Predatory Healthcare

Predatory Healthcare Pricing

“Because I Can”

Remember Martin Shkreli? He is the New York vulture capitalist who bought the drug company that makes EpiPens, inexpensive devices that can save your life if you get stung by a bee and go into anaphylactic shock. That would have been acceptable, except that Shkreli then jacked up the unit price five hundred plus percent, putting Epi-Pens out of reach of many who need them. His justification essentially was “I did it because I can.” He instantly became the poster child for all that is wrong with American healthcare.

If you think predatory healthcare pricing is limited to big cities in the East, let me introduce you to Ascension Senior Living, a Catholic healthcare system that provides long term care to the elderly, especially those with debilitating diseases like Dementia, Alzheimer’s, Huntington’s and other independence robbing cognitive maladies.

Those who have lost the freedom to come and go to the fog of brain disease or injury are often placed in long term care facilities called “assisted living” or “memory care” units when they can no longer safely be cared for in the community. Those confined to these facilities who have no money or limited incomes can receive government assistance, usually funded by Medicaid, to pay the cost of their care.

If your grandmother was able to amass some retirement savings before becoming afflicted with memory loss or the ability to make rational decisions and has to be placed in “assisted living,” there is no government assistance until her savings are depleted, so she pays the full cost of her care until her money is gone.

Most “assisted living” facilities accept both Medicaid funded and private pay residents. Both are supposed to receive the level of care appropriate to their individual needs without respect to who pays the bills. The rates charged to Medicaid funded residents are regulated by state and federal rules. The rates charged to those who pay their own way are not.

In my retirement, I work part-time providing guardianship services by court appointment for those suffering from diseases that impair their ability to make decisions on their own and need someone to make fundamental decisions to make sure they receive adequate care and treatment. Guardians can also be appointed to manage the financial assets for those in their charge. Guardians must follow an objective standard with respect to decisions made for their wards, both personal and financial, that requires them all to be made with the ward’s “best interest” as the foremost consideration.

In these dual roles as a guardian, I am responsible for an 80 plus year old person with dementia who has been placed at Alexian Village, an “assisted living” facility in Northern Milwaukee County, for several years. My ward’s condition is stable and no one anticipates that the level of care provided by Alexian Village staff will increase substantially in the near future. The level of care and the quality of life provided has been excellent. Because my ward has money saved, the rate charged by the facility for services provided was about $5,400 per month, which is average for similar facilities in the area.

Ascension Senior Living recently purchased Alexian Village. The new owners decided that they needed a greater profit margin from Alexian. In order to justify rate increases, they came up with an 11 page assessment questionnaire that purports to measure how much staff time a resident will need to receive the care they need. After “assessing” my ward, without my knowledge or consent, the new managers decided that my ward was on “Level Two” and would be required to pay an additional $1,200 per month.

The problem with this 20+% bump, $14,000 more per year, is that Alexian Village is not going to provide any additional services or staff time to my ward for these additional payments. After I complained about the arbitrary and unconscionable increase, the regional vice-president asked for a meeting where they announced they had recalculated the assessment and figured out my ward was really at “Level One,” lowering the additional payment for the same level of service to a mere $800 more per month or $9,600 more per year. The justification offered amounted to little more than a Shkreliesque, “Because we can.”

Ascension management knows they have a captive and vulnerable population. They know it would be terribly disruptive and damaging for those in their care to be uprooted from all they currently know and moved to a more reasonably priced facility. Ascension raised the unregulated rates for those who can pay just to turn a larger profit.

If you need to start looking for “assisted living” for an elderly parent or grandparent, consider anyplace else other than Alexian Village or any other facility connected to Ascension Senior Living. Their pricing philosophy is anything but Christian and they do not seem to care. Shkreli would be proud, but probably say they did not raise the rates enough.

