Author: cmh

An Insurance Maze for U.S. Doctors – NYTimes.com

An Insurance Maze for U.S. Doctors – NYTimes.com:

“Researchers asked hundreds of physicians and administrators in private practices across the United States and Canada how much time they spent each day with insurers and other third-party payers, tracking down information for claims that were denied or incorrectly paid, resolving questions about insurance coverage for prescription drugs or diagnostic tests, and filing the different forms required by each and every insurance company.

“Physicians in Canada, where health care is administered mainly by the government, did spend a good deal of time and money communicating with their payers. But American doctors in the study spent far more dealing with multiple health plans: more than $80,000 per year per physician, or roughly four times as much as their northern counterparts. And their offices spent as many as 21 hours per week with payers, nearly 10 times as much as the Canadian offices.

“The amount of time we spend on this is just crazy,” said Dr. Sara L. Star, a partner in a three-physician pediatrics practice in suburban Chicago. “But each insurance company has its own language, its own set of rules and specific contracts with certain laboratories, hospitals, physicians and pharmaceutical companies.”

The Health Affairs article is here.

The rich are different — and not in a good way, studies suggest – Health – Behavior – msnbc.com

The rich are different — and not in a good way, studies suggest – Health – Behavior – msnbc.com:

“In other words, rich people are more likely to think about themselves. “They think that economic success and political outcomes, and personal outcomes, have to do with individual behavior, a good work ethic,” said Keltner, a professor of psychology at the University of California, Berkeley.

Because the rich gloss over the ways family connections, money and education helped, they come to denigrate the role of government and vigorously oppose taxes to fund it.

“I will quote from the Tea Party hero Ayn Rand: “‘It is the morality of altruism that men have to reject,’” he said.

– Sent using Google Toolbar”

What Republicans get wrong about capitalism – Great Recession | Economic Recession, Economic Crisis – Salon.com

What Republicans get wrong about capitalism – Great Recession | Economic Recession, Economic Crisis – Salon.com: “Smith would be highly skeptical of such claims. In the final edition of the ‘Theory of Moral Sentiments,’ written over a decade after ‘The Wealth of Nations,’ he added a chapter in which he describes the ‘disposition to admire, and almost to worship, the rich and the powerful, and to despise, or, at least, to neglect persons of poor and mean condition.’ This disposition, Smith says, colors the way we view the world, leading us to conflate wealth and greatness with virtue and poverty and weakness with vice.

It also leads to confusion in thought. Who makes capitalism work? is a very different question from For whom has capitalism worked best? We should guard against presuming the answers are necessarily one and the same.

– Sent using Google Toolbar”

9 Things The Rich Don’t Want You To Know About Taxes

9 Things The Rich Don’t Want You To Know About Taxes: “For three decades we have conducted a massive economic experiment, testing a theory known as supply-side economics. The theory goes like this: Lower tax rates will encourage more investment, which in turn will mean more jobs and greater prosperity—so much so that tax revenues will go up, despite lower rates. The late Milton Friedman, the libertarian economist who wanted to shut down public parks because he considered them socialism, promoted this strategy. Ronald Reagan embraced Friedman’s ideas and made them into policy when he was elected president in 1980.

For the past decade, we have doubled down on this theory of supply-side economics with the tax cuts sponsored by President George W. Bush in 2001 and 2003, which President Obama has agreed to continue for two years.

You would think that whether this grand experiment worked would be settled after three decades. You would think the practitioners of the dismal science of economics would look at their demand curves and the data on incomes and taxes and pronounce a verdict, the way Galileo and Copernicus did when they showed that geocentrism was a fantasy because Earth revolves around the sun (known as heliocentrism). But economics is not like that. It is not like physics with its laws and arithmetic with its absolute values.

Tax policy is something the framers left to politics. And in politics, the facts often matter less than who has the biggest bullhorn.

The Mad Men who once ran campaigns featuring doctors extolling the health benefits of smoking are now busy marketing the dogma that tax cuts mean broad prosperity, no matter what the facts show.

– Sent using Google Toolbar”

S&P’s credit rating cut: Downgrading our politics | The Economist

S&P’s credit rating cut: Downgrading our politics | The Economist: “Investors largely tuned out the debt-ceiling debate until its final days out of a belief based on long experience that for all the antics and rhetoric of the Tea Party, the people who actually run Capitol Hill would never compromise the country’s credit worthiness. After all, it was Mr Boehner who reminded his freshmen colleagues that on the debt ceiling they’d have to act like “adults.”

That is not what happened. As the fight dragged on, the leadership moved closer to the Tea Party, not the other way around. And they seem happy with the results. Why else would Mitch McConnell have promised on August 1st to do exactly the same the next time the debt ceiling must be raised?

