La. scrambles to fund clinic
By MARSHA SHULER
Advocate Capitol
News Bureau
The Jindal administration has
agreed to try to help come up with the financing that will allow a regional
mental health emergency center to open at LSU’s Earl
K. Long
Medical Center
in Baton Rouge.
The $29 billion
state budget that went into effect July 1 contains no funding to operate the
facility that is designed to relieve pressure on area hospital emergency
rooms while providing more coordinated care for the individual.
The lead agency in
developing the mental health crisis center — the Capital Area Health and
Human Services District — did not find out that the funding was not
appropriated until LSU announced the center could not open as scheduled
because of lack of funding.
“We are working on
a potential solution,” state Department of Health and Hospitals Secretary
Alan Levine said Tuesday. He said the mental health crisis unit is “a
priority for the state, and we need to find a way to make it work.”
CAHSD executive
director Jan Kasofsky said she met with the
governor’s deputy chief of staff Stephen Waguespack as well as officials the
state health agency last week.
“There has been
great support,” said Kasofsky.
Kasofsky said her agency is working on a budget and
a potential three-way contract among her agency, LSU and DHH involving cost
reimbursement for staff salaries.
“Nothing is final
but there is much support and action is forthcoming,” she said.
Waguespack was
traveling out of state and could not be reached for comment, Gov. Bobby Jindal’s press secretary Kyle Plotkin
said. Plotkin referred questions to Levine.
The 24-bed Mental
Health Emergency Room Extension unit was recently constructed with federal
funds on the LSU hospital’s Airline
Highway property.
The unit is part
of a 10-step program to address mental health needs in the area. It is
designed to provide law enforcement and others a place to take people with
mental health problems that have become threatening to themselves or others.
Currently, the people are taken to hospital emergency rooms throughout the
area and taking up beds that can be used for acute medical problems.
LSU System Vice
President Fred Cerise said he has discussed the situation with Levine and Kasofsky in recent days. Efforts are under way to develop
a budget using different funding streams, he said. In excess of $1 million in
operating funds are needed, he said.
Cerise said a
starting point would be identifying money to provide the match for federal
uninsured care dollars and uncovered costs. “There’s going to be a need for
state funds to make this work,” he said.
“We will see what
DHH and Jan can come up with. We don’t have spare state funds hanging
around,” said Cerise.
Cerise said the
news that LSU did not have the funds to open the center “caused quite a stir.
We didn’t know it was a mystery.”
LSU sought funding
for the mental health unit operations in presentations to the House
Appropriations and Senate Finance Committees during budget hearings, Cerise
said. “But the funding was not provided,” he said. “Now there’s a scramble to
pull it off.”
http://www.2theadvocate.com/news/51365412.html?showAll=y&c=y
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Paul Murphy /
Eyewitness News
Watch the story: http://www.wwltv.com/topstories/stories/wwl072109cbdhs.62ea5a38.html
NEW
ORLEANS – Louisiana's Charity
Hospital system is more
than a safety net – it's the only way the most indigent patients in the state
get their health care.
The federal
government sends the state nearly $1 billion a year to help cover the costs
through Disproportionate
Share Hospital
payments, also known as DSH funds.
Louisiana Health
Secretary Alan Levine said the U.S. Congress is now considering a proposal to
cut the DSH program by at least $10 billion a year to help pay for a series
of new health care reforms.
"There's no
doubt that if the house bill were to pass, the public system would see a
reduction," said Levine.
Levine said the
DHS cuts, on top of other expected reductions in federal health care
spending, could have a devastating effect on the state's charity hospital
system.
"Make no
mistake, with $100 million in cuts next year coming down from the federal
government and additional cuts in DHS because of reform, we're going to have
to figure out what is the role going forward of the public hospitals,"
said Levine. "There may be some that may not be able to survive
financially without the stream of funds."
Dr. Fred Cerise
heads LSU's health care system, the agency that now runs the state's charity
hospitals. He said under the health care reforms, the increased number of
people with new access to health insurance would offset the DHS cuts.
"If you're
going to insure everybody, there's less of a need for the DHS dollars, which
are dollars specifically identified for uninsured care," said Cerise.
Levine said
there's no guarantee that if the federal government increases the number of
people with health insurance, it will make up dollar-for-dollar for the cut
in DSH funds at Louisiana public hospitals.
"Typically,
once people get their card, what we have found is that they go to some of the
other hospitals, they don't just stay in the Charity system," said
Levine. "Once they get their coverage and they go to another hospital,
the Charity hospital loses the money."
"If the
federal plan goes through, as it's coming out of the house, the overall
impact would be a greatly expanded amount of money spent on health care, not
a reduction," said Cerise.
Levine and Gov.
Bobby Jindal are now urging congress to slow down
and consider all of the "unintended consequences" of the health
care reform proposals now on the table.
For his part,
Levine said so far, he's read about 700 pages of the more than 1000 page
bill.
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LSUHSC School of Nursing named Art of Caring featured partner
New
Orleans, LA – LSU Health Sciences Center New Orleans School of Nursing will be
featured as a community partner in conjunction with the Art of Caring: A Look
at Life through Photography exhibit at the New Orleans Museum of Art (NOMA)
on July 25,
2009. LSUHSC nursing faculty and students will be at the museum
from 11:00 a.m. - 3:00 p.m.
The LSUHSC nursing
school is one of the community partners invited by NOMA to assist in the
presentation of a special series of awareness days related to the themes of
the exhibition. Featured partners share information about the contributions
they make to our community and raise awareness about important issues that
shape our lives.
The exhibit
features more than 200 photographs, organized into seven themes–Children and
Family, Love, Wellness, Disaster, Caregiving and
Healing, Aging, and Remembering. The exhibit, representing such photographers
as Annie Leibovitz, Alfred Eisenstaedt, and W.
Eugene Smith, captures poignant moments as well as everyday events.
The theme being
celebrated on July 25th is "Caregiving and
Healing" and LSUHSC faculty and students will be taking adult blood
pressures, distributing new toothbrushes to children, offering coloring books
about car seat safety, and distributing literature about the nursing
education programs offered at the LSUHSC School of Nursing.
