Injury Health Care 2013: November 2013

Saturday, November 30, 2013

How Will We Know If HealthCare.gov Is Fixed?

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Health care specialist Stacy Chagolla helps William Bishop compare plans at an Affordable Care Act enrollment fair in Pasadena, Calif., this month.

David McNew/Getty Images

Health care specialist Stacy Chagolla helps William Bishop compare plans at an Affordable Care Act enrollment fair in Pasadena, Calif., this month.

David McNew/Getty Images

Saturday is the day the Obama administration set as its deadline for making HealthCare.gov a "smooth experience" for most users.

A tech-savvy team of engineers, database architects and contractors has been working through the holiday to ensure the White House makes good on that promise, but judging the success of their efforts may take some time.

How will we know whether the website is fixed? NPR's health policy correspondent Julie Rovner says that partly depends on how you define "fixed." She joins Weekend Edition Saturday host Scott Simon to explain what that means.

Interview Highlights

What "fixing" HealthCare.gov means

Remember the promise is to have it working for what they call the "vast majority of users," by which the administration means 80 percent of visitors to the site.

That means 1 of every 5 people will still need to use a call center, an in-person counselor, or a paper application due to a technical problem or because his or her individual situation is too complex to be handled online. So Amazon or Orbitz this is not.

But then again, this is not buying a TV or a plane ticket, either. Many people have pointed out that spending a couple of hours buying health insurance online is still a lot faster than the old way, when you might have had a 50-page paper application and a process that literally took weeks.

How the administration has been fixing the website

There was a little show and tell earlier this week, where the White House actually showed reporters some of the 300 or so people who have been working pretty much around the clock from various centers located in the Washington, D.C., suburbs.

They've got a separate hardware team doing upgrades to increase the website's capacity, for example � they're saying it should be able to handle 800,000 separate visits per day going forward.

Then another team is working on software. They're fixing bugs and trying to make the website more user-friendly for consumers.

Will anyone be able to tell if the site is really fixed?

That's the really frustrating part. I'm not sure we will, at least not at first. We do already know it's working better than it was in October � which, frankly, was a pretty low bar to get over. The administration has all kinds of fancy metrics to show how well the website is working, but we don't have our own independent access to them.

We do know a big test is likely to come on Monday, when people who have been talking to relatives over the long holiday weekend � or who wake up and suddenly realize it's December and they want coverage in January � all try to sign on at once.

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Key parts of the site that must wait

Insurance companies are getting increasingly worried. It seems that while so much effort has been going into what they call the "front end" of the site � where consumers go to compare insurance plans and sign up for coverage � some parts of the "back end" of the site � where insurance companies actually get paid � haven't even been built yet.

The administration says it will get that done before money has to begin to change hands sometime in January, but given that nothing up until this point has happened on schedule, that doesn't make insurance companies feel a whole lot better about things.

One piece of the site that will wait an entire year

Small businesses were supposed to be able to sign up online to enroll their employees through the federal website starting this month. That was already delayed from Oct. 1. Now that won't happen online until next November.

They can still compare plans online, but they'll have to use paper applications and go through an insurance broker or agent or an insurance company directly, unless they're in one of a handful of states that's got its small-business exchange up and running.

The administration has been pretty candid about this � they've said their top priority is to make the website work for consumers first, and pretty much everything else is taking a back seat.

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Wednesday, November 27, 2013

Small-Business Access To Online Health Exchanges Delayed Again

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Monday, November 25, 2013

21 Ways the Canadian Health Care System is Better than Obamacare

Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.

Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.

Love, Canada

Number 21:
In Canada, everyone is covered automatically at birth � everybody in, nobody out.

In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.

Number 20:
In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.

Number 19:
In Canada, coverage is not tied to a job or dependent on your income � rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 18:
In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.

Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of �in-network� vendors and no extra hidden charges for going �out of network.�

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking � thus restricting freedom of choice � and if you want to go out of network, you pay for it.

Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, under Obamacare, for thousands of Americans, it�s pay or die � if you can�t pay, you die. That�s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don�t even see a bill.

In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.

Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn�t cover tens of millions of people.

Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.

Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.

Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: �What�s wrong?�

In the United States, the first thing they ask you is: �What kind of insurance do you have?�

Number 10:
In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:
In Canada, there are no necessary co-pays or deductibles.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 7:
In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 6:
In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 5:
In Canada, nobody dies due to lack of health insurance.

