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SCOTUS Chastises Congress and the Executive Branches

by run 75411


Update:  Beverly Mann adds this note lifted from comments:

The Supreme Court is rarely in session. It’s seasonal, part-time work. They usually hear argument in 10 cases a month, seven months a year. In December, they didn’t hear even that many.
There’s really sooo much that can, and should, be said about the issue of (virtually universal lack of) access to the Supreme Court, and its repercussions. Roberts’ bizarre, cutesy annual report is … oh … I don’t know …characteristically hubristic?



SCOTUS Chastises Congress and the Executive Branches

A pencil and piece of paper was all Clarence Earl Gideon needed to state his case of being denied council in court after being accused of robbery and sentenced to prison. Gideon did get a review of his case under a violation of his 6th Amendment rights to council. Today it is near to impossible for the same to occur and the probability of achieving a review by SCOTUS would be akin to a grain of sand on a Florida beach. The highest court in the nation reviews issues and issues opinions for an ~85 cases/year few of which would be of the same stature as Gideon’s. It is all about who gains access to the court. Filing a petition is no easy task and the cost of which runs ~$3,000 for a dozen or so copies. The days of Gideon are long gone.

Why would I bring this up on an Economics board? Most recently Chief Justice Roberts got into the Congressional/Executive fray and their battle over finding a solution to the hypothetical fiscal cliff.

Our country faces new challenges, including the much-publicized ‘fiscal cliff’ and the longer-term problem of a truly extravagant and burgeoning national debit,” he wrote. “No one seriously doubts that the country’s fiscal ledger has gone awry. The public properly looks to its elected officials to craft a solution.” 

Chief Justice Prods Congress to Resolve Budget Talks and Control National Debt, http://www.nytimes.com/2013/01/01/us/chief-justice-roberts-prods-congress-on-fiscal-matters.html?_r=0
Roberts goes on to add;

The federal judiciary makes do with a budget appropriation of about $7 billion, he wrote, “a mere two-tenths of 1 percent of the United States’ total budget of $3.7 trillion.”
“Yes,” he went on, “for each citizen’s tax dollar, only two-tenths of one penny goes toward funding the entire third branch of government!”




That is notable cost control and Roberts cites how much it costs each citizen to have access to SCOTUS. The Robert’s SCOTUS saw an ~ 64 cases last year which is down from the typical 75-85 cases seen yearly and down even further from the 1963 cases reviewed by SCOTUS. By reviewing fewer cases, the Roberts SCOTUS controls costs and further reduces the probably of another Gideon achieving review. This is not true cost control, his waxing elegantly on how SCOTUS achieves reduced costs is suspect, and comes at the expense of the citizenry. Instead of working 8 hour days (if they were hourly), SCOTUS now works 7 hour days and produces less.

Less throughput and a selective one at best.

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Raising the Price of Pizza 10 to 14 cents. . .

by Bill aka run75441

Raising the Price of Pizza 10 to 14 cents. . .

Will pizza and food prices really have to increase to cover healthcare costs for the mostly young employees of the Olive Garden’s, Denny’s, and Papa John’s restaurants?

A 10 to 14 cents increase per pizza is being proposed by Papa Johns’ to pay for the PPACA. At the same time, Papa John’s is advertising a 2 million-pizza giveaway with the help of Peyton Manning “Two Million Free Pizzas” (must be a freebie?). Not sure myself how I might decide to account for the cost; but, here is a try; free pizza for 2 million NFL fans to increase sales, . . . cut employee hours to avoid the PPACA and keep the price, . . . raise prices 10 to 14 cents per pizza to have healthcare insurance for the restaurant staff, . . . or maybe a kind of half cheese/half sausage combo. . . healthcare and free pizzas with Peyton Manning promoting the social responsibility of Papa John’s?

Maggie Mahar at The Health Beat Blog “Can US Businesses Afford Obamacare?” points to an interesting article by John Padua of Managed Care Matters discussing who bears the healthcare reform cost if restaurant owners opt out while Forbes Caleb Melby runs the numbers and questions the increased costs suggested by Papa’s John’s CEO “Papa John’s Obamacare Math” .

The issue(s): The Affordable Care Act dictates that full-time employees (30 hours or more per week) at companies with more than 50 workers need to be provided health insurance. CEO John Schnatter has further claimed that some employers will cut employee hours to avoid providing them with healthcare.

The Cost: John Schnatter estimates that Obamacare will end up costing his company $5-8 million annually.

The Price Increase: 10 to 14 cents per pizza

Checking John Schnatter’s Math: Last year, Papa John’s International captured $1.218 billion in revenue. Total operating expenses were $1.131 billion. If Schnatter’s math is accurate (Obamacare will cost his company $5-8 million more annually), then new regulation translates into a .4% to .7% expense increase. It is difficult to set that ratio against the proposed pie increase and across all sizes given size and topping differentials, but many of their large specialty pizzas run for $16. Remarkably, a 10-14 cent increase on a $16 pizza falls in a comparable range of .6% to .9%; but, the cost transference becomes less equitable if you are looking at medium pizzas which run closer to $12, meaning a .8% to 1.15% price increase.

Lets say that Papa John’s sells exactly half medium/half large specialty pizzas. Averaging the ranges for both sizes, then averaging that product yields a .86% price increase — well outside the range of what Schnatter says Obamacare will cost him.

So how much would prices go up, under these 50/50 conditions, if they were to fairly reflect the increased cost of doing business onset by Obamacare? Roughly 3.4 to 4.6 cents a pie.

3.4 to 4.6 cents does not seem like such a huge increase to bear by either customer or the business and if the advertising is done right; it might prove more positive than giving away 2 million freebie pizzas during the NFL season . . . a little like Schooner Tuna in the movie “Mr. Mom,we are in this together for the long haul.'” What customer would not buy into this?

