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Hypocrisy ??? – Updated

Update to the Hobby Lobby decision comes as a result of a SCOTUS injunction the day before the 4th of July 2014

The nonprofit Wheaton College filed a petition to keep it from having to a file self-certification document certifying it is a religious organization and should be exempt from having to provide contraceptives. Sotomayer writes:

“Let me be absolutely clear: I do not doubt that Wheaton genuinely believes that signing the self-certification form is contrary to its religious beliefs; but, thinking one’s religious beliefs are substantially burdened … does not make it so.” She adds, “Not every sincerely felt ‘burden’ is a ‘substantial’ one, and it is for courts, not litigants, to identify which are.”

The court granted the emergency injunction from Wheaton College.

What the plaintiffs in the nonprofit cases are seeking is to be treated like churches – no contraception for anyone. But the majority claims that “nothing in this interim order affects the ability of the applicant’s employees and students to obtain, without cost, the full range of FDA approved contraceptives,” because the government already knows about their objection from the lawsuit and can tell the insurer itself. But without the form, Sotomayor argues, how could the administration “ever identify the organizations eligible for the accommodation and perform the administrative tasks necessary to make the accommodation work?”

Hat Tip: Karoli, Crooks and Liars

***************************************

Hobby Lobby won its case at SCOTUS and is now exempt from having to pay for contraceptive devices or pharma for its female employees. At one commenter pointed out at a different blog, this did not include any pharma for men they may need to father a child or just for fun. This is not the Hobby Lobby hypocrisy I am pointing to although it is fair game in critiquing the company’s viewpoint.

While Hobby Lobby does not want to foot the bill for contraception, it has no problem in investing retirement funds in companies which manufacture emergency birth control measures which is something Hobby Lobby exhausted itself in explaining to the court. David at Crooks and Liars reports on a recent CNN broadcast concerning Hobby Lobby. Given its erroneous reporting on the VA recently, CNN has not been high on my list of reputable sources for news.

“While CNN host Ashleigh Banfield on Wednesday highlighted the “hypocrisy” of Hobby Lobby for investing in companies that made the same birth control products that it refused to provide to female employees,” CNN Business Correspondent Alison Kosik gives Hobby Lobby the benefit of the doubt by suggesting Hobby Lobby may have overlooked where its retirement funds may be going. Yea right and one word, “baloney!” and I could have used two words but AB is kind of a family-type-of-blog :). These are religious fanatics who wear their religion on their sleeve and will not hesitate a second to cram it down your throat to gain an advantage. They convinced the world they were being put-upon by the PPACA, President Obama, and the US government until it comes to making a buck.

Maybe SCOTUS will do a “do-over” and rethink their decision which will have some far reaching consequences going into the future as detailed in a recent LA Times Op-Ed The broad reach of the narrow Hobby Lobby ruling by Erwin Chemerinsky. As taken from the Op-Ed:

– “Christian Scientists could claim that they do not have to provide any health insurance to their employees.”
– “a family-owned business ‘could’ require as a condition of employment that no money paid as salary will be used to buy contraceptives, or other things that violate the employers’ religious beliefs?”
– Justice Samuel A. Alito, “it might apply to racial discrimination by saying, ‘The government has a compelling interest in providing equal opportunity to participate in the workforce without regard to race, and prohibitions on racial discrimination are precisely tailored to achieve that critical goal.'”
– “what of employers who have a religious belief that women with children should not work outside their homes, or businesses that claim a religious basis for sexual-orientation discrimination?”
– etc.

And of a reconsideration by the court? Doubtful with this crop of activist conservative judges as JackD pointed in the comments . . . and the door is open for other exemptions for those fictional entities called corporations.

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“Does Chief Justice John Roberts show a certain casualness about the truth?”

Each week I get an email from Slate telling me what the latest articles are there, this one caught my attention; Richard Posner on Roberts” For those of you who may not know, Richard Posner writes articles on the economy; but, he is also an 7th District Appeals Court Justice. The 7th District is the same district handling Scott Walker’s election snafu except the justice in that appeal is Frank Easterbrook.

What I find interesting about this article is Justice Posner is talking about SCOTUS Chief Justice Roberts and seemingly questioning McCutcheon v. Federal Election Commission. Here is an abbreviated take on what is being said by Justice Posner:

“Which brings me to Chief Justice Roberts’ opinion in McCutcheon v. Federal Election Commission, the decision in April that, in the name of free speech, further diminished Congress’ power to limit spending on political campaigns. The opinion states that Congress may target only a specific type of corruption—quid pro quo corruption—that is, an agreement between donor and candidate that in exchange for the donation the candidate will support policies that will provide financial or other benefits to the donor. If there is no agreement, the opinion states, the donation must be allowed because ‘constituents have the right to support candidates who share their views and concerns. Representatives are not to follow constituent orders, but can be expected to be cognizant of and respon­sive to those concerns. Such responsiveness is key to the very concept of self-governance through elected officials.

