture.  He does a good job supporting the push for expanded Social Security.  Unlike Krugman, I think it can happen real soon.....


RUN AND VOTE FOR LABOR AND JUSTICE CANDIDATES IN ALL PRIMARIES.....ALL OF MARYLAND DEMOCRATS ARE NEO-LIBERALS....SHAKE THE BUGS FROM THE RUG!


Expanding Social Security
By PAUL KRUGMAN Published: November 21, 20  New York Times


For many years there has been one overwhelming rule for people who wanted to be considered serious inside the Beltway. It was this: You must declare your willingness to cut Social Security in the name of “entitlement reform.” It wasn’t really about the numbers, which never supported the notion that Social Security faced an acute crisis. It was instead a sort of declaration of identity, a way to show that you were an establishment guy, willing to impose pain (on other people, as usual) in the name of fiscal responsibility.

But a funny thing has happened in the past year or so. Suddenly, we’re hearing open discussion of the idea that Social Security should be expanded, not cut. Talk of Social Security expansion has even reached the Senate, with Tom Harkin introducing legislation that would increase benefits. A few days ago Senator Elizabeth Warren gave a stirring floor speech making the case for expanded benefits.

Where is this coming from? One answer is that the fiscal scolds driving the cut-Social-Security orthodoxy have, deservedly, lost a lot of credibility over the past few years. (Giving the ludicrous Paul Ryan an award for fiscal responsibility? And where’s my debt crisis?) Beyond that, America’s overall retirement system is in big trouble. There’s just one part of that system that’s working well: Social Security. And this suggests that we should make that program stronger, not weaker.

Before I get there, however, let me briefly take on two bad arguments for cutting Social Security that you still hear a lot.

One is that we should raise the retirement age — currently 66, and scheduled to rise to 67 — because people are living longer. This sounds plausible until you look at exactly who is living longer. The rise in life expectancy, it turns out, is overwhelmingly a story about affluent, well-educated Americans. Those with lower incomes and less education have, at best, seen hardly any rise in life expectancy at age 65; in fact, those with less education have seen their life expectancy decline.

So this common argument amounts, in effect, to the notion that we can’t let janitors retire because lawyers are living longer. And lower-income Americans, in case you haven’t noticed, are the people who need Social Security most.

The other argument is that seniors are doing just fine. Hey, their poverty rate is only 9 percent.

There are two big problems here. First, there are well-known flaws with the official poverty measure, and these flaws almost surely lead to serious understatement of elderly poverty. In an attempt to provide a more realistic picture, the Census Bureau now regularly releases a supplemental measure that most experts consider superior — and this measure puts senior poverty at 14.8 percent, close to the rate for younger adults.

Furthermore, the elderly poverty rate is highly likely to rise sharply in the future, as the failure of America’s private pension system takes its toll.

When you look at today’s older Americans, you are in large part looking at the legacy of an economy that is no more. Many workers used to have defined-benefit retirement plans, plans in which their employers guaranteed a steady income after retirement. And a fair number of seniors (like my father, until he passed away a few months ago) are still collecting benefits from such plans.

Today, however, workers who have any retirement plan at all generally have defined-contribution plans — basically, 401(k)’s — in which employers put money into a tax-sheltered account that’s supposed to end up big enough to retire on. The trouble is that at this point it’s clear that the shift to 401(k)’s was a gigantic failure. Employers took advantage of the switch to surreptitiously cut benefits; investment returns have been far lower than workers were told to expect; and, to be fair, many people haven’t managed their money wisely.

As a result, we’re looking at a looming retirement crisis, with tens of millions of Americans facing a sharp decline in living standards at the end of their working lives. For many, the only thing protecting them from abject penury will be Social Security. Aren’t you glad we didn’t privatize the program?

So there’s a strong case for expanding, not contracting, Social Security. Yes, this would cost money, and it would require additional taxes — a suggestion that will horrify the fiscal scolds, who have been insisting that if we raise taxes at all, the proceeds must go to deficit reduction, not to making our lives better. But the fiscal scolds have been wrong about everything, and it’s time to start thinking outside their box.

Realistically, Social Security expansion won’t happen anytime soon. But it’s an idea that deserves to be on the table — and it’s a very good sign that it finally is.


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People, the amount of fraud in Medicare and Medicaid is escalating as hedge funds and global corporations are allowed to run health institutions. WE ALL KNOW FRAUD WILL SOAR. We know as well that trillions of dollars in health fraud from last decade need to come back to these Trusts. DO YOU HEAR YOUR POL SHOUTING THIS? IF NOT, HE/SHE IS A NEO-LIBERAL WORKING FOR WEALTH AND PROFIT.

The Affordable Care Act actually guts Medicare and Medicaid access to quality health care, pushing people to access less due to co-pays and deductibles and to access only preventative care for the most part in the case of Medicaid.   Almost 90% of Americans will fall into these categories soon as neo-liberals work to keep unemployment high and cut social programs rather than bringing back tens of trillions of dollars in corporate fraud!


Below you see a well-researched paper on health fraud.  Notice that the amount of fraud back in 1998 was $250 billion a year.....THAT WAS BEFORE CORPORATE FRAUD WENT ON STEROIDS...Google it and read the entire thesis!


'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'

 by
Emily Fisher
April 2008

ABSTRACT
Health care fraud is an important and visible factor associated with increasing health care costs in the United States. Medicare and Medicaid contribute to a vast majority of those cost sand therefore must be heavily scrutinized. This thesis will investigate the types of fraud, who commits them, and why the health care system is more susceptible to fraud. More specifically, the problems and complications of current fraud investigation for Medicare and Medicaid are examined. This thesis will then evaluate how successful these initiatives were in reducing health care fraud and explore new suggestions for preventing health care fraud in the future.


RUN AND VOTE FOR LABOR AND JUSTICE IN ALL PRIMARIES!



Senators Press Medicare for Answers on Drug Program

by Charles Ornstein and Tracy Weber
ProPublica, Dec. 24, 2013, 5:55 a.m.

Senator Tom Carper, D-Del., chairman of the Homeland Security and Governmental Affairs Committee, said in a statement that he is concerned about "serious vulnerabilities" of Medicare's popular prescription drug program as detailed in a ProPublica report. (Andrew Harrer/Bloomberg via Getty Images)

A Senate committee chairman said he is concerned about the “serious vulnerabilities” detailed in a ProPublica report about scams that target Medicare’s popular prescription drug program.

Sen. Tom Carper, D-Del., who chairs the Homeland Security and Governmental Affairs Committee, said in a statement that he plans to ask Medicare officials and the inspector general of the U.S. Department of Health and Human Services “to look into the specifics of these cases, as well as determine the extent of any program-wide vulnerabilities that may have allowed them to occur.” The committee monitors fraud in government programs.

ProPublica reporters, using Medicare’s own data, identified scores of doctors whose prescription patterns within the program bore the hallmarks of fraud. The cost of their prescribing spiked dramatically from one year to the next — in some cases by millions of dollars — as they chose brand-name drugs that scammers can easily resell.

The cost of medications prescribed by one Miami doctor jumped from $282,000 to $4 million in one year, but her lawyer said Medicare never questioned it. A Los Angeles psychiatrist said Medicare didn’t shut off his provider identification number, used to fill prescriptions, even though he claimed someone had forged his name on more than $7 million worth of them.

All told, just the schemes identified by ProPublica totaled tens of millions of dollars.

While credit card companies routinely flag or block suspicious charges as they happen, the detection system used by Medicare’s massive drug program sometimes allows years to pass before taking action that might stop the fraud.

Known as Part D, the program provides coverage to 36 million seniors and disabled people. It cost taxpayers $62 billion last year.

ProPublica has spent the past year examining Medicare’s oversight of Part D. It found that Medicare doesn’t analyze its prescribing data to root out doctors whose inappropriate drug choices endanger patients. Nor has it flagged those whose unchecked devotion to name-brand drugs, instead of generics, adds billions in needless expense.

ProPublica also noted how doctors who had been terminated from state Medicaid programs for questionable prescribing patterns have continued to give patients large quantities of those same drugs through Part D.

Spurred by that report, Sen. Charles Grassley, R-Iowa, the ranking Republican on the Senate Judiciary Committee, sent a letter Friday to Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, asking what the agency is doing about such doctors.

Several months ago, Grassley asked each state Medicaid program to explain its process for terminating doctors and notifying Medicare once it does so. In his letter to Tavenner, Grassley said he is particularly concerned that doctors can be terminated “without cause” from Medicaid and remain in good standing with Medicare.

He cited three doctors identified by ProPublica who had been suspended or terminated from Medicaid but remained large prescribers in Part D.

This practice by states, he wrote, “may speed their ability to protect Medicaid patients, but it can expose Medicare recipients to potentially unsafe medical treatment and keeps tax dollars flowing to unworthy providers,” he wrote.

Grassley found that states varied widely in how they terminated providers in Medicaid. He asked Tavenner to explain how her agency keeps track of such providers.

Jonathan Blum, principal deputy administrator of CMS, said in a statement that his agency takes fraud in Part D seriously and is committed to making improvements. "We look forward to working with Congress and the HHS Inspector General to continue to protect beneficiaries and taxpayers from Medicare fraud, waste and abuse," he wrote.

PUBLIC SECTOR EMPLOYEES OF ALL KINDS ARE BEING REPLACED BY PRIVATE NON-PROFITS IN MARYLAND AND ESPECIALLY BALTIMORE.  DO TEACHERS, FIRE AND POLICE, AND STATE AND CITY EMPLOYEES NOT KNOW THEY ARE NEXT!!!!

STOP SUPPORTING PUBLIC PRIVATE PARTNERSHIPS!

It's almost like Maryland is trying to get long-time teachers to quit in frustration and stop students from wanting to major in teaching!  YOU BETCHA!!!!  THAT IS HOW YOU KILL A TOP DEMOCRATIC PROFESSION!  What the heck......we can get someone working with Humanim to sit in a classroom and start and stop online lessons.


This is indeed union-busting as Race to the Top is all about.  Remember, Race to the Top wants to make businesses of individual schools-----national charter chains are poised to take over-----and you know how Wall Street hates union labor and any labor earning over poverty!   This is why reformers press forward with the reforms when everyone can see they harm, not help students and teachers.

We need to be clear, this is taking all education from K-college to union apprenticeships to public disability development.  Once privatized, as Baltimore City is well on the way, the structure built for this will expand statewide and soon after nationwide and global.  THESE PRIVATE NON-PROFITS ARE BUSINESSES IN THE MAKING.  THEY JUST WANT TO USE TAXPAYER MONEY TO EXPAND THE BUSINESS JUST AS JOHNS HOPKINS USED TAXPAYER MONEY TO GO FROM A SMALL PRIVATE UNIVERSITY TO A GLOBAL CORPORATION.

Each time we allow yet another sector of the public be taken we lose all voice as citizen.  That is why the public is taken by security from public meetings for trying to comment.  THESE NEO-LIBERALS DO NOT RECOGNIZE CITIZENSHIP.  THEY ONLY WORK TO USE THE PUBLIC TO MAXIMIZE CORPORATE PROFIT.  ALL DEMOCRATIC LEADERS AT ALL LEVELS ARE NEO-LIBERALS AND WE NEED TO GET RID OF THEM!

Simply run and vote for labor and justice.  We can turn this around NOW but we cannot wait too long as they replace all democratic institutions. 

