| Doctors Chime in regarding Socialized Medical Care and the "Medicare Provider Bureaucratic Nightmare" Posted: 21 Mar 2011 02:46 PM PDT I received a number of interesting emails from a number of doctors in response to Medicare Provider Bureaucratic Nightmare, a post regarding the plight of John Peters, a practicing psychologist, and his quest to obtain a Medicare Provider Number. Please read the above link if you missed the original article. Here are some responses from doctors willing to sign their names. War of AttritionDr. Denise Szczucki writes Dear Mish
I am a physician and went through this exact scenario when I had to change my tax ID number a few years ago. 25 percent of my income was held up for over 6 months while the re-credentialing took place.
Two things that helped me were:
- I hired my biller to do the work. An outside party is less emotional since it is not their food money on the line.
- I redid the entire application including the canceled check. They pulled that canceled-check stunt with me too.
This is a war of attrition.
CMS is a nightmare and it used to be so simple. When I renewed in 2000 it took a month and a single application, no check, to get it done. Now you have to keep calling, faxing and mailing (certified ideally) until it gets done and it takes forever.
Even then it will take months to get the first set of checks.
Good Luck
Dr. Denise Szczucki Incentives to Delay Mark Woodward, O.D. writes ... Mish,
It's not really hard to understand. By federal regulations Medicare should credential "any willing provider" who meets the credentialing process. However, Medicare is going bust as we speak.
Medicare simply has no incentive to increase provider roles. One way to limit expenditures is to limit the number of providers. This is the same tactic used by HMO's and some other health plans.
In a more global context I believe the transition to socialized medicine in this country will be exceptionally difficult. The only way government can move to a completely socialized delivery system is to co-op different participants in the delivery system and put the pressure on the non co-opted participants.
Watch for government to increase contracting with "Healthcare delivery systems" like UHS, Tenet Healthcare, and HCA.
While these delivery systems may be more efficient than civil service workers, they will also swallow greater and greater share of the reduced reimbursement amounts. Ultimately, government will abandon their co-opted partners when citizens are fed up with reduced benefits, limited access, and poor quality. People will then ask for a fully socialized system administered by the government.
New and future graduates of medical training programs can only hope to start at salaries higher than the accountants hired by the feds to track the program. Those New doctors will become debt slaves. They graduate $250,000 to $350,000 in debt and will have to accept any wage. Veteran doctors will quit en mass rather than put up with all the bureaucratic red-tape with much less reimbursement.
The sad thing is heath care expenses do not substantively alter our countries productive output. They really shouldn't be considered as part of the GDP just like the profits from the derivative finance industry should never have been considered part of the GDP.
Mark Woodward, O.D. Suggested Course of Action for Dr. John PetersAllen Bennett, a retired M.D. has these suggestions for Dr. John Peters Hi Mish
Regarding "Medicare Provider Bureaucratic Nightmare", John Peters might consider sending a letter by registered mail to Marilyn Tavenner, COO, Centers for Medicare and Medicaid Services, 200 Independence Ave S.W., Room 445-G, Washington, D.C. 20201 with copies to Senators Boxer and Feinstein.
He needs to include the names of all involved "analysts".
The bureaucratic nightmare of John Peters appears to be a wonderful way to cut health care costs while keeping a largely unnecessary intermediate bureaucracy "busy".
I have often worried about newly-minted health care providers and their ability to get on approved provider panels, so they can bill and get paid. It used to be no problem, but apparently it is now.
Your daily analysis is always enlightening. Keep up the great work!
Sincerely,
Allen Bennett, M.D. Mike "Mish" Shedlock http://globaleconomicanalysis.blogspot.com
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| Supreme Court Gives Fed 5 Days to Release Emergency Bank Loan Details; An Important Step in the Right Direction Posted: 21 Mar 2011 10:50 AM PDT In a rare victory for common sense, the Supreme Court has rejected appeals by banks and the Fed that disclosure of the emergency loans by the Fed to various banks in 2008 were "trade secretes". The court gave the Fed 5 days to release the information. Please consider Fed Must Release Loan Data as High Court Rejects AppealThe Federal Reserve will disclose details of emergency loans it made to banks in 2008, after the U.S. Supreme Court rejected an industry appeal that aimed to shield the records from public view.
"The board will fully comply with the court's decision and is preparing to make the information available," said David Skidmore, a spokesman for the Fed.
The order marks the first time a court has forced the Fed to reveal the names of banks that borrowed from its oldest lending program, the 98-year-old discount window. The disclosures, together with details of six bailout programs released by the central bank in December under a congressional mandate, would give taxpayers insight into the Fed's unprecedented $3.5 trillion effort to stem the 2008 financial panic.
"I can't recall that the Fed was ever sued and forced to release information" in its 98-year history, said Allan H. Meltzer, the author of three books on the U.S central bank and a professor at Carnegie Mellon University in Pittsburgh.
Under the trial judge's order, the Fed must reveal 231 pages of documents related to borrowers in April and May 2008, along with loan amounts. News Corp. (NWSA)'s Fox News is pressing a bid for 6,186 pages of similar information on loans made from August 2007 to November 2008.
