Tag Archives: health care

The Rape of Florida Medicaid


The other day, in my post Without a Doctor, I claimed that the Medicare system here in Florida had been raped by the gubernatorial administrations of Jeb Bush and Charlie Crist; thus decimating their effectiveness as originally envisioned.

In the comments section of The VSJ, in ekg’s post They Really Will Stop at Nothing…our sparring partner lilMike, in a reply to me, asked:

Medicaid in Florida is trashed because Republicans have ruined it?

The short answer: YES! ABSOLUTELY!

In 1965, President Johnson signed the law establishing Medicare and Medicaid. The original purpose of the Medicaid program was:

The Medicaid program, authorized under Title XIX of the Social Security Act, was enacted to provide health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities.

Going way back to the days of Gov. Claude Kirk (whom I had the pleasure to know personally, regardless of his political leanings), Medicaid has been a prime target of Republican Death Squads.

Gov. Bob Martinez (whom I worked under while with the Florida Board of Nursing) cut, sliced, and pared Medicaid at an alarming rate, especially with regards to our elderly.

But it wasn’t until the reign of Jeb Bush (for whom I billed Medicaid and Medicare at a home health agency) that Medicaid in this state went under the greatest change.

One of Jeb’s first actions upon taking office was to kill his predecessor’s, Lawton Chiles (the only Florida governor in recent history to actually care about health care for children, the disabled and the poor) health care initiative for individuals and small businesses, the Florida Health Care Purchasing Alliance.

But that wasn’t Jeb’s first foray into the rape of Medicaid. In 2003:

Governor Bush is proposing to drop health care and long-term care coverage for about 26,000 seniors and people with disabilities, although they would retain prescription drug coverage.  The governor also is proposing steep increases in co-payments for prescription drugs, which likely would make it harder for some poor patients to afford their medications.  The state already implemented modest cuts in the Medicaid eligibility of elderly and disabled people last year.

In 2005, Jeb had the bright idea (not!) to be among the first to follow his brother George’s edict to make state Medicaid coverage over modeling it like (get this!) a health insurance company, complete with limits on coverage:

Gov. Jeb Bush of Florida and Gov. Mark Sanford of South Carolina, both Republicans, have proposed radical changes intended to inject market forces and competition into Medicaid. Under their proposals, the state would give Medicaid recipients a fixed amount of money to buy health care or private insurance.

Under Governor Bush’s proposal, Florida would contribute a fixed amount toward coverage for each Medicaid beneficiary. Patients could use the money to “opt out of Medicaid altogether and purchase health care insurance in the private market,” Mr. Bush said.

(Ironically, today Jeb is on the board of Tenet Healthcare, the same company required to repay the government over 900 million dollars in Medicare and Medicaid overpayments and is plagued by scandal after scandal.)

Even today, Jeb Bush’s failed Medicaid managed care decisions are affecting the State negatively:

”We’ve done the experiment. It has failed,” said Durell Peaden, the Senate’s health care budget chief. “The reports are unsettling. People couldn’t get to specialists, couldn’t get adequate care. And they couldn’t do it cheaply.”

I’m sure Lawton Chiles, the only Florida governor in 40 years to care about it’s citizens, is rolling in his grave right now
 
The son of Gov. Lawton Chiles said today Gov. Charlie Crist has “betrayed” needy children and old people by raiding a tobacco-funded trust fund for $700 million needed to balance Florida’s budget.
 

Is Health Care Reform Constitutional?


Is it a right? Are the American people guaranteed good health?

That’s a question I’ve seen a lot over the past year or so. Many of those opposed to health care reform often cite the Constitution; usually with the rally cry,

WE THE PEOPLE

Perhaps they should read a little further…

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Here’s the definition of “Welfare” from Merriam Webster: “of, relating to, or concerned with welfare and especially with improvement of the welfare of disadvantaged social groups…”

From The Free Dictionary: “Health, happiness, and good fortune; well-being.”

We The People, Indeed!

The Health Care Summit


Courtesy The Huffington Post

Here’s a look at yesterday’s Health Care Summit (kudo’s to The Huffington Post for publishing a full transcript of the summit) I’ve highlighted Republican talking points and constructive dialogue in Red, Democrats in Blue:

THE PRESIDENT: Good morning, everybody. Welcome. Thank you so much for participating today. I am very grateful to all of you because I know how busy you are.

