Today the much-talked about new book by Nobel Prize-winning economist Joseph Stiglitz and co-author, Harvard professor, Linda Bilmes, is hitting the book stores. It’s called The Three Trillion Dollar War and it explains how the Iraq war, a war that was originally billed as a conflict that would all but “pay for itself,” has already has cost the U.S. Treasury $845 billion out of pocket but, according to Stiglitz, will cost at minimum three trillion dollars in real costs, says Reuters in its article on the Stiglitz book.

What we could have bought with that money.

Contrast those numbers with the last segment on Sunday’s 60 Minutes broadcast, a story about what happened when an non-profit medical relief organization brought its huge, portable medical clinic to Knoxville, Tennessee, for a weekend, and offered free medical check-ups, mammograms, dental and eye care to anybody who showed up.

In the past, the organization, called Remote Area Medical, or RAM, used to airlift medical relief to isolated regions of the Amazon. Now RAM is doing 60 percent of its work in rural America because, says the organization’s founder, the need here is just so great.

In the weekend that 60 Minutes covered, RAM treated 920 visibly stressed and desperate people who waited for hours in 27 degree weather in the hope of getting in, some driving over 200 miles to seek care. Most were working poor, people who had done what America had asked of them yet were unable to afford basic medical care for themselves and their families. Many who came had insurance, but couldn’t pay the deductible their insurance required. When the weekend was over, and the RAM docs finished speeding as many patients as humanly possible through medical, dental and ophthalmological treatments, at least 400 additional people were turned away.

If you watch the 60 Minutes video, as I suggest you do (it’s a painful but, in its own way, heroic story), or if you watch the night’s first segment on the Ohio primary where Ohioans talk about the pain of lost jobs due to plant shutdowns and a sinking economy, just remember….

…three trillion bucks.

And for what?

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It’s not been a particularly good week for feeling warm and fuzzy about your health insurance carriers.

First, earlier this week, the LA Times did a story revealing that Blue Cross, “the state’s largest for-profit health insurer,” was trying to get California’s physicians to be on the lookout for conditions that the Blue Cross folks might use to cancel new patients’ medical coverage.

(The next day Blue Cross claimed that its intentions were horribly misunderstood and it was back-peddling on the strategy.)

Then yesterday, New York’s Attorney General, Andrew Cuomo, held a press conference at which he reported… “an industrywide scheme perpetuated by some of the nation’s largest health insurers to deceive and defraud consumers.”

How cheering!

Here’s more from the New York Times:

It is a common medical puzzler. The benefits statement arrives from the insurance company, saying that although the doctor has charged, say, $200 for that recent office visit, only $80 is covered — and the consumer is obliged to pick up the balance….

Mr. Cuomo announced a sweeping investigation into whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer’s networks.

According to the LA Times, the alleged scheme “could affect 70% of Americans with health insurance coverage.”

It seems that the nation’s largest health insurers —among them UnitedHealth Group, Health Net, Aetna and Cigna—have been cheating patients by rigging the rates companies pay physicians and forcing consumers to pay higher medical bills.

At the heart of the case, [Cuomo] said, is Ingenix, a company that sells data the insurers use to decide how much they will reimburse patients for out-of-network visits to physicians.

Cuomo said that insurance companies typically use the data to lowball the amount they pay these out-of-network doctors and that most policies require consumers to make up the difference.

[SNIP]

New York officials said 70% of people with health insurance are on plans that require them to pay a higher fee for the right to use physicians who are not under contract with their carrier. Such out-of-network arrangements often require the insurance company to pay 80% of “reasonable and customary” rates for physician services.

The investigation found that poor and distorted data from Ingenix allowed insurers to keep their reimbursements down by lowballing local market rates for various types of physician services, investigators said.

For example, the investigators said, insurers knew that most physicians charged $200 for a routine visit. But the insurers, using Ingenix data, claimed to their members that the typical rate was $77. Applying the 80% reimbursement rate, they covered only $62, leaving the patient to pay $132 out of pocket.

“Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is,” Cuomo said at a news conference. “But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need.”

Right. And this is exactly why health care is one of the biggest issues in this year’s presidential race.

PS: While you’re at it, have a listen to this Terry Gross interview on the three front-runners’ health care proposals (Dem and Repub). It’s informative and seems even-handed.

God knows we’ve got to do something.

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Brand new and very smart writer (and USC graduate student), Matt Mundy has written a strong piece on General Relief in LA Citybeat. It’s very much worth reading. Here are the first few ‘graphs to get you started.

