PNHP

Number of Uninsured Up Another Million

Number of Uninsured Up Another Million

By John Gever
MedPage Today, Sept. 13, 2011

A record 49.9 million Americans were without health insurance during 2010, up almost 2% from the 49.0 million uninsured in 2009, the Census Bureau reported.

The percentage of the population without insurance rose 0.2 percentage points, from 16.1% to 16.3%, though this was not significant at the P<0.1 level, the agency said.

Results from the agency’s 2010 Current Population Survey also found increases in the number of Americans living below the poverty level (46.2 million versus 43.6 million in 2009) as well as declines in inflation-adjusted median household income. The proportion of the population with private health insurance overall also declined, as did the proportion with insurance provided by employers.

In a statement, the Census Bureau indicated that these trends were outgrowths of the recent recession, even though the economy was officially in recovery during 2010.

The agency noted that the first years after previous recessions were also typically marked by increases in poverty rates and declining income and health coverage.

Regionally, the biggest increase in being uninsured occurred in the Northeast, jumping 0.6 percentage points from the previous year, to 12.4%. But the 2010 rate was still lower than for any other region.

Southern states, on the other hand, had the highest overall uninsured rate, at 19.1%, but this was actually a slight drop from 2009 when the rate stood at 19.2%.

Ironically, individuals with jobs were more likely to be uninsured than the population as a whole. The survey found that, among people 18 to 64 years old who worked at some point during 2010, 28.0 million (19.5%) lacked health insurance.

Also, people with disabilities were hit hard in 2010. Whereas 16.0% lacked health coverage in 2009, last year the figure rose to 17.3%.

Other results from the survey concerning health insurance included:

* Percent covered by private health insurance: 64.0% in 2010, down from 64.5% in 2009
* Percent covered by employer-based plans: 55.3% in 2010, down from 56.1% in 2009
* Percent covered by Medicaid only: 11.2% in both years

In the Current Population Survey, lack of health insurance is supposed to mean that respondents had no coverage at any time during the year. The Census Bureau said the survey includes a series of questions meant to confirm the complete lack of insurance, but it acknowledged that misunderstandings by respondents are common.

Consequently, the survey’s final tally “more closely approximates the number of people who were uninsured at a specific point in time during the year than the number of people uninsured for the entire year,” according to a disclaimer in the report.

John Gever is senior editor at MedPage Today.

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/28488

Hospital Association and others support raising Medicare age to 67

Medicare eligibility age should go up, hospitals say

By Susan Jaffe
Politico, September 8, 2011

The American Hospital Association has a strategy for heading off any more Medicare payment cuts: Tell Congress to get the money from Medicare beneficiaries instead.

The association is urging its nearly 5,000 members to lobby Congress to raise the Medicare eligibility age from 65 to 67, in addition to other money-saving alternatives.

http://www.politico.com/news/stories/0911/63020.html

And…

The health industry case for raising Medicare’s eligibility age

By Sarah Kliff
The Washington Post, September 14, 2011

The Health Leadership Council, a consortium of 47 health industry leaders including Aetna, Pfizer and the Cleveland Clinic, will vote Wednesday on whether to endorse raising Medicare’s eligibility age. It’s “very likely” that the group will throw its weight behind the proposal, says HLC vice president Michael Freeman.

States, employers and seniors would all suffer if the Medicare eligibility rules were changed. It would shift about $11.4 billion in new costs to those parties while saving the federal government only $5.7 billion, according to the Center on Budget Priorities and Policy.

“This policy does nothing to control costs,” Sen. Bernie Sanders, an independent from Vermont, wrote in a memo obtained by the New York Times. “It simply shifts substantial costs from Medicare to other parts of government and to private and public employers.”

