Saturday, February 14, 2009

The worst of the worst...the Ten Worst Insurance Companies in America

From John Curry, February 14, 2009
Brought to you by the American Association for Justice (formerly the Association of Trial Lawyers of America). This 29 page Adobe Download should open a few more eyes!
"How they raise premiums, deny claims, and refuse insurance to those who need it most."
Here is the link to this excellent study of how low one can go:
P.S. Can you find YOUR insurance company on this list?

TRST takes a page out of Dr. Leone's playbook?

From John Curry, February 14, 2009
Teacher Retirement System officer forgoes incentive pay
Pension fund employees' bonuses also will be deferred until investment returns improve.
By Kate Alexander
Saturday, February 14, 2009

The chief investment officer of the Teacher Retirement System of Texas will forgo his incentive pay after a burst of legislative outrage over investment bonuses at some state trust funds.
Britt Harris, who oversees the investment of the $81 billion pension fund, offered Friday to give up nearly $168,000 in incentives that would be due to him based on the trust fund's 2008 performance.
In addition, payment of the $2.5 million in incentives due to more than 80 other employees in the investment division will be deferred until the fund generates a positive return, the retirement system Board of Trustees decided in a 6-to-2 vote.
Britt Harris
System policy already delayed all incentive payments until 2010 because the fund balance had declined about 27 percent last year as the economy took a nosedive.
The hasty change to the incentive policy followed a political firestorm earlier this month over bonuses paid at the University of Texas Investment Management Co. that led to the board chairman resigning in protest.
Senate Finance Chairman Steve Ogden, R-Bryan, said he appreciated the move by Harris and the teacher pension fund. But Ogden said his "focus is not on individuals but on the way we compensate our investment managers so that we maximize the returns of the funds."
The incentive deals at the state's endowments and pension funds, all of which took big hits in the market tumult this fall, appear to encourage investment managers to take more risk while taxpayers are ultimately on the hook, Ogden said.
As chief investment officer, Harris said, he should forgo his incentive pay because he must bear a greater responsibility for the fund's recent decline than the other investment employees.
Pension fund board members lauded Harris for his "gracious gesture" even as some tried to turn down his offer.
But others said it was important that the retirement system send the message that the concerns of the state's political leaders have been heard.
"We are going to generate a lot of good will from the Legislature, the governor and the lieutenant governor. And I think that's important," said Mark Henry, a board member and superintendent of the Galena Park Independent School District.

Friday, February 13, 2009

Duane Tron to former student re: 'worthless charter schools, the biggest waste and boondoggle, of public tax dollars in Ohio'

