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12
Right now if you’re a Medicaid patient or are a nurse or a nurse’s aide who cares for a patient you’re facing hard times – your medical care’s being cut or your hours are being cut or your pay’s being cut, by Craigan Gray Medicaid Director at DHHS.
 
But if you’re one of the legion of ‘management companies’ who lobby DHHS for contracts it’s boom time. Take CCME – The Center for Carolina’s Medical Excellence (formerly known as the Medical Review of North Carolina) – one of Secretary Cansler’s old clients in the days when he was a lobbyist.
 
CCME is DHHS’s version of an HMO. It doesn’t provide an iota of care for patients. Instead, it’s a ‘gatekeeper’ managing part of the state’s Medicaid Home Care Program for DHHS. And while DHHS is cutting wages to nurses and aides who do actually care for patients it just gave CCME a whopping 29% fee increase. CCME now gets paid more for a few hours work than a home care provider earns in two weeks.
 
On top of the fee increase, Secretary Cansler’s Department also just awarded CCME three new contracts – one for $8 million, one for $5 million and one I haven’t figured out the cost of yet.  So, in the middle of the recession CCME’s fees going up 29% and new contracts are pouring in thanks to Secretary Cansler’s new policy of his Department handing out no-bid contracts.
 
Now some folks might see cutting pay to people who actually care for patients while paying corporate managers more looks like misplaced priorities – but not the folks at DHHS.
 
At DHHS that’s what passes for common sense.
 
 
 

 

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12
The Big Dog’s got the scent. Democrats should pay attention.
 
For all his faults, Bill Clinton has one of the best noses in politics. And this week he gave Senate Democrats exactly the right strategy for passing health-care reform:
 
It’s the economy, stupid.
 
That is, reform will help the economy by slowing down rising medical costs and covering uninsured Americans.
 
For all his strengths, President Obama hasn’t made the economic case yet. Here’s one time he should listen to Bill.

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11
I was never sure Cal Cunningham was totally committed to running for the Senate. Now I’m not sure he’s committed to sit it out.
 
A Machiavellian part of me suspects his withdrawal could be a ploy aimed at the Democratic Senatorial Campaign Committee.
 
The DSCC has been waiting – it seems like forever – for Bob Etheridge to make up his mind about running.
 
As I’ve said before, giving up a safe congressional seat for a risky Senate race doesn’t strike me as Etheridge’s style.
 
Two years ago, Kay Hagan dropped out of the Senate race when the DSCC was courting Grier Martin. When Martin passed, the DSCC went back to Hagan on hands and knees.
 
Maybe Cunningham is positioning himself for that two-step. If he is, my estimation of him will go up.

 

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11
 
Since he’s a former health care lobbyist I guess it’s not surprising Secretary Lanier Cansler has decided to run the Department of Health and Human Services as if, well, it was an HMO or an insurance company.
 
Of course, the thing folks hate most about insurance companies is simple: When they go to their doctor, he says, You need this treatment, then, an insurance company bureaucrat tells them, You don’t need that treatment and, what’s more, we’re not paying for it.
 
Turning DHHS into an HMO is an odd thing for the liberals in Governor Perdue’s Administration to see as a good idea – but that’s what’s happening right now.
 
Step #1 is handing out $250 million in no bid state contracts, including contracts to companies to a lot of the same people Secretary Lanier Cansler used to be friendly with in his lobbying days. For instance, in recent weeks DHHS announced it’s given four huge state contracts to CCME, a firm Secretary Cansler’s former lobbying partner works for. Cansler gave another contract – for a whopping for $23 million – to a Tennessee company called Med Solutions.
 
What Secretary Cansler wants Med Solutions to do is pure HMO: If a Medicaid patient goes to his doctor and the doctor tells him he needs a CAT scan, MRI or ultra sound, Med Solutions is going to decide whether he gets it. And here’s the caveat: Secretary Cansler is going to pay Med Solutions more money each time it tells a patient, No. So if you’re a Medicaid Patient and your doctor tells you that you need a CAT Scan whether you get it or not is going to be decided by a corporate bureaucrat in Tennessee who makes more money if he turns you down.
 