The Budget and Policy center estimates that if the Medicare eligibility age were raised, seniors under age 67 would have to spend $3.7 billion more in out-of-pocket cost. For many in the political system, that’s enough to reject the idea out of hand. But for some in the health-care system, that’s a profit waiting to be made.

http://www.washingtonpost.com/blogs/ezra-klein/post/the-health-industry-case-for-raising-medicares-eligibility-age/2011/09/14/gIQAJJ8sRK_blog.html

Comment: 

By Don McCanne, MD

Most of us who believe that the health care system should be designed to serve patients are enraged by America’s health industry leaders who believe that the system should be designed to serve the industry. Yet who has red carpet access to Congress and President Obama? Aren’t we going to do anything about that?

Gov. Shumlin announces appointments to Green Mountain Care Board

SEPTEMBER 13- MONTPELIER – Gov. Peter Shumlin today announced his appointments to the Green Mountain Care Board, a body that is central to the implementation of health reform in Vermont.  The Board is responsible for creating the first single payer health care system in the country, which will control costs and guarantee coverage regardless of employment status.

“In putting together this team, I looked for five really smart people who are fully committed to the goal of controlling health care costs, achieving universal coverage, and who can work as a team,” Gov. Shumlin said. “I also looked for people who could think creatively about how to encourage and reward Vermonters and Vermont health care practitioners for improving health and getting the most value out of our health care dollars.”

The Governor’s appointees include a business person, a practicing Vermont physician, an internationally-known health policy leader, an experienced state leader with extensive health care experience, and an expert in state-based health care reform.  They are:

Chairwoman Anya Rader Wallack, Ph.D. of Calais.  Wallack will chair the Green Mountain Care Board.  Wallack has served as Gov. Shumlin’s Special Assistant for Health Reform since January and spearheaded his legislative effort on health reform during the 2011 session.  Wallack is a native Vermonter who has lived for the past 13 years in Rhode Island.  She staffed then-Gov. Howard Dean on health care in the 1990s and ran the Vermont Program for Quality in Health Care.  More recently she ran the Massachusetts Medicaid Policy Institute and served as interim President of the Blue Cross Blue Shield of Massachusetts Foundation before launching a consulting business in state health policy.

 Al Gobeille of Shelburne.  Gobeille owns a restaurant business in Chittenden County.  He is active in the Lake Champlain Chamber of Commerce and serves on the Shelburne select board.  He also is a board member of the Visiting Nurse Association and a member of the state of Vermont’s payment reform advisory committee.

Karen Hein, M.D. of Jacksonville.  Hein is immediate past President of the William T. Grant Foundation, which funds research to improve the lives of adolescents throughout the U.S.  Previously she served as Executive Officer of the Institute of Medicine, overseeing the IOM Quality Initiative and numerous projects and publications aimed at informing efforts to improve health care delivery.  Hein was a Robert Wood Johnson Health Policy Fellow with the U.S. Senate Finance Committee in 1993-94.  She also is a longstanding faculty member at Columbia University and the Albert Einstein College of Medicine, where she has conducted extensive research on adolescent HIV/AIDS.  Hein has served on a number of non-profit boards, including the Dartmouth Medical School Board of Overseers and the board of RAND Health.

Con Hogan of Plainfield.  Hogan has worked for the past 10 years as an international consultant and co-authored two books about Vermont health reform with Dr. Deb Richter.  Previously he served as Secretary of Human Services under Governors Dean and Richard Snelling.  Hogan was President of the Montpelier firm International Coins and Currency from 1980-1991.  Before that he served in numerous positions in the State’s Department of Corrections.  Hogan is a well-known single payer advocate who has authored several books on Vermont health reform.

Allan Ramsay, M.D. of Essex Junction.  Ramsay is a family physician in Colchester.  Ramsay has been a professor in UVM’s Department of Family Medicine since 1980.  He has been a national leader in developing unique models for making sure that patients’ wishes are followed at the end of their lives.  Before coming to Vermont, Ramsay served as Medical Director for an HMO in rural Colorado and served in the National Health Service Corps.

