[lbo-talk] radicalizing healthcare debate, was Sicko

(Chuck Grimes) cgrimes at rawbw.COM
Sat Jul 21 11:29:49 PDT 2007


How about we talk about what the radical American Left can do on the issue of health care reform.

There was alot of footsie happening between the radicals and the NGOs. That's one reason why "diversity of tactics" came about.

What can we do to make the U.S. government afraid of us? Chuck

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Information. Most people have no idea how the system works and even less about their insurance, if they have it.

The US government is all ready afraid. Its health plans that include Medicare, Medicaid, civil service, and military systems have all been cut or trimed many times over. In addition their internal rules and policies are under constant change to selectively filter out as much coverage as possible. Most of these federal systems are not actually managed by federal civil service, but are subcontracted to the same corporate insurance giants that are also running their own private systems.

So when you try to find out what is covered and what isn't you are usually dealing with ten dollar an hour people---probably also subcontracted by the subcontractor to tell you no.

So, the point is information is completely hidden. The policies that determine what is covered and what is not are hidden under dozens of layers of bullshit. Nobody is apparently responsible. Nobody can be reached. Nobody is in charge, Nobody knows. And nobody knows who does know. In other words, no.

So, a simple method of presenting core information is in effect a radical assault on the system. Exposure of the detailed path of the paperwork is enough to outrage. I am serious.

Here is an example. Let's say you get a flat tire on your wheelchair. You roll in to a place like were I work. If we have a complete and up to date record on you, I look up your coverage and then look up your repair record. I see you were in here two weeks ago with a flat tire and I fixed it. I see you have Medicare. Medicare only pays for two flat tires or two replacement tires every six months. So, okay, I can fix your tire. Great. Now what about a month from now? Too bad.

Let's say you have a private insurance plan. They follow the same guidelines as Medicare, but in addition they require a prior authorization. I write up the repair, print it out on a computer and take it to the billing department. They call the insurance carrier and either get or don't get an okay. You wait until that happens.

What does a complete record mean? It means we have a doctor's diagnosis on file that says you are disabled. We have a current prescription on file that says you need repairs. We have repair record that lists everything we've done on your chair, and whether or not your provider has authorized and paid the claims we have filed. We have an account register that shows how much of the claim was paid, because most providers do not pay in full. They pay a percentage of what they allow. With some private insurance coverage, the percentage is so low that the work can not be done. (This is why my boss is trying to sell the shop and sell the business, and get out of this trade.)

For example, Medicare has a register of allowables that lists how much they will allow on almost every kind of repair. They do not pay this allowed amount. They pay 80% of what is allowed. Many of the allowables are so low, that in effect we can not do the work, because the parts cost us more than the listed allowable. Most of these parts are exactly the ones that are most often needed---of course stands to reason, doesn't?

I have to explain this whole long bullshit deal over and over and over everyday to almost everybody I see. I hate it.

Earlier this year when the new allowables came down from Medicare, it was obvious that we were going to be in trouble within a few months. I called Barbara Lee's office and after several calls found the name of which aid dealt with healthcare issues. I finally got a hold of her and tried to set up an appointment to talk to her. She said she was very busey with some crisis that Bush had just stirred up. I forget what it was. She said she would call me back. Of course she didn't. I called again several more times and never got to talk to her again.

In the old days this never would have happened. The disabled community always had an aid in Dellums office staff who worked directly with representatives from the commmunity, some of whom had done office time in the same office or the one for the State representative, along with contacts in at least one of the State senators office---along with well known contacts in the Cal Senator's local offices in SF or Oakland.

Over the years I discovered that many of these political office staffs of the House member or the local state house member actually didn't know much about the very healthcare system and its policies that they voted on, unless they were on the specific committee charged with legislation and oversight.

(This lack of information and insight into policy is exactly what makes the lobbyist and industry associations so important to just about everything in government. They provide information, reports, budgets, statistics, policy initatives. This all the work that a House member or Senator's staff should be doing for themselves, but there are not enough of them, not enough time, not enough money and most of them don't know how to even start to be a comprehensive professional on most of these issues. Think tank staffs, corporate lobby groups do this as a profession. So the staff member works with them. These private scum in effect become adjuncts to government. And this is why is extremely important to match their efforts, their information, their policy proposals with community based groups doing the same work.)

