Health Care.

Joe Szakos leads the Virginia Organizing Project, an almost fifteen year-old community organization that Health Care for America Now works with in Virginia to organize for health care reform. Szakos’s organization employs dozens of people, and they get their health care through Anthem Blue Cross/Blue Shield.

This year, Szakos was informed that Anthem was going to increase the premiums on Virginia Organizing Project’s health plan by 14.1%. Around the same time, the Virginia Organizing Project received an email from Anthem:

We strongly support reform that builds a strong, sustainable private-sector health care system – and strongly oppose creating a government-run health plan. We are urging our elected officials in Washington to take bipartisan action that will accomplish that. We are educating policymakers in Washington and working with our trade associations to encourage Congress to build on the current system and not disrupt the quality, affordable coverage on which our members depend….

As our elected officials debate health care, they need to hear directly from you.

Szakos immediately had some questions for Anthem. Chief among them, why is Anthem using its resources to lobby against health care reform with a public health insurance option while at the same time increasing rates by 14.1%?

Szakos, along with three other Virginia Organizing Project board members, went down to Anthem’s offices in Richmond, VA to ask. He left in handcuffs. Watch the video:

Szakos, a customer, couldn’t get an answer from Anthem. There was no justification for raising rates on one hand, and spending money lobbying against health care reform on the other. And instead of trying to offer Szakos an explanation, they had him arrested.

As Szakos said in the video, this is about greed and force. There is no good explanation for these rate increases, and there is no justification for Anthem to spend money it collects in premiums from customers suffering under its “health care” plans on lobbying against reform that would help these very same people. The only thing motivating Anthem – and all insurance companies – is greed. And they get and keep their money by force.

If the insurance companies win, you lose, and if you protest, you’ll be arrested. That’s health care in this country right now, but it cannot be our future. Reform must work for you, not the industry, and that means no more denying care for pre-existing conditions, coverage you can afford, and the choice of a public health insurance option to increase competition and keep these greedy corporations honest.

Anything less is a win for the industry and a loss for you.

Szakos’s trial is scheduled for September 22nd. Szakos’s legal defense team has subpoenaed Anthem’s CEO C. Burke King and director of public relations Scott Golden to appear in court on Tuesday to explain themselves. Stay tuned for more…

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Who should help pay for health care? At its heart, the health reform debate is about this question.

Right now, you and I pay for health care, as evidenced by the growing mountains of medical bankruptcies in this country. Health care costs are heaped on consumers and on their employers, while insurance companies profit.

Under reform, this burden would be more fairly distributed. Consumers would still pay for health care, but government would help them shoulder the burden. That’s not enough, however. Insurance companies would have to compete with a public health insurance option, driving down costs. And lastly, employers would have to continue chipping in.

At least that’s how it should be. However, business right-wing groups like the Chamber of Commerce are against this “employer mandate,” claiming, like everything they disagree with, that the provision would destroy business. (Some employers, like Wal-Mart interestingly, disagree.)

Employers do help pay for health care now, as most people get their health care through work with at least some help from their employer. Asking employers to share the responsibility for providing health care to their workers would strengthen the employer based health care system, a system business defends as necessary for attracting talent. Employer responsibility provisions would also ensure people get not just health care, but good health care by requiring employers to meet a minimum standard for health benefits.

Of course, employers could choose not to offer health care, and that’s their right. But if they do, they should not get off Scot free. It’s only fair to ask employers, who share in the fruits of a healthy workforce, to help pay to keep that workforce healthy. If employers don’t want to provide health benefits, they should pay the government to provide benefits for them.

This is how the “pay-or-play” provisions in health reform should work, and it is how they do work in the House health reform bill, HR 3200 [pdf]. Jacob Hacker, one of the fathers of the health reform plans promoted by President Obama and others, feels these pay-or-play provisions are a necessary part of reform. For moral reasons, I agree.

Of course, it helps that this idea is not only fair, but popular. In Kaiser’s August health care tracking poll [pdf], 68% of people thought a pay-or-play requirement was a good idea:

Employers should have to help pay for health coverage, just like consumers and government, and the American people agree.

Too bad Senator Max Baucus doesn’t. His bill, released yesterday, has no measures to hold employers responsible. To make things worse, it has a “free rider” provision that would discriminate against the hiring of older workers, poor and minority workers, workers with children, and unmarried workers.

Sounds like reform that works for business better than it does for you, right?

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Senator Rockefeller gives Senator Baucus evidence that health insurance cooperatives are “untested and unsubstantiated — and should not be considered as a national model for health insurance.”