Gov. Shumlin said he was pleasantly surprised at the level and volume of talent exhibited by applicants to the Green Mountain Care Board.  More than 100 people applied for the five jobs.  A nine-member nominating committee reviewed their applications and forwarded to the Governor 22 candidates who they deemed “qualified” to meet the requirements set forth in Act 48, the state’s health reform law.  Gov. Shumlin thanked the nominating committee for their work and also thanked those who applied for the board and were not chosen as appointees. 

“All of the candidates showed a strong commitment to meaningful health system reform and had impressive skills and experience,” the Governor said. He said that in making his choices, he focused on competence, experience, and a proven ability to affect real change in the health care system. 

“These five people have their job cut for them,” Gov. Shumlin said. “But I have no doubt that they will rise to the challenge and lead Vermont toward a bright future in which all of our citizens can afford access to quality care and our health care system is an asset unmatched by that of any other state.”

The Green Mountain Care Board will begin work on October 1.

Hospital Association and others support raising Medicare age to 67

Medicare eligibility age should go up, hospitals say

By Susan Jaffe
Politico, September 8, 2011

The American Hospital Association has a strategy for heading off any more Medicare payment cuts: Tell Congress to get the money from Medicare beneficiaries instead.

The association is urging its nearly 5,000 members to lobby Congress to raise the Medicare eligibility age from 65 to 67, in addition to other money-saving alternatives.

http://www.politico.com/news/stories/0911/63020.html

And…

The health industry case for raising Medicare’s eligibility age

By Sarah Kliff
The Washington Post, September 14, 2011

The Health Leadership Council, a consortium of 47 health industry leaders including Aetna, Pfizer and the Cleveland Clinic, will vote Wednesday on whether to endorse raising Medicare’s eligibility age. It’s “very likely” that the group will throw its weight behind the proposal, says HLC vice president Michael Freeman.

States, employers and seniors would all suffer if the Medicare eligibility rules were changed. It would shift about $11.4 billion in new costs to those parties while saving the federal government only $5.7 billion, according to the Center on Budget Priorities and Policy.

“This policy does nothing to control costs,” Sen. Bernie Sanders, an independent from Vermont, wrote in a memo obtained by the New York Times. “It simply shifts substantial costs from Medicare to other parts of government and to private and public employers.”

The Budget and Policy center estimates that if the Medicare eligibility age were raised, seniors under age 67 would have to spend $3.7 billion more in out-of-pocket cost. For many in the political system, that’s enough to reject the idea out of hand. But for some in the health-care system, that’s a profit waiting to be made.

http://www.washingtonpost.com/blogs/ezra-klein/post/the-health-industry-case-for-raising-medicares-eligibility-age/2011/09/14/gIQAJJ8sRK_blog.html

Most of us who believe that the health care system should be designed to serve patients are enraged by America’s health industry leaders who believe that the system should be designed to serve the industry. Yet who has red carpet access to Congress and President Obama? Aren’t we going to do anything about that?

Number of uninsured climbs to highest figure since passage of Medicare, Medicaid

50 million uninsured shows urgency of enacting single-payer Medicare for all: national doctors group

FOR IMMEDIATE RELEASE
Sept. 13, 2011

Contact:
Garrett Adams, M.D., M.P.H.
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in 43 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing an increase of about 1 million in the number of Americans without health insurance in 2010 – to a 45-year high of 49.9 million persons, or 16.3 percent of the population, under the bureau’s revised calculation method – underscore the urgency of going beyond the Obama administration’s federal health law and swiftly implementing a single-payer, improved Medicare-for-all program, spokespersons for Physicians for a National Health Program said today.

Employment-based coverage continued to decline. The bureau said 55.3 percent of Americans were covered by employment-based plans in 2010, down from 56.1 percent in 2009. It was the eleventh consecutive year of decline, from 64.2 percent in 2000.

