Today for the third time in a month transportation workers and taxi drivers in the city of Reynosa, Mexico which sits opposite South Texas have orchestrated a closing of the international bridge allegedly to protest abuses of the Mexican army. Mexico’s President Calderon has been using the Mexican army as his primary weapon to fight the drug cartels in Mexico because of wide spread corruption and ineptitude of police. According to El Universal , the protest began at 8:00 am when “thousands” of taxi drivers and transport drivers blocked the entrances and exits of the bridge. They further reported that the Mexican army withdrew to a government building to avoid confrontation with the demonstrators.
There are reports that cell phones are not working and also some land lines are not working leading some to speculate that communication workers may also be participating. There are also unconfirmed reports of gunfire in the city of Reynosa between Mexican army units and “narcos” the term Mexicans use for those involved with the drug cartel. A grenade attack was reported near a school. The Valley Morning Star is reporting at least 5 dead in Reynosa.
Other similar protests are occurring all along the Texas-Mexican border from Cuidad Juarez across from El Paso to Reynosa across from McAllen. Mexican Army and government officials believe that the protests are being organized by the drug cartels. Truckers and transport companies have also been demanding that the government freeze the price of diesel and have staged slow-downs or strikes in other parts of Mexico recently.
Drug violence has killed over 6,000 people in Mexico in just the last year. Twenty-four Mexican journalist have been killed by drug cartels and thousands of policeman have quit their jobs on threat of death to themselves and their families. Mexican drug cartels now openly recruit with large signs strewn over highways and on the internet including on You Tube.
President Calderon began the drug war offensive in 2006 against the three major drug cartels in Mexico. Although he has arrested numerous kingpins, arrested hundreds of cartel associates, and confiscated thousands of weapon and drug catches many say the tide has not yet turned.
Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years.He is a member of the National Association of Hispanic Journalists.
The Pew Research Center recently published a study about where Americans would like to live. The findings of this study got me thinking about a recent conversation I had with McAllen Commissioner, John Ingram, during McAllen’s New Year’s Eve Bash where he told me one of the things he wanted to do by encouraging more cultural events in the city was to prevent the loss of talented young people leaving the area. This brain drain has also been identified as a significant problem by the Lower Rio Grande Development Council in their Strategic Plan 2009-2014.
The Pew Study found that although a majority of the population as whole would like to live in a place that is not a large city except for those under age 30. 57% of that age group said they would prefer to live in a big city. Younger people are looking for a faster pace in life and opportunity. With a lack of lifetime experience to reflect upon, the life is greener on the other side of the fence sentiment is no doubt strongest in the young.
The study did show that as people aged they tended to prefer living in slower paced smaller communities in the South and West with a better climate. Leading among the desirable large cities was Denver with San Antonio coming in fifth place. Positive attributes in their order of importance was a place to raise children, recreational and outdoor activities, opportunities to meet people and make friends, shopping, climate, cultural activities, cost of living, and job opportunities. Although there is still the feel of a small town, the size of the McAllen metropolitan area is now over 700,000 in population making it the 70th largest area in the country. The ever increasing population growth of the Rio Grande Valley and the McAllen metroplex occurs because of the local strength’s in these areas:
The strong Hispanic culture of the region which places a primary focus on family is reflected in the every day life of the community, commerce, and local government.
Money has consistently listed the McAllen metroplex since 2000 as one of the 25 best places to find a job in the United States.
The influx of millions of shoppers annually from Mexico helps make the retail shopping available equal to that of some of America’s largest cities.
The City has been recognized for developing pedestrian walkways and parks
Has a mild winter climate that draws thousands of Mid-Westerners and Northerners every winter
Has a symphony orchestra, opera, venues for major performing artists, professional sports leagues, and a long history of producing local Spanish language artists
The continued development of the University of Texas at Pan American in Edinburg and South Texas College has allowed thousands of students to receive a college education who otherwise would not and additionally allows many to stay in the area instead of leaving the area for a higher education. The nationwide recession and high cost of attending college is also a force driving more students to attend a public university while still living with their parents. Curiously this effect may have a side effect of keeping more young people in the Rio Grande Valley during their formative higher education years.
Unfortunately we still lack in professional schools. The State of Texas needs to listen to local Valley leaders who are calling for the establishment of more professional (medical,law,engineering) and graduate schools in the Rio Grande Valley. This is long overdue.
McAllen’s city leaders including the Mayor and City Commission are taking the right steps in helping to retain our young people. As a young man in the 70’s I could not wait to get out of the Valley now as a 50 something I find it’s a place I can never wait to get back to.
Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years.He is a member of the National Association of Hispanic Journalists.
You are healthy 40 year old male who has never been to the doctor and always assumed you had “good” health insurance from your employer of 20 years. Suddenly on April 1st 200X you awaken at midnight with severe flank pain, nausea and vomiting which is the most severe illness you have ever experienced. Your wife brings you a glass of water but you cannot keep it down and instead vomit six more times until your retching on an empty stomach. Feeling so weak you cannot stand up and collapse on your bathroom floor. After your wife called the ambulance they arrive quickly and take you to the nearest hospital fortunately just five minutes from your home. The ambulance paramedic tried to start an IV( intravenous) but gave up after one attempt failed because the trip to the hospital was so short.
It is a busy night night in the emergency room and you have to wait about 20 minutes to be seen after the triage nurse talks to you in the waiting area. Finally you are taken into a room where the charge nurse with 30 years of experience starts an intravenous line in your arm and tells you the doctor will be in soon. After taking your history and examining you the nurse tells you “You probably have a kidney stone”.
About 30 minutes later the emergency room doctor comes in and asks for forgiveness because the emergency room is so crowded. After his exam he concurs with the nurse’s diagnosis and orders some intravenous pain medication which finally relieves your pain. He says they will order a “Cat Scan” to confirm his suspicion’s but reassures you the chances of a complete recovery are excellent.
Eight hours later after which you have undergone the “Cat Scan” and have passed the kidney stone in your urine the pain is now gone. The nurse gives you some fluids to drink to see if you can keep them down. Since you drink the whole glass of water and do not vomit they discharge you after spending a total of 10 hours at the hospital.
A month goes by and you are feeling great until an envelope arrives from your health insurance that says the following:
“The following claims for care received at are being denied.”
The above scenario is based upon a real case that happened this year and illustrates the unsoundness of the current health care system in the United States.
The most important part of any medical chart is the history that the patient gives to the provider regardless of whether it is a paramedic, nurse, or physician. These statements are the main factors often in determining not only what is the quality of care but also whether there was a medical need for the treatment that is received. If the medical need is not demonstrated by the medical record then the insurance company does have to pay for it.
There is a sequential process followed :
1.Providers (doctors, nurses,therapists) input information often by hand initially
2.Formal dictated reports by physicians are transcribed and entered later
3.Hospital coders convert diagnosis and procedures into a numeric coding system
4.Hospital and providers billing specialists use codes to determine correct billing based upon patient insurance contracts
5.Insurance companies use their own formulas to determine if diagnostic, procedural, and billing specifications are appropriate. These formulas include how the care compares with historical norms or more simply does all the information fit together in a typical pattern.
6.Insurance companies make determinations of eligibility for coverage by reviewing contracts with patient and providers, premium payments, and “ in or out of network status”.
7.In order for a payment to be made to a provider the care must meet the threshold of being “medically necessary”. Quite often repeated appeals to a grievance process may be required.
In the case above which is a based upon a real life event what happened was that the final diagnosis given to the insurance company was “renal lithiasis” or kidney stone. The insurance company argued that by itself there is nothing that makes a kidney an emergency in fact many times they cause no symptoms at all.
The ambulance crew and the emergency room were very busy that evening so that the medical documentation was sparse. The record did not adequately reflect that the patient had vomited multiple times but only said there was nausea and vomiting. The additional conditions of “dehydration” requiring intravenous fluids and the “severity of the pain’ requiring injectable pain medication which are needed to make kidney stones an “emergency” were not documented sufficiently in the opinion of the insurance company.
The emergency doctor and hospital were not in the network of the insurance company. Most states allow care to be given by out of network facilities if there is a documented emergency and sometimes the patient is required to be transported (at his own expense) from an out of network to a network facility once his condition is “stable”. The lack of documentation of an emergency as well as the fact that the patient in the above case was not transferred to an in network facility ( which was 20 miles away) were reasons for denial of payment.
The hospital charged a special emergency fee for the “Cat Scan” which the insurance company denied because the diagnosis and treatment did not require an emergency test to confirm in their opinion. Thus the test could have been done as outpatient or non-emergency at a lower cost the next day argued the insurance company.
Although in most states the burden for the patient to receive emergency medical care is not an expert medical review but rather how a reasonably prudent lay person would act this is not enforced. Insurance companies put up many hurdles to deny coverage based upon lack of documentation which often leave everyone perplexed. The Obama administration’s initiative to modernize medical records is a first step in creating a more appropriate system but it will not be the plenary answer.
