In an op-ed published in the Baltimore Sun yesterday and augmented on the Huffington Post today, Ambassador Joseph C. Wilson argues that Hillary Clinton is the only candidate who can come away from the national election still standing.

He centers his argument on a single exchange of letters between Senator Obama and Senator McCain concerning a bipartisan effort to draft campaign finance reform laws. Unfortunately, his Huffington Post article links to a completely unrelated and somewhat bombastic series of comments relating to an exchange between McCain and Obama on the campaign trail last May, shortly after McCain paid a visit to Iraq and then argued for the ’surge’ upon his return.

The actual letter exchange is very different than Ambassador Wilson describes.

But will Mr. Obama fight? His brief time on the national scene gives little comfort. Consider a February 2006 exchange of letters with Mr. McCain on the subject of ethics reform. The wrathful Mr. McCain accused Mr. Obama of being “disingenuous,” to which Mr. Obama meekly replied, “The fact that you have now questioned my sincerity and my desire to put aside politics for the public interest is regrettable but does not in any way diminish my deep respect for you.” Then McCain said, “Obama wouldn’t know the difference between an RPG and a bong.”

Mr. McCain was insultingly dismissive but successful in intimidating his inexperienced colleague. Thus, in his one face-to-face encounter with Mr. McCain, Mr. Obama failed to stand his ground.

What gives us confidence Mr. Obama will be stronger the next time he faces Mr. McCain, a seasoned political fighter with extensive national security credentials? Even more important, what special disadvantages does Mr. Obama carry into this contest on questions of national security?

Let’s step back and understand something here, beginning with the correct sequence of events. Letters were exchanged on February 2nd (Sen. Obama to Sen. McCain), and February 6th (Sen. McCain to Sen. Obama and reply by Sen. Obama). The exchange ended with this from Sen. Obama:

I confess that I have no idea what has prompted your response. But let me assure you that I am not interested in typical partisan rhetoric or posturing. The fact that you have now questioned my sincerity and my desire to put aside politics for the public interest is regrettable but does not in any way diminish my deep respect for you nor my willingness to find a bipartisan solution to this problem.

The Ethics Reform bill passed in January, 2007. John McCain voted for it. So who, exactly, backed down? Not Sen. Obama, who invited McCain to the table, McCain declined, and the legislation was introduced and passed with a near-unanimous majority.

Then, in a somewhat disingenuous move, Ambassador Wilson links up a comment McCain made in MAY, 2007 with this 2006 correspondence when in fact, it was related to McCain’s argument for the surge in Iraq. The comment was this one: “Obama wouldn’t know the difference between an RPG and a bong.” , which Ambassador Wilson incorrectly attributes to Sen. McCain, when in fact it was a McCain aide. The response from the Obama camp was anything but a retreat:

“America doesn’t need juvenile name-calling from Washington, we need a commitment to end this war and bring our brave troops home.”

Again, how does that equate to ‘backing down’? I would guess that Wilson is taking aim at Sen. Obama’s vote to fund the troops (including the surge), which Hillary Clinton also voted for. Here’s a news flash for Ambassador Wilson: A vote to fund the troops and pay them is hardly a vote for the war in Iraq. Even doves like me who also wouldn’t know an RPG from a bong know that much. I also know that Ambassador Wilson’s characterization of the War Authorization bill that Hillary voted for is incorrect. He may know something about diplomacy, but his knowledge of the actual facts of Senate actions appear to be a bit thin, despite the fact that it’s all in the public record right here on the Internet for anyone to see.

When the facts are considered, the air is blown right out of Ambassador Wilson’s argument, leaving a trail of ‘vapid rhetoric’ in the wake.

Folks, this is classic Clinton fighting style. Take facts, twist them around into a spin that demonizes the opponent, and then use a ‘weighty voice’ to carry them across the internet and airwaves as her proxy. This is why she cannot be the Democratic candidate — her ‘get in the gutter and fight’ tactics that Mr. Wilson admires so much are divisive, manipulative, underhanded and will guarantee John McCain the Presidency.

