26 July 2009
What About Workers Compensation?
Labels: governors, health care financing, labor entitlements, Republicans Bush Wackovia Pelosi crisis, workers comp
Correct Me if I'm Wrong- -please!
In the past five years, we have had a national focus on the American system of providing health care to its citizens. During his first term, President Obama sponsored and achieved the passage of federal legislation aimed at establishing a national policy for health care. Attempts by many groups to introduce a single payer system, basing health care for everyone on a federally-funded insurance program akin to Medicare or the Veterans Health Services. The private insurance industry and the AMA fought for no changes, invoking 1930's images of socialized medicine under a totalitarian state and by providing media coverage to assert that the American approach to health care has resulted in the best health care possible in the world. Neither end of this political spectrum was successful in defeating all aspects of the other's arguments. The Affordable Care Act of 2010 (ACA) was the result. Almost immediately and henceforth to today, the Republican leadership in Congress has attempted to repeal the ACA and repealing the act was a principal theme during the Presidential election of 2012. To date, those efforts to repeal have been defeated by vote and by reelection of President Obama for a second term.
WHAT MORE NEEDS TO BE DONE?
The Cost of Medical Education One cost driver in the health care industry is the cost paid to educate and train a physician. While a student in medical school, student loans help pay tuition costs and housing expenses in excess of $50,000 per year. After four years of medical school and their residencies of up to three additional years, the amount of personal debt from student loans for a licensed, medical doctor makes the National Debt seem trifling when compared to the monthly payments on her loans.
Medicare's vetting and reimbursement bureaucracy is not an overnight service. For large medical centers and hospitals, the delay between incurring an expense and receiving revenue can extend weeks and months. Therefore, an additional piece of overhead are the costs incurred before receiving revenue from services, i.e., the cost of the float or sufficient cash to pay employees and its vendors.
To help hospitals with their float, Medicare instituted regular cash payments each month on the assumption of the amount Medicare eventually will pay, or not pay. Hospitals negotiate their overhead percentages with Medicare. The reimbursement rates from Medicare and Medicaid are set in Washington.
Costs for Inpatient Care The Admission process does not inhibit providers from full-cost-plus pricing. Once a patient signs the admission form, the patient accepts responsibility for all costs incurred while hospitalized. From that point on, our private health care system gives the green light for spending what the physician considers prudent, necessary care and treatment. After all, we agree to inpatient care because we "know" that the hospital is the place for the best care. As dubious as the patient's assumption may be, our society expects the best care. We Americans are reminded quite frequently in the media and by the health care industry that "our country offers the best health services in the world." That assertion is a pernicious public myth that is interfering with reforming our national health care system.
According to this commercial propaganda, a public-option health care system takes away our choice of physician. Most HMOs, keystones of Managed Care, require members to choose from among the physicians they have. Leaving one's physician may seem traumatic after a number of years, but employer-based health insurance can require one to do so in a job transfer. We have to inquire if our regular physician accepts our private insurance plan before receiving services. There are no standard reimbursement rates for professional fees and office visits. Medicare and Medicaid beneficiaries have to ask if a doctor accepts those patients. Sometimes, one hears that the doctor is no longer accepting new Medicare patients. I doubt if that is legal. The Medicare law maintains that if a doctor has just one Medicare patient out of hundreds, that doctor must accept new Medicare patients. The only way a doctor can refuse a new Medicare patient is if that doctor stops treating all Medicare patients in the practice. I have had to find a new physician because my doctor closed his mostly-Medicare/Medicaid practice. He said he could no longer afford to maintain his practice.
And yet, the most cited cause of individual bankruptcy is a person's inability to pay for health care received. Suppose that person makes about $45,000 per year in take-home pay. What rationale exists to expect that patient to pay $25,000 $50,000 $300,000 and still have a place to life, food to eat, and time for rest. Sure that person signed that agreement of financial responsibility, but he or she may have made a different choice even to live with infirmity. A parent may choose to contribute to a retirement fund or a college fund, rather than be impoverished by medical bills. A patient may decide that he or she will treat or live with a health condition until they die. That is personal accountability and an informed one if the amount of money required for inpatient treatment could be known in advance.
The Constitution does not make a provision for arbitration as a substitute for access to the courts system. What is the motivation for arbitration? It is to lessen the costs of a mistake, an accident, or malpractice. The patient does not have to agree to arbitration, regardless of consequences. The court system remains available.
