Saturday, March 30, 2013

Obamacare Won't Affect Most 2012 Taxes, Despite Firm's Claim

More From Shots - Health News HealthIn India, Discrimination Against Women Can Start In The WombHealthSand From Fracking Could Pose Lung Disease Risk To WorkersHealthNumber Of Early Childhood Vaccines Not Linked To AutismHealth CareObamacare Won't Affect Most 2012 Taxes, Despite Firm's Claim

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Pennsylvania Tightens Abortion Rules Following Clinic Deaths

March 28, 2013

Listen to the Story 4 min 26 sec Playlist Download Transcript  

A police car is posted outside the Women's Medical Society in Philadelphia, on Jan. 20, 2011. Dr. Kermit Gosnell, accused of murder, performed abortions in the clinic.

Matt Rourke/AP

A Philadelphia doctor who performed abortions is on trial for murder. Kermit Gosnell, 72, is accused in the deaths of a female patient and seven babies who the prosecutor says were born alive. District Attorney R. Seth Williams laid out the case in disturbing detail in a grand jury report last year.

When authorities raided Gosnell's clinic in 2010 they found squalid conditions: blood on the floor, the stench of urine and a flea-infested cat wandering through the facility.

In court, Gosnell's attorney said his client is unfairly being held to standards one might expect at the Mayo Clinic. A jury will decide Gosnell's fate, but what is clear now is that state regulators were not doing their job.

"Unfortunately and tragically in Pennsylvania, facilities were going uninspected for years," says Maria Gallagher, a lobbyist with the Pennsylvania Pro-Life Federation. Gosnell's clinic went 17 years without an inspection, according to prosecutors.

"As for Dr. Gosnell's case, there were admitted failures in oversight at the department," says Aimee Tysarczyk, press secretary for Pennsylvania's Department of Health. But now the agency is inspecting abortion clinics regularly and making sure they meet state standards.

In 2011, the Gosnell case was mentioned frequently as Pennsylvania's General Assembly passed a law that put stricter requirements on abortion clinics. Now most clinics in the state are held to the same standards as outpatient surgery centers. That means abortion clinics must have doors and elevators that can accommodate a stretcher in case something goes wrong.

For some clinics, such as Planned Parenthood of Southeastern Pennsylvania, that meant expensive remodeling.

"Overall the cost was about $450,000 to get two of our facilities into compliance," says CEO Dayle Steinberg. The nonprofit had to install hands-free sinks. Tile floors were torn out and replaced with seamless floors that are easier to clean. The clinic's heating and air-conditioning system was upgraded and a new room was built to house sterilization equipment.

Steinberg says her organization already had a low rate of complications � less than one-tenth of 1 percent. She contends Pennsylvania's new requirements did nothing to improve services for women at her clinics.

"They were thinly disguised as improving patient safety, when really it was about increasing the cost for abortion providers � hoping that some of them wouldn't be able to afford it," Steinberg says.

Enlarge image i

An undated photo of Gosnell released by the Philadelphia District Attorney's office. Gosnell, who catered to minorities, immigrants and poor women at the Women's Medical Society, was charged with murder in the deaths of a patient and seven babies.

AP

An undated photo of Gosnell released by the Philadelphia District Attorney's office. Gosnell, who catered to minorities, immigrants and poor women at the Women's Medical Society, was charged with murder in the deaths of a patient and seven babies.

AP

The author of the legislation that put the tougher regulations in place disputes that.

"This is all about patient safety," says state Rep. Matt Baker. "We made it clear that we weren't going to arbitrarily and capriciously shut down abortion clinics."

Abortion opponents were not the only ones supporting Baker's legislation. State Rep. Margo Davidson says her 22-year-old cousin, Semika Shaw, died of sepsis and infection after an abortion at Gosnell's clinic. Davidson delivered an emotional speech on the Statehouse floor in 2011.

Dedicating her vote to Shaw, Davidson said she hopes the law will safeguard the health of women seeking abortions, "so that never again will a woman walk into a licensed health care facility in the state of Pennsylvania and be butchered, as she was."

Now that the law is in effect there are five fewer abortion clinics in Pennsylvania, though it's unclear whether the stricter regulations were the only reason they closed. That leaves 17 other providers in the state. Backers of the law say now if a woman enters a clinic in a poor neighborhood � or a rich one � she can be assured it is meeting a basic standard of care.

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Tuesday, March 26, 2013

Employers Try To Spur Healthy Behaviors With Health Plan Rewards

More From Shots - Health News Health CareEmployers Try To Spur Healthy Behaviors With Health Plan RewardsHealthSequencing Of HeLa Genome Revives Genetic Privacy ConcernsHealthMaybe Isolation, Not Loneliness, Shortens LifeHealthArkansas Medicaid Expansion Attracts Other States' Interest

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Saturday, March 23, 2013

Strike Debt Abolishes $1.1 Million of Medical Debt

Strike Debt, a group that emerged from the Occupy Wall Street movement, has planned a week of actions in multiple cities across the country to mark the abolition of $1.1 million in medical debt belonging to 1,064 people as part of the �Rolling Jubilee� project.

While that may already seem like a huge number, Strike Debt claims it�s only getting started and ultimately hopes to abolish around twenty times what they raised, which would be nearly $12 million.

�What we do is buy debt for pennies on the dollar,� Jacques, a member of Strike Debt, explained to activists gathered at Bryant Park on Thursday evening. �And instead of collecting on it like the debt collectors, we basically abolish it. We�re here today because we purchased over one million dollars of medical debt from over a thousand people in Kentucky and Indiana who had emergency room debt.� (A full report of the purchased debt can be found at the Rolling Jubilee�s transparency site.)

In order to kick off the �Life or Debt� week of action, protesters planned a medical bankruptcy tour to the various health insurance companies who Strike Debt sees as being exploitive of the sick and vulnerable by using insurance payments to fatten the wallets of the companies� CEOs instead of using that money for actual healthcare.

Paused before Aetna�s offices on Park Avenue, an activist announced to the group that Aetna�s CEO Mark Bertolini received over $10 million in total compensation last year, which is around 300 times the average worker�s pay.

A woman named Jamie spoke in front of Aetna�s office about how she wrote a letter to Bertolini after being denied coverage by the company due to a chronic work industry.

�I was frightened and heartbroken,� Jamie said. �I just couldn�t believe it. How could someone in charge of care turn their back on someone in unrelenting pain?�

Jamie�s letter was returned, unopened.

At the front of the procession, Strike Debt activists carried a banner that read �62% of all bankruptcies are due to medical debt.�

Another activist carried a sign: �Medical bills: death by spreadsheet.�

In front of the insurance giant CIGNA, a protester recounted the death of 17-year-old Natalie Sarkisyan, who died after having her liver transplant surgery first denied and then later delayed by the company.

In 2007, Natalie�s mother addressed a crowd of supporters in front of CIGNA�s Philadelphia headquarters.

�CIGNA killed my daughter,� Nataline�s mother Hilda told security. �I want an apology.� Sarkisyan was not able to speak to [CIGNA CEO] Hanway; a communications specialist talked to her instead. After their conversation, employees heckled the group from a balcony; one man gave them the finger. CIGNA called the police and had the family and their friends escorted from the building.
A CIGNA executive later apologized for the incident in a letter about a month later.

Over the weekend, Strike Debt activists have planned a free health fair and march to highlight hospital closings. The march will feature sites like the closed St. Vincent�s community hospital, which will enjoy a �second life� as the site of luxury condos priced between $1.4 and $8.2 million. The tour will be followed by free legal advice and health care at Judson Church. On Saturday, practitioners will also be on call to answer medical questions at Strike Debt�s website.

�These debts are literally killing patients, students, providers and communities,� the group states at its website. �They deepen the already entrenched inequalities that divide races, classes, and genders. Our healthcare system doesn�t make us well; it prolongs our illnesses in the name of profit.�

Dr. Ben Carson: Health Care Is 'Upside-Down'

March 11, 2013

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Dr. Ben Carson is known for blazing trails in the neurological field � including breakthrough work separating conjoined twins. Now he's making waves for his political views. Host Michel Martin talks with Carson about the current state of health care in America and his upcoming speech at the Conservative Political Action Conference.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. We're going to start off the week by meeting people who are involved with some of this country's more challenging debates around health care. In a few minutes, we'll meet the first person in this country to try out a new method for prostate cancer treatment. The treatment worked and now he's hoping his experience would persuade other skeptics, especially other African-Americans to participate in clinical trials.

