http://world-news.newsvine.com/_news/2012/06/24/12381551-ipsos-poll-most-americans-oppose-obama-health-law-but-like-provisions#entercomment ________________________________________________________________________________ "No one ever lost any money underestimating the American public." P.T. Barnum. Well, the American public has spoken again. That is, if you believe (a) pollsters; (b) how polls are worded, asked, conducted, and interpreted; (c) whether the American public (if this is in fact a representative sample) has any idea of what is in its best interest. Why do I say that? Remember when this debate started again during Obama's first term? People would stand up at town halls and tell the moderator, "Keep gummint's hands off my healthcare!" Of course, many of those speaking were seniors, all of whom are covered by Medicare, the government-run healthcare system! How did people get so stupid and/or ignorant about something which is vital to their physical--and fiscal--well being? If this were the 1950s, I'd guess that the Russians had put something in the air and water supply. While that may still be the case--remember Love Canal, the Cleveland River that burned, and the recent mercury emissions controls that the Senate voted down last week--the Russians don't have a hand in it. We are doing just fine poisoning ourselves. One explanation for the collapse of the Roman Empire relates to the lead content of the pipes with which they constructed their system of aquifers. Lead poisoning weakens the brain's cells and their ability to think. Today, while lead is pretty much out of the water, we have fluoride, mandated in every municipal water system in the country in the 1950s to prevent cavities, as a long-standing substitute. As I said above, the powers that be in this country haven't lost a step when it comes to damaging the public's health in their efforts to "protect" it. That's where the Supreme Court comes in. Given the majority's predilection for interpreting the life out of the nearly impenetratable wording of the laws that govern us all, it won't surprise any Court watchers if they deem the individual mandate unconstitutional. A rough analogy would be: They know the cost of everything but the value of nothing. I wish us all good luck!

The Dark Side Of The Force--a.k.a. The GOP--once again showed its mean-spiritedness and insensitivity to the needs of those for whom they work; i.e., us. The House GOPers passed their version of a law designed to eliminate a cost-cutting panel mandated in Obama's healthcare bill and reduce total compensation courts can award to patients harmed by a medical professional or entity. Here's the article: House Republicans combined two ill-conceived health care measures into a single bill and passed it on a largely party-line vote last month. One measure repealed an independent board that is one of the major cost-control measures in the health care reform law. The other imposed restrictions on medical malpractice awards that would limit the ability of patients who have been grievously harmed to receive fair compensation for their injuries. The board, known as the Independent Payment Advisory Board, is supposed to come up with ways to ramp down Medicare spending if its growth rate is projected to exceed a specified target. Despite what Republicans claim, the board, which will include doctors, consumers and patient advocates (misleadingly described by critics as “unelected bureaucrats”) is not allowed to “ration care.” It is largely restricted to recommending cuts in payments to health care providers that would go into effect only if Congress failed to find comparable alternative savings. According to the Congressional Budget Office, repealing the board would drive up federal spending on Medicare by $3.1 billion over a decade. The malpractice measure would make it harder to seek compensation for noneconomic damages such as pain and suffering and would limit awards to $250,000, which is far too little to compensate someone who is paralyzed or blinded for life by medical negligence. It would also limit patients’ ability to file punitive damage suits and limit awards in those suits to $250,000 or twice the amount of economic damages awarded. Malpractice reforms are needed. But there are ways to encourage fair settlements and reduce the amount of malpractice by doctors without limiting the ability of badly injured patients to receive adequate compensation. The Senate needs to reject or bury this legislation. Let's hope the Senate rejects this febrile attempt to eliminate two ways the healthcare law will help and empower people to keep a lid on costs and receive proper compensation for harm at the hands of professionals.

Want to know a big--and continuing--reason why healthcare costs keep going up? Yes, it's that recurring bugaboo, administration. This time, the IRS gets into the act, levying fines for noncompliance with the new health law. Once you know the IRS will be part of the administration of this law, you can expect incompetence, inefficiency, "one-size-fits-all" bureaucracy, and waste. Remember: the IRS fails to collect nearly $400 billion in taxes each year. Why would anyone expect its record on collecting and administering health law financial compliance to be any different? Read the article at http://www.foxbusiness.com/investing/2012/03/29/irs-already-gearing-up-for-health-care-crackdown/?link=mktw and weep!

You know my #1 issue: Our broken health care/health insurance system. I've been inveighing against the way we do things for over 25 years. But, you know what. Back then, the problem/the solution/the lack of political will were EXACTLY THE SAME as they are today. Gutless politicians on the payroll of insurance/big pharma/healthcos, people who count things determining how doctors practice medicine and who gets--and does NOT get--treatment all result in the 99%--that's US--getting screwed!! Read this article: http://usnews.msnbc.msn.com/_news/2012/03/29/10926817-hospital-mom-booted-from-er-to-die-in-jail-was-treated-appropriately?ocid=twitter It's just one example of how "the best health care in the world" caused yet another person's death.

http://www.nytimes.com/2012/03/07/business/aarp-study-says-price-of-popular-drugs-rose-26.html?_r=1&emc=tnt&tntemail1=y The clue to why this report is important comes, no surprise, at the very end. Note the mention of the "doughnut hole." If you are not familiar with that term, it's the you-couldn't-make-this-stuff-up part of the prescription drug bill, written by a big pharma executive and passed during the 2nd administration of He Who Shall Not Be Named. The real effect of the doughnut hole is to repay to big pharma all the $$$ saved by seniors on their first $2,500 or so of prescription drug coverage. At that threshold, the doughnut hole opens, and seniors have to pay the full price of their drugs until the hole closes at about $5,000. THE FULL PRICE OF THEIR DRUGS!! Only in America could such a mean-spirited, head-up-the-ass provision pass. As the reporter notes, the increases reported by the AARP mean that seniors are propelled faster toward the yawning maw of the doughnut hole, so big pharma gets its $$$ even faster! The other point worth noting is generics. Any doctor or pharmacist will tell you, if asked, that many generics are less potent or efficacious than the full-strength name brand variant. So, no surprise that they cost less. Pay special attention, too, to the fact that insurance companies report paying out more for name-brand drugs. Who do you think will make up this "loss" experienced by the insurance companies? IT'S ALL OF US!! Read this article and understand an important reason why health care and health insurance costs continue to rise.

