Thursday August 16, 2018

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Don't Let A Few Bad Facilities Lead To Privatization Of The VA

Posted by Rick Staggenborg, MD
Rick Staggenborg, MD
Dr. Rick Staggenborg is a retired VA psychiatrist, former Army member and member
User is currently offline
on Monday, 12 March 2018
in Wisconsin

veterans-for-peace-va-marchOur scandal-obsessed media has distorted our impression of the VA, but don't let politicians use myths of privatization to milk the taxpayers by providing inadequate care to veterans.


ROSEBURG, OR - Recent articles detailing the history of mismanagement at the Roseburg VA paint a sorry picture of our local facility. It’s a story that must be told, but it’s important to put the facts into context. Generalizing from the problems of individual facilities without providing context gives the impression that the system is broken, as some claim. However, we can’t make sweeping conclusions about the VA without comparing outcomes between it and other healthcare systems. When we do, it’s clear that both by objective measurements and patient satisfaction ratings, VA care is superior to that provided by the private sector.

It’s important to recognize that our scandal-obsessed media has distorted our impression of the VA, because some politicians and their deep-pocketed benefactors have taken advantage of the negative coverage to target the VA for privatization. Using such stories to justify diverting funds to the private sector, investors in for-profit healthcare like the Koch brothers can reap enormous profits. Under the guise of increasing veteran “choice,” these privateers and their political lackeys have already outsourced 40 percent of patient visits and are pushing for more.

veteran-olderIt may seem a good idea to give veterans the option of getting help outside the VA, given claims that waiting times are excessive. That is, until you look at the facts. While it is true that at some facilities (including Roseburg) waiting times are longer than in the private sector, nationwide this isn’t the case. Where it does happen, as in Roseburg, the problem is more due to a lack of providers than mismanagement. This is partly because medical care providers at the VA are grossly underpaid relative to their counterparts elsewhere, another result of chronic underfunding of the VA by Congress.

There are currently nearly 50,000 unfilled positions at the VA nationwide. Is it any wonder that there are problems? VA facilities in places like Roseburg are chronically understaffed, as anyone who has been a primary care patient there for any time knows. As much as we love this place, it is just a little too rural for most doctors. Given that, the low pay and the unfairly poor reputation of the VA, it’s hard to staff the facility with providers and administrators who can choose to live almost anywhere. The solution to the problems of the VA isn’t diverting funds, but increasing the proportion spent within the system, including making salaries competitive.

Some people think that you can partially privatize the VA by letting it specialize in orthopedics and mental health, areas where it clearly has capabilities lacking in the private sector. What they don’t realize is that the greatest feature of the VA is that primary care is seamlessly integrated with specialty care. Primary care doctors know how to screen for stress-related conditions, traumatic brain injury, Agent Orange-related problems and other issues specific to vets. They can easily get them help with their specialist colleagues. The VA also has case managers and social workers whose jobs include making sure that these handoffs are as easy and reliable as possible, which is unheard of in for-profit medicine. This is especially critical with the aging VA population, those with head injuries and those who have trouble tracking appointments because of trauma-related problems with memory and concentration.

VA doctors know how to work with vets. In contrast, a recent Rand Corporation study of the ability of private care providers to work with veterans found that only about one in three providers met the study’s “minimum threshold for familiarity with military culture” and only one in five routinely asked if their patients had a military background.

In view of these facts, it’s obvious that privatizing even some of the functions of the VA will damage a well-coordinated system. The money spent on outsourcing beyond that which is necessary to provide good service could be better spent staffing the VA. Not only is the need greater, but the money goes much further. With its drug formulary and ability to negotiate prices, and without the profit incentive and other expenses unique to private care, the VA can deliver comprehensive services that would cost far more in the private sector, if such a system existed.

Fortunately, there is a growing effort to raise awareness of this attempt to milk the taxpayers for providing inadequate care to veterans. Veterans Fighting for Healthcare (www.ffvhc.org) is a growing national coalition whose mission is to organize to oppose privatization of the VA. As one of its most active partners, Veterans for Peace is staging actions around the country to educate the public about this problem. If you agree that veterans have earned the best medical care available in the US, join VFP of Douglas County when we gather at 4 p.m. on March 15 at the front gate of the VA on Garden Valley Road.

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Wisconsin Pharmaceutical Price-Gouging Bill Announced

Posted by Citizen Action of Wisconsin, Robert Kraig
Citizen Action of Wisconsin, Robert Kraig
Robert Kraig is Executive Director, Citizen Action of Wisconsin, 221 S. 2nd St.,
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on Wednesday, 07 March 2018
in Wisconsin

news confBill would give Attorney General power to investigate skyrocketing generic drug prices set by big pharmaceutical corporations to lower prices and protect Wisconsinites.


