Westhill Healthcare Consulting Jakarta fraud prevention review - FTC Warns about fake health insurance sites trying to trick you out of personal information - Westhill Consulting Insurance

Tulsa – October marks the start of when many health insurance plans open enrollment. Medicare and Obamacare will also soon begin enrolling for next year’s coverage.

2NEWSProblem Solver Jamil Donith has a word of caution before you shop for health insurance online.

According to the Federal Trade Commission, health insurance scams are preying on consumers shopping for or comparing health plans online. Scammers use websites or phony non-profit sites that seem to offer discount medical plans. In reality, the sites are set up to get your personal information. Things like your age, occupation, contact information, marital status and whether you have pre-existing medical conditions.

The FTC advises:

·        Be stingy with your personal information when you’re on the web. When a site asks for your personal information know that data could end up in the wrong hands. A health insurance website might look like the real deal, but many are fronts for criminals wanting to steal your money and personal information.

·        Research a company before giving it your business. Enter the company’s name and the “complaints” into an online search engine to see what comes up. And, before giving any personal information ask the company for the details in writing about what you want to buy. If it can’t provide the fine prince, that’s a big red flag.

·        Finally, check to find out if the plan you want to buy is really insurance. The State Insurance Department can tell you whether the plan is legitimate and whether an insurance provider is licensed to do business in Oklahoma. The Oklahoma Insurance Department website link is www.oid.ok.gov

Westhill Healthcare Consulting Jakarta fraud prevention review Wonkbook: Why the Obama administration won’t oversell Obamacare in year two

Wonkbook’s Number of the Day: 70 percent. That’s the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced.

Wonkbook’s Chart of the Day: Oil prices are falling, and fast.

Wonkbook’s Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless.

1. Top story: With a month to go, why the Obama administration won’t oversell Obamacare in year two

Team Obama’s year-two strategy: Underselling Obamacare. “The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered — and burned — by last fall’s meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won’t be perfect but will be improved.” Jennifer Haberkorn in Politico.

Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post.

If you like your plan, can you keep it this time? “Health insurance companies, at least so far, seem to think HealthCare.gov is on the right track to function more smoothly for new customers. But insurers still see gaps in the system for people who want to renew their coverage, including pitfalls that threaten consumers with duplicate enrollments, unexpected cancellations, or surprising tax bills. Insurers aren’t necessarily worried about problems as dramatic as last year’s HealthCare.gov failure, but rather what one industry official called ‘a soup of kind of icky things’ that could make life difficult for returning enrollees. Some of the technical problems stem from the difficult balance between keeping people enrolled and encouraging them to shop for a better deal.” Sam Baker in National Journal.

The potential perils of auto-renewing. “If you auto-renew, you’ll most likely be assigned the same tax credit as you had for 2014. But if your income has increased, your credit may be too large — and you could end up owing the government money, when the numbers are reconciled at tax time. Consumers are supposed to report changes in income during the course of the year, he said, but it’s likely that many have not. So by re-enrolling and updating details about income, you’ll help make sure the credit is properly adjusted. Also, because of a quirk in the way the A.C.A. calculates the tax credits, some consumers who stick with their same plan actually could end up paying more — even if their original plan doesn’t raise its rates.” Ann Carrns in The New York Times.

Explainer: How the new HealthCare.gov stacks up with the old Ricardo Alonso-Zaldivar and Calvin Woodward in the Associated Press.

An Obamacare October surprise? “Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act….The attacks could easily give the impression that the health care law is causing premiums to go through the roof around the country. They’re not.” David Nather in Politico.

For employer-based plans, expect modest premium hikes and higher consumer costs likely. “Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes. Experts anticipate that premiums will rise a modest 4 percent in 2015, on average, slightly higher than last year but lower than typical recent Increases. Even so, more employers say they’re making changes to their health plans in 2015 to rein in cost growth….They are motivated in part by upcoming changes mandated by the health law.” Michelle Andrews in Kaiser Health News.

Cities are eliminating health benefits once promised to retirees. Can Obamacare fill the gap? “Indeed, public employers across the country may soon begin following Detroit’s lead and withdrawing coverage for retirees, instead sending them to the health-care exchanges set up by the Affordable Care Act. ‘Since the passage of the Affordable Care Act, I think it is fair to say that every public-sector employer is looking at the exchanges as a potential way to get out of the unfunded liabilities that the public sector is bearing,’ said Olivia Mitchell, executive director of the Pension Research Council and a Wharton professor. ‘People are becoming more expensive to take care of.’” Alana Semuels in The Atlantic.

Medicaid backlogs could worsen once Obamacare signup season arrives. “The delays stem from various technical problems and the sheer volume of Medicaid applications states must process. Some applications that come through the federal enrollment site, HealthCare.gov, and are transferred to the states still have problems with data accuracy, said Matt Salo, executive director of the National Association of Medicaid Directors. While consumers can apply for Medicaid anytime, an influx is expected when exchanges reopen for enrollment on Nov. 15 and eligible applicants go into the Medicaid system.” Stephanie Armour in The Wall Street Journal.

Other health care reads:

Your guide to Medicare open enrollment. Jonnelle Marte in The Washington Post.

U.S. finds many failures in Medicare plans. Robert Pear in The New York Times.

KLEIN: Obfuscating on Obamacare in Kentucky. “In attempting to navigate this environment, McConnell has staked out a position that’s incoherent — arguing that he wants to wipe out the awful entity ‘Obamacare,’ while trying to create the impression that it wouldn’t affect anybody’s benefits….But Grimes wasn’t being forthright either. It’s popular to criticize Republicans for attacking Obamacare without offering an alternative. On the flip side, Grimes vowed to streamline and fix Obamacare, without offering a single workable suggestion for how she’d go about it.” Philip Klein in the Washington Examiner.

Top opinion

THOMA: What’s the best way to overcome rising economic inequality? “So my approach to fighting inequality in the short-run is to use taxation and corrective redistribution to ensure that workers receive the income they deserve, to fix the distributional problems that have allowed those at the top to capture more than their fair share of income, and enact supply-side incentives that have been shown to work as soon as possible. The hope is that the supply-side policies and corrections to the distribution of income will produce the types of jobs and equitable compensation that are needed to solve the inequality problem in the longer run. But there’s a chance that no matter what we do, the inequality problem will persist.” Mark Thoma in The Fiscal Times.

FEYMAN: Are private exchanges the future of health insurance? “In 2014, about 2.5 million people across companies of all sizes will be enrolled in health insurance through so-called private exchanges. These are analogous in some ways to Obamacare’s state and federal-based health insurance exchanges but instead are run by private consultancies like Aon Hewitt or Mercer. While these platforms generally offer a similar ‘e-commerce’ approach to purchasing health insurance — either with a single carrier or multiple carriers offering plans — as the public exchanges do, there remain key differences.” Yevgeniy Feyman in Forbes.

PORTER: The risks of cheap water. “As climate change and population growth further stress the water supply from the drought-plagued West to the seemingly bottomless Great Lakes, states and municipalities are likely to impose increasingly draconian restrictions on water use. Such efforts may be more effective than simply exhorting people to conserve. In August, for example, cities and towns in California consumed much less water — 27 billion gallons less —than in August last year. But the proliferation of limits on water use will not solve the problem because regulations do nothing to address the main driver of the nation’s wanton consumption of water: its price.” Eduardo Porter in The New York Times.

