Michelle Obama’s Next Attack on the Poor? Should There Be a Ban on Food Stamps to Buy Soda?

Michelle Obama has tried telling tens of millions of student across the nation what they are allowed to eat under her watchful eye. They have rebelled and trash her food—preferring good tasting food. Now the Left is looking at another way to control what people eat. The 47 million people on Food Stamps, if Michelle and her gang have their way, will stop soda from being bought with the Stamps. Once that is passed, you know ice cream, beef, cakes/cookies and other items will also be outlawed.

I understand alcohol and tobacco products not being bought with food stamps—but the makings of a meatloaf? Michelle’s birthed two children—the rest of America she adopted and now acting like we must listen to her.

The researchers also looked at the impact of giving 30 cents back to SNAP participants for each dollar they might spend on fruits and vegetables. While such a reward doubled the number of people who eating the recommended requirements of fruits and vegetables, but obesity and diabetes indicators “did not improve considerably,” Basu said.”

First food stamps

Should There Be a Ban on Food Stamps to Buy Soda?

KQED, 6/3/14

Banning the use of food stamps to purchase sodas and other sugary drinks could reduce both obesity and type 2 diabetes rates, according to new research from Stanford University School of Medicine.

“Shift in policy could prevent 400,000 cases of obesity.”

About one in seven Americans — more than 46 million people — currently receive food stamps funding, now called the Supplemental Nutrition Assistance Program, or SNAP. Government surveys show that the average SNAP recipient drinks the equivalent of a little more than a can of soda a day.

Stanford researchers used two data sets, one on diet and another on price data for food, and then used simulations to estimate the effect of a ban on using SNAP funds to buy sugary beverages, including sodas and sports drinks, but excluded 100 percent fruit juices.

Over a ten-year period, the simulation indicated that such a ban would load to a 2.4 percent drop in obesity prevalence and a 1.7 percent decline in type 2 diabetes, among SNAP recipients.

While those percentage changes sound small, lead author Dr. Sanjay Basu, a professor of medicine at Stanford, says the real impact across a population would be impressive.

“This shift in policy would be preventing around 400,000 cases of obesity in the next decade and nearly 250,000 cases of type 2 diabetes,” Basu said.

The study was published in the journal Health Affairs.

The American Beverage Association criticized the idea of a ban. In a statement, the group said a ban would be an “expensive and unnecessary restriction that (has) negligible benefits.” The association called instead for heath education and healthy incentives.

But Harold Goldstein, executive director of the California Center for Public Health Advocacy, was intrigued by the analysis. “I look at these federal dollars as a subsidy to Coke and Pepsi,” he said. “Here’s a strategy that could have a significant impact on low income folks who have among the highest diabetes rates in the country.” Goldstein was not involved in the research.

Another federal program, Women, Infants and Children, already does not allow the purchase of sugar-sweetened beverages.

The researchers also looked at the impact of giving 30 cents back to SNAP participants for each dollar they might spend on fruits and vegetables. While such a reward doubled the number of people who eating the recommended requirements of fruits and vegetables, but obesity and diabetes indicators “did not improve considerably,” Basu said.

Last June, a bipartisan group of mayors sent a letter to House speaker John Boehner and House Minority Leader Nancy Pelosi advocating for improvements to the SNAP program, saying it was time to consider limiting subsidization of sugar-sweetened beverages.

Monday’s study comes against a backdrop of renewed calls in California cities for a soda tax — and just days after the California Senate passed a bill which would require a health warning label on sodas and other sugary beverages.

Doctors and other public health professionals are growing increasingly concerned about the health impact of sugary beverages or what Goldstein referred to as “liquid sugar.”

“We know that there is overwhelming science that the liquid sugar in these beverages is a unique driver in today’s skyrocketing obesity epidemic,” he said.

 

USDA Creating $1.9 Million Research Center Devoted to Changing American’s Food Choices

Governments waste money. It has more money than it can honestly and efficiently spend. Then you have Michelle Obama who has appointed herself as the “Food Commander” for America. She tells kids in government schools what they are allowed to eat, her people are looking at disallowing Food Stamps to be used for soda (that will be just the start—and this affects 47 million Americans). This is not enough. Now the USDA is spending $1.9 million for a food research center to “teach”, “persuade” the American citizens to eat what Michelle wants, not what we want. No need for new taxes—just cut the Michelle Obama programs.

“The USDA Center will facilitate new and innovative research on the application of behavioral economics theory to healthy food choice behaviors that would contribute to enhancing the nutrition, food security, and health of American consumers,” the USDA’s grant announcement said.

Behavioral economics? That is Washington talk for raising the cost of a product—they want the cost of fast food to go so high it is no longer affordable.

Corn Field

 

USDA Creating $1.9 Million Research Center Devoted to Changing American’s Food Choices

BY: Elizabeth Harrington, Washington Free Beacon, 6/2/14

The U.S. Department of Agriculture (USDA) is creating a $2 million research center to study how the government can “nudge” Americans toward making healthier eating habits.

The agency is currently accepting grant applications to establish a “Center for Behavioral Economics and Healthy Food Choice Research,” which will facilitate studies such as how breaking up combo meals at fast food restaurants would influence customers.

“The USDA Center will facilitate new and innovative research on the application of behavioral economics theory to healthy food choice behaviors that would contribute to enhancing the nutrition, food security, and health of American consumers,” the USDA’s grant announcement said.

