Tag Archives: citizens

Medical Debt , Your new Handcuffs

credit-report-killer-1-5-americans-unpaid-medical-debtAngelia Fowler was surprised to learn that the debt-collection agency she says is ruining her life is owned by the hospital company that saved it.

Fowler had been sick for months in November 2015 when her son finally took her to the emergency room with what turned out to be pneumonia. She spent much of the next month in a coma in intensive care at St. Mary’s Medical Center in West Palm Beach, Florida.

The bill arrived in January. After discounts, the hospital wanted her to pay $80,770. Other bills from specialists boosted the sum she owed above six figures, enough to buy a condo in West Palm Beach. It was a sum she couldn’t pay.

Millions of patients like Fowler are on the receiving end of the health-care industry’s collections machine. The amount of past-due medical debt in the U.S. is about $75 billion, spread among 43 million people, according to estimates from economists at MIT, Northwestern University and the University of Chicago. About half of all collections lines on credit reports are related to medical debt, a 2014 report (PDF) from the Consumer Financial Protection Bureau showed.

Fowler, who is uninsured and doesn’t qualify for Medicaid in Florida, lives off unemployment and help from her son, a chef. The bill from St. Mary’s went to a collections agency called Central Financial Control, which reported it to credit bureaus. Though Fowler attained a Master of Business Administration degree online this fall, she said three employers have declined to hire her because of the medical debt, a practice that’s legal in Florida and 38 other states.

“When you’re handed this type of debt because of health reasons, it is like a set of debt handcuffs,” said Fowler, who is now 60. “It throws your life off trajectory.”

Though Fowler didn’t realize it, St. Mary’s Medical Center and Central Financial Control are both owned by Tenet Healthcare Corp., the for-profit hospital operator. As Tenet and other hospital companies struggle to make money providing medical care, they are turning to the profitable and growing business of collecting debt.

Most hospitals have finance departments or outside companies that try to ensure they get paid by insurers and patients. But Tenet has gone a step further than most, turning its operation into a separate business line called Conifer and contracting its services to other medical providers.

Conifer serves the 77 hospitals Tenet operates. It also works for more than 700 others, including hospitals run by the nonprofit Catholic Health Initiatives, which owns a minority stake in the business. The collections agency that contacted Fowler, Central Financial Control, is the operating name of a Conifer subsidiary called Syndicated Office Systems LLC.

Conifer is one of the few bright spots at Tenet. The Dallas-based company is selling off hospitals to manage its $15 billion debt load. Even as Tenet has unloaded hospitals, it keeps them on as clients of Conifer, according to the company’s earnings presentation (PDF) last month. Acting Chief Executive Officer Ronald Rittenmeyer, during Tenet’s earnings call Nov. 7, said he plans to cut jobs at Conifer, which employed 15,570 people at the end of 2016.

While Conifer accounts for just 5 percent of Tenet’s revenue, it has an outsize influence on the company’s bottom line. Measured by earnings before interest, taxes, depreciation and amortization, Conifer’s margins have been roughly twice as large as those in Tenet’s hospital business. The parent company doesn’t directly report how much Conifer contributes to its net income.

Tenet and Conifer declined to make executives available for an interview. In an emailed statement, Ryan Lieber, a spokesman for St. Mary’s, said that Conifer “helps our patients understand and navigate the financial aspects” of their care, including applying for charity care and other financial help. The business has helped more than 25,000 St. Mary’s patients in the past two years, he said.

Fowler’s account “was never classified as a charity care case,” Lieber said. After Bloomberg asked about her situation, the hospital said it will reach out to her “to close out her account and resolve credit reporting issues.”

Other medical providers are in the collections business. HCA, the nation’s largest for-profit hospital chain, has a subsidiary called Parallon that boasts on its website about collecting $41 billion annually. MedNax Inc., a company that provides staffing to hospitals for such services as anesthesiology and neonatal intensive care, purchased a billing and collections company in 2015.

Medical providers got more sophisticated about billing and collections during the 1990s. That’s when insurers, under pressure to contain costs, became more restrictive about what medical services they would pay for. More recently, insurance policies have put more costs on patients. The average deductible for employer-sponsored coverage more than doubled in the past decade, to $1,505 for an individual. That means hospitals are increasingly chasing payments from individuals as well as insurers.

