Sunday, December 29, 2013

Senator Coons, Too Many Cooks In The Iran Kitchen

Originally posted in Delaware Liberal by Progressive Populists on December 28.

Well, maybe living in a Blue state is not all its cracked up to be after all.  I now read that Senator Coons has signed onto the Menendez bill with some of the worst the Republican party has to offer to mess with the Iran peace/nuke disarmament recipe.
I was taught that Congress has an advice and consent role with foreign policy, not a micro-management involvement.  Yes, he's a member of the Foreign Affairs Committee.  But after President Obama and Secretary Kerry have come up with the first potential breakthrough in our troubled relationship with Iran, he feels they need extra help?  Come on now, they've done amazing work here after years of "Bomb, Bomb, Bomb Iran"  refrains emitted from the mouths of the all too meddling Republican party.
Let the Administration do its work.  Let them play out this welcomed initiative before you and your kitchen mates foul up the recipe.  Those of us who served our country in the military don't need this ill timed coupe you're engaged in to cause the new regime in Iran to wonder who is in charge of negotiations from the U.S.A, empowering our own war mongers to go for a kill here.
Iranians have plenty of evidence of historical confusion about U.S. policy with them.  They well remember our CIA's role in the 50's in overthrowing their hard earned first attempts at democracy.  Again in the 70's they remember our invitation to the Shah and his court who pillaged Iran's  coffers, to live out his last days in the U.S. after being ousted.  And again in the 80's when Republicans sabotaged  President Carter's peaceful efforts to retrieve our hostages for Reagan to win the U.S. Presidency.  Not also to forget the Iran/Contra crime by the Reagan administration.  Not a great track record, eh?  They really are wondering who is running the kitchen here and now you and your R buddies are about to screw it up again.
The sanctions we have going there, relaxed a bit for these breakthrough negotiations,  are for policy change aims in Iran, not punishment.  Menendez wants to reduce further Iranian oil sales with a global oil boycott in 2015.  And, institute bans in engineering, mining and construction industries, all of which is fuel for the modernization of their economy.   Tell me this, Senator Coons.  What do international oil politics have to do with these proposed sanctions?  You are well aware of Iran's designs for gas pipelines across the middle east in competition with Bush's buddies, the Saudis.
Also other trade politics figure in here including Iran's enhancing its relationship with India and Iraq.  Iran can be positioned through a peace/nuke disarmament deal to become a much bigger power in the middle east and Af/Pak region, further diminishing the house of Saud.
Or is it AIPAC's and Israel's justified paranoia about Iranian nuclear weapon's development ?  It appears your President and Secretary of State have a pretty good handle on stemming that threat through these negotiations.  And certainly Israel's paranoia is informed by their own undisclosed nuclear weapons stockpile, somehow being exempt from the world's nuke disarmament movement.
So, Senator, give us the real rationale behind your recipe for spoiling the Iranian peace broth.

