|
U.S. Rep. Bill Cassidy,
R-Baton Rouge, right, holds a town-hall meeting to discuss a national
health-care plan in Livingston. Cassidy
said he is in favor of reform, but claims President Barack Obama’s proposal
would create a federal bureaucracy to replace the insurance company
bureaucracy.
|
By
BOB ANDERSON
LIVINGSTON — A standing-room
crowd Tuesday night vented frustration about medical costs, insurance
companies and a proposed health-care bill.
“We
all agree there has to be reform,” U.S. Rep. Bill Cassidy told the gathering.
“The question is how to get there.”
He
said the health-care proposal being pushed by the president simply replaces
insurance company bureaucracy with federal bureaucracy.
It
builds on a Medicare system that is already going bankrupt, Cassidy told the
town-hall gathering that filled the more than 200 seats in the Livingston
Parish Health Unit auditorium and left people standing in lines along the
walls.
“Everybody
wants it fixed,” said Cassidy, a Baton Rouge Republican.
Instead
of a public-option system, Cassidy told the crowd, he prefers a
patient-centered system in which people build up health-care savings accounts
while having a “wrap-around policy” that protects people from the high cost
of a catastrophic illness.
When
one member of the audience suggested that such a system would discourage
people from getting medical checkups and would result in more people having
to spend money on higher costing emergency room visits, Cassidy said
statistics don’t support that opinion.
People
with health-care savings accounts spend as much as others on preventative
medicine, he said.
To
complaints about health insurance premiums that people can’t afford,
particularly if they have pre-existing conditions, Cassidy said that problem
could be helped by having everybody in the same age range pay the same amount
for the same insurance policy.
People
should be able to get insurance and pay what other people the same age pay,
he said.
“Reform
has to happen,” Cassidy said. “I am not against reform.”
The
congressman drew applause when he told the crowd the current bill isn’t being
written by the mainstream in Congress, but by a few of its more liberal
members.
“I
hope that we come up with a bill that does have common ground,” he said.
Every
member of Congress who votes for the bill should have to sign every page to
show they have read it, said Vickie Parrish, of Killian.
Cassidy
said he has read the bill.
The
congressman, who is also a doctor, touted a system that empowers patients.
“You
should know how much something is going to cost” before the procedure,
Cassidy said.
http://www.2theadvocate.com/news/54883337.html?showAll=y&c=y
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A
Vietnamese-born Republican congressman from New Orleans is running into rancor from
both sides of the health care debate -- from the city's mostly Democratic,
black residents, and more conservative white voters in his district.
It's
a difficult balancing act for Rep. Anh
"Joseph" Cao at town hall meetings to discuss President Barack
Obama's health care plan.
In
the working-class suburb of Westwego recently he encountered cries of
"No!" and "Just vote no!"
Days
earlier in New Orleans,
supporters called for reform. Sally Stevens complained she had $8,000 in
medical bills. "I'll let you and your insurance lobbyist buddies handle
them," she said, leaving behind a handful of hospital bills before she
stormed out.
Emotions
have run high at similar town halls across the country, though Cao faces a
unique quandary of pleasing his party and a mostly Democratic district still
recovering from Hurricane Katrina's devastation in 2005. How he handles the
situation will likely affect his 2010 re-election campaign.
Cao,
42, said he is leaning toward voting for the Democrat-backed legislation and
expects to discuss it with President Barack Obama, but he is concerned about
its possible effect on the deficit, Medicare and small businesses.
One
deal-killer, the lawyer and former Jesuit seminarian said, would be a lack of
explicit language forbidding federal funding for abortion. That position drew
shouted criticism from abortion rights supporters at one recent town hall.
Cao,
who fled to the U.S. as a
child in the 1970s as what was then Saigon
fell to the communists, squeaked into office in a low-turnout election last
December. He defeated nine-term incumbent Democrat William Jefferson, who was
convicted on corruption charges earlier this month.
Although
a recall effort sparked by Cao's party-line vote
against Obama's economic stimulus package has since fizzled, he has at least
one declared opponent for the 2010 race.
"I
think he's going to have to really do a gut check on some of his votes and
understand that, although he is a Republican, he represents a Democratic
district and there shouldn't be a split in votes," said state Rep. Juan LaFonta, D-New Orleans, who is black and plans to run
against Cao.
Cao
argues the stimulus package was too costly and did little for his district.
He also points out he has broken with his party to vote for expanding a
children's health insurance program and making it easier to challenge
workplace pay discrimination.
"My
emphasis has always been the recovery of the district and to look at the
issues rather than look at party politics," Cao said.
Cao
has hired African-Americans for key staff positions and says he has reached
out to black voters with meetings at schools and churches in black
neighborhoods.
That's
left many political opponents and voters unconvinced. The online magazine
"Politico" recently tagged him as a "dead man walking" in
Congress.
"I
think he's just paying lip service," said Stevens, a white Jefferson supporter who dumped the hospital bills on
the table at Cao's town hall meeting.
But
Bryan Wagner, a former New Orleans
city councilman and state Republican stalwart, believes Cao's
$365,000 in campaign contributions for the second quarter of 2009 are strong
evidence. Wagner also says Cao's vote on health
care may not be a huge indicator because of growing skepticism over the plan.
"If
there had been a quick vote on universal health care and he had voted against
it, I think that it might have been a lot more difficult for him to get
elected," Wagner said.
Wagner
says Cao will follow his conscience, even if it costs him politically.
"He is somebody who does what's right," Wagner said.
http://www.nola.com/politics/index.ssf/2009/08/rep_cao_taking_heat_from_both.html
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Local
residents will have multiple opportunities in the coming days to query the New Orleans region's
congressional members about the continuing health insurance debate, headlined
by Sen. Mary Landrieu's first town-hall style forum of the August recess.
Landrieu,
a Democrat, will be in Reserve on Thursday for a 2 p.m. session at the Army
National Guard Readiness Center, 4120
W. Airline Highway. Organizers are suggesting
that citizens arrive by noon, given the potential for an overflow crowd.
The
event has garnered attention from the White House's political operation,
which this week e-mailed its subscriber list, encouraging recipients:
"Please arrive as early as possible to the health care town hall, and
make sure that the most powerful voices in this debate are those calling for
real reform, not angrily clamoring for the status quo."
Louisiana's senior senator has
voiced opposition to a health insurance overhaul that includes a public plan
to compete with the private sector, a key component of the outline President
Barack Obama presented Congress. She calls a public plan too expensive for
the federal budget and says any effort should focus first on containing costs
in the current system, before attempting to expand coverage. The chairwoman
of the Small Business Subcommittee, Landrieu also has expressed doubts about
mandating that employers provide coverage.
Landrieu
has since 2007 been co-sponsor of the proposed Wyden-Bennett bill, health
care legislation geared in part toward moving the country away from an
employment-based insurance system. Generally, the bill would remove income
tax exemptions on health benefits but grant generous tax incentives to cover
policy premiums. Despite Landrieu's efforts on the Wyden-Bennett bill, most
Capitol watchers believe the Senate will act on whatever emerges from
separate negotiations among key members of the Finance Committee.
On
Friday, Sen. David Vitter and several Louisiana GOP lawmakers, including 1st
District Rep. Steve Scalise of Jefferson, will
welcome Sens. Tom Coburn of Oklahoma and John Barrasso
of Wyoming, both physicians, to a town hall at the Pontchartrain Center, 4545
Williams Blvd. The session, scheduled for 2:30 p.m., is part of a national
tour for Coburn and Barrasso.
Rep.
Joseph Cao, R-New Orleans, will continue his schedule of solo town halls. He
will hold one tonight at 6:45 at 5069 Willowbrook
Drive in eastern New Orleans, and Monday from 6-7:30 p.m. at Kenner Heritage
Hall, 303 Williams Blvd.
Cao
could be the only member of the Louisiana
delegation to support a plan anchored by a public option. The unlikely
representative of a Democratic district, Cao has said he is leaning toward
supporting HR 3200, the Democratic leadership's preferred bill, provided the
final version includes language expressly forbidding a public plan to cover abortion
services.
http://www.nola.com/politics/index.ssf/2009/08/health_care_town_halls_schedul.html
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The
Louisiana Recovery Authority wants a final decision on Charity
Hospital in New Orleans. It's been shuttered since
Hurricane Katrina amid fights with FEMA.
The
state wants to build a new hospital if they get enough cash for the old
Charity building. They want to use the former hospital for something
completely different.
"Once
we settle this first dispute and that's about the money, then we can start
moving forward with some of those ideas," LRA Director Paul Rainwater
said. "So then, Big Charity looks a lot different as office space or
condos... mixed use."
If
the governor agrees to send it to arbitration a final decision could be in by
the end of the year.
"An
arbitration panel... will give you a decision within 60 days," Rainwater
said. "An answer is what we all want, to be very frank with you because
I think it has gone on long enough."
[Listen
to Rainwater]
Opponents
want Charity to be a hospital again and say the damage was not nearly as bad
as the state has suggested.
http://www.wwl.com/pages/5075557.php?
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Opinion - DuBos: LSU pays price for strong-armed tactics
Clancy
DuBos / WWL-TV Political Analyst - Gambit Columnist
(The
column is a reprint of Clancy's editorial that first appeared in Gambit.)
NEW ORLEANS - For decades, LSU
was the proverbial 800-pound gorilla of Louisiana politics. There was virtually
nothing the Ole War Skule couldn’t get out of a
governor or lawmakers. In fact, governors often were LSU’s most effective
lobbyists. No longer.
LSU’s
flagging political fortunes are partly a result of legislative term limits
(many freshmen lawmakers are not beholden or connected to LSU), but mostly
they reflect the university’s own failure to recognize changing political
realities — particularly the one about it no longer being the 800-pound
gorilla.
Case
in point: the controversy surrounding the proposed $1.2 billion LSU teaching
hospital in New Orleans.
By
way of disclosure, this newspaper signed on in support of the LSU-VA plan
early.
Conceptually,
there’s a lot to like about the idea. Unfortunately, the university and its
boosters have behaved like bullies in attempting to execute the plan. They
have tried to steamroll residents and businesses in the historic Lower
Mid-City neighborhood, where LSU hopes to build the proposed hospital; they
have stiff-armed Tulane Medical School, which deserves a seat at the table
with regard to governance; they reneged on a governance compromise that was
struck during the legislative session; they have resisted attempts to open
the planning process to the public, particularly the notion of public
hearings by the New Orleans City Council or the City Planning Commission; and
they have not-so-subtly threatened to move LSU’s medical school to Baton
Rouge if they don’t get their way. On top of all that, LSU hasn’t even come
close to finalizing a concrete, bankable plan to pay for the new hospital.