Can so naive-seeming a conception of the political process reflect the actual beliefs of the intellectually sophisticated chief justice? Maybe so, but one is entitled to be skeptical. Obviously, wealthy businessmen and large corporations often make substantial political contributions in the hope (often fulfilled) that by doing so they will be buying the support of politicians for policies that yield financial benefits to the donors. The legislator who does not honor the implicit deal is unlikely to receive similar donations in the future. By honoring the deal he is not just being ‘responsive’ to the political ‘views and concerns’ of constituents; he is buying their financial support with currency consisting of votes for legislation valuable to his benefactors. Isn’t this obviously a form of corruption?'”

Mind you, I have not see a lower level judge question a higher level judge’s viewpoint and legal opinion. So this is rather unusual for me having been through all of the court levels. This comes outside of the realm of an appeal which would change a lower court’s ruling if a justice found a lower court’s ruling in error or not to their interpretation. Maybe other readers such as JackD and Bev can offer a better opinion than mine.

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NY Fed’s Bogus Estimate of Return on College and Brookings Institute Misses the Student Loan Crisis

Yves at Naked Capitalism writes “NY Fed’s Bogus Estimate of Return on College and the Neglect of the Intellectual Commons”

Yesterday, the New York Fed released a new report by Jaison R. Abel and Richard Dietz, Do the Benefits of College Still Outweigh the Costs? which is getting good coverage in the mainstream media. Its major finding is that despite the fall in wages to college graduates due to the crappy economy, a college degree is still worth the expense because wages of high-school graduates have fallen too, keeping the wage premium of a college education high while reducing the opportunity cost of staying in school.

The assumption is college educated students with student debt are still coming out ahead over the long term. In an earlier post on Angry Bear using graphs as taken from Student Debt is Challenging the Reason for Getting that Long Sought After College Degree I was able to show those without student loan debt appear to come out financially better over the years.

“Based on its projections, the indebted household will suffer a lifetime wealth loss of nearly $208,000, compared to “baseline” of the debt-free household. Nearly two-thirds of this loss ($134,000) comes from the lower retirement savings of the indebted household, while more than one-third ($70,000) comes from lower accumulated home equity; because of the two withdrawals from savings later in their lives, the liquid savings gap is just $4,000. The gap in retirement savings is particularly large because the household with student debt was forced to save significantly less for retirement early in their working lives while paying back their student loans, a gap which was exacerbated because of the significant compound interest that would have been earned had they been able to save the same amount as the household without student loan debt.”

Simply stated, Abels and Dietz assumptions do not appear to be true.

Yves takes on their analysis and the use of IRR as opposed to NPV. “Instead of performing a proper NPV analysis, the authors used internal rate of return. We’ve debunked that at length in a previous post, and even McKinsey hectored CFOs for relying on it precisely because it tends to overstate investment returns. Emphasis ours:

Maybe finance managers just enjoy living on the edge. What else would explain their weakness for using the internal rate of return (IRR) to assess capital projects? For decades, finance textbooks and academics have warned that typical IRR calculations build in reinvestment assumptions that make bad projects look better and good ones look great…the most dangerous problems with IRR are neither isolated nor immaterial, and they can have serious implications for capital budget managers. When managers decide to finance only the projects with the highest IRRs, they may be looking at the most distorted calculations — and thereby destroying shareholder value by selecting the wrong projects altogether.

But let me turn briefly to a much more important issue, which is the perverse nature of thinking about education as an investment. This is yet another manifestation of the degree to which citizens are inculcated to view the social order through the lens of markets.” There are reasons not to use Fair Market Valuation of student loans which I will get into later.

Coincidentally, the NYT ran an article by David Leonhardt featuring a Beth Akers and Matthew Chingos Paper, Is a Student Loan Crisis on the Horizon?. Suprisingly, the dynamic conservative dual used 2010 Fed data as opposed to the more current 2012 data as caught by News Busters Tom Blumer

“the study’s authors, directly contradicts the sunshine they’re trying blow up our keisters. What’s even worse is that you don’t even need to dig into the detail once you learn which year’s data they used — 2010. For heaven’s sake, guys, total student loan debt has grown by between 50 percent and 60 percent since then. and to $1.2 trillion rather than the ~$770 billion used by Akers and Chingos. It gets more interesting as you read Yves Smith article, the Fed study, Akers and Chingos authored study, and my comment on Yves article. TheFed, Akers and Chingos grossly underestimate the impact of student loans on the economy and on students.

In my reply on Yves thread, I attempt to bring to light some of the concerns I have:

I just finished reading both Beths and Matt’s paper “Is a Student Loan Crisis on the Horizon?” and as before they make light of the issue with student loans. Toss in with them Jason Delisle of The New America Foundation and we have the three amigos of conservative origin telling main stream America there is no problem with student loans. I have problems with their origins and we are not just talking attending a conservative university. Their backgrounds reads like an up and coming who is who of conservatism who are getting their experience at more liberal orgs only to join AEI or Heritage down the road.

