Beginning next year, Florida businesses that have 100 or more employees and don’t offer affordable health insurance will pay $2,000 to $3,000 per employee per year to help pay for their workers’ coverage under the ACA. Businesses with 50 to 100 employees will pay those fees beginning in 2016.

A private study has estimated that the total cost to Florida businesses could be $253 million a year. Many of the workers affected would qualify for expanded Medicaid.

via The question for Gov. Rick Scott and the Legislature is not just whether to expand Medicaid but whether to establish a Florida exchange |

With the multi-billion-dollar, four-month enroll-a-thon for Florida’s Statewide Medicaid Managed Care program now complete, totals show WellCare Health Plans still on top.  The Tampa company’s Staywell plan now has more than 600,000 Florida Medicaid members. That’s 23 percent of the state’s roughly 3.3 million residents with Medicaid coverage, according to calculations by Citigroup Global Markets’ analyst Carl McDonald.

via WellCare, Centene Medicaid Winners | Health News Florida.

A joint report from the Robert Wood Johnson Foundation and the Urban Institute projects that, over the next 10 years, the state will leave $66.1 billion in Medicaid funding on the table by not approving the expansion included in the Affordable Care Act to cover individuals with income up to 138 percent of the federal poverty level.That will mean more than 1 million uninsured state residents will not qualify for health care coverage, the report said.Over the next decade, Florida’s hospitals will miss out on $22.6 billion in federal reimbursements, the report projected. During that 10-year time span, a combined $423.6 billion in federal monies will not flow to the two dozen states that declined the expansion.

via Florida to suffer most for not expanding Medicaid, studies show |

Moving a parent into a care facility is often a wrenching decision for families. Despite the emotions involved, it’s important to remain clear-eyed when it comes to signing the contract. Otherwise, adult children could find themselves on the hook for much more than they bargained for.

via How a parent’s health-care bills could hurt you – Elizabeth O’Brien’s Retire Well – MarketWatch.

Crist said, “Expanding Medicaid would create 63k jobs.”

A study released by the White House said federal dollars that Florida would have gotten to expand Medicaid would create 63,800 jobs between 2014 and 2017.

Most of the health care experts we interviewed agreed that injecting billions of federal dollars into Florida for Medicaid would spark some job growth, but it’s difficult to pinpoint a number, particularly as there are other changes in the health care landscape. Other studies have found numbers as high as 120,000 and as low as 10,000.

We rate this claim Half True.

via By not expanding Medicaid, Florida is missing out on 63,800 jobs, Charlie Crist says | PolitiFact Florida.

Mental illness is a big driver of Medicaid costs because it is twice as prevalent among beneficiaries of the public insurance program for the poor as it is among the general population. Studies show that enrollees with mental illness, who also have chronic physical conditions, account for a large share of Medicaid spending.Yet many Medicaid programs, including Florida’s, have traditionally contracted with separate companies to provide coverage for mental health services, making coordination more difficult. “We don’t want to have a situation where your brain is in one HMO, your teeth are in a second HMO and your eyes are in a third HMO,” said Florida Medicaid Director Justin Senior. “Your whole head should be in the same organization and that is why we have done this reorganization.”About 140,000 low-income Floridians are expected to be eligible and Magellan predicts about 20,000 will participate voluntarily in the first year.  Medicaid recipients who meet the plan’s criteria will automatically be assigned to it by the state, though they have the option to switch to a different managed care plan within 90 days of enrollment.Coverage begins July 1 in Miami-Dade and Broward counties, then will roll out to other regions by September.

via Florida Shifts Medicaid Mental Health Strategy – Kaiser Health News.

The new funding formula was a little-known part of Florida’s 2011 Medicaid reform law, a Republican-driven overhaul of the state and federal insurance program for the poor.

The provision was intended to make the distribution of an estimated $1 billion a year in federal Medicaid matching funds more equitable. But its unintended consequences are now becoming clear, as the funding mechanism known as “tiering” is scheduled to take effect.

Hardest hit are hospitals that serve large numbers of uninsured and Medicaid patients, and counties such as Miami-Dade that put their own residents’ tax dollars toward Medicaid. Those local dollars are matched by federal funds.

via TALLAHASSEE: Jackson Memorial Hospital expected to lose $140 million under new Medicaid law – Miami-Dade –

Bloomberg News talks about how the Affordable Care Act impacts Medicaid Hospital Grants.  Without adoption of the Affordable Care Act Hospitals in states such as Florida will not have access to federal grants to pay for those who can not pay.  States like Florida are at major risk of small rural hospitals closing. However few citizens are aware of the mighty impact this well have on large urban hospitals.  In the future services will be limited for those without insurance coverage.

Take a look at the cite below.

Obamacare Cutbacks Shut Hospitals Where Medicaid Went Unexpanded

via Obamacare Cutbacks Shut Hospitals Where Medicaid Went Unexpanded – Bloomberg.


Book review: ‘Reinventing American Health Care’ by Ezekiel Emanuel

By Amanda Bennett, Published: March 14

Amanda Bennett is the author of “The Cost of Hope,” about her late husband’s journey through the health-care maze.

Early in his new book, “Reinventing American Health Care,” Ezekiel Emanuel pictures the late senator Arlen Specter (Pa.) holding up an incomprehensible chart of the U.S. health-care system — in 1993. What Emanuel calls the “interconnected weirdness” of our health-care system has only gotten weirder since.

