healthcare

Review: The Poverty Industry

~ wheelhelmina ~ 2 Comments

One of my clients recently recommended that I read Professor Daniel Hatcher‘s The Poverty Industry. So I did. Now I understand why my client was so adamant that I read the book, and with the same urgency, I recommend that you do the same.

9781479874729_Full.jpg

Hatcher addresses the “poverty industry,” akin to the military industrial complex of which President Eisenhower warned. But it’s worse than that:

In 2011, the defense industry spent in excess of $134 million on government lobbying efforts. Impressive. But the healthcare industry spent almost four times that amount – more than half a billion dollars, including a significant focus on lobbying related to government healthcare problems for the poor. The defense industry also spent almost $24 million in 2011 on campaign contributions, but the healthcare industry multiplied that amount by almost eleven. In fact, campaign contributions made only on behalf of hospitals and nursing homes were about equal to all the campaign contributions made on behalf of the entire defense industry.

Not many Americans are aware of the extent to which private interests are intimately involved in healthcare aspects of what Hatcher refers to as “fiscal federalism.” Most of us believe that the federal government provides money to states, and permits states to deliver those funds to vulnerable populations in a manner most meaningful to the particular circumstances of those populations. But private contractors are interjected into this relationship, creating the iron triangle and the worrisome statistics noted above.

Contractors like MAXIMUS and PCG (the Public Consulting Group) operate internationally, helping governments’ take advantage of financial opportunities. What opportunities that we talking about? Taking Social Security benefits from children in the foster care system.  Taking Medicaid payments for nursing home care, and applying them to state general fund coffers or other projects that have absolutely no linkage to care of the elderly. (By the way, such contractors are often also hired by the federal government for audit activities, creating a scenario in which they are responsible for checking off on their own behavior.)

One of the examples Hatcher shares in the book hits close to home. The Marion County Health & Hospital Corporation in Indianapolis began buying for-profit nursing homes throughout Indiana. It then contracted with American Senior Communities to manage them. Owning the nursing homes permitted the claiming of more federal dollars, which would presumably be used to increase the quality of care nursing home residents were receiving. (Note that Indiana rates abysmally in regard to the quality of care experienced by nursing home residents.) In fact, the Indiana General Assembly passed a bill that would require any additional federal dollars to be spent on nursing homes. However, Governor Frank O’Bannon vetoed the bill, allowing the federal dollars to be routed elsewhere. Ultimately, they were used to fund Eskenazi Hospital. Quality of care in Indiana’s nursing homes is still deplorable.

The Poverty Industry describes numerous other examples of private companies – often with shareholders to keep in mind – working with the government to take advantage of those to whom the money was intended. It is a great eye-opener, and is likely to disturb you like no other non-fiction book on the market. I strongly recommend that everyone read this and then look into how their own state manages public benefits coming from the federal government.

Review: An American Sickness

~ wheelhelmina ~ Leave a comment

You know by now that I love reading and sharing information that I learn from a good book. Elisabeth Rosenthal‘s An American Sickness: How Healthcare Became Big Business and How You Can Take It Back is truly one of the most interesting books I’ve read all year! Especially now, as Senators discuss repealing and/or amending the Affordable Care Act, read this book!!!

410kNvpsHYL._SX327_BO1,204,203,200_.jpg

Rosenthal, a former journalist and physician, begins by thoroughly describing how the medical-industrial complex takes advantage of patients and legal loopholes. She devotes a chapter each to the ills of insurers, hospitals, physicians, pharmaceutical companies, medical device companies, ancillary service providers, billing and coding contractors, medical researchers, conglomerations, and patient complacency. The facts presented are fascinating: for example, “[t]he average hospital cost per day in the United States was $4,300 in 2013,” more than triple “the cost in Australia and about ten times the cost in Spain”!

The concept that irked me the most is “venture philanthropy.” Of it, Rosenthal writes:

The problem is that many charitable foundations no longer see themselves as funders of research for knowledge propelled by donor dollars to cure a disease, but instead as inventors in new treatments.

When insulin was developed in the 1920s, researchers did not stand by patent protection to reap income, but instead shared their knowledge with the community. When the March of Dimes helped fund vaccination research, it did not bill children or their families for inoculation. Now, medical charities are investing money in research. Because any successful discovery will likely result in royalties to the charity shareholder, the charity has no financial incentive to advocate for the cost of that discovery to be accessible to those served by the charity. Talk about conflict of interest!

Rosenthal devotes the second portion of the book to offering both systemic reform, as well as individualized, methods to save money on medical treatment. Again, this section was disturbing, given that neither Republicans nor Democrats are proposing many of the reforms proposed by Rosenthal. Although concepts like tort reform have been initiated in states like Indiana, contemporary federal reform efforts appear completely off the mark.

Last, but most certainly not least, the end of the book contains multiple appendices patients can use to arm themselves in price negotiation. Although options for comparison shopping for medical procedures are limited, Rosenthal provides links to those options that are available. She also includes template letters patients can use when objecting to healthcare charges.

This book contains good stuff, all around. I’ve been bugging my coworkers about it all week long, eager to share stories about how we are all getting ripped off. This book, however, is not a ripoff, but a real gem for the bookshelf!

Review: Life, Liberty & the Defense of Dignity

~ wheelhelmina ~ Leave a comment

Leon Kass‘ Life, Liberty & the Defense of Dignity: The Challenge for Bioethics is an oldie, but a goodie. The premier bioethicist explains the philosophy of dignity, and describes how various technological advances, including cloning and progress toward immortality, threaten dignity and humanity itself.

51QQBHfwuYL._SX329_BO1,204,203,200_.jpg

The book is heavy stuff. In addition to the gravity of the subject matter, Kass dives into Kantian ethics, etymology, and the philosophy of science. Perhaps this will deter the casual reader, but those interested in the subject should appreciate the thorough eloquence of the author.

The main challenges Kass addresses include: the origins of procreation, genetic therapy, cloning, the sale of organs, the so-called “right to die,” the quest for immortality, and the nature of biology. Throughout, Kass argues in favor of restraint and respect for human nature.

I was particularly intrigued by those  passages of the book in which Kass opines on the nature of humanity itself, writing that the corporeal nature of our situation should not be discounted.

The point is crucial, and stands apart from the text that teaches that: everything high about human life – thinking, judging, loving, willing, acting – depends absolutely on everything low – metabolism, digestion, respiration, circulation, excretion. In the case of human beings, “divinity” needs blood – or “mere” life – to sustain itself. And because of what it holds up, human blood – that is, human life – deserves special respect, beyond that which is owed to life as such; the low ceases to be the low.

If the above quote gets you thinking, I highly recommend reading the remainder of Kass’ book! Indeed, given the attention on healthcare as of late, Kass’ theories are all the more timely and deserving of contemplation.