‘Broad’ health care tax cut for small business leaves out some companies

By Ricardo Alonso-Zaldivar
Los Angeles Times
May 19, 2010
When the administration unveiled the small business tax credit earlier this week, officials touted its “broad eligibility” for companies with fewer than 25 workers and average annual wages under $50,000 that provide health coverage.
Lost in the fine print: The credit drops off sharply once a company gets above 10 workers and $25,000 average annual wages.
It’s an example of how the early provisions of the health care law can create winners and losers among groups lawmakers intended to help — people with health problems, families with young adult children and small businesses. Because of the law’s complexity, not everyone in a broadly similar situation will benefit.
http://www.latimes.com/business/nationworld/wire/sns-ap-us-health-care-tax-cut-fact-check,0,3521831.story

We could have had a health care financing system that automatically included everyone. Instead we enacted a complex, fragmented system with so many eligibility and payment variables for a large variety of plans and programs that it is impossible to fit everyone into a slot. Not only is this the most expensive way to pay for health care, it also ends up being inequitable since individuals with similar circumstances can end up having quite different financial obligations, or even end up with one covered and the other not.
It doesn’t have to be this way. We can still enact a single payer national health program that would cost less and actually work for everyone.

Can Health Care Save Detroit?

By Noah Ovshinsky
NPR
May 20, 2010
A few weeks ago, officials with the Detroit Medical Center, the city’s largest health system, made an announcement that was as startling as it was welcome: that they intended to sell the nonprofit to an investor-owned company. As part of the deal, Nashville-based Vanguard Health Systems promised to spend $850 million on much-needed capital improvements.
The Detroit Medical Center, or the DMC as it’s called locally, is the city’s primary safety net, providing more uncompensated care than any other health system in the state. That commitment comes at a cost. While the DMC has turned a profit for six years in a row, officials say the health system’s payer mix makes raising money on Wall Street all but impossible. As a result, the facilities are showing their age.
Without selling hospitals, turning away needy patients or cutting services, experts say they don’t see how Vanguard will get a good return on its investment.
http://www.npr.org/templates/story/story.php?storyId=126283823&ft=1&f=1001

And…

Vanguard, DMC Announce Letter of Intent

Vanguard Health Systems
March 19, 2010
The Detroit Medical Center (DMC) Board of Trustees and Vanguard Health Systems Inc. announced today that they have signed a letter of intent for DMC to become part of the Vanguard system and for Vanguard to invest $850 million in capital improvements to DMC’s eight-hospital system.
Charles N. Martin, chairman and chief executive officer of Vanguard Health Systems, said… “We are very excited about entering the Detroit market and look forward to working with the DMC management team, who has an outstanding record of delivering care and managing financial challenges.”
(Do not rely on any forward-looking statements as such statements are subject to numerous factors, risks and uncertainties that could cause Vanguard’s actual outcomes, results, performance or achievements to be materially different from those projected. These factors, risks and uncertainties include, among others, Vanguard’s ability to negotiate a definitive agreement for the acquisition of the DMC System and to successfully consummate the acquisition and integrate its operations; Vanguard’s high degree of leverage and interest rate risk; Vanguard’s ability to incur substantially more debt; operating and financial restrictions in Vanguard’s debt agreements; Vanguard’s ability to generate cash to service its debt; potential liability related to disclosures of relationships between physicians and Vanguard’s hospitals; Vanguard’s ability to grow its business and successfully implement its business strategies; Vanguard’s ability to successfully integrate any future acquisitions; the potential that acquisitions could be costly, unsuccessful or subject Vanguard to unexpected liabilities; post-payment claims reviews by governmental agencies that could result in additional costs to Vanguard; conflicts of interest that may arise as a result of Vanguard’s control by a small number of stockholders; the highly competitive nature of the healthcare business; governmental regulation of the industry including Medicare and Medicaid reimbursement levels; changes in Federal, state or local regulation affecting the healthcare industry; the possible enactment of Federal or state healthcare reform; pressures to contain costs by managed care organizations and other insurers and Vanguard’s ability to negotiate acceptable terms with these third party payers; the ability to attract and retain qualified management and personnel, including physicians and nurses; claims and legal actions relating to professional liabilities or other matters; the impacts of weakened economic conditions and volatile capital markets on Vanguard’s results of operations, financial position and cash flows; Vanguard’s failure to adequately enhance its facilities with technologically advanced equipment could adversely affect its revenues and market position; Vanguard’s exposure to the increased amounts of and collection risks associated with uninsured accounts and the co-pay and deductible portions of insured accounts; Vanguard’s ability to maintain or increase patient membership and control costs of its managed healthcare plans; the geographic concentration of Vanguard’s operations; the technological and pharmaceutical improvements that increase the cost of providing healthcare services or reduce the demand for such services; the timeliness of reimbursement payments received under government programs; the potential adverse impact of known and unknown government investigations; and those factors, risks and uncertainties detailed in Vanguard’s filings from time to time with the Securities and Exchange Commission, including, among others, Vanguard’s Annual Reports on Form 10-K and its Quarterly Reports on Form 10-Q.)
http://www.vanguardhealth.com/news/article113.html