The business of making sure doctors and hospitals get paid—known in industry jargon as revenue-cycle management—is by one estimate a $24 billion market. Along with billing and collections, it includes verifying patients’ insurance, checking whether they’re eligible for government assistance and making sure the services that doctors provide are properly documented and billed.

Collecting payment has become more important as hospitals’ traditional revenue streams come under pressure. Looming cuts to Medicare reimbursements may make as many as 60 percent of U.S. hospitals unprofitable, compared with about 25 percent currently, according to a 2016 Congressional Budget Office analysis.

“The stakes are higher, the dollars are bigger and therefore, they simply can’t afford to not be good at this,” said Jim Lazarus, managing director at Advisory Board Co., a hospital consulting company.

Tenet’s practices have drawn backlash from patients and regulators for years. In June 2015, the Consumer Financial Protection Bureau ordered (PDF) Conifer to pay $5 million in relief to consumers. The regulator said it failed to send consumers proper documentation and didn’t adequately respond when debts were disputed.

The bureau has recorded 889 consumer complaints about Tenet since 2013, including 358 so far in 2017. Many don’t mention the hospital company directly but refer instead to Central Financial Control or Syndicated Office Systems. Among complaints about medical debt, only two collections agencies were cited more frequently than Tenet. None of Tenet’s for-profit hospital competitors have a similar record of complaints, although some of those companies outsource the work.

When Fowler was unable to meet her obligation, she appealed online to an organization called RIP Medical Debt, a nonprofit that buys debt on the secondary market and forgives it. It was founded by two former collections industry executives. The nonprofit identifies people who can’t pay their medical debts and then tries to raise money to buy the delinquent accounts for pennies on the dollar, forgiving the debt. The charity said it hasn’t yet taken up her account.

Fowler said the hospital never discussed charity care with her and that her attempts to set up a payment plan after she was discharged went nowhere.

“They said nothing to me. I just got this giant bill in the mail,” she said. “I’m very grateful that you saved my life. But does our health care have to decimate us financially? It’s destroying me.”

USA Oligarchy

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According to a new Princeton study, the U.S. can no longer be strictly called a democracy, as ordinary citizens have effectively lost their say over public policy. Instead, the U.S. more precisely resembles an oligarchy, or a form of government in which the economic elite — less than 1 percent of the population — has control over most of the policymaking decisions.

The study, conducted by Martin Gilens of Princeton University and Benjamin I. Page of Northwestern University, will be published this fall in the journal Perspectives on Politics. Their conclusions, though unsurprising, are nevertheless chilling and raise some serious questions about the direction our country is headed in.

The central point that emerges from our research is that economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy, while mass-based interest groups and average citizens have little or no independent influence.

To be clear, Gilens and Page never use the word “oligarchy” in their report, instead using the phrase “economic elite domination.” But this is all semantics. Our lawmakers are being economically dominated by the most affluent individuals in America such as Charles and David Koch, who push policy in their favor rather than that of the majority of the U.S. population.

Gilens and Page insist ordinary Americans are hoodwinked into believing that they have any real decision-making powers. With the advancement of Citizens United and the Supreme Court’s recent lifting of federal campaign donation limits, a vast majority of the population has little hope at convincing legislators to take up their cause.

Americans do enjoy many features central to democratic governance, such as regular elections, freedom of speech and association, and a widespread (if still contested) franchise. But we believe that if policymaking is dominated by powerful business organizations and a small number of affluent Americans, then America’s claims to being a democratic society are seriously threatened.

The study shows above all else that when the economic elites favor something, it tends to happen. Conversely, when they oppose something, it is extremely unlikely to happen. In essence, then, they wield a sort of citizens’ veto power. This is grim news indeed.

In the United States, our findings indicate, the majority does not rule — at least not in the causal sense of actually determining policy outcomes. When a majority of citizens disagrees with economic elites and/or with organized interests, they generally lose. Moreover, because of the strong status quo bias built into the U.S. political system, even when fairly large majorities of Americans favor policy change, they generally do not get it.

What this means, unfortunately, is that the “status quo bias” guarantees the longevity of this oligarchic form of government which began to emerge thirty years ago during the Reagan administration.

President Calvin Coolidge once said that “the chief business of the American people is business.” Now, it seems, business is also our master.

