Jindal:
New clinic La.’s
future
By MARSHA SHULER
Advocate Capitol
News Bureau
New clinic opened.
Baton Rouge State Sen. Sharon Broome (in red at center) and
Herbert Brown cut the ribbon opening LSU’s new $18 million North
Baton Rouge clinic.
An $18 million state-of-the-art LSU-operated medical
clinic officially opened Thursday in north Baton Rouge.
In the next few weeks, primary care, women’s health and
cancer services will move from the campus of LSU’s Earl K. Long Medical
Center north on Airline Highway
to the new clinic.
In Thursday’s ceremonies marking its opening, state Sen.
Sharon Broome, D-Baton Rouge, was already promoting “a vision” for future
expansion of the facility, which is in her legislative district.
“We need an urgent-care center attached right over there,”
Broome told Gov. Bobby Jindal, one of the speakers.
“I wanted to say it in front of all these witnesses.”
Jindal called the clinic the way of Louisiana’s
health-care future. It will emphasize preventive and primary care. He praised
LSU officials for their leadership role in establishing “medical homes,”
which provides patients with medical care in their communities.
Jindal said Louisiana is one of leading states in the
nation for use of emergency rooms for nonemergency medical problems. He said
facilities like the north Baton
Rouge clinic would provide early diagnosis and care
that would reduce expensive emergency room visits and hospital stays.
North Baton Rouge Clinic
“This is exactly our vision for reform,” said state
Department of Health and Hospitals Secretary Alan Levine. “We are going to
give you the tools and infrastructure where it can be done properly.”
The 44,000-square-feet, two-story building has 30 exam
rooms, a community meeting room, a diagnostic laboratory, a pharmacy and
radiology services.
Broome said it took a lot of different people to make the
clinic reality from the Florida
businessman, who donated the land, to Gov. Kathleen Blanco’s administration,
which committed the funds and many others in-between. Blanco’s commissioner
of administration, Jerry Luke LeBlanc, attended.
Earl K. Long Medical Center Administrator Kathy Viator
said physicians started seeking obstetrics and gynecology patients at the
clinic on Monday. Cancer services will be moved from the EKL campus next,
then internal medicine services after July 1, Viator said.
Patient care will continue to be at the same high level
just in different and better surroundings for patients, physicians, nurses
and others, Viator said.
“You have a modern state-of-the-art facility that will
effectively serve patients’ needs. Our building down the street is
antiquated,” said Viator.
Richard
Alan Hannon/The Advocate
LSU medical students Suhas
Patel, left, Myles Bevan and Mary Plaisance listen to speakers Thursday who
helped open a state-of-the-art medical clinic where they will train. Sitting
at back is LSU System Vice President Fred Cerise, who oversees medical education
and hospitals.
Herbert Brown, who donated the clinic land to LSU, and his
family participated in the ceremony officially opening the facility.
Brown gave the old Kmart property at 5439 Airline Highway — a short distance
from EKL — in memory of his son H. Graham Brown who died tragically at age
15. A plaque will be placed on the building in his memory.
“We are still trying to do what Scripture said: ‘It is
more blessed to give than to receive’,” said Brown.
Dr. Michael Butler, chief of the LSU Health Care Service
Division of which EKL is a part, shared a litmus test he uses in judging
health-care facilities.
“Can you say you would want this for your momma? If you
can’t say that, you need to do better. LSU-Earl K. Long has finally come up
with something that’s good enough for you momma,” Butler said to applause from the crowd.
http://www.2theadvocate.com/news/47004687.html
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Watch Video: http://www.2theadvocate.com/news/46978862.html?showAll=y&c=y
A new health clinic is open in north Baton
Rouge so people don't have to go to Earl K. Long Hospital
for non-emergency cases. News 2's Christine Lewis visited the new LSU North
Baton Rouge Clinic on Airline
Highway and found it is cutting down the wait
time.
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By Kate Moran
Business writer
The local nursing home operator St. Margaret's is
exploring the possible purchase of Lindy Boggs Medical Center, the devastated
Mid-City hospital that was slated as recently as last year to be torn down to
make way for a retail center.
St. Margaret's signed a purchase agreement for the
hospital this week and plans to spend the next three to six months inspecting
the building and weighing whether to move forward with the deal, according to
Jason Hemel, the vice president of business
development.
Hemel said the nonprofit, which is affiliated with the Roman Catholic Church and
serves the elderly poor, would like to build a state-of-the-art nursing home
in part of Lindy Boggs and seek a hospital operator to run the remainder as a
health-care facility open to the public.
"St. Margaret's is not in the business of running
hospitals. We would look to bring in an operator, if that aspect is even
feasible," Hemel said. "We are very much
in the infancy of our due-diligence process."
Lindy Boggs was among the suite of five hospitals that
Tenet Healthcare, a publicly traded hospital operator based in Dallas, ran in the New
Orleans area before Hurricane Katrina. Tenet sold
three hospitals after the storm to Ochsner Health
System, which declined to purchase Lindy Boggs because of its heavy damage.
Tenet sold the vacant hospital in 2007 to Victory Real
Estate Investments, a Georgia
company that accumulated an enormous sweep of land in Mid-City for a big-box
retail development, an effort that met with considerable resistance from
neighborhood groups.
As the economy contracted and retail chains began
rationing the launch of new stores, Victory put its retail plans on ice and
enlisted local real estate broker Don Randon to
find a buyer for the property it owned in Mid-City. Randon
referred calls about the purchase agreement for Lindy Boggs to St.
