Drug Health Care 2013: March 2013

Friday, March 29, 2013

Pennsylvania Tightens Abortion Rules Following Clinic Deaths

March 28, 2013

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All Things Considered

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A police car is posted outside the Women's Medical Society in Philadelphia, on Jan. 20, 2011. Dr. Kermit Gosnell, accused of murder, performed abortions in the clinic.

Matt Rourke/AP

A Philadelphia doctor who performed abortions is on trial for murder. Kermit Gosnell, 72, is accused in the deaths of a female patient and seven babies who the prosecutor says were born alive. District Attorney R. Seth Williams laid out the case in disturbing detail in a grand jury report last year.

When authorities raided Gosnell's clinic in 2010 they found squalid conditions: blood on the floor, the stench of urine and a flea-infested cat wandering through the facility.

In court, Gosnell's attorney said his client is unfairly being held to standards one might expect at the Mayo Clinic. A jury will decide Gosnell's fate, but what is clear now is that state regulators were not doing their job.

"Unfortunately and tragically in Pennsylvania, facilities were going uninspected for years," says Maria Gallagher, a lobbyist with the Pennsylvania Pro-Life Federation. Gosnell's clinic went 17 years without an inspection, according to prosecutors.

"As for Dr. Gosnell's case, there were admitted failures in oversight at the department," says Aimee Tysarczyk, press secretary for Pennsylvania's Department of Health. But now the agency is inspecting abortion clinics regularly and making sure they meet state standards.

In 2011, the Gosnell case was mentioned frequently as Pennsylvania's General Assembly passed a law that put stricter requirements on abortion clinics. Now most clinics in the state are held to the same standards as outpatient surgery centers. That means abortion clinics must have doors and elevators that can accommodate a stretcher in case something goes wrong.

For some clinics, such as Planned Parenthood of Southeastern Pennsylvania, that meant expensive remodeling.

"Overall the cost was about $450,000 to get two of our facilities into compliance," says CEO Dayle Steinberg. The nonprofit had to install hands-free sinks. Tile floors were torn out and replaced with seamless floors that are easier to clean. The clinic's heating and air-conditioning system was upgraded and a new room was built to house sterilization equipment.

Steinberg says her organization already had a low rate of complications � less than one-tenth of 1 percent. She contends Pennsylvania's new requirements did nothing to improve services for women at her clinics.

"They were thinly disguised as improving patient safety, when really it was about increasing the cost for abortion providers � hoping that some of them wouldn't be able to afford it," Steinberg says.

Enlarge image i

An undated photo of Gosnell released by the Philadelphia District Attorney's office. Gosnell, who catered to minorities, immigrants and poor women at the Women's Medical Society, was charged with murder in the deaths of a patient and seven babies.

The author of the legislation that put the tougher regulations in place disputes that.

"This is all about patient safety," says state Rep. Matt Baker. "We made it clear that we weren't going to arbitrarily and capriciously shut down abortion clinics."

Abortion opponents were not the only ones supporting Baker's legislation. State Rep. Margo Davidson says her 22-year-old cousin, Semika Shaw, died of sepsis and infection after an abortion at Gosnell's clinic. Davidson delivered an emotional speech on the Statehouse floor in 2011.

Dedicating her vote to Shaw, Davidson said she hopes the law will safeguard the health of women seeking abortions, "so that never again will a woman walk into a licensed health care facility in the state of Pennsylvania and be butchered, as she was."

Now that the law is in effect there are five fewer abortion clinics in Pennsylvania, though it's unclear whether the stricter regulations were the only reason they closed. That leaves 17 other providers in the state. Backers of the law say now if a woman enters a clinic in a poor neighborhood � or a rich one � she can be assured it is meeting a basic standard of care.

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Saturday, March 23, 2013

Health Insurers Warn on Premiums

From the Wall St. Journal –

Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation’s biggest firm projecting that rates could more than double for some consumers buying their own plans.

The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year�a subject of rigorous debate.

The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.

The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law’s effects will be. Carriers will be filing proposed prices with regulators over the next few months.

Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers’ premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down.

Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people’s health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees’ health status and claims history.

Friday, March 22, 2013

Doubts Raised About Cutting Medicare Pay In High-Spending Areas

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Colorado Doctors Treating Gunshot Victims Differ On Gun Politics

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Wednesday, March 20, 2013

Law Says Insurers Should Pay For Breast Pumps, But Which Ones?

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Saturday, March 16, 2013

Matchmaker, Er, Match Week, Make Me A Doctor

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Friday, March 15, 2013

Seniors are Saving Money Today and Tomorrow, Thanks to Health Care Law

Like thousands of Americans, Vero Beach, Florida resident William Morris is suffering from a rare, but treatable cancer. Compounding that difficult diagnosis is further bad news that, like many cancer drugs, the medicine he so desperately needs is very expensive.
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But help with this cost came for William and his wife Suzanne from newly enhanced benefits under Medicare Part D � made possible by the health care reform law, the Affordable Care Act.� Thanks to the law, William saved $2,000 on the cost of his chemotherapy drugs.

Suzanne and William Morris are not alone. For years, seniors have watched their health care bills go up. The Affordable Care Act helps folks like the Morris family, and other seniors, by closing the gap in prescription drug benefits known as the �donut hole.��To assist those in the coverage gap, the law adds increased help for seniors and people with disabilities over time until the donut hole closes in 2020.� �William and Suzanne benefited from that help when they received big discounts on the medicine they needed.� People in the coverage gap also receive a 50% discount on expensive brand-name drugs covered by Part D and a 7% discount on generic medicines.

Today, we announced that in 2011 about 3.6 million people with Medicare benefited from donut hole discounts�saving a total of $2.1 billion, or an average of $604 per person.
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And a new report released today finds that these discounts and other parts of the Affordable Care Act will lead to even bigger savings in the years ahead. According to the report, the average person with Medicare will save approximately $4,200 from 2011 to 2021, while those with high prescription drug costs will save much more � as much as $16,000 over the same period.� This is especially good news for people with chronic conditions such a diabetes and high blood pressure who must take their medication every day for many years.

For older Americans and people on disabilities who live on fixed incomes the value of this help cannot be overstated. Evidence indicates that as many as 25 percent of people with Medicare Part D stop taking their medicine when they are in the coverage gap. Thanks to the Affordable Care Act, they won�t have to.
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For people like William who are fighting life-threatening or debilitating diseases, this benefit can help them heal, improve the quality of their lives and prevent the sometimes devastating results of leaving chronic conditions untreated.