Wednesday, December 18, 2013

Eliz. Warren Gets It Right On Credit Score Bullies

This blog was published in Delaware Liberal on December 18

I read with interest that Sen. Elizabeth Warren is submitting legislation to regulate and rein in consumer credit scoring companies on their abuse of our citizens.  This warms my populist heart.  It mainly aims at employer's use of this unreliable and often inaccurate information but at least it is a start for us consumers/job applicants.
When I first retired, I decided I'd finally have the time to check out my credit reports and make sure they were in order.  I'd had no particular problem with getting credit having done some modest real estate investing requiring loans.  Also, I had then a friendly community banker who gave me a heads up on my credit reports.  I noticed then an erroneous item on a mortgage I'd had years earlier and decided to check further, though it seemed  not to impede my qualifying for more current loans.
To my amazement, these companies, Experian, TransUnion and Equifax had attained enormous power over consumers beyond credit and bank loans;  employers were using their data on a massive scale to check out job applicants for "character flaws" and risk issues.
As I got into the process I learned the power these bureaus hold over those persons on whom they report.  They claim no responsibility for accuracy, fading the heat back to the source of the transaction information they receive from their information sources on you and offer little or no help in correcting inaccurate information send to them by retail stores, credit card companies, auto and home loan lenders.  Further, it is on you, not them, to go back to the original source for corrections or modification of their reports to the bureaus.  But, their accuracy is taken for granted by employers it seems.
In my case, I had two issues to "clean up"; an erroneously reported late payment on a mortgage I'd had 15 years earlier and long since paid off and an non-existent late payment on a credit card account of about the same vintage.
Net, net, it took months, about 6 in total, to address these error laden reports and with no help from the bureaus.   I had to go back to the sources, the mortgage company and credit card company, via snail mail at their demand, to provide challenging and correcting information.  Back and forth with endless exchanges until they acknowledged their errors and then documented their errors back to the three bureaus.  Now imagine if I was having to do this in conjunction with a job application or potential employer?  6 months?  I'd be blown out of the water on the job before the correct information was finally documented in the credit reports read by the employers.
The fact is that these bureaus are data base managers of information provided by credit and money lenders and your information depends, in part, on the accuracy of the data entry staffer with the bureau as well as the accuracy of the lenders/credit issuers in their data entry and reporting.  And you have no power over either.  But your job or loan hangs in balance based on their accuracy or correct reporting.  And they, the sources and the bureaus won't help you correct the information or explain the mitigating circumstances.  You're all on your own here and you'd damned well better have the time, persistence and energy to root out the errors and with some luck and minimal cooperation from them, get the record corrected. Often, the result is just permission to write and publish on their reports a brief statement from you on the mitigating circumstances, not a full retraction, deletion of erroneous information or complete correction of the record.  At least, not unless you're in a position to hire an attorney.
So, thank you Senator Warren for standing up for the little guy or gal.  And, Senators Coons and Carper, are you on board with justice for consumers in this case?  Will you sign on?  Why aren't you co-sponsors?

