I perused the news for the last week or so and found a number of issues that could impact the elections.
Rev. Ted Haggard resigned as the head of the National Association of Evangelicals. Ted reportedly purchased gay sex and used methamphetamine under the pseudonym of “Art”. An e-mail to Ted’s home congregants indicated “some of the accusations against him are true”. Rev. Haggard is a 50 year married father of 5, who had direct connections to the White House on issues like same sex marriage, which Ted vehemently opposes. How will their 30 million members respond? Will they sit at home shaking their heads about leaders claiming the moral high ground but behind the scenes doing a little ditch digging? This question conveniently leads us to our next development.
The House Ethics panel’s only case will conclude after elections. It involves none of the numerous elected officials charged with crimes but the study of who knew what and when in the case of Rep. Mark Foley’s pursuit of young male pages. Absent from investigation since the last election were Tom Delay, Bob Ney, Duke Cunningham, William Jefferson, Curt Weldon, and Dennis Hastert. I would add Bill Thomas to the list for his donations from for profit healthcare companies followed by hearings on their behalf. Almost 1/3 of Americans believe their own congressperson is corrupt.
Pennsylvania Rep. Don Sherwood combines payola with sexual impropriety. The incumbent reportedly settled a civil lawsuit with his outside love interest for $500,000. The agreement purportedly required silence until after Election Day. Sherwood admitted having the affair but denies abusing her in the incident that resulted in a 911 call. Sherwood is a 65 year old married father of three and considered a conservative family values Republican candidate.
If politicians are going to buy off their illicit love interests, they need money. Exxon Corporation reported near record quarterly earnings of $10.5 billion. While gas price drops for the quarter paralleled the President’s approval ratings the last two years, Exxon still had a stellar financial performance. While Bush remains hands off on the price of energy, he likes price controls in healthcare as Medicare fixes prices for cardiac pacemakers and portability devices.
Speaking of Medicare, how many Part D patients are currently floating in the donut hole, where they continue to pay both the full cost of drugs and the prescription drug insurance premium? How many “dual eligibles” are livid over his comments just a week or so ago about seniors not having to choose between food, drugs and rent? From my view President Bush has done nothing, zero, zippo on the issue since identifying it as a problem in his February speech in Dublin, Ohio.
A tsunami is forming, the question remains as to its size. Will it wash enough Republicans out of office? The bad news is the Democrats it will deposit on the steps of the Capital are mostly Republican Lite. In their effort to get elected, they’ve mostly become the mirror image of those they wish to unseat. Ask Tom Daschle about imitation. He looks awfully Republican with his high dollar lobbying job with Alston & Bird and his seat on an investment house board. So what if it’s not The Carlyle Group?
Isn’t that what the competition is all about, who can send the book of federal business to their friends? Neither appears to want to serve the people…
Friday, November 03, 2006
Thursday, November 02, 2006
Shannon Triad Merger Deal Off
Just three days after Triad CEO Denny Shelton bragged to the investment community about the San Angelo deal, the Shannon Health System Board pulled the plug on the two week old intent to merge creating one for-profit hospital in town. The Standard Times has a report on why.
While relieved that the Shannon mission remains intact, I hoped the merger process would go a bit longer, giving the community time and space to discuss the issues. Health care is very difficult under the Bush health care agenda thus driving such combinations. Citizens in San Angelo could have become more aware of the challenges institutions face and this case could help educate Texans and the greater country.
We will miss that chance, but Mr. Shelton has the opportunity to conduct an even larger stock repurchase with the Shannon deal going down.
While relieved that the Shannon mission remains intact, I hoped the merger process would go a bit longer, giving the community time and space to discuss the issues. Health care is very difficult under the Bush health care agenda thus driving such combinations. Citizens in San Angelo could have become more aware of the challenges institutions face and this case could help educate Texans and the greater country.
We will miss that chance, but Mr. Shelton has the opportunity to conduct an even larger stock repurchase with the Shannon deal going down.
