Health IT Funds Included in Stimulus Package

The latest version of the economic stimulus legislation includes 187 pages called the Health IT for Economic and Clinical Health Act, or HITECH, with $20 billion in funding to implement a nationwide system of electronic health records (EHRs).

This is something that President Obama spoke of frequently during his campaign, and now it appears to be coming into fruition.

The Congressional Budget Office (CBO) envisions that, within a decade, some 90 percent of physicians and 70 percent of hospitals and other providers will become electrified (that word doesn’t quite work, does it?) as a result of HITECH. In other words, they will be using electronic health records (EHRs).

HIPAA, the Health Insurance Portability and Accountability Act of 1996, comes into play here, but when HIPAA was written, no one was really envisioning a nationwide data base of health records available online. However, here it all comes.

The law also creates an Office of the National Coordinator for Health IT to oversee matters and enforce rules.

Finally, the law comes with a stick as well as a $20-billion carrot. At some point in the future, those who choose not to go electronic will get docked in their Medicare and Medicaid payments.

Ouch. That’ll teach ’em.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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New I-9 Form: Paperwork Reduction in Action?

The United States Customs and Immigration Service (USCIS), formerly INS until becoming part of the Department of Homeland Security (DHS), has issued a new form I-9, which is used by employers to verify that potential employees have the legal right to work in the United States.

The form has been revised to comply with new USCIS regulations concerning which documents can be used for verification. Out are any expired documents (which implausibly were acceptable until these new regs), and in is a new Passport Card (which can also be used in lieu of a full passport when traveling to and from Canada or Mexico, but just by car).

The new form, which goes into effect Feb. 2, is a five-page document, and in the middle of the document is one entire page of white with one lone, shaded box called “Paperwork Reduction Act.” The box advises users that the form will take, on average, 12 minutes to fill out, and then it asks that suggestions on improving the process be sent to a certain address.

One whole page of paper for one paragraph of information in the name of paperwork reduction!

I quickly gave a call to a compliance and labor law researcher at Personnel Concepts by the name of Dave Daniels. We both got a chuckle out of that virtually blank page, and he said he had called USCIS about the form (just released on Tuesday) to see whether that reduction-notice page needs to be submitted with the form. He was told no. He also asked why the new I-9 had an expiration date of July 2009, and the USCIS person expressed surprise at the early expiration date and said this was the first time he’d noticed it!

“Our government hard at work,” we both concluded.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Bailout Blues: Tax Shelters and Huge Bonu$e$

The Associated Press recently reported that 600 executives at the banks just bailed out by the U.S. government took in $1.6 billion in salaries, bonuses and perks last year. That comes to about $2.6 million per exec, but we all know that not all execs are created equal.

Then came this news from the Government Accountability Office (GAO), which searched publicly available data filed with the Securities and Exchange Commission (SEC) and determined that 83 of the 100 largest publicly traded corporations and 63 of the 100 largest federal contractors maintain subsidiaries in countries generally considered havens for avoiding taxes.

Prominent among these entities are Citigroup, Morgan Stanley, Bank of America and American International Group (AIG), bailout faves of Henry Paulsen. Citigroup alone has 427 tax haven subsidiaries.

The GAO made no determination as to whether these companies actually used their subsidiaries to avoid U.S. taxes, but we all know what the assumption is.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Many Miss Out on Unemployment Insurance Benefits

Unemployment insurance was commenced in 1935 as a bridge between jobs, but this recession seems to be testing the limits of the system and revealing some inherent cracks.

First, not all states run their unemployment programs the same or use the same eligibility standards. The result of this disparity nationwide is that some 37 percent of those laid off fail to qualify for unemployment insurance.

This hits the lowest paid the hardest since they are twice as likely to be laid off while only one third of them ends up receiving unemployment checks.

Problems with the system began in 1982 when the federal government started demanding interest payments on funds borrowed to cover state unemployment insurance needs. In 1986, unemployment income started being taxed while states were suddenly required to eliminate unemployment payments from those receiving pensions or Social Security even though they otherwise qualified.

Curiously, even though the working world is now computerized, the unemployment system still goes by pre-computer standards and doesn’t recognize a worker’s last quarter of earnings. So, for those laid off in December 2008, no wages from Oct. 1 on counted in the computation.

Say you were a recent college graduate who started working in June 2008. If you were laid off in December, only the wages and work weeks from June through September would count. This would disqualify you in many states.

Fear not as the Obamites have a handy piece of legislation to reintroduce called the Unemployment Insurance Modernization Act. This act never made it out of the Senate the first time, even though Barack Obama was a sponsor, but chances are now good for its approval.

If enacted, the law would provide states with $7 billion to cover another 500,000 workers (works out to $14,000 per). An additional $500 million would be passed along to cover administrative expenses.

