Category: FAIL

Paramedics, the VA, and Eric Garner: When Deference to Authority Goes Horribly Wrong (Part 2/4)

Posted by – August 15, 2014

Part 2 of 4 of the series When Life and Death is “A Matter of Policy”

Annnnnnnnnd we’re back… in part one of this series, I detailed one policy driven by No Discernable Medical Purpose (NDMP), and that’s the “no foreign ventilator” policy hospitals have, affecting me in the past and maybe at points in the future.
In the past, I blogged about paramedics not wanting to move a dude suffering cardiac arrest “because liability,” No Discernable Medical Purpose (NDMP).

Here in the NY metro area especially, paramedics have been in the spotlight lately… not for good reasons, but in connection with the death of Staten Island gentle giant Eric Garner.  Garner, known in his neighborhood as “Big E,” was murdered in broad daylight by an illegal NYPD chokehold for talking back to cops who were harassing him for a past pattern of selling “loosies” (single cigarettes).  Garner, who wasn’t even selling anything that day, said “this stops today!” and “please just leave me alone,” among similar things, which apparently constituted resisting arrest and justified initiating force against him—an unarmed man—straight up police brutality.  Here in NY, Garner’s murder has occupied conversations, newsprint, blogprint, radio and TV, and the role of the paramedics who seemed to make no effort to resuscitate him was/is being investigated, and the EMS team involved was suspended pending the investigation.

It’s evident from the horrifying footage of Garner’s death that none of the normal medical protocols were followed, and all nurses and doctors who have talked about it on the record (see Eyewitness News 7 report) are unanimously flummoxed and dismayed at the unusually lackadaisical approach EMS took.  The New York Times spoke to Dr. Alexander Kuehl, who led Emergency Medical Services in New York City during the ’80s. “She certainly didn’t do her job,” he said of the paramedic girl on the infamous cell phone video of the Garner killing.
“She’s totally overawed by the cops. She doesn’t do her assessment at all. There was something very peculiar about her approach.” (full NYT article)

We may never know the full story. It’s apparent from the horrendous footage that the cops waylaid EMS, saying “not yet,” and also telling the crowd Garner was fine and still breathing in order to avert the whole neighborhood going into full-on rioting (crowd control). But that two EMTs + two paramedics took the NYPD assailant’s word for it and didn’t intervene in any of the usual ways is more than a little discouraging.  The decisions made, whether directed by the NYPD on the scene, or driven by weird liability fear-related policies, or the EMS supervisor, or all of the above, self-evidently do not reflect advocating for your patient or serving Any Discernable Medical Purpose.

Recently an EMS-related surreal hospital policy also grabbed headlines (in conjunction with the increased scrutiny around the VA scandal) when the policy directing staff anywhere outside of the main buildings to CALL 911 if a patient collapses was followed, and killed a Vietnam veteran who, through unlucky happenstance, had a heart attack in the hospital cafeteria.

The AP reported:

ALBUQUERQUE, N.M. (AP) — A veteran who collapsed in an Albuquerque Veteran Affairs hospital cafeteria — 500 yards from the emergency room — died after waiting around 20 minutes for an ambulance, officials confirmed Thursday.

It took between 15 and 20 minutes for the ambulance to be dispatched and take the man from one building to the other, which is about a five-minute walk, officials at the hospital said.

Kirtland Air Force Medical Group personnel performed CPR until the ambulance arrived, VA spokeswoman Sonja Brown said.

Staff followed policy in calling 911 when the man collapsed on Monday, she said. “Our policy is under expedited review,” Brown said.

Full story here: Veteran dies waiting for ambulance in VA hospital

In this Dave Granlund political cartoon, wheelchair inaccessibility serves as a visual metaphor for the inaccessibility of V’A medical care/doctors’ appointments writ large. Unfortunately, architectural barriers to medical care are too often non-metaphorical in many parts of the country.

In the initial local TV News reports, the implicated hospital said simply “we followed policy.”

“Just following orders.”

Sadly, this is yet another instance of “No Discernable Medical Purpose” (NDMP). The best medical treatment for this veteran easily WAS NOT waiting for an outside ambulance, after all “every second counts” with a heart attack. What he needed was heroic action by the staff hoofin’ it to get him to the Emergency Room with all possible rapidity, where cardiac crises are something U.S. medicine is set up to handle really well.  If their Emergency Dept. has no one who can rapid response with a gurney to code blues in adjacent buildings, that is a matter of leadership and policy too, NDMP as it was not serving a legit medical goal.

Deference to whacked-out policies is baffling, especially in the United States, where you’d expect a bit more spunk and middle-finger wielding to authority figures from the descendants of rebellious colonists who sparked a revolution over the British effort to inhibit their tea smuggling and rum running (among other things).  Here, that meek obedience—maybe even “willful blindness—the higher-ups like to cultivate led to horrible consequences.  Sometimes disobedience is needed, even essential, as I also discussed in the post Law and Order: When Is It Wrong to Follow The Law?

In Part 3, I’ll look at the psychology behind the tendency to OBEY, bad incentives at the VA, and how these problems can be ameliorated.

Nick

2/4 Series When Life and Death is “A Matter of Policy”

In Part 3, the Milgram experiment, James Madison, and hospital ethics
Part 4: activism and rays of hope from medical bloggers

or go back to Part 1: introduction to the series/weird ventilator rule

In a Nutshell: America’s Regulatory Octopus and Non-working Toilets

Posted by – July 13, 2014

Part of a new series, “In a Nutshell,” in which I try to explain an idea in 500 words or less.

When the tentacles of regulation clog your toilet

The Commerce Clause of Article I of the U.S. Constitution gives Congress the power “To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes,” and that is the basis for so much of our legal and regulatory system, from drug laws and gun control, to water use regulations for toilets.

Things like building the Hoover Dam to bring water and electricity to multiple states in the American Southwest seems a no-brainer for federal action. Air and water pollution too, with its impact on multiple states and countries, seems to me an obvious place for federal intervention, and the number of regs waived during the past two decades—the carte blanche given to mountaintop removal and hydraulic fracking—should concern all Americans. In many areas, there ought to be more and better regulation, and there are reams of highly questionable or unnecessary regulation too.

A classic example of this “regulatory state” gone awry is what happened with toilets in the ’90s. As the first episode of Constitution USA explores, at around the 40:00 mark, the Energy Policy Act was signed into law by George H.W. Bush in 1992, and water use standards were set for toilets in the U.S. at 1.6 gallons. While I’m the first to favor most water conservation and cleanliness measures, I have to acknowledge the unintended consequences of this toilet rule are bad.
Does the toilet in your home clog at the slightest provocation?  If your home/building was built or had a toilet installed between 1993-2000, this rule is probably why.  Toilet manufacturers immediately adhered to less water per flush, but that meant low-flow toilets.  It was years before toilet design and flush technology caught up, and until then, toilets failed with solid material of even modest size. This legacy of toilet failure is still keenly felt in apartment buildings erected between ’93 and the coming of the 21st century.

The blogosphere had a field day poking fun at Rand Paul for mentioning the non-working toilets at a Senate committee hearing on energy regulations, but dude-bro has a point when he said “the toilets in my house don’t work and I blame you…” (full text statementvideo evidence)
Though Paul’s rant kind of reminds me of that Seinfeld episode when Kramer and Newman hated the new low-flow shower heads installed due to related ’90s water regs, so they got crazy high-flow shower heads for circus elephants on the Yugoslavian black market (Seinfeld video), Randy nonetheless has a point. We need technology that works in our homes, and eventually you get innovation and mega uber toilets invented like the Sydney Smart because of the regs, but meanwhile EPIC FAIL occurs. I think a grace period or something to ease the transition is warranted.