The records were originally requested under FOIA, which allows citizens access to government papers, by the late Bloomberg News reporter Mark Pittman.
As a financial crisis developed in 2007, "The Federal Reserve forgot that it is the central bank for the people of the United States and not a private academy where decisions of great importance may be withheld from public scrutiny," said Matthew Winkler, editor in chief of Bloomberg News. "The Fed must be accountable to Congress, especially in disclosing what it does with the people's money."
The Clearing House Association contended that Bloomberg is seeking an unprecedented disclosure that might dissuade banks from accepting emergency loans in the future.
Bloomberg initially requested similar information for aid recipients under three other Fed emergency programs. The central bank released details for those facilities and others in December, after Congress required disclosure through the Dodd- Frank law.
The New York-based Clearing House Association, which has processed payments among banks since 1853, includes Bank of America NA, Bank of New York Mellon, Citibank NA, Deutsche Bank Trust Co. Americas, HSBC Bank USA NA, JPMorgan Chase Bank NA, U.S. Bank NA and Wells Fargo Bank NA.
In trying to shield the documents from disclosure, the Clearing House invoked a FOIA exemption that covers trade secrets and commercial or financial information obtained from a person and privileged or confidential."
The cases are Clearing House Association v. Bloomberg, 10- 543, and Clearing House Association v. Fox News Network, 10-660. Information-Wise, a Big YawnThe argument that information represents "trade secrets" is of course preposterous, as is the idea that "disclosure that might dissuade banks from accepting emergency loans in the future". If banks need money to survive, they will take it. We will know soon enough, but I expect the information to be a big yawn. We will see some loan amounts and names but everyone knows the names anyway. Perhaps there will be some excitement over loans to foreign banks. Important Step in the Right DirectionWhatever excitement there is, will last all of a day. However, this was an important step in the right direction, that removes some unwarranted secrecy at the Fed. The Fed hides behind a cloak of secrecy, doing what they want, when they want, with no disclosure, and no accountability to anyone. Five Steps to Eliminate the FedThe first step is a full disclosure of what happened. The second step is a full and complete audit. The third step is a plan to phase out the the Fed. The fourth step is Congressional approval of that plan. The fifth and final step is removal of the Fed itself. This first step was a very small one actually, but every trip begins with a single step. It will take years to get rid of the Fed. I am hoping I live to see the day it happens. Mike "Mish" Shedlock http://globaleconomicanalysis.blogspot.com
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| Current Decade of Job Losses vs. Great Depression; How Did Quasi-Public Jobs Fare? Who is Whining? Posted: 21 Mar 2011 01:51 AM PDT It may surprise you to learn that job losses in the most recent decade ending February 2011 are reasonably comparable to the job losses from 1929-1939. Moreover, if we exclude government and "quasi- government" jobs, the latest decade is the worst ever, by far. Please consider A Decade of Labor Market Pain by Mike Mandel. In February 2001, nonfarm payrolls hit their business cycle peak of 132.5 million. Ten years later, the latest data pegs February 2011 payrolls at 130.5 million, a 1.5% decline. To put this in perspective, the ten-year period of the Great Depression, 1929-39 saw a 2.3% decline in nonfarm employment, roughly the same magnitude.
But even that 1.5% understates the extent of the pain for most of the workforce. I divide the economy into two parts. On the one side are the combined public and quasi-public sectors, and on the other side is the rest of the economy. Public, of course, refers to government employees. 'Quasi-public', a term I just invented, includes the nominal private-sector education, healthcare, and social assistance industries. I call them 'quasi-public' because these industries depend very heavily on government funding. For example, social assistance includes 'child and youth services' and 'services for the elderly and disabled', which are often provided under government contract.
The chart below shows employment growth in the public/quasi-public sector, compared to employment growth in the rest of the economy, with February 2001 set to 100. We can see that public/quasi-public employment rose steadily over the past ten years, and is now up 16%. By comparison, the rest of the private sector is down 8% in jobs over the past 10 years.
Once again, we look at the Great Depression for an analogy. From 1929 to 1939, government employment rose by about 30%. If we back that out, then private sector non-ag jobs fell by 6% over the Depression decade. That compares to the contemporary 8% decline in private non-ag non-quasi-public jobs since 2001. So by this measure, the past 10 years have been worse for the labor market than the decade of the Great Depression. The first chart below is from the BLS, the second chart below is from Mandel. Nonfarm Payroll Employment - Seasonally Adjusted Total
The above chart shows the 1.5% drop between February 2001 and February 2011. Note that nonfarm employment is below where it was 11 years ago dating back to February 2000. The next chart is the one Mandel created. Public and Quasi-Public Jobs vs. Everything Else Please see Mandel's article for a state-by-state breakdown. Who is Doing all the Whining?Who is doing all the whining and all the pissing and moaning? The answer of course is those who fared the best in the last decade: the police and fire unions, the teachers' unions, transit unions, and public unions in general. Many in private sector fields have been hammered silly with rapidly rising healthcare costs and lower paychecks (assuming they have a job at all). Meanwhile those with the most benefits and those who have suffered the least are the ones unjustifiably bitching to high heavens about how unfairly they are being treated. Mike "Mish" Shedlock http://globaleconomicanalysis.blogspot.com
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