211: Hotline to Care

211. That's the number Detroit residents who lack insurance will soon be able to call for health care assistance. Patricia Anstett, medical writer for the Detroit Free Press, reports the details:

The Safety Net Resource Center is to begin operations within the next few weeks, run by the Detroit Wayne County Health Authority and 25 community organizations.

Callers to United Way's 211 hotline will receive information on where to find free care, said Chris Allen, chief executive officer of the health authority. The authority, which helps coordinate information on uninsured and underinsured people in the area, is able to offer the additional help because federal and state funds have helped the agency's budget grow from $2 million several years ago to $8 million today, Allen said.

With the millions of uninsured in the U.S., it is surprising that this is the first time I have run across an initiative of this nature. One of the objectives is to connect patients with a "medical home," a place where their medical care needs are centralized. Allen is quoted as saying of medical homes, "It's where they belong, not in the emergency department."

The 90,000 uninsured of Detroit's east side are the initial primary target of the program.

SOURCE: "211 hotline to free care nears" 04/28/08
photo courtesy of tj_scenes, used according to its Creative Commons license

Rockefeller, Congress, and Healthcare: The Quote Heard 'Round The Net

One of the big topics in the blogosphere right now is the article by Manu Raju on The Hill that talks about Congressional Democrats crabwalking on the issue of health care reform:

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

It is still seven months before Election Day, but already senior Democrats are maneuvering to lower public expectations on the key policy issue.

Considering the profile of the health care debate in the current election, this is news that, unsurprisingly, seems to be spreading like wildfire across the Internet. The most often quoted part is this statement:

"We all know there is not enough money to do all this stuff," said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. “What they are doing is … laying out their ambitions."

Ezra Klein at The American Prospect has his doubts about the veracity of this report, and that quote is one of the reasons:

That scans oddly for two reasons. The first is money. Obama's aides say the plan would cost between $50 billion and $65 billion a year. Assume they're lowballing, and the real number is $80 billion. That's some cash, to be sure but it's not a level of outlay that tends to make Senators balk. We're spending far more on Iraq, on tax cuts, and a host of other projects. The money could probably be found fairly easily -- and it's certainly not hard for Senators to say it could be found fairly easily. So that looks strange.

When viewed in relation to other governmental expenditures it does seem like a comparatively small sum. Klein goes on to analyze the quote itself and the reporter who provides it:

The second oddity is "all this stuff." A health care bill contains a lot of stuff, to be sure, but it's generally referred to in the singular. It's a bill. It's big, and you can either do it or not do it. Moreover, the only proof we have that he was talking health care is that the reporter says so. It sounds to me like Rockefeller is saying something much broader and more mundane: That if you look at the domestic agendas of Clinton and Obama, there's not enough money nor political will to do all of it. You're not going to get health care and tax cuts and energy policy and housing reform and education and poverty and everything else you promised in the campaign. And even if you could muster the will, you can't find the funds. That leads to the question of priorities, but that's no surprise.

Jonathon Cohn of the New Republic's response is dismayed:

This is pretty discouraging stuff. Rockefeller is a longtime advocate for universal coverage; his moral commitment to the issue is not in question. And Baucus, whose comments were much less negative but still not enthusiastic, chairs the Finance Committee--through which any universal coverage bill must go.

Still, this isn't the last word on the subject. I just got off the phone with Andy Stern, president of the Service Employees International Union, who in recent years has done as much to promote the cause of universal coverage as any single person in politics. And he is not at all happy.

"I thought it was embarassing," Stern said. "I think it showed an incredible lack of appreciation for what most Americans are confronting every day in this health care system. ... What was said in this aritcle is not the kind of leadership that I think Americans are expecting after this election."

Whatever the context of the quotes was, it sure is generating a lot of discussion. I am sure that by the time this is posted there will be a vast array of opinions being voiced from blog pulpits and news outlets everywhere. Go check out these articles and render your own opinion. Our comments section welcomes you!