Yet what he does is enormously helpful: He sorts it all out and gives us a clear and straightforward accounting of a system that is anything but. Emanuel starts at the beginning (1790, to be exact) and progresses logically to the present, through the development, political wrangling and legal journey of the Affordable Care Act (ACA). Then he hurtles into cheerily optimistic projections about the future — perhaps more than a tad more optimistic than his own accounting of the past would warrant.

His review of how our health-care system got this way is a depressing reminder of forces that have little to do with health care and nothing to do with health. How did hospitals become so dominant? How did the Depression lead to the spread of health insurance? How did World War II price controls help lock health insurance to employment? And what do tax breaks have to do with it?

Quick: What’s the biggest single tax break in the United States? Tax-free health benefits, nearly four times as large ($250 billion) as the mortgage interest deduction ($70 billion). With employers able to offer health insurance to employees free of tax, the benefits became an increasingly important part of pay over the years. Getting rid of that deduction, Emanuel makes clear, is one fix that he regrets was left out of the new health-care law.

Despite this and other critiques of the legislation, it’s clear that he’s a wildly enthusiastic fan. Consider his view that “beginning in 2020 or so, the ACA will increasingly be seen as a world historical achievement, even more important for the United States than Social Security and Medicare has been. And Barack Obama will be viewed more like Harry Truman — judged with increasing respect over time.” Wow. His logic is that by 2020, the law and its effects will arrest health-care inflation to simply match the rise in gross domestic product, instead of the recent rate of two percentage points above the annual increase that has rocketed costs to nearly 18 percent of GDP today. That would indeed be a major accomplishment.

Emanuel is no dispassionate outsider. A professor of medical ethics and health policy at the University of Pennsylvania, he was a special adviser to the White House on health-care reform and worked directly on the Affordable Care Act. He also peppers his story with accounts of expletive-laden exchanges with his brother Rahm, current mayor of Chicago and former Obama White House chief of staff.

In 2009 and 2010, Ezekiel Emanuel was labeled “Dr. Death” after Michele Bachmann and Sarah Palin, among others, twisted his medical ethics work to conclude that he favored withholding health care from the disabled and advocated “death panels.” That’s sheer nonsense.

Whether you agree with his conclusions or not, they’re well argued, and he has marshaled an impressive amount of information. Some of the simplest facts bear repeating. For example, how vulnerable every one of us was before passage of the health-care law: More than half of us got health insurance through our jobs. But three-quarters of the uninsured were in households with at least one paycheck, and nearly one in 10 uninsured households brought in more than $94,000 a year. It wasn’t just money that kept some people from having health-care coverage, it was also access. For some, their jobs didn’t provide insurance. And yet others were rejected, ironically, because they were too sick.

Emanuel also reminds us that there is much more to the Affordable Care Act than the troubled insurance exchanges. There are targets to induce hospitals to lower infection rates, incentives to adopt electronic medical records, rules for better pricing transparency (a current nightmare!) and more complete data on hospital safety and outcomes, and better access to free preventative services such as immunizations and mental health screenings.

Where Emanuel goes off the rails is in extrapolating from these provisions of the law a vastly different future. He posits the end not only of health-care inflation but also of medical insurance as we know it. He sees employers ceding their roles as providers of access to health care, technology replacing costly hospital stays and specialists, hospitals closing in large numbers, and the remaining ones becoming safer and more efficient.

That’s wishful thinking. His own very persuasive review of history shows how exterior forces — and grabs for dollars — have thwarted and distorted sensible plans.

Look at the advertising in the D.C. Metro opposing cuts to hospital funding to see how rocky the path to hospital closings will be. Check out the sad fate of a Maryland nonprofit start-up, the faltering Evergreen Health Co-op, for a view of how hard it will be to create alternatives to traditional care. Anyone who has ever been part of a technology changeover anywhere can imagine what it will take to link the whole messy U.S. health-care system electronically. And consider the travails of 23andMe, a genetics company whose medical service was shut down by the Food and Drug Administration, for an example of how difficult it will be for newcomers to break into spaces that others own.

The nightmarish launch of the health-care exchanges alone should be enough to convince anyone that just because something is in a law doesn’t mean it will happen. At least not exactly the way it was planned. Or as Bob Kocher, another Obama health-care adviser, was recently quoted as saying, “It is actually harder to do some of these things in reality than we thought when we put it down on paper.”


Amanda Bennett is the author of “The Cost of Hope,” about her late husband’s journey through the health-care maze.

REINVENTING AMERICAN HEALTH CARE How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System By Ezekiel J. Emanuel PublicAffairs. 380 pp. $26.99

States Accelerate Shift Of Nursing Home Residents Into Medicaid Managed Care – Kaiser Health News.

By Jack Rosenkranz

Kaiser Health News reports that ” States had traditionally been reluctant to place frail and elderly people into managed care. But that caution is fading as officials become comfortable with managed care and more anxious to curb Medicaid spending.”

The State of Florida has mandated a limit to its Medicaid spending.  They are hoping that a managed care approach will support elders to stay at home or seek less expensive care rather that nursing home.

Kaiser Health News calls this an ‘Unprecedented’ Shift

The State of Florida approach is a massive change.

