Let's Talk About Health Care and I Don't Mean the ACA
Let's talk about health care. I don't mean debating the Affordable Care Act. I mean health care, as in: If everyone needs health care, guarantee that everybody gets it.
I know, when it comes to health care, it's easy to get into a debate for or against Obamacare. But we nurses see the world through a different lens: our patients.
Good health care is a fundamental resource that keeps America's big engine running. Every day, as we do our best to care for our patients, nurses see people with chronic disease like asthma or diabetes who can't afford insurance costs or medication. Maybe they're absent from work, tired, and distracted from trying to manage their health on a shoestring. They run the risk of hospitalization. They struggle for a distant unreachable shore hoping something will help. They can't get ahead because their health keeps dragging them down.
And yet the answer isn't on the horizon, the answer is in our pockets, in our hands. It's our taxes. We pay them and we ought to benefit from them.
There's one thing that every American does. Every working American (OK, except the Wall Street crowd) pays taxes. But what do we pay taxes for? Increasingly, we wonder where our money is going, how our money is serving our communities, and how our tax money is helping us and our families.
Wrestling With Dying Hospitals
By THE EDITORIAL BOARD
Think about New York City and public health, and the mind instantly goes to soda cups and cigarette bans, to Mayor Michael Bloomberg’s 12-year campaign of behavioral modification to make his fellow citizens ditch their bad habits. But eating better is not the only way to a healthier city, especially when so many New Yorkers lack access to decent health care in their own neighborhoods.
On that, the Democratic candidates agree about the need for more primary and preventive care and far less reliance on the emergency room. One candidate, Bill de Blasio, has taken on that problem with a plan to save dying community hospitals in his home borough, Brooklyn.
Mr. de Blasio was arrested last month, protesting plans by the State University of New York to close Long Island College Hospital in Cobble Hill, which has hemorrhaged money and patients for years.
Mr. de Blasio has made fighting hospital closings a crusade, and his office sued to block the shutdown, arguing that it lacked proper review and would rob the community of needed services. A court order is keeping the hospital open for now, though it has only a handful of patients and no apparent future.
It’s easy to dismiss Mr. de Blasio’s arrest as a way to broadcast his solidarity with 1199 S.E.I.U., the health care workers’ union, which has endorsed him. But he has elevated an important issue on which Mr. Bloomberg long ago checked out. Struggling community hospitals, including the two on the brink of extinction — Long Island College Hospital and Interfaith Medical Center in Bedford-Stuyvesant, which is in bankruptcy court — have been badly managed and are ill equipped to survive in a changing marketplace. Many are disappearing under mountains of debt and need to be either rescued or reinvented.
In states not expanding Medicaid, poor could still get Obamacare help
Posted Aug. 12, 2013, at 9:42 a.m.
Some of the millions of poor people expected to lose out on Obamacare coverage next year because their states are not expanding Medicaid might have a way to get help, but the strategy carries risk.
Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four.
That would entitle them to federal subsidies that would cover nearly all the cost of private coverage sold on new online insurance marketplaces set up by the federal health law. The subsidies are available on a sliding scale to people making between the poverty level and four times that amount.
Everyone applying for subsidies must estimate their 2014 income. For the poor, the difference between qualifying — or not — could be $1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That’s one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor.
While there are steep fines for knowingly lying on a government application for financial assistance, if someone merely miscalculates their income above the poverty level in 2014, and is later found to have made less than the poverty level, they won’t have to pay any money back, according to the Treasury Department.
“There’s little risk because under the rules you don’t have to pay anything back,” said Richard Trembowicz, vice president for Celtic Insurance Co., a subsidiary of Centene Corp. which is offering plans on several exchanges, including Mississippi.
While most people are unaware of this option now, “I would be surprised if this is not commonly known before the end of March 2014,” Trembowicz added, saying he expects advocates and others to advise people about the eligibility rules for subsidies when the exchanges open Oct. 1.
In addition, he said, people will have a new incentive to report income to the government that they might not have disclosed before, such as cash from babysitting and tips.
President Bush’s unnecessary surgery
Posted Aug. 11, 2013, at 7:37 a.m.
Former president George W. Bush, widely regarded as a model of physical fitness, received a coronary artery stent on Tuesday. Few facts are known about the case, but what is known suggests the procedure was unnecessary.
