Medicaid funds allegedly misused: U of L doctors used $4.8 million in Medicaid money for bonuses, Shaughnessy says | The Courier-Journal | courier-journal.com

Medicaid funds allegedly misused: U of L doctors used $4.8 million in Medicaid money for bonuses, Shaughnessy says | The Courier-Journal | courier-journal.com:

Doctors at the University of Louisville medical school used about $4.8 million in state Medicaid funds to pay themselves “financial bonuses” — money that was supposed to be used for indigent care, state Sen. Tim Shaughnessy says.

And they used another $5.2 million for an electronic records system that would make U of L doctors eligible for additional bonuses from the federal government, according to new details of a controversial transaction that Shaughnessy said he recently obtained from Attorney General Jack Conway’s office.

A spokeswoman for Conway said Wednesday that the office determined only that the $4.8 million was compensation for U of L doctors. But Shaughnessy insisted that Conway’s staff described the money as “bonuses” at a recent meeting.

“I was shocked,’’ said Shaughnessy, a Louisville Democrat who was the first to publicly question a transfer of about $30 million in surplus health funds in 2008 and 2009 from Passport Health Plan to U of L, University Physicians Associates, or UPA, and others represented on Passport’s board.
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Under a settlement Conway announced in July, UPA will repay the state $9 million over five years. Other groups that received funds from Passport’s $30 million transfer agreed to repay the funds according to various schedules. They include U of L, University Medical Center and local hospitals that provided capital to start Passport.

But Shaughnessy said the repayment doesn’t address his basic concern — that U of L’s board wasn’t involved in major financial transactions involving groups with which it is affiliated, including Passport, UPA and the U of L medical center.

“There was no involvement of the U of L Board of Trustees,” Shaughnessy said. “How did these millions of dollars get allocated without any involvement of the board?”

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Heads Of Largest Children's Hospitals Receive Big Salaries And Rich Benefits - Kaiser Health News

Heads Of Largest Children's Hospitals Receive Big Salaries And Rich Benefits - Kaiser Health News:

The pay packages have continued to climb even as the economy has languished and millions of Americans struggle to pay their health care bills. For some, the generous compensation raises questions about the mission of children’s hospitals, which operate as tax-exempt charities.

"Hospital CEOs, including those at children's hospitals, are among the most lavishly compensated executives in the nonprofit field," said Daniel Borochoff, president of the American Institute of Philanthropy, a charity watchdog group based in Chicago.

"These seven-figure CEO pay packages make it hard for nonprofit hospitals to justify their tax-exempt status," he added. "If hospital CEO compensation were more in line with other large nonprofits then there could be more funding for community benefits such as free or discounted health care or important medical research."

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The Social Contract - NYTimes.com

The Social Contract - NYTimes.com:

According to new estimates by the nonpartisan Tax Policy Center, one-fourth of those with incomes of more than $1 million a year pay income and payroll tax of 12.6 percent of their income or less, putting their tax burden below that of many in the middle class.

Now, I know how the right will respond to these facts: with misleading statistics and dubious moral claims.

Go read the whole thing!

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A glimpse at the high pay for children's hospital CEOs - Sacramento Living - Sacramento Food and Wine, Home, Health | Sacramento Bee

A glimpse at the high pay for children's hospital CEOs - Sacramento Living - Sacramento Food and Wine, Home, Health | Sacramento Bee:

"Hospital CEOS, including those at children's hospitals, are among the most lavishly compensated executives in the nonprofit field," said Daniel Borochoff, president of the American Institute of Philanthropy, a charity watchdog group based in Chicago. "If hospital CEO compensation were more in line with other large nonprofits then there could be more funding for community benefits such as free or discounted health care or important medical research."

In 2009, an advocacy group for nonprofit hospitals and other health care groups warned its members that the pay packages were coming under increasing scrutiny. "Boards would be wise to streamline their executive compensation programs to make them less tempting targets," a report prepared for the Alliance for Advancing Nonprofit Health Care stated.

The report pointed to cars, bonuses, generous retirement payouts and country club memberships as likely to attract criticism. "Many nonprofit organizations have been pressing their luck by imitating patterns in the for-profit sector," it noted.

That year, CEO compensation at the 25 largest independent children's hospitals ranged from a high of nearly $6 million to a low of $686,125, records show.

