Tuesday, May 29, 2012

Health Care Reform Articles-May 31, 2012

Waking Up to Major Colonoscopy Bills

Scott Menchin
Patients who undergo colonoscopy usually receive anesthesia of some sort in order to “sleep” through the procedure. But as one Long Island couple discovered recently, it can be a very expensive nap.
Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. But in both cases, the gastroenterologists chose full anesthesia with Propofol, a powerful drug that must be administered by an anesthesiologist, instead of moderate, or “conscious,” sedation that often gastroenterologists can administer themselves.
And in both cases, the gastroenterologists were assisted in the procedure by anesthesiologists who were not covered by the couple’s insurance. They billed the couple’s insurance at rates far higher than any plan would reimburse — two to four times as high, experts say.
Now the couple, Lawrence LaRose and Susan LaMontagne, of Sag Harbor, N.Y., are fending off lawyers and a debt collection agency, and facing thousands of dollars in unresolved charges. All this for a cancer screening test that public health officials say every American should have by age 50, and repeat every 10 years, to save lives — and money.
“Doctors adopt practices that cost more, insurers pay less, and patients get stuck with a tab that in many cases is inflated and arbitrary,” said Ms. LaMontagne, whose communications firm, Public Interest Media Group, is focused on health care. “I work on health care access issues every day, so if I’m having a hard time sorting this out, what does that say for other consumers?” 

A Hospital That Gave Its Patients Time to Heal

It is probably pointless to suggest that all the individuals presently shaping our health care future spend a quiet weekend with “God’s Hotel,” Dr. Victoria Sweet’s transcendent testament to health care past. Who interrupts cowboys in the midst of a stampede?
But if you’re one of the millions of doctors and patients out there choking on their dust, this is the book for you. Its compulsively readable chapters go down like restorative sips of cool water, and its hard-core subversion cheers like a shot of gin.
Dr. Sweet writes about the 20 years she spent practicing medicine at San Francisco’s old Laguna Honda Hospital, a giant chronic care facility for the city’s destitute and ill. At one point, almost every county in the nation had a place like it, where patients could live for months, years, as long as it took. These medical back wards, like their psychiatric counterparts, have now evaporated in the name of community-based services: the old Laguna Honda was called the last almshouse in America.
On the days she was not at the hospital, Dr. Sweet was earning a Ph.D. in the history of medicine, focusing on the life and work of the remarkable 12th-century German nun Hildegard of Bingen. Cloistered from age 12 until her death at 81, Hildegard became not only a prominent theologian and a composer of Gregorian chants, but also a health care guru, devising medical regimens for her own community and leaving behind several influential manuscripts.
Dr. Sweet surrounds the stories of her patients with detailed excursions into Hildegard’s medical practice and its occasional unexpected utility for modern problems. And while these two layers would make for a perfectly fine memoir, what turns “God’s Hotel” into a tour de force is its third: a bitingly skeptical eyewitness account of Laguna Honda’s transformation from anachronism into efficient, computerized 21st-century rehabilitation center.

Health cost issue divides former allies in Mass.

For business groups, stakes are higher as focus is on revenues

The state’s largest business groups, which came together to play a key role in passage of the 2006 law that expanded health insurance coverage, are now divided over how aggressively to slow the growth of health costs.
Associated Industries of Massachusetts, a business trade group, has called for tighter controls on spending than the House or Senate has proposed. Its regular allies - including the Massachusetts Taxpayers Foundation, a research organization for employers - warn against over-regulation.

Thousands of patients in California and across the nation who take expensive prescription drugs every month for cancer, rheumatoid arthritis and other ailments are facing sticker shock at the pharmacy.
Until recently, most of these patients typically paid modest co-pays for the advanced drugs. But increasingly, Anthem Blue Cross, Aetna and other insurers are shifting more prescriptions to a new category requiring patients to shoulder a larger share of the drug's cost.
The result: Pharmacy bills are going up by hundreds of dollars a month — on top of insurance premiums.

Groundbreaking Study Shows Why Fixing Healthcare Costs Is Still a Top Priority

By Joshua Holland, AlterNet
Posted on May 28, 2012, Printed on May 29, 2012

The greatest rip-off in the world is getting worse. According to a groundbreaking study released last week (PDF), the cost of employer-based health insurance – which covers a majority of the population -- has risen at twice the rate of inflation during the Great Recession, even while Americans have come to use less medical services.
It is a tragic irony that even as Washington debates whom to screw over to cut the Phantom Menace of our federal deficit, it has so far failed to address the single most important factor driving those deficits over the long term (if we paid the same for health care per person as the 30-plus countries with longer average life expectancies, we'd be looking at budget surpluses). It's a problem that also leads to tens of thousands of unnecessary deaths annually, creates some of the worst health outcomes in the developed world, makes American firms less competitive in the global marketplace and contributes a great deal to wage stagnation for the middle class and the working poor.