Arthur Walker is unsure where he’s going to sleep tonight. Slumped at the back of the Department of Public Social Services office on the fringe of Los Angeles’ Skid Row, he’s put in a long, restless, eight-hour day. A hint of fidgetiness emerges every so often, but it’s obvious he’s been here before. If waiting were a card game, his slump would be his tell.

Desperately poor with a lifetime of hard knocks weighing him down in his chair, the 38-year-old African American fits in well with the other people crammed into this office. Overweight and bald, glasses adding a semblance of scholarliness to a baby face notable for its soft anonymity, he cuts a sympathetic figure. His voice has an understated urgency to it, words tumbling out at a rhythmic clip, rising only when he gets frustrated.

After passing through the metal detector at the front door, Walker joins dozens of others shoehorned into the cramped, windowless office, waiting for their names – many waiting for hours – to be called out over the crackling intercom. Two large sections of faded-green, stiff-backed chairs provide the seating areas, where some have already fallen asleep, limbs uncomfortably splayed out. Two upright fans futilely recycle the rank air while a lopsided television hangs in one corner, turned off. Everyone looks miserable.

Walker is here to grasp at the last rung on the welfare ladder for single, childless adults: General Relief. But it’s a slippery rung. At just $221 a month, no one can survive on it for long, and it’s a short fall to the streets. That’s beside the point for Walker right now – he must get approved first, and the earliest the money can come will be next month, too late to help him out tonight.

The rest is here.

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That’s the opening of Steve Lopez’s column in Wednesday’s paper. It’s been emailed to me by four different people, so I finally managed to read it. I’ve printed the opening below, but be sure to read the whole thing. Then let’s get more agressive at holding these candidates running around Iowa accountable for this issue.

Here’s the heart of what Lopez writes:

I was on my way to the Encino home of a 10-year-old boy named Preston, but I could have gone in any direction for the same kind of story.

Ever since I wrote a few years ago about a San Gabriel Valley woman who had breast cancer and couldn’t get health insurance (her family resorted to a yard sale to pay her medical bills), I’ve gotten a steady trickle of similar tales. Last week, I had one involving an oncologist whose cancer treatment is not being covered because his health insurance company says his illness is a pre-existing condition.

Preston doesn’t have cancer, but he was born with cystic fibrosis. And the cost of the medicine that keeps him breathing just shot up like a rocket, thanks to an insurance company decision I’m still trying to decipher.

I’ll get to the details in a moment, but first, some political context.

Read the rest of this entry »

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My full column for the LA Weekly on last Friday’s closure of Martin Luther King Jr.-Harbor Hospital is online now. (Some of the stuff we’ve already discussed here at WLA.) I’ve posted a healthy chunk of it below. (NOTE: “Chernof” is Dr. Bruce Chernof, the director and chief medical officer of the LA County Department of Health Services. He is also pictured in the photo above.)

,,,In all, the report painted a picture of a hospital that had been in deep water for a long time and, despite warning after warning, had not made the most basic of changes needed to save itself. As the federal officials pointed out in a summary letter, “Repeated certification surveys and complaint investigations have identified serious health and safety violations and documented the hospital’s inability to comply with these federal standards.” As a consequence, the feds saw no choice but to pull the hospital’s Medicare provider agreement and, with it, $200 million in federal funds MLK needs to operate. “This decision is final,” said the letter — in case anyone hoped there might still be wiggle room.

But although most of MLK is closed, the county faces substantial community and political pressure to find a way to reopen it. Thus, on Monday, Chernof outlined a plan for the hospital to eventually be resurrected.

The idea, he said, was to find a “non-county operator” — maybe a private hospital or university — to take over. Or, failing that, to find some outside entity to supervise the hospital’s makeover, using “reconfigured county leadership” — an apparent reference to the feds’ finding that the Board of Supervisors is one of MLK’s problems. Some of the board members pushed Chernof to set a reopening timetable, but he demurred, and sources close to the board admitted to the L.A. Weekly that the county is a long way from finding a partnership.

“Trust me, it’s not that easy,” agrees Downey hospital’s Guest. “At best, this will take a while.”

Through much of Monday’s meeting, politicians such as Supervisor Yvonne Burke and U.S. Congresswoman Maxine Waters repeated the mantra that everyone should “just move forward” and “we should not place blame.”

But others wondered privately if a little blame placing might not be crucial to the hospital’s recovery, if it is ever to recover. After years of multipage reports issuing dire warnings — not to mention the board’s expenditure of $18 million in taxpayer funds on consultants — and after scores of broken promises, perhaps residents of Los Angeles County deserve to know why, as of last Friday, MLK still had nurses on its staff who could not mix medicine.

