Wednesday, November 07, 2012

Brown People Count -- and Other Election 2012 Lessons for Republicans

Early on during election night, even before President Obama was announced the winner, I watched a Fox News pundit soberly realize, as she put it, that Republicans need to realize they can no longer win many races without "brown people" and that they perhaps "overplayed" the whole Obama is a socialist thing.  Gee, you think? 

Grog's Gamut opened my eyes to a few other insightful take-home messages:  1) "All Obama lost from 2008 was Indiana and North Carolina which voted Republican even when Clinton was running in 1992 and 1996, let alone when George W won in 2000 and 2004. So it wasn’t a case of Romney making inroads, but more just getting back what the GOP used to take for granted"; 2) math and science rule; and 3) yes, the electoral map still looks like roadkill if you just look at land mass,

but the margins of victory at the county level may tell the more important story: 
 "Where Obama won big was in the big cities; where Mitt won big was in places that didn’t matter because they were never in play – such as Utah...
In Colorado for example Obama won big in and around Denver and Boulder. In Florida he won the Miami-Dade Country with 62% of the vote – that county had around 829,000 voters, next door in Broward County he won with 67%. It has around 719,000 voters. Together those 2 counties account for nearly 20% of the entire state’s vote.  In Ohio it’s the same story." [Grog's Gamut, 11-7-12]

Grog goes on to point out that radical Republican/Tea Party logic just will not win you votes in national and statewide elections in many states, nor will trying to appeal to (or trying not to piss off) that illogical segment of the population.  I think many Republicans fail to appreciate this. 

In a Facebook conversation I had with some local Republican friends hoopin' and hollin' about Scott Brown's loss to Elizabeth Warren, like they were born and raised in Massachusetts or something, I echoed that theory of flawed TEA (Taxed Enough Already) Party logic.  Especially in the MA Senate race, I believe it boiled down to this:  Republicans  underestimated how much people are hurting. People want health care and to not be raped by their credit card companies more than they want tax cuts. Tax cuts aren't bad, but what the hell am I going to do with a tax credit I have to spend money up front to take advantage of if I don't have any money in the first place?

Friday, November 02, 2012

For Mitt Romney's Health Plan, Look to Gov. Jindal

Want to know how Mitt Romney would fix America's healthcare problem?  Just look to how Gov. Bobby Jindal is reforming healthcare in Louisiana: by eliminating it.  If you think I am kidding, look at the Governor's travel schedule.  Louisianians already know that Jindal spends more time with Romney and raising money for him than he does at the state capitol.  Who else would Romney look to for advice other than the Republican-proclaimed healthcare guru?

Every time Jindal and his band of suck-up, "whatever you say, boss" state healthcare administrators have reassured us they are only cutting healthcare costs without sacrificing services, it has turned out to be a boldface lie.  Each time, they and Jindal have known exactly what the plan was all along, then proceeded to tell the public the exact opposite.  

It all started with mental health. Three years ago, the state's Medical Director clearly stated their intent to eliminate inpatient psych services for youths.   Remember New Orleans Adolescent Hospital? Remember how all those beds in New Orleans were moved to the northshore?  Isn't it convenient how NOAH was sold earlier this year just before the state decided publicly announced that Southeast Louisiana Hospital was closing and that those "psych beds" would be relocated back to the southshore?  I put "psych beds" in quotes because even though the state has already moved the patients out of Southeast Louisiana Hospital, it has yet to even identify where those "beds" will ultimately physically exist, which means they don't exist. And they likely never will.  Just like those more abundant outpatient services to replace the shuttered hospital units don't exist -- and in many cases never did. 

Using the loss of federal Medicaid funding as an excuse for decimating the LSU system is, in my estimation, Jindal and Greenstein being less than totally honest, to put it charitably.  The trip down that road has been underway since last summer when Jindal single-handedly and against the will of the legislature, and therefore that of the people, CHOSE to eliminate about $24 million in federal healthcare funds when he CHOSE to veto the renewal of the 4-cent cigarette tax.  The trip continued with the privatization of Medicaid with his brainchild the Bayou Health Program and with giving control of mental health services to the private insurer Magellan which slashed reimbursement rates to providers 30-40% before Jindal even learned of the federal Medicaid funding cuts, which of course led to even deeper cuts.