In all, CEOs collected more than $38 million, including deferred income and supplemental retirement awards, for an average of $1.5 million each.

If you are interested in looking up data for your own hospital or for any non-profit, go to Guidestar at http://www2.guidestar.org/Home.aspx and search for the organization. When you have found it, go to the Form 990 section (you will have to register - it's free). Then you will have to look for either page 7, which is where the data may be, or go to an appendix/attachment at the end. Happy hunting.
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How Do You Say ‘Economic Security’? - NYTimes.com

How Do You Say ‘Economic Security’? - NYTimes.com:


"In 1934, the government was us. We had shared circumstances, shared risks and shared obligations. Today the government is the other — not an institution for the achievement of our common goals, but an alien presence that stands between us and the realization of individual ambitions. Programs of social insurance have become “entitlements,” a word apparently meant to signify not a collectively provided and cherished basis for family-income security, but a sinister threat to our national well-being.


"Over the last 50 years we seem to have lost the words — and with them the ideas — to frame our situation appropriately. "


I firmly believe that one of our major problems today is that conservatives view our government, the one established in our Constitution by the people, for the people, to provide for the General Welfare, is "them," while liberals view it as "us," and thus we must take responsibility for making it better, rather than just tearing it down.


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It’s not ‘class warfare,’ it’s Christianity - - The Washington Post

It’s not ‘class warfare,’ it’s Christianity - - The Washington Post:

"Let me be clear as I can be. We need to understand the so-called “Christian” underpinnings of the anti-tax, anti-government, anti-the-poor, “let him die” approach to economics and public policy today as completely un-Christian, as well as un-American. What we need to do is re-establish our national values of fairness, equality and opportunity for all, values that I believe are actually the core of the Christian faith, (as well as of other religious traditions and of humanist values)."

A nice summary of how un-Christian the Americanus Christianus really is!

Many of the same points I mad a while back in my "Tea Partiers as Christians - Big Fail" post a while back.

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The human face of disability - and one of the doctors assessing it : The Pump Handle

The human face of disability - and one of the doctors assessing it : The Pump Handle:

"If you hold a job right now, here's something to think about: If you became disabled and were no longer able to work, how would you pay your bills? If your disability were due to an on-the-job injury or an occupational illness, you might be able to get workers' compensation benefits. But what if you were paralyzed after falling down a flight of stairs at home or suffering a stroke? If you're lucky, you'll have disability insurance, which some employers offer as a benefit. But for most people whose ability to work becomes compromised before they're able to retire, disability payments from Social Security become a crucial source of income. "

A sobering look at the Social Security Disability Income program. Our safety net is strung so that most of it lies on the ground.

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NJ Spotlight | Filling in the Details of NJ's Health Insurance Exchange

NJ Spotlight | Filling in the Details of NJ's Health Insurance Exchange:

"In Massachusetts, officials have tailored the requirements for participating insurance companies to ensure a certain high level of benefits; in Utah, the exchange is open to most of the companies that wish to do business in the state. The website for the Massachusetts exchange includes tools to help consumers select the best product, and the signup process takes less than ten minutes, researchers found. Utah’s exchange is more of an online portal, linking customers to existing insurance products, and the state has received a number of complaints about the complexity of the enrollment process.

"According to the Georgetown report, 'you get what you pay for.' Massachusetts’ exchange has a $30 million annual budget and 46 full-time workers, whereas Utah spends $600,000 and employs two staff members. With greater resources and outreach, Massachusetts has reached some 220,000 people, compared with 2,200 now in Utah’s program. According to 2009 data, after a few years with the exchanges in operation, Massachusetts had insured more than 95 percent of its residents and Utah had about 85 percent covered, when including those who obtain insurance through their jobs or the private market.

"The healthcare coalition in New Jersey did not focus on any single state in developing its list of principles, Snedden said, but worked with members to determine what was most critical here. The group also plans to launch a public campaign this summer to help individuals and business owners become more familiar with the concept of the exchange.

"'What we’re doing is getting the conversation started,' Snedden said. 'We want to make 'exchanges' a word that actually rings a bell.'"

