By: Lelia Chaisson
Posted: 10/9/08
Two years ago, Americans couldn't get enough of the health care debate. With Massachusetts leading the way to universal coverage, health care dominated the headlines. Forty-seven million uninsured, staggering U.S. expenditures on medical technology and lagging U.S. health statistics were disturbingly familiar, and it seemed certain that America was on its way to health care reform.
So what happened?
Right in the middle of our attempt to fix the "broken system," health care lost its momentum, much as it did in the 1990s with Hillary Clinton's failed attempt to revolutionize it. In both cases, huge movements swiftly lost their authority and eventually faded into the background, leaving Americans to deal with the ever increasing costs of health care. It seems that, despite the perpetual health care calamity in America, every time we get close to making some progress, health care disappears from the headlines.
Health care has once again taken a back seat in the 2008 election, despite the fact that recently published reports show that access to health care remains a considerable problem for more American families than ever before. Indeed, the Center for Studying Health System Change recently disclosed that almost one in five families struggled to pay medical bills last year; Twenty percent of those having problems even considered declaring personal bankruptcy. Nor is the issue limited to those without medical insurance. Reports indicate that of the 57 million Americans under pressure, 43 million have some form of insurance. The health care crisis is far from over, yet real reform is not even on the horizon.
Why is it so hard to get the ball rolling on health care? It's not because Americans don't want health care reform. While the issue has slipped behind the financial crisis and the Iraq war in the current election, it remains firmly in the top three issues among all demographics. Nor is it for lack of ideas. Over the years myriad diverse plans have been proposed by Republicans and Democrats alike.
I can only conclude that the standstill is due to the public's wishy-washiness. Americans simply don't know what they want. Or, rather, they know what they want, but they aren't willing to take any of the necessary steps to get it. What is perhaps the most interesting thing about this debate is the combination of America's conviction that every person should have access to affordable, high-quality care, and its simultaneous skepticism concerning every proposed plan for change.
Just look at the public's reaction to some of the ideas for reform. To the suggestion that we require coverage for every American to promote preventive care comes the loud retort that forcing everyone to have insurance is un-American. To the notion that we should cut spending on costly, infrequently used procedures comes the cry that Americans should have access to any medical procedure they could ever possibly want, nevermind the price tag.
Now, I'm not saying that all of these ideas are perfect. I'm just pointing out the irony that Americans demand affordable coverage and access for all, yet reject any policy that has the potential to address these problems.
America's fickleness has reared its head once again in the current election. On the one hand, Barack Obama has suggested creating a national health plan available to all Americans, with guaranteed eligibility, benefits similar to those offered in the plan available to members of Congress and subsidies for those who do not qualify for Medicaid or SCHIP but still need financial aid.
Seemingly, his plan has addressed every criticism. No mandate for universal coverage. Affordable care for every American. Guaranteed access. Choice between private and employer-based coverage.
The public's reaction? Obama's plan is too costly and will create too much regulation.
Senator McCain, on the other hand, wants nothing close to a national health care plan, and instead advocates stimulating the private market and doing away with tax breaks for employer-based health insurance.
Now, come on. Voters say they want to ensure affordable coverage for every American. They say they want to take some of the power away from greedy insurance companies that deny care to the sick and disadvantaged. Is there really any question as to which plan will better address these issues? Granted, Obama's plan is going to be expensive. But let's be serious. Doing away with tax breaks will encourage employers to do away with their health care plans. And a $5,000 tax credit will be a drop of water in a sea of health care costs, which now average $12,680 a year for U.S. families. In addition to this, it is widely speculated that McCain's plan will leave millions of people uninsured and give more power to the insurance companies everyone despises.
But, in the end, no matter who gets elected, I doubt we'll ever get far enough to see either of these plans enacted. America loves to talk the talk, but won't walk the walk. When given the choice of actually addressing their constantly reiterated concerns about health care or doing nothing, Americans consistently choose the latter.