ALL OF THE CURRENT CANDIDATES FOR MARYLAND GOVERNOR AND STATE/CITY ATTORNEY GENERAL ARE NEO-LIBERALS----how does that make free and fair elections?  It doesn't.

WE NEED LABOR UNIONS TO RUN LABOR LAWYERS FOR STATE/CITY ATTORNEYS OFFICE TO ENFORCE LABOR AND JUSTICE LAWS.  WE NEED ALL UNION MEMBERS RUNNING FOR ALL OFFICES AGAINST NEO-LIBERALS IN PRIMARIES.  If your labor and justice organization is not doing this they are not working for you and me!

Union Says Common Core Overworks Teachers
By Gwendolyn Glenn

  Credit Gwendolyn Glenn / WYPR Abby Beytin, President of the Teachers Association of Baltimore County

Listen 0:48 Union Says Common Core Overworks Teachers

The Baltimore County teachers’ union has filed a grievance against the school board, alleging that the new Common Core curriculum makes teachers work too many hours.

Union officials said they support the new, more rigorous Common Core standards, but many teachers have not received formal training in those standards and don’t have time to prepare lessons. Abby Beytin, president of the Teachers Association of Baltimore County, said teachers are getting the new curriculum from the district a week or two before they have to teach it, and that violates their contract.

The Common Core is a set of national standards that Maryland, the District of Columbia and 45 other states adopted. It outlines what students should learn in math and English/language arts.  Local districts developed their own curriculum in line with the Common Core standards.

Beytin asked her teachers to keep logs for a two-week period to document the hours they worked. She said many are putting in 30 to 40 extra hours each week. “My teachers are drowning under the work load,” Beytin said. “We need some of this work load taken off the plate and we need the curriculum in a timely manner so the teachers can really do their best work.”

Beytin, whose union represents the county’s 8,700 teachers, said her members are spending time during their lunch and planning periods as well as after hours through the week and weekends trying to figure out the new curriculum.

Some county teachers received Common Core training over the past three summers in classes organized by the state and county. At a Common Core conference earlier this month in Washington, Maryland Superintendent Dr. Lillian Lowery said her goal is to have 50 percent of teachers in the state formally trained in the new curriculum by the 2016-2017 school year.

Beytin said she has discussed her concerns with the county’s school board and officials in county school district offices. “We are happy to work with the school system in a collaborative manner to come up with solutions,” she said. “But we felt we needed to move this faster so the importance of it was understood. My teachers are really upset about not having the curriculum in a timely manner so they are comfortable with what they are teaching students.”

Beytin wants more aides hired to take over some of the teachers’ clerical duties, such as copying documents, helping to collect data the district requires, taking attendance or collecting money for student projects. She said this way the teachers could focus more on the new curriculum.

Baltimore County Superintendent Dr. Dallas Dance said in an email Wednesday that he could not comment on the grievance because he just received a copy. But he added he would “be looking at the remedy, which every grievance must have, to determine what are federal, state versus local concerns.”

He noted that all parties, including the union, signed on to the curriculum change.

But Beytin accused officials of rushing the implementation of the Common Core. “The state and feds are in a rush and insist that things have to be done now without building in professional training and development,” she said. Beytin said she is optimistic that union and school officials can reach an agreement. If not, they would bring in a mediator to help resolve the issues.

___________________________________________

This article shows why labor and justice should not be voting and supporting neo-liberals. How did Corey Booker win in New Jersey when we know he is a raging Wall Street shill? Why is the same thing happening in Maryland with Anthony Brown? All neo-liberals are pushing the handing of schools over to corporations for profit and to use as job training K-college. WHY WOULD LABOR AND JUSTICE SUPPORT THAT? RUN AND VOTE FOR LABOR AND JUSTICE.

SADLY, IT IS PEOPLE OF COLOR BACKING THESE POLS THAT ARE ENDING BROWN VS BOARD OF EDUCATION AND EQUAL OPPORTUNITY/ACCESS EDUCATION. WORSE-----IT IS ENDING DEMOCRATIC EDUCATION FOR MOST AMERICANS.

Lean In or Stand Up?
Thursday, 14 November 2013 09:30 By Jenny Brown, Labor Notes | Op-Ed

Sheryl Sandberg’s hyper-publicized book Lean In is the Facebook COO’s “sort of a feminist manifesto” and it’s full of engaging, self-critical stories as she tries to trim back her workaholic ways to enjoy her family life. These appear alongside enraging anecdotes about the sexism she and women co-workers endure in the male-dominated tech world, and advice on how to deal with it.

But one anecdote jumped out at me. Sandberg tells the story of a dear friend with 14-month-old twins who cut her paid hours by two-thirds and ended up doing all the household work. Sandberg wants her friend to say yes to an exciting new job offer, advising that it will make the husband step up to his responsibilities.

The job she’s suggesting turns out to be administering a $100 million donation from Facebook founder Mark Zuckerberg to the Newark schools.

Things worked out great for Sandberg’s friend—she took the job and her husband learned to buy groceries. Things didn’t work out so well for the Newark schools.

The $100 million from Zuckerberg had a goal: to institute merit pay in the teachers’ contract. “Highly effective” teachers would get a bonus of between $5,000 and $12,500. Teachers deemed unsatisfactory by supervisors could be disciplined or even fired. (The contract also created two tiers: teachers with masters’ degrees could opt out of the merit pay scheme, and most did.)

Teachers unions have rightly resisted this kind of subjective basis for raises because it rewards brown-nosing and shreds solidarity.

Nonetheless, after the contract passed with 60 percent of the vote, AFT national President Randi Weingarten celebrated the new contract with New Jersey Governor Chris Christie.

At the same time, Newark Mayor Corey Booker was privately pushing to close schools and replace them with charters, with Zuckerberg’s foundation picking targets. Newark parents rose up in arms when they found out.

Emails released due to a parent lawsuit revealed that Sandberg was heavily involved, corresponding with Booker’s office, which was trying to make it look like the community was engaged, without actually engaging the community.

The emails revealed a desire to spread merit pay to teachers nationally, although Sandberg sounded queasy about emphasizing this. “I wonder if we should basically make this focused on Newark with just a touch of ‘and this will be a national model,’” she wrote.

Teach Harder!

From Sandberg’s boss’s-eye view of the world, pay-for-performance leads to excellence. Teachers just need incentives to teach harder. In the real world, merit pay schemes increase pressure but don’t actually improve teaching. “It’s not as if teachers are sitting on their best lessons waiting for a bonus,” said public education defender Diane Ravitch in a recent talk.

“Now that components [of the contract] are being implemented,” Newark teacher Brandon Rippey told Labor Notes, “it’s turning teachers’ lives upside down.” He said some supervisors are using the evaluation tool vindictively.

They’re also using it narrowly. Only 5 percent of Newark’s teachers got merit pay in the last cycle, a total of $1.4 million out of the $50 million that was promised over three years. Where’s the rest of the money going? To pay Sandberg’s friend to administer it, for one.

But that’s not the end of the story—Newark teachers angry about the contract formed a caucus and promised a vigorous fight against the billionaires’ agenda. They won 18 of 29 e-board seats and almost took the presidency. Instead of leaning in, they stood up, together.

Which happens to be a pretty good strategy for dealing with sexism, too, Ms. Sandberg.

____________________________________________
REgarding HUMANIM as a private non-profit replacing public disability programs:

EVEN IF YOU ARE A SMALL GOVERNMENT PERSON, LOSING OUR ENTIRE PUBLIC SECTOR MEANS LOSING PUBLIC POLICY INPUT AND CONTROL IN ALL PLANNING ASPECTS IN COMMUNITIES.  THIS CORPORATION WILL NOT ALLOW PUBLIC ACCESS TO DATA WITHOUT WHAT IS BECOMING AN IMPOSSIBLE PUBLIC JUSTICE REQUEST.  IT IS VERY, VERY, VERY BAD  and brought to you by the same people that give us Baltimore Development Corporation.


You see education for disabled and hiring and oversight of disabled is being privatized.  Special needs students are being mainstreamed into schools with little staff able to adequately address their needs so quality of education for special needs will fall in all but affluent schools.  Meanwhile, private non-profits will be ready to use these students when its time for them to work.  What we are seeing is a move towards warehousing of special needs and assignment to simple tasks rather than having a career choice.

Below you see yet another piece of propaganda as Obama and neo-liberals respond to demands with lots of money sent to lots of private non-profits all supposedly ready to get the disabled to work.  As the next article shows.....as of today, nothing is happening.


Report faults federal hiring of disabled
Mar. 29, 2010 - 04:48PM   | 
By STEPHEN LOSEY 

Andrew Pike, an Army veteran who was shot and paralyzed in the Iraq war, watches his new service dog Yazmin pull a door open. The government needs to make sure managers are really committed to hiring people with disabilities, better monitor agency progress, better train and educate hiring and program managers, and offer improved physical and technical accommodations, a recent survey says.

Andrew Pike, an Army veteran who was shot and paralyzed in the Iraq war, watches his new service dog Yazmin pull a door open. The government needs to make sure managers are really committed to hiring people with disabilities, better monitor agency progress, better train and educate hiring and program managers, and offer improved physical and technical accommodations, a recent survey says.
The federal government is not doing enough to attract, retain and accommodate employees with disabilities, according to a survey released today.
*************************************

US making little progress on jobs for disabled Americans

Published March 24, 2013
Associated Press

    In this photo taken Friday, March 1, 2013, Jennifer Lortie works on an iPad in her Willimantic, Conn. office. Of the 29 million workingage Americans with a disability Lortie, who has limited arm and leg use due to cerebral palsy, is one of the 5.1 million, who are actually employed. The National Council on Disability's Jeff Rosen says long-standing prejudicial attitudes need to be addressed to boost jobs. (AP Photo/Jessica Hill)
 

WASHINGTON –  Whether it means opening school track meets to a deaf child or developing a new lunch menu with safe alternatives for students with food allergies, recent Obama administration decisions could significantly affect Americans with disabilities. But there's been little progress in one of the most stubborn challenges: employing the disabled.

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

HUMANIM is just that kind of private non-profit that is taking the place of a public agency tasked with care and programming for the disabled that was once well-funded and provided strong life-long developmental and placement programs for disabled.  Now, the group homes, the workshops, the social workers as public support are gone.  In their place is what WYPR gave as an example with Humanim.

Now, we know that Baltimore Development Corporation has privatized all public policy with development in the city; we know that VEOLA is privatizing all transportation and soon VEOLA WATER AND WASTE will take all public services; we know that Parks and People are basically the Baltimore City Parks Department; and Johns Hopkins is public health; so, Humanim is simply the social services branch of all of the privatizing of public services.  AND GUESS WHAT?  THE SAME PEOPLE ARE ON THE BOARDS OF ALL THESE PRIVATE NON-PROFITS  CONTROLLING ALL PUBLIC POLICY IN BALTIMORE!!!!  HOPKINS AND BALTIMORE DEVELOPMENT FIGURE PROMINENTLY.

So, I pointed out last week that the Oliver Community Association-----which has the same people from the boards above on its roster as Oliver, next to Hopkins will be THE COMMUNITY FOR THE AFFLUENT! had all kinds of volunteers cleaning the neighborhood----from vets to students doing the work of public sector employees.  Humanim is an extension of this.  Below you see a staff of 750 people and a $24 million budget and this 'non-profit' has expanded all over Maryland. 

