Sunday, April 11, 2010

Something for nothing

My father had an 8th Grade education, but he was a very wise man.
One of his sayings was "You never get something for nothing--unless someone, somewhere, is getting nothing for something".

Well, you can see the logical result: The ones getting nothing for something will stop producing that something, regardless of whether it isw a product or a service.

Yet, Liberals have two hallmarks: Fantasy and Hypocrisy.

Under their Fantasy heading, they started making bankers and lenders accept nothing for something in 1977 with the Community Re-Investment Act (Sounds like an Obama theme song, doesn't it?)

The original Act was passed by the 95th United States Congress and signed into law by President Jimmy Carter on October 12, 1977 (Pub.L. 95-128, 12 U.S.C. ch.30). Several legislative and regulatory revisions have since been enacted.
The CRA was passed as a result of national pressure to address the deteriorating conditions of American cities—particularly lower-income and minority neighborhoods. Community activists, such as Gale Cincotta of National People's Action in Chicago, had led the national fight to pass, and later to enforce the Act.

The CRA followed similar laws passed to reduce discrimination in the credit and housing markets including the Fair Housing Act of 1968, the Equal Credit Opportunity Act of 1974 and the Home Mortgage Disclosure Act of 1975 (HMDA). The Fair Housing Act and the Equal Credit Opportunity Act prohibit discrimination on the basis of race, sex, or other personal characteristics. The Home Mortgage Disclosure Act requires that financial institutions publicly disclose mortgage lending and application data. In contrast with those acts, the CRA seeks to ensure the provision of credit to all parts of a community, regardless of the relative wealth or poverty of a neighborhood.

Before the Act was passed, there were severe shortages of credit available to low- and moderate-income neighborhoods. In their 1961 report, the U.S. Commission on Civil Rights found that African-American borrowers were often required to make higher downpayments and adopt faster repayment schedules. The commission also documented blanket refusals to lend in particular areas (redlining). The "redlining" of certain neighborhoods originated with the Federal Housing Administration (FHA) in the 1930s. The "residential security maps" created by the Home Owners' Loan Corporation (HOLC) for the FHA were used by private and public entities for years afterwards to withhold mortgage capital from neighborhoods that were deemed "unsafe". Contributory factors in the shortage of direct lending in low- and moderate-income communities were a limited secondary market for mortgages, informational problems to do with the lack of credit evaluations for lower-income borrowers, and lack of coordination among credit agencies.

In Congressional debate on the Act, critics charged that the law would create unnecessary regulatory burdens. Partly in response to these concerns, Congress included little prescriptive detail and simply directs the banking regulatory agencies to ensure that banks and savings associations serve the credit needs of their local communities in a safe and sound manner. Community groups only slowly organized to take advantage of their right under the Act to complain about law enforcement of the regulations
Yeah, right. During Bubba Clinton's reign, Janet Reno threatened lenders with prosecution if they failed to lend to low- or no incomers.

Then, Ted Kennedy and his fellow senator from Massachussets gave us:

The Emergency Medical Treatment and Active Labor Act (EMTALA is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004, or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate. Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented." More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care. There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

Illegal immigrant ALIEN residents
According to the Census Bureau, some 9.7 million of the nation's 45.7 million uninsured people in 2007 were non-citizens. Access by illegal immigrants to U.S. health care through EMTALA remains a source of controversy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 contains a provision for $250 million per year for fiscal years 2005-2008 in payments to eligible providers for emergency health services provided to undocumented aliens and other specified aliens.

According to a 2007 analysis by the Kaiser Commission on Medicaid and the Uninsured, uninsured adult low-income non-citizens were the least likely to use emergency rooms, with only about one in ten reporting a visit in the past year. Adult non-citizens most often rely on clinics and health centers, many of which are funded by charities as well as hospitals seeking to unburden their emergency rooms.