Duane Tron to Congressman Jim Jordan, February 13, 2009
The charters' sponsor throws up the smoke screen and attempts to come in the back door....
I loved this article! It really starts getting to the nuts and bolts of Ohio's worthless charter schools and the scam they've been running and calling education. If your buddy David Brennan has to close up shop it's going to put a dent in your campaign war chest isn't it? Jim, we didn't vote for Obama at our house because we find him and his ideology quite scary but for the first time in our lives my wife and I voted for a Democrat for governor of Ohio. In fact I know a ton of Republicans who defected and voted for Strickland and we're going to support the dismantling of the charter school fraud that has been taking place under the guise of improving public education through competition in Ohio. Jim, charters have never posed any real competition to public education as far as educational value provided to each child. I was able to access some of Brennan's charter schools in Ohio, through close friends who worked in them, and they are a farce, a total waste of taxpayer dollars. Students were sitting around doing nothing. They would have one instructor, often not even certified in education, trying to work with two dozen students at different computers and nobody knew what they were doing. Three former directors told me that the bottom line was the number of students they could enroll. All of them told me that after they enrolled students the majority only attended less than half the time and when they did come to class they did NOTHING but disrupt and waste everyone's time. And you and other conservative Republican's try and tell us this is quality education?? You try and tell us this provides a better alternative to public schools? Jim, I'm a very well educated man with nearly 40 years as an educator and I know the difference between quality education and educational fraud.
You claim to be a fiscal conservative, a watchdog, of the public's money! Jim, I agree with your opposition to the stimulus package because I understand it's not going to do anything to permanently stimulate the economy! It's a major waste of taxpayer money and resources. On a smaller scale, it's kind of like the charter schools you so fervently defend and support. Does this make you a hypocrite?? How can you oppose waste of public tax dollars on one front and support it when it comes to Brennan making large donations to charter school supporters. Doesn't this smack of the "good old boy" special interest crowd you publicly and vehemently denounce? You claim to oppose the waste of our tax dollars and charter schools are one of the biggest wastes of tax dollars in Ohio. As a taxpayer I can assure you we aren't getting anything close to what you and your special interest friends have been peddling and that is the idea that charter schools are good and are helping kids. They aren't good, they aren't helping kids, they aren't helping improve education in Ohio, and they have become a drain on necessary tax dollars needed to improve existing schools. For the past eight years I have served as principal of a faith-based after school program, for at-risk, children in grades 1-3 from Springfield City Schools. None of us are working for the money. We are committed to improving public education and helping children become successful students in their regular schools. We scrounge and beg for every dime we get to help kids. We give our own money to make education work. In the past four years since we've partnered with Springfield City Schools we've raised proficiency test scores, on the fourth grade proficiency tests, from academic emergency to continuing improvement, in three of ten buildings and this year another three buildings may make the jump. And we do this with committed volunteers, part-time teachers, retired teachers, and retired administrators such as myself. You see unlike your buddy, Brennan and the scam he runs, we are doing what we do for the good of the community, our state, and the nation. We are presently serving 117 children because it's what needs to be done.
Let me point out that you, Jeff, and Jenny all profited quite admirably from your public education experiences! Polly and her brothers all did quite nicely as a result of their public education experience as well. Then after you placed your children in the public schools Rachel, Ben and the others have all benefitted from attending public school. When I reflect back on all of the students I've had the opportunity to work with, in four schools systems, the overwhelming majority have all excelled in their chosen fields of endeavor, including those who came out of Fremont City Schools. Amazing!
The solution to fixing the big city school problems is steeped in breaking down the huge city districts into smaller school districts and providing local control. The formula has never been a big secret. Bigger isn't necessarily better anymore than charter schools are the way to fix education. I will continue the battle in opposition to charter schools and I will continue the battle to reduce the size of large mega school districts. Jim, there are a lot of things government can't do well and shouldn't be attempting to do in the private sector. Two things the government does well are run a highly effective and competent military, and given the right resources, providing quality public education for every American child. To these ends Mr. Tron does know what he's talking about! I look forward to hearing from you and in the meantime I will fight you on every street corner to eliminate worthless charter schools, the biggest waste and boondoggle, of public tax dollars in Ohio. Read the following from retired educator, John Curry, and article below it!
Duane Tron
One of your former teachers!
St. Paris, OH 43072

From John Curry, February 13, 2009
Subject: The charters' sponsor throws up the smoke screen and attempts to come in the back door....
Remember that Fordham "study" about two years ago (, you know, the one that criticized the Ohio retirement system for Ohio's public school educators (Ohio STRS)? My opinion is that they weren't criticizing the needed and ongoing reform at Ohio STRS....they were criticizing the "concept" of public education and using Ohio STRS as a scapegoat in the effect, creating a smoke screen and diverting attention so as to enhance the spread of charter schools throughout Ohio. Fordham is also a non-profit(!) sponsor of charter schools in the State of Ohio, I'll bet you didn't know that, did you?
You see, charters and their sponsors really aren't in love with the reality that they too have to "part with" (translated = mandated) 14% of "their" teachers' wages into benefits for their educators. After all, that cuts into their "profits," doesn't it? They would be happier if their schools only had to part with 6.2% (Social Security employer contribution rate) to Social Security for their teachers as opposed to the current 14% rate those schools have to contribute to Ohio STRS as mandated by law. That would leave the charter school "employers" with an additional savings (translated=profits) of 7.8%, wouldn't it? Their (Fordham's charters) bottom line conflicts with their own educators' bottom line.....a retirement system (Ohio STRS) that pays far better retirement benefits than does Social Security. Of course, Fordham doesn't see it that way, do they? I often wonder if the charter school administrators inform their educators of the benefits(?) of a Social Security retirement vs. an STRS retirement? What do you want to bet that they don't compare and contrast these differences with their teachers......and for obvious reasons?
Well, Governor Strickland is helping to clear up that smoke screen in a way that the charters most certainly don't like....and, he's not just blowing smoke! How is the Governor clearing the air of the smoke? Well, read on...........
P.S. I know, most educators don't like to delve into politics as it's almost like them uttering a four-letter word, isn't it? Well, if public school educators really understood the politics behind the attempt to trash public education and their retirement system in this state, they'd be on the front lines, wouldn't they?

Thursday, February 12, 2009

Thank You, Governor Strickland

For years David Brennan of White Hat Management, Inc. has run some of the most notorious for-profit charter "schools" in the country--and definitely the worst in Ohio.about to end:
That is
. . . .Stanford noted that this budget does not seek a moratorium on charters, unlike two years ago when such an attempt failed to win support from legislators.

