03/08/2013 archive

Journalist Steve Brill wrote brilliant cover story for Time magazine, Bitter Pill: Why Medical Bills Are Killing Us, which lays out the reason US health care costs are out of control, just follow the money. He explains how the hospitals and their executives are scamming the system through billing to maximize profits. As an examples of the absurd charges, for a 15 cent Tylenol tablet hospitals charge as much as $1.50, $6 for a marker used to mark the body before surgery and as much as $77 for each of four boxes of gauze used. In hospital a patient can be charges as much as $450 for an electrocardiogram that in a doctor’s office would only cost $150.

This doesn’t happen in other countries where costs are controlled by government set rates for what both private and public plans can charge for various procedures. The problem here in the US isn’t that we don’t have single payer, it’s that the government doesn’t regulate the prices that health-care providers can charge. But in an article at the Washington Post by Sarah Kliff for the Wonkblog writes that we don’t need to look to other countries:

Maryland has succeeded in controlling costs for about four decades now. It is the only state that sets rates for hospitals, with the state government deciding what every Maryland hospital can charge for a given procedure..

That system started in 1976, when Maryland had hospital costs 26 percent higher than the rest of the the country. In 2008, the average cost for a hospital admission in Maryland was down to national levels. “From 1997 through 2008, Maryland hospitals experienced the lowest cumulative growth in cost per adjusted admission of any state in the nation,” the state concluded in a 2010 report (pdf).

Here is a brief summery of the article and what you should know about why health care in this country costs so much (and it isn’t malpractice lawsuits, as some would have you believe):

Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer-Medicare-from even trying to negotiate the price of drugs.

Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

Cancer treatment – at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson – has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Recently, Mr Brill sat down with Hardball guest host Michael Smerconish  and Neera Tanden from Center for American Progress to discuss how the rising health care costs are killing Americans:

   And it actually that bears on the conversation we’re having, because a chunk of that money is paid by Medicare. Medicare is I point out in the article is very efficient at most things. It buys health care really efficiently, which is a great irony, because it’s supposed to be the big government of bureaucracy.

   Where Medicare is not efficient is where Congress, because of lobbyists have handcuffed Medicare. Medicare can’t negotiate what it pays for any kind of drugs. It can’t negotiate what it pays for wheelchairs, diabetes testing equipment. And if Congress took those handcuffs off of Medicare, you could get about half of the spending cuts that we’re sitting around here talking about.

Raising the eligibility age and/or applying a means test as ways to reduce the cost of Medicare will not fix the rising costs. Only government regulation of the hospitals and the ability of Medicare to negotiate pricing for procedures, equipment and supplies will cut the cost for the patient and the tax payers. Take the profit motive out of saving lives and keeping Americans healthy.

“Punting the Pundits” is an Open Thread. It is a selection of editorials and opinions from around the news medium and the internet blogs. The intent is to provide a forum for your reactions and opinions, not just to the opinions presented, but to what ever you find important.

Thanks to ek hornbeck, click on the link and you can access all the past “Punting the Pundits”.

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New York Times Ediorial: Mr. Brennan’s Excuse

John Brennan, the newly confirmed chief of the Central Intelligence Agency, has been at the agency for most of 25 years. He had two counterterrorism jobs during the administration of George W. Bush. In one, he compiled intelligence reports from 20 agencies (including the C.I.A.) for Mr. Bush’s morning briefing. He was President Obama’s national security adviser in his first term and an architect of the Obama administration’s targeted killings policy.

Yet, at his Senate confirmation hearing in February, he appeared to be one of the few people (apart from maybe Dick Cheney and some other die-hard right-wingers) who thinks there is some doubt still about whether the Bush administration tortured prisoners, hid its actions from Congress and misled everyone about whether coerced testimony provided valuable intelligence.

Paul Krugman: The Market Speaks

Four years ago, as a newly elected president began his efforts to rescue the economy and strengthen the social safety net, conservative economic pundits – people who claimed to understand markets and know how to satisfy them – warned of imminent financial disaster. Stocks, they declared, would plunge, while interest rates would soar. [..]

Sure enough, this week the Dow Jones industrial average has been hitting all-time highs, while the current yield on 10-year U.S. government bonds is roughly half what it was when The Journal published that screed.

O.K., everyone makes a bad prediction now and then. But these predictions have special significance, and not just because the people who made them have had such a remarkable track record of error these past several years.