McARDLE: Don’t care about the deficit? Now you should. “As the Fed tightens up on monetary policy, our borrowing costs are going to rise, not just for the new debt we take on, but also for the debt we already have. As old debt matures, we’ve been borrowing at record-low interest rates, which has helped hold down the deficit. But as the Fed tightens, that party will end, and the numbers will start moving in the other direction. This will take time — the Obama administration has been actively working to lengthen its debt maturities in order to take advantage of the low rates. But in future years, this will place constant upward pressure on our deficit.” Megan McArdle in Bloomberg View.

CRAWFORD: A Nobel-winning message for the FCC. “Jean Tirole’s Nobel Prize in Economic Sciences is being celebrated on both sides of the Atlantic by academics and economists. But there is no joy in the power circles of U.S. telecommunications policy. More than a decade ago, federal policy makers turned their backs on Tirole’s sensible assessments of private communications utilities — and with disastrous results. Tirole’s insight was that any company controlling physical lines into homes and businesses, left to its own devices, would act as a natural monopoly, extracting tribute from every other business and customer that depends on communications capacity. To constrain that power, regulators might need to separate wholesale and retail communications-access services, and require interconnection with other networks.” Susan Crawford in Bloomberg View.

FRIEDMAN: A pump war? “Bottom line: The trend line for petro-dictators is not so good. America today has a growing advantage in what the former Assistant Energy Secretary Andy Karsner calls ‘the three big C’s: code, crude and capital.’ If only we could do tax reform, and replace payroll and corporate taxes with a carbon tax, we’d have a formula for resiliency and success far better than any of our adversaries.” Thomas L. Friedman in The New York Times.

Science interlude: Schrödinger’s cat — the thought experiment, explained.

2. How America is treating its Ebola patients

Breaking: 2nd worker who cared for Ebola patient tests positive. “The worker reported a fever Tuesday and was immediately isolated at Presbyterian hospital. Preliminary tests were performed late Tuesday by the laboratory for the Texas Department of State Health Services in Austin, and the positive results were received at about midnight. Additional tests to confirm the positive reading were underway by the federal Centers for Disease Control and Prevention in Atlanta. Officials interviewed the worker to identify anyone else who might have been exposed, the Texas Department of State Health Services said in a statement, but it was unclear whether any others were being monitored.” Manny Fernandez in The New York Times.

As nurses balk at protocols, hospital, CDC to ramp up its response measures. “A nurses’ union released a scathing statement that it said was composed by nurses at the Dallas hospital where the nurse, Nina Pham, 26, contracted Ebola. The statement told of ‘confusion and frequently changing policies and protocols,’ inadequate protection against contamination and spotty training….Officials at the hospital, Texas Health Presbyterian Hospital, defended their efforts to ‘provide a safe working environment,’ but said they would review any concerns raised by nurses. C.D.C. officials…pledged to dispatch within hours a newly created response team to any hospital that had a confirmed case of Ebola, and they increased the amount of expertise, oversight and training at the hospital.” Manny Fernandez and Jack Healy in The New York Times.

Nurse with Ebola was given serum from surviving American doctor. “In late July, when it looked like Dr. Kent Brantly wasn’t going to make it, a small news item escaped Liberia. It spoke of Brantly’s treatment — not of the Ebola vaccine, Zmapp, which Brantly later got. But of a blood transfusion. He had ‘received a unit of blood from a 14-year-old boy who had survived Ebola because of Dr. Brantly’s care,’ the missive said. Now months later, Brantly, who has since recovered from his battle with the virus, has passed on the favor. A 26-year-old Dallas nurse named Nina Pham, who contracted the illness while treating the United States’ first Ebola patient, has received Brantly’s blood.” Terrence McCoy in The Washington Post.

Why not give this blood to everyone? “It’s sheer luck that Brantly has been a match for all three. Another Ebola survivor, missionary Nancy Writebol, offered blood to Thomas Eric Duncan, but it wasn’t a match. Duncan died last week. The use of what’s called convalescent serum — blood from survivors of Ebola — is also controversial. It’s not clear whether it helps patients recover, although Brantly also received serum, in his case from a boy he treated in Liberia….Is there a way to make a ‘universal’ donor? Is there some way to make blood that doesn’t react with anyone’s blood? That’s what the makers of the experimental drug ZMapp are trying to do.” Maggie Fox in NBC News.

Company puts sole focus on experimental Ebola drug ZMapp. “As Ebola continues to ravage West Africa and spreads for the first time in the United States, a Kentucky company is putting all other work aside to concentrate solely on producing the experimental medicine ZMapp. The goal: to ramp up production of the drug and get it approved and to the people who need it more quickly. Kentucky BioProcessing, contracted by privately held drugmaker Mapp Biopharmaceutical of San Diego to produce ZMapp, makes the compound using tobacco plants. The plants act as ‘photocopiers’ to mass-produce proteins.” Laura Ungar in USA Today.

Chart: Experimental drugs used for Ebola. The Washington Post.

Experts question ethics of placebo trials for Ebola drugs. “A group of influential health experts has argued the standard practice of using placebos in drug trials would be unethical in the case of experimental medicines for Ebola, given that the world is in the middle of a deadly epidemic….A different group of disease experts last month argued in a letter to the Journal of the American Medical Association that experimental Ebola drugs were best tested in normal RCTs. A similar debate is going on in the field of cancer drugs, where researchers increasingly question whether randomisation — where some patients are given a treatment and others get a ‘control’ substance for comparison — makes sense in patients with an incurable disease.” Kate Kelland in Reuters.

Explainer: A summary of promising Ebola therapies. Liz Szabo in USA Today.

The long quest for a vaccine slowed by ethics, politics and science. “The insidious nature of the Ebola virus has been among the hurdles in the long, elusive quest to develop an effective vaccine and treatment for one of the most dangerous viruses the world has ever known. Progress also has been slowed by the hazards that come with researching it and — perhaps more than anything else — by the economic and moral questions of focusing on a pathogen that until the current outbreak had infected fewer than 2,400 people worldwide….In the coming months, as caregivers, politicians, and armies struggle to deal with the spiraling number of cases, a handful of vaccines and treatments will be tested on humans for the first time.” Karen Weintraub in National Geographic.

Has virus mutated to become more dangerous? We don’t know yet. “While scientists don’t fully understand what the changes mean, some are concerned that alterations in the virus that occur as that pathogen continues to evolve could pose new dangers. Researchers have identified more than 300 new viral mutations in the latest strain of Ebola, according to research published in the journal Science last month. They are rushing to investigate if this strain of the disease produces higher virus levels — which could increase its infectiousness. So far, there is no scientific data to indicate that.” Robert Langreth, Michelle Fay Cortez and John Lauerman in Bloomberg

KLEIN: Panic, but not because Ebola threatens the US. “if Ebola becomes endemic in West Africa, all this will get much worse. In addition to the ongoing breakdown in basic services, it will be harder for West Africans to travel because few countries will let them in, it will be harder for them to trade because fewer businessmen will want to travel to the region, it will be harder for them to invest because international bankers will be scared off by the disease. It could set the region’s development back decades. That’s worth panicking over, not because it might kill vast numbers of Americans, but because it might cause a vast amount of human suffering. So yes, panic about Ebola. But if you live in the United States, calm down, it’s not going to kill you.” Ezra Klein in Vox.