There is more work to do for improving our health care system. These questions are for politics, not religion-based morality or individual codes of ethics. Our society that accepts living within the social and political boundaries of our Constitution and judicial due process determines the secular basis for such a question through its laws. We as a nation should be more scrupulous about knowing the content and intent of proposed legislation as they enter our legislative process, not after they are enacted.
Change, reform is happening. Love it or leave it. (I did not originate that last challenge, but it now seems useful)
Sherfdog
Out Yourselves! about Health Care Reform
- "What is sufficient for you personally and for those you represent?"
- "How will you know if reform is best for you personally and for those you represent?"
If the President wants this process to foster creativeness, then I believe this last step should be completed by the Administration Departments and the Congress--and made public--before Congress adjourns in 2012..
Labels: Administration, health care public Obama/Biden competitive markets anti-competitive, health care public plan, lobbyist, McConnell, Reid, single payer
20 July 2009
Federal Fiscal Policy Discounts Greed
Congress failed to help the public, their constituents, to have the means to acquire more control over their debt management and, as a result, to improve their ability to access consumer credit, apartment rental units, jobs, and sense of self-worth. Indeed, the recent legislation has had the effect of making retail credit less attractive to consumers.
Congress failed to address the shrinking of real estate market values for property owners whose property is near to a foreclosure sale, a short sale, or an auction. Reality check: If all homes in a particularly wealthy neighborhood have an average market value of $1.3 million (determined from the prior six months' sales prices), the entire neighborhood's market value can fall several percentage points if a small number of sellers have lost their jobs and can no longer pay their mortgage loans, or if a small number of repossessed homes go on the market at prices over 50% lower than the market value of homes in proximity, the entire real estate market in that area will experience a reduction in home equity value and in sellers' asking prices. Given the lower market value of competing homes in an area, buyers can take advantage of this price cutting, negotiate still lower home prices and the purchase prices negotiated will establish the new average market value for like homes in that neighborhood, perhaps around $675-700,000 or 52% lower.
The banks also have changed their underwritiing standards for mortgage loans. No longer can a mortgagor expect to find a lender using the 20% down/80% loan criterion for taking a new mortgage loan. More emphasis is being placed on the applicant's LTV (loan-to-value) as determined by the appraiser. An equivalent ratio of retail credit-debt-used to available-limits also affects the underwriter's criteria for mortgage loan approval.
There are no steps I can take to increase my credit score, other than to pay down my debts on time and with at least the minimum amount due. I have never had a mark on my payment record, I have owed more than now and I am paying, with exceptions, more each month than the min. amt. due. A year ago, my debt to available credit ratio was 47%. This ratio makes up approximately one-third of my credit score. Another one-third is affected by my debt and payment history. I used to not worry about this latter portion because of my cash available from my home's equity and my IRA. Lenders kept raising my available credit limits because of my access to liquid assets (i.e., to cash). Special rate offers enabled me to transfer a debt at 13.25% to a 0% debt rate for one year, thereafter at an 8.9% rate or to transfer a debt to an account with a 4.99% rate until the entire amount transferred was paid off. I used both, depending on which gave me the better cash flow in the future. Because of my excellent credit score and report, I could refinance my property and pay off all retail credit debt in escrow, and still keep my mortgage payments at almost the same amount as prior to refinancing. Refinancing is no longer an option, because there is no longer any equity in my home's value. TARP and other federal stimulus funding did not directly address the mortgage loan market's dependence on LTV, compounding the error of not addressing the shrinking values or credit card charge limits.
On their own, with nothing other than their ability to do so, all but one of my creditors have lowered my available credit by several thousand dollars. Now, my debt to available credit exceeds 85%. Nothing has changed on my end. How will this 47% to 85+% affect my credit score? I don't know and the credit bureaus are not talking.
In addition, with no constraints or sanctions for the card issuers, and despite the infusion of cash by the Treasury Department and new legislation, creditors still can raise the interest rates on retail credit balances whenever it makes business sense to them. When this has happened to me, I have seen the minimum amount due, as posted for my monthly statement, double my monthly payment.
Because of our "free market" economy, Bank A could care less about Bank B's change of the minimum amount due on Bank A's credit card balances. I put quotation marks around 'free market' because we have never in this country, since the Whiskey Rebellion, had our financial markets unfettered of federal and state regulations and rules for operating. Thus, if Bank B finds out about Bank A's increasing interest rate or minimum amounts due, Bank B can do the same thing. It every bank adopts this method for its revolving credit accounts (credit cards) this action becomes an industry standard way of doing business, not anti-competitive.