But it does once again go after the for-profit management companies that some charters hire. New contracts would be prohibited, and existing ones wouldn't be renewed.

The companies would include White Hat Management, which is headed by Akron businessman David Brennan, a long-time contributor to Republican candidates. White Hat runs Brennan's Life Skills centers, Hope academies and an online charter, the Ohio Distance and Electronic Learning Academy.

The ban on for-profit management companies goes too far for Terry Ryan, who heads the Thomas B. Fordham Institute's Ohio office. The related Thomas B. Fordham Foundation is a nonprofit sponsor of charter schools.

"Quite frankly, some of the for-profits are good and some are bad," Ryan said. "But let's not throw out the baby with the bath water."

Strickland, however, is adamant. The day after his State of the State speech, he was asked about his stand during an appearance at Cleveland's Louisa May Alcott Elementary School.

"I do not believe injecting the profit motive into public education is a good thing," he said.
When the profit motive of the "non-profit" charter schools is understood by politicians who stupidly praise them, perhaps we will see a similar phenomenon. The tax-dodging non-profit corporations are definitely the more prominent threat to public education.

RH Jones: Caution advised in use of our pension funds

From RH Jones, February 11, 2009
Subject: Caution on using our funds to shore up banks
To all:
K. Fluke, PhD. and I think that our STRS Ohio should take care on: “The Proposal to Shore Up Banks With Pension Funds” as reported in the NY Times. Give pension funds at least a month to decide. Money for Obama’a TARP should be given a chance first. Our STRS should wait and see.
I am in concurrence with Dr. Fluke,
A STRS retired teacher member
A Proposal to Shore Up Banks With Pension Funds
New York Times
February 9, 2009
Click image to enlarge.
Financial institutions in the United States probably need hundreds of billions of dollars in additional assistance, and one congressman wants to harness state and local pension funds to help them.
James Estrin/The New York Times “Some of us are getting tired of writing checks with public money” and seeing no results, said Representative Gary L. Ackerman, Democrat of New York. Rather than rely more heavily on the Treasury, which has already put $350 billion in the nation’s banks, Representative Gary L. Ackerman sees an opportunity in the trillions of dollars in public pension funds. Most of the funds suffered giant losses last year in the market turmoil. But they do not need all of their assets immediately, because their time horizon for paying benefits is decades long.
Mr. Ackerman, Democrat of New York, is sponsoring legislation that would allow public pension funds to pool some of their money and use it to create a sole-purpose entity that would buy $50 billion to $250 billion worth of preferred stock in America’s banks. That would strengthen the banks’ balance sheets and, Mr. Ackerman hopes, get them lending again.
“Some of us are getting tired of writing checks with public money” and seeing no results, Mr. Ackerman said. He said pension fund officials who had heard about the measure so far were eager to participate.
Since the nation’s banks are shaky, and pension funds cannot afford more investment losses, Mr. Ackerman’s measure also calls for the Treasury to guarantee the funds’ principal, plus an annual return of about 8.5 percent.
This guarantee would solve one of the biggest problems now facing most public pension funds: They need to achieve average annual investment returns of 8 percent, and in today’s markets, they cannot do so with the types of securities they are required to invest in.
Plan rules generally limit the amount of market risk the plans can take on. At the moment, risk-free assets like Treasury bills are paying next to nothing. The benchmark 10-year Treasury is yielding just under 3 percent.
If public pension funds had to adjust their numbers to reflect the bleak state of the stock and bond markets, many would no longer be viable. Even if they lowered their investment-return assumptions by three percentage points — to 5 percent, which is the rate of return the Treasury has been promised on its bank investments — their business models would no longer make sense.
The models typically call for two-thirds of the cost of the benefits promised to retirees to be covered by investment gains. At 5 percent a year, on average, the investments will not generate enough cash.
Getting the plans back into balance would then mean pumping in lots of cash, which presumably would come from taxpayers in the states and municipalities that sponsor the plans. Local governments would be hard-pressed to come up with extra money in this downturn.
A federally guaranteed return of 8.5 percent, meanwhile, would avoid such misery, and give the public pension funds a new lease on life. There would, of course, be considerable risk that the banks would not be able to generate those returns, in which case the federal government would be on the hook, as it would for any loss of the funds’ principal, under the proposal.
Mr. Ackerman, a member of the House Financial Services Committee, has been circulating a draft bill and assessing support. The bank investment program would be available only to public pension funds, not pension funds sponsored by companies. The corporate plans are covered by federal funding rules and as a result tend to be stronger.
Some public plans have made mistakes during the boom years. The state of New Jersey, for instance, used its pension fund to balance the state budget for a number of years and parted with hundreds of millions of dollars, something a corporation would not be allowed to do.
The state of Illinois has a pension model that assumes the benefits will never be entirely funded instead of covered over 30 years, as is generally required. In Pennsylvania, the state legislature passed a law in the 1980s allowing local governments to contribute smaller amounts than what is actuarially required to meet their obligations.
Mr. Ackerman and his advisers acknowledged that some public pension funds had made missteps, but said there was not time to tighten up the whole sector’s practices before starting a bank bailout. There are about 2,700 public pension funds in the United States.
“Sometimes, you have to do things to benefit people who didn’t behave so well,” Mr. Ackerman said, explaining that the need to keep public pension funds afloat and promote bank lending were too urgent to wait.
How such a plan would work with the Treasury’s newest assistance package for banks, set to be unveiled Tuesday, was not clear.

