Thursday, February 28, 2013

Seniors Fight Back Against Medicare Fraud

President Obama is making unprecedented strides in cracking down on health care fraud � already over $10.7 billion has been recovered since he took office.� And thanks to the Affordable Care Act, we have even more tools to stop fraud � including more law enforcement boots on the ground and more time in prison for criminals.� We�re also using state-of-the-art technology to spot fraud, similar to what�� your credit card company �uses . �As a result, prosecution of health care fraud cases is up 75% since 2008.

But for all of our new technology and investigative muscle, the most valuable resource we have in the fight against Medicare are the millions of seniors who serve as �our eyes and ears.� Seniors who notice services they never �received on their Medicare statements� often provide the �first tip that fraud is happening, so we�ve redesigned Medicare statements to make them easier to read and understand.� And our Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

That�s why the Obama Administration is investing more in the Senior Medicare Patrol. Today, the HHS Administration for Community Living announced more than $7 million in new funding to support Senior Medicare Patrol projects around the country.� This investment means more seniors will learn how to stand up for Medicare and will have even more support when they suspect that something isn�t quite right.

Seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare. ��

I heard from a Medicare beneficiary in Texas who was asked to sign a work order for his diabetes supplies.� He said that normally he would have just signed and thrown the paper away.� But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month�s supply.� So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he�d received only one of each.� The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received.�

Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling.� His daughter, Deborah, and his doctor arranged for him to have a motorized chair to help him get around.� But the chair that arrived was not the chair that Mr. Gilman ordered.� It was smaller, flimsier, and made by an entirely different manufacturer.� Deborah called the supplier, but their hands were tied � Medicare had already processed the payment for the chair.� So Deborah turned to the SMP for help.� After weeks of investigating, they uncovered that someone had intercepted Mr. Gilman�s order and replaced it with the less sturdy chair.� The SMP was able to work with Medicare to correct the problem, get Mr. Gilman the correct chair, and make sure that Medicare wasn�t charged twice.

Chuck Johnson in Montana received a telemarketing call offering him diabetic testing supplies that he didn�t want or need.� But even though he was clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.� Mr. Johnson got in touch with the SMP to see if they could help fix the problem.� Not only did his call mean that Medicare recovered money in his case, it also opened up a broader investigation into the organization that called him and could result in additional savings and prevented fraud.�

These three stories are eye opening, but they are not unique.� More than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud.� Together they�ve saved Medicare and the federal government in excess of $100 million. �

To all of you reading your Medicare statements carefully and tipping us off to fraud, I say thank you.� And I know your fellow American taxpayers say thank you, too. To learn more about the SMP program and to join us in our fight against Medicare fraud, go to www.stopmedicarefraud.gov.

Wednesday, February 27, 2013

Should You Fear The 'July Effect' Of First-Time Doctors At Hospitals?

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Monday, February 25, 2013

Medical students embrace Medicare for all

If you ever want to rekindle your hope for American medicine, spend time with medical students. These bright, energetic minds are going into medicine for all the right reasons � to help people, relieve suffering and find new ways to cure illness and eradicate disease.

Their idealism is a pleasure to behold, particularly to a veteran physician like me. Yet I’m painfully aware of how our current health care ‘system” can undermine students’ idealism, especially if they see no alternative.

Fortunately, a better alternative is waiting in the wings: a single-payer, improved Medicare-for-all program. Most Americans, including 59 percent of physicians, want access to an improved Medicare. I’m pleased to report that our physicians-in-training are strong supporters of this truly universal, comprehensive and affordable alternative.

Why? Even before they graduate, today’s medical students learn how our Byzantine, antiquated system of patchwork private insurance undermines medical care. They recognize an imperative to correct social injustice, for both moral and pragmatic reasons.

Medical students learn that as practicing doctors they’ll be dealing with dozens of different insurance schemes, each with its own rules, paperwork and bureaucratic headaches.

As physicians-in-training, they encounter patients who have delayed surgery until they qualified for Medicare at age 65 � often with more difficult and sometimes fatal complications as a result. They meet grandmothers who have had to decide between paying for medications for their hypertension and paying the rent.