SOURCE: "Dems hedge on Health Care" 04/23/08
SOURCE: "Is Congress Backing Off health Care Reform?" 04/24/08
SOURCE: " Stern to Congress: Don't Chicken Out on Health Care." 04/24/08
photo courtesy of The Gold Guys /Lumax Art, used under its Creative Commons license

Medicaid Battle: Congress vs. The Veto

A battle over proposed cost saving measure proposed by the Bush administration is brewing in the U.S. House of Representatives. With a veto threat already on the table, things are looking interesting as another face-off between the two branches of government begins.

Jim Abrams gives us the scoop in his article for Time Magazine:

Passage of the legislation in a vote scheduled for later Wednesday would send it to the Senate Finance Committee, where Chairman Max Baucus, D-Mont., is reviewing options for suspending the regulations, his press officer said.

The governors of all 50 states, state Medicaid directors and others oppose the rules, Energy and Commerce Committee Chairman John Dingell, D-Mich., told the House. "They know the devastating effects these rules would have on local communities, upon hospitals, and upon vulnerable beneficiaries." Dingell's committee approved the bill earlier this month on a 46-0 vote. [Emphasis added. -GW]

So far during the current administration Congress has only been able to successfully override one veto from the President: a water projects bill last November. While this does not bode well for Congress in the coming conflict, this issue is far from dead in the water. Legislators, state governors, health care providers and more are coming together in favor of the moratorium because they fear the administrations plans will simply cost shift the burden to the poor and the state governments.

Once again, the Executive branch and Legislative branch of our government are locking horns, this time on one of the top issues of the current electoral season.

The White House, in a statement Tuesday warning of a veto threat, said the bill would "thwart these efforts of the federal government to regain fiscal accountability and integrity in Medicaid." Health and Human Services Secretary Mike Leavitt, in a letter to lawmakers, said it "puts billions of dollars of federal funds at risk, and may turn back progress that has already been made to stop abusive state practices."

But the proposed changes have met opposition from states, health care providers and advocates for poor who say they will shift costs from the federal government to the states and create new hardships for the needy. "Some of these regulations already have become effective and current state estimates of the impact could be as high as four times the administration's $13 billion estimate," National Governors Association chairman Tim Pawlenty, D-Minn., and other governors wrote lawmakers this month. Timely action to impose the one-year moratorium was "critical to avert significant disruptions in coverage for vulnerable populations," they wrote.

So it looks like the fiscal side of American health care rears its head once again. With 48 million people participating in Medicaid over 2007 the impact of this legislation will be felt far and wide. The Time article paints the cost of Medicaid programs at $352 billion, $200 of which was supplied by the federal government, an amount guaranteed to make the public sit up and take notice.

When was the last time you can recall the governors of all 50 states in the U.S. agreeing on something?

SOURCE: "House Challenging Medicaid Rules" 04/23/08
photo courtesy of euthman, used according to its Creative Commons license

Email and Your M.D.

Among American doctors, less than a third use email as a health care tool. Alicia Chang of the Associate Press takes a look at this strange deficiency:

"People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," said Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind other industries."

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don't get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.

Once again, we see an example of how embracing Internet technology, even in its most basic form, can improve the overall health care crisis our nation faces. The studies available state that not only is response time quicker from doctors who use email, but it also helps to reduce costly office visits and repeated phone calls.

For example, a 2007 University of Pittsburgh study published in the journal Pediatrics followed 121 families who e-mailed their doctors. Researchers found 40 percent of e-mails were sent after business hours and only about 6 percent were urgent. Doctors received on average about one e-mail a day and responded 57 percent faster than by telephone.

A separate study by health care giant Kaiser Permanente published in the American Journal of Managed Care last year found patients who used its secure Web system were 7 to 10 percent less likely to schedule an office visit. Patients also made 14 percent fewer phone calls than those who did not use the online services.

In Chang's article she adds a human face to the equation: Suzanne Kreuziger, R.N. Kreuziger works for a doctor who chooses not to utilize email. Kreuziger stresses the ability to have a documented virtual paper trail that she can go back to at any point as a key element of why email can be such an incredibly useful tool for both physicians and patients. Being able to simplify basic needs such as asking for prescription refills, setting appointments, and getting medical test results would be a boon to all involved.

She also points out that the complaint on the part of providers that time spent emailing is not billable seems to hold little water as phone calls are also not billable, and take a greater amount of time in most cases. Chang provides a wonderful look at this minor but important aspect of American health care.