Thursday, February 12, 2009

The Rescission Bonus....the kind of bonus that you probably never heard of!

From John Curry, February 12, 2009
"The trial also revealed that Health Net paid bonuses to an employee based in part on how many rescissions she carried out."
Health Net agrees to settle rescission lawsuits
The Woodland Hills insurer will pay as much as $14 million to close the books on litigation over the canceling of health policies.
By Lisa Girion
February 12, 2009
Woodland Hills insurer Health Net has agreed to pay as much as $14 million to settle a pair of lawsuits brought on behalf of 800 former policyholders whose coverage was dropped after they submitted substantial medical bills.
Under the deal, which won preliminary court approval Wednesday, individuals whose health insurance policies were canceled since 2004 are eligible for payments of up to $218,000. The average payment is expected to be $7,836.
The settlement would resolve a class-action lawsuit filed by Claremont lawyer William Shernoff, as well as a suit filed by Los Angeles City Atty. Rocky Delgadillo.
In addition to the payments to customers, it requires Health Net to pay a fine of $2 million to the city attorney and to contribute $500,000 to charities. Shernoff's firm will earn $2.1 million.
It follows a two-year crackdown by state regulators on the widespread and controversial practice known as rescission. In deals with regulators, insurance providers Health Net, Anthem Blue Cross and Blue Shield all have agreed to make substantial changes in the way they sell individual coverage in an effort to reduce the number of rescissions.
In all, Health Net has agreed to pay more than $40 million to resolve the regulatory actions and litigation over rescission.
Health Net is the only company that has been forced to defend rescission at trial. Nearly a year ago, an arbitration judge awarded $9 million to Patsy Bates, a Gardena hair salon owner whose coverage Health Net dropped after she was diagnosed with breast cancer. The rescission forced her to suspend her chemotherapy treatments for several months.
That was one of 1,600 rescissions that helped Health Net save $35.5 million over several years, according to trial documents. The trial also revealed that Health Net paid bonuses to an employee based in part on how many rescissions she carried out.
Health Net stopped those bonuses and, under the settlement, agreed not to reinstate them.
"This case proved that no matter how much money these organizations make, they are not above the law," said Invia Betjoseph, a San Jose family therapist who served as the lead class member in the suit against Health Net.
Betjoseph was left with about $8,000 in medical bills and went for more than a year without health insurance when Health Net rescinded his coverage three years ago. He said Health Net accused him of lying on his application for coverage.
Specifically, he said, Health Net alleged that he knew beforehand, but didn't divulge in his application, that he had a benign mass, which he had surgically removed shortly after his policy took effect.
But Betjoseph said doctors didn't discover the mass until after he had signed up with Health Net. His doctor wrote Health Net a letter in an effort to get his coverage restored.
"It said, 'Mr. Betjoseph didn't know about the mass because I, his surgeon, didn't know,' " Betjoseph said.
The letter apparently was ignored, he said: "You work hard all your life, follow the rules and do the right thing, and, when you need them, they abandon you."
Health Net said it was simplifying its coverage application and would do a better job of checking applicants' health history in the future. It also said it was committed to broad-based insurance reforms that would end the practice of rescissions.
"Health Net believes all Americans should have access to high-quality and affordable healthcare," it said in a statement. "To that end, we have been working with our regulators and the Legislature to reform the entire system in support of guaranteed issue and an individual mandate, which would make rescissions obsolete."
Health Net's class-action settlement is the first of its kind. Shernoff, the lawyer representing rescinded policyholders, said it was unusual in that it makes payments to class members without requiring them to submit claims.
Typically, he said, class-action settlements that require claims result in a very small number of actual payouts. He said class members would have the option of forfeiting the payout and filing a suit on their own.
Anthem and Blue Shield also face class-action suits alleging they gamed state insurance laws so they could cancel people's coverage after they got sick and thereby avoid paying their medical expenses.
Delgadillo also has enforcement actions pending against the other insurers and said he hoped the Health Net settlement would "serve as a model for other companies which stand accused of engaging in unlawful rescission practices."
The Health Net agreement includes provisions that parallel earlier settlements with regulators, including an offer to extend coverage to the affected consumers without regard to preexisting conditions.
It also requires Health Net to reimburse medical expenses paid out of pocket by former policyholders after they were rescinded.
In addition, Health Net agreed to extend its self-imposed moratorium on rescissions until lawmakers or regulators establish standards for them -- or until the company establishes a third-party review process that is acceptable to the judge overseeing the case.

