Welfare isn’t a dirty word
Posted Feb. 06, 2013, at 11:25 a.m.
As I prepared this column addressing common objections to “welfare,” I wanted to speak to a public figure with strong negative opinions about our human services support system. Because Republicans have been most vocal in their criticisms, I looked to the party’s new chairman. But, after the new voice of Maine’s Republican Party, Richard Cebra, didn’t return my (long) phone message left at his home office, my inquiry via his website, or the letter I sent through the U.S. Postal Service, I resorted to his public comments to get a sense of his opinions.
As I’ve found so common among opponents of programs such as food stamps and MaineCare, Cebra seems to believe “welfare” is the government taking care of people who don’t want to take care of themselves. In his last column for The Bridgton News, he wrote, “Policies geared to free enterprise are increasingly rejected by people, who prefer that government take care of them.” In 2010, he went so far as to say in a radio address, “Those rugged Mainers of yesteryear have been replaced by people who have turned the safety net into a welfare hammock and a way of life.”
Well, just like the typical critics of “welfare,” it appears there are some things he doesn’t understand. First, he is ignoring the fact that government takes care of all of us.
We all benefit from government welfare programs. In fact, it’s right there in the preamble to The Constitution: “Promote the general welfare.” There is no such thing as a self-made man or woman in this country.
If you live in the United States, it would be nearly impossible to not benefit from government handouts paid for by the taxpayers. If you’ve driven on a road, you’ve benefitted from a taxpayer-funded program. Had any food not riddled with E. coli or other foodborne illnesses? Taxpayer funded program. Flushed your toilet, and you don’t have to treat the sewage yourself? That works because of taxes. Firefighters, police officers, emergency rescue workers, the list of benefits we all live with everyday goes on. All of us are living off other people’s taxes.
The second problem is the assumption that people should prefer misery to a higher quality of life. People who work themselves to the bone to try to make ends meet — whose lives are constant struggles filled with fear they will lose everything — but who don’t access what are perceived to be problematic governmental supports are supposed to be models for everyone else?
How does my having the courage to say I need help make me less strong than someone who grinds away at life in misery, unwilling to ask for help? When someone who has gone before tells me they barely made it, couldn’t pay the bills, or lived without a steady home for a long time, it doesn’t make me think, well, gee, then, I should really refuse the help I sought to cover some of the cost of groceries. That person was desperately poor, and I can only imagine the exhaustion and hopelessness they lived with. I should … what, be like that?
Perhaps people with views like Cebra’s need to convince themselves those folks survived on their own, and perhaps telling someone like me that those other people did it without help, and it was difficult, makes them feel better about their political views. I’m sorry the people who haven’t asked for “welfare,” but who might benefit from the support, aren’t brave enough to ask for help. I’m not sorry, however, that I don’t want to spend every day struggling and wondering if I’ll have enough money for rent.
Insurers say health spending on rise in Mass.
WALTHAM — Despite more modest increases in recent years and a state push to hold down costs, the message from health insurance executives gathered here Thursday for a market outlook seminar was clear: Massachusetts health spending is heading up in 2013.
Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year.
Medical cost trend is a mix of what doctors and hospitals bill insurers for care and the volume of services and procedures performed. Over the past five years, health care providers have come under pressure from payers and state officials to charge less, while many people have postponed elective surgeries and other care in a weak economy.
The new projections of accelerating costs are a sobering sign those moderating trends may be fading. The market outlook was discussed at an event hosted by the New England Employee Benefits Council, a trade group for insurance brokers and company benefits managers.
Republican governors embrace part of health-care law
By Sarah Kliff ,
Several Republican governors have embraced a key pillar of President Obama’s health-care law: Extending Medicaid to 17 million Americans.
Many Republicans balked at the expansion when the Supreme Court made the Medicaid expansion optional in its ruling last in the summer. Supporters of the law worried that the opposition could undermine the entire health-care overhaul by shrinking the pool of Americans who would gain coverage.
But six Republican governors have since come to back the program, including Michigan Gov. Rick Snyder on Wednesday and Ohio’s John Kasich on Monday. Arizona Gov. Jan Brewer announced her support in mid-January.