IT IS A PRIVATE CORPORATION THAT NOW RUNS ALL OF BALTIMORE'S AND OTHER'S PUBLIC SOCIAL SERVICES.

Let's take the example WYPR gave in using Humanim in 'greening'.  You have an historic building being torn down and recycled to build new buildings.  Now, when this was a public function, city workers getting a salary and  benefits would be sent to gut the building of hardware and materials of value and the city would then sell these salvage items or use it on public building projects.  So, public employees were paid a good salary to do work that gave government revenue from salvage.

Now, Humanim uses people with disabilities and low-income workers that are 'training' to do the demolition with the salvage going to Humanim and we can imagine then sold/given to city developers, many of whom are on the board of Humanim.  So, developers have gotten free labor to demolish property and then received the salvage to use on their own projects------all subsidized by taxpayer money and free labor from 'training' programs. 

TAXPAYERS AND GOVERNMENT COFFERS GET NOTHING BUT CONTINUED CORPORATE WELFARE AND WORKERS GET TO WORK FOR NEXT TO NOTHING.

Trade unions have all kinds of on-the-job training for construction jobs that pay workers who then pass through a top-notch trades program.  One would imagine that would be a good venue for extending disability training for example.  Here, a Baltimore corporation that is probably getting a corporate tax break for existing is 'donating' to Humanim for another corporate tax break and getting what will be free labor and product for cheap.

Because Humanim is a private non-profit, public transparency is harder to get.  Because this corporation that is doing work across all kinds of private sector industries is designated 'non-profit' it pays no taxes.  The 750 staff across all of Maryland represents a microcosm of public sector employees whose jobs are replaced by what are heavily volunteer activities developed by these 750 people state-wide.  So, high-unemployment in Baltimore because public sector jobs have disappeared bring the high crime and violence, and as offenders, these unemployed will no doubt be sent to 'volunteer' with the corporation Humanim.


Statewide Contract for Maryland Behavioral Support Services Partnership To Launch

Baltimore, MD - September 18, 2013

Humanim, The Arc of Southern Maryland, The Arc of Washington County and Somerset Community Services

 have been awarded the Statewide Behavioral Support Services contract to provide comprehensive Behavioral Support Services to Maryland residents with intellectual and developmental disabilities. The providers have formed the Maryland Behavioral Support Services Partnership, which will become effective October 1, 2013.

“Humanim is thrilled to be a member of the Statewide Partnership for Behavioral Support Services,” said Cindy Plavier Truitt, Director of the Partnership and Chief Operating Officer of Humanim representing the Baltimore Metropolitan Region. “Along with the other partners, we believe this new approach will create enhanced support for families and individuals with intellectual and developmental disabilities. We look forward to partnering with the Developmental Disabilities Administration on this new initiative.”

This historic Maryland Behavioral Support Services Partnership will create a uniform network of services that will increase the efficacy and efficiency of services that will improve the overall statewide quality of services.


Humanim - Director of Family and Youth Services



humanimLocation: Baltimore, MD

Humanim is seeking a dynamic, experienced Director of Family and Youth Services to lead and build the workforce development services for transitioning youth and financial stability services for families (youth and adults).  The director will actively support Humanim’s mantra of providing “uncompromising human services” as it connects with individuals of all ages throughout Maryland.

Headquartered in Baltimore, MD, Humanim’s mission is to identify those in greatest need and provide uncompromising human services. Our vision is that all people in our community have access to the human services that they need.  Governed by a 14-member board of directors, Humanim is a 501(c)(3) with annual operating revenues of approximately $24 million and a staff of over 750 individuals.  For additional information please visit www.Humanim.com.

THE POOR, WORKING CLASS AND MIDDLE CLASS ARE GETTING THE SHAFT WITH THE ACA HEALTH REFORM----THE HEALTH INDUSTRY IS SOARING IN PROFITS. The PHARMA industry declared over a trillion dollars in profits as it expands overseas. In the US----citizens cannot afford the co-pays.


What Is Medicaid?
Created by Congress in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Medicaid is funded jointly by the federal government and the states.

Each state operates its own Medicaid program within federal guidelines. Because the federal guidelines are broad, states have a great deal of flexibility in designing and administering their programs. As a result, Medicaid eligibility and benefits can and often do vary widely from state to state.

In 2012, Medicaid provided health coverage for 67 million low-income Americans over the course of the year, including 32 million children, 19 million adults (mostly low-income working parents), 6 million seniors, and 11 million persons with disabilities, according to Congressional Budget Office estimates.

Do you know that 75% of Americans are now in poverty or at the line?  That's who are without health care or with very little.  Before the reform the poor could go to emergency rooms for health events and now they cannot.  The health clinics they can access do minor surgeries.

WILL YOUR FAMILY SLIP INTO THIS CATEGORY?  YOU BETCHA IF NEO-LIBERALS REMAIN IN OFFICE!!

I sat on the bus the other day listening to a tirade by a military veteran bashing 'ObamaCare'----aka the ACA. Since the goal of ACA is to restrict access to most health care for most people so health industry's profits are maximized.....this conversation says 'mission accomplished'! All the people around him rang in to how they are no longer able to access basic care and the co-pays have already bankrupted the vet who was just released with tens of thousands in medical bills. This is one month into this new law. So, what do Maryland and Baltimore Health officials feel they need to educate the poor about? DAMAGE CONTROL. THEY ARE GOING TO MAKE LOSING HEALTH ACCESS IS A BENEFIT! It's like listening to another black leader telling mothers of special needs being pushed to warehousing in poor schools that private non-profits are working to make that work! NO ONE BELIEVES IT!

When the rich made this plan to use massive fraud to move all working/middle class wealth to the top they were all saying in regards to retaliation in elections----THE POOR WILL ALWAYS VOTE WITH THE WEALTH AND PROFIT CANDIDATES BECAUSE THEY ADMIRE US! What they are saying is that the poor are being tied to more and more subsidy for basics of life and are being made to vote out of fear. Indeed, that has happened with unions fearful of losing collective bargaining et al. So, will the rich capture elections with this fear tactic used in third world countries? I DON'T THINK SO! WHEN I ATTEND MEETINGS AND PROTESTS I HEAR VERY ANGRY IMPOVERISHED PEOPLE WANTING CHANGE....NOT ACQUIESCENCE!!!

So, the rich think they will get away with stealing the wealth of the working/middle class by creating this divide and send out the crony support teams into poor communities to do reparations. We'll see if it works this time as people are being left to die for lack of access to basic care.

Do you know that much of the coverage for the poor is the same they receive in free clinics for decades? The idea that ACA is about coverage for low-income is not true!!!! It will leave most people without access to most health care!

'I AM NOT WALKING AWAY FROM 40 MILLION PEOPLE WHO HAVE A CHANCE AT HAVING HEALTH INSURANCE FOR THE FIRST TIME' says Obama. The poor are saying-----please keep walking away!!

Raise your hands if you knew republican states would use this reform to refuse Medicaid funding?  Since they have worked for decades to end entitlements -------EVERYONE KNEW THAT.  Raise your hand if you know Maryland defunded Medicaid so much, on top of Federal cuts, that Maryland's poor are not much better than republican states!

How can somebody in poverty not be eligible for subsidies?' Millions of poor not covered by health law
Thu Oct 3, 2013 10:27 AM EDT
259

James Patterson for The New York Times

By Sabrina Tavernise and Robert Gebeloff, The New York Times

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.

People shopping for insurance on the health exchanges are already discovering this bitter twist.

“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.

At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”

Poorest states rejected Medicaid expansion
The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.

In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.

“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel, a Republican, who opposes expansion.

30 million eligible for help
The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help.

But the Supreme Court’s ruling on the health care law last year, while upholding it, allowed states to choose whether to expand Medicaid. Those that opted not to leave about eight million uninsured people who live in poverty ($19,530 for a family of three) without any assistance at all.

Poor people excluded from the Medicaid expansion will not be subject to fines for lacking coverage. In all, about 14 million eligible Americans are uninsured and living in poverty, the Times analysis found.

The federal government provided the tally of how many states were not expanding Medicaid for the first time on Tuesday. It included states like New Hampshire, Ohio, Pennsylvania and Tennessee that might still decide to expand Medicaid before coverage takes effect in January. If those states go forward, the number would change, but the trends that emerged in the analysis would be similar.

Mississippi has the largest percentage of poor and uninsured people in the country — 13 percent. Willie Charles Carter, an unemployed 53-year-old whose most recent job was as a maintenance worker at a public school, has had problems with his leg since surgery last year.

His income is below Mississippi’s ceiling for Medicaid — which is about $3,000 a year — but he has no dependent children, so he does not qualify. And his income is too low to make him eligible for subsidies on the federal health exchange.

“You got to be almost dead before you can get Medicaid in Mississippi,” he said.

He does not know what he will do when the clinic where he goes for medical care, the Good Samaritan Health Center in Greenville, closes next month because of lack of funding.

“I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”

Less-generous safety nets
The states that did not expand Medicaid have less generous safety nets: For adults with children, the median income limit for Medicaid is just under half of the federal poverty level — or about $5,600 a year for an individual — while in states that are expanding, it is above the poverty line, or about $12,200, according to the Kaiser Family Foundation. There is little or no coverage of childless adults in the states not expanding, Kaiser said.

The New York Times analysis excluded immigrants in the country illegally and those foreign-born residents who would not be eligible for benefits under Medicaid expansion. It included people who are uninsured even though they qualify for Medicaid in its current form.

Blacks are disproportionately affected, largely because more of them are poor and living in Southern states. In all, 6 out of 10 blacks live in the states not expanding Medicaid. In Mississippi, 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population.

Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks.

That is compounded by the country’s rapidly changing demographics, Dr. Geiger said, in which minorities will eventually become a majority, a pattern that has produced a profound cultural unease, particularly when it has collided with economic insecurity.

Dr. Shirley said: “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs. It’s a tactic that appeals to people who would rather suffer themselves than see a black person benefit.”

Opponents of the expansion bristled at the suggestion that race had anything to do with their position. State Senator Giles Ward of Mississippi, a Republican, called the idea that race was a factor “preposterous,” and said that with the demographics of the South — large shares of poor people and, in particular, poor blacks — “you can argue pretty much any way you want.”

The decision not to expand Medicaid will also hit the working poor. Claretha Briscoe earns just under $11,000 a year making fried chicken and other fast food at a convenience store in Hollandale, Miss., too much to qualify for Medicaid but not enough to get subsidies on the new health exchange. She had a heart attack in 2002 that a local hospital treated as part of its charity care program.

“I skip months on my blood pressure pills,” said Ms. Briscoe, 48, who visited the Good Samaritan Health Center last week because she was having chest pains. “I buy them when I can afford them.”

About half of poor and uninsured Hispanics live in states that are expanding Medicaid. But Texas, which has a large Hispanic population, rejected the expansion. Gladys Arbila, a housekeeper in Houston who earns $17,000 a year and supports two children, is under the poverty line and therefore not eligible for new subsidies. But she makes too much to qualify for Medicaid under the state’s rules. She recently spent 36 hours waiting in the emergency room for a searing pain in her back.

 This story, "Millions of Poor Are Left Uncovered by Health Law," was originally published in the New York Times.




