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Why Oncologists Should Support Single-Payer National
Health Insurance
By Ray E. Drasga, MD, and Lawrence H. Einhorn, MD
St Clare Clinic for the Indigent, Crown Point; and Indiana University School of Medicine, Indianapolis, IN
By Ray E. Drasga, MD, and Lawrence H. Einhorn, MD
St Clare Clinic for the Indigent, Crown Point; and Indiana University School of Medicine, Indianapolis, IN
Oncologists face growing difficulties in caring for patients be-
cause of the rising cost of treatment coupled with the high
prevalence of uninsurance and underinsurance. A diagnosis of
cancer is often the single most catastrophic health care event in
an individual’s life. The stress of the situation increases expo-
nentially when patients realize the burden of cost on themselves
and their families.
Oncologists face the dilemma of advising a treatment schema that the patient can afford. Therapies may need to be compromised as a result of the patient’s inability to pay. Pa- tients often present with more advanced disease because they have never had cancer screenings because of a lack of insurance or concerns about cost. Meanwhile, the prices of cancer-related drugs are rising sharply, prompting some oncologists to sound the alarm.1
Different insurance plans have their own procedures for use review and benefit determinations, making it difficult for providers to interpret whether cancer treatment will be cov- ered. The average patient finds it frustrating to navigate the bureaucracy with his or her life and financial security on the line. This article will outline the scope of these issues and offer an evidence-based case for single-payer national health insurance.http://org.salsalabs.com/o/307/images/Drasga%20Einhorn%20authors%20proof-edited%20(1).pdf
John Stewart Interviews Steven Bril on Health Care Costs - worth watching.
http://www.thedailyshow.com/full-episodes/thu-january-16-2014-steven-brill
Oncologists face the dilemma of advising a treatment schema that the patient can afford. Therapies may need to be compromised as a result of the patient’s inability to pay. Pa- tients often present with more advanced disease because they have never had cancer screenings because of a lack of insurance or concerns about cost. Meanwhile, the prices of cancer-related drugs are rising sharply, prompting some oncologists to sound the alarm.1
Different insurance plans have their own procedures for use review and benefit determinations, making it difficult for providers to interpret whether cancer treatment will be cov- ered. The average patient finds it frustrating to navigate the bureaucracy with his or her life and financial security on the line. This article will outline the scope of these issues and offer an evidence-based case for single-payer national health insurance.http://org.salsalabs.com/o/307/images/Drasga%20Einhorn%20authors%20proof-edited%20(1).pdf
Help With Medical Bills
In September 2012, as Gladys Puglla was thanking everyone for coming to a community organization board meeting, she blacked out from a stroke. It felt, she recalled, as if “my soul was leaving my body.”
She woke up at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. After surgery and a nine-day hospital stay, Ms. Puglla owed about $138,000 — after her health insurance paid its share of the medical bill.
There was no way Ms. Puglla, a clerical worker, could pay that astronomical amount on her $37,000 annual salary. The community organization where she volunteers, Make the Road New York, assigned a staff lawyer free of charge, and with help from the Community Service Society, a New York Times Neediest Cases Fund agency, negotiated with doctors and the hospital to reduce the balance to $6,900. After the Neediest Cases Fund agreed to pay $3,450, Cornell forgave the remainder. The fund also agreed to pay an ambulance bill of $1,020.
Clearing that medical debt was critically important, but Ms. Puglla still struggles with co-payments for continuing therapy, doctors’ visits and medicine. Because of those bills, she has fallen behind on her rent and is battling eviction.
But that is another fight, she said. For now, she is back at work and getting back on her feet.
http://www.nytimes.com/2014/01/18/opinion/help-with-medical-bills.html?emc=edit_tnt_20140117&tntemail0=yJohn Stewart Interviews Steven Bril on Health Care Costs - worth watching.
http://www.thedailyshow.com/full-episodes/thu-january-16-2014-steven-brill
In health care, need is trumped by profit
By Laura Berger
Wisconsin State Journal, Letters, Jan. 17, 2014
I was surprised and pleased to see the large ad in Wednesday's State Journal by the Tri-County Medical Society, including Barron, Burnett and Washburn counties, about the high cost of medical care in the United States. We need more voices about health care from rural areas.
I agree that reading Time magazine writer Steven Brill's March 2013 piece "Bitter Pill" will show our need to shift discussion from "how do we pay for health care" to "'why is it so expensive?"
The Wisconsin Physicians for a National Health Care Program has launched a petition to state government officials urging uniform, transparent and affordable pricing for all health care services (see www.pnhp.org/states/wisconsin).
What is undermining health care is not government, but corporate profits and inefficiencies. Instead of government's impossible and complex attempts to walk a line between public need and corporate profit, let's acknowledge there's another way.
An elegant and simple solution to achieving affordable health care for all can be found in Canada and in U.S. House Resolution 676. Call it expansion of Medicare or single payer -- that is how we get there.
