Archive for the ‘Healthcare’ Category
The VA too often fails in its mission, and very little seems to be done to fix that. If we had a functioning Congress, they could exercise their oversight, but Congress is almost totally dysfunctional at this point. Caitlin Dickerson reports on NPR (and there’s an audio report at the link):
In secret chemical weapons experiments conducted during World War II, the U.S. military exposed thousands of American troops to mustard gas.
When those experiments were formally declassified in the 1990s, the Department of Veterans Affairs made two promises: to locate about 4,000 men who were used in the most extreme tests, and to compensate those who had permanent injuries.
But the VA didn’t uphold those promises, an NPR investigation has found.NPR interviewed more than 40 living test subjects and family members, and they describe an unending cycle of appeals and denials as they struggled to get government benefits for mustard gas exposure. Some gave up out of frustration.
In more than 20 years, the VA attempted to reach just 610 of the men, with a single letter sent in the mail. Brad Flohr, a VA senior adviser for benefits, says the agency couldn’t find the rest, because military records of the experiments were incomplete.
“There was no identifying information,” he says. “No Social Security numbers, no addresses, no … way of identifying them. Although, we tried.”
Yet in just two months, an NPR research librarian located more than 1,200 of them, using the VA’s own list of test subjects and public records.
The mustard gas experiments were conducted at a time when American intelligence showed that enemy gas attacks were imminent. The tests evaluated protective equipment like gas masks and suits. They also compared the relative sensitivity of soldiers,including tests designed to look for racial difference.
The test subjects who are still alive are now in their 80s and 90s. Each year more of their stories die with them.
“We weren’t told what it was,” says Charlie Cavell, who was 19 when he volunteered for the program in exchange for two weeks’ vacation. “Until we actually got into the process of being in that room and realized, wait a minute, we can’t get out of here.” . . .
There’s lots more: it’s a lengthy report.
Justice Scalia seems to have trouble remembering his own opinions. Linda Greenhouse reports in the NY Times:
Sometimes the Supreme Court moves in mysterious ways. The health care decision was not one of those times.
A case that six months ago seemed to offer the court’s conservatives a low-risk opportunity to accomplish what they almost did in 2012 — kill the Affordable Care Act — became suffused with danger, for the millions of newly insured Americans, of course, but also for the Supreme Court itself. Ideology came face to face with reality, and reality prevailed.
The 6-to-3 vote to reject the latest challenge means that one or perhaps two of the justices who grabbed this case back in November had to have jumped ship. Here’s why: It takes at least four votes to add a case to the court’s docket. Given that the decision to hear this case, King v. Burwell, was entirely gratuitous — the Obama administration had won in the lower court, and an adverse decision in a different appeals court had been vacated — we can assume the votes came from the four justices who nearly managed to strangle the law three years ago in National Federation of Independent Business v. Sebelius.
These four were Justices Anthony M. Kennedy, Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. Maybe Chief Justice John G. Roberts Jr., excoriated in right-wing circles for having saved the statute with a late vote switch last time, also agreed to hear the new case. Or maybe his four erstwhile allies were trying to put the heat on him. It’s a delicious question without, at least for now, an answer.
When I think of this case on its trajectory toward the court, the image that comes to mind is of the great white shark in “Jaws,” swimming silently under the water, its lethal teeth bearing down on the statutory language freshly discovered by the administration’s enemies: “Exchange established by the State.”
Do “words no longer have meaning,” as Justice Scalia put it in his angry dissenting opinion? What, after all, could be clearer? The state, not the federal government. The two are not the same. They are different! So poor and middle-class people in the 34 (mostly red) states that refused to set up their own insurance exchanges, defaulting that task to the federal government, are just out of luck. They aren’t eligible for tax subsidies to help them buy insurance, subsidies that are critical to making the law work. End of story, end of case, end of the Affordable Care Act (or Scotuscare, as Justice Scalia said the law should be re-named).
The chief justice’s masterful opinion showed that line of argument for the simplistic and agenda-driven construct that it was. Parsing the 1,000-plus-page statute in a succinct 21-page opinion, he deftly wove in quotations from recent Supreme Court opinions.
Who said that we “must do our best, bearing in mind the fundamental canon of statutory construction that the words of a statute must be read in their context and with a view to their place in the overall statutory scheme”? Why, it was Justice Scalia (actually quoting an earlier opinion by Justice Sandra Day O’Connor) in a decision just a year ago.