"LSUHSC
nursing faculty also plan to use the exhibit to teach students the affective
art of caring in nursing," notes Marjorie Kraus, LSUHSC Assistant
Professor of Clinical Nursing. "We believe in the power of the visual
arts to confront difficult life issues and to promote the art of healing
through nursing."
Admission is free
to NOMA members and Louisiana
residents courtesy of the Helis Foundation. The
exhibit will be on display at NOMA through October 11, 2009.
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New Orleans, LA -- Stephania
Cormier, PhD, Associate Professor of Pharmacology at LSU Health Sciences
Center New Orleans, has shown for the first time that early exposure to
environmentally persistent free radicals (present in airborne ultrafine
particulate matter) affects long-term lung function. She recently presented
her latest research data at the 11th International Congress on Combustion
By-Products and Their Health Effects at the Environmental
Protection Agency
Conference Center
in Research Triangle Park,
N.C.
Dr. Cormier, a
2006 National Institute of Environmental Health Sciences Outstanding New
Environmental Scientist awardee, is conducting
research to determine how inhalation exposure to environmental factors such
as allergens, pollutants, and respiratory viruses during infancy leads to
pulmonary inflammatory diseases, such as chronic obstructive pulmonary
disease (COPD) and asthma later in life.
Using protein
profiling techniques, Dr. Cormier's lab was able to determine that early
exposure to these ultrafine pollutants caused genes to produce a number of
proteins, including one associated with COPD and steroid-resistant asthma,
and also caused proteins to misfold, rendering them
dysfunctional. These genetic defects are linked to structural changes in the
lung, airflow limitations, and permanent changes in immune responses.
"It is no
surprise that elevations in airborne particulate matter (PM) are associated
with increased hospital admissions for respiratory symptoms including asthma
exacerbations," notes Dr. Cormier. "What has come as a surprise is
that early exposure to elevated levels of PM elicits long-term effects on
lung function and lung development in children."
These results
could be especially important because the US Environmental Protection Agency
does not currently regulate ultrafine PM emissions.
According to the
National Institutes of Health, more than 12 million Americans are currently
diagnosed with COPD and another 12 million probably have it and don't know
it. Asthma is now the most common chronic disorder of childhood, affecting an
estimated 6.2 million US
children under the age of 18.
"Glucocorticoid (steroid) treatment is the foundation of
asthma treatment; however, while the majority of patients with asthma respond
to glucocorticoid treatment there are a number of
patients who do not," says Dr. Cormier. "In cells, a protein called
cofilin-1 appears to inhibit glucocorticoid function.
We are currently testing whether cofilin-1 also does this in the body. If it
does, then it is possible to envision the development of therapeutics aimed
at inhibiting cofilin-1 for use in steroid-resistant asthmatics."
LSU Health
Sciences Center New Orleans educates the majority of Louisiana's health care professionals. The
state's academic health leader, LSUHSC comprises a School
of Medicine, the state's
only School of Dentistry, Louisiana's
only public School of Public Health, Schools of Allied Health Professions
and Graduate Studies, as well as the only School
of Nursing in Louisiana within an academic health
center. LSUHSC faculty take care of patients in
public and private hospitals and clinics throughout Louisiana. In the vanguard of biosciences research
in a number of areas worldwide, LSUHSC faculty have
made lifesaving discoveries and continue to work to prevent, treat, or cure
disease. LSUHSC outreach programs span the state.
http://news.google.com/news?pz=1&ned=us&hl=en&q=health-care+OR+healthcare+OR+%22health+care%22%2B+louisiana&cf=all&scoring=n
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Advocate Opinion
page staff
If this year’s
state budget crisis was fun, wait until next year.
Because of the
formula used in the calculation of Medicaid support from the federal
government, Louisiana might face significant new budget cuts in the 2011
fiscal year that begins next July 1. And then, in 2011, not only does
Medicaid reimbursement take another dive, but the federal stimulus aid to the
state also goes away — a double-whammy.
Gov. Bobby Jindal and U.S. Sen. Mary Landrieu, D-La., recently met
on the problem.
We hope Landrieu
and the state’s delegation in Congress can plot a way through this thicket.
Because Louisiana
is a relatively poor state, the federal reimbursement for Medicaid — the
principal medical program for the poor — is in the range of 70 percent of the
cost of the care. That rate is determined by a formula based on total
personal income in the state, as calculated by the independent Bureau of
Economic Analysis.
The problem? Louisiana’s income was
artificially inflated by insurance payments and federal aid in the wake of
the hurricanes of 2005. If the reimbursement rate is adjusted for that bogus
“income,” Louisiana
faces a shortfall in the hundreds of millions of dollars per year.
“The people of Louisiana have been
devastated by four major storms in just over three years and they’re fighting
to get back on their feet, and should not be victimized again by their own
government,” Jindal said. “This formula will put
severe pressure on health-care funding, higher-education funding and other
key Louisiana
priorities.”
Jindal’s top health aide, Alan Levine, has been to Washington to press
the state’s case for relief.
We hope that the
Obama administration and Congress listen, but the state’s case for assistance
is clouded by political concerns. Overall, there is the problem of “Katrina
fatigue,” with the state’s woes after the hurricanes receding in national
consciousness.
Further, there are
ballooning federal budget deficits — for which Jindal
is trying to score political points by criticizing President Barack Obama.
Aid to Louisiana
on this front will add to the deficit; members of Congress might be reluctant
to make even this one change because the nonpolitical formula should be
preserved against future raids.
We don’t agree
with the latter position, because of the hugely exceptional circumstances of
the 2005 hurricanes, but it is an argument that is going to be heard.
Finally, the state
government is going hat-in-hand to the U.S. government for more than
$700 million in Medicaid funds. But this is the same state government, under
Govs. Kathleen Blanco and Jindal, that has cut
state income taxes by roughly the same amount. Most of those tax cuts,
although not all, went to wealthier families; Congress can rightly question
why the state’s poor are a federal obligation while legislators used the
state’s short-term surpluses to benefit the better-off.