Each time I read a story like the one that follows, I start bouncing off the ceiling. Who could cobble together such a convoluted, outright mean-spirited, and stupid, plan for offering--and withholding--treatment and stiffing the providers of that care. Of course, it's the people who know the price of everything and the value of nothing. These are people who make Scrooge seem like Santa by comparison. But, you know, that is too kind a tone. These cretins are vile little shits who dole out treatment while withholding compassion. They besmirch the compact between the people and their government and its elected officials, all the while imagining that whatever cost-cutting measures they take will somehow improve health care delivery and the quality of care. The rest of the world looks on in amazement and disgust. Medicaid Cuts Rile Doctors Hospitals Also Fight Washington State's Drive to Trim Emergency-Room Visits By ANNA WILDE MATHEWS A plan by Washington state's Medicaid agency to stop paying for certain emergency-room visits is prompting pushback from hospitals and doctors, who say they will be stuck with bills for vital care they often are legally required to provide. The new cuts, set for April 1, focus on about 500 diagnoses including common infections, mild burns, strains and bruises. If an enrollee comes to an emergency room and is diagnosed with one of these conditions, the Washington Medicaid program won't pay the hospital and doctors. Doctors and hospitals are up in arms about a Washington state Medicaid cut that will deny coverage if beneficiaries go to the ER for any of about 500 conditions including a number of common infections. Anna Mathews has details on The News Hub. Instead, the state will pay a screening fee of about $50 if the patient is in a private-plan version of Medicaid, which currently enrolls about 60% of beneficiaries and is slated to grow. Patients won't be charged. The move would be the latest cut to Medicaid programs as states struggle to reduce health-care costs—and as the downturn has boosted Medicaid's ranks. Some 43 states have Medicaid initiatives designed to deter unnecessary use of emergency rooms, according to the Kaiser Family Foundation, a nonpartisan, nonprofit organization that studies health issues. Several states now charge patients copays for nonemergency services in an ER. The Washington policy is being watched by other states, said Alan Weil, executive director of the National Academy for State Health Policy, a nonpartisan research organization. Washington's legislature last spring ordered the Medicaid agency to cut spending on unnecessary ER visits, spurred by a budget shortfall then projected at $2 billion. Officials say too much routine care is given in ERs, often the most expensive setting, and that this plan would save the state $17 million a year. Doctors and hospitals, which got an earlier version of the plan blocked on procedural grounds after suing the state, say the new effort goes too far. They say the cuts would put them in a bind because federal law requires them to screen and stabilize all patients, which may involve imaging and lab tests. Stephen Brashear for The Wall Street Journal Stephen Anderson, head of Washington state's emergency-physicians group, says a new policy would saddle hospitals and doctors with unpaid bills. Moreover, because of ethical and liability concerns, hospitals often will have to treat some conditions the state considers nonurgent, such as urinary-tract infections, they say. The upshot, they say, is they will be forced to do unpaid work, and the costs ultimately could be shifted to private health-care payers. "If you fall down the stairs, and your ankle is twice its normal size, and I X-ray it and it's broken, they'll pay me, and if I X-ray it and it's not broken, they won't," said Stephen Anderson, president of the Washington chapter of the American College of Emergency Physicians. The doctors say that patients, even though they face no bills themselves, may feel pressure to avoid coming to the hospital even if they urgently need care due in part to publicity about the state's effort. They also argue that a number of diagnoses on the list are relatively serious conditions, such as candidal endocarditis, which involves fungal infection of the heart. State officials say procedures such as pregnancy tests don't belong in the ER. State officials say that for many situations, emergency-room staff can make a quick assessment and steer patients toward a lower-cost venue, like an urgent-care clinic, without extensive testing. For ankle pain, for example, doctors have evaluation guidelines, and "screening procedures don't need to go on to X-rays" in all cases, said Jeff Thompson, chief medical officer of the state agency that oversees Medicaid, the Health Care Authority. "We will be happy to work with doctors and hospitals to ensure care is done appropriately and in the appropriate time frame," Dr. Thompson said. He said if a patient with the heart infection had symptoms that required hospital admission, that would be paid, but a chronic case without symptoms might not be covered in an emergency visit. The agency also will cooperate with providers to ensure the excluded diagnoses are appropriate, and it plans to add and subtract from the list it issued, Dr. Thompson said. He said procedures such as pregnancy tests and most well-baby exams shouldn't occur in an emergency room. The state also is focused on Medicaid beneficiaries with histories of frequent emergency-room use or narcotics abuse, and visits by these people will get a special review. Stephen Brashear for The Wall Street Journal Dr. Nathan Schlicher at St. Joseph Medical Center in Tacoma, Wash. A spokesman for the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicaid, said it is "in touch with Washington state officials regarding their plans." Washington state's emergency-physicians group, as well its medical and hospital associations, are lobbying legislators and officials to halt the initiative. The groups have outlined an alternative plan to save money, which includes boosting use of generic drugs and monitoring frequent ER users. Other states are taking similar tacks. Since July in Tennessee, Medicaid pays only a $50 ER screening fee for diagnoses considered nonurgent, though it excludes children under two. Iowa in September launched a tiered plan that cuts payment for emergency visits for nonurgent conditions, but it doesn't apply to enrollees younger than 21, among other groups. The earlier version of the Washington policy, which was blocked by a state court in November after the doctor and hospital groups sued the state, would have allowed three nonemergency ER visits before the program refused to pay. "States are looking for any possible way to reduce spending," said Diane Rowland, executive vice president of the Kaiser Family Foundation. Medicaid beneficiaries go to the ER more often than others, according to an analysis from the Centers for Disease Control and Prevention, partly because they don't always have access to other doctors. But by and large, states have limited levers to trim their Medicaid tabs: The federal health overhaul law generally forbids them from reducing the populations they cover, and states are required to provide certain benefits. The number of people eligible for the program is expected to expand sharply in 2014 under the health overhaul. Federal and state laws often require that insurers cover ER visits that occur for reasons that a "prudent layperson" would consider an emergency, said Thomas Barker, an attorney at the firm Foley Hoag. That standard applies to all plans provided by employers that are self-insured, as well as private-plan versions of Medicare and Medicaid. It doesn't necessarily apply to traditional Medicaid, though, he said. Regardless of what they are paid, hospitals are obligated under a different federal law, the Emergency Medical Treatment and Labor Act, to provide a "medical screening examination" to anyone who asks, Mr. Barker said, and if the person has an "emergency medical condition" the hospital either must stabilize it or arrange to transfer the patient to another hospital that can do so.