It’s an extraodinary turnaround that suggests the lure of federal dollars could halt Republican obstruction of the health-care overhaul. Twenty-two states and the District are now on board, and 17 others are deliberating. The remaining 11, all with Republican governors, have said no — but observers believe the recent decisions could change some minds.
“It’s a tipping point,” Bill Pierce, a former Health and Human Services official under George W. Bush, said. “You’ve now got a real conservative state, a battleground state and a blue state all signed up. If you’re a Republican governor thinking about this, you fit into one of those categories.”
Since the court’s decision, hospitals and other health care providers have lobbied governors aggressively to expand Medicaid. The providers had accepted billions in cuts to health care reimbursements because they thought they would gain millions of newly insured patients through Medicaid.
They have teamed up with local chambers of commerce and small businesses to argue that states could net a windfall of federal dollars with little investment of their own.
Governors have become increasingly worried about getting their fair share: If they do not extend Medicaid, their federal tax dollars will still foot the bill for expansions in other states. The Obama administration has also gone out of its way to reassure governors that upcoming budget reductions will not derail the program.
“Medicaid cuts for this president are not on the table,” White House senior economic adviser Gene Sperling told a conference of health advocates last week.
Any health law program still remains a tough sell among conservatives and could endanger governors seeking re-election as soon as 2014. Most Republican governors have refused to set up health insurance marketplaces under the Affordable Care Act, including Brewer and Kasich. But because of their positions on Medicaid, the Wall Street Journal’s editorial board recently described those two governors as “Obamacare Flippers” who accepted “Mr. Obama’s Medicaid bribe.”
“This is going to be a serious problem for them if they want to seek higher office,” Michael Cannon, health policy director at the libertarian Cato Institute, said. “It doesn’t matter if they say ‘I don’t consider this Obamacare.’ Their base does, and their base really dislikes this law.”
The Medicaid expansion will begin to cover everyone below 133 percent of the Federal Poverty Line – $11,170 for an individual – in 2014. If all states were to participate in the Medicaid expansion, the Congressional Budget Office estimates it will cover 17 million Americans by 2022.
“The logjam has broken,” Ron Pollack, executive director of Families USA, said. “When you have a governor like Kasich getting to yes, you have a critical mass.”
Le Page Appoints Critic to Dirigo Board
Posted Feb. 07, 2013, at 6:23 p.m.
AUGUSTA, Maine — Gov. Paul LePage has nominated a vocal opponent of the state’s Dirigo Health program to sit on its board of trustees as the health care program launched by his predecessor, Democrat John Baldacci, winds down in the coming year.
LePage this week chose Jonathan McKane of Newcastle, a Republican who served four terms in the Maine House, to serve on the Dirigo Health board.
LePage also nominated former Rep. Wesley Richardson, R-Warren, who served with McKane in the House, and renominated current board member Gary Reed of Falmouth. In addition, he chose another recently departed Republican legislator, former Bangor Sen. Nichi Farnham, to serve on the State Board of Education.
“I was probably one of the biggest opponents of Dirigo,” said McKane, whose time in the Legislature ended last year. “I didn’t see it as a well thought-out plan. There wasn’t really a good, sound business plan in the beginning.”
Dirigo Health, a signature initiative of Baldacci’s first term as governor, started in 2003 as an effort to make insurance coverage more affordable for small groups and individuals. Its mission originally was to make low-cost coverage available to all Maine residents by 2009. Today, the program offers coverage through Harvard Pilgrim Health Care, and some of the plan’s participants qualify for subsidies. The plan covered about 16,500 people in November 2011.
On the campaign trail and after taking office as governor, LePage opposed the program, and the Republican-led Legislature in 2011 phased out the funding mechanism for the program’s subsidies. Dirigo Health is funded largely through assessments charged to insurance companies on paid claims, and that funding stream is scheduled to dry up by the end of the year.
Dirigo Health also operates the Maine Quality Forum, the program’s research arm whose mission is to collect data on health care quality in Maine and disseminate best practices in health care.
