PNHP

Medical Triage at Encampment

Medical Triage at Encampment

By JESSICA FIRGER and SUMATHI REDDY
The Wall Street Journal, October 22, 2011

[PNHP note: The following article mentions the involvement of Dr. Mary O’Brien and several other members of the New York Metro chapter of PNHP in the Occupy Wall Street actions. For a more complete picture of the chapter’s participation in the OWS movement in New York, visit their blog.]

As temperatures dip and the Occupy Wall Street protesters head into their sixth week of camping at Zuccotti Park, health professionals say they are treating activists for ailments ranging from hypothermia to skin infections, the effects of living outside in crowded conditions with little more than sleeping bags and tarps.

At a medic tent at the Lower Manhattan encampment volunteer doctors and nurses treated more than 100 patients one day this week for a variety of conditions, many of which were related to the rainy and increasingly chilly weather.

“One person had a dislocated shoulder, another with asthma,” said Mary O’Brien, a member of Physicians for a National Health Program who volunteered Tuesday evening at the tent. Another had a seizure disorder and no medication, she said.

Daniel Todd, a member of the protesters’ “street medic” committee, said he saw 25 cases of hypothermia on Wednesday.

The 21-year-old CPR-certified Brooklyn resident was mincing garlic and ginger on Thursday. “I’m the herbalist here,” he said, explaining he would combine the ginger and garlic with apple cider and cayenne pepper to make what he calls fire water. The concoction, he said, is “for congestions and colds.”

Protesters had formed their own medic committee, whose members wear reflective vests with stickers that say “99 percent ER.” Now they are working with National Nurses United, which has established more formal first-aid tents at Occupy movements across the country.

The group also has circulated a petition to city officials seeking permission for protesters to erect tents to sleep in to protect them from the increasingly cold weather. City rules say tents and other structures can’t be put up on public spaces. Still, on Friday night, a dozen or more personal tents began appearing.

A spokeswoman for Mayor Michael Bloomberg didn’t respond to a request for comment.

At the National Nurses United tent, three nurses work six-hour shifts. Four doctors from PNHP also have signed up to volunteer, and several more have expressed interest. The city had threatened to dismantle the tent earlier in the week, according to the nurses group, but has allowed it to remain standing in recent days. Outside the tent, there is a “help yourself” first-aid station with bandages, antacid, witch hazel, calamine lotion and vitamins.
George Machado, 20 years old, was among the protesters who have sought medical assistance. Mr. Machado said he sprained his ankle at a protest at Washington Square Park. “There was some swelling,” he said. “I went in the tent and they elevated it and iced it. This is great, I don’t have health insurance.”

Mr. Machado’s case isn’t unusual.

“Everyone I saw yesterday had no health insurance,” said Maria Fehlig, an NNU member who left her family and hospital job in Las Vegas to volunteer for three weeks.

Some protesters have been directed to the nearby Access Community Health Center on Maiden Lane, which largely serves residents without health insurance.

Debra Sorkin, executive director of the center, said they have seen a steady flow of protesters. Most prevalent are fungal and skin infections and respiratory illnesses “from the torrential downpours,” said Ms. Sorkin. “The first ones came to us about two weeks ago,” she said, adding that they hope to make flu shots available soon.

Health care at Zuccotti Park extends beyond unions and formal organizations. Jack Berall, 70, visits Zuccotti Park about four or five times a week. A doctor with a private practice, he also works at a clinic.
In a rumpled suit and with a copy of the Occupied Wall Street Journal in his jacket pocket and a stethoscope around his neck, Dr. Berall surveys the park to see if anyone needs medical help. His main piece of advice: that protesters and visitors refrain from shaking hands. He suggests they do a “fist bump” instead.

http://online.wsj.com/article/SB10001424052970204485304576645531217538502.html

Is medical care a good business?

By Philip Caper
OpEd, Bangor Daily News, Oct. 20, 2011

For the past several decades, America has been experimenting with applying the principles of business to our health care system. Many believed that by unleashing the power of markets, health care costs would be controlled and access and quality improved.

That experiment has been a spectacular failure. Today, a larger percentage of Americans lack health insurance or are seriously under-insured than at any time since the enactment of Medicare and Medicaid 46 years ago. That number is increasing every day.

Health care costs are at levels never before seen anywhere in the world and are increasing in an uncontrolled and unsustainable way. Despite our high per-person costs — double those of other developed countries — tens of thousands of Americans die every year from lack of timely access to health care.

The degree of interference with doctors’ and patients’ health care decisions that exists in America today would not be tolerated anywhere else in the world. “Death panels” do exist in America, but they are run not by government but by private corporations. Their purpose is to maximize profits.

Americans are unique in the world in thinking about health care as a business. In no other country is that notion so widely and unquestioningly accepted.

In his landmark 1983 book about the sociology of American medicine, Paul Starr describes its evolution throughout much of the 19th and 20th centuries as being driven primarily by mission — preventing illness when it could and diagnosing, treating, curing and comforting patients when it couldn’t. In the early 20th century, George Merck, founder of the large pharmaceutical company bearing his name, provided an example of this approach when he said “If we develop good medicine that cures people, money will take care of itself.” Mission, not money, motivated most of those involved in medical care.

Starr’s book describes the successful efforts of physicians to block the creation of health care as a right of all Americans during the first half of the 20th century. They were afraid of a government takeover of medicine. But, Starr warned, the real threat to the autonomy of American doctors was not government, but corporations.

Now, almost thirty years later, Starr’s warning has come true. Large corporations, many of them for-profit and publicly traded now dominate the financing and delivery of American medical care. As Melody Petersen has documented in her book “Our Daily Meds,” instead of embracing George Merck’s philosophy, pharmaceutical companies have become huge marketing machines. They now are focused far more on their profitability than on their healing mission. Producing medicine that cures diseases instead of just treating symptoms has become a bad business model. Once a disease is cured the customer disappears and profits decline.

It was not always this way. Thinking about medicine shifted during the late 1970s due to the belief that what was needed to cure the rising costs and increasing numbers of uninsured was a more businesslike approach. Business schools began to offer courses in health care and doctors began to acquire MBAs.

The culture and vocabulary of health care underwent a remarkable change. Where hospital directors used to be called “administrators,” they became CEOs. What used to be called “hospital services” became “product lines.” Those who used to be called “patients” became “market share.” Advertising by doctors and hospitals, once considered unethical, became commonly accepted.

Although these changes resonated with many Americans, there was one huge problem. The mission of health care is very different from the mission of business. Health care is about keeping people healthy or returning them to health when they become ill. Business is about generating wealth for its owners. In investor-owned businesses, wealth comes in the form of profits. In nonprofit businesses, it is in the form of unchecked expansion and high executive compensation.

Both health and wealth are missions that have their places. But in health care they often conflict. In Maine, 80 percent of doctors are now corporate employees. In too many cases, corporate executives, not caregivers, are calling the shots. In today’s corporate health care industry, physician “productivity” is often measured not by patient health but by profit.

That conflict explains why so many doctors are becoming so frustrated with their profession. Likewise, many patients are becoming distrustful of our increasingly corporatized and bottom-line-driven health care system and of their own doctors. But trust is crucial to healing.

The corporate takeover of health care in America is one of the most important factors driving the explosion in health care costs and the rising number of Americans without timely access to medical care. This change in the culture of American health care from a mission of healing to a mission of profit has had profoundly damaging consequences.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be contacted at pcpcaper21@gmail.com.

http://bangordailynews.com/2011/10/20/health/is-medical-care-a-good-business/

OECD/WHO report on the Swiss health system

NOTE: The Swiss have a universal, highly regulated system of social insurance based on nonprofit private insurance plans. Many consider their system to be superior to ours and one that ours might eventually emulate. Though this message is long, you should save it if you don’t have time to read it now. It explains why an “ideal” system based on private health plans is not such a great idea after all.

OECD Reviews of Health Systems: Switzerland 2011

OECD, World Health Organization
Organization for Economic Cooperation and Development (OECD)
October 18, 2011

Chapter 2 – Health Insurance

(Excerpts)

In 1996, Switzerland implemented the Health Insurance Law (LAMal), which sought to achieve three main objectives: strengthening solidarity in the Swiss health system, containing health spending, and guaranteeing high-quality coverage.