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The Independent Payment Advisory Board — Congress’s “Good Deed” | Health Policy and Reform

The Independent Payment Advisory Board — Congress’s “Good Deed” | Health Policy and Reform:

"Among the most important attributes of legislative statesmanship is self-abnegation — the willingness of legislators to abstain from meddling in matters they are poorly equipped to manage. The law creating the Federal Reserve embodied that virtue. Congress recognized the abiding temptation to use monetary policy for political ends and realized that it would, at times, prove irresistible. To save themselves from themselves, wise legislators created an organization whose funding and operations were largely beyond the reach of normal legislative controls. Short of repealing the law, Congress denied itself the power to do more than kibbitz about monetary policy.

"In establishing the Independent Payment Advisory Board (IPAB) in section 3403 of the Affordable Care Act (ACA), Congress may once again have shown such statesmanship. For several reasons, however, it is too early to be sure. The board must surmount major challenges — first to survive and then to function effectively. Harold Pollack has neatly summarized the problem, the solution, and the problem with that solution: “Every Democratic and Republican policy expert knows that we must reduce congressional micromanagement of Medicare policy. Unfortunately, every Democratic and Republican legislator knows that mechanisms such as IPAB that might do so would thereby constrain their own individual prerogatives.”1

"Medicare’s founding legislation stated that “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine.”2 Duly warned, Medicare administrators have largely forborne from using coverage policy or financial incentives to discourage ineffective or needlessly costly methods of care. Members of the legislative branch have not, however, displayed similar restraint. They have pressured those same administrators on coverage policies and passed laws to impose them.

"In the view of many observers, both executive inactivity and legislative intrusiveness have been unfortunate — the former because the leverage that the country’s largest single buyer of health care could wield to effect reforms has gone largely unused, the latter because few members of Congress are well enough informed to make such decisions wisely, and some are in thrall to campaign contributors and producers and suppliers of medical services."

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Squandering Medicare’s Money - NYTimes.com

Squandering Medicare’s Money - NYTimes.com:

"MEDICARE has suddenly taken center stage in American politics, with Democrats now trying to score an advantage from the unpopularity of the Republican plan to overhaul the government health insurance program. Apart from the politics, though, Medicare’s financing challenges are worsening: this month, Medicare’s trustees projected that the insurance program would become insolvent by 2024, five years earlier than previously estimated.

"Much has been said about the growing gap between the program’s spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. Examples abound:"

Go to the original piece for the rest!

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What Is a 'Just' Physician's Income? - NYTimes.com

What Is a 'Just' Physician's Income? - NYTimes.com: "The payment of physician income has been the subject of a lively debate for centuries. In fact, one finds it addressed at length in the famous Code of Hammurabi, chiseled into stone tablets some 4,000 years ago by edict of the Babylonian King Hammurabi along, by the way, with a malpractice system that makes today’s look like a pussycat.

Adam Smith, who generally is regarded as the father of modern economics, mused at length on the compensation of physicians in his celebrated book “An Inquiry Into the Nature and Causes of the Wealth of Nations” (1776).

Chapter 10 of Book 1, titled “Wages and Profit in the different Employments of Labour and Stock,” is a gracefully written treatment of what we now call labor-market theory. It is well worth a read.

“Honour makes a great part of the reward of all honourable professions,” Smith wrote. “In point of pecuniary gain, all things considered, they are generally under-recompensed, as I shall endeavour to show by and by. … Disgrace has the contrary effect. The most detestable of all employments, that of public executioner, is, in proportion to the quantity of work done, better paid than any common trade whatever.” (Italics added.)

Today we teach students that seemingly mysterious differences in the pecuniary income of different occupations can be explained in part by what we call “compensating variations in the psychic income” associated with different occupations.

Remarkably, in his treatise on compensation, Smith then departed sharply from the traditional demand-and-supply framework he popularized and we economists usually employ to explore employment and wages. Instead, for physicians and lawyers he appeared to lean on the medieval doctrine of “just price.” Thus he wrote:

We trust our health to the physician: our fortune and sometimes our life and reputation to the lawyer and attorney. Such confidence could not safely be reposed in people of a very mean or low condition. Their reward must be such, therefore, as may give them that rank in the society which so important a trust requires. The long time and the great expense which must be laid out in their education, when combined with this circumstance, necessarily enhance still further the price of their labour.

Although I’m a card-carrying economist who normally is quite comfortable with our supply-demand framework for virtually anything, I do find Adam Smith’s perspective persuasive.

