Tuesday, July 30, 2013

Panel Urges Lung Cancer Screening For Millions Of Americans

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Monday, July 29, 2013

High-Deductible Health Plans, Gamble For Some, On The Rise

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Near the end of last year, a big finance company in Charlotte, N.C., was doing what a lot of other businesses have been doing recently: switching up their health care offerings.

"Everything was changing, and we would only be offered two choices and each were a high-deductible plan," says Marty Metzl, whose husband works for the company.

High-deductible plans are the increasingly common kind of health insurance that have cheaper premiums than traditional plans, but they put you on the hook for thousands of dollars in out-of-pocket costs before the insurance kicks in.

According to the Kaiser Family Foundation, back in 2006, just 10 percent of Americans who get health insurance through their employers had a high-deductible plan. Today, more than a third have them, and that percentage is growing daily.

The trend, which could increase with implementation of the Affordable Care Act, has some doing the math before seeking care.

What's It Going To Cost?

For the Metzls, the options were deductibles of $3,000 or $4,500.

"After much angst and thinking and talking, we decided to choose the higher deductible plan," Metzl tells NPR's Jacki Lyden. "It really just felt like we were rolling the dice and gambling that none of us would get sick or have any catastrophic accident in 2013."

That gamble didn't pay off. Late one night, Metzl was working at home when she heard her husband yell for her to come to the bathroom. Her son had hit his head. She says that even though blood was running from his head and down his back, her thoughts quickly went to the family's insurance.

"It was like something out of a horror movie, and I was standing there thinking � instead of, 'Oh my gosh what happened to my son' � I'm thinking, 'Oh my gosh, how much is this going to cost if we have to take him to the ER at 11 at night?' " Metzl says. "I mean, I was horrified that that thought even came into my mind, but that's where my brain went."

The Metzls decided not to take their son in. Instead, they patched him up as best they could and sent him back to bed.

Making The Decision

Frank Wharam, a physician and researcher at Harvard Medical School, has been studying high-deductible plans since they first started appearing in the early 2000s. The reasons for the upswing are twofold, he says. First, there's the ever-present pressure on employers to save money. Plus, he says, the Affordable Care Act is driving up the numbers.

"It's going to be the result of the fact that there are mandates for people to be insured, so more and more people will be required to purchase insurance. And high-deductible health plans have the lowest upfront costs," Wharam says.

That's precisely the reason Brian Updyke has a high-deductible health plan. He's a freelance television producer, a job that makes finding health insurance especially difficult.

"They don't provide benefits. You're switching jobs every eight weeks, 10 weeks," he says. In the end, he bought his own plan � the cheapest on � with a $40 monthly premium and a deductible of $4,500.

High-deductible plans like his exempt a lot of preventative care � like regular checkups and cancer screening � from that deductible because of provisions in the Affordable Care Act.

Change In Behavior

For the first couple years, Updyke went to his annual doctor's appointment and that was that. But in 2009, he started having a little stomach pain and didn't rush to the hospital for help.

"I kind of went for a few days because I sort of was thinking it wasn't that painful," Updyke says; he thought it might be an ulcer or indigestion. But when he finally did get to the hospital, it turned out his appendix had ruptured.

A few days after surgery, someone brought him a laptop so that he could check on his health benefits � he didn't know how much treatment his insurance covered.

Katy Kozhimannil studies high-deductible plans at the University of Minnesota. She says the kind of confusion Updyke experienced is common � and so was his trepidation about visiting the emergency room, according to research.

"After transitioning to a high-deductible plan, men reduced use of the emergency room for all different kinds of visits and conditions," says Kozhimannil. That's different from the changes her studies have found among women; they tend to reduce their medical visits only for low-severity symptoms.

"It's possible that men are forgoing care because of those cost issues," says Kozhimannil.

Talk With Your Doctor

Wharam, who spends time every week in a clinic seeing patients, says that high-deductible health plans make it all the more important to figure out, with your doctor, the value of medical services.

"Some services are so important and valuable that no matter what the cost, the patient and physician should figure out a way that those services can be obtained," the Harvard physician says. That could be something like CAT scans to screen for colon cancer in high-risk individuals. Wharam agrees that their $1,500 price tag is high, but he says it's a cost worth incurring, unlike, for example, the cost of an MRI for lower back pain that is likely due to simple sprain.

Wharam says he's noticed a gradual uptick in the number of patients asking questions about prices and value.

"It's an interesting challenge because physicians don't know that. They don't tend to have a screen in front of them or the data in front of them to say how much a service costs," he says.

Finding The Positive

Ironically, while these high-deductible plans have some second-guessing their trips to the hospital, others have found ways to make the system work for them. Updyke, the Californian with the burst appendix, says that after he paid up to the level of his $4,500 deductible, he could get a lot more care for free.

"I had a small, benign cyst that was on my wrist. I had to have the doctor look at it, they were like, 'There's really nothing there, you can get it out if you want to, but it's not an emergency,' " he says. But later that year, he got it removed anyway.

As the Obamacare mandate kicks in this January, more and more people are likely to find themselves with high-deductible plans. And the White House is hoping Updyke is not alone in his satisfaction.

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Thursday, July 25, 2013

Plan B To Hit Shelves, Protected From Generics

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Plan B To Hit Shelves, Protected From Generics

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Friday, July 19, 2013

White House Muddles Obamacare Messaging — Again

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Thursday, July 11, 2013

GOP Says, Why Not Delay That Health Care Law, Like, Forever?

