Derek Daniel | LSUHSC-S Coordinator of Public
A new tradition
began Thursday at LSU Health Sciences
Center at Shreveport with the unveiling of a portrait
of Dr. John C. McDonald, the
transplant surgeon who will go down in history as the first Shreveport chancellor of the academic
appointment in 2000 by the LSU Board of Supervisors culminated an intense
grassroots campaign by area civic leaders for the local Health Sciences
Center to gain its own
chancellor rather than continue to report to a New Orleans-based chancellor.
In addition to
being the chief executive officers of the LSU
Center at Shreveport,
Dr. McDonald held the dual title of Dean of the School
of Medicine in Shreveport.
He retired earlier this year after a decade as Chancellor/Dean.
McDonald’s tenure, the LSU Health Sciences
Center at Shreveport
expanded to include the E. A. Conway Medical Center
in Monroe and
the Huey P. Long Medical Center in Pineville. In 2005, the Louisiana
Legislature statutorily separated the LSU
Center at Shreveport
from its former parent institution, the LSU
Center at New Orleans.
joined the faculty of LSUSHC-S in 1977 and is nationally known for his
pioneering work in organ transplantation, a medical treatment still in its
infancy when Dr. McDonald began his career.
When he came to LSUHSC-S, Dr. McDonald established kidney, liver,
pancreas and heart transplantation programs in North Louisiana.
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When Mayor Ray Nagin undertook
to clear 34 Mid-City acres so the VA could build a new hospital, someone -- a
government attorney or a newspaperman, say -- ought to have wondered whether
he had the right to do it.
But, until a lawsuit was filed last week, nobody asked the
question, at least not in public. People will start saying we are slow on the
uptake around here.
It is no secret that the American system of government
does not allow for the untrammeled power enjoyed by, say, a sheikh. Yet here
was an American mayor in 2007 blithely agreeing to kick out all the residents
and business owners, close all the streets, rip up
water and sewerage lines and destroy any sign of the old neighborhood.
The council did adopt a resolution urging that the
hospital be built at that site, but never signed off on the deal Nagin concocted with the VA. That was a violation of the
City Charter, a lawsuit now alleges, as was the failure to secure Planning
Commission approval or to publish the "memorandum of understanding"
Nagin signed with the VA.
Nobody expects Nagin to know
what's in the City Charter, of course, but the rest of us should have checked
it out. To judge from the lawsuit, which seeks to have Nagin's
memorandum nullified, we would have had plenty of scope to jump all over him
when he signed it.
Still, better late than never.
Many of our leading thinkers believe the city will be
better off if the 34 acres are handed over, for our best shot at economic
salvation is to establish New Orleans as a major player in the medical racket
by building whizbang replacements for the old VA
hospital and Big Charity, both overwhelmed by Katrina.
The plan is to establish the two new hospitals as a couple
so that they will beget "synergy" and blossom into a
"biomedical corridor" to attract budding doctors and non-charity
cases in droves.
That would not be easy to achieve if we had wise and
dedicated teams working in harmony on the twin projects, but this show is
being run by politicians and academics, so tantrums and backbiting are the
order of the day.
The VA hospital has had the easier path, since the money
to build it is available and there seemed to be no obstacle to a 2012 opening
until four citizens filed the lawsuit to block expropriation. Since Nagin's alleged offense was to exceed his authority and
fail to follow procedures laid down in the City Charter, the deal could
presumably be redone as protocol demands. The opening date might be delayed,
but you'd still have to bet the new VA hospital will rise on the chosen site.
Nearby, where LSU lusts to build a glistening replacement
for Charity, the outlook is not so rosy. Even if the project does not exceed
its $1.2 billion budget estimate -- and that would be a first -- it is
difficult to see where the scratch is coming from. The budget assumes that
FEMA will swallow LSU's highly imaginative account of the damage done by
Katrina, and chip in $492 million, the full replacement cost of Charity. So
far, FEMA reckons $150 million would be more like it.Even
if FEMA had just fallen off a turnip truck, the new medical center would
still need to raise at least $400 million in a precarious bond market.
The state has in any case suspended land acquisition at
the proposed site while LSU and Tulane squabble over the make-up of the board
that will run the medical center if it ever does come to pass.
Until now the VA must have contemplated the travails of
its would-be neighbor with a certain bemusement, since acquiring the necessary
land for its hospital had been such a breeze. Or, at least, so it appeared. Nagin's offenses against the City Charter, as set out in
the lawsuit, were so blatant and so numerous that it was only a matter of
time before a challenge was mounted.
Certainly the attorneys representing the plaintiffs must
have known from jump street that Nagin could not
hand over a huge chunk of the city off his own bat. If, as City Attorney Penya Moses-Fields contends, this has been "one of
the most extensive public participation processes in the city's
history," the citizenry has been woefully misinformed.
The lawsuit alleges a slew of other violations of the City
Charter, with which the plaintiffs' attorneys are more familiar than most.
One of them, Sal Anzelmo, was city attorney under
Dutch Morial, and the other, Tommy Milliner, worked
in the legal department in two administrations. These are not such guys as
would need two years to conclude that Nagin is too
big for his boots.
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By MARK BALLARD
Bob Himel, left, and Gilda Himel, of Folsom; Brenda Ortis,
second from right, from 15 miles north of St. Francisville;
and Patsy Becker, of Baton Rouge, protest President Barack Obama’s proposed
health-care plan. Supporters and opponents met Thursday morning on the
sidewalks around the U.S.
Courthouse on Florida Street.
On the day after
President Barack Obama asked the nation to back his planned revamp of the
$2.4 trillion system that pays for health care, opponents and supporters
squared off Thursday on the sidewalks surrounding the U.S. courthouse in downtown Baton Rouge.
kept the two groups — which police estimated to be about 125 people — apart
as the sides shouted at one another.
The gathering was
largely peaceful — police reported no arrests — but points made on
health-care plans soon were overshadowed by arguments of whether the
president is an American citizen.
Obama spoke to the
nation Wednesday night, arguing his proposed overhaul of the health-care
system would help provide coverage for an estimated 47 million uninsured
Americans and curtail the rising costs for consumers.
“I’ve also pledged
that health insurance reform will not add towards deficit over the next
decade. And I mean it,” Obama said during a nationally televised news
before Congress, now controlled by Democrats, generally provide subsidies for
people and employers to purchase insurance, penalize
those who don’t and provide a larger government safety net for those who
can’t afford a policy.
health care for the poor and uninsured. Medicare provides health care for the
include Gov. Bobby Jindal and U.S. Rep. Bill
Cassidy, R-Baton Rouge, contend taxpayer subsidies and the ability to operate
at a loss eventually would drive most consumers into government-run health
“I don’t believe
it’ll work,” Dwight Hudson, of Central, told the crowd of opponents to
“Cost is the
problem,” said Hudson,
adding he is not particularly satisfied with his health insurance because the
deductible is too high.
He favors a
consumer-driven system that allows competition within private industry to
drive down prices and expand opportunities, he said.
Hudson said he is affiliated with a newly formed
local “Tea Party.”
Tea Party is funded by the some of the biggest donors to the Republican
Party, according to media reports.
Hudson said he was a registered to vote as an
independent and was unsure of the GOP’s position on the issue.
Hudson said he and others in the local Tea Party
became aware through an Internet posting that supporters of Obama’s plan
would rally at the courthouse.
Tea Party members,
who contacted each other via e-mails and phone calls, and others arrived
about 15 minutes into the supporters’ event in numbers that eventually came
to overwhelm the couple of dozen attending the original event.
City police were
called for help at 10:15 a.m., said Sgt. Don Kelly, a spokesman.
kept the crowd off the steps of the courthouse and on narrow sidewalks.
Many spilled into Florida Street.
Steven Walker of New Orleans, state director of Louisiana’s
Organizing for America,
said he wanted a handful of people to share their struggles caused by
inadequate health-care insurance.
Obama’s plan would
lower costs and free up options for people with insurance while giving people
without insurance access to policies, said Walker, whose group is affiliated with the
Democratic National Committee, which is promoting Obama’s agenda.
Walker said Obama’s plan would allow individuals
“But this is a
campaign of smear and fear,” Walker
said pointing to an opposition sign that condemned the president as a
“These people are
anti-Obama,” he said.
A few feet down
the sidewalk, on the other side of a cordon of police officers, Kurt Wagner,
a Port Allen insurance sales manager, asked the crowd: “Is he rightfully the
The issue of
whether Obama was born in the U.S.
has been making the rounds on blogs since the election.
distributed copies of a certification from the state of Hawaii
saying he was born in Honolulu.
certification of a live birth is not a birth certificate, some people contend
the president has not adequately proven he was born on American soil, one of
the criteria for becoming president.
