Category Archives: Federal Government

Despicable!

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Winston Churchill

 

Here we have two quotes dealing with the same subject. The first quote is from the father of Scientific Socialism, i.e., Marxism and Communism, and the second quote is from the wartime Prime Minister of Great Britain, who was a staunch anti-Communist.

But what transpired today in Washington, is far from the view of Marx, or the view of Churchill. In other words, it is DESPICABLE!

Never before in the history of the United States, has the government of the people, by the people, and for the people ever taken away something the government gave them in the first place.

Not even the enactment of the 18th Amendment outlawing the sale and production of alcohol, stoops to the level of total disregard for the health and welfare of the American people. Alcohol was never something the government had to give to people, they produced it themselves. Our founding fathers were brewers and distillers of alcoholic beverages.

But the vote this afternoon represents a step towards a society this nation has not seen in many decades. You hear that Republicans want to take the country back. The obvious place they want to take us to is the 19th century, when no one had health care, there was no Medicare or Medicaid, or Social Security, Unemployment Insurance, and Workers’ Comp.

There are specific reasons for this, which I will discuss.

First, pure and simple, it is greed. They want the money dedicated for health care and the other medical plans for a huge tax cut for their wealthy friends.

Second, the health insurance companies can now get to pick and choose who they want to cover, what they will cover, and what they will charge you if you have a serious pre-existing condition or a life-threatening disease. We know this as adverse selection.

Third, they don’t believe in giving “entitlements” to anyone except the military and the wealthy.

Fourth, their libertarian, puritanical, Calvinism teaches them that the poor are undeserving of the benefits that money brings, so let them die, and who cares if they are poor, it is a sign of a moral failing.

Another quote from Churchill says that you can always trust the Americans to do the right thing after they have tried everything else.

Well, after today, we have tried everything else. We have given employers the right to offer health insurance to their employees, we have allowed private insurance companies to sell policies to individuals, and we have created separate health care plans for children, the elderly, the military and their families, members of Congress, and the poor.

But for all the reasons I have given above, and many more, this nation refuses to enact single payer health care, the only thing we haven’t tried, and the one form of universal health care every other Western nation provides its citizens.

One fellow blogger last year during the Democratic Primary, said that while he liked Bernie Sanders, he knew that the health insurance companies were not going to scrape their businesses and start from scratch.

But maybe they should. It is because the capitalist profit motive is at the heart of what, in the words of Walter Cronkite, our health care system really is. “America’s health care system is neither healthy, caring, nor a system.” Too many are profiting from other people’s misery, and driving many into poverty. This is the richest nation on Earth, and this is how we treat our fellow citizens.

It is strange that the Conservative Party of Great Britain believes in single payer, but the American Republican Party does not. The truth is, they are no longer the Republican Party but the Republican Libertarian Party.

Once upon a time, members of their right-wing decried the nation’s drift towards “Creeping Socialism.” With this vote, and with executive orders flowing from 1600 every day, we are witnessing “Creeping Fascism.’ The new Secretary of Labor comes from the fast food industry where workers were mistreated, and still are in some places.

Worker’s rights are being eroded with new overtime rules, wages are stagnant, unemployment is still too high despite what the government says.

One other reason for enacting single payer is that doing so will free employers from having to provide it to their employees, and workers over forty will not have to face losing their jobs and careers they spent their lives in.

We, as a nation, must decide; either we take away health care for millions of Americans, or we make sure everyone has it. There can be no half-measures. Many pundits have said the AHCA (Zombie Health Care Bill) will not pass the Senate, but that is what they said about the House of Representatives.

I hope the Senate will defeat this, but if they don’t, the only option left is single payer.

One More Thing on Health Reform

Could not ignore Joe Paduda’s first post this morning, which is also covered on the Health Wonk Review blog.

He lays out in great detail who would be affected by passage of this zombie legislation, and who would come out ahead,

It’s enough to make you sick, that such people exist who will take away health care from the very people who put them in office, and don’t care that many of them will die because they can no longer get health care.

Comedian Jimmy Kimmel went on his show the other night and confessed to the entire country about his newborn son’s heart disease. What was the response from the Nazi right? Attacks.

Why do these people continue to vote against their own economic interests? There are many reasons for this. The first one is simply, they don’t believe Democrats. And why? Because for far too long, Democrats have engaged in Identity Politics, and have ignored the heartland.

Second, the Democrats have generally avoided campaigning in, or developing their local or state parties in those states most likely to vote Republican, but would benefit from Democratic policies in education, job creation, health care, etc.

