|
|
A checks-and-balances kind of thing...
Monday, February 08, 2010
Assembly Budget Committee Chair Noreen Evans (D) and others assailed the administration Monday for making cuts to a breast cancer screening program for low-income women against the Legislature’s wishes. The Department of Public Health in December decided to reduce access to the “Every Woman Counts” early detection program by freezing enrollment until June 2010, and limiting enrollment to only women 50 and older. For the past decade, the program had offered annual breast cancer screening to low-income women who lacked health insurance and were at least 40 years old. Statewide, 1.2 million are eligible for the program through about 1,000 locations, including community health clinics. The program served 249,000 in fiscal year 2006-2007; 270,000 in fiscal year 2007-2008 and then 310,000 in 2008-2009. With the demand increasing, however, the Schwarzenegger Administration decided to shift some EWC funding to other programs, thus freeing up some money to help plug the growing budget deficit. This was done even though the Legislature had rejected the cutbacks outlined by the administration during budget negotiations after the governor submitted his May spending-plan revision. At a hearing well-attended by breast cancer survivors and supporters, an irked Evans told bureaucrats that “It’s unacceptable to me that these screenings won’t take place…In my opinion, we’ve had way too much testosterone in the budget talks….and enough of the macho knife-waving, alpha-male politicians in the process. How many Californians will have to die for budget negotiators to see it’s time for us to grow up?” Despite having been told by Evans that the planned program cutbacks would not be approved by the Legislature, the Department of Public Health “suddenly and surprisingly changed” the program, Evans said. Assemblyman Hector de la Torre (D) added, “The administration is not allowed to run around making unilateral decisions. There is a checks-and-balances thing going on here.” A round of applause broke out in the hearing room after Assemblyman Sandre Swanson (D) said the cutbacks in services would cause greater expenditures in the final analysis, as women get sicker and require extensive treatment. “You’re just shoving these costs off onto other programs – and you are costing lives, too.” Several medical experts and community providers testified that women who are diagnosed with breast cancer in their 40s are more likely to have aggressive forms of the disease and therefore need early detection to survive. Many also testified that the age-group accessing services through Every Woman Counts are more likely to be women of color with few economic resources. The hearing came after a bake sale held by Evans, other legislators and breast cancer awareness representatives to raise money and awareness about the program cutbacks. Following the hearing, a large rally was held outside, where several other legislators, including Senate President Pro Tem Darrell Steinberg, declared their opposition to the cuts and support for restoring the program. The rally ended with the Capitol being bathed in pink light, a color of significance for breast cancer survivors. Meanwhile, two bills -- with a third likely to come -- have been proposed to reinstate the program, Evans said. Labels: Budget, Legislation, Prevention
posted by Cynthia Craft |
Permalink |
6:04 PM
a
Health insurance reform: The first step in health reform
Thursday, September 10, 2009
Earlier this year, I participated on a panel at the conference of the California Pan-Ethnic Health Network, where I, as an advocate for health access and coverage, was supposed to "debate" public health advocates, about which is more important. It was a debate that neither side engaged, because we recognized it to be a false choice: both are important. That said, I tried to make the point that for those interested in actually improving the health of Californians, health insurance reform wasn't a solution but a necessary foundation. Health insurance reform is more about our families' economic health than their medical health. But if we make the societal commitment to universal health care, and make changes to the incentives in the medical system, then suddenly we have a basis to actually build healthier communities and society. Writing in the New York Times, Micheal Pollan, the noted writer on food issues, makes the point better than I did. Here are excerpts,with emphasis added: That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry...
We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.
The American way of eating has become the elephant in the room in the debate over health care... But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet...
As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.
But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change. The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.
When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.
...But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind....
In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda...
...All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.
But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.
For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.
Labels: Prevention, YearOfReform
posted by Anthony Wright |
Permalink |
3:52 PM
a
Healthier from health reform?
