I thought TAHCS had done providers in Texas a favor and closed its doors; no one I know has heard a peep out of them since their conference in October. None of my contacts was mourning, unless I count those who missed howling with laughter about the bad grammar, atrocious spelling, and too-often hysterical tone of the TAHCS missives.
I have to confess that they always made me laugh too.
Barry Johnson is quoted in today's HomeCare Monday, talking about the changes in Texas Medicaid's incontinence product quantities as announced on February 11, 2011. He complains that the change was posted with "literally no notice;" it's effective April 1, 2011.
Should HHSC have posted a notice that they were going to post a notice? The posting on February 11 was the notice that a change was coming up. Perhaps the notice could and should have been posted sooner, but it's not as though the change was posted on March 31 with an effective date of the next day.
Johnson goes on to say that "at least one major vendor [manufacturer] has said that meeting the April 1 date isn't possible." Yes, there are some repackaging challenges to meet the new date, but the fact is that, based on everything I've heard and read about supplier and manufacturer meetings that the TCPA and HHSC hosted, many of them suggested reducing the allowed product quantities because most recipients don't use what they get.
This is a common-sense move that most suppliers understand will save the state millions of dollars that they don't and shouldn't have to spend. Sending 300 per month when only 240 (or fewer) are actually used is wasteful, Barry Johnson.
If vendors didn't see this coming, they weren't paying attention. It's obvious that Johnson wasn't either.
Johnson goes on to whine about "no guidance" from HHSC about what would qualify on the LMN for approval of additional supplies." How hard can it be to figure out what a physician would need to say to justify that a patient needs more than 240 diapers and (or) 120 underpads?
Thank you, Barry Johnson, for stating the obvious (and thank you, HomeCare magazine, for giving the man an undeserved platform from which to spew his drivel); no one would have figured out without you that lower monthly allowable could have an impact on some special-needs patients.
That's what the LMN is for. D-U-H.
It's only Monday, but here is the line that I'm giving the Dumbest Quote of the Week award for: "Guess nobody said the state had a heart for less fortunate individuals who cannot go to the Capitol and complain."
Cue the violins!
Anyone who's provided incontinence supplies to patients knows that the majority of the time the maximum monthly allowable isn't used. In some cases, the recipients sell them to others, give what they don't use to family members who don't qualify for entitlement programs, or throw them away. There are those out there who do use them all, but that's generally the exception, not the rule.
Legislators can have the biggest hearts in the world, but there are financial realities that we all have to deal with. States need to cut budgets. There are people out there who are struggling to make ends meet, but who are still considered "too wealthy" to receive assistance from the state. They too are "less fortunate" individuals, but they can't benefit from the programs that they're forced to support.
If the people out there struggling to make ends meet have to accept less than what they're used to in these tough economic times, then so too do the "less fortunate" that Johnson imagines himself champion of.
Johnson says that the reduction is ridiculous. If Texas is trying this reduction in lieu of a competitive bid for the incontinence products, it benefits patients and suppliers alike. I don't know that this is what the state is doing, but it is what many suppliers, manufacturers, and MESA (the association for Texas DMEs) has suggested to the state since the proposed initiative was announced.
I'd rather go down the road of a reduction of monthly allowables than see my business bid out of existence.
If anything is ridiculous here, it's Johnson (which is no surprise).
I did some digging around and found the presentation, mentioned by Johnson in the same article, that HHSC chief Suehs made to several committees. In it, a new bid program for many DME items is very clear; what isn't clear is whether or not the bid will be at provider or manufacturer level.
What is clear is that something called "Rider 61" grants HHSC the power to do what they want with no limitations imposed by the Texas legislature. There is nothing I could find that permitted the agency to dispense with rule-making and standard implementation procedures, but I don't do business in Texas, so there could be something I've missed.
I doubt it, but it is a possibility.
The HomeCare Monday article goes on to say that Johnson says that he "would be testifying" before "the" committee (there are several of them; which one does he mean?) about the "effects of such a change."
Well, he says he'll testify "if they listen."
Johnson will only testify if they invite him. I checked out the pertinent Texas legislature committees, and as far as I can tell, they're only hearing testimony from those invited. Unless Johnson has been invited (I can't imagine who'd do something like that), then he's not testifying anywhere.
That would be a (very) good thing, because I'm very sure that there are people out there who are more credible, reliable, and articulate than Barry Johnson.
I'm sure there are more useful ones too; several of my readers tell me that while MESA gave the state a comprehensive alternative proposal to the incontinence bid, TAHCS did not. Attending meetings and mumbling opinions into a microphone does not count, in my opinion, as effective advocacy, and this is what Johnson and TAHCS has to offer.
It's my opinion that if providers in Texas need Barry Johnson and TAHCS to save them, they're already done for.
I think that Johnson is trying to keep TAHCS alive (or keep the illusion that TAHCS is alive) because he feels more empowered with it than he is as an individual. If he can make legislators and state agencies believe that he has a following through TAHCS, his opinions will matter more as a representative of many than as an individual.
Barry Johnson the individual might not get attention if he sends a press release containing his thoughts to a publication like HomeCare magazine, but if he sends it out as the president of TAHCS, a lazy publication (HomeCare magazine) will accept it (without questioning and fact-checking, apparently). I can only hope that HME News won't take the same downward step.
The problem with Johnson's illusion (delusion?) that he represents a multitude is that it's misleading. TAHCS does not have a following, and Johnson doesn't have a cohesive, intelligent, and organized approach. He is not representative of suppliers in Texas, and playing the "have a heart" card is just plain stupid.