Thursday, March 14, 2013

Healthcare Advocates: Time To Bury the Hatchet

Health insurance executives breathed a sigh of relief when the Supreme Court upheld their favorite part of the Affordable Care Act (the part that is one of the least popular among the rest of us)�the individual mandate. And then, I�m confident, moments after they exhaled, they were on a conference call with their army of lobbyists and PR people to approve a strategy, developed months ago, to gut the provisions that the rest of us do like. These are the parts of the law that require insurers to provide coverage to millions they have long shunned like lepers, and that make the most egregious but profitable industry practices a thing of the past, like canceling our policies when we get sick.

Part of their strategy will be a propaganda campaign to persuade us that the consumer protections in the law are not in our best interest. �The new health care reform law includes a number of provisions that will increase the cost of health care coverage,� warned America�s Health Insurance Plans (AHIP), the industry�s largest PR and lobbying group, after the ruling. The provisions in question are the ones that help finance the expansion of coverage, make premiums more affordable for older Americans and outlaw benefit plans that provide inadequate coverage. AHIP�s real concern, of course, is that such measures will negatively impact insurers� profit margins.

The strategy will also encourage the industry�s political and media allies to keep referring to �Obamacare� as a �government takeover� of healthcare. This fabrication has been widely accepted as truth�one reason the Affordable Care Act polls so poorly.

Finally, the strategy will seek to exploit the hostility many on the left feel toward the ACA�and the deep divisions among progressives over whether it really is a step in the right direction. Insurance executives are counting on single-payer progressives to stay so disillusioned with the law and those responsible for it that they will boycott the November election, helping the industry�s Republican friends to take back Washington.

I�m sure that conference call took place because I was a regular participant in many like it while serving as head of communications for Humana and, later, Cigna, two of the country�s largest insurers. Right up until the day I walked out the door in 2008, I was working with my peers at other companies on such a strategy to influence public opinion. One of the reasons I quit�and became a vocal critic of the industry I served for two decades�was that I didn�t have the stomach to be a part of yet another deception-based effort to undermine reform. During my career I helped implement the industry�s game plan to defeat the Clinton reform proposal. A few years later I helped lead a behind-the-scenes fearmongering campaign, fronted by the National Federation of Independent Business but planned and financed by the insurance industry, to make sure Congress never passed a Patient�s Bill of Rights. Congress never did (although the Affordable Care Act does contain some of those �rights�).

One of the things that differentiates insurance company executives from many healthcare reform advocates, I�ve learned, is that the former never approach any high-stakes political game without a well-planned strategy, one that seeks to take advantage of their opponents� weaknesses and divisions. It�s true that without reform advocates, President Obama wouldn�t have had a bill to sign into law. But in other battles, we in the industry found that advocates could almost never seem to craft a well-planned strategy or sustainable coalition. One reason we don�t have universal coverage in the United States today is the failure of these same advocates to recognize the need for a strategy�and the need to compromise.

Senator Ted Kennedy, who fought so hard for universal coverage, learned a tough lesson on compromise when Richard Nixon was president. Worried that Kennedy and other liberal Democrats might be able to get enough votes in Congress to pass a single-payer bill, Nixon proposed an alternative plan that would have required employers to provide health insurance to their workers. It also would have had the government finance coverage for low-income Americans who didn�t have a job. Kennedy refused to negotiate seriously, thinking he could get his own reform plan enacted the next time a Democrat�maybe even himself�occupied the White House. He condemned Nixon�s plan as a windfall for insurance companies. (Sound familiar?)

Kennedy said years later that his refusal to bargain with Nixon was the biggest regret of his career. He had underestimated the ability of the insurance industry, the American Medical Association and other entrenched special interests to join forces and forge a strategy to ensure that, even after the Democrats took back the White House in 1976 and solidified their control of both houses of Congress, single-payer legislation would go nowhere. This experience was one of the reasons he supported reform legislation nearly forty years later that he knew would fall short of achieving universal coverage and that would be condemned by many die-hard single-payer supporters as, yes, a windfall for insurance companies.

Among today�s die-hards (many of whom are good friends)are members of Physicians for a National Health Program and Healthcare-NOW! They are still furious at the president and the Democrats for their baffling decision not to give single-payer legislation a decent hearing and for compromising too early and too often, in their view, with the special interests. Many are no longer on speaking terms with the staff of Health Care for America Now, the umbrella organization for unions and advocacy organizations, which didn�t join their calls to kill the bill when the public option was stripped out. They believed, as Kennedy did years earlier, that more could be gained by starting over. Many still do and could be seen alongside the Tea Partiers on the steps of the Supreme Court, demanding the entire law be struck down.

These divisions are playing right into the hands of my former colleagues. Progressives must bury the hatchet and get down to the business of developing a strategy to move forward. The two factions actually see eye-to-eye on many things, including the fact that the law does much good but does not get us close enough to universal coverage, and that Obama and Congressional Democrats made strategic and tactical blunders throughout the reform debate. Now they must recognize that their true opponents are the people I used to work for�not one another.

States Pushing Medicaid Ruling to Cut Rolls Immediately

It’s true that states could, after 2014, reduce their Medicaid rolls without the potential consequences of losing their entire federal share of funding. But some states aren’t waiting until 2014.

The court, which upheld most of the law, struck down penalties for states choosing not to expand Medicaid. A few states are also trying to go farther, arguing that the ruling justifies cuts to their existing programs.

Within hours of the Supreme Court’s ruling on June 28, lawyers in the Maine attorney general’s office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state’s rolls�including 19- and 20-year-olds�beginning in October to save $10 million by next July.

“We think we’re on solid legal ground,” Attorney General William Schneider said in an interview. “We’re going to reduce eligibility back to the base levels in a couple of areas,” he said. Maine, like some other states eyeing cuts, earlier expanded its Medicaid program beyond national requirements.

Other states, including Wisconsin and Alabama, are expected to follow Maine’s lead, though there is disagreement over whether the high court gave the states such leeway. That could lead to battles between states and the federal government that could drag the health law back to the courts. New Jersey and Indiana also said they were evaluating the decision and did not rule out challenging the requirements.

This looks to me like an expansion of what the Court actually said. The Court’s ruling specifically regarded tying the Medicaid expansion to the initial program funding as unconstitutional. If the cuts contemplated now started before the expansion, that seems to fall under the same maintenance of effort rules that remain in place until 2014. This will take further litigation and a new ruling to figure out.

But it does show that states view the Medicaid program as something to raid, not something to nurture. They want to push the limits of the ruling to make as many cuts as possible. So suggestions that red state governors will not be able to pass up a “good deal” like the Medicaid expansion doesn’t match with this reality.

Meanwhile, given these statistics out of Texas, it’s not clear whether an expansion will really result in an expansion.

The number of Texas doctors willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, showed a survey by the Texas Medical Association provided to The Associated Press on Sunday before its Monday release.

Only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients. In 2000, that number was 67 percent.

