Sunday, June 30, 2013

As Doctors Leave Syria, Public Health Crisis Looms

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Refugees fill cans with water inside a camp in Baalbek, Lebanon, for Syrians who have fled the fighting in their country.

Spencer Platt/Getty Images

Refugees fill cans with water inside a camp in Baalbek, Lebanon, for Syrians who have fled the fighting in their country.

Spencer Platt/Getty Images

The death toll in Syria's ongoing civil war may now be as high as 100,000. As the violence mounts, another emergency is looming: a public health crisis across the region.

That's the conclusion of a new study published by the British medical journal The Lancet. Syria's health care system is near collapse. Outbreaks of disease are on the rise in the country, and refugees sheltered beyond the border are also at great risk.

One medical clinic in a poor neighborhood in Beirut is always busy. The two-story building is up a narrow street of cinder-block homes. Syrian refugees have moved in, adding to the crowding and the caseload, Dr. Abdul Kader Abbas says. He says he's treated 758 Syrian families here � many already sick when they arrived in this densely packed neighborhood.

"With the additional numbers," Abbas says, "we are afraid that any disease could spread easily in such circumstances." That's the same warning spelled out in the latest Lancet report.

Seventy percent of Syria's medical professionals have fled the country. Public health researchers Dr. Adam Coutts and Dr. Fouad Fouad say there has been a dramatic rise in communicable disease.

For example, Coutts says, there were 7,000 cases of measles in northern Syria in the past few months after a vaccination program was disrupted by war, and the list is growing to include TB, leishmaniasis, typhoid and cholera, which will come up during the summer months.

Leishmaniasis is spreading so fast among the displaced people inside of Syria that it is now called the "Aleppo boil" � for the running skin sores transmitted by sand fleas. Fouad says with the collapse of Syria's health care system, many Syrians have not had any medical care or medicine for more than two years.

When you consider chronic diseases like diabetes, Type 1 and 2, and cancer, Fouad says, you start to see that more people are dying of disease rather than war.

Disease moves easily across boundaries along with the refugees. Coutts and Fouad warn this could lead to a public health crisis for the entire region. By the end of this year, the Syrian refugee population is expected to reach more than 3 million.

In Jordan, the patient load in hospitals has jumped 250 percent in the past five months. Lebanon's health system is under strain with more registered refugees than any of its neighbors.

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"With this huge influx of refugees now in Lebanon," Fouad says, "the number will come to change the whole system."

One expected change is in the school system. U.N. officials estimate that when school starts in the fall, Syrians will outnumber Lebanese kids in the country's public schools. That worries Hayda Mohammed Al Jeeshi, the nurse at the health care center.

She says many Syrian kids missed childhood vaccinations before they fled to Lebanon and that puts Lebanese children at much greater risk. The measles outbreak that started in northern Syria is now showing up among the refugee community in Lebanon.

Scrambling to care for one of the world's largest refugee populations is another burden of the Syrian war. The U.S. government has upped its contribution to host countries to more than $800 million, with an additional $300 million pledged this month for food, shelter and health care.

"Diseases don't care whether you're for Assad, or against Assad, or uninterested in politics," says Anne Richard, the U.S. assistant secretary of state for refugees, who was in Lebanon this week. "It strikes everyone, as an equal opportunity."

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Friday, June 28, 2013

Maine Once Again Allows Mail-Order Canadian Drugs To Cut Costs

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Wednesday, June 26, 2013

How The End Of DOMA Will Affect Obamacare, Federal Employees

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How The End Of DOMA Will Affect Obamacare, Federal Employees

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Monday, June 24, 2013

Could LeBron and RGIII Help Sell The Affordable Care Act?

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Sunday, June 23, 2013

Ohio Family-Planning Services At Mercy Of Budget Bill

Listen to the Story 11 min 29 sec Playlist Download Transcript   Enlarge image i

Family-planning clinics would be pushed down the list of health services receiving funding from the state if a budget bill moving through the Ohio Legislature is signed into law.

iStockphoto.com

Family-planning clinics would be pushed down the list of health services receiving funding from the state if a budget bill moving through the Ohio Legislature is signed into law.

iStockphoto.com

Working its way through the Ohio Legislature is a state budget bill that has major implications for the way family-planning services are provided. The Ohio budget contains language that puts family-planning clinics at the bottom of the list to receive funding.

Family Planning Association of Northeast Ohio operates several independent family-planning clinics. They do not provide abortions and have no affiliation with Planned Parenthood, but the clinics are still at the end of the line under a new tiered system because they give referrals.

Ahead of the facilities are local health departments, places like emergency rooms and free clinics. Family Planning's executive director, Mary Wynne-Peaspanen, says if there's any money left over � which she says is not likely � "then they could consider applications from independent, specialty clinics like my organization and like Planned Parenthood."