THE PRESIDENT: …it’s for that reason that last year, around this time, actually, I hosted in the White House a health care summit and indicated to Congress that it was absolutely critical for us to begin now moving on what is one of the biggest drags on our economy and represents one of the biggest hardships that families face.

SEN ALEXANDER: …clean sheet of paper

SEN ALEXANDER: …start over

THE PRESIDENT: Well, thank you, Lamar.

SPEAKER PELOSI: It was almost a year ago, March 5th of last year, when you brought us together in a bipartisan way to set us on a path to lower cost, improved quality — expand access to quality health care for all Americans. In the course of that time in our committees in the House and the Senate, we’ve had lively discussions. Here we are today.

SENATOR REID: Mr. President, my friends in the House and in the Senate, I want to spend a few minutes talking about Nevada, about our country, and not what’s going on here in Washington. I want to start by talking about a young man by the name of Jesus Gutierrez. He works hard. He has a restaurant in Reno, Nevada. He had everything that he wanted, except a baby. He had health insurance. He had employees that liked him. But he was fortunate — they were going to have a baby and it was going to be a little girl. And the baby was born, and in just a few minutes after the birth of that baby, he was told that the baby had a cleft pallet. “But that’s okay,” he was told. “We can take care of that.” And they did. They did some surgery on the baby; he was happy — that is, Jesus was happy — until he got his mail four months later, opened the envelope, and the insurance company said, “We didn’t realize that your baby had a preexisting disability. We’re not covering the $90,000 in hospital and doctor bills you’ve already run up.” So he’s trying to pay that off. The baby needs a couple more surgeries. This shouldn’t happen to anyone in America. He had health insurance. He paid his premiums. 

THE PRESIDENT: Well, thank you very much, Harry…  just want to address very quickly, Lamar, the issue of process that you raised at the beginning and then we’ll move on and start talking about the specifics. As I listened to your description of the House/Senate bill, as well as the proposal that I put on our Web site, obviously there were some disagreements about how you would characterize the legislation.

On the other hand, when I listened to some of the steps that you thought Republicans would be open to, I thought, well, a bunch of these things are things that we’d like to do, and in fact are in the legislative proposals.

SEN ALEXANDER: Well, may I — may I — You’ve made some interesting points…

SENATOR McCONNELL: …some liberties have been taken here…

SENATOR COBURN: …with young kids going to the ER, whether they have meningitis or asthma, they’re going to get treated in this country…

THE PRESIDENT: Well, Tom, I appreciate what you said. I think we’re going to have Steny Hoyer go next. I just want to make this quick point. Every good idea that we’ve heard about reducing fraud and abuse in the Medicare and Medicaid system, we’ve adopted in our legislation. So that’s an example of where we agree — we want to eliminate fraud and abuse within the government systems.

You mentioned the idea of buying across state lines, insurance. That’s something that I’ve put in my proposal that’s actually in the Senate proposal.

CONGRESSMAN HOYER: Mr. President, thank you very much. A quote I will use is, we should have available and affordable health care to every American citizen, to every family. I suppose there are a whole lot of every Americans and American families listening to us today and watching us, and they’re hoping that we’re all sitting around here talking about them, not about us.

THE PRESIDENT: Before you go, Max, I just want to ask, whether it’s you, Tom, or anybody else on the Republican side, and maybe some of the House members might be interested — Senator Coburn mentioned some cost containment issues where it sounds like we agree: fraud and abuse. We agree. It sounds like you have maybe one other idea that you don’t think is in our proposal, but the idea of undercover patients, but that’s something that I’d be very interested in exploring. I don’t think conceptually that would be a problem.

CONGRESSMAN KLINE: …we’re looking at thousands of pages of legislation…

SENATOR BAUCUS: Sure. Absolutely, though I’d first like to say something that just strikes me just in spades. Frankly, we all have studied this issue a lot — health care reform. We basically know what the problems are, all of us. We basically know that the current system is unsustainable. We are actually quite close.

CONGRESSMAN CAMP: …maybe you shouldn’t be spending a trillion dollars on health care…

THE PRESIDENT: Dave, I don’t mean to interrupt. But the — we’re going to have the whole section talking about deficits. And we can talk about the changes in Medicare. We were trying to focus on costs related to lowering families’. And the only concern I’ve got is — look, if every speaker at least on one side is going through every provision and saying what they don’t like, it’s going to be hard for us to see if we can arrive at some agreements on things that we all agree on.