For
all this, LSU has paid a price.
House
Speaker Jim Tucker introduced a bill this year to take hospital governance
away from LSU entirely. When LSU sabotaged a negotiated settlement of that
issue at the eleventh hour, the Jindal Administration halted land
acquisitions in Lower
Mid-City, bringing the
entire process to a halt. As for the threat of relocating the medical school
to Baton Rouge,
that one will be tough to pull off without a governor and legislature in full
support.
In
addition to losing political support in Baton Rouge,
proponents of the new hospital have some problems in New Orleans as well. A recent survey of New Orleans voters by veteran pollster and political
scientist Ed Renwick shows that local voters would prefer putting the new
teaching hospital back in the old Charity
Hospital facility by a margin of
2-to-1 rather than razing substantial portions of Lower Mid-City.
The actual poll numbers were 60 percent favoring a new hospital inside
Charity, 30 percent for putting it in Lower Mid-City.
An even larger proportion (71-20 percent)
favor
an objective analysis of the two proposals. In the end, this should be a
financial and medical decision — but public support is crucial to making it
work.
The
poll was commissioned by Smart Growth for Louisiana, a nonprofit group that supports
the Charity model. While that may taint the results in the eyes of some,
anyone who knows Renwick knows his polls are not for sale. The numbers are
legit.
The
same poll shows that the controversy will be an issue in the upcoming
citywide elections. Forty-four percent of those surveyed said they would be
more likely to vote for candidates who favor building a new hospital inside
Charity, compared to just 11 percent would said they would be less likely to
support such candidates.
None
of this is meant to suggest that LSU should abandon its plans. It should,
however, change its tactics. The gorilla is on the ropes, and somebody needs
to teach it some manners.
http://www.wwltv.com/local/stories/wwl082509mldubos.11598c579.html
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By
Jeremy Alford
After
four years of private and public meetings, the parties involved with planning
the $1.2 billion medical complex in New
Orleans’ Mid-City finally produced a memorandum of understanding
earlier this year. If it seems like the document was delivered late in the
game, that’s because it was.
At
some point in late 2007 or early 2008, officials from LSU and Tulane couldn’t
agree on what kind of process had been used during the first few years to
determine costs and other planning details. A study would be left up to LSU,
only to have Tulane claim it never took place, and so on and so forth.
Alan
Levine, who inherited the drama last year when he became Department of Health
and Hospitals secretary, rubs his temples with both hands while recounting
his early days on the job. Two red marks remain on either side of his
forehead. “If I told you some of the back and forth that’s gone on, you would
think I was making it up,” Levine says. “They see a boogeyman in places that
I don’t.”
That’s
why the MOU had to be perfect. LSU and Tulane had to be on the same team.
“Every single word was parsed and argued,” Levine says. “I’m not kidding.” It
also wasn’t a joking matter when LSU signed off on the memorandum this
summer, but only after it added a few tweaks. Tulane, meanwhile, had simply
rubber-stamped the state’s revised draft, ready to move forward.
It’s
the second Thursday of August, and Levine’s boss, Gov. Bobby Jindal, has been
telling reporters in New Orleans
the deal will be sealed in roughly a year. Levine agrees with the assessment,
but adds one caveat. There’s still a lot of room to make up between LSU and
Tulane, who would partner with a few other universities to run the 424-bed
medical complex, or what basically amounts to a cutting-edge teaching
hospital.
The
divide between LSU and Tulane is generations old, although Levine has only
recently been steeped in the duality that exists in New
Orleans and Baton Rouge,
from its politics to its territorial universities. But it’s only one aspect
of the deal—there are also governance issues, financing, property questions
and legal battles. “This is the most interesting challenge of my entire
career,” Levine says. “There really are a lot of moving pieces, and there’s a
great deal of things going on and progressing that are parallel.”
Under
Levine’s MOU, a not-for-profit corporation would be set up to run the
hospital and associated medical complex, which is scheduled to be built
alongside a new Veterans Affairs Department hospital in lower Mid-City
[veterans officials recently said their project stands separate from the
teaching hospital]. A 12-member board would oversee the nonprofit, with four
members—including the board chairman—coming from LSU, one from Tulane, one
from Xavier University and one nominated on a rotating basis by the
presidents of Dillard and Southern universities and Delgado Community
College. The remaining five members would include individuals not affiliated
with any of the universities.
The
LSU Board of Supervisors, however, amended its MOU draft to create an
11-member board with five LSU representatives, including the permanent
chairman. In a press release, Charles Zewe, LSU’s vice president for
communications, said, “LSU board members contend that the LSU System is
putting up the money for the project and should have more control. Under the
draft MOU, LSU would own the medical center and lease it to the
not-for-profit corporation.”
In
other words, LSU officials are concerned about assuming any debt that would
come as a result of the deal. And, with LSU now wanting more of a leadership
role, Tulane’s top officials are expressing concerns to the state about being
under LSU’s thumb.
Levine
says it was a game of “shuttle diplomacy” up until then, with LSU in one part
of his offices on the ninth floor of the Bienville Building
downtown and Tulane in another. Most everyone thought a resolution was
forthcoming. Maybe that’s why Commissioner of Administration Angele Davis
announced shortly after LSU’s amendment that the state would no longer pursue
land acquisitions until a true agreement is reached. Tulane spokesperson Mike
Strecker says hopes are high that the state’s
ultimatum “will resolve the impasse created by the decision of the LSU Board
of Supervisors.”
Levine
says one solution could be to change the kind of nonprofit that would be
formed. Under the second MOU draft, a state-sponsored nonprofit is called
for, which would place all monetary responsibilities on the board. A
traditional nonprofit also could be created, but that would require approval
by the Legislature and then appropriations. It’s not something the parties
involved really want to do, considering how lawmakers tried to block part of
the project this spring. “We’re discussing both options right now,” Levine
says.
Then
there’s the land needed for the complex, some 70 acres in all. The
expropriation law that would be used—taking for the public good—still is
untested in the courts. But that battle might be on the far horizon,
especially since there are other pending cases waiting to be decided.
Opponents—many would rather see something built inside the old Charity Hospital—have filed lawsuits.
Attorney
William Borah, president of Smart Growth for Louisiana, a planning and
advocacy group that’s suing the City of New Orleans over the VA hospital,
calls the whole deal “destructive” because it would set into motion a plan
that would be “abandoning Charity Hospital, abandoning the Central Business
District and destroying a historic residential neighborhood struggling to
rebound.”
According
a recent public opinion survey of New Orleans
voters by political scientist Edward F. Renwick, the controversy is likely to
become a hot issue in the approaching Crescent City
mayor and council elections. In the poll, voters preferred building a new
hospital inside Charity by a 2-for-1 margin to the alternative location in
the lower Mid-City neighborhood. “The voters at this point seem to have very
clear preference for candidates who are open to putting a new hospital inside
the old Charity building,” Renwick says.
Finally,
there’s the financing question. The state is ponying
up $300 million in capital outlay cash, but FEMA is floundering on an
expected $492 million that’s meant to reimburse Katrina damages to Charity,
offering the state only $150 million. The rest will come from bond sales that
will be repaid with future operating income, which is a process Levine says
will help the proposed board “stay honest,” since debt holders will be
watching closely.
To
many people, despite all the legal complications, territorial disputes and
money questions, the proposed facility simply is a promise that was made four
years ago in the desperate, trying aftermath of Hurricane Katrina. Today, they’re
still waiting, which Levine admits is agonizing. But he says he recognizes
the need to deliver on that promise, which is supposedly about a year away.
“The plan is to build a new hospital,” he says, “and I don’t see any reason
that’s not going to happen.”
http://www.businessreport.com/news/2009/aug/24/sticking-points-hlcr1/?health-care
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By
Stephanie Riegel
If
you become really sick in Livingston Parish, you have to leave—and seek
medical care in Baton Rouge or Hammond.
True,
a few primary care clinics have opened in recent years. But for anything more
serious than the flu or common cold, you have to travel east or west to see a
specialist, undergo tests or have any type of surgical procedure.
That
situation, however, is about to change.
Hammond-based
North Oaks Health System already has broken ground on a 47,000-square-foot
complex that will be located off Interstate 12 at the Satsuma exit in the
central part of the parish and will give patients access to a variety of
outpatient diagnostic and treatment services.
Just
four miles to the west, Baton Rouge-based Our Lady of the Lake Regional
Medical Center,
meanwhile, is planning an outpatient diagnostic facility and freestanding
emergency room that will be located off I-12 at the Walker exit.
Officials
of the hospitals say they’re moving into Livingston
in an effort to better serve the growing number of patients who live in what
has become one of the state’s fastest-growing parishes. Health care experts
say the hospitals are in something of a race, competing for a larger share of
a market that until now has been fairly evenly divided between Hammond and Baton
Rouge.
Livingston residents say the
motivating factors behind the medical building boom are long overdue, and
they’re glad providers finally are moving into the parish.
“We
wish it had happened sooner,” says consultant Delia Taylor, a lifelong
resident of Denham Springs. “There’s no question the population is here, and
there’s no question that we need it.”
That
might be an understatement.
Livingston currently ranks
second to Ascension among the state’s fastest-growing parishes. Its
population has increased more than 25% over the past eight years to more than
118,000. And growth is expected to continue: By 2030, state estimates place Livingston’s population at close to 245,000.
But
for all its growth, the parish is medically underserved. Years ago, it had a
small hospital, Dixon Memorial in Denham Springs, which has since closed.
Even when Dixon
was open, it had a spotty reputation among residents and was considered a
provider of last resort.
“You
were basically signing your own death warrant if you had to go there,” Taylor says.
As
a result, parish residents who live on the east side of Livingston typical travel
to North Oaks in Hammond for medical care, and residents who live on the west
side go to Baton Rouge, where they have several choices, the largest of which
is Our Lady of the Lake.
In
recent years, Livingston officials have
taken steps to lure more providers, including a 2004 partnership with North
Oaks to bring it to the parish. That year, the hospital opened two clinics in
Walker. It
opened a third clinic in 2007.
In
April, it began construction on the $32 million North Oaks-Livingston Medical
Complex. The two-story facility will be located on 30 acres in the southwest
quadrant of the Satsuma exit and is scheduled to open for business in October
2010.
Granted,
the facility will not be a full-service, acute-care hospital, but it will
fill a gap in the parish. It will offer a range of outpatient and diagnostic
services, including cardiology, laboratory, radiology and rehab. It also will
include an acute care center, family medicine clinic and specialty clinic.