The report continues:

“The mandatory transition of large numbers of consumers who use long-term care … is unprecedented,” says Laura Summer, an analyst with the Georgetown University’s Health Policy Institute.

The shift has consumer advocates and nursing home operators worried, especially since Medicaid pays the bills for nearly two thirds of nursing home residents nationwide. 

“It throws a monkey wrench in the equation to get care issues resolved quickly,” says Brian Lee, executive director of Families for Better Care, a patient advocacy group in Tallahassee.

Nursing homes are concerned about losing residents, money and autonomy. “We are not anti-managed care,” says Mike Cheek, a vice president with the American Health Care Association. But he worries the plans will delay payments and that states won’t have the capability to properly oversee them.

Review the report by clicking on the link above

As I contunue to study the Medicaid Reform,  I think there is a loss of understanding that  Provider Service Networks  are provider owned rather than an insurance company. The report states: Earlier studies by the same group did not discover “the relatively large savings” found in the new report, which was published in a health policy journal, Health Research and Educational Trust. The UF team noted  that it appears to take several years before such changes start to show. Earlier studies had less data they could use for analysis. The new study also provides good news for those who run Provider Service Networks (PSNs) – non-profit organizations that are owned by doctor groups or other health-care providers, rather than an insurer. via Medicaid ‘Reform’ Pays Off: Study | Health News Florida.

AP  Reports.

Results from a study of Florida’s Medicaid Reform Pilot Project show that provider service networks, which the state intends to implement this year throughout the state, control costs better than traditional Medicaid.

PSNs, like HMOs, or health maintenance organizations, are managed care companies that coordinate patient care. HMOs deliver care through contracts with provider organizations such as hospitals, while PSNs are directly organized by providers.

The idea of both is to guide, and ideally streamline, patients’ care without sending them to expensive specialists unnecessarily, explained Paul Duncan, one of the study authors and a University of Florida professor in the College of Public Health and HealthProfessions and the director of the Florida Center for Medicaid and the Uninsured.

via New study: Florida’s networks control health costs better than Medicaid – Health – The News Herald.

Prestige Wins Medicaid Contracts | Health News Florida.

Health News Florida reports that Prestige has been awarded a contract to be an Medicaid managed care organization. “The final order, signed by AHCA Secretary Liz Dudek on Friday, rejects a recommendation from an administrative law judge who held hearings in the case in November.  The judge, John Van Laningham, wrote that the corporate structure of Prestige Health Choice did not meet the definition for a “provider service network,” or PSN”

To review the full report click on the link above.


April 8, 2013

Be Fruitful and Simplify!



Conquering the Crisis of Complexity

By Alan Siegel and Irene Etzkorn

Illustrated. 237 pages. Twelve. $26.99.


The Future of Government

By Cass R. Sunstein

Illustrated. 260 pages. Simon & Schuster. $26.


Less is more. The bare essentials. Back to basics. User-friendly. No fine print. Clutter-free. Transparent. Clean. Easy.

Back in the mid-19th century Henry David Thoreau exhorted us to “simplify, simplify,” and his appeal to distill things down to “the necessary and the real” has only gained more resonance, as our Internet-driven, A.D.D. culture has grown ever more complex and frenetic.

The re-embrace of simplicity is not exactly new. In the 1990s some neo-hippies and fed-up yuppies took up the idea of Voluntary Simplicity, Downshifting or Simple Living. In 2000 the commercial possibilities of this trend were ratified with Time Inc.’s introduction of the magazine “Real Simple,” and in 2005 Staples started promoting itself with an “Easy Button.”

Two tech behemoths are completely identified with their minimalist design styles: Apple, with its coolly modernist iPods, iPads and MacBooks; and Google, with its distinctive, pared-down home page, which has become synonymous with its brand. Now come two new books that are part manifestoes, part templates for achieving simplicity in business and government. Both display a lot of common sense, arguing for the elimination of bureaucracy and redundancy and insisting that consumers (of health care, insurance, credit and products large and small) deserve more transparency. But both also sidestep some of the difficulties involved in reducing or containing complexity in today’s lawyered-up and interconnected society.

Simple,” by two business consultants, Alan Siegel and Irene Etzkorn, is a straightforward brief on simplicity, providing the reader with interesting examples of companies that have successfully embraced it as a business strategy while only occasionally slipping into overly simplistic advice. (“Simplification requires a thorough and pervasive commitment by an organization to empathize, distill and clarify.”)

Simpler,” by Cass R. Sunstein — who as the administrator of the White House Office of Information and Regulatory Affairs from 2009 to 2012 helped “oversee the issuance of nearly 2,000 rules from federal agencies” — is a more detailed, more nuanced look at how rules and regulations can be made simpler, and how the social environment in which we make decisions can be “nudged” in ways that help us to make more rational, sensible choices. Many of the more original and illuminating ideas in this book, however, were previously mapped out by Mr. Sunstein and Richard H. Thaler in their fascinating 2008 best seller “Nudge: Improving Decisions About Health, Wealth and Happiness,” or build upon the groundbreaking ideas laid out by Daniel Kahneman in his compelling 2011 book “Thinking, Fast and Slow.”

Both “Simple” and “Simpler” stress the importance of understandable language. Mr. Sunstein writes that he pushed for “the use of plain language, reductions in red tape, readable summaries of complex rules, and the elimination of costly, unjustified requirements.”