I’d make a much broader point: the authority for all this regulation is the Commerce Clause, and all the case law built atop it, but libertarian-ish right-wingers like Rand Paul blame that underlying system… the underpinning system is not the problem as much as the corruption of the guys who write the rules (Congress and/or the federal agencies). That corruption is where things really go wrong. Removing corporate sponsors and corruption from our gov’t is desperately needed, and that is your answer. The wholesale dismantling of the regulatory system is not going to happen.
But criticism of the regulatory state is certainly understandable. What kind of system regulates toilets so rigidly they can’t manage waste of any rigidity, but can’t regulate the hydraulic fracturing industry’s radioactive waste? a corrupt mess of a system that has been affected by “regulatory capture” in a piecemeal fashion, with different but increasing-in-number tentacles of the regulatory octopus captured over the years.

acrylic painting © Vanessa Barrett

Ultimately, even if the Congress ends up frying a lot of the regulatory octopus’ tentacles, our Commerce Clause is going to mean that federal regulation of things like toilets continues, since toilets are sold across numerous state jurisdictions, and also affect water use regionally and nationally. No toilet exists in a self-contained pocket universe, y’know? But our regulatory state as-is is too messed up, the contradictions too great, and the trust of the rising generation too low-flow for it to be sustainable. Change will have to come for our regulatory octopi, too.

Nick

over 600 words – objective not reached 

Recommended resources:
First ep in the documentary mini-series Constitution USA – exploring the Commerce Clause and the state and federal legal tug of war built in to the constitutional system. Can guns built, bought, and used ONLY in Montana be federally regulated under “interstate commerce?” (the Commerce Clause)
The Atlantic -Rand Paul and the 19-year Libertarian War on Low-flow Toilets – the issues here are long-standing…

The Accursed 113th Congress: Are Our Democratic Institutions Broken?

Posted by – November 18, 2013

ac·cursed
1: being under or as if under a curse
2: damnable

Source: Merriam-Webster’s dictionary – accursed

I am probably one of the few bloggers who would notice our worst. Congress. ever. is also the 113th Congress, and feel a gut feeling that the correlation isn’t really… entirely coincidental.  Too many horrendous events have happened to me and those I know on the 13th day, especially Friday the 13th, and though I know on the intellectual level that correlation doesn’t imply causation—a number can’t damage you, and dates on the calendar are more subjective…or more Wibbly Wobbly Timey Wimey than you might initially realize, for example the Jewish calendar may tell you it’s the 5th of Tishrei instead of September 13th—nonetheless I have some mild triskaidekaphobia, fear of the number 13… or at least some discomfort and anxiety around thirteen.   Or, as Alejandra said in another context, not meaning 13-itself, “numbers are bad enough… odd numbers are shady mtherfkers.” 

Prior Congresses (Congrii?) have been notably awful: there’s the last session—the 112th Congress—which brought us to the brink of a sovereign default crisis in 2011 which led to Standard & Poor’s downgrading the credit rating of the United States government for the first time, and we lost international credibility big time, and so on.  Of course there was the infamous 80th Congress, which President Truman ran against as “the Do Nothing Congress,” though it was a marathon of productivity compared to the 112th and 113th Congress.  We would much prefer “the Do Nothing Congress” to the current situation.  All the available polling data bears that out. And the 113th Congress is even worse than the 112th by every available yardstick.

Confidence in Congress has never been lower.

Put another way, when Public Policy Polling did a survey during the shameful government shutdown last month, asking registered voters questions like “what do you have a higher opinion of: Congress or hemorrhoids?” hemorrhoids won 53% to 31%… people have a higher opinion of dog poop than Congress 47% to 40% and when asked about zombies vs. Congress, people have a higher opinion of zombies 43% to 37%… at least you know where zombies stand…well, shamble.  [Public Policy Polling full results PDF]

The 113th Congress is also on track to be the least productive in history, demonstrating a shocking inability to pass legislation, even ceremonial laws like congratulating the winner of the World Series and the like…

Ceremonial vs. Substantive legislation in recent Congrii. Source: Washington Post’s “The Fix”

The inability to pass legislation has become so bad during the 113th Congress, the federal government is unable to fund itself, meaning funding only getting done in half-hearted three month CRs (Continuing Resolution), creating dysfunction in everything from scientific research to military procurement.  We’re on a three month CR right now; the weeks of government shutdown lowered expectations so much, it’s seen as a success.  The legislative machinery of our republic is going grinda-grinda-grinda, grinding nearly to a halt, and the dysfunction is mostly due to choices made by the House leadership.

Now, to the real thrust of this post: the decay of our democratic institutions and the weakening of American constitutional values occurring at present.  For example, the mechanism, or underpinning, enabling law that made the government shutdown possible was House Resolution 368, which banned anyone bringing legislation to the floor to re-open the government except the House Majority Leader or his designate, a new, innovative abuse of parliamentary rules and certainly extra-constitutional—not in the constitution, as the parties are not mentioned in the constitution, nevermind a party’s “Majority Leader”—and against the spirit of constitutional law if not its letter.
H. Res. 368 was snuck-in at 1am as the government shutdown began October 1st. Maryland’s Chris Van Hollen, whose DC suburb-district is made-up heavily of federal employees and was disproportionately harmed by the government shutdown, proposed that the House vote on the Senate bill to re-open the government in order to force the Speaker-designate to block him under H. Res. 368, so he could question H. Res. 368 in public; the video clip of Van Hollen’s effort became the first “parliamentary inquiry” to go viral on Facebook and Twitter.  Ironically, the Majority Leader given the sole power to re-open the federal government, and kept it shut down for over two weeks, was Eric Cantor, whose DC-suburb district has broad swaths of its working population depending on federal contracts and paychecks, and was nearly as disproportionately harmed as Van Hollen’s district.

Underpinning all that, how we find ourselves with appropriations stalled and shutdowns possible in the first place, is the Hastert rule.  The Hastert rule, which really should be called the Gingrich rule, as it was first added under Newt Gingrich’s speakership, requires majority support among the Republicans before the speaker will bring legislation to the House floor for a vote.  As the constitution envisions legislation passing the House with simple majorities, the Hastert rule to require legislation either passes with majority-Republican votes or never gets considered, is unconstitutional.  Similar to the situation in the Senate, where the constitution requires supermajorities in cases of ratifying treaties, expelling a Senator, removing a president, not for routine legislation like the 60-vote supermajority needed for passage of most everything, since most everything is now held up by filibusters, this Hastert rule violates the spirit if not the letter of the constitution,  The filibuster certainly isn’t mentioned in the constitution, and the routine blocking of run-of-the-mill legislation and nominations is an innovation not seen until recently.

In the House of Representatives, the Hastert rule has meant nothing gets voted on until the Speaker and/or Majority Leader “have the votes” of the majority of the Republican caucus.  This has meant a vocal minority of the Republicans can grind the legislative

Male elephants tusk-jousting for dominance. Photo by EPA/DAI KUROKAWA

machinery to a halt; the elephant factions have to battle it out and come to a resolution before anything can happen.  This explains the historically low number of bills voted on and passed, the inability to appropriate funds for federal departments, etc. And because of the rapidly changing dynamics within the GOP, which, in my recent post discussing the shifts in conservatism I describe as “revolutionary flux,” the Hastert rule is freshly problematic, not only because of its inevitable enabling of an extremist minority shutting down the government, but because of Republican unity on positions so radical they risk extinction in future presidential elections if the Speaker had held fast on the Hastert rule.  For example, an extension of the Violence Against Women Act (VAWA) had the majority of the Republicans united in opposition, but the national GOP didn’t want to head into the next elections having removed assistance for battered wives, so Speaker Boehner allowed a vote; VAWA passed with only 38% of the Republicans in the House voting yes.  Similarly a “danger zone” for national disgrace, Speaker Boehner had to bring the Hurricane Sandy disaster relief bill to the floor despite harsh opposition, even drawing no votes from Republicans representing damaged New Jersey districts; it passed with a healthy majority of 241 votes, but only 49 Republican votes, a mere 21% of the majority.