The center will be given at least $1.9 million over three years, with the possibility of future funding. Its research will focus on “facilitating food choice behaviors” and improving the diets of Americans enrolled on food stamps and the Women, Infants, and Children (WIC) program.

The USDA said it is their responsibility to attempt to alter the food choices of Americans since 25 percent receive food aid from government programs.

“With a total outlay of $108.9 billion in FY 2013, food and nutrition assistance accounted for 72 percent of USDA’s budget,” the announcement said. “Approximately 1 in 4 Americans participated in at least 1 of the 15 food and nutrition assistance programs at some point during FY 2013, making these programs fundamental to the nutritional well-being of millions of Americans.”

“These diverse activities share the common goal of improving the nutrition, food security, and health of American consumers,” it said.

The USDA claims that food choices are not made in a “purely rational manner,” but are influenced by food manufacturers and retailers.

“The idea of complete rationality is challenged by repeated observance of cognitive biases such as hyperbolic discounting that can lead to decisions that seem to over-value short-term benefits such as the taste or convenience of foods versus long-run benefits such as health,” the grant announcement said.

A list of “Topics of interest” provided by the USDA sheds light on the type of research the new center will conduct.

“How are firms’ product development, pricing, marketing, and promotion strategies affected when consumers have systematic biases in decisionmaking?” the agency asked. “Can package or portion sizes be presented or promoted in a manner that encourages healthful consumption?”

The USDA also wants to know how changes to fast food combo meals can force Americans to eat healthier.

“What would be the impact of changing the presentation order in which food is displayed on fast food menu boards or the manner in which foods are bundled for fast-food or restaurant meals?” they asked.

The USDA also proposed a study on changing how food is described on menus, labeling low-sodium and low-fat versions as “regular,” and “framing regular versions of certain snack products as high-fat or high-sodium.”

In addition, the agency is interested in research that could encourage Supplemental Nutrition Assistance Program (SNAP) participants to plan meals in advance, make shopping lists, and avoid shopping when hungry, the USDA said.

Much of the research will involve SNAP, since the average 47.6 million people who received food stamp benefits each month in 2013 had “diets in need of improvement,” the USDA said.

“Studies could also explore retailer-participant interactions—for example, could retailers design store formats that assist SNAP participants, perhaps by using store-based symbols or logos that highlight foods that are both healthful and economical, in a manner that simplifies and speeds choice for SNAP shoppers?” the grant announcement said.

“Finally, studies could examine behavioral factors related to SNAP program operations, such as behavioral messaging and cues (‘nudges’) that prompt healthful food choices,” it said.

The research will ultimately impact policy. The USDA is seeking to use the studies as a basis for new regulations, after findings are shared with policymakers, program officials, and the general public.

“Studies are expected to focus on ideas that can be implemented within existing legislation and regulations rather than options that change them,” the announcement said.

 

Government Employee Unions – The Root Cause of California’s Challenges

During the lengthy BART strike in San Fran, it was estimated that 20% of the workers could not get to their jobs. Wonder how many are forced to stay home due to the MUNI strike. Of course Google and other technology workers do not have that problem, since their firms provide free bus rides to work. But remember, the unions oppose this free service to workers—now you know why. Unions wanted the technology workers to suffer like everybody else. Watch other large firms start providing workers with free transportation to the job.

“But the deeper story is how government employee unions are not only failing to “protect” California’s aspiring multitudes, but are in fact enabling the wealthy special interests they claim to protect us from. The most entrenched and massive corporate entities are not harmed by excessive regulations, because they can afford to comply. An obvious example would be California’s impending $13 per hour minimum wage. Large corporate entities like MacDonalds will simply automate a few positions, tinker with the menu and recipes, incrementally raise prices, and go forward. Large corporations can hire attorneys and lobbyists, they have access to capital, and when the smaller players go out of business they gain market share. They benefit from over-regulation, but the consumer suffers.”

Unions pension public sector

Government Employee Unions – The Root Cause of California’s Challenges

By Ed Ring, Union Watch, 6/3/14

Spokespersons for California’s government employee unions perpetuate a myth of staggering absurdity and tragic consequences – that they are protecting working Californians from wealthy corporations and wealthy individuals.

The reality is that government employee unions are focused on one thing: Expanding government employee pay, benefits and privileges. This requires expanding government, and that priority comes in front of everything else, including the cost to society at large. Expansive environmentalist regulations have made prices in California for housing and utilities the highest in the nation. Expansive compensation packages for unionized government workers have resulted in chronic deficits and accumulating state and local government debt that by some measures already exceeds $1.0 trillion. Expansive taxes and regulation have made California consistently rank as the most inhospitable place in the nation to run a small business.

Exactly how does any of this protect the poor from the wealthy?

It doesn’t, of course. But the deeper story is how government employee unions are not only failing to “protect” California’s aspiring multitudes, but are in fact enabling the wealthy special interests they claim to protect us from. The most entrenched and massive corporate entities are not harmed by excessive regulations, because they can afford to comply. An obvious example would be California’s impending $13 per hour minimum wage. Large corporate entities like MacDonalds will simply automate a few positions, tinker with the menu and recipes, incrementally raise prices, and go forward. Large corporations can hire attorneys and lobbyists, they have access to capital, and when the smaller players go out of business they gain market share. They benefit from over-regulation, but the consumer suffers.