Third, Republicans have done a great job of convincing people of an “us versus them” mentality. Republicans sound like “us”, act like “us”, enjoy the same activities as “us”, where “they” do not. You hear the words, “elite”, or “elitist” thrown around, as was done yesterday in response to Kimmel’s plea by an alt-rightist.

Forth, Republicans know how to frame an argument by using simple words and phrases, where Democrats go into long, drawn out lectures on policy. They talk to Americans as if every American has a college degree in political science or sociology. Yex, polls do so that many Americans agree with Democratic policies, but we know that polls are not always accurate.

The last election proved that.

Lastly, the Democrats have been late to the party as to what is happening to working people, both blue collar and white collar workers. In fact, the Republicans know all too well what is happening, as they are responsible for the prolongation of their misery, and will do nothing to stop what is about to happen when jobs are replaced by automation.

Universal Basic Income (UBI)? Not from this crowd of neo-fascist, libertaritards. (Take that, Rush Limbaugh!) Want some more Oxycodone?

As we are witnessing day by day, the US is going backwards. All the way back to the 19th century, the very century the GOP is most comfortable with, because that is when they had complete control of the entire government, and their friends in industry were getting richer and richer, and there were no government programs or laws protecting workers and the poor.

So if this zombie health care law gets passed, look out…there will be more zombies where that came from.

Ding, Dong, Health Care “Reform” Is Dead: A Political View

Time for another rant, but this time it is based on actual facts, plus an understanding of the real reason repeal and replace of the ACA is not going to happen.

There are many reasons for why repeal and replace has failed; some of them have to do with the complexity of the health care marketplace, others have to do with the fact that all the negative things the opposition said about the law did not come to pass, even though some people are paying higher premiums, or cannot find a doctor because there aren’t enough where they live and have to travel long distances to find a doctor (primary or specialist), or the insurance companies have exited the exchanges, thus limiting the number of payers.

Joe Paduda has been conducting an ACA Deathwatch, and yesterday, Joe wrote that ACA repeal will not happen.

This, he says, is due to the defection of one major GOP legislator, Fred Upton, of Michigan.

But what Joe does not say is why the GOP has been so single-minded in wanting to destroy the ACA (besides the obvious reason of tarnishing Obama’s legacy).

The one guiding principal and reason for “repeal and replace” is solely due to the adoption by the Republican Party (or should I say takeover) by out and out libertarians, and rampant libertarianism.

This has nothing to do with the Libertarian Party, although many members of that party were Republicans in the past; case in point, former New Mexico Governor Gary Johnson, who ran for President last year as the Libertarian Party candidate.

To prove to you that this is the case why the GOP has been so one-track minded, one only has to read the response from former GOP Congressman Joe Walsh (you remember him, the guy who yelled “you lie” to Obama during the SOTU speech).

Walsh, not to be confused with the Joe Walsh of rock and roll, said the following in his tweet response to Jimmy Kimmel’s tearful admission that his newborn son had a heart defect that needed surgery, and Kimmel defended the right of others not as fortunate as him and his wife to afford that surgery, which would have been fatal to any other child whose parents could not afford it.

Here is the exact tweet:

Joe Walsh@WalshFreedom

Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.

At first, you might think this guy is a heartless SOB, but if you read the tweet carefully, and look closely at the word “freedom” after his name, and the tweet itself, you will see that to Mr. Walsh and the rest of his “Freedom” Caucus, it is not that he is heartless, it’s that he is brainless.

Because only a brainless idiot still clings to a political philosophy that time and again has been discredited. He believes he nor anybody else is obligated to pay for someone else’s health care, but I bet he does not feel that way when other people have to pay for his or his children’s public school education, or their ability to have lunch while in school or to even have books to read and pens and pencils with which to do schoolwork with. Or to bring it even closer to home, to have other people (namely taxpayers) pay for his health care when he was in Congress. Do as I say, not do as I do.

Or maybe he sends his kids to private school?

You see, the real reason the GOP is against the ACA is they don’t believe it is the role of the government to do anything for anyone, and that includes providing health care. They are fundamentally opposed to it on philosophical and ideological grounds, and like their Speaker, are slavishly devoted to the rantings and writings of a 20th century novelist and the reactionary views of an economist few have ever heard of.

You know, of course, where the Freedom Caucus came from? It is the legislative part of the Tea Party, founded by former Congressman Tom DeLay (there’s a name for you), and the Tea Party has nothing to do with a hot beverage. It means “Taxed Enough Already”.

But the real impetus behind the Tea Party was not the old folks demanding the government keep its hands off their Medicare. It came from the very wealthy who donated large sums to elect Republicans to office. It started with Howard Jarvis in CA, spread under Reagan and both Bushes, and popped up during the debate over the ACA.