Saturday, September 05, 2009
Does expanding health coverage actuall improve people's health?This is not as obvious an answer as you might think. Frankly, health reform is more about improving our economic health, rather than their personal health. Health care and coverage often comes after people are sick... it ensures that people get care but also that they don't fall into medical debt or bankruptcy for seeking such care. The focus of H.R.3200 and other health reform proposals is to provide economic security to families. That said, the Wall Street Journal Health Blog had a revealing post a few weeks ago that does give a few concrete examples of how these health reforms can actually help our health. They interviewed John Auerbach, the commissioner of Massachusetts’s Department of Public Health. He gave a few indicators he's watching. In particular, he cites three pieces of data as short-term indicators:
1) Smoking rates: In the first year of the effort that started in 2006 to get all residents insured, there was a surge in people covered by Medicaid, which pays for smoking cessation patches and counseling. Some 11% of smokers on Medicaid choose to take advantage of cessation tools that year. In 2007, Massachusetts saw an 8% drop in adult smokers, its largest dip in 10 years. In addition to having the patches paid for, Auerbach believes that a number of recently insured adults received a physical in that year and discussed smoking cessation with their docs.
2) Colonoscopies: There was a statistically significant increase in age-appropriate colonscopies in the state. “If you’re uninsured, you’re not going to get a colonscopy,” Auerbach said.
3) Flu vaccines: The percentage of adults who received a flu vaccine increased above and beyond the increases the state had been seeing in recent years. The largest percentage of vaccines are given in private doctors’ offices, so it makes sense that if more people are going to their primary care docs, the more likely they would be to receive a flu shot, according to Auerbach. I have a sense there are many more health benefits to health reform--on top of the economic benefits--especially as time goes on. (And the two are intertwined--in people have less economic anxiety, and are not driven into poverty because of medical costs, that will have health benefits as well.) But those are good initial indicators about why this effort is so important. Labels: OtherStates, Prevention, YearOfReform
posted by Anthony Wright |
Permalink |
10:02 AM
a
Don Draper's health reform...
Monday, August 17, 2009
 The big TV event this weekend was the season premiere of Mad Men, the AMC show that depicts the life of New York advertising executives and their families in the early 1960s. It is smartly written and filmed to highlight the differences in everything from fashion to gender relations. Guest New York Times columnist Timothy Egan made a fascinating contribution about the changes in public health:
My parents and their friends were nicotine fiends, the women smoking even during late pregnancy. The high point of tobacco addiction was around 1964, when 42 percent of adults smoked. Today, the figure is less than 20 percent — a modern low.
I remember rattling around inside a station wagon filled with secondhand smoke. No seat belts, of course. And after the ride, we 6-year-olds reeked of Lucky Strikes.
Now, smokers are such pariahs that the actors on the set of “Mad Men” can’t even puff real cigarettes; they have to use herbal ones, or run afoul of the law.
If a driver of that station wagon had a drink or two before getting behind the wheel, so what? Drunken driving was a respected social skill. Last year, 11,773 Americans died in accidents involving drunken driving — tragically high, but down by more than 50 percent from a generation ago.
Roger Sterling, the silver-haired sybarite in the “Mad Men” ad agency, suffered a major heart attack, telegraphed from his first three-martini lunch. Today, coronary heart disease is still the leading cause of mortality in the United States, but the death rate from heart attacks is down 72 percent since 1960.
The brooding, unfathomable ad man at the center of the show, Don Draper, has high blood pressure. When his doctor asks how much he’s boozing, he admits, after some hesitation, to five drinks a day. He also has sexual problems, unable to match the passion of his stunning wife, a Grace Kelly look-alike who is a shrink session away from going full Betty Friedan.
...Is all of this progress, a march toward a more tolerant, equitable, less socially inauthentic society? Sure. Plus, Don Draper would have Lipitor for his heart and Viagra for his sexual troubles. For a show in the 1960s, explicit politics and policy is only in the background on the show--in the premiere on Sunday, the only reference was to an ad executive bemoaning the 60%+ upper-income tax brackets of the day. And the serious health care issues that led to the passsage of Medicare and Medicaid in the late 60s are not shown. But there's a lot here to inform our health reform debate. It's a useful reminder about the significant progress that there has been in not just sexual politics, but in the realm of prevention and public health: * Tobacco control, which has included taxation, limiting its use in public spaces, medical research, educating young children, litigation, major public awareness efforts, and the overall changing of social mores. * Drunk driving reductions through changes in law and increases in penalties and enforcement, as well as a major public education effort that includes changing its social acceptability. * Seat belts took a combination of ensuring that they were provided as standard in cars, and then a variety of public education strategies to get people to use them. These things, by themselves, have saved untold lives and increased are life expectancy. Like the cause of gender and racial equality, these didn't happen overnight or without struggle. Each of these efforts were long, concerted, multi-year, multi-pronged campaigns by many players. And it's not over yet: For example, while the three martini lunch may not be as prevalent, we may not have some to terms with the full health impact of alcohol, so there is more work to do for groups like the Marin Institute. The current conversation on health insurance reform, as the President not calls it, is less about people's health, and more about the health of their finances, and the health of the economy. That's not a bad thing: it's essential to prevent people who go bankrupt for medical reasons, or to remove the economic insecurity that so many people feel when they need care, either for age or accident. There are elements of the reform bills that focus on prevention, doing more research, focusing on public health efforts, and making sure that there are no financial barriers to screening and preventative care. Here's a prevention fact sheet on H.R.3200: Beyond the policy specifics, my hope is that once we finally make a public policy commitment for quality, affordable health care for all, that such a changes creates a platform and investment to move toward a healthier environment and society. So I can imagine another form of entertainment 50 years from now, where our current technology looks quaint, our fashion looks sophisticated, our music is nostalgic, and some of our current diet and lifestyle choices, as well as current policies and industry practices, look as unhealthy and silly as the smoking and drunk driving scenes in Mad Men today. Labels: InTheNews, Prevention
posted by Anthony Wright |
Permalink |
11:38 PM
a
The Governator's health reform letter...