The Issue(s): From the annals of I made this; “Everyone is looking for a way ‘not‘ to provide insurance for their employees. It is essentially a huge tax on all us business people,” declares Denny’s RREMC Franchise Owner CEO John Metz on Fox News. To offset costs further, John adds; “he also will slash most of the staff’s time to fewer than 30 hours per week” to start January 2014.

Talk about giving a long notice for plant closures to employees. What happens if franchise owner sidesteps the insurance provision of the PPACA and cuts hours to fewer than 30? John Padua of Managed Care Matters says the cost falls back on the US citizenry, employees, and customers of these restaurants.

If companies do not provide insurance for low-paid workers, we taxpayers have to. That is the way Obamacare works; folks with incomes below 400% of the FPL can get subsidized coverage. If restaurants cut workers’ hours so as not to insure employees, all of us taxpayers get to pay for their health insurance. These companies are avoiding their responsibility and increasing our tax burden. “The Cost of Obamacare -14 cents per pizza”

The Cost: Maggie Mahar raises the question in her “Can They Afford It???” post. Metz employs 1,200 associates at his Denny’s RREMC franchise. Taking the extreme case of all 1200 employees going into the state exchange and being subsidized up to 400% of FPL; by slashing everyone’s hours to 28, Metz avoids the $2,000 penalty (~$2.34 million in total) for those going into the state exchange.

The Price Increase: 5% surcharge to all meals in 40 Denny’s in Georgia, Florida and Virginia. (note: I wonder how that will appear on the bill?)

Checking The Math: The CBO (which forever appears to be anti-healthcare reform) found in a recent study, 2014 comprehensive healthcare insurance could be had at $3,400 for an employee up to 30 years of age and single. Understanding we are not talking about writing off Metz’s employee expenses from his corporate income tax yet and knowing the PPACA requires an employer to pay 65% of the employee’s healthcare insurance, the $3,400 per person (down from a projected $6,700 without the PPACA) now becomes $2,210 per person.

Denny’s franchise owner Metz is angry with Obama, the PPACA, and his employees. Granted, the example is as much an extreme as Metz’s knee jerk reactions and posturing; but, it points to the overall fallacy in the too-much-healthcare- cost is a drag on my business argument. Both of these entrepreneurs did take grief for their stances. Denny’s CEO John Miller did call john Metz to discuss his stance and John Schnatter has been called out in various blogs and is the subject of multiple boycotts.

Much of this sounds like sour grapes starting with SCOTUS affirming the PPACA and is carryover from the re-election of Barack Obama to the Presidency. Some have protested the validity of the PPACA claiming it was immoral to force business owners to pay for employee healthcare insurance. In an email exchange, John Paduca answers:

“In response to your query as to when it became an employers’ responsibility to provide health insurance, that would have occurred when PPACA was passed, signed into law, and upheld by the Supreme Court. Laws run this country, not morals. If ‘morals’ did, we never would have invaded Iraq or water-boarded prisoners or interned Japanese Americans or overturned legitimate governments in Africa and Central America or supported the Shah of Iran. ‘Morals’ are personal; laws are societal.”

Maybe it is just Republicans having to cancel their airline tickets to Boston for the celebration on November 7th which has placed both Johns in a bad mood. Or could it be pent up anger with the very people who elected Barack to The White House for a second term? You know, those 47 percenters who might make up the bulk of the restaurant workers.

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Hospital Consolidation and ACO’s

Jason Shafrin over at the Healthcare Economist points to this recent paper over at the RWJF. Interestingly the authors find that hospital consolidation increases prices and could decrease quality. Something that many of us have considered in the past.

In concentrated markets, the effects were even more pronounced with price increases over 20% noted.

Competition was noted to increase quality under an “administered” pricing system, ala the NHS in the UK. The evidence for competition increasing quality in a market system was much more mixed.

I have thought this for some time, and have even wrote about the concepts of leverage in the past. For example, I have cited a BNET article before. When one examines the the health markets in Milwaukee and Chicago, which are both midwestern cities, and geographically close to each other, one finds higher prices in Milwaukee, with providers not accepting less than 200% of Medicare. Which does not seem intuitive, as there is far more market competition in the health insurance industry there. In Chicago, one insurer, BC-BS, is rather dominant and prices are lower, with providers accepting 112% of Medicare on average. It would seem to make sense that increasing the leverage of the hospitals and providers through the mechanism of consolidation will increase prices. The same thing happens in Milwaukee, which has no dominant insurer, and therefore is unable to exert leverage over the hospital systems in Milwaukee.

The ACO models as proscribed by the ACA will increase consolidation. By developing an accountable model of care delivery, providers will attempt to consolidate to increase quality and minimize risk exposure in the sense of decreasing reimbursements.

The problem with the RWJF paper, as it rightly notes, is that the study does not really examine integrated health care systems. When you look at consolidation with true vertical and horizontal integration, it is my belief that quality improves even in the absence of competition. True integration in the case of Mayo Clinic and Kaiser also lowers prices.

In essence, I don’t think the problem is consolidation…..I think the problem is consolidation in the absence of integration.

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New Report on Getting the Best Care

by Run 75441

New Report on Getting the Best Care

Both Matthew Yglesias at Slate and Sarah Kliff at WonkBlog and a host of other sites have posted some interesting results coming out of a recent study by the Institute of Medicine  Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.

Unfortunately as a lowly and unpaid (99% of the time) blogger, I do not have access to the entire report. What I do have is a abstract of what the report is about and some of the charts placed on Wonkblog.

