Tuesday, February 16, 2010

British government uneasy with criticism of health care

I wonder why?

The task of ensuring decent standards in hospitals is being undermined by ministerial sensitivity to criticism, England’s former health regulator has warned. Baroness Young of Old Scone said that her brand of “rugged independence” had collided with the Department of Health’s desire for someone “much more emollient” to scrutinise the NHS and social care system. In her first interview since unexpectedly resigning as chairman of the Care and Quality Commission (CQC) in December, she also said that the health-check ratings system must “change radically” and signalled that dozens of underperforming trusts should face “pretty stringent conditions” when new licences are awarded in April.

Her abrupt departure followed criticism of the CQC for failing to spot significant problems in highly rated hospitals. Senior government sources later claimed that the “volatile and hot-headed” regulator had sent abusive e-mails to colleagues. She told The Times, however, that she had decided to resign as early as September — only five months after the CQC started work as the super-regulator of health and social care.

Lady Young denied that there had been a personality clash with Andy Burnham, the Health Secretary, but suggested that her notion of what was required of an independent regulator sat uneasily with the Department of Health. Describing the vetting before she took up the post, Lady Young said that MPs had emphasised the importance of “not being in the pocket of government” and of being candid.

She added: “It became clear to me, as we went through the whole process, that government knew it should want an independent regulator but in practice didn’t feel very comfortable about that . . . Rugged independence is not what they are looking for, they are looking for something much more emollient and collaborative. “[The CQC] is one of the few fields where the regulator — for saying anything that is unsatisfactory in terms of a service — is actually saying directly that the service being run by a minister is unsatisfactory, and ministers find that quite difficult.”

She suggested that ministers might be braver, particularly in cases where trusts are independent foundations. Instead, in the most controversial cases last year, “it was kick the regulator time — and life is too short. I think the idea that the regulator can prevent every leaf fallen is nonsense.”

Lady Young said that she hoped the vital role of robust, independent regulation would not be compromised by future politicking — which too often turned the identification of problematic hospitals into a blame game with the regulator as the scapegoat.

More here

Sickening corruption at a U.S. community hospital

Have you heard the one about the politician, the preacher and the unemployed single mother of two? No, it’s not the opening line of a stand-up comic’s joke; instead, it’s a story about small-town health care that might turn your stomach.

The story was shared with me recently by a man who identified himself as the former administrator of a small-town community hospital in the Midwest. In order to protect his identity, I’ll call him “Pat” and not disclose the name of the town in which the hospital is located.

Pat approached me in late December, hoping I would help him expose a loophole of sorts he had observed during nearly a decade of work as an executive in the world of taxpayer-funded, small-town health care.

Pat told me about the cases of the elected city official, the preacher and the single mom that came to the attention of the hospital’s five-member board a few years ago as a result of their failure to pay the “responsible portions” of their hospital bills for services received.

At one of the board’s monthly meetings, Pat offered recommendations to board members regarding the disposition of their cases:

* He recommended that the elected city official — who owed in excess of $20,000 and was notorious for not paying her bills at the facility — be sent to a collection agency;

* He recommended that the $5,200 debt compiled by the preacher — who lived in a 5,000-square-foot home and also had a track record of not paying her bills — be turned over to a collection agency; and

* He recommended that the unemployed single mother of two — who had always paid her bills — be given more time to pay her bill of almost $8,000.

Incredibly, members of the unelected board did not follow any of his recommendations. “I was told not to pursue the elected city official or the preacher and that the unemployed single mother of two could be garnished,” Pat explained.

Why did the board vote in such a way? According to Pat, politics and social standing in the community of fewer than 5,000 people played a significant role in the decision-making process. At the time her case came to the attention of the board, the elected city official was well connected, Pat said. In addition to having family members on every kind of board and committee imaginable, she owns two highly-visible businesses in town. Similarly, the preacher is well-connected and holds a prominent place in the community as one of the leaders of a non-denominational church that is one of the town’s largest worship facilities.