But first we want to speak with a man of medicine who is now making a splash in the political arena. You might know Dr. Benjamin Carson as one of the preeminent neurosurgeons in the world. He was the first man to successfully separate twins who were born joined at the head. You might know him from his remarkable life story that inspired a movie starring Cuba Gooding, Jr. Or you might know him from his interview on this program after he was awarded the Presidential Medal of Freedom.

But lately, he's been getting a lot of attention for this speech that he gave at the National Prayer Breakfast last month.

(SOUNDBITE OF BREAKFAST SPEECH)

DR. BENJAMIN CARSON: It's very difficult to speak to a large group of people these days and not offend someone. I know people walk around with their feelings on their shoulders waiting for you to say something - ahh - did you hear that? And they can't hear anything else you say. The PC police are out in force at all times.

MARTIN: He went on to criticize President Obama's policies on everything from health care to taxes - all this while the president sat just a few steps away. After the speech, the Wall Street Journal ran an editorial titled "Ben Carson for President." The Atlantic called him a, quote, "new conservative folk hero." Now all eyes are on Dr. Carson for his next speech at the Conservative Political Action Conference, or CPAC, which is this week.

And Dr. Carson took time from his busy schedule to speak with us about it. Dr. Carson, welcome back to the program. Thanks for joining us.

CARSON: Thank you. Good to be back.

MARTIN: Now your concerns about health care in this country, the health care system overall, how it's practiced, are not new. For example, you talked about these issues when you were on this program. Are you talking more about these issues or are more people listening now?

CARSON: Well, you know, I've been talking about it for a long time. If you go back and read my 1999 book called "The Big Picture," a lot in there about health care. I've been very concerned about how we do it. And I wouldn't characterize myself as criticizing the president. I've been talking about these things long before he was on the scene. So it's not so much a criticism of him as it is placing out there some other ideals about how we get this thing under control.

And, you know, we spend twice as much per capita on health care in this country as the next closest nation and yet we have tremendous access problems. And I believe there are some ways that we can do it which would provide very excellent access to everybody at substantially less cost.

MARTIN: Why do you think your speech at the National Prayer Breakfast got so much attention?

CARSON: Well, I think it resonated with a huge number of people. You know, I've gotten literally thousands of contacts from people across the country - and the most poignant ones being elderly people - who said I had given up on America and I was just waiting to die. And now they felt revived. And I think what I really talked about, again, was not a criticism of anything but just some stuff that makes sense, logical things that make sense.

People are starving for that coming out of Washington. And it's not a Democrat thing or a Republican thing. I think it's a politician thing.

MARTIN: I do want to talk more about the substance of some of your ideas, particularly for people who haven't had a chance to read some of your books. In fact, you talk a lot about your ideas about health care in your latest book "America the Beautiful: Rediscovering What Made This Nation Great."

But I want to spend just a couple more minutes talking about where you decided to make these comments, about the conservative syndicated columnist Cal Thomas, who's one of the organizers of the prayer breakfast, said that he felt your remarks was inappropriate for the occasion, that you turned a non-political occasion into a political occasion. And he said it's not about politically correct; it's about being rude.

And I've personally heard you speak about the importance of being courteous. He says you owe the president an apology. Do you think you do?

CARSON: I don't think so at all. In fact, I don't believe that expressing your opinion, regardless of who is there, is being rude. And it's a shame that we've reached a level in our country where we think that you don't have the right to put your opinion out there. And the setting, I think, is extraordinarily appropriate because we're talking about the health of our nation, not only the physical health of our nation but also the spiritual health of our nation.

MARTIN: Do you think that your race plays some role in the attention that is being gotten here? I mean, the fact is that you and the president are both highly achieving African-American men from humble beginnings, if I can put it that way, and that there's something delicious in that confrontation.

CARSON: I suspect that in some people's minds that probably did create a little tasty tidbit, particularly those individuals who tend to think that if you're black you have to think a certain way and you have to act a certain way, which I find really quite offensive.

MARTIN: If you're just joining us, I'm speaking with Dr. Ben Carson. He's the director of pediatric neurosurgery at the Johns Hopkins Hospital. He's speaking at the Conservative Political Action Conference later this week and he's getting a lot of attention for comments he made at the National Prayer Breakfast which was last month. Talk a little bit more, if you would, about - I know your interest in some of these issues goes beyond health care, but health care is, I think, the area that you know best.

What is it that you think - the particular nugget that you would want people to come away with? What you think would be better?

CARSON: Well, first of all, in order to have good health care you need a patient and you need a health care provider. Along has come the middle man to sort of facilitate the relationship and now the middleman has become the primary component with the patient and the health care provider at its beck and call. This is totally upside down, and anything that we do that enhances that middleman and decreases the doctor-patient relationship actually exacerbates the situation rather than making it better.

So what - the reason that I proposed health savings accounts for everybody starting at birth, is because you very quickly accumulate an amount of money that you can use for your interactions with those health care providers. Also, you develop a very good doctor-patient relationship and also because you now have some responsibility for that account, you're going to be looking for good bargains. Other people are going to be making sure that they provide good bargains. You bring the whole health care system into the free market. And that's going to help to control cost as well.

MARTIN: You also talk, though, about the need for some sort of catastrophic insurance to address truly catastrophic situations.

CARSON: Yes.

MARTIN: Is that getting an equal amount of attention?

CARSON: Well, no one's really asking me about that. I appreciate you asking about it. Yes, that obviously does have to be a component of the plan. And that is the place where you can bring the government and where you can bring Medicare or Medicaid in. We can work out a system whereby that's done for considerably less money than we're spending now. Because you're taking the middleman out of the equation for 80 percent of the medical encounters.

MARTIN: I noted that you are talking with the Conservative Political Action Committee next week, CPAC which is, well, in Washington circles it's a big deal. It's considered a platform for people with political aspirations. Do you consider yourself a conservative?

CARSON: I consider myself a logical person and, you know, a lot of people try to categorize me in one way or another. You know, there are some of the things that I say that probably would be considered very much non-conservative. For instance, I think that the medical insurance industry needs to be reformed dramatically because we've put them in an untenable situation.

They make money by denying people care. That's an inherent conflict of interest. That situation needs to be addressed. Some people would say that's not a conservative way of thinking. But I don't think really conservative or liberal; I think what makes sense? What's going to help the American people? What's going to give them what they need? Not only in health care but in terms of jobs, in terms of education, in terms of a whole host of issues that, you know, I addressed in the most recent book, "America the Beautiful."

MARTIN: The Wall Street Journal editorial, as I mentioned, the title of it is "Ben Carson for President." We mentioned that CPAC has been a springboard for people who are aspiring to kind of a broader place in the public debate. Do you have aspirations for a career in public service? Do you have any intention of perhaps finding other platforms to discuss your ideas about policy?

CARSON: Certainly that has been pushed upon me many times in the past and there's no way I'm getting into the cesspool of special interest groups. Wouldn't do it anyway in the world. People say, well, why don't you run for Congress? You could get there very easily. Why would I want to run for Congress and continue to get tainted with all the things that people get tainted with as they come along the system.

I think perhaps a much better role would be to use my voice and to use my influence to help change the tone of this nation, to help us to realize that, you know, we're not enemies. A very wise man once said a house divided against itself cannot stand, and here we find ourselves in a situation where we're more divided than ever and we need to develop the kind of leadership that encourages people to work together, to join together, to utilize their strengths in order to improve our situation, not to continue to exacerbate it.

MARTIN: But on the question of the tone and the timing, could a reasonable person say, you know, the time for you to be heard on this issue was when healthcare reform was being debated, and that was not for a short amount of time. More broadly, one could argue, it's been debated for 40 years; narrowly, in this administration, one could argue, it was debated in the first two years of the administration.

