Andrew Sullivan at the Daily Dish recently blogged about American health care costs in "Why Does Healthcare Cost More In America?"  Ezra Klein studies why American procedures are much more expensive. One theory:

“In my view, health is a business in the United States in quite a different way than it is elsewhere,” says Tom Sackville, who served in Margaret Thatcher’s government and now directs the IFHP. “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.” The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high.

Follow-up here. In other health spending news, a new study finds that electronic medical records are associated with more testing and, therefore, more healthcare spending. Drum defends them regardless:

I never bought the notion that electronic records would really restrain costs much anyway. I just think they’re a good idea because they’ll reduce medical errors and make life more convenient. I’ve been with Kaiser Permanente for the past few years, and their extensive computerization of everything really does streamline the whole process of dealing with the healthcare system. I’m totally sold, regardless of whether they’re saving any money by doing it.

Yglesias bets the healthcare spending will increase no matter what:

Once you’re talking about a middle class family in a developed country—a family that’s not worried about starving to death or freezing on the streets or being unable to afford shoes—you’re talking about a family that’s going to plow what resources it has into attempting to address the potentially limitless health care needs of its members.

Philadelphia’s NBC10 reported the arrest of nursing home employee Shakeana Sims after a traffic stop led to the discovery of property stolen from residents at Kendal Crosslands Nursing Home. Police say a computer inquiry revealed Sims had several outstanding capiases issued by the New Castle County Court of Common Pleas. After she was taken to county headquarters, police say they discovered she was in possession of a stolen watch, bank card and blank check. Upon further investigation, police say they learned the property belonged to two elderly residents whom Sims cared for as a nurse’s aide.



Illinois State Senators and consumer advocates are concerned about nursing home operators failing to increase RN staffing according to articles in the State Journal-Register and the Illinois Times.  Advocates for residents and operators of nursing homes both say they support increases in direct-care staffing required by the state’s 2010 landmark nursing-home reform law.  The law, spurred by a series of articles published by The Chicago Tribune, calls for a total of 3.8 hours per resident per day of “nursing and personal care” in skilled-care facilities by 2014.  By 2014, the proposed requirement works out to about 0.75 hours of RN time — only 46 minutes — allotted to each resident each day.

The state’s nursing homes currently operate without any minimum RN staffing levels.  Registered nurses are best equipped to spot changes in residents’ health and intervene, and the presence of RNs has been proven in research to improve care.  Advocates for residents and officials from Gov. Pat Quinn’s administration say nursing homes can afford to hire more RNs.

“When you don’t have registered nurses, you have urinary-tract infections, bed sores, more hospitalizations and even deaths occurring in some nursing homes,” said state Sen. Jacqueline Collins, D-Chicago. 

Comstock said two-thirds or more of residents in most for-profit nursing homes are on Medicaid. The percent of residents on Medicaid is much lower in most not-for-profit homes, which also may receive funding from foundations and religious organizations, she said.

Proposed RN staffing requirement

*A proposal to be considered Tuesday by the Illinois General Assembly’s bipartisan Joint Committee on Administrative Rules would require 20 percent of the “nursing and personal care” provided daily for each nursing home resident to be provided by a registered nurse.

*The nursing-home reform law signed by Gov. Pat Quinn in July 2010 requires:

— 2.5 hours of nursing and personal care each day per resident in skilled-care facilities, effective July 1, 2010; and 1.7 hours for residents in intermediate care.

— 2.7 hours of nursing and personal care each day per resident in skilled-care facilities, effective Jan. 1, 2011; and 1.9 hours for residents in intermediate care.

— 3 hours of nursing and personal care each day per resident in skilled-care facilities, effective Jan. 1, 2012; and 2.1 hours for residents in intermediate care.

— 3.4 hours of nursing and personal care each day per resident in skilled-care facilities, effective Jan. 1, 2013; and 2.3 hours for residents in intermediate care.

— 3.8 hours of nursing and personal care each day per resident in skilled-care facilities, effective Jan. 1, 2014; and 2.5 hours for residents in intermediate care.


The nonpartisian Congressional Budget Office previously estimated that tort law changes would save at the most $54 billion over the next decade, which is about 0.5% of all health care spending. House Republican leadership is looking to include these so-called “cost savings” from medical malpractice as a way to pay for tax cuts to the top 1%.   It is hard to believe that we have elected representatives who would advocate for a law that would further harm individuals and families who are already hurting from the results of medical negligence. Instead of focusing on limiting patients’ legal rights, more attention should be paid to making sure people aren’t injured in the first place, which will save money and lives.