Texas doesn’t have enough primary-care doctors to serve the size of the state or its rapid population growth. The doctors’ reluctance to take on new Medicaid patients comes at a bad time, since the new federal health care law proposes adding 6 million additional people to the Texas Medicaid rolls with the intent of ensuring every U.S. citizen has access to health insurance. The state ranks last in the nation in terms of percentage of people insured, with 27 percent of Texans without any kind of insurance, according to a March Gallup poll.

Obviously, having health insurance coverage that 31% of doctors will honor is better than having no coverage at all. But geographic distribution matters here. Texas is a big place, and a low-income resident, on the off chance that the state expands its Medicaid coverage, may not be able to find a doctor for many miles. The primary-care doctor problem is central to this debate. States predisposed to reject the expansion will justify it by saying they don’t have the resources to accommodate all these new eligible patients on the Medicaid rolls.

Tuesday, March 12, 2013

Helping Medical Students Choose Primary Care

As a fourth year medical student, you make one of the toughest decisions of your life: what field of medicine to enter. Today, with the help of the Affordable Care Act, we are launching a new effort to help more medical students become primary care physicians.

The $12 million National Health Service Corps Students-to-Service Loan Repayment Program Pilot program, supported �by the Affordable Care Act, aims to make it easier for decision-making fourth-year medical students to choose primary care as their field of choice.

The program provides support to medical students by helping to repay their often burdensome loans in return for a commitment to serve as primary care clinicians in an underserved area upon completion of a residency program. ��Students can receive loan repayment of up to $120,000 in return for three years of full-time service or six years of half-time service in areas of �the country where there are primary care physician shortages .�

We are particularly excited about this new program because it not only boosts our nation�s primary care workforce, but it boosts our National Health Service Corps. �Just last month, we� announced that we now have more than 10,000 NHSC clinicians. �That means nearly three times the number of NHSC clinicians are working in communities across America than just three years ago, thanks to investments like those from the Affordable Care Act. �And these clinicians are providing quality care to more than 10.5 million people at more than 17,000 NHSC health care sites in urban, rural and frontier areas. �That�s an amazing number, and with this new pilot program, we look forward to serving even more patients in needy communities across the country as we expand the primary care workforce.

Interested students can apply online here. The NHSC anticipates making 100 Student-to-Service Loan Repayment Program awards in the pilot year.� The 2012 NHSC Students to Service application cycle will remain open until December 14, 2011.

Monday, March 11, 2013

How The Sequester Could Affect Health Care

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Debt Collector Is Faulted for Tough Tactics in Hospitals

From the New York Times –

Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.

This and other aggressive tactics by one of the nation�s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.

The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.

In some cases, the company�s workers had access to health information while persuading patients to pay overdue bills, possibly in violation of federal privacy laws, the documents indicate.

The attorney general, Lori Swanson, also said that Accretive employees may have broken the law by not clearly identifying themselves as debt collectors.

Accretive Health has contracts not only with two hospitals cited in Minnesota but also with some of the largest hospital systems in the country, including Henry Ford Health System in Michigan and Intermountain Healthcare in Utah. Company executives declined to comment on Tuesday.

Although Ms. Swanson did not bring action against the company on Tuesday, she said she was in discussions with state and federal regulators about a coordinated response to Accretive Health�s practices across the country. Regulators in Illinois, where Accretive is based, are watching the developments closely, according to Sue Hofer, a spokeswoman with the State Department of Financial and Professional Regulation.

�I have every reason to believe that what they are doing in Minnesota is simply company practice,� Ms. Swanson said in an interview, but declined to provide details.

In January, Ms. Swanson filed a civil suit against Accretive after a laptop with patient information was stolen, saying that the company had violated state and federal debt collection laws and patient privacy protections. That action is still pending.

An Accretive spokeswoman declined to comment on whether other states were looking into its practices and issued a brief statement, �We have a great track record of helping hospitals enhance their quality of care.� In its annual report, the company said it was cooperating with the attorney general to resolve the issues in Minnesota.

As hospitals struggle under a glut of unpaid bills, they are reaching out to companies like Accretive that specialize in collecting medical bills.

Hospitals have long hired outside collection agencies to pursue patients after they have left hospital facilities. But financial pressures are altering the collection landscape so that they are now letting collection firms in the front door, according to Don May, the policy adviser for the American Hospital Association, a trade group.

To achieve promised savings, hospitals turn over the management of their front-line staffing � like patient registration and scheduling � and their back-office collection activities.

Concerns are mounting that the cozy working relationships will undercut patient care and threaten privacy, said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. �The mission of these companies is in direct opposition to the supposed mission of these hospitals.�

Still, hospitals are in a bind. The more than 5,000 community hospitals in the United States provided $39.3 billion in uncompensated care � predominately unpaid patient debts or charity care � in 2010, up 16 percent from 2007, the hospital association estimated.

Accretive is one of the few companies specializing in hospital debt collection that is publicly traded. Last year, it reported $29.2 million in profit, up 130 percent from a year earlier.

Sunday, March 10, 2013

Many Medicaid Patients Could Face Higher Fees

Millions of low-income people could be required to pay more for health care under a proposed federal policy that would give states more freedom to impose co-payments and other charges on Medicaid patients.

Hoping to persuade states to expand Medicaid, the Obama administration said state Medicaid officials could charge higher co-payments and premiums for doctors� services, prescription drugs and certain types of hospital care, including the �nonemergency use� of emergency rooms. State officials have long asked for more leeway to impose such charges.

The 2010 health care law extended Medicaid to many childless adults and others who were previously ineligible. The Supreme Court said the expansion of Medicaid was an option for states, not a requirement as Congress had intended. The administration has been trying to persuade states to take the option, emphasizing that they can reconfigure Medicaid to hold down their costs and �promote the most effective use of services.�

In the proposed rule published Tuesday in the Federal Register, the administration said it was simplifying a complex, confusing array of standards that limit states� ability to charge Medicaid beneficiaries. Under the proposal, a family of three with annual income of $30,000 could be required to pay $1,500 in premiums and co-payments.

As if to emphasize the latitude given to states, the administration used this heading for part of the new rule: �Higher Cost Sharing Permitted for Individuals With Incomes Above 100 Percent of the Federal Poverty Level� (that is, $19,090 for a family of three).

Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, said the administration had not adequately defined the �nonemergency services� for which low-income people could be required to pay. In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out.

�This is just a way to reduce payments to physicians and hospitals� from the government, Ms. Tomar said.

With patients paying more, the federal government and states would pay less than they otherwise would. Medicaid covers 60 million people, and at least 11 million more are expected to qualify under the 2010 law. The federal government pays more than half of Medicaid costs and will pay a much larger share for those who become eligible under the law.