Almost no one has an insurance plan that requires no additional payments beyond the monthly premiums. The Employee Benefit Research Institute has done research confirming that this state of complexity for patients is increasing. More and more working Americans (60% at least) are dealing with higher deductible health insurance plans with limited networks and are paying more out of pocket costs than ever. Meanwhile the other 40% of Americans do not have insurance at all.
Apart from under-reimbursement issues and putting up intentional roadblocks the greed of health insurance companies has been seen to extend to corporate leadership. In 2008, the CEO of America’s largest insurance company, United Healthcare, had to pay about $30 million dollars in an inappropriate stock options scandal and forfeit another $618 million in future options according to the Wall Street Journal. He still got to keep in excess of $500 million.
Everyone agrees the current health care financing system in the United States is in critical condition. However, the health care industry wields tremendous influence. In the 2008 Presidential campaign according to OpenSecrets Obama received over $18 million from health care industries compared to only $7 million for McCain. Health insurance companies backed Obama 2:1 in funding over McCain. Ties with health insurance companies who paid consulting fees in the millions to former Senator Tom Daschle, a strong and early Obama supporter, led to his voluntary withdrawal from nomination as the Secretary of Health and Human Services.
In the vacuum left by the Daschle departure , Senator Max Baucus (D-MT) has the most visible option for revision of America’s health care financing as a Democrat. A review of his 2008 election contributions does show however that more than half of his contributions came from health insurance companies and pharmaceutical companies. The goals of his plan as stated in his press release of November 2008 are
1.Achieve universal coverage
2.Reduce health care costs
3.Improve the quality of care our system provides
4.Baucus’ vision for achieving these objectives includes an individual responsibility to hold health insurance – once quality, affordable, care is accessible to all.
5.His plan seeks to reach that point through measures to shore up the employer-based system, through a one-stop insurance marketplace for individuals and businesses, and through limited expansions of public programs.
A significant part of the plan includes extending Medicare coverage to age 55, making Medicaid a universal backup for all Americans not employed, and enlarging the states’ Children’s Health Insurance Program (CHIP). He is also promising stricter accountability to prove effectiveness of treatments and to stress preventive care measures.
So far the Republican’s have yet to put forth a coherent counter proposal. For many years they have been incredulous on the concept of nationalized health plans such as in other countries like Canada. These examples demonstrate a primary principle they believe that government-run universal health care leads to inefficiencies. Instead they have proposed a private alternative options:
1. A reformed Medicare to give seniors choice, flexibility
2. Give individuals tools to manage their own health needs
3. Allow customization of insurance, support health centers
4. Tort reform
4. Stress access over universality
There is, however, only one Republican who was actually the architect of a health care system that has ever been put in place. Former Governor and Presidential candidate Mitt Romney signed his plan into law in April of 2006. The Massachusett’s Plan has enjoyed wide political support and has dramatically reduced the number of uninsured in the state. However, there is the still the issue of rapidly accelerating costs.
The plan improved access by creating an individual mandate. All state residents must report their insurance status on their state income tax forms (there is a 98% compliance rate). Thousands of young previously uninsured workers are now paying into the system instead of waiting to join the system in their forties. Many economists agree that getting high numbers of healthy younger workers to pay into a health care system is a key investment for society. The Massachusetts plan gets good grades in two of the three necessary attributes of a health care system (access or universality, quality, and cost control). As yet they are still struggling with costs.
In retrospect, given the ultimate importance of the economy and health care to the future of America’s prosperity many enlightened Republicans are wondering what if Mitt Romney had won the nomination? His mastery of economic issues and practical executive experience in health care are unique and special. The Massachusett’s experiment needs to be carefully watched and analyzed. No doubt significant additional work needs to go into controlling cost but offers Republicans the best foundation upon which to build an alternative to the Democratic mandate.
Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years.He is a member of the National Association of Hispanic Journalists.
In the vacuum left by the Daschle departure , Senator Max Baucus (D-MT) has the most visible option for revision of America’s health care financing as a Democrat. A review of his 2008 election contributions does show however that more than half of his contributions came from health insurance companies and pharmaceutical companies. The goals of his plan as stated in his
The plan improved access by creating an individual mandate. All state residents must report their insurance status on their state income tax forms (there is a 98% compliance rate). Thousands of young previously uninsured workers are now paying into the system instead of waiting to join the system in their forties. Many economists agree that getting high numbers of healthy younger workers to pay into a health care system is a key investment for society. The Massachusetts plan gets good grades in two of the three necessary attributes of a health care system (access or universality, quality, and cost control). As yet they are still struggling with costs.