I don’t usually quote others at great length like this, but the blog Gravitas: A Voice for Civics has an excellent explainer on the unconstitutionality of the Hastert rule, explaining it much better than I can:

For example, right now there is an initial impetus to oppose the death penalty between what we call liberal or progressive politicians and libertarians. Usually, these two groups of politicians are known for their antagonism toward each others’ positions, but here is one area in which they agree. Now, I don’t know whether there are enough liberals and libertarians to form a majority, but there is the possibility that if not today, maybe eventually. This potential is exactly what the Founding Fathers foresaw and I believe hoped for. But the Hastert Rule makes such an eventuality almost impossible.

Why? The Hastert Rule calls for limiting the bills that come before the House for a vote to those that are supported by a “majority of the majority.” Let me explain. The Constitution calls on each chamber of Congress to form its own rules. The formal rules of the House state that the Speaker has the role of placing on the voting agenda those bills he or she feels should be considered by the membership. So, if the Speaker is against a bill, it will not come up for a vote unless 218 members sign a “discharge” petition – a very unlikely development. In effect, this role gives the Speaker a great deal of power. An informal rule – one not voted on by the membership – states that the Speaker will not call up a bill that is not supported by a majority of the members who make up the majority party in the House – presently, the Republican members. This, in effect, can give as little as one quarter of the members veto power over any considered policy option – a far cry from the rule of the many. That is what the Hastert Rule allows. The Democrats have never implemented the Hastert Rule when they held the majority, but Republicans have, although there have been a few occasions when the present Speaker has brought up a very limited number of bills that didn’t have a majority of the majority’s support. The Hastert Rule is named after a former Speaker, Dennis Hastert, but it was in effect under a previous Speaker to Hastert, Newt Gingrich.

Whatever its origins, the rule counters a constitutionally conceived quality: the possibility and, hopefully, the likelihood that Congress, particularly in the House, would have rolling coalitions that form over particular issues and policy considerations. These coalitions would form over one area, dissolve, and then other coalitions would form over other considerations. In each, there would be a different collection of members. This reflects a more congregational atmosphere in our Congress and would give meaning to its name: a congress, not a parliament. The Hastert Rule belies this entire conception and, as such, it is un-constitutional with a small “c.”

Read the post in its entirety: AN UN(c)ONSTITUTIONAL RULE

Perhaps we need a new word for things that violate the intended system, instead of “against the spirit of the constitution,” or “un-constitutional with a small ‘c,'” we could call it counter-constitutional, meaning it runs counter to the framers’ intent for our constitutional system of government.

People have a tendency to chuckle at the EPIC FAIL of our

from an early Bob Dylan music video, in which he captions the song with signs that he flips through for every word of the lyrics

from an early Bob Dylan music video, in which he captions the song with signs that he flips through for every word of the lyrics

system: you know, “LOL Congress is less popular than dog poo,” or “haha, we make Europe’s coalition parliaments that collapse every year look functional.”  But I’ve written so much about the dysfunction and the erosion of constitutional values in hopes people will notice the problems.  I want blogging to save us.

The weakening of constitutional values seems to be worsening not only in our legislative branch but in disregard and non-enforcement of the Fourth Amendment leading to a case of the police unnecessarily forcing a colonoscopy on a guy they thought was hiding drugs in his butt (he wasn’t).  The president suspending sections of the Affordable Care Act by executive fiat isn’t exactly a sign of constitutional health either: the law blog The Volokh Conspiracy points out the order’s lack of constitutionality.
Our country desperately needs its legislative branch, the broken branch, fixed.  We badly need to get the budgetary and lawmaking machinery running at normal speeds again, break the cycle of budgeting by emergency CRs; we need an end to austerity and a return to normalcy.  There’s such a yearning for a return to normalcy, you even heard the House GOP calling for a return to “regular order” in legislative procedure and budgeting in the first half of 2013 (though that rhetoric seemed long-forgotten by gov’t shutdown zero-hour October 1st).
I wouldn’t be surprised if, in the 2014 midterm elections to seat the 114th Congress and in the presidential primaries in late 2015 and early 2016, candidates on all sides run on variations of the “return to normalcy” theme.   I expect to see at least one presidential campaign reminiscent of Warren G. Harding‘s strategy in his 1920 run; Harding’s main campaign slogan was a “return to normalcy,” tapping into the American public’s weariness of the economic upheaval (and unimaginable carnage) of Woodrow Wilson’s presidencies and World War I.  Harding won in a landslide.

For Congress, normalcy would look like a string of routine appropriations bills passing and fully funding federal departments and programs.  Appropriation bills have become more “rarity” than “routine,” a situation that desperately needs reversing.
The accursed 113th Congress has visited upon us so many evils, the most obvious being the government shutdown, but an even longer-lasting evil is the distortion of expectations to the point that the vicious cycle of three-month budgets via emergency CRs is seen as regular, and anything resembling a healthy appropriations process is seen as remote, a distant thing on the horizon, at the verge of impossibility.  The 113th Congress’ dysfunction feels even more egregious because more voters voted Democratic party for Congress in the 2012 Congressional elections than voted Republican, yet redistricting allowed the GOP to keep a healthy majority in the House; unlike the awful 113th, the 112th Congress had a definite democratical mandate for obstruction and/or reversal of the incumbent’s policies behind a sizable GOP victory.
Hopefully the departure of the unluckiest 113th Congress following the 2014 midterm elections, a year hence, will mean a breath of fresh air and full funding for federal obligations for a full fiscal year.

If you don’t remember anything else from this post, please absorb this: for better or worse, the House and Senate are our democratic institutions, meaning the democratically-elected, collaborative, “people’s house(s),” and when democratic institutions are weak, the authoritarian parts of our system—the increasingly “unitary” executive, an enforcement branch run amuck without Congressional oversight, etc.—inevitably become stronger.  Despite the absence of a savvy demagogue-executive who could strip Congress of power, it seems the Congress and “the suicide caucus” could still self-destruct, de facto leaving the U.S. with a unitary executive by process of elimination (only the executive still functioning). We have to have healthy, functioning democratic institutions lest “separation of powers” whittle away, and a much more unitary/much less representative system emerges as a fait accompli, justified as a necessity in the face of a Congress that isn’t able to even keep the lights on.  Our democratic institutions MUST regain credibility.

Keep bloggering on.

Nick

Bribeocracy Update: the Quid Pro Quo status quo—Revolving Door

Posted by – March 3, 2013

Bribeocracy Update Winter/Q1 2013

I want this blog to be a useful source of information you’ll not get from TV or other web sites. You certainly don’t hear about Medicaid issues like “aging out” of most in-home support at age 21, and how it impacts the ventilator-dependent population, on other blogs. You won’t get in-depth coverage of Medicaid, how Medicaid is changing in the age of ObamaCare (eligibility is broadening under the “Medicaid expansion” without addressing anything else) and the policies that must change, on many other sites. But I also feel a responsibility to spotlight the disease, not just the symptoms, strike at the root causes, cover the corruption that prevents our government from listening to us, filling the gaps in our social safety net, improving services. The corrupto-sclerosis clogging the gears of the federal machine has not been this obvious, awful, and destructive to the people, in my lifetime. Corruption has made Congress and the executive branch so dysfunctional that we’re seeing symptoms of unprecedented severity, like the oddly-named “sequestration.”