I have previously expressed great respect for Ambassador Wilson and his wife, Valerie Plame Wilson. It’s disappointing to see him spend such a monumental store of goodwill on a dying candidacy. If this is an indication of what Senator Clinton has up her sleeve, then she really should suspend her campaign now, before she and Fmr. President Clinton tear the Democratic party apart and the country along with it.

A personal note to Ambassador Wilson: My own family served in the US Department of State for 30 years, and I have nothing but the utmost respect and fondness for the intelligence and passion of the US Diplomatic Corps. Your self-indulgent fact-twisting on the Huffpo piece is insulting to me on a personal level. In your haste to do Hillary Clinton a favor, you trounced all over the credibility of your colleagues. That’s truly a disappointment.

Technorati Tags: Clinton, Obama, Joseph Wilson, spin, dirty tricks, lies, McCain

Note: this is guest-blogged by my 13-year old daughter, who came home today in a huff after tussling with friends and peers at school over such diverse subjects as the Iraq war, warrantless wiretapping, Election 2008, and illegal immigration all in the span of a 90-minute PE class. I asked her to blog it because I was taken aback by her passion and by the depth of her own thought and knowledge on the topic. Hers is a self-described small voice that “doesn’t matter” (her words, not mine), but her post represents the voices of the next wave of voters, and how our decisions today have such a deep impact on their lives, tomorrow. I know she’d love comments, please feel free to leave some.

Beware!

…small girl speaking–giving opinions–on big subjects.

Though my voice does not matter, and won’t be wanted until I’m eighteen, I can nevertheless help but speak it.

The presidential election of 2008 is, in fact a) a historical one; b) an exciting one; and, c) an important one. It’s a crucial time in our history, what with the war and the economy, etc… and the kids, children, teens, or whatever you want to call us can’t help but notice. We have the influence of the news and reporters telling us this and that; we have our parents’ influence whether it be Democratic or Republican, all the while learning about the Constitution and our government in history class. In short, we develop opinions, and with opinions come disagreements.

Unlike the majority of my peers I don’t have the luxury of believing what my parents believe in terms of politics. My daddy is a Republican, born and bred; my mom is a Democrat. My dad’s side of the family (Republican) lives closest to us, and I get more exposure to them than my mother’s side of the family (Democratic). My mom’s side of the family, however, is more involved and opinionated about politics. Basically I pretty much see both sides of the issues. I also see one or more small disputes that come up because of this. In addition to that, I’m also a blogger and the daughter of a blogger and seem to pick up reports and information more than my friends on these issues. This helps when you’re in an advanced history class, learning government, and are constantly bombarded with projects in which you must take various issues, research, and reflect on them. I will say we are pretty lucky to be learning this during an election. It makes it easier to understand, but unfortunately as I said before, adds to more opinions and more disputes.

Lately, these discussions have been more frequent in school. They started in our yearbook class when our teacher wasn’t there to tell us not to. There are usually about six of us who are the most involved. Two of us, me and another, are very independent thinkers, and very open to opinions which, luckily, agree with each other. The rest are fairly spread out.

It usually starts out, “I want a women president, that would be sooo cool.” I personally hate these comments, why should someone be nominated or elected based on their gender or race? Shouldn’t it be on their ideas, how they would lead us? I voice my opinions and the response is, “Whatever, I still want a women president!” Whatever.

Another person, “My dad is registered as a Democrat so he can vote for Hillary and she can lose to McCain.” I personally think that’s not a trait I would want to share with others, why play like that? Not cool, dude. The other independent, “Obama ‘08! We need change after Bush, not more war and fighting, or more lies like Hillary.” Another person, “Ew, Bush sucks, all my family supports him but me, and they get mad at me for it. I don’t get it, we’re fighting a war that’s not ours to fight.” Me: ”I agree, but why should they be mad at you for your own opinions and differences?” Anyway it usually carries on like this till the end of the period, usually just discussion on the latest primary or caucus, not fighting. The real disagreements came today in PE.

After awhile of the debates and speeches, I decided I was with my mother on Obama, and here’s the great part: My dad, the homegrown Republican, voted Obama too, Woo! So we usually have 10 minutes or so before class starts since it’s 1st period PE, and I usually talk with my friends, and some others, usually the other people in my Honors classes.

