What you can expect with government health care

After Obama succeeds in destroying your current health insurance plan by making it too expensive for small and midsize businesses, what can you expect from the federal government when your employer catches on? It won't be what our elected officials, or civil servants, or even Medicare recipients currently get (although that's about to end). Or even what 3.3 million Native Americans and Alaskan First People get, who have cradle-to-grave care and yet have the highest disease burden and the lowest life expectancy of any U.S. group (how's that plan working). We're about to see one of the biggest give aways to any special interest group (medical technology) from ARRA (stimulus package)--$20 billion--and I know that's just the beginning price tag. I don't know as I'd call those "shovel ready" stimulus jobs or not--the tech field was doing just fine, I thought, with entrepreneurs like Bill Gates and the Google Guys. If you've ever worked with computers, you know the constant upgrading, not talking to each other, and screw ups that can happen. Especially if the government is doing it (I've lost track of the times my identifying information (state of Ohio) has been lost to a hacker or someone taking home a gov't computer that shouldn't and having the computer stolen out of the back seat.)

But back to the Indians and their care givers--I wonder how the IHS will be able to squander the ARRA funds?

"Since June 2008, when Indian Health Service (IHS) officials agreed to implement more stringent controls over property management, the agency has lost about $3.5 million in equipment, according to a Government Accountability Office (GAO) report released on June 2 (http://www.gao.gov/new.items/d09450.pdf).

According to the report, missing items included an ultrasound unit (valued at $170 000), an x-ray mammography machine (valued at $100 795), dental chairs, cardiac and vital sign monitors, and a pharmacy tablet-counting machine.

The GAO criticized IHS for taking few steps to ensure that its employees are aware of and complying with property policies. It also suggested that the agency failed to hold individuals accountable, noting that the executive in charge of the agency's property group and other areas was given a $13,000 bonus after a GAO report issued last year found that an estimated 5,000 items with an acquisition value of $15.8 million were reported lost or stolen in fiscal years 2004-2007. Mike Mitka, JAMA, July 8, 2009, p. 136.

And although the government disapproves of businesses giving out bonuses to executives for incentives if the business is losing money, it doesn't mind giving bonuses through its own agencies and programs which are notorious spendthrifts and seem to have gotten us into this pickle, which the government now claims it is going to solve by throwing more money into the laps of the same people! This is not new to the Obama Administration. Before, Obama Bush was the all-time big spender President--Obama has made him look like a penny pinching piker.

"The federal government plans to kick its purchasing power into high gear by offering Medicare and Medicaid bonuses to physicians and hospitals that demonstrate "meaningful use" of interoperable, certified EHRs starting in 2011. The stimulus package also provides billions of grant dollars to federal and state organizations for research and the promotion of health-IT adoption." Government technology

I'm all in favor of incentives--but only in private hands. But guess what else is wanted with that $20 billion from the tax payers? Your patient data. Ah, yes. They are salivating over that--and not for you, oh no, but for the "common good" . . . "the collection of aggregate patient data that could vastly improve patient safety, public health monitoring, and medical knowledge. Kind of HIPAA in reverse, I think. There is also a proposal being floated that we not have a choice about participating in medical research (as a control, as a donor, etc.) "The Obligation to Participate in Biomedical Research," JAMA, July 1, 2009 p. 67. I thought it was about the scariest thing I'd ever read combined with the med tech rec threat. The authors, Schaefer, Emanuel and Wertheimer, called reluctance or refusal to participate, "free riding." In other words, your DNA, your experience, or your sick child are just so much gravel to pave the road to losing your freedom. It could be a trade off for the charitable deduction which will probably be taken away (Biden and Obama really didn't use those much anyway)--donate at the lab instead of church.

Another medical boondoggle in the ARRA is $1 billion to support comparative effectiveness research. I'd call that a jobs program for researchers who didn't get medical degrees comparing this device to that device, practice A to practice B, therapy Y to therapy X and then filing for more grant money when no one pays attention.

Year end stories

As an information junkie and recovering librarian, I live for these. Especially the science "break throughs." They almost always confirm my own 6-day creationist beliefs, whether they are micro or macro. "In the beginning God. . ." But here's an interesting sociological "year end" bit of research--about how people might perform to win that end of the year bonus.

Judi McLean Parks and co-author James W. Hesford had a hunch that compensation packages had something to do with the rising tide in fraud, estimated to total $994 billion annually in the U.S. Specifically, they suspected the type of compensation plans--contingent versus non-contingent--(and the form of that contingency, as a bonus or penalty based on performance), might be related to fraudulent reporting and the misappropriation of assets.

To test their hypothesis, McLean Parks and Hesford conducted a controlled laboratory study using a random sample of students who were paid for solving anagrams according to one of three different compensation plans, although in all cases the expected value of the compensation--regardless of the form of the compensation--was identical. The students self-scored their work and in half of the cases signed a statement attesting to the veracity of their reported results.

� Participants receiving a 'flat salary' for their work were the most honest about reporting their scores.

� Many participants who received a performance based bonus cheated when reporting their results.

� Participants who were penalized based on low performance not only cheated but also stole the nice pens that were to be returned at the end of the study!

McLean Parks believes the study's results have implications for CEO compensation plans and the financial difficulties many companies are experiencing today. "All I have to do is look at Enron, Fannie Mae, Freddie Mac to know that this does happen. And now we've demonstrated the causal link to contingent pay." Fraud uncovered at Fannie Mae alone from 1998-2004 has been estimated to be in excess of $10.6 billion."

So a fair salary with no year end bonus, even for the big wigs? Could it stop corruption? From clerk-in-the office to CEO, I suspect no one will buy it. Even the secretaries in Dreier's law firm were making $200,000 a year. That's a huge temptation not to blow the whistle and go back to $40,000.

There's too much common sense in this research. Let me count the ways--they too are all Biblical. Greed, envy, and pride; lying, cheating and stealing; waste, sloth and addictions; anger, hate and licentiousness. Full news release at Science News Daily.