Good government has disintegrated in the acid of dysfunctional, corrupt Washington. It’s gotten SO BAD that “the sequester” is taking effect, meaning we can’t even agree that laying off a generation of NIH scientists and breaking the back of American medical research is bad, that gutting Head Start and K-12 funding is bad, that yanking housing vouchers out from under 125,000 Americans, many of them people with disabilities, is bad. Americans with disabilities will need homeless shelters—oh wait, they’re gutting funding for emergency shelters too, dumping an estimated 100,000 homeless people, who will end up on the sidewalks or end up suffering a traumatic displacement to other shelters, or more likely, emergency rooms (the standard dumping ground for populations our society hates and doesn’t want to face or deal with). This will hit New York City at the worst possible moment; in January 2013, more than 50,000 people, on average, slept in our city’s homeless shelters each night, a new record, easily surpassing past NYC averages, even those during the notorious The Warriors-looking NYC of the ’70s and ’80s. It’s likely that, by putting vulnerable populations out onto the streets en masse, we’ll create 21st century horror stories I can’t even imagine right now. All this brought to you by “the sequester.”

“Sequestration,” again, is just a symptom. The root cause is the culture of corruption and dysfunction in Washington that runs deeper, and is more corrosive and paralyzing now, than it has been during any other era in my lifetime. I believe that we have to attack corruption, and, recognizing that Team Donkey and Team Elephant swim in the same corrupt pond, mercilessly expose bribery and the quid pro quo status quo to the sunlight wherever it lives. Under the tag Bribeocracy, I’ve been trying to shed light on corruption on this blog for years. Last month, I talked about the quid pro quo status quo within the executive branch, which I hope ya’ll will understand is not okay; even if you give President Obama a pass for giving ambassador posts to top campaign contributors, I hope you won’t let him off the hook for giving out cabinet positions in the same manner, to CEOs who were top donors.

Today, I’ll talk about the “revolving door,” the phenomenon of creatures of Washington rotating in and out of lobbying and powerful positions in the White House, executive branch agencies, Congress, and Congressional staffs. These are the Senators, Congressmen, and key staffers who purport to work for the public good, then exit public service but stay on Capitol Hill to cash in on the work they did under oath to serve their district. They use their contacts and knowledge to advantage monied interests.

Some high profile examples: Rep. Billy Tauzin of Louisiana’s 3rd Congressional district, chair of the House committee that oversees prescription drugs during GWB’s first term as president, negotiated the 2003 Medicare Prescription Drug Bill—soon after known as Medicare Part D—on crazy-skewed terms in favor of the pharmaceutical conglomerates (not only were private pharmacies and citizens banned from importing affordable drugs from Canada, ever, Medicare is banned from negotiating bulk prices or paying anything below full sticker price for prescription drugs) and then turned around hardly two months later and quit Congress in order to take the helm at the Pharmaceutical Research and Manufacturers of America (PhRMA), the giant trade association he had essentially let craft Medicare Part D while chairman. It’s one of the most brazen revolving door kickbacks the media has ever ignored. In Tauzin, Louisiana lost its most powerful voice in the House—seniority means how much clout and bargaining power your state and district has in the House—and the loss of voice, and betrayal, must’ve deeply stung his constituents; they might have felt like some unstoppable vixen took their man.

In my post Living in Zomerica, I mentioned that the so-called “Fiscal Cliff Bill,” passed two hours into falling off the cliff (2 a.m. EST on New Year’s Day, January 1, 2013) had egregious corporate welfare in it. Man, that thing was stuffed like a piñata with goodies for corporate campaign contributors. But beyond the eight industries receiving subsidies that I mentioned in my prior post, reports soon surfaced of a lucrative loophole for pharmaceutical company Amgen in the Fiscal Cliff Bill. The New York Times uncovered a sordid, almost unbelievably bizarre “revolving door” story that led to the kickback for Amgen. The loophole for Amgen was negotiated by a top aide for Sen. Orrin Hatch who previously worked as a health policy analyst for Amgen. The former chiefs of staff for both Sen. Max Baucus (D – Corrupt) and Sen. Mitch McConnell (R – Corrupt) came back to Capitol Hill as Amgen lobbyists and lobbied their recent ex-bosses; it’s thought that notoriously bribable Senator Max Baucus slid the Amgen provision into the Fiscal Cliff Bill in the dark of night at the eleventh-hour, but it’s clear that there’s no daylight between Republicans and Democrats on this revolving door problem. They’re both up to their elbows equally in this cesspool of corruption.
In this Bill Moyers interview, tiny Vermont’s only representative in the House, Peter Welch, explains why he’s fighting to get Amgen’s “sweetheart deal” repealed.

A case like Rep. Tauzin’s emerged recently. Rep. Jo Ann Emerson, about two weeks after being sworn in to the 113th Congress for her tenth term, announced her resignation January 22, 2013 and took a job as CEO of the National Rural Electric Cooperative Association.National Rural Electric Cooperative Association NRECA, where the last CEO was paid around $1.7 Million for a year, one of Washington’s largest and most influential trade associations. Now, the 8th district in Missouri’s “bootheel”—the poorest in Missouri, and one of the 10 poorest in the nation—has to foot the bill for a reported $1 million election on June 4th.

The National Rural Electric Cooperative Association was the biggest single campaign contributor to both Jo Ann over the years, and to her husband Rep. Bill Emerson, who she inherited the Congressional seat from upon his death in 1996. Both Mr. and Mrs. Emerson were lobbyists in Washington prior to serving in the House of Representatives, and seem to be entirely creatures of Washington; neither were born in or near the impoverished rural district they swore to represent. Her ties to the district are much more tenuous than her husband’s were—at least he was a Missourian—she’s from Maryland, born and raised. So even though Jo Ann Emerson was Missouri’s most senior member of Congress, so Missouri loses a lot of clout in the House upon her departure, but it’s not the same as losing a Billy Tauzin, who’s deeply connected to his district. I think that understanding a district is essential to representing it. When I met with my Rep. in Mobile, Jo Bonner (Alabama’s 1st Congressional district, covering the entirety of Alabama’s Coastal counties, that is to say, Mobile and environs) even though we’re on the opposite sides of plenty of issues, since he comes from Mobile, we immediately have a shared culture, references, points of context, that make it easy for us to work together. Having that local connection is so very important!

The founding generation (the framers of the Constitution, founding fathers and mothers, and others of the spirit of ’76) intended the House of Representatives to be a constantly improving and updating body of the most knowledgable and wise representatives of the districts, to assess the realities on the ground, the results of the American experiment, and respond when adjustments are necessary. I know that because of bribeocracy supplanting democracy, we can’t expect good government to return in 2013, but definitely we can do better than the blatant abuse of people like Tauzin and Emerson using, then losing Congressional districts, cashing in on seniority.

Details of the sordid, weird, revolving Emerson in this CNN investigative report:

Worst revelations from the report:

    Unintended consequences? Laws prohibiting members of Congress from becoming registered lobbyists for two years after leaving office have backfired, making people like Emerson even more valued hires; they can bribe and influence on Capitol Hill for two whole years without any of the regulations or limitations registered lobbyists are subject to under current law. Monied interests are gaining from the two year waiting period purportedly designed to shut the revolting door.
    Jo Ann Emerson isn’t alone in leaving the House as the 113th Congress begins, she is one of five outgoing members—four Republicans and one Democrat—to abandon their constituents in favor of “influence industry” jobs.

Never stop exposing corruption.

Nick

Easter egg: mousing over a few links reveals hidden lulz in some of the tags

What New Fall TV Shows To Avoid (2010)

Posted by – October 6, 2010

It’s true. Lots of what’s on TV is just unbearable.