“We did get some positive things out of Dirigo,” McKane said, referring to the Maine Quality Forum, which is funded in the same way as the program’s subsidies. However, “I don’t see how we could continue to fund that, but you never know.”
McKane’s nomination will go before the Legislature’s Insurance and Financial Services Committee — the panel on which he served while in the Legislature — before it goes to the Senate for confirmation. He’s likely to face some resistance from the committee’s Democrats.
“It’s an interesting nomination to say the least,” said Rep. Sharon Treat, D-Hallowell, the committee’s House chairwoman. “Certainly, Rep. McKane did spend about his entire career in the Legislature opposing Dirigo Health and pursuing efforts to undermine or end it. I’m sure that the committee will have many questions for him.”
Obamacare: not all employers have to offer a plan
Will hourly employees get medical insurance with the health reform changes? Right now, my employer gives the salaried people health insurance but not the hourly people. Most of the hourly people are like me and work anywhere from 25 to 40 hours a week, depending on the workload. I’d love to get onto their plan! I’ve been without coverage for over a year now.
Working Hard, Going Bare
Dear Working Hard, Going Bare,
For health reform, whether you are hourly or salaried does not matter. It is the size of the company that makes the difference. Employees will get group medical insurance if they are at companies with 50 or more employees and work 30 hours per week for at least 120 days a year. This is the “employer mandate” part of the health reform law.
Employees at smaller companies might also be offered a health plan, but smaller companies are not required by health reform to do so. The same is true for part-timers: some employers may offer part-timers coverage, but it is not required.
Regardless of employment,
Dr. Andy Coates: Health care is a social responsibility
The following is an excerpt from an unofficial transcript of a Jan. 28 telephone interview with Dr. Andrew Coates, president of PNHP and internist in Albany, N.Y., conducted by Dr. Margaret Flowers and Kevin Zeese on their radio show “Clearing the FOG” on We Act Radio, 1480 AM, in Washington, D.C. The program is also streamed at WeActRadio.com. The text below has been slightly edited for clarity.
Dr. Margaret Flowers: Our next guest is Dr. Andy Coates, president of Physicians for a National Health Program. He was recently featured in an article in the Buffalo News in an article titled “Doctor sees shift to single-payer health care.” Good morning, Andy.
Dr. Andrew Coates: Thank you for having me.
Dr. Flowers: In the Buffalo News article you talk about a person who left the hospital early despite having a serious problem. Can you talk about the concept of self-rationing that exists in the United States?
Dr. Coates: We have an incursion, first of all, of high-deductible private health insurance plans. People will pay $1,000, $2,000 even $5,000 out of pocket before their insurance kicks in. And if you think about the median income being in the $40,000 per year range for the average household, you can see the problem.
Dr. Coates: We have an incursion, first of all, of high-deductible private health insurance plans. People will pay $1,000, $2,000 even $5,000 out of pocket before their insurance kicks in. And if you think about the median income being in the $40,000 per year range for the average household, you can see the problem.
And then if you think about poor households – like here in New York state, where the middle of the bottom half is somewhere around $14,000 per household, a shockingly low number – the problem is extreme. In upstate New York cities such as Buffalo and Schenectady, we have a third or more – huge numbers – of children living in poverty.
So in view of out-of-pocket costs for health care going up and up and up, all the time now when we discharge people from the hospital we have to think about exactly how much the prescription is going to cost. It could easily be more than a week’s wages just for an antibiotic prescription, for example. And we have chronically ill people who we know are on six, eight medications.
All of those out-of-pocket costs discourage people from getting care. And there are studies to prove it. The randomized control trial that is famous was the RAND study of co-pays, which showed people avoid necessary care when they have to make out-of-pocket payments. But there are oodles of other studies that show co-pays, deductibles, coinsurance – all those things are impediments to care.
As I was thinking about today’s show, I looked at Franklin D. Roosevelt’s second inaugural address, and I just wanted to share with you these five lines or so.
“Here is the challenge to our democracy: In this nation I see tens of millions of its citizens — a substantial part of its whole population — who at this very moment are denied the greater part of what the very lowest standards of today call the necessities of life.