There are 310 million people in this country, and I would guess that most of them go to a dentist at one time or another. Since the administrative labyrinth for dental coverage and services is quite complex, you can appreciate how much $$$ could be saved on health care if those expenses could be either reduced or eliminated. Here's a micro example of what many in the macro populace face every day. My HBSM--Healthcare Bullshit Meter--looked like a tachometer displaying 7,000 RPM in 1st gear when I received a call from my dentist just now. The billing person wanted to know what kind of dental coverage I have. It seems they have to contact Blue Cross Blue Shield before my appointment on Monday to find out what coverage I've got--a.k.a. how much $$$ the dentist can expect to receive from BCBS--whether there are any exclusions, etc. Luckily, I was able to reassure her that, if worse came to worse, I would pay for the procedure myself. While this dentist is perfectly competent to perform this onlay--she's done three others for me--the woman who runs the practice is totally $$$ focused, which, of course, plays into the insurance companies' hands perfectly. They want practitioners dependent upon their underwriting allowances. The hope is that practitioners will in turn put the financial squeeze on their patients to get payment. This of course means hiring professional office people WHO WENT TO SCHOOL TO LEARN MEDICAL BILLING. You will appreciate that this also drives up the cost of delivering quality care and reduces the amount of time available to the dentist to do so. There is a better way. You know my themes: Universal, Cradle-to-Grave, Single Payer. These concepts, when realized in this society for the benefit of every American, will cut costs, increase quality of care, do away with the fee-for-service model, cut insurance companies and HMOs out of the equation, and make situations like the one I am about to enter into a thing of the past. If you saw the movie "Sicko," you'll remember the scene in which Michael Moore wanders around a hospital in France asking for directions to the billing office. No one understands his request. That is the way it should be in the United States. Take the people who studied medical billing, never mind those folks who got PhDs in Taxation (I am not making this up, such a degree exists), teach them new skills in areas that actually produce something tangible so they can become productive members of society. Let me know your thoughts.

Here's another reason why health care costs remain high and go higher--gutless government representatives who suck at the money teat of the pharmaceutical and health care bureaucracy. Here's an article about one example of this, in CA: "OK, now the bad news. As you know, if you have been a participant of this distribution list for a while, we have been valiantly advocating for a single payer health care system for many years. Such a bill (SB 840) was passed by both chambers of the CA state legislature in 2006, but the bill was vetoed by Governor Maid Molester (Schwarzenegger). At the time we TRIED to get the Democratic nominee Phil Angelides (who had previously claimed to support single payer) to do an action to demand that Arnold sign the bill. It would have been a great campaign issue for him, but he was too chicken hearted or corrupt himself (your choice) to do it, and he lost by 30 points or something like that. The same bill passed in 2008 and was vetoed again. Now fast forward the clock to last week, when single payer (renumbered SB 810) was again in front of the CA Senate, but now with a Democratic governor, Jerry Brown, who would be expected to sign the bill. All of a sudden four Democratic senators refused to even vote at all. That's right, folks, they ABSTAINED, which is being in the room for the vote and refusing to cast a vote one way or another. At least three of these abstainers had voted "Yes" for single payer the last time. So we cranked out a targeted action aimed only at these turncoat abstainers and have good information they got LOTS of phone calls for them to reconsider. But reconsideration never happened. So what's really going on here? Here's what the sponsor of the bill, Mark Leno, said on the Thom Hartmann show when gently challenged on why previous supporters were now abstaining. "Arnold Schwartzeneggar was always going to veto the bill, so if one had an interest in not ruffling the feathers of the insurance industry, the possibility is to vote for it with the wink of the eye that it's not going anywhere anyway." In Greek mythology, Tantalus as his eternal punishment was cursed to stand in a pool of water underneath a fruit tree with low hanging branches always just out of reach, with the water always receding before he could take a drink. THAT is the very image of what the Democratic party has become for the interests of the people who consider themselves constituents. It's all a scam, folks, just one great, big, giant, honking scam. This is essentially the same thing that happened in 2010 with that phony baloney health care bill, with a bottom line of nothing but pig grease for the medical insurance corporations. After lulling people along for almost a year with the promise of a "public option", itself a feeble impersonation of single payer, they refused to even allow a vote on it. In the end, having been forced to pass the bill using a reconciliation gimmick requiring only 51 votes, and 51 Democratic senators on record as supporting the so-called public option, they simply REFUSED to bring it up for a vote, even though they had the votes to do. And the worst thing about it is that even the so-called good guys are in on it. Mark Leno, the sponsor of SB 810, KNOWS it will never pass, that the vote will always be manipulated so it falls just short in some way. The only reason for him to bring the bill up at all is to CON his own constituents into thinking he's on their side, otherwise he would be vociferously calling out these abstainer traitors, not accidentally spilling the beans as he did. It's nothing but a cynical PR stunt, and they are ALL in on it. No matter how many Democrats we vote for, till the end of all eternity, they will always find some way to fail to pass single payer health care. We swore two years ago, in the aftermath of the last health care debacle, that we would never again work for anybody but independent candidates. But we still have not made a decision as to what to do with regards to Rocky Anderson. We have asked for your input and we ask for it again. Many are afraid an independent presidential alternative will just end up electing the worst of the two evils. Shall we play Tantalus for the rest of our lives? Please tell us what you think this resource should do." You can't make stories like this up. But, an election's coming! Vote the bastards out and lobby for real change.

