RKMBs Forums .::Important::. Politics and Current Events A right to Health Care

...As for the president's speculation that families making $83,000 would be covered, the nonpartisan FactCheck.org stated that claim is false, noting new guidelines from the Center on Medicare and Medicaid Services making it "quite difficult" for any state to raise its eligibility for SCHIP recipients for those making more than 250 percent of the federal poverty level, $51,625 for a family of four.

Washington Post

abcnews

I don't know if Health Care is a "right" in the constitutional sense but it seems to be the right/humane thing to do. What good is all this money the U.S has if we can't help people. Especially on something like Health. So many problems in the world why let people worry about paying for medical care when we can do something about it.

Financial woes jeopardize area hospitals

Nearly two dozen are at risk. Losing even a few would mean greater strain on the region's healthcare network.

By Daniel Costello and Susannah Ros

By Daniel Costello and Susannah Rosenblatt, Los Angeles Times Staff Writers
September 23, 2007

Nearly two dozen private hospitals in Los Angeles and Orange counties, accounting for up to 15% of beds in the region, are in dire financial straits and in danger of bankruptcy or closure, according to hospital administrators, industry experts and state data.

The troublesome development follows the closure of community clinics and hospitals in recent years that has left the healthcare system seriously overburdened.

We're talking about a system that is already in crisis.
— Carol Meyer, director of governmental affairs, L.A. County Department of Health Services

If even a few other hospitals close or reduce costly critical-care services, it could mean longer ambulance rides to hospitals, additional delays in emergency rooms and less access to care, especially for poor and uninsured people.

Among the hospitals in poor financial health, according to industry analysts, are Downey Regional Medical Center, Centinela Freeman Health System in Inglewood, Brotman Medical Center in Culver City, Century City Doctors Hospital and four Orange County hospitals owned by Santa Ana-based Integrated Healthcare Holdings Inc. including Chapman Medical Center in Orange and Western Medical Center in Santa Ana, one of three trauma centers in the county.

In interviews, senior executives at Centinela and Downey said they were considering closing their emergency rooms. Downey's chief operating officer, Rob Fuller, added that his hospital could close entirely as early as next year if its financial picture didn't improve soon.

"It's fasten your seat belt it's going to be a bumpy ride time," said James Lott, executive vice president of the Hospital Assn. of Southern California, a trade association.

The financial woes result from a multitude of developments:

* An increasing load of uninsured and low-income patients has resulted from overcrowding and the shutdown of public facilities. The number of uninsured patients visiting private hospitals, particularly in poor areas, has increased by one-third in Los Angeles County since 2002. California's Medi-Cal program for the poor reimburses hospitals at one of the lowest rates in the country.

* The closure of Martin Luther King Jr.-Harbor Hospital in Willowbrook last month left half a dozen nearby hospitals to absorb most of the 47,000 patients who used the public hospital's emergency room last year.

* Smaller community hospitals are drawing fewer patients as a few larger facilities attract a growing share of doctors and insured patients.

* As insurers have consolidated in recent years, they've squeezed many smaller facilities. Private insurance companies generally pay higher rates to larger hospitals with greater bargaining power.

* New, stricter state mandates on nursing ratios have raised labor costs, and a 2013 deadline to retrofit all hospitals to better withstand a major earthquake is estimated to be costing medical facilities $110 billion statewide.......................

Health insurer tied bonuses to dropping sick policyholders

By Lisa Girion, Los Angeles Times Staff Writer
November 9, 2007

One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

[b]Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

These cancellations have been the recent focus of intense scrutiny by lawmakers, state regulators and consumer advocates. Although these "rescissions" are only a small portion of the companies' overall business, they typically leave sick patients with crushing medical bills and no way to obtain needed treatment.

Most of the state's major insurers have cancellation departments or individuals assigned to review coverage applications. They typically pull a policyholder's records after major medical claims are made to ensure that the client qualified for coverage at the outset.

The companies' internal procedures for reviewing and canceling coverage have not been publicly disclosed. Health Net's disclosures Thursday provided an unprecedented peek at a company's internal operations and marked the first time an insurer had revealed how it linked cancellations to employee performance goals and to its bottom line.

The bonuses were disclosed at an arbitration hearing in a lawsuit brought by Patsy Bates, a Gardena hairdresser whose coverage was rescinded by Health Net in the middle of chemotherapy treatments for breast cancer. She is seeking $6 million in compensation, plus damages.

Insurers maintain that cancellations are necessary to root out fraud and keep premiums affordable. Individual coverage is issued to only the healthiest applicants, who must disclose preexisting conditions.

Other suits have been settled out of court or through arbitration, out of public view. Until now, none had gone to a public trial.

Health Net had sought to keep the documents secret even after it was forced to produce them for the hearing, arguing that they contained proprietary information and could embarrass the company. But the arbitrator in the case, former Los Angeles County Superior Court Judge Sam Cianchetti, granted a motion by lawyers for The Times, opening the hearing to reporters and making public all documents produced for it.

At a hearing on the motion, the judge said, "This clearly involves very significant public interest, and my view is the arbitration proceedings should not be confidential."