Outside the Baton Rouge federal
courthouse Thursday, the debate over Obama’s birth raged much longer than the
one involving his health plan.
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By Gordon Deal
In a nutshell,
most of us want health care reform. But we’re not on board with coughing up
so much tax money to get it done.
In Rep. Paul
Ryan’s (R-WI) easy-to-follow opinion piece in the Milwaukee Journal Sentinel,
he wrote that before members of Congress even had time to read the 1,000-page
bill, it already had cleared two major House committees. They didn’t even
know the cost. So expensive, so complex, and potentially so
powerful as to forever change the role of the federal government, and yet
they’ve fast-tracked it?
The quick deadline
that President Obama wants serves what purpose? He says in Washington, things don’t get done without
a deadline. How about a $787 billion stimulus package? How about the
government takeover of banks and car companies? The health care overhaul
proposal blows those issues out of the water in terms of size and cost. The
President says the American people are demanding a deadline. I don’t know of
anybody who wants to see action this fast on something so important and yet
so poorly thought out.
Budget Office, standing tall in the face of Democratic outrage, provided
analysis that shows the President’s plan will NOT reduce government spending
on health care like he said it would, and that it will substantially increase
the federal deficit – despite tax increases.
says providing a public option that people can choose to join will keep
insurance companies “honest.” But comparing a government plan to a private
health insurance plan is not honest. As Rep. Ryan notes, the private sector
pays taxes; the government COLLECTS taxes. The private sector pays the doctor
or hospital a rate that’s been negotiated; the government pays a rate that’s
Harold Meyerson, editor-at-large of American Prospect and the
L.A. Weekly, wrote an opinion piece for the Washington Post defending tax
hikes on the wealthy to help pay for the government’s plan. He can’t understand
why centrist Democrats (Blue Dogs) are opposed to taxing the wealthiest 1
percent. Really? Rich people don’t pay enough taxes already? It’s laughable
that even in discussing such monumental costs,
nobody has produced specific plans to reduce spending.
Mr. Meyerson also has no pity for the tax burden on small
businesses. He quotes the Center on Budget and Policy Priorities which claims
that only the top 4 percent of those businesses would be affected by the
proposed surcharge. If there’s 27 million small businesses in America,
4 percent of those is 1,080,00. You have to figure
that they’re already hurting in this economy. How would they respond to
additional taxes? With layoffs. Most Americans are employed by a small
business. Why hurt the sector that does the most hiring?
Governor of Louisiana, says one of the seven ideas for reforming health care
should include pooling for small businesses, the self-employed, and others.
He’d like to see people free to purchase their health coverage without tax
penalty through their employer, church, union, etc. He says individuals
should benefit from the economies of scale currently available to those
working for large employers. We all would like the chance to buy the
least-expensive, highest-quality insurance available.
Gov. Jindal also
proposes that low-income working Americans without health insurance get help
in buying private coverage through a refundable tax credit.
desperate to hear specifics from our leaders in Washington so we can formulate an educated
opinion about the health-care reform proposals. Specifics have been clearly
lacking so far.
One thing that
would help: inviting financial reporters to White House press conferences to
ask questions on these matters; not political reporters. Then we, and
President Obama, wouldn’t waste an hour of our evening (like this past
Wednesday) on useless question-and-answer sessions that add to the public
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By BOBBY JINDAL
In Washington, it seems
history always repeats itself. That’s what’s happening now with health-care
reform. This is an unfortunate turn of events for Americans who are
legitimately concerned about the skyrocketing cost of a basic human need.
In 1993 and 1994,
Hillary Clinton’s health-care reform proposal failed because it was concocted
in secret without the guiding hand of public consensus-building, and because
it was a philosophical over-reach. Today President Barack Obama is repeating
The reason is
plain: The left in Washington
has concluded that honesty will not yield its desired policy result. So it
resorts to a fundamentally dishonest approach to reform. I say this because
the marketing of the Democrats’ plans as presented in the House of
Representatives and endorsed heartily by President Obama rests on three
First, Mr. Obama
doggedly promises that if you like your (private) health-care coverage now,
you can keep it. That promise is hollow, because the Democrats’ reforms are
designed to push an ever-increasing number of Americans into a government-run
If a so-called
public option is part of health-care reform, the Lewin
Group study estimates over 100 million Americans may leave private plans for
government-run health care. Any government plan will benefit from taxpayer
subsidies and be able to operate at a financial loss—competing unfairly in
the marketplace until private plans are driven out of business. The
government plan will become so large that it will set, rather than negotiate,
prices. This will inevitably lead to monopoly, with a resulting threat to the
quality of our health care.
Democrats disingenuously argue their reforms will not diminish the quality of
our health care even as government involvement in the delivery of that health
care increases massively. For all of us who have seen the Federal Emergency
Management Agency’s response to hurricanes, this contention is laughable on
its face. When government bureaucracies drive the delivery of services—in
this case inserting themselves between health-care providers and their
patients—quality degradation will surely come. House Democrats seem willing
to accept that problem to achieve their philosophical aim—the long-term
removal of for-profit entities from the health-care landscape.
Third, Mr. Obama’s
rhetoric paints a picture of a massive new benefit that will actually cost
average Americans less than what they pay today. The Democrats want
middle-class taxpayers to believe they won’t feel the pinch of this
initiative, even as their employers are assessed massive new taxes. They
might as well try to argue that up is down. The analysis of the Democrats’
proposal by the Congressional Budget Office shows that it will not reduce
government spending on health care, and that it will substantially increase
the federal deficit—and this despite all the tax increases.
I served in the
U.S. House with a majority of the current 435 representatives, and I am
confident that if given the proper amount of legislative review, they will
not accept the flawed Pelosi plan that is currently stuck in committee. Yet
there is general agreement among Republicans and Democrats that we need
health-care reform to bring costs down. This agreement can be the basis of a
genuine, bipartisan reform, once the current over-reach by Mr. Obama and Mrs.
Pelosi fails. Leaders of both parties can then come together behind
health-care reform that stresses these seven principles:
guided by transparency. We need a system where individuals choose an
integrated plan that adopts the best disease-management practices, as opposed
to fragmented care. Pricing and outcomes data for all tests, treatments and
procedures should be posted on the Internet. Portable electronic health-care
records can reduce paperwork, duplication and errors, while also empowering
consumers to seek the provider that best meets their needs.
interests. Consumers should be financially invested in better health
decisions through health-savings accounts, lower premiums and reduced cost
sharing. If they seek care in cost-effective settings, comply with medical
regimens, preventative care, and lifestyles that reduce the likelihood of chronic
disease, they should share in the savings.
reform. The practice of defensive medicine costs an estimated $100
billion-plus each year, according to the American Academy of Orthopaedic Surgeons, which used a study by economists
Daniel P. Kessler and Mark B. McClellan. No health reform is serious about
reducing costs unless it reduces the costs of frivolous lawsuits.
Congress should establish simple guidelines to make policies more portable,
with more coverage for pre-existing conditions. Reinsurance, high-risk pools,
and other mechanisms can reduce the dangers of adverse risk selection and the
incentive to avoid covering the sick. Individuals should also be able to keep
insurance as they change jobs or states.
•Pooling for small
businesses, the self-employed, and others. All consumers should have equal
opportunity to buy the lowest-cost, highest-quality insurance available.
Individuals should benefit from the economies of scale currently available to
those working for large employers. They should be free to purchase their
health coverage without tax penalty through their employer, church, union,
performance, not activity. Roughly 75% of health-care spending is for the
care of chronic conditions such as heart disease, cancer and diabetes—and
there is little coordination of this care. We can save money and improve
outcomes by using integrated networks of care with rigorous, transparent
outcome measures emphasizing prevention and disease management.
credits. Low-income working Americans without health insurance should get
help in buying private coverage through a refundable tax credit. This is
preferable to building a separate, government-run health-care plan.
These steps would
bring down health-care costs. They would not bankrupt our nation or increase
taxes in the midst of a recession. They are achievable reforms with
bipartisan consensus and public support. All they require is a willingness by the president to slow down and have an
honest discussion with Americans about the real downstream consequences of
his ideas. Let’s start there.
Mr. Jindal is governor of Louisiana.
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(AP) — BATON
- A federal inspector general's report claims the state overbilled the
federal government $7.7 million for care of psychiatric patients at a Mandeville
hospital in the wake of Hurricane Katrina.
Medicaid director, Jerry Phillips, said the state had special permission from
federal officials to bill for the costs, which otherwise would not be allowed
under rules of the government health insurance program.