Follow The Money

Look beneath the purported story theme of testing ADHD meds to protect the lives of those taking them--http://online.wsj.com/article/SB10001424052970204336104577094624185636102.html?KEYWORDS=adderall--and you will find one explanation for why some drugs cost more than others and how the big pharma companies stand to profit while disposable income of medication users goes down. The FDA should not be practicing medicine. Yet, the FDA is doing just that when it arbitrarily halts the production of entire classes of drugs because there is a suspicion that some of those taking these medicines could be harmed by them. It is up to the physicians treating these people & prescribing these medicines to decide which people might be at risk. But wait--they ALREADY DID THAT when they took a history before prescribing these or any other meds as part of the patients' treatment plans. So, why is the government taking its usual "one-size-fits-all" approach in shutting down supply of these drugs? In the case of Adderall XR, for example, it appears to be a case of "nobody goes there anymore--it's too crowded." In other words, because students and others needing to improve alertness and concentration (how they got scripts is another question) have been taking Adderall in increasing numbers, Adderall XR's popularity grew to the point where the Feds decided that too many people were benefitting from it. So, in their infinite wisdom, they left the supply of regular Adderall intact on drugstore shelves but choked off the supply of Adderall XR so no one could get it. Guess what happened. Patients lobbied their doctors to prescribe them the closest real (as opposed to generic) medication, in this case a newer (a.k.a. still under patent protection) drug called Vyvanse. The dosing is different as is its absorption--it's smoother in than Adderall by a tad less efficacious. What no doubt interested the drug companies manufacturing these drugs is that Adderall XR, an older drug no longer patent protected, costs patients a copay of $30. However, Vyvanse, a newer drug, costs users a $50 copay as a Class III medication. Neither the government or big pharma acknowledge that doctors prescribe these drugs based on the needs of individuals, not with a "take-two-of-these-and-call-me-in-the-morning" approach. Illness is routinely measured in large patient groups, but, if you have a disease, it's YOUR disease. Your response to it and subsequent treatment is for YOU, not an anonymous large patient population. Offering this nuanced approach to prescribing is one reason doctors go to school for all those years. So, until at least 2012, Adderall and other medicines in its and related classes will not be available to anyone who was using them. And, if you follow the money in the way I suggest, you will understand why.

The problem--and the solution--remain.

Got a letter from my dentist last week. What did she want? I'm all paid up, haven't missed any appointments, so why send postal mail? Here's what she wanted to tell me: Use you remaining benefits before the end of the year or lose them! Just one more example of how convoluted, how constipated, our current system is. The principles remain simple: UNIVERSAL. CRADLE-TO-GRAVE. SINGLE-PAYER. Of course, you'll hear the opponents say, "It'll never fly. It's socialism! No one wants the government to control their healthcare. We've got to cut expenses, not increase revenues or taxes! It's too hard!" Sure, it's hard! If it were easy, we would have done it already! Confront the problem and solve it! No guts, no glory! Or--and I like this variation better--"No pressure. No diamond." It's a weird situation: Everyone, in their heart of hearts, knows that the principles above are the answer. It's been the same for the past 20+ years. For the same span of time, though, since many legislators are in the pockets of big pharma and the medical establishment, politics--and, of course, lack of courage--stops them from acting in the best interests of the people who elected them. Time for a change, no?