While trying to investigate this story by using the state-level equivalent of the Freedom of Information Act, I ran into obstacles presented by the Health Insurance Portability and Accountability Act of 1996, a law often referred to by its acronym, HIPAA (“Hip-Uh”).

In a request made to the current hospital administrator one month ago, I asked for copies of “Documentation of all cases during the calendar years 2006 and 2007 that involved individuals’ with medical bills totaling $5,000 or more that were “written off” and/or deemed not to be collected by a vote of the Board of Trustees.”

Realizing that HIPAA guidelines might restrict the hospital from releasing the information in “as is” condition, I added the following note to my request: “Note: If those minutes contain confidential information, such as the names of patients, please ensure that you redact those names and any personally-identifiable information from the records, per HIPAA guidelines, before sending.”

In explaining why she couldn’t fulfill my request, the current hospital administrator cited HIPAA.

Thinking the obstacle could be overcome, I contacted an attorney who provides counsel to journalists in situations such as mine. Much to my surprise, the attorney confirmed for me what appears to be a glaring loophole in the law: Unelected officials overseeing taxpayer-funded community hospitals can seemingly act with impunity and play “good ol’ boy politics” when it comes to deciding who pays bills or not.

In short, there seems to be little or no oversight of board members’ actions at the community-hospital level. As a result, good ol’ boy politics is allowed to run unchecked.

Pat told me that when he left the hospital more than two years after the above-described meeting took place, the unemployed single mother of two had paid her bill in full. The preacher and now-former city official had not.


Is Health Care Overhaul Doomed to Failure?

Fate of President Obama's Health Care Agenda Hangs in the Balance as Democrats and Republicans Remain Skeptical of Bipartisanship

As Democrats and Republicans sharpen their knives ahead of President Obama's summit on health care, experts are questioning whether the president's health care agenda is doomed to fail just as President Clinton's did in the 1990's.

"If I had to place a bet on it, I would say two to one, it doesn't [pass]," said Dean Baker, co-director of the Center for Economic and Policy Research and a proponent of health care reform. "But it's not an absurd idea. It could happen. Given how much stake President Obama and Democrats have in it, they have to do something. ... They have every reason in the world to pull out all the stops to try and make it happen."

Obama has invited Republicans and Democrats to a televised bipartisan meeting on health care on Feb. 25, but experts are skeptical about whether the open event will be any more than political theater and actually achieve any concrete results in bringing both sides together.

"It could either be a choreographed professional wrestling match or it could be another 'Kumbaya' meeting, and I think both would be totally useless," said Uwe Reinhardt, a professor of political economy at Princeton University. "It should be a frank exchange -- thoughtful, polite, but the way adults should talk to each other."

The president is hoping to thaw the ice on a health care overhaul bill that right now faces grim prospects on Capitol Hill. By bringing both Republicans and Democrats to the table, the White House hopes to resurrect the momentum by energizing wary Democrats and staunchly opposed Republicans.

"Bipartisanship can't be that I agree to all the things that they [Republicans] believe in or want, and they agree to none of the things I believe in and want, and that's the price of bipartisanship," Obama said at an impromptu press conference Tuesday, "but that's sometimes the way it gets presented.

"I'm willing to move off some of the preferences of my party in order to meet them halfway," he said. "But there's got to be some give from their side as well. ... That's what I'm hoping gets accomplished at this summit."

Some health care experts say bringing the debate out in the open when talks haven't even really begun does not bode well for the future of health care overhaul. "I don't think this is the right way to get that kind of dialogue taking place," said Stuart M. Butler, vice president of domestic and economic policy studies at The Heritage Foundation, a conservative think tank. "All this will do is lead to political sound bites and not much else, in my opinion."

The GOP leadership wants Obama to go back to the drawing board. "Why are we going to talk about a bill that can't pass?" House Minority Leader John Boehner, R-Ohio, said Tuesday, after a meeting with Obama on jobs. "It really is time to scrap the bill and start over."