Less obvious is how the financial sector also benefits from an overbuilt, financially irresponsible, unionized government. When excessive rates of pay and benefits consume government budgets, financial institutions step up to extend debt. Bond underwriters collect billions each year in fees in California to issue new debt and refinance existing debt. When excessively generous pension plans are granted to unionized government employees, pension funds pour hundreds of billions into Wall Street investment firms, earning additional billions in fees. As for “carbon emissions auctions,” now in its third year of implementation in California, as that ramps up, virtually every BTU of fossil fuel energy consumed will put a commission into the hands of a financial intermediary. Trillions are on the table.

Unionized government hides behind environmentalism to justify pay and benefits over investment in infrastructure – which after all is environmentally incorrect. As the cost-of-living inevitably rises through artificial constraints on the supply of land and energy, the unionized government workers negotiate even higher pay and benefits to compensate, and the corporate monopolies that control existing supplies of land and energy get more revenue and profit. And of course the resultant asset bubble is healthy both for pension funds and wealthy investors, even as low and middle class private sector workers are priced out of owning homes – or even automobiles – and struggle to make ends meet.

The power of public employee unions starts with the fact they collect and spend more money than any other special interest. In California they collect well over $1.0 billion per year in dues and fees. About one-third of that money is reported as explicitly political spending – that’s over $600 million per two-year election cycle. The rest of it is still spent indirectly on politics, since all of their negotiating and public education campaigns concern how we manage our public institutions. The portion of this billion per year that goes to entirely nonpolitical activity is negligible.

With the best academic studies, political consultants, public relations firms, and lobbyists that money can buy, with political action committees that extend down to the most obscure local elections, government employee unions make or break candidates at every level in California.

It is crucial to perceive the irony. Government unions empower the worst elements of the capitalist system they persistently demonize. The crony capitalists and speculative financial interests benefit from an overbuilt, over-regulating, state and local government populated with overpaid unionized workers. Those virtuous capitalists who want to compete without subsidies are successfully lumped together with these robber barons, discrediting their support for reform. Those small business owners who want to grow their enterprises are harassed and marginalized.

If government employee unions were illegal, the most powerful political force in California would cease to exist. But it wouldn’t “turn California over to the corporations and billionaires.” Quite the opposite. It would take away the ability of those corporations and billionaires to collude with local and state government unions who currently control the lawmakers. It would force them instead to compete with each other, lowering the cost of living for everyone. It would restore balance to our debate over environmental policy, energy policy, and infrastructure investment.

Government unions have taken over California. Their agenda is inherently in conflict with the public interest, their rhetoric is compelling and formidable and utterly deceptive, their financial power is immense. They are turning California into a feudal state, where the anointed and compliant corporations build monopolies, government workers lead privileged lives, the rich get richer, the middle class diminishes, and the poor become dependent on government. Nobody who is serious about reversing California’s decline – or America’s potential decline – can ignore the fundamental enabling role unionized government is playing in its demise.

 

Can California Keep Tesla’s Car Manufacturing Jobs in the Bay Area?

If you were looking to make a profit and to grow your business, would you keep the manufacturing process in California? All previous auto makers have left the State, along with steel manufacturers, most technology is made in other States and nations. The oil industry is shipping its headquarters to other States, as is the financial industry. California is a dying State—as we give $100 million in tax incentives to the Hollywood billionaires, they are filming in other States and Canada—very little in this State.

The TSLA people want to open a new battery plant, starting by the end of June. It will take years of hearings, votes and court fights before TESLA could begin building in California—in Texas, it would be a matter of weeks. Time is money, why waste time or money in California?

“Elon Musk, Bloomberg wrote, “has cited lengthy approval processes as the main reason Tesla is considering other states for its gigafactory,” though he also said that California is still in the running for the plant. Governor Jerry Brown has announced a raft of tax incentives, but it’s not clear that specific breaks can make up for the state’s generally high costs. Musk called a California gigafactory“improbable” but still possible.”

 

 

 

Can California Keep Tesla’s Car Manufacturing Jobs in the Bay Area?

By Stephen J. Smith, Next City, Public CEO, 6/3/14

Late last month, Toyota handed California some bad news: The world’s largest automaker would be moving its American sales headquarters from Torrance, in Los Angeles County, to the suburbs of Dallas, and is taking around 2,000 workers with them. The move was just the latest in the exodus of car makers from L.A.‘s South Bay, an industrial area in the southwestern part of the county that’s increasingly lost its industry. Nissan left nearby Gardena in 2006 for Nashville, Tennessee, while Honda took its executives out of Torrance last year and moved them to Columbus, Ohio.

But it’s not all bad news for California’s car sector. Elon Musk’s Tesla Motors announced just two weeks later that it’s snatched the car-making crown from Toyota. With more than 6,000 employees in the state — more than the 5,300 that Toyota currently employees, before its move to Texas — Tesla is now the state’s largest automaker by worker count. And the electric carmaker will add 500 more jobs by the end of the year, a spokesperson told Bloomberg. (To be fair to the Japanese manufacturers and California, most of them still do higher-skill work in California in design, engineering and R&D.)

