Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts

Thursday, March 29, 2007

HHS Official Resigns Amid Mass. Debacle

Thursday March 29, 2007 11:46 PM

By KEVIN FREKING

Associated Press Writer

WASHINGTON (AP) - The head of the federal agency responsible for providing women with access to contraceptives and pregnancy counseling resigned unexpectedly Thursday after Medicaid officials took action against him in Massachusetts.

The Health and Human Services Department provided no details about the nature of the Massachusetts action that led to Dr. Eric Keroack's resignation.

Just five months ago, Keroack was chosen by President Bush to oversee HHS' Office of Population Affairs and its $283 million annual budget. The pick angered Planned Parenthood and other pro-abortion rights groups that viewed him as opposed to birth control and comprehensive sex education. Keroack had worked for an organization that opposes contraception.

``Yesterday, Dr. Eric Keroack alerted us to an action taken against him by the Commonwealth of Massachusetts' Office of Medicaid. As a result of this action I accepted his resignation,'' Dr. John Agwunobi, assistant secretary for health, said in a terse statement Thursday evening.

Massachusetts Medicaid officials did not return phone calls seeking comment.

Sunday, November 26, 2006

California Legislature Votes to Kill the Health Insurance Industry....

Opinion by Consumer Advocate Tim Bolen

Sunday, November 26th, 2006


There is a war on in the United States over health care. On one side is the "status quo" represented by the medical monopoly, the pharmaceutical industry, the health insurance carriers, and an entrenched bureauracracy wholly beholden to, and run by, the people they are supposed to regulate.

The US system, according to the World Health Organization, is rated 72nd in quality, but number one in cost, worldwide. The "Death by Medicine" study shows that the system itself is the number one killer of Americans. The number two and three killers of Americans are heart disease and cancer, diseases which those of us outside of the "status quo" know are curable, and preventable - but those cures and preventive treatments are being suppressed by agents of the "status quo."

On the other side is a beleaguered America simply trying to find ways to survive.

(1) The medical monopoly is so evil, in itself, that medicine is no longer an honorable profession. For it isn't about helping people - it's about gouging money out of an unsuspecting public. For instance: there are five million legitimate health professionals working in the United States, three million of which are licensed by individual States, and two million of which are unlicensed. But only seven hundred thousand (14%) of those can bill health insurance, Medicaid, or Medicare for their services.

Why is that? Because the American Medical Association (AMA) has a contract with the US Department of Health & Human Services (DHHS) to write billing codes (about 6,500 CPT Codes) for ALL health professionals - but will not invent codes for anyone but those seven hundred thousand medical doctors (the number one killer of Americans). This, of course, means that all four million three hundred thousand other health professionals in the US, in order to get paid, must bill THROUGH an MD using "their" codes - so that the MD gets a cut of the money (and increases the costs). There are only two exceptions - out of the approximately 6,500 CPT Codes available, there are four codes for Chiropractors to use, and one for Acupuncturists.

(2) The pharmaceutical industry is so corrupt few Americans believe anything they say - despite their massive television advertising campaigns. Since the drug industry got permission from the US FDA in 1998 to advertise directly to the consumer the only change we've seen is a 500% increase in the price of prescriptions. The money seems to go for television news hour advertising.

(3) The US health insurance industry is rotten to the core. The biggest group of individual bankruptcies in the US are those that had health insurance for an illness and found out, the hard way, how the health insurance system actually works.

For instance: If you have an 80-20 policy, supposedly where the insurance company pays 80% and you pay 20%, and you end up in the hospital, generating a bill for $100,000, you are, very suddenly, handed a bill (to be paid immediately) for $20,000. Do you think the insurance company is going to pay $80,000? No, they are not, for the have a "deal" with the medical monopoly, and they generally pay, by my calculations, only about twenty two cents on the dollar - so their part of the hospital bill is going to be 22% of $80,000 or $17,600. Hardly 80%. YOU will write bigger checks than the insurance company will...

Only God can help you if you have a 50-50 insurance plan.