Healthcare Prices: Over Seas Health Care & Our Local Hospital Merger
Businesses are exploring sending employees overseas for health care procedures to save money. A fraction, 500,000 of the almost 47 million uninsured, went overseas for treatment. That equates to just over 1% of the uninsured who have the resources to afford travel costs, time off from work and cost of treatment (unless they are going to a country that has a national health system).
The promotion of overseas care to save money strikes me as odd, especially given America’s ban on imported medicines from our neighbors to the north or south due to quality control reasons. If international competition is a viable strategy to reduce medical costs one might think drugs would be included.
The President’s health care plans rely on competition. Health insurers will compete with each other on price and service (the model for Medicare Prescription Drug program). Hospitals and doctors will compete with one another on price as individuals shop around for health care. Under the Bush health care strategy, the nearly 3 million people covered by high deductible health plans will flip behavior in a market of 300 million people. Only 1.2 million have funded health savings accounts with which to pay tax deductible money on those negotiated prices. When was the last time 1% or less of a market flipped prices?
Just yesterday I listened to Triad Hospitals earnings conference call and then perused some of their prior investor presentations. One slide showed hospital prices to be inelastic which means they don’t vary with demand. The company can raise prices with little impact on volume. Triad’s revenue rose 6% the last quarter from price increases alone.
Their strategy is to gain sufficient presence in a market to get better contract pricing from payers. My hometown of San Angelo, Texas is ground zero for this strategy. Just two weeks ago our longtime nonprofit community hospital system, anchored by Shannon Medical Center, announced it would sell out by joining with the local Triad facility in a new for profit joint venture. In the investors Q & A CEO Denny Shelton called the merger “an incredible opportunity on a significant consolidation play in that market”. He stressed “Together we can make it; apart we might be killing each other.” The corporate chief announced that such consolidation gives the company greater leverage in negotiating contracts with insurers.
Our community has 28% of the population without health insurance. Triad made it clear in their conference call with analysts their plans to control bad debts by managing self pay patient accounts better. One strategy is to educate physicians on elective and non emergency care for the uninsured. They plan to implement a credit scoring system to identify patients who can afford to pay. From the conference call it is clear Triad has a plan to manage self pay patients and their corresponding bad debts.
Taking the national figures to our local level of 28,000 uninsured, some 280 might already travel overseas for care. This leaves 27,720 people needing care domestically. Triad will provide emergency care regardless of insurance status for legal reasons. They also recognize their responsibility to do a bit more than the minimum when their facility is the only one in a community. However, they likely will not provide the amount of free care Shannon has historically given, especially as they embark on their bad debt management plans.
So what do the 27,720 people do for care? Will the Antitrust division of the Justice Department look at this issue? What will the Texas Department of Health do in their review? How will the county judge approach changing the will of J.M. and Margaret Shannon, the benefactors who established Shannon Medical Center via their final wishes that those without resources have a place to be treated?
The Triad CEO stated some nonprofit hospitals approached his company as foundation resources supporting the institution had been depleted. Was he referring to the Shannon Trust? Is that why the Trust is doing the deal, to get a $46 million influx of cash? How will they put that money to work fulfilling the Shannon's final wishes? Will the Shannon Trust begin paying for those same folks to travel overseas for care? Will they take the $46 million from Triad and purchase a hospital in Thailand or India to serve the poor in San Angelo? The times they are a changing...
The promotion of overseas care to save money strikes me as odd, especially given America’s ban on imported medicines from our neighbors to the north or south due to quality control reasons. If international competition is a viable strategy to reduce medical costs one might think drugs would be included.
The President’s health care plans rely on competition. Health insurers will compete with each other on price and service (the model for Medicare Prescription Drug program). Hospitals and doctors will compete with one another on price as individuals shop around for health care. Under the Bush health care strategy, the nearly 3 million people covered by high deductible health plans will flip behavior in a market of 300 million people. Only 1.2 million have funded health savings accounts with which to pay tax deductible money on those negotiated prices. When was the last time 1% or less of a market flipped prices?