Read more…

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NEWS

Baucus Offers Health Plan but Lacks G.O.P. Support – New York Times

The chairman of the Senate Finance Committee on Wednesday unveiled his long-awaited plan to remake the nation’s health care system and insure millions of Americans. But he did not win support from a single Republican despite tailoring his proposal to be less costly and to extend the reach of government less than other health bills moving through Congress.

Baucus health care bill gets lukewarm reception – USA Today

A long-awaited plan to revamp health care got a tepid response from lawmakers Wednesday, underscoring the challenge President Obama confronts as his top priority enters a critical new phase.

All sides go on attack as senator issues health plan – Boston Globe

Max Baucus, chairman of the Senate Finance Committee, released his long-awaited health care proposal yesterday without the bipartisan support he had sought over months of painstaking negotiations, only to see it attacked from every corner of the political spectrum.

Guarded Optimism Among Insurers, but Some Health Sectors Remain Skeptical – New York Times

In an important victory for the insurance industry, Senator Max Baucus’s legislative proposal does not call for a government-run health plan that would directly compete with private insurers. Insurance stocks rose on that news Wednesday.

Chasm In Congress Over How Much Individuals Should Pay For Health Care – Kaiser Health News

How much can people afford to pay for health care?

New A.F.L.-C.I.O. Leader Calls for Public Option – New York Times

In his speech accepting the presidency of the A.F.L.-C.I.O on Wednesday, Richard L. Trumka dove headfirst into the health care debate.

Ganging up on Baucus: Senator’s plan garners bipartisan grumbles - The Hill

Sen. Max Baucus (D-Mont.) finally introduced his much-anticipated healthcare reform bill Wednesday — and was rewarded with a chorus of disapproval from both the left and the right.

Michelle Obama turns to health care – Politico

Pushing for health care reform didn’t turn out so well for the last first lady in a Democratic White House.

Vacant Senate Seat Triggers Flip-Flop – Wall Street Journal

The Democrat-controlled legislature in Massachusetts is poised to pass a bill in coming days giving Democratic Gov. Deval Patrick authority to appoint an interim senator to succeed the late Edward M. Kennedy, strengthening the party’s U.S. Senate majority and bolstering prospects for passage of a health-care overhaul.

Firms Split From NFIB On Public Option – CongressDaily

A network of small-business owners, saying that their interests have been misrepresented by K Street, are holding out hope for the inclusion of a public insurance option in the healthcare overhaul, even as the nation’s top business …

Subsidies in Baucus Health Reform Plan Would Fall Short of What Is Needed for Many People to Afford Health Care – CBPP

The difficulty Congress is encountering in finding ways to finance health reform legislation is placing in jeopardy the adequacy of the legislation’s subsidies to help low- and moderate-income people afford health coverage and out-of-pocket costs. The plan unveiled today by Senate Finance Committee Chair Max Baucus, reflecting deliberations by a group of the Committee’s Senators, would provide more limited subsidies to help people purchase coverage than the Senate HELP Committee bill or the House bill. The Baucus plan could leave many people who are eligible for subsidies facing fairly steep insurance premiums and cost-sharing charges that they could have difficulty affording.

OPINION

The Baucus Health Care Plan: Who Will Vote for THIS? – Change.org

You’ve heard endlessly about how you need 60 votes to pass anything in the Senate. (It’s the number of votes required to end a filibuster.) You’ve even heard the number 60 used to justify why the Senate Finance Committee is jettisoning something as popular as the public option from their bill. As Sen. Kent Conrad said again and again on TV, there are “not 60 votes in the U.S. Senate” to pass a public option. But given the reaction to Sen. Max Baucus’ bill, crafted in secret with a bipartisan “gang of six” including Mr. Conrad, the magic number is not 60. It’s 12.

The Only Good News About Senate Finance Bill? It Won’t Pass - Mike Lux

I have written several times of the media’s fixation with the bill that comes out of the Senate Finance Committee on health care. It’s finally starting to move now, creaking its way up the track like a half-dead carcass. Traditional media will act like whatever is in the Senate Finance bill will be the bill, that the deal is done. Not even close, folks.

There Are Enough Votes For *A* Triggerless Public Option – Chris Bowers

In our email petitioning Harry Reid earlier today, I claimed “we have the votes to pass a public option in health care reform.” This is a statement I stand by, as long as the emphasis is on a triggerless public option, rather than on any of the triggerless public options that currently passed through Congressional committees.

Conrad Praises Baucus Bill Which Contains Co-Ops He Proposed After Meeting With UnitedHealth Group - Think Progress

After months of legislative deliberation aimed at forging a bipartisan health care bill that began by ejecting single-payer advocates from his hearing room, Senate Finance Committee Chairman Max Baucus (D-MT) unveiled his committee’s health care bill today with zero Republican support. Baucus’s bill — which former Cigna executive Wendell Potter has referred to as “an absolute gift” to the health insurance industry — includes no public option, an individual insurance mandate, and the creation of health care co-ops.

