Medicare flim-flam from the Orwell Administration

An earlier, slightly different, version of this entry appeared in my DailyKos diary.

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For just a few minutes earlier today, an important story on the Bush lies about Medicare appeared on the front page of the New York Times site. Then, quicker than you can say "General Accountability Office", it vanished into website limbo, buried near the bottom of the NYT's "National" page. For the record, the story is on page A17 of the dead-trees version of the Times.

Those intrepid patriots in the GAO have once again demonstrated that there is no connection between Bushista rhetoric and objective fact. As Times reporter Robert Pear drily puts it near the end of the article:

The report was the fourth in two years to find that the administration had skirted federal law in pursuing health policy objectives. In July 2002 and last January, the accountability office said the administration had improperly allowed states to divert money from the Children's Health Insurance Program to provide coverage for childless adults.

Earlier this month the auditing agency said that the Bush administration had illegally withheld data from Congress on the projected cost of the new Medicare law.

This time, the GAO offers its assessment of a Centers for Medicare & Medicaid Services (CMS) demonstration project ... a preferred provider organization (PPO) model, running since January 2003 in 214 counties around the country. The demonstration purports to show that PPOs would be better than traditional fee-for-service Medicare in both cost and beneficiary coverage.

Instead, the GAO found that the demonstration actually costs Medicare an extra $650-750 per beneficiary, even though the project acceded to the demands of the insurers, waiving statutory benefit and coverage requirements in 29 of the 33 PPOs in the study. In other words, the plans were allowed to deny coverage for some services if they were obtained from out-of-network providers.

That's not the way a PPO is designed to work. What's supposed to happen is that the plan makes it more expensive for beneficiaries to obtain services from non-PPO sources, in order to encourage and incentivize subscribers to use in-network providers, presumably under an agreement to accept lower payments than they might otherwise have obtained. However, in every PPO I've ever run across, there will be some defined coverage for services performed by out-of-network providers.

Thus, not only did this PPO demonstration cost Medicare more than the traditional model, some beneficiaries faced large out-of-pocket expenses for denied coverage of services that would have been partially reimbursed under the traditional model. Truly a lose-lose proposition.

This is another of those Orwellian black-is-white programs so emblematic of the Bushies. Traditional fee-for-service Medicare allows a beneficiary to obtain covered services from any doctor, hospital, nursing home, home health agency, lab, rehab facility, etc. No assigned primary care "gatekeeper", no "referral network". How much much more freedom of choice can a beneficiary have than that? Certainly not in a PPO, not even one that (unlike most of the plans in the demonstration) actually pays something for out-of-network services. Yet PPOs, and, even worse, the bastardized and misrepresented atrocities in this Medicare demonstration, are hawked by the malAdministration as somehow increasing the choices available to Medicare beneficiaries. It defies logic and common sense.

But that's not exactly breaking news by now, is it? Certainly not in the Bush netherworld of Dr. Mark McClellan, administrator of CMS (Medicare's parent agency). According to Pear's article,

In negotiations over the Medicare bill last year, the administration pressed for more money and authority to foster the growth of preferred provider plans, saying they would be more efficient and would save money over time. Administration officials reiterated that view on Monday.

After reviewing the report, Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, insisted that private plans were "an attractive option" that would save money and improve coverage for beneficiaries.

Oh, by the way, did I mention that the CMS administrator bears a rather striking resemblance to another high-ranking official in the malAdministration? Quite the family...

Opening night

Just a quick message about this evening's Vote For Change concert in Seattle...

This was the very first show in the entire series, which will consist of six sets of entertainers touring for the next couple of weeks. It will culminate with the groups combining for a huge event in Washington DC on October 11.

Tonight's show at Seattle's opera house, McCaw Hall (special irony in that, as wireless magnate Craig McCaw regularly hosts Bush events at his posh estate across the lake in Medina), featured three wondrous talents combining their efforts for three wondrous hours. Leading off was bluesman Keb'Mo', who sang a couple of classic songs like Nick Lowe's (What's So Funny 'Bout) Peace, Love and Understanding, and the one original composition Talk, from his just-released CD Peace...Back By Popular Demand.