The latter is a
particularly good argument, but we don’t believe those are compelling reasons
to cut Medicaid spending in Louisiana.
The attack of
hurricanes Katrina and Rita was one of America’s most extraordinary
events, an act of war by Mother Nature. To allow this funding formula to cut
Medicaid reimbursement is a travesty, and Jindal
and the legislative delegation are right to point that out. We hope the
delegation in Congress can persuade the administration and its colleagues of
the unfairness of the formula adjustment.
http://www.2theadvocate.com/opinion/51360777.html.
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Louisiana Gov.
Bobby Jindal says post-storm damage payments from
insurance settlements and Louisiana's
Road Home program following Hurricanes Katrina and Rita are contributing to a
$1 billion Medicaid shortfall for his state. Jindall's
office says he is trying to work out a solution with federal officials over
the looming crisis.
Advertisement
Medicaid, which
serves the poor and uninsured, calculates payment schedules to the states
based on per-capita income. That figure goes far beyond wages and salaries -
including all payments from all sources.
Louisiana's impending dramatic decrease in federal
funding is due to what the governor says is a faulty calculation of sources
of income in the state, including insurance and Road Home payments after the
2005 storms. From 2005 to 2007, according to the Bureau of Economic Analysis,
Louisiana's
per-capita income is reported to have increased by 42 percent - a dramatic,
sudden increase which will drop the state's federal Medicaid funding,
according to the governor's office.
Jindal says Louisiana's reimbursement rate will drop
from as high as 73 percent to 60 percent - forcing cuts to either public
health or higher education. Within the next year, Louisiana will face the largest decrease
of federal Medicaid funding in the nation - a decrease almost twice that of
the state with the next largest decrease, North Dakota, the governor's office
said.
Louisiana's Medicaid funding, which would normally
be 72 percent, is temporarily enhanced by the federal stimulus. This coming
October, it will decrease to 67 percent, and then will decrease to 63 percent
in October 2010. The drop from 72 to 63 percent will cost the state an
estimated $700 million per year. The state will start seeing this loss of
funding this October, with the full impact starting January 2011.
http://www.claimsjournal.com/news/southcentral/2009/07/22/102426.htm
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Louisiana Tells Congress: Stop Healthcare
Discrimination
Restoring equal
access to Medicare for five million dually eligible people with Medicare and
Medicaid improves healthcare finances and decreases healthcare disparities.
NEW ORLEANS, July
22 /PRNewswire-USNewswire/ -- In June 2009, the
Louisiana Legislature unanimously passed a resolution asking Congress to stop
healthcare discrimination for five million of the oldest, poorest, sickest,
and most disabled people in the nation. These are dually eligible people --
poor Medicare beneficiaries who also have Medicaid. They are the most costly
population covered by any public healthcare program. In 2005, they cost
Medicare and Medicaid almost $200 billion. NACDEP, the National Coalition for
Dually Eligible People, supports Louisiana
with its Position Paper at http://www.nacdep.org.
The Congressional
Balanced Budget Act of 1997 decreased Medicare benefits for dually eligible
people and created a two-tiered, discriminatory Medicare system. Wealthy
Medicare beneficiaries get full Medicare benefits, while five million poor
beneficiaries get partial Medicare benefits. In 2003, Tommy Thompson reported
to Congress this decreased their access to primary medical and psychiatric
care by 5% to 21%.
As access to
primary care decreases, expensive emergency room visits, hospitalizations,
and nursing home admissions increase. Decreasing healthcare access for our
most expensive and fastest growing Medicare population is financially
reckless.
The Balanced
Budget Act decreased access for poor Medicare beneficiaries who are
disproportionately elderly minorities and mentally and physically disabled
people. This violates the intent of the Civil Rights Act of 1964 and the
Americans with Disabilities Act. In the CMS Civil Rights Compliance
Statement, Nancy-Ann DeParle pledged to abolish
healthcare discrimination.
Dr. Sheldon Hersh, NACDEP President said, "Most dually eligible
people in my New Orleans
practice are elderly African-American grandmothers. Out of 40 dually eligible
patients, 39 are African American, and 33 are women. One woman is 99 years
old. Another woman is 103 years old. Decreasing healthcare access threatens
their lives and is morally unjust."
NACDEP's plan will restore access, stop civil
rights violations, decrease government-induced healthcare disparities, and
help state Medicaid agencies -- at little cost to taxpayers. All Medicare
beneficiaries worked, paid taxes, and earned the same Medicare benefits.
NACDEP applauds Louisiana
for leading the nation in healthcare justice for five million frail people.
http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/07-22-2009/0005064314&EDATE=
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By Bill Theobald
and Deborah
Barfield Berry
WASHINGTON — Fiscally conservative House Democrats,
including Rep. Charlie Melancon, thrust themselves
into the middle of the health care reform debate this week, blocking
legislation drafted by their own party's leadership.
If the 52 members
of the Blue Dog Coalition remain united against the bill, they could bar its
passage in the House Energy and Commerce Committee and later in the full
House.
On Tuesday,
objections by Blue Dog members of the committee to the cost and other aspects
of the health care bill prompted committee chairman Rep. Henry Waxman, D-Calif., to delay discussing and amending the legislation
for at least a day. Also Tuesday, President Barack Obama met with Democrats
on the committee.
"We're not
Blue Dogs anymore — we're the bulldogs. We're slowing this thing down,"
said Rep. Bobby Bright, a Blue Dog from Alabama.
Eight Democrats on
the committee, including Melancon, are Blue Dogs
who said they have serious problems with the bill's estimated $1 trillion
cost over 10 years.
Only Rep. Jane
Harman of California
spoke in favor of the bill.
Members of the
Blue Dog Coalition say the House bill:
- wouldn't reduce
the growth in health care costs.
- would punish
small businesses by raising taxes on families making more than $350,000 per
year as a way to pay for health care reform.
