By Bill Barrow
Staff writer
David Grunfeld/T-P
file photo
This neighborhood in lower Mid-City is slated for
razing so the U.S.
Department of Veterans Affairs and the state of Louisiana can build adjacent medical
complexes to replace those damaged by Hurricane Katrina.
The uncertainty
about financing and governance of a proposed state teaching hospital in lower
Mid-City does not affect the U.S. Department of Veterans Affairs as it plans
an adjacent hospital, a top agency official said Wednesday.
"We have a
commitment from the state that (its) facility will be built in that
location," said Don Orndoff, who directs the
Veterans Affairs construction and facilities office, during a planning forum
to discuss the latest VA schematic designs. "We take them at their
word."
Pressed further, Orndoff cited private assurances from Gov. Bobby Jindal, and Orndoff dismissed
concerns that potential delays or changes to the state's plan for a $1.2
billion, 424-bed complex could hinder the VA's 200-bed hospital.
Yet it has become
increasingly clear in recent months that the state project faces obstacles
that do not burden the VA. And architects conceded to the planning,
preservation and neighborhood group leaders gathered Wednesday that, despite
"ongoing" conversations about shared services, the two hospitals
are being designed to "stand on their own."
Both projects are
the subject of state and federal lawsuits, but the VA has congressional
financing and no questions of governance.
The state,
meanwhile, continues to haggle with the federal government over how much
damage Hurricane Katrina inflicted on Charity Hospital,
with the eventual settlement answering a key piece of the financial puzzle
for the proposed replacement. The Jindal
administration has thus far been unable to negotiate a governance agreement
for a new corporation to own and operate the hospital -- and, more
immediately, sell the bonds necessary to build it.
In that context,
some attendees at Wednesday's session questioned how federal officials can continue
to talk of synergy between the two hospitals, particularly given their
caveats about independence.
Architects
presented VA designs that, like previous renderings, depict a federal complex
covering about 30 acres bound by Galvez
Street, Canal Street, South Rocheblave
Street and Tulane Avenue,
with the main entrance fronting Galvez
Street. The state complex would rise across
Galvez, reaching to South
Claiborne Avenue.
Katy Coyle, a VA
planning consultant, said VA and state officials -- from Louisiana State
University, in
particular -- could share as many as 12 clinical departments. One hospital
would build the facilities, she said, with the other paying for use. Coyle
did not identify the functions.
Designers also
repeated that there are "ongoing discussions" about one central
energy plant. Current plans do not reflect that.
Responding to
previous criticisms that initial designs did not reflect Mid-City's landscape
and architecture, architects touted tree-lined avenues that would track
existing streets in an effort to preserve part of the city grid.
But carrying that
plan through both campuses, as drawn by VA architects, could depend on the
state building a second phase of its complex. The state has confirmed that
its $1.2 billion estimate covers only an initial round of construction
involving about half of the buildings shown on the VA's drawings.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1250141425109560.xml&coll=1
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By MARSHA SHULER
Advocate Capitol
News Bureau
Two rounds of cuts
to the state’s Medicaid health insurance program for the poor could cost Baton Rouge area
hospitals at least $10 million, according to a new Louisiana Hospital
Association analysis.
Executives of two
of the area’s major hospitals said the 2009 reductions — part of $98 million
in private hospital cuts statewide — are prompting reviews of their operating
budgets to determine how to handle the revenue loss.
“We just found out
last week what the numbers are. For us it is $3.8 million, which is
definitely a real number,” Our Lady of the Lake Regional Medical Center CEO
Scott Wester said. “Like all other hospitals, we
are looking carefully at resources and services.”
Wester said the hospital’s budget must be
adjusted to take into account the funding loss.
Woman’s Hospital
CEO Teri Fontenot said some home-health-care services for intensive care
babies who need monitoring after they leave the hospital may be curtailed as
a result of the latest round of cuts.
The hospital made
changes in its employee pay and benefits structure as a result of the first
round of cuts in February, Fontenot said.
The hospital
association report puts Woman’s net revenue loss at $389,600.
Fontenot said the
instability of the Medicaid revenue stream has put “on hold” the new
replacement hospital that Woman’s plans to build down Airline Highway from its facilities on Goodwood Boulevard.
“We are such a
large provider of Medicaid services — 40 percent of our revenue comes from
it,” she said. Project investors are wary so it’s hard to line up financing,
Fontenot said.
Officials at Baton Rouge General Medical Center
declined comment on a potential $4.1 million in cuts to their operations that
are projected by the hospital association.
“No specific plans
have been finalized, so we don’t want to communicate anything that could
change down the road,” the General’s communications chief Scott Wilson said.
The latest round
of hospital cuts come as a result of the $6.28 billion budget the Legislature
passed for the Medicaid program. The program primarily serves infants and
children, pregnant mothers, the elderly and developmentally disabled.
Of the amount,
$4.25 billion is earmarked to reimburse private providers such as hospitals,
physicians, pharmacists and others who provide Medicaid services. Hospital
funding was cut 6.2 percent. It followed a February reduction of 3.5 percent.
Dollars lost on
the Medicaid side led to a cost-shifting to those who have private insurance,
according to hospital association executives.
The LHA analysis
took a look at claims for Medicaid reimbursement paid to hospitals between July 1, 2008,
and June 30,
2009. From that it estimated the impact February and August 2009
budget reductions would have on the amount hospitals receive for inpatient
and outpatient care.
LHA president John
Matessino said the report does not take into
account the free care that hospitals deliver as patients present themselves
and must be seen.
Matessino said the financial picture could have been
a lot worse for Woman’s Hospital if it had not been time for the every other
year adjustment in reimbursement rates for the specialized critical care
hospitals that care for fragile, high-risk newborns.