STRS may very well have an additional $250 "stimulus" coming your way!

From John Curry, February 12, 2009
Lawmakers Add $250 Tax Credit For Retired Public Employees
February 12, 2009
By Martin Vaughan
WASHINGTON -(Dow Jones)-
Retired public employees in states including Massachusetts, Ohio, Colorado and California won't miss out on a $250 stimulus payment, thanks to a last-minute change to economic recovery legislation Congress is expected to approve by the weekend.
"This is teachers, firemen, police and cafeteria workers," said Rep. Richard Neal, D-Mass. "There would have been at least a million people in state and local retirement funds that would not have derived a benefit from this bill."
Thanks to the last-minute addition, retired public servants that aren't covered by Social Security will be able to claim a $250 credit on their 2009 tax returns.
The stimulus legislation that the Senate passed this week included a one-time payment to seniors who receive Social Security, certain veterans and recipients of disability benefits. In House-Senate conference negotiations this week, lawmakers reduced the amount of the payment to $250, from $300 in the original Senate bill.
But under the original Senate language, certain public employees who receive benefits from state and local pension plans wouldn't qualify. That's because many localities didn't opt into Social Security, instead setting up other retirement options for their retirees.
Ohio is the state with the lowest percentage of retired public servants covered by Social Security, at 3%. It is followed by Massachusetts at 6%. California, Maine, Nevada and Texas all have less than half of retired public workers covered by Social Security.
The change would cover about one million retirees, and would add about $250 million to the cost of the stimulus bill, according to a congressional aide.
Under the stimulus agreement, seniors that are covered by Social Security, retired railroad workers, and recipients of veterans and disability benefits that don't have other income would receive a $250 one-time payment in the mail.
By contrast, retired public employees not covered by Social Security will not get a check in the mail, but will be able to claim their $250 tax credit when they file their 2009 tax returns next year.
By Martin Vaughan, Dow Jones Newswires

Wednesday, February 11, 2009

STRS Board meeting Feb. 18-20, 2009

From STRS, February 11, 2009
The State Teachers Retirement Board and Committee meetings currently scheduled at the STRS Ohio offices, 275 East Broad Street, Columbus, Ohio 43215, are as follows:
Wednesday, February 18, 2009
...10:30 a.m. Disability Review Panel (Executive Session)
.... 1:00 p.m. Staff Benefits Committee
Thursday, February 19, 2009
.....9:00 a.m. Retirement Board Meeting
Friday, February 20, 2009
.....9:00 a.m. Resumption of the Retirement Board Meeting
...10:00 a.m. Special Meeting - Health Care Educational Session
The Retirement Board meeting will come to order at 9 a.m. on Thurs., Feb. 19, and begin with a report from the Finance Department. The Executive Director's Report is expected directly after the lunch break, followed by public participation, a report from the Member Benefits Department regarding pension benefits and a report from the Investment Department. The Retirement Board meeting will resume at 9 a.m. on Friday, Feb. 20, with a report from the Human Resource Services Department, routine matters, old business, new business and any other issues that require Board attention.

Tuesday, February 10, 2009

Craig Brooks: Response to Tom Curtis

From Craig Brooks, February 10, 2009
Subject: Re: 021009 Brooks, Wage & Salary Committee Member
We have had one committee meeting since the November meeting. I do not have the agenda for the February Board meeting but believe that compensation related issues will be discussed at that meeting.

Tom Curtis to Craig Brooks: Request for update on committee action

From Tom Curtis, February 10, 2009
021009 Brooks, Salary & Benefits Committee Member
Hello Mr. Brooks,
I have sent Mark Meuser, chair of the salary and benefits committee, two emails to date asking for an update on Dr. Leone's motion in November for a wage and salary freeze, but he fails to respond. So.....
Would you kindly provide me with an update of what action your committee has taken on Dr. Leone's motion in November for a wage and salary freeze for all staff?
Also, how many times has the committee met since the November board meeting?
Thank you,
Tom Curtis

Just another day at the MD's office...PLUS

From John Curry, February 10, 2009

No Day is an Ordinary Day
Feb 08, 2009

Saturday was a short day in the office. I came in to handle some paperwork and to see a few patients whom I couldn't manage to work in over the course of a busy week. It was an ordinary day with a typical, ordinary selection of patients....which is to say, that almost every one came with a story which cried out about how we desperately need change in our health care system.