– Ms. Akers spent 2007/8 as “Staff Economist, White House Council of Economic Advisers (2007-2008).” How does she fit into this other than being a closet conservative?

– Mr. Chingos has been the recipient of support from the “Smith Richardson Foundation, the American Enterprise Institute, and the Lumina Foundation, where three former Sallie Mae directors are board members.”

– Mr. Delisile was “a senior analyst on the Republican staff of the U.S. Senate Budget Committee, where he played a key role in developing education legislation. From 2000 to 2006 he was a legislative aide in the office of Rep. Thomas Petri (R-WI).”

Yet the three of them write for organizations which I would term as centrist (am I wrong on this?) organizations. What am I missing here???

This is nonsense:

“The basis for this theory is that, unlike physical capital, human capital—or the skills that one obtains through education—cannot effectively serve as collateral for a loan. This makes student lending inherently risky, because a lender cannot foreclose on a student’s education the same way it can foreclose on a borrower’s home if he goes into default. More generally, the federal loan program ensures that all students have access to higher education, regardless of their ability to pay.

as well as this too:

“Unlike the loans offered in the federal lending programs, private lenders offer loans with interest rates that reflect a borrower’s likelihood of default. This means that borrowers from low-income households or borrowers attending colleges with lower completion rates are likely to face the highest rates. In addition, private student loans carry less generous repayment terms than federal loans, an important distinction given that both federal and private student loans are more difficult to discharge in bankruptcy than other types of consumer debt.”

What Beth and Matt leave out is the inability of students to discharge student loans in bankruptcy. Students with a simple signature on a piece of paper, check into a proverbial ‘roach motel” to which there is no escape except by death or disability, portions can be done away with through public service, or wait 20-25 years on an Income Based Plan to escape the balance of the loan only to have it appear as income from the IRS. There is no default and neither can it be discharged through bankruptcy. The government with either Federal Direct Loans or with the equivalent Sallie Mae, etc. will garnish your payroll wages, your Social Security, your disability income to secure the money loaned to you. These outcomes are conveniently left out by the three of them.

When you look at Student Loans in this manner, what risk whether determined by NPV or IRR are we talking about here? The Department of Education has decades of history on student loan returns. Student loans make more money when the students quit paying on them and as Alan Collinge pointed out for every $1 loaned an unpaid loan through default makes $1.20, far greater than what Geithner let banks and investment firms off the hook. Why do student loans have to be measured according to risk when there is no escape from them and they make a return when paid back or in a technical default status. CBO Director Elmendorf would change to Fair Market Valuation in the blink of an eye except he is tied to other methodology by law. In the past, he has done the calculation both ways and has reported on it. Nothing new there and again the CBO Director has shown his partisanship.

Yes, people with college degrees make more money when compared to high school graduates who have increasing household income due to the over abundance of them and a lack of jobs requiring just a high school degree. At the same time, entry level jobs for first time college grads have experienced similar declines just not to the same extent as high school grads. Over the life time of those who did not have student loan debt compared to those who did have student loans, the ones without loans accumulated more wealth and income.

“Based on its projections, the indebted household will suffer a lifetime wealth loss of nearly $208,000, compared to “baseline” of the debt-free household. Nearly two-thirds of this loss ($134,000) comes from the lower retirement savings of the indebted household, while more than one-third ($70,000) comes from lower accumulated home equity; because of the two withdrawals from savings later in their lives, the liquid savings gap is just $4,000. The gap in retirement savings is particularly large because the household with student debt was forced to save significantly less for retirement early in their working lives while paying back their student loans, a gap which was exacerbated because of the significant compound interest that would have been earned had they been able to save the same amount as the household without student loan debt. Some of this gap in net assets also comes from the higher lifetime income of the household without student loan debt; though the indebted household begins their careers earning more, their income falls behind that of the debt-free household by its early 40s, and earns significantly less during the peak earning years of the mid-50s.“How Student Debt Reduces Lifetime Wealth”

And you might wonder why I have concerns about students and student loans?

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The VA, Still The “Best Care Anywhere”

Today, “Economist’s View showcased Paul Krugman’s latest NYT article“Veterans and Zombies”. Paul discusses how the hyped-up VA issues are being used as an example of under performing government healthcare to emphasize how bad the much larger PPACA healthcare reform could be if allowed to proceed. Of course this is not true; but both Mark and Paul missed the data found by the most recent VA audit. The results of the audit were released June 9th. I left a long reply on the thread detailing the findings of the recent VA audit.