The American people are being played by corporate pols from both sides.  Republicans are playing the mandate side of the policy as bad while they would have done the same thing. Why do you think conservative Roberts on the Supreme Court voted for it?  The mandate is all about sending hundreds of billions in profit to the health insurance industry in premiums while the ACA limits the ability of most people to use the insurance.  IT IS ALL ABOUT PROFIT!

We heard Sebelius shout out to a conservative reporter saying that young people are not signing because they see these plans are bad deals -----THEY WILL BUY IT BECAUSE THE MANDATE IS LAW.  SO IF THEY ARE NOT BUYING IT NOW THEY WILL WHEN THE DEFAULT BECOMES ABOUT $600 IN 2016! 
WHAT A CORPORATE PROFIT CHEERLEADER SEBELIUS IS!
NO WONDER OBAMA NOMINATED A NEO-LIBERAL FROM THE MOST CONSERVATIVE STATE....KANSAS ....TO BE HEALTH SECRETARY!

The good news is everyone is now heading to Universal Care with Expanded and Improved Medicare for All!  IF THEY WANT TO MANDATE INSURANCE-----WE WILL TAKE THIS STATE BY STATE!

 Obamacare's Fatal Flaw

Updated: Tuesday, November 19 2013, 11:45 AM EST  WBFF/\Baltimore

The roll-out of Obamacare has been plagued with technological setbacks and lower-than-expected enrollment, prompting an apology from President Barack Obama. "We fumbled the rollout on this healthcare law," Obama said last week, after millions of Americans were kicked off their existing health insurance plans despite presidential assurances to the contrary. But insurance broker Ari Gross says an apology might not fix the mess that has engulfed the Affordable Care Act. That's because almost half his clients have lost their insurance, fallout from the new law he's not sure can be fixed. "It's such a large animal at this point, I don't even know if there's a way to tweak it," Gross said. "In theory we could go back today, but there is no reset button." The problem, he says, is the underlying premise of the law that healthy people were supposed to sign up to subsidize care for everyone else. "The reality is, this system right now, it simply can't work because our young population - which is vital to the success of the system - they're not buying it," Gross said. It's a fatal flaw in the law that may come down to numbers. The Obama administration estimates it needs 2.7 million young healthy adults to sign up in the first year to make the law work, but so far only 100,000 people have enrolled, with no word yet on how much this small number is made up of young, healthy adults. In Maryland only 1,700 people have signed up for plans. At the same time, Medicaid enrollment is drastically higher -- people who aren't paying into the system. The lack of interest among the young and healthy and the growing Medicaid numbers do not come as a surprise to Towson Economics Professor Thomas Rhoads. "These young people, they're making an economic decision, a cost-benefit analysis already," Rhoads noted. He says the low participation rate reveals what he believes to be the true purpose of Obamacare. "I think when we really get to the heart of the matter Obamacare is really about insurance reform, not really about healthcare reform," Rhoads said. It could lead to more drastic changes. "The fee that people are paying if they do not get individual health insurance for them or their families, it's a tax according to the Supreme Court," Rhoads said. "So why didn't they just use a tax that's increased on everybody in order to get Medicare applied to more people?" A single payer system, says Jeff Singer, adjunct professor of public policy at University of Maryland, would ultimately save money. "In the United States roughly 30% of all healthcare dollars are spent on administrative costs," Singer said. "That's close to $800 billion a year that doesn't go to healthcare." Still, Gross says he worries a system without private insurance could do more harm than good. "We're on the cutting edge of medicine; this is where everything is happening," Gross said. "That's because we have a system where people paid for their service. Once we turn this into a federal system where's the motivation?" Even if he's not sure that the current law can be salvaged "This was revolutionary, but it was not built properly," Gross said. But Singer counters that health insurance may simply be obsolete. "I think 30 years from now we will think of private insurance in the same way that we think about blacksmiths," Singer said. "It was an activity that had a lot of use in a society in a particular historical time." To illustrate just how much ground Obamacare has to make up, as of November 1 nearly 81,000 Marylanders have enrolled in Medicaid, while only 3,000 have signed up for private insurance.


_____________________________________________


The capture of public forums like public media where all this discussion would occur is forcing lots of new venues so the word is out. I liked the FOX report with

We need to be clear about what single-payer looks like. What Obama and neo-liberals are pressing will be almost all American citizens on a Medicaid level coverage-----in fact EJ DIONNE, a neo-liberal pundit came out and said it----expand Medicaid for All. That is what these state health systems are for; pushing both Medicaid and Medicare from Federal programs to state programs that all look like Medicaid. Remember, Medicaid is no longer a Federal program. It was severely gutted of funding and sent to the states to administer as they want with very little Federal oversight. Now, Medicaid looks like a public health program that gives little access to anything other than preventative care.

The American people are being played by corporate pols from both sides. Republicans are playing the mandate side of the policy as bad while they would have done the same thing. Why do you think conservative Roberts on the Supreme Court voted for it? The mandate is all about sending hundreds of billions in profit to the health insurance industry in premiums while the ACA limits the ability of most people to use the insurance. IT IS ALL ABOUT PROFIT!

We heard Sebelius shout out to a conservative reporter saying that young people are not signing because they see these plans are bad deals -----THEY WILL BUY IT BECAUSE THE MANDATE IS LAW. SO IF THEY ARE NOT BUYING IT NOW THEY WILL WHEN THE DEFAULT BECOMES ABOUT $600 IN 2016!
WHAT A CORPORATE PROFIT CHEERLEADER SEBELIUS IS!
NO WONDER OBAMA NOMINATED A NEO-LIBERAL FROM THE MOST CONSERVATIVE STATE....KANSAS ....TO BE HEALTH SECRETARY!

The good news is everyone is now heading to Universal Care with Expanded and Improved Medicare for All! IF THEY WANT TO MANDATE INSURANCE-----WE WILL TAKE THIS STATE BY STATE!

SINGLE-PAYER ADVOCATES ARE SAYING 'EXPANDED AND IMPROVED MEDICARE FOR ALL'

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Open Society Institute (OSI) - Baltimore : Audacious Thinking For Lasting Playing For CHANGE

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.osted by Jeff Singer on February 21st, 2011 at 8:02 am

My automobile’s engine was sputtering. The mechanic called to report that it had been repaired; however, a glance under the hood revealed that the engine had been expanded with more cylinders and carburetors, but still ran raggedly. “It would have been cheaper to replace it, but we wouldn’t have made as much profit.”

The Patient Protection and Affordable Care Act [PPACA], last year’s Federal health care reform, is like that jerry-built engine. It will reduce the number of people without health insurance, but in the most costly manner possible. The House of Representatives recently voted to repeal the legislation, yet they ignore the most efficient way forward: a single payer system.

Health care in the U.S. costs more than anywhere else in the world, but our life expectancy ranks 49th (according to that radical group the CIA). Generally, nations with higher life expectancy have truly universal coverage and, unlike ObamaCare, private insurance plays only an ancillary role.

If health care were privately delivered but had one payer, hundreds of billions of dollars wouldn’t be wasted on paperwork, advertisements, and administration. Doctors, hospitals, and clinics like Health Care for the Homeless wouldn’t worry about which clients were eligible for what services. Rather we could use our limited resources to deliver the care that people need.

The PPACA does not replace, but rather expands the existing dysfunctional system. Everyone will be required to pay for the enormous paperwork costs and profits that grow as private insurance expands.

An audacious idea: consider health care as a public good like fire protection. A scene in Martin Scorsese’s Gangs of New York demonstrates the point: rival firefighters allow a building to burn because the owner didn’t pay either of them. Our ancestors eventually discovered that rather than being a profit center, fire protection ought to be a public service. We have learned the same lesson with the police, education, and food safety. Let’s apply it now to health care.

In health care as in so many other aspects of our society, we need a complete overhaul, not just a larger, but still dysfunctional, system.

PLEASE GO TO THE BOTTOM OF THIS BLOG TO READ A REALLY WELL-RESEARCHED STUDY OF HEALTH FRAUD.  IT SHOWS HOW SO MUCH OF ENTITLEMENT MONEY WAS LOST TO FRAUD AND NOW WE ARE WATCHING AS NEO-LIBERALS AND REPUBLICANS FIGHT TO DENY ACCESS TO HEALTH CARE FOR MOST PEOPLE!


Wouldn't it be better if O'Malley simply reinstate Rule of Law and follow the public money that is supposed to give health care to the poor and mentally ill, to the old and young and end the massive fraud that takes 1/2 of all taxpayer money sent for health care in these groups?

Maryland has a history of underfunding all social programs and then allowing what little it sends to be lost to fraud and corruption.  Whether the poor dying 20-30 years earlier than others from lack of access to care or whether Veterans who have to deal with a VA hospital worst in the nation, you can bet that mental health facilities are grossly underfunded and unable to operate.

Do you hear a repeated pattern in all administrative issues regarding the government in MD?  Remember, MD is one of the richest states in the nation so it is not the lack of funding....it is the lack of funding making it to the operation before it goes into someone's pocket....ergo, the wealth inequity in the state.

We need MD citizens to shake these corporate pols out of the rug..they are only working for wealth and profit.  A democrat does not allow these conditions to be systemic at huge expense to the people.  Whether repub or dem....incumbents need to go!  Rule of Law needs to be reinstated in MD so fraud and corruption in the state stops the short-changing of social programs and undermines quality of life for everyone!


Below you see an area of Maryland that has a high number of working class and poor and you know why patient numbers are down....they cannot gain access to hospital care but instead are being treated in clinics and by home health care. 

Salisbury hospital laying off 58; offering buyouts Peninsula Regional Medical Center says it is treating fewer patients

By Andrea K. Walker, The Baltimore Sun 2:17 p.m. EDT, September 18, 2013

Peninsula Regional Medical Center announced Wednesday that it will lay off 58 employees and offer buyouts to 130 as the number of patients it treats declines.

The employees who lose their jobs will be offered severance packages and the opportunity to apply for other jobs at the Salisbury hospital, the company said in a statement.

Peninsula Regional on average has 66 fewer patients in the hospital a day than last year. The medical center is licensed for 288 beds and expects that number to decrease to 250 within the next two years. The hospital was licensed for 363 beds four years ago.

Maryland has recently eliminated 703 licensed beds, including 406 in the past two years, the hospital said.

Peninsula Regional also said that it lost $4 million in lost revenue from Medicaid cuts as a result of federal sequestration. It also said that hospital rate increases approved by the state's Health Cost Services Review Commission have not kept up with inflation, also putting pressure on revenue.

Patient declines are occurring as more people are getting outpatient care rather than at a hospital where they stay overnight, hospitals officials said in the statement. Hospitals will soon be designed for the critically ill, complex surgeries and emergency care, Peninsula Regional officials said.

Peninsula Regional is among other hospitals, including Johns Hopkins Bayview and the University of Maryland Medical Center, that has cut staff in recent months.
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Across the nation we are seeing a disturbing fall in level of care and staffing as the health industry moves to profit over care with no regulation.
These neo-liberals are working to throw Medicare and Medicaid into these private health systems that will leave most unable to pay for quality caregivers and with no nursing homes.....you will get what they send to your home!

Career Diploma in
Home Health Aide

Our online Home Health Aide training course shows you how to help the elderly, the disabled and people in ill health to maintain their quality of life and independence at home. As a graduate of our online Home Health Aide (HHA) classes you’ll be prepared to take the Personal Care and Support Credential exam delivered by our partner, the Direct Care Alliance, certifying your professional-level knowledge.

