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18
 
Here’s another odd story about how the Department of Health and Human Services works.
 
Early in the Easley Administration, when Lanier Cansler was Assistant Secretary, the department decided to ‘Reform Mental Health’ in order to save taxpayers money and provide better care.
 
About the same time Assistant Secretary Cansler was handling bidding out a $265 state contract for DHHS. Later, after the ‘Mental Health Reform’ plan got rolling, he decided to leave the department to go to work lobbying for one of the firms bidding on the $265 million contract.
 
That left the folks in the Mental Health Department carrying out the reforms, including Deputy Director of Mental Health Tara Larson – then Ms. Larson landed in hot water for running up 6951 minutes of cell phone charges making personal calls on her state phone. The department’s solution was to move her into the backwaters of DHHS where she spent the next few months lying low.
 
Next, after Cansler and Larson departed the scene, ‘Mental Health Reform’ turned out to be a disaster. It left the state’s mental health care programs in a shambles and cost taxpayers a whopping $400 million.
 
Now you might have thought that might leave the ‘Reformers’ – including Cansler and Larson – behind the eight-ball. But it didn’t.
 
When Governor Perdue was elected she promoted Ms. Larson to Deputy Director of DHHS $12 billion Medicaid department and made Cansler Secretary of the whole department.
 
So now the folks who reformed ‘Mental Health’ are running Medicaid and, on top of that, three months after the Governor made him head of DHHS Cansler’s department awarded the $265 contract to his former client.
 
Now the question you might ask is: Does anyone in state government have a lick of common sense?
 
And the answer is: Well, yes. If you look at it from their perspective.
 
If you’re the Director of a state Agency and another director or deputy Director – like Ms. Larson – gets in trouble common sense comes into play real quick and what it says is: The same thing could happen to you. So to Ms. Larson’s peers Governor Perdue rescuing her with another state job has a soothing feeling about it.
 
And what if you’re Secretary Cansler? Well, with Governor Perdue looking like an odds on favorite to be a 1-term governor common sense may be whispering to him, You’d better stay friendly with your old clients – because he may be back in the lobbying business sooner than he anticipated.
 
In fact, the only person who’s not showing much common sense is Governor Perdue – who’s got a problem her deputies and Cabinet Secretaries don’t. She’s got to face voters in three years. And what common sense may be whispering to them is, We’ve had enough of running state government like a three-ring circus.
 
 

 

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17
Back in August in her rush to pass the budget and get the legislature out of town, it looks like Governor Perdue slipped up and pulled a number out of thin air. What the Governor did to balance the budget (at least on paper) was tell legislators she was going to cut the Department of Health and Human Services budget $400 million.
 
Only she missed one fact: DHHS runs entitlement programs: Like Medicaid. And by law if someone’s poor and sick and needs help the state can’t just cut their care. The only way to cut Medicaid is to change the law to take away the entitlement.
 
But the Governor (and legislators) didn’t do that.
 
Which leaves Medicaid Director Craigon Gray wrestling with the knotty problem and it looks like he’s come up with sneaky solution.
 
Director Gray has decided thousands of Medicaid patients – who his department’s been saying for years are entitled to care – are not actually eligible.
 
Now, in the real world, discovering ten or twenty thousand Medicaid patients don’t need care would be a welcome savings – except this revelation isn’t the result of welfare reform. Instead it’s the result of the Governor’s $400 million mistake and the poor folks on Medicaid just happened to be standing in the wrong place at the wrong time – and eligible or not they’re about to get cut.
 
Worse, what’s going to happen when Gray executes his plan is going to be a huge train wreck – at taxpayers’ expense.
 
To put a fig leaf on his cuts Director Gray’s paying $24 million – to a former client of Secretary Cansler’s – to review every patient in one program, Medicaid Home Care. What’s odd is that even before the first patient’s been examined Director Gray’s already announced the results: The study will find 40% of the patients are ineligible. And he’ll cut, he says, exactly $138 million.
 
And here’s what is going to happen then: Every patient Director Gray cuts – by law – has a right to appeal. There’ll be appeals and lawsuits out the wazoo and when there’re done there’ll probably be the same number of patients on Medicaid as there are now – except taxpayers will be out the $24 million Director Gray paid for his study, plus untold millions in legal fees.
 
Oh, yes, and while Director Gray is telling folks he’s got to cut care to patients with diseases like Muscular Dystrophy – Secretary Cansler spent $140,000 to fly 16 bureaucrats to sunny San Diego for two weeks for a conference.
 
 
 

 

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16
 
Back in 1984 when Governor Hunt fessed up to making political trips on the state airplane and reimbursed the state $180,000, Tom Ellis, the attorney running Jesse Helms’ campaign to defeat Hunt told me, You know, give a politician a free airplane and he’ll hang himself every time.
 
It turns out – for Secretary Lanier Cansler – a state automobile is pretty deadly too.
 
Secretary Cansler has been moaning about how his department is strapped for cash and telling folks how he hates like the dickens to cut medical care for elderly Medicaid patients and children but what can he do – there’s no money.
 