Margaret's.
Hemel declined to disclose the
agreed-upon price for Lindy Boggs, which Victory acquired for $11.5 million.
Tenet agreed as part of the sale to pay $2.1 million to tear down the
hospital, which would have effectively reduced the price Victory paid had the
company moved forward with the demolition. The hospital still stands.
St. Margaret's currently runs a nursing home in Bywater, but Hemel called it a
temporary facility that was designed to help bring the elderly poor home
after the storm. The Federal Emergency Management Agency helped renovate the Bywater location, and it will provide additional money
for the permanent nursing home, Hemel said.
The nonprofit also hopes to secure new market tax credits
to help with the renovation of the portion of Lindy Boggs that would be open
to the public as a health-care facility. New market credits are a federal
incentive designed to spur investment in distressed and low-income areas.
Hemel said Lindy Boggs would
require a major renovation before St. Margaret's could move in. He said a
new, modern nursing home at the former hospital would serve about 116
seniors, about the same as the temporary facility on St. Claude Avenue.
The purchase agreement St. Margaret's signed this week
includes the main hospital as well as the medical building, but not some
parking and other land associated with the former hospital.
Hemel said St. Margaret's would
hold meetings in the coming weeks with Mid-City neighborhood groups. Jennifer
Weishaupt and Virginia Blanque,
both Mid-City neighborhood leaders, could not be reached for comment Thursday
evening to comment on the proposal.
"We want community involvement," Hemel said.
Residents previously have expressed frustration with the
slow return of health care to Mid-City, and they supported the U.S.
Department of Veterans Affairs as it explored whether to build its new
hospital on the site of the former Lindy Boggs hospital. The VA eventually
selected a site closer to downtown, where it would share a hospital campus
with Louisiana State University.
As it mulls whether to buy the former Lindy Boggs site,
St. Margaret's is managing the redevelopment of a medical center in Algiers that used to be
owned by Little Sisters of the Poor. Hemel said the
nonprofit is renovating St. Luke's, a facility next to Holy Cross
College, on behalf of
several partners.
The 130,000-square-foot building on the West
Bank eventually will hold a nursing home, a geriatric
psychiatric hospital, a rehabilitation center, a cardiology office run by
Tulane and a retail pharmacy, among other health-care uses, according to Hemel.
http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-13/124417984974800.xml&coll=1
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Jindal
favors merit raises for state workers
By MARSHA SHULER
Advocate Capitol News Bureau
Gov. Bobby Jindal said Thursday
he favors the granting of a 4 percent pay raise to state workers in the
coming budget year.
But Jindal said changes need to
be made so in the future the so-called “merit” raises are better tied to
employee performance on the job.
“They should be truly merit based,” Jindal
said.
Jindal noted today’s system
grants the same raise to state workers whether their job performance rating
is merely acceptable or exceptional.
The state Civil Service Commission on Wednesday postponed
action on a proposal that would have withheld the 4 percent raise from some
60,000 rank-and-file state employees.
The commission’s staff had recommended the plan as a way
to help reduce employee layoffs because of a $1.3 billion downturn in state
revenue available for spending in the fiscal year that begins July 1.
But commission member Burl Cain recommended the panel wait
to see if other options materialized.
The House version of the budget included language barring
agencies from giving the employee pay raises. The Senate reversed that
decision late Wednesday night as senators put their imprint on the proposed
$28 billion state budget document.
There is no extra money in the budget for the pay
increases. Agencies — as they have traditionally done — would be required to
cut in other areas to fund them.
The 4 percent pay raise is nearly automatic and is awarded
annually to most state workers on the anniversary date of their employment.
Only those with less stellar job ratings don’t get the “merit” increase.
According to Civil Service — state government’s employment
agency — some 96 percent of state classified employees get merit pay
annually.
Civil Service Deputy Director Jean Jones said the agency’s
compensation division has been working on “a comprehensive revision to our
pay system, including — but not limited to — merit increases. … We’ll
probably have a proposal sometime later this year.”
A couple of state representatives have been pushing for
Civil Service layoff and pay policy changes during the legislative session.
State Rep. John Schroder, R-Covington, wants Civil Service
to develop a system where employees would get anywhere from 0-to-4 percent
merit pay increases depending on their job performance.
Meanwhile, House Concurrent Resolution 6 by state Rep.
Mike Danahay, D-Sulphur,
requests that Civil Service revise the system to give bosses “greater
flexibility in compensating employees based on job duties and evaluations of
performance.”
The same resolution urges Civil Service to move away from
seniority as the sole factor in determining who goes and who stays when
employee layoffs are required. The resolution seeks inclusion of other
factors such as knowledge, performance and ability in the decision-making
process.
The Civil Service Commission on Wednesday approved policy
changes that would keep seniority as a factor but also consider performance
and other factors. The policy would end automatic “bumping rights” which
allow more senior employees to displace less senior workers when their jobs
are eliminated in layoffs.
Jindal said he agrees with the
commission decision, saying other factors, “not just length of service,” need
to be considered.
State employees who opposed the policy change told the commission
that performance ratings were not a good barometer because they are
subjective.
Some said it could easily interject politics into a system
where workers are supposed to be protected from the ebb and flow of
governor’s administrations.
http://www.2theadvocate.com/news/47004737.html
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By JORDAN BLUM
Advocate Capitol News Bureau
A debate that lasted several days in the Legislature about
allowing dental care in schools was resolved Thursday with changes to a
measure that would force the Louisiana State Board of Dentistry to enact
rules for dentistry in schools or mobile dental units.