MADISON - At a news conference at the State Capitol today Citizen Action of Wisconsin, Senator Dave Hansen (Green Bay) and Rep. Jimmy Anderson (Fitchburg) announced new legislation that would empower the State Attorney General to block pharmaceutical corporations from price-gouging patients who depend on generic prescription medications.

Skyrocketing generic prices are harming families in Wisconsin and across the nation. A 2016 GAO report found that 1 in 5 generic drugs had an “extraordinary price increase” of at least 100%; 48 generic drugs had price increases by 500%; and 12 generic drugs had price hikes over 1000%. Well known examples are Albuterol (asthma medication) which increased 4,014%; Doxycycline (medication for bacterial infections) which spiked up 8,281%, and Pravastatin (heart conditions) which jumped 573%.

Pharmaceutical corporations have been pocketing the increases as profit, failing to give  legitimate explanations for the shocking price hikes. Under the legislation, the Attorney General can petition the circuit court to enjoin price gouging, or compel a corporation to justify large rate increases.

dave-hansen“It’s time to shine a light on what is becoming a very dark corner of the generic drug market,” said Sen. Dave Hansen, the Senate author of the bill. “People who can least afford it are getting squeezed by corporations and CEOs bent on generating bigger and bigger profits without any regard for the potential harm their greed is costing patients both in terms of dollars and personal health. This should not be an acceptable business practice here in Wisconsin.”

jimmy-anderson“Prescription drug prices are one of the leading out of pocket healthcare expenses for Wisconsin families. The ability of pharmaceutical companies to corner the market and set unreasonable prices hurts consumers, while doing nothing to improve treatment or outcomes,” said Rep. Jimmy Anderson, the Assembly author of the bill. “By enabling the Attorney General to order documents from drug manufacturers, we will better understand how drug prices are being set and how to control prescription drug costs. This legislation is vital in ensuring that our healthcare industry is focused on protecting Wisconsin families rather than simply kowtowing to the whims of massive drug manufacturers. It is imperative that we act now to protect Wisconsinites from exorbitant, unfair costs before this problem grows any larger.”

“As a practicing primary care physician I see first hand the growing financial burdens placed on patients and their families due to rising health care costs,” said Dr. Nike Mourikes at the news conference. “One in five Americans report skipping medication dosing or skipping prescriptions because of cost. This pharmaceutical price-gouging bill has come not a moment too soon, because the well-being and in some cases the lives of our fellow Wisconsinites hang in the balance.” (Dr. Mourikes is a member of Physicians for a National Health Plan and of Citizen Action’s Health Care for All Organizing Co-op)

robert-kraigAt the news conference Courtney Waller, the parent of a child with a complex disease who is literally kept alive by prescription medications, told the story of the vulnerability of her family to prescription drug prices. “This is a story you her time and time again from Wisconsin families who have children with medically complex diseases. And it is an issue which keeps many of us up at night.”

“The only way to protect Wisconsinites who rely on prescription drugs from exploitation at the hands of giant pharmaceutical corporations is to use the full power of our democratic government to even the playing field,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “In recent years the Legislature has abdicated its role as a public watchdog, and that needs to change. Senator Hansen and Rep. Anderson are to be commended for offering common sense legislation empowering the Attorney General to intervene on the public’s behalf when the greed of pharmaceutical corporations threatens the lives and livelihoods of Wisconsinites who depend on vital medications.”

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Sen. Hansen, Rep. Anderson Unveil Plan to Go After Predatory Drug Pricing

Posted by Wisconsin Senate Democrats, Jay Wadd
Wisconsin Senate Democrats, Jay Wadd
Wisconsin Senate Democrats, Jay Wadd has not set their biography yet
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on Wednesday, 07 March 2018
in Wisconsin

drug-costDrug companies are increasing prices on generics by as much as 500%, and it's time to shine a light on this dark corner of the prescription market says Green Bay senator. Bill would give AG power to investigate.


MADISON - Joined at a press conference today by Dr. Robert Kraig of Citizen Action and people directly impacted by the predatory practices of some generic drug makers, Senator Dave Hansen (D-Green Bay) unveiled a plan he is introducing with State Representative Jimmy Anderson (D-Fitchburg) aimed at tackling the growing problem of predatory pricing by makers generic and off-patent drugs.

caw“We are seeing example after example of drug companies increasing prices on much-needed generic drugs by as much as 500%, 4,014% and even 8,281%,” said Hansen. “This can’t be allowed to go on.”

Recent examples of drugs that saw exorbitant price increases include Pravastatin, used to treat heart conditions which jumped 573%. Albuterol, used to control asthma, increased 4,014%.

