Tuesday, March 9, 2010

Medical Mistakes Costs Lives and Money

During the health care reform "debate" of the past few months, the issue of tort reform has been raised as a way to hold down spiraling health care costs. Republican lawmakers bemoaned the lack of any restrictions on "frivolous lawsuits" in the health reform legislation. What frivolous lawsuits? Interestingly, whenever these subjects come up, there never seem to be any statistics to back up their case. The only statistic mentioned is how much malpractice insurance rates have risen!

The logic goes something like this: Poor, altruistic hospitals and medical doctors do their darnedest to keep us all healthy, only to be slapped with lawsuits from disgruntled patients. This, in turn, causes their malpractice insurance rates to rise, forcing them to charge more for their services. Oh, and don't forget all those useless tests they "have" to order on every patient lest they be sued for malpractice.

How much truth is there to this argument? Not much, it seems. While the whiners never cite any supporting data for their cause, there is plenty to show the kind of harm the health care industry wreaks on patients. A 2004 report by HealthGrades, an organization that rates medical facilities, showed that for the years 2000-2002, patient deaths caused by medical errors averaged 195,000. Those were just deaths, mind you, and so were just a fraction of all medical errors that actually occurred in those years.

In other news, the December 2007 issue of Consumer Reports cited increasing rates of patient deaths from implanted medical devices. They cite statistics from the Food and Drug Administration reporting 2830 deaths, 116,086 injuries and 96,485 malfunctioning devices. And that's for the year 2006, alone! The magazine notes that many of these cases involved devices that had been on recall lists.

As for medical tests, an article in the September 2009 AARP Bulletin relates that fully half of all prescribed antibiotics are unnecessary; $1.1 billion is wasted each year in this manner. Not only that, but this practice is largely to blame for the appearance of "superbugs" such as MRSA and C. difficile. MRI and CT scans are also over-prescribed, by as much as one-third. These scans represent a $100 billion a year industry, so it's easy to see why doctors think everyone should have one. There's one problem, though: CT scans bathe patients in enough radiation to equal 50 chest x-rays, a definite cancer risk. Why do physicians over-prescribe and over-test? According to doctors interviewed for the article, it's easier than explaining to the patient why they don't need it! To top it all off, Consumer Reports notes in its October 2009 issue that doctors fail to notify patients of adverse test results in 7% of cases. Why order the tests if the results won't be reported?

The industry is doing little if anything to reduce these errors. The latest issue of Consumer spotlights the high rate of "central-line" infections that occur in ICU wards. These bloodstream infections, caused by contamination of large intravenous catheters, represent 30% of the 99,000 reported hospital-infection related deaths each year. Total infection rates, by the way, are in the neighborhood of 1.7 million every year.

As of October 1, 2008, Medicare no longer pays bills associated with hospital errors; unbelievably, hospitals and doctors have the nerve to bill Medicare and insurance companies for mistakes they make, then for the treatment necessary afterward. "Tort reform" and "frivolous lawsuits"? They've got to be kidding.

Wednesday, March 3, 2010

What Jim Bunning's Grandstanding Was Really About

Finally, Jim Bunning, R-Kentucky, has backed off on his self-serving rhetoric regarding "deficit spending" and let the 30-day extension of benefits for unemployed Americans go through. Why the turnaround? Some news sources say that Democratic chiding and criticism within his own party is what changed his mind. Bunning is no stranger to either of these situations, however, and I think the reason for the sea change is much simpler: He got what he wanted.

What was that, exactly? Attention, and a little revenge. He is leaving congress this year, so the effects of his filibuster will not impinge upon a re-election bid. Recent news articles have mentioned that he is "retiring" this year, but go no further than that. As it turns out, it is a forced retirement, engineered by his own party, with no other than Mitch McConnell at the helm.

Bunning, a former Baseball Hall of Famer, possesses an abrasive personality and lack of tact that has earned him few admirers, even within his own party. Michael Lindenberger of Time reported last July that Bunning, in his announcement that this term would be his last, placed the blame for this decision squarely in the lap of McConnell. The powerful Senate minority leader merely dropped a few hints regarding the prudence of another run by Bunning, and the money flow soon shut off. The Republican party, in true survivor fashion, was cutting out a cancer that could put the entire entity at risk, and it was done quietly and efficiently.

