Comments for Weston Policy http://westonpolicy.wordpress.com Discussion of national and state policy issues Fri, 30 Jan 2009 11:28:52 +0000 http://wordpress.com/ hourly 1 Comment on Credit Default Swap Clearinghouse by Bill Hodgson http://westonpolicy.wordpress.com/2008/09/19/credit-default-swap-clearinghouse/#comment-210 Bill Hodgson Fri, 30 Jan 2009 11:28:52 +0000 http://westonpolicy.wordpress.com/?p=178#comment-210 Some comments: Regulation: All OTC products are traded within regulated legal entities. No one will execute an OTC trade with an offshore unregulated firm, unless they pass the full KYC & AML regulations required by the on-shore regulators. The only firms who place themselves offshore are usually hedge funds and asset managers. All the major banks are on-shore, and regulated. Each regulator can ask for details of each banks OTC trades should they wish to. Notionals: The notional value of a trade is not the market value, but a number used for other cash flow calculations. An Interest Rate Swap would have a typical notional value of $100m - not the price you pay for the trade, but the number used for the interest calculations. In addition, the size of the CDS market in notional value, is not a meausure of the net market risk, but just the quantity of business being transacted. Standards: More or less 100% of CDS contracts are now matched and processed on the DTCC Trade Information Warehouse, making them very much a standard product. Notification / Selling / Change of ownership You refer to trades being 'sold' - this in the industry terms is a Novation or Assignment. In 2005 the paper based way of tracking these was broken, hence the recommendation by Tim Geithner at the New York Fed that firms make use of the DTCC Deriv/SERV platform to automate the process. This was achieved, and since then a great deal more automation has been provided for this process. Pricing / Mark Value All CDS trades are re-priced daily, to enable firms to call margin between each other under the terms of their ISDA (CSA) margin agreements. Bond underlying ISDA and the industry have more or less completed a move away from physical settlement of a CDS contract to avoid the squeeze you describe when buyers of protection have to deliver the impaired bond to the seller. During 09 ISDA intend to hard wire this into the standard CDS contracts processed by the Warehouse (and anywhere else). I these comments help, Bill. Some comments:

Regulation:
All OTC products are traded within regulated legal entities. No one will execute an OTC trade with an offshore unregulated firm, unless they pass the full KYC & AML regulations required by the on-shore regulators. The only firms who place themselves offshore are usually hedge funds and asset managers. All the major banks are on-shore, and regulated. Each regulator can ask for details of each banks OTC trades should they wish to.

Notionals:
The notional value of a trade is not the market value, but a number used for other cash flow calculations. An Interest Rate Swap would have a typical notional value of $100m – not the price you pay for the trade, but the number used for the interest calculations.

In addition, the size of the CDS market in notional value, is not a meausure of the net market risk, but just the quantity of business being transacted.

Standards:
More or less 100% of CDS contracts are now matched and processed on the DTCC Trade Information Warehouse, making them very much a standard product.

Notification / Selling / Change of ownership
You refer to trades being ’sold’ – this in the industry terms is a Novation or Assignment. In 2005 the paper based way of tracking these was broken, hence the recommendation by Tim Geithner at the New York Fed that firms make use of the DTCC Deriv/SERV platform to automate the process. This was achieved, and since then a great deal more automation has been provided for this process.

Pricing / Mark Value
All CDS trades are re-priced daily, to enable firms to call margin between each other under the terms of their ISDA (CSA) margin agreements.

Bond underlying
ISDA and the industry have more or less completed a move away from physical settlement of a CDS contract to avoid the squeeze you describe when buyers of protection have to deliver the impaired bond to the seller. During 09 ISDA intend to hard wire this into the standard CDS contracts processed by the Warehouse (and anywhere else).

I these comments help, Bill.