North
Oaks is not alone in filling a void in Livingston.
Our Lady of the Lake has been expanding into
the parish as well.
OLOL
has established a pediatric clinic in Denham Springs as well as a Lake After
Hours clinic. In September, the hospital purchased 192 acres in the southwest
quadrant of the Walker
exit, and later purchased an additional 44 acres. The property will house
physician offices, a facility for outpatient and diagnostic services and a
freestanding emergency room.
OLOL
remains in the development and planning phase of its project. But the target
date to begin construction is late in the first quarter or early in the
second quarter of 2010, with a scheduled completion date of late 2011.
Executives
with the facilities say their expansions into Livingston Parish are designed
to better serve their growing number of patients who live there.
“A
good deal of Livingston Parish residents already come to North Oaks in Hammond,” North Oaks
Health System Executive Vice President/COO
Michele Sutton says. “So we wanted to make it more convenient
for them.”
That’s
also what motivated Our Lady of the Lake to
move toward building its new facility, according to CEO Scott Wester.
“It’s
really two things,” he says. “To make sure they have good access to primary
care services that are in close proximity to where they live, and to provide
easy access for those who need emergency treatment.”
But
it also has a good deal to do with economics. Livingston
is a rapidly growing area, and the hospitals are trying to take advantage of
an emerging market.
“Hospitals
want to put facilities in a high-growth area because that’s where the people
are,” says John Montessino, president of the
Louisiana Hospital Association. “What you’re going to see more and more of is
that they’re going to develop a lot more business activities over there, and
there will be less and less of an excuse or need for the people of Livingston
to come to Baton Rouge or Hammond.”
What’s
more, outpatient hospitals and clinics are ideal feeders for secondary and
tertiary care facilities. By developing relationships with patients now, both
hospitals are laying the groundwork to grow their inpatient bases in the
future.
“They’re
trying to build relationships within that community,” says Jack Finn, a
health care consultant, who headed the Metropolitan Hospital Council in New Orleans for more
than 20 years. “The outpatient facilities will help grow those
relationships.”
Experts
say building outpatient facilities is the smart way to expand into the market
because it’s far less expensive than inpatient facilities and is increasingly
becoming the mode of delivery in health care today.
“They’re
proceeding in an appropriate manner by focusing on outpatient delivery and
not the inpatient side,” Montessino says.
But
is there enough demand in the market for two facilities, especially with Ochsner Health System’s full-service hospital off I-12 at
the O’Neal Lane exit [See related story, page A12]? More than enough,
according to economic development officials in Livingston Parish.
“We
were desperately needing the health care industry to
ramp up in our area,” says Melanie Woodworth, the interim director of the
Livingston Economic Development Council. “They may have competitive issues
when it comes to workforce, but there won’t be an issue with not having
enough patients.”
For
their part, the hospitals say they’re not worried about competition from one
another. North Oaks’ Sutton says even though her institution began planning
its facility first, they always knew there would be others before long. The
market is just too big and growing too fast.
“There
is absolutely enough market for more than one provider,” she says. “We went
into this with our eyes open, and we would have never committed the resources
to building if we didn’t believe there was enough there.”
Wester declines to talk about the
competition, but he insists there’s enough market share to go around.
“This
is not an arms race,” he says. “It’s about meeting the needs of patients in
Livingston Parish as we have been for many years.”
Aside
from property signage along I-12, neither hospital is actively marketing or
advertising its new facility. But parish residents are well aware of their
presence in the market.
“I’m
excited they’re both coming,” Taylor
says. “It’s been slow out here for too long.”
Three’s
a crowd?
When
Ochsner Health System of New Orleans took over the
200-bed acute-care hospital two years ago at Interstate 12 and O’Neal Lane
previously run by Ardent Health System, it was positioned in a prime location
to take advantage of the growing Livingston Parish market.
After
all, the facility was the closest full-service hospital for residents of the
area—just three miles from the Denham Springs exit and eight miles from the
Walker exit—and in bumper-to-bumper traffic as much as 30 minutes closer than
Our Lady of the Lake Regional Medical Center’s Essen Lane campus or Baton
Rouge General’s Bluebonnet campus.
But
now that OLOL and Hammond-based North Oaks Health System are expanding into Livingston with medical complexes that will include
diagnostic and outpatient treatment facilities, specialist offices and urgent
care centers, parish residents will have a lot more options and a much
shorter drive when it comes to meeting many of their medical needs.
Ochsner officials say they’re not troubled by
the encroaching competition, however. On the contrary, Ochsner
Medical Center of Baton Rouge CEO Mitch Wasden
predicts that as more health care providers set up shop in and around
Livingston Parish, more patients will seek care there—instead of facilities
in the center of Baton Rouge.
“I
think you’ll see travel patterns change,” he says. “It’s kind of like when
you put one restaurant in a place, it creates a little volume. But when you
put four or five there, it becomes a destination.”
Of
course, choosing a facility for a surgical procedure is a bit more
complicated than picking where to eat for dinner, and one of the primary
factors in the decision-making process is based on where the physicians
themselves send their patients.
In
that respect, Ochsner is able to hold its own. The
health system has always had an extensive physician network that steers
business to its hospitals.
“It’s
always possible you will have competitors take market share,” Wasden says. “But we have such a large percentage of our
business from our own physician group, it won’t have
as much impact as it might otherwise have.”
What’s
more, while the Ochsner facility at O’Neal Lane draws
patients from Livingston Parish, it also pulls patients from all over the
Capital Region who participate in the Ochsner
network. They go there because it’s the only Ochsner
facility in the area that is performing a full range of surgical procedures.
It is also expanding, and will open a labor and delivery wing next year that
is projecting to make about 1,000 deliveries in 2010.
Still,
Ochsner has a relatively small percentage of the
Capital Region market—about 11%, according to Wasden.
While it would like to increase its share, Ochsner
has long tried to position itself as a regional provider, with its flagship
tertiary care facility in New Orleans that
attracts patients from as far away as Latin America and Europe.
In that respect, having feeder hospitals strategically positioned around the
area makes sense.
“Our
mission is to be one of the full-service health care providers in southeast Louisiana, from
immunizations to transplants,” Wasden says. “So
it’s very important for us in the Capital
City to have a
significant presence.”
It
also means that, at least as far as Ochsner is
concerned, the race isn’t so much for a share of the Livingston Parish or
Baton Rouge market as it is for a piece of a bigger pie.
“When
it comes to the really big stuff, people go to New
Orleans,” says consultant Jack Finn, the former head of the
Metropolitan Hospital Council in New
Orleans. “So when you’re talking about providing
tertiary care, that’s where some of the real competition comes in.”
http://www.businessreport.com/news/2009/aug/24/doctors-are-almost-hlcr1/
[BACK TO TOP]
By
Maggie H. Richardson
From
a business perspective, cancer treatment is complicated. It cuts across
medical disciplines and calls for teamwork among physicians. It requires
substantial funded research to reveal next generation strategies in fighting
the disease. And it must be accessible to vast numbers of people, rural and
urban, insured or not, since early detection and the availability of
treatment dramatically impact mortality rates.
About
85% of cancer patients are treated not at National Cancer
Institute-designated facilities like M.D. Anderson in Houston or Memorial
Sloan-Kettering in New York,
but at community centers like Mary Bird Perkins. Such facilities must focus
on making themselves accessible to regional patients, while also constantly
push to integrate new methods and ideas, President/CEO Todd D. Stevens says.
“Our
board’s vision has been very clear. [We] want this organization to be on the
cutting edge,” says Stevens, who was recruited to Baton
Rouge from the University of Texas M.D. Anderson Cancer Center in
Houston a
decade ago. Stevens has led Mary Bird through a handful of noteworthy
accomplishments that have helped place the cancer center on the national map.
Since
2004, Mary Bird has earned accreditation and respect for its retooled medical
physics program, a partnership with LSU that is producing substantial
research. The facility also was recently selected to participate in two major
national pilots, including the National Community Cancer Center Program,
which makes care accessible to more residents and advances research. A total
of 14 cancer centers nationwide were selected.
A
second pilot, the Total Cancer Care program, brings Mary Bird patients into a
major research initiative. While cancers have historically been grouped
according to area affected [breast, prostate, lung], the cancers can be
grouped further by their genetic imprint, Stevens says. Determining the
cancer’s unique makeup, or “fingerprint,” will help oncologists select the
right course of treatment. The research project will lead to cancer treatment
to become more personalized, rather than follow a blanket approach, Stevens
says.
While
the participation in the program is purely about research, not individual
care for participants, the program gives Mary Bird access to one of the most
exciting developing fields in cancer treatment.
“These
programs are really going to help us accelerate where we are and reach our
objectives faster,” Stevens says.
Mary
Bird has also gained national traction with its medical physics program. Five
years ago, Stevens helped recruit Kenneth Hogstrom,
a well-known medical physicist and 25-year veteran of M.D. Anderson. He was
hired to grow the small medical physics program shared between the cancer
center and LSU, which had potential but little heft. Medical physicists are
instrumental in cancer treatment, since they program, monitor, calibrate and
research the potential of linear accelerators, the large scanners that
dispense radiation.
The
research of medical physicists has substantially advanced radiation therapy,
which now is able to hit tumors with unprecedented accuracy despite
obstructions, thus minimizing residual damage on healthy tissue.
Hogstrom, who holds the Dr. Charles Smith
Chair of Medical Physics at LSU and is chief of physics at Mary Bird, has
produced substantial results. The now-accredited medical physics program
features hands-on, focused curriculum, a residency program and ongoing
significant research. A Ph.D. program is under way.
Program
graduate Koren Smith, now a staff medical physicist
at Johns Hopkins
Kimmel Cancer
Center in Baltimore, started the MBPCC-LSU program
the same year Hogstrom arrived. She says she
watched him transform it into a dynamic research hub in which students had
substantial clinical time. The hands-on nature of her training was one of the
factors that helped her land her current position, she says.
“A
whole year, for half a day every day, we were in the clinic working with
patients, and it helped me so much in looking for job,” Smith says. “The
mentoring was wonderful.”
Talented
students, Hogstrom says, are key
to advancing the program because they push research.
“We
continue to publish work in national journals, and we continue to have
success in bringing grants to Mary Bird for research,” he says.
The
program’s 12 graduate students helped produce eight papers at the annual
conference of the American
Academy of Physicians
in Medicine this year, including groundbreaking research on improved cosmesis in breast cancer patients. They found new ways
of attacking tumors with less impact on the thin tissues of the chest that
are set to become the new national protocol. His students and staff also have
participated in research that has narrowed the treatment field of brain
tumors and nerve conditions in the head and neck to better than 1 millimeter.
