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Newsletter "What's Going On?" June 19, 2010

Note

An important development this week.  The League of Women Voters, in its national convention, called on its Board to advocate for improved Medicare for All.

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The Economist has an article that reinforces one central point: the prime cause of increase in America’s long term indebtedness is rising health care cost in the Medicare and Medicaid programs.  “…the mark of someone serious about debt issues is an obsession with health cost control. Pundits fretting about the debt impact of stimulus are poseurs.”  The United States lags most other countries in the world in controlling cost as well as in providing universal access.

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Ever wonder why specialists in this country earn so much more than primary care doctors?  There was a great article, a couple of years ago, that provides much of the answer. The Primary Care–Specialty Income Gap: Why It Matters.  Thomas Bodenheimer, MD; Robert A. Berenson, MD; and Paul Rudolf, MD, JD.   Brad Flansbaum has an update with comparisons of incomes of specialists and primary care physicians in a number of other countries and in this country.

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Peter Orszag and Dr. Ezekiel Emanuel authored an article, Health Care Reform and Cost Control, in the New England journal of Medicine this week.   Their optimistic projections that the new law actually will do something effective to control costs are echoed in Maggie Mahar’s authoritative blog, “What Many Liberals Don’t Understand About Health-Care Reform.  I may have to modify my cynicism.

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Small businesses in California have been hit this year with premium increases of 58-75%, levied by Blue Cross of California.   The increases more than offset the tax credits available to those small businesses under the health care reform bill.

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A consensus around abolishing fee-for-service care in emerging in Massachusetts, reports Naftali Bendavid: "There is fairly broad agreement on how to fix the system. A state commission -including representatives of government, insurers, doctors and hospitals-recommended in July (of 2009) that Massachusetts adopt a "global payment" system. Health professionals would be paid for caring for patients over a certain period of time, rather than compensated for each test or treatment. Implementing the fixes, though, will take years."  From the Wonkbook.  The quote is accurate but out of context.

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o   Rising Costs: A Health Care Challenge For Democrats NPR by Julie Rovner - For Democrats, passing the new health care law may have been the easy part. Now that it's the law, everything that happens in health care, whether due to the Patient Protection and Affordable Care Act or not, is their responsibility.  "The Democrats have guaranteed that the American health care system is going to be affordable. They put it in the title of their bill," health policy analyst Bob Laszewski said. "So everything that happens after March 23, 2010 [the day President Obama signed the measure] is theirs. They own it."... Both Thompson and Laszewski say next year's rising costs aren't due to the new health law. And none of the new law's provisions intended to restrain health spending have yet to take effect. But those are subtleties likely to be lost on most of the public. They're simply going to wonder why their costs keep going up.  From the Herndon Alliance Health Care Media Summary. 

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Dr. Ezekiel Emanuel, Rahm’s brother, had a post this week about malpractice reform initiatives under the new health care reform law.

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Doctor and nurse retirements threaten to dull the impact of health care reform, reports Darryl Fears: "Health-care economists and other experts say retirements in that group over the next 10 to 15 years will greatly weaken the health-care workforce and leave many Americans who are newly insured under the new legislation without much hope of finding a doctor or nurse. Nearly 40 percent of doctors are 55 or older, according to the Center for Workforce Studies of the Association of American Medical Colleges."  From the Wonkbook.  The Health Affairs Blog adds that the impact of retirements doesn’t factor in the increased demand that the new health care reform act will create.  The author of one of the studies quoted said, “That’s a knockout number. It knocks the system down. It stops it.”  Hmmmm.

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This week, House Republicans quietly took aim at the individual mandate component of the health care reform act, but were defeated.  Still, Firedoglake reports: “And what that shows is that the danger to the Affordable Care Act is less repeal than a gradual assault on individual provisions, one by one. The subsidies are probably most at risk, since they have to be affirmatively approved. But expect House Republicans to continue to attack provisions like the individual mandate as well, perhaps even with eventual success, if this vote and the expected gains in November are any indication.”

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President Obama guarantees the American Nursing Association that 'in just two weeks, Americans denied coverage because of preexisting conditions will be able to enroll in a new national insurance pool.' That means the states that refused to run the program themselves, leaving that task to the feds, could well be the first to start delivering benefits. POTUS (POTUS=President Of The United States) urged the states running their own pools to 'start enrolling people as soon as possible.' From what we hear, 'as soon as possible' will be significantly longer than two weeks: Many state-level insurance officials have told PULSE they do not expect to begin enrollment until late summer.  From Politico Pulse. 

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With funds expected to start flowing on July 1, states are drilling down to the very specifics of their high risk pools. Michigan arguably has the most developed high risk pool so far, now out with specifics on what exactly the insurance would look like (h/t: Free Press http://bit.ly/9o7Pd3): $1,000 deductible, $20 co-pay for office visits, $10 for generic prescriptions, some benefit caps (ex. Chemotherapy capped at $100,000).  Politico Pulse. 