]]> Comment on Your Health Insurance Experiences by Bur http://westonpolicy.wordpress.com/obama-healthcare-forum/your-health-insurance-experiences/#comment-199 Bur Sun, 04 Jan 2009 22:46:09 +0000 http://westonpolicy.wordpress.com/?page_id=330#comment-199 1. This example shows the need for digitized, networked medical records system. 2. Apparently a living will is not enough. This gentleman could have reduced the strain on his daughter if, before he became ill, he had given his doctor a simple statement appointing his daughter (or other family member) as his health care agent and attorney-in-fact for health care decisions when he was not able to understand his health care treatment options. 3. What is the public policy recommendation here? Should the Medicare Administration division of the Social Security Administration distribute information about the difference between a living will and an appointment of a health care agent and attorney-in-fact for health care decisions when the patient is mentally incapacitated? 1. This example shows the need for digitized, networked medical records system.
2. Apparently a living will is not enough. This gentleman could have reduced the strain on his daughter if, before he became ill, he had given his doctor a simple statement appointing his daughter (or other family member) as his health care agent and attorney-in-fact for health care decisions when he was not able to understand his health care treatment options.
3. What is the public policy recommendation here? Should the Medicare Administration division of the Social Security Administration distribute information about the difference between a living will and an appointment of a health care agent and attorney-in-fact for health care decisions when the patient is mentally incapacitated?

]]> Comment on HEALTH CARE SYSTEMS: BIG PICTURE by Leslie Wile, CSW, ACSW http://westonpolicy.wordpress.com/obama-healthcare-forum/healthcare-systems-big-picture/#comment-190 Leslie Wile, CSW, ACSW Sun, 28 Dec 2008 16:25:58 +0000 http://westonpolicy.wordpress.com/?page_id=285#comment-190 A single payer system is definitely the answer, and I certainly agree with the above comments about the importance of prevention and the clamping down on the influences of agribusiness and the pharmaceutical corporations. For more than a dozen years (along with my private psychotherapy practice), I worked for Managed Care companies reviewing psychiatric cases, both inpatient and outpatient. The insurance companies hire the managed care entities to save them money, yet interjecting this intermediate layer brought huge, and in my opinion, unnecessary profits to the managed care entities. It was my task to review symptoms and the treatment given--and to determine whether continued treatment at a particular level was "medically necessary." Inpatient cases were reviewed daily, and over the course of my tenure, the criteria for continued inpatient stays and the number of outpatient sessions became tighter and tighter. The last company I worked for also had a medical department which worked in the same way. By the time I retired, inpatient cases were having to be brought for "supervision" to our chief psychiatrist daily. If a patient's stay began to exceed five days, there was pressure toward discharge. When I first began working for these companies, an intermediate supervisor advised me, "Always do what's in the best interests of the patient," which advice I never deviated from, even if it meant I was a bit "disloyal" to the company. My rationale for this was that by the end, criteria had "evolved" to the point where it was said that it was OK to discharge a patient who was still having psychotic symptoms (hearing voices, etc.). To me, this was unconscionable. As a "senior clinician," my judgment was infrequently questioned. Another problem was reconciling the decisions of the medical department with those of the psychiatric department. These days, when many constellations of psychiatric symptoms are intimately related to neurological causality--and because MRI's, brain scans, etc. are so expensive, patients are often given superficial treatment--frequently a cocktail of powerful drugs (pushed by the pharmaceutical industry) which can allay symptoms in a trial and error way, but which never really uncover root causes. Many of these medications can have immediate and disturbing side effects or eventual devastating results--e.g., irreversible stiffness of the body, neuroleptic malignant syndrome and even (yes, listen to some of the TV ads) death. In any case, over the course of my work for managed care, there were certainly a number of abuses uncovered; and discontinuance of payment to the provider and/or change of provider saved wasted money and presumably helped the patient. But, as far as I have observed, "Managed Care" as a profit making industry should be completely abolished. Review of cases ("utilization review") could be accomplished as effectively by professionals employed by the single payer. I have been speaking of psychiatric cases, and the other practice that needs to be universally instituted is so-called "Parity" which is currently in effect in some states. Because of ignorance and antiquated stigma associated with mental illness, insurance companies in most states pay for psychiatric treatment at a lower rate than for physical illnesses. Frequently, those patients least able to pay the large differential/co-payments go untreated. Parity (equal rate of payment for psychiatric and medical treatment) is especially justified now that we have a better handle on brain function, genetics and the many newly discovered connections between neurology and psychiatry. In any case, as with so much of the vanishing of resources from our economy, corporate greed, along with a deficit of ethical accountability, seem to be the root causes of what's wrong with our healthcare system. A single payer system is definitely the answer, and I certainly agree with the above comments about the importance of prevention and the clamping down on the influences of agribusiness and the pharmaceutical corporations. For more than a dozen years (along with my private psychotherapy practice), I worked for Managed Care companies reviewing psychiatric cases, both inpatient and outpatient. The insurance companies hire the managed care entities to save them money, yet interjecting this intermediate layer brought huge, and in my opinion, unnecessary profits to the managed care entities. It was my task to review symptoms and the treatment given–and to determine whether continued treatment at a particular level was “medically necessary.” Inpatient cases were reviewed daily, and over the course of my tenure, the criteria for continued inpatient stays and the number of outpatient sessions became tighter and tighter. The last company I worked for also had a medical department which worked in the same way. By the time I retired, inpatient cases were having to be brought for “supervision” to our chief psychiatrist daily. If a patient’s stay began to exceed five days, there was pressure toward discharge. When I first began working for these companies, an intermediate supervisor advised me, “Always do what’s in the best interests of the patient,” which advice I never deviated from, even if it meant I was a bit “disloyal” to the company. My rationale for this was that by the end, criteria had “evolved” to the point where it was said that it was OK to discharge a patient who was still having psychotic symptoms (hearing voices, etc.). To me, this was unconscionable. As a “senior clinician,” my judgment was infrequently questioned.