Here are some shows to avoid at all costs:

Chase – NBC, 10/9central Monday night

This show is about a Houston task force of U.S. Marshals who chase the most dangerous, most wanted fugitives in Texas. But unlike most crime dramas, where you’re rooting for the cops, with Chase, you’re rooting against the cops just as much as the criminals; the U.S. Marshals are every bit as unsympathetic and unsavory as the fugitives. In the pilot, they’re breaking doors off their hinges and intimidating the mom and fiancée of a suspect like freakin’ thugs.

"Annie Frost," played by Kelli Giddish

Maybe that’s an important commentary on what law enforcement has become in the 21st century, but it isn’t fun TV. The lead character, Annie Frost (played by Kelli Giddish from All My Children) lives up to the “frost” name, because she’s a frosty, cold shell of a woman with all the human warmth of an Arctic winter. I turned this show off after less than 15 minutes; it was that unappealing. Avoid this.

Hawaii Five-O – CBS, 10/9central Monday night

This is a remake of CBS’ original Hawaii Five-O series (1968-1980), trying to make it slick and hip for the new era. Problem is, it’s not that appealing because it’s layered in cheese. The episode last week was a good example; it centered on a kidnapping of a business leader who was about to expose security threats to Hawaii and nearby naval forces. Grace Park (formerly an awesome performer on Battlestar Galactica) is an actress of Korean extraction, unconvincingly portraying native Hawaiian rookie cop “Kono” on the Hawaii 5-0 team (no CBS, Korean people do not look like native Hawaiians! How dumb do you think we are?!)

Poor Grace Park

She (Kono) is guarding the kidnapped CEO’s young son, when suddenly she finds a note in a foreign language on the kitchen counter. The CEO’s white, normal-looking girlfriend is behind the kidnapping! It’s what we least expected! The white, model-looking girl sees Kono (Grace Park) uncovering the secret plot, and reveals she’s actually evil and has an incredibly fake Russian accent and she ambush attacks Kono in the kitchen! They start an epic martial arts battle! The girlfriend slams Grace Park’s face into the kitchen counter, and then they karate each other ferociously and crash fakely through fake bamboo and end up poolside. Then the girlfriend, who’s evidently secretly been an enemy commando, knocks Grace Park into the pool and Grace Park spins horizontally, dramatically like a figure skater in a tight twirl or a phony Matrix parody. Soon we end up inside the white terrorist/mobster lair (Dano mentions they’re Serbian cyber-terrorists? LOL) and Grace Park is tied to a chair along with the CEO dude and now his preteen son, too. The dude’s white model girlfriend is carrying some giant carbine or something, half her size, and pointing this weapon at the hostages and pacing menacingly and angrily spitting threats in her fake Slavic accent “you’re going to die! only matter of time.” The ridiculousity line has been crossed. I start openly laughing at the show. Laughable isn’t what CBS was going for at all, but they got it in spades. Grace Park is a great actress, capable of some awesome dramatic performances, and I’m sure she’ll look back on this Hawaii Five-0 part of her career with intense regret.  :-/

.

THE EVƎNT – NBC, 9/8central Monday night

The TV review blogs HATE this show; they reject it as a blatant, heavy-handed rip off of 24 and Lost and are just savaging it.

The discerning nerd audience at Comic-Con

The backlash is probably because it was hyped heavily to the discerning nerd audience at Comic-Con in July, and then the pilot seemed like one long trailer for a pilot and the epic “event” the plot revolves around doesn’t actually occur in the pilot, so it failed to meet those high Comic-Con expectations (note to NBC: don’t write cheques your ass can’t cash). The reason people cared about the elaborate mysteries in Lost was they cared about the characters and their backstories and what will happen to them; THE EVƎNT pays little attention to characters but expects us to care about the half-dozen complicated, interconnected unanswered mysteries they’ve presented? FAIL! Listen up NBC, people don’t watch undeveloped characters they don’t care about, especially when you gotta break your brain on mysteries; that is the reason THE EVƎNT got crushed in its time slot, coming in third behind ABC and CBS. Third-place won’t pay THE EVƎNT’s big stunt and special effects budget and fat salaries for Blair Underwood and Laura Innes, so I expect NBC to pull the plug fairly soon.

"THIS ENDS NOW"

$#!T My Dad Says – CBS, 8:30/7:30central Thursday night

I was rooting for a show from the internets to do well, a lot of us were. But this show is just terrible. The canned laughter, the laugh track, sounds so incredibly fake, and it’s really unbearable to hear it over and over and over and over. The jokes are very forced, and fall flat. Nothing funny here. Avoid.

Outlaw – NBC, 10/9central Friday night

Not only is this show awful, the worst premiering show of 2010, it’s the worst premiering show I’ve witnessed in YEARS. Sweet Lord, this show is atrociously, hilariously awful. Plan 9 from Outer Space bad. It’s the first drama ever produced by Conaco Productions, Conan O’Brien’s production company, and it often verges on comedy, albeit unintentional. Most everything in the pilot is preposterous and impossible; it just can’t happen in real life. Jimmy Smits plays Cyrus Garza, “the most conservative justice on the Supreme Court,” and son of fictional Latino civil rights activist Francisco Garza who worked alongside César Chávez. After Francisco and Cyrus’ car crashes, and only Cyrus survives the accident (implausible plot device #1) Cyrus randomly sleeps with a random (beautiful model) ACLU protester and suddenly does a 180 on his bedrock political beliefs and lifelong legal philosophy and he resigns from the Supreme Court to become a liberal activist lawyer, defending the downtrodden and dispossessed–pro-bono–against “the system” that he spent his career bolstering (outrageously absurd plot device #2). He gives a nonsensical speech about how he’s resigning because the role of the Supreme Court is upholding the law and defending “the system,” and he wants to challenge the law for people “the system” doesn’t work for and blah blah blah blah blah, while sitting in open session on the bench with the other justices (really implausible). Then he becomes the defense attorney for Greg Beals, the death row inmate his own Supreme Court opinion gave another chance to (very implausible). Then he is somehow able to use the majority opinion he himself wrote, Beals v. Pennsylvania, as precedent to introduce new evidence to exonerate his client…Beals. The legal impossibilities just stack higher and higher until it becomes a kid’s cartoon of the judicial process.

Left, Cyrus Garza (Jimmy Smits), center, Al Druzinsky (David Ramsey) and Mereta Stockman (Ellen Woglom) at right

The women characters are just as “profiles in preposterous,” even bordering on offensive with the female cliches. Cyrus is a chauvinist pig who womanizes blatantly. First, a random liberal protester who angrily protests and denounces him for being neutral (“I’m Switzerland!”) about the Beals case, and, of course he ends up in bed with her.
Second, his legal aide from the Supreme Court, Mereta (pictured above) overhears Cyrus’ bookie telling him he has to have all his hundreds of thousands of dollars in gambling debt paid in full within three months, and because in this show women are dim-witted, she thinks that this means Cyrus has three months to live. Later, she interrupts Cyrus talking to the death row guy’s girlfriend and the rest of the 4-person legal team by the courthouse stairway and, in front of everybody, desperately throws herself at him! She’s all “Now that I know the truth you’ve only got three months left, we can focus on what really matters. I LOVE YOU, CYRUS!” It’s a failed caricature of a woman, a failed attempt to twang romantic heartstrings, and reinforces negative stereotypes of women and negative stereotypes of people with terminal illness.
Third, Cyrus’ private investigator “Lucinda Pearl,” a caricature of a sexy, bisexual leather cyberpunk chick in knee-high boots who’s always doing something extremely brazen sexually like taking her top off to distract guards so she can swipe info, and teasing Cyrus’ chief clerk with single entandres and popping her gum.
Come on man, can you get more blatantly ratings-whoring than this, with such exaggerated, fake, cartoonish, borderline degrading characters? It’s like the pilot’s creators don’t have a wife or daughter or any woman they respect in their lives. What’s it say about American culture today that this one-dimensional, shock-jock type caricaturing is how we view women?