Just yesterday I listened to Triad Hospitals earnings conference call and then perused some of their prior investor presentations. One slide showed hospital prices to be inelastic which means they don’t vary with demand. The company can raise prices with little impact on volume. Triad’s revenue rose 6% the last quarter from price increases alone.
Their strategy is to gain sufficient presence in a market to get better contract pricing from payers. My hometown of San Angelo, Texas is ground zero for this strategy. Just two weeks ago our longtime nonprofit community hospital system, anchored by Shannon Medical Center, announced it would sell out by joining with the local Triad facility in a new for profit joint venture. In the investors Q & A CEO Denny Shelton called the merger “an incredible opportunity on a significant consolidation play in that market”. He stressed “Together we can make it; apart we might be killing each other.” The corporate chief announced that such consolidation gives the company greater leverage in negotiating contracts with insurers.
Our community has 28% of the population without health insurance. Triad made it clear in their conference call with analysts their plans to control bad debts by managing self pay patient accounts better. One strategy is to educate physicians on elective and non emergency care for the uninsured. They plan to implement a credit scoring system to identify patients who can afford to pay. From the conference call it is clear Triad has a plan to manage self pay patients and their corresponding bad debts.
Taking the national figures to our local level of 28,000 uninsured, some 280 might already travel overseas for care. This leaves 27,720 people needing care domestically. Triad will provide emergency care regardless of insurance status for legal reasons. They also recognize their responsibility to do a bit more than the minimum when their facility is the only one in a community. However, they likely will not provide the amount of free care Shannon has historically given, especially as they embark on their bad debt management plans.
So what do the 27,720 people do for care? Will the Antitrust division of the Justice Department look at this issue? What will the Texas Department of Health do in their review? How will the county judge approach changing the will of J.M. and Margaret Shannon, the benefactors who established Shannon Medical Center via their final wishes that those without resources have a place to be treated?
The Triad CEO stated some nonprofit hospitals approached his company as foundation resources supporting the institution had been depleted. Was he referring to the Shannon Trust? Is that why the Trust is doing the deal, to get a $46 million influx of cash? How will they put that money to work fulfilling the Shannon's final wishes? Will the Shannon Trust begin paying for those same folks to travel overseas for care? Will they take the $46 million from Triad and purchase a hospital in Thailand or India to serve the poor in San Angelo? The times they are a changing...
San Angelo’s Hospital Merger Mania
Dear Justice Department Representative,
Last week, Shannon Health System and Triad Hospitals announced the merger of our only two hospitals, the result being San Angelo will no longer have a nonprofit community hospital. My article in the newspaper sums up my concerns.
Misguided Merger: Shannon Transformation Won’t Benefit City
Several issues not mentioned in the article include, whether the new privately held company will employ Quorum Health Resources, a division of Triad, for management services. Should this be the case, the merged entity will not only take on $2 million in new local taxes, it will be burdened with a management fee as well. This will provide Triad with another contract layer, further increasing profits. Recall the layers of contractors post Hurricane Katrina, each with their profit objective. This more than wiped out any savings from quick approval of no bid contracts.
If any easy $2 million in savings could be quickly accomplished, the experienced management team at Shannon (many are ex-HCA/Triad employees) would have already snatched them. Triad will cut staff and possibly programs/services to achieve their profit goals.
My second concern requires a group such as yours to investigate. How will previous volunteer community board members be treated in the new private for-profit company? Gifts of stocks to key board members have been common in past mergers/acquisitions. Are any Shannon Medical Center board members benefiting financially from the turning over of a community asset to a for-profit corporation?
Will any public meetings be held on the merger by the Justice Department or FTC? I understand case history shows most mergers are readily approved, however San Angelo's health care marketplace could be dramatically changed to the detriment by this merger for our community's 28% uninsured. Your organization even referenced this in Chapter 4 Competition Law: Hospitals of a 2004 Report, Improving Healthcare: A Dose of Competition.