Peter
Almond, a well-known medical physicist at M.D. Anderson and former president
of AAPM, says the advancements in the MBPCC-LSU program have been impressive.
“Ken has brought a new depth that really wasn’t there before,” says Almond,
adding that while many community centers exist alongside universities, the
partnerships don’t always exist.
“You
have to have the right cancer center and the right research institution and
the right person to make it happen,” Almond says. “There’s a
uniqueness to what’s going on at LSU and Mary Bird Perkins.”
Elsewhere,
Mary Bird has made substantial strides in bringing education, screening and
treatment to more Louisianans.
“Access
to cancer care saves lives,” Stevens says, “and for many patients treatment
close to home makes all the difference because they can continue their
routine and fall back on the support of friends and family.”
To
broaden its reach, Mary Bird Perkins has added partnerships with regional
hospitals outside Baton Rouge, including St.
Tammany Parish Hospital in Covington, Terrebonne General Medical
Center in Houma
and, most recently, St. Elizabeth Hospital
in Gonzales, announced earlier this year. The partnerships allow Mary Bird to
reach 18 parishes.
Stevens
says Mary Bird’s involvement in the NCCCP program gives the facility exposure
to the latest trends in the field, including national clinical trials and
integrated treatment practices—all of which benefit patients.
Participation
in NCCCP also will improve how Mary Bird can build upon its history of
reaching underserved populations by introducing best practices from around
the country. Similarly, the program is setting standards on how facilities
should handle biospecimens, which will enable
long-term research.
One
of the factors that helped Mary Bird land the NCCCP designation was its IT capacity,
which will help it integrate into a nationwide research registry. Stevens
says the country is on the cusp of streamlining research and drawing from a
larger pool of patients, a factor that will accelerate research.
The
NCCCP program recently announced it would extend the three-year grants to a
fourth year.
“Participation
in programs like these is giving us a competitive advantage,” Stevens says.
“It will fast track our progress.”
http://www.businessreport.com/news/2009/aug/24/hitting-target-hlcr1/
[BACK TO TOP]
By
Emma James
Standing
at the counter of your favorite neighborhood pharmacy, whipping out a pharmacy
card and forking over your co-pay is just one more step in completing the
transaction that will hopefully make you a healthier human being.
While
the average customer probably won’t see any changes in their part of this
exchange, the way prescription drugs are priced will undergo a radical
makeover in two years that will impact the way employers and health plans
negotiate with pharmacy benefit managers on behalf of the employees they
represent.
The
change will start Sept. 26 with a pricing decrease of up to 5% on 400
prescription drugs. This drop is the result of a class-action suit filed
against California-based First DataBank, a company
that publishes the average wholesale price, a benchmark for pricing
prescription drugs that comes from averaging costs from manufacturers and
wholesalers.
Lawsuits
filed by AFSCME District Council 37 Health and Security Plan and New England
Carpenters Benefits Fund against FirstData Bank and
California-based drug manufacturer McKesson in 2005 and 2006 alleged the companies
arbitrarily inflated the prices of more than 400 drugs by 5% from 2002-05.
A
final settlement filed in March with the U.S. District Court in Massachusetts reversed
the change, lowering the prices to an AWP ranging from a 120% to 125% markup.
So
what does this mean for Baton Rouge
employers? It depends on the company, and the contract they have with their
health plan or pharmacy benefit manager.
Companies
deal directly or contract with health plans to negotiate with PBMs for prescription drug prices, and those contracts
typically contain a percentage discount off the AWP. To offset the decrease,
health plans or PBMs have worked out mathematical
equations that decrease the discount so employers are getting only the
discount for which they originally contracted.
For
example, if an AWP is $80 and is marked up by 125%, then the retail price of
the drug is $100. Subtract a 16% benefit discount, and the customer pays $84
for the prescription. If the markup on that same $80 drug is reduced to 120%,
then the retail price is $96. If PBMs apply that
same 16% discount, they lose money because they are technically paying more
than what was originally contracted.
“That
wouldn’t be fair,” says Gil Dupre, CEO of the
Louisiana Association of Health Plans. “That’s why the health plans and PBMs are renegotiating contracts with new discounts that
will hopefully make the net effect zero.”
Employers
potentially could see some lower costs depending on the structure of their
benefits and whether or not their employees use the drugs being marked down.
Turner Industries, which has more than 16,000 employees, would like to see
lower costs, but does not yet know what impact the
decrease will have, Benefits Manager Dan Burke says.
“We
work closely with consultants with whom we meet with quarterly to track cost
trends and expenses,” he says. “I don’t think that there will be an
exponential decrease, but it’s hard to say.”
Turner
Industries recently renegotiated its 2010 contract with Pennsylvania-based
pharmacy benefits manager Highmark Blue Cross Blue Shield. Burke says their
costs are in line with the national average for the construction industry,
which is $47.97 per member per month.
For
the Office of Group Benefits, the price decrease did not impact a 2010
contract with PBM Catalyst Rx, which contracts with a broad network of chain
and independent drug stores. The organization, which administers health and
life benefits for state employees and some school boards, plans to conduct an
audit to ensure their members are receiving the correct discount, says
Malcolm Veazie, OGB’s
deputy assistant secretary.
“Language
in that contract means that our members receive a transaction price that is
lower than the AWP, the usual and customer price, or the price submitted by
the pharmacy, whichever is lower,” Veazie says.
“That language acts as a safeguard so our members get the lowest price,
especially as prices roll down.”
The
biggest risk that an employer faces is that the mathematical equations the PBMs use to determine the new discounts won’t fulfill the
terms of their original contract, says Ginger Campbell, a pharmacy benefit
consultant at Wright & Percy Insurance.
If
employers audit before or after the pricing change, Campbell says, they can significantly
reduce the risk of PBMs not delivering on the terms
of the contract because of miscalculations in that equation.
“The
deal isn’t to win or lose by it, it’s to get that discount you are contracted
for,” she says. “It’s to make sure that this temporary adjustment was done
correctly and I didn’t lose. I might not have gained, but I didn’t lose. I
got what I paid for and what my contract says.”
The
settlement with First DataBank and McKesson also
requires drug manufacturers, wholesalers and PBMs
to come up with a completely new pricing methodology for prescription drugs
by Sept. 26, 2011. Currently, there are several pricing methodologies under
discussion, Campbell
says, but there is no guarantee every PBM will agree to use the same one.
“That
would be horrible,” Campbell
says. “You’d have some bids at a discount minus, some at a discount plus.
There’s no way an employer is going to be able to evaluate the pricing
because it’s going to look totally different, especially if they don’t pick
the same methodology.”
While
the possibility exists that different PBMs will
choose different pricing structures, Dupre says
it’s unlikely because their goal is to preserve the stability of the system.
“The
system will work better and be more efficient if the PBMs
adopt the same pricing methodology,” he says. “We just don’t know what that
will be. These are very important changes that have attracted a lot of
attention, but in the final analysis, it should have very little or no impact
on employers.”
Burke
says Turner Industries is more concerned with the current health care reform
that is under debate in Congress than with prescription drug pricing.
“We’re
more concerned about how that’s going to impact our benefits plans overall,”
Burke says. “Even though it’s [prescription plan] an important part of a
benefit plan, we’re more concerned about health care reform.”
LITIGATION
TIMELINE
June
2005: AFSCME District Council 37 Health and Security Plan and New England
Carpenters Benefits Fund file a class-action lawsuit against California-based
First Databank Inc. and California-based McKesson Corporation, alleging the
companies conspired in 2002 to add an arbitrary 5% to Average Wholesale
Prices of more than 400 brand-name drugs published in First Databank’s drug
pricing guides
October
2006: A settlement is announced, which includes First DataBank
agreeing to rollback the AWP from 25% to 20% and agreeing to cease publishing
AWP data within two years of the court’s approval of the settlement
May
2007: Another benchmark publishing company, Medispan,
joins the settlement
June
2007: Preliminary approval on the settlement was granted
January
2008: The judge refuses to grant final approval to the settlement, citing
particular concerns about the proposed rollback applying to drugs that are
not part of the original complaint and an unwillingness to approve ordering
First DataBank and Medispan
to cease publication of AWPs within two years of
the settlement becoming final
March
2008: The judge refuses to approve the revised settlement or schedule a final
fairness hearing; the third-party payor damages
class is certified for the period of Aug. 1, 2001-Dec. 31, 2003
November
2008: A proposed settlement is reached between McKesson and the plaintiffs
December
2008: A final fairness hearing takes place, and a number of parties and
organizations that are not class members object to the settlement; final
approval from the judge is pending
March
2009: The judge issues the final order and judgment giving final approval to
the settlement; First DataBank pays $2.1 million,
agrees to decrease the price of inflated drugs and to stop publishing the AWP
within two years
SOURCES:
The Burchfield Group, Prescription Access Litigation
http://www.businessreport.com/news/2009/aug/24/prescription-change-hlcr1/
[BACK TO TOP]
By
David Jacobs
Monday,
August 24, 2009
Mike
Reitz has been the president and CEO of Blue Cross and Blue Shield of
Louisiana since April, but he’s been with the company for three
decades—including two stints as its interim president.
Reitz,
who had served as senior vice president and chief marketing officer since
2000, was named interim president and CEO in August after the departure of Gery Berry.
Reitz also filled the interim position for nearly a year in 2004.
When
he started with the company, Blue Cross might have paid $150 for an
appendectomy or $1,500 for brain surgery. “Today, $1,500 might get you a
single pill in some of these specialty drug therapies being introduced in the
market,” he says.
1.
Do you think a government mandate to buy health insurance, for individuals or
for businesses, is a good idea?
There
are more pieces of the health care reform initiatives that we all agree on
than the very few pieces that we disagree on. [The health insurance industry]
agreed to guarantee issue to everyone regardless of medical condition without
a waiting period for pre-existing conditions. The caveat is that everyone
must purchase insurance, so it’s a mandate. If we’re going to make it
available to everyone, we need to be able to get a good spread of risk. We
need to get the “good” people along with the “bad” people.
2.
But if you have a mandate to buy insurance without a public option to keep
the industry honest, wouldn’t that just be a windfall?
We
see no value in a government-run plan. The objective of that plan would be to
re-engineer a health care plan to disrupt access to care and disrupt the
current quality system we have in place today.
3.
Would a public option run you out of business?