- would not insure
all of the 46 million people without health insurance. The bill would leave
about 9 million uninsured, the Congressional Budget office estimates.
Melancon, co-chairman of the Blue Dog Coalition,
has been meeting regularly with Democratic leaders.
"He's trying
to influence the bill and bring it to something he can support," said
Robin Winchell, a spokeswoman for Melcancon.
"He's very concerned about the need for health care reform, and he's
working to shape the bill in a way that will benefit Louisiana."
Melancon is particularly concerned about driving
down the cost of health care and finding more savings for consumers and the
government, Winchell said. The bill doesn't go far enough to rein in health
care costs, she said.
Republican leaders
are targeting Blue Dogs and freshmen Democrats in hopes of lining up more
opposition.
"There's a
lot of disgruntlement on the other side of the aisle," said Rep. Charles
Boustany, R-La., a physician and a GOP point man on
the issue.
Boustany said even if all the Republicans oppose
the measure, they will need some Democrats to defeat it.
"A lot is
going to depend on the Democrats," said Boustany.
"The ball is in their court now. We don't have the votes. The pressure
is on them."
House Speaker
Nancy Pelosi of California
downplayed conflict within her party, as did Obama.
The president has
said he wants health reform legislation to pass before Congress recesses in
August.
Two House panels —
the Ways and Means Committee and the Education and Labor Committee — have
approved the House health care reform bill.
A similar bill won
approval in the Senate health committee, but that bill doesn't address how to
finance health care reform. The Senate Finance Committee is struggling to
reach bipartisan agreement on that issue.
Some lawmakers are
suggesting Congress will have to work through its normal month-long August break to reach consensus.
Meanwhile, Rep.
John Fleming, a Republican, recently introduced a resolution that would
require lawmakers who vote for legislation creating a government-run program
to join the program. Fleming, a physician, said he does not support
government-run health care.
"Republicans
are very in favor of health care reform, but we want to see common-sense
health care reform, not nonsense health care reform," said Fleming.
"I would love be in the yes (column) if it were right for the American
people."
Health reform
legislation moving through the House would:
- Establish a
government-run health insurance option to compete with private insurers and
subsidize premiums for people with lower incomes.
- Allow people to
maintain their current insurance, although it's possible that options created
by the legislation could replace some options that exist now.
- Maintain
employers as the primary providers of health insurance. Those that don't
provide insurance would pay a penalty.
- Invest billions
in prevention and wellness.
- Generate $540
billion over 10 years by assessing an income tax surcharge on individuals
making more than $280,000 and couples making more than $350,000.
http://www.dailyworld.com/article/20090722/NEWS01/907220304/1002/-Blue-Dogs--playing-key-role-in-health-care-debate
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Sandra Moore
Please support HR
3200, the America’s
Affordable Health Choices Act of 2009. As you are aware, Louisiana has consistently ranked at the
bottom of the nation in poor health indicators. In addition, the state has
suffered from high poverty rates in comparison to the national average for
years; and though some progress has been made over the years through state appropriations
and recent stimulus monies, more is needed to provide health services to the
1.327 million plus uninsured residents in the state.
Advertisement
HR 3200 contains
specific language that will substantially increase the number of federally
qualified health centers in the nation and ultimately Louisiana. The bill specifically calls for
a $38 million dollar incremental funding increase for the health center
program until 2019.
Please support HR
3200 and specifically the provisions to fund health centers and the National
Health Services Corps Program.
Sandra Moore, New Iberia
http://www.theadvertiser.com/article/20090722/OPINION03/90722012/LETTER--Support-the-House-s-health-care-reform
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by The
Times-Picayune
Federal and state
officials announced today that an additional $32.9 million in federal monies
have been released to help pay recovery costs at Tulane University, the
largest employer in New Orleans, after Hurricane Katrina.
The announcement
came from the Federal Emergency Management Agency and Louisiana Recovery
Authority.
Following the 2005
storm, Tulane employed teams of contractors and ordered materials in bulk as
part of an aggressive effort to reopen its multiple sites for the spring 2006
semester.
The university
sustained storm damages totalling $650 million.
FEMA has processed more than $241 million in Tulane's storm damage claims,
and the university covered much of the total with payments from insurers.
FEMA officials say they have supplemented the insurance proceeds for Tulane
with about $95 million in public assistance grants, including the newly
released $32.9 million.
"Through
working with the university and the state, FEMA is able to support additional
eligible work that is not just specific to one building, but is related to
restoring all damaged facilities," said FEMA's Louisiana Transitional
Recovery Office acting director, Tony Russell.
LRA Executive
Director Paul Rainwater said, "Having the university come back as
quickly as it did from Hurricane Katrina allowed both students and employees
to return to some sense of normalcy, and we applaud their efforts. Tony
Russell and his team at FEMA have done a good job working through complicated
rebuilding issues to support Tulane's recovery."
http://www.nola.com/news/index.ssf/2009/07/fema_releases_more_recovery_mo.html
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New Orleans CityBusiness |
07.22.09
by The Associated
Press
WASHINGTON — After more than a week of tirelessly
pressuring Congress to move his top domestic priority, President Barack Obama
may have to settle for a fallback strategy on health care overhaul.
Instead of votes
in the House and Senate by August, the best Democrats may be able to hope for
this summer is action by the full House by the end of the month and some sort
of agreement on a bipartisan plan in the Senate before lawmakers head home
for vacation.
Not only are
Republicans honing their opposition, but some Democrats in both chambers are
voicing doubts about moving such complex and costly legislation too quickly.
"No one wants
to tell the speaker (Nancy Pelosi) that she's moving too fast and they damn
sure don't want to tell the president," Rep. Charles Rangel, D-N.Y., a
key committee chairman, told a fellow lawmaker as the two walked into a
closed-door meeting Tuesday. The remark was overheard by reporters.
Obama has
scheduled a prime-time news conference today, expected to focus on health
care. It's turning into a major test of his leadership. One Republican
senator says if the party can stop Obama on health care, it will break him.