In 2010, Tesla bought the old New United Motor Manufacturing Inc. (NUMMI) plant, which Toyota used to share with General Motors before it was shuttered in 2009. The plant is located in Fremont, which has the advantage of being located in the housing-rich East Bay, and very close to tech-heavy Silicon Valley. Tesla’s headquarters is in Palo Alto, less than a 20-mile drive across the San Francisco Bay from Fremont.

While California and the Bay Area’s high costs — for housing, wages, regulations — have so far been worth the hassle for Tesla, the state and region’s highly skilled workforce may not be enough to keep America’s newest car manufacturer nearby.

California’s next test will come when Tesla opens its so-called “gigafactory” later this decade. As I wrote two months ago, Tesla is the world’s largest buyer of lithium-ion batteries, and plans to start manufacturing the fuel cells itself, moving away from its current strategy of buying them in bulk from Asia. The $5 billion factory could employ 6,500 workers, doubling its current workforce, but the Palo Alto-based company has not committed to opening the plant in California.

Elon Musk, Bloomberg wrote, “has cited lengthy approval processes as the main reason Tesla is considering other states for its gigafactory,” though he also said that California is still in the running for the plant. Governor Jerry Brown has announced a raft of tax incentives, but it’s not clear that specific breaks can make up for the state’s generally high costs. Musk called a California gigafactory“improbable” but still possible, though it will face tough competition from Texas (where a location near San Antonio is in the running), Arizona, New Mexico and Nevada.

And in the long run, there’s always the threat of outsourcing. It’s a long way off — Tesla hasn’t delivered any cars to China yet, or picked a local partner — but Elon Musk said last month: “At some point in the next three or four years we’ll be establishing local manufacturing in China.”

The initial reason to enter China may be to avoid import duties and win government subsidies, but if Tesla can tool up a factory in China, the lower wages may one day pose a threat to plants in the U.S.

 

Jane Fonda Called American Soldiers “War Criminals” To Speak at UCLA Graduation

Full disclosure—I am a Viet Nam vet and remember how Jane Fonda caused American soldiers to be tortured—how she told the North Viet Namese the secrets the soldiers told her to take back to their families. She is an inhumane, hateful person that prefers the Chinese system, to freedom (“If you understood communism in China you would get down on your knees and pray for it here.”). She loves government and really loves it when people pay to see her act. Otherwise she hates capitalism.

Yet the bigots that run UCLA (these administrators use race, illegally, as a reason to enroll students) have invited Hanoi Jane to speak to graduates. She can tell them how to support totalitarians against America. Fonda can tell them that making a profit is bad, owning a car kills the planet and eating a good steak is disgusting. I am embarrassed that students will be forced to listen to this hateful person.

“We are truly honored to have Jane Fonda speak at this year’s commencement ceremony,” said Teri Schwartz, dean of UCLA School of Theater, Film and Television. “Jane is a visionary and a remarkable artist who has spent her life telling deeply powerful stories that have moved and inspired audiences worldwide to action for the greater good and to a greater understanding of our common humanity through her films, philanthropic efforts and personal journeys.”

unknownsoldier

Veterans see red as Jane Fonda tapped to speak to UCLA grads

FoxNews 6/2/14

TO SEE COMPLETE STORY CLICK ON HEADLINE

Vietnam veterans in California are furious all over again with Jane Fonda, after the actress was chosen to speak this month at a UCLA graduation ceremony.

Fonda, who in 1972 traveled to Hanoi, Vietnam, to meet with enemy soldiers and called American soldiers “war criminals,” has been picked to be the graduation speaker at UCLA’s School of Theater, Film and Television’s commencement ceremony on June 13.

“We hate her.”

“We hate her,” Nick Callas, 67, president of the Santa Clarita chapter of Vietnam Veterans of America, told FoxNews.com. “We won’t ever see any of her movies or support anything she did. It makes me sick to see her get this kind of recognition.

San Fran Radicals: Use Dial Up Internet Service Instead of Broadband

This is impossible to understand among adults. AT&T wants to upgrade its broadband service to the people of San Fran. They want to go back 15 years. From broadband, fast Internet service, they want you to go back to the “good ole days” of dial up for the Internet. That can be the only explanation for opposition to AT&T. San Fran is the Luddite capitol of California. For all the technology companies in the city, they really hate technology as a cultural standard. Modern food, technology, transportation, they would be happier if this was 1914 not 2014.

How silly? The radicals demand an EIR for an upgrade of the broadband system. How about an EIR for moving your car, just as sensible.

“Before city leaders could approve the updated plan, however, the neighborhood groups sued. They asked the trial court to order an environmental impact report with mitigation measures addressing their concerns, as the California Environmental Quality Act requires – requests the court later denied.”

