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Texas Just Messing Around with Health Navigator Testing

dmwt_logo_tempNew Orleans  Driving through Texas, the highways are littered with signs, mile after mile, reminding the driver to “not mess with Texas.”  When it comes to the Affordable Care Act and enrollment of the millions of people who have no health insurance though, the state does nothing but push boulders into the road.

You will remember that at one point the Governor and Presidential candidate wannabe, Rick Perry, was ranting at the Texas Department of Insurance to come up with almost impossibly strict guidelines for navigators who were assisting in Obamacare enrollment.  At one point he wanted all navigators to take classroom and on-line tests before the sign-up deadline to stall the whole process, pay $800 for the testing, endure fingerprinting and police background checks, and any number of other things, just to monkey wrench the process.  At least they were honest.  They just wanted to slow down enrollment.  Plain and simple.

Unfortunately, the governor and his drooling, mad dog supporters had a problem since the standards they had for assistors for Medicare and insurance agents themselves were not as burdensome as what they were requiring for navigators who were limited to only helping people get on the website and enroll.  At the end of the day they pushed back the new requirements to May 1st after the March 31st deadline for Affordable Care, and the costs were more in the range of $130 or 150 per test.  Oh, yeah, you still had to get fingerprinted and police checked, but that was more harassment than anything else.

So what is this new rigorous testing and instruction really like?  Talking to some of the navigators who are going through the three hour a day, instructed on-line teaching, most of them are finding it something of an “out of body” experience.  As one wrote me,

The TDI class is unbearable.  90% has nothing to do with being a navigator or ACA.  It seems to be a course to encourage people to NOT be navigators.  All the presenters are lawyers and spend most of their time quoting state law and acting like we are becoming insurance agents.  Every so often they will say, “This part is important for ACA.”

Truth to tell, they are clearly just faking it, so that they can say to someone that they piled it on these poor navigators.  Everyone is just marking time and some Republican legal-beagle donors are making some easy bucks pretending to teach.

And, truth to tell, this is also a complete political charade, not only because of the obvious, which is the fact that the main 2014 enrollment period is now over until October opens up for 2015, but also because the navigation program was only funded by Congress for one year and times out in August 2014.  Talk about kicking a dead horse!  Unfortunately for the millions of people that need them to help get on Affordable Care, there just won’t be any federally funded navigators ready to help for 2015.

This will be just another Texas tall tale of how they whooped it to the navigators so they couldn’t help sign up any more people to that darned Obamacare, when in truth the politicians were just beating a dead horse and play acting for the cheap seats the whole time anyway.  Hey, it’s only about life and death, so in Lone Star cynicism, who cares anyway, and the devil take the hindmost.

Texas Judge Slaps Down James O’Keefe Voter Reg Claims

Screen-Shot-2013-03-18-at-4.03.11-AMNew Orleans    It’s only a matter of time before someone sues James O’Keefe, the video scammer, for false advertising to prevent him from calling his operation Project Veritas, since veritas means truth in Latin, and he has no clue what that is.

O’Keefe’s latest tempest in a teapot had been his accusations against the Battleground Texas voter registration project.  He and his associates had memorably called the group something on the order of the “new ACORN” so that obviously attracted my interest and enthusiastic support for them right “from hello.”  Once you stripped down all of the hyperbole, allegations, accusations, and his general cry that the “sky was falling” on democracy in Texas, the kernel of his argument was that somehow the Battlegrounders were keeping the phone numbers of folks they registered in order to call and remind them to vote when the next election came nigh.   Oh, and the O’Keefers also said this was all done at the behest of Wendy Davis, one of the Democratic candidates for Governor, once Rick Perry is done.

The O’Keefers filed their complaints amidst hubbub from the Republican Tea-people and the general red meat crowd so a Texas judge appointed a couple of special prosecutors to look into the mess, including one who was a Republican, since fair is fair still, even for some folks in Texas.   Needless to say, there was “no there, there.”  In his dismissal of all charges the judge administered a slap down in his conclusion:

The Veritas video was little more than a canard and political disinformation. The video was particularly unprofessional when it suggested that the actions of Battleground Texas were advocated by a Texas gubernatorial candidate and that the actions of a single volunteer deputy registrar may even involve private health data, which is not involved in the voter registration process.