In the proposed rule, the administration said it had discovered several potential problems in its efforts to carry out the law.

First, it said, it has not found a reliable, comprehensive and up-to-date source of information about whether people have employer-sponsored health insurance. The government needs such information to decide whether low- and middle-income people can obtain federal subsidies for private insurance.

The subsidies can be used to buy coverage in competitive marketplaces known as insurance exchanges. Under the law, people can start enrolling in October for coverage that starts in January 2014, when most Americans will be required to have health insurance. People who have access to affordable coverage from employers will generally be ineligible for subsidies.

In applying for subsidies, people must report any employer-sponsored insurance they have. But the administration said it could be difficult to verify this information because the main sources of data reflect only �whether an individual is employed and with which employer, and not whether the employer provides health insurance.�

Since passage of the health care law, the administration has often said that people seeking insurance would use a single streamlined application for Medicaid and the subsidies for private coverage. Moreover, the state Medicaid agency and the exchange are supposed to share data and issue a �combined eligibility notice� for all types of assistance.

But the administration said this requirement would be delayed to Jan. 1, 2015, because more time was needed to establish electronic links between Medicaid and the exchanges.

Leonardo D. Cuello, who represents Medicaid beneficiaries as a lawyer at the National Health Law Program, expressed concern.

�Under the proposed rule,� Mr. Cuello said, �many people will be funneled into health insurance exchanges even though they have special needs that are better met in Medicaid. And if you asked the right questions, you would find out that they are eligible for Medicaid.�

The federal government will have the primary responsibility for running exchanges in more than half the states. About 20 states are expected to expand Medicaid; governors in other states are opposed or uncommitted.

The proposed rule allows hospitals to decide, �on the basis of preliminary information,� whether a person is eligible for Medicaid. States must provide immediate temporary coverage to people who appear eligible.

Kenneth E. Raske, president of the Greater New York Hospital Association, said this could be a boon to low-income people. �Currently,� he said, �only children and pregnant women are presumed eligible for inpatient admissions under Medicaid in New York.�

The public has until Feb. 13 to comment on the proposed rule. Comments can be submitted at www.regulations.gov.

Saturday, March 9, 2013

UnitedHealthcare Pledges To Keep Popular Coverage, Regardless Of Supreme Court

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Teaming Up with WebMD to Take Your Questions

Starting August 1st, and for the first time ever, women will have access to potentially life-saving preventive care free of charge.� Thanks to the health care law, services including well-woman visits, gestational diabetes screening, breastfeeding support and supplies, contraception, domestic violence screening, and more will be covered without cost sharing in new health plans starting August 2012 � giving women more control over their own health.

To talk about these new benefits becoming available for women, we are teaming up with WebMD to take your questions on what this means for women and their families. Please join HHS Secretary Kathleen Sebelius and Annic Jobin, WebMD�s Director of News and Partnerships, for a live online discussion on Wednesday, August 1st at 1:30pm EST.

You can watch the conversation live at www.healthcare.gov/live, and submit questions on Facebook at www.facebook.com/healthcaregov or on Twitter using the hashtag #womenshealth. You can also join the conversation here on WebMD.

To learn more about the preventive benefits that many insurers are required to cover, visit www.healthcare.gov/prevention. We hope you can join us for this important discussion.

Friday, March 8, 2013

The Lion Sleeps Tonight

Spoiler alert: this is not a fawning, gushing, lie-filled eulogy of Saint Edward Kennedy. Read no further if you believe the �Liberal Lion� or as I prefer to call him, the �Lion King,� actually made this country a healthier, more equitable place to live in. You have been warned�.

*Conflict of interest, almost full disclosure: I grew up in Massachusetts and spent several weeks each summer in Buzzards Bay, Cape Cod at my aunt�s house. There were yearly treks to Hyannis Port to pay respects to slain President John F. Kennedy and to gaze forlornly at his eternal flame. We gaped slack jawed though, at the massive, sprawling and luxurious �Kennedy compound� with stunning ocean views. I was taught to believe the Kennedy clan was royalty, a little piece of Camelot in the Yankee Bay State. Portraits of Kennedy family members were embossed on everything from mugs to rugs.

This is the anti-eulogy, the antidote to the reams of press coverage proclaiming Kennedy – the spawn and scion of one of America�s most wealthy and powerful families � to be the most effective, spectacular lawmaker in the history of the Senate, a man who worked on behalf of the poor and downtrodden. This latter characterization of Kennedy makes me crazy. He cared about the poor and oppressed when it was politically expedient and when pushed by events happening around him. And it was always about him, about advancing his career and individual and family notoriety for supposedly doing good deeds, of getting yet another piece of legislation or building named �Kennedy.� In fact, Saint Edward knew very little of the lives of the oppressed and disenfranchised in America. He shuttled decade after decade between the secluded and secured, exclusive enclave of the Kennedy Compound in Massachusetts and the inner sanctums of the �Millionaires Club,� er, the United States Senate in Washington, DC. According to the Center for Responsive Politics, Teddy was the seventh richest member of Congress weighing in at over $100,000 million.

Kennedy never worked to get anything: his career in politics was handed to him the old fashioned way, via family connections. Nepotism. Moreover, name recognition and the family fortune bought him a lifetime seat in the Senate that the Kennedy clan always believed was their personal property and birthright.

Much was made of the Lion King�s �unbridled appetites,� in particular for women and booze. That rich and powerful playboy men have numerous wives, girlfriends, mistresses, liaisons, and messy affairs is not surprising. Membership in the good ole� boys club of rich and powerful men bestows that right. That Kennedy drank heavily for most of his life is not surprising, either. Think about it: when you are caught cheating at Harvard and are humiliated and expelled; when you�re dodging the draft and at a loss as to what to do with your pampered and privileged life and daddy gets you a cushy, do-nothing NATO job in Paris for a couple of years; when you feel inferior to your older, smarter brothers (one, of course, made it all the way to the highest office in the land) and then both are murdered, shot in cold blood; when one night you drive your car off a bridge into the sea and are responsible for your passenger drowning to death and you head home and go to sleep and the next day your first instinct is to call your closest political advisors; when a sister and nephew die in plane crashes; when you almost die in a plane crash, well, there are more than a few reasons to drink. Night after night, year after year Teddy had a lot of reasons to hit the bootleg scotch daddy trafficked in. I could almost forgive and forget Kennedy all those mistakes and tragedies because despite the silver spoon in his big Brahmin Boston brogue of a mouth, Teddy was curiously, stubbornly, human.