How Does Baucus Protection Stack Up? - Jon Cohn

One of the big questions about the Baucus proposal is affordability–that is, what protection it provides and at what cost. The best answer I’ve seen, so far, comes from Nicholas Beaudrot. He had the good sense to compare the provisions of the Baucus bill to those now available in Massahcusetts, under its newly reformed system. Better still, he put the results on a chart.

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President Obama gave a compelling speech this morning to an enthusiastic and predominantly young crowd at the University of Maryland in College Park. "It’s about what kind of country you want to be," Obama told them, and "… our history tells us that each and every time we faced a choice between the easy road that leads to slow decline or the hard road that leads to something better, something higher, we take the higher road. That’s how Americans are, we refuse to stand still. We always want to move forward."

To help amplify the president’s message, the Office of Health Reform at HHS also published a report detailing how health reform can help young adults, Young Americans and Health Insurance Reform: Giving Young Americans the Security and Stability They Need . Young adults make up nearly one-third of the uninsured population, and nearly one in four are paying off medical debt. Frightening statistics — especially for soon-to-be college graduates who may soon find themselves among the ranks of the uninsured.

In his speech, Obama described health care as "the struggle of this generation," and outlined the many ways health reform will benefit young Americans:

• Young adults will be able to stay on their families’ health insurance policies as dependants until the age of 26
• Young adults who are not covered at work will be able to buy quality, affordable coverage fthrough the new health insurance exchange
• Many people will be able to get certain preventive care services for free, and the health care system will invest more in wellness and prevention.
• Small businesses will get a tax credit to help them cover their employees
• Insurance companies will have to limit what young adults would have to pay in out-of-pocket expenses, co-pays, and deductibles.
• There will be limits on how much insurance companies can spend on administrative costs

Young adults have much to gain from proposed reforms, but they will also be asked to contribute their fair share to reform. Shailagh Murray of the Washington Post explains:

A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

Young Invincibles — a term used to describe these young adults who willingly forgo insurance because of their good health — is also a campaign "committed to making sure young people are heard in the debate about the future of our country." Their site contains hundreds of stories from young adults across the nation explaining why health reform matters to their generation.

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Richard Elmore, hosts the latest Health Wonk Review over at Healthcare Technology News. This week’s edition features a piece by Tom Emswiler highlighting how savings from better care can help pay for reform, as well as piece from Elizabeth Carpenter setting the record straight about some of the misinformation around reform. Check it out!

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As policymakers put the final touches on health care legislation that would expand coverage to millions of Americans, it is important that they ask themselves, "Coverage for what?"

Two new reports from the Georgetown University Health Policy Institute and the Kaiser Family Foundation tackle this question head on, looking at health coverage for children and individuals with special needs. Both groups require specialized care. The reports analyzed how insurance coverage differs between a benchmark private plan and public programs. Read the full reports, respectively, here and here.

Their key findings, from last week’s discussion, Matching Health Benefit Packages to Health Needs: Key Issues to Consider in Health Reform, are interesting:

Individuals with Special Needs and Health Care Reform:

• The medical needs of individuals with special needs are diverse, complex, specialized and life-long
• Medicaid offers comprehensive coverage with little or no cost-sharing
• The typical private plan falls short in providing necessary long-term services and support for individuals with disabilities and chronic conditions

Children and Health Care Reform:

• Children have unique health care needs (e.g. vision, dental, hearing) that are often limited or excluded from private plans. Appropriate health care can help children avoid preventable and serious conditions as well as promote nutrition and physical activity.
• Even families with relatively healthy children will face high medical bills under a typical private insurance plan
• Children with special needs face coverage gaps and high medical bills under private coverage; often families will put off children’s preventive care
• Medicaid fully covers children’s acute care and long-term needs with limited or zero cost sharing

While private plans offer generous benefits for acute problems, the public plans are better able to accommodate individuals with long-term conditions, children and low-income families/individuals. Yet while benefit packages in Medicaid may be more comprehensive, funding issues can create significant barriers to care.

Clearly one size does not fit all in health care. Which is why we are pleased that reform proposals in Congress place such an emphasis on creating more options for Americans to get the health care coverage they need.

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I’ve met Dr. Doug Eby twice, exchanged emails, spoken on the phone, read articles by and about him, and I’m still not quite sure how he ended up practicing medicine in Anchorage, Alaska. But I do know that the innovations and quality he and his colleagues have achieved in a challenging setting is attracting notice in the lower 48.