“I see millions of families trying to live on incomes so meager that the pall of family disaster hangs over them day by day.
“I see millions whose daily lives in city and on farms continue under conditions labeled indecent by a so-called polite society half a century ago.
“I see millions denied education, recreation, and the opportunity to better their lot and the lot of their children. …
“I see one-third of a nation ill-housed, ill-clad, ill-nourished.”
“I see millions of families trying to live on incomes so meager that the pall of family disaster hangs over them day by day.
“I see millions whose daily lives in city and on farms continue under conditions labeled indecent by a so-called polite society half a century ago.
“I see millions denied education, recreation, and the opportunity to better their lot and the lot of their children. …
“I see one-third of a nation ill-housed, ill-clad, ill-nourished.”
This was in 1937. If you think about the pressure that came to bear on that White House and the frank recognition of poverty in these words, it’s a striking contrast to what we have today.
The Universal Notebook: Nothing healthy about health insurance
Monday, February 4, 2013 at 12:30 pm
Folks on the far-right fringe – tea partiers, libertarians, secessionists, etc. – were in open revolt against Obamacare until the Supreme Court told them what the rest of us already knew: the individual mandate is completely constitutional. While they were complaining that President Obama had gone too far this time, I was thinking he hadn’t gone near far enough. What we really need in this country is universal single-payer health care.
Health care, like education, should not be a business. It’s also not a privilege, as the privileged few seem to think, but a right. There’s no reason anyone should profit from illness, least of all the corporations that profit most – insurance companies. We don’t need to get the government out of the health care, we need to get private insurance companies out of the market.
Like his father before him, my father sold life insurance for many years. The fact that at 89 he doesn’t have any himself is instructive. First lesson: insurance salesmen generally don’t know any more than you do about how insurance really works. Second lesson: there’s a good chance your insurance company is going to screw you.
After my father suffered a series of strokes, I set about to put my parents’ financial affairs in order. I discovered in the process that they were paying premiums on a decreasing term policy that had a cash value less than what they had paid in over the years. To make matters worse, it was the Veterans Administration that had sold him the policy.
When I asked the VA to explain how they could treat a veteran of World War II and Korea that way, I was told that my father could have converted to whole life at any time, but chose not to do so. The truth is that he and my mother had no idea what was going on with that policy, which is why I find the conservative proposals to turn Medicare into a voucher system so hateful. Too many Americans would buy the wrong product and end up worse off than they are now.
Being American Is Bad for Your Health
February 7, 2013 |
"Americans are sicker and die younger than people in other wealthy nations."That stark sentence appears [3] in the January 2013 issue of the Journal of the American Medical Association, and it comes from the authors of a landmark report [4] -- "Shorter Lives, Poorer Health" -- on differences among high-income countries.
You probably already know that America spends more on health care than any other country. That was one of the few facts to survive the political food fight pretending to be a serious national debate about the Affordable Care Act.
But the airwaves also thrummed with so many sound bites from so many jingoistic know-nothings claiming that America has the best health care system in the world that today, most people don't realize how shockingly damaging it is to your wellness and longevity to be born in the U.S.A.
This is made achingly clear in the study of the "U.S. health disadvantage" recently issued by the National Research Council and the Institute of Medicine, which was conducted over 18 months by experts in medicine and public health, demography, social science, political science, economics, behavioral science and epidemiology.
Compare the health of the American people with our peer nations -- with Britain, Canada and Australia; with Japan; with the Scandinavian countries; with France, Germany, Italy, Spain, Portugal, Austria, Switzerland and the Netherlands. Side by side with the world's wealthy democracies, America comes in last, and over the past several decades, it's only gotten worse.
With few exceptions -- like death rates from breast cancer -- we suck. Our newborns are less likely to reach their first birthday, or their fifth birthday. Our adolescents die at higher rates from car crashes and homicides, and they have the highest rates of sexually transmitted infections. Americans have the highest incidence of AIDS, the highest obesity rates, the highest diabetes rates among adults 20 and older, the highest rates of chronic lung disease and heart disease and drug-related deaths.