I mean at this point could a reasonable not mean person say that this is a heckler's veto?

CARSON: Well, let me put it this way. During the healthcare debate, I was contacted by the administration to get my views and I was having quite a very decent conversation with the gentleman until he asked me what did I do for the president during the campaign, and I said that I'm an independent and that was the end of that conversation. Two months later I get another call. I guess they thought better of it and I was teaching a lesson.

I said I'm in the middle of teaching a lesson, can we talk in 40 minutes. The person was offended. I mean how could you possibly be doing anything more important than taking to the White House. That was the end of that conversation. You know, I talked to David Axelrod about that, and I tell him about those two conversations. He said, well, you know, we have some young people who perhaps don't exercise the best judgment and you shouldn't judge the whole administration on that basis.

I take him at his word that you shouldn't, but it's not that I haven't made an attempt to influence the direction of things.

MARTIN: That was Dr. Benjamin Carson. He's the director of Pediatric Neurosurgery at Johns Hopkins Hospital. His latest book - he's written many of them - is "America the Beautiful: Rediscovering What Made This Nation Great," and he was kind enough to take time out of his busy schedule to join us from member station WYPR in Baltimore. Dr. Carson, thanks for joining us.

CARSON: My pleasure.

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“Protect our Health, Not Their Wealth” Rally in Albany

Wednesday, March 20 – 60 people rallied in front of Albany Medical Center under the banner, “Protect OUR Health, Not THEIR Wealth.” Speakers and protesters called for “No Grand Bargain” – Hands off Medicare, Social Security and Medicaid,” “Scrap the Cap on Social Security,” “Oppose Privatization of our Public Hospitals and Nursing Homes,” and “Single Payer, Improved Medicare for All.”

A broad coalition representing nurses, physicians, medical students, labor unions, senior citizens, faith groups, grassroots organizations, and Occupy Albany – the driving force behind the event, joined the rally.

Sponsoring organizations:
New York State Nurses Association
Public Employees Federation
Physicians for a National Health Program – Student Chapter
Single Payer NY
Capital District .Area Labor Federation
Albany Central Federation of Labor
The Labor Religion Coalition
Capital District Alliance for Universal Healthcare
Statewide Senior Action
Citizen Action
MoveOn
Occupy Albany

Additional participating unions: AFGE, SEIU, NALC

Thursday, March 21, 2013

How A Patient's Suicide Changed A Doctor's Approach To Guns

More From Shots - Health News HealthHow A Patient's Suicide Changed A Doctor's Approach To GunsHealthAs Health Law Turns Three, Public Is As Confused As EverHealthHow Ideas To Cut ER Expenses Could BackfireHealthLaw Says Insurers Should Pay For Breast Pumps, But Which Ones?

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Wednesday, March 20, 2013

Affordable Care Act at 3: Holding Insurance Companies Accountable

Enacted three years ago, the health care law is making the insurance market work better for you by prohibiting some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.

As a former state insurance commissioner, I know that for too long, too many hard-working Americans paid the price for policies that handed free rein to health insurance companies. For more than a decade before the Affordable Care Act, premiums rose rapidly, straining the budgets of American families and businesses. And insurers often raised premiums without any explanation.

It wasn�t fair and it was costing you your hard-earned dollars, security, and peace of mind.

The Affordable Care Act is working to bring affordability and fairness to the marketplace by barring insurers from dropping your coverage when you get sick or placing a lifetime dollar limit on coverage. In 2014, it will prohibit discriminating against you or anyone with a pre-existing condition, such as high blood pressure, asthma, or cancer.

In an effort to slow health care spending and give all Americans more value for their health care dollars, the Affordable Care Act has brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring an insurance company to justify a rate increase before it shows up on your bill, thereby preventing arbitrary or unnecessary costs. Insurers must provide clear information so you can understand their reasons for significant rate increases.

We know this is making a difference, and that the law is driving down health insurance premium costs in the private market by holding insurers accountable.

A report last month shows that since the rule on rate increases was implemented, the number of requests for insurance premium increases of 10% or more plummeted from 75% to an estimated 14% since the passage of the health care law. The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggests that this slowdown in rate increases is continuing into 2013.

Even when an insurer decides to increase rates, consumers are seeing lower rate increases than what the insurers initially requested. More than half of the rate requests for 10% or more ultimately resulted in customers receiving either a lower rate increase than requested or no hike at all.

In 2014, insurers will be required to report all proposed rate increases, not just those 10% or more, in the individual and small-group markets.

Furthermore, the rate review program works in conjunction with the 80/20 rule, which requires insurance companies to spend at least 80% (85% in the large group market) of premiums on health care, rather than administrative costs (such as executive salaries and marketing) and profits, or provide rebates to their customers. Insurers that did not meet the 80/20 rule have provided $1.1 billion in rebates that benefited about 13 million Americans, at an average of $151 per family.

Insurance benefits and costs also will become clearer to millions of Americans and small businesses starting on October 1, 2013, when they will have the opportunity to shop in a Health Insurance Marketplace in their state. You will be able to find information to make apples-to-apples comparisons of health plans by quality and price and buy the one that best fits your needs and budget.

Delivering smarter health care includes holding insurers accountable, and that is helping to hold down costs. In the past three years, we�ve seen the slowest growth in overall health care spending since the government started keeping records more than 50 years ago.

We still have challenges to face. But for the first time in recent history, we�re making real progress in driving down the rate of growth and driving up the quality of care.

Find out more about the Effective Rate Review Program and the 80-20 rule.

Learn more about the key features of the Affordable Care Act at www.healthcare.gov/law/features.

Follow Secretary Sebelius on Twitter at @Sebelius.

Friday, March 15, 2013

Vermont Single-Payer Financing Plan Released

The Shumlin administration released two financing plans Thursday evening: one for funding a publicly financed health care system and another to pay for portions of the state�s new health benefit exchange.

The much-anticipated single-payer financing plan provides more of a map of the state�s health care finance landscape than it does a course of action through it. The document itself alludes to the need for a plan with substantive revenue-generating measures.

�A future financing plan will likely feature a substantial and regular individual and employer contribution, similar to current law, albeit one paid through a public system,� the plan says.

The plan � which was drawn up by the University of Massachusetts for a price tag of $300,000 � estimates that the total savings of reforming the system would be about $35 million in 2017. The total $5.91 billion cost of the system would place a burden of $1.61 billion on taxpayers, after federal funding, and a $332 million chunk would be placed on employers who continued to enroll their employees on their insurance plans after the system takes effect.

While the plan points to a slate of tax bases for raising such revenues, the architects of the plan acknowledge the lack of information they had to work with � and, therefore, the potential inadequacy of their findings.

�Many details regarding the structure of a single payer system in Vermont have not been determined,� they write. �These details may significantly affect the assumptions underlying our models and therefore the results of our models.�

When Gov. Peter Shumlin and the Legislature approved Act 48 in 2011, they set the state on a track towards a publicly financed health care system. Part of that legislation called for a financing plan to be submitted to the Legislature by Jan. 15, 2013, that �shall recommend the amounts and necessary mechanisms to finance Green Mountain Care and any systems improvements needed to achieve a public-private universal health care system.�

On Thursday, Director of Health Care Reform Robin Lunge said the plan met the statutory goal.

�It has amounts, and it has necessary mechanisms included; it just doesn�t have one,� she said. Furthermore, she added, the plan seeds the Statehouse for constructive debate over how to pursue and implement such a health care system.

Jeffrey Wennberg, who runs the anti-single payer group Vermonters for Health Care Freedom, panned the report for its lack of substance.

�The report � contains surprisingly little information within its 91 pages,� he said in a public statement. �There is no multi-year budget or projection, and the Act 48-required recommendation for a funding source is completely absent.�

Wednesday, March 13, 2013

Convenience And Efficiency Fuel Boom In Retail Clinics

More From Shots - Health News HealthWhy Relatives Should Be Allowed To Watch CPR On Loved OnesHealthPostpartum Depression Affects 1 In 7 MothersHealthDengue Fever No Longer Just A Visitor To Florida KeysFoodCan Free Video Consults Make Parkinson's Care Better?