They see patients with employer-sponsored health insurance get sick, lose their job, lose their insurance and declare bankruptcy. In fact, medical expenses are the most common cause of bankruptcy.

Like everyone else, medical students are shocked when they see these inequities and inefficiencies. They believe your wealth should not determine your health and that poor health should not be able to destroy your wealth. And, of course, they’re right.

I recently had a chance to discuss these issues with students at both of the major medical schools in town. Just last month the new St. Louis chapter of Physicians for a National Health Program brought in Dr. Garrett Adams, PNHP’s national president, and Dr. Carol Paris, a single-payer advocate from Maryland, to speak with students at those schools.

The sessions were co-sponsored by the American Medical Student Association, a long-standing supporter of a single-payer system that has about 30,000 members nationwide.

It was clear from our local meetings that growing numbers of our medical students reject our dysfunctional, insurance-based system. They want something better. Many understand there is a breathtakingly simple solution: fix the limitations in Medicare and provide it to every American. More than 30 percent of the health care dollar today is wasted on the administrative costs associated with the private health insurance industry; Medicare spent only 1.5 percent on administrative costs during 2011.

A landmark study in the New England Journal of Medicine (2003) showed that by replacing our fragmented, inefficient patchwork of multiple insurers with a single, streamlined, nonprofit agency like Medicare that pays all medical bills, our nation would save about $400 billion annually in reduced administrative costs � enough money to provide comprehensive, high-quality coverage to every American for no more than our nation spends now.

According to Gerald Friedman, professor of economics at the University of Massachusetts-Amherst in the March/April 2012 issue of Dollars and Sense, “a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits.” Spending would increase by $326 billion from expanding coverage and adjusting Medicaid rates. Americans would net a savings of $244 billion, enjoy universal coverage and eliminate the dreadful scenarios described above. Disposable income would increase for 95 percent of Americans.

Because a single-payer system would possess enormous bargaining clout, it also would be able to rein in costs for pharmaceutical drugs and other medical supplies over the long haul.

I believe that adopting an “improved and expanded Medicare for all” is the best way for students and physicians to return to their mission of caring for our patients, rather than squandering our time navigating administrative barriers erected by insurance companies. And make no mistake � these are barriers to care, with dire consequences.

Although we spend more on health care per capita than any other country in the world, American life expectancy ranks 38th.

My colleagues and I came away from our student meetings confident that the future of medicine is in good hands. The medical students we met didn’t get lost in jaded political quagmires.

They know it’s inevitable. They just want it to happen now.

Me too.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program�St. Louis.

Saturday, February 23, 2013

Businesses Sue Government Over Birth Control Mandate

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Friday, February 22, 2013

For Americans Under 50, Stark Findings on Health

Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States.

Researchers have known for some time that the United States fares poorly in comparison with other rich countries, a trend established in the 1980s. But most studies have focused on older ages, when the majority of people die.

The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.

The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.

The panel called the pattern of higher rates of disease and shorter lives �the U.S. health disadvantage,� and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.

�Something fundamental is going wrong,� said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University, who led the panel. �This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it�s getting worse.�

Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said. �The bottom line is that we are not preventing damaging health behaviors,� said Samuel Preston, a demographer and sociologist at the University of Pennsylvania, who was on the panel. �You can blame that on public health officials, or on the health care system. No one understands where responsibility lies.�

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability over all of surviving to the age of 50. The report�s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.

�We expected to see some bad news and some good news,� Dr. Woolf said. �But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.�

There were bright spots. Death rates from cancers that can be detected with tests, like breast cancer, were lower in the United States. Adults had better control over their cholesterol and high blood pressure. And the very oldest Americans � above 75 � tended to outlive their counterparts.

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.

Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.

The report also explored less conventional explanations. Could cultural factors like individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.

The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. But the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.

