Saturday, October 17, 2009

VA Dept. hospitals botched treatments

The VA is an "already existing" socialized medicine system in America. It gives an idea of what a similar system for all Americans would be like. It wouldn't be better

The Veterans Affairs Department committed grave safety mistakes at several of its medical centers and delayed other needed educational and financial services to thousands of veterans, agency chief Eric Shinseki said Wednesday to a congressional panel. "While this process is at times painful, it is the right thing to do for veterans and the nation and will ultimately result in greater trust and better quality," said Mr. Shinseki about disclosing the problems at the Veterans Affairs Medical Center in Philadelphia.

Over a six-year period at the center nearly 100 brachytherapy procedures - used to treat prostate cancer by implanting radioactive seeds to destroy cancerous cells - were botched.

Additionally, VA personnel failed to properly clean endoscopic equipment at hospitals in Tennessee, Georgia and Florida, exposing 10,000 veterans to possible infections. The VA has reported that six veterans taking follow-up blood checks tested positive for HIV, 34 tested positive for hepatitis C, and 13 tested positive for hepatitis B. The VA most recently apologized to nearly 2,000 veterans who erroneously received letters for patients diagnosed with Lou Gehrig's disease.

"I am proud of our people and our accomplishments, but there have been challenges, missed opportunities and gaps in providing the quality of care and services veterans expect and deserve," Mr. Shinseki said.

The agency has seen some recent success for the 8 million veterans who are enrolled for health care, including the expansion of its system to more than 1,000 outpatient clinics and mobile clinics.

Testifying before the House Veterans Affairs Committee on the state of his agency, Mr. Shinseki cited other setbacks the agency has suffered recently, including a hold-up in educational funding for veterans who served in Iraq and Afghanistan. "Across the nation, veterans who applied for benefits under the GI Bill have been told their payments are being delayed because of an overwhelming number of problems at both the department and the schools," said Rep. Bob Filner, California Democrat and committee chairman.

Rep. Steve Buyer, Indiana Republican and ranking committee member, said the backlog of education benefits as well as disability claims continues to accelerate. "The challenges you have stepped into are almost a runaway train, so how do you stop that train?"

Mr. Shinseki said the VA will conduct an "emergency exercise" so it can "enter the spring semester with no backlog" of educational GI Bill funds. As for the backlog on disability payments, the VA closed 92,000 claims in July, as another 91,000 claims poured in for processing, Mr. Shinseki said. Mr. Shinseki said veterans suffering from post-traumatic stress disorder (PTSD) will get the care they deserve, but he did not address a new rule under consideration by his agency that would change the evidence required to prove that a veteran suffers from the malady. "If a stressor is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD," veterans would be eligible for medical treatment.

However, Rep. John Hall, New York Democrat and chairman of the Veterans subcommittee on disability assistance and memorial affairs, led a separate roundtable with veterans' organizations who questioned whether diagnosis should be limited to VA doctors and what factors are the cause or trigger of PTSD. "When we send troops into combat zones, every moment of every day is not documented," Mr. Hall said. "So when the veteran files a claim for PTSD, the stressors are not always easy to verify, which has resulted in too many of our combat veterans being denied an earned benefit."

Added Mr. Filner: "America owes its combat veterans a debt of gratitude, not loopholes and hurdles."


No quiet fadeaway for federal insurance option

Fears about high costs of the health care overhaul and mistrust of insurers are rekindling interest in letting the government sell health insurance as part of the plan. The leading congressional proposal as of Wednesday — a Senate Finance bill that relies on private coverage with no new government plan — could price out some 17 million Americans. And the insurance industry may have unwittingly helped the case for public coverage with a report over the weekend asserting the Finance bill would raise premiums for everyone.

Business groups and conservatives remain steadfastly opposed to government insurance — formidable political opposition that shows no sign of weakening. So advocates are getting creative, trying to reformulate the "public option" in a way that can gain the 60 votes needed to clear the Senate. Instead of an all-or-nothing approach, they're trying to provide choices.

What if each state could decide whether to offer public coverage instead of having it decreed from Washington — as proposed by Sen. Tom Carper, D-Del.?

What if states had a menu of options, from nonprofit co-ops to using their own employee health plans?

What if public coverage were offered only as a backstop in areas where one insurer has a lock on the market?

