Tuesday, November 24, 2009
Sunday, November 22, 2009
Breast Cancer Screening
One of the central cost containment ideas in “health care reform” got tested this week, and it failed miserably. I’m talking about using the idea of “best practices” to eliminate waste in the medical system.
The idea behind best practices, also known as evidence based medicine, is to do studies of what works and what doesn’t work in treating various medical conditions. Once the most effective protocol is determined, insurers will only pay for the approved protocol. Other treatments will not be reimbursed. The goal is to prevent overuse of medical testing and procedures that enrich doctors, but do little to improve overall outcomes.
It’s not a bad idea in theory. Too bad it doesn’t work in the real world.
The case in point from this week’s news is the new breast cancer screening guidelines. A group from the United States Preventive Services Task Force (USPSTF) studied the data, and concluded that as a nation, we are doing way too many mammographies. Instead of testing every woman over 40 every year, they are now setting a guideline of every woman over 50, every two years. The few additional live spans increased did not justify the extra biopsies, unnecessary lumpectomies, and related stress and anxiety caused by false positive screenings.
In exchange for doing a difficult job, loaded with hard technical analysis, the USPSTF was promptly thrown under the bus. You may substitute metaphors involving running into buzz saws or being fed to wolves if you prefer.
Katherine Sebelius, the Health and Human Services cabinet secretary, disavowed the findings of the Task Force, even though they were working for her when they did the study.
This does not bode well for the ability of any health care reform plan under consideration to lower costs if enacted into law.
The idea behind best practices, also known as evidence based medicine, is to do studies of what works and what doesn’t work in treating various medical conditions. Once the most effective protocol is determined, insurers will only pay for the approved protocol. Other treatments will not be reimbursed. The goal is to prevent overuse of medical testing and procedures that enrich doctors, but do little to improve overall outcomes.
It’s not a bad idea in theory. Too bad it doesn’t work in the real world.
The case in point from this week’s news is the new breast cancer screening guidelines. A group from the United States Preventive Services Task Force (USPSTF) studied the data, and concluded that as a nation, we are doing way too many mammographies. Instead of testing every woman over 40 every year, they are now setting a guideline of every woman over 50, every two years. The few additional live spans increased did not justify the extra biopsies, unnecessary lumpectomies, and related stress and anxiety caused by false positive screenings.
In exchange for doing a difficult job, loaded with hard technical analysis, the USPSTF was promptly thrown under the bus. You may substitute metaphors involving running into buzz saws or being fed to wolves if you prefer.
Katherine Sebelius, the Health and Human Services cabinet secretary, disavowed the findings of the Task Force, even though they were working for her when they did the study.
This does not bode well for the ability of any health care reform plan under consideration to lower costs if enacted into law.
Monday, November 16, 2009
Getting Ready for Tax Season
I have not had a lot of time for writing the last week or so. A few crises with vendors at my day job, combined with prepping for an exam at the accounting class I’m taking, with tax preparation classes piled into the mix for the last week. The combination of the three has kept me pretty busy.
But the process of getting ready for the start of tax season next January has brought up an issue I want to comment on, so once again I am spurred to set pen to paper (or push electrons onto CRT screen, whatever the computer equivalent is).
Part of the tax prep classes this weekend covered due diligence for tax preparers assisting clients in filing for the earned income credit. The EIC is supposed to supplement the income of wage earners, usually with children. It is a refundable credit, which means that even if you get all of your withholding back, you can still get thousands of dollars in additional money.
Under 2008 tax law, you max out your EIC with two children. If you have more than two children, you receive no additional benefit. If you have zero or one child, you get a smaller benefit. If you have less earned income, you get a smaller check from the government.
So what happens is that people with more earned income and fewer kids claim the children of people who have already maxed out their tax benefit. The amount of fraud and misrepresentation connected to the Earned Income Credit is massive. Every tax preparer in my class had a war story about making claims that just weren’t believable.
But do we turn those people away? No we do not. We accept the client’s statements at face value. We can question the story and document the answers, but we do not require any corroborating evidence. We leave that up to the IRS.
The thing that strikes me about that is that we aren’t being paid by our clients. Sure, the client is getting his or her withholding back. That’s part of their refund. But the lion’s share of the “refund” is provided by credits such as the EIC. The tax preparer is taking his fees out of the government’s money, not the tax filer’s.
That sets up a massive conflict of interest on the part of the tax preparer. If we turn a blind eye to holes in the client’s story in order to get them a bigger refund check, we get a bigger fee for doing the paperwork. The client has huge incentives to cheat, and the tax preparers have incentives to facilitate the cheating.
If I were the IRS, I would step up my auditing of tax preparer’s work by a factor of ten. That would make the tax preparers less willing to accept dodgy answers from a client.
After all, unlike many of the clients, I actually pay income taxes. I don’t want to see my tax dollars going to a fraud.
But the process of getting ready for the start of tax season next January has brought up an issue I want to comment on, so once again I am spurred to set pen to paper (or push electrons onto CRT screen, whatever the computer equivalent is).
Part of the tax prep classes this weekend covered due diligence for tax preparers assisting clients in filing for the earned income credit. The EIC is supposed to supplement the income of wage earners, usually with children. It is a refundable credit, which means that even if you get all of your withholding back, you can still get thousands of dollars in additional money.
Under 2008 tax law, you max out your EIC with two children. If you have more than two children, you receive no additional benefit. If you have zero or one child, you get a smaller benefit. If you have less earned income, you get a smaller check from the government.