It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls.

Would YOU like to be able to communicate with your doctor via email? Share your thoughts.

SOURCE: "It's no LOL: Few US doctors answer e-mails from patients" 04/22/08
photo courtesy of Mzelle Biscotte, used according to its Creative Commons license

Veterans Vs. The VA: Health Care Showdown

Vietnam. Iraq. Afganistan. Names that evoke a variety of emotion laden memories, and stridently held opinions.

Neil MacFarquhar of The New York Times tells us how these memories and opinions have entered the courtroom in a federal case pitting the Office of Veterans Affairs (VA) against Veterans for Common Sense and Veterans United for Truth. The reason for this face off? You guessed it, health care issues:

"Our ultimate goal is guaranteed health care, timely health care, timely decisions on disability payments," Gordon P. Erspamer, the lead lawyer representing the two veterans groups, said in an interview.

"The system is choking on the claims; the delays are unconscionable," Mr. Erspamer said.

The trial, before Judge Samuel Conti, an Army veteran of World War II, does not seek monetary damages but asks the court to appoint a special master or otherwise intervene to make the department run more efficiently.

Claims for help from the department jumped 25 percent in recent years, hitting 838,000, Richard G. Lepley said in his opening statement for the government.

The defense said the jump was generated by a combination of veterans returning from Iraq and Afghanistan, where head injuries that can lead to stress problems are a signature issue, as well as an upswing of Vietnam veterans seeking help for medical conditions associated with aging. News coverage from the current wars has also led to new mental health problems among Vietnam veterans, said Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, Calif.

So the aging of the Baby Boomers is creating one wave of new patients as the survivors of Vietnam begin retiring while another wave of young and injured soldiers is returning home from the Iraq/Afganistan theater of operations. Meanwhile, the VA is stuck in the middle and drastically understaffed.

Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, California, quoted the number of suicides among veterans over the past year at 6,600. That's 20% of all suicides, or one in every five suicides occurring in the United States. Combine that with extended wait times for treatment caused by lack of personnel and it paints a grim picture indeed for our soldiers.

Some of the statements made at the trial paint a grim initial picture of the VA defense:

The number — 126 suicides a week, higher than the 120 published in previous studies — was in a December e-mail message from Dr. Ira Katz, the head of mental health services for Veterans Affairs, to Dr. Michael J. Kussman, the under secretary for the Veterans Health Administration in the department. Mr. Erspamer displayed the message in his opening argument.

The department has long been reluctant to release specific numbers regarding suicides or suicide attempts, lawyers for the veterans groups said. "We certainly think there was a cover-up in some sense," said Heather Moser, a lawyer for the plaintiffs.

A second department e-mail message from Dr. Katz shown at the trial starts with "Shh!" and refers to the 12,000 veterans per year who attempt suicide while under department treatment. "Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" it asks.

This is one story that bears watching.

SOURCE: "In Federal Suit, 2 Views of Veterans’ Health Care" 04/22/08
photo courtesy of Jurek D., used according to its Creative Commons license

Sin Tax For Health

Many states have considered enacting additional taxes -- so-called "sin taxes"-- on tobacco products to help defray the skyrocketing cost of health care. The Kaiser Family Foundation has just released a report on this very subject that should prove of interest:

Several states have sought to increase their tobacco taxes to fund health care programs and address budget deficits, but efforts to increase tobacco taxes in some cases have prevented the passage of health care proposals, the New York Times reports.

According to the Tobacco Merchants Association, in 2008, 22 state legislatures have considered bills that would increase tobacco taxes. Last year, 11 states enacted such legislation, according to the National Conference of State Legislatures. R.J. Reynolds Tobacco estimates that state tobacco taxes raise $14.5 billion in revenue annually and that the federal tobacco tax raises $7.3 billion in revenue annually.

"For some states, tobacco taxes are seen as a kind of magic bullet that are really quite different from less popular kinds of taxes," Richard Cauchi, a health policy analyst from the National Conference of State Legislatures, said, adding, "Legislators are able to argue that it's a sin tax, and the voters seem more accepting if they know the funds are going to be earmarked for some kind of health initiative."