However, immigration restrictionist groups like the Center for Immigration Studies and Federation for American Immigration Reform have argued that illegal immigrants still disproportionately burden the emergency rooms as they are uninsured to a far higher extent, and are therefore to a much higher extent unable to pay for their emergency room visits. Also, they claim that because the children of illegal immigrants are often U.S. citizens, the cost of treating them is ignored. Nevertheless, since non-citizens make up 21.2% of the uninsured, and they are the least likely of the uninsured to use emergencies rooms, their cost is at most $8.6 billion per year.


And getting up to date:

Valley doctors worry deep Medicare pay cuts may remain in place

Read more:
By Barbara Anderson / The Fresno Bee
Medicare patients in the central San Joaquin Valley could have a harder time getting medical attention this year, if the government goes ahead with a deep pay cut for doctors.

Congress cut doctors' reimbursement by 21.2% this month, and doctors say the cut could force many of them to drop out of the insurance program.

In the past, Congress has rescinded such pay cuts, and it could still repeal this year's reduction. But already one attempt to scrap it has been blocked. Doctors worry the cut will stand.

"If this cut goes through, we will not be able to see new Medicare patients," said Dr. Cynthia Bergmann, a Fresno gynecologist. "And we will have to look hard at what we have to do with our current patients, whether we can afford to take care of them."

It's not as bad in the Valley as in many other places, because many doctors here will be eligible for a 10% Medicare pay increase next year as part of the health reform package. Doctors in designated health-professional shortage areas will qualify.

Even so, the bonus wouldn't offset a 21.2% pay cut -- and some physicians have already made a decision to curtail Medicare practices.

Community Medical Providers in north Fresno, a 10-doctor office, decided last year not to add new Medicare patients, except for patients referred to it by a Medicare health maintenance organization that has a contract with the group.

"Basically it is the reimbursements," said Walene Herzog, office manager. "We all knew the cutbacks were coming -- and it's already started."

In the Valley, more than 220,000 patients rely on Medicare, the federal insurance program for the elderly and those with disabilities. Nationwide, about 40 million are enrolled.

Fixing the formula

Medicare payments are set by a complicated formula known as the SGR, which stands for "sustainable growth rate." The payment rate -- established in 1997 to cut Medicare costs -- is based on the gross domestic product.

When the economy is booming, rates go up. When the economy stalls, they can go down.

Doctors have been pushing Congress to change the formula to reflect rising health-care costs.

"We're not saying let physicians spend whatever they want -- have strong accountability and utilization controls -- but give a stable reimbursement system," said Elizabeth McNeil, vice president of government relations for the California Medical Association, an organization representing 35,000 doctors.

Doctors say that even in a recession, the costs to practice medicine keep increasing.

"Everything is more expensive today," said Dr. Michael Krueger, a Fresno cardiologist. "Physicians' incomes are way down."

But most Valley doctors are waiting to see what happens before limiting the Medicare patients in their practices.

Congress returns Monday from spring recess and could move to scrap the pay cut.

So far, nationwide access to doctors has remained good for Medicare patients, according to the Medicare Payment Advisory Council, which advises Congress on Medicare payments.

A 2009 nationwide survey found most Medicare enrollees have doctors. Only 6% were looking for a new doctor.

Of those, about 25% reported having some trouble finding one.

But the survey did not look specifically at areas such as the Valley.

"I think there can be regional differences and regional spot shortages of doctors, and we need to take a close look as to why that's happening," said Joe Baker, president of the Medicare Rights Center, a nationwide consumer service organization.

Most Medicare patients are unaware of the payment turmoil. Doctors say that's because they shield them from it.

"We want to take care of patients, and we want to take care of them well," Bergmann said.

Lee Coulter, 76, of Los Banos, has used Medicare more than most. She's had 28 surgeries and had cancer twice. She has not had a problem finding doctors, she said.

Medicare and a supplemental insurance policy cover her out-of-pocket costs, she said. But she has seen her medical bills and what Medicare paid her doctors. "Sometimes, they've hardly paid anything," she said.


So, more and more doctors are saying,"Screw it --I can't pay my costs with the money that the Government pays me". Result: Doctors retire, change careers or refuse to take Medicare Patients.

And OBamacare will only worsen this getting nothing for something scenario

No comments:

Post a Comment