Thursday, February 21, 2013

Medical Waste: 90 More Don'ts For Your Doctor

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Tuesday, February 19, 2013

Yoga On Commission: More Employers Pay For Good Health Habits

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Saturday, February 16, 2013

Health Care Spending: A 21st Century Gold Rush

Winston Churchill once remarked, �Americans will always do the right thing, once they�ve exhausted all alternatives.� His observation, at least the second half of it, is proving itself as we continue to struggle with our health care system, especially its out-of-control costs that are crippling the budgets of businesses and government alike.

There is a lot of money in our health care system, and no enforceable budget. That leads to carelessness when it comes to spending that money.

What are some of the reasons health care costs continue to rise? Here are a few examples.

For at least the past 40 years, I�ve heard colleagues say, �We�d better get our fees and charges up now, because next year they�re really going to crack down on us.� It has never happened, yet. The problem is intensifying as outpatient �providers� have morphed from being real people into being corporations.

The Los Angeles Times reported on a case where a teacher�s group health plan was billed $87,500 by an �out of network� provider for a knee procedure that normally costs $3,000. Her health plan was willing to pay it. Outraged, the teacher ratted on the orthopedic surgicenter to California�s attorney general. After the press got involved, the charge was �reduced� to only $15,000. Not a bad pricing strategy, from the surgicenter�s point of view.

The New York Times reported an incident where a student who needed emergency gallbladder surgery ended up with a couple of �out-of-network� surgeons through no fault of his own. He was billed $60,000. His insurance company was willing to pay only $2,000. He was left to deal with the rest of the bill on his own.

There are many more examples. Privately insured patients are not the only ones affected. Governors around the country are continuing to struggle with how to pay for their Medicaid programs. In Oregon, Democratic Gov. John Kitzhaber is trying to find ways to impose a fixed budget on Oregon�s Medicaid program without adversely affecting Medicaid beneficiaries. But, he acknowledges, disciplining Medicaid alone will not do the job. He hopes his approach will be adopted by most other health insurance programs.

In Maine, Republican Gov. Paul LePage is struggling not only with how to keep up with burgeoning current Medicaid costs, but also how to pay the state�s almost $500 million past-due Medicaid debt to hospitals. He has proposed lowering liquor prices to boost sales, and mortgaging Maine�s future liquor revenues to secure bonds to pay the debt. His Republican colleagues in the Legislature have described this idea as �creative.�

One of the central features of Obamacare is the creation of �health insurance exchanges,� or online marketplaces. But the law has recognized that many people will need help making the right choices. So it has created an army of �navigators� to help them. A recent Washington Post story points out that a huge number of such experts will be necessary (California alone plans to certify 21,000 of them). Their cost will be reflected in higher health insurance premiums and has sparked opposition from insurance brokers who view them as competition. That will be an expensive fight, without increasing the amount going to actual health care by a single dollar.

Then there is the purchase of politicians by powerful corporate interests. When the Medicare prescription drug benefit was enacted in 2003, it was prohibited from negotiating lower drug prices, even though the veterans health system and many Medicaid programs are permitted to do so. The lead congressman pushing that provision retired from Congress soon after it was passed to take a lucrative job with the pharmaceutical industry. This has become standard practice in Washington.

And don�t forget the for-profit levels of compensation paid to the executives of nonprofit hospitals.

Meanwhile in Massachusetts, where Obamacare was born, health care costs are expected to rise six to 12 percent next year. Last year, their legislature passed a law capping increases in total private and public spending statewide, limiting them to the rate of growth of the Massachusetts economy. But the job of figuring out how to actually get it done was turfed to an �expert panel� of �stakeholders.� My bet is that such cost control will be difficult or impossible to achieve unless we simplify and centralize the way we finance health care.

Why does this financial abuse of taxpayers and patients continue? Because we let it. Americans often react to structural problems by simply throwing more money at them. We seem to be unable to say �no more.�

Maybe it�s time to revisit the part of Churchill�s comment about Americans always doing the right thing � by emulating the policies of most other wealthy countries. They have health care systems that are more popular than ours, provide better access to care, get better results, and are far less expensive.

