healthy4u: ppaca

On this day of government dysfunction in the US, it is time for our latest installment on the "<a href="http://hcrenewal.blogspot.com/search/label/revolving%20doors">revolving door</a>," the interchange of insiders among government legislative offices that affect health policy and agencies that implement it, and large health care corporations and the lobbyists and attorneys who represent them.  While we have been discussing this issue since March, 2011 (look <a href="http://hcrenewal.blogspot.com/2011/03/those-big-doors-keep-revolving.html">here</a>),  it got major media attention in the form of a New York Times <a href="http://www.nytimes.com/2013/09/18/us/politics/reaping-profit-after-assisting-on-health-law.html?pagewanted=all">article</a> two weeks ago.<br /><br />We have accumulated several other relevant stories since late August, 2013, which we will group by the type of government offices and agencies affected, and within them, by the date the story first came out..<br /><br /><b>Regulatory and Law Enforcement Agencies</b><br /><br /><u>Health Care Antitrust Leader at the Federal Trade Commission to Arnold & Porter</u> <br /><br /> From the MainJustice.com <a href="http://www.mainjustice.com/2013/09/09/ftc-senior-antitrust-attorney-joins-arnold-porter/">site</a>,<br /><br /><blockquote class="tr_bq">Peter J Levitas, a former senior antiturst attorney at the Federal Trade Commission, is joining Arnold & Porter LLP in Washington, D.C....<br /><br />Levitas has spent the past four years as deputy director of the FTC's Bureau of Competition and oversaw investigations and litigation for mergers and conduct cases in numerous industries.  </blockquote><br />So,<br /><br /><blockquote class="tr_bq">Levitas joins the firm's antitrust practice with experience3 addressing complex merger and conduct investigations, particularly in the healthcare, pharmaceutical and technology industries.</blockquote><br /><u>Leader of Health Care Fraud Enforcement for US Attorney New Jersey Office to Lowenstein Sandler </u><br /><br />From the ComplianceWeek.com <a href="http://www.complianceweek.com/former-health-care-fraud-chief-rejoins-lowenstein-sandler/article/311549/">site</a>,<br /><br /><blockquote class="tr_bq">Maureen Ruane, a former health care fraud chief at the U.S.  Attorney's Office for the District of New Jersey, has rejoined the law  firm Lowenstein Sandler to lead its new health care litigation,  investigations and compliance practice.<br /><br />The new practice will help the firm's healthcare and life science  clients strengthen their regulatory and compliance programs, as well as  defend corporate and individual clients who become the subjects or  targets of government investigations or enforcement actions.  <br /><br />Prior to rejoining Lowenstein Sandler, Ruane most recently served for  more than three years as the Chief of the Health Care & Government  Fraud Unit at the U.S. Attorney's Office for the District of New Jersey.</blockquote><br /><b>Health Policy Implementation</b><br /><br /><u>Counsel for Department of Health and Human Services to Sidley Austin</u><br /><br /><a href="http://www.nytimes.com/2013/09/18/us/politics/reaping-profit-after-assisting-on-health-law.html?pagewanted=all">Per</a> the NY Times,  <br /><br /><blockquote class="tr_bq">Dr. [Dora] Hughes, a former Obama administration  official, has something Washington lawyers and lobbying shops covet: an  insider’s understanding of the new health care law.         After nearly four years as counselor to Health and Human Services  Secretary Kathleen Sebelius, she left government last year to work for  Sidley Austin, which represents insurers, pharmaceutical companies,  device makers and others affected by the law. </blockquote><br />Previously,<br /><br /><blockquote class="tr_bq">she  began a decade ago, first as a health policy adviser to Senator Edward  M. Kennedy, and later to Mr. Obama, then a senator.        </blockquote><br /><u>Deputy Assistant Secretary of Department of Health and Human Services to Glover Park Group</u><br /><br />Also from the NY Times,<br /><br /><blockquote class="tr_bq"> Elizabeth Engel, who oversaw health legislation and served as a liaison  to Congress when she was a deputy assistant health secretary under Ms.  Sebelius, is now advising health care clients for the Glover Park Group.         </blockquote><br /><u>White House to Avenue Solutions</u><br /><br /><a href="http://www.nytimes.com/2013/09/18/us/politics/reaping-profit-after-assisting-on-health-law.html">From</a> the NY Times,<br /><br /><blockquote class="tr_bq">Yvette Fontenot, a mother of three who began her Washington career in  1997, analyzing Medicare for the Office of Management and Budget. Ms.  Fontenot worked on the health bill as a Finance Committee aide and later  moved to the White House. Four months ago she joined Avenue Solutions, a  boutique lobbying shop. </blockquote><br /><u>White House "Health Czar" and Deputy Chief of Staff to Consonance Capital, and CVS</u><br /><br />While we <a href="http://hcrenewal.blogspot.com/2013/08/the-door-revolves-again-former-white.html">noted</a> this in August, 2013, the NY Times reported in September as part of its larger article,  <br /><br /><blockquote class="tr_bq">   <a href="http://m.healthcarefinancenews.com/news/aca-architect-returns-private-equity">Nancy-Ann DeParle</a>,  Mr. Obama’s former 'health czar' and later his deputy chief of staff,  now guides health care investments as a partner in a new private equity  firm, Consonance Capital, with colleagues from her pre-White House days. </blockquote><br />Actually, as we <a href="http://hcrenewal.blogspot.com/2009/03/meet-new-boss-same-as-old-boss-health.html">discussed</a> in 2009, Ms DeParle has been oscillating back and forth through the revolving door for a while.  She  was the administrator of the Health Care Financing Administration in the Department of Health and Human Services under President Clinton from 1997-2000.  She left to become managing director of a private equity firm, CCMP Capital.  She also served on the boards of directors of Boston Scientific, Cerner, and Medco.  Then she went back to the executive branch as noted by the the Times above.<br /><br />Furthermore, as reported by AP, <a href="http://news.providencejournal.com/breaking-news/2013/09/cvs-caremark-board-adds-former-white-house-adviser.html">via</a> the Providence Journal,<br /><br /><blockquote class="tr_bq">Drugstore chain CVS Caremark has added to its board of directors a  former top adviser to President Barack Obama on the health care  overhaul.