Category: GOP Politics

by Dave Mindeman

The US House minority GOP caucus had their retreat. And you would think they had just won the lottery. I guess they are convinced that their smaller group has the ability to unify in ways they haven't before. Since most of this group comes from hard core districts, they probably do have a lot in common. But can that bring them back to a House majority?

The election of Michael Steele as RNC chair was probably the better indication that they are coming back. Of all the candidates vying for the position, Steele can probably attract the broadest appeal.

And in a way, it was probably a good sign for Governor Pawlenty's national ambitions. Steele and Pawlenty are closer in broader goals than any of the other RNC candidates.

However, the message is still not changing much. Eric Cantor, the House minority whip, spoke about the recent stimulus vote:

“I know all of you are pumped about the vote the other day,” Virginia Rep. Eric Cantor, the party whip, told lawmakers Friday night, eliciting loud cheers from the roomful of Republicans. “We’ll have more to come.”

Pumped up about a bill they lost by over 50 votes? Cheers that they all voted to do nothing? I guess victory is in the eye of the beholder.

Maybe I'm missing something, but being negative and obstructionist when the country desperately needs action seems like a wrong headed message to me.

And here's another puzzling symbolic gesture:

Indiana Rep. Mike Pence, the chairman of the Republican Conference whose office organized the three-day retreat, kicked off the final dinner with a clip of George C. Scott as Gen. Patton imploring his troops, “We’re going to kick the hell out of (the enemy) all the time, and we’re going to go through him like crap through a goose.”

After the drubbing the House Republicans have taking in the last two election cycles, you have to wonder which side they think Scott/Patton is supposed to be referring to.

The voice of reason came from our own Governor Pawlenty, as an invited speaker:

He also warned Republicans away from the divisive politics and infighting that have plagued the party for years. “We don’t have a big enough party to be throwing people overboard,” the conservative governor said.

Nice thought....but a little late.

I guess the most symbolic distortion of reality came from Cantor:

Cantor had all his deputies sign a magnum of wine to uncork when the GOP wins back the House.

Well, they say wine always gets better with age.

Category: Health Care

by Dave Mindeman

The terminology and references to the health care debate always gets lost in assumptions and inaccurate comparisons. As we sink deeper into an economic nightmare, health care should come to the forefront -- because fixing it can speed up our economic recovery.

My perspective comes from two things: I am a pharmacist and see health care issues up close....and my wife has a chronic illness that requires constant insurance involvement. Secondly, I have come to believe strongly in the single payer solution. And as I discuss some of these things, you will see why.

Right now, I want to discuss the daily grind that providers deal with regarding insurance issues. Most of my references are going to involve PBM's (Pharmacy Benefit Managers) -- Doctors and hospitals have more issues but have to deal with PBM's as well.

Several years ago, PBM carriers were touted as an answer to skyrocketing health care costs. They would reduce costs by making claims and benefits more efficient. And at first, they did slow some of the escalating costs. Briefly. But they very quickly reversed that trend as profit motives required more squeezing of providers and patients.

Here are a few of the ways PBM's have complicated health care:

DUR (Drug Utilization Reviews) -- In theory, this should have added to health care quality. What it is supposed to do is examine a drug claim and compare it to recent claims for the same patient to look for drug incompatibilities, overuse, and dosage problems. Pharmacies have their own internal checks but with patients filling prescriptions at multiple locations, it can be hard to keep track of a patient's history. But, although well intended, DUR has ended up adding to costs.

Here is an example: A woman brought me a prescription for a rather high dose of Warfarin -- a blood thinner. The dose was higher than recommended on a normal basis, but this patient had a special situation and the doctor insisted that the dose was correct. The insurance carrier blocked me from filling the presciption citing a DUR violation. After calling the insurance company, they told me the remedy would be a prior authorization application (you will be hearing a lot about prior authorization). In order to obtain an override in this manner, the Doctor (not the pharmacy which had already done the calls and verification) would have to submit a PA request. So, the doctor calls the insurance company and files a form -- a review board decides whether the reason is sufficient and if they agree, they authorize the claim. Notice that the review board...not the doctor... has the final say. One more thing, this woman had obtained a prior authorization for this dosage in 2008; however, her place of employment had changed the plan with this carrier (same insurance company, just a different plan) which invalidated the previous prior authorization and required everyone to go through the whole process again.

Efficient?

Refill Too Soon -- Again, for well intentioned reasons, this method of denying a claim is meant to evaluate whether or not a patient is overusing a medication. Unfortunately, most insurance carriers don't seem to understand that patients do go on vacation, or sometimes lose bottles, drop pills down the sink by mistake, or have changes in dosage by the doctor. So, the pharmacy has to call the insurance company and obtain an override. The request is usually granted -- but the hoops must be jumped through so that the carrier can document such events. Some carriers will "allow" only two such events within a year -- if a third time is required, the patient either pays cash or goes without. In addition, everytime this call is made requires long phone waits on hold with the carrier. Time wasted -- administrative costs added.