As I've written before, when healthcare availability and delivery are controlled by people who know the price of everything but the value of nothing, stories like the one below occur. We'll be hearing about similar situations all too often in the near future and beyond: Clinic Rejects Immigrants After Impasse With Hospital By KEVIN SACK ATLANTA — After the collapse of negotiations between Atlanta’s public hospital and the world’s largest dialysis provider, a dozen immigrants suffering from renal failure were refused treatment at an Atlanta clinic on Thursday and advised to wait until their conditions deteriorated enough to justify life-saving care in an emergency room. Unless the deadlock is broken, 22 patients, most of them illegal immigrants, face a debilitating cycle. Rather than receiving dialysis three times a week, as is standard protocol for cleansing their blood of toxins, they must wait until they are in sufficiently serious jeopardy to trigger the federal law that requires hospital care. Dialysis patients said that typically means placing themselves at risk of serious impairment or death. “Trust me, it is just like dying,” said Bineet Kaur, 28, an illegal immigrant from India who was turned away on Thursday morning from the clinic, operated by Fresenius Medical Care. “You are almost unconscious, you know. Even if you are talking, your brain is not working. Sometimes you have to be hospitalized for days or weeks.” As was said in a different context in the 1950s, "Have you no sense of decency, sir?" My mother was on dialysis for several years, and, while she would occasionally skip one of the three required weekly treatments, she knew, as we all did, that to stop dialysis meant death. These illegal immigrants know it, too. Yes, they should have become citizens, but, for whatever reasons, they didn't or couldn't. And, because they have a medical condition that requires three-times-a-week treatment for life, they get an additional penalty imposed. Not only do some folks want to deport them (which, if they were healthy, might be an option), these same people want to withhold the dialysis keeping the immigrants alive. This act would cause cruel and unusual punishment for a somewhat victimless crime: Self poisoning followed by death. You know that old saying: Every 4th house in America will be burgled. So, look out your front door and count down three houses. In other words, withholding medical treatment for cost reasons could happen to anyone in this country. Here's a specific example--from 20 years ago! A doctor told me about a patient of his who went for a routine mammogram. As sometimes happened, the film's resolution was marred, so the facility asked her to return the following week to repeat the scan. The second scan showed no disease. However, when the patient applied for life insurance, the potential insurer saw that she'd had two mammograms in two weeks, and, "reasoning" that she all but had breast cancer, refused to insure her! The doctor went to bat for his patient, and, eventually, the insurance company relented, making a Solomon-like decision. It insured the woman, BUT NOT HER BREASTS!!! And so, the pattern goes in America. We are the only industrialized country that apportions health insurance and healthcare delivery on the basis of whether an applicant can afford it, rather than as a basic right of citizenship. Oddly enough, this rationing drives healthcare costs up much more than insuring the entire population by virtue of citizenship would. Let me know your thoughts.

Here is an important piece of the puzzle about why health care costs (for both delivery and insurance) rise year after year: " . . . a fundamental reason that private-plan costs have outpaced Medicare fee-for-service spending: 160 million Americans with employer-sponsored coverage are quietly subsidizing seniors’ coverage through cost-shifting. When confronted with inadequate Medicare reimbursements, doctors, hospitals and other providers learned long ago to shift costs to the under-65 population by demanding higher payments from private insurers. This cost-shift, in turn, has fueled premium increases and rising medical costs for working families. Meanwhile, traditional Medicare fails to provide seniors with a comprehensive benefit akin to what working Americans currently have. If Medicare “as we know it” is such a good deal for seniors, why is it that nearly 90 percent of beneficiaries supplement their traditional Medicare plan with Medicare Advantage, employer-sponsored retiree coverage or Medigap policies?" The latter is a good question, but the answer is self evident: MediGAP (my emphasis) fills the coverage "donut hole" in Medicare.

But, we may well ask, why do these kludges, patches, tweaks, and other "baby steps" exist? Everyone knows how to fix health care insurance and delivery so everyone receives insurance and treatment cost effectively. Just apply the formula: Universal. Cradle-to-grave. Single-payer. Problem solved. Of course, everyone also knows that the moneyed and powerful strive mightily to prevent implementation of these principles. Perhaps the best explanation, though, comes from an observation by Winston Churchill on the American character: "America will always do the right thing, but only after exhausting all other options."

Another result of the abysmal U.S. healthcare "system"

More Pregnant Women Dying in CA, Says Study

By Jen Phillips | Wed Apr. 27, 2011 3:14 PM PDT

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Despite what the protesters at your local Planned Parenthood may say, abortion is not unsafe. In fact, you're about 20 times more likely to die from childbirth-related ailments than you are from getting an abortion.* In California, a disturbing new report [1] shows that more pregnant women are dying than before, due to increased obesity rates, more Cesarean sections, older mothers, and limited health care access. Part of the rise is also attributed to better data reporting methods.

The study (PDF [2]) says that the maternal mortality rate in California is about 14 out of 100,000 live births. In 2005, it was around 12 and in 2002 it was around 10. The rate (and increase) may not sound high, but take into consideration that more than half a million women give birth in California each year, and the state accounts for 1 of 8 births in the US.

In 2004, 82% had insurance that covered maternity services. Today, only 22% do.

The rise in mortality seen in California also reflects national trends, the report says, which is bad news for moms, especially moms of color. African-American women suffer maternal mortality rates far higher than any other ethnic group: about 46 of 100,000 African-American mothers die due to childbirth, as compared to much lower rates in Whites (12.4), Hispanics (12.8), and Asians (9.3). The authors of the report are still not sure exactly why African-American women are four times as likely to die than women of other races, but they suspect a combination of higher obesity rates, lower use of prenatal health care, less adequate care, and various risk factors as a result of lower socioeconomic status (e.g. higher stress). But the authors still seemed to be scratching their heads about how one ethnic group could make up only 6% of all California births, but 22% of maternal deaths.

Another anomaly: although Hispanics overall account for 51% of all California births, foreign-born Hispanics had much better health than those born in the US. "Immigrant Hispanics tend to have better health than the average American population, in spite of what their aggregate socioeconomic indicators would predict," write the study's authors. It could be because foreign-born women give birth at younger ages, when they are less likely to encounter complications. Or it could simply be that the American lifestyle, and health care system, is so unhealthy that it's actually a liability. The high Cesarean rate, which accounts for a third of all births, in particular, is directly related to maternal mortality. And then there's the question of care, and of cost. Only 22% of people with health insurance in California (the report says) have coverage for maternity services: In 2004, 82% of them did. For those who can't get, or can't afford, private health insurance, there's Medi-Cal, which paid for 47% of all prenatal and pregnancy-related costs in 2008. An especially interesting tidbit found in the report is that 7% of women in Medi-Cal's maternity program actually HAVE private insurance: their insurance just doesn't cover maternal services.