We spend $750 billion on unnecessary health care. Two charts explain why. This report documents much of the whys to a much needed Healthcare Reform in the numeric of it. Phillip Longman in his book The Best Care Anywhere touches upon a similar transition in the VA administration and the experiences of his and Timothy Noah’s wives in being treated for cancer. Unfortunately, the best named hospitals and the best insurance does not guarantee the best care. Too much is spent inefficiently on the wrong type of care.

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The second series of chart is an accounting of how some of these expenditures are made within the system. Again, this is something which Phillip Longman touched upon with his book on the VA and how they overcame the inefficiencies. Sarah Kliff at Wonkblog calls it creating an environment in which it is easy to create waste. When healthcare and its associated industries were not the monsters in cost, no one paid attention to the cost, loss of efficiency, and the lack of quality outcome in treating patients. We spent for the services and not the outcome with the results being a higher cost.

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Constantly targeted within today’s healthcare system is the cost of treating the elderly. While it is true as we grow older, the costs of treating us increase due to our aging and failure to care for ourselves. Within the system it is easy to have increased waste as treatments and records may not be logged to computer leading to duplicate treatments and a lack of coordination amongst way to many doctors in treating patients. It has happened where a group of consulting doctors can be describing treatments when the oncologist knows there is little more to be done.

What does the IOM recommend? I will leave you with Sarah Kliff’s post on Wonk Blog to find out. What’s Possible for Healthcare

Getting back to today’s politics between Romney and Ryan vs Obama, would you want more of the same? More of today’s private market with its rising healthcare cost is precisely what is being advocated by Mitt Romney and Paul Ryan. More to come.

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The war against women

by Maggie Mahar    (The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney.
Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times and other publications. (Her first book, Bull: A History of the Boom and Bust 1982-2003 (Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report.
)

As the Republicans Take Tampa, Consider What a GOP Victory Would Mean for Women’s Health

For decades, Republicans have opposed abortion. This, we know, and so it comes as no surprise that Mitt Romney, the Party’s presidential candidate, has called “Roe vs. Wade“ one of the darkest moments in Supreme Court history.”

But what some call the “war against women” is escalating. This year, the Republican platform calls for a constitutional amendment that would make abortion illegal.

In 1976, the GOP blueprint acknowledged that “the question of abortion is one of the most difficult and controversial of our time,” and the Party called for “a continuance of the public dialogue on abortion,” which it called a “moral and personal issue.” Just eight years ago, the preamble to the Republican platform declared: “we respect and accept that members of our party have deeply held and sometimes differing views.” But today, there is no such language in a platform that calls for “a human life amendment to the Constitution,” and declares that “abortion is detrimental to women’s health and well-being.”

Meanwhile Alabama, Arizona, Idaho, Indiana, Kansas, Louisiana, Nebraska, North Carolina, Oklahoma, and Ohio all have passed legislation outlawing abortion after 20 weeks, even though, as the Center for American Progress’ Emillie Openchowski points out “complications are sometimes discovered after this point in a pregnancy that could cause serious harm to the woman. In those states, a woman would be forced to continue the pregnancy, no matter the risk to her health.” This is frightening.

While Republicans parade women across their Tampa stage– and avoid talking about what they have quietly embedded in the Party platform–it seems a good time to consider what a Republican victory would mean for women’s health.

Turning Back the Clock: Contraception

Susan Faludi’s Pulitzer-prize winning 1991 book, Backlash, is subtitled: “The Undeclared War Against American Women.” Twenty-one years later, it seems the war is out in the open . As a recent New York Times editorial observes: “Having won on abortion, social conservatives are turning to birth control.”

The Affordable Care Act (ACA) promises women access to contraception without co-pays, an idea which enjoys widespread popular support–at least among women. Nationwide 80% of women voters support the idea, according to a June survey by Hart Research Associates. An earlier Hart poll revealed that 77% of Catholic women and 72% Republican women approved of free birth control. By contrast, just sixty percent of all men embrace the proposal. Still, that’s a majority.

Who, then, actually opposes making birth control available to all women, regardless of income?
The extreme conservatives who now run the Republican Party have made their feelings clear. In February, House Speaker John Boehner, stood on the House floor, and promised to overturn any rule requiring employers to pay for birth control for their workers:

“It must not stand and it will not stand,” delcared Boehner, who believes that bosses who object to birth control should not be forced to cover contraception. Senate Minority Leader Mitch McConnell, R-Ky, along with Senators Kelly Ayotte, R-N.H.; Roy Blunt, R-Mo.; Marco Rubio;, R-Fla.; and John Thune,quickly joined in, arguing that this provision is a threat to religious freedom.

The right-wingers who now control the GOP seem to view contraception as a “women’s issue” that should be decided by men. Thus, at a House Oversight Committee hearing, House Republicans convened a panel on denying access to birth control coverage with five men– and no women.

As for Republican presidential candidate Mitt Romney, in a Fox interview just last Sunday, he said: “of course women have a right to use contraception”– if they can afford it.

In March Romney told a Town Hall meeting that if “a woman wants access to free birth control” she “should vote for the other guy,” adding, “there are a lot of things that we have in our society that we may like,” but that government should not be paying for.” This suggests that “the Pill” is a luxury, like a $75 blouse.
Romney also has endorsed the “Blunt amendment” that would let any employer drop health insurance coverage for contraception and other health services on religious or moral grounds.

Here we are not just talking about Catholic colleges and hospitals. President Obama is making special provisions to accommodate their concerns. But the Republican “Blunt amendment” would go further, to include private companies such as Hercules Industries, a Denver-based heating and air conditioning company.

Co-owner Andy Newland objects to birth control, and in July, the company obtained an injunction from a federal court, allowing it to delay complying with the law until three months after the case is decided.