In Massachusetts, whose 2006 health reform is widely viewed as the model for the federal health law, 370,000 people remained uninsured in 2010, representing 5.6 percent of the population, a jump from 4.3 percent who were uninsured in 2009.

Some states posted greater than a 3-percentage-point to 5-percentage-point increase in their uninsured rate, namely Idaho, Louisiana, Mississippi, Montana and South Carolina. In terms of absolute numbers, Louisiana had the largest increase in the number of uninsured, 240,700, followed by New York (177,700) and South Carolina (173,300). (See link to table of historical state-based data below.)

Among various population groups, the greatest loss of coverage was among working-age adults between the ages of 35 and 64, people with incomes below $49,999, and people with disabilities. Hispanics continue to disproportionately face uninsurance (30.7 percent), compared with blacks (20.8 percent), Asians (18.1 percent) and non-Hispanic whites (11.7 percent).

About 7.3 million children remain uninsured, the bureau said. Young people between the ages of 19 to 25 had a drop of 1.6 percentage points in their uninsurance rate, a figure the Census Bureau suggests is linked to the federal health law’s provision that allows dependent children to be covered under a parent’s health plan.

Lack of health insurance is known to have deadly consequences. A 2009 study in the American Journal of Public Health showed that 45,000 deaths annually can be linked to lack of coverage. Along the same lines, studies have shown that uninsured people with chronic illnesses like heart disease often delay or forgo care, often leading to serious complications of their medical condition and, in some cases, premature death.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 50,000 people — that’s about one death every 10 minutes,” said Dr. Garrett Adams, president of PNHP, a nationwide organization of 18,000 physicians.

The Louisville, Ky.-based physician said that even if the administration’s new health law works as planned, the Congressional Budget Office estimates 23 million people will remain uninsured in 2019.

Adams was in Washington today, testifying before a subcommittee of the Senate Health, Education, Labor and Pensions Committee on the topic, “Is poverty a death sentence?”

Significantly, the Census Bureau said the number of people living in poverty, 46.2 million, is the largest number recorded in the 52 years such estimates have been published.

The increase in the uninsured would have been significantly higher had it not been for an increase in the number of people covered by government health programs such as Medicare, Medicaid, and military health care. Some in Congress have urged substantial cuts to such programs, particularly Medicare and Medicaid. If implemented, such cuts would almost certainly increase the uninsured rate in years ahead.

“The only remedy for this persistent problem is to insure everyone,” Dr. Adams said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage. The new system’s bargaining clout would also help rein in rising costs.”

Dr. Steffie Woolhandler, professor at the City University of New York School of Public Health and visiting professor of medicine at Harvard Medical School, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress, personal bankruptcy and poor medical outcomes,” Woolhandler said.

Referring to the Affordable Care Act, she said, “The new law’s subsidies for health insurance will not be sufficient to provide quality and affordable coverage to the vast majority of Americans. Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform. We need a single-payer national health insurance program.”

*****

Historical state-by-state data on the uninsured from 2007-2010, compiled by PNHP staff from the Census Bureau’s newly adjusted data, can be found here: https://pnhp.org/docs/2011/Uninsured-by-state-2007-2010.pdf

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Census numbers on the uninsured

Income, Poverty, and Health Insurance Coverage in the United States: 2010

U.S. Census Bureau
September 2011

Income

Real median household income was $49,445 in 2010, a 2.3 percent decline from 2009.

Comparing changes in household income at selected percentiles shows that income inequality is increasing.

Poverty

The official poverty rate in 2010 was 15.1 percent — up from 14.3 percent in 2009.

In 2010, 46.2 million people were in poverty, up from 43.6 million in 2009.

The number of people in poverty in 2010 is the largest number in the 52 years for which poverty estimates have been published.

Health Insurance Coverage

The number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009. In 2010, the percentage of people without health insurance, 16.3 percent, was not statistically different from the rate in 2009 (16.1 percent).