The first item on my plate was a patient who called to say that the asthma medication he had been on for years and which had allowed him to control his symptoms and stay out of the hospital was no longer covered by his insurance.

I explained to him that there were likely alternatives that would probably work as well and proceeded to compose an email to his pharmacist, outlining the possibilities I wanted him to explore.

My patients are gathered in the waiting room of my office on December 31, 2008 to discuss health care. A less than ten minute edited video of this discussion can be seen here.

From my perspective, the pressure from health care financing sources, be they public or private, to encourage doctors and patients to find equally effective treatment modalities at a lower cost is not wrong. I often appreciate this push. Particularly in an environment where drug companies and medical technology companies are pushing their expensive new treatments or diagnostics as the only way to go, a little pushback can help a busy provider make more appropriate decisions.

What is wrong is when the pushback comes because insurance company "alpha" had made a deal with drug company "beta" that makes drug "A" suddenly "preferred" and drug "B" suddenly "non-formulary" while another insurance company has struck a deal with another drug company to do just the opposite! This wastes my time and leads to patient confusion and non-compliance while serving little or no social benefit. Multiply these arbitrary rules by the three pages of different insurance companies with which I must be involved and you can imagine the daily waste this produces.

My first patient, M.R., walked in, largely recovered after his recent hernia surgery, but concerned about the findings of his pre-operative exam when he was noted to have aortic stenosis, a type of heart condition which makes control of his elevated blood pressure even more important. His major concern, however, was to see if I could provide him with free samples of the blood pressure medication, the dose of which had been increased by his cardiologist. His insurance company, like most, only allows him refills once monthly, and with the increased dose he was going to run out earlier than expected.

The rule that patients can only get a month’s worth of medication at their local pharmacy (a three month supply is generally allowed if patients use a mail order service) has its origin in the fact that in our mobile society patients may switch employers, and hence health insurers, fairly often and is tied also to the fact that there are so many uninsured in our country. It is a logical business decision. If an "insured" this month may be an "uninsured" or an insured of a different company the next month, then why allow him to have two months of therapy? Similarly, why take the chance that an insured might pass on medication to an uninsured friend or relative? Of course this would not be a meaningful issue if all health care were covered under a single payer financing system, but that is not the system I deal with.

B.R. slipped in briefly afterwords so I could remove sutures that had been placed a week earlier in the emergency room. While I snipped and pulled them out of the well-healed wound we discussed his gouty arthritis and I reviewed the proper use of his medications. It is good, indeed essential, that there are emergency rooms when we need them, but as he left I considered how much more efficient and cost effective it would be if we had a health care system which would have made it easier for B.S. to have had his stitches placed by his primary care doctor who could manage his gout at the same time.

Next came, G.C., a longstanding patient whom I hadn't seen for three or more years. Her blood pressure was way up. Why? "I haven't had insurance, and times are hard." She had been separated from her husband, an alcoholic and methamphetamine addict, but now they were back together, he was clean and sober and employed with insurance. We joked in a bitter way about how unfair it seemed that she and her husband should not have had health coverage at a time when they needed it most. Understanding the nature of one aspect of the waste generated by the private health insurance industry she sardonically remarked, "My husband works for The cable company. They’ve got a pile of different cable 'plans' to choose from. I guess it works the same way with health insurance. The companies spend a lot of our money figuring out "plans" that can extract the most money from each one of us."

D.E., my next patient, came to update much-delayed health care maintenance evaluations. A lovely, gentle man, this 59 year old handyman carries so-called consumer-directed health insurance because this type of high deductible high co-payment insurance is all he felt he could afford. Unfortunately, the up front costs to him had delayed him from coming to see me. As he confided that he was at a loss, not sure what he was going for health coverage in the future after having this month received a notice that his family's insurance cost was set to rise by $400 a month, I realized that today’s visit was a way of getting as much done as possible before he would take a chance without insurance.

His predicament reveals the fallacy in the notion that making insurance "available" will somehow lead to people being insured. Instead, it results in patients not buying the medications they need, delaying or avoiding preventive health care, and ultimately, as I suspect D.D. will decide, risking going without insurance at all. A need for even a minor surgery or an illness requiring a few days hospitalization could be all that is needed push D.D. into bankruptcy, joining the 50% of all American bankruptcies caused by health care expenses.

