Politics: Onward from New Hampshire

[Replaced_Texan]

Originally posted by ltl/fb
Not Me may be confused and be thinking that physicians are employees of hospitals (or, who knows, maybe they are where s/he lives?) and it falls under the rules about providing meals when someone is required to be on-site etc. This may be true for interns and residents. I am totally unfamilar with Stark and how it might apply to employees.

It seems to me that physicians (who have completed their formal training programs) are generally not employees of hospitals except maybe as administrators, but my perception may be based on geographic locale/experience. I am pretty sure this is the case in TX and CA.

Yeah, she could be in a corporate practice state. Like most Texans, I'm suspicious of the corporate practice of medicine, though it is increasingly more common. The hospital chains and espeically the ones with an HMO product love it, though, since they can control a hell of a lot more of what goes on in their hospitals. California medical staff is even entitled to separate legal counsel. The TMA would probably storm the capitol if anyone tried to fuck around with Flynn Brothers.

[Not Me]

Originally posted by Replaced_Texan
Really? There's a $300 limit per year under Stark for de-minimus gifts at 42 C.F.R. section 411.357 (k), but I'll be damned if I can find a de-minimus exception in the anti-kickback law.

So are you saying that a $5 cafeteria lunch meets the definition of a kick-back? If so, every hospital in the US is guilty of these kick-backs. I don't know of any hospitals that don't have doctor's lounges in which they provide free food for the doctors except for maybe county hospitals on tight government funded budgets. It is a common practice for hospitals to do this. If you have any friends who are doctors, ask them.

And I don't think it qualifies as a kickback unless there is some sort of quid pro quo. Perhaps I am wrong and if you give someone something for free and ask for and expect nothing back, that is a kickback.

Originally posted by Replaced_Texan
It's not clear by your posts whether you read public health literature, so I guess we're even.

What specifically in my posts makes you think I don't read public health literature?

Originally posted by Replaced_Texan
I've been watching medical savings accounts since they were introduced (in a very limited way) in HIPAA. I know a few people who've taken advantage of them, and they get mixed reviews. One couple I know ended up swapping out the MSA for a high-deductible insurance policy through a professional organization. The problem was that ultimately, the consumer ended up paying astronomically high premiums for individual insurance, probably because the insurance pool was so small. I agree that they're promising, but the law needs to be expanded beyond self-employed individuals to see how well they will end up working.

The problem is indeed that they have been limited to self-employed individuals. There were a few employer-based plans that used the MSA approach and were studied by economists and had good results.

The main difficulty in MSAs is structuring the incentives properly and if it is an employer-based plan, all the EEOC regulations. Sometimes it is not clear cut what is discretionary healthcare spending and what is not and if it is considered discretionary and the employee has to pay more for this, would the EEOC find some sort of discrimination is occuring.

[bilmore]

Originally posted by Replaced_Texan
Like most Texans, I'm suspicious of the corporate practice of medicine, though it is increasingly more common.

Knowing next to nothing about this subject, I have to ask - why? I would think that a corporate practice would be a fairly cost-effective way to administer lots of care. Not so?

[Not Me]

Originally posted by ltl/fb
Not Me may be confused and be thinking that physicians are employees of hospitals (or, who knows, maybe they are where s/he lives?) and it falls under the rules about providing meals when someone is required to be on-site etc.

No I am not under that impression. However, you and the other one who are discussing this with me must not know any doctors IRL. This is a common practice that occurs in every hospital I am aware of except for county hospitals.

If you all are saying this violates the law, then someone needs to alert the OIG or whoever would investigate this because it is a widespread practice to provide free food to doctors in doctor's lounges in hospitals.

[Not Me]

Originally posted by bilmore
Knowing next to nothing about this subject, I have to ask - why? I would think that a corporate practice would be a fairly cost-effective way to administer lots of care. Not so?

A typical corporate practice of medicine organization is a closed panel HMO. Need I say more?

If I do need to say more, then what is bad about this is the risk of the doctor's fiduciary duty to the patient being compromised by the corporate bottom line. Perhaps you can argue that when doctors are self-employed this same potential exists. However, I think in practice that when doctors are employees of corporations and their salaries and promotions are determined by a corporation, the risk is greater that the doctor will compromise their fiduciary duty to the patient to promote the goals of the corporation.