In an interview
with CBS News on Tuesday, the president insisted on action by lawmakers, even
as he conceded some of the criticism was valid. Referring to objections from
a group of conservative Democrats in the House, Obama said, "I think,
rightly, a number of these so called Blue Dog Democrats — more conservative
Democrats — were concerned that not enough had been done on reducing
costs."
Obama said those
issues can be addressed as the legislation keeps moving forward. Congress has
already spent years studying and debating the problems in the health care
system, he said.
Meanwhile, a
conservative South Carolina Republican, Sen. Jim DeMint, refused today to
back away from his earlier assertion that the health care overhaul will prove
to be Obama's "Waterloo."
Interviewed on
NBC's "Today" show, DeMint said the statement was "not
personal." But he also said someone must "put the brakes on"
Obama, accusing the president of engaging in "a spending spree."
DeMint said he
agrees that health care changes are needed but that it would be a mistake to
push through such complex legislation before the August congressional recess,
as Obama has demanded.
House Democrats
put their divisions on display over the details and timing of health care
legislation Tuesday. The Democratic leadership juggled complaints from
conservatives demanding additional cost savings, first-term lawmakers upset
with proposed tax increases and objections from members of the rank-and-file
opposed to allowing the government to sell insurance in competition with
private industry.
Pelosi, D-Calif., vowed weeks ago that the House would vote by the
end of July on legislation to meet two goals established by Obama. The
president wants to extend health coverage to the tens of millions who now
lack it, and at the same time restrain the growth in health care costs far
into the future. The upfront costs, however, could reach $1 trillion to $1.5
trillion over 10 years.
The president also
has vowed that the legislation will not swell the deficit, although a senior
administration official told reporters Tuesday that the pledge does not apply
to an estimated $245 billion to increase fees for doctors serving Medicare
patients over the next decade.
Peter Orszag, the White House budget director, said that was
because the administration always assumed the money would be spent to avert a
scheduled cut of 21 percent in doctor's fees.
At the White
House, Obama and moderate and conservative Democrats verbally agreed on a
council of experts to find savings in Medicare, coupled with a mechanism to
force Congress to act on the recommendations. The cost curbs may help woo
some of the conservatives.
In the Senate, a
small, bipartisan group of lawmakers on the Senate Finance Committee met
behind closed doors, pursuing an elusive agreement. The negotiations, led by
Sen. Max Baucus, D-Mont., have taken on new urgency. But it's unclear whether
they will produce a breakthrough — or peter out in frustration.
Obama has spoken
in public nearly every day for more than a week on health care, sometimes
more than once. At the same time Republicans have upped the political stakes.
On Monday, Michael
Steele, the Republican Party chairman, likened Obama's proposals on health
care to socialism and said the chief executive wanted to conduct a
"risky experiment" that will damage the nation's economy and force
millions to lose the coverage they now have.
Last week, DeMint
was quoted as telling fellow conservatives: "If we're able to stop Obama
on this, it will be his Waterloo.
It will break him."
Given the
struggle, the polls show slippage for Obama, although he remains popular. The
president is battling the impression if not the reality that his proposal is
stalled. In the CBS interview, Obama recognized that perception.
"There have been so many times, during my political career ...
where people have said, 'Boy, this is make or break for Obama,'" he
said. "When the stock market went down everybody was saying, 'This is a
disaster.' And what I found is that as long as we are making good decisions,
thinking always what's ... best for the American people, that, eventually, as
long as we're persistent and we're listening to the American people, that
things get done."
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25860
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The New York Times | 07.22.09
By SHERYL GAY STOLBERG
WASHINGTON — Six months into his administration,
President Obama is at a pivotal moment. He has pushed through a $787 billion
economic stimulus package, bailed out Wall Street and, on Tuesday, managed to
beat the defense industry in the Senate, which voted to kill a high-profile
fighter jet program.
On Wednesday night
Mr. Obama addresses the nation in a prime-time news conference as the public,
and lawmakers, are growing skittish over his next big plan, to remake the
American health care system. How he handles the issue over the next several
weeks could shape the rest of his presidency, shedding light on his political
strength, his relationship with both parties in Congress and his appetite to
fight for his own agenda.
With some fellow
Democrats balking over his insistence that both the House and the Senate pass
health legislation before the August recess, Mr. Obama has a tough decision
to make: Does he take a hard line, demanding that lawmakers stick to his
timetable — and risk losing the support of Republicans and moderate
Democrats? Or does he signal flexibility, allowing lawmakers to take their
time — and give opponents the chance to marshal their case against the bill?
“He’s got to be
careful that while he ratchets up the pressure, he doesn’t bet his whole
presidency on whether this gets done before the August recess,” said Kenneth
M. Duberstein, who orchestrated President Ronald Reagan’s first-term
legislative strategy. “He has a broad, broad agenda that he’s in a rush to
enact, and if he’s not careful he will be viewed as a steamroller who tries to
get things fast and not necessarily right.”
Rahm Emanuel, the White House chief of staff,
said in an interview that the president intended to use the news conference,
scheduled for 8 p.m. Eastern time, as a “six-month report card,” to talk
about “how we rescued the economy from the worst recession” and the
legislative agenda moving forward, including health care and energy
legislation, which squeaked through the House and faces a tough road in the
Senate.
Polls show that
Mr. Obama is more popular than his own policies, a worrisome sign for a
president with such an ambitious agenda. Mickey Edwards, a former Republican
congressman who is now vice president of the Aspen Institute, said Mr. Obama
might be making a mistake in reading his election as a mandate for dramatic
change.
“A lot of people
supported Obama because they wanted to repudiate the Bush administration,”
said Mr. Edwards, who backed Mr. Obama for president. “I was one of those
people who supported him for reasons other than the policies he is proposing.
He seemed more thoughtful, more contemplative — I felt he had the right
temperament to be president. But I think his health care proposal goes beyond
what the public at the moment is ready to accept.”
Mr. Obama came
into office promising a more bipartisan Washington tone, which he has so far been
unable to achieve. His actions in the coming weeks on health care may
determine his long-term relationship not only with Republicans but also with
his fellow Democrats.