NoInternetTaxBanner

Dirty Panels No Cause for Alarm on SF Sidewalks

By WILLIAM DOTINGA, Court House News   6/2/14

   

A state appeals court refused to block AT&T’s plans for 726 new utility boxes, despite claims by neighborhood groups that the cabinets would attract graffiti and public urination.
AT&T plans to install the boxes as part of its “Lightspeed” project to upgrade broadband speed with an expanded fiber optic network throughout San Franicsco. The company applied for an environmental review exemption for the project, which city officials granted in 2007.
Neighborhood groups – including plaintiffs San Francisco Beautiful, San Francisco Tomorrow, Dogpatch Neighborhood Association, Portrero Boosters Neighborhood Association and Duboce Triangle Neighborhood Association – complained about the size of the planned cabinets. They said the cabinets would block sidewalks, obstruct views, and attract vandals and urine.
After a public meeting in 2008, AT&T took the comments to heart and downsized both the number and size of the utility boxes. The company also promised safer placement of the boxes and to slap a decal on each box with a phone number for residents to report graffiti – which AT&T said it would clean.
Before city leaders could approve the updated plan, however, the neighborhood groups sued. They asked the trial court to order an environmental impact report with mitigation measures addressing their concerns, as the California Environmental Quality Act requires – requests the court later denied.
On appeal, the groups claimed San Francisco officials made a mistake in determining the project qualified for a CEQA exemption that is typically applied to upgrades of existing utility structures. They argued the project’s 726 new boxes can’t be considered “a limited number” under CEQA, and also involves installing new structures rather than upgrading existing boxes.
But writing for a panel of the First Appellate District, Judge Maria Rivera said that the project qualifies for the environmental exemption thanks to regulations passed by city leaders in 2005 that govern utility structures built on or under San Francisco’s 122 million square feet of sidewalks.
The panel also rejected the groups’ call for a review due to “significant environmental impacts.”
“Plaintiffs have not identified any way in which the utility boxes would create impacts that would ‘differ from the general circumstances of the projects covered by’ the exemption, or for that matter any circumstances that ‘create an environmental risk that does not exist for the general class of exempt projects,'” Rivera wrote, citing 2002’s Communities for a Better Environment v. California Resources Agency. “The record indicates that the city has, at a minimum, tens of thousands of street-mounted facilities including: 1,100 bus shelters, 13,000 MUNI-maintained poles, 132 cabinets to support MUNI operations, 33 advertising kiosks, 5,800 signalized intersections, 25 automatic toilets, 113 kiosks, 744 news racks, 5,151 trolley poles, 21,891 street lights, and five street light controllers, for a total of 47,994 such facilities. This number, however, does not include mail boxes, PG&E surface facilities, water department surface facilities, fire hydrants, or street trees. There is no basis to conclude the addition of 726 additional utility cabinets would be ‘unusual’ in the context of the city’s urban environment, which is already replete with facilities mounted on the public rights-of-way.”
MUNI is San Francisco’s public transportation system, which uses both buses and electric trams and trains.
Rivera noted the concerns of residents and even some supervisors and planning commissioners that current utility boxes are “graffiti magnets,” and that additional panels might add to the problem. But public controversy does not automatically require an environmental report when a project calls outside CEQA requirements, Rivera said.
“We recognize the concern that the new cabinets will become targets for graffiti or public urination,” Rivera wrote. “However, given the presence of numerous other structures on the rights-of-way, there is no basis to conclude people are more likely to engage in those antisocial behaviors in the presence of the cabinets than in their absence – that is, that the cabinets will bring about an increase in this behavior in a way that would rise to a significant impact. On the facts of this case, there is no fair argument they will create a significant environmental impact.”

 

Medicare Cuts Reimbursement for Cancer Treatment—But Will Pay Doctors for Death Panel Discussions

Women in need of special drugs for breast cancer are not being allowed to get the lifesaving drugs. Pregnant women cannot find doctors, under ObamaCare, to take care of the birth. Networks lied about the doctors and hospitals that participate and hospitals are firing nurses and closing, along with non-profits serving the very poor and the illegal aliens.

But ObamaCare has enough money to pay doctors to tell patients not how to stay alive, but to die, soon. Barack would rather people die than live—isn’t that what this priority says?

“The American Medical Association soon will issue recommendations on what doctors should be paid for advance care planning, or conferring with patients about the care they would want if they were incapacitated.”

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Feds to Consider Paying Doctors for End-of-Life Planning

By Michael Ollove, Stateline, 6/2/14

The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.

Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation.

The American Medical Association soon will issue recommendations on what doctors should be paid for advance care planning, or conferring with patients about the care they would want if they were incapacitated. Every year, the AMA makes reimbursement recommendations on a broad range of procedures and services to the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program and works with state governments to administer Medicaid. CMS and private insurers don’t have to follow AMA’s recommendations, but they typically do.

Medicare is the country’s largest health insurer. It has about 50 million beneficiaries, most of them over 65.

Geriatricians, oncologists and other medical specialists who see gravely ill patients say it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation. Would a particular patient, for instance, want to pursue additional procedures that, while grueling, offer some slim possibility of success? Or would the patient want doctors to intervene only to alleviate pain?

If Medicare reimburses doctors for such discussions, as it pays them for examining patients and performing procedures, they are much more likely to happen.

Some private insurers, including Excellus Blue Cross Blue Shield of New York, already reimburse doctors who help patients with advance care planning. Under Medicaid, states largely determine what medical services are covered. At least two states, Oregon and Colorado, provide reimbursement for advance care planning. In Colorado, doctors can be compensated up to $80 for a 30-minute conversation to discuss advance care planning.

“We are doing this to incentivize providers to have these conversations with our clients,” said Judy Zerzan, chief medical officer of the Colorado Department of Health Policy.

