Francine Hardaway

Our Children's Future: Healthcare v. Deficit

2010-02-03T11:09:28-05:00

Well, health care has gone to the back burner. Now everyone, not just Republicans, is unwilling to talk about it. Allegedly, Democrats are scrambling behind the scenes to figure out a way to pass something, but we are definitely finished having a debate about it.

President Obama revealed his budget today, to the usual "OMG the debt will leave our children with a lower standard of living" from the people across the aisle. Pressed on how he thought the budget deficit ought to be addressed, one of Chris Mathhews' Republican guests admitted that the only way to lower the deficit would be to "transition people 55 and under out of Social Security and Medicare benefits and into a different plan that isn't so expensive." I bet that will be a sure election-winner: work all your life and get kicked to the curb in favor of someone else's grandchild.

Nobody talks about changing the objectives of the system, the delivery, or the costs. All they talk about is the budget deficit and cutting. In the mean time, what's the quality of life for people who need health care now?

In Arizona, where I live for most of the year, Medicaid enrollment has gone up 18% since last year, and the state has one honkin' deficit itself. As a response,

... Governor Jan Brewer, struggling with a $1.4 billion deficit this fiscal year (and a projected shortfall of $3.2 billion in fiscal 2011), ordered the state to stop enrolling children in KidsCare, that state's CHIP program that provides coverage for 47,000 children. Brewer has also introduced a ballot measure that would roll back a 10-year-old expansion of Arizona's Medicaid program, resulting in 310,500 -- more than 4 percent of all Arizonans -- losing their coverage.

It will be interesting to see how long it takes everyone to figure out that if we reformed not the money piece, but the delivery piece, of the health care system, we might be able to provide care for children and the elderly and still decrease the deficit.

I actually do think automating the systems will help a little, and auditing Medicare and Medicaid more carefully and completely will also help. Both programs, according to people I know who have done pilot recovery auditing projects for them, are full of waste -- excess utilization, incorrect billing, duplicate payments. And as for fraud, "60 Minutes" exposed how easy it is to defraud Medicare in Florida several months ago.

There are all sorts of other pilot programs in the bill-that-will-never-be-passed, from the Primary Care Medical Home to prevention to outcomes research. Now most of that will be scrapped, and a paralyzed Congress will just keep trying to figure out how to reduce the deficit on the backs of the vulnerable.

The military budget? Two wars at a time? That might be a little expensive, but why cut back on that? Instead, the budget has been framed as a Hobson's choice: leave our children with debt later, or leave them without health care now. Let's just throw some poor kids out of a Medicaid program and use the savings to buy drones that kill civilians in other countries.

Health Care: How Can You Ignore 18% of the GDP

2010-01-19T15:33:21-05:00

The pundits are saying the Massachusetts special election today is a referendum on Obama's health care reform plan. Massachusetts voters, they say, don't care about health care reform. That's too easy.

People in Massachusetts already have universal health care. If they vote down Ted Kennedy's legacy, it will be for many other reasons: either they don't care about anyone else in the nation getting insurance, or because it isn't working and is breaking their state. Or maybe they think the big issue is elsewhere -- the banks, the economy, or Afghanistan, and Washington is misguided. Or they have ceased to believe in government at all. Or it's snowing, and it's a pain in the ass to go vote. Any of those could be true.

I'm no expert in Massachusetts politics, but I worry about the outcome of today's Senate election for an entirely different reason. I've become an expert in the law of unintended consequences. You get that way if you live long enough.

The pundits are calling the election over on Morning Joe. TV programs like that have a way of setting the agenda, so it probably is, indeed, over. The "fix" is in. The health care lobbyists have done their work.

Now what, though? Health care is 18% of our GDP and growing. How do we fix the economy, or create jobs, without doings SOMETHING to control health care costs? Here are some interesting, if probably unpopular, alternatives that could emerge:

1) Cut Medicaid and Medicare sharply. Let the poor and the elderly fend for themselves. The poor don't vote anyway, and the elderly will soon die.

2) Allow the re-importation of drugs, which wasn't part of the original bill. Let people get their drugs in Canada and Mexico. This will create that NAFTA Bill Clinton wanted anyway.

3) Put all the jobless to work in the healthcare industry; if we're going to spend so much of our tax money on health care, let's create "white coat" jobs rather than green job.

4) Cut the military budget, and use the money for health care.

5) Do nothing, and let the country rot.

6) Raise taxes

You see where I'm going with this. There are no good alternatives. Something must happen.
File this away somewhere and haul it out in four years: my prediction is that the Republicans will sweep into power in 2010 and 2012, running on the change Obama just ran on. They will then, Obama having prepared the public for it, enact some sort of health care reform and get the credit for it.

Things are changing. Republicans aren't rich anymore. They are the middle class. Democrates are limousine liberal elites. This would be hilarious if I didn't pay taxes for it.

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What Caused the Financial Collapse of America?

2010-01-07T10:52:15-05:00

Gucci shoes
BMWs
Driver-attended Lexus sedans
Park Avenue apartments
Westchester country clubs
Greenwich mansions
Jackson Hole vacations
NetJet accounts
Black towncars
Island summer homes
Manhattan steak houses

OK, those aren't the real reasons, but they are the outward trappings. The "real" ten reasons are probably the seven deadly sins, de-regulation, globalization, and the decline of public education.

