By MARSHA SHULER
health-care chief Fred Cerise said Thursday the state relied on
recommendations from building experts to make the decision to keep Charity Hospital
in New Orleans
shut after Hurricane Katrina.
claims by the retired Army general who led recovery efforts that were
reported earlier this week.
Retired U.S. Army
Lt. General Russel Honoré
said the cleaned-up hospital could have reopened for business in late
September 2005, a month after the storm hit.
advised to the contrary, Cerise told the LSU Board of Supervisors.
Honoré said recently then-Gov. Kathleen Blanco
told him a month after the hurricane hit that the hospital would never be
His remark added
to speculation that state officials used the hurricane as an excuse to
shutter the Depression-era facility and get federal money to help build a
Blanco has said
she did not recall such a conversation with Honoré.
She said she never would have made the statement because she did not know
what the plans were for Charity
Hospital at the time.
came during a meeting of the LSU Board of Supervisors.
to a question from LSU Board member Tony Falterman, who asked, “Why so many
years after the fact, he (Honoré) would come
forward with this information?”
“With so much
controversy going on around the hospital, who knows what the genesis of his last round of remarks are,” Cerise replied.
“It’s four years later.”
preservationists and some area residents contend Charity Hospital
should be renovated and reopened as a hospital by LSU.
challenging state plans to build a proposed $1.2 billion medical complex on
other property which would be part of a development with the U.S. Department
of Veterans Affairs.
Cerise said Blanco
called him about Honoré’s claim.
Blanco could not
recall any such comments and asked if he did, Cerise said.
“I told her I
certainly was not involved in those decisions at that time,” said Cerise, a
physician who was Blanco’s health secretary at the time.
“There was no
doubt there was a first-floor cleanup, but there are a lot of other factors
that enter in,” said Cerise, of Honoré’s clean-up
In other words,
Falterman said, “It’s not as simple as clean up the first floor.”
Cerise said the
administration was relying on advice from the state Office of Facility
Planning and Control run by Jerry Jones.
against the reopening of Charity
Hospital, he said.
Sciences Center-New Orleans chief Larry Hollier
said architectural and engineering consultants gave their professional
opinions on whether Charity
Hospital should be
“It was not a
viable alternative to put it back as a hospital. The first floor was clean,
but that doesn’t take care of the mold in the air and other environmental
problems,” Hollier said.
Dr. Jack Andonie, chairman of the LSU board’s health committee,
said the building is “nothing but a total disaster. There’s asbestos in the
“What people don’t
understand it’s OK to open an emergency room and you have an emergency room,
but where do you take patients for surgery, ICU? Where do you do the acute
care?” asked Andonie. “They have to have the back
By JORDAN BLUM
The LSU Board of
Supervisors opted Thursday not to delve deep into budget-cutting plans to
eliminate 600 positions statewide and will instead wait until the Aug. 27
meeting for final approval on campus plans.
The LSU board did,
however, sign off on graduate school tuition increases that were approved
weeks ago by the Legislature.
On top of 5
percent tuition increases for all students at public universities, LSU
graduate school students will pay an additional $30 per student credit hour.
A full-time student typically takes nine to 15 credits per semester.
increases LSU School of Veterinary Medicine tuition by $1,500 a year and LSU
master’s of business administration programs by $2,000 annually.
The LSU board also
approved a $120 per semester academic excellence fee for LSU Paul M. Hebert
students. The Legislature approved the fee nearly 10 years ago, but the law
school did not use it until now.
As for budget
cuts, LSU System President John Lombardi said he thinks board members limited
their discussion Thursday because they want more time to absorb all the
proposed campus plans.
“They’ll be pretty
close to what we see now,” Lombardi said of what he expects Aug. 27.
chancellor of the flagship LSU campus, said he expected more discussion
Thursday about budget cuts.
got to digest it,” Martin said. “This is going to be a work in progress
throughout the year.”
The LSU System —
with five academic campuses, medical schools, law school, agricultural center
and biomedical research center — is being cut $52 million because of dipping
The Baton Rouge campus is
coping with a nearly $20 million cut, about a 9 percent decrease in state
funds. That does not count close to $10 million already slashed in January.
Factoring in extra
tuition revenues and annual inflationary expense increases, the main campus
is left with $28 million less than last year.
Gov. Bobby Jindal and the Legislature worked out a last-minute
compromise that was finalized June 25 to limit the budget cuts so colleges
could downsize more slowly and prepare for more budget reductions projected
budget plans propose 142 layoffs and eliminating 453 vacant positions.
On the main
campus, only 24 would be laid off, but 176 vacancies would be sliced. The
layoffs are being kept small because of merit-pay raises put on hold and
plans to furlough — time off without pay — about 1,700 employees, not
counting tenure-track faculty. The main LSU campus has about 3,300 total
The furlough plan
is the most public point of contention because Lombardi and some board
members said they are not fans of the quick-fix philosophy.
“The issue is
always — what do you do when they’re over,” Lombardi said.
Because more cuts
are expected through 2012, Lombardi said the budget situation cannot be
resolved with a one-time Band-Aid like furloughs.
furloughs have become a national trend during the recession and “buy us a
That way, more
jobs can be cut through attrition rather than layoffs.
“But that still
may be controversial,” Martin said.
has not said he opposes the furlough plan.
Either way, they
have more than a month until Aug. 27 to work out any differences.
[BACK TO TOP]
by Bill Barrow,
Eliot Kamenitz / The Times-Picayune
The first patients from the doomed New Orleans Adolescent
Hospital, pictured here earlier this week, start moving next week.
The first patient
transfers from the New Orleans Adolescent Hospital
to the Southeast
in Mandeville will begin next week as the state implements a plan to close
the Uptown New Orleans mental facility.
Five minors will
be moved from the 35-bed New Orleans
hospital, with more moves scheduled during the next three weeks. The goal,
authorities said, is to move as few patients as possible, with empty beds
being transferred after patients are discharged.
meanwhile, were delivered this week to 46 employees at NOAH, which since
Hurricane Katrina has served both adults and children with inpatient beds and
outpatient services. Of those workers, 26 are in permanent positions, while
23 are still in their probation periods; 122 employees have been given
opportunities to transfer to Southeast
Workers who received layoff notices would get the first chance to take any
permanent spots if a prospective transferee refuses to move.
The job losses
take effect Aug. 14, assuming the expected final approval from the state
Civil Service Commission.
provide NOAH outpatient services will transfer to two new clinics expected to
open in August: one in Mid-City at 3801
Canal St., the other in Algiers at a location the state has yet to
The changes have
drawn considerable attention amid statewide budget cuts and Gov. Bobby Jindal's veto of a legislative attempt to keep the New Orleans inpatient
services operational. A lawsuit from two hospital patients and one employee
is pending in Orleans Parish Civil District Court, with a hearing set for
July 27 on their request for a preliminary injunction to stop the closure.
officials said Thursday that the overarching plan maintains inpatient beds in
the region while expanding outpatient offerings through the clinics, with the
long-term aim of reducing the demand for hospitalization.