“We were told that Harbor-UCLA would take over management of Martin Luther King,” said state Assembly Member Laura Richardson when it was her turn to address the county supervisors. “And that never happened. Well, why didn’t it happen?”

On Tuesday, the Weekly asked county health department spokesman Mike Wilson those same questions. Why were the majority of MLK staff — who were supposed to receive rigorous off-site retraining — never retrained? Why were a significant percentage of MLK staff — who were supposed to be laid off or transferred — never laid off or transferred? And why, after officials announced that the respected Harbor-UCLA Medical Center was taking the reins of MLK — and even changed the hospital’s tainted name from King-Drew Medical Center to Martin Luther King Jr.–Harbor Hospital — did that transfer of power fail to occur? Who stopped it?

“I don’t know,” an exhausted-sounding Wilson said finally. “Dr. Chernof made all those requests.”

Yet someone chose not to put Chernof’s vital “requests” into practice. It was clear this week that county officials, and some of the most powerful politicians in California, had no idea who prevented the ordered changes, or why. If Martin Luther King Jr.–Harbor Hospital is ever to successfully rise from its own ashes to serve the communities that need it, those and other questions must still be answered.

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I’ll post more on this tomorrow when my very quick and dirty MLK-Harbor postmortem goes up on the LA Weekly website. But, in the meantime, for the morbidly curious, you can read the entire 124-page final survey report in which CMS (federal Centers of Medicare and Medicaid Services) listed MLK’s failures that led to the feds yanking their Medicare certification, and the $200 mil that went with it.

At first, county officials had no intention of handing over the CMS report. But when a lot of press and community members threw fits at this withholding behavior, County Supervisor Gloria Molina wisely urged the board to release the thing at Monday’s special Board of Sups meeting. So, Monday night the full report quietly appeared in PDF form on the Board’s website.

The CMS report describes in dizzying detail a staggering level of incompetence. For instance, inspectors found MLK nurses who were unable to “correctly calculate dosages for medication” to be given to pediatric patients, and worse, other nurses incapable of locating “critical equipment and medications on the pediatric emergency cart.”

CMS also outlined how MLK patients were “placed at serious risk for exposure to contagions, such as tuberculosis” because of such basic lapses in hospital hygiene as the staff’s failure to “clean and track” bronchoscopes.

One particularly alarming section describes a psychiatric patient who was “observed through the window of the room door, cutting both arms with a scalpel.” When first questioned, MLK staff members insisted that the arm-gouging patient brought the scalpel in with him in “a bag of Doritos chips.” (Unfortunately, I’m not kidding about this.) Yet when the fed team looked a bit further they noticed \that the scalpel’s lot number matched that of other scalpels stored in MLK’s locked ER supply cabinet. In other words, the instrument came from the hospital—not a Doritos bag. And when the CMS people looked still further, they found that the psych patient had been observed alone next to a “gurney that had open drawers” —inside which there was a supply of “needles, ….tubes, and scalpels.”

Now remember, all this leaving of scalpels within reach of suicidal psych patients, and the inability to mix kids’ medicines, occurred during the feds’ make-or-break inspection–i.e., when hospital personnel were theoretically on their best behavior.

Not good.

We all truly hope that King-Harbor Hospital will eventually reopen, since the more than 45,000 emergency room patients that use its services each year, desperately need the facility back up and running—as does the County of Los Angeles, with its already overburdened emergency health system.

At Monday’s four-hour long, specially-convened County Board of Supervisors meeting, I talked privately to two of the heads of the hospital ERs that are expected to pick up MLK’s slack. They were somewhat freaked at the prospect.

And, as one county official said to me Tuesday, “Yeah, and what if LA had a real emergency medical crisis—like a terrorist attack. Then what would we do?”

What indeed?

Yet, if we are to have a prayer of MLK rising again Phoenix-like, we need to really understand what went wrong. And so far no county official in a position to know seems willing or able to tell us.

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Federal inspectors announced today that they are pulling the plug on $200 million in federal funding for Martin Luther King-Harbor Hospital.

It’s over.

The fat lady ain’t officially sung yet; the decision ultimately lies with the Los Angeles County Department of Health Services (DHS), which answers to the LA County Board of Supervisors. But that fat lady is warming up.

The hospital’s emergency room will shut down as of 7 pm Friday night

DHS director, Bruce Chernof has announced that he is requesting a “voluntary suspension of the hospital license.”