It is striking that the proponents of this strategy seem so oblivious to its impact. Our economy is lubricated by a sophisticated and stable credit market whose most vital component is also the most ephemeral: trust. As the crisis amply demonstrated, when trust erodes, the system freezes up. America has built a reputation for responsible and credible management of its finances over the centuries, and that reputation has been reduced to a political football, like a federal judgeship. Henceforth a foreign pension fund or central bank that once mindlessly ploughed his spare cash into Treasurys will have to think twice.

I never had much sympathy for the view that America’s economy was about to be eclipsed by China’s, and the main reason was our political institutions. Those checks, balances and laws provide an orderly means to change course in response to new challenges. China’s authoritarianism deprives the government of a feedback mechanism to tell it when it is meeting the needs and aspirations of its people. That makes its system intrinsically fragile.

Events of the last few weeks have forced me to reconsider.

– Sent using Google Toolbar”

The Oregon Health Insurance Experiment: Evidence from the First Year

The Oregon Health Insurance Experiment: Evidence from the First Year: “In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

– Sent using Google Toolbar”

Taking a Side | Crooks and Liars

Taking a Side | Crooks and Liars:

Just a terrific paragraph:

To me, that question is the most critical one there is when it comes to government policy. I don’t believe that government is inherently good — having lived through Vietnam, Watergate, J. Edgar Hoover’s corruption at the FBI, the massive deficit producing tax-cuts-for-the-rich policies of Reagan and Bush, the S&L crisis, financial deregulation, media consolidation, the Iraq war, Katrina, and the utter economic incompetence of the President George W. Bush economic years. I have no illusions that government as a whole is always on the side of most people. But what I want and believe in is a government of, by, and for the people — most especially for the people. Given the size and power of the financial industry, and other huge multinational corporations, I want a government that is on our side in making sure these massive companies don’t destroy our economy (again), and then demand bailouts (again) because they are too big to fail. I want a government on our side so that big insurance companies don’t tell people they can’t have coverage anymore because they got sick. I want a government on the side of senior citizens who have worked hard their whole lives and now want to live with some modest measure of dignity and economic security through Social Security, Medicare, and Medicaid coverage. I want a government on the side of working class families thrown out of their jobs and homes through no fault of their own. I want a government that is on the side of our kids and helps them get a good education. I want a government that is on the side of small business and start-up entrepreneurs as they work their butts off trying to compete with huge corporations.

This is the converse of the argument I often make about how wonderful people think private business is viz the government: Ever try switching cell phone carriers? Cable companies? Understand your credit card agreement?

To paraphrase Barney Frank. “If you think government is terrible, private businesses aren’t so hot, either!”

Old LTE on Jon Stewart

Given Jon Stewart’s recent dust up over on Fox News Sunday, I Googled and old LTE to the Pittsburgh Post Gazette I wrote before the 2004 election. I think it is still pretty spot on, if I do say so myself (and so did the crowd over at Democratic Underground, apparently)!

Pittsburgh Post-Gazette

Friday, September 10, 2004

Mr. Koppel, here’s why we watch ‘The Daily Show’

I hope this is it. I hope television journalism has hit rock bottom like an alcoholic who wakes up on a downtown sidewalk and understands he must find a 12-step program.

If you stayed up late enough last Wednesday night to see the very end of Ted Koppel’s “Nightline,” you would have been able to witness just how obtuse television news reporting has become. Ted Koppel tried to teach an elementary lesson in Journalism with a capital J to “The Daily Show’s” Jon Stewart, and was repeatedly verbally dope-slapped by the comedian to no apparent effect. Jon Stewart, as he frequently does, was stating the case that journalists were failing miserably at their job. So miserably, in fact, that many people feel they have to watch a basic cable fake news show to find “The Truth.”

Mr. Koppel then patronizingly tried to explain to Mr. Stewart the difference between facts and the truth. He suggested that if the president gave a speech calling Mr. Koppel a rapist and pedophile that this assertion would be a fact and newsworthy in that the president called a famous, well-respected journalist a rapist and pedophile, even if the accusation were untrue.

Not being a journalist, I was dumbstruck. Mr. Koppel believes that the correct headline for a journalist to report on this hypothetical event is “President accuses journalist of pedophilia” because it is factually correct. I think the rest of us non-journalists would agree that the headline should be “President falsely accuses journalist of pedophilia.” I have been trying to get my head around why journalism has gotten so bad in the past 20 years and Ted Koppel has finally shown me. When Gerald Ford mistakenly argued in a presidential debate with Jimmy Carter that Eastern Europe was not under the influence of the Soviet Union, yes, indeed, it was reported that he said this. But it was never reported without it being noted that he was completely wrong.