There is no comparison to be made of the VA healthcare to private healthcare. The VA is ahead of private healthcare and where private healthcare should be if it were going to improve. In a nutshell, the VA is well beyond the typical private healthcare system in providing “evidence-based protocols of care — not inadvertently ordering up dangerous combinations of drugs, or performing unnecessary surgeries and tests just to make a buck and treating the whole patient and not just one part at a time.” The services for fees cost model does not exist in VA healthcare for veterans.

If you remember, I had recently written “Wait Times at the VA” detailing what the recent Inspector General had discovered in the audit of the VA as reported June 9th “U.S. Department of Veterans Affairs VA Access Audit & Wait Times Fact Sheet System-Wide Overview”. Phillip Longman the author of the “Best Care Anywhere” featured the Inspector General’s report on the Washington Monthly “Just How Long Is The Wait”

“The nationwide Access Audit covered a total of 731 separate points of access, and involved over 3,772 interviews of clinical and administrative staff involved in the scheduling process at VA Medical Centers (VAMC), large Community Based Outpatient Clinics (CBOC) serving at least 10,000 Veterans and a sampling of smaller clinics.” Included in the finding were these issues:

– A complicated scheduling process resulted in confusion among scheduling clerks and front-line supervisors.
– A 14 day wait-time performance target for new appointments was not only inconsistently deployed throughout the health care system but was not
attainable given growing demand for services and lack of planning for resource requirements.
– Overall, 13% of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter a date different than what
the Veteran had requested.
– 8% of scheduling staff indicated they used alternatives to the official Electronic Wait List (EWL). In some cases, pressures were placed on
schedulers to utilize unofficial lists or engage in inappropriate practices.

Immediate Actions to Be taken as a result of the Audit:

– VA has accelerated care for Veterans currently waiting for health care services. VHA is in the process of contacting in excess of 90,000 Veterans
during the first phase of VA’s “Accelerating Access to Care Initiative.” The first phase is the first appointment.
– VHA will provide Veterans who do not currently have an appointment, or are waiting for additional care or services longer than 30 days the option
to be rescheduled sooner if VA capacity exists, keep their scheduled appointment, or be referred to non-VA providers in the community.
– VA has suspended all VHA Senior Executive Performance Awards for FY14
– VHA will remove 14-day performance goal from employee performance plans
– VHA will revise, enhance and deploy Scheduling Training
– VHA will implement a site inspection process.

What is so different about this if one were to compare the VA to private healthcare is, if the issue occurred in private healthcare nothing would have happened or reported to correct the issue. The VA had set up guidelines for scheduling people, a 14 day window, and a procedure to report on it. People created work-a-rounds to the procedures and processes to surpass the reporting and they got caught. The issue went public. Little if any of this reporting occurs in private healthcare, much less public reporting. Yet Congress and critics think that closing down the VA and turning veterans over to the private healthcare system is a benefit to veterans. It is not a benefit to veterans and is a detriment

Audit Findings: Long Term and Other Actions:

– VHA will overhaul the scheduling and access management directive.
– VHA will roll out near-term changes to the legacy scheduling system.
– VHA will acquire and deploy long-term scheduling software solutions.
– VHA will reassess and establish access timeliness goals.
– VHA will strengthen accountability for integrity in scheduling and access management.

The VA is implementing change to again take on scheduling of Veterans for appointments. That the VA even had a 14 day goal for appointments is far beyond what can be see in private healthcare except if one goes to the ER.

Wait Time Information

On May 15th, the VA had ~ 6 million appointments scheduled across its system. ~57,000 Veterans are waiting to be scheduled for care. ~ 63,000 veterans over the past ten years have enrolled in the VA healthcare system and have not been seen for an appointment. The VA is making contact with those who need scheduling and the new enrollees to clear up the backlog.

– Of the 6,004,350 total appointments scheduled, 96% of them or 5,763,291 appointment were made in 30 days or less.

– Conversely, 242,059 veterans or 4% of the 6,004,350 scheduled appointments were made after 30 days.

– The audit shows that even appointments at the Phoenix, AZ VA (the ground zero of the VA scandal), 89 percent of people enrolled in the system
received an appointment in less than 30 days. The average wait for established patients to see a primary care doc coming to just over 14 days.

– Most everywhere else in the VA system, average wait times for established patients to see a primary care doc are in the range of 2 to 4 days, as
are waiting times to receive specialty care.

Mind you, three months for a doctor’s visit is too long; but, it is not so out of the ordinary as what is being experienced in private healthcare today. The audit did reveal there are ~ 57,000 veterans who have waited for a doctor’s visit longer than 90 days and representing ~ 1% of the 6 million vets taken care of by the VA. Furthermore, there are ~ 63,000 veterans who are more-than-likely not the newly arrived veterans from Iraq/Afghanistan as claimed by CNN and the rest of the media. Much of this numeric can probably be explained by the relaxing of VA regulations on admission into VA care. Many Vietnam Veterans have reapplied to the VA with the idea we may be accepted. I would urge any veteran to apply as the regs do change as well as your income and you can be grandfathered even if the next president tightens the regulations as Bush did.

