Copyright

(c) 2010-2024 Jon L Gelman, All Rights Reserved.
Showing posts sorted by date for query health care debate. Sort by relevance Show all posts
Showing posts sorted by date for query health care debate. Sort by relevance Show all posts

Thursday, October 2, 2014

Maine Rolls Back Health Coverage Even As Many States Expand It

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
NORTHPORT, Maine – By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare.


Laura Tasheiko, 61, sits in her home in Northport, Maine (Photo by Joel Page for USA TODAY).
But that was nearly six years ago, and the state Medicaid program was generous then. Tasheiko was eligible because of her modest income, and MaineCare, as it is called, paid for all of her treatment, including the surgery, an $18,000 drug to treat nerve damage that made it impossible to hold a paintbrush, physical therapy and continuing checkups.
But while much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan. 1, just as the Affordable Care Act was being rolled out nationwide, MaineCare terminated her coverage, leaving her and thousands of others without insurance.
Maine Gov. Paul LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers, which at least until recently, boasted one of the lowest rates of uninsured in the nation.
Maine was the only state ­in New England, and...
[Click here to see the rest of this post]

Sunday, September 28, 2014

Debate Grows Over Employer Plans With No Hospital Benefits

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.
“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”
Timothy Jost is pretty sure the whole thing was a mistake.
“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.


As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.
At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits.
The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a...
[Click here to see the rest of this post]

Monday, September 8, 2014

Some Embattled Democrats Embracing Obamacare

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

News outlets look at Democratic Sen. Mark Pryor's promotion of the health law in a campaign ad as a sign the law may be less radioactive. Meanwhile, Politico notes that 30 of the 34 House Democrats who voted against the law are no longer in office as the partisanship that it engendered grows.

The Associated Press: Democrats Reframe Debate On Health Care
One of the most vulnerable Senate Democrats is standing by his vote for President Barack Obama's health care law, a fresh sign that the unpopular mandate may be losing some of its political punch. In an ad released this week, two-term Arkansas Sen. Mark Pryor says he voted for a law that prevents insurers from canceling policies if someone gets sick, as he did 18 years ago when he was diagnosed with cancer. That prohibition on ending policies is one of the more popular elements of the 4-year-old law that Pryor never mentions by its official name — the Affordable Care Act (Cassata, 8/22).

The Hill: Dems Find Obamacare Ammo
Vulnerable Democrats are finding ways to tout ObamaCare in an election cycle where the unpopular law was expected to be a liability for their party. The most overt emphasis on healthcare came this week, when Sen. Mark Pryor (D-Ark.) debuted an ad centered on his 1996 bout with cancer and his vote for the 2010 legislation, which protects people with pre-existing medical conditions from losing insurance coverage. "No one should be fighting an insurance company while you're fighting for your...

[Click here to see the rest of this post]

Monday, September 1, 2014

The Medicare Miracle

Today's post is shared fromPaul Krugman of the nytemes.com
So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate.
The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue.
But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
This is a really big deal, in at least three ways.
First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these...
[Click here to see the rest of this post]

Sunday, August 31, 2014

Endless Assault on Health Care Reform

Today's post is shared rom nytimes.com
The opponents of the Affordable Care Act make no secret of their consuming hatred for the law that has already provided health care to millions of lower-income people.
From the beginning, they have tried everything they could to kill it. As one conservative scholar, Michael Greve, said in 2010: “I do not care how this is done, whether it’s dismembered, whether we drive a stake through its heart, whether we tar and feather it and drive it out of town, whether we strangle it.” Yet the challengers keep losing in Congress and in court.
The latest jerry-built effort to destroy health care reform could be defeated in the full federal appeals court in the District of Columbia. In July, a three-judge panel of that court — taking a ridiculously crabbed view of a section in the law — ruled 2-to-1 that tax-credit subsidies are allowed only for those buying insurance on a health exchange “established by the state.” Therefore, it said, no subsidies for people in 36 states where the federal government set up the exchange because the states refused to do so.
There is no evidence that Congress intended to make this distinction, which defies the law’s central purpose. In fact, this argument was rejected unanimously by a three-judge panel of the federal appeals court in Virginia.
Now the fight has shifted to an arcane legal debate over whether the full appeals court in the District of Columbia should rehear the case or allow it to be appealed...
[Click here to see the rest of this post]

