Thursday, September 17, 2009

Government health insurance already hard at work in America

Instead of a check, VA sends widow a profanity-laced screed, denying her payments she is entitled to and admitting that they have deliberately lost the medical records she needs to support her claim

Following my Aug. 25 column ("Does government-run health care work? Ask vets"), I got a call from Bessie Krone, the widow of a World War II Navy veteran. She faxed me a copy of a shocking letter she said she recently received from the Department of Veterans Affairs' regional office in Montgomery, Ala.

The profanity-laced screed, date-stamped Sept. 3, 2009, and stapled to Form 4107 ("Your Rights to Appeal Our Decision"), brazenly admits that VA employees deliberately removed medical records from her late husband Robert's file.

"Mrs. Krone, are you that stupid?" asked the letter, supposedly signed by triage assistant coach Mark Carter, who acknowledged that the VA owed her late husband eight years of back pay in addition to a special monthly disability allowance he never got: "I still do not know why the previous team did not give that to him in September 1997. It was an oversight (maybe) but not likely. ... Your husband's application that he placed back in 1987 and his doctor's statement is still safely tucked away until you give up. Then it will be placed back into the file."

The letter also stated that Carter's boss, service center manager Amy Hill, repeatedly lied when she promised to approve Krone's overdue benefits if she dropped her complaint with the VA's Office of Inspector General: "You have personally spoken to Amy several times now, and both times she b-slapped you while looking straight into your eyes. She told you that if you would trust her and not ask for a OIG investigation, that she would grant your claim. What a truckload of s... that was.

"As you know an appeal would take years to achieve, only to be denied again," the letter continued. Hill "wanted you to trust her because [regional office director Ricardo] Randall told her to make you go away and to clean up her s... Randall and Amy both know what a s... load of trouble they are in and you Mrs. Krone are once again the toilet paper."

The letter added that Carter was told to "give the impression that you do not have a claim, no matter what you do or how you may respond."

When Krone personally asked Hill three times if she was aware of the shocking content of the letter, Hill allegedly said she was. I called Hill myself Friday, but she quickly said, "I can't comment," before referring me to the VA's public information office, which said that the matter was under investigation by the OIG. On Monday, Krone called again to say that her entire $35,000-plus claim had been deleted from the system.

Whom to believe? A woman with crippling arthritis who spent a year demonstrating in front of the Montgomery regional office demanding benefits the VA still owes her and thousands of other military families?

Or a government agency that, the U.S. Court of Appeals noted in a landmark Aug. 12 ruling, illegally altered disabled Vietnam veteran Philip E. Cushman's medical records to avoid paying his decades-old $100,000 claim? That's a no-brainer.

More here


Make a complaint about government employees, and you – not them –could end up as the target of a criminal probe. That’s exactly what happened to Bessie Krone, a 62-year-old disabled widow from Montgomery, Alabama who recently received a expletive-filled letter from the Department of Veterans Affairs.

Instead of finding out who sent her the vile letter and why, the VA’s Office of Inspector General, Division of Criminal Investigations is apparently investigating her!

Krone told me that Special Agents Humes and Hudson from Atlanta interrogated her for nearly an hour and a half at a nearby Arby’s restaurant. “A hamburger does not get as much grilling as I got today,” she told me. “They knew everything about me – how many brothers and sisters I had, when I was born, where my son lives, the number of grandkids I have, my cell phone number, when I went to the store this morning, even the exact time I called The Examiner.”

“So I told them: ‘You’ve investigated me real good. Now go investigate whoever sent that letter and leave me alone.’”

The agents kept pressing her again and again for the name of her alleged accomplice, Krone told me, but she didn’t budge. “They told me that I knew somebody in the VA who was feeding me this information and I needed to tell them who it is. If I didn’t cooperate, I could be charged with being an accessory to conspiracy. I kept telling them, ‘I do not know anybody in that VA office.’”

“They said I had a ‘friend,’ a VA employee who was trying to help me get my claim settled. I said, ‘You just showed me a letter showing that my claim was denied,’” she added.

Krone said she did tell the agents that the only person at the VA to whom she had given her new post office box was service manager Amy Hill, who refused to discuss the letter when contacted by The Examiner.

“Why did you go to the newspaper with this?” Krone said one of the agents asked her.

“My past experience with the VA, sir,” she replied.

“The VA has begun my punishment already,” Krone told me. When she called the VA’s 800 number to get an update, she was told that her claim number had been ordered removed by the same regional office she complained about.” Without a claim number, she won’t get her modest widow’s pension on Oct. 1.