The
details would determine whether or not that would happen. It could start by
creating a two-tiered system and eventually, depending on the way the
government runs their plan, would determine the fate of the insurance
industry. For example, if the government uses current Medicare levels of
reimbursement to establish their premiums, those levels are significantly
less than what the private market pays today. So it’s been estimated that their
product would be priced 30% to 40% less than the commercial market. A number
of people would flock to the government plan, and it would just create a
death spiral for the commercial plans.
4.
Some say the public option is the back door to a single-payer system. Would
that be such a bad thing? Other industrialized countries do it that way.
There’s
obviously money to be saved when you go to a single-payer system, but what
you’re going to do is sacrifice access to quality health care. I don’t think
you can point to another industrialized nation that’s on a socialized type of
health care plan and say that plan operates successfully in the eyes of the
consumer.
5.
But those countries with single-payer systems are democracies. Apparently
there is broad support for those systems, or the public would force a change.
They
could get rid of it, but if all of a sudden they wanted to reintroduce and
redesign a health care system once it’s dismantled, it becomes very difficult
to create that system again. When all of a sudden your doctors begin working
for the government, you begin to challenge the current stream of talent that
goes into medicine as a profession.
6.
Critics say the insurance industry just doesn’t want to compete with a public
plan. The American Medical Association says the vast majority of health
insurance markets are dominated by one or two health insurers. Who is your
competition?
Aetna,
CIGNA, United, Humana, Coventry,
local HMOs, Health Plus, Vantage and a host of other smaller carriers. How
many plans do you need? Do you need 500? Do you need 10? I think that
competition is pretty much responsible for keeping the insurance industry in
a responsible financial mode.
7.
Do we have a true free market for health insurance? Say I’m a business owner
who provides health insurance, and I have employees with pre-existing
conditions. Can I realistically drop my insurance company and go find another
one?
Yes,
you can. In Louisiana,
we have small business rating laws which guarantee that we will issue a policy.
It enables us to rate up depending on the medical conditions, but you can get
coverage. And then there are the portability laws that were passed a few
years ago where you come to the new plan and you get credit for waiting
periods served under the previous plan.
8.
So you would argue lack of competition isn’t a problem in Louisiana?
We
take great pride here in Louisiana
in the fact that we’re an individual, small-group state. We have a tremendous
portfolio of products to meet whatever the economic needs are of our
membership, and we have products available statewide, in urban as well as
rural markets. I don’t think lack of access is a problem. Affordability is
the problem.
9.
What are some other reform ideas that you do like?
We
need to standardize some of the administrative functions within the insurance
industry. There’s a tremendous need for us to standardize electronic medical
records. We could assist our providers with some tort reform initiatives, so
they don’t have to practice defensive medicine. The government could
encourage the marketplace to participate in wellness and
behavior-modification programs.
We
have to reform the way providers are paid. Right now, provider payments in Louisiana are based on
volume incentives. The more times you provide services, the more opportunity
you have to seek third-party reimbursement. We need to begin the migration to
a system that’s based on improving outcomes of a particular population.
10.
Last year, the relationship between Blue Cross and Franciscan Missionaries of
Our Lady [which runs Our Lady of the Lake Regional Medical Center among
others] nearly ended in a dispute over reimbursement costs, which would have
been bad for everyone involved. Can we prevent what almost happened then from
happening in the future?
The
struggle that we often find ourselves in is meeting the income needs of a
provider like a hospital and the needs of our membership. We are in constant
conversation with our provider groups, trying to make sure they understand
the balance between their income needs and the needs of our customers.
THE
REITZ FILE
Title:
President/CEO, Blue Cross and Blue Shield of Louisiana
Hometown:
Baton Rouge
Education:
LSU (1976)
Professional
experience: Provider affairs representative, Blue Cross and Blue Shield of
Louisiana, 1976-80; Louisiana Health Maintenance Plan, BCBSLA, 1980-81;
Director, provider affairs, BCBSLA, 1981-84; Assistant vice president,
individual sales and public affairs, BCBSLA, 1984-86; Vice president of
individual sales and government relations, BCBSLA, 1986-90; Vice president of
corporate development/major account executive, BCBSLA, 1990-91; State
manager, MediPak USA USAble
Life, 1991-95; Vice president of individual sales and marketing, BCBSLA,
1995-2000; Senior vice president and chief marketing officer, BCBSLA,
2000-09; President/CEO, BCBSLA, 2009-present
Noteworthy:
Also served as interim president/CEO in 2004 and from 2008-09
http://www.businessreport.com/news/2009/aug/24/10-questions-mike-reitz-hlcr1/
[BACK TO TOP]
By
Timothy Boone
Construction of a new Woman’s Hospital campus
remain
on hold while officials look for a new source of financing for the $350
million project.
Work
on the campus at Pecue Lane and Airline Highway
was halted in January, about six months after construction began. Woman’s
says the national recession made it difficult to secure permanent financing
for the project because the credit markets were frozen. A Woman’s Hospital
spokeswoman says officials are looking at the budget and scope of the
construction and hope to make an announcement in the
near future.
One
possibility could be private financing for the hospital. Woman’s CEO Teri
Fontenot said this spring the hospital looked for a fixed-rate, 30-year
private deal.
http://www.businessreport.com/news/2009/aug/24/fair-condition-hlcr1/
[BACK TO TOP]
Four
years ago, Hurricane Katrina devastated New
Orleans and its' health care system. CNN's Dr.
Sanjay Gupta reports on health care reforms in the city since Katrina:
"Out of the woodwork, in unorthodox places, the community is
responding." CNN
reports on the Lower Ninth Ward Health Clinic, which was started by two
former nurses at Charity
Hospital, and Project
Rising Sun, which organizes free therapeutic drumming sessions to help with
mental health needs in the city.
http://www.cnn.com/video/#/video/health/2009/08/25/am.gupta.nola.health.cnn?iref=videosearch
[BACK TO TOP]
BATON
ROUGE — When you inherit a name everyone in the region knows and you’re
running for the same state Senate seat your father famously held for a
generation, political logic dictates that your candidacy would be anything
but an outside shot.
Yet
Norby Chabert, son of the late Leonard J. Chabert
and a candidate for Senate District 20, said that’s exactly how he feels.
“My
opponent is part of the political establishment, and I do consider us an
underdog,” the younger Chabert said. “We’ve been running this campaign like
we’re 10 points down, but I relish that role. After the economy, the recent
hurricanes and rising insurance costs, everybody down here, everyone I grew
up with, is an underdog.”
Chabert
points to the fortunes of his opposition, former Lafourche Parish Councilman
Brent Callais, R-Cut Off, who was raising money
alongside Gov. Bobby Jindal Monday evening and has benefitted from heavy
handed donations from the Louisiana Republican Party and the Legislature’s
top lobbies.
Chabert’s campaign, meanwhile,
has received little or no boost from the Louisiana Democratic Party, which
has been tagged as an disorganized group in recent
media accounts.
Only
fellow party members from the state Senate have stepped up to help with money
so far, with only five days remaining until Saturday’s special election.
“Statewide,
Democrats have reached out and offered help, and I appreciate that, but we’ve
worked hard to keep outside interests out of our camp,” said Chabert, who
lives in Houma
but touts his roots along Bayou Little Caillou. “We
made it a goal early on to try and keep our players local.”
Regardless
of those intentions, Chabert has spent more time instituting damage control
on federal politics and officials than he has talking about Baton Rouge politics.
That’s
because Callais’ supporters have blanketed the
district with mailings linking Chabert to President Barack Obama’s
health-care plan, which he said he opposes. A more recent mailer even
distorts Chabert’s face to make him appear
devil-like.
“My
opponent is trying to make this whole race about party politics and Washington, and that’s
unfortunate,” Chabert said. “I have a record of working with and for both
Republicans and Democrats. He can’t say that, but I can. We just can’t send a
hard right or a hard left to Baton
Rouge right now and expect that person to legislate
effectively.”
The
“dirty politics,” he contends, has taken time away from discussing local
health-care issues, like the future of Leonard
J. Chabert
Medical Center
in Houma, and
Jindal’s involvement distorts the eventual harm his
administration could eventually bring to the district.
“We
should both be sitting down with Gov. Bobby Jindal’s
administration right now and talking about Nicholls State University,” said
Chabert, who held an administrative post at his alma mater until, he said,
the position was eliminated. “It could be targeted as a two-year school, and
we need to make sure the administration understands its role in the region.”
Such
scenarios, whether rumors or actual policy alternatives, are bound to arise
over the next three fiscal years through 2012 as the state braces for an
unprecedented, collective $5 billion shortfall.
Chabert
said he’s “not in favor of raising taxes” but is open to all possibilities.
As
for an immediate strategy, he said he wants to get involved right away with
the two commissions that are already working in Baton Rouge to streamline government and
reform the education system.
Both
panels have been charged with offering recommendations to the Legislature for
consideration in next year’s regular session.
“I
don’t want to go to Baton Rouge
just to cut, cut, cut,” he said. “I also don’t want to raise taxes. We’ve
already taxed too much. But there is something that can be done to improve
services and get our fiscal house in order. I’m ready to look at the
challenge from the top to the bottom. A combined approach will be needed.”
Chabert
said he’ll also be a good fit in the Senate, which has earned a reputation in
recent years for acting independently of the governor and offering its own
solutions.
“The
governor is not a king,” Chabert said. “It’s important for the Legislature to
do its job independently, and I won’t be heading to Baton Rouge owing anyone anything.”
Asked
what he would do if Jindal called him up to his fourth-floor office and
threatened an earmark for the district if he changed his stance on a party
issue, Chabert said he would have no problem opposing Democrats or Republicans
to secure money for the region.
“I’m
not being sent to the Senate to tout my own personal philosophy,” Chabert
said. “If it’s good for the district, but not my own party, you won’t see me
compromising on that issue.”
As
for coastal restoration and hurricane protection, Chabert said voters have
heard enough from candidates who do nothing but champion popular projects
like Morganza-to-the-Gulf.
“Real
leadership” is needed to advance the agenda of coastal Louisiana, he said.
“One
of my top priorities will be finding a project that moves sediment into the Barataria
Basin between
Terrebonne and Lafourche parishes,” Chabert said. “That’s where we’re losing
the most land. There are a couple of plans out there to do that, but we’ve
got to get organized in Baton Rouge.”
The
ongoing struggle of commercial fishermen is another issue that requires a
fresh vision, he added. Last week, south Louisiana shrimpers went on strike and
staged protests as dockside prices slid by 25 percent or more.