The day after Super Tuesday I was talking with them and I asked what the end result of the democratic primary in California was. “I think Hilary won by about 15%,” someone says. “That sucks,” I say. “Why? You WANT Obama to win??” by someone else. Now that’s not cool, don’t you dare get mad at me for my opinions. “Yes I do.” “Seriously? WHY?” (…did you seriously just say that? sigh…) ”Because he is who I prefer, I would personally not like to send in more troops, and I agree with most of his ideas. Jeez, you don’t have to get indignant over a difference of opinions, not cool.” “Whatever.” Haha I love this, “Bananas not War.” I say, and just as the whistle blows to get in our spots she says, “What!?” Haha, live, laugh, love.

So then, next PE the subject of politics comes up again, someone says,”Mitt Romney dropped out last night, that’s too bad I wanted him to be president.” Really? I didn’t know that, Cool. “Well McCain’s going to win anyway so he shouldn’t waste his money.” Another says we are all idiots. If that person wasn’t my friend I would be getting mad again at the intolerance they have toward other’s opinions.

“Hillary better be the Democratic candidate, she’ll be easier to beat.” That’s true, it was projected that if it was Hillary and McCain, McCain would win, but with McCain and Obama, Obama was projected to win. Of course that isn’t exactly the election, anything could happen.

“It bugs me how, although Hillary is the one running for president, lately you see more Bill than Hillary. We’re voting for Hillary, not Bill and Hillary. But I suppose you get them as a package, that’s one of the things I don’t like, some of the remarks he made were uncalled for.” Such as after S. Carolina. haha, NOT.

“I don’t really care.” Another says. The other person again, “I don’t care–McCain’s going to win.” “Do you really want that huge war hawk as president?” I say, I’m starting to lose my temper, although I shouldn’t. Come on, it’s early, I’m sleepy and I’m about to run a mile. I’m still civil though. “What?” she askes. “Dude, he’s like all for the war in Iraq, it’s time to bring our troops home, stop spreading our chaos and messing everything up even more.”

“Oh. My. Gosh, we can’t leave Iraq! Are you kidding? As soon as we leave they are like, going to bomb us!”

“Are you serious? They aren’t going to bomb us. And they don’t have weapons of mass destruction either.”

“Do you read at all? Hellllo, 9/11! If we leave they will Iraq will bomb us again!” hmm, I wonder if I say 9/11 they will jump, because they seem reaaally paranoid.

“Ok, first of all, do not say ‘Iraq will bomb us’. 9/11 was terrorists, NOT Iraq. By saying that you are condemning everybody in Iraq, all the innocent people whose homes WE have invaded, for NO reason! Second off, IRAQ and IRAN do NOT have nuclear bombs! It’s proven, do you know Iraq said they did to keep from being attacked?”

“As soon as we leave they will get Nuclear Bombs and bomb us.” grr…

“From where? They have no Money! We’ve already destroyed so much of their land, with no help to clean it up, How on earth would that happen!”

“Thats not true!”

“Really? Prove it to me.”

“Thats not the point.” Ha, no you’re avoiding the point. “The point is we are in a war that we need to win, then we can bring all the troops in that you like.”

“Dude, so many people are there right now, fighting for us! You want to send in more innocent people to go and mess up the other innocent people’s homes? You dont find any of that wrong?”

“If they don’t want to fight for us they don’t have to, heck I’ll go. It gives me an excuse to shoot people.”

“What if you get shot?” another person asks.

“I don’t care, I just won’t get shot, and even so I’ll just come home with one leg.”

Dear God, someone shoot me now so I can stop listening to this. “Are you kidding me!” It occurs to me that the people I’m standing next to all have no older brothers. “You don’t get it, you don’t get how serious this is, dude people are dying, DYING, over there and you’re joking about it–”

“I’m not joking.”

“–either that or you haven’t watched an older brother join the army–”

“If he didn’t want to go, don’t enlist.”

“Stop cutting me off! He didn’t have a choice. He needed to pay for college. I was little at the time, and didn’t always understand, but the first night he left I had nightmares that he would be out there fighting, in danger! Killed! Fighting for people like you, who could care less for one life. And as you said if people didn’t enlist they would start up the draft again, the draft that my OTHER BROTHER was MADE to sign! You don’t get that, you’ve never seen that, never had that small chance of something that important taken away from you. Also on the subject of 9/11, did you know Bush was tapping our phone lines before it happened?”

