Archive for the ‘Healthcare’ Category
Brave New Films has a series Over-Criminalized, the first part of which is a look at defining mental illness as a crime worthy of prison time. Another film in the series looks at how homelessness is also a crime in much of the US. It’s as if the state and federal government and policymakers, have decided that the police are best equipped to deal with social problems, by locking people away, much as in international affairs the US relies mostly on its military to deal with the challenges of international relations. If your primary reflex is armed response, every problem looks like an enemy and every approach to solving it is treated as a war.
The first film in the series, shown below, is only 8 minutes long, and it’s worth watching. Their blurb:
Instead of helping the mentally ill, police often put them behind bars. Watch how one police department is making a positive difference.
It’s simple. Diversion programs work better than incarceration – for everyone. In cities like Seattle, San Antonio, and Salt Lake City, we see that successful solutions are a viable option to help end serious social problems. These services alter the course of people’s lives in a positive way and save taxpayers huge amounts of money. We cannot continue to isolate and imprison people who suffer from mental illness, substance abuse, or homelessness. We must treat them with compassion and care to better serve our communities and our pocketbooks.
It’s time we got serious about pulling our money out of incarceration and putting it into systems that foster healthy communities. Hundreds of thousands of people are locked up not because of any dangerous behavior, but because of problems like mental illness, substance use disorders, and homelessness, which should be dealt with outside the criminal justice system. Services like drug treatment and affordable housing cost less and can have a better record of success.
This summer, news stories from around the nation provided the American people with a litany of issues about how police officers respond to community members. By highlighting programs like Crisis Intervention Training (CIT), Law Enforcement Assisted Diversion (LEAD), and Housing First, OverCriminalized explores the possibility of ending incarceration for millions of Americans who, through successful intervention programs, can put their lives back on track.
OverCriminalized focuses on the people who find themselves being trafficked through this nation’s criminal justice system with little regard for their humanity and zero prospects for actual justice. They are victims of unwillingness to invest in solving major social problems, and the consequent handling off of that responsibility to the police, the courts, and the prisons. They are the mentally ill, the homeless, and the drug addicted. Sometimes they are all three.
Quick facts on over criminalization:
- Approximately 20 % of state prisoners and 21 % of local jail detainees have a “recent history” of a mental health condition.
- Approximately 26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders.
- In 2012, it was estimated that 23.1 million Americans needed treatment for problems that related to drugs or alcohol.
- Pew Research finds that 67% of Americans say that the government should focus more on providing treatment for those who use illegal drugs such as heroin or cocaine. Just 26% think the government’s focus should be on prosecuting users of such hard drugs.
Wal-Mart is using an Obamacare provision to stop paying for health insurance for employees working under 30 hours per week.
Totally sensible move for Wal-Mart: cut costs by externalizing the price of healthcare insurance—the workers without healthcare insurance from their employer can get health insurance from Obamacare, and in that income bracket, subsidies as well. Plus they have more coverage choices (the various plans). So it works out well for the employees, too.
Should this practice not be illegal?
“Best medical system in the world”: ER physicians are now independent contractors and do not accept insurance
The US developed a medical system that uses the free market to resolve problems, rather than socialistic single-payer system (as in, say, France). The US approach has some serious problems if you need to go to the ER. But probably the invisible hand of the market will fix that. /sarcasm
UPDATE: Kevin Drum has a good post on this.
Once they’ve collected your insurance premiums, health insurance companies are loathe to spend that money
Basically, insurance companies love having the money come in as premiums, but they hate paying out settlements and in general do everything in their power to stall and reduce payments. Now they have adopted a new tactic, reported by Charles Ornstein at ProPublica:
Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.
Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments. But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.
The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments “non-preferred,” according to the editorial.
“It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,” the editorial says. “One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.”
I recently wrote about the confusion I faced with my infant son’s generic asthma and allergy medication, which switched cost tiers from one month to the next. Until then, I hadn’t known that my plan charged two different prices for generic drugs. If your health insurer does not use such a structure, odds are that it will before long.
The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Servicesclaiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.
Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.
“It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,” said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.
Turner said he feared a “race to the bottom,” in which plans don’t want to be seen as the most attractive for sick patients. “Plans do not want that reputation.”
In July, more than 300 patient groups, covering a range of diseases, wrote to Sylvia Mathews Burwell, the secretary of health and human services, saying they were worried that health plans were trying to skirt the spirit of the law, including how they handled co-pays for drugs.
Generics, which come to the market after a name-brand drug loses its patent protection, used to have one low price in many insurance plans, typically $5 or $10. But as their prices have increased, sometimes sharply, many insurers have split the drugs into two cost groupings, as they have long done with name-brand drugs. “Non-preferred” generic drugs have higher co-pays, though they are still cheaper than brand-name drugs.
With brand names, there’s usually at least one preferred option in each disease category. Not so for generics, the authors of the editorial found.
One of the authors, Gerry Oster, a vice president at the consulting firm Policy Analysis, said he stumbled upon the issue much as I did. He went to his pharmacy to pick up a medication he had been taking for a couple of years. The prior month it cost him $5, but this time it was $20.
As he looked into it, he came to the conclusion that this phenomenon was unknown even to health policy experts. “It’s completely stealth,” he said. . .
Obviously some laws and regulations will be needed to prevent this sort of discriminatory price.
Greg Gordon reports for McClatchy:
During a meeting that was secretly recorded, a salesman for Reliance Medical Systems promised that within a month or two of joining its illicit kickback scheme, spinal surgeons could collect enough money to pay for their kids’ college educations, Justice Department lawyers charge.
Taxpayers were the multimillion-dollar sugar daddies in this plot, initially uncovered by two doctors-turned-whistle blowers who could collect a sizable reward under a law compensating those whose tips lead to federal financial recoveries.
In May 2010, a Michigan spinal surgeon bought into one of the schemes that aimed to circumvent a federal law barring device manufacturers from making payments to induce physicians to use their products, the government alleges in two suits filed under the federal False Claims Act.
One suit charges that Dr. Aria Sabit, who now lives in Birmingham, Mich., and Sean Xie, who was studying under Sabit, each paid $5,000 to become an investor in Apex Medical Technologies, a distributorship for Southern California-based Reliance. That month, the government alleges, each got back $20,117 from Apex – a return of more than 400 percent in 30 days’ time.
That was just the beginning.
Over the next nine months, Apex paid Sabit $264,957 while he repeatedly used Reliance products for spinal fusion surgeries, some of them unnecessary – and $483,570 before he stopped using Reliance equipment, the suit said. Sabit also presumably collected handsome physician fees for his services.
Meanwhile, Community Memorial Hospital in Ventura, Calif. paid Apex $1.4 million for the cost of the implants that Sabit used in his surgeries.
The hospital, in turn, billed Medicare – and federal taxpayers – for nearly all of those devices.
A second California-based Reliance distributorship, known as Kronos Spinal Technologies, made improper payments to two other physicians, Drs. Ali Mesiwala and Gowriharan Thaiyananthan, the suit said. Kronos was based at the same Jacksonville, Fla., address as Apex, it said. One of the distributorships’ owners allegedly was recorded as saying that the scheme was formed as part of a plan to “get around” the federal Anti-Kickback Statute, it said.
In July 2011, Mesiwala was recorded as stating that there was an “expectation” that doctors who bought into the distributorships would be using Reliance equipment, the suit said. He also was quoted as saying: “If you truly are in this to make money and you have a finite time limit to do it, I don’t know a better way to do it.”
Kronos paid its investor physicians $4.9 million from August 2007 through September 2012, the government said. . .