2.1  General trends in the Swiss health insurance market

The Swiss health insurance market relies on regulated competition based on a set of key principles: health insurers cannot make profits on contracts for mandatory health insurance, consumers have free choice of insurer, and insurers are compelled to accept any applicant. The benefit basket covered by health insurance is defined at national level for all insurees and health insurers must offer the same premium to all enrollees with the same health insurance contract provided they are in the same age category and same region. Health insurers can propose optional health insurance contracts which provide lower premiums in exchange for higher deductibles or “managed care” contracts. Insurers can also offer “bonus” contracts, where insurees receive premium reductions if they do not claim any reimbursement from their insurance fund.

#  Swiss health insurance offers comprehensive coverage of health care

In principle, all medical treatments and diagnostics prescribed by doctors and dispensed by licensed professionals are covered, unless they are explicitly excluded from the benefit basket. Mandatory health insurance also covers the costs of medical care provided to patients receiving long-term care in institutions or at home.

After paying a deductible, patients contribute to the cost of care through coinsurance rates – usually 10% of costs – up to an annual ceiling.

“Rationing” has not been part of the political agenda. The level of user charges, however, is one of the highest in the OECD.

#  Consumers can choose between different options for health insurance plans

Ordinary contracts offer the highest level of financial protection against health care spending but also have the highest level of premiums. Other forms of health insurance contracts offer lower premiums with either higher deductibles or restrictions in the choice of doctor or hospital.

The take-up of ordinary plans has been continuously declining, first to the benefit of high-deductible health plans. However, since 2004, the popularity of plans with restricted choice of provider has increased dramatically, with the share of insurees choosing such plans (36.9%) now higher than ordinary plans (35.2%), high-deductible plans (27.9%) and bonus plans (0.1%).

#  Consumer choice has increased at cantonal level, in spite of market concentration nationally

#  Private supplementary health insurance covers one third of the population

2.2  The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain

#  Switzerland has reached universal coverage

Health insurers have been required to refuse payment for health care bills presented by negligent defaulters (366,000) until they have fully recovered unpaid premiums and related interests. In March 2010, the parliament revised the law with the objective of protecting people facing serious financial problems for paying premiums.

#  Health insurance premiums vary widely across and within cantons

These intra-cantonal premium differences persist because of insurers’ risk-selection activities and also because relatively few insurees switch insurers from year to year, although this number has been rising recently.

#  Public subsidies help some individuals and families pay health insurance premiums

By nature, non-income related premiums are very regressive. In 2008, premiums accounted for 11.8% of household income for the lowest income quartile and 3.4% for the highest income quartile.

The LAMal requires premium reductions of at least 50% for children and young adults in training in low and middle income households, but lets cantonal authorities define the thresholds used to define “low and middle income.”

Sixteen cantons fix a maximum percentage of households’ income to be spent on premiums and subsidise any additional amounts. While this limits the households’ effective burden, premium payments remain regressive.

It is worth noting that achieving horizontal equity in health financing is not an explicit policy goal in providing premium subsidies in Switzerland. Furthermore, subsidies do not address health financing inequities resulting in out-of-pocket expenditure, such as copayments and deductibles which are independent of household incomes.

#  Swiss patients face relatively high out-of-pocket payments for health care

Per capita out-of-pocket payments in Switzerland are significantly higher than in all other OECD countries: they are 60% higher than the United States and almost three times as high as the OECD average.

#  Out-of-pocket payments are usually regressive and thus the least equitable means to finance health care.

The fact that an increasing number of consumers are opting for high-deductible plans is very likely to increase user charges for “essential care” and weaken the solidarity of the health insurance system.

#  Contributions to the financing of health spending are inequitable

#  Financing health care is a high burden for low-income families

There is some indication that people forego health services due to high out-of-pocket expenditure, and that this is related to socio-economic status.

2.3  Competition in health insurance markets does not deliver all its promises

#  Switching rates are still low, though increasing in the recent period

#  Fragmentation increases administrative costs and premiums

Multiple fund systems, especially with small pools, often coincide with relatively higher administrative costs. Moreover, a risk equalisation mechanism also creates additional administrative costs. Switzerland has relatively higher administrative costs for both social and private health insurance. Those accounted for respectively 5.9% and 17.0% of total health insurance costs.

#  Health insurers mainly compete on risk-selection

Van de Ven et al. (2007) listed possible strategies for insurers to select good risks despite their obligation to accept any applicant. The list includes:

*  Marketing through targeted advertisements aimed at the healthier.
*  Selective contracting with providers (i.e., in managed care contracts) likely to attract the healthier who are more willing to accept limited provider choice.
*  Designing complementary insurance benefits packages and setting premiums such that low-risk individuals are attracted.
*  Exclusively offering contracts with high deductibles, which will offset higher risk individuals.
*  Establishing insurance conglomerates to channel new enrollees to specific contracts depending on their health risks; this strategy most often works due to the huge number of different contracts on offer, limiting the consumer’s ability to be fully informed.
*  Identifying high risks via a health status declaration for those seeking complementary insurance.
*  Delaying reimbursements for chronically ill persons in order to make them leave the insurance.
*  Terminating insurance activity in areas with any high-cost patients.

Many of these strategies are indeed manageable options for Swiss health insurers. The extent to which they really use them is not easy to determine.

#  Managed care plans have taken off since 2006 but insurers only modestly “manage care”

The extent to which current managed care networks increase quality and efficiency in health care delivery is not well known. By nature, the impact of managed care is difficult to assess and disentangle from risk-selection, since these specific forms of contracts are known to attract people with good health risk profiles. Thus, age and gender adjusted comparisons of health care spending of managed care policy holders and other insurees are not sufficient to estimate savings achieved through managed care.

#  The inclusion of another risk factor into the risk-equalisation formula is a good step but may not be enough

Initially, the risk equalisation mechanism was based on two simple risk factors only: age and gender.

A new and third risk factor – hospitalisation beyond three days in the previous year – has been included in the risk equalisation formula and will be applied from January 2012 onwards. While this new factor will not fully avoid risk selection, it will now also be profitable for insurers to invest in product innovation, i.e. further develop managed care contracts.

(Single payer)

The high levels of fragmentation in a country with a small population raises questions about a single health insurer. In theory, a single insurer could pool risks more effectively. In light of risk equalisation mechanisms that are imperfect as long as there remain incentives for risk selection, a single insurer might in principle better ensure health financing equity across the population and strong purchasing, in addition to a tendency for lower administrative costs. Moreover, it provides incentives to focus more on prevention. A single insurer system thus has some important advantages. However, it has also its drawbacks, since it eliminates consumer choice, may inhibit innovation in insurance products or risk under-provision and rationing care when negotiated prices are too low.

Shifting from a multiple insurer system to a single insurer system is with no doubt a tremendous challenge, although Korea demonstrated that a step-wise merging into a single fund is possible. However, this is likely to be particularly difficult for Switzerland, which has a very long history of multiple insurers for over 100 years, a strong preference for choice, and as a reflection of its federalism, an attachment to cantonal organisation. Moreover, there are considerable transaction costs to consider, not least the question about where to place all staff from the current health insurers. Any such reform option thus needs to be critically assessed as to its overall financial implications, its practical implementation as well as political feasibility. In fact, the option of a single insurer in Switzerland has already been rejected several times so far by the population, although a new initiative was launched in 2011.

OECD Reviews of Health Systems: Switzerland 2011 (160 pages):
http://www.oecdbookshop.org/oecd/display.asp?sf1=identifiers&st1=9789264120907

It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end.

There is one bit of good news buried in this report. A single payer system would correct these deficiencies. Although the report mentions the drawbacks of eliminating consumer choice and inhibiting innovation in insurance products, these are actually advantages. The loss in consumer choice is the loss in the ability to choose from a large market of private health plans which often take away provider choice. Eliminating the plans returns choice of providers to the patient. Innovations in insurance products are designed to benefit the private insurers by gaming the system to the detriment of the patients. That’s innovation that they can do without.

