Arizona’s Medicaid Cuts On Transplants Is A Classic Example of Decisions Not Based on Medical Needs But Rather Budget Only
Posted Dec 05 2010 2:21am
What is also interesting about this story too is the fact the the Arizona Governor has isolated herself from comments and the press on this situation as it is dead wrong to be making life and death decisions based strictly on a budget. I have several doctors write to me over this situation that were outraged as they stated transplants can and do work for those who have other chronic conditions. It’s a total lack of ethics and for saving a life.
Arizona seems to have created their own “death panels” and certainly there are times to look at the big picture but not at this level. The algorithm folks were wrong and anger from this is not going to diminish anytime soon. One man who was waiting for a transplant has since died. How do people making such decisions sleep at night I ask? There are other areas of a budget that could be considered to be cut without these measures.
What also gets to me is the fact that Health IT spending is at an all time high and there’s a lot of areas where private industry makes millions by using data base information from government agencies too, all they do is write and publish some algorithms and make millions. Read this book if you are in the dark as those algorithms are used for decision making processes for budgets and it’s the interpretation and use of the data that is the problem. What we have here is the “dark side” of mathematical formulas interpreted wrong, ethically wrong.
MSNBC did a full video and story on this topic as well.
The governor will not call a special session and there are 98 others in the same situation as the people shown in this video. Below is the post from earlier this week.Arizona Access had 2 companies provide them with statistics to make these decision on transplants.See how powerful these algorithms are that compile data are and they don’t contain ethics issues.
Arizona has also cut Medicaid compensation to doctors and if it is anything like here in California, it will be hard to find doctors who will take Medicaid patients. I hear that from doctors here all the time with the difficulty of finding doctors who will accept that level of payment. Arizona has also eliminated coverage for emergency dental procedures, insulin pumps and orthotics.
The Kaiser Commission of Medicaid and Uninsured was the association that brought up the fact that decisions made only by budgetary considerations is resulting in denial of care. It is sad to say, but many private insurers are right in here too with creating new algorithms for coverage, and some have been in the news big time where people have died. On the other side of the coin we have mismanaged data to where the City of Buffalo paid over 2 Million dollars in health insurance premiums for “dead” employees too, so how good are these folks at budgeting? Those patients in Arizona could have used some of this money and funny that in 2 years that the health insurers were not asking for mammograms or other preventive information on the “dead employees” as they are usually all over everyone's back on those issues, so this was 2 Million dollars of easy money for the insurer and now the City does not know if they can get it back.
The financial part of healthcare is what really needs to be streamlined with cuts made there on price and they should be working closer with device and drug companies to help keep costs down as we have almost hit the bottom of the barrel with hospitals (as around 55% are in the red today in the US) and many doctors are considering leaving their practices, especially if Medicare rates are dropped any lower, and we have our illustrious Congress to thank for that issue which needs news laws to be changed.
Here’s one big perfect example of big business making millions with running web data services that rank doctors and it is not even accurate as you can read how I found my former MD, who had been dead for over 7 years still listed. They take state medical board data with insurance company data, query it and put up a website for consumers to find information and they rank hospitals. Just recently the company was sold to a private equity firm, Vestar after a long roll on Wall Street. The only work they did was with running some algorithms and creating a web site and they made millions.
Subsidiary Watch – The private equity firm of Vestar has over 7 billion in assets and under management. There are several healthcare companies already included in their portfolio and the combination of information data bases and business structures could be right around the corner. We are seeing business models connecting industries and companies that in the past would have never worked together but the big change today is that they all have “data” to work with, exchange and query for business intelligence type decisions that will lead to bigger profits by using algorithms to calculate.
This is where so much of the expense is today in healthcare in supporting the Health IT systems that keep feeding itself. We need Health IT, but not at the cost and sake of running profits on Wall Street like they do for some flimsy algorithmic data work. This is behind the scenes and a big reason why we pay so much and why so many get denied care as the algorithms can be rogue and skewed, and then like in Arizona, we have those that are “non participants” with little or no digital IT literacy making decisions that kill people when they need care. Someone told me that the Governor in Arizona was lacking a high school diploma and I don’t know if that is all truthful, but that is what the word is being circulated as it can’t be found on the internet.
Those are the wrong kind of people without the proper intellect to be making such decisions and I have also heard that her staff is pretty much a big group of former lobbyists as well. That part is nothing new with staff as Rachel Maddow informed us all about the GOP Pledge for America was written by former lobbyists of AIG, Pfizer and more. You can see the video from a few months back and she has it in black and white as they didn’t know how or forgot how to remove personal information from a pdf before releasing it, a sad state of affairs and scary as to that is what is at the top of the helm.
This sadly all comes back around that word that is center stage on my blog, “algorithms” and earlier this year I did an short interview with a Mass General Hospital magazine about “rogue algorithms” and we touched on that subject lightly, but again you need to get to the intelligence of any circle that controls the programmers that create these things, as well as the folks who use them to make decisions to get anything done.
In the case of Arizona, in my opinion, it is largely due to those making decisions outside of healthcare, and they don’t even have enough digital consumer literacy to properly interpret, that is responsible for creating these “death panels”, again I had doctors outraged writing to me that the transplants do work and there no 100% with anything but the numbers are good and many have been very successful.
How do those people sleep at night? Are they that illiterate to not understand that with all these algorithmic formulas used for budgets that there are names and lives attached to those numbers. Last year during the Senate hearings, Senator Rockefeller asked the CEO of United Health Care the same question. BD
The Arizona case, said Diane Rowland, director of the Kaiser Commission on Medicaid and the Uninsured , “is a classic example of making decisions based not on medical need but based on a budget.” And, she added, “it results, potentially, in denial of care to individuals in a life-or-death situation.”
The federal Centers for Medicare and Medicaid Services do not monitor which states use Medicaid money for transplants. But health experts said no other state had withdrawn coverage for patients pursuing transplants.
Arizona’s decision, by Gov. Jan Brewer , a Republican, and the Republican-controlled Legislature, was made after state officials assessed success and survival rates for a number of transplant procedures. National transplant groups call the figures misleading.
Jennifer Carusetta, the legislative liaison for Arizona’s Medicaid agency, said the transplant cuts would save a mere $800,000 in the current fiscal year, and only $1.4 million for a full year.