Friday Mashup (8/2/13)

August 2, 2013
  • The theme today is “Right-Wing Idiocy on Health Care Reform”- as noted here from The Daily Tucker…

    Republicans on Capitol Hill say the Obama administration is trying to regulate or prevent small companies from providing self-funded insurance for their employees because self-funded insurance plans could be the “Achilles heel” for Obamacare implementation.

    The majority of U.S. employers now offer self-funded insurance plans, in which companies finance employee health plans from their own funds. Many of the companies purchase stop-loss insurance plans from insurance providers. These companies would therefore avoid many Obamacare regulations when the law takes full effect in 2014. The practice of self-funded insurance, which was outright banned in early drafts of Obamacare, represents the “Achilles heel” for Obamacare implementation, according to insiders.

    What a laughable attempt at attribution – and those same “insiders” tell us the following…

    Phyllis Borzi, the Obama administration’s assistant secretary for employee benefits security in the Department of Labor, is a well-known opponent of stop-loss insurance and is suspected of making behind-the-scenes moves to prevent small companies from providing it…

    I would say that that’s a pretty defamatory accusation and could be a real problem if it were actually true; I’d be inclined to believe, though, that Patrick Howley of The Daily Tucker doesn’t know what the hell he’s talking about (“according to insiders,” naturally).

    If the Obama Administration hates “stop/loss” insurance so much, then how come the following is true (from an article by Matthew Buettgens and Linda J. Blumberg of The Urban Institute dated November 2012 – sorry, but I’m unable to link to a URL or a .pdf)…

    The Affordable Care Act changes the small-group insurance market substantially beginning in 2014, but most changes do not apply to self-insured plans. This exemption provides an opening for small employers with healthier workers to avoid broader sharing of health care risk, isolating higher-cost groups in the fully insured market. Private stop-loss or reinsurance plans can mediate the risk of self-insurance for small employers, facilitating the decision to self-insure. We simulate small-employer coverage decisions under the law and find that low-risk stop-loss policies lead to higher premiums in the fully insured small-group market. Average single premiums would be up to 25 percent higher, if stop-loss insurance with no additional risk to employers than fully insuring is allowed—an option available in most states absent further government action. Regulation of stop-loss at the federal or state level can, however, prevent such adverse selection and increase stability in small-group insurance coverage.

    So it looks like “stop/loss” in insurance could be further regulated, but Number 44 isn’t trying to go that route.

    Oh, and by the way, I checked the CAP article by John Podesta mentioned by Howley, and I learned the following (here)…

    There are two types of stop-loss insurance: specific, or individual, stop-loss insurance, which protects an employer from a single, unusually high claim from any one employee; and aggregate stop-loss insurance, which limits the total amount the employer must pay each year for all employee health-care claims. In both types, the point at which stop-loss coverage begins is called the “attachment point.” Lower attachment points minimize the employer’s financial risk, and if they are particularly low, they blur the line between self-insured plans and self-funded plans entirely. A self-insured plan with a specific attachment point of $5,000, for example, functions in the same way as a plan with a $5,000 deductible.

    Insurers may also structure stop-loss policies to protect employers from unpredictably high claims that might cause cash-flow issues. Stop-loss policies that limit liability exposure in a single month, for example, or provide immediate reimbursement for claims above the attachment point eliminate this risk.

    Little data exist, however, about the use of stop-loss policies. One survey found that nearly 60 percent of all self-insured firms also have stop-loss insurance. Even less data are available on the type of stop-loss policies and the level of attachment points purchased by self-insured employers. Although survey data suggest that the average individual attachment point for businesses with 5,000 employees or more is about $340,000, similar data for smaller firms are unreliable due to a much smaller sample size.

    The Affordable Care Act requires a study on self-insurance policies used by employers in the large-group market. The U.S. Department of Health and Human Services, Department of Labor, and Department of the Treasury also issued a joint request for information about the use of stop-loss insurance in 2012, asking specifically about stop-loss policies with low attachment points. This data collection and analysis is ongoing.