The report also cautions that a single payer could “risk under-provision and rationing care when negotiated prices are too low.” This is a criticism of single payer systems that does have some merit, but it ignores the fact that this risk is even greater in privately insured managed care models. All systems face capacity and access problems, but the public stewards of a single payer system are in a position to act in the public interest, whereas private insurers use tools to deliberately obstruct access in order to reduce spending. Public single payer stewards are much more capable than private insurers of using capacity refinement and queue management to reduce the risk of under-provision (rationing) of care. It is true that conservative fiscal hawks, when they are in control, continually threaten excessive budget constraints, but the behavior in the private sector is much worse as ever more of the costs are shifted to those with greater health care needs, creating a formidable financial barrier to care. Our U.S. system of inhumanely rationing care by ability to pay is far worse than systems that struggle with capacity and queues because of budgetary limitations, especially when you consider that we already have by far the largest per capita health care spending of all nations.

The important take-home point is that an “ideal” social insurance program based on the mandatory purchase of highly regulated, nonprofit private health plans, such as that in Switzerland, is far from ideal in that it fails to prevent the flaws inherent in the private insurance model – including segmentation and fragmentation, costly administrative excesses and inefficiency, inequitable regressive financing, excessive premium variation, shifting of costs (risks) to patients in order to protect insurance plans, and, perhaps most fundamentally, rejecting a public service model in favor of a private business model that intrudes in the relationship of patients and their health care professionals and institutions by gaming the system for the primary purpose of achieving success as a business, while relegating serving patients to a secondary role.

In 2007, even though the Swiss understood the advantages of a single payer system, they rejected it in a ballot measure. The predominant reason was that 70 percent of the Swiss were not willing to trade their private insurance plans, which were perceived to be functioning fairly well except for high premiums, for a public program for everyone that they feared would be like their existing health welfare program for the poor, which most believed was plagued by bureaucratic inefficiency and cost overruns. They feared that they would be worse off in such a public program. In their campaign against the single payer proposal, the organization representing Switzerland’s private health insurers, santésuisse, deliberately mislead the public by modeling the single payer proposal as a welfare program that would be funded primarily by middle-income citizens, creating this widely held misperception that resulted in the measure’s defeat.

The Swiss voters will get another chance with a new initiative launched this year. The question is, when will we get our chance?

Why I won’t give up in the fight for single payer

By Robert Peck, M.D.

Dr. Robert Peck is the honorary chair of the Los Angeles Chapter of PNHP California. The following is a brief autobiography of a physician who has dedicated his life to patient advocacy.

Nineteen-twenty-six was a great year to be born. I have been part of all that has happened since. From ’26 to 1934 we were living pretty well in Canton, Ohio. My father, Sam Peck, managed a department in the local department store. My parents were inordinately happy to have this only child. We had a maid, spent three winter months in Miami Beach every winter. My Uncle Si rented a big house and invited his four siblings and their families to join him. My father voted for Hoover in 1932.

But our status came to a sudden end in ’34 when my father lost his job in the deepening Depression. We came to Los Angeles “to starve in the sunshine.” He became an ardent partisan of Franklin Roosevelt and the New Deal. So did I, and I still am. I started my public career speaking for School Bonds when I was 10. L.A. schools were unsafe after a big earthquake. People did not have money but they voted yes for school bonds.

I became radicalized when I was 14 and Uncle Si gave me a subscription to The Nation. When I was 15, in December 1941, Japan bombed Pearl Harbor. Two months later, my junior high school pal Jiro was ordered to leave his home along with all people of Japanese descent on the West Coast and were held in relocation centers. This further radicalized me.

In medical school at USC, I organized a chapter of the Association of Interns and Medical Students. AIMS worked for universal health care, which was proposed in the Murray Wagner Dingell Act at the time, for admission of all colors and varieties of applicants to med schools, end to the Cold War and other peace and justice issues. We in AIMS were clearly “subversive” in the lexicon of the FBI and the House Un-American Activities Committee. Fueled by the Cold War and then the hot war in Korea, they swooped down on AIMS and many progressive organizations. AIMS was driven off medical campuses one after another.

I was a medical resident at the University of Chicago in 1951 and ’52. I worked like hell, night and day, as I had as an intern at L.A. County Hospital the year before. I also circulated a petition urging Cedars of Lebanon Hospital in Los Angeles to reinstate three prominent physicians who had been dropped from the staff for being alleged Communists. The last national convention of AIMS was held in Chicago in 1951. Quentin Young and I and other house staff and medical students fought a rearguard action to save AIMS but the Korean War, the FBI and frightened medical school administrators shut us down. A few months later I was fired from my residency. On balance, Chicago and AIMS, working with my fellow radical activists, were great human experiences.

My wife, baby daughter, and I moved from Chicago to Harlan County, Ky. There I joined a three-man group providing care to coal miners and their families under the United Mine Workers Welfare Fund. I was the internist of the group and I also delivered babies. I loved it. But then as now you have to understand, “There’s a war on.”

In 1953 I was drafted into the Air Force illegally. The Doctors Draft Law required that drafted doctors had to be given officers commissions. Thirty-two of us refused to sign Cold-War-generated loyalty oaths and were held as “doctor privates.” As always I worked hard taking care of my patients, talking to other Air Force members about the evils of the AF loyalty oath. A year later a conservative federal judge granted my petition for a writ of habeas corpus and I was out of the Air Force.

Back home to Los Angeles, I joined the Community Medical Center (CMC), a small group medical practice which provided good quality health care to patients who could not afford usual fees. Soon after, the Un-American Activities Committee held hearings on “Communism in the medical profession.” The star witness was an alleged former member of the CMC medical staff whom I had never seen. She testified, “Those doctors are not working for patients, they are working for the Communist Party.” That was the headline in the L.A. Examiner and the “red meat” lead on TV. We gained patients after this “expose.” By contrast the CMC failed a year later because of internal rifts. The group practice survived.

From 1953 to 1974 I practiced as internist in our small medical group and then left for three more years of training and emerged as a cardiologist and assistant clinical professor of medicine at UCLA, later at Keck/USC medical school where I teach part time. Every week I take six first-year medical students from the medical school, across the street to the L.A. County General Hospital where they interview and examine patients, one-on-one, and begin the process of becoming physicians.

Achieving the universal human right to health care is a lifelong commitment. But it is not a single life issue. For example in 1961 the Civil Defense Agency urged homeowners to dig “fallout shelters” in their backyards to survive an anticipated Russian nuclear attack. School children did “duck and cover” exercises. They ducked and got under their desks to stay safe in case of an atom bomb. This widespread paranoia was produced by the U.S. government and amplified by the media. This mendacious campaign was considered essential to convince the public to support nuclear war fighting; for “defense,” of course.

In 1961, Dr. Bernard Lown, a Harvard cardiologist, and several other Boston academics, analyzed Civil Defense data supporting the premise of survivability after a single Hiroshima size bomb exploded over Boston. Their study demonstrated conclusively that no one would survive for miles around Boston. They published their results in the New England Journal of Medicine. The Civil Defense Agency didn’t survive much longer. (Now we have a federal Department of “Homeland Security.”)

But in 1961, Physicians for Social Responsibility (PSR) was born. Lown was its obstetrician and cardiologist. I began organization of the first local chapter, LAPSR. PSR is now a large, well-established national organization. For 50 years we have published, testified and demonstrated against nuclear war preparation and the nuclear industry which underpins it. PSR issues have broadened to include the environment, and others.

Two other organizations were formed by leaders of PSR. One was the International Physicians for Prevention of Nuclear War (IPPNW): “What cannot be treated must be prev
ented.” IPPNW grew rapidly among physicians in many countries including the Soviet Union. All worked to prevent nuclear weapons in their own countries. Lown worked with his counterpart, Dr. Chazov, cardiologist to the general secretary of the Soviet Communist Party, against nuclear war. In 1985, Lown and Chazov, on behalf of IPPNW, were awarded the Nobel Prize for Peace.

Soon after the founding of PSR the struggle for civil rights mobilized Americans to a degree not seen since the great Depression. Dr. Quentin Young and some other progressive doctors in Chicago organized the Medical Committee for Human Rights. We in Los Angeles organized the L.A. chapter of MCHR. Later we merged LAPSR and LAMCHR. Issues of Peace and Human Rights cannot be separate. During the Freedom Summer, 1964 LAPSR/MCHR sent MDs to Mississippi for short stays to support SNCC and others who were registering Black citizens to vote. My brief sojourn with Mississippians and the civil rights workers, who came to register them, was one of the most inspiring of my life.

