Federal Healthcare Reform

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

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

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

Kathleen Sebelius

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

Political Pundits: Is Kansas The Most Conservative State?

By Stephen Steigman & Steve Kraske

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

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

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

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

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

How does the State of Maryland moves to Expanded and Improved Medicare for All?

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

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

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

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

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

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

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

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

NATIONAL COMMITTEE POSITION

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

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

Require the federal government to negotiate drug prices

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

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

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

Repeal the means-testing of Part B premiums

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

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

Repeal the 45 percent cap on general revenue funding for Medicare

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

Prevent implementation of the 2010 comparative cost adjustment demonstration

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

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

CONCLUSION

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

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

Government Relations and Policy, March 2009

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I am a Conscientious Objector to the ACA

I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.

I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.

I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. Click on this link to do so.

The Issue is Access to Care, Not the Number Who Buy Insurance

As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.

The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.

Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.

In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.” The Insurance Scam

As Kevin Zeese and I wrote last fall, the ACA is one of the biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.

And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme. And it is a scheme, because there are no guarantees that people who have insurance will be protected from financial ruin if they have a serious health problem. It is essential to remember that nothing about the basic business model of insurance companies has changed. They exist to make a profit and they are very good at it. While they complain about the ACA, because its regulations require more work on their end to find ways around them, it has been very lucrative for them. Health insurance stock values have doubled since the law passed in 2010.

One of their major work-arounds is the use of narrow and ultra-narrow provider networks to discourage patients with pre-existing conditions from buying their plans and leave patients footing more of the bill. Narrow networks exclude at least 30% of local hospitals and ultra-narrow networks exclude at least 70%. This means that if the local cancer center isn’t included in a plan, then people with cancer are unlikely to buy that plan. To make it worse, it’s difficult for patients to determine what providers are included in different plans because the information on the insurance exchange websites has been found to be wrong half the time.

The reason for the narrow networks is that when patients don’t go to an approved health provider, they bear most or all of the costs. The limit on how much money people can be required to spend in addition to premiums doesn’t apply when patients go out of network (and the limit was removed for 2014 anyway). In practice, if someone develops a serious health condition and the hospital or health professional that treats the condition is not in their network, they will have to go without care or find a way to pay for it. And if a person has a serious accident and is taken to a hospital that is out of network, the patient will again bear the total cost. Buying insurance is a health care crap shoot.

The Race to the Bottom in Health Care Benefits

Medical bankruptcy and self-rationing, foregoing necessary care due to cost, are two products of our market-based health system and we can expect them to continue under the ACA, even as more people become insured. Supporters of the ACA often quote the slowed rise of health care spending that has been happening since the financial crash in 2008. They claim it is a sign of the law’s positive effect; however, the slowing is actually due to fewer people using health services. In 2012, 80 million people went without necessary care because of cost.

Self-rationing will continue because there has not been an economic recovery for most of us. More than 80% of people are buying lower tier health plans that require high up-front payments for care at a time when most families are living paycheck to paycheck. The number of people who are considered poor or low income is rising. And, as Paul Bucheit writes, if we updated our standards for measuring poverty to reflect the current economic realities (the costs of food, housing, health care, education, etc), the poverty threshold would be over three times higher than it is now. He adds that half of the US population owns zero wealth because of debt. It is a sad irony that people are being forced to pay monthly premiums for health insurance that will leave them without money for actual care.

And now that lower coverage plans are legal, they are accelerating the race to the bottom in employer health benefits. Employers are shifting more of the cost of health care onto employees, reducing coverage for dependents, moving employees into private insurance exchanges (which do not qualify for subsidies) and penalizing employees for poor health habits, which places the blame for health problems on the individual without acknowledging that many drivers of poor health are out of the individual’s control. While tying health care to employment is not ideal, in the US at least the employer-based plans used to provide better benefits than those on the individual market.

The Practical Solution

The solution to the ongoing health care crisis is obvious. We need to reverse direction completely and move to a national publicly-funded health insurance for everyone. Some call this a single payer or ‘Medicare for all’ plan. We are already spending enough on health care in the US to provide high quality care to everyone. It is just wrong from a standpoint of what works to continue shifting more of our health care dollars to bureaucracy instead of to care and to the private insurance industry which is designed to keep as much for itself as it can get away with. It is immoral to protect insurance company profits instead of protecting the health and wellbeing of our people.

Putting our money into the insurance industry is a step in the wrong direction. The Expanded and Improved Medicare for All Act, HR 676, in Congress, would eliminate the insurance industry and create lifelong comprehensive coverage for everyone. No matter what you choose to do about insurance, tell your Congress member to support HR 676. And if you are one of the millions who do not plan to buy insurance, join me in telling Obama why. Click here to write President Obama.

This article was originally published on Popular Resistance.

Margaret Flowers, MD is a participant in PopularResistance.org; she co-directs It’s Our Economy and co-hosts Clearing the FOG. Her twitter is MFlowers8.

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REMEMBER, OBAMA AND NEO-LIBERALS SAID EVERYONE WOULD HAVE INSURANCE AND INDEED THEY MANDATED IT. THEY NEVER SAID PEOPLE WOULD THEN BE ABLE TO ACCESS HEALTH CARE-----AND MOST WON'T WITH ACA!

Obamacare subscribers: Beware of high deductibles Commentary: Coverage 'not as affordable as many people need it to be'
By Wendell Potter 6:00 am, March 17, 2014 Updated: 3:06 pm, March 17, 2014 Center for Public Intergrity

“I’m very proud of our House Democrats, not only how they’ve embraced the Affordable Care Act … but how proud they are of it,” Pelosi said. “I think the Republicans are wasting their time using that as their election issue and they will find that out.”

Pelosi went on to say, however, that, “there are some things (about the law) that need to be fixed.”

She didn’t suggest what those things are, but I’m betting at the very least she wishes she and others who helped write the law had made it simpler for people to get the insurance protection they need.

The reform law made many of the insurance industry’s most despised practices illegal, like refusing to offer coverage to applicants with pre-existing conditions and canceling people’s policies when they get sick.

And the ACA now requires insurers to provide information about their policies in understandable language and in a format that enables people to compare one plan with another. It also established federal and state health insurance “exchanges” to make shopping for coverage more convenient and less stressful.

But despite those and other important benefits of the law, trying to figure out which health plan among many is best for you is anything but a walk in the park.

With only two weeks left before the March 31 deadline to enroll in a plan for 2014, I talked to Rachel DeGolia — one of the specially trained ACA navigators who is helping folks in Cleveland, Ohio, figure out how to move out of the ranks of the uninsured — to find out how she would fix the law if she had the power to do so.

I also consulted the 114-page “Navigator Resource Guide” developed by the Center on Health Insurance Reforms at Georgetown University Health Policy Institute to help navigators like DeGolia deal with all the questions they get every day from folks.

Although DeGolia still believes a single-payer system would be better than the multi-payer system the ACA is built upon, she nevertheless considers the law “a huge step in the right direction.”

But, she says, lawmakers need to figure out how to make coverage more affordable and to reduce the complexity that has defined the health insurance industry for decades.

“Coverage is not as affordable as many people need it to be yet,” she says.

@Health investigations in your inboxSign up for the Center for Public Integrity's Watchdog email and get the news you want from the Center when you want it.

Email (required) More options ▼In the 25 states that have expanded their Medicaid programs to include residents with incomes up to 138 percent of the federal poverty level, the people at the lower end of the income spectrum are in many cases better served by the law than middle income individuals and families.

“If you make $30,000 and can find an affordable premium but still have a $5,000 deductible, that’s not a great deal if you get sick,” she said.

“It doesn’t make sense to me why we have to have these high deductibles,” she added. “Maybe they exist because people need to have ‘skin in the game,’ but I haven’t met people who overuse services. That’s not the norm. I’m afraid the deductibles will be so high for some people that it will deter them from getting the care they need, even if they are insured.”

And because plans with the highest deductibles have the lowest premiums, she says she worries that people will “settle” for a plan that provides less comprehensive coverage than then they really need.

Another problem with the health plans being offered on the exchanges is that many of them have “narrow” provider networks, meaning that a person’s doctor might not be included.

“It’s a challenge is to help people who have never had insurance to explain it to them,” said DeGolia. “You can easily spend two hours with them. It’s a big learning curve.”

DeGolia also wishes the ACA didn’t limit enrollment to just a few months a year — which brings me to that Georgetown Navigator Resource Guide. Here’s Question 37 (of 270):

“Why can’t I buy a plan when I need it? Why do I have to wait for the open enrollment period?

Answer: If everyone were allowed to wait until they were sick to buy coverage, premiums would be very expensive … Health insurers need a mix of healthy and sick people to make premiums fair for everyone.”

(Of course, if everyone were covered and automatically enrolled in a single-payer system as in other countries, there wouldn’t be a need for open enrollment. Our health care system is complex in large part because we have so many payers.)

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Everyone understands that consolidation ends competition and fuels lack of accountability!

Massachusetts' Hard Look at Hospital Mergers As consolidations have become increasingly more common across the country, Massachusetts has the nation's only independent state agency focused on evaluating their effects.
by Chris Kardish | March 18, 2014

The Massachusetts Health Policy Commission, which came to life with a landmark 2012 law that sets caps on health spending increases and attempts to move away from the fee-for-service payment system, is the nation's only independent state agency that makes reform recommendations and reviews merger proposals. Its first major merger action came last month, when it discouraged a merger between Partners HealthCare and South Shore Hospital, the two largest medical providers in southeastern Massachusetts. The commission concluded that it would lead to an increase of up to $26 million in spending and give the combined system considerable leverage negotiating prices with insurers.

Mergers between major hospital systems are increasingly more common, in part because of the Affordable Care Act’s demands for greater coordination between networks of health-care providers. In three years, the number of consolidations almost doubled from 55 in 2009 to 105 in 2012, according to Irving Levin Associates, a business research firm.

A growing body of research argues hospital consolidations lead to higher prices for consumers, particularly in areas where there are already few competitors. But hospitals and lobbying groups contend that only a small percentage of mergers occur in markets that lack enough independent hospitals to maintain competition and those transactions often lead to new investments that benefit consumers or improve the finances of the smaller partner in the deal.

In the case of Partners HealthCare and South Shore Hospital, the two argued a deal would allow them to combine more services to better monitor patients across the system and improve their health through new investments in electronic records and care coordination. But the commission—which can only review mergers and send reports to the state attorney general—decided those initiatives and others won’t outweigh new costs from higher prices.

“This was its first real challenge for the commission as a new public entity, and so people were watching to see if it would call the shots as it saw it or [whether it] would pull its punches and play it more politically -- and they didn’t [do that]", said John McDonough, a professor at the Harvard School of Public Health.

Even without the authority to halt a merger, the commission is the nation's only independent state agency that's focusing on hospital consolidation. States have always exercised some power over mergers through licensing authority, but after decades of inactivity, they’ll start looking harder at mergers either through agencies or attorneys general, McDonough said.

“It appears there’s some momentum here because people understand with a lot more evidence that these mergers have consequences with health system costs, so the states that aren’t afraid of government intervention are looking more seriously at these activities,” he said.

Idaho’s attorney general recently won a judicial victory against a merger with the help of the Federal Trade Commission (FTC), and Pennsylvania’s attorney general joined the FTC to stop a deal late last year. In the Massachusetts case, Partners can’t move forward with its deal for 30 days, giving the attorney general until late March to file a suit. But it’s also possible the attorney general will work out a deal that extends that window to allow for negotiations that address the state’s antitrust concerns.

Each merger case needs to be considered on its own merits and the nature of the market where the hospital systems are based, said Robert Huckman, a professor of business administration at Harvard who specializes in health care. The ACA encourages hospital coordination and large investments in electronic health records, but those goals often require some level of consolidation, he said.

“The flip side of that is greater market concentration,” Huckman said. “There’s a balance that needs to be struck between encouraging integration but discouraging excessive consolidation.”

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The point missing here is that the Affordable Care Act has more patients at home with these home health industries serving people at home. If you think failures in care happen in nursing homes more than hospitals, wait until home health care is assessed. We know workers are being sent to homes without to proper training of level of degree. Those workers are telling us that they have no medical specialist-nursing staff to call for consulting.

The Affordable Care Act places this home health on steroids and national chain businesses are filling the void. Let's talk about this NOW instead of waiting decades.

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”.

_____________________________________________________________
THAT'S WHAT AFFORDABLE CARE ACT IS TALKING ABOUT------CORPORATE PROFITS ALREADY SOARING AS THE AMERICAN PEOPLE ARE NO LONGER ABLE TO ACCESS BASIC HEALTH CARE! CUTTING STAFF AND WAGES TO MAKE THINGS MORE 'EFFICIENT' IS OK WHEN HEALTH CARE BECOMES DEREGULATED...... IT'S ABOUT THE PROFITS SAY NEO-LIBERALS!

NOW, ALL OF THESE HOSPITAL EARNING THESE MILLIONS SOON TO BE BILLIONS ARE ALL NO DOUBT CATEGORIZED AS PRIVATE NON-PROFITS PAYING NO TAXES! MAXIMIZING TAXES RIGHT AND LEFT!

You know what has neo-liberals really excited? Life expectancy for most people will take a deep drop because of all this lack of access to ordinary health procedures. People dying early do not need Medicare and Social Security!

NEO-LIBERALS ARE ALWAYS THINKING!

The Growing Bottom Line: 16 Statistics on Profits by Hospital Bed Count
Written by Bob Herman | January 24, 2014

Community hospitals amassed sizable profits in 2012 despite the variable healthcare environment, and the bottom lines at the largest hospitals were in the tens of millions of dollars.

According to the American Hospital Association's 2014 edition of AHA Hospital Statistics, the 4,999 U.S. community hospitals posted $64.4 billion in cumulative profits in 2012 — a 21 percent increase from 2011.

The largest community hospitals, or those with 500 or more beds, had an average profit of $67.8 million in 2012. Hospitals with more than 300 beds collected more than $30 million in earnings, on average. Critical access hospitals and small rural hospitals posted more modest profit figures, ranging from $1.3 million to $5.3 million.

Here are 16 statistics on hospital profits, sorted by hospital bed count. Note: Average profit per hospital figures are means, not medians.

Cumulative profit in 2012
Hospitals with 6 to 24 beds: $587.6 million
Hospitals with 25 to 49 beds: $2.8 billion
Hospitals with 50 to 99 beds: $5.1 billion
Hospitals with 100 to 199 beds: $11.1 billion
Hospitals with 200 to 299 beds: $9.7 billion
Hospitals with 300 to 399 beds: $10.5 billion
Hospitals with 400 to 499 beds: $6.2 billion
Hospitals with 500 or more beds: $18.4 billion

Average profit per hospital in 2012
Hospitals with 6 to 24 beds: $1.3 million
Hospitals with 25 to 49 beds: $2.3 million
Hospitals with 50 to 99 beds: $5.3 million
Hospitals with 100 to 199 beds: $11 million
Hospitals with 200 to 299 beds: $17 million
Hospitals with 300 to 399 beds: $30.2 million
Hospitals with 400 to 499 beds: $32.8 million
Hospitals with 500 or more beds: $67.8 million

___________________________________________________________________-
There we see what Affordable Care Act is all about......hospital corporations consolidating and growing into global systems just as the banking sector turned into Wall Street. Private health systems that end all public health......WHAT COULD GO WRONG WITH THAT?

DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL!

7 Major For-Profit Hospital Companies Post $562M in Quarterly Earnings Written
by Bob Herman | March 10, 2014

Seven of the largest for-profit hospital operators reported quarterly earnings over the past several weeks.

In the quarter ended Dec. 31, 2013, the big seven hospital companies recorded a cumulative net profit of $561.7 million. However, that figure is somewhat skewed as HCA and UHS drove a vast majority of the profit. In addition, several companies continued to post lower earnings and net losses due to soft volumes, acquisition-related costs and high regulatory expenses.

Here are the quarterly financials of all seven hospital companies, starting with the most recently released.

1. In fiscal year 2013, Franklin, Tenn.-based hospital operator Capella Healthcare lost $31.8 million, which was more than double its $14.1 million loss in 2012. In the fourth quarter alone, Capella lost $14.6 million.

2. Universal Health Services, based in King of Prussia, Pa., posted $124.5 million of net profit in the fourth quarter — an 8 percent drop from the same period in 2012.

3. Dallas-based Tenet Healthcare Corp. posted a net loss of $24 million in the fourth quarter of fiscal year 2013 — compared with a $49 million profit last year — due mostly to acquisition-related costs and higher operating expenses.

4. Net revenue and profit at Franklin, Tenn.-based Community Health Systems dropped in the fourth quarter and full year as weak inpatient volumes defined 2013. For the three months ended Dec. 31, net revenue fell 1.4 percent to $3.23 billion. Operating income totaled $52.3 million, a 39 percent decline from $85.6 million posted in the same period a year ago. Total profit slipped 55 percent to $28.2 million.

5. Brentwood, Tenn.-based LifePoint Hospitals recorded $35.6 million of profit in the fourth quarter of 2013, a 1.9 percent drop from $36.3 million in 2012.

6. Franklin, Tenn.-based IASIS Healthcare posted $5.2 million in net income in its first quarter ended Dec. 31, but that number would have been in the red if the company hadn't sold its Florida market to a competitor.

7. Despite a 1.8 percent drop in same-hospital admissions in the fourth quarter, Nashville, Tenn.-based Hospital Corporation of America still managed to post a $424 million profit — up 35 percent from the fourth quarter in 2012.

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For those not understanding what happens when public health care becomes profit-driven and run by global corporations.....Baltimore and Maryland have handed much of senior health care to the Carlyle Hedge Fund under Manor Care for example. Now, if this hedge fund bets on patient's life, do they work to fix the bet? Since public oversight is being dismantled, no one would be checking.

Here you see an SEC that shouts out about the terms of this kind of financial bet but not on the fact that Wall Street is betting on people's lives. So, if someone will profit if people die what will stop these 1% for making that happen? Not the SEC unless it causes someone to lose money on a bet.

Variable Annuities Scheme to Profit from Imminent Deaths of Terminal Patients

March 13th, 2014

from the Securities Exchange Commission (SEC)

The Securities and Exchange Commission today announced enforcement actions against a pair of brokers, an investment advisory firm, and several others involved in a variable annuities scheme to profit from the imminent deaths of terminally ill patients in nursing homes and hospice care.

Follow up:

Variable annuities are designed to serve as long-term investment vehicles, typically to provide income at retirement. Common features are a death benefit paid to the annuity’s beneficiary (typically a spouse or child) if the annuitant dies, and a bonus credit that the annuity issuer adds to the contract value based on a specified percentage of purchase payments. The SEC Enforcement Division alleges that Michael A. Horowitz, a broker who lives in Los Angeles, developed an illicit strategy to exploit these benefits. He recruited others to help him obtain personal health and identifying information of terminally ill patients in southern California and Chicago. Anticipating they would soon die, Horowitz sold variable annuities contracts with death benefit and bonus credit features to wealthy investors, and he designated the patients as annuitants whose death would trigger a benefit payout. Horowitz marketed these annuities as opportunities for investors to reap short-term investment gains. When the annuitants died, the investors collected death benefit payouts.

The SEC Enforcement Division alleges that Horowitz enlisted another brokerMoshe Marc Cohen of Brooklyn, N.Y., and they each deceived their own brokerage firms to obtain the approvals they needed to sell the annuities. They falsified various broker-dealer forms used by firms to conduct investment suitability reviews. As a result of the fraudulent practices used in the scheme, some insurance companies unwittingly issued variable annuities that they would not otherwise have sold. Horowitz and Cohen, meanwhile, generated more than $1 million in sales commissions.

Agreeing to settle the SEC’s charges are four non-brokers and a New York-based investment advisory firm recruited into the scheme. Also agreeing to settlements are two other brokers who are charged with causing books-and-records violations related to annuities sold through the scheme. A combined total of more than $4.5 million will be paid in the settlements. The SEC’s litigation continues against Horowitz and Cohen. Said Julie M. Riewe, co-chief of the SEC Enforcement Division’s Asset Management Unit:

This was a calculated fraud exploiting terminally ill patients. Michael Horowitz and others stole their most private information for personal monetary gain.

According to the SEC’s orders instituting administrative proceedings, the scheme began in 2007 and continued into 2008. Horowitz agreed to compensate Harold Ten of Los Angeles and Menachem “Mark” Berger of Chicago for identifying terminally ill patients to be used as annuitants. Berger, in turn, recruited Debra Flowers of Chicago into the scheme and compensated her directly. Through the use of a purported charity and other forms of deception, Ten, Berger, and Flowers obtained confidential health data about patients for Horowitz.

According to the SEC’s orders, after selling millions of dollars in variable annuities to individual investors, Horowitz still desired to generate greater capital into the scheme. Searching for a large source of financing, he began pitching his scheme to institutional investors. A pooled investment vehicle and its adviser BDL Manager LLC were created in late 2007 in order to facilitate institutional investment in variable annuities through the use of nominees. Commodities traderHoward Feder, who lives in Woodmere, N.Y., became each firm’s sole principal. Feder and BDL Manager fraudulently secured broker-dealer approvals of more than $56 million in annuities sold through Horowitz’s scheme. Feder furnished the brokers with blank forms signed by the nominees enabling the brokers to complete the forms with false statements indicating that the nominees did not intend to access their investments for many years. Feder understood that the purpose of Horowitz’s scheme was to designate terminally ill patients as annuitants in the expectation that their deaths would result in short-term lucrative payouts. BDL Group received more than $1.5 million in proceeds from its investment in the annuities.

The order against Horowitz and Cohen alleges that they willfully violated the antifraud provisions of the Securities Act of 1933 and the Securities Exchange Act of 1934 and they willfully aided and abetted and caused violations of the Exchange Act’s books-and-records provisions. Horowitz also acted as an unregistered broker.

Ten, Berger, Flowers, Feder, and BDL Manager consented to SEC orders finding that they willfully violated Section 10(b) of the Exchange Act and Rule 10b-5. They neither admitted nor denied the findings and agreed to cease and desist from future violations. The individuals agreed to securities industry or penny stock bars as well as the following monetary sanctions:

Ten agreed to pay disgorgement of $181,147.64, prejudgment interest of $20,858.80, and a penalty of $90,000.
Berger agreed to pay disgorgement of $119,000, prejudgment interest of $11,579.61, and a penalty of $100,000.
Feder agreed to pay a penalty of $130,000.
BDL Manager agreed to pay disgorgement of $1,550,565.55, prejudgment interest of $196,608.97, and a penalty of $1,550,565.55.

The SEC’s order against Richard Horowitz and Marc Firestone finds that they negligently allowed point-of-sale forms for 12 annuities in the scheme to be submitted to their firm with inaccurately overstated answers to the form’s question asking how soon the customer intended to access his or her investment. These inaccurate answers led to each annuity’s issuance, and Horowitz and Firestone were each paid commissions.

Richard Horowitz and Firestone consented to the order finding that they caused their firm to violate Section 17(a) of the Exchange Act and Rule 17a-3. Without admitting or denying the findings, they agreed to cease and desist from committing or causing future violations of those provisions as well as the following monetary sanctions:

Horowitz agreed to pay disgorgement of $292,767.89, prejudgment interest of $36,512.20, and a penalty of $40,800.
Firestone agreed to pay disgorgement of $127,853.20, prejudgment interest of $17,140.89, and a penalty of $40,800.

The SEC’s investigation was conducted by Marilyn Ampolsk, Peter Haggerty, Jeremiah Williams, and Anthony Kelly of the Enforcement Division’s Asset Management Unit along with Christopher Mathews and J. Lee Buck II. The SEC’s litigation will be led by Dean M. Conway.

_____________________________________________
This is a good example of people and unions working to create the health care environments needed. You can fight for change......ACA hurts both labor and patient access to quality care.

Tuesday, Mar 11, 2014, 1:47 pm
Care Before Profit? Nurses Get Radical in Fight to Save Brooklyn Hospitals
BY Sarah Jaffe

Long Island College Hospital (above) is fielding new proposals for purchase and evaluating the bids via a committee of individuals from the community and labor groups that have fought to keep it open for the past year. Zdvash/Wikimedia Commons

“We are here tonight because our hospitals are in a crisis,” said New York City Public Advocate Letitia James as she stood behind a podium at Pleasant Grove Baptist Church in Bedford-Stuyvesant, Brooklyn on Thursday evening. James was at the church to host a town-hall meeting about healthcare needs in Brooklyn and the possible closure of Interfaith Medical Center along with other elected officials, advocates and workers from the New York State Nurses Association (NYSNA) and 1199SEIU United Healthcare Workers East.

In Brooklyn, James stressed, there are just two hospital beds per thousand people. Meanwhile, across the river in the borough of Manhattan, there are six beds per thousand people. And without the battle that unions and community members have been waging for over a year now, there might be even fewer, because Interfaith and Long Island College Hospital (LICH) would very likely be shuttered already.

The question when it comes to Interfaith, according to NYSNA organizer Eliza Carboni, is, “How do we get decisions about our healthcare needs out of bankruptcy court and into the hands of the community?” The hospital, which has been in bankruptcy court since 2012, has nearly closed several times—most recently this winter—before the state agreed to release some $25 million in funds to keep it open through March as bankruptcy proceedings continue. The crowd at the church hopes to see real changes in how healthcare decisions are made in a borough where most people get their primary care at the hospital, and where a large number of residents are reliant on Medicaid and Medicare to cover their treatment. They're hoping that the state will step in to help keep it open. But NYSNA and 1199, together with community and elected leaders, are also exploring the idea of running the hospital as a cooperative—a move that if successful could have far-reaching implications in the healthcare sector.

A recent win for a community-labor coalition at LICH, which has kept the hospital open for the last year, suggests a blueprint for organizing at other cash-strapped hospitals. The unprecedented deal reached in court over LICH opens up a new request for proposals (RFP) to purchase the hospital and its property. Unlike previous iterations, the new RFP will prioritize proposals that keep a full-service hospital open, and the community and labor groups that filed suit to save the hospital will be represented on the committee that will evaluate the bids. While this doesn't guarantee the hospital will remain open, it represents a huge shift in priorities—nurses and elected officials had previously felt that the State University of New York (SUNY), which currently operates the hospital, simply wanted to sell off the valuable real estate to the highest bidder, regardless of healthcare need.

Vincent Alvarez, president of the New York City Central Labor Council, said that the partnership between the unions and the community “embodies the mission of the labor movement.” But NYSNA wasn’t always engaged in this kind of deep community organizing. While 1199 has a long history of progressive activism, it was only when a new, more activist board won control of the union in 2012 that the nurses' union began investing in organizing. After having experienced other hospital closures (notably at St. Vincent's in Manhattan in 2010), the nurses rallied immediately when rumors began that LICH would be closed, staging protests, holding health fairs and other creative public actions that even drew the participation of now-Mayor Bill de Blasio, who was arrested outside of SUNY's Manhattan office in July. Like other recent successes for labor, most notably the Chicago Teachers Union, the nurses and hospital workers succeeded by putting community needs at the center of their demands and putting union resources to work building a base that trusts them.

Throughout the fight, which has kept the hospital open for more than a year past its supposed closure date, the hospital administrators at LICH diverted ambulances and transferred patients to other facilities. Security guards filled the halls. But day after day, the nurses kept showing up to work. Carboni thinks that commitment, demonstrated on the job and in the streets as they fought to save their workplace, should make the staff at LICH even more appealing to a potential bidder. Nurses, doctors and other labor and community leaders made presentations to some prospective new operators last Monday, March 3. (One of those potential new operators is John Catsimatidis, former Republican mayoral candidate and owner of Gristedes foods.)

At both LICH and Interfaith (as well as other struggling Brooklyn hospitals), a major issue is Medicaid and Medicare funds. Smaller, independent facilities often receive lower reimbursements for the same services than larger ones, which have more leverage to negotiate with insurance companies for favorable rates. As a result, Carboni notes, doctors are incentivized to take paying patients to hospitals that are part of a larger chain. That leaves hospitals in lower-income neighborhoods (often in communities of color) even more dependent on Medicaid and Medicare dollars—and those rates may fluctuate. “It's not that it's not possible to balance your books off of a Medicare/Medicaid population, it's just that it requires more work to do so,” Carboni says.

If Interfaith is to remain open, it will require an infusion of money to keep it going. James, the nurses and hospital employees, and Bed-Stuy community members hope that some of that money will come from a Medicaid waiver requested by the state in 2012. That waiver, recently approved, will send $8 billion in federal funds to New York, but it's not clear yet how it will be spent. Governor Andrew Cuomo, James reminded the crowd at Pleasant Grove Baptist, promised that the money would be spent on Brooklyn hospitals—but she and others noted that such promises have not been kept in the past. As negotiations continue over where that money will go, state officials are debating which hospitals qualify as “safety net.”

Interfaith serves a federally-recognized healthcare shortage area in Bedford-Stuyvesant and Crown Heights. Its neighborhood (which includes this reporter’s apartment) has gentrified in recent years, but still is home to many low-income residents who have long been underinsured and undercared-for. Around 60 percent of its services go to Medicaid enrollees, according to NYSNA.

Much of the future of Interfaith rests on the decisions Cuomo makes about the Medicaid money and what happens in bankruptcy court. The unions are pushing for the definition of “safety net” not to be solely dictated by the Hospital Association, but defined around community needs. That means hospitals like Interfaith, which if closed could create a “healthcare desert,” should be prioritized for funding.

There's also the question of who is going to be in charge of guiding Interfaith towards a possible new future. Carboni says that NYSNA is concerned anyone appointed to govern the hospital through bankruptcy court is going to be “slash and burn, just making sure the bills get paid.” Instead, the state should be involved to ensure that a trustee doesn't simply steer the hospital toward closure.

“We hope that whoever is going to make decisions for Interfaith to remain open, they will look at the needs of the community,” says Charmayne Saddler-Walker, a nurse in the psychiatric department at Interfaith, and part of a group of women workers saluted at the church Thursday night for their part in keeping the hospital open. “Not on the financial structure or where we stand financially but the needs of the community.”

As a parallel track to the bankruptcy proceedings, the community-labor coalition that has rallied around Interfaith is working on an alternative model for Interfaith—a co-op, based on the idea that decisions on healthcare services at the hospital should be according to the needs of a community with high levels of diabetes, heart disease, and psychiatric illness, rather than the logic of the market. This model, Carboni told the crowd at Pleasant Grove, would save money by cutting administrative bloat, not healthcare services. They're hoping that a successful hospital co-op, which would be the first of its kind, could be a model for others in the future.

Indeed, the battles over Brooklyn healthcare illustrate well why markets don't work for many human services: If profit is the only goal, it will always be more profitable to build condos for the wealthy than healthcare for the sick.

Brooklyn Borough President Eric Adams appears interested in the co-op plan. At the church, he told the crowd that he'd be holding listening sessions around the idea at Borough Hall.

The hospital fights may have benefited from an election year where candidates wanted to find an issue that made them stand out from the pack. It certainly helped de Blasio, who benefited from endorsements from 1199 and, eventually, from NYSNA—notably, the nurses didn't make their endorsements until shortly before the primary and after de Blasio had made his famed trip to lockup. James and other elected officials have continued to play a role in the hospital fight, while Sharonnie Perry, chair of Interfaith's Community Advisory Board, noted Thursday night that de Blasio hasn't been around as much lately. “We miss him,” she said.

It will be a while before any permanent solutions are found for either LICH or Interfaith, but the struggle of the workers and their communities to save the hospitals has already challenged some of the basic assumptions of the American healthcare system. The radical ideas that profit has no place in healthcare, that patients deserve care whether or not they can make hospital executives rich, and that communities should be able to make decisions about the services that exist within it are out there before the broader public.

“Both unions and the community leaders, we have used every medium possible to educate the community about what's going on,” says Saddler-Walker. “They're really aware of what is really going on.” That's included a “race for care” from underserved Red Hook to LICH, a public theater performance at Interfaith, and regular rallies, vigils and marches.

And as for the hospitals, she says, “We're still open for care, we make sure all our patients are safe and that the quality of care that we give is one of the best.”

______________________________________________________________________
Here's a group that knows the problem of ACA----please join a Expanded and Improved Medicare for All group in your state!

Does America need a new healthcare
system?

DUH! TO
DONATE: visit our page at www.DUH4all.org

Our 3-week tour to California, Oregon, and Washington in April and
early May will provide many participants an opportunity to see The Healthcare
Movie, participate in panel discussions, town halls, and social-justice fairs
and forums. We need $10,000 to help us drive home the point that
Healthcare is a basic human need.

45 million Americans remain without access to basic healthcare. Even
with the ACA, it is estimated that more than 30,000 will die every year until we
are finally able to provide truly universal, single-payer healthcare.
Won't you help us make a difference? Your money will be used to
defray printing costs (posters, brochures, petition), the costs of renting two
vehicles and gassing them up for the trip, communications (website,database,
Internet, phone), T-shirts and equipment. Other costs associated with the
tour will be shared by our core travel group.

We will be traveling with The Healthcare Movie. This film is a tool for
advocates to boost awareness and call people to action to create a tax-supported
universal medical care system in the US.

The Future We Are Creating
Background:

Every developed country in the world except the United States offers a health
care system that covers all its residents. Health care in the United
States is complicated, expensive, unfair, financially devastating, and deadly
for many Americans. Even as the Affordable Care Act goes into
effect, it is predicted that 30 million people will still be uninsured, and many
more will be under insured.

Other countries have proven that a comprehensive, accessible universal
healthcare system costs far less, includes everyone, and has better outcomes.
It's time we Americans stop messing around and get this done.
_____________________________________________________________

Between privatizing most of the Veteran's Administration to private non-profits that are found to get public money and often don't do the service and Affordable Care Act that privatizes public health to maximize profits making hospitals about earning profits instead of giving care-----ACA will not allow quality health programs to be built.

Remember, the problems with costs in health care for civilians and military are massive health industry and defense industry frauds of trillions of dollars. Not how much care the public accesses. THIS IS A NEO-CON/NEO-LIBERAL policy to deny health care access to most!

Why Hospitals Are Failing Civilians Who Get PTSD
Wednesday, 05 March 2014 11:37 By Lois Beckett, ProPublica | Report

Undiagnosed post-traumatic stress disorder is having a major impact on injured civilians, particularly those with violent injuries, as we detailed last month. One national study of patients with traumatic injuries found that more than 20 percent of them developed PTSD.

But many hospitals still have no systematic approach to identifying patients with PTSD or helping them get treatment.

We surveyed 21 top-level trauma centers in cities with high rates of violence. The results show that trauma surgeons across the country see PTSD as a serious problem. But only one trauma center, at the Interim LSU Public Hospital in New Orleans, actually screens all acutely injured patients for PTSD. (See the full survey.)

Why don’t hospitals do more to identify PTSD? Here is what surgeons and other trauma experts told us.

It’s too expensive

Paying for additional hospital staff to screen patients for PTSD and connect them with treatment might only cost $100,000 or $200,000 a year. But cash-strapped hospitals are often reluctant to incur any new expenses.

“As much as we’d like to [screen] — we’d really like to be able to do it — we as hospitals are simply trying to find a way to survive, to pay the bills,” said Dr. Carnell Cooper, a trauma surgeon at Baltimore’s Adams Cowley Shock Trauma Center, which doesn’t do routine PTSD screenings.

At, Chicago’s Cook County Hospital, researchers found that 43 percent of the patients they surveyed had signs of PTSD. A trauma surgeon at the hospital proposed spending about $200,000 a year to add staff focused on PTSD. But the hospital administration suggested that she look for outside funding. The taxpayer-subsidized hospital currently provides no institutional funding for systematic PTSD screening.

Doctors say they don’t screen for PTSD because they don’t know if their patients can get treatment

Another barrier to screening civilian patients for PTSD is a lack of mental health professionals in many communities.

"Right now, we’re not doing the PTSD screening for everybody because we can’t treat everyone," said Carol Reese, the violence prevention coordinator at Cook County Hospital in Chicago.

Finding mental health treatment can be challenging even for patients with health insurance, said Cooper, the Baltimore trauma surgeon. And for the uninsured, finding treatment can be an “exercise in frustration,” ending with hospital staff “begging for favors from contacts and friends, to make sure the patient gets the care he or she needs.”

“If we knew that we could find people treatment,” Cooper said, “then we would find a way to screen them.”

Patients and their families often have little awareness of PTSD

One of the researchers who helped demonstrate the high rates of PTSD in civilian trauma patients is Dr. Gregory “Jerry” Jurkovich, who is now the chief of surgery and trauma services at Denver Health in Colorado, which was not part of our survey.

If more patients knew how common PTSD is among civilians, “there might be a demand from the ground level up for something to be done about it” Jurkovich said. So far, he added, “that hasn’t existed.”

Surgeons are just beginning to realize how many civilians get PTSD

At Baylor University Medical Center in Dallas, Texas, researchers recently found that 25 percent of patients screened positive for PTSD six months after their injuries.

Dr. Michael Foreman, the chief of the division of trauma surgery, said the study “dramatically” changed his perspective on PTSD.

Previously, he said, he had assumed that only a small fraction of his patients developed post-traumatic stress. “I don’t know if my patients were trying to be nice to me and didn’t want to, quote, ‘bother’ me, or I just wasn’t asking the right questions,” he said.

“It was quite surprising and humbling to me to recognize that this was happening…to start hearing these disturbing stories, of people’s lives and how profoundly they had been affected, and to realize how I was unaware of it,” he said.

While the hospital is trying to improve patient awareness of PTSD, the trauma center is still not doing routine screening for all patients.

Dr. Martin Croce is the medical director of the Elvis Presley Memorial Trauma Center at the Regional Medical Center in Memphis, Tenn. A few years ago, Croce said, he was skeptical about whether PTSD was a serious issue in civilian patients. But the growing research has led him to do “a complete 180.”

Now, Croce said, “The only people that don’t think it’s real are people who have not been keeping up.”

___________________________________________________________________
Since the goal of ACA is consolidating health industries into global corporations and maximizing profit by deregulating the health industry and getting rid of public health....we never expected businesses to be mandated to cover employees. The state health systems are meant to end Federal programs Medicare and Medicaid and throw public sector health plans into this system that will look like Medicaid for All. So, what Obama is doing is giving time for corporations to end health plans and send many workers away from private coverage and into these state tiered plans that most people will not be able to access health care. The individual mandate is still there for people not able to afford premiums or forced into a subsidized level of care. All requirements of businesses have been eliminated or 'delayed'.

Obama administration to further delay healthcare employer mandate

President Obama returns to the White House after traveling to Lansing, Mich. (Nicholas Kamm / AFP/Getty Images / February 7, 2014)

By Noam N. Levey 4:25 p.m. EST, February 10, 2014 Baltimore Sun

WASHINGTON -- The Obama administration will phase in a requirement that large employers provide their workers with health benefits in 2015 and 2016, offering businesses more relief from the so-called employer mandate in the president’s healthcare law.

Under regulations issued Monday, only employers with more than 100 full-time workers will be subject to fines in 2015 unless they offer coverage.

The requirement that all employers with more than 50 full-time employees provide health benefits or pay fines -- which was supposed to begin this year under the Affordable Care Act -- will not take effect until 2016.

The phase-in follows the administration’s decision last year not to impose the penalty on employers at all in 2014, a move that drew widespread criticism from political opponents of the healthcare law.

But administration officials said Monday that the additional phase-in period for a crucial part of the law was necessary to help businesses adapt to the new requirement.

“While about 96% of employers are not subject to the employer responsibility provision, for those employers that are, we will continue to make the compliance process simpler and easier to navigate,” said Assistant Treasury Secretary for Tax Policy Mark J. Mazur. “Today’s final regulations phase in the standards to ensure that larger employers either offer quality, affordable coverage or make an employer responsibility payment starting in 2015 to help offset the cost to taxpayers of coverage or subsidies to their employees.”

The new regulations also allow employers to offer coverage to only 70% of their workers in 2015. They will have to provide coverage to 95% of full-time workers in 2016.

The requirement that companies with more than 50 full-time workers provide insurance or pay a fine is designed to prevent firms from dropping health benefits once the government offers subsidies to help individuals buy coverage.

The law's authors worried that firms would be tempted to stop offering coverage, shifting the cost of healthcare to the government.

Under the law, large employers that do not provide insurance will be fined $2,000 per employee beyond the first 30 employees.

The new regulations are almost certain to provide new fuel to Republican critics of the law, who have charged repeatedly that the administration has exceeded its authority in selectively implementing parts of the law.

But administration officials said Monday that the law allows such adjustments.

“The secretary has very broad authority to implement the tax law in a way that benefits tax administration, and we think the phase-in approach really is a way to administer the law better and enhance overall compliance,” a senior Treasury Department official said.

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Here is a good look at how ACA affects immigrant health care. As with the domestic low-income workers you see the opportunity to buy insurance but undocumented will not get subsidies and have the same hardship in paying any premium.

WHEN NEO-LIBERALS SAY EVERYONE WILL HAVE AN OPPORTUNITY TO BUY INSURANCE....THEY ARE NOT SAYING EVERYONE WILL BE ABLE TO ACCESS HEALTH CARE.

We will see immigrants having a harder time finding a health system that allows for care.

A Simple Guide To The Affordable Care Act For Immigrants

By Esther Yu-Hsi Lee on October 1, 2013 at 4:50 pm

341 171 "A Simple Guide To The Affordable Care Act For Immigrants"

Depending on their legal status, uninsured immigrants will have access to new health care marketplaces starting Tuesday under the Affordable Care Act, which is more commonly known as Obamacare. Almost 20 percent of the total non-elderly, uninsured population are immigrants.

Although the Obama administration is attempting to reach out to as many uninsured individuals as legally possible, some immigrants will remain completely excluded while other immigrants still face eligibility restrictions for health coverage. To navigate through the varying degrees of access, here is a simple breakdown of the type of immigrants who qualify for enrollment:

Naturalized citizens and legal permanent residents who have lived here for more than five years. For naturalized citizens and green card holders who have been in the country for five years or more, they will be able to enroll in the health care program just like U.S.-born citizens. These immigrants will also qualify for Medicaid, which is income-dependent. Medicaid coverage is available to people under the age of 65 who earn up to 138 percent of the federal poverty line.

Legal permanent residents who have lived here for less than five years. Legal permanent residents with incomes up to 400 percent below the federal poverty level can qualify for subsidized health care coverage. Those who have been in the country less than five years do not qualify for Medicaid.

Refugees, asylees, immigrants exempt on humanitarian grounds. All of these individuals qualify for health insurance coverage and Medicaid, even if they have lived in the United States for less than five years.

Palau, Marshall Islands, and the Federated States of Micronesia residents. Under a special compact, the United States considers individuals from these three United Nations trust territories to be non-citizens who do not receive federal benefits. They do however qualify for marketplace coverage. They do not qualify for Medicaid.

H-1B, F-1, J-1 visas. Individuals who are on work visas, student visas, or have been in the country for less than five years are eligible to buy insurance through the health care exchange, but they do not qualify for Medicaid.

Deferred Action. The estimated 455,455 undocumented youths who were approved for deferred action status through a presidential initiative will qualify for neither the health insurance coverage nor Medicaid.

Immigrants who were granted deferred action by the judicial system, but not through a presidential initiative, will be eligible for marketplace options and Medicaid.

Undocumented immigrants. The 11.7 million undocumented immigrants living in the United States are ineligible for healthcare coverage. However, undocumented immigrants with social security numbers or identification cards issued by a foreign consulate can apply for private, but not state-based, health insurance, if they can afford it. In some states like California, undocumented immigrants can apply for Medicaid (or Medi-Cal), but coverage extends to emergencies, prenatal, and long-term care. The cost is funded not by federal resources, but through state funds.

Undocumented immigrants with U.S. citizen children. This group of immigrants will still be unable to enroll in the health insurance exchange, but their U.S. citizen and legal permanent resident children can qualify for health insurance coverage and Medicaid. Separately, states can choose to use state and federal Medicaid funds to cover pregnant women and other “lawfully present” children.

Legal Latino immigrants make up nearly 30 percent of the total uninsured population. The government has launched a Spanish-language website, CuidadodeSalud.gov, but that enrollment through the site has been delayed until October 21. However, the English-language website launched on the first day of open enrollment and the the government’s help line has provided Spanish-language speakers along with speakers of 150 other languages.

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A republican policy placed on steroids by neo-liberals handing all that is public to private contractors while the taxpayer pays all the cost of operation...... maximizing corporate profits big time!

CRIME OF THE CENTURY SAYS ONE COMMENTER AND YET......EVERY CANDIDATE FOR GOVERNOR RUNNING AS A DEMOCRAT SHOUTS LOUDLY THAT THEY WILL KEEP UP PUBLIC PRIVATE PARTNERSHIPS AND WALL STREET LEVERAGED BOND DEALS. THAT IS A NEO-LIBERAL, NOT A DEMOCRAT!

Garson TomDispatch / Op-Ed Published: Wednesday 5 February 2014

To get your government-subsidized mortgage modification, you applied at your bank; to get your government-mandated health coverage, you buy private insurance.

The Public Private Profiteers

Health care isn't the first boon that President Obama tried to give us through a public-private partnership. When he took office, more than 25% of U.S. home mortgages were underwater -- meaning that people owed more on their houses than they could get if they tried to sell them. The president offered those homeowners debt relief through banks. Now he's offering health care through insurance companies.

In both cases, the administration shied away from direct government aid. Instead, it subsidized private companies to serve the people. To get your government-subsidized mortgage modification, you applied at your bank; to get your government-mandated health coverage, you buy private insurance.

Let a Hundred Middlemen Bloom

In other countries with national health plans, a variety of independent health care providers -- hospitals, doctors, and clinics, among others -- deliver medical care, while the government doles out the compensation. They let a hundred healthcare providers bloom, but there’s only a single payer. If the U.S. moved to single-payer healthcare, however, what would happen to the private health insurance business?

In the 1990s, the conservative Heritage Foundation floated the idea of extending health coverage to more Americans via government exchanges or "connectors" that would funnel individual buyers to competing, for-profit health insurance companies. In other words, let a hundred middlemen bloom.