“That’s the only
thing that’s saving them at this point,” Matessino
said.
Matessino said Woman’s benefited from what is called
“rebasing” while other hospitals such as Women’s and Children’s in Lafayette are estimated
to lose $3 million.
Fontenot said she
has not been officially notified by state Medicaid officials that the hospitals has been granted relief in the so-called
“outlier” program.
Individual
hospitals are beginning to look at their individual situations based on LHA
data projecting losses, Matessino said. He said he
has heard from many hospital CEOs who are contemplating employee layoffs,
cutting employee benefits and in some instances reductions or elimination of
some medical services offered.
“They are a little
hesitant to make public announcements until they get the actual numbers from
the Department of Health and Hospitals,” which oversees Medicaid, Matessino said.
Matessino said hospitals are also bracing for more
reductions in the coming months. Department of Health and Hospitals Secretary
Alan Levine has already said he anticipates Medicaid spending to be running
ahead of appropriated dollars which will trigger more cuts, Matessino said.
http://www.2theadvocate.com/news/politics/53092172.html
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BATON ROUGE, La.
(AP) — Louisiana's
health secretary is asking provider groups to help rally congressional
support for the state's looming Medicaid funding problems.
Unless Congress
intervenes, Louisiana
is poised to lose about $700 million a year for Medicaid.
State Health and
Hospitals Secretary Alan Levine called a meeting this week with health care
providers — groups representing hospitals, doctors, drug companies and
advocates. He's asking them to push for help from Washington.
Medicaid costs are
shared between states and the federal government, tied to the state's
per-capita income. Hurricane recovery work gave a temporary boost to Louisiana's per-capital
income. Because of that, the federal government's share of Louisiana's Medicaid costs is expected to
shrink from 80 percent to 63 percent in 2011.
http://www.theadvertiser.com/article/20090813/NEWS01/90813003
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By GERARD SHIELDS
Advocate Washington bureau
WASHINGTON — During the August recess in 2005,
Democrats successfully torpedoed President George Bush’s plan to privatize
Social Security.
After the break,
the idea sank into obscurity.
The Louisiana
Republican congressional delegation is hoping to return the favor and do the
same with President Barack Obama’s health-care proposal.
Federal GOP
lawmakers are fanning out across the state during the break to tell why they
are opposed to the plan. And unlike town halls shown in television footage
across the country, Louisiana
members aren’t seeing the rabid, raucous protests.
“We haven’t had
anybody who’s been ugly with us,” said U.S. Rep. Rodney Alexander, R-Quitman.
“Most people are concerned but nobody has been rude.”
U.S. Sen. David
Vitter has had two meetings in halls filled to capacity. One event drew 800
people in Pineville, while another in the Jefferson Parish council chambers
was filled to capacity with a standing room only crowd of 350 that left
hundreds unable to get in.
“People are
interested and passionate, it’s been lively but it’s been civil,” said
Vitter, who will hold a meeting in West Baton Rouge
on Aug. 24.
The reason the
meetings may not have been filled with shouting and finger-pointing between
supporters and opponents is that all of the Louisiana delegation — including its two
Democrats — oppose the plan.
U.S. Rep. Charlie Melancon, D-Napoleonville, was one of three Democrats to
vote against the proposal in the House Energy and Commerce Committee before
the break. Melancon listed everything from a
provision that requires at least one provider in the region to offer
abortions to the trillion-dollar price tag of the bill as reasons for his
opposition.
Melancon has not scheduled any town hall meetings
but said he expects to be approached at community events such as festivals
and Rotary clubs. Liberal groups such as MoveOn are
criticizing Melancon and Democratic U.S. Sen. Mary
Landrieu in radio ads.
“He’s being
targeted as much by the left as the right,” Kevin Franck, a spokesman for the
Louisiana Democratic Party, said of Melancon. “It’s
not real political down here.”
Landrieu wants
people to be given tax deductions to purchase insurance. She plans to hold a
town meeting in the River Parishes sometime at the end of the month.
Franck didn’t get
into the Vitter meeting in Jefferson Parish, where questions were written
down by attendees and submitted to a Vitter aide before being handed over,
according to one media report of the event.
“The crowds are
stacked in his favor, they’re pre-screening the questions,” Franck said.
“They’re controlling it pretty tightly.”
All of the members
are using the meeting to decry the plan. Alexander said he’s concerned about
any impact on Medicare because he has 100,000 Medicare recipients in his
district. Obama has said Medicare patients won’t be affected and the
administration can make up a $200 billion cut by finding waste in the
program.
“They all know
there is a need for health care,” Alexander said of town hall attendees.
“There are some serious questions that have not been answered.”
Vitter wants a
provision that would cut down on bogus lawsuits and has pushed for allowing
less costly prescription drugs to be brought into the country. Republican U.S.
Rep. Steve Scalise, Metairie,
agrees that most health-care providers are scheduling tests and procedures
just to cover the liability if sued.
“When you listen
to people, you really get a sense of what’s happening,” said Scalise, who has scheduled six town hall meetings. “The
more that the public is armed with the facts of the government proposal, they
don’t like it.”
Republican U.S.
Rep. Bill Cassidy, of Baton Rouge,
a gastroenterologist, said he has no fear of wading into any health-care
fray. Cassidy will have four town hall meetings this month and is preaching
health-care savings accounts and wellness programs, such as weight loss and
smoking cessation, that could benefit employers.
“Where I am is
where most of my district and most of the American people are,” Cassidy said.
“I am passionate about health-care reform but I want reform that works.”
http://www.2theadvocate.com/news/53092147.html.
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Paul James
The
medical-industrial complex must be getting desperate. According to Public
Radio, it is spending almost $1 1/2 million per day in efforts to defeat
health-care reform, a million and a half that is coming from our premiums.
