July 2005

July 30, 2005

The always informative Blog, Left In Lowell, did an interview with Deval Patrick, Democratic Candidate for Governor. Here's what he had to say about health care:

LYNNE: So you’ve talked about health care as a centerpiece of your campaign and your most ambitious proposal, and a lot of people are wondering: how will you succeed where others have failed before you?

PATRICK: Well, you know, the fact that people have failed before me is a factor but it can’t be that we’re at this position today in politics where if it hasn’t been achieved before, it can’t be achieved in the future. The point is, that everybody, whether you have insurance or not, whether you are an employee or employer, whether you’re a doctor, an HMO, a hospital, everybody agrees that the system we have is not working well. And to me, that is an opening for leadership because all of the stakeholders have a reason to come to the table. They don’t have the same reason necessarily, but they have a reason to come to the table. And I think with the right leadership, we can drive through to a result that works for everyone.

Of the proposals that are out there, there are three, you probably know. The governor has a proposal, the Senate president has a proposal, and then there’s a proposal from Health Care for All. Those are, I’d say, the most developed, the most concrete ideas that are on the table. I do think that the destination of health care for everyone is important. Even if we can’t get there in one step. The most ambitious of the proposals is the one that appeals to me the most, which is the Health Care for All proposal. I’m studying them all but I’m focusing on that one.

July 29, 2005

Got a call from a reporter the other day following Gov. Romney's role reversal on abortion from pro-choice to pro-life. Question: the Gov's insiders say he needs to postpone any announcement that he's not running for re-election so that prospects for health reform will not be jeopardized. Hmmmm...

Nope. These days anyone who believes there's a chance the Gov. might run for re-election has a thing for the tooth fairy. The Gov's lame duck status is already a given and well factored into anyone's political equation, a fact of life. So does that mean prospects for health reform are cooked duck too?

Nope. The Gov's commitment to health reform, whatever style, is helpful in keeping this issue on the public and media radar screen. Alone, it is not enough to convince the Legislature to enact difficult and controversial reforms. Reform will occur if House and Senate leaders become convinced that: a. our health system problems are bad enough they must be addressed; b. the proposed policy solutions make sense; and c. there's sufficient consensus among key system participants that the reforms will work for them.

No disrespect to the Gov. For health reform to happen, it must be bigger and more important than the Governor's personal, political agenda. Bottom line: it's up to all of us, not to him.

July 28, 2005

OK, OK. It's taken us longer than it should. Today we unveil our new, improved blogsite. The best part of it -- you can now respond to my postings and have the rest of the world see your comments. Yeah, so maybe we were a little timid in our original version -- it's been a 4 month trial to see if we could keep up the pace of blogging on a regular basis.

So let us know your opinions and reactions to any daily posting. And let us know your reactions to the blog overall. You can post them for anyone to see, or you can send me an email at your leisure -- mcdonough@hcfama.org

Meanwhile, we mentioned in an earlier blog about the Citizens Health Care Working Group, established by federal law through the efforts of Oregon Sen. Ron Wyden. Their charge is to come up with a comprehensive reform plan for the US health care system (perhaps fix global climate change while they're at it). They are coming to Boston on August 16 and 17 to hold a public hearing. Click here for information (such as it is) on this session, to be held at Harvard Medical School. I've heard Sen. Wyden talk with great excitement about this effort. We'll have to wait and see...

July 27, 2005

A new study in the American Journal of Public Health documents that health expenditures for immigrants are substantially lower than for US born persons. This is important because immigrants are often blamed for high costs of the health care safety net, and such erroneous conclusions are used to justify denying coverage to non-citizens. Here are some juicy data bits:

-- Per capita health expenditures for immigrants were 55% lower than those of US born persons ($1139 vs. $2546); immigrant children had 74% lower health expenditures than US born children.

-- Immigrants account for 10.4% of the US population, and only 7.9% of health care expenditures.