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'We Shouldn't Have To Live Like This'

March 13, 2013

Listen to the Story 7 min 47 sec Playlist Download Transcript   Hide caption Linwood Hearne, 64, and his wife, Evelyn, 47, stand near Interstate 83 in Baltimore where they have slept on and off for the past four years. According to the local nonprofit Health Care for the Homeless (HCH), a growing percentage of homeless patients nationally are 50 or older, with complex mental and physical conditions. Previous Next Kainaz Amaria/NPR Hide caption Evelyn displays her bag of prescription medications, which she says are for asthma, chronic obstructive pulmonary disease and depression. HCH offers comprehensive services, including medical care, prescription subsidies, mental health services, housing assistance, and access to education and employment. Previous Next Kainaz Amaria/NPR Hide caption Linwood has long suffered from schizophrenia and admits that he was evicted from public housing after stabbing a neighbor in a fight. Many of the city's chronic homeless have criminal records, which makes it harder to get employment. "I'm getting older, and being out on the streets plays with my mental stability," he says. Previous Next Kainaz Amaria/NPR Hide caption Meredith Johnston, HCH's director of psychiatry, meets with Linwood once a month to review his medications and screen for behavioral symptoms. "Getting into housing will be a huge stabilizing change for Linwood and Evelyn," Johnston says. Previous Next Kainaz Amaria/NPR Hide caption HCH also runs a convalescent floor in a nearby shelter where patients can recover from fractures or recent surgeries. Susan Zator, a community nurse for more than 41 years, bandages 66-year-old William Jones' foot injury. Zator says this service is vital for homeless men and women who cannot recover properly while living on the street. Previous Next Kainaz Amaria/NPR Hide caption Physician assistant Jean Prevas tends to Jones' leg wound. Many aging homeless suffer from ailments not readily visible to outsiders. Medical conditions often go untreated and escalate into more acute health problems. Previous Next Kainaz Amaria/NPR Hide caption Albert Monroe and many others sleep on the porch and under the bright lights of the HCH clinic. Many say it's safer than sleeping under the highway or in city shelters, where theft and violence aren't uncommon. Previous Next Kainaz Amaria/NPR Hide caption Paul Behler, 59, and Tony Simmons, 51, leave a shelter where residents have to be out at 5 a.m. HCH also cultivates potential advocates still struggling to get back on their feet, like Behler and Simmons. Previous Next Kainaz Amaria/NPR Hide caption Behler lost his job as a piano tuner and has been living in shelters for a year and a half. "I'm going to find the way back," he says, "and part of this lobbying effort is making inroads in that respect." The two pass time at a 24-hour Dunkin' Donuts before HCH opens for the day. Previous Next Kainaz Amaria/NPR Hide caption Behler and Simmons take up issues on behalf of the homeless population. Here, they discuss Maryland House Bill 137, which calls for proof of identification at polling places, before going to a hearing in Annapolis. Simmons argues that many homeless have lost their IDs but shouldn't be disenfranchised. Previous Next Kainaz Amaria/NPR Hide caption Simmons irons a dress shirt at his storage unit, which he shares with three other homeless men, in preparation for the hearing. A father of three, he became homeless after a 2011 drug arrest and has been staying in shelters for 14 months. Previous Next Kainaz Amaria/NPR Hide caption Simmons, now clean for more than two years, lost his family and says he's too ashamed to go back home. "I have to find my own way now," he says. "This is my way." Previous Next Kainaz Amaria/NPR Hide caption Simmons hugs Evelyn inside HCH. He has been trying to help the Hearnes and many others get off the streets. Previous Next Kainaz Amaria/NPR

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Tony Lithgow and Andrea Mayer have been living under a highway overpass in downtown Baltimore, Md., since last year. He's 49 and has been homeless on and off for eight years. She's 51 and has been homeless for 10 years.

Living on the streets has clearly taken a toll on the couple, both physically and mentally. While they're standing at a corner waiting for a free city bus to take them to a soup kitchen, Tony shouts at a passenger staring at them from a car stopped at the light.

"We're homeless!" Tony calls out to the man.

Andrea tries to get him to stop, but Tony is on a roll. His anger is palpable.

"You're one paycheck away," he says. "That's all they are. And they don't understand. That's all it was for us."

A growing number of the nation's homeless are reaching what's called "premature old age." They're in their late 40s and 50s, but suffer from ailments more common for those in their 70s. Many will likely die over the next decade. This has posed a challenge for communities trying to care for the homeless, and could mean hundreds of millions of dollars in added costs, especially for health care.

Tony and Andrea say bad circumstances and bad decisions sent them spiraling from their middle-class lives and onto the streets.

"My husband died. I screwed up and I blew all the money," Andrea says. She adds that she was also very sick at the time and couldn't work. She suffered from Lyme disease, high blood pressure, memory loss and osteoarthritis.

Tony took care of his mother until she died of multiple sclerosis, and that cost him all of his savings. He says he worked as a cook and locksmith, but when the economy soured, he couldn't get a job.

Worsening Health Problems

Now they're homeless. Andrea's physical problems have only gotten worse and Tony has a bulging disc. You can see the pain on his face when he hikes a huge, duffel bag onto his back. He carries all their essentials � 75 pounds of clothing, toiletries, important documents and medication. This includes a dozen pill bottles, mostly for Andrea.

She's also in constant pain and needs to have both of her knees replaced. She walks with a cane she received from another homeless person, after hers was stolen.

"I don't feel safe without it," she says. "Because my knees buckle, you know... By the end of the day, I'm in excruciating pain. Right now, I'm living on painkillers."

“ Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach.- Yvonne Jauregui, nursing services coordinator It might seem unusual for someone who's 51, like Andrea, to be so infirm. But, it's extremely common if you're homeless. For those living out on the streets, 50 is old. Aging Prematurely "It ages you prematurely," says Nilesh Kalyanaraman, chief medical officer at Health Care for the Homeless, a clinic in Baltimore. Like similar clinics across the country, the Baltimore facility is seeing a growing number of older patients as the baby boom generation ages. Kalyanaraman says people's health problems only snowball the longer they're outside, which makes treatment more difficult and expensive. "If you're on the street, you're about three times more likely to have hypertension, or cardiovascular disease. You're about 50 percent more likely to die from it as well," he says. "Diabetes is more prevalent if you're homeless. It's harder to control." He says it's especially difficult to have a healthy diet when you're homeless. When Andrea and Tony go to the United Church of Christ soup kitchen for dinner, the meal is heavy on the starch � white beans, mashed potatoes with cut-up hot dogs, white hamburger rolls and a pastry. Tony whispers to Andrea that the beans look a little scary. But they have little choice, and know that people here mean well. They finish eating in about 15 minutes, and tell the servers that they'll see them again next week. Finding Work, Finding A Home Tony is frustrated. He says he'd like to get a job, but doesn't want to leave Andrea alone outside. It's too dangerous. Andrea was punched in the face when they were robbed recently at a bus stop. Tony thinks they could afford a small efficiency apartment � using Andrea's Social Security disability payments � but he says they don't have enough money for a security deposit. Source: Analysis of U.S. Census data by Dennis P. Culhane Credit: NPR "I got to get her off the street and I can't do it. Nobody's helping us. I'm tired. I'm tired. I'm exhausted," he says as his voice cracks. "This is not a joke anymore. I hurt." Tony stands up. Andrea watches him walk away with a concerned expression on his face. "I've never seen this, seen him so emotional," she says. The Population On any given night, more than 600,000 people are homeless in the U.S. By some estimates about a third are 47 or older � almost half the single adults. And this group is growing. Enlarge image i

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Researchers say that's partly due to younger baby boomers who are more likely than others to be homeless. They came of age in the late 70s and 80s, when the economy was especially bad, there was a crack cocaine epidemic and some of them never quite got on track.

After dinner, Andrea and Tony take another bus back to a small parking lot downtown under the interstate highway. This is where they sleep, as thousands of cars pass overhead. Their blankets, sleeping bags and everything else they own are hidden away � at least that's what they hope.