Worse yet, is that the average cost to a US employer for this health insurance is $14,7000 per year, and employers in the US with over two hundred full-time employees are REQUIRED to provide coverage. Out of that $14,700 premium, by my calculations, only about 9% goes to pay health claims. The rest is divided up long before - 40% commission to the health insurance broker that sold the policy to the company, 35% goes to overhead (insurance companies own marble buildings), 10% goes to the stockholders as a dividend, and 6% goes to miscellaneous, including the costs of lobbying Congress. That leaves only 9% to pay claims.

And if that isn't enough - several sleazy health insurance companies are filing "fraud" charges against health professionals with licensing boards simply because they don't want to pay claims - and several of those boards are actually prosecuting doctors over those billing disputes.

(4) The bureauracracy that regulates health care in the US is shameful. There is no arguing for the system. It has turned against America, and is operating not to regulate the industry, but to protect it from competition and change. Period. There is nothing more to be said. Facts are facts. Change is necessary.

Things are being done to fix these problems...

I don't need to go into detail here about how each of these problems, described above, is being attacked. Read my other newsletters, and you'll get the idea. Today I'm going to tell you about how just one of those issues is being addressed in, and by, the State of California. The health insurance issue.

Why is it important to study what California is doing? Because California is the fifth largest stand-alone economy on Planet Earth. It is a vibrant State, with vibrant people. What happens here migrates to other States quickly.

Sit down before you read this next section. You're going to be shocked...

The California Legislature, both the Senate and the House, have passed Senate Bill 840, which in effect, will make it illegal to sell health insurance within the State of California. The bill is heading for the Governor's desk.

I have, below, copied a section from a website for a group called "Health Care For All," where you can go to get even more information about SB840. The section is self-explanatory.

A bill creating universal healthcare through a publicly financed administration in California, authored by Senator Sheila Kuehl, D-Santa Monica, was introduced to the Senate in February, 2005. A copy of the bill is now available from the legislature. Download bill here. For ease of use, get our Table of Contents for the bill.

Available for download is a comprehensive Fact Sheet from Senator Kuehl's office. We offer a 10-page Word document about the Features of SB 840. Also available is a shorter summary, SB 840 Summary. See also a Fact Sheet in Spanish.Principal workers on this bill are consultant Judy Spelman and Senate staff member Sara Rogers.

You can download a list of the co-authors for SB 840.

See a list of endorsing organizations that support SB 840. See a recent statement by the League of Women Voters- California showing their position on this bill.


The bill incorporates the following features:

Security - Everyone is covered. No one will ever lose coverage for any reason.

Choice - Everyone can choose their doctors and other providers. Under this single payer plan, health care delivery is in the private sector.

Comprehensive Benefits - Everyone has full benefits that include prescription drug coverage and mental health care.

High Quality - Doctors and patients, not administrators, make medical decisions. Hospitals can afford safe staffing levels for registered nurses. Primary and preventive care are priorities.

Efficient Administration - Huge savings result from removing insurance companies from health care. Provider and patient paper work is slashed.

Fair Cost sharing - Employers and employees pay a modest health care premium, which is less than most pay now.

Fair Reimbursement - Providers receive fair and full compensation for their services.

Cost Controls - Health care inflation is controlled by efficient administration, global health care budgets, bulk purchases of drugs and durable medical equipment, coordination of capital expenditures, and linkage to growth of the State Gross Domestic Product.

I am an Orange County California Conservative Republican. SB840 is sponsored by Liberal Democrats and I wholly support it. Absolutely. It can't happen soon enough. I applaud the bill's sponsor, Senator Sheila Kuehl and her staff for their efforts.

Stay tuned...

Tim Bolen - Consumer Advocate

http://www.bolenreport.net/feature_articles/feature_article042.htm

Friday, November 24, 2006

The Money Party vs. The People Party

This Associated Press story about the prospects for pharmaceutical importation legislation came out just a few hours after I wrote my post on how calls for “bipartisanship” between Republicans and Democrats hide the real power equation in Washington between the Money Party and the People Party. This piece shows exactly what I’m talking about.