The VA is not flawless as many of veterans today know and I surely do. Of the 57,000 veterans waiting for an appointment, some veterans may have been forgotten by the VA, some may have moved to another city and missed the appointment, some may have gotten group insurance, and many may have enrolled immediately upon discharge to insure grandfathering and not need an appointment. This was the broad base upon which CNN made up its news story along with other media outlets and politicians with unsubstantiated data which is proving to be more hyperbole than fact.

Sending veterans to private healthcare after breaking up the VA is what CNN, the media, and the politician’s call a “benefit” bestowed upon Veterans. It is not a benefit and will only make healthcare treatment worse for veterans.

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Quelle Surprise, Wisconsin Governor Scott Walker Accused ???

If you have been watching the ongoing saga unfolding in Wisconsin on Governor Scott Walker and his recall election and election shenanigans, it probably comes as no surprise there was fire where there was smoke.

Prosecutors allege Gov. Scott Walker was at the center of an effort to illegally coordinate fund” raising among conservative groups to help his campaign and those of Republican state senators facing recall elections during 2011 and ’12, according to documents unsealed Thursday.

In the documents, prosecutors lay out what they call an extensive ‘criminal scheme’ to bypass state election laws by Walker, his campaign and two top Republican political operatives — R.J. Johnson and Deborah Jordahl. This marks the first time prosecutors have disclosed the details of their probe.”

Mind you, this did not happen in the last day or so. This has been an ongoing John Doe investigation in 2014 (and earlier) which Scott Walker and the Wisconsin Club for Growth have been attempting to quash. Wisconsin District Judge Randa agreed with Walker’s group and ordered all documentation destroyed. The case was appealed to the 7th District COA where Judge Easterbrook and two other judges over ruled Randa. “Federal Judge Rudolf Randa is a member of the Federalist Society and his wife donated often to Walkers campaign. Judge Randa’s Judicial Assistant is the wife of Scott Walkers lawyer.” Hey, its all in the family.

“Federal Appeals Judge Frank Easterbrook unsealed the court documents Thursday as he reviews a lawsuit attempting to end the John Doe probe. Two unnamed individuals this week tried to intervene in the case to prevent the release of the records, but Easterbrook rebuffed their request.” I wonder who that could be?

One alleged Scott Walker email with Karl Rove was released by Easterbrook in the ~250 pages.

“The documents include an excerpt from an email in which Walker tells Karl Rove, former top adviser to President George W. Bush, that Johnson would lead the coordination campaign. Johnson is also Walker’s longtime campaign strategist and the chief adviser to Wisconsin Club for Growth, a conservative group active in the recall elections.’

‘Bottom line: R.J. helps keep in place a team that is wildly successful in Wisconsin,” Walker wrote to Rove. “We are running 9 recall elections and it will be like running 9 Congressional markets in every market in the state (and Twin Cities.)'” No crime there yet; but, it is a smoking gun.

Walker and the Wisconsin Club for Growth are accusing the state prosecutors of violating their rights to freedom of speech due to the gathering of this information which reveals the names of donators to pro-Republican/Conservative funds. They accuse the prosecutors of violating the same elections laws they are accused of doing.

The 7th District COA with Judge Easterbrook as the chief judge of a panel of three is reviewing the case. Like Posner, Easterbrook is not so easily swayed by politics. It should get interesting.

References:
Prosecutors Allege Scott Walker At Center Of Campaign Finance Criminal Conspiracy, Huffington Post
John Doe prosecutors allege Scott Walker at center of ‘criminal scheme, Milwaukee Wisconsin Journal Sentinel

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Wait Times at the VA

Lead story at CNN was this:

Washington (CNN) — An internal Veterans Affairs audit released Monday said tens of thousands of newly returning veterans wait at least 90 days for medical care, while even more who signed up in the VA system over the past 10 years never got an immediate appointment they requested.

I have been following Phillip Longman, the author of “Best Care Anywhere” subtitled “Why VA Healthcare is Better than Yours” since he asked AB to review his book. Unfortunately, I did not have the time to do so. After talking to Maggie Mahar at Health Beat, she reviewed Phillip’s book A Salute to the VA on Memorial Day—Part 1. If you not had the chance to read the review, now is the time to do so. I would also recommend Phillip’s book for an understanding of how healthcare can improve and how the VA healthcare did improve to be superior to what private healthcare provides. In a nutshell, the VA is well beyond the typical private healthcare system in providing “evidence-based protocols of care — not inadvertently ordering up dangerous combinations of drugs, or performing unnecessary surgeries and tests just to make a buck and treating the whole patient and not just one part at a time.”

