By Richard Harris

– A Yale University study analyzed the experience of 60 million Americans covered by traditional Medicare between 1999 and 2013, and found “jaw-dropping improvements in almost every area,” the lead author says.
Ann Cutting/Getty Images

Here’s a bit of good news for Medicare, the popular government program that’s turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they’re living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a study in the Journal of the American Medical Association.

Doctors, hospitals and government administrators have put a lot of effort into making Medicare more efficient in the past 15 years. Dr. Harlan Krumholz and colleagues at Yale University took on a study to see whether that effort has paid off.

“The results were rather remarkable,” says Krumholz, a cardiologist and leading health care researcher. “We found jaw-dropping improvements in almost every area that we looked at.”

The researchers looked at the experience of 60 million older Americans covered by traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily during that time, and people were much less likely to end up in the hospital.

“If the rates had stayed the same in 2013 as they had been in 1999, we would have seen almost 3.5 million more hospitalizations in 2013,” Krumholz says.

“People who were being hospitalized were having much better outcomes after the hospitalization,” he says. “They had a much better chance of survival.”

And the average cost of a hospital stay dropped too, he says, from $3,290 to $2,801 in inflation-adjusted dollars over the 15-year period for patients in the traditional Medicare program. (Researchers couldn’t quantify the experience in Medicare Advantage, the managed-care alternative to Medicare).

Krumholz attributes the improvement to a wide variety of measures designed to boost patients’ health, from prevention programs to advances in medical care. He says some of the savings also came about because medical care shifted from hospitals to less expensive outpatient clinics.

“They’re pointing out a very good thing in the medical system,” says economist Craig Garthwaite at the Kellogg School of Management at Northwestern University. He says the recession, which helped slow rising health care costs overall, apparently played a minor role in this story of Medicare.

Costs really are being contained, Garthwaite says. One other reason that’s happening is that the federal government is reimbursing hospitals and doctors less for treating Medicare patients.

“That’s an easy way to get control of medical spending in Medicare,” Garthwaite says, but “it’s just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall.”

With the post-World War II baby boom now reaching retirement age, more and more people are turning 65 and becoming eligible for Medicare. That growth continues to drive up the overall cost of the program, even as that average cost per illness or hospitalization comes down. And as older Americans live longer lives, they use Medicare for more years than previous generations did.

Medicare is still running a bit of a deficit, but the situation is improving. The program’s trustees say its trust fund will be solvent through 2030. Some adjustments would be needed to keep the program in good financial health beyond that date.

Garthwaite says other recent trends could make matters worse, with one especially worrisome example being sharply rising drug prices.

“Some of these [new cancer] products are providing only a few months of life for several hundred thousand dollars,” he says. And the system doesn’t do a good job of making difficult judgments in situations like that.

Joseph Antos, an economist in health policy at the American Enterprise Institute, agrees that the good news from the Yale study doesn’t assure a rosy future. He’s concerned about the financial health of Medicare if, for example, an effective drug for Alzheimer’s disease is developed.

“I would argue that if anybody came up with an effective treatment for Alzheimer’s today, that treatment would be hailed as a major breakthrough and we wouldn’t be looking at the cost,” Antos says.

And that would almost certainly break the pattern that’s been documented over the past 15 years, where improving health has actually helped drive down the cost of medical care.

Source – http://www.npr.org/sections/health-shots/2015/07/28/426740179/happy-50th-birthday-medicare-your-patients-are-getting-healthier

By Aaron Moselle

– A political corruption scandal and an open state Senate seat mean some Philadelphia voters are heading to the polls next month to pick new lawmakers.

Three special elections scheduled for Aug. 11 will mint new state representatives in the 174th District in Northeast Philadelphia; Southwest Philadelphia’s 191st District; and the 195th District in North and West Philadelphia.

Democrat John Sabatina Jr. resigned from his post in the 174th after winning a special election to the state Senate.

Ronald Waters resigned in the 191st after pleading guilty to conflict-of-interest charges. Ditto for Michelle Brownlee, who represented the 195th.

Waters and Brownlee were both part of a sting operation that caught several lawmakers accepting money or cash in exchange for official acts.

Democratic committeewoman Donna Bullock, who last worked for Philadelphia City Council President Darrell Clarke, is one of two candidates running to replace Brownlee.

“I wanted to serve my community … to improve our schools, create job opportunities,” said Bullock.

She will face Republican ward leader Adam Lang, who wants to protect longtime homeowners in his Sharswood neighborhood from being pushed out by gentrification.

“The first piece of legislation I would introduce would be to change the tax assessment system to where a property’s tax assessment is locked in at the value that someone purchases their house,” Lang said.

In the 174th, Republican Timothy Dailey, a teacher, will challenge former City Councilman Ed Neilson.

In the 191st, Democrat Joanna McClinton, chief counsel to state Sen. Anthony Hardy Williams, is going up against political consultant Tracey Gordon, who is running as a member of the Tracey Gordon Party, and Republican Army veteran Charles Wilkins.

The candidates who win will serve the remaining 16 months of the two-year terms.

Voter registration heavily favors Democrats in all three districts, though voters with any party affiliation will be able to cast a ballot.

Source – http://www.newsworks.org/index.php/local/item/84509-special-vote-set-for-aug-11-to-elect-three-to-pa-house-

By Sean Kitchen

– Yesterday, Budget Guru and House Speaker Mike Turzai claimed that House Republicans are ready for a veto override, but there’s an issue. A math issue to be exact.