What I cannot ever forgive or ever forget is Kennedy�s record on health care. He called it �the cause of my life.� Even a cursory glance at the senator�s record shows he was a colossal failure at the cause of his life. How is it that the American mainstream media and even some left-wing media get away with promoting Kennedy as successful reformer of health care when the country is facing a health care crisis of staggering proportions? Two statistics speak volumes: 50 million uninsured and at least 20,000 people die every year due to lack of access to health care. If Kennedy was so committed to the plight of the uninsured and making health care accessible to everyone in the 46 years he was in the senate, why the hell is the health care crisis killing so many, swelling the ranks of the uninsured every day, and threatening to crash the economy? Here�s why: decades ago Kennedy sold out to the blood sucking, profit-hungry, killer insurance corporations.

It�s hard to believe looking back now, but the Lion King started out with the right idea. In1971, Kennedy, along with Representative Martha Griffiths (D-Mich.), supported the Health Security Act. It eliminated the role of the commercial insurers entirely and created a single-payer, government financed health care system. The Kennedy-Griffiths bill, as it came to be called, was a watershed in American politics and would have, if passed, made health care a human right and divorced health care from employment status for good. He had solid backing from the labor movement. Kennedy faced off against evil President Richard Nixon�s health care plan and charged that it �would provide the insurance industry with a windfall of billions of dollars annually.� Teddy was right.

Then between 1971 and 1974, Kennedy gave up, he completely abandoned single-payer, national health care and became the great compromiser. His next piece of health care legislation was the Mills-Kennedy Bill. It was the opposite of Kennedy-Griffiths. It maintained the link between employment and insurance, didn�t include the entire population and required those with coverage to shoulder much of the expense of basic medical care through high deductibles and co-pays. Labor refused to endorse the Mills-Kennedy bill and in a meeting with members of the Committee for National Health Insurance, Kennedy reportedly was furious and belligerent and said he resented the charge made against him that he was �selling out on the health issue.� Consumer advocate Ralph Nader and his organization Public Citizen Research Group also criticized Kennedy for selling out and caving to the insurance industry. But that�s exactly what Kennedy did and he never fought for single-payer health care again.

In 1979, Kennedy submitted to Congress the mistitled Health Care for All Americans Act, which became known as the Kennedy-Waxman bill. It was another rotten compromise that didn�t uproot the fundamental problems at the core of the health care system. It required employers to pay up to 65 percent of employee health insurance premiums. The legislation went nowhere and the number of uninsured increased.

Fast forward to 1993. Kennedy was an ardent supporter of the Clinton health care reform overhaul. Hillary Clinton organized a Health Care Task Force of powerful members of the insurance and pharmaceutical industries. The health care reform proposal from members of Physicians for a National Health Program (PNHP) was arrogantly dismissed. The meetings were conducted in secrecy and the Association of American Physicians and Surgeons, along with several other groups, filed a lawsuit against Clinton over the closed-door meetings. The bill that finally emerged was 1000 pages long, the complexity – stunning. It was a disaster: an enforced mandate for employers to provide health insurance to workers through health maintenance organizations (HMO�s.) It never passed, but the terrible era of HMO hegemony began.

The Kennedy-Kassebaum bill (1996) was another incremental attempt to stop the hemorrhaging in the employment-based system of health care provision. It was DOA – dead on arrival. Named the Health Insurance Portability and Accountability Act (HIPAA), it was intended to narrow conditions under which insurers could refuse coverage. What finally passed was a watered-down bill that eliminated a few of the more egregious practices of the small group market. However, HIPAA didn�t stipulate that health insurance policies had to be offered at an affordable rate and it contained enough loopholes to allow insurers to avoid covering people with chronic and �expensive� health conditions. At the time of its passage, the American Academy of Family Physicians (AAFP) released a statement saying, �Although this doesn�t solve the nation�s problems with lack of insurance and under-insurance, this legislation does increase the security blanket for many who can already afford health coverage. Now, Congress and the president must turn their attention to extending affordable health insurance to the more than 40 million Americans who have no health coverage.� Gee Teddy, thanks for your life-long commitment to make quality health care a reality for all Americans.

The year 2006 was a double debacle and setback for fundamental health care reform. Kennedy heartily supported the draconian Massachusetts mandate that funneled millions of government subsidized dollars into insurance industry coffers and punished people that didn�t buy their defective product by stealing their tax refund. Three years later the Massachusetts mandate is unraveling as we knew it would. It never included undocumented immigrants, benefits for legal immigrants are being drastically cut, and over 200,000 people are still uninsured. Kennedy�s second miscast vote was in favor of the now widely acknowledged pharmaceutical industry give away, commonly known as Medicare Part D. Besides being inordinately complex, the legislation forbids the federal government from negotiating drug prices. Kennedy sided with the drug company vampires in bamboozling and ripping off millions of seniors.
With Obama�s election, Senator Kennedy, by now the all-time health care legislation loser, again went to work on health care reform, but this time with an incurable brain tumor growing in his head. President Obama promised transparency and all views would be heard in the health care debate. Saint Edward, accountable to no one, held secret, closed door meetings with the same cast of crooked corporate characters responsible for the health care crisis. Perched at �Ted�s table� were lobbyists from America�s Health Insurance Plans (AHIP), big PhRMA, and the Business Roundtable. Single-payer activists didn�t find out about the clandestine meetings until the New York Times ran a front page article exposing them and were rightfully outraged at being shut out once again. Kennedy�s proposal to reform health care this last time around: the Massachusetts Mandate grafted onto the entire country.

The more things changed, the more Kennedy stayed the same. He never heeded his oft quoted, unoriginal and hokey one liner, �Sometimes a party must sail against the wind.� He sailed with the entrenched, profit-gouging, corporate, hurricane force winds that control health care, inflict, and are responsible for unspeakable suffering and death. Kennedy bears responsibility, too, and has the blood of hundreds of thousands of people on his hands. Because it could have turned out very differently. If Kennedy hadn�t given up the fight for the National Health Act in 1971 the United States wouldn�t be mired in a massive health care meltdown today. Kennedy was especially well positioned to take on the powerful insurance industry and pass legislation that evicted them from health care and created a government financed health program. He was independently wealthy and didn�t need corporate campaign donations to fund his reelection campaigns. He had the power and prestige of the Kennedy name, the connections and tons of money to keep up the fight for as long as it took. Remember, he served in the senate for 46 years! If the liberal lion had shown any courage or had any balls (lions have big balls, but perhaps not if they�re liberals) and actually stuck to the uncompromising principle that health care is a human right for all, not a commodity, he could have claimed a well deserved and genuine legacy as a champion of health care reform, he could have gone down in history as the Aneurin Bevan of American health care. But he didn�t, so he can�t.