Mel Brooks is
right: It is good to be the king.
One of the claims
often made by reform opponents is that we already have the “best health care
in the world.”
Wrong.
We have the best
health-care providers in the world — the doctors, nurses, technicians and
office staffers. They are the best, and are themselves often frustrated to
the point of despair by the infinite nit-picking of company bureaucrats (who
outdo anything the government can offer),
bureaucrats whose careers depend upon denying benefit claims and maximizing
company profits.
But the
health-care system? Time magazine reports we have slipped to No. 30 in infant
mortality, down from 11th place in 1960.
Do you need care
on the weekends? Good luck. Try finding a walk-in clinic that takes Medicare.
Or you can always go to the emergency room where, judging by my family’s
experiences, you can wait for three to eight hours before an overworked team
can help you.
Before it burned,
I worked at Perkins Road Hardware. It was usually the case that there would
be one or more mason jars on the counter, each bearing a child’s photograph
and a label asking for assistance in paying for needed surgery or treatment.
You’ve seen them;
you’ve dropped in your contribution. You’ve bought tickets for jambalaya
lunches. You’ve seen the occasional announcements in Smiley Anders’ column
for a benefit to aid someone in their medical need.
Each of these
cases represents some family that has had to swallow pride, doing whatever it
takes to help a loved one, even if this means literally begging from
strangers.
It is beyond
comprehension that the richest nation on Earth should tolerate such shabby
treatment of its citizens. In the rest of the industrialized world, it would
be incomprehensible; health care is regarded as just another public service,
like fire and police protection.
We need
health-care reform. Expensive? Yeah, it’ll cost a ton, and so what? It’s
called “sacrifice,” and it is good for the soul, not to mention our kids. It
does take guts. Our parents had high courage, and we call them “the greatest
generation.”
When did we lose
our nerve? When did we get all fat and comfy? When did we decide that the
best national policy was to simply pass by on the other side?
Paul James
lamp repairman
Baton Rouge
http://www.2theadvocate.com/opinion/53088477.html
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Elisabeth Gleckler
I have private
insurance right now through my job. Nonetheless, I still have a long wait to
get an appointment with a physician. What happens if I get really sick with a
condition that eventually gets bad enough so I can't work? I will lose my
health insurance, and have to run through my savings.
I won't be able to
afford COBRA. Maybe I'll go bankrupt due to medical costs, the cause of 60
percent of the nation's bankruptcies.
Then, I will use
government care, show up in emergency rooms with conditions that could have
been treated or mediated with timely health care. Perhaps I will die sooner
than I should.
Sooner or later we
all pay for poor health care through some government services to the
destitute or through someone's decreased contribution to society. We need
reform. We need to stop being hysterical about it and focus on the fixes, not
the hype.
Elisabeth Gleckler
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1250141528109560.xml&coll=1
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Ricardo Febry, M.D.
The debate about
health care reform has led many detractors to misrepresent proposed payments
for end-of-life care counseling by physicians as government-sponsored
"death panels."
Perhaps it is
little-known that Medicare already pays on behalf of its beneficiaries for a
one-time, end-of-life care consultation when it is determined that the
patient has a terminal illness.
The health care
reform proposal would lift the restrictions for end-of-life consultations
beyond the one-time limit and the requirement of having a terminal illness.
It also would drop the current requirement that the service be provided by a
hospice medical director exclusively.
Instead, healthy
people would also have access to a consultation, helping set and update the
framework for end-of-life care decisions to come.
Common sense
dictates that such an enhancement of coverage would be an improvement over
the current benefit.
Ricardo Febry, M.D.
Hospice Associates
of New Orleans
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1250141473109560.xml&coll=1
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Richard O. Wornat
We should be able
to improve health care without overhauling the entire system, without forcing
enrollment and without increasing the deficit.
First, Congress
should enact meaningful tort reform. This would greatly reduce the tests and
procedures that many physicians now do to avoid litigation. It will also
reduce malpractice insurance premiums, which should reduce physicians' fees.
Second, Congress
should tax employer health insurance that exceeds a reasonable value.
Although the above
two actions would be politically difficult, they should provide sufficient
savings to send everyone a credit card that could be used only toward the
purchase of health insurance. This leaves the decision of purchasing health
insurance up to the individual.
Then, Congress
should provide for a system of community urgent-care facilities across the
nation, removing the requirement for hospitals to accept everyone who comes
to the emergency room.
The legislation
should increase the importance of the primary care physician by increasing
their allowed fees so that more people entering medical school would elect
that "specialty." The primary care physician should be the
"gatekeeper" to specialized care.
Finally, all
health insurance should be personal -- that is, not tied to one's employment
-- and should accept all applicants.
This legislation
probably could be incorporated in 100, instead of 1000, pages. I move its
adoption.
Richard O. Wornat
Pearl
River
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1250141510109560.xml&coll=1
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Dr. Michael S.
Ellis
As a physician, I
have watched with great interest the push to reform our health-care system.
My personal belief is that reform is about more than paying bills. It’s about
delivering quality care and treatment to patients. Patients must come first.
The way to do that is by thoughtfully fixing the current system, not trying
to rush through plans to build a new one.
What I am most
concerned about is the public option, a euphemism for another government
insurance product designed to compete against private insurance companies.
With Medicare near bankrupt and Medicaid bankrupting states, do we believe
more government will be better? Original cost estimates for each of them were
a fraction of the actual cost.
I see this state’s
medical care up close every day. In Louisiana,
17 percent of our population is uninsured (21 percent in New Orleans) and 24 percent have Medicaid.
These patients have major access problems, particularly to specialty care.