Waring R. Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Just Saying No Isn't Governing

Just Saying “No” Is Not Governing

Compromise Works

Republican legislators, state and federal, are slowly learning that actual governing requires more than just saying “no” to new taxes, kowtowing to wealthy donors and sticking to talking points crafted by those whose agenda is to advance their own personal agendas and dismantle the government.

On the federal level, even with control of both houses of congress, allies in the Oval Office and a majority on the Supreme Court, the GOP cannot pass its signature piece of legislation repealing and replacing the dreaded Obamacare.

The House of Representatives’ version pushed and praised by Speaker Paul Ryan was homage to his mentor and philosophical guru, Ayn Rand. Their vision of healthcare insurance coverage is to take it away from over 22 million Americans, dismantle and underfund what might be left of Medicaid, and provide enormous tax breaks to the wealthy and health insurance companies already reaping substantial profits on the misery of the ill. Their mantra appears to be, “I’ve got mine. If you cannot afford it, you cannot have it and clearly do not deserve to have it.”

The initial version from the U. S. Senate was not much better. 22 million would still lose coverage and Medicaid remained on the chopping block. Senate Majority Leader Mitch McConnell could not corral 51 votes from his fellow republicans for his bill, even after arm-twisting from the White House and closed door deals with hold out senators.

The next version was released on Thursday with small tweaks to try to win over skeptics in the GOP ranks. There were some improvements, but the basic flaws remain. Here are the low points.

Medicaid payments would be fixed per-person amounts to the states that are guaranteed not to keep up with rising healthcare costs. These cuts will hurt the young and elderly disproportionally, especially when joined with the rollback of Medicaid expansions.

Insurance plans would no longer have to meet minimum coverage benefit standards. Sicker people would be forced into higher benefit plans, driving up the costs which would lead to higher premiums, co-pays and deductibles. This will drive up premiums. The fund created to help high premium costs is wholly insufficient.

Tax credits and health savings accounts for catastrophic health insurance plans are useless to low-income folks who lack disposable income to utilize them.

Also still gone will be the requirement for all to carry health insurance. With the young and healthy out of the pool, premiums for the remaining older and sicker will skyrocket.

McConnell’s move to keep the Obamacare taxes on the wealthy is a sly move to win senate votes, but is merely sleight of hand to cover a later, larger tax cut for the rich under the budget reconciliation rule that will only require 51 votes to pass.

Public pushback from all sectors has been substantial and will continue making it hard for some GOP senators and representatives to support the Senate bill in its current form. Without a large measure of compromise to win over enough Democratic votes, Obamacare will remain the law of the land until driven to ruin by GOP sabotage.

In Wisconsin, we are not much better off. Even with control of both houses of the legislature, the governor’s office and the Supreme Court, we cannot pass a state budget for the next two years. The state’s budget was supposed to be passed by July 1^st. We did not run out of money or close up shop like some other states without passed budgets, but we remain stalled nonetheless.

A majority of us want to put money back into public education that previous budgets stripped away. We also want decent highways and roads upon which to travel. Because our legislators are still stuck on “no new taxes,” we do not know how much state aid will flow to our public schools leaving local budgets in limbo. Similarly, we have highway construction projects around the state in limbo and no idea what may be available to fix local roads in our cities and towns. School funding appears to be contingent upon road funding.

Many conservatives no longer buy into increased borrowing to fund road construction and repair. They recognize the need for increased revenue to fix the problem.

One solution, a non-starter for the leadership, would be to increase the gas tax by five cents a gallon. The gas tax used to be indexed to inflation, but that died under GOP control so we are stuck with a 2006 tax level. Cars and truck are more fuel efficient, so we buy less gas. Gas tax revenues are down as a result.

Not finding a solution to road funding jeopardizes education funding and local budgeting. A three-month budget delay will keep the DOT from proceeding with some planned projects. A four-month delay will impact local road budgeting and a delay until August could mean loss of federal highway funds.