This is your morning Open Thread. Pour your favorite beverage and review the past and comment on the future.

Find the past “On This Day in History” here.

March 8 is the 67th day of the year (68th in leap years) in the Gregorian calendar. There are 298 days remaining until the end of the year.

On this day in 1911, International Women’s Day is launched in Copenhagen, Denmark, by Clara Zetkin, leader of the Women’s Office for the Social Democratic Party in Germany.

International Women’s Day (IWD), originally called International Working Women’s Day is marked on the 8th of March every year. It is a major day of global celebration of women. In different regions the focus of the celebrations ranges from general celebration of respect, appreciation and love towards women to a celebration for women’s economic, political and social achievements.

Started as a Socialist political event, the holiday blended in the culture of many countries, primarily Eastern Europe, Russia, and the former Soviet bloc. In many regions, the day lost its political flavour, and became simply an occasion for men to express their love for women in a way somewhat similar to a mixture of Mother’s Day and St Valentine’s Day. In other regions, however, the original political and human rights theme designated by the United Nations runs strong, and political and social awareness of the struggles of women worldwide are brought out and examined in a hopeful manner.

The first IWD was observed on 19 March 1911 in Germany following a declaration by the Socialist Party of America. The idea of having an international women’s day was first put forward at the turn of the 20th century amid rapid world industrialization and economic expansion that led to protests over working conditions.

In 1910, Second International held the first international women’s conference in Copenhagen (in the labour-movement building located at Jagtvej 69, which until recently housed Ungdomshuset). An ‘International Women’s Day’ was established. It was suggested by the important German Socialist Clara Zetkin, although no date was specified. The following year, 1911, IWD was marked by over a million people in Austria, Denmark, Germany and Switzerland, on March 19. In the West, International Women’s Day was first observed as a popular event after 1977 when the united Nations General Assembly invited member states to proclaim March 8 as the UN Day for Women’s Rights and International Peace.

Demonstrations marking International Women’s Day in Russia proved to be the first stage of the Russian Revolution of 1917.

Following the October Revolution, the Bolshevik Alexandra Kollontai persuaded Lenin to make it an official holiday in the Soviet Union, and it was established, but was a working day until 1965. On May 8, 1965 by the decree of the USSR Presidium of the Supreme Soviet International Women’s Day was declared a non working day in the USSR “in commemoration of the outstanding merits of Soviet women in communistic construction, in the defense of their Fatherland during the Great Patriotic War, in their heroism and selflessness at the front and in the rear, and also marking the great contribution of women to strengthening friendship between peoples, and the struggle for peace. But still, women’s day must be celebrated as are other holidays.”

2011 International Women’s Day

Events are scheduled to take place in more than 100 countries around the world on March 8, 2011, to commemorate the 100th anniversary of International Women’s Day. In the United States, President Barack Obama proclaimed March 2011 to be “Women’s History Month”, calling Americans to mark IWD by reflecting on “the extraordinary accomplishments of women” in shaping the country’s history. Secretary of State Hillary Clinton launched the “100 Women Initiative: Empowering Women and Girls through International Exchanges”, on the eve of IWD.

The “sequester that wouldn’t happen” kicked into reality last Friday. So far all the dire warnings of job losses, airport delays and threats to national security haven’t materialized but give it a month for the effects to kick in. Meanwhile the Stock Market seems to have not noticed and is reaching new pinnacles for a third say. If you read the financial pages of the New York Times or the Wall Street Journal, you’d think the economy was on a rapid road to recovery, yet the economy continues to languish, along with the middle class and manufacturing as naked capitalism founder Yves Smith noted:

It’s hard to fathom the celebratory mood in the US markets, save that the moneyed classes are benefitting from a wall of liquidity reminiscent of early 2007, when risk spreads across virtually all types of lending shrank to scarily low levels. Then the culprit was not well understood, although Gillian Tett discerned that CDOs were a huge source of leverage, and in April 2007, an analyst, Henry Maxey at Ruffler, LLC, did an impressive job of piecing together how levered structured credit strategies were driving market liquidity.

Now it’s a lot easier to see what is afoot. The Fed has been trying to reflate asset values to goose the real economy. What it has done instead is goose the incomes of the top 1% while everyone else is on the whole worse off. But the central bank is suffering from a very bad case of “if the only tool you have is a hammer, every problem looks like a nail” syndrome. It’s unwilling or unable to admit that its program is working only for a very few. It has convinced itself that if it just keeps on the same failed path long enough, things will turn around.