All of this has to be formally approved when the Board of Sups meets in special session on Monday. But it’s a done deal.

The cynical among us wondered if Dr. Chernof would actually pull the plug on MLK—if and when the feds pulled the money. There was the worry that political correctness and factional pressures would continue to win out. And that once more there would be a series of last ditch efforts and promises….

….but then, as has happened over and over, the fundamental changes needed would not be made.
(To illustrate, here is the LA Times timeline on MLK’s history.)

Nobody wanted to see it come to this. It’s tragic for the community, a failure for the city and county. But when 27 percent of all patients walking into MLK’s emergency room are considered at risk, it’s time to clear the table and start again fresh.

We can’t afford more horror stories like those of Juan Ponce and Edith Rodriguez.

Now the question is, where do we go from here.
*********************************************************************

UPDATE:

NOTE: I’m working an analysis of all this for the LA Weekly, trying to make sense out of what we should take away from this, and where we DO go from here, and have been chatting with some of those involved in order to sort out some thoughts. Not that anyone in the entire town, as yet, has an answer.

Mike Antonovich, not usually among the most enlightened of men, was—of the County Sups—the most forthright in pointing the finger at his own board, himself, and some others in this city, for allowing the failures to go on unchecked for so long.

Chernof, in his official statement said that MLK will eventually reopen. “… the department is committed to reopening King-Harbor as a full-service hospital as soon as possible,” he said, “and is working to identify potential private operators, or options for County operation under a reconfigured model….”

Well, okay. Good luck. In the past, DHS has tried to find private operators with no cheerful takers. I’m not sure what exactly makes the prospect MORE attractive for private companies now that the situation has gotten worse, not better.

It’s a heartbreaker. But, so, so much money has been poured into a place where the clean-up job that was promised over and over again, was simply never done. The staff that was supposed to be fired….wasn’t. The people who definitely, positively, we swear on our mothers lives, were going to be retrained….weren’t. UCLA-Harbor, which was supposed to provide new management, never took over.

And so the awful mistakes continued, and the lies, the excuses, and the prevaricating….

And yet……

“It’s a very personal relationship this hospital and the community have,” a sobbing Lark Galloway-Gilliam, executive director of Community Health Councils, said to the LA Times. “People fought to have this place built, and it’s been employment for some people. It’s been a symbol that our community is somewhat whole, that the resources are there that you need when you want them.”

Well, not anymore.

***************
PS: This somewhat bumped the wild and woolly school story I promised today. Look for it early Monday morning.

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Folsom Prison

Federal Judges Thelton E. Henderson and Lawrence K. Karlton have absolutely HAD IT with Governor Arnold Schwarzenegger and the California State Legislature. The judges feel they’ve given clear warnings. They’ve said what the consequences would be if Arnold and the Leg don’t get their collective act together in terms of relieving prison overcrowding that has metastasized to such an extreme, say the judges, that it has created inhumane conditions clearly in violation of the U. S. Constitution—particularly in areas pertaining to prisoner health and mental health.

(I can attest to this—at least second hand. Because of my work, I get weekly collect calls from various state correctional institutions, and the tales I hear on a regular basis are pretty horrifying. Of course, they are also tough to prove as, with extremely rare exceptions, reporters are prevented from visiting prisoners.)

In response to the judge’s previous warnings, earlier this year lawmakers endlessly congratulated themselves for passing AB 900, a monster $7.4-billion prison-building bill. The judges, however, were not molified and all but visibly spat on the legislation, correctly pointing out that while it adds 54,000 additional beds, it does so without also adding extra staffing or any appreciable rehabilitation programs for prisoners. In other words, it would make things worse.

“From all that presently appears,” said Judge Karlton, who is overseeing a mental health care class-action lawsuit against the prison system, “new beds will not alleviate this problem but will aggravate it…..Given the almost twelve years that this case has been in its remedial phase,” he growled, “and given the constitutional considerations at stake, the direction in which the State has at present chosen to go by enacting AB 900 simply fails to address in any timely way relief from the overcrowding crisis and its attendant impact.”

This brings us to yesterday when the two judges announced that they were talking matters out of California lawmakers hands and into their own—then appointed a three person panel to come up with a way to alleviate the overcrowding. This is the last legal step before the judges actually “cap” the population—meaning that they could enforce dramatic remedies to keep the statewide prison population down to a fixed, manageable level. For instance, to do so they could require:

1. Certain low-level offenders to be released early. (This means that as many as 35,000 prisoners could get sprung.)

2. Thousands of offenders released to serve the rest of their sentences at home with an electronic anklet. (Since a significant portion of California’s prisoners are locked up for technical violations of their parole, not for new crimes, they would likely be first on the list along with non-violent, low-level drug offenders.)