The amended House Bill 687 was approved on a 64-30 House
vote to require the state dentistry board to adopt new health and safety
guidelines by Jan. 1.
The amended legislation also requires any dentist
providing such school care to have at least $1 million in medical malpractice
liability insurance. Opponents said the insurance measure would price out
many dentists from practicing.
HB687 centers on the new trend in Louisiana of dentists going to schools in
primarily low-income and rural areas and performing dental work on children
who are covered by Medicaid, the government insurance program.
Bill sponsor and state Rep. Kevin Pearson, R-Slidell,
contended removing “partial” dentistry care in school libraries and gyms is
needed to encourage parental involvement and to get students the quality care
they really need.
Several in opposition have argued that dentistry in
schools is the only way many students from low-income families will get any
dental care at all.
House Speaker Jim Tucker, R-Terrytown,
offered the compromise amendment that finally solved the debate.
“If we’ve learned anything, rulemaking should be kept at
the dental board level,” Tucker said.
State Rep. Fred Mills, D-St. Martinville,
who initially opposed the bill, worked on the compromise with Tucker. Mills
said the compromise is good because neither side of the debate is thoroughly
pleased with it.
“It just tells the Board of Dentistry to get your act
together and set guidelines,” Mills said. “If they don’t get it done, then
let’s get a new board.”
State Rep. Chris Roy, D-Alexandria, expressed concern
about the insurance requirement.
“The amendment is a clever way to make it impossible to
practice mobile dentistry,” Roy
said.
Only about 1,000 dentists in the state have agreed to
treat Medicaid patients. However, more than 430,000 young people on Medicaid
are not seeing dentists outside of schools.
The Louisiana Dental Association and its 1,800 or so
members have lobbied for the legislation, but Mills said much of the
association’s members are split on the issue. The LDA contends students need
to visit dentist’s offices in order to get proper care.
State Rep. John Bel Edwards,
D-Amite, complained the compromise was reached between Pearson, Tucker, Mills
and no other legislators as promised. Edwards said the amendment was too
restrictive and threatened to punish the Board of Dentistry too harshly.
“This amendment doesn’t do what we were told it was going
to do,” Edwards said.
Edwards offered a counter-amendment for the Board of
Dentistry to enact guidelines. But Edwards’ amendment had fewer restrictions,
unlike Tucker’s tighter “road map,” and did not threaten to remove dentistry
board members.
Edwards withdrew his amendment after Tucker’s proposal was
approved on a 65-31 House vote.
The legislation next moves to the Senate for
consideration.
Voting YES on House Bill 687 (64): Mr. Speaker and Reps Abramson,
Arnold, Badon A., Badon
B., Barras, Billiot, Burford,
Burns, H., Burns, T., Champagne, Chaney, Connick,
Cortez, Cromer, Danahay, Dove, Downs, Ellington, Fannin, Foil, Gallot, Geymann, Guillory,
Guinn, Hardy, Hazel, Henry, Hill, Hoffmann,
Howard, Hutter, Johnson, Jones, R., Katz, Kleckley, LaBruzzo, Lambert, LeBas, Leger, Ligi, Little, Lopinto, McVea, Mills, Monica, Nowlin, Pearson,
Perry, Pope, Pugh, Richardson, Schroder, Simon, Smiley, Smith G.,
Smith J., Talbot, Templet,
Waddell, White, Williams, Willmott and Wooton.
Voting NO on the measure (31): Reps. Armes,
Brossett, Burrell, Carmody,
Carter, Chandler, Dixon, Doerge, Edwards, Ernst,
Franklin, Gisclair, Greene, Henderson, Honey,
Jackson G., Jones, S., Landry, Montoucet,
Morris, Norton, Peterson, Ponti, Richard, Richmond, Ritchie, Robideaux,
Roy, St. Germain,
Stiaes and Thibaut.
Not Voting (9): Anders, Aubert, Baldone, Barrow, Harrison, Hines, Jackson M.,
LaFonta and Smith, P.
http://www.2theadvocate.com/news/47004337.html
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Jindal:
Protecting higher ed,
health care important
By Gov. Bobby Jindal
We have all seen the effects of the national economic
downturn, even as our state continues to out-perform the nation. Indeed, many
families and small businesses across the country and here in Louisiana are
tightening their belts and finding ways to cut costs. The state budget we are
currently crafting for next year is no different.
While we all want to eliminate waste in government, no one
in Louisiana
and certainly none of our elected leaders want to cut critical services. We
must be clear on that point. The challenge we are currently facing is how to
balance our state budget. When faced with a deficit, and required to balance
the budget, we are met with only two true choices: we can raise taxes on our
people or we can trim the size of government. We must choose one or the
other. Unlike the federal government, we can’t simply print more money and
pass the bill on to the next generation, or borrow money from China.
Given only these two real choices, we know that trimming
government and keeping taxes low encourage growth and success in Louisiana. On the
other hand, increasing taxes on our people or our businesses, or taking away
planned tax relief, would be the wrong choice for fostering growth and job
creation during this national economic downturn. There is something we can do
right now, however, and that is to reform our budget process so that in tough
economic times we can trim government in all areas and better protect
critical services, especially in higher education and health care.