Maybe it is time to sit down with Democrats and find solutions that will command the votes to govern, as our government requires.

Waring Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Take Blue Highways

America is Already Great

See for yourself

Our travels in the West continue to amaze. After leaving the high desert, we went to Las Vegas so my wife could present at her professional association’s annual conference. The difference between the natural beauty of the mountains and parks and the fake aura that is Las Vegas was made all the more stark by the blistering heat. We then crossed the low desert into the Los Angeles basin and remarked at the lack of apparent life along the way. Cactus and solar farms stretched for miles with little else to break the heat. 

Once in Southern California, the temperatures moderated some by nightfall. We went to one of our favorite haunts in South Pasadena, the Henry Huntington Gardens and Library. This was once the home of a railroad titan who spent his money collecting classic art and old rare books while building spectacular gardens to recall his various world travels. Thousands of plants along with an original Gutenberg Bible, an original Ellesmere edition of Chaucer’s Canterbury Tales and handwritten author’s notations on Mark Twain novels along with the original Gainsborough painting of The Blue Boy are on display for all to see. Couple those with an exhibit on Octavia Butler, an African American science fiction author from Pasadena, and it made for another memorable visit.

Leaving my home stomping grounds, we drove north to Moro Bay and then up the central valley from whence come most of our vegetables to Berkeley and then to Point Reyes Station across the Golden Gate into Marin County. Pt. Reyes is where the San Andreas Fault leaves the mainland and goes into the Pacific through Tomales Bay. It is home to a National Seashore preserve that protects many species of birds and sea mammals as well as providing miles of accessible beaches on the Pacific Ocean. It was good to be back at the ocean once more.

Once back on the road, we drove up US Highway 101 into Oregon. Once again, we were transfixed by the changes in scenery and topography. Open valleys filled with vineyards gave way to steep mountain ravines dotted with trees standing in brown waving grasses. We took a side jaunt before reaching Eureka that meandered along the Eel River through the Humboldt Redwoods State Park. The road is aptly named the Avenue of the Giants as the groves of those magnificent beings stretch to the sky on trunks wider than two cars. The canopy shadows the road even in full sunlight. The aroma of damp redwood is sublime.

Our journey the next day took us along the coast of Southern Oregon. Tall conifers line the highway until steep mountain cliffs to the sea provide breathtaking views of rocky coastlines and an ocean that does not stop until it reaches Asia. Many of the low areas sport signs warning of Tsunami hazard areas with well marked evacuation routes to higher ground. Our tornado sirens are replaced there with Tsunami sirens. Roads that hug the costal cliffs and provide the only routes connecting costal communities are engineering marvels. Many were carved out and maintained by hand to provide paths for lumbermen and gold miners of years gone by. The beaches and surf lines are dotted with rock formations that provide wonderful vistas. Small natural harbors along the way provide homes for fishing fleets that venture out to provide today’s catch to city eateries up and down the coast.

We finally turned east towards home and started up the McKenzie River along Oregon Rt. 126 out of Eugene. The mountains are heavily forested with old and new growth as logging is still in full swing here.  We will go over the McKenzie Pass and into Idaho on our way back to Wisconsin. 

We have driven to many great places in this diverse country over our years on the road. I think very few can compare to the span we have covered on this trip. We are a great nation because the people who inhabit it face unique challenges posed by their local environments and each have risen to meet those challenges in order to survive and prosper. Traveling and experiencing those differing environments while reflecting on the history of these places helps break down barriers of perceived differences among our peoples.

When you have the chance, get in your car and drive someplace you have never been. Take the blue highways. Get out and look around. Talk to the people who live there and eat local food. You will begin to appreciate how lucky we are to live in America.

Waring R. Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Flat Earth Madness

The GOP Flat Earth Madness

The current Republican madness can easily be summarized with three recent examples of their governing prowess.

First, we have our own local Rep. Jesse Kremer's recent pronouncement during a legislative hearing on a bill limiting free speech that, "the Earth is 6000 years old. That's a fact."