Nonprofit hospitals may have different long-term missions and have a different level of public accountability because of their long-term community obligations.175 There is some empirical evidence that institutional status affects the mix of services provided by a hospital.
For that reason it warrants scrutiny, open dialogue, and honest accounting for how care for those needing medical services from a safety net facility will change. I would like to trust the Justice Department to help provide such an environment, but have been concerned by the federal bias (at least Congressional) towards for-profit healthcare companies.
Please write me back with answers to my questions. Sincerely,
State of the Division
It turns out I didn't have to hold my breath for more than a day as the Justice Department replied to my e-mail. It is below:
Dear Mr. State:
Thank you for contacting the Antitrust Division of the U.S. Department of Justice. The function of the Citizen Complaint Center is to receive, review and file complaints and/or concerns from citizens. We are prohibited from providing legal advice or answering questions about the legality of certain situations so unfortunately we are unable to answer your questions. However, we have forwarded your concern to the appropriate legal staff for further review and should they need additional information, they may contact you in the future. We appreciate your interest in the enforcement of federal antitrust laws.
Sincerely,
Citizen Complaint Center
Antitrust Division
Department of Justice.
Last week, Shannon Health System and Triad Hospitals announced the merger of our only two hospitals, the result being San Angelo will no longer have a nonprofit community hospital. My article in the newspaper sums up my concerns.
Misguided Merger: Shannon Transformation Won’t Benefit City
Several issues not mentioned in the article include, whether the new privately held company will employ Quorum Health Resources, a division of Triad, for management services. Should this be the case, the merged entity will not only take on $2 million in new local taxes, it will be burdened with a management fee as well. This will provide Triad with another contract layer, further increasing profits. Recall the layers of contractors post Hurricane Katrina, each with their profit objective. This more than wiped out any savings from quick approval of no bid contracts.
If any easy $2 million in savings could be quickly accomplished, the experienced management team at Shannon (many are ex-HCA/Triad employees) would have already snatched them. Triad will cut staff and possibly programs/services to achieve their profit goals.
My second concern requires a group such as yours to investigate. How will previous volunteer community board members be treated in the new private for-profit company? Gifts of stocks to key board members have been common in past mergers/acquisitions. Are any Shannon Medical Center board members benefiting financially from the turning over of a community asset to a for-profit corporation?
Will any public meetings be held on the merger by the Justice Department or FTC? I understand case history shows most mergers are readily approved, however San Angelo's health care marketplace could be dramatically changed to the detriment by this merger for our community's 28% uninsured. Your organization even referenced this in Chapter 4 Competition Law: Hospitals of a 2004 Report, Improving Healthcare: A Dose of Competition.
Nonprofit hospitals may have different long-term missions and have a different level of public accountability because of their long-term community obligations.175 There is some empirical evidence that institutional status affects the mix of services provided by a hospital.
For that reason it warrants scrutiny, open dialogue, and honest accounting for how care for those needing medical services from a safety net facility will change. I would like to trust the Justice Department to help provide such an environment, but have been concerned by the federal bias (at least Congressional) towards for-profit healthcare companies.
Please write me back with answers to my questions. Sincerely,
State of the Division
It turns out I didn't have to hold my breath for more than a day as the Justice Department replied to my e-mail. It is below:
Dear Mr. State:
Thank you for contacting the Antitrust Division of the U.S. Department of Justice. The function of the Citizen Complaint Center is to receive, review and file complaints and/or concerns from citizens. We are prohibited from providing legal advice or answering questions about the legality of certain situations so unfortunately we are unable to answer your questions. However, we have forwarded your concern to the appropriate legal staff for further review and should they need additional information, they may contact you in the future. We appreciate your interest in the enforcement of federal antitrust laws.
Sincerely,
Citizen Complaint Center
Antitrust Division
Department of Justice.