Phillip Rodgers, a professor at the University of Michigan Medical School and a member of the AMA group that makes compensation recommendations, said a decision by Medicare to approve reimbursement for advance care conversations would allow patients to control decision-making as their medical options narrow. Compensating doctors for such discussions would be an acknowledgement that, “these conversations are a highly beneficial service that makes certain that the care we provide is the right care based on the patients’ wishes,” he said.

Studies show that when given a choice, patients often forgo invasive procedures at the end of life. Such procedures can be costly while doing little to extend or improve the quality of the patient’s life.

But some people fear that end-of-life conversations could lead to rationing health care or withholding it entirely.

Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, said he wasn’t aware of the AMA’s proposal. But Balch expressed concern that the measure would result in the “denial of life-saving medical treatment.”

“It is one thing genuinely to determine what people’s treatment wishes are but the danger is very grave that efforts to pay for advance care planning sessions (under) Medicare will turn into subtle efforts to pressure some of the most vulnerable patients to surrender their right to live,” Balch said.

‘Death Panel’ Debate

Like the current proposal, the provision that sparked controversy in 2009 would have provided Medicare reimbursement to doctors who used office time to discuss living wills, advance care planning or other matters pertaining to patients’ end-of-life preferences. It did not require such conversations, but ensured that doctors or other practitioners would be compensated for these often difficult sessions.

Then Sarah Palin weighed in.  “The America I know and love,” she wrote in a now infamous Facebook post, “is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”

“Such a system is downright evil,” she wrote.

Whether it was a willful misrepresentation of the actual proposal or a misreading of it (PolitiFact, a fact-checking operation run by the Tampa Bay Times, described Palin’s posting as the “Lie of the Year.”) Palin’s broadside ignited an outpouring of criticism on conservative media.  Other Republicans, including then-House Republican leader John Boehner, picked up the refrain. “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law,” he said.

It wasn’t long before the provision was scrubbed from the bill. Two years later, the administration proposed a similar measure through regulation, but withdrew it out of fear of sparking another controversy.

Request from Illinois

The current effort began last year, when the Illinois State Medical Society recommended that the AMA adopt specific medical codes for the reimbursement of doctors for advance care conversations. Medical codes provide a uniform description of hundreds of medical procedures and services and are used by medical providers, hospitals and insurers across the country. In response to the Illinois request, an AMA panel approved a new code for advance planning.

In the absence of a code, doctors who want to have such conversations with their patients have had to squeeze them into medical appointments ostensibly held for another purpose. Many providers say that forces them to give short shrift to a discussion intended to help a patient — and often, family members — understand all the medical options and the risks associated with each one. Those sessions take time and delicacy, doctors say, and shouldn’t have to be fitted in among other medical procedures or exams.

“It may take up to two hours to bring everyone to an understanding of the situation and the various options,” said Thomas J. Smith, an oncologist and director of palliative care at Johns Hopkins Medicine.

Furthermore, there is no current reimbursement for phone consultations, for instance with relatives who don’t live in the area. It’s also not easy to get reimbursement for patients who are well but still want to discuss advance directives.

“You essentially have to be deceitful to get paid to do advance care planning for the patient who doesn’t have a medical illness,” said Christopher A. Jones, an assistant professor of palliative care at Duke University.

“The federal government places no value on this conversation. None,” said U.S. Rep. Earl Blumenauer of Oregon, a Democrat who is sponsoring a bill that would require reimbursement for advance care planning.

“If reimbursement occurs at all in the federal program, it’s incidental to the primary treatment or somebody miscodes, and that’s not the way it should be,” Blumenauer said. “Under the best of circumstances, this is a difficult conversation for both doctors and families alike that takes time and focused attention.”

The lack of compensation for advance care discussions is part of a broader pattern:  Doctors who perform procedures, such as surgeons, generally are paid more than those who examine and counsel, such a geriatricians and internists. Studies consistently show that the compensation for  “proceduralists“ is three times or more higher than that of primary care doctors and others  whose practices usually involve diagnosis and noninvasive treatment.

In Congress, Blumenauer is hopeful his bill will get a hearing free of any death panel outcry. It helps, he said, that among his 30 co-sponsors are a number of Republicans, all of whom oppose the ACA.

“They know this is not about the ACA at all,” Blumenauer said by phone from Oregon. “I don’t care if you’re for the ACA or against it or don’t care one way or the other. This is legislation that is supported by 90 percent of the public.”

 

Funding shortfall of more than $1.3 billion could push safety-net hospitals to financial brink

Private hospitals in Napa, Connecticut, Georgia and in rural America are being forced to close or cut back. All because of cuts in reimbursement by Medicare, Medicaid and private insurers due to ObamaCare mandates. Now the non-profit health care industry is also being cut back. The safety net is being demolished—by the Democrats. Wonder if the poor will complain about how Obama/Brown are killing their health care coverage?

Here is where we stand: private hospitals are closing, nonprofit facilities are closing. Doctors are refusing to participate in ObamaCare or Medicaid. The death spiral to a Third World health care system is moving rapidly.

“Several county hospitals — including LAC + USC Medical Center, Santa Clara Valley Medical Center, Alameda Health System, Harbor–UCLA Medical Center and Olive View–UCLA Medical Center — may be especially vulnerable because they receive the highest disproportionate-share hospital (DSH) payments in the state and are located in regions with large numbers of undocumented immigrants who are not eligible for Medi-Cal, California’s version of the Medicaid program.”