Phillips said the
state has filed a response and is awaiting word from the federal Center for
Medicare and Medicaid Services, and the regional inspector general.
reimbursement involves alleged inappropriate billings for 119 Southeast
patients ages 22 through 64.
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The Capital Area
Human Services District has been selected as one of eight regional finalists
for a 2009 Council of State Governments Innovations Award for its Behavioral
Health and Primary Care Integration Program.
The Council and
the Southern Legislative Conference made the announcement recently.
The goal of
Capital Area’s Behavioral Health and Primary Care Integration program is to
provide community-based integrated preventive, primary and behavioral health
services for the uninsured and underinsured adult population, according to
the district’s director, Jan Kasofsky.
The care is
delivered through public health units, local Federally Qualified Health
Centers, the Louisiana Primary Care Association, Our Lady of the Lake Regional
mobile clinic and CAHSD’s behavioral health
system of care provides screening, triage, referral and follow up care with a
minimal amount of resource investment, Kasofsky
said. A primary focus of the program is to engage clients who do not
typically seek or utilize traditional health services by building a local
system of care with medical case management, she said.
Regional Innovations Selection Committee will review the applications of the
finalists on Aug. 17 and determine two award winners at the 63rd annual SLC
meeting in Winston-Salem,
the Innovations Awards Program in 1986 to bring greater visibility to exemplary
state programs and practices.
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By Stephen Largen
Area health care
providers who rely heavily on state Medicaid reimbursements are taking
serious steps to tighten their belts as they await word on how severe their
looming state funding cuts will be.
provides in-home care for developmentally disabled participants, is preparing
for a small funding cut from the Louisiana Department of Health and Hospitals
expected to be announced at the end of the month and a deeper cut from the
Louisiana Department of Health and Hospitals in state Medicaid funding
following the first quarter of the fiscal year, which began July 1.
provider relies almost exclusively on Medicaid reimbursements to provide
services and pay staff.
Roma Kidd, the
group's executive director, said she expects around a 4.2 percent budget cut
following a 3.5 percent midyear cut.
But the group is
not waiting for DHH's final word to introduce major
Kidd said several
vacant positions have been eliminated, salaries frozen and overtime pay
ARCO managers, who
normally oversee the work of in-home providers, have also been asked to
provide care in addition to their normal duties.
that we wait to make cost-saving changes compounds the problem for the rest
of the year," Kidd said.
"So we jumped
on it right away just to try to get ahead of it."
Response, the sole emergency ambulance provider for Ouachita Parish, is
taking less drastic steps to prepare for smaller reimbursements.
"It puts us
in a bind because fuel costs and medical supply costs have gone up,"
said operations manager Joel Plummer.
Plummer said in
addition to budget cuts, the state is denying more and more reimbursement
AMR has not had to
slice any jobs — in fact they are hiring more workers — but the company has
switched from buying supplies from national providers to local providers.
Medical Center chief executive Louis Bremer is cautiously optimistic that the
final budget cut for the hospital will be less than originally expected.
know yet what the final impact will be," Bremer said.
it might not be as bad as we originally thought, but we still anticipate
Bremer said the
original estimates for cuts to St. Francis were $5.3 million, but that could
be closer to $3 million to $4 million now.
He said one set of
cuts would be very broad for reimbursements. A second specific cut could
impact the neonatal intensive care unit.
to analyze the impact and how we'll deal with it once the final numbers come
in," he said.
compromise by the Legislature reduced cuts for health care for fiscal year
2009-2010 from $440 million to $280 million. Much of the restoration went to
neonatal intensive care units.
Health care and
higher education suffered deep budget cuts as a result of an expected $1.3
billion shortfall in state revenue.
The two areas of
spending are the most vulnerable to cuts in lean budget years because they
are not constitutionally protected.
captures 49 percent of the state general fund dollars subject to cuts, and 36
percent goes to health and human services. The remaining 15 percent of funds
subject to cuts are divided among public safety (8 percent), general
government (3 percent), business and infrastructure (3 percent), and
environment and natural resources (1 percent).
"None of us
are happy with the cuts, but we have to live within our means," said
House Health and Welfare Committee Chairman Kay Katz, R-Monroe.
Katz said the
state must do something to address health-care funding during the next few
years, when revenue is not expected to improve, one-time monies like those
from the federal stimulus package will run out, and deeper cuts are almost
look at everything across the board," she said.
But Katz said any
solution must wait for any potential overhaul by the federal government, as
is being pushed by President Obama, before moving forward.
"Most of us
are watching to see what Washington
does," she said.
meantime we're telling everybody to look forward to the budget years that are
Kidd and other
leaders of area health-care providers all said they supported the Legislature
making constitutional changes that would make more areas of spending eligible
for the budget scalpel.
budgeting process needs to be amended," Kidd said.
long-term solutions if they're willing to actually address the issue."
would likely have to come from a constitutional convention called by the
Legislature, which would require a two-thirds vote of each legislative house.
legislators called for such a move in this year's session, but a convention
did not materialize.
In the meantime,
providers are waiting for the budget-cut dust to settle and expressing
concern about the future.
"We can't cut
anything more than we've already cut," Kidd said.
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Why wait on
question that President Barack Obama is quite right to ask. And neither
Democrats nor Republicans on Capitol Hill, who’ve talked this issue to a
near-death experience, seem to have a good answer.
Will the varying
versions of the bill put forward by Senate and House Democrats be bad for the
economy? We doubt it. What’s bad for the economy is
people being locked into jobs they can’t leave because health coverage would
go away. What’s bad for the economy are businesses
forced to drop insurance because premiums are out of control.
deficits inherited by the Obama administration — and exacerbated by stimulus
bills aimed at combating an incipient depression — are going to take a long
time to pay off. Every American can figure that out. Both higher taxes and
significant efficiencies in health care are part of the answer. We pray for
cutting operations of government to save money, but that’s not popular
current bills don’t do enough to rein in health-care costs. But the reality
is that reining in costs isn’t politically popular, and neither fumbling
Democrats nor their opportunistic Republican critics are going to espouse
real expenditure cuts openly. Those will occur over time, as any new system
starts to ratchet down on costs over a period of years. Not months or weeks,
Nor is the
continuing large-scale failure of today’s system to provide insurance to
those who need it. America’s
economic productivity depends on its people. Our people are our economy. To
leave the uninsured behind is a recipe for stagnation in the future. This is
a huge question that critics of the Democrats’ plans aren’t facing up to;
wellness programs and the like don’t constitute an alternative in this real
bills have some good ideas in them, including community rating — so that
individuals aren’t priced out of insurance because of the state of their
health — and banning denial of insurance based on pre-existing conditions.
The health insurance lobby has gone along with some reforms.
However, and this
is what the president is exactly correct on, any deal can come undone very
quickly when influential special interests — including doctors, insurers,
hospitals — see financial advantage or loss.
We urge the
president and the Congress to strike compromises and move legislation this
year. But all concerned should be fully prepared for fixes, probably
substantial fixes, for parts of the Obama plan that don’t work as advertised.
[BACK TO TOP]
I support the
efforts to guarantee medical coverage for all Americans. This is a right, but
it does not have to be gold-plated one that serves mainly the insurance,
medical and pharmaceutical industries and heaps great deficits on future
We Americans like
to have choices. I do not agree that a public option for a basic health care
coverage plan threatens these industrial interests. Many Americans will wish
to enhance their health security by purchasing more sophisticated products
and plans available in the private sector.
The private sector
will find ways to make profits in an environment of national health care.
They have managed to find ways of making profits in every other conceivable
environment over the last 100 years.
President Barack Obama's efforts to guarantee medical coverage for all of us
without having to pay protection money to the insurance, medical and
That is what the
2008 election was about, and it's what the elections of 2010 and 2012 will be
[BACK TO TOP]
I would like to
express my disagreement with Pamela Behan’s July 15 letter asserting that it
would be a tragedy if President Barack Obama’s current health-care initiative
implies that it is the “powerful profit-making insurance and provider
corporations” opposing more government control of the health-care sector.
However, I believe
opposition to President Obama’s plan is based on a more grass-roots
recognition of the waste, inefficiency and fraud inherent in virtually all
Does anyone want
our hospitals to provide the same efficient, quality service that we receive
at the Louisiana Office of Motor Vehicles? When we think back to the
mind-boggling incompetence of FEMA, do we really want to place more of our
health-care system under the control of indifferent bureaucrats?
blithely accept government’s promise to deliver wonderful, low-cost medical
care, shouldn’t we look at government’s actual track record, for example
Everything I read
indicates Medicare is a financial time bomb (e.g., $86 trillion in unfunded
liabilities), and Congress has shown absolutely no disposition to craft a
Why in the world
should we give the government even greater control over the health-care
sector when it has already proved itself to be an utterly irresponsible
If we want to
improve health care in the United
States, the first step is to decisively
reject Obamacare. Then we need to systematically
eliminate existing state and federal regulations that inhibit the free choice
provided to consumers by market-oriented solutions.