[Bad_Rich_Chic]

Originally posted by bilmore
Christian Science Monitor thinks Hizbullah will be our next big anti-terrorism target.

http://www.csmonitor.com/2003/0425/p02s01-usgn.html

I disagree, perhaps only because of hindsight with a year of further developments, though I think Iran itself is not unlikely to crack down as part of the considerably warmer cooperative relationship with the US they've developed of late. Giving the US cover while it achieves majority (i.e.: Shia) rule in Iraq will deliver to Iran much more geopolitical power and cred than backing bombers and charities in the OT ever will, and if the US wants some crackdowns on Iran's pet terrorists in exchange for not frustrating Iranian influence over a democratically reconstituted Iraq, I would wager the mullahs would oblige and consider it a good deal.

[bilmore]

Originally posted by Not Me
A typical corporate practice of medicine organization is a closed panel HMO. Need I say more?

If I do need to say more, then what is bad about this is the risk of the doctor's fiduciary duty to the patient being compromised by the corporate bottom line. Perhaps you can argue that when doctors are self-employed this same potential exists. However, I think in practice that when doctors are employees of corporations and their salaries and promotions are determined by a corporation, the risk is greater that the doctor will compromise their fiduciary duty to the patient to promote the goals of the corporation.

Isn't this argument just as valid regarding large law firms?

[Not Me]

Originally posted by bilmore
Isn't this argument just as valid regarding large law firms?

Yes. And haven't all of us in fact seen that happen in large firms? And as bad as that is for lawyers to do, isn't it worse when a doctor does it? Maybe not if we are just talking about treating something minor, but the minor stuff is usually cheaper to treat and it seems less likely for that sort of stuff to happen when the cost of care is cheaper. But when a doctor doesn't do a proper work-up to save some HMO money and a cancer diagnosis is delayed, that seems worse to me than some lawyers overbilling a corporation.

[bilmore]

A Clinton advisor is saying that Clarke shot down chances to get at OBL? (I add the ? because it's NewsMax. I don't know about NewsMax.)

"Monday, March 22, 2004 10:24 p.m. EST
Ijaz: Clarke Blocked bin Laden Extradition

Clinton administration diplomatic troubleshooter Mansoor Ijaz charged Monday that one-time White House terrorism czar Richard Clarke blocked efforts to gather intelligence on al Qaeda and torpedoed a deal to have Osama bin Laden extradited from Afghanistan in the years before the 9/11 attacks.

"I was personally asked to brief Condoleezza Rice's deputy National Security Advisor Stephen Hadley on exactly what had gone wrong in the previous efforts to get bin Laden out of the Sudan, to get the terrorism data out of the Sudan, which I negotiated the offer for," Ijaz told Fox News Channel's "Fox & Friends."

He said he also personally negotiated an deal "to get bin Laden out of Afghanistan in the spring and summer of 2000, using at Abu Dhabi Royal Family as a proxy to get him out on an extradition offer."

But Ijaz told Fox:

"In each case of things that were involved in the Clinton administration, Richard Clarke himself stepped in and blocked the efforts that were being made over and over and over again."

The unofficial diplomat said that if Clarke hadn't put up roadblocks to obtaining Sudanese intelligence, the bombing of two U.S. embassies in East Africa in 1998 might have been prevented.

He called Clarke's account denying offers of Sudanese cooperation "absolutely disingenuous; it comes very close to flat-out lying."

After months of denials from his former aides, ex-President Clinton finally admitted that he personally turned down the offer by Sudan to arrest bin Laden.

"We'd been hearing that the Sudanese wanted America to start dealing with them again," Clinton told a New York business group in February 2002.

"They released him. At the time, 1996, he had committed no crime against America so I did not bring him here because we had no basis on which to hold him, though we knew he wanted to commit crimes against America.

"So I pleaded with the Saudis to take him, 'cause they could have. But they thought it was a hot potato and they didn't and that's how he wound up in Afghanistan."

In his book, "Against All Enemies," Clarke called reports that Clinton had turned down the Sudanese offer "a fable.""

[Replaced_Texan]

Originally posted by Not Me
So are you saying that a $5 cafeteria lunch meets the definition of a kick-back? If so, every hospital in the US is guilty of these kick-backs. I don't know of any hospitals that don't have doctor's lounges in which they provide free food for the doctors except for maybe county hospitals on tight government funded budgets. It is a common practice for hospitals to do this. If you have any friends who are doctors, ask them.

Depends on the hospital. I went back and checked again, because it was bothering me, and the stark exception is more likely to be in 42 C.F.R. section 411.357 (m) (medical staff incentives). There are a lot of hospitals in the Texas Medical Center that only provide meals to residents and medical staff members with Medical Director appointments.

