Understanding Government

Remember the kwashiorkor plague striking Northern California — where the African childhood disease was spreading like wildfire, but only amongst seniors with Medicare getting treatment at hospitals affiliated with Prime Healthcare?

Well, according to Christina Jewett and Stephen K. Doig of California Watch, in a story published in today’s San Francisco Chronicle, in addition to a chronic case of upcoding, Prime Healthcare is also apparently hospitalizing patients who should be discharged, in an effort to maximize bills to Medicare and various H.M.O.’s. (more…)

One of the big, if not the biggest, Republican criticism of the landmark health care reform bill was that it would significantly reduce seniors’ Medicare coverage. It was an ironic stance given that cuts in Medicare were once part of the Republican party agenda. But fears about reduced Medicare were also effective: the Republicans dominated the midterms thanks in large part to the votes of concerned seniors.

In other words, changes in Medicare regulations from the Affordable Care Act should be a BIG, CONTROVERSIAL DEAL. But it’s hard to see anything controversial about new Medicare prescription drug regulations being rolled out in Wisconsin. (more…)

Getting the bum’s rush at a hospital may be counterproductive to patients and the nation’s health care system.

That seems to be the finding of a report prepared by California’s Office of Statewide Health Planning and Development. The report, covered in detail by Bobby Caina Calvan in the Sacramento Bee, finds that patients returning for more treatment after being discharged are costing insurance companies, along with state and federal health programs, big bucks. (more…)

So says the New York Times’ David Leonhardt, who decries the lack of a leader at the Center for Medicare Services in the Dept. of Health and Human Services. This vacant federal agency leadership position can’t be blamed on the Senate: Barack Obama and Health and Human Services Sec. Kathleen Sebelius have yet to even nominate someone. Leonhardt’s makes a compelling point that a bill full of compromises will require bureaucratic expertise:

So we’re left with bills in the House and the Senate that try to reform the system using hundreds of technocratic tweaks. The only real alternative appears to be the status quo.

The technocratic approach, however, comes with risks. The first is simply that the bureaucracy won’t be up to the job.

Mark McClellan, who ran Medicare from 2004 to 2006 and now works at the Brookings Institution, likes to tell the story of a Medicare demonstration project that Congress approved in 2003. Once the bill passed, officials had to devise the project’s details, decide how to measure the results and choose the locations. All of that took until 2009. The first round of projects — coordinating care across medical specialties, in Indiana and North Carolina — has only recently started. Years more will pass before the results are in.

Meanwhile, despite sweeping/massive/ginormous changes in Medicare in both 2003 and, almost certainly, 2010, the Center for Medicare Services has only intermittently had a White House-nominated, Senate-confirmed leader. This means that either the Bush and Obama administrations and Congress didn’t really care if their medicare overhauls got successfully enacted — or it means that the political appointment process is broken.

One sort of positive take is that a politically appointed person to run Medicare is unimportant. What’s more important are civil servants good enough to execute health care reform. Perhaps the number of politically appointed members of the bureaucracy should dip from a mind-boggling 488 to, maybe, 64 — one White House appointed leader for every federal agency. Or maybe 100 — one appointed leader for each agency and 2-4 at bigger, cabinet-level agencies like the Pentagon.  Or maybe 20 — Does it truly benefit agencies like the General Services Administration to have White House-appointed leadership? The status quo means that low-profile political leadership positions — and almost every position beyond cabinet posts is “low-profile” — can potentially be vacant for years.

The stimulus works, the stimulus works, the stimulus works reports the Wall Street Journal’s Deborah Solomon:

Economists say the money out the door — combined with the expectation of additional funds flowing soon — is fueling growth above where it would have been without any government action.

Many forecasters say stimulus spending is adding two to three percentage points to economic growth in the second and third quarters, when measured at an annual rate. The impact in the second quarter, calculated by analyzing how the extra funds flowing into the economy boost consumption, investment and spending, helped slow the rate of decline and will lay the groundwork for positive growth in the third quarter — something that seemed almost implausible just a few months ago. Some economists say the 1% contraction in the second quarter would have been far worse, possibly as much as 3.2%, if not for the stimulus.

For the third quarter, economists at Goldman Sachs & Co. predict the U.S. economy will grow by 3.3%. “Without that extra stimulus, we would be somewhere around zero,” said Jan Hatzius, chief U.S. economist for Goldman.

An argument can be made that the stimulus bill should have been even bigger and also included more direct aid to states (and many who made that argument now push for a 2nd stimulus). An argument can also be made, as Solomon notes, that maybe the Federal Reserve’s aggressive and secretive buying of Treasury debt and mortgage backed securities is where the government is helping most.

But the argument made during the stimulus bill debate by almost every Republican in Congress, and a few Democrats, that the stimulus will just run up the national debt is being proven wrong. The stimulus is indeed running up the debt, but so are Republican/moderate-Democrat supported plans like the Afghanistan War, the Iraq War, the 2003 Medicare overhaul, and the Bush tax cuts for the rich. The stimulus is helping the economy significantly more than any of those policies.