-- Immigrant health expenditures in 1998 were $39.5 billion; $25B were payments by private insurers, $2.8B was paid directly by immigrants, and $11.7B was paid by government sources. Per capita expenditures were lower for immigrants in every payer category.

As the authors point out, the National Research Council concluded that immigrants add as much as $10B each year to the nation's economy, and that immigrants pay on average $80,000 per capita more in taxes than they use in government services over their lifetimes. The Social Security Administration estimates that workers without valid social security numbers contribute $8.5B annually to Social Security and Medicare even though they claim no benefits for their contributions.

Great job by the authors -- three of whom work at Cambridge Hospital: Drs. Steffie Woolhandler, David Himmelstein, and David Bor. And let's quit the immigrant bashing. And thank you to the Massachusetts House and Senate for restoring health benefits for elderly and disabled legal immigrants.

July 26, 2005

This is a special week for Americans. On Saturday, July 30, we celebrate the 40th anniversary of the enactment of Medicare and Medicaid, America’s health care program for the most vulnerable among us. Families USA has produced a Flash e-card celebrating Medicaid’s accomplishments. Please view the card and pass it on. At the end of the animation, you can take action to protect Medicaid from cuts pending in Congress.

Forty years ago this Saturday, President Lyndon Johnson signed into law—with Harry Truman at his side—an amendment to the Social Security Act creating Medicaid and Medicare. Since that day, Medicaid has provided health care for millions of people with disabilities, working families, the elderly, children, and moms-to-be. Today, Medicaid is stronger than ever, providing health care to 53 million of the most vulnerable Americans.

Despite its success, some in Congress propose cuts to Medicaid that could damage the program beyond repair. It is during these times of economic uncertainty and rising income inequality that we need to keep Medicaid strong. Along with Social Security and Medicare, Medicaid is a vital component of America’s safety net. It is the most visible sign of America’s resolve to take care of our most vulnerable citizens, regardless of income or social status. It is a concrete expression of our values—in America, no one gets left behind. On this historic week, help us celebrate and protect Medicaid:

Families USA has produced a new fact sheet, Medicaid: Four Decades of Success(PDF), along with an easy-to-print, double-sided booklet version(PDF) you can pass out during your own activities around Medicaid’s birthday. Another great site for information and materials on Medicaid -- go to Medicaid Matters, run by Community Catalyst.

July 25, 2005

Today Globe, Health & Science section, includes a profile of Dr. Mark Doherty, a public health dentist in Massachusetts who doesn't avoid -- and rather runs to -- caring for the dental needs of the neediest and most disadvantaged in society. Click here for the article.

This past spring, HCFA gave Dr. Doherty one of our Community Leader Awards -- here's a clip from today's article: His award: Health Care For All, a Boston health care advocacy group, honored Doherty for his work this year, giving him a 2005 community leadership award. ''It was humbling," Doherty said. ''In public health, you kind of grind it out and keep on plugging, and then something like that happens."

Not only is Mark a great dentist, he was an expert witness in HCFA's federal civil rights lawsuit, (see July 15th Blog below) and he's an executive committee member of the Oral Health Advocacy Task Force. And we're proud to have his active involvement and friendship. Congrats to Mark!

July 24, 2005

Today's (Sunday's) Washington Post has the first of a three part series on poor quality in the Medicare program and the costs associated with it. (Click here -- free registration required.) Bottom line:

"In a four-year period, 106 heart patients at Palm Beach Gardens (hospital) developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died. How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more. Under Medicare's rules, each time a patient comes back for another treatment, a hospital qualifies for an additional payment. In effect, Palm Beach Gardens was paid a bonus for its mistakes. Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine."

But, wait a minute, this is Massachusetts, the mecca of medicine. Aren't we great? Well, not really. The Post includes an informative interactive graphic showing each state's quality of care ranking along with its per capita Medicare spending. How does Massachusetts compare -- on quality of care, we're the 15th best; on costs were the 7th most expensive. Whose more expensive? Louisiana $8239, Texas (hi George!) $7558, California (hi Arnold!) $7289, Maryland $7190, Florida (hi Jeb!) $7111, New York $7035, MA $7012.