"We are all talking together, trying to find something that not everyone will love but the entire (Democratic) caucus will come to agreement on," said Sen. Chuck Schumer, D-N.Y., who for months has been seeking a politically viable compromise. "It's going to be something flexible, but not weak," Schumer added. His idea: a federal plan that states can opt out of.

The lone Republican to back health care overhaul legislation, Maine Sen. Olympia Snowe, has suggested a possible way out: allowing a public plan to kick in if competition among health insurance companies under a revamped system fails to bring down costs. Snowe is opposed to government insurance as a first-line solution.

What if Snowe's idea is combined with an approach that lets states make the call? "Those are all elements that one could easily fashion into an outcome that would seem to be elegant," said economist Len Nichols of the New America Foundation. "It would show the left: 'Look we will be there when we're needed if coverage is not affordable.' And it would show the right that this not some backdoor government takeover, because we're only going where we're needed."

What to do about the public plan is the most politically sensitive issue on the agenda of Senate Majority Leader Harry Reid, D-Nev., as he sets out to merge the Finance bill with a Senate health committee version that does include a government option.

The health overhaul drive got a potential boost Wednesday as a second Republican senator signaled she's open to voting for a health care bill. Sen. Susan Collins, R-Maine, told The Associated Press that the Finance bill needs substantial improvements to make coverage more affordable, contain costs and protect Medicare, but she joined Snowe in endorsing the goal of far-reaching changes. "My hope is we that can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support," Collins said in an interview.

On Wednesday, top White House aides, including chief of staff Rahm Emanuel and Health Secretary Kathleen Sebelius, traveled to the Capitol to meet with Reid, Democratic Sen. Chris Dodd of Connecticut and Finance Committee Chairman Max Baucus, D-Mont., about combining the Finance bill with the Senate health panel measure. Reid is giving no hints. Asked Wednesday if he thought it was likely there would be a public plan in his merged bill, he responded: "I'm not betting on health care. 'Likely' is in a game of craps."

Republicans say the fix is in for a public plan. Behind the scenes, Democrats will take Baucus' middle-of-the-road plan and turn it hard to the left, they say. "We know that the bill written behind closed doors here in the Capitol will be another 1,000-page, trillion-dollar Washington takeover," said Senate Republican leader Mitch McConnell of Kentucky.

Democrats did try one new tack Wednesday, on an issue involving doctors. Senate Democrats are now pushing for quick passage of separate legislation to spare doctors a $247 billion cut in Medicare fees over a decade. That would raise federal deficits, but the White House says the increase should not count in the price tag for the health care overhaul.

A senior Democratic aide said Reid is focused on what's politically achievable. The public option is being assessed in terms of what it would mean for health care overall and, just as importantly, whether it can win approval, said the staff member, who spoke on condition of anonymity because of the sensitivity of the negotiations. A drawback of the Finance bill is that its 10-year, $829 billion budget wouldn't be enough to guarantee access to affordable health insurance for everyone. People with solid middle-class incomes who buy their own coverage would still have to pay hefty premiums — even after tax credits intended to help them out.

For example, a family of four making $66,000 a year and headed by a 45-year-old would face $11,080 in premiums. After a tax credit of $3,182, the family in the example would still have to come up with $7,898 — less than a mortgage but probably more than a year's car payment. The ballpark figures come from the Kaiser Foundation's Health Reform Subsidy Calculator.

Because there isn't enough money in the bill for everyone, the Congressional Budget Office projects the Finance bill would leave some 17 million citizens and lawful immigrants without coverage in 2019, when it's fully phased in.

The insurance industry study asserting that the Finance bill would raise premiums for everyone only added fuel to the fire. "The report says costs are going up — the best way to get costs down is the public option," said Schumer.

The heated rhetoric was evident Wednesday at a Senate Judiciary Committee hearing in which Reid and Schumer called for repealing the antitrust exemption for health insurers.

Support for a public option runs high in opinion surveys. But opposition from influential interest groups stands as a formidable barrier. It's not just the insurance industry, but many medical providers and businesses big and small. One group, the National Federation of Independent Business, praised the Finance Committee for passing a bill with no government option and no requirement that employers offer coverage. But if Reid and the Democrats stick either of the two back in, "they will derail health care reform altogether," warned NFIB vice president Susan Eckerly.