Psychiatrists Seek New Patients at Annual Meeting

Monday, 28 May 2012 11:16By Martha Rosenberg, Dissident Voice | Report
The first week in May brought a new leader in France and new prospects for same sex couples seeking marriage. But at the American Psychiatric Association’s annual meeting in Philadelphia, attended by 11,000 psychiatrists, it was the same old same old. Instead of listening to the public outcry about overmedicated children, soldiers, elderly and everyday people watching too many drug ads, the psychiatry group re-affirmed its resolve to pathologize healthy people and even rolled out new groups to target.
House to Consider Amended Health Care Bill
Posted By Stephan Burklin On May 12, 2011 @ 11:40 am In Featured,News | No Comments
Members of the Maine House of Representatives are expected to debate Senate changes to a bill that would overhaul the state’s health insurance market.
In a nocturnal session yesterday, Senate Republicans wooed the support of three Democrats and the chamber’s lone independent with two amendments clarifying aspects of the bill, LD 1333 [1], which was ultimately approved by a margin of 24-10.
The House, which engrossed the bill in a 79-68 vote on Tuesday, must now either concur with the Senate amendments or adhere to its own iteration of the bill.
Debate in the Senate centered on misgivings about the bill’s impact on Maine’s rural and elderly populations.
Consumer advocacy groups and the AARP contend that older adults will suffer from expanded community rating bands, the allowable premium differentials established by the Bureau of Insurance.  Under LD 1333, insurers could raise the premium charged to an older individual from 50 percent up to 500 percent more than the premium charged to a younger individual.
Supporters of the bill argue that lower premiums for younger and healthier individuals will entice them back into the market, thereby broadening the pool of insured members to the point where premiums for the elderly begin to fall.  Opponents acknowledge that the younger demographic will benefit, but are skeptical that lower premiums for the older segment will materialize.

For Some, Exercise May Increase Heart Risk

Michael Zamora/Corpus Christi Caller-Times, via Associated Press
Could exercise actually be bad for some healthy people? A well-known group of researchers, including one who helped write the scientific paper justifying national guidelines that promote exercise for all, say the answer may be a qualified yes.
By analyzing data from six rigorous exercise studies involving 1,687 people, the group found that about 10 percent actually got worse on at least one of the measures related to heart disease:blood pressure and levels of insulin, HDL cholesterolortriglycerides. About 7 percent got worse on at least two measures. And the researchers say they do not know why.
Marie ConstantinClaude Bouchard
“It is bizarre,” said Claude Bouchard, lead author of the paper, published on Wednesday in the journal PLoS One, and a professor of genetics and nutrition at thePennington Biomedical Research Center, part of the Louisiana State University system.
Dr. Michael Lauer, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute, the lead federal research institute on heart disease and strokes, was among the experts not involved in the provocative study who applauded it. “It is an interesting and well-done study,” he said.
Others worried about its consequences.
“There are a lot of people out there looking for any excuse not to exercise,” said William Haskell, emeritus professor of medicine at the Stanford Prevention Research Center. “This might be an excuse for them to say, ‘Oh, I must be one of those 10 percent.’ ”

Markets and Morals

Does it bother you that an online casino paid a Utah woman, Kari Smith, who needed money for her son’s education, $10,000 to tattoo its Web site on her forehead?
Or that Project Prevention, a charity, pays women with drug or alcohol addictions $300 cash to get sterilized or undertake long-term contraception? Some 4,100 women have accepted this offer.
Michael Sandel, the Harvard political theorist, cites those examples in “What Money Can’t Buy,” his important and thoughtful new book. He argues that in recent years we have been slipping without much reflection into relying upon markets in ways that undermine the fairness of our society.
That’s one of the underlying battles this campaign year. Many Republicans, Mitt Romney included, have a deep faith in the ability of laissez-faire markets to create optimal solutions.
There’s something to that faith because markets, indeed, tend to be efficient. Pollution taxes are widely accepted as often preferable than rigid regulations on pollutants. It may also make sense to sell advertising on the sides of public buses, perhaps even to sell naming rights to subway stations.
Still, how far do we want to go down this path?

Sunday, May 27, 2012

Health Care Reform Articles-May 28, 2012

Realigning Health with Care

The misalignment between the expansive goal of “health” and a cramped definition of “care” has cost the United States untold lives and treasure. Yet realignment is in reach: Through expanding the scope of health care, the place where it is delivered, and the workforce that provides it, the US health care system could significantly improve health outcomes and reduce inefficiencies.
By Rebecca Onie, Paul Farmer, & Heidi Behforouz

Mass. hospitals urged to apologize, settle

For hospitals, avoiding lawsuits may mean learning to say ‘I’m sorry’

Friday, May 25, 2012

Health Care Reform Articles-May 26, 2012

Legislation may enable states to offer universal healthcare

To make universal coverage work at the state level, you'd need to channel federal healthcare funds into the system. A bill being drafted by Rep. Jim McDermott would allow that to happen.