    So, though it could potentially represent an “Achilles Heel” of sorts to HCR if “stop-loss” policies started popping up all over the place, I would consider that to be highly unlikely, if for no other reason than the fact that large companies would have to start shelling out more and more money to cover their employees just to get out of coverage requirements of the Affordable Care Act.

    And as far as small businesses are concerned – well, if all the employees are comparatively young and fit with minimal health care needs aside from preventive care, you’re may be fine with a stop-loss plan. However (again, from CAP)…

    …once the group’s health status declines, self-funding becomes far more risky and expensive. Stop-loss plans, for example, can raise premiums or refuse to renew coverage once a group becomes less healthy or more expensive to cover. In this case small employers could either drop coverage or return to the fully insured small-group market, adding its less healthy employees to that risk pool.

    And I think the following should also be noted from here (the .pdf should open the viewer, but it’s fussy)…

    Self-insured employers have an increasing cost to control: that of high-dollar medical claims. Just how much healthcare reform will impact those claims is still up to debate. According to an Aon report1, healthcare reform so far has had a .08% to 1.5% impact, depending on the size of the group. That percentage can continue to increase as more provisions go into effect.

    So basically, nobody really has any idea how much self-insured plans will be affected by the Affordable Care Act.

    But then again, to expect anything close to serious journalism from Patrick Howley based on this (in which Howley tried to egg on antiwar protestors at the Smithsonian Institution to make them look bad, something typical of James O’Keefe) is a delusional notion anyway.

  • Next, Scott Gottlieb recently opined as follows at the Murdoch Street Journal (here, on the subject of the expansion of the 340B program as part of health care reform – he explains, somewhat)…

    Under 340B, eligible hospitals are allowed to buy drugs from drug companies at forced discounts of 25% to 50%. The hospitals can then bill government and private insurers for the full cost of the drugs, pocketing the spread. The arrangement gives 340B-qualified hospitals a big incentive to search for patients and prescribe lots of drugs. The costlier the drugs, the bigger the spread. So expensive cancer drugs are especially appealing.

    The original legislation creating 340B envisioned that only about 90 hospitals that care for a “disproportionate share” of indigent patients would qualify. But remember, this is a well-intentioned government program handing out money, with the usual result: By 2011, 1,675 hospitals, or a third of all hospitals in the country, were 340B-qualified.

    Call me a filthy, unkempt liberal blogger, but could the expansion actually be due to the fact that more and more hospitals are seeing more and more indigent cases?

    To quote Steve Martin, “Naaaaahhhhh!”

    Of course this has to be another Obama “scandal” where insurers and drug companies are seeing a financial hit, with more and more hospitals “pocketing the spread.” How silly of me not to realize it! All Hail Rush, Sean Hannity and Falafel Bill! And by the way, BENGHAZI!!!

    OK, I’ll stop (and I love the demagoguery about “a well-intentioned government program handing out money,” of course).

    Gottlieb also laments the likelihood that more patients will be treated at hospitals or outpatient facilities than doctor’s offices. Well, suppose we’re talking about a population with easier access to the former than the latter? Or are they invisible as far as the Journal is concerned?

    And this excerpt was a bit of a head-scratcher also…

    Even flourishing hospitals like the Hospital of the University of Pennsylvania and Duke University Health System feed off the subsidies. In 2011, Duke bought $54.8 million in drugs from the discount program and sold them to patients for $131.8 million, for a profit of $76.9 million—a substantial portion of the health system’s 2011 operating profit of $190 million. Only one in 20 patients served by Duke’s 340B pharmacy is uninsured. The rest have their prescription costs covered by Medicare, Medicaid or commercial insurers.

    Now ObamaCare is encouraging even wider 340B abuses.

