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Tuesday, June 30, 2009
Labor and Industry Join Forces to Change the Path of Health Care Delivery
The nation’s largest private employer, Walmart (non-union), and the nation’s largest union representing health care workers, SEIU, as well as the influential policy think-tank, the Center for American Progress, delivered a letter to President Obama today, endorsing a mandate for employer and employee contribution for a health care plan.
Citing the Senate Finance Committee (Max Bacus (D-Montana, Chairman) that “health care expenditures are expected to consume nearly 20 percent of the GDP” by 2017, the collation seek, “…an employer mandate which is fair and broad in its coverage.”
While the debate is being to flow in the direction of the adoption a “public plan” option, the “single payer system” has not yet been ruled out entirely. Funding continues to remain a concern.
It is anticipated that if a “public plan” is adopted, the workers’ compensation system will probably be targeted as an economic engine to contribute generated revenue through various reimbursement mechanisms in addition to outright payment reform including incentive based medicine. It is estimated that the plan's cost may amount to a $2 Trillion cost.
Cost shifting enforcement could be more strictly pursued. Additional fines, penalties and user fees, maybe assessed under the Medicare Secondary Payer Act. Even taxing workers’ compensation benefits may become an option if other employer provided health care benefits are also subject to tax.
Friday, November 22, 2013
California Doctors Prescribe More Name-Brand Drugs Than Any Other State
The only thing that perhaps matched the vastness of the spread or the depth of the traction of the "death panel" lie was the predictability that such a lie would come to be told in the first place. After all, this was a Democratic president trying to sell a new health care reform plan with the intention of opening access and reducing cost to millions of Americans who had gone without for so long. What's the best way to counter it? Tell everyone that millions of Americans would have increased access ... to Death! The best account of how the "death panel" myth was born into this world and spread like garbage across the landscape has been penned by Brendan Nyhan, who in 2010 wrote "Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate." |
Friday, November 15, 2013
More Obamacare Enrollees In California Than In 36 States Combined
Today's post was shared by Huffington Post and comes from www.huffingtonpost.com
The only thing that perhaps matched the vastness of the spread or the depth of the traction of the "death panel" lie was the predictability that such a lie would come to be told in the first place. After all, this was a Democratic president trying to sell a new health care reform plan with the intention of opening access and reducing cost to millions of Americans who had gone without for so long. What's the best way to counter it? Tell everyone that millions of Americans would have increased access ... to Death! The best account of how the "death panel" myth was born into this world and spread like garbage across the landscape has been penned by Brendan Nyhan, who in 2010 wrote "Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate." You should go read the whole thing.But to summarize, the lie began where many lies about health care reform begin -- with serial liar Betsy McCaughey, who in 1994 polluted the pages of the New Republic with a staggering pile of deception in an effort to scuttle President Bill Clinton's health care reform. As Nyhan documents, she re-emerged in 2009 when "she invented the false claim that the health care legislation in Congress would result in seniors being directed to 'end their life sooner.'"Nyhan: "McCaughey's statement was a reference to a provision in the Democratic health care bill that would have provided funding for an advanced care planning for Medicare recipients once every five... |
Thursday, June 25, 2015
The Path to Federalization: US Supreme Court Again Validates the Affordable Care Act
Sunday, March 22, 2009
The Voice of Change in the Medical Care Debate
Thursday, October 8, 2009
New Jersey’s Shining Star
Sunday, September 1, 2013
In California, Renewed Debate Over Home Care
An important struggle over home health care is playing out in California, the nation’s most populous state, including nearly five million residents age 65 and older. Unions and organizations representing the elderly have joined together to push for legislation that would license agencies, certify workers and create a publicly accessible caregiver registry. Home care agencies are pushing back, saying they favor regulation but oppose the measures under consideration. The legislation, Assembly Bill 1217, has already passed the State Assembly and was passed out of the State Senate’s appropriations committee on Friday. It will be up for a vote on the Senate floor next week. An estimated 1,400 home care agencies and 120,000 paid caregivers would be affected by the proposed legislation, which is essentially an effort to bring consumer protections to an industry that has been likened to the Wild West. “It’s just not right that I can check the license status of an air-conditioning repairman but I can’t do so for someone coming into my home to care for a loved one,” said Assemblywoman Bonnie Lowenthal, a Democrat and the bill’s sponsor. |
Wednesday, October 21, 2009
Insuring Disabled Seniors and The Public Option
Wednesday, November 13, 2013
Professionalism and Caring for Medicaid Patients — The 5% Commitment?