Anybody want to predict what’s going to happen?
 
None of this seems to set off alarm bells with the bureaucrats at DHHS or anyone else in the Perdue Administration – Secretary Cansler just continues to blissfully pass out no bid contracts with the same sang-froid he had last summer when – in the middle of the budget crisis – he spent $38,000 to buy crab pots to set a handicapped man up in the fishing business.
 
It’s like it’s never occurred to Secretary Cansler or anyone else at DHHS one day all these chickens are going to come home to roost and they’re going to have another boondoggle on their hands, like the one they created a few years ago (when Cansler was Under-Secretary) that led to the mental health care meltdown that cost taxpayers $400 million.
 
 

 

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10
Life as a moderate Democrat in North Carolina isn’t for the weak of heart.
 
Like England in the ‘60s, it’s the Mods versus the Rockers. But these Rockers come at the Mods from both sides: the Obama disciples on the left and the Rush-Beck wrecking crew on the right.
 
Larry Kissell voted against the health-care bill. The House leadership may have given him a pass – unless they really, really needed him to pass the last bill.
 
Bob Etheridge voted for it. He had little choice. He’s part of the leadership.
 
Kay Hagan is in the cross-hairs now.
 
In Raleigh, one rumor is that Tony Rand grew tired of refereeing the moderate-liberal battles in the caucus.
 
Vote for Obama and incur the wrath of the right? Or vote with him and gamble that the legions of voters Obama turned out in 2008 will be there in 2010 or 2012?
 
Maalox, please.

 

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09
They’re a lot of things going on at DHHS that are just plain odd, even for a state agency. For instance, Governor Perdue put a health care lobbyist in charge of DHHS’ budget – which includes granting billions in health care contracts.
  
Then the lobbyist – Secretary Lanier Cansler - put a gynecologist in charge of running the state’s Medicaid program. Then the gynecologist (who in fairness is also a lawyer) turned out to be an apparatchik capable of sitting in an office all day pouring over reams of statistics and reports then flicking a pen and issuing missives that send ripples through the lives of North Carolina’s 1.5 million Medicaid patients.
 
For instance, Medicaid Director Craigan Gray recently flicked his pen and cut medical care to low income pregnant women and troubled children 40% – that created such a rhubarb even North Carolina’s own version of a health care Czar had to beat a retreat.
 
But not for long. A few days later Director Gray flicked his pen again and this time it looks like he’s created an even bigger rhubarb: Because he’s cutting care for patients in Medicaid PDN (Private Duty Nurses). What’s Medicaid PDN? It’s a tiny program that only cares for 350 patients but they are among the sickest people in North Carolina – they suffer from MS, Cerebral Palsy, Lou Gehrig’s disease and other less known malady’s like Apert’s Syndrome and Pierre Robbins Syndrome – they’re paralyzed, have tracheotomies, use ventilators and are fed through tubes and many are infants and young children.
 
Here’s one example: Nathan is an eleven month old infant born with a chronic brain disorder. He can’t eat or breathe on his own and has up to 25 seizures a day.
 
 
The only reason he can stay at home – instead of spending the rest of his life in a Nursing Home – is because Medicaid provides a home care nurse to help his mother look after him.
 
As soon as Tim Rogers, head of the Home and Hospice Care Association, heard Director Gray was cutting care to these patients he went to see Secretary Lanier Cansler and asked him to reconsider. And, in response, Secretary Cansler said he was shocked and he’d sure look into it.
 
Then a couple of days later Rogers received an email from Dr. Gray who told him bluntly in no uncertain terms that providing home care nurses was costing the state $900 a day while putting patients – like Nathan – in an institution only costs $450 a day.
 
Now Director Gray’s math’s shaky. No Nursing Home can provide 24 hour a day nursing care to an eleven month old infant with chronic brain damage for $20 an hour. In fact, if Director Gray takes away his home care nurses Nathan is going to end up in a hospital intensive care ward and Director Gray is really going to learn the meaning of soaring medical cost.
 