Maybe it�s time to put everybody into a single, nonprofit system we can all support, within a budget acceptable to the majority of people. That arrangement would eliminate the political fights among people in different health insurance programs, each questioning change by asking, �How does it benefit me?�

Such a system would be best if done at a national level. But it could work initially at the level of individual states, such as Maine. That�s how the Canadians did it � one province at a time. If Maine could be one of the first states to do that, the people of Maine could truly say �Dirigo, I lead.�

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

What Nuclear Bombs Tell Us About Our Tendons

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Friday, February 15, 2013

Conyers Reintroduces National Single-Payer Health Care Bill

Today, Representative John Conyers, Jr. (D-Mich.) reintroduced H.R. 676, �The Expanded And Improved Medicare For All Act.� This bill would establish a privately-delivered, publicly-financed universal health care system, where physicians and non-profit health care providers would be in charge of medical decisions — not insurance companies.

H.R. 676 would expand and improve the highly popular Medicare program and provide universal access to care to all Americans. The program would be primarily funded by a modest payroll tax on employers and employees, a financial transaction tax, and higher taxes on the wealthiest Americans.

H.R.676 has been introduced in Congress since 2003, and has a broad base of support among universal health care activists, organized labor, physicians, nurses, and social justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians For A National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, and the NAACP. Last Congress, 77 other Members in the House of Representatives signed on as cosponsors of the legislation. In 2011, the Vermont legislature passed legislation that lays the foundation for a single-payer health care system in the state.

Representative Conyers issued this statement following the release of the bill:

�I am pleased to announce the reintroduction of H.R. 676, �The Expanded And Improved Medicare For All Act,� in the 113th Congress. I have introduced the bill in each Congress since 2003 and I will continue to do so until the bill is passed,� said Conyers.

�Many Americans are frustrated with high out-of-pocket costs, skyrocketing premiums, and many other serious problems that are part and parcel of a health care system dependent on private health insurance plans. H.R. 676 would reform this broken system.

�Passage of the Patient Protection and Affordable Care Act was an important initial reform, which will provide health insurance to millions of our nation�s uninsured and eliminate many of the worst practices of the private health insurance industry.

�However, it is my opinion, and the belief of many leading health care practitioners and experts, that establishing a non-profit universal single-payer health care system would be the best way to effectively contain health care costs and provide quality care for all Americans. It is time for Members of Congress, health policy scholars, economists, and the medical community to begin a serious discussion of the merits of a universal single-payer health care system.�

Tuesday, February 12, 2013

Can You Get A Flu Shot And Still Get The Flu?

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Monday, February 11, 2013

Barring Insurance Discrimination Based on Pre-Existing Health Conditions

Too often, I�ve heard from people worried that they couldn�t leave a job because they had diabetes or breast cancer and they wouldn�t be able to get health insurance on their own because of their pre-existing condition.

Thanks to the health care law, those fears will soon be a thing of the past. As part of the Affordable Care Act, HHS today proposed a rule that would prohibit some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.

Under this new rule, starting in 2014, families and individuals would see new protections from egregious insurance company practices, including higher premiums or the denial of health coverage because of a pre-existing condition.

No longer would women like Myrna Rodriguez Previte, a breast cancer survivor, have to struggle to find health coverage because insurance companies refused to cover her because she had cancer previously.

No longer would young adults like Abby Schanfield, who has a rare genetic parasitic disease that has required multiple surgeries, and Steven Giallourakis, a two-time cancer survivor with chronic health conditions, have to worry about being refused coverage or charged more because of their medical history.

The proposed rule that HHS is issuing today would guarantee that being sick will not keep you, your family, or your employees from getting affordable health coverage.

This rule builds off earlier successes of the Affordable Care Act, which prohibited health plans from denying children health coverage because they had a pre-existing condition.

To learn more about how this proposed rule would create a better health insurance market for consumers, please see this page.

The Obama Administration today also issued the following:

A proposed rule outlining policies and standards for coverage of �essential health benefits,� while giving states flexibility to implement the Affordable Care Act. Essential health benefits are a core set of critical benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. For more information regarding this rule, visit this page.A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while also ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. For more information regarding this rule, visit this page.