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Wednesday, July 10, 2013

A Busy ER Doctor Slows Down To Help Patients Cope With Adversity

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Monday, July 8, 2013

New Handicapped Sign Rolls Into New York City

Listen to the Story 3 min 34 sec Playlist Download Transcript   Enlarge image i

This new handicapped sign will appear in New York City this summer.

Sara Hendren

This new handicapped sign will appear in New York City this summer.

Sara Hendren

The handicapped sign is getting a new look � at least in New York City.

The initial design, created in 1968, depicted a person with no head in a wheelchair. The sign has changed since then � the figure eventually got a head � and now it's trying something new.

Sara Hendren, a Harvard graduate design student, is co-creator of a guerrilla street art project that replaces the old sign with something more active.

"You'll notice in the old international symbol of access, the posture of the figure is unnaturally erect in the chair," she says. "There's something very mechanical about that."

Hendren's new design looks more like a person wheeling him or herself independently. "Ours is also leaning forward in the chair. There's a clear sense of movement, self-navigation through the world," she says.

A Sign That Brings A New Attitude

It might not seem like much of a difference, but it was enough to fire up a young man with cerebral palsy named Brendon Hildreth, who uses a wheelchair. He and Hendren met as the project gained momentum, and the North Carolina 22-year-old adopted the icon as his own.

Hendren says Hildreth has become a kind of one-man machine around this symbol. He's made t-shirts with his family and has invited local businesses and institutions to change their signage.

Hildreth can only speak through a machine that he types into, and people have looked at him differently all his life.

"He's someone who has been treated as though he had less of a complex and interesting life and wishes for his future," Hendren says.

Enlarge image i

In the beginning of their project, Sara Hendren and Brian Glenney stuck their new design over existing handicapped signs around Boston.

Darcy Hildreth

In the beginning of their project, Sara Hendren and Brian Glenney stuck their new design over existing handicapped signs around Boston.

Darcy Hildreth

Guerrilla Art Tactics

That misperception is what drew Hendren and her partner, Brian Glenney, to start this project. It helped that Glenney, an assistant professor at Gordon College in Massachusetts, is also somewhat of a graffiti artist on the side.

"He said, 'Well, why don't we do something?' He was used to kind of altering public property," Hendren says.

They went all over Boston, putting stickers of the new symbol over with the symbol we're all familiar with.

People began to notice, in part because what Hendren and Glenney were doing � defacing public property � is technically illegal.

"That's true, but we were glad we did, because we raised some conversation," Hendren says.

The response was so strong that they ended up sending stickers to people around the country. It took just one cold call to to reach Victor Calise, New York City's commissioner for people with disabilities, and convince him to join the cause. This summer, the old symbol will be replaced with the new one in all five boroughs.

The Power Of Symbols

But for all the successes, the project still has its critics.

"We've certainly had people who say, 'It's just an image, and I'd rather you spend your time lobbying for other kinds of concrete changes,' " Hendren says.

But she sees the new, more active symbol as an opportunity to open the conversation and change people's perceptions.

"An icon, an image, a symbol, can be a really powerful kind of seed for much larger efforts," Hendren says.

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Saturday, July 6, 2013

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Wednesday, July 3, 2013

Canadians pay taxes for universal healthcare, and now they’re richer than us

I�ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.

Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.

Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.

Since the Legislature has now refused to override the governor�s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.

Some opponents of expansion claim that they don�t trust the feds to keep their word (even though it�s now written into law) and that we won�t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.

This fight could be avoided, and is just a symptom of a more fundamental underlying disease � the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into �risk categories.�

This phenomenon was made worse by PL 90, the �pro-competition� health insurance reform law passed by the Republican legislature in 2011. Now we�re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.

Many conservatives still characterize Medicaid as �welfare,� and many think of it as such. Presumably other types of health care coverage have been �earned� (think veterans and the military, highly paid executives, union members and congressional staff). We resent our tax dollars going to �freeloaders.� Until the slicing and dicing is ended, the finger pointing, blame shifting and their attendant political wars will continue.

In sharp contrast, our Canadian neighbors feel much differently. Asked if they resent their tax dollars being spent to provide health care to those who can�t afford it on their own, they say they can�t think of a better way to spend them. �Isn�t that what democracy is all about?� I�ve heard Canadian physicians say, �Our universal health care is the highest expression of Canadians caring for each other.�

Here in Maine, the response tends to be much different. Canadians seem to think health care is a human right. We don�t � yet.

If everybody was in the same health care system in the U.S., as is the norm in most wealthy nations, we would be having a much different and more civil conversation than what we are now witnessing in Augusta. No other wealthy country relies on the exorbitantly expensive and divisive practice of insurance underwriting to finance their health care system. They finance their publicly administered systems through broad-based taxes or a simplified system of tax-like, highly regulated premiums. Participation is mandatory and universal.

Taxation gets a bad rap in the U.S. and consequently is politically radioactive. Yet it is the most efficient, most enforceable and fairest way to finance a universal health care system.

In her excellent New Yorker essay called �Tax Time,� Jill LePore points out that taxes are what we pay for civilized society, for modernity and for prosperity. Taxes insure domestic tranquility, provide for the common defense, promote the general welfare, and take some of the edge off of extreme poverty. Taxes protect property and the environment, make business possible and pay for roads, schools, bridges, police, teachers, doctors, nursing homes and medicine.

Oliver Wendell Holmes once said, �Taxes are what we pay for a civilized society.� The wealthy pay more because they have benefited more.

Canada�s tax-financed health care system covers everybody, gets better results, costs about two-thirds of what ours does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.

What�s not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

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