During his set, Keb'Mo' was briefly joined by the fiery Bonnie Raitt, who reappeared after a very brief intermission to do a set of her own. My recollection of her songs is a bit hazy, though I definitely recall her dedicating her version of John Prine's Angel From Montgomery to her mother. Moving from acoustic guitar to piano to some nasty bottleneck on an electric borrowed from sideman Mark Goldenberg, Bonnie lit up the stage as always.

One reason I'm so uncertain about Bonnie's set is that I don't remember whether she sang John Hiatt's Thing Called Love in her set or when she joined Jackson Browne in his. I've heard Bonnie (more than once) and Keb'Mo' before, but this was my first time seeing Jackson Browne. He performed several of his well-known political songs, like For Everyman and of course the chilling Lives in the Balance. Jackson remarked at one point that he usually has to think up ways to fit his political music into a show, but for this one the challenge was to drop in a love song or two.

For me, the high point of the evening was the next-to-last song. With all three artists on the stage, it began with just Keb'Mo' on his guitar. The intro didn't immediately signal to me what this piece would turn out to be. Then he quietly began singing:

There's something happening here
What it is ain't exactly clear
There's a man with a gun over there
Telling me I got to beware
I think it's time we stop, children, what's that sound
Everybody look what's going down

For What It's Worth, Stephen Stills's masterpiece for the comet that was Buffalo Springfield, remains as powerful and evocative a warning as when it was written 38(!) years ago.

There's battle lines being drawn
Nobody's right if everybody's wrong
Young people speaking their minds
Getting so much resistance from behind
I think it's time we stop, hey, what's that sound
Everybody look what's going down

In many ways, its prescience is even more remarkable and more disturbing now than it was during the Vietnam era. In this rendition (also featured on Keb'Mo's new release), it was clear that each of the artists felt its every word, and those stabbing lyrics dug deep into the audience as well. In his verse, Jackson Browne made one small, but telling, change:

What a field-day for the heat
A thousand million people in the street
Singing songs and carrying signs
Mostly say, hooray for our side
It's time we stop, hey, what's that sound
Everybody look what's going down

The song cycled back to Keb'Mo' for its conclusion, as the spectres of John Ashcroft, Tom Ridge, Karl Rove, Don Rumsfeld, and George W. Bush hung on every word:

Paranoia strikes deep
Into your life it will creep
It starts when you're always afraid
You step out of line, the man come and take you away

We better stop, hey, what's that sound
Everybody look what's going down
Stop, hey, what's that sound
Everybody look what's going down
Stop, now, what's that sound
Everybody look what's going down
Stop, children, what's that sound
Everybody look what's going down

In the end, there was little cheerleading, little haranguing by the stars. They knew that they didn't have to tell those in attendance how important it is to vote in this election. Nor did we have to be cajoled into working in our communities to get out the vote, to canvass, to work the phones, to ring doorbells, to speak up wherever and whenever we can. We're doing it. This evening was a brief respite from the battle, an opportunity to enjoy the talents of three remarkable and committed progressive musicians. Wherever these artists -- and their numerous splendid colleagues, from Bruce to Sweet Baby James, from Mellencamp to Vedder, from Maines to Matthews, from Stipe to Fogerty -- are playing, everyone should take the opportunity to see them. You won't be disappointed.

Schmirthday

Twenty-two minutes left before my birthday is over. As we age, landmarks such as this become less exciting than they once were. This one, though, was a particularly uneventful event.

I got back from an extended trip last night -- visited good friends in New England last weekend, then participated in a weeklong business meeting near Baltimore. Was exhausted, due to poor sleeping patterns during the trip. Not just because I spent too many hours in the saloon with colleagues, but also due to a pinched nerve or something like that in my neck/shoulder, which has been bothering me for several weeks. If it's getting better, it's at a remarkably imperceptible pace.

So I drifted in and out of sleep all night and into the daylight hours. Eventually got up, hummed a bar or two of Happy Birthday to myself, and went to take a shower. As I pulled the curtain, the tension bar holding the curtain bar between the walls on each end of the tub snapped its spring. That sent the entire assembly -- bar, rings, curtain, liner -- crashing to the floor of the bathroom. It made for a rather careful shower, as I tried to minimize the amout of water bouncing off me and the tile walls onto the floor.

