on: April 14, 2015, 09:01:23 PM
Started by DougMacG - Last post by Crafty_Dog
You think Team Rubio is euphoric about the way Drudge handled his campaign kick-off?
That’s Rubio in the middle, with his parents. No, no, I kid. I really like the guy and was writing about him back in August 2009, when he was a little-known long-shot in the Senate primary. I’m just saying I wouldn’t send Rubio to buy beer without his ID.
Stephen Miller with a pretty good observation: “His other strength is none of the potential GOP candidates have had the practice to run against someone like Clinton. Marco Rubio has, having dispensed limousine loving, ventriloquist dummy Charlie Crist to the political ash heap. Crist and Clinton are cut from the exact same elitist cloth, believing themselves entitled and destined, the voters be damned. Both of them have gotten creamed in elections staking out that position by someone an electorate found more charismatic and in tune with every day values.”
You can argue that Scott Walker ran against and beat a larger collective opponent in his recall election and, perhaps, his 2014 reelection bid. Ted Cruz might argue he was as big a long-shot when he began against David Dewhurst in the Texas Senate primary. Bobby Jindal’s early 20-point lead helped drive then–Louisiana governor Kathleen Blanco to not seek reelection, but she was seriously damaged goods after her bumbling response to Hurricane Katrina. And the one other caveat is that Rubio beat Crist in a three-way race in 2010. Having said that, you could argue Rubio beat Crist twice, once by driving him to quit the GOP primary and declare himself an independent, then again on Election Day.
Over on NRO’s home page, I take a look at Marco Rubio’s two years spent as Speaker of the Florida House -- his management and leadership style, what he accomplished and what he left unfinished, and how he dealt with a thoroughly uncooperative Florida senate and the shamelessly demagogic, opportunistic Crist.
As Speaker and in earlier leadership positions in the Florida House, Rubio demonstrated a willingness to delegate to focus on his strengths, communicating and negotiating. The record suggests that a President Rubio would drive a hard bargain, and hold out until the eleventh hour, but rarely walk away from the table without a deal.
The Speaker of the Florida House is an important and powerful position, but one perhaps a bit easier to reach than comparable positions in other states. Representatives in Florida are limited to four two-year terms. The Speaker of the House is elected by his fellow representatives for a two-year term, and is usually in his final term -- meaning the Florida House is effectively led by a new speaker every two years.
Because of the term limits and constant turnover at the top, careers in the Florida state legislature accelerate quickly. The legislature works a brief, fast-paced schedule, a 60-day session starting in March, supplemented by occasional special sessions. The legislature is the GOP’s ballgame; Republicans have controlled the Florida House and Senate since 1996. But that doesn’t mean there aren’t often deep divisions; Rubio’s tenure as speaker exacerbated friction with the man who would later become his defeated Senate rival, then-governor Charlie Crist.
This is part of my new year’s resolution to attempt some actually useful campaign journalism by digging into chapters of the GOP contenders’ lives that haven’t been covered extensively yet. The first offering was looking at Ted Cruz’s work for the Federal Trade Commission from 2001 to 2003, where he earned a reputation as a passionate boss intent on tracking the success of the office’s efforts in granular detail.
I had some material that didn’t quite fit in the Rubio piece. If you’re not a fan of Rubio, curse the heavens, because his political career came close to ending quite early.
For starters, he nearly lost his first Florida House election, coming in second in the first round and winning the runoff by 64 votes.
In his early years in the state legislature, he was skyrocketing in stature -- he was named Majority Whip within his first nine months on the job -- but going through extreme financial difficulties.
He was making $72,000 as an often-unavailable land use and zoning attorney at the now-defunct law firm Ruden McClosky and made $28,608 as a state legislator. Money was so tight for the young lawmaker and his wife and then-one child that he sold his car and moved in with his mother-in-law. In his autobiography, An American Son, Rubio writes he strongly contemplated leaving politics to focus on earning enough money to support his growing family.