Secretary Sybil Richard said Louisiana
has depended too heavily on hospital care both for mental and physical health
problems. "That is just the wrong way to do things,
" she said, repeating her months-old contention that state would
have closed the New Orleans
independent of budget cuts.
Dalton, medical director for the state Office of Mental Health, cited planned
expansion of the clinical staffs of the outpatient clinics and new treatment
programs. "Our goal is to get our community services to the point so we
can in the next two years discontinue the hospitalization of children, " he said. "That's not a fiscal goal. That's a
promised five-day-per-week transportation for families of patients moved to
the north shore. And she said the minor patients who receive schooling as
part of their treatment will not miss any lessons.
Dalton said the state health agency also will
implement new patient assessments, going beyond length and frequency of
hospital stays to track patients' symptoms and their quality of life. The
data, which could be analyzed slightly more than a year from now, will
validate the changes, he said.
[BACK TO TOP]
Shreveport Times | 07.17.09
By Del Brennan
We now have a
golden opportunity to fix health care in this country by controlling upwardly
spiraling costs and providing coverage for everyone. The only way to do this
is to provide a public option for those who have no access to private
insurance. The House of Representatives recognizes this and has passed
legislation that includes the public option. But the Senate could kill this
Is this socialism,
as the Republicans and insurance companies claim? Not unless you also call
public education and Medicare socialism. Recipients would pay reasonable,
affordable premiums, and coverage would be guaranteed without regard to
employer or pre-existing condition.
states that a responsibility of government is to "promote the general
welfare." Medicare meets the needs of senior citizens, Medicaid helps
the poor and disabled, and SCHIP provides for children of working parents.
But 45 million Americans have no health insurance. As a result many of them
will go bankrupt, and many will die, paradoxically, in a country that
believes the right to life is unalienable. Moreover, even those who do have
private insurance are often denied needed services.
The public option
will force for-profit insurance companies to compete by offering better care
at lower prices. A large segment of the population prefers private insurance,
especially when their employer pays a good portion of it. These Americans
will simply stay with their private insurer when the public option is
implemented and will benefit from improved standards of quality and
Democrats have a strong Senate majority, some of those from conservative
states plan to oppose the public option. Louisiana's Sen. Mary Landrieu is one of
them. She is under pressure from Republican constituents as well as from big
health and insurance interests that gave her $1.6 million in contributions
(not uncommon, by the way).
Is there any way
to provide the public health care option without raising the national debt?
Actually, there is. Canceling George Bush's tax cuts for the wealthy would
more than cover it. But however it is paid for,
staying with our current system will be more costly in the long run.
health care reform can call Landrieu's local office (318-676-3085) to ask her
to reverse her opposition to the public health care option. We spend far more
than any other industrialized country on health care but deny access to more
of our citizens. Let's change that and provide health care for everyone.
Del Brennan lives
in Bossier City.
[BACK TO TOP]
Washington politicians describe a national health
plan as a "public option" to imply that patients will retain choice
in their health care decisions. However, government-run health care would be
dependent on federal subsidy, buy-or-else coverage mandates and higher taxes
on employee earnings and health benefits.
A national health
plan would likely:
choice by patients and employers. Currently, employees decide what level of
coverage they want and what provider to use. This would be jeopardized by
government health care. To pay for its $1.5 trillion health plan, their
message to employers and patients is "Pay now; ask questions
Raise taxes on
benefits already provided by employers. Under the plan now in Congress,
Americans with the average health plan at work ($4,700 per year) would face
an extra tax of $1,100 per year. At a time when many families face lower
earnings, why spend more money on higher taxes?
There can be no
one-size-fits-all health plan. Only individual families can know what is
right for themselves and their budgets. Government should respond accordingly
and allow individuals to continue to make these choices. Congress should
concentrate on improving quality of care and affordability for what it
already controls -- Medicare and Medicaid -- instead of taking over one-sixth
of the American economy, as it is currently proposing.
[BACK TO TOP]
Letter: Dr. Pou deserves to be out of media spotlight
public's long wait," Our Opinions, July 7.
The opposition to
the release of former Attorney General Charles Foti's
Memorial Hospital investigative file to the
news media was based upon concerns for the release of such records in an
uncontrolled manner. That is what occurred when Mr. Foti
selectively released certain expert opinions solicited by him, while hiding
other expert opinions he solicited that did not support his case for arrest
of Dr. Anna Pou and her colleagues.
misinformation, half truths, innuendo, hearsay and third-party comments,
which seem to make up a large part of the record, has the effect of
misinforming and confusing -- not educating -- the public.
reimbursement of Dr. Pou's legal fees as approved
by a bill passed by the Legislature and signed by Gov. Jindal,
is a totally unrelated issue to that of a release of the records. Attempts to
link the two are disappointing and a stretch at best. A long-standing state
statute entitles a state employee who is the target of a grand jury
investigation and is not convicted to reimbursement of his or her legal fees.
This is not a special exemption being offered only to Dr. Pou.
Notably, but not
mentioned in your editorial, is the fact that the vast majority of reimbursed
legal fees will be distributed to LSU (her employer), not Dr. Pou herself.
should instead be directed at those who orchestrated the public arrest of
three well regarded medical professionals. While The Times-Picayune seems
preoccupied with the public's long wait, what about Dr. Pou's
long wait to be out of the media feeding frenzy and returned to some
semblance of normalcy and privacy?
Counsel for Dr.
[BACK TO TOP]
by David Espo, The Associated Press
WASHINGTON (AP) --
The White House and Democrats are struggling to bring a complex,
controversial bill to remake the U.S. health care system --
President Barack Obama's top domestic priority -- to a vote in both houses of
Congress before lawmakers leave town for their August break.
In a potential
setback to their efforts, Congress' budget umpire warned on Thursday that
their health care bills won't meet Obama's goal of slowing the ruinous rise
of medical costs, giving weight to critics who say the legislation could
break the bank.
bipartisan group of senators said they wanted time beyond the president's
early August deadline to pursue an agreement.
Slowing the rate
of growth for health care spending is one of Obama's twin goals, alongside
expanding health care to the 50 million people who now lack it, in the only
developed nation that does not have a comprehensive national health care
provides coverage for the poor and elderly, but most Americans rely on
private insurance, usually received through their employers. With
unemployment rising, many Americans are losing their health insurance when
they lose their jobs.
The United States
spends about two-and-half times as much on health care as other
industrialized countries, but it does no better on life expectancy and other
measures than nations that spend far less.
As a sign of the
urgency, some House members worked through the night. The Education and Labor
Committee debated amendments to health care legislation until about 6 a.m.