Physicians have good reasons for not accepting Medicaid patients, as I learned from direct experience as a member of a nine-physician primary care practice in California. We accepted Medicaid patients, but it was difficult. Medicaid's payment rate was very low — we lost money on each Medicaid visit. When referrals were necessary, we often had to personally ask specialists to accept our patient.... |
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- Lousy Medicaid Arguments (workers-compensation.blogspot.com)
- Federal Court Deems CMS Interpretation of the MSP Act Impenetrable (workers-compensation.blogspot.com)
- US Inspector General Wants More Disclosure By Back Surgeons Who Implant their Own Devices (workers-compensation.blogspot.com)
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Monday, December 21, 2009
Good Medicine for an Ailing Compensation System
The stage was set last June 17th, when the US Environmental Protection Agency (EPA) declared Libby, Montana, a Public Health Emergency, because of asbestos present at the site. The geographical location was the site of a W.R. Grace vermiculite mine.
The legislative provision was "buried" deep in the legislation at the last moment, reported Robert Pear of the NY Times. The amendment was made Senator Max Baucus of Montana, who lead the Senate legislative committee crafting the legislation. The convoluted political bartering over the last few days reflects a sentinel change in how injured workers may be receiving medical care in the years ahead. It is anticipated that major changes will be offered over the years ahead to modify and expand the coverage.
Occupational diseases have always been problematic to the State workers' compensation systems. They have been subject to serious and costly proof issues. They were "tag along" claims for a compensation system that initially was enacted in 1911 to cover only traumatic claims. The proposed legislation is a first major step to move occupationally induced illnesses into a universal health medical care system and will provide a pilot project for addressing the long awaited need to furnish medical care without serious and costly delays.
By allowing Medicare to become the primary payor and furnish medical care, those without a collateral safety net of insurance will be able to obtain medical care effectively and expeditiously. While cost shifting from workers' compensation to Medicare has been an historically systemic problem in the compensation arena, this legislation maybe a first major step to legitimatize the process. The legislation may allow for great accountability and expansion of the Medicare Secondary Payment Act (MSP) to end cost shifting that has become epidemic in proportion. It is good medicine for an ailing workers' compensation system.
Click here to read more about workers' compensation and universal health care.