So what happens is that people with more earned income and fewer kids claim the children of people who have already maxed out their tax benefit. The amount of fraud and misrepresentation connected to the Earned Income Credit is massive. Every tax preparer in my class had a war story about making claims that just weren’t believable.
But do we turn those people away? No we do not. We accept the client’s statements at face value. We can question the story and document the answers, but we do not require any corroborating evidence. We leave that up to the IRS.
The thing that strikes me about that is that we aren’t being paid by our clients. Sure, the client is getting his or her withholding back. That’s part of their refund. But the lion’s share of the “refund” is provided by credits such as the EIC. The tax preparer is taking his fees out of the government’s money, not the tax filer’s.
That sets up a massive conflict of interest on the part of the tax preparer. If we turn a blind eye to holes in the client’s story in order to get them a bigger refund check, we get a bigger fee for doing the paperwork. The client has huge incentives to cheat, and the tax preparers have incentives to facilitate the cheating.
If I were the IRS, I would step up my auditing of tax preparer’s work by a factor of ten. That would make the tax preparers less willing to accept dodgy answers from a client.
After all, unlike many of the clients, I actually pay income taxes. I don’t want to see my tax dollars going to a fraud.
Tuesday, November 10, 2009
... Before a Fall
The US House of Representatives voted on a version of health care “reform” over the weekend. Actually, it would probably be more accurate to call the legislation health insurance overhaul. However, since various forms of health insurance pay for the overwhelming majority of medical care in this country, it is clear that if the legislation also gets out of the Senate, a gigantic restructuring of the health care sector of the economy is envisioned.
Health care is one of the largest sectors of the economy. Currently, about one out of every seven dollars spent in America is spent of health care. The House just passed a vision of how to reengineer 17% of the economy.
The final vote tally: 220 for to 215 against.
Now, call me crazy (you wouldn’t be the first one), but I think the scale of the legislation is wildly out of proportion to the margin in favor. As a conservative, my natural inclination is to make small, evolutionary changes to society’s existing structures, instead of big sweeping alterations. But even liberals who think they are smart enough to restructure one seventh of the economy in one fell swoop should at least wait until they had some kind of consensus, shouldn’t they?
220 for to 215 against doesn’t exactly shout out “consensus,” does it?
If the House wanted to change the speed limit on the Interstates, 220 to 215 is an acceptable margin of victory. Add a few square miles of Federal land to a national park? Hey, 220 to 215 means the will of the people is clear.
But to radically restructure the health insurance industry and create a massive new entitlement? It is an act of the highest degree of hubris to assume that because you have 50.6% of the votes, you should pass legislation of this scale, just because you can.
The ancient Greeks had a saying: Who the Gods would humble, they first make proud.
Health care is one of the largest sectors of the economy. Currently, about one out of every seven dollars spent in America is spent of health care. The House just passed a vision of how to reengineer 17% of the economy.
The final vote tally: 220 for to 215 against.
Now, call me crazy (you wouldn’t be the first one), but I think the scale of the legislation is wildly out of proportion to the margin in favor. As a conservative, my natural inclination is to make small, evolutionary changes to society’s existing structures, instead of big sweeping alterations. But even liberals who think they are smart enough to restructure one seventh of the economy in one fell swoop should at least wait until they had some kind of consensus, shouldn’t they?
220 for to 215 against doesn’t exactly shout out “consensus,” does it?
If the House wanted to change the speed limit on the Interstates, 220 to 215 is an acceptable margin of victory. Add a few square miles of Federal land to a national park? Hey, 220 to 215 means the will of the people is clear.
But to radically restructure the health insurance industry and create a massive new entitlement? It is an act of the highest degree of hubris to assume that because you have 50.6% of the votes, you should pass legislation of this scale, just because you can.
The ancient Greeks had a saying: Who the Gods would humble, they first make proud.
Thursday, November 5, 2009
Pet Peeve #4368: Toner Warning
I use an HP LaserJet printer. It is a terrific printer, fast and almost flawless. I’ve had it for years, and have been very pleased with the performance I’ve gotten out of it.
Except for one little thing.
When the toner cartridge gets down to about 10% full, you get a warning message flashed on your screen, telling you it is time to replace the toner cartridge. All well and good, except that you really don’t need to replace the toner cartridge. At least, just not yet.
You can run for a while before you actually run out of toner. You know when you’re really low on toner because your printing starts to get blank streaks going down the page. Even then, you can pop the toner cartridge out, shake it to redistribute the remaining toner, and start pumping out documents again.
The last 10% of the toner is still enough to print hundreds of pages. If you are like me, and print about ten to twenty pages a day, that 10% can last weeks, or even months. In the meantime, though, the warning message flashes on your screen every time you hit the Print button.
Every freaking time!
This irks me. I’m irked.
I’m just saying …
Except for one little thing.
When the toner cartridge gets down to about 10% full, you get a warning message flashed on your screen, telling you it is time to replace the toner cartridge. All well and good, except that you really don’t need to replace the toner cartridge. At least, just not yet.
You can run for a while before you actually run out of toner. You know when you’re really low on toner because your printing starts to get blank streaks going down the page. Even then, you can pop the toner cartridge out, shake it to redistribute the remaining toner, and start pumping out documents again.
The last 10% of the toner is still enough to print hundreds of pages. If you are like me, and print about ten to twenty pages a day, that 10% can last weeks, or even months. In the meantime, though, the warning message flashes on your screen every time you hit the Print button.
Every freaking time!
This irks me. I’m irked.
I’m just saying …
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