(1000 GMT) Friday and planned to resume at 9:15 a.m. (1315 GMT)
And earlier Friday
morning, the Ways and Means Committee voted to approve the tax provisions of
the House bill, which would impose $544 billion in new taxes over the next
decade on families making more than $350,000 a year. Other committees worked
on separate parts of a bill that would cost roughly $1.5 trillion.
Speaker Nancy Pelosi has vowed to pass it by the end of the month. But
Democratic Sen. Max Baucus, one of the key senators at work on the issue,
said Obama "is not helping us" with his opposition to a new tax on
leaders recently shot down the tax approach, but Baucus, who chairs the
Finance Committee, still favors it as a way to pay for a health overhaul.
the head of the Congressional Budget Office, Congress' budget watchdog, said
of the legislation so far, "We do not see the sort of fundamental
changes that would be necessary to reduce the trajectory of federal health
spending by a significant amount. And on the contrary, the legislation
significantly expands the federal responsibility for health care costs."
At its core, the
new effort involves a requirement for insurance companies to offer policies
to all willing buyers, and bars them from charging higher premiums on the
basis of pre-existing medical conditions. Legislation would rely on
government subsidies to make insurance more available for lower-income
individuals and families, and use tax increases as well as cuts in current
government health programs to pick up the cost.
"I will not
defend the status quo," Obama said Thursday in New Jersey, where he used a political
fundraising appearance for Gov. Jon Corzine to make
his latest plea for congressional action.
remarks gave ammunition to Republican critics of the bill. Senate Republican
leader Mitch McConnell said the budget director's warning should be "a
Yet there was good
news for Pelosi and the administration in hearing rooms not far away.
Republicans on the
House Education and Labor Committee failed on party-line votes to delete
major portions of the bill, including provisions for the government to offer
insurance coverage and create a new way of shopping for health plans through
a purchasing exchange.
no more successful in the House
Ways and Means Committee, where Democrats shot
down amendments to eliminate the government insurance option and delete
requirements for employers to provide health care. Republicans also failed on
amendments to limit medical malpractice awards, and to prevent the government
insurance plan from covering abortions. All the votes were largely along party
[BACK TO TOP]
Written by: BayouBuzz Staff
U.S. Senator Mary
Landrieu has been under fire in recent weeks by liberal groups nationally,
and progressive activists locally, for her refusal to back a public option
under the universal health care bill. Instead, she and six other Democrats
support the bipartisan measure Bennett-Wyden that guarantees universal health
care revenue neutrally--and truly fulfills the pledge President Obama ran
upon, guaranteeing the health care that members of Congress get to all
that is the problem with the legislation introduced this week in the U.S.
House of Representatives, at huge cost, does neither.
The $1.5 billion
dollar price tag has only scared the Blue Dog Democrats in the house. One of their leaders, Louisiana Congressman
Charlie Melancon observed that the day before the
bill was introduced seven of his caucus members (who sit on the committee)
opposed the bill. By Thursday, it was
ten of his fellow Conservative Democrats.
That is a recipe
for defeat of any meaningful health care reform.
concentrated on the impact of a public option. Our editors at The Louisiana Weekly
instead choose to look at the essence of Landrieu’s and Melancon’s
All but the
smallest of businesses, those with a revenue of $250,000 or less, will be saddled
with a new tax equal to a percentage of payroll if they don't provide health
care for their workers.
According to 2006
data from the National Federation of Small Business, firms with between five
and nine workers, representing about one million employers, had an average
payroll of around $375,000 a year. A report from the Kaiser Family Foundation
found that only about half of firms with three to nine workers offered health
benefits in 2008. Many of these are
African-American American owned businesss stuggling in the wake of the economy nationally, and with
the ravages of the storms locally.
The tax proposed
by the House Democratic leadership will be 8% on businesses with payrolls
over $400K, and step down incrementally from there.
five to nine employees are not only the backbone of the economy during a
recession, but they are the very companies that President Obama pledged not
to tax in his campaign (ie, no one making less that
businesses that are barely holding on during these difficult times would be a
those without company insurance, Section 401 of the bill applies. Any
individual (or family) that does not have health insurance would have to pay
a new tax, roughly equal to the smaller of 2.5% of your income or the cost of
a health insurance plan.
The bill authors’
might reply, as one Weekly Standard authored noted, "But why wouldn’t
you want insurance? After all, we’re subsidizing it for everyone up to 400%
of the poverty line."
would be true. However, if one is a single person with income of $44,000 or
higher, then you’re above 400% of the poverty line. You would not be
subsidized, but would face the punitive tax if you didn’t get health
insurance. This bill leaves an important gap between the subsidies and the
cost of health insurance. CBO says that for about eight million people, that
gap is too big to close, and they would get stuck paying higher taxes and still
without health insurance.
These are the very
Middle Class voters that constitute a majority of the 47 million Americans
that currently lack health insurance.
The House bill could make things worse instead of better.
an individual based system that actually removes the costs of health care
from most businesses, while providing subsidies for all Americans to purchase
was written primarily by one of the most liberal members of the Senate,
though to hear Moveon.org tell it, Ron Wyden has betrayed the left.
Why? Because the Oregon Democrat would give the
same health care members of Congress receive to all Americans.
would tax health benefits on the corporate side, but would correspondingly
provide a $3000 a person voucher for every American to purchase health
Individuals not able to buy on the open market could choose amongst
the five policies that members of Congress and federal employees have as
do not like the plan since it creates an individual mandate to have health
insurance, and eliminates the ability of insurance companies to deny coverage
to those with pre-existing conditions.
Without these provisions, though, younger, healthier insurees do not enter the insurance system, forcing up
prices for the remainder, and it is unconsciencable
in a modern society to deny health care to those that need it.
Wyden’s plan because it does not have either the vaulted “public option” or
an employer mandate. They particularly
hate the fact that he taxes health care benefits, a perk many of the party’s
union supporters have won in extensive contract struggles.
that all the House bill does is expand Medicaid to
$110 million Americans. It is a fee
per service based system that the liberal Democrat calls “apartied”. More and more doctors refuse Medicaid patients,
a process that Wyden believes would accelerate under the House proposal.
And, as the
President’s own health expert Dr. Zeke Emmanuel, brother of the Chief of
Staff pointed out, a fee for service model is the reason that doctors perform
unnecessary procedures. It is what is
driving Medicare into bankruptcy by 2026, and the House plan only accelerates
is a 37 Trillion dollar deficit in Medicare.
Adding most of the population to the public system, according to the
Congressional Budget Office, would drive the gap between federal revenue and
expenditures even higher--to 7% of gross domestic product in 2020--even if
the program begins revenue neutrally now as Speaker Pelosi has promised. And that's assuming that the economy
returns to full employment between now and then.