<br /><br />The Woonsocket, R.I., company said Wednesday after markets closed  that Nancy-Ann M. DeParle, 56, will be an independent director who  serves on the board's audit committee.</blockquote><br /><u>White House to health care venture capital</u><br /><br />Also from the NY Times story,<br /><br /><blockquote class="tr_bq">Bob Kocher, a doctor, management consultant and former member of Mr.  Obama’s economics team, is a California venture capitalist, helping  finance health start-ups.        </blockquote><br /><b>Legislative Offices</b><br /><br /><u>Senate Finance Committee Staff, then Department of Health and Human Services Staff to Avenue Solutions</u><br /><br />As <a href="http://thehill.com/business-a-lobbying/318577-architects-of-obamacare-reap-windfall-as-washington-lobbyists">reported </a>by The Hill bog,<br /><br /><blockquote class="tr_bq">The firm Avenue Solutions, for instance, recently hired Yvette  Fontenot, a former staffer for both the Senate Finance Committee, which  wrote ObamaCare’s tax-related provisions, and HHS's Office of Health  Reform, which is assisting the implementation.<br /><br />Since her hire in  April, the four-woman firm has picked up Health Care Service Corp. as a  client, and Fontenot is now lobbying for the Blue Cross Blue Shield  Association</blockquote><br /><u>Congress to Alston & Bird </u><br /><br />In the same report,<br /><br /><blockquote class="tr_bq">Former Rep. Earl Pomeroy (D-N.D.) joined Alston & Bird in 2011  after dealing with healthcare and tax issues as a member of the House  Ways and Means Committee.<br /><br />Now Pomeroy and his one-time chief of  staff, Bob Siggins, are lobbying on ObamaCare for clients such as  clients such as Vision Service Plan, the National Coordinating Committee  for Multiemployer Plans and Medicare — a health insurance provider.</blockquote><br /><u>Health Counsel for Senate Finance Committee from WellPoint, Now to Johnson & Johnson</u><br /><br />Note that we touched on part of this story back in 2010<a href="http://hcrenewal.blogspot.com/2010/04/pay-for-hypocrisy-for-health-insurance.html"> here</a>.  Now <a href="http://www.nytimes.com/2013/09/18/us/politics/reaping-profit-after-assisting-on-health-law.html?pagewanted=all">from</a> the New York Times,  <br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Liz Fowler, a onetime executive with WellPoint, the insurer, helped  draft the legislation as the chief health counsel for the Senate Finance  Committee and later joined the administration. Now she runs global  health policy for Johnson & Johnson, the medical equipment and  pharmaceutical giant, which strongly backed the health bill and stands  to benefit from it. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Ms. Fowler is not a registered lobbyist, but she does provide in-house  advice on the bill — work that has drawn criticism from publications  like the British newspaper <a href="http://www.theguardian.com/commentisfree/2012/dec/05/obamacare-fowler-lobbyist-industry1">The Guardian</a> and the Web sites <a href="http://www.salon.com/topic/liz_fowler/">Salon</a> and <a href="http://www.huffingtonpost.com/bill-moyers/watch-washingtons-revolvi_b_2316245.html">The Huffington Post</a>,  where the journalist Bill Moyers singled out Ms. Fowler, asserting that 'when push comes to shove, corporate interests will have the upper  hand.'</div></blockquote><div itemprop="articleBody"><br /></div><div itemprop="articleBody"><b>Summary</b></div><div itemprop="articleBody"><br /></div><div itemprop="articleBody"> It's enough to make one's head spin: all that traffic through the revolving door reported just in the last five weeks.</div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">As we have said many times before, the constant interchange of health care insiders among government offices, lobbying and legal firms, and large health care corporations certainly suggests that health care, like many other sectors, seems to be run by an amorphous group of insiders who owe allegiance neither to government nor industry.  The NY Times tried to explain this in a benign way,</div><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody">Yet the progression from government to the private sector is also  predictable, a window into the peculiar rhythms of life in the capital.  Young aides, often fresh out of college or graduate school, acquire  highly specialized knowledge but eventually settle down, build lives and  long for jobs that pay more and let them see their children at night. </div></blockquote><div itemprop="articleBody"><br /></div><div itemprop="articleBody">While the private sector may offer good pay, is it just for these poeples' skills and expertise?  Or are these offers only for those who while in government service evinced friendship to private vested interests?  Do government workers who think longingly of higher pay and shorter hours wonder what it would take to please those that might offer such opportunities?</div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Yet those who work in government are supposed to be working for the people, and those who work on health care within government are supposed to be working for patients' and the public health.  If they are constantly looking over their shoulders at potential private employers who might offer big checks, who indeed are they working for?</div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Attempts to turn government toward private gain and away from being of the people, by the people, and for the people have no doubt been going on since the beginning of government (and since the Constitution was signed, in the case of the US).  However, true health care reform  would require curtailing the severe sorts of conflicts of interest  created by the revolving door.  This might require both improving pay  and working conditions for government regulators, law enforcers, and legislative staffers; and  specific laws to prevent immediate transitions from being a regulator,  law enforcer, or legislator to handling corporate responses to or defenses against such  regulation and enforcement. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">That bit does not seem to be part of the current Affordable Care Act, yet it was hardly to enact such restrictions on conflict of interest that certain members of Congress have shut down the government.   </div><div itemprop="articleBody"><br /></div>