GOTTLIEB AND TROY: Countering the domestic Ebola threat. “Health care professionals at all levels are of course not perfect and will make mistakes. Hospital protocols and public health preparedness plans must leave room for human error — especially when it comes to very hot pathogens like Ebola. But the CDC must do a better job of establishing clear and accurate procedures, take appropriate measures to reduce risk, and properly calibrate its public statements, if we’re going to inspire the public confidence that will be needed to prevent disruptions in the likely event of a wider, future outbreak.” Scott Gottlieb and Tevi Troy in Forbes.

TORREY: How the US made the Ebola crisis worse. “A 1974 report on the ‘Brain Drain’ for the House Foreign Affairs Committee noted that the current policy was widening the gap between rich and poor nations, and warned that the policy ‘has a great potential for mischief in the Nation’s future relations with the LDC [less developed countries].’ Despite such complaints, U.S. policy has continued to encourage the immigration of physicians and other health workers from poorer countries….The consequences of this policy may be more than ‘mischief.’ Ebola may be merely the first of many prices to be paid for our long-standing but shortsighted health manpower policy.” E. Fuller Torrey in The Wall Street Journal.

Animals interlude: A wrinkly bulldog puppy attempts to howl.

3. More clues on Obama’s Holder successor

Ruemmler said to be the favorite. “Former White House Counsel Kathryn Ruemmler has emerged as President Barack Obama’s preferred candidate as the next attorney general, though he hasn’t decided on a nominee and is still weighing other choices, people familiar with the deliberations said. Advisers have told Obama that Ruemmler would encounter tough questioning in confirmation hearings about advice she gave the president during episodes of his presidency that have drawn Republican scrutiny, including the handling of lapses by the Secret Service, they said….A White House official said earlier today that Obama will wait until after the Nov. 4 midterm congressional elections to announce his choice to succeed Eric Holder.” Mike Dorning and Del Quentin Wilber in Bloomberg.

The delay carries some legislative risks. “The White House aide said the decision to wait was driven in part by Senate Democrats. Had a nominee been named before the elections, Democratic Senate candidates inevitably would have been hounded on the trail to weigh in on the choice — presenting an uncomfortable situation for people who have been trying to keep their political distance from Obama, but would eventually be called on to support the president’s pick….The delay could create a chaotic situation if the White House wants a lame duck confirmation, even if the nomination comes immediately after Election Day. The the majority of the Senate might not be known for days, given several tight races. It could even take weeks.” Edward-Isaac Dovere in Politico.

As Holder packs his bags, the DOJ plans to change its counsel competence waiver practices. “The Justice Department said Tuesday that it will no longer ask criminal defendants who plead guilty to waive their right to claim that their attorney was ineffective and deprived them of their constitutional right to a competent counsel. Attorney General Eric H. Holder Jr. said the new policy, his latest effort to reform the criminal justice system, is an attempt to ensure that all individuals who face criminal charges are ably represented.” Sari Horwitz in The Washington Post.

Meanwhile, SCOTUS messes with Texas: Justices block state’s controversial abortion law. “The court’s decision is not a judgment on the Texas law, but whether the law’s new restrictions should be delayed while the legal battle continued. Texas has been a leader among a number of states that have enacted new requirements for abortion clinics….At issue is the Supreme Court’s decision more than 20 years ago that, although states may regulate access to abortion, they may not pose an ‘undue burden’ on women who seek an abortion early in pregnancy. But the new laws test the extent of that ‘undue burden’ with new requirements that abortion providers say are hard for them to meet.” Robert Barnes in The Washington Post.

Chart: Number of states imposing new regulations on abortion providers is growing. The Washington Post.

But Texas can enforce its voter ID law, appeals court says. “Texas won emergency permission to keep the law in effect while it appeals the trial judge’s ruling, which included a finding that 600,000 registered voters would be kept away from the polls. The decision will slow the momentum of Democratic efforts to increase voter turnout and may fuel a push by some Republican-controlled statehouses to make people prove their eligibility to vote. Republicans say the measures are needed to prevent fraud, while Democrats contend they’re designed to suppress turnout of poor, minority and elderly voters, who are less likely to have photo IDs and more likely to vote Democratic.” Laurel Calkins and Mark Niquette in Bloomberg.

For SCOTUS, dental case is like pulling teeth. “The Supreme Court seemed to have little problem Tuesday concluding that a state board dominated by dentists should not get to decide who can perform teeth-whitening services. But when it comes to brain surgery, many of the same justices said they would rather empower neurologists than bureaucrats. As a result, they had a conundrum.The case before the court dealt with a North Carolina dental board’s exclusion of non-dentists from the business of teeth whitening — a procedure that had been offered in shopping malls, spas and stores. Although most justices recognized the risk of letting dentists push others out of the market, they might not want to place the same restriction on neurologists.” Richard Wolf in USA Today.

Other legal reads:

Where the fight for gay rights is headed now. Kaveh Waddell in National Journal.

Trick shots interlude: Dude Perfect, Dallas Stars edition.

4. How climate change could threaten national security

A ‘threat multiplier.’ “U.S. military officials have long warned that changes in climate patterns, resulting in increased severe weather events and coastal flooding, will have a broad and costly impact on the Defense Department’s ability to protect the nation and respond to natural and humanitarian disasters in the United States and around the globe. The new report — described as a Pentagon roadmap — identifies four things that it says will affect the U.S. military: rising global temperatures, changing precipitation patterns, more extreme weather and rising sea levels. It calls on the department and the military services to identify more specific concerns, including possible effects on the more than 7,000 bases and facilities, and to start putting plans in place to deal with them.” Lolita C. Baldor in the Associated Press.

Explainer: 5 ways that climate change threatens national security. Brianna Ehley in The Fiscal Times.

What should a Paris emissions deal look like? A U.S. envoy explains. “His remarks about this emerging hybrid system — a pact with some kind of binding element but that doesn’t impose emissions mandates on nations — underscore the intricate task that negotiators face. The talks are aimed at crafting a plan that can win buy-in from big developing nations that did not face obligations under the 1997 Kyoto Protocol….The U.S. never joined the Kyoto treaty. In addition, a new formal treaty would be dead on arrival in the U.S. Senate for the foreseeable future, so many observers expect the talks, if they succeed, to yield some kind of pact that would not need formal U.S. ratification. Stern’s remarks, however, did not address that topic.” Ben Geman in National Journal.

Advocates: EPA underestimating electricity’s ability to be green. “The report says the U.S. Environmental Protection Agency set each state’s renewable energy production targets far too low in the proposed Clean Power Plan, the Obama Administration’s effort to reduce carbon dioxide emissions from existing coal-fired power plants. The plan’s goal is to reduce CO2 emissions 30 percent below 2005 levels by 2030. The Union of Concerned Scientists (UCS), a science advocacy organization, says states can reduce emissions even more, by an average of 40 percent by 2030, mainly through the expansion of renewable power production far beyond what the Obama administration may expect from each state.” Bobby Magill in Climate Central.