Wednesday, August 20, 2014

California Court Limits Caregiver Suits

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com

The California Supreme Court has ruled that a home health aide may not sue a client with Alzheimer’s disease for an injury incurred on the job. The case is one of the first in the nation to assess legal remedies available to paid caregivers who work with Alzheimer’s patients at home.
The facts: In September 2008, Carolyn Gregory, 54, was washing dishes in the home of Lorraine Cott, an 88-year-old woman with advanced Alzheimer’s. Without warning, Ms. Cott came up behind Ms. Gregory, knocked into her and began reaching toward the sink. As the caregiver struggled to restrain the older woman, a large knife Ms. Gregory was washing fell and sliced into her left hand. Ms. Gregory subsequently lost sensation in her thumb and two fingers and experienced considerable pain.
Since Ms. Gregory was employed by a home health agency, she was entitled to redress for the injury under the agency’s workers’ compensation policy. The question at issue was whether she could sue Mr. and Mrs. Cott (both died last year) for negligence as well.
In a 5-to-2 ruling, the California Supreme Court said the caregiver could not, citing a legal doctrine known as the “primary assumption of risk.” That principle holds that workers who perform jobs they know to be dangerous — firefighters and police officers are primary examples — cannot seek recompense from clients when bad things happen, as might be expected, on the job.
“Those hired to manage a...
[Click here to see the rest of this post]

Monday, August 11, 2014

Addressing Caregivers’ Loss of Retirement Income

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com
Earlier this month Representative Nita M. Lowey, Democrat of New York, introduced what she’s calling the Social Security Caregiver Credit Act, intended to increase retirement income for middle-class citizens who must reduce their work hours or leave the work force because of caregiving duties.
It’s hard to feel optimistic about its passage in this political environment. I’m braced, even here, for a chorus of “How can we possibly afford that?” But you can’t really argue with the problem it tries to address.
Representative Nita M. Lowey
Representative Nita M. Lowey
Representative Nita M. LoweyCredit Pablo Martinez Monsivais/Associated Press

The toll that family caregiving can take isn’t only emotional and physical; it’s also financial, but not always in obvious ways.
The groceries you pick up on the way to see your mother, the utility bills you quietly pay for your aunt — you’re aware of those. If you cut back your hours, turn down promotions or leave your job, as some caregivers feel forced to, you’re keenly conscious of your lost income.
But I wonder how many people consider the ways that their own retirements, years down the road, may suffer. The pressures of caring for a disabled or dependent family member can reduce Social Security income for the rest of the caregiver’s life.
And not by peanuts.
A MetLife study in 2011, based on data from the national Health and Retirement Study, estimated that men who reduced work hours to...
[Click here to see the rest of this post]

Saturday, December 14, 2013

When Life Goes On, and On ...

The debate over a longer lifespan confronts many issued including medical costs, insurance coverage and quality of life. Workers' Compensation programs pay for lifetime care also in most instances. Today's post is shared from the NYTimes.org  .
To the Editor:
Re “On Dying After Your Time,” by Daniel Callahan (Sunday Review, Dec. 1): Mainstream aging research neither promises radical immortality nor seeks to keep old people sick longer. Aging is a driving factor in the most prevalent and costly chronic diseases. Research indicates that interventions slowing aging delay the onset of these diseases. Therefore, they extend not only life span but also health span, the disease-free and functional period of life.
Fundamentally, the goals of aging research are not dissimilar from efforts to prevent or treat Alzheimer’s or other chronic diseases in that they both seek to improve quality of life in the elderly. The difference is that interventions in aging may prevent not just one but a range of debilitating diseases simultaneously.
The reality is that the world is rapidly getting older. With baby boomers leaving the work force, there won’t be enough workers to pay the ever-increasing Medicare costs of the retired. Extending health span will lower Medicare costs and allow aging people to stay engaged.
Interventions that slow human aging will provide a powerful modality of preventive medicine: improving quality of life by keeping people...
[Click here to see the rest of this post]

Monday, November 25, 2013

These Are The 36 Countries That Have Better Healthcare Systems Than The US

surgery doctors
12 years ago, the World Health Organization released the World Health Report 2000. Inside the report there was an ambitious task — to rank the world's best healthcare systems.
The results became notorious — the US healthcare system came in 15th in overall performance, and first in overall expenditure per capita. That result meant that its overall ranking was 37th.
The results have long been debated, with critics arguing that the data was out-of-date, incomplete, and that factors such as literacy and life expectancy were over-weighted.
So controversial were the results that the WHO declined to rank countries in their World Health Report 2010, but the debate has raged on. In that same year, a report from the Commonwealth Fund ranked seven developed countries on their health care performance — the US came dead last.
So, what can we learn from the report?
NOTE: The rankings are based on an index of five factors — health, health equality, responsiveness, responsiveness equality, and fair financial contribution. As noted above, all data is from 2000 or earlier and these findings have been questioned.
[Click here to see the original post]

Sunday, November 24, 2013

The ePrognosis App: How Calculating Life Expectancy Can Influence Healthcare Decision-Making

Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com

By Leslie Kernisan, MD

Last month an intriguing new decision support app launched, created by experts in geriatrics and palliative care. It’s meant to help with an important primary care issue: cancer screening in older adults.
Have you ever asked yourself, when considering cancer screening for an older adult, whether the likely harms outweigh the likely benefits?
Maybe you have, maybe you haven’t. The sentence above, after all, is a bit of wonky formulation for the following underlying questions:
  • How long is this person likely to live, given age and health situation?
  • Given this person’s prognosis, does cancer screening make sense?
The first question seems like one that could easily occur to a person — whether that be a patient, a family member, or a clinician – although I suspect it doesn’t occur to people perhaps as often as it should.
As for the second question, I’m not sure how often it pops up in people’s minds, although it’s certainly very important to consider, given what we now know about the frequent harms of cancer screening in the elderly, and usually less frequent benefits.
Furthermore, there is abundant evidence that “inappropriate” cancer screening remains common. “Inappropriate” meaning the screening of people who are so unwell and/or old that they’re unlikely to live long enough to benefit from screening.
For instance, one astounding study found that 25% of physicians said...
[Click here to see the rest of this post]

Social Security’s Job

The Social Security system is an "unfair" benefit distribution plan according to some authorities. Compounding this issue is the patchwork of workers' compensation system that all seem to apply different rules for setoff f benefits from lifetime benefits as well as COLA modifications. Choosing the "right" jurisdiction to file a workers' compensation total disability claim can make all the difference in the world for the amount of benefits an injured worker receives during his or her lifetime. Today's post was shared by Steven Greenhouse and comes from economix.blogs.nytimes.com

Ratio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Ratio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Source: The Urban InstituteRatio of Social Security benefits to Social Security taxes paid, by race or ethnicity and year.
Does Social Security need to be fixed?
As Democrats and Republicans grapple over how to reduce the government’s budget deficit in the face of rising costs for pensions and health care, whether Social Security should be touched remains one of the most controversial topics in American budgetary politics.
But something big is missing to the debate over the finances of what is still the largest component of the social safety net: an understanding of how well it does its job.
When you peek under the hood, it doesn’t always look so great. Indeed, this supposedly great redistributive program — which uses a broad tax on all workers to protect the elderly from poverty — exhibits some fairly stark regressive features.
One well-known regressive feature comes from the rule that benefits must be annuitized, paid out over time in monthly installments rather than as a lump sum. This means that richer people who tend to live longer will get a bigger benefit than poorer people with shorter life spans. Survivor benefits redistribute money from the singles — who don’t get the benefit — to the married, who do.
Eugene Steuerle, Karen Smith and Caleb Quakenbush of the Urban Institute in Washington just discovered another unsuspected regressive...
[Click here to see the rest of this post]

Friday, November 22, 2013

California Doctors Prescribe More Name-Brand Drugs Than Any Other State

Today's post was shared by Huffington Post and comes from www.huffingtonpost.com


The only thing that perhaps matched the vastness of the spread or the depth of the traction of the "death panel" lie was the predictability that such a lie would come to be told in the first place.

After all, this was a Democratic president trying to sell a new health care reform plan with the intention of opening access and reducing cost to millions of Americans who had gone without for so long. What's the best way to counter it?

Tell everyone that millions of Americans would have increased access ... to Death! The best account of how the "death panel" myth was born into this world and spread like garbage across the landscape has been penned by Brendan Nyhan, who in 2010 wrote "Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate."

Wednesday, November 20, 2013

New obesity treatment guideline released

Obesity is now been classified as disease. With such a designation of Worker's Compensation systems will be impacted by request for benefits in order to diminish obesity is a pre-existing and coexisting diagnosis. Treatment plans will need to be included for the reduction of weight in order to treat certain diseases by protocols including medication.Today's post was shared by RWJF PublicHealth and comes from www.bostonglobe.com

A new guideline for obesity treatment, released last week by the American Heart Association and American College of Cardiology, provides a solid road map for doctors challenged with helping overweight patients achieve a healthier weight.
Insurance coverage for weight-related counseling, such as helping patients plan new menus with fewer calories or outline a realistic fitness program, could improve under this new recommendation. More importantly, the panel of physicians and weight researchers outlined which interventions are the most effective based on clinical trials.
Doctors should treat patients who are obese — a BMI of 30 or above (180 pounds or more for a 5-foot-5 person — as well as those who are overweight with a BMI between 25 to 30 (150 to 180 pounds for a 5-foot-5 person) if they have certain heart disease risk factors such as type 2 diabetes, the guideline states. People at a healthy weight, or who are overweight without any health problems, should keep their weight steady.
“It’s not just about body weight, but whether excess body weight is associated with medical conditions,” said Dr. Timothy Church, director of preventive medicine research at Pennington Biomedical Research Center, who was not involved in writing the guideline.
Doctors can offer drugs or bariatric surgery to help reverse obesity, but they should first try providing patients with intensive counseling to help them exercise and eat right.
[Click here to see the rest of this post]