Both books also emphasize that more information does not necessarily mean more clarity, that disclosure, as Mr. Sunstein puts it, “must be not merely technically accurate but also simple, meaningful, and helpful.”

Mr. Siegel and Ms. Etzkorn cite a study showing that half of the gadgets returned to stores (and the cost of returned products in America, they estimate, is some $100 billion a year) are “in good working order, but customers can’t figure out how to operate them.” The authors also mention a study showing that “80 percent of child safety seats are improperly installed or misused and the instructions for installing them are the root of the problem.”

Needless to say, identifying such problems hardly equals finding a plausible solution. Ms. Etzkorn and Mr. Siegel point out that “banks, credit card companies, insurers and other types of businesses find ways to make money from the fine print nobody can read or understand,” and that “lawyers have inundated us with mind-numbing disclaimers, disclosures, terms, instructions, amendments and amendments to amendments” to “avoid lawsuits or other potential problems.”

We are reminded of the challenges of simplifying the federal government by the fact that the United States tax code, according to Mr. Siegel and Ms. Etzkorn, has “nearly tripled in volume during the last decade” to 3.8 million words. And CNN recently reported that the Veterans Affairs Department has almost 630,000 benefit claims that have been pending for more than 125 days, because of an outdated paper-based process and the complexities of returning veterans’ cases.

Government simplification, Mr. Siegel and Ms. Etzkorn argue, requires many of the same things needed to simplify businesses: “strong leadership, clarity of purpose” and a culture “that prizes openness, empathy, and innovation.” In New York City, they write, “Mayor Michael Bloomberg has demonstrated that it’s possible to radically simplify the way one of the largest cities in the world communicates with its residents.” Back in 2003 pages and pages of listings in the city directory were replaced with one phone number, 311, to cover a wide range of complaints and questions (in the authors’ words, “everything from leaking fire hydrants to gaping potholes”).

In “Simpler” Mr. Sunstein puts a lot of emphasis on the utility of “nudges”: approaches, based on how human beings act and think, that “influence decisions while preserving freedom of choice”: for example arranging items in a grocery store so that healthy foods are conspicuous, letting voters know on the day of an election exactly how to get to the polls or working with the private sector to discourage texting while driving.

Some of the nudges Mr. Sunstein mentions here are really default rules, which, he says, can have a huge effect on outcomes (in part because of inertia, in part because people see an implicit endorsement in a default choice). Take for instance a default rule that automatically enrolls people in a health care plan (unless they opt out), or a default rule that automatically protects users’ privacy online (unless they say otherwise). Such nudges, he says, “respect free markets and private liberty,” allowing people to make their own choices while at the same time emphasizing “that people may err and that, in some cases, most of us can use a little help.”

One of the central principles animating Mr. Sunstein’s tenure at the Office of Information and Regulatory Affairs — known as OIRA (pronounced oh-EYE-ruh) — was an empirical testing of regulations, he writes; another involved cost-benefit analysis and the maximizing of net benefits. He says that during the Obama administration’s first three years the net benefits of regulations reviewed by his office and issued by executive agencies exceeded $91 billion.

While at the Office of Information and Regulatory Affairs Mr. Sunstein reviewed rules related to President Obama’s health care act and Dodd-Frank financial reform legislation. He backed higher fuel efficiency standards for motor vehicles and new toxic emissions rules for power plants, and he helped oversee a deal that would make appliances more energy efficient.

Along the way he also came under considerable criticism from environmentalists, consumer advocates and progressives who argued that under his stewardship the regulatory office had been too deferential to business interests and insufficiently tough in its regulatory role. Among the most frequently cited complaints was its role in a decision to postpone a plan to cut ozone emissions. In “Simpler” Mr. Sunstein describes that decision as “controversial but unquestionably correct” and writes that “we refused to issue a large number of rules favored by progressive groups, generally on the theory that they could not be justified, especially in an economically difficult time.”

Such debates over decisions made by Mr. Sunstein underscore just how difficult it can be to find consensus-winning solutions to complex problems. In other words, simplification is often not so simple at all.

Citing information from the National Center for Health Statistics, the  New York Times reports with Venn diagrams to explain how Alzheimer’s disease, high blood pressure and heart disease overlap for those who reside at Assisted Living Facilities.

For another view of Medicaid reform in Florida read below:

Medicaid Cure patients rate better than patients trapped in old Medicaid in nearly two-thirds of national health categories. And Medicaid Cure patients report higher satisfaction rates in 83 percent of satisfaction measures compared to patients in both old Medicaid and commercial HMOs.

The Medicaid Cure makes patients healthier and happier through choice, competition, accountability and personal responsibility. It is saving patients’ lives. But is it saving budgets?

Florida taxpayers have saved an estimated $118 million annually since the five-county pilot began. When the federal government green-lights the Cure for statewide expansion, taxpayers here are expected to save almost $1 billion every year. And if the Medicaid Cure was replicated in every state, not only would Medicaid patients across the country be healthier and happier, American taxpayers would save more than $1 trillion over the next decade.

via Florida’s pro-taxpayer cure for Medicaid.

Gov. Rick Scott having refused millions of dollars of federal grants for setting up an insurance exchange now appears ready to move forward.  However the Governor and other Republican leaders still are not in favor of expanding the Medicaid roll by another million citizens.  The state may well decide to opt out stay under the funding cap of the old system.  This approach would save the state over a billion dollars by 2018.

via Florida reluctantly starts to implement Obama’s health care law – Orlando Sentinel.