There's something seriously wrong when your health insurer doesn't cover your prenatal care. Maybe this could be a new torch for the pro-life movement, or a larger one for the pro-choicers. It seems like a perfect platform for a "family values" Republican, no?

*This is provided your abortion is in the first trimester, as 90% of all abortions are. The risk goes up for later abortions.

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Source URL: http://motherjones.com/blue-marble/2011/04/new-study-shows-more-pregnant-women-dying

Links:
[1] http://www.cdph.ca.gov/data/statistics/Pages/CaliforniaPregnancy-AssociatedMortalityReview.aspx
[2] http://www.cdph.ca.gov/data/statistics/Documents/MO-CA-PAMR-MaternalDeathReview-2002-03.pdf

Making an offer employees can't refuse

I never thought I would find a reason to relate to Sarah Palin's phrase "death panels," but a headline in the Boston Globe made me revise that position: "Plans steer patients to lower-cost hospitals" (you can read the full article at http://www.boston.com/business/healthcare/articles/2011/02/10/plans_steer_patients_to_lower_cost_hospitals/). The reporter, Liz Kowalczyk, writes that Blue Cross/Blue Shield (BC/BS) of MA lauched a new "product" purportedly to help small businesses continue to offer health insurance to their employees.

Once again, the health insurance establishment shows itself to know the price of everything but the value of nothing. This cost shifting by BC/BS reflects the belief that patients won't mind going to a community hospital instead of a teaching hospital because doing so will save money for themselves and, wink-wink, their insurers (Three guesses: What will the insurers do with the money saved?). After all, a hospital is a hospital and a specialist is a specialist, right?

Here's the tenor of the deal offered: "The Blue Cross Hospital Choice plan, which went on sale last month, charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI, at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women’s hospitals, Children’s Hospital Boston, and UMass Memorial Medical Center in Worcester. Companies and workers that sign up get a significant break on their health insurance premiums: a 4.5 percent increase for the first quarter of the year instead of a 10 percent increase."

What a deal! You can pay $1,000 more in your choice of ways: Either stay in the hospital following surgery or go home the same day as the surgery. In other words, you will pay $1,000 more no matter which choice you make! And, to sweeten the deal, BC/BS says that, while everyone pays an increase every year, if you choose this new plan, your increase will be less--but only for the first three months of the first year. To seal the deal, the state will pay each employee's three-month share of the premium when the employer enrolls. With choices like these, how could anyone refuse to enroll?

Wait until employees referred for medical treatment to a hospital find out they can't choose the hospital. For "those" people not affected by price--I guess you can call them "price inelastic"--it's no big deal. They will continue to go where they want for the services they need, regardless of cost. But, for the working-class guy or gal and their families, the new plan means they've been "price triaged"--they have less money to spend on their treatment, so the system sends them to the lowest-cost provider. As Stevie Wonder put it: "Livin' just enough for the city." Or, rather, dyin'.

To add insult to injury (pun intended), the reporter quotes the head of an insurance agency on why this plan is such a good idea: "These plans 'really help the employer and the employee start to understand what is driving health care premiums higher', said Paul Pietro, chairman of Mid-State Insurance Agency Inc., an insurance broker in Worcester. 'Simple things, like MRIs and CAT scans, if you’re just able to stay out of those hospital settings, that can save money. It helps everybody'." If you can't believe an insurance broker about what is good for your health, who can you believe?

So, while I don't want to encourage use of Sarah Palin's "death panel" phrase, the BC/BS MA plan comes closer to what Ms. Palin meant than President Obama's initiative.

What do you think?

I read the following today in the New York Times medicine section: "Republicans recalled, however, that they secured approval of two huge changes in domestic social policy that worked much better than Democrats had predicted. They remade welfare programs in 1996 and added a prescription drug benefit to Medicare in 2003. 'The idea that Republicans are just not interested in health care and won't do anything is belied by history', said Stuart M. Butler, director of the Center for Policy Innovation at the conservative Heritage Foundation." My interest lies in the second observation, that adding the prescription drug benefit to Medicare in 2003 demonstrates Republican in health care.

If you recall the phrase "donut hole," you understand why I question the facts behind Mr. Butler's superficially true statement. Here's how Reason magazine wrote about it at the time: "The cost is also likely to rise because of demands to close the drug plan's weird gap in coverage: After a $250 deductible, it will pay 75 percent of prescription drug expenses, up to $2,250 a year; but between $2,250 and $5,100, the point at which the plan starts paying 95 percent of costs, there will be no coverage at all." When one runs the numbers, one realizes that (a) Medicare enrollees are reimbursed up to $2,250 per year and (b) at that point, Medicare enrollees reimburse insurance companies for the same amount, up to $5,100. How did this come about?

As you might guess, the insurance industry had a lot to do with it. In fact, it was an insurance industry lobbyist who wrote the bill! Only in America.

What everyone forgets but should remember: The bulk of the new health insurance law won't kick in until 2014. No one knows how all those changes will affect care, cost, universality, etc. Of course, that hasn't stopped those who throw slings and arrows about ObamaCare, death panels, and other points on the right-hand side of the Sane<------>Lunacy scale from turning the dark sides of their imaginations loose:

• It will bankrupt the country
• It's a socialist plot
• "I don't want no gummint messin' with my healthcare!" (often heard from those ignorocrats who don't know that Medicare, Medicaid, etc. are government-run programs)

It will be a long time before the populace and those elected to govern them acknowledge that the real solutions--universal, cradle-to-grave, single payer--will take the concerns about who get what and how much and at what cost off the table. Then, we can focus on more important problems:

• Food
• Water
• Education
• Industry & jobs
• Security

Let me know your thoughts.

Laughter is the best medicine!