A new job offer came along before Rubio finalized his decision to quit politics; in 2001, Rubio moved to Becker & Poliakoff to expand the firm’s practice in Miami-Dade, making $93,000 per year. By 2004, when Rubio was the Speaker-in-waiting, the law firm Broad and Cassel hired him at $300,000 per year.
The Alleged Democratic Contender Everyone Forgot About
Yesterday I mentioned how Democrats and their allies can convince themselves that their candidate is the perfect to handle any situation. (Admittedly, Republicans do this as well.) I distinctly remember the night of Biden’s selection in 2008, some enthusiastic young Democratic talking head on CNN insisting that Biden was a foreign-policy “genius.” It was a good example of the Democrats’ need to not merely tout their candidates, but to whip themselves into a frothing frenzy of enthusiasm for the messiah-like choices of Obama.
Obama’s first Secretary of Defense, Robert Gates, saw things differently, calling him “wrong on nearly every major foreign policy and national security issue over the past four decades.”
Asked to back up his harsh words Jan. 13, 2014, on National Public Radio’s Morning Edition, Gates replied:
“Frankly, I believe it. The vice president, when he was a senator — a very new senator — voted against the aid package for South Vietnam, and that was part of the deal when we pulled out of South Vietnam to try and help them survive. He said that when the Shah fell in Iran in 1979 that that was a step forward for progress toward human rights in Iran. He opposed virtually every element of President Reagan’s defense build-up. He voted against the B-1, the B-2, the MX and so on. He voted against the first Gulf War. So on a number of these major issues, I just frankly, over a long period of time, felt that he had been wrong.”
For what it’s worth, it’s not clear Biden applauded the fall of the shah. He just offered to send the Mullahs a couple hundred million dollars shortly after 9/11, “no strings attached.”
Here we are today:
Vice President Joe Biden said he had not made a decision on whether he will run for president and sounded the alarm about Republican plans to cut estate taxes.
Biden made the statement in a roundtable discussion with reporters at the White House Monday including The Detroit News a day after former Secretary of State Hillary Clinton announced her run for the Democratic nomination. He said he has plenty of time to decide.
“I haven’t made up my mind on that. I have plenty of time to do that, in my view,” Biden said. “If I am wrong, I’m dead wrong, but there’s a lot the president and I care about that has to get done in the next two, three months and when you run for president you’ve got to run for president — and I’m not ready to do that — if I am ever going to be ready to do that.”
Remember, Joe Biden isn’t a joke. Newsweek assured us of this:
on: April 14, 2015, 08:18:22 PM
Started by Crafty_Dog - Last post by ccp
The million dollar question:
"But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?"
As Nursing Homes Chase Lucrative Patients, Quality of Care Is Said to Lag
****The New York TimesThe New York Times
The New York Times
By KATIE THOMAS8 hrs ago
A USS Arizona survivor salutes the remembrance wall of the USS Arizona during a memorial service for the 73rd anniversary of the attack on the US naval base at Pearl harbor, on December 7, 2014, in Pearl Harbor, Hawaii
Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore. © Jessica Kourkounis for The New York Times Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore.
Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.
But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.
Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.
A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.
“These nursing homes were not built for this purpose,” said Dr. Arif Nazir, an associate professor of clinical medicine at Indiana University who studies geriatrics. He said many patients leave hospitals with acute medical needs, before infections have been fully treated, or as they adjust to new medications.
“These patients are leaving the hospital half-cooked, and believe me, the latter part of the cooking is the hardest part,” he said.
Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.
At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery, for example. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.
The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.
So lucrative are Medicare payments that some homes have decided not to take lower-paying Medicaid patients at all.
The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid insurance. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”
Representatives of nursing homes acknowledge that the challenges are substantial, but they are optimistic about the progress they are making.
“It’s uneven, but I think, that said, we’re trending in the right direction,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group. “I think you’re seeing a much greater linking of quality, and an emphasis on it,” he added.
Dr. Gifford and others say they are paying close attention to quality — not only because it is the right thing to do, but because hospitals and large health systems are beginning to demand it. Under the new health care law, hospitals may be penalized if too many of their patients are readmitted within a certain time.