Wyden’s bill which
coauthored by Mary Landrieu and five other Democrats, along with Utah
Republican Bob Bennett and five other Republicans, brings the currently
uninsured into the system by taxing the so-called “Cadillac Plans” of the
rich. It ends the separate but equal
system of those trapped in Medicaid and those outside of it. And, it guarantees that those who cannot
get health insurance have the resources and the opportunity to win coverage.
The first line of
the more than 2,000 year old oath that every graduate physician must take
before he sees his first patient is "first do
no harm". It is good advice when dealing with health care policy as well
as patients. As a newspaper that enthusiastically supported the elections of
both Mary Landrieu and Barack Obama, we urge the President to listen to the
Senator when she renders such advice.
[BACK TO TOP]
WASHINGTON (AP) --
Democrats' health care bills won't meet President Barack Obama's goal of
slowing the ruinous rise of medical costs, Congress' budget umpire warned on
Thursday, giving weight to critics who say the legislation could break the
assessment from Congressional Budget Office Director Douglas Elmendorf came
as House Democrats pushed to pass a partisan bill through committees, while
in the Senate a small group of lawmakers continued to seek a deal that could
win support from both political parties.
With the pressure
mounting on all sides, Senate Majority Leader Harry Reid, D-Nev., dismissed as "a waste of money" a
television ad campaign by Obama's political organization aiming to nudge
moderate Democrats off the fence. He called it "Democrats running ads
From the beginning
of the health care debate, Obama has insisted that any overhaul must
"bend the curve" of rapidly rising costs that threaten to swamp the
budgets of government, businesses and families.
Asked by Senate
Budget Committee Chairman Kent Conrad, D-N.D., if the evolving legislation
would bend the cost curve, the budget director responded that "the curve
is being raised."
Elmendorf: "In the legislation that has been reported, we do not see the
sort of fundamental changes that would be necessary to reduce the trajectory
of federal health spending by a significant amount. And on the contrary, the
legislation significantly expands the federal responsibility for health care
Even if the
congressional legislation doesn't add to the federal deficit over the next
years, Elmendorf said costs over the long run would keep rising at an
unsustainable pace. Part of the reason is that Obama and most Democrats have
refused to accept a tax on high-cost health insurance plans as part of the
overhaul. There's wide agreement among economists that such a tax would give
businesses and individuals an incentive to become thriftier consumers of
flashing yellow light from the budget office, Congress pushed ahead Thursday.
won a coveted endorsement of their legislation from the American Medical
Association, saying the bill "includes a broad range of provisions that
are key to effective, comprehensive health system
On the heels of
the Senate health committee's approval Wednesday of a plan to provide
coverage to the uninsured, three House committees shifted into action on
their version of the legislation. The Democratic bills also call for the
creation of a government-sponsored insurance plan to compete with private
coverage, although they differ on the details.
Education and Labor Committee passed an amendment to speed up access to health
insurance for people with pre-exisiting medical
conditions. The bill as written would have stopped insurance companies from
denying coverage because of pre-existing conditions, starting in 2012. The
panel agreed Thursday to move up the date for group plans to six months after
the bill takes effect.
Ways and Means Committee also was working on a piece of the legislation,
which seeks to provide coverage to nearly all Americans by subsidizing the
poor and penalizing individuals and employers who don't purchase health
insurance. It would boost taxes on high-income people and slow Medicare and
Medicaid payments to providers.
A third House
committee, Energy and Commerce, also was considering the measure Thursday,
but the road was expected to be rougher there. A group of fiscally
conservative House Democrats called the Blue Dogs holds more than a half
dozen seats on the committee - enough to block approval - and is opposing the
bill over costs and other issues.
Rep. Mike Ross,
D-Ark., chairman of the Blue Dogs' health care task force, said the group
would need to see significant changes to protect small businesses and rural
providers and contain costs before it could sign on. "We cannot support
the current bill," he said.
Obama was doing
all he could to encourage Congress to act. He met Thursday morning with two
potential Senate swing votes, Sens. Ben Nelson, D-Neb., and Olympia Snowe, R-Maine. On Wednesday, he met with a group of
Senate Republicans in the White House in search of a bipartisan compromise
and appeared in the Rose Garden for the latest in a series of public appeals
to Congress to move legislation this summer.
Obama also pushed
his message in network television interviews, and his political organization
launched a series of 30-second television ads on health care aimed at
wavering moderates, and criticized by Senate leader Reid.
And in another ad
campaign backing the president's goal, Harry and Louise - the television
couple who helped sink a health care overhaul in the 1990s - are returning to
the small screen, this time in support of revamping the health system.
[BACK TO TOP]
The New York Times | 07.16.09
By NATASHA SINGER
Stephen Crowley/The New York
Harry Johnson and, from left, Louise Caire Clark, with Christopher Dodd and Barbara Mikulski.
HARRY and Louise have changed their minds about
health care reform.
suburban couple featured in a series of national television spots sponsored
by the health insurance industry in 1993 and 1994 stoked fears that helped doom a government-created health plan promoted by a
Democratic president, Bill Clinton.
“Having choices we
don’t like is no choice at all,” the Louise character fretted to her husband
in one spot set around a kitchen table stacked with medical bills.
Now, the same
actors are back in a new campaign, this time to support a government overhaul
of the medical system promoted by a Democratic president, Barack Obama.
The ad’s sponsors
— a trade group representing drug makers and Families USA, a nonprofit group
advocating affordable medical care — reflect the strange bedfellows lining up
behind the latest reform effort.
“A little more
cooperation, a little less politics,” Louise says to Harry in the new spot,
scheduled to appear on cable and network stations this weekend, “and we can
get the job done this time.”
The main issues —
accessible, affordable and portable medical coverage — have not changed since
the 1990s. But the reappearance of Harry and Louise as the avatars of health
care reform dovetails with a new economic reality for consumers.
early-middle-aged Harry and Louise in the 1990s ads were concerned about
their own welfare and their own pocketbooks. They were white middle-class
me-generation professionals scripted to raise red flags about the fear of
losing private health insurance. Now, the mellowed AARP-eligible Harry and
Louise of this campaign seem more charitable and outward-directed. They even
invoke the plight of the uninsured.
Which either means
that Harry and Louise have changed, or that the actors who play them — Harry
Johnson and Louise Caire Clark — are adept at
emoting whatever political point of view they are paid to evoke. For their
sponsors, the characters’ seeming empathy is meant to reflect a climate in
which mounting unemployment, combined with the high cost of health insurance
for individuals and small businesses, has created a new urgency for change.
“We ought to work
together to find a good and successful health care compromise,” said Billy
Tauzin, the president of the Pharmaceutical Research and Manufacturers of
America, or PhRMA, a sponsor of the new spot.
“Middle-class people like Harry and Louise are not going to be living in a
successful society if we don’t do something about it.”