Accountability encourages safe healthcare. H.R. 5 destroys accountability. The Institute of Medicine found that 98,000 people die every year from preventable medical errors.


How to Help: Contact your members of Congress and tell them:


· The Institute of Medicine found that 98,000 people die every year from preventable medical errors, at a cost of nearly $300 billion over 10 years.

· This amount doesn’t even include the costs associated with people who are injured but survive the event.

· Decreasing the number of patients killed by medical errors would have potential savings six times greater than tort law changes.


I found the following article on AlterNet about the study on how rich people are more likely to lie and cheat.  Very interesting and explains how nursing home executives perjure themselves so easily.

Bloomberg (yes, the same Bloomberg news outlet owned by multibillionaire New York City mayor, because you can’t make this stuff up) reports that a new study in the Proceedings of the National Academy of Sciences found that the "upper class"–their words–are more likely to behave unethically than those of us with less money.

Elizabeth Lopatto at Bloomberg wrote:


The “upper class,” as defined by the study, were more likely to break the law while driving, take candy from children, lie in negotiation, cheat to increase their odds of winning a prize and endorse unethical behavior at work, researchers reported today in the Proceedings of the National Academy of Sciences.

Taken together, the experiments suggest at least some wealthier people “perceive greed as positive and beneficial,” probably as a result of education, personal independence and the resources they have to deal with potentially negative consequences, the authors wrote.


Take candy from children? Really now, guys, shouldn’t there be limits?

The tests used in the study ranged from studying video to see whether people obeyed traffic laws–those with more expensive cars were less likely to do so–to having people interview a potential job candidate for a short-term job. In the job-seeking case, the participants were told that the job would shortly be eliminated, but the wealthier participants were less likely to tell the candidate that the job wouldn’t last.

One more test had participants playing a game in which a computer rolled dice for them, for a chance to win a $50 gift certificate. The wealthier participants once again were more likely to lie about their score, even though the prize was comparatively less to them.

“A $50 prize is a measly sum to people who make $250,000 a year,” one of the study authors told Bloomberg. “So why are they more inclined to cheat? For a person with lower socioeconomic status, that $50 would get you more, and the risks are small.”

If the rich are more likely to lie and cheat for a tiny prize, why do so many still have a hard time believing that the Wall Streeters who helped crash the economy knew that they were doing something wrong?


Public News Service published an article about the importance of understanding the signed agreements in the Nursing home admission paperwork because most agreements sign away your constitutional right to a jury trial.  Many of these clauses are hidden in the piles of paperwork or in tiny print, and never explained to the resident or family members.  The intimidating, exhausting, and emotional affects of being admitted to a facility leaves little time for people to research and chose the nursing home best suited for the needs of their loved ones; often times people are left making hasty decisions on the basis of the number of available beds.  The anxiety of this situation is only perpetuated by the number of documents thrown at people in order for admission, with little or no explanation as to what they are actually signing. The rushed nature of this process often forces people into sign documents such as the arbitration agreement in the fear that it will prevent their loved one from being admitted and getting the care they need.

Mandatory arbitration clauses are put in place to protect the facilities and their corporate owners from accountability for their neglect, and do not protect the humanity of the loved ones being admitted. The article concluded that people are seldom told that signing the arbitration agreement is not necessary and cannot prevent loved ones from being admitted. A Milwaukee Attorney, Jeff Pittman said that “you do not have to sign an arbitration agreement, and the nursing home can’t refuse to admit your loved one if you don’t sign such an agreement” and that by signing the arbitration agreement “you’re giving up your rights”.

When admitting a loved one to a nursing home it is important to understand your constitutional rights and the documents that may sacrifice those rights. The care of your loved one is primary in this process and with statistics of upwards of 35, 000 nursing home residents nationwide suffering injury or death from nursing home negligence, it is important to make sure your making the best choice to protect your loved one.


Kaiser Health News reported the decision by the Supreme Court of Maine allowing Maine to limit insurance premiums and presumably their profits.  The decision upheld state regulators’ authority to hold down rate increases sought by Anthem Health Plans of Maine. The Supreme Judicial Court said that Maine’s insurance superintendent had “properly balanced the competing interests” in arriving at an approved rate increase of 5.2 percent. The insurer, a unit of Wellpoint, the nation’s largest insurer, had sought a 3 percent profit margin as part of an overall 9.2 percent increase in health insurance rates for policies sold to individuals in 2011. It argued that state regulators’ decision to grant a 1 percent profit margin violated state law and the U.S. Constitution by depriving the company of a “fair and reasonable return.”