The most realistic character in the show was Mereta’s (apparent) Corgi mix. Whatta good dog!

Just as fake as the characters were the sets. The pilot opens with ridiculous paper mache bricks on the “prison.” Later, Lucinda goes to a crime scene with a skeleton that looks so fake it had to come from Rite Aid halloween clearance. Jeez, NBC! Fund your pilots, otherwise Conan’s company is gonna keep the C team on sets.

Don’t take this show seriously; you’ll end up offended. If you’re going to watch this drek, put on your LOLLERSKATES and get in your ROFLCOPTER because this clunker is layered in (unintentional) hilarity; you will ROFL, indeed.

Other good reviews of Outlaw:

USA Today: NBC’s outlandish ‘Outlaw’ richly deserves death penalty (“That’s not a prime-time show, it’s a Saturday Night Live sketch.” “Preposterous to a painful degree”)

Washington Post: Jimmy Smits’s new NBC courtroom drama, ‘Outlaw,’ should be dismissed (“ludicrously dumb” “my eyes rolled so hard that my contact lenses popped out” “Smits is a fully glazed, overcooked ham”)

Collider TV Review: NBC’s OUTLAW (“painstakingly exaggerated” “veritable treasure trove of cliches” “searing pain that runs through my leg (and the rest of my body) when I think of all the resources wasted on a show like this”)

Discerning readers will note that the network responsible for the most shows on my “avoid at all costs” list is NBC. This network seems hopelessly mired in creative, programing and financial FAIL. Time for some serious soul-searching at 30 Rock, dudes, and at Comcast HQ too….

For my list of newly premiering shows actually worth watching, read my previous post, What New Fall TV Shows To Watch (2010) Spoiler: nearly none of them are from NBC.

If you have other shows or other things you want me to review, put it in the comments!

Nick

Feds Fiddling While State Medicaid Programs BURN

Posted by – May 21, 2010

Question: In light of Obama’s plan to expand Medicaid eligibility, is anyone in Congress noticing the MASSIVE state budget cuts to Medicaid across the country and ruminating about how that jives with this impending expansion? I fear that if states have to raise income eligibility and bring millions of uninsured onto the Medicaid rolls, that will mean even deeper cuts in “optional” home care programs to pay for the expansion, and even more people with disabilities’ dreams shattered.

I wish Congress would have put protecting the most disabled Americans ahead of uninsured able-bodied people, but they didn’t. For Congress, people like me are invisible.

The states slashing Medicaid the deepest (the Southern states) are the ones that will see the most new Medicaid eligibles thanks to “Health Care Reform.”

PERFECT
FISCAL
STORM

That means life for people with disabilities in the South is about to get even worse. Good thing I fled Alabama.

Medicaid, especially in the South, is increasingly in tatters. State Medicaid programs were slashed to the bone in the 90s thanks to “the Republican Revolution” and now there’s no fat left to trim, so they’re taking chainsaws to muscle and bone.

In the Wall Street Journal, it discusses a woman who’s had to sit in her own waste all day thanks to state budget cuts. I suppose the state hoped her bed sores and inevitable sepsis take her quickly, otherwise Medicaid will be on the hook for expensive hospital stays that would dwarf the cost of just leaving her f#$%ing home care uncut in the first place. I’ve seen this happen over and over again to people I fight for. It’s left me scarred to depths few of you could ever understand.

Here’s the Wall Street Journal piece, by Clare Ansberry.

FLORENCE, S.C—Tandem forces of shrinking state budgets and rising health-care costs have collided and struck a small brick ranch house in this rural town, home to Barbara Hickey.

Born with cerebral palsy, Ms. Hickey, now 67 years old, is confined to a motorized wheelchair. She lives alone and relies on certified nurse’s assistants to get her in and out of bed, bathed, clothed and fed.

In December, she received a letter from the South Carolina Department of Special Needs and Disabilities, saying her weekly 50 hours of personal-care help was being cut to 28 hours. That meant Ms. Hickey would get help for two hours in the morning and two hours at night. If she needed to use the bathroom in between, she would sit in a soiled diaper.

After several days of reduced care, the local office of the South Carolina Legal Services appealed the cuts on behalf of Ms. Hickey. Her hours have been restored pending the appeal.

Home health care—funded largely by Medicaid—generally costs less money than institutionalizing developmentally disabled people like Ms. Hickey. But the political reality is that it’s easier to cut back home services than to close a 24-hour facility, which can leave people with nowhere to go. Thus, some of the biggest cuts around the country are happening in the basic services that help the disabled cope at home.

South Carolina says it has little choice but to cut funding for Medicaid. It faced a $563 million deficit for the current fiscal year, and like other states must have a balanced budget. Medicaid, the joint federal-state health-insurance program for the poor and disabled, already consumes about 20% of its $5 billion budget and is one of its fastest growing costs.

The health-care program is on course to consume 40% of the budget of South Carolina in five years, and leaves little for anything else, says Gov. Mark Sanford. “It could force legislators to either cut further into bone in the areas of education, law enforcement and economic development, or raise taxes. Neither option is palatable.”

The state already is making painful cuts elsewhere. The state’s Department of Juvenile Justice has closed five group homes and cut 25 after-school programs. There are 1,000 fewer public-education teachers this school year than last.

Across the country, budget-strapped states are focusing on Medicaid. Created in 1965, it is now a $379 billion program, including state and federal funds. State spending grew an average 7.9% in fiscal 2009 as the economic crisis hit and more people signed up for Medicaid.

It was the highest growth rate since the last downturn six years ago. Spending is expected to keep growing at that pace for the next decade because of rising costs and growing enrollment.

But states don’t have much flexibility when it comes to what they can and can’t cut inside Medicaid. Although it is a state-managed system, the federal government pays a percentage of each state’s total costs and makes many of the Medicaid rules. Under federal Medicaid law, states must offer inpatient and outpatient hospital care, X-rays and lab services. They also have to cover nursing-home services and meet certain standards, such as staffing ratios.

There are further constraints this year. States can’t reduce Medicaid eligibility this year because of a condition attached to federal stimulus money, and under health-care reform, they can’t eliminate existing programs.

States also run up against other laws when they make deep cuts. Lawsuits have been filed in South Carolina, Florida, Connecticut, Virginia, Mississippi and New York, claiming Medicaid cuts make it impossible for those with disabilities to live at home and that it violates the Americans with Disabilities Act.
(I know the lawyers behind this class action. I say RIGHT ON!!!!)

Logically, states would cut the most expensive, least efficient services and keep the most cost-effective. But because of mandates and the need to save money quickly, that isn’t as easy as it sounds.

For example, home care—because relatives often provide some of the care—is generally cheaper than housing people with developmental disabilities in institutional facilities. In 1993, the average Medicaid cost for each person with disabilities was $48,500. At the end of 2008, the latest figures available, it cost an average $55,000. Adjusted for inflation, that actually represents a 23% decrease, largely as a result of more services being shifted away from costly institutions to the home, says Charlie Lakin, director of a University of Minnesota program that tracks services for the developmentally disabled.

But many in-home services, though critical to those receiving them, are optional. Furthermore, there aren’t many minimum standards set for in-home services, so it’s easier to cut them without violating funding requirements. There are fewer immediate consequences for the state when it cuts those services because families won’t generally abandon disabled relatives and leave states on the hook for housing.