The campaign could
also garner good will from politicians for the group, which last month
pledged $80 billion in savings to help further health reform.
This is actually
the fifth television campaign for Harry and Louise.
The first tour
placed the couple in familiar suburban scenes to raise pointed questions
about the Clinton
health care plan. At a time when the insurance industry felt excluded from
the process, which was led by Hillary Rodham Clinton and an adviser, Ira C. Magaziner, Harry and Louise were meant to galvanize the
kind of middle-class Americans who might be talking about health care reform
as they sat in their kitchens looking at bills. More than a dozen different
commercials ran in 1993 and 1994, at a cost of about $14 million.
“Harry and Louise
began a dialog with the American people in a sense,” said Charles N. Kahn
III, who oversaw the original campaign as the executive vice president of the
Health Insurance Association of America, a trade group that later merged with
another group to become America’s Health Insurance Plans. “This was not done
to beat health reform. It was done to get the attention of policy makers.”
But many industry
analysts viewed that series as attack ads that helped scuttle the Clinton version of
reincarnated Harry and Louise in 2000 for a campaign to urge legislators to
adopt an industry proposal to help people buy private insurance.
Ben Goddard, a
public affairs executive whose firm, Goddard Claussen,
created all of the campaigns, used the couple a third time in ads to oppose a
bill that would have curbed stem cell research. In 1997, Mr. Goddard married
the actress Ms. Clark.
But the real
comeback for the couple occurred last year, when a group of nonprofit associations,
including Families USA, sponsored ads before the presidential election in
which the couple urged candidates of both parties to put health care at the
top of their agendas.
Now Families USA
has teamed up with PhRMA for a $4 million campaign
to be broadcast starting this weekend on channels like CNN, MSNBC, Fox,
Comedy Central and on some network news and Sunday talk shows.
“This is really a
historic opportunity,” said Ron Pollack, the executive director of Families
USA. “We have a better chance of getting health reform done than ever
For political news
media analysts, however, Harry and Louise signify more than mere icons of
health reform. The original ads represent the first successful political
issue campaign to activate consumers en masse to put pressure on Washington. The ads
ushered in the era of political issue advertising as a major component of
lobbying, said Evan Tracey, the chief operating officer of Campaign Media
Analysis Group, which tracks political advertising.
Since that time,
“there hasn’t been a major piece of policy, federal or state, that hasn’t had
an issue advocacy campaign,” said Mr. Tracey. “That’s what, in essence, Harry
and Louise gave birth to.”
Mr. Tracey said
the new ads, endorsing change, were unlikely to have the same impact as the
first, more negative campaign. With Congress seemingly determined to pass a
health care package this year, the return of Harry and Louise as cheerleaders
for reform may be aimed mainly at keeping the issue at the top of the news
Instead of framing
the debate, in other words, Harry and Louise may now be symbols of going with
the flow. “What would health care reform be without them?” Mr. Tracey said.
[BACK TO TOP]
The New York Times | 07.16.09
By PAULINE W.
One afternoon not
long after I finished my training, two sisters, both well-respected
in their late 40s, came to the hospital
clinic. Both sisters had hepatitis B, and the older sister, like a fair
number of chronic hepatitis B patients, had developed liver cancer. She and
her sister were hoping that we might be able to remove the tumor.
watching the sisters’ faces turn grim as the younger of the two drew a family
tree on the flimsy paper covering the examining table. Under each branch, she
wrote out the names of siblings and parents, and I shuddered over the number
of “L.C.’s,” her abbreviation for “liver cancer,”
this sister scrawled next to a name.
Their parents had
immigrated to the United States
a half-century earlier. In the midst of raising six children, their mother
developed and then died from inoperable liver cancer. A little over two
decades later, two of their siblings succumbed to the same lethal disease —
one brother a few months prior to the sisters’ visit to my clinic, and
another brother a few months later.
After the first
brother had died, the family members assumed that his untimely death was due
to bad luck or perhaps a “cancer gene.” But soon after the second brother was
diagnosed, the remaining siblings sifted through their family’s medical
records. They discovered that both brothers had had hepatitis B, a viral
infection that predisposes individuals to cirrhosis, liver failure and
cancer; and they realized that their mother’s symptoms in the years prior to
her death were consistent with progressive liver failure from cirrhosis.
They learned that
while the incidence of hepatitis B is higher among Asians than among other
racial groups in the United States,
Chinese are at the highest risk, particularly those who hail from Fujian, the province
from which the sisters’ parents had immigrated. Infections could spread
insidiously through “vertical transmission,” where infected mothers would
unknowingly pass the virus to their newborns during birth. The children then
go on to develop a chronic active infection and are predisposed to developing
early cirrhosis and liver cancer. If they were female, they run the risk of
passing the virus on to a whole new generation of family members.
Over the course of
the next few months, the surviving siblings learned that every one of them
had been infected with hepatitis B, probably from their mother at birth.
While each had developed varying degrees of cirrhosis, they realized that
without the necessary close surveillance by a liver specialist, they could
die from liver cancer as their brothers and mother had. The sisters
spearheaded the effort to find liver specialists who would follow all of
them, and it was during this search that they discovered the older sister’s
tumor and my clinic.
It would turn out
that the older sister’s cancer was small enough to remove surgically. And a
year after her operation, I ran into one of the liver specialists I had
referred the family to for regular follow-up. The siblings he cared for, I
learned, were faring well. “But what a pity,” my colleague said shaking his
head. “If only one of the clinicians they had seen earlier had been a little
more aware of some of the health concerns of Asian-Americans.”
Over the last two
decades, that awareness has been increasing. While researchers have begun to
understand the profound extent to which a patient’s cultural background can
influence health care, more and more medical schools and training programs
have integrated what is termed “cultural competency” into their curricula.
“Culture works at all levels,” said Dr. Arthur Kleinman,
professor of medical anthropology and psychiatry at Harvard Medical
School. “It affects
health disparities, communication and interactions in the doctor-patient
relationship, the illness experience and health care outcomes.”
Clinicians who are
unaware of cultural influences may not only miss important medical
implications for a patient but can also inadvertently exacerbate an often
already tenuous therapeutic relationship. “From the statistics in the
literature,” said Marjorie Kagawa-Singer, a nurse and professor at the School of Public Health
of the University of California, Los
Angeles, “adherence to a
medication or a treatment regimen is usually less than 50 percent. But that
figure is further exacerbated when there are cultural variations.”
awareness of cultural context can also dramatically affect patients’
perceptions of the quality of care they receive. “So much research has shown
that communication is important to the health care experience,” said Nadia
Islam, deputy director of New
Center for the Study of Asian American Health. “Communication is not just
about language or interpreters; it is also being cognizant of what patients
bring with them.” Ms. Islam is co-editor of “Asian American Communities and
Health: Context, Research, Policy and Action” (Jossey-Bass,
2009), a recently published book that not only focuses on a growing and
hugely diverse cultural group in the United States but also underscores the
importance of context in any relationship between a clinician and patient.