The latest outcry, which will of course be ignored by Jindal, is against his cuts to the LSU system that stand to cripple the training of future doctors.  Even his handpicked henchmen on LSU's Board of Supervisors weren't aware of the extent of Jindal's destructive plans:
"The shortage came as a surprise to members of the LSU Board of Supervisors, who recently approved a plan to cut $150 million out of operations of seven LSU hospitals in south Louisiana." -The Advocate 10/29/2012
Oh wait. Except they were lying about not knowing.  An article from six days earlier titled, "Medical Plan Caught Up in Cuts to LSU," noted:
"...the LSU budget cuts could jeopardize training programs’ accreditations and standards, threatening medical education in Louisiana and chasing away medical students needed to treat patients in a state that already has issues about access to health care and doctor shortages in rural areas.  LSU leaders and the governor’s health secretary, Bruce Greenstein, say they’re keeping all of that in mind and have graduate medical education at the forefront of their planning." -The Advocate, 10/23/2012
How are you surprised to learn of something you promised a week ago to keep in the forefront of your mind?  Seems to me that Jindal and his yes-men are lying about saving medical education too.  Why would they if they're getting rid of the places those doctors would practice?  

So if you're down with that, then by all means, cast your vote for Romney and roll out the welcome mat for incoming Secretary of the U.S. Department of Health and Human Services & new Cabinet member Gov. Bobby Jindal.

Thursday, September 20, 2012

Mitt, Big Government, and the Deeply Confused Deep (Red) South

People living on the Gulf Coast, especially Louisianians, should be the last ones complaining about big government programs.  D-SNAP, FEMA, NFIP, USACE, National Guard, Road Home Program, etc.  Need I say more?

No I don't.  But I will.

Many local Republicans decry the amount of federal dollars spent on those no-income-tax-paying leeches living off the government dole, those same leeches who Mitt believes will never support him.  What many local Republicans seem unable to recognize, or at least admit, is that they are those leeches.


Such folks are either misled, uninformed, or disingenuous.  Either way, if they want the rest of us to start taking them seriously, Republican politicians and their local supporters need to walk their talk.  The ones living in St. John the Baptist, Plaquemines, and St. Tammany need to vote for enough new taxes to cover the full cost of the levees they want.

(Well OK, they don't have to hold that vote now.  We can wait until after they get out of the disaster food stamp line.)

Sunday, September 09, 2012

Hurricane Isaac: A Post-Mortem Analysis

I was going to do a comparison/retrospective pre-storm post cleverly titled "Isaac Meet Gustav.  Gustav, Isaac" --  a flashback-flashforward piece, if you will, involving this post.  However, my detailed prep routine highlighted in that Gustav post prevented that.  

Folks getting their extra 2 inches of parking elevation pre-Isaac

Isaac, as irritating as he was, provided positive experiences I would not have otherwise had.  I learned that I have some very interesting neighbors.  Despite New Orleans' reputation for close-knit communities, I had never gotten to know these folks.  A lot of bonding can happen on a neighbor's front porch on the pitch black, windy, wet second night of a 'cane.  The cool Tulane college students who live next door and I finally had the opportunity to really hang out.  They even came over and made a delicious meal in my candlelit kitchen, complete with enthralling conversation that made me feel like a dope compared to their brilliance.  I, in return, provided some "radio action" during which Margaret Orr wowed them and, consequently, gained a new fan or two.  I experienced the kindness of my neighbor, about 7 or 8 years old, who swept the leaves off of my side of the porch in the heat of the morning without even being asked to.  

I learned that if you have older candles you haven't used in a while, you should make sure before the power goes out that the wicks aren't buried in the wax. 

I learned that my cat BoBo gets car sick. 