“Really?” one person pipes up.

“He did that so he could catch the people planning to do it!”

“So he knew it was going to happen then?” I ask.

“No but, just in case.”

“Well, I can see how well that worked out, so why are they still doing it? And why in such an unproductive manner? What if we accidently say something that’s like, I dont know. a code for something else? Then that person is automatically being watched, innocent because they accidently said something.”

“Well if they are innocent then they don’t have anything to hide.”

“Seriously? Have you heard of the INNOCENT people detained right NOW? Being deprived of their right of habeas corpus? Thats AGAINST the Constitution, the thing the president SWEARS to uphold and protect. Just because they aren’t citizens–”

” Well if they aren’t citizens they can get their butts out off our country!”

“Oh my gosh!” That wasn’t me, that was the girl from Vietnam standing right next to me. She is not a citizen. I lost my temper completely now.

How could anybody so arrogant to say something as that? How much of an arrogant fool do you have to be to shoot off your mouth like that and say that to a friend!

“Oh!” another person pulls the girl from Vietnam away from the group as I go stomping away, the arrogant person cries halfhearted apologies and the whistle blows. I’m still quite mad by the time PE is over and can’t help but remark on my way to the dressing rooms, “You know not everyone has the abilities and resources to become a citizen right away, including money, and time.” I’m not sure if she replied. I didn’t care enough to listen.

I’m pretty sure that’s it. I probably shouldn’t have gotten mad, and could have handled it better, but what can I say? These kinds of disputes really suck, they completely ruin your day. How could we, only 13, have such big mouths? haha jk, but we really do. It’s annoying sometimes…

–If you choose to comment on my post please keep a civil tongue and I will keep one as well. We all have differences of opinion which you are welcome to say as long as it is conducted appropriately. thankyou.—-

Can we?

“Yes we can!”

peace, love, dance.

I hope you all enjoyed the opinions of the world through the eyes of the voices that do not yet register as important

cross-posted on my own blog, too

My theory runs directly contrary to what Steven Weber writes. In my opinion, Al Gore not only won’t run, he shouldn’t run. Why? Because he has much, much more influence outside the Beltway and can operate unfettered by the petty crap that’s tossed around in the hallowed halls of the White House. If Gore were to run his message would be obliterated by the din of nasty Republicans criticizing his son, his wife, his silverware and his suit. Better that he stands apart where he has real influence with the people, with the politicians, and with the press.

Technorati Tags: Al Gore

Back in January I said we needed to impeach Cheney first.

Now Glenn Greenwald and BraveNewFilms.org agree. It’s time to impeach Cheney, and then Bush.

Sign the Petition

It is time to stand up and reclaim our democracy from the hands of despots and dictators. George Bush and Dick Cheney are doing what they are because we are permitting them to do it. Say “No More!” Start with Cheney, then Bush.

Democracy means using your voice. Now is not the time for silence.

Hat tip: Crooks and Liars

Technorati Tags: impeach cheney, dick cheney, george bush, crime, democracy, impeachment

I’ve been following the discussion surrounding universal health care and Sicko closely over the past couple of weeks. It’s interesting to me to see the polarity of opinion around the question of how best to deliver health care in this country.

One thing is sure: Reasonable, open discussion of the issues with solutions attached is nearly non-existent. Reactions range from “Universal Health Care will doom this country” to “Universal Health Care is the solution to all of our ills, physical and otherwise.” Where is the middle ground here? Is there a starting point? For me, there is.

dn lpnsk, via Flickr

The three-pronged profit pitchfork of our current healthcare system:

1. Pharmaceuticals: Rising costs associated with medications and delivery
2. Malpractice Lawsuits and uncapped damage awards
3. Insurance Companies – Profit-taking Enterprises posing as non-profits with extraordinarily costly administrative layers

Starting with a reasonable dialogue about how to limit the financial and political control that the three groups associated with the three prongs named above have on the reform process is a good place. Three of the most powerful lobbies in Congress are represented there. It seems to me that to have a reasonable dialogue about access to healthcare at a reasonable price, there needs to be a commitment (or revolt) that excludes any interest other than the national interest; that is, the citizens of this country and their need to receive healthcare at some sort of reasonable price.

