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Newsletter, What's Going On, November 2, 2010

November 2, 2010 

The Affordable Care Act is in trouble.  Republicans are passionate about repealing it, replacing it or un-funding it.  The Act’s centerpiece, the individual mandate, is widely disliked, and there’s a distinct possibility that that the Supreme Court will find it unconstitutional.  Even its supporters concede that the Act needs improving. 

Which is a golden opportunity.  Something else clearly has to be done.  Our job is to be sure that ‘something’ is single payer.  National single-payer, state single-payer, but single-payer. 

To do that, we need to become more visible in our communities, in our state, with a positive image.   We need to be sure that when people think of further change, they think of single payer, with a smile. 

And so…in the next few weeks…you’ll hear announcements of scheduled meetings…social events…volunteer opportunities of several sorts…more about truth squads, and that’s just for starters.  We’ll be learning as we go along, so if you have ideas to add, chuck them in the pot!  To begin with: another try at an organizing meeting, Thursday, November 11, in the Conference Room of the Emmet O’Neal Library, 50 Oak Street, (Crestline Village) Mountain Brook.  At 6:30 we’ll begin the organizing business.  At 7:05, we’ll preview a PowerPoint Presentation of the Business Case for More Health Care Reform.  And with all the restaurants in that part of Mountain Brook, we’ll probably adjourn (by 8 PM) to one of them to keep the conversation going. 

You’ll also be hearing requests for donations.  Leaflets, brochures, bumper stickers, T-shirts, meeting room rental, volunteer recruiting and retention all cost money.  We hope you’ll be generous…we need to be limited only by the number of good ideas we come up with, not by our finances.   

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You’ll have noticed the change in font size.  I’m open to comment.  

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A little-known entity..the RUC Committee of the American Medical Association…plays a dominant role in determining how much Medicare pays for each medical test or procedure it covers.  Its recommendations over the years have appeared to favor specialists strongly over primary care doctors.  Medicare is due to revisit the rules it lays down for the Committee on November 1.  From first indications, not much is going to change.  Peter VanVranken. 

Orlando Sentinel: … most people's health plans will be relatively untouched by the overhaul next year. "If you were expecting dramatic changes in your workplace's health plan next year because of the health-care overhaul, here's some good news: Most employers aren't substantially changing their plans. Now, here's the bad news: Employees' health-care premiums are expected to jump 12.4 percent, on average, in 2011" (Shrieves, 10/27). NPR reports that rate increases across the country "are being blamed on the new health law." But is that really the cause? "Absolutely not, says Jay Angoff, who heads the Office of Consumer Information and Insurance Oversight for the U.S. Department of Health and Human Services. ... 'To the extent that the insurance companies blame the new law for rate increases, they know better,' Angoff says. 'They've said themselves that the new law would only raise rates by between 1 and 2 percent.' And even those increases would pay for a number of new benefits."  Kaiser Daily Health Policy Report. 

HOWEVER:  Health care reform is already expanding coverage for small business employees, reports Janet Adamy: "The number of small businesses offering health insurance to workers is projected to increase sharply this year, recent data show, a shift that researchers attribute to a tax credit in the health law. Many small businesses, however, remain opposed to the law...According to a report by Bernstein Research in New York, the percentage of employers with between three and nine workers and which are offering insurance has increased to 59% this year, up from 46% last year. The report relies on data from a September survey by the nonprofit Kaiser Family Foundation. A full tax credit is available to employers with 10 or fewer full-time workers and average annual wages of less than $25,000."  From the Wonkbook. 

More than two-thirds of doctors will cap the number of Medicare patients they accept if Congress doesn't prevent reimbursement cuts that will take effect Dec. 1….The Medical Group Management Association reported that 67.2% of medical practices are likely to limit their Medicare populations. Nearly half (49.5%) will stop seeing new Medicare patients and more than one-fourth (27.5%) will stop treating all Medicare patients.  ACP Internist. Kaiser Health News staff writers Andrew Villegas and Mary Agnes Carey, working in collaboration with The Washington Post, talked with the AMA president about action surrounding Medicare payment issues: "While most people are focused on the midterm elections Tuesday, the American Medical Association is gearing up for the lame-duck congressional session scheduled to start Nov. 15. Unless Congress intervenes, payments to doctors for treating Medicare patients will be cut by 23 percent on Dec. 1 and another 6.5 percent on Jan. 1" (Villegas and Carey, 11/1). Read the story 

How Reform Law Funds Itself, Strengthens Medicare, and Cuts the Deficit: Part 1  Maggie Mahar.  Health Beat Blog. 