Eby is a family physician and the medical director of a nonprofit health care system that serves Alaska Native people in Anchorage and far flung remote communities, some accessible only by air.

He has learned that a diagnosis and a pill don’t necessarily make a patient well. And he has helped organize Southcentral Foundation (SCF), the tribal-owned system that has attracted notice nationally for its innovation and ability to find a better way to deliver quality health care

Before the makeover, he wrote:

The system misunderstood the core product as being tests, diagnosis, pills and procedures. When individuals sought health care services, providers would take their signs and symptoms, perform a physical examination, and produce a differential diagnosis. Then providers would do what health care does really well: order a bunch of tests. That would lead to a definitive diagnosis, which would then result in pills being prescribed, procedures and tests being ordered, and perhaps some advice being delivered. When the visit was done, the provider thought the work was done.  

 

 

 

 

 But really, that isn’t the model that works best for chronic illness, long-term conditions, prevention and wellness. 

The customer decides whether to pick up the medicine the provider prescribes, whether to take it as prescribed, whether to share it with a neighbor, whether to split it in half so it lasts longer, whether to stop taking it in a few days, whether to exercise, what to eat, whether to drink too much, whether to smoke… All of these things are determined by the customer and not always in the provider’s presence.

 

 

 

 

SCF, which runs outpatient centers focusing on primary care and jointly operates a 150-bed hospital with the Alaska Native Tribal Health Consortium, regards patients as both its owners and its customers. SCF focuses on community and primary care (broadly defined). The consortium is responsible for more specialized inpatient care.

The clinics provide about 400,00 outpatient visits a year, integrating primary care, behavioral health, and, when appropriate, traditional healing and complementary medicine such as acupuncture. For complex historical and economic reasons, they have to do it efficiently. As Eby explained, they have no choice.

SCF isn’t a purely safety net hospital, but it has a safety-net component. Many customers are educated, health-literate and insured. They could seek care outside the tribal system, and, before the SCF makeover about a decade ago, they did. But now they choose to get their care there.

But Eby and the other providers also see poverty, unemployment, and a fair amount of dislocation and family disruption as people transition from a rural subsistence lifestyle to an urban, cash-based environment. "It’s fair to say that our population has higher than the general community’s averages of risk factors," Eby said. Health care, therefore, must include getting a handle on stresses, smoking, alcoholism, nutrition.

The patient mix means there is also a payment mix — Medicare, Medicaid, private insurers, and a payment from the federal government based on the tribal status. The federal money gives SCF some flexibilty and room to innovate — but it also never keeps up with the rising cost of care, Eby said. "We have to become smarter about how we design and deliver services every year," said Eby, who has been there nearly 20 years.

"In our system, every bit of outpatient care is delivered through an integrated primary care team," he said. The team has access to "immediately available advice and support" from cardiologists or other specialists but they are "truly consultants, and not primary care givers." Specialists do see the patients, of course, when needed, but at about one-fourth the rate elsewhere. And when a patient (or customer) does need to see, for instance, the cardiologist, he or she is seen that day or soon after. No weeks of waiting. It’s fast and convenient — the specialists are right across the street, and next spring they will move into the primary care building.

When patients need something, they call their care team — not via a clerk at a front desk.The team assesses whether they need to come in, and can usually arrange an appointment that day. The team includes primary care provider, a case manager, two medical assistants, and there’s one behavioralist for every three teams. 

Because the team works so closely, they pack as much of the routine annual care into a visit. For instance, if a child comes in with an ear infection, the team will make sure they do the appropriate preventive care, immunization, screening and wellness services at the same time. That way there’s no need for a special "well-child visit" (unless the child never gets sick enough to need the doctor in between scheduled checkups). A woman who comes in with a sprained ankle may also get caught up on her routine OB/GYN care. If a 45-year-old man comes in for the first time in five years, and he’s happy and healthy other than, say, an ingrown toenail, he’ll get the relevant routine checks and maybe a tetanus shot. But if he’s not so happy and healthy, he may get some help with diet and exercise, smoking cessation, lowering his risk for things like diabetes and heart disease.

It is all holistic — and scientific. They measure outcomes — both through standard HEDIS measures and patient satisfaction surveys. Eby lists successes:

• Hospital days per 1,000 people have dropped by more than half
• They have 40 percent fewer inpatient admissions
• Emergency room visits have plummeted
• Specialty visits dropped by 60 percent
• Diabetes is being better controlled
• They have high immunization rates
• They have high rates of screening for colorectal cancer and depression

In part two of this post, Eby shares his "to do" list — What problems have not yet been solved, what they are doing about it — and how health reform can help.