Non-Formulary Drug -- Here is another example of care being controlled by the insurance. Doctors often prescribe a specific drug for a course of treatment, but the insurance company has decided that a "less expensive" therapeutic equilavent is the preferred drug. Preferred drugs are put on a "formulary" list. The non-preferred drugs may still be allowed but have to go through a prior authorization process. The Doctor has to provide a reason for using that particular brand. Often, the only reason the insurance carrier prefers one drug over another is that the preferred has a generic alternative which will greatly reduce the cost to the insurance company. One extreme example of this is that I had a patient that needed to use the brand name Zocor for cholesterol. The insurance required that the generic be used, however, this patient had a reaction to the tablet color dyes of any the generics we could get. After several weeks of haggling, the insurance carrier allowed the brand product but reduced the pharmacy reimbursement to the point that we lost money every time this person had the Zocor filled.

These are just some examples of how insurance carriers control health care in America. Doctors, Dentists, and Hospitals have other stories to tell I am sure.

I'll be going over additional problems with the so-called "competitive health care model" in future posts..... as well as why single payer can improve the situation immensely.

Health care is being held hostage by a system that has too many complications and rules. If we are to compete in a global market, one area that we are losing badly in, is health care.

Maybe we can overcome our economic issues -- but without fixing health care, we will only get dragged down again.

Category: Michele Bachmann

by Dave Mindeman

Michele Bachmann writes an op-ed in the Star Tribune teaching us the historical lessons of the Great Depression.

Here we go:

Hoover not only dramatically hiked income and import taxes, but he instituted big-government spending programs all but identical to those being debated today. Hoover's Reconstruction Finance Corporation tried to ease economic pain by funneling tax money to state governments, local governments, banks and a variety of businesses. His Federal Home Loan Bank Act extended loans in an effort to increase low-income housing -- beginning the ill-fated history of federal intervention in the housing market.

These measures proved a dismal failure, and things got only worse. In the 1932 campaign, Franklin Roosevelt actually attacked Hoover for his big-government policies, decrying Hoover's presidency as "the greatest spending administration in peacetime in all of history."

The problem here is that Ms. Bachmann condenses 4 years of policy into two paragraphs. How, when and why these things happened have critical historical importance. Let's try to expand this a bit.

One of the first things Herbert Hoover did when he became President in 1928 was put together a massive tax cut. The top rate was reduced from 73% down to 24%. When the stock market crashed in 1929 and the economy ground to a halt, Federal revenues dropped off the cliff.

That set in motion a series of ill conceived remedies. In 1929, Hoover got the Mexican Repatriation program authorized....blaming Mexican workers for American unemployment. Sound familiar? About half a million people of Mexican descent were repatriated back to Mexico.

Then in June of 1930, the Smoot-Hawley Tariff Act became law. Hoover thought that this would protect American goods by placing expensive tariffs on imported goods and raise much needed revenue for the government. As free trade advocates love to point out, this set off a world wide tariff war and ended up strangling American exports. (Overreactions to the necessity of Free Trade agreements have occurred ever since.)

In 1931, as the depression worsened, Hoover urged the banks to join a voluntary group called the National Credit Corporation. Hoover encouraged the member banks of the NCC to provide loans to smaller banks in order to prevent them from collapsing. Unfortunately, the banks within the NCC were often reluctant to provide loans, usually requiring banks to provide their largest assets as collateral. The banking situation continued to deterioate.

Finally, in 1932, as unemployment topped out at 24.9%, Hoover began to use government intervention. As foreclosures escalated, Hoover signed into law the Federal Home Loan Bank. This established lending through savings and loans and continues to this day. In 1932, it slowed the rate of foreclosures but was widely seen as happening too late to reverse the problem.

In desperation, Hoover pushed into law the Revenue Act of 1932. This was passed in June and virtually reversed the heavy tax cuts that Hoover had enacted at the beginning of his administration. Hoover thought that deficit spending would worsen the economic situation and tried desperately to get rid of the Federal red ink.

In January of 1932, Hoover made an attempt at government intervention with the Reconstruction Finance Corporation. This was going to pour government money into projects across the country. But Hoover negated a lot of the effect by instituting his huge tax bill in June. And the political arguments are much as they are today. U-S-History.com summed it up this way:

Democratic politicians argued with some justification that federal assistance was going to the wrong end of the economic pyramid. They believed that recovery would not occur until the people at the bottom of the heap had their purchasing power restored, but the RFC poured money in at the top. To many Americans, the Reconstruction Finance Corporation was viewed as a relief program for big business only.

When FDR took office in March of 1933, he did criticize the government policies of Hoover. But what he did was to improve upon and expand the RFC into a large public works program. It was also the basic financing method used to transform our manufacturing plants into defense operation prior to World War II. It helped move us quickly into a war economy.

Hoover's policies gradually evolved into the proper response. He had just dug a deep hole and didn't stop digging in time.

So, Ms. Bachmann's condensed historical perspective tends to say only what she wants it to say.

In order to avoid repeating history's mistakes, you have to actually examine the whole history book....not the Cliff Note version.