In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.

Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority � many for different reasons � oppose Obamacare.

Number 3:
In Canada, the tax payments to fund the health care system are progressive � the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare�s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage �we have to pass the bill so that you can find out what is in it.�

Number 1:
In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system � single-payer, free choice of doctor and hospital , everybody in, nobody out.

Sunday, November 24, 2013

Colorado Ads Use Sex And Alcohol To Sell Health Insurance

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Thursday, November 21, 2013

The U.S. Lags in Life Expectancy Gains

From Bloomberg Businessweek –

Life expectancy in the U.S. has been growing more slowly than in other developed countries and is now more than a year below the developed-country average, according to a new report (PDF) from the Organisation for Economic Co-operation and Development.

Even though Americans, on average, live to be almost 80, this is not good news. Life expectancy at birth is affected by trends in everything from infant mortality, accident rates, and violence to chronic diseases and care for the elderly, which makes it a highly sensitive indicator of a nation�s economic development.

U.S. life expectancy in 2011 was 78.7 years. That was an increase of a little less than eight years since 1970. Impressive, but not as big as the 10-year gain for the OECD as a whole. �Life expectancy [in the U.S.] is now more than a year below the OECD average of 80.1,� the OECD said in a press statement, �compared to one year above the average in 1970.�

Why has the U.S. fallen off pace? The OECD report sums up some American studies by the National Research Council and the Institute of Medicine that suggest some causes. None of the theories reflect well on the U.S.:

1. The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured;

2. Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates;

3. Adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.

Ouch.

Wednesday, November 13, 2013

More Than 106,000 Chose Health Plans Under Affordable Care Act

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Tuesday, November 12, 2013

Despite Health Law, Uninsured Rely On Prevention Care Patchwork

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Self-Employed And With Lots Of Questions About Health Care

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Saturday, November 9, 2013

When Caregivers Are Abusers: Calif. Complaints Go Unanswered

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Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Nurse assistants and home health aides provide intimate care, bathing, feeding and dressing the elderly, disabled or ill. So what happens when an abusive caregiver hurts a patient?

Public health regulators in California have been letting many complaints sit for years � even when they involve severe injuries or deaths.

'Beaten To A Pulp'

Elsie Fossum's nieces and nephews say she was the aunt you wanted to have.

"She gave us our first car," Janet Flynn remembers. Her brother, Jim Fossum, chimes in: "A '59 Ford Galaxie 500, with massive fins on it."

Flynn says their aunt, a librarian and teacher who never married or had kids, always looked chic.

Enlarge image i

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

"She would come for the summer with this tiny Samsonite suitcase," Flynn says. "And she would be impeccably dressed, mixing and matching, and her hair was always done. Always looked wonderful."

But on the morning of July 3, 2006, Elsie Fossum lay in a pool of blood on the floor of her bedroom at Claremont Place, a Los Angeles-area assisted living facility. The 95-year-old Fossum had lived there for two years.

Her eyes were bruising black, her lip was badly cut, and her right arm was broken. But she was alive.

The lone caregiver on Fossum's floor that night said Fossum fell, but Beverlee McPherson, a registered nurse who supervised nurse assistants at Claremont Place, suspected abuse.

"She looked like she went four or five rounds with Muhammad Ali," McPherson says.

Unable to take much food or water through her swollen mouth, Fossum died of dehydration less than three weeks later. A Los Angeles County coroner could not rule out assault and called the manner of death undetermined.

McPherson is resolute.

"Oh, I'm 100-percent convinced she didn't fall out of bed, 100 percent," she says. "If you saw this woman's face, I mean, her entire face was beaten to a pulp."

'Staying On Top Of Complaints'

Emergency room nurses who treated Fossum at a nearby hospital also suspected abuse. The hospital quickly notified the California Department of Public Health, the agency responsible for decertifying nurse assistants who violate standards of care.

Cases Closed With No Action Taken

The number and rate of license revocations against nursing assistants and in-home health aides suspected of abuse have plunged, while cases closed without action have increased.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

But internal documents obtained by the Center for Investigative Reporting show department investigators shelved Fossum's case for six and a half years.

CDPH Director Ron Chapman blames the delays in handling complaints on a backlog of more than 900 cases that piled up between 2004 and 2008.

"There were a number of reasons for that backlog, including poor management decisions during that time," Chapman says.

The department implemented a plan in 2009 to address the backlog, says Chapman, who was sworn in to his position in 2011.