The budget bill from the Republican-controlled Legislature could well put the nonprofit out of business. Since 1970, it has served primarily low-income women, but it's facing an anticipated 40 percent hit to its funding.

"They've been very clear about the fact � at the General Assembly � that their target is Planned Parenthood. But that doesn't change the fact that there are other organizations that will be impacted by this funding," Wynne-Peaspanen tells Jacki Lyden, host of weekends on All Things Considered.

National Trend

In Ohio and elsewhere, family-planning clinics typically provide a range of women's health services, like cancer screenings, blood pressure tests and contraceptive services.

Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, says the vast majority of women who are sexually active have used contraception at some point in their lives.

"So on one level, we as a nation have recognized that contraceptives are not only what everybody uses, but they also are very important for women's health," she says. "There is, however, a minority of politicians who try to use any issue related to 'sex' to make some kind of political hay out of it."

Waxman says a handful of states are looking at centers that receive Medicaid or state funding for family-planning services � and some are cutting the budgets. Those states include Indiana, Arizona, Wisconsin and now Ohio.

The Anti-Abortion Lobby

Michael Gonidakis is the president of Ohio Right to Life, one of the groups that lobbied hard for the current legislative approach. He admits the ultimate objective is a straightforward one.

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"Our goal is to find a way to end abortion. Not make it illegal, but to end it," he says. "We're big proponents of adoption reform, foster care reform, and we want to find ways to continue to help women who find themselves in unintended pregnancy, to realize that they can have their baby, that there's support services there for them to keep their child."

He doesn't expect that women will have less access to family planning, not even those who are low-income.

"There's nowhere � and I repeat, nowhere � in the state of Ohio where there won't be other options in a very close walking proximity to ... a clinic that may go out of business," he says. "We're doing some good things here in Ohio, and there's access to these types of services and care for low-income women across the state."

But it still worries Jess Locher, a 28-year-old uninsured cosmetologist in Chardon. She went to the local branch of the Family Planning Association as a teenager. Ten years later, the mother of two still goes to the same clinic because she can't afford anything else.

"If they took family planning away, I wouldn't be getting the female care that I need because my job doesn't offer me insurance, so I couldn't afford to go to a gynecologist," Locher says.

Take Texas, For Example

Ohio is on the verge of making decisions that would alter the way family planning is funded. Texas started down this road two years ago.

"When the Tea Party wave came through Texas in 2010, there was a big movement to oust Planned Parenthood from all of the state health programs," says journalist Becca Aaronson.

Aaronson, who covers health care for the Texas Tribune, says state lawmakers took a three-pronged approach to cutting family-planning funds. They cut family-planning funding, then set up a tiered financing system prioritizing comprehensive health clinics. Third, they prohibited any group affiliated with a provider that performed abortions from participating in the Medicaid women's health program.

More than 50 clinics throughout Texas closed their doors. As the dust settled, the consequences of this policy started to become apparent, Aaronson says.

"The state estimates that roughly 24,000 babies are going to be born as a result of these changes, and that's because women don't have as much access to birth control," she says.

The spike caused enough of a stir in Texas for state legislators to restore some of the funding to family planning.

"They decided to put an extra $100 million toward primary care for women's health, so that many uninsured women of all ages could get cancer screenings, diabetes treatment and family-planning access," Aaronson says.

Waxman of the National Women's Law Center considers the Texas legislation "a failure for women in the state."

"It's possible in some circumstances that women could go somewhere else, but many other health centers don't provide family-planning services because they know Planned Parenthood is available to do that," she says.

Stay Tuned

Waxman says the issue is an ideological one. "I can only hope that those people that are really outliers on this issue not continue to erode and really hurt the women in their states," she says.

Who's hurt and who's helped by laws on access to family-planning services is in part, of course, a matter of deeply held opinion and even religious faith.

In Ohio, Wynne-Peaspanen at the Family Planning Association is bracing herself.

"I've been with the agency for 27 years. And funding cuts happen and, you know, funding increases happen. But this is ... the most serious," she says.

Gonidakis from Ohio Right to Life says he's confident things will be just fine.

"I do not foresee any situation whatsoever where a woman's going to be denied services because of the availability of so many other clinics in the state of Ohio," he says.

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Saturday, June 22, 2013

Political Fight Jeopardizes Medicaid In Mississippi

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Political Fight Jeopardizes Medicaid In Mississippi

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Thursday, June 20, 2013

Universal Healthcare and Economic Freedom Go Hand-in-Hand

One of the most pernicious myths of the past half century is that guaranteeing healthcare for all Americans would strike a mortal blow against this country’s system of free enterprise.

That claim has been made endlessly in the context of the Affordable Care Act, and Obamacare critics are now ramping up their predictions of doom as implementation of the law grows near.