As the U.S. chills, the world burns. “While the United States is on pace for its coolest year in almost two decades, global temperatures could set a new record high for the year. The world experienced its warmest September since records began in 1880, according to data from the National Aeronautic and Space Administration. Similar record-breaking months to close out the year would make 2014 the hottest recorded. U.S. residents, though, aren’t feeling the heat, given the unusually mild summer that followed a frigid winter.” Zack Colman in the Washington Examiner.

Other environmental/energy reads:

U.S. shale oil output seen growing even as prices drop. Dan Murtaugh and Jing Cao in Bloomberg.

Oil prices plunge as production rises, fueling concern in OPEC. Steven Mufson in The Washington Post.

The incredible shrinking Keystone XL. Elana Schor in Politico.

Life’s ponderables interlude: Is it unhealthy to be standing in front of a microwave while it’s cooking?

5. The administration’s new push for the long-term jobless

Long-term jobless grants get $170M from Obama administration. “The Obama administration is announcing $170 million in grants divided among 23 work projects across the country that aim to reduce the number of long-term unemployed Americans….Labor Secretary Tom Perez and National Economic Council director Jeff Zients announced the grant awards late Tuesday. The two officials and Vice President Joe Biden will hold a round-table meeting with top corporate CEOS on Wednesday at the White House to discuss their efforts to meet commitments earlier this year to hire more long-term unemployed workers.” Jim Kuhnhenn in the Associated Press.

Audition programs are helping the long-term jobless. “More than five years into the U.S. expansion, 2.9 million Americans are long-term unemployed….Vives is among the 2 million who have been off the payrolls for more than a year. The slow progress in bringing that share down is a sign of lingering weakness in the labor market and a potential limit on the consumer spending that makes up the biggest part of the economy. It’s one reason for Federal Reserve policy makers to be patient in raising interest rates, and has prompted the White House to funnel money into programs aiding that segment of the jobless. Vives has landed at one of those programs: Platform 2 Employment, or P2E.” Michelle Jamrisko in Bloomberg.

Job market for new graduates is looking up. “Campuses’ career counselors have been seeing encouraging signs, and now a major survey of employers backs them up: The coming year looks to be a much better one for new college graduates seeking jobs. Job openings for those graduates are projected to grow by double digits in 2014-15, following several years of smaller increases, according to key findings from the survey, which was released on Tuesday. Hiring of new bachelor’s-degree recipients will increase by 16 percent, the survey projects; hiring among all degree levels will grow at the same rate.” Beckie Supiano in The Chronicle of Higher Education.

Cities hiring most since 2008 thanks to the economy. “More U.S. cities are hiring than at any time since the Great Recession as the reviving economy and rising property taxes allow higher spending for a second straight year, according to a report released today. One-third of cities and towns expanded their workforces this year, compared with reductions in 18 percent, according to an annual survey by the National League of Cities. This is the first year since 2008 that job additions outpaced cuts. The gains come as 80 percent of cities said their financial position is stronger than a year ago, the most in at least 29 years.” William Selway in Bloomberg.

Other economic/financial reads:

The $11 trillion advantage that shields the U.S. from turmoil. Shobhana Chandra in Bloomberg.

AIG bailout architects leave questions for executives. Andrew Zajac and Christie Smythe in Bloomberg.

Fed is silent on “doomsday” book, a blueprint for fighting crises. Binyamin Appelbaum in The New York Times.

Proposal interlude: A lip-dub marriage proposal at a cafe.

Wonkblog roundup

The Supreme Court deals a fresh setback to efforts to restrict access to abortions. Wonkblog Staff.

The Ebola outbreak is not just a human tragedy. It’s also an economic one. Ylan Q. Mui.

Paul Ryan has a trick up his sleeve when it comes to taxes. It won’t work. Matt O’Brien.

It’s not just Ebola. Health care is pretty dangerous work. Jason Millman.

Colorado marijuana revenues hit a new high. Christopher Ingraham.

Whites are more supportive of voter ID laws when shown photos of black people voting. Christopher Ingraham.

The many reasons millennials are shunning cars. Emily Badger.

Et Cetera

How churches are slowly becoming less segregated. Laura Meckler in The Wall Street Journal.

Government snooping proves weak campaign issue. Erin Kelly in USA Today.

Key Obama decisions on hold until after midterms. Josh Lederman in the Associated Press.

Senior House Financial Services members propose bipartisan Ex-Im Bank bill. Kristina Peterson in The Wall Street Journal.

Got tips, additions, or comments? E-mail us.

Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.

Source: Westhill Healthcare Consulting Jakarta fraud prevention review

Everyday Low Benefits Wal-Mart dumps 30,000 part-timers onto the ObamaCare

Walmart-Logo

Wal-Mart endorsed ObamaCare in 2009 and helped drag the bill through U.S. Congress, and so far it hasn’t recanted. By holding back economic growth and incomes, perhaps the law is expanding the retailer’s customer base. Another plus—at least for management—is that Wal-Mart can jettison its employees into the ObamaCare insurance exchanges.

The Associated Press reported Tuesday that the largest U.S. private employer is dropping health benefits for some 30,000 workers, or about 5% of its part-time workforce. Earlier health-plan eligibility triage in 2011 had removed tens of thousands of Wal-Mart workers from the balance sheet, so this latest purge was probably inevitable.

Wal-Mart cites its inability to manage higher-than-anticipated health expenses. Perhaps— wasn’t ObamaCare supposed to bring those costs down? Obviously the company is also responding rationally to ObamaCare’s incentives. With a subsidized government alternative now open for business, and since corporations aren’t liable for a penalty for not covering people who work fewer than 30 hours a week on average, cost-control logic says to send such coverage ballast over the side. Other retail and grocery chains including Target, Home Depot and Trader Joe’s have already done the same.

ObamaCare’s critics predicted that such insurance dumping was inevitable, and the only question now is how many and how fast other companies partake of the new all-you-caneat entitlement buffet. Get whatever you like, the bill’s on taxpayers. The disruptions will be concentrated in industries with large numbers of low-skilled and low-income workers, like restaurants, hospitality and, yes, retail.

The irony is that even as Wal-Mart drops insurance because it is too costly, President Barack Obama is claiming credit for lowering health costs. He boasted the other day that the law gave every U.S. family “a $1,800 tax cut” by supposedly reducing the rate of employer-premium growth. ObamaCare had nothing to do with that, and it surely won’t be any consolation to Wal-Mart’s latest health-plan diaspora.

4 Tips for Navigating Open Enrollment for Insurance

When shopping for a plan, start with the basics of what you’re looking for and what you’re willing to pay for, says Michael McMillan,Executive Director of Market and Network Services at Cleveland Clinic. Then make your selection carefully so you get what you’re paying for, he adds.

To help you navigate enrollment — either on health insurance exchanges or elsewhere — McMillan offers the following helpful tips:

 

1. Know what services are covered under a selected plan

Start by reviewing what each particular plan offers. For example, what does the network of care providers look like? What services are most important to you based on your particular health needs or conditions, and are they available within a plan’s coverage?

“This will be a period of great change, and consumers will have a lot of options they haven’t had before on the exchanges,” McMillan says. “It’s important to be clear on what’s available and what isn’t.”

 

2. Make sure your providers are part of the network

When choosing plans, this is a major factor. Look at any given plan to see if your doctors and hospitals you use regularly are listed as network providers.