Bunning, apparently, doesn't feel the need to go quietly. In addition to pointing out the source of his political downfall, he has threatened to sue the Republican party. Truth be told, he barely won each election anyway, so the smallest of nudges was really all that was necessary. Nevertheless, Bunning seemingly saw his opportunity to annoy and embarrass not only Democrats, as any good GOP member is wont to do, but also those within his own party, who he views as traitors. The jobless bill, with its unusual agreement between the two parties that quick action was needed, worked very nicely. Who could argue against "fiscal responsibility" and a "ballooning deficit", phrases constantly trumpeted by Republicans these days?

The downside, of course, is that people in his own state would also suffer, and did. Surely Bunning knew this at the outset of his little public temper tantrum, though, and didn't care. He got the attention he craved, though his status as martyr is probably not secure. Probably a senator of this ilk would have failed re-election, anyway. The Republican party, however, not willing to chance it, took matters in its own hands. No one will miss this guy, and they know it. And the machine hums on.

Tuesday, March 2, 2010

Tea, or Coffee? How About Hot Cocoa?

I guess it was just a matter of time until someone came up with the answer to the so-called Tea Party: The Coffee Party. Conceived by Anabel Park and birthed on Facebook, this new political movement is building up a full head of steam. What do they stand for? Civility, inclusiveness and a desire to see government fulfill promises made during the presidential campaign. Okay, I can get behind that. I do think, though, that "Coffee Klatch" sounds better.

Of course, those same concerns are part and parcel of the Tea Party shtick, in as far as its members also feel government is deaf to ordinary people's needs and is spiraling out of control. They also want lower taxes and "smaller" government (whatever that means). The Coffee Party, besides forming as a knee-jerk reaction to the Tea Party, has a charge that is a little more fluid. According to a new member interviewed by Dan Zak of the Washington Post, this movement is "very grass-roots, there's no official organization and individuals can participate as individuals without having to see eye to eye on everything". Well, that will surely get things done!

To be fair, the Tea Party was unclear about its goals at first, too (actually, they still are). These two groups may have more in common than they think: Both express disgust for a federal government that is ineffective and out of touch with voters. Coffee people used the same methods to organize as did the Tea Party, namely social websites. This is something that the Democrats should take note of, and use to their own advantage. Why did it take 8 years of Republican rule for people to get fed up, versus one year of a Democratic government? The GOP has the marketing down, and the Dems would do well to copy their tactics.

Where will all this lead? Well, change would be nice, finally, but don't count on it. It seems that politics always trump good intentions, so expect to see infighting in both these "parties" fairly soon. Is there no hope? The best thing these two groups could do is find common ground and unite. The corporate/government model is big enough to crush disorganized, warring factions, but might have to take notice of a nationwide voter rebellion. "Hot Cocoa", anyone?

Monday, March 1, 2010

Who Says Americans Don't Want Health Care Reform?

The "health care summit" has come and gone, and, as expected, partisanship is still alive and well. Instead of focusing on what is best for the country, our elected leaders took this opportunity to once again bicker amongst themselves, proving to one and all just how useless they really are.

Republicans, of course, had no intention of negotiating away any of the deep fissures between themselves and Democrats on this issue. Their main concerns going into this meeting were split between concerns for citizens and concern for industry. For example, they wanted to discuss how to make insurance available and affordable to those with pre-existing medical conditions, but also want to end "frivolous lawsuits" and expand health care cost related savings accounts. They keep bleating that the nation just can't afford this legislation (where were these budget-squeezers when the bailout bill was passed?) and that the "American people" don't want it, anyway.

Not that the GOP is entirely to blame. Democrats are quickly losing the membership that was once willing to vote in favor of their health reform bill. Back in November, the House's version squeaked by with a 5-vote majority, and even that seems barely attainable now. Rep. Jason Altmire, D-PA, is quoted in an AP article by Alan Fram as saying that some Democrats who initially voted "yes" on the health care legislation would now vote "no" because, "they went home and got an unpleasant experience" due to the way they voted.