Sunday, February 10, 2013

Opening Day Crowd Shows Growing Support for Single-Payer in Oregon

An Oregon house bill sponsored by Rep. Michael Dembrow, D-Portland, is not expected to pass, but advocates claim momentum

Nearly a thousand people swarmed the front of the Oregon Capitol Building for the opening session Monday, demanding that Oregon become the second state to enact single-payer healthcare legislation, which would set up a government financing system to pay for and provide health care coverage and access for all Oregon residents.

Protestors at the Health Care for All Oregon rally hoisted signs, listened to speeches, heard woeful tales of the current health care system, and sang along to bluesman Norman Sylvester: �I don�t care what party you�re in, Democrat or Republican, we don�t need to fight, healthcare is a human right.�

�The brother said we don�t need a fight, but they�re going to fight us,� said Rep. Michael Dembrow, D-Portland, leading the crowd. Dembrow is the chief sponsor of the single-payer legislation, House Bill 1914. �We don�t necessarily need to fight back, we need to organize. Let�s go forward and organize this state, everybody in, nobody out.�

Dembrow said HB 1914 and companion legislation in the Senate already had 19 co-sponsors, all Democrats � eight more sponsors than its predecessor from the last session, HB 3510.

One of those new sponsors, Rep. Jennifer Williamson, D-Portland, said she supported the legislation because her sister was one of the thousands of Oregonians who each year file for bankruptcy under the weight of medical bills.

�I�ve been a legislator for three weeks now,� Williamson said. �The first bill I signed onto as chief legislator was a bill for universal healthcare.�

Dr. Paul Gorman, a member of Physicians for a National Health Program, said he ran a free clinic where a man came in complaining of pain in his abdomen. The man had no insurance and he put off seeing a doctor for a long time, allowing his pain to get worse and worse. �By the time he came to see us, his liver cancer was advanced, and he died.� Gorman said 500 Oregonians die each year because they don�t have insurance.

Health Care for All Oregon argued that while the Affordable Care Act signed into law by President Obama in 2010 does improve access for some people � expanding Medicaid and offering private health insurance subsidies to others � the single-payer advocates said the reforms were inadequate and would do little to rein in skyrocketing costs.

Single-payer healthcare would work similar to Medicare, with a single government fund paid for through taxes rather than paying premiums to several private companies.

HB 1914 isn�t expected to pass the Legislature or even come to the floor for a vote this session. But Dembrow expected to double the number of legislative sponsors and asked everyone in the crowd to lobby their representatives to support single-payer, hoping to find three more legislators by the end of the day.

The number of sponsors didn�t immediately grow to the goal of 22 legislators, but Marissa Johnson, an aide for Dembrow said they hoped to exceed that goal by the end of the week.

�We have interest from more than a handful of representatives and [Dembrow] will be following up with them today,� Johnson said.

Dembrow said at the rally he expected a million votes would be needed to pass a statewide measure while withstanding millions of dollars of negative advertising from groups like the for-profit private health insurance industry, which would be cut out of healthcare under the proposed system.

�The real work is not going to be done inside this building,� he said. �It�s going to be solved by a million people in Oregon, organized.�

�I think it�s going to take a lot of people stepping outside their comfort zones,� said Rio Davidson of Newport, who volunteered at the end of the rally handing out lists of legislators and asking people to contact their representatives. �Unfortunately, a lot of people who want single-payer are working low-wage jobs.�

Longtime advocate Betty Johnson said afterward that 60 organizations had been involved in the Health Care for All Oregon rally, and the group had recently hired a full-time field organizer. �Absolutely we are growing. We are organizing a number of chapters throughout the state,� she said.

Gov. John Kitzhaber has not shown support for single-payer, putting his energies instead into implementing a private health insurance exchange and transforming the healthcare delivery system through coordinated care organizations. Despite his position, Johnson said she hoped he would meet with single-payer advocates to discuss how it could work in tandem with the CCO model.

�He�s strengthening the delivery system,� Johnson said. �We really want to change the financing system. When we pass single-payer, the CCO system will work alongside it.�

Dembrow said there are restrictions in the federal Affordable Care Act that prevent states from passing single-payer laws without special permission before 2017. He lamented the added restriction, but said it also gave single-payer supporters three years to build support, get better organized, and develop a plan that would work for Oregon.