The huge administrative costs and “certification” hassles of Medicare and
private insurers need reform, but if we aren’t careful, we could make all of
this worse. Congress is facing a health-care bill with 1,000 pages, which
leadership has placed on the fast track. Hidden in the fine print is the fact
that government bureaucrats will decide what treatments are “covered.”
Patients will lose the freedom of choice at all levels of the health-care
decision-making process.
There are ways to
reach our nation’s health-care goals, which will leave us with choices in
coverage instead of a one-size-fits-all approach. We should proceed with
caution and make sure that we are aware of just what is in this bill and what
its impact will be on patients. Lives are at risk.
Dr. Michael S.
Ellis
Clinical professor
Tulane University
New Orleans
http://www.dailycomet.com/article/20090812/LETTERS/908129966/-1/MOBILE01?Title=Patients-come-first
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The Wichita Eagle | 08.13.09
By MARILYNN
MARCHIONE
Associated Press
Breast cancer
survivors have been getting bum advice.
For decades, many
doctors warned that lifting weights or even heavy groceries could cause
painful arm swelling. New research shows that weight training actually helps
prevent this problem.
"How many
generations of women have been told to avoid lifting heavy objects?"
physician Eric Winer, breast cancer chief at the
Dana-Farber Cancer Institute in Boston, lamented after seeing the surprising
results of the new study. "Women who were doing the lifting actually had
fewer arm problems because they had better muscle tone."
The study was led
by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania,
and funded by the federal government. Results are in Thursday's New England
Journal of Medicine.
More than 2.4
million Americans are breast cancer survivors, and the study could mean a big
difference in their quality of life. Cancer-treatment-related arm swelling
now appears to be one of many ailments made better by exercise — not worse,
Schmitz said.
"Fifty years
ago we told people who had a heart attack not to exercise anymore," and
people with sore backs to heal with bed rest, Schmitz said. "It was
well-meaning advice but it was polar opposite of the truth."
Women who have had
radiation to the armpit, or lymph nodes removed to check for cancer, can
suffer lymphedema — a buildup of fluids that causes
painful and unsightly swelling of the arms or hands.
To avoid it,
doctors have advised women to avoid using the affected arm to lift toddlers,
carry a heavy purse or scrub floors. Even activities like golf and tennis
raised concern.
Women think,
"Oh, my God, I need to baby the arm," Schmitz said.
Lifting weights —
which boosts mood, muscle mass, bone strength and weight control — was
thought to be a bad idea for women prone to lymphedema.
Schmitz challenged
that notion with a small study several years ago, finding that weight
training did not make lymphedema worse. Her new
study is the first one large and long enough to give clear proof that this is
so, and even suggests that weightlifting can help.
It involved 141
breast cancer survivors who had suffered lymphedema.
Half were told not to change their exercise habits. The rest were given
90-minute weightlifting classes twice a week for 13 weeks at community gyms,
mostly YMCAs.
They wore a
custom-fitted compression garment on the affected arm and gradually worked up
to more challenging weights and repetitions. For the next 39 weeks, they
continued these exercises on their own.
The women's arms
were measured monthly. After one year, fewer weightlifters had suffered lymphedema flare-ups — 14 percent versus 29 percent of
the others. Weightlifters reported fewer symptoms and greater strength. Rates
of change in arm size due to swelling were similar in both groups.
"I found it
was really very effective. It not only gave me strength and mobility but it
improved my balance and coordination," said one participant, Clare
Faber, 66, of suburban Philadelphia.
"It really does offer women hope."
Another
participant, Gay McArthur, 56, of Smithfield,
N.J., has continued
weightlifting on her own since the study ended.
"When I first
got diagnosed with lymphedema, they said I couldn't
lift more than five pounds," she said. But weight training caused no
problems and has made her feel better, she said.
It also should
save money, though the study did not measure this, Wendy Demark-Wahnefried, of the University of Texas M.D. Anderson
Cancer Center in Houston,
wrote in an editorial in the medical journal. In the study, the group of
weightlifters made only 77 visits to doctors or physical therapists for lymphedema flare-ups versus 195 visits for the others,
she noted.
Another part of
the study is evaluating whether weight training can prevent a first case of lymphedema in breast cancer survivors; results are
expected soon, Schmitz said.
Breast cancer
survivors should not rush into weight training — that could trigger problems.
Schmitz suggests:
- Have a certified fitness professional
teach you how to do the exercises properly.
- Start slow, with a program that
gradually progresses.
- Wear a well-fitting compression
garment during workouts.
http://www.kansas.com/living/health-fitness/story/928348.html
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By Marilynn Marchione
Associated Press
Breast cancer
patients with even the tiniest spread of the disease to a lymph node have a
much higher risk of it recurring years later and may need more treatment than
just surgery, new research suggests.
For years, doctors
and patients have struggled with what to do about a microscopic tumor or
stray cancer cells in a lymph node.
Women with “micro
tumors’’ usually are given estrogen-blocking drugs, chemotherapy, or both;
those with isolated cancer cells usually are not, because those were thought
to be of low concern.
The new study
challenges that view. It suggests that either type of metastasis, or spread,
raises a woman’s risk of having cancer show up in the breast or anywhere else
in the next five years by about 50 percent.
“This took an area
that was very gray and I think made it black and white,’’ said Dr. Linda Vahdat, director of breast cancer research at Weill
Cornell Medical College and an adviser for the breast cancer patient website
of ASCO, the American Society of Clinical Oncology.
“I think it will
influence treatment,’’ she said of the study. “If we’re considering treating
the patient, we probably should.’’
Dr. Daniel Hayes,
director of breast cancer treatment at the University of Michigan,
agreed.