Laura Berger is a public health nurse in Madison and Dane County.
http://host.madison.com/news/opinion/mailbag/in-health-care-need-is-trum...
Wisconsin State Journal, Letters, Jan. 17, 2014
I was surprised and pleased to see the large ad in Wednesday's State Journal by the Tri-County Medical Society, including Barron, Burnett and Washburn counties, about the high cost of medical care in the United States. We need more voices about health care from rural areas.
I agree that reading Time magazine writer Steven Brill's March 2013 piece "Bitter Pill" will show our need to shift discussion from "how do we pay for health care" to "'why is it so expensive?"
The Wisconsin Physicians for a National Health Care Program has launched a petition to state government officials urging uniform, transparent and affordable pricing for all health care services (see www.pnhp.org/states/wisconsin).
What is undermining health care is not government, but corporate profits and inefficiencies. Instead of government's impossible and complex attempts to walk a line between public need and corporate profit, let's acknowledge there's another way.
An elegant and simple solution to achieving affordable health care for all can be found in Canada and in U.S. House Resolution 676. Call it expansion of Medicare or single payer -- that is how we get there.
Laura Berger is a public health nurse in Madison and Dane County.
http://host.madison.com/news/opinion/mailbag/in-health-care-need-is-trum...
Mike Tipping: Real people, not caricatures, should inform MaineCare expansion debate
Rhetoric about the proposal’s impact insults the hardworking Mainers who would benefit.
Richard Holt’s family has been connected to the sea for generations. His grandfather was a ship captain sailing out of South Portland, and he is a commercial fisherman working the same harbor. He scallops and has held his lobster license since 1974.
Holt’s family also has a deep connection to the best ideals and values of Maine’s Republican Party. His mother was a political activist and founded the Portland chapter of the League of Women Voters.
It’s from this tradition that he gained his deeply held beliefs in the importance of personal responsibility and independence. When Holt built his boat with his own hands, he refused to accept a tax cut on the materials. He figured he didn’t need it and didn’t want to have to rely on anyone for anything.
As the years have gone by, an injury Holt suffered as a young man has worsened and has affected how much he’s able to fish. What has allowed him to keep working at all is the medicine and care he’s been able to access through MaineCare.
Because of Gov. LePage’s refusal to accept federal funding to continue and expand the health care program, Holt lost his coverage two weeks ago. Unless the Legislature overturns LePage’s decision, Holt may soon lose his home and his boat, and his family will lose its link to the sea.
Tom Benne has as deep a connection to the land as Holt does to the water. He owns a farm in Whitefield where he and his wife grow crops and raise some cattle.
They’re as self-sufficient as they can make themselves, and he also works for his neighbors as a handyman and doing construction. He’s proud of his own skills and that he’s never had to take his car or tractor to an outside mechanic.
Benne has had arthritis since he was 18, but he doesn’t like hospitals much and avoided going to the doctor for it.
A few years ago, though, things got so bad that by noon each day he couldn’t walk at all. Because he had MaineCare coverage, he was able to have surgery that let him walk again and get back to work. Because of LePage’s veto, he also lost his coverage at the start of this year.
Handful of Republican lawmakers may hold key to expanding Medicaid in Maine
Posted Jan. 18, 2014, at 6:16 a.m.
AUGUSTA, Maine — A handful of Republican state lawmakers, if they haven’t already, are about to become the most popular — or depending on how you look at it —- among the most wanted people at the Legislature in the weeks ahead.
“There is a fair amount of pressure coming from both sides,” said Rep. Corey Wilson, R-Augusta.
Wilson, a first-term legislator, is among five Republicans in the Maine House who have previously voted for an expansion of the state’s Medicaid program, MaineCare — a prospect Republican legislative leaders and Gov. Paul LePage are dead-set against.
Republican leaders and LePage say the state’s low-income health care program is a constant source of budgetary woe. Expanding it, they say, is a massive expansion of welfare.
Expanding the program under the federal Affordable Care Act has been a top priority for Democrats over the last two years. Democrats also maintain the expansion, because it will be largely paid for with federal funds, would pump $700,000 a day into the state’s economy.
But Republicans, pointing to a recent report produced by a private consultant hired by LePage’s administration, say an expansion will cost the state more than $800 million over the next 10 years.
Republicans also say that until the state does something to provide health care to some 3,100 children, elderly and disabled that are currently on waiting lists for MaineCare programs they won’t support expanding the program to cover more Mainers.
Democrats estimate the expansion would give health care to about 70,000 more low-income Mainers but Republicans argue the figure is more like 100,000.
“Adding 100,000 able-bodied people to Medicaid is just a bad idea when it comes to our state’s budget and the ability of taxpayers to sustain it,” said David Sorensen, a spokesman for House Republicans. “We don’t intend on meeting halfway on a bad idea. This isn’t a biennial budget bill; it doesn’t need to be passed.”
Sorensen and others also say that about half of those who would be covered under a Medicaid expansion could buy health insurance on the open market that would be covered by federal subsidies under the ACA. Democrats counter that most of the expansion would be for people too poor to be eligible for a subsidy under the ACA.