    Sooo…as far as Gottlieb is concerned, it’s “abuse” for a population of probably poor and elderly individuals to qualify for the 340B drug discount if they already are covered under Medicare or Medicaid? Has Gottlieb tried to price drugs lately for people living on fixed incomes?

    And I’m sorry, but as far as I’m concerned, the “operating profit” of a medical institution is secondary to me versus how effective they are at providing patient care.

    Also…

    The regulatory loosening has led to a proliferation of abuse. The Health Resources and Services Administration, the federal agency that (nominally) oversees the program, recently audited 340B-eligible hospitals. The agency found “adverse findings” (like discounted drugs diverted or dispensed to ineligible patients) with almost half of the 34 institutions the agency examined.

    Didn’t Gottlieb say earlier that, as of 2011, 1,675 hospitals were covered under 340B? So, out of that total, the HSA reported on 34 institutions (and let’s say that “almost half” of 34 is 16, of the total institutions that were examined; those were the ones with “adverse findings”).

    So what percentage of 1,675 is 34? Well, that would be 0.020 percent (maybe not much of a sample, but then again, not much of a reason to carry on about alleged wrongdoing either).

    But of course Gottlieb is no stranger to propagandizing on this issue (this link takes us to a post where he claimed that the individual market for health care would be eliminated outside of the health care exchanges – if I were Politifact, I would rate that as a “pants on fire” claim).


  • Finally, I’ve been meaning to follow up on this item concerning our wet noodle U.S. House rep, so I guess I’d better get to it…

    I expected (The American College of Physicians) Leadership Day to be inspiring, empowering, and a way for me to share my thoughts on health reform with our lawmakers. However, the meeting with my Congressman this past June exceeded all of my expectations. Not only was I able to advocate for patients and physicians, but I also discovered an incredible opportunity in my hometown of Bensalem, Pennsylvania.

    As a constituent of the 8th district of Pennsylvania, I am represented by Congressman Michael Fitzpatrick. On Leadership Day, other members of the Pennsylvania delegation and I were able to speak to the Congressman directly about key ACP issues. Currently, I am a fourth-year medical student at Philadelphia College of Osteopathic Medicine and am planning to pursue a career in primary care. I told Congressman Fitzpatrick about my passion for public health, community health, and working in underserved communities, and how important it was to expand federal health programs and GME funding for primary care programs. The Congressman was thoughtful and listened—and then asked if I knew about the BCHIP clinic. BCHIP, or the Bucks County Health Improvement Partnership, is the largest free clinic serving uninsured, low-income adults in Bucks County, PA. Founded in 1993 and located in Bensalem, PA, it is locally driven and provides care to over 2,000 adults every year. I was immediately interested in learning more. And then, Congressman Fitzpatrick suggested that we visit the clinic together so I could get a closer look at community health in my own community.

    The article is generally complimentary towards Fitzpatrick, and that’s fine. Any means of providing care to people who otherwise wouldn’t get it is a worthy goal.

    However, here is my concern – suppose you run into complications?

    Because, as a friend of mine pointed out, if you have, say, cancer, you may get a referral to a specialist at a clinic, but that may not necessarily lead to care (suppose the referral doesn’t take your insurance? Suppose you don’t have insurance?). Suppose further that the clinic cannot perform a colonoscopy? And suppose even further that the clinic cannot provide OB/GYN care for women, including pre-natal care and/or pap screens?

    Nope…as good as the free clinic is, it often isn’t a “one-stop shop” for health care, nor can it be that in all cases. In the event of the circumstances I noted above, Planned Parenthood (which Mikey and his pals want to defund) would be needed, as well as the legally mandated provisions of the Affordable Care Act (same thing).