What specifically in my posts makes you think I don't read public health literature?

Your comments regarding education and lifestyle as not being part of health care. Public health, in part, is about developing programs to assist people in changing lifestyle. From simple things like washing hands and brushing teeth, to more complex nutrition education.

The problem is indeed that they have been limited to self-employed individuals. There were a few employer-based plans that used the MSA approach and were studied by economists and had good results.

The main difficulty in MSAs is structuring the incentives properly and if it is an employer-based plan, all the EEOC regulations. Sometimes it is not clear cut what is discretionary healthcare spending and what is not and if it is considered discretionary and the employee has to pay more for this, would the EEOC find some sort of discrimination is occuring.

I agree, and I think that MSAs could be promising. I think, though, that there need to be some minimum, perhaps rationed, safety nets put in place outside of the MSA that would help in the event that there is not enough in the MSA to cover an otherwise treatable disease or condition.

[Atticus Grinch]

Ah, memories. The labels you've been mentioning got traded back and forth among a small group of regional brewers that eventually morphed into enormous holding companies that drove many of the labels into the ground. Some, like Falstaff, used to be top-sellers and continue to have regional good will. Those that survive are licensed to local brewers for continued production and aren't owned by their founders, except for Yuengling. (Almost all of them were at one point owned by the same holding company that bought Pabst in the mid-'80s.)

Check this site for a reliable history of brand consolidation and demise.

Is Lowenbrau now made by the same people who brew it in Europe? Over there, it's not a shitty beer, but Miller got the license and made it famously badly for a while. I'd like to have the street cred of ordering something that sounds like cheap American shit, but I don't want the bad drinking experience of actually drinking a shitty beer. If Lowenbrau is now imported, it sounds like the perfect candidate.

[Replaced_Texan]

Originally posted by bilmore
Isn't this argument just as valid regarding large law firms?

Yes, and that's why for the most part, non-lawyer-owned corporations are not allowed to own law firms or split fees with lawyers.

Physicians can own hospitals in corporate practice states, but hospitals that are not owned by physicians cannot directly employ or control physicians.

Edited because I put too many "non-lawyer" refrences in there

[bilmore]

Originally posted by Replaced_Texan
Yes, and that's why for the most part, non-lawyer-owned corporations are not allowed to own law firms or split fees with non-lawyers.

Physicians can own hospitals in corporate practice states, but hospitals that are not owned by physicians cannot directly employ or control physicians.

Cool. It helps to see this in a context I can understand.

[bilmore]

Originally posted by Atticus Grinch
Is Lowenbrau now made by the same people who brew it in Europe?

Only if Germany is importing gap-toothed Wisconsinites as brewmasters.

(I think it's still licensed for brewing here.)

[Hank Chinaski]

Originally posted by Atticus Grinch
Ah, memories. The labels you've been mentioning got traded back and forth among a small group of regional brewers that eventually morphed into enormous holding companies that drove many of the labels into the ground. Some, like Falstaff, used to be top-sellers and continue to have regional good will. Those that survive are licensed to local brewers for continued production and aren't owned by their founders, except for Yuengling. (Almost all of them were at one point owned by the same holding company that bought Pabst in the mid-'80s.)

Check this site for a reliable history of brand consolidation and demise.

Is Lowenbrau now made by the same people who brew it in Europe? Over there, it's not a shitty beer, but Miller got the license and made it famously badly for a while. I'd like to have the street cred of ordering something that sounds like cheap American shit, but I don't want the bad drinking experience of actually drinking a shitty beer. If Lowenbrau is now imported, it sounds like the perfect candidate.

Even when it was made here, you could get the import here also. Problem is, Miller/Lowenbrau was marketed as super-premiun, although it tasted like shit- Translation- no street cred. Poor people thought you uppity, rich people thought you ignorant.

I remember someone from Georgia coming back to school with something that was quite awful. How awful? I drank the first bottle, which I did not enjoy. When drinking the second bottle, I thought the taste was actually worse. Now the only saving grace of the truly cheap beer is that you can purchase sufficient quantity that there will be several where you are no longer bothered by the tast.

Yet, this second bottle did taste marginally worse. When I was finishing the bottle I noticed a cigarette butt had been dropped into my beer. That is, the beer was so bad that a butt only slightly lowered the taste, and did not clearly stand out as something wrong. I can't remember the name of it thought.