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© Copyright 2008 News-Letter
Sunday, October 12, 2008
Saturday, October 4, 2008
Debit Card For unbanked Americans
Comerica Bank Named as Card Issuer
Washington, D.C. - (Jan. 4, 2008) - The U.S. Department of the Treasury's Financial Management Service (FMS) has designated Comerica Bank as its financial agent in a new initiative to give millions of unbanked Americans the option of using a prepaid debit card for receiving Social Security and other federal benefit payments. The "Direct Express®" card provides a safer and more convenient alternative to paper checks. Comerica Bank was selected, in part, because of its experience as a prepaid card issuer for millions of benefit recipients, particularly for state government programs.
"Direct Express represents a significant step forward in the evolution of federal benefit payments," said FMS Commissioner Judy Tillman. "The explosive growth in the prepaid card industry offers an important opportunity for Treasury to give unbanked payment recipients secure, easy access to their funds, at low or no cost to the cardholder. We ultimately would like to see an all-electronic Treasury - with all the security, efficiency and cost savings that would entail. This card takes us closer to that goal by combining the best in payment innovation with sound public policy. If every unbanked federal check recipient signed up to use the card, it would save taxpayers about $44 million per year."
The Treasury estimates that four million Social Security and Supplemental Security Income (SSI) check recipients do not have bank accounts, placing them at greater risk of check delivery delays due to poor weather, national or local emergencies, and other check related problems, such as lost or stolen checks. In fact, nine times out of 10, problems with Social Security payments are linked to paper checks, not direct deposit.
Financial Flexibility and Security
The Direct Express card will be introduced in spring 2008 and will be phased into national distribution by the end of the summer. Direct Express card holders will benefit from improved financial flexibility and security as compared to paper check recipients.
Each month, payments will be automatically deposited on the Direct Express card account on the federal beneficiary's designated payment day - which means people will have faster access to their money than they would if they had to cash a paper check. Card holders will be able to access their money at ATMs and financial institutions nationwide. They will be able to use their card to get cash back and make purchases at retail locations, as well as pay bills and make purchases online. In addition, these accounts are PIN-protected, FDIC-insured, and subject to federal consumer protection regulations (Regulation E).
"Millions of federal beneficiaries remain outside the banking system, which means they don't have access to payment methods that most Americans take for granted, such as getting cash at an ATM or paying with a card at a store," said Nora Arpin, Director of Government Electronic Solutions for Comerica Bank. "The Direct Express card provides an opportunity for people outside of the banking system, either because of personal choice or perhaps their inability to obtain a bank account, to gain a foothold in the financial mainstream."
The Treasury has already experienced significant success in increasing electronic payments with its Go Direct campaign, which is aimed at motivating banked federal benefit recipients to switch from paper checks to direct deposit. To date, Go Direct has achieved more than 1.6 million direct deposit conversions.
"Direct Express" is a registered trademark of the U.S. Department of the Treasury, Financial Management Service.
Last Updated: Thursday January 03, 2008
Washington, D.C. - (Jan. 4, 2008) - The U.S. Department of the Treasury's Financial Management Service (FMS) has designated Comerica Bank as its financial agent in a new initiative to give millions of unbanked Americans the option of using a prepaid debit card for receiving Social Security and other federal benefit payments. The "Direct Express®" card provides a safer and more convenient alternative to paper checks. Comerica Bank was selected, in part, because of its experience as a prepaid card issuer for millions of benefit recipients, particularly for state government programs.
"Direct Express represents a significant step forward in the evolution of federal benefit payments," said FMS Commissioner Judy Tillman. "The explosive growth in the prepaid card industry offers an important opportunity for Treasury to give unbanked payment recipients secure, easy access to their funds, at low or no cost to the cardholder. We ultimately would like to see an all-electronic Treasury - with all the security, efficiency and cost savings that would entail. This card takes us closer to that goal by combining the best in payment innovation with sound public policy. If every unbanked federal check recipient signed up to use the card, it would save taxpayers about $44 million per year."