“I will be a 62-year-old disabled homeless person next month,” Krone told me. “My small Social Security check will not be enough to live on and I will have to live in my car or go back to living in a rental shed like I did after my husband (a WWII Navy veteran) died.”

This is how our government treats the widows of men who fought and died for this country. As the daughter of a WWII Army vet myself, I am sickened and appalled.


Obamacare will hit the wallets of the middle class

The chairman of the Senate Finance Committee said Monday that he will propose an overhaul of the nation's health-care system that addresses a host of GOP concerns, including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits and banning federal subsidies for abortion.

But even after Max Baucus (D-Mont.) spoke optimistically of gaining bipartisan backing, lawmakers continued to haggle over a question at the heart of the debate: How can the government force people to buy insurance without imposing a huge new financial burden on millions of middle-class Americans?

Even within his own party, Baucus confronted a fresh wave of concern about affordability. Sen. Ron Wyden (D-Ore.) declared himself dissatisfied with the chairman's plan, which, like other congressional reform proposals, would require every American to buy health insurance by 2013. "Additional steps are going to have to be taken to make coverage more affordable," Wyden said, "and my sense is that will be a concern to members on both sides of the aisle."

Under the Baucus plan, described in a "framework" he released last week, as many as 4 million of the 46 million people who are currently uninsured would be required to buy coverage on their own, without government help, by some estimates. Millions more would qualify for federal tax credits, but could still end up paying as much as 13 percent of their income for insurance premiums -- far more than most Americans now pay for coverage.

People further down the income scale would receive much bigger tax credits, effectively limiting their premiums at 3 percent of their earnings. But experts on affordability say even those families could find it difficult to meet the new mandate without straining their wallets. "We're talking about the equivalent of a middle-class tax increase," said Michael D. Tanner, a health-care expert at the libertarian Cato Institute. "Yes, they're paying it to an insurance company instead of to the government. But, suddenly, these people are paying more money to somebody."

A plan drafted by House Democratic leaders would offer more generous tax credits, but it would cost more than $1 trillion over the next decade.

Baucus's team of three Democrats and three Republicans from the Finance Committee has labored for months to cut that cost as it crafts a reform plan that could win support from both parties. By squeezing the size and scope of the subsidies, the negotiators have lowered the cost to a more politically palatable $880 billion -- within the range President Obama specified last week in a speech to Congress.

But a smaller bill would mean less help for people -- particularly those who earn too much to qualify for Medicaid but too little to easily slip the equivalent of a second rent payment into their budgets.

According to the latest Census data, about three-quarters of the uninsured earn less than 300 percent of the poverty level, or about $32,500 for an individual and $66,150 for a family of four. Nearly half are childless adults. In surveys, many say that they are not offered coverage by their employers or that they simply cannot afford it.

The centerpiece of the Baucus proposal is a series of "exchanges" where people without access to affordable coverage through their employers could apply for government subsidies and choose among a range of private insurance options. The plan would not, as liberals have demanded, create a government-run insurance option to compete with private firms, but would finance the creation of state or regional cooperatives run by consumers -- a concession aimed at winning over Republican lawmakers.

Baucus and his colleagues wrangled Monday in the hopes of persuading Republican Sens. Charles E. Grassley (Iowa) and Mike Enzi (Wyo.) to support the measure. The two conservatives have stayed at the bargaining table all summer, despite GOP leaders' strong opposition to the reform effort.

Baucus said the strategy is working. "Senators on and off the committee, their comfort level is starting to come up a bit," he told reporters. "I believe, in the end, we'll have some significant bipartisan support." But the chairman said Monday night that he will move forward Wednesday with or without Grassley, Enzi and Sen. Olympia J. Snowe (Maine), the most moderate Republican involved in the negotiations. He said the bipartisan group, known as the Gang of Six, would continue to negotiate until the full committee begins work on the bill next week.

Baucus said he will comply with Republican demands that illegal immigrants would receive "no benefits" through the new insurance exchanges. Meanwhile, negotiators are crafting a provision that would authorize states to start pilot projects to try to lower health-care costs by reducing the number of malpractice lawsuits, an approach similar to the one Obama outlined in his speech. "States would be given resources to help them experiment with what works best," said Sen. Kent Conrad (D-N.D.), another participant in the talks.

Also unresolved Monday was the question of how to pay for an expansion of Medicaid to cover every U.S. citizen whose income falls below 133 percent of the federal poverty level, about $14,500 for an individual or $29,500 for a family of four. Governors in both parties strongly oppose an expansion that is not fully financed by the federal government. The Senate negotiators are scheduled to brief governors by conference call Tuesday afternoon, and Baucus predicted they would be "pleasantly surprised."

"The Medicaid costs," he said, "are not going to cost states near as much as feared."