While most Republicans are digging their heels in, a handful including Wilson and Rep. Jarrod Crockett, R-Bethel, say there’s more room for compromise on the issue than the party stalwarts are letting on.
Wilson is careful to say he’s not a flat-out “yes” vote on expansion, but he would support it as part of legislation that also aims to control costs and improve the quality of the medical care that’s delivered to MaineCare recipients.
“To me, we can use [expansion] as an opportunity to put in measures to control costs,” Wilson said.
The high cost of care, not necessarily the number of people using MaineCare, is the biggest problem with the system now, Wilson said.
Adding sliding scale co-payments for emergency room visits or other requirements for MaineCare recipients that encourage preventive care and create incentives for healthier lifestyles could be elements in a compromise on expansion, Wilson said.
Other ideas include the establishment of so-called “medical homes” — a primary care practice where a Medicaid recipient would receive most of their health care — instead of accessing it at relatively high-cost emergency departments.
Expansion, according to Wilson, shouldn’t be just an extension of the status quo with MaineCare.
Wilson said details of what a compromise on expansion might look like are still emerging.
Doctors worry pressure on ERs may rise under Obamacare, but rank Maine high for care
Posted Jan. 18, 2014, at 5:57 a.m.
WASHINGTON — People seeking urgent medical care could face longer wait times and other challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on Thursday that gives the nation’s emergency infrastructure a near failing grade.
In its latest “report card,” the American College of Emergency Physicians said such reduced access earned the nation a “D+” — that’s down from the overall “C-” grade from the group’s last report in 2009.
Shortages and reduced hospital capacity make it more difficult to access emergency care, the group said. It also warned about the impact on disaster preparedness.
While the report does not measure the actual quality of care provided, it does offer a snapshot of national and state policies affecting emergency medicine as seen by providers.
Washington, D.C., was ranked the highest in the report, earning a “B-” grade, while Wyoming ranked last and was the only state to earn an overall failing grade of “F.”
The group’s task force looked at scores of measure in five major categories — access to care, quality and patient safety, liability, injury prevention and disaster preparedness — and relied on data from the Centers for Disease Control and the Centers for Medicare and Medicaid Services, among others.
The report comes just as the Affordable Care Act, also known as Obamacare, comes into full effect this year. The 2010 law aims to expand access to health insurance and reduce the nation’s health care costs, but it has become a political flashpoint amid a troubled rollout of the federal insurance exchange website.
While the physician’s report does not factor in all of the effects of the law — its grades are based on data from early 2013 — emergency rooms could be used even more as more Americans gain insurance coverage under Obamacare, it said.
Some health experts have predicted that increasing the number of insured patients should reduce pressure on hospital emergency rooms because access to regular doctor care will improve, something that is hoped would prevent chronic conditions from spiraling out of control or help catch other problems before they worsen.
But insurance coverage could also lead those who might have held off going to the emergency room to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University of Maryland who oversaw the group’s report card.
Nation Recalls Simpler Time When Health Care System Was Broken Beyond Repair
WASHINGTON—With the Affordable Care Act now making it possible for a greater number of Americans to purchase medical coverage, the nation looked back this week and fondly recalled a simpler time when its health care system was broken beyond any hope of repair.
Describing a more innocent period in the country’s history—before opponents of the act temporarily shut down the government, and before the disastrous rollout of the new insurance exchanges led to widespread public exasperation—citizens shared with reporters their warm memories of what they called a bygone golden era.
“Back then, if you couldn’t afford health insurance and got really sick, you went bankrupt, plain and simple,” said Dominique Otis, a Modesto, CA mother of three. “They didn’t have this whole mess of lower-cost options, or all these subsidies you might or might not qualify for based on your income. People didn’t have to deal with any of those headaches. They just went ahead and died of preventable causes.”
“Those were the good old days, ya know?” she added with a sigh.
According to nostalgic sources, there was a time when Americans who lost their jobs and the benefits that came with them simply went without insurance, and that was that. During this halcyon age there was reportedly no way anyone who was out of work could afford health care, and if people had a serious preexisting condition, they knew for certain they would never again qualify for decent coverage.
Harkening back to that less complicated past, citizens noted, for example, how parents who had no way to pay for their newborn baby’s much-needed surgery never even bothered getting their hopes up, but simply accepted that their child would never have a first birthday party.
As they spoke with reporters, many Americans reminisced about the comfort they once took in the predictable dysfunction of this status quo.
“When I had esophageal cancer and needed $180,000 worth of treatments not covered by my health plan, I knew immediately I’d lose my house,” said 58-year-old Tobias Czwerda of Braintree, MA, who smiled as he flipped through snapshots of the Christmas he and his family spent in a homeless shelter. “Yes, sir, things were simpler then. You knew in advance that no matter how much you argued with your insurance company, in the end it would always come down to the same two options: pay or die.”
“Call me old-fashioned, but there was something reassuring in that,” he added.
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