Maine law, like that in many states, says premium increases cannot be excessive, inadequate or unfairly discriminatory.  The District of Columbia and 26 states, including Maryland and Virginia, have the authority to veto rates deemed excessive for at least some types of insurance, generally policies sold to individuals and small businesses. Seven states, including California, have the power to review rate increases in advance but not to block them.

“This is great news for consumers because it reaffirms that a state insurance regulator, when they have the authority, can do a balanced, comprehensive review of rates,” Kofman, now a researcher at Georgetown University’s Health Policy Institute.


NPR published an article that discussed the difficulty Americans have to pay medical bills despite having access to Medicare and Medicaid.  In a survey of more than 50,000 people taken by the National Center for Health Statistics, results showed that in 2011 alone one in three Americans were left struggling to pay current medical bills, previous medical bills, or were unable to pay the bill at allResearch also showed that despite access to Medicaid, which bars hospitals from billing beneficiaries, 41.3 of people below the poverty line are still unable to pay off bills.  Still 48.5 percent of people just above the poverty line were unable to pay medical bills.

The most shocking statistics showed that even of those ages 65 to 75 nineteen percent struggled to pay medical costs and of those 75 and older still twelve percent could not front medical costs. Despite the universal coverage of Medicare for elderly, a percentage of them are stressed with medical costs. In the years to come, with the retirement of some 78 million “baby boomers”, the continued rising healthcare costs, and inability for Medicare to cover costs, the future looks grim.

This is the major problem with for profit health care system.  too much money goes to administrative costs, overhead, and executive bonuses and salaries.

The NY Times reported in two articles here and here about the fraud by NY hospital Beth Israel Medical Center. Beth Israel Medical Center has admitted that it fraudulently increased fees for services to Medicare patients in order to receive millions of additional dollars from the federal government. The New York hospital agreed to pay more than $13 million in damages in a health care False Claims Act lawsuit that was filed and settled this week.   The fine does not pay back all the money taken from the fraudulent scheme.  The complaint says the fraudulent practice, known as "turbocharging," went on at Beth Israel from 1998 through 2003. The complaint says the hospital deceived the Medicare program into believing that the costs associated with inpatient medical care were higher than they actually were. Beth Israel is a component of Continuum Health Partners, Inc.

The plot involved 10 doctors, 9 separate clinics in New York City and 105 different corporations, all in service of a health care fraud ring that federal authorities say conspired to steal more than a quarter of a billion dollars.  This one, like many others, was rooted in Brighton Beach, Brooklyn, the locus of the city’s Russian-speaking immigrant population   Brighton Beach has one of the highest rates of health care fraud in the nation, according to federal statistics. In fact, an analysis of data from the Centers for Medicare and Medicaid Services, the federal agency that regulates those two programs, shows that more health care providers in the Brighton Beach ZIP code are currently barred from the programs for malfeasance than in almost any other ZIP code in the United States. (The top spot is in southern Florida, with its high proportion of older residents.)

Federal law-enforcement officials say they have seen groups of these polymaths of fraud migrate from stock schemes in the mid- to late 1990s to mortgage fraud during the last decade and health care fraud.  While the outlines of the health care fraud scheme itself were relatively typical, its scope — a conspiracy to steal more than a quarter of a billion dollars over five years from private insurance companies — suggested a sprawling criminal organization.  The ring sought reimbursement for so many excessive and unnecessary medical treatments that it had to set up three separate billing processing companies just to handle the paperwork, according to court papers.

The ring, according to the indictment, created and ran the nine clinics in the Bronx, Brooklyn and Queens, which provided unnecessary and excessive medical treatments, including physical therapy, acupuncture, pain management, psychological services, X-rays, M.R.I.’s and other services. Its members are charged with conspiring to steal $279 million.

In part because of statutes of limitation, the settlement covers only the period from Feb. 21, 2002, through Aug. 7, 2003, when the federal rules changed and turbocharging stopped. But the complaint quotes from internal memorandums and e-mails by hospital executives who embraced the strategy for increasing Medicare outlier payments recommended by a consultant, the National Revenue Group, years earlier.  For example, in an e-mail exchange in 2000, Continuum’s vice president for patient financial services wrote that the hospital was going to try to “keep the charges high even at the lowest levels of service in the E.R.” The vice president for patient accounting agreed, “This is a good start. … Go for the gusto!”

Later, another executive wrote of “feeling a bit giddy” at the thought of “getting $10 million of outlier revenue,” while another advised caution because she had become wary that Beth Israel’s turbocharging would be detected.

Why haven’t more people been arrested?