Currently, funding for higher education and health care
are too often singled out for cuts in tight budget years, while there are
nearly 400 dedicated funds with more than $3.7 billion in funding that are
protected and not often examined for efficiency in spending. Under our
antiquated budget rules, these funds are off limits and not scrutinized.
We are trying to change that through legislation in this
session to make significant constitutional and statutory changes to protect
our spending priorities by forcing every government dollar and agency to
compete for funding. These reforms include being able to examine dedicated
funds frequently to ensure they match up with our state priorities and to
redirect their funding into more critical service areas when they do not. We
are also supporting significant reforms to curtail civil service red tape,
fund both preK-12 and higher education based on their performance, and to
streamline government.
Prioritizing state spending and making reductions where we
need to is not an easy process, but it is necessary to balance our budget in
a time of deficit. Most importantly, by keeping our taxes low and trimming
government so we live within our means, we will further strengthen Louisiana as a
competitor with the best places in the world for attracting business
investment, job creation, and greater economic growth. When you hear someone
mourn the fact that we have to trim government in lean times, remember two
things – first, we can make this process better by changing our budget rules,
and second, the alternative is to raise taxes.
http://www.thetowntalk.com/article/20090604/OPINION/90604015
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Battle to halt higher ed cuts intensifies
Ruston Daily Leader | 06.04.09
T. Scott Boatright, Reporter
This is one prizefight Louisiana Tech and Grambling State University
officials will have their eyes on.
Louisiana Senate’s budget-writing committee gave their
support for a more than $28 billion spending plan Wednesday that would
reverse proposed cuts to public colleges and health care by tapping into the
“rainy day” fund and delaying a scheduled income tax break.
The move sets up a battle with Gov. Bobby Jindal’s administration and the House, both of which have
already stated opposition to some of the financing plans used in the
patchwork proposal by the Senate Finance Committee for the new fiscal year
that begins July 1.
Jindal has said he would veto
the bill in its current form, and a majority of House members have signed
news releases promising to vote it down.
Tech and GSU have been at work for months to craft budget
plans that would address cuts that will hit the two universities.
Jindal’s original budget planned
for $220 million in cuts to higher education, $400 million in cuts to health
care programs and millions of dollars in cuts to arts programs, state parks
and social services. That plan would have sliced a combined $13.2 million
from the budgets of Tech and GSU — $8.3 million for Tech and $4.9 million for
Grambling.
The House reworked some of those plans, reversing $100
million of the $220 million in cuts Jindal proposed
for public colleges, though part of that was linked to a tuition increase
legislators agreed to levy on students. Higher education leaders say the
remaining cuts still would force layoffs, boost class sizes and damage
services to students.
Budget analysts said the Senate’s new bill, authored by
Sen. Lydia Jackson, D-Shreveport, would shrink higher education cuts to less
than $100 million and health care cuts to about $170 million next year as
lawmakers struggle to cope with a $1.3 billion projected drop in state
general fund revenue. Other agencies also still wouldface
cuts, and state government jobs would shrink by 1,400.
Jackson’s
bill would delay implementation of a 2007 law that allows taxpayers to deduct
100 percent of their excess itemized deductions — including mortgage interest,
charitable donation and health care costs — compared to the current 65
percent. The change is scheduled to take effect for 2009 tax forms, but Jackson’s bill would
delay that change until taxpayers fill out their 2012 forms.
About a quarter of Louisiana’s
taxpayers, mostly those with high incomes, itemize their deductions,
according to the state Department of Revenue.
The full Senate plans to debate the budget proposal
Friday. If approved there, it would head back to the House, where it was expected
to run into a flurry of complaints.
A majority of House members have signed onto statements
opposing the delay of a tax break for individual taxpayers
who itemize their state returns until 2012, but the Senate agreed Wednesday
to the tax cut delay and the Finance Committee budgeted the anticipated $118
million for college programs.
Senate opponents included Sen. Buddy Shaw, who called
supporters of the bill hypocrites because they’re backing off a tax break
promised to voters in 2007.
The committee also advanced legislation that would use
money from the state’s rainy day fund and then budgeted $86 million from it
for health care, agriculture, tourism marketing and other items.
Attempts to use the rainy day fund in the House have
stalled in committee.
http://rustonleader.com/news.php?id=5347
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Meg Farris / Eyewitness News
NEW ORLEANS
– There are 50,000 children across the state who are
eligible for state health insurance called LaCHIP
but have never signed up.
Video: Watch the Story
There is also help for people who have recently lost their
jobs and can't afford health insurance.
For the next three days dozens of state workers are
hitting malls, groceries, drug stores and other public places on a blitz to
sign up thousands of infants, children and teens who are eligible but have
never signed up for state health care insurance.
It's not only Medicaid. There are more than 30 different
types of health insurance programs for seniors, children and the disabled.
Working adults who can't make ends meet can even buy into an inexpensive
health insurance policy.
"It's regular it's private
health insurance that's run, state group benefits, same insurance that the
state employees have. They pay $50," said Venessa
Simmons, the Regional LaCHIP Coordinator.
Some are embarrassed to sign up because they have never
needed assistance.
"You're dealing with working families people that may
have worked all their lives. The economy now is bad so a lot of people are
being laid off from work," added Simmons.
"We've got to do something about our health
rankings. We've got to do something about
our children who are not insured and are unhealthy and I am just tired of
being at the bottom," said Rudy Macklin, executive director of the
Governor's Council on Physical Fitness and Sports. “I mean, I'm tired of Louisiana being on
cruise control.”