One evolving trend has been for health plans to create narrow networks — smaller versions of their standard network that help them achieve a lower price. The bottom line: Not all providers are included in these limited networks, so it’s worth your effort to check first and make sure your new plan includes the doctors and other practitioners you see regularly, McMillan says.

 

3. Know your out-of-pocket costs

These are costs associated with the care received. They include things such as deductibles — the amount you pay before coverage kicks in — as well as copays and coinsurance on services. Out-of-pocket costs vary by the “metal” level of plan you choose on a health insurance exchange. So, for example, you would pay 40 percent of costs of coinsurance in a bronze plan, and 30 percent for silver.

 

In some high-deductible health plans, the first several thousand dollars will be your responsibility, too. For your personal budgeting and planning, it’s critical to know how much money you’ll have to pull out of your pocket when you go to the doctor, to the hospital, to the medical lab or for any other health service, McMillan notes.

 

4. Understand how your monthly premium works

Premiums are the monthly payments you make for your insurance coverage. Because the benefits for most plans, both on and off the exchanges, have become standardized, it should be fairly easy to make apples-to-apples comparisons among plans.

“You should be able to compare premium amounts, how much you pay every month for the service,” McMillan advises. However, your personal premiums may vary depending on your own circumstances — including whether you’re single or married, a smoker or a nonsmoker, and other factors.

2015 open enrollment for health insurance exchanges starts Nov. 15, 2014 and lasts until Feb. 15, 2015. Open enrollment periods for insurance plans outside of exchanges vary. No matter which path you pursue, learn as much as possible about your plan options before you buy, and you’ll end up with coverage that suits your needs as a result.

New York Regulators Slash Health Insurance Rates For 2015

The average health insurance rate increase next year will be about 6 percent in New York State.

State regulators today set the rates for 2015 after reviewing proposals from insurers, which requested an average increase of about 13 percent. Westhill Healthcare Consulting

While some reduction was expected, some insurers told the Albany Business Review severe 2015 rate cuts by state regulators would harm the companies.

The state Department of Financial Services sets the rates.

“We closely scrutinized the proposed rate increases insurers requested and reduced them significantly where appropriate,” Benjamin Lawsky, superintendent of the department, said when announcing the reductions. Westhill Healthcare Consulting Review

On one hand, CEOs of insurers said the rate increases must properly reflect rising medical costs. They also cited increased taxes and fees tied to the Affordable Care Act, or ACA, as a main factor in proposing the 13 percent average rate hikes. They warned recent losses and job cuts at insurers would only get worse if rates insufficiently increased in 2015.

On the other hand, some business owners say they can’t afford the rate hikes. Prior to state regulators setting the average rate increase at 6 percent, business owners told the Albany Business Review that the 13 percent average increases for 2015 would threaten health benefit packages they offer workers.

In response to state regulator’s decision to reduce the rates, Paul Macielak, president and CEO of the New York Health Plan Association, an industry trade and lobbying group representing health insurers, described the figures as irresponsible. He warned some insurers may rethink offering some coverage plans and products instead of adhering to the state adjusted rates.

“The bottom line is inadequate rates will result in reducing product choice or otherwise de-stabilizing the market, which is ultimately harmful to the health care system as a whole and the consumers who rely on it,” Macielak wrote in an email.

On the individual market, the average increase will be about 5.7 percent, down from the 12.5 percent requested by insurers.

For the small group market, the average increase will be 6.7 percent, down from 13.9 percent requested by insurers.

Here are details from the state Department of Financial Services about rates for each insurer.

The Albany Business Review also previously talked with health care leaders who explained why state regulators would reduce the proposed rates.

If Your Kids Get Free Health Care, You’re More Likely to Start a Company

Starting a business is risky enough in the best of circumstances. Most new ventures fail, and the prospect of forgoing a salary is enough to keep many would-be entrepreneurs from taking the plunge.

But think about how much harder it would be if your child had a health condition, and you couldn’t get her insurance if you struck out on your own.

That’s less of a problem in the U.S. than it was a few years ago, thanks to Obamacare, but until recently it was a very real conundrum. So does the extension of publicly provisioned health insurance prompt more people to start companies? That’s the question asked by a paper released earlier this year by Gareth Olds of Harvard Business School.

Olds analyzed Census data from before and after the passage of the Children’s Health Insurance Program in the U.S. in 1997 to assess its impact on entrepreneurship. CHIP, or SCHIP as it was previously known, provides publicly funded health insurance to children whose families don’t qualify for Medicare, but whose incomes still fall below a cutoff (typically around 200% of the federal poverty line).

His results suggest that the policy did significantly increase business creation by those families affected. The self-employment rate for CHIP recipients increased from just under 15% of those eligible to over 18%. That amounts to an a 23% increase. The rate of ownership of incorporated businesses — a better proxy for sustainable, growth entrepreneurship — increased even more dramatically, from 4.3% to 5.8%, an increase of 31%.

What about all the other factors that might skew this sort of analysis? Olds used several quasi-experimental statistical methods in his research to control for such variables. The basic intuition behind his methods is that a family just above the CHIP cutoff isn’t all that different from a family just below it. Whether you make 199% of the poverty line or 201% doesn’t matter for much, except whether or not you’ll be able to enroll in the program. With that in mind, his methods zero in on this sub-group, in order to confirm that the policy actually caused the increase in firm creation.

The mechanism by which Olds believes CHIP boosts entrepreneurship is relatively straightforward: it reduces the risk of “consumption shocks,” i.e. the possibility of having to pay out a large chunk of cash unexpectedly for a child’s illness. Lower the risk and more people start companies.

Though it may seem counterintuitive given the political rhetoric around social insurance and economic growth, Olds’ is not the only research to suggest that welfare programs can promote entrepreneurship. Previous research has found that American self-employment rates jump at 65. Why is 65 a better age to start a company than 64? Because you qualify for health insurance through Medicare.

All of this serves as a reminder that bigger government needn’t discourage entrepreneurship and risk-taking. The relationship between the two ultimately depends on what government chooses to spend money on.

The final takeaway from Olds’ work is just how many business owners do depend on public programs like CHIP. “12% of households with incorporated businesses report enrollment in a public program,” he writes, not even counting Social Security, Medicare, or veterans benefits. And “disproportionately more entrepreneurs are receiving public healthcare benefits than would be expected based on their income alone.”

Overall, though, entrepreneurs still hail from disproportionately well-off families. The lesson from Olds’ paper is that starting a business doesn’t have to be a risk only wealthy people can afford to take — and the government can help.

How to Spot and Prevent Medical Identity Theft

Foxbusiness.com | westhill consulting insurance - While credit card breaches at retailers are grabbing headlines, identity thieves are quietly homing in on an even more lucrative area: health insurance and medical records.

More than 1.8 million people in the U.S. were victims of medical identity theft in 2013, according to a survey by the Ponemon Institute released in September. That’s a 19 percent increase over the previous year. “Medical identity theft is the fastest growing component of ID theft,” says Drew Smith, founder and CEO of InfoArmor, a provider of business-to-business identity theft solutions.