    And with all this in mind, I give you the following from here (based on this story)…

    Congressman Fitzpatrick has established his opposition to the Affordable Care Act (ACA) aka Obamacare and he has spoken consistently against “government control” of health care. In his letter printed June 17 he bemoaned the “army of bureaucrats implementing regulations” under (HHS) Secretary (Kathleen) Sebelius for not being bound by the Hippocratic Oath. He said if they were, “regulations would not exist denying a 10-year-old child a life saving operation.” Fact is, the role of the Department of Health and Human Services is to protect the citizens from harm, all 350 million of us.

    Secretary Sebelius, a politically appointed bureaucrat, was asked by Sen. Pat Toomey, a politician, not a doctor, to alter the transplant rules in a singular independent act. It would defy years of scientific and medical findings and regulations created by medical experts, scientists, doctors, surgeons, and ethicists.

    Fitzpatrick denied that asking Sebelius to alter the regulations was asking for interference when, in my view, that is exactly what it was. He is attempting to connect those “regulations” to Sebelius and eventually the ACA. In a June 17th letter to the newspaper, he condemned a federal bureaucrat for not making a medical decision while saying a federal agency should not be evaluating patients, which is contradictory. At a town hall meeting, he seemed to reserve the right to tell millions of people that if they need a doctor go find a free clinic or charity, when he told a questioner without insurance to do just that.

    Those regulations are not hers to alter; they are hers to administer. There is a deliberate and complicated process in procuring organs and selecting candidates that seeks to ensure fairness. Sadly, because of a finite supply of organs when a patient gets a transplant another will die waiting and that includes mothers and fathers of 10 year old children.

    Fitzpatrick knows the facts, but used the 10 year old child to attack the ACA by saying Sebelius’ action “is an indication of government takeover of healthcare and the ACA exacerbates the situation”. There it is, his real agenda, the continued attack on the ACA.

    It’s nice that Mikey has advocated on behalf of free clinics so those who might not otherwise obtain any care at all would receive it. But his continued intransigence and opposition to the Affordable Care Act is beyond a joke at this point. And using the life-endangering circumstances of a 10-year-old girl in furtherance of this unholy goal is a new low, even for him.


    Friday Mashup (5/24/13)

    May 24, 2013
  • I get it that this Andrew Marcus character is trying to hawk his “documentary” called “Hating Breitbart” on the site of The Daily Tucker, and he’s pretty much trying to do whatever he can to get people to pay attention to him, but even by wingnut standards (low as they are), I would say that trying to draw some sort of equivalence between John Podesta of the Center for American Progress and H.R. Haldeman, former chief of staff to President Richard Nixon, is pretty lame (here)…

    In “Hating Breitbart,” John Podesta emerges as someone who perfectly embodies the left’s penchant for creating an environment of corruption, abuse and personal attacks. As the co-chairman of Obama’s 2008-2009 transition team, Podesta obviously enjoys a very close relationship to this White House. Today he runs the Center for American Progress, a far-left think tank, and exerts a great deal of influence in media circles. The political culture he has helped create is exactly what Andrew Breitbart so passionately resisted and despised.

    Let me be clear: I have no evidence that Podesta has been personally involved in any of the scandals that are currently rocking the Obama presidency. But what I do know about Podesta is that his Center for American Progress has been instrumental in dehumanizing Obama’s political opponents. In doing so, he has created fertile ground for these scandals to take root.

    As far as “scandals” that are “rocking” the Obama presidency (and, as usual, there’s no actual evidence of wrongdoing on Podesta’s part, just more guilt by association), this tells us that the stuff on the IRS and the Teahadists, the AP and Eric Holder and BENGHAZI!! are pretty much being met with a collective yawn (to the point where even Republican staffers are wondering if the elected officials they support have lost what little is left of their minds here).

    And this is just REALLY way too damn funny from Marcus (page 3)…

    Ultimately, it’s people like H.R. Haldeman and John Podesta who build the nests and turn the eggs — though Richard Nixon’s crimes pale in comparison to what has been recently alleged of the Obama administration. Congress was never able to establish any broad-based abuse of the IRS against Nixon’s “enemies list,” but even Nixon’s comparatively modest abuses merited an article of impeachment. Obama’s IRS has already admitted to misconduct. Who knows what other scandalous evidence may ultimately emerge?