The Cost of Contraception
According to Fox News’ Greg Gutfield, “Anybody can afford birth control.” In July, he asked his audience, “How much more affordable can you make it? . . I mean, do we–should we start up like a ‘buy the pill’ campaign? Like ‘feed the children’ where we make sure we all adopt one woman and pay for her pills?”
Gutfield is, of course, wrong about the cost. In recent years, birth control has become extremely expensive for low-income women, even if they are insured. Co-payments for pills typically range between $15 and $50 per month, and for other contraceptive devices, such as IUDs, co-pays and other out-of-pocket expenses can reach into the hundreds of dollars.

“Since the average American woman wants to have two children,” Planned Parenthood points out, “she‘ll spend approximately five years pregnant, postpartum, or trying to have children, but 30 years trying to prevent pregnancy. That can add up to thousands of dollars spent on prescription birth control.”
Little wonder that, according to a recent survey, more than one-third of American women voters have struggled with the cost of prescription birth control at some point in their lives, and, as a result, have used birth control inconsistently. Planned Parenthood reports that “this number rises dramatically among younger women, with more than half (55 percent) mentioning a time when they could not afford to use birth control consistently.”

Thus, “In the U.S., half of all pregnancies are unintended.” Inevitably, a great many uniplanned pregnancies end in abortion. “If we are serious about reducing the unacceptably high rate of unintended pregnancies in this country, we need to get at the root cause and take practical steps to increase access to affordable birth control,” Planned Parenthood observes.

Without the Affordable Care Act– What Women Would Lose
The GOP platform states that a Republican President would use his waiver authority “on his first day in office” to halt progress in carrying out the Affordable Care Act. Romney has pledged to repeal health reform during his first 100 days in the White House.

This means that insurers selling policies in the individual market would be able to continue charging a women at least 30 percent more than they would charge a man for exactly the same policy–even if the coverage did not include maternity benefits.

Women also would lose free access to a list of preventive services that the ACA requires that insurers offer without co-pays, and without applying deductibles.

For women, the essential preventive services include: free screening for cervical and breast cancer; breastfeeding support, supplies, and counseling; well-women visits, prenatal care, screening and counseling for sexually transmitted diseases, including HIV; screening for gestational diabetes; and screening and counseling for domestic partner violence.

Planned Parenthood and Title X
Mitt Romney has pledged that he will “get rid of” Planned Parenthood, an organization that operates nearly 800 health centers throughout the United States, offering sexual and reproductive health care for the nearly three million women and men who visit these centers each years. While helping women avoid unintended pregnancies, Planned Parenthood also provides roughly 770,000 Pap tests and nearly 750,000 breast exams annually, along with more than four million tests and treatments for sexually transmitted infections. At sometime in their lives, one in five American women have found help at Planned Parenthood.
During his Sunday interview on Fox, Mitt Romney reiterated his desire to defund the organization, arguing that taxpayer dollars should not fund abortion.

Here is the truth: abortion constitutes only 3 percent of Planned Parenthood’s services and abortion is covered by private funds. Federal dollars are not used.

Mitt Romney’s fiscal plan also proposes eliminating Title X—the main federal family-planning program supported by President Nixon and then-Congressman George Bush Sr. at its creation in 1970. Title X does not pay for abortions, but it prevents abortions and unintended pregnancies by the hundreds of thousands each year. It also pays for cancer screening and some abstinence counseling for teenagers.
In Texas Republican Governor Rick Perry already has rejected Title X money, assuring that countless poor women in his state will be denied access to all reproductive health care, from birth-control pills to Pap smears.

Misogyny: The Elephant in the Room
That both Bush and Nixon supported Title X serves as a reminder of how much the Republican party has changed. As New York Magazine’s Frank Rich points out in a marvelous piece titled “Stag Party”: “For much of its history, misogyny was not the style of the party of Lincoln. For most of the twentieth century, the GOP was ahead of the curve in bestowing women’s rights

Today, many Americans under 40 have no idea how different the GOP (not the mention the country as a whole) was 25 or 30 years ago.

Rich takes us back, reminding us that Republican presidential candidate Barry Goldwater (who in 1964 was considered ultra-conservative) was married to a woman who had been “inspired by birth control pioneer Margaret Sanger.” Thus, Peggy Goldwater “would help build one of the nation’s largest Planned Parenthood affiliates.”

Barry Goldwater favored abortion rights. “‘I think the average woman feels, My God, that’s my business,’ and that’s the way we should keep it,” he said late in his career.
Rich goes on to reveal that “Prescott Bush, the Connecticut senator who sired a presidential dynasty, was another Sanger enthusiast and treasurer for the first national Planned Parenthood fund-raising campaign. His son, George when a congressman in the sixties, was an ardent birth-control advocate and the principal Republican author of the trailblazing Family Planning Act of 1970.

“Capitol Hill colleagues jokingly nicknamed him ‘Rubbers.’”

Even Richard Nixon, that much misunderstood liberal Republican, favored the Equal Rights Amendment and in 1972 signed the Equal Employment Opportunity Act to strengthen the policing of workplace discrimination.”

But Nixon was nothing if not a study in anguished contradictions. “At the tail end of the Nixon presidency,” Rich notes, “the GOP started backing away from its traditional beneficence on women’s issues.” In a telling shift, “Nixon vetoed a bipartisan bill enabling child care for the millions of mothers then rapidly joining the workforce.”

Looking back, the timing makes sense. Both Watergate and Nixon’s “enemies’ list” foreshadowed the deepening parenoia that would lead to a purge with the Republican party itself.
Granted, it would be two decades before the GOP’s “Big Tent” collapsed. The liberal and moderate Republicans who I had admired in the 1970s and 1980s (Nelson Rockefeller, Lowell Weicker, and Charles Mathias, to name a few) would disappear. But it was not until the 1990 that the long knives came out, and moderates began to be sliced out of the party. Some gave up and retired.