Healthcare--service delivery, insurance, portability, coverage--is serious business. However, even in the face of life-and-death decisions, occasionally a beam of levity emerges. Often, it seems even funnier because of the extremem alternative. Here are some examples:

1. Check out the Summer 2009 Lahey Clinic magazine (they didn't print a URL in the issue, so you will have to root around on the Internet). In New England, the Lahey Clinic is one of the top medical empires, rivaling even esteemed Mass General Hospital. But, in the article entitled, "New Wing To Open This Summer", white-haired white men in suits are pictured as the drivers behind the project. But, the hilarious--if pathetic--photos attest to the lack of understanding these senior executives have about the needs--and interests--of their patient base.

There are five non-people photos. The first shows the building. This is, of course, an example of the navel-gazing vision of 19th-century New England mill owners; the edifice complex. In a way, they want to show their tomb, as they believe it is something that will outlive them, and that succeeding generations will remember THEM because of the building they caused to be built; a.k.a. paid for.

This pales in comedic comparison to three of the four other shots, depicting (a) The Sophia Gordon Cancer Center, The Pain Center, and Opthalmology's State-of-the-Art (SOTA) Clinic. Well, let me rephrase that description. Pictured are NOT the cancer treatment facility, or pain center treatment rooms, or cutting-edge (no pun intended) eye treatment equipment. What the pictures do show are--wait for it--WAITING ROOMS!!! That's right. They're giving patients--people in pain, fear, and medical need--better, more modern, roomier places in which to WAIT FOR TREATMENT!! The fourth picture, of the new Emergency Room, shows not SOTA treatment rooms, but a pristine, well-lighted carefully constructed sign-in desk and filing cabinet (no doubt for paper files, which are SO 20th century).

You can't make this stuff up! But wait, there is more!

2. Read "The Immortalists", an article in the July 26 Boston Globe Sunday magazine by a freelance writer (and boomer) Jennifer Graham. The lead sentence reads:  "The baby boomers are the first generation that will-let's be honest-actually live too long." While she doesn't mention the word "euthanasia", that is exactly what she means. I won't quote other parts of the article here, but I will mention how she justifies expressing this opinion:  "Meanwhile, maybe they could lighten up on the All Bran and hit the trans fat. Just sayin'. For posterity's sake." Well, when it comes to being made into Soylent Green, Jennifer Graham can have my place in line.

That's the current phrase that's being used by all manner of people to justify their loony, loopy opinions:  "Just sayin'." I think the Globe printed this article because the author does make an attempt to take a tongue-in-cheek tone, but she totally fails. I'm just sayin'.

3. Like The Wall Street Journal? Who doesn't? It's a non-stop source of comedic content. Take, for example, the Friday, August 7th, front-page article headlined, "France Fights Universal Care's High Cost". The lead example provided by the author, David Gauthier-Villars, of the collapse of the French system--widely acknowledged as the finest health care delivery system in the world--is that a woman named Laure Cuccarolo went into early labor and had to call the local fire brigade to take her to hospital 30 miles away! C'est horrible!! In the United States, these things happen all the time. Thousands of moms have given birth in taxi cabs, subways, apartment bathrooms, etc. Mostly, they're just victims of circumstances, traffic jams, and poor planning. Years later, I bet their kids get a kick out of being told their godfather is a Russian taxi driver. 

The real reason, of course, that the Journal printed this story is not because it has any real news or even feature story value, but because propaganda theory demands such an approach. After all, if you can't attack the best example from the opposition of why its approach makes sense, then you try to tear that example down. Some people will believe it to be true. And, for the propagandist, that's the key:  Not whether something is true or false, but whether it is believable.

I am sure you can add to the list of examples I've provided--and, I wish you would. There is a tinge of gallows humor about all these citations, because we realize instinctively the insidious intent of the authors. Still, it is good to step back and laugh in the face of so much seriousness.

I'm just sayin'.

Let me know your thoughts.

No One Is Willing To Say, "Yes!"

Lots of people say, "No!" to President Obama's proposed healthcare reform package; mostly Republicans, whose entire legislative strategy for this session of Congress can be summed up in that one word. Unfortunately, even some Democrats are saying, "No!", too. Why they are doing this is a mystery, because if Obama's plan fails to be enacted, the Democrats will have handed the next election to the Republicans. 

Even in the contorted realm of political logic, this one defies description. Here's the situation:  the Democrats control both houses of Congress and the White House. Celebrating this outcome the day after the elections, any Democrat--be he yellow dog, blue dog (why do politicians have to have colors for everything?)--would be justified in thinking, "Now we're gonna turn things around and get this country back on its feet!"

But, hey--these are politicians we're talking about. They've got no spine or moral compass. All they care about, regardless of which party they're in, is getting re-elected. Want an example? If you were a U.S. Senator in 2002, knowing then what you know now, would you elect Harry Reid to be your leader? He's a textbook definition of gutless wonder. And Nancy Pelosi in the House? All I'll say is that she's even worse than Reid.

However, they're what we've got to unite the legislative troops behind President Obama's many initiatives, healthcare reform being the most pressing and immediate. We need people who can stand up and say, "Hell, YES! I'm gonna support my President and his programs!" Obama must feel like he's being nibbled to death by ducks. Here he's the head of a party that has all the pieces in place to go out and make real change in this country, to turn it around from the descent into Hell the previous administration engineered over eight years of rule by the foulest, most despicable, inbred, power-mad, war-hungry criminals this country has ever seen.

Even my wife, who is one of the smartest people I know, complains that she doesn't want a plan that takes her tax dollars to subsidize the healthcare of people who are obese and unexercised because they brought on their own health problems, like diabetes and heart failure. She's drunk the Republicans propaganda Kool-Aid, leading her to link this societal problem to Obama's healthcare reform package. THEY'RE MUTUALLY EXCLUSIVE! TWO SEPARATE PROBLEMS! YOU CAN WORK TO FIX THEM BOTH AT THE SAME TIME WITHOUT ANY CROSSOVER!

