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Sunday, November 25, 2007

Saving Medicare One Wound At A Time

Currently, the Senate Finance committee is attempting to put together a bill to determine payments to physicians for 2008. The current number being bandied about is a 15.1% cut in pay for physician services spread out between 2008 and 2009. The cut would start with a 10.1% cut for 2008 followed by a 5% cut for 2009.

As it stands right now, Finance Committee Chairman Max Baucus wants a package that avoids these cuts entirely, while Charles Grassley, the ranking minority member of the committee, wants a one-year suspension for 2008 and the entirety of the cut to come in 2009.

In the past, what has invariably happened at this time of year goes as follows. The desired cut is announced by the Centers for Medicare & Medicaid Services (CMS). Through a combination of AMA lobbying, book cooking and the desire to pass the buck, the desired cut doesn’t appear in the budget and gets put off another year.

At the point that payments to physicians are about to be cut by 15.1%, it can be safely stated that the day of reckoning has arrived. As expected, when a budgetary emergency presents itself, every special interest cockroach comes out of the woodwork to claim the crumbs. Already, 30 senators from both parties have signed a letter that was sent to the committee asking that no cuts be applied to radiology services.

By far, the biggest stumbling block (as if we should be surprised) is Senate Republicans.

Max Baucus has a good plan. He wants to suspend the pay cut to physicians and replace that funding by reducing the payments made to insurance carriers for administrating Medicare Advantage plans. Senate Republicans, having never met a corporate welfare plan they didn’t like, are backing Grassley’s plan instead.

A Medicare Advantage plan, sometimes called a Medicare Fee for Service plan, works somewhat like a standard commercial insurance plan. They cover (in theory if not always in practice) everything that Medicare covers, plus additional benefits like routine physicals at the administrator's discretion.

Since the introduction of the Medicare Part D drug benefit, enrollment in Medicare Advantage plans has exploded. When a Medicare recipient looks for a carrier to handle their Medicare Part D coverage, they are looking for a carrier and a plan that includes the litany of drugs the patient is taking into one formulary. The recipient does not commence this process looking to change their base Medicare coverage from traditional Medicare to a Medicare Advantage plan, but this happens frequently. The sales pitches put forward by many of these plans remind me a lot of the days of long distance phone carrier "slamming". Most recipients don’t realize that they need not switch their basic Medicare coverage to be enrolled in a Medicare Part D plan.

When Medicare Part D came into existence, the focus of the budget busting affects of the program seemed to be focused on the enormous giveaway it represented to the pharmaceutical industry with regard to "Average Sale Price" versus "Average Wholesale Price". The dollars paid to insurance carriers for the administration of Medicare Advantage plans in many instances is just as crippling. It is yet another example of the billions of dollars funneled to Corporate America under this president.

The ramifications of a 15% pay cut to physicians are already being made abundantly clear. Doctors, via the AMA, are already announcing that they may close their practices to new Medicare patients if the cuts are approved. This would be just in time for the Baby Boomers who will begin turning 65 in 2010 to be left out in the cold for primary medical care.

Republicans have made it their mission to starve Medicare and Social Security of needed funds until both can no longer function in any form, leading to what they hope will be their eventual demise. People like Newt Gingrich and Grover Norquist have made this very clear publicly over the last 15 years. It is now clear that while they attempt to destroy both, they might as well perfect a form of legal embezzlement of funds to their friends in the insurance and pharmaceutical industry.

Baucus wants to stop a portion of the bleeding of funds with the next bill. While this doesn't address the big hemorrhage to the pharmaceutical industry, it can be at least viewed as a start. Whether he has enough Roach Motels at the ready remains to be seen.

Friday, November 23, 2007

Georgia Runs Out Of Water; Blue Stater Yawns

So, if all the major news stories are correct, the reservoirs around Atlanta and surrounding areas in Northern Georgia will be out of water in roughly 80 days.

The current cracker Governor, Sonny Perdue, (a name that perfectly symbolizes the lack of working intellect of its holder) snapped into action immediately. He summoned his ill-informed political followers to the state capital and prayed for rain. When I think of effective government, this is not the picture that pops into my head, but I guess that’s just me.

No one should be surprised that a state rich in Republican tradition displays this kind of ineptitude on a state level. Rather than spending the last 20 years planning for the day in early 2008 when the wells run dry, Georgia spent their resources on the ’96 Olympics, the lengthy investigation of Richard Jewell for not setting off a bomb at those same Olympics, the initiation of a state lottery and the passage of Voter ID laws that are for all intents and purposes a reintroduction of the Poll Tax.

The contingency plans are now down to praying and (in the likely event that fails) diverting water from the Great Lakes.

As a resident of Milwaukee, Wisconsin, located semi-majestically on the banks of Lake Michigan, I proudly say "HA!" to the first idea and "Fuck you!" to the second.

As a person with a Democratic Governor, two Democratic senators and a real Democratic congresswoman, I now say to Georgia without the least bit of pity, "How’s that small, non-intrusive government theory working for you now?" By placing your state government in the hands of people who hate governmental operations, you get what you deserve. The only thing missing from the Governor and State Assembly members in Georgia to place them firmly in the Middle Ages is chain mail armor being worn to work.