An outgrowth of PSR was the Committee of Responsibility for War Injured Vietnamese children (COR). This organization grew in cities across the U.S. I was the Los Angeles board member of COR. We brought war injured Vietnamese children to U.S. medical centers for complex surgeries. In L.A., Dr. Leonard Linde, a UCLA pediatric cardiologist, organized with UCLA faculty surgeons to treat two VN children at UCLA Medical Center by the hospital and the doctors without charge. Dr. Linde was their attending pediatrician. He had to confront the medical school dean who opposed our plan. The dean rightly believed that exposing the U.S. public to the effects of our VN war on children would adversely affect public support of the war. The children underwent multiple surgeries and postoperative rehabilitation services. They lived with a member of COR and her family when they were not in the UCLA Hospital. One of the children came back to Los Angeles at age 20, a lovely young woman transformed from her grotesque face when she first arrived at UCLA.

In the U.S., there was growing resistance to the draft and widespread revulsion over the nightly TV pictures of U.S. forces killing women and children, including by napalm. Of course we organized to stop the war. In 1967, we joined several thousand other people to confront President Johnson at the Century Plaza Hotel over his escalating war in Vietnam. The police used excessive force against us. Ruth Peck confronted a policeman who was threatening a person with epilepsy who was on the ground and could not “Move On!” Next day, Ruth arranged a press conference at our house. Doctors who had been at Century City the day before testified about what they saw, an entirely peaceful demonstration with policemen attacking demonstrators. Soon after, Johnson announced that he would not run for reelection.

Ruth also organized large successful fund-raising parties to benefit the Committee of Responsibility for War Injured Vietnamese Children. At one if these events our featured speaker was renowned pediatrician and antiwar activist Dr. Benjamin Spock. A footnote that evening was the meeting of Dr. Spock and Mr. Spock, Leonard Nimoy, of “Star Trek.” Another speaker was Howard Levy, M.D., who was ordered when he was in Indochina to teach indigenous men to do first aid to win their tribes people over to fight for the Americans.

This order clearly violated the Hippocratic Oath. Levy refused and was court marshaled and sent to Leavenworth prison. He had just been released before our party. Dr. Levy told the gathering that he was a super patriot because he helped make the U.S. do right and get out of Vietnam.

On the other hand, the demands for civil rights gave Lyndon Johnson the ammunition he needed to push civil rights and Medicare through Congress. Opposition to Medicare from the Right was powerful. I debated against officers of the L.A. County Medical Association who invariably declaimed that Medicare was socialism and would put a government agent in every examining room. Some reactionary MDs pledged that they would never treat patients who wanted their services under Medicare. A few months later, all of them were treating seniors and billing Medicare, and doing very nicely, thank you. Medicare established health care as a right, but only when you reach 65 or are totally disabled.

Medicare provides seniors with a physician of their choice, has greatly expanded medical education. It has funded research which led to treatments we could only dream of before 1965. It has created millions of well-paying jobs which cannot be exported overseas. Medicare is a not-for-profit system that runs on 3 percent overhead. It is the best thing that has happened to patients and physicians. HMOs run on 20 percent overhead and are the worst thing that has happened to us and our patients.

Now we are in the long bitter struggle to improve Medicare and extend it to everyone By the mid-’70s I had been an activist for 30 years. If I had stayed in the service for 30 years, a ghastly hypothetical, I could have retired with full pension. I gave myself an honorable discharge from leadership positions in our organizations. In 1992, I helped organize CAPA, now Physicians for a National Health Program-California, and worked diligently for Proposition 186 to establish an expanded Medicare-type program for California. The authors of this bill were Dr. Kevin Grumbach, UC-San Francisco Medical School professor and CAPA leader, and a few others. Prop. 186 started out ahead in the polls but then, was defeated. For the details, please google “Buying An Election – California’s Universal  Health Care Initiative – 1994” by Gordon Skene on Jan. 30, 2010.

Greed succeeded. The insurance industry used appealing actors. Remember Harry and Louise, the lovable couple who told us innumerable times on TV how they loved their HMO and feared government intervention? They overwhelmed us. Prop. 186 went down in defeat.

Now I limit my organizational activism to PNHP-CA, and serve on the board of directors. I am not available for any executive position. I serve in the new position of PNHP representative in the 29th Congressional District of Congressman Adam Schiff. Since Franklin Roosevelt was president, we always had Republican congressmen in Pasadena. In 2000, we finally defeated the last Republican troglodyte and elected Adam Schiff. I have met with him often to urge he support single-payer health care. He never does. He does cast some liberal votes and we progressives in the district compliment him on these.

In CD 29 I work in coalition with other organizations. We have lobbied in meetings with Rep. Schiff, our state senators and Assembly members and the Pasadena City Council. A leading organize
r of this coalition is Irma Stranz, chairperson in Pasadena of Health Care for All, a member of the League of Women Voters, and an active member of PNHP in Los Angeles. Other organizations we work with include the Teachers Union, other unions and the Presbyterian Church. I go to rallies, march and write, for universal humane health care and for justice and to end all our imperial wars.

I also participate with Veterans for Peace in the weekly Arlington West memorial events, remembering all of U.S. war dead in Iraq and Afghanistan, when I can. We set out 6,000-plus crosses and Mogen Davids and crescents one for each of our servicepersons killed in Iraq and Afghanistan on the sand north of the Santa Monica pier each Sunday morning and take them down Sunday evenings.

Keep working for the changes we know are right and remember the 2,000-year-old Roman adage, Illegitimi non carborundum: “Don’t let the bastards wear you down.” In this case, the bastards who stole health care.

What Has Obama Done for Poor People?

By Cynthia Gordy
The Root, Oct. 19, 2011

He’s done a lot, says the White House in a new report. Anti-poverty advocates weigh in on their progress.

Anger and disillusionment over the widening wealth gap may have reached a national tipping point, as evidenced by the Occupy Wall Street movement. Yet leading politicians rarely mention poor folks.

“It’s almost as if poverty is a dirty word,” economist Julianne Malveaux, president of Bennett College for Women, told The Root. “Joe Biden is leading the Middle Class Task Force, and I think they’re doing some good work — but what about the poor?”

Perhaps the Obama administration has taken heed. Last week the White House released “Creating Pathways to Opportunity,” a report that confronts the country’s dismal unemployment rates and the growing ranks of Americans below the poverty line. The 44-page document makes its case for numerous actions that the administration has taken to deliver help to low-income communities, from targeted job-training programs to expanded Pell Grants. It also contends that President Obama’s American Jobs Act — which he continues to push, despite its failure to pass in the Senate — is needed to build upon their progress.

But does the scale of the president’s policies match the scale of the challenges? And with the economy struggling and African Americans facing a record 16 percent unemployment, can the administration really afford to rest on its accomplishments?

The Root will pose these questions and others to Domestic Policy Council Director Melody Barnes and Senior Adviser Valerie Jarrett in a special “Open for Questions” event hosted by the White House on Thursday. The 45-minute discussion, in front of a live audience, will be streamed on The Root and whitehouse.gov/live; it will also allow questions from the audience and readers on Facebook and Twitter.

For this article, The Root posed the questions to experts outside of the White House on six core areas.

Health Care

On Day 16 of Obama’s presidency, he signed legislation expanding health coverage to 4 million uninsured children. The law added to the 7 million kids already covered under the Children’s Health Insurance Program in part by allowing the children of documented immigrants to enroll (instead of requiring them to wait five years after entering the country, as was done previously).

“This bill is only a first step,” the president vowed at the signing ceremony. “Providing coverage to 11 million children through CHIP is a down payment on my commitment to cover every single American.” As the administration sees it, Obama kept his promise. They claim that 2010’s Affordable Care Act will ensure coverage for 34 million uninsured people when fully implemented, with the poor being eligible for either Medicaid or tax credits to buy insurance.

Claudia Fegan, a physician serving low-income patients in Chicago and a spokesperson for Physicians for a National Health Program, says that Obama’s initiatives have good intentions. “But the process is too complicated for most poor people, who have fairly chaotic lives, to access,” she said, citing the bureaucratic application process for CHIP as an example. “It’s hard enough to get people the care they need without making them prove that the need it, requiring documentation and jumping through hoops to get it.”