And Doxycycline which is used for bacterial infections skyrocketed 8,281%.

dave-hansen“While companies that engage in this type of predatory practice make greater profits, those profits come at the expense of many of the people who need those drugs the most, as they are priced out of their ability to obtain them,” said Hansen. “It’s time to shine a light on what is becoming a very dark corner of the generic drug market.”

Many if not most makers and distributors of generic and off-patent drugs do their best to keep them affordable for the people who need them. Some less scrupulous companies, however, look to corner the market on a specific off-patent or generic drug and raise prices simply because they can. And the reason they can is because the drugs are critically important to the health and wellbeing of so many people.

The bill provides the Attorney General with the tools necessary to go after less scrupulous drug makers and distributors who see markets for certain drugs as a path to quick and big profits at the expense of the lives and health of people who need them.

Under the bill the Attorney General would have the power to compel drug companies to provide information justifying the price increase and petition the court to provide remedies ranging from enjoining the drug’s maker form engaging in price gouging, requiring them to return excessive profits to consumers as well as require t drug makers to pay civil forfeitures of up to $10,000 for each instance of price gouging.

“People who can least afford it are getting squeezed by corporations and CEOs bent on generating bigger and bigger profits without any regard for the potential harm their greed is costing patients both in terms of dollars and their personal health. This should not be an acceptable business practice here in Wisconsin,” concludes the Senator.

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One Step Moves Us Forward to More Affordable Healthcare

Posted by Kathleen Vinehout, State Senator 31st District
Kathleen Vinehout, State Senator 31st District
Kathleen Vinehout of Alma is an educator, business woman, and farmer who is now
User is currently offline
on Tuesday, 06 March 2018
in Wisconsin

affordablecareA new law creates Risk Corridors* for Health Care insurance providers in Wisconsin, a technical mechanism to help level the risk for insurers. Minnesota enacted a similar law to achieve a premium reduction, and also created their own health care network and accepted Medicaid expansion dollars, ideas that could benefit Wisconsin.


MADISON - “Lord willing, and the creek don’t rise, I’ll see you Tuesday.” I said as I left the office in Madison.

By the next day, the creek at the base of my farm’s steep driveway had risen over the road. The rushing water cut a channel through the gravel town road, making the road impassable.

My forward-thinking husband kept an eye on the water’s progress and moved vehicles over to the other side before the rushing water completely cut through the road.

This morning twelve bluebirds and a robin hung out by the bird feeders. Spring comes one step at a time: snow melt, more snow, more melting and mud. The old farmers say snow must fall three times on a robin’s tail. Another big snowfall this week is snowfall number one on the robin’s tail.

Back in Madison, at the State Capitol, there is not much evidence of a thaw between the Senate and Assembly or between the majority and the minority parties. However, the Senate did pass a bipartisan bill to help lower health insurance premiums.

“What do you think of Risk Corridors?” an older Barron County farmer recently asked me at a public meeting in Eau Claire. Quite surprised, I asked him “How did you know about “risk corridors?”

“I’m paying attention!” he smiled. “And, I pay too much for health care. I think this plan will help lower my premiums.”

I agreed, “It’s a good idea and I voted for the bill.” The rest of our group looked very puzzled.

Risk corridors is a wonky phase describing an idea to lower premiums under the Affordable Care Act (Obamacare). I explained the plan like this: Remember when we had Blue Cross Blue Shield as not for profit health insurance. Plans were community rated – meaning everyone paid the same price regardless of age and health. This was an “up-front” leveling or sharing of risk for insurance companies.

Risk corridors are similar in purpose, but a more behind the scenes leveling. Think of risk corridors like a profit and loss sharing mechanism to help insurers balance risk.

The Barron County farmer joins about 200,000 people in Wisconsin who buy insurance on their own through the healthcare.gov marketplace.

Wisconsin saw premiums in the marketplace increase on average 36% from 2017 to 2018. Many families were dropped by their health plans and had to find other insurance. Still others dropped coverage because of price increases.

Minnesota took up the idea of risk corridors and lowered 2018 insurance premiums under Obamacare by 20%, compared to where premiums would have been without risk corridors. This savings was possible in part because Minnesota has its own marketplace – MNsure – and expanded Medicaid (MinnesotaCare). These are two ideas I strongly support and would help Wisconsin get to Minnesota’s 20% premium drop.

Senate Bill 770, the bill to create risk corridors, recently passed the Legislature and was signed into law by the Governor. The bill passed in an interesting bipartisan vote. Some Republicans voted “no” because they thought the bill went too far; some Democrats voted against it because they didn’t think the bill went far enough.

Leaving the event in Eau Claire I reflected on the two persistent questions I heard at the forum: how are you going to fix health care and how are Democrats and Republicans going to work together?

