You see this is a lot bigger than having a “for profit” business competing. What we got here is a George Orwell like system(s) of relationships, the non-profits state bureaucracies and politicians, who basically work in the filthy smoke filled rooms – with them telling us they are working for the altruistic benefit for our truly vulnerable population. What we got here, is the bureaucrats are no better than the communist Chinese like-minded functionaries, who are only out for their self interest and power –and the nature of the game is to hide the “death” dealing dysfunction of the vulnerable care from the public. You see it everyone’s interest to hide what going on from the public, especially the governmental non-profits that have extraordinary communist traits of being non transparent and maintain close relationships to the politicians -for the good of the communist (the untransparent system of self interest that enslaves the disabled party) –or in their term to protect the privacy of the mentally disabled.
It would be better to look at this system who cares for our vulnerable; the politicians, the human service lobbyist political special interest, the non profits, the state and federal overseers –as the communist Chinese functionaries whose game to create a international and public illusion for their own gains. You should ask what’s the pay compensation of these top non profit executives are compared to the pay of the home health aids. The pay of these guys are extraordinary. Even the state human investigator have been silence to protect their jobs and the politicians
Worst, I can make the case that the public in general has decided that can’t afford to take care of the disabled –the me’s and you’s don’t care about any morality, we don’t care about any amounts of suffering, creating shunted lives…we tell the politicians to cover up the true conditions of the lives of the disabled to meet our needs of lower taxes. What it comes down too, is we tell elites of the human service industry that we will compensate you massively, you can access to extraordinary power and untransparency in your job, you’ll have political access –but you will have to starve the lower side of service to disabled. Functionally you turn the mental disability of the vulnerable into meeting the compensation needs of the human service elites and professional class. Why are all these licensed professionals keeping quite –because their compensation needs are being met on the back of the disabled.
So you get that, the mom and pops of us, the daughters and sons of us, don’t see the necessity of taking care of the weak like Jesus warned us –we’ve told the politicians, the state bureaucrats, the profits and non profits, to lie to us if you want your jobs –so we don’t have to pay taxes. Basically we’ve said our national economic system has become so dysfunctional and unaffordable –we are going to have to close our eyes to the suffering of the lowest segment of the population.
All of us have gotten into this trance where
Panel says home care monopoly must end
March 25, 2005
By John Zicconi Vermont Press Bureau
BURLINGTON — A state advisory panel wants Vermont to end the monopoly held by a dozen nonprofit home-health agencies in treating Medicare and Medicaid patients.
The Public Oversight Commission voted overwhelmingly Thursday to allow Professional Nurses Service to become Vermont's first for-profit home-health agency to treat all patients whose health care is paid by the government.
Vermont currently allows profit-making agencies to bill the government for only a small number of highly specialized home-health services.
The vote was 8-2 by the commission, which is panel of citizens charged with advising the Douglas administration about health care regulation.
The panel wants John Crowley — commissioner of Banking, Insurance, Securities and Health Care Administration — to issue the Winooski-based visiting nurse organization a Certificate of Need to treat Medicare and Medicaid patients.
Crowley, who has until mid-May to rule, is under no obligation to heed the commission's advice. But compliance with its recommendation would end a monopoly now held by 12 nonprofit agencies that have divided up the state and vowed not to compete with each other.
"We are very, very excited," said Jean McHenry, president and chief executive officer of Professional Nurses Service. "I feel energized and a little numb. This is not the final decision, so I will have reserved enthusiasm until we get that. But this is a very big step."
Professional Nurses Service has been in business for a quarter-century and has treated private-pay clients in every Vermont county, McHenry said. The agency has twice before asked for state approval to treat Medicare and Medicaid patients, but was denied each time.
At McHenry's request, the U.S. Department of Justice over the winter began investigating Vermont's home-health monopoly that prevents for-profit businesses from accessing some $90 million annually in government reimbursement for possible antitrust violations.
Commission members said their recommendation is a result of the nonprofit groups' inability to care for about 5 percent of the Medicare and Medicaid population and that the federal investigation played no part in their decision.
McHenry believes otherwise.
"Its been a factor," she said. "I believe the state has to be considering the fact that this investigation continues."
Department of Justice officials did not return phone calls. But a source who has been interviewed by federal officials said it appears the enforcement agency wants to see how the state handles Professional Nurses Service's application before it issues a ruling.
Vermont's nonprofit home-health agencies do not want competition and are working on two fronts to stop it. They are encouraging Crowley not to heed the commission and lobbying the Legislature to grant them so-called "designated agency" status, which would essentially outlaw competition.
The Legislature so far has been unwilling to debate the issue. Crowley, who has attended commission meetings regarding home-health competition, declined to discuss what he will decide.
"I need to review the material that has been submitted and read the record, which is voluminous," Crowley said. "After reading the record carefully and reviewing the law, I will make a decision."
The Vermont Assembly of Home Health Care Agencies, a trade group that represents the dozen nonprofit groups, said federal data shows Vermont's noncompetitive system treats more patients per-capita than any other state.
For-profit competition could "cherry pick" high-profit clients and leave only those that cost money to the nonprofit agencies, said Phil White, the groups' attorney. Losing high-profit clients would threaten the millions of dollars in annual charity care provided by the nonprofit groups, he said.
"A market-driven home-health system is likely to have a major impact on the existing system to serve the poor, uninsured, under-insured and those who live in remote locations," White said.
"We are the only state in the country that provides universal access to home-health consumers," he said. "We are very concerned this may be a step backwards."
Commission members recognize this fear and advised Crowley to cap the number of government-subsidized patients Professional Nurses Service can treat to 5 percent of the statewide total.
About 21,000 Medicare and Medicaid patients received home care in 2004, meaning the for-profit agency could treat a little more than 1,000 people.
McHenry, who employees about 200 traveling nurses and nurse's aides, was disturbed by the cap and wondered how the Justice Department's anti-trust investigators would view such a barrier to free enterprise.
"I'm not sure the Justice Department, if it has issues with competitive practice, will be satisfied with limited choice," McHenry said. "We would rather not have restrictions, but this is a huge step. We will work with what we've got and try to improve the system over time."
Julie Bushey Trevor, a retired home-health nurse who now acts as an advocate for low-income and disabled patients, also questioned the cap.
"There is significant unmet need," Bushey Trevor said. The nonprofit agencies "provide a tremendous service … but there are a number of people out there who want a choice because they do not feel they are being properly advocated for."
Contact john Zicconi at john.zicconi@rutlandherald.com.
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