Under the Baucus plan, subsidies would be offered to people who earn up to 400 percent of the poverty level ($43,000 for an individual or $88,000 for a family of four) in the form of tax credits that would be paid directly to the insurance company of the person's choice. The credit would be calibrated on a sliding scale to ensure that people at the bottom of the income range paid no more than 3 percent of their earnings for premiums while those at the top would be liable for as much as 13 percent.

That would amount to more than $700 a month for a family of four making $66,000 a year -- significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Families earning less than 300 percent of the poverty level also would be eligible for assistance with deductibles and other out-of-pocket expenses, but families who earn more would be on their own. "That group does spend in the neighborhood of 12 percent of their income. But it's not just the premium. It includes out-of-pocket spending," Blumberg said, adding that the Baucus plan "is going to be somewhat of a wakeup call."

Families that do not purchase insurance would face penalties on their annual tax returns of up to $1,500 a year if they make less than 300 percent of the poverty level, or $3,800 a year if they make more. But Senate Finance Committee negotiators are quick to point out that a hardship waiver would be available. "We're doing our very best to make the insurance requirement as affordable as we possibly can," Baucus said, without driving up the overall cost of the bill.


Health care reform faces inconvenient questions

Now that President Obama has outlined his goals for an overhaul of the American health care system, Democrats are trying to fashion new legislation that will include all of Obama's aims. The president wants a new government-run insurance program, additional regulations for the insurance industry and rules requiring all Americans to buy insurance if they can afford it or be given coverage if they can't. Obama's plan draws elements from the multiple bills in Congress. But in trying to merge the ideas into a compromise bill, Democratic leaders face a series of inconvenient questions:

1. Who would foot the bill for extending health insurance to 30 million more Americans?

Obama's plan draws heavily from a proposal in the Senate Finance Committee that would tax insurance companies that provide expensive health plans. There would be new taxes on drugs and health care providers. The House would impose a tax on incomes of more than $280,000 for individuals and $350,000 for couples. No proposed plan would cover all the costs.

2. Would doctors and hospitals be able to cope with the expected influx of millions of new patients?

Advocates say that many new enrollees would be young and not in need of frequent medical care and that preventive care would help stave off diseases that require more services. But many of the newly insured would also be poor and suffering from chronic conditions. Critics expect long waits for medical services as in Europe and Canada.

3. Wouldn't illegal immigrants still get care, often for free, in hospitals?

No bill would block free hospital care for illegal immigrants. The House bill would not allow illegal immigrants to receive subsidized care, but there is nothing in the bill that would prohibit illegals from buying insurance policies or joining the government option. The Senate bill will likely block subsidized coverage for illegals.

4. Who would enforce the requirement that individuals have coverage?

The IRS would be the chief enforcer of the individual mandate. That's because the government would impose an additional income tax on those who do not purchase coverage. The IRS would verify coverage claims with the names and Social Security numbers of customers provided to the agency by insurers. The IRS would also evaluate individual incomes to determine eligibility for subsidized coverage.

5. Will employers stop providing health care coverage if a public plan is available?

There is no plan in Congress to prevent this. The Congressional Budget Office found that if one Democratic plan in the Senate becomes law, "about 6 million people who would have employment-based coverage under current law would not have such coverage under the proposal."

6. How can spending less on Medicare produce better care for participants?

The president says that cutting $500 billion from Medicare in the next decade will rid the system of waste and fraud and increase access to care. But members of both parties are worried about the president's plan to give an appointed board power to make the cuts, as well as access to care in rural areas.

7. What other programs would need to be cut if Obama's promised savings don't materialize?

The president said in his address to Congress that if the hundreds of billions of dollars in government health savings don't materialize, he would find savings in other areas. But only 38 percent of the federal budget is subject to cuts, and that includes hard-to-trim departments like Defense, Transportation and Education.

8. Similar plans have failed in several states. How would a federal plan avoid the same fate?

Critics of the Democratic plans say the outcome would be similar to public plans initiated in several states that have either failed completely, like Hawaii, or are struggling, like Massachusetts, where the program has been deemed too costly for residents and too expensive for the state to afford. Advocates say savings and efficiencies are possible if all 310 million Americans are subject to the plan.

9. Can the president make good on his promise not to "add one dime" to the national debt?

The Congressional Budget Office estimates the House health care bill will increase the deficit by $239 billion over the next 10 years, while the Senate bill would add more than $1 trillion to the national debt in the next decade. Democrats discount those figures, saying they do not include the savings they anticipate.

10. The president says that he can save $500 billion in waste and fraud in Medicare. Has the government ever succeeded in such an ambitious cutting effort?