CONGRESSMAN CAMP: …mandates…

CONGRESSMAN ANDREWS: Thank you, Mr. President. I want to thank my friend Tom Coburn, and John Kline, for the spirit of conversation which they offered and try to carry that forward a little bit. The President asked at the beginning of this what ideas do we share about cutting costs. And Tom, I think you had some very good ones. Fraud, that the President has a proposal that says we should have a database, if you’ve committed fraud against Medicare once, you can’t make a contract again. Wellness, there’s a lot of good ideas in the bills. Junk lawsuits, I think that there’s — what Secretary Sebelius is doing is very important in curtailing that.

CONGRESSMAN KLINE:…I don’t hear people complaining about the insurance policies that they’re getting from their big companies.

CONGRESSMAN ANDREWS: But, John, would you favor a standard that says they have to do something like that or would you just leave it up to the insurance company?

SENATOR McCONNELL: Mr. President, could I just interject one quick point here very quick, just in terms of trying to keep everything fair, which I know you want to do. To this point, the Republicans have used 24 minutes, the Democrats 52 minutes.

THE PRESIDENT: I’m the President and so I made — (laughter) — I didn’t count my time in terms of dividing it evenly. In this section, Mitch, we’ve gone back and forth pretty well.

THE PRESIDENT: But I just wanted to point out that when we start talking about how much government involvement is at issue here, it’s not because the House or the Senate bills are a government takeover of health care; it is that the House and the Senate bills put in place some regulations that restrict how insurance companies operate, and if there’s an exchange or a pool that’s set up, that there’s a baseline sort of minimum requirements that were expected. And I understand that there may be some philosophical differences on the other side of the aisle about that issue.

SENATOR KYL: federal government would mandate it under your legislation

THE PRESIDENT: Okay, Jon. I’m going to go to you, Jim, but I — since as has tended to happen here, we end up talking about criticisms of the existing bill as opposed to where we might find agreement

THE PRESIDENT: Okay. I think this has actually been a very useful conversation. What I’m going to do is move on to the next topic, but maybe after we break for lunch and come back, I want to go through some areas where we decided we agreed and I know that abuse is a good example; some areas where we still disagree.

SENATOR KYL: …employers would drop you from their coverage…

REPRESENTATIVE BOUSTANY: …take a step back, and go step by step…

THE PRESIDENT: Okay. Thanks, Charles. We’re going to go to George Miller — and if you want to respond to some specific things that Charles raised or make some more general points. We’ll then go back to a Republican. At some point in this discussion — and we’re going to have to be a little more disciplined in our time in order to stay on schedule on this section — at some point I’d like Secretary Sebelius, who is not only a former governor but also an insurance commissioner, to address some of the issues that have been coming up around insurance and minimum payment.

SENATOR McCAIN: …the 2,400 pages…unsavory…deal-making…people are angry…special interests…PhRMA

THE PRESIDENT: John, can I just say —

SENATOR McCAIN: Can I just finish, please?

…back to the beginning

THE PRESIDENT: Let me just make this point, John, because we’re not campaigning anymore. The election is over.

SENATOR McCAIN: I’m reminded of that every day. (Laughter.)

THE PRESIDENT: Yes. So we can spend the remainder of the time with our respective talking points going back and forth. We were supposed to be talking about insurance.

SENATOR McCAIN: Could I just say, Mr. President, the American people care about what we did and how we did it. And I think it’s a subject that we should discuss. And I thank you.

THE PRESIDENT: They absolutely do care about it, John. And I think that the way you characterized it obviously would get some strong objections from the other side. We can have a debate about process, or we can have a debate about how we’re actually going to help the American people at this point. And I think that’s — the latter debate is the one that they care about a little bit more.

REPRESENTATIVE CANTOR: Mr. President, thank you again very much for having us and for staying with us for the six hours. I appreciate that. I don’t know if you will after the six hours or not. But I want to — (Places stack of papers on table…)

THE PRESIDENT: Let me just guess — that that’s the 2,400-page health care bill. Is that right?