Great Tamperer Warns on Nicaragua
Oliver North of “arms for hostages” fame is warning about U.S. policy in Nicaragua given the democracy’s impending elections. In his October 6th column he wrote “official U.S. policy in Nicaragua has been blind to the realities of Nicaraguan politics.” Ollie cited the U.S. ambassador’s pressuring private sector leaders with potential reprisals for supporting the wrong candidate in the four way race.
Pre-election the State Department just issued a public announcement warning Americans not to travel to Nicaragua because of the prospect for “violent demonstrations” and “sporadic acts of violence”. Ollie and his entourage just visited the country and saw no reason for such a declaration.
Recall Sec. of Defense Donald Rumsfeld has visited the country twice in the last two years? In 2004 he met with military leaders and stressed the threat of a Sandanista resurgence. Donald failed to mention this takeover would come from democratic elections.
He returned in October 2006 for a meeting of defense ministers. Did Rumsfeld prime the pump for a Thai like military coup should Daniel Ortega win the Presidency? Stay tuned as the latest generation of tamperers extends it tentacles in Central America…
Pre-election the State Department just issued a public announcement warning Americans not to travel to Nicaragua because of the prospect for “violent demonstrations” and “sporadic acts of violence”. Ollie and his entourage just visited the country and saw no reason for such a declaration.
Recall Sec. of Defense Donald Rumsfeld has visited the country twice in the last two years? In 2004 he met with military leaders and stressed the threat of a Sandanista resurgence. Donald failed to mention this takeover would come from democratic elections.
He returned in October 2006 for a meeting of defense ministers. Did Rumsfeld prime the pump for a Thai like military coup should Daniel Ortega win the Presidency? Stay tuned as the latest generation of tamperers extends it tentacles in Central America…
Bravo to Retired Judges Challenging Military Commissions Act
Seven retired judges from both sides of the aisle filed papers with the U.S. Court of Appeals urging parts of the just signed Military Commissions Act to be declared unconstitutional.
The judges said stripping courts of the right to question how the military handles terrorism suspects "challenges the integrity of our judicial system" and effectively sanctions the use of torture.
Bingo! Anyone who has read the act can easily find disturbing language that opens a Hummer sized hole for both permanent detentions without trial and the use of torture. Thank heaven a few courageous leaders stepped in from the sidelines. It's time for more to come forward.
The Justice Department had no comment and has until November 13th to respond. My history with Justice Department response has been less than satisfactory. They completely blew off my concern about the White House leaving out the New Orleans hospital with the highest patient death toll post Hurricane Katrina. I’m sure The Carlyle Group’s lawyers appreciate the free pass given to their affiliate, LifeCare Hospitals in the President’s Lessons Learned report.
Justice’s Antitrust Division gets a second chance to respond as I contacted them with my concerns about our two local hospitals merging to form a new for-profit entity. The Bush healthcare “blanket party” is causing our long time nonprofit safety net hospital to throw in the towel. Will Justice do any better the second time around? Should I hold my breath the normal way or self waterboard?
The judges said stripping courts of the right to question how the military handles terrorism suspects "challenges the integrity of our judicial system" and effectively sanctions the use of torture.
Bingo! Anyone who has read the act can easily find disturbing language that opens a Hummer sized hole for both permanent detentions without trial and the use of torture. Thank heaven a few courageous leaders stepped in from the sidelines. It's time for more to come forward.
The Justice Department had no comment and has until November 13th to respond. My history with Justice Department response has been less than satisfactory. They completely blew off my concern about the White House leaving out the New Orleans hospital with the highest patient death toll post Hurricane Katrina. I’m sure The Carlyle Group’s lawyers appreciate the free pass given to their affiliate, LifeCare Hospitals in the President’s Lessons Learned report.