“I think this will
be a major factor in defining his presidency,” said Tom Daschle, the former
Senate Democratic leader, who remains a close adviser to the White House on
health issues. “Because he’s made it such an issue, and because he has
invested so much personal time and effort, this will, more than stimulus and
more than anything he has done so far, be a measure of his clout and of his
success early on. And because it is early on, it will define his subsequent
years.”
On the Republican
side, one question is whether Mr. Obama will succumb to the temptation to
turn health care into a partisan fight, even as he tries to court the
opposing party. He is, after all, still a popular new president confronting
an unpopular Republican Party, and so it would be easy for him to demonize
Republicans as obstructionists who want to stand in the way of progress.
Senator Jim
DeMint, Republican of South Carolina, gave Mr. Obama an opening to do just
that the other day, and the president took it. Mr. DeMint called health care
a “Waterloo
moment” that could break Mr. Obama. The president struck back, declaring,
“This isn’t about me.” But if Mr. Obama extends that line of attack to
Republicans more broadly, and rams a bill through without their support, any
claim he may have to bipartisanship will quickly evaporate.
As for Democrats,
Mr. Obama faces a balance-of-power conundrum. He has said all along that he
will set out broad principles for a bill and leave the details to Congress.
But now House Democrats in the fiscally conservative Blue Dog Coalition,
including seven who hold decisive votes on the Energy and Commerce Committee,
say they will not support the House bill without big changes.
One question for
Mr. Obama is whether to try to strong-arm them, and face a rebellion from
some of the very same conservative Democrats who helped put him in office. If
he forces them to vote for a bill their constituents do not like, on a
timetable that feels too rushed for them, it could hurt them at home. That
could mean a bigger political problem for the White House: a resulting loss
of Democratic seats in the 2010 midterm elections.
Another question
is how hard Mr. Obama will push Congress as a whole to adopt his progressive
agenda, not only on health care but also on climate change and a variety of
other issues.
The next few
weeks, as the president tries to broker a health care deal, may well tell
Americans just how far he is willing to go.
http://www.nytimes.com/2009/07/23/us/politics/23obama.html?_r=1&ref=health
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Shreveport Times | 07.22.09
Always consult
your doctor before altering diet or medication.
Is your blood
pressure high? Do you know someone with hypertension? With half of the adults
over 65 with high blood pressure this is sure to be a healthy eating plan for
them and the whole family.
The DASH Diet
(Dietary Approaches to Stop Hypertension) is a medication-free program to
lower blood pressure in just two weeks. This program is recommended by the
American Heart Association and is called "one of the 10 most important
scientific discoveries of the year."
About 50 million
Americans suffer from hypertension, and many must control their pressure by
taking drugs. High blood pressure, a symptomless condition referred to as the
"silent killer," is a leading cause of heart attack, stroke,
enlarged heart and kidney damage.
The DASH Diet has
been proven as effective in controlling elevations in blood pressure as a
typical antihypertensive medication. This study commanded serious attention
because:
• The National
Institutes of Health supported it.
• The diet was
tested at several of the world's most-respected medical institutions
• Eight hundred
participants enrolled in the study.
• The study
participants were carefully monitored.
• The study and
its results were reviewed by a panel of experts who recommended it for
publication in the New England Journal of Medicine.
• The diet is
recommended by the American Heart Association and several other medical
organizations.
• The DASH diet is
now part of the official high blood pressure guidelines here in the United States
and abroad.
A word of caution:
Even though remarkable results were reported — participants reduced their
blood pressure in 14 days — never change your medication or stop taking any medication
without first getting clearance from your doctor.
Based on an 1,800
calories diet, the DASH Diet recommends eating about four servings of fruits,
four servings of vegetables, two to three servings of low-fat dairy foods,
seven to eight grains/grain products, two or less meats, poultry and fish,
two to three fats and oils each day. Fatty foods, red meats and
sugar-sweetened foods are limited.
Even thought this
diet is recommended for people with high blood pressure, it is nutritionally
sound and appropriate for individuals without high blood pressure too. Since
our blood pressure tends to go up as we age, the DASH Diet can help avoid
this tendency.
"The DASH
Diet for Hypertension," by Thomas Moore, M.D., is available at most
bookstores and can give you more information about this eating plan. Or call
our office at (318) 226-6805 for the publication The DASH Diet Eating Plan.
http://www.shreveporttimes.com/article/20090722/LIVING0406/907220301/DASH-Diet-lowers-blood-pressure-without-medication
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By Carl Bialik
My print column
this week examines signs that rapid rises in childhood obesity in the
developed world may have abated.
HealthSome researchers say they have trouble getting
the word out, since it contradicts the dominant view that childhood obesity
remains a growing problem. “I have found it unusually difficult to get these
results published, possibly due to this prevalent view,” Lauren Lissner, a nutritional epidemiologist at the University
of Gothenburg in Sweden, said. “There has been particular resistance to
findings of decreasing prevalence rates.”
Some researchers
warn against making too much of such findings, since rates continue to rise
among certain subgroups of children, perhaps a particular gender or ethnic or
income group.
Anecdotal evidence
also contradicts the findings. “I consider what they’re reporting the calm
before the storm,” said Melinda Sothern, professor of public health and
director of health promotion at LSU Health Sciences Center New Orleans.
Furthermore, rates
that hold steady aren’t good news for the health-care system, which must
contend with high rates of disease among these children as they age. “These
numbers, as high as they are, still underestimate the true impact of
childhood obesity on public health,” said David Ludwig, director of the
optimal weight for life program at Children’s Hospital in Boston.
Meanwhile,
statisticians caution that obesity data are spotty, perhaps too spotty to
draw broad conclusions yet. “As indicated by the results, it does seem that
the obesity prevalence has not increased in the last few years,” Swapnil Rajpathak, an epidemiologist at Albert Einstein College
of Medicine, said. “However, whether the obesity epidemic in children has
reached a plateau from which it could potentially start to decrease cannot be
concluded from these data.”