And who said that “a provision that may seem ambiguous in isolation is often clarified by the remainder of the statutory scheme” because “only one of the permissible meanings produces a substantive effect that is compatible with the rest of the law”? Why, Justice Scalia again.
“In this instance,” Chief Justice Roberts wrote, “the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” He concluded: “A fair reading of legislation demands a fair understanding of the legislative plan.” Among the chief justice’s silent partners in the six-justice majority opinion was Justice Kennedy, by most accounts the driving force behind the near miss three years ago. . .
An editorial in the NY Times:
One would imagine that congressional Republicans, almost all of whom are on record as adamantly opposing abortion, would be eager to fund programs that help reduce the number of unwanted pregnancies.
That would be the common sense approach, anyway.
And yet since they took over the House in 2011, Republicans have been trying to obliterate the highly effective federal family-planning program known as Title X, which gives millions of lower-income and rural women access to contraception, counseling, lifesaving cancer screenings, and treatment for sexually transmitted diseases.
They tried and failed in 2011, when the Senate was under Democratic control — although they still managed to extract significant cuts from an already underfunded program. Now that Republicans run the show, opponents of sensible and effective family planning are back to kill it off for good. Last Tuesday, a House subcommittee on Labor, Health and Human Servicesproposed to eliminate all Title X funding — about $300 million — from a2016 spending bill.
The bill would also slash funding by up to 90 percent for sex education, specifically President Obama’s teen-pregnancy prevention initiative. The only winner was abstinence-only education, whose funding the subcommittee voted to double, despite the fact that it has basically no effect on abstinence and has been associated with higher rates of teen pregnancy.
Meanwhile, Title X, which was enacted by overwhelming bipartisan majorities in Congress in 1970, is caught up once again in the nation’s abortion wars — even though like all federal programs, it is barred from providing any funding for abortions.
Republicans have complained that this ban is subverted by Planned Parenthood, which performs abortions and is Title X’s biggest recipient. They want to deny the organization any federal funds at all. But 90 percent of the women who visit Planned Parenthood clinics are there to get contraception or other reproductive health care, not abortions.
What Title X grants actually do is help prevent unwanted pregnancies —more than one million in 2012, which translates to about 363,000 abortions avoided. . .
Willoughby Mariano reports in the Atlanta Journal Consitution:
Since 2000, the state’s largest hospital has failed to tell police about as many as 1,500 possible sex crimes, including more than 130 where the victims asked the hospital for help to bring rapists to justice, an Atlanta Journal-Constitution investigation found.
Grady Memorial officials said a federal medical privacy law blocked them from alerting police or providing them with evidence they collected from patients, such as bodily fluids and hair.
But had staff notified police when they learned of the possible crimes, the federal law would have been no barrier, legal experts told the AJC. What’s more, state law requires hospitals to alert law enforcement to injuries that may have been caused by a crime. Other hospitals contacted by the AJC said they report immediately and give the evidence stored in “rape kits” to investigators.
As it is, victims at Grady may have undergone an invasive, grueling rape exam for nothing, advocates said, and dangerous criminal may have gone unpunished. Police could have been flagged to patterns of attacks. Entering DNA samples into a national database could have unmasked attackers who were strangers to their victims or prevented serial rapists from striking again.
Grady officials later acknowledged that 136 patients who said they were raped had requested in writing that the hospital turn over findings and answer questions from police. Hospital Attorney Timothy Jefferson wouldn’t say why those assaults were not reported to law enforcement.
“Obviously there was a mistake made somewhere. Or something else happened,” Jefferson told the AJC.
He insists, though, that the federal Health Insurance Portability and Acccountability Act barred the hospital from notifying police. If Grady doesn’t have patients’ written and verbal consent to provide evidence to police, it locks the rape kits away in a storage room. There they stay unless patients change their minds and file police reports themselves.
He said he disagrees with the other attorneys’ interpretation of the federal law, and that Grady plans no immediate changes in its policy.
Following the AJC’s inquiries, Grady did hand Atlanta police the 136 rape kits, without telling them why. . .
For-profit hospitals should be made illegal in all states, as they are in some, and for a very good reason: they mercilessly gouge people who are ill and cannot fight back. Wendell Potter reports at the Center for Public Integrity:
If you think costs would come down if hospitals were all owned and operated by big for-profit corporations like Hospital Corporation of America, you might want to take a look at a study published last week by the journal Health Affairs.