Fegan has similar “good intentions” concerns about the Affordable Care Act: “As this program goes forward, more people will be insured, but at what cost? We provide more people access to care, but we lose by decreasing funding for safety-net providers and cutting back on some of the Medicare reimbursement. But poor patients need more than just a doctor to prescribe medication — they need social services and assistance navigating the system, resources that other providers don’t necessarily have.”

If Obama hadn’t given up on the single-payer system from the start of 2009’s health care debate, Fegan thinks the resulting compromise might have been easier to administer. “People say that the Affordable Care Act is socialized medicine, but nothing could be further from the truth,” she said. “We’re pushing people into the private insurance industry. We did what was politically expedient, but we put in place a very complicated system.”

Safety Net

The president often points out that when he first took office, each month we were bleeding nearly 750,000 jobs. Tax cuts from his American Recovery Act, the administration says, kept 1.6 million Americans out of poverty and gave relief to more than 100 million others. The stimulus measure also expanded the Supplemental Nutrition Assistance Program, which, despite increasing poverty, staved off a rise in child hunger.

Pitching the Recovery Act in February 2009, at his first joint session of Congress, Obama said, “I reject the view that says our problems will simply take care of themselves, that says government has no role in laying the foundation for our common prosperity.”

Economist Malveaux, president of Bennett College for Women, says there’s no doubt that Obama has provided assistance to the poor, but cites challenges. “There are some really good things that the administration has done around poverty, but they have not been proportionate to the extent to which the problem has increased,” she said.

“You’re nibbling around the edge when you say there’s a little program here and there’s a tax cut there,” she continued. “I think this should have been more central two years ago because, while doing health care was great, the first thing people want to do is be fed and know they’ll have a secure situation. And many Americans just don’t know that anymore.”

Housing Crisis

With 4 million Americans seriously behind on mortgage payments or in foreclosure, and a continued drop in housing prices, the president says that he has taken critical steps to meet historic needs. Through its loan-adjustment programs, the administration takes credit for more than 4 million loan modifications and touts the Hardest Hit Fund, which provides $7.6 billion for anti-foreclosure plans in states hurting most from the crisis.

“Creating Pathways to Opportunity” claims that the Homeless Prevention and Rapid Re-Housing Program, connecting families to supportive services like rental assistance and credit counseling, has averted or ended homelessness for more than 1 million Americans. And the administration’s $126 million Choice Neighborhood grant funds coordinated efforts to transform poor neighborhoods, including mixed-income housing, transit and job opportunities.

“The foreclosure crisis hit the African-American and Latino communities in 2002, so we’re talking about a problem that is really entrenched,” said Lisa Rice, vice president of the National Fair Housing Alliance. “I think the administration has done some things well, but we’re playing catch-up to a large degree.”

Rice clarifies the report’s “4 million loan modifications” figure — a baffling number, since, as of August, Obama’s floundering mortgage-modification program had served only about 816,000 homeowners. The number refers to a range of efforts not necessarily initiated by the administration, such as private modifications by loan servicers and pre-existing Federal Housing Administration programs.

“The question now becomes whether or not those modifications are sustainable and successful, because we’re seeing high re-default rates,” she said. “Another concern is around the administration being led by the industry instead of leading the industry. These are banks and institutions that received TARP bailout funds, and I think the administration can do more to make their loan-modification program more effective.”

Rashad Robinson, executive director of ColorOfChange, expressed his concern more sharply. “The decimation of black we
alth through predatory lending and foreclosures has been a major factor in the widening of the racial wealth gap in this country. What’s been really disappointing is that the administration is advocating for a settlement with some of the biggest banks that amounts to a slap on the wrist for the widespread deception and fraud against investors and homeowners,” he said, arguing that these firms should be prosecuted, or at least investigated. “Big banks are getting off, while everyday black people in communities all across the country are left holding the bag.”

Relief for the Unemployed

Obama’s immediate response to the ever-rising unemployment rate — which officially stands at 16 percent for African Americans — has been repeated extensions of unemployment benefits. While pushing a contested bill last summer, he said, “We need to pass it for all the Americans who haven’t been able to find work in an economy where there are five applicants for every opening.”

According to census data, extended unemployment insurance in 2010 kept 3.2 million people above the poverty line. The American Jobs Act calls for another extension, as well as legislation making it illegal to refuse to hire out-of-work job applicants.

“I commend the Obama administration for beginning to put the pieces of the economic puzzle back together — but when they talk about ‘long-term unemployed,’ the longest of the long-term unemployed are not a part of that conversation,” said Gregg Rosen, president of the American 99ers Union, an organization representing individuals who have been unemployed for longer than 99 weeks and have exhausted all state and federal unemployment insurance benefits. These workers are not included in Obama-backed legislation, effectively having disappeared from the government’s notice.

Rosen contends that extending benefits to the millions of Americans who make up “the 99ers” would have a stimulating effect on the economy. “You’re looking at more than 7 million Americans, and the average unemployment insurance check is $303 per week. If you put those dollars into the hands of the 99er community, you’re looking at a return investment of billions of dollars every week in economic spending. That, to me, is a solid stimulus.”

Education

“In the 21st century, one of the best anti-poverty programs is a world-class education,” Obama said in his 2010 State of the Union address. Calling for changes in public education, his $4.3 billion Race to the Top competition rewards states with funding if they present innovative plans for turning around their lowest-performing schools.

Modeled after the successful Harlem Children’s Zone — which provides charter schools, parenting workshops and weekend community centers to support education from “cradle through college” — the administration’s Promise Neighborhoods grant program helps cities jump-start their own neighborhood interventions. On the higher-education front, the president has more than doubled Pell Grants for low-income college students.

Education advocate and author Steve Perry pounces on Obama’s reform agenda. “I think the idea behind Race to the Top is a solid one, but with the country in a tremendous deficit, and a recession on top of that, there’s not enough money to sustain the changes,” he said. “We’re borrowing from our children’s future with the expectation that it will improve their future?”

Perry, principal of the Capital Preparatory Magnet School in Hartford, Conn. — and outspoken school-voucher campaigner — says that instead of investing money in schools, federal education money should go directly to families and let them choose the best place for them. “I have more faith in families to pick good schools than I do administrators and Board of Education members, who keep failed schools open. Parents always choose the best schools in the community. If we let them pick them, we’d only have the best ones stay open. I’m not for education reform; I’m for education revolution.”

Jobs

Plugging several provisions from the Recovery Act, the administration says that its youth summer jobs program for low-income youths employed 367,000 young adults — approximately 40 percent of them African American — in 2009 and 2010. The legislation’s Temporary Assistance for Needy Families emergency contingency fund hired 260,000 low-income adults in subsidized jobs.

In June the Department of Labor announced $39.7 million in grants to help low-income noncustodial parents and ex-offenders gain job skills (and boost their employability) by placing them in temporary, paid work experiences. And the American Job Act’s infrastructure investment reserves $50 million for transportation-related job training for minorities, women and low-income workers.

“Independent economists have looked at this jobs bill, and they’ve said it will create nearly 2 million jobs,” Obama said on Tuesday at a Virginia high school during his three-day bus tour promoting the American Jobs Act, expressing confusion over why Republicans would vote it down. “I don’t want us to be playing politics all the time. I want us to meet this moment. I want us to get to work. “

Despite the administration’s current efforts, there’s still that stubborn 9 percent national unemployment rate. Rep. Keith Ellison (D-Minn.), chair of the Congressional Progressive Caucus, is reluctant to say that the president hasn’t done all he can. “It’s important to understand that the administration is not making decisions in an unconstrained environment where the president can do whatever he wants,” said Ellison, referring to the Republican blockade in Congress. “The bottom line is, the president has been fighting to fully invest in jobs and alleviate poverty, and he’s trying to do the same thing now.”

Ellison’s primary quibble with the president is not with his policies so much as his political tactics. “I think his orientation toward consensus, and trying to bring two sides together, has been a miscalculation. He’s always started out the conversation with the spirit of compromise, and the Republicans are not,” he said.

“I think he could have been a lot more combative with them from the beginning, but I’ve noticed a shift in the president’s rhetoric with the American Jobs Act,” Ellison continued. “I think it’s an acknowledgment that he’s dealing with unreasonable people, and he doesn’t have to negotiate.”