 

The latest case involves the alleged theft by Chinese hackers of 4.5 million medical records from Community Health Systems, a company that runs 206 hospitals in 29 states. Thieves stole records including names, addresses, birth dates, telephone numbers and Social Security numbers. Like any type of identity theft, medical ID theft can damage your credit and cost you hours of hassles trying to clear it up. But it could also endanger your life if incorrect information appears on your medical records.  Why the bull’s-eye? Health information is easier to hack than credit. In April, the FBI issued a private industry notification warning to health care providers that their data networks are not as robust as those in the financial and retail sectors, and “the possibility of increased cyber intrusions is likely.” 

Safeguards are in the works, but the move to electronic records and the health exchanges set up under the Affordable Care Act, otherwise known as Obamacare, have opened new opportunities for fraud, both online and off. Experts say Americans can expect to see medical fraud heat up again in the months before open enrollment for 2015 government-subsidized insurance begins in November 2014. 

Your medical ID: black market gold

Why would hackers bother with health insurance when they could get a direct line to your pocketbook via credit cards or financial accounts? “It’s very lucrative,” says Ann Patterson, senior vice president and program director at the Medical Identity Fraud Alliance. “Stolen protected health information can be monetized for a much greater value than traditional financial account information.” 

A complete medical identity — including name, address, phone number, Social Security number, medical insurance information and access to medical records — is worth about $50 on the black market, says Michael Bruemmer, vice president of Experian’s Data Breach Resolution group. “Without medical or insurance information, that drops to about $10 for someone’s stolen information.” Bruemmer’s group helped resolve 1,000 health care client breaches last year, including the largest breach of HIPAA, the Health Insurance Portability and Accountability Act. 

Medical identity theft usually happens on a large scale, with hundreds or even thousands of identities stolen at one time. Once hackers have a medical ID, they can use it to procure prescription drugs or expensive medical equipment or simply to commit financial fraud — often for months or years before anyone notices. Why? Partly because people don’t pay much attention to their medical or insurance records. While most of us wouldn’t let a bank or credit card statement go unread, we tend to ignore the explanation of benefits (EOB) issued by our health insurance after we have a doctor’s appointment or medical procedure. 

'Friendly' fraud common

More than half of all medical identity theft is what’s known as “friendly fraud” or “a victimless crime,” according to the Ponemon Institute study. A typical example: an uninsured sibling or friend borrows your insurance card for a procedure, with or without your permission. 

In 2013, the Medical Identity Fraud Alliance interviewed 800 victims of medical fraud. When asked what they would do differently, half said nothing. “Especially with the Robin Hood or ‘victimless’ crime, most people don’t think there are consequences,” says Patterson. “They say it’s no big deal.”  Yet there is no such thing as victimless medical identity theft. “If your sister has allergies that you don’t have or a different blood type, her allergies and blood type are now comingled in your records,” Patterson says. If you’re unconscious and need an emergency transfusion or injection, that misinformation can kill you. 

That kind of consequence comes, in equal measure, from both friendly and malicious medical identity theft, yet we continue to be lax about sharing our health information. “As a society, we just look at health in a very different way than we look at our finances,” Patterson says. 

Detecting medical fraud before it hurts you

Sometimes it takes a questionable medical bill to alert someone of a compromised medical identity, but even that doesn’t always do the trick. Many people simply ignore such bills from their insurance companies. By the time a red flag goes up, your insurance may have been used to procure prescription drugs, black-market medical equipment and emergency room visits. 

The consequences can be expensive. The Ponemon Institute found that 36 percent of medical ID theft victims pay to resolve the issue, and their out-of-pocket costs average nearly $19,000. Even if you don’t end up paying out of pocket, such usage can wreak havoc on both medical and credit records, and clearing that up is a time-consuming headache. That’s because medical records are scattered. Unlike personal financial information, which is consolidated and protected by credit bureaus, bits of your medical records end up in every doctor’s office and hospital you check into, every pharmacy that fills a prescription and every facility that processes payments for those transactions. 

Bruemmer expects that will change soon, with more progressive states raising the bar. “California, in particular, has the most stringent standard for what constitutes a medical or health care breach,” he says. If an individual’s username and password is compromised on a health care portal there, the provider is required to notify him or her within five days, Bruemmer says. “I actually think that’s the way the industry is going and there will be more regulations across more states,” Bruemmer says. 

Compiling a composite identity for the big scam

One small breach of information here and there may not seem like much, but each one could be adding up to something serious. “Five years ago, most hackers were looking for Social Security numbers, credit card numbers. They were going for the quick, easy fraud,” says Smith. “Today, they’re looking to steal someone’s health credentials, insurance information, credit card account passwords, so they can continue to monetize victims’ identities over a longer period of time.” 

"Thieves are getting smart," Bruemmer agrees. "One organization may take a username and password, another is your credit information, and another is your Social Security number. The last one may actually get your medical records. What they’re doing is amassing, in three or four incidents over a period of time, the full identity stream." Bruemmer says, for example, that thieves often use hacked email accounts to gain personal information. "People say, ‘Oh, it’s just the username and password for my email account, I’ll just change that.’ You’d be surprised how many people forget and let it go. Then, all of a sudden, something really bad happens." 

As with any organized crime, fraudsters jump from one channel to the next, as each locks down. “In the financial world, they jumped from hard checks to electronic to online banking, and now mobile fraud,” Patterson says. “Now they’re jumping from traditional financial channels into health care channels.” 

Like the RAM-scraping in 2013’s big retail breaches, online medical fraud has become more sophisticated in recent years. Yet old-fashioned huckstering is alive and well. In July, the owner of NC Behavioral Health and Counseling Services of Durham, North Carolina, was indicted for health care fraud, identity theft and 13 other criminal charges after submitting bogus claims for at least 56 clients. Court records allege that instead of covering medical services for the patients, the owner spent the $1 million she received from Medicaid on a Cadillac Esplanade, a Mercedes and a swimming pool. 

New fraud opportunities courtesy of Obamacare

Obamacare and the expansion of Medicaid have opened up a whole new stream of opportunities for fraudsters, experts say. In June, a backpack was discovered on a street in Hartford, Connecticut, near the Access Health CT exchange. Inside were four notepads containing the Social Security numbers of 151 people enrolled in Connecticut’s Obamacare exchange. “There are so many opportunities out there to defraud people,” says Dennis Jay, executive director of the Coalition Against Insurance Fraud. “You’re dealing with populations that are new to insurance and don’t understand the dangers of selling a Medicaid number or sharing a health ID number.” 

Just before the rollout of Obamacare, roving gangs began knocking on doors in lower-income neighborhoods, requesting health information they said was needed to expedite the new health plans. “People gave it out,” Jay says. He expects that kind of fraud to pick up as the open enrollment period for 2015 coverage through the health insurance exchanges nears. 

The expansion of Medicaid accompanying Obamacare has led to similar door-to-door solicitations, he says. “The Medicaid expansion also concerns us because there are roving gangs that will pay you to share the numbers with them,” Jay says. “Once [fraudsters] have those numbers, they know they’re golden. A lot of Medicaid systems won’t detect it for many months and there could be tens of thousands or even tens of millions gone before that happens.” It’s too early to measure the impact of the health exchanges set up under Obamacare and the sharing of health records online. “We haven’t even seen how secure those sites are,” Smith says. “But given the problems they’ve had, it would be surprising if we don’t see identity theft bump up over the next couple years because information has been compromised.” 