Saturday, August 01, 2009
There was a time when Governor Arnold Schwarzenegger had significant national attention and credibility on health care issues, as a Republican leader who had proposed a serious health reform proposal. But he showed little ability to bring Republicans along with him in California, so it was unclear how he would fare in DC. And that was before he cut Medi-Cal benefits and savaged the Healthy Families program, denying coverage to hundreds of thousands of children. The notion that he is the "health care governor" now seems a cruel joke. It's remarkable that given his record, Governor Schwarzenegger decided to weigh in on the health reform discussion anyway. Here's the Governor's letter in full in italics... and some annotation and commentary exploring the full contradictions of the Governor, where he can be absolutely right on and amazingly wrong-headed in the same breadth. July 31, 2009
Dear Senator Reid, Senator McConnell, Madam Speaker and Mr. Boehner,
I appreciate your commitment and hard work toward reforming the nation’s health care system. I think we can all agree that the current system is not working as it should, and I have long supported a significant overhaul. Costs continue to explode, while tens of millions remain uninsured or underinsured. Many families are one illness away from financial ruin - even if they do have insurance. We have the greatest medical technology in the world at our fingertips, yet Americans’ health status lags behind many countries that spend less than half what we do per capita. Any successful health care reform proposal must be comprehensive and built around the core principles of cost containment and affordability; prevention, wellness and health quality; and coverage for all. Here, the Governor makes an impressive and important case for health reform, as he did in 2007, and reiterates the same talking points as he did back then. It's like its 2007 all over again. Cost Containment and Affordability
Cost containment and affordability are essential not only for families, individuals and businesses, but also for state governments. Congress is proposing significant expansions of Medicaid to help reduce the number of uninsured and to increase provider reimbursement. Today, California administers one of the most efficient Medicaid programs in the country, and still the state cannot afford its Medicaid program as currently structured and governed by federal rules and regulations. The House originally proposed fully funding the expansion with federal dollars, but due to cost concerns, members decided to shift a portion of these expansion costs to states. I will be clear on this particular proposal: if Congress thinks the Medicaid expansion is too expensive for the federal government, it is absolutely unaffordable for states. Proposals in the Senate envision passing on more than $8 billion in new costs to California annually - crowding out other priority or constitutionally required state spending and presenting a false choice for all of us. I cannot and will not support federal health care reform proposals that impose billions of dollars in new costs on California each year.