“Hospitals are starting to get really worried, and when hospitals are worried, skilled nursing facilities are worried, because they are their sources of patients,” said David Grabowski, a professor of health care policy at the Harvard Medical School.
Promises of Care
Dr. Lois Johnson-Hamerman, a retired neonatologist, said she thought she had done her homework when she checked into the Watermark at Logan Square, a nursing facility in Philadelphia.
The home had a reputation for quality and got high marks from the federal government. Until a recent revision, its website promised “top-notch health care” with amenities including a staff willing to administer a “decadent hot bath” at any hour of the day.
But just one month after arriving at Watermark for short-term rehabilitation of an injured foot in 2012, Dr. Johnson-Hamerman ended up in the emergency room with a severe bedsore that had become dangerously infected. Far from the service she said she had been promised, she said the workers never gave her a full bath or shower, were slow to respond to her requests to have her diaper changed and did not turn her every few hours, a crucial step in preventing bedsores.
She said she left the facility only after friends, including doctors and nurses, became so horrified by her care that they insisted that she be taken to a hospital.
Geriatric researchers call this disconnect the “chandelier effect.” Attractive lobbies and enticing amenities do not always mean that a home provides good medical care.
In reality, said Dr. Steven Handler, a geriatrician and assistant professor at the University of Pittsburgh School of Medicine, many nursing homes are struggling to provide consistent, quality care despite genuine efforts. “The nursing homes are kind of stuck in an older model that is based on a very small operating margin, low-staffing model and low physician presence,” he said.
Dr. Johnson-Hamerman, who is 87, is suing Watermark over what she describes as negligent care.
“At least I’m still here,” she said recently at her home. “But where would I be if I didn’t have the friends and resources to do something about it?”
C. Jill Hofer, a spokeswoman for Watermark, said that the home was committed to providing quality care and that it denied the allegations in the lawsuit.
Bull Market for Short-Term Homes
The nursing home industry has long argued that it relies on higher Medicare payments to offset the rates it receives from Medicaid, which usually pays for the care of long-term residents.
And indeed, even though facilities earned a 2 percent overall profit in 2013, they lost about 2 percent on non-Medicare patients, according to the Medicare Payment Advisory Commission, or Medpac, an agency of Congress.
But in recent years, that focus on Medicare patients has intensified as many long-term residents have moved to assisted-living facilities and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.
Some companies are now eliminating Medicaid payments entirely by building homes solely for the more lucrative short-term patients.
Santé Partners, a developer in Arizona, recently opened four nursing homes that do not accept any long-term residents. A fifth is set to break ground this summer.
The buildings resemble hotels, with high-quality restaurants and private rooms that have kitchenettes. Developers say their singular focus allows them to provide better care.
“I think pretty much every company now is going in this direction,” said C. Mark Hansen, the president and chief executive of Santé Partners.
Some for-profit chains have aggressively increased their numbers of Medicare patients. In California, the share of Medicare patients at several large chains has far outpaced the state average, according to an analysis of state nursing home data by The New York Times.
On a typical day in 2012, about 11 percent of beds in California nursing homes were occupied by Medicare patients, The Times’s analysis showed.
But at HCR ManorCare, one of the nation’s largest chains, 32 percent were Medicare patients at its California nursing homes. At the Ensign Group, a large chain based in California, Medicare covered 20 percent of patients on a typical day in 2012.
HCR ManorCare said that it had invested in treating patients with complex medical needs and that that helped explain why its percentage of Medicare patients was higher than the state average. A spokeswoman for Ensign declined to comment.
Ensign is one of several chains that has recently paid federal fines to settle charges that they exaggerated the therapy needs of patients to increase Medicare payments. The company paid $48 million in 2013 to settle such claims. In October, a large Canadian company, Extendicare Health Services, paid $38 million in a similar case.