Round and Round Spins the Revolving Door, Unimpeded by "Obamacare," Nor By Those Protesting "Obamacare"

On this day of government dysfunction in the US, it is time for our latest installment on the "revolving door," the interchange of insiders among government legislative offices that affect health poli…

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While the specifics in this <a href="http://www.youtube.com/watch?v=OW92MP-yyOo">Xtranormal video</a> "Dr. TruthHurts" on the <span style="font-weight: bold;">Patient Protection and Affordable Care Act (PPACA)</span> might be incorrect, and the political views expressed offensive to some, <span>the scenes of "Dr. A.C.O." using a computer</span><span style="font-weight: bold;"> </span><span>(starting at about time 4:09)</span><span style="font-weight: bold;"> might not be far from the future cybernetic "truth" we are headed towards</span>.<br /><br />While the computer-use scenes are mostly sound-based and somewhat hyperbolic, if physicians  are not vigilant and outspoken, I fear the machines -- and their users -- will further become servants of bureaucratic control and of money.<br /><br />Click to play the YouTube video.<br /><br /><br /><div style="text-align: center;"><a href="http://www.youtube.com/watch?v=OW92MP-yyOo"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5562258723599160386" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdwVnvHvCvYu-WfkpkNXwlyFHKzb0ahxNknk3xrqG4U4Gu0afjhc5MKXFdOrMymr9Sp9WRSsypLCODWXHDVZmZeJ12KsaAzgwu94xd20SxtFWYF5SuCZVbbJuw3jwJs1d0d2PDeBywsyfM/s320/ppaca.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 194px;" /></a><span style="font-size:85%;"><span style="font-weight: bold;">Click image to play video</span><br /></span></div><br /><br />I also note that the diagram of the healthcare bureaucracy in this cyber-puppeteer video is real:<br /><br /><br /><div style="text-align: center;"><a href="http://www.house.gov/jec/news/2010/obamacare_chart.pdf"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5562255991429227346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPn9U9FMHL8NPPp3DGolylsAvh07gW_Xg1QV2K7R4J9y9SnGRl5ecxev0ld2m1yl7Z_uTpVN2WNda4u2WATdYF1Qrfb-96u5tyNfJ7eGw7WX4ivZjChPZm7EumXdE4XZB5s2SOoPOD9c7d/s320/hcsystem.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 250px;" /></a><span style="font-size:85%;">The coming Health Care Mega-Bureaucracy (click to download PDF from House.gov).<br /></span></div><br />Somewhere, buried in that morass of <span style="font-style: italic;">healthcare facilitators</span>, are quaint relics of the work of the <span style="font-style: italic; font-weight: bold;">healthcare enablers</span> such as the doctor-patient relationship,  informed consent, and private medical decision-making between physician and patient.<br /><br />Oh wait...I forgot, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">there are computers</a> to make the bureaucratic morass all work seamlessly.<br /><br />-- SS

Cyber-Puppeteering on Health IT by Dr. TruthHurts

While the specifics in this Xtranormal video "Dr. TruthHurts" on the Patient Protection and Affordable Care Act (PPACA) might be incorrect, and the political views expressed offensive to some, the sce…

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