In the sharpest part of the letter--and perhaps the real point--the Governor is reacting to a change in the House bill demanded by the "Blue Dogs" to lower the cost of the health reform bill, by having the states' pick up a small percentage of the Medicaid expansion, rather than take on the full cost of that expansion. The Governor has a valid point on the policy: it is preferable for the federal government to fund the cost of health expansions in Medicaid, even though most of the program now is a state-federal partnership. The federal government has the funding flexibility that states do not have, especially during tough economic times when state revenues are down but the need for such safety-net services increase. States who had to put up even a portion of the match may simply not do the expansion. That said, the figure that the Senate bill might impose $8 billion in new annual costs seems wildly inflated. And this is a Governor who, a mere 18 months ago, was willing to support billions of dollars in increased taxes and revenues for his own health reform... but now he seems to say he would oppose anything that would require the state to raise a fraction of such revenues to implement a federal health reform that is relatively similar but does not have his name? I know it only reflects the same inconsistency of the Governor in supporting revenues to expand Medi-Cal and SCHIP in health reform, but opposing revenues in the budget process to prevent steep cuts in those very same programs. It's not a surprise that this or any Governor would advocate for the California budget. But he missed the opportunity--and responsibility--to advocate for the California consumer. The "Blue Dog" amendments in the House also sought to reduce affordability subsidies to low- and moderate-income families. The Governor refrained from making a comment--even though Californians would be most negatively impacted: * California has a disproportionately high percentage of low-wage workers that would need and benefit from such affordability subsidies. * And since California has one of the highest costs of living in the nation, having meaningful subsidies go up the income scale to 400% of the federal poverty level is incredibly important. One would hope that the Governor of our state would make the case not just for the budget, but for his constituents. California was lucky to have the Progressive Caucus, Black Caucus, Asian CaucOne us--led by California Representatives Lynn Woolsey, Barbara Lee, and Mike Honda, respectively--as well as the Hispanic Caucus, fight for those affordability subsidies. The inclusion of maintenance of effort restrictions on existing state Medicaid programs only compounds any cost shift to states. We simply cannot be locked into a cost structure that is unsustainable. Governors have three primary ways to control Medicaid costs: they can adjust eligibility, benefits and/or reimbursement rates. Maintenance of effort requirements linked to existing Medicaid eligibility standards and procedures will effectively force state legislatures into autopilot spending and lead to chronic budget shortfalls. Here, the Governor actually argues against the health and welfare of Californians. He wants the ability to limit eligibility, drop reimbursement rates, and scale back benefits--even in the context of a universal health system with an individual mandate.With a requirement for individuals to take up coverage, there needs to be a resulting requirement that government--at the state and federal level--will provide the necessary assistance to get quality, affordable coverage. It was the Governor's lack of understanding about the need for that commitment that made negotiations on health reform so frustrating... and that prevented a broader coalition from coming around in support of the final proposal in California. The federal government must help states reduce their Medicaid financing burden, not increase it. A major factor contributing to Medicaid’s fiscal instability, before any proposed expansion, is that the program effectively remains the sole source of financing for long-term care services. Therefore, I am encouraged by congressional proposals that create new financing models for long-term care services. Proposals that expand the availability and affordability of long-term care insurance are steps in the right direction, but they must be implemented in a fiscally sustainable way. More fundamentally, however, the federal government must take full responsibility for financing and coordinating the care of the dually eligible in order to appreciably reduce the cost trend for this group. This realignment of responsibilities is absolutely essential to controlling costs for this population, while ensuring that state governments will be better positioned to fill in any gaps that will undoubtedly arise from federal health care reform efforts.
I also encourage Congress to incorporate other strategies to help stabilize Medicaid costs for states. Delaying the scheduled phase-out of Medicaid managed care provider taxes pending enactment of new Medicaid rates, reimbursement for Medicaid claims owed to states associated with the federal government’s improper classification of certain permanent disability cases, and federal support for legal immigrant Medicaid costs are examples of federal efforts that could provide more stability to state Medicaid programs. Moreover, given the fiscal crisis that many states, including California, are experiencing, I strongly urge Congress to extend the temporary increase in the federal matching ratio to preserve the ability of state Medicaid programs to continue to provide essential services to low-income residents pending full implementation of national health reform.
The Governor here makes the pitch for more federal resources for California and the states in general. He actually brings up issues that are currently in discussion--the budget signed last week includes $1 billion in Medi-Cal savings from negotiating with the federal government over some of these disputed issues. The Governor missed another opportunity in advocating for Medicaid savings--a robust employer requirement. The more that employers continue to provide coverage to their workers, the less likely they are to fall onto state programs like Medicaid. The proposal in the House (which is closer to what Governor Schwarzenegger agreed to at the end) is much more likely to provide state savings, than the relatively weak employer contribution in the Senate, which might actually increase Medicaid enrollment for currently eligible categories. He had a chance, consistent with his health reform proposal, to make the case for employer responsibility in an area where he could have made a difference, where there is real fluidity in the national discussion. The Governor also makes the case for continuing the increased federal-state matching rate that California is getting from the stimulus, that has provided nearly $10 billion in federal funds, but that will expire at the end of 2010. Given that California is not likely going to be out of this fiscal hole that soon, such a request is necessary--however, it's probably more likely to come not under health reform, but in a second stimulus or more targeted package of aid to states. Prevention, Wellness and Health Quality
Prevention, wellness and health promotion, along with chronic disease management, can help to lower the cost curve over the long run and improve health outcomes in the near term. This was one of the cornerstone pieces of my health care reform proposal in California, and I continue to believe it should be a key piece of the federal efforts. Prevention, wellness and chronic disease management programs should include both the individual and wider population levels.
