Oddly enough, today’s quote of the day is about a macaque monkey that’s been running loose in Tampa, FL. And no, this is not about the upcoming Republican convention, to be held in Tampa.

But it is about governance and democracy and finding ways to accommodate ourselves to others, including other primates, it’s from Jon Mooallem’s What’s a Monkey to Do in Tampa? that ran in the New York Times on August 22.

Referring to the novel that became the basis for the movie, Planet of the Apes, Mooallem writes:

Reality and science fiction sloshed together. Some of us in America seemed to be sliding into the same disillusioned lethargy that undid humanity in the novel, while others of us were doing the exact opposite: vigilantly looking for the worst in our government, and in one another, to keep from being conned out of even the thinnest sliver of our freedom.

It occurred to me that the two mind-sets — apathy and paranoia — probably yield the same result. You wind up off to the side of real democracy, disengaged from the strenuous project of brokering a better society.

The article is amusing at the beginning. It moves on to wan observations about the state of the nation. Ultimately, the monkey and a family develop a wary, standoffish, but ultimately functional relationship. Perhaps we can too.

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NY Numbers of the Day

by John W Rodat on August 23, 2012

Question:

Among counties in New York (excluding New York City and excluding Columbia County, which at the time I pulled the data, had not submitted theirs), from 1998 to 2010, which county had the highest rate of growth in employee benefit expenditures and what was it?

Rensselaer County at 375.6 percent.

Which had the lowest? Chemung County at 41.3 percent.

That’s quite a range, huh? The statewide figure was 129.6 percent.

These “answers” of course depend on the accuracy and consistency of data reported to the State Comptroller and the deeper I go, the more skeptical I become.

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Couple of nursing home stories.

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Take a look here. ProPublica, a public interest journalism site, has a tool for identifying nursing homes by location and severity of deficiencies. It has free text capability as well.

By way of example, the link is set for New York and the nursing homes with the worst deficiencies.

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National Public Radio does a story on New York’s counties getting out of the nursing home business. Click here for text and sound.

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We’ve been waiting for Albany County to reveal what responses they got to their RFP’s regarding sale or management of the Albany County Nursing Home. The Times-Union grew impatient and filed a FOIL request.

Here’s the TU’s story on what they learned. There were no bids to buy the facility and only one bid to manage it.

The lone nibble on privatizing the management came from Lowell Feldman and Martin Liebman, who have spent decades running Bronx nursing homes. They offered to take on the duties of running Albany County’s 250-bed home for five years for a $1.37 million annual management fee.

The partnership pledges to streamline operations and cut costs that would save the county a projected $2.2 million annually, according to a copy of the proposal released to the Times Union under a Freedom of Information Law request. The plan pegs the five-year savings at just over $11 million, fueled in part by an estimated $2.1 million annual labor savings, which Feldman said would come largely through consolidation and job cuts.

“We would sit down and talk with the union representatives, and you have to come with an amicable outcome for the services to continue. I don’t think anybody wants to continue the losses,” Feldman said. “I think there would have to be some (job reductions), probably some by attrition. There is some overstaffing.”

By the way, the current senior management staff doesn’t make anything approaching $1.37 million.

Well, this is interesting …

It’s a marked contrast to the response in other counties. For example, Ulster got six bids (at or above their minimum price of $10.5 million.) Kinda funny to speculate as to why there were no purchase bids and only one management bid: Lousy building? lousy location? crazy Albany politics? saturated market? financial threat of Medicaid managed long term care? what else? Most likely, all of the above.

So let’s assume a sale by Albany is off the table. Some legislators will take the lack of response regarding a sale will mean they have no alternative but to build a new facility. We’ve already seen what a money loser that it, at least the way Albany County operates. They’ll talk again about a public benefit corporation and they may try it. But financially they’ll still wind up paying for it.

It may be the time to remind everyone of home and community based alternatives.

The one thing you can count on is that Albany County is behind the curve and acts, or fails to act, accordingly.

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Well, I tried to take a vacation …

While I was away, a friend tracked me down. He’s analyzing what a specific county (not to be named here) might and should do with their nursing home.

A couple of things came up.

The first and most interesting was the number of patients who had been admitted before there had been a determination of Medicaid eligibility, and who were determined to be ineligible because they had violated the law with respect to transfer-of-assets. For those of you who don’t follow these issues closely, here’s what that means.