An astute politician summed up Kennedy�s career this way: �Usually at the end of the day, he [Kennedy] would make a compromise that his most loyal fans would be disappointed with. �Oh, you�ve given up too much, Teddy� � but he would know how much you needed to give up to pass the bill��

Helen Redmond, LCSW, CADC, is a member of Chicago Single-Payer Action Network (CSPAN.) She blogs at http://helenredmond.wordpress.com and can be reached at redmondmadrid@yahoo.com

This article was written in memory of Marilyn Clement and Nick Skala. Marilyn was the national coordinator for Health Care Now! and Nick was a senior research associate at Physicians for a National Health Program (PNHP.) Both were fierce advocates for single-payer and never sold out.

For Midwife, 71, Delivering Babies Never Gets Old

March 6, 2013

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Morning Edition

7 min 31 sec Playlist Download Transcript

Editor's Note: This video contains a scene of childbirth that includes graphic imagery and explicit language.

Credit: John W. Poole/NPR

Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce.

Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be.

Sparling founded an obstetrics and gynecology practice called Womancare 31 years ago. During her career, she has delivered around 2,000 babies. Last year, she decided she'd retire from that part of her job, though she continued to see patients in the office. She didn't miss being on call � the person who's awakened in the middle of the night when a patient goes into labor.

"When you're on call, you just can't really plan for anything. You just need to be available, both physically and your heart and soul available, to do midwifery work. And when it's an unknown, I think it's a little bit more draining," Sparling says.

A few months ago, one of the other midwives in her practice had to take an extended medical leave. So Sparling had to go back to being on call.

Enlarge image i

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

"It would be horrible if I had to do this and stay up all night and didn't love what I do," she says.

'A Wonder To Behold'

It's just past daybreak at the hospital's birth center, and Sparling has been here since 4 a.m. with patient Amanda Trujillo, who is about to deliver her third baby. It's her second with Sparling as her midwife. The two are comfortable with each other. The atmosphere is relaxed. Sparling tells Trujillo to just be patient a little while longer.

When Sparling leaves Amanda and goes out to the nurses' station in the birth center, her spiky white hair sets her apart from her younger colleagues. Nurse Kathy Clarkson makes a point of telling her she was missed during her brief semi-retirement.

"We're glad that you're back working again, Dian," Clarkson says. "When you retired, we were all crying."

Nurse Julie Christin says that as a midwife, Sparling works more closely with women in labor than do most MDs.

"Physicians rely on us to do a lot of the labor support," Christin says. "But Dian spends a lot of time with her patients when they're in labor. I like that, because then she's involved and can make decisions quicker, and does what the patient wants to do, which is good."

Sparling is "in tune with them emotionally as well as physically," Clarkson says.

And then it's time for Sparling to get back in tune with Trujillo, who's ready to start pushing. Her husband, Isaiah, supports one leg, and delivery nurse Keri Ferguson supports the other.

“ It would be horrible if I had to do this and stay up all night and didn't love what I do.- Certified Nurse Midwife Dian Sparling As Amanda Trujillo works, her husband, Sparling and Ferguson cheer her on and report on the baby's progress. First his head emerges. Then his shoulders. And finally, there is a new little person named Samuel in the world, though at nearly 9 pounds, maybe not so little. "There he is, Amanda," Sparling says. "Reach down here and grab your baby." Samuel is born just before 10 a.m. Sparling has been at the hospital for six hours. And she's jazzed. "People have asked me, 'Does this feeling after a delivery ever get old?' Absolutely not," she says. "It's a wonder to behold, and my adrenaline stops pumping about two hours after a delivery. And then I can go to sleep." But it takes her twice as long to recover from an all-nighter as it used to. Her closest friends worry about her. Sparling is long divorced. Her two sons live back East, so this group of friends are the ones she refers to as her "support people." "We think she should be retired, but she doesn't think she can," says Sparling's friend, Wayne Peak. "She's our age and we're retired and we like to travel and relax a whole bunch, and she's on call and has to stay up in the middle of the night and deliver babies. That's not good." More In This Series Working Late: Older Americans On The Job When A Bad Economy Means Working 'Forever' Working Late: Older Americans On The Job For One Senior, Working Past Retirement Age Is A Workout Working Late: Older Americans On The Job At 85, 'Old-School' Politician Shows No Signs Of Quitting

Another friend, Nancy Grove, says she was not happy when Sparling first told her she was going back to being on call.

"Once I stopped thinking about myself and started thinking a little more about Dian, I really wanted to support her in what she wants to do, needs to do, because she's a very valuable asset in our community," Grove says.

A Line In The Sand

Sparling has reassured her friends that she will not keep delivering babies forever. In a way, she longs for retirement � from deliveries, from the office, from work. But that would mean finding someone to take over her practice and run it the way she believes it should be run. For instance, no patient is turned away because of lack of insurance or inability to pay.

"The truth of the matter is this is not a money-making business," Sparling says. "It makes our salaries. It makes our health care insurance payments for ourselves, it pays for our malpractice insurance, which is required by the state and also by our hospital. We can exist and pay for ourselves, but it doesn't make money."

Sparling says that at 71, she realizes time is not on her side. As much as she loves her work, she wants to pursue the other pleasures of life.

"One of which is travel. There are so many places in the United States and the world that I would love to go," Sparling says. "And one is taking piano lessons. I was given a piano at age 7 by my grandmother, and really never made proper use of it and practice. And you need time to do that."

Sparling has given herself deadlines for retiring before. None have stuck. But she's still trying.

"And now I guess I can draw a line in the sand and say it's going to be [at] 75, I will no longer be seeing patients in the office," she says.

But she acknowledges that maybe a line in the sand isn't the best metaphor. She says, "you know how sand flows."

Share Facebook Twitter Email Comment More From Working Late: Older Americans On The Job Around the NationFor Midwife, 71, Delivering Babies Never Gets OldAround the NationAt 85, 'Old-School' Politician Shows No Signs Of QuittingAround the NationWhen A Bad Economy Means Working 'Forever'EconomyWorking Late: In Tough Economy, Retirement Gets Pushed Back

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Whacking the Old Folks

In setting up his National Commission on Fiscal Responsibility and Reform, Barack Obama is again playing coy in public, but his intentions are widely understood among Washington insiders. The president intends to offer Social Security as a sacrificial lamb to entice conservative deficit hawks into a grand bipartisan compromise in which Democrats agree to cut Social Security benefits for future retirees while Republicans accede to significant tax increases to reduce government red ink.

Obama’s commission is the vehicle created to achieve this deal. He ducks questions about his preferences, saying only that “everything has to be on the table.” But White House lieutenants are privately talking up a bargain along those lines. They are telling anxious liberals to trust the president to make only moderate cuts. Better to have Democrats cut Social Security, Obama advisers say, than leave the task to bloodthirsty Republicans.