At the individual level, proposals to provide refunds or other incentives to Medicare, Medicaid and private plan enrollees who successfully complete behavior modification programs, such as smoking cessation or weight loss, are critical reforms. To ensure they are widely used, individual prevention and wellness benefits should not be subject to beneficiary cost sharing. Because individuals’ behaviors are influenced by their environments, health reform must place a high priority on promoting healthy communities that make it easier for people to make healthy choices. California has demonstrated through its nationally recognized tobacco control efforts that population-based strategies can be effective and dramatically change the way the people think and act about unhealthy behaviors, such as tobacco use. A similar model, community transformation grants, has been advanced in the Senate Committee on Health, Education, Labor, and Pension legislation, and it should be included to support policy, environmental, programmatic and infrastructure changes that address chronic disease risk factors, promote healthy living and decrease health disparities.
Quality improvement measures are also critical to health reform. The House proposal for a Center for Quality Improvement to improve patient safety, reduce healthcare-associated infections and improve patient outcomes and satisfaction is a positive step. Coordinated chronic disease management is necessary to improve outcomes for chronically ill people. Systematic use of health information technology and health information exchange, including access for public health agencies, is vital to providing the necessary tools to measure the success of quality improvement efforts. Finally, investments in core public health infrastructure can be facilitated through the creation of the proposed Prevention and Wellness Trust.
These are important elements--and we wish the Governor's policies and actions met the rhetoric. He opposed a tobacco tax (Prop 86) on the ballot in 2006, and refused to consider another during this awful budget crisis. However, this emphasis on focusing on healthy environments and communities--not just personal responsibility for better health--is much needed. His endorsement of "community transformation" and better public health infrastructure are all welcome and should be heeded by the DC policymakers. Unfortunately, some of these items have come under scorn, and maybe he can help defend them from attack. Coverage for All
Coverage for all is also an essential element of health care reform and I believe an enforceable and effective individual mandate, combined with guaranteed issuance of insurance, is the best way to accomplish this goal. The individual mandate must provide effective incentives to help prevent adverse selection that could occur if the mandate is too weak. Creating transparent and user-friendly health insurance exchanges to help consumers compare insurance options will also help facilitate participation. States should maintain a strong role in regulating the insurance market and have the ability to maintain and operate their own exchanges, with the understanding that some national standards will need to be established. California has a long history of protecting consumers through our two separate insurance regulators, one covering health maintenance organizations and the other monitoring all other insurance products. Maintaining a strong regulatory role at the state level is in the best interest of consumers, and I urge Congress to maintain this longstanding and effective relationship as you design these new market structures. There's a common understanding that the individual insurance market is broken, from the allowance of insurers to deny coverage for "pre-existing conditions," to the utter complexity and confusion to understand benefit packages or make apples-to-apples comparisons. The new "exchange" would place new oversight over insurers and fix many of these issues, while preserving a wide range of choices for consumers.In this section, Governor Schwarzenegger argues for the continued role of state regulators. This is an area where a federal floor would be welcome, but also the ability for states to set higher standards where needed. California's insurance market has often been compared to the wild, wild West, in deperate need of taming--on issues from rescissions to the lack of minimum benefits--so a federal presence would be welcome. But there are areas where California has lead the way in consumer protection, such as with our HMO Patients' Bill of Rights, independent medical review, and advances on issues like timely access and language access. We wouldn't want to lose our ability to continue to improve consumer protections. I hope our experience in California working toward comprehensive health care reform has informed the debate in Washington. There will be many short-term triumphs and seemingly insurmountable roadblocks for Congress and the nation on the road to comprehensive health care reform. We must all remain focused on the goal of fixing our health care system and remember that we all have something to gain from the reforms, and we all have a shared responsibility to achieve them. I look forward to working with you as you move forward on this desperately