On the face of it, such a plan would seem expensive, since it means supporting two bureaucracies, one of which would be obliged to take profits for investors. Meanwhile, doctors would still have the expense of trying to collect from multiple insurers with reasons to stall. But the Heritage plan had one great advantage. Since Harry Truman, American presidents have tried unsuccessfully to get us national health care. The exchange system, however awkward it might be, pacified the insurance companies which had previously spent millions of dollars to defeat other plans for "socialized medicine." With the support of those companies for a program that not only kept them in the picture, but also promised to deliver millions of new, subsidized customers to them, Obama gave us a national healthcare law.

The danger is that it essentially makes insurance companies our medical receptionists, a profit-making face that greets sick people whenever they try to use their government healthcare. That gives private companies a lot of power to make the government look bad.

That's why it's important to understand how banks used Obama's mortgage subsidy program to sabotage debt relief and discredit government. If we grasp how they pulled that off, we may be able to protect the present health plan and someday even get genuine single-payer healthcare out of it. So here’s the story.

The Home Affordable Modification Program (HAMP) offered banks government incentives -- cash bonuses -- to lower the principal or interest on underwater mortgages. Of course, health insurance companies don’t actually provide healthcare, but banks did provide the underwater mortgages so, however ill-advised or fraudulent they were, those institutions obviously had a role in negotiating their modification. The HAMP partnership was structured so that the government's role was to provide cash incentives to banks, while participating banks would be required to accept and process the applications of those who were eager to modify their onerous mortgages. Whether they granted a modification was, however, strictly up to them.

In 2009, when I visited Balthazar ("Balty") Alatas in Vallejo, California, he had been out of work for a year and had been negotiating a HAMP mortgage modification with Bank of America for nine months. He was beginning to suspect that the bank's elaborate application procedure was deliberately designed to give people just enough hope to keep paying their old mortgages for as long as humanly possible. He had already emptied his Individual Retirement Account and borrowed all he could, in good conscience, from his in-laws. "But I may be too cynical,” he said. “See what you make out of it." And he set down a pile of printed correspondence about a foot and a half thick in front of me.

The initial piece of paper I drew randomly from the stack was a request for documents verifying income and expenses. It wasn’t the first time he had gotten such a letter, as he would show me. Like HAMP applicants at other banks, Balty complained of receiving letters asking for the same documents over and over. He’d learned that it was quicker to send things again than to try to locate the person at the bank who’d already received and even discussed the documents with him.

“No matter how many times they ask, I’ve always complied in full,” he told me.

“I bet you didn’t submit this in full,” I said, indicating a request for utility bills and death certificates.

“Well, there hadn’t been any death in the family,” he responded. He had indeed, however, resubmitted the utility bills.

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One letter I pulled from the pile indicated that his case was being transferred to the “Hope Team.” That sounded hopeful to me, but in Balty’s experience each transfer within the bank -- he’d recently been “escalated" to the Escalation Q Unit -- only meant that he had to start all over again with someone new. At one point, he complained to a California banking agency about the delays. Bank of America's response to the state’s inquiry read in part:

“At times the process can be repetitive and lengthy. Our work-out negotiators work diligently to minimize delays, however, at times unforeseen occurrences beyond anyone’s control may further delay the process. We appreciate your continued patience as we work toward completing the modification of your loan.”

"Repetitive," "lengthy," full of "unforeseen occurrences beyond anyone's control": the bank's own description sounded remarkably like the morass so many HAMP applicants described to me. Now, I was starting to wonder: Could it possibly be that way on purpose?

No Modification Granted

If anyone could cope with paperwork it was Balty Alatas. He’d done a lot of it in his former job and, in some perverse way, he found filling out the forms almost soothing. That was definitely not the case on the next stop in my underwater-mortgage tour of America -- the mostly poor, mostly black city of Richmond, California, where house values had gone down by 66% since 2007.

Alice Epps, a home care attendant, was already behind on her mortgage payments when she heard about what her neighbors called the “Obama modifications.” “So that’s when I went to all those different government agencies,” she told me. (Actually, some were community groups, but the confusion was easy enough to understand.) “I waited all day in Pittsburg,” she continued, mentioning a nearby city in the San Francisco Bay Area. “All those people getting money from the federal government saying they are helping people with modifications. They wouldn’t even talk to me -- said I wasn’t eligible.” That was true since HAMP modifications were only available to people who were assessed as having a good likelihood of repaying a new mortgage.

But along with the do-gooder organizations that told Alice she wasn't eligible, the inevitable do-badder outfits had sprung up to help people through the HAMP application for a fee.

"So I hooked up with Help-U-Modify," Alice went on, "and they charged me $3,500. Come to find out, Help-U-Modify wasn’t even licensed. They was taking people’s money -- they’re still taking people’s money -- but they don’t do nothing. Do Obama know what’s going on?” Mrs. Epps wailed.

When I remember that wail -- and I remember it too often -- I think of Russian peasants asking whether their "little father," the Czar, could possibly know that his Cossacks had shot them down when they came to his palace with a petition.

Within days of our conversation, Alice Epps lost her home. It took a full year and a half before Balty Alatas finally got a definitive rejection from Bank of America.

Five years later, I learned that its modification morass had been far more calculated and vicious than anything Balty Alatas -- or I -- suspected. The bank had hired a firm called Urban Lending Solutions to set up an operation that was authorized to call itself “the Office of the CEO and President.” As part of a deliberate subterfuge, HAMP applicants like Alatas were "escalated" to this "Office of the CEO" located in Colorado. (Bank of America’s actual headquarters are in North Carolina.)

An investigative article at Bloomberg News has since revealed how Urban Lending employees sent modification applicants requests for unneeded documents at regular 30- or 60-day intervals, how they falsified or destroyed records -- sometimes merely to meet work quotas -- and how they responded with "inaccurate statements" to congressional representatives or banking oversight officials who inquired on behalf of individual homeowners.

If a letter of inquiry from a congressman or a regulator's office was "dry signed" -- that is, computer generated -- it would be answered with boilerplate doubletalk of the type Balty Alatas showed me. If it had been signed personally -- "wet signed" -- it was to be forwarded to the bank's lawyers who were presumed better qualified to spot possible legal problems.

The signatures of some senators, including Harry Reid from the top housing-bust state of Nevada and Carl Levin of Michigan, were enlarged and pinned on a wall so that employees could better recognize their personally inked signatures.

I don't know whether other big banks created fancifully named "offices of the CEO." But the complaints of underwater borrowers and mortgage modification statistics suggest that Alice’s and Balty's experiences were the norm. Six million nine hundred thousand Americans applied for HAMP modifications. Only 13% of them were granted one, and 22% of those who got a modification had their homes foreclosed anyway. At Bank of America that figure was 33%.

Bloomberg News concluded:

“Instead of helping homeowners as promised under agreements with the U.S. Treasury Department, Bank of America stalled them with repeated requests for paperwork and incorrect income calculations, according to nine former Urban Lending employees. Some borrowers were sent into foreclosure or pricier loan modifications padded with fees resulting from the delays.”

Why should any of us be surprised that private banks perverted a government debt relief program? From their perspective, it made good business sense to encourage homeowners, by whatever means, to continue their mortgage payments while occupying and keeping up their property during the turbulent period after the housing bust of 2007-2008. A more advantageous time to foreclose was when home prices had stabilized and banks could incorporate any foreclosed properties into newly profitable investment vehicles like, for instance, the rental-backed securities that may replace the mortgage-backed ones that were such hot items for financialization before the crash of 2008.

The Blame Game

Balty Alatas never complained to me about the government. He understood that it was a bank -- or rather the real estate trust that held his mortgage -- that was denying him relief. Other HAMP victims tended to conflate the government and private banks into a generic “they.”

A church-going black woman who had applied for a HAMP modification from Wells Fargo assured me that, after the way “they” had treated her, she definitely wouldn’t vote for President Obama again. Her minister had a different but no less devastating way of describing the two HAMP partners. "Obama,” he said, “was the shepherd who delivered up a couple of our weaker members to the wolves."

In a somewhat similar fashion, the Affordable Care Act delivers millions of us up to insurance companies. The administration was embarrassed when its website couldn’t shepherd new customers to the companies fast enough because of computer bugs. Now that it’s working as it's supposed to, the real embarrassments begin.

We've already seen the president take full blame for assuring people that, under the new law, they could keep their old policies if they chose. Apparently he didn't anticipate that, in the months between the passage of the Affordable Care Act and its implementation, insurance companies would rush to sell policies that didn’t meet the minimal standards set in the law. Insurance companies knew that they would have to cancel these and other non-compliant policies as soon as the law went into effect. In the meantime, however, what a great two-fer: first you get to collect and invest the premiums, then you get to stick it to your government partner by announcing to customers that their policies are being canceled thanks to Obamacare.

For insurance companies, this blame game is more than just sport; it's their only real defense against single-payer healthcare. Vermont has already created a state health care plan that will go into effect in 2017. Oregon, Massachusetts, and Washington State are seriously considering similar plans. Seattle congressman Jim McDermott (who happens to be a doctor) hopes to attach “a patch” to the Affordable Care Act that would make it easier for governors to use the healthcare money Washington will send themto create statewide single payer options.

The insurance companies were successful in lobbying any kind of public option out of the national health care law and they will fight every local public option to the death. For if it works anywhere, it offers Obamacare a way to evolve, state by state, into “Medicare for all.”

Private health insurance companies can only survive if people throw their hands up in horror at the thought of an incompetent and intrusive government. Expect, then, that the untimely requests for death certificates, the delayed payments to doctors, the arbitrary denials of coverage, and all the other slings and arrows that the insured already endure will be baroquely embellished and cynically blamed on “government.”

If it was hard for underwater homeowners to distinguish between bankers and bureaucrats while they were losing their homes, it will be even harder for frustrated sick people to untangle the public and private strands so tightly braided into the Affordable Care Act. That, however, is what has to happen if Americans are to move toward a simpler, go-to-the-doctor-when-you’re-sick healthcare system.

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Health-Care Law Expected to Take Greater Toll on Workforce

Affordable Care Act Seen Cutting 2.3 Million Full-Time Workers by 2021

By Damian Paletta Updated Feb. 4, 2014 12:25 p.m. ET WASHINGTON--

The Affordable Care Act is projected to reduce the number of full-time workers by roughly 2.3 million people through 2021 and insure two million fewer people this year than previously estimated, the Congressional Budget Office said Tuesday.

The CBO had previously estimated the labor force impact would be around 800,000 people in that time frame. CBO said the jobs figures largely represent Americans who will choose not to...

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The Affordable Care Act is all about ending corporate health plans with strong health coverage and replacing them with these wellness programs that neo-liberals are even subsidizing corporations to create. This will make sure that most workers will only have preventative care as once corporate health plans go.....premiums, co-pays, and deductibles will keep most people from accessing ordinary care. As this article shows, taxpayers are paying for the development of these programs that have no evidence of doing anything for wellness.....

Are Workplace Wellness Programs All They're Cracked Up to Be?
Written by Molly Gamble January 28, 2014   Becker's Hospital REview

It's tough to take issue with the idea of workplace wellness programs, but a new book — through analytics and data — does just that.

The Patient Protection and Affordable Care Act authorized funds for small business wellness programs and required insurers to report on their own initiatives to encourage wellness as part of their quality reporting obligations. The reform law also lets insurers count the expenses of their wellness programs with their claims expenses for calculating their medical loss ratios, according to a blog from Health Affairs.

Workplace wellness is a $6 billion industry in the United States, and there are an estimated 500 vendors now selling workplace wellness programs, according to a May 2013 Reuters report. Although wellness programs are picking up steam, it remains to be seen how and if many will save employers money or curb healthcare spending.

RAND Corp. conducted an analysis last year, collecting information about wellness programs from about 600 businesses with at least 50 employees and analyzed medical claims collected by the Care Continuum Alliance, a trade association for the health and wellness industry. While many employers told RAND they were overwhelmingly confident that the workplace wellness programs would reduce costs, only 44 percent have actually evaluated their efforts, and only 2 percent had precise savings estimates.

A recent study in Health Affairs looked at PepsiCo's Healthy Living program, which involves components such as health risk assessments, on-site wellness events, lifestyle management, disease management, a 24/7 nurse advice line and maternity management.

The lifestyle management and disease management components of the program were estimated to return an average of $0.48 and $3.78, respectively, for every dollar invested when both healthcare and absenteeism impacts were included. Researchers concluded participation in lifestyle management interventions was associated with a small decrease in absenteeism, but had no statistically significant effect on healthcare costs.

Many hospitals are also implementing wellness programs, both in an effort to control costs and to get better footing in the business of population health management. A 2012 survey found 84 percent of 45 hospitals in New York, New Jersey and Connecticut offered wellness programs, and only 35 percent of that pool relied on wellness program options from insurers. The majority of the hospitals had internal wellness coordinators and wellness committees to govern the initiatives.

Oakland, Calif.-based Kaiser Permanente launched an interesting wellness program last fall — one that was actually the brainchild of unions representing its employees. Through the program — which is for all 133,000 employees, union and nonunion alike — Kaiser is offering up to $500 bonuses to regional groups of employees who lose weight, lower their blood pressure, stop smoking and lower their cholesterol levels. If the employee group reaches its health goals, every employee in the group will receive the monetary bonus, even if they do not take steps to get healthy.

It appears as though workplace wellness is an entrepreneurial hot spot, but critics are beginning to question the benefits of these programs. The new book, "Surviving Workplace Wellness: With Your Dignity, Finances and (Major) Organs Intact" takes some stabs at the "clinical comedy of errors as workplace wellness vendors bamboozle employers with the government-propelled fairy tale that the way to save healthcare dollars is to spend more of them."

Paul Levy, former president and CEO of Beth Israel Deaconess Medical Center in Boston and author of the blog Not Running a Hospital, wrote a post about the book. He said the book authors, Al Lewis and Vik Khanna, "pierce the veil of political correctness on this topic, explaining how human resources departments align with vendors and insurers to exploit the understandable hope of all of us that there is a holy grail in the healthcare world."

While ROI for employer-based disease management programs seems to be quite clear, those for general wellness programs are not. Should an employer invest?

A healthy workforce is certainly a desirable aim, but industry trends seem to point to a future where concerns over the health status of a population won't worry employers as much as it will providers.

The move to value-based, population-based care will likely mean providers, not employers, need to be more interested in wellness programs, as their payments will be on the line for the wellness and health improvements employers are trying to hard to achieve today. Providers will also need to navigate the hundreds of vendors offering workplace wellness programs, or internally develop the most effective approaches for their own.

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Make sure to know that Medicare is being dismantled in Maryland and is expected to be used as a model in your neck of the woods. If you do not shout for Expanded and Improved Medicare for All and stop neo-liberals like Obama from dismantling Medicare nationally with privatization.....we cannot have Medicare for All.

Med students lobby for New Yorkers' health Medical students lobby lawmakers to advance health care proposals

By Claire Hughes Published 9:04 pm, Tuesday, January 28, 2014 Times Union.com

Albany

Doctors must advocate for their patients' health — with supervisors who approve procedures, for instance, or insurance companies that pay for services.

On Tuesday, dozens of doctors-to-be tried different advocacy skills — lobbying state lawmakers to advance proposals they believe will improve New Yorkers' health.

"If we are not going to fight for our patients, who will?" Albany Medical College student Xin Guan asked a few dozen young adults in white coats who had stopped in the basement of the Legislative Office Building for coffee, bagels and a press briefing between their morning and afternoon visits to lawmakers.

It was the first Medical Student Advocacy Day, organized by Guan, originally from California, and two other second-year students from Albany Med, Ajay Major of Indiana and Phyllis Ying of Seattle.

Some 60 to 70 students from around the state joined them. A glance at the coats suggested most were from Albany Med, but some had traveled from several downstate schools, including Albert Einstein College of Medicine, SUNY Downstate Medical Center and Mt. Sinai Medical Center.

Guan, Major and Ying had prepped them with some activist training before the event. Lobbying representatives was a new activity for about half the students, they said.

While the group shared a concern for health issues, they spoke with legislators about proposals that interested them as individuals. Small groups organized around a few popular issues, including bills to provide universal health coverage for all New Yorkers, allow marijuana for medical use, and prohibit doctors from participating in the torture and improper treatment of prisoners.

Anti-hunger advocate Mark Dunlea gave the students a pep talk before they headed back out to meet their afternoon slate of legislators. Dunlea's group, Hunger Action Network of New York State, works with a coalition of organizations that provide aid to low-income people who struggle with the costs of health care.

He told the students that their future profession would carry some weight with legislators. And he reminded them that legislators are public servants.

"Remember, these guys work for you," he said.

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Raise your hands if you understand that the ACA reforms make hospitals profitable and therefor they are not private non-profits. Look, they are being rated for profitability for goodness sake.....TAX THEM AND USE THAT TAX TO BUILD AND RUN PUBLIC HOSPITALS!

33 Statistics on Nonprofit Hospital Operating Margin by Credit Rating

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

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

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

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

Fitch Ratings

Hospital credit rating

Median operating margin (2012)

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

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

Dr. Ramanathan Raju Named President of New York Health and Hospitals Corporation
Written by Akanksha Jayanthi (Twitter | Google+) | January 21, 2014   Becker Hospital Review

0
inShare New York City Mayor Bill de Blasio has selected Ramanathan Raju, MD, as president of New York Health and Hospitals Corporation, the largest public hospital system in the country.

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

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

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

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

Even Rachel Maddow?????? Especially Rachel Maddow!!!!!

Obamacare penalties spawn 'skinny' plans

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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ALL NATIONAL LEADERS PUSHING THE AFFORDABLE CARE ACT KNEW THIS....LABOR UNIONS, POLITICIANS, POLITICAL PUNDITS AND ORGANIZATIONS....MARYLAND HEALTH CARE FOR ALL.....

You know who is advocating for the people by who was shouting against the ACA and for universal care. IT'S NEO-LIBERAL VS PROGRESSIVE DEMOCRATS IN POLICY

Medical debt will persist despite health law
Jayne O'Donnell, and Paul Overberg, USA TODAY 11:36 a.m. EST January 15, 2014(Photo: Joe Raedle, Getty Images)

Story Highlights

Out-of-pocket expenses still not affordable for many
Most people have less than $3,000 available to pay medical bills, study shows
New law caps costs but not for out-of-network doctors or drugs not covered by plans

Millions of Americans will get health insurance through the Affordable Care Act that will protect them from potentially ruinous medical expenses, but a new USA TODAY analysis shows the health plans they can choose still leave them vulnerable to thousands in deductibles and other out-of-pocket costs each year.

Medical insurance deductibles for plans on the federal exchange covering 34 states average $3,000, and those for the least expensive, bronze-level plans average $5,082, according to the USA TODAY analysis of deductible data for HealthCare.gov. Those costs, according to a recent study, may still be more than many people can afford.

The USA TODAY analysis also found the lowest out-of-pocket limits on HealthCare.gov plans were $4,350 for individuals on bronze plans and $8,700 for families, although these were not the norm and are likely paired with high premiums.

Even relatively modest cost sharing can prove unaffordable because expenses are often unexpected, and most Americans have less than $3,000 to cover such costs, according to a new Kaiser Family Foundation report on medical debt among the insured concludes.

The new health care law requires consumers' portions of health care expenses — known as cost sharing — to be capped at $6,350 for individuals and $12,700 for families.

Many plans have lower limits on out-of-pocket costs than the federal limit, but the plans increasingly also have separate deductibles for prescription drugs. And expenses for drugs that aren't covered by plans or for out-of-network physicians aren't applied against limits.

That makes it more likely consumers, especially those with chronic health conditions such as asthma or high blood pressure, will be hitting these out-of-pocket maximums, says Matt Eyles, executive vice president at consulting firm Avalere Health.

"The ACA is an important safety net, but it doesn't necessarily solve the problem of high up-front medical expenses for those who don't have ability to pay for them," Eyles says.

Kaiser analyzed Centers for Disease Control and Prevention survey data and did case studies of 23 people with medical debt, which is the leading cause of bankruptcy in the U.S. It found cost sharing for covered services that were in-network providers and facilities was the leading contributor to debt for those interviewed. CDC's 2012 National Health Interview Survey showed 34% of people in higher-deductible health plans had difficulty paying medical bills compared with 24% of people in lower-deductible health plans

"It starts with the cost sharing that they're not really prepared to pay and are not in a position to budget for," says Karen Pollitz, a Kaiser Family Foundation senior fellow who co-authored the study with the Georgetown Health Policy Institute. "Then there are the multiplying factors where it's the mom and the infant and it's crossing plan years and people start doing drastic things" to pay the debt.

Department of Health and Human Services spokesman Joanne Peters said the situation is still far better than it was before the ACA.

"The new marketplace is night and day from what consumers faced in the individual market before the health care law, where they could see unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they (could) even get coverage without being denied for a pre-existing condition," Peters said in an e-mail.

Walgreens tech Mercedes Betaneo, left, helps Christine Matthews, who was using the insurance she purchased under the Affordable Care Act to buy medicine after she couldn't renew her other insurance due to a pre-existing condition on Jan. 8, 2014, in Miami. Some health plans now have separate deductibles that have to be met before prescription drugs are covered.(Photo: Joe Raedle, Getty Images)

The 40% portion of medical bills borne by those with bronze plans may also shock many consumers when the bills start rolling in. Consumers with incomes below 250% of the federal poverty level ($28,725 for an individual) have lower cost-sharing limits if they buy silver plans on the exchanges. But families of four with incomes above 400% of poverty ($94,200) are ineligible for financial assistance and unlikely to have enough cash on hand to pay even the deductible for many plans, the Kaiser study showed. These families tend to have about $12,000 in liquid assets, Kaiser says, but when other consumer debt is taken into consideration, most have net liquid assets of $5,200 or less.

Premiums can add significantly to health care costs: An earlier USA TODAY analysis of premiums on the HealthCare.gov site found more than half of counties lacked a plan that would meet the federal affordability test for a couple making about $62,000 a year, or just over the amount eligible for subsidies. A third didn't have a plan deemed affordable for an individual above 400% of the poverty level or about $47,000, meaning the premium cost more than about 8% of annual income.

John Roll, a former transportation consultant from Southern California, has an outstanding medical bill of $88,000 from neurological tests that followed brain surgery in 2009. That bill went to a collections agency. Making matters worse, Roll has an urgent operation coming up this year to remove a hematoma near his liver. He can't work and his wife is unemployed, but at least having that bill capped at under $6,500 makes it possible that they could pay it out of retirement savings, he says.

"I'm hugely relieved," Roll says of the ACA caps. "In 2011, we were talking about a strategic divorce so we wouldn't have to get sucked under by the medical bills."

Cathy and Scott Carson of Truckee, near Reno, say medical debt will be unavoidable for them. They are waiting to hear whether they can get a hardship exemption so they don't have to buy a new plan to replace the one that got canceled last year because it didn't meet the ACA requirements. The cheapest one they can find includes a $5,000 deductible for each of them and costs $729 a month, Cathy Scott says that's more than they can afford on their combined $80,000 annual income, which is patched together through seasonal and contract work. But she hardly likes the option of going without insurance either.

Either way, "Debt is only an accident or serious illness away," she says. Any unexpected health cost at a doctor's office — where upfront payment is generally required — would have to be paid for by credit card, she says, and it could take years to pay if off.

While deductibles are increasing in amount, they are increasingly applied even before co-payments start. So while preventive care is covered in full under ACA, many plans will charge the full cost of visits for injuries or ailments until the deductible is met. This is going to create some sticker shock for consumers used to paying small co-pays for these, says Nancy Thompson, senior vice president at CBIZ Benefits and Insurance Services.

Deductibles for employer-provided plans have increased in the last five years, but are far below the averages on HealthCare.gov The average deductible was $1,135 a year in 2013, according to a study Kaiser released in August. While that was largely unchanged from 2012, it was up considerably from the average of $735 in 2008. For at least another year, employers can basically double workers' out-of-pocket costs by having a separate drug deductible if an outside company manages the company's drug benefits.

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This is why Dean Baker cringed when four years ago I shouted that the Affordable Care Act was all about consolidating health institutions into global corporations and I said that was bad......he and the others on this 'progressive' panel sat silent and did not mention this the entire time ACA was being forced upon us. He did that because he is a neo-liberal economist....not a progressive. This article touts the very reason for ACA.....US global health institutions expanding into say India operating cheaper than in the US are now HEALTH CARE TOURISM.

So, instead of being progressive and push Expanded and Improved Medicare for All, Dean Baker will now be cheerleader for US health care tourism.....YEAH, THIS IS JUST WHAT THE AMERICAN PEOPLE NEED....A BILL GATES GLOBAL HEALTH INSURANCE BUSINESS THAT SENDS AMERICANS OVERSEAS TO GET HEALTH CARE THEY SHOULD BE ABLE TO AFFORD RIGHT HERE.

This is neo-liberal talk for -------maximizing profits at any cost!!!!

Remember, Gates Foundation and his Health Initiative came at the time they knew global health businesses would come and Global PHARMA would top the industries!!!!

Medical Travel: If Bill Gates Wanted to Do Something Good for the World

Monday, 13 January 2014 10:54 By Dean Baker, Truthout | Op-Ed
Everyone knows Bill Gates, the man who got incredibly rich by gaining a near monopoly in the computer operating system market. In the last decade Gates has devoted much of his money to the foundation he created for the ostensible purpose of helping humanity.

Whatever the merits of his foundation’s programs, he is missing out on an enormous opportunity to do good for the United States and the world. As has been often documented, health care costs in the United States are hugely out of line with health care costs elsewhere in the world. There is a huge gap with costs in the developing world, but the ratio of costs for most items and procedures is more than two to one even in comparison with other wealthy countries.

And, this gap is not explained by better care in the United States. We actually have worse outcomes compared with most other wealthy countries.

What fans of the market everywhere should be able to see is that this enormous gap in costs leads to huge possibilities for gains from trade. Just as people in the United States can benefit from buying cheaper steel or clothes produced in other countries – and those countries can benefit from selling these products to us – we can also gain from getting cheaper medical care in other countries.

However providers of medical care in the United States, drug companies, medical equipment suppliers, doctors and others who benefit from high prices, are far more powerful than steelworkers or textile workers. As a result, the trade deals we have been writing over the last three decades have not been designed to facilitate medical trade.

This is where Bill Gates and his fortune could make a huge difference. Suppose he established an insurance company that gave people the option of getting some of their health care in other countries. The potential savings would be enormous. For example, according to the International Federation of Health Plans the average cost of a hip replacement in the United States is $40,400. The average cost in Spain $7,700 and in Argentina just $3,400. For heart bypass surgery the average cost in the United States is $73,400 compared with $12,400 in Chile or $8,900 in Argentina.

The insurance could be structured so that people in need of these services could still get them in the United States and be covered as they would with other standard insurance policies. However they could also have the option of using high quality facilities in other countries and splitting the savings with the Bill Gates Insurance Company. To ensure that the population of the receiving country benefits as well, the insurer could pay 10 percent of the cost to support the training of additional doctors and other health care professionals in the country.

Imagine someone needing bypass surgery chose to get it in Chile. Their half of the $60,000 in savings would be enough to cover the airfare and hotel stay of several family members for several weeks and still leave tens of thousands of dollars to put in the bank. The same would be true for many other expensive procedures; patients would see an enormous dividend from escaping the wasteful U.S. health care system.

This would have three hugely beneficial effects in the United States, in addition to providing an additional source of revenue to support health care in developing countries. The most immediate benefit would be the obvious one: tens of thousands of people would receive much lower cost health care than would otherwise be possible.

The second effect would be that by reducing demand in the United States for many of these procedures it would put downward pressure on prices in the United States. Many highly-paid specialists whose skills are currently in limited supply would suddenly find a lack of demand for their services. This would put hospitals, insurers, or the government in an excellent position to bring their pay scales back down to earth. The same is true for the drug companies and the medical equipment suppliers.

The third benefit would be the educational effect of seeing that other countries have high quality medical care at a fraction of the price that we pay in the United States. This is due to the fact that they organize their health care systems far more efficiently.

While many people may read about the greater efficiency of other health care systems, this information will have much less impact than actually experiencing the greater efficiency first hand. Everyone who puts $20,000 in their pocket after getting top notch surgery in Chile or India will be a huge billboard for the reform of the U.S. health care system.

Of course this is why our laws are not conducive to this sort of insurance arrangement. There are issues of legal liability that act as a major disincentive for insurers to go this route. However if Gates were to use his money and power to deal with such problems, he should be able to get an insurance company promoting medical travel in high gear.

With national health care costs running close to $3 trillion a year, if U.S. costs could be brought in line with costs in other wealthy countries the potential savings would be on the order of $1.5 trillion a year. Those savings could provide a lot of health care for people in the United States and around the world. That would be a really big deal, something that the richest person in the world might be in a position to make happen.

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People are now seeing the connection between the Massachusetts RomneyCAre and Affordable CAre Act. If you look at RomneyCare, in place for a decade or two with lots of stats to research, you see that health costs and expenditures have increased substantially as has those 'insured' but health outcomes for MA citizens show no more access or positive health results.

That is because all that public money expended in building RomneyCare went to this health corporation now heading for global reach. THAT IS WHAT AFFORDABLE CARE ACT DOES NATIONALLY. Everybody in means you pay health insurance premiums, but health outcomes do not improve because people cannot access the health care. This has been the case in Maryland for as long as RomneyCare has operated in MA with the same results....we have global Johns Hopkins for this!

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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The Myth of Health Care's Free Market
NewsWeek
By David Cay Johnston

19.1k Share Has it ever occurred to you to negotiate with the pilot of the plane you just boarded about her pay?

Assuming the pilot was willing to take bids for her services, would you have any idea of how to evaluate the worth of that particular pilot compared to anyone else who might be at the controls? How long would it delay the flight while you and other passengers haggled over that fee?

And what of the risks in having a pilot focused on whether she negotiated good deals with her passengers, rather than getting everyone safely to their destination?

While haggling with pilots is absurd, the idea that individual Americans should negotiate the prices each pays for health care is getting a lot of serious discussion right now. The reason is the Affordable Care Act, a.k.a. Obamacare, which critics are desperate to find some way to stop.

For weeks, politicians and writers in the opinion pages of The Wall Street Journal and other critical outlets have declared Obamacare a failure with plenty of victims. Those are silly assertions because the law only took effect this week, on the first day of 2014.

These critics are all outrage with no detailed alternatives, except the mantra that competition will magically bring down health-care costs. The libertarians at the Cato Institute argue "we need market competition more than ever. Not the mealymouthed substitutes bandied about by most health policy wonks. We need something that none of us has ever seen - real competition in a free health-care market."

No. We need something easier, simpler, and already proven to cut costs.

For starters, markets can push prices up as well as down. The electricity market rules, initially written by Enron (at the urging of former Vice President Dick Cheney, who was pals with the company's late founder), can raise prices to 90 percent of what an unfettered monopolist could charge, as I showed in my book Free Lunch, citing research by Professor Sarosh Talukdar of Carnegie-Mellon University that no one has challenged.

Then there's the knowledge component of markets. When one side knows and the other side is ignorant, you get price-gouging. Under current policies, prices for medical services are generally confidential. You could call hospitals and your health insurer to ask the cost of a standard medical procedure, say cataract or gall-bladder surgery. I tried that, and was told at every turn that prices were proprietary information - none of my business, until I got a bill.

More than four decades ago the Supreme Court defined a fair market as the "price at which the property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or to sell and both having reasonable knowledge of relevant facts." How many of us have "reasonable knowledge" of medical procedures, costs, or even the difference between a neurologist and a nephrologist?

Is an accident victim writhing in pain, life's blood flowing out of his body, free of compulsion?

And how many of us know the assortment of facts needed to price an MRI, an angiogram or just a dozen stitches? Or, for that matter, whether any of those procedures is the best alternative, or even necessary?

We don't have a free market for health-care services. If we did, we would see a narrow range of prices for the same service. After all, a Ford F-150 pickup with the same options costs about the same in Washington, West Virginia, or Wyoming. Not so hospital and medical costs, a fact brought home in the 2012 Pricing Report of the International Federation of Health Plans, a trade association for health insurance companies.

While the average U.S. hospital stay is just under $4,300 per day, one in four patients are charged $1,514 or less and one in 20 pay $12,537 or more.

The total cost for an appendectomy ranges from $8,156 for a fourth of these procedures to more than $29,426 for the most expensive 5 percent. The average cost is $13,851.

Economists learn before they get their undergraduate degrees that such huge variations are signs of inefficient markets or even faux markets. Such wide price variations may even indicate collusion among some providers to jack up prices, which is generally illegal.

But even if we ignore these huge price variations, the trade industry report illustrates another problem: American health-care costs are completely out of line with the rest of the modern world.

In France the average daily cost of a hospital stay is $853; in the U.S., it's $4,287.

An MRI costs on average $335 in Britain and $363 in France, but $1,121 in the U.S.

Routine and normal childbirth costs, on average: $2,641 in Britain and $3,541 in France but in the U.S. averages $9,775. Caesarean section delivery runs $4,435 in Britain, $6,441 in France; $15,041 in the U.S.

This pattern holds for all 21 procedures examined in the report.

Excessive health-care costs drain both the public purse and private purses, make manufacturing uncompetitive and force employers to divert attention from running their firms to dealing with health insurers.

Our universal single-payer health-care plan for older Americans, Medicare, has lower costs and lower overhead than the system serving those under age 65. If everyone in the U.S. was on Medicare, the savings would move the federal budget from deficit to surplus.

Of the 34 modern economies, the U.S. has by far the costliest health care system. For each dollar per capita that the other 33 economies spend on health care the U.S. spends $2.64, my analysis of Organization for Economic Cooperation and Development data shows.

Canada, Germany, and France each spend about 11.5 percent of their economy on health care, compared to 17.6 percent in the U.S.

We could have eliminated the income tax in 2010 had we adopted the Canadian, German, or French health-care systems.

Look at your pay stub and how much goes to federal income taxes, then think about the unnecessary economic pain American health care causes you.

One important distinction between other modern countries and the United States is that they all provide universal health care, while 48 million Americans had no health insurance in 2012 and another 30 million had coverage for only part of the year. Millions have coverage riddled with loopholes and exceptions, not paying for such vital services as an ambulance, even when the patient is unconscious. And all private health insurers try to avoid paying claims in various ways, from requiring onerous paperwork to denying a procedure was necessary.

On top of all this are restraints on trade in American medicine, like limiting the supply of doctors and nurses. The American Medical Association has acknowledged that it worked to hold down the number of physicians to push up income for doctors. Under state licensing rules, many of even the best-trained foreign doctors cannot practice here.

And then there are the drug and other medical patents. Economist Dean Baker notes that in America, "we grant patents to providers and then let them charge pretty much whatever they want, while other countries also grant patents, but then limit the prices charged."

When a patent expires, American law allows the drug company to pay would-be makers of generic versions to not produce the drug. That keeps prices, and profits, high. It ought to be illegal.

Congress expressly forbids Medicare from negotiating wholesale price discounts for the Medicare Part D program initiated by President George W. Bush, so Americans pay far more for drugs available in other countries, which negotiate huge discounts.

Finally, not everything should be judged by price competition. The love and affection of our families, the loyalty of our diplomats, and the integrity of jetliner makers and of the airlines that hire pilots are not matters for market economics.

We could experiment with the kind of price competition that the Cato Institute proposes. It might even work, though I doubt it. But why? We already know that universal coverage with a single payer is much cheaper than what America spends now. And we know that the quality of U.S. health care is far from the best - 37th in the world, according to the World Health Organization, which ranks France No. 1.

When opponents of the Affordable Care Act argue for patients negotiating health-care prices they make as much sense as proposing that passengers haggle over pay with an airline pilot.

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Federal insurance providers not required to provide autistic children specialized treatmentOPM allows, rather than requires, insurance companies to provide applied behavior analysis
January 04, 2013|By Yvonne Wenger, The Baltimore Sun

Autistic children of federal workers in 22 states begin receiving insurance coverage this month for a key behavioral treatment, under a decision by the Office of Personnel Management.

Maryland, home to the third-largest population of federal workers in the nation, is not one of them.

"These families desperately need the best coverage for their kids," said Stuart Spielman, senior policy adviser and counsel for Autism Speaks. He said the advocacy group would petition the OPM to expand its coverage as quickly as possible.

"I am always hopeful that we are going to see positive changes," he said. "I can tell you we will be working to make sure more children, rather than fewer, will be covered."

Advocates say the treatment, called applied behavior analysis, or ABA, is essential to helping autistic children reach their fullest potential. But under the Federal Employees Health Benefits Program, it had been considered an educational, not medical, intervention.

The OPM has decided to allow, rather than require, coverage for ABA. Maryland is one of 28 states and the District of Columbia in which no insurance carrier for federal workers is providing coverage.

For autistic children of federal workers in Maryland and other such states, OPM Director John Berry said, the Federal Employee Health Benefits Program covers speech, occupational and physical therapy, mental health treatment and medications.

"This decision on ABA coverage offers an opportunity for the provider base to grow and ABA coverage to expand," Berry said in a statement. "Knowing the impact this therapy can have on federal families, we are committed to continue monitoring and studying ABA on an annual basis."

But Jacque Simon, policy director at the American Federation of Government Employees, said the mix of therapies and medication is not a substitute for applied behavior analysis. Simon said the union has fought for decades for coverage.

"It's long been recognized as the most effective treatment," she said. "It's been absolutely horrible on the part of OPM to delay coverage for this long. It's really a half-measure, but it's better than nothing."

Rebecca Landa, director of the Kennedy Krieger Institute's Center for Autism and Related Disorders, described applied behavior analysis as a set of principles that guide intervention for children with autism on areas as diverse as social interaction, tooth brushing and math lessons. The treatment provides clear instructions, cues, prompts and feedback tailored to the individual child's ability level.

Landa said intervention at a young age —when the brain is most malleable — is important so the child's social and educational development is not limited.

Because the treatment is expensive, paying for it out of pocket is difficult for many families.

"We have the technology to help individuals with autism learn more effectively, which really reduces the costs to society," Landa said. "I do think it's time for insurance companies to examine carefully their decision about providing these kinds of interventions for individuals with autism."

The Centers for Disease Control and Prevention reports that autism affects about one in 88 children.

The OPM announced in April that it would allow, but not require, carriers to provide the coverage for families of federal workers. The decision was based on clinical research and evidence from the state-level coverage that is administered by health professionals, spokeswoman BrittneyManchester said.

ywenger@baltsun.com

twitter.com/yvonnewenger

Lacking coverage

Maryland is one of 28 states in which insurance carriers do not cover a key autism treatment for children of federal workers. The Office of Personnel Management has declined to demand the coverage. States in which no carrier is offering the coverage include:

Connecticut

Delaware

The District of Columbia

Maryland

Minnesota

New Jersey

North Carolina

Ohio

Oregon

Rhode Island

West Virginia

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'Six of the 9 most expensive hospitals in the US - all setting their prices at 10 times their costs - are run by either Community Health Systems or Health Management Associates. RNs protested the merger, which won't be good for patients, especially those in rural communities where they have no other options for hospital care'.

THIS IS WHAT WILL HAPPEN.....CONSOLIDATION OF THE HIGHEST QUALITY HEALTH INSTITUTIONS INTO SYSTEMS THAT THEN CHARGE MORE THAN MOST POLICIES WILL BE ABLE TO AFFORD. MEANWHILE, BRONZE PLANS, MEDICARE AND MEDICAID ARE BEING SENT TO A SYSTEM OF CLINICAL CARE BY NATIONAL CHAINS. Where will you fall when your employer sheds its benefits?

Shout loudly for Expanded and Improved Medicare for All!

HMA shareholders overwhelmingly approve merger with Tenn.-based hospital system

By KRISTINE GILL, LAURA LAYDEN
Posted January 8, 2014 at 9:29 a.m., updated January 8, 2014 at 10:08 a.m.

A small group of registered nurses gathered Wednesday, Jan. 8, 2013 outside the Tiburon Country Club to protest a multi-billion dollar hospital merger.

Shareholders in a Naples-based hospital operator have overwhelmingly approved the sale of the company to Community Health Systems Inc.

Nearly 98 percent of the votes cast by shareholders in Health Management Associates Inc. at a special meeting today were in favor of adopting the merger agreement.

A 70 percent vote was required. Shareholders holding 81.7 percent of HMA's outstanding common shares voted for the acquisition.

In a statement, Wayne T. Smith, board chairman, president and CEO of Community Health Systems, said, "We are pleased that HMA stockholders have seen the significant strategic value in combining with CHS. We are working now to finalize regulatory approvals, and we expect to complete this transaction quickly so that we can integrate our two companies and deliver on our plans for long-term growth and value creation."

The transaction is expected to closed by the end of January.

EARLIER

A small but widely representative group of registered nurses gathered Wednesday morning outside the Tiburon Golf Club in North Naples to protest a multibillion dollar hospital merger.

Inside the club, shareholders from Community Health Systems and Health Management Associates were to discuss Tennessee-based CHS's offer to buy Naples-based HMA, which operates two Physicians Regional hospitals and other hospitals in the U.S.

"Our concern, No. 1, is that CHS operates six of the nine most expensive hospitals in this country," said Steve Matthews, a labor representative for the National Nurses Organizing Committee.

About 10 people from California, Pennsylvania and West Virginia met near the intersection of Tiburon Boulevard amid a light drizzle, hours before each was to board their respective flights home.

Veronica Poss, a registered nurse working at a CHS-owned hospital in Fallbrook, Calif., said the decision will negatively impact patient care at her hospital and locally.

"They're cutting corners to get this money and do this," she said.

A 75-patient cardiac rehab center at her hospital which she said costs $110,000 a year to run was shut down through a CHS decision this year, a casualty, she believes, of the group's attempts to monopolize patient care in small communities where other options are not within reasonable distance.

"I'm just trying to be an advocate and let everybody know," she said.

The group was to disband by 10 a.m. but their fight with CHS would not be over, regardless of the decision made Wednesday.

"It's a different day, same story for me," said Tim Thomas, a registered nurse at a CHS facility in Watsonville, Calif. where he is currently involved in contract negotiations with the union there.

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The reason this article talks about diet and health is that the TPP gives global corporations the right to profit and allows for science to decide public health policy...as we know universities are now being paid by corporations or are corporations creating research that no longer represents public interest, but product interest. So, lung cancer and smoking? Not a public policy because someone can get lung cancer from simply breathing bad air say the tobacco industry.

TPP ends all ability to use public health and research to stop a product from being sold....from fracking to chemicals in plastic....we would no longer be able to protect people from harmful products. Fracking chemicals do not harm health says Penn State research.....then frack away!!!!

A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement

Sharon Friel1*, Deborah Gleeson2, Anne-Marie Thow3, Ronald Labonte4, David Stuckler5, Adrian Kay6 and Wendy Snowdon7

* Corresponding author: Sharon Friel Sharon.friel@anu.edu.au

Globalization and Health 2013

Published: 16 October 2013 Abstract Trade poses risks and opportunities to public health nutrition. This paper discusses the potential food-related public health risks of a radical new kind of trade agreement: the Trans Pacific Partnership agreement (TPP). Under negotiation since 2010, the TPP involves Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA, and Vietnam. Here, we review the international evidence on the relationships between trade agreements and diet-related health and, where available, documents and leaked text from the TPP negotiations. Similar to other recent bilateral or regional trade agreements, we find that the TPP would propose tariffs reductions, foreign investment liberalisation and intellectual property protection that extend beyond provisions in the multilateral World Trade Organization agreements. The TPP is also likely to include strong investor protections, introducing major changes to domestic regulatory regimes to enable greater industry involvement in policy making and new avenues for appeal. Transnational food corporations would be able to sue governments if they try to introduce health policies that food companies claim violate their privileges in the TPP; even the potential threat of litigation could greatly curb governments’ ability to protect public health. Hence, we find that the TPP, emblematic of a new generation of 21st century trade policy, could potentially yield greater risks to health than prior trade agreements. Because the text of the TPP is secret until the countries involved commit to the agreement, it is essential for public health concerns to be articulated during the negotiation process. Unless the potential health consequences of each part of the text are fully examined and taken into account, and binding language is incorporated in the TPP to safeguard regulatory policy space for health, the TPP could be detrimental to public health nutrition. Health advocates and health-related policymakers must be proactive in their engagement with the trade negotiations.

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Here you have nations all over the world protesting en masse against what they know will be a COUP against their country's sovereignty and an attack on public health.....US media simply reported citizens were protesting an administration they did not like.

TPP threatens public health, advocate says
Teerin Julsawad
The Nation

BANGKOK: -- Health advocates yesterday expressed concerns over the US-led Trans-Pacific Partnership (TPP), a proposed free-trade agreement that seeks to deepen economic ties and liberalise trade among a group of Asia-Pacific nations.

"It is very worrisome and a matter of life and death for the country," said Hatai Chitanondh, president of the Thailand Health Promotion Institute of the National Foundation. "The agreement is so secretive. I want to bring awareness of this deal to the public, as I believe it will threaten our economy as well as the health of citizens."

Hatai said the deal is of concern to health advocates because by opening up the tobacco sector it could lead to increased levels of smoking.

On a purely economic level, meanwhile, it poses a potential threat to Thai tobacco farmers, Hatai said.

The Thailand Tobacco Monopoly (TTM) would not be able to compete against international tobacco firms because the reduction of tariffs would boost competition between foreign and domestic industries, Hatai said.

Chitanondh warned the TPP would not only heavily affect the TTM and Thai tobacco farmers, but also prevent free implementation of regulations. "All our legislative measures and regulations will be put aside. Anyone can come in to Thailand and do what they want… We'd have to abide by their rules."

The TPP is under negotiation by the US, Australia, Brunei, Canada, Chile, Malaysia, Mexico, New Zealand, Peru, Singapore and Vietnam. Japan will take part in the next round of free-trade talks to be held later this month in Kuala Lumpur. Due to the secrecy of the agreement, the TPP has drawn much criticism from the public.

In April, US Ambassador Kristie Kenney said the US government has provided data to the Thai government about the TPP so that it could make a decision soon. Thailand, however, has not hinted at a decision, and it remains unclear if it will discuss the matter.

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I won't be so cynical to say that all who supported Affordable Care Act did not know its goal was maximizing profits at the expense of quality health care and access, but it is clear to all players now. National union leaders are allowing themselves to be manipulated into supporting issues they know are bad for their members in an effort to protect labor union rights and laws.