I’m not sure how this act modernizes unemployment insurance, but maybe there’s more language in there to patch up those cracks. Otherwise, it’s just a one-time payment.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Chances of Health Care Reform: Check Out This List

I found this interesting. It was on some far-left (the author called himself progressive, but he was way off the spectrum) blog, and it’s a list of who’s received the most in campaign donations from the insurance industry, to wit:

John McCain (R-AZ) $2,799,156
Barack Obama (D-IL) $2,184,670
Chris Dodd (D-CT) $2,138,446
Earl Pomeroy (Blue Dog-ND) $1,735,356
Charlie Rangel (D-NY) $1,346,785
Ben Nelson (D-NE) $1,185,299
Max Baucus (D-MT) $1,171,363
Joe Lieberman (I-CT) $1,033,802
Arlen Specter (R-PA) $1,007,130
Chuck Schumer (D-NY) $943,400
Mitch McConnell (R-KY) $918,007

Said author also reports that, since 1990, insurers have donated $309,549,407, 63% of it to Republicans. Interesting since most of the people on the top-ten list are Democrats.

I’ll take this guy’s word for it even though he didn’t list any sources for this information. On its surface, the list does appear accurate, name-wise anyway.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Analysis Correct, But Proposed Solution Doesn’t Add Up

A group calling itself Physicians for National Health Program (PNHP) has issued a press release revealing the failure of Hillarycare as it was resurrected in Massachusetts by former Governor Mitt Romney (who somehow has now seen the light of his transgressions from Republican orthodoxy).

Costs are up, services are hard to get, the state is going broke, and what was once free for the indigent now costs them money–that’s the Massachusetts health care plan implemented in 2006.

So far, so good–these are the inevitable results of government interference in the free market. (Watch for higher costs and more rationing coming down the pike soon.)

However, PNHP then advocates the adoption of a single-payer national health care system “while maintaining the private delivery system.” This plan is embodied in H.R. 676, the so-called United States National Health Care Act.

The group claims implementation of H.R. 676 would save Massachusetts alone “about $8 billion to $10 billion a year in reduced administrative costs,” but it fails to say how except that it would eliminate (now, really?) the 31-percent administrative fees built into private insurance plans. Eliminate some admin costs, yes, but all, no, but PNHP never goes into detail.

Also, how does this differ from just putting everyone on Medicare? No clue in the press release.

What H.R. 676 really amounts to is a massive “fee-for-service” cash grab by the physicians of America who, once they got their hands on an “unlimited” federal money spigot, would open the valve as wide as possible with a) more patients and b) more services for every patient they see.

Unless they can provide better details than this crappy press release does, these physicians need to go back to the drawing board–and figure out how they can see more patients for the same, or less, than they do now.

Otherwise, it’s just more greedy pigs lining up at the federal trough (see banks, the Big Three, the states, housing, unions, etc.).


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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USCIS (nee: INS) Finally Receives Funds to Modernize

The U.S. Citizenship and Immigration Services (USCIS) branch of the Department of Homeland Security (DHS) is a $2.6-billion-a-year agency. It is also the paper-jammed and -backlogged agency formerly known as the INS (Immigration and Naturalization Service).

Ask anybody who’s dealt with the agency in either incarnation and you’ll hear horror stories of standing in blocks-long lines before dawn and spending the whole day waiting for your name to be called. Then a year or two later, you might hear something–if you’re lucky.

Someone caught on to the nightmare known as the INS in 1999 and began a modernization process, but they forgot to fund it. Then came 9/11, then the merger into DHS, and then more lack of funds.

Finally, late in 2008 IBM was chosen to take the whole process online in a $500-million, long-overdue project. Considering that it costs the USCIS $100 million a year just to ship and store the huge files it creates for each immigrant, it seems that they coulda and shoulda found the $500 million many long years ago. In five years of operation or so, the computerization will pay for itself.

The goal is to process each applicant in six months’ time, down from the 18 months to three years that it typically takes, using electronic applications and database filing.

The new system will allow government agencies, from the Border Patrol to the FBI to the Labor Department, to access immigration records faster and more accurately. In combination with initiatives to link digital fingerprint scans to unique identification numbers, it would create a lifelong digital record for applicants. It also would eliminate the need for time- and labor-intensive filing and refiling of paper forms, which are stored at 200 locations in 70 million manila file folders. (Big Brother has finally arrived!)

To its credit, the USCIS did manage to put its appointments system online a few years back (for another cool $500 mil), and those lines that snaked around several city blocks have now been reduced. Queues still exist, but people show up at appointed times rather than lining up for a limited number of seats each morning. That part is now more manageable, but the processing time is still far too lengthy.

The whole system is so dysfunctional that immigrants who get tired of the wait (or whose documents are simply lost or misplaced, rendering them a non-person) can turn to the court of last resort called (funnily) OIL, Office of Immigrant Litigation, which employs 250 lawyers and costs the government another $20 or more million a year to operate.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Did FDR Actually Prolong the Great Depression?

The liberal media are all over themselves anointing Barack Obama as not only the second FDR but also the second Abraham Lincoln (which Obama seems to be vainly promoting himself).