There is one bright spot. Americans who live past their 75th birthday have the longest life expectancy. But for everyone else -- from babies to baby boomers and beyond -- your chances of living a long life are the butt-ugly worst among all the 17 rich nations in our peer group.
http://www.alternet.org/print/personal-health/being-american-bad-your-health
Long-awaited stroke studies show hopeful new treatment no better than older one
By David Brown,
Three long-awaited studies have shown that mechanically removing a blood clot from a stroke patient’s brain is no more useful than the older treatment of giving an IV dose of a clot-dissolving drug to the whole body.
The results of the clinical trials, presented this week at a meeting in Hawaii, shocked and surprised stroke physicians. Many had already adopted the more aggressive strategy over the past decade.
“For the stroke field, this is a really big deal,” Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, said of the findings, which were presented over three days at the International Stroke Conference in Honolulu.
NINDS paid for two of the trials, one of which cost $27 million. One study took eight years to complete because it was so difficult to enroll patients willing to take the chance that they would be randomly assigned to get the older treatment.
Practitioners hoped that “endovascular treatment,” in which a catheter is threaded into a blocked artery and the clot pulled out, would do for stroke patients what it has done for heart attack patients. In them, going after clots with angioplasty balloons and stents is clearly more effective than giving clot-dissolving drugs through a vein in the arm.
“We did this study with the strong expectation that we would find a positive benefit. We were surprised,” said Joseph P. Broderick of the University of Cincinnati Neuroscience Institute, who headed one of the studies.
His view was echoed by Alfonso Ciccone, a neurologist from Milan who led a clinical trial in Italy: “We were surprised. We wanted the superiority of endovascular treatment.”
Whether the findings will cause physicians to abandon the practice is uncertain.
A delicate new balancing act in senior healthcare
Cedars-Sinai has launched the 'frailty project,' in which a medical team works to help at-risk elderly avoid lengthy hospital stays or readmission. The federal healthcare reform law is a driving factor.
By Anna Gorman, Los Angeles TimesFebruary 9, 2013
When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.
She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.
Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.
The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.
"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."
At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.
The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.
"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.
Medicaid expansion divides GOP governors
Foes of President Obama's healthcare law have tried to unite Republican governors against its Medicaid expansion — but now some are welcoming the change and the federal money it offers.
By Paul West, Washington Bureau5:19 PM PST, February 7, 2013
WASHINGTON — Some of the nation's most prominent Republican governors have moved to embrace a key feature of President Obama's healthcare law, providing a significant boost to the administration and highlighting a fissure inside the GOP on an emerging campaign issue.
At stake is the goal of expanding health insurance under the Medicaid program, one of two main ways the law is to provide coverage to those who lack it. Starting in 2014, the law broadens Medicaid to cover people who earn up to about $15,500 a year, but under last year's Supreme Court decision upholding the law's constitutionality, states have the option of rejecting the expansion and the federal money that comes with it.
Opponents wanted to unite all Republican governors against participating in the Medicaid expansion; they have lined up 15, including Rick Perry of Texas and Bobby Jindal of Louisiana. Opposition in Republican states means the law will probably cover about 5 million fewer people in the first few years than originally expected, the Congressional Budget Office reported this week.
The opposition governors say that despite the federal promise to pay the full cost of expansion for the first three years and 90% thereafter, the change eventually could lead to unsustainable costs.
But the unified strategy has begun to crack in recent days. This week, GOP Govs. John Kasich of Ohio and Rick Snyder of Michigan announced they would support the expansion, bringing the number of Republicans in favor of it to six.
With governors in several major states yet to be heard from, conservatives have attacked those who are backing the Medicaid expansion, accusing them of putting political expediency ahead of the GOP's small-government principles.
"Kasich is up for reelection, and he wants to win, and he is simply judging where the people of his state are," Rush Limbaugh said on his radio show. "He's reading tea leaves. Other governors are doing the same thing."
http://www.latimes.com/health/la-na-medicaid-20130208,0,722009,print.story
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