However, those ten symbols (to which all the major characters in this gripping narrative had unfettered access), although never part of the lifestyle of the average American, are part of every Wall Street banker's repertoire. Even as they failed to mark their worthless assets to market (translation: tell the truth about the crap they had securitized) and continued to demonstrate unfamiliarity with the numbers in the businesses they were supposed to be running, these CEOs were living in unbridled luxury thinking they were taking part in "real life."

By now you probably can guess that I'm reading Andrew Ross Sorkin's Too Big to Fail, and it is making me sick. From what I can tell, none of these investment banking firms or mega-banks had so much as a controller to tell them when to stop spending. Throwing around multi-billion dollar numbers in deals that repeatedly bet the farm (or the firm), they operated in an atmosphere of outright denial about what money actually means. Even the ones from poor backgrounds forgot that their portfolios of toxic assets contained the remnants of other peoples' lives.

And none of those people, with the exception of Dick Fuld of Lehmann Brothers, a hot-tempered egotist, have lost their jobs. They're still in position: John Mack of Morgan Stanley, Lloyd Blankfein of Goldman Sachs, Jamie Dimon of JP Morgan Chase, Vikram Pandit of Citibank, and Ken Lewis of B of A. Not to mention Tim Geithner, then-head of the New York Fed, now Treasury Secretary. These guys vandalized our financial system and were never apprehended. As far as they were concerned, they did nothing wrong. They moved pieces on a board, and played to win, that's all. When it doesn't work out, they say "holy shit," and scramble for the bailout exits.

Almost two years later, their assets are still toxic. Lehmann crumbled, but my own experience trying to get a mortgage modification has convinced me their real estate division still refuses to mark its assets to market; they still want to value my home, now worth $511,000, at the $769,000 it was worth in 2005. If they didn't, they'd modify my mortgage. But that would mean they would take the write down. Instead, I take it. And I don't mean just me -- I mean every middle class American who owns a home, lost a job, or can't get a loan. We are all taking it.

I also take the new "inactivity fee" for not using my Citibank credit card, and the new "transfer fee" for moving money from my business line of credit to my checking account to pay a bill. And I take the "finance charge" on my Visa, and the ATM fee, and the overdraft fee. We have to take those, so the bankers can keep their compensation.

The fees are going up even as I write this, as the banks fight to get their profits locked in before the new regulations start in February.

Simon Johnson, one of the writers of "The Baseline Scenario" has voted with his feet. He has closed his accounts at the big banks. He can't trust them. He knows they won't help him. They will do anything to preserve their hegemony. They don't even trust each other. In Sorkin's book, even in the most dire circumstances, the ethos is always "don't help the competition." Only when they think the competition's death might bring them down as well do they offer to work together. Wall Street is all about WIIFM: what's in it for me.

In the mean time, the rest of us have learned a different lesson. In our world, where people can no longer afford to eat out or take a vacation, we've learned that we must work together, sharing what little resources we have left so that we can survive in this brave new world the bankers have brought us.

Happy New Year -- But Not to You, Aurora Loan Services

2010-01-04T10:47:33-05:00

Happy New Year. Wish me a happy anniversary, too. I'm celebrating the first anniversary of my effort to modify my mortgage through Aurora Loan Services.

You are going to see a lot of this post in the near future, because I'm going to cross-post it everywhere until I find someone who knows someone in Aurora Loan Services or its regulator. I've never wanted to bring a company down before, but I do now.

I wasn't quite angry enough until last week, when I read an article in the Times that made me realize I was not an isolated case, but an example of a widespread and apparently deliberate policy on the part of this particular servicer to deny homeowners programs the government has sought to extend, even though failing to extend these programs helps no one but Aurora itself.

Background: It all started in 2008, when Lehmann Brothers collapsed. Aurora is a unit of Lehmann. Right after that came the collapse of Bear Stearns, and then the disappearance of all my investments, my real estate deals, and my consulting clients.

Ooops! Those were supposed to be my retirement. No matter. I'm not in a hurry to retire. But I didn't have any cash flow all of a sudden.

The first time I called Aurora, I thought they'd say yes to modification, because I had no income for November and December 2008.

But they said no, because they said I couldn't afford the house.

Then came Obama's Making Home Affordable Program.

I applied, and Aurora said no, because I wasn't a Fannie and Freddie mortgage. Nothing in the Bay Area is a Fannie and Freddie Mortgage. We pay the big bucks here for a 1500 square foot house that would cost $150k anywhere else in the country. Here, in 2005, my house cost $769,000. I could afford it. I documented it with tax returns. I'm not stupid, and my loan is not subprime. However, the world has changed, and, with it, the value of my house.

Aurora bought my first mortgage from Princeton Capital, and probably tore it into a million little pieces. Citibank has my HELOC. You couldn't get just a mortgage in northern California in 2005; you had to buy a house with a mortgage and a HELOC. My 30-year-old house is a starter home in my community, not a McMansion. It was where I wanted to retire, because my kids live here.

Want to know what it's worth now? Mint says $511k. But let's not talk about that. I don't want to sell it. I want to own it. And I couldn't sell it anyway. In my neighborhood, houses don't sell anymore unless they are foreclosed.

I waited a while, following the news, and then, because Obama had put out some new programs, I applied again. This time I spoke to someone on the phone who told me my business didn't break even so I wasn't eligible. She explained that I had to break even and could then re-apply.

I waited three more months. All this time I paid out of savings and lines of credit while the value of the house dropped. Obama came into office with the audacity of hope, and yet another a new program had me apply again.

