Walk Today in Memory of Amy Pettit

Today's CROP Walk begins at 2:00 pm at the Pavilion next to Kids' Kingdom Playground.  The walk raises money to alleviate hunger, locally and beyond.  For years Amy Pettit walked, but she did so with special purpose for CROP.

As a young mother in the Depression, Amy and her infant daughter Lois knew hunger.  Times were brutal.  Daily, Amy's husband Al looked in vain for work.  The generosity of a neighbor, a bootlegger, kept the family barely fed.

Work eventually came, but Amy and Al never forgot their trials.  They looked for people to help and organizations that did likewise.  CROP fit the bill.

CROP walking became a family affair with daughter Lois and granddaughter Kristin.  The three would frequently raise over $1,000 each in a friendly competition.

Lois will walk today, in memory of Amy, who passed on August 4, 2011 at the age of 96.  Lois raised over $6,000, with $5,000 of that coming from heaven.  Amy, the longtime walker and alleviator of hunger, will walk in spirit with her daughter.  There's no place Amy would rather be.

Health Insurance Absent from COSA Council Agenda

The San Angelo City Council agenda is out.  Employee and retiree health insurance is absent from the October 18 agenda.  City Manager Harold Dominguez and Councilman Kendall Hirschfeld highlighted promising bids in early September.  The "good news" remains untold.  I remain curious how far benefits will be cut to achieve the city's no new money criteria.

Tom Green County Indigent Health Expenditures

The Tom Green County Indigent Health Program finished the 2010-2011 fiscal year. While no year end report has been filed and shared at a County Commissioners' meeting, a mid-year report was available. Of nearly $2.1 million the county is required to set aside, it spent $128,000 over seven months.  Add in the $1 million used to leverage Upper Payment Limit funds and the total grows to $1.13 million. 

If the first seven month experience held, the County spent $220,000.  That would leave $780,000 to transfer into the general fund.  I'll update the numbers when the County releases actual year end figures.  (Click in the image above to make it larger).

TGC Indigent Health: History Rewrite

Texas County Progress has a teaser on Tom Green County's Indigent Care Program, specifically collaborative efforts that helped the county spend money more effectively.  It reported:

In the spring of 2002, Tom Green County staff helped organize a Health Access Subcommittee. The subcommittee met approximately once every six weeks to discuss local health care problems and find resolutions for those problems within the committee. The subcommittee consisted of the local chief executive officers and chief financial officers of the two local hospitals, the administrator to the federally qualified health center, the social services director, pharmacists, physicians, the Health Foundation chief executive officer, county commissioners, the county judge, and the director of indigent health care. Together, the subcommittee was able to remove barriers in communications between organizations and better coordinate benefits for indigent health care clients, in addition to understanding the educational and financial crises of the impoverished of our community. 

Unfortunately, time may have clouded the author's memory of events. San Angelo's Health Access Coalition was formed in 1999.  It had three subgroups, Access & Financing, Health Promotion and Data/Information.  The Access/Financing subgroup offered to help the county, which consistently overspent its budget the prior three years.

Community leaders, especially Shannon Medical Center's Vice President for Legacy Insurance, provided specific recommendations for stretching dollars further.  This included covering nurse practitioners (in addition to physician assistants), paying for outpatient surgery vs. one night surgical hospital stays, and paying FQHC services vs. expensive ER visits.  Leaders also recommended searching for other payor sources for patients who might be retired military or have access to other benefits.

The vision and goal for Tom Green County Indigent Health Care was to provide all eligible clients more primary care and specialist services, as well as additional optional health care services, while lowering Tom Green County expenditures.

My recollection of the vision and goal was to spend money more effectively so more people could be covered with the same resources.  The HAC hoped income eligibility would increase from "the poorest of the dirt poor."  Instead the program has become Tom Green County's cash cow, replenishing reserves on an annual basis.  As the facilitator and minute taker for all HAC subcommittees, I want to be on record with a more accurate version of history.

City Misses Health Insurance Milestone

The City of San Angelo planned to present health insurance bids to elected leaders in today's council meeting:

They missed their milestone.  Thus, the public remains unaware of the magic used to keep health insurance rates steady or lower when other employers face 25% premium increases.

How much will benefits fall to hold the premium line? It remains to be seen.

Cozy Oil Spew Commission Keeps Alaska Open

Two members of President Obama's Oil Spill Commission had ties to BP and ConocoPhillips.  William Reilly had a vested interest in Alaskan offshore drilling via his $2 million in ConocoPhillips stock and board of directors position, which resumed when his commission submitted its report.  Fran Ulmer's University of Alaska received $30 million in donations from BP and ConocoPhillips. 

BP and ConocoPhillips stand to profit from increased Alaska oil production.  Conoco benefits if their leases strike black gold, but both firms profit if Shell's efforts produce, given Shell plans to use the Trans Alaska Pipeline, an 800-mile (1,287-kilometer) pipeline ending at Valdez.  Line owners include BP, Exxon and ConocoPhillips.