But as Robert Frank explained this weekend in the New York Times, the lived experience of other countries like Sweden with national healthcare systems doesn’t bear out the fears.

In fact, you don’t need to take the word of a progressive economist like Frank on this point. The Heritage Foundation’s research indicates the same thing.

Consider Heritage’s “Index of Economic Freedom,” which measures how friendly countries are to business, investors, and property rights.

The countries that rank the highest on the list are: Hong Kong, Singapore, Australia, New Zealand, Switzerland, Canada, Chile, Mauritius, Denmark, and the United States.

Of those ten countries, nearly every one has a universal healthcare system or mandates that individuals pay into medical savings accounts. Australia and Canada both have single-payer systems. Denmark’s system is pretty much government controlled. Switzerland’s system is similar in many ways to Obamacare. Among the top twenty nations on the list are Ireland, the U.K., Germany, Sweden, and Finland — other countries that also have universal healthcare systems.

There are some good reasons why such systems might go hand-in-hand with economic freedom. For one thing, as Robert Frank noted, these systems help keep down healthcare costs:

The United States spends more than $8,000 a person per year on health care, well more than twice what Sweden spends. Yet health outcomes are far better in Sweden along virtually every dimension.

Lower healthcare costs mean that business and individuals can channel more money into productive uses that foster a vibrant and globally competitive market economy.

Universal healthcare systems also make it easier for people to be entrepreneurs or self-employed. While we think of the United States as a place where people are uniquely likely to strike out on their own, this is largely a myth. The U.S. actually has a much lower self-employment rate than most developed countries. Australians, Brits, Germans, Swedes, and so on all are more likely to work for themselves than Americans.

It’s hard to say how much universal healthcare insurance determines self-employment rates, but common sense suggests you’re more likely to go out on your own if you’re not worried about losing your health insurance.

Now, does all this mean that Obamacare will produce more economic freedom in America? Not necessarily. Ironically, government run healthcare system are better for free enterprise than those — like the ACA — which impose mandates on employers.

I say ironically because, of course, such a truly “socialized” system was off the table during the healthcare debate thanks opposition by supposed defenders of economic freedom.

Universal Healthcare and Economic Freedom Go Hand-in-Hand

One of the most pernicious myths of the past half century is that guaranteeing healthcare for all Americans would strike a mortal blow against this country’s system of free enterprise.

That claim has been made endlessly in the context of the Affordable Care Act, and Obamacare critics are now ramping up their predictions of doom as implementation of the law grows near.

But as Robert Frank explained this weekend in the New York Times, the lived experience of other countries like Sweden with national healthcare systems doesn’t bear out the fears.

In fact, you don’t need to take the word of a progressive economist like Frank on this point. The Heritage Foundation’s research indicates the same thing.

Consider Heritage’s “Index of Economic Freedom,” which measures how friendly countries are to business, investors, and property rights.

The countries that rank the highest on the list are: Hong Kong, Singapore, Australia, New Zealand, Switzerland, Canada, Chile, Mauritius, Denmark, and the United States.

Of those ten countries, nearly every one has a universal healthcare system or mandates that individuals pay into medical savings accounts. Australia and Canada both have single-payer systems. Denmark’s system is pretty much government controlled. Switzerland’s system is similar in many ways to Obamacare. Among the top twenty nations on the list are Ireland, the U.K., Germany, Sweden, and Finland — other countries that also have universal healthcare systems.

There are some good reasons why such systems might go hand-in-hand with economic freedom. For one thing, as Robert Frank noted, these systems help keep down healthcare costs:

The United States spends more than $8,000 a person per year on health care, well more than twice what Sweden spends. Yet health outcomes are far better in Sweden along virtually every dimension.

Lower healthcare costs mean that business and individuals can channel more money into productive uses that foster a vibrant and globally competitive market economy.

Universal healthcare systems also make it easier for people to be entrepreneurs or self-employed. While we think of the United States as a place where people are uniquely likely to strike out on their own, this is largely a myth. The U.S. actually has a much lower self-employment rate than most developed countries. Australians, Brits, Germans, Swedes, and so on all are more likely to work for themselves than Americans.

It’s hard to say how much universal healthcare insurance determines self-employment rates, but common sense suggests you’re more likely to go out on your own if you’re not worried about losing your health insurance.

Now, does all this mean that Obamacare will produce more economic freedom in America? Not necessarily. Ironically, government run healthcare system are better for free enterprise than those — like the ACA — which impose mandates on employers.

I say ironically because, of course, such a truly “socialized” system was off the table during the healthcare debate thanks opposition by supposed defenders of economic freedom.