But that’s not the point: The point is staring at his rows of statistics Craigan L. Gray missed something no number can define: He sees nothing wrong with taking patients – like Nathan – out of their homes where their mothers can help care for them (at least for part of the day when they’re not working) and putting them in institutions.
 
I’m all for cutting government waste but sometimes doing it takes a little more thought than staring at rows of statistics and adding up numbers and flicking a pen.
 
For example, right now, North Carolina is one of just six states without a Medicaid ‘Preferred Drug List. What’s a ‘Preferred Drug List’? It’s simple: It encourages the use of generic instead of name brand drugs. Director Craigan L. Gray’s North Carolina Medicaid program spends a billion dollars a year on drugs – and using generics would save $89 million.
 
Of course, the Pharmaceutical Companies don’t want a ‘Preferred Drug List’ and they’ve fought it tooth and toenail. In fact, Pharma, the Pharmaceutical Industry’s political arm has hired Gray’s bosses – Secretary Lanier Cansler’s – wife’s law firm to lobby for their interests in state government.
 
So, here’s a pretty clear example of the looniness in DHHS: Using generics would save $243,835 a day. But Craigan L. Gray’s bent on putting patients with MS and Lou Gehrig’s disease in Nursing Homes to save $450 each.

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09
My old friend and North Carolina native Harrison Hickman, a Washington pollster, has written “a 2010 survival guide for Democrats”
 
He writes that, “Survival is possible even in the worst of climates, as many Democrats in 1984 and 1994, and many Republicans in 1986 and 2008 have shown.”
 
Here’s his first prescription:
 
“Get real. 2008 didn’t change politics. Voters and the party’s image are much like they were before. Republicans have slipped but not enough to ensure victory. If President Obama has magical dust, he’s more likely to save it for 2012 than sprinkle it on you.”
 
Hickman is one of the most clear-eyed political analysts I’ve ever known. I invite Democrats (no Republicans please) to pay attention.

 

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09
Over the summer I did TV ads and Internet videos for the Association for Hospice and Home Care and, in the process, got a close up look at the inner-workings of the Department of Health and Human Services – which has to be the looniest department in state government.
 
I guess the best example is Secretary Lanier Cansler – back in the middle of the state budget crisis – buying $38,000 in crab pots to put a disabled man in the fishing business on the theory it was vocational rehabilitation.
 
And there are a lot of other things going on at DHHS that are just plain odd – and most go back to Governor Perdue’s budget.
 
It’s an odd thing for a liberal Democrat to do but Beverly Perdue decided to cut Home Care for elderly Medicaid patients $160 million (or 40%). But, right off, the Governor encountered a big problem. Because Medicaid Home Care is an entitlement program the state’s legally bound to provide care to every patient who’s eligible. So to cut 40% – or the equivalent of 15,000 patients – she needed to change the eligibility requirements. And make them tougher.
 
But the Governor didn’t do that. Because the Obama Administration told DHHS (the Department of Health and Human Services) No – and added if the Governor went ahead anyway it could cost North Carolina $2 billion the next time President Obama passed out ‘Stimulus Money.’
 
Now you’d have thought at that point the Governor – unless she wanted to risk $2 billion – would have left well enough alone and cut the new $25 million fishing pier in Nags Head and the other pork from the budget and left home care alone.
 
But she didn’t. Instead she made the $160 million cut – but didn’t change the eligibility requirements. That meant she had balanced the budget on paper – but, in reality, she had no way to cut 15,000 patients who are legally eligible.
 
It gets sillier.
 
For years, DHHS – the Department of Health and Human Services – has assessed and reassessed North Carolina’s 35,000 Medicaid home care patients and confirmed they are eligible. But now, suddenly, the Department has discovered it was dead wrong. The patients aren’t qualified. And DHHS has hired an old client of Secretary Cansler’s – CCME – for $8 million to ‘review’ each patient.
 
And here’s what’s strangest of all.
 
Before the first reviews been done DHHS has projected exactly how much money is going to be saved when CCME finishes cutting patients: Exactly $138 million.
 
Now, does that sound like an even handed review or does it sound like DHHS told CCME, Here’s the deal: We pay you $8 million and your job is simple: Come back with $138 in cuts.
 