NFIB, which represents small businesses, is well known in the health care debate. It was instrumental in killing then-President Bill Clinton's health care plan in the 1990s.


The Trouble With Health Care Is Paying For It

The legislative process can also be a learning process, and as Congress considers health care legislation -- the latest act being the Senate Finance Committee's vote in favor of Chairman Max Baucus' bill, or "conceptual language" -- we have been learning something useful. It's that legislators would like to provide generous, even gold-plated health insurance coverage to almost all Americans, but that no one wants to pay for it.

The learning process should have started last February, when Congressional Budget Office Director Douglas Elmendorf indicated that the CBO did not back the Obama administration's assertion that preventive care would save money. But it still came as a shock when the CBO confirmed its preliminary finding in its June assessments of the cost of Senate Democrats' bills.

This should have been obvious all along. Early screening can reduce the cost of treating a particular patient. But the costs of early screening add up when you test lots of people who will never need such treatment. So much for "bending the cost curve" down by preventive care.

Then House committees passed a bill financed in part by a "millionaire's tax." But freshman Jared Polis of Colorado, a successful entrepreneur, and 20 other House Democrats came out against that, on the reasonable theory that a tax on high-earners is a job-killer in today's economy. And tax increases on high-earners, thanks to creative accountants, never net as much revenue as static analysts like the CBO predict.

Baucus' bill would impose $829 billion in added costs, financed by a variety of taxes and spending cuts that are just as dubious. One is a tax on so-called Cadillac health insurance plans. But unions that have negotiated such plans are opposed, and House Democratic leaders are uninterested. Another is a tax on makers of medical devices that will be paid for by consumers. Critics have pointed out that most of these taxes will fall on people with ordinary incomes, far below the $250,000-plus moguls that Barack Obama said would bear all his tax increases.

Another Baucus tax is the penalties that would be paid by those who don't buy health insurance. But the penalties in his bill are so low that many will choose to pay them and go uninsured, thus foiling the goal of lowering the uninsured percentage. And as the insurers' lobbying group has pointed out, this will increase premium costs for those who are insured -- a form of tax on those behaving the way Baucus wants.

Then there are the Medicare cuts that supposedly would finance the Baucus bill. But this Congress can't bind future Congresses, and Congresses controlled by both parties have regularly cancelled projected cuts in reimbursement rates. Democratic leaders have made this easier by exempting such actions from its pay-go rules.

So as Michael Cannon of the Cato Institute points out, "Universal coverage is so expensive that Congress can't get there without taxing Democrats." So when those taxes are cut on low and middle earners, there's not enough money to finance the deals the White House has been making with health care interest groups.

The insurers and medical device people are squawking now -- look for more squawking from pharmaceutical companies, hospitals and physicians' groups when they get targeted. House Speaker Nancy Pelosi has made it clear that she doesn't feel bound by deals the White House has made.

The Senate Finance Committee got bipartisan cover from Maine Republican Olympia Snowe. But Snowe says she was just voting to "continue the process" and won't necessarily vote for the bill Senate leaders will meld from the Finance and Health committee versions.

So the learning process may not be over. We know now that it costs a lot of money to pay for insurance policies with expanded coverage for an expanded number of people. And we know that no one wants to pay the price.

We may be in the process of learning something else. Which is that insurance coverage that further insulates patients from costs results in unanticipated increases in health care spending. Yes, it bends the cost curve, but in the wrong direction. That's what has happened with the much-praised Massachusetts system.

Democratic leaders may still have the votes to jam something through. In which case it could, as the Atlantic's Megan McArdle predicts, "spin out of control and eat a gigantic hole in the deficit." Who's going to pay for that?


Health Care 'Reform' -- Getting Less for More

The Democratic-controlled Congress reached another hurdle in achieving health care "reform." The Senate Finance Committee passed a version, 14-9, with one Republican vote. At last, "bipartisanship"!

It requires people to get health insurance, expands Medicaid, provides tax credits to help low- and middle-income people buying coverage, creates "health insurance exchanges" for individuals and small businesses, and requires employers who don't offer coverage to help pay for employees' government-subsidized coverage.