Non-profit Detroit Medical Center (DMC) is the city’s primary safety net, providing more uncompensated care than any other health system in Michigan. In spite of difficult economic conditions, DMC has been profitable for the past six years. Even Vanguard’s chairman states that the DMC management “has an outstanding record of delivering care and managing financial challenges.” So why is DMC selling to an out-of-state, for-profit hospital chain?
The reason given is that highly-leveraged (i.e., debt laden) Vanguard intends to infuse funds for capital improvements. But why should DMC relinquish its tax-favored status that helps to ensure that retained profits can be moved to the capital budgets, as with other non-profits? With Vanguard ownership, not only will they lose revenue in taxes, they also will have to divert more revenue to servicing Vanguard’s massive debt.
This says nothing about the fundamental business differences between non-profit hospitals with a sole mission to provide patient care and for-profit hospitals with an SEC-mandated mission to enhance investor value.
Nobody reads the fine print of the “forward-looking statements” disclaimers, but they are customized to provide the type of transparency that we clamor for today. If you think that transferring a major non-profit center that is successfully providing much needed safety-net services to a highly-leveraged, for-profit, out-of-state hospital chain is a good deal, then you should read the fine print of the “forward looking statements” above.
Congressman John Conyers’ Medicare for All bill, H.R. 676, calls for conversion of the for-profit, investor-owned components of our health care system into non-profits. It would be sad indeed if this important center in his own home city of Detroit were to undergo the opposite conversion, placing the demands of rich investors ahead of the needs of low-income patients.

Hospitals criticized over offers to earn or save money by sharing electronic patient data

By Jason Roberson
The Dallas Morning News
May 18, 2010
The $45 billion set aside for electronic health records in the federal government’s 2009 stimulus package created a carrot-and-stick approach to lure providers into the electronic age. Physician practices could be paid up to $44,000 over five years, and hospitals could get a maximum of $15.9 million to install systems that comply with federal rules.
On the other hand, the government would penalize providers that don’t participate, reducing their Medicare and Medicaid payments by 1 percent beginning in 2015. In later years, the penalty grows to 3 percent.
Electronic records are expected to allow doctors to coordinate care for the sickest patients, eliminate paper-transcribing errors that lead to inaccurate prescriptions, and avoid duplicate lab and imaging tests.
But with the promises of efficiency come questions of privacy.
The vendor that Dallas-based Tenet Healthcare Corp. uses has been criticized for sharing patient data with drug companies. The vendor that Fort Worth’s Cook Children’s Health Care System uses is considering offering physician customers discounts for sharing patient data.
Texas Health Resources Inc., an Arlington-based hospital system, and Children’s Medical Center Dallas announced April 27 that patients seen at one hospital will have their records available electronically at the other if they need to be admitted.
This summer, Parkland Health & Hospital System, which operates Dallas County’s public hospital, is expected to join them. That means a patient’s medical records will be seamlessly, electronically transferable to three of North Texas’ largest hospitals.
Cerner Corp. – a Kansas City-based electronic health record vendor with 200 Texas customers, including Tenet Healthcare – shares unidentifiable patient records with drug companies and researchers looking for patients to participate in clinical trials, says a company spokeswoman.
Doctors long have made extra money by referring patients to clinical drug trials. Cerner says it simplifies and cleans up the process by acting as a middleman of sorts between doctors and drug companies.
But Dr. Deborah Peel, an Austin psychiatrist and founder of the nonprofit advocacy group Patient Privacy Rights, questions whether a patient’s most confidential information in their medical records, such as psychological treatment or HIV testing, will be secure at those hospitals.
Cook Children’s electronic records system is different from most others in hospitals. Rather than pay $50 million to $120 million installing software for its 400 physicians in 55 locations, it paid less than $1 million for an online record-keeping service.
But the key difference, Peel said, is that the damage of illegally accessed electronic records is more extensive.
“Once your information is released, it’s like a sex tape that lives in perpetuity in cyberspace,” Peel said. “You can never get it back.”
http://www.dallasnews.com/sharedcontent/dws/bus/stories/051810dnbuspatientprivacy.1372a8f4.html