Louisiana
ranks at the bottom when it comes to health. Children have type 2 diabetes,
heart disease and high blood pressure.
"These are adult type of illnesses. Why are
11-year-olds and 10-year-olds having these types of problems? And we found
out that those kids have never been to the doctor since they were born,"
adds Macklin.
LaCHIP insurance allows this
mother to give her sons regular doctor's visits.
"We keep up with our doctor's appointments now,"
said Shadana Sorrell, who has her two sons on LaCHIP. They are 9- and 11-years-old.
And before you had the insurance, you couldn't keep up
with the appointments?
"I couldn't afford it at all," said Sorrell,
"Even with two jobs."
The blitz is already helping.
"I took the brochure because my neighbor have a
daughter that needs medical care, and she don't have none at all," said
Linda Crosby, a resident who passed by the sign up table.
http://www.wwltv.com/local/stories/wwl060409cbchildren.4b6f2cae.html
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Mobile
dentists bill heads to Louisiana Senate
New Orleans CityBusiness |
06.04.09
by The Associated Press
BATON ROUGE — A battle over who tends to the teeth of Louisiana's poor
children shifts to the state Senate, after the House approved a reworked
proposal today that would require tighter regulations on mobile dental
clinics at public schools.
The House previously rejected a bill that would have
banned the clinics outright, but today lawmakers revamped the bill to instead
direct the Louisiana State Board of Dentistry to come up with new regulations
for them. That compromise gained enough votes for passage, 64-30, and went on
to the Senate.
The mobile clinics bill by Rep. Kevin Pearson, R-Slidell,
has become one of the more contentious issues of the legislative session.
The facilities have provided care to thousands of poor Louisiana children on
school campuses, proliferating in recent years as the state increased
reimbursement rates for dental work through the Medicaid program for the
poor.
Critics of the clinics, including House Speaker Jim Tucker
and the Louisiana Dental Association, said it is unsanitary and unsafe to
drill on children's teeth in school gyms, libraries and cafeterias. They
question whether the clinics can properly handle infections and emergencies
and whether they know enough about the children's medical history and drug
allergies before treating them.
Others argue the mobile clinics bring care to poor
children who otherwise would never see a dentist, and they note that no
complaints or problems with the clinics have been reported to the dentistry
board. They call the bill a bid by some dentists to get more money for
themselves now that the state is paying more money for the care.
The changes approved today by the House didn't soften all
the opposition to Pearson's bill.
Several opponents of the reworked bill said while it
doesn't outright ban the clinics, it would give regulation instructions to
the dentistry board that are too strict and would force some clinics to
close.
"The better practice would be to get the Legislature
out of this business and to let the dental board do its job, but then we come
back with an amendment that tells them exactly how to do their job,"
said Rep. John Bel Edwards, D-Amite.
As approved by the House, the bill would require the
dentistry board to adopt regulations for the clinics for record-keeping,
practice standards, parental consent forms, parental consultation, equipment
standards, inspection plans and guidelines for disposing of infectious waste.
The rules would have to be in place by January 2010 or the members of the
board would be removed.
Also, a dentist at the mobile clinic would have to get a
permit to run the clinic and would have to have at least $1 million in
medical malpractice liability insurance. Opponents said that insurance
requirement is 10 times the amount of insurance many dentists have and would
be a disincentive to participation.
Tucker, R-Terrytown, disagreed,
saying the proposal would ensure safety, take liability concerns off the
schools and still provide dental care.
"This allows competition. This allows dentists to go
into the schools," he said.
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25104
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The New York Times | 06.05.09
By PAUL KRUGMAN
“I appreciate your efforts, and look forward to working
with you so that the Congress can complete health care reform by October.” So
declared President Obama in a letter this week to Senators Max Baucus and
Edward Kennedy. The big health care push is officially on.
But the devil is in the details. Health reform will fail
unless we get serious cost control — and we won’t get that kind of control
unless we fundamentally change the way the insurance industry, in particular,
behaves. So let me offer Congress two pieces of advice:
1) Don’t trust the insurance industry.
2) Don’t trust the insurance industry.
The Democratic strategy for health reform is based on a
political judgment: the belief that the public will be more willing to accept
reform, less easily Harry-and-Louised, if those who
already have health coverage from private insurers are allowed to keep it.
But how can we have fundamental reform of what Mr. Obama
calls a “broken system” if the current players stay in place? The answer is
supposed to lie in a combination of regulation and competition.
It’s a sign of the way the political winds are blowing
that insurers aren’t opposing new regulations. Indeed, the president of America’s
Health Insurance Plans, the industry lobby known as AHIP, has explicitly
accepted the need for “much more aggressive regulation of insurance.”
What’s still not settled, however, is whether regulation
will be supplemented by competition, in the form of a public plan that
Americans can buy into as an alternative to private insurance.
Now nobody is proposing that Americans be forced to get
their insurance from the government. The “public option,” if it materializes,
will be just that — an option Americans can choose. And the reason for
providing this option was clearly laid out in Mr. Obama’s letter: It will
give Americans “a better range of choices, make the health care market more
competitive, and keep the insurance companies honest.”
Those last five words are crucial because history shows
that the insurance companies will do nothing to reform themselves unless
forced to do so.
Consider the seemingly trivial matter of making it easier
for doctors to deal with multiple insurance companies.