According to Dr. Islam, when professional caregivers fail to take into
account an individual’s context, “patients may hear what the doctor is saying
but may not take it to heart in terms of their own health practices.”
misunderstandings can even affect a patient’s sense of hope. Jeffrey
Caballero, a contributor to the book as well as executive director of the
Association of Asian Pacific Community Health Organizations, added, “There’s
a rich cultural gap that sometimes needs to be crossed for patients to be
able to feel that a provider understands them and that they can have hope.”
For physicians who
are struggling with time constraints in their practices, however, juggling
all of these considerations successfully during a patient visit can be
challenging. “It’s hard to be open and aware of all the issues given the
increasing demands on doctors to see more patients in less time,” said Dr.
Lydia Gonzalez, a pediatrician who has taught medical school courses in
cultural awareness and who practices at the Morris Heights Health Center in
the Bronx. “Some clinicians do it really well, others poorly. But I think the
important thing is that one has to want to develop this attitude.”
Doing so does not
require the acquisition of lots of information — a working knowledge, for
example, of how individuals from different cultures may interpret an illness
— but rather an increased awareness of the cultural context of patients as
well as doctors. “The term ‘cultural competence’ can be limiting,” Dr. Kleinman noted. “It tends to suggest that culture is not
fluid and is only important for patients. The danger of the term is that it
can then stop conversations altogether rather than opening them.”
cultural issues on the patient’s side and the doctor’s side,” Dr. Kleinman continued, “and both sides should be aware of
that and be able to reflect on it in a self-critical way. Physicians bring
their own cultural orientations to the relationship, even if they are from
the ‘mainstream.’ ”
In addition to
their own cultural contexts, doctors also carry their professional one, the
values and priorities acquired during training. This “culture of biomedicine”
can result in misunderstandings as profound as those that come about as a
result of a patient’s particular background.
because the culture of the medical profession is oriented to the detection
and treatment of disease and not to the experience of illness, patients
sometimes believe that their physician places little value on how they feel.
“It’s not because doctors are innately insensitive,” Dr. Kleinman
said. “In their training, part of a physician’s acculturation is learning to
view the disease process as fundamentally true and the experience of being
ill as a related but less important epiphenomenon. There’s this belief that
the experience of being ill will just disappear if we can treat the disease.”
And while culture
can often play an important role in treating a patient, there are also
situations where it is superfluous. “Culture doesn’t always matter for
patients,” Dr. Gonzalez observed. “I think clinicians need to be aware that
diseases or issues may be more prevalent in a certain ethnic group, but they
should not generalize accordingly.”
The key, Dr. Kleinman advises, is determining “whether culture is
really at stake and if so, how it is at stake.” Health care providers need to
“show an interest, affirm the person as an individual.” The ability to do so
should not be part of a specialized skill set; instead they should be a
routine part of how clinicians think about caregiving.
“What you don’t
want,” Dr. Kleinman said, “is doctors carrying
around plastic cards listing the five things you need to think about when you
see, for example, an Asian-American patient. What you want is the ability to
inquire, to ask questions.”
discussion on the Well blog, “How Cultural Background Impacts Health.”
[BACK TO TOP]
The New York Times | 07.16.09
By NATASHA SINGER
“Don’t forget to check
your neck,” says an advertising campaign encouraging people to visit doctors
for exams to detect thyroid cancer.
In another cancer
awareness effort, Representative Debbie Wasserman Schultz, a Florida
Democrat, has more than 350 House co-sponsors for her bill to promote the
early detection of breast cancer in young women, teaching them about
screening methods like self-exams and genetic testing.
foundation of the American Urological Association has a prostate cancer
awareness campaign starring Hall of Fame football players. “Get screened,”
Len Dawson, a former Kansas City Chiefs quarterback, says in a public service
television spot. “Don’t let prostate cancer take you out of the game.”
Nearly every body
part susceptible to cancer now has an advocacy group, politician or athlete
with a public awareness campaign to promote routine screening tests — even
though it is well established that many of these exams offer little benefit
for the general public.
An upshot of the
decades-long war on cancer is the popular belief that healthy people should
regularly examine their bodies or undergo screening because early detection
saves lives. But in fact, except for a few types of cancer, routine screening
has not been proven to reduce the death toll from cancer for people without
specific symptoms or risk factors — like a breast lump or a family history of
cancer — and could even lead to harm, many experts on health say.
That is why the
continued rollout of screening campaigns, and even the introduction of a
Congressional bill, worries some health experts. And these experts say such
efforts add to the large number of expensive and unnecessary treatments each
year that help drive up the nation’s health care bill. Rather than heed
mass-market calls for screening, these experts urge people without symptoms
or special risks to talk to their own doctors about what cancer tests, if
any, might be appropriate for them.
do come with medical risks. A recent European study on prostate cancer
screening indicated that saving one man’s life from the disease would require
screening about 1,400 men. But among those 1,400, 48 others would undergo
treatments like surgery or radiation procedures that would not improve their
health because the cancer was not life-threatening to begin with or because
it was too far along. And those treatments could lead to complications
including impotence, urinary incontinence and bowel problems.
Then there is the
economic cost. There are no credible estimates for the amount that routine
cancer screening contributes to the approximately $700 billion spent each
year in this country on unneeded medical treatment of all types. But health
policy experts say such screenings and the cascade of follow-up tests and
treatments do play a role.
Americans spend an estimated $4 billion annually on mammograms, according to
Dr. David H. Newman, author of the book “Hippocrates’ Shadow: Secrets from
the House of Medicine.” Some of those tests cause false alarms that lead to
unnecessary follow-up surgery on normal breasts, at a cost of $14 billion to
$70 billion over a decade, according to Dr. Newman, the director of clinical
research in the department of emergency medicine at St. Luke’s Roosevelt
Hospital Center in Manhattan.
campaigns can be a disservice to the public by making
people overestimate their risk of dying from cancer, according to Dr.
Steven Woloshin, a researcher at the Dartmouth
Institute for Health Policy and Clinical Practice. Thyroid cancer, for
example, is a rare disease that kills an estimated 1,600 Americans a year.
But the campaign called “Check Your Neck” makes it seem as if everyone should
worry about the disease, Dr. Woloshin said.
Thyroid cancer doesn’t care how healthy you are,” reads the text of one ad
that has appeared in national magazines like People. The ads promote a quick
physical exam, called palpation, in which doctors feel for unusual lumps in
the thyroid, a small gland in the front of the neck. “Ask your doctor to
check your neck. It could save your life.”
The campaign is
part of an effort by the Light of Life Foundation, an advocacy group for
thyroid cancer patients founded by Joan Shey, who
was told she had the disease in 1995.