"You know, we never know if we're going to be OK until we check the stuff. And it's usually the homeless ripping off the homeless," Andrea says.

Someone stole all their things � including her dentures � last fall, when Andrea had to be rushed to the hospital for emergency gallbladder surgery. She still has no teeth.

Baltimore and other cities are trying to get their homeless residents off the streets and into permanent supportive housing. But money is scarce and they've only scratched the surface.

'Living High Class' Compared To Others

Like other couples, Andrea and Tony prefer to sleep outside rather than in a city shelter, where they'd be separated. And in the parking lot, they've found an electric outlet to charge their phones and plug in a small heater.

"I mean, we're sort of living high class compared to what these people are living," says Andrea, referring to the dozens of others sleeping nearby on city streets. "We're warm at night. These people are freezing to death."

Exhausted, Andrea sits down on a bag and watches Tony proceed with their nightly routine. He takes some rope and attaches solar blankets to a street sign to form a makeshift tent. He then covers the ground with layers of blankets and sleeping bags.

"See, what I do is I put the heater in first. I turn it on and it gets nice and warm in here, while I'm putting it together," he says.

And the tent is pretty cozy inside by the time Tony is finished. Still, he says, this is no way to live. When Andrea was released from the hospital after her surgery, this is where she came to recuperate and where he changed her dressings.

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Affordable Care Act is Working to Bring Down Health Care Costs

Before the Affordable Care Act passed, the dramatic rise in health care costs put access to health care coverage out of reach for many Americans. With many people no longer able to afford coverage, the cost of uncompensated care in hospitals rose and those costs were passed along to people that could afford coverage. And, at the same time, health care�s share of the nation�s economy was growing rapidly.�

Three years later, the Affordable Care Act is working to bring down health care costs.

The law includes innovative tools to drive down health care costs.� It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste. ��After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it�s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today reported health care providers and analysts found that �cost-saving measures under the health care law appear to be keeping medical prices flat.�

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive.� In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term.� The facts show that employers, patients and our federal budget can�t afford to roll back the law now:

Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade.� It would also shorten the life of the Medicare Trust Fund by eight years.Health care spending grew by 3.9 percent in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.The proportion of requests for double-digit premium increases plummeted from 75 percent in 2010 to 14 percent so far in 2013.Medicaid spending per beneficiary decreased by 1.9 percent from 2011 to 2012.Medicare spending per beneficiary grew by only 0.4 in fiscal year 2012.Slower growth is projected to reduce Medicare and Medicaid expenditures by 15 percent or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.

At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage.� Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service.� And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.�

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets.� If we turn Medicare into a voucher program, our system doesn�t have any incentives to be more efficient and lower costs.� Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket. �

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes � without cutting costs at seniors� expense.� In recent years, we have seen dramatic slowing of the growth of federal health care programs.� The best approach to reducing our deficit is to continue implementing common-sense reforms.� The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.�

Affordable Care Act is Working to Bring Down Health Care Costs

Before the Affordable Care Act passed, the dramatic rise in health care costs put access to health care coverage out of reach for many Americans. With many people no longer able to afford coverage, the cost of uncompensated care in hospitals rose and those costs were passed along to people that could afford coverage. And, at the same time, health care�s share of the nation�s economy was growing rapidly.�

Three years later, the Affordable Care Act is working to bring down health care costs.

The law includes innovative tools to drive down health care costs.� It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste. ��After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it�s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today reported health care providers and analysts found that �cost-saving measures under the health care law appear to be keeping medical prices flat.�

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive.� In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term.� The facts show that employers, patients and our federal budget can�t afford to roll back the law now:

Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade.� It would also shorten the life of the Medicare Trust Fund by eight years.Health care spending grew by 3.9 percent in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.The proportion of requests for double-digit premium increases plummeted from 75 percent in 2010 to 14 percent so far in 2013.Medicaid spending per beneficiary decreased by 1.9 percent from 2011 to 2012.Medicare spending per beneficiary grew by only 0.4 in fiscal year 2012.Slower growth is projected to reduce Medicare and Medicaid expenditures by 15 percent or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.

At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage.� Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service.� And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.�

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets.� If we turn Medicare into a voucher program, our system doesn�t have any incentives to be more efficient and lower costs.� Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket. �

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes � without cutting costs at seniors� expense.� In recent years, we have seen dramatic slowing of the growth of federal health care programs.� The best approach to reducing our deficit is to continue implementing common-sense reforms.� The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.�

Tuesday, March 12, 2013

Pills On The Job: Companies Add Prescription Services

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Monday, March 11, 2013

Magnets May Pull Kids With Sunken Chests Out Of Operating Room

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More From Shots - Health News

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Sunday, March 10, 2013

The Midterm Elections and Medicare For All

As we approach Nov. 2, it’s fair to say that in many ways the distortion of political discourse in our country has never been worse.

Extreme right-wing personalities – reincarnated Know-Nothings – are elbowing their way into the nightly airwaves via paid advertisements and Fox News. Billionaires are lavishly funding the Tea Party movement and an assortment of anti-government themes.

As our serious economic destabilization continues, and in the absence of vigorous progressive voices offering convincing, evidence-based solutions to our problems, our population is increasingly being abandoned to the clutches of ultra-right yahoos like Sharron Angle in Nevada, Pat Toomey in Pennsylvania, Ed Martin in Missouri and Christine O’Donnell in Delaware, to name just a few.

Pernicious ballot initiatives aiming to turn the clock back on health care and other social issues have been put on several state ballots, often the result of ultra-conservative stealth organizations deploying deliberately misleading language. Arizona’s Proposition 106, which would proscribe a single-payer system (and prohibit various other federal health programs), is a case in point.

These developments are creating a perilous situation for the republic.

It must be said that the quality of political discourse in the run-up to the midterm elections has not been facilitated by the flawed health reform legislation that the administration squeaked through Congress this spring.

While there are some desirable parts of the Obama administration’s new health law – the funding of community health centers, the expansion of Medicaid, the modest but not unimportant efforts to curb insurance company abuses – it is still widely viewed with unease by the public.

In fact, a recent AP/Stanford/Robert Wood Johnson Foundation poll showed twice as many Americans – 40 percent – believe that the law doesn’t go far enough as believe the government should not have a role in health care, and four-fifths of the public favor “making sure that more Americans get the health care they need.”

The recent spate of insurance company premium hikes and their pre-emptive dropping of whole classes of potentially unprofitable policies, such as those that cover individual children, by insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana, haven’t helped build public confidence in the new law’s ability to rein in these corporate profiteers.

Nor have reports that insurance companies and employers are successfully negotiating waivers to evade some of the modest requirements contained in the law.

As a result, skepticism in the law abounds. Polls suggest Republican calls to repeal or defund the new law have gotten some traction, even though their crude scare tactics – e.g. their charge that the administration’s health law is “socialist” – are patently ridiculous.

Big insurers are giving large donations to the GOP again (after having given so generously to Democrats in the run-up to the new law), hoping to dictate the terms of the law’s implementation in a way most favorable to their mercenary interests.

Meanwhile the health care situation in the U.S. is deteriorating at a more rapid pace. The Census Bureau data reported a few weeks ago indicated a startling 4.3 million increase in the number of uninsured since 2008, to 50.7 million people last year. This number would have been much larger if public insurance programs, in the first place Medicaid, hadn’t enrolled an additional 6 million people. The new uninsured numbers represent enormous human suffering.

It’s worth noting that the much vaunted public option, had it been incorporated into the new law, would have had a negligible affect on this number, according to a letter from the Congressional Budget Office. Besides inviting an insurer’s field day of cherry picking, such a provision would have been anything but a step toward single payer, as some of its advocates claimed.

So what to do?

First, it’s important to recognize there are a number of candidates running for office this November who support single-payer legislation, both incumbents and challengers. The candidacy of Dr. David Gill in Illinois’ 15th congressional district is but one example. Building up a single-payer caucus in Congress is an important goal, as is the continuing enlistment of support for single-payer legislation like Rep. John Conyers’ H.R. 676 and Sen. Bernie Sanders’ S. 703.

