A Choice for Recovering Addicts: Relapse or Homelessness
bby Kim Barker - May 30, 2015 - New York Times
After a lifetime of abusing drugs, Horace Bush decided at age 62 that getting clean had become a matter of life or death. So Mr. Bush, a homeless man who still tucked in his T-shirts and ironed his jeans, moved to a flophouse in Brooklyn that was supposed to help people like him, cramming into a bedroom the size of a parking space with three other men.
Mr. Bush signed up for a drug-treatment program and emerged nine months later determined to stay sober. But the man who ran the house, Yury Baumblit, a longtime hustler and two-time felon, had other ideas.
Mr. Baumblit got kickbacks on the Medicaid fees paid to the outpatient treatment programs that he forced all his tenants to attend, residents and former employees said. So he gave Mr. Bush a choice: If he wanted to stay, he would have to relapse and enroll in another program. Otherwise, his bed would be given away.
“‘Do what you do’ — that’s what he told me,” Mr. Bush recalled.
Mr. Bush, rail-thin with sad eyes, wanted to avoid the streets and homeless shelters at all costs. He turned to his self-medication of choice: beer, with a chaser of heroin and crack cocaine. Then he enrolled in a new program chosen by Mr. Baumblit.
In the past two and a half years, Mr. Bush has gone through four programs, just to hold onto his upper bunk bed.
Mr. Bush had fallen into a housing netherworld in New York City, joining thousands of other single men and women recovering from addiction or with nowhere to go. The homes are known as “three-quarter” houses, because they are seen as somewhere between regulated halfway houses and actual homes.
Virtually unnoticed and effectively unregulated, the homes have multiplied over the past decade, driven by a push to reduce shelter rolls, a lack of affordable housing and unscrupulous operators.
One government official estimated recently that there could be 600 three-quarter houses in Brooklyn alone. But precise numbers are elusive. The houses open and close all the time, dotting poor neighborhoods mostly in the Bronx, Brooklyn and Queens.
The Lie Factory
by Jill LePore - The New Yorker
What follows is an excerpt from Jill LePore's New Yorker article about politics and public relations. It's worth reading the entire article - just follow the link
-SPC
In the fall of 1944, Warren got a serious kidney infection. This set him thinking about the rising costs of medical care, and the catastrophic effects that sudden illness could have on a family less well provided for than his own. “I came to the conclusion that the only way to remedy this situation was to spread the cost through insurance,” he wrote in his memoirs. He asked his staff to develop a proposal. “We concluded that health insurance should be collected through the Social Security System. After some studies, it was determined that the employers and employees in that system should each contribute one and one half per cent of wages paid by or to them.” After conferring with the California Medical Association, he anticipated no objections from doctors. And so, in January of 1945, during his State of the State address, he announced his proposal for comprehensive, compulsory health insurance for the state of California.
Earl Warren began his political career as a conservative and ended it as one of the most hated liberals in American history. What happened to him? One answer is: Whitaker and Baxter.
Retained by the California Medical Association for an annual fee of twenty-five thousand dollars to campaign against the Governor’s plan, Whitaker and Baxter took a piece of legislation that most people liked and taught them to hate it. “You can’t beat something with nothing,” they liked to say. They launched a drive for Californians to buy their own insurance, privately. Voluntary Health Insurance Week, driven by forty thousand inches of advertising in more than four hundred newspapers, was observed in fifty-three of the state’s fifty-eight counties. Whitaker and Baxter sent more than nine thousand doctors out with prepared speeches. They coined a slogan: “Political medicine is bad medicine.”
They lobbied newspaper editors. Whitaker boasted that “our people have personally called at more than 500 newspaper offices,” to persuade editors to change their positions. Many of these newspapers did a vast amount of advertising business with Campaigns, Inc., and received hundreds of words of free copy, each week, from the California Feature Service. “In three years,” Whitaker reported, “the number of newspapers supporting socialized medicine has dwindled from fifty to about twenty. The number of papers opposing compulsory health insurance has jumped from about 100 to 432.”
They invented an enemy. They sent out twenty-seven thousand copies of a pamphlet called “The Health Question,” which featured a picture of a man, a woman, and a child in the woods—“a forest of fear”—menaced by skeletons who have in their mouths, instead of teeth, the word “BILL.” Whitaker and Baxter sent out two and a half million copies of another pamphlet, called “Politically-Controlled Medicine.” They printed postcards, for voters to stick in the mail:
Dear Senator:Please vote against all Compulsory Health Insurance Bills pending before the Legislature. We have enough regimentation in this country now. Certainly we don’t want to be forced to go to “A State doctor,” or to pay for such a doctor whether we use him or not. That system was born in Germany—and is part and parcel of what our boys are fighting overseas. Let’s not adopt it here.