Michael Moore drives home how loudly the money talks. When he points out that there isn’t a single person in Congress who hasn’t received funding on some level from the companies with a vested interest in the status quo, I was tempted to throw my hands in the air and give up before even beginning. But I think we can make this work.

The following links all came by way of Kevin, MD, who does a great job of linking yeas and nays alike, though he tends to lean away from the universal healthcare system proposed by Moore. (I’m not sure I’m sold on it either, at least not if the administrator is the federal government). Here are some of the ‘nays’ I’ve read in the past few days:

USA Today, June 21st:

Sicko uses omission, exaggeration and cinematic sleight of hand to make its points. In criticizing politicians, insurers and drug makers, it says little about the high quality of U.S. care. In lauding Canada, Great Britain, France and Cuba, it largely avoids mention of the long lines and high taxes that accompany most government-run systems.

In fairness to the authors of this op-ed piece, they do make an effort to present a balanced view, but overall this quote states the premise of the author’s opinion. However, what they miss is that the quality of health care in the US isn’t relevant to people who have no access to it. This is the crux of the issue to me — we have to find a way to open the lines of access to healthcare and do it without bankrupting individuals or the country.

WizBang writes:

I do not believe that we have a health care crisis in the United States.

I do believe that we have a serious problem with the financial aspect of the health care industry.

I also believe that the biggest contributor to the health care financing crisis has been lawyers.

Personal injury lawyers like John Edwards, who can claim a large portion of the credit for crippling the obstetrics field in his home state.

The cost of health care has skyrocketed in the last few decades, while the actual income of physicians has not kept pace. In some cases, it’s declined tremendously. That means that a lot of money is going into the system is getting sucked out before it reaches those who actually provide the services. Some of it is leeched out by the personal injury lawyers, both directly (through lawsuits) and indirectly (through malpractice insurance premiums).

Some of it is sucked up by the tremendous bureaucracies instituted by the insurance companies, whose purpose is to minimize how much money gets through them to doctors and other health care providers.

Some of it goes into the increased overhead of doctors, who have to comply with zillions of regulations from health insurance companies and the government.

While I agree with some of what Wizbang writes, I disagree with the statement that we are not nearing a health care crisis in this country. We surely are heading in that direction. Less students are applying to medical schools. More doctors are leaving active practice for academics, consulting, and other areas of practice which relieve them of the need to pay exhorbitant malpractice premiums, expanding their payroll to include employees to manage the administrative red tape involved with insurance companies, and being paid less to do more. The students who do go to medical school are heading for specialty practices more often than not, leaving our family practices without general practitioners.

Yes, we are heading toward a crisis, Wizbang. But you’re right about the contributors to it, for sure.

On the other side of things, The Health Care Blog rightly points out that making a change is hardly as easy as snapping our fingers and making a new system:

A big problem I have with those who now advocate moving to a single-payer system is how really poorly thought-out their proposal is. Proponents seem to presume that you can get from Point A to Point B in one easy move.

The problem is that since 1965 those who operate in the the U.S. health care system have become something akin to drug addicts–they are addicted to all the incentives we have–good, bad, and perverse.

Both are excellent points. In the 1970’s a similar dialogue was taking place around pension and retirement security, and how best to reform the pension system in a way that was fair to employers and employees and would provide some measure of retirement security to all. Sen. John Erlenborn led the way to the passage of ERISA — a sweeping reform of how benefits were to be administered and delivered, how retirement assets were to be protected, and minimum requirements for the operation and administration of pension plans.

Despite Congress’ addiction to amending the pension laws every 2 years or so, the foundational spires of ERISA remain intact: No discrimination against employees; trust assets must be for the exclusive benefit of participants; vesting and benefit accruals must be earned over a limited number of years, and employees must receive annual disclosures and statements related to their benefits. There are other provisions, but these are the basics. By stripping retirement security down to the most basic level and starting there, a plan could be developed for implementation that actually delivered results.

We need to do the same thing with our current health care system. Take what we have, figure out the most basic requirements going forward, and then find a way to deliver those basics fairly and economically, which may mean forming some sort of foundation (non-profit) outside of the government but accountable to administer it.