I learned that given the choice, I would pick air conditioning over cable TV, telephone service, and yes -- even Internet.

The bluish (some see more green, others more purple) glow given off by transformers in the pitch black darkness of a windstorm is eerily cool!

Tree down on Leake Av. - Wed., Aug. 29th, 2012

I learned that my what-to-cook-in-the-order-it-will-spoil-without-electricity strategy needs a great deal more refinement.

I learned that if it involves using the oven in an already sweltering house that I will most likely not cook it.  To hell with it spoiling!

Saturday, August 11, 2012

Did Mayor Landrieu Just Say Chief Serpas Knows Jack About Reducing Murders?

The title of this CBS piece, "New Orleans Mayor Fights to End Culture of Violence," is the exact opposite of what I heard Mayor Landrieu say in this interview, which was that no one IN THE WHOLE ENTIRE COUNTRY knows how to stem the epidemic of young black males killing each other here in New Orleans.   

Based upon my grasp of the English language, population statistics, Venn diagrams, and if not A then not B logic, "Nobody in the Country" includes Landrieu's Police Chief Ronal Serpas.  So why did he hire this guy?

Other cities have brought down their black-on-black murder rates, so SOMEBODY SOMEwhere must know SOMEthing about how to do this.  Right?

UPDATED 8/14/12:
This seems like a far cry from nobody knowing what to do: 

Wednesday, March 21, 2012

I Am So Not Gellin', Magellan!

Louisiana completely privatized mental health services on March 1, 2012.  The behavioral health insurance company Magellan is now the gatekeeper to pretty much ALL mental health services paid for by the state.  

True, there appear to be some advantages.  Services heretofore unavailable to LA Medicaid recipients, such as group therapy and reimbursement for meeting with your child's therapist without the child having to be present, are now available. 

Other than that, it's been HELL.  Where do I even begin?

1. Provider reimbursement rates have been SLASHED by about 30%.  Imagine finding out    
on March 5th that your salary would be cut by 30% -- beginning March 1st.  Yes, March 1st of the same year.  Uncle Bobby Jindal decided to privatize healthcare, or so he says, because the private sector provides the same or better services for lower costs without all the bureaucratic overhead and logjams.  What he didn't mention is that in his kingdom, he would let the private sector insurance company pay psychiatrists and therapists 30% less for services provided to its Medicaid customers than it pays the very same psychiatrists and therapists to see its non-Medicaid customers. 

2.  As of yesterday, zero of my clinic's claims appear to have been processed, so we have no feedback regarding whether Magellan is the type of insurer that will regularly deny 15%, 30% or whatever% of our claims (i.e., payment for services already provided).  You would think the lauded private sector would understand that to keep a business from going under you need to be able to project your revenue.

3. As reported yesterday by Gambit, Clinical Advisor still doesn't work.  
Clinical Advisor is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It's not working. As a result, providers — many of which, like the Guidance Center, serve Medicaid clients — haven't been able to submit Medicaid claims. What's more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid. [Gambit, 3/20/2012]

4. Forget about Magellan paying for your child to undergo a formal psychological evaluation.  They are denying ANY test that in ANY way could POSSIBLY be used to diagnose learning or educational problems even if the test has other uses, AND even if the psychologist states s/he wants to use that test for one of its other uses.  Magellan reasons that the federal government already provides that service.  In reality, the federal government mandates that school districts evaluate any child 0-21 years of age suspected of having a learning or emotional disability.   They just don't provide the schools with all the funding needed to accomplish that.  

5. Our insurance specialist has spent most of her time on hold when calling Magellan, one time for 30 minutes before the call was simply disconnected.  I emailed a question to the provider account plastered all over their website and on DHH's site -- 8 days ago.  Still no response, not even a form reply stating they have received my email.