“It really does
look like our biases are wrong,’’ he said. “For the first time, it suggests
that isolated tumor cells or micrometastases do
have biological significance.’’
Vahdat and Hayes had no role in the study, which
was done by researchers throughout the Netherlands. The results are in
today’s New England Journal of Medicine.
Meanwhile, another
study out today suggests doctors have been giving bad advice regarding
lifting weights.
For decades, many
doctors warned that lifting weights or even heavy groceries could cause
painful arm swelling. New research shows that weight training actually helps
prevent this problem.
“How many
generations of women have been told to avoid lifting heavy objects?’’ Dr.
Eric Winer, breast cancer chief at the Dana-Farber
Cancer Institute in Boston,
lamented after seeing the surprising results of the new study.
“Women who were
doing the lifting actually had fewer arm problems because they had better
muscle tone.’’
The study was led
by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania,
and funded by the federal government. Results are in today’s New England
Journal of Medicine.
More than 2.4
million Americans are breast cancer survivors, and the study could mean a big
difference in their quality of life. Cancer treatment-related arm swelling
now appears to be one of many ailments made better by exercise - not worse, Schmitz
said.
The Netherlands
study is not ideal: It simply observed a large number of women, rather than
assigning some to get treatment and comparing how they fared compared with
others who were not treated.
The study also was
done at a time when treatment was less aggressive and in a country where
doctors had been treating breast cancer more conservatively than in the United States.
In the United States,
many women with early stage breast cancer are given hormone blockers.
“The big issue is,
should these patients also get chemotherapy?’’ Hayes said.
Not all women
benefit from chemotherapy, however, even when their risk of a recurrence is
high, Winer said.
http://www.boston.com/news/nation/articles/2009/08/13/micro_tumors_rise_on_the_risk_scale/?rss_id=Boston+Globe+--+National+News
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The New York Times | 08.12.09
By DAVID D.
KIRKPATRICK
WASHINGTON — In pursuing his proposed overhaul of the
health care system, President Obama has consistently presented himself as
aloof from the legislative fray, merely offering broad principles. Prominent
among them is the creation of a strong, government-run insurance plan to
compete with private insurers and press for lower costs.
Behind the scenes,
however, Mr. Obama and his advisers have been quite active, sometimes
negotiating deals with a degree of cold-eyed political realism potentially at
odds with the president’s rhetoric.
Last month, for
example, hospital officials were poised to appear at the White House to
announce a deal limiting their industry’s share of the costs of the overhaul
proposal when a wave of jitters swept through the group. Senator Max Baucus,
the Finance Committee chairman and a party to the deal, had abruptly pulled
out of the event. Was he backing away from his end of the deal?
Not to worry, Jim
Messina, deputy White House chief of staff, told the lobbyists, according to
White House officials and lobbyists briefed on the call. The White House was
standing behind the deal, Mr. Messina said, capping the industry’s costs at a
maximum of $155 billion over 10 years in trade for its political support.
Some Democrats and
industry lobbyists now argue that, in negotiating deals through Mr. Baucus’s panel with powerful health care interests, the
White House was tacitly signaling as early as last spring that it might end
up accepting something more modest than the government insurer the president
has said he prefers.
The Finance
Committee, for example, appears to be coalescing around the idea of nonprofit
insurance cooperatives instead of a government-run plan. It is a proposal the
health care industry prefers, but many liberal Democrats oppose, in both
cases because cooperatives are likely to have less leverage over health care
prices.
Rahm Emanuel, the White House chief of staff,
disputed that the administration had elevated the work of the Senate finance
panel above the four other committees that have all approved strong
government insurers.
“They are an
important committee,” Mr. Emanuel said. “They have a bipartisan process. The
president would like that to work, just as he is proud that the other
committees have done their work. They don’t get an exalted status over
everybody else.”
But he also
acknowledged the political realities that have made the Finance Committee’s
still-unfinished cooperative plan a center of attention. “We have heard from
both chambers that the House sees a public plan as essential for the final
product, and the Senate believes it cannot pass it as constructed and a co-op
is what they can do,” he said. “We are cognizant of that fact.”
Asked whether the
president would accept the weaker co-op, Mr. Emanuel declined to comment. “I
am not going to fast-forward the process,” he said.
Industry lobbyists
and moderate Democrats in both chambers, though, argue that the White House’s
actions behind the scenes show a recognition that
the finance panel’s anticipated compromise is the most likely template for
any final legislation.
“The House has
largely been a sideshow,” said Representative Jim Cooper of Tennessee, a member of the so-called Blue
Dog caucus of conservative Democrats. “The Senate Finance Committee is where
it really matters. That’s the bottleneck.”
Members and staff
of the four other committees say the White House has largely stayed on the
sidelines. “They have been — what is a good way to put it? — available for consultation,” Mr. Cooper said.
Mr. Obama and his
top aides have immersed themselves in the Senate Finance Committee process.
The president talks to Mr. Baucus several times a week, people briefed on
their conversations say. Mr. Obama has also held a few calls with the panel’s
ranking Republican, Senator Charles E. Grassley of Iowa.
In addition, Mr.
Obama invited both senators to a private lunch at the White House early in
the summer and met with six panel members for another White House session
last week. White House advisers have held long evening and weekend meetings
with Finance Committee staff members.
Nancy-Ann DeParle, charged with leading the White House health
effort, has a standing biweekly meeting with Mr. Baucus, while Peter R. Orszag, the White House budget director, has spent so
much time in the senator’s office that he helps himself to the Coke Zeros tucked
away in Mr. Baucus’s personal refrigerator.