[BACK TO TOP]
a poor mentor on health
Re: "Jindal blasts Demo health plan: He says it would kill
private insurance," Page A2, July 21.
What Gov. Bobby Jindal has done for Louisiana health care would be disastrous
for the country.
Louisiana has reclaimed its status as the least
healthy state in the country, according to the 2008 America's Health Rankings
conducted by United Health Foundation.
Last year, Louisiana ranked 49th.
Since 1990, Louisiana has ranked
50th every year except in 2003, 2005 and 2007. (Jindal
has been a presence either at a state level or a federal level in health care
issues for at least the past 14 years.)
The report cited
reasons for Louisiana's
status: a high prevalence of obesity, a high percentage of children in
poverty and a high rate of uninsured residents.
Since Jindal became involved in our health care issues, we have
seen little or no improvement in prevention or treatment of obesity, no
reduction in the number of Louisiana
children living in poverty and increased numbers of uninsured people as well
as increased difficulty in patients' access to health-care providers.
Once again, we're
first in the worst and last in the best . . . and Jindal
expects the nation to listen to his lectures about health care management?
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Fran Lawless, MHA
Re: "Sex ed urged in N.O. schools," Metro, July 21.
article on HIV care simplifies a complex issue and diverts attention from
challenges affecting people living with HIV and AIDS in New Orleans. The article captures the need
for education and prevention, but focuses on superficial issues like
In glossing over
the intricacies in the complex system of care, you failed to describe how
people can access life-saving programs.
contracting delays were an issue last year, but these have been resolved, and
such delays do not necessarily prevent patients from getting services.
Changing federal requirements have shifted toward more medically focused
agencies this presents a critical challenge. But the true challenge is not
for the agencies to remain in business, but for the city to provide services
for people living with HIV and AIDS. Agencies that depend on one funding
stream are ill-equipped to survive the shift in federal legislation as it is
moves towards universal health care.
dramatically reduced processing delays. These changes are often overlooked.
Our community needs education and services, not conflict and division.
Fran Lawless, MHA
Office of Health
Policy & AIDS Funding
[BACK TO TOP]
Shreveport Times | 07.24.09
The Associated Press
BATON ROUGE — Louisiana's health
department is starting its annual back-to-school campaign to encourage enrollment
in public health insurance programs for children.
drive lets parents know about coverage available to uninsured children
through the Louisiana Children's Health Insurance Program, known as LaCHIP, and other Medicaid programs.
LaCHIP representatives will show up at schools,
stores, churches and community centers to distribute information.
income at up to twice the federal poverty level — about $44,100 a year for a
family of four — can get free children's health insurance coverage through LaCHIP. Families with income between 200 percent and 250
percent of the federal poverty level can purchase health care coverage for
their children at a reduced cost through the LaCHIP
is available at www.lachip.org or by calling 1-877-2LaCHIP (1-877-252-2447).
is available at www.lachip.org or by calling 1-877-2LaCHIP (1-877-252-2447).
[BACK TO TOP]
By William Johnson
The emergency room
at the new South Campus of Opelousas General Health System opens today in an
effort to improve treatment options and reduce wait times.
another option to serve all of our communities," OGHS President Gerald Fornoff said. "By reopening this emergency room, we
will make access to urgent care that much easier for everyone."
The emergency room
at the former Doctors' Hospital, which OGHS purchased and renamed as its
South Campus earlier this year, has been closed for several months during the
Fornoff said it will now be open 24 hours a day,
seven days a week as a fully functional emergency room but with a difference.
encouraging people to use it for walk-in traffic," Fornoff
While it will be
fully staffed with emergency room doctors and nurses, he said the facility is
designed to accommodate people with problems such as sore throats, fevers,
non-critical cuts that may require a few stitches and such.
hopefully allow us to use the emergency department at the main campus for
critical emergency services," Fornoff said.
"All the ambulance services have agreed to direct their traffic to the
main campus. This will hopefully decrease our wait time at both
Should what a
patient believes is a minor injury need further
treatment, Fornoff said ambulances will be
available to rush them to the main campus.
As for the rest of
the South Campus, Fornoff said work is coming along
well, and new departments are opening or relocating on a regular basis.
center has moved, the senior psych facility is now
in operation. Pain management and radiology are there. We hope to open our
long-term acute care facility in August," Fornoff
said. "It is a pretty busy campus."
John Armand, head
of emergency services at both campuses, said a second emergency room is
He said the number
of emergency room visits is close to double what it was only a few years ago.
"We get about
30 ambulances a day," Armand said.
He said that means
the main 43-bed emergency room is currently overwhelmed with everything from
major trauma cases to people who simply need to see a doctor but don't have a
By treating the
less severe cases at the South Campus ER, the hospital hopes to help relieve
overcrowding at the main campus.
While the emphasis
of the new ER will be on minor care, he said the facility is a fully-staffed,
14-bed emergency room.
X-rays, lab work, a CT machine," Armand said. "The lab is
[BACK TO TOP]
by Erica Werner,
The Associated Press
AP file photo
President Barack Obama is continuing to push for a
health care overhaul this year. He is scheduled to meet today with Senate
leaders who yesterday said there would be no final vote on the matter until
the fall, after the deadline Obama initially preferred.
WASHINGTON (AP) --
President Barack Obama is likening overhaul of the nation's health care
system to one of the government's greatest triumphs: the NASA program that
landed astronauts on the moon 40 years ago.
initiative is to be anywhere near as successful, it will be by small steps
taken in a divided Congress right now. No giant leaps are in sight.
on Thursday demonstrated the challenges anew, formally killing off plans to
vote on a health bill before Congress goes on its August recess. That broke a
deadline Obama had set.
on saying, 'Wow, this is really hard. Why are you taking it on?' You know, America doesn't shirk from a challenge,"
Obama said during a town hall meeting in Ohio.
President John F. Kennedy's challenge to land a man on the moon, Obama said,
"There were times where people said, 'Oh, this is foolish, this is
Now may be one of
those times in Obama's young presidency.
But the president
played down the announcement from Senate Majority Leader Harry Reid, D-Nev., that action on the Senate floor would be delayed
until September at the earliest.
OK," the president said. "I just want people to keep on working.
Just keep working."
legislation that would, for the first time, require all Americans to be
insured. A new government insurance program would compete with private
insurers, and insurance companies would be barred from excluding people with
pre-existing conditions. The goals are to hold down costs and extend coverage
to most of the 50 million uninsured. The price tag: $1 trillion-plus over a
Obama planned to
meet in the Oval Office on Friday with Reid and Senate Finance Committee
Chairman Max Baucus, D-Mont., who is leading a group of a half-dozen
Democratic and Republican senators laboring to produce a bipartisan bill.
announcing the Senate vote would be delayed, Reid said the Finance Committee
would act on its portion of the bill before lawmakers' monthlong
break after the first week of August.
It can't be fast
enough for some of the Senate's more liberal Democrats, who are chafing over
the repeated delays by the Finance Committee and grousing that they can't be
expected to support whatever legislation the committee produces.
negotiators are looking at a bill that would not go far enough for some
Democrats in embracing some liberal goals, like the new public insurance
plan, that were included in legislation passed by the Senate's health
committee. Finance Committee members are looking at nonprofit co-ops instead.
The two measures would have to be merged.
Committee keeps dragging their feet and dragging their feet and dragging
their feet. It's time for them to fish or cut bait," Sen. Tom Harkin,
D-Iowa, a member of the health committee, said in a conference call with Iowa reporters.
"The people of America
voted for Barack Obama last year to lead this country and make changes."
Democrats in the House are threatening the schedule there, too. Energy and
Commerce Committee Chairman Henry Waxman, D-Calif.,
has postponed work on the legislation since Monday while he negotiates with
seven Democrats who are members of a group of fiscal conservatives called the
The group, which
wants more cost-cutting in the House bill that has already passed two other
committees, spent hours Thursday meeting with Waxman, House Democratic
leaders and White House officials including chief of staff Rahm Emanuel. At the end of the day, one of the Blue
Dogs, Rep. Baron Hill, D-Ind., said that he'd heard
some encouraging ideas, though he declined to give details.
from various parts of the country are also asking for changes to address
regional discrepancies in Medicare reimbursement rates. Democratic leaders
met into the night Thursday with a group of them.