Why did Nixon kill the childcare bill? Rich explains: “His veto was accompanied by a jarring statement that child care would threaten American families by encouraging women to work,” The inspiration for this unexpected reactionary broadside came . . . from political strategists eager to exploit the growing backlash against the sixties feminist movement.”

Backlash–As Male “Influence and Power” Declines

What we are seeing in the GOP today is a continuation of the pay-back that Susan Faludi described in her 1991 book, Backlash.

Conservatives like to claim that “The War Against Women” is a metaphor manufactured by Democrats as they prepared for the 2012 election. This simply is not true. Long ago, women such as Faludi saw that herd of elephants coming our way.

In fact, as Rich points out, in 1996 “Tanya Melich, the daughter of a state senator in ultraconservative Utah” who grew up “to be a stalwart New York Republican and a 1992 Bush convention delegate, wrote a book titled The Republican War Against Women. “These days,” he writes, “her eyewitness account of her party’s transformation seems more pertinent and prescient than ever.”

The anger that Republicans direct toward women that can be traced to the “women’s movement” of the 1960s. Men feared that women would take their jobs. Husbands were threatened; once their wives had some financial independence, they might decide to strike out on their own. Fathers realized that the “Pill” would give their daughters sexual freedom: marriage could become a choice, not a necessity.

Worst of all, as women gained power, both in the workplace and in government, this could mean that men would find themselves having to answer to the likes of Elizabeth Warren. (In 2009, when Warren, who is now running to recapture Ted Kennedy’s Senate seat for the Democrats, questioned Treasury Secretary Timothy Geithner about 13 billion dollars Goldman Sachs got out the back door of AIG –“Do you know where the money went?” — her tough, probing questions made jaws drop– including Geithner’s. Geithner would later express opposition to her possible nomination to head the Consumer Financial Protection Bureau.)

In Backlash, Faludi quotes Seymour Martin Lipset and Earl Raab, two political scientists who have explored the “politics of backlash”: “The reaction” is driven by “groups which are declining in a felt sense of importance, influence and power,” they explain, “Unlike classic conservatives” Faludi adds, “these ‘pseudo conservatives,’ as Theodore Adorno dubbed them…are not so much defending a prevailing order as resurrecting an outmoded or imagined one.”

She also quotes the historian Richard Hofstadter: “‘America has largely been taken away from them and their kind, though they are determined to try to repossess it and to prevent the final destructive act of subversion.’”

In other words, they are afraid, and when people are “on the run,” some turn mean.
Conservative white men know that the demographics are against them. Before long, they will be outnumbered, and in future years, more and more African Americans, Latinos, Asians and women of all races will be in positions of power.

Let me be clear: I am not talking about majority of white men. My husband, his brother, my son, his father (my ex-husband), and a great many men who I know either personally or professionally do not fit this mold.
But, without question, some white conservative men saw Barack Obama’s election in 2008 as a sign that the country “was being taken away from them.” To Mitch McConnell, Obama’s re-election would constitute what Hofstadter terms “the final destructive act of subversion.”

In a sense, those who feared the rise of feminism in the 1960s were right. The women’s movement would never be snuffed out. Instead, it became part of our culture. Today many fewer women call themselves “feminists.” The vast majority of younger women simply assume that they have a right to work, to assume positions of power in the larger world, to control what happens to their bodies. This is the legacy of the Sixties.

The Violence against Women Act

Women also take it for granted that they have a right to protection against the rage that sometimes threatens them–and their children– in their own homes.

Nevertheless, this year, House Republicans felt free to block renewal and expansion of the Violence Against Women Act (VAWA), a 20 -year-old law that offers shelter and counseling to women who have been beaten or sexually assaulted by spouses or partners.

In the past, renewal was not even in question. But today, “Some conservative groups view the Violence Against Women Act as “a slush fund for feminist causes that harms men unfairly and encourages the dissolution of marriages,” the New York Times reported .

Last week, I wrote about how and why Republicans were able to block the VAWA on HealthInsurance.Org. Conseratives claim that Democrats “politicized” the issue by turning it into a fight over illegal immigrants, Gays and Lesbians. I do not buy that argument. Nor did all seven Republican women in the Senate. They voted to renew the bill.

That post also explains why it is so important that, in November, women–and men who like women–come out to vote. The turnout, not just in the Presidential contest, but in many Congressional races, will determine who takes over Washington.

Before going to the polls, check out this piece Healthinsurance.org, showing how your elected representatives havevoted on heatlh care reform. Those votes will help you measure where they stand on protecting women’s health.

cross posted with  Healthbeat blog

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The Elephants are Still Thirsty

by Run 75411

The Elephants are Still Thirsty

In my earlier post on Carrying Water for Elephants I explained how the $716 billion in planned reductions to Medicare was calculated, who it impacted, and from where it originated.

The $716 billion is far larger than the initial $449 billion first reported. In 2010, the CBO arrived at an estimate of savings of ~$449 billion starting from 2012 onwards and covered 6- 7 years from when the bill takes full effect in 2014 to 2019. The second estimate of savings was the result of John Boehner’s request for a review of the costs and gains realized from the repeal the ACA in its entirety. The second review covered the period from 2014 to 2022 and resulted in the $716 billion. “Medicare Cuts: What is the Fight About?” Brookings Institute

Above the explanation of how the $716 billion calculated; I presented Ezra Klein’s pie chart explaining where the reductions were made. Not one of the reductions comes from reductions in Medicare benefits to recipients which as I also explained is denied the PPACA. In last night’s Republican Convention Paul Ryan again claimed the reductions to providers are actually cuts in benefits to Medicare recipients and the reductions are being used to fund the PPACA. Neither statement is true; but then, Paul Ryan is a Republican VP candidate who hopes to confuse the voters with supposition and conjecture. Paul should be made to explain what he will do with the reductions achieved from similar reductions he has proposed for Medicare . . . maybe more tax breaks for the 1 percenters???