Photo copyright Southcentral Foundation

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We are not quite sure what Lyndon Johnson would have done had he lived in the age of YouTube (the mind boggles), but his daughter, Linda Bird Johnson Robb, jumped in to make a video with the Alliance for Retired Americans that aims to reassure U.S. seniors that health reform is in their interest, and in the interest of a  healthy sustainable Medicare program.

Robb, who reached Medicare eligibility age herself this year, recalled the achievements of  Presidents Roosevelt, Truman, Kennedy and Johnson — "Social Security, Medicare, Medicaid and more."

She recalled the day her father signed Medicare into law — and gave the first Medicare card to former President Harry Truman.

Now it’s time, she said, to complete "the unfinished business of our generation."

"Reject the falsehoods," she said.  Pass health reform.

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When you, or more likely your doctor, reads an article in a medical journal on the efficacy of a certain drug, it would be nice to know whether the article includes research or writing contributions from people or companies other than the credited author — such as, say, the pharmaceutical company …

[This is a content summary only. Click the headline to visit Our Bodies, Our Blog for the full post, links, other content and more!]

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It’s almost World Series time in the US, so here’s a baseball story, courtesy the Pittsburgh Business Times,

University of Pittsburgh Medical Center lobbyist Leslie McCombs used Pittsburgh Pirates baseball tickets purchased by UPMC’s insurance arm to entertain film executives and others to promote the creation of a state film tax credit, according to the State Ethics Commission.

The commission fined McCombs $5,025 for failing to promptly register as a lobbyist for Lions Gate Entertainment Corp. and omitting a daytime phone number in registering as a lobbyist for UPMC, according to a commission ruling reached on July 22. The confidential decision was disclosed Sept. 9 by The Associated Press.

McCombs, who works for UPMC as a consultant, received permission from UPMC President and CEO Jeffrey Romoff to lobby on behalf of Lions Gate, which she described in a February 2007 e-mail to him as the, ‘largest independent producer and distributor of motion pictures and television in the country.’

Romoff cleared her work with Lions Gate after consulting with UPMC legal counsel and assured by McCombs in the e-mail that, ‘UPMC signs will be prominently featured throughout the (‘Kill Pit’ television) series.’

Filming for the eight-part miniseries, which was renamed ‘The Kill Point,’ began in March 2007 in Pittsburgh. Gov. Ed Rendell signed the Film Production Tax Credit bill into law in July 2007, which provided for a 25 percent film tax credit to offset production expenses.

Also,

From 2005 to 2006, McCombs was director of public relations for UPMC Health Plan, a for-profit subsidiary of the nonprofit hospital network. She was then named senior consultant with UPMC’s government relations department.

The State Ethics Commission lists 18 baseball games where McCombs treated Lions Gate and government officials using UPMC tickets.

In addition, she attended a June 15, 2007, matchup against the Chicago White Sox with Rendell and his wife, Marjorie, and Romoff and his wife, Stefania, according to the commission.

It’s not clear from the commission report whose interests McCombs was representing at that game, but Rendell later reimbursed $960 for the tickets to the five games that he attended, which was returned to the health plan.

In 2007, UPMC Health Plan bought $61,440 worth of Pittsburgh Pirates tickets, which were available to employees of the insurer ‘in the performance of their duties,’ the report states. The sum included a $20,000 seat license.

So did you get all that? The director of public relations for the UPMC Health Plan, the managed care subsidiary of UPMC, a large academic medical center, lobbied the state governor for the enactment of a tax credit for television and movie production, partially so that the UPMC logo would appear in a television series, and entertained the governor using a few of the more than $60,000 worth of baseball tickets the medical center purchased for employee use. Amidst the complication, the public relations director violated state lobbying rules. None of these shenanigans had anything directly to do with health care, or medical education and research. The only conceivable advantage accruing to the institution would be the appearance of the UPMC logo in a television series. But most likely everyone had good times at the ball game.

This story again suggests that managers of health care organization are more focused on playing marketing and political games than on health care, and generally are more focused on benefiting themselves than upholding their organizations’ mission. The amounts of money involved in this case may be small, but do not underestimate the collective effects on health care access, cost and quality of managers who have their eyes on the wrong balls.

UPMC has provided grist for the Health Care Renewal mill before, see earlier posts here, here, here and here.

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At Healthcare Renewal we often write of the dangers of financial conflict of interest towards medical research and practice.

Here is a plea from a father of an 18 year old patient whose death became a cause célèbre against conflict of interest, only to then be swallowed up in the sea of silence known as the “anechoic effect.” The plea is in our local newspaper, but deserves much wider attention:

Philadelphia Inquirer

Posted on Thu, Sep. 17, 2009

Seeking justice for my son

He died in a gene-therapy trial. Penn and the FDA should release the records.