Essentially, these patients had given away their assets – impoverished themselves – in order to become eligible for Medicaid. Over 10 percent of the patients in this county nursing home had their applications for Medicaid rejected. What that means for the nursing home – and the county – is that there will be no Medicaid reimbursement and they are now stuck with paying for the entire cost of care out of county revenue. It also means that when the county looks to sell the nursing home, it’s likely to significantly reduce what any potential buyer will pay because they may get stuck with that unreimbursed cost.

So much for the “traditional county mission” of being the placement of last resort and taking in the poor that no one else will take. These were patients who were decidedly not poor. They gave away what they had – probably to family members – in an attempt to get the taxpayer to cover their cost. And they succeeded. But the county that took them in, a decidedly Republican county by the way, gets stuck with the tab. If I had the time, I’d FOIL every county as to how many patients they had in such a status.

This particular county is another that has not had their facility sprinklered. But in this case, they have no plans to. That’s nuts. While I was away, CMS turned down Albany’s request for a waiver to sprinkler its nursing home. So they have to spend around $700 thousand to get that work done. Regular readers certainly know that in most cases, and certainly in Albany’s case, I believe that the facility should be sold. I preferred substitution of assisted living and other community based capacity, but Albany County pols are a decidedly bricks and mortar crew. They can’t put their names on a plaque for home care. Nevertheless, to continue operating a nursing home without sprinklers is just nuts:

  • The requirement was announced four years ago with a deadline a year from now. That’s plenty of notice. Failure to get it done means that Federal funds, Medicaid, Medicare, Veteran’s, essentially all of it, gets cut off.
  • Any potential buyer will heavily discount their offer price for a building that’s not sprinklered, if there’s enough time to get the work done after they gain title and get possession. However, they won’t make an offer at all if there’s not enough time to get the work done.
  • Not even appearing to make an effort to get the work done suggests that county officials are either irresponsible or that they’re holding the patients hostage while trying to force a decision to sell or close. That’s not a politically attractive position to be in.

Sorry folks. You have to get your facility sprinkled or you have to shut it down entirely by August, 2013.

And in the meantime …

Ulster County received six bids of at least $10.5 million for its Golden Hill Nursing Home.

Evidently spurred by a NYSAC analysis, there was a spate of news stories on what’s going on generally with respect to county nursing homes. Here’s the Albany Times-Union. It reported that “about half of the counties operating nursing homes in New York are “actively exploring privatization or other measures in order to stop the financial hemorrhaging.” Here’s WXXI’s story. When you hear these stories, don’t be too sympathetic to the counties. After all, their main public message these days is about “unfunded mandates.” Yet county nursing homes are just the opposite. They are not mandated, but they sure are funded at county and Medicaid expense.

Of course, there are always a couple of outlier exceptions. Evidently, Columbia County is actively considering building a new facility. Here’s a story from March, when the projected capital costs were about $32.35 million for a 128 bed facility. And here’s a story from late last year. We may have more to say about Columbia County in a bit.

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Limited Posts

by John W Rodat on July 15, 2012

Obviously I haven’t posted much the past couple weeks. I won’t the next week either as I’ll be offshore and (mostly) offline.

In the meantime, yes take the Supreme Court’s Medicaid decision seriously. It’ll keep people busy for a while. But ultimately states will come around because they’d be foolish not to and because their citizens will be hurt if they don’t. On both sides of the ledger.

Not only will states that don’t use the ACA’s provisions for Medicaid expansion deprive many of health care, their taxpayers will be paying for care of citizens and provider revenue in states that do take advantage.

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LIBOR?

by John W Rodat on July 15, 2012

This will be short since I’m writing it on a phone.

If New York’s Comptroller and Attorney General are not evaluating the impact of the LIBOR scandal on local governments, they’d best start soon.

Not only is LIBOR built into lots of debt obligations, it’s used in determining depositor bank charges such as through compensating balances.

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Like most, I’ve done my tea-leaf reading. If we were sitting around over coffee or beer, I’d speculate with you on what the Supreme Court will announce tomorrow as its decision on the Affordable Care Act, health care reform. I won’t here. It’s pointless and there are thousands who’ve already covered that ground.

I will go a bit further and say that in my non-lawyer opinion, I believe the entire Act is Constitutional and that if the Court rules otherwise, it’s because the majority decided on the conclusion they wanted and then backed into it. If they do overturn the Act, or even just the part reputably most likely to be overturned, the mandate to purchase coverage, they will be undoing precedents that reach well beyond healthcare and the purchase of health insurance. Moreover, it would be part of a larger trend that started with Bush v. Gore, and moved on to Citizens United and, when combined with other factors has led, in the trenchant words of James Fallows, to a “slow motion coup.” Fallows later, unfortunately in my judgement, softened those words, but we certainly agree that the right-wing and the bulk of today’s Republican Party is “radical.”