The Guardian‘s US finance and economics editor, Heidi Moore explains why this rally is not an indicator of US economic growth and why we shouldn’t trust the Dow:

The last time the Dow hit a high, in 2007, the Federal Reserve and the European Central Bank were already collaborating on a global economic bailout, and Bear Stearns collapsed six months later. Before that, the high was in January 2000, only about three months before the market started a long, ugly downward slide in the wake of the tech boom. Go back further, in 1987, when the Dow hit a temporary high before the recession of the late 1980s and early 1990s hit. In 1966, the Dow hit 1,000 and by 1967 the economy began a long downward slide into the stagflation of the 1970s and the recession of the early 1980s.

None of that, however, beats the Dow’s high in September 1929, just weeks before the giant crash that ushered in the Great Depression. The Dow cannot defy gravity. The higher it rises, the harder it will fall.

So when the Dow is high, you should smile – briefly. Then duck.

If you’re getting a bad feeling about this, you should.

On MSNBC’s The Rachel Maddow Show Tuesday, Rachel’s guests Joseph Stiglitz, Nobel Prize-winning economist and Frank Rich, New York Magazine writer-at-large discuss the stock market and corporate profits reaching record setting heights while most Americans see their wages stagnant and unemployment rates barely moving.

Between having to admit that it was too big to prosecute (TBTP) the Too Big To Fail (TBTF) banks, his testimony on the legality of targeted assassinations and having to clarify lethal drone attacks on Americans in America after Rand Paul’s thirteen hour filibuster, Attorney General Eric Holder has not has a good week.

In his testimony before the Senate Judiciary Committee, AG Holder responded to Iowa Republican Sen. Chuck Grassley’s concern that the “mentality of too-big-to-jail in the financial sector” was leading to the spread of terrorism (re:HSBC) with this:

HOLDER: The concern that you have raised is one that I, frankly, share. And I’m not talking about HSBC now. That (inaudible) be appropriate.

But I am concerned that the size of some of these institutions becomes so large that it does become difficult for us to prosecute them when we are hit with indications that if you do prosecute, if you do bring a criminal charge, it will have a negative impact on the national economy, perhaps even the world economy. And I think that is a function of the fact that some of these institutions have become too large.

Never mind laundering money for terrorist activity and giving it a pass, it’s all about protecting the world’s 1%. The Federal Reserve just keeps handing them $83 billion in handouts every year while Obama negotiates away Social Security and Medicare benefits at fancy dinners in Washington posh hotels with Republicans.

If they’re TBTP, then it time to break them up

Then came Kentucky’s Republican Sen. Rand Paul’s pique over Mr. Holder’s failure to answer three inquiries regarding armed drone attacks on Americans on American soil. Sen Paul’s 13 hour filibuster which at times bizarre (you try talking for that long and not sound a little weird) causing Mr. Holder to back off on his assertion that the president can do just that. In his second letter, Mr. Holder told Sen. Paul that the president would not have the authority to order a drone to kill an American citizen on U.S. soil who was “not engaged in combat.”. How nice, he can’t use drones. But AG holder can take solace, the author of the Bush administration legal memos justifying the use of torture, John Yoo, thinks thinks “President Obama is really getting too much grief over targeted killing“:

“I admire libertarians but I think Rand Paul’s filibuster in many ways is very much what libertarians do, they make these very symbolic gestures, standing for some extreme position,” said Yoo, now a UC Berkeley law professor, who once suggested it was okay for the president to order a child’s testicles be crushed. Referring to Paul’s marathon filibuster, an attempt to force the Obama administration to clarify its views on the use of military force against terror suspects in the United States, Yoo said “It sort of reminds me of young kids when they first read The Fountainhead or Atlas Shrugged and they suddenly think that federal taxation equals slavery and they’re not going to pay any federal taxes anymore.” Yoo’s statements were made on a conference call Thursday held by the Federalist Society, an influential conservative legal organization.

Now that’s an endorsement you can take to a war crimes trial.

It is unconstitutional to target a group or an individual without due process under Article I, Section 10, Clause 1 of the Constitution which bans bills of attainder, and the Fifth Amendment.

So long as this president has a list of people he thinks can be targeted for assassination without due process, by armed drone or any other means, there are should to be questions and not just from a handful of Tea Party Libertarians. As for AG Holder, if he can’t prosecute banks or uphold the Constitution, then he should be fired, resign or impeached.