Oh, yeah, did I forget to say that while they were taking shots at ACORN, in equally scattershot fashion they had alleged that somehow their complaints were also connected to hanky-panky by the Battlegrounders with Obamacare.  Invoking Obama’s name on the O’Keefe besotted wacko-right is a clue that the fur is about to fly, so you can’t fire off an angry screed without connecting the dots back to Obama, ACORN, etc, etc, etc,

As for the actual allegation, well to quote MSNBC.com’s report

… the special prosecutors wrote that the prohibition on recording phone numbers only applies to the official county registrar, not volunteer registrars like Battleground Texas activists.

Readers will recall that O’Keefe is in Texas largely at the behest of Brietbart.com which is hoping there and in the United Kingdom that their brand of hate-agation can stir up confusion for upcoming elections in both places.

MSNBC reminded readers that it’s all about voter suppression of course and that there’s plenty at stake:

Texas has one of the lowest turnout rates in the country. And because Hispanics in the state are registered to vote at a significantly lower rate than other ethnic groups, boosting their participation rate is crucial to Democratic hopes.  For the GOP, hampering that effort is a key strategy for holding onto power. Already, Texas Republicans have made registration more difficult: A 2011 law required that anyone registering voters complete an extensive training program, and imposed other restrictions. And the state’s strict voter ID law, currently being challenged by the Justice Department, has been shown to disproportionately affect hurt non-whites.

I couldn’t have said it better myself, but trust me on this, O’Keefe’s total lack of a moral compass and disregard for anything resembling the truth, makes him immune from embarrassment since his only interest is in drawing blood at the first, deepest cut, not whether or not he suffers some scrapes himself.   Nonetheless as his base continues to narrow, we can count the months until his minders, less immune to the damage, finally cut him off at the funding stream, which is the only thing he’ll ever notice.

Wanted: Medicare Whistleblowers!

amaNew Orleans   It’s easy to see why the American Medical Associations, the powerful AMA, the doctors’ closed shop union, wanted to keep the wraps on how doctors collected $77 billion worth in Medicare payments from the nation’s elderly.  There’s just nothing that seems right about one single Florida-based ophthalmologist raking in $21 million all by his lonesome.  Hey, the eyes have it for goodness sakes, but he’s not doing brain surgery for crying out loud, but luckily all of our eyes are now going to be on his practice to see if it he’s padding the bills.

            143,000 elderly are getting treatments for macular degeneration that cost over $1 billion.  These treatments can occur as frequently as monthly and involve a shot with a needle into the eyeball, which I know from my own dear mother, is also very painful.  Meanwhile there’s a drug that may be just as good and that is a whole lot cheaper and perhaps less painful as well.  I’m not saying these docs are putting a bunch of old folks through the ringer, but I definitely want to know for sure that this is the right thing they are doing, so having a lot of light shining on the issue is very important.

            It was also pretty shocking to see that only 2% of the doctors sucked up nearly a quarter of the payments totally $15.1 billion of the $77 billion.  Maybe there will be a big argument about inequality among the docs now, too!  

            As this kind of information for doctors, clinics, which were not included in these totals, and hospitals is processed, I have two feelings.  On the one hand we’re going to finally have some real tools to try and avoid the rip-off folks and hopefully to shame some of these institutions into dialing back some of the bill padding especially for needless procedures.  On the other hand I’m already getting mad though because, frankly, I’m not convinced that any amount of shaming will impact them because so much of the medical market is based on location and scarcity and therefore can easily hold desperate patients in a predatory position with the government paying for the pain and privilege. 

            The best news I could see was at the end of the coverage in the New York Times:

Regulators and others are also likely to seize on some of this information to find those doctors who perform an unusually high volume of services, raising the question of whether every test or procedure … was medically necessary. “There’s a lot of potential for whistle-blowers and justified worry for fraudsters,” said Steven F. Grover, a lawyer who represents whistle-blowers who sue doctors and hospitals who they claim have committed fraud against the Medicare program. “There’s going to be a lot of litigation over this,” he said.  The Office of Inspector General for the Department of Health and Human Services, which serves as a federal watchdog on fraud and abuse for the agency, released a report in December recommending greater scrutiny of those physicians who were Medicare’s highest billers. The report recommended that Medicare establish a threshold to look more closely at the high billers. Regulators have also said they are scrutinizing the use of high-paying codes in places including the emergency room.

It’s too late for me to be a rich man or in this case a doctor when I grow up, but being a whistleblower sounds like something right up my alley.   Time to buy a green eyeshade, calculator, and better glasses, and all of us start pouring through these records and seeing who is fair and square and who is crooked and sleazy, and making the latter pay for a change, rather than getting paid big change.  Big data might be our friend and at our fingertips.  Did you know you can even go on the Center for Medical Services website and check on your doctor now?  Caveat emptor is going down, and OG’s with a doctor’s license better start remembering the motto about “do no harm.”