We must strengthen labor's hands in fighting loudly ourselves against these neo-liberal policies. When we watch Obama demanding that public health around the world be downsized so private US health businesses can profit, we know the policies implemented in the US mirror that goal.

WORK FOR EXPANDED AND IMPROVED MEDICARE FOR ALL!!!!

The Left after the Failure of Obamacare
Shamus Cooke

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Shamus Cooke View all posts by Shamus Cooke Shamus Cooke is a social service worker, trade unionist, Occupy activist, and writer for Workers Action. He can be reached at portland@workerscompass.org - See more at: http://workerscompass.org/the-left-after-the-failure-of-obamacare/#sthash.ydz7qKAR.dpuf

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

This is what the ACA is all about. It is a mirror of the Clinton banking deregulation and consolidation and is only meant to create global health corporations like these. Hopkins declared health institutions have never been more profitable as quality of care/access has plummeted.
8 Health Systems That Created International Partnerships in 2013

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

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

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

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

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

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

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

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

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

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

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

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Raise your hand if you know that the reason for building these state health systems is to throw Medicare and Medicaid to the states and ending them as Federal programs!!!!!! WAKE UP----THEY ARE ENDING ENTITLEMENTS RIGHT BEFORE YOUR EYES WITH YOU CHEERING ON! These entitlements will be joined by public sector health plans all having Medicaid-level health access. Do you know that TPP is working to end subsized health care in countries all around the world----Obama and neo-liberals are doing this!

DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL IN YOU STATE AND GET RID OF NEO-LIBERALS IN CONGRESS WORKING TO END ALL WAR ON POVERTY AND NEW DEAL PROGRAMS/LAWS!

The Website Isn't the Only Problem with Obamacare by Stateline | January 2, 2014 By Michael Ollove Governing

Signing up for health insurance on the new state and federal exchanges was supposed to be the easy part of the Affordable Care Act. The really dicey part, lots of health policy experts have always feared, would come on Jan.1.

That is when Americans who have enrolled in health insurance for the first time under the ACA begin to discover that having coverage doesn’t guarantee them easy access to a primary care doctor, dentist or mental health professional.

Some changes in the works, such as the use of new technologies and allowing mid-level medical providers to perform some functions usually reserved for doctors and dentists, should improve health care access in the long run. “In the meantime,” said Linda Rosenberg, president of the National Council for Behavioral Health, “people are going to suffer.”

According to the Health Resources and Services Administration , the federal agency charged with improving access to health care, nearly 20 percent of Americans live in areas with an insufficient number of primary care doctors. Sixteen percent live in areas with too few dentists and a whopping 30 percent are in areas that are short of mental health providers. Under federal guidelines, there should be no more than 3,500 people for each primary care provider; no more than 5,000 people for each dental provider; and no more than 30,000 people for each mental health provider.

According to the Association of American Medical Colleges (AAMC), unless something changes rapidly, there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020.

In some ways, the shortage of providers is worse than the numbers indicate. Many primary care doctors and dentists do not accept Medicaid patients because of low reimbursement rates, and many of the newly insured will be covered through Medicaid. Many psychiatrists refuse to accept insurance at all. Christiane Mitchell, director of federal affairs for the AAMC, predicted that many of the estimated 36 million Americans expected to gain coverage under Obamacare will endure long waits to see medical providers in their communities or have to travel far from home for appointments elsewhere.

During the debate over the ACA, Mitchell said the AAMC pushed for the federal government to fund additional slots for the training of doctors, but that provision was trimmed to keep the ACA from costing more than a trillion dollars over 10 years.

Aging Boomers

There are various reasons for the shortages. Certainly a big contributor is the aging of the baby boomers, who may still love rock ‘n roll but increasingly need hearing aids to enjoy it. The growing medical needs of that large age group are creating a huge burden for the existing health care workforce. The retirement of many doctors in the boomer cohort is compounding the problem.

The federal government estimates the physician supply will increase by 7 percent in the next 10 years. But the number of Americans over 65 will grow by about 36 percent, according to the U.S. Census Bureau.

Money also is a factor in the shortages. During the course of their careers, primary care physicians earn around $3 million less than their colleagues in specialty fields, which makes primary care a less appealing path for many medical students.

In mental health, the problem is that much of the work is in the public sector, where the pay is far less than it is for providers in other medical specialties, who tend to work in the private sector. As an example, according to the National Council for Behavioral Health, a registered nurse working in mental health earns $42,987 as compared to the national average for nurses of $66,530.

Valuing Work-Life Balance

But financial factors are not the leading reason that medical students are avoiding primary care, Mitchell said. In surveys of medical students conducted by AAMC, students valued “work-life balance” more than money when they were choosing their specialties. Because primary care often involves long hours and night and weekend calls, it is far less desirable to this generation of students.

“Half of the physicians in training are women,” Mitchell said. “You find more of them are looking for a career that might be compatible with part-time hours, that don’t involve being on call. Men are more engaged in child care today, and they have similar concerns as they consider their career choices.”

A steady stream of negative attention has made medicine in general a far less attractive career choice than it once was, according to Rosenberg of the National Council for Behavioral Health. Insurance headaches, pricey technologies, long hours and the risk of liability have convinced many talented students to eschew medicine as a career choice.

“Nowadays,” Rosenberg said, “the best and the brightest are talking about becoming investment bankers or going off to Silicon Valley.”

Dwindling Dentists

To some extent, dentistry created its own problem. Richard Valachovic, president of the American Dental Health Association, said today’s shortage of dentists can be traced to the closing of seven dental schools in the 1980s and 1990s. In 1980, he said, the United States produced 6,300 dentists. Ten years later, the number was down to 4,000.

Why did the schools close? “There was a perception that we had conquered dental disease,” Valachovic said. “Kids weren’t getting cavities anymore so we thought we wouldn’t need as many dentists.” Dental health did improve, he said, but not for the poor and those without insurance.

Twelve new dental schools — smaller than their predecessors — have opened since 1997, Valachovic said, so the U.S. is back to graduating 5,700 dentists a year. But the ACA has made pediatric dental care coverage a requirement for all insurance, which will extend benefits to as many as 8.7 million children by the year 2018. Demand will far exceed capacity to produce dentists for years to come.

Some Cause for Optimism

Despite the shortages, many believe that new technologies will extend the reach of medicine in ways that will ameliorate the problem.

For example, health care professionals can serve more people by using Skype or other telemedicine technologies to examine, treat and monitor patients. Similarly, patients can be fitted with electronic devices that remind them to take their medications and provide other guidance about their conditions. These and other technologies are already keeping patients out of hospitals and doctors’ offices.

Changes in the way medicine is delivered, such as the use of “medical homes” and “accountable care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. These organizational changes will make primary care physicians more important than ever, which might make primary care a more appealing — and lucrative — career choice.

A more controversial idea is to allow nurse practitioners, physician assistants, pharmacists and dental aides to do some of the work usually reserved for doctors and dentists. Many states have passed such legislation while others are eyeing similar measures. The Pew Charitable Trusts has supported such efforts.

The American Dental Association, however, opposes allowing mid-level dental workers to perform some of the functions of dentists, such as routine preventive and restorative work. The organization, which represents 157,000 dentists, questions federal data on a dentist shortage, suggesting the problem is more of an uneven distribution of dentists.

Some groups representing doctors are resisting similar efforts to allow nurse practitioners to, for example, write prescriptions and admit patients to the hospital. But many believe the trend is unstoppable.

“Health care is not a zero-sum game where there’s a limited amount of care to be given,” said Polly Bednash, the head of the American Association of Colleges of Nursing. “If there’s more care needed than we can deliver in the world, we have to decide who else can provide quality care.”

A Health Professional Shortage Area (HPSA) is a geographic area or population group with too few health care providers to serve people’s medical needs. Under federal guidelines, there should be no more than 3,500 people for every one primary care provider; no more than 5,000 people for every one dental provider; and no more than 30,000 people for every one mental health care provider. The graphs below show the percentage of the population in each state that lives in an HPSA.

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Howard Dean as with republicans are selling the wrong message------IT WAS NEO-LIBERALS AND NOT DEMOCRATS WHO WROTE AND PASSES THE AFFORDABLE CARE ACT-----democratic voters need to vote against them and educate friends and family that this is a republican policy so do not vote republican. RUN AND VOTE FOR LABOR AND JUSTICE IN ALL PRIMARIES!

Remember, the poor had more health coverage options BEFORE the Affordable Care Act so the MANDATE is not about providing care to the poor----it is only about maximizing profits. BIG PHARMA IS WINNING BIG IN TPP AS OBAMA AND CLINTON FIGHT FOR THESE US GLOBAL HEALTH INDUSTRIES!
Howard Dean on Obamacare Individual Mandate

The individual mandate was not necessary - the insurance companies like it because it does bring young, healthy people who aren't likely to get sick into the system. Dylan ScottTalking Points MemoDecember 30, 2013Former Governor and presidential candidate Howard Dean
AP Photo / Denis BeaumontFormer Democratic presidential candidate Howard Dean said Monday that Obamacare's individual mandate "wasn't necessary" and would damage Democrats during the 2014 election.

"The individual mandate was not necessary and it's probably a big political thing, and that is going to hurt the Democrats because people don't like to be told what to do by the government no matter what party they're in," Dean said on CNBC.

Dean insisted that Obamacare could have functioned without the mandate, though administration officials and outside experts have routinely said that the requirement to purchase health coverage was foundational to the law's reforms. Without it, they've said, the insurance market would be flooded with sicker people while those who are healthy would forgo buying insurance until they needed it.

Those factors would combine to drive up prices for insurance companies and, in turn, consumers. But Dean isn't convinced.

"The truth is, that wasn't necessary," Dean said, "and the insurance companies like it because it does bring young, healthy people who aren't likely to get sick into the system."

Independent analysis has shown that implementing Obamacare's other reforms, such as outlawing discrimination against those with preexisting conditions, has driven up prices in states like New York that have done so without the individual mandate, Kaiser Health News reported this summer.

New York has seen huge drops in its insurance premiums in anticipation of Obamacare's mandate taking effect in 2014, which analysts said was a strong indicator of the mandate's importance.

"New York is like the poster child for why you need an individual mandate," Sabrina Corlette, a research professor at Georgetown University, told KHN. "They implemented all the reforms without the individual mandate, and premiums just went through the roof."

Posted by Portside on January 1, 2014
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We need labor and justice to shout out to friends and family that the Affordable Care Act is a republican policy and voting republican because they see how badly the ACA treats most people is not the answer. SHOUTING OUT FOR EXPANDED AND IMPROVED MEDICARE FOR ALL IN YOUR STATE IS!

Democratic senator warns of Obamacare 'meltdown'
Published: Sunday, 22 Dec 2013 | 3:00 PM ET

President Barack Obama's healthcare law could have a "meltdown" and make it difficult for his Democratic Party to keep control of the U.S. Senate next year if ongoing problems with the program are not resolved, a Democratic senator said on Sunday.

Senator Joe Manchin of West Virginia, who has urged delaying a penalty for people who do not enroll for health insurance in 2014 under the law, told CNN that a transitional year was needed for the complex healthcare program, commonly known as Obamacare, to work.

"If it's so much more expensive than what we anticipated and if the coverage is not as good as what we had, you've got a complete meltdown at that time," Manchin told CNN's "State of the Union" program.

"It falls of its own weight, if basically the cost becomes more than we can absorb, absolutely."

The White House has been scrambling for months to control the damage from the botched October 1 launch of the law, formally called the Affordable Care Act, which aimed at making sure that millions of Americans without health insurance are able to receive medical coverage.

There have been complaints from consumers about higher premiums than they previously had to pay for health insurance after their old plans were canceled because of new standards under the law, as well as lingering problems with the main web portal used to sign up for insurance, HealthCare.gov.

Manchin said Senate Democrats who are up for re-election next year are "feeling the weight" of the program's woes and could have trouble keeping their majority in the chamber.

Obamacare 'utter chaos': Pro Discussing hardship exemptions under the Affordable Care Act, with Avik Roy, Manhattan Institute Senior Fellow, and Grace-Marie Turner, Galen Institute president. Republicans have been highlighting the healthcare law's difficulties as they seek to gain the six seats they would need to win control of the 100-member Senate.

"It needs to turn around," Manchin said of Obamacare. "I'm not going to say that I think we will lose it (the Senate). It's going to be extremely challenging. We have some very good people who are truly there, I believe, for the right reason. They're going to be challenged for the wrong reason."

Obama acknowledged on Friday that that the bungled launch of the healthcare law was his biggest mistake of 2013. His public approval numbers have dropped to historic lows over the law's debut.

The president said more than 1 million people have signed up so far for new coverage under Obamacare through HealthCare.gov, which services 36 states, and 14 state-run marketplaces.

A day earlier, Obama's administration said people whose insurance plans were canceled because of the law may claim a "hardship exemption" to the requirement that all Americans must have coverage by March 31 next year or face a penalty.

Manchin, a conservative Democrat whose state of West Virginia has been increasingly trending Republican, has made no secret of his frustration over the program's fits and starts.

Last month he introduced legislation to delay by a year the $95 penalty for failing to sign up for health insurance, saying Americans should not be penalized while Obamacare is going through its "transition period."

Manchin does not face re-election next year, but some Democrats who do have also urged changes to the program, such as extending the open enrollment period beyond the March 31 deadline. One third of the Senate is re-elected every two years.
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As people are now seeing that the intent of ACA is to limit access to health care for most in order to maximize profits for health industry corporations, we need to be sure to shout out that this is not a democratic policy....it is a neo-liberal policy and republicans will do the same thing.

AP-GfK poll: Health law seen as eroding coverage

By RICARDO ALONSO-ZALDIVAR and JENNIFER AGIESTA December 15, 2013 2:28 PM Associated Press

WASHINGTON (AP) — Americans who already have health insurance are blaming President Barack Obama's health care overhaul for their rising premiums and deductibles, and overall 3 in 4 say the rollout of coverage for the uninsured has gone poorly.

An Associated Press-GfK poll finds that health care remains politically charged going into next year's congressional elections. Keeping the refurbished HealthCare.gov website running smoothly is just one of Obama's challenges, maybe not the biggest.

The poll found a striking level of unease about the law among people who have health insurance and aren't looking for any more government help. Those are the 85 percent of Americans who the White House says don't have to be worried about the president's historic push to expand coverage for the uninsured.

In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year — mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law's passage.

Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing.

Only 21 percent of those with private coverage said their plan is expanding to cover more types of medical care, though coverage of preventive care at no charge to the patient has been required by the law for the past couple of years.

Fourteen percent said coverage for spouses is being restricted or eliminated, and 11 percent said their plan is being discontinued.

"Rightly or wrongly, people with private insurance looking at next year are really worried about what is going to happen," said Robert Blendon, a professor at the Harvard School of Public Health, who tracks public opinion on health care issues. "The website is not the whole story."

Employers trying to control their health insurance bills have been shifting costs to workers for years, but now those changes are blamed increasingly on "Obamacare" instead of the economy or insurance companies.

View gallery Graphic shows results of AP-GfK poll on health care; Political leanings seemed to affect perceptions of eroding coverage, with larger majorities of Republicans and independents saying their coverage will be affected.

The White House had hoped that the Oct. 1 launch of open enrollment season for the uninsured would become a teaching moment, a showcase of the president's philosophy that government can help smooth out the rough edges of life in the modern economy for working people.

Instead, the dysfunctional website became a parable for Republicans and others skeptical of government.

At the same time, a cresting wave of cancellation notices hit millions who buy their policy directly from an insurer. That undercut one of Obama's central promises — that you can keep the coverage you have if you like it. The White House never clearly communicated the many caveats to that promise.

Disapproval of Obama's handling of health care topped 60 percent in the poll.

With the website working better and enrollments picking up, Democrats are hoping negative impressions will quickly fade in the rearview mirror. The poll found that Democrats still have an edge over Republicans, by 32 percent to 22 percent, when it comes to whom the public trusts to handle health care.

But other potential bumps are just ahead for Obama's law.

It is unclear whether everyone who wants and needs coverage by Jan. 1 will be able to get it through the new online insurance markets. Some people who have to switch plans because their policies were canceled may find that their new insurance covers different drugs, or that they have to look for other doctors.

View gallery House Minority Leader Nancy Pelosi of Calif., speaks to reporters following a meeting of House Democ … In the poll, taken just after the revamped federal website was unveiled, 11 percent of Americans said they or someone in their household had tried to sign up for health insurance in the new marketplaces.

Sixty-two percent of those said they or the person in their household ran into problems. About one-fourth of all who tried managed to enroll. Half said they were not able to buy insurance, and the remaining quarter said they weren't sure.

Phyllis Dessel, 63, of Reading, Pa., believes she is finally enrolled after 50 attempts online. The retired social worker, a political independent, currently has her own private insurance.

When Dessel described her experience, she jokingly asked, "Do you mind if I cry?"

Thanks to tax credits available under the law, she was able to save about $100 a month on the monthly premium for her new coverage. But she had to switch carriers because staying with her current insurer would have cost more than she was willing to pay. She hasn't gotten an invoice yet from her new insurance company.

The premiums she found on the new insurance marketplace were "not at all" what she expected, said Dessel. "They were much, much higher."

A supporter of Obama's overhaul, she believes changes are needed to make the coverage more affordable.

"I think with a lot of amendments or updates, it could be very, very helpful and beneficial," said Dessel. "I know a lot of people who don't have insurance. My hairdresser, my plumber don't have insurance and they're not going to get it if it's not affordable."

The AP-GfK Poll was conducted Dec. 5-9 and involved online interviews with 1,367 adults. The survey has a margin of sampling error of plus or minus 3.5 percentage points for all respondents.

The survey was conducted using KnowledgePanel, a probability-based Internet panel designed to be representative of the U.S. population. Respondents to the survey were first selected randomly using phone or mail survey methods, and were later interviewed online. People selected for KnowledgePanel who didn't otherwise have access to the Internet were provided with the ability to access the Internet at no cost to them.

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Have you noticed that all of the requirements for businesses have been relaxed but the mandate for the public is still in place. THINK SMALL BUSINESSES WILL SIMPLY OPT OUT OF HEALTH COVERAGE once you have your own policy? OF COURSE THEY WILL. Larger corporations are only required to have preventative coverage.

Feds delay small biz access to HealthCare.gov Maggie Fox NBC News Nov. 27, 2013 at 7:59 PM ET

Video: The Obama administration announced Wednesday that small businesses will have to wait a year before they can use the federal website to enroll workers in health insurance through a program called SHOP. NBC’s Kristen Welker reports.

There’s another delay for people wanting to use the federal government’s troubled health insurance website. This time, small businesses will have to wait a year to use HealthCare.gov.

The Small Business Health Options Program (SHOP) won’t be available for a full year, the Centers for Medicare and Medicaid Services, which runs the online exchange, said Wednesday. “We anticipate that small employers throughout the country will have online access to an online SHOP Marketplace by November 2014,” the Health and Human Services Department says in its blog.

CMS spokeswoman Julie Bataille said her agency had to focus on the most important customers of the exchange – individuals who don’t have health insurance. “It was important for us to prioritize the functionality that would enable consumers to shop and enroll online in coverage,” Bataille told reporters in a conference call. In other words, they had to focus on making the website work.

It was the second delay in a week. CMS said earlier that the Spanish-language website won’t be up and working until December. And earlier this month CMS gave people an extra eight days, until Dec. 23, to enroll in time to get coverage starting the first day possible, Jan. 1.

Republican critics of the health reform law accused the administration of burying the news in the Thanksgiving rush. "Just as it did over July 4 while we celebrated our independence, today the administration is doing its best to bury the latest confirmation that this law was not ready for prime time," Michigan Republican Rep. Fred Upton, chairman of the House Energy and Commerce Committee, said in a statement. It was in July that the Health and Human Services Department announced a delay in the requirement that businesses provide health insurance to workers.

"For months officials looked us in the eye and told us everything was ‘on track’ but we have now learned through our investigation that internally the administration had serious concerns about its ability to deliver on October 1," Upton added.

"This new delay announcement is a disappointment but not a surprise," said Kevin Kuhlman of the National Federation of Independent Business. "Small businesses continue to be low on the priority list during the Obamacare implementation process. It probably matters little to people in Washington that the failure to get the small business exchanges online adds yet another onerous paperwork requirement for job creators."

Bataille says small businesses can still enroll employees through brokers.

The government has pledged to have the website “working smoothly for the vast majority of users” by the end of the month, which is Saturday. Bataille says capacity will have doubled by then, from the current 25,000 users on the site at any one time, to 50,000 at once.

"November 30 does not represent a relaunch of HealthCare.gov. It is not a magical date," Bataille said.

In case there are more than that, CMS plans to roll out an “advanced queuing system.” Users will be told to wait or given the option of getting an email to tell them when to try back.

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This is what should happen, but mergers and acquisitions and creating monopolies has soared during this administration....anti-trusts enforcement? REALLY?

5 Key Ways to Minimize Hospital Transaction Antitrust Risks
Written by Helen Adamopoulos (Twitter | Google+) | December 17, 2013 Becker's Hospital Review

During a recent webinar, McGuireWoods partner Howard Feller, JD, and associate Holly Carnell, JD, discussed the antitrust implications of hospital mergers and joint ventures.

Hospital and health system consolidation has been on the rise lately. The industry's merger and acquisition activity increased by almost 20 percent in the third quarter of 2013 compared with the same quarter a year ago, with 267 deals announced in the past three months, according to Irving Levin Associates.

In line with this increased merger and acquisition activity, the Federal Trade Commission and the U.S. Department of Justice have expressed their intent to keep a close eye on hospital transactions and have actively pursued enforcement actions in the healthcare industry.

In the midst of this climate, it's important for hospitals and health systems to be aware of antitrust concerns and take steps to minimize them, according to Holly Carnell, JD, an associate at law firm McGuireWoods.

"It's really important that hospital leaders proceed with caution, especially with regards to sharing information with competitors during the transaction process," she said.

During a Dec. 11 webinar, Ms. Carnell and McGuireWoods partner Howard Feller, JD, discussed the antitrust implications of hospital mergers and joint ventures and tactics for reducing risk.

1. Be able to show pro-competitive efficiencies for joint ventures. In the case of a joint venture (under which the parties involved don't end up forming a single entity and neither has majority ownership and control), antitrust concerns generally won't arise if the two participants aren't competitors. However, if they are competitors, they should ensure they comply with antitrust conspiracy laws, Mr. Feller said.

"First, the government agencies are always going to ask, 'Why are you doing this transaction?'" he said. "There needs to be a legitimate business rationale for the joint venture."

The deal should produce beneficial, pro-competitive efficiencies. Typically, Mr. Feller said these fall into the category of providing new services that didn't exist previously, reducing costs, being more proficient in providing services and improving quality of care.

"They have to be something that's verifiable," he said. "Hopefully you can, in a quantitative sense, substantiate these efficiencies."

In order to justify the transaction, participants also need to show joining forces is the only way they can achieve these efficiencies.

2. Be aware of the market share and pricing impact of mergers. As far as mergers (where the parties involved integrate and form one entity) are concerned, Mr. Feller said the main consideration for federal regulators is whether prices are likely to increase because of the transaction.

"The agencies will look at a number of factors," he said. "They look at the concentration in a marketplace. How many significant competitors are there in a particular geographic area? What is the market share of those hospitals, and what's going to be market share of the merging entity?"

The definition of service or geographic markets is a "very important" component of that analysis, he said. Looking at the broader hospital service market, the merger might not seem problematic. However, the regulators could find issues if they look at the transaction from a narrow service market standpoint.

Concerning market share, Mr. Feller said there's no "bright line" test for what will attract antitrust scrutiny. However, he estimated a merger will likely get attention from regulators if the resulting entity holds 35 percent of market share or more.

3. Reduce the sensitivity of information exchanged during the due diligence period. A hospital or health system carrying out a deal with a competitor must be vigilant concerning what information it shares with the other party during the due diligence and pre-closing process, according to Mr. Feller. He said the government seeks to prevent collusion at a later point in time.

"It might increase the likelihood that the parties could collude in some fashion even if they don't do their transaction," he said.

Organizations involved in a transaction must remember they are still competitors until the day of closing and must continue to operate independently, he said. If they integrate before the closing date, federal officials could sue them for colluding.

Competitively sensitive information such as current and future fee charges, reimbursement rates from payers and business and strategic plans should not be shared. A good rule of thumb for hospitals and health systems is to ask whether they would share the information in question if they weren't involved in a possible deal with the other party, he said.

It's possible to desensitize information by aggregating, redacting or limiting its competitive usefulness.

"For example, instead of sharing payment rates per procedure, you would share information on total revenues received from a particular payer," Mr. Feller said.

4. Limit access to sensitive information. If the organizations involved want competitively sensitive information to be evaluated as part of the transaction process, they can also "set up firewalls" and allow only certain, screened people to view the information, according to Mr. Feller. These individuals should commit to a confidentiality agreement.

For instance, he said hospitals and health systems could hire third parties, such as a consultant, to evaluate competitively sensitive information and convey their conclusions to the transaction participants without disclosing details.

Overall, healthcare organizations should generally "limit information to what is necessary to evaluate the transaction," he said.

5. Ensure documents evaluating the transaction can stand up to scrutiny. Additionally, organizations involved in a merger or joint venture must realize regulators could scrutinize any documents related to the evaluation process. Therefore, the documents should be free of overstatements, speculation and ambiguous statements, according to Mr. Feller.

Furthermore, he recommended any documents that evaluate a potential transaction should be prepared in draft form and reviewed by an attorney before they're distributed to anyone else.

"These documents can become a real problem if there's ever an investigation," he said.

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That will get health care costs down....people hired at the top only for their ability to earn profits!

Study: New Hospital CEOs Increasingly Have No Healthcare Experience

Written by Akanksha Jayanthi (Twitter | Google+) | December 18, 2013

11
inShare A poll by Clearwater, Fla.-based Black Book Rankings estimates that almost two-thirds of CEOs hired in 2014 will have little to no healthcare experience, according to a news release. The poll was completed by 1,404 healthcare provider organizations' human resource officers and board members.

The number of hospital CEOs coming from another hospital CEO position fell from 79 percent in 2009 to 39 percent in 2013, according to another Black Book survey.

Doug Brown, managing partner at Black Book, sees a lack of healthcare experience as potentially being beneficial, especially for hospitals in crisis. "An outside hire will not have developed hospital management skills from within or understand an organization's unwritten rules at first, but that's not a bad thing either as more hospitals face fresh ideas to avoid bankruptcy, expedite smoother consolidations, conquer payment reform, and productivity issues," he said in a news release.

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Keep in mind that MA and RomneyCare are just as ACA----there are no provisions that keep fraud and profiteering in place. So, as we see, a policy after two decades costing more due to increasing commercial prices. We will not see cost drop even as patient access is limited because the goal is profit.

Look at the fact that Medicaid and Medicare is seeing the larger costs. This is where fraud and profiteering is worse.

Comment from a MA health activist:

'Below is a State House New story about a new report by the Health Policy Commission showing that Massachusetts health care costs are the highest in the nation, with taxpayers paying more for their care, with the bulk of that spending going to hospitals, particularly large teaching hospitals operated by health care conglomerates like Partners, Baystate Health, UMass Memorial Medical Center and Beth Israel Deaconess. While ranking at the top for costs, our patients are suffering from some of the worst patient care conditions in the nation, as Massachusetts ranks near the bottom for costly hospital readmissions, meaning patients are leaving the hospital in worse condition than when they entered the hospital. Numerous research studies show excessive patient assignments for registered nurses are the primary cause for these readmissions. This report underscores the need for the two ballot initiatives supported by the MNA/NNU. The Patient Safety Act will protect patients when they enter the hospital by ensuring a safe patient limit for nurses to ensure patients receive the safe care they deserve. The Hospital Profit Transparency and Fairness Act will ensure taxpayer health care dollars are accounted for and that these dollars are directed to patient care and the services patients need'.

Health care cost in Massachusetts tops US average by 36%

By Michael Norton State House News Service Posted Dec 18, 2013 @ 06:21 AM
The Metro-West Daily News

BOSTON — Massachusetts residents see doctors more often than most other Americans and the cost is higher than in any other state, according to a new report that pegs per capita spending on health care in Massachusetts at 36 percent higher than the national average.

The report by the state Health Policy Commission found that in addition to higher use of medical services, Massachusetts also has higher prices than the national average.

“Spending in Massachusetts is the highest of any state in the U.S., crowding out other priorities for consumers, business, and government,” said the report, which is marked for release and discussion at the commission’s annual meeting Wednesday. “Over the past decade, Massachusetts health care spending has grown much faster than the national average, driven primarily by faster growth in commercial prices.”

The report drew many of its conclusions from data from 2009.

After expanding coverage opportunities with a 2006 law, state policymakers are hoping new transparency, cost control and care delivery methods will bring health care cost growth in line with or beneath growth in the state economy. The preliminary findings of the 2013 cost trends report will factor into the continuing debate over whether the cost control law is working as intended.

Among the report’s findings:

Health care spending as a proportion of the state economy rose over the last decade, from under 13 percent in the early 2000s to 16.8 percent in 2009, a rate estimated to roughly hold through 2012. The report also used 2009 figures in concluding per capita health care spending in Massachusetts is the highest among states, at $9,278, compared to U.S. per capita health care spending in 2009 of $6,815.
Spending on hospital care and long-term care accounted for the bulk of the difference between per capita health care spending in Massachusetts and nationwide. Higher per capita state spending on hospital and long-term care was evident in the massive Medicare and Medicaid programs as well.
Compared to the United States, Massachusetts has a higher percentage of residents enrolled in Medicaid and spends more per Medicaid enrollee. Using 2009 figures, the report estimated $8,278 in expenditures per Medicaid enrollee, 21 percent higher than the U.S. figure of $6,826, due to factors such as the health status of enrollees, the “breadth of benefits,” and higher reimbursement rates to physicians. At 20.3 percent, Massachusetts has 23 percent more of its residents enrolled in Medicaid than the U.S., at 16.5 percent, a situation attributed to broader eligibility categories and differences in demographics.
Massachusetts residents used outpatient hospital services 72 percent more than their U.S. counterparts, and inpatient admissions were 10 percent higher than the United States. Emergency department visits in Massachusetts were 13 percent higher and outpatient surgeries were 27 percent higher than the U.S.
Major teaching hospitals play a far bigger role in the delivery of inpatient care in Massachusetts compared to the national average. For example, 40 percent of Medicare discharges in Massachusetts are in major teaching hospitals, compared to 16 percent nationwide.
At 15.4 percent, the Massachusetts asthma rate was higher than the U.S. rate of 13.6 percent, but Massachusetts showed lower rates of chronic disease prevalence than the U.S. as a whole, including rates of diabetes, coronary heart disease, cancer and depression.

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If you think this is hyperbole you should look at the direction Baltimore's policy of ending public health and creating a system of private non-profits that are doing the same thing as in this article!

The Disabled to Be Used for Slave Labor: UK Government Plan March 15, 2012 by GAIA HEALTH

To be disabled is to have limitations in one’s ability to get through tasks that most people can do routinely, without a second thought. For those who’ve never been in that position, it’s hard to imagine how utterly humiliating it can be. Though there may be a few who would choose such a life, it should be obvious that the need for personal dignity precludes it in nearly all of us.

As part of the current UK government’s overhaul of the health and welfare systems, people with disabilities—including those diagnosed with terminal cancer, stroke victims, accident victims, those pressed into taking antipsychotics, and any others deemed needy of “work experience”—will be forced to labor for free, with no end in sight, or face losing their already meagre benefits.

The Program In other words, the disabled will be forced into slave labor or lose the paltry amount that allows them to survive. Will the work help the disabled get a leg up into a career? We’ve already seen the sort of job that the unemployed with skills are expected to perform as slaves: menial, boring, dehumanizing work. What chance is there that the disabled will be pressed into anything better?

The Department for Work and Pensions (DWP) has been drawing up plans for the program under the Welfare Reform Bill. Section 54 is the new Workfare provision for the disabled. It will apply to the group placed in the category called Work Related Activity Group (WRAG). The name is misleading, but those placed in the WRAG class are considered unable to work, though with the possibility of being able to work in the future.

This program will be run by private interests, not by the government. The private interests will be the same ones currently operating the Workfare program for the unemployed. Their situation—their enslavement—is discussed in Both the US and the UK Governments Support Slavery of Their Own Citizens. People with university degrees are given “work experience” doing things like stocking shelves for discount chains.

People who receive benefits because their disabilities make them unable to work will be forced to work for corporations like supermarkets and discount stores. Sometime soon, when you walk into a supermarket to purchase a can of beans, keep in mind that it may have been placed there by someone with Parkinson’s disease or cancer.

Or, picture this entirely plausible scenario:

The person sitting in a wheelchair who stocked that shelf the night before could be someone who was an employee the previous year, but ended up in that chair after an accident that happened in that very same store because reasonable care wasn’t taken to prevent the injury. Before, that person was earning a wage for that work. Now, the same person will be doing it for free, because, otherwise, the pain medications would be taken away. And the corporation no longer pays the wages for that labor.

How likely is it that the private interests operating the slavery program will use slaves for their own benefit? Slave house cleaners? Slave gardeners? Slave file clerks in their offices? Why not? There doesn’t appear to be any rule against it.

Replacing Paid Laborers with Slave Labor Statue at the Old Slave Market in Zanzibar. The chain was actually used on slaves there. (Photo by Fay Venegas. Photostream link is below.)

Of course, those jobs being done by people whose lives have already become limited by disabilities will no longer be available for the able bodied. What will become of the health of these new age slaves? How will they ever have a chance to learn new skills, if they’re forced to spend their time performing labor for corporations?

Will we see the day when charity shops are staffed by the very people they’re supposedly helping?

The DWP, of course, has a different spin on this issue. According the The Guardian, a DWP spokesperson stated:

It is clear that some groups wish to label people with a variety of illnesses and conditions as unable to work. This is not only wrong, it is unfair to those individuals who despite their illness want to keep working.

Somehow, we’re supposed to believe that forcing people to work without pay, forever, with no end in sight, is for their benefit. When questioned about the potential length of an assignment, the spokesperson rather disingenuously stated:

Placements would normally be short-term, but there is currently no set duration and this will generally be agreed between the adviser and claimant.

In other words, a person on disability can be forced to labor for free forever. Seriously, what sort of “agreement” can possibly exist between a slave, now to be called a claimant by the DWP, and a slave master, now called an “advisor”.

This is just the beginning. Prisoners are forced into slave labor, and few people think anything about it, even though such labor eliminates wage-paying jobs. The young are already forced into slavery simply by being unemployed. Corporations are getting free labor for which they’d previously paid—and wage-paying jobs disappear. At least, each individual job being filled by an unemployed slave is limited to a few weeks.

Now, though, the plan is to eliminate the time limit for disabled slaves. No concern exists among the powers-that-be for the welfare of these people. The work they’ll be forced to do will likely harm them even further. They are, after all, receiving benefits because of an inability to work. Their time will be taken up trying to perform tasks they’re unlikely able to do well, perhaps causing them further harm and reducing their chances of recovery.

Workfare is a nice-sounding term. It brings forth an image of people learning to be productive, getting a leg up on life. The reality, though, is entirely different. In more language twisting, the government calls this “reform”. It’s not. It’s dismantling the safety net for those most in need.

Slavery is forced labor. It matters not what it’s officially called. A rose is a rose no matter what its name—and a latrine’s stench isn’t made sweet by calling it a perfume dispenser.

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FDA'S New Voluntary Antibiotics Policy Fails to Protect Human Health
Kaye Spector EcoWatch / News Report Published: Thursday 12 December 2013

The U.S. Food and Drug Administration (FDA) on Wednesday issued new guidelines regarding use of antibiotics in food animals that are not sick.

Under the new rules, food animal producers will no longer be able to use antibiotics to make animals grow faster. If producers need to give the drugs to a sick animal, they will have to get a prescription from a veterinarian.

The agency will ask drug manufacturers to change labels to feature language to deter using the medicines to make animals grow. Companies will have three months to tell the agency whether they will change the labels, and three years to carry out the new rules.

The long-pending guidelines came under criticism by groups such as the Natural Resources Defense Council (NRDC) and others because the drug label changes are only voluntary and do not compel any changes in the use of antibiotics.

About 80 percent of the antibiotics sold in the U.S. are for use in cows, chickens and pigs—mostly on animals that are not sick. That practice has been widely recognized by scientists to breed antibiotic-resistant bacteria and threaten human health. When antibiotics are used day after day at low doses to speed up animal growth or compensate for crowded, stressful and unsanitary feedlot conditions, some bacteria become resistant, multiply and escape the feedlot to threaten human health.

The FDA’s policy would address only the use of antibiotics to speed up animal growth. Preventive uses to avoid diseases associated with poor factory farming conditions pose the same risks, are similar in nature and have significant overlap with uses for growth promotion, the NRDC said.

“FDA’s policy is an early holiday gift to industry. It is a hollow gesture that does little to tackle a widely recognized threat to human health,” Avinash Kar, NRDC health attorney, said in a media release.

“FDA has essentially followed a voluntary approach for more than 35 years, but use of these drugs to raise animals has increased,” Kar said. “There’s no reason why voluntary recommendations will make a difference now, especially when FDA’s policy covers only some of the many uses of antibiotics on animals that are not sick. FDA is failing the American people.”

Leading health groups, medical doctors and other scientists such as the American Academy of Pediatrics and the Infectious Disease Society have sounded the alarm, saying that “overuse and misuse of important antibiotics in food animals must end, in order to protect human health.” The World Health Organization and the Institute of Medicine of the National Academy of Sciences have reached similar conclusions.

A new report, Antibiotic Resistance Threats from the U.S. Centers for Disease Control and Prevention (CDC) estimated that at least 23,000 Americans die each year from drug-resistant infections and that antibiotic resistance is implicated in at least 2 million infections annually.

While human overconsumption of antibiotics contributes to the problem, the CDC has confirmed the link between antibiotic use on industrial farms and the rise of antibiotic resistance, saying that there is “strong scientific evidence of a link between antibiotic use in food animals and antibiotic resistance in humans” and warns of “potentially catastrophic consequences” if resistance is not slowed. The report also states: “Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”

In 1977, the FDA concluded that feeding animals low doses of the antibiotics penicillin and tetracyclines, which are used in human medicine, could promote antibiotic-resistant bacteria capable of infecting people, and posed a risk to human health.

NRDC and its partners brought a lawsuit to force the FDA to act and won two landmark decisions in federal district court in 2012. The FDA has appealed the decisions and a decision is pending on appeal. NRDC’s partners in the litigation are the Center for Science in the Public Interest, the Food Animal Concerns Trust, Public Citizen and the Union of Concerned Scientists.

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Look at Figure 3 to see the goal of the ACA and health reform....whether private health plans users, Medicare, or Medicaid the access to care is so low as in some cases to be negative. Neo-liberals call this a win because it lowers the deficit by keeping people from accessing care. They also call it 'making health care affordable' for the same reason. THIS GRAPH SHOWS HOW DRAMATIC THE DROP IN ACCESS TO HEALTH CARE THESE FEW YEARS HAS BECOME. THE NUMBER OF PEOPLE DYING FROM THIS LACK OF ACCESS WILL SOAR IN JUST A FEW MORE YEARS. THAT NUMBER WILL NOT BE MADE PUBLIC!!!!

I SEE......IT IS NOW WORKERS HEALTH CARE COVERAGE THAT IS HOLDING BACK ON HIRING......IT WAS WAGES......THEN IT WAS THE ECONOMIC UNCERTAINTY.....THEN IT WAS ALL THE REGULATIONS....
"Reduced health care costs for employers could lead to 200,000 to 400,000 new jobs per year by the second half of the decade.

What is the Real Story on Health Care Costs? December 12th, 2013

Econintersect: President Obama has been speaking out about the success of PPACA (aka Obamacare or Affordable Care Act) in bringing down the rate of growth of healthcare costs. Others have said that such claims are at odds with "the most basic facts" about health care spending. Spokesmen for the AEI (American Enterprise Institute), Thomas Miller and Abby McCloskey presented a very critical review of cost reduction claims last week in The Wall Street Journal.

Follow up:

The White House Council of Economic Advisors (WHCEA) has issued a report claiming that data indicates a dramatic drop in growth of the nation's health expenditures during the years 2007-2010 by to half of the previous eight-year average. Then another drop by 1/3 for the years 2010-2013. (See Figure 3 below.) The report claims that health care inflation is the lowest in 50 years. Jason Furman, chairman of the WHCEA, said the report offers positive economic implications (USA Today):

"Reduced health care costs for employers could lead to 200,000 to 400,000 new jobs per year by the second half of the decade. If just half the recent slowdown in spending can be sustained, health care spending a decade from now will be $1,400 per person lower." The report issued by the Office of the President contains the following graph:

The president's report also shows the following graph indicating that health care costs are now increasing at the same rate as the overall inflation:

The AEI analysis is not discussing the same numbers. Miller and McCloskey wrote in the WSJ article:

National spending on health care is projected to reach a record $2.9 trillion in 2013, according to the Centers for Medicare and Medicaid Services. This is more than 25% above pre-recession spending levels in 2007. Health-care expenditures per capita and as a percentage of GDP are also at record highs, expected to top out this year at $9,216 and 18% respectively.

The only apparent bright spot is that the average annual rate of health-care spending increases has slowed. Over the past three years, growth in health-care spending averaged 3.9% year-over-year, considerably slower than the historical average. The authors do not provide links to their references to Centers for Medicare and Medicaid Services (CMS) (above) and the Congressional Budget Office (elsewhere in their Op Ed). Econintersect has tried to find appropriate publications that might have been their sources. Here is the location of a CMS report that may have been their reference, which contains the following table:

Click on table for larger image.

Miller and McClosky point out that there are lots of things that have been reducing health care cost growth:

However, annual health-spending growth rates began to decline a decade ago. In 2002, health-care spending grew by nearly 10% in a single year. The growth rate dropped to 7.1% in 2004, 6.2% in 2007, and bottomed out at 3.9% in 2009-the worst year of the Great Recession, where it has stayed ever since. Again the WSJ is quoting data from a different source (not given) than The White House which indicates that health care cost inflation has been below 5% for the past 20 years. (See Figure 2 above.)

Both of the positions presented are based on data but clearly not the same data. To make sense of trends in health care costs there is clearly needed a scientific (rather than political) review of data. And once the real data is defined then a proper analysis should be carried out by non-political actuaries.

And then there are reports that can best be described as anecdotal, even though they apparently represent a sizable sample, such as the one reported by Jim Angle in an article at Fox News:

"...one insurance plan that asked not to be identified analyzed its pool of 375,000 people and found that, even after subsidies, only 10 percent would actually see a decrease in costs, while one third would face significant rate increases as a result of ObamaCare. " Such reports could be representative, could be too optimistic about cost reductions or could be too pessimistic. There is simply no way to evaluate what such a report means.

This brings us back to the headline: What is the real story on health care costs? The Washington Post published a recent "Fact Checker" article about the president's claims for cost savings and couldn't reach a conclusion. It is not only Econintersect which is confused.

John Lounsbury

Sources:

National Health Expenditure Projections 2012-2022 (Centers for Medicare & Medicaid Management, Office of the Actuary, National Health Statistics Group, not dated but July 2013 or later based on data release dates shown in the report)

Officials: Slower health spending growth may boost jobs (Kelly Kennedy, USA Today, 20 November 2013)

New Report from the Council of Economic Advisers: The Recent Slowdown in Health Care Cost Growth and the Role of the Affordable Care Act (Jason Furman, Chairman of the Council of Economic Advisors, White House.gov, 20 November 2013)

Trend in Health Care Cost Growth and the Role of the Affordable Care Act (Office of the President, November 2013)

The Next ObamaCare Mirage (Thomas Miller and Abby McCloskey, The Wall Street Journal, 25 November 2013)

Fact Check: Is President Obama's latest health care promise true? (Jim Angle, Fox News, 02 December 2013)

President Obama’s claim that ‘Obamacare’ has helped hold down health-care costs (Glenn Kessler, The Washington Post, 15 November 2013)

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Did you know that Lockheed Martin is in an industry....the defense industry.....that has a trillion dollars in losses to defense industry fraud? Just think, recovering that fraud from the defense industry and Lockheed Martin would cover Universal Care.

Maryland citizens have decided to go with Expanded and Improved Medicare for All so no need for private corporations to line up to enter the health industry!

Lockheed Martin looks to grow health care role New Baltimore health care center comes amid military cuts

By Natalie Sherman, The Baltimore Sun 7:58 p.m. EST, December 4, 2013

Lockheed Martin, a government contractor best known for its fighter jets, formally opened a health care center in Baltimore County Wednesday, part of a bid to expand the company's role in the medical sector.

While health care services still represent a small portion of Lockheed's business, company representatives said they see the opportunity to apply Lockheed's technology and security background to the rapidly increasing amount of data entering the medical field.

"We've done really large information systems in other domains, like defense intelligence … and health care is, I don't want to say just another domain, but it's going through the same pains and revolutions that we've seen in our other businesses," said chief scientist Michael Hultner.

Lockheed, one of the largest private employers in Maryland, has been hit in recent years by cutbacks in military spending, as the federal government has increased its role in health care through health care reform. Since 2008, Lockheed's workforce has shrunk from 146,000 to 116,000, and on Nov. 14, executives announced plans to cut 4,000 additional positions and consolidate operations.

About 2,000 of the company's 116,000 employees work in health care in roles that range from providing software support to performing medical evaluations, said Karoom Brown, a Lockheed executive director of strategy and business development. In the Baltimore area, Lockheed's health and life sciences division occupies six buildings and employs about 500 people, some of whom are based offsite.

"Over the last five years Lockheed's made a conscious decision to increase our focus and investments in health care," Brown said. Health care generates almost $1 billion in revenue per year for the company, he said.

The new center for health innovation is a glass-filled showroom with ergonomic chairs and portable touch screens located on the first floor of an office park on Lord Baltimore Drive near Milford Mill. The facility, which Lockheed formally opened Wednesday but has been in operation for about a year, includes a wellness center, where Lockheed employees can go for treatment and "tele-medicine."

The center will act as a hub where Lockheed can meet with clients and connect them to the company's technologies, which include developing the data processing systems and analysis that many believe will be critical to future advances in medicine.