There is no amount of water Paul Ryan or Mitt Romney can carry to quench the thirst of this elephant of misrepresentation.

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Do Successful Business people make good Presidents?

WARNING****** Not health care related

Romney has continually flouted his business experience, and how this will lead him to be a better President than Obama. That got me thinking….We’ve had to have businessmen become Presidents before, right? So what’s been our track record? How have they done? Surely, they’ve been successful Presidents too, right?
Well, not so much. Businessmen make good businessmen. Historically, they have not done well as President’s. We’ve had five President’s with significant business experience that were successful since 1900. Carter, Bush I, Bush II, Harding, and Hoover. Yep…..Those five.

As is mentioned in the Bloomberg article…..CEO’s are generally surrounded with like minded goal oriented people all working together to achieve a goal or vision…..

That doesn’t exist in politics, when you have to listen to multiple opinions and take abuse that a CEO would never tolerate. The country is not a business……let’s say it again…the country is not a business.

From the first article:

None of the great or near-great presidents—Teddy Roosevelt, Franklin Roosevelt, Harry Truman, or Woodrow Wilson—was a businessman. Truman was a failed businessman (a haberdasher) before entering politics, but that hardly constitutes a ringing endorsement of Romney’s claim for private sector ascendency.

For that matter, none of the better-than-average presidents was a businessman either. In this category think of Presidents John F. Kennedy, Dwight Eisenhower, Ronald Reagan, Lyndon Johnson, and Bill Clinton.

Probably the most successful president with real business experience (and success) was George H.W. Bush. Before going into politics he founded Zapata Petroleum, which ultimately became Pennzoil. Bush 41 ended up a one-term president unable to kick-start an economy in a recession and seemingly out of touch with the problems of the common man. Sound familiar?

It gets worse from here. Jimmy Carter, another one-term president beset with economic woes, was a success in agribusiness (peanut farming) before getting into politics. He generally falls into the lower half of the historians’ rankings.

And then we get the big three—the men widely considered by historians to be the worst presidents of the modern era: Warren G. Harding, Herbert Hoover, and George W. Bush. One left the country on the verge of a depression, one left the country in a depression, and one presided over such corruption and ineptitude that despite the failings of the other two he still manages to get the lowest ranking of them all. And yet all three made millions of dollars in the private sector before entering politics. All three were successful businessmen (a newspaper publisher, a mining tycoon, and the owner of a professional baseball team). Bush 43 even went to Harvard business school, like Romney, and like Romney promised to bring business principles to the Oval Office.

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Medicare Cuts: What is the Fight About?

by Run75411

“Water For Elephants”

carrying water for elephants” is a phrase that means carrying a heavy load, much like carrying a secret that you can’t tell even someone you love wholeheartedly, just as in the end Jacob does for his wife
.
An elephant drinks 25-75 gallons of water a day far more than any man would be able to carry at any given time. http://angela-michelle.hubpages.com/hub/Water-For-Elephants “Water for Elephants” Sometimes when you get older . . . things you think on and wish on start to seem real. And then you believe them, and before you know it they’re part of your history.”

Most recently former NY Lt. Governor Betsy McGaughey in the WSJ (August 8th) commented on the ACA in “ObamaCares’s Phoney Deficit Reduction” choosing to carry water for the Republican candidates Romney and Ryan with the hope she can convince voters that President Obama’s ACA will not reduce the cost of Medicare and instead will rob the Medicare TF. By her words alone, Ms. McGaughey cannot change the numeric of Medicare expected and occurring reduced growth and costs resulting from the passage of ACA. In her, Romney and Ryan’s mines the logic of how the robbery of benefits and the Medicare is all too real even when the proof of the opposite is self-evident. The three will have to do double time if they are to provide enough water to conflate the ACA to the public if in fact they are to make them believe the illusion.

Ms. McGaughey critiques CBO Director Elmendorf’s and the JCT’s analysis (letter to House Leader John Boehner) on the impact of repealing the ACA, what it means to the country in increased costs, and then conflates the cuts to the Advantage Program and other parts of Medicare as actual cuts in benefits to Medicare recipients. The ACA states Medicare benefits cannot be reduced for Medicare recipients.

As operated by commercial insurance companies, the Advantage Program intent was to provide competition to Medicare and separate from Medicare. As Betsy believes and everyone else imagines, private commercial insurance can provide similar benefits at a lower cost and more efficiently. Except the Advantage Program did not do so and has out spent Medicare by an average of $1000 or 7% to 18% (dependent on who you read) more and in total for similar Medicare benefits.

                                        Ezra Klein , “Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how.”  
                                  Note: HMO is health maintenance organization; PPO is preferred provider organization.
   http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/romneys-right-obamacare-cuts-medicare-by-716-billion-heres-how/ 

                  

The very same CBO Director who wrote about the impact of repealing the ACA to House Leader John Boehner and the resulting increased costs was also a part of the CBO team which pounded the final nail into the “Hillarycare” coffin resulting in its demise in Congress. Healthcare then was 20% of the cost of what it is today. I doubt Director Elmendorf has lost any of his boldness since Clinton. So, who is right?

The best way to counter supposition and conjecture by Romney, Ryan, and Ms. McGaughey is to present detail about the cuts and to what they are related , the same as the actual cost of the Advantage program in relation to Medicare. The planned reduction in Medicare costs come from three areas, which also include the government sponsored Advantage program.

                                SOURCE: Medicare Payment Advisory Commission Report to Congress, March 2008.
                               “Medicare Advantage”; Kaiser Foundation http://www.kff.org/medicare 

30.2% of the planned reduction in Medicare costs will come from the elimination of Advantage subsidies as I stated above. The ACA also applies the same rules to the Advantage insurance programs it applies to hospitals by tying reimbursement (or fees) to quality of outcomes instead of a fee for the number of services provided.