By Paul Gelsinger

Ten years ago today, my 18-year-old son, Jesse Gelsinger, died at the University of Pennsylvania in a gene-therapy trial. Who is responsible? Could his life have been saved? Are other patients at risk? These questions have yet to be fully answered.

Jesse lived with a rare metabolic disease. The point of the research trial was to see if an adenovirus (a cousin of the cold virus) could safely deliver corrective genes to Jesse’s liver. Instead, the adenovirus killed Jesse.

Jesse became the poster child for what not to do in human-subjects research. Neither he nor I was warned that, as the Washington Post later reported, monkeys had died in a prior trial. And the Wall Street Journal reported that the researcher who developed the adenovirus, James Wilson, had a seven-figure financial interest in the trial’s outcome, as did Penn.

I stood by Penn, Wilson, and the two principal investigators, Mark Batshaw and Steven Raper, until I understood the extent of Wilson’s financial ties and the extent to which Jesse was misled about the risks and efficacy of the therapy. I eventually sued and ultimately settled. The amount of the settlement was sealed; the documents were not.

The federal government also sued, claiming that the researchers blew through clinical stop signs in conducting the trial, ignoring evidence that Jesse was not well enough to receive the adenovirus and failing to sufficiently alert the Food and Drug Administration about severe incidents involving prior patients. The researchers disagreed, saying they had the discretion to proceed despite Jesse’s test results, and that they had alerted the FDA. The government also reached a settlement, which restricted the researchers’ activities for a period of years.

Before the government settled, I urged federal officials to make the documents they collected public. They refused, saying this is simply not done.

I believe a better understanding of what happened to Jesse could improve practices. So I gave the documents collected for my lawsuit to a law professor, Robin Wilson, who teaches at Washington and Lee University in Lexington, Va. They appear in her new book, Health Law and Bioethics: Cases in Context.

While they are incomplete, the documents show a chilling pattern. They show that a lot of good people inside Penn raised alarms about Wilson’s financial ties from the get-go, but that Penn approved the deal anyway. The documents also show misleading disclosures to Jesse about the risks posed to him. For example, although animals died in prior trials, we were told that “animals have not shown toxic effects … at the dosage of virus that is needed to transport the gene in this study.”

I thought the lawsuits brought by me and the government would change research practices and the rules governing research. When I settled, real reform seemed likely. The Senate had held hearings, the FDA was investigating whether mistakes were made in the trial, and influential medical bodies such as the Association of American Medical Colleges had begun to examine disclosure practices and financial ties.

But, sadly, we have not yet learned enough from Jesse’s death. The shroud of secrecy that envelops legal settlements has helped hinder reform. No one has publicly accounted for the mistakes that led to Jesse’s death.

We don’t know whether the FDA was misled or dropped the ball. We don’t know whether the researchers’ claims of efficacy had any basis in fact or were just wishful thinking. We don’t know why Penn approved the deal despite warnings. And we don’t know whether the researchers’ decision to administer the virus to Jesse was reasonable or reckless.

Ten years ago today, my son died in a science experiment. A complete record of what the researchers and FDA regulators knew is the best precaution against future tragedies like Jesse’s death.

I am asking that the University of Pennsylvania and the FDA finally do the right thing and release their records. If they did nothing wrong, let us see the proof. If they made a mistake, let us all learn from it and do better in the future. We owe it to Jesse to make his life and death mean something.

[Emphases mine - ed]

Other than stating that I strongly agree that these records should be released for others to learn from, I do not think additional commentary is necessary.

– SS

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“If we think this is clear, then we are only in implementation mode,” says Rother. He draws a distinction between implementing tools and becoming truly lean as an organization.

Rother says:

“We will not be successful in the Toyota style until we adopt more of a do-it-yourself problem-solving mode.”

But I guess there are a lot of consultants who want to sell their services as a way to tell you how to do it… many clients and organizations want that, regardless of your industry, right?

How does your organization (or your consultant) balance learning from Toyota and thinking to develop your own plan versus just copying or following a rote roadmap?

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There are several potential uses for Google Wave in the healthcare context. The first, most powerful use is the ability of the health community to implement patient-centered communication. Doctors and patients are able to initiate communicate around a condition and all things related to the patient’s condition are captured within a wavelet (individual conversations/collaborations). Things like MRI’s and test results can be appended to a wave and doctors and specialists can collaborate through the wave. Since the communication is server-based, these conversations can be captured, secured, tagged, searched.

This is great way of improving doctor-patient communication as well as patient-patient communication !

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At Imperial College London, medical students navigate a full-service hospital where they see patients, order X-rays, consult with colleagues and make diagnoses.

It’s an interactive, hands-on learning experience — and none of it is real.