Who are these Americans who don't want health care reform? They are not anyone I know, or the readers who write into our local paper's editorial page. Why in the world would an average person put the concerns of the insurance industry and the health care profit machine before their own financial and personal health? We, the voters, are not getting cash gifts and free cruises, or large donations to our re-election campaigns. For these congresspeople to say it is the "will of the people" is just plain ludicrous.

As usual, our needs will be ignored as congress and industry ride off, hand in hand, into the sunset. The only real way to determine whether or not the citizenry want health care reform is to put it to a vote. Would you vote against changing the system? I know I wouldn't. Funny how that idea never came up, isn't it?

Wednesday, February 24, 2010

Do the New Credit CARD Rules Help or Hurt?

The much-lauded Credit Card Accountability, Responsibility and Disclosure (CARD) Act finally went into effect this week, after months of unethical shenanigans by the credit card industry as they tried to squeeze as much money out of consumers as possible. Signed by Obama last May, the law's implementation was put off until February in order to give the credit card companies and banks time to "adjust". What they did, of course, was play havoc with customer's money, jacking up fees, applying them retroactively, and instituting interest rates close to 1000%.

Now, though, the party is over. Or is it? Closer inspection of the law's provisions certainly seem protective of consumers: Caps on certain fees, 45-day notice on interest rate increases (which took effect last summer), and the scoop on exactly how long it will take to pay off your debt if you pay the minimum each month. These things are all good, especially the part where the print must be readable without the use of an electron microscope. The effect on consumers, though, is not quite so positive.

Eileen AJ Connelly, a reporter for the AP, writes that banks and other lenders that issue credit cards are already finding ways around the new law. Since the newly enacted restrictions will reduce their profit margins by half within three years (according to FICO), lenders have responded by creating new fees, re-instituting annual fees (almost unheard-of for the last few years) and cutting lines of credit. If you find yourself affected by these changes, consider yourself lucky: Many accounts were simply closed by credit card companies in order to reduce their risk. The account holders had no say in the matter.

Although the new 6-week notice for interest rate hikes is a good thing, there is no cap on high those rates can climb. In addition, many cards that previously had fixed interest rates have now, unilaterally by the lenders, been changed to variable rates. Since the only direction at this point for rates to go is "up", this does not bode well for card holders. Overall, credit cards will be much less accessible for everyone, particularly those with lower incomes.

Card issuers argue that not only does the new law decrease their profits, but the recession also took its toll on their bottom lines. According to the Nilson Report, lenders saw their earnings plunge from $19 billion in 2007 to $6.32 the next year. Of course, that's still a hefty profit, and, since much of the decrease was due to unemployed people defaulting, I guess they didn't suffer as much as others did. However, since the laws are written for the big guys and not everyman, their suffering is worth more. A reasonable person might expect that reduced profits during economic downturns are just a cost of doing business in the credit industry, but never mind. That yardstick only applies to small businesses, apparently. Therefore, they are able to make up their profits in new ways unavailable to the rest of us. Score another one for the big boys.

Monday, February 22, 2010

Americans Addicted to Sex-Addicted Celebrities

Dave Letterman, John Edwards, Steve Phillips and Tiger Woods. What do these four men have in common? Unless you've been living in a cave, you know that each one has recently been "outed" for sleeping with women other than their wives. Except for Letterman (who was not technically married at the time of his affair), each has seen his career ruined as a direct result of the affair becoming public. Oh, and two of them have admitted to being a "sex addict" and have done a stint in a Sex Addiction Clinic where, presumably, this particular monkey has been forcibly removed from both Phillips' and Woods' backs.

Now, just the other day, came the piece de resistance: Tiger Woods making a public apology for sleeping with several women during his marriage. He admitted that he had "cheated" and "hurt" those he loves. Okay, but why do the rest of us need to hear this? Apparently, sponsors have fled, and a public apology is believed to be the remedy. I wonder if that is part of his therapy: A kind of 12-step program, perhaps?

