Doomed Medicare Advantage Works Better Than Parent

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Category : Random Musings

Admittedly, the group compiling the data and the findings is a health insurance trade organization, but according to its culling of Agency for Healthcare Research and Quality (AHRQ) findings, the program Obama wants to cut–Medicare Advantage–far surpasses regular Medicare in results:

Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have “potentially avoidable” admissions, for common conditions ranging from uncontrolled diabetes to dehydration, according to a new analysis of publicly available AHRQ data released today by America’s Health Insurance Plans (AHIP).

In other words, Obama will pay for “health care for all” by cutting health care for seniors. No wonder they’re up in arms.

‘How the Mighty Fall’ Describes GM, Obamacare to a T

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Category : Federal Labor Law, Random Musings

Back in January (I can’t believe this year is already almost half over!) I read and reported on a book entitled Good to Great, which offered case studies on firms that rose to the top in their field, including Circuit City and Fannie Mae. Of course, we all know what happened to those two entities. Circuit City liquidated itself, and Fannie Mae likely would’ve been forced into bankruptcy as well had it not been for a government bailout (ongoing, by the way).

At the time I read the book, I e-mailed the author to see if he had an explanation for why those two entities went bust. I heard nothing for months, so I figured author Jim Collins was busy with more important pursuits than answering my half-scornful e-mail. Then a couple of weeks ago, I received an e-mail from Collins, who used a nutritional metaphor to explain what happened to Circuit City and Fannie Mae. He said a person could be in perfect health while watching his diet, but if he started making poorer food choices, his health could go south. In other words, those two firms changed what they were doing and lost their way.

Collins also offered to send me a gratis copy of his new book entitled, in a most timely way, How the Mighty Fall, in which he discusses Circuit City’s fall in more detail. Overall, he describes how companies “fall” by using a five-step process: First comes hubris and arrogance (“we can do no wrong”), which is followed by loss of discipline and lust for more (wealth, power); then denial of risk or peril; then grasping for salvation; and finally, capitulation to irrelevance or outright demise.

The book is a quick read, and I highly recommend it. (The author doesn’t extend the five-step death trot to individuals, but I certainly see how it applies to our daily lives and choices as well.)

What really struck me, what with the ongoing General Motors reorganization into government/union hands and the Obamaniacal thrust to put health care under government control, was a passage on page 56.

Collins first describes what he calls Packard’s Law (named after David Packard, one of the founders of Hewlett-Packard), which is that companies can grow only as fast as they are able to find and retain good employees.

Then, this section describes why both the GM reorganization and the taking over of health care are doomed to fail:

But a Stage 2 company [the second step, loss of discipline and lust for more] can fall into a vicious spiral. You break Packard’s Law and begin to fill seats with the wrong people; to compensate for the wrong people’s inadequacies, you institute bureaucratic procedures; this, in turn, drives away the right people (because they chafe under the bureaucracy or cannot tolerate working with less competent people or both); this then invites more bureaucracy to compensate for having more of the wrong people, which then drives away more of the right people and a culture of bureaucratic mediocrity gradually replaces a culture of disciplined excellence. When bureaucratic rules erode an ethic of freedom and responsibility within a framework of core values and demanding standards, you’ve become infected with the disease of mediocrity.

Actually, poor management in the face of union-imposed mediocrity and bureaucracy long ago doomed GM, but Team Obama has just permanently glued the company to that mediocrity. GM will be smaller but just as mediocre under government-cum-union tutelage. As for health care, well, fill in the blanks–it will become bureaucratic and mediocre in no time flat. Good doctors will decide to retire early or go into business for themselves. Lines will form; what’s left will be rationed; and everywhere there will be mediocrity–and bureaucratic rules to die by, which is what many people will literally do in the face of unavailable services.

Is this really change you can believe in?

Has Obama Gone Bananas and Taken Us With Him?