Whose better than us on quality? Fasten your seat belt:

  1. New Hampshire
  2. Vermont
  3. Maine
  4. North Dakota
  5. Utah
  6. Iowa
  7. Colorado
  8. Wisconsin
  9. Connecticut
  10. Minnesota
  11. Oregon
  12. Nebraska
  13. Montana
  14. Delaware
  15. Massachusetts

What kind of nonsense is the Post measuring? "Based on 24 basic measures of care from the Centers for Medicare and Medicaid Office of Clinical Standards for Quality, including the percentage of hospitals that give heart attack patients aspirin and Beta Blockers within 24 hours of admission."

Fascinating isn't it? Not one of the top 6 most expensive states makes the list for the best on quality. And the prize goes to ... Louisana. Hold the gumbo ... # 50, dead last on quality, and #1 on cost. That takes work doesn't it?

The health care cognoscenti want us to believe the problem with health care is the insatiable demand by consumers for services. Health system, heal thyself!

July 22, 2005

A bill known as the Health Care Choice Act would allow insurance companies to avoid consumer protections by selling individual health insurance across state lines, and is being rammed through the US House. Under this bill, insurance companies would only have to follow the laws of one state -- the state with the fewest consumer protections -- and could sell policies to consumers in all 50 states. This would create a "race to the bottom," leaving consumers with higher premiums, unpaid medical bills, and bare-bones coverage, hurting 26 million Americans who buy individual market coverage.

This legislation (H.R. 2355), introduced by John Shadegg (R-AZ), is moving quickly in the House. It is likely to come to a floor vote next week, while a companion bill, S. 1015, has been introduced in the Senate by Jim DeMint (R-SC). This bill has flown under the radar screen, and many members of Congress are unaware of the effects it would have on consumers. The so-called Health Care Choice Act is the wrong choice for consumers and a stealth attack on consumer protections, passing undetected.

Please call or e-mail your members of Congress and urge them to vote against the Health Care Choice Act. It is important that members of Congress get this message loud and strong: This legislation would hurt consumers and make insurance unaffordable. It is the wrong choice for health care consumers.

  • U.S. Capitol switchboard: 202-225-3121 (then ask for your Representative's office)
  • To find the number for your Representative's district office, visit Congress.org and type your zip code in the box.

Tell Members this bill would result in:

  • More consumers with unpaid medical bills,
  • Higher premiums and unfair premium increases, and
  • Bare-bones coverage that does not include critical services like diabetes treatment and cancer screening.

For more info on the Health Care Choice Act visit Families USA.

July 21, 2005

Thank you, House and Senate, for overriding Gov. Romney's vetoes of important health care issues in the FY06 state budget.

First, the House and Senate overrode the Governor's vetoes of affordable premiums for the Children's Medical Security Plan. CMSP provides primary and preventive care services for kids who can't get family coverage or MassHealth. High premiums imposed in 2003 discouraged many lower income families from enrolling kids in CMSP. Thanks for Rep. Steve LeDuc, Rep. Kathy Teahan, and Sen. Tom McGee.

Second, the Legislature rejected language inserted by the Governor to require low-income elderly and disabled legal immigrants to hit up their sponsors before qualifying the MassHealth assistance. Thanks to Rep. Byron Rushing, Rep. Tony Cabral, Rep. Anne Paulsen, Sen. Montigny and others.

Both of these vetoes are reasons why the health access community is less than fully trusting of the Governor's health reform assurances. If we can't count on the Governor to do the right thing on these issues, why should be rely on him on the host of other related issues? Good question....

July 20, 2005

This morning, Governor Romney announced the filing of his health reform plan with the Legislature. You can obtain the full legislative text from HCFA's website by clicking here. In many ways, the legislation is less revealing than the Governor's less-than-revealing Powerpoint. For example, the powerpoint shows hypothetical premiums that would be paid by lower income folks to be insured -- the legislation simply directs the new Insurance Exchange board to develop premium levels.