Second, several state-based movements for single payer are pressing their agenda for local reform. These states include Vermont, where an important Legislature-funded study on state models for reform – including single payer – is well under way, where several candidates have been vying with each other as to who’s more supportive of single payer, including gubernatorial candidate Peter Shumlin. Sen. Sanders has pledged to seek whatever federal waivers are needed should the people of his state declare their preference for a single-payer system.

Third, Medicare, Medicaid and Social Security are under a serious threat from the National Commission for Fiscal Responsibility and Reform. The commission is presumably going to make recommendations for changing these vital social insurance programs in its report to a lame-duck Congress by Dec. 1. Any cuts should be emphatically rejected. Medicare should be strengthened by improving it and expanding it to everyone. That’s also one of the surest ways to control skyrocketing health costs, as a recent congressional briefing by PNHP leaders and others recently pointed out.

Finally, our educational work in support of an improved Medicare for all remains indispensable. There are good reasons to believe that the new health law will be subject to destabilizing pressures from several quarters, including from actions by incorrigible offenders like the insurance industry (which is already complaining about the law’s minimal restraints), and the law may unravel sooner than many suspect. Single-payer Medicare for all needs to be ready to fill the gap when that happens, and a powerful people’s movement needs to be ready to push it forward in a new, dramatic way.

Doctors Group Tells Patients To Go For Cheaper, High-Value Treatments

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Friday, March 8, 2013

Sick in America: Hispanics Grapple With Cost And Quality Of Care

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Doctors Urge Their Colleagues To Quit Doing Worthless Tests

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Wednesday, March 6, 2013

Nixoncare Finally Wins

“The time is at hand this year to bring comprehensive, high-quality health care within the reach of every American. I shall propose a sweeping new program that will assure comprehensive health insurance protection to millions of Americans who cannot now obtain it or afford it.” – Richard Nixon

The Supreme Court decision to uphold the constitutionality of Barack Obama�s Affordable Care Act has caused a rejoicing among liberals not seen since the 2008 presidential election. The threat of repeal of the legislation now known by friend and foe alike as Obamacare, has united democrats and republicans too. The inability of any president to successfully provide universal health care to Americans made the passage and survival of Obamacare seem like a greater victory than it actually was. Republicans are united in thwarting the initiatives of any democratic president, especially a black one whose very presence causes them to react like one of Pavlov�s dogs.

Barack Obama�s health care plan is very much like a health care plan first presented by another president in 1971. Then president Richard Nixon presented a plan that was very similar to the over hyped Obamacare. Nixon proposed forcing private insurance companies to cover everyone regardless of prior health condition, and the government subsidizing those unable to pay.

The elation created by the Obama court victory is symptomatic of many things that are very wrong in the American body politic. Once again we see proof that the democrats of the 21st century are akin to the republicans of forty years ago. There is no other way to explain their bizarre rejoicing because a bandaid has been placed over a gunshot wound.

Nixon�s proposal ultimately failed because the late senator Ted Kennedy opposed it. Kennedy was the democratic point person on health care and he saw the obvious flaws in a plan which maintained a dependence on the rule of private health insurers. He assumed that an eventual democratic presidential victory would bring true health care reform, and torpedoed the Nixon initiative which is now being celebrated by democrats as a progressive triumph.

The Obama plan does address some of the major problems inherent in the current system, such as allowing parents to continue covering young adult children and preventing pre-existing conditions from barring access to coverage. These are certainly worthy goals, but a true single payer, medicare for all plan would address those problems too, and would also address the biggest obstruction to true health care reform, the reliance on private health insurance companies to provide care for every person.

Private health insurance companies are the problem, and the Affordable Care Act presents a huge windfall for them. When Obama�s plan goes into full effect in 2014, there will still be nothing to prevent health insurance companies from manipulating the market place and giving Americans access to inferior coverage with high deductibles. Medical care bankruptcies will not disappear, and the true death panel, privately run health care, will continue with the help of government dollars. Nixon�s plan was in some ways superior to Obama�s because it called for strict federal oversight of the insurance companies. Greater regulation would have prevented what will now be an inferior and overly expensive system from dictating health care outcomes.

As Vice President Biden famously said, the Obama plan is a �big f*ing deal.� It is a tremendous political victory for Obama but once again we must ask if political victories and also victories for the people. We now have a deeply flawed health care system which is more entrenched than ever. The argument that this plan will eventually lead to a single payer system is highly problematic. Big pharma and health insurance companies were at the negotiating table every step of the way while single payer advocates were locked out.
This act solidifies their control over our lives and shows once again the degree to which corporations drive American public policy.

A victory for Obama is not necessarily a victory for the people, even if that political victory causes insanity among republicans. Scorn from Sarah Palin, Glenn Beck and Rush Limbaugh are not necessarily justifications for rejoicing. Republicans can�t strike a blow against Obama in part because he accepted and promoted so many of their policies. From making war around the world, to bailing out the banks, to bailing out health care, Obama and the democrats act like the republicans they say are their political enemies.

We are told that Ted Kennedy must be smiling in his grave because his long held dream came true. After living to see only backward steps in the health care system he acknowledged regret at not accepting the Nixon plan The president who resigned in disgrace ended up winning in the end. Nixon may also be happy in the great beyond. It took a black man and the democratic party to give him his final political victory.

For Midwife, 71, Delivering Babies Never Gets Old

March 6, 2013

Listen to the Story 7 min 31 sec Playlist Download Transcript  

Editor's Note: This video contains a scene of childbirth that includes graphic imagery and explicit language.

Credit: John W. Poole/NPR

Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce.

Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be.

Sparling founded an obstetrics and gynecology practice called Womancare 31 years ago. During her career, she has delivered around 2,000 babies. Last year, she decided she'd retire from that part of her job, though she continued to see patients in the office. She didn't miss being on call � the person who's awakened in the middle of the night when a patient goes into labor.

"When you're on call, you just can't really plan for anything. You just need to be available, both physically and your heart and soul available, to do midwifery work. And when it's an unknown, I think it's a little bit more draining," Sparling says.

A few months ago, one of the other midwives in her practice had to take an extended medical leave. So Sparling had to go back to being on call.

Enlarge image i

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

"It would be horrible if I had to do this and stay up all night and didn't love what I do," she says.

'A Wonder To Behold'

It's just past daybreak at the hospital's birth center, and Sparling has been here since 4 a.m. with patient Amanda Trujillo, who is about to deliver her third baby. It's her second with Sparling as her midwife. The two are comfortable with each other. The atmosphere is relaxed. Sparling tells Trujillo to just be patient a little while longer.

When Sparling leaves Amanda and goes out to the nurses' station in the birth center, her spiky white hair sets her apart from her younger colleagues. Nurse Kathy Clarkson makes a point of telling her she was missed during her brief semi-retirement.

"We're glad that you're back working again, Dian," Clarkson says. "When you retired, we were all crying."

Nurse Julie Christin says that as a midwife, Sparling works more closely with women in labor than do most MDs.

"Physicians rely on us to do a lot of the labor support," Christin says. "But Dian spends a lot of time with her patients when they're in labor. I like that, because then she's involved and can make decisions quicker, and does what the patient wants to do, which is good."

Sparling is "in tune with them emotionally as well as physically," Clarkson says.

And then it's time for Sparling to get back in tune with Trujillo, who's ready to start pushing. Her husband, Isaiah, supports one leg, and delivery nurse Keri Ferguson supports the other.