As station manager of KABF, we get to preview new music, please enjoy this new release called Cardiac Arrest by Bad Suns. 

Unions, the First and Last Hope for Egyptian Revolution

0,,15498914_4,00New Orleans   When more than 20 organizers from labor unions and community organizations as part of the Organizers’ Forum delegation visited Egypt in 2011 after the revolution several years ago scores of meetings with political parties, activists, community and labor organizers, proved the one clear reality-tested conclusion that cut through all of the hype was that this was no Facebook revolution whatsoever.  If there was one clear, unheralded hero in the drama whose relentless pressure broke the Mubarak government it was the labor movement.   Their continuing strikes kept the pressure on the government no matter how much repression and press coverage occurred in the Square.  The events leading to Tahir Square and the surge of hope for change in Egypt that many called the Arab Spring were the classic case of something that seemed like a victory having a thousand fathers while a defeat is a bastard child.

            We were also convinced even in the fall of 2011 that the revolution was slipping away.  Now three years later so many of the hopes and aspirations of that time are mired in disappointment.  The elected government, dominated by the best organized, which in that case was the Muslim Brotherhood, failed to right the economy or open government to the array of voices that had made the revolution so vibrant.  In fact repression grew and for those of us who had been there it was not a surprise to see the government go after the leadership of independent trade union federations, often with minor or trumped up charges.  Labor unions were not silent during this period largely because they felt that one of the promises of the revolution were breeched when the new government continued to prop up the state controlled labor apparatus and hold down the ability of emerging, autonomous unions to bargain or even collect dues.  The alienation of some of the independent worker advocates was so extreme that some of them heralded the military coup that displaced the elected government as a relief, hoping that they would finally be able to appropriately establish their unions.

            I often wondered whether we were the only ones stumbling through the hype to the real story until I stumbled on a recent piece in the Wall Street Journal of all places finally giving some credit to workers as the last line of protest and defense threatening “to disrupt the widespread public adulation expected to propel Abdel Fattah al Sisi into the presidential palace….”   In a piece by Matt Bradley and Leila Elmergawi they not only gave credit to workers and trade union activists for their role in ousting Mubarak finally but also noted the price the labor movement is paying by continuing to put on the pressure for rights and wages, including the fact that leaders of the Post Office Union have been taken away and accused of creating a “terrorist” cell and a suit by against 11 strike leaders.  Teachers, doctors, police, and transport workers have also created independent unions and struck the government.  The Journal points out that only about one million of Egypt’s 23 million workers belong to independent unions, and that the government will obviously try to cut separate deals, but the unionization numbers are higher when state unions are counted and workers are still voting with their feet to hit the street in wildcat actions even from these more tightly controlled unions. 

            Unfortunately, unions by themselves can’t restore democracy in Egypt, but their continued pressure will eventually win wage relief from the government and will continue to speak to the courage and the aspirations of people.  You can’t tweet that or post it on Facebook easily, but workers are still proving that it’s strength at the base that counts more than Hail Mary shots at the powers that be through the internet’s social media channels.  It’s got to be feet on the ground, not just fingers on a key board to make real change.

The Non-existent “Laboratory Conditions” on Union Elections in Auto and Sports

nlrbNew Orleans    Later in April a hearing officer for the regional office of the National Labor Relations Board covering Chattanooga will determine whether or not things like the Governor’s contingent promise to provide Volkswagen with $300 million in tax benefits and subsidies to add a new production line only if workers voted against representation by the UAW was illegal interference with the election.  The NLRB’s responsibility is to assure that “laboratory conditions” guaranteeing a fair election workers free of coercion, inducements, and other interference.  Companies and others will argue that their freedom of speech should allow them to throw whatever rocks at the election they feel like slinging.  There’s no question that you can no longer divorce a workplace election from the larger community, but whether a governor can try to dangle a big bribe to influence the vote is an important question.

            It is easy to see the National Collegiate Athletic Association, the NCAA, walking that line right now in the run-up to the union election coming for football players at Northwestern University outside of Chicago.  Out of one side of their mouths they are saying essentially that the union election doesn’t move them, and out of the other side of their mouth they are saying it is the end of collegiate sports and they’ll change.  More to the point the NCAA and its leaders are claiming that after years of dithering around on the question of whether or not athletes should get any share of the huge revenue in big time basketball and football, that they are about to punt the question over to the big conferences give them the autonomy to pay athletes more if they want to do so.  In essence the NCAA is making the standard company claim in a union election that if you stick with us, then change is coming.