I hadn’t realized that high risk pools are now operational in all 50 states, nor what limitations exist on how they’re constructed.  It sure looks as if everyone with pre-existing illness can now get insurance, if they can afford it. 

No one ever said it would be easy.  Since 1999, Great Britain has had a National Institute for Health and Clinical Excellence, called NICE.  It was charged with evaluating drugs and treatments, recommending coverage to the National Health Service of drugs that worked.  Further, it was designed to evaluate how much benefit a drug provided compared with alternatives, and at how much cost.  Along the way it recommended against drugs for treating Alzheimer’s and renal cell cancer as having unfavorable cost/benefit analyses.  Pharmaceutical makers fanned grass roots unhappiness with the recommendations, understandably.  With the emergence of a Conservative government in the last British election, the role of NICE is being redefined with its authority to pass judgment on individual drugs essentially removed.  

In Massachusetts, Question 4 on the ballot is a non-binding question that asks voters in the 11th Norfolk District whether they want to instruct their state representative, Paul McMurtry, “to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single-payer health insurance system like Medicare that is comprehensive, cost-effective, and publicly provided to all residents of Massachusetts? 

The Health Experts blog addresses  “How will the Midterms affect the Reform Law?”   (as this is written, the question has been posed, but responses not yet posted.) 

Free Birth Control: Health Care Overhaul May Provide Pill As Preventative Medicine.  Huffington Post discussion

Dr. Aaron Carroll has just completed another of his series of intelligent articles, this time on the quality of American Medicine.  This post summarizes the series

CMS grapples with creation of physician comparison website The CMS is considering how it will move forward with developing a website that will allow the public to compare physicians online, as mandated by the health reform law. "We realize this creates quite a few more issues that other (website) settings may not have, and we know there's a lot of interest and opportunity but also some anxiety about it as well and how it will come out," an agency official said. HealthLeaders Media  From AAP Smartbriefs. 

State officials charged under the new health law with providing affordable insurance to people with preexisting medical conditions are trying to stretch the federal dollars available for that growing need by asking outside groups to help pay the tab.  These state health specialists are tapping unconventional funding sources to help people afford the high-risk-pool premiums. They're turning to a variety of sources—from local medical providers, such as hospitals and national charities such as the American Kidney Fund—in order to cover as many people as possible. 

Providing Medicare to Everybody Increases Continuity of Coverage.  At KevinMD, Dr. Aldebra Schroll wrote: “At a recent staff meeting, a colleague mentioned her client was at an “awkward age”  I thought she was referring to a teenager, but she quickly clarified herself. She was referring to the age before someone is old enough for Medicare at sixty five, an awkward time indeed.  Many people between the ages of fifty to sixty four find that relatively minor health problems make health insurance unaffordable. For those with more serious diagnoses such as a history of cancer, they may play a dangerous waiting game until they can enroll in Medicare.”  Her post continues

The number one health care blog on Facebook is the Daily Beck blog.  (This information courtesy of the number two blog, which used to be number one.) 

Dale Quinney, Executive Director of the Alabama Rural Health Association, sent along the following assorted random facts that point to just how dire the needs are (or just how great the opportunities are) in rural Alabama. 

51 of Alabama’s 55 rural counties are currently classified as having a shortage of primary care physicians.  Only Coffee, Dallas, Marion, and Pike counties are not currently considered shortage areas.  (This classification measures the provision of MINIMAL rather than OPTIMAL care.)  

To eliminate all shortage designations, Alabama needs an additional 128 primary care physicians.  402 additional primary care physicians are needed to provide optimal care.  

All 55 rural counties are currently classified as having a shortage of dental care providers.    To eliminate all shortage designations, Alabama needs an additional 288 dentists.  348 additional dentists are needed to provide optimal care.  Alabama’s only dental school currently admits only 55 students each year.  

All 55 rural counties are currently classified as having a shortage of mental health care providers.    To eliminate all shortage designations, Alabama needs an additional 44 psychiatrists.  185 additional psychiatrists are needed to provide optimal care.  

More than one half of all actively practicing primary care physicians in Alabama are aged 50 years or more.  

It is estimated that the number of annual office visits to primary care physicians in Alabama will increase by more than 1,785,000 by the year 2025 – primarily due to the aging of Alabama’s population.  Over 904,000 of these additional office visits will involve rural physicians.  This increase does not consider such adverse factors as obesity with nearly one third of all adult Alabamians currently being obese, not simply overweight.  