Back in 1993, the political strategist (and former Times
columnist) William Kristol, in a now-famous memo,
urged Republican members of Congress to oppose any significant health care
reform. But even he acknowledged that some things needed fixing, calling for,
among other things, “a simplified, uniform insurance form.”
Fast forward to the present. A few days ago, major players
in the health industry laid out what they intend to do to slow the growth in
health care costs. Topping the list of AHIP’s proposals
was “administrative simplification.” Providers, the lobby conceded, face
“administrative challenges” because of the fact that each insurer has its own
distinct telephone numbers, fax numbers, codes, claim forms and
administrative procedures. “Standardizing administrative transactions,” AHIP
asserted, “will be a watershed event.”
Think about it. The insurance industry’s idea of a
cutting-edge, cost-saving reform is to do what William Kristol
— William Kristol! — thought it should have done 15
years ago.
How could the industry spend 15 years failing to make even
the most obvious reforms? The answer is simple: Americans seeking health
coverage had nowhere else to go. And the purpose of the public option is to
make sure that the industry doesn’t waste another 15 years — by giving
Americans an alternative if private insurers fall down on the job.
Be warned, however. The insurance industry will do
everything it can to avoid being held accountable.
At first the insurance lobby’s foot soldiers in Congress tried
to shout down the public option with the old slogans: private enterprise
good, government bad.
At this point, however, they’re trying to kill the public
option in more subtle ways. The most recent ruse is the proposal for a
“trigger” — the public option will only become available if private insurers
fail to meet certain performance criteria. The idea, of course, is to choose
those criteria to ensure that the trigger is never pulled.
And here’s the thing. Without an effective public option,
the Obama health care reform will be simply a national version of the health
care reform in Massachusetts:
a system that is a lot better than nothing but has done little to address the
fundamental problem of a fragmented system, and as a result has done little
to control rising health care costs.
Right now the health insurers are promising to deliver
major cost savings. But history shows that such promises can’t be trusted. As
President Obama said in his letter, we need a serious, real public option to
keep the insurance companies honest.
http://www.nytimes.com/2009/06/05/opinion/05krugman.html
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The New York Times | 06.04.09
By DONALD G. McNEIL Jr.
Six years of worrying about bird flu did much to prepare the
United States
for the current swine flu outbreak, federal officials and an independent
monitoring group said Thursday, but they cautioned that there were still gaps
in planning.
After the H5N1 avian flu emerged widely in Asia in 2003, killing about 60 percent of those
infected by it, many countries took steps to head off the crisis that would
emerge if that virus were to acquire the ability to jump easily from human to
human. It has not, but a number of the measures were helpful. These are some
of them:
The federal government stockpiled 50 million courses of Tamiflu.
New vaccine factories were opened.
Pandemic plans were written, and emergency drills were
held.
“Everyone was concerned about the avian flu, and biology
played a trick on us,” said Jeffrey Levi, executive director of the
monitoring group, the Trust for America’s Health, a nonprofit
organization that has tracked the country’s preparations for flu pandemics
for several years.
The first case of the H1N1 virus in the United States — a
San Diego resident who is believed to have fallen ill on March 28 — was
uncovered only because of pandemic planning, said Dr. Anne Schuchat, director of immunization and respiratory
disease for the Centers for Disease Control and Prevention.
A Navy medical laboratory in San Diego was trying out a new rapid flu
test and realized it had found something different from any previous virus.
The sample then had to be sent to the C.D.C. for sequencing, which produced
its results the same week as the Canadian national laboratory sequenced some
flu samples taken in Mexico.
The H5N1 virus “was really a wake-up call for the world
that serious threats are out there,” Dr. Schuchat
said.
But a report from Dr. Levi’s organization pointed out
weaknesses. These are some of them:
Closing schools to slow the spread of the epidemic caused
confusion and frustrated parents and their employers.
Conversely, many adults went to work sick, endangering
their co-workers. According to the report by the Trust for America’s Health, 48 percent of
Americans have no paid sick days.
Some hospitals were overwhelmed, even by mild cases,
because the “worried well,” especially those people with no insurance or
family doctor, filled emergency rooms.
Underfinanced state laboratories fell chronically behind
on testing.
The World Health Organization’s pandemic alert levels
caused confusion.
It also became clearer Thursday that little vaccine would
be available by the fall, even if nothing went awry in production.
The goal of pandemic plans is to make 600 million doses in
six months, enough for two doses for each American; that could cost $8
billion. Manufacturers now have seed virus. But clinical trials of their
first runs will last into the summer, and federal regulators must wait until
those are finished, Dr. Schuchat said.
Domestic production capacity is still “completely
inadequate,” according to a 2008 Congressional Budget Office report, and it
seems unlikely that foreign governments will let vaccine factories on their
soil export doses before their own needs are met.
http://www.nytimes.com/2009/06/05/health/policy/05flu.html?_r=1&ref=health
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The New York Times | 06.04.09
By ROBERT PEAR and JOHN HARWOOD
WASHINGTON
— Republican frustration with Democratic plans to remake the health care
system boiled over Thursday, as Republicans complained about the size, shape
and cost of the emerging proposal. But Democratic leaders said they still
intended to push a bill through the Senate this summer.
Despite the Republicans’ concerns, the chairman of the
Finance Committee, Senator Max Baucus, Democrat of Montana, and its senior
Republican, Senator Charles E. Grassley of Iowa, expressed confidence that
they could come together on a bill producing near-universal coverage.
“I share the confidence that we’re going to get it done
because the people of this country expect us to get it done,” Mr. Grassley
said in a New York Times/CNBC interview.