    Let me know if and when John Podesta is convicted of perjury, conspiracy and obstruction of justice and sentenced to 18 months in the federal pen, OK, as noted here (although this is cause for a bit of concern about CAP, though when it comes to undisclosed foreign donations to the “U.S.” Chamber of Commerce, it’s a speck by comparison – here).

    And as far as the “Obama vs. Nixon” stuff goes, here is my answer.

  • Next, it looks like former Repug Senator and potential Obama Commerce Secretary Judd Gregg has decided to cash in, as noted here

    Former Sen. Judd Gregg (R-N.H.) has been named CEO of the Securities Industry and Financial Markets Association (SIFMA), a powerhouse trade group for Wall Street.

    The top job at SIFMA was one of the hottest openings on K Street, and it comes with a hefty payday. The group’s last leader, Tim Ryan, earned $2.9 million in compensation in 2010, according to the group’s tax form for that year.

    Gregg said he plans to use his new platform to champion the message that Wall Street is good for the economy.

    “I suspect what I’m going to be doing is what we have talked about, which is reorient ourselves on the issue of how you communicate the importance of this industry to people on Main Street America and their jobs,” Gregg told reporters on a conference call.

    SIFMA, which represents financial giants such as Bank of America and Morgan Stanley, lobbies extensively on Capitol Hill and at regulatory agencies, and has been particularly active on the implementation of the Dodd-Frank financial reform law.

    (“Particularly active” being Beltway media-code-speak for trying to gut Dodd-Frank every way possible, as noted here, which is what I think this is really all about anyway.)

    And as noted here, “Skank” of America was one of the banks that made yet another fortune off fees charged to the city of Detroit while that once-great metropolis restructured its debt (and as noted here, the financial rogue colossus recently asked a judge to throw out a lawsuit over the mortgages Countrywide wrote for Fannie Mae and Freddie Mac…totally on their own and without any prompting from anyone, BOA took over Countrywide in 2008).

    And as far as Morgan Stanley is concerned, this tells us about the toxic CDOs (Collateralized Debt Obligations) they peddled, which basically were collections of mortgage-backed securities that the investment banking geniuses at M-S knew would blow up, so they sold them to the Chinese…what a cunning plan; antagonize the country holding the single largest volume of our debt among all others. Brilliant!

    And these are the people Gregg will be shilling for in his cushy new gig.

    “Them that’s got shall get, them that’s not shall lose…”

  • Continuing, I’d at first planned to stay away from commenting on the tornado disaster in Moore, Oklahoma earlier this week (and if you are able to assist in any way, please click here), but I really felt like I had to say something in response to this from Seth Borenstein of the AP (here…kind of laughable to me that he’s the “science” writer after reading this)…

    WASHINGTON (AP) — Everything had to come together just perfectly to create the killer tornado in Moore, Okla.: wind speed, moisture in the air, temperature and timing. And when they did, the awesome energy released over that city dwarfed the power of the atomic bomb that leveled Hiroshima.

    I don’t have any information to contest that claim, but I think, based on this, that any comparison between the Moore tornado and the Hiroshima atomic bomb explosion is ridiculous. And that is because, as deadly as the Moore tornado was, it was only the wind at work, not the combination of wind, blast-furnace heat and radiation that was inflicted on Hiroshima (and I’ve heard many scholarly arguments against dropping the bomb, including that of Oliver Stone in his “Untold History of the United States” here, but sorry – I still believe it was the right thing to do; Stone, for example, argued that the Soviet Union would have assisted the U.S. in an invasion of mainland Japan, but I don’t think his evidence on that is totally credible).