Barry Johnson, please shut up and go away. HomeCare Monday, please develop some journalism standards and stop publishing garbage.
Monday, February 28, 2011
Thursday, February 17, 2011
Conundrums and Conflicts
I've had some feedback on my last blog. I'm always appreciative of the dialogues that I have with readers; the back-and-forth is invariably productive, thoughtful, and intelligent. My readers and I may not always agree on all points, but communication is the doorway to understanding.
Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving. (Dale Carnegie)
No, this isn't going to be a feel-good blog; I'm not going "soft" on you.
Tell me and I'll forget; show me and I may remember; involve me and I'll understand. (Chinese Proverb)
There is a great difference between knowing and understanding; you can know a lot about something and not really understand it. (Charles F. Kettering)
Conundrums
I'm using the word "conundrum" as a synonym for "enigma." Here is the definition so you can view the word in context: A conundrum is a paradoxical, insoluble, or difficult problem; a dilemma.
It may well be doubted whether human ingenuity can construct an enigma ... which human ingenuity may not, by proper application, resolve. (Edgar Allan Poe)
It seems to me that when Mr. Poe said that, he wasn't taking government into consideration.
Competitive bidding is this industry's biggest conundrum. I don't think it's a problem that's impossible to solve, but I do think it's going to take greater efforts and better tactics than we've used for the last decade.
I've written a few times that the definition of insanity is doing the same thing over and over again and expecting different results. That definition wasn't lost on one of my readers, who pointed to AAHomecare's new attempt to get a bid-program repeal bill introduced as somewhat insane.
Deja vu!
The latest AAHomecare-inspired bill doesn't stand a chance, and here's why: I'm told by several sources that there is no pay-for in it. If this is true, who's going to touch it?
Bear in mind that I haven't seen the bill, so I can't confirm if what I've been told is correct. But when I have more than one person telling me the exact same thing, I have to move forward on the premise that they're giving me factual information.
The government is working on slashing budgets; our deficit is ridiculous. If what AAHomecare is offering in exchange for repeal doesn't save the program the money it's looking to save, the bill is useless.
As I said in my last blog, AAHomecare has two task forces "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
Task forces are an "action" way to say committee.
A committee is a group of the unprepared, appointed by the unwilling to do the unnecessary. (Fred Allen)
A committee is a group that keeps minutes and loses hours. (Milton Berle)
A committee is an animal with four back legs. (John le Carre)
Here's what I think: AAHomecare has excellent -- and convenient -- timing. It's just amazing how they've timed their "legislative effort" announcement to coincide with their legislative conference. The bill they're supposed to be working on won't be ready for the lobbying they want you to do, but have faith, it'll appear soon.
I don't believe that AAHomecare is serious about repealing competitive bidding. I think that organization's focus is on trying to redesign the program to "make it more fair" (whatever that means). Their noise about a bill is just that: noise. AAHomecare really had no choice; most of the industry is very much against "redesigning" the program, and no doubt the association felt the backlash.
The village idiot would've figured out that that plan would be unpopular before it became public knowledge and would probably have had second thoughts about it before letting it out of the gate.
I think the AAHomecare bill is pointless, and I think AAHomecare knows it. I think this tactic is about damage control, not productivity. I think the bill is about appearances; if the industry thinks that AAHomecare is going to actually fight for repeal, AAHomecare's legislative conference might attract more attendees (which will have a positive impact on what the association makes on the event).
One of my readers told me that "if all who went to D.C. for this no-gain conference [just] wrote a check for [a fraction of] the cost of the trip ... probably $400, and met with them (legislators) [in district offices], we might just make some friends."
I agree. In contributing a few hundred dollars to a legislator, you buy some influence. You'd also save quite a bit of money by approaching the problem with this method than with an expensive lobbying trip to D.C. that will achieve absolutely nothing.
You can go, you can spend time with an aide, and once you've walked out that door, you're forgotten. Yes, the aide took notes, and made appropriate-if-noncommittal noises at you. Yes, you got a certain amount of consideration because you're a constituent (or because you represent a group of constituents). But once the election is over, the legislator's need for you is over until he or she runs for re-election.
If you're a contributor, however, you'll be taken more seriously; after all, if you contribute once, you might do so again, and your checkbook is a good motivator.
Cynical? No. It's how politics works.
It's your money, and you have to decide how important it is to spend it in such a way that you get something out of spending it.
Conflicts
It's occurred to me that people who own or represent DME companies, and who have won contracts in the bid areas, should not sit on the boards of DME associations that are actively fighting to repeal the program.
It's about a conflict of interests and ethics.
I understand that those who participated in the bid process did so to stay in business. I really do get that. But participation implies consent just as effectively as silence does.
It's all well and good to say that you don't want competitive bidding and that you want to see it repealed, but if you came out of the process with a contract (or contracts), you have nothing to lose by playing both sides.
Those who didn't win contracts, however, have almost everything to lose.
Having gone through the bid process and come out a "winner," there is a reason to hope that the program stays in place. Bid winners have a lock on the new beneficiaries who need equipment in the bid categories, and as a result of the program, the competition for those beneficiaries is less than it used to be.
Yes, the reimbursement rates in the bid areas are low, but whose fault is that? The bidders themselves dictated the rates.
This, in my opinion, goes far in explaining the "tweak" strategy of AAHomecare; it serves the interests of the AAHomecare board members who hold contracts. It's a strategy that will benefit the association because it supports those companies most likely to be left standing once the program has been rolled out coast-to-coast.
It raises the specter of a conflict of interest. It's an ethical question. (Roberta Baskin)
I have formed the opinion that I have because AAHomecare's agenda is what it is. I don't think there's any deliberate manipulation or deliberate malice involved; I think it's more about survival of the fittest than anything else.
