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Thursday, October 16, 2014

Health Care Reform Articles - October 16, 2014

Think about your health when you vote in November

By Dr. Philip Caper, Special to the BDN
Posted Oct. 16, 2014, at 10:15 a.m.
Elections matter. And when it comes to health care, the upcoming election on Nov. 4 will matter a lot. This seems an appropriate time to take stock of where we stand.
I strongly believe in health care with dignity for everybody. When I took the Hippocratic Oath, I swore to put the patient first. That means treating people according to their medical needs, not their employment status, net worth, place of employment, age, gender, lifestyle or where they happen to live.
The United States spends more on health care — about 50 percent more — than any other wealthy country. Despite continuing to pour more and more money into health care,we still rank behind those countries on infant mortality, life expectancy, health care quality and access to needed care. The fact that we continue to do so every year tells us we need new thinking.
Where is all that money going? According to the Institute of Medicine, we in the U.S. waste $750 billion a year on our broken health care system.
The Affordable Care Act is a first step in trying to repair it. Offering federal subsidies for private insurance, expanding Medicaid and neighborhood health centers and regulating insurance industry abuses are important advances. We shouldn’t toss them aside. Repealing the ACA, as many conservatives propose, would be a disaster for Maine and for the country — unless we replace it with something better.
The ACA is in some ways a step forward, but it is not enough. Even with greatly expanded coverage, too many Americans will not see the benefits they would with a universal health care system.
Maine is the only state in New England that has failed to expand Medicaid and is one of just two states in the country where the number of people without health insurance increased in 2013. Expanding MaineCare would cover an additional 70,000 Mainers at almost no cost to the state and would inject nearly $1 million a day of federal revenue into our economy. Failure to do that — because of Gov. Paul LePage’s vetoes, sustained by Republicans in the Legislature — has cost the people of Maine more than $300 million so far.
We can do much better than that. We need a simpler, less expensive system that includes everybody. We already have such system for seniors — it’s called “Medicare.” When Medicare was implemented by the federal government in 1965, 19 million people were enrolled within nine months, using index cards. There were no software glitches, no crashing websites and little confusion. There was no need to re-enroll every year. Once people are enrolled in Medicare, they stay in it for life.
We need to extend the benefits of Medicare to every Mainer and to every American. There are two ways we can accomplish this.
Congress could pass a new law expanding Medicare. There are bills in the House and the Senate that would do that. But we don’t need to wait for new national legislation. There is another way.
Starting in 2017, existing federal law allows individual states to design their own health care reform if it provides at least as many benefits at no greater cost. No more exchanges, mandates on businesses and individuals to buy private insurance, or hard-to-enforce tax penalties.

Scarier Than Ebola

OCT. 14, 2014

We Americans do panic really well.
We could use a few pointers on prudence.
Do me a favor. Turn away from the ceaseless media coverage of Ebola in Texas — the interviews with the Dallas nurse’s neighbors, the hand-wringing over her pooch, the instructions on protective medical gear — and answer this: Have you had your flu shot? Are you planning on one?
During the 2013-2014 flu season, according to the Centers for Disease Control and Prevention, only 46 percent of Americans received vaccinations against influenza, even though it kills about 3,000 people in this country in a good year, nearly 50,000 in a bad one.
These are deaths by a familiar assassin. Many of them could have been prevented. So why aren’t we in a lather over that? Why fixate on remote threats that we feel we can’t control when there are immediate ones that we simply don’t bother to?
On matters exotic, we’re rapt. On matters quotidian, which are nonetheless matters of life and death, we’re cavalier. Tens of thousands of Americans die in car crashes annually, and according to a federal analysis from 2012, more than half of them weren’t wearing seatbelts.
Perhaps that didn’t make a difference in many cases. In some, it probably did. But on this front, as on others, we have clear answers about how to minimize risk and we simply proceed to forget or ignore them.
There’s no way to square skin-cancer statistics in the United States — more than 3.5 million cases diagnosed yearly and almost 10,000 deaths — with the number of Americans showing off their tans. They aren’t all getting body paint. They’ve been lectured about sunscreen and shade and hats. But vanity trumps sanity, and melanoma rides its coattails.
I’m not dismissing the horror of Ebola, a full-blown crisis in Africa that should command the whole world’s assistance. And Ebola in the United States certainly warrants concern. We’re still searching for definitive answers about transmission and prevention.
But Americans already have such answers about a host of other, greater perils to our health, and we’d be wiser to reacquaint ourselves with those, and recommit to heeding them, than to worry about our imminent exposure to Ebola.
http://www.nytimes.com/2014/10/15/opinion/frank-bruni-scarier-than-ebola.html?emc=edit_tnt_20141014&nlid=1311158&tntemail0=y&_r=1