This time they lost my information. And, oh by the way, I kept on paying. And I kept on working. In May, I broke even.

I applied again. They lost my information again. I re-sent it again.

I have a system by now for assembling stuff. My last two years' tax returns and last two months' financial statements and bank statements, along with my hardship letter, are in a folder on my desktop. I update my age in the hardship letter. I update the statements every month of so. And I fire off the package again.

Now they have an automated email system that tells me they have my materials. They also tell me it takes 90 days to get an answer. In 90 days I get another letter in response to my inquiries that says my materials are out of date again. In July, re-submitted. In October they told me they didn't have an answer yet. In November I told them to hurry. They sent me another email referring me to yet another program.

I have now been through the Making Home Affordable Program, the Home Retention Program, and the Mortgage Modification Program.

For the mortgage modification program, I was told last week that I am not eligible. Why? Because I have $22,000 left in savings, which they say is enough for three months of mortgage payments. Having this much money (my mortgage is nearly $5000 a month) makes me ineligible.

But the helpful cheery voice said, "please call us back again. In a few months, you may qualify." When? When I have eaten up the very last of my savings? And then they will tell me I don't qualify because I don't have any savings?

Why don't I just keep paying for thirty years? Because I have an adjustable mortgage, and when it adjusts I will not be able to refinance the loan because the house has no equity. It will be a numbers game, and I will lose the house whether I've been paying or not.

Help me out by forwarding this to anyone you know, anywhere. I want to call these people out for what they're doing. It's not the house, and it's not the money -- it's the principle. I will never be in the street. I will never starve. But other people will, like the four homeowners from Queens in the NY Times story. They're not writers, though, and I am. Perhaps I can use my pen, supposedly mightier than the sword, to help us all.

Posted via email from Not Really Stealthmode

Health Care Reform Is Good Even If It's Bad

2009-12-15T08:43:33-05:00

It is shocking to me that one Senator, in this case Joe Lieberman, can bring something as important as health care reform to a halt. Clearly everyone has worked very hard to compromise on this bill, and blowing it out of the water this late in the game, especially when you are now refusing to vote for something you championed just a few years ago, seems selfish to me. We need this reform, even if it's bad.

Why bother with a bad bill? Why not go back and start from the beginning and get it right, as the Republicans argue? Because anything that dislodges old ways of doing things, no matter how slightly, forces us to reconsider, shakes things up, changes the picture in the kaleidoscope. I read Atul Gawande's article in last week's New Yorker and I believe he's right. We can't have real reform through legislation, public option or not. We can only have that when all the players involved decide to change their attitudes toward health care.

Right now, the provider is being blamed for most of the cost increases. But most health care providers I know are in business to heal people, and if they were left to their own devices, they could lower their cost of care by themselves. Do you think they want eight or nine employees to support each physician, each with taxes, benefits, and all the issues that come with employees?

Of course not. But a lot of their costs come from compliance: with insurance companies, with government regulations, with absurd CYA efforts to avoid being sued. That, rather than anything else, raises the overhead of the individual provider.

For the hospital, it's a bit more complex, because many hospitals have boards, and shareholders, and pressures to generate revenue. They also have to deal with the "cost shift" : treating the uninsured free and charging the insured $10 per aspirin. That takes a lot of paperwork and administration, and then they also have to contend with the things that cripple doctors -regulations and insurance companies.

For the payer, the incentive to increase profits and provide "shareholder value" is paramount. Nothing else matters. The insurance company is in it for the money, pure and simple.

For the patient, it's getting the newest and best treatment, whether useful or not. (This morning I heard Deepak Chopra say that most of the prescriptions Americans take are of marginal utility, and that we endure horrible side effects as a result).

We are overcharging, over-diagnosing, and over-treating. Our health care system is as soft and obese as our population. We could lower costs just by putting the entire country on a health care diet: less care, rather than more.

But we will never do that without the impetus of some regulatory change. It's a shame, because we should. We should be able to change ourselves without a crummy law.

Looking For Waste in the Health Care System? Try Anywher

2009-12-01T12:00:05-05:00

How much of our rising health care costs comes from fraud
in the health care system by players who know how to game it for their
own benefit? Enough to cloud the reform debate, that's for sure. And it
can't be pinned on one player; it's up and down the value chain in
medical care.

On the one hand, you have the recent 60-Minutes report on drug dealers in Miami who
defraud Medicare by opening fake clinics and pharmacies. They get
reimbursed for artificial limbs ordered for patients whose IDs they have
bought on a black market for Medicare information.

Further up the line you have hospitals who bill Medicare for
procedures that could be done in an outpatient setting where they would
cost less, or for total care of a patient whose actual care is split
between two hospitals, both of whom bill for the entire care. (Go look
on the Center for Medicare
and Medicaid Services web site for the Recovery Audit Contractor pilot program in which
this was discovered.

And then there's the sweetheart deal the insurers got to participate
in the Medicare Advantage program, which was started when CMS was
afraid not enough providers would participate in Medicare. In Medicare
Advantage, all the players get paid more than by regular Medicare for
providing the same services. Medicare Advantage is targeted by the
cost-cutting initiatives, but here's what the plans said: "many
commenters contend that, if rates are reduced, MA organizations will
have trouble maintaining their provider networks, because they will have
to pay providers less, and will have to raise premiums, increase
co-pays and deductibles, especially in rural areas, Puerto Rico, in the
case of Special Needs Plans (SNPs), PACE plans, and plans that are in
direct competition with cost plans."