AAHomecare can try to point to its two task forces that have two different purposes to illustrate that my conclusions are incorrect, but when I'm thinking about this, I take into consideration AAHomecare's consistent failure to get results and the fact that the organization developed its "program redesign" strategy well before it announced a continued fight to repeal (an announcement that was motivated by anger from the industry, I suspect).
There needs to be some reform on some industry association boards. The victors cannot objectively represent or work for the interests of the losers. And when the losers suspect the motives of the winners, the faith in the organization in question is eroded. It doesn't matter if the doubt is justified; what matters is that it exists.
The good news is that AAHomecare doesn't appear to have the influence or the credibility to follow through on any strategy it develops. This is good in one way and dire in another; if our "voice in Washington" isn't taken seriously by legislators and CMS, the industry as a whole won't be either.
We are judged by the company we keep.
Events of Interest Closer to Home
The state and regional associations offer conferences and seminars that are informative and closer to home (less expensive to attend, too). Coming up through March are:
SCMESA Meeting: Columbia, SC, February 24
CAMPS Annual Convention, Irvine, CA, March 1 - 2
VADMEC Winter Conference, Richmond, VA, March 8 - 9
MESA All-Star Conference, Dallas, TX, March 15 - 18
JAMES General Meeting, Monroe, NJ, March 22
MAMES Convention and Expo, Omaha, NE, March 24 - 25
TAHC Spring Conference, Franklin, TN, March 27 - 29
If your state doesn't have an organization, or if your state's association doesn't offer opportunities like the ones above, you might want to look into going to one taking place in a nearby state.
Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving. (Dale Carnegie)
No, this isn't going to be a feel-good blog; I'm not going "soft" on you.
Tell me and I'll forget; show me and I may remember; involve me and I'll understand. (Chinese Proverb)
There is a great difference between knowing and understanding; you can know a lot about something and not really understand it. (Charles F. Kettering)
Conundrums
I'm using the word "conundrum" as a synonym for "enigma." Here is the definition so you can view the word in context: A conundrum is a paradoxical, insoluble, or difficult problem; a dilemma.
It may well be doubted whether human ingenuity can construct an enigma ... which human ingenuity may not, by proper application, resolve. (Edgar Allan Poe)
It seems to me that when Mr. Poe said that, he wasn't taking government into consideration.
Competitive bidding is this industry's biggest conundrum. I don't think it's a problem that's impossible to solve, but I do think it's going to take greater efforts and better tactics than we've used for the last decade.
I've written a few times that the definition of insanity is doing the same thing over and over again and expecting different results. That definition wasn't lost on one of my readers, who pointed to AAHomecare's new attempt to get a bid-program repeal bill introduced as somewhat insane.
Deja vu!
The latest AAHomecare-inspired bill doesn't stand a chance, and here's why: I'm told by several sources that there is no pay-for in it. If this is true, who's going to touch it?
Bear in mind that I haven't seen the bill, so I can't confirm if what I've been told is correct. But when I have more than one person telling me the exact same thing, I have to move forward on the premise that they're giving me factual information.
The government is working on slashing budgets; our deficit is ridiculous. If what AAHomecare is offering in exchange for repeal doesn't save the program the money it's looking to save, the bill is useless.
As I said in my last blog, AAHomecare has two task forces "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
Task forces are an "action" way to say committee.
A committee is a group of the unprepared, appointed by the unwilling to do the unnecessary. (Fred Allen)
A committee is a group that keeps minutes and loses hours. (Milton Berle)
A committee is an animal with four back legs. (John le Carre)
Here's what I think: AAHomecare has excellent -- and convenient -- timing. It's just amazing how they've timed their "legislative effort" announcement to coincide with their legislative conference. The bill they're supposed to be working on won't be ready for the lobbying they want you to do, but have faith, it'll appear soon.
I don't believe that AAHomecare is serious about repealing competitive bidding. I think that organization's focus is on trying to redesign the program to "make it more fair" (whatever that means). Their noise about a bill is just that: noise. AAHomecare really had no choice; most of the industry is very much against "redesigning" the program, and no doubt the association felt the backlash.
The village idiot would've figured out that that plan would be unpopular before it became public knowledge and would probably have had second thoughts about it before letting it out of the gate.
I think the AAHomecare bill is pointless, and I think AAHomecare knows it. I think this tactic is about damage control, not productivity. I think the bill is about appearances; if the industry thinks that AAHomecare is going to actually fight for repeal, AAHomecare's legislative conference might attract more attendees (which will have a positive impact on what the association makes on the event).
One of my readers told me that "if all who went to D.C. for this no-gain conference [just] wrote a check for [a fraction of] the cost of the trip ... probably $400, and met with them (legislators) [in district offices], we might just make some friends."
I agree. In contributing a few hundred dollars to a legislator, you buy some influence. You'd also save quite a bit of money by approaching the problem with this method than with an expensive lobbying trip to D.C. that will achieve absolutely nothing.
You can go, you can spend time with an aide, and once you've walked out that door, you're forgotten. Yes, the aide took notes, and made appropriate-if-noncommittal noises at you. Yes, you got a certain amount of consideration because you're a constituent (or because you represent a group of constituents). But once the election is over, the legislator's need for you is over until he or she runs for re-election.
If you're a contributor, however, you'll be taken more seriously; after all, if you contribute once, you might do so again, and your checkbook is a good motivator.
Cynical? No. It's how politics works.
It's your money, and you have to decide how important it is to spend it in such a way that you get something out of spending it.