Wednesday, December 11, 2013

Meet The Best Health Care, The VA

Published in Delaware Liberal by ProgressivePopulist on Dec. 11

Yes, the best health care in the USA is the VA.  Not private, for profit care but the system owned and run by the people of the United States, via the federal government.  Yes, government healthcare that is essentially socialized medicine.
How do I know?  I've been under their care for about 15 years and have some basis of comparison having had a career in health care marketing for an equal number of years, working on a strategic level with managements of some of the largest health systems across the USA.  Hands on and very much in touch with the measures by which this field judges its quality.
My own care was with the VA hospital and clinics in Houston and more recently right here in Wilmington, DE up off the Kirkwood Highway.  Issues?  Age (over 70), 35 years of blood pressure treatment, atrial fibrillation, runners knees, eye surgery to correct stigmatism and cataracts, diabetes and a one time cancer scare. Countless clinic visits and tons of meds to deal with the issues above.
A buddy gave me a heads up on the VA years ago  when I was lamenting the shitty care and systems I was receiving from a recently opened huge clinic my then wife's HMO health plan assigned us to.  A real architectural monument with all the external flourishes they taught at architecture school.  Only problem, they ran out of money after paying the architects and failed to bring their patient records and computer systems up to any kind of reasonable standard.  One department's IT system would not talk the the one next door down the hall.  So it was endless refilling out of forms by patients and staff, stop by stop down the hall.   I fired them and went to the VA down the street at the Texas Medical Center when approved.  It took them three months to transfer my medical records to the VA by courier after I hounded them repeatedly to do so.
Anyway, the first sight on my first visit to the VA waiting room filled will fellow geezers made me wonder if I'd made the biggest mistake of my life.  Turns out, they had a system of moving people through their appointments, blood work et al administered by the friendliest desk staffers I'd ever encountered as both a patient and consultant to hospitals and clinics.  Boom, they got it done with smiles, efficiency and compassion like I'd never experienced in the private sector.
Oh, and did I mention cost?  Co-pays for visits about $25 bucks and a list of meds that would choke a horse that cost a fraction, literally, compared to private sector meds pricing. A few hundred a year for about half a dozen meds taken daily.  My rates are based on my income; some pay less, some other low income vets pay nothing.
Systems?  While the rest of health care was debating whether to convert from paper to electronic medical records ad nauseum (they still are debating),  the VA created a system using open source that became the envy of the health care field.  The rest of the world is still catching up.  Records, physician notes, RX regimes, diagnostic results and the images from MRI, Xray, etc. all securely stored and pulled up with lightening speed by the providers.
The actual care delivery?  Primary care by salaried physicians, PA's and Nurse practitioners.  Turns out, the profession has discovered that routine primary care doesn't  need an MD, but these other folks with MD's on staff to consult with patient and them as needed.  Efficient as hell.  Cost efficient too.  So, into one room for labs/blood work, wham.  Out over to the clinic waiting room.  Wham again, visit complete with tons of info, smiles and good history/records update done by the clinician themselves.  Rx refills. Done online and either pick up down the hall in 20 minutes or mailed  to home more often than not. When specialists are needed, often this is provided by local medical school faculty and MD's in training on contract  who come to the VA to provide their expertise.  I've always sought out providers active with medical school faculties for their expertise on current research, not usually acquired on cruises by your friendly pharma or med-technology manufacturers.
And just in the past year, my records were flawlessly transferred electronically from Houston to Wilmington, where I met them with my new MD for intro and review with an appointment made before leaving Houston.  Now, on a smaller scale, the same friendly and efficient clinic visits, labs et al.
And, just introduced in the past year, a fantastic online resource called where I can reorder meds, schedule or change appointments, email questions to my nurse or MD and get same day answers or info.  I can review my meds list on it and can go in an read my medical records and recent visit Dr. or PA notes on my care, situation, etc.  Seamless and secure.
Yes, I am acutely aware of the terrible backlog the VA is fighting to process in new patients. No excuses are suitable for this travesty but sadly, the nation, congress, appropriations committees  et al either did not anticipate the Republican-driven consequences of two unfunded wars and the millions returning damaged forever by amputations, PTSD and other psychological damage wrought on young lives by these obscene misuses of our military. These young people have earned this care and deserve immediate attention, even if it has to be provided temporarily by the private health care sector under contract until the VA can be expanded to do their amazing work for this need breed of veteran.
Results of VA care ?  A 2010 study of available clinical literature on key quality measures concluded:
"Overall, the available literature suggests that the care provided in the VA compares favorably to non-VA care systems, albeit with some caveats. Studies that used accepted process of care measures and intermediate outcomes measures, such as control of blood pressure or hemoglobin A1c, for quality measurements almost always found VA performed better than non-VA comparison groups. Studies looking at risk-adjusted outcomes generally have found no differences between VA and non-VA care, with some reports of better outcomes in VA and a few reports of worse outcomes in VA, compared to non-VA care. The studies of processes of care are mostly those about medical conditions, while the studies of outcomes are mostly about surgical conditions and interventional procedures."
From another source, Phillip Longman of the New America Foundation : see "The Best Care Anywhere," Washington Monthly, January/February 2005), the VA also comes out on top of virtually every study ranking the quality, safety, efficiency, and cost-effectiveness of U.S. health care providers.
Mr. Longman updated his 2005 published work in 2010 with comparable claims.
Doug Waller of Time Magazine, in 2006 wrote this:
"For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index... Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs... Harvard University just gave the VA its Innovations in American Government Award for the agency's work in computerizing patient records."
Hospital inflation data suggests that during a recent 10 year period, VA costs remained static, with dramatically reduced staffing compared to private sector hospitals whose costs rose 40%.  I'll be writing more about these costs in future blogs.