“We have to look at overriding if we’re not going to have a substantive discussion,” Mr. Turzai, R-Marshall, said at a luncheon of the Pennsylvania Press Club, adding that Mr. Wolf’s own budget proposal has too little legislative support for negotiators to simply meet in the middle.

“I can assure you that many of my Democratic colleagues are not interested in Gov. Wolf’s tax package, and they would be more than happy with House Bill 1192,” Mr. Turzai said, referring to the Republican-crafted budget. “Some have even privately called it quite responsible. I think that’s a direction we have to consider.”

But here’s the problem. There are 203 members with Republicans holding 120 seats. To get a veto override, House Republicans would need 13 Democrats to defect and override Governor Wolf’s veto, which will not happen because there is one person who came into Harrisburg with a mandate, and that is Governor Wolf. Wolf campaigned on raising a severance tax and among others to fund public education. Republicans claim to have a mandate because of their outrageous majorities, but they do not because of the ridiculous gerrymandering that happened in 2010.

Source – http://www.ragingchickenpress.org/2015/07/28/pabudget-guru-mike-turzai-fails-at-first-grade-math/

By The Pa. AFL-CIO

– A pair of bills in Congress are seeking to undermine the rights of rank and file workers at the Department of Veterans’ Affairs. These two radical bills, HR 1994 – introduced by Rep. Jeff Miller (FL), and S 1082 – introduced by Sen. Marco Rubio (FL), represent a knee-jerk reaction to calls for accountability at the VA. Instead of taking concrete steps to improve services at the VA, these bills seek to scapegoat front line employees while giving a free pass to managers who engage in misconduct.

If this legislation passes, every VA worker will be an at-will employee, with no meaningful recourse – even if their termination was a result of whistle blower retaliation or discrimination.

Stand with our brothers and sisters in AFGE now! E-mail or call your members of Congress, and tell them to OPPOSE HB 1994 and S 1082.

Go to – https://www.afge.org/?Page=SaveDueProcessattheVA to Take Action! NOW, and to download flyers and fact sheets that will arm you with the information you need today!

Source – http://www.paaflcio.org/?p=6211

BY David Moberg

– Are you an employee?

It seems like a simple question that must have a simple answer for most people. But definitions in different laws and rulings enforcing the laws vary. And that variation provides an opening for a growing number of employers to cheat governments of taxes and workers of income, benefits and protections by misclassifying their employees, especially as “independent contractors.”

Last week, the administrator of the Department of Labor’s Wage and Hour Division, David Weil, released a “letter of guidance” that clarifies who is an employee and who is an “independent contractor”—that is, essentially an individual running his or her own business. He argues that the most definitive statement from Congress comes from the Fair Labor Standards Act, which says that “to employ” means “to suffer or permit to work.” And, he concludes, “under the Act, most workers are employees.”

The decision is “incredibly important,” says Catherine Ruckelshaus, general counsel and program director of the National Employment Law Project (NELP), a pro-worker nonprofit organization, and may help to clear up confusion in the courts and encourage more enforcement of the law.

In recent years, many companies—from 10 percent to 30 percent or more of employers—employ at least several million people who are misclassified as independent contractors, according to a recent NELP report. They even go so far as to require workers to form a limited liability corporation or franchise (with themselves as the one and only participant) or to sign contracts declaring that they are independent contractors. According to another study from economist Jeffrey Eisenach of George Mason University, the number of independent contractors rose by one million from 2005 to 2010, including both fake and real contractors (often unemployed workers who re-label themselves as “consultants”).

One high-profile example is the Federal Express delivery driver—who wears a FedEx uniform, drives a company truck, follows a route set by the company and still is treated as a contractor. Weil’s ruling may also tip the judgment against companies like the Uber taxi service, increasingly targeted in lawsuits as improperly treating its drivers as independent contractors.

When employers misclassify workers, they often pay less for contractors, but most important, the workers lose a wide range of protections and benefits under the law such as unemployment compensation, workers’ compensation, minimum wage and overtime regulations, and governments lose billions of dollars a year in taxes that support those programs.

In his recent book The Fissured Workplace, Weil argues that workplace phenomena like subcontracting, using independent contractors, franchising and other ways to make employers less responsible for their employees is not just a result of competition driving down costs, whether as a result of globalization, weakening of unions, new technologies or new work processes, but also “pressure from public and private capital markets to improve returns.”

Unlike the “common law” test for who is an employer, which emphasizes the degree of control over one’s work, the FLSA standard usually relies on an “economic realities” test, which examines many different dimensions of work without favoring one above all others. But in his guidance letter, Weil writes, “the ultimate inquiry under the FLSA is whether the worker is economically dependent on the employer or truly in business for him or herself.” But the varied economic realities tested include such questions as how integral the worker is to the business, how much does managerial skill affect possible profit or loss, how big is the worker’s relative investment, does the worker’s success rely on special business skills in addition to any technical skills, what kind of control does the employer exercise, or how permanent is the relation of the worker to the employer.

The impact of this guidance letter may first be felt in courtrooms and in various federal or state agencies, but Ruckelshaus hopes that employers will voluntarily take it seriously. More likely, it will only be quite meaningful if there are systematic state and federal efforts to audit employer behavior, especially in industries where abuses are common, such as lower-skill construction, home care and janitorial work. Unions are also in a position to push for more vigorous enforcement, as Ruckelshaus said the Carpenters have been.

And when it is clear that the workers are not contractors but employees, the unions can do the workers a favor and invite them to join the union.

Source – http://inthesetimes.com/working/entry/18224/independent-contractor-laws-department-of-labor