Even homes with a history of poor care are marketing their high-end amenities. The Medford Multicare Center for Living on Long Island recently opened a wing intended for short-term care known as “The Lux at Medford.” Guests have access to a putting green, a model apartment and a parked PT Cruiser to teach them how to resume their day-to-day activities.
The New York State attorney general sued the facility last year over issues of quality, and seven employees were indicted on a range of charges related to the death of Aurelia Rios, a patient in the facility’s ventilator unit. Federal officials recently placed the home on a watch list of the nation’s poorest-performing facilities.
Jason Newman, a spokesman for the home, says the owners of Medford dispute the charges. “The owners of this facility care very, very much about this place,” he said.
Claims of Lapses, and Death
Deaths attributed to lapses in care are not uncommon. In 2010, Mary Dwyer checked into Harborview Healthcare Center in Jersey City to recuperate after dislocating her shoulder in a fall.
Ms. Dwyer, who was 87, planned to return home, but her condition deteriorated rapidly because of what her family described as negligent care. Staff members were so overworked that Ms. Dwyer was not fed properly and not repositioned frequently in her bed, according to a lawsuit the family later filed in New Jersey state court alleging negligence and wrongful death.
In a month, Ms. Dwyer lost 20 pounds and developed a bedsore so severe that it exposed her bone.
She was treated at a hospital for her injury, and she died about a month later. Last year, a jury awarded her family more than $13 million.
The amount has since been reduced to $4.75 million and the case is being appealed by the nursing home. A spokeswoman for Harborview said the company denied the charges and maintained an outstanding record for quality.
“Nobody really took responsibility,” Ms. Dwyer’s daughter, Henrietta Dwyer, said recently. “It seemed nobody was accountable for anything.”
Industry specialists say that competition is so intense that eventually quality will prevail, as hospitals and insurers, who cover some Medicare patients, will balk at sending patients to homes that perform poorly.
Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore. She died a month later. © Bryan Anselm for The New York Times Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore…
Hospitals now pay penalties if too many patients are readmitted.
And under new payment models, health systems are beginning to coordinate the care of patients even after they leave the hospital. They are rewarded for keeping costs low, but they also must prove that certain quality goals are met.
The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out. © Kirsten Luce for The New York Times The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out.
“It’s happening at a head-spinning rate,” said Dr. Nazir of Indiana University. “It has been a very positive thing.”
Dr. Gifford of the industry trade group said his group’s members had reduced re-hospitalization rates by 14 percent. And the group has supported other measures to improve quality, he said, including one passed by Congress last year that will withhold a percentage of Medicare payments from facilities, who can then earn back some of the money if they meet certain standards.
Mr. Hansen, the chief executive of Santé Partners, said his facilities did not bring in high profits because the company invests heavily in quality. That investment pays off, he said, because he can demonstrate that his facilities provide good care at a lower cost than, say, a hospital.
“It’s bringing down the total cost of the health care spend,” Mr. Hansen said.
Still, some insurers and hospitals continue to send patients to homes with poor records.
Kaiser Permanente, which combines a nonprofit insurance plan with its own hospitals and clinics, sends patients to a network of outside nursing homes in Maryland and Virginia that the organization says meet its “high standards of care.” However, of the 12 so-called core nursing homes in Kaiser’s network, four held a one-star rating for their health inspection. One was ranked five stars, the highest score.
After The New York Times contacted Kaiser, a spokesman said it would end its association with one of the poorly rated homes, Commonwealth Health & Rehab Center in Fairfax, Va.
The spokesman said that the company sends Kaiser doctors and staff members to the facilities to treat its patients, and that most of them are placed in homes with the higher ratings. He said Kaiser was working with the low-rated homes to improve their conditions.
“The care and safety of our members and patients are our top priorities,” said the spokesman, Marc Brown.
But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?
“I think a lot of the time when it comes to managed care, it’s a race to the
on: April 14, 2015, 01:42:58 PM
Started by Crafty_Dog - Last post by Crafty_Dog
In the Business World, We'd Call Bill Clinton's Wife an Empty Suit
Posted by Herman Cain - 04-13-2015
Lots of talk. Not much to back it up.