The documents show that in 2002, the company's goal for Barbara Fowler, Health Net's senior analyst in charge of rescission reviews, was 15 cancellations a month. She exceeded that, rescinding 275 policies that year -- a monthly average of 22.9.

More recently, her goals were expressed in financial terms. Her supervisor described 2003 as a "banner year" for Fowler because the company avoided about "$6 million in unnecessary health care expenses" through her rescission of 301 policies -- one more than her performance goal.

In 2005, her goal was to save Health Net at least $6.5 million. Through nearly 300 rescissions, Fowler ended up saving an estimated $7 million, prompting her supervisor to write: "Barbara's successful execution of her job responsibilities have been vital to the profitability" of individual and family policies.

State law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions.

But Health Net's lawyer, William Helvestine, told the arbitrator in his opening argument Thursday that the law did not apply to the insurer in the case because Fowler was an underwriter -- not a claims reviewer.

Helvestine acknowledged that the company tied some of Fowler's compensation to policy cancellations, including Bates'. But he maintained that the bonuses were based on the overall performance of Fowler and the company. He also said that meeting the cancellation target was only a small factor.

The documents showed that Fowler's annual bonuses ranged from $1,654 to $6,310. But Helvestine said that no more than $276 in any year was connected to cancellations.

He said Fowler's supervisor, Mark Ludwig, set goals that were reasonable based on the prior year's experience.

"I think it is insulting to those individuals to make this the focal point of this case," Helvestine said.

Bates' lawyer, William Shernoff, said Health Net's behavior was "reprehensible."

He said the cancellation goals and financial rewards showed that the company canceled policies in bad faith and just to save money. After all, he told the arbitrator, canceling policies was Fowler's primary job.

"For management to set goals in advance to achieve a certain number of rescissions and target savings in the millions of dollars at the expense of seriously ill patients is cruel and reprehensible by any standards of law or decency," Shernoff said.

The company declined requests to make Fowler available to discuss the reviews.

Cianchetti, the arbitrator, earlier ruled the rescission invalid because Health Net had mishandled the way it sent Bates the policy when it issued coverage. At the end of the hearing, it will be up to Cianchetti to determine whether Health Net acted in bad faith and owes Bates any damages.

The disclosures surprised regulators. A spokesman said state Insurance Commissioner Steve Poizner was troubled by the allegations.

"Commissioner Poizner has made it clear he will not tolerate illegal rescissions," spokesman Byron Tucker said. "We are going to take a hard and close look at this case."

In recent months, the state's health and insurance regulators have teamed to develop rules aimed at curbing rescissions and to more closely monitor the industry's cancellation policies.

Other insurers that have rescission operations, including Blue Cross of California and Blue Shield of California, said they had no similar policies linking employee performance reviews to rescission levels. Blue Cross said it conducted audits to ensure that claims reviewers were not given any "carrots" for canceling coverage.

Bates, who filed the suit against Health Net, owns a hair salon in a Gardena mini-mall between a liquor store and a doughnut shop. She said she was left with nearly $200,000 in medical bills and stranded in the midst of chemotherapy when Health Net canceled her coverage in January 2004.

Bates, 51, said the first notice she had that something was awry with her coverage came while she was in the hospital preparing for lump-removal surgery.

She said an administrator came to her room and told her the surgery, scheduled for early the next day, had been canceled because the hospital learned she had insurance problems. Health Net allowed the surgery to go forward only after Bates' daughter authorized the insurance company to charge three months of premiums in advance to her debit card, Bates alleged. Her coverage was canceled after she began post-surgical chemotherapy threatments.

"I've got cancer, and I could die," she said in a recent interview. Health Net "walked away from the agreement. They don't care."

Health Net contended that Bates failed to disclose a heart problem and shaved about 35 pounds off her weight on her application. Had it known her true weight or that she had been screened for a heart condition related to her use of the diet drug combination known as fen-phen, it would not have covered her in the first place, the company said.

"The case was rescinded based on inaccurate information on the individual's application," Health Net spokesman Brad Kieffer said.

Bates said she already had insurance when a broker came by her shop in the summer of 2003, and said she now regretted letting him in the door. She agreed to apply to Health Net when the broker told her he could save her money, Bates said.

She added that she never intended to mislead the company. Bates said the broker filled out the application, asking questions about her medical history as she styled a client's hair in her busy shop and he talked to another client waiting for an appointment at the counter. She maintained that she answered his questions as best she could and did not know whether he asked every question on the application.

Bates' chemotherapy was delayed for four months until it was funded through a program for charity cases. Three years later, she can't afford the tests she needs to determine whether the cancer is gone.

So she is left to worry. She is also left with a catheter embedded in her chest where the chemotherapy drugs were injected into her bloodstream. Bates said she found a physician willing to remove it without charge, but he won't do it without a clear prognosis. That remains uncertain.

Shernoff, Bates' lawyer, claimed that the performance goals for Fowler showed that Health Net was bent on finding any excuse to cancel the coverage of people like Bates to save money.