The percentage of people covered by private health insurance decreased in 2010 to 64.0 percent (195.9 million). The percentage and number of people covered by government health insurance increased to 31.0 percent and 95.0 million in 2010.

The percentage of people covered by employment-based health insurance decreased to 55.3 percent in 2010 from 56.1 percent in 2009 (decreased to 169.3 million from 170.8 million).

The percentage and number of people covered by Medicaid in 2010, 15.9 percent and 48.6 million, were not statistically different from 2009 estimates.

The percentage and number of people with Medicare coverage in 2010 increased to 14.5 percent and 44.3 million.

In 2010, the uninsured rates decreased as household income increased — 21.8 percent of people in households with incomes ranging from $25,000 to $49,999 were uninsured; 15.4 percent of people in households with incomes ranging from $50,000 to $74,999 were uninsured; and 8.0 percent of people in households with incomes of $75,000 or more were uninsured.

U.S. Census release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

Full report (95 pages):
http://www.census.gov/prod/2011pubs/p60-239.pdf

Comment: 

By Don McCanne, MD

This Census report for 2010 shows that 919,000 more people were uninsured this past year than in 2009. This may be considered a ho-hum statistic by those who seem to be reassured by the provisions of the Affordable Care Act since the Act would expand coverage. However, there are other reasons to be very concerned, not the least of which are the statistics on income and poverty from this same report.

Of significance is the fact that this report counts anyone who was insured for any part of the year as being insured. It leaves out from the count of the uninsured those who have gaps in their coverage even if they were uninsured for most of the year. This results in a serious undercount of of those impacted by not being insured.

Another important deficiency is that this study makes no effort to quantify the rates of under-insurance. Employers and insurers have been redesigning their insurance products to shift more health care costs to the patient. Many studies have shown that this has impaired access to care and has caused significant financial hardship. The Census report is silent on this problem.

What is the shocker in this report is that these unfavorable insurance statistics are imposed on a background of declining income and expanding poverty. Median household income has dropped to $49,445 while income inequality is increasing. Further, the number of people in poverty (46.2 million) is the largest number in the 52 years for which poverty estimates have been published!

Anyone who has studied the Affordable Care Act realizes that health insurance policies will be very expensive even though they have relatively low actuarial values (leaving the patient responsible for 30 to 40 percent of health care costs). The new national standard in health insurance is “unaffordable under-insurance.” The subsidies for the premiums and for out-of-pocket spending have been shown to be inadequate for far too many people, again impairing access, creating financial hardship, and even leaving tens of millions with no insurance at all.

Had we enacted a single payer national health program, we could have included everyone, while eliminating under-insurance by providing first dollar coverage. We could have paid for it by eliminating the profound administrative waste that uniquely characterizes our system, and by introducing the other efficiencies of a single payer system. Wouldn’t it have been nice to be rid of the problem of the uninsured and under-insured so that we could intensify our efforts to improve income and reduce poverty? Or are those just not our national priorities?

Census numbers on the uninsured

Income, Poverty, and Health Insurance Coverage in the United States: 2010

U.S. Census Bureau
September 2011

Income

Real median household income was $49,445 in 2010, a 2.3 percent decline from 2009.

Comparing changes in household income at selected percentiles shows that income inequality is increasing.

Poverty

The official poverty rate in 2010 was 15.1 percent — up from 14.3 percent in 2009.

In 2010, 46.2 million people were in poverty, up from 43.6 million in 2009.

The number of people in poverty in 2010 is the largest number in the 52 years for which poverty estimates have been published.

Health Insurance Coverage

The number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009. In 2010, the percentage of people without health insurance, 16.3 percent, was not statistically different from the rate in 2009 (16.1 percent).

The percentage of people covered by private health insurance decreased in 2010 to 64.0 percent (195.9 million). The percentage and number of people covered by government health insurance increased to 31.0 percent and 95.0 million in 2010.