Another problem was reconciling the decisions of the medical department with those of the psychiatric department. These days, when many constellations of psychiatric symptoms are intimately related to neurological causality–and because MRI’s, brain scans, etc. are so expensive, patients are often given superficial treatment–frequently a cocktail of powerful drugs (pushed by the pharmaceutical industry) which can allay symptoms in a trial and error way, but which never really uncover root causes. Many of these medications can have immediate and disturbing side effects or eventual devastating results–e.g., irreversible stiffness of the body, neuroleptic malignant syndrome and even (yes, listen to some of the TV ads) death.

In any case, over the course of my work for managed care, there were certainly a number of abuses uncovered; and discontinuance of payment to the provider and/or change of provider saved wasted money and presumably helped the patient. But, as far as I have observed, “Managed Care” as a profit making industry should be completely abolished. Review of cases (“utilization review”) could be accomplished as effectively by professionals employed by the single payer.

I have been speaking of psychiatric cases, and the other practice that needs to be universally instituted is so-called “Parity” which is currently in effect in some states. Because of ignorance and antiquated stigma associated with mental illness, insurance companies in most states pay for psychiatric treatment at a lower rate than for physical illnesses. Frequently, those patients least able to
pay the large differential/co-payments go untreated. Parity (equal rate of payment for psychiatric and medical treatment) is especially justified now that we have a better handle on brain function, genetics and the many newly discovered connections between neurology and psychiatry. In any case, as with so much of the vanishing of resources from our economy, corporate greed, along with a deficit of ethical accountability, seem to be the root causes of what’s wrong with our healthcare system.

]]> Comment on HEALTH CARE SYSTEMS: BIG PICTURE by Bur http://westonpolicy.wordpress.com/obama-healthcare-forum/healthcare-systems-big-picture/#comment-184 Bur Wed, 24 Dec 2008 02:31:08 +0000 http://westonpolicy.wordpress.com/?page_id=285#comment-184 Comment from Amy Kalafa Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options. The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission? A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe - really - I have elderly family members in France who are 100% satisfied with the care they receive. Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options. The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn't it be great if First Lady Michele Obama takes on school food as her mission? A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe - really - I have elderly family members in France who are 100% satisfied with the care they receive. amy@angrymoms.org Amy Kalafa http://angrymoms.org 0 Comment from Amy Kalafa

Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options.

The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission?

A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe – really – I have elderly family members in France who are 100% satisfied with the care they receive.

Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options.

The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission?

A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe – really – I have elderly family members in France who are 100% satisfied with the care they receive.
amy@angrymoms.org
Amy Kalafa
http://angrymoms.org
0

]]> Comment on HEALTH INSURANCE REFORMS for SELF-EMPLOYED & SMALL BUSINESS by Bur http://westonpolicy.wordpress.com/obama-healthcare-forum/reforms-for-small-business-self-employed-health-insurance/#comment-183 Bur Wed, 24 Dec 2008 02:29:11 +0000 http://westonpolicy.wordpress.com/?page_id=301#comment-183 Excellent points! Excellent points!