The piece says that most Democrats support allowing Americans to buy cheaper, FDA-approved medicines from places like Canada. It also notes this:


“Things were headed in the right direction with reimportation to begin with, but the election will speed up that process because it’s removed leadership that was opposed to reimportation. I am a Republican and support leadership in general, but on reimportation they were opposed to it,” said Sen. David Vitter of Louisiana. Vitter and Sen. Bill Nelson, D-Fla., recently sponsored legislation to halt the seizures of imported Canadian drugs for personal use — something the government now allows only on a limited basis. And Vitter continues to block confirmation of Dr. Andrew von Eschenbach, President Bush’s nominee to lead the Food and Drug Administration, until federal drug import laws are further relaxed.
[…]
“A lot of people say, ‘Oh, it’s just the Democrats,’ but it’s not. It depends on where you’re from, and who are your constituents,” said Rep. Jo Ann Emerson (news, bio, voting record), R-Mo., a key sponsor of previous reimportation legislation.

Still, Emerson says the issue will have a “fighting chance” in the new Congress, even without a veto-proof majority. Others are less sanguine.

“This is one of those things where I think that the conventional wisdom may not be accurate. I personally think reimportation has a much tougher prospect of moving with the Democrats in charge, particularly in the House,” said Ira Loss, an analyst at Washington Analysis.
Loss points to the potential opposition of Rep. John Dingell, D-Mich., who will take over as chairman of the House Energy and Commerce Committee that oversees the FDA. Dingell previously has warned of the safety risks posed by imported drugs — as do both the FDA and pharmaceutical industry.

So, in other words, there are Democrats and Republicans like Vitter and Emerson willing to stand up for the People Party on this critical issue, but there are people like Democratic Rep. John Dingell who may use a patently fake argument about imported drugs being unsafe in order to defend the Money Party.
The New York Times also gets in on the action, with reporter Robert Pear going even further to show the Money Party vs. People Party divide in his story about the drug industry developing strategies to stop Democratic reforms in Congress:
Billy Tauzin, president of [PhRMA], a lobbying organization for brand-name drug companies, recently urged Representative Edolphus Towns, Democrat of New York, to seek a position as chairman of a powerful House subcommittee, said Karen Johnson, a spokeswoman for Mr. Towns. The subcommittee has authority over Medicare and the Food and Drug Administration. Democrats have yet to decide who will head the subcommittee.

[…]

Amgen, the biotechnology company, recently disclosed that it had retained as a lobbyist George C. Crawford, a former chief of staff for Representative Nancy Pelosi of California.

[…]

Amgen is also seeking strategic advice from the Glover Park Group, a consulting firm whose founders include Joe Lockhart, a former press secretary for President Bill Clinton.
Other major drug companies have been snatching up Democratic former-aides-turned-lobbyists. Merck recently has hired Peter Rubin, a former aide to Representative Jim McDermott of Washington, one of the more liberal House Democrats. Cephalon has hired Kim Zimmerman, a health policy aide to Senator Ben Nelson, a conservative Democrat of Nebraska.
The Biotechnology Industry Organization has retained Paul T. Kim, a former aide to two influential Democrats, Senator Edward M. Kennedy of Massachusetts and Representative Henry A. Waxman of California.

This is the real divide that matters in politics - not Republicans and Democrats, but Money vs. People. Don’t let the pundits’ calls for nebulous “bipartisanship” fool you. Don’t let the pledges of “civility” from politicians divert your attention. There is too much bipartisanship in pursuit of selling out, and too much civility that hides a very uncivil class war that Congress has waged - and may continue to wage - on middle America.

COMMENTS: Go to Sirota's Working Assets site to comment on this entry

posted 11/24/2006 by David Sirota @ 10:24 am Permalink

http://davidsirota.com/index.php/2006/11/24/the-money-party-vs-the-people-party/

Drug Industry Is on Defensive as Power Shifts

November 24, 2006

By ROBERT PEAR


WASHINGTON, Nov. 23 — Alarmed at the prospect of Democratic control of Congress, top executives from two dozen drug companies met here last week to assess what appears to them to be a harsh new political climate, and to draft a battle plan.