Monday, November 25, 2013
These Are The 36 Countries That Have Better Healthcare Systems Than The US
The results became notorious — the US healthcare system came in 15th in overall performance, and first in overall expenditure per capita. That result meant that its overall ranking was 37th. The results have long been debated, with critics arguing that the data was out-of-date, incomplete, and that factors such as literacy and life expectancy were over-weighted. So controversial were the results that the WHO declined to rank countries in their World Health Report 2010, but the debate has raged on. In that same year, a report from the Commonwealth Fund ranked seven developed countries on their health care performance — the US came dead last. So, what can we learn from the report? NOTE: The rankings are based on an index of five factors — health, health equality, responsiveness, responsiveness equality, and fair financial contribution. As noted above, all data is from 2000 or earlier and these findings have been questioned. |
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Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
Sunday, August 31, 2014
Endless Assault on Health Care Reform
Today's post is shared rom nytimes.com The opponents of the Affordable Care Act make no secret of their consuming hatred for the law that has already provided health care to millions of lower-income people. From the beginning, they have tried everything they could to kill it. As one conservative scholar, Michael Greve, said in 2010: “I do not care how this is done, whether it’s dismembered, whether we drive a stake through its heart, whether we tar and feather it and drive it out of town, whether we strangle it.” Yet the challengers keep losing in Congress and in court. The latest jerry-built effort to destroy health care reform could be defeated in the full federal appeals court in the District of Columbia. In July, a three-judge panel of that court — taking a ridiculously crabbed view of a section in the law — ruled 2-to-1 that tax-credit subsidies are allowed only for those buying insurance on a health exchange “established by the state.” Therefore, it said, no subsidies for people in 36 states where the federal government set up the exchange because the states refused to do so. There is no evidence that Congress intended to make this distinction, which defies the law’s central purpose. In fact, this argument was rejected unanimously by a three-judge panel of the federal appeals court in Virginia. Now the fight has shifted to an arcane legal debate over whether the full appeals court in the District of Columbia should rehear the case or allow it to be appealed... |
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- Taking liberties with law and word - a surreply to Rob Weiner (washingtonpost.com)
Wednesday, June 10, 2009
The Lack of Equality in the CMS Reimbursement Policy
In a very insightful article, Robert Pear of The New York Times on June 9, 2009 reported that costs of medical care were not uniform through out the nation and that an increase in expenditures for treatment did not improve the outcome. These “disparities,” as Pear points out demonstrate major fluctuations in the cost of Medicare payments for the same types of treatment. “Nationally, according to the Dartmouth Atlas of Health Care, Medicare spent an average of $8,304 per beneficiary in 2006. Among states, New York was tops, at $9,564, and Hawaii was lowest, at $5,311.”
The costs for medical care paid by Medicare based upon geographical jurisdictions are unequal. More specifically, higher costs states were reported to be: Florida, Massachusetts, New Jersey and New York. The lower cost states were reported as: Iowa, Minnesota, Montana, North Dakota, Oregon and Washington.
CMS has sought to seek reimbursement under the MSP Act for medical care, present and future, based on a nationally tailored program. Unfortunately, the benefits paid by each state program are not the same.
While the program to deter the shift of billions of dollars Medicare funds yearly to pay for work related injuries and disease is a noble goal and legitimate function, it is now unequally applied to beneficiaries across the country since all workers’ compensation benefit programs are not the same and the costs of medical treatment vary.
The need for uniformity and equality should be address by Congress as it debates the future of medical care legislation. The enactment of a single payer medical care system would be a good first step to leveling the playing field for both employers and employees.
Tuesday, October 22, 2013
The Great Coronary Angioplasty Debate: Giving Patients the Right to Speak | The Health Care Blog
By Nortin Hadler, MD
Earlier this month, the editors of THCB saw fit to post my essay, “The End of the Era of Coronary Angioplasty.” The comments posted on THCB in response to the essay, and those the editors and I have directly received, have been most gratifying. The essay is an exercise in informing medical decisions, which is my creed as a clinician and perspective as a clinical investigator. I use the recent British federal guideline document as my object lesson. This Guideline examines the science that speaks to the efficacy of the last consensus indication for angioplasty, the setting of an acute ST-elevation myocardial infarction (STEMI). Clinical science has rendered all other indications, by consensus, relative at best. But in the case of STEMI, the British guideline panel supports the consensus and concludes that angioplasty should be “offered” in a timely fashion. I will not repeat my original essay here since it is only a click away. The exercise I display is how I would take this last consensus statement into a trusting, empathic patient-physician discourse. This is a hypothetical exercise to the extent that little in the way of clear thinking can be expected of a patient in the throes of a STEMI, and not much more of the patient’s caring community. So all of us, we the people regardless of our credentials, need to consider and value the putative efficacy of angioplasty (with or without stenting) a priori. For me, personally, there is... |
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Thursday, June 14, 2012
National Experts Call Workers Compensation System Irrational and Unjust
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Sunday, November 24, 2013
The ePrognosis App: How Calculating Life Expectancy Can Influence Healthcare Decision-Making
By Leslie Kernisan, MD
Have you ever asked yourself, when considering cancer screening for an older adult, whether the likely harms outweigh the likely benefits? Maybe you have, maybe you haven’t. The sentence above, after all, is a bit of wonky formulation for the following underlying questions:
As for the second question, I’m not sure how often it pops up in people’s minds, although it’s certainly very important to consider, given what we now know about the frequent harms of cancer screening in the elderly, and usually less frequent benefits. Furthermore, there is abundant evidence that “inappropriate” cancer screening remains common. “Inappropriate” meaning the screening of people who are so unwell and/or old that they’re unlikely to live long enough to benefit from screening. For instance, one astounding study found that 25% of physicians said... |
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Thursday, September 10, 2009
Congressional Action on Workers’ Compensation
From coast to coast, the patchwork of state workers’ compensation systems continues to be under constant scrutiny for change. The problems seem global in characteristic as the frustrations continue to rise. The fate of the entire system may result in the effort to enact or defeat legislation to embrace a new national commission on workers’ compensation.