• Prerequisite: None
• Study Method: eBook (Online Textbook & Exams)
• Program Length: As few as 6 Months

Elder Abuse by In-Home Aids a Growing Problem
Jul 16, 2008 | Parker Waichman LLP

Elderly people who want to avoid nursing homes often employ in-home aids to help meet their day-to-day needs.  However, in many cases, the in-home aid industry is unregulated, and advocates for the elderly say that this situation has led to a growing number of cases of elder abuse, neglect or fraud in which home caregivers take advantage of the elderly.

A district attorney in San Diego County, Calif. told The Wall Street Journal that  he prosecuted at least 25 home caregivers in the past year, mostly for stealing from elderly clients.  Another, from Lake County, Calif., told the Journal that about 80 percent of his office's 74 prosecutions of elder abuse in the past year involved home aides.

In-home care has been touted as a way to keep older people  happier and healthier, and at a lower cost, than they would be in a nursing home.  According to The Wall Street Journal, it costs Medicaid program about $6,000 per person per year for home care, versus about $20,000 for care in a nursing home.  About 1.6 million people are employed in home care, split about equally between those who provide basic health services, and those who provide housekeeping, cooking and nonmedical help.

Of the two types of aids, health aids are often certified nursing assistants who face licensing requirements and other regulations.  However, most in-home elder abuse cases involve non-medical aids, who require no special licensing, and are loosely regulated.

According to The Wall Street Journal, in California, Florida, Connecticut and at least 19 other states, nonmedical aides don't have to be licensed or pass a criminal background check to get a job. In other states where employment agencies are required to do some type of checks, applicants with criminal records can slip through the cracks, some research has found.

The problem goes deep.  A recent study sponsored by the Centers for Medicare & Medicaid Services conducted at Michigan State University screened 214,167 people who held or sought jobs working with the elderly, including home care, in that state between April 2006 and November 2007. Of those, 5,462 had criminal histories that should have disqualified them.   Michigan is one of the states that does require background checks of caregivers for the elderly, but as the study shows, that requirement clearly doesn't go far enough.

Consumers seeking in-home help for an elderly loved should ask an employment agency exactly what a prospective caregiver has been screened for, and require at a minimum a state police criminal background check.  Those hiring on their own can also request a background check from state police, and references should always be checked.
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Who are getting the growing share of home health care worker jobs? Immigrants who have no labor protections and have their wages stolen.  What Wall Street wants is to have the elderly at home with no access to what we now know as retirement communities because no one will be able to afford them.   We are seeing the elderly now being told not to come to the hospital with symptoms that are not immediately treatable. 

NATIONAL LABOR UNIONS MUST TAKE THIS LACK OF ENFORCEMENT TO COURT TO PROTECT DOMESTIC WORKERS AS WELL.


News Release WHD News Release: [09/17/2013]
Contact Name: Jennifer Marion or Jason Surbey
Phone Number: (202) 693-5795 or x4668
Email: marion.jennifer.r@dol.gov or Surbey.Jason@dol.gov
Release Number: 13-1922-NAT

Minimum wage, overtime protections extended to direct care workers by US Labor Department Nearly two million home health and personal care workers to benefit

WASHINGTON — Fulfilling a promise by President Obama to ensure that direct care workers receive a fair day's pay for a fair day's work, the U.S. Department of Labor announced a final rule today extending the Fair Labor Standards Act's minimum wage and overtime protections to most of the nation's workers who provide essential home care assistance to elderly people and people with illnesses, injuries or disabilities. This change will result in nearly two million direct care workers — such as home health aides, personal care aides and certified nursing assistants — receiving the same basic protections already provided to most U.S. workers. It will also help guarantee that those who rely on the assistance of direct care workers have access to consistent and high-quality care from a stable and increasingly professional workforce.

"Many American families rely on the vital services provided by direct care workers," said Secretary of Labor Thomas E. Perez. "Because of their hard work, countless Americans are able to live independently, go to work and participate more fully in their communities. Today we are taking an important step toward guaranteeing that these professionals receive the wage protections they deserve while protecting the right of individuals to live at home."

"Direct care workers play a critical role in ensuring access to high-quality home care that many people need in order to remain healthy and independent in their communities, and they should be compensated fairly for this important work," said Secretary of Health and Human Services Kathleen Sebelius. "We will continue to engage with consumers, states, advocates and home care providers in the implementation of this rule to help people with disabilities, older adults and their families receive quality, person-centered services."

The home care industry has grown dramatically over the last several decades as more Americans choose to receive long-term care at home instead of in nursing homes or other facilities. Despite this growth and the fact that direct care workers increasingly receive skills training and perform work previously done by trained nurses, direct care workers remain among the lowest paid in the service industry. There are an estimated 1.9 million direct care workers in the U.S., with nearly all currently employed by home care agencies. Approximately 90 percent of direct care workers are women, and nearly 50 percent are minorities.

Today's announcement extends minimum wage and overtime protections to all direct care workers employed by home care agencies and other third parties. Fifteen states already extend state minimum wage and overtime protections to direct care workers, and an additional six states and the District of Columbia mandate state minimum wage protections.

"The department carefully considered the comments received from individuals who receive home care, workers, third-party employers and administrators of state programs that support home care," said Laura Fortman, the principal deputy administrator of the Wage and Hour Division, the agency that administers and enforces the FLSA. "In response, the final rule provides increased flexibility, and gives programs sufficient time to make any needed adjustments. Together these changes will allow the rule to better meet consumers' needs while better protecting direct care workers."

The final rule also clarifies that direct care workers who perform medically-related services for which training is typically a prerequisite are not companionship workers and therefore are entitled to the minimum wage and overtime. And, in accordance with Congress' initial intent, individual workers who are employed only by the person receiving services or that person's family or household and engaged primarily in fellowship and protection (providing company, visiting or engaging in hobbies) and care incidental to such activities, will still be considered exempt from the FLSA's minimum wage and overtime protections.

The rule will be effective Jan. 1, 2015. The Department of Labor has created a new web portal with interactive web tools, fact sheets and other materials to help families, other employers and workers understand the new requirements. These, along with information about upcoming webinars on the rule, are available at www.dol.gov/whd/homecare/.

• Read this news release en Español.
  
• _____________________________________________

This is what we knew would happen....when they say people will be covered they do not tell you the level of care you will receive and it is startling some of the basic care that will not for Medicaid.  Remember, most low-income people are on Medicaid.

Medicaid programs vary in coverage of preventive care, report says

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

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

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

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

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

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

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

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

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

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

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

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


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Below you see a well-researched paper on health fraud.  Notice that the amount of fraud back in 1998 was $250 billion a year.....THAT WAS BEFORE CORPORATE FRAUD WENT ON STEROIDS IN THE 2000s


'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'

Emily Fisher
April 2008

ABSTRACT
Health care fraud is an important and visible factor associated with increasing health care costs in the United States. Medicare and Medicaid contribute to a vast majority of those cost sand therefore must be heavily scrutinized. This thesis will investigate the types of fraud, who commits them, and why the health care system is more susceptible to fraud. More specifically, the problems and complications of current fraud investigation for Medicare and Medicaid are examined. This thesis will then evaluate how successful these initiatives were in reducing health care fraud and explore new suggestions for preventing health care fraud in the future.


INTRODUCTION
As elections approach Americans are hearing more and more about health care reform, and what needs to be done to fix the ailing health care system. The main problem candidates are trying to address is the dramatic increase in health care costs that are causing the number of underinsured and uninsured patients to increase across the country. Many different factors are related to the increase in health care costs. This paper will focus on health care fraud and abuse, and more specifically health care fraud and abuse within the Medicare and Medicaid programs.
Health care fraud is an important and visible factor associated with increasing health care costs, because there is no positive side to it. Some of the other factors that increase costs, such as better technology, have positive implications, but health care fraud is only viewed as a drain on health care resources. Health care fraud and abuse costs the United States an estimated 110 billion dollars a year (Caldwell 1997). Because health care fraud has played such a vital role in increasing the cost of health care it has gained a lot of attention from the government and the United States people. In the 1990’s the Clinton administration began a health care reform campaign and focused a lot of resources on stopping and, furthermore, preventing health care fraud within the Medicare and Medicaid programs. This paper will investigate those reforms, and evaluate how successful they were in reducing health care fraud. This paper will also address some of the many different types of fraud, who commits them, why the health care system is vulnerable to fraud, the problems and complications of current fraud investigation, and explore new suggestions for preventing health care fraud in the future.


THE IMPACT OF FRAUD ON RISING HEALTHCARE COSTS

Since the 1960’s health care costs have risen from 28 billion dollars per year to an estimated 1.9 trillion dollars per year in 2004 (Snapshot, 2006). That rise in cost accounts for an average of 6,300 dollars per person per year spent on health care, compared to 3,600 dollars per person per year in 1994 (Snapshot, 2006). This substantial increase in cost causes a problem for most Americans because average income has not increased as steadily as health care costs, leaving many Americans unable to afford or access health care (Effect, 2007; Snapshot, 2006). The “health care cost inflation invariably exceeds growth in the economy as a whole” (Sage, 1999). Many factors have contributed to the dramatic increase in health care costs such as a cultural preference to focus on expensive treatment instead of preventative measures, technological advances, the ability to live longer thus using more resources, medical malpractice, and healthcare fraud.
Factors Increasing Health Care Costs
The first cause of rising healthcare costs is related cultural values and patient preferences. When it comes to health care, it seems like Americans are always looking for a quick fix. As obesity rates increase, Americans turn to easy ways to lose weight immediately, like liposuction or gastro bypass surgery, instead of focusing on changing their diet and increasing their activity. Americans celebrate beating cancer, and call those who do heroes, but very rarely stop to consider the lifestyle choices that may have contributed to the disease. People do not choose to get cancer, but in many cases, like most diseases, lifestyle choices play a big factor. Americans do not consider the possibility that expensive chemotherapy, radiation treatments, and possibly the whole disease itself may have been prevented if in some cases a person wore sunscreen, smoked less, drank less alcohol, ate healthier or stayed physically active. Instead of changing

unhealthy lifestyles and focusing on preventing disease, Americans continue to come up with innovative and often expensive ways to fix things. Because American culture continues to value expensive retrospective medicine instead of preventative medicine, health care costs will continue to increase.
The need to compete and have more innovative technology is also a contributing factor to the dramatic rise in health care costs. In the United States healthcare is treated like any other billion dollar business, and each facility strives to provide the best care. In order to provide the best care each facility spends a large amount of money each year purchasing new top-of-the-line equipment. They do this even though the equipment they are replacing is still useful and efficient and in some instances are still being paid off. Providers spend millions of dollars purchasing and advertising their new-top-of-the-line equipment in order to win consumers. The problem is that as each provider spends millions on every new piece of technology available they have to charge the consumers more to pay for their new technology. If healthcare facilities would collaborate more, costs would be less. Instead of each facility in the area competing for market domination in their cardiovascular department by spending millions of dollars on new innovative equipment, one could focus on oncology, while the other focuses on cardiovascular. Collaboration would decrease the need for each facility to have every single piece of new innovative equipment, put the focus back on the patient, instead of the competition, and decrease costs for all involved.
New technology does not only increase costs, it also makes it possible for people to live longer. The result is that the longer a person lives the more health care they need to maintain a normal quality of life. As a person ages their health care needs encompass more types of procedures, more types of physicians, their healthcare becomes more expensive, and their procedures and physician visits become more frequent. As a person ages they need more health