And assuming the Court overturns all or part, what then? Here are a couple of examples that are nowhere need exhaustive:

  • If the Court overturns the mandate, but only the mandate, then the health insurance industry is in trouble. Given how much money they’ve thrown into the public relations campaign against the act (the largest share of over $230 million), there would be considerable justice in this result because they would still have to adhere to a host of other requirements that will cost them money, but they won’t gain as many new, lower cost clients to balances things out. Because it’s central to the overall framework, I hope the mandate is upheld, but if it isn’t, I’ll feel no sympathy for the insurers.

    If this is the result, Republicans in Congress without question and some Democrats will try to save the insurers. Despite it being far less than an ideal result, the Democrats should use this result for bargaining leverage and resist.

  • Overturning the entire Act will produce a negative public reaction much greater than most of the pundits have actually anticipated. And the first reactions will center on the newly re-opened “doughnut hole” in Medicare pharmaceutical coverage, coverage of those with pre-existing conditions (count on a lot of local news coverage of individuals who will be hurt by this) and coverage for young adults (up to 26) on their parents coverage. It won’t only be the young adults, but their parents fretting about them who will react.

Of course if the Court upholds the entire Act, I’ll look for some friends with which to share a celebratory beer. If not, we can begin planning the counter-attack.

As many have pointed out and pessimists assume, historic failures to enact healthcare reform have been once-a-generation events. Therefore, it will be at least a decade to two before there’s another opportunity. I strongly disagree.

All the previous attempts at universal coverage failed. This one did not. In itself, that’s a game-changer, even more to the degree that the Court’s decision will be perceived as politically driven rather than legally principled. And the same dynamic, system pressures that strongly contributed to enactment of the ACA will compound and accelerate further increase the probability of success. The Republicans have no plan. And absent an individual mandate, they have no path to a plan that does not require even more governmental involvement than the ACA. Yet the dysfunction of the healthcare system, healthcare coverage, and the public’s distress over both will increase the pressure to solve those problems – a lot. And no Randian notion of doing nothing or even a Paul Ryan voucher plan for Medicare, much less everyone else will solve the problem either in terms of policy or politics. Rather than opposing anything the President touched while attempting to de-legitimize him, the Republicans should have declared victory, taken credit, and gone home. Not incidentally more people or at least a higher proportion from red states (Republican) will or would have benefited from the ACA than from blue states (Democratic).

If the ACA is overturned, success next time will come faster and will look different. I have argued for universal coverage for decades. I first wrote about it during the 1980s. Here’s something I wrote in 2005.

At the same time, I have also argued against “single-payer.” Despite those arguments, the need for universal coverage trumps the specifics of how. Absent a complete governmental takeover by radical conservatives who wish to return to the social and economic stratifications described by Dickens, the next version of reform will come faster than many expect and will be more centralized and more governmentally based. Regrettably, my working assumption is that the Congressional Republicans actively prefer Dickens. They do not want any solution or rather they want no solution. I’ve only come to believe this since the ACA was enacted since up until that time, most conservatives and Congressional Republicans in the policy-analytical and political realms supported such a mandate. Or at least they said they did. There’s no need to consider Mitt Romney anywhere in this debate because even if he took a position (leaving it to the states is not a position, much less a policy worth debating), we could not count on it for more than a week or two anyway.

The next version of reform, will either be “Medicare for All,” an extension of today’s Medicare program, which is primarily directly operated by the Federal government, but which has some private plan options or it will be something akin to what the ACA would have given us with or without the mandate, but with a “public option.” Essentially they’re the same. Public coverage as a default or backstop with a private plan option paid for by the Federal government. They just have different defaults and different emphases.

Most importantly, what matters most is not the politics and it’s not the policy debates, it’s universal coverage. When one burrows into the polls on the public’s attitudes on “Obamacare,” one finds that the public supports most of the components. One also finds there is a significant group that opposes it not because it went too far, but because it did not go far enough. And thus there are some who want universal coverage who also want the ACA overturned.

I’m not a policy purist. Delaying coverage for years for some theoretical ideal hurts individual people in the meantime. In the midst of all that as far as healthcare is concerned , there will be one essential to remember. Overturning any part of the Act will mean that fewer people are covered, more will be unhealthy, and more will suffer. And some will die.

One of the two or three most important things we’ve learned about healthcare in the past three decades is that no single factor has as much effect on whether and when people get necessary medical care than does whether or not they have health insurance.

Coverage matters.

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