Finally, we get to the pharmaceutical companies, where we learn from a great piece by Naomi Freundlich that
"by suppressing negative studies, relentlessly pursuing positive trial
results, and paying academic researchers to promote their therapy, Merck
Schering-Plough has managed to hold onto a $4.6 billion market for a
drug that has never been proven to be better than cheaper generics in
preventing heart attacks or death.
"

That's a pretty shocking allegation from the HealthBeatBlog. It seems that
Merck Schering-Plough holds the patents on Vitorin and Zetia, two
widely advertised drugs that in studies have proven no more effective
than the vitamin niacin and a generic statin, simivastin.

And this doesn't even begin to touch controversial issues like
outcomes-based medicine, which might mean fewer mammograms, CT scans,
and other procedures that irradiate us often unnecessarily as the doctor
either tries to prevent malpractice allegations or perhaps even owns
the imaging center.

Everywhere you look there is waste and downright fraud in the health
care system, perpetrated by both payers and providers, public and
private. I have no doubt that Obama is right that we could fund health
care reform by cleaning up the waste, but the lobbyists for the staus
quo don't want it cleaned up. They are profiting from waste and fraud,
not from legitimate services, IMHO.

A Shocking Blow to Women's Health: HR 3962

2009-11-12T13:19:19-05:00

My source on HR 3962, Timothy
Jost of Health Affairs Blog, says this about Saturday night’s big
change in the House health care reform bill, the Stupak amendment:

The Stupak amendment ... prohibits the use of any funds authorized or
appropriated under the Act “to cover any part of the costs of any health
plan that includes coverage for abortion,” except in cases of rape, incest, or physical life endangerment, even if the abortion coverage is paid for
with a separate premium. Private plans can only offer abortion coverage
to persons receiving federal affordability subsidies if the coverage is
offered as separate supplemental coverage, paid for with premiums that
are not subsidized under the Act and that fully cover the administrative
costs of the abortion coverage. The public plan may not offer abortion
coverage at all. Private plans that participate in the exchange and
include abortion coverage (i.e. plans that are sold without
affordability credits) must also offer plans through the exchange that
are identical in every respect except for not covering abortion.
Exchanges are not required to offer plans that cover abortion.

The amendment covers all funds authorized and appropriated under the
Act. It is not, therefore, limited to the affordability credits, but
also to credits paid to small employers to encourage them to insure
their employees and presumably to other programs like school-based
health clinics, nurse managed health centers, or health services for
Native Americans that are also funded under the Act. (The Act already
contained separate abortion coverage prohibitions for school-based and
Native American Health Services.

In other words, any plan, public or private, that wants any Federal
money, cannot offer abortion services.

As a foster parent who has taken the impoverished,
unwanted and neglected children of drug abusers into my home, I can
honestly say that in some cases, abortion would have been preferable to
the abuse they suffered as babies and children, often homeless, beaten,
and unfed. It’s not easy to raise a child: it takes love, training, and a
fair amount of money. Children having children helps no one. And the
dream of adopting all these kids is far-fetched: most foster children
NEVER get adopted.

I’m not talking here about abstract issues of women’s rights, although of course I (a
woman) believe in them. I’m talking about grim reality. I took my foster
daughter to get an abortion at Planned Parenthood when she got pregnant
at 16 by a ne’er-do-well, and now she is a happy mother of 25. She
thanks me every day. And by the way, I paid for that out of my own
pocket.

Michael Jackson Still Had it at the End

2009-11-03T11:42:57-05:00

Trying
to duck the trick-or-treaters on my block on Saturday night (Halloween induces a
bark-a-thon at my house), I escaped into the closest movie, Michael
Jackson's This is It. I
expected nothing. Like everyone else, after Jackson died I watched
every person who ever met him once parade through Larry King Live
saying what a good person he was, and listened to Liz Taylor moan about
how she couldn't go on. While I never thought Michael Jackson was a
child molester, I wasn't a true fan, either. And I probably believed he
couldn't make it through fifty shows on the drugs he was on.

I
now question my own judgment. The very first show would have
electrified the world and given Jackson the adrenalin to go on. The man
was a genius. Coming into rehearsals, he clearly knew every song, every
move, every note. It was as if the music poured out from inside his DNA
, where it always lived and now was being given the chance to express.
Having never been anything but a performer, Michael Jackson was still a
performer at 50, capable of astounding dance moves and exquisite
timing. Not only that, but at 50 he was happy to be in the role of
mentor to the younger dancers and musicians, rather than a competitor
with them. He clearly wanted to give them an opportunity to shine. The
audience would have loved him. Did he do every acrobatic move that the
younger dancers did? Of course not. But he reminded me of a great
tennis player who can win a match through superior strategy even though
athletically past his prime.

At the rehearsals, he seemed
comfortable with the show. Never irritable on camera, he appeared
gracious and loving. By the time they were set to go to London, he had
accepted the cast and crew as family, and they gave him the adulation
he deserved. Many of them had traveled around the world to audition for
the show. It's sad they never got the chance to hear the applause. And
it's sad Michael never got a chance to do even one show, because the
sets, costumes, lighting, and graphics would have been out of the
ballpark. Go see this movie to see what they were working on; this
production would have been worth the ticket price even if the
understudy went on for Michael Jackson.