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Bruce Bartlett: Are Taxes in the U.S. High or Low? - NYTimes.com

Bruce Bartlett: Are Taxes in the U.S. High or Low? - NYTimes.com:

"The truth of the matter is that federal taxes in the United States are very low. There is no reason to believe that reducing them further will do anything to raise growth or reduce unemployment.

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Myopia

[Originally posted at Doctors for America's Progress Notes Blog]

Andrew Sullivan's tag line, via George Orwell, is that "It is a constant struggle to see what is past the end of one's nose." One of my favorite lines is from Upton Sinclair, "It is difficult to get a man to understand something if his livelihood depends upon his not understanding it."

When I say "favorite," I mean I like it because it says a lot about the human condition in general, and about our political struggles in particular. Unfortunately, in these times, this myopia in our world views has the potential to lead to human misery, and to continue America on the road to tragedy, as we already have passed farce. I consider myself an optimist, but recent events including our world class embarrassment of a debt ceiling "deal" have left me pessimistic for our short term prospects of reinvigorating our priorities as a nation and consequently our intermediate term prospects of leaving the nation better than we found it.

We have been at our best as a nation when we have had visionary leadership, from Teddy Roosevelt's "Square Deal," to Franklin Roosevelt's "New Deal," to LBJ's "Great Society." Even Eisenhower's more mundane Interstate Highway System and JFK's goal to put a man on the moon represent aspirational goals for America. ("We chose to do these things, and the others, not because they are easy, but precisely because they are hard!") Now, our political will has been demeaned to the lowest common denominator: how will I keep more of my meager income for myself in the short term?

Paul Krugman, Robert Reich, and others have been banging this drum for over a decade now: investing in human capital is the way to grow the economy and keep us a great country. Many wish to continue the defunding of our societal investment in human capital: reducing investments in education and research, reducing money spent on the health of the population, demolishing our social welfare programs like Medicare, Medicaid, SCHIP and Social Security. This is short sighted and a recipe for disaster (with all the ingredients mise en place).

We now have plugged in a small group of Congress Persons in the wildly inappropriately named "Super Congress," with the stated goal of resolving our budget stalemate. I am skeptical, to say the least, and two articles in this week's New England Journal of Medicine reinforce my pessimism.
Jonathon Oberlander points out that "austerity politics" are now in force, and there are real potential dangers that Medicare and Medicaid funding could be cut substantially, including reduced payments to providers, reductions in federal funds for state Medicaid programs, increasing cost-sharing for enrollees, repealing the long term care insurance provisions in the ACA, and - per Paul Ryan's plan - changing Medicare into a voucher plan.

While Oberlander doesn't say it, I will: the "austerity politics" manufactured in Washington by power brokers with lots of money behind them are designed to take an axe to the programs that provide medical care to those who need it and prevent expansion to those who need it even more. We at DFA are all too aware of deficiencies in our current health care system and are not shy at all about pointing them out. But we also know that reforming health care requires a greater intellectual effort than unthinking cuts born out of myopic political calculations.

In the same NEJM issue, Christopher Jennings notes that many stakeholders in health care are coming to realize that there is almost no good that can come out of the work of the Super Committee. Because of the construction of the debt ceiling deal, if the Super Committee reaches no deal and the "automatic cuts" are enacted, Medicaid is exempt from cuts and Medicare would face "only" a two percent cut. As he explains, it is hard to imagine a deal crafted by the twelve that would so good to health care funding:

From the current vantage point of these stakeholders, the choice is therefore not a close call; the automatic cuts are by far the best poison to be forced to take, particularly in comparison to the concoction they fear the super committee could produce. It would meet the requirement of the law, protect against unknown and much larger cuts, and preserve resources and bargaining chips for the next big deal, which will probably take place in 2013 after the presidential election.

So, there is hope, if I ditch my own myopia and hope and pray and work for a new, better Congress in 2013, we may be able to get on the path to becoming a great country again, instead of the "dollar store" nation that so many seem to believe is our destiny!

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FactCheck.org : Premium Nonsense On Medicare

FactCheck.org : Premium Nonsense On Medicare:

My sister-in-law sent me one of those BS right wing chain emails (they try to misinform while staying under the radar of actually informed people by sending it to their fellow in-the-Fox-bubble friends) about rising Medicare premiums because of the Affordable Care Act. Here is the original quote, in the hopes that people Googling for this nonsense will find the correct information, then the FactCheck response (the full response is at the link at the top):

The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; And $247.00 in 2014. These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns. Send this to all seniors that you know, so they will know who's throwing them under the bus.

