Category: Health Care Reform

Harvesting Organs From the Poor. The American Way.

More sophisticated than whacking someone over the head and stealing their organs.

The papers and media are full of talk about former Vice President Dick Cheney’s recent heart transplant. There was much discussion about whether at age 71 he was too old, or whether he took advantage of special privileges to jump the line of thousands of others hoping to receive this potentially life-extending procedure. I am not prepared to comment on most of that: whether you call it an organ-allocation process or rationing, some will always consider themselves lucky, and others losers. I wish Mr. Cheney well.

Organ transplantation is often considered one of the triumphs of modern medicine. It has also made a lot of money for hospitals and doctors who do the procedures. Think of all the ads and press coverage we hear as hospitals seek to enhance their prestige and to attract other customers. The year I worked in Congress, Washington was attacked by lobbyists seeking to gain advantage in the national system of allocating donated organs. As much as these highly paid armies spoke of fairness, better outcomes, more equitable distribution, and the like; all of us staffers knew they were just fighting over the money. It was a cynical business. Continue reading “Harvesting Organs From the Poor. The American Way.”

I Love My Socialized Medicine.

I am less happy with private-sector managed confusion.

As I may have mentioned in these pages before, I am the beneficiary of socialized medicine in America. Yes, your tax dollars, supplemented by my lifetime of Medicare premiums (already spent on someone else) have been paying for my health care for the past year. Fortunately for you, I am in pretty good shape at the present time. Even better for me, the Supplemental Premiums paid into the kitty by my fellow United Healthcare Seniors are now paying my monthly gym fee through the Silver Sneakers program. That’s $30 or more a month I can spend on gin. I for one am in love with government-run socialized medicine.

Regular Medicare was easy for me. Uncle Sam signed me up automatically for the classic plan. It’s the private sector part of Medicare that is giving me fits. Picking a private Medicare supplement to cover copays and deductibles was relatively easy because UofL (my former employer) partially subsidizes only a single program for its retirees, and because of their feud with Humana, does not provide any support for Medicare Managed Care that might provide drug coverage. The University had earlier abandoned their promise to retirees that they would contribute to drug insurance coverage. (Ironic for an institution that aspires to be a drug company itself– or perhaps very smart.) We are on our own for drugs. Continue reading “I Love My Socialized Medicine.”

Second Organizational Meeting of the UMC Ad Hoc Hospital Review Committee.

Not the promising start I had hoped for. Secrecy and control still in abundant evidence.

The Ad Hoc Operations Review Committee of University Medical Center, Inc. (UMC) met yesterday, March 12, 2012, for the second time. [Read about the history of this committee here, here, and here.]  I counted six of the 10 members present, three of whom were outside Committee members. There had been some “briefing” beforehand that I suspect will not show up in the minutes of the meeting. (TC #1) [Minutes of last meeting here.]

A new potential partner!

Perhaps the most interesting piece of news was that the healthcare strategy firm that had been updating the 2008 report of UMC’s financial future just notified the hospital that they had been hired to represent another hospital system that intended to respond to UMC’s request for proposal (RFP) for a new system-wide partner! (I had suspected as much from the content of some of the questions proposed in writing following the Pre-Proposal Conference.) The potential responder (not KentuckyOne Health) appears to be serious, although the opportunity to gather business intelligence as a motive cannot be dismissed by me at this point. Continue reading “Second Organizational Meeting of the UMC Ad Hoc Hospital Review Committee.”

Review of UofL Hospital by Kentucky Auditor of State Accounts.

An Open Letter to State Auditor Adam Edelen.

Re: An appeal to make broad your audit of UofL Hospital.

Dear Mr. Edelen,

Although it is like pulling teeth, small amounts of information about the financing of the University of Louisville and its University Hospital are slowly becoming public. The public is aware that your office is looking at the University’s handling of its QCCT funding for indigent care in its hospital. I am writing to try to convince your office that examination of QCCT funding alone is insufficient and that to fully judge whether the state and local components of that fund are truly being used to the best advantage of the public, other aspects of University accounts must also be examined.

For example, in last week’s release of information in response to questions submitted by potential responders to the University’s RFP for a new partner, the amounts of transfers from University Hospital funds to the University were outlined to the tune of $74 million of the $430 million of hospital clinical revenues. More than 17% of hospital revenues go directly to the University! Some of this is Medicare money designated to pay the salaries of Residents, but under its ongoing veil of secrecy the University does not detail where its money came from, nor how it is spent.

Given that the University has a long history of pooling its state money and using it as it sees fit, and in the wake of the Passport and other scandals, the public is entitled to a fully justified explanation. How else can we know whether the $34.4 million of current QCCT funding is too much, too little, or just right. A dollar of money drawn from the QCCT means another dollar that might legitimately be used to support indigent care can be spent elsewhere. Indeed, I believe the whole concept of the QCCT fund needs to be revisited. Why, for example, should not state indigent dollars follow the indigent, no matter where that service is provided? Why shackle the indigent to a place they may not care to go? Does the current QCCT reimbursement formula lead to artificially higher charges to all patients at the hospital? Does having a captive patient population blunt faculty motivation to make University Hospital the most desirable and highest quality hospital in town? To make such determinations, the public needs a full audit of the University of Louisville, its Foundations and Hospital. Continue reading “Review of UofL Hospital by Kentucky Auditor of State Accounts.”