And I fasted. Today is Yom Kippur, the Day of Atonement that is the highest of the High Holy Days. This year, Yom Kippur falls smack dab on my birthday.

To break the fast, I went over to my sister's house. But it wasn't a birthday repast prepared by a professionally-trained chef (as previously noted here, my sister graduated from Philadelphia's Restaurant School), nor was it a candle-bedecked birthday cake. No, it was a pizza that I shared with my nephew. You see, the reason I'd been invited over there was to keep an eye on the kid while my brother-in-law and sister joined their friends for dinner and an evening at the theater.

Birthdays really aren't what they were in the Good Old Days.

MUST read!

Riverbend has posted another of her far too infrequent entries on Baghdad Burning.

You must, must, must, MUST read her reaction to viewing the DVD of Michael Moore's Fahrenheit 9/11. Searing, painful, upsetting, sorrowful, angry ... words don't do it justice.

She closes with this:

We have 9/11’s on a monthly basis. Each and every Iraqi person who dies with a bullet, a missile, a grenade, under torture, accidentally- they all have families and friends and people who care. The number of Iraqis dead since March 2003 is by now at least eight times the number of people who died in the World Trade Center. They had their last words, and their last thoughts as their worlds came down around them, too. I’ve attended more wakes and funerals this last year, than I’ve attended my whole life. The process of mourning and the hollow words of comfort have become much too familiar and automatic.

September 11… he sat there, reading the paper. As he reached out for the cup in front of him for a sip of tea, he could vaguely hear the sound of an airplane overhead. It was a bright, fresh day and there was much he had to do… but the world suddenly went black- a colossal explosion and then crushed bones under the weight of concrete and iron… screams rose up around him… men, women and children… shards of glass sought out tender, unprotected skin … he thought of his family and tried to rise, but something inside of him was broken… there was a rising heat and the pungent smell of burning flesh mingled sickeningly with the smoke and the dust… and suddenly it was blackness.

9/11/01? New York? World Trade Center?

No.

9/11/04. Falloojeh. An Iraqi home.

Read. It. Now.

Kay uncovered

Last night, I attended a Democracy for Washington-sponsored screening of Robert Greenwald's Uncovered: The War on Iraq. From all appearances, it's an expanded and updated version of the DVD he produced (and the MoveOn.org Voter Fund distributed widely) last year.

Without a doubt, the most interesting personage in this edition of the flick is David Kay. In a fairly lengthy sequence, Kay offers an extended explanation of the approach he took in leading the Iraq Survey Group's inquiries.

He describes an interesting empirical model. The key methodological feature was that he set up paired survey teams. In each pair, the teams went in with pre-defined opposing hypotheses to evaluate -- team A might go in with a mindset that no evidence of WMDs would exist, while team B was oriented toward finding evidence of WMDs. At the end of each workweek, the teams would gather together in a comparative debriefing session. They would describe the week's findings, offer critical questions to their colleagues, refine their thought processes. The debriefing also entailed each team laying out their plans for the next week's investigations, again with their colleagues free to probe their reasoning, critique their planned operations, suggest avenues of inquiry.

As the survey progressed, it became apparent to all that the WMDs-yes teams were finding very little to support their hypotheses, and that they were running out of things to look for that might support their preconceived notions. Eventually, the empirical investigation drove Kay to conclude that there were no WMDs. And he's enough of a logician and enough of a patriot that he was unafraid to tell anyone who'd listen that he'd been wrong previously.

Other officials in the Bush malAdministration have turned into critics of what Dubya and his handlers are doing -- Paul O'Neill and Richard Clarke come to mind. But none of those personages had been as deeply enmeshed in what was supposed to have been Dick and Don's Excellent Iraq Adventure as was David Kay. He was their go-to guy, the one who was supposed to trump all the nay-sayers who insisted that Saddam had no major weapons, the one who was going to dot the I's and cross the T's that would justify the invasion.

Instead, he's joined the legions who argue that the emperor has no clothes. He sees now that his role was actually intended to mislead and deceive his countrymen. It's refreshing to see that even someone who had seemingly drunk deeply from the Kool-Aid container nonetheless retained his mind, his scruples, and his courage.