With SB 770, we took a small step forward. Just a small step on the long road toward healthcare for all - but in today’s political climate perhaps only small steps are possible.

Politics often seems to be the art of the possible. I strongly believe whatever steps forward we CAN take, we SHOULD take.

Spring does not arrive all at once. We welcome the first robin, and see the robin as the first sign of the coming of spring. So it is with health care; I welcome any step forward as a sign that we can make our way down the road.

We never get to the end of the road until we travel it.

****

* Risk Corridors can be described as a healthcare exchange re-insurance pool where participating insurers who MADE MONEY in a given year would kick a percentage of their profits into the pool, administered by the Federal Government, from which any insurers who LOST MONEY during that same year could recoup their losses.

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A Wheelchair is Not a Trampoline: Questioning Assumptions about Support

Posted by Kathleen Vinehout, State Senator 31st District
Kathleen Vinehout, State Senator 31st District
Kathleen Vinehout of Alma is an educator, business woman, and farmer who is now
User is currently offline
on Tuesday, 27 February 2018
in Wisconsin

family-worried-billsThe recently passed Special Session bills make it more difficult for people living in poverty to achieve their dream of family supporting jobs and getting off government assistance.


MADISON - “Public assistance should be a trampoline not a hammock,” read the title of Governor Walker’s press release touting work on a package of bills introduced in a Legislative Special Session. The bills made changes to certain programs targeted at helping those living in poverty.

During the recent Senate debate, proponents of the bills declared the best road out of poverty was a job. No one in the Senate disagreed. However, what these bills really do is KEEP people in poverty and make a few companies richer while providing little accountability.

The assumption of the hammock metaphor is that people are lazy and just need a kick to get moving. Another assumption is that fraud is rampant. Both assumptions are false. FoodShare is heavily scrutinized to ensure compliance. Wisconsin has an error rate around one percent.

Most people who use FoodShare or BadgerCare do so short term. According to Kaiser Family Foundation, 60% of non-elderly folks who use Medicaid are already working. Another third are in school, ill or caring for someone in need.

According to David Lee of Hunger Task Force in Wisconsin, about two-thirds of those who get FoodShare are seniors, disabled, and children – people who cannot work. Of the remaining third, half are already working. Many others are caregivers – for either the elderly, disabled or children.

Part of the Special Session plan is to make it harder to get FoodShare and BadgerCare. Families may have to sell their home if it’s more than 200% of average state value. Farmers may have to sell livestock, equipment and farm buildings. Disabled folks might lose their accessible van if it’s worth over $10,000.

These rules fly in the face of common sense. If we want a farmer to do better, or a wheelchair bound person to succeed why would we make them sell items essential to their livelihood?

The cornerstone of the Governor’s plan is a program called FoodShare Employment and Training – FSET for short. The program relies on several contractors around the state who screen people and get them into work.

Lawmakers heard stories of FSET companies creating incentives for job counselors to get people into low wage jobs as soon as possible. For example, we heard about a young woman who wanted to get her GED to improve her ability to get work. Instead, the FSET job counselor sent her to a minimum wage fast food job.

The Legislative Fiscal Bureau (LFB) reported that FSET participants, who gained employment in December of 2016, made an average of $12.19 an hour and worked an average of 34 hours a week. The LFB reported that participants with those wages and hours worked would still be eligible for FoodShare.

Further, the LFB reported on a string of problems with FSET. Costs per person per month were more than double the original budget estimate. Federal inspections turned up problems in Milwaukee, including civil rights violations, the lack of individualized services, and restricted education and training opportunities. Corrective actions and recommendations were slow or not completed. Despite three years of problems, the state made only one onsite visit.

Despite such poor performance and lack of evaluation, state officials awarded bonuses. The Department of Health Services gave “pay for performance” bonus money to all but one of the 11 FSET companies for “accuracy” and “timely completion of quarterly reports” – requirements FSET companies should meet at a minimum.

Unbelievably, Special Session Assembly Bill 6 more than quadrupled these “pay for performance” bonuses to the FSET companies.

Every group that works with those struggling to gain economic stability opposed these Special Session bills. Their thoughtful and compelling testimony clearly demonstrated that people want to move out of poverty and off government assistance. All they need are the tools to help them achieve their dream.

A wheelchair is not a hammock, but essential equipment. A warm house, food, health care and education are not a hammock but rather the essential tools to help people get that job that moves them out of poverty.

The measure of a civilized society is how we treat those in need. The Governor’s plan cuts the springs holding up the trampoline just as a person jumps.

For many, life is very difficult. When we reach out helping hands to those in need, we do our part to make not only their lives better, but ours as well.

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