Yesterday, Phillip Longman presented the results of the VA audit Just how long are those wait times at the VA really? Remember CNN claims “Audit: More than 120,000 veterans waiting or never got care.”

– Of the 6,004,350 total appointments scheduled, 96% of them or 5,763,291 appointment were made in 30 days or less.

– Conversely, 242,059 veterans or 4% of the 6,004,350 scheduled appointments were made after 30 days

– The audit shows that even appointments at the Phoenix, AZ VA (the ground zero of the VA scandal), 89 percent of people enrolled in the system received an appointment in less than 30 days. The average wait for established patients to see a primary care doc coming to just over 14 days.

– Most everywhere else in the VA system, average wait times for established patients to see a primary care doc are in the range of 2 to 4 days, as are waiting times to receive specialty care.

Mind you, three months for a doctor’s visit is too long; but, it is not so out of the ordinary as what is being experienced in private healthcare today. The audit did reveal there are ~ 57,000 veterans who have waited for a doctor’s visit longer than 90 days and representing ~ 1% of the 6 million vets taken care of by the VA. Furthermore, these are more-than-likely not the newly arrived veterans from Iraq/Afghanistan as claimed by CNN and the rest of the media. Much of this numeric can probably be explained by the relaxing of VA regulations on admission into VA care. Many Vietnam Veterans have reapplied to the VA with the idea we may be accepted. I would urge any veteran to apply as the regs do change as well as your income and you can be grandfathered even if the next president tightens the regulations as Bush did.

The VA is not flawless as many of veterans today know and I surely do. Some veterans may have been forgotten by the VA, some may have moved to another city and missed the appointment, some may have gotten group insurance, and many may have enrolled immediately upon discharge to insure grandfathering and not need an appointment. This was the broad base upon which CNN, other media outlets, and politicians made their unsubstantiated claim which is proving to be more hyperbole than fact. Auditors did not find tens of thousands of veterans who have been waiting for up to ten years to get an appointment they requested. As Phillip explains, the audit U.S. Department of Veterans Affairs VA Access Audit & Wait Times Fact Sheet actually finds “there are 63,869 who over the past ten years have enrolled in our healthcare system and have not been seen for an appointment.” And this is CNNs, the medias, and the politician’s “benefit” bestowed upon Veterans from flawed coverage of the issue?

Reference:

Just how long are those wait times at the VA really?, Phillip Longman

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Interesting Virginia Primary Results Just Moments Ago

Novice Tea-bagger Representative candidate Dave Brat just handed Republican House Majority Leader Eric Cantor a defeat in the Virginia GOP primary. A $200,000 campaign fund challenging a 6-digit campaign fund. Apparently, Cantor was not backwards, conservative enough for the 7th District Tea-baggers.

“‘There needs to be a change,’ said Joe Mullins, who voted in Chesterfield County Tuesday. The engineering company employee said he has friends who tried to arrange town hall meetings with Cantor, who declined their invitations.”

“Brat has accused the House majority leader of being a top cheerleader for “amnesty” for immigrants in the U.S. illegally. Cantor has responded forcefully by boasting in mailers of blocking Senate plans ‘to give illegal aliens amnesty.'”

House Majority Leader Eric Cantor loses Virginia GOP primary, AP reports

The present atmosphere of The House has been one split three ways between Democrats, Republicans, and Tea-baggers. Almost nothing moves through The House having a progressive bend to it. If the Tea-baggers take a larger portion of the split, then the stance will be one of greater obstinacy. I am assuming this district will remain Republican or Tea-bagger even with the recent development.

It will be interesting to see if Cantor still runs and splits the Republican/Tea-bagger vote.

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What is Wrong with “Our” VA

This was an answer in the local Weekly Reader to a couple of others who insisted VA healthcare should be disassembled and handed over to the private sector. I guess I could have said “nuts; I did say “nonsense.”

“All right, they’re on our left, they’re on our right, they’re in front of us, they’re behind us…they can’t get away this time.” You figure out who said this.

Senator Bernie Sanders bill failed by 4 Republican votes to get out of the Senate. Within that bill there were several sections dealing with meeting the needs of veterans.

Section 327 would require VA to develop and transmit to Congress a strategic plan for improving access and quality of health care services for veterans in rural areas. This plan would include goals and objectives for: the recruitment and retention of health care personnel in rural areas; ensuring timeliness and improving quality in the delivery of health care services in rural areas through contract and fee-basis providers; implementation, expansion, and enhanced use of telemedicine services; ensuring the full and effective use of mobile outpatient clinics.

Section 501 would direct VA to reorganize the Veterans Health Administration (VHA) into geographically defined VISNs. In addition, it directs the Secretary to ensure that each VISN provides high quality health care to veterans, increases efficiency in care delivery, implements best practices, enhances collaboration with partner entities, among other management functions. Finally, this section requires the Secretary, at least every three years, to review and assess VISN structure and operations and submit review results to the Committees on Veterans’ Affairs.