Cynthia Gordy is The Root’s Washington reporter.

http://www.theroot.com/views/pathways-progress-opinion-roundup?page=0,0

The Root is the leading online source of news and commentary from an African-American perspective. Founded in 2008 under the leadership of Prof. Henry Louis Gates Jr. of Harvard University, The Root offers a unique take on breaking news, provides solid analysis and presents dynamic multimedia content. The Root raises the profile of black voices in mainstream media and engages anyone interested in black culture around the world. The Root is owned by the Washington Post Company. Visit us at www.theroot.com, on Twitter @TheRoot247 and on Facebook.

Health care policy: faith- or evidence-based?

By Philip Caper, M.D.
The Ellsworth American (Maine), Oct. 20, 2011

Sen. Brian Langley’s recent commentary praising the newly enacted law (PL 90) that replaces Maine’s carefully crafted system of health insurance regulation with a more “market-based solution” [“Health Insurance Reform Shows Signs of Promise,” Ellsworth American, Oct. 13] deserves comment.

He evidently has a great deal of faith in the role of markets and competition in health care. He is apparently unaware that we in the U.S. have been conducting the world’s leading experiment in market-based health care for over 30 years. No other developed country in the world relies as heavily as we do on market forces to provide access to affordable health care for their people.

That experiment has been a spectacular failure. It has resulted in by far the highest health care costs in the world that continue to spiral out of control. Despite our high costs, we suffer from having the highest proportion of uninsured citizens of any developed country. Medical costs are a leading cause of personal bankruptcy in America, and it is reliably estimated that over 45,000 Americans die unnecessarily each year due to impaired access to medical care.

Sen. Langley’s confusion is understandable. LDI1333, the legislation leading to the enactment of PL 90, was rammed through the Legislature along party lines without adequate time for study (except perhaps by those who crafted it), without hearings, without meaningful debate, and without giving the superintendent of insurance the chance to assess its likely impact on the people of Maine. It was the most irresponsible exercise of political brute force I have witnessed in my 45 years in health care.

Although a few relatively young, healthy and employed people may we a slowing in the rate of increases in their health insurance premiums, many older and less healthy Mainers, especially those living in rural areas, will pay a heavy price.

They will see massive increases in their costs of health insurance to the point of unaffordability, or will be dumped into a publicly administered “high risk pool” that will likely soon become underfunded. The new law has created open season for insurance companies to sell skimpy policies to unsuspecting Mainers that will prove to be inadequate when the time comes to use them.

This law does nothing to slow the explosion in the costs of medical care. These costs are driven by inappropriate overuse of expensive (and lucrative) diagnostic and therapeutic technologies (often without any clear evidence of benefit), windfall profiteering due to unnecessarily high prices by corporations selling health care products and services, and massive inefficiencies in the way we finance and pay for health care. These factors are not unique to Maine, but we certainly suffer from them.

We need less, not more competition among health insurance companies. Competition does not work in medical care as it does in normal markets. The proof is in the fact that our current market-based system is failing.

We need to learn a lesson from our Canadian neighbors who have a single publicly managed insurance system, yet retain free choice of provider. Despite the fact that Canadians’ may have to wait somewhat longer for elective procedures than people with good health insurance in the U.S., they apparently believe the advantages outweigh a little inconvenience. Their system is far more popular than is ours. If you ask Canadians whether they would trade our system for theirs, most simply laugh. No Canadian politician who wants to stay in office, including their current conservative government, dares to propose tinkering with its fundamentals.

Virtually every Canadian is covered, and bankruptcy due to medical costs is essentially nonexistent. Almost every measurable health outcome of their system exceeds ours in quality. What’s not to like?

All other wealthy countries have similar systems. Their overall health care costs average about half of ours.

It’s time to change the way we think about health care in America. We need to move away from faith-based policy and toward policy based on evidence. It’s time for an improved Medicare-like system for all Mainers.

Dr. Philip Caper resides in Brooklin, Maine.

Wal-Mart squeezes employee health benefits

Wal-Mart Cuts Some Health Care Benefits

By Steven Greenhouse and Reed Abelson
The New York Times, October 20, 2011

After trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff.

Citing rising costs, Wal-Mart, the nation’s largest private employer, told its employees this week that all future part-time employees who work less than 24 hours a week on average will no longer qualify for any of the company’s health insurance plans.

In addition, any new employees who average 24 hours to 33 hours a week will no longer be able to include a spouse as part of their health care plan, although children can still be covered.

Wal-Mart also significantly reduced the amount of money it contributes to the savings accounts workers can use to pay for medical bills that are not covered under their plan. Last year, the company put $1,000 into accounts for families but it will cut the amount by half for next year to just $500.

Barbara Collins, a sales associate at the Wal-Mart in Placerville, Calif., said that the premiums for the H.M.O. plan for herself and her 5-year-old son would rise to $18 every two weeks from $10. Her big concern, she said, was that her deductible would jump to $5,000 a year, from $1,000 — a daunting amount considering she earns $19,000 a year.

Dan Schlademan, director of Making Change at Walmart, a union-backed campaign, condemned the changes.

“No wonder people are protesting in the streets,” he said. “This is another example of corporations putting profits ahead of what’s good for everyday Americans. It’s outrageous and damaging to many hard-working families that the biggest corporation in America is increasing health care costs for many employees by 40 percent.”

http://www.nytimes.com/2011/10/21/business/wal-mart-cuts-some-health-care-benefits.html?_r=1&hp=&pagewanted=all

And…

The Richest People in America

Forbes
September 21, 2011

#6 Christy Walton $24.5B

#9 Jim Walton $21.1B

#10 Alice Walton $20.9B

#11 S. Robson Walton $20.5B

http://www.forbes.com/forbes-400/#p_2_s_arank_All%20industries_All%20states_All%20categories_

And…

Wage Statistics for 2010

Social Security Online
October 21, 2011

By definition, 50 percent of wage earners had net compensation less than or equal to the median wage, which is estimated to be $26,363.55 for 2010.

http://www.ssa.gov/cgi-bin/netcomp.cgi?year=2010

Comment:

By Don McCanne, MD

A fundamental principle in the Affordable Care Act is that we would continue to rely very heavily on employer sponsored plans for the majority of health care coverage in America. How is that working? Wal-Mart, the nation’s largest private employer, is increasing the insurance deductible to $5,000 for an employee earning $19,000 per year.

Yet look at her employers. Four members of the Walton family are amongst the eleven wealthiest individuals in America, each worth over $20 billion. (Compare that with the Koch brothers, who own Congress, each worth $25 billion.) This is in a nation with a median wage of $26,364.

Relying on employers to do the right thing no longer cuts it. Not only do they fail to pay enough, they can no longer be relied upon to see that their employees and their families receive adequate health benefits.

It’s time to enact an improved Medicare for all, even if we have to “Occupy Congress” to accomplish that.

Wal-Mart squeezes employee health benefits

Wal-Mart Cuts Some Health Care Benefits

By Steven Greenhouse and Reed Abelson
The New York Times, October 20, 2011

After trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff.

Citing rising costs, Wal-Mart, the nation’s largest private employer, told its employees this week that all future part-time employees who work less than 24 hours a week on average will no longer qualify for any of the company’s health insurance plans.

In addition, any new employees who average 24 hours to 33 hours a week will no longer be able to include a spouse as part of their health care plan, although children can still be covered.

Wal-Mart also significantly reduced the amount of money it contributes to the savings accounts workers can use to pay for medical bills that are not covered under their plan. Last year, the company put $1,000 into accounts for families but it will cut the amount by half for next year to just $500.

Barbara Collins, a sales associate at the Wal-Mart in Placerville, Calif., said that the premiums for the H.M.O. plan for herself and her 5-year-old son would rise to $18 every two weeks from $10. Her big concern, she said, was that her deductible would jump to $5,000 a year, from $1,000 — a daunting amount considering she earns $19,000 a year.

Dan Schlademan, director of Making Change at Walmart, a union-backed campaign, condemned the changes.