“ It would be horrible if I had to do this and stay up all night and didn't love what I do.- Certified Nurse Midwife Dian Sparling As Amanda Trujillo works, her husband, Sparling and Ferguson cheer her on and report on the baby's progress. First his head emerges. Then his shoulders. And finally, there is a new little person named Samuel in the world, though at nearly 9 pounds, maybe not so little. "There he is, Amanda," Sparling says. "Reach down here and grab your baby." Samuel is born just before 10 a.m. Sparling has been at the hospital for six hours. And she's jazzed. "People have asked me, 'Does this feeling after a delivery ever get old?' Absolutely not," she says. "It's a wonder to behold, and my adrenaline stops pumping about two hours after a delivery. And then I can go to sleep." But it takes her twice as long to recover from an all-nighter as it used to. Her closest friends worry about her. Sparling is long divorced. Her two sons live back East, so this group of friends are the ones she refers to as her "support people." "We think she should be retired, but she doesn't think she can," says Sparling's friend, Wayne Peak. "She's our age and we're retired and we like to travel and relax a whole bunch, and she's on call and has to stay up in the middle of the night and deliver babies. That's not good." More In This Series Working Late: Older Americans On The Job When A Bad Economy Means Working 'Forever' Working Late: Older Americans On The Job For One Senior, Working Past Retirement Age Is A Workout Working Late: Older Americans On The Job At 85, 'Old-School' Politician Shows No Signs Of Quitting

Another friend, Nancy Grove, says she was not happy when Sparling first told her she was going back to being on call.

"Once I stopped thinking about myself and started thinking a little more about Dian, I really wanted to support her in what she wants to do, needs to do, because she's a very valuable asset in our community," Grove says.

A Line In The Sand

Sparling has reassured her friends that she will not keep delivering babies forever. In a way, she longs for retirement � from deliveries, from the office, from work. But that would mean finding someone to take over her practice and run it the way she believes it should be run. For instance, no patient is turned away because of lack of insurance or inability to pay.

"The truth of the matter is this is not a money-making business," Sparling says. "It makes our salaries. It makes our health care insurance payments for ourselves, it pays for our malpractice insurance, which is required by the state and also by our hospital. We can exist and pay for ourselves, but it doesn't make money."

Sparling says that at 71, she realizes time is not on her side. As much as she loves her work, she wants to pursue the other pleasures of life.

"One of which is travel. There are so many places in the United States and the world that I would love to go," Sparling says. "And one is taking piano lessons. I was given a piano at age 7 by my grandmother, and really never made proper use of it and practice. And you need time to do that."

Sparling has given herself deadlines for retiring before. None have stuck. But she's still trying.

"And now I guess I can draw a line in the sand and say it's going to be [at] 75, I will no longer be seeing patients in the office," she says.

But she acknowledges that maybe a line in the sand isn't the best metaphor. She says, "you know how sand flows."

Share 27Facebook 3Twitter Email Comment More From Working Late: Older Americans On The Job Around the NationFor Midwife, 71, Delivering Babies Never Gets OldAround the NationAt 85, 'Old-School' Politician Shows No Signs Of QuittingAround the NationWhen A Bad Economy Means Working 'Forever'EconomyWorking Late: In Tough Economy, Retirement Gets Pushed Back

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Tuesday, March 5, 2013

Don't Count On Extra Weight To Help You In Old Age

More From Shots - Health News HealthA Costly Catch-22 In States Forgoing Medicaid ExpansionHealthOften A Health Care Laggard, U.S. Shines In Cancer TreatmentHealthGot A Health Care Puzzle? There Should Be An App!HealthBest Defense Against Fire Ants May Be Allergy Shot Offense

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Monday, March 4, 2013

Why Tea Party Gov. Rick Scott Flip-Flopped on Obamacare

Florida Gov. Rick Scott was elected in 2010 almost entirely thanks to his activism opposing the Affordable Care Act, better known as Obamacare. Scott spent $20 million of his own considerable fortune attacking the law, and the Republican backed the state’s lawsuit challenging its constitutionality all the way to the Supreme Court. Scott had declared last summer that Florida would implement the law basically over his dead body, including the optional part that would provide federal funding to expand Medicaid to people making up to 138 percent of the poverty line.

So it was a bit of a surprise Wednesday when he announced suddenly that he had changed his mind: Florida should embrace the Medicaid expansion. We’d like to think that this article might have had something to do with his decision; Scott himself claims that mother’s death inspired his change of heart. But it’s more likely that the decision was a direct result of the US Department of Health and Human Services agreeing to grant Florida a waiver that would allow it to move more Medicaid recipients into private managed-care plans�many of which are part of huge corporate insurance companies waiting to cash in on the latest installment of Obamacare. (The Medicaid expansion is expected to send $66 billion in federal funds to Florida in the next decade.)

Scott has been saying for months that if HHS approved Florida’s waiver request, he might be more willing to take the Medicaid expansion. He was in DC in January meeting with HHS Secretary Kathleen Sebelius over the issue. But HHS’s decision to grant the waiver was somewhat surprising, given that the state was asking to expand a very troubled pilot project going back to the Bush era. The pilot project, which also required a waiver from HHS, allowed the state to put Medicaid recipients in five counties into private, HMO-type health plans rather than the traditional government health plan for the poor and disabled. Scott has championed the pilot as an innovative way of keeping government spending in check. Health care advocates, though, saw the program as a major disaster.

A study by the Georgetown University Health Policy Institute backed up their claims, finding that the biggest problem with the “reform” was that insurance companies got into the program thinking they’d make a lot of money, only to discover that they actually had to care for people who were expensively sick. Nine plans dropped out of the pilot project in a year, leaving many patients without access to any primary health care. There were horror stories, too: the woman denied a kidney transplant, the man with a lifelong seizure disorder who suddenly found he couldn’t get the Botox injections that calmed his seizures. If the patients weren’t getting dropped by the managed-care plans, they were fleeing them for whatever other options they could find. There’s no evidence that the private plans saved the state any money.

“We’ve been raising hell for a couple of years saying this is a problem,” says Laura Goodhue, executive director of Florida CHAIN, a consumer advocacy group that works for the uninsured in Florida. “When you’re caring for an expensive population with multiple conditions, lots of mental-health issues, the only way to make a profit is to delay and deny services, and that�s what we saw in Florida.”

Some of the companies chosen to lead the Medicaid “reform” pilot project weren’t exactly stellar performers before they got there. Wellcare, one of the HMOs in the project (and a major donor to Florida’s GOP), paid out $80 million in 2009 to settle charges federal criminal charges that it had lied about how much it actually spent on health care for poor kids and other vulnerable clients. Last year it paid out another $137.5 million to settle False Claim Act lawsuits alleging schemes to wring extra money out of Medicaid programs, including those in Florida, as well as cherry-picking customers and other abuses.

Despite experiences like these, the Florida Legislature in 2011 voted to expand the pilot project, and big insurers have been jumping to get into this market, (The insurance giant WellPoint, for instance, recently bought Amerigroup, a large Medicaid managed care company, to get in on new business thanks to Obamacare.) But to fully implement its new privatization law, Florida needed the federal government, which pays for about half the program, to waive certain requirements designed to protect patients.

Consumer advocates had fought the law and have been lobbying the Obama administration against granting Florida a waiver. And they had some success. Recently, HHS refused to allow Florida to let HMOs charge Medicaid enrollees $10 co-pays for doctor visits or $100 for emergency room visits for non-emergency care, as the state law allows.

And while Scott has heralded this week’s news about the latest waiver approval as a victory, what HHS actually agreed to is less than the governor and the HMO companies lobbying for the changes were probably hoping for. Among other things, HHS said that the state still has a long way to go to protect consumers enrolled in private plans, and that the approval of the waiver was “conditional,” premised on Florida developing “robust” community input and data-driven goals and strategies.

Goodhue says the new waiver has many more consumer protections built into it than the one granted under the Bush administration, and that hopefully it will prevent some of the problems that occurred under the state’s pilot program. She still doesn’t think that managed care is the way to go to improve Medicaid. But in the end, she�s pleased that it’s not as bad as it could be, and if it means that a million Floridians will get new coverage, that’s something advocates can get behind.

Why are you Thankful?

If you follow @HealthCareGov on twitter, you already know some of the many reasons why we are thankful for the health care law, the Affordable Care Act. From preventive benefits to strengthening Medicare, the Affordable Care Act is helping keep Americans healthy and protecting them from some of the worst abuses of the insurance industry.