]]> Comment on HEALTH INSURANCE REFORMS for SELF-EMPLOYED & SMALL BUSINESS by Amy Kalafa http://westonpolicy.wordpress.com/obama-healthcare-forum/reforms-for-small-business-self-employed-health-insurance/#comment-181 Amy Kalafa Tue, 23 Dec 2008 23:31:38 +0000 http://westonpolicy.wordpress.com/?page_id=301#comment-181 Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options. The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn't it be great if First Lady Michele Obama takes on school food as her mission? A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe - really - I have elderly family members in France who are 100% satisfied with the care they receive. Until the federal government prohibits agribusiness and pharmaceutical corporate giants from determining food and health policy in America, our population will continue to be the sickest and fattest of all industrialized nations. Food policy is prevention. Small scale, diversified farms have been nearly wiped out in our country, resulting in factory farmed and highly processed foods being the cheapest, most available and least healthy options.

The best health care is prevention, currently only 1% of the entire health care budget in the US. President-elect Obama must insist that schools clean up their food environment by connecting the curriculum and the cafeteria. We need to create a nationwide food literacy initiative, much as JFK instituted physical education during his Presidency. Wouldn’t it be great if First Lady Michele Obama takes on school food as her mission?

A single payer system that gives incentives to medical professionals as well as individuals for maintaining wellness would bring health care costs down for everyone. There are wonderful models in Europe – really – I have elderly family members in France who are 100% satisfied with the care they receive.

]]> Comment on Your Health Insurance Experiences by Bur http://westonpolicy.wordpress.com/obama-healthcare-forum/your-health-insurance-experiences/#comment-179 Bur Tue, 23 Dec 2008 18:53:42 +0000 http://westonpolicy.wordpress.com/?page_id=330#comment-179 Anne Hunt Says: December 23, 2008 at 12:21 pm edit "Having just gone through a devastating two year period with my father as he suffered through Alzheimer’s disease, the care of the elderly MUST be addressed ASAP. Because of the current HIPA laws, the family was not informed when he was suddenly whisked away from his rehabilitation unit to the hospital because temporary staff chose not to deal with him. Trying to find out what medications he was taking also proved to be a monumental task. He was continually poked, prodded and stuck with needles. Tests were preformed again and again. Wasted medical expenses. At one point, he was transferred to a psychiatric hospital where his dietary diabetes requirements were ignored. Consequently, his condition worsened. The thought of facing anything like what he faced makes me shudder. He had a living will which specified “do not resuscitate”. That was also repeatedly ignored. We treat our animals with much more humanity than we do our elderly and this has got to stop." Your father should have been treated with more dignity. How should the federal laws be changed to prevent this type of healthcare deficiency? More training for rehabilitation center workers, or a change in HIPA laws to require notification of next-of-kin in the case of Alzheimer's patients? Think about how you would rewrite the existing laws. Anne Hunt Says:

December 23, 2008 at 12:21 pm edit

“Having just gone through a devastating two year period with my father as he suffered through Alzheimer’s disease, the care of the elderly MUST be addressed ASAP. Because of the current HIPA laws, the family was not informed when he was suddenly whisked away from his rehabilitation unit to the hospital because temporary staff chose not to deal with him. Trying to find out what medications he was taking also proved to be a monumental task. He was continually poked, prodded and stuck with needles. Tests were preformed again and again. Wasted medical expenses. At one point, he was transferred to a psychiatric hospital where his dietary diabetes requirements were ignored. Consequently, his condition worsened. The thought of facing anything like what he faced makes me shudder. He had a living will which specified “do not resuscitate”. That was also repeatedly ignored. We treat our animals with much more humanity than we do our elderly and this has got to stop.”

Your father should have been treated with more dignity. How should the federal laws be changed to prevent this type of healthcare deficiency? More training for rehabilitation center workers, or a change in HIPA laws to require notification of next-of-kin in the case of Alzheimer’s patients? Think about how you would rewrite the existing laws.