Lobbyists for the
drug and hospital industries say that, as early as June, White House
officials directed them to work out cost-saving deals with Mr. Baucus’s committee. Drug industry lobbyists said they negotiated
a deal to contribute $80 billion over 10 years toward the cost of an overhaul
with Mr. Baucus, under White House supervision, before taking it to the
president for final approval. House lawmakers have said they were caught by
surprise when it was announced.
Hospital industry
lobbyists, speaking on the condition of anonymity for fear of alienating the
White House, say they negotiated their $155 billion in concessions with Mr.
Baucus and the administration in tandem. House staff members were present,
including for at least one White House meeting, but their role was
peripheral, the lobbyists said.
Several hospital
lobbyists involved in the White House deals said it was understood as a
condition of their support that the final legislation would not include a
government-run health plan paying Medicare rates — generally 80 percent of
private sector rates — or controlled by the secretary of health and human
services.
“We have an
agreement with the White House that I’m very confident will be seen all the way
through conference,” a lobbyist, Chip Kahn, director of the Federation of
American Hospitals, told a Capitol Hill newsletter.
Mr. Emanuel and
liberal Democrats argued that the White House had worked more closely with
the Senate Finance Committee because it was stepping in to break up
legislative logjams. In the same way, they said, Mr. Obama and Mr. Emanuel
had personally interceded to resolve a last-minute revolt by conservative
House Democrats that threatened to derail a bill in the energy and commerce
panel in July.
Representative
Henry A. Waxman, the California Democrat who is chairman of the Energy and
Commerce Committee, said Mr. Obama had assured House members that he did not
intend to let the Senate Finance Committee determine the final bill.
“This is going to
be a genuine conference with give and take,” Mr. Waxman said. He added: “The
president has said he wants a public option to keep everybody honest. He
hasn’t said he wants a co-op as a public option.”
Still, industry
lobbyists say they are not worried. “We trust the White House,” Mr. Kahn
said. “We are confident that the Senate Finance Committee will produce a bill
we fully can endorse.”
http://www.nytimes.com/2009/08/13/health/policy/13health.html?_r=1&ref=health
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The New York Times | 08.12.09
By JENNIFER
STEINHAUER
Ruth Fremson/The
New York Times
People receiving free dental treatment at The Forum
in Inglewood, Calif., on Wednesday.
INGLEWOOD, Calif. — They came for new teeth mostly, but also
for blood pressure checks, mammograms, immunizations and acupuncture for
pain. Neighboring South Los Angeles is a
place where health care is scarce, and so when it was offered nearby, word
got around.
For the second day
in a row, thousands of people lined up on Wednesday — starting after midnight and snaking into the early
hours — for free dental, medical and vision services, courtesy of a nonprofit
group that more typically provides mobile health care for the rural poor.
Like a giant MASH
unit, the floor of the Forum, the arena where Madonna once played four
sold-out shows, housed aisle upon aisle of dental chairs, where drilling,
cleaning and extracting took place in the open. A few cushions were
duct-taped to a folding table in a coat closet, an examining room where Dr.
Eugene Taw, a volunteer, saw patients.
When Remote Area
Medical, the Tennessee-based organization running the event, decided to try
its hand at large urban medical services, its principals thought Los Angeles would be a
good place to start. But they were far from prepared for the outpouring of
need. Set up for eight days of care, the group was already overwhelmed on the
first day after allowing 1,500 people through the door, nearly 500 of whom
had still not been served by day’s end and had to return in the wee hours
Wednesday morning.
The enormous
response to the free care was a stark corollary to the hundreds of Americans
who have filled town-hall-style meetings throughout the country, angrily
expressing their fear of the Obama administration’s proposed changes to the
nation’s health care system. The bleachers of patients also reflected the
state’s high unemployment, recent reduction in its Medicaid services for the
poor and high deductibles and co-payments that have come to define many
employer-sponsored insurance programs.
Many of those here
said they lacked insurance, but many others said they had coverage but not
enough to meet all their needs — or that they could
afford. Some said they were well aware of the larger national health care
debate, and were eager for changes.
“I am on point
with the news,” said Elizabeth Harraway, 50, who is
unemployed and came for dental care. “I think the president’s ideas are
awesome, and I believe opening up health care is going to work."
Stan Brock, Remote
Area Medical’s founder and among the many khaki-wearing volunteers in the
arena, said his organization’s intent was not to become part of the health
care debate, but to do what it had done for nearly 25 years: offer charity to
people in need. Still, the group attracted attention last month when
President Obama visited Bristol, Va., just days after it held a health care
event in nearby Wise, Va.
“My position on
the Obama plan is that I am delighted to see so much focus on the health care
issue," Mr. Brock said. “There is incredible focus on what we do, but
that is not my doing."
In the past,
Remote Area Medical has also provided services in mid-sized American cities,
including New Orleans
after Hurricane Katrina, but had never tried an operation in such a large
metropolitan area. Mr. Brock said the considerable logistics were made
possible with the help of Don Manelli, a film
producer, but he said he was disappointed in the dearth of volunteers among
local providers — specifically dentists and optometrists — which made it hard
to provide services for all comers.
Ana Maria Garcia,
who works for Orange
County, has health
insurance that covers her husband and 3 ½-year-old daughter,
but her dental deductibles are too high for them all to get care, she said.
Ms. Garcia’s
husband, Jorge, who was laid off from his custodial job last October, arrived
from their home — a 90-minute drive away — at 4 p.m. on Tuesday to get the
family’s spot in line.
But the Garcias’ number never came up, so they slept in their car
for a few hours and lined up again early Wednesday morning, awaiting a chance
to get root canals and cleanings that Ms. Garcia figured were worth thousands
of dollars. They made a friend in the bleachers outside, who gave the family
some coffee and hot biscuits for breakfast.