What you can do to keep your medical identity safe 

   •    Be vigilant about your personal information. Shared all documents with any kind of sensitive information and change your passwords on a regular basis. “Don’t use the same password on multiple platforms,” Bruemmer advises, “particularly health care platforms, financial institutions, government records.” 

   •    Don’t share health information with solicitors or phishers. Steer clear of links in emails that request that information online. Don’t give out your information over the phone to someone claiming, for example, to represent your insurance company. Don’t give it to anyone who appears at the door, either. A common scam now, according to Jay, is to knock on doors asking for medical information to renew an Obamacare policy. 

   •   Avoid sharing sensitive information. Even health care providers sometimes over-reach. Many automatically ask for your Social Security number. “In many cases, they don’t need it but it’s the default question,” Bruemmer says. “As rule of thumb, don’t share anything of a personal nature with a health care provider that you wouldn’t consider sharing with your neighbor.” 

   •   Read that EOB, preferably via email. An Explanation of Benefits from your insurance provider is not exactly easy reading, but it’s worth more than a scan — and the sooner, the better. “I encourage people to get their explanation of benefits via email,” Smith says. “They come through much faster, instead of getting lost in the mail. Anything you can do to monitor your EOB is a great start.” 

   •   Move quickly on breach notifications. If you get a letter from a health care provider saying your health care information has been exposed, read it carefully and follow the instructions immediately. Such letters usually offer helpful tips on how to protect yourself and take advantage of free services provided. 

   •   Check credit reports and medical records regularly. You can access each of your credit reports from the three major credit bureaus for no cost once a year at AnnualCreditReport.com. Evidence of medical identity theft often shows up there in the form of unpaid medical bills. You also have the right to review your medical records. Any time you have a medical procedure or visit a new physician, you should request and review a copy of your records.

'Fraud' and 'cover-up' exposed in failing semi-privatised Irish healthcare - Westhill Consulting Insurance

 Pharmaceuticals. Flickr/Waleed Alzuhair.

Commerce has corrupted healthcare in the Irish semi-privatized insurance-based system.

Late last year Senator John Crown revealed under parliamentary privilege in Ireland’s Senead that his own hospital, St. Vincent’s University Hospital in Dublin, had in 2002 billed the country’s largest private health insurer €1 million for the drug trastuzumab (Herceptin). But the drug had in fact been supplied to the hospital free by pharmaceutical giant Roche, as part of clinical trials for women with breast cancer.

This was not an inadvertent error as the hospital claimed, said Senator Crown, but deliberate financial fraud, which the hospital board had spent perhaps tens of thousands trying to cover up, employing ‘substantial intimidation’ to bury the matter.

Senator Crown is also Professor Crown, arguably Ireland’s most distinguished oncologist. He had been told of the fraud in 2002 and at once notified all relevant health authorities.

An investigation started, and then stopped in its tracks. The hospital argued it had not known about this major research program me taking place on its premises.

The debacle had ended with the suspension of the drugs trial for a year, jeopardising the lives of women with breast cancer who might otherwise have participated in this important trial, said Professor Crown.

This was not the only instance of the hospital charging insurers for drugs which had been provided for free, he said (Seanad Eireann, 2013), but only recently had additional corroborating documentation come into his possession.

The bombshell about St Vincent’s creative accounting highlights several aspects of the unworkable two-tier Irish health care which should serve as a warning to English readers.

The growth in unaccountable private hospitals, Big Pharma’s protected presence in Ireland, and a rapacious private health insurance industry, and the very best paid consultants and managers. All of these have benefitted from the supposedly ‘non-political’ structures set up in recent years to oversee health provision.

'Taking politics out of health' - or taking democratic accountability out of health?

The Minister for Health no longer has any direct responsibility for the administrative running of the health services. He merely presents its expenditure plans, drawn up behind closed doors, to the Irish parliament for approval each year.

Instead, the Health Act 2004 established the Health Services Executive with promises that are eerily familiar to UK readers: modernising the health services, increasing efficiency and accountability, removing ‘political’ influences from the running of the health services, and opening up private health care options as a challenge to a public health care system made sluggish by being starved of finance for frontline workers and resources for decades. 

The HSE built on a chaotic system that has certainly served some well. Professor Crown’s revelations came on top of other scandals about the pay of senior managers in at least 13 other state-funded hospitals. Additional pay and allowances were being made outside of officially sanctioned salaries and budgets of the Health Services Executive (HSE). There were previously undisclosed top-up payments to many of these senior people from unacknowledged ‘private sources’.

A chaotic two-tier system of healthcare

Since independence in 1922, Irish healthcare has been a confused jumble of public and private provision. Former county workhouses for the indigent were converted into hospitals and the state also remained heavily dependent for buildings and nurses on religious charities. These latter hospitals often had private wings where doctors served the needs of the wealthy.

Irish people have never had access to a universal health care system. Instead they rely either on a means-tested medical card giving access to public state-funded care (currently, 1.86 million people out of a population of 4.59 million), or if they are not eligible, on private health insurance - or on taking their chances.

The insurance scheme at the centre of the cancer drug scandal, VHI, was set up in 1957 as a semi-state body with the Minister for Health as its sole shareholder. In the absence of state-funded care, it was meant to provide affordable health insurance, subsidised through income tax relief, for those above the eligibility limits for the medical card.

The VHI remains the largest single insurer. But its client base tilts towards an aging population, and might no longer be considered cutting edge compared to the range of services offered by newer entrants like BUPA since the opening up of the Irish health insurance market to competition from multinational insurance corporations from 1996 onwards.

Aside from covering the cost of illness, private health insurance means faster access to care facilities, though in fact waiting times are still a problem.

The numbers of in-patient beds have been cut by over 5,000 since 1981, and have not been compensated for by increases in day places. Cuts to public bed numbers have contributed to growing inequalities of access, and waiting for a hospital bed in the public hospital system has become an everyday experience.

The system has been characterised as ‘Irish Apartheid’ (1). The government, won over by the enticements of privatisation and treating health as a commodity, has sleepwalked its population into a major health disaster.

The government has proposed replacing the HSE with an interim board and setting up a system of ‘universal health insurance’ promoted by the globalised private health insurance industry to promote ‘competition’. Each person would be required to purchase a ‘basic’ health care package from a private insurer and the state would pay the basic package for those with no means.

In effect, this is American healthcare system - and the one some see the UK rushing towards.

The globalised health care market increases health inequalities

In 1981 hospital consultant doctors were given a ‘contract to die for’ (2), with a very generous public salary for work in public hospitals, unlimited access to beds in public hospitals for their private practice, and a commitment that they need spend as little as six hours a week in actual public work as long as they had registrars to cover for them.

In 1988, hospital consultant doctors earned a public salary of €42,000, with average annual earnings of €30,500 from their private practices. The average industrial wage was just under €23,000. These differentials have widened painfully with the explosion in private health care. A senior hospital consultant can count on a combined income between public and private practice of approximately €350,000, whilst newly qualified nurses and midwives are paid a starting wage of just €22,000.

The greed this stimulated fitted all too well with the expanding agendas of global privatised health care. Purely private hospitals mushroomed, many also offering beds to the over-stretched public health care system for the more profitable procedures. By the early 2000s, many Irish consultants cum businessmen had joined the ranks of private multinational healthcare conglomerates, such as the American UPMC, seeking new markets.