With Electronic Medical Records, Doctors Read When They Should Talk

By 
Will history someday show that the electronic medical record almost did the great state of Texas in?
We do not really know whether dysfunctional software contributed tolast month’s debacle in a Dallas emergency room, when some medical mind failed to connect the dots between an African man and a viral syndrome and sent a patient with deadly Ebola back into the community. Even scarier than that mistake, though, is the certainty that similar ones lie in wait for all of us who cope with medical information stored in digital piles grown so gigantic, unwieldy and unreadable that sometimes we wind up working with no information at all.
We are in the middle of a simmering crisis in medical data management. Like computer servers everywhere, hospital servers store great masses of trivia mixed with valuable information and gross misinformation, all cut and pasted and endlessly reiterated. Even the best software is no match for the accumulation. When we need facts, we swoop over the surface like sea gulls over landfill, peck out what we can, and flap on. There is no time to dig and, even worse, no time to do what we were trained to do — slow down, go to the source, and start from the beginning.
On the hospital wards, mixed messages abound. A couple of months ago, I was on the receiving end of a furious, expletive-laden outburst from one sick patient, the printable fraction of which ran, “Can’t you people read?”
This man had by then recounted the long story of his bad leg to three separate teams of doctors and nurses. I was the 14th interrogator by my count, and despite my standard opening gambit (“I know you’ve been over this before”) I was the one to flip his switch: The patient ordered me and my team out of his room and pulled the covers over his head.
Who can blame him for assuming that in this day and age, once told, his story needed only to be retweeted. But medical care requires dialogue. Although we plucked some information from the glut of words in his chart and cobbled together a plan, we didn’t do him justice, not by a long shot.

An expert's heroic fact-checking of Mitch McConnell on Obamacare

Michael Hiltzik

LOS ANGELES TIMES
nate Minority Leader Mitch McConnell (R-Ky.), who is facing a stiff reelection challenge this year, has stuck to his stated determination to repeal the Affordable Care Act if his party takes control of the Senate in the next election.
This is a curious and delicate position for McConnell to hold, because his home state is one of the shining beacons of the ACA's rollout. The Kentucky health insurance exchange, Kynect, is enormously popular among Kentuckians. Some 527,000 residents have signed up for qualified health plans or Medicaid, which the state expanded.
Much of the credit belongs to Democratic Gov. Steve Beshear, so don't expect much acknowledgment from McConnell. Still, the extent to which McConnell twisted facts and figures on the ACA during his debate Monday with challenger Alison Lundergan Grimes amazed knowledgeable observers, perhaps none more than Charles Gaba, proprietor of the indispensable ACASignups website.
So Gaba sat down to fact-check every misstatement. He identified 13 uttered during about a five-minute discussion of the ACA, plus about 14 "questionable/confusing statements by either him or the moderator." Many of the misstatements -- heck, call them lies, as Gaba does -- are part of discredited Republican attacks on the ACA going back years; what's shocking is that McConnell is still hauling them out.