These prospective doctors are treating virtual patients in Second Life, the Internet world where users interact through online alter egos called avatars. The third-year med students are taking part in a pilot program for game-based learning, which educators believe can be a stimulating change from lectures and textbooks.

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FacetoFace Health is your trusted site for connecting one-on-one with others who share similar health experiences. Share your story, and find others, quickly and privately. Humanizing Healthcare – that’s what we do.

I like the idea that you can “match yourself” with patients with similar diseases.This way, expert patients can help newbies deal with the medical care system !

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OK, so apparently after Joe Wilson was publicly rebuked for calling the President a liar, the administration decided rather than ignore the outburst, they’d throw him—and his fellow xenophobes, a bone. Obama has made it clear from the start that undocumented immigrants will not have access to any government programs or subsidies for health care. But over the weekend, the administration decided to go further and released this statement about limiting access to the proposed health exchanges on Monday:

“Under President Obama's plan, undocumented immigrants would not be allowed to enter the exchange. People who are lawfully present in this country would be able to participate in the exchange.”

That statement, which echoes a provision that is included in the newly-released Senate Finance Committee’s version of health reform, means that even undocumented workers who want to pay out of pocket for health insurance—with no government subsidy—will be denied access to the exchanges.

This is a short-sighted political move that is designed clearly to pander to the Conservatives who have dredged up the illegal immigrant issue (along with abortion and end-of-life counseling) in an attempt to block any version of health care reform. It won’t garner more support for reform legislation, it eliminates cost-savings and it moves us further from the stated goal of being a compassionate nation.

There are an estimated 11 million illegal immigrants living in the U.S. According to Rep. Luis Gutierrez (D-IL), some 40% of them already get some insurance through their employers—the meat packing plants, hotels, restaurants and home health agencies that employ them. Of those remaining, it’s unlikely that a huge number would even be able to buy full-priced insurance. But if they could, why wouldn’t we want them to pay into the system, get preventive care and avoid costly trips to the emergency room?

Michael Scherer, writing on the Time blog Swampland puts it this way:

“Though the political reasons for taking this position are not in doubt, the White House stand does present a potential policy irony. The purpose of the exchange, and health care reform as a whole, is to decrease the number of people who avoid insurance and choose instead to get health care in hospital emergency rooms, a cost that is eventually picked up by the local, state and federal government. By frustrating the opportunities for illegal immigrants to purchase insurance with their own money, the White House position suggests that those here illegally could continue to cost public money by using emergency rooms. In other words, by banning illegal immigrants from paying their own way on the exchange, it is possible that the taxpayer cost of health care for illegal immigrants would be higher, not lower.”

Baucus’s plan also includes more stringent verification of citizenship status that includes social security information and a cross-check with the Homeland Security Office. This will undoubtedly add administrative costs to the system and, as was apparent in the 1990s when Medicaid began requiring more documentation, it will end up making it harder to enroll those vulnerable Americans we do want to insure.

As for documented permanent residents—the kind of immigrants who came here legally and pay taxes—the health reform plans all still require a five-year wait before they can become eligible for Medicaid. Republicans like Mike Enzi and Chuck Grassley want legal permanent residents to wait those same five years before becoming eligible for government subsidies on the health care exchanges, but Democrats have allowed for all “legal residents” to be eligible.

As I have discussed before on HealthBeat, there are many good reasons to provide health care coverage to immigrants—even the undocumented ones. Unfortunately, the immigration issue has been used as a divisive wedge to drive dissent between Republicans and Democrats, and even between liberals and moderates in Congress. The outrage originated with xenophobic and really, racist, individuals who irrationally see “foreigners” as the root of all that’s wrong with this country. They distort figures on the “burden” immigrants place on the health care system and refuse to acknowledge their very real contributions to society.

Time will tell how important the immigrant issue will be to the successful passage of health care reform. Obama has already made enough concessions to the Joe Wilson’s of this nation—increasing verification of citizenship, banning illegal immigrants from public programs and  the health insurance exchanges. Before he gives away more—the public option, reasonable subsidies, taxes on the health industry, individual mandates and other strategies the Republicans oppose—let’s make sure it’s not an exercise in futility.

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Introduction:

Diabetes is a disease that affects how the body uses glucose (say: gloo-kose), a sugar that is the body’s main source of fuel. It is a chronic condition that needs close attention, but with some practical knowledge, you can become your most important ally in learning to live with the disease.

“The prevalence of diabetes is increasing because obesity is increasing,” says Judith Fradkin, director of the National Institute of Diabetes, Digestive and Kidney Diseases at the National Institutes of Health. Normally, the first step in treatment is to make patients understand that this is a condition that can be effectively controlled. “The amount of money it will cost in ten years to manage diabetes is going to bust the economies of many countries” says institute president Paul Robertson.