Conflicts
It's occurred to me that people who own or represent DME companies, and who have won contracts in the bid areas, should not sit on the boards of DME associations that are actively fighting to repeal the program.
It's about a conflict of interests and ethics.
I understand that those who participated in the bid process did so to stay in business. I really do get that. But participation implies consent just as effectively as silence does.
It's all well and good to say that you don't want competitive bidding and that you want to see it repealed, but if you came out of the process with a contract (or contracts), you have nothing to lose by playing both sides.
Those who didn't win contracts, however, have almost everything to lose.
Having gone through the bid process and come out a "winner," there is a reason to hope that the program stays in place. Bid winners have a lock on the new beneficiaries who need equipment in the bid categories, and as a result of the program, the competition for those beneficiaries is less than it used to be.
Yes, the reimbursement rates in the bid areas are low, but whose fault is that? The bidders themselves dictated the rates.
This, in my opinion, goes far in explaining the "tweak" strategy of AAHomecare; it serves the interests of the AAHomecare board members who hold contracts. It's a strategy that will benefit the association because it supports those companies most likely to be left standing once the program has been rolled out coast-to-coast.
It raises the specter of a conflict of interest. It's an ethical question. (Roberta Baskin)
I have formed the opinion that I have because AAHomecare's agenda is what it is. I don't think there's any deliberate manipulation or deliberate malice involved; I think it's more about survival of the fittest than anything else.
AAHomecare can try to point to its two task forces that have two different purposes to illustrate that my conclusions are incorrect, but when I'm thinking about this, I take into consideration AAHomecare's consistent failure to get results and the fact that the organization developed its "program redesign" strategy well before it announced a continued fight to repeal (an announcement that was motivated by anger from the industry, I suspect).
There needs to be some reform on some industry association boards. The victors cannot objectively represent or work for the interests of the losers. And when the losers suspect the motives of the winners, the faith in the organization in question is eroded. It doesn't matter if the doubt is justified; what matters is that it exists.
The good news is that AAHomecare doesn't appear to have the influence or the credibility to follow through on any strategy it develops. This is good in one way and dire in another; if our "voice in Washington" isn't taken seriously by legislators and CMS, the industry as a whole won't be either.
We are judged by the company we keep.
Events of Interest Closer to Home
The state and regional associations offer conferences and seminars that are informative and closer to home (less expensive to attend, too). Coming up through March are:
SCMESA Meeting: Columbia, SC, February 24
CAMPS Annual Convention, Irvine, CA, March 1 - 2
VADMEC Winter Conference, Richmond, VA, March 8 - 9
MESA All-Star Conference, Dallas, TX, March 15 - 18
JAMES General Meeting, Monroe, NJ, March 22
MAMES Convention and Expo, Omaha, NE, March 24 - 25
TAHC Spring Conference, Franklin, TN, March 27 - 29
If your state doesn't have an organization, or if your state's association doesn't offer opportunities like the ones above, you might want to look into going to one taking place in a nearby state.
Monday, February 14, 2011
Next Up: Round Two
Like everyone else in the industry, I've been waiting for details about round two of competitive bidding. It's inevitable; sort of like death and taxes, but worse, because it's a slow and very painful process that seems to have no end.
It should come as no surprise to anyone that CMS is working on round two.
There may be additions to items in the bid, but I, like most, don't expect huge changes to the program. Why change what's billed as a good thing?
I think that there's going to have to be more prep work because so many MSAs are involved, and this may explain why we're not hearing much out of CMS about the bid.
HME News did an article about this topic last week, and the publication said that stakeholders are hoping that CMS is taking its time "to improve its outreach efforts to referral sources and beneficiaries."
I'm going to run against the herd and say that I didn't think that CMS did such a bad job notifying beneficiaries in the round-one MSAs.
I'll pause while you recover from the shock of what I just said.
My parents are Medicare beneficiaries, and they received literature from CMS that was very clear, in a basic kind of way, about competitive bidding and how it would have an impact on their Part B benefits. Though it didn't have paragraph after paragraph of detail, it did give an overview of competitive bidding for DME, and what equipment was included.
CMS may be stretching the truth when it claims that the program is a wonderful thing, but there are good aspects to it from the consumer and tax-payer point of view. With the reduced reimbursements, beneficiaries do save money on co-pays.
Peter Amico is quoted in the article talking about "all the problems with round one with doctors and patients being confused and misled," but based on everything I've read (and I've gone looking for news about it), there wasn't as much confusion and there weren't as many problems as the industry had hoped for.
Saying that doctors and patients were "misled" is a bit strong. There was definitely some misunderstanding, and perhaps CMS could have given better information. But the avalanche of problems and complaints that we needed simply didn't materialize.
This is a problem.
AAHomecare has task forces -- two of them -- "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
We've had more than a decade to come up with the former, and the latter is, I firmly believe, AAHomecare's goal because they know they are incapable of getting rid of the competitive bid.
It's the easier of the two goals, but I'm going to say now that I don't think AAHomecare has the credibility to accomplish either one.
They have an upcoming legislative conference, but they have no bill to promote and no strategy. Yet they want us to come to D.C. and talk to legislators about competitive bidding and the fact that we don't want it.
You can attend their event and engage in no-point lobbying for the bargain-basement price of $245 for members and $355 for nonmembers!
Now add to your registration fee the cost of transportation to get there, and a hotel room for a stupid amount of money per night, plus meals and incidentals, and you've spent a tidy sum of money to attend an event that has no strategy, no talking points (other than the fact that competitive bidding is bad), and no cohesive goal.