"It's a good place where you can see all of Lockheed's technologies in one place; customers can touch and demo it," said Brown, noting that the location capitalizes on proximity to the Social Security Administration and Centers for Medicare & Medicaid Services, which use Lockheed for similar services, as well as other institutions, such as Johns Hopkins.

Lockheed's health care projects include efforts to design systems to sift and compress the hundreds of gigabytes generated by a single sequenced genome, streamlining the data into information that a doctor could use during an appointment with a patient, Hultner said.

David Seo, chief medical information officer and associate professor of medicine at the University of Miami, is working with Lockheed to develop computer programs that will use patients' medical data to ask and answer the questions the doctors want. He said the partnership is critical so that doctors can use data to help them prevent problems, instead of simply treating them when they arise.

"Most hospital systems — and even most university medical centers — they don't actually have the capability to do this work," Seo said. "It's really when you combine [efforts] that you can really push the field."

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We need to remember what drives these prices and profits! Obama in enacting the republican market-based health reform deliberately left PHARMA out of the reform and we all know PHARMA is the main culprit in cost, not only in profiteering but in massive fraud. Why did Obama allow the gorilla in the room off the hook? Because of the even bigger gorilla in the room--making public health care along with public education the next Wall Street market! Why do you think Obama sent hundreds of billions to universities to build research facilities? Because universities are now corporations patenting and selling their research that is successful. That is why Balt has the biotechs firms at both Hopkins and UMMS. PHARMA will be the research of choice for the global market!

Obama and neo-liberals went even further to maximize health industry profits in PHARMA by demanding that nations that subsidize PHARMA to help their citizens afford it or that create generics to make PHARMA cheaper--be made to stop it. Obama says that neo-liberals want medicine to be as expensive all over the world as it is here in the US! WHAT HUMANITARIANS THOSE NEO-LIBERALS ARE!

First, we have to remember that the health fraud in the US is trillions of dollars and PHARMA is a big part. That money needs to come back to augment health costs here. Stopping TPP will help as well but Universal Care is the answer!

Global spending on drugs may top $1 trillion next year, IMS predicts

By Lisa Girion 8:30 a.m. EST, November 19, 2013

Global spending on pharmaceuticals is expected to surpass $1 trillion for the first time next year, propelled in large part by the rising demand for cheap generic drugs in China and other emerging markets, according to a new forecast from the IMS Institute for Healthcare Informatics.

More than two-thirds of all pharmaceutical drug spending occurs in eight countries: the U.S., Germany, France, Italy, Britain, Spain, Japan and China, the institute found.

Still, the next five years will see two starkly different trends in pharmaceutical consumption, according to the global forecast.

The U.S. will continue to lead the world in per-capita spending on pharmaceuticals, largely because of its heavy reliance on expensive, brand-name drugs, the institute predicts.

However, the rate of growth in drug spending in the U.S. and the rest of the developed world will continue to slow as generics gain traction and, in Europe, as austerity measures imposed in response to the economic slowdown take hold.

In China and other developing countries, on the other hand, drug spending is expected to grow rapidly as economic fortunes improve, the middle class expands and governments invest in broader access to healthcare.

Although patients in the developing world are primarily buying generic drugs, which sell for a fraction of the price of name-brand versions, the increasing use of pharmaceuticals across large populations is driving a surge in drug spending, the institute found.

As consumers everywhere stretch their medical dollars, the institute projects that spending on generic drugs will rise over the next five years from 27% to 36% of the total.

The institute also said the drug pipeline includes innovations in the treatment of rheumatoid arthritis, cystic fibrosis, melanoma and prostate cancer.

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Public hospitals serve all patients and sometimes the most expensive so we would expect them to not meet the efficiency model. You see why ACA is all about health industry profit. These public hospitals, just as public schools being made charter, will send more patients into for-profit!

Safety-Net, Public Hospitals Lose the Most Under Quality-Based Payment Program

Written by Helen Adamopoulos November 20, 2013 Becker Hospital Review

Public and safety-net hospitals are faring the worst within CMS' Hospital Value-Based Purchasing program, according to a blog post by Ashish K. Jha, MD, a professor at the Harvard School of Public Health.

According to an analysis conducted by Dr. Jha and his colleagues, hospitals in the highest quartile of the disproportionate share hospital index — those treating the most low-income patients — received an adjusted average total payment penalty of 0.09 percent, while public hospitals average a penalty of 0.1 percent.

Meanwhile, hospitals with the lowest DSH quartile received an average bonus of 0.06 percent. Nonprofit hospitals got an average penalty of 0.03 percent, and for-profits, on average and adjusted for other factors, received neither a bonus nor a penalty, according to Dr. Jha.

The Patient Protection and Affordable Care Act established the VBP program. For FY 2014, this meant CMS took back 1.25 percent of Medicare reimbursements at hospitals paid under Medicare's inpatient prospective payment system. The resulting $1.1 billion would then be dispersed to hospitals based on how well they performed on healthcare quality measures, like treatment of heart attack and congestive heart failure, as well as patient satisfaction. More than half of all hospitals within the program will lose some portion of their reimbursements in 2014.

It's unclear why public and safety-net hospitals do worse than others in the VBP program, Dr. Jha wrote.

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WHAT A SURPRISE!!!!

Insurers restricting choice of doctors and hospitals to keep costs down

By Sandhya Somashekhar and Ariana Eunjung Cha, Published: November 20 E-mail the writers

As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

In most cases, the decision was about the cost of care.

In Seattle, the region’s predominant insurer, Premera Blue Cross, decided not to include the children’s hospital as an in-
network provider except in cases where the service sought cannot be obtained anywhere else. “Children’s non-unique services were too expensive given the goal of providing affordable coverage for consumers,” spokesman Eric Earling said in an e-mail.

For example, a pediatric appendectomy at Children’s costs about $23,000, he said. At another community hospital, the cost is closer to $14,100. Melzer said his hospital often bills more than community hospitals for comparable procedures because the children it treats are often gravely ill, so even a routine tonsillectomy may be more complicated.

But as a result, families like Jeffrey Blank’s, which has relied on Seattle Children’s since his daughter, Zoe, received a diagnosis of a rare bone disorder, face difficult decisions. Under some of the new law’s health plans, the family would no longer be able to take Zoe to Children’s for her routine checkups, or it could count as an “out-of-
network” visit, saddling the family with huge bills.

“It just stresses me,” said Blank, 53, a self-employed massage therapist who is sorting through his options but readily admits that his family has benefited from other parts of the health law. “I hope things continue wonderfully for my daughter and that she doesn’t need the level of care she got after her diagnosis, but there’s this unknown.”

In New Hampshire, Frisbie Memorial Hospital took legal action against an insurer that excluded it from its marketplace plans, and in Missouri, consumer advocates successfully lobbied an insurer to add a children’s hospital after it unveiled a plan that lacked one.

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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.

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This is the problem with corporate universities.....the institutions that held power accountable are now patenting research and getting profits so just as likely to give false data as corporations

Risk Calculator for Cholesterol Appears Flawed
By GINA KOLATA Published: November 17, 2013

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Enlarge This Image Mark Graham for The New York Times Dr. Nancy Cook and Dr. Paul M. Ridker of Harvard Medical School found that a new online calculator used to assess heart treatment options overestimated the risks that many people face.

Multimedia Graphic Estimating Risk Related in Opinion Room for Debate When Medical Experts Disagree How should doctors and patients react to the latest findings that come out about health concerns? How do you know whom to trust?

The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

The controversy set off turmoil at the annual meeting of the American Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.

Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review. Both reported back that the calculator was not working among the populations it was tested on by the guideline makers.

That was unfortunate because the committee thought the researchers had been given the professors’ responses, said Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University.

Drs. Ridker and Cook saw the final guidelines and risk calculator on Tuesday at 4 p.m., when a news embargo was lifted, and saw that the problems remained.

On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.

Other experts said there has not been a real appreciation of the difficulties with this and other risk calculators. “I don’t think people have a good idea of what needs to be done,” said Dr. Michael Blaha, director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University, who was not associated with forming the new guidelines.

Dr. Blaha said the problem might have stemmed from the fact that the calculator uses as reference points data collected more than a decade ago, when more people smoked and had strokes and heart attacks earlier in life. For example, the guideline makers used data from studies in the 1990s to determine how various risk factors like cholesterol levels and blood pressure led to actual heart attacks and strokes over a decade of observation.

But people have changed in the past few decades, Dr. Blaha said. Among other things, there is no longer such a big gap between women’s risks and those of men at a given age. And people get heart attacks and strokes at older ages.

“The cohorts were from a different era,” Dr. Blaha said.

This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.

The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

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Do you know that the Baltimore VA is the worse run in the nation because funding cuts make it unable to operate as it should? Do you know that substance abuse treatment is part of the VA? So, why do we have cuts in funding for the VA but we have funding for private non-profits for VA? Do you know that there is a lack of public transparency with non-profits, so why would we do this?

Nonprofit to Open $2.3M Facility for Homeless Veterans
Tuesday, March 22, 2011 Related

A nonprofit is building a center to treat homeless veterans with drug or alcohol addictions in the Sandtown-Winchester neighborhood of West Baltimore.

The center at 1611 Baker St. will cost the Baltimore Station $2.3 million to build and acquire the property, executive director Michael Seipp says.

The west Baltimore site currently houses a former Catholic Rectory and two rowhomes. The 16,800-square-foot Baker Street Station will be the nonprofit's second treatment center.

Funding for the center comes from four sources: the Department of Veterans Affairs, the Maryland Department of Health and Mental Hygiene, the Abell Foundation, and the France-Merrick Foundation.

The Baltimore Station is also hosting a fundraiser April 14 in Federal Hill's Cross Street Market to raise money for the new center.

Many military troops in Iraq and Afghanistan are being asked to serve multiple tours of duty, which puts them at a higher risk of getting post-traumatic stress disorder, Seipp says. And many of these men turn to alcohol or drugs, which, in turn, can lead to homelessness.

Veterans represent about one-quarter of all homeless people, twice that of the civilian population, according to the center's statistics.
The Baltimore Station employs 28 and has a $2 million annual operating budget.

Writer: Julekha Dash
Source: Michael Seipp, Baltimore Station

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This is US military doing third world work on environment and worker safety overseas. You know neo-liberals who allow this behavior overseas will allow it to expand in the US. We are seeing all workplace protections in the US dismantled by Obama. Health care reform places required co-pays and deductibles that will keep all citizens.....vets as well from accessing the level of care needed.

Leaked Memo: Afghan ‘Burn Pit’ Could Wreck Troops’ Hearts, Lungs

By Spencer Ackerman
05.22.12
5:00 AM

A bulldozer dumps a load of trash into a burn pit just 300 yards from the runway at Bagram Airfield, January 2012. An Army memo from 2011 found the burn pit is associated with "long-term" health effects on soldiers at Bagram. Photo: U.S. Army

For years, U.S. government agencies have told the public, veterans and Congress that they couldn’t draw any connections between the so-called “burn pits” disposing of trash at the military’s biggest bases and veterans’ respiratory or cardiopulmonary problems. But a 2011 Army memo obtained by Danger Room flat-out stated that the burn pit at one of Afghanistan’s largest bases poses “long-term adverse health conditions” to troops breathing the air there.

The unclassified memo (.jpg), dated April 15, 2011, stated that high concentrations of dust and burned waste present at Bagram Airfield for most of the war are likely to impact veterans’ health for the rest of their lives. “The long term health risk” from breathing in Bagram’s particulate-rich air include “reduced lung function or exacerbated chronic bronchitis, chronic obstructive pulmonary disease (COPD), asthma, atherosclerosis, or other cardiopulmonary diseases.” Service members may not necessarily “acquire adverse long term pulmonary or heart conditions,” but “the risk for such is increased.”

The cause of the health hazards are given the anodyne names Particulate Matter 10 and Particulate Matter 2.5, a reference to the size in micrometers of the particles’ diameter. Service personnel deployed to Bagram know them by more colloquial names: dust, trash and even feces — all of which are incinerated in “a burn pit” on the base, the memo says, as has been standard practice in Iraq and Afghanistan for a decade.

Accordingly, the health risks were not limited to troops serving at Bagram in 2011, the memo states. The health hazards are an assessment of “air samples taken over approximately the last eight years” at the base.

The memo’s findings contradict years of U.S. military assurances that the burn pits are no big deal. An Army memo from 2008 about the burn pit at Iraq’s giant Balad air base, titled, “Just The Facts,” found “no significant short- or long-term health risks and no elevated cancer risks are likely among personnel” (.pdf). A 2004 fact sheet from the Pentagon’s deployment health library — and still available on its website — informed troops that the high particulate matter in the air at Bagram “should not cause any long-term health effects.” More recently, in October 2010, a Pentagon epidemiological study found “for nearly all health outcomes measured, the incidence for those health outcomes studied among personnel assigned to locations with documented burn pits and who had returned from deployment, was either lower than, or about the same as, those who had never deployed” (.pdf).

Over the years, thousands of Iraq and Afghanistan veterans have experienced respiratory and cardiopulmonary problems that they associate with their service. Some have sued military contractors for exposing them to unsafe conditions. For months, Rep. Todd Akin (R-Mo.) has urged the military to create a database of vets suffering neurological or respiratory afflictions, a move that’s winding through the legislative process. But the military has argued it doesn’t have sufficient evidence to associate environmental conditions on the battlefield with long-term health risks — and it argued that months after this memo is dated.

“As recently as April, in correspondence with the Defense Department and in discussions with my staff, the Departments of Defense and Veterans Affairs both continued to maintain that research has not shown any long-term health consequences due to burn pits,” Akin tells Danger Room. “They also maintained that remaining burn pits in Afghanistan were away from military populations to reduce exposure. It is disturbing to discover that at least at Bagram the military concluded that burn pits posed a serious health risk.”

The Iraq and Afghanistan Veterans of America (IAVA) has collected “hundreds” of anecdotes from vets complaining of health problems connected to serving near burn pits. “It’s good to see someone in the military is acknowledging there are going to be long-term problems with burn pits, but it’s disturbing that this memo is more than a year old and it doesn’t seem like the military has done anything about it,” says Tom Tarantino, IAVA’s deputy policy director, who deployed to Iraq in 2005 as an Army captain. “I lived next to a burn pit for six months at Abu Ghraib. You can’t tell me that was OK. That was pretty nasty. While I was there everyone was hacking up weird shit.”

Any visitor to the sprawling Bagram airfield knows the burn pit — if not by sight, then by smell. It’s an acrid, smoldering barbecue of trash, from busted furniture to human waste, usually manned by Afghan employees who cover their noses and mouths with medical breathing masks. Plumes of aerosolized refuse emerge from what troops refer to as “The Shit Pit,” mingle with Parwan Province’s already dust-heavy air, and sweep over the base. In February, that was where soldiers at the nearby Parwan detention facility accidentally incinerated the Koran.

At the time of the memo’s issuance, it noted that the affected population on the base contemporaneously was “40,000 Service Members and contractors.” Hundreds of thousands have cycled through the giant base since the U.S. seized it in 2001. Bagram is a major transit and logistics hub for the Afghanistan war, and one of the first bases the U.S. took and continuously operated during the war. Millions more have served in Iraq and Afghanistan near similar burn pits.

According to the Environmental Protection Agency, studies conducted on the effects of breathing in Particulate Matter 10 and 2.5 have determined “a significant association between exposure to fine particles and premature mortality.” The Army memo reports that Bagram’s air had twice the amount of Particulate Matter 10 than the federal National Ambient Air Quality Standard, and more than three times the amount of Particulate Matter 2.5 as the standard.

Burn pits remain in use across Afghanistan. And although a study by the Institute of Medicine and sponsored by the Department of Veterans Affairs found last October that there is insufficient data to correlate those pits with health risks, troops’ cardiovascular problems are clearly on the rise: There were 91,013 cases reported in 2010, up sharply from 65,520 in 2001. A 2010 study found half of a small sample of soldiers who struggled to run two miles had undiagnosed bronchiolitis. Hundreds of troops have sued the pits’ contractor operators after experiencing chest pains, asthma and migraines. For years, the U.S. government has pled ignorance about the causes of those veterans’ ailments. And unless the military formally acknowledges that the burn pits pose a long-term health risk, it will be difficult for veterans to receive long-term health care for associated respiratory and cardiopulminary ailments from the Department of Veterans Affairs.

“The acknowledgement that air-sampling data is now indicating that burn pits may pose a risk of chronic illness to our servicemen and women validates the need for the national burn pit registry that I have proposed,” Akin says. Tarantino backs him up: “We don’t want another Agent Orange scenario, where it takes 40 years for the military to admit the stuff was bad and then has to spend all this effort tracking down affected servicemembers.”

The U.S. Army and the NATO military command in charge of the Afghanistan war did not immediately respond to requests for comment.

Even casual visitors to Bagram know that the air is a menace. Within days of my most recent reporting trip there, in August 2010, I developed a disgusting, productive cough that kept me from sleeping comfortably. Airmen and soldiers joked with me about catching “Bagram Lung.”

But for at least a year, the U.S. military has known that “Bagram Lung” won’t stay at Bagram. There’s a significant chance that it will plague a generation of Afghanistan veterans for the rest of their lives.

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Do you know that the US is trying to end public subsidy for health care in nations overseas as the US is the worst for fleecing patients with fraud and profiteering? The ACA is all about the TPP and global health markets and we already see major hospitals marketing themselves overseas for healthcare tourism. As this article shows the only way the US can compete, having the worst health care quality and charging more for it, is to force other nations to charge more -------hurting US citizens and the world.

NEO-LIBERALS WILL EXPLOIT ANYTHING THAT MOVES!!!!!!

Heart Surgery in India

August 14th, 2013

By Dr. Mercola

The average cost of a coronary bypass at the Cleveland Clinic in Ohio is $106,385. In India, you can get the same procedure for 95,000 rupees, or $1,583, which is half the price it cost 20 years ago. And, efforts are underway to bring the cost down even more, to about $800, within a decade.

Follow up:

The lower cost is the result of one Indian heart surgeon’s quest to make health care more affordable for India’s population, where two-thirds live on less than $2 a day and most pay for health care entirely out of pocket.

His efforts to drive down costs include cutting out unnecessary pre-op testing and using Web-based computer software as opposed to building new systems for each hospital.

Even sourcing lower-priced disposable surgical gowns and drapes helps, showing that lower costs are not only attainable, but that the cost-saving measures could theoretically be duplicated in developed countries, including the US.

“The current price of everything that you see in health care is predominantly opportunistic pricing and the outcome of inefficiency,” Devi Shetty, the aforementioned heart surgeon, noted.1

More Americans Are Taking Advantage of Medical Tourism It’s because of drastic price differences like these that many Americans – upwards of 600,000 a year – are traveling abroad to receive medical care, a phenomenon known as ‘medical tourism.’ These numbers are expected to grow up to 20 percent annually,2 fueled largely by the aging Baby Boomer generation coupled with rising health care costs in the US.

Even after factoring travel expenses, including airfare and hotel accommodations for the patient and a guest, Americans may still save tens of thousands of dollars depending on the type of surgery received. According to Patients Beyond Borders, which specializes in medical tourism, if your total quote for US medical treatment is $6,000 or more, you’ll probably save money by traveling abroad for your care.3

India, where patients can receive savings of up to 85 percent on medical procedures compared to the US, remains a top medical tourism destination, but others, such as Costa Rica, which has a higher health system ranking than the US,4 are quickly gaining popularity.

There are certainly drawbacks to medical tourism, such as exposure to different kinds of superbugs and, sometimes, language barriers, so it’s crucial to do your research and educate yourself on the potential benefits and risks before trying this (including whether or not the surgery you’re being recommended is truly necessary).

But from a strictly cost-savings perspective, especially if you’re uninsured, it’s easy to see why this practice is growing. Here is an example of the price differences for some common procedures in the US compared to India, Thailand and Taiwan:5

US India Thailand Taiwan Hip replacement $33,000 - $57,000 $7,200 $12,700 $8,800 Prostate surgery (TURP procedure) $10,000 - $16,000 $3,600 $4,400 $2,750 Bypass surgery with heart valve replacement $75,000 - $140,000 $9,500 $25,000 $30,000
Why Are US Health Care Costs so High? Seeing the vast discrepancies in prices for medical procedures around the globe certainly begs the question of why US health care is so expensive. Contrary to popular belief, it’s not typically because the US provides better care.

The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia. Despite that, the US ranks dead last in terms of quality of care among industrialized countries, and Americans are far sicker and live shorter lives than people in other developed nations. How is this possible? The short answer is: We’re being fleeced. Journalist and author Steven Brill recently discussed this very issue in a Time magazine investigative piece, writing.6

“Simple lab work done during a few days in the hospital can cost more than a car. A trip to the emergency room for chest pains that turn out to be indigestion brings a bill that can exceed the price of a semester at college. When we debate health care policy in America, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?”

In his article, Brill gives numerous examples of shocking markups on many hospital charges, such as $1.50 for a generic acetaminophen tablet, when you can buy an entire bottle of 100 tablets for that amount, $18 per Accu-chek diabetes test strip that you can purchase for about 55 cents apiece, or $283.00 for a simple chest X-ray, for which the hospital routinely gets $20.44 for when it treats a Medicare patient.

Even Hospital Administrators Have a Hard Time Justifying Their Costs…

This is a Flash-based video and may not be viewable on mobile devices.

In the video above, CNN interviews a family blindsided by medical bills amounting to more than $474,000 after 60-year-old Bob Weinkoff spent just a few days in the ICU, suffering from difficulty breathing. Trying to break down the costs from an average hospital stay is daunting, however, and may be virtually impossible for the average patient. According to Brill, each hospital has an internal price list called a chargemaster, which contains every single item you may be given or come in contact with during your hospital stay. Even a toy given to a child (which many mistake as a “gift”) can be billed at upwards of $200. The problem is, no one quite knows how the prices in the chargemaster are created. Brill explained:

“It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it…

I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills... No hospital’s chargemaster prices are consistent with those of any other hospital, nor do they seem to be based on anything objective – like cost – that any hospital executive I spoke with was able to explain. 'They were set in cement a long time ago and just keep going up almost automatically,' says one hospital chief financial officer with a shrug.

...That so few consumers seem to be aware of the chargemaster demonstrates how well the health care industry has steered the debate from why bills are so high to who should pay them... [T]he drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.”

Today in the US, even nonprofit hospitals are making greater profits than some prosperous for-profit businesses, and hospital presidents and department heads can make upwards of $2 million to $4 million in annual salary.

Unnecessary Procedures Are Also Common It’s not only the inflated costs of medical care that the average American needs to be aware of but also the high likelihood that some of the procedures you’re being recommended are unnecessary. According to a report by the Institute of Medicine, an estimated 30 percent of all medical procedures, tests and medications may in fact be unnecessary – at a cost of at least $750 billion a year7 (plus the cost of emotional suffering and related complications and even death – which are impossible to put numbers on). Examples of care deemed to be of little or no benefit include the following.8

Using feeding tubes in patients with advanced dementia. Assisting such patients to take food by mouth is more advantageous to the patient EEGs on patients with recurring headaches. The test does not improve diagnosis or outcome, only increases cost Routine annual PAP tests on women between the ages of 30-65. Once every three years is enough Leaving implantable defibrillator on when a patient with incurable disease has elected to forgo resuscitation Using cough and cold medicine in children under the age of four suffering from respiratory illness. These medications offer little benefit, can have serious side effects and can lead to accidental overdose Repeat bone scans for osteoporosis more frequently than bi-annually. Healthy women over 67 with normal bone mass can go up to 10 years without repeat bone scan Use of benzodiazepines, such as Valium, sedatives, or sleep aids in older adults with insomnia, agitation or delirium. These drugs more than double risk of auto accidents, falls, hip fractures, and death Screening healthy individuals for cancer using CT or PET scans, as the likelihood of finding cancer with these means is only about one percent. The scans are likely to detect harmless growths, which lead to additional tests, biopsies and unnecessary surgeries Inducing labor or performing a cesarean section for a baby who's less than full term without medical cause. Labor induction and/or C-section can increase the risk of learning disabilities and respiratory problems Routine CT scans on children with minor head injuries. Simple observation is just as good, and spares the child from radiation-related health risks

The Solution? Take Control of Your Health Ultimately, the solution to avoid being ripped off by medical care costs, or having to make a decision about whether you’re better off traveling abroad to receive a certain procedure, is to stay as healthy as possible by taking control of your health. It's important to remember that the more you take responsibility for your own health – in the form of nurturing your body to prevent disease – the less you need to rely on the "disease care" that passes for health care in the United States. If you carefully follow some basic health principles – simple things like exercising, eating whole foods, sleeping enough, getting sun exposure, and reducing stress in your life – you will drastically reduce your need for conventional medical care, which in and of itself will reduce your chances of suffering ill side effects.

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We want to be clear, MD has never had even the most basic of mental health care even when Medicaid/public mental health was fully funded. Government watchdogs have shown that social workers having caseloads that far exceed the limit of what can be called 'care' has been the status quo in MD for decades as MD is one of the lowest in funding all things social service. So, before we start this 'new plan to help mentally ill patients' we need to remember that the current system only has patients on paper being handed PHARMA and sent on their way with no followup. Ergo, the system has patients feeding the PHARMA industry with taxpayer money and these patients falling off their meds---often having them stolen for resale on the black market----and no social worker followup because these staff have caseloads that will not allow it.

So, now since the financial crisis caused by moving tens of trillions of dollars by corporate fraud from government coffers, we watched as Medicaid funding was slashed at Fed and State level --Medicaid was gutted--along with these social services. Now, this insurance requirement is just that--insurance--not access. So, we will see more taxpayer money going to health businesses who will continue to ignore service to these patients because, it's all about the profit.

What makes it worse in MD is that Johns Hopkins, which is writing these policies, is privatizing all of public health services to private non-profits with no public oversight and lots of ability to take what is already 1/2 of Medicare/Medicaid spending lost to health industry fraud and place this on steroids. We have Hopkins busy researching and patenting bio-meds with its connections to corporate university partners and every incentive to market them. So, the failed system I describe below where the patient is seen only to be handed meds and then have them go lost or stolen soon after will continue.

The second piece to this other than the massive health industry fraud and corruption in the mental health area is the widening of what is considered 'depression'. Where we want people to access all available aid for what we know is a health issue, we know that people being depressed about normal upset in life and chronic depression that is clinical is now being made fuzzy..and it feels an awful like a reason to sell PHARMA to this medical academic.

The solution to gook health policy is to rebuild oversight and accountability into MD government. Well-written laws defining health fraud and tight enforcement will move the state back to cost effective and quality access to care for all. We encourage all MD to join Universal Care to get rid of profit-driven health care!

THE MENTAL HEALTH INDUSTRY USES PHARMA FOR MASSIVE FRAUD.

New rules require equal insurance coverage for mental ills

Baltimore Sun staff and wire reports 8:30 p.m. EST, November 8, 2013

Most Americans with health insurance will be guaranteed access to mental health services, including for depression and alcoholism, equal to medical and surgical treatment under long-delayed rules issued Friday by the Obama administration. But the protections do not apply to tens of millions of people, including the elderly.

The rules implement the 2008 Mental Health Parity and Addiction Equity Act, which took on greater urgency with the administration's vow to address gun violence after a series of mass shootings across the United States in the past few years.

Health and Human Services Secretary Kathleen Sebelius estimated that 90 percent of Americans with substance-use disorders do not receive the care they need.

"For way too long, health plans openly discriminated against" Americans with mental illness, she said in a call with reporters Friday. Labor Secretary Thomas Perez called mental illnesses "the stepchildren of the health care system."

Behavioral Health System Baltimore, a nonprofit that funds behavioral and mental health programs, said the new rules would improve access to treatment for those with mental health problems.

It "is a crucial step toward ensuring that these conditions are treated no differently than any other illness," the group said in a statement. "We see this as significant progress toward removing those obstacles and stigmas that often prevent or discourage people from seeking treatment."

In any given year, about one-quarter of American adults have a mental illness that meets diagnostic criteria, according to the National Institute of Mental Health.

Under the final rules, health plans must not have different co-pays, deductibles or visit limits for mental disorders and substance abuse than they do for other illnesses.

If they allow people to receive out-of-state treatment for, heart disease, for example, then they must do so for mental illness as well. If an insurance plan uses particular clinical guidelines in determining what medical conditions and treatments to cover, it must use comparable ones for mental disorders.

Covered health plans are also prohibited from imposing a separate deductible for mental health treatment. And they cannot limit patients to receiving mental health treatment only from licensed social workers rather than physicians and psychologists, as some plans have done to limit spending.

Dr. Peter Beilenson, who started the insurance co-op Evergreen Health Cooperative Inc., applauded the decision, because, he said, people with mental-health problems are often underserved. Many visits to primary-care doctors are because of a mental health condition, such as depression. These people really should see mental-health professionals, he said.

Health centers that serve Evergreen members will have mental-health professionals on site.

"I think it is an absolutely wonderful thing and it is a long time coming," he said.

The rules had been so long in coming that on Thursday, former Rep. Patrick Kennedy, who was instrumental in passing the 2008 law, told a Senate panel that it had "entered a kind of twilight zone." The five-year wait was a "particularly bad example" of how laws can languish without being implemented, said Kennedy, who has discussed his battles with bipolar disorder and addiction to prescription drugs.

After passage of the 2008 mental-health parity law, more than 30 states passed laws of their own implementing its requirements, including Maryland. But the largest plans, since they are regulated at the federal level, were not affected by state laws.

President Barack Obama's health care reform law requires that all individual and employer-based health insurance policies, including those sold on the state-based insurance exchanges, cover mental health and substance abuse as one of 10 "essential health benefits." The only exceptions are those few plans that have been unchanged since the law was signed in March 2010.

As a result, the final rules on mental-health parity have already been largely incorporated into plans sold since Oct. 1 on the online exchanges set up under the Patient Protection and Affordable Care Act, also known as Obamacare. They are also part of most employer-based plans, according to the administration, which estimates that mental-health treatments make up 5 percent of the benefits that plans pay for.

Loopholes remain, however.

The parity rules do not apply to standard Medicaid plans, the joint federal-state program for poor Americans. If states require Medicaid beneficiaries to enroll in managed-care plans, however, those plans must cover mental-health treatment.

A bigger loophole is that the rules do not apply to Medicare, the government-run health care program for the elderly.

The 2008 parity law included that exemption "because it was a cost issue," said Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness. "They would have had to make up the additional costs elsewhere" by cutting other benefits, "and Congress didn't want to do that."

Depression alone affects more than 6.5 million of the 35 million Americans old enough for Medicare, the alliance estimates.

"Medicare," Kennedy said, "still has a distance to cover in its journey to parity."

Large employer-based plans also have an escape hatch. If mental-health parity causes their costs to increase at least 2 percent in the first year it's in place, or 1 percent any subsequent year, the plan may apply for an exemption. Sperling said he believes the exemption will be onerous enough to apply and qualify for that few employers will request it, however.

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Raise your hand if you know that this health reform that creates private state health insurance is all about sending entitlements and public sector pensions into these state systems ending these Federal programs! Medicaid has already been dismantled as a Federal agency and is now in state exchanges and Medicare will be next. THEY ARE BUILDING THE STRUCTURE TO END ALL ENTITLEMENTS. Neo-liberals in Congress are afraid that republicans will win in 2014 because all public policy coming from Capitol Hill has been republican policy----from health care reform to education reform et al. THE DEMOCRATIC BASE OF LABOR AND JUSTICE ARE 80% OF THE DEMOCRATIC PARTY------WE WILL BE VOTING NEO-LIBERALS OUT OF THE PARTY, NOT VOTING FOR REPUBLICANS FOR GOODNESS SAKE!

OpEdNews Op Eds 11/3/2013 at 08:23:03

What's Scary? Lumping the Affordable Care Act in with Medicare
By Steve Blank (about the author)

Steve Blank is a broadcast journalist with the Health Writers collective of Madison, WI. The radio program focuses on issues of social and economic justice. Steve is a founding member of Madison's Single Payer Action Network and serves on several (more...)

On Tuesday, when Marilyn Tavenner took responsibility for the failure of HealthCare.gov to launch effectively, I was confused and troubled.

"I want to apologize to you that the website does not work as well as it should," she told the House Ways and Means Committee, adding that HealthCare.gov "can and will be fixed."

Why was I confused? Because Marilyn Tavenner is the head of the federal Centers for Medicare and Medicaid Services (CMS), and it hadn't occurred to me that the ACA would fall under the auspices of CMS. After all, the ACA operates under a completely different model than Medicare and Medicaid which are federal programs that use tax dollars to subsidize payments to health care providers and hospitals. On the contrary, the ACA's Marketplace uses tax dollars to subsidize payments to private health care insurers.

This is a critical distinction, and it begins to explain why the ACA confuses so many people. The ACA uses federally collected dollars to subsidize health care, a long-sought aspiration of liberal health care expansion, but the money ends up in the hands of shareholders and CEOs, a characteristic of neo-liberal federal spending. The ACA, unlike Medicare and Medicaid, is not a public service at all, but a conduit for flowing tax dollars into the pockets of CEOs and shareholders of private insurance corporations.

The ACA does more than maintain the status quo, it reinforces an obsolete insurance model that was never good in the first place. So long as employer-based health insurance remains a "perk" for full-time workers, employers will be encouraged to reduce employee hours, lowering workers' pay, and freeing businesses from the legal obligation to provide their employees with health insurance. The notion that the workers can then simply go to the exchange for comparable insurance is a fallacy because their yearly incomes and benefit packages have just been reduced. Paying for health care insurance that used to be a perk of your job after your pay has been reduced is an unfair burden, even at subsidized rates.

While it is true that the employee's reduced income may mean she/he is entitled to federal health insurance subsidies on the ACA Exchange, it is important to realize that these subsidies are being paid to the private insurance companies for brokering the deal instead of being paid directly to health care providers and hospitals, as it is under the Medicare program. Ultimately, the insurance corporations are the ones being subsidized, not low-income people.

This law is a travesty, and it may effect the way public spending is framed in future discussions. And this is why I am so troubled. Lumping the ACA in with CMS sets a dangerous precedent. If embraced by our non-representatives in Congress, the practice of subsidizing private corporations to run federal programs that have historically been publicly operated is very likely to become the new model for Medicare and Social Security in the future. (We already see this happening with our public education system and the corporate-run charter school explosion).

The ACA positions health care as a corporate commodity and distances us from a place where health care is embraced as a human right. The shareholders are winning and people are losing. This is not the road toward Single Payer, and any foggy notion to see it as such must be resisted.

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As you see, health care reform was about maximizing health industry profit and you see that inpatient numbers are falling as people are forced into outpatient settings for even invasive procedures. As it says here....preventative care is the money maker as checkups are all that most people will have and there is no expense to that!

LifePoint Posts Big Q3, Profit Soars 71%

Written by Bob Herman | October 25, 2013

Brentwood, Tenn.-based LifePoint Hospitals recorded $32.8 million of profit in the third quarter of this year, a 71 percent jump from the third quarter of 2012 and the best quarter of the company's 2013 fiscal year.

LifePoint's revenue and EBITDA in the third quarter both increased significantly as well. Revenue soared 9.7 percent to $899.7 million, and adjusted EBITDA increased 25.1 percent to $134.3 million.

Outpatient volumes drove much of the positive movement for LifePoint in the third quarter, while the inpatient side remained soft. Same-hospital outpatient surgeries increased 3.5 percent, while inpatient surgeries dropped 5.2 percent. Admissions fell 4.3 percent.

For the nine months ended Sept. 30, LifePoint's profit is still lagging due to poor first and second quarters. Net income totaled $92.6 million, down almost 20 percent from the first nine months of 2012. Revenue, however, increased 9.1 percent to $2.73 billion.

Bill Carpenter, chairman and CEO of LifePoint, said the company was "pleased" with the third-quarter results. He thinks LifePoint is poised to enter 2014 with a strong financial profile, and more hospital acquisitions are expected in the near future.

"While the overall volume environment remains challenging, our strategic initiatives drove growth in outpatient volumes. Our M&A program remains active, with all pending acquisitions on track to close within the next six months," Mr. Carpenter said. "Our recently acquired hospitals are performing well, and we have a strong pipeline of potential opportunities. We have the processes and people in place to maximize enrollment on healthcare exchanges and in government programs, and we believe we are well positioned to benefit from the new healthcare environment."

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This tax was put in place simply to eliminate strong health policies for public employees. Why would a democrat place this burden on public sector unions? The Affordable Care Act is only about maximizing corporate profit and having employees with strong health care in the public sector means public revenue would go to the employee and not to private projects.

Obamacare's Cadillac Tax Forces a Tough Decision on Governments The law's new excise tax on high-cost health insurance plans leaves government officials with three choices -- all of which have undesirable consequences.
by Ryan Holeywell | November 2013 0 8 0 0 0

For years, the philosophy on compensation for public-sector workers has been fairly straightforward: The pay isn’t always great, but the benefits are. But that’s changing, and the political implications could be big for public officials.

Under the terms of the Obama health reform law, so-called “Cadillac” health insurance plans worth more than $10,200 for individuals or $27,500 for families face a 40 percent excise tax starting in 2018. The logic behind the plan is that rapidly exploding health costs are driven partly by overconsumption of health-care services by Americans who have little skin in the game thanks to low co-pays and deductibles. The goal is to tax the most generous Cadillac plans to drive people toward plans that make them contribute more. Taxes collected from those who stay in Cadillac plans could be used to fund other aspects of the law.

But these taxes are proving be a thorn in the sides of public-sector employers and workers, who have long understood that strong health-care benefits are often granted in lieu of less-than-stellar pay. Because the threshold is indexed to inflation—not health-care costs, which historically increase at a much faster rate—the assumption is that more plans will be subject to the tax each year. Already, it’s started coming up in multiyear negotiations between governments and workers.

The Cadillac tax will be levied on health insurance companies, which many expect will pass the tax along to governments. That leaves government officials with a big decision: They can cut employees’ health plans so they fall below the Cadillac threshold; pass the tax cost on to workers; or eat the tax themselves and make other budget cuts. Each choice has consequences. “Quite honestly, the decision is almost unmakeable for a local official,” says Sonny Brasfield, executive director of the Association of County Commissions of Alabama.

The feds estimate that 12 percent of all insured workers will be in plans affected by the excise tax in 2019. It’s hard to say how many of that percentage will be public-sector workers, but most assume they’ll be impacted at a much higher rate than the average worker. Barbara VanEpps, deputy director of the New York State Conference of Mayors and Municipal Officers, estimates that at least two-thirds of her members’ employees could be impacted. She says her organization is trying to educate both sides about the tax so that when it’s time to negotiate, it’s something employers and employees will understand.

Unlike private-sector CEOs—who might damage their relationship with employees but wouldn’t risk losing their own jobs—the stakes are higher for government leaders who cut benefits. Politically powerful unions could cost officials their jobs if they’re unhappy with potential health-care cuts. If taxes have to rise or other services are cut to pay the Cadillac fee, then elected officials will likely anger taxpayers. Essentially, state and local politicians are in the unenviable position of being thrown into a fight they didn’t even pick.

The unions initially scored a victory by delaying the tax until 2018, and some cynics say they’ll use the time to continue fighting for its repeal. But already its impact is starting to be felt. In Orange County, Calif., for example, the Newport-Mesa Unified School District reportedly predicts the tax could cost $2.3 million in its first year. (Three public unions—the American Federation of State, County and Municipal Employees; the American Federation of Teachers; and the International Association of Fire Fighters—didn’t comment for this story.)

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This does a good idea of explaining what I've been saying from the beginning of Obama's term......

Obamacare: The Biggest Insurance Scam in History
Wednesday, 30 October 2013 10:21 By Kevin Zeese and Margaret Flowers , Truthout | Op-Ed

The Affordable Care Act (ACA), also called "Obamacare," may be the biggest insurance scam in history. The industries that profit from our current health care system wrote the legislation, heavily influenced the regulations and have received waivers exempting them from provisions in the law. This has all been done to protect and enhance their profits.

In the meantime, the health care crisis continues. Fewer people, even those with health insurance, can afford the health care they need because of out-of-pocket costs. The ACA continues that trend by pushing skimpy health plans with low coverage and restricted networks.

This is what happens in a market-based system of health care. People get only the amount of health care they can afford, rather than what they need. The ACA takes our failed market-based system to a whole new level by forcing the uninsured to purchase private health plans and using the government to sell and subsidize them.

Sadly, most Americans are being manipulated into supporting the ACA and do not even know they are being bamboozled. That is how scams work. Even after the con is completed, victims do not know they have been manipulated and ripped off. They may even feel good about being scammed, thinking they made a deal when they really had their bank accounts picked. But it is the insurance companies that are the realizing windfall profits from the Obamacare con even as it falters.

The mass media is focused on the technical problems with getting the insurance exchanges up and running. These problems result from the complexity of the law and outsourcing of services to corporations that are often more costly and less effective than government. In comparison, in 1965 when Medicare started, everyone 65 and over was enrolled within six months - using index cards.

If all US residents were in one plan, Medicare for all, rather than the ACA's tiered system that institutionalizes the class divides in the United States, not only would the health system be fairer and improve health outcomes, but it would be less bureaucratic, less costly and easier to implement. The Medicare-for-all approach considers health care to be a public good, something that all people need, like schools, roads and fire departments.

Rather than being distracted by the problems of the exchanges, the more pressing issue is whether we want to continue using a market-based approach to health care or whether we want to join the other industrialized nations in treating health care as a public good. This conversation is difficult to have in the current environment of falsehoods, exaggerations and misleading statements coming from both partisan directions, echoed by their media supporters and nonprofit organizations.

Of course, the Republicans attack Obamacare for partisan reasons. And they are often blatantly dishonest in their criticism. Their foundational claim, calling Obamacare socialized medicine, is the opposite of reality. And, the Obama administration and its allies in the nonprofit world also have their fair share of falsehoods about the ACA. We will describe these farther below.

A Primed Public

In reality, the US health care system is the worst of the wealthy nations. We spend the most per person, have the lowest percentage of our population covered and have poor health outcomes. Forty-five thousand adults die each year merely because they do not have insurance, and 84,000 Americans die each year of preventable illnesses that would not die in the French, Japanese or Australian health systems.

Even those with insurance find it to be inadequate when they get seriously ill. Medical costs and illness are the greatest reasons for bankruptcy, and insurance does not prevent financial ruin. Every family is touched by the failures of US health care.

The Institute of Medicine issued a report in 2013, US Health in International Perspective, that documents the failure of the US health care system. In summary: "Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, 'peer' countries."

The health care crisis had grown to such proportions that by the 2008 election it could not be ignored. It was a major topic of the presidential campaigns. The health industries knew this and invested heavily in the candidates. Candidate Barack Obama overwhelmingly received more in donations from health care-related industries than any of the other candidates.

The public was ready for health care reform. Knowing that the majority of the public supports a Medicare-for-all system, it was going to take serious planning to silence that majority and enact a law that protected the interests of the health industries.

Obamacare: The Insurance Scam

A scam is a fraudulent operation designed to make money. A scam unfolds over time with a team of swindlers seeking to rob the victim without the victim ever knowing they have been scammed.

In Confessions of a Confidence Man, Edward H. Smith lists the "six definite steps or stages of growth in every finely balanced and well-conceived confidence game." Let's go through these six steps and see how the process of selling the ACA to the public fits.

1. Develop the Foundation

The foundation of a scam is the preparation done ahead of time to set up the scheme. In the case of the ACA, the foundation began with the health law passed by Massachusetts in 2006. The template was created by Stephen Butler of the Heritage Foundation, a conservative think tank. The law was passed under a Republican governor, Mitt Romney.

The next task was to sell this idea to Democrats. The Robert Wood Johnson foundation gave a major assist when it made large grants to state health reform groups in 2008 to promote Massachusetts-style reform in their states, called the "public-private partnership" model.

To further sell the ACA, Roger Hickey, a longtime Medicare-for-all advocate of the Campaign for America's Future (closely allied with the Democratic Party), took an idea from Jacob Hacker to create a new public insurance modeled after Medicare to 'compete' with private insurance. Hickey sold the model to progressive groups, and Hacker's proposal was used by the Obama campaign.

In July, 2008, Hickey and others rallied progressive groups to create a new coalition, Health Care for America Now, which received tens of millions of dollars to build grass-roots support for the ACA. The name was similar enough to the longtime Medicare-for-all organization, Healthcare-Now, to cause confusion.

2. The Approach

The approach is the way that the con artist gets in touch with the victim. The vehicle for the ACA con was the tech-savvy political campaign of Barack Obama. The candidate promised hope and change. Obama, who had supported single payer before running for president, was able to point to all of the problems in the US health care system and excite people with the potential of a new leader who understood the crisis and would fix it.

After his election, the campaign organized Health Care House Parties in December 2008. People were encouraged to invite friends and neighbors to their homes, and the Obama transition team provided the materials. The booklet that was used was tightly scripted to build support for the ACA rather than actually elicit citizen input on what kind of health system was desired.

3. The Buildup

In this stage, the victim is excited about the prospect and is filled with anticipation so their judgment is warped and caution is thrown away, setting them up to fall for the scam.

Throughout the winter and spring of 2009, the Obama administration gave the appearance of bringing all of the "stakeholders" together to work for health reform. The president held a White House Health Summit in March 2009, which included representatives from health insurance corporations, hospitals and pharmaceutical companies. The only groups that were not included, until there was a threat of protest, were those who advocate for Medicare for all. The single-payer advocates did not speak, but the insurance spokesperson opened and closed the White House summit.

Throughout the spring, the president and allies reassured the public that if they liked their health insurance, they could keep it; that insurance would be made more affordable (not that health care would be more affordable); and that reform would aim for universal coverage.

4. The Convincer

The convincer for many who supported real health reform was "the Public Option." The idea was that the law would force the uninsured to purchase insurance but would include the choice of a public health insurance plan. The public was told that this option would be more cost-effective than private insurance and, thus, less expensive, which would make it more attractive.

Many were convinced that a public option would become a Medicare-for-all system, that it was a "back door" to single payer. They were told that going straight to a single-payer health care system would be too difficult and that the public option was a first step. Health Care for America Now organized grass-roots groups to put their energy into fighting for a public option, and many responded.

There was real animosity directed toward those who pointed out that from a policy standpoint a public option made no sense. It was simply adding another insurance plan to an already-complex and expensive system of hundreds of insurances and that, as had occurred time and again at the state level, it would attract those with the greatest health needs and as a result would ultimately fail because of high costs.

