What is “How can you tell if Barry is lying?”
Posted by admin on August 8, 2009 under ***IMPORTANT LEGISLATION***, 2K9 Tea Party Revolution, ObamaCare | 
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I can’t tell you how I look forward to the knock on my door from flag@whitehouse.gov! Talk about FISHY!
Posted by admin on under Ummm - Your Intolerance is Showing!, Voter Mentality | Be the First to Comment
This is the short version. If you want to view the 3-part series, start here
Posted by admin on August 7, 2009 under ***IMPORTANT LEGISLATION***, 2K9 Tea Party Revolution, ObamaCare | Be the First to Comment
Steve Steckler, Chairman and founder, Infrastructure Management Group (IMG):
The debate over a public option in health care has exposed a core public policy issue that until now has been seen only at the local level: what services should be provided directly by the government and its employees versus simply having the government ensure access to those services in the open market. Enlightened conservatives like the late Jack Kemp, who respected the power of free markets but wanted to make sure that low- and moderate- income citizens were empowered to benefit from them, have argued passionately that government has a moral obligation to ensure access to these services but a near-equal obligation to stay out of the service business itself. Kemp—and Al Gore, incidentally—once said government works best when it steers rather than rows, otherwise it tends to become bloated and—when competing with private firms—gluttonous. Indeed, in the few opportunities I had to discuss Kemp’s populist ideas with him, he was quick to cite the painful experiences of local service firms and non-profits in their competition against federally subsidized, book-cooking and rule-bending local governments.
Our various levels of government provide many essential services, from the city planning and law enforcement to safety inspection and professional licensing. These particular types of services are direct expressions of the government’s police power, and so are rightfully and for the most part confined to public providers. A second service category is more discretionary, which means they could be provided by the private market but, for both good and bad reasons, the government has intervened as the monopoly provider. These usually include mass transit, water and sewer services, etc. Rarely—as in almost never—has a government allowed private firms to continue to compete for customers once it has established itself as a provider, and truly never on a level playing field.
For example, private jitney services are forbidden in most US cities, especially in densely-traveled bus corridors (i.e., where the customers are). And as President Obama prepares to push billions of new dollars into intercity high-speed passenger rail, Amtrak is already claiming with legislative justification that it has a monopoly to operate the trains in almost every corridor in which the services are being planned, despite the existence of dozens of US and global companies eager to do so. Solid waste collectors are routinely blocked from offering their services in service areas attended to by a public operator. And then there’s K-12 education, where any family using anything other than government schools must pay twice (once through their property taxes and again through tuition), while the poor are economically prohibited from choosing at all. In fact, many public union teacher contracts allow the sale of surplus school property to almost anyone, such as liquor store operators and shopping mall developers, but not to private school foundations that might build a competing facility. Reduce…
Other barriers are less obvious but equally effective. They amount to cheating, and they have a huge and readily calculable cost to taxpayers. Here’s how they work:
1. Cooked Cost Accounting: For a time in the 1990’s, numerous city governments invited private companies to bid against their public in-house operations to provide services ranging from wastewater treatment to city vehicle maintenance. Unfortunately, the cities usually limited the contracts to 3-5 years, too short to allow private firms to recover the cost of the equipment they’d have to buy or to earn back their other start-up costs. Moreover, when comparing their own service costs to the private option, the government usually left out much of its general overhead and long-term liabilities, such as pensions and equipment replacement, arguing that they would have to carry those costs whether the service was contracted out or not. The private competitors, on the other hand, had no choice but to include these costs in their bid. So they often lost. Once the private competition was wiped out or otherwise deterred, the public operator breathed a big sigh of relief and usually returned to its normal cost escalation or lower service level.
2. Debt and Capital Subsidies: Government debt is subsidized by federal taxpayers; that is, the interest on the government’s debt is generally tax-free, while interest on a private provider’s debt is taxed at combined rates of up to 50 percent. This means that, by comparison, taxpayers pays up to half of the debt service cost of public option vis-a-vis private companies. The result is that public operators can borrow at 3 or 4 percent while private service and infrastructure companies—and health insurers—must raise their capital in private debt and equity markets at normal, much-higher rates. Even worse, the equity component of a private operator’s financing is taxed twice: once at the corporate level (corporate income tax) and then again at the individual shareholder level. Government providers almost never include the enormous taxpayer cost of these subsidies in a public-versus-private comparison.