At least with Dellums, once he found out what was going on, he immediately put a staff member in charge who worked, researched, followed up and so forth---all the work necessary to actually understand and see what the community issues were with the legislation and policies that effected it. This kind of well trained staff member is invaluable. They are the ones who tract down the bureaucrats who actually manage policy in the executive branch. They represent the House member and if they don't get access to information they want, woe betide the stonewaller. Sooner or later, they would get a call from Mister D himself. Well in the waay back. And back then you did not want to hear from Mister D. Why? Because Mr. D was chairman of the Armed Services committee and the whole military industrial complex had to suck up on his ass, if they wanted anything.

Okay, so how to radicalize the healthcare debate? First a website, at the very least. It has to have several parts. One an information outline on all the federal programs and most of the major carriers along with addresses and phone numbers. Public record stuff, so if people have issues they can find out who to tract down. Don't forget children's services on this list. Parents are very good advocates.

The second part of such a site is advocacy, with the contact information about other advocacy groups of course, but also the names and phone numbers of the local office staffs for Senate and House members, along with the local state government representatives and their staff offices. The name, phone extension, email of the particular aid in charge of covering healthcare issues would certainly help. Also whatever numbers can be found for the federal agencies. Track down CMS, SCHIP and get the information from these agencies and its implimenting legislation. Go here for an outline of what's involved:

http://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medicaid_Services

The third part of this website has to be interactive where people can write out their personal issues with the system. Among the no doubt thousands of these exchanges that some coordinator has to monitor, as in mine these exchanges to find the potentially electrifying local issues. That's where the protests, the demos, the pro-active agitators arrive. Should be mostly faceless corporate sites, local state and federal offices, politican's offices, hospitals, clinics, etc, etc, etc. When the news crews arrive, that's when to hand out a press briefing, and give a quick summary of the specific issue, noting such dasdarly things wouldn't happen if we had universal healthcare, free, cradle to grave... blah, blah, blah.

What I've outlined is pretty much how the nasty anti-abortion groups built up their power through local churchs, into the political mainstream.

Getting back to a different issue, the devolution of Medicare. Go to the above wikipedia entry and read the brief history sketch.

Now realize that the anti-universal healtcare crowd is vast and powerful. If you go to the site listed below, you can get some information, but you can also see what kind of free-market professionals any people's movement faces.

Try here the latest:

http://www.piperreport.com/archives/2007/03/new_federal_ove.html

Here's a clip. Notice its more extensions of executive authority, and less Congressional oversight:

``Under a new Executive Order, President Bush has significantly expanded the authority of the White House Office of Management and Budget (OMB) over policymaking by the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA).

Specifically, OMB now has the authority to review and approve a vast array of written guidance issued day-to-day by CMS and FDA. The expansion of OMB's oversight authority has far-reaching implications for Medicare and Medicaid policy and the regulation of the drug and device industries.

In recent years, an increasing amount of agency policymaking has come in the form of "sub-regulatory guidance." That is, written guidance that does not go through the formal rulemaking process. In the case of CMS, this written guidance shows up, for example, as memorandums to health plans, letters to state officials, and manuals or other instructions. In its role administering the Federal Food, Drug, and Cosmetic Act (FDCA), the FDA has its own system of guidance documents.

While the FDA approach to sub-regulatory guidance has its own critics and limitations, the FDA approach is better organized and managed than CMS' approach. FDA has been at it longer than CMS but also has (relatively speaking) a narrower, more explicit scope of work. The FDCA and all its amendments is no walk in the park, but Titles 18, 19, and 21 of the Social Security Act are exercises in pure legislative surrealism....

President Bush's new Executive Order means that much of this written guidance is now subject to prior review and approval by OMB. While OMB has always been a key player, particularly in Medicare and Medicaid policy, the E.O. greatly increases OMB's influence and may result in a substantial power shift in many day-to-day issues affecting providers, health plans, drug manufacturers, states, and other stakeholders. (In the interest of full disclosure, my career includes service on OMB's Medicare and Medicaid team.)''

In other words, George W. Bush is responsible for all the misery I see every damned day. And the motherfuck will likely put me out of a job.

If you got this far, go back up and re-read some of the top of this post, and put the dots together.

CG



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