Jimmy Kimmel said the problem with health care was partisanship; however, as written in Salon, the problem is with one party…the Republicans. This by no means lessens the impact of Kimmel’s plea.

The response from President Obama, DNC Chairman Tom Perez, and Senate Minority Leader Chuck Schumer was overwhelmingly positive.

The current occupant continued his insane view that the ACA was dead. Sort of like saying Andrew Jackson could have prevented the Civil War, or that he recently met with Frederick Douglass.

Finally, the defeat of repeal and replace is laid at the feet of those GOP congresspersons who are vulnerable in the next election, and are hesitant to incur the wrath of their constituents, if the recent town hall meetings are any indication.

Like health care itself, the defeat has many reasons, but at the core lies the simple fact that libertarian, free market solutions are more dangerous to the health of the American people than the alleged disaster the GOP has painted the ACA with.

Disaster Averted

Yesterday’s crushing defeat of the so-called “American Health Care Act” or AHCA, signals the end of the seven-year long attempt by the Republican Party to legislatively kill the Affordable Care Act (ACA).

Yet, as was pointed out on one cable news network last night, it won’t stop the health insurance industry from getting the Republicans in Congress to kill parts of the law slowly by eliminating the taxes that go to pay for the coverage.

Call it “genocide by stealth”, since millions of Americans will die, as per the Congressional Budget Office (CBO’s) scoring of AHCA. If they can’t kill the law outright, the so-called “Freedom Caucus”, actually the Congressional version of the Tea Party, will kill it slowly.

Why do you think they keep saying it is a disaster and it is crumbling? It’s because they are dead set against anyone getting health care unless someone else can make a profit from selling a policy.

Then there is the other question, the one usually raised by liberals and progressives, especially those who supported Vermont Senator Bernie Sanders last year in the primaries, as to why we are the only Western country without universal coverage.

The answer is complex, but not complicated (“who knew health care was so complicated?). First, everything the government of the US has ever implemented for the benefit of people has had to pass muster with the Constitution. It either has to be covered by the Constitution directly, or implied through the taxing mechanism.

Second, the Founding Fathers never mentioned or promoted the right to health care, as the prevailing political and social philosophy of the day was concerned with freedom, liberty, and private property. It has been unclear what, if anything, was meant by the phrase, “life, liberty, and the pursuit of happiness”, let alone, the phrase, “promote the general welfare.”

Why they never mentioned health care and why other nations have it, is due to the fact that the US was founded during the first half of the period historians call, “the Enlightenment”, when the right to private property, liberty, and freedom were the topics of discussion on both sides of the Atlantic. Basically, the difference between Classical Liberalism (Conservatism) and Modern Liberalism (Liberalism) is between negative rights (the right not to be killed) versus positive rights (the right to a job, education, housing, health care, etc.)

Canada gained its limited independence from Britain nearly a hundred years after we did, and therefore was influenced by the philosophy of the second half of the Enlightenment, which stressed involvement by government in the economy.

The only time the Founders cared about providing some kind of health care plan was directed towards a particular group of citizens in the late eighteenth century, as I wrote about in this post.

What is now called the Public Health Service began as a government-sponsored, health plan for merchant sailors on ships entering and leaving US ports and on inland waterways. It was never challenged in the Supreme Court as unconstitutional, nor was it ever attacked by members of the opposition party. In fact, it was supported by both Federalists and Anti-Federalist politicians of the day.

The third reason why we don’t have universal, single-payer is because the government allowed employers to provide coverage during WWII to attract women into the workplace when the men went overseas. The UK is often cited as an example for single-payer, but what most supporters of this type of plan do not realize is that because of the devastation the UK suffered at the hands of German bombs, their health care system needed to be re-built from scratch, so the government stepped in with the NHS. Even Churchill supported it.

Fourth, we have always provided health care to certain at risk groups like the poor (Medicaid), the elderly (Medicare), and to children (CHIP), as well as to former service persons and their families (Tricare), etc. Perhaps the way to begin to get universal coverage is to merge all of these programs into one, then expand it to cover everyone else.

But for the time being, a major disaster was averted, but we should not think this is the end of the debate, nor is there victory. The battle lines are drawn, and the enemy is not surrendering. This is not a time for congratulation, but for vigilance and resolve.

 

Models, Models, Have We Got Models!

FierceHealthcare.com today reported that CMS (those lovely folks with all them rules), launched three new policies Tuesday that continue the push toward value-based care, rewarding hospitals that work with physicians and other providers to avoid complications, prevent readmissions and speed recovery.

The newly finalized policies are meant to improve cardiac and orthopedic care, and also create an accountable care organization (ACO) track for small practices, according to the report.

