Thursday, April 10, 2014

7.1 Million Sign-ups Don’t Say Nothing


Unlike most folk of my ilk (poverty stricken African Americans), I find it troubling that we have given our Federal government the ability to make us buy a flawed product, or any product regardless if we want to or not. But putting that aside, I want to briefly discuss How I view the metrics of the Affordable Care Act or what is frequently called Obamacare (actual law in picture).

It seems as if many of its supporters are hooping and a hollering that the program has proven to be a success just because it had 7 million plus sign up. I on the other hand, can’t even understand how anyone can use this as an indication of success. Personally, to use this number I would have to know how many who signed up actually had insurance before but lost it due to the law itself. Next, I would have to know how many of those that signed up actually will be receiving Medicare. For example, currently, more than half the states and the District of Columbia are proceeding with a Medicaid expansion which allows them to extend medical coverage to single and childless adults, of which has encouraged jail operators in many of those states to use this criteria to enroll and provide coverage to inmates under ACA.

Last, I won’t be able to see the law in action until all the exemptions and waivers the President unilaterally awarded to businesses and other entities go into effect. Just looking at Maryland for example, we know that only 60,000 people have signed up for Obamacare through the state’s exchange although more than 70,000 in the state lost their health insurance. Is this a marker of success (I know more than 250,000 in total but I am not including Medicare).  But I digress.

Yet still, even without such, that I can see where the Affordable Care Act is going and all I have to do is look at the only other major health delivery operation the government runs is functioning, and that is the Veterans Administration Hospitals.

Everywhere you look the VA is having problems, both with patient enrollment and service delivery. In South Carolina recently, it was noted that problems at the Department of Veterans Affairs hospital in Columbia covered everything but the kitchen sink including but not limited to problems with surgical procedures, operating rooms not always being stocked with backup surgical instruments and equipment and not monitoring patient care close enough. More importantly, problems associated with infection control and rarely following up to ensure problems are solved adequately. And this is after reports of six deaths due to delayed screenings for colorectal cancer at the Hospital.

At the Buffalo Veterans Administration, New York, more than 700 patients at the Center may have been exposed to HIV, hepatitis B or hepatitis C because of accidental reuse of insulin pens, between Oct. 19, 2010 and November 2012.  Then there are the, three deaths that occurred at the Memphis VA, of which one of the deaths occurred because the patient was given a drug despite a documented allergy to that medication and another due to receiving a lethal dose of a painkiller. The last because VA staff did not give the patient the proper medication.

A drug abuse rehabilitation program at Miami’s Veterans Affairs hospital failed to monitor patients, provide sufficient staff, control access to the facility or even curb illicit drug use among patients because Staff members were frequently absent or in a back room instead of monitoring patients in the drug abuse rehabilitation unit. As expected numerous deaths have resulted as a consequence, specifically due to cocaine and heroin overdoses. The Miami VA is part of a network which also saw five cancer patients die because of long waits and delayed care. Not to mention that in 2009, the Miami VA revealed that nearly 2,500 veterans might have been exposed to HIV and other illnesses during colonoscopies performed with improperly cleaned equipment. In 2010, the St. Louis VA hospital may have exposed more than 1,800 patients to HIV and hepatitis in 2010 as a result of contaminated dental equipment. At the West Los Angeles VA Medical Center a 47-year-old Air Force veteran had the wrongtesticle removed during surgically which left him without any functioning testes.

I could go on and on but the fact remains that what we see with the government run VA is what we can expect from the government run Affordable Care Act. The delays that new veterans facebefore receiving disability compensation and other benefits often is way way longer than the private sector, with an average wait time of 273 days. Even worse are those veterans who served in Iraq and Afghanistan filing their first claim, wait nearly two months longer.  And don’t live in New York, Los Angeles or Chicago because that time is doubled.

Across the VA system we observe benefits claims taking longer than ever to process according to a recent report by the Center for Investigative Reporting. Before 2009, the number of veterans waiting more than a year for their benefits was 11,000. Since 2009 that figure grew to 245,000. And all the Federal Government does is asking for and gives more money as if that is the solution.  It is not. The problem with the VA, which is indicative of how the federal government manages health systems. It is one of management, administration, lack of understanding about health care delivery and oversight.  And this is the case for other VA hospitals around the nation in places like Dayton, Atlanta, Pittsburgh and Jackson,Mississippi.

All of the aforementioned is happening even after five years ago the president made a pledge to repair the VA bureaucracy. There should be no way in the world that a dysfunctional systemlike the VA top brass keep getting millions and gain capacity in only by underserving the millions veterans. Yet VA network directors get tens of thousands of bonuses every year on top of six figure salaries.
Rica Lewis-Payton, the network director of the South Central Health Care Network, which includes Jackson, got almost $36,000 in bonuses last year: Washington, D.C., Diana Rubens, the VA executive in charge of the nearly 60 offices that process disability benefits compensation claims, collected almost $60,000 in bonuses. Rima Ann Nelson, the former director of the St. Louis VA (where HIV and hepatitis exposure is believed to have occurred),  had received close to $25,000 in bonuses since 2009; At the  Atlanta VA Medical Center, three of which VA’s inspector general linked to widespread mismanagement, former director James Clark received $65,000 in bonuses over four years.

Again, the issue is management. If we do take the 7.1 or 10 million as a metric of success, we must acknowledge that less than a million of that number did not have insurance, meaning folks who had private insurance were forced to purchase government insurance, allowing the federal government to run and control 16 percent of the U.S. economy. If this isn’t a corporate takeover or monopoly, nothing is.  Second, the ACA to reduce the cost of CARE and or better management. Insurance is based on math and the actuarial sciences. 

Fact is that comparatively speaking, young men use very little health care when compared to young women use more than young men. No way in the world would folk stand for young men saying they should pay the same rates of women, when the fact is that young men driving habits dictate they should pay more than young women.

But like I said, numbers won’t tell the story, but if you look at how the government currently runs health care from filing claims to service delivery, we need only look at the VA and the disproportionately negative health outcomes occurring compared to the private sector. And if Obamacare is managed in the same inept manner, as long as hospitals and insurance companies raking in the loot, money will go to huge profits before health care is provided. And as a result, all the regular folk gonna see is higher co-pay, higher deductibles, higher premiums, folk losing their doctors, not having access to the hospitals in their community and the same old federal mismanagement practices. I mean, is it feasible to expect that people who never read the ACA prior to voting to pass it as law, actually know what it does to manage it even modestly? The real issue is not having coverage but lowering cost and improving service delivery. Unfortunately politicians have people equating health insurance to improved health care or even just health care when it is not. Having health insurance makes you no healthier than having auto insurance makes you a safer driver.

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