The
commercial shrimpers argue that middlemen are to blame because they’re
conspiring to lower prices to benefit their own businesses.
“It’s
unfortunate that it’s come down to this, but the hard truth is that
processors have shrimp stacked in their freezers that they can’t move and
fishermen can’t get the prices they need,” he said. “The solution is eat more shrimp, but it’s never quite as simple as that.”
Chabert
said he’s willing to explore tax breaks for fuel and other supplies.
“At
this point, I think we’re all willing to look at anything,” he said.
As
for his professional life, Chabert said he is done with being a political
consultant, although he could see himself becoming more active in civic
causes should he lose.
“I’ve
really been inspired by this campaign, and I think there’s a lot of places I
could help out,” Chabert said. “But as far as running campaigns and political
consulting, I’m done with that.”
Today,
Chabert makes the bulk of his money from Chabert Development, a land company
with more than $500,000 worth of holdings, and he’s still looking for a new
location for Blue Chips Bar and Grill, which was scheduled to open in
downtown Houma
before the recent hurricanes.
“If
I win, I’ll continue to grow Chabert Development and look for opportunities
to branch out from there,” Chabert said. “We’ll just have to see. The Lord
has a plan, and that’s what I’ll follow.”
He
would also enter elected office as a single man, like his opponent, but said
his 17 nephews and nieces provide him with a real and tangible understanding
of the challenges families face.
It’s
also an appreciation that was instilled in him by his late father, who died
when he was just 15.
While
campaigning, Chabert said a day hasn’t gone by that a story about his father
hasn’t been shared or comparisons drawn. While some might shy away from such
a shadow, Chabert said he’s still enjoying it.
“I
would never run from my family,” he said. “I’m proud of it. But there’s no
doubt I’ve run this race on my own and, if I’m lucky enough, it’ll be Norby Chabert in the Senate casting votes, just like my
father did.”
http://www.dailycomet.com/article/20090825/ARTICLES/908259894?Title=Chabert-says-he-feels-like-the-underdog
[BACK TO TOP]
HOUMA — A 30-year-old who
abused pain medicine while pregnant and passed the addiction to her unborn
child pleaded guilty to a cruelty charge Monday.
Anahit Dufrene of Houma was arrested after Leonard J.
Chabert Medical
Center doctors reported
to officers her newborn girl was suffering from withdrawal symptoms, deputies
said.
Her
daughter, now 7 months old, is still undergoing treatment, said Jason Lyons,
a Terrebonne Parish assistant district attorney. The girl and Dufrene’s two other children are in the custody of her
husband’s parents.
“A
mother needs to be punished rather severely for making this choice for the
child, who couldn’t make the choice on its own,” Lyons said.
Dufrene is scheduled for sentencing at 9 a.m.
Friday in District Judge David Arceneaux’s downtown
Houma courtroom, Lyons said.
Dufrene told officers she had been prescribed
a small amount of the painkiller OxyContin before
becoming pregnant and she developed an addiction, Lyons said. She had also tested positive
for hydrocodone, he said, an ingredient in
prescription painkillers.
OxyContin is more addictive
than other painkillers and some doctors limit prescriptions of it “because
there was a market for abuse there,” said Maj. Darryl Stewart of the
Terrebonne Narcotics Task Force.
After
Dufrene gave birth to her daughter, doctors noticed
the baby cried constantly and appeared extremely irritable, Lyons said. To treat the newborn, doctors
gave her morphine, a painkiller, and then weened
her off the substance.
Hospitals
are required to notify law enforcement if a child has symptoms of an
addictive disorder such as withdrawals, Lyons
said.
“There
is no crime that specifically mentions a mother who gives birth to a child
who is addicted,” Lyons
said. “It fits under the cruelty statute.”
Dufrene posted her $100,000 bond Feb. 10 and
was released, a Terrebonne jail official said. She could be required to pay
fines of up to $1,000 and spend up to 10 years behind bars.
The
case is among the first the Terrebonne Parish District Attorney’s Office has
brought to court in which a mother is accused of cruelty that began before
birth, Lyons
said.
http://www.dailycomet.com/article/20090825/ARTICLES/908259891?Title=Mom-on-drugs-while-pregnant-guilty-of-cruelty
[BACK TO TOP]
NEW ORLEANS -- The statistics
are staggering: one in five people in Louisiana
has no health insurance, and 61 out of 64 parishes are medically
under-served.
Those
are just some of the stunning facts disclosed at a forum on health care
reform on Tuesday night.
Experts
said a lack of health insurance contributes to poor health and more trips to
the emergency room. Ultimately those who are insured pay for it, in the form
of higher insurance rates and hospital bills.
At
the forum, nearly a dozen community groups discussed the issue.
"Only
40 percent of our state supports health care reform," said Christopher
Williams, an attendee.
The
conversation about the need for health care reform took a personal turn when
Dr. Beverly Wright spoke of her bi-polar nephew living on the streets,
self-medicating with alcohol.
"If
you have a mentally ill person in your family right now, until he kills you
-- they will not do anything for you -- there's nothing in this city, there
is no place for you to go," said Wright. She is the director for the Deep South Center for Environmental Justice.
"He is now living from house to house. He gets a check from the state
every month for $500. He does not take his medication. We have been searching
and searching for help for him."
A
panel of health care experts listened intently, and then discussed why better
health care is needed here.
Monique
Harden from Advocates for Environmental Human Rights said "There are
people here in New Orleans, in this room, in Louisiana and around this
country that have some of the most toxic levels of chemicals in their blood
in their hair, tissues and internal organs through no fault of their own,
because of where they live. There are approximately 300 petrochemical plants
in Louisiana."
Organizer
Tracie Washington said she hopes the event paints a clear picture of the
community's needs.
"When
we're really listening to what people are saying I know we're going to get
the best outcome," said Washington.
Only
state lawmakers showed and U.S.
lawmakers did not. Even so, Dr. Kevin Stephens, the director of the health
department, stressed the needs for personal responsibility as low-cost
preventative maintenance, in terms of eating right and exercising.
"Our
president can't fix the problem, the governor can't fix problem and mayor
can't fix the problem, but all of us -- we can fix the problem. We have the
ability to do it and I will say we must do it," Stephens said.
Mary
Joseph, a representative for the Children's Defense Fund, said she would like
a health care bill with specific language that would support easy access for
services for children.
Joseph
said it's simple, "Children are inexpensive to cover. If you treat a
child in a physician's office for asthma, it's under $100. If that attack
blooms into a larger attack and the child ends up in the emergency room,
you're looking at more than $7,000."
When
it comes to President Barack Obama's health care reform bill, most at the
forum were in support of it.
Washington said "The
public option is really the compromise. To have health care reform in this
country -- you need single payer. I don't think folks want to talk single
payer, but when you look at the plans, it's truly the way we're going to wind
up going."
http://www.wdsu.com/health/20557577/detail.html
[BACK TO TOP]
By
GINA KOLATA
Rates
of hip fractures, an often devastating consequence of osteoporosis, have been
steadily falling for two decades in Canada, a new study finds. And a
similar trend occurred in the United
States, researchers found. But it is not
clear why.
Drugs
that slow the rate of bone loss may be part of the reason, but they cannot be
the entire explanation, osteoporosis researchers say. And although experts
can point to other possible factors — like fall prevention efforts and a
heavier population — the declining rates remain a medical mystery.
The
new study, published Wednesday in The Journal of the American Medical
Association, analyzed Canadian hospitalization data. From 1985 through 2005,
the researchers report, hip fracture rates, adjusted
for the age of the population, fell by 32 percent in women and by 25 percent
in men.
A
United States
study, published in 2007 to little notice, analyzed national data on hospital
discharges from 1993 through 2003 and found nearly the same percentage
declines in hip fracture rates.
Dr.
Stephen H. Gehlbach of the University of
Massachusetts-Amherst reported a 20 percent decline in the age-adjusted hip
fracture rate for men and women in that 11-year period. The drop was so
pronounced that even though there were more older
people in the population in 2003 than in 1993, there actually were fewer hip
fractures. In 1993, 225,000 Americans were discharged from hospitals after
being treated for a broken hip. In 2003, that number was 209,000.
In
Canada,
there was a slight increase in the absolute number of hip fractures in the
21-year period studied because there were more so many more elderly people in
2005 than in 1985.
“I
was amazed,” said Dr. William D. Leslie, a professor of medicine and
radiology at the University
of Manitoba and the
Canadian study’s lead author.
“As
to what’s responsible for all this,” Dr. Leslie continued, “that’s the
million-dollar question.”
Dr.
Ethel S. Siris, director of the Toni Stabile
Osteoporosis Center
at Columbia University Medical
Center, warned against
complacency.
“What
I don’t want to see happen is for people to say, ‘Oh look. Fewer hip
fractures. Now we don’t have to worry about it,’ ” said Dr. Siris, a past president of the National Osteoporosis
Foundation.
Hip
fractures are often the start of a downward spiral for elderly people,
leading to a loss of mobility, a nursing home and other fractures. “Loads of
people recover but never walk normally again,” Dr. Siris
said. “Their quality of life is severely impaired.”
The
risk of hip fractures can be lowered by a class of drugs, bisphosphonates, that can
slow bone loss. They are likely to have played a role in the declining hip
fracture rates in the United States
and Canada,
researchers say, but other factors must also be involved.
In
Canada,
for example, the trend was well under way long before bisphosphonates
became available in the mid-1990s. And the rates in Canada and the United States fell in men as well
as women, Dr. Gehlbach noted, although far fewer
men than women take the drug.
Dr.
Steve Cummings, a professor emeritus of biostatistics and medicine at the University of California,
San Francisco,
said the drugs still were not widely used. Less than 15 percent to 20 percent
of older women take them, Dr. Cummings said. And even though the drugs must
be taken continuously to have an effect, more than half of those who start
taking them stop within a year.
So
with bisphosphonates insufficie
nt to explain the
decline, researchers asked what else might have changed in those at risk.
Perhaps
it is the growing girth of populations. It is not so much that being fat is
protective as that being thin and frail puts people at risk for osteoporosis
and hip fractures.
“It’s
the thin, frail people who fracture the most,” said Dr. Clifford J. Rosen of
the Maine Medical Center’s
Research Institute.
In
the United States, said
Katherine Flegal of the National Center
for Health Statistics, there are fewer thin old people than there used to be.
Ms. Flegal provided data on people ages 70 and
older with body mass indexes of less than 22, meaning that their weight in
relation to height was near or below the midpoint of the range considered
“normal weight.” The percentage of men in that category was 14.6 percent in
the years 1988 to 1994. In 2005-6, it dropped to 10 percent. Among women, the
percentage fell to 15.7 from 20.6.