Oh, it could be that the illegal aliens will be harmed the most.

http://www.dreamstime.com/-image8534492

Funding shortfall of more than $1.3 billion could push safety-net hospitals to financial brink

California will fare better than other states but will still feel pain

Gwendolyn Driscoll, UCLA Center for Health Policy Research, 6/2/14

Public hospitals in California that serve the poorest patients could face a $1.54 billion funding shortfall in 2019, when federal funding cuts go into effect. Those cuts, along with health-care cost inflation, could jeopardize the financial stability of the state’s safety-net hospital system, according to a new study by the UCLA Center for Health Policy Research and Virginia Commonwealth University published in the June issue of the journal Health Affairs.

Several county hospitals — including LAC + USC Medical Center, Santa Clara Valley Medical Center, Alameda Health System, Harbor–UCLA Medical Center and Olive View–UCLA Medical Center — may be especially vulnerable because they receive the highest disproportionate-share hospital (DSH) payments in the state and are located in regions with large numbers of undocumented immigrants who are not eligible for Medi-Cal, California’s version of the Medicaid program.

“Hospitals that can least afford a cut are the most at risk,” said Dylan Roby, director of the UCLA center’s Health Economics and Evaluation Research Program. “Policymakers should ensure that the impending shift in federal funding does not destabilize institutions that are the backbone of public health in California.”

California’s safety-net hospitals rely heavily on federal DSH funding, which compensates them for treating the most vulnerable patients — those who are uninsured and those on Medicaid, primarily children, pregnant women, the disabled and the elderly. In 2010, DSH funds paid more than half of $2 billion in DSH costs ($1.1 billion) to the 21 safety-net hospitals included in the study, with county and state funds covering the rest.

But with impending DSH cuts, the study estimates payments would drop to roughly $830 million to $980 million and leave hospitals struggling to cover $1.38 billion to $1.54 billion in DSH costs in 2019. As many as 4 million Californians and 30 million Americans nationwide are still likely to be uninsured at that time. Without a strong safety-net hospital system, those patients will have few places to turn to for care.
Consequence of legislation
The cuts are a consequence of the Affordable Care Act, whose authors anticipated that as more patients gained health coverage under the ACA, they would generate more revenue for public hospitals, decreasing the need for DSH payments.

But the newly insured patients may not be revenue-generators at public hospitals, and there will be many remaining uninsured patients, according to the study, which used the California Simulation of Insurance Markets (CalSIM) to model hospitals’ future patient payer mix. For instance, some of the newly insured patients at public hospitals may switch to private hospitals and take their insurance payments with them.

Other states may fare worse

Hospitals in other states that opted out of expanding their Medicaid programs could be much harder hit than California for two reasons: They won’t get federal funding from Medicaid expansion, and their DSH payments will be cut.
“As challenging as these cuts will be for safety-net hospitals in California, they will be much worse in other states,” said Katherine Neuhausen, lead author of the study and a clinical assistant professor at Virginia Commonwealth University who conducted the research as a Robert Wood Johnson Foundation Clinical Scholar at UCLA. “Safety-net hospitals in states that do not expand Medicaid and those in states that do not target DSH payments to the hospitals with the greatest need could be in jeopardy.”
Public hospitals on a ‘shoestring’

Still, California is not immune to the coming budgetary realignment.
California highly targets its DSH payments to 21 public hospitals (just 4 percent of the state’s hospitals), including 15 county hospitals and six University of California hospitals. Many of these public hospitals — which operate half the state’s trauma centers and a quarter of the burn centers, as well as teaching hospitals — are in low-income areas with few paying patients and are especially vulnerable to any loss of funds.

“They’re already operating on a shoestring,” Roby said.

At LAC + USC Medical Center, half the people receiving outpatient services were found to be uninsured, and more than a third were on Medicaid. At hospitals statewide, the figures were much lower: 21.3 percent and 29.3 percent, respectively.
California awards DSH payments to public hospitals based on their numbers of uninsured and Medicaid discharges and their share of uncompensated care costs. Therefore, public hospitals with greater uncompensated care costs and more low-income patients should retain more of their DSH funds, according to the authors.
The authors conclude that California and other states can take steps to close the funding gap and keep hospitals stable. Hospital leaders, they say, could work with policymakers to make sure DSH payments are targeted to the safety-net hospitals that serve the most uninsured and Medicaid patients; states that expanded Medicaid under the ACA could pay higher reimbursement rates to safety-net hospitals for people who are newly eligible for Medicaid, which is already done in California; and safety-net hospital leaders in states that opted out of Medicaid expansion could seek out additional county and state subsidies.
Read the journal article: Disproportionate-Share Hospital Payment Reductions May Threaten the Financial Stability of Safety-Net Hospitals.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking.

 

Guv Brown to Hold Lottery for Hollywood Billionaires: $100 Million of Your Tax Dollars to be Transferred to Them

Sony is moving its special effects division to Canada. Many TV shows and movies are filmed in Tennessee, Texas, Canada, Europe and Costa Rica. California is just for the money. Now Guv Brown is about to repay his Hollywood Billionaires with your tax dollars. His administration is going to give $100 million to the rich of Hollywood—money taken from the poor and middle class of California. This is how Hollywood has money to donate to Obama, Brown, Boxer and their Leftist buddies—your tax dollars finance the Billionaires of Hollywood.