34.8% of the reduction in cost comes from revised calculations in the reimbursement of hospitals for provided services. Hospitals not only give up the pay-for-services cost model to embrace better quality outcomes for services cost model; but, they move to electronic record keeping (which proved to be cost effective with the VA, Longman “Best Care Anywhere“), and the bundling of payments eliminating multiple billings and forcing a split of the total compensation. Knowing the increase in patients coming from the addition of the uninsured, there is also the influx of an aging baby-boomer population, which also influenced hospitals to accept the changes.

35% of the reduction result from a combination of smaller cuts in extra funds ( ~5%) given to hospitals to cover the uninsured (not needed as more people will be covered), reductions in homecare providers (~8%), fraud reduction, etc..

The $716 billion is far larger than the initial $449 billion first reported. In 2010, the CBO arrived at an estimate of savings of ~$449 billion starting from 2012 onwards and covered 6- 7 years from when the bill takes full effect in 2014 to 2019. The second estimate of savings was the result of John Boehner’s request for a review of the costs and gains realized from the repeal the ACA in its entirety. The second review covered the period from 2014 to 2022 and resulted in the $716 billion. http://www.brookings.edu/blogs/up-front/posts/2012/08/15-medicare-cuts-galston “Medicare Cuts: What is the Fight About?”


And what of other things implied?

– Healthcare spending was 17.9% of GDP in 2010 and will rise to 19.6% in 2021. Neglected and a part of the article from which this snippet of CMS information was pulled is this: Current projections also do not include potential drops in spending through health care delivery reforms, such as the accountable care organizations and medical homes being promoted by the health law.” In other words, the author projections of $ and % are being made as if the ACA did not exist. The author of this particular article is an MBA and not an economist or a doctor. Quelle Surprise?

– “Repeal also would reduce government spending, lower taxes, and undo the evisceration of Medicare; all good results.” I guess it is still unclear how Medicare is to be eviscerated under the ACA when Obama will plow the results back into Medicare, and the CMS has lengthen the TF out to 2024-2029. Comparing this to Romney wishing to end Medicare and Ryan wanting to keep the very same reductions as the ACA and take the savings for tax breaks, who is eviscerating what?

Healthcare Costs have been decreasing for years? Maybe not so long and since 2009/2010 at the earliest?

Secretary of Heath Kathy Sebelius made the comment in an article that a family of 4 paid ~$6,000 for private insurance in 2000 and ~$12,000 for similar insurance in 2009. http://www.voxxi.com/kathleen-sebelius-affordable-care-act/ “Public Needs To Get Their Facts Straight” Part of this is due to increased administrative costs and much more is a reflection of increased healthcare care costs which insurance and Medicare reflects.

Medicare has had slower growth because it has taken the necessary actions to control much of the costs associated with healthcare through pilot programs, negotiations, etc. The results of its actions are clear in the S&P Indices. The increase in enrollment of healthier patients over the last two recessions has contributed to the slow down; however, it is the ACA which started hospitals and doctors to begin to plan for full implementation and take the steps necessary to meet ACA goals for commercial insurance.

spending per enrollee slowed to 4.2% annually, as compared with 4.5% among private payers. After large increases in enrollment due to two recessions and the increasing numbers of Americans with disabilities are accounted for, growth of Medicaid spending per enrollee was relatively slow (less than 3% per… http://www.nationaljournal.com/healthcare/both-obama-and-romney-medicare-plans-fail-to-solve-the-cost-problem-20120816Medicare and Medicaid Spending Trends and the Deficit Debate”

– And the Pink Cadillac Tax? The ACA does impose a tax on plans exceeding $27,000 and typically carried by executives in the rarefied levels of management. They can always shuck it off and go to one of the insurance exchanges for a cheaper plan with no tax. There is also an excise tax on plans with premiums exceeding $10,200 for individuals or $27,500 for a family tax Other taxes include Increase Medicare tax rate by .9% and impose added tax of 3.8% on unearned income for high-income taxpayers.

So what is the Fight About? It is about whether Romney/Ryan can eliminate Medicare and repeal the ACA, and keep the same proposals President Obama put in play for Medicare but using the savings from it elsewhere (tax breaks – think SS surplus) rather than within Medicare, as both are opposed to Obama plowing the savings back into Medicare. http://www.brookings.edu/blogs/up-front/posts/2012/08/15-medicare-cuts-galston “Medicare Cuts: What is the Fight About?”

References:


Maggie Mahar Health Beat Blog

http://www.cbpp.org/cms/index.cfm?fa=view&id=3161 Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/romneys-right-obamacare-cuts-medicare-by-716-billion-heres-how/ ” Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how
http://www.drugchannels.net/2011/08/cms-bright-future-for-drug-spending-in.html CMS Bright Future for Spending . . .
http://www.cms.gov/apps/docs/ACA-Update-Implementing-Medicare-Costs-Savings.pdf
Affordable Care Act Update: Implementing Medicare Cost Savings
http://www.ajhp.org/content/69/5/405.abstract Projecting future drug expenditures—2012
http://www.brookings.edu/blogs/up-front/posts/2012/08/15-medicare-cuts-galston Medicare Cuts: What Is the Fight About?
http://www.kff.org/medicare/upload/2052-11.pdf Medicare Advantage
http://factcheck.org/2012/06/romney-obama-uphold-health-care-falsehoods/ Romney, Obama Uphold Health Care Falsehoods
http://www.voxxi.com/kathleen-sebelius-affordable-care-act/ Public Needs . . .
http://www.reuters.com/article/2012/06/12/us-usa-healthcare-spending-idUSBRE85B1DI20120612 Government forecasts modest health spending growth
http://online.wsj.com/article/SB10001424052702303768104577462731719000346.html?mod=WSJ_hps_LEFTTopStories ” Steep Rise in Health Costs Projected”
http://www.nejm.org/doi/pdf/10.1056/NEJMp1204899 “Medicare and Medicaid Spending Trends and the Deficit Debate”
http://www.urban.org/UploadedPDF/412419-Containing-the-Growth-of-Spending-in-the-US-Health-System.pdf “Containing the Growth of Spending in the U.S. Health System”