Friday, November 15, 2013

More Obamacare Enrollees In California Than In 36 States Combined

Today's post was shared by Huffington Post and comes from www.huffingtonpost.com

Obamacare California
Obamacare California

The only thing that perhaps matched the vastness of the spread or the depth of the traction of the "death panel" lie was the predictability that such a lie would come to be told in the first place. After all, this was a Democratic president trying to sell a new health care reform plan with the intention of opening access and reducing cost to millions of Americans who had gone without for so long. What's the best way to counter it? Tell everyone that millions of Americans would have increased access ... to Death! The best account of how the "death panel" myth was born into this world and spread like garbage across the landscape has been penned by Brendan Nyhan, who in 2010 wrote "Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate." You should go read the whole thing.But to summarize, the lie began where many lies about health care reform begin -- with serial liar Betsy McCaughey, who in 1994 polluted the pages of the New Republic with a staggering pile of deception in an effort to scuttle President Bill Clinton's health care reform. As Nyhan documents, she re-emerged in 2009 when "she invented the false claim that the health care legislation in Congress would result in seniors being directed to 'end their life sooner.'"Nyhan: "McCaughey's statement was a reference to a provision in the Democratic health care bill that would have provided funding for an advanced care planning for Medicare recipients once every five...

[Click here to see the rest of this post]

Wednesday, November 13, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Today's post was shared by NEJM and comes from www.nejm.org

Interview with Prof. Sara Rosenbaum on the health care safety net, Medicaid expansion, and access to care.
Interview with Prof. Sara Rosenbaum on the health care safety net, Medicaid expansion, and access to care.
Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry.1 Physicians practicing in higher-income areas are less likely to accept new Medicaid patients.2 Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.3
Physicians have good reasons for not accepting Medicaid patients, as I learned from direct experience as a member of a nine-physician primary care practice in California. We accepted Medicaid patients, but it was difficult. Medicaid's payment rate was very low — we lost money on each Medicaid visit. When referrals were necessary, we often had to personally ask specialists to accept our patient....
[Click here to see the rest of this post]

Tuesday, October 29, 2013

Spinal fusions serve as case study for debate over when certain surgeries are necessary

The necessity of medical treatment is coming under increased questioning as payers want to rein in costs. This article is shared from the washingtonpost.com.

By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year.

Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary?

To answer that question, the hospital in early 2010 paid for an independent review of cases in which Vinas and two other neurosurgeons had performed a common procedure known as a spinal fusion. The review was conducted by board-certified neurosurgeons working for AllMed, a company accredited to audit health-care businesses.

Of 10 spinal fusions by Vinas that were selected, nine were deemed not medically necessary, according to a summary of the report.

Vinas is still working at Halifax Health, and a hospital spokesman said that, after the AllMed report, the hospital conducted an internal review that validated his surgeries. Another review conducted this year in response to litigation also validated them, the spokesman said. The hospital would not answer further questions or release details of those reviews.

Vinas “has never and will never perform an unnecessary surgical procedure on any patient,” his attorney, Robert H. Pritchard, said in a statement.

More than 465,000...
[Click here to see the rest of this post]

Wednesday, October 23, 2013

Questioning Statins for Older Patients

Limiting medication can reduce overall patient care costs. The efficacy of controlling cholesterol in the "very old" population is now being discussed. Today's post was shared from the NYTimes.com.

Should older adults take statins if they have elevated cholesterol but no evidence of heart disease? It’s a surprisingly controversial question, given the number of seniors taking statins.

Recently AMDA, a professional group representing physicians working in nursing homes, highlighted the issue in a list of five questionable medical tests and treatments. The list was drawn up as part of the national “Choosing Wisely” campaign, which alerts consumers to inappropriate or overused medical interventions, an effort that caregivers would do well to follow.

The standout item on the AMDA list: “Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.” That means anyone older than 70, according to the medical society.

Dr. Hosam Kamel, an Arkansas geriatrician who is vice chair of AMDA’s clinical practice committee, said that there is scarce scientific evidence supporting the use of statins by 70- or 80-year-olds without pre-existing cardiovascular disease. Only a handful of studies have focused on outcomes (heart attacks, strokes, premature death) in this older population.

Most of the data on the benefits of statin use come from larger studies that looked at adults of varying ages. The results...
[Click here to see the rest of this post]