AAHomecare wants us to come to D.C. and tell lawmakers that the program is "flawed," but what documentation can they offer to substantiate the claims they want us to make? We've been telling lawmakers for more than three years that the program is "flawed," and has that gotten us anywhere?
No.
This is a tired event, and it's a lot of money for someone to spend when there are no results (and never have been results). If I'm going to spend my money on something, I expect to get something in return.
I can (and do) lobby my representative and senators in my district. I don't have buckets of cash to spend on an event that's held every year and that produces no results.
And I'm not going to pay an outrageous registration fee to AAHomecare; lining the pockets of an organization that's failed the industry for more than a decade is not, in my opinion, a sound investment.
Especially when AAHomecare is employing the same, worn-out arguments against the bid. They're trying the same thing over and over again, and expecting different results.
That's not only insane, it's misleading. AAHomecare says it's no time to pull back? They may be right, but considering how little good they've done the industry, it's also no time to help fund an event and an organization that doesn't work.
Think about it.
It should come as no surprise to anyone that CMS is working on round two.
There may be additions to items in the bid, but I, like most, don't expect huge changes to the program. Why change what's billed as a good thing?
I think that there's going to have to be more prep work because so many MSAs are involved, and this may explain why we're not hearing much out of CMS about the bid.
HME News did an article about this topic last week, and the publication said that stakeholders are hoping that CMS is taking its time "to improve its outreach efforts to referral sources and beneficiaries."
I'm going to run against the herd and say that I didn't think that CMS did such a bad job notifying beneficiaries in the round-one MSAs.
I'll pause while you recover from the shock of what I just said.
My parents are Medicare beneficiaries, and they received literature from CMS that was very clear, in a basic kind of way, about competitive bidding and how it would have an impact on their Part B benefits. Though it didn't have paragraph after paragraph of detail, it did give an overview of competitive bidding for DME, and what equipment was included.
CMS may be stretching the truth when it claims that the program is a wonderful thing, but there are good aspects to it from the consumer and tax-payer point of view. With the reduced reimbursements, beneficiaries do save money on co-pays.
Peter Amico is quoted in the article talking about "all the problems with round one with doctors and patients being confused and misled," but based on everything I've read (and I've gone looking for news about it), there wasn't as much confusion and there weren't as many problems as the industry had hoped for.
Saying that doctors and patients were "misled" is a bit strong. There was definitely some misunderstanding, and perhaps CMS could have given better information. But the avalanche of problems and complaints that we needed simply didn't materialize.
This is a problem.
AAHomecare has task forces -- two of them -- "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."
We've had more than a decade to come up with the former, and the latter is, I firmly believe, AAHomecare's goal because they know they are incapable of getting rid of the competitive bid.
It's the easier of the two goals, but I'm going to say now that I don't think AAHomecare has the credibility to accomplish either one.
They have an upcoming legislative conference, but they have no bill to promote and no strategy. Yet they want us to come to D.C. and talk to legislators about competitive bidding and the fact that we don't want it.
You can attend their event and engage in no-point lobbying for the bargain-basement price of $245 for members and $355 for nonmembers!
Now add to your registration fee the cost of transportation to get there, and a hotel room for a stupid amount of money per night, plus meals and incidentals, and you've spent a tidy sum of money to attend an event that has no strategy, no talking points (other than the fact that competitive bidding is bad), and no cohesive goal.
AAHomecare wants us to come to D.C. and tell lawmakers that the program is "flawed," but what documentation can they offer to substantiate the claims they want us to make? We've been telling lawmakers for more than three years that the program is "flawed," and has that gotten us anywhere?
No.
This is a tired event, and it's a lot of money for someone to spend when there are no results (and never have been results). If I'm going to spend my money on something, I expect to get something in return.
I can (and do) lobby my representative and senators in my district. I don't have buckets of cash to spend on an event that's held every year and that produces no results.
And I'm not going to pay an outrageous registration fee to AAHomecare; lining the pockets of an organization that's failed the industry for more than a decade is not, in my opinion, a sound investment.
Especially when AAHomecare is employing the same, worn-out arguments against the bid. They're trying the same thing over and over again, and expecting different results.
That's not only insane, it's misleading. AAHomecare says it's no time to pull back? They may be right, but considering how little good they've done the industry, it's also no time to help fund an event and an organization that doesn't work.
Think about it.
Thursday, February 3, 2011
A Sensitive Debate
So far all of my blogs have been about DME. It's an important topic because the industry's role in healthcare has been under-valued and misrepresented (to a degree).
But today I'm going to discuss something else entirely.
A Norwegian politician has nominated WikiLeaks for a Nobel Peace Prize; the reason for doing so is because the site has contributed to "democracy and freedom of speech" worldwide.
I have mixed feelings about WikiLeaks and Julian Assange.
There have been many blogs about WikiLeaks, and those defending the organization (and Assange) fall back on our "freedom of speech." Before I launch into the meat of this blog, I want to examine our freedom of speech. Here's the text of the oft-cited first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
I've never understood how burning the flag can be permitted by the first amendment; burning a flag is neither speech, nor is it a peaceable assembly. Burning flags may be a method of expression, but I'm not sure that I agree that the amendment should be interpreted the way it has.
Am I a lawyer? Of course not. But my own opinion is that lawyers are part of what's wrong with this country, and one doesn't (or shouldn't) need a lawyer to interpret a document that's relatively easy to understand. Once a lawyer puts his or her "spin" on things, we run into issues. Lawyers tend to interpret things in ways that best serve them. That's a generalization (I'm sure there are some honest lawyers out there), but I think it's one with which many will agree.