            More sober observers point out that the NCAA “sky is falling” claim is full-blown Chicken Little.  The NLRB ruling only effects private universities as private employers of athletes for example, and in big time sports that means places like the Northwestern, the University of Miami, Notre Dame, the University of Southern California, Tulane, and others, but doesn’t touch public universities which dominate the SEC, Big 10, and Pacific conferences where the top football contenders rule.  In basketball there’s more competition with smaller, private schools, like Duke, Marquette, and others, but it’s still publics with UConn, Kentucky, Florida, and North Carolina that often rule and are outside of NLRB jurisdiction.  Interestingly, it might even be easier in some of the states to organize under public sector union rules, but someone will have to move in that direction first, so we’ll have to wait and see.

            Either way it’s impossible to feel sorry for even a second for the NCAA.  While schools make billions young men – and women – play for pride and the old school tie, get hurt, get cut, and get nothing.  If the NCAA cared for a minute about the educational enterprise they might just step back and stop their whining and let the young folks figure this one out without all of this adult interference.  Heck, even Nike, surprisingly, came out for the right to organize.  Yes, that’s not the right to unionize, but it’s something. 

            Let’s go with the “laboratory conditions” for workers.  Let a bit of democracy into the mix.  The kids will be all right.

How can Billion Dollar Fines be Little More Than Water off a Duck’s Back?

indexNew Orleans   I hate to admit it, but to me a billion dollars still seems like a whole lot of money.  Unfortunately, I’m afraid saying so makes me hopelessly hide bound and old school.

            Why?

            Because the government seems to be passing out billion dollar fines like candy to banks, utility companies, oil companies, automobile manufacturers, and others and it seems to have no discernible impact on their behavior whatsoever.  I’m sure you’ve noticed the same thing.  The government takes a victory lap, a couple of months or maybe a year goes by, and the same corporate culprit is doing the same perp walk to the ATM to pay out another billion dollar fine.  Billion dollar fines seem to have replaced the space on corporate balance sheets where they once wrote “goodwill,” and now it’s an item called “reserve” for a future expenditure for bad behavior.  Cheating consumers has simply become a mundane part of corporate culture.  Rapacious capitalism is no longer an insult, but a rally cry.

            How many gazillions has Bank of America now paid out for example due to the mortgage mess and their acquisition of Countrywide?  It hardly matters it seems as they get ready to pay another $800 million because they couldn’t keep themselves from selling non-existent products to their credit card holders.  One financial institution after another these days from HSBC to storied European banks are lining up to pay huge, billion plus fines for laundering money for Iran and other countries under sanctions by the international community.  JP Morgan Chase, only a few years ago was basking in arrogance with financial folks hanging on Jamie Dimon’s every word, but the number of fines it has paid for cheating and stealing from its customers makes him seem like the boss for a serial criminal mob.  Citicorp is running around in crisis having failed a “stress test,” not because they want to get a good grade on Wall Street it seems, but largely because they may be the only big bank fine payer not able to increase the dividend to their investors, and of course having somehow lost $400 million through their Mexican subsidiary they are claiming fraud, and the government is investigating, what else, but money laundering to drug cartels in that country.

            But speaking of a criminal enterprise, how about Wall Street itself?  I’m more than half-way through Michael Lewis’ new book called Flash Boys, where the real story is about the billions that some companies are making and that all of the big banks are abetting of front-running stock trades through high-frequency trading , which is of course totally illegal,.  And, yes, the FBI is now investigating, and the SEC is embarrassed, and the Attorney-General of New York State is letting subpoenas rain down like tickertape on Wall Street, but all that means is that the outcome of this latest scandal is likely to be, yes, you know, more fines!   An analysis of super-investor Warren Buffet’s portfolio over the last 5 years says he has even underperformed the Standard & Poor’s 500 stock index.  Friends, if he can’t beat the house on Wall Street in the biggest gambling casino in the world, you know on one else has a fair chance.

What’s the answer?  If it’s not fines, is it jail?  Hardly, since the big whales only offer up the small fry to do time. 

It’s time to clean house, but it looks like the walls are so rotten and the foundation is so shot, that it’s gut rehab time, but from top to bottom there doesn’t seem to be anyone willing and able to take on the job.

What a heckuva a mess!  Seems like if we have five dollars we might as well hide it in our shoe and take our chances on street crime, since no one seems able to stop Wall Street crime.