"In the two years that I've been in the job, there's now new management from top to bottom, and we're staying on top of all the complaints as they come in," he says.

Yet the number of nurse assistants facing disciplinary action following complaints has dropped, from 27 percent a few years ago to 9 percent last year.

Chapman says he sees no evidence that addressing the backlog has undermined the quality of the department's current work, but Marc Parker, who headed the investigations section for nine years, says he was forced to cut corners.

"Hundreds of cases were closed, hundreds, with nothing but a phone call," he says.

'A Failure To Protect'

Parker says without visits to facilities, investigators are unable to see the layout of a room, conduct impromptu interviews, or assess a person's body language. Parker retired in December of 2011, earlier than planned.

"I could not protect the public any longer," he says. "There was just a failure to protect the most vulnerable people in our state from abuse and neglect."

A Sudden Drop

The California Department of Public Health is required to notify the attorney general's office when its investigators find evidence of crimes, especially violent acts, at health care facilities. After 2009, the department all but stopped sending patient abuse deaths to state prosecutors.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

Public health regulators are required to report all suspected crimes to the state attorney general. In the seven years before addressing the backlog, the department referred an average of 37 deaths a year. Last year, they referred three. The year before that, two.

"We don't understand that decline in numbers," Chapman says. "It's very concerning to me and we are looking into it." He says his staff is drafting agreements with the attorney general's office to improve communication.

As for Elsie Fossum's suspicious death, department investigators closed her case this year, and decided no action was warranted against her caregiver.

Also this year, however, the Los Angeles County Sheriff's Department opened a homicide investigation into Elsie Fossum's death. Her caregiver is the sole person of interest. Chapman now says he's willing to review the case.

Elsie Fossum's nephews and niece say they never heard from the Department of Public Health. Flynn says their calls and emails to state agencies and local police have turned up little information.

"I would think that this would be very chilling to anyone who has loved ones in a facility, especially if you think safeguards are in place and you think that staff are qualified and that this is being regulated, and this I find chilling," Flynn says.

This story was co-reported by Ryan Gabrielson at the Center for Investigative Reporting.

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Friday, November 8, 2013

White House Releases Long-Awaited Rules On Mental Health

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White House Releases Long-Awaited Rules On Mental Health

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Thursday, November 7, 2013

How The Affordable Care Act Pays For Insurance Subsidies

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Wednesday, November 6, 2013

The President Wants You to Get Rich on Obamacare

From the New York Times –

Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the �21� Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: �Washington to Wall Street�). Today�s discussion centered on the most significant change in decades to the nation�s health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.

During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses � insurance companies, for instance, and hospital chains � have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law. According to Thomson Reuters, private equity investment, usually the lifeblood for entrepreneurialism, has dropped by an astonishing 65 percent in the health care sector this year.

Scully has been trying to assuage these worries, but the nervous questions keep coming at him. Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. �No way,� Scully said. �Way more � way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.� Another asked if Scully was worried about Congressional repeal. �It�s just not going to happen,� he said. �Don�t pay attention to Rush Limbaugh.� When Scully finally began his speech, he noted that the prevailing narrative among Republicans � assuming that many in the room were, like him, Republican � was incorrect. �It�s not a government takeover of medicine,� he told the crowd. �It�s the privatization of health care.� In fact, Obamacare, he said, was largely based on past Republican initiatives. �If you took George H. W. Bush�s health plan and removed the label, you�d think it was Obamacare.�

Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically � and surely many there did not think much of it � the law was going to make some people very rich. The Affordable Care Act, he said, wasn�t simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.

Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives � like the shift to private-insurance programs � that Obamacare has put into law. Under George W. Bush, he ran the Centers for Medicare and Medicaid Services and oversaw a host of proto-Obamacare reforms, like Medicare Part D, which introduced competition into the government-supported health care market. After leaving C.M.S. in 2004, Scully began working simultaneously at Welsh, Carson, Anderson & Stowe, a leading health care private equity firm, and Alston & Bird, a law firm and health care lobbying organization. When the Affordable Care Act became law in 2010, he found himself in the rare position of being a lobbyist, private equity executive and former government health care official with access to a serious amount of capital. During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

The President Wants You to Get Rich on Obamacare

From the New York Times –

Monday, November 4, 2013

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Friday, November 1, 2013

Which Plans Cover Abortion? No Answers On HealthCare.gov

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