There’s much more to be said. This is just the beginning. I’ll be posting updates with opinions pro and con as I have time. Or you can save me some and post a comment here to start things off.

Technorati Tags: Sicko, health care, universal health care, policy, reform

Again I say, This organization should lose its tax-exempt status or remove Dobson as its head. He is either in ministry or in politics, but he can’t do both and we shouldn’t be financing his campaign.

“Everyone knows he’s conservative and has come out strongly for the things that the pro-family movement stands for,” Dobson said of Thompson. “[But] I don’t think he’s a Christian; at least that’s my impression,” Dobson added, saying that such an impression would make it difficult for Thompson to connect with the Republican Party’s conservative Christian base and win the GOP nomination.

- James Dobson, in an interview for US News & World Report

Just for fun, here’s an extra tidbit from the article. Really – Focus on the Family should not be a non-profit organization.

While making it clear he was not endorsing any Republican presidential candidate, Dobson, who is considered the most politically powerful evangelical figure in the country, also said that [Newt] Gingrich was the “brightest guy out there” and “the most articulate politician on the scene today.”

Technorati Tags: James Dobson, Focus on the Family, politics, religion, taxes

Part II of a series on healthcare reforms

Adam J. Wolfberg wrote an excellent commentary for the Boston Globe today on “Hippocritical Doctors”. The issues he describes in his column go right to the heart of the issues at the heart of the PBM problem in my previous posts and deeper to the heart of the overall brokenness of our healthcare system.

Dr. Wolfberg’s daughter has cerebral palsy. The best treatment for her condition is physical therapy which was denied by his insurance by two separate doctors paid to review and deny claims. Describing his experience, he notes the following:

While one of these doctors has no expertise with cerebral palsy, the second one does. In his other job, he cares for children with severe physical disabilities and is a proponent of therapy for disabled children. As he wrote to me in an e-mail, “my personal view is that children with [cerebral palsy] benefit from therapy services.” However, in his review of my appeal, he wrote a careful explanation justifying why the health plan should not pay for the therapy.

So two doctors, one with NO expertise in the area of treating children with cerebral palsy, and one with extensive experience in the field and who holds the personal opinion that children benefit from physical therapy, are charged with saving the insurance company the cost of covering the therapy. Dr. Wolfberg definitely has an opinion about this:

This doctor and others like him are making money denying care – and they might as well hang up their white coats. They may believe that their administrative decisions are medically justifiable. However, it often appears that they are hired because their MD degrees lend a patina of legitimacy to administrative decisions that are based on interpretation of a health plan’s policies, not a chart, lab test, or CT scan.

This is the dark side of our healthcare system: There is only incentive to deny claims, not to evaluate them fairly and approve or deny based upon facts, expertise and the best interest of the patient. The ones who are harmed are the patients, with real conditions, some life-threatening, others not. Dr. Wolfberg concludes with this:

Individuals are harmed when medical care is withheld. Many of these health plan doctors, whose job it is to reject claims, end up being paid to violate the Hippocratic oath they took when they graduated from medical school – to “first, do no harm.”

That is the heart of the matter: There is an irreconcilable conflict when insurance companies place physicians, bound by oath to do no harm, in a position where their decisions are driven by the bottom line instead of the patient’s needs. The most qualified individual to determine a patient’s needs is their own PHYSICIAN. What we have here is a system where the decisions of treating physicians are disrespected in favor of an arms-length review and denial by colleagues who sold their white coat for a paycheck.

Anyone seeking a career as a doctor (particularly one in general practice) today would have to be certifiably insane.  Assuming they make it through medical school, their internship and residency, they come away with tremendous debt.  Then they are injected into a system where their decisions are second-guessed by insurance company physicians, their malpractice insurance costs equal more than they pay for their homes, their rates are dictated by arbitrary price-fixing and they have to navigate a maze of red tape and paperwork to see patients at all.

Contrast this with one person’s recent experience in an emergency room in France:

…there’s no paper needed anywhere, no forms, no signatures. The French have developed what I would call the USERNAME system of medicine. Just like many web sites who just want you as a user and don’t really care about your real identity, the French Emergency Health care system is the same. They would like to know who you are but they do not need to know who you are when you are in a medical emergency.