]]> Comment on Bush Vetoes Medicare Bill (H.R. 6331) by vote for third party http://westonpolicy.wordpress.com/2008/07/15/bush-vetoes-medicare-bill-hr-6331/#comment-178 vote for third party Tue, 23 Dec 2008 18:19:33 +0000 http://westonpolicy.wordpress.com/?p=55#comment-178 We the citizens of the United States of America deserve QUALITY HEALTH CARE period....the exact care we GIVE to congress and their families...the care the wealthy expect....and get...etc... A lot of greedy people (CONGRESS, AMA, FDA, INSURANCE COMPANIES) are fighting for the abundance of money to be made on the backs of hard working people...but giving back inferior care to boot... Congress will push the public to the point of no return and the people will go with third party honest men and women who follow the constitution... I would rather spend my tax money on what is right for humanity and also the poor than over kill by greedy people who would take all and more rather than share a little....ex...bank bailouts, airlines, car companies etc...but no help for the people.... Pray for peace and the people in charge.... We the citizens of the United States of America deserve QUALITY HEALTH CARE period….the exact care we GIVE to congress and their families…the care the wealthy expect….and get…etc…

A lot of greedy people (CONGRESS, AMA, FDA, INSURANCE COMPANIES) are fighting for the abundance of money to be made on the backs of hard working people…but giving back inferior care to boot…

Congress will push the public to the point of no return and the people will go with third party honest men and women who follow the constitution…

I would rather spend my tax money on what is right for humanity and also the poor than over kill by greedy people who would take all and more rather than share a little….ex…bank bailouts, airlines, car companies etc…but no help for the people….

Pray for peace and the people in charge….

]]> Comment on Obama Healthcare Forum Participants’ Guide by Anne Hunt http://westonpolicy.wordpress.com/obama-healthcare-forum/obama-healthcare-forum-participants-guide/#comment-177 Anne Hunt Tue, 23 Dec 2008 16:21:09 +0000 http://westonpolicy.wordpress.com/?page_id=273#comment-177 Having just gone through a devastating two year period with my father as he suffered through Alzheimer’s disease, the care of the elderly MUST be addressed ASAP. Because of the current HIPA laws, the family was not informed when he was suddenly whisked away from his rehabilitation unit to the hospital because temporary staff chose not to deal with him. Trying to find out what medications he was taking also proved to be a monumental task. He was continually poked, prodded and stuck with needles. Tests were preformed again and again. Wasted medical expenses. At one point, he was transferred to a psychiatric hospital where his dietary diabetes requirements were ignored. Consequently, his condition worsened. The thought of facing anything like what he faced makes me shudder. He had a living will which specified “do not resuscitate”. That was also repeatedly ignored. We treat our animals with much more humanity than we do our elderly and this has got to stop. Having just gone through a devastating two year period with my father as he suffered through Alzheimer’s disease, the care of the elderly MUST be addressed ASAP. Because of the current HIPA laws, the family was not informed when he was suddenly whisked away from his rehabilitation unit to the hospital because temporary staff chose not to deal with him. Trying to find out what medications he was taking also proved to be a monumental task. He was continually poked, prodded and stuck with needles. Tests were preformed again and again. Wasted medical expenses. At one point, he was transferred to a psychiatric hospital where his dietary diabetes requirements were ignored. Consequently, his condition worsened. The thought of facing anything like what he faced makes me shudder. He had a living will which specified “do not resuscitate”. That was also repeatedly ignored. We treat our animals with much more humanity than we do our elderly and this has got to stop.

]]> Comment on HEALTH CARE SYSTEMS: BIG PICTURE by Hippocrates http://westonpolicy.wordpress.com/obama-healthcare-forum/healthcare-systems-big-picture/#comment-168 Hippocrates Fri, 19 Dec 2008 16:09:43 +0000 http://westonpolicy.wordpress.com/?page_id=285#comment-168 What about the national insurance pool recommended by several Democratic Presidential candidates, including Barack Obama and Hillary Clinton? Wouldn't they be not only non-profit insurance companies, but also subsidized in the case of low-income people? What about the national insurance pool recommended by several Democratic Presidential candidates, including Barack Obama and Hillary Clinton? Wouldn’t they be not only non-profit insurance companies, but also subsidized in the case of low-income people?

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