Nancy Pelosi, D-Calif., expressed confidence in the
ultimate outcome. "We will take the bill to the floor when it is ready,
and when it is ready, we will have the votes to pass it," she said.
Pelosi spoke after
a contentious leadership meeting where Rep. Jim Clyburn of South Carolina, the third-ranking House
Democrat, called for canceling the August recess if a bill isn't passed.
Pelosi didn't rule that out.
afraid of August," she said. "It's a month."
say it's all part of the legislative process, but Republicans are latching on
to the disarray in delight. The Republican National Committee has taken to
issuing news releases headlined "Chaos" that highlight
disagreements within the Democrats' ranks.
Hospitals React to Proposal To Revamp Medicare
Kaiser Health News | 07.24.09
In an effort to
trim medical costs, President Barack Obama is trying to strengthen the role
of an independent commission to determine how much Medicare pays doctors and
Kaiser Health News
reports on the reaction of certain hospitals including many model systems
that are critical of the commission: These facilities "pride themselves
on holding down costs and improving quality and are fed up with how slowly
Congress has moved to change the payment system." KHN reports that the
hospital industry "said creating a super MedPAC
would unfairly usurp legislative power" and "the Association of
American Medical Colleges, which represents teaching hospitals, had a similar
view." Meanwhile, "CHRISTUS Health, a Catholic health system with
more than 50 hospitals largely in Texas and Louisiana, supports
the Obama strategy."
"Setting Medicare payment rates is
traditionally a process filled with political squabbling as members of
Congress look to protect dollars going to their local hospitals and doctors
rather than promote fees and payment plans that drive efficiency in the
health system. The Obama administration plan is to establish an agency called
the Independent Medicare Advisory Council that would make recommendations on
Medicare fees to the president. For Congress to overturn this council's
recommendations, lawmakers would have to pass a joint resolution within a
month. It would work similarly to the Defense Base Closure and Realignment
Commission, which was formed to reduce the political infighting involved in
closing military bases" (Galewitz, 7/24).
Post-Bulletin reports: "Mayo Clinic is finding health-care reform
legislation in Washington
easier to swallow now that some sugar has been added: The proposed creation
of a council that would pay more for efficient, value-driven health
care." The Mayo Clinic initially criticized the idea and signed a letter
to Congress that expressed its "significant concerns" about health
reform legislation because the plan was too similar to the Medicare system.
However, Mayo changed its' stance and offered support for an Independent
Medicare Advisory Council: "Mayo's Health Policy
Center released the
statement on its blog Tuesday applauding the proposed creation of the IMAC
that would move Medicare to a 'value-based payment' model. One of Mayo's
complaints about health reform was that it didn't sufficiently reward health
providers such as Mayo that provide quality health care at a low price,
instead rewarding those who order the most procedures" (Klein, 7/23).
[BACK TO TOP]
The New York Times | 07.24.09
By RONI CARYN RABIN
Women who undergo hysterectomies often have both ovaries
removed along with the uterus in order to prevent ovarian cancer. But a new
study suggests ovary removal may increase the risk of another seemingly
unrelated ailment, lung cancer.
of Montreal scientists
stumbled onto the connection while investigating the relationship between
lung cancer and hormones in women. They found no relationship between
hormonal factors like menstruation patterns, child-bearing or breast-feeding
histories and the risk of lung cancer. The researchers did, however, discover
that women whose menopause had been induced medically were at 1.92 times greater risk of developing lung cancer than women
who had experienced natural menopause.
“We were surprised — we had no prior expectation of this
finding,” said Anita Koushik, a researcher at the University of Montreal’s Department of Social and
Preventive Medicine and the first author of the study, published online in
May in The International Journal of Cancer. “Aside from the fact that smoking
increases your risk of lung cancer, the results of this study suggest that
having a non-natural menopause contributes to an almost doubling of the
risk.” She noted, though, that the findings could have occurred by chance.
The vast majority of women who had experienced a
non-natural menopause had had both ovaries surgically removed, she added.
While smoking is the leading cause of lung cancer, other
factors may play a role in enhancing the impact of the carcinogens in
tobacco, Dr. Koushik said. In women, these factors
could be hormonal. Both normal and cancerous lung tissue express estrogen
receptors and may be influenced by levels of the hormone in the body, Dr. Koushik said. The patterns of expression are different in
men and in women.
Medically induced menopause usually occurs at a younger
age than natural menopause. Surgical menopause results in a sudden drop in
estrogen levels, compared with the more gradual decline in hormone levels that occurs with natural menopause. Dr. Koushik suggested the increased lung cancer risk may be
linked to the impact of plummeting hormone levels.
In the study, the scientists examined data on 422 women
diagnosed with lung cancer in the greater Montreal area in 1996 and 1997 and compared
them with 577 randomly selected control subjects. The women were asked about
a variety of hormone-related factors, including when they got their first
periods, how many children they had, whether they breast-fed their children
and whether they had gone through menopause. The researchers also gathered
detailed information about smoking, occupational history, education and
The report is not the first to link ovary removal with an
increased risk of lung cancer. A recent analysis of data from the Nurses’
Health Study, published in the journal Obstetrics and Gynecology in May,
reported that women who had had hysterectomies but kept their ovaries lived
longer than women who had had the procedure but whose ovaries were removed.
While those who had their ovaries removed were less likely
to develop breast cancer and virtually eliminated their risk of ovarian cancer,
they were more prone to heart disease and were at greater risk for other
kinds of cancer, including a doubling of the risk for lung cancer among those
women who never used hormone therapy.
[BACK TO TOP]
New Orleans CityBusiness |
by The Associated
SHAKER HEIGHTS, Ohio — President Barack Obama stepped up his
us-against-them pitch for overhauling health care today, saying the American
people need it and must overcome resistance from opponents in Washington,
whom he described vaguely as naysayers and skeptics.
be coming too soon for some in Washington,"
Obama told hundreds who packed a high school gym in the Shaker
Heights suburb of Cleveland.
"But it's not soon enough for the American people."
The president took
a few swipes at Republican critics. But his biggest obstacles are fellow
Democrats who control the House and Senate and are moving slowly on his call
for widespread changes to U.S.
said today they could not meet Obama's deadline for a vote before the August
recess. And a key House committee is struggling to placate moderate Democrats
worried about the plan's costs.
"We just heard
today that, well, we may not be able to get the bill out of the Senate by the
end of August or the beginning of August," Obama said. "That's OK.
I just want people to keep on working. Just keep working."
The president said
his critics were urging delay so the overhaul would stall and they could
avoid politically difficult votes.
delay in Washington
occurs because people don't want to do anything that they think might be
controversial," Obama said, citing the challenges lawmakers faced when
creating Medicare and Social Security.
He ratcheted up
the rhetoric at the town hall forum here, likening the bid to overhaul health
care to the manned missions to the moon 40 years ago.
"Going to the
moon was controversial. But at some point, if we're going to move this
country forward we can't be afraid to change, especially a system that we
know is broken. We've got to get it done and we've got to get it done
In response to a
question at the town hall-style event, Obama jumped at a chance to tell the
people in audience — and anyone else listening — how they can help him get a
bill to his desk. He advised people to lobby senators and representatives for
health care reform by telling their own personal stories of concern.
Obama said members
of Congress need to hear from the people because "frankly, they are
hearing from the other side."
folks who are out there saying, 'We can't afford this, this is socialism,
this will lead to government-run health care,' all of the folks who are getting
ginned up on talk radio, and some of these cable news shows, you know, I have
to say, they have an effect on members of Congress."
criticism that his plan is too big and moving too fast, saying most of the
changes would be phased in over several years.
"Now, is it
too much? I don't think it's too much," he said. "It's only too
much by the standards of Washington
Starting with a
news conference Wednesday night in Washington,
Obama increasingly is pitching his remarks directly to American voters,
hoping they will pressure reluctant lawmakers.
those who see our failure to address stubborn problems as a sign that our
best days are behind us," Obama said before taking audience questions.
He said he believes this generation is ready "to defy the skeptics and
His plan would
insure more Americans, partly through government subsidies; provide a
government-run option to compete with private insurers; require large
employers to contribute to health coverage one way or another; and control
Medicaid costs by empowering an executive branch agency to set reimbursement
rates for doctors and hospitals, subject to a congressional veto.
For all his
efforts, which have included public statements each weekday for the past few
weeks, Republican lawmakers and other critics sense
momentum building against Obama's plan. They particularly cite nonpartisan
cost projections that have not predicted the savings the White House
"What I heard
last night was a president that seems somewhat frustrated that people do not
understand what this government health care plan is all about," Rep.