A Manhattan advertising
agency designed the ads as a pro bono project after one of its own employees
was found to have the disease. Bernie Hogya, one of
the creators behind the “Got Milk” ads, created the cancer awareness
campaign. Full-page ads valued at $800,000 have run free in national
magazines like Sports Illustrated.
Ms. Shey said the campaign was intended to save lives through
the early detection of cancer.
Dr. R. Michael
Tuttle, an endocrinologist at Memorial
who is on the foundation’s board, said he hoped the campaign would remind
busy family care doctors and gynecologists to check routinely for the disease.
The campaign could also prompt people with symptoms like nodules or swollen
lymph nodes in their necks to see their doctors, Dr. Tuttle said.
But there is no
evidence that routine neck exams reduce the risk of dying from thyroid
cancer, said Dr. Barnett S. Kramer, the associate director for disease
prevention at the National Institutes of Health, which has a cancer Web site
describing the potential benefits and risks of many cancer screening tests.
Most thyroid cancers are so slow-growing and curable that early detection
would not improve their prognosis, he said, while a rarer form of thyroid
cancer is so aggressive that a surge in screening would be unlikely to have
an impact on the death rate.
screening, he said, does have the potential to do harm because neck exams can
find tumors that would not otherwise have required treatment, potentially
setting off a cascade of unnecessary events like ultrasounds, needle biopsies
in the neck, operations to remove the thyroid and complications like damage
to the vocal cords. Meanwhile, Dr. Kramer said, the exams can miss some
life-threatening cancers that are not detectable by touch.
The “Check Your
Neck” campaign is one of many that prompt Dr. Kramer to compare mass cancer
screening to a lottery. “In exchange for those few who win the lottery,” he
said, “there are many, many others who have to pay the price in human costs.”
Dr. Ned Calonge, the chairman of the United States Preventive
Services Task Force said, “There are five things that can happen as a result
of screening tests, and four of them are bad.” His group consists of
independent medical experts that Congress has commissioned to make
recommendations, based on medical evidence, about what preventive measures
The one good
result of screening, Dr. Calonge said, is
identifying a life-threatening form of cancer that actually responds to
The possible bad
outcomes, he said, are results that falsely indicate cancer and cause
needless anxiety and unnecessary procedures that can lead to complications;
that fail to diagnose an existing cancer, which could lull a patient into
ignoring real symptoms as the cancer progresses; that detect slow-growing or
stable cancers that are not life-threatening and would not otherwise have
required treatment; and that detect aggressive life-threatening cancers whose
outcome is not changed by early detection.
Experts like Dr. Calonge say screening is useful only if, on balance, the
deaths prevented by treating cancers outweigh the harm done by treatments
that are not medically necessary. The problem is, most current screening
tests are not sophisticated enough to determine which cancers might not
require treatment — or to predict which life-threatening cancers will respond
He is among those
suggesting that people consult their doctors about whether to be screened and
not make decisions based on public awareness campaigns. And doctors, experts
say, should make sure they understand the pros and cons of screening and be
sure to tell patients about the possible risks.
No one advocates
that people eschew tests if they have symptoms or special risk factors. “Once
something bothers you or changes or is unusual, this is no longer routine
screening,” Dr. Calonge said.
But, for otherwise
healthy people with no symptoms, he said, only a few
routine tests have proven to significantly reduce cancer deaths among certain
age groups. The task force recommends pap smears for cervical cancer
beginning no later than age 21; regular mammograms to screen for breast
cancer in women starting at age 40; and tests for colon cancer starting at
age 50. And the task force notes that the evidence supporting the breast cancer
screening is not as strong as for cervical and colon cancers.
Most other types
of screening, meanwhile, have not been proved to reduce the death toll from
cancer, said Dr. Kramer at the National Institutes of Health.
“You need a high
bar of evidence to start advertising screening to healthy people, most of whom will not benefit,” Dr. Kramer said.
federal Centers for Disease Control makes it clear
on its Web site: there is no medical proof yet that routine screening for
lung, ovarian, prostate and skin cancer reduces deaths from those cancers.”
Congress that deals with breast cancer has become a flashpoint in the debate
over cancer screening for the general public.
introduced in the House in March, is called the Breast Cancer Education and
Awareness Requires Learning Young Act of 2009, or the Early Act. It mandates
an education and media campaign, aimed at women under
45 and their physicians, on the early detection of breast cancer.
The bill would
spend $45 million over five years to teach young women and their doctors to
recognize breast abnormalities. It would promote lifestyle changes like
eating habits to reduce the chances of getting the disease. It would focus
special attention on members of certain racial or ethnic groups who are at
higher risk for more aggressive cancers. It would also provide grants to
groups supporting young women with breast cancer.
sponsor, Ms. Wasserman Schultz, was told she had breast cancer in 2007.
Breast-cancer advocacy groups, like the Young Survival Coalition and Susan G.
Komen for the Cure, said they hoped the bill would
teach young women to notice changes in their bodies, talk to their doctors
and seek second opinions when necessary.
“It is worth
spending the federal government’s money, because it will save lives,” Ms.
Wasserman Schultz said in an interview.
But critics say
the House bill promotes techniques like breast self-exams that have not
proved to find cancer at an earlier stage or to save lives. The concern is
that the technique could cause younger women — a group for whom breast cancer
is a rare disease — to find too many medically insignificant nodules that
would lead doctors to perform unneeded biopsies, in which tissue is removed
biopsies could make breast cancer harder to detect when the women are older
and have a much higher risk of getting the disease, critics say. And such
false alarms can also cause women to distrust the medical system and skip
mammograms later in life when the tests have been proved to reduce the death
toll, said Dr. Otis W. Brawley, an oncologist who is the chief medical
officer of the American Cancer Society.
The breast self-exam
is a formal procedure in which women are taught to examine their breast
tissue monthly, inch by inch and layer by layer, in a grid pattern. But
instead of such a thorough probing, which might detect minute irregularities
of no medical significance, many cancer institutions
now recommend a less formal process called “breast self-awareness”. Its
premise is that women should become familiar with their breasts and seek
medical attention if they notice a change like a persistent lump or rash.
Opposition to the
Early Act surfaced soon after its introduction, in a specialist newsletter
called the Cancer Letter.
In it, some
prominent public health and cancer experts attacked the bill’s central tenet
— that lifestyle changes and early-detection methods had been proved to
reduce breast cancer deaths in women in their 20s and 30s who have no special
risks for the disease.
mammograms, for example, which have been shown to reduce deaths from breast
cancer in older women, have not proved to reduce the toll in women in their
20s and 30s, said Dr. Susan M. Love, a breast cancer surgeon in Santa Monica, Calif.
That is because breast tissue in younger women is typically too dense for
routine mammograms to be effective. And this test can needlessly expose young
women to radiation, Dr. Love said.