…there’s absolutely no paperwork. I had never seen anything like that. You tell them your name, they believe you, you tell them your address, they believe you. They don´t ask you for medical insurance nor for any kind of payment and the whole admission takes at most 45 seconds.

… the legal system is mainly absent from French medicine. When it was all done it was shocking for me to leave the hospital without having to sign any release forms. The surgeon herself notified the administrative staff that I was done and she released me simply saying that I could go home without seeing anybody.

This author concludes:

But what’s wrong with the American health experience is that it is invaded by a lot of elements that are foreign to medicine. The result is a cost so onerous that the percentage of GDP Americans spend on medicine is much higher than in France but the results are very disappointing.

Indeed.

(Hat tip to Kevin, MD for the link to Dr. Wolfberg’s article)

Technorati Tags: medical benefits, claims review, health insurance

[First in a series on healthcare reform]

Those who read my personal blog know that I have a special place on my hit list for Pharmacy Benefit Managers, or PBMs. This stems from: a) My personal experiences and ongoing struggles to force Caremark to honor their contract and cover prescription ADHD medications which are necessary and which are prescribed by a qualified physician after the proper diagnosis was made, and b) My professional experience as a third-party pension administrator with more than 20 years time in the business and a better-than-average understanding of ERISA and employee benefit plans.

In our current healthcare system, PBMs are viewed as a cost-saving mechanism to deliver prescription medications to insureds under contracting health insurance plans. Let’s be clear:  They are an invention of the major insurance companies, who separated themselves from pharmacy benefits in order to continue to realize profits on one of their largest profit centers while becoming non-profit corporations.

In fact, PBMs create an additional layer of administrative costs while serving as a pathway to deny legitimate benefits to insureds while keeping the insurance companies’ involvement at arms-length. They are the unclothed emperor of the health insurance industry, but there are some who are calling them what they are.

Recently, I wrote that Caremark dodged a legal bullet when a Federal Appeals Court ruled that Caremark had no fiduciary liability for denying benefits to covered individuals, defining them as a contract administrator only. I disagree with this ruling for a number of reasons, despite the party line that the Caremark employee-commenters like to leave about how the insurance contract dictates the benefits, Caremark merely carries out the contractual arrangement and so on. The fact is that it is Caremark and Caremark employees, qualified or otherwise, which make the determination as to whether or not to deny access to a “prior authorization required” medication. I have copies of letters proving that, where a gastroenterologist who has not practiced for two years denied my access to ADHD medications.

Now it seems, the courts and state legislators are waking up to that fact. Over on the Health Plan Law blog, they report that PBMs just lost a significant decision, and that there is legislation pending to regulate PBMs in 36 States and the District of Columbia. They report:

Thus, state lawmakers are taking seriously the allegations of fraud and abuse by PBM’s and are doing something about it.

In this particular case, the courts continued to hold that PBMs are not fiduciaries under ERISA. (Note: That determination does not preclude them from being considered fiduciaries under a less restrictive standards. ERISA is one of the most restrictive definitions of fiduciary on the books). This particular aspect of the ruling went to the benefit of the PBM, since it stands to release them from any liability for arbitrary and capricious denial of benefits.

What was good about this particular ruling was the larger issue: State regulation of PBMs.  It paves the way for states to force transparency and disclosure, which is definitely a victory for insureds who are subject to their whimsical claims denials, as well as unbridled rebating practices and other methods of lining executives’ pockets.

In other litigation involving Caremark and Medicaid, it seems that Caremark was denying claims for Medicaid reimbursement, because the insureds were not presenting a Caremark card and therefore not compliant with the pharmacy benefit plans they administered. But here’s the catch: The insureds in the TennCare plan could not comply with the card presentation requirement because the agency responsible for Medicaid benefits did not have a card. Further, Medicaid is the final payor if there is other coverage present. In other words, all other avenues for payment have to be exhausted before Medicaid will make a claim for benefits. When TennCare would file with Caremark for reimbursement, they were denied on the basis of not presenting a card and not filing a timely claim.