Smoking
increases the risk of osteoporosis, and smoking rates are going down. But in
considering whether smoking was the answer, Dr. Leslie said, he concluded
that it “was just not enough to explain this.”
Another
factor, Dr. Rosen said, might be increasing efforts to prevent falls in the
elderly, like getting rid of throw rugs, improving the use of walkers and
using gates at the top of stairs.
Dr.
Siris agreed that fall prevention had improved. But
she wonders how much of the effect goes back to improved health and nutrition
early in life.
“When
you are old, the amount of bone you have is a function of how much you built
during the years you were building it and how much you lost in the years you
were losing it,” Dr. Siris said. “I’m guessing that
if you grew up with a healthy diet and were not starving, if you were blessed
to live in an era of peace and tranquillity, that may show up in your peak bone mass in your early
30s.”
And
a greater peak bone mass, she added, might result in a lower risk of hip
fractures in old age.
“That’s
really worthy of study,” Dr. Siris said, “and I
think the capacity to study it is there.”
http://nytimes.twi.bz/Ec
[BACK TO TOP]
By
RONI CARYN RABIN
A
new report suggests that a drug widely used to prevent the recurrence of
breast cancer may have a rare but dangerous side effect: increasing the odds that long-term users may develop an uncommon but
aggressive new tumor.
But
medical experts were quick to question the significance and methodology of
the study, saying clinical trials had repeatedly found that the drug, tamoxifen, reduced the recurrence and spread of common
breast cancers and that its benefits exceeded any possible risks.
Even
the author of the report, which is based on an observational study and not
the kind of randomized, controlled clinical trial considered the gold
standard in medicine, said the findings should not affect practice because
the drug’s benefits were well established.
“All
treatments have risks associated with them,” said Dr. Christopher I. Li, an
associate member of the Fred Hutchinson Cancer
Research Center
in Seattle
and the first author of the study, which appeared Tuesday in Cancer Research.
“Here we’re adding another potential risk to the risk side of the equation
for tamoxifen. But the broader context is that tamoxifen lowers a patient’s risk of dying of the
disease.”
Tamoxifen, which blocks the
effects of estrogen, significantly reduces the recurrence and spread of
estrogen-sensitive cancers, which are the most prevalent.
The
new study, which assessed the likelihood of developing a new cancer in the
second breast, found that women who took tamoxifen
for five years or more were 60 percent less likely than nonusers to develop a
new estrogen-sensitive tumor in the second breast, and 40 percent less likely
to develop a new tumor of any kind in the second breast.
But
the study also found that the long-term tamoxifen
users were possibly four times as likely as nonusers to develop a new tumor
that was not estrogen-sensitive. Those tumors are harder to treat, but also
relatively rare; only 1 in 7 of the women studied who developed a cancer in
the second breast had the kind of tumor that falls into this category.
The
finding of a four-fold increase was questionable both because the number of
women who developed the unusual tumor was small, and because women who took tamoxifen for one to four years were not affected,
statisticians said.
Dan
Berry, a biostatistician with the M.
D. Anderson
Cancer Center
in Houston,
said the findings might well be “a statistical fluke.”
“This
is what we call a case control study, and we all know the problems associated
with these studies,” Dr. Berry
said. “Case control studies showed conclusively that hormone replacement
therapy protected women from cardiovascular disease, which turned out to be
not only wrong but in the wrong direction.”
The
study assessed the history of tamoxifen use among
more than 1,000 breast cancer survivors from the Seattle-Puget Sound region
who learned they had an estrogen-sensitive breast cancer when they were 40 to
79 years old. It compared the histories of 358 women who developed a new
cancer in the second breast with 674 women who did not develop a second
cancer. Most of the women who took hormonal therapy used tamoxifen.
Several
breast cancer experts said they were concerned that breast cancer patients
who heard about the new study might stop taking their tamoxifen,
even though the main reason to take the drug is to prevent the cancer they
already have from recurring and spreading, which can lead to death.
“You
have to keep in mind, this drug isn’t being given to women to prevent cancer
in the other breast — it’s to prevent cancer from spreading to the bones and
the liver and the lungs,” said Dr. Eric Winer,
director of the breast oncology center at the Dana-Farber Cancer Institute in
Boston. “We
know from other studies that in this setting, tamoxifen
is able to lower the chance the cancer will spread to other parts of the body
and improve overall survival.”
http://www.nytimes.com/2009/08/26/health/research/26cancer.html
[BACK TO TOP]
By
DONALD G. McNEIL Jr.
ATLANTA — Up to 90,000
deaths from swine flu in the United
States, mostly among children and young
people?
Up
to 1.8 million people hospitalized, with 50 percent to 100 percent of the
intensive-care beds in some cities filled with swine flu patients?
Up
to half the population infected by this winter?
On
Monday, a White House advisory panel issued a report with these estimates,
calling them “a plausible scenario” for a second wave of infections by the
new H1N1 flu. The grim numbers by the panel, the President’s Council of
Advisers on Science and Technology, got considerable play in the news media.
On
Tuesday, however, officials at the Centers for Disease Control and
Prevention, the agency with the most expertise on influenza pandemics,
suggested that the projections should be regarded with caution.
“We
don’t necessarily see this as a likely scenario,” said Dr. Anne Schuchat, director of the National Center
for Immunization and Respiratory Diseases.
A
press officer for the disease centers, speaking carefully to avoid a feud
with the White House press office, said, “Look, if the virus keeps behaving
the way it is now, I don’t think anyone here expects anything like 90,000
deaths.”
Even
one of the experts who helped prepare the report said Tuesday that the
numbers were probably on the high side, given that some weeks had passed
since the calculations were finished in early August.
“As
more data has come out of the Southern Hemisphere, where it seems to be fading,
it looks as if it’s going to be somewhat milder,” said the expert, Marc Lipsitch, an epidemiologist at the Harvard School of
Public Health. “If we were betting on the most likely number, I’d say it’s
not 90,000 deaths; it’s lower.”
Dr.
Harold Varmus, president of the Memorial
Sloan-Kettering Cancer Center
and one of the panel’s chairmen, defended the report.
“A
lot of people think the flu is over,” Dr. Varmus said. “We think it’s
important that there be a dose of reality. It’s certainly not an outlandish
proposal. A lot of people are going to be infected.”
For
a report with such striking figures, it was released with little fanfare and
less coordination than might have been expected among public health
officials.
The
report was posted on the White House Web site on Monday, two weeks late,
since it was dated Aug. 7. With President Obama on vacation in Martha’s Vineyard, no news conference with the White
House or with the report’s authors was scheduled.
Kathleen
Sebelius, secretary of health and human services,
was at the disease centers’ headquarters in Atlanta, addressing a special symposium on
swine flu.
A
summary of the report was handed out by the centers’ press staff to medical
reporters as she spoke, but Ms. Sebelius did not
dwell on it or mention its forecast of 30,000 to 90,000 deaths, more than
twice the 36,000 deaths usually caused by seasonal flu.
With
the centers’ director, Dr. Thomas Frieden, by her
side, she said fall would be a challenge when flu returned, and acknowledged
a recent Washington Post poll showing that few Americans were worried. She
even joked that it might bring handkerchiefs back into fashion.
Both
she and Dr. Frieden acknowledged that “some people”
would die, but neither gave an estimate.
Dr.
Varmus said he was not happy with the way the report had been released “but
that’s above my pay grade.”
A
debate over alarming predictions for flu would recall September 2005, when
Dr. David Nabarro, then in charge of the United
Nations response to H5N1 avian flu, estimated that a human outbreak could
kill 5 million to 150 million people.
Headlines
focused on the larger number, and arguments over the wisdom of such estimates
went on for months. But the flu never mutated to transmit easily between
people and thus far only 262 deaths have been attributed to it by the World
Health Organization.
Since
the epidemic began, the centers have been reluctant to issue projections
about probable swine flu cases, and the agency has even stopped estimating
how many Americans have already had the flu. The official estimate has been
stuck at “more than one million” for months.
At
the Atlanta
symposium, Lyn Finelli, head of surveillance for
the influenza division, was asked when that would be updated. “Sometime in
the next few weeks,” Dr. Finelli said. “We’re
working on the model.”
Officials
at the centers said they had known that the panel’s report was in the works,
but had focused on the recommendations it would make.
They
included these:
·
Releasing some vaccine for high-risk people in September,
even before clinical trials are finished.
·
Speeding plans for intravenous flu drugs and clarifying
guidelines for using drugs like Tamiflu.
·
Using social media that appeal to youth to urge them to
get shots.
·
Changing federal rules and programs that discourage
school closings.
Agency
officials said they had already adopted some measures. For example, vaccine
makers have been asked to prepare early batches of vaccine, and the disease
control centers are already on Facebook and
Twitter.
Even
while distancing themselves from the grim forecasts presented in the White
House advisers’ report, officials at the centers saw a possible benefit.
“Anything
that breaks the complacency is a useful tool,” said Glen Nowak, the director
of media relations at the centers.
http://www.nytimes.com/2009/08/26/health/26flu.html
[BACK TO TOP]
By
NEIL KING JR.
The
Republican Party issued a new salvo in the health debate Monday with a
"seniors' health care bill of rights" that opposed any moves to
trim Medicare spending or limit end-of-life care to seniors.
Intended
as a political shot at President Barack Obama, the Republican National
Committee manifesto marks a remarkable turnaround for a party that had once
fought to trim the health program for the elderly and disabled, which last
year cost taxpayers over $330 billion.
The
Republican stance also underscores how tough it will be for Mr. Obama to find
politically palatable savings to pay for new coverage while reining in
spiraling health-care costs.
The
Republicans said they aimed to "protect Medicare and not cut it in the
name of health-care reform," in a statement and an accompanying op-ed
written by RNC Chairman Michael Steele and published in Monday's Washington
Post.
The
party also vowed to oppose any Democratic effort to ration care or to insert
the government between seniors and their doctors.
The
Obama administration has repeatedly said it does not intend to ration care to
seniors.
Congressional
Democrats shot back at the Republican statement. "The Republicans are
doing nothing but saying 'No' and spreading lies," said Rep. Jan
Schakowsky (D., Ill.), on a conference call with reporters sponsored by the
Democratic National Committee.
The
Republicans are hoping to tap into unease among seniors. Recent polls have
shown that support for sweeping health-care changes is ebbing most rapidly
among Americans over the age of 65.