The price? No one really knows -- and few really care. The only certainty is that whatever Congress says it will cost will fall woefully short of the real cost. Cost projections as grossly inaccurate as the ones government gave for Medicare and Social Security could land someone in the private sector in jail.

The Congressional Budget Office projects a cost of $829 billion over 10 years. But the CBO claims it actually would reduce the federal deficit by $81 billion! How? "Reform" curbs the growth of spending on federal health care programs. In Washington, when predicted future spending rises less than previously projected, we've "saved" money. The legislation would impose taxes on health insurers, pharmaceutical companies and medical device companies.

Under this latest legislation, insurance companies could not deny coverage or charge more for pre-existing medical problems. Initially, the insurance companies went along with that because they expected Congress to require everybody to get coverage. This would mean a windfall to the insurance companies. But wait! The bill would soften the penalties for those who fail to get insurance, and the insurance companies now oppose the bill. "The bill imposes hundreds of billions of dollars in new health care taxes and provides an incentive for people to wait until they are sick to purchase coverage," said Karen Ignagni, CEO of America's Health Insurance Plans -- an expense to insurance companies that would be paid for by all their customers.

Meanwhile, this latest bit of legislation needs to be reconciled with a measure passed by another Senate committee back in July. And a whole host of heavily Democratic-backed options are still on the table -- including requiring businesses to cover employees and a government-run public option.

It's not as if some states haven't tried this kind of something-for-nothing health care. Hawaii offered universal child health care -- for seven months. Then it dropped the plan. Why? People (and employers) with private plans dumped them to ride the "cheaper" government train. One of Hawaii's health care administrators lamented, "I don't believe that was the intent of the program." And Hawaii is a small state, without nearly the number of "health insurance needy" as we have on the mainland.

Several New England states offer health care "reform," using most of the ideas floated by the Obama administration. Vermont, Maine and Massachusetts all have "guaranteed issue," forcing insurance companies to provide insurance to everybody -- regardless of an individual's health conditions. And insurers can't charge different rates based on factors such as a person's state of health, age or gender -- a policy called "community rating." Maine also offers a "public option" (a government-run plan with taxpayer-subsidized premiums that competes with private plans), and Massachusetts imposes an "individual mandate" that requires everyone to purchase insurance.

New England boasts that its number of uninsured has gone down (although not as much as predicted). But health care in New England now costs more than anywhere else in America. Many insurance companies just abandoned these states, resulting in less competition and higher premiums. As health care subsidies consume more and more of the states' budgets, they turn to higher taxes, rationing and, excuse please, cost containment.

The Council for Affordable Health Insurance is a research and advocacy organization that includes, among others, free-market-oriented health care providers. It examined current rates in Massachusetts, the only state with "individual mandate," "community rating" and "guaranteed issue." The cheapest plan available for a family of four -- with a $3,500 deductible -- is more than $9,000 a year, and the most expensive is more than $19,000 a year. This about doubles what families currently pay in most other states.

"Reformers" point to the "unfair" number of claims turned down by private insurers. But Medicare, as a percentage of claims filed, actually turns down more than do non-government carriers. According to the American Medical Association, Medicare turns down 6.85 percent of claim lines, followed by Aetna at 6.8, Anthem at 4.62, Health Net at 3.88, Cigna at 3.44, Coventry at 2.88 and UHC at 2.68. All private carriers combined averaged a denial rate of 4.05 percent, making Medicare's rejection rate 170 percent higher!

Hold on to your wallets.


Swing State Senators Face Health Care Reform Threat -- Losing Next Election

By and large, the pundit class has it that momentum now favors passage of a national health care program. There's a fly in the ointment, however. Too many of the Senate Democrats needed to pass such legislation hail from states where even if the concept of health care reform is tepidly endorsed by the people, that support breaks down when ways of actually paying for reform are considered. So ultimate passage of any bill is problematic.

Take the swing state of Florida. Democratic Sen. Bill Nelson is a moderate Democrat. Since our recent InsiderAdvantage survey of Florida shows a state equally divided on the issue, Nelson conceivably could vote for a health care bill. His problem is to figure out what to support in the funding of the bill. The state's senior population is dead-set against any more cuts in Medicare benefits. And they aren't wild about the reductions proposed for the Medicare Advantage program.