The footage was shot
with two cameras, fortunately in high definition, but nothing like a
finished movie. It was meant to be for Jackson's personal archive, and
it is truly a documentary -- it documents the rehearsals without window
dressing. In it you can see the mutual respect between Kenny Ortega,
who directed the movie and co-directed the show with Michael, and
Michael Jackson. Clearly they are used to working together, and they
help each other out. I especially liked it when Ortega told Jackson to
"hold on" to the bars on the cherry picker the first time Jackson took
a ride on it. Jackson seemed fearless, wanting to take it higher and
sing while doing it, but Ortega only wanted him to take the ride and
test the safety.

Was Michael Jackson a sick drug addict? No way.
Did we, the public and the media, hasten the death of a man who felt
for the planet and wanted to deliver a message of love to the world?
Probably. We have a grim way of eating our public figures alive these
days. I'm sure Michael Jackson wasn't perfect, but neither are we.

EmpowHer Launches Free Health Events Database for Women

2009-10-21T12:47:05-04:00

Scottsdale-based EmpowHer.com, is not waiting around for reform in the health care system, it is providing the information women need to manage their own conditions, practice prevention and wellness, and help each other heal. Like many other Health 2.0 communities, it supports patient empowerment, specifically for women. Women, although in charge of many of the family health decisions, still tend to think of themselves last.

Now the site has a new feature, "Health Events," that contains 1.6 million health education and screening events, most of them free, all over the country. For people who want to make life changes, and people without health insurance, these events can be the difference between life and death.

EmpowHer began as a specifically women's online health resource started by Michelle Robson, who when sick herself, despite all her resources and access, learned from personal experience that women are under served. She also learned about the incredible forces arrayed on the side of the status quo.

Out of her own illness and her search for alternatives, she became a powerful advocate for women, and started EmpowHer to scale her daily outreach further than just answering her phone and her Blackberry to connect women with resources she had discovered herself. Her goal is still to make women more knowledgeable, healthier and happier. You should see her offices: EmpowHer staff is down the hall from a personal trainer, and the company pays for its people to work out under the trainer's supervision. For a startup, that's not only rare, but it's walking the talk.

When she started the company, Michelle knew nothing about technology, social networks, or online communities, but she knew the web could help information spread and could be a powerful resource. Most web developers are male, and it took Michelle a while to settle on the team (both men and women) that "got it" about what she was trying to accomplish and why. Two years later, EmpowHer is one of the leading patient communities on the web, and has a male CEO, a tech veteran who understands the power of high quality health information not biased by vested interests.

With its powerful "ASK" and "SHARE" messages, EmpowHer invites women to contribute their stories and ask for help from experts. A team of "Her Writers," most of whom are women with chronic conditions, are paid to write about their expertise, which ranges from post-partum depression to heart disease. While anyone can contribute their own experience under the "Share" tab, the "Her" writers are charged with assuring the quality of content on the site. It's not advertorial; it's helpful. And the cool part is that these women who can't go out and work ordinary jobs, receive income for sharing their learning.

And then their are the physicians. They are anxious to allow themselves to be taped in short segments so they can offer women information they often don't have time to give in their own offices. EmpowHer sends teams around the country to locate the leading experts in each of their fields and interview them, posting the interviews on the site. Want to know what the latest nutritional advances are in osteoporosis - Dr. Maoshing Ni, a 38th generation doctor of Chinese medicine can tell you, or you can read the latest allopathic research results under "Her News" and can click through to the National Osteoporosis Foundation.

We've all but lost the idea of reforming health care in our efforts to reform health insurance. But wise policymakers know that the best way to bend the cost curve is to give people tools to practice prevention and wellness. Cynics think people won't easily give up their bad health habits, but EmpowHer has millions of visitors who expose that as false.

Disclosure: Michelle Robson is a personal friend. And I share my own health stories on EmpowHer.

Last Words From the Vanishing Middle Class

2009-10-13T17:32:58-04:00

I began trying to refinance my home in Half Moon Bay
on the day Obama announced the supposed homeowner retention program. At
first I wanted to do it because I was having trouble making payments
during the fall and winter financial crisis. I'm still trying to do it
because I'm about $150,000 under water, which wipes out my second
lender completely and makes it impossible to refinance the house when
the ARM adjusts. I have no equity, but I like living in the house.
Eventually, the ARM will adjust and I will be kicked out or the
payments will get higher.

Because I own my own business, Aurora Loan Services
asked me for three years of tax returns, three months of bank
statements, a year-to-date P&L, a hardship letter, and a personal
financial statement. I sent them all, at a cost of about $100 by the
time I printed everything at Kinko's and FedExed it to them. And then I
had to turn around and do the same thing for Citibank which holds my
home equity line, because the "mortgage" I was given is actually a
melange of a mortgage and a HELOC (common in California avoid the very high rates for jumbo loans).

After about 60 days Aurora told me 1) I was not eligible for Obama's
program because I didn't have an FHA loan, and 2) they couldn't do
anything for me.

After I heard the government had put more pressure on the lenders to
restructure mortgages, I reapplied. Once again, I had to send all those
documents, and once again I was told they couldn't help me. Their
"investors" had said no.

In April, I learned that if I could break even on paper I could
refinance, so I sent everything again. This time Aurora asked for my
2008 return, and I sent it. They told me they were now very busy trying
to restructure loans, and to wait 90 days.

I heard nothing, so I called: they said they were missing my tax
returns, proof of the contracts responsible for my income for the rest
of the year, and three months of current bank statements. I sent those
in July. I called in August, and they asked me whether I remembered
that I had to wait 90 days.