Eric Cantor of Virginia, the House Republican whip, said today on NBC's
"Today" show. "I think people still have a lot of questions about
what a (new) health care plan means for them and their families."
The number of
Americans who disapprove of the president's health care plan has jumped to 43
percent, compared with 28 percent in April, according to the latest
Associated Press-GfK poll. Obama still holds a
strong hand, with most Americans favorable to him in general and half
supporting his health care agenda.
But it's the
negative trend in polls that worries his supporters, and some want the
president to be even more forceful and visible in pushing his top domestic
great communicator," said Rep. Jim Cooper of Tennessee, a moderate Democrat who wants
lower costs but supports the overall thrust of Obama's efforts. "If
anybody can explain this, he can."
"The White House
needs to assert more authority," said Cooper, who has focused on health
care for years. "I'll be relieved when they take over the marketing of
this, because Congress has done a terrible job."
It's hard for
Obama, or anyone, to succinctly advocate health care changes just now because
multiple versions are slowly moving through the House and Senate.
"The case has
not been made" for a particular version because the eventual legislation
is unclear, said Rep. Artur Davis, D-Ala.
[BACK TO TOP]
The New York Times | 07.23.09
By KEVIN SACK
SNELLVILLE, Ga. —
As Craig Brown watched President Obama’s news conference on Wednesday night
on his TiVo-equipped television, he kept hitting the pause button so he could
throw questions at the image frozen on the screen.
How much will this health care plan really cost, he asked. How can
we cover nearly everybody without higher taxes or debt? Who is going to
decide which treatments are allowed? Why cannot they just get rid of the
waste without changing the whole system?
Like many in the
country, Mr. Brown, a 36-year-old father of four who lives in an Atlanta suburb, has grown increasingly anxious about Washington’s efforts
to reconfigure health care and what it may mean for his middle-class family.
Although he and his wife, Judith, supported John McCain in the presidential
race, they find Mr. Obama an earnest and compelling pitchman. But they remain
frustrated by the lack of available detail about his plan’s contours and
They say they feel
they are being asked to buy on spec from a government they do not trust. And
they have lots of questions.
“The bottom line
is there are so many unknowns,” said Ms. Brown, 35, who works part time at
her church and cares for her young children. “What we do know is there is
going to be more government control, and with more control you’re going to
have fewer choices. It’s an innate part of being American to have those
A similar unease
was apparent in three other living rooms where families gathered to watch the
news conference. An affluent small-business owner from near Chicago, a
middle-class manager from Denver, and an
uninsured worker from Cleveland
each expressed skepticism that change would improve their lots.
Although she may
well benefit from Mr. Obama’s plan to subsidize health insurance for the
working poor, Rowena Ventura, the uninsured worker from Cleveland, wondered whether she could
afford it. “I’m worried because they’re talking about forcing people to buy
insurance,” said Ms. Ventura, a registered Democrat and part-time health care
worker. “You just can’t ask any more of me. You just can’t.”
Ms. Ventura, 44,
who also attends community college, has moved her ailing mother into the
living room of the house she shares with her disabled husband. She said she
recently discovered a lump on her left foot but cannot afford to see a doctor
about it. Yet she is cynical about Mr. Obama’s prescription.
“You see,” she
said, gesturing at Mr. Obama on the television, “he’s saying he wants to
continue private insurance, but then he says they’re part of the problem.
Well, which is it? It’s just ridiculous.”
Dean Raschke, a McCain voter who owns two Chicago-area
businesses, one providing roadside assistance and
the other making debit cards, said he worried that Washington would end up taxing the health
benefits he provides to his 50 employees. He said he also feared that
Congress would raise his income taxes to pay for the plan, although his
earnings are well below the $1-million-a-year threshold now being considered.
“I have very
conflicted emotions because I do want to help people who aren’t as fortunate
as we are,” said Mr. Raschke, 38, watching the news
conference with his wife, Jill. “But I have a big issue about what this
health care plan would do to small businesses like mine that already have a
health care plan. I’m afraid that people could be unintentionally harmed.”
Recent polls have
detected a modest slippage in public support for the kinds of changes being
considered in Congress, and in Mr. Obama’s handling of health care. The
president has made the case for his plan at scripted events each day this
week, including at a town-hall-style meeting in Cleveland on Thursday.
acknowledged the spectrum of concerns during Wednesday’s news conference.
“I understand that
people are feeling uncertain about this,” he said. “They feel anxious, partly
because we’ve just become so cynical about what government can accomplish.”
He said he understood that people might prefer the devil they know.
president’s expression of empathy provided scant comfort to the Browns. They
still did not feel they were getting straight talk, as when Mr. Obama
responded to a question about what Americans would have to sacrifice.
“He said they’re
going to have to give up paying for things they don’t need, and that was an
awesome answer for a politician,” Mr. Brown said sardonically. “You mean I
don’t have to give up anything I already have?”
The Browns are
Jamaican immigrants who met in college in Florida. Mr. Brown gained citizenship in
1999; his wife expects to do so next year. The family is insured through his
job at a family-owned trophy shop, where he earns about $38,000 a year.
Mr. Brown said he
realized that his escalating insurance premiums, which have doubled since
2006, had suppressed his wages. He noted that he and his wife were still
struggling to pay off $3,000 in uncovered medical expenses from the birth of
their youngest child.
But the Browns
said Mr. Obama and the Democrats had not convinced them of the need for
radical change. They said the notion of establishing a new government health
plan to compete against private insurers seemed un-American. They questioned
the wisdom and fairness of taxing the rich. And they said individuals should
bear more responsibility for staying healthy.
“I know the system
is not perfect, but I’m not completely convinced it’s broken,” Mr. Brown
said. “And even if it’s broken, I’m not sure the government is the solution.”
Unlike the Browns,
Liz Wessen, 32, a manager for a market research
firm in Denver,
supported Mr. Obama in November. But that good will does not negate her nervousness
about the money being spent in Washington.
“My only concern
is that this comes on the heels of the stimulus package,” Ms. Wessen said from her home in the Highlands
neighborhood. “Where is this money supposed to be coming from? I’m not sure
if this is the best time to fix another enormous problem.”
president, she said she was pleased to hear that the Democrats wanted to
prevent insurers from denying coverage to those with pre-existing conditions
and to allow those who change jobs to hold on to their coverage. But she said
she wanted more specifics and wished that Mr. Obama would dictate terms to
Congress rather than merely prod lawmakers to act.
“I think the press
conference was more convincing people of his motives than it was to actually
explain the program,” Ms. Wessen said. “I expected
it to be more.”
Karen Ann Cullotta contributed reporting from Gilberts, Ill., Dan Frosch
from Denver and Christopher Maag from Cleveland.
[BACK TO TOP]
By Joe Carlson
As the Senate
Finance Committee debates whether to include stricter rules on charity care
provided by not-for-profit hospitals in a healthcare reform law, a new study
finds that 95% of hospitals in one state would have failed similar
requirements proposed by the committee two years ago.
The study of Maryland hospitals'
provision of charity care, published in the journal Health Affairs, finds
that only two of the state's 45 hospitals provided charity care that was
equivalent to 5% of their annual expenditures. In 2007, Republican Senate
Finance Committee staff members proposed establishing a “bright line” test
under which not-for-profit hospitals would have to earn their tax-exempt
status by providing free care equivalent to 5% of either expenditures or net
revenue. Insiders say the proposal is still an item of active negotiation in
the committee, which has yet to release its version of a reform bill.
The Health Affairs
article stands in contrast to other published reports that found most
not-for-profit hospitals would easily meet the 5% bright line test. The new
journal article says the senators are considering a narrow definition of
charity care that would exclude uncollected debt and shortfalls in government
reimbursements from the definition of charity care.
[BACK TO TOP]
The New York Times | 07.23.09
By PAULINE W.
Like most doctors
I know, every time I see a patient in clinic, questions scroll down my mind’s
eye like credits at the end of a movie. Over the years, I have whittled down
the number of questions, from the exhausting repertoire I memorized as a
medical student to the streamlined clinical checklist I use today.
Some of the
questions I ask are generic: What brings you here today? What medications are
you taking? Some are specialized: Was your liver transplant done “piggy
back”? Have you had any episodes of rejection? But a few of the questions
have nothing to do with the work I do or the care I am trained to offer.
Rather, they are questions about being well and preventing disease: Are you
exercising? Do you smoke? Have you had a mammogram?