The percentage of people covered by employment-based health insurance decreased to 55.3 percent in 2010 from 56.1 percent in 2009 (decreased to 169.3 million from 170.8 million).

The percentage and number of people covered by Medicaid in 2010, 15.9 percent and 48.6 million, were not statistically different from 2009 estimates.

The percentage and number of people with Medicare coverage in 2010 increased to 14.5 percent and 44.3 million.

In 2010, the uninsured rates decreased as household income increased — 21.8 percent of people in households with incomes ranging from $25,000 to $49,999 were uninsured; 15.4 percent of people in households with incomes ranging from $50,000 to $74,999 were uninsured; and 8.0 percent of people in households with incomes of $75,000 or more were uninsured.

U.S. Census release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

Full report (95 pages):
http://www.census.gov/prod/2011pubs/p60-239.pdf

This Census report for 2010 shows that 919,000 more people were uninsured this past year than in 2009. This may be considered a ho-hum statistic by those who seem to be reassured by the provisions of the Affordable Care Act since the Act would expand coverage. However, there are other reasons to be very concerned, not the least of which are the statistics on income and poverty from this same report.

Of significance is the fact that this report counts anyone who was insured for any part of the year as being insured. It leaves out from the count of the uninsured those who have gaps in their coverage even if they were uninsured for most of the year. This results in a serious undercount of of those impacted by not being insured.

Another important deficiency is that this study makes no effort to quantify the rates of under-insurance. Employers and insurers have been redesigning their insurance products to shift more health care costs to the patient. Many studies have shown that this has impaired access to care and has caused significant financial hardship. The Census report is silent on this problem.

What is the shocker in this report is that these unfavorable insurance statistics are imposed on a background of declining income and expanding poverty. Median household income has dropped to $49,445 while income inequality is increasing. Further, the number of people in poverty (46.2 million) is the largest number in the 52 years for which poverty estimates have been published!

Anyone who has studied the Affordable Care Act realizes that health insurance policies will be very expensive even though they have relatively low actuarial values (leaving the patient responsible for 30 to 40 percent of health care costs). The new national standard in health insurance is “unaffordable under-insurance.” The subsidies for the premiums and for out-of-pocket spending have been shown to be inadequate for far too many people, again impairing access, creating financial hardship, and even leaving tens of millions with no insurance at all.

Had we enacted a single payer national health program, we could have included everyone, while eliminating under-insurance by providing first dollar coverage. We could have paid for it by eliminating the profound administrative waste that uniquely characterizes our system, and by introducing the other efficiencies of a single payer system. Wouldn’t it have been nice to be rid of the problem of the uninsured and under-insured so that we could intensify our efforts to improve income and reduce poverty? Or are those just not our national priorities?

VA experience suggests that most readmissions may not be preventable

VA Experience Shows Patient 'Rebound' Hard To Counter

By Jordan Rau
Kaiser Health News, September 12, 2011

The Veterans Health Administration, the largest integrated health care system in the country, has long employed many of the approaches Medicare is pushing on all hospitals to cut unnecessary readmissions. But new data show VA hospital patients are just as likely to end up back in a hospital bed as are patients at private hospitals.

Studies have found the VA does better than most hospitals in following appropriate guidelines for the best care to give patients.

The new statistics underscore how hard it may be for hospitals to stop patients from rebounding back through their doors, a major goal of Medicare as it seeks to curtail the nation’s ballooning health costs.

http://www.kaiserhealthnews.org/Stories/2011/September/12/VA-readmissions.aspx

Comment: 

By Don McCanne, MD

Obviously, when a patient is discharged from a hospital, every effort should be made to avoid slip-ups that might result in an unnecessary readmission soon after discharge. Yet many patients have serious, unstable conditions that can require readmissions that are unavoidable.