Once again, for anyone who will listen: you can’t put people in charge of government whose sworn ideology is the piecemeal destruction of that government.

Sometime in early Spring (if they have any chance at all of getting attention in the middle of a Presidential race) the situation will be so dire in Northern Georgia that the proud Bible-waving governor will be screaming at FEMA and the Army Corps of Engineers to immediately fix the problems created by decades of Republican neglect. He and his brethren in state government only need look to New Orleans to see what type of response they’re likely to get.

I have friends in the Atlanta area that will be directly affected by all of this to whom I’ll more than likely ship a case of water. I really wish I could sit here and state that I care about what happens to the area as a whole. Yet I wasn’t the one who elected these charlatans to the state government of Georgia year after year. If the residents of Northern Georgia want to get mad at someone for a lack of water, look to your state and local governments that allowed an overpriced McMansion-style gated community to go up in every piece of free space in the North of the state. Here’s some math for you:

One New House = One New Dwelling Needing Water

Your government created the problem. If they can’t fix it, that’s your fault for either not voting at all or voting for these idiots when you had the choice of someone else.

Lake Michigan and its contents belong to the people abutting Lake Michigan. We do our job by continually monitoring the health of the immediate Great Lakes and the effects of changes on the residents surrounding it. You can’t have it now or at crunch time. Tough shit. That’s life.

Picture for a moment that scene in the movie "The Three Amigos" where Steve Martin, Martin Short and Chevy Chase are riding through the desert. They each take turns opening their canteens. Steve Martin gets five drops of water into his mouth. Martin Short gets a canteen full of sand in the mouth. Chevy Chase dumps a canteen full of water into his mouth and onto his head as the other two look at him longingly. He then turns to the other two and offers them lip balm.

Georgia, thy name is Ned Nederlander. No worries though. I’ll be happy to send you some Chap Stick.

Tuesday, November 20, 2007

Why Is David Stern Still Employed?

A funny thing happened to David Stern on his way back from the bank.

He was returning from depositing checks made out to the NBA by Mark Cuban. The fines had been levied by Stern against Cuban for criticizing the referees of the NBA for lackluster performance. Stern, being the commissioner of the league, scolded Cuban but good utilizing the power of the pocketbook, and strolled back to the league office with the confidence and swagger of a man confident in his decision making.

Then he passed the newsstand.

It seems that half of the referees in the NBA had violated the rules of the league by going to casinos in the off-season. One referee in particular, one Tim Donaghy, was indicted for fixing games in favor of illegal gambling interests.

David Stern acted decisively - by doing nothing.

Tim Donaghy had already resigned from the league by the time the story of his game-fixing hit the streets at large, requiring nothing more of David Stern than was required of Pontius Pilate. He washed his hands of Donaghy and let the feds take care of the execution of justice.

The other casino-hopping refs got the Scooter Libby treatment. Their punishment for breaking the rules of the NBA was for the head of the NBA to change the rules to make it OK for the refs to go to casinos in the off-season. This kind of reaction doesn’t even rise to the level of making each ref sit facing the corner wearing a dunce cap for 20 minutes. Rather than face the problem head-on, Stern saw a problem and ignored it by imperial fiat.

You have to admire the arrogance of David Stern, if nothing else. He sits on his New York throne like Queen Elizabeth II, as the head of a fading empire, TV ratings heading in a downward direction, shrinking attendance, officials with questionable ethics and a dysfunctional ownership team at the helm of the blue-chip franchise down the street at Madison Square Garden.

Through his leadership, he has done everything in his power to exclude the African-American community as fans of the sport in exchange for a well healed (read: WHITE) fan that, if we are to judge strictly by attendance figures, apparently doesn’t exist. Not to worry though, African-American fans! You can still purchase throwback jerseys at a ridiculously high price and display your pride in the NBA from a distance, where David Stern prefers you.

In a league that includes Donald Sterling among the NBA ownership group, it’s not a complete mystery as to why David Stern keeps his job. Having stated that, I appear to be the only person in the public at large who thinks that David Stern got a free pass on a problem he helped create. By constantly displaying to the world at large that he would back up the referees against all criticism, he helped form a Teflon class of official like no other in any sport. One wonders what rule the officials will break next, knowing that unless they go the full illegal route like Donaghy, Stern still has their collective backs.

The NBA has been dogged for years by criticism stating that a separate set of rules appears to exist for the star players in the league. Stern could laugh off that kind of charge based on the lack of long-term statistical evidence. Tim Donaghy throwing games and altering the results of those games for the benefit of gambling interests throws the entire product put forward by the NBA under a cloud. How can any fan of professional basketball watch the NBA and trust the product now?

As long as Stern continues to sit at the helm of the NBA, this league can’t reasonably consider itself credible. When an entity loses the public trust, the eventual destruction of that entity is spent for a short time on outrage, followed by long term indifference. I for one have now reached the latter category.