Jaywalking

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Police Commissioner Bill Bratton is walking to a different drumbeat than most New Yorkers.

In just over two months on the job, he has embraced Mayor de Blasio’s vow to cut pedestrian deaths — with the NYPD issuing 452 jaywalking tickets through the end of February, compared with just 50 during the same period last year.

That’s a 900 percent increase in summonses, prompting residents to demand the former LAPD boss put the brakes on de Blasio’s crackdown.

Overall, cops issued 531 tickets for all of 2013.

New Yorkers say jaywalking is as much a part of city life as horn-honking cabbies and dirty-water hot dogs.

“This isn’t LA, commissioner. Leave it alone,” pleaded Luis Suarez, 50, a Brooklyn sanitation worker. “You’ve got more important things to worry about — like actual crime. This is New York. Everybody gets around this way.”

South Bronx construction worker Miguel Baez, 50, argued that New Yorkers are too busy to wait for the light or cross at the corner. “This is what we do. This is how we get around,” Baez fumed.

De Blasio campaigned on a promise to cut pedestrian fatalities and serious injuries to zero within a decade.

He cited statistics that showed about 250 New Yorkers are killed every year in traffic accidents and thousands more are seriously hurt.

But even the mayor has had trouble following his own advice.
The Post caught him on video jaywalking across a Brooklyn street, a day after his two-SUV motorcade was filmed by TV reporters blowing two stop signs and going over the speed limit in Queens.

Bratton this week told WPIX/Channel 11 that the number of jaywalking tickets issued on his watch was only about 300 and that New Yorkers should “get over it.”

But a police source familiar with traffic issues urged Bratton to properly educate the public about jaywalking.

“You’re trying to change the culture of New York City. But no one here is going to stand around at a red light with no cars coming. That’s ridiculous,” the source said.

The Asshole

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The English word ass (meaning donkey, a cognate of its zoological name Equus asinus) may also be used as a term of contempt, referring to a silly or stupid person. In the United States, and, to a lesser degree, in Canada, the words arse and ass have become synonymous; however, in the rest of the English-speaking world, ass still only refers to the donkey, rather than the arse (buttocks). It is worth noting that speakers of some varieties of English “drop their Rs” before consonants, leading to a pronunciation of arse that is quite similar to ass.

Political usage

In 2000, during a Labor Day event, then candidate George W. Bush made an off-hand remark to his running mate, Dick Cheney, that New York Times reporter Adam Clymer was a “major league asshole.”

In February 2004, American media reported that during a rally of supporters, Venezuelan President Hugo Chavez called Bush “an asshole” for believing his aides in supporting a coup against Chavez in 2002. The word in the original Spanish was “pendejo”, and in news coverage the word was widely, though incorrectly, translated as “asshole”; the meaning of the word varies substantially in Latin America, and in Venezuela its meaning is closer to “fool”.

Bloomberg Advice

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NYC Mayor Michael Bloomberg, the billionaire founder of media giant Bloomberg LP, said on his radio show that people who want to be successful shouldn’t go the bathroom a lot.

“Everybody’s got different opportunities in front of ‘em, different skill sets they bring and luck plays a part of it. But my experience is that you make your own luck. The harder you work, the luckier you get.”

“I always tried to be the first one in in the morning and the last one to leave at night, take the fewest vacations and the least time away from the desk to go to the bathroom or have lunch. You gotta be there. I mean, everybody says, ‘Oh, that’s crazy!’ But if you want to succeed, … you can’t control how lucky you are, you can’t control how smart you are, but you can control how hard you work, so that’s the first thing.”

Cross your legs, folks.

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Do you Care

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For the last few months, Elisabeth Rosenthal of the New York Times has been working on a series of stories about the high price of healthcare in America. In July she wrote about the high cost of childbirth, and earlier this month she wrote about the truly insane cost of hip replacements in America. But Bob Somerby has noted something interesting: nobody else in the media seems to care:

These articles deal with a very important topic—the massive looting of U.S. consumers which characterizes American health care. This looting helps explain a welter of major social and political problems—our nation’s growing income inequality; our stagnant wages; the failure to provide full medical coverage; the nation’s problems with federal deficits and debt.