Differentiating avoidable from unavoidable readmissions can be very difficult. This report on VA hospital readmissions reveals that it may be nearly impossible, or that the numbers may be negligible. The VA already has in place guidelines and systems that should prevent unnecessary readmissions, yet their readmission rates are the same as private hospitals.

This brings into question the current efforts by Medicare to save costs by penalizing hospitals for readmitting patients. This policy could be particularly harmful if it resulted in the refusal to readmit patients who really needed to be back in (e.g., manage them in the emergency room and then send them back home).

Although quality improvement should be a continuing effort, this is simply another example of the totally inadequate cost containment measures of the Affordable Care Act – measures that only pretend that we are going to control costs. We need a massive overhaul of the financing system if we ever expect to bring costs under control – yes, a single payer national health program.

VA experience suggests that most readmissions may not be preventable

VA Experience Shows Patient ‘Rebound’ Hard To Counter

By Jordan Rau
Kaiser Health News, September 12, 2011

The Veterans Health Administration, the largest integrated health care system in the country, has long employed many of the approaches Medicare is pushing on all hospitals to cut unnecessary readmissions. But new data show VA hospital patients are just as likely to end up back in a hospital bed as are patients at private hospitals.

Studies have found the VA does better than most hospitals in following appropriate guidelines for the best care to give patients.

The new statistics underscore how hard it may be for hospitals to stop patients from rebounding back through their doors, a major goal of Medicare as it seeks to curtail the nation’s ballooning health costs.

http://www.kaiserhealthnews.org/Stories/2011/September/12/VA-readmissions.aspx

Obviously, when a patient is discharged from a hospital, every effort should be made to avoid slip-ups that might result in an unnecessary readmission soon after discharge. Yet many patients have serious, unstable conditions that can require readmissions that are unavoidable.

Differentiating avoidable from unavoidable readmissions can be very difficult. This report on VA hospital readmissions reveals that it may be nearly impossible, or that the numbers may be negligible. The VA already has in place guidelines and systems that should prevent unnecessary readmissions, yet their readmission rates are the same as private hospitals.

This brings into question the current efforts by Medicare to save costs by penalizing hospitals for readmitting patients. This policy could be particularly harmful if it resulted in the refusal to readmit patients who really needed to be back in (e.g., manage them in the emergency room and then send them back home).

Although quality improvement should be a continuing effort, this is simply another example of the totally inadequate cost containment measures of the Affordable Care Act – measures that only pretend that we are going to control costs. We need a massive overhaul of the financing system if we ever expect to bring costs under control – yes, a single payer national health program.

A decade later

Following is the Quote of the Day from September 12, 2001.

Editorial
The New York Times, September 12, 2001

“But this is an age when even revenge is complicated, when it is hard to match the desire for retribution with the need for certainty. We suffer from an act of war without any enemy nation with which to do battle. The same media that brought us the pictures of a collapsing World Trade Center shows us the civilians who live in the same places that terrorists may dwell, whose lives are just as ordinary and just as precious as the ones that we have lost.”

https://pnhp.org/news/2001/september/nyt-editorial

And now…

Editorial
The New York Times, September 10, 2011

“A decade later, we’re still trying to understand, looking back and looking ahead. It is not enough simply to remember and grieve.”

http://www.nytimes.com/2011/09/11/opinion/sunday/loss-and-hope.html

A decade later

Following is the Quote of the Day from September 12, 2001.

Editorial
The New York Times, September 12, 2001

“But this is an age when even revenge is complicated, when it is hard to match the desire for retribution with the need for certainty. We suffer from an act of war without any enemy nation with which to do battle. The same media that brought us the pictures of a collapsing World Trade Center shows us the civilians who live in the same places that terrorists may dwell, whose lives are just as ordinary and just as precious as the ones that we have lost.”

https://pnhp.org/news/2001/september/nyt-editorial

And now…

Editorial
The New York Times, September 10, 2011

“A decade later, we’re still trying to understand, looking back and looking ahead. It is not enough simply to remember and grieve.”

http://www.nytimes.com/2011/09/11/opinion/sunday/loss-and-hope.html

Study: Costs Keep Med Students From Much-Needed Mental Health Care

By Fran Cronin
WBUR CommonHealth blog, Sept. 7, 2011

Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.