What most people did not understand at that point was that the public option was not only a non-solution to the health care crisis but that it was not even destined to be in the final legislation. Senator Max Baucus reported in March 2009 that it was a "bargaining chip" to get health insurers to accept regulations. Glenn Greenwald exposed this more fully when the Democratic leadership in the Senate actively worked to keep the public option from being included in the Senate health bill. The public option was just part of the con.

5. The Hurrah

The Hurrah phase of a con involves some sort of crisis that must be overcome. This phase started in August 2009, when the Tea Party, backed by Americans for Prosperity (a Koch brothers front group), came out very aggressively against the ACA at local town halls. They called it "government-run" and opposed its fictional "Death Panels." This served to energize the progressive groups to rally around the president and come out strongly in favor of the law. Rallies in favor of health reform were organized across the country.

Health reform advocates were activated further to support the law as the House and Senate struggled to come to consensus. As more aspects of the law that were important to health reform supporters were jettisoned, such as coverage for immigrants and inclusion of reproductive services, and the public option was whittled down to nothing, support for the law became a partisan statement of support for President Obama.

Members of Congress who supported the Medicare-for-all approach told us that they were going to "hold their nose and vote for it." Progressive groups and media feared that if the health bill did not become law, it would ruin the Democrats' chance to hold a majority in Congress in the midterm elections and would destroy the president's chance to be re-elected.

6. The In-And-In

The purpose of the final phase of the con is to make sure the victims do not realize they've been conned.

Obama signed the ACA on March 23, 2010. Immediately the marketing began. The three words we heard the most to describe it were universal, affordable and guaranteed. Of course, the ACA is none of those. But members told us personally that if they told the truth, they wouldn't be re-elected.

Progressive groups started the work of explaining the advantages of the new health law to the public. The few positive aspects of the law were promoted without explaining the big picture. Overall, the ACA is similar to other neoliberal economic policies; it defunds and destroys our public health insurances and further privatizes health care.

The end goal of the ACA con, to make sure people do not realize they have been conned, is ongoing. As we will see below, salespeople, often the same nonprofits who pushed the ACA, are getting big money to sell insurance with Madison Avenue marketing manipulation tactics.

At the same time, leading single-payer advocacy groups fear further marginalization in their communities and so are afraid to tell the truth about Obamacare. The public has been so hoodwinked by the partisan debate between Republicans and Democrats, based on misinformation from both sides, that single-payer advocates are afraid if they tell the truth, their allies, many whom are Democrats, will push them away. So the truth has few emissaries, while the well-funded deceivers continue the ACA con.

The Con Continues: The Product

A fundamental problem with the ACA is that it is based on continuing our complicated private health insurance or market-based system. Despite their advertising slogans, private insurers primarily exist to create profit for their investors or, in the case of "nonprofit insurers," to pay exorbitant salaries to their executives. They care about health as much as Big Oil cares about the environment.

Health insurers make their profits from charging the highest premiums they can and by restricting and denying payment for care. They want to take in as much money as they can, while paying out as little on health care as possible. They have many tools with which to do this, and they've successfully skirted regulations for decades. When they can't make a profit, they simply pull that product from the shelf and create new products.

The public has been led to believe that the ACA has changed the behavior of health insurers. In this section we briefly explain some major areas of concern and why many of the promises of the ACA are false.

More-expensive insurance premiums: A major promise was that people could keep their insurance if they liked it, but many are finding that this isn't working out. Kaiser Health News reported last week: "Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies." The Society of Actuaries released a report in March 2013 that showed insurance pools are set to see an average increase of 32 percent in underlying claims costs by 2017.

The Charlotte Observer reported: "Across North Carolina, thousands of people have been shocked in recent weeks to find out their health insurance plans will be canceled at the end of the year - and premiums for comparable coverage could increase sharply."

The increase in premiums will force more people to use the state health insurance exchanges, where prices are supposed to be more affordable, but even that is not a solution. Russell Mokhiber of Single Payer Action describes the dilemma he faces in West Virginia. Mokhiber received a notice that his current insurance expires January 1, 2014. If he wants to keep his plan, it will cost twice as much. In his state only one insurance company, Highmark, will be listed on the exchange. He called Highmark to find out what his choices were and got bad news: "The skimpiest plan is going to cost me more than I'm paying now and have a higher deductible and out-of-pocket costs."

There are reports of increased premiums from across the country. One reason for the increase in cost is, as USA Today reports: "About a third of insurance companies opted out of participating in the exchanges in states where they were already doing business, according to a recent report by McKinsey & Co. About half of states … will see a 'material decline' in competitors."

Decreased coverage: The ACA will increase the number of people who have inadequate insurance that requires high out-of-pocket costs and does not cover all necessary services. The ACA significantly lowers what is considered to be adequate insurance coverage through its system of tiers. The insurance exchanges offer four levels of coverage, with the least-expensive plans paying for 70 percent and 60 percent of covered services.

These plans include high co-pays and deductibles that are barriers to care - especially when 76 percent of Americans are living paycheck to paycheck. And insurers are restricting coverage further by limiting their networks so they do not include major medical centers or adequate numbers of health professionals.

It is important to highlight that insurers pay only for covered services because people don't usually understand that they will have to pay for uncovered and out-of-network services themselves. The use of out-of-network services is often involuntary and occurs without being known at the time of care, especially in emergency situations.

The New York Times reports:"Most of the 15 exchanges run by states and the District of Columbia do not have provider directories or search tools on their Web sites - at least not yet - so customers cannot easily check which doctors and hospitals are included in a particular plan's network."

People are likely to choose the least-expensive plans without fully understanding that a serious accident or illness could bankrupt them even though they have insurance. And the race to the bottom in coverage will affect everyone. It is already estimated that 44 percent of large employer-based plans will be high-deductible plans by 2014.

Tricks to mistreat those with pre-existing illness: One of the great selling points of the ACA con is that those with pre-existing illnesses will not be denied coverage. This is true, but insurers have many ways to avoid the ill. The ACA was written by an insurance company executive from Wellpoint, Liz Fowler, who went on to be hired by Obama's HHS to implement the law and now works for a pharmaceutical giant. So, all along the way, the insurance companies had someone protecting their interests.

One way to avoid the sick was mentioned above: excluding hospitals where people with serious health problems go, like major medical centers. Another way is by providing poor service to people who have a lot of claims so they change insurers. And a third has to do with the fact that insurance companies are allowed to charge more in geographical areas where health costs are higher. If a plan in a particular area is not making enough profit, the insurance company can simply stop selling in that area.

Insurance companies also can charge three times as much based on age. Because most pre-existing illness comes with age, this greatly undermines the protection of those with pre-existing illness. Insurance companies are excellent at gaming laws and regulations, so we can expect more creative avoidance of people who actually need health care.

Almost no reduction in youths without insurance: One of the highly touted claims of the ACA con was that youths would be covered on their parents' insurance until they are 26 years old. While this is true, the percentage of 19- to 26-year-olds without insurance has merely fallen from 48 to 41. Why? Most parents cannot afford the increased premiums that are required when more family members are covered. As a result this promise has been one of little value, except to the wealthy - and to those selling the Obamacare con.

No cap on out-of-pocket spending: One of the selling points of the ACA con was that it would limit how much people pay out of pocket for health care. Of the thousands of waivers granted by HHS, one was the limit on out-of-pocket spending. The insurance companies claimed that their computers were not set up to handle this change. HHS took this absurd rationale seriously and gave them a waiver on this important provision.

The Con Continues: The Dealers

The most egregious aspect of the ACA is the individual mandate that those without health insurance who do not qualify for public insurance such as Medicaid must purchase private insurance or pay a penalty for being uninsured. The public is being led to believe that the solution to the health care crisis is to increase the number of people who have insurance. This ignores the fact that having insurance does not mean that patients will have access to or will be able to afford the health care they need.

The ACA required states to create new marketplaces for insurance called exchanges or else the federal government would create the exchange. In essence, the federal government is using billions of public dollars to finance the exchanges, hire people to sell insurance and subsidize the purchases. Imagine what a benefit it would be if those billions of dollars were used instead to hire health providers and pay for actual care.

The federal government plays a big role in running 26 of the state health exchanges but is funding all of them. The annual cost of operating the exchanges will be $15 million to several hundred million per state. In the end, consumers will pay the cost through monthly surcharges tacked on to their premiums.

Part of the federal spending will be on "navigators" and "assisters," people whose job it is to help people buy insurance. The Obama administration announced in 2013 that it would be directing $200 million to states, private groups and local health centers so that they can hire workers, called navigators, to sell insurance to Americans.

How are navigators paid? A House Committee on Oversight and Reform issued a report on September 13, 2013, that examined how navigators will be paid. One problem is that many are paid based on the number of people they enroll. Obviously this could lead navigators and assisters to not merely "facilitate" enrollment but to persuade people to enroll. And navigators are not required to disclose this incentive.

This payment structure is just one problem, the House report summarizes, warning of scammers:

"… the training to be Navigators and Assisters will last only five to 20 hours and there is no requirement for a background check of Navigators and Assisters who will have access to highly sensitive personal information, such as Social Security numbers, dates of birth, and income for everyone in an applicant's household. Given the stories about how scammers are gearing up to take advantage of the tremendous confusion caused by ObamaCare, Americans are at an increased risk of being the victim of fraud and identify theft because of the Administration's poor development of its outreach programs."

The official navigators and assisters are only one part of the continued conning of America. The groups that advocated for Obamacare have evolved into Enroll America. The group (whose logo is incredibly similar to insurance giant Wellpoint) not only includes advocacy organizations but also interests that profit from the market-based US health care system, e.g. insurance companies, hospitals and pharmaceutical companies. The president of Enroll America, Anne Filipic, served in the Obama White House, the HHS, the Democratic National Committee and in Obama's 2008 campaign.

Information on the budget of Enroll America has been vague. In June Reuters reported: "In a conference call with reporters, Filipic declined to answer repeated requests for details on the group's budget. In January Congressional Quarterly reported they were eyeing a $100 million budget and quoted founder Ron Pollack, who led an NGO that lobbied for Obamacare, saying: "We keep on saying it's got to be in the significant tens of millions of dollars, and hopefully we reach another digit." Reuters reported that the cost of the public outreach campaign would range into the tens of millions of dollars, with "at least seven figures" going to paid advertising. In a press release they described the advertising campaign:

"Enroll America plans to organize a massive public education/advertising campaign about coverage eligibility and the ways people can enroll in coverage. We expect to involve well-known athletes and celebrities in the campaign. The advertising campaign will be segmented so that it effectively reaches different demographic groups, such as young adults, people in communities of color, low- and moderate-income families, etc. Depending on the availability of resources, we may be able to tailor ads to specific states."

The campaign is expected to spend tens of millions of dollars on polling, focus groups, paid advertising and running its operations with a staff of a few hundred people. Americans will be subjected to all of the tools of Madison Avenue marketing through Enroll America along with sales by navigators, assisters and the insurance industry.

How is Enroll America raising money? Secretary of Health and Human Services Kathleen Sebelius has been one of the fundraisers for the organization. According to the New York Times, her fundraising has caused a political uproar, with some Republicans claiming it was illegal and two House committees investigating the activity. They report: "Senator John Barrasso of Wyoming and Representative Jack Kingston of Georgia, both Republicans, said Ms. Sebelius appeared to be 'shaking down' businesses and other potential donors." The Hill echoed this, reporting that insurance companies felt like they were being pressured by the administration to donate to Enroll America. One concern is that HHS has a lot of power over insurers as the agency can delay or deny approval of their health-insurance plans for federally approved exchanges.

Sebelius is seeking funds from groups like Robert Wood Johnson Foundation and H&R Block. And the Hill noted "Obama himself made a vague but personal appeal for a close partnership with insurers, which some in the industry saw as a precursor to direct fundraising pitches." In April 2013, "Obama reportedly sat in for an hour-long meeting he was initially not scheduled to attend and told insurance executives that the White House and the industry were now "joined at the hip" trying to make the healthcare law work."

Americans want health care, so why do they have to spend so much money to convince people to buy ACA insurance? The American people will be subjected to a sophisticated, echo chamber of marketing to sell them flawed insurance that provides insufficient coverage, huge out-of-pocket costs and limited networks of health professionals and hospitals.

Understand the Con, End It and Replace It

The ACA con is part of a broader con Americans and people around the world are having inflicted on them, the false idea that privatization is a better way to provide services than government. Even though there is virtually no evidence to support this claim and there has been a long history with many examples of privatization costing more and providing less, this is a centerpiece of neoliberal economics. Politicians like President Obama and the leadership of the corporate duopoly who believe in market solutions are pushing privatization at home and through big-business-rigged trade agreements like the Trans-Pacific Partnership.

The fundamental flaw of the ACA is that it entrenches a market-based system that treats health care as a commodity and profit center for Wall Street. The big drivers of the rising cost of health care - insurance, pharmaceuticals and for-profit hospitals - continue. The wealth divide that is a major byproduct of neoliberal economics is institutionalized by law under the ACA. Some, like Senator Ted Cruz, will receive the best health care from their employer, in Cruz's case his wife's employer, Goldman Sachs. Others, forced into the individual insurance marketplace, will be divided in four classes based on wealth, and millions will be in Medicaid, the inadequate health plan for the poor. Thus, after a high-stakes partisan battle, we've made no progress in confronting the fundamental problems in US health care. Indeed we have made some of them worse.

There was an easier route and a more politically popular route. All that President Obama had to do was to push for what he used to believe in, Medicare for all. By just dropping two words, "over 65," the United States would not have needed the 2,200-page ACA. Then the country could have worked to gradually improve Medicare so that the United States moved toward the best health care in the world, rather than being mired at the bottom.

To replace Obamacare with the single-payer system, we need to be clear about the shortcomings of the law, especially its fundamental flaw of making a human right, one of many human rights Americans do not realize they have, into a commodity like a cellphone. We need to recognize that ending the corporate domination of health care is part of breaking the domination of big business over the US government and the economy. Health care is at the center of the conflict of our times, the battle between the people and corporate interests, the battle to put people and planet before profits.

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Raise your hand if you see how consumers will be soaked and have no choice or control if these health systems promoted by Evergreen get off the ground..EVERYBODY. Imagine, a automobile manufacturer, mechanics, auto insurance, and auto sales all fell under the same corporate umbrella. How do you think consumers would fare as regards quality/access and service? The manufacturer sells you a car reasonably priced because once you have it they will soak you with the insurance rate, repair bills, and re-sale. THAT IS THE TECHNOLOGY MODEL OF SELLING A CELL PHONE FOR NEXT TO NOTHING AND THEN SOAKING PEOPLE FOR CONNECTION, APPS, AND DOWNLOADS.

For those not reading the Wall Street news that is the goal of these 'co-op' systems that will handle largely the middle-class because they are the one's with enough wealth to soak. So, think Hopkins hospital with its own insurance, medical device/procedure R and D, teaching school, and control of public health and you have the concept of EVERGREEN. If you join them you have to buy and use everything else in the system. This is naked capitalism and you see they are labelling it as socialism with the co-op theme.

MD citizens have already decided they are going with Universal Care. We know health care is a right and that trillions lost to health fraud need to fund equal care for all. Health care is not for-profit--it is life and death!

Evergreen faces challenges in delivering health insurance Small businesses may be the future of health insurance co-op in Maryland

By Meredith Cohn, The Baltimore Sun 12:04 p.m. EDT, October 29, 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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You’re Frustrated by the ACA Site, You’ll Hate These ‘Centrist’ Ideas Nation of Change

Republicans who are trying to exploit the difficulties with Obamacare’s rollout for political gain are, as usual, getting it all wrong. Those problems with “healthcare.gov” don’t prove what conservatives think they prove. They’re an indictment of the Right’s visions of privatization, and of the self-described “political center’s” ambitions for Medicare, Medicaid and Social Security.

Lead Republican budget negotiator Paul Ryan says so himself: They want to dismantle Medicare as it exists today and replace it with “Medicare exchanges.” Hey, what could go wrong?

That’s why I only partially agree with Bill Scher when he says that “liberal journalists shouldn’t pile on” to criticisms of the healthcare exchange websites. Mike Konczal comes much closer to my own viewpoint when he says that the website’s problems are an indictment of neoliberalism, that “third way” Democratic Party attempt to reconcile the interests of the public with those of deep-pocket corporate and individual donors.

That approach gives conservative Democrats some common ground with the Republicans. But the neoliberal agenda forces its adherents to package social initiatives in Rube Goldberg-like contraptions, in an attempt to reconcile the ideology of the free market and the interests of powerful corporations with those of the public.

How’s that working out for you?

Social insurance, Rube Goldberg-style.

The Affordable Care Act was born, as many people know, in the bowels of the conservative Heritage Foundation think tank as an alternative to the health reforms being proposed by Bill and Hillary Clinton in 1993 and 1994. The Clinton initiative was overly complex because it, too, tried to reconcile the needs of private corporations with the need to provide broader health care coverage.

In that sense, therefore, the ACA can be seen as a streamlined version of the Clinton proposal. But even a streamlined version of a program like this is extraordinarily complicated.

What makes the process so complex? First, a variety of individual insurers must be connected with the government exchanges. Second, their bids must all be assembled and presented to the public in uniform and readable form. As one who designed health systems for insurance companies in a previous life, I can tell you: this process is more complicated than it sounds.

But what makes it especially complicated is the fact that, in a certain sense, healthier individuals are expected to subsidize the cost of caring for sicker individuals, which means the success of the entire program rests on the ability to make enrollment as attractive as possible to them.

Quotes that sell. That’s why it’s become so hard for people to get quotes on the exchanges. The “quick glimpse” of pricing that most people would like to get, without having to submit a lot of information, would only show the amount insurance companies will be receiving for their care.

The systems designers wisely understood that this would drive a lot of people away. The system couldn’t be designed simply to offer raw insurance quotes. The quotes had to be as low as possible in order to seal the deal. (This process also hides the subsidies which insurance carriers receive taxpayers, although that may not have been the intent.)

For this reason, designers only wanted them see the rates they themselves will pay – rates which will often be lower than the “raw” rate, especially for the younger and healthier individuals the program needs to attract.

That complicated set of requirements led directly to the problems were seeing today.

The Republican healthcare exchange. Yes, the government should have seen these problems coming. And I’m baffled by the fact that nobody has introduced to me what seems like a very quick fix, by allowing people to submit their demographic information in a quick and easy front-end screen which could then be “batch processed” in a day or two. They wouldn’t be kept online, bottlenecks would be relieved, and a system like that is easy to design, relatively speaking. If the government had gotten on it as soon as the problems began, it could’ve been in place by now.

But the real cautionary tale of “healthcare.gov” is one that should disturb Republicans more than anyone else. The Ryan budget – that is to say, the Republican budget – has proposed that all Americans will become eligible for Medicare after the year 2023 purchase that program from private insurers.

Rep. Paul Ryan and the Republicans have a system which seniors can use to purchase health insurance once they’ve eliminated Medicare as we know it. As Ryan’s website points out, they call it a “Medicare Exchange.” Republicans had a similar plan for Social Security back in 2005. They intended to dismantle this popular and successful program and replace it with a series of private offerings.

Neoliberalism made complicated.

The neoliberal agenda – which includes the “bipartisan” consensus behind that ever-elusive “Grand Bargain” – believes that Medicare should be means-tested. Means-testing is the process which has caused so much difficulty with the ACA website.

And it is the insistence that we purchase health insurance from private entities which is created all these problems in the first place. Medicare enrollment, by contrast, is quick and relatively simple. It will remain so as long as it doesn’t have means-testing or other neoliberal/conservative restrictions imposed upon it.

This leads us into the category of what Konczal calls “Category A” social insurance programs, conservative/neoliberal inventions which are based on means-testing and complex public/private hybrids. Although neoliberals love to present themselves as “technocrats,” let’s be perfectly clear: these types of programs are ideologically-driven, at least as much as today’s Social Security and Medicare – and perhaps even more so.

Programs like Social Security and Medicare, unlike the neoliberal contraptions which serve as their equivalent, have a long track record of success.

Private sector, public failure.

Lastly, Republicans have used this as an opportunity to rail about the ineptness of the government in administering large – scale programs. That’s where I agree with Scher. Some of the liberal critiques come close to drawing the same conclusion. In fact, government has proven extraordinarily effective at delivering certain types of programs, even in the face of increased spending cuts.

The problem is, government successes are largely invisible to the American people. The processing of Social Security applications, the issuance of Medicare payments, this is the sophisticated analyses of medical costs, fraud, and billing practices that constitute the back end of governments healthcare processing systems – all of these remain hidden from public view.

But conservatives or neoliberals who trumpet the private sector’s supposedly efficiency in these areas need to explain to the American public why they have so much difficulty with private insurance’s administrative processes.

How many of the people who are attacking the ACA website today have tried to call their health insurance company to get a simple question answered? Nowadays that task can involve many minutes or even hours on hold, and an endless series of baffling and frustrating voice response menus which are eventually followed by an unsatisfying interaction with an uncooperative employee.

We won’t even talk about what it takes to get a claim paid.

Neoliberals, beware. You need to think less about placating corporate sponsors and reflect more on that old adage: If it ain’t broke, don’t fix it.

And be careful, Republicans! Every critique you offer against the ACA rollout is a damning indictment of your ideology of privatization and your vision for ‘reforming’ Social Security and Medicare. Whether you want to call the customer service line at your private health insurer, or are eager to slam the healthcare.gov website for partisan reasons, our advice to you is the same either way:

Don’t go there.

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Raise your hand if you recognize this!!!! EVERYONE. This is what corporate NPR tries to tell us will happen and we better get use to it now that all of the TRUST funds have been stolen. Indeed, home health services are sending people to homes to care for the elderly and chronically ill that have absolutely no training or abilities to do the job. They are often made frustrated with the job and take it out on the people for whom they are sent to care. IT IS HAPPENING IN THE US WITH HEALTH CARE REFORM RIGHT NOW!

Remember, the problem with health care costs is massive health industry fraud and profiteering not the number of people accessing care!

Asia is a terrible model for elderly care, Jeremy Hunt Low pensions, patchy health insurance and the increasing reluctance of many to live with their ageing parents condemn many elderly Asians to miserable conditions

- Hans Schattle
- theguardian.com, Friday 18 October 2013 16.33 BST

Asia is now looking to Europe for models of how to care for the elderly. Photograph: Burger/Phanie/Rex Features Jeremy Hunt is now pointing to Asian culture as exemplary in caring for the elderly, saying he is struck by the "reverence and respect" for older people in Asian cultures as the health secretary. I have lived in South Korea for five years, and I wish I could say I have been struck by the same things. Instead, I've been struck by frightening poverty among older people whose living conditions are miserable. It's a sad irony that for all the supposed emphasis on respecting elders in Confucian societies, so many of them across Asia live in a state barely better than completely neglected.

Take South Korea, for example. Certainly many older people live in clean and comfortable surroundings with their children, but far too many are shunted aside, on their own in cramped, run-down apartments or worse, badly run nursing homes. Earlier this year, one of the leading daily newspapers in Seoul reported the indignities that many elderly Koreans suffer in care homes plagued by filthy conditions including the stench of excrement and body odour. At one institution, patients were regularly bathed out in the open and then forced by staff to walk back to their rooms naked. As the headline in the Hankyoreh newspaper asked: "Where are human rights for the elderly?"

People in Britain had better start asking the same question if the government wants to follow Asia's lead. Run a Google search on any east Asian country along with the phrase "elder poverty", and the sickening truth comes to light.

Even in Japan, by far the richest country in Asia, the number living in poverty has nearly tripled since the country's economic downturn brought savage cuts in welfare assistance. More and more of Japan's seniors are homeless and malnourished, and as the Washington Post reported – in direct contradiction of the health secretary's Asian illusions – "Many have been abandoned by children bucking the Japanese tradition of living with one's elderly parents."

Across Asia, the younger generations are less willing than before to take in ailing parents, even though middle-class families today are wealthier than in generations past. It would be one thing if east Asian societies had generous pensions and comprehensive universal healthcare coverage, but in fact the health insurance is usually patchy – many catastrophic illnesses are not covered by national insurance systems – and pensions remain low or even non-existent. The same generation that built up east Asia's "tiger" economies and middle-class societies have been suffering neglect in their advancing years, and the problem is likely to worsen because birth rates have fallen.

In fact, many east Asian policy elites and advocates for the elderly have been looking to Europe's welfare states as possible models in improving conditions here, though as Europeans have learned, welfare states cost money. South Korea's president, Park Geun-hye, owes her election last year in part to promises she made to increase the country's meagre pensions by providing a monthly payment to all senior citizens here totalling about £110 per month. After taking office, Park scaled back the programme, saying the country's economy could not afford her original plan. This is a tragedy in a country in which nearly half the population over 65 lives in poverty and the suicide rate among the elderly has more than doubled in the past decade.

I would like to think Jeremy Hunt is sincere when he says that he wants Britain to be "the best place in the world to grow old in". But if he really means this, then he should help Britain find its own suitable path and harbour no illusions about daily life for the elderly in Asia.

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What we see below is the corporation Obama chose to create the Health Care.gov website. Never mind it failed to perform well, the problem is that it is yet another global corporation dealing with security and hedge funds controlling people's data.

When you are told there is no policy in place to centralize all personal data on each person THEY ARE LYING. The intent is to have all data together and to sell data for data mining while tracking individuals wherever they go. Now, if you are one of those pesky activists that Obama hates......THERE GOES ALL YOUR PERSONAL INFORMATION TO CGI.

BUSH USED THIS FOR GOVERNMENT CONTRACTS AND OBAMA DOES TOO. MEDICARE HAS ITS OWN DATABASE-------NOT FOR LONG!

See how this health care reform is not a step toward socialist systems---it will replace the current Federal Medicare structure that Universal Care people want expanded! THAT IS THE POINT OF THE AFFORDABLE CARE ACT.

Nightly News | October 17, 2013

CGI

More than $196 million spent on glitch-ridden Heathcare.gov The company that built the botched website where people are supposed to sign up for the Obama’s health care exchanges has spent millions of dollars developing Healthcare.gov, but people are still having trouble signing up. NBC’s Tom Costello reports.

Visit our country sites

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In Baltimore, asthma is a primary health condition and since asthma is particularly present in underserved families, it is Medicaid that gets hit with the bill or families cannot afford these inhalers. With the gutting of Medicaid to pay down the national debt from massive corporate fraud, Medicaid has been cut.

Generics is a huge issue with the TPP as US PHARMA is fighting the use of generics to bring down global drug costs. REmember, it has always been Americans stuck paying extremely high prices for PHARMA while the rest of the world worked to get drugs more cheaply to their citizens. The US is using TPP to change this!

Here's Why Your Asthma Inhaler Costs So Damn Much —By Kevin Drum Mother Jones

| Wed Oct. 16, 2013 9:58 AM PDT

147

Dr. Russell Saunders is pissed off:

As I’m sure comes as no surprise, I prescribe a lot of medications....One medication I prescribe with great frequency is albuterol, a bronchodilator. Asthma is a very common childhood illness, and one that primary care providers can often manage without consulting subspecialists.

....So I prescribe a lot of albuterol [inhalers]. Or rather, I would if they existed. Unfortunately, albuterol inhalers per se are not currently on the market. What my patients really get are prescriptions for Proventil or Ventolin or Proair. There are, at this time, precisely zero generic albuterol [inhalers] on the market.

The reason why there are none on the market and thus patients (or their insurance companies, if they are blessed with good coverage) are forced to pay for the name brands is contained in this horrifying and infuriating article about pharmaceutical pricing in the New York Times. If it does not make your blood boil, then I congratulate you for having a more even temperament than I.

I'm pretty sure that I don't have a more even temperament than Saunders, but I do have one advantage over him: I already knew what was going on with asthma inhalers even before Elisabeth Rosenthal's piece—the latest in her series about the high cost of American health care—appeared a few days ago.

Here's the short version of the story: as Saunders says, albuterol is a cheap medication because it went off patent long ago. Then, a few years ago, as part of the campaign to eliminate CFCs and save the ozone layer, CFC-based inhalers were set to be banned. Pharmaceutical companies took advantage of this to design new delivery systems and surround them with a thicket of patents. As a result, even though albuterol itself might be off patent, only name-brand asthma inhalers are available—and since there's now no generic competition the big pharmaceutical companies are free to jack up prices to their heart's content. And they have. After all, as Rosenthal points out, this isn't like acne medicine that you can do without if it costs too much. If you have asthma, you need an inhaler, period.

Is your blood boiling? Well, wait a bit. The story is actually even worse than this. You're probably thinking that what happened here is (a) overzealous environmentalists insisted on banning CFC inhalers even though they don't really have much impact on the ozone layer, and (b) pharmaceutical companies cleverly took advantage of this to suck some extra money out of asthma sufferers.

Well, the ozone layer was the initial cause of all this, so feel free to place some of the blame on environmentalists if you like. But as it turns out, scientists raised some early concerns about the inhaler ban because the replacement for CFCs was a powerful greenhouse gas. So they suggested that maybe it was better just to make an exception for asthma inhalers and let well enough alone. At that point, the pharmaceutical companies that had been eagerly waiting for the old inhalers to be banned went on the offensive. Nick Baumann picks up the story from there:

The pharma consortium transformed from primarily an R&D outfit searching for substitutes for CFC-based inhalers into a lobbying group intent on eliminating the old inhalers. It set up shop in the K Street offices of Drinker Biddle, a major DC law firm. Between 2005 and 2010, it spent $520,000 on lobbying. (It probably spent even more; as a trade group, it's not required to disclose all of its advocacy spending.) Meanwhile, IPAC lobbied for other countries to enact similar bans, arguing that CFC-based inhalers should be eliminated for environmental reasons and replaced with the new, HFC-based inhalers.

The lobbying paid off. In 2005, the Food and Drug Administration (FDA) approved an outright ban on many CFC-based inhalers starting in 2009. This June, the agency's ban on Aerobid, an inhaler used for acute asthma, took effect. Combivent, another popular treatment, will be phased out by the end of 2013.

In other words, pharmaceutical companies didn't just take advantage of this situation, they actively worked to create this situation. Given the minuscule impact of CFC-based inhalers on the ozone layer, it's likely that an exception could have been agreed to if pharmaceutical companies hadn't lobbied so hard to get rid of them. The result is lower-quality inhalers and fantastically higher profits for Big Pharma.

Rosenthal has a lot more detail in her piece about how the vagaries of patent law make this all even worse, and it's worth reading. But she misses the biggest story of all: none of this would matter if drug companies hadn't worked hard to make sure the old, cheap inhalers were banned. How's your blood doing now, Dr. Saunders?

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The medical device industry has stolen the most from Entitlements over a few decades and we would want to tax them for the tens of billions of dollars lost.

The Myth of the Medical-Device Tax
By TOPHER SPIRO Published: October 16, 2013New York Times

WASHINGTON — IN the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign — even garnering the support of many Democrats who favored the law — arguing that the tax would stifle innovation and increase health care costs.

Connect With Us on Twitter For Op-Ed, follow @nytopinion and to hear from the editorial page editor, Andrew Rosenthal, follow @andyrNYT.

This argument is doubly disingenuous. Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.

The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.

Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.

Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.

Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.

There are several ways policy makers could lower device costs. The first step would be to end the anticompetitive practices that prevent hospitals from getting the best deals. Senator Charles E. Grassley, Republican of Iowa, has sponsored legislation that would foster transparency by posting online price information for implantable medical devices.

In addition, instead of simply paying hospitals based in part on what they have spent on devices, Medicare should force manufacturers to compete for business based on a product’s price and quality.

Medicare should also pay hospitals a single lump sum for all of the associated costs of a given procedure (like a hip replacement). This approach, known as “bundling” the costs, would create incentives for hospitals to lower device costs. Savings should be shared with the physicians, so that their incentives are aligned with the hospital’s.

Bundling has been used successfully in pilot programs. Under Medicare’s Acute Care Episode Program — which bundled payments for cardiac and orthopedic procedures — physicians worked together to choose high-quality, cost-effective devices. Baptist Health System in Texas, which participated in the program, used clinical evidence to choose devices and negotiated lower prices for both Medicare and non-Medicare patients.

States could adopt similar payment reforms for private insurance and their Medicaid programs. In Arkansas, the Medicaid program and private payers — including Walmart — have collaborated to adopt bundled payments for several procedures, including hip and knee replacements.

To complement these efforts, the new Patient-Centered Outcomes Research Institute, a nongovernmental body created by the Affordable Care Act, should pay for research that compares the effectiveness of devices so physicians can make informed choices. (Three years into its existence, the institute has initiated few, if any, studies of medical devices.) Medicare or the Food and Drug Administration should also require the use of registries that track when devices fail.

Currently, medical-device manufacturers allocate only a sliver of profits to research and development and often focus on “tweaks” to existing devices, without providing any evidence that they are of better quality. Competitive pressures from public and private payers would provide incentives for the industry to become more innovative, producing technologies that actually lowered costs and offered truly advanced breakthroughs.

Instead of using its clout to lobby against the device tax — which helped foment opposition to the Affordable Care Act — the medical-device industry needs to share the responsibility of lowering costs for patients, businesses and taxpayers.

Topher Spiro is the vice president for health policy at the Center for American Progress.

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I want to say that the idea that no medical information will not be released is pure fiction. We see all across the country where medical information is now sold to the highest bidder by universities and even state health departments as a revenue tool. Washington State just had an expose released about the extent of this practice. Are we to believe a state like Maryland which is as corporate and profit-oriented as any in the country will not or does not do this already?

Of course not. What Dr Sharfstein and others do not tell you is that medical data is already a Wall Street investment vehicle. It makes billions of dollars for businesses buying it from public agencies who sell it for pennies on the dollar. He will tell you---OH, ALL DATA SHARED IS STRIPPED OF IDENTIFYING INFO--- and I have swampland in Florida to sell you! As studies already done show most of this data can be tracked back to you and in fact corporations hiring new employees have ways to do that. IT ALREADY HAPPENS.

We need people joining Universal Care group--National Physicians Md will tell you where-- to end what will be most people unable to access health care and all of your information sold to the highest bidder. GET RID OF YOUR INCUMBENT AND RUN AND VOTE FOR LABOR AND JUSTICE TO DO THIS!

Maryland health exchange data privacy under the microscope

By Nayana Davis and Kevin Rector, The Baltimore Sun 10:53 a.m. EDT, October 16, 2013

Marylanders who signed up for coverage through the state's new health insurance exchange did so under the condition that their information could be shared with law enforcement.

The policy sparked debate in the conservative blogosphere after the Weekly Standard published a post saying it raised privacy concerns.

"We will not sell your information to others. Any information that you provide to us in your application will be used only to carry out the functions of Maryland Health Connection," the policy states. "The only exception to this policy is that we may share information provided in your application with the appropriate authorities for law enforcement and audit activities."

Maryland Health Connection, the state's health insurance marketplace, opened Oct. 1 as a key part of the federal Affordable Care Act, also known as Obamacare. The online system has been plagued by glitches, but state officials said Friday that 1,121 Marylanders had enrolled.

Joshua Sharfstein, Maryland's health secretary, said concerns about the privacy policy are misplaced. The language is in line with federal law and acknowledges "the obvious point that there are certain demands for information that any entity or agency would have to comply with, just like an insurance company would have to comply," he said.

Danielle Citron, a professor who focuses on privacy at the University of Maryland Francis King Carey School of Law, said the statement describes the standard handling of health insurance information. She said such information would likely only be used if there was a subpoena or some form of court order involved.

"That is something that is consistent with HIPAA," she said, referring to the Health Insurance Portability and Accountability Act, a widely used federal privacy law.

But she said she was troubled by another element of the privacy policy, which states that emailed correspondence with exchange officials "could be disclosed to other parties upon their request in accordance with Maryland's Public Information Act." The Weekly Standard mentioned that aspect as well.

"That sentence leads us to worry that our sensitive health information could be put out there," Citron said. "It is definitely a disturbing line."

Sharfstein said no medical information would ever be released. "This is just restating that we comply with the Maryland Public Information Act, but there are very strong protections for privacy under that law, too," he said.

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You had better believe it. The entire mandate issue was never about paying for health care for the poor....it was only about sending hundreds of billions of dollars to corporate profit. Paying for a insurance premium and not able to access health care because of the co-pays and deductions does not indicate a wanting to cover the most people! Just as the Department of Education now run by credit recovery agencies----this will be predatory.

This comment is true in many respects. First, there will be a fine for not being insured and it will include garnishing of whatever personal wealth source, whether paycheck or savings. Second, they deliberately made that fine low at first so as to no scare people but let's be clear....they intend to get you to into the market so the fine will soon be more than the insurance.

Viral Facebook post says Obamacare fines to be seized from bank accounts
By Lilly Maier
Published on Monday, October 7th, 2013 at 6:00 a.m. PolitiFAct

Did you see a Facebook post about one man's experience with Obamacare's new health care marketplaces?

Here's the post:

"I actually made it through this morning at 8:00 A.M. I have a preexisting condition (Type 1 Diabetes) and my income base was 45K-55K annually I chose tier 2 ‘Silver Plan’ and my monthly premiums came out to $597.00 with $13,988 yearly deductible!!! There is NO POSSIBLE way that I can afford this so I ‘opt-out’ and chose to continue along with no insurance. I received an email tonight at 5:00 P.M. informing me that my fine would be $4,037 and could be attached to my yearly income tax return. Then you make it to the ‘REPERCUSSIONS PORTION’ for ‘non-payment’ of yearly fine. First, your drivers license will be suspended until paid, and if you go 24 consecutive months with ‘Non-Payment’ and you happen to be a home owner, you will have a federal tax lien placed on your home. You can agree to give your bank information so that they can easy ‘Automatically withdraw’ your ‘penalties’ weekly, bi-weekly or monthly! This by no means is ‘Free’ or even ‘Affordable’."

The post includes many elements that make no sense or are flat-out wrong -- and can be easily debunked by reading the law or reliable summaries of it. We went through these points in a recent fact-check and concluded its claims were false. ________________________________________________________________
"The problem [with the ACA] is that it leaves the foxes guarding the hen house, offers them a new luxury coop and delivers them a million more hens," he said, comparing for-profit insurance companies to hungry foxes.
Though the system would be created by a legislative bill, it would not necessarily be run by the government, he said.

I thank this candidate for shouting loudly and strongly for Universal Care. We do need to know what he means by 'it wouldn't necessarily be run by the government. We know how bad public private partnerships are for the people!

District 12 candidate wants health care for all
By Amanda Yeager, ayeager@tribune.com 12:15 p.m. EDT, October 8, 2013 Baltimore Sun

Read more: http://www.baltimoresun.com/news/maryland/howard/columbia/ph-ho-cf-ca-at-sachs-1010-20131008,0,415848.story#ixzz2hFQqbD3B
Last week, Adam Sachs became the eighth candidate to file for a shot at a House of Delegates seat in District 12. He said he hopes a platform focused on health care will help him stand out from the still-growing list of hopefuls.

The 50-year-old Democrat from Columbia said he wants to bring health care to every Maryland resident, and streamline the health care system to eliminate costly administrative fees and reduce lofty executive salaries.

He said his vision is for Maryland to have a system "where health care is treated as a human right instead of a privilege, and health care is a public good, instead of a private benefit."

Sachs wants Maryland to create a single-payer, nonprofit health care system that would cover every state resident and be run through a single administrative entity. That way, he argues, the system could cut down on administrative costs and have stronger bargaining power with pharmaceutical and medical supply companies.

Though the system would be created by a legislative bill, it would not necessarily be run by the government, he said.

Health care is a familiar issue for Sachs, who worked for about four years for CareFirst BlueCross BlueShield before leaving to become a public relations specialist at the American Nurses Association in Silver Spring.

While he says his ideas on health care represent his views and not those of the ANA, his involvement on both sides of the health care aisle helped him gain perspective on the issue.

"It's a very costly system that we have in America, and a lot of the costs don't really go to actual health care," he said.

Sachs said his decision to run in District 12, which includes parts of Howard and Baltimore counties, was the result of a confluence of circumstances. With President Barack Obama's signature Affordable Care Act beginning enrollment earlier this month, health care has been at the forefront of public debate. And the departure of all three of District 12's incumbent delegates at the end of this term provided an open field and, he said, a good shot at a seat.

Sachs said the Affordable Care Act, popularly known as Obamacare, has its advantages — notably, making health care available to people with pre-existing conditions — but he also called it a piecemeal approach to a complex system.

"The problem [with the ACA] is that it leaves the foxes guarding the hen house, offers them a new luxury coop and delivers them a million more hens," he said, comparing for-profit insurance companies to hungry foxes.

He said his health-care plan isn't new. It's already been introduced in Annapolis as the Maryland Health Security Act, but hasn't yet seen enough votes to be successful.

He hopes that by shining a spotlight on the issue, it can gain some traction.

"I decided to run because I believe I can be bold enough to be a voice to raise the issue … where I didn't really see it happening with the other candidates," he said.

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About Our Clinic

People's Community Clinic is a unique Austin institution and one of the oldest continually-running independent clinics for primary care in America. Founded in 1970 by a group of volunteer doctors and nurses, the Clinic has never wavered from its mission: to improve the health of medically underserved and uninsured Central Texans by providing high quality, affordable healthcare with dignity and respect.

Thu Jul 18, 2013 at 12:46 PM PDT

Women's health care going from bad to worse in Texas
by Laura Clawson

Planned Parenthood is closing three clinics in Texas in response to the ongoing effects of the state's broader defunding of women's health care and, in one case, the state's new anti-abortion law. Those clinic closings—only one of a clinic that provided abortions—means the health care situation for women in the state, especially women who don't live in urban areas and who don't have good health insurance, is getting worse. And it was already bad:
About a year after Texas slashed its family-planning budget by two-thirds, with 50 clinics shutting down as a result, the Texas Policy Evaluation Project surveyed 300 pregnant women seeking an abortion in Texas. Nearly half said they were "unable to access the birth control that they wanted to use" in the three months before they became pregnant. Among the reasons: cost, lack of insurance, inability to find a clinic, and inability get a prescription. The state's health commission says Texas will see nearly 24,000 unplanned births between 2014 and 2015 thanks to these cuts, raising state and federal taxpayer's Medicaid costs by up to $273 million. [...] The Planned Parenthood clinics that anti-choice legislators booted from the state's Women's Health Program serviced nearly 50 percent of the program's patients. Along with contraceptive counseling, the clinics provided basic screenings for cancer, hypertension, and other key problems. There's no shortage of need: women in Texas suffer high rates of STIs and unintended pregnancies compared to national figures, and the state ranks 50th for diabetes prevalence in women.

Statistics like these show clearly that what Texas Republican lawmakers really care about isn't abortion—if it was, they'd be making damn sure women had access to every kind of birth control under the sun. No, they're engaged in a much broader attack on women's health. Poor women's health, specifically. And their actions will lead to more unplanned pregnancies and more unsafe, unregulated abortions.

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Is Obamacare Enough? Without Single-Payer, Patchwork U.S. Healthcare Leaves Millions Uninsured DEMOCRACY NOW

Topics Healthcare Guests Dr. Steffie Woolhandler, professor of public health at CUNY-Hunter College and a primary care physician. She is a visiting professor at Harvard Medical School and the co-founder of Physicians for a National Health Program.

John McDonough, professor at the Harvard School of Public Health and director of the New Center for Public Leadership. Between 2008 and 2010, he served as a senior adviser in the U.S. Senate and former executive director of Health Care for All in Massachusetts. He recently wrote a book called Inside National Health Reform.

Related "Dramatic, Painful" Government Shutdown Disproportionately Impacts Working Poor, People of Color Oct 03, 2013 | Story Tea Party Forces Government Shutdown with Obamacare Revolt; How Will It Impact Ordinary Americans? Oct 01, 2013 | Story Decoding Obamacare: A Guide to New Healthcare Marketplaces Designed to Help 48 Million Uninsured Sep 27, 2013 | Story Links "Inside National Health Reform.” By John McDonough (University of California Press) Healthcare Debate: As Supreme Court Hears Landmark Case, Does Law Do Enough to Fix Health Crisis? (Democracy Now! 2012) Physicians for a National Health Program DONATE → This is viewer supported news Printer-friendly Despite helping expanding affordable insurance, "Obamacare" maintains the patchwork U.S. healthcare system that will still mean high costs, weak plans and, in many cases, no insurance for millions of Americans. We host a debate on whether the Affordable Care Act goes far enough to address the nation’s health crisis with two guests: Dr. Steffie Woolhandler, a primary care physician and co-founder of Physicians for a National Health Program; and John McDonough, a professor at the Harvard School of Public Health and former senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. Between 2003 and 2008, McDonough served as executive director of Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law, known as "Romneycare," regarded by many as the model for the current federal healthcare law.

Transcript This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We turn to a discussion on whether Affordable Care Act, or "Obamacare," goes far enough in addressing the nation’s health crisis. The New York Times recently reported the new healthcare law will leave out two-thirds of the nation’s poor blacks and single mothers and more than half the nation’s low-wage workers who don’t have insurance. That’s because they live in 26 states controlled by Republicans that have rejected the vast expansion of Medicaid.

We’re joined by two guests: Dr. Steffie Woolhandler, professor of public health at CUNY-Hunter College and a primary care physician, visiting professor at Harvard Medical School and co-founder of Physicians for a National Health Program; and we’re joined from Boston by John McDonough, professor at the Harvard School of Public Health, director of the New Center for Public Leadership. Between 2008 and ’10, he served as a senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. And between 2003 and ’08, he served as executive director for Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law known as "Romneycare," regarded by many as the model for the current healthcare law. He recently wrote the book Inside National Health Reform.

We welcome you both back to Democracy Now! Let’s start in Boston with John McDonough. Your thoughts on this seven-day rollout, where most of the websites have not worked?

JOHN McDONOUGH: It was predicted, and it’s disappointing, and we hope they will get it fixed up as quickly as possible. And we recall what happened in 2006 with the rollout of the Medicare prescription drug program, which was plagued for many months with significant technical problems, and those problems were dealt with and addressed, and hardly anybody remembers them right now. What they remember is that the program is working pretty well for the tens of millions of Americans who are in it.

AMY GOODMAN: And, Dr. Steffie Woolhandler, your thoughts on this program that started October 1st?