“No wonder people are protesting in the streets,” he said. “This is another example of corporations putting profits ahead of what’s good for everyday Americans. It’s outrageous and damaging to many hard-working families that the biggest corporation in America is increasing health care costs for many employees by 40 percent.”

http://www.nytimes.com/2011/10/21/business/wal-mart-cuts-some-health-care-benefits.html?_r=1&hp=&pagewanted=all

And…

The Richest People in America

Forbes
September 21, 2011

#6 Christy Walton $24.5B

#9 Jim Walton $21.1B

#10 Alice Walton $20.9B

#11 S. Robson Walton $20.5B

http://www.forbes.com/forbes-400/#p_2_s_arank_All%20industries_All%20states_All%20categories_

And…

Wage Statistics for 2010

Social Security Online
October 21, 2011

By definition, 50 percent of wage earners had net compensation less than or equal to the median wage, which is estimated to be $26,363.55 for 2010.

http://www.ssa.gov/cgi-bin/netcomp.cgi?year=2010

A fundamental principle in the Affordable Care Act is that we would continue to rely very heavily on employer sponsored plans for the majority of health care coverage in America. How is that working? Wal-Mart, the nation’s largest private employer, is increasing the insurance deductible to $5,000 for an employee earning $19,000 per year.

Yet look at her employers. Four members of the Walton family are amongst the eleven wealthiest individuals in America, each worth over $20 billion. (Compare that with the Koch brothers, who own Congress, each worth $25 billion.) This is in a nation with a median wage of $26,364.

Relying on employers to do the right thing no longer cuts it. Not only do they fail to pay enough, they can no longer be relied upon to see that their employees and their families receive adequate health benefits.

It’s time to enact an improved Medicare for all, even if we have to “Occupy Congress” to accomplish that.

Ratings plummet for Medicare drug plans serving low-income patients

Lower Income Seniors See Star Ratings Drop in Available Medicare Prescription Drug Plans in 2012

Avalere Health
October 19, 2011

According to a new Avalere Health analysis of the Centers for Medicare and Medicaid Services’ (CMS) landscape file of the 2012 Medicare market, a high number of prescription drug plans (PDPs) eligible for auto-assignment of low income subsidy (LIS)-eligible beneficiaries will see a drop in their star ratings from 2011 to 2012. In 2012, 52 percent of LIS-eligible plans are rated 2 stars compared to only 3 percent in 2011. In 2011, 83 percent were rated 3 stars and 14 percent were rated 4-5 stars. In 2012, 43 percent are rated 3 stars, and only 5 percent are rated 4-5 stars.

Avalere Health attributes this precipitous decline in star ratings to the new rating system established by CMS for 2012. The new system places a greater emphasis on clinical outcome measures like medication adherence. Previous year ratings emphasized more process-oriented measures such as how long a person was kept on hold when calling a plan for assistance. Moreover, unlike the Medicare Advantage program, which rewards plans with higher payments for achieving higher ratings, there is no payment incentive in Medicare Part D.

http://www.avalerehealth.net/wm/show.php?c=&id=890

Comment: 

By Don McCanne, MD

We can only speculate as to why there was a very dramatic decline in the star ratings earned by Medicare prescription drug plans serving low income subsidy (LIS)-eligible individuals.

Was it because the plans simply don’t care about this low income population as long as they get their business?

Was it because there is no financial reward for Part D plans receiving higher star ratings?

Was it because of the change in the measurements of a new rating system? If so, that would confirm the findings of other studies that have shown that when efforts are made to improve results on measured processes or outcomes (“teach to the test”), then less attention is paid to those processes and outcomes which are not measured. Suddenly adding in measurements of neglected processes and outcomes would certainly cause star ratings to plummet.

Regardless of the explanation, we pay far more for the private sector to manage these plans, while our choices in products and providers are restricted, and value is diminished by the diversion of funds to these intrusive intermediaries that provide worthless services. They really do care only about their investors and not about us. It’s time to replace them and the rest of the wasteful intermediaries with our own publicly-administered, improved Medicare for all.

Some states seek flexibility to push health-care overhaul further

By Sarah Kliff
The Washington Post, Oct. 16, 2011

As far as health-reform boosters go, Oregon Gov. John Kitzhaber is among the most stalwart.

“We want to show that health reform is something real, that it actually works,” he said. “Oregon is a place that can actually make it happen.”

His state has aggressively implemented the health overhaul Congress passed last year, taking more than $100 million in federal funding to do so.

But at the same time, the health-care law puts Kitzhaber (D) in a bind. This year, Oregon passed its own plan, which starts with changing how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid, the federal insurance program for low-income Americans. There’s just one big obstacle: What Oregon wants to do would require the Obama administration to waive integral pillars of its signature legislative accomplishment.

“We would need a number of waivers to implement all of this,” he said. If Oregon doesn’t get them? “That,” Kitzhaber said, “would be a problem.”

Kitzhaber isn’t alone. A handful of states are pursuing health measures that go far beyond the Obama administration’s signature legislative accomplishment, the Affordable Care Act.

They stand in contrast to Republican governors, who have aggressively opposed the law. Twenty-seven states are challenging the law in the courts as unconstitutional, while two, Florida and Louisiana, have just refused to implement much of the law.

For Democratic governors who want to push changes further, navigating the federal law is a much more complex and nuanced task. They want to implement the law, as well as be waived from key parts of it.

“The Affordable Care Act’s main goal was to expand coverage,” Kitzhaber said. “We’re trying to pivot from that and go quite a bit further.”

The health-care law does allow states to pursue ideas outside its purview. It includes State Innovation Waivers for those that want to bypass key components such as the mandated purchase of insurance, so long as they can meet certain benchmarks on cost and coverage. The waivers become available in 2017, three years after most of the law takes effect.

But for states such as Oregon and Vermont, that timeline is problematic. Because most of the law takes effect in 2014, they worry about setting up a system only to dismantle it a few years later, to implement the policies they really want.

In February, President Obama endorsed legislation that would allow the waivers to start in 2014. But it has been languishing in the Senate for months, never seeing a committee hearing.

Meanwhile, states continue to lay the groundwork for health measures that go well beyond the Affordable Care Act, meeting regularly with administration officials to discuss what flexibility might be available.

Vermont has moved swiftly in pursuing universal health care. In May, the state became the first to attempt to implement a single-payer system. The state has begun discussions with the Obama administration about waivers that would be necessary to convert health insurance there into a single-payer health plan, run by a public board.

“We’ve had some very general discussions with the federal government about our single-payer plans, [and] we’ll continue to push for earlier waivers,” said Anya Rader Wallack, chair of the new Vermont Green Mountain Care Board, which held its first meeting last week. She had been a top health policy adviser to Gov. Peter Shumlin (D). “If we can’t have it, we can’t implement our reforms as fast as we’d like to. It’ll make a difference in terms of the degree of simplification in implementation and the savings associated with that.”

Montana has also started exploring single-payer options. Last month, Gov. Brian Schweitzer (D) announced that he would seek permission to open up his Medi­caid program to government employees and other individuals, laying the foundation for a future universal coverage program.

“Most of the Republican governors have either asked or plan to ask for a block grant, which is kind of what I’m talking about here,” he said. “Send me the money and I’ll take responsibility for my Medicaid population. Don’t be my partner anymore.”

Schweitzer has spent three years working on the plan, modeled after one in Saskatchewan, the Canadian province directly north of Montana. But unlike Vermont officials, he’s skeptical that the Obama administration will give him permission to move forward. As evidence of a lack of federal flexibility, Schweitzer points to another waiver request he made, one that would offer a prescription drug benefit to non-Medicaid patients, that the federal government denied.

“Since we’re proposing to save citizens’ money, you’d expect some kind of chorus and music, maybe a presentation with some plaques and flowers,” he said. “That’s what you’d expect. But in my experience, that’s not what you get.”

The Obama administration has spent “countless hours” working with states to implement ideas that diverge from the federal law, White House spokesman Nick Papas said. “Giving states the chance to pursue innovative ideas that strengthen the health-care system is one of our top priorities,” he said.

For some states, though, it’s already too late. Before the health-care law was enacted, Connecticut had explored the possibility of a public option, an insurance plan administered by the state. But after the health-care law came into being, that proposal got pared back to a study of publicly financed insurance. At the time, Gov. Dan Malloy (D) said his top priority was implementing the federal law — the state’s own ideas would have to wait.