California will cancel Obamacare coverage for 10,000 over citizenship
California's health insurance exchange is canceling Obamacare coverage for 10,474 people who failed to prove their citizenship or legal residency in the U.S.
Covered California, the state-run insurance exchange, enrolled more than 1.2 million people during the rollout of the Affordable Care Act this year. For most consumers, the exchange said, it could verify citizenship or immigration status instantly with a federal data hub.
But more than 148,000 enrollees were lacking proof of eligibility and needed to submit documentation. People living in the U.S. illegally aren't eligible for health law coverage.
Covered California began sending notices to affected individuals last month.
The exchange said 130,105 people submitted proof of legal status. Covered California said it's still reviewing information related to 7,629 people who sent in paperwork.
That left the 10,474 people who will receive a "pre-termination notice" this week. Their health plan will send a final cancellation notice.
Peter Lee, executive director of Covered California, said there's still time for those individuals to provide proof of residency.
"We are hopeful that anyone receiving these notices will respond by providing appropriate documents so we can work with them to ensure their ongoing eligibility for health coverage," Lee said.
"Our goal is to continue coverage for anyone who is lawfully present," he added.
Covered California is gearing up for its second open enrollment period starting Nov. 15. It will run until Feb. 15.
Customer service at Covered California's call centers has suffered in recent weeks as workers were pulled away to deal with these residency verification issues.
Consumer advocates had pressed the exchange to communicate clearly in its notices and include information in multiple languages.

Maine Hospitals See Price Increase for Specialty Cancer Drugs

By 
A new change in the way three of the most commonly used cancer drugs are distributed could cause new headaches for hospitals and their patients. In addition, hospitals are losing discounts that were previously available to them. And that means a hefty price tag.
The drugs — Avastin, Herceptin, and Rituxan — are considered blockbusters in cancer care. Brian Marden, senior director of pharmacy at Maine Medical Center, says they're used in about half of cancer treatments nationwide.
"For these 3 drugs, they dominate the market, and there's no competitor," he says
And when Marden crunches the numbers, he says the cost of the new distribution policy for MaineHealth — which includes multiple hospitals in the southern part of the state — is about $450,000 a year.
"So, significant cost, which ultimately gets passed along to consumers and payers," Marden says.
In the past, Maine Medical Center ordered the cancer drugs from a distributor in Massachusetts that gave it discounts under a base agreement. But in mid-September, drug maker Genentech announced it would limit distribution from about 80 centers nationwide down to six. Now Maine Medical Center has to order from a specialty distributor in Tennessee. What used to show up at the hospital's pharmacy within a day of ordering now takes longer, travels through more channels and leaves more chance for error for the refrigerated drugs, Marden says.
"Genentech says this is about protecting product integrity, I actually think it might be putting more risk when it leaves the distribution facility," he says.
The clinical manager of the pharmacy department at Eastern Maine Medical Center, Jamie Cronin, says the hospital was already getting the cancer drugs from one of the designated specialty distributors. But the change severely limits the hospital's choice.
"It's likened to, you know, I tell you you have to shop at Hannaford, and you say, 'Well, no big deal, I don't care. I shop at Hannaford anyway.'" Cronin says. "Well, maybe two weeks from now, Whole Foods comes into town and you say, 'I want to shop at Whole Foods,' and we're like, 'No you can't. You have to shop at Hannaford whether you like it or not.'"

In debate, LePage misses reality of his MaineCare vetoes

by Amy Fried
In last night’s governor’s debate, Rep. Mike Michaud used his one chance to ask another candidate a question to say to Gov. Paul LePage, “Governor, someone is watching us right now, is going without life-changing medication because of your five vetoes. Would you be able to look into the camera and tell those people why they were too costly to care [for]?”
In responding, LePage incorrectly claimed that his vetoes didn’t stop anyone from getting health coverage.
LePage said that people who wouldn’t be getting MaineCare because of his vetoes could all get subsidized private insurance through the exchange.
That’s not true.
LePage’s five vetoes not only meant that some can’t gain coverage, but his choices also led to some losing health insurance.
As Kaiser Health News reported about a Northport woman:
By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare. . .
[W]hile much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan. 1, just as the Affordable Care Act was being rolled out nationwide, MaineCare terminated her coverage, leaving her and thousands of others without insurance. . .
“It’s nerve-wracking,” said Tasheiko, who like many working poor in this rugged state makes ends meet by raising laying hens, heating her home with a woodstove and eating and canning vegetables she raises in her garden. “Cancer doesn’t just stop — it’s not over. But my health coverage is over.” [source]
There are real human consequences to LePage’s actions that he either doesn’t know about or isn’t acknowledging.


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