REMEMBER THIS IN NOVEMBER 2012 & VOTE ACCORDINGLY

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FACTCHECK.ORG

The Real Effect of the Health Care Law

That’s not to say that the health care law won’t have an effect on the premiums paid by some seniors. It will, but not in the way this bogus message claims. The change will affect only a small minority of upper-income Medicare beneficiaries.

Currently, about the top 5 percent of seniors pay an "income-related premium" that was enacted as part of the same 2003 law that created the new Medicare prescription-drug benefit. Upper-income seniors have been paying more than the standard premium since 2007. Currently those earning between $85,000 and $107,000 for individuals (between $170,000 and $214,000 for couples) pay a total of $161.50. The amounts grow larger for higher-income groups, reaching $369.10 per month for seniors making more than $214,000 (or $428,000 for couples).

The new law doesn’t increase those premiums, but does ensure that more high-earning seniors will pay them. It does this by freezing the income brackets at 2010 levels through 2019, rather than allowing them to rise with inflation as originally enacted. The Kaiser Family Foundation released a report in December projecting that in 2019 the top 14 percent of seniors would be paying the income-related premiums — an additional 3.5 million seniors.

The law also established a separate set of income-related premiums for Medicare Part D — the prescription-drug benefit — which previously had charged only a standard premium for all. Taken together, these changes are expected to bring in an additional $36 billion over 10 years, Kaiser’s study said.

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GOP and Obama's jobs plan: Do Republicans oppose the president's economic policies for ideological reasons or political ones? - By Jacob Weisberg - Slate Magazine

GOP and Obama's jobs plan: Do Republicans oppose the president's economic policies for ideological reasons or political ones? - By Jacob Weisberg - Slate Magazine:

"You can group the conservatives who reject the economic consensus into three rough categories: fundamentalists, cynics, and sheep. The fundamentalists are ideological and come in several varieties. The more primitive prefer Hoover to Keynes, or in some cases God to Hoover. Rick Perry, the Texas governor and presidential candidate, believes that the purpose of the economic crisis is to bring us back to "Biblical principles." Asked on the campaign trail how he would create jobs if he were in office, Perry responded: "You won't have stimulus programs under a Perry presidency. You won't spend all the money." This is a pretty good summation of the Tea Party's know-nothing view that all government spending makes all things worse, always.

"That's not to say that everyone who rejects Obama's stimulus spending is a default-welcoming ignoramus. Libertarians or libertarian-leaners don't necessarily think stimulus won't grow the economy; they just worry that it will grow the government at the same time and that it won't ever shrink back. But they don't mind stimulus tax cuts, which reduce the resources available to government. Rep. Paul Ryan, for instance, the government-slashing chairman of the House budget committee, has argued that stimulus spending is an evanescent sugar high that produces no lasting economic benefit.

"The cynics, by contrast, don't offer any economic analysis at all. They simply reject whatever President Obama proposes. In the now immortal words of Senate Minority Leader Mitch McConnell: "The single most important thing we want to achieve is for President Obama to be a one-term president." McConnell, like Boehner and House Majority Leader Eric Cantor, happily voted for the stimulus bill George W. Bush proposed in 2008, which cost $152 billion. Back then, they felt some responsibility for the economy. Now it's Obama's problem. Mitt Romney knows enough about finance to understand that shrinking spending would raise unemployment. But he also knows that running against Obama with a 9 percent unemployment rate is a better bet than running against Obama with an 8 percent unemployment rate. "

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Trying to understand income inequality, the most profound change in American society in your lifetime. - By Timothy Noah - Slate Magazine

Trying to understand income inequality, the most profound change in American society in your lifetime. - By Timothy Noah - Slate Magazine: Timothy Noah's 10-part series on inequality, published in Slate last September, has won the 2011 Hillman Prize for magazine journalism, an honor awarded annually by the Sidney Hillman Foundation for reporting that "fosters social and economic justice." It was clear from the moment of publication that "The Great Divergence" struck a chord, treating a profound and complicated issue in an engaging and understandable way, and we're delighted that the Hillman Foundation has recognized Noah's work. You can read the series below, or print a PDF.

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