For years I
believed that this last group of questions was a clinician’s equivalent of
performing a good deed. After all, discussing such topics could help a
patient avoid the kind of potentially preventable diseases I had seen other
patients suffer from. And since I knew that countless health care resources
had been depleted while caring for those patients, I also couldn’t help but
feel as if bringing up these questions with patients, however briefly, was
like contributing to some greater public good. Any kind of preventive care
that I could offer as a doctor, I believed, had to save money.
But it turns out
that at least one of my assumptions — that I could help to save money — was
erroneous. Sort of.
In the enormous
pie that makes up health care expenditures, only 1 to 3 percent can be
attributed to preventive interventions. The miniscule size of this share is
due in part to the fact that very few clinical preventive services actually
result in savings. In fact, the data for savings is so lackluster that some
economists have argued that it is less cost-effective to prevent illness than
it is to simply let people get sick. Other economists have taken that
argument even further, contending that preventive care adds to societal costs
by extending lives and thus the time we must care for people (though one
would hope that costly treatments might result in the same “problem”).
But according to
Dr. Steven H. Woolf, a professor of family medicine at the Virginia Commonwealth
University in Richmond and a leading expert on preventive
care, all of these assertions are premised on the wrong question. In a
commentary published earlier this year in The Journal of the American Medical
Association, Dr. Woolf maintains that the economic argument for disease
prevention rests not on how much people save but on how much value they gain
for each dollar spent.
“Health is a good,
like food or gas,” Dr. Woolf said. “When you go to a grocery store or gas up
a car, you don’t ask whether it will produce a net savings. You don’t expect
the cashier to give you money back. The more appropriate question is whether
we are getting good value for the money we’re spending.”
To help determine
value, Dr. Woolf utilizes a unit of measurement — the Quality Adjusted Life
Year, or QALY. QALY has been used historically in studies to assess the
relative value of different interventions, with each intervention carrying a
“price tag” or a rough estimate of the cost to save a comparable year of
Viewed in terms of
QALY value then, there are indeed some clinical preventive services that
confer few health benefits for the amount of money spent. But several
preventive interventions turn out to be downright bargains. Childhood
immunizations and smoking cessation cost so little per QALY (less than $5,000
per QALY gained) that they may actually end up yielding net savings. Other
preventive services, like taking aspirin daily if you are at high risk for
cardiovascular disease, cost roughly a third to a fifth of more expensive
disease interventions that are now routinely paid for, like angioplasty, the
procedure that widens or “roto-rooters” narrowed
There is also
value added beyond these cost efficiency calculations. Last fall, the
National Commission on Prevention Priorities found that by increasing just
five preventive services, clinicians could save more than 100,000 lives per
year. These services include breast cancer screening in women 40 and older,
flu immunizations in adults 50 and over, colorectal cancer screening in
adults 50 and over, smoking cessation counseling, and a daily aspirin in high
risk cardiovascular patients.
Much of the
responsibility of these preventive services currently rests on clinicians’
shoulders. This focus has contributed in part to the poor data regarding preventive
medicine’s results, since relying on clinical settings alone is a relatively
inefficient way of changing health behaviors and preventing illness. “Putting
it all on doctors and the clinical setting is not a powerful formula,” Dr.
Woolf noted. “What is unique about prevention is that so much is happening
outside of the clinical setting. Good preventive care requires breaking down
the boundaries and getting beyond the constraints of a doctor’s appointment.
It requires thinking more broadly in terms of a community-based approach.”
It is in this way
that preventive medicine offers an additional public good: the potential to
strengthen and broaden how we define the patient-doctor relationship.
To that end, Dr.
Woolf and his colleagues recently spearheaded a program using electronic
medical records to link nine physician practices to several community
services that offered telephone and group counseling services. “If their
patients who smoked were interested,” Dr. Woolf said, “doctors could click a
button and auto-enroll the patient with the state’s quit smoking line. Two
days later, those patients would receive a call to enroll.” Dr. Woolf’s group
created similar electronic links to Weight Watchers and to Alcoholics
These quick and
reliable connections between physicians and community-based programs resulted
in significant improvements for patients and a higher rate of referrals from
doctors. “It’s not feasible for doctors to offer intensive smoking cessation
counseling in 15 minutes and to be there through the whole process,” Dr.
Woolf said. “The barriers to change are at home, work,
school, the store. That’s where people need help with behavior change. The
last physician or emergency room visit only goes so far.” Such connections
are even more critical for patients with chronic diseases, since these
individuals often have complicated care plans and can benefit tremendously
from increased coordination with preventive and caregiving
resources in the community.
All of these
links, however, require additional outside support, at least initially. “What
is needed is a third party,” Dr. Woolf said, “individuals apart from the busy
physicians or busy community organizations who can work out the logistical
details. Once you have done that, it takes literally seconds to connect the
dots for patients.”
But as long as the
focus is on savings and not on value, such support is not likely to be
forthcoming, and preventive care stands to remain a nearly negligible part of
our health care expenditures.
and wellness have been pushed aside in the health care reform debate partly
because we have been focused on net savings, not value,” Dr. Woolf observed.
“That analysis has not been favorable with preventive medicine, so people
continue to get highly expensive studies and procedures that are ineffective,
even though we have cost-effective public health interventions at our
“It’s as if our
house is going up in flames,” Dr. Woolf continued. “There is one room, filled
with explosives, that hasn’t yet caught on fire. But people are hesitating to
put out the fire because they believe they don’t have the data.”
Join the discussion
on the Well blog, “The Value of Prevention.”
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The New York Times | 07.23.09
By SARAH ARNQUIST
The nation’s top
public health officials are alerting doctors that swine flu may cause
seizures, after four children were hospitalized in Texas for neurological complications.
All four children
fully recovered without complications after being treated at a Dallas hospital,
according to a report released Thursday by the Centers for Disease Control
does not surprise doctors accustomed to seeing complications in the brain
caused by the seasonal flu viruses that circulate every year.
to be expected given that so far this novel H1N1 flu is behaving like the
seasonal flu that we are familiar with,” said Dr. Anne Moscona,
a professor of pediatrics and microbiology at the Weill Cornell Medical
flu-related brain complications are more common in children than adults and
swine flu seems to infect children more often than adults, public health
experts expect to see more cases of children who develop swine-flu-related
neurological complications as the pandemic continues.
Parents should not
be alarmed, Dr. Moscona said, but if they notice a
change in their child’s personality or behavior, like increased irritability
or memory problems, soon after the onset of a respiratory illness, it might
be swine-flu related and parents should alert their child’s doctor as early
In the four
children described in the disease centers’ report, neurological problems,
including seizures, confusion and delirium, followed the onset of respiratory
symptoms within one to four days. The complications were less severe than
those previously described in the medical literature as associated with
seasonal flu, according to the report.
complications in children are among the most serious side effects of
influenza, said Dr. Andrew T. Pavia, chief of pediatric infectious diseases
at the University
of Utah. Milder
complications like seizures or brain swelling are moderately common, whereas
death occurs in only a couple of cases each year, Dr. Pavia said.
Some flu strains
are worse than others when it comes to causing brain-related complications,
and scientists do not yet know how bad H1N1 will be, he said.
Most swine flu
cases so far have been fairly mild, but many questions remain about the
severe cases, like what complications are most likely and who is most likely
to develop them, he said.
“The usefulness of
this case report is that many doctors who deal with outpatient flu only may
never have seen a case with neurological complications,” Dr. Pavia said.
“It’s an important reminder that flu can present as seizures or as
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U.S. researchers have linked free radicals
inhaled as an infant to lung disease as an adult.
profiling techniques, the researchers found the genes of infants breathing in
environmentally persistent free radicals present in airborne ultra fine
particulate matter produced a number of proteins -- including one associated
with chronic obstructive pulmonary disease and steroid-resistant asthma. The
exposure to ultra fine air pollution also caused proteins to misfold, rendering them dysfunctional.
"It is no
surprise that elevations in airborne particulate matter are associated with
increased hospital admissions for respiratory symptoms including asthma
exacerbations," study leader Stephania Cormier
of Louisiana State
in New Orleans
said in a statement. "What has come as a surprise is that early exposure
to elevated levels of particulate matter elicits long-term effects on lung
function and lung development in children."
The study findings
were presented at the 11th International Congress on Combustion By-Products
and Their Health Effects held in Research
Triangle Park, N.C.
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The New York Times | 07.23.09
By MATTHEW L. WALD
— A global shortage of a radioactive drug crucial to tests for cardiac
disease, cancer and kidney function in children is emerging because two aging
nuclear reactors that provide most of the world’s supply are shut for
The 51-year-old reactor in Ontario, Canada,
that produces most of this drug, a radioisotope, has been shut since May 14
because of safety problems, and it will stay shut through the end of the
year, at least.