3. Sentencing reform, sentencing reform, sentencing reform.

Arnold and the state legislature swear they’ll be able to get this all in hand before the panel brings down the hammer.

The judges don’t seem one bit convinced.

The LA Times, and the NY Times among others have stories.

PS: Several of my felonious collect callers tell me they’ve heard about the possible cap and are keeping their fingers crossed that it’ll happen and they’ll be on the Get-Out-Of-Jail Card list.

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I have something to tell you that may come as a shock. Are you all sitting down? Okay, here it is: PRISON INMATES SOMETIMES HAVE SEX WITH EACH OTHER. Yes, yes, I know. Even though, it’s against the law, it sometimes occurs anyway.

As a consequence, the nation’s prisons have become fertile breeding grounds for deadly blood-borne viruses like hepatitis C and H.I.V..

California’s disastrously overcrowded prison system is particularly at risk. (And remember, our prisons feature a health care system that is so freaking awful it’s presently controlled by a federal monitor.) California is so at risk, in fact, that the NY Times saw fit this morning to publish an editorial on the subject, which reads in part:

The Centers for Disease Control and Prevention underscored this point last year when it urged states without condom-distribution programs to think about starting them as a way of preventing the spread of H.I.V. behind bars. By protecting the inmates, the states would also protect the all-too-vulnerable wives and lovers to whom they inevitably return when their sentences are completed.

The California State Legislature tried to take the C.D.C.’s advice last year, passing a landmark bill that would have allowed public health agencies to enter prisons and distribute condoms to inmates who wanted them. The bill had the overwhelming support of the voting public.

And what did Gov. Arnold Schwarzenegger do in response to the passage of said bill? Did he congratulate the state’s lawmakers for managing to work together long enough to pass a sensible piece of legislation?

No, he did not. He vetoed it. Condoms might would justify illegal sexual activity, opined Arnold. (He also worried that inmates might use condoms to smuggle drugs into or out of prisons. News flash. Arnold, honey, it’s already as easy to get drugs inside prison, as it is on the street. You might want to ask around about this issue BEFORE you veto an important bill next time.)

Never mind that California inmates continue to become HIV positive at a rate that is eight times higher than the general population. Ditto when it comes to acquiring Hep C.

Why, by the way, is it only the NY Times who’s bothering to take a reasonable stand this? The Daily News has ZERO. The LA Times has ZIP. And the Orange County Register—whose editorial page editors should be locked immediately in a cell with a large, overly-affectionate, condom-free inmate named Bubba—writes the following:

Perhaps the epitome of Nanny State philosophy is embodied in the “Condoms for Cons” bill, AB1334. It’s against the law for prison inmates to engage one another in sex acts, but this bill would facilitate that activity by allowing private groups to distribute condoms and other “sexual barrier protection devices” to prisoners. Nanny Staters insist that if the law is going to be broken, it must be broken their way.

I mean, why bother acting in the best interest of public health and public safety when you can advance partisan talking points, right?

Fortunately, seventy percent of Californians are in favor of condom distribution in prison—mainly because most people are not idiots.

Now a new bill, proposed by Oakland Assemblyman Sandré Swanson, is working its way through the California legislature. Let’s hope it passes, and that Schwarzenegger does the right thing.

In the interim, listen: I’m really, really against determinate sentencing laws, but maybe for certain editors exceptions could be made.

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You gotta wonder how much L.A. County supervisors really want to save Martin Luther King Jr.-Harbor Hospital, formerly known as King-Drew. Next month federal inspectors could very likely shut down the horror house, where substandard care has killed and maimed dozens of people over the years. Here are three steps supervisors could take today if they really care about the hospital and serving the thousands of consitutents who, for better and often worse, depend on it.

–Convene their regular meetings in one of the hospital’s now vacant wings. This not only will boost the supervisors’ goodwill in the community, but will offer up-close views of their efforts to improve care.

–Order all hospital employees who are holdovers from the old, killer regime to wear black armbands. Not only will this make them visible to supervisors, who claimed to be surprised this week by the lack of progress on-site adminstrators have made replacing them, but it will show the public who they need to stay away from.

–Cancel the supervisors’ health insurance plans and require them to see doctors at King-Harbor for all of their medical needs.

*** The Father’s Day celebration that almost didn’t happen. Read Celeste Fremon’s latest story in the L.A. Weekly on the emergency-room saga of Juan Ponce.

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