Only 20 of Alabama’s 55 rural counties have hospitals that perform obstetrics.  In 1980, 46 of these counties had hospitals performing obstetrics.  

More than one in every five (22.1 percent) rural Alabamians are eligible for Medicaid services.  This is nearly one half ((44.5 percent) for rural Alabama’s children.  

The per capita personal income for rural Alabama residents is $29,170 which is over 21 percent lower than the per capita income of $37,109 for urban residents and over 27 percent below the figure of $40,166 for the nation.  Five rural Alabama counties (Wilcox, Bullock, Barbour, Sumter, and Bibb) are among the 250 poorest counties in the nation. 

The motor vehicle accident death rate in Alabama’s rural counties is 25.1 deaths per 100,000 population.  This rate is only 14.6 for the nation.  30 rural counties have motor vehicle accident death rates that are more than double the national rate with eight having rates that are more than triple the national rate.  While there are a number of reasons for this disparity, the great variation in emergency medical service among the counties must be recognized as a contributing factor. 

Nearly one in every ten (8.5 percent in 2000) rural Alabama households have no vehicle for transportation.  This percentage is in double digits for 22 rural counties.  

From Training Doctors in South Alabama blog.  

From the One Payer States Conference call, Friday, October 29: “In advance of the Leadership Conference for Guaranteed Health Care general meeting in Philadelphia on Friday, Nov 12, and the Healthcare-Now Annual Strategy Conference on Saturday and Sunday, Nov. 13 and 14, we discussed what we'd like presented about our work and about state-based single-payer effort to these conferences where many people have been more directed at national single-payer work for some time.” 

BEFORE YOU SAY THE ELECTION IS ABOUT HEALTH CARE - Only 3 percent of registered voters told an NBC-Wall Street Journal poll out recently that they would use their vote to tell Congress they support health care. (If only votes came with message cards.) Another 3 percent said their message would be they oppose it.  POLITICO Pulse.

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Are you ready for Leadership Training? New PNHP members - and longtime members who want to take the next step and get active - are invited to come to Denver the day before the Annual Meeting to participate in PNHP's popular crash course in health policy and politics starting on Friday, November 5, at 1:00 p.m. We look forward to working with you! Contact Matt Petty at matt@pnhp.org or 312-782-6006 to register. 

Please join PNHP in Denver for our Annual Meeting on Saturday, November 6, at the Sheraton Denver Downtown Hotel. The Annual Meeting is PNHP's most important, energizing and inspiring gathering of the year. This year's theme is "From PPACA to Single Payer: Next Steps for Single-Payer Activists in the Wake of the Obama Health Plan." Speakers will include Amy Goodman, PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, and more. A limited number of travel scholarships are available for medical students. 

Sunday, November 7 (probably),  7PM CDT.  Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4. 

Thursday, November 11, 2010.  Organizational meeting, Health Care for Everyone – Alabama, Conference Room, Emmet O’Neal Library, 50 Oak Street, (Crestline Village), Mountain Brook.  6:30-7:00 business.  7:05-8:00.  Dr. Wally Retan will present a test presenation of “The Business Case for Further Health Care Reform”.  Afterwards, adjourn to one of Crestline’s restaurants (optional) 

Leadership Conference for Guaranteed Health Care meeting, November 12, Philadelphia. 

Healthcare-NOW National Strategy Conference.  When: Saturday, November 13th and Sunday, November 14th Where: William Way Community Center, 1315 Spruce St., Philadelphia, PA Time: Sat, 4pm to 9pm; 
Sun, 8am to 4pm
 Fee: $30 for Healthcare-NOW! Members and $50 for Healthcare-NOW! Non- Members  Go to our National Strategy Conference page to register and more information.  (10/25 New: Draft Agenda.) 

Thursday, November 18, 2010.  @5:30 PM.  Third Thursday happy hour (social gathering), at 801 Franklin (Huntsville). 

Thursday, November 18, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code.  

Saturday, November 20, 9 AM.  Pippa Abston’s home.  Vision 2011 Workshop to develop roadmap and plan of action for 2011 activities of NAHA, North Alabama Healthcare for All, the north Alabama Chapter of PNHP, Physicians for a National Health Program. 

Wednesday, December 1, 2010.  Lunch, (social gathering) Panera Bread, Airport Road, Huntsville.  Wednesday before each monthly meeting. 

Wednesday, December 1, 2010. - B'nai Shalom Temple, Women's Group, anticipates about 30 people. Pippa Abston to present. 

Monday, December 6, 2010  @ 5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium.


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