If you spend much time in business, you'll meet one of them. They're not hard to spot. They may have gotten a position by way of nepotism. Or maybe they gave a very impressive interview, but once hired it became painfully clear they didn't have what it took to do the job on a day-to-day basis. They had learned how to speak some of the language of business, but actually getting things done and done well was an entirely different story.
We call them empty suits.
I suppose a lot of them might be attracted to politics because all you have to do in politics is appear to be getting things done. Like Dr. Stantz said in Ghostbusters, "In the private sector, they expect results!" And those who can't deliver tend not to last very long. They might have a resume that lists a lot of jobs that look impressive, but there's a reason they list so many. They don't stick around anywhere very long because it quickly becomes obvious that they either don't have what it takes, or they won't do the work that's required.
And that brings us to Bill Clinton's Wife, who thinks she should now get a turn as president. Democrats will point to her resume. Eight years as a U.S. senator. Four years as Secretary of State. Pretty impressive, no?
Actually, no. Because it's not just the positions you held. It's what you did in them. And in her case, it's why you had the jobs in the first place. What significant accomplishment can she point to during her years as New York's junior senator? What major piece of legislation did she sponsor and successfully push through to implementation, only to see it work well for the American people? What important problem did she help to solve?
You don't remember any? That's because there weren't any.
What have been the results of her tenure as Secretary of State? Are you kidding me? The Russian reset button gimmick was lame and naive, but not as bad as the actual results in terms of our relations with Russia, which is more hostile toward us (and fears us less) than ever. The Middle East is completely out of control. Iran is close to getting the bomb. Syria is in chaos. And relations everywhere from Great Britain to Israel to Egypt to Turkey to even Canada are worse than they were back in the days when, according to Democrats, George W. Bush was "shredding our alliances." (Remember that one? Seems pretty preposterous given the current state of affairs, doesn't it?)
Oh, and let's not forget her decision to deny extra security in Benghazi, only to tell the victims of the attack there not to worry because she'd make sure a guy who made a YouTube video was "brought to justice".
At least she knew how to make decisions about trade deals. She would just check and see who donated to the Clinton Foundation and then take a position. These Clintons do have a way of doing things, don't they?
And let's not forget: Everyone knew before she ever became a senator, and before she ever became Secretary of State, that she wanted to be president and thought she should be president. She only pursued those jobs to make herself look more qualified for the job she wished she could just move right into. This is classic empty suit stuff! And once she had those jobs, her only purpose in doing them was to make herself look more qualified for the presidency.
I'm honestly baffled as to why so many people support such an empty suit. I know why the political consultant class supports her. They think her name recognition gives her a great chance of being elected and they see her as a meal ticket for another four years. And I know that while she often infuriates the liberal media with her secrecy (you can treat everyone else badly, but not them), they will still cover for her if she wins the Democrat nomination - lying by omission as they ignore the many scandals and other storylines that demonstrate her lack of preparation and qualification for the Oval Office.
But what's with normal, everyday people who are telling pollsters they want her to be president? I guess an empty suit can pretty easily fool people who only pay very limited attention. In fact, that's what they count on. It sounds good to them when she says she wants to be their "champion," but if they were really to think that statement through, they might ask, "Champion of what?" And when have the Clintons ever been champions of anything except themselves and their own interests?
There's a reason we refer to her around here as Bill Clinton's Wife. It's because she has only ever gotten anywhere in politics because of who she's married to. She is only taken seriously as a candidate for president because of who she's married to. Anyone else with her unimpressive track record would be laughed off the stage. Not only does she have no impressive accomplishments in her career, but she hasn't even offered any compelling policy ideas, or even any serious priorities or goals.
She just commands lots of attention, without so much as a hint of why she deserves any of it. It's hard for me to believe that as she goes through the rigors of a campaign, where serious opponents will challenge her on substance, that she can continue the illusion. That's usually when empty suits, shall we say, fold like a cheap suit.