Section 502 would require VA to establish not more than four regional support centers within VHA to assess how effectively and efficiently each VISN conducts outreach to veterans who served in contingency operations; administers programs for the benefits of women veterans; manages programs that address homelessness among veterans, and consumes energy. In addition, the regional support centers would assess the quality of work performed within finance operations, compliance related activities and such other matters concerning the operation and activities of each VISN as the Secretary considers appropriate. “Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014”

Here is what some of those needed four Republican Senators said:

“I don’t think our veterans want their program to be enhanced if every penny of the money to enhance those programs is added to the debt of the United States of America,” Senator Jeff Sessions Republican Alabama.

“Greatly expanded spending without any realistic offset,” as he dickered with Reid over sanctions on Iran. Republican Senator Mitch McConnell, Kentucky

“I think the decision we got here, as we debate this legislation, is whether we are going to commit to a promise that is bigger than what our kids can fulfill.”It costs more than our kids can afford (with a little sh*t-eating grin on his face). My colleagues pointed out most of the veteran organizations support this bill in fact correct. Senator Richard Burr Republican North Carolina

As far as the bill, the chairman has offered here, this bill has already been debated and there are problems with this bill that is an extensive piece of legislation that has many good elements in it. It also has a cost issue at a time when our nation owes $18 trillion and that was the reason why so may on my side of the aisle objected to it and that is why I would object as to the motion made here today by the Senator from Vermont.” Republican Senator Mario Rubio, FLA.

After causing Senator Bernie Sander’s bill to fail by 4 votes, these same 4 Senators are now trying to get to the bottom of why there are delays in getting care for veterans. The VA has always had a degree of issues with it in waiting for the benefits offered and this has been the case for decades. Too often and too late much of the delay is the result of the lack of funding to meet the influx of newly discharged and veterans (disabled and healthy). The issue extends to the Vietnam Veterans who are now arriving at the VA installations with issues resulting from age. Old Mr. Invincible has seen a few instances of physical vulnerability.

To answer to the insistence on leaving Veteran healthcare to the free market, we pretty much have done so with everyday people over the decades. What have we experienced?

– Since the proposal of Hillarycare in the nineties, we have seen the cost of providing healthcare quadruple. There are no controls or incentives to stem the persistent and ever-increasing cost of healthcare by the industry as it is a service- for- fees- cost- model, which makes it money by selling you more. The US has one of the most expensive healthcare systems in the world without the benefit of the best care globally.

– We have left the training of doctors and the supply of them to the free market. Increasingly we are experiencing a shortage of primary care doctors not only at the VA; but, it is being experienced in the private healthcare market today. Only 20% of the students hoping to be doctors are going into primary care and the shortage is growing. “The US is short ~16,000 Primary-Care Doctors. The PPACA attempts to solve the problem by skewing funding and salary to primary care except Congress is cutting PPACA funding “Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts “catastrophic.” Nurse Practitioners are coming on line; but, the time table is long and they will not be abundant for years yet Some of this is a contrived shortage as cited by PNHP:

“(Nursing schools are trying to produce more Nurse Practitioners (NPs) to deal with the crisis in primary care, but have been consistently attacked by MDs who insist that NPs are not well enough educated to provide even routine primary care.)” “Lack of funding is the Real VA scandal”

– Try getting in to see a Cardiologist or specialist or primary care doctor in 2-3 weeks in the commercial market. You can not and the wait times extend outward from 1-3 months in private medical care clinics (my experience). This is typical. Phillip Longman the author of The Best Care Anywhere most recently pointed to the wait for a private clinic doctor’s appointment.

patients who already have good private insurance have trouble scoring an appointment with a primary care physician. Which is why, (Philip Longman interview at Vox) , wait times for an appointment in Los Angeles are on average up to 59 days and in Boston up to 63. Newspaper reports like that in the New York Times spotlight vets who have been able to get immediate appointments in the private sector.

Well I congratulate them.

Most people I know, even those with good health insurance have a pretty hard time finding a PCP whose practice is even open to new patients and have to wait a good long time for specialist care as well. How will the nation’s overtaxed primary care doctors suddenly be able to accommodate millions of vets when they can’t handle the patients they already have, plus the influx of patients who will now be insured thanks to the Affordable Care Act?”

And the acting VA Chief is planning on dumping thousands of veterans into the commercial market? The placing of Veterans in the commercial market will start an erosion of VA benefits for those who have earned it serving the “4 chicken-hawks” I named above who sent them to war.

– The VA offers more to veterans than what the private healthcare clinics can. As one Livingston Daily Veteran (Jim Pratt) pointed out: “The VA system has major advantages over private hospitals in some things- such as electronic medical records, coordinated care, and early screening and detection of issues that of are particular need for military veterans. U of M medical center does not screen for PTSD, or for titanium dust (Camp Victory), depleted uranium exposure (All our engagements since the 1980’s), or exposure to ionizing radiation. The VA can do those, and more.