Bottom line? We still have our share of concerns -- the real affordability of these hypothetical products, the content of the insurance policies, the security of the safety net, the treatment of noncitizens, the appropriateness of the Commonwealth acting as collection agent for hospitals, and the fiscal soundness of the plan.

Still, this is a serious effort at devising a new way of conceptualizing health care reform and deserves study and attention. The Administration -- which admonishes the health industry to be more "transparent" -- needs more transparency itself in sharing its data, assumptions, models, and other essential components. If they do that, the health care community has an obligation to give this plan a most serious and detailed examination.

Ten years ago., Charlie Baker and Bruce Bullen (for Gov. Bill Weld) produced a health reform blueprint that had some real weaknesses. Yet the underlying framework was revolutionary and pathbreaking; the Legislature fixed the weaknesses and produced an historic health reform plan. Maybe this is the same, and maybe it isn't -- we have an obligation to find out.

So no snap judgments -- let's take a good look under the hood.

July 19, 2005

Great column yesterday by EJ Dionne on a new report by the Center for Budget and Policy Priorities documenting the value public programs play in lifting families out of poverty. More than 27 million Americans are lifted out of poverty by public benefits. More than 90 million obtain decent health coverage through Medicare, Medicaid, and the Children's Health Insurance Program. Food Stamps help 25 million poor folks obtain a healthy diet. The Women's Infants and Children's Program (WIC) helps 8 million pregnant and postpartum women obtain supplemental nurtrition.

"Does all this cost a fortune? Not by any fair reckoning. Federal spending on Medicaid and SCHIP represents 1.5 percent of gross domestic product. Federal financing for the rest of the low-income programs consumes just 2.3 percent of GDP. For a sense of comparison, consider that defense spending consumes 4 percent of GDP and interest on the national debt gobbles up 1.5 percent. President Bush's tax cuts -- which go in large part to the wealthiest Americans -- will consume roughly 2 percent of GDP."

You can obtain the full reports from the Center by clicking here.

July 18, 2005

All the pretty ads for health plans. Even puffery for Medicare. What do you never, ever see -- ads talking about how good MassHealth is. Unthinkable. So here's a public service announcement on how MassHealth gets things right for their clients, the most vulnerable and difficult population in the Commonwealth. An article in the July/August issue of Health Affairs -- T Coughlin et al -- (sorry subscribers only -- email me and I'll send it to you) looks at MassHealth compared with 12 other states and with private health plans serving low income folks in all 13 states. Interesting results:

MassHealth US Medicaid MA Private US Priv.

Doctor Visits% 84 79 85 81
Dental Visits% 63 54 67 65
Breast Exam/Pap Smear% 53 45 43 48
Unmet Surgery/Med Need% 6 8 8 7
Unmet Drug Need% 5 10 7 7
Unmet Dental Need% 17 18 12 13

With the glaring exception of dental (helllooooooo) MassHealth compares favorably on nearly every measure with other Medicaid populations and with private health plans serving low income populations -- public and private. While there's plenty of room for improvement, let's give cheers to the folks at MassHealth and to the folks throughout our health care system who serve them. If only we had money for an ad...

Meanwhile, as the nation's governors talk about the glories of copays and other cost sharing for Medicaid clients, another Health Affairs piece (Wright et al) examines the impact of cost sharing on Oregon Medicaid . Here's what they did to the poor in Oregon -- new premiums ranging from $6 to 20 per month; new copays of $5 per office visit, $50 for emergency department, and $250 for inpatient admisssion; and elimination of premium exemptions for homeless, those with zero income, and people who experienced crime, domestic violence, natural disasters, or death in the family. And finally, a six month lockout for whose who missed even one monthly payment.

The results? A 46 percent drop in covered lives, from 88,874 to 47,957 covered lives between February and December 2003. For those who left, the vast majority became uninsured, and the principal reason for leaving was the new cost sharing.

The Governors say they want to make sure their new cost sharing proposals don't lead to clients leaving the program. Whom do they think they're kidding?</s