DR. STEFFIE WOOLHANDLER: OK, well, the completer glitches will get sorted out, but the complexity that caused the computer glitches is baked into "Obamacare." The exchanges have to deal with millions of enrollees and doing income verification. They have to deal with thousands of private insurance plans. It’s a very complex system. And unfortunately, that complexity also contributes to high expense. The private insurance industry that’s offering the coverage through the plans has overhead costs that are about four times as high as traditional Medicare. And in addition, we’re going to have overhead of about 4 percent added to insurance overhead just for the exchanges. So it’s a complex system, a very expensive system, and when we see the way it’s performing, we understand why we need a simple single-payer system that could save about $400 billion on administrative simplification.

AMY GOODMAN: For people who don’t have insurance or want to get cheaper insurance, do you encourage them to go to the websites to sign up for the new—under these new exchanges?

DR. STEFFIE WOOLHANDLER: Well, absolutely people need to take a look, but they also need to know that many of the new plans have high co-payments, high deductibles. They can have very restrictive networks. So, for some people, this will be a great deal. If your income is in the low range and you get a big subsidy, it can be a very good deal. If you’re sort of middle-income, I think you’re going to find you’re paying an awful lot of money for some very skimpy coverage through the exchanges.

AMY GOODMAN: Your response, John McDonough?

JOHN McDONOUGH: Well, yes, the law and the system around the law are complicated, and our underlying healthcare system is incredibly complicated, far more than it needs to be. I don’t really have a disagreement with my—with my friend and colleague, Steffie Woolhandler, about a division of what we would like to see. The reality is that this was probably the best we could have gotten in 2009, 2010. Getting anything even close to this would be politically impossible today. And, you know, I hope this is a movement in the direction toward a more rational and less complex system, but it is an important start and an important step forward for potentially tens of millions Americans, a lot of whom are going to get coverage that’s going to be very affordable and at almost no cost.

AMY GOODMAN: Is this a road to single-payer, Dr. Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, it’s only a road to single-payer if we fight for single-payer.

AMY GOODMAN: And what does that mean when we say "single-payer"?

DR. STEFFIE WOOLHANDLER: OK, well, single-payer is also known as expanded and improved Medicare for all, also known as nonprofit national health insurance. It means you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion, which would allow us to afford the system. I mean, I just want to remind you that when Medicare was rolled out in 1966, it was rolled out in six months using index cards. So if you have a simple system, you do not have to have all this expense and all this complexity and work.

AMY GOODMAN: What do you mean, "index cards"?

DR. STEFFIE WOOLHANDLER: They didn’t have computers back in 1966, OK? So they expanded—went from zero to over 20 million people enrolled in Medicare in a period of six months. And because it was a simple system, based on the Social Security records, it was a tax-based system, you didn’t have hundreds of people programming the state of Oregon, thousands of different plans, tons of different co-payments, deductibles and restrictions—one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want, which is not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.

AMY GOODMAN: Democratic Senator Barbara Mikulski of Maryland has hailed "Obamacare" as a victory for women.

SEN. BARBARA MIKULSKI: [Forty-two] million people in the United States of America don’t have a doctor, don’t have access to a doctor, but they have hope because the healthcare is being implemented. We speak for the 150 million women in the United States of America who now have healthcare because "Obamacare" has been implemented. Being a woman in the United States of America is no longer considered a pre-existing condition by the insurance companies. We have been denied healthcare because of pregnancy, because of domestic violence and because of other things.

AMY GOODMAN: That’s the Democratic Senator Barbara Mikulski of Maryland. Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, that’s great that there’s some guaranteed issue, meaning that the insurance companies have to give you coverage if you apply. But much of the coverage is going to be extremely skimpy and not particularly affordable. And there will be 31 million Americans left out of "Obamacare," and about five million of those 30 million uninsured will be uninsured because of the red state governors opting out of Medicaid. But 25 million of those uninsured are uninsured by the very design of "Obamacare."

AMY GOODMAN: How?

DR. STEFFIE WOOLHANDLER: They were never included in the original estimations of the bill. That’s because you have to take money out of your pocket to buy insurance, and as you get up into the middle-income levels, the insurance is extremely expensive, and many people won’t be buying it. About one-third of those people will be undocumented immigrants, but two-thirds will be U.S. citizens, mostly working poor, who still cannot afford—afford health insurance under "Obamacare."

AMY GOODMAN: John McDonough, your response to that and whether you—how you see this transitioning? I mean, do you ultimately see expanded Medicare for everyone as the answer in this country?

JOHN McDONOUGH: Two very big questions, Amy. So, on the first piece, on the 25 million, so, you know, when Medicaid was started in 1965, it was voluntary for states to get in. It wasn’t until the 1970s that most—nearly all states were in, and it wasn’t until 1982 that all 50 states were in. Arizona was the last state to join, in 1982. I would predict that within five years all 50 states will be participating in this new Medicaid expansion, because the benefits of it are so great for states, and it’s—it will be a lot easier when the temperature on "Obamacare" as a political issue diminishes.

The other thing to keep in mind, of the 25 million, about a third of them are people who will be eligible for Medicaid and who fail to sign up for Medicaid. We would like those folks obviously to sign up and get all of the preventive care and primary care, but the important thing to understand is that when those folks show up at a clinic, at a hospital for care, they won’t be told, "We can’t treat you." They can get signed up and qualify for Medicaid on the spot. So it’s a different relationship in terms of who will still be uncovered. There will still be a significant number uncovered, but they will have access to services, and they will not walk in and say, "Sorry, you’re going to have to pay, or we won’t treat you." It’s going to be a very different situation for those people.

Whether this leads to a Medicare single-payer, I think it’s way too early to say. I would hope that it would, because, frankly, I didn’t see any particular traction in terms of trying to move to that direction before "Obamacare." And I think there’s enough changes going on right now that there may be some changes in terms of the prospects.

AMY GOODMAN: Dr. Woolhandler?

DR. STEFFIE WOOLHANDLER: Yeah, well, I’m very doubtful that people can just walk into any doctor’s office and say, "I’m uninsured," and get care because somebody there happens to think they might get Medicaid. That’s not how things work now, and I don’t see why it would work that way under "Obamacare." I mean, unfortunately, "Obamacare" is--

JOHN McDONOUGH: It works that way in Massachusetts now.

DR. STEFFIE WOOLHANDLER: —is a very expensive program that offers halfway coverage to half of the people who need it. And we need to be moving forward to single-payer to make sure every single American can go to any doctor they want and be able to afford that.

AMY GOODMAN: President Obama--

JOHN McDONOUGH: The way--

AMY GOODMAN: Oh, go ahead. Go ahead, John McDonough.

JOHN McDONOUGH: No, I mean—no, the way it works in Massachusetts and the way it has worked since the health reform law in 19—in 2007 is that if you are eligible for Medicaid, categorically eligible, and you go into a clinic, a community health center or a hospital, and you can get enrolled in Medicaid, you get enrolled in Medicaid on the spot. And so, you walk in—so, yeah, you were uninsured. You need medical services, you go in, and you’re covered. So, and that is the model for how the system is designed to work under the ACA beginning on January 1st.

AMY GOODMAN: President Obama has cited a woman named Natoma Canfield as inspiration for his Affordable Care Act.

PRESIDENT BARACK OBAMA: You know, there’s a framed letter that hangs in my office right now. It was sent to me during the healthcare debate by a woman named Natoma Canfield. For years and years, Natoma did everything right. She bought health insurance. She paid her premiums on time. But 18 years ago, Natoma was diagnosed with cancer. And even though she had been cancer-free for more than a decade, her insurance company kept jacking up her rates, year after year. And despite her desire to keep her coverage, despite her fears that she would get sick again, she had to surrender her health insurance and was forced to hang her fortunes on chance. I carried Natoma’s story with me every day of the fight to pass this law.

AMY GOODMAN: Steffie Woolhandler, would a woman like Natoma Canfield now have better options than before?

DR. STEFFIE WOOLHANDLER: Well, it really depends on her income. If her income is hovering around 400 percent of the poverty line, the health insurance would be very, very expensive indeed. And what we need is something that just covers everyone automatically.

AMY GOODMAN: So how are you doing that work now? I mean, you talk about how expanded Medicare, you know, Medicare for all, would be the path to go, but you see now the—just "Obamacare" alone has brought down the government. Or do you see "Obamacare" not as a step to single-payer, that it makes sense to you that even—that Republicans would be objecting to this, as well?

DR. STEFFIE WOOLHANDLER: Well, "Obamacare" is the law of the land. And there are some good things. Certainly expanding the Medicaid program is a good thing. But we need to be thinking about single-payer, moving forward. And our group, Physicians for a National Health Program, has about 17,000 members. And as you can imagine, there’s some disagreement. Some people are very pro-"Obamacare." Some people are more tepid, like myself. But we all agree that it is not a solution, that we still need single-payer, and we need to be moving forward and building the movement to go forward to single-payer.

AMY GOODMAN: Dr. John McDonough, the issue of Medicaid being denied to so many millions of people around the country—was "Obamacare" framed around them actually getting that Medicaid so—what is your response to that?

JOHN McDONOUGH: Yeah, Title II of the Affordable Care Act deals with Medicaid. And the way it was written by the folks in the House and the Senate was that all states, on January 1, 2014, are required to open up their Medicaid programs to all uninsured people with incomes below 138 percent of the federal poverty line, which is about $14,000 to $15,000 for a single adult. And it was the U.S. Supreme Court decision in June of 2012 that changed that. The one substantive change the Supreme Court made in the ACA was to say that the Medicaid expansion had to be a state option. And so, we are faced with this really awful situation where, beginning January 1 of next year, the only Americans who will not have some form of health insurance available to them as a matter of law are poor individuals who live in states that have chosen not to expand Medicaid. So, it is probably one of the most cruel and despicable forms of rationing I can imagine that it is folks who are among the most vulnerable in some of the neediest states who are denied this coverage. I do think it’s going to change. I do think it’s going to happen relatively quickly. And again, I’d say within five years, I think just about all states are going to be part of this expansion.

AMY GOODMAN: Your response to that, Dr. Steffie Woolhandler? And how are you organizing for expanded Medicare, Medicare for all?

DR. STEFFIE WOOLHANDLER: OK, well, it depends a lot on your definition of "affordable." Under "Obamacare," someone my age with an income of about $45,000 a year or more would have to pay $8,300 a year in premiums, more than $8,000 a year in premiums. And very few people have room for that in their budget. And that’s why many middle-income people will remain uninsured under "Obamacare." Plus, they’ll be paying a penalty for not purchasing that expensive insurance. It’s simply not going to be affordable.

Our group, Physicians for a National Health Program, has been working with Healthcare-NOW!, has been working with unions, and mostly working in our own community—that is, the physician community—to educate people about single-payer, to advocate for single-payer, to continue to push for single-payer both at the state level and at the national level. And we feel that once people see what "Obamacare" really is, that it is not a solution to the healthcare crisis, once they realize "Obamacare," whatever its strengths, is not a solution, they’ll be motivated to join the movement for single-payer.

AMY GOODMAN: And how do they get—what do you think is the most critical first step now in that movement, given how the Republicans are even responding to this?

DR. STEFFIE WOOLHANDLER: Well, I think people need to educate themselves about single-payer. They need to work in their communities around single-payer. I think that the—what the Republicans are doing is reprehensible. I’m not supportive of that, obviously. But I think we need to be pushing, saying we want single-payer. I mean, the Republicans have made a big deal out of about half of Americans reject "Obamacare," but what they don’t tell you is that a third of those people reject "Obamacare" because they didn’t think it went far enough. And, in fact, in The New York Times on Saturday, they interviewed a very conservative guy in Georgia who said, "I hate 'Obamacare.' I support the Republicans. What we need is a single-payer system." So, I think a lot of people are coming around to that view, and we need to continue to put that out there and push for that, because that’s what Americans need.

AMY GOODMAN: If we were going to single-payer, expanded Medicare, today—or let’s say October 1st—what would have happened?

DR. STEFFIE WOOLHANDLER: Well, we could have just enrolled everyone automatically through the Social Security Administration, which already has the names of everyone through Social Security numbers or ITNs. It already knows our income. It knows at least where we work and probably where we live, so he wouldn’t have had to set up all these exchanges and new systems with all of these glitches and all this expense, because by going with a Social Security-based system, like they have in Canada, like they have in most of Europe, you save all that paperwork cost, and that allows you to devote more money to care. You know, other nations have nonprofit national health insurance and spend substantially less than we do and cover everyone, largely because they save on that administrative complexity and expense.

AMY GOODMAN: I want to thank you both for being with us, Dr. Steffie Woolhandler, now at CUNY-Hunter College—that’s City University of New York—and a founder of Physicians for a National Health Program; John McDonough, with us from Boston, the Harvard School of Public Health, has written the book Inside National Health Reform. He contributed to shaping "Romneycare" and then "Obamacare."

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October 4, 2013, 10:35 am

Dealing With Drafting Errors in the Health Care Law
By PHILLIP SWAGEL Phillip Swagel is a professor at the School of Public Policy at the University of Maryland and was assistant secretary for economic policy at the Treasury Department from 2006 to 2009.

In legislation as mammoth as the two bills that together constitute Obamacare, it is not surprising to find drafting errors in which the text of the law signed by President Obama does not accomplish the intent of Congress. The desirable response to such errors is for new legislation to be enacted to correct the mistake. With the Affordable Care Act at the center of the current legislative stalemate, however, the possibility for such changes seems remote. Indeed, it is difficult to imagine opening up the law to just minor changes at any point — political forces might well lead members of Congress to seek large-scale changes, whether to gut the law or to expand it to cover some of the 30 million people projected by the Congressional Budget Office to be uninsured in 2016 even after the law has been in effect for several years.

With political reality affecting even narrow legislative fixes favored by both parties, it is fascinating to consider the different treatment by the Obama administration of two salient drafting errors in the president’s signature legislative accomplishment. One error in the legislation, discussed recently in Economix, would make Congressional staff members pay thousands of dollars more for their health insurance than was intended. This situation was addressed by the Office of Personnel Management through a rule change of dubious legality reportedly made under pressure from the White House, which in turn was responding to pressure from both sides of the Congressional aisle.

A second error in the health care law, involving the calculation of the level of insurance costs that are affordable, is projected to leave millions of people with low to moderate incomes unable to qualify for government subsidies to purchase health insurance. As a result, many people who were clearly meant to be covered will remain uninsured. In this second instance involving people with less power and lower incomes than those on Capitol Hill, the Obama administration is implementing the law as written, even though this surely does not reflect the administration’s policy preference or Congressional intent.

As explained by the Congressional Research Service, there are special procedures in the House and Senate for dealing with changes that are technical in nature when a bill has been “enrolled” after positive votes in the House and Senate but not yet signed into law. Once the president has used his pen to turn a bill into law, however, new legislation is required to fix mistakes.

Legislation to make “technical corrections” has become relatively infrequent as Congressional partisanship has mounted over the decades, but it is still done to fix minor legislative glitches (the word “glitch” is a familiar presence in anything written about Obamacare these days). Public Law 110-244, for example, was enacted on June 6, 2008, to make technical corrections to a 2005 transportation funding bill. In addition to providing money for the “bridge to nowhere,” the original legislation included earmarks for projects that by 2008 no longer existed. Among other things, the corrections bill redirected those funds.

Such an approach of a technical corrections bill seems natural to fix the drafting error affecting the Congressional staff. As discussed in detail by the health policy expert Doug Badger, the language of the health care law requires Congressional employees to obtain health insurance through an exchange created by the law, but other parts of the federal legal code restrict the ability of the federal government to pay the usual employer share for group insurance programs approved by the Office of Personnel Management. The complication is that the policies in the new exchanges are individual plans, not group, and they are not approved by the personnel office.

A straightforward reading of the law thus means that Congressional staff members, starting in January 2014, will have to obtain insurance through the Affordable Care Act but pay for it on their own without the normal contribution from their employer — Congress. This would be a multi-thousand-dollar income hit for those affected. Some could presumably switch to coverage offered by their spouse’s employer, but many others would potentially feel the pain, giving rise to concerns over a potential brain drain of Congressional staff members finding other employment.

This was clearly a drafting error and not what Congress intended. A recent Politico article reported that the federal personnel office initially ruled that Congressional staff members would not be eligible for the subsidies, and then changed this decision under pressure from the White House (and thus indirectly from Congress).

A second drafting error in the Affordable Care Act will limit the eligibility of millions of moderate-income families to receive subsidies to help pay for insurance policies in the new exchanges (once the glitches are worked out). As explained in The Times, the health care law provides subsidies for people with low and middle incomes to obtain insurance through a government-run exchange. To preserve the employer-based insurance system, however, these subsidies are available only for people who cannot obtain affordable coverage from their employer.

The glitch arises because affordable insurance is based on the cost of individual coverage offered by an employer, which is considerably less expensive than family coverage. Families with moderate incomes could then face a situation in which they can afford individual insurance for the employee and thus do not qualify for subsidies, but cannot afford family coverage. Indeed, research by Richard Burkhauser, Sean Lyons, and Kosali Simon of Cornell University and Indiana University found that nearly four million dependents would be ineligible for subsidies as a result of the legislative problem.

A natural solution analyzed by researchers at the University of California, Berkeley, would be to split the determination of eligibility for insurance subsidies so that family members could receive subsidies to purchase coverage in the exchanges in the instances in which the worker obtained affordable individual coverage through an employer. The administration determined, however, that this approach was outside the boundaries of the legislative text — a decision described by The Times’s health reporter as a “cramped reading of the law” but by others as simply following it. As noted by The Times’s editorial board, this outcome “undercuts the basic goal of health care reform — to expand the number of insured people and make their coverage affordable.”

The unfairness of the situations discussed above is twofold. The first inequity is that the drafting errors in the legislation defeat the evident intent of Congress. People are harmed by the errors — potentially millions of spouses and children will not have health insurance when they were meant to.

The second dimension of unfairness relates to the exceptional treatment of Congressional staff members. With the affordability issue, the administration appears to have faithfully executed the law, just as President Obama swore in his inaugural oath. Congressional staff members of both parties are dedicated public servants who deserve proper compensation, including the employer contribution to health insurance that is normal in the American system. But it is deeply unfair that this is being accomplished by an administrative decision that sets aside the law, even if done with the connivance of Congress.

It should be possible for the larger (and incredibly heated) debate over the merits of Obamacare to proceed even while specific flaws in the legislation are addressed to avoid unintended harms to thousands of Congressional employees or millions of vulnerable families. I write that without making a judgment about the larger questions surrounding the Affordable Care Act. Indeed, I support the idea of expanding insurance coverage but believe the approach taken by the Obama administration is deeply flawed (a subject for a future column). And yet, in today’s political climate, addressing these unintended harms is not possible, with fault to be assigned at both ends of Pennsylvania Avenue.

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As we watch neo-liberals lowering the level and quality of care most people receive we are seeing laws that protect public justice over health malpractice being dismantled. So, health malfeasance will soar with the health reform and protections of people disappear. Neo-liberal Maryland is ground zero for this! The Maryland Assembly works hard to make sure the public does not take away an corporate profit....health care included.

Below you see the start of medical clinical trials being replaced by the 'THROW IT OUT THERE AND SO WHAT IT DOES' approach to new medical developments. So, instead of studying a new procedure with controlled and supervised clinical trials, the FDA simply approves a drug/procedure using the companies research results to justify safety concerns. This started in the Clinton Administration and is part of the COST BENEFIT ANALYSIS that says policy should not cut into corporate profits embraced by neo-liberals like Clinton and now Obama.

What this says is that because the FDA OK'ed the use of this drug in 1999, but then found in 2011----twelve years later (the normal length of a clinical trial)....that it looked to increase bladder cancer, people dying from exposure to this drug have no recourse. Mind you that the FDA is still doing this---Obama and neo-liberals have not changed the FDA's oversight and using corporate research to approve usage.

For those in Maryland it gets even worse because Maryland works hard to protect profit over people it has a law called CONTRIBUTORY NEGLIGENCE barring recovery of money in a tort lawsuit. So, the family whose loved one died from bladder cancer in Maryland taking this drug will have the corporate lawyers saying that because this man smoked ( the contributory negligence) the bladder cancer could have come from that even though ACTOS has been identified as causing this cancer. Just think how many things can be used for Contributory Negligence-----smoking, drinking, bad eating habits, air pollution. JUST ABOUT ANYTHING.

Contributory Negligence in Maryland
December 28, 2011 By mdlawyer

Maryland is one of only four states that recognize contributory negligence in personal injury claims. Contributory negligence means that you have contributed, in some way, to your injury. If you have contributed to your personal injury you are not permitted to recover any damages for the injury. This means that if you are only one percent liable, while the other party is 99 percent responsible, you cannot recover any money for medical bills, lost wages, pain and suffering, or anything else. Most other states recognize comparative negligence, which is where the fault of both parties is looked to in order to determine what amount of damages is fair for the injured party to receive. A Maryland accident attorney can help you to determine if you will be able to recover for a personal injury.

'For now, however, any plaintiff whose own negligence contributes to his or her injury is completely barred from recovery. The Court of Appeals has spoken, and contributory negligence remains the law in Maryland'.

Commentary: Contributory Negligence Remains the Law in Maryland

By James P. Steele and Andrew M. Williamson | August 6, 2013

On July 9, 2013, Maryland’s highest appellate court, the Court of Appeals, declined to abandon the longstanding common law doctrine of contributory negligence, which is a complete bar to recovery for any plaintiff whose negligence contributes to his or her injuries.

In Coleman v. Soccer Association of Columbia, a case that had been highly anticipated by Maryland’s legal community, the Court affirmed that it had the power to adopt comparative negligence as the law in Maryland but elected not to do so.

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Click Here to Learn More.In comparative negligence jurisdictions, a plaintiff recovers only for those damages for which he or she is not responsible. The 15 page opinion was accompanied by a 51 page dissent and a 4 page concurrence.

The case arose as a result of injuries sustained by James Kyle Coleman, “an accomplished soccer player who had volunteered to assist in coaching a team of young soccer players in a program of the Soccer Association of Columbia (Association), in Howard County, Maryland.”

When evaluating the insured’s liability, insurers can continue to consider whether a plaintiff’s own negligence contributed to the alleged injuries, creating a complete bar to recovery. During a team practice, Coleman jumped up and grabbed the crossbar of a goal. The crossbar was not anchored to the ground, and Coleman fell backwards, “drawing the full weight of the crossbar onto his face.”

Coleman’s injuries included facial fractures that required three titanium plates in his face. Coleman sued the Association, which asserted contributory negligence as a defense.

At trial, the parties offered differing testimony about what, if any, duty the Association owed Coleman and whether Coleman’s injuries were caused solely by his own negligence. The Association’s evidence showed that it neither owned nor provided the goal in questions, and that the goal was not in an area that the Association controlled.

The Association also offered evidence that the goal’s condition was open and obvious and that Coleman was responsible for his own injuries. Coleman disputed this, arguing further that it is common for players to hang from crossbars, and the Association should have anticipated this and anchored it properly.

At the close of evidence, Coleman submitted a jury instruction on comparative negligence, which the judge declined to give to the jury.

The jury found that the Association’s negligence was a cause of Coleman’s injuries, but that Coleman’s own negligence also contributed to his injuries. Under Maryland’s doctrine of contributory negligence, Coleman was completely barred from recovery. The trial court denied Coleman’s motion for judgment notwithstanding the verdict and entered judgment in the Association’s favor.

The Court of Appeals agreed to hear the case before it was briefed and argued at Maryland’s intermediate appellate court, the Court of Special Appeals.

Coleman’s sole issue on appeal was whether the Court of Appeals “should retain the standard of contributory negligence as the common law standard governing negligence cases,” in Maryland.

The Court of Appeals answered this question by noting that it “has the authority to change the common law rule of contributory negligence,” but it declined to abrogate this “long-established common law principle….”

Judge John C. Eldridge (Retired, Specially Assigned), who wrote the opinion, revisited the last time the issue of whether to replace contributory negligence with comparative negligence was before the Court.

In Harrison v. Montgomery County Bd. Of Educ., 295 Md. 442, 464, 456 A.2d 894 (1983), the Court ruled that contributory negligence remained the law in Maryland and that “any change in that established doctrine [was for] the Legislature.”

In Harrison, the Court reviewed the historical origins of contributory negligence, including early English cases. The Harrison Court noted that early American courts adopted contributory negligence because of concerns that high jury awards would stifle emerging industries.

Early courts also were wary of rewarding people who suffer injuries as a result of their own wrongdoing. Relying on these concepts, Maryland first adopted contributory negligence in an 1847 case, Irwin v. Sprigg, 6 Gill. 200, 205. (Maryland later modified the doctrine to note exceptions for injured persons under 5 years old and if the defendant could have exercised sufficient care to avoid the consequences of plaintiff’s carelessness.)

The Harrison court noted that in the early 20th century, Maryland’s legislature adopted comparative negligence for “certain perilous occupations,” but later repealed those provisions. In 1983, 31 of the 39 states that had adopted comparative negligence did so by statute.

While acknowledging that the trend favored adopting comparative negligence, the Harrison court noted that there are different versions and it is best to have the legislature decide which version, if any, to adopt.

The court also invoked the legal doctrine of stare decisis as weighing in favor of leaving contributory negligence as the law in Maryland absent legislative action.

Judge Eldridge noted that since Harrison, Maryland’s “General Assembly has continually considered and failed to pass bills that would abolish of modify the contributory negligence standard.”

This failure to act legislatively is “a clear indication of” and “very strong evidence that” the legislative policy in Maryland is to retain contributory negligence. Courts should not change common law contrary to Maryland’s public policy as set forth by the General Assembly.

In the concurring opinion, Judge Clayton Greene noted additional problems that would arise were the Court to throw out contributory negligence and adopt comparative negligence. How would it apply in cases of multiple tortfeasors? How would it impact the concept of joint and several liability? Would it destroy the viability of the Uniform Contribution Among Joint Tort-Feasors Act? Would it abolish the doctrines of last clear chance and assumption of the risk?

These questions, and the question of which version of comparative negligence to adopt, are best suited for the General Assembly to decide, in Judge Greene’s view.

Judge Glenn T. Harrell, Jr., in dissent, compared contributory negligence to a dinosaur that, in his view, the Court should have rendered extinct.

Judge Harrell invoked long standing criticism of the “all-or-nothing consequences” of contributory negligence. Citing many legal commentators, Judge Harrell called for a comparative negligence system that “apportions damages between a negligence plaintiff and negligent defendant according to each party’s relative degree of fault.” Ultimately, Judge Harrell would prefer adoption of pure comparative negligence.

Judge Harrell noted that even at the time Harrison was decided, the Court of Appeals recognized that jurisdictions that had transitioned from contributory negligence to comparative negligence did so with little difficulty.

Further, none of the judges on the Court of Appeals disputed that the Court had the power to make the change. Judge Harrell was unconvinced that stare decisis was sufficient reason to refrain from making the change and believed that the court need not defer to legislative inaction.

Judge Harrell wrote the dissent hoping that a future majority of the Court of Appeals would rely on it to abolish contributory negligence and adopt comparative negligence.

Coleman has implications for insurers and insureds alike. Insurers will not face the increased litigation that may have accompanied a switch to comparative negligence as Maryland sorted out implementing this new law.

When evaluating the insured’s liability, insurers can continue to consider whether a Plaintiff’s own negligence contributed to the alleged injuries, creating a complete bar to recovery. Further, the specter of a defense verdict based on the Plaintiff’s negligence can be useful to insurers during settlement negotiations.

Insureds remain able to avoid adverse liability findings for their negligence, but they also continue to risk looking like they are “blaming the victim” when they rely on contributory negligence as a defense.

It remains to be seen how, if at all, this opinion spurs any legislative action in the General Assembly to change Maryland to a comparative negligence jurisdiction.

For now, however, any plaintiff whose own negligence contributes to his or her injury is completely barred from recovery. The Court of Appeals has spoken, and contributory negligence remains the law in Maryland.
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THESE ARE THE MARYLAND COURT OF APPEALS APPOINTMENTS MADE DURING O'MALLEY'S TERM AS GOVERNOR-----they all voted for corporate interests. It was Glendening's appointments that called this law a dinosaur!

Shirley M. Watts, 6th Appellate Judicial Circuit. Appointed July 3, 2013. Sworn in July 31, 2013, to replace Robert M. Bell, who retired July 6, 2013.
Mary Ellen Barbera, 7th Appellate Judicial Circuit. Appointed Chief Judge July 3, 2013. Sworn in July 8, 2013, to replace Robert M. Bell, who retired July 6, 2013.
Robert N. McDonald, 2nd Appellate Judicial Circuit. Appointed Dec. 22, 2011. Sworn in Jan. 24, 2012, to replace Joseph F. Murphy, Jr., who retired Sept. 30, 2011.
Mary Ellen Barbera, 7th Appellate Judicial Circuit. Appointed Aug. 7, 2008. Sworn in Sept. 2, 2008, to replace Irma S. Raker, who retired April 24, 2008.
Sally D. Adkins, 1st Appellate Judicial Circuit. Appointed May 27, 2008. Sworn in June 25, 2008, to replace Dale R. Cathell, who retired July 30, 2007.
Joseph F. Murphy, Jr., 2nd Appellate Judicial Circuit. Appointed Dec. 4, 2007. Sworn in Dec. 17, 2007,

Harrell noted that only Maryland, Virginia, Alabama, North Carolina and the District of Columbia still have the law.
Judge Glenn Harrell, writing in dissent along with recently retired Judge Robert Bell, compared the law to “a dinosaur.”

The federal Food and Drug Administration approved the drug in 1999 to treat type 2 diabetes, and it became the diabetes drug of choice in 2007 after GlaxoSmithKline’s Avandia was linked to a higher risk of heart attack. However, the FDA released a safety advisory on June 15, 2011, stating that using Actos for more than one year “may be associated with an increased risk of bladder cancer.”

Tuesday, September 3, 2013 Volume 124 | Number 229 Online at TheDailyRecord.com

Actos trial set for Md.

In first case to go to jury, Calif. judge set aside April verdict of $6.5 million BYSTEVELASHSteve.Lash@TheDailyRecord.com

Jury selection is scheduled to begin Tuesday in a Baltimore family’s $10 million wrongful death lawsuit against the maker of the prescription diabetes medication Actos. Diep An’s widow and three children allege An died because Takeda Pharmaceuticals U.S.A. Inc. and its affiliates did not meet its legal duty to warn doctors and patients that longterm use of the drug could cause bladder cancer. Diep An, who began taking Actos in 2007 for type 2 diabetes, died on Jan. 14, 2012. Takeda denies the family’s allegations and said it plans to mount a strong defense of Actos during what attorneys expect will be a four-week jury trial before Judge M. Brooke Murdock in Baltimore City Circuit Court. Last April, in the first Actos trial to go to verdict, a California state jury awarded the plaintiffs $6.5 million. However, the judge in the case threw out the verdict in May, ruling there was insufficient evidence to link plaintiff Jack Cooper’s bladder cancer to his use of Takeda’s drug. The Deerfield, Ill.-based company is also fighting similar claims elsewhere, including more than a thousand in actions that were filed in federal courts nationwide and consolidated in the U.S. District Court in western Louisiana. “Takeda is confident in the therapeutic benefits of Actos and its importance as a treatment for type 2 diabetes,” Kenneth D. Greisman, Takeda Pharmaceuticals U.S.A. Inc.’s general counsel, said in a statement. “We have empathy for the plaintiff, but Takeda believes that we acted responsibly with regard to Actos,” Greisman added. “Patient safety is a critical priority for Takeda and we intend to vigorously defend Takeda against these lawsuits.” Failure to warn claim Actos has had a checkered history. The federal Food and Drug Administration approved the drug in 1999 to treat type 2 diabetes, and it became the diabetes drug of choice in 2007 after GlaxoSmithKline’s Avandia was linked to a higher risk of heart attack. However, the FDA released a safety advisory on June 15, 2011, stating that using Actos for more than one year “may be associated with an increased risk of bladder cancer.” That same month, Germany and France suspended distribution of the drug due to its suspected link to bladder cancer. In its lawsuit, the An family claims that Takeda knew of the drug’s risks before it was prescribed to Diep but did not warn him or his doctors. The Takeda companies “concealed and continued to conceal their knowledge of Actos’ unreasonably dangerous risks from Diep An, his physicians, other consumers and the medical community,” the complaint states. “Specifically, defendants failed to adequately inform consumers and the prescribing community about the risk of bladder cancer associated with the use of Actos,” the lawsuit adds. “Diep and his physicians would not have used Actos had defendants properly disclosed the risks associated with its long-term use.” The family’s failure to warn claim is one of several related allegations it makes against Takeda. The lawsuit also alleges design and manufacturing defects in the drug, as well as breaches of express and implied warranties of safety by the company. Stuart Simms, an attorney for the family, declined to comment on the coming trial beyond citing the papers filed with the court since the initial filing on June 8, 2012. “From all parties and all sides it would be inappropriate to comment prior to commencement” of the trial, said Simms, of Brown Goldstein Levy LLP. The Baltimore law firm is serving as co-counsel in the case, which was filed by attorney Michael J. Miller of The Miller Firm LLC in Orange, Va. The firm was also on Cooper’s legal team in the California litigation. The An family’s claim is one of at least three similar lawsuits that have been filed against Takeda in state and federal courts in Maryland. On March 2, 2012, the estate and family of John Dunlavey Sr. filed suit

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The biggest problem surrounding this stent case is the fact that it is systemic across the US and there is no oversight of the medical/health care industry that would have easily seen this criminal behavior years ago. THIS IS THE PROBLEM AND IT STILL EXISTS AND AS WE HEAR NO CRIMINAL CHARGES HAVE BEEN FILED FOR A CRIMINAL ACT. We do not want a millionaire suing for millions lost to capture what wealth may be available for who are average Americans needing the money more.

Next problem, the failure of the AMA and doctors groups to police themselves. Raise your hands if you understand that most doctors and hospital execs knew this fraud was happening--that's right, all of us. We have a government that says business can monitor itself and then it never does, we have the wrong public policy. It appears duplicitous in its neglect in protecting the public don't you think?

Repub voters need to stop listening to their wealth and profit pols tell them it is good for business to have no regulations that 'hinder job creation'. It is a lie. Dem voters need to stop allowing neo-liberals working for wealth and profit to capture the people's party. Vote them out by running and voting for labor/justice. The problem here is naked capitalism having no regulatory agencies, no oversight, and no enforcement and prosecution. Keep this millionaire away from these limited funds!

Cordish Co. partner said he lost millions because of unnecessary stents Stent trial starts Monday with jury selection
By Tricia Bishop, The Baltimore Sun 5:00 a.m. EDT, September 30, 2013

In November 2006, Glenn Weinberg appeared a healthy and hearty 50-year-old, who exercised regularly and was fully engaged in the competitive world of real estate development as a partner of the Baltimore-based Cordish Co.

But he scaled everything back after a cardiologist — Dr. Mark Midei — falsely led him to believe he had severe coronary artery disease and placed three expensive stents in his body that month, according to a lawsuit filed in Baltimore County Circuit Court.

The case, scheduled to begin Monday with jury selection, alleges that Midei cost Weinberg at least $50 million in lost work. Among the projects that Cordish completed while Weinberg was trying to take it easy was the Maryland Live Casino in Hanover — the state's largest casino, earning $377 million in table and gaming revenue so far this year.

"As a result of Dr. Midei's intentional misrepresentations … Mr. Weinberg significantly reduced his role and responsibility at the Cordish Company, forfeiting ownership in many Cordish Company projects and suffering tremendous economic loss," claims the lawsuit, which seeks $50 million in compensatory damages and $100 million in punitive damages.

Attorneys for Midei and co-defendant St. Joseph Medical Center in Towson did not respond to requests for comment. Midei also did not respond to a message. He has not been charged with criminal wrongdoing.

Weinberg's civil lawsuit is one of hundreds filed against Midei, a former star cardiologist who was found by a state physicians board to have repeatedly falsified medical records to place unnecessary stents in patients at St. Joseph. But Weinberg's case stands out because of the significant damage claims and his background.

In addition to his Cordish connection, Weinberg is the nephew of Harry Weinberg — who with his wife, Jeanette, founded one of the country's largest private charitable foundations — and the owner of the $6.9 million Hawaiian house at which the Obamas like to vacation.

He is represented by attorney Robert Weltchek, who has represented the Cordish Co., and William H. "Billy" Murphy Jr., who has a national reputation for taking on high-profile cases worth millions of dollars.

Weinberg and his attorneys declined to comment. David Cordish, chairman of the Cordish Co., did not respond to a message.

Midei, who lost his Maryland medical license in 2011, has said he acted in the best interests of his patients. And the hospital, which sent warning letters to nearly 600 of Midei's patients telling them their stents may have been unwarranted, has also said it is blameless.

Weinberg's complaint, like most others, claims lasting medical complications, an emotional toll and economic losses from the unnecessary stents, while complaining that St. Joseph failed in its oversight responsibilities. The suit was originally filed in 2010 when the allegations against Midei were made public.

It claims that Weinberg, who was feeling healthy and vigorous, visited a cardiology practice in November 2006 to get clearance for hernia surgery and that he was referred to Midei after tests showed possible cardiac abnormalities.

Midei was to check for blockage in Weinberg's arteries and intervene only if medically necessary. He wound up placing stents — tiny mesh tubes that prop open compromised arteries and cost about $10,000 to place — in three of Weinberg's arteries. He claimed in medical records that they were almost completely blocked, the suit said: Two of the arteries were 95 percent closed, and the third was 90 percent shut, Midei is said to have written.

In reality, the arteries were perfectly functional, Weinberg's lawsuit claims.

"In the winter and spring of 2010, various news media reports revealed that hundreds of Dr. Midei's stent patients had been notified by St. Joseph Medical Center that stents they had received may have been unnecessary. Following these reports, in early summer 2010, Mr. Weinberg's investigation revealed that the stents he had received were unnecessary and not medically indicated," the lawsuit claims.

It seeks damages on seven counts, including medical malpractice and fraud on both Midei and St. Joseph's parts. The hospital, which was owned by Catholic Health Initiatives at the time Midei worked there and bought by the University of Maryland last year, knew Midei had an abnormally high stent volume, which should have raised alarms, the suit claims.

In May, lawyers for Midei and St. Joseph settled unnecessary procedure claims by nearly 250 of Midei's former patients, avoiding years of legal proceedings. Roughly 45 civil suits remain.

The Weinberg trial is expected to last at least a month.

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The sad thing is that these labor union leaders knew ACA would kill union health plans but backed it anyway. We need union leadership that will work for its membership and not for pols that give one labor issue!

Laborers’ Union: Fix Obamacare or Repeal It; ‘We’re Getting Our A-- Kicked Here’

September 25, 2013 - 1:02 PM By James Beattie and Michael W. ChapmanSubscribe to James Beattie and Michael W. Chapman

Terry O'Sullivan, president of the Laborers International Union of North America. (AP)

(CNSNews.com) – Terry O’Sullivan, president of the 600,000-plus-member Laborers’ International Union of North America (LiUNA), often referred to as the Laborers’ Union, said that if Obamacare is not fixed, then “it needs to be repealed.” At a convention in Las Vegas of the AFL-CIO, with which the Laborers’ Union is affiliated, O’Sullivan took to the podium to endorse a proposition and then launched into a criticism of Obamacare, how it is hurting union members’ health coverage, and demanded it be fixed, adding that if it is not fixed, labor will make the issue a “big fricking deal.”

“If the Affordable Care Act is not fixed, and it destroys the health and welfare funds that we have all fought for and stand for, then I believe it needs to be repealed,” said O’Sullivan. “We don’t want it repealed, we want it fixed, fixed, fixed, and I commend Richard Trumka and the AFL-CIO for leading that charge. ”

Trumka is the president of the AFL-CIO, a national federation of labor unions with 11.5 million members. The Laborers’ Union was founded in 1903, and its members do a lot of work in construction, highway, and infrastructure work across the country. O’Sullivan became president of LiUNA in 1999.

He continued, “We can’t have the unintended consequences for the proud men and women that we represent to be collateral damage in the health care fight in this country. We’re getting our ass kicked here, there, and everywhere when it comes to retirement security -- and now our health and welfare funds are under siege.”

President Barack Obama and Vice President Joe Biden. (AP Photo)

“So we beg the president, we ask the president, we ask the Congress of the United States of America to do the right thing, to do the right thing for the proud men and women we represent,” said O’Sullivan on Sept. 11, during the weeklong conference. “ We’ll be damned if we’re going to lose our health insurance because of unintended consequences in a law [Obamacare],” he said. “ It needs to be changed, it needs to be fixed, and it needs to be fixed now, brothers and sisters.”

O’Sullivan, whose father worked in the Laborers’ Union, went on to talk about the union’s history and the many sacrifices of its members over the decades to get health insurance coverage.

“We fought, we went on strike, we laid down in the street to get health insurance,” said O’Sullivan. “We can’t afford to have a law that takes it away.”

AFL-CIO President Richard Trumka. (AP)

Again citing the hard work and sacrifices of the union’s members, O’Sullivan stressed that he and the union are going to fight to “make sure, like the president said, ‘If you like your health insurance, you can keep it.’ We want him to live up to that promise. And we will work with him to do that.” In closing, O’Sullivan said, “Vice President Biden – I won’t use his exact words – but I remember and you remember the picture of him whispering in the president’s ear, with the passage of the Affordable Care Act, and he said that, ‘This is a big fricking deal.’”

“Well,” he continued, “we need to make sure that we raise our voices loud, brothers and sisters, and say it’s going to be a big fricking deal if we, our members, lose our health insurance.”

Many labor unions, including the entire AFL-CIO have expressed strong objections to the way Obamacare is unfolding in real people’s lives and are calling upon President Obama and Congress to make changes to the law.

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Actually Obama does not recognize that democrats hate the ACA just as much as republicans. Well, he recognizes it, he just doesn't care. NO, this health reform will not stand as most citizens are now moving to Universal Care groups that will change this law to one that expands and enhances Medicare for All! Neo-liberals only represent a small percentage of the democratic party and they will be voted out of office as health care becomes the number one issue for most. People see that the Affordable Care Act is only about building global health systems that could care less about people and care and instead all about profit. That is for what Obama works. Make no mistake, republican pols want this as well....the ACA is a republican approach to health care....wealth and profit.

So, students who are going to be made to pay premiums for little access to care....get out and run for office! We are seeing these people Obama say are going to be insured getting co-pays and deductibles that most cannot meet and therefor they are not able to access the most basic of care. People are already dying from this lack of access. MD is a rampant global health system policy center with Johns Hopkins in the lead! RUN FOR OFFICE AND GET RID OF THE NEO-LIBERALS!

Obama tells Md. students health care law 'here to stay' Visit comes days before insurance 'marketplaces' open

President Obama spoke in Largo on Thursday to promote his Affordable Care Act. (WJZ Video)

By John Fritze, The Baltimore Sun 8:12 p.m. EDT, September 26, 2013

LARGO —— President Barack Obama used a visit to Maryland on Thursday to push back against congressional Republicans who are working to delay provisions of his health care law set to take effect next week.

The president vowed that his signature domestic initiative is "here to stay," despite an effort unfolding on Capitol Hill to cut funding for it. And he told nearly 2,000 students at Prince George's Community College that signing up for coverage would be as easy as shopping for "a TV on Amazon."

Democrats have been working feverishly to explain the controversial law as health insurance "marketplaces," the centerpiece of the policy, are set to open for business on Tuesday. Much of the effort is focused on getting the young and healthy to sign up for coverage.

"Part of the reason I need your help to make this law work is because there are so many people out there working to make it fail," Obama told the cheering students. "The fact is the Republicans' biggest fear at this point is not that the Affordable Care Act will fail. What they're worried about is it's going to succeed."

Hundreds of thousands of Marylanders are expected to enroll for coverage through the new exchanges.

Republicans ridiculed Obama's address as a sales pitch to unwilling customers. Senate Minority Leader Mitch McConnell cited polls showing skepticism about the law.

"It must be frustrating for him that folks seem to be tuning out all the happy talk," the Kentucky Republican said.

Congress has yet to approve any federal spending for the fiscal year that begins Tuesday. Conservative GOP lawmakers are threatening to vote down any budget bill unless Democrats agree to strip out funding for the health care law.

If the deadlock continues, the government will shut down after Monday.

"The American people don't want the president's health care bill, and they don't want the government to shut down," House Speaker John Boehner said Thursday.

Obama's appearance in Maryland was part of larger effort the administration is planning over the next several days to explain the law. The president appeared with former President Bill Clinton on Tuesday at an event in New York intended to ease fears about the Affordable Care Act's implementation.

But his speech in Maryland was more emphatic and political. He said Republicans who opposed the law are "crazy" and full of "hot air" and called attempts to tie it to must-pass government funding measures irresponsible.

"The closer we get, the more desperate they get," Obama said. "Shutting down the government just because you don't like a law that was passed and found constitutional, and because you don't like the idea of giving people new access to affordable health care — what kind of idea is that?"

He extolled what he said would be the benefits of the law, and made a prediction: "Once it's working really well, I guarantee you they will not call it 'Obamacare.'"

But his argument was undercut somewhat Thursday by the latest in a series of glitches and delays the administration has acknowledged. Officials said small businesses in some states will have to use paper forms to sign up for coverage until November. The delay will not affect Maryland businesses.

Rep. Andy Harris, the state's only Republican congressman, said that "every major promise the president made about Obamacare is turning out to be a lie."

"Another speech won't change the fact that insurance costs are continuing to climb and people across the country are not being able to keep the insurance plans and doctors they like," said the Baltimore County lawmaker, who is also a physician.

Speaking generally, Maryland was friendly territory for Obama's pitch. State officials in Gov. Martin O'Malley's administration have been the most energetic in the nation in setting up the insurance exchanges.

"It's going to be smoother in places like Maryland where governors are working to implement it rather than fight it," Obama said.

The state is home to roughly 750,000 people without insurance; about one-third of those are expected to get coverage through the new exchanges. The U.S. Department of Health and Human Services estimated this week that the lowest-cost plans offered would have an average monthly premium of $197.