needed legislation. The letter seems disjointed, wanting to continue the Governor's rhetoric from last year as a health reformer, but the main thrust--as most media reported it--was to send a signal of opposition, particularly about state costs. Unfortunately, in making that case, especially on any maintenance of effort requirement, he shamefully argues for the state at the expense of its residents. And he When reading this, our Congressional delegation, who after all represents the same constituency, will reject the self-serving arguments, but also recognize the good points in the letter. There's some common ground for our delegation in supporting more resources for California, prevention-oriented policies, and the ability for state regulators to craft key consumer protections. With most Republicans attacking health reform, it's just a shame--in more ways than one--that the Governor has lost his pro-reform voice and credibility on the issue with his recent actions. The letter only serves to continue his many contradictions. Labels: Federal, Prevention, Schwarzenegger, YearOfReform
posted by Anthony Wright |
Permalink |
11:38 PM
a
A novel concept
Wednesday, July 23, 2008
The NYTimes had a story this week about paying doctors more so they can do more preventive maintenance for their patients. What a concept. It seems that we learn really basic concepts at a very early age: that often (not 100% of the time, but frequently) you get what you pay. If you want higher quality, you pay more. We also learned that if you do things right and carefully the first time, you won't have to redo it later (I admit, this is a lesson I'm STILL trying to master). The trend for our medical system, however, has been the opposite, leading to what we have now, which is harried doctors rushing from patient to patient paying a few minutes of attention. But the NYTimes story points out that insurers are now applying these adages to medicine (as is Medicaid and Medicare). Higher compensation enables doctors to hire more staff to follow up with patients, answer questions when they call/e-mail and make sure they're up to date on tests. It seems funny to say this is an innovation (because it seems like common sense to focus on wellness up front before patients get too sick after receiving episodic or inattentive care)....but hope the trend continues Labels: Insurers, InTheNews, Prevention
posted by Hanh Kim Quach |
Permalink |
10:53 AM
a
So "never events" never happen...
Monday, June 30, 2008
Jordan Rau at the Los Angeles Times has an important article (with lots of links to primary source documents!) on the key issue of "never events"--those things that should never, ever happen when you get care. It's a list that includes getting severe ulcers from bedsores, having equipment left in a person during surgery, undergoing the wrong surgery or having the wrong limb amputated, or being given the wrong medication or wrong dosage. Unlike other parts of the art of medicine, these are problems that are preventable if the systems are in place. The number of these adverse events reported is over 1,000 in a 10-month period. It's a wake-up call--Many in the health care community would not have predicted such a large number. These medical errors are serious--in some cases, deadly serious. By definition, these are "never" events--not "sometimes OK" events. The article highlights AB2146 (Feuer), an important bill supported by many consumer groups like Health Access California, AARP, CALPIRG, Consumers Union, as well as business and labor organizations. It would have California follow the federal government in not paying for these adverse events, as part of a shift to change the financial incentives in this category. I would also add AB2967 (Lieber), which would add more transparency to the cost and quality of the care being provided in California. This information is valuable in its own right, and will have a impact in getting hospitals to prevent these errors, which will improve health outcomes, and save money too. Information shouldn't be the only tool, but it should be part of more aggressive oversight. Read the article. It's worth your time. Labels: Hospitals, InTheNews, Legislation, Prevention, Research
posted by Anthony Wright |
Permalink |
1:32 AM
a
Blaming the victim
Wednesday, October 03, 2007
The story that got my attention today was this LATimes story about saving $1 trillion through healthy living -- particularly the last sentence, where the researcher "blamed Americans' diet and sedentary lifestyle." There’s something to be said about an individual proactively exercising, not smoking, etc.... I totally agree with that. But these studies and stories don’t take into account the worker who must take 2 jobs to survive -- rides the bus, lives in an industrial area, has an aging parent at home to care for, maybe younger siblings, maybe children. Where does this person find time, beween family obligations, work and trying to get places on public transit, to exercise. And where could they exercise without exposing themselves to carcinogens. And if the answer is, "get a gym membership," where does a low-income worker find the $50 to $100 a month to join a gym? Labels: Prevention
posted by Hanh Kim Quach |
Permalink |
10:13 AM
a
"When is something less than nothing?''