The Treasury estimates that four million Social Security and Supplemental Security Income (SSI) check recipients do not have bank accounts, placing them at greater risk of check delivery delays due to poor weather, national or local emergencies, and other check related problems, such as lost or stolen checks. In fact, nine times out of 10, problems with Social Security payments are linked to paper checks, not direct deposit.
Financial Flexibility and Security
The Direct Express card will be introduced in spring 2008 and will be phased into national distribution by the end of the summer. Direct Express card holders will benefit from improved financial flexibility and security as compared to paper check recipients.
Each month, payments will be automatically deposited on the Direct Express card account on the federal beneficiary's designated payment day - which means people will have faster access to their money than they would if they had to cash a paper check. Card holders will be able to access their money at ATMs and financial institutions nationwide. They will be able to use their card to get cash back and make purchases at retail locations, as well as pay bills and make purchases online. In addition, these accounts are PIN-protected, FDIC-insured, and subject to federal consumer protection regulations (Regulation E).
"Millions of federal beneficiaries remain outside the banking system, which means they don't have access to payment methods that most Americans take for granted, such as getting cash at an ATM or paying with a card at a store," said Nora Arpin, Director of Government Electronic Solutions for Comerica Bank. "The Direct Express card provides an opportunity for people outside of the banking system, either because of personal choice or perhaps their inability to obtain a bank account, to gain a foothold in the financial mainstream."
The Treasury has already experienced significant success in increasing electronic payments with its Go Direct campaign, which is aimed at motivating banked federal benefit recipients to switch from paper checks to direct deposit. To date, Go Direct has achieved more than 1.6 million direct deposit conversions.
"Direct Express" is a registered trademark of the U.S. Department of the Treasury, Financial Management Service.
Last Updated: Thursday January 03, 2008
Wednesday, October 1, 2008
Nursing Home Tansparency and Quality of Care Improvement ACT
September 30, 2008
A report by the HHS Inspector General’s Office has gotten a great deal of press attention, and we wanted to provide you access to the report in case you get questions from the media or others. The report uses OSCAR data to show trends in deficiencies from 2005 – 2007 and is contained in a memorandum from Inspector General Daniel Levinson to Kerry Weems, the Acting Administrator at CMS. You can access it on the OIG website, Trends in Nursing Home Deficiencies and Complaints (OEI-02-08-00140) http://intranet/oiginternet/oei/reports/oei-02-08-00140.pdf.
Among the highlights of the findings:
The percentage of nursing homes with deficiencies increased from 91.1% in 2005 to 91.9% in 2007.
The average number of deficiencies per nursing home increased from 6.4% to 7.0%. 74% of deficiencies in 2007 were for quality of care violations.
94% of for-profit facilities were cited in 2007, compared with 88% of nonprofits and 91 percent of government-owned nursing homes. For-profit nursing homes also had a higher average number of deficiencies.
7.3% of chain-operated facilities were cited in 2007, compared with 6.7% of single-owned facilities.
There was a slight increase in the scope and severity of deficiencies cited, with a higher percentage of for-profit nursing homes cited for immediate jeopardy or actual harm (17% versus 15% for nonprofit and government facilities).
Facilities with substandard quality of care deficiencies increased from 3.0% of nursing homes in 2005 to 3.6% in 2007. Again, for-profit nursing homes had higher citations—4.2% compared to 2.3% for nonprofits and 3.0 for government facilities.
The number of substantiated complaints fell from 14,781 in 2005 to 14,394 in 2007. Only about 39% of complaints were substantiated. About 20% of substantiated complaints involved abuse or neglect.
The report does not address an issue raised in a previous OIG report and in repeated Government Accountability Office (GAO) studies: undetected care problems and the under-citing of deficiencies. A GAO report published last spring found that when federal surveyors did comparative (look-behind) surveys, about 15% of the federal surveys “identified state surveys that failed to cite at least one deficiency at the most serious levels of noncompliance—actual harm and immediate jeopardy.” (See Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses GAO-08-517, May 9, 2008.) The GAO attributes understatement of deficiencies to surveyors’ weak investigative and analytical skills.
