Obamacare and hospital costs; sourcing Leno stories; and firing civil servants

March 26, 2013

1.  Obama administration malingers on hospital bill collecting abuses:

Here’s a compelling story for any reporter who wants to shine light on a failure of basic competence – or maybe it’s backbone – by the Obama administration on an issue that affects millions of middle class and poor Americans and that was supposed to be the president’s number one priority.

In the article about healthcare prices that I wrote last month for TIME, I reported that supposedly non-profit hospitals not only charge ridiculously inflated prices (from a price list called the chargemaster) to people who are uninsured or underinsured, but they also routinely sue and demand that those full prices be paid. It’s a prime reason medical bills are the cause of more than 60% of personal bankruptcies and even more demolished credit ratings across the country.

However, one of the little-noticed provisions of Obamacare, which was passed three years ago this week, requires that non-profit hospitals, as a condition of keeping their tax exempt status, must adhere to rules to be promulgated by the IRS that would, among other things, not allow them to send bill collectors or lawyers after patients except under certain conditions. Those conditions include that the patients first be informed through aggressive outreach efforts of the availability of financial aid for patients unable to afford the bills and, more important, that for patients whose incomes are below certain levels, hospitals can only dun them or sue them for the discounted amounts they usually charge insurance companies, rather than the far higher chargemaster prices.

In theory, the IRS, which is a unit of the Obama Administration’s Treasury Department, could have promulgated those regulations at any time after March 23, 2010, the day Obamacare was signed into law. But the first draft of the rules was not issued until two and a half years later – last summer. And then the American Hospital Association’s lobbyists pushed back, calling the proposed rules “too prescriptive.” (To me, if anything, they seemed not prescriptive enough.) Since then, nothing has happened. No final rules have been published. That means that three years after the Obamacare signing ceremony in the White House there is still no protection from hospital lawyers and bill collectors for the patients least able to pay.

Any reporter who wants a legitimate gotcha story should ask the people drawing salaries at the Tax Exempt Government Entities division of the IRS and at its Chief Counsel’s office, as well as the Office of Tax Policy in the Treasury Department, why it takes more than three years to write rules that would immediately protect millions of Americans from the most blatantly unfair aspect of our healthcare system.  Or, next time he has a presidential press conference, why not ask the man who said health care reform was his highest priority?

2. Another story behind the Jay Leno story?

Yes, it’s interesting that NBC is moving to replace late night host Jay Leno with Jimmy Fallon. But to me what’s more interesting is how the entire story, which has made headlines across the country and especially in New York, has relied wholly on anonymous sources. The New York Times scoop last week by Bill Carter – who wrote a best-selling book on the network’s late-night competition and seems to have access to everyone involved – contained not a single named source.

Carter’s lead, that “NBC has settled on two new stars for ‘The Tonight Show’: Jimmy Fallon and New York City,” explained that the news that Fallon was going to succeed Leno and move the show to New York was “according to several senior television executives involved in the decision.” (By the way, how many is “several”? Couldn’t Carter at least tell us that?)

From there the sources became “the executives,” “one senior executive,” “the executives,” “many TV executives speculated” (how many is “many”?), “two executives” and, finally, an “NBC spokeswoman,” who “declined comment on the move.”

I don’t doubt that the story is true. But I wish another reporter would try to figure out who those sources were – because that may be at least as interesting a story.

Here’s why: Depending on who the sources are, the leaks to Carter and others might either have been a concerted effort by both the Leno and NBC camps to begin a gradual and trouble-free transition, or they could have been the opening round in new game of corporate back stabbing.

Interestingly, Carter never writes about whether he asked Leno to comment. That seems to suggest that the leaks came only from the NBC side, in which case they would be evidence of an NBC effort to push Leno out early.

Carter writes that despite the fact that Leno is still leading in the ratings, “many TV executives speculated that NBC could not wait too long to promote Mr. Fallon, or it might risk having Mr. Kimmel [Jimmy Kimmel, who is on ABC opposite Leno], 45, lock up the young adult viewers who are the lifeblood of late-night television.”

So, was Leno blindsided by the stories? Is this a reprise of NBC’s ham-handed effort in 2010 to juggle Leno and Conan O’Brien?

In short, the fact that all of these sources are anonymous and don’t seem to include anyone from the Leno camp suggests that Carter’s story should become part of another fun story: “Network Moves to Push Out Popular Late Night Star Without Leaving Fingerprints.”

3. What do you have to do to get fired in Washington?

The week before last the Washington Post  reported that the federal General Services Administration “was ordered…to reinstate a senior executive who lost his job last year amid revelations of lavish spending at a Las Vegas conference.”  Something called the Merit Systems Protection Board, the Post reported, had “ruled the agency failed to prove that the career civil servant in charge of federal buildings in the Rocky Mountain region was guilty of misconduct.”

The official, Paul Prouty, was awarded eleven months’ back pay and returned to his job as head of federal buildings in the agency’s Rocky Mountain region.

As the Post reminded it readers, “The $823,000 conference… became an embarrassment for the Obama administration after GSA Inspector General Brian Miller [reported] last April on a four-day junket that had spun out of control. Lodging at an opulent hotel, entertainment by a $3,200 mind reader, after-hours parties in 2,400-square-foot loft suites, a $7,000 sushi reception, a bicycle-building exercise — all took place at taxpayers’ expense. The planning included about six scouting trips, at a tab of $130,000.”

According to the Post, “dozens of employees from Prouty’s staff in Region 8 attended the conference.” But his lawyer told the Post that although Prouty “engaged in some of the planning, GSA was unable to provide any evidence of misconduct.”

“At least two other fired senior executives are awaiting rulings from the merit board on similar appeals,” the Post noted.

So here’s an obvious follow-up: What does it take to fire a senior civil servant? Can incompetence ever be good enough, or must there be proof of misconduct, which has more to do with motive than performance? And is anyone in Congress or elsewhere pushing for a change in these budget-challenged times? (Then again, it would seem odd for anyone in Congress to want simple incompetence to be a trigger for losing a job.)

I bet a good reporter with a knack for conveying the absurd would have a field day attending a few Merit Systems Protection Board hearings.

PHOTO: U.S. President Barack Obama smiles during taping of the Tonight Show with Jay Leno Show in Burbank, California October 25, 2011.  REUTERS/Jason Reed 

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