Last week I emailed them. And guess what? They told me they needed
copies of my 2008 tax return, a year-to-date P&L, those contracts
again, and proof of which bank deposits came from those contracts. You
have no idea how hard it is to keep generating and updating these
documents, even for me a person whose information is mostly in the
cloud as mine is (not the contracts, which are sent to me by
municipalities for signing as hard copies that I have to mail back).

It has been 9 months since I began trying for relief. So it's only fitting that this afternoon I went to see Michael Moore's Capitalism: A Love Story.

I urge you to see this film.

I am the first to agree that Michael Moore exaggerates. But in this movie,
not so much. It is 100% true that Congress is owned by the financial
institutions lock, stock and barrel. I don't care which party you
belong to -- I'm an independent -- you should be outraged by this movie if
you are young, or have children, or work, or build businesses. Because
America has been, and continues to be, ruined for the rest of us by
about a hundred people on "Wall Street" who have all the money and
therefore run the government and your life. It's everything from credit
card fees to subprime mortgages, to Ponzi schemes, to health insurance
reform.

In Phoenix, the real estate market has bottomed and the "investors"
are coming in and beating first-time home buyers to foreclosed houses
with all cash deals. The banks don't care who they sell to; the people
who want to take advantage of the tax credit can't get in on the deals.

Because Moore shows a lot of archival footage in the movie, I got to
think about how much American life has deteriorated for the middle
class during the past 25 years. When I started my business in 1980, I
made a great deal more money doing essentially the same thing, and I
had a pretty good life. Twenty-five years later, my standard of living
has totally deteriorated. I personify the vanishing middle class, and
so do most of you. I wouldn't ignore it if I were you. As my friend
Fred says to me every Saturday night, "It's a good thing we're not
going to be here to see what's coming."

Americans on Drugs

2009-10-05T17:30:36-04:00

We
are a nation addicted to prescription drugs of one sort or another. But
we seldom take them exactly as they were prescribed, and we endure a
lot of adverse effects. Online information about prescription
medications has been, as you would expect, both a blessing and a curse.

This is the conclusion I draw from iGuard.org’s publication of a white paper on prescription drug trends in the US. iGuard
is a service that helps patients monitor drug safety, publishes alerts,
and clearly collects data. Some of the data in the white paper is their
own, and the rest comes from respected sources.

Nearly half of all Americans take at least one prescription drug and one in six Americans takes three or more medications. (Source: Institute of Medicine (IOM) 2007. The Future of Drug Safety: Promoting and Protecting the Health of the Public, Washington DC: National Academies Press)

• 32 million Americans are taking three or more medications daily. (Source: American Heart Association)

• Prescription drug use is rising among people of all ages, and use
increases with age with five out of six persons 65 and older taking at
least one medication and almost half the elderly taking three or more. Source: CDC National Center for Health Statistics: Health, United States 2004 – 12/2(S/04

The top classes of drugs for all patients in July 2008 included:

1. Codeine, alone and in combination (typically with acetaminophen)

2. Statins (cholesterol-lowering, simvastatin, atorvastatin)

3. Beta Blockers (heart drugs)

4. SSRI antidepressants (e.g., Lexipro, Celexa, Prozac, Zoloft, Paxil)

5. ACE Inhibitors (hypertension, Lisinopril)

6. Seizure disorders (used for epilepsy as well as migraines (Topamax),
bipolar disorder (Lamictal), and pain (Lyrica, neurontin)

7. Thyroid medications

8. PPIs for ulcers, GERD (e.g., Nexium, Aciphex, Prevacid)

9. Benzodiazepines (anxiety – Xanax, Valium)

10. Calcium channel blockers (hypertension)

The top classes of drugs that children from ages 0-17 are taking include:

1. Analeptics (medications for ADHD)

2. Aminopenicillins (antibiotics)

3. Cephalosporn (antibiotics)

4. Leukotriene agents (Singulair, allergy & asthma)

5. Corticoids, dermatological (topical steroids)

6. Macrolides (antibiotics)

7. Beta Agonist Aerosol (e.g., albuterol)

8. Codeine and combination

9. Oral corticoids (oral steroids)

10. Antibiotic drops for the ear

You can see that kids get a lot of antibiotics and asthma meds.
Adults get a lot of pain-killers (physical and emotional). This costs
the health care system big bucks.

• More than half (53%) of all consumers go online to look for prescription drug information, vs. 41% in 2007 (Source:
11th annual national survey, “Consumer Reaction to DTC Advertising of
Prescription Medicines,” conducted by Prevention, Men’s Health and
Women’s Health magazines, with technical assistance from the FDA. The
study is one of the primary consumer studies informing the FDA’s stance
on Direct-to-Consumer (DTC) issues. 6/10/08)

• The same Prevention study reported that of those taking prescription
medicines, 55% saw an advertisement for the medicine they were taking.
“Consumers are firmly rooted in the era of online health management as
more and more patients embrace tools and trackers such as Google, Yahoo
and Revolution Health,” said Cary Silvers, Director of Consumer
Insights at Rodale, who spearheaded the 2008 study. “Along with the
doctor and pharmacist, the online component has become the third leg of
the stool as consumers learn about drugs. The more consumers know, the
more likely they are to take action.”