The state of Vermont enacted single-payer legislation in 2011 to cover all of its residents, but funding mechanisms are still being worked out and the state will also have to wait until 2017 to receive federal waivers.

Dembrow is introducing a second bill this session that would call on the Legislature to support a formal study of how single-payer would work in Oregon. Activists on Monday called on supporters to ask their legislators for public money, but Johnson said Dembrow believes the study could be paid for with private money.

Saturday, February 9, 2013

Needle Exchanges Often Overlooked In AIDS Fight

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Friday, February 8, 2013

Free Breast Pumps And The Cost Of Health Care

More From Planet Money BusinessHow Happy Is America?Planet MoneyFollow-Up To Our Show, 'An FBI Hostage Negotiator Buys A Car'Planet MoneyPlanet Money Meets RadiolabBusiness'Give Me The Money Or I'll Shoot The Trees'

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Tuesday, February 5, 2013

These Are The Tweets That Will Get A Doctor In Trouble

More From Shots - Health News HealthAggressive Care Still Common For Dying Seniors, Despite Hospice UptickHealthExercise Can Be Good For The Heart, And Maybe For Sperm, TooHealthWhy Prostate Cancer Screening Is So TrickyHealthWill Your Long-Term Care Coverage Keep Up With Changing Times?

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Monday, February 4, 2013

Health Care Spending In America, In Two Graphs

More From Planet Money Health CareHealth Care Spending In America, In Two GraphsAsiaA Union Vote For Chinese Workers Who Assemble iPhonesPlanet MoneyA French City Cleans Out Its Wine CellarPlanet MoneyEpisode 267: A New Mom And The President of Iceland

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How I Lost My Fear of Universal Health Care

When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canada’s Universal Health Care, I was somewhat disgusted. This meant we couldn’t choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom.

When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted. So imagine my surprise when I discovered that midwives were not only covered by the Universal health care, they were encouraged! Even for hospital births. In Canada, midwives and doctors were both respected, and often worked together.

I went to my first midwife appointment and sat in the waiting room looking at the wall of informational pamphlets. I never went to the doctor growing up, we didn’t have health insurance, and my parents preferred a conservative naturopathic doctor anyways. And the doctor I had used for my first 2 births was also a conservative Christian. So I had never seen information on birth control and STDs. One of the pamphlets read “Pregnant Unexpectedly?” so I picked it up, wondering what it would say. The pamphlet talked about adoption, parenthood, or abortion. It went through the basics of what each option would entail and ended by saying that these choices were up to you. I was horrified that they included abortion on the list of options, and the fact that the pamphlet was so balanced instead of “pro-life.”

During my appointment that day, the midwife asked her initial round of questions including whether or not I had desired to become pregnant in the first place. Looking back I am not surprised she asked that, I was depressed at the time, (even though I did not list that on my medical chart) and very vocal about my views on birth control (it wasn’t OK, ever.) No wonder she felt like she should ask if I was happy to be having this baby. But I was angry about the whole thing. In my mind, freedom was being violated, my rights were being decided for me by the evils of Universal Health Care.

Fast forward a little past the Canadian births of my third and fourth babies. I had better prenatal care than I had ever had in the States. I came in regularly for appointments to check on my health and my babies’ health throughout my pregnancy, and I never had to worry about how much a test cost or how much the blood draw fee was. With my pregnancies in the States, I had limited my checkups to only a handful to keep costs down. When I went in to get the shot I needed because of my negative blood type, it was covered. In fact I got the recommended 2 doses instead of the more risky 1 dose because I didn’t have to worry about the expense. I had a wide array of options and flexibility when it came to my birth, and care providers that were more concerned with my health and the health of my baby than how much money they might make based on my birth, or what might impact their reputation best. When health care is universal, Drs are free to recommend and provide the best care for every patient instead of basing their care on what each patient can afford.