“… a sex tape that lives in perpetuity in cyberspace…” Certainly very few if any readers of these comments have personal sex tapes that could live in perpetuity once released in cyberspace, but we all have personal medical data that we would just as soon not share with the world, even if we are revealed as living a perhaps boring life of relative purity. Even that is no one else’s business.
Yet the federal government is going to penalize Medicare and Medicaid providers that do not covert their patient data into electronic form. Promises of system security provide little reassurance when people with other interests, whether for business purposes or for more nefarious intent, have access to those records. As mentioned in this article, hospitals are already taking liberties with private patient data.
How well does controlled access work? Rupert Murdoch controls Internet access to certain articles in The Wall Street Journal, limiting them to paid subscribers.
Try this experiment. Log onto The Wall Street Journal at http://online.wsj.com/home-page. Go to the section labeled subscriber content. Click on any article. You will see only the opening preview of the article, but then must subscribe to see the full article. But wait. Cut the precise title of the article and paste it into a Google search box. The first item that comes up in the Google search is likely a selection that lists the same title, with a WSJ link. Click on it and you have – voila – the full article, which already has been released into cyberspace.
Admittedly, electronic health systems vendors will use a higher level of security for patent records, but they are no more secure from hackers than are Murdoch’s subscriber-only articles secure from theft by those of us with only the simplest of computer skills.
At this stage, infallible cybersecurity is only a wish, especially for a system that will eventually have over 300 million patient records with variable degrees of interconnectivity. It is premature for the government to start penalizing us for declining to expose patient data to this potential threat.
Looking for the magic in information systems has been yet one more unfortunate diversion from achieving the most consequential goal of all – affordable health care for everyone through an improved Medicare for All. Let’s work on that first.