3. Implicit Service and Revenue Guarantees: There are two main types of public service operating agencies: internal enterprise fund units, such as the Chicago Department of Aviation, and independent public authorities, such as the Port Authority of New York and New Jersey. Bonds issued by or on behalf of internal enterprise funds may or may not have the explicit backing of the participating government; that is, the government has varying hurdles (sometimes none) it must clear to backstop one of its financially underperforming business units. This contrasts somewhat with bonds issued by independent (but still government-owned) public authorities, which are usually prohibited by their covenants from being backstopped by general government revenue. But what governments can almost always do fir their captive operators is to direct customers, and therefore revenue, to its business units. It does so by adding additional communities to its client base (e.g., incorporating smaller suburban jurisdictions into its service area, thus improving its economies of scale) or by driving private providers out of the market, either through regulation or temporary or customer-class marginal cost pricing. It can also use its monopolist oligopolist pricing power to simply raise rates to cover bloated costs.
4. Artificial Scale: The government is almost always the largest provider of public-use services in its region. A private company hoping to provide potable water or other infrastructure alternatives therefore finds itself competing against not just the “natural monopoly” aspects of infrastructure, with miles of existing pipe and connections already in the ground, but against the enormous economies of scale that benefit the government in the first place. It’s the same advantage that a handful of private companies like Wal-Mart and Verizon enjoy because of the relative size of their customer base. It manifests itself in enormous, competition-killing way, including input pricing (e.g., Wal-Mart’s power to squeeze its suppliers) and installed service structure, such as Verizon’s numerous cell towers in its Bell-legacy regions. The US health insurance market has a large number of private providers, but state-by-state regulation has kept many of them confined to their regional customer base. A Fannie Med public option, by contrast, would operate nationally and, as Medicare does in many cases, would surely use its scale to force its will on hospitals, doctors and drugmakers while other insurers pick up the real tab.
5. The Fannie Mae Lesson: Fannie Mae and Freddie Mac were supposed to be stand-alone, corporate-like purchasers of home mortgages (this should be sounding familiar already). The authorizing legislation that created them and the language of their founding charters refer many times to their full operating and financial independence from the government and, by exclusion and more, the absence of taxpayer liability for any possible corporate mishaps. In its subsequent competition with other firms offering the same mortgage bundling services, the feds were never supposed to be able to step in. But that’s exactly what happened in late 2008, to the tune of hundred billions of dollars of taxpayer dollars. You can be absolutely certain that the new managers of any public option—and most of its prospective customers—will remember that comforting golden parachute. And while the Congressional Budget Office can tell you how costly it is to taxpayers, Lehman Brothers can tell you how it is not to have had it.
No doubt President Obama will make promises that the House and House-Senate conference committee’s won’t keep when it comes to the financial independence and honest accounting of the public health insurance option. But even if they don’t explicitly empower a new public entity to cheat as it competes with private insurers, and even if they do offer the usual platitudes about ensuring a level playing field, there are at least five big reasons and many billions of dollars of experience to convince you not to believe a word of it.
Posted by admin on August 5, 2009 under ***IMPORTANT LEGISLATION***, 2K9 Tea Party Revolution, ObamaCare | Be the First to Comment
South Florida Geriatric Care Manager Amy Seigel, RN, CCM Testifies on Need for Coordinated Health and Elder Care
Health care reform is at the top of President Obama’s agenda, and he is looking for Congress to present a solid plan by this summer. In anticipation of this deadline, members of Congress are busy gathering tools and ammunition for the mammoth undertaking to revamp our current health care system.
As part of this preparation, health care practitioners from across the country recently gathered on Capitol Hill to brief members of Congress on specific recommendations to improve health care delivery.
Leading this charge was the National Academies of Practice, a consortium of 10 different medical disciplines committed to changing and improving health care. NAP Vice President of Policy and founder of Biscayne Institutes of Health & Living in Miami, Dr. Marie DiCowden, explains, “We need to expand the traditional model of care so it focuses on interdisciplinary care for both preventive and primary care.”
One of these practitioners, Amy Seigel, a Certified Nurse Care Manager and founder of Advocare Care Management of South Florida, provided testimony related to the needs of the senior population. Seigel provided two compelling examples of the need for more coordinated elder care.
One example illustrated how one senior’s continued denial for routine care by her HMO led to amputation of her fingers, resulting in the loss of her ability to continue as a caregiver for her husband. The ultimate consequence – loss of independence, faster progression to skilled nursing, and more burden on the U.S. taxpayer.
Her next example hit very close to home with the legislators.
Seigel read testimony from one of her clients, the wife of a former US Senator. She pointed out that even with the excellent benefits of U.S. Senate insurance combined with Medicare, the couple had difficulty with an overwhelming and fragmented medical system. Though they were fortunate to have a Nurse Care Manager to help them navigate the system, many seniors cannot afford or are not aware of this type of assistance.