Another veteran, Jack Samples points to the efforts of the Ann Arbor VA in handling its patient workload. Having been there myself, I can vouch for it also. Guarantees two-week maximum waits for primary care appointments, Provides 24-hour emergency care, provides daily urgent care for anyone who does not have an appointment but needs or wants to see a doctor, etc.

– VA Primary Care doctors are underpaid and making less than their commercial counterparts do. It is difficult to attract more primary care doctors to the VA when more can be made in commercial hospitals.

The list goes on, on how Congress has failed the veterans of this nation with some lame excuses for not funding the last two wars and preparing adequately to receive veterans. Much of this is not the fault of the VA. The generalities expressed by two readers do not hold up to a close examination and there is no economic reason to give veteran healthcare over to a failed private healthcare system which abandoned millions of people.

“The Architect of the VA’s Quality Transformation Under Clinton Speaks Out”, Phillip Longman

“VA Care: Still the Best Care Anywhere? Part II”, Phillip Longman

“How to Beat the Doctor Shortage”, Marsha Mercer

“The Best Care Anywhere”, Phillip Longman

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The Short Version–Piketty

June’s issue of Atlantic Monthly brings to the reader a series of graphs as presented by Derek Thompson’s “How the Rich Shall Inherit the Earth”. The article gives a pictorial representation of what has taken place since the eighties in skewing income to a small, very small group of individuals numbering < than a hundred thousand taxpaying households. The bulk of the ~1 % are much like the 99% and make their income mostly from wages. It is the 1% of the 1% who have excelled in making their money from investments and inheritances.

There are quite a few discussions going on at various blogs as to whether r > g or not and whether it is a fundamental law of capitalism/economics. Side comment; FIFA governs soccer games utilizing the laws of the game which are open to interpretation by various referees monitoring the game. Laws are not rules and are open to interpretation. Courts also give interpretations of laws, which can be superseded by higher courts. When various district federal courts disagree, SCOTUS can and may make an interpretation. There does not appear to be such a governing body in economics the same as FIFA or SCOTUS..

This one comment by Yves Smith caught my eye as it does ring true:

“What I’m bothered by is that the ‘fauxgressives’ are flogging Piketty, when I don’t see his argument as helpful to the left. If you believe r > g, then large and rising wealth disparity is a state of nature. You have handed the argument over to conservatives, who will contend that you have to interfere in a very basic way in the operations of capitalism to undo that.”

In my opinion, this result is not a natural state of being and it is the result of manipulation. In a series of charts, Thompson has captured what Piketty has said in 700 pages(?) and the result of the skewing of income to a minority of taxpaying households.

– Since the late seventies, income growth among the top 1 percent of Americans has outpaced the income growth of the other 99%. In further examining the 1%, it is the top 1% of the 1% which has experienced the greatest growth.

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– Thompson poses the question; Who are these people? and answers his own question “amongst the top 0.1 percent half work in finance or as corporate executives. They are people compensated directly or in­directly by the growth of the stock market in various forms other than payroll wages. In the past 30 years, CEOs at top firms have been paid more and more with stock.”

CEO Compensation

– Adding to his earlier comment; “the richer you are, the more likely it is that your wealth came from stocks and not income from payroll wages. Most people want to believe they are capable of achieving great wealth resulting from their labor and the wages paid for it. Wages resulting from Labor “are less relevant to earnings at the top of the income pyramid”.

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“The above chart compares the inflation-adjusted incomes of the top 0.1 percent with annual inflation-adjusted S&P 500 prices, both indexed to 100 beginning in 1913. (Note: The income numbers for the 0.1 percent come from Picketty and Saez. The real S&P prices come from Robert Shiller).”

– The importance of those various factors to the increase of 3.6 percentage points in the Gini index for total market income between 2002 and 2007 differs yet again. More than 80% of the total increase in the Gini index over those years stemmed from an increase in the share of total income coming from more highly concentrated capital gains. An increase in the concentration of capital income accounts for most of the remaining increase. Labor income became somewhat less concentrated over that period, but the effect on overall income dispersion was small.” Page 12-13, Trends in the Distribution of Household Income Between 1979 and 2007

Gini

– ‘The top 1% of US households, own 38.2% of all US stock market wealth and the richest 10% of households own a combined 81.2% of all the stock market wealth, whilst the bottom 60% of US households only own 2.5% of stock market wealth.'”

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Taken from: Economic Policy Institute, “‘The State of Working America 2011, Share of Stock Holdings Held by Top 10% Has Barely Budged in Last Two Decades.’ Includes direct ownership of stock shares and indirect ownership through mutual funds, trusts, IRAs, Keogh plans, 401(k) plans, and other retirement accounts.

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