But then the information gets ugly. The number one problem doctors
report about treating patients is failure to take prescription
medications correctly, regardless of patient age. Most Americans
receive the prescriptions they need, but either don’t fill them, don’t
finish them, or don’t take them correctly. More than half of Americans
with chronic diseases don’t follow their physicians’ advice. People go
so far as to fill their prescriptions and then fail to take ANY of the
medicines.

These are big public health problems. We are throwing money spent on
pharmaceuticals — and it’s something over $100 billion a year — down
the toilet. The wrong people are taking the drugs — the sick don’t take
them, and the lifestyle experimenters and addicts do.

Many people don’t take their drugs because of adverse events. They
are beginning to report those online in patient forums and to the FDA,
but not nearly in the numbers they should for the information to be
effective. However, in 2006, consumers replaced physicians as the
largest source of adverse event reporting to the FDA.

Consumers need to be encouraged to report adverse events that aren’t
serious enough to hospitalize them but are enough to make them stop
taking a medication, or the FDA can’t do its aftermarket surveillance
properly. iGuard’s own member data reports that 25% of its diabetic
members are taking medications with a risk rating of 4 out of a
possible 5.

As consumers, we can fix this system if we each contribute our own
experience. It’s called crowd-sourcing, and it’s very valuable.

(crossposted to http://azhealthworks.org/americans-on-drugs)

Public Plan Bites the Dust, Obama With it

2009-09-30T15:57:41-04:00

So
I have given this post a somewhat hyperbolic title. But not as much as
you would think. The Senate Finance Committee voted down the public
plan today, and because I was driving around Maricopa County Arizona (all 9200 square miles of it) for a good
part of the morning, I heard the good, the bad, and the ugly about the
debate. Snippets that I caught included:

"There is no competition among insurance plans in 95% of the states. Two insurers rule the market."
"The doctors, at least the ones I've talked to, don't want to be paid Medicare rates."
"Medicare has a $37 trillion unfunded liability. Does anyone even know how much money that is?"
""A public option won't mean government run health care this year, or maybe even next, but just wait until 2013 or 2014."

A few hardy Democrats tried to say the people wanted a public plan, but they were beaten back by one Senator saying
"I don't even think these people shopping for a public plan or a private plan even know what they're buying."

And someone else said, "the person whose doctor says get an MRI is in
no position to judge whether he needs iit or not. He has to trust the
doctor."

These snippets tell me we are nowhere near a consensus
on what health care should be like in America, much less how to get
there.

Eons ago, Steve Gillmor told me that if we got nothing
out of reform but an end fo rejecting people for pre-existing
conditions, we would have achieved a lot. At the time, I thought that
was nothing. I now totally agree with him, and believe that in the
current climate, the Democrats are lucky to escape with their shirts.

The lack of a coherent plan that people could rally around has left
Obama in the dubious position of violating his own dictum: "Strategy
first, then resources." If that's good enough for Afghanistan, it
should be good enough for health care. If we pass reform this year, we
will be throwing resources at a non-strategy.

You can tell I'm a
registered Independent, or as that is translated in Arizona, "no
political party." Having a choice of Republican, Democrat, Green or
Libertarian, I opt out.

I agree that there is no competition
among health plans. I remember when there was, and no one could get
enough traction to justify the expenses of operating, so different
plans gradually withdrew from certain states, other companies merged
and acquired and consolidated, and now we have what we have.

I
also agree that Americans cannot have everything and pay nothing, and
that rationing is a part of every health care system and should be
brought out into the open and discussed. It's not the province of the
public plan; in fact, one reason that Medicare has so much financial
trouble is that Medicare rations much less viciously than private plans.

We've had almost a year of debate based on half truths,
circumlocutions, slogans, and bull-oney. Now we're here. No matter what
happens henceforth, the Democrats will lose in 2010, probably Obama
will lose in 2012, and health care costs will continue to rise. We
have wasted an entire year of lobbyist time, company money, and
consumer trepidation for nothing. All we've done is show that on the
health care side our government is as broken as it is on the banking
side.

Is your credit card interest rate 29.99% Is your house
under water? Can you get in to see a doctor? Is your doctor happy with
his or her occupation?

Money wins. Doctors and patients lose. And I am disappointed because I really thought Obama was talking change.

The U.N.May Have Jumped the Shark

2009-09-25T14:23:37-04:00

The United Nations meeting yesterday stunned me. I grew up thinking
the UN was one of the pinnacles of global achievement. And I thought
disrespectful debate was the province of the USA until I heard Gadhafi and Ahmadinejad. Now I wonder if the UN is worth stopping NYC traffic for.

I'm pretty much a disciple of Ghandi, so I understand why Obama
would address the United Nations, trying to "be the change" he wants to
see. But I also wonder if when the US media calls out these guys as
"crackpots," we are seeing things through our own eyes and those of our
allies, or through the eyes of their constituents. How do I know how
much credence to give these unfamiliar-behaving world leaders?

I'm troubled by the fact that, even in the Internet era, I
can't get a good fix on whether these guys represent mainstream opinion
in their countries, or are indeed the lunatic fringe. Ghadafi, who
wanted to pitch a tent on Donald Trump's lawn because he doesn't like
elevators, is a little easier to dismiss than Iran's president, but he,
too, seems not to be an accepted leader in his own country. And Karzai?
Another crooked election?

So is the UN outdated, bloated, and over? I suspect so. By
having these meetings, we are showcasing people who would be
marginalized if we didn't bring them an audience of global media. Or
are we showing different points of view about the world that need to be
aired? How crooked are our own elections?