If President Bush makes a speech declaring that the moon is made of cheese, the headline is not “President declares moon made of cheese,” the headline is “President delusional!” or “White House assures nation that president misspoke.”

If you have been paying attention, you have seen this slide to the bottom coming for a long time. Newt Gingrich in the early ’90s put the pedal to the metal when he developed his dirty words to call your opponent that won’t be challenged. The press, pathetically, and the Democrats, even more pathetically, did nothing to call this slimy tactic by its proper name. This first inroad led us down the path to where we are now: the unchallenged assertion.

On MSNBC’s “Hardball” last week, Sen. Rick Santorum finished up his interview with Chris Matthews with some stunning assertions about John Kerry: “Well, I mean, I only have to allude to his testimony before Congress … And I think that kind of anti-American sentiment, that kind of America can’t do it, America isn’t good enough anymore, and sort of being critical, as he has been of the president, not supporting our troops, all that coming out in Pennsylvania is just not going to sell.”

Well, thank goodness for Chris Matthews and his hard-hitting journalism and integrity. His “hardball” response? “OK. It’s great talking to you tonight, Senator Rick Santorum, the junior senator from Pennsylvania.”

OK. So for Rick Santorum and the panoply of militarily challenged members of the Bush-Cheney administration, every returning Vietnam veteran, every student, every reporter, every housewife, every member of Congress, and every soldier on a swift boat or in a jungle who opposed the Vietnam War were anti-American? Everyone who believed that Nixon and Kissinger and McNamara were conducting an unnecessary war in a reprehensible manner are anti-American?

Am I incorrect in thinking that our nation’s general consensus is that those who opposed the war and literally fought to bring it to an end were courageous, patriotic Americans who fought an unpopular fight but in the end were proven right? “OK.”

And thank goodness Sen. Santorum and Sen. Zell Miller are supporting our troops, because apparently if John Kerry were in charge, we’d be fighting “with spitballs.” The idea of letting a leader of the majority party of the U.S. Senate say that one of its members from the loyal opposition does not support the troops is repugnant and should not go unchallenged. Why doesn’t Chris Matthews (or any journalist for that matter) ask Mr. Santorum: If John Kerry voted for the $87 billion the first time, why didn’t it pass? And how did Mr. Santorum and Mr. Miller and Dr. Frist and Mr. McCain vote that time?

And the next time someone says that Mr. Kerry or anyone voted “against body armor” or “against cancer research” or “to poison pregnant women” or any of those outlandishly stupid comments that pass for political discourse these days, shouldn’t some high-profile journalist ask them about their obviously ludicrous implication: So you think Mr. Smith is for cancer? So you think Mr. Jones really hates our troops?

I don’t care if George W. Bush doesn’t do nuance, the rest of us do! We can understand that voting for a bill that includes both $87 billion to fund the Iraq war and tax rollbacks to finance it is different than voting for a bill that doesn’t include the tax rollbacks. That second vote wasn’t a vote against our troops, it was casting an unpopular vote to make a point that this administration is rolling up massive deficits that will come back to haunt us and our children.

But let’s get back to Jon Stewart and Ted Koppel. Koppel has said recently that “a lot of television viewers — more, quite frankly, than I’m comfortable with — get their news from … ‘The Daily Show.’ ” As Stewart points out, that is because “The Daily Show” is willing to point out that what passes for political discourse by well-respected and supposedly well-trained broadcasters when they interact with the pull-string Chatty Cathy dolls spewing forth their disingenuous talking points is what it is, crap.

Mr. Stewart identifies himself as neither a Republican nor a Democrat and believes that the conservative/liberal paradigm no longer works. He is “anti-b.s.” Consequently, the current administration, whose ability to make the aforementioned substance smell like reasonable public policy is epic, is a favorite target. And fortunately, Mr. Stewart and his staff apparently have resources not found at virtually any other news organization in the country: collectively, they have half a brain and the writers apparently devote some of their time to research.

Mr. Stewart believes that it is the job of real journalists to adjudicate our national political debate. In a recent segment with “Daily Show” “correspondent” Rob Corddry, Stewart asked about the factual basis of the swift boat vets’ charges. “Facts?” said Corddry, “Our job is to parrot what one side says and then parrot back what the other side says!” Apparently this is what politicians can now reliably count on, but I hope the profession of journalism gets into a good 12-step program before the election.

CMHMD

Huge Profits for Health Insurers as Americans Put Off Care – NYTimes.com

Huge Profits for Health Insurers as Americans Put Off Care – NYTimes.com:

“The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care. “

I know, I’m shocked, too.

Doctors Soften Their Stance on Obama’s Health Overhaul – NYTimes.com

Doctors Soften Their Stance on Obama’s Health Overhaul – NYTimes.com:

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

As I pointed out here many times over the past couple years, doctors support health reform.

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