California Court Rules Care Cannot Be Withheld From Gays

Health care access is a constant issue in modern America. The poor of our country have so little of it due to finances. Many rural residents don't have it simply because there are no health professionals nearby. Then there is an aspect of access I don't believe I have touched upon until now: access for gays.

That sort of discrimination, rooted in this case in religious beliefs of the practitioners, was determined illegal yesterday.

Via The Associated Press:

California's highest court on Monday barred doctors from invoking their religious beliefs as a reason to deny treatment to gays and lesbians, ruling that state law prohibiting sexual orientation discrimination extends to the medical profession.

Justice Joyce Kennard wrote that two Christian fertility doctors who refused to artificially inseminate a lesbian have neither a free speech right nor a religious exemption from the state's law, which "imposes on business establishments certain antidiscrimination obligations."

There are more than enough hurdles to be leaped over when navigating the American health care system as it currently stands. Adding discrimination to that array is something that the California court and I agree on. It should not be done. Since the business of health care is huge, as evinced by statistics shared in prior posts here and numerous reports elsewhere, it should be held to the same antidiscrimination practices as other businesses that cater to the general public.
It also seems that I am not alone in thinking that this is a decision that could well have far reaching implications on the national level as well:

Jennifer Pizer, [Guadalupe] Benitez's [the plaintiff's] attorney, said that the ruling was "a victory for public health" and that she expected it to have nationwide influence.

"It was clear and emphatic that discrimination has no place in doctors' offices," Pizer said.

The ruling was unanimous and a succinct 18 pages, a contrast to the state Supreme Court's 4-3 schism in May legalizing marriage between same-sex couples.

It is good to see that while the debates rage on about other issues impacting the gay community, the line has been drawn on the fundamental right to health care. Despite, as one might imagine, a wide variety of groups supporting the Christian doctors, an even wider array of groups stepped up to the plate in favor of an end to these practices.

While The American Civil Rights Union, The Islamic Medical Association of North America, the Christian Medical & Dental Associations and a variety of anti-abortion groups fought against it support from across the spectrum was forthcoming from an even wider array of groups.

The California Medical Association reversed its early support of the Christian doctors after receiving a barrage of criticism from gay rights activists, joining health care provider Kaiser Foundation Health Plan to oppose the Christian doctors.

The American Civil Liberties Union, California Attorney General Jerry Brown, the National Health Law Program and the Gay and Lesbian Medical Association filed papers backing Benitez.

All in all, it was a good day in court, one which takes us a small step closer to universal health care, and access thereof.

SOURCE: "Calif top court: Docs can't withhold care to gays" 08/18/08
photo courtesy of Made Underground, used under its Creative Commons license

Cost of Care: The Long Term

Medicine costs. Hospital equipment costs. Staffing for health care providers costs. Emergency services cost. To make matters worse, these costs are consistently rising, and not slowly.

This is one of the pillars of the health care crisis facing our nation, the cost of care. It is frequently noted in headlines and blog posts, often focusing on a patient who either in unable to pay for needed care or in studies that project its steady and unrelenting increase in the future.

One aspect of the cost issue that is not as often touched upon is how these cost factors will impact late life long-term care. Prudential Financial's newly issued "2008 Long-Term Care Cost of Care" research report aims a microscope at these issues and provides some useful and startling tools as well.

Via Market Watch:

Prudential's Cost of Care study sheds light on the State-specific average costs associated with nursing homes, assisted living facilities, and home health care services. The study results show the average assisted living costs and average nursing home costs in Alaska as the most expensive in the country at $82,956 per year and $183,595 per year respectively. Detroit ranked the highest for home health care hourly rate at $38.

The fact is, without proper planning, the annual cost of long-term care can quickly deplete even a sizable nest egg. "While no one wants to think about 'that time' when they may need care in an assisted living facility, a nursing home, or at home care, it's essential that consumers consider the costs now and implement a financial plan to help ensure they receive the quality of care they desire," added [Andy] Mako [Senior Vice President, Long-Term Care Insurance, Prudential].

I'm glad I don't live in Alaska. I doubt I'll come close to a six-figure income in my own lifetime, let alone be able to pay that in my retirement. As with most health care oriented figures, these are sobering to consider. Of course, Prudential does lend a hand with coming to grips with the problem in an informed fashion. They have a new cost of care mapping tool online which allows those interested to drill down and get state by state cost info, in some cases involving larger urban areas. It even gives city by city data.

Check it out. The numbers will probably startle you.