The government has never been able to save money on this scale. Most recently, Obama's effort to make cuts at the Cabinet level yielded about $267 million in savings. And the government's biggest effort yet, initiated by then-Vice President Al Gore in 1993, claimed savings of just $12.3 billion after four years.

11. Is it true, as the president and Democratic leaders have argued, that "special interests" are trying to block reform?

The pharmaceutical industry has already cut a deal with the administration to lower drug costs for seniors and will be paying for $150 million in pro-reform advertising. The American Medical Association last week approved the Obama plan. AARP, one of the nation's largest insurers, has spent millions of dollars on pro-reform ads.

12. Do we need "demonstration projects" on medical malpractice reforms to find effective ways to control lawsuit costs?

In Texas, 2005 limits on damages in malpractice cases has led to a 27 percent decrease in malpractice premiums. An additional half-dozen states have cut frivolous suits through similar means. Obama's decision to do yet more state testing, rather than propose legislative changes, leaves critics worrying that he has no intention of implementing nationwide reform.


The New Third Rail

Why 'death panels' are a political killer

If Hogwarts were a school for politicians, there would be a required class on "Defense Against the Dark Arts of Demagoguery." President Obama considers his health reform effort a target of this dark art--indeed, he seems to view it as the main reason reform has faltered on Capitol Hill.

Here is the defense he mounted in his big speech to Congress this week: "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

Professor Snape would not be impressed. At issue, of course, are the two words "death panels," uttered widely in opposition to Obamacare, most famously by Sarah Palin, the prominent politician to whom the president alluded. The phrase may indeed be "cynical" shorthand for a new government role in deciding on appropriate care as one nears the end of one's life; certainly it is polemical. And it may even be "irresponsible"--in exactly the same way that Democratic political operatives for decades have irresponsibly tried to frighten the elderly into believing Republicans were going to take away their Social Security benefits. But "laughable" is precisely what it isn't. End-of-life care is beginning to look a lot like a new third rail of American politics. Republicans will be happy to let Democrats learn this lesson the hard way.

Now, it is true that none of the proposed reform legislation calls for convening panels of government bureaucrats to make life-and-death decisions about the elderly on a case-by-case basis, with the power to shut off their medical care. Unfortunately for Obama, that doesn't make "death panels" a "lie, plain and simple." Rather, it is an exaggeration. When Obama responds to an obvious exaggeration with the rejoinder that it is not literally true, he is missing the point. The question is what this exaggeration is getting at. And the answer is that it is getting at something very real, the primal anxiety people feel about the end of their own lives.

It is just folly to pretend that this anxiety is anything but genuine among those who are getting on in years or who have received a diagnosis that looks to be life-threatening in the absence of treatment, and perhaps even with. And it is disingenuous in the extreme to pretend that the current reform effort doesn't have potentially large-scale implications for treatment decisions for the old and sick. Obama would like to ignore both points while blaming Republicans for making the whole thing up, but it won't work.

Since, as we all know, health care is expensive and the demand for it is vast, there has to be some way of settling the scarcity question. The current system is an unlovely hybrid with major deficiencies, but it has a couple of core virtues: Quality of care is first among them, but another important one is that for those with insurance or Medicare or Medicaid, care decisions are (within limits) mostly between people and their doctors, who take their Hippocratic Oath seriously. Even the limits have the virtue of being mostly known or knowable. True, people get unpleasant surprises from time to time about what's covered and what isn't; the system senselessly ties insurance to employment, inhibiting mobility, especially when "preexisting conditions" come into the picture. And it's not like the cost of insurance coverage and copays is going down. But there is an intelligibility and reliability to the system as it exists for those who are in it.

At a minimum, Obamacare introduces a major element of uncertainty. Of course nobody really knows what Obamacare is, including Obama; the term is a catch-all for whatever (if anything) Congress comes up with that the president can sign. But that's just another way of saying that overall uncertainty is high and rising, including on the issue of "end-of-life" care. And it won't do to try to alleviate the concern here by pointing to specific provisions of possible pieces of legislation and saying, "See, it's not there." Everything is up for grabs, and people don't like it when everything is up for grabs.

Then we have the more specific reasons for people to be concerned about who will be deciding what for them as they become sick or grow old. It is hardly fanciful to suppose that in a system in which resources are limited, global treatment protocols are going to decide eligibility for care in a way they do not currently. Likewise, people who are eligible for a particular treatment are going to have to wait in line until it's their turn. If there is any currently existing national health care system, such as the left dreams about, that does not contain these features, it's strange that no one has pointed to it to prove that health care, unlike everything else, need not involve tradeoffs.