There will be three new cardiac care payment models for hospitals and clinicians who treat patients  for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.

Federal officials said that the cost of their care…varied by 50% across hospitals and the share of patients readmitted to the hospital within 30 days also varied by 50%. Medicare, the article points out, spent more than $6 billion in 2014 for care provided to 200,000 Medicare patients who were hospitalized for heart attack treatment or underwent bypass surgery.

As for orthopedic care, the new payment model is for physicians and hospitals that provide care to patients who receive surgery after a hip fracture, other than hip replacement.

They also finalized updates to the Comprehensive Care for Joint Replacement Model, which began earlier this year.

So far, that’s three models. But wait, there are more where those came from.

There’s the new Medicare ACO Track 1+ Model, that has a more limited downside risk than other tracks in the Medicare Shared Savings Program (another model I discussed a while back in the post, “Shared Savings ACO Program reaps the most for Primary-care Physicians“).

These new five-year models provide clinicians with other ways to qualify for a 5% incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. (three more models — so many, in fact, I am losing count)

Why am I pointing out the problem with the release of new payment models?

I’ll tell you why. When I began my MHA (Masters in Health Administration) degree program, I took an online elective on Healthcare Quality. The textbook we read discussed how CMS over a period of several decades, created and instituted so many models and programs, that it made me wonder why our health care system was so complex, expensive and so out of whack compared to health care systems of other industrialized countries.

The answer was simple. Too many models, programs, rules, and so on that only gum up the works and make real reform not only impossible, but even more remote a possibility as more of these inane models are added to what is already a broken system.

Winston Churchill said that you can always count on Americans to do the right thing, after all the other things were tried. We are still on the trying part, and I am afraid we will never get to where Sir Winston said we would.

 

Deaf, Dumb and Blind, part Deux

Back in June, I wrote a post with the above mentioned title. Then, I was on a rant, now I am just reporting what my fellow blogger, Joe Paduda has written about today regarding a report from the U.S. Department of Labor (DOL) on the various state workers’ compensation systems.

This report harks back to one conducted in 1972 on the state of workers’ compensation then, but as Joe points out today, seeking a return to that Commission report and to that decades-old recommendations is absurd.

Rather than give you my take on this meeting from yesterday, here is Joe’s article. I always give credit where it is due, and he is due a lot of credit for his reporting.

It would seem that not only is the workers’ comp industry deaf, dumb and blind, but so is the federal government, if we are to take Joe at his word.

And in the meantime, who gets hurt while these eggheads, bureaucrats, nincompoops and sticks-in-the-muds do more study, research, look back forty years and pine for an economy and workforce that no longer exists? The injured workers.

And who, in the meantime, while the insurers, employers, and various stakeholders gouge and game the system, gets hurt, disabled or even dies? The injured workers.

It seems to me that the only thing that matters to the eggheads, bureaucrats, nincompoops, sticks-in-the-muds, insurers, employers, and various stakeholders is, how to screw the worker, save money by not paying adequate wages and benefits, make more profits off of someone’s disability, and not the care and treatment of the one who is disabled and forced into poverty.

Here is the perfect example of the state of affairs in workers’ comp, both inside and outside the industry:

hear-no-evil-see-no-evil-speak-no-evil

 

Where No One Has Gone Before: Or Will Captain Kirk Save Work Comp?

Tom Lynch, of LynchRyan published an excellent piece today about the bumpy ride workers’ comp has had since 1972, when a commission established by Richard Nixon made 19 recommendations for the improvement and uniformity of state workers’ comp standards.

As the Chairman of the Commission, John Burton suggested, “if we continue to advance at this rate, the 19 essential recommendations will be law throughout the land sometime in the 23rd century.”

“Hailing frequencies, open Captain.”

Tom is not the only one who wrote recently about the vested interests holding back progress and change. David De Paolo last week said the same when he wrote,

“Insurance companies are as much a vendor in either scenario as physicians, bill review companies, utilization review companies, attorneys, vocational counselors, etc. Each and every single one makes a buck off work comp, and each and every one has an interest in maintaining the status quo.”

Do we really have to wait until warp engines and transporters carry us off to far distant planets to have meaningful and substantial reform of workers’ comp that benefits the injured worker and minimizes the abuse by vested interests?

Or do we continue to illogically believe that nothing can change, and that new ideas are stupid and ridiculous and a non-starter? Or do we ignore those in the industry who blog about workers’ comp, but are impeding change by denying the credibility of the individuals presenting new ideas, or the ideas themselves?

These 19 recommendations should be looked at again and implemented, along any other ideas, outside of opt-out to bring injured workers better and less expensive medical care. To do otherwise is illogical.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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