Cutting home care could ultimately prove penny-wise and pound-foolish, however. It could push more people into institutions or large group homes because that is where services are guaranteed, even though institutional care is more expensive.

The department’s fiscal problems have been exacerbated by past spending decisions. A special state audit released in December 2008 showed that the department hadn’t provided many new services for which it had received funding and, as a result, it couldn’t recoup millions in federal matching Medicaid dollars. For example, the state spent less than $700,000 of $10 million allocated to serve autistic children, which resulted in the loss of $13.6 million in federal matching money. The state said it couldn’t ramp up the program fast enough because it couldn’t find qualified service providers. After the audit, the executive director of the department and four of the department’s seven commissioners resigned. The department has since implemented most of the recommendations made by the Legislative Audit Council.
(This same thing nearly happened with the NHTD –Nursing Home Transition & Diversion– waiver here in New York: the bureaucracy imposed on providers was SO ridiculous than very few participated, and the rules were so cumbersome for patients that, in the program’s first two years, only one patient downstate–me–transitioned home from a facility!)

Recent state cuts have targeted developmentally disabled people living at home. In December, families were told that some of their in-home support was being cut by as much as half.

Brian Phillips, a 37-year-old with cerebral palsy, was told that he was losing half of his personal-care hours. He can work a TV with a remote control but can’t dress or feed himself, or get in and out of his bed or wheelchair.

He lives alone with his father, James, 70. The elder Mr. Phillips, who has had open heart surgery and whose heart functions at only 26% of its capacity, cannot lift Brian on his own. He appealed the cuts and the hours were restored pending his appeal.

“These are cuts no one wants to make. They are very difficult for agencies to implement and they are very upsetting and very, very difficult for our families,” says Lois Park Mole, spokesperson for the state Department of Disabilities and Special Needs.

People will generally do what they must to keep their disabled family member at home regardless of the cuts. At some point, however, even the most dedicated may not be able to continue, especially as their own health deteriorates.

In Aiken County, Board of Disabilities Executive Director Ralph Courtney says waiting lists for services are growing. There are more than 5,000 on waiting lists for various services, from residential programs to in-home programs.

“We want to give families hope to keep their family unit together, but in reality there is very little we can put in place to assist them,” says Mr. Courtney.

In-home support is cheaper, he says, than the alternative: group homes and larger residential programs that need to be maintained and staffed 24 hours a day. “But you can’t put people out on the street,” he says. “You can cut in-home support.”

Even though Ms. Hickey lives alone and needs help with nearly every aspect of daily living, it cost less to have her live in a house with 50 hours of personal care help than in a nursing home. Institutional care in South Carolina costs about $100,000 per person a year, compared to $39,000 for home and community services, according to the University of Minnesota research.

Read the entire article here: Disabled Face Hard Choices as States Slash Medicaid

How does littering the entire country with families destroyed by Medicaid cuts, jive with HEALTH CARE REFORM?

Honestly, I have gotten so many hate messages over the years, I’m now convinced that the Americans will continue to react with cold indifference, or, worse, celebration–“good riddance! No one is gonna force me to pay for you useless leeches!”–as Medicaid policy continues to cull out people with disabilities like me, UNABATED.

And you wonder why I’m so angry that I’d consider reconstructing the U.S. entirely? It’s because my every day experience involves the above Kafkaesque Medicaid policies harming me or the people I care about!

Nick

Fix The Broken Foundation Before Building A Skyscraper On Top Of It

Posted by – August 22, 2009

My biggest beef with Health Care Reform right now is that we’re building a new tower on top of a broken foundation. Medicare and Medicaid are badly broken, and we’re building more programs on top of that. Bad idea.

Insurance company bureaucracy is even worse, but federal programs have to be significantly better in the future for there to be meaningful competition. Right now, the government health care system is still far too fail. Medicaid is deeply corrupt, admitting people to nursing homes because institution owners and their lobbyists line the pockets of state legislators; people are even stripped of home care just for turning 21, and forced into institutions. As far as Medicare goes, its fee schedule encourages procedures over responsible diagnosis and management, causing the death of primary care and creating a costly and disastrous situation for patients. An old man will have no problem finding a cardiologist to do an angioplasty, but may find it near-impossible to find a primary care specialist who can manage him with meds instead.  A crude example, but it speaks to how costs can explode when so few primary care docs are around and it’s mostly proceduralists who have survived the extinction. Most new doctors the past few decades have stayed away from family practice because Medicare’s the AMA‘s drastic undervaluing of the E&M (evaluation and management) reimbursement codes make it difficult to survive financially as primary care physicians. You get what you pay for, and Medicare (and the private insurance industry that follows Medicare’s lead) pays for procedures, procedures, procedures, NOT talking to patients and thinking about what’s best for us. According to Medicare, taking a detailed history from a patient is worth nothing more than something like the first 27 seconds of a proctoscopy; I rarely see doctors taking detailed histories anymore, outside of residents in university hospitals who are ordered to do so. Do plenty of docs have to do more and more procedures just to stay afloat and keep their doors open? YES!!

Aside from a fee schedule that has buried primary care and incentivized unnecessary procedures, Medicare has also become such an unwieldy bureaucracy that even the most basic functions are drowning in red tape.

Read this personal experience from primary care specialist Dr. Toni Brayer:

Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to “cognitive, diagnosing, talking” physicians makes the idea of expansion untenable.

May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief…22 pages for a change of address. It is now mid-August and I still do not have the “approval” for my address change.

I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.

I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information “overnight, registered” because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my “bank officer” and a utility bill from the office. Mr President, I don’t have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients…but I certainly did comply.

I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.

I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.

Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.

A loyal American,
Internal Medicine (aka: primary care) physician

Source: EverythingHealth: Fix Medicare

It seems like the government doesn’t want doctors participating in Medicare, and makes the reimbursements so low and the hassles so high (they can’t even manage a simple change of address without a half-year bureaucratic nightmare) that more and more providers just give up. Yes, this is yet another case of the government’s unfortunate cranial-rectal inversion.

Dr. IcedLatte lists more aspects of modern medicine that desperately need to change here.

The Tower of Babel

The Tower of Babel

I support a public option in the new health care reform package, but (unlike some conservatives) I realize we already have several widely-used public options, Medicare and Medicaid, that the government runs, and should fix as a core part of health reform. If a new government program just continues the failures of Medicare and Medicaid, that’s not reform. We have to include the CCA in the bill, include a wider adoption of the PROMETHEUS bundled payment system (PROMETHEUS stands for Provider payment Reforms, Outcomes, Margins, Evidence, Transparency, Hassle-reduction, Excellence, Understandability, Sustainability) so that the government’s skewed, guaranteed-to-fail fee for service billing system doesn’t bankrupt Medicare. Don’t build a tower of babel that’s just going to fall. Listen to all the experts, doctors and patient advocates, and FIX MEDICARE AND MEDICAID. I agree (mostly) with this article by David Ignatius, focus on health system reform, not just “health insurance.” We have to fix the foundation or the new skyscraper is going to collapse.

Nick

Is The U.S. The World Leader In Disability Rights?

Posted by – August 7, 2009

So, the U.S. has now signed on to the historic UN Convention on the Rights of People with Disabilities (CRPD). People are saying this is wonderful, the ACLU is saying that it marks America’s return as a world human rights leader (by the way, the Senate has yet to ratify the treaty). I’m concerned that this is largely happy talk, just more lip service while meanwhile we’re badly behind in enforcing the Rehab Act, the ADA, Olmstead, and the other disability rights legislation we’ve fought so hard for. Will the CRPA become yet another unenforced law on top of that growing pile? Particularly grating to me was this commentary on AAPD’s Justice For All blog, which closes with this:

The US can engage in meaningful partnerships across sectors and help developing nations with the construction of accessible infrastructure, expanding inclusive education and vocational training opportunities. By signing the Convention the US is dedicated to these efforts. Can we make a different, “Yes We Can!”