A physician’s perspectiveAs a family physician, I have struggled to help my patients get necessary health services, but with Thursday’s Supreme Court ruling upholding the health-care-reform law, my patients and millions of Americans have improved access to health care.The Affordable Care Act ACA provides insurance security for everyone; no longer will health-care access be determined by how much you earn, where you live or what you look like.Under the ACA, insurance companies are required to use more of your premium on insurance benefits instead of salaries and administrative costs. Insurers must cover everyone, regardless of pre-existing conditions, and are no longer able to impose yearly or lifetime caps for needed services. Adult children can stay on parents’ insurance plans until they turn 26. Preventive care is available to all Americans without co-pay, allowing health-care providers to detect illnesses before significant harm is done. The ACA expands access to Medicaid for our nation’s poorest citizens and strengthens Medicare to protect seniors.With the Supreme Court’s ruling, now we can put patients ahead of politics, and Americans can realize all the benefits of the Patient Protection and Affordable Care Act PPACA.— David Evans, M.D., Seattle

via U.S. Supreme Court upholds Obamacare | Northwest Voices | The Seattle Times.

Nearly 9 million poor and sick Americans are “dually eligible” for both Medicare, the federal health care program for seniors and disabled individuals, and Medicaid, the joint federal health system for low-income people.  They use a lot of health services and their care is often fragmented.

Melanie Bella’s new job is to help fix that.

via When Care Is Split Between Medicare And Medicaid: KHN Interview With Melanie Bella – Kaiser Health News.

JUNE 23, 2010 4:00 AM
A Conversation with Arthur C. Brooks, Part 1
The new culture war is not about guns, gays, and abortion — it is about free enterprise, which in turn is about human flourishing and human freedom.
By Interview
AEI’s Arthur C. Brooks always manages to see the world from a fresh prospective, one that is buoyed by first principles. A manifestation of this is his latest book, The Battle: How the Fight between Free Enterprise and Big Government Will Shape America’s Future. Brooks, the president of the American Enterprise Institute, talks about The Battle — and the future — with National Review Online’s Kathryn Jean Lopez in this two-part interview.
KATHRYN JEAN LOPEZ: Culture war? Didn’t we evolve beyond such talk somewhere around a Pat Buchanan speech at a Republican convention?

ARTHUR C. BROOKS: For many, that 1992 convention speech defined the term “culture war.” But what I’m talking about is a new culture struggle — one fought not over guns, gays, and abortion but over the core characteristic of America: free enterprise. In my book I don’t just demonstrate that free enterprise is the most efficient way of organizing an economy (which it is). I also show that it’s an expression of American values, and, thus, that a fight for free enterprise is very much a fight for our culture.
LOPEZ: Has President Obama made Americans less happy? Is it even fair or reasonable or constructive to ask such a question?

BROOKS: Happiness is important to discuss. The opponents of free enterprise always claim they will make America a happier nation, and we always lamely respond with arguments about economic efficiency. Yet in truth, the better prescription for happiness is on our side, not theirs.

Redistributionists always make the argument that relative income is a huge driver of unhappiness — that poorer people are unhappier than richer people simply because they have less money through no fault of their own — and thus we can get a happier, fairer society by equalizing incomes. This is based on a colossal misreading of data and a whole lot of ideology. The truth is that relative income is not directly related to happiness. Nonpartisan social-survey data clearly show that the big driver of happiness is earned success: a person’s belief that he has created value in his life or the life of others. Of course, in a capitalist system, earned success is often rewarded financially, so people who have earned a lot of success tend to have more money than others. But it’s the success, not the money, that does the trick. (We show this by comparing the happiness of people who have the same level of income but have different perceived success levels.)

The system that enables the most people to earn the most success is free enterprise, by matching up people’s skills, interests, and abilities. In contrast, redistribution simply spreads money around. Even worse, it attenuates the ability to earn success by perverting economic incentives. Free enterprise is essentially a formula not just for wealth creation, but for life satisfaction.
LOPEZ: Are free enterprise and big government natural enemies?

BROOKS: There are some things that government does well. When the U.S. government was fighting Nazi Germany and Imperial Japan, it was the champion of freedom in the world. It took a big government to win World War II. But it takes a smart one to realize it is only the entrepreneurialism of individuals that can deliver thriving economies and human flourishing. Government has a role, of course, such as enforcing the rule of law. But when it takes resources out of the hands of innovators and risk-takers, when it regulates small businesses out of existence, when it favors crony corporations instead of entrepreneurs, when it taxes corporations so much they move abroad — then, yes, big government becomes the enemy of free enterprise.

LOPEZ: We’re always told that free enterprise is merciless. Isn’t it the source of misery for everyone but the guys at the very top? (And of course they are guys, because everyone knows women are oppressed in the American economy.)

BROOKS: Absolutely not. The data show that a poor man who earns his success and believes he has a chance to get ahead through his own efforts — that man is happier than a “guy at the very top” who does not feel he has earned his success (or that anyone really can). And it’s as true for women as it is for men. Free enterprise does not bow to gender, class, race, or ethnicity. It rewards hard work, dedication, initiative, talent, and street smarts. It’s truly a force for liberation, not oppression.
LOPEZ: Is big government always an enemy of conservatism? And of a lot of what makes America America?