Americans can't get enough of this sort of drivel, it seems. Everybody likes sex (right?), and probably droves of us would have more of it if we weren't so working-class and boring. So, why is it surprising that those who lead exciting, spare-no-expense lives have more sex than we do? They have all the ingredients to attract partners, such as money, looks, money, talent, and money. Yet, each time some celebrity is found to have had extra-marital affairs, the media acts as if infidelity has just been invented (again).

Prurient interest aside, I think the real reason behind this feeding frenzy is the idea that each of these guys, particularly Woods, has been brought down a peg. Think about it. Whenever someone achieves some status that regular Joes and Janes only dream about, the media will almost immediately begin its search and destroy mission. Thus, beauty queens are dethroned for having posed nude (imagine!) earlier in their careers. Exemplary athletes like Michael Phelps become pariahs for taking a toke at a party, and the most gifted golfer in history finds himself in therapy designed to make him master of his domain. Let's face it: It took a lot of digging with heavy machinery to turn a one-car accident into the current scandal. None of this stuff was come across by accident, and every tidbit gets played for all it's worth.

Celebrities are people just like us, just richer (always) and more talented (usually). Tearing them down and exposing their foibles doesn't make them less so, but it does seem to make the general public feel better about themselves. It also doesn't make people like us any more important, or morally superior. If people want to be titillated, my suggestion is to subscribe to the Congressional Quarterly. At least knowing these peoples' shortcomings enables us to votes the bums out.

Wednesday, February 17, 2010

Reverse Mortgage Meltdown

Advice articles abound during recessions, each touting a new (or old) way to make every dollar count. When I saw an article about reverse mortgages by Saul Friedman, writing for the McClatchy-Tribune News Service, my interest was piqued. I had read about these financial instruments last September in Consumer Reports magazine, and that feature was not very flattering. It was obvious that Friedman was hawking these mortgages, so I read on to see how his perspective differed from that of Consumer.

He wrote about how many seniors are living in poverty but are not eligible for federal or state aid. If they own a house free and clear, however, they could tap the equity in their homes to pay bills and make their golden years worry-free. This is where the reverse mortgage, or Home Equity Conversion Mortgage, comes in. According to Friedman, these loans are safe because the Federal Housing Administration guarantees them, which means the borrower is protected not only from losing money if the property value drops below that of the loan amount, but also from losing the property itself. He asserts that none of these loans have gone belly up, so no taxpayer funds will need to be set aside to cover losses.

Consumer Reports tells a different story. According to their research, the number of reverse mortgage loans bailed out by the feds has increased fourfold in the last few years: from $81.3 million in 2004 to $381.3 million in 2008. Additionally, insurance policies paid for by borrowers used to cover these losses, which are now becoming the taxpayer's responsibility. What type of situation would trigger such a loss? When the money from the sale of the home doesn't cover the loan.

Friedman states that he himself has a HECM loan and has invested some of the proceeds. Consumer indicates that pressure to invest money procured from these loans seems to be part of many lenders' loan packages, regardless of whether it is a good fit for the customer. And while Friedman mentions the counseling requirement and some drawbacks to reverse mortgages, the article glosses over the negatives, which are many and could be ruinous.

The Consumer article profiles a man who lost his home after taking out such a mortgage. Since he was under age 62, the lender suggested putting the loan in his wife's name, who was older (and very ill). When his wife died, the loan came due. He could not pay off the loan, and the lender refused to re-negotiate terms. The house had fallen in value, and the associated costs of the loan and mounting interest payments caused the payoff amount to balloon. Indeed, the magazine noted that fees over the life of such a loan could easily reach one-sixth of the amount borrowed.

While the risks to seniors are legion, the banks love these loans because they can't lose: The taxpayer picks up the tab every time. And the costs are growing. The amount requested for FY 2010 was $798 million; in the mean time, the banks, insurance companies and investment firms are getting rich. Meanwhile, the equity in borrowers' homes gets dissolved by interest and fees, even if they don't take out the full amount of the loan. It's just a matter of time until our tax dollars are used to bail out the reverse mortgage industry, since there is no impetus for them to stop writing these loans, despite the mounting failure rate. By the way, where is that financial institution reform legislation?