Our founding fathers did the best they could at the time this country was founded. They could not have foreseen where technology would take us, or that in a short two hundred (or so) years, Americans would be more interested in their "rights" than in their responsibilities.
If one looks at the culture at the writing of the Constitution, the intents of the authors become clear. Certain tweaks were definitely in order (allowing women to vote, etc., was an obviously needed change), but on the whole, it's a solid document.
A lot of people, when discussing WikiLeaks and Julian Assange, throw our "freedom of speech" concept around; some people use it for WikiLeaks, and some use it against. Most foreigner posters use it like a club on Americans, even though it's clear from their posts that they don't understand us or our laws (I'm always amused when someone who's never been here tells us what's wrong with us).
Americans are a contradictory group, and we never seem to be able to agree on much. The last time the majority of this country agreed on something, we were wrong (in a huge way).
Don't believe me? Search your memories for how most Americans were gung-ho about W leading us into Iraq because of WMDs and links to al quaida; you'll do well to remember how Americans who publicly disagreed were villified and accused of being traitors.
Those "traitors" were right though. There were no WMDs, there were no links to bin Laden, and Iraq was no threat to our national security. We were lied to. We know that now, but the consequences of those lies have helped to shape the world view of our country and the people in it. And though the U.S. hasn't always been popular everywhere, our Bush-era belligerence and aggression turned many in the world against us.
As I said, I have mixed feelings about WikiLeaks and Julian Assange. I can argue for and against them. I know people who feel strongly about the topic, and who see WikiLeaks and Julian Assange only one way.
So I'm going to state the case for both sides.
For Them
WikiLeaks isn't a terrorist organization.
The organization's stated goal is to ensure transparency and accountability of governments and other institutions (banks, for example).
There is a lot that we don't know; there's a lot of information that our government deliberately hides from us. And though there are defense secrets that shouldn't be published or broadcast, there is information that's kept from us that has nothing to do with defense or security.
Yes, even in the United States. Don't believe me? Try to do a public records request, and see how much information is redacted or, worse yet, how often a government agency will seek to evade releasing information that might do the agency harm (largely because of their own internal waste and incompentence).
Every time a government agency -- take CMS for example -- withholds information, it's evading scrutiny. I've submitted records requests to CMS on several occasions, but gotten very little in return. There are an astounding number of "exemptions" that allow an agency like CMS to keep information from you.
Yes, even though you're a tax-payer and citizen, and should have the right to know what your government is doing.
It's unfortunate that lawmakers have built in so many exemptions and appeals for agencies to attorneys general that you can be told "no," and have no recourse at all (except through expensive litigation, which most of us can't afford, and the government knows this).
There is a mass delusion that because a citizen can do a public records request, that there is transparency in government; all you have to do is ask (and sometimes pay) for the information.
WikiLeaks has exposed corruption, torture, war crimes, and duplicity. WikiLeaks has exposed hypocrisy, censorship, and deception. Though those things aren't what we associate with our government, we should, because they exist.
WikiLeaks says that it improves transparency, which in turn leads to reduced corruption. I agree that transparency reduces corruption and improves accountability. I think that every single government agency and government employee should be held to a very high standard and should be prepared to be investigated and answerable for what's done. Government exists on the backs of the people who pay taxes, and the people who pay taxes have a right to know what's going on.
It's unfortunate that the opposite is true. Don't believe me? Let's look at Charles Rangel, the U.S. Representative who was recently censured by the House. This is a man who, for 17 years, deliberately failed to pay taxes on a property he owned, and who withheld documenting assets (among several other things). Was he prosecuted? No. Was he kicked out of the House? No. He had to submit to a public rebuke (and whined about how unfair it was).
If the average citizen had done what Rangel did, we'd be facing prosecution.
The standards for people like Rangel are different from the ones imposed on the rest of us; the legislators protected their own. There was no appropriate accountability in Rangel's censure, nor was the man held to high standards. I call that corruption.
It's corruption on a relatively smalll scale, but if it's so blatant there, then corruption is everywhere. No, I'm not one of those conspiracy theorists. But I do firmly believe that our government hides much from us and lies to us on a regular basis.
Exposing that is a good thing; it might make the people who are supposed to be working for us hesitate the next time they do something that really isn't in our interests if only because they don't want the embarrassment that public exposure will bring.
For a too-brief-yet-glorious moment, we had our legislators nervous during the election season. We were angry, and we sent a message that we were tired of the games they play. The problem is that elections are over, they're still playing the same games, and we're not doing anything about it. The problem is that we're all fundamentally lazy, and we have short attention spans.
We're angry for a moment, and then things return to normal. We accept that our legislators play partisan politics; we ignore the fact that they waste most of our tax dollars. We avoid acknowledging that they lie to us and hide things from us in the name of national security (even when what they're doing has nothing to do with national security). We accept crappy service from civil servants (I'm talking to you, USPS); in short, we settle for what our employees are willing to give.
We imagine that we're informed because we watch the news every night, but blissfully ignore the fact that our journalists slant their stories to match their agendas, the owners of their media outlets, and the expectations of their advertisers.
Enter WikiLeaks. They have no advertisers, and they put no spin on what they publish because the supporting documents are there for all to see.
Governments, search engines, and some carriers have tried to block access to WikiLeaks. I don't know about you, but I'm not interested in having my government or my carrier decide what I can and can't see; I equate censorship with tyranny. If this country guarantees in its Constitution free speech and freedom of the press, then what WikiLeaks is doing is not illegal (and so our government should stop looking for ways to successfully prosecute Assange, assuming they can get their hands on him).