In the interest of completeness, I'll note that the next two patients, K.N., a 62 year old man with severe heart and kidney failure as a result of a viral infection, whose health coverage comes from the county's Medicaid HMO, and B.E., who has a private employer-based H.M.O. insurance had no current problems with respect to their health coverage.

I then taught L.Q., a twenty one year old student here for the third time this week for treatment of an abscess, how to care for her wound herself. It probably would have been better to have scheduled one more visit, but as she has no health coverage, even with the deep discounts I had provided for my services, the costs of treating this infection have been adding up.

In considering her care, and the way in which I’ve offered her a discount, I think about the health insurance crisis in this country from my perspective. I serve a wide variety of patients, from all ethnic and economic circumstances, and with many different sources of payment for their care, in my practice. From some I feel well-paid, from some I feel less well paid. Although I try not to let this happen, there are times where this disparity has felt oppressive to me and where I’ve felt it could affect my judgment or my enthusiasm in providing the care a patient needs. Many of my colleagues wrestle with the same issue, some resolving the problem by going outside the usual health care system or restricting their practices to patients or insurers which pay the best; others accepting the reality that even a "poor-payer" pays more than the marginal cost of adding on an extra patient. I have found it difficult to place any limits on my practice based upon ability to pay but find myself longing for a unified system where such disparities would disappear.

E.R. came next, thinking he needed a physical, a result of having paid on his own for a "comprehensive health screening" which had identified a number of problems for which he was advised to follow up with his physician. His insurance plan is actually quite adequate, and the health screening he had paid for included tests which were not only unnecessary, but which are considered by The United States Preventive Health Services Taskforce to be counterproductive, because of their documented uselessness or tendency to lead to bad medical care. As I discussed with him the results of his screening tests and reviewed appropriate health care maintenance guidelines, I mused to myself about how good it would be to have a health care system guided by research into what really works best at lowest cost rather than a system which is pushed primarily by a focus on how to make the most money....

Finally, came M.N., a new patient, a 31 year old research biologist with acne. I enjoyed the visit. We talked about the pathophysiology of acne, the pluses and minuses of the different drugs, and about her work. I decided not to address the fact that her insurance might not allow a dermatology referral because her condition, at her age, was considered cosmetic. I wanted to enjoy just practicing medicine for a moment.

Monday, February 09, 2009

If STRS adopts a Medicare Advantage (translated: 'privatized') health plan you may very well need this First Aid kit


If you are affected by the Government Pension Offset (GPO), you may be interested in this Q & A link:

Sunday, February 08, 2009

STRS PBI Bonuses

From John Curry, February 7, 2009
Subject: STRS PBI Bonuses
Thanks to an active teacher candidate for STRS Board (James Stoll) for asking....... we now have this detailed list of the now-famous (and, thanks to Dr. Leone) "now-quashed" STRS investment associate's bonuses. Pretty handsome, I'd say!
John ("STRS Articles Portfolio Mgr."....!)

Note...Mr. Stoll is the gentleman who furnished the list of PBI bonuses in the email that I just distributed. HE is one "active" who really does know what is going on at STRS! John
From James A. Stoll
January 13, 2009
State Teachers’ Retirement Board (STRS)
Nominating Petition for James A. Stoll
Dear Colleague:
• Did you know that our STRS Retirement Fund lost over Six Billion dollars of its value? $6,098,021,000 in the fiscal year ending June, 2008.
• Did you know, unfortunately for us, that between June 30, 2008 and December 31, 2008, STRS has LOST 18 BILLION dollars in net assets and these net assets have gone from approximately 70.4 Billion on June 30, 2008 to 52.5 Billion on December 31, 2008 per Laura Ecklar, Director of Communications, STRS.
• Did you know that the STRS Board employs more than 87 investment associates to manage your money?
• Did you know that in spite of our retirement fund losing Six Billion dollars last year and approximately 18 Billion so far this year? Eighty-seven investment associates received “Performance Bonuses” of approximately Six Million dollars? That’s an average bonus of nearly $72,000 per associate.
• Did you know that some investment associates received bonuses in EXCESS of $200,000 in spite of decline in net assets of more than Six Billion dollars?
• Did you know that the top two investment associates had total compensation last year of over $500,000 – Yes, that’s over a half million dollars in salary and bonus to manage your money!
Please see the attached spreadsheet which details the title for each associate, their annual salary, their 2008 bonus, and their total compensation for 2008. [This is posted immediately below in five parts; click on each to enlarge.] In my opinion, the salary and bonus figures are outrageous. At an absolute minimum, this data should at least raise some serious questions to which we deserve some answers. For instance, what are these investment associates’ qualifications and job duties? What are the terms of the bonus plan that would entitle individuals to such hefty bonuses, despite what appears to be a horrendous performance? Do changes need to be made to better protect our hard-earned money to ensure that it will be there, as expected, for our retirements? It seems ludicrous, in my opinion, that there are 66 “Investment Associates” with STRS that were paid between $140,000 and $529,200 (which is more than almost all Superintendents of School Districts in Ohio).
If you agree, that the time has come for us to receive answers to our questions and an explanation of how our money is being spent, please support my nomination by signing the enclosed nomination petition. I will work to CHANGE this compensation package as a member of the STRS Board.
Thank you for your time in reviewing these materials, reflecting upon their significance, and considering my interest in representing you as a member of the STRS Board.
James A. Stoll