““We had 380 applications on the first day last year, and the $100 million only covered 34 of them,” says commission director Amy Lemisch.  “Each year, we get more than the previous year.”

So how does the film commission handle the overload? With a lottery.”

Aerial_Hollywood_Sign

Calif. opens bidding for $100M in film and TV tax credits

Brian Watt, KPCC, 6/2/14

A film crew on location in downtown Los Angeles. (File photo)

The California Film Commission began accepting project applications Monday morning for $100 million in tax credits from California’s Film and Television Tax Credit program.

If the program’s recent history is any indication, by the end of the day, there will be more applications turned in than the money can cover.

“We had 380 applications on the first day last year, and the $100 million only covered 34 of them,” says commission director Amy Lemisch.  “Each year, we get more than the previous year.”

So how does the film commission handle the overload? With a lottery.

Staff assigns a number to each application received at the commission’s Hollywood Boulevard office by 3 p.m.  At 3:30, the drawing begins — overseen by the state fire marshal’s office.  The numbers are drawn at random to see which projects will receive the tax credit and which are on a waiting list.

“The lottery is California’s unique solution to a unique problem — demand for our tax credits far exceeds supply,” the Film Commission wrote in its recent newsletter.

This year’s lottery will happen just days after a bill to expand the tax credit program passed the California State Assembly. Support was unanimous, but so far legislators have avoided declaring exactly how much they want the tax credit pot to grow.

New York, with a film tax incentive fund of more than $400 million, is the Golden State’s most aggressive competitor.  As the bill moves through the California Senate this summer, legislators must determine whether to try to match or exceed New York’s offering, or simply raise California’s offering to something more competitive than $100 million.

What legislators are ready to do is make more projects eligible for the tax incentives, which cover about 20 percent of production costs if shot in California.  The bill would allow big budget feature films to apply for the  incentives, as well as TV pilots and new one-hour TV series, which include original programming on streaming services like Netflix.

Last year’s winners of California’s tax credit lottery included a feature film version of the HBO series “Entourage,” Lionsgate’s “The Wash” and “Pretty Little Liars.”  Past recipients include the Oscar-winning “Argo” and the television series “Body of Proof.”

“Producers constantly tell us that California is their preferred choice for shooting,” Lemisch told KPCC.

On Monday afternoon, the commission will announce how many applications it received. On Tuesday, it will announce the number of projects that are under review for the tax incentive, Lemisch said.

Unlike in years past, as Variety reports, the commission will wait until early July to announce the names of the winning projects.

 

Playing the Slots: Technology’s Growing Role in Bringing Efficiency to Parking

Photo courtesy Brian Auer, flickr

Photo courtesy Brian Auer, flickr

Playing the Slots: Technology’s Growing Role in Bringing Efficiency to Parking

Los Angeles and San Francisco are jumping into variable-rate parking in a big way.

By Charles Chieppo, Public CEO, 6/2/14

Using technology to implement roadway pricing has a lot going for it. Approaches such as variable highway tolls can reduce congestion by better managing demand, improving customer service and providing a revenue source for public transit, which in turn takes vehicles off the road.

Now Los Angeles and San Francisco are among the cities taking a similar concept and applying it to make it easier to find a parking space.

LA Express Park, a pilot program that covers a 4.5 square-mile area of downtown, uses technology to match on-street parking prices with demand. Its goal is to ensure that between 10 and 30 percent of the parking spaces on each block are open throughout the day. “Smart meters” and sensors compile occupancy and payment data. Based on that information, a pricing algorithm recommends parking rates for various times of day that are designed to ensure that meters are used but that no area is overly congested.

San Francisco has a longer history with dynamic parking pricing.SFparkbegan in 2011. It’s in use over a wider swath of the city and also covers city-owned parking garages. Similar to LA Express Park, it aims to achieve a consistent space-occupancy rate of about 85 percent. In some ways, SFpark is more precise. For example, it applies special rates around AT&T Park during Giants baseball games.

SFpark and LA Express Park both offer free apps that provide users with real-time space-availability information.

As parking expert Donald Shoup, a professor of urban planning at UCLA, puts it, these programs “reduce cruising, speed up buses, [and] reduce air pollution.” By minimizing the experience of driving around endlessly in search of a parking space that all of us who live in and around big cities know all too well, they also improve customer service.

Since parking patterns change continuously, adjustments to LA Express Park rates take effect on the first Monday of each month and are made public in advance. SFpark rates change less frequently — no more than every other month.

In Los Angeles, pilot-wide rates have decreased by 11 percent but revenue is up by 2 percent, thanks to better utilization of parking spaces and the increased rates in high-demand areas. The pattern has been similar in San Francisco.

Thus far, neither program has been used to raise significant new revenue, but the technology could certainly facilitate that. For example, meter hours could be extended past the typical 6 p.m. in areas that are busy in the evening.

One challenge these programs face is awareness. A survey in Los Angeles found that 76 percent of drivers would choose to park in a less-expensive space a little farther from their destinations, but those drivers must know about the dynamic-pricing plan to take advantage of it.

In transportation, we’ve increasingly seen in recent years that when technology is applied to improve customer service, it can also enhance revenue and create environmental benefits. Early results from San Francisco and Los Angeles suggest the same is true for parking.