Democrats have been relatively quiet and awaiting direction from Obama. After a whirlwind few months of crafting legislation that would get broad support and pass both the House and Senate, Democrats faced a striking blow when Sen. Scott Brown was elected to fill late Sen. Ted Kennedy's term. Brown vowed to become the 41st GOP senator to vote against the health care bill, deflating any hopes of passing the legislation as the majority party had planned.

Experts say the president made a mistake by stepping away from the debate and leaving it up to lawmakers. He now has to take the lead and play "hardball politics," Baker said. "I think President Obama will have to work very, very aggressively ... [and] be prepared to pull out all the stops. That's the most likely path," Baker said. "If he could basically shame some of the more moderate Republicans such as [Maine Sen.] Olympia Snowe into coming on board in a public session and try to put them on the line, I think that might be a way he gets bipartisanship."

Sen. Judd Gregg, the top Republican on the Senate Budget Committee, has also been billed as another GOP leader who has shows signs of bipartisanship on the health care front. But the senator from New Hampshire is also calling for the administration and lawmakers to start from scratch. "I say, let's step back, let's start with a blank sheet of paper. And let's start putting on that sheet of paper things we can agree about," Gregg said in an MSNBC interview Friday.

Baker said he is "not terribly optimistic" about the summit at the end of this month. However, there are areas where Republicans and Democrats can come together and coalesce on a new bill.

More here

Obama the winter Olympian

Why the House Democrats are about 100 votes short

My colleague Mark Tapscott cites an anonymous quote by a House Democratic leader from a Politico story on why the House Democratic leadership can’t muster the votes needed to pass the Senate health care bill. “‘You just need to twist enough arms to pass the Senate bill.’ You can twist arms if you’ve got a handful of them to twist. You can’t twist over 100 arms. There needs to be some reality check there.” Mark takes that as an indication that House Democrats are short 100 votes of passing the Senate bill.

Clever liberals in the blogosphere are still urging House Democrats to pass the Senate health care bill, with the Senate then making changes through the reconciliation process requiring only 51 votes and the Senate going along. Sounds like a clever idea. But as my Examiner colleague Mark Tapscott writes, an anonymous quote from a House Democratic leader suggests that they are 100 votes short of passing the Senate bill. I wouldn’t take that 100 votes as a precise number, but as an approximation.

Why are House Democratic leaders having such trouble getting the 217 votes needed for a majority (because there are vacancies now in two Democratic-held seats)? Look at it this way. Imagine you’re a Democratic congressman from a not entirely safe district. The leadership comes to you and says, We’d like you to vote for the Senate bill. Oh, and by the way, we can’t change a word in it. You’ve got to vote for the Cornhusker Hustle and the Louisiana Purchase and all that other garbage.

But hey, the leadership guy will go on, there’s no risk, because the Senate will fix everything through the reconciliation process. You will be suspicious of this. You will note that using the reconciliation process requires favorable rulings from the Senate parliamentarian, rulings over which you have no more leverage than you have over phases of the moon. It requires 50 Democratic senators willing to go along with reconciliation, and given the poll numbers that have been coming out lately that’s not a sure thing. And it requires steady leadership from Harry Reid—who just last week, without notice to the White House, the House leadership or the senators involved, yanked a Baucus-Grassely bipartisan “jobs” bill and substituted a much smaller one of his own.

So you, as a Democratic member with potentially serious opposition, do the political caucus. If you vote for the Senate bill, you’re voting for something that has 35% support nationwide and probably a little less than that in your district. You will have voted for the Cornhusker Hustle and the Louisiana Purchase. Your Republican opponent will ask why you voted for something that gave taxpayers in Nebraska and Louisiana better treatment than the people you represent (there are no Democratic House members running for reelection in those two states: Nebraska has only Republican House members and the single Louisiana House Democrat is running for the Senate). The only protection you have against this is the assurance that the Senate parliamentarian and scared incumbent senators will come through for you, and that Harry Reid will pursue a steady course.

So your response to the leadership is either, I gotta think about this, or, Hell no. The House Democratic leadership’s problem is that it cannot credibly promise that the Senate will keep its part of the bargain.


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