Indeed, the Senate majority leader, Harry Reid, Democrat
of Nevada, said senators should expect “a very long, hard work period in
July,” with roll-call votes from Monday through Friday every week.
“We cannot complete this most important legislation by
working just Tuesday through Thursday,” Mr. Reid said, referring to the
Senate’s customary schedule.
But after weeks of amiable optimism, Republicans who
emerged from a two-hour meeting of the Senate Finance Committee on Thursday
volunteered sharp-edged political comments.
Senator Pat Roberts, Republican of Kansas, said
Republicans were being pressed by Democrats to support tax increases to pay
for a bill they had not seen, with an unknown price tag.
“I’d like to see a bill,” Mr. Roberts said. “All I’ve seen
is slide shows. After every show, I send the information to our health care
providers. Then, after cardiac arrest, they come back and say, ‘Whoa, wait a
minute, how is this going to affect doctors, hospitals, home health care,
clinical laboratories, pharmacists, ambulance drivers?’ ”
The Democratic bill is likely to include a requirement for
people to carry health insurance, subsidies for those who cannot afford it,
and a requirement for employers to contribute to the cost.
Senator Orrin G. Hatch, Republican of Utah, said he feared
that Democrats, with a solid majority in the Senate and strong support from
President Obama, would ignore Republican concerns about a big expansion in
the role of government.
Mr. Hatch predicted that such an approach would meet the
same fate as President Bill Clinton’s plan for universal coverage.
“If the Democrats go ahead with a purely partisan bill,”
Mr. Hatch said, “you saw what happened on Hillarycare,
and this will be just as bad.”
Mr. Grassley said many Republicans agreed that Americans
should be required to have “insurance of some kind or another.” But he said
he and other Republican senators did not believe the government should
require employers to provide or pay for coverage of their employees.
Creation of a new government insurance plan remains the
most contentious issue in the debate.
“A bill that passes the Senate will have some version of a
public option,” Mr. Baucus predicted on Thursday. “If there is a public plan,
we have to make sure it does not set prices, there really is competition and
the government’s thumb is very, very light.”
Mr. Grassley said, “If there is a solution here, it’s got
to be one that does not have the government setting prices or unfair
competition.” But he also said: “Our caucus is very, very much against a
public option. It’s kind of a litmus test.”
In a letter to senators on Wednesday, Mr. Obama came down
strongly in favor of “a public health insurance option operating alongside
private plans.” Mr. Grassley said Mr. Obama’s letter “was not helpful.”
Mr. Baucus and Mr. Grassley agreed that Congress was
likely, in the end, to limit the decades-old tax break for employer-provided
health insurance. Revenues raised from this change could help finance
coverage of the uninsured, proponents say.
But much more money would be needed.
“When you look at what the Democrats want to do, the costs
are astronomical,” Mr. Hatch said.
http://www.nytimes.com/2009/06/05/us/politics/05health.html?ref=health
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Should Health Insurance Be Mandatory?
The New York Times | 06.04.09
By The Editors
Photo: Mandel Ngan/Agence France-Presse —
Getty Images
President Barack Obama said this week that he is now open
to Congressional proposals that would make every American responsible for
getting health care insurance. In a letter to Senators Edward Kennedy and Max
Baucus, he wrote that employers would have to share in the cost and that
there would have to be a hardship waiver for those who could not afford
insurance.
During the campaign last year, he opposed such a broad
individual mandate, which Hillary Rodham Clinton supported. At that time, he
argued for a more incremental approach, requiring that children be covered
first.
Is a broad mandate that Americans have medical insurance a
workable way to begin health care reform? Would taking a bolder step be more
efficient or more disruptive?
Defining the
‘Hardship Waiver’
Stuart M. Butler
Stuart M. Butler, an adjunct professor in public policy at
Georgetown University, is the vice president for
domestic policy at the Heritage Foundation.
President Obama has opened the door this week to a serious
conversation about “individual responsibility” in health care. As he reminded
Hillary Clinton during the primaries, and now reminds Congress, any mandate
is unjust if it is unaffordable. So his “hardship waiver,” which would exempt
Americans who cannot afford it, is welcome. Still,
we need to know what counts as “hardship.”
Why not first try automatically enrolling families in
workplace plans or default private plans selected by each state?
But there remain basic questions about a mandate, in
addition to the concern about paternalist compulsion. A mandate to buy what?
In automobile insurance it’s typically to protect other people against the
damage the driver might do to them. The parallel in health is a mandate for
me to buy insurance to cover emergency and catastrophic costs that you
(taxpayers and insured people) would be stuck with if I can’t pay my hospital
bill.
Also, should families be mandated to buy whatever Congress
decides, after being pressured from health lobbyists to add everything they
can think of into a mandatory “basic” plan? I don’t think so! So let’s
discuss what I should be responsible for and who decides that question before
embracing any mandate.
And finally, President Obama should propose using a
mandate as the last resort, not the first. It turns out that you can get most
people to sign up for something by using “automatic enrollment,” where the
default is that you are signed up unless you actively decline. Part B of
Medicare is voluntary, and yet thanks to automatic enrollment about 96
percent of eligible seniors are enrolled.
President Obama has proposed that workers be automatically
enrolled in individual retirement accounts to boost retirement savings. So
rather than fight over mandates, why don’t we try automatically enrolling
families in plans at their workplace or default private plans selected by
each state. Let’s first try individual responsibility as the default option
before sending the cops around to enforce a mandate.