BROOKS: Well, as I said earlier, not when the government is defending American interests and liberties. But when the government takes over large parts of the economy that could be better run by the private sector, when it brings the top down simply to level outcomes, and when it picks the winners and the losers and makes markets fail, it is a problem not just for conservatives but for Americans in general. Government’s role is an important (but restricted) one: protecting the environment in which honest people can earn their success.
LOPEZ: You talk about the “soul” of America” being “at stake.” Is there even a consensus about what exactly that soul is? Do we even all want her to have a soul? And can I call her “her”?

BROOKS: By “soul” I mean the essence of what it means to be American. And yes, there is a fairly broad consensus, a shared understanding of what makes us American. In the mainstream — among at least 70 percent of Americans, according to nonpartisan data sources — there is a strong belief in liberty, equality of opportunity, and entrepreneurship. In other words, the free-enterprise system is understood as being more than an economic alternative — it is understand as being the center of our culture.
LOPEZ: What is the “30 percent coalition”?

BROOKS: The last question hinted at the answer to this one. The “30 percent coalition” is a term I coined for the minority in this country who do not like or support our free-enterprise culture, and who seek to change it for the rest of us. The 30 percent are led by the usual suspects — opinion-leaders in academia, the media, the entertainment industry, and so on. All the data available tell us these are among the most radical players in the battle against our culture of free enterprise. But adding them all up doesn’t get us to 30 percent. The ranks of the coalition are swelled by others, especially young people, who have not (yet) experienced the depressing realities of a redistributive economy. A January 2010 Gallup poll found that a majority of Americans between the ages of 18 and 34 actually hold a positive view of socialism. Which probably makes sense, since the only socialists they’ve seen are their professors at college.

LOPEZ: What’s the “Obama Narrative,” and what’s so wrong with it?

BROOKS: The Obama Narrative is the administration’s basic account of how we got into the financial crisis of 2008 and how President Obama said he would get us out of it. It blames Wall Street and weak regulation for getting us in — and promises big government and strong regulation to get us out. It’s not accurate. Ill-advised government policy was responsible for a large part of this mess (particularly the federal mandates for Fannie Mae and Freddie Mac to ramp up their lending even to people who had sub-par credit). Bigger government will not clean it up. The enterprise, initiative, and ingenuity of the American people will — if we allow these forces to work.
LOPEZ: Are you a defender of economic inequality? Isn’t it the cause of misery?

BROOKS: Unequal outcomes don’t make us miserable. Americans like success stories — they feel they can succeed, too. Misery comes from thinking you have no chance to improve your lot in life, no chance to get ahead through hard work and drive. If you approve of people getting big rewards for big efforts, that’s not defending economic inequality — that’s defending fairness. A fair system is not one that levels outcomes — it is one that rewards hard work, merit, and excellence (while penalizing free riding and laziness). Fairness is a concept that we in the free-enterprise movement have to take back.

Incidentally, none of this is to suggest that we can’t ever be in favor of minimum basic services for people, which might be necessary to allow citizens to exploit opportunity. Even Hayek noted that this is can be a legitimate competency for government. But protecting people from starvation is very different from what the welfare state increasingly focuses on today: redistribution for the sake of equality (“fairness and balance” in our tax code), social engineering (everybody deserves a mortgage, no matter how lousy his credit), and policies intended to take the downside risk out of our decisions (bailouts).
LOPEZ: You write that “People are surprisingly satisfied with their jobs in America.” How can that be so? Everyone seems to tell us otherwise.

BROOKS: I know, it’s surprising, but it’s true. A great deal of data show that Americans are overwhelmingly satisfied with their jobs, and this doesn’t depend on education or even income levels. And Americans in general are much more satisfied with their jobs than Europeans. According to the International Social Survey Programme, we are 52 percent likelier than the Germans, 42 percent likelier than the British, and about 190 percent likelier than the Spanish to say we have complete job satisfaction.

LOPEZ: Is it fair to say that conservative economic policy is as bleeding-heart as the Left portrays itself as being? That it actually could tackle poverty if truly implemented? Or is that way too simplistic and idealistic?

BROOKS: If by “conservative economic policy” you mean free enterprise, then yes. It’s absolutely about the heart. Free enterprise promotes human flourishing and individual achievement, earned success and personal well-being. These are the arguments I make in the book — and the reason some have even characterized it as a self-help book. It doesn’t tell you how to get rich or win a promotion or get elected to office or win friends and influence people. But it tells you how you can pursue happiness — and why free enterprise is the best system to make that happen. Entrepreneurs really are the New Age radicals, tapping into the transformative power that comes from striving, achieving your potential, and creating value in your own life and the lives of your loved ones. The fact that it also produces the most explosive economic outcomes, for individuals and societies alike, is secondary (although nice).
LOPEZ: How important is free trade in this new culture war?

BROOKS: It is important. Free trade has been responsible for the greatest increases in prosperity for the poor all around the globe. Since 1950, the volume of merchandise traded worldwide has increased by a factor of 27. This has led to rising living standards for the people of China, India, Brazil, and many other places in the developing world — and for Americans too. And there’s another benefit. Free trade among nations also fosters cross-cultural understanding and the growth of democracy and civil society worldwide. Unfortunately, we currently have an administration that is not clearly committed to free trade because, many argue, of its political debt to labor unions.
LOPEZ: You use the phrase “world stewardship.” How do conservatives reclaim the language of talking about these things? We’re so often buying into others’ frameworks. You’re not.