In 1945, Warren’s bill failed to pass by just one vote. As Warren’s biographer G. Edward White remarked, “The scuttling of his health insurance plan was a confirmation for Warren of the nature of the political process, in which advocates of programs based on humanity and common sense were pitted against selfish, vindictive special interests.” Warren reintroduced the bill. And again Whitaker and Baxter defeated it. “They stormed the Legislature with their invective,” Warren later wrote, “and my bill was not even accorded a decent burial.” It was the greatest legislative victory at the hands of admen the country had ever seen. It was not, of course, the last.
Federal Investigators Fault Medicare’s Reliance on Doctors for Pay Standards
By ROBERT PEAR
WASHINGTON — The government relies too heavily on advice from the American Medical Association in deciding how much to pay doctors under Medicare, and the decisions may be biased because the doctors have potential conflicts of interest, federal investigators say in a new report.
This reliance on the association, combined with flaws in data collected by the influential doctors’ group, “could result in inaccurate Medicare payment rates,” the investigators said.
The report, by the Government Accountability Office, a nonpartisan arm of Congress, reveals new details of an obscure process that distributes more than $70 billion a year to doctors treating Medicare patients.
Medicare uses a fee schedule and sets rates based on its estimate of the “relative value” of each service. For example, by the government’s reckoning, a hip replacement operation involves more than twice as much work as cataract surgery and about 20 times as much as a routine office visit with an established patient. In measuring work, the government takes account of a doctor’s time and the amount of mental and physical effort and technical skill required to perform a particular service, compared with other services.
Medicare’s decisions ripple through the health care system and directly affect consumers. Medicare beneficiaries often pay about 20 percent of the Medicare-approved charge for doctors’ services. In addition, many private insurers use the Medicare fee schedule as a guide in deciding how much to pay doctors. If Medicare overvalues a particular service, it may create an incentive for doctors to provide more of it, and vice versa.
Critics have complained for several years about the unusual role of doctors in the setting of Medicare’s rates. The report tends to validate some of the criticism.
New rule ignites fight over insurer profits
By KIM BARKER
By Peter Sullivan - 05/28/15 06:00 AM EDT
A sweeping new Obama administration regulation is reigniting the debate over the profits of health insurance companies.
The rule, released late Tuesday, states that insurance companies that manage Medicaid plans have to spend at least 85 percent of their revenues on medical care, as opposed to profit or administrative expenses.
Similar limits, known as a medical loss ratio, were imposed on commercial insurance plans during the implementation of ObamaCare.
Insurers are now dusting off their arguments that the categorization of different expenses lacks reasoning and ends up restricting important spending that isn't directly related to medical care.
“An arbitrary cap on health plans’ administrative costs could undermine many of the critical services — beyond medical care — that make a difference in improving health outcomes for beneficiaries, such as transportation to and from appointments, social services, and more,” Dan Durham, interim CEO of America’s Health Insurance Plans, said in a statement.
The White House has hammered insurance companies over their profits, using the issue to boost public support for ObamaCare.
In 2013, President Obama invited Americans to the White House who had received rebates from insurance companies that fell short of the Affordable Care Act’s limit on administrative expenses.
“What do opponents of this law think the folks here today should do with the money they were reimbursed?” Obama said then. “Should they send it back to the insurance companies? Do they think that was a bad idea to make sure that insurance companies are being held accountable?”
With Sickest Patients, Cost Sharing Comes at a Price
The growth in health care spending is slowing down, and one reason might be that cost sharing is rising.
The proportion of insured workers with at least a $1,000 deductible was 41 percent in 2014, quadruple that in 2006. Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down.
When patients face higher cost sharing for prescription drugs, they tend to cut back on them. That’s a finding from a recent study from the National Bureau of Economic Research by Peter Huckfeldt and colleagues, who examined employer-based health plan enrollees who use drugs to treat high cholesterol, hypertension and diabetes. They even found that patients cut their drug use when drugs were exempt from the deductible. Perhaps they did so because they did not understand the drugs had no deductible. They may also have cut back on visiting the doctor to get a prescription because the visits were subject to the deductible.
These kinds of cuts in care can be especially problematic for patients with more severe illnesses. A number of studies document the adverse effects of cost sharing on sicker patients. When applied indiscriminately, cost sharing can hurt the sicker patients by prompting them to delay or avoid the preventive care they need. A 2012 study showed that higher cost sharing reduces spending on physician visits and drugs, but can increase hospital spending. When Medicare beneficiaries face higher cost sharing, hospitalizations go up, not down, especially for those with chronic illnesses.
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