The president has stacked the deck to encourage this strategy. The eighteen-member commission is top-heavy with fiscal conservatives and hostile right-wingers who yearn to dismantle the retirement program. The Republican co-chair, former Senator Alan Simpson, is especially nasty; he likes to get laughs by ridiculing wheezy old folks. Democratic co-chair Erskine Bowles and staff director Bruce Reed secretly negotiated a partial privatization of Social Security with Newt Gingrich back when they served in the Clinton White House, but the deal blew up with Clinton’s sex scandal. Monica Lewinsky saved the system.

Any recommendations require fourteen votes, and Obama has at least five loyalists who will protect him�Senators Dick Durbin and Max Baucus, Representatives Jan Schakowsky and Xavier Becerra, and former SEIU president Andy Stern. On the other hand, if Obama really wants to make a deal, these commissioners will very likely support him.

The people, once again, are kept in the dark. The Obama commission will not report its recommendations until after this fall’s elections�too late for voters to express objections. Both parties assume they can evade blame by holding hands and jumping together.

What’s extraordinary about this assault on Social Security is that a Democratic president is leading it. Obama is arm in arm with GOP conservatives like Wall Street billionaire Pete Peterson, who for decades has demonized Social Security as a grave threat to the Republic and has spread some $12 million among economists, think tanks, foundations and assorted front groups to sell his case. If Obama pulls the deal off, this will be his version of “Nixon goes to China”�a leader proving his manhood by going against his party’s convictions. Even if he fails, the president will get some protective cover on the deficit issue. After all, he is targeting Big Government’s most beloved and trusted program�the New Deal’s most prominent pillar.

Obama’s initiative rests on two falsehoods spread by Peterson’s propaganda�the notion that Social Security somehow contributes to the swollen federal deficits and that cutting benefits will address this problem. Obama and his advisers do not say this in so many words, but their rhetoric implies that Social Security is a big source of the deficit problem. Major media promote the same falsehoods. Here is what the media don’t tell you: Social Security has accumulated a massive surplus�$2.5 trillion now, rising to $4.3 trillion by 2023. This vast wealth was collected over many years from workers under the Federal Insurance Contributions Act (FICA) to pay in advance for baby boom retirements. The money will cover all benefits until the 2040s�unless Congress double-crosses workers by changing the rules. This nest egg does not belong to the government; it belongs to the people who paid for it. FICA is not a tax but involuntary savings.

As a candidate, Obama assured voters that any shortfall was in the distant future and could be easily resolved with minor adjustments. As president, he has abandoned this accurate analysis and turned rightward without explaining why. He faces an awkward problem, however. Despite conservative propaganda, cutting Social Security will have no impact on the deficit problem that so stirs public anxiety. The White House knows this, and some advisers admit as much. So why is the president targeting Social Security?

Paul Volcker, former Federal Reserve chair and adviser to the president, declares, “In my view, we can deal with the Social Security problem fairly promptly.” Cutting benefits, Volcker adds, “is not going to deal with the deficit problem in the short run, but it’s confidence building.” John Podesta of the Center for American Progress, another adviser, agrees but says, “Reforms could starkly demonstrate to skeptical debt markets that the United States is willing to take on a politically difficult fiscal issue.”

In other words, targeting Social Security is a smokescreen designed to reassure foreign creditors and avoid confronting the true sources of US indebtedness. The politicians might instead address the cost of fighting two wars on borrowed money or the tax cuts for the rich and corporations or the deregulation that led to the recent financial catastrophe and destroyed vast wealth. But those and other sources of deficits involve very powerful interests. Instead of taking them on, the thinking in Washington goes, let’s whack the old folks while they’re not watching.

This issue is a seminal fight with the potential to scramble party politics. If Democrats can no longer be trusted to defend Social Security, who can be? The people from left to right overwhelmingly support the program (88 percent), and a majority (66 percent) believe benefits should be increased now to cope with the loss of jobs and savings in the Great Recession.

Citizens can win this fight if they mobilize smartly. We can do this by arousing public alarm right now, while members of Congress face a treacherous election and before Obama can work out his deal. Some liberal groups are discussing a “take the pledge” campaign that demands senators and representatives sign commitments to keep Hands Off Social Security Benefits. If politicians refuse to sign, put them on the target list for November. Barack Obama is standing on the third rail of politics�let’s give him a warning jolt.

Thursday, March 7, 2013

Arizona Seeks To Balance Patients And Profits With Home Care

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Wednesday, March 6, 2013

Hospital Food So Fresh, Even The Healthy Come To Dine

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Tuesday, March 5, 2013

Single-payer system is the way to go

Millions of families are struggling with economic hardship. Health-care costs are weighing on more Americans, contributing to about a million bankruptcies a year, and are a major factor in many home foreclosures.

Distressed companies are struggling with the rising costs of providing health coverage for their employees, and there is evidence of poorer health outcomes for the uninsured. More deaths occur from lack of insurance than because of auto accidents, leading to more deaths from cancer and chronic diseases and worse outcomes from emergency care.

One in three families is now distressed by medical costs. Yet health-care costs continue to rise faster than inflation and squeeze both families and businesses.

We pay an estimated $50 billion for health care for the uninsured and an additional estimated $180 billion in lost productivity due to employee health problems. Yet with more than $10 trillion in national debt, but assets rated at only $1.5 trillion, how can we afford to reform this dysfunctional system?

Let me show how we must undertake this task.

For-profit insurance companies must go. Their mission is to make money, and they do this best by enrolling only people who are healthy and unlikely to need care. Then, when medical expenditures are called for, the health insurers benefit by denying tests or treatments. Enormous profits for their 1,500 companies and investors are possible in this way, but at highly expensive administrative effort and waste.

Since 1970, the number of administrative personnel in the health-care industry has increased 2,500 percent, while the number of physicians has only doubled. Some health-care CEOs have reaped salary and benefits of more than $1 billion a year. Profit and overhead in the U.S. health-care industry is now 31 percent, compared with less than half of that in most other industrialized countries.

Eliminating the insurance companies and replacing them with a single-payer system such as HR 676 proposes would save our country an estimated $350 billion a year, enough to provide comprehensive health care for all of us, including dental coverage, long-term care, full pharmacy and mental-health benefits � all with no co-pays or deductibles and at no additional cost to our country beyond what we now spend on health care.

The so-called mandate plans, of which the Barack Obama campaign proposal is representative, have been tried in a number of states and have never been sustainable or successful at covering the uninsured or controlling costs.

All were plagued by soaring cost increases and failed in just a few years.

Insurance works best when the largest possible number of individuals is covered in the same risk pool, so that the healthy individuals share in the cost of paying for treatment of the sick.

Any dividing up of the risk pool by for-profit insurance companies leaves those in sicker risk pools with rising costs, whether those pools are Medicaid or other insurers.