This month, we�re highlighting the many reasons to be thankful for these new benefits. �So we put out the call asking you to give us a few examples about the new health care benefits you�re thankful for, and share stories about how you�ve been helped by the law. Already, on we�ve heard from hundreds of you.� Using the hashtag #ThanksHCR, here are just a few examples of what people across America have said on Twitter:

@MaineCAHC: #ThanksHCR for keeping Julie on her mom�s insurance so she can get the care she needs http://t.co/lGO4F5JN

@TxWellHealthy: In Texas, 149,000 young adults gained coverage due to ACA allowing kids under 26 to stay on parents� policies. #ThanksHCR

@AmerAcadPeds: Thanks to health reform, insures can�t deny coverage to kids due to pre-existing conditions. #ThanksHCR

@ABCardio1: Thanks to health reform, people with Medicare get a free annual wellness visit, AKA more time with their doc http://1.usa.gov/uRd3go #ThanksHCR

@NHCouncil: This thanksgiving season NHC gives thanks for ACA policies that help people with #chronic conditions. #ThanksHCR

@whereisthao: #ACA in effect - calling out unfair rate hikes by health ins industry! ow.ly/7BzWs #ThanksHCR

@HealthPolicyHub: #ThanksHCR for protecting #Medicare benefits for seniors and providing free preventive care with no co-pay.

@RWV4HealthCare: Love the fact that children can stay on their parents' insurance plans till age 26! #thanksHCR

@apiahf: Thanks 2 #HCR, people w #Medicare get discounts on prescription drugs and a free annual wellness visit. #ThanksHCR

@VA Organizing: #ACA is helping to protect patients from medical errors & making hospitals more reliable, less costly. 1.usa.gov/sQNMtK #ThanksHCR

So this Thanksgiving, as you gather around the table with family, friends, and great food, remember to share why you are thankful. Talk to your loved ones about the key features of the law that can help keep them healthy. And keep sharing your stories about why you are thankful for the many new benefits in the health care law by sending a tweet using the hashtag #ThanksHCR.

Ashley-Care: Health Care Coverage Without Stress for a Young Adult

Today, 3.1 million people are newly insured thanks to a provision in the law that enables young adults to stay on their parents� health care plans. Ashley Drew is one of them. Ashley, a young woman from Scarborough, Maine, was born with Cystic Fibrosis, a life-threatening chronic disease. She spends a lot of time in hospitals getting special IV antibiotics, respiratory therapy and physical therapy to clear her lungs and fight infections. One month in the intensive care unit cost her about $144,000; her last stay was for three months.

Ashley was diagnosed with end-stage lung disease and waited on two transplant lists for more than 500 days. She recently successfully underwent a double lung transplant.

Because of the health care law, the Affordable Care Act, young adults under the age of 26 may be able to stay on their parents� health insurance, and for Ashley, this has made all the difference. Staying on her parents� insurance allowed her to pursue her education to become a music teacher and to study instrumental conducting � at a pace she could handle with her health condition � and not worry about how to make sure she had coverage.�

�The fact that the Affordable Care Act is in effect, it�s amazing, because it�s horrible to have to worry and stress about your health and, in my case, something that everyone takes for granted: breathing,� Ashley says. �Everyone deserves to breathe, but unfortunately without health insurance that�s not a reality for some people.�

Without the security that staying on her parents� insurance plan provides, Ashley says she would be spending all her time trying to figure out how to come up with the money for her treatment.

Ashley believes the benefits under the law are important for people who don�t have her immediate health concerns as well. �I think the Affordable Care Act brings peace of mind to people all over this country because you don�t know when something�s going to happen,� she says. �Just to know that you have health insurance � You�re not going to lose your car and you�re not going to end up homeless because you got sick.�

Sunday, March 3, 2013

The Affordable Care Act Turns Two

The President's health law gives hard working, middle-class families the security they deserve.� The Affordable Care Act prohibits insurance companies from dropping your coverage if you get sick, billing you into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.�

All Americans will have the security of knowing that they don't have to worry about losing coverage if they�re laid off or change jobs.� And insurance companies are required to cover preventive care like mammograms and other cancer screenings without co-pays or deductibles.�

The new health care law is already making a difference. Thanks to the Affordable Care Act:

2.5 million more young adults have health insurance on their parent�s plan.5.1 million people with Medicare saved an average of $635 on the cost of their prescription drugs. And everyone on Medicare can get preventive services like mammograms for free.Insurance companies must spend at least 80% of your premium dollars on health care and not overhead. They can no longer raise your premiums by 10% or more without any accountability.It�s illegal for insurance companies to deny coverage to children because of a pre-existing condition. And in 2014, discriminating against anyone with a pre-existing condition will be illegal.

Protesters outside and inside White House health care forum in Iowa

By O.Kay Henderson for Radio Iowa–

There were protesters outside and inside this morning’s White House health care forum in Des Moines.

About 20 protesters stood on the street outside, waving signs and chanting. A psychiatrist from University of Iowa Hospitals in Iowa City stood in the middle of the group, wearing his white lab coat and chanting “Everybody in, nobody out” along with the others. Dr. Jess Fiedorowicz is a member of Physicians for a National Health Program. “‘Everybody in, nobody out’ truly universal health care. Universal health care has become a buzz word in the elections, but if you look at the proposals people are proposing, they truly do not intend to cover everybody,” the doctor said. “�We’re interested in everybody being covered.”

Sixty-one-year-old Vashti Winterburg of Lawrence, Kansas — another protester — opposes any plan that keeps health insurance companies in business. Winterburg said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly. “It costs us a thousand dollars per policy, per employee, per month,” Winterberg said. “That’s horrible.”

Iowa Farmers Union president Chris Peterson of Clear Lake said he’s glad the forum was held in the Midwest, as most Americans don’t understand the challenges rural citizens face. “Rural Iowans struggle with finding affordable insurance. Even solidly middle class farmers are feeling the pinch. Nearly one in eight Iowa farmers battle outstanding health debt,” Peterson said. “I am one of them.”

Peterson, who is 53, was kicked off his private insurance plan about two years ago for what the company said was a preexisting condition. Peterson and his wife, who has no private insurance either, have accumulated $14,000 in medical debts in the past two years. “The health care system in this country is dysfunctional and burdensome,” Peterson said of the private insurance industry. “…Personally, what I’ve been through, it seems at times it’s a ponzi scheme — they’re taking your money — or (it’s) just the robber barons pulling money out of your pockets.”

Once the forum got underway, protester Mona Shaw of Iowa City stood to call the event “shameful” because health insurance companies were participating. As she was escorted out of the event hall, Shaw accused insurance companies of ignoring the needs of their customers. “Governor Culver has taken $20,000 from Blue Cross-Blue Shield, of course he’s not going to let the insurance industry take any of the flack for this,” Shaw shouted toward reporters as she left. “Iowans are dying.”

President Obama’s White House advisor on the health care issue sat on a panel that included Iowa Governor Chet Culver, the governor of South Dakota and Senator Tom Harkin. Seventy-five-year-old Darlene Neff of Iowa City, a retired school teacher, told the group she’s survived breast cancer and a brain tumor. “We who are retired and have insurance as well as Medicare know how good we have it as far as health care goes, but we know, too, that there are millions out there who don’t have good health care,” Neff said. “That basic health care should be available to everyone today.”

Small business people like John Piper of Des Moines were among those who talked of their difficulties in keeping employees because they cannot offer health insurance as a benefit. “I reduced the size of my company because of health insurance,” Piper said. “So now, it is a one-person company.”

Those who provide health care services were part of the discussion, too. Karen Van De Steeg , executive director of a cancer center in Sioux City, urged officials to consider private companies are doing things to control the cost of health care. Van De Steeg manages Siouxland Pace which provides inhome care to the elderly.

“Essentially, the private sector, our company has taken on risk for taking care of these patients,” Van De Steeg said. “We are providing some of the poorest, oldest, most-frail people the absolute best care they could possibly get in their homes. It’s an alternative to nursing home care and the whole reason we’re successful is it’s about prevention. We do everything possible to keep that person well.”

A couple of state legislators and a pharmacist from eastern Iowa were among those who also stepped to the microphone to air their thoughts on health care reform, too.

From Radio Iowa.