At times like these, I think I don't get out of my comfort
zone enough, and that perhaps I should go to places like Pakistan,
Afghanistan, Libya and Iran before I accept the judgment of the cable
news networks that I so readily dismiss on issues like health insurance
reform, where I possess enough information to form my own judgment.
Knowledge is power.

The Truth About Medicare

2009-09-15T16:31:49-04:00

Now that Obama has given his speech about health care, people are actively talking about their horrible experiences with Medicare and wondering if the "public option" will produce care for everybody that's as bad as what they've seen their own aging relatives receive. These examples, however, show me there's a profound misunderstanding about what Medicare (or any public program) does.

Here it is in simple terms: Medicare writes the checks. It doesn't operate on the wrong leg, over-radiate a cancer patient, miss a cancer, or give people too many prescriptions.

That's the job of the provider, who is hamstrung by a larger problem, which is lack of continuity of care. And there's also a shortage of doctors.

Here's what Medicare is designed to do: provide a safety net for catastrophic illness. That's all. It covers mainly hospitalization, although you can buy a supplement that takes care of co-pays, tests and doctor visits, and another supplement that covers prescription drugs. I have fancy Medicare and supplements by AARP; everything is covered, For this I pay $132 a month. I pay a premium for Medicare part D, the drug plan, of $47.74 a month.

I can go to any doctor I want. At age 65, I had a hip replacement, no waiting, for which the bills totaled nearly $50,000. I paid only for the special physical therapy I wanted that was beyond what I really needed (I wanted to go back to athletics and yoga).

I have no complaints about Medicare. It covers a lot more than the insurance I had just one year previously, when in the same good health I paid $600 a month with a $1000 deductible. And I have chosen my providers with care. I get good treatment from people who treat me well. But that's because I've taken the time to learn the system, evaluate doctors, and look up information.

You see, folks, there are three players in any health care transaction–the payer, the provider, and the patient. All three have a responsibility. As the patient, your responsibility is to take care of yourself and to be informed and to be realistic.

Waiting? That's the provider. How busy is he/she? Family practice, internists and pediatricians are very busy because there aren't enough of them. And there aren't enough of them because they don't make enough money to pay off their medical school debts by going into primary care.

Negligence? That's the provider, too. Medicare doesn't mark the wrong leg for surgery or fail to diagnose an illness. That's between the patient and the provider.

Kicked out of the hospital before you think you are well? Private insurance kicks people out of the hospital just as quickly as Medicare does, and often more quickly.

So when you have a beef with the health care system, which we all do, at least lay the blame in the right place. It doesn't matter who pays the bill. It's who does the job. When the government pays the bill, the entire "business" side of the issue gets taken care of more efficiently with less waste and expense.

Glossary:

Payer:

Establishes coverage guidelines
Juggles available funds to decide how much money is spent per patient per life
Decides if it is a hospital treatment (Medicare) or an outpatient treatment that's paid for
Gives money to provider for the treatment
[Medicare pays more over the life of a patient and includes more
treatments than almost anything else because it doesn't have to be profitable]

Provider:

Doctor or nurse or hospital or outpatient facility. That's who makes you wait, doesn't have automated records, makes you fill out forms over and over, and sometimes mis-diagnoses things because he/she is only a human being

Patient:

The person who receives the treatment and should know all this, but often doesn't. The person who likes to blame others for lifestyle choices that have to be corrected by the health care system at great cost to society

10 "Simple" Steps to Health Care Reform

2009-08-28T11:38:41-04:00

How can you argue about a reform plan when you don't even know what will be in it? And yet, town halls go on and on through the hot and lazy last days of summer.

So, as my father used to say, if you want something to cry about, I'll give you something (raised hand above my shrinking frame). Here are ten simple things we can do to reform health care.

Make health insurance mandatory, but make coverage compulsory for insurers. The insurers can't survive if they don't have the healthy people on their rolls as well as the sick, and the healthy young people often opt out. (As it is, the rise of DNA testing is going to change the insurance industry as people use their DNA test results to decide whether or not to buy insurance and what kind to buy. In the future, without mandatory health insurance the system will collapse.)

Make everyone pay something -- employers, employees, and the unemployed, but make the premiums reflect true costs. Medical care is expensive. Subsidize those who truly can't pay. Become tranparent about the costs of medical care.

Regulate insurance companies like utilities, and do it nationally. Allow buyers to buy across state lines.

Negotiate with drug companies nationally.

Put a limit on jury awards and on legal fees in medical cases.

Go back to the days of banning law firm and drug company advertising. We have created an artificial demand for drugs that treat overactive bladder and restless leg syndrome by re-defining annoyances as sicknesses and creating pills for them at great expense.

Make computerization of medical records mandatory within a few years, and subsidize (i.e., tax credits) record conversion to get it done. Introduce uniform applications, medical records, and claims forms nationally, preferably open source.

Increase the number of doctors and nurses by providing subsidies and tax benefits to both students and medical educational institutions. Provide some form of loan forgiveness for primary care docs , pediatricians and geriatricians. Not every doctor visit should be to a specialist.

Put everyone under the same system. No separate deals for Congress, Federal and State employees, high paid executives, or special groups like retired railroad workers.

Basic coverage for everyone, with 5 star benefits only for those who can pay. Not everyone can have a Cadillac.

I wish I had thought of all these. Some of them are mine, but the bulk of them come from a retired insurance industry exectutive.

Now go off and fight in your town halls.