STRS Performance-Based Incentive Payments (PBIs or Bonuses)

Click images to enlarge.

Have you hugged your attorney today? I'll bet you have in the past and didn't even know it!

From John Curry, February 8, 2009
Just a little 'ol bonus for an STRS paid attorney just doin' his job........the $66,640 hug!
STRS Cuddly Bonus Hug (CBH)

Retirees (and active educators as well),
Below, from line 32 of an STRS spreadsheet, comes this revelation. The "R/E Counsel" listed below really means the STRS "real estate attorney." You know, the attorney who oversees STRS's real estate purchases, sales, and so on? Just his "bonus" for one year's work is listed as $66,640! That's $66,640 on top his "regular" STRS salary of $170,000 for a total annual salary of $236,640! I'll bet that bonus alone is significantly more than most educators (active and retired alike) ever see in one year's worth of educating, isn't it?
Well, not to worry as finally STRS Board member Dr. Leone's motion to quash the bonuses at STRS finally sunk into the skulls of most of the STRS Board members. I say "finally" because Dennis initiated this motion to quash the bonuses several months back AND DIDN'T EVEN GET A SECOND TO HIS MOTION. This time 'round reality finally sunk in...the Board voted 6-3-1 to do away with the bonuses (yes, even the bonus for the real estate attorney as listed below)!
Maybe the "3" STRS Board members above (Meuser, Cervantes, and Myers) who voted to keep the bonuses can explain to you why they felt that these bonuses (paid for by you-the educator) were of necessity....should you decide to ask. While you're at it, you might even want to "drop an email" to STRS Board member Conni Ramser since she was the "1" abstaining vote in the tally above. She did not take a stand on this issue. You might want to drop an email off to her to ask why. I'll even make it easy for are their respective email addresses:
Mark Meuser [voted to KEEP the bonuses]
Mary Ann Cervantes [voted to KEEP the bonuses]
Tim Myers [voted to KEEP the bonuses]
Conni Ramser [ABSTAINED]
P.S. Is the culture of entitlement finally dead at STRS? CORE members will be watching, won't they? If you want to see the "others" on this quashed bonus list just email me and I'll gladly send it to you - here's my email address:
P.S. #2 Please share this with an active educator as I have a hunch they don't even have the slightest idea of where some of their 10% salary contributions to STRS WERE going.
(Line 32 of Bonus chart; click image below to enlarge)

RH Jones: The old Board days are over; monitoring is in

From RH Jones, February 8, 2009
Subject: Fw: STRS PBI Bonuses
To all:
The Ohio STRS board has to wake up. Obviously, they are not aware that their judgments are now being monitored not only by the (CORE) Concerned Ohio Retired Educators but by a large number of organizations? The old days are over for them.
They must realize that their decisions which allow for illogical extravagances turns off -- in my opinion -- any support that we may have in the struggle to get a steady stream of income to allow for adequate (HC) health care benefits. How in the world are they going to sell an increase in employer/employee contributions to funding STRS HC without showing fiscal responsibility to those who will be paying "up-front"? Every penny is precious to those who contribute and have contributed to the system. I do think that they have not taken this into consideration. Despite board and employees expounding on "so called" studies that back past extravagances; the opposition to any increases will play "hard ball" when the chance arises for them to reveal in the STRS what might be thought of as any mishandling of revenue -- even when funds may be available within the budgeted limits -- public relations is always extremely important in every decision involving money.
This message is not meant to be critical. As a retired teacher member, financially dependant upon them making logical decisions, I am asking them to stay current with the economic events of the day. These events offer an opportunity to move our STRS forward. The board then has an awesome responsibility to always use common sense. I do hope all my unions realize this as well.
My thoughts,
RHJones, a retired teacher and union member
Larry KehresMount Union Collge
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