Thursday, November 15, 2007

The Smart Money's On The Planet

I must preface this writing by stating unequivocally that I am not a scientist. I tend to base my conclusions on what I observe and for the big scientific questions, I tend to default to the majority opinion among reputable scientists presenting research free from personal or political bias. Based on observation and majority scientific opinion, I have come to the conclusion that yes, global warming is a measurable phenomenon that is occurring and that the prevailing evidence shows that the behaviors of humans are a major factor in the warming trend.

While what happens next if the overall problem continues is still open to speculation as far as I can tell, it appears ultimately that human life in certain corners of the planet is at risk. This leads to a conclusion that humankind, by continually engaging in actions not directly related to the survival of the species, has placed its own species at imminent risk of not surviving.

This is the point where I state without hesitation that I eagerly await the planet’s final response to humankind’s existence on it.

So the reader at this point is horrified. "How utterly sick!" you think to yourself, "Are you actually arguing in favor of the natural destruction of the human race?"

In a word, yes.

If you could just take a moment, take your heart off your sleeve and tuck it back into your chest, take a deep breath, swallow the nearest industry-forced psychotropic medication at your disposal and relax, I’ll explain myself.

Isaac Newton posited that for every action, there is an equal and opposite reaction. There are many examples of this in everyday life. If you use logic and criticize a Republican using intellect and reason, Rush Limbaugh and Bill O’Reilly tell everyone within earshot that you hate America, which while hysterical and devoid of reason, can be classified in the simplest terms as a reaction to a stimulus. If you rub a sexual organ (yours or someone else’s; I’m not judgmental) at a certain angle with the necessary combination of force and energy, you stimulate a reaction (and it’s hoped for all involved that it’s not the spoken phrase "Are you done yet?").

Now consider the planet. Since the Industrial Revolution of the late-19th Century, the actions of humankind have acted as a stimulus toward the planet on which we all coexist. The planet’s well-considered reaction is becoming abundantly clear with each passing day. It is curious to the species of humankind that for every man-made emergency, we begin with soul-searching, in most cases asking ourselves "what can I do differently to change what has occurred or what is about to occur?" With the evolutionary gift of reason, it is our conceit that we believe we can come up with solutions for every problem that presents itself.

There are two problems with that conceit. The first is humankind’s lousy track record of ideas, with an overwhelming majority of what we’ve come up with thus far being worthless and not at all helpful to the overall health and survival of the species.

Don’t believe me? Below is a list of items created by the minds and hands of humankind. How many can you spot that are/were necessary to the survival of humankind as a species?

Handguns

Bombs (atomic and non-atomic)

The Tacoma Narrows Bridge

The Chevy Vega

The Ford Pinto

The 5-day deodorant pad

Tris pajamas

Lead paint

The Dalkon Shield

Thalidomide

PCB

CFC’s

Asbestos insulation

Cigarettes

Crystal methamphetamine

Plastic containers

The Maginot Line

This is the short list. I’m certain a better mind than mine can find other sterling examples of human ingenuity throughout history that led to no improvement whatsoever in the human condition or led to lives being saved. I am certain that still others can name things that have helped in the survival of the species, such as penicillin and any of a number of vaccines that argue in opposition.

The second problem with the above conceit is much more concrete. If I had to lay a wager (a uniquely human activity that does nothing to benefit humankind by the way; add that to the list above) between humankind’s capacity to save itself from extinction, and a planet that has already survived past climate shift and inundation by large land mammals and comets, I’d bet everything on the planet. While humankind has had its successes, it is still a species ruled both literally and figuratively by its vices. While homo sapiens evolved from other species that were much more primitive, one check of any given day’s disasters in the news, from Pakistan to Burma to Darfur to any given day in the life of the current occupant of our White House, proves beyond doubt that there is still much work yet to be done on the evolutionary front. We are at best a species with potential long-term viability doomed to be disconnected from that eventuality by our emotions, terrible judgment and litany of bad ideas.

Being infected with human feelings, I take no personal or emotional comfort in self-inflicted human extinction. However, I do take comfort in the knowledge that the planet’s oncoming reaction to the negative stimulus of human encroachment presents Nature with an opportunity for improvement upon previous life models. As millions of species on our planet have disappeared, millions of others have taken their place, with each exchange bringing about either subtle or significant improvement (with the salient exceptions of the duckbill platypus and Ann Coulter). This heavenly mass teeming with life that we all coexist upon is a marvelous series of experiments to behold in that way.

Many generations from now, someone or something will discover what was Washington, DC at the bottom of a 10,000-meter underwater trench and will be curious about the primitive architecture for about 30 seconds. After that they’ll continue on their way, much like we all did when the Woods Hole Institute found the Titanic. It’s not the planet as an entity that is destroyed by global warming, but merely the myriad life forms upon its surface. While I currently recycle, compost and utilize a rain barrel and an economy car, I am aware that no amount of recycling, composting, organic farming, emission limits, carbon credits or vegetable oil buses alters the truth of supremacy of planet over inhabitants.

Look at the bright side though. Pat Robertson and James Dobson will bite the biscuit like everyone else. In and of itself, that should give everyone hope for a more evolved phoenix rising from the ashes of humankind.