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Category : Federal Labor Law, Personnel Concepts

I work New York hours and live in California, which means I get home in plenty of time to watch both Jim Cramer and Larry Kudlow live on CNBC. While Cramer seems like a liberal who mostly agrees with Obama and his cohorts, Kudlow is a staunch Reaganite supply-sider. Cramer has been virtually silent on the Obamian approach to the reorganization of Chrysler and GM (now Government Motors), while Kudlow has been extremely vocal about how Obama is turning contract and bankruptcy law on its head.

Specifically, the pre-packaged “bankruptcy” deals that Obama has announced for Chrysler and GM force secured creditors (banks, hedge funds, etc.) to stand in line behind unsecured creditors (mainly, the UAW). In a very union-friendly approach to say the least, Team Obama wants secured creditors to take 33 cents on the dollar and unsecured creditors (the union, natch) 50 cents on the buck. A traditional bankruptcy would reverse that arrangement if not in fact award the unsecured creditors nothing or a ticket to stand in line for leftover scraps.

Cramer’s silence has me concerned, but he still offers good advice and insight into Wall Street investing. Kudlow, who’s my favorite commentator on CNBC (okay, Melissa Lee ain’t bad either but for reasons other than sage observations), seems to be drawing a line in the sand over upending the rule of law by fiat, if not downright threats and coercion.

At least one other author agrees (as I do) with Kudlow, and he’s gone even further in describing Obama as a reverse/perverse anthropologist and a “Czar” (quoting someone else) who is turning the U.S. into a Banana Republic where there is no rule of law in the capital markets.

Spengler (aka David P. Goldman)  makes for perceptive reading in his “Banana republic law and zombie economics.” Pay special attention to his anthropologist analogy.

Thankfully, there are still thinkers out there who aren’t cowed by White House threats–and still a few writers who haven’t traded in their objectivity for a chance at being part of the Banana Republicization of the United States that they have so long coveted.

Tom Daschle Lives On in the Stimulus Package

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Category : Federal Labor Law, Random Musings, State Labor Law

Those who were fretting that the extinction of Tom Daschle as potential secretary of Health and Human Services might delay health care reform needn’t worry.

The inclusion of several stealth provisions in the stimulus package now sailing through Congress will implement, mostly unnoticed, provisions from Daschle’s government-heavy idea of reform in his book, Critical: What We Can Do About the Health-Care Crisis.

His idea to prescribe which treatments and medications can and cannot be used by individual doctors lives on through the electronic health records (EHRs) initiative, which would be overseen by a National Coordinator of Health Care Technology. This latter person/office would monitor everything going on in the EHRs to make sure every doctor is following government guidelines and giving cost-effective care. And every doctor means your doctor.

Not only that, but the stimulus package includes the creation of a Federal Coordinating Council for Comparative Effectiveness Research to define and dictate cost-effective care: What physicians and hospitals can and cannot do.

In other words, this is the stealth implementation of Daschle’s plan to create a board similar to the one in Great Britain that dictates every medicine and every procedure for every known medical problem so that they are both efficient and cost-effective (but most of all cheap). Now, on the surface, this sounds reasonable until you face the actual results as a patient.

The British agency Daschle fell in love with (with the totally disingenuous acronym of NICE) has done things like, well, forbidding treatment of macular degeneration because the medicine was too expensive until the patient went blind in one eye. (This policy was reversed finally after three years of public outrage.)

Betsy McCaughey, former lieutenant governor of New York and now an adjunct senior fellow at the Hudson Institute,  calls this “Ruin Your Health With the Stimulus Plan.” She explains:

The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

There’s little wonder, then, that President Obama continually and frantically insists that the stimulus package be hurried through Congress–he doesn’t want anyone actually reading it. As his chief of staff quipped, this is “no time to waste a good crisis.”

As these pages have been predicting since the git-go, the only way anybody in government–using government solutions–can make health care both “accessible and affordable” is by restricting and rationing what’s available.

Hey, if you successfully lower health care expectations, maybe enough people will start kicking off before they reach 65, and the government won’t have to pay Social Security or Medicare.

Nice plan.