And that leads the Governor into an even bigger problem.
 
Because every patient CCME cuts has a right to appeal. Do the math. CCME and DHHS cut 15,000 patients who’re legally eligible – and there’ll be thousands of appeals. It’s a lawyer’s dream. There’ll be enough appeals to clog state agencies and courts for years and cost millions of dollars and while the appeals are being heard every patient has the right to continues to receive care. And when the appeals are done every legally eligible patient will be reinstated.
 
So instead of saving millions Governor Perdue’s creating another boondoggle, not unlike the mental health meltdown the same DHHS bureaucrats created a couple of years ago that cost taxpayers $400 million.
 
So let’s sum up: The Governor passed a budget that wasn’t balanced, now has to end run the law to cut $138 million, is about to clog the courts with appeals and when all’s said and done it will cost the state millions.
 
And, right now, that’s the plan the looniest Department in state government is working day and night to implement.
 

 

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06
Over at the Department of Health and Human Services Secretary Lanier Cansler has been lamenting that he’s got to cut $4 billion or $1 billion (the number seems to change from day to day) from his department’s budget.
 
When you think about it it’s an odd thing – but the liberals in the Perdue Administration have decided to cut medical care (especially Medicaid) to everyone from pregnant women to troubled children to senior citizens who receive home care so they don’t have to go into Nursing Homes.
 
So given all Secretary Cansler’s complaints about the dire financial straits of his Department it comes as shock to open the newspaper this morning and read he’s sending a troop of sixteen bureaucrats on a two-week sojourn to San Diego, paid for with $140,000 of President Obama’s ‘Stimulus Money.’
 
When the story hit the front page of the News and Observer Secretary Cansler’s P.R. machine went into high gear, waxing eloquent and telling the press how much benefit North Carolina children were going to reap from sixteen bureaucrats attending a child care seminar in sunny San Diego. But the News and Observer gave them a pretty blunt answer, pointing out there are 41,000 children (from low-income families) the state says it can’t provide financial aid to so they can receive day care.
 
Cansler’s decision puzzled even Governor Perdue’s fellow liberals and left child care advocates shaking their heads. As one told the News and Observer, “It seems like they have it backwards.”
 
But Secretary Cansler’s P.R. machine had an answer to that too. They explained Secretary Cansler had no choice, that the federal government wouldn’t let him spend the money to provide day-care to children from low income families – so he spent it on the trip to California instead.
 
So let’s get this right: President Obama forced DHHS to spend stimulus money on junkets for bureaucrats – rather than on providing child care?
 
That’s hard to believe.
 
Maybe the bureaucrats in Washington are as crazy as the bureaucrats in Raleigh but I can’t help but ask if anyone at DHHS – or Governor Perdue herself – called the White House and said, Look, we’ve got a better idea about how to spend this money – so let’s work it out.
 
DHHS is a pretty odd place so maybe it’s fitting it’s located on the old Dorothea Dix campus. Last summer in the middle of the budget crisis Secretary Cansler spent $38,000 to buy 1,100 crab pots to set a disabled man up in the fishing business as part of a vocational rehabilitation program. Now, he’s spending $140,000 to send bureaucrats to San Diego to improve child care.
 
Welcome to how government works over on the Dorothea Dix Campus.
 

 

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06
Democrat Creigh Deeds’ disastrous campaign for governor of Virginia may give North Carolina Democrats a foretaste of 2010.
 
 
“Faced with the choice of running as an unapologetic Democrat in a state trending toward his party or keeping his distance from Washington in the fashion of a generation of Southern Democrats, Creigh Deeds tried to do both.”
 
That’s the dilemma Democrats here – from the legislature to the Senate – will face next year.
 
Traditional pro-business Democrats – like the current Senate leadership – will argue that the path to victory is the same here as it’s been since 1976: down the middle of the road.
 
Younger, more liberal Democrats will say no, the party must excite the young voters and minority voters who carried North Carolina for Obama in 2008.
 
My sense is that, right or not, the party is headed left.

 

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