care, and even with government assistance they are often unable to pay for it. They are unable to afford healthcare, because most are unable to work, and often live their last 20 years or so in retirement, only earning small amounts of money from retirement funds and possibly the government. This is a huge problem, because the population who needs the most health care are the least able to afford it. We are beginning to see this trend as the baby boomers reach retirement. According to the American Academy of Family Physicians in 2000 there were 354,000 uninsured people 65 years and older in the United States, and that number is expected to grow (Surprising, 2004).As the growing number of elderly struggle and are unable to find ways to pay for the health care that they need the number of people who are uninsured or underinsured increases.
As the number of uninsured or underinsured Americans increase the cost of health care for all Americans increases. Even though uninsured and underinsured Americans can not afford health care, they still seek treatment in the emergency room, where federal law requires treatment under the Emergency Medical Treatment and Active Labor Act (EMTALA). The cost of their treatment is often expensive; because being treated in the emergency room usually is more expensive in general, and their condition may be more serious because they were unable to afford to see the doctor earlier in order to prevent their condition from worsening. Because the uninsured and underinsured can not pay for treatment in the emergency room and the law requires they are treated, the cost of their treatment is shifted to those who do have insurance or already pay for care out of pocket, which further increases the costs of health care for everyone else.
Another reason that health care costs are increasing is that medical malpractice insurance for physicians is on the rise. In order for physicians to practice they must have medical

malpractice insurance. Medical malpractice insurance is then used to pay for negligence or other claims against the doctor. As more and more people collect medical malpractice money, the rates rise, and as the rates rise for the physicians prices for the patients rise as well. Some states, such as Indiana, have enacted laws limiting medical malpractice claims to reduce the burden of litigation on medical practice. These laws have helped, but some physicians fear being sued for malpractice. To protect themselves from possible lawsuits, they make very conservative recommendations and utilize additional health care procedures. Over-utilization of unnecessary procedures further leads to an increase in health care costs.
Like the other factors discussed above, health care fraud also contributes to the increase in health care costs. Health care fraud can be committed many different ways by any person involved with the health care system. Since most Americans are involved with the health care system, whether they are providing health care, or consuming health care, most Americans have the opportunity to take advantage of the system and commit fraud. In 2003, Blue Cross Blue Shield released a survey stating that out of $1.7 trillion spent on health care, $85 billion of that was lost to health care fraud (Blue, 2004). That $85 billion dollars was essentially stolen. Health care fraud is the most obvious and often the most upsetting factor that has increased health care costs.


Health Care Fraud Defined

Out of all of the factors mentioned above, Americans believe health care fraud is the most significant reason for the rise in health care costs (What, 1997). It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending

in 1998 (Liberman and Rolle, 1998). It is estimated that 25 cents of every dollar being spent on health care are supporting fraudulent practices, and that a family of four pays as much as 1,400 dollars per year on health care fraud related costs (Liberman and Rolle, 1998). Health care fraud has been one of the fastest growing U.S. criminal activities of the last decade. Many criminals are abandoning credit card fraud, drug trafficking and other dangerous activities in favor of the safe, lucrative arena of health care fraud (Allmon, 2005; Coccia, 1997; FBI, 1995). Given the surge in health care expenditures, it is not surprising to find an increase in the number and complexity of schemes devised to steal from the health care system (Morris, 1993). With so much money at stake it is essential for the American people and the government to explore the reasons why the health care industry is at risk for fraud, how they can minimize the occurrences of fraud, and take positive steps to prevent fraud related costs in the future.
Health care fraud has become a main stream issue (Kalb, 1999). Because of this, the government has spent the last ten years focusing on investigating health care fraud with the goal of decreasing its occurrence, and they continue to initiate new policies, and investigative bodies to deal specifically with health care fraud. Health care fraud is a critical issue for the government for many reasons. First off, the government is the principal payer of health care, and health care fraud is a waste of taxpayer money. “Elimination waste, fraud, and abuse is one of the few steps about which “disparate political ideologies can agree” (Sage, 1999). Secondly, they are in charge of regulating the health care system. Finally, they are entrusted with protecting the American people from criminals. Because of these reasons the government has dedicated many resources towards researching and investigating fraud, and how it occurs with the hopes of identifying new ways to fix the problem.

The National Health Care Anti-Fraud Association (NHCAA) has defined health care fraud as: “an intentional deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual or the entity or to some other party (Offen, 1999). This definition encompasses a broad range of activities. Through studying health care fraud cases from the past investigators have been able to define the specific types of fraud that are committed most often, and have attempted ways to stop them from happening. Research has also suggested that the health care industry is more vulnerable to fraud than most other industries, because the medical field is complicated and the lay person does not understand it, and the regulations that govern the health care industry are constantly changing and ambiguous.
Why the Health Care Industry is Vulnerable to Fraud
The Complexity of Medicine
As medicine becomes more technological, payment methods more ambiguous, and health policy becomes more complex, the average American often find themselves left in the dark. Because of this confusion, the health care industry is highly susceptible to fraud. Most Americans know very little about medicine, which procedures match which diagnosis or how insurance works. Until recently, the patient-doctor relationship was completely unbalanced. The doctor told the patient what to do, and the patient trusted the doctor completely without questioning the doctor’s treatment method. People had very little exposure to medicine, so they did not have any other option besides trusting the doctor (Sultz and Young, 2006).
With globalization and the internet, the doctor patient relationship has changed. Doctors are not the only ones with the answers anymore. Now, people can research symptoms on

WebMD, get a second opinion from an online doctor, or chat about different treatments with other patients who have experienced the same illness. Even with all of these new resources it is suggested that the average patient still ‘has neither the knowledge nor inclination to question a doctor’s recommendations” (Morris, 1993). The patient is weak and vulnerable, and just wants to feel better, so the doctor is able to take advantage of this. The physician is able to run pointless tests, try ineffective treatments, prescribe useless medications, and recommend the use of unnecessary equipment while charging it all to a third party payer who is oblivious to the “true” necessity of these things. Medical professionals are responsible for committing 72 percent of health care fraud (Stats, 2001).

The Ambiguity of the Payment System

The rules governing the coverage and reimbursement of medical services are ambiguous and always changing, which makes the rules confusing for all involved. In 1993 the Medicare program had 34 different carriers that administered Part B of the program, and each different carrier had the authority to set there own guidelines for coverage and reimbursement (Morris, 1993). The number of carriers administering the Medicare program has only increased, adding more complications and confusions for medical providers, and making excuses easier for those intending to abuse the system.
Sometimes medical providers are unaware of the mistakes they make. On the other hand, because of the confusion providers who intend fraud often rely on the excuse that it was an accident, and the government has limited means to prove otherwise. “Many billing disputes involve complex and ambiguous issues. Government suffers from what economists call “information asymmetries.” In other words, in many cases, and especially those involving coding, the government can find it hard to distinguish among proper billing, minor mistakes, and

a deliberate effort to skim off small extra payments from a large number of claims” (Stanton, 2001). Medical providers need better training on the correct ways to code, how to read the guidelines, and/or they need to have more options to hire an office administrator who has been trained in coding, third party payment systems, and reimbursement guidelines.

Limited Knowledge on Fraud

The United States only began to focus on health care fraud control in the past fifteen years. Because of this, experts know very little about health care fraud control as a science or an art. There are not many available experts for guidance in the field, causing us to always act after the fact, and most times too late to have the effect necessary (Sparrow, 1996). Until recently, there have not been any generally accepted fraud audit field standards, leaving investigators to make it up as they went along. The only thing that investigators really knew how to deal with was internal corruption (employee embezzlement), rather than outside corruption (criminal attacks) (Sparrow, 1996).
Fraud Investigators Limited Medical Knowledge
Another problem investigators have is challenging health care professionals. Investigators are often some kind of law enforcement who have very little experience in the medical field. When investigators find themselves challenging respected health care professionals they feel greatly disadvantaged (Sparrow, 1996).

Acceptable Targets

The United States health care system is very complex and part of what makes it so complex are the private third party payers, insurance companies. Insurance companies are often viewed as rich, greedy, exclusionary corporations out to take advantage of the working class

American (Sparrow, 1996). Often times because of this view, insurers are regarded by significant segments of the population as socially acceptable targets for fraud (Sparrow, 1996; Coccia 1997).
Fraudulent Techniques and Who Commits Them
Although fraud between medical professionals and patients is suspected to be the most common type of fraud, it is not the only type. Fraud exists in many areas of the health care system. It is estimated that health care facilities, such as hospitals and prompt care centers, are responsible for 8 percent of health care fraud, patients are responsible for 10 percent, while the remaining 10 percent are still unknown (Datawatch, 2000). However, it is suggested that health care fraud committed by patients/consumers is increasing as the number of underinsured and uninsured Americans increases (Farber, 1997)


Who Commits Health Care Fraud?

As the health care system expands, becomes more complicated, and involves more people, the acts of fraud committed also continue to become more complicated, involve more

people, and encompass many different sectors of the health care system. In order to decrease health care costs, fraud must decrease as well. It is important that we understand the types of fraud that have been committed in the past, so that we may initiate ways to stop those same kinds of fraud from happening in the future. In order to understand how the most common types of fraud are committed, one must recognize how medical professionals and health care facilities are reimbursed for their services. In most cases a patient does not pay for a service directly. Most payments to medical professionals and health care facilities are made by a third party payer, whether it is private insurance or a government program like Medicare. The third party payers and the health care providers have come up with a system made up of a series of numbers and descriptors which are used for reimbursement among many other things (Liberman and Rolle, 1998). This system is known as “coding”. Coding is very complicated, and encompasses more than 500 groups that include more than 3,500 medical procedures and 12,574 diagnostic codes (Liberman and Rolle, 1998).

Upcoding

Upcoding occurs when a healthcare provider claims a code that legitimizes a higher reimbursement level than they actually provided (Liberman and Rolle, 1998). Upcoding is very easy to accomplish, and difficult to detect. All a physician has to do is embellish a patient’s diagnosis to justify higher payments from both the patient and the third party payer. It is easy to do, because the patients and the payers know very little about medicine and what the correct diagnosis should be. Upcoding accounts for an estimated 22 percent of health care fraud (Datawatch, 2000).

Phantom Billing

Phantom billing happens when providers are charging for services not actually provided to patients (Liberman and Rolle, 1998). Phantom billing can happen two different ways. The first way happens when a physician codes that a patient has received a procedure, but does not provide the service. This type of fraud is simple to accomplish, because many patients are unaware of what they are billed for and third party payers often do not share the details with the patients. The second type of phantom billing takes place when a physician codes a procedure for a non-existent patient. This activity occurs frequently in home care and nursing homes. For example, a nursing home could submit claims for a patient who had died. Phantom billing accounts for an estimated 34 percent of health care fraud (Datawatch, 2000).

Bogus Billing

Bogus billing takes place when a billing code is altered to cover services that are not supposed to be covered (Liberman and Rolle, 1998). Many providers do this when new drugs and experimental treatments are not yet covered under Medicare or private insurance. Instead, of coding them properly they code them as a similar drug or procedure that they know is currently covered and will be paid for by a third party.
Unnecessary Services
Billing unneeded services happens most in ambulatory care facilities (Liberman and Rolle, 1998). Routine blood tests, urinalyses, and radiographs can be categorized as unnecessary billing when a patient does not need them, or they are perfectly healthy. These cases are sometimes hard to prove, because physicians can claim they were just erring on the safe side. Billing unneeded services accounts for an estimated 18 percent of health care fraud (Datawatch, 2000).