In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.

Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.

Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.

For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment.

Nardin said the survey also revealed that “Private medical schools are more likely than public schools to offer worse-than-average cost-sharing for outpatient substance abuse treatment. The worst region in the country, she said, was the Northeast.

Boyd, a faculty psychiatrist and an outspoken advocate for physician health, served for six years as associate director of the Physician Health Services, Inc., a nonprofit subsidiary of the Massachusetts Medical Society that provides confidential consultation and support to at-risk medical students and doctors across the state.

“Over the past two decades,” he said, “I have seen medical schools try to humanize the student’s experience and observed hospitals ratcheting up easier practices along with their awareness of physician health.” But the reality remains that medicine is very intense and stressful for those who are vulnerable to depression, anxiety, and substance abuse.

Troubled students often resist seeking treatment at the onset of their symptoms, fearing high out-of-pocket costs and an accumulation of more school debt. “But with any psychiatric disorder or substance abuse,” said Boyd, “early intervention definitely correlates to better outcomes.”

“There is a lack of sympathy for this fear of debt,” he said. “Most people just assume doctors will make a lot of money. But mounting debt from long stints at expensive schools weighs very heavily upon the students and most will do anything they can to avoid increasing it.”

According to statistics from the graduating medical school class of 2008, Nardin said, the median debt for public school students was $145,00 and for private school students it was $180,000.

To provide context for the cost of outpatient substance abuse treatment, I spoke with Talbott Recovery Campus, in Atlanta, Georgia, well known by Boyd and others for its Impaired Professionals Program. Debbie Kingston of the intake department told me: “The 90-day residential treatment program costs $39,000 for out-of network plans. If in-network, most insurance plans only cover $2000-$8000 of the total cost.”

Kingston added that detox, even though required, was not included in this tab. Depending on the addiction, detox can take from two to ten days. These costs also do not include the need for on-going monitoring and mental health support once a patient completes their residential stay.

In an article posted recently on Commonhealth, Rachel Zimmerman reported on a study, also authored by Boyd, that points to a more general obstacle to mental health care. The study’s hypothesis, which was borne out, posited that availability of psychiatric services has greatly diminished “due to a combination of paltry reimbursement rates and budget cutbacks.” The study’s authors wrote: “Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible.”

Of the 64 medical facilities listed by Blue Cross and Blue Shield in the greater Boston area and contacted for the study, only four could offer an appointment within two weeks. Others refused to offer an appointment due to requirements that all patients be enrolled with a primary care doctor affiliated with that particular psychiatric facility. Study researcher Andy Lindenmeyer, a fourth- year resident in the Harvard Longwood psychiatric program, said, “I think the point here is that having health insurance does not equal access to care.”

Stephanie Woolhandler, a professor of public health at City University of New York and a visiting professor of medicine at CHA, summed up  the state of mental health care in a recent email: “The reality is that access to mental health care is very poor in this country, even for people with private insurance. Because mental illness is stigmatized, the mentally ill are often unable or unwilling to fight their insurance company to get their care reimbursed. The result is a very uneven distribution of care, with abundant mental health resources available to those who can pay out of pocket, while those that must rely on their insurance find that mental health care is restricted or even unavailable.”

“We need our medical schools to push themselves to provide students with more affordable care,” said Boyd. “What’s best for the health of our students will result in better physicians and the future well-being of their patients.”

A note of disclosure: Both Drs. Boyd and Nardin, authors of the survey letter published in JAMA, are active members of the group Physicians for a National Health Program, an organization of physicians who advocate for single-payer national health insurance.

http://commonhealth.wbur.org/2011/09/med-students-psych-care/