Currently, individuals tend to switch insurance plans an average of every two years, and continuity with one’s physicians gets disrupted. So there are no incentives for the insurer to practice preventive medicine, which, because of cost reduction, tends to pay off in the long run.

HR 676 is not socialized medicine, and it is not government-run medicine. Care would be provided by private physicians, and hospitals would continue to be private. Guidance for the single-payer plan would be through health planning boards on a regional basis, appointed by state legislators and advised by medical experts. Huge savings would be realized by having only one not-for-profit insurer for everyone.

Benefits beyond the financial would be realized by having a readily accessed database on what kind of health care works and levels of utilization on a national basis. Pilot programs like HR 676 have been hugely successful. A fine example is the national health insurance in Taiwan, with an overhead of less than 2 percent, functioning well since 1995 and covering 99 percent of the Taiwanese at less than half the per-capita health-care costs of the U.S. system. Medical bankruptcy is unheard of in those countries with national health insurance.

Our organization, Physicians for a National Health Program (www.PNHP.org) represents more than 15,000 physicians and many nonphysicians who are advocating for passage of HR 676.

Several additional members of Congress were elected on Nov. 4 who advocate for this position, including one U.S. senator, Mark Udall of Colorado. Surveys indicate about two-thirds of the public wants some form of national health insurance, and 59 percent of physicians favor this also, as well as more than half of our surveyed members of the Capital Medical Society who responded. Since it is the only comprehensive program that is affordable, can we get on about the business of passing HR 676 and let go of the idea that a private market of for-profit health insurers, with their exorbitant profits and administrative expenses, is in some way compatible with our interest?

This article is from www.tallahassee.com.

Single Payer Amendment Narrowly Defeated in Mass.

From Benjamin Day, Executive Director of Mass-Care –

This Tuesday, after an hour and a half floor debate, the Massachusetts Senate narrowly voted down a single payer amendment to a broader cost control bill, on a 15 to 22 vote. The amendment would have instructed the state to, every year, measure our actual health care spending against what we would be spending under a comprehensive single payer plan, and if this ‘single payer benchmark’ by fiscal year 2015 proved more cost-effective than our current system, the state would be instructed to draft a single payer implementation plan for approval by the legislature.

Amendments opposed by Senate leadership rarely receive this level of support, so please thank the courageous Senators who voted ‘yes’ on Amendment #125. Just as important, a broad range of grassroots organizations made calls and asked their members to call their Senators to support this effort – it was an unprecedented mobilization for single payer, with less than a week’s notice from the time the Senate introduced their bill.

Click here to visit Mass-Care’s web-site where you can download the language of the amendment, see a complete list of Senators voting for and against, and video footage of every Senator who spoke to the amendment. I find it incredibly uplifting that we have come so close to setting Massachusetts on a path towards single payer health reform – we are just a few votes away! Let’s keep organizing this year!

Monday, March 4, 2013

Better Health and Lower Costs for Medicare Beneficiaries

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services

It�s been a big summer for the millions of Americans who are benefitting from improved Medicare coverage thanks to the Affordable Care Act. The benefits are clear: More people are getting preventive services to keep them healthy and people with high prescription drug costs are seeing the donut hole coverage gap starting to close � lowering the cost of drugs so that people don�t have to worry about being able to afford the care they need. Take a look at the past few months:

June: Through the end of June, 899,000 Americans with Medicare have benefited from the discount on brand name drugs in the Medicare Part D "donut hole" coverage gap -- an increase of over 420,000 individuals in the month of June alone.These discounts have saved seniors and people with disabilities a total of�$461 million, including $200 million in June alone!July: Through the end of July, 17.3 million people with traditional Medicare, or 51.5 percent, have received one of more free preventive services.�During the same time period, over 1 million Americans with traditional Medicare have taken advantage of Medicare�s new free Annual Wellness Visit, up from 780,000 in mid-June;

To learn more about these new benefits, check out the Medicare campaign, �Share the News, Share the Health�, to learn about the importance of prevention for people with Medicare.

But the good news doesn�t stop here. Over the coming years, provisions of the Affordable Care Act will help close the donut hole coverage gap completely. Here is a sense of what Medicare beneficiaries can look forward to:

2013: You will pay less and less for your brand-name Part D prescription drugs in the donut hole.2020: The coverage gap will be closed, meaning there will be no more �donut hole,� and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit.

The chart below shows Medicare prescription drug savings over time:

�Medicare prescription drug savings over time�You Will Pay This Percentage for Brand-name Drugs in the Coverage GapYou Will Pay This Percentage for Generic Drugs in the Coverage Gap2011

50%

93%

2012

50%

86%

2013

47.5%

79%

2014

47.5%

72%

2015

45%

65%

2016

45%

58%

2017

40%

51%

2018

35%

44%

2019

30%

37%

2020

25%

Source: Centers for Medicare and Medicaid Services

This all amounts to even more examples of how the Affordable Care Act is providing better health care for people covered by Medicare and making a difference in the lives of millions of Americans.

Sunday, March 3, 2013

Lab Findings Support Provocative Theory On Cancer 'Enemy' Within

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Saturday, March 2, 2013

What's Up, Doc? When Your Doctor Rushes Like The Road Runner

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Friday, March 1, 2013

For One Senior, Medicaid Provides Model Care

Petersen says her mom couldn't afford the nursing home on her own. Her Social Security income is $600 a month and after selling her house she cleared only $3,500. A doctor suggested signing up for Medicaid to pay the $80,000 a year bill for her long-term care. Scarrow is left with about $50 of her Social Security check each month for spending money.

Petersen said, at first, her mother was embarrassed about accepting government help, because she's always been independent and supported herself. Much of her life was spent in facilities like this one, as a nurse's assistant.

"Mom worked in an era when health care was what it was called. It was called care. Kindness and care. In today's world, health care is money," said Petersen.

States Feel The Pinch

Colorado has nearly a half-million people on Medicaid and, like in a lot of other states, that number rose dramatically in the past year, increasing by more than 10 percent. The economy and unemployment are largely to blame.

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Typically states and the federal government split the cost of Medicaid, though with the recent stimulus money the federal government is picking up a larger share now. Even with that help, Colorado has difficulty paying its share. Recently the governor trimmed payments to doctors and hospitals to help balance the state's budget.

Hoping For Overhaul

Politically, Petersen says she typically votes Republican. But last year she voted for Obama, and she's excited about efforts to overhaul health care in the United States. She's frustrated with the costs of her own coverage, but very happy with the Medicaid coverage her mother receives.

She doesn't have a specific solution for health care overhaul, but she does support things like tort reform and tighter regulations for insurance companies. In coming months, she'll watch closely to see what solutions policymakers in Washington come up with.

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