"I haven't seen this kind of thing for years," Shernoff said. "It doesn't get much worse."

lisa.girion@latimes.com

yeah, and the government would never dream of anything like that.

Having worked for a time in the medicaid fraud unit of a government agency I can tell you that the government already does reward employees who try to bump people off the government health care dole.

Having worked for a time in the medicaid fraud unit of a government agency I can tell you that the government already does reward employees who try to bump people off the government health care dole.

How the hell do you equate the shenanigans being done in the article with your job of weeding out the people who are abusing the system???

apparently 'don't get sick' seems to be a bit too extreme a suggestion.

Last month, the California Nurses Association and the National Nurses Organizing Committee ran ads in Iowa newspapers advocating for a single-payer health-care bill, highlighting the fact Vice President Dick Cheney has benefited from his government-provided coverage. “If he were anyone else, he’d probably be dead by now” due to his long history of health problems, claimed the ad.



In the group’s newest round of ads, which ran “in eight New Hampshire papers” on Friday and will go “national” today, they dub a new name for “guaranteed, publicly-funded health care for all Americans”: CheneyCare.

The ad “asks readers to go to CheneyCare.org and sign a petition in support of CheneyCare for all Americans”:




Cheney’s office “did not respond to a request for comment” by the Washington Examiner, but in December, when the original ads ran, Cheney spokesperson Megan Mitchell said that “something this outrageous does not warrant a response.”

As ThinkProgress noted at the time, what is actually outrageous is the fact that there are roughly 47 million people in America without health insurance, including 3.2 million children, but President Bush twice vetoed legislation that would have expanded coverage to 4 million more children.

While it is certainly good that Vice President Cheney was able get the medical attention he needed, the groups’ ad is right. Americans do deserve “CheneyCare for all.”

I myself wonder why the Democrats don't just pass legislation or a vote that would require any politician who uses the phrase "socialized medicine" to drop out of their dread socialized Congressional health care and have them join an HMO. A Nay vote for "socialized health care" would enroll them in Blue Shield. Put their money where their rhetoric is.

After all if they're so against it, they shouldn't have to suffer under socialized medicine.

I'm against a federal government with too much power. If a state government wanted to offer universal health care for its citizens, you wouldn't hear me say anything against it.

I think you and I are very like minded on this Doc.

I don't necessarily want it either but...it seems hypocritical that they don't offer it.

Not at all. We have always made (and through our elected representatives have made) choices as to the amount of control the government has over us. We've always drawn lines and distinctions. That's what politics and voting (or civics, if you prefer) are about, determining the size and limits of government.

If you are going to argue that government intervention in one area mandates even more intervention later on, you are basically arguing that any government regulation at all requires totalitarianism.

That's an interesting version of the usual "slippery slope" argument.

Actually, however, the government uses the fact that it already pays for at least some health care (medicare, medicaid, subsidized insurance) as their rationalization for why it can control our actions even if they don't affect others.

In fact, that's how they justify making us wear seatbels. Being one of the old farts here, I remember when the government mandated seat belt use in the early 80s. They said that they had the right to do so because people who were injured often ended up, if injured severly enough, on public assistance. Therefore, they had the power to tell us what to do with our own bodies (if you will).

I also remember that some of the more libertarian elements of the country argued "if we let them get away with THAT argument, next they rationalize banning smoking, then drinking, then fatty foods, then..." And the do-gooders said "no, no...they'd never do that.."

So if you have a federal government that pays for everyone's health care you can guarantee that you'll have a federal government that tries to assert more and more control over our lives over time, on the theory that they have a right and duty to cut costs by mandating we only engage in "healthy" activities.

In fact, that's how they justify making us wear seatbels. Being one of the old farts here, I remember when the government mandated seat belt use in the early 80s. They said that they had the right to do so because people who were injured often ended up, if injured severly enough, on public assistance. Therefore, they had the power to tell us what to do with our own bodies (if you will).

I also remember that some of the more libertarian elements of the country argued "if we let them get away with THAT argument, next they rationalize banning smoking, then drinking, then fatty foods, then..." And the do-gooders said "no, no...they'd never do that.."

except the fact that cigarette, alcohol, and especially fast food companies have lots of lobbiests in washington. hell they have so much influence that, since reagan let them become a monopoly, meatpacking is practically unregulated and fast food is left all but untouched.

...
except the fact that cigarette, alcohol, and especially fast food companies have lots of lobbiests in washington... so much influence....

Yeah, Ray. They have so much influence that smoking is banned nearly everywhere in many states, taxed to the hilt nationally, trans fats have been banned in NYC and elsewhere and the drinking age was raised to twenty-one.



But let me ask you: are you saying that you WANT to be told by the government whether or not you can smoke, drink or eat fatty goods?

hey, G-Man, if you don't want to wear a seat belt, I'm cool with it.

So G-Man, are you down with Cheneny Care?

Last month, the California Nurses Association and the National Nurses Organizing Committee ran ads in Iowa newspapers advocating for a single-payer health-care bill, highlighting the fact Vice President Dick Cheney has benefited from his government-provided coverage. “If he were anyone else, he’d probably be dead by now” due to his long history of health problems, claimed the ad.