“An obvious
weakness is the time frames of these studies, and the statistical variability
regarding annual rates,” added Donald Berry, chairman of the department of
biostatistics at the University of Texas M.D. Anderson Cancer Center. “If you
home in enough on any curve it will look flat.”
Drawing trend
lines between infrequent studies is difficult. “Globally we have not been
particularly good at measuring the trends in overweight and obesity in young
people,” says Timothy Armstrong, coordinator of the World Health
Organization’s surveillance and population-based prevention unit.
Among the
challenges is finding repeated surveys with similar methodologies. “Most of
the time, the problem is to have repeated studies using the same
methodologies and analyzed according to the same references to allow
international and over-time comparisons,” according to Benoit Salanave, an epidemiologist at the French Institute for
Public Health Surveillance. “In France for example, there was no
national data before the year 2000.”
Sweden soon will have better data, thanks to a plan to measure children
throughout the country and computerize the findings, according to Max Petzold, associate professor in epidemiology at the
Nordic School of Public Health in Goteborg,
Sweden.
Timothy Olds, a
professor of health sciences at the University
of South Australia, cautions that
his findings of a leveling off of obesity rates in Australia have been
misinterpreted. “I do worry it will lead to complacency, and, more
importantly, to misrepresentation by groups such as food manufacturers
resisting political regulation, especially in relation to fast food
advertising. There have been lots of examples of the latter with my data.
There are a lot of ethical issues here — the conflict between reporting the
truth as a researcher and the possible deleterious social effects, the
investment some researchers (and manufacturers of anti-obesity drugs) have in
‘talking up’ the epidemic, and the interest food retailers have in talking it
down, the concern of many educators that fat kids are being stigmatised … it’s a bit of a social, political and
ethical minefield.”
But reporting
accurate figures trumps other concerns. “It’s the numbers that tell the
story, and the numbers don’t lie,” said Jenny O’Dea, associate professor in
nutrition and health education at Australia’s
University of Sydney.
Further reading:
Studies from the U.S., Australia, New
Zealand, France,
Sweden, Switzerland and the U.K. suggest a plateau in obesity
rates. Other research out of the U.K.
and Australia
differs. The International Association for the Study of Obesity has an
extensive database. The New Yorker reviews recent books on obesity, and Slate
pokes holes in the use of Body Mass Index. My obesity writing includes a
critique of BMI and of a projection that all Americans would some day be
overweight.
http://blogs.wsj.com/numbersguy/maybe-children-arent-getting-fatter-759/
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The Dallas Morning News | 07.21.09
By JASON ROBERSON
/ The Dallas
Morning News
Doctors frustrated
with medical claim denials issued a report card Tuesday of the nation's
largest insurers.
This is the second
year of the American Medical Association's National Health Insurer Report
Card, which measures the nation's eight largest health insurers on claim
denials, timeliness, accuracy and transparency.
Also Online
"We are
encouraged that health insurers took the AMA's initial report card findings
seriously and made improvements, but the new results from this year's report
card shows there is still work to do," said Dr. William A. Dolan, AMA
board member.
According to the
report, the percentage of medical claims denied in 2008 ranged from
Medicare's 6.9 percent to UnitedHealthcare's 2.7
percent. The percentages improved this year, ranging from Anthem Blue Cross
Blue Shield's high of 4.3 percent to Aetna's
low claim denial rate of 1.8 percent.
Paul Marchetti, head of Aetna's
National Networks and Contracting Services, said he shares the AMA's goal and
appreciates its ongoing effort to make interactions with physicians easier.
Aetna has 800,000 North Texas plan members.
"We are proud
of the progress we have made," he said.
Humana's internal
report card, where the insurer grades itself, found that 94 percent of claims
are paid within 14 days with more than 99 percent accuracy, said Anna Hobbs,
Humana spokeswoman
http://www.dallasnews.com/sharedcontent/dws/bus/stories/072209dnbusReportcard.6151aeb4.html
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The New York Times | 07.21.09
By DAVID LEONHARDT
WASHINGTON — What’s in it for me?
On the subject of
health care reform, most Americans probably don’t have a good answer to the
question. And that, obviously, is a problem for the White House and for
Democratic leaders in Congress.
Current bills
would expand the number of insured — but 90 percent of voters already have
insurance. Congressional leaders say the bills would cut costs. But experts
are dubious. Instead, they point out that covering the uninsured would cost
billions.
So the typical
person watching from afar is left to wonder: What will this project mean for
me, besides possibly higher taxes?
Barack Obama was
able to rise from the Illinois State Senate to the presidency in large
measure because of his ability to explain complex issues and then to make a
persuasive argument. He now has a challenge worthy of his skills.
Our health care
system is engineered, deliberately or not, to resist change. The people who
pay for it — you and I — often don’t realize that they’re paying for it.
Money comes out of our paychecks, in withheld taxes and insurance premiums,
before we ever see it. It then flows to doctors, hospitals and drug makers
without our realizing that it was our money to begin with.
The doctors,
hospitals and drug makers use the money to treat us, and we of course do see
those treatments. If anything, we want more of them. They are supposed to
make us healthy, and they appear to be free. What’s not to like?
The immediate task
facing Mr. Obama — in his news conference on Wednesday night and beyond — is
to explain that the health care system doesn’t really work the way it seems
to. He won’t be able to put it in such blunt terms. But he will need to
explain how a typical household, one that has insurance and thinks it always
will, is being harmed.
The United States
now devotes one-sixth of its economy to medicine. Divvy that up, and health
care will cost the typical household roughly $15,000 this year, including the
often-invisible contributions by employers. That is almost twice as much as
two decades ago (adjusting for inflation). It’s about $6,500 more than in
other rich countries, on average.
We may not be
aware of this stealth $6,500 health care tax, but if you take a moment to
think, it makes sense. Over the last 20 years, health costs have soared, and
incomes have grown painfully slowly. The two trends are directly connected:
employers had to spend more money on benefits, leaving less for raises.