The Culture of Excess

How America Lost Self-Control and Why We Need to Redefine Success

By J.R. Slosar
Praeger/ABC-CLIO
From the Introduction
The first chapter provides a background of definition and symptoms of narcissism and its application to our culture and society. The complexity of the concept is presented from history, research, and application. Chapter 2 separates out the factors in the economic marketplace that contribute to cultural narcissism. Chapter 3 focuses on coping with the impact of the factors of cultural narcissism, and explores reality and loss, rigidity and self-destruction, and perfectionism and deception. The fourth chapter looks at our avoidance and anxiety of numbers, math or quantitative analysis, a cultural weakness that opens the door to faulty comparisons and poor decisions. A different perspective is offered in Chapter 5, as our health care system is offered as a primary example of how our society sanctions cultural narcissism and self-defeating behavior. Chapter 6 focuses upon changes in reality and hero images as representative of today’s cultural narcissism. An analysis of sports as a dramatic seeking of reality is discussed. Chapter 7 discusses identity theory and development with the focus on today’s youth and how they see and present themselves. Finally, the last chapter summarizes, integrates, and offers structural recommendations to help change directions and return to a more balanced and realistic appraisal of our economic system and our day-to-day lives and decisions.
From Chapter 5 – Health Care: Waste, Excess and Brokers
The dramatic insistence on free market principles and competition determines the way  health care is delivered today. The entire process exemplifies the culture of excess and cultural narcissism. The excess comes from the tremendous waste of money and resources. This is coupled with the ability of brokers and corporate entities to overcharge and take out money at everyone else’s expense. These are the entitled “me” in the equation. The rest of us continue to pay more and more and even get less and less. Or, many just cannot afford health care at all. Facts and meaningful comparisons are dismissed and not considered by the fear of an alternative labeled as Socialism.
From Chapter 8 – Generation We
To address current trends, our culture must develop a new generation that will move toward a different concept and process of attaining success or “making it.” This new concept is based on connectedness with culture and has a broader perspective of inclusiveness. It also involves having less sense of entitlement, more realistic expectations, and more willingness to regulate one’s own behavior and the marketplace we live in. These are the components need to develop a Generation of We. To effect these changes will mean challenging basic economic assumptions and the elevated status of established economic theories and principles. In turn, we must challenge our current definition of success. The transition from a “me” society to a “we” society can be framed as the classic dichotomy of individualism versus collectivism. But it is a larger and more complex issue than that.
The literature in social psychology is extensive in arguing about the issue of what comes first in order to change. Is it necessary to change behavior first, for change to occur – or is it necessary to change attitude before behavior change can occur? The dichotomy of behavior versus attitude for individuals to change is also applicable to our culture. Changes in individual behavior will principally follow changes dictated by policy. Our mass consumption society will only redirect when forced to. Narcissistic entitlement is too high – self-control is pummeled and expectations of voluntary change are naive. The cycle and patterns  of the culture of excess are too ingrained. As a result, regulation in policy will be an important factor in the change process, and replace the conscious efforts of deregulation and no regulation. As discussed earlier, the cultural deregulation and no regulation movement has deregulated our inner mechanisms of individual self-control. Changes in attitude and thinking will also be related to policy; however, confrontation must occur between current attitudes and thinking that is “me based.” Challenging some existing and entrenched beliefs about economics and economic growth will be necessary for change to occur.
http://www.cultureofexcess.com/

When you look at different models of health care delivery and its financing, the logic of single payer prevails. President Obama has stated such, and even many conservatives agree, though ideologically opposed. So it has been difficult for those of us who support health care justice to understand why there has not been an adequate national grassroots uprising demanding the enactment of an improved Medicare for all. Dr. Slosar’s book provides some insight as to why.
In “The Culture of Excess,” Dr. Slosar gives us the perspective of the discipline of psychology, both as applied to individuals and as applied to our culture. He explains how cultural narcissism has permeated our society and has led to the culture of excess. As the “me” society has dominated over the “we” society, narcissism has suppressed the support for collective solutions to our social problems. Within that framing, it is easier to understand why a near-perfect “we” solution for health care reform – single payer Medicare for all – was rejected in favor of the highly-flawed “me” solution – the individual private insurance plans.
Although the process will not be easy, Dr. Slosar shows us why addressing our cultural narcissism must be an integral part of achieving health care justice for all. In a Generation We, everyone will have the health care that they need.

Gingrich in Va.: A Republican Congress could defund health care law

By Rosalind Helderman
The Washington Post
May 14, 2010
(Former House Speaker Newt) Gingrich’s comments came at a health-care industry sponsored conference held by Center for Health Transformation, a project of his consulting firm.
Gingrich argued the federal law has been intentionally designed to encourage businesses to drop health care for their employees, incurring a new fine in the law for not offering insurance. Employees will then enter new individual health exchanges, Gingrich argued, but find them so expensive that they will clamor for a nationalized health care system.
http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html

Although we don’t agree with Newt Gingrich’s solution for our health system’s problems (computerize and privatize the entire system), we do agree with him and the multitude of other conservatives who state that the intolerable costs of health care eventually will drive the nation to demand a nationalized health care system. It’s just too bad that so much more suffering will take place before we arrive there.