SOURCE: "Prudential Study Sheds Light on the Increasing Costs of Long-Term Care- Interactive web-based tool allows consumers to view city and state specific cost data" 08/18/08
photo courtesy of EggyBird, used under its Creative Commons license

Electronic Medical Records: An Open Source Option

Electronic medical records are commonly acknowledged as something that can slice a huge percentage of current health care costs right off the top. The big issue is getting them deployed and implemented. For many smaller practices, and some larger ones as well, the price of getting an EMR system set up and all of the current records entered into it is prohibitive.

Of course, this is the 21st Century and creative options abound. What would happen if we subtracted the cost of the EMR software itself from the equation? After all, look at how many people use Google's Gmail for the small price of having advertisements displayed in the margins. What is something similar could be done with an EMR application?

Dana Blankenhorn over at ZDNet Health Care answers that question as he reviews a new approach to electronic record keeping:

It’s called Practice Fusion, and if you can tolerate some ads on your screen you can use it as a software service free of charge.

Chris Anderson of Wired calls this the "Google Model" having coined the term "Freeconomics" to describe the result.

As always, security is an issue, but this looks like a model that might have legs. If proven secure and successful, this could end up being a quantum leap for adoption of EMR systems. I am curious to see reports on the security of the software as that will certainly be a major factor in how viable it proves to be. In the meantime, I am stunned that I have not seen anyone take this approach before.

In an age increasingly defined by open source, it is a logical stance.

SOURCE: "Psst. Want a free Electronic Medical Records system?" 07/31/08
photo courtesy of magerleagues, used under its Creative Commons license

A Great Experiment

Everybody wants it. Better health care results for less financial outlay, that is. It's so high on most people's lists that it pulls even in their estimation with the Holy Grail of health care: universal care.

This is why an examination of a demo project being run by the Centers for Medicare and Medicaid Services is well in order. While the results so far are neither large in scale nor conclusive, they do show a consistent trend in the desired direction. The approach is a logical one. They are trying to re-leverage the system of incentives used in health care.

The current incentive system is, as stated by George C. Halvorson, "perverse." This project is testing out a different approach, one in which incentives are are earned by hitting a series of quality benchmarks. There are ten group practices involved in the program.

Vi Anna Wilde Matthews of The Wall Street Journal's Health Blog:

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards. See more details by clicking here.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

Nothing is perfect and all things take practice. With the program still in its early phases but already showing measurable improvement, I would say this is one worth watching.

SOURCE: "In Experiment, Doctors Save Medicare Money While Improving Care" 08/15/08
photo courtesy of takomabibelot, used under its Creative Commons license

Texas As An Example?

When ranking states, Texas is next to last in children's access to health care, yet U.S. Sen. John Cornyn (R-Texas) presents it as a shining example for the rest of the nation.

Here's a clipping from the Commonwealth Fund report (emphasis mine):

[...] the 13 states at the bottom quartile of the overall performance ranking—Illinois, New Mexico, New Jersey, Alaska, Oregon, Arkansas, Nevada, Texas, Arizona, Louisiana, Mississippi, Florida, and Oklahoma—lag well behind their peers on multiple indicators across dimensions[...]

Now for a bit of perspective on his health care stance: Cornyn voted against SCHIP, which now covers about half a million Texas children. He also opposed the reinstatement of adequate Medicare reimbursements to providers. Cornyn initially opposed reinstating adequate Medicare reimbursements to doctors, causing the Texas Medical Association to rescind their endorsement of him during a recent re-election bid.

Now according to The Houston Chronicle he has been speaking out about Texas as a shining example. Here's a quote form the Chronicle story:

"So, you have to understand what I mean when I say I want to make Washington, D.C., and the rest of our country more like Texas (because), frankly, we know the policies that actually work." [-U.S. Sen. John Cornyn]

As the debate continues and we see more instances like this, it would behoove us all to beware of political spin from either side and focus on the facts. The Commonwealth Fund has been doing a magnificent job of providing hard data at a time when it is so desperately needed. Thanks, guys!

SOURCE: "Out of touch Senator's depiction of Texas' health care system as a national role model departs from reality" 08/14/08
SOURCE: "U.S. Variations in Child Health System Performance: A State Scorecard" 05/25/08
photo courtesy of little black spot on the sun today, used under its Creative Commons license

Deval Patrick: Massachusetts Health Care Law Signed

A few days ago, Massachusetts Governor Deval Patrick signed into law one of the nation's strictest limits on gifts given to medical professionals by drug salespeople. Applauded by some and excoriated by others, the law attempts to curtail the influence of marketing in health care.