But other alternatives put forth in Washington, like a tax on sodas and sweet drinks, or even a tax on financial transactions, such as the sale of stocks or other equities, get low marks from the voters, too. Signing on to almost any of the proposed ways of paying the health care piper would likely be more politically fatal to a senator than voting for the reform bill itself.

In North Carolina, another presidential swing state, Sen. Kay Hagan's approval ratings have plummeted since her election last year. She could easily seal her eventual political fate this year. When she runs again five years ahead, she could be sunk by charges that her support for a health care bill triggered any number of finance mechanisms that might ultimately be needed to pay for it. The list of moderate Democrats in similar straits is not short.

And then there's the idea of charging a fee on Americans who don't sign up for health care under whatever reform bill that might emerge. Polling suggests that any lawmaker that supports that neat little twist might be doing the political equivalent of swallowing a time-released poison pill.

Most amazing is that Congress continues to fret feverishly on a potentially unworkable and even disastrous health care bill while so many other pressing issues go unaddressed. The suddenly resurgent stock market may be misleading Washington into thinking our economy has at last passed "Go" again.

Tell that to the people in most states, like Sen. Nelson's Florida. Voters there continue to say the recession has negatively affected them. A majority says Florida's economy is either as bad as or worse than it was six months ago.

My bet is that the oh-so-critical-vote in the Senate Finance Committee for a health care reform bill by the lone Republican to do so, Olympia Snowe of Maine, will melt like a snow cone in July before this whole reform movement plays out. Snowe tied her vote to enough caveats to allow her plenty of room to back away from whatever the final bill entails.

Recently, Newsweek extolled the virtues of Vice President Joe Biden. (Biden does seem to be one of the more likeable people in the administration.) The magazine noted that Biden had cautioned President Obama early on that it might not be wise to take on health care reform in his first year in office. That's likely because Biden's deep institutional knowledge of the Senate told him that no matter how excited the Democratically controlled House might get over a health care reform effort, his more moderate colleagues in the Senate would be given pause by being placed in the ultimate political pickle.

As of late this week, the pickle jar was still full of moderate Democratic senators. They continue to praise some form of national health care bill, but one by one, they're all coming to the realization that erasing the potential perils and pitfalls of such legislation may not be possible. They're right. The plan is too ambitious.

No matter how the pundits try to tell us that a significant bill will pass this year, I have trouble buying it. Too many polls in too many states -- states represented by moderate senators -- say that while the notion of health care reform is marginally palatable, the details turn the stomach.


Senate Dems Stealing $247 Billion from Your Children to Pay for Obamacare

According to the Associated Press, at the direction of White House Chief of Staff Rahm Emanuel, Senate Democrats are plotting to pass a bill, by as early as next week, that grants doctors a $247 billion increase in Medicare fees over a decade. This will no doubt add to the deficit. Why are the Democrats so intent on spending $247 billion in one week? To pave the way for the White House to claim that Obamacare is deficit neutral.

Senate Majority Leader Harry Reid (D-NV) and Senate Democratic Leadership are meeting, as you read this, behind closed doors with White House staff . They are trying to cut and paste the complex provisions of the Senate Finance Committee health bill (the Baucus Bill) and the Senate Health, Education, Labor and Pensions bill ( the Kennedy-Dodd bill). They want to produce an overhaul of one sixth of the economy under federal control that is somehow coherent and yet not add “one dime,” as President solemnly promised, to the deficit.

The Senate leaders know that when they cobble all of this together they are going to have a big problem making the numbers come out right. So, fellow citizens, they are contemplating a classic shell game: Hide the increased spending under the shell of different bills. For example, Sen. Debbie Stabenow (D-MI) is proposing separate legislation (S.1776) that would repeal the Medicare payment update formula (one of the more bizarre Congressional administrative pricing creations), and the result would be a $247 billion increase Medicare spending by $247 billion. For the Senate leaders, it’s a neat little way around the public appearance of aggravating the already enormous “deficit problem” They raise ten year health spending by $247 billion, but keep it out of the Senate health bill. That way, they’ll be able to claim, with sort of a straight face, that the Senate’s final product, crammed with additional spending, is still “deficit neutral.”

It’s like maxing out on the company credit card. Then, to show the accountants that one is not running up debt on the card, one simply goes out and buys a new credit card. Then, continue to run up more debt on the new one. How convenient.


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