But so what? Despite their high profile and apparent salience, Rosenthal’s reports have met with universal silence, except for last week’s Fresh Air….It’s going to win the Pulitzer Prize—and it’s going to do so in silence!

Despite the high profile afforded this series, the silence has been general all over the press, which seems paralyzed, dead in life. At the end of this report, we’ll offer our own speculations about the resounding silence.

Is this really true? Rosenthal’s piece implied that artificial hips cost about $350 to manufacture, but sell to hospitals for upwards of $5,000 or more—and are then marked up further by the hospital before they end up in an OR getting installed. It’s not clear if $350 is just the manufacturing cost, or if that’s the all-in burdened cost of producing a hip, but it almost doesn’t matter. Even if it’s the former, it means the full cost is unlikely to be more than $1,000 or so. Nonetheless, in the case of one particular implant, Rosenthal reports that U.S. hospitals pay an average of $8,000 and that even Belgian hospitals, which benefit from government-controlled pricing, pay $4,000. So everyone is paying a pretty hefty markup. Americans are just paying a super-hefty one, made worse by the fact that hospitals then add their own markup, bringing the price of the implant up to $30,000 or more.

So that’s at least a 30x markup to the end user just for the cost of the part. And that’s despite the fact that the technology is mature, volumes are high and increasing, and there are five companies “competing” for business. So what’s going on?

Rosenthal has some ideas, but in the end it remains unclear. Where are insurance companies? Where’s Medicare? Why isn’t anyone outraged by this? Is it just fatigue at the never-ending tsunami of stories about the lunatic cost of all the various bits and pieces of American healthcare? Bob is right: it’s a mystery.

Source: mother jones

Ku Klux Klan Neighborhood Watch

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Aside from a jury duty notice, a bag of burning feces or maybe an Amway salesman, the last thing anyone wants to find on their doorstep is an invitation from the Ku Klux Klan. So imagine the horror of Springfield, Missouri, residents last week who discovered a recruitment flier from the Traditionalist American Knights of the Ku Klux Klan while reaching for their morning papers. New York City neighborhoods are the next focus on influence for the Klan, watch out.

The flier, which features an array of bold text in different fonts and sizes, attempts to convince intrepid young Springfielders (Springfieldites? Springfieldians?) to join their neighborhood watch program. “You can sleep tonight knowing the Klan is awake!” it promises.

Naturally, many Springfield residents did not sleep better knowing that wild-eyed, hooded bigots were trolling the neighborhood at all hours, and immediately contacted local news station KY3 News, who called the number listed on the flier. While Klan representative Frank Ancona said he didn’t know whether the fliers were distributed as part of an organized effort by the group (as opposed to, y’know, invisible, magical racist elves), he did say that the neighborhood watch program was not racist, and that if a Springfield resident reported seeing a white guy “up to no good” the Klan would also intervene.

So rest easy, Springfielders: If there’s something strange in the neighborhood, no need to call the Ghostbusters. Call the Traditionalist American Knights of the Ku Klux Klan. They don’t have proton packs, but they do have pointy hats. And rudimentary Microsoft Office skills.

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Scan those Plates

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License plate scanners are the dark horse of the surveillance world. They’ve been around for a decade, but people rarely notice. They don’t look much different from closed circuit cameras, perched over busy intersections. Or they’re just another device mounted on a passing police car.

But they notice you: A scanner can ID thousands of plates a day. And a new ACLU report says the vast majority of police agencies now use them.

The report’s chief author, Catherine Crump, says her organization isn’t opposed to the technology per se.

“At first, we didn’t think it posed much of a privacy problem,” Crump said. The ACLU saw a system that triggered a real-time alert to the presence of a stolen vehicle, or a car linked to a fugitive, and that seemed acceptable. But then the group realized police were storing the license plate scans — whether or not there had been a “hit.”

The ACLU’s public records requests show some departments have accumulated millions of scans, and the agencies store the data for years — even indefinitely. The scans are also being shared across departments, and with the federal government.

Privacy hawks worry that this has the makings to become a powerful search engine of past traffic. The more ubiquitous the scanners become, the easier it’ll be to verify where you’ve driven over the past years. The databases can place your car in a city you claim you’ve never visited, or in front of the house of a person you claim not to know.

“Having all this information, sitting in a database, I think could be quite chilling,” Crump says.