Since for every action there is an equal and opposite reaction, the blogosphere is already debunking FDR (I don’t think anyone would take on Lincoln). Some sites, including Motley Fool and Michelle Malkin, have dredged up a four-year-old research finding that attempted to show how FDR actually prolonged the depression by seven years, thus making it forever remembered as the Great Depression.

UCLA economists Harold L. Cole and Lee E. Ohanian, using a unique argument, claim that the National Industrial Recovery Act (NIRA) allowed companies to avoid collusion charges so long as they let wages be determined by collective bargaining. Thus, both wages and prices rose by about 25 percent, choking off both new hiring and new spending. In other words, companies acceded to collective bargaining and then colluded with one another to fix prices.

“High wages and high prices in an economic slump run contrary to everything we know about market forces in economic downturns,” Ohanian said. “As we’ve seen in the past several years, salaries and prices fall when unemployment is high. By artificially inflating both, the New Deal policies short-circuited the market’s self-correcting forces.”

It’s a fun argument, but there’s a big problem with their basic thesis. The NIRA was implemented in 1933 and ruled unconstitutional two years later.

Read “FDR’s policies prolonged Depression by 7 years” and see what you think.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Are New Minimum Wages Fueling Layoffs?

Many have argued that minimum wage laws price certain people out of the job market skill-wise and also lead to layoffs as small businesses cope with their finances and the added burden of higher wages.

In this light, it’s notable that fully 40 percent of the 693,000 who lost their jobs in the latest ADP report (November-December 2008) were from small businesses.

Arthur Bruzzone, a former California state commissioner, frequent columnist and native of the city, writes that San Francisco is really courting disaster with its minimum wage of $9.79 (one of two cities with minimum wages above $9). Team that new rate with mandates to provide health care, paid sick days and transportation assistance, and you can see that City by the Bay small businesses are headhunting–counting heads to chop off the payroll, that is.

In “City Hall’s ‘progressive’ small business mandates will now exact pain,” Bruzzone writes:

City Hall is responsible for bleeding San Francisco’s small businesses. Now the City Hall’s progressive initiatives will bring real pain to thousands of San Franciscans. Of course, those who keep their jobs will have sick leave, health care, higher hourly wages. But what of those who have no job?

Another in a series on the unintended (but foreseeable) consequences of good intentions.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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AHRQ: The (Scary) Little Agency That Thinks It Can

Can do the impossible, that is, which to prescribe which medicines and medical procedures are both most efficacious and most cost-effective. So far, I can find little proof of AHRQ’s accomplishing anything near this goal on the site of the Agency for Healthcare Research and Quality.

AHRQ is in the news since it just got a whole new set of fangs in the Obama stimulus plan (aka the Tom Daschle stealth strategy for health care reform). Rush Limbaugh and the Washington Times have equated the new powers of AHRQ to Hitler’s program of euthansia for the old, infirm and disabled of any age. These people are not productive, so why treat them and waste resources? Get rid of ’em.

Daschle, of course, is not prescribing euthansia per se, but he wants a federal agency (which is now the AHRQ, ironically started under Dubya in 2004) to determine, among other things, when someone in the last stages of life should be denied services and asked to give up the ghost. Daschle says that seniors should gladly accept “hopeless diagnoses” and “forgo experimental treatments,” except when it comes to pols like himself who will get the gold standard of cradle-to-grave health care. (Can you imagine Ted Kennedy’s being denied brain-tumor surgery last year even when a majority of doctors proclaimed it a waste of time and money, which they actually did?)

I keep bringing up Daschle’s name because it was his prescriptions for a federal agency to determine most cost-effective treatments and to track everyone’s health care through electronic records that was slipped into the stimulus bill under the innocuous-sounding name of the Health Information Technology for Economic and Clinical Health (HITECH) Act–and then rushed into law before anyone had a chance to thoroughly read it.

Except Betsy McCaughey, former lieutenant governor of New York who’s been tracking health care matters, when she did read it and warned that you can “Ruin Your Health With the Obama Stimulus Plan,” especially if you’re a senior citizen.

Is the AHRQ really that scary and powerful? Not yet. I read through some of its Web site pages and found nothing revolutionary. In fact, it looks to be an impossible task for any person or agency to make valid health care cost-containing assessments. The best AHRQ could do was to compare findings of 61 studies on treating hypertension and to conclude that both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are equally effective, though the former have generic brands available while the latter don’t, yet.

Which means that the best anyone is going to do in measuring effectiveness in health care is to rule out quackery–and then just to rule out high-cost medicine, with a few rare exceptions (Daschle and company). Which is where it all really gets scary–down the line in the future when Obama and others call it a “health care crisis” and “we have to act now.” Wham, bam, no more angioplasties (fill in the blank) after age 62 (fill in the blank) and so on.

What really got me scared came when MSNBC’s Keith Olbermann, who’s never gotten any fact or issue correct in his life (except baseball arcana), felt compelled to devote a whole show to “debunking” the charges by Limbaugh and McCaughey.

McCaughey’s response? “Let’s hold a debate.”

Problem is, people like Olbermann don’t won’t a debate–they want a crisis, real or imagined.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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