“Once you have
made women more ‘aware’ of their potential risk, you will have nothing to
tell them to do!” Dr. Love wrote in a letter to Ms. Wasserman Schultz asking
her not to pursue the bill.
Dr. Love and other
critics have also argued that a public health campaign could cause younger
women to overestimate their chances of dying from breast cancer. Of the
estimated 41,000 deaths a year in the United States from breast cancer, about
1 in 14 involve women younger than 45, according to the C.D.C. Only 1 in 33
breast cancer deaths — about 1,200 a year — occurs in women younger than 40.
Schultz says her bill is necessary because too many women do not pay
attention to their breast health until they are 40 or older. “Leaving young
women in the dark, just because there is a group of experts who believe we
don’t know what to tell them, isn’t right,” she said. Ms. Wasserman Schultz
said a panel of experts overseen by the federal Centers for Disease Control
and Prevention would create the breast cancer campaign based on the latest
medical science. She said the legislation did not endorse any particular
methods of early detection. Yet it does call for a report to measure the
campaign’s impact — including the percentage of young women who perform
breast self-exams and the frequency of such exams.
Schultz’s bill has been referred to committees in both the House and Senate.
“Ultimately,” she said, “Congress will decide.”
But Dr. Brawley of
the American Cancer Society said the Early Act reminded him of the 1960s,
when the cancer society teamed up with the advice columnist Ann Landers for
an awareness campaign to promote routine chest X-rays for the early detection
of lung cancer. The test later proved to increase medical complications
without reducing the cancer death toll, he said.
“It is a real
problem,” Dr. Brawley said of well-meaning members of Congress. “They are
doing things that might actually harm the people they want to help.”
[BACK TO TOP]
Mass. Panel Backs Radical Shift in Health
The New York Times | 07.16.09
By KEVIN SACK
BOSTON — A high-level state commission
recommended Thursday that Massachusetts
seek to rein in health care costs by radically restructuring the way doctors
and hospitals are paid.
action kicks off the second phase of a health care overhaul that has
succeeded in covering nearly every resident of the state but done little to
slow the relentless growth of spending.
recommendations, if approved by the legislature and Gov. Deval
Patrick, would make Massachusetts
the first state to end the practice of paying health care providers for each
office visit, laboratory test or procedure.
care physicians, specialists and hospitals would group themselves into
networks that would be responsible for a patient’s well-being and would be
compensated with a flat monthly or annual fee known as a global payment.
commission deferred many central decisions to the legislature and to a new
authority that would be created to establish and oversee the new payment
system. In doing so, it preserved cautious support from the state’s hospital
association, medical society and leading insurers for a proposal that
resembles guiding principles more than bill language.
those groups joined in a unanimous commission vote for the recommendations.
But they made clear that their continued support might depend on devilish
details, the kind that will determine whether their members are net losers
and, if so, by how much.
It was only by
keeping those stakeholders at the negotiating table that the state succeeded
in 2006 in vastly expanding subsidized coverage for the uninsured.
Maintaining that coalition is expected to be more difficult as the state
tries to slow the growth of costs, an effort that typically translates into
less revenue for providers and insurers.
The existing “fee
for service” system has been roundly criticized as offering incentives that
encourage doctors to provide more treatment than is necessary, a significant
contributor to the high cost of health care.
it is thought, would reward health care providers for keeping their patients
well rather than for merely treating their ailments. If the cost of treating
a patient was less than the global payment, the provider networks, called
accountable care organizations, would keep the difference as profit.
payment system has also been central to the health care debate in Washington. Thus far,
those discussions have focused more on providing financial rewards for
high-quality preventive care than on demolishing the fee-for-service system.
commission was created last year by the legislature and was led by Mr.
Patrick’s chief finance and health policy advisers. But on Thursday the
governor, a first-term Democrat, stopped short of endorsing its
recommendations, saying only that they “bring an important focus to cost
containment and quality.”
legislators said that they recognized the political challenge in enacting
such a plan but that Massachusetts’
circumstances demanded it. Senator Richard T. Moore, co-chairman of a joint
legislative committee on health care financing, said he expected to hold
hearings on the recommendations this fall.
other leader, Representative Harriett L. Stanley, said, “It’s going to be a
very long haul, but it’s a trip worth taking.”
stressed the importance of changing the way doctors and hospitals are paid
not only by private insurers but also by Medicare and Medicaid. That would
require permission from the federal government.
are hardly a new idea, as the concept closely resembles the capitation model
that incited a backlash by consumers who accused health maintenance
organizations of skimping on care. But members of the Massachusetts commission said their plan
would offer financial incentives for performance that would transform
physicians into care coordinators rather than gatekeepers.
“This is not about
containing costs by sacrificing quality,” said Mr. Patrick’s finance
director, Leslie A. Kirwan, a co-chairwoman of the
commission. “That’s been tried and rejected, and rightly so.”
recommended that its plan be carried out over five years. The state would not
set rates, which would be negotiated by insurers and the new provider
networks. But it would require those payment rates to account for variations
in the health condition and socioeconomic status of patients seen by
individual doctors and hospitals.
The report left the
details of such risk adjustments to the new authority that would be
established. It also made no projection of what it would cost to set up the
with heavy stakes embraced the proposal, but warily.
“Hospitals want to
be part of this historic endeavor,” said Lynn B. Nicholas, president of the
Massachusetts Hospital Association. But Ms. Nicholas added that “the success
of moving to a global payment system is not a foregone conclusion” and
expressed concerns about how risks would be adjusted and how start-up costs
would be covered.
The president of
the state medical society, Dr. Mario E. Motta, also urged caution. “A big
transition like this has never been done on such a broad scale,” Dr. Motta
said, “so it must be done very carefully, deliberately and thoughtfully.”
The commission issued
its recommendations three years after the state enacted one of the most
sweeping restructurings of health care in the country’s history. By requiring
nearly all residents to have health insurance, and providing subsidies to
those earning no more than $66,150 for a family of four, the state has
managed to cover 97 percent of its residents.
That is by far the
highest rate of any state, and elements of the plan have been adopted by
President Obama and Congressional Democrats in their proposals to revamp the
national health care system.
But to maintain
political support for expanding coverage, Massachusetts political leaders
deliberately deferred any serious discussion then about how to control health
care costs. Those costs have continued to rise at what state leaders
acknowledge is an unsustainable annual rate of 6 percent to 9 percent.
Although the state’s new subsidized insurance program, Commonwealth Care, has
kept a lid on premium increases, it is now straining the state’s budget for
the second consecutive year.
“We are among the
highest-cost states,” said Sarah Iselin, Mr. Patrick’s health policy adviser
and the other co-chairwoman of the commission. “Without intervention, our
projections are that spending on a per-person basis could double by 2020.”
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