Second, the U.S. Secretary of the Interior, Ryan Zinke, recently told a meeting of the Recreational Vehicle Association that he did not want to be in the business of running campgrounds because his audience would do a better job than the National Park Service. This explains his budget proposals severely curtailing the fine work the Park Service provides to the public.

Third, the Secretaries of both U.S. Environmental Protection Agency and Department of Energy have declared that humans have no impact on our changing climate and that the scientific consensus to the contrary is nothing more than a "hoax." They are systematically cleansing their agency's public information systems of all references to climate change while slashing funding for research into what can be done to reverse it and save the planet. They are reversing policies promoting the development of renewable energy systems and curtailing the continued use of fossil fuels.

My wife and I are currently traveling in the West. We recently spent time in both Arches and Zion National Parks. In both and along the Interstate highways leading to and from them, one can easily see that Rep. Kremer's "facts" are nothing more than beliefs based upon selected biblical references that are fine in church on Sunday but have no place in legislative deliberations. As we marveled at the towering mountain cliffs etched vertically down thousands of feet, we could clearly see the effects of millions of years of sedimentary deposits subsequently upthrust from the horizontal to near vertical and then eroded over millions of years by wind, rain, snow and swollen rivers into deep canyons. The National Park Service and U.S. Geological Survey have clearly not caught up to Rep. Kremer's beliefs turned into "facts" upon which laws can be crafted. The signage the Rangers provide at viewpoints and on trails clearly proclaim the passage of many millions of years for the creation of the formations we saw.

In the National Parks we visited this Summer and over many past road trips around this beautiful country there are always exhibits covering the local history surrounding the development of each park. Invariably, they were taken from Native inhabitants who deemed them sacred by force or treaty and turned over to local citizen immigrants. These pioneer developers were often railroad titans or other profiteers who saw these pristine places as a means to make a buck when packed with tourists. They cut down trees, re-routed rivers, laid railroads or built roads to their lodges and campgrounds, then charged admission for as much as they could for as long as the resource held up. 

The creation of the Department of the Interior and the National Park Service helped reverse the damage caused by those privateers and preserve the natural beauty and sacred places for us all to enjoy. They manage the resources to preserve and protect them, to tell the histories and local stories, to advance the scientific inquiries into local ecosystems and share that knowledge without regard to profit. Secretary Zinke ignores the very mission of his agency when he proposes to cut its funding and turn over administration of the park campgrounds once more to those driven by profit.

Not content to merely re-negotiate the Paris Accords on climate change as President Trump proposes, his minions at the DOE and EPA are forging ahead to dismantle years of work aimed at saving the planet. On our travels West, we noted long coal and oil tanker trains moving antiquated fossil fuels around the country. In juxtaposition, we saw field upon field of large wind turbines in every state. In the barren Nevada dessert, we saw hundreds of acres of photovoltaic panels aimed at the sun. These are the energy sources of the future that will help prolong life on our planet. Even as our government cuts back on renewable energy, the energy industry is cutting back on fossil fuels and switching to renewables. Energy titans will continue to squeeze the fossil fuel balloon until it runs dry to be sure, but they will already be on the renewable bandwagon when it does.

The GOP, led by Trump and his shadow, Steve Bannon, will continue their madness of dismantling the government as long as we let them. Hopefully, there will still be National Parks to visit and enjoy after we send them packing.

Waring R. Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Trump Fails to Protect Mother Earth

On Thursday, President Trump glibly announced that the United States would withdraw from the Paris climate change agreement negotiated by former President Obama in 2015.

Trump made the announcement to fulfill a campaign promise, but failed to mention that we would be following the withdrawal protocol in the accord that will take three to four years to complete. That means we can change course by voting for the environment in 2018 and, more importantly, 2020 before the damage becomes too permanent.