Of the 50 U.S. hospitals that mark up prices the most, 49 of them are part of for-profit hospital chains, according to the study’s authors, Ge Bai of Washington & Lee University and Gerard Anderson of the Johns Hopkins Bloomberg School of Public Health.
Using 2012 data provided by 4,483 hospitals to the Centers for Medicare and Medicaid Services, Bai and Anderson found that those 50 had an average markup of 1,013 percent over what Medicare pays for the thousands of items on hospitals’ “chargemasters.” (Chargemasters are lists of all the items and services hospitals bill for. Hospitals set their own charges. Few states set any limits on what hospitals can charge.) That’s almost three times the average markup at the other 4,433 hospitals. The average markup for all those other hospitals—most of them nonprofits—was 340 percent.
Of those high-markup 50, more than a fourth of them are owned and operated by Nashville-based Hospital Corporation of America (HCA). But with 14 hospitals on the list, HCA was just in second place. A full half of the top 50 are owned by HCA’s biggest rival, Community Health Systems, a Franklin, Tennessee company that operates 199 hospitals in 29 states.
At the very top of the markup list was North Okaloosa Medical Center in Crestview, Florida. That hospital, in the Sunshine State’s panhandle, had the distinction of marking up its costs an average of 1260 percent. The Atlantic’s Olga Khazan took a look at North Okaloosa’s markups. She found, for example, that the hospital charged $79,350 to treat a hemorrhage. That’s compared to Medicare’s reimbursement of $5,177.
As the authors noted in their Health Affairs article, “Collectively, this system (of giving hospitals free rein to mark up their costs) has the effect of charging the highest prices to the most vulnerable patients and those with the least market power.” Those who are the most vulnerable, of course, are the uninsured and under-insured. Bai and Anderson pointed out that even when (or if) the Affordable Care Act is fully implemented, there will still be 30 million people without insurance. When those folks get sick or injured and wind up in the hospital, they’ll be on the hook to pay whatever the hospitals decide to charge. This means that even with the ACA, thousands of families will still find themselves in bankruptcy court every year because of medical bills they can’t possibly pay.
(Note to the uninsured: it’s in your best interest to find out which hospitals near you are nonprofit and which ones are for-profit. And that’s not just because the for-profits’ markups are higher. The ACA requires nonprofit hospitals to provide discounts to eligible uninsured patients. There are no such requirements for for-profits.)
Most of the high-markup hospitals are in the South. And of the top 50, 20 are in for-profit-hospital-friendly Florida, whose governor is former HCA CEO Rick Scott.
Scott has a long history in the world of for-profit health care. When I worked for Humana in the early 1990s, the company decided to sell its hospital division, and Scott and one of his business partners at the time, David Vanderwater, bought them. Soon after that, Scott negotiated a merger with HCA and became the combined company’s chief executive. He resigned from HCA in 1997 after the government launched an investigation into whether the company had committed Medicare fraud. . .
Big surprise: he has nothing unless he lies, so he lies.
As long as we’re on the subject of how poor people get screwed in the United States, the Washington Post revisits an old favorite today: the way hospitals gouge the uninsured. Here’s their summary of a new study that looks at the 50 biggest gougers, which charge uninsured patients more than ten times the actual cost of care:
All but one of the these facilities is owned by for-profit entities, and by far the largest number of hospitals — 20 — are in Florida. For the most part, researchers said, the hospitals with the highest markups are not in pricey neighborhoods or big cities, where the market might explain the higher prices.
….Community Health Systems operates 25 of the hospitals on the list; Hospital Corp. of America operates another 14. “They are price-gouging because they can,” said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health, co-author of the study in Health Affairs. “They are marking up the prices because no one is telling them they can’t.”
….Most hospital patients covered by private or government insurance don’t pay full price because insurers and programs like Medicare negotiate lower rates for their patients. But the millions of Americans who don’t have insurance don’t have anyone to negotiate on their behalf. They are most likely to be charged the full hospital price. As a result, uninsured patients, who are often the most vulnerable, face skyrocketing medical bills that can lead to personal bankruptcy, damaged credit scores or avoidance of needed medical care.
It’s hard to find the words to describe how loathsome this is. It’s a structure deliberately designed to bleed the maximum possible amount from the people who are least able to afford it and least able to fight back. We normally associate this kind of thing with Charles Dickens novels, or with thugs in leather jackets who have a habit of breaking kneecaps. But these thugs all wear suits and ties.
I’m not really sure how they sleep at night, but I guess they find a way.