The States universally enacted Workers’ Compensation in 1911 in an effort to replace civil litigation with an administrative system. The approach was to provide a remedial system to injured workers in a summary manner while providing a cost effective approach for employers. Despite the efforts to reduce benefits and limit access States are struggling to maintain the system in one fashion or another. Rumors are spreading that New York, a former industrial jurisdiction, may join the list of radically modifying their system.
The once touted as a “no fault” system, the nation’s workers’ compensation has been besieged by efforts to assert more restrictive requirements for benefits. Medical delivery has stagnated in a complex world of etiology and evidential proof of occupational claims. The cost of soaring medical care, once shifted easily to collateral health insurance companies and the Social Security system, has been met with convoluted reimbursement efforts. Large corporations and public entities that in the past were able to provide an additional stream of revenue to injured workers are now rapidly drying up and or become non-existent under bankruptcy laws. State governments, that maintain the administrative system, are now facing a monumental shortage is revenue and are closing down operations and converting some for criminal and economic sanctions to merely benefit the general state revenues. The few remaining second injury funds have become insolvent and the future remains bleak as the premiums committed to finance these agencies and programs become depleted.
On January 22, 2009, Representative Joe Baca, a Democrat from California, introduced legislation (HR635) to establish a second National Commission on State Workers' Compensation Laws [Commission]. The first Commission was established under the Nixon administration in accordance with the Occupational Safety and Health Act. The new legislation that is now supported by representatives of injured workers lacks co-sponsors. Opposing the legislation is a long line of Industry based employers including the Americans Manufacturing Association and the National Chamber of Commerce.
John Burton, the former chair of the 1971 Commission, in a recent interview, commented that many of the present systems do not even comply with threshold recommendations of the original Commission and that many of the present programs face some serious challenges.
Patrice Woeppel, Ed.D., author of Depraved Indifference the Workers' Compensation System, has called for a single payer medical system to embrace both work and non-worker related injuries. By allowing the employer and insurance carrier to control the medical care she indicates, results in "restricting treatment to the cursorily palliative" or delay and denial of treatment to the injured worker. Additionally medical plan administrative costs of duplicative and wasteful.
As the national health care debate continues and the final legislation unfolds, the workers’ compensation medical delivery issues and wage replacements for temporary and permanent disability may become incorporated into direct or ancillary legislation. A second Commission, in one form or another, aimed at nationalizing the workers compensation system, may indeed become a reality.
Monday, September 8, 2014
Some Embattled Democrats Embracing Obamacare
Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
News outlets look at Democratic Sen. Mark Pryor's promotion of the health law in a campaign ad as a sign the law may be less radioactive. Meanwhile, Politico notes that 30 of the 34 House Democrats who voted against the law are no longer in office as the partisanship that it engendered grows. The Associated Press: Democrats Reframe Debate On Health Care The Hill: Dems Find Obamacare Ammo |
Wednesday, May 11, 2011
Common Themes, The Green Mountain System & Newt Gingrich
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
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