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Endogenous Economic Growth and Health

Repeat after me:

H_(t+1)=E(H_t )+[G(B-φ(K))] × s_H Y

This follows the work of Mokyr (1993) and is the final construct of Bishai and Kung. 
Basically, H_t is the current health stock of the population, E is a decreasing function of health stock as an environmental contagion, G is the quality of health production technology, B is the best available health technology in the area, and φ represents the gap between the best health technology and the actual health technology and is a decreasing function of capital. 
What does this mean? Why should anyone care? 
Simple…..
Any economy is dependent on the equation Y = f(K,L,H) with Y representing GDP, K equaling capital, L-labor, and H-health of the labor force.
What it means for the average reader? Well, investment in healthcare improvement by the government creates a positive feedback cycle where better health= better economic performance, which then becomes:
more health = more income= more health, etc. 
Certainly there are also exogenous factors as demonstrated by the Preston Curve, and McKeown has documented these well, although not without criticism. But that is the subject of an entirely different post. 

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Repeal the ACA and Lower Costs for Citizens

by Run75441

Repeal the ACA and Lower Costs for Citizens…

clip_image001
Chicken Little, Courtesy of “EW.Com Entertainment Weekly”

What presidential candidate Romney has vowed to repeal is showing more benefit than harm in driving down the cost of healthcare for individuals, groups, and commercial insurance. If repealed by Romney, the results could cost more than leaving it in place.

The most recent projections of the CBO and JCT reflect a decrease in the insurance cost coverage provision of the ACA over the 11-year period 2012-2022, a decrease of ~$86 billion from the initial projection of $1.252 trillion to $1.1.68 trillion. The projected decrease does not include other aspects of the ACA which in the aggregate will drive the reduction in healthcare cost further. http://www.cbo.gov/publication/43473 , July 24, 2012.

In the same report, the CBO addresses a letter from House Speaker Boehner asking about the benefits of repealing the ACA. Speaker of the House Boehner and he House Republicans have floated a bill which would repeal the ACA. In a separate CBO letter to John Boehner, the CBO estimates the repeal would reduce outlays by ~$890 billion and revenues by $1 trillion. Over the same period 2012 – 2021, the repeal would increase deficits by ~$109 billion. This estimate does not include the hidden costs of people not being insured if the ACA is repealed.

Over at Maggie Mahar’s Health Beat, Maggie touches upon the decreasing cost of healthcare Breaking The Curve of Healthcare Inflation and what the intent is of the ACA:



“- The ACA told insurers that they would no longer be able to shun the sick by refusing to cover those suffering from pre-existing conditions. They also won’t be allowed to cap how much they will pay out to a desperately ill patient over the course of a year –or a lifetime.”


“- insurance companies selling policies to individuals and small companies will have to reimburse for all of the “essential benefits” outlined in the ACA–benefits that are not now covered by most policies and if they hope to stay in business, they will have to find a way to ”manage” the cost of care–but they won’t be able to do it by denying needed care.”


“providers too will be under pressure. A growing number will no longer be paid ‘fees for service that rewarding them for ‘volume’ or for ‘doing more.’ Bonuses will depend on better outcomes, and keeping patients out of the hospital–which means doing a better job of managing chronic illnesses.”


But, what of the overall program results?

– “From 2000 through 2009, Medicare’s outlays climbed by an average of 9.7 percent a year. By contrast, since the beginning of 2010, Medicare spending has been rising by less than 4 percent a year.” It is now ~2.5%.

– “Zeke Emanuel (an oncologist and former special adviser for health policy to White House OMB director Peter Orszag) to Maggie: providers are ‘anticipating the Affordable Care Act kicking in. They can’t wait until the end of 2013: They have to act today. Everywhere I go, ‘Emanuel, added, ‘medical schools and hospitals are asking me, How can we cut our costs by 10 to 15 percent?'”


– “Rather than have Medicare set prices for lab tests and medical devices we should put all such purchases out for competitive bidding. ‘In 2011,’ he (Peter Orzag) pointed out, ‘bidding reduced Medicare spending on wheel chairs and other equipment by more than 40 percent.'”


And for the average person, what are and what were the paybacks? Exploring Maggie’s article further, this chart can be found on the US Department of Health detailing the amounts of rebates in total, by state, and by Healthcare Insurance Company. “The 80/20 Rule” http://www.healthcare.gov/law/resources/reports/mlr-rebates06212012a.html

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To take this a step further and look up your own insurance company, a pivot table at the Healthcare.gov site will allow you to look up insurance companies by state and what the average rebate is if called for from the application of the MLR. Your Insurance Company and Cost of Coverage

 How successful the MLR has been can be measured by the impact of the MLR in measuring administrative costs of insurance companies against benefits, providing rebates to citizens, and giving states the ability to review requests for insurance increases through greater access to information. There are fewer double digit increases requested, more decreases in insurance rate requested, and reversals in rates at the state level due to greater information provided to states. 2012 Progress Report: Health Reform is Opening the Insurance Market and Protecting Consumer


Early on, the ACA is having a tremendous impact on controlling and reducing costs providing better value for the money and reducing the inflationary impact of the overall healthcare industry.

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