    And get a load of this bit of wankery (returning to Borenstein)…

    Scientists know the key ingredients that go into a devastating tornado. But they are struggling to figure out why they develop in some big storms and not others. They also are still trying to determine what effects, if any, global warming has on tornadoes.

    Really? I guess, as far as Borenstein and his denialist pals are concerned, 97 percent of a consensus on the subject just isn’t good enough, as noted here (h/t Wonkette…think “more extreme weather patterns,” and maybe this too).

  • Further, I thought I should let you know what at least one of Willard Mitt Romney’s confidants is up to now that we haven’t sworn The Mittster in as our 45th president (thank God), along with Mr.-Puppy-Dog-Eyes-With-The-Shiv as his veep – I’m referring to Glenn “Give It Your Best Shot” Hubbard here

    The United States itself has a larger GDP and higher productivity than 10 years ago, but its long-term growth rate has slowed by half. That’s a reflection of internal imbalance – budget deficits, heavy taxes that hinder incentives to work and innovate, unfunded entitlements and more.

    Actually, there’s no freaking demand, you soulless parasite, as noted here (unless he considers that to be part of the “and more,” and the sequester is doing absolutely nothing to help of course, as noted here…and isn’t this encouraging also – not!).

  • Finally, I’d like to point out the utterly obvious fact that Memorial Day weekend is basically upon us, and it is quite appropriate for us to ponder the sacrifices made by the men and women in our military who have given much (and, in many cases, given all), and say a prayer of two in gratitude, wish good thoughts for them, visit cemeteries to pay our respects, and engage in all manner of solemn events for the occasion to express our gratitude (or assist the VA and/or veterans groups as our means allows).

    The heroism we appreciate on this occasion takes place in the name of maintaining our freedom, a thought that occurred to me as I read an otherwise generic (in its wingnuttery, I mean) opinion column from Repug Louisiana Governor Bobby “Don’t Call Me Piyush” Jindal here (and I apologize in advance for conflating notions of honor and courage here with rank political claptrap)…

    Look at liberalism across every issue, from healthcare to energy to spending, and one thing is crystal clear: Liberals don’t believe in the dynamic and transformative power of freedom. Bigger government and more power in the hands of a few means the interests of the public will be violated.

    With this idiocy in mind, I’d like to offer the following in response from Mike Malloy (here)…

    Why do conservatives hate freedom? The question may be startling. After all, don’t conservatives claim they are protecting liberty in America against liberal statism, which they compare to communism or fascism? But the conservative idea of “freedom” is a very peculiar one, which excludes virtually every kind of liberty that ordinary Americans take for granted.

    In the cases of freedom from racial discrimination and freedom from sexual repression, American conservatives have been solidly on the side of government repression of the powerless and unprivileged. The same is true with respect to workers’ rights, debtors’ rights and criminal rights.

    To listen to their Jacksonian rhetoric, American conservatives are the champions of the little guy against the “elites.” But not, it appears, in the workplace or the bank. The American right is opposed to anything — minimum wage laws, unions, workplace regulations — that would increase the bargaining power of workers relative to their bosses.

    What would America look like, if conservatives had won their battles against American liberty in the last half-century? Formal racial segregation might still exist at the state and local level in the South. In some states, it would be illegal to obtain abortions or even for married couples to use contraception. In much of the United States, gays and lesbians would still be treated as criminals. Government would dictate to Americans with whom and how they can have sex. Unions would have been completely annihilated in the public as well as the private sector. Wages and hours laws would be abolished, so that employers could pay third-world wages to Americans working seven days a week, 12 hours a day, as many did before the New Deal. There would be far more executions and far fewer procedural safeguards to ensure that the lives of innocent Americans are not ended mistakenly by the state.

    That is the America that the American right for the last few generations has fought for. Freedom has nothing to do with it.

    4991033-american-flag
    And with that in mind, please allow me to extend best wishes to one and all for a happy and healthy Memorial Day weekend.


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