Hitting another health care issue near and dear to our hearts here at Health Care Reform Now!, it also supplies $25 million to promote the transition to electronic medical records. Other sections of the law give regulators the power to hold hearings over rises in health insurance premiums and also require the state university to increase the size of its classes in order to produce more primary care doctors.

Despite having more doctors per capita than anywhere else in the country, Massachusetts is still facing a shortage -- one predicted to worsen as more people gain insurance and enter the health care equation. This is a critical aspect of the big picture since primary care doctors are the ones who make the initial care decisions.

Still, with all the variety of measures embraced, the one which is causing the most stir is the limit on corporate gift giving. The pharmaceutical industry's trade group Pharma has stated that lawmakers could regret their efforts, citing the fact that it would create a chilling effect on researchers if their research grants were posted on a public listing of industry gifts.

Via Scott Allen at The Boston Globe:

[Sen. Mark] Montigny [New Bedford Democrat] had hoped that, after failing twice, he might succeed in banning gift-giving between salespeople and healthcare professionals altogether. However, representatives of the drug and medical device industry successfully argued that the measure went too far, potentially banning money paid to doctors and hospitals to conduct medical research. Though the Senate passed the full ban, the House backed only restrictions.

Still, the limits in the law put Massachusetts at the forefront of states in cracking down on the use of financial incentives to persuade doctors to prescribe particular drugs or medical devices. In addition to banning some gifts and requiring disclosure of others, it calls for the state to develop a code of conduct for industry representatives that includes a $5,000 fine for each violation.

The great experiment of Massachusetts continues!

SOURCE: "Leaders nip, tuck healthcare policy - Limits enacted on drug firm gifts" 08/11/08
photo courtesy of limako used under its Creative Commons license

What's Wrong With US Health Care: Jane's Story

Karen Hover is a doctor in Maine. As such, she is in a prime position to note the shortfalls, mistakes, and outright failures of the American health care system. On Monday, she wrote a guest OpEd column for The Bangor Daily News in which she puts a face on these wide and dangerous gaps in the way we take care of our sick.

In it, she relays the story of "Jane" (not her real name), an administrative assistant who suffered an accident that broke both her elbows after falling off a roof. As you might imagine, the splints used to immobilize the fractures stretched from fingers to armpits. She rapidly discovered that the splints kept her from being able to do, well, anything.

"I couldn’t scratch my nose, or feed myself, or get a glass of water, or pull my pants down." She needed around the clock care. Jane called her insurance company, which told her that her plan included 100 days of skilled care.

Arrangements were made to go to a rehabilitation facility on Friday, which was good because Jane’s friend had to go back to work. When Jane arrived, around noon, administrators told her that the insurance company had denied her claim and that she could not be admitted because she had no need for skilled medical care. After a couple of hours on the telephone, no one had a better idea, so she was sent back to the emergency room. By this time, she needed to go to the toilet, but staff refused to take her because of fear of liability. Her ex-husband helped her.

Can you imagine? Not the runaround -- that is something we have all come to expect (at least those of us who have had to deal with the health care system directly) -- but the treatment. Imagine yourself with both arms in splints, bladder bursting, lots of people around whose job is to help you, and yet no one does. This points up an aspect of the current system I do not often get to touch upon: the fact that often there seems to be no attempt made to help a patient preserve basic dignity.

The emergency room was packed. She was seen by a doctor who asked her if she had cash to pay for a hospital room. He talked to her about going to a local shelter. Jane was hungry, dirty and in pain. "I just need someone to take care of me," she said. A stranger who had been following the story brought Jane supper at 10 p.m. and fed it to her. She was admitted at midnight.

Jane's adventures are far from over though. It took another eight days of refusing her claim before the insurance agency came around and had her transferred to a rehab facility. Sounds like things should have been fine from there on out, doesn't it? Unfortunately not.

She was sent to the same facility that had treated her so badly before and spent three weeks there, enjoying inappropriate food, an accidental injury, an often unclean toilet, miscommunications between staff and her orthopedist, and a banging door that prevented sleep. The splints were removed. Jane went home with a new case of athlete’s foot. She learned to use her arms again and is now back at work. She feels her family and friends were very supportive.

No, this is not a scene from Stephen King's The Kingdom. It is yet another homegrown horror story cultivated right here in the United States. This is why we need to keep health care at the forefront of the Presidential debate, to stop this from happening.

For Jane's sake.

SOURCE: "Karen Hover: How our health care system failed Jane" 08/11/08
photo courtesy of hypertypos, used under its Creative Commons license