> [mailto:owner-lbo-talk at lists.panix.com]On Behalf Of Doug Henwood
> >If folks want to see what the alternative is to tax credits for
> >individuals, the Health Insurance Association of America is promoting plans
for subsidies to
> >business to keep workers tied to employer-based health care and the insurance
> >industry -- NN
>
> Wait a minute. isn't your pal Bradley going to direct now-public
> money into private insurance companies?
Get your scorecard Doug. HMOs are not insurance companies and health insurance companies selling group coverage to business are in a major (and losing) dogfight with HMOs. Remember, the original Harry & Louise ads objected to the fact that the Clinton plan would essentially create a series of regional super-HMOs that would have cut insurance agents out of the game. If everyone is shopping off a defined list of HMO-style providers from the Federal Employee Health Benefits Program, the folks actually selling insurance don't have anything to do.
Now, folks on the list bemoan the fact that "public money" now going to Medicaid might go to private medicine under Bradley's plan. Guess what-- Medicaid already largely goes to private for-profit hospitals and providers. The government may be paying the bills, but for-profit ventures are making plenty of profit. And even the non-profit hospitals often contract out services to for-profit labs and other operations with close ties to doctors and administrators at those non-profits.
So we have three systems of delivering profit into the hands of private medicine right now. The government pays the bills directly which has the virtue of simplicity and the drawback of inflexibility and wholesale fraud in some cases. We have fee-for-service where insurance companies take a cut in paying fees to different hospital and medical professionals. And we have HMOs where a single monthly payment is made-- thereby limiting the billed cost but possibly undermining the quality of care.
Don't be sentimental Doug- Medicaid like Medicare is an integral part of capitalist Medicine in the US. It delivers high profits to many private health care providers while taking many high-risk patients out of the insurance pool. So both the insurers and the hospitals win.
A complete single-payer health care system of payment would decrease this sleight-of-hand, which is one reason I favor it as an improvement, but the Bradley plan at least has the virtue of integrating a lot of those high-risk/high-cost patients into the general pool and thereby would decrease the easy profits of those skimming Medicaid right now.
Attached I have a release by the United Food and Commercial Workers which has been fighting union-busting Beverly enterprises at its nursing home chain. According to this release, Beverly received over 75% of its profits from Medicare and Medicaid. They apparently stole something on the order of $225 million -- probably more since they agreed to settle for that amount.
I think the antipathy to Bradley's plan and the attachment to Medicaid is naive. Marta offers some specific advantages for some disabled patients from the Medicaid system, but that is a very different thing from arguing that it is "public" medicine while Bradley's plan is "private." All are capitalist medicine with profit criterion driving their operation from end to end -- just manifesting itself at different points along the delivery chain. They all are a system of delivering public money to private medicine and contra the comments about the inherent efficiency of Medicaid, there are lots of ways that private hospitals and firms have leveraged inefficient profits and fraud out of that system.
So given these capitalist alternatives, I still choose the one that delivers the most access to low-income folks. If instead of Beverly getting fat on the system, some Alabama HMO gets its bit instead, I really don't feel a great need to choose between them. I am all for mobilizing for socialization of the whole system, but don't try to tell me that the present Medicaid system is even a faint echo of socialism or "public money".
And right now, the simplest step to take is to get as universal coverage as possible. After that, with fewer divisions and sleight-of-hand cost-shifting possible via Medicaid, it may be easier to make a case for complete overhaul of the system.
-- Nathan Newman
U.S. Newswire Copyright 1999 Friday, August 6, 1999
Beverly Fraud Penalty Brings Renewed Demand for Investigation of Company Profits in Alabama
Facing two federal investigations into Medicare fraud at Beverly Enterprises, the nation's largest nursing home chain has tentatively agreed to pay $225 million to resolve the dispute. The charges stem from investigations launched in July, 1998 by the Department of Justice and Office of the Inspector General from the Health and Human Services Department.
Beverly's settlement appears to be preemptive strike to avoid a "guilty" conviction which would ban the company from Medicare and from Medicaid for five years. Seventy-five percent of Beverly's profits come from the taxpayer-funded programs. In 1998, $2.1 billion of Beverly's $2.8 billion in total revenues came from Medicare and Medicaid.
The Medicare fraud settlement sheds new light on a recent report of Beverly's soaring profits in Alabama and stagnant patient care rates. The Care Gap: A Report on Patient Care and Profits at Beverly Enterprises Inc. in Alabama, released by the United Food and Commercial Workers International Union (UFCW), exposes the wide gap between profits and hours of hands-on care at Beverly's Alabama facilities.
The report shows that in Alabama in 1997 and 1998, profits rose 27 percent, Beverly's hands-on care by Certified Nurses Aides (CNAs) rose only 1.03 percent. Beverly provided an average of 2 hours and 3 minutes of daily CNA care, 15 percent below the state average.
Beverly's track record of putting profits before patients, and before the law, is clear. The Care Gap proves the impact of greed- driven corporate practices on the well-being of its patients. Beverly's shareholders have filed a class action suit claiming Beverly illegally inflated company revenues through misleading billing practices. Now, the company is paying the government $225 million to settle fraud charges.
The UFCW renews its call for a statewide investigation into Beverly's Alabama operations to further protect nursing home residents and improve staffing ratios in Alabama and across the country by:
-- Holding legislative hearings to examine the relationship between profit, staffing and patient care.
-- Passing legislation to increase staffing ratios to the minimum level of 2 hours and 42 minutes of CNA care per resident day as recommended by experts in nursing home care.
-- Tracking the patient care performance of homes owned by the same for-profit chain, as called for by President Clinton and the ( General Accounting Office.
-- Requiring nursing homes to post staffing schedules and state Medicaid cost report summaries, including profits, in public areas.
-- Enacting whistle-blower laws to protect nursing home workers that report poor and illegal practices in nursing homes, including staffing shortages.
-- Implementing legislation that provides targeted reimbursements to increase nursing home wages for CNAs and other front line staff to reduce turnover.
The UFCW, with 1.4 million members, is one of the largest unions in the U.S. with members in the healthcare, retail food, meat packing, poultry, food processing, footwear, garment and textile, and chemical industries.