Cansler’s department’s so strapped for cash the other day one of his employees called the mother of a child with Muscular Dystrophy (who gets in-home nursing care through a Medicaid program) and asked her to voluntarily agree to cut her daughter’s care 50%. When the mother said it didn’t look to her like that was possible Secretary Cansler’s aide bared her fangs and let fly saying either the mother ‘voluntarily’ accepted the 50% cut or she (Cansler’s aide) was going to ‘officially’ recommend a deeper cut. The mother got that message: She had to either say yes or hire a lawyer and fight the entire Department of Health and Human Services by herself.
 
So to hear Secretary Cansler tell it DHHS is broke – except for one problem. A story on WRAL-TV the other night that revealed Secretary Cansler has 1,023 automobiles under lease for his department and just paid a whopping million dollars for unused mileage. In other words DHHS leased the cars, didn’t use them and still had to pay for them.
 
Which leaves Lanier Cansler facing a mess – because now he’s got to explain why he’s cutting nursing care to a child with muscular dystrophy while paying a million dollars for cars sitting in a parking lot doing nothing.
 

 

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13
The famous Boss Plunket of Tammany Hall, explaining his singular talent for getting the most out of politics (and what he called “honest graft”), told his biographer, ‘I just seen my opportunities and took ‘em.
 
At first glance Boss Plunkett, who was a colorful New York Irish politician, and DHHS Secretary Lanier Cansler, a buttoned down Raleigh lobbyist, don’t appear to have much in common. But consider this:
 
March, 2009: Secretary Cansler’s Department awards CSC Corporation a $265 million  state contract, and CSC announces Cary’s SAS Corporation will be joining its team to work for Cansler’s department.
 
The former lobbyist for both CSC and SAS: DHHS Secretary Lanier Cansler.
 
August, 2009: Cansler’s department awards Med Solutions of Nashville, Tennessee a no-bid contract to manage $230 million in Medicaid business;Med Solutions announces Dataflux – a SAS subsidiary – will help with the state work.
 
SAS current lobbyist – Secretary Lanier Cansler’s wife’s law firm.
 
August, 2009: Two years ago CCME Corporation paid Secretary Cansler’s lobbying firm $93,000. On August 27 of this year CCME re-hired Cansler-Fuquay Associates, Secretary Cansler’s old firm.
 
October 27, 2009: Two months later CCME receives $24 million in no-bid state contracts from Cansler’s department.
 
Boss Plunket would be proud.
 
 

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13
I’m all for having regular guys and gals in high office. But this is too much.
 
The New York Times reported this anecdote in a story about Federal Research Chair Ben Bernanke lobbying against bills aimed at the Fed:
 
“At one recent meeting, Senator Sherrod Brown challenged Mr. Bernanke’s bona fides as a regular guy by giving him a pop quiz on baseball statistics. Mr. Bernanke, a passionate fan, passed.”
 
I like baseball. I stayed up way past my bedtime to watch the Yankees win the series. But I don’t care if the chairman of the Fed knows the first thing about baseball. Instead, I hope he knows something about the economy and interest rates.

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13
 
It turns out Craigan L. Gray, the MD and JD (lawyer) and newly appointed Director of Medicaid is pretty thin skinned.
 
When Tim Rogers – head of the Association for Home and Hospice Care – asked Secretary Lanier Cansler to reconsider Gray’s cuts in a tiny Medicaid program that provides nurses to care for 350 patients who have MS, Cerebral Palsy and other crippling diseases Gray erupted and fired off an email to Rogers reprimanding him, saying he found it just plain difficult for him to hold ‘constructive conversations’ with Rogers because of ‘constant background chatter and threats of lawsuits.’
 
What Gray means by ‘background chatter’ is he doesn’t like Rogers publically criticizing his policies.
 
But Rogers has a point – Gray’s cuts are going to make life harder for a lot of sick and frail people. And Rogers had a point last summer when he threatened to sue Gray’s Department because it failed to respond to his freedom of information act requests.
 
What happened back then is instructive: Rogers asked for information about a state report (which later turned out to be inaccurate) Gray had given State Senator Doug Berger. In response, one of Dr. Gray’s top aides said her emails had somehow ‘migrated’ out of her computer, so she couldn’t provide them. The emails have never been seen again.
 
Later, when State Senator Doug Berger tried to cut Medicaid home care (a program that actually saves taxpayers money by keeping patients out of Nursing Homes) 60% based on Gray’s inaccurate report, Rogers spoke up and said, Wait a minute. Those statistics are inaccurate and the Department ought to set the record straight.
 
And, in fact, it later came out that Secretary Lanier Cansler had actually warned Berger about the problems with the report.
 
But, in the end, none of that mattered. Gray wrote his buddy Berger and said he and Berger had both been ‘slurred’ by Rogers and Berger went ahead and made the cuts.
 
Follow the logic: Director Gray gives Berger an inaccurate report. Tim Rogers proves the report is inaccurate. Then Gray says Rogers has ‘slurred him.’ And Berger cuts 15,000 patients’ home care.
 
And here’s what’s even more incredible: Right now, today, Gray is using the same inaccurate report to cut care again. As I said, DHHS has to be the looniest Department in State Government.
 

 

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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
 
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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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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