Double Billing

Double billing/unbundling occurs when duplicate bills are sent to the same payer or when the bills are sent to different payers (Liberman & Rolle, 1998). Double billing accounts for an estimated 4 percent of health care fraud (Datawatch, 2000).
Pharmacy Fraud
Pharmacy fraud can take place along two distinct lines. The first instance takes place when a generic brand of drugs is dispensed to a patient while the payer is charged for the brand name, which is more expensive. The difference can then be pocketed. Secondly, a pharmacy can fill prescriptions paid for by a third party, buy them back from the patients, and then sell them to other patients at a higher price (Liberman and Rolle, 1998). Pharmacy fraud accounts fro an estimated 8 percent (Datawatch, 2000).

Types of Fraud Committed:

Physician Defense to Health Care Fraud:
Because medical providers are responsible for 72 percent of health care fraud, there are many resources dedicated to the defense of physicians. These resources are often from the view point of physicians, and should be examined to offer a better understanding of why and how unintentional fraud is committed, and how it can be minimized.
Most physicians claim that the coding system is complicated and confusing, even to those who are supposed to be experts. It is suggested that many physician practices are busy and sometimes physicians erroneously code a service. They feel that they should not be blamed, because they were trained in medicine not in coding. Physicians also think that it is unreasonable to hold the physician responsible for the coding mistakes of employees. Physicians also feel as if they are treated as if they are guilty until proven innocent instead of the other way around. They feel like they have no chance to correct their error, before they are prosecuted (Friedman, 1996).
Even if they have a chance to defend themselves, some physicians feel it is still unfair because the government has a massive fraud enforcement program that has access to far more resources than they do leaving them at a disadvantage to defend themselves (Sage, 1999; Stanton, 2001). Physicians also have very little information to use for their defense. Because physicians are very busy and pressed for time, they often only write brief notes describing what was done for a patient and why in the medical record. So if they are prosecuted all they have as evidence is the chart with notes on it, and they see so many patients that they may not be able to remember exactly why they did what they did (Friedman, 1996).

THE PROBLEM: HEALTH CARE FRAUD WITHIN MEDICARE/MEDICAID

Many Americans who are unable to afford health care rely on the government for assistance through programs like Medicare and Medicaid. Medicare and Medicaid are government assistance programs introduced in the 1965 through the Social Security Act. The goal of both programs is to supply and finance a range of medical benefits to specific populations of Americans who can not afford health care. In 2003 Medicare and Medicaid were responsible for financing 26.3 percent of health care in the United States (Grayson, 1998). Because, these government programs serve so many people and provided a significant portion of funding in the health care field, they are often targeted for fraudulent behavior. In 2004 Medicare and Medicaid estimate that 14 percent of their health care costs were spent fraudulently (Grayson, 1998). Since these programs spent about 2 trillion dollars total on healthcare, about 90 billion dollars were spent fraudulently (Allmon, 2005). In comparison, credit card fraud, widely perceived to be a huge problem, results in annual losses of 788 million dollars annually in 2004 (Allmon, 2005).
Health care fraud is a massive problem for the entire health care system, not just government programs such as Medicaid and Medicare. But because of the large amount of money lost fraudulently every year through the Medicare and Medicaid programs the government has taken notice of the issue, and begun to make attempts along with other private entities to minimize and abolish its occurrence. The Department of Justice has declared health care fraud to be its second highest priority, following violent crimes (Kalb, 1999). In the past fifteen years the government has spent millions of dollars fighting health care fraud. The governments have committed millions of dollars more to fighting health care fraud in the future, new agencies have been created as well as new policies, and new ideas are always in development.
16
Medicare/Medicaid Fraud and Abuse Legislation
One of the first noticeable attempts at minimizing health care fraud came in 1996 through the Health Insurance Portability and Accountability Act. The act was passed with the goal of decreasing expenses to the Medicare and Medicaid programs through various reforms, and by focusing on reducing the occurrence of fraud and abuse in the government health care programs (Faddick, 1997). Through these reforms the government wanted to gain more tools for detecting and weapons for fighting fraud and abuse, recover money that had previously been spent fraudulently, and produce settlements (Faddick, 1997).
The Health Insurance Portability and Accountability Act (HIPAA) was created under good intentions, but from a practical perspective it has some problems. The new programs initiated under the HIPAA come with a substantial price tag. In 2002 the new initiatives cost an estimated 310 million dollars, without any sunset provisions for the future, which means the programs and costs of the programs have no definite end. HIPAA also has the potential to harm many health care providers by producing the unintended consequences of fewer settlements, more court battles, and the entanglement of the innocent in the intricacies of the governments new and very broad punishment tools (Faddick, 1997; Stanton, 2001).
HIPAA represents one of the most expansive programs the government has ever initiated to fight fraud and abuse in the health care system (Stanton, 2001). Specifically HIPPA focuses on fighting fraud and abuse proactively. HIPPA does this through these three major programs: the Fraud and Abuse Control Program, the Medicare Integrity Program, and the Beneficiary Incentive Program. HIPAA also amends the permissive exclusion provisions, provides certain minimum exclusions periods, expands the scope of civil monetary penalties, instructs the

Secretary to issue advisory opinions, protects certain risk-sharing arrangements from illegal anti-kickback penalties, creates new crimes relating to health care fraud, and establishes a national data base to house reports of adverse actions relating the delivery of health care services (Faddick, 1997).
The Fraud and Abuse Control Program was created through HIPAA to coordinate federal, state, and local health care anti-fraud enforcement programs. This program focuses on conducting investigations, financial and performance audits, inspections, and evaluations; and maintaining a public database, establishing and modifying safe harbors, and issuing advisory opinions. Specifically this program establishes a procedure to solicit recommendations at least annually, to publish proposals to modify existing procedures and add new safe harbors, and to issue special fraud alerts. This program is jointly administered by the Attorney General and the Secretary of Health and Human Services. It is funded through the Medicare Hospital Insurance (Part A) Trust Fund. Fines, penalties and other fraud and abuse recoveries also aid in funding this program (Faddick, 1997). So far this program has been successful at convicting health care fraud offenders, and collecting fines. Between 1997 and 2006 this programs has collected more than $10.4 billion in fines and restitution returned to the Medicare Trust Fund (United States. Dept. of Health, 2007) . Since this program began it has saved taxpayers more than $38 billion, and has increased convictions and other successful legal actions by more than 240 percent (Comprehensive, 1999).
Created though HIPAA the Medicare Integrity Program gives the Department Health and Human Services (HHS) the right to contract with private companies to perform fraud and abuse detection, cost report audits, provider payment determinations, and utilization reviews. The program also is in charge of providers, beneficiary, and public education; and developing a list of

durable acceptable medical equipment. This program is also administered by the Secretary of HHS, and funded by the Medicare (Part A) Trust Fund (Faddick, 1997). In 1997 alone, this program returned $14 for every $1 spent, and saved taxpayers an estimated $7.5 billion (Comprehensive, 1999).
HIPAA created the Beneficiary Incentive Program to entice Medicare beneficiaries and others to aid in identifying fraud and abuse. The program offers incentives such as monetary payments to beneficiaries who provide information that leads to monetary recoveries or other criminal or civil sanctions under the Medicare Program. This program has had some trouble with efficiency, because it struggles with a way to encourage beneficiaries to report incidents of fraud and abuse against the Medicare Program without reporting frivolous or irrelevant information. In order to encourage Medicare beneficiaries to be responsible for monitoring their own health care for fraud and abuse, this program provides each individual with an explanation of benefits for every item or service Medicare pays for. Then if an individual finds a discrepancy and reports it and that report leads to at least 100 dollars in recovery from the provider, they may receive a monetary reward (Faddick, 1997).
All of these programs aim at reducing fraud and abuse throughout the health care system. They increase the tools used for investigating fraud and abuse by unifying resources; setting standards; educating the providers, beneficiaries, and the public; working together with external entities; and by encouraging users of health care to get involved. HIPAA also discourages fraud and abuse by expanding the reasons and opportunities for penalties, increasing the amount of civil monetary penalties, increase prosecution and charges of criminal offenses, and by increasing the likelihood of exclusion from Medicare and Medicaid Programs (Faddick, 1997).

The Medicare and Medicaid Patient Protection Act

(Anti-Kickback Statute) was another statute created by the government to decrease fraud and abuse. This statute prohibits providers from knowingly and willfully paying or receiving any payment directly or indirectly, overtly or covertly, in cash or kind, in exchange for prescribing, purchasing, or recommending any service, treatment, or item for which payment will be made by Medicare, Medicaid, or any other federally funded health care program (Bennett and Medearis, 2003; Kalb, 1999). Violations of the Anti-Kickback Statute can receive up to $25,000 fines, 5 years in prison, or both. In order to convict a provider the government must prove that a provider solicited or received payments, the payments induced a referral related to a government program, and the transaction was knowingly and willfully entered into by the provider. Conviction under the Anti-Kickback Statute is often difficult, because the government must prove that the defendant acted with specific intent (knowingly and willfully). The program also protects against relationships that could result in conflicting interests, such as: discount arrangements, incentives given to providers, payments for services, and the practices of manufactures giving gifts and other business courtesies (Bennett and Medearis, 2003; Kalb, 1999).
The problem with this statute is that kickbacks are not specifically defined, which means that technically anything a provider receives from a manufacturer may be considered a kickback, even box of donuts or a pizza from a pharmaceutical company. This issue is being addressed presently by the American Medical Association (AMA). AMA suggests that providers only accept gifts that primarily benefit patients, such as educational materials (Bennett and Medearis, 2003; Kalb, 1999).


Another statute created to minimize fraud and abuse in the health care system was the False Claims Act. The False Claims Act is the most important law enacted by the federal government to enforce fraud and abuse legislation (Kalb, 1999; Stanton, 2001) The False Claims Act (FCA) has penalties for inaccurate billing practices and laws concerning false statements and overpayments, which penalize organizations that make false statements to the government or fail to return overpayments (Shane, 2000). If convicted of violating the False Claims Act, the government can receive up to three times the amount billed, and fines up to $10,000 for each false claim. These claims can be brought against any government contractor by the government or a private citizen. The act also includes qui tam provisions, which allows private citizens the right to file a lawsuit on behalf of the government and receive a monetary reward (up to 15%) from the recoveries (Bennett and Medearis, 2003; Cady, 2007; Kalb, 1999; Stanton, 2001). These types of provisions that encourage whistleblowers are important especially when addressing types of fraud like upcoding or bogus billing. Upcoding and bogus billing are hard to prove, because if caught providers can claim “honest mistake” (Stanton, 2001). Therefore, this type of fraud is best proven by the testimony of an insider (whistleblower), such as the billing clerk, who can outline the scheme and illustrate the provider’s fraudulent intent (Morris, 1993; Cady 2007, Stanton, 2001).

The Prescription Drug Marketing Act (PDMA) prohibits the sale or trade of drug samples. It was created by the government to correct abuse by individuals who repackage, distribute, and sell sample drugs that often resulted in misbranded and contaminated products. Violation of the PDMA can result in up to 10 years in prison, and fines of up to $250,000 (Bennett and Medearis, 2003). Due to the broad definition of “drug sample” these cases are often complicated and hard to prove.