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Number of Uninsured Jumped By Nearly 3 Million in 2009.  One in five working age adults are uninsured.  And the trend is sharply greater for the number of underinsured.   

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The Associated Press reports, "A new Associated Press-GfK poll finds public support for President Barack Obama's new health care law has risen to its highest point. The nation remains divided, with 45 percent in favor and 42 percent opposed to the president's signature domestic accomplishment." Last month, the poll found that 39 percent supported the bill and 46 percent opposed it (Alonso-Zaldivar and Tompson, 6/17).

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On July 1, the Administration will unveil a new web insurance portal.  Karen Pollitz, responsible for the site development,  said, “…on July 1st, (the site will show) all of the big health insurance policies that are for sale, for individuals and small businesses throughout the country. So you can go on the website, look up your state and see what’s available for you. A little bit later this year, we’ll put out information about pricing, sort of what, at least the sticker price is for those policies. And then, a few months down the road after that, we’ll start loading up some really important performance information.

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Accountable Care Organizations are new kids on the block with health care reforms.  They have potential pitfalls

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Many of us speak, not only of Medicare for Everyone but of improved Medicare for Everyone.  Maggie Mahar has an excellent, detailed post describing some of the present problems with Medicare as senior citizens see them, and the nature of a serious threat to both Medicare and Social Security.  If you’re inclined to brush off talks of threat to Medicare as improbable, this post should be required reading.  It will also help understanding of why, all of a sudden, there’s so much worry about the size of the deficit.  (This is the first part of the story…second part due next week).   This issue raises a question: where should we, as a coalition, go from here?  Health Care for Everyone – Alabama is presently a single-issue coalition, advocating the same, high-quality, affordable health care for everyone.  Defense of Medicare and Social Security needs a fight, but to this point, it hasn’t been our fight.  Healthcare-NOW has a different opinion, that the assault on Medicare degrades our ability to advocate improved Medicare for All.  Is there need for a redefinition of the Coalition’s mission?  Is there need for a chapter of Healthcare-NOW in this state?  If so, who’s up to start it?  Or should there be another response?

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The Archives of Internal Medicine this month published the result of the first nationwide survey of free clinics in 40 years. Overall, 1007 free clinics operate in 49 states and the District of Columbia. Annually, these clinics provided care for 1.8 million individuals, accounting for 3.5 million medical and dental visits. Their mean operating budget was $287,810. Overall, 58.7% received no government revenue. Clinics were open a mean of 18 hours per week and generally provided chronic disease management (73.2%), physical examinations (81.4%), urgent/acute care (62.3%), and medications (86.5%).  In an invited commentary on the census, physicians from the San Francisco free clinic believe that the new health care reform law won’t put free clinics out of business.  There are still millions of people who won’t be covered under PPACA, and millions of others who won’t be able to find or to afford care even with their new insurance. 

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The nation of Rwanda has had national health insurance for 11 years.  92% of its citizens are covered.  The premium is $2.00 a year. 

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From HuffPostHill: WOMAN SHOOTS SELF TO GET HEALTH CARE- A North Carolina woman shot herself to receive ER attention for her shoulder pain. "Kathy Myers, 41, said she was pushed to the brink of desperation Thursday night because she was ‘crazy in pain,’ and the local hospital emergency room wouldn't help her. 'Pain will make you do silly, crazy things,’ the 41-year-old Niles, Mich., woman said in a YouTube.com interview with News 8 in Grand Rapids, Michigan. 'I knew they wasn't going to do anything, again. They said if it wasn't life-threatening, no health insurance, you can't get no help.’" http://huff.to/8ZUXOd

 

Who’d be interested in planning a Birthday Bash for Medicare when it turns 45 this July?  We ought to be able to get some cake, serve it with candles to some elected officials, local TV and newspapers.  Let me know if you’re interested. 

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Thursday, June 24.  8 PM Central.  PNHP Conference Call.  Call me for the number and the Conference Code.

 

Sunday, July 4. (May be rescheduled) Healthcare-NOW! will be hosting it's standing activist conference call at 7pm (CDT). Please use this Dial-in Number: 1-218-862-1300 and Conference Code: 441086.

 

Monday, July 5, 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.

 

July 30.  Medicare Birthday. Healthcare-NOW is “looking to July 30th this year as a major day of action to protest the cuts and privatization of our hard-won entitlement programs. These cuts are simply, ‘off the table.’  We hope you will consider activating your network on July 30th to demonstrate at your local Congress person's office, your state capitol, a private insurance company, or another target that you think will bring awareness, media attention, and pressure on our elected officials. Healthcare NOW will help to support your efforts with sample press releases, media kits, post cards, petitions, staff support, and email blasts. We need you on the ground to make the noise, and collectively, our work to protect these important programs will build our networks in advocating for what we know can help alleviate so much of the unnecessary suffering in this country: expanded and improved Medicare for All.  Please let Healthcare NOW staff know if you are interested in planning actions for July 30th at info@healthcare-now.org.”


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