Some experts fear it will never reopen. The isotope,
technetium-99m, is used in more than 40,000 medical procedures a day in the United States.
Loss of the Ontario
reactor created a shortage over the last few weeks. But last Saturday a Dutch
reactor that is the other major supplier also closed for a month.
The last of the material it produced is now reaching
hospitals and doctors’ offices. The Dutch reactor, at Petten,
is 47 years old, and even if it reopens on schedule, it will have to be shut
for several months in 2010 for repairs, its operators say.
“This is a huge hit,” said Dr. Michael M. Graham,
president of the Society of Nuclear Medicine and a professor of radiology at
There are substitute techniques and materials for some
procedures that use the isotope, Dr. Graham and others said, but they are
generally less effective, more dangerous or more expensive. With the loss of
diagnostic capability, “some people will be operated on that don’t need to
be, and vice versa,” he said.
Dr. Andrew J. Einstein, an assistant professor of clinical
medicine at the Columbia University College of Physicians and Surgeons, said
the isotope was used to determine if a patient had a coronary blockage that
required an angioplasty or stent. Without the test, Dr. Einstein said, those
invasive procedures would be performed on some who did not need them. His
hospital is already sometimes using smaller doses of the radioactive drug
than guidelines specify, he said.
In patients with a known cancer, the drug pinpoints
additional tumors in bone. At a tumor site, new bone will develop, and new
bone growth absorbs the radioactive material.
In breast cancer surgery, the radioisotope is injected to
find the lymph node nearest the tumor, so it can be biopsied for signs of
cancer, to determine whether more extensive surgery is needed.
The alternative is to inject a dye, which sometimes does
not let the surgeon find the node.
Without the tool, Dr. Graham said, the quality of medical
care is “dropping back into the 1960s.”
On Tuesday, Representative Edward J. Markey, a
Massachusetts Democrat who is one of the House’s fiercest critics of the
nuclear industry, declared that the United States was facing “a
crisis in nuclear medicine.”
Mr. Markey, chairman of the House Energy and Commerce
subcommittee on energy, called for establishing new production facilities in
the United States.
He joined the ranking Republican on the subcommittee, Representative Fred
Upton of Michigan,
to introduce a bill to authorize $163 million over five years to assure new
The White House is coordinating an interagency effort to
find new sources of supply, involving the Nuclear Regulatory Commission, the
Food and Drug Administration and the Energy Department, but officials said
the process would take months.
The reactors are typically small — sometimes no larger
than a homeowner’s trash barrel — but a complete setup costs tens of millions
Tech-99m, as it is abbreviated, emits a gamma ray that
makes its presence obvious. It has a half-life of six hours, meaning that it
loses half its strength in that period. Thus it does its job quickly, without
lingering to give the patient a big dose. But it also means the isotope must
be produced and used faster than most other drugs.
Tech-99m is the product of another isotope, molybdenum-99,
which also has a short half-life, 66 hours. Thus a week after it is made,
less than a quarter of the molybdenum-99 remains. Stockpiling is not
“You lose about 1 percent an hour,” said another expert,
Kevin D. Crowley, director of the Nuclear and Radiation Studies Board at the
National Research Council. “So time is of the essence.”
Molybdenum-99 is made when uranium-235 is split, but only
about 6 percent of the fission fragments are molybdenum. Purification has to
be done in a heavily shielded “hot cell.”
The common method is to put a uranium target into the
stream of neutrons produced in the reactor as uranium is split. But the
preferred material is a high-purity uranium-235, which is also bomb fuel.
Mr. Markey and others are trying to have the industry
switch to low-enriched — nonweapons-grade —
Dr. Crowley said that could be done, although the industry
The reactors’ poor condition has been obvious for a while.
In 2007, Canadian safety regulators said the Ontario reactor should not restart, but
the Canadian Parliament overruled them.
In 1996, the company that purifies the molybdenum from the
reactor, MDS Nordion, contracted with Atomic Energy
of Canada Ltd., which owns the reactor, to build two new ones. MDS Nordion paid more than $350 million for them.
But when the new reactors were started up, both showed a
problem: as the power level increased, the reactors had a tendency to run
faster and faster, a condition called positive coefficient of reactivity.
That is a highly undesirable characteristic in a reactor, one that
contributed heavily to the Chernobyl
disaster in 1986. So Atomic Energy of Canada Ltd., which is owned by the
Canadian government, said it would not open them.
For all the years that the Ontario plant was running or the
replacements were under construction, other potential manufacturers believed
they could not compete, Dr. Klein said. And the business has always been
small, he said, adding that a big pharmaceutical company “can make more on
Viagra in two days than on tech-99m in a year.”
Several long-term alternatives are available. Babcock
& Wilcox, a reactor manufacturer, has proposed a new kind of reactor that
would manufacture molybdenum that could be siphoned off continuously.
In a few weeks, a company in Kennewick, Wash.,
Advanced Medical Isotopes, plans to test a new
system, using a linear accelerator, a machine that shoots subatomic particles
at high speeds.
Reactors in Belgium,
France, South Africa and Argentina could also be used to
make small amounts.
The High Flux Reactor at the Oak Ridge National Laboratory
in Tennessee, owned by the federal
government, and a research reactor at the University of Missouri,
could do the work, but neither has the equipment in place to extract the
molybdenum from the targets.
For the time being, said Dr. Crowley of the National
Research Council, “we are in a triage situation.”
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By ALICIA CHANG,
AP Science Writer
LOS ANGELES –
Medicare's 3-year-old prescription drug plan has largely met its main goal of
making lifesaving medicines more affordable for seniors, a new report found.
The analysis by
the nonprofit Kaiser Family Foundation examined government data and past
studies and found that for the most part, people who used to lack drug
coverage saw their out-of-pocket costs drop after enrolling in the Medicare
published in Thursday's New England Journal of Medicine, provides the most
comprehensive look yet at how Medicare consumers have fared since the
program, called Medicare Part D, went into effect in 2006.
The program allows
seniors and the disabled enrolled in Medicare to join a private drug plan
that is approved and subsidized by the federal government. The benefit is
widely hailed as the biggest expansion to Medicare since it was signed into
law in 1965.
Part D, only two-thirds of beneficiaries had drug coverage. That forced many
with diabetes, high blood pressure and other chronic illnesses to stop
filling prescriptions or skimp on their doses, according to various surveys.
Today, 90 percent
— or about 41 million — have drug coverage. Of those, about 27 million are
enrolled in Medicare Part D. The rest are retirees who get coverage from
former employers or through the military.
spending on the Medicare drug benefit has also been lower than expected and
is one of the rare federal programs to come in under budget. The program cost
$40 billion in 2007, less than the projected $66 billion, the report said.
Jonathan Oberlander, a health politics expert at the University of North
Carolina at Chapel Hill,
called Part D a "mixed success."
improved coverage for prescription drugs for Medicare beneficiaries. Program
costs have been significantly lower than initially forecast. And more seniors
now have access to critical medications," said Oberlander,
who had no role in the study.
But it's not
perfect, Oberlander and the Kaiser researchers
note. Among the challenges:
_Some 4.5 million
Medicare beneficiaries still lack drug coverage today, the same as in 2006.
They include people who have opted to go without because they believe they
are in good health and those who are unaware of the drug benefit and don't
know how to sign up.
_Between 2006 and
2009, the average monthly premium for prescription drug plans rose 35
percent, from about $26 to $35.
_More than 2 million
who are eligible for low-income drug subsidies are not getting them.
One of the biggest
concerns during the Medicare drug benefit debate was that private insurers
wouldn't want to offer the drug plans. That turned out not to be the case.
Seniors now have dozens of Medicare drug plans to choose from, each with its
own list of covered drugs, premiums, copays and
But seniors do not
always pick the cheapest plan despite having many choices, the report found.
"It's still a
work in progress," said lead author Tricia Neuman,
director of Kaiser's Medicare Policy Project.
said it's hard to know whether consumers are getting a good deal on
medications because key information is missing. Private insurers negotiate
prices with drug makers and are not required to disclose drug discounts.
The coverage gap —
known as the "doughnut hole" — continues to be a problem. The plan
applies to the first $2,700 in prescriptions. Beneficiaries then hit the gap
and have to pay for their drugs until their out-of-pocket expenses reach
$4,350 for the year, at which point coverage resumes. Average monthly
out-of-pocket spending nearly doubled for people who enter the coverage gap,
the researchers found.
discussing ways to close that gap as it struggles to revamp the nation's $2.4
trillion health care system.
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