For those who say that Assange is a traitor, I remind you that he's not a citizen of this country, and so owes the U.S. no allegiance (or discretion). And don't bother telling me that if he's not a citizen that our free speech/free press laws don't apply to him; the fact is that we can't preach those freedoms and encourage other countries to adopt our freedoms, and then try to deny them to others when it suits us. We either believe in those freedoms or we don't. We can't have it both ways.
We deserve the truth. That we don't get it from our government is an incredibly sad thing (and it's something we should correct). If WikiLeaks and its supporters are willing to take the heat and the risks to try to ensure transparency and accountability through exposure, we should thank them even as we ask ourselves why getting the truth out there has to come with risks (and persecution).
Against Them
WikiLeaks is a terrorist organization.
They get secret information via secret means, and then ambush their targets without warning.
Some of the information they make public has the potential to put lives at risk; I give you the American military information they've posted, and I give you the current protests in the middle east as examples of the violence that exposure can cause.
Hiding behind a self-righteous and self-serving mission, they take it upon themselves to publish what they get with little thought to the inevitable consequences associated to what they post. They employ no discretion and appear to have damned little regard for the human lives thrust into the turmoil that WikiLeaks creates.
This apparent disregard exposes very little humanity; an argument can be made that WikiLeaks and Assange enjoy the reactions of the organizations they ambush, and that they enjoy having the power to cause them.
There are people involved here, and while the "great" might get singed, it's the "little people" who will pay the greatest price.
WikiLeaks is a group of shadowy people who are taking it upon themselves to make public things that that, in the end, might do more harm than good. There are reasons why things are kept secret (and sometimes those reasons are good).
WikiLeaks is creating situations in which innocent people are getting hurt, and I've seen no sign that Julian Assange takes the human aspect into any consideration; this is a moral and ethical hole in a man who claims to only do good for society. Assange doesn't seem to understand that society is made up of individuals, and that he and WikiLeaks don't (or shouldn't) have the right to do them harm (even if the harm is inadvertent).
Perhaps the WikiLeaks philosphy is that a little chaos now is a small price to pay for a better, more transparent future, but is that the organization's call? No. If WikiLeaks is so committed to accountability, it needs to stop and consider its own.
You Decide
I'll go back to posting on DME-related topics in my next blog. But in the meantime, WikiLeaks and Assange are food for thought.
But today I'm going to discuss something else entirely.
A Norwegian politician has nominated WikiLeaks for a Nobel Peace Prize; the reason for doing so is because the site has contributed to "democracy and freedom of speech" worldwide.
I have mixed feelings about WikiLeaks and Julian Assange.
There have been many blogs about WikiLeaks, and those defending the organization (and Assange) fall back on our "freedom of speech." Before I launch into the meat of this blog, I want to examine our freedom of speech. Here's the text of the oft-cited first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
I've never understood how burning the flag can be permitted by the first amendment; burning a flag is neither speech, nor is it a peaceable assembly. Burning flags may be a method of expression, but I'm not sure that I agree that the amendment should be interpreted the way it has.
Am I a lawyer? Of course not. But my own opinion is that lawyers are part of what's wrong with this country, and one doesn't (or shouldn't) need a lawyer to interpret a document that's relatively easy to understand. Once a lawyer puts his or her "spin" on things, we run into issues. Lawyers tend to interpret things in ways that best serve them. That's a generalization (I'm sure there are some honest lawyers out there), but I think it's one with which many will agree.
Our founding fathers did the best they could at the time this country was founded. They could not have foreseen where technology would take us, or that in a short two hundred (or so) years, Americans would be more interested in their "rights" than in their responsibilities.
If one looks at the culture at the writing of the Constitution, the intents of the authors become clear. Certain tweaks were definitely in order (allowing women to vote, etc., was an obviously needed change), but on the whole, it's a solid document.
A lot of people, when discussing WikiLeaks and Julian Assange, throw our "freedom of speech" concept around; some people use it for WikiLeaks, and some use it against. Most foreigner posters use it like a club on Americans, even though it's clear from their posts that they don't understand us or our laws (I'm always amused when someone who's never been here tells us what's wrong with us).
Americans are a contradictory group, and we never seem to be able to agree on much. The last time the majority of this country agreed on something, we were wrong (in a huge way).
Don't believe me? Search your memories for how most Americans were gung-ho about W leading us into Iraq because of WMDs and links to al quaida; you'll do well to remember how Americans who publicly disagreed were villified and accused of being traitors.
Those "traitors" were right though. There were no WMDs, there were no links to bin Laden, and Iraq was no threat to our national security. We were lied to. We know that now, but the consequences of those lies have helped to shape the world view of our country and the people in it. And though the U.S. hasn't always been popular everywhere, our Bush-era belligerence and aggression turned many in the world against us.
As I said, I have mixed feelings about WikiLeaks and Julian Assange. I can argue for and against them. I know people who feel strongly about the topic, and who see WikiLeaks and Julian Assange only one way.
So I'm going to state the case for both sides.
For Them
WikiLeaks isn't a terrorist organization.
The organization's stated goal is to ensure transparency and accountability of governments and other institutions (banks, for example).
There is a lot that we don't know; there's a lot of information that our government deliberately hides from us. And though there are defense secrets that shouldn't be published or broadcast, there is information that's kept from us that has nothing to do with defense or security.
Yes, even in the United States. Don't believe me? Try to do a public records request, and see how much information is redacted or, worse yet, how often a government agency will seek to evade releasing information that might do the agency harm (largely because of their own internal waste and incompentence).
Every time a government agency -- take CMS for example -- withholds information, it's evading scrutiny. I've submitted records requests to CMS on several occasions, but gotten very little in return. There are an astounding number of "exemptions" that allow an agency like CMS to keep information from you.