What do I mean? Obama's plan addresses the three key aspects of healthcare:  coverage, services, delivery. When his plan is enacted--never mind getting true universal coverage, like the rest of the civilized world--yes, fat people and their problems will be covered. BUT, THEY'RE NOT FAT BECAUSE THEY'RE COVERED. THEY'RE COVERED BECAUSE THEY'RE AMERICANS. Two separate problems. Get it?

Let me know your thoughts.

You can't make these names up!

Here's a quote from today's New York Times: "Richard Kronick, a professor at the School of Medicine at the University of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would." A doctor named Kronick--what are the odds?--especially with the topic he researched.

It would be interesting to see his research protocol for this study. After all, beyond the superficial data points that can be known--age, sex, marital status (but, how many times married? I bet not), homeowner or renter, etc.--the information one gathers is squishy at best.

For example, of what illness(es) did each person in the study die? As an example, I'll use my mother. She had kidney failure and was on dialysis three times a week for about six years. She also developed Alzheimer's, gradually and insidiously, over many years. She had pulmonary problems, due at least in part to smoking for about 40 years (she quit for the last 18 years of her life). The list continues: Macular degeneration, cataracts, migraine. But, the cause of death listed on her death certificate is acute aortic stenosis. Yes, she had health insurance, which covered just about every treatment and prescription. The question is: If you put her into your research categories of "Had Insurance" and "Lived to Age . . .", what have you learned? Very little, in my opinion.

This is a point I've mentioned before, but it bears repeating; in fact, this blog is in large part dedicated to hammering on this point until at least a majority of people in this country (and, elsewhere) accept it as valid: The people who make the decisions about your, and my, healthcare options, insurance, and eligibility are people who know the price of everything but the value of nothing. As a society, we have not evolved to the point where the fruits of innovation, discovery, initiative, and concern for the well-being of others are valued much less than the ability to show a profit. Until we do, healthcare--and education, childcare, work opportunities, etc.--will generally go to the people most able to afford them. This is a kind of rationing, which is the topic of the article from which the quote at the outset is taken.

As Damon Runyon once wrote, “The race is not always to the swift, nor the battle to the strong, but that's the way to bet.”

Let me know your thoughts.

We're in trouble . . .

. . . now that Professor Michael Porter published his new book about how to cut health care costs. To his credit, Professor Porter espouses a solution based on the principles that he lives and dies by and teaches to students at the Harvard Business School. But, as soon became clear during an interview on WBUR (an NPR affiliate at Boston University), Professor Porter's solution is a classic ivory tower confabulation having no relationship with the realities of health insurance and delivery of health care services.

His solution? Let's change the way we pay health care providers for their services. Instead of paying a fee for service, which we do now, Professor Porter proposes to pay physicians and others based on health care service outcomes. On the surface, this might seem to be reasonable. After all, when you take your car in to be repaired, you get a warranty on the work performed. Bring it back within the warranty period if anything specific to the repair goes wrong, and they'll fix it for free. Closer to the topic, a patient, or whoever is responsible for issuing payment, might determine that it took little Johnny three weeks to get over his cold rather than the "normal" recovery time of seven days. As a result, Johnny's pediatrician would be paid less. If little Johnny has a relapse (how do we know it's the same cold?), the doctor might receive no payment because of the unsatisfactory result of his treatments.

This is about as logical as Broadway Danny Rose saying to his paramour, when she tells him bad guys shot her ex-boyfriend through the eyes, "Oh, my god, he's blind!" "No, you idiot," she retorts, "he's dead!!"

A medical example might make this more apparent. Say you have a hernia repaired. How long does the doctor have to wait before h/she is paid? Well, if it's done laparoscopically, you walk out of the hospital the same day--the so-called outpatient procedure--and recuperate at home for 10 days-two weeks before resuming normal activities. If it's done with an incision, there's a two-day hospital stay, followed by six weeks of recuperation, during which you can't lift anything. Regardless of which kind of repair is done, any surgeon, if you ask (most patients do not), will tell you that the real test of a surgical repair comes 10 years after the repair. If it's still solid after all that time, you can think of yourself as "cured". Does the doctor have to wait 10 years to get paid?

Or, suppose you break a leg. Dr. Porter and a fair number of other folks with, as my father used to say, "more nerve than brains," will tell you that market forces will determine the path to the most cost-efficient solution to the problem. In other words, much as if you were buying a refrigerator or a computer, you will compare prices, brands, customer experiences, and other things that will lead to a wise purchase.

But, wait a minute! YOU HAVE A BROKEN LEG! YOU ARE IN PAIN! PERHAPS YOU CAN SEE THE BONE COMING THROUGH THE SKIN--A COMPOUND FRACTURE!! You are not going to shop around for the best price for treatment. You are about to go into shock. You must get to the nearest hospital STAT! "I don't care! Just end the pain", you tell the emergency room people as they track down the orthopaedic surgeon on call.

In that scenario, who will evaluate the doctor? On what basis will the evaluation be performed? Did you remember to ask the doctor about his warranty policy? It should be clear by now that Professor Porter and that tribe of business-oriented, cookie-cutter solution-loving people he represents--those who know the price of everything but the value of nothing--offer loopy approaches to problems that can't be measured or contained. They are squishy and fluid, not solid and of fixed shape.

So, avoid the trouble this kind of approach brings. Everybody knows the real solutions to the problem: single-payer, universal coverage, cradle-to-grave coverage. Demonstrating that they will do the job and contain the costs is the next real challenge.

Let me know your thoughts.