BROOKS: To me “world stewardship” means being cognizant of the fact that we are blessed in America with great abundance, having the wisdom to understand why, and then sharing the means to that abundance. I strongly believe that what will keep America strong is (1) a deep confidence that our success as a nation is earned, (2) a national willingness to share the means to prosperity — the free-enterprise system — with others around the world, and (3) an ironclad resistance to policies that will mortgage away our system from our children and grandchildren. This is world stewardship. In the book I talk a little about actual policy prescriptions that do these things, and I refer readers to works by scholars who really get it, like my colleagues Mauro De Lorenzo and Glenn Hubbard.
LOPEZ: So how do we stop America’s current slide toward Europeanization? That’s a big question, I realize.

BROOKS: One way is simply to point out the ethical differences between the Greek and the American street today. In the past month, Greek citizens have rioted and gone on strike against the government. Why? Despite the worst economic conditions in years, labor unions and state employees are demanding that others pay for their early retirements, lifetime benefits, and lavish state pensions. In America, by contrast, our tea partiers demonstrate not to get more from others, but rather against government expansion, bloated government debt, bailouts, and a government overhaul of the health-care industry. In other words, the tea partiers are protesting against exactly what the Greeks are demanding. It is a near-perfect example of American exceptionalism.
LOPEZ: Why do social conservatives need to care about the fate of free enterprise?

BROOKS: Our founders wanted Americans to be the freest people in the world, and Alexis de Tocqueville believed they had succeeded. Liberty is more than a theory, though — it is a value to be practiced. And the way we practice liberty in our workaday lives — the way we express our values as we support our families — is through free enterprise. It is fundamentally a cultural issue in itself, and bound up in what each of us sees as a moral, equilibrated life.

– Kathryn Jean Lopez is editor-at-large of National Review Online.


Nearly a year after lawmakers approved moving to a statewide Medicaid managed-care system, the Agency for Health Care Administration last week sent another round of detailed information to federal officials about how the plan would be carried out.

The information, in a document dated Friday, indicates that the number of beneficiaries enrolled in HMOs and another type of managed-care plan is expected to double — and possibly triple — by the end of 2014.

Also, with the state divided into 11 Medicaid regions, it says beneficiaries would move into managed-care plans in a “staggered” fashion and that timelines would be developed for each county.

via Agency details Medicaid plan | The News-Press |

Tens of millions of people every year decide they can’t afford or simply won’t buy health insurance. Some are out of work or underemployed. Many are young and early in their working careers, self-employed or without access to large group plans through work.

The Obama administration wants to cover 30 million more people by providing incentives for nearly everyone to buy insurance. The Affordable Care Act expands government programs such as Medicaid, offers subsidies for lower-income people and imposes a penalty for those who don’t sign up with a private, employer-based or government plan.

Now the individual mandate to buy insurance is in the cross hairs of a challenge to the law by Florida, 25 other states and business groups before the U.S. Supreme Court. Among other objections, opponents say forcing people to purchase insurance or pay a penalty is a step too far, an unconstitutional overreach by the government.

The court’s decision, expected as a landmark ruling in June or July, could uphold the law, strike it down or perhaps kill the mandate while leaving other parts intact.

But if the law and the mandate survive, there’s still a fundamental problem with incentives, said Bruce Vogel, associate professor in the Department of Health Outcomes and Policy at the University of Florida’s College of Medicine.

via Experts see few barriers to stop people from buying health-care coverage only when sick.

Hillsborough County has joined an ongoing dispute over health care costs for its poorest residents.

The Hillsborough County Commission on Wednesday unanimously backed a lawsuit challenging the constitutionality of a plan to collect local Medicaid payments before billing. It approved spending $5,000 for legal costs in the Florida Association of Counties lawsuit to be filed soon in Leon County Circuit Court.

via Hillsborough joins Medicaid lawsuit |

The state budget and an implementing bill signed this week by Gov. Rick Scott would delay the phasing in of Medicaid managed care plans for dentistry, but Scott made clear he would support the plans in the future.

The language would require the agency to continue allowing dentists to bill for Medicaid patients under the traditional fee-for-service system in areas outside Miami-Dade County, but would expire in July 2013. The Agency for Health Care Administration announced it was delaying the statewide implementation of the managed care system after the language was approved by the Legislature.

via Budget would delay statewide Medicaid managed care for dentistry | The Florida Current.

Medicaid remains the black sheep of the health care reform litigation. Before the six-and-a-half hours of oral argument at the end of March, commentators focused primarily on whether Congress may require a minimum level of health insurance coverage. Even the number of amicus briefs filed about 23 on the Medicaid issue versus about 78 on the “individual mandate” indicates lack of attention to the spending question in Florida v. US Department of Health and Human Services. Both Solicitor General Donald Verrilli and Paul Clement referred to Medicaid as Medicare, a blunder that may be natural after three days of arguments. But, such stumbles suggested a lack of understanding of both spending doctrine and the Medicaid expansion and do not bode well for the Courts decision-making processes.

via JURIST – Forum: Medicaid in the Supreme Court: Small Errors, Big Problems.