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Vanderbilt University Medical Center Faces Allegations of Patient Dumping
Written by Molly Gamble | September 25, 2013

Nashville, Tenn.-based Vanderbilt University Medical Center is facing claims of patient dumping after it allegedly discharged an uninsured patient prematurely, according to a Tennessean report.

A lawsuit working its way through Nashville's circuit court claims VUMC discharged a patient two weeks after he underwent surgeries that saved his legs, which were injured in a motorcycle accident.

The patient, Patrick Miller, was sent Nov. 5, 2010, but returned to VUMC two days later "with an infection so severe that his right leg had to be amputated above the knee," according to the report.

The suit claims VUMC engaged in patient dumping, or prematurely discharging Mr. Miller in light of his uninsured status for economic reasons, according to the report.

VUMC spokesperson John Howser told The Tennessean the hospital consistently runs at or near patient capacity and that VUMC provides more than $370 million a year in uncompensated care, according to the report.

Vanderbilt lawyers have denied deficient care for Mr. Miller or patient dumping, and they have asked for the case to be dismissed. Lawyers also said Mr. Miller's surgery was "very complex" due to the severity of his injuries, according to the report.

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AS WE SEE HERE...QUALITY OF CARE IS FALLING AND REGULATORS AND OVERSIGHT ARE BEING DISBANDED......THIS IS NOT WHAT A FIRST WORLD HEALTH SYSTEM LOOKS LIKE!

Critics Question Medicare's Competitive Bidding Program, Set to Begin Saturday
Written by Rachel Fields | December 28, 2010

1
inShare As Medicare's Competitive Bidding Program gears up for its Saturday launch, critics renew their warnings that the program will put patients in jeopardy, according to a Press-Enterprise report.

CMS will implement the program in nine metropolitan statistical areas during its first round. CMS hopes that these areas will start to see savings of up to 30 percent on certain durable medical equipment, prosthetics, orthotics and supplies beginning Jan. 1.

The government says the process is a necessary change to a program marked by wasteful spending and fraud, according to the report. But critics say the program will close businesses or force suppliers to cut staff, and that Medicare and Medicaid have cut rates so low that winning bidders can't afford to provide the services they promised. Critics fear patients will ultimately suffer when contracts are awarded to financially unstable business who cannot meet patient needs.

Dissolution of California Board of Registered Nursing Raises Patient Safety Concerns
Written by Jaimie Oh | February 01, 2012

Critics are speaking out after an October veto by Calif. Gov. Jerry Brown led to the formal dissolution of the state's Board of Registered Nursing, which went into effect this year, according to a California Watch report.

The nursing board, which has been in existence for more than 100 years, investigated complaints against nurses and also processed applications for new nurses. Gov. Brown vetoed a bill that would have extended the nursing board's existence until 2016, citing the proposal "would dramatically expand pension benefits for […] board investigators" and makes "no sense fiscally and flies in the face of much needed pension reform," according to a statement.

As a result of the veto, the state's Department of Consumer Affairs was granted authority to oversee the dissolved board's everyday operations. The move has sparked criticism from former members of the nursing board, including the former president Jeannine Graves. Ms. Graves argues the board's disbanding is a disservice to the public as well as nurses, who are entitled to due process if they are accused of any misconduct.

Another former public member of the board, Richard Rice, who served as a former senior adviser to then-Gov. Arnold Schwarzenegger, also criticized the board's dissolution. He argued the move put a stop to the board's ongoing policy work, including more robust legislation that would require nursing schools to teach clinical and classroom skills, according to the report.

However, state government officials said although the board has been dissolved, its work is still being done.

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HEALTH CARE REFORM IS ALL ABOUT MAKING HEALTH INSTITUTIONS MOST PROFITABLE....SENDING ALL THE COSTLY PATIENTS TO THESE SMALL BUSINESS OWNERS NEEDING SHORTCUTS TO STAY PROFITABLE? REALLY?

Moody's: ASCs to Benefit From Declining Hospital Inpatient Surgeries

Written by Bob Herman September 24, 2013

As hospitals continue to record stagnant or falling inpatient surgery procedures, ambulatory surgery centers will see their volumes increase, according to a report from Moody's Investors Service.

Patient utilization in hospitals, especially for elective surgeries, has decreased significantly over the past five years for several reasons. Millions of Americans lost health insurance due to rising unemployment, and those with insurance have been forced to pay more of their healthcare costs through high-deductible health plans.

In addition, private payers, Medicare and Medicaid have been looking for ways to reduce their own costs, and consequently, they have turned to lower-cost ASCs for surgeries. On average, ASCs are reimbursed 57 percent of hospital rates for similar procedures.

Moody's found that from 2007 through 2012, hospital same-facility inpatient surgery cases dropped 0.22 percent per year, on average. At ASCs, same-facility inpatient surgery cases grew between 0.5 percent and 1 percent.

Moody's analysts said the 5,000-plus ASCs in the United States will continue to record growth in surgery cases this year and more years going forward. In particular, the large for-profit ASC companies like AmSurg, Symbion, Surgical Care Affiliates, Surgery Partners and United Surgical Partners International — which together own 14 percent of the ASC market — will fare the best because they can leverage economies of scale and attract more physician joint ventures, which could provide a "steady supply of patient referrals," according to the report.

Small Businesses in Your CommunityASCs,
sometimes called surgicenters, are usually small businesses owned by members of their com-munity. In fact, 70 percent of ASCs have 20 or fewer full-time employees. These small, community-based businesses benefit their communities not only by providing access to reasonably priced surgical care, but also by contributing to the local property and income tax bases and providing services and con-tributions to community charities. ASCs also make significant contributions to their communities as family-friendly employers that usually offer good health and retirement benefits and often offer flex-ible work schedules to their employees. Several anesthesiologists opened the first ASC in Phoenix in 1970 to provide high-quality, cost-effective surgical care to their patients. Continuing that tradi-tion, most ASCs today are owned and operated by community physicians. Some ASCs are jointly owned by local hospitals and physicians. By involving physi-cians in their management, ASCs ensure that those who are committed to providing topnotch patient care and actually deliver that care are also choosing the equipment and designing the policies they need to provide that care. This makes ASCs great places for physicians to practice and great places for patients to receive care. For nearly four decades, ASCs have worked to im-prove patient care and advance outpatient surgery. As a result, ASCs have introduced a number of health care innovations that benefit all patients, not just those who receive care in ASCs
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This is what we have been shouting for two years now.....the costs are low because you won't be able to access. So, you will pay a premium for insurance and then not be able to access anything other than preventative care.

REMEMBER, BABY BOOMERS PAID INCOME AND PAYROLL TAXES FOR DECADES ALL USED TO FUND MEDICAL ADVANCES WE HAVE TODAY.....WE PREPAID HEALTH ACCESS!

Lower Health Insurance Premiums to Come at Cost of Fewer Choices

By ROBERT PEAR Published: September 22, 2013

WASHINGTON — Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.

Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.

Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas.

“The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” said Joseph Mondy, a spokesman for Cigna.

The current concerns echo some of the criticism that sank the Clinton administration’s plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients’ options, their access to care and their choice of doctors.

At the same time, House Republicans are continuing to attack the new health law and are threatening to hold up a spending bill unless money is taken away from the health care program.

In a new study, the Health Research Institute of PricewaterhouseCoopers, the consulting company, says that “insurers passed over major medical centers” when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, among other states.

“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”

In California, the statewide Blue Shield plan has developed a network specifically for consumers shopping in the insurance exchange.

Juan Carlos Davila, an executive vice president of Blue Shield of California, said the network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.

Mr. Davila said the new network did not include the five medical centers of the University of California or the Cedars-Sinai Medical Center near Beverly Hills.

“We expect to have the broadest and deepest network of any plan in California,” Mr. Davila said. “But not many folks who are uninsured or near the poverty line live in wealthy communities like Beverly Hills.”

Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, which represents 9,000 clinics around the country, said: “We serve the very population that will gain coverage — low-income, working class uninsured people. But insurers have shown little interest in including us in their provider networks.”

Dr. Bruce Siegel, the president of America’s Essential Hospitals, formerly known as the National Association of Public Hospitals and Health Systems, said insurers were telling his members: “We don’t want you in our network. We are worried about having your patients, who are sick and have complicated conditions.”

In some cases, Dr. Siegel said, “health plans will cover only selected services at our hospitals, like trauma care, or they offer rock-bottom payment rates.”

In New Hampshire, Anthem Blue Cross and Blue Shield, a unit of WellPoint, one of the nation’s largest insurers, has touched off a furor by excluding 10 of the state’s 26 hospitals from the health plans that it will sell through the insurance exchange.

Christopher R. Dugan, a spokesman for Anthem, said that premiums for this “select provider network” were about 25 percent lower than they would have been for a product using a broad network of doctors and hospitals.

Anthem is the only commercial carrier offering health plans in the New Hampshire exchange.

Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H., said his hospital had been excluded from the network without any discussions or negotiations.

“Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals,” Mr. Gosline said. “It’s very inconvenient for patients, and at times it’s a hardship.”

State Senator Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said, “The people of New Hampshire are really upset about this.”

Many physician groups in New Hampshire are owned by hospitals, so when an insurer excludes a hospital from its network, it often excludes the doctors as well.

David Sandor, a vice president of the Health Care Service Corporation, which offers Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, said: “In the health insurance exchange, most individuals will be making choices based on costs. Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals.”

Premiums will vary across the country, but federal officials said that consumers in many states would be able to buy insurance on the exchange for less than $300 a month — and less than $100 a month per person after taking account of federal subsidies.

“Competition and consumer choice are actually making insurance affordable,” Mr. Obama said recently.

Many insurers are cutting costs by slicing doctors’ fees.

Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were “often below our cost of doing business, and definitely below commercial rates.”

Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.

Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.

“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”

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In other words, when Obama said that buying insurance on the exchanges would be like buying “a flat screen TV,” he was at best ignorant, and at worse was flat-out lying.

Obamacare, Obfuscation and Functional Discontinuities

August 29th, 2013
in Op Ed

Opposition to ObamaCare Considered Rational on Grounds of Equity by Lambert Strether

Cross posted from Naked Capitalism.

From his latest presser, Obama’s partisan perspective on ObamaCare:

OBAMA: Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail, their number-one priority.

However, from the public purpose perspective, the really interesting question is why our “friends” in both parties refuse to put truly universal coverage — for example, single payer Medicare for All — on the table at all. Remember, ObamaCare is, pathetically, projected to enroll only 7 million people in its first year, and when fully implemented will leave about as many uninsured as newly insured — 25 or 30 million, but with “these people,” who’s counting?

Follow up:

Be that as it may, we’re stuck with ObamaCare for now. And no matter what Obama says, the real problems with ObamaCare are not “glitches” and can’t be solved with “adjustments” or “administrative changes”‘; they are fundamental to its system architecture, which demands that every American be thrown into one eligibility bucket or another, with the number of possible buckets being 1 (Federal) x 50 (states) x 9 (the number of income levels) = 450. At least I think so.* Maybe somebody smarter than me wants to calculate the combinatorial explosion, taking the differences between the actual plans offered in each jurisdiction into account. Anyhow, as I’ve been relentlessly documenting, ObamaCare’s complex, confusing, and Rube Goldberg-esque system of eligibility determination mean that people inevitably get thrown into the wrong buckets, or there aren’t even the right buckets for them. Worse, people are thrown into buckets for whimsical and arbitrary reasons, leading to a fundamental lack of equity, of common fairness, for the entire program. Today I’d like to ObamaCare’s fundamental lack of equitable treatment for all citizens by using Kaiser’s Subsidy Calculator** for people at “the margins”: Those at the top, too well-off to participate in the Exchanges, and those at the bottom, too poor to do so. For continuity with this (conservative) example, the test case will be a family of two 56-year old non-smokers, with two children under 20.*** (Hat tip Beowulf — yes, that Beowulf — for the example, and for extending it to the poor.)

First, let’s define the margins:

If your income is lower than 400% poverty level (top, maximum), you will receive assistance paying for your health insurance and if you earn less than 138% poverty level (bottom, minimum), you will be eligible for Medicaid – unless you are in one of those states that made the ridiculous decision not to expand Medicaid coverage for their poorest citizens.

(Matters are actually more complicated; the maximum is 400% of poverty level or 9.5% of income, whichever is least.) Taking our income figures from the 2013 Poverty Guidelines, let’s plug the figures at the top margin (400%) household into the calculator:

Click to enlarge

Now, since we’re at the margin — 400% of the poverty level exactly — let’s add a dollar and see what happens:

Click to enlarge

Before: $18,637 unsubsidized – $8,160 subsidy nets to $10,477.

After: $18,637 – 0 = $18,637. That extra dollar of household income at the margin cost you $8,160 dollars worth of (actuarially determined) health care. I ask you: How can effect so grossly disproportionate be fair? Is there any way for a health care program to justify this? And that’s before we realize that a relatively well-off household is going to be able to afford the professional services to manage their income so as to retain the subsidy. Of course, this obvious inequity is a consequence of Obama’s system architecture: Buckets have edges, and people fall in a bucket, or out of it.****

And now, let’s plug the figures at the bottom margin (138%) household into the calculator:

Click to enlarge

And now one dollar less:

Click to enlarge

Before: $18,637 unsubsidized – $17,383 subsidy nets to $1,254.

After: Medicaid.

Never mind that some states “expanded” Medicaid and others did not. Here is the central point of unfairness for me, and the Kaiser site describes it falsely. They write:

“[Y]ou will be eligible for coverage.”

In fact, you aren’t “eligible,” because you don’t have a choice. You’re forced into Medicaid. This is important if you’re over 55, because Medicaid expenses will be clawed back from your estate.***** ObamaCare, in other words, prevents you, by force majeure, from providing for your children if you’re poor and over 55. You don’t even have the option of taking on risk by buying a crappier policy. How can that be fair?

The bottom line, again: ObamaCare, by its very system architecture, is riddled with these nutty distinctions, these whimsical and arbitrary inflection points, where a dollar this way or that way has massive and disproportionate effects that play out with people’s health (for pity’s sake). That’s why health care should be a guarantee — and although Obama occasionally nods to universality, he’s very careful not to deliver it — and a clean and fair system like single payer Medicare for All is the right way forward.

•••••••••••••••••••••••••••••••••••••

END-NOTES

* It’s true that only 17 states are building their own exchanges, but I think that different states can have different policies even if they are using the Federal exchange. All this when we have a proven single payer system in action already — Medicare — which LBJ rolled out to all over 65s in just one year, back in the day when Big Iron mainframes roamed the earth, and women wearing bunny ears was considered quite the thing. All in all, ObamaCare seems like a case of what Yves calls devolution. Infestation of the body politic with rent seekers will do that.

** Here’s Kaiser’s caveat on its calculator:

We assume an average premium for a single adult enrolled in the second-lowest cost Silver plan to be $4,827 (before subsidies). This estimate was derived by multiplying the CBO estimate for a family premium by 37% (the average ratio of single to family premiums in previous CBO estimates) and then adjusting for assumed inflation and differences over time in the aggregate reinsurance pool to arrive at a 2014 estimate. Premiums could vary from this amount due to assumptions insurers make in setting premiums or the degree of competition in the market, and will also differ based on regional variations in underlying health costs.

In addition, the entire notion of calculators is flawed: Exchange values, and hence the values the calculator spits out, represent actuarial values, not the dollar value of real services delivered, and as a study from Kaiser shows, actuarial values can differ wildly by insurer (i.e., can and therefore will be gamed). Of course, the details are obuscatory. From Kaiser:

[T]he levels of coverage in the ACA are not defined using specific deductibles, copays, and coinsurance. Rather, they are specified using the concept of an “actuarial value” (AV). … [A]ctuarial values are not an inherently intuitive idea for most people, so the Kaiser Family Foundation initiated a study to estimate the deductibles and coinsurance that would meet the thresholds defined in the ACA. Because there is inherent uncertainty in actuarial analysis – driven by different assumptions and data – the study commissioned estimates from three well-established actuarial and benefits consulting firms. … Apart from the specific details of any of the plan designs, one notable conclusion from the analysis is the substantial variation in the estimates … The analysis also points to the potential for substantial variation in plan designs meeting the actuarial value thresholds in the law, suggesting that the terms of coverage could vary significantly across insurers. …

In other words, when Obama said that buying insurance on the exchanges would be like buying “a flat screen TV,” he was at best ignorant, and at worse was flat-out lying.

*** The effects are smaller for smaller families, but the principle remains the same.

**** Some might make a similar argument against progressive systems of taxation. Since taxes don’t fund spending, the same government services can be delivered regardless of tax structure. However, one might, from the perspective of public purpose, support a steeply progressive tax system (the top rate under Eisenhower was 91%) to prevent the development of an aristocracy of inherited wealth (unfair) and/or to prevent the rich from buying the State (also unfair) with the loose cash they’d otherwise squander on yacht covers and expensive handbags. (It seems to me there’s a difference between passing on creature comforts to one’s heirs, if any, and (say) entailing an estate, let alone primogeniture. Perhaps that is a petty bourgeois perspective, or a perspective limited by the post-World War II fashion for home-ownership. And a discussion for another day.)

***** To be fair — and I’m guessing here — if you’re poor and at the 138% margin, your income is more likely to fluctuate than if you were destitute, or (relatively) well-off, and so you’ll be falling into Medicaid and then escaping into the Exchanges again.

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This is a good article but what it doesn't say is that if we do not cap the size of these health systems, whether private or public, they will go global and be just as unstoppable as Wall Street has become. We need Universal Care advocates shouting loudly and strongly to cap the size of these health systems!

Health law's ailments can be cured by single-payer system All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers.

In a Nevada news broadcast last month, Senate Majority Leader Harry Reid called the Affordable Care Act “a step in the right direction” but added that the U.S. would have to “work our way past” private insurance-based healthcare. (J. Scott Applewhite, Associated Press / September 6, 2013)

By Michael Hiltzik September 10, 2013, 6:12 p.m.

With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you'll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America's healthcare system in our lifetimes. Here are a couple of things to keep in mind:

First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.

Second, there's an obvious way to correct this flaw: The country should progress on to a single-payer system.

Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA "a step in the right direction" but adding that the U.S. would have to "work our way past" private insurance-based healthcare. "We're far from having something that's going to work forever," he said.

"There isn't a popular groundswell yet" for a single-payer plan "because most people haven't seen the ACA at work in detail yet," says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October "and accelerate through the winter."

Among the law's shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don't have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)

That's not to say that the ACA won't make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.

In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they're actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.

The ACA's critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn't go far enough — that is, further toward single-payer.

In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the "public option," a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry's insistence.

But the U.S. does offer a healthcare program that resembles single-payer. It's Medicare, the broadly popular health plan that covers all Americans over 65. Medicare's administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That's why one oft-proposed version of single-payer is "Medicare for all" — simply expand its coverage beyond the 65-plus.

Canada's single-payer system is another model. It's popular and efficient and costs about one-third of America's system to administer. Don't believe the myths purveyed about Canada's healthcare by the U.S. insurance industry's minions.

As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it "rations" care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.

There's little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.

Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn't include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.

Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors' offices, they calculated.

What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they're totally ineffective at cost control.

Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn't hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn't buy adequate oversight.

The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.

"Private insurance is a parasite in the system," says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. "It adds nothing of value commensurate with its cost."

Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more "accountable care organizations" — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.

What's really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.

The forces of opposition won't lie down; the insurance industry won't give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.

"It's going to be a slow and painful process," Relman says. "But sooner or later we'll have to turn to single-payer. It's the only logical solution."

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This policy of privatizing health care is happening all over the world as the US pushes all nations through the TPP trade deals to end subsidized public health and build structures that create health markets based on profit. In Baltimore we have Johns Hopkins who go to places like this article....the Philippines.....to work with that government in building these structures so that Hopkins.....now becoming a global health corporation will profit. AMERICANS NEED TO REVERSE THESE PRIVATIZATION POLICIES BY WORKING FOR UNIVERSAL CARE AND A STRONG PUBLIC HEALTH DEPARTMENT AT ALL LEVELS OF GOVERNMENT. OBAMA IS TURNING THE DEPARTMENT OF HEALTH INTO PRIVATE JUST AS THE DEPARTMENT OF EDUCATION IS NOW PRIVATELY RUN. If you have no public health department.....you will have no accurate health data and no public protections against fraud and misuse!

December 11, 2012
Opposition vs. privatizing public health care snowballs

65 2 101 1 By CONG B. CORRALES
Bulatlat.com

CAGAYAN DE ORO CITY — Opposition to a proposed law, aimed at turning public hospitals into government-owned and controlled corporations (GOCCs) has snowballed, here. This, despite its proponents’ claim that the bill would boost public health care.

Entitled, “An Act Converting Government Hospitals into National Government Corporation, Providing Funds Therefore and Other Purpose,” HB 6069 authored by Bacolod City Rep. Anthony Golez and SB 3130 authored by Sen. Franklin Drilon, have been widely criticized because, people’s organizations said, will make public health care more inaccessible to marginalized Filipinos.

Earlier this month, local people’s organizations under the Network Opposed to Privatization (NOP) held a picket rally in front of the Northern Mindanao Medical Center (NMMC) to show their resistance against the proposed act. NMMC is a tertiary regional government hospital here.

Vice Mayor Caesar Ian Acenas, in a text message, enjoined members of Congress not to be too hasty in passing HB 6069 and SB 3130 into law.

“I still have to (study) the details of the proposed (law). But if the purpose is for profit only, our legislators should think twice,” said Acenas.

“I still maintain my stand that public hospitals in the Philippines (are) for services, especially for the needy and indigents,” he added.

Department of Health (DOH 10) spokesperson Emiliano Galban concurs with Acenas’ stand that government hospitals are supposed to be for public health care service and not for revenue generation.

“Can they guarantee that when this bill is passed into law, there will be no hike in the cost of services and of the medical professionals’ fees?” Galban rhetorically asked.

In an interview over the internet, Monday evening, Gene Nisperos, MD, national vice chair of the Health Alliance for Democracy (Head) said that privatization by any other name spells more suffering for the people.

“The two bills are explicit in their statement on the rationale behind corporatization—fiscal autonomy, revenue-generating activities and public-private partnerships (PPP). The context of corporatization is the national government’s refusal to provide adequate funds for health care,” he said.

Gabriela Women’s Party regional coordinator Rhodora Bulosan, said in a phone interview, Tuesday, that the proposed law will make NMMC even more inaccessible to the people.

“They may call it whatever they like but in essence, the law is corporatization of public hospitals and is really geared towards the privatization of government hospitals—including NMMC,” said Bulosan.

“A private investor, who will shell-out capitalization to augment medical equipment of public hospitals, would always aim to earn their profit or the return of their investment (ROI) the soonest time possible. Who will benefit from the 10 units of Dialysis Machines in NMMC if it will be privatized,” she added.

Bulosan posited that it is bad enough that regular check-ups in the Out Patient Department at NMMC are not free of charge anymore. “This law will make NMMC even more inaccessible to the public,” she remarked.

“Presently, the poor expectant mothers in the region have reported that is has become increasingly difficult for them to access to free maternal delivery at the charity ward of NMMC. You have to pay before a doctor could attend to you,” said Bulosan.

She further claimed that laboratory test fees at NMMC have increased since “about 90 per cent of the laboratory equipment at NMMC is already privately-owned.”

“In essence, corporatization of DOH-retained hospitals is all about money. It is about the national government giving less—not more—money for health, even when this has run contrary to social imperatives, in particular,” Nisperos posited.

“At the bottom of this is the lie that has been repeated as justification of past and present administrations for giving the health sector such a low budget: ‘the government has no money.’ In fact, what the Aquino administration has is (the absence of) political will,” he added.

- See more at: http://bulatlat.com/main/2012/12/11/opposition-vs-privatizing-public-health-care-snowballs/#sthash.jhMEdqrl.dpuf

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Since these private insurance exchanges are simply made to sell tiered insurance policies designed to have people pay premiums and then not afford to access the level of care needed....it is a given that these systems are only meant to send all health policies...employer and public entitlements....into what is for most a Medicaid level of care. WORK FOR UNIVERSAL CARE/HEALTH CARE FOR ALL! It is not ignorance that keeps people away for goodness sake!

TELL OBAMA TO DECLARE WAR ON FRAUD AND BRING BACK TENS OF TRILLIONS OF DOLLARS TO GOVERNMENT COFFERS AND FUND HEALTH CARE FOR ALL!

Ignorance of Obamacare exchanges threatens plan's success
Published: Friday, 23 Aug 2013 | 10:08 AM ET By: Dan Mangan | Health Care Reporter

Miguel S. Salmeron | Stockbyte | Getty Images With just 38 days to go before the opening of Obamacare insurance exchanges, public ignorance about those marketplaces remains sky-high, threatening the very goal of offering affordable health care to the uninsured, several studies show.

And according to a troubling conclusion in at least one study earlier this year, awareness about the new health-care law had declined among some groups more than three years after Obamacare was signed.

But whether knowledge is slipping or stagnantly low, health-care advocates are now in crunch mode as they work to spread the word about exchanges, whose success is dependent on large consumer participation.

What's an insurance exchange?

Just 22 percent of adults ages 18 to 64 had heard "a lot" or "some" about the insurance exchanges, according to a Kaiser Family Foundation study in June. But 45 percent said they knew "nothing at all about them," according to the study.

Perhaps most troubling is young adults, who appear particularly clueless about the Affordable Care Act exchanges due to open Oct. 1 and begin coverage. A whopping 73 percent of adults between the ages of 19 and 29 are unaware of the marketplaces, a separate Commonwealth Fund study this week found.

"If you continue to see that very low level of awareness even as you get toward October, that's a sign that we may not be getting the enrollment, and the exchanges are going to be at a bit of risk from that," said Commonwealth Fund report co- author Sara Collins.

"You want a broad, healthy diverse risk pool in the marketplaces. It's really important that young, healthy people come into the market," said Collins, noting the danger of premium hikes from having a disproportionate number of older, sicker people in insurance plans.

Even if they know about the exchanges, a surprising 68 percent of people with pre-existing health conditions—who potentially have the most to benefit because the law now will bar denial of insurance in such cases—say they are unsure if they will buy the plans there, according to a separate report this month from InsuranceQuotes.com. That same report found that 14 percent of such people with health conditions said they actually would not buy insurance.

(Read more: Health-care changes on the horizon)

'Knowledge gap'

"I think it shows that people are really confused. I think it just shows a basic misunderstanding," said Laura Adams, senior analyst at InsuranceQuotes.com. "If these people don't know this law is around the corner and designed to benefit them, then I think that shows a real knowledge gap that I don't think we're going to close before Oct. 1."

"Next year, we're probably going to see a lot of people who could be getting benefits not signing up," Adams said.

The wide knowledge gap has sparked a scramble to educate the uninsured about the exchanges and to push them to sign up during the six-month open enrollment.

"We've definitely got our work cut out for us," said Jessica Barba Brown, national communications director of Enroll America, a nonprofit group that's spending tens of millions of dollars and deploying more than 3,000 volunteers to spread the word about the exchanges.

"This is going to be a huge, unprecedented option for millions and millions of Americans that never had it before," said Barba Brown. "So yeah, it's a big deal, and it's definitely not going to be easy."

Confusion about health insurance

The government-run exchanges being set up in all 50 states and the District of Columbia will offer a menu of health insurance plans that all must have certain minimum benefits and be affordable. The plans will be offered at different levels of premiums—ranging from bronze plans up to platinum plans—and subsidies will be available to many people to help them pay for the coverage.

Most Americans, about 80 percent, already have insurance through their employers. But for 50 million or so other people, the exchanges will be their primary way of obtaining insurance, which is required by the Affordable Care Act.

Making the job of selling the brand-new exchanges even more difficult is the public's general ignorance about health insurance. A recent Journal of Health Economics study found that just 14 percent of people were able to correctly define all of four insurance terms that could affect plan-buying decisions: deductibles, copays, coinsurance and maximum out of pocket costs.

But the persistent ignorance about the Obamacare exchanges is striking given extensive news coverage of the health-reform law upheld by the Supreme Court last year as well as a presidential election, which was seen as a referendum on President Barack Obama's championing of the legislation.

Play Video Health-care success depends on the young It's crunch time for Obamacare and the success of the new law depends on young people signing up early and often, reports CNBC's Bertha Coombs. Liz Hamel, an associate director for surveys at the Kaiser Family Foundation, said, "We certainly haven't seen an increase in public knowledge since the law passed" in 2010.

In fact, a Kaiser survey in March found that "awareness had decreased" among some groups about Obamacare, Hamel said.

Since then, there have been news headlines about Obamacare that have left some people with the mistaken impression that the exchanges are either going to be delayed for a year or have been overturned altogether, neither of which is true. Contributing to that confusion are repeated votes by the Republican-controlled House of Representatives to either repeal or defund the law.

The risk of ignorance about the exchanges isn't limited to potential premium hikes stemming from lower-than-projected enrollment.

There are also "some dramatic consequences" for the health of the people who don't obtain insurance, said Jeffrey Levi, executive director of the Trust for America's Health, a health advocacy group.

"For example, there are estimates that as much as a quarter of people that are HIV-positive do not know they are infected," said Levi, noting that if those people had insurance coverage they would be getting "routine screening" that could detect the virus.

"This is not just preventing the people with HIV from developing AIDS, but we also know that people in treatment are much less likely to transmit the disease."

Like many other states, New York is launching a multifront effort to overcome lack of awareness about the exchanges and get people to enroll.

Donna Frescatore, director of New York's exchange, said this week's roll out of its official name, "New York State of Health," a tax credit calculator on the marketplace's website and the release of information about the insurance plans being offered in each county were "a big step" in raising awareness.

New York, which has received nearly $41 million in federal funds to market the exchange over two years, also launched a social media campaign on Wednesday, targeting potential exchange users on Facebook, Twitter and Google, popular platforms for younger people, Frescatore noted.

But New York State of Health is waiting until late September to begin TV, print and radio advertising, which were originally expected to begin earlier. Frescatore said that means more people will hear about the exchanges closer to the time they can actually enroll.

Her exchange also is partnering with about 150 organizations and subcontractors to bolster enrollment, training insurance brokers in the exchange's protocols and is working with hospitals, health plans, libraries, YMCAs, faith-based groups and other entities to get the word out.

Out of 2.7 million total uninsured people in New York, Frescatore said the exchange hopes to enroll 1.1 million people in the near term, but "we expect that will probably take 2 ½ to 3 years." Currently, only about 17,000 people buy insurance for themselves on the open market in New York, she noted.

Frescatore said the average 53 percent reduction in premium prices on the exchange's plans compared with existing individual open-market rates, which Gov. Andrew Cuomo announced last month, "are built largely" on the enrollment assumptions she cited.

"We're optimistic that will happen," she said of those projections, but "that's what makes this outreach so critical."

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THERE IS THE COST SAVINGS IN HEALTH CARE YET THESE MEDICAL DEVICE/EQUIPMENT COMPANIES ARE ON YOUR STATE HEALTH SYSTEM COMMITTEES WRITING POLICY THAT HAS PATIENT ACCESS GONE AND THEIR PROFITS SUSTAINED!

This is how Maryland rolls!

It Costs $350 to Make an Artificial Hip. But It Will Cost You $30,000 to Get One.
—By Kevin Drum

| Fri Aug. 16, 2013 10:27 AM PDT Mother Jones

190

For the last few months, Elisabeth Rosenthal of the New York Times has been working on a series of stories about the high price of healthcare in America. In July she wrote about the high cost of childbirth, and earlier this month she wrote about the truly insane cost of hip replacements in America. But Bob Somerby has noted something interesting: nobody else in the media seems to care:

These articles deal with a very important topic—the massive looting of U.S. consumers which characterizes American health care. This looting helps explain a welter of major social and political problems—our nation’s growing income inequality; our stagnant wages; the failure to provide full medical coverage; the nation’s problems with federal deficits and debt.

But so what? Despite their high profile and apparent salience, Rosenthal’s reports have met with universal silence, except for last week’s Fresh Air....It’s going to win the Pulitzer Prize—and it’s going to do so in silence!

Despite the high profile afforded this series, the silence has been general all over the press, which seems paralyzed, dead in life. At the end of this report, we’ll offer our own speculations about the resounding silence.

Is this really true? Rosenthal's piece implied that artificial hips cost about $350 to manufacture, but sell to hospitals for upwards of $5,000 or more—and are then marked up further by the hospital before they end up in an OR getting installed. It's not clear if $350 is just the manufacturing cost, or if that's the all-in burdened cost of producing a hip, but it almost doesn't matter. Even if it's the former, it means the full cost is unlikely to be more than $1,000 or so. Nonetheless, in the case of one particular implant, Rosenthal reports that U.S. hospitals pay an average of $8,000 and that even Belgian hospitals, which benefit from government-controlled pricing, pay $4,000. So everyone is paying a pretty hefty markup. Americans are just paying a super-hefty one, made worse by the fact that hospitals then add their own markup, bringing the price of the implant up to $30,000 or more.

So that's at least a 30x markup to the end user just for the cost of the part. And that's despite the fact that the technology is mature, volumes are high and increasing, and there are five companies "competing" for business. So what's going on?

Rosenthal has some ideas, but in the end it remains unclear. Where are insurance companies? Where's Medicare? Why isn't anyone outraged by this? Is it just fatigue at the never-ending tsunami of stories about the lunatic cost of all the various bits and pieces of American healthcare? Bob is right: it's a mystery.

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Hospitals are being made into global health systems and as such they will get CEO pay packages just as any other Wall Street business. That is towards what the Affordable Care Act works. Taking a public service like health care....and these corporate pols and their handlers are doing the same to public education....and making them the next global market all while denying access to care because it cuts profits is unscrupulous. We see a stellar public institution like U of M Medical Center being turned into a corporate university that turns people away if they have Maryland Health coverage.

This is O'Malley's legacy and it is behind all of the MD Assembly's positioning on the U of M in Baltimore being tied to College Park as corporate interests are now tied to our public universities. We need people to join the fight for Universal Care to make sure the top priority is patient access to all health options before these health institutions are allowed to make hospitals into corporations headed by CEO as is the case with U of M. The Governor appoints these heads so we need to elect pols that are working for the people and not corporate profits. All of the current democrats are neo-liberals....corporate pols. Whether Brown/Ulman or Gansler/Washington, or Mizeur..all will continue this privatizing of all that is public. Demand your labor and justice organization run candidates!

Some hospital CEOs get bigger compensation packages Pay scrutinized as medical institutions complain about tight budgets

By Andrea K. Walker, The Baltimore Sun 2:09 p.m. EDT, August 18, 2013

Many Maryland hospital and health system CEOs received pay increases in recent years even as they complained of shrinking profit margins and warned of cutbacks unless they could increase the rates they charge.

Eleven executives earning seven-figure compensation packages including salary, bonus, retirement and other pay saw their total pay rise from as little as 0.13 percent to as much as 308 percent in the fiscal year that ended in 2012, according to tax filings. Another executive earning more than $1 million saw a pay cut.

Some of the larger compensation increases included retirement benefits earned over years of service that were reported as income under new tax rules. In those cases, the CEOs won't collect the money until they retire.

But many of these same CEOs took home tens of thousands of dollars more than the previous year because of bonuses and increases in base pay. Others got money for social clubs and gym memberships in an era when many companies have stopped offering these perks.

Hospitals defend the compensation, saying CEOs are paid fairly for the high-profile, complex duties that come with their jobs.

And at least two hospital systems — Saint Agnes Healthcare and the University of Maryland Medical System — have since instituted pay cuts or freezes for executives, given budgetary constraints.

See a database of compensation for Maryland health executives.

The CEO pay question — always a hot-button issue — is generating debate again this year after a state panel spurned a push by hospitals for higher rates, instead approving smaller increases and calling on them to do more to curb expenses. Hospitals have sought rate increases in each of the past three years, and this year at least one Baltimore-area hospital responded with layoffs in an effort to trim labor costs.

Health care watchdogs and union leaders say more scrutiny should be paid to what executives earn for running nonprofit institutions, which get tax breaks and set-asides to treat the poor.

Those critics say hospital CEOs need to examine their own salaries as they face financial pressures and look to cut costs.

"If they are laying off staff and decreasing what they invest in the community and executive compensation is increasing, that is a real question," said Jessica Curtis, project director of the hospital accountability project at Community Catalyst, a national advocacy group that promotes wider access to affordable health care.

Hospitals argue that they have to offer competitive compensation to attract talent to run a complicated business.

Executives need to understand everything from the latest health technologies to regulatory changes, including health reform. Hospitals note that they compete with private sector businesses where their executives could choose to work instead.

Is value received?

"I would say no matter whose compensation you're looking at, the question is if there is value being received for that service," said Carmela Coyle, CEO of the Maryland Hospital Association, a trade group that lobbies on behalf of hospital members that operate in the state.

"Hospital executives are in charge of incredibly complex organizations," she said. "They are organizations that are open 24 hours a day and are highly regulated. These are really difficult, difficult jobs."

The Baltimore Sun analyzed the compensation packages of the CEOs and presidents from more than 40 Maryland hospitals and health systems using the 990 forms they must file with the Internal Revenue Service each tax season. The survey relied on forms for the fiscal year ending in 2012, which were posted on the website of the Health Services Cost Review Commission, the body that sets hospital rates in Maryland.

Those who operate large health systems earned the most.

The state's highest-compensated hospital executive that fiscal year was Kenneth A. Samet, the CEO of the 10-hospital MedStar Health system, who earned $6.3 million. More than half — $3.5 million — was money earned in a supplemental retirement plan during his 23 years of service. He won't get the money until he retires. His base pay was $1.2 million, and he received $1.5 million as a bonus and incentives.

The other top five highest-paid executives in Maryland are James Xinis, CEO at Calvert Memorial Hospital in Prince Frederick; Ronald Peterson, president of the Johns Hopkins Hospital and Health System; Robert A. Chrencik, CEO of the University of Maryland Medical System; and Thomas Mullen, CEO of Mercy Medical Center

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You know what the American people need far more than more medical research? They need to access the medical research for which taxpayers have already paid. Hundreds of billions of dollars are funneled to medical research at a time when the Affordable Care Act is creating global health systems that are all about profit..making private non-profits like Johns Hopkins into corporations as now they are patenting research and earning profits even as they are the team of health businesses writing policy for MD's private health systems.

Politicians pretending there is a shortfall in Medicare/Medicaid and that health costs are growing because of bad health choices of citizens and those pesky longer lives. What we have is massive health industry fraud that has stolen 1/2 of Medicare/Medicaid funding these few decades and a system that has allowed costs to soar in order to allow profits to get ever larger. It has nothing to do with patients. These private health systems are limiting most people to preventative care because it is cheap and easily defrauded while medical research for advances that are now going to be patented and earn profits for these new university corporations are funded by hundreds of billions of dollars.

We do not need new research until all people can access the existing advances. Payroll/ income taxes paid for all existing medical procedures..bought and paid!

Hopkins, U-Md. await word on grant funding key in medical treatment discoveries NIH budget squeeze affecting 'translational' research focused on improving human health

Midhillun Muqaribu of Newark DE is participating in an HIV prevention research study at Johns Hopkins School of Medicine. Jennifer Breakey, R.N. , left, helps Karen Edmonds, right, who is the nuclear medical technician as they get the patient situated in the CT scanner. (Barbara Haddock Taylor, Baltimore Sun / June 9, 2013)

By Scott Dance, The Baltimore Sun 1:51 p.m. EDT, August 16, 2013

Dr. Craig Hendrix is exploring a novel concept: whether antiviral drugs can be absorbed through certain areas of the body to prevent sexual transmission of HIV.

To test such hypotheses, Hendrix and his Johns Hopkins colleagues typically can put up healthy test subjects in hospital beds overnight, which creates a more effective experiment by allowing for more data collection and limiting outside variables. But volunteers in Hendrix's study are sleeping in a hotel between two long days of blood-drawing and CT scans because of a funding squeeze in a innovative federal grant program.

Elsewhere at Hopkins, researchers are in a holding pattern, unsure whether there will be funds for projects come fall, and young researchers hoping for small pilot grants to launch careers face long odds. The funding problem also could affect researchers at the University of Maryland, Coppin State and Morgan State, as they compete for a share of a National Institutes of Health program worth tens of millions of dollars.

The NIH program, designed to fund cooperative research and resource sharing that improves health or saves lives, funnels money to dozens of universities around the nation. Hopkins alone received $80 million over the past five years.

Recently, though, the Clinical and Translational Science Awards have come under pressure. After federal lawmakers criticized the awards for pulling money from other NIH priorities, a congressionally mandated report found the program needs more oversight to succeed.

Hopkins' record in the program also has come under scrutiny. The school sought a five-year extension in 2012 but came away with only limited stopgap funding, and must wait until next month to see what the next round brings. NIH has called for changes in the way Hopkins and other schools organize their work, according to a Hopkins official who oversees the grant.

"For very large organizations, that is difficult," said Dr. Daniel Ford, who oversees the grant as vice dean for clinical investigation at Johns Hopkins Medicine.

Pressures on the program come at a difficult time for NIH. The across-the-board federal cuts known as sequestration cut the Bethesda-based agency's budget 8 percent — about $1.5 billion.

"I have never seen a year where there is going to be such a need for advocacy around NIH funding," Ford said.

The grant program seeks to transform scientific enterprise from a model in which a scientist toils alone until a "Eureka!" moment into one that emphasizes collaboration, focused on working across disciplines to solve problems rather than individually just to identify them.

It pays for a central infrastructure of scientific resources and encourages researchers from different fields to collaborate. The infrastructure includes facilities such as the inpatient research beds as well as training opportunities and small pilot grants for young scientists.

Hopkins researchers who have used the translational grant money say it helped speed and coordinate their studies.

It paid for the shared services of a chemist and labs needed to develop synthetic molecules that could inhibit enzymes that can cause cancer or influence metabolism. Investors were drawn to the technology, which has been spun out of Hopkins to form Seattle-based startup Acylin Therapeutics.

Without access to the translational research grant's central resources, "it would have been very difficult for us to have made progress in any kind of time frame that we worked in that led us to getting the biotech company launched," said Dr. Philip A. Cole, a pharmacology researcher at Hopkins and co-founder of Acylin.

For researchers receiving pilot grants, the program helps them hurdle the challenge of receiving traditional NIH grants, which fund specific research for a defined period. The application processes for NIH grants can take two years with just a one-in-10 shot of succeeding.

To dole out the pilot grants, a panel of Hopkins administrators acts like a venture capital fund, reviewing applications for $100,000 pilot awards and looking for those that can develop some sort of product or treatment. The budget had allowed for about 10 such projects per year.

"You can't be too meek and stay in clinical research these days," said Dr. Josef Coresh, a professor of epidemiology who specializes in translational research using biostatistics. "You have to believe you're going to succeed."

Budget challenges threaten the ability to do that, researchers said.

When Hopkins sought a 5-year extension of its translational grant starting in fiscal 2012, the NIH instead offered a smaller one-year pool of money. NIH officials would not release documents detailing their review of Hopkins' performance, citing an exemption from public information laws.

But Ford said it involved a push to reorganize faculty and resources to reflect the grant's transformative mission.

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WHO DIDN'T SEE THIS COMING WHEN BUSINESSES ARE GIVEN THE POWER TO REQUIRE WORKERS TO MEET HEALTH REQUIREMENTS FOR INSURANCE COVERAGE!

Weigh In or Pay

July 22, 2013 By Colleen Flaherty Inside Higher Ed

It’s increasingly common for colleges and universities, like other businesses, to offer the employees they insure incentives for staying healthy. And that makes sense; experts agree it’s a lot cheaper to treat illnesses earlier rather than later, or to prevent them altogether. But instead of offering “carrots” to its employees for seeking preventive care, Pennsylvania State University starting this fall is opting for the “stick,” imposing a $100 monthly surcharge on those who don’t meet new health requirements.

Perhaps unsurprisingly, Penn State’s “Take Care of Your Health” initiative has some faculty up in arms.

“I care about my health – I try to exercise every day and I eat pretty well,” Matthew Woessner, professor of political science at the Harrisburg campus. “But I resent that my employer requires that I submit to medical exams, essentially. There’s a fine line between encouraging employees to be healthy and requiring them to comply with health screenings.”

Larry Backer, a professor of law and past Faculty Senate president at Penn State’s main campus in University Park, agreed.

“The coercive feature is novel, at least at Penn State, though program administrators tried hard to mask it in the language of choice and consequences,” he said, noting the Senate wasn't consulted on the plan.

In addition to publishing a web page, Penn State mailed employees brochures detailing what it says is part of a strategic plan to better control health care costs. By November, faculty and their spouses or domestic partners covered by university health care must complete an online wellness profile and physical exam. They’re also required to complete a more invasive biometric screening, including a “full lipid profile” and glucose, body mass index and waist circumference measurements. (Mobile units from the university’s insurance company, Highmark, will visit campuses to perform these screenings.)

Employees and their beneficiaries who don’t meet those requirements must pay the monthly insurance surcharge beginning in January.

“It is important to note that screening results are confidential and will not be used to remove or reduce health care benefits, nor raise an individual’s health care premium,” a university announcement reads. “The results only are for individual health awareness, illness prevention and wellness promotion.”

Reidar Jensen, a spokesman for the university, said in an e-mail that Penn State’s health care insurance is self-funded, so the “more proactive we can be in managing our health, the healthier our employees, the lower our shared insurance costs and the more efficient our operations.”

Moreover, Jensen said, “during the last decade, many federal regulatory agencies have increasingly favored workplace wellness programs.” For example, he said, the Affordable Care Act raised the maximum levels of differential contributions toward health insurance based on participation in wellness programs. (Maximum rewards or penalties are now capped at 30 percent of the total cost of coverage, including both employer and employee contributions, up from 20 percent.)

While it’s clear that preventive care incentives result in savings and increased productivity (medical costs fall $3.27 on average for every dollar spent on wellness programs, and absentee day costs fall by about $2.73 for every dollar spent, according to one Harvard University study), it’s unclear both how widespread or effective punitive measures such as Penn State’s may be.

Mark Pauly, a professor of health care management and business economics at the University of Pennsylvania’s Wharton School, said he’d heard of a few other employers using the “stick” approach, but not for so “daunting” a menu of exams.

“The evidence does not really support the idea that this forced wellness helps, but employers these days are afraid to try anything else,” he said in an e-mail. “It is a mystery to me why Penn State would start irritating their workers.”