Government Organizations Responding to Health Care Fraud

The government has committed numerous organizations to investigating health care fraud. A few of these organizations are: the U.S. Department of Justice (through the Criminal Health Care Fraud Division and the Civil Health Care Fraud Division), the Internal Revenue Service, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and state Medicaid fraud control units (Shane, 2000). These organizations along with the programs, listed above, and other internal anti-fraud programs such as corporate compliance programs have helped minimize fraud and abuse to an extent.
In 1998, alone, the Federal Bureau of Investigation (FBI) obtained 322 criminal convictions, up from 105 in 1993, and recovered $480 million in fines, recoveries, and restitutions, representing $13.65 for each dollar spent on the actual investigation. In the same year the state Medicaid Fraud Control Units, secured 683 convictions and recovered $42.8 million in fines, restitution and overpayments. Meanwhile, the Office of Inspector General in the Department of Health and Human Services, recovered $5.4 billion in fines, settlements, restitutions, and other recoveries involving federal health programs, and excluded 3,021 individuals and entities from government programs (Kalb, 1999; Sparrow, 1996).
The conviction and recovery amounts continue to increase, as investigators understand more about fraud, and the public is educated further. From 2001-2005 the FBI alone recovered $3.8 billion in restitutions, $477 million in recoveries, $1.11 billion in fines, and $102.8 million in seizures (United States Dept. of Justice, 2005). In 2006, the Department of Health and Human Services (DHHS) recovered $2.2 billion in judgments and settlements, and $378.4 million in recoveries (United States Dept. of Health, 2005). In 2000, the Health Insurance Association of

America revealed that 58 organizations responding have saved a total of $232 million through internal anti-fraud efforts, and had a return on investment of $11 saved for every dollar spent. Since 1994 the Federal Bureau of Investigation has quadrupled the number of health care fraud investigators, causing them to obtain 560 federal convictions for health care fraud, and recoveries around $290 million in 2001 (Stats, 2001). From 2001-2005 the FBI had 4,952 convictions, and 2,775 indictments (United States Dept. of Jusitce, 2007). As government organization continue to find success with health care fraud recovery they continue to increase the size and budget of the investigation units, with hopes of further recoveries made.
SUGGESTIONS TO PREVENT HEALTH CARE FRAUD
These programs and statutes have unified federal efforts to minimize fraud and abuse, encouraged education, given more tools to use for investigation and prosecution, and increased penalties and punishments for fraudulent behaviors, but it is not enough. It seems like all of these organizations have done a decent job of recovering money spent fraudulently, and they have done so with a reasonable cost to recovery ratio. However, recovering fraudulent money is not enough. Only 4 percent of fraudulent claims have been recovered or identified before payment (Allmon, 2005). It is important to anticipate weak spots in the health care system where fraud is likely to occur and continue to monitor and build in new ways to effectively prevent fraud and abuse from happening in the future.
As our health care system evolves and gets more convoluted the ways that fraud are committed evolve and become more complex. The health care system we have is mostly run by computers with minimal or no scrutiny of suspicious claims (Grayson, 1998). Often times because of this, once a computers fraud warning is triggered it is often too late to catch the

criminal. Most criminals simply disappear with their loot or even more troubling start more innovative schemes under different names and addresses (Grayson, 1998). Some new suggestions for preventing fraud are to implement a measurement program, use more human scrutiny of payment records and claims processes along with innovative deception detection software, encourage the use of corporate compliance programs, and involve consumers in the fight against health care fraud.
One way in which we can aim to prevent fraud from occurring is to implement more human scrutiny in the inspection of payment records and the claims processes. Many of the computer programs out there now are not able to detect some things that a trained human eye can. Often times the computer programs that are able to detect fraud as well as the human eye, are either too complicated or to expensive to be a practical purchase. Better detection technology is in the future, but while we wait we should increase training for individuals in fraud detection, coding, etc. and implement more individuals to inspect cost reports, payment records, and claims processes (Grayson, 1998).
Some of the new software systems being introduced to fight health care fraud are: advanced analytics software, decisioning technology software, and predictive modeling software. Advanced analytics software can scan million of records in seconds, comparing every transaction or claim with defined patterns, behaviors, and billing norms (Allmon, 2005). This software will be able to detect if there is any unusual service or payment pattern at a certain location. It will be able to tell if a certain physician charges a patient twice for the same service, if a physician seems to be doing too many mastectomies, etc. Decisioning technology software is being used by some private insurance companies to reduce fraudulent losses, improve productivity, and bottom-line results (Allmon, 2005). This software does analysis of data such as medical records

and claims, in order to find “errors”. It then converts the data into actionable results, and gives each provider or entity a score based on the rate of “errors”. Then claims adjusters, fraud investigators, case managers, and other personnel can focus their review on claims with the highest likelihood of fraud, abuse, or error (Allmon, 2005). This system if used correctly can also help providers, who are unintentionally making errors by showing them where there errors are and how to correct them before they are accused of fraudulent behavior. The most advanced type of software uses predictive modeling, a statistical technique that analyzes historical claims and claims-related data to predict the risk of fraud for each claim or behavior (Allmon, 2005). This type of software is able to detect fraud more accurately over time, thus giving organizations a better opportunity to catch fraud, abuse, and erroneous claims prior to payment and before losses mount. All of these software programs could be used to catch fraudulent activity before claims are paid. This software is important, and has the potential to drastically minimize the amount of money lost to fraud, because once claims are paid the time, effort, and costs of trying to recoup losses rise exponentially (Allmon, 2005).
Compliance programs are another way that many organization are trying to combat health care fraud. Health care compliance programs aid an organization in detecting and fixing health care fraud internally. They do this by creating a series of internal controls and measures to ensure that an organization is following federal, state and local statutes and regulations governing the federally funded health care programs (McKessy and Saner, 1998). More specifically, a compliance program may include: legal reviews of contracts and operating procedures, directives and training for employees, procedures for reporting violations of your specific compliance plan and/or government regulations, and monitoring and auditing mechanisms to discover violations (McKessy and Saner, 1998). In many cases compliance programs establish new positions for

corporate compliance officers to educate employees, develop standards of conduct, and monitor “high- risk” areas. Usually compliance programs also include an anonymous hotline to allow employees to report potential problems, and along with that there are policies requiring no retaliation to encourage reporting (Shane, 2000). Compliance programs are often successful, because they can be designed and/or customized by each individual organization to address their individual needs (Cantone, 1999). Furthermore, having a compliance program in place may help if the government does target a specific organization. Because a compliance program forces an organization to document their efforts to follow the law, it may help avoid criminal prosecution and exclusion from the federal health care programs, and provide an argument for lighter fines and penalties if a mistake is made (Cady 2007; Cantone, 1999; McKessy and Saner, 1998;). Overall compliance programs are very useful to prevent health care fraud. The Medical Group Management Association (MGMA) have supplied resources like: the “Compliance Programs for the Small Group Practice” booklet, an employee educational program plan, packets of research and survey information on compliance in physician practices, a website dedicated to creating compliance programs, and a monthly compliance newsletter called the “Physician Practice Compliance Report”, that can be used to create compliance programs (McKessy and Saner, 1998). Many other organizations, including the federal government, have also developed resources for organizations to use to create their own compliance programs.
One aspect of health care fraud prevention that is not mentioned enough is the consumer’s role. Consumers need to get involved with there health care, beyond just going to the doctor and taking their medicine. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Consumers can serve as important allies in the fight against

health care fraud as well. Some recommended methods for consumers to use to identify and reduce fraud are (Liberman and Rolle, 1998):
1.
Be wary of telephone solicitors who promise free checkups, testing, or medical equipment.
2.
Be cautious about rolling labs and health fairs, especially when a battery of tests is administered as opposed to a specific test.
3.
Do not provide a detailed medical history or sign multiple insurance forms that assign automatic reimbursement authority to a provider.
4.
Be skeptical when someone offers a free treatment. A provider may promise to waive part of the bill and suggest that the insurance company will cover the remainder of the cost. This may be untrue.
5.
Review all medical bills closely. Any billing discrepancies should be promptly reported to the clinician who provided the service.
6.
Do your research. Research each health agency contacted. Try to identify a provider who has been operating for at least five years, licensed by the state, certified by Medicare, and accredited by JCAHO.
7.
Report suspected fraudulent acts to proper authorities.


CONCLUSION
There has been some progress made toward minimizing health care fraud and abuse through government statutes and programs, and better education. However, as more money continues to be spent on health care more criminals will be attracted, and more fraud will be committed. As more people commit health care fraud, more complex types of fraud will be created. The best way to prevent health care fraud in the future is to address these issues now, and in order to do so Medicare and Medicaid must spend the money on the new deception detection technology along with hiring and training more fraud investigators. They must continue to research all aspects of health care fraud, train providers, and physicians in the correct way to code claims, and other parts of the claims process, continue to involve the public in their

health care, and pass legislation forcing every provider of health care to have and annually update a compliance program.
First, every step in the claims process needs to include regularly updated preventative deception detection software, in order to stay ahead of the new fraud techniques. Even though these programs are not able to detect everything, they have a good chance of flagging irregularities if linked with the national data base and alert system, created by the Fraud and Abuse Control Program. Along with the new technology we must also increase the number of fraud investigators in every aspect of the claims process, so that the irregularities that the deception detection technology flagged can be checked by trained investigators, and dealt with correctly. It is important that we update preventative deception detection software and hire and train more fraud investigators to achieve maximum success.
Secondly, we need to continue research of fraudulent activities, who commits them, why and how in order to continue to minimize their occurrence. The federal government should create a National Fraud Research Center to be in charge of funding and performing fraud research throughout the country, and training all of the FBI’s Fraud Investigators. The research center could be easily funded by the money that is returned from fraud convictions.
The National Fraud Research Center can also be responsible for accomplishing my third recommendation to prevent health care fraud: better education for everyone involved in the health care system. In order to better train providers, physicians, and administrators the National Fraud Research Center could hold mandatory conferences and training sessions throughout the country that each must attend in order to keep their licenses current. They could also pass legislation that forces physicians with a certain amount of patients to hire a certified

administrator who can then be responsible for all of the coding, billing, and claims. In order to educate the public legislation could be passed requiring insurance companies to hold public training sessions on how to read their specific summary of benefits. The National Fraud Research Center could also begin some kind of campaign to educate the public on health care fraud’s importance, and how they can aid in the fight against it.
Finally, the federal government needs to pass legislation forcing every provider of health care to have and annually update a compliance program. The legislation at a minimum will outline what is necessary in each program, and if a corporate compliance officer is needed depending on the number of consumers a provider/physician serves. It will also force each organization to do an internal audit to address their weaknesses. Compliance programs have been proven successful, and are relatively inexpensive. They have many benefits for the providers as well as the federal government, and should be easily initiated with all of the resources already available.
Throughout this paper it has been proven that fraud is a huge factor contributing to the growing cost of health care in the United States. If it continues more and more Americans will be unable to afford the health care that they desperately need. In order to stop fraud, it is imperative that the United States government and the citizens of the United States take an active role in pursuing more effective ways to identify and prevent fraud. If we all work together it is possible to control rising health care costs, and fighting fraud, through the ways mentioned above, is a good first step.

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