“Regardless if you
are employed or not,” Ms. Garcia said, “everything in California is expensive, and so I can
empathize with everyone here. Looking at this crowd, I think this is what
people fear health care is going to be with reform. But to me it also shows
the need.”
Last month, the
state dropped its dental and vision coverage for MediCal
enrollees, and has since capped enrollment in the state’s health insurance
program for children of the working poor. Thousands of people across the
state lost their coverage in the middle of complex, multimonth
procedures and have found themselves at a loss.
Sammie Edwards, a
retired welder, was in the middle of getting dentures made when his care ran
out, he said. A friend at a food bank clued him into the free clinic. “A lot
of older people are caught in the midst of this,” Mr. Edwards said.
Begun in 1985 as a
mobile health clinic serving undeveloped countries and later rural America,
Remote Area Medical provides various medical services through units to people
who are largely unable to gain access to health care. Officials from the
organization said they believed that this week’s event in Los Angeles constituted the largest free
health care event in the country, with the arena and all supplies and
services provided free to the group. Other expenses were covered by the
group’s fund-raising.
On Tuesday,
volunteers provided 1,448 services to about 600 patients, including 95 tooth
extractions, 470 fillings, 140 pairs of eyeglasses, 96 Pap smears and 93
tuberculosis tests, the organizers said. Hundreds of volunteer doctors,
dentists, optometrists, nurses and others are expected to serve 8,000
patients by the end of the eight days.
For those willing
to endure the long waits, the arena was like a magical medical kingdom, where
everything was possible once a person got through the door. Mike Bettis, who runs security for a nightclub in Hollywood, and his
fiancée, Lourie Alexander, who cleans homes, said
they usually went on Craigslist, exchanging a home cleaning for a dermatology
appointment.
By Wednesday, the
couple had gotten between them dentures (him); a breast exam, Pap smear and
general physical (her); and acupuncture (both).
“What I liked
about it was that everyone was so sweet,” Ms. Alexander said. “You know when
you haven’t seen a doctor in so many years you have a lot of questions.”
http://www.nytimes.com/2009/08/13/health/13clinic.html?ref=health
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The New York Times | 08.12.09
By DAVID STOUT
WASHINGTON — Lawmakers ran into fresh anger and skepticism
on Wednesday as they fielded questions from constituents worried about
changes in the health care system, and about a lot of other things having to
do with government.
The queries hurled
at legislators from the Atlantic Seaboard to the nation’s midsection
reflected deep-seated fears, a general suspicion of government and, in some
cases, a lack of knowledge on the part of the questioners.
“Why does the
government want to rush into this bill when many don’t want it?” Senator Ben
Cardin, Democrat of Maryland, was asked at a “town meeting” in Hagerstown. “Why are you
rushing this?”
Calmly, the
senator replied in a snippet shown on CNN, “We’ve got to take as much time as
we need to get it right.” And he added, “The status quo is unacceptable.”
The senator was
too polite (or intent on survival) to correct his questioner by pointing out
that there is not one bill yet, but rather several proposals working their
way through five committees in both houses of Congress, and that to talk of
“the government” as a single entity makes no sense, at least in this context,
because of the divisions between Republicans and Democrats, House and Senate,
Capitol Hill and the White House.
Mr. Cardin had to
raise his voice slightly to speak over shouts from the audience. "I’m
not going to vote for any bill that adds to the national debt," he said
at one point.
As for any
implication that there is a “rush” to enact health-care legislation,
President Obama may have been responsible for that, at least in part, by
calling for final action before the House and Senate adjourned for August.
And fixing health care, whose costs have been soaring, has been talked about
for years, most notably in the failed attempt to enact sweeping changes early
in the administration of President Bill Clinton.
Many hundreds of
miles away on Wednesday, in Iowa, Senator Charles E. Grassley, perhaps the
state’s most popular Republican, found it necessary to tell an audience at
the Winterset Public Library that he is against any plan that “determines
when you’re going to pull the plug on grandma,” against any plan that would
provide government-funded care to people in the country illegally, and
against end-of-life counseling when death is near.
Mr. Grassley was
apparently reacting to groundless assertions that health-care legislation
would call for “death panels” to determine who lives and dies (the AARP, the
lobby for older Americans, calls such charges “lies”), and provide health
coverage to illegal immigrants when none of the major proposals before Congress
would do so.
“What we stand for
is that the government is not going to take over our health-care system,” Mr.
Grassley said, to cheers and applause. “What we stand for is to make sure
that no bureaucrat gets between the doctor and the patient.”
Were he more
professorial and condescending, Mr. Grassley might have pointed out that
government already has a fairly big role in health care, as in Medicare,
Medicaid and, to an extent, Social Security.
But the senator
did not. In 2004, he proudly said that his constituents “don’t feel like Washington has gone to
my head,” according to The Almanac of American Politics. He surely
understands that older people, who worry almost reflexively about any hints
at changes in Medicare or Social Security, vote in big numbers — whatever
their gaps in knowledge and information — and that their ranks are growing.
Senator Arlen
Specter, the Republican-turned-Democrat from Pennsylvania,
endured another day of hostile, sometimes fact-defying questions at a town
meeting in State College,
Pa., The Associated Press
reported.
“What’s up with
all this?” one questioner said. “This is socialism.” Cheered on by some in
the audience, the questioner persisted. “What about the money and speed of
all this? If this is for the people, what’s the big hurry?”
The senator
replied, “We’re slowing down. We’re taking our time to do it right.” (Mr.
Specter could have pointed out that, whatever its virtues, the Senate is not
designed for speed.)
Senator Claire McCaskill, a Democrat from Missouri, got an earful on Tuesday, being
greeted by jeers at a health care session in her home state. “I don’t
understand this rudeness,” she said at one point. “I honestly don’t get it.”