The point for single-payer advocates, including in their "public option" guise, is that equality is the highest virtue, and that means equal access to what is available. It's simply unjust, in their view, that some people can afford high-quality care while others get none: If the price of a universal system is that some lose privileges they have long enjoyed, that's the kind of a tradeoff they are prepared to make.

But old folks and sick people in the current system, or people thinking about either prospect, may not see it that way. The question they have is, "What's going to happen to me?" The baseline they have is the care the system around them currently provides. They are right to worry about changes to the system.

To the general problem of the need to find a basis for allocating finite health care resources, one must add certain specific anxiety-inducing details that have come out in the debate: First, the inclusion in some of the early legislative language of provisions funding end-of-life counseling sessions--the objective correlative of the "death panel" polemics.

Second, the quick ditching of the counseling proposal once the "death panel" rhetoric hit, fostering the impression that the proposal was indeed up to no good.

Third, Obama's own musing in a New York Times interview about whether the decision to provide a hip replacement to someone diagnosed with cancer (in this case, his grandmother) is "a sustainable model."

Fourth, his public reflections on the high health care costs associated on average with the last six months of a person's life.

Fifth, the statements of such supporters as Todd Gitlin, whose only criticism of a speech he found otherwise inspiring was: "You can say that he's still not willing to talk to Americans straight about the need to limit high-tech medicine for the very old and very frail. Presidents won't do that."

Sixth, the administration's insistent and probably misguided attempt to portray its health care reform as cost-cutting--reduced spending on the health care of whom, exactly?

At the end of Shakespeare's Tempest, Prospero, the greatest wizard prior to Albus Dumbledore, gives up his powers and prepares to "retire me to my Milan, where / Every third thought shall be my grave." People do brood about death, quite unbidden.

When they are made to brood about it, as in the case of the new focus on end-of-life care--previously known as medical care for the very sick and elderly--they are likely to resent the intrusion. And when the substance of the intrusion is a proposal that upsets the expectations they have formed on this most difficult of topics, many will be inclined to reject it. Obama's sinking job-approval numbers among seniors and the broad decline in support for the plan likely reflect these tendencies.

Obama will not dispel the anxiety by saying the rhetoric about "death panels" would be laughable were it not so irresponsible and cynical. You disrupt the expectations of the elderly only at great political peril, and there are more such Americans every day.


Obamacare runs counter to GOP principles

The six Senate Republicans seeking a "bipartisan compromise" on President Obama's proposal for a government-run health care system are flirting with a provision - an individual mandate to buy government-approved health insurance - that runs counter to everything the GOP stands for. This "gang of six" includes senators Olympia Snowe of Maine, Charles Grassley of Iowa, Robert Bennett of Utah, Lindsay Graham of South Carolina, Mike Crapo of Idaho, and Lamar Alexander of Tennessee. Snowe has been covertly negotiating with Obama for weeks, while Grassley supports the concept of a health care insurance co-op. The other four are co-sponsors of S. 391, the Healthy Americans Act introduced by Sen. Ron Wyden, D-OR, which includes some attractive features but at its heart is an individual mandate. Individuals and fFamilies would be fined as much as $3,800 annually for not buying approved health insurance.

An individual mandate should be anathema to all GOPers for two reasons. First, the individual mandate is the fulcrum of cooperation between government-run health care advocates and the big health insurance companies that would profit immensely if it's approved. As the Social Security Institute's Larry Hunter trenchantly observed, the big insurers "desperately want an individual mandate passed and will accept anything short of having their CEOs pushed out of an airplane door to get it." Such a "public-private partnership" will work no better for health care than it has in the mortgage industry with Fannie Mae and Freddie Mac.

Second, the approach makes a mockery of individual freedom of choice because it forces everybody to buy a government-approved health insurance plan from a government-approved insurer with oversight by government bureaucrats. Finally, because of the intensive government regulation involved, mandated rationing of health care is just as inevitable under this approach as it is under Obamacare. And bureaucrats will be just as likely to make treatment choices that ought to be made by doctors and patients. Supporting such legislation will mark Senate GOPers as Republicans-In-Name-Only (RINO) enablers of the Democrats' long-sought government takeover of health care.

Senate Republicans are fools if they think they can safely get away with sprinkling some "bipartisan compromise" pixie dust on any government-run health care bill. Among the August recess lessons is that people, unlike most members of Congress, are reading the bills as never before and they aren't going to be fooled by flowery rhetoric. That is why surveys appearing this week make clear that Obama's much-ballyhooed address last week to Congress was no game-changer, contrary to predictions from the White House and the liberal media. It is also why the people will know RINOcare is just another way of saying Obamacare.


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