David Lazarus - LA Times

Universal coverage, Medicare for all, single payer — call it what you will. It's clear that conservative forces are determined to prevent such a system from ever being introduced at the national level. So it's up to the states.

The catch is that to make universal coverage work at the state level, you'd need some way to channel Medicare, Medicaid and other federal healthcare funds into the system. At the moment, that's difficult if not impossible.

But legislation quietly being drafted by Rep. Jim McDermott (D-Wash.) would change that. It would create a mechanism for states to request federal funds after establishing their own health insurance programs.
If passed into law — admittedly a long shot with Republicans controlling the House of Representatives — McDermott's State-Based Universal Healthcare Act would represent a game changer for medical coverage in the United States.

It would, for the first time, create a system under which a Medicare-for-all program could be rolled out on a state-by-state basis. In California's case, it would make coverage available to the roughly 7 million people now lacking health insurance.

"This is a huge deal," said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. "This is a lifeline for people who want to create a Medicare system at the state level."

Your family doctor is now a team

Posted May 24, 2012, at 3:43 p.m.
When it came to being your family doc, I tried darn hard to do it all. I delivered your babies, took care of you in the hospital, palpated your parts, and much more. If space aliens had flown out of your navel I would have tried to fix that problem for you, too.
Unfortunately, it turns out that what I thought was pretty good care for you has not been good enough. I could not do enough comprehensive care of my patients with diabetes, high blood pressure, heart troubles, or other chronic diseases to help them avoid some preventable complications. Too many of my patients with congestive heart failure ended up in the hospital too often. I thought I was doing a great job, but I was wrong. Smart and dedicated, but wrong.
So were many thousands of my colleagues in primary care — the family docs, internists, family nurse practitioners and physician assistants who have been working like demons providing preventive and chronic illness care for millions of Americans. We practiced good care to the limits of our training and our resources, and it was not enough. Study after study started showing we were not doing nearly as good a job as we hoped.
When we figured that out, we did what good doctors always do; berated ourselves and worked harder. Pirates would have been impressed as we flogged ourselves until morale and performance improved. It barely helped. So we did it some more, which barely helped some more, but not enough.
Now, slowly and surely, we are coming to understand what it really takes to take great care of you in your primary care physician’s office — a whole darn team. That’s a team of nurses, medical assistants, office staff, computer geeks, and all the other people around town in emergency rooms, hospitals, specialist offices, labs, etc. that also help take care of you. And it takes you, too, more than ever. Your primary care is a team sport.

MAY 25, 2012, 9:20 PM

Control: An Update

Anxiety: We worry. A gallery of contributors count the ways.
MJ SieberDominick Brocato in July 2011.
Last week’s Anxiety post, “Control,” featured an interview with Dominick Brocato, conducted and transcribed by DW Gibson, the author of the forthcoming book and documentary film, “Not Working.” Many readers who commented wanted to know how Mr. Brocato was managing his various challenges — unemployment, illness and a lack of medical insurance among them — since the interview, which took place in July 2011. To provide that update to readers, Mr. Gibson contacted Mr. Broacato by e-mail and phone earlier this week.
DW Gibson writes: When I contacted Dominick, I learned that he’d had surgery on his right knee (unrelated to his cancer) just the day before. I immediately suggested we talk later but he ignored the offer. True to my memory of him, he was at attention, instantly composed and engaged. His own words — “I am still a vital and vibrant person” — still echo in my head. The update below is composed of Dominick’s words from our e-mail correspondence this week and a follow-up conversation over the phone.

Maine hospital cuts 47 positions

By BETTY ADAMS Kennebec Journal

AUGUSTA -- MaineGeneral Medical Center is trimming 47 positions from its staff as a cost-cutting measure to meet its almost $400 million operating budget for the next fiscal year.

The move means 15 jobs will be eliminated and 32 vacant positions will not be filled, hospital officials said.
Those losing jobs have 45 days to apply for another job within the hospital, said Chuck Hays, president and chief executive officer for MaineGeneral Medical Center.
Staff reductions affect both MaineGeneral Medical Center and the parent organization, MaineGeneral Health, and are spread throughout the organization, Hays said.
"Three of the open positions were clinical," Hays said Friday. "The rest were support and administrative."
The hospital is building a $312 million regional hospital in north Augusta that will incorporate inpatient services from the Thayer campus in Waterville and replace the hospital on South Chestnut Street in Augusta.
Hays said that the job cuts will not affect the massive project.