Hoping to prevent Congress from letting the government negotiate lower drug prices for millions of older Americans on Medicare, the pharmaceutical companies have been recruiting Democratic lobbyists, lining up allies in the Bush administration and Congress, and renewing ties with organizations of patients who depend on brand-name drugs.

Many drug company lobbyists concede that the House is likely to pass a bill intended to drive down drug prices, but they are determined to block such legislation in the Senate. If that strategy fails, they are counting on President Bush to veto any bill that passes. With 49 Republicans in the Senate next year, the industry is confident that it can round up the 34 votes normally needed to uphold a veto.

While that showdown is a long way off, the drug companies are not wasting time. They began developing strategy last week at a meeting of the board of the Pharmaceutical Research and Manufacturers of America.

Billy Tauzin, president of that group, a lobbying organization for brand-name drug companies, recently urged Representative Edolphus Towns, Democrat of New York, to seek a position as chairman of a powerful House subcommittee, said Karen Johnson, a spokeswoman for Mr. Towns. The subcommittee has authority over Medicare and the Food and Drug Administration.

Democrats have yet to decide who will head the subcommittee.

Mr. Tauzin, a former congressman, also met with Senator Byron L. Dorgan, a North Dakota Democrat who has been trying for six years to allow drug imports from Canada. The industry vehemently opposes such legislation.

James C. Greenwood, president of the Biotechnology Industry Organization, another trade group, said, “There is a lot of pent-up animosity among Democrats against the pharmaceutical industry.”

Mr. Greenwood, a former Republican congressman from Pennsylvania, said he had a list of 37 Congressional Democrats whom he intended to call in the next month.

Amgen, the biotechnology company, recently disclosed that it had retained as a lobbyist George C. Crawford, a former chief of staff for Representative Nancy Pelosi of California. Ms. Pelosi, the House Democratic leader, is in line to become speaker in January and has said that the House will immediately take up legislation authorizing Medicare to negotiate prices with drug manufacturers.

The 2003 Medicare law prohibits the federal government from negotiating drug prices or establishing a list of preferred drugs.

Amgen is also seeking strategic advice from the Glover Park Group, a consulting firm whose founders include Joe Lockhart, a former press secretary for President Bill Clinton.

Other major drug companies have been snatching up Democratic former-aides-turned-lobbyists. Merck recently has hired Peter Rubin, a former aide to Representative Jim McDermott of Washington, one of the more liberal House Democrats. Cephalon has hired Kim Zimmerman, a health policy aide to Senator Ben Nelson, a conservative Democrat of Nebraska.

The Biotechnology Industry Organization has retained Paul T. Kim, a former aide to two influential Democrats, Senator Edward M. Kennedy of Massachusetts and Representative Henry A. Waxman of California.

A Medicare expert who works for House Democrats said he recently received three job offers in one day from the drug industry, by telephone and in person.

At a dinner last week at the Hotel Monaco here, as part of their board meeting, pharmaceutical executives dissected the midterm election results with experts including Ed Goeas, a Republican pollster, and Stuart Rothenberg, the editor of a political newsletter.

Drug makers have not set a budget for their campaign. They and their trade groups already spend some $100 million a year on lobbying in Washington.

“We have new political realities to attend to,” Mr. Tauzin said in an interview after the board meeting. “We and our allies will do everything we can to defend the Medicare drug benefit, to get out the message that it is working.”

To reinforce that message, drug companies plan to mobilize beneficiaries and urge them to contact Congress.

“I’m putting my trust in beneficiaries,” said Mr. Tauzin, who represented Louisiana in the House for more than two decades, first as a Democrat and then as a Republican. Several recent surveys suggest that at least three-fourths of the people with Medicare drug coverage are satisfied.

But Representative Frank Pallone Jr., Democrat of New Jersey, who hopes to head the health subcommittee of the Energy and Commerce Committee, said price negotiations for Medicare were his priority.