Regressive and
Unaffordable
Marcia Angell
Marcia Angell is a senior lecturer in social medicine at Harvard Medical School
and former editor-in-chief of the New England Journal of Medicine.
There would be no need for an individual mandate in a
single-payer system, since everyone would be covered automatically and it
would be paid for through their income and payroll taxes. So asking me, a
supporter of a single-payer health system, about mandates is a little like
asking someone whether he’s stopped beating his wife.
Only a single-payer system would stop the private
insurance industry from holding us hostage.
But even within our current system, I’m troubled by the
notion of an individual mandate. I live in Massachusetts, where we have one. It
requires people to buy private insurance at whatever price the companies
choose to charge. As might be expected, this is a windfall for the insurance
industry. Premiums are rising much faster than income, benefit packages are
getting skimpier, and deductibles and co-payments are going up.
Many people can’t afford the premiums for the best plans,
and so have to choose bare-bones, low-premium plans with high deductibles and
co-payments. They are then left with insurance that they might not be able to
afford to use, but have to purchase anyway.
A mandate is also extremely regressive. In Massachusetts,
mandated insurance and co-payments can amount to nearly a third of income.
Income taxes apportion the costs of public services more fairly, and I see no
reason not to adopt that approach in paying for health care. To be sure,
President Obama has said he would exempt people from the mandate who couldn’t
afford to purchase their own health insurance. But aren’t these precisely the
people most in need of it? Massachusetts
has exempted 62,000 people from the mandate for that reason.
I would hope the President and Congress would come up with
something less regressive and truly universal, and stop holding the rest of
us hostage to the private insurance industry.
We Need a Market,
Not Mandates
Grace Turner
Grace-Marie Turner is president of the Galen Institute, a
nonprofit research organization focused on free-market ideas in the health
sector.
President Obama said during the 2008 campaign, “I believe
that the problem is not that people don’t want health care. It is that they
can’t afford it.” His reasoning was correct in opposing a mandate that
individuals must purchase health insurance. In his letter to Congress this
week, he moved toward support for a mandate but again conditioned it on
health care being more affordable.
The government-dominated proposals that Obama is endorsing
have a poor track record of producing the savings he needs for this plan to
work.
But the kind of centralized, government-dominated
proposals he endorses elsewhere in his letter have a poor track record of
producing the savings he needs for this plan to work. And there is no
evidence that Congress will significantly cut the growth of spending in
Medicare or Medicaid nor will more spending on information technologies,
disease management and prevention produce the needed savings.
As Massachusetts
has learned, it is essential to get control of costs first. The state imposed
a health insurance mandate on individuals and employers, and cost increases
are now the biggest concern. Plans offered through the Massachusetts health insurance exchange
have few, if any, of the tools that the private sector is using to engage
consumers as partners in managing health costs. The state
kept in place the expensive mandates and insurance regulations that
had made private coverage so expensive in the first place. Washington appears to be headed down the
same path.
The best evidence we have for programs that work is
through the incentive-based models that have produced genuine savings for
consumers and employers. Deloitte’s Center for Health Solutions found that
the cost of consumer-directed health plans increased by only 2.6 percent in
2006 among the 152 major companies it surveyed. This is about a third the
rate of increase for traditional plans.
Flexibility, competition and a properly functioning market
— which we do not have now — are far preferable to mandates, price controls
and more government regulation to reform our health sector.
Universal Coverage
Is the Linchpin
Charles Moulton
Dr. Charles P. Mouton, professor and chairman of the
Department of Community and Family Medicine at the Howard University College
of Medicine and chief attending physician for the Howard University Hospital
Free Clinic. He was recently co-investigator for a study to examine the
health of more than 80,000 U.S.
women to determine how diet, hormone therapy, calcium and vitamin D might
prevent heart disease, cancer, bone fractures and other ailments.
In his letter to Congress, President Obama indicated he
might be supportive of a requirement that every American have health
insurance, with employers sharing some of the cost. Coverage for every
American is essential to any health care reform package. No longer can the
public afford a system that shifts the burden of care for the uninsured onto
those who have health insurance or onto the fragile health care
infrastructure.
Every American needs to have a physician who provides them
a “medical home.”
As those who have lost their jobs through layoffs, plant
closings and corporate failures lose their health coverage,
attempts to recover from the economic downturn will likely be stopped in its
tracks without health reform. The Obama administration understands this.
Universal coverage is the necessary linchpin to stabilizing the health care
system.
Some opponents think that merely encouraging health
insurance companies to expand their enrollment will be enough to correct the
problem of the uninsured. They seem to be prescribing a new whip for a dead
horse. As health insurers continue to shift costs, add more pre-existing conditions
that would not covered and deny coverage, the number of uninsured Americans
will increase.
Perhaps equally important to providing the fundamental
change to the system, universal coverage will provide the opportunity for
every American to have a physician who provides them a “medical home.” No
longer will millions of families seek routine medical care through hospital
emergency rooms. Instead, they will have a family physician focused on
coordinating care for their illnesses and assuring that they receive care
that promotes health and wellness. Only through coverage for everyone will we
begin to raise the health of Americans from 37th among industrialize
countries to the top where it belongs.
http://roomfordebate.blogs.nytimes.com/2009/06/04/should-health-insurance-be-mandatory/?scp=1&sq=%20%20Should%20Health%20Insurance%20Be%20Mandatory?&st=cse
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