The reactions from all but those in fossil fuel industry pockets were universally horrible. The clear winners were climate change deniers like Scott Pruitt, Trump’s head of the US EPA and shadow president Steve Bannon, whose primary goal is to dismantle the government.

Trump’s decision relies upon severely discredited theories on the impact of climate change, a deeply flawed belief that the way to economic prosperity is found by using more coal and oil and ignores the clear scientific consensus on the environmental and public health consequences of failing to reduce carbon emissions.

Pandering to a small base of his supporters, Trump ignored at his peril the majority of American voters who support the Paris Accord. A November poll by George Mason and Yale universities shows 70% of registered voters say we should stay in the Paris Accord and only 13% contend we should leave.

Foreign leaders around the planet condemned the decision. Trump ignored our global allies pleas to remain in the international effort to save the planet. Unwittingly, he turned over leadership on climate change to the Chinese who have used their economic engine to ramp up production of renewable energy technologies and are poised to take over solar panel production, which just happens to be one of the fastest growing sectors of the American economy. China’s leaders are already stepping into the global leadership vacuum Trump’s decisions are creating and exerting all the leverage their economic engine can produce to extend their influence. Trump even ignored the letter from a noted scientist who also happens to be Pope Francis urging his continued support to reduce the effects of climate change.

American businesses understand the climate change science and the economic opportunities it provides. In January, 630 business leaders and investors like DuPont, Hewlett Packard, Pacific Gas and Electric signed an open letter to then president-elect Trump urging him to reject climate denier theories, to continue investment in a low-carbon economy and to not withdraw from the Paris Accord. As Trump was finalizing his decision, other prominent business leaders such as Apple’s Tim Cook, Tesla’s Elon Musk and GE Chief Jeff Imelt, all urged him to stay in the effort to fight climate change. Musk and Disney leader Robert Iger resigned from Trump’s business advisory council in protest over the decision. US farmers, already reeling from increasingly bad weather due to climate change, stand to lose even more from Trump’s decision to change policy.

More enlightened state and local leaders also stepped into the breach, vowing to continue the Paris Accord guidelines to reduce carbon emissions. Mayors from New York City, Chicago, Atlanta, Los Angeles and Boston all vowed to continue their environmental protection efforts. Over 60 mayors wrote an open letter to Trump urging him to stay in the Paris agreement. Former New York Mayor Michael Bloomberg has joined with other mayors, state governors and business leaders and plans to donate $15 million to the United Nations Climate Secretariat to continue its work on reducing global climate emissions in anticipation of Trump’s cutbacks to UN funding. California Governor Jerry Brown has already committed to continuing to use renewable energy sources and to reduce carbon emissions.

Not unexpectedly, climate scientists and environmental groups that have been sounding the alarm over greenhouse gas emissions, rising seas, vanishing glaciers and polar ice caps, rising temperatures, increasingly violent weather patters from hurricanes to tornadoes and other environmental catastrophes for decades also joined the condemnation of Trump’s decision.

Besides gearing up to defeat the climate change deniers in the White House and halls of Congress in the upcoming elections, there is a lot we can do locally to combat the looming disasters caused by carbon emissions. Buying food grown locally by small farm entrepreneurs will cut down on carbon emissions from food trucked over long distances. Conserving energy with efficient appliances and lighting, buying electric vehicles and installation of renewable energy technology in homes and businesses are good places to start. Join an environmental group and work to protect our clean air and water. Go to politician’s offices and town halls and demand they stand up for the environment by supporting bills to combat climate change. 

Our economy will react favorably to the need for technological changes to protect the environment. There is no Planet B to head to if we don’t protect her.

Waring R. Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Reject White Nationalism

White Supremacy Prevents Democracy

White nationalists recently marched at night in Virginia holding flaming torches while chanting racially charged and support for Russia slogans. The historic reference to Klu Klux Clan nighttime, torchlight marches was not lost on anyone familiar with America’s racist history. 