In spite of shortcomings in the study, it provides an opportunity for advocates to make a case to the press and policymakers for the Nursing Home Transparency and Improvement Act (S. 2641), sponsored by Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI), and its House companion bill, the Nursing Home Transparency and Quality of Care Improvement Act (HR 7128), introduced last week by Representatives Pete Stark (D-CA) and Jan Schakowsky (D-IL). The bills will provide the public better information about nursing homes’ owners and operators, expenditures, staffing levels, and sanctions, and will provide better tools for the government to monitor and sanction chains. It also lends support to passage of the Fairness in Nursing Home Arbitration Act, S. 2838 and HR 6126, which would invalidate providers’ efforts to force residents and their families into arbitration when a resident was neglected or abused.
A report by the HHS Inspector General’s Office has gotten a great deal of press attention, and we wanted to provide you access to the report in case you get questions from the media or others. The report uses OSCAR data to show trends in deficiencies from 2005 – 2007 and is contained in a memorandum from Inspector General Daniel Levinson to Kerry Weems, the Acting Administrator at CMS. You can access it on the OIG website, Trends in Nursing Home Deficiencies and Complaints (OEI-02-08-00140) http://intranet/oiginternet/oei/reports/oei-02-08-00140.pdf.
Among the highlights of the findings:
The percentage of nursing homes with deficiencies increased from 91.1% in 2005 to 91.9% in 2007.
The average number of deficiencies per nursing home increased from 6.4% to 7.0%. 74% of deficiencies in 2007 were for quality of care violations.
94% of for-profit facilities were cited in 2007, compared with 88% of nonprofits and 91 percent of government-owned nursing homes. For-profit nursing homes also had a higher average number of deficiencies.
7.3% of chain-operated facilities were cited in 2007, compared with 6.7% of single-owned facilities.
There was a slight increase in the scope and severity of deficiencies cited, with a higher percentage of for-profit nursing homes cited for immediate jeopardy or actual harm (17% versus 15% for nonprofit and government facilities).
Facilities with substandard quality of care deficiencies increased from 3.0% of nursing homes in 2005 to 3.6% in 2007. Again, for-profit nursing homes had higher citations—4.2% compared to 2.3% for nonprofits and 3.0 for government facilities.
The number of substantiated complaints fell from 14,781 in 2005 to 14,394 in 2007. Only about 39% of complaints were substantiated. About 20% of substantiated complaints involved abuse or neglect.
The report does not address an issue raised in a previous OIG report and in repeated Government Accountability Office (GAO) studies: undetected care problems and the under-citing of deficiencies. A GAO report published last spring found that when federal surveyors did comparative (look-behind) surveys, about 15% of the federal surveys “identified state surveys that failed to cite at least one deficiency at the most serious levels of noncompliance—actual harm and immediate jeopardy.” (See Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses GAO-08-517, May 9, 2008.) The GAO attributes understatement of deficiencies to surveyors’ weak investigative and analytical skills.
In spite of shortcomings in the study, it provides an opportunity for advocates to make a case to the press and policymakers for the Nursing Home Transparency and Improvement Act (S. 2641), sponsored by Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI), and its House companion bill, the Nursing Home Transparency and Quality of Care Improvement Act (HR 7128), introduced last week by Representatives Pete Stark (D-CA) and Jan Schakowsky (D-IL). The bills will provide the public better information about nursing homes’ owners and operators, expenditures, staffing levels, and sanctions, and will provide better tools for the government to monitor and sanction chains. It also lends support to passage of the Fairness in Nursing Home Arbitration Act, S. 2838 and HR 6126, which would invalidate providers’ efforts to force residents and their families into arbitration when a resident was neglected or abused.
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