I found out that religious rights were still respected. The Catholic hospital in the area did not provide abortions, and they were not required too. I had an amazing medically safe birth, and excellent post-natal care with midwives who had to be trained, certified and approved by the medical system.

I started to feel differently about Universal government mandated and regulated Health care. I realized how many times my family had avoided hospital care because of our lack of coverage. When I mentioned to Canadians that I had been in a car accident as a teen and hadn’t gone into the hospital, they were shocked! Here, you always went to the hospital, just in case. And the back issue I had since the accident would have been helped by prescribed chiropractic care which would have been at no cost to me. When I asked for prayers for my little brother who had been burned in a camping accident, they were all puzzled why the story did not include immediately rushing him to the hospital. When they asked me to clarify and I explained that many people in the States are not insured and they try to put off medical care unless absolutely needed, they literally could not comprehend such a thing.

I started to wonder why I had been so opposed to government mandated Universal Health care. Here in Canada, everyone was covered. If they worked full-time, if they worked part-time, or if they were homeless and lived on the street, they were all entitled to the same level of care if they had a medical need. People actually went in for routine check-ups and caught many of their illnesses early, before they were too advanced to treat. People were free to quit a job they hated, or even start their own business without fear of losing their medical coverage. In fact, the only real complaint I heard about the universal health care from the Canadians themselves, was that sometimes there could be a wait time before a particular medical service could be provided. But even that didn’t seem to be that bad to me, in the States most people had to wait for medical care, or even be denied based on their coverage. The only people guaranteed immediate and full service in the USA, were those with the best (and most expensive) health coverage or wads of cash they could blow. In Canada, the wait times were usually short, and applied to everyone regardless of wealth. If you were discontent with the wait time (and had the money to cover it) you could always travel out of the country to someplace where you could demand a particular service for a price. Personally, I never experienced excessive wait times, I was accepted for maternity care within a few days or weeks, I was able to find a family care provider nearby easily and quickly, and when a child needed to be brought in for a health concern I was always able to get an appointment within that week.

The only concern I was left with was the fact that abortion was covered by the universal health care, and I still believed that was wrong. But as I lived there, I began to discover I had been misled in that understanding as well. Abortion wasn’t pushed as the only option by virtue of it being covered. It was just one of the options, same as it was in the USA. In fact, the percentage rates of abortion are far lower in Canada than they are in the USA, where abortion is not covered by insurance and is often much harder to get. In 2008 Canada had an abortion rate of 15.2 per 1000 women (In other countries with government health care that number is even lower), and the USA had an abortion rate of 20.8 abortions per 1000 women. And suddenly I could see why that was the case. With Universal coverage, a mother pregnant unexpectedly would still have health care for her pregnancy and birth even if she was unemployed, had to quit her job, or lost her job.

If she was informed that she had a special needs baby on the way, she could rest assured knowing in Canada her child’s health care needs would be covered. Whether your child needs therapy, medicines, a caregiver, a wheelchair, or repeated surgeries, it would be covered by the health care system. Here, you never heard of parents joining the army just so their child’s “pre-existing” health care needs would be covered. In fact, when a special needs person becomes an adult in Canada, they are eligible for a personal care assistant covered by the government. We saw far more developmentally or physically disabled persons out and about in Canada, than I ever see here in the USA. They would be getting their groceries at the store, doing their business at the bank, and even working job, all with their personal care assistant alongside them, encouraging them and helping them when they needed it. When my sister came up to visit, she even commented on how visible special needs people were when the lady smiling and waving while clearing tables at the Taco Bell with her caregiver clearly had Downs Syndrome.