One of the Virginia marchers’ objections was removal of Confederate war hero statues from public areas in several Southern states.  Others phoned death threats to the crane companies employed in New Orleans to take down Jefferson Davis’ statue. The crane operators had to work at night and wear masks while taking down the statuary for their own protection.

Let that sink in.

Trump’s thinly veiled campaign plea to white supremacists, “Make America Great Again,” followed by his open embrace of unabashed white nationalists Steve Bannon, Sen. Jeff Sessions and others has unleashed a wave of racially motivated violence and protests across the country starting during his campaign rallies and continuing into his presidency.  His appeal to those who hated Barack Obama for no other reasons than his mixed race heritage and temerity to have been the leader of the free world for eight years was clear.

Jeff Sessions’ appointment as Attorney General and much of their subsequent shared agenda continues to exacerbate white fear of darker skinned fellow Americans. White racists are being openly encouraged to lash out publicly against those perceived as different and inferior, even after being shamed in Facebook videos. Videos from Wal-Mart checkout lines, public beach confrontations and stand your ground shootings by fearful white citizens and even police officers are much too common.

Those who denigrate fellow citizens because of perceived superficial differences seem to be easy prey for weak-kneed politicians who happily whip up racial frenzy instead of thoughtfully addressing real problems facing all of America’s citizenry. Senseless calls to deport or imprison those with different skin tones, foreign sounding names, culturally different clothing choices or non-Christian religious practices further inflame white fears and baseless notions of white superiority.

Travel bans unconstitutionally aimed at those who believe in Islam and come from some Middle Eastern countries, but not others, evidence Trump’s discriminate hatred of Muslims without a shred of proof they pose a danger to the homeland. Federal trial and appellate courts rightfully look to Trump’s campaign promises as evidence of his illegal racial and religious motivations in proposing the bans. Many of his supporters use the bans as a license to harass and intimidate people who look “Muslim,” even though they may just as easily be Christians, Jews or Hindu.

This imaginary fear mongering has found its way into our public policy in many other disturbing ways. Cuts to urban public education, failure to pass much needed infrastructure funding, get tough on crime policy pronouncements, frenzy over gun rights, opposition to sensible firearm restrictions, restrictions on local political control, new voter suppression laws, gerrymandered political districts, attacks on reproductive choice, restrictions on public health policy, environmental regulation rollbacks and even foreign policy decisions all have roots in white nationalistic superiority beliefs.

America is already great, in large measure because we have historically overcome notions of white Anglo-Saxon Christian superiority in favor of inclusion and diversity. We are stronger and project a more vibrant and creative image to the world when we embrace and celebrate our differences. We are better when we are kinder to our neighbors and the rest of those who share in the riches our fragile planet can provide. Divide and conquer politics diminishes our greatness and weakens the American fabric, especially when motivated by racial animus.

Trump’s pathetic calls for an end to words that incite violence will continue to ring hollow until he purges the ranks of his political appointees of the white superior nationalists and reverses the policies he and they have implemented to forward their mutually shared agendas.

Those of us from white Anglo-Saxon backgrounds take for granted our privileged position in American society and political life. That needs to change in favor of actively embracing a more diverse and inclusive world-view if we are to survive as a democracy. Authoritarian imposition of white superiority will never succeed and is a sure path to the end of the American democratic experiment.

All of us need to take a hard look at the actions our government is taking and hold those who enact them accountable when racial or religious bias is shown to motivate changes. We must step up and demand that our representatives adopt race neutral policies and laws that do not favor any religion over another.

Waring R. Fincke is a retired lawyer and serves as a court appointed guardian for the elderly and disabled.

Why I Resist

People ask why I advocate for direct action against those who oppress us. Today is the 47th anniversary of the Kent State Massacre and the 57th anniversary of when the first Freedom Riders got on the bus. The issues raised in those events are still with us. #Resist