“The 2003 Medicare law was essentially written by the drug industry,” Mr. Pallone said in an interview. “That’s why you don’t have negotiated prices. Republican policies have served special interests like the pharmaceutical industry, and the American taxpayer is paying the price.”

Drug lobbyists believe that the Senate will be receptive to their argument that price negotiations lead inevitably to price controls, and to restrictions on access to drugs, likely to be unpopular with beneficiaries.

Michael O. Leavitt, the secretary of health and human services, said the White House opposed federal price negotiations because they would unravel the whole structure of the Medicare drug benefit, which relies on competing private plans.

Among leaders who attended the board meeting last week were Kevin Sharer, chairman of Amgen; Jeffrey B. Kindler, chief executive of Pfizer; Sidney Taurel, chairman of Eli Lilly; and Richard T. Clark, chief executive of Merck.

Drug lobbyists say they want to work with the new Democratic majority, but that will not be easy. In its campaign contributions, the pharmaceutical industry has overwhelmingly favored Republicans over Democrats. Drug companies infuriated many Democrats in 2003, when they worked closely with Republicans to create the Medicare drug benefit, in a process from which Democrats were largely excluded.

On other issues, Democrats are pushing for stricter regulation of drug safety and for legislation to encourage development of low-cost generic versions of expensive biotechnology drugs. They are determined to allow imports of drugs from Canada, where brand-name products are often cheaper.

They want to investigate drug pricing and profits, drug advertising aimed at consumers and the marketing of drugs to doctors for purposes not approved by the Food and Drug Administration. Democrats may try to repeal some of the liability protections that have been given to vaccine manufacturers.

Outspoken critics of the pharmaceutical industry will gain power as a result of Senate committee assignments made last week. Senators Debbie Stabenow, Democrat of Michigan, and Maria Cantwell, Democrat of Washington, are joining the Finance Committee, which has sweeping authority over Medicare and Medicaid. Three liberal senators — Sherrod Brown of Ohio, Barack Obama of Illinois and Bernard Sanders of Vermont — are joining the Committee on Health, Education, Labor and Pensions, which oversees drug regulation and biomedical research.

The pharmaceutical industry lost one of its most effective defenders when Senator Rick Santorum, Republican of Pennsylvania, was not re-elected. The new Senate Republican whip, Trent Lott of Mississippi, is no friend of the brand- name drug industry. He supports bills to allow imports from Canada and to increase access to generic drugs.

Top pharmaceutical executives are hurriedly planning a response to the Democratic agenda.

“It’s all hands on deck,” said Ken Johnson, a senior vice president at Pharmaceutical Research and Manufacturers of America. “It’s like a hurricane warning flag. You don’t know where it will hit. You don’t know who will be affected. But everybody has to be prepared.”

Drug companies may be open to some changes in the Medicare drug benefit, but they say they cannot accept any form of price negotiation.

“The new Medicare program is clearly benefiting seniors and people with disabilities and has exceeded initial expectations,” Mr. Tauzin said. “But we are open to new ideas that could make it even better. We will propose at the same time we are opposing.”

Specifically, Mr. Tauzin said, drug companies would like permission to fill a gap in coverage that has angered many Medicare beneficiaries.

Many drug companies have programs to provide free drugs to people with limited incomes. When such programs are used to fill the gap in the Medicare drug benefit, they may run afoul of federal law — the anti-kickback statute — because they steer patients to products made by one particular company.

The drug industry is anxiously waiting to see details of the Democratic proposal. Lawmakers are weighing several options. At a minimum, Congress could simply repeal the ban on price negotiations, without requiring Medicare officials to do anything. Many House Democrats want to go further. They would direct Medicare officials to negotiate prices for a government-run prescription drug plan, which would compete with dozens of existing private plans.

The government could negotiate prices for all drugs or just for brand-name drugs that have no competition. Alternatively, Congress could require manufacturers to provide a specified discount, so Medicare would get the “best price” available to any private buyer.