The testimony concluded that community and home based services such as Geriatric Nurse Care Managers could help reduce unnecessary ER visits, increase access to appropriate services, and better coordinate multiple medical practitioners and prescription medications.
Source: http://www.southfloridahospitalnews.com/current/default.asp?page=2&articleID=4155
Posted by admin on under ***IMPORTANT LEGISLATION***, 2K9 Tea Party Revolution, ObamaCare | Be the First to Comment
One of the hottest topics among medical professionals today is national healthcare reform. And while there have been some policy statements released on the subject, the fact is, no one really knows what to expect. For this reason, the Florida Orthopaedic Society (FOS), along with other state medical and specialty organizations, is working to keep its members up-to-date on all of the information available.
“A great number of people are concerned with the idea of government-directed or government-controlled healthcare reform,” explained Julio Gonzalez, M.D., a member of the FOS Board of Councilors. “There are many different ideas out there about how that can look—whether it’s a universal single payer system, which is the classic idea of universal healthcare, or a multipayer, government-directed system. There aren’t a lot of details available on which way the administration, and the leadership in the House and Senate, want to direct the plan.”
For the past year, Dr. Gonzalez has been heavily involved in the healthcare reform debate. “I was catapulted to a much higher level of debate after reading Call to Action: Healthcare Reform 2009 by Senate Finance Committee Chairman Max Baucus,” he explained. “When I read about the amount of government intervention, manipulation and oversight inherent in the plan, I was appalled. I felt threatened, for myself and for my patients.”
In answer to the Montana senator’s paper, Dr. Gonzalez wrote a book entitled Health Care Reform: The Truth. He also began working with state medical organizations to inform their members, and started a grass-roots group, The Alliance for Responsible Healthcare Reform, to bring more attention to the issues. Through this group, medical professionals from all sectors, including nursing homes, physical therapy groups and hospitals meet with district congressman to voice their concerns.
According to Dr. Gonzalez, there are many factors that need to be addressed in the healthcare reform debate, including the timeline of the reform itself. “I find it appalling and irresponsible that the Legislature wants to come out with a bill by June, and have it ready to go before the president by October 15,” he explained. “By all accounts, they are revamping the way we deliver healthcare in this country in what is essentially a four-month process, without sharing the contents of their bill with the public for discussion and debate.”
While a few policy statements have provided a general overview of the plan, Dr. Gonzalez, and many other medical professionals, are alarmed by the lack of detail on funding, logistics and short- and long-term goals. “I went to Washington, D.C. in April, and met with Republican and Democratic members of Congress,” he explained. “Not only does the public not know what’s in the bill, but even members of both parties are not familiar with what it contains.”
Of specific interest to medical specialty groups are issues dealing with the loss of autonomy for patients in choosing the provider and the type of healthcare they receive, and the concept of bundling payments to a hospital. “A hospital will get reimbursed for all of the care provided to the patient, and then they are responsible for deciding how and to whom they divvy up the payments,” said Dr. Gonzalez. “This is going to cause a lot of politicking between different team member within the patient care delivery system who should be working together.”
The ‘budget neutral’ concept, in which general physicians receive enhanced reimbursements at the expense of specialty physicians, is also a sticking point. “A budget-neutral approach to increasing reimbursement for generalists and primary care at the expense of specialists ignores the fact that there is a universal shortage of physicians, affecting specialists and generalists alike,” said Dr. Gonzalez. “Enhancing reimbursement of one group at the expense of the other will lead to shortages in specialty care like you see in Canada and Europe.”
Dr. Gonzalez is also alarmed by the government’s idea of not allowing physicians to own hospitals, citing conflict-of-interest. “Some of the greatest hospitals in the country—the Mayo Clinic, Cleveland Clinic, New York University Hospital for Specialty Surgery, Venice Regional Medical Center in Florida—were all created by physicians,” he said. “This concept ignores the fact that physician expertise and involvement lead to the creation of top-notch medical centers.”
Until the actual bill comes out, Dr. Gonzalez is working with a number of organizations to raise awareness, and encouraging people to review the bill with thought, an open mind, insight and research. “It is imperative that patients know what’s coming, and determine if this is what they really want,” he said. “I have a feeling that the American patient really doesn’t want to have the government dictate what will happen in the exam room.”
Source: http://www.southfloridahospitalnews.com/specialfocus/default.asp?articleID=4051
Posted by admin on under 2K9 Tea Party Revolution, Obama and Other Hypocrites, ObamaCare | Be the First to Comment