Wut?? The U.S. is going to be like the Peace Corps for accessibility of the third-world’s infrastructure or some $#!T?! PLEASE!! We can’t even implement our own disability rights laws! As we speak, the feds are moving against ENTIRE TOWNS that are inaccessible and violating the ADA! Don’t send the Accessibility Corps to Africa or India; first send them to renovate the Mobile Public Schools! First send them to Ann St. in Lower Manhattan, where most of the businesses are inaccessible, and all over the five boroughs, where inaccessible pre-war buildings seem to be the rule, not the exception. Where’s the US’ “meaningful partnerships across sectors” to address this inaccessible McDonald’s on 429 7th Ave. off W 34th, which is a major tourist area?

Picture of some serious McFail in accessibility.  Alejandra provides us an important public service by documenting the many accessibility fails of NYC

Picture of some serious McFail in accessibility. Alejandra provides us an important public service by documenting the many accessibility fails of NYC

We weren’t looking for some McDs yesterday, we were searching for pizza. The Spinelli’s pizza next door was accessible. When a locally-owned pizzeria tops a mega-giant multi-national chain in basic accessibility, that gigantic corporation needs to do some rethinking. As a special double bird to the elderly and disabled, this particular McDonald’s location has accessible entrances on either side of the stairs…that only open from the INSIDE, and only lead to stairs for the basement, staff confirmed. That leaves the middle stairs as the only access point for this location. Well done 7th Ave. McDonald’s, that’s some top-notch FAIL!

The U.S. has a lot of changes to make before we are a disability rights leader, an example to follow.

Any idea of when I’ll be able to access currently INACCESSIBLE public businesses? Maybe for the ADA’s 29th anniversary? 39th? Dammit, where’s the enforcement? We have no room to finger-wag and advise other countries about disability rights!

Nick

Disabled Still Forced Into Institutions Just For Turning 21: Open Letter To The Disability Community, August 2009

Posted by – August 2, 2009

Obama Administration Signs the CRPD Treaty, But Is In Flagrant Violation Of It, The ADA, Olmstead, and Its Own “Year of Community Living” PR Campaign, As Arbitrary Termination of Medicaid Home Care Services at Age 21 Continues Unabated

The recent addition of the U.S. as a signatory to the UN Convention on the Rights of People with Disabilities (CRPD) has been much ballyhooed. Any idea if/when Article 19 of the CRPD Treaty will be enforced? That’s the article that guarantees me community choice, the freedom to live in my community, without fear of being segregated in a nursing home because the government will only provide care in institutions. You know, the right to “the most integrated setting” that TEN YEARS AGO the Supreme Court ruled we’re entitled to under the ADA?! This is particularly bitter for me because I am currently STUCK IN AN INSTITUTION.
Why agree to Article 19 when we are not following it?! The feds continue to look the other way while poorer states cut off community services for the severely disabled just because they’ve turned 21, and leave them no choices but death and/or an institution. I had to fight that policy years ago in Alabama, and won, but apparently this despicable practice is still going strong in Illinois, as I recently read on VentWorld:

My son turns 21 at the end of August and will lose his current funding source. There are no adult waivers or funding that would provide him with the same level of support he has now. Trying to get info to prove that he would NOT be safe in a skilled nursing facility or nursing home. I found a web site where I can look up the name of a home to find out their staffing levels, ratios, violations, etc. but I have to know the name of the homes first. When I do search for homes the results are not specific to ones that can handle complex ventilator care. The state of Illinois wants the cheapest plan for my son which means without proper documentation they will only provide him with minimal funding for nursing care in our home. He currently has 114 hours per week and 336 respite care hours per year. The state is saying the adult program only allows for about 30-40 hours per week – more if we use non-skilled people. The state wants to find the cheapest way to care for him and if that is a nursing home then I must have proof that the staffing ratios will not be adequate for him. Plus there are no facilities anywhere close to where we live so he would have to leave his community, his friends, his family, his job, etc. He is very social, wants to continue living at home and just because he has a birthday his life is being turned upside down. If you know of facilities that take patients 21 years of age or older with complex ventilator care and what level of staff and their ratios please respond. Thank you.

I’ve been fuming furious ever since I found this post a few days ago; despite all my years of work on the 21 “aging out” policies, despite the fact that I brought national attention to the problem and forced the HHS secretary to notice, the government (state AND federal) are still allowing this unintended consequence of the EPSDT program to put even ventilator-dependent people and their families in a horrible, untenable positions where their lives will be torn apart at best, and lost to nursing home neglect at worst. For adults, it’s incredibly difficult to remain at home if you have a severe disability. As Dr. Ford Vox wrote in a recent piece in Salon: “…if your electric wheelchair breaks down or needs a new battery, we’ll have no problem moving you into a nursing home. You’d prefer a new battery so you can continue living at home? You picked the wrong state. As a poor Missourian, you’ll have no more than 30 days for your rehabilitation. Not quite ready to go home? Need a few more days of intensive therapy? Again, you picked the wrong state. Missouri Medicaid wants to admit you to a nursing home so much that it also doesn’t allow for outpatient physical therapy services or in-home therapies, taking another essential tool out of the hands of your medical team.”

We won CRPA, The ADA, Olmstead, and more, but our victories seem almost inversely proportional to the realities on the ground, as states slash services to the bone at the same time as the disabled population (uninsured or uninsurable) grows. The president announced his “Year of Community Living” as a mother in Illinois prepares to move her ventilator-dependent son away from his job and community and into an institution just because he’ll soon turn 21 and “age out” of what little services the feds require state Medicaid agencies provide to children.

The “out of sight, out of mind” mentality of our politicians makes me angry; the fact that so many advocates in the disability community, who should be fighting for our most vulnerable people, are every bit as unaware of the 21 cutoff infuriates me. The termination of Medicaid home care services at 21 is like this wormhole that’s continuing to suck innocent people in and lead them to institutionalization and/or death, and the fact that I’m (as far as I know) still the only activist noticing this and fighting back is intensely frustrating and disturbing. We’ve GOT to stop fiddling while Rome burns, and unite to end the worst injustices. And the ongoing FAILURE to rectify the 21 cutoff situation should certainly be at the top of that list.

Nick

The ADA Turns 19. Are Businesses Listening?

Posted by – July 26, 2009

There is, deservedly, much talk this ADA anniversary of the broken promise that the ADA guarantees people can live in “the most integrated setting” and how Obama just signed the UN Convention on the Rights of Persons with Disabilities (CRPD) while continuing to ignore long-term care (and the CRPD’s article on community choice).

But what about the most basic accessibility?  The most fundamental provisions of the ADA involve a guarantee of disability access to buildings open to the public.  But we’re not there yet.  Even in the Big Citysteps block wheelchair access to businesses.

19 YEARS after the Americans with Disabilities Act (ADA) enshrined accessibility in federal law, we’re still dealing with this crap!

We wanted to get into this Popeyes on Ann St. but couldnt because of this one step.

We wanted to get into this Popeyes on Ann St. but couldn't because of this one step.

ADA FAIL

ADA FAIL

They’ve had almost two decades to build basic and inexpensive ramps, but haven’t.

It is UNJUST that we can’t access restaurants just because we’re disabled. These are some of the injustices that the ADA was primarily written to rectify. But the law is moot when unheeded and unenforced.

Does the ADA matter if businesses aren’t listening?

Nick

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