Such details, defining the federal role, are immensely important and could determine the outcome of any votes in Congress.

http://www.nytimes.com/2006/11/24/washington/24drug.html

Thursday, November 16, 2006

They have no shame


by nyceve
nyceve@aol.com
Nov 16, 2006


And I mean all of them--certainly almost all of them. I'm speaking of the political class.
And the exceptions are well known to us. They know who they are. Thank you, John Conyers--and a few others.

Maybe the greatest gift the new Democratic majority can bestow on the American people is a collective sense of shame, how we as a nation have failed so many, so miserably in so many ways.

The same Democrats who refused to call a pig a pig. That is, refused to call Mr. Bush what he is--a liar. They sidled, and slipped and contorted themselves and the best they could come up with for six long bleak years was that he misled the American people.
No Democrats, he lied.

Now it's time to use some equally harsh language--like the word shame when it comes to addressing the myriad national tragedies that afflict this once proud nation.

In order to fix the problems, you need to feel deep and profound shame. We have no time for more niceties and euphemisims. Nothing less then the stark and bitter truth will suffice.
So you all can fight amongst yourselves about Murtha or Hoyer, but you know something, most Americans look at you and don't know whether to laugh or cry. Because they are so fucking desperate for someone to emerge as a leader and look into the television camera and start talking from the heart and from the gut.

Who among you will start to show some shame for the tragedies swirling around us?
Last night I had to write a diary about Lee Kinchen a woman in Louisiana who is unable to obtain desperately needed surgery. Why? Because she is an uninsured American citizen.
Why did I have to write this, because you refuse to stand up for the American people. Because you feel no shame.

You can read it here:

Some Americans, like this lady, can't wait for the Dems to act
http://www.dailykos.com/...

I feel overwhelming shame that I had to write this diary. Do you politicians reading this feel the same shame as I feel? If you don't, go away, leave, you are not fit for anything much less public office.

Do you feel shame that bloggers are carrying your water and doing your work, because we feel the shame that somehow eludes you?

Read this diary, do you feel shame?

[updated] Save a Life: Please help Lee Kinchen
http://www.dailykos.com/...

Then this morning I woke up and found in my email a likely reason why Ms. Kinchen cannot obtain Medicaid.

I suppose because her care is costly and Medicaid is being privatized to for-profit HMO's. It's profits before people.

"[M]any states are moving aggressively" to place more Medicaid beneficiaries in HMOs, and more than one in three beneficiaries now receives care through a private insurer, the Wall Street Journal reports. As a result, some companies that contract with Medicaid are growing rapidly. For example, Centene reported nearly 1.2 million members from Medicaid and $1.5 billion in revenue in 2005, up from 142,000 members and $200 million in revenue in 1999. States that contract with HMOs to manage Medicaid "often calculate what they would spend on Medicaid patients directly and pay the HMOs a per-patient premium below that amount," giving HMOs an incentive "to keep their costs under the premium because they keep the difference as profit," the Journal reports. Medicaid costs nationwide are not growing as quickly as they were several years ago, according to a recent report by the Kaiser Commission on Medicaid and the Uninsured, although it is "unclear how much HMOs have contributed" to the trend, the Journal reports. Some doctors and patients say the insurers offer inadequate services. According to the Journal, Medicaid HMOs "restrict medical tests and use of prescription drugs" and also "spend the money they get from states on items that don't have an obvious connection to patients," such as executive compensation, entertainment, political contributions and profit for shareholders. Jerry Flanagan, health care policy director for the Foundation for Taxpayer and Consumer Rights, said, "What's really happening is we're giving less money for far, far fewer services." However, executives maintain that "their profits are justly earned and don't come at patients' expense," the Journal reports. Ruben Jose King-Shaw, a former CMS official who joined WellCare's board in 2003, said HMOs "deliver a good-quality product at a reasonable price." King-Shaw said states often require HMOs to achieve quality standards such as high rates of vaccination that were not met by traditional Medicaid (Martinez, Wall Street Journal, 11/15).
http://www.kaisernetwork.org/...

I feel such deep shame reading this.

Political class, does this make you feel shame? It makes me feel intense shame.

http://www.dailykos.com/story/2006/11/16/95618/911

Related:

Kaiser faces charges in patient 'dumping' case