Kitzhaber is trying to make sure that doesn’t happen in Oregon. He spent several days in Washington last week trying to clear the way for his state’s proposed changes. He met with Valerie Jarrett, White House senior adviser, and Nancy-Ann DeParle, deputy chief of staff, on the issue last Monday. The next day he met with Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, to discuss a Medicaid waiver Oregon would soon request.

Kitzhaber said Berwick was “very supportive” of his ideas for Medicaid, and his White House meeting went well, too.

“I do think they’re very interested in a state that can demonstrate, on the ground, that health reform is working in the face of all these attacks,” he said.

But whether the White House can give Kitzhaber the flexibility he wants remains an open question.

“We obviously are interested in moving much sooner” than current law allows, he said. “States are going to hit a wall way before 2017.”

http://www.washingtonpost.com/national/health-science/some-states-seeking-flexibility-to-push-health-reforms-further/2011/10/14/gIQALX7VpL_story.html

Gov. Schweitzer pushes universal health care in Montana, ahead of Affordable Care Act

By Joan McCarter
Daily Kos, Fri Sep 30, 2011

Montana Governor Brian Schweitzer, not willing to wait for the Affordable Care Act to kick in in two or three years, is challenging the federal government to start having a dialogue about real health care reform now by allowing Montana to set up a system modeled on “SaskCare,” the Saskatchewan health system, the first universal health care system among the Canadian provinces.

In an interview with Daily Kos Friday, Schweitzer talked about his rationale for the plan. It builds on a request he made last year for a Medicaid waiver for his state to set up a “Medicaid Part D” program, as he called it, a prescription benefit plan for all Montanans. That proposal, intended to hit at the heart of a long-time Schweitzer foe—the pharmaceutical industry—would have allowed the state to offer a prescription drug program to all Montana citizens that would provide the drugs at Medicaid prices.

That waiver request was denied.

Building on that, and taking Saskatchewan as his model, Schweitzer will request a waiver from HHS for not just Medicaid, but Medicare, Veterans Administration and Indian Health Services funds that are provided to the state. He wants a block grant of those moneys to set up a single payer system. And he’s using Saskatchewan as his model because of the similarities between that province and his state.

“Montana has a population of 990,000 people,” he explains. “Saskatchewan has a population of 1,050,000. Their average age is about the same average age of Montana. They’re about 10 percent Indian, we’re about 7 and a half percent Indian. The other ethnic groups—they’re a mirror image of us … So we have the same ethnic population, we’re farmers, we’re loggers, we’re miners, we’re oil developers … They, in Saskatchewan, live two years longer and have lower infant mortality.”

Looking at those basic elements, Schweitzer asked province Premier Brad Wall for details on their health system. He discovered that the province spends about $4 billion a year on universal health care, about $4,000 per person. In Montana, all systems—public and private, state and federal—it’s a little more than $8 billion, and about twice as much per person.

“So they’re living longer, less infant mortality, and they’re paying half as much,” said Schweitzer. “Unlike Washington, D.C., that piqued my interest. This is maybe a system that I want to look into.”

Schweitzer talked about all of the factors at work in the high cost of care in the United States, factors that are well-known to anyone who has followed the health care reform debate: high costs in pharmaceuticals, in medical devices, in the number of services provided, in the fractured and divergent system providing care.

“In Saskatchewan,” he explained, “they have five MRIs for the entire province. We have three in Helena for 35,000 people and a couple of dozen for Montana. Why? Because they cost $3 million and you can make $500,000 a year on them.”

“We have an $8 billion health care industry in Montana right now, and 50 percent of it, or $4 billion, is coming directly from the federal government,” he continued. “That may be enough so that we can get the rest of Montana in it. We turn to the rest of Montana and say to them we’ve got this $4 billion, and we’re taking care of all these people, and now we’ve run the rates and if you want to pay into this system, here’s how much it’s going to be. If you don’t want to buy into that system, you don’t have to.”

“If you want to pay twice as much for Blue Cross and Blue Shield and have their accountants lie to you,” the governor said, “you just stay right where you’re at. But I think they’ll knock our door down.”

Schweitzer is not too optimistic about the chances of this broad waiver being granted, but wants the health care reform discussion to continue. He’s also not sure that in the intervening years between now and when the major provisions of the Affordable Care Act are implemented, that the core of the law will actually be maintained.

“The Affordable Care Act is probably not going to be implemented,” he argued. “And most of it isn’t going to be implemented until ’14, and by that time it’s going to have changed a great deal. We have people who continue to live lives, and they have children who get sick and there’s elderly people who get sick and sometimes people get in accidents—we can’t wait around for Congress.”

http://www.dailykos.com/story/2011/09/30/1021603/-Gov-Schweitzer-pushing-single-payer-in-Montana,-ahead-of-Affordable-Care Act

Disarray of our health care workforce

National Center for Health Workforce Analysis

Health Resources and Services Administration (HRSA)

For at least a decade, the United States has experienced worsening workforce shortages in the health professions. Analysts now are projecting a nationwide shortage of almost 100,000 physicians, as many as one million nurses, and 250,000 public health professionals by 2020.

Due to the high cost of health insurance and increasingly pervasive staffing shortfalls in the health professions, at least 50 million Americans lack access to the most basic care. A third are children.

http://bhpr.hrsa.gov/healthworkforce/

And…

The Complexities of National Health Care Workforce Planning

Authored by a team from Deloitte Center for Health Solutions
Bipartisan Policy Center, October 18, 2011

Background

Establishing future workforce requirements is an inherently imprecise activity. Health care is a complex environment with many uncertainties affecting workforce supply and demand. Characterized by multiple stakeholders at the national, state and local levels and within professional, educational and other jurisdictions, the interdependencies between the groups that make up the health care sector are complicated. Moreover, efficient and effective workforce planning and deployment is inextricably linked to changes in demand for services, clinical technologies that facilitate diagnosis and treatment, payments that influence provider behaviors, workforce policies that frame licensing and scope of practice, as well as the overall structure of the system especially as it is impacted by the recently-passed Patient Protection and Affordable Care Act of 2010.

Section Five of the Patient Protection and Affordable Health Care Act of 2010 emphasizes the need for strategies to increase workforce supply and capabilities, develop workforce diversity, and strengthen professional areas where supply is weak. These strategies are necessary to plan for a supply of professionals that is able to meet the changing demands of the health care system.

Looking Ahead: Workforce Innovations in the U.S.

National Health Workforce Commission:  A 15-member committee (as yet unfunded) appointed by the General Accountability Office, the National Health Care Workforce Commission is required to review health care workforce supply and demand and make recommendations regarding national priorities and policy. Other areas of focus will involve review of the implementation of state health workforce development grants program and workforce development actions including career pathways, policies and practices regarding recruitment, retention and training of the health care workforce.

Findings

The U.S. health care industry is capital intense, highly regulated and labor intensive. These three factors complicate efforts to radically and/or quickly change its workforce composition. Health care consumes 17 percent of the U.S. gross domestic product (GDP), and the U.S. consistently spends more on health care per capita than other developed countries. As widely noted, health care costs exceed $9,000 per capita and will increase at six percent annually for the next decade. Innovative approaches to educating and training the health care workforce are imperative to effectively manage increased demand for services while reducing costs and improving quality. Traditional supply-demand analyses for the health care industry workforce fall short in addressing both objectives. Fragmented and inconsistent data collection, variance in methodological assumptions and rigor, mistrust between professional groups and wide differences in regulatory and educational context contribute to an incomplete understanding of workforce supply and demand. 
 
To ensure an adequate, effective workforce in the U.S. health care system, a fresh approach is critical. The National Health Workforce Commission as well as the National Center for Health Workforce Analysis are integral to the transformation of the US health care system. These bodies must lead in the creation of a solid methodological foundation upon which workforce shortages, demand and regulatory oversight must be constructed.

http://www.bipartisanpolicy.org/system/assets/drupal/Workforce%20Study.pdf

Comment: 

By Don McCanne, MD

Health care consumes 17 percent of the U.S. gross domestic product, yet our health care workforce is in a terrible state of disarray. The fragmentation of our health care system makes it virtually impossible for the private sector to plan and coordinate the development of our health care workforce. This is exactly the type of need that requires government action and oversight. Yet the 15 member National Health Workforce Commission remains unfunded.

Occupy Wall Street? Maybe it’s time to Occupy Congress!