Diabetes, caused by the body’s inability to produce or use insulin effectively to prevent a buildup of sugar in the blood, now afflicts nearly 21 million in the USA and roughly 250 million worldwide. It is a condition that can also cause long-term complications in some people, including heart disease, stroke, vision impairment, kidney damage and can also cause other problems in the blood vessels, nerves, and gums.

Blood:

During the past decade, medical studies have shown that by lowering high blood pressure and cholesterol and keeping blood sugar levels as close to normal as possible, diabetics can forestall many of the disabling complications that once appeared inevitable.

“This knowledge, along with simpler, more accurate blood tests and better drugs, has improved treatment”, says Buse, an endocrinologist at the University of North Carolina at Chapel Hill. “New drug treatments, more accurate methods for monitoring blood sugar levels and assessing control of diabetes, and practical steps that patients can take are more common than ever”, she says. “Until 1993, it wasn’t clear that lowering blood sugar prevented or delayed complications, and it’s only within the past decade that doctors learned that managing blood pressure and cholesterol reduced complications”, she says.

Types:

There are 2 major types of diabetes: type 1, an autoimmune disease that results in loss of the insulin-producing cells in the pancreas and most often occurs in children or young adults, who need daily insulin shots; and type 2, which accounts for 90 percent of diabetes cases and is associated with obesity and inactivity and diminishes the body’s ability to use insulin efficiently.

Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) occurs when the person’s own immune system attacks and destroys the cells of the pancreas that produce insulin. Type 1 diabetes occurs at about the same rate in men and women, but it is more common in Whites than in minorities.

Type 2 diabetes (formerly named non-insulin-dependent diabetes) is different. It is the most common kind of diabetes and about 9 out of 10 patients with diabetes have type 2 diabetes. It is more common in older people, primarily in people who are overweight.

Conclusion:

The best way to prevent diabetes is to make some lifestyle changes and maintain a healthy weight.

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Today Max Baucus (D-Montana), Montana senator, and leader of the Senate Finance Committee’s Gang of Six, three Democrat and three Republican senators ,who have spent months laboring to craft a bipartisan health reform bill, released the final version of his bill.

The bill’s contents drew immediate negative responses – from Democratic Senators Jay Rockefeller and Ron Wyden and Dr. Howard Dean, head of the Democratic Party. Nary a Republicans signed on . There was a collective sense that this thing was DOA and this pig wasn’t going to fly, especially among fervid liberals and fuming conservatives. Doom and gloom prevailed on both sides of the aisle.

This response caused me to wonder and to recall two verses from Alice in Wonderland.

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’ ‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’ ‘The question is,’ said Humpty Dumpty, ‘which is to be master – that’s all.”

“The time has come,” the Walrus said, “To talk of many things; Of shoes – and ships – and sealing-wax – Of cabbages – and kings – And why the sea is boiling hot – And whether pigs have wings.”

The question here is, who is going to be the master – Obama, Democratic liberals, or the Republican opposition?

President Obama has staked his domestic reputation on the success of health reform. He wants to be master of health reform. Many say the Baucus plan achieves Obama’s overall objectives – extending coverage, affordable care, and a major overhaul to achieve “fairness” under government rules and regulations. Obama wants the plan to be “bipartisan,” which I interpret to mean he wants to get one or more Republicans to sign on. Olympia Snowe of Maine is everybody’s token candidate for Republican sacrificial lamb for the Democratic cause.

Republicans, meanwhile, are hoping Obama has met his political Waterloo, has aroused the anti-socialist grassroots, will end his first year in office empty-handed on the health care issue, and will be set-up for defeat in the November 2010 off-year elections.

What Baucus has done, it seems to me, is to throw a lot of proposals on the wall to see what sticks. Baucus is betting the collection of deals Obama has engineered with health plans, hospitals, drug makers, medical device manufacturers, the AMA, unions, business and the “Harry and Louise’ crowd have enough concessions and new protections to keep the “special interests” at bay. At the heart of these deals is the bet that 30 million new customers from the uninsured ranks will bring enough new business to offset news fees of $93 billion to be inposed on these industries.

As the Walrus said, “The time has come to talk of many things, of tax credits for small businesses; prohibiting denial of coverage for pre-existing illnesses; allowing premiums to vary with tobacco use, age, gender; establishing of competition via health exchanges; catastrophic coverage for young adults; individual mandates; business mandates for those with 50 or more employees; limits on HSAs and other flexible savings accounts; and annual fees on profit-making health industries to help fund the whole kit and caboodle.

It’s enough to boggle the mind , goggle the media, toggle the political switches, and boondoggle the health system.

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