Friday, August 10, 2007
That's what yesterday's USA Today article asks, in response to a recent JAMA study finding that underinsured children are vaccinated at lower rates than uninsured children. For those buying health insurance through a group (such as work), in California, consumer protections guarantee that even flimsy health plans are required to provide preventive care for children following the American Academy of Pediatrics guidelines, which includes immunizations. However, if you're buying coverage on your own -- it's not only more expensive, but as this study shows, it also doesn't cover the essentials. The study confronts the insurance company's lines about creating "innovative'' products. Innovation comes at the consumers' expense. They argue that the reason health care is "expensive'' in California is because people have to pay for health coverage they don't need. But without "mandates'' this is what happens -- children don't get properly immunized, cancers don't get discovered, diabetes doesn't get treated. And I would argue that in California -- the mandates aren't enough -- given that 464,000 children who have insurance in the individual market are not guaranteed proper preventive care in their most formative years. Labels: Affordability, InTheNews, Prevention, Underinsurance
posted by Hanh Kim Quach |
Permalink |
3:07 PM
a
All the President's Polyps...
Tuesday, July 24, 2007
San Francisco physician Margot Kushel delivered this succinct message to President Bush in today's NY Times' Letters to the Editor: Mr. Bush: one cannot get a preventive colonoscopy in the emergency
room. In case anyone missed it, earlier this month, the President insensitively remarked: "I mean, people have access to health care in America. After all, you justgo to
an emergency room." -- President George W. Bush (Cleveland,7/10/07) Of course. We can't all get presidential health care. But we can get preventive care -- like the President did on Saturday (does that mean it was a house call?) which eventually resulted in the extraction of five (!) polyps. Well said, Dr. Kushel. Labels: Bush, Prevention, Underinsurance
posted by Hanh Kim Quach |
Permalink |
12:36 PM
a
Women and Health and the Glass Ceiling
Wednesday, June 27, 2007
We all know gender inequality issues still exist in the workplace. Men still get paid more than women. Fewer women are promoted than men. Another place where gender discrimination is allowed to tacitly continue is in health care. As recently as 2002, women were charged copays of between $500 and $2,000 to deliver babies. Meanwhile (mostly or only men) who had prostate surgery, back surgery, brain surgery, coronary bypass surgery did not have to pay copays. (Some might argue that maternity costs more. Not so. Average costs for labor and delivery was $1,980 then. Meanwhile, average costs for surgeries for those other procedures ranged from $4,422 to $29,539 -- okay, now i'm really annoyed). Why am I upset about this now? Here's the situation: Gov. Arnold Schwarzenegger and Republican cohorts are constantly calling for "flexibility" that would allow insurance companies to offer consumers more "choice'' and more "affordable'' options. What they really mean is getting rid of a host of "benefits'' that California wrote into the law years ago to make sure health coverage actually covered health care. Here are some of the benefits they're talking about. (see a full ist of mandates here) California mandates 23 benefits; six directly relate to women. They include coverage for: - complications of pregnancy, (for plans that provide maternity benefits);
- breast cancer screening, diagnosis and treatment;
- mammograms;
- cervical cancer screening (if policy includes coverage for treatment/surgery of cervical cancer)
- prenatal in the Expanded Alpha Feto Protein program, if maternity benefits are included
- prescription contraceptive methods (if prescription drugs are part of the benefit package)
Two other mandated benefits are "tweeners,'' while they could apply to both genders, I would say they predominantly apply to women: - diagnosis, treatment and appropriate management of osteoporosis
- immediate accident and sickness coverage for each newborn infant and adoptive child.
Of course, the biggest cost for women -- maternity coverage -- is not a mandated benefit and was actually vetoed by Schwarzenegger in 2004 on the grounds that it would make coverage too expensive for everyone. As I pointed out earlier in this post, the collective "we'' pays for a lot of health care that is used primarily by men, including the gov's various heart surgeries. So don't buy the wrap about "choice,'' "flexibility'' and "affordability.'' It's just another way to help keep women in their place. Click here for the San Francisco Chronicle's excellent Sunday Op-Ed about women and health care. Labels: Affordability, Prevention, Schwarzenegger, Underinsurance
posted by Hanh Kim Quach |
Permalink |
1:00 PM
a
Prevention...
Tuesday, February 06, 2007
Many of our consumer allies have been invited to major press event today by the Governor, focusing on prevention and wellness issues. Expect that he might release more details about the public health campaigns on diabetes, obesity, and smoking cessation. You can watch the event at the Governor's website, here: http://www.gov.ca.gov/Labels: HealthyLiving, Prevention, Sacramento, Schwarzenegger, YearOfReform
posted by Anthony Wright |
Permalink |
9:46 AM
a
Webmaster: webmaster@health-access.org
|
|