Justice’s Antitrust Division gets a second chance to respond as I contacted them with my concerns about our two local hospitals merging to form a new for-profit entity. The Bush healthcare “blanket party” is causing our long time nonprofit safety net hospital to throw in the towel. Will Justice do any better the second time around? Should I hold my breath the normal way or self waterboard?
Wednesday, November 01, 2006
BumbleMort’s Return!
Dear President Bush,
We corresponded last summer on the rash of apologies demanded by politicians in Washington, D.C. for offensive statements said by rivals. After probing my contacts, I found out Harry Potter cast an Apologus Demandus spell over the Capital. The only way to break the spell was to have the evil BumbleMort cast a sincere apology for his nefarious words. Despite your mobilizing the significant intelligence assets of the U.S. government, Bumblemort’s identity remains a secret. At one point evidence pointed to Rep. Tom Tancredo who suggested nuking Mecca, but that theory failed and the key to resolving the spell remains a secret.
It appears the spell has grown in strength as it spread from the Capital to the White House. Your press minion, Tony Snow asserted that Senator John Kerry should apologize for “insulting the troops”. Having read Mr. Kerry’s words, I believe he insulted you and your advisors as opposed to the troops. He also commented on job opportunities available to people with only a high school degree.
My question to you is “do you think Senator Kerry is Bumblemort?” If he gives a sincere apology will the spell be broken? Or do you think Tony Snow is the secret sinister figure? After all he suggested Kerry “put gasoline on the fire” of an already sizzling election. That analogy right after 4 firefighters died in Southern California is pure Bumblemort, sinister and slippery.
Watching the negative campaign commercials, I realize many candidates qualify for “he who shall not be named”. Yet there is so little time to identify the evildoer and enact a sincere apology. Good thing you changed our interrogation techniques as the old ones likely wouldn’t work on the embodiment of evil. Will you waterboard Bumblemort into a contrite position? Or will you microwave him into that sincere apology?
If he doesn’t survive the torture, ooopps, I mean tough interrogation techniques then the world may be destined to an endless stream of politically offensive statements followed by demands for an apology. So have your minions be careful with prospective Bumblemorts!
P.S. My money is on Dick Cheney as “he who shall not be named”. What do you think?
We corresponded last summer on the rash of apologies demanded by politicians in Washington, D.C. for offensive statements said by rivals. After probing my contacts, I found out Harry Potter cast an Apologus Demandus spell over the Capital. The only way to break the spell was to have the evil BumbleMort cast a sincere apology for his nefarious words. Despite your mobilizing the significant intelligence assets of the U.S. government, Bumblemort’s identity remains a secret. At one point evidence pointed to Rep. Tom Tancredo who suggested nuking Mecca, but that theory failed and the key to resolving the spell remains a secret.
It appears the spell has grown in strength as it spread from the Capital to the White House. Your press minion, Tony Snow asserted that Senator John Kerry should apologize for “insulting the troops”. Having read Mr. Kerry’s words, I believe he insulted you and your advisors as opposed to the troops. He also commented on job opportunities available to people with only a high school degree.
My question to you is “do you think Senator Kerry is Bumblemort?” If he gives a sincere apology will the spell be broken? Or do you think Tony Snow is the secret sinister figure? After all he suggested Kerry “put gasoline on the fire” of an already sizzling election. That analogy right after 4 firefighters died in Southern California is pure Bumblemort, sinister and slippery.
Watching the negative campaign commercials, I realize many candidates qualify for “he who shall not be named”. Yet there is so little time to identify the evildoer and enact a sincere apology. Good thing you changed our interrogation techniques as the old ones likely wouldn’t work on the embodiment of evil. Will you waterboard Bumblemort into a contrite position? Or will you microwave him into that sincere apology?
If he doesn’t survive the torture, ooopps, I mean tough interrogation techniques then the world may be destined to an endless stream of politically offensive statements followed by demands for an apology. So have your minions be careful with prospective Bumblemorts!
P.S. My money is on Dick Cheney as “he who shall not be named”. What do you think?
Subscribe to:
Posts (Atom)