In exchange for
the $6,500 tax, we receive many things. We get cutting-edge research and
heroic surgeries. But we also get fabulous amounts of waste — bureaucratic
and medical.
One thing we don’t
get is better health than other rich countries, whether it’s Canada, France,
Japan
or many others. In some categories, like emergency room care, this country
seems to do better. In others, like chronic-disease care, it seems to do
worse. “The fact that we spend all this money and don’t have better outcomes
than other countries is a sign of how poorly we’re doing,” says Dr. Alan
Garber of Stanford
University. “We should
be doing way better.”
So far, no one has
grabbed the mantle as the defender of the typical household — the opponent of
spending that creates profits for drug companies and hospitals at no benefit
to people’s health and at significant cost to their finances.
Republicans have
actually come out against doing research into which procedures improve
health. Blue Dog Democrats oppose wasteful spending but until recently have
not been specific. Liberals rely on the wishful idea — yet to be supported by
evidence — that more preventive care will reduce spending. The American
Medical Association, not surprisingly, endorses this notion of doing more
care in the name of less care.
Mr. Obama says
many of the right things. Yet the White House has not yet shown that it’s
willing to fight the necessary fights. Remember: the $6,500 tax benefits
someone. And that someone has a lobbyist. The lobbyist even has an argument
about how he is acting in your interest.
These lobbyists,
who include big names like Dick Armey and Richard Gephardt, have succeeded in
persuading Congress to write bills with a rather clever feature. They include
some of the ideas that would cut costs — but defang them.
One proposal would
pay doctors based on the quality of care, rather than quantity, but it’s a
pilot project. Doctors who already provide good care may well opt in; doctors
providing wasteful but lucrative care surely will not. The bills would also
finance research on which treatments are effective. But Medicare officials
would not be prevented from continuing to spend taxpayer money on ineffective
treatments.
In reaction, some
people who should be natural supporters of reform have become critics. The
Mayo Clinic — one of Mr. Obama’s favorite models of care — says the
legislation fails to “help create higher-quality, more affordable health
care.”
On Thursday, Mr.
Obama will visit another example he likes to cite, the Cleveland Clinic. Its
successes capture what real reform would look like. Like Mayo, the Cleveland
Clinic pays its doctors a salary, rather than piecemeal, and delivers
excellent results for relatively little money.
“I came here
30-some years ago,” Delos Cosgrove, a heart surgeon who is the clinic’s chief
executive, told me. “And I have never received any additional pay for
anything I did. It never made a difference if I did five heart operations or
four — I got paid the same amount of money. So I had no incentive to do any
extra tests or anything.”
This is the crux
of the issue, economists say: the current fee-for-service system needs to be
remade. The administration has made some progress, by proposing a powerful
new Medicare overseer who could force the program to pay for good results and
stop paying for bad ones.
But even a strong
Medicare plan won’t be enough. Reform will need to attack the piecemeal
system in numerous ways. Among the most promising, which Mr. Obama has
resisted, is a limit on tax subsidies for the costliest health insurance
plans. This limit would give households and employers a reason to become
smarter shoppers.
Above all, reform
can’t revolve around politely asking the rest of the medical system to become
more like the Cleveland Clinic.
In recent weeks,
polls have shown that a solid majority of Americans support the stated goals
of health reform. Most want the uninsured to be covered and want the option
of a government-run insurance plan. Yet the polls also show that people are
worried about the package emerging from Congress.
Maybe they have a
point.
http://www.nytimes.com/2009/07/22/business/economy/22leonhardt.html?ref=health
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The New York Times | 07.21.09
By RONI CARYN RABIN
Many studies have
suggested that a diet rich in fish is good for the heart. Now there is new
evidence that such a diet may ward off dementia as well. One of the largest
efforts to document a connection — and the first such study undertaken in the
developing world — has found that older adults in Asia and Latin America were
less likely to develop dementia if they regularly consumed fish.
And the more fish
they ate, the lower their risk, the report found. The findings appeared in
the August issue of The American Journal of Clinical Nutrition.
The study, which
included 15,000 people ages 65 and older in China, India, Cuba, Venezuela,
Mexico, Peru and the Dominican Republic, found that those who ate fish nearly
every day were almost 20 percent less likely to develop dementia than those
who ate fish just a few days a week. Adults who ate fish a few days a week
were almost 20 percent less likely to develop dementia than those who ate no
fish at all.
“There is a gradient effect, so the more fish you eat, the less
likely you are to get dementia,” said Dr. Emiliano
Albanese, a clinical epidemiologist at King’s College London and the senior
author of the study. “Exactly the opposite is true for meat,” he added. “The
more meat you eat, the more likely you are to have dementia.” Other studies
have shown that red meat in particular may be bad for the brain.
Fish, especially
oily fish, may be protective against dementia because it is rich in omega-3
long-chain polyunsaturated fatty acids, which studies suggest may have
numerous health benefits, among them anti-inflammatory properties. Omega-3
fatty acids have been shown in animal studies to reduce the build-up of
atherosclerotic plaques and may also prevent the accumulation of amyloid plaques in the brain characteristic of
Alzheimer’s disease, Dr. Albanese said.
But though
numerous observational studies in the West also have indicated fish may
reduce dementia risk, there is little evidence as yet from randomized
controlled clinical trials, which provide the best scientific evidence but
are expensive and difficult to carry out.
Although the new
study was an observational study, Dr. Albanese suggested that since the
findings are consistent both in the West and in developing countries, where
the environment and lifestyle are so different, the new data lend support to
the hypothesis that fish is protective against dementia.
Most of the
elderly surveyed in the study lived with extended families, and those seniors
who had electricity and indoor plumbing, or several assets like a car, a
phone, a TV or a refrigerator were considered relatively well off.
Researchers
assessed the dietary habits of 14,960 study participants by going
door-to-door to do face-to-face interviews, and they diagnosed dementia by
using culturally validated criteria. The data were adjusted to account for
differences in such variables as sex, age, education, income,
smoking and physical health.
http://www.nytimes.com/2009/07/21/health/21fish.html?ref=health
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