Outbreak In Saudi Arabia Echoes SARS Epidemic 10 Years Ago

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Monday, June 17, 2013

To Find Out How The Health Law Affects You, Ask The President

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Thursday, June 13, 2013

Judge Reluctantly Approves Government Plan For Morning-After Pill

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A Delay In Relief From Copays For Costly Drugs

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Wednesday, June 12, 2013

Feds Drop Opposition To OTC Sales Of Morning-After Pill

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Saturday, June 8, 2013

A Restaurant Brainstorms How To Afford Obamacare

Listen to the Story 6 min 43 sec Playlist Download Transcript   Enlarge image i

Clyde's of Georgetown, part of the 14-restaurant Clyde's Restaurant Group, is just one of many restaurants trying to navigate the changes the Affordable Care Act will bring.

Courtesy of Clyde's Restaurant Group

Clyde's of Georgetown, part of the 14-restaurant Clyde's Restaurant Group, is just one of many restaurants trying to navigate the changes the Affordable Care Act will bring.

Courtesy of Clyde's Restaurant Group

Almost 20 percent of American workers are working part-time, a historic high. Those part-time workers will be able to get health coverage beginning next year under Obama's Affordable Care Act, but many business owners worry about how they'll pay for it.

Business owners like Clyde's Restaurant Group, a family-owned chain of 14 restaurants in the Washington, D.C., area. For half a century, Clyde's has been a meeting place for politicians and lobbyists � like those who passed the Affordable Care Act � to meet over drinks away from Capitol Hill.

Restaurants face particular challenges adapting to the new health care laws. Supplemented by tips, most restaurant employees work for low wages. That means restaurant owners must pay a relatively larger portion of premiums than other businesses to make health care affordable.

It's not as simple as just cutting employee pay or raising prices to bring in the extra money needed, Clyde's Chief Financial Officer Jeff Owens says. Clyde's has had to rethink its business plan.

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"It started out as a brainstorming exercise for us," Owens says. "We were able to sit in a room and ... list out any ideas that would generate either cost savings or additional revenue."

Some of those ideas included things like using paper napkins over cloth, reducing portion sizes and, of course, staffing changes. There's also raising prices, which Owens says is last on the list.

"It's a tricky thing, because it's hard to forecast what the decrease in your traffic is going to be," he says.

All of this, in order to prepare for bearing the increased cost of covering employee health care under Obamacare.

"For one to two years it's been the No. 1 issue on our radar," he says. "We're not trying to run away from it, but it's a frightening proposition."

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Friday, June 7, 2013

30 Million to Remain Uninsured Under Obamacare

Harvard and CUNY researchers say 4.9 million Texans and 3.7 million Californians will still be uninsured in 2016

A study released today on the Health Affairs blog finds that between 29.8 million and 31.0 million people will remain uninsured after the implementation of the Affordable Care Act in 2016 and breaks down those figures by state.

The research team from Harvard Medical School and the City University of New York School of Public Health projects that the demographic composition of today�s uninsured population will change little under Obamacare.

The share of the uninsured who are U.S. citizens will rise slightly from 80 percent to 81 percent. White persons (of all ethnicities) will continue to constitute 74 percent of all uninsured Americans. About 59 percent of the uninsured will have incomes between 100 percent and 399 percent of poverty, while 27 percent will have incomes below poverty.

The researchers also estimated uninsured figures for each state (see table below).

The study analyzed Census Bureau data on current patterns of uninsurance, and used a coverage prediction model based on the model used by the Congressional Budget Office.

The researchers projected two coverage scenarios for each state. One assumed that the state turns down a Medicaid expansion and the other assumed that the state implements Medicaid expansion despite the Supreme Court ruling that such expansion is optional. The national estimates use the Advisory Board Company�s latest summary of which states are likely to participate in the Medicaid expansion.

Study co-author Dr. Steffie Woolhandler, a professor at CUNY and visiting professor of medicine at Harvard, said: �Many people believe that Obamacare will cover everyone. But the reform is so deeply flawed that 30 million or more will still be uninsured after it�s fully implemented. Even if the Supreme Court hadn�t let states of the hook for Medicaid expansion, 26 million would have been uninsured. We need to replace Obamacare with a simple single-payer system that would cover everyone.�

Lead author Dr. Rachel Nardin, chief of neurology at Cambridge Health Alliance and assistant professor of neurology at Harvard, commented: �Even in Massachusetts, where a reform like Obamacare has been in place since 2006, too many patients still can�t get the care they need. Hundreds of thousands are still uninsured, and many more have such skimpy coverage that they face unaffordable co-payments.�

�The Uninsured After Implementation of the Affordable Care Act: A Demographic and Geographic Analysis,� Rachel Nardin, M.D., Leah Zallman, M.D., M.P.H., Danny McCormick, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., David Himmelstein, M.D. Health Affairs blog, June 6, 2013.