This ability to raise or lower interest rates does not stop per se the entry of a new bank into the retail credit market nor does it lead to a monopoly, so our existing anti-trust laws do not offer the consumer any basis for complaint. It seems to me that collusion among bankers or establishing a new industry standard for doing business in the retail credit market should be wrong. After all, the banks' actions have harmed the public at large, especially those persons living on fixed incomes or those persons whose household income is no longer sufficient to pay off existing loans plus provide for day-to-day living expenses.
I wrote in an earlier post about the curious behavior of banks' offering extremely low interest on savings accounts and certificates of deposit (CDs). The cost of cash to a bank, or the federal funds rate, has held constant for the past six months at 0.25 or $ 99.75 per $100 bought. This same bank will lend this $99.75 through a variety of loans and credit card accounts. To attract private capital, a bank today will pay an average interest rate of 1.311 to 1.321% on an average minimum deposit of $10,252, dependent upon the number of days up to 365 days those deposits remain in a money market account or a savings account. Banks will sell CDs of various time periods at an average yield of from a 3-month CD at 0.923 for an average purchase of $8, 547 to a 5-yr. Jumbo CA at 2.728 for an average purchase of $100,000.
In other words, a bank can pay 0.25 % (federal fund rate) up to 2.728% (to depositors) for the bank's operating cash. For an idea of how profitable this capital is, compare the following rates charged for different loans and consumer credit accounts:
- WSJ Prime Rate 3.25%
- Mortgages 5.372 APR for FHA 30-yr. fixed
- Credit Cards:
- Balance Transfer Cards 13.77%
- Cash Back Cards 14.35%
- All Variable 11.14%
- Low interest cards 9.17% [Source: www.bankrate.com, 20 July 2009]
On the other hand, there is nothing to interfere with a new lender coming into the consumer credit market offering completely different, more customer friendly and less costly terms for their customers. Any enterprise can go against an industry practice and such an ability can change the market practices completely.
With an abundance of Stimulus Money available today, perhaps some entrepreneur could have access to the minimum capital required, by regulation, to start a new consumer credit card business as a bank. A strong, perhaps using a different business model, competitor is something that we all need now that the banking industry standard practice for retail credit accounts is stifling small business owners and retail customers from buying and rebuilding our economy with more jobs to handle increased production and sales.
The next Reform stage should start at the local level, incorporate the Enterprise Zone incentives for small business and tax bank revenues from consumer loans and credit card accounts, including all associated fees, for the rate amounts above 10 percent. Residual TARP and Stimulus funds should be used to establish reserve levels before being remitted to the federal government.
Labels: banks, cost of money, credit cards, FICO scores, loans, reform legislation
16 July 2009
Who Should Be The Change Agent?
Labels: change, communications, consultants, fees, organizations
New Light on White House Reform Leader
By Anne Zieger | Comment | Forward |
White House health reform director Nancy-Ann DeParle is in a tight spot. A new investigative report has concluded that DeParle earned more than $6 million serving on the boards of major healthcare corporations, some of which have been accused of fraud, mismanagement and regulatory violations during her service there.
While there's no evidence she was aware of or involved in allegedly illegal activities, she served in three cases on board committees overseeing the companies' legal and regulatory compliance. That certainly doesn't look good, regardless of what actually happened, particularly given her rep as a progressive.
One example of the problem was her involvement as director and compliance committee member at DaVita Inc., which has been subject to investigations into its billing and drug-prescribing practices. She also served in a similar role at medical equipment supplier Guidant, whose execs apparently knew of cases in which its devices failed but never disclosed those failures.
To learn more about these issues:
- read this Kaiser Health News piece
10 July 2009
Economics can be summed up as the study of the commerce of rents. When I use one of my credit cards, I rent cash from the card's issuer on previously established T&C. For this, the issuer bills me monthly for rent in the amount I paid to the merchant. Using VISA as an example, the merchant will receive about 97% of the amount (including sales tax) shown as the transaction amount charged to my card. The card issuer has an agreement with VISA for VISA to function as the clearing house between me and issuer. For acting as the intermediary or clearing house, the issuer pays VISA to accurately record the transaction total for which I rented cash using the issuer's card and pays VISA the cash transaction total amount. The next paragraph explains two different corporate policies for accounting for revenues.
Banks saw an opportunity to expand their retail banking products to include credit cards for individuals and businesses. Prior to expanding into retail and wholesale credit business, the banking industry's markets were underwriting and mortgages, also known as funding loans and structured repayment loans for real estate and personal, unsecure loans. Bank revenues came from interest charged on mortgages and other loans.