The report goes on to detail recent efforts along these lines that various states have put on the table. California, New York, South Carolina, and Massachusetts efforts are detailed on their site.

As always the arguments pro and con have a familiar ring to them:

• "It will help prevent underage smoking."
• "It is an unreliable source of revenue."
• "It is unfair to smokers"
• "It will generate the revenue we need."

It is no secret that the tobacco companies are against this, and they bring an amazing advertising budget with them when they engage the battle for public support. California Speaker Fabian Nunez has been quoted many times across the media as saying that "Big Tobacco" killed health care efforts in California. The question truly is whether this is a viable approach or not. Will diminishing sales in areas that do enact a tobacco tax provide enough revenue to make an impact on the health care system as it stands?

SOURCE: "Kaiser Daily Helath Policy Report" 04/21/08
photo courtesy of Porcelin Girl used according to its Creative Commons license

5th Annual World Health Care Congress

A stupendous array of health care expertise is gathered in Washington, D.C., supplemented by the health care policy advisors for U.S. Presidential candidates Sen. Barack Obama, Sen. Hillary Clinton and Sen. John McCain. It's the World Health Care Congress, and as you might expect, George C. Halvorson is there.

From the press release about this morning's panel:

-- Hear the Presidential candidates' platforms for health care reform

-- Compare proposals to address universal coverage and the fiscal
stability of Medicare

-- Reactor panelists provide an in-depth critique by evaluating the
economic and social impact of Democratic and Republican proposals

Panelists:
-- U.S. Rep. Jim Cooper (D-TN), Health Care Policy Advisor to Sen. Barack
Obama

-- Chris Jennings, Health Care Policy Advisor to Sen. Hillary Clinton,
former Senior Health Care Advisor to President Clinton.

-- Thomas Miller, resident fellow, American Enterprise Institute for
Public Policy Research, Health Care Policy Advisor to Sen. John McCain

-- George Shutlz, former U.S. Secretary of State, Labor and Treasury, co-
author "Putting Our House In Order: A Guide to Social Security and
Health Care Reform"

-- George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and
Hospitals

Health care reform, universal coverage, Medicare woes, and a solid analysis of the positions taken by our current crop of Presidential candidates should make for a fascinating (and hopefully productive) gathering.

The listing above covers on the first panel of the day for this event, in addition to those listed above there is an extensive roll call of movers and shakers in the Health Care scene in attendance who will be combining their expertise:

• Michael Leavitt, Secretary, U.S. Department of Health and Human Services
• James Hagedorn, CEO, Scotts Miracle-Gro Company
• Delos (Toby) Cosgrove, MD CEO, Cleveland Clinic
• Denis Cortese, CEO, Mayo Clinic
• Greg Tullman, CEO, Allscripts
• George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and Hospitals
• Mack Banner, CEO, Bumrungrad International (Thailand)
• Sam Nussbaum, Executive Vice President and Chief Medical Officer, Wellpoint
• Thomas Miller, health care policy advisor to Sen. John McCain
• Prof. Hans Rosling, MD, PhD Professor of International Health, Karolinska Institutet (Sweden)
• Michael Howe, CEO, MinuteClinic
• Paul Speranza, Chairman, U.S. Chamber of Commerce, Vice Chairman and General Counsel, Wegmans Food Markets
  

Best of all, in my opinion, is the fact that you can stream MP3 audio podcasts of the featured speakers here. Look for Mr. Halvorson's podcast, "Reforming the Delivery of Care to Impact 85% of Total Health Care Costs." It just went live!

Today, I would like to close with a quote about the event:

"This is the largest gathering of health care providers, thinkers and experts anywhere in this world."
—Lee Scott, President & CEO, Wal-Mart Stores, Inc.

Let us hope this massive array of talent and expertise can help us find our way down this complex and emotionally charged path to effective health care reform!

SOURCE: "5th Annual World Health Care Congress Kicks off April 21 With Obama, Clinton, McCain Health Care Policy Advisor Presidential Health Care Agenda Forum" 04/21/08
SOURCE: "5th Annual World Health Care Congress- Podcasts"
photo: Screencap of WHCC Website