While Alaska's Chukchi Sea is covered in ice from early December to mid May, Valdez remains an open water port.  William Reilly, Bush I's EPA Chief, oversaw the Exxon Valdez disaster in Prince William Sound.  What role might he play in an Arctic oil spew?  For one, Reilly reset the drilling deck.

Point Hope doubts the oil industry's ability to operate without spills.  The tiny village depends on the sea.  While their doubts are well founded, another narrative shows few David's in today's world of financial and energy Goliaths.  Goliath William Reilly represents both kinds.

Roots of Pay for Performance in Healthcare

Pay for performance is sold as the panacea, the balm for America's health care ills.  One root of the movement came in an "Open Letter in Health Affairs 2003":

We call on the administration and congressional leaders of both parties to act in a bipartisan spirit on health care quality and to join the campaign to rally our underperforming health care system by empowering Medicare to take the further necessary and decisive steps to make pay-for-performance a national strategy for better quality. We should settle for nothing less.

The first two signers were:

Donald M. Berwick
Institute for Healthcare Improvement, Boston, MA

Nancy-Ann DeParle (MedPAc)
J.P. Morgan Partners LLC, Washington, DC 

Dr. Berwick is the Interim Chief of the Centers for Medicare/Medicaid, while Ms. DeParle, a former CMS chief and private equity underwriter (PEU), served as President Obama's health czar, before her promotion to White House Deputy Chief of Staff.

Dr. Berwick called incentive pay a toxic daisy chain while at the Institute for Health Improvement.  Pay for performance kills intrinsic motivation, the internal desire to perform good work.  People focus on what it takes to get the prize.  That behavior is frequently unethical.  This leads us to another signee of the P4P letter:

Gail R. Wilensky (MedPAC)
Project HOPE, Bethesda,

Wilensky's 2003 ManorCare bio showed her on the board of Advanced Tissue Sciences, Inc.; Gentiva Health Services, Inc.; Quest Diagnostics Incorporated; Syncor International Corporation; and UnitedHealth Group.

UnitedHealth Group employed the most pure form of incentive compensation, executive stock options.  Wilensky sat on the Compliance and Government Affairs Committee of UnitedHealth's board.  SEC filings described the committee's responsibilities.

The Compliance and Government Affairs Committee is responsible for the development of guidelines and procedures for ethical and legal compliance; ensuring adequate guidance, reporting and investigation processes; monitoring compliance with Company guidelines and ethics policies; and monitoring and evaluating corporate governance.

Corporate governance set and implemented executive compensation, thus Wilensky's committee bore responsibility for ensuring stock option pay remain ethical and legal.  Wilensky, on the board since 1993, missed nearly a decade of stock option cheating by CEO William McGuire, MD.  Bloomberg reported:

McGuire is the most visible CEO to leave his job in the continuing probe into options-granting practices at U.S. companies.

At least 144 companies are conducting internal investigations or are subject to government probes on the matter. Executives at two companies, Brocade Communications Systems Inc. and Comverse Technology Inc., have been charged by federal authorities with securities fraud. At least 30 executives and directors have left their jobs, and hundreds of lawsuits have been filed.

A repricing of McGuire's options from 1994 through 2002 to the high closing price of each year, assuming he hasn't yet exercised any of the options, would deny him a profit of $155 million, according to a Bloomberg analysis. From 1994 through 2005, McGuire realized $333 million in option gains.

Wilensky may not have known about pay for performance's toxic effects in 2003, but she clearly knew in 2006. 

Other letter signers were the beneficiaries of clean executive stock option pay:

John W. Rowe

Aetna, Hartford, CT

Leonard D. Schaeffer

WellPoint Health Networks, Thousand Oaks, CA

Corporate influence permeates the letter:

William L. Roper
University of North Carolina, Chapel Hill, NC

Roper was on the board of Davita, Medco Health Solutions, Luminex Corporation and Quintiles Transnational Corp at the time.  Nancy-Ann DeParle, signer #2, served alongside Roper on the Davita board.  She also had board slots for  Guidant, Accredo Health, Cerner, Triad Hospitals, Medco, Boston Scientific and Specialty Labs.

Toxic corporate pay practices will not solve the ills of America's healthcare system. While it's interesting to know who set the stage for today's non-solutions and how they may profit, it's not the least bit comforting.

Update 11-14-11: Nancy Ann DeParle's board track record reveals a number of investigative settlements, with more potential fraud investigations on the way.  The quest for quality will be undermined by extrinsic motivation schemes.

Update 5-30-23:  HuffPo's "The Golden Age of White Collar Crime" stated:

32 percent of American managers said they were comfortable behaving unethically to meet financial targets.