By Wednesday
morning, Ms. McCaskill apparently did. “These
people are frustrated, and they don’t trust government,” she said in an
interview on MSNBC.
At the White
House, President Obama’s chief spokesman, Robert Gibbs, was asked again on
Wednesday if, perhaps, the administration had not done a good enough job
explaining and selling the proposed health care overhaul. Mr. Gibbs suggested
that the media bore some of the blame, for doing too many “X said this, Y
said this” stories, without rooting out, and pointing out, unambiguous
falsehoods.
But Jessica Yellin, CNN’s national political correspondent,
commenting on Senator Cardin’s town meeting in Hagerstown, Md.,
pointed out what news people already know: when journalists cite outright
misstatements by public officials, the American people “don’t seem to trust
us.”
http://www.nytimes.com/2009/08/13/health/policy/13townmeeting.html?ref=health
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The New York Times | 08.12.09
By RONI CARYN
RABIN
Cheap, ubiquitous
aspirin has long been known for health benefits from basic pain relief to
heart attack prevention. But after a new study this week provided tantalizing
evidence suggesting that aspirin might increase survival chances for
colorectal cancer patients, experts were quick to warn that the drug, a
medicine cabinet staple, also had its risks.
“If I were on a
desert island, one of the drugs I would choose to have with me, hands down,
maybe No. 1, is aspirin,” said Dr. John A. Baron, a professor of medicine at
Dartmouth Medical School. “It’s a fascinating, wonderful drug, a great drug.
But it is a real drug, and it has side effects.”
Both Dr. Baron and
other medical experts cautioned against starting a daily regimen of aspirin
without consulting a physician, because of the risks of gastrointestinal
bleeding, and the potential risk for hemorrhagic strokes, or bleeding in the
brain.
“Aspirin is a drug
that been with us a little over 100 years, and we continue to learn
impressive and important things about its potential benefits,” said Dr. Otis
Brawley, medical director of the American Cancer Society. “But it is a
double-edged sword.”
The study found
that patients with colorectal cancer who were regular aspirin users had a
much better chance of surviving than non-users, and were almost one-third
less likely to die of the disease, while those who began using aspirin for
the first time after the diagnosis cut their risk of dying by almost half.
Earlier studies
had shown that people who took aspirin regularly were less likely to develop
tumors of the colon, but the new study, published in The Journal of the
American Medical Association, is the first to have found that patients who
had colorectal cancer and took aspirin survived longer.
One colon cancer
expert who commented on the recent study called it “remarkable” and
“revolutionary.” But then his patients started seeking advice, and he was
more circumspect.
“It’s one thing to
talk philosophically,” said the expert, Dr. Alfred I. Neugut,
an oncologist from the College of Physicians and Surgeons at Columbia
University who wrote an enthusiastic editorial on the study in this week’s
Journal of the American Medical Association. “But this is only one study. To
know that it’s true, it needs to be repeated. Every experiment needs to be
repeated once.”
The new study was
not a controlled clinical trial, where patients are randomly assigned to
receive either a particular treatment or a placebo. That kind of study is
considered the gold standard for determining clinical recommendations in
medicine, but it is also far more expensive and cumbersome. Observational
studies, like this new one, can be weaker or misleading.
One clinical trial
is under way in Asia, where the National Cancer Center of Singapore is
enrolling 2,660 patients with nonmetastatic disease
in Hong Kong, India,
Indonesia and Singapore,
who will continue their treatment and be randomly assigned to either get
aspirin or a placebo daily for up to three years, according to the National Cancer
Institute Web site.
Most colorectal
cancer tumors are positive for cyclooxygenase-2, or COX-2, an enzyme that is
not expressed in a healthy colon but flares up under certain circumstances.
The enzyme appears to be involved in fueling abnormal cell growth and
contributing both to the development and spread of the cancer, said Dr.
Andrew T. Chan, the author of the new study.
Aspirin’s
anti-cancer property is believed to be linked to its action as a COX-2
inhibitor.
A clinical trial
of another COX-2 inhibitor, celecoxib, which has
the brand name Celebrex, is in the planning stages and will be enrolling
patients early next year, Dr. Chan said. Although more is known about
aspirin’s effects on preventing colorectal polyps and tumors than other
cancers, some studies have also hinted that aspirin could reduce the risk of
developing breast, lung and prostate cancers, which are also associated with
inflammation, Dr. Brawley said.
“It seems like —
and we’re still talking in theory in some instances here — there is a
relationship between inflammation and cancer in certain tumors,” Dr. Brawley
said. “And these drugs appear to be beneficial because they are
anti-inflammatory, and they inhibit inflammation by inhibiting COX-1 and
COX-2.”
The new colorectal
cancer study found not only that patients who took aspirin regularly after a
diagnosis of colorectal cancer had a better chance of survival than those who
did not, but also that those who had tumors that overexpressed
the COX-2 enzyme were particularly responsive to the aspirin.
Dr. JoAnn E. Manson, chief of preventive medicine at Brigham
and Women’s Hospital, which is affiliated with Harvard Medical School, warned
about the risks of using even small doses of aspirin on a daily basis, saying
that in a large women’s health study, half doses of baby aspirin were
associated with a 40 percent increase in serious gastrointestinal bleeds that
required transfusions.
But, she
acknowledged, patients who already have colorectal cancer may feel they do
not have the luxury of waiting for additional results.
“I don’t think
everyone should be running out and taking aspirin,” she said, “But there may
be some patients who would benefit from it at this point; and if they talk
with their doctors they may learn they’re reasonable candidates, and some of
them may not be in a position to wait.”
http://www.nytimes.com/2009/08/13/health/13aspirin.html?ref=health
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