Jonathan Levin, a professor of economics at Stanford University and its School of Business who studies preventive care incentives, said businesses typically offer two kinds of incentives. Most popularly, businesses – including Stanford with its BeWell program – offer financial rewards for people who get physical exams and participate in health counseling. Other businesses offer direct incentives for healthy behavior, such as losing weight or quitting smoking.

Although not immediately clear, Levin suggested that Penn State’s plan could still fall into the first category if “framed” differently.

“The upshot of incentive programs is that people end up with different financial rewards,” he said. “If you think of the people who get less as the baseline, those who get more are getting a ‘bonus.’ If you think of the people who get more as the baseline, those who get less are getting a ‘penalty.’ ”

Nevertheless, it’s hard for some faculty to see the plan in a positive light.

Woessner said he thought Penn State was deliberately “burying the lede” in announcing the plan in the middle of July, when so many faculty are away and not able to voice their objections. Consequently, he said, “Take Care of Your Health” is likely here to stay (the requirements are annual).

Backer said didn’t suspect a “bad motive” on the part of the university. But because there was little faculty involvement in the shaping the plan, “it’s not clear that other alternatives might have achieved better aggregate health metrics and saved money.”

_______________________________________________________________________________

This is a Maryland Health Systems printout of what my health insurance choices would be if I lose my private insurance. The cost for a plan like I have now.....about $450 a month......several thousand a year. As they push health care cuts onto individuals you see all of people's income eaten by health insurance and health bills. Corporations are shedding the costs.

We found 21 plans from CareFirst BlueCross BlueShield starting as low as a month Results based on 1 applicant located in BALTIMORE CITY County, effective 09/01/2013 (Edit)

HealthyBlue 2.0 - $1,500 (Featured Plan) Rating: 4.1 AM Best Rating: NR-5

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Deductible: $1,500
Coinsurance: 0%
Office Visit: PCP: No charge, no deductible; Specialist: $40 copay, no deductible

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Monthly Cost $418.00

Personal Comp - $10,000 (Featured Plan) Rating: 3.8 AM Best Rating: NR-5

Plan Type: Indemnity
Deductible: $10,000
Coinsurance: 20%
Office Visit: 20% after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
Not HSA Eligible

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Monthly Cost $135.00

BluePreferred HSA - $2,700 Rating: 4.4 AM Best Rating: NR-5

Plan Type: PPO
Deductible: $2,700
Coinsurance: 0%
Office Visit: You pay $30 after deductible

Plan Details

Prescription Included
No Vision Included
No Maternity Included
HSA Eligible

Monthly Cost $332.00

Personal Comp - $5,000 Rating: 3.5 AM Best Rating: NR-5

Plan Type: Indemnity
Deductible: $5,000
Coinsurance: 20%
Office Visit: 20% after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
Not HSA Eligible

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Monthly Cost$181.00

HealthyBlue 2.0 - $2,500 Rating: 3.4 AM Best Rating: NR-5

Plan Type: Network
Deductible: $2,500
Coinsurance: 0%
Office Visit: PCP: No charge, no deductible; Specialist: $40 copay, no deductible

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Monthly Cost $369.00

BluePreferred-Saver - $2,500 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $2,500
Coinsurance: 30%
Office Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ deductible then 30%

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Prescription Included
Vision Included
No Maternity Included
Not HSA Eligible

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Monthly Cost $294.00

Personal Comp - $1,000 Rating: 3.3 AM Best Rating: NR-5

Plan Type: Indemnity
Deductible: $1,000
Coinsurance: 20%
Office Visit: 20% after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
Not HSA Eligible

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Monthly Cost $492.00

BluePreferred-Saver - $10,000 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $10,000
Coinsurance: 0%
Office Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ deductible then 0%

Plan Details

Prescription Included
Vision Included
No Maternity Included
Not HSA Eligible

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Monthly Cost $177.00

BluePreferred-Saver - $5,000 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $5,000
Coinsurance: 0%
Office Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ deductible then 0%

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Prescription Included
Vision Included
No Maternity Included
Not HSA Eligible

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Monthly Cost $266.00

HealthyBlue Advantage HSA - $5,000 Not Yet Rated AM Best Rating: NR-5

Plan Type: Network
Deductible: $5,000
Coinsurance: 0%
Office Visit: PCP: No charge after deductible; Specialist: $40 copay after deductible

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Monthly Cost $221.00

HealthyBlue Advantage HSA - $3,000 Not Yet Rated AM Best Rating: NR-5

Plan Type: Network
Deductible: $3,000
Coinsurance: 0%
Office Visit: PCP: No charge after deductible; Specialist: $40 copay after deductible

Plan Details

Monthly Cost $300.00

HealthyBlue Advantage HSA - $4,000 Not Yet Rated AM Best Rating: NR-5

Plan Type: Network
Deductible: $4,000
Coinsurance: 0%
Office Visit: PCP: No charge after deductible; Specialist: $40 copay after deductible

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Monthly Cost $253.00

BluePreferred HSA - $1,400 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $1,400
Coinsurance: 20%
Office Visit: $30 after deductible

Plan Details

Prescription Included
No Vision Included
No Maternity Included
HSA Eligible

Monthly Cost $466.00

BluePreferred - $300 - 80/20 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $300
Coinsurance: 20%
Office Visit: $25, no deductible

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Prescription Included
Vision Included
No Maternity Included
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Monthly Cost $771.00

HealthyBlue Advantage HSA - $1,500 Not Yet Rated AM Best Rating: NR-5

Plan Type: Network
Deductible: $1,500
Coinsurance: 0%
Office Visit: PCP: No charge after deductible; Specialist: $40 copay after deductible

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Monthly Cost $425.00

BlueChoice HSA - $2,700 Rating: 3.6 AM Best Rating: NR-5

Plan Type: HMO
Deductible: $2,700
Coinsurance: 0%
Office Visit: You pay $30 after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
HSA Eligible

Monthly Cost $465.00

Personal Comp HSA - $2,500 Rating: 3.6 AM Best Rating: NR-5

Plan Type: Indemnity
Deductible: $2,500
Coinsurance: 0%
Office Visit: You pay nothing after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
HSA Eligible

Monthly Cost $476.00

Personal Comp - $2,500 Rating: 3.8 AM Best Rating: NR-5

Plan Type: Indemnity
Deductible: $2,500
Coinsurance: 20%
Office Visit: 20% after deductible

Plan Details

Prescription Included
No Vision Included
Maternity Included
Not HSA Eligible

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Monthly Cost $308.00

BluePreferred - $500 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $500
Coinsurance: 20%
Office Visit: $25, no deductible

Plan Details

Prescription Included
Vision Included
No Maternity Included
Not HSA Eligible

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Monthly Cost $732.00

BluePreferred - $300 - 90/10 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $300
Coinsurance: 10%
Office Visit: $25, no deductible

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Prescription Included
Vision Included
No Maternity Included
Not HSA Eligible

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Monthly Cost $896.00

BluePreferred - $100 Not Yet Rated AM Best Rating: NR-5

Plan Type: PPO
Deductible: $100
Coinsurance: 10%
Office Visit: $25, no deductible

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Prescription Included
Vision Included
No Maternity Included
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Monthly Cost $1,038.00

________________________________________________________________
Besides more affordable insurance, the ACA's backers once claimed that the law would "bend the cost curve down" when it came to health care spending. But increasing the cost of insurance, and then shifting the burden of paying for it to taxpayers, is doing nothing to control overall health care spending. In fact, it is only making the problem worse.

Conservatives wanting to kill this bill are right...it is a bad bill for all Americans. They don't hate it for the making of a global market out of a public service all have a right to access....they hate it because it is regulated and subsidized. The ACA is indeed all about profit at the expense of access. It does to health care what Clinton did to banking...makes them global, profit-driven, and unaccountable all bad things for all people. It will make health care more expensive for ever lessening of access to care. Catastrophic level of care for all? Better than hospitals writing off losses and profits these neo-liberals say!
Progressives realize that the ACA is bad for all people. Health Care for All Maryland with United Workers and Physicians National Health Care are organizing against this as large numbers of people sign on for Universal health. Johns Hopkins lobbied hard against universal/public option because it plans to be the health business that goes global and profits at our expense!

The Affordable Care Act will make insurance less affordable Obamacare exchanges rob consumers of choice and force them to buy more expensive plans

By Marc Kilmer 1:19 p.m. EDT, August 5, 2013 Baltimore Sun

With full implementation of the Affordable Care Act (ACA) less than two months away, Marylanders may expect their health insurance to become more affordable. It's right there in the title of the law, after all. However, if you plan on buying an individual insurance plan through Maryland's state exchange, you will probably be paying more for insurance, thanks to the ACA.

Affordable insurance was a key selling point of health care reform. When he signed the bill into law, President Barack Obama claimed, "This legislation will also lower costs for families," and state-run health insurance exchanges would be a primary vehicle to help consumers realize these lower costs. The exchanges would be online marketplaces, where consumers would have better choices and lower prices.

That was the theory. Now we are seeing what's happening in reality. Maryland is getting ready to roll out its health insurance exchange so individuals who do not receive health insurance through their work can buy a policy there. State regulators recently released the premium prices they approved for insurance companies looking to sell their products in the exchange. They aren't good news for consumers.

Today, a 25-year-old man on the Eastern Shore who goes to esurance.com can purchase an Aetna insurance plan for $75 a month. Under the rates approved by the Maryland Insurance Commission, Aetna's cheapest plan in the exchange is $203. That's a 171 percent increase, and it wasn't even enough for Aetna to provide what the ACA requires; the company has decided to pull out of Maryland's insurance exchange. The price differences for other plans are similar.

To be fair, the lowest-cost plans for sale today are not the same as the lowest-cost plans that will be sold in the exchange. The exchange plans will be much more comprehensive. Many of the cheapest health insurance plans available for sale in the individual market today have high deductibles and may not cover as many situations as do the other plans. But that's not a bad thing — it gives Marylanders choices in prices and in how much risk they're willing to carry themselves or put on the insurer. For most Marylanders, the cheaper plans are excellent choices, but for some Marylanders they're not.

Currently, you can also buy both the cheap plans and the comprehensive plans in the individual market. But you won't have the choice to buy high-deductible, low-cost plans in the exchange. You have to buy a plan that is designed by bureaucrats and politicians in Washington and Annapolis.

Some may claim that a high-deductible policy is like having no health insurance at all. That paternalistic view ignores both individual choice and the trade-offs that come with purchasing any product. Many people cannot afford to buy high-end health insurance. Their choice is between buying a low-cost, high-deductible policy and going without insurance. Others — especially healthy, young adults, who typically have lower incomes and little wealth — don't see a lot of value in having comprehensive health insurance. They may decide that having a policy covering them against big losses is all they need. Whatever their reason, those who want these policies should be free to buy them.

For some Marylanders with low incomes, the high cost of insurance in the exchange will be partially offset with federal subsidies. These subsidies don't lower the cost of insurance, however. Instead, they merely reduce the cost of insurance to those who are buying it, transferring that cost to taxpayers. It's a cost shift, not a cost reduction. Given the federal government's large deficit, these subsidies are another burden that future taxpayers will be forced to deal with.

Besides more affordable insurance, the ACA's backers once claimed that the law would "bend the cost curve down" when it came to health care spending. But increasing the cost of insurance, and then shifting the burden of paying for it to taxpayers, is doing nothing to control overall health care spending. In fact, it is only making the problem worse.

The large premium increases that Marylanders will experience when they enter the state insurance exchange are only the beginning of the painful consequences of health care "reform." As more of the law is enacted, we will see other problems for consumers and health care providers. If Congress is unable to repeal the legislation, it should at least rename it. There's nothing affordable about this flawed law.

Marc Kilmer is a senior fellow at the Maryland Public Policy Institute. He can be contacted at mkilmer@mdpolicy.org.

______________________________________________________________________
Does everyone notice how the Affordable Care Act is consolidating the health industry like Clinton consolidated the banking industry? Thin Big Banks give better service? Then why are you trusting global health systems will?

Healthcare M&A Spending Plummets 38% in 2012

Written by Kathleen Roney | January 22, 2013

2012 was one of the busiest years in the past decade in terms of the number of healthcare deals but one of the lowest years in terms of dollar volume, according to an Irving Levin Associates report.

A total of $143.3 billion was spent in 2012 to finance the year's merger and acquisition activity. The total represents a 38 percent decline compared with the $231 billion spent in 2011. In addition, 2012 was ninth out of the last 10 years in terms of healthcare M&A dollar volume. However, there were 1,063 deals in 2012, up 5.9 percent compared with 1,004 deals in 2011.

The hospital market had 94 deals in 2012 compared with 92 in 2011 — a 2.2 percent increase. In 2012, those deals were worth $1.88 billion, a 77.2 percent decrease from 2011's $8.28 billion.
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As this article shows, as in Detroit, Baltimore has the same issues with public pensions and you are seeing the same solutions....and we have all democrats and are in the wealthiest state in the country. This dismantling of public sector unions is planned by neo-liberals working with republicans to end unionization. It is interesting that Orr seems intent on investigating fraud committed by the union and workers but he has not mentioned the tens of trillions of dollars stolen in corporate fraud.....much from cities like Detroit. That is how you know he is a corporate pol as is Rawlings-Blake and O'Malley.

Pensions lost 1/2 there value from malfeasance between Comptrollers and the banks in 2006.....WHY NOT INVESTIGATE THAT!
More important you see the first mention of moving public sector pensions and health benefits into the private markets. That is what the Affordable Care Act and the state health systems do....grow privatization of health care even as people are demanding UNIVERSAL CARE. Medical bankruptcy is now the leading consumer debt! In the article with this blog, the young men stealing in Fells Point would not have health care burdens he had to steal to meet!

Kevyn Orr orders corruption probe of pensions, benefits; unions vow fight against cuts 8:54 PM, June 20, 2013

Detroit retiree expresses frustration with Orr's plans: Former Detroit Water and Sewerage Department employee Catherine Phillips, 55, talks about how she doesn't agree with Emergency Manager Kevyn Orr's proposals for changes to retiree pensions. Robert Allen/Gannett

By Joe Guillen, Matt Helms and Alisa Priddle

Detroit Free Press Staff Writers

Henry Gaffney, president of the Amalgamated Transit Union Local 26, which represents more than 600 city bus drivers, said unions were ready to fight potential cuts to pensions in court. / Eric Seals/DFP Purchase Image Zoom Kevyn Orr must reach agreements with all of Detroit's creditors, including the city's two pension funds, to avoid filing for bankruptcy. / Detroit Free Press ADVERTISEMENT The high-stakes battle between Detroit emergency manager Kevyn Orr and city workers and retirees ramped up Thursday, as Orr called for a corruption and fraud investigation of the pension funds and all employee benefits, on the same day his consultants delivered more sobering news to about 200 union and pension officials that retiree benefits are in serious jeopardy.

The growing animosity between Orr and Detroit’s workers and retirees only increases the likelihood Detroit will file for Chapter 9 bankruptcy.

Orr will have no other legal option if retirees do not agree to the cuts he is seeking as part of a massive restructuring plan he announced last week to resolve the insolvent city’s debts and liabilities of up to $20 billion.

Union officials who met with Orr’s team on Thursday to discuss pension cuts already are prepared for a legal fight.

“We’ll fight you in court,” said Henry Gaffney, president of the Amalgamated Transit Union Local 26, which represents more than 600 city bus drivers.

“We’ll probably stand a better chance, because one thing about a bankruptcy judge, he’s not going to feed into all this nonsense stuff,” he said. “If you’re going to come, you’re going to have to come correct in bankruptcy court.”

Irregularities found As negotiations to avoid bankruptcy will be ongoing for weeks, Orr’s investigation of the pension funds will look into whether they lost tens of millions of dollars through questionable and possibly corrupt investment deals.

The pension funds, which also are under federal investigation, are the main focus of Orr’s review. But all Detroit employee benefits programs, including health care for workers and dependents, will be examined, Orr spokesman Bill Nowling said.

Orr has found several irregularities in his ongoing analysis of the pension funds’ health, Nowling said during an impromptu news media briefing Thursday at city hall.

Nowling said a preliminary look at the funds shows the city’s General Retirement System could be underfunded by 30% to 40%, and the Police and Fire Retirement System by more than 20%. If those figures hold, Orr has the power under the state’s emergency manager’s law to remove pension trustees.

Troubles at the pension systems have become familiar news, with federal investigations resulting in prison terms in recent years. The Free Press reported in 2011 that risky investments had cost the funds $470 million since 2008.

The investigation also comes just weeks after the Free Press reported that four members of the city’s pension boards flew to Hawaii for an all-expenses-paid trip — costing the pension funds $22,000 — to attend an educational conference at a Hilton resort on Waikiki. Orr reacted angrily to the news, saying it was a tone-deaf move even if trustees went there to learn about pension fund management.

Nowling said Thursday that the Hawaii trip is an example of mismanagement.

“We think that spending $20,000 to fly a quarter way around the globe to attend something that they could get online is not a good use of public funds — especially pension funds,” he said. “And we want to ask the question, ‘What other bad decisions have been made?’ ”

The city’s auditor general and inspector general will conduct the investigation and report back to Orr in 60 days. Evidence of criminal wrongdoing will be passed on to proper state and federal authorities, Nowling said.

Matt Gnatek, chairman of the Police and Fire Retirement System, questioned the need for Orr’s investigation but pledged to cooperate fully.

“If anybody’s been investigated more than us, I don’t know who that is,” Gnatek said. “We’ve been thoroughly investigated by several different federal entities. We’re an open book.”

In a joint statement, the two retirement systems questioned Orr’s authority under the state’s emergency manager law to order the investigation.

“We are disappointed that the EM has not held any substantive meetings with the pension funds before making the decision to launch an investigation,” the statement said. “We intend to cooperate fully.”

Benefits changes The announcement of the investigation came as Orr’s restructuring team met with employee, retiree and labor groups Thursday to present proposals including moving workers to health care exchanges, freezing employee pensions for current workers and moving new workers and some who are not vested in pensions — workers who’ve been on the job less than 10 years — into 401(k)-style retirement plans instead.

■ Related story: In Detroit’s financial crisis, a restructuring: Services, groups affected

■ Related story: Q&A with Kevyn Orr: Detroit’s emergency manager talks about city’s future

The proposed changes would affect about 30,000 workers and retirees. Retirees outnumber workers by a 2-1 ratio.

Ed McNeil, special assistant to the president of the American Federation of State, County and Municipal Employees Council 25, said Orr has a long road ahead to get unions on board because his plans are not detailed.

“This is not a bargaining session. We’re not bargaining with them at this point,” McNeil said after the meeting. “They really didn’t have a legitimate proposal.”

Thursday’s meetings with union and pension groups provided a more in-depth look at some of the proposals unveiled last week during a private meeting with all the city’s creditors. The city’s unfunded health care liabilities alone are said to be about $5.8 billion, and Orr’s proposal last week said the city’s pension funds may be unfunded by another $3.5 billion.

Orr’s restructuring plan includes a proposal to pay some unsecured creditors pennies on the dollar for debt they are owed. Orr also decided to halt some debt service payments, including a $40-million bill due June 14 for principal and interest pension fund payments, to help free up cash for city services.

The overview on Thursday for 8,280 police and fire retirees and 3,816 active workers outlined a potentially sweeter deal than non-uniformed workers.

Because the funds for police and fire workers are said to be better funded — about 80% — and the legacy costs lower, Orr’s team is proposing restructuring in a way that saves pensions not only for current workers with vested plans, but also for those who have been part of the plan for fewer than the 10 years it takes to be vested.

That is different than the stance for the 11,109 non-uniformed retirees and 6,888 active workers whose fund Orr says is only 70% funded and projected to decline annually.

The city says it needs to freeze their plans, and the non-vested workers would be provided the opportunity to participate in a defined contribution plan.

Following the meeting for uniformed employees, Dan McNamara, president of the Detroit Fire Fighters Association, said he “appreciates accurate facts for the first time.” McNamara said time will be spent analyzing all the data.

“We will have a unified response for all police and fire,” he said, but would not put a time frame on how long that would take.

'Cuts are a reality' Orr was not present for Thursday’s meetings. His consultants held two sessions — a morning meeting for non-uniformed workers and an afternoon session for police and fire representatives.

The consultants’ message was that cuts to health care and pensions are likely, said Chet Kulesza, labor representative for the Police Officers Labor Council, which represents detention facilities officers and other workers.

“ ‘Significant cuts are a reality’ – that’s how they started the meeting,” Kulesza said. “Nothing in there is bright and cheery.”

Kulesza said the consultants urged the union officials to ask retirees whether the unions could represent them in negotiations with Orr over cuts to pension benefits.

The consultants didn’t seem to understand that union officials do not represent retirees, Kulesza said.

“We know where the retirees are, but we don’t represent them, and we’re not — for (Orr’s) benefit — going to herd more sheep to the slaughter,” he said. “If you want to do them dirty, just go do them dirty.”

Denise Banks, 50, a district clerk for the city’s Department of Public Works and a member of the Association of City of Detroit Supervisors who attended the morning meeting, said bluntly: “That was the biggest crock of crap I’ve ever heard in my life. They’re talking about freezing our pensions. I just feel like crying.”

The city estimates it will have a $185.4-million cash payout this year for retiree health care, dropping to $176.1 million in 2014 and then slowly growing to $215.7 million in 2017.

On health care, Orr proposes offering some additional city-paid health care over and above hospital and professional care costs that eligible workers would collect from Medicare.

The city would supplement that by offering workers a choice of a city-paid prescription drug only benefit or a modest medical and prescription plan. The plan does not rule out including spouses and surviving spouses from this coverage.

The target would be a monthly premium of $100 to $130 per retiree, and the city would pay annual premium increases up to 3% with retirees paying premium hikes beyond that.

Employees not eligible for Medicare would receive a monthly stipend of $100 to $130 if they are 55 to 64 years old. It would be $200 to $250 a month after age 65 to those not eligible for Medicare.

Patrick Anderson, CEO of Anderson Economic Group, said there is much confusion and many questions about fees, penalties and regulations governing how health care will work in the U.S. under the Affordable Care Act and what it will cost employers.

“Detroit is unusual for the breadth of people affected and that it is happening in June 2013,” Anderson said. “In six months, there will be a wave across the country” of moving employees to government health plans.

“Detroit is just facing it sooner,” Anderson said, “but a lot of companies and municipalities are likely looking at this.”

Moving employees to defined-contribution pension plans — with and without matching contributions from the employer — started decades ago in the private sector, Anderson said.

Trustees could go Union officials have vigorously disputed Orr’s contention about pension underfunding, calling it a move to grab a major asset of city workers.

A final analysis of the retirement systems’ funding level is due within weeks, and if the report by the Milliman actuarial firm shows the systems are less than 80% funded, Orr could remove one or more pension trustees.

“Clarity is a rare commodity in Detroit,” Nowling said.

State Treasurer Andy Dillon could appoint Orr as sole trustee of the funds if they fall below the 80% threshold.

As sole trustee, Orr, with Dillon’s approval, could transfer the Detroit pension funds to another system, such as the Municipal Employees’ Retirement System of Michigan, which manages pension assets for more than 700 municipalities.

___________________________________________________________________
Monday Jul 15, 2013 12:22 pm

IBEW Chimes In with Obamacare Concerns
By Bruce Vail

In a new ad campaign, the International Brotherhood of Electrical Workers (IBEW) asks the President to close Obamacare loopholes that would leave many construction workers without coverage. (From the IBEW website)

The International Brotherhood of Electrical Workers (IBEW) added its voice last week to the growing number of labor unions with complaints about how President Barack Obama is handling implementation of the Affordable Care Act of 2010 (ACA), better known as Obamacare.

The 725,000-member IBEW released a white paper on July 11 calling for changes to how the law treats multi-employer plans (also known as Taft-Hartley plans). These plans, which are jointly administered by unions and their employers, are endangered by the ACA because it will discourage employers from participating in the plans, and place some existing union employers at a financial disadvantage. The health insurance of more than 350,000 IBEW members covered by such plans is at risk, says IBEW spokesperson Jim Spellane.

IBEW’s concerns echo those voiced on May 20 by Joseph Hansen, president of the 1.3-million member United Food & Commercial Workers (UFCW) union and the first major labor leader to publicly criticize the ACA implementation. In an op-ed published in The Hill, Hansen also called for changes to the law, either through an administrative ruling or through new legislation to amend ACA. Among other things, Hansen wants the rules adjusted so that low-income workers can receive the same government subsidy for buying insurance through a union plan than for buying insurance through the new insurance exchanges.

The law “creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctors. Others will be channeled into Medicaid, where taxpayers must pick up the tab,” Hansen wrote.

Neither the UFCW nor the IBEW have been attacking the ACA directly, or calling for repeal. One union official tells Working In These Times that a number of unions have been working quietly with government officials to address problems, but have only recently become so frustrated at the slow progress that they decided to go public. By choosing venues like The Hill to voice complaints, unions hope to pressure legislators to involve themselves more actively on behalf of union members, he says. Other unions—particularly the International Brotherhood of Teamsters and UNITE HERE—are expected to join in soon, he says.

While there are some important similarities between the complaints raised by the two union leaders, there are also major differences, IBEW’s Spellane tells Working In These Times. One particular concern of IBEW is the provision of the ACA that exempts employers with less than 50 workers from any requirement to provide health care coverage at all. That exemption will cover almost all of the building construction industry, where most IBEW members earn their living, he says.

“By not requiring construction employers to offer health care coverage to their employees, the ACA begins a race to the bottom with respect to benefits. Employers contributing to multiemployer health plans will be forced to choose whether to provide health care benefits for their employees or remain competitive,” according to the IBEW white paper.

Such a change will likely require legislation, rather than bureaucratic rule-making, Spellane concedes. "We supported the ACA back in 2009-2010 with full knowledge that it wasn't perfect and would need tweaking. Now that the deadlines are fast approaching, it is time to make those changes that will allow multiemployer plans to continue to operate," to provide good health coverage to union workers, he says.

IBEW cited efforts by a Washington, D.C.-based coalition of unions and employer groups that has been frustrated in attempts to clarify new Obamacare rules as they apply to multiemployer plans. The National Coordinating Committee for Multiemployer Plans (NCCMP) has been working on technical issues associated with ACA since it was enacted in 2010.

NCMMP estimates that some 20 million people—including union workers, retirees and family members—receive health care insurance through multiemployer plans.

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Neo-liberal states like New York will try to put lipstick on this Affordable Care Act pig with all these claims of lower rates that are completely fabricated. They are preparing to subject a level of health care so low and/or with co-pays so high as to not have people able to access care. It is the catastrophic auto insurance of health care. Most people pay this insurance rate and then cannot afford to access the care they used to get. THIS IS A REFORM ABOUT MAXIMIZING CORPORATE PROFIT BY ENDING ACCESS TO CARE FOR MOST!

On the New York Department of Financial Services website, which gives approved rates for policies to be sold in the New York exchange, I found New York Fidelus offering a policy for $308.33, a bronze plan sold approved for sale on the exchange for someone in New York City that covers only 60 percent of someone's medical costs. What is the cost sharing? What is the coinsurance? Is it a high deductible plan? How large a choice of doctors and hospitals does a policyholder have.

General News 7/19/2013 at 07:46:15
Exchange Watch: Are New Yorkers getting a bargain? A closer look is in order
By Trudy Lieberman

Re-printed with the permission of the Columbia Journalism Review

The state announces a big win on health policy prices, but a closer look is in order

Hallelujah! New York's insurance exchange--kept under wraps for months by the administration of Gov. Andrew Cuomo--has finally brought forth some information about the rates that health insurers will charge New Yorkers next year. What a story this has become, beginning with what appeared to be a leak to The New York Times in Wednesday's paper in advance of a press release from the governor's office. The Times ran the news with an A1 leader and a dramatic headline: " Health Plan Cost for New Yorkers Set to Fall 50% ."

Twitter was ablaze, with Obamacare advocates quickly cheering the great news. Igor Volsky , the managing editor of ThinkProgress.org, was particularly prolific. A sample of his tweets: "NYT story on NY health premiums falling as a result of Obamacare is on A1. Haven't seen in other NY papers yet," and "Will be interesting to see how much coverage NY premium rates get since producers/editors always play up the anti Obamacare stories." Matt Yglesias of Slate tweeted "An ObamaCare triumph for New York State." He carried on his commentary in a muddled post called "The New York Obamacare Triumph and Why It matters." The New York exchange and the governor couldn't have asked for a better debut.

But a closer look is in order.

Karan Chhabra, who writes for Project Millennial , a site that is gaining a reputation for incisive looks at health policy, tweeted a caution: "Read NYT NYS Insurance article to the end. Underlying reason (guaranteed issue w/o mandate not true in other states." To explain a bit: For months, actuarial experts had been predicting that rates would fall in New York--and in other states that already had tight insurance regulation that mirror what the Affordable Care Act calls for in January. Obamacare requires insurance to reach certain standards. New York and a few other states are already there.

Most states currently are not. Jim O'Connor, an actuary at the consulting firm Milliman, told me those who live in states like Ohio or Indiana--where regulators have used a softer approach-- will see higher rate increases than those in New York and New England, where rates are already higher because of tougher state regulation. New York already required carriers to insure all applicants no matter how sick they are, and those people generate high claims. The state also already uses community rates--meaning the old and the young pay the same for coverage. That has also meant that New York had higher overall insurance rates.

Higher premiums in other states do not negate good news in New York, of course. But New York will still have relatively high insurance premiums, because the cost of medical care in the state is among the highest in the country. The Times story was hardly a model of clarity about what is going to happen in New York, and committed some of the apples and oranges kind of sins I have been warning reporters about in their coverage of the exchanges.

The second graph, for example, reported that "individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower." But what kind of plans is the Times talking about? How old is the person they were comparing rates for? What kind of benefits would people get for $1,000 a month now versus $308 in January? On the New York Department of Financial Services website, which gives approved rates for policies to be sold in the New York exchange, I found New York Fidelus offering a policy for $308.33, a bronze plan sold approved for sale on the exchange for someone in New York City that covers only 60 percent of someone's medical costs. What is the cost sharing? What is the coinsurance? Is it a high deductible plan? How large a choice of doctors and hospitals does a policyholder have.

To judge how good a deal this is, someone needs to know more than just the premium. And the same goes for the $1,000 plan from this year. What were its benefits and cost-sharing requirements? We don't have a clue. The Times may have been comparing apples and pomegranates, as so many reporters have done in covering announcements from the state exchanges. It's just not clear.

In the 13th graph, the Times acknowledges that "while the rates will fall over all, apples-to-apples comparisons are impossible from this year to next because all of the plans are essentially new insurance products." It might have helped to report this higher in the story--or omit the dramatic, but incomplete and misleading, comparison at the outset.

We know that plans with rock bottom premiums may come with very narrow networks of providers, meaning consumers may have little choice. Insurers are limiting their networks only to those who give the deepest discounts, which enable them to compete with lower prices. The Times did note that cheap plans offered by "newcomers" in the market may have limited networks, but established insurance plans have narrow networks as well. And the Times did allude to this problem at the end with an anecdotal kicker--some quotes from 46-year-old Jerry Ball from Queens, who now pays nearly $18,000 for a high deductible plan from Oxford. The least expensive Oxford plan offered next year, he says, would cost him about as much as he pays now. According to the state Department of Financial Services, an Oxford HMO--a bronze plan sold outside of the exchange--would cost him $20,175 for the year. Oxford didn't appear to be offering a bronze plan in the exchange. Ball worried that if he switched carriers, he might also have to switch doctors. "I'm concerned that some of the better doctors aren't going to take health insurance," he said. Would Ball be eligible for a subsidy that would send him to the exchange? We don't know. Again, more vagueness from the paper.

The Times did acknowledge that some people shopping in the exchanges would be eligible for subsidies, but again clarity was lacking. In a graph following a predictable quote from the governor saying that the exchange "will offer the type of real competition that helps drive down health insurance costs," the paper noted that an individual with an annual income of $17,000 will pay about $55 a month for a silver plan, while someone with an income of $25,000 would pay about $145. The paper did not make clear that these were subsidized rates and picked for its comparison--maybe to emphasize how cheap premiums will be in the New York exchange--only for those with the low incomes. (The higher someone's income, the lower the subsidy and thus the higher the out-of-pocket costs.) A better comparison might have been to use a family with the median income in New York state, about $57,000.

In fairness, though, the release from the Department of Financial Services was short on details. For example, it didn't give the full name of the policies it was comparing. Some plans offer more than one. It didn't give ages of the people who would get the rates it presented. It didn't tell consumers (or reporters) where they could get the nitty-gritty details of the policies whose rates they were touting. It didn't explain what it meant for a policy to be on or off the exchange.

The release was a win for the exchange, but not for New Yorkers who need to know much more. It's too bad the Times didn't use its stature to lead the way to better reporting about the exchanges. Like so many other news outlets, it passed along only part of a very complicated story.

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The health care profession is under attack as profits become the drive. Training is becoming lower quality and wages and work environment is stressed. WE NEED TO SHOUT LOUDLY FOR UNIVERSAL CARE AND FAIR WORK CONDITIONS!

Health Care Workers Suffer Most Injuries, Have Few Federal Protections A new study finds that 650,000 health care workers – nurses, orderlies, aides and others – are injured or contract occupational-related illness each year.

Jul. 18, 2013 Sandy Smith

Health care workers suffer more injuries and illnesses on the job each year than workers in other industries, but OSHA conducts relatively few inspections of health care facilities and is hamstrung in its ability to take action to resolve unsafe conditions by an absence of needed safety standards, according to a new report from Public Citizen.

“OSHA is required by law to ensure safe conditions for every employee in the United States,” said Keith Wrightson, worker safety and health advocate for Public Citizen, and a co-author of the report, “Health Care Workers Unprotected.” “The record is clear that the government has broken its promise to health care workers.”  

Nurses, nursing aides, orderlies and attendants suffer more musculoskeletal injuries than workers in any other field. Costs associated with back injuries in the health care industry are estimated to be more than $7 billion annually.

“Most Americans are not aware that hospitals and other medical facilities are actually the most frequent site for workplace injuries,” said Dr. L. Toni Lewis, chair of the health care division of the Service Employees International Union (SEIU), which advised Public Citizen on the report. “This is an issue that affects so many frontline workers and their patients – nurses, CNAs, radiologists, physical therapists – women and men who are trying to meet the needs of their patients safely and effectively. The current patchwork approach is not working for workers.”  

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Unions: Obamacare Will Shatter Backbone of Middle Class

By Meghan Foley | More Articles July 17, 2013

The Affordable Care Act now has a formidable opponent in U.S. labor unions. The unions were a key ally in the law’s passage: They spent a large sum of money on the congressional campaigns of Democrats in 2006 and 2008, and union leaders lobbied in favor of health care reform in 2009 and 2010. But with growing worries that the legislation will disrupt the health benefits of its members, America’s largest unions are asking Congress to step in.

Representatives of three of the nation’s largest unions sent a letter to Democratic Sens. Harry Reid of Nevada and Nancy Pelosi of California on Thursday.

“When you and the President sought our support for the Affordable Care Act, you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat,” letter said. “Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour workweek that is the backbone of the American middle class.”

The letter was written by James P. Hoffa, general president of the International Brotherhood of Teamsters; Joseph Hansen, international president of the United Food and Commercial Workers International Union; and Donald Taylor, the president of Unite-Here, a union representing hotel, airport, food service, gaming, and textile workers.

Their letter noted that their respective unions have long been supporters of the idea that all Americans should have access to quality, affordable health care. “We have also been strong supporters of you,” the three union presidents wrote. “In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision.”

But the problem is that “this vision has come back to haunt us.”

The union leadership is seeking “reasonable regulatory interpretations” to the Affordable Care Act that would help prevent the destruction of nonprofit health plans. However, according to the letter, earlier requests for government action have been “disregarded and met with a stone wall by the White House and the pertinent agencies.” In their opinion, this disregard compares unfavorably with how the administration responded to requests made by other so-called stakeholders, citing the government’s decision to make a “huge accommodation” for the employer community by extending the deadline for the employer mandate and penalties.

“Time is running out: Congress wrote this law; we voted for you. We have a problem; you need to fix it,” wrote the union leaders. “The unintended consequences of the ACA are severe. Perverse incentives are already creating nightmare scenarios.”

The letter lists three complaints. First, that the law creates an incentive for employers to keep workers’ hours below 30 hours per week. Second, that millions of Americans, including a great majority of union members, are covered by nonprofit health insurance plans. But with the implementation of Obamacare, union workers will be “treated differently and not be eligible for subsidies afforded other citizens.” Finally, the letter argued that while union, nonprofit plans will not receive the same subsidies, they will be taxed to pay for those subsidies.

Hoffa, Hansen, and Taylor believe that there are “common-sense” fixes that can be made to the legislation that will allow union members to keep their current plans and benefits as Congress and President Barack Obama promised. Unless the changes are made, they said that pledge is hollow.

“We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions,” the letter concluded.

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TIAA-CREF shareholders meeting hears call to divest from ‘unethical’ private health insurers Shareholder’s comments provoke response from company’s president

CHARLOTTE, N.C. – Having suffered an earlier rejection by the leadership of TIAA-CREF of a shareholders resolution calling on the huge, nonprofit investment company to divest its funds from private health insurance firms because of the latter’s “unethical behavior,” a spokesperson for the divestment group took the microphone at the organization’s annual meeting Tuesday and urged just such a course of action.

Shareholder Sandra Fox, speaking on behalf of herself and others who have appealed to TIAA-CREF to divest its holdings in WellPoint and other giant health insurers, said such firms are not managed in an “exemplary and ethical manner” – a criterion for inclusion in the company’s portfolio – and therefore should be scrapped.

Going into to the meeting, Fox said: “The practices of these companies are anything but socially responsible. They make money by denying coverage, raising premiums, and increasing co-pays and deductibles, deterring patients from seeking care. Their everyday operations result in high overhead expenses, spiraling health care costs, worsening health, premature loss of life, and bankruptcy of countless Americans.”

Speaking from the floor to her fellow shareholders, she reiterated those points and stressed that the big health insurers have been repeatedly cited and fined by regulatory bodies and the courts for improper, unethical conduct.

Roger Ferguson, president and CEO of TIAA-CREF, who chaired the meeting, acknowledged Fox’s comments and said her group’s efforts had already made an impact. Ferguson said MSCI, its vendor for rating companies, had downgraded the stock of two health insurance companies based on the information her group had provided. He did not name which two companies they were.

Ferguson also said the dialogue on this issue would continue.

TIAA-CREF is one of the nation’s top financial services companies. It manages retirement, life insurance and other funds for people in academic, medical, faith-based and cultural fields. Its annual meeting was held today at its gated office complex in Charlotte.

Fox, a longtime social worker who lives in Pittsburgh, cited the findings of Harvard Medical School research and the congressional testimony of insurance industry whistleblowers to support her charge that private health insurers are not serving the public interest, but in fact are doing serious harm.

She is part of a larger national movement, the Divestment Campaign for Health Care, which is supported by Healthcare-NOW!, the national single-payer health care advocacy organization, and whose website is HealthCareNotWealthcare.us.

On their website, the group says the private companies should be replaced by a single-payer, improved-Medicare-for-all system, which “would provide excellent coverage to all by taking the private health insurance companies out of the equation and putting the needs of patients before profit.”

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Johns Hopkins is merely becoming a corporation just as MIT and Stanford for a few others. This is not a corporate partnership; it is not a plan to grow jobs and businesses. As we see from the history of these two other elite private universities that are now corporate factories, the intent is to patent research paid for by taxpayers through grants from the NIH or the NCA for example. As with MIT these corporate universities simply combine businesses and Rand D to where a university department head is paid like a corporate executive he is and the students who come through this university..remember these are elite schools with affluent families attached to the schools..very few of the 95% included. Also remember that Hopkins was built on trillions of dollars in taxpayer money and now they intend to partner with business and patent research paid for through large Federal grants all while staying in the category of 'non-profit meaning they pay no taxes.

University of Maryland is a smaller public version of this that uses students more as free labor and student tuition to fund marketing and research facilities for what will be startups that simply are handed over to global corporations. That is also what will happen at Hopkins as the taxpayer funded research that is successful will be patented and Hopkins will hand it over to connected corporate interests for patent profit.

Now, it is important to know that none of this has any value to the Baltimore community as all the students come from all over the world and almost none from the city. It also takes all of Baltimore's revenue to keep a corporation that is categorized as a non-profit operating and let's nt even talk about Baltimore as a Hopkins' company town.....corporate rule.

Hopkins is the driver of private health systems and fought the public option and universal care because it intends to be the global health corporation that is enriched by all of this. It is empire-building on the backs of the people and taking their access to health care away all for corporate profits. These are really dangerous dudes! When you patent medicine as they are trying to do with biogenetics you have left the arena of hippocratic oath and entered the arena of public 'superfund for toxic waste of public money'. We need to be heading in the opposite direction as Johns Hopkins has a huge debt to society that needs to be paid by making the hospital and services free.....HOPKINS IS A PUBLIC HOSPITAL UNTIL THE PEOPLE RECEIVE THE TRILLIONS OF DOLLARS FUNNELLED TO HOPKINS TO GO GLOBAL.

Hopkins accelerator aims to give startups a jump start FastForward facility is part of university's entrepreneurship push

1/13 By Jamie Smith Hopkins, The Baltimore Sun 6:23 p.m. EDT, June 24, 2013

In the bowels of a building where a long-gone manufacturer once made fine silver, the Johns Hopkins University cultivates fledgling firms.

The FastForward business accelerator is a first for Hopkins, which quietly launched the operation last year and will publicly unveil it Thursday. The move into business incubation is the latest example of the university's effort to remake itself into an entrepreneurial engine — something it has felt pressure to do over the years.

Three startup businesses are in the accelerator now, with about half a dozen more coming later this year and others in talks. The university expects all 16 slots will be full in a year or two.

Hopkins, which licenses its intellectual property to companies around the world, sees the startup assistance as an opportunity to help its research bear commercial fruit — including jobs — close to home.

"Companies tend to stay where they're created," said John N. Fini, director of intellectual property and technology commercialization at Hopkins' Whiting School of Engineering, which is paying for the new facility. "It's very rare for a company to move."

Maryland has about 30 business incubators, most of which receive some public funding, said Rob Rosenbaum, president and executive director at Maryland's Technology Development Corp., better known as TEDCO.

Hopkins is late to the university incubator party, but it was hardly the last institution in Maryland without one. Rosenbaum can think of five other universities in the state that run incubators. The oldest is the University of Maryland's Technology Advancement Program, created in 1984.

Hopkins conducts more research and development — $2.1 billion in 2011 — than any other U.S. academic institution. But it has lagged in commercialization, and officials have ramped up efforts in that area in recent years.

Kelvin Liu, founder and CEO of biotech firm Circulomics, one of the FastFoward companies, sees a difference since he came to Hopkins in 2004 to get a doctorate in biomedical engineering. Hardly anyone he met there in those days seemed interested in going the startup route — a sharp difference from his experience in California, where he worked for three startups.

"Now," Liu said, "there's more and more of that. I think it's great."

Richard Clinch, director of economic research at the University of Baltimore's Jacob France Institute, said Hopkins will probably make its accelerator a success. But he thinks it might have been better to locate the facility cheek by jowl with the biotech park just north of Johns Hopkins Hospital. When it comes to entrepreneurship, he said, you want lots of people working in close proximity so they can spark off one another.

"Location matters," he said.

Rosenbaum, for his part, sees great potential in the accelerator's rapid prototyping capabilities.

"One of the strengths that you have with Hopkins is the biomedical engineering, or more simply put, medical devices — the intersection of their medical school and their engineering school," he said.

Indeed, a medical-device company was the first on board at FastFoward. Clear Guide Medical moved in a year ago, when the space still needed major work and the idea was so new that organizers weren't even promoting it within the university.

The building, on Wyman Park Drive near the university's Homewood campus, was the Stieff Co. factory until it closed in 1999. Remnants of the fine-silver maker still remain as the university converts the basement into offices, labs and other work space.

It's not a window-filled, tech-startup backdrop. The site is zoned industrial. There's a machine shop behind one of the doors, a bio lab behind another and a forklift in the hallway. FastForward staff are in the midst of converting one large space into an area for building "major things," as Fini puts it — the sorts of products that require a crane to move. (The crane's already in place.)

The engineering school has budgeted $1 million a year to operate the facility. Participating companies can stay up to two years, rent-free, in exchange for debt that the university can convert to a stake in each firm down the road. The companies also receive services intended to help speed them toward profitability, such as assistance with business plans and introductions to potential investors.

Firms don't need an engineering-related product to move in, but they must have a Hopkins connection — intellectual property or people.

Clear Guide Medical has both ties. Two Hopkins labs developed the technology the company hopes to take to market next year — an ultrasound guidance device — and the small staff includes Hopkins faculty and graduates.

The company's product clips onto ultrasound imaging devices and guides doctors as they insert a needle into patients for biopsies. Guidance devices are on the market already, but company officials say their technology is much less expensive, takes less time to use and is more portable than the competition.

Clear Guide Medical is tucked into about 2,000 square feet of the accelerator, space that looks quite different now than it did last year.

"When we first saw this, there was this enormous spray booth — a silver spray booth," said Dorothee Heisenberg, the company's chief operating officer. "It is sort of a transformation."

jhopkins@baltsun.com

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Breaking ’08 Pledge, Leaked Trade Doc Shows Obama Wants to Help Corporations Avoid Regulations download: Video Audio Get CD/DVD More Formats

A draft agreement leaked Wednesday shows the Obama administration is pushing a secretive trade agreement that could vastly expand corporate power and directly contradict a 2008 campaign promise by President Obama. A U.S. proposal for the Trans-Pacific Partnership (TPP) trade pact between the United States and eight Pacific nations would allow foreign corporations operating in the U.S. to appeal key regulations to an international tribunal. The body would have the power to override U.S. law and issue penalties for failure to comply with its ruling. We speak to Lori Wallach, director of Public Citizen’s Global Trade Watch, a fair trade group that posted the leaked documents on its website. "This isn’t just a bad trade agreement," Wallach says. "This is a 'one-percenter' power tool that could rip up our basic needs and rights." [includes rush transcript]

Transcript This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: We turn now to a controversial trade pact between the United States and eight Pacific nations that until now h