Hospitals lack democracy and accountability

Since the economic collapse, these private hospitals have faced mounting problems.

The Mount Carmel private maternity hospital faced a High Court liquidation order on the morning of 24 January, 2014. Within an hour, business firms supplying pharmaceuticals and medical equipment arrived at the hospital to remove their goods from the premises to the shock of patients (including public patients referred for orthopaedic procedures) and frontline staff who had not been informed of the impending court action. The hospital closed its doors a week later.

There are a number of other private hospitals facing stressed financial circumstances and closure or sell-off, including the UPMC Beacon Hospital, and Waterford’s Whitfield Clinic, a specialist cancer centre whose loans are being sold off by KPMG.

The same hospital board of which John Crown speaks, St. Vincent’s, has no public representation on the board. Accountability is impossible. It has found it easy to glide between its obligations as a publicly state-funded hospital meant to serve Irish citizens and a private hospital on the same site which needs to seek greater profits for its shareholders.

St. Vincent’s hospital’s CEO earned a state-funded salary of €145,000 and received top-up payment of at least €50,000 from undisclosed sources. He brokered a deal in 2010 using the public hospital as collateral to raise loans for an expansion of the private hospital. 

IMF-imposed cuts leave families muddling through on a wing and prayer

More cuts have flowed from the imposition of the EU/IMF troika deal on all public services as the price for the billions loaned to the Irish state in 2010 as part of the so-called bailout program me. A and E overcrowding is a constant in people’s lives. People can wait for years for diagnostic tests and consultant appointments in the public system and these delays have cost some their lives (1).  

The gap between health outcomes for best off children and the poorest has doubled since 2010 with terrible long-term repercussions (3).

There is a sharp downturn in numbers paying private health insurance since 2007 with over 250,000 people leaving insurance schemes. Huge wage cuts, new taxes, unemployment, and endless rises in insurance fees have left people with no choice but to cancel cover, especially those with young families. With no medical card, they are muddling through on a wing and a prayer.

They must weigh up the possibility of becoming ill and, without insurance, needing to cover fees such as these:

€45-€65 for a GP visit

€100 for treatment at a hospital A and E unless one has a GP’s letter of referral

€150 average cost of an appointment with a consultant doctor

€75 per day for a hospital bed to a maximum of ten days, after which that fee is capped

Ireland spends more on drugs than any other country - why?

Pharmaceuticals, another global growth area, also have had a specific impact on Irish healthcare.

Multinational pharmaceutical producers have located their production plants in Ireland under favourable financial terms, including the low Irish corporate tax rate. They accounted for almost 57% of all exports from Ireland in the Celtic Tiger years of the 90s and noughties. With 72 factories established here by 2004, Ireland outdistanced even Switzerland in exporting drugs (4). The pressures for medicine board regulators ‘to be overly responsive to commercial imperatives’ (Löfgren, 2009) may account for the high purchase price in Ireland of drugs produced by these companies.  

According to 2009 OECD figures, Ireland was spending more per capita on drugs than any other developed country. Drug costs for individuals are highly problematic. The state reimburses a person for drug costs over €144 a month. Up to that ceiling, s/he must pay out of pocket. There is a limited list of serious conditions for which drugs are free, regardless of medical card status, but many conditions are excluded such as asthma: a preventative corticosteroid inhaler with beta agonist, as currently recommended by NICE for asthmatic patients, costs €87 per month.

Retrieving a proper sense of the political and the ethical

From the outset, the board of the HSE has reflected private financial interests and has been a revolving door between those companies and corporations with an increasing stake in how health services are run because of the profit-taking opportunities (1). Opaque, unreachable, top heavy with a swollen bureaucracy, with frontline staff left in the dark as to how management is actually working, the HSE has provided a consistent stream of serious health care scandals to a disillusioned and weary general public.

Ordinary people are the ones who have suffered. Compared with European averages and even compared with Northern Ireland, Ireland has earlier mortalities, a higher burden of morbidities and chronic long-term illness, and poorer outcomes and survival rates for a range of cancers.

The Irish case makes clear why health is a core social need which requires a well-functioning state presence to secure a health system that is genuinely not for profit and is accessible to all. As it stands, we have created a toxic society in Ireland of rampant health inequalities, premised on greed and profit-taking.

We urgently need to construct the political arguments for health and health services as a personal and social good that must be funded by the state, that is, the wider community of us all. We all need good health services at some point and when that point arrives, my need is not greater than yours simply because I am rich and you are an average wage earner or someone who is unemployed. Health cannot be left to the ideology of private profit-taking from whatever direction.

This sense of the political, as an urgent open-ended public project to which all contribute, as articulated by the philosopher and defender of genuine democratic engagement, Sheldon Wolin (5) makes us think about the wellpool of resources there for all to ‘promote and protect the wellbeing of the community’.

As John Crown has written so powerfully, ‘we have to dream to end the nightmare’, to have ‘an Irish health service where every woman, every man and every child could see the same doctor in the same hospital or clinic following the same reasonable wait if they have the same illness, regardless of their financial circumstances.

English people trapped within the false premises and corrupting ideology of the Health and Social Care Act should take note of the Irish experience.

Source: Westhill Consulting Healthcare Insurance

Protect yourself from Marketplace fraud

Austin Company Leads Medicaid Fraud Crackdown

Austin Company leads Medicaid fraud crackdown

Texas pays out $28 billion a year to some 4.8 million people, according to Kaiser.

The state picks up one-fourth of the tab, and the feds pay the rest.  The FBI estimates that 10% of Medicaid claims are fraudulent, which comes out to $2.8 billion a year in Texas alone.

On Monday, Austin company 21CT launches a new computer system called “Torch” to help the state bring scammers to justice.

Torch will collate state data around the clock. The system will monitor frequency of claims, the size of claims and any funny patterns or anomalies.

21CT has grown to over 100 employees, most of them devoted to the crackdown. Company officials say what they are finding is eye opening.

“You know it’s there,” said Kyle Flaherty, Vice President of Marketing for 21CT. “What’s so surprising is how complex and entrepreneurial the fraudsters can be. This is a business for them and we need to disrupt the business they are creating.”

Torch will eyeball providers: businesses, medical supply companies, doctors, therapists, dentists, ambulance firms, hospitals and more. The system will make it easier to sort out.

“In my old job as a healthcare fraud investigator for the state I would have eighteen browser windows open with tabs in them,” Ross Worden, 21CT Director of Data Science said. “I had no idea what was going on. Now, it’s all in one place. I can click through and see who is connected to what… what they are doing… what they are going to do potentially. It’s a fantastic tool.”

Cheats use patterns to pull off their scams, but they can be spotted if you know what to look for. However, Torch isn’t talking.

“The reason I won’t tell you what they are is they may be listening,” Flaherty said. “The last thing I want a fraudster to know is the techniques we can pick up on.”

Those could include suspicious associations, peculiar transaction accounts and unsavory networks.

A little modest bill padding, or honest mistakes are to be expected in Medicaid. Torch looks for the big boys.

“There’s always something where you say no, you knew it,” Worden said. “It was bad and you tried to hide it. Those are the things that really interest us. We want the bad people.”

When the red flags fly, they are passed along to state investigators to pick up the trail.

If you are busted, it could mean a fine, paying restitution or even jail time.