Before he underwent his annual physical, Bush reportedly had no symptoms. Quite the opposite: His exercise tolerance was astonishing for his age, 67. He rode a bike more than 30 miles in the heat on a ride for veterans injured in the wars in Iraq and Afghanistan.
If Bush had visited a general internist practicing sound, evidence-based care, he would not have had cardiac testing. Instead, the doctor would have had conducted age-appropriate cancer screening. For the former president, this would include only colon cancer screening. It no longer would include even prostate-specific antigen testing for cancer. The doctor would have screened for cholesterol, checked for hypertension and made sure the patient was up to date on age-appropriate vaccinations, including those for pneumococcal pneumonia and shingles. Presumably, Bush got these things, and he got the cardiac test as well.
What value does a stress test add for an otherwise-healthy 67-year-old?o study has shown that this examination improves outcomes. The trials that have been done for so-called routine stress testing examined higher-risk patients. They found that performing stress tests on people at high risk of cardiovascular disease may detect blockages but does not improve symptoms or survival. Routine stress testing does, however, increase the use of procedures such as coronary stenting.
Unfortunately, Bush, like many VIPs, may be paying the price of these in-depth investigations. His stress test revealed an abnormality, prompting another test: a CT angiogram. This study showed a blockage, which was stented open during an invasive procedure. It is worth noting that at least two large randomized trials show that stenting these sorts of lesions does not improve survival. Because Bush had no symptoms, it is impossible that he felt better after these procedures.
Official: People ‘falling through the cracks’ in transition to new system for MaineCare rides
Mary Putansu (left) of Belfast heads to work this week at Little River Apparel after getting a ride by Waldo County Transportation driver Winnie Fowler. The state's August 1 switch to a new MaineCare transportation brokering, or dispatching, system has meant that many elderly, ill and impoverished Mainers have missed medical and other appointments in the last week. Buy Photo
BELFAST, Maine — Driver Winnie Fowler unlocked the maroon Waldo County Transportation minivan early Wednesday morning and double checked the list of her first pickups of the day — three people with special needs who live in downtown Belfast and needed a ride to work.
She and the other drivers from the Waldo Community Action Partners program help some of the most marginalized people in the county get to where they need to go. That includes chemotherapy treatments, dialysis appointments, physical therapy sessions, the grocery store, preschool, methadone clinics and more.
“I never knew how many illnesses there were until I started driving,” Fowler said. “There’s a lot of people hurting.”
In a large, rural state with limited public transportation options, services such as those offered through Waldo CAP is critical. But after the state switched to a new transportation brokerage system for its MaineCare patients on Aug. 1, officials say many of those marginalized people have started to slip through the cracks. The new broker that serves Waldo County and surrounding areas is Coordinated Transportation Solutions, a Connecticut-based company that recently opened an operations center in Lewiston. That company referred media calls to the Maine Department of Health and Human Services.
Eastern Maine Healthcare Systems plans $5.25 million medical office building
Posted Aug. 09, 2013, at 2:43 p.m.
BANGOR, Maine — Eastern Maine Medical Center needs more room for its primary care providers and that room could be provided through a $5.25 million medical office building project located off of Maine Avenue.
“We’re doing more care and [our practitioners] need more space,” said Joel Farley, facilities administrator for EMMC. “We’re increasing our level of action with patients, particularly with those managing with chronic illness.”
Under the deal, which the City Council will consider during a meeting Monday night, Eastern Maine Healthcare Systems would purchase from the city 2.4 acres of land in the Maine Business Enterprise Park, known as Lot 8A, for $183,000, according to Tanya Emery, interim director of Economic and Community Development for the city. The plot is adjacent to Northeast Cardiology Associates.
EMHS would then build a 30,000-square-foot, two-story medical office building, which would help Eastern Maine Medical Center house a growing number of physicians and nurses, according to Farley. EMHS expects the project will cost about $5.25 million.
“We’re constantly looking at what the community needs in terms of care,” Farley said, adding that the hospital is actively courting more practitioners to meet the needs of Maine residents.
EMHS has agreed to make an annual payment in lieu of taxes equal to 30 percent of the property value once it’s built and assessed.
“We are extremely proud of the relationship we have with [Eastern Maine Medical Center] and EMHS,” Emery said. Steve Bolduc, a Bangor business development officer, brokered the deal between the city and EMHS.
“The healthcare segment of our economy continues to grow in Bangor,” Emery said.
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