At
the same time, voters are expressing disenchantment with Republican
positions. In an NBC News poll released last week, 62% of respondents -- and
42% of Republicans -- disapproved of how congressional Republicans were
handling the health-care issue.
The
same poll found that 41% of respondents favored Mr. Obama's handling of the
issue, while 47% disapproved.
The
country's largest lobbying group for seniors, AARP, said it welcomed the RNC's commitment to protect Medicare. But the group,
which supports efforts to overhaul the health-care system, also dismissed the
RNC statement as misleading and alarmist.
"Change
by itself is anxiety producing, but as we have analyzed the various bills
[before Congress], the proposed Medicare savings do not limit benefits, they
do not impose rationing and they do not put the government between patients
and their doctors," said John Rother, AARP's
executive vice president.
Mr.
Rother said that AARP was frustrated by the lack of
concrete proposals being put forward on the Republican side of the debate.
"The debate as I see it doesn't even focus on health care," Mr. Rother said. "It is all about the role of government
and the importance of the federal deficit."
The
Republican statement highlights an irony in the health debate, as illustrated
during some of the emotional town-hall meetings this month: Many Americans
say they fear a government takeover of health care, even as they resist any
cuts to Medicare, the federal government's largest health program.
Tensions
are evident within the Republican Party over its posture in the health-care
debate. Some conservative commentators are proposing steps to contain
health-care costs that center on "consumer-directed" policies,
including requiring people to pay for routine care out of their own pockets to
encourage comparison shopping.
But
others in the party oppose making specific proposals now, arguing that the
better strategy is to oppose what Democrats are putting forward.
The
new RNC position doesn't offer any significant cost-cutting ideas and instead
focuses on preserving Medicare and health benefits for military families.
Katie Wright, an RN!spokeswoman,
said Republicans still believed in controlling Medicare costs but think
"money shouldn't be taken from Medicare to fund a new entitlement."
Republicans
and Democrats have feuded over Medicare since its inception in 1965, and it
is usually Democrats who adopt the stance of protecting the program against
cost-cutters.
Ronald
Reagan proposed cutting $1 billion in Medicare spending while president in
1981, when the program cost just $40 billion a year.
In
the mid-1990s, congressional Republicans proposed deep cuts in Medicare and
Medicaid to pay for tax cuts. That sparked a backlash and gave President Bill
Clinton his best weapon to fight back against the Republican "Contract
With America."
President
George W. Bush, realizing Medicare's popularity among seniors, pushed for
including prescription drugs in the program. The legislation won Democratic
support and went into effect in 2006, marking the largest increase in
benefits since Medicare's creation.
During
the 2008 presidential election, both candidates acknowledged that any
health-care overhaul had to grapple with exploding Medicare costs, but
neither Mr. Obama nor Arizona Republican Sen. John McCain offered much
detail. Democrats charged that Mr. McCain planned to trim Medicare spending
to help pay for his plan to give all households a $5,000 tax credit to buy
health insurance, but he rejected the claim.
Douglas
Holtz-Eakin, Mr. McCain's top economic adviser
during the campaign, said the RNC attack was, for Mr. !Obama, "a classic
example of 'reap what you sow.'"
"The
Obama guys blistered us for proposing radical cuts to Medicare, when what we
were proposing were efficiency gains and delivery reforms that would have
reined in the growth of costs," he said. "So, welcome to the
club."
http://online.wsj.com/article/SB125112553661853921.html
[BACK TO TOP]
By
JONATHAN WEISMAN
WASHINGTON
-- In the rhetorical battle over health care, the forces backing President
Barack Obama's overhaul have spent years polling and using focus groups to
find the precise language that would win over voters -- an effort that
doesn't at the moment appear to be working.
When
Mr. Obama told grass-roots organizers last week that the mandatory purchase
of health insurance would "be affordable, based on a sliding
scale," the phrasing precisely mirrored language that had been
poll-tested and put before batteries of focus groups by Democratic
consultants over the past few years.
The
words had been carefully chosen in an effort to take away the rhetorical
targets of health-overhaul foes and replace them with terminology that would
bring ordinary Americans on board. But under steady attack from opponents
using more-emotional language, some of the president's allies are rethinking
the linguistic strategy.
video
Health-Care
Reform's War on Words
2:06
What
are the semantics of health care reform? The Herndon Alliance, a center-left
coalition, was formed to frame reform in rational terms but its appeals may
be losing ground to emotionally-fraught phrases from the right, Jonathan
Weisman reports.
"There
are emotions on both sides, and some of these recommendations really avoid
connecting to emotion in a way that we hoped would bring the temperature down
and disarm opponents," said John Rother,
executive vice president for policy and strategy at AARP, the giant seniors
lobby. "I don't want to second-guess them, but the research is very much
a product of where the debate was at the time. Times have changed.
Temperatures have gone up."
An
Obama spokesman said at least one member of the administration had met with
the group crafting the health-care language, but declined to comment on
whether the research had affected Mr. Obama's own language in discussing
health care.
[war
of words]
The
effort began four years ago, when a center-left coalition of advocacy groups,
union leaders and health-care experts teamed up to try to change the language
of the health-care debate. The Herndon Alliance, named after the northern Virginia suburb where
proponents first met, included the AARP, Service Employees International
Union, the American Cancer Society and the liberal health-policy group
Families USA, among others.
The
alliance, now based in Seattle, hired the
Democratic polling outfit Lake Research and California
market-research firm American Environics.
The
idea was to take a page from the Republican playbook, said Robert Crittenden,
a physician and founder of the Herndon Alliance. Republicans had become adept
at using words to seize issues, turning the estate tax into the "death
tax," for instance.
"We
always had the facts on our side," Dr. Crittenden said. "But our
language hasn't connected with what the general public actually cared
about."
The
first polling began in the fall of 2005 and continues today. In 2007,
American Environics met with senior members of the
Obama campaign staff, according to people familiar with the meeting. Alliance
representatives met with Neera Tanden,
a top Obama administration official involved in the overhaul effort.
Herndon
participants aren't saying they dictated the language the president is using.
An administration official acknowledged Ms. Tanden's
meetings, and said she appreciates the work done on behalf of a health-care
overhaul. But Herndon members do say they have influenced the lexicon of
overhaul advocates.
"When
you've gotten the groups speaking with a similar voice and you've got data to
show one phrase works well and one doesn't, that gets into circulation,"
said Ron Pollack, executive director of Families USA.
The
results are echoed in the words of Mr. Obama and others. Out is talk of
"universal" health-care coverage, a "government"
health-insurance option or "health care for all." In are such
phrases as "quality affordable health care," a "public"
option and a "choice of private and public plans."
But
Republican aides with their own lexicon argue that in the end, voters will
see little difference between a "public option" and a
"government plan."
The
alliance and its pollsters planned responses to the charge of
"government-run health care" and "socialized medicine,"
and thought through how to neutralize fear that expanding health-insurance
coverage would help illegal immigrants and what to say to small businesses.
But
Dr. Crittenden said no one anticipated the charges that the Obama program
would include "death panels" or advocate euthanasia. Perhaps more
important, said Lake Research head Celinda Lake, no one foresaw the intensity of
protests at town-hall meetings.
"To
the extent that we're getting our message out, it's been very influenced by
Herndon work. Our biggest problem is it's not getting out," Ms. Lake
said.
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By
DOUGLAS BELKIN
HUMBOLDT,
Iowa -- Sen. Charles Grassley signaled growing skepticism about the
likelihood of Democrat-led health-care legislation passing this year, telling
a town-hall meeting here Monday, "Now is the time to do this right or
not do it."
The
senior Republican member of the Senate Finance Committee is central to the
national debate as the bipartisan leadership of that committee -- the
so-called Gang of Six -- struggles to forge a compromise plan. But speaking
in front of a mostly friendly audience of about 250, Mr. Grassley stressed
the distance between the two parties and what he thinks wouldn't work.
"Government
is not a competitor, it's a predator," he said of the public option that
has been embraced by key congressional Democrats. "We'd have 120 million
people opt out [of private insurance], then pretty soon everyone is in health
care under the government and there's no competitor."
Estimates
of how many people would leave private plans have been far lower. But Mr.
Grassley's criticisms echoed those of other Republicans who have turned more
decisively against Democratic-led legislation in recent days. Sen. Richard
Lugar (R., Ind.) said Sunday that President Barack Obama should focus on
boosting the economy and drop health care until "next year or in subsequent
times." The Senate's No. 2 Republican, Jon Kyl
of Arizona,
said last week, "There is no way that Republicans are going to support a
trillion-dollar-plus bill."
As
the prospect of passing bipartisan legislation dims, Democrats are looking at
several options, including a parliamentary maneuver known as reconciliation,
Sen. Charles Schumer (D., N.Y.) said Sunday on NBC's "Meet the
Press." Senate rules require 60 votes to stop a filibuster, but
reconciliation, used for budget matters, requires a simple majority.
Mr.
Grassley, 75 years old, is running for a sixth term in 2010 and faces the
possibility of a challenger in the GOP primary. He is typical of Republicans
whose rejection of a public option has hardened over the August recess.
Conservatives have mobilized across the country at town-hall meetings to
express their distrust of a government health-care plan.
"We
need to slow down and do a little less," Mr. Grassley told another
town-hall gathering in Pocahontas,
Iowa, Monday afternoon.
"We need to fix what's broken and leave alone what's working well."
In
an interview, he vowed not to vote for an "imperfect bill" that
includes a public option or gives the government too much control over
end-of-life issues.
Mr.
Grassley said he wouldn't vote for a bill that lacks significant Republican
support. He said Sens. Edward Kennedy (D., Mass.) and House Speaker Nancy
Pelosi (D., Calif.) are championing approaches that cost too much and are too
partisan.
Questions
and comments from the crowd of mostly older retirees were generally
sympathetic to Mr. Grassley's positions. "The mood of the country is
sour," said Charles Anderson, 74, who retired from the retail grocery
business. "People are as distrustful of government as I've ever
seen."
The
meeting was punctuated by rounds of applause that generally followed comments
skeptical of the government. A man who stood up out of turn and began talking
about the need for health-care reform was shouted down with calls of
"Socialist" and "You don't like it, go back to Russia."
Mr.
Jensen, the mayor, said Mr. Obama received about 60% of the votes here in the
2008 presidential election. But Mr. Jensen estimated that 90% of this town of about 4,500 people were leaning against
significant health-care reform because of the potential cost.
"People
have worked hard here all their lives," Mr. Jensen said. "They see
this as having to pay to take care of someone else."
http://online.wsj.com/article/SB125113580959054311.html
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