I also discovered that the Canadian government looked out for it’s families in other ways. The country mandates one year of paid maternity leave, meaning a woman having a baby gets an entire year after the birth of her baby to recover and parent her new baby full-time, while still receiving 55% of her salary and their job back at the end of that year. Either parent can use the leave, so some split it, with one parent staying at home for 6 months and the other staying at home for 6 months. I could hardly believe my ears when I first heard it. In America, women routinely had to return to work after 6 weeks leave, many times unpaid. Many American women lost their jobs when becoming pregnant or having a baby. I knew people who had to go back to work 2 weeks after giving birth just to hang onto their job and continue making enough money to pay the bills. Also every child in Canada gets a monthly cash tax benefit. The wealthier families can put theirs into a savings account to pay for college someday (which also costs far less money in Canada by the way), the not so wealthy can use theirs to buy that car seat or even groceries. In the province we lived in, we also received a monthly day care supplement check for every child under school age. I made more money being a stay at home mom in Canada than I do in the States working a close to a minimum wage job. And none of the things I listed here are considered “welfare” they are available to every Canadian regardless of income. For those with lower incomes than we had there are other supports in place as well.

If a woman gets pregnant unexpectedly in America, she has to worry about how she will get her own prenatal care, medical care for her child, whether or not she will be able to keep her job and how she will pay for daycare for her child so she can continue to support her family. In Canada those problems are eliminated or at least reduced. Where do you think a woman is more likely to feel supported in her decision to keep her baby, and therefore reduce abortions?

Since all of these benefits are available to everyone, I never heard Canadians talking about capping their incomes to remain lower income and not lose their government provided health coverage. Older people in Canada don’t have to clean out their assets to qualify for some Medicare or Social Security programs, I heard of inheritances being left even amongst the middle classes. Something I had only heard about in wealthy families in the USA.

And lest you think that the Canada system is draining the government resources, their budget is very close to balanced every year. They’ve had these programs for decades. Last year Canada’s national debt was 586 billion dollars, the USA has 15.5 trillion dollars in national debt. Canada has about one 10th the population of the US, so even accounting for size, the USA is almost 3 times more indebted. And lest you think that taxes are astronomical, our median income taxes each year were only slightly higher than they had been in the States, and we still got a large chunk of it back each year at tax time.

In the end, I don’t see Universal health care as an evil thing anymore. Comparing the two systems, which one better values the life of each person? Which system is truly more family friendly?

Former Quiverfull believer, Melissa is a member of the Spiritual Abuse Survivor Blogs Network at No Longer Quivering – she blogs at Permission to Live.

Saturday, February 2, 2013

Progress Continues in Setting up Health Insurance Marketplaces

Ten months from today, Americans in every state can begin to choose health insurance in new state marketplaces where they will have access to affordable coverage.� Many will have never had health insurance, or had been forced to make the decision to go without insurance after losing a job or becoming sick.� It is a groundbreaking time for health care in our country.

Today, we�re announcing that six states who applied early have made enough progress setting up their own marketplaces or Exchanges that we are ready to conditionally approve their plans�meaning they are on track to meet all Exchange deadlines.� These early applicant, early approval states include: Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington.�

We are excited to be reviewing applications from other states making progress in building their Exchange.� We will make many more announcements like this in the weeks and months to come and expect that the majority of states will play an active role operating their Exchanges.

Some states have requested additional information to help guide their work implementing the health care law.� We value the hard work states are undertaking and to ensure that states have all the information they need to move forward, today we are providing more information that will answer some questions states have been asking.� You can read the letter I sent to Governors here.

This letter follows information we have provided to states in the past month to help them build their Exchanges, expand and improve their Medicaid programs, and make health care coverage more affordable for every American.� It answers frequently asked questions by state officials, summarizing previous guidance and offering new information.�

For example, we explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes.� We clarify in our new guidance that states have the flexibility in Medicaid and the Children�s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt �bridge plans� that offer coverage through both Medicaid and Exchanges � keeping individuals and families together when they cross the line between Exchanges and Medicaid.� And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.�

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, �Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.�

Today�s approval for these six early states and our continued effort to give states the guidance and tools they need to move forward, ensures that starting in October 2013, consumers in all states can begin filling out applications for private health insurance in affordable, quality plans. ��And our work with states will continue.� If states decide they want to play a larger role in running the new marketplace in their state in 2015, 2016 and beyond, we will work with them so they can have the opportunity to take on that role. �We are excited about the progress we�re announcing today, and we will continue to work side-by-side with states as they implement the critical reforms to our health care system that our citizens need and deserve.���