Yes, even though you're a tax-payer and citizen, and should have the right to know what your government is doing.
It's unfortunate that lawmakers have built in so many exemptions and appeals for agencies to attorneys general that you can be told "no," and have no recourse at all (except through expensive litigation, which most of us can't afford, and the government knows this).
There is a mass delusion that because a citizen can do a public records request, that there is transparency in government; all you have to do is ask (and sometimes pay) for the information.
WikiLeaks has exposed corruption, torture, war crimes, and duplicity. WikiLeaks has exposed hypocrisy, censorship, and deception. Though those things aren't what we associate with our government, we should, because they exist.
WikiLeaks says that it improves transparency, which in turn leads to reduced corruption. I agree that transparency reduces corruption and improves accountability. I think that every single government agency and government employee should be held to a very high standard and should be prepared to be investigated and answerable for what's done. Government exists on the backs of the people who pay taxes, and the people who pay taxes have a right to know what's going on.
It's unfortunate that the opposite is true. Don't believe me? Let's look at Charles Rangel, the U.S. Representative who was recently censured by the House. This is a man who, for 17 years, deliberately failed to pay taxes on a property he owned, and who withheld documenting assets (among several other things). Was he prosecuted? No. Was he kicked out of the House? No. He had to submit to a public rebuke (and whined about how unfair it was).
If the average citizen had done what Rangel did, we'd be facing prosecution.
The standards for people like Rangel are different from the ones imposed on the rest of us; the legislators protected their own. There was no appropriate accountability in Rangel's censure, nor was the man held to high standards. I call that corruption.
It's corruption on a relatively smalll scale, but if it's so blatant there, then corruption is everywhere. No, I'm not one of those conspiracy theorists. But I do firmly believe that our government hides much from us and lies to us on a regular basis.
Exposing that is a good thing; it might make the people who are supposed to be working for us hesitate the next time they do something that really isn't in our interests if only because they don't want the embarrassment that public exposure will bring.
For a too-brief-yet-glorious moment, we had our legislators nervous during the election season. We were angry, and we sent a message that we were tired of the games they play. The problem is that elections are over, they're still playing the same games, and we're not doing anything about it. The problem is that we're all fundamentally lazy, and we have short attention spans.
We're angry for a moment, and then things return to normal. We accept that our legislators play partisan politics; we ignore the fact that they waste most of our tax dollars. We avoid acknowledging that they lie to us and hide things from us in the name of national security (even when what they're doing has nothing to do with national security). We accept crappy service from civil servants (I'm talking to you, USPS); in short, we settle for what our employees are willing to give.
We imagine that we're informed because we watch the news every night, but blissfully ignore the fact that our journalists slant their stories to match their agendas, the owners of their media outlets, and the expectations of their advertisers.
Enter WikiLeaks. They have no advertisers, and they put no spin on what they publish because the supporting documents are there for all to see.
Governments, search engines, and some carriers have tried to block access to WikiLeaks. I don't know about you, but I'm not interested in having my government or my carrier decide what I can and can't see; I equate censorship with tyranny. If this country guarantees in its Constitution free speech and freedom of the press, then what WikiLeaks is doing is not illegal (and so our government should stop looking for ways to successfully prosecute Assange, assuming they can get their hands on him).
For those who say that Assange is a traitor, I remind you that he's not a citizen of this country, and so owes the U.S. no allegiance (or discretion). And don't bother telling me that if he's not a citizen that our free speech/free press laws don't apply to him; the fact is that we can't preach those freedoms and encourage other countries to adopt our freedoms, and then try to deny them to others when it suits us. We either believe in those freedoms or we don't. We can't have it both ways.
We deserve the truth. That we don't get it from our government is an incredibly sad thing (and it's something we should correct). If WikiLeaks and its supporters are willing to take the heat and the risks to try to ensure transparency and accountability through exposure, we should thank them even as we ask ourselves why getting the truth out there has to come with risks (and persecution).
Against Them
WikiLeaks is a terrorist organization.
They get secret information via secret means, and then ambush their targets without warning.
Some of the information they make public has the potential to put lives at risk; I give you the American military information they've posted, and I give you the current protests in the middle east as examples of the violence that exposure can cause.
Hiding behind a self-righteous and self-serving mission, they take it upon themselves to publish what they get with little thought to the inevitable consequences associated to what they post. They employ no discretion and appear to have damned little regard for the human lives thrust into the turmoil that WikiLeaks creates.
This apparent disregard exposes very little humanity; an argument can be made that WikiLeaks and Assange enjoy the reactions of the organizations they ambush, and that they enjoy having the power to cause them.
There are people involved here, and while the "great" might get singed, it's the "little people" who will pay the greatest price.
WikiLeaks is a group of shadowy people who are taking it upon themselves to make public things that that, in the end, might do more harm than good. There are reasons why things are kept secret (and sometimes those reasons are good).
WikiLeaks is creating situations in which innocent people are getting hurt, and I've seen no sign that Julian Assange takes the human aspect into any consideration; this is a moral and ethical hole in a man who claims to only do good for society. Assange doesn't seem to understand that society is made up of individuals, and that he and WikiLeaks don't (or shouldn't) have the right to do them harm (even if the harm is inadvertent).
Perhaps the WikiLeaks philosphy is that a little chaos now is a small price to pay for a better, more transparent future, but is that the organization's call? No. If WikiLeaks is so committed to accountability, it needs to stop and consider its own.
You Decide
I'll go back to posting on DME-related topics in my next blog. But in the meantime, WikiLeaks and Assange are food for thought.
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