REPRESENTATIVE CANTOR: We don’t care for this billthere are plenty of taxes additional taxes mandate…

THE PRESIDENT: Well, let me — since you asked me a question, let me respond. The 8 to 9 million people that you refer to that might have to change their coverage — keep in mind out of the 300 million Americans that we’re talking about — would be folks who the CBO, the Congressional Budget Office, estimates would find the deal in the exchange better. It would be a better deal. So, yes, they would change coverage, because they’ve got more choice and competition. So let’s just be clear about that, point number one.

Point number two, when we do props like this — stack it up and you repeat 2,400 pages, et cetera — you know, the truth of the matter is that health care is very complicated.

And we can try to pretend that it’s not, but it is. Every single item that we’ve talked about on the Republican side, if we wanted to exhaustively deal with fraud and abuse, would generate a bunch of pages. So I point that out, just because these are the kind of political things we do that prevent us from actually having a conversation.

Now, let me respond to your question. We could set up a system where food was probably cheaper than it is right now if we just eliminated meat inspectors and we eliminated any regulations in terms of how food is distributed and how it’s stored. I’ll bet in terms of drug prices, we would definitely reduce prescription drug prices if we didn’t have a drug administration that makes sure that we test the drugs so that they don’t kill us.

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Health Care: The President’s Plan


A short while ago The White House released the President’s plan for health care. An extensive and comprehensive plan, it’s an excellent compromise of  the House and Senate legislation.

The Wonk Room has an excellent overview of the President’s proposal and a comparison between it, the Senate version and the House version. From The White House:

Overview of the President’s Proposal

The President’s Proposal puts American families and small business owners in control of their own health care.

  • It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
  • It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
  • It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
  • It will end discrimination against Americans with pre-existing conditions.
  • It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Although the plan does not include a Public Option, it would be safe to say that such an option will be within the bill when it is passed through reconciliation, hopefully within the next two months.

Where does this leave the Republicans? After more than a year of record-breaking obstructionism, it’s time for them to get on the bus and work with the President and Congress on this issue, or continue their non-productive agenda.

We’ll know in three days

The President should be commended for his actions and the obvious action right now is to do what Steve Benen of The Washington Monthly said last month:

Pass the damn bill.

Just Pass the Damn Bill!


I’m a big fan of Steve Benen over at The Washington Monthly. Here’s his latest post in it’s entirety. I couldn’t agree more!

I have no idea whose advice would be most likely to influence congressional Dems on health care reform, but Paul Krugman was recently named the most influential commentator in the nation, so here’s hoping his message gets through: “Stop whining, and do what needs to be done.”

A message to House Democrats: This is your moment of truth. You can do the right thing and pass the Senate health care bill. Or you can look for an easy way out, make excuses and fail the test of history.

Tuesday’s Republican victory in the Massachusetts special election means that Democrats can’t send a modified health care bill back to the Senate. That’s a shame because the bill that would have emerged from House-Senate negotiations would have been better than the bill the Senate has already passed. But the Senate bill is much, much better than nothing. And all that has to happen to make it law is for the House to pass the same bill, and send it to President Obama’s desk.

Right now, Nancy Pelosi, the speaker of the House, says that she doesn’t have the votes to pass the Senate bill. But there is no good alternative. […]

[S]ome Democrats want to just give up on the whole thing. That would be an act of utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care — remember, both houses of Congress have already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual.

 Americans have been waiting for this for a century. The top domestic policy priority of the Democratic Party for generations is right there in front of them, just waiting for a single roll-call vote.

House passage of the Senate bill would help millions suffering under the dysfunctional status quo. It would prove that Democrats can deliver on their agenda. It would take advantage of a once-in-a-generation opportunity and be a historic achievement. It would steer clear of electoral suicide that would cost Democrats’ their majority and leave the country much worse off.

The solution is so goddamn obvious it’s literally unbelievable that Dems aren’t rushing to embrace it.

Pass. The. Damn. Bill.

Pass. The. Damn. Bill.

Pass. The. Damn. Bill.

Steve Benen

A Special LOST: Untangled


With the final season of LOST coming up, I’m going to be busy, busy, busy over at DarkUFO and the SpoilerTV Forum as well as at Howey’s LOST Tribe. Unfortunately (or not :)), political posts on this thread will be at a minimum (unless something important happens – like passage of a decent health care bill).

In the meantime, I’ll be posting some goodies from LOST, including this new LOST: Untangled covering the first five seasons of LOST in 5 minutes. Enjoy and Namaste!