Perhaps ObamaCare will be remembered as the breaking point for top-down planning. There is not enough information available for the government to micromanage a system as complex as health care, which represents more than 15% of the economy. Austrian economist Friedrich Hayek wrote some 50 years ago about the “pretence of knowledge,” meaning the conceit that planners could know enough about complex markets to dictate how they operate. He warned against “the belief that we possess the knowledge and the power which enable us to shape the processes of society entirely to our liking, knowledge which in fact we do not possess.”

via Crovitz: Complexity Is Bad for Your Health –

The test uses a chemical called florbetapir, known by the brand name Amyvid, which is a radioactive agent that tags clumps of a sticky substance called an amyloid. Amyloid proteins are hallmarks of Alzheimer’s disease. The chemical, which costs $1,600 per dose, then is detected using a brain imaging technique called positron emission tomography, known as PET scans.

For patients who already have some symptoms of cognitive decline, a positive scan suggests that moderate to frequent amyloid plaques are present in the brain, which is consistent with Alzheimer’s disease.

via FDA Approves Alzheimer’s Test Developed by Eli Lilly –

The Age of Double Standards.

Although this article addresses the historical issue of debtors, debtors prisons, and Bankruptcy,  I find it interesting as the Health Care System evolves. The Number One reason for personal bankruptcy is health care bills

How Health Care Affects Filing Bankruptcy


As Health Care restructures its delivery system, watch large health care systems work their way through bankruptcy. This may seem far fetched at this time.  However with the significant Medicaid and Medicare budget cuts major cash flows will be altered.  Large Health Care Providers which have made large capital outlay to capture what was in the past a major cash flow will experience financial distress.

A cut of 60.5 million a year will effect Florida Nursing Homes in a big way.  These cuts are effecting how the Nursing Homes are paid by Medicaid for those residents that have not paid there bills.  There is an  a way that the Nursing Home industry  can add  the bad debt to their cost of doing business, which will effect the rate medicaid will pay.  Under a new law this will be changed.

A new Avalere Health analysis detailing the negative impact on Skilled Nursing Facilities (SNFs) resulting from so called “bad debt” provisions passed in the Middle Class Tax Relief and Job Creation Act of 2012 finds facilities in Florida, Ohio, Illinois, Pennsylvania, North Carolina, Louisiana, Indiana, Tennessee, Georgia and New Jersey will absorb the largest Medicare funding cuts. Nationally, the provision will cut SNF payments by at least $3 billion over the FY 2012-21 budget window.

Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care (AQNHC), pointed out that the phrase “bad debt” is a complete misnomer. The federal government itself, he said, prevents SNFs from collecting as much as 90 percent of SNF bad debt. “SNFs have no legal recourse to collect ‘bad debt’ from state Medicaid agencies — and is more accurately described as ‘uncollectible debt’ as mandated by federal law,” he stated. He noted the U.S. SNF sector, America’s second largest health facility employer, faces yet another $8-9 billion in cuts between FY 2012-21, resulting just from the looming sequestration threat

via New Avalere Health Analysis Details State Impact of “Bad Debt” SNF Medicare Funding Cuts – MarketWatch.

According to a Kaiser Family Foundation poll .pdf released last week, the Medicaid expansion provision in the Affordable Care Act has 70 percent approval from Americans.

The poll also found that most provisions in the law have considerable support from the public, except for the individual mandate, which bottoms out with a 32 percent approval rating.

via Poll: 70 percent like Medicaid expansion in health care reform law | Florida Independent.

The Financial State Of Florida’s Medicaid | – Florida Health News.

University of South Florida Public Radio Reporter,  David Gulliver has written one of the best analysis of the funding of Medicaid.  In great detail he describes the two billion dollar cuts to Medicaid that only saves the state of Florida 442 million. To understand the scale of the Medicaid Program and the programs impact to the state economy, Gulliver reports, that medicaid represents 21.2 billion of Florida total budget of 70 billion.  The cuts represent less than a 10 percent cut.

David Gulliver also drives home the point that in tough economic times the Medicaid enrollment grows.  From 2003 to 2008 Medicaid caseload  was flat. As the recession impacted Florida, over 1 million people joined the Medicaid rolls.

The article ends by looking at the future of Medicaid reform and the pilot program that privatized Medicaid in five Florida counties. It is still unknown if real savings are achieved by this approach. David Gulliver cites the two studies done at the University of Florida and Georgetown University.

Great Reporting.

Miller – McCune has a great article about the politics of the Supreme Court. As the Supreme Court considers the Affordable Care Act and Medicaid today, they must do so with great respect for their opinion to be honored. However the backlash will be great what ever decision they will make. It is my prediction that the Supreme Court will not render a decision until after the Presidential election this fall.

If the smear of partisan decision-making tars the unelected U.S. Supreme Court after these decisions, the fundamental legitimacy of the institution may become precarious.Why exactly is legitimacy so important?Legitimacy means that an institution has the right to make decisions, and, because those decisions are fairly, impartially, and procedurally properly made, citizens are under the obligation to accept those outcomes, even when they disagree with them. So, in this sense, legitimacy is for losers — those on the losing side of the issues the Supreme Court decides.

via Can the Supreme Court Survive a Health-Care Decision? – Miller-McCune.

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