But police see things differently. These plate-scan databases are a potential gold mine for detectives who might have nothing else to go on. A quick dip into a list of plates scanned near the crime scene might produce that precious first step: a name.

“It’s another tool in our belt,” says Sgt. Robert Eberling, who’s with the police department in Grapevine, Texas. It’s a midsized suburb of Dallas, but the ACLU’s records show that, as of August 2012, it had collected and stored 2 million plate scans.

Eberling says that number is inflated by the fact that the department uses the scanners in the parking lots of a big shopping mall, where stolen cars are often abandoned. He says the scanners are very useful for recovering those vehicles. But he concedes the resulting database may also come in handy down the road.

“God forbid if the day came that a child is abducted from that mall,” he says. “We would have that tool available to us, to look at that data and see if we can’t find a possible suspect vehicle.”

Eberling says the police department is in the process of coming up with new rules for how long to keep the data. Texas doesn’t impose any limit on how long police can keep the scans, but as the technology spreads, a couple of states have stepped in. Arkansas and Maine bar police from storing scans not linked to crimes, and the Minnesota State Patrol deletes records after two days.

Want to know how long your local police save the scans? Check the ACLU map. The organization filed public document requests with nearly 600 police agencies, and heard back from 300. If your local police responded, you can read what they said about their scanners.

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Anonymous Research

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Anonymous Exposes U.S.’s Biggest Private Prison Company As a Bad Financial Investment

The oldest and largest for-prison company is not what it would have you believe, at least according to Anonymous. A faction of the hacktivist group released a report this morning concluding that the publicly traded prison operator Corrections Corporation of America (CCA) is not an efficient, profitable free-market solution — but a bad investment for shareholders.

Companies like CCA currently profit from America’s addiction to incarceration – converting a bloody trail of prison riots, deaths, and general human misery into black balance sheets. The conventional financial wisdom is that CCA will be reliably profitable in the future because of its strong history of growth over the past thirty years. But this growth has been fueled by an historical anomaly. Between 1970 and 2005, the U.S. prison population grew by 700 percent, far outpacing both population growth and crime. As a result, our country now has 5% of the world’s population but 25% of the world’s prisoners.

CCA did not exist before this massive expansion of incarceration – and the company depends on it to survive. But Anonymous’ report shows us that as America weans itself from that addiction, CCA’s ledgers will quickly turn red.

This is not Anonymous’ first foray into corporate issues. Since 2011, it has published four reports digging into the financials and governance of publicly traded Chinese companies. Each report has seriously rattled the target company; in one case, the Financial Times reported that the company responded by suspending trading of its shares on the Hong Kong stock exchange. Today’s report on CCA marks the first time, however, that Anonymous has trained its sights on a U.S. company. They have certainly found a deserving target.

Anonymous points outs that state governments are increasingly enacting policy reforms designed to reduce their reliance on incarceration – including top CCA “customers” like California and Colorado. Based on a state-by-state examination of these reforms, combined with a close look at CCA’s falling occupancy rates and decreased spending on new construction, Anonymous identifies ongoing criminal justice reforms as posing a far more serious risk to CCA’s business model than CCA’s management is willing to admit. It concludes that CCA’s management “has been caught up in its own hype” and that “winter is coming” for the company.

Recent events lend support to Anonymous’ conclusions. In just the last few months, four state governments have announced the cancellation of five prison contracts with CCA: Idaho, Kentucky, Texas, and Mississippi. While the Idaho and Mississippi cancellations seem to have arisen from dissatisfaction with CCA’s performance (the Mississippi prison was rocked by two riots in just twelve months, and CCA employees at the Idaho prison recently falsified nearly 4,800 hours of staffing records), the Texas and Kentucky cancellations were driven by falling state prison populations that rendered the CCA contracts unnecessary.

Of course, continuing this momentum requires the political will to further reduce the flow of people into prisons. The ACLU is working on a number of fronts to make this happen, and an increasing number of state legislators are realizing that current incarceration rates are unsustainable. And we will continue to emphasize that handing control of prisons over to for-profit prisons are a bad public investment: one that fails to offer a real solution to state or local fiscal problems, lets those companies engage in sharp tactics to garner more government contracts and avoid public accountability, and has resulted in a truly horrifying track record of abuse, neglect, and misconduct.

Source: anon analytics

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