6. We have heard that Magellan is requiring inpatient psychiatric providers to obtain daily authorization for hospitalized patients, a process that colleagues say is taking about 2 hours/day.  This despite what is written on page 15 of their 21-page FAQ document for providers [updated 2/24/2012]:
Q: For our inpatient unit, I was requesting authorizations practically every day, for different patients. I would get multiple authorizations of two days or three days or four days. If a patient comes in to this short-term unit, am I going to have to get an authorization every day?
A: You do not have to obtain an authorization every day, but the authorizations will be for short periods of time. We want to be sure first of all that the person still clinically needs the inpatient level of care and could not be safely returned to services in their community. Secondly, we want to have a discussion at every review about the discharge plan. Discharge planning, in our view, begins at the time of admission. We want to make sure that members have a well-established plan for aftercare services in place when they are discharged. So we are going to be reviewing every two to three days depending on the status of the person’s clinical condition and the plan for discharge.

And those are just the things I care to write about right now. 

Saturday, March 17, 2012

Jindal Will Sell New Orleans Adolescent Hospital

Gov. Jindal's current budget depends on the sale of New Orleans Adolescent Hospital (NOAH). 

In the spending plan for the LSU public hospitals, $35 million is tied to the sale of the New Orleans Adolescent Hospital, which hasn't yet been sold. [Alexandria Town Talk, 3/12/2012]

The state acquired the property through a Dec. 16, 1981 transfer agreement from the federal government. That deal specified that the property would used for "general health care" services for 30 years, a period that expires in December 2011. [Times-Picayune, 4/7/2010]
You remember NOAH.  

That's the safe place we used to have for our suicidal and homicidal kids before we routinely shipped them off to Shreveport. 

Tuesday, March 06, 2012

Is LA Medicaid Putting Fat Cats' Profits over Patient Health?

No, I don't mean the so-called "fat cat" doctors that people who aren't doctors think get rich off Medicaid payments.  I mean pharmaceutical companies.

I learned today that Medicaid patients need prior authorization for generic ADHD medications.  Name-brand (i.e., more expensive than generic) ADHD medications are on the current Louisiana Medicaid Preferred Drug List, but generic versions of those same medications are not.  This means that LA Medicaid will pay, no questions asked, for Adderall XR, Focalin, Focalin XR, and Concerta; but physicians must submit Prior Authorization forms for the less expensive generic forms of these medications.

That means that providers who prescribe these drugs to Medicaid patients must fill out additional paperwork, and may even have to call the state medicaid office, to justify why the state should pay for the CHEAPER  generic version.    

As if that isn't problematic enough, there is a shortage of stimulant medications used to treat ADHD, and many pharmacies only have generic versions.  They couldn't get the name-brand versions of the drugs if they wanted to.

I find this policy interesting, considering Governor Jindal's push to save healthcare dollars by privatizing Medicaid and his constant hootin' and hollerin' about how much Louisiana pays to fund Medicaid. 

Monday, February 27, 2012

Santorum, Risky Parenting, Heresy, and the Quran

Rick Santorum thinks President Obama is a snob for wanting Americans to go to college.

Santorum wants to create jobs so that people can remake their children in their own image.  While you do want your children to adopt your positive characteristics, everyone knows that trying to make your children grow up to fit some ideal persona that you have in mind for them can be disastrous.  For all of Santorum's questioning of the President's theology, what he just said is heresy.  Our children are made in God's image, not our own.

As for the violence over the military's destruction of the Quran, were these rare collectors' special edition Qurans or something? We apologized.  They do have more copies left, right?  I'm going to need the Afghans to simmer. 

Thursday, January 05, 2012

New Orleans: Boldly Going Where We've Been Before

To reduce the murder rate, Police Chief Serpas is going to map crime hotspots, which I could swear he said he was going to do last year.  And the year before that.  Remember COMSTAT, anyone?  

The City Council pitched in today by voting to implement earlier curfews -- because law-abiding murderers and armed robbers will surely respect an 8pm curfew, and it's a no-brainer that crime will decrease if you limit the hours during which kids can commit them. Duh!  

And finally, to REALLY increase the quality of life in The Big Easy, the city's Health Department is improving the availability and delivery of mental health care by...drumroll, please...typing lists