Caremark effectively constructed a Catch-22 that insureds could not navigate their way through:  They created compliance requirements that the insureds could not meet.

The court ruled that the requirements were discriminatory against Medicaid; however, Caremark has still weaseled away from any liability by passing it through to the insurance company it serves. If Caremark has the power to deny payment of benefits and is subsequently found to be liable for those benefits, the cost for the benefits pass through to the insurance company.

All of this leads back to this question:  What good is the PBM?

The answer: Not much. On the Health Plan Law Blog again, an excellent analysis of the utility (or non-utility) of the current PBM structure.

PBM’s promise to deliver cost savings to health plans through plan design, effective purchases of appropriate pharmaceuticals, disease management and various ancillary services. The PBM’s dictate the formularies that drive traffic toward certain drugs and away from others based on reimbursements that the PBM’s specify. Inasmuch as the big are posed to get even bigger, these current events present an occasion to reflect on the utility and effect of the PBM mechanism in the American health care system.

The entire post should be required reading for anyone interested in our current healthcare delivery system and the corrupt structure of the PBMs. It points out that the use of rebates is rarely passed through to the consumer, though the price for acquisition of prescription medications is increased in the United states by 50-70%, mail order savings are not passed through to the consumer, there is non-transparency of price fixing on generic medications, bloated costs associated with an additional layer of administration, and the liability for claims denial skips the PBM and lands at the feet of the employer and insurer anyway. Those factors say to me that the answer to whether PBMs help or hurt the healthcare system is clearly “NO”.

If we are to have any hope of arriving at meaningful healthcare reform, it’s going to be necessary to shed the idea that there are sacred cows which cannot be sacrificed. There isn’t much dispute that the current system is broken, and rather than putting a bandaid on it, we’d do better to look hard at each piece of the current system and make a decision about whether it should remain in a reformed system. I do not believe there is a place for PBMs in the reformed system. Claims management for pharmaceuticals should follow a standardized procedure that encompasses all claims, with no special carve-out for pharmacy benefits. I would be much more supportive of a system that applied fair and non-discriminatory standards to prescription drug coverage than the arbitrary, capricious, and profit-taking system we have now.

Technorati Tags: Caremark, PBM, ExpressScripts, healthcare reform, pharmacy benefits, courts, legal

Via the Huffington Post, this report of a key computer stolen from MN Democrats’ HQ. I blogged earlier about a break-in at the New Hampshire Democratic headquarters.

There has been almost no national press on this. Why not?

Technorati Tags: democratic headquarters, break-in, crime, politics

The two Edwards campaign bloggers who were under fire last week for exercising their right to free speech resigned today in the face of some interesting ‘valentines’ from some folks claiming to be good, God-fearing Christians, citing concern for the negative impact on the campaign.

Of course, by NOT being attached to the campaign, they’ll be much freer to speak their mind and I’m certain they will. I just wish some of the folks calling themselves Christians would stop. It’s mortifying. Politics and religion shouldn’t be mixed together. Christians shouldn’t be threatening toward others ever. The blend of those two factors is an utter disaster. Score one for the bad guys in good guys’ clothing. What a mess, but at least there’s some serious pushback on the conservatives who sparked and fueled this nasty war of words.

This has been going on for a very long time. Before bloggers, message boards were the target. Back in the dark and gloomy days of the Clinton impeachment, the CNN Community was deluged 24/7 with trolls paid to try and shut down the conversation by spamming the boards over and over again with meaningless rhetoric. We used to play tag-team board moderation — one of us would be banning by the dozen while the other was mopping up the mess on the boards in real time.

If I close my eyes and think about it, I can almost quote them verbatim, because the message hasn’t changed, just the target and the method of delivery. Now that they have a ready-made platform on Fox News, they’ve become bolder, but still uncreative and cretin in their delivery.

Perhaps the campaigns should not pay bloggers at all. Maybe they should provide a platform (similar to the MyBarackObama.com site) for people to blog and that’s it. That way the best political bloggers can maintain their own voices and choices of expression without risking the campaigns, and no one can plaster the ‘paid shill’ label on them in the process (one of the milder accusations dropped this week).

Technorati Tags: John Edwards, Amanda Marcotte, Pandagon, Melissa McEwan