Tuesday, February 21, 2012

PolitiFact | The Obameter: Invest in electronic health information systems

PolitiFact | The Obameter: Invest in electronic health information systems:

Quote from ONC Coordinator David Brailler on whether the 2009 stimulus bill had helped overcome the market failure that was preventing wider adoption and innovation in health IT, particularly electronic health record systems:

"I think the investment that the Congress and the administration have made was meant to correct a market failure, which stemmed from the fact that we don't sufficiently reward providers of care for high-performance, lower- cost, higher-quality. We pay them by piece work, whether it's a high-quality or high-cost product or a low-quality product," Blumenthal said. "We will very soon, I think, see that (health information technology) becomes an essential part of doing body care to the American people, one that physicians, nurses, health care institutions don't feel they can afford not to have. And at that point I think the federal government and my office can pass the baton to the professional community, to the hospitals, the nurses of the country, and the market will take off and do its own work for the American people."

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Monday, February 20, 2012

High-Deductible Health Insurance Pinches Workers From Both Sides

High-Deductible Health Insurance Pinches Workers From Both Sides:

This just in: High deductible health plans are like death panels!

Like many Americans, Debbie Bass' health insurance policy is utterly confounding: It's more expensive than it used to be, but the coverage is worse and the rules just seem to get more arcane.

Last year, her health plan paid for surgery, chemotherapy and radiation to treat her colorectal cancer. This year, her employer switched to a new plan, which won't even pay for a $39 box of ostomy bags.

Bass, a 57-year-old school bus driver from Hazlehurst, Ga., is among a rising number of Americans with shrinking health benefits and expanding deductibles. Bass said her new plan costs $333 per month to cover her and her husband, up from $210. The plan also comes with a staggering $3,000 deductible. Though her employer put $1,000 into an account to help pay for medical bills, Bass has already spent half of it on prescription drugs and other expenses. She'll soon need to find an extra $2,000 before her insurance kicks in.

Easier said than done. Bass takes home $395 a month. Her husband's disability benefits bring in another $1,285. "We are completely broke," she said. Her oncologist ordered a PET scan to check whether the cancer has stayed away, but she doesn't know how much it costs or whether her plan will cover it. She's going in for the test anyway.

High-deductible health insurance is becoming more common, according to survey data reported by the Employee Benefit Research Institute last December. In 2011, 27.7 million working-age people were enrolled in a health plan with a deductible of at least $1,000 for individuals and $2,000 for families. The proportion of insured Americans who have this type of coverage has more than doubled since 2005, the report says.

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Wednesday, February 15, 2012

Raise the Gasoline Tax? Funny, It Doesn’t Sound Republican - New York Times

Raise the Gasoline Tax? Funny, It Doesn’t Sound Republican - New York Times:

A piece about the  "Pigou Club," economists who favor taxes on things that have significant externalities, in this case, fossil fuels.

In late September, as [Alan Greenspan] spoke to a group of business executives in Massachusetts, a question was posed as to whether he’d like to see an increase in the federal gasoline tax, which has stood at 18.4 cents a gallon since 1993. “Yes, I would,” Mr. Greenspan responded with atypical clarity. “That’s the way to get consumption down. It’s a national security issue.”

Mr. Greenspan isn’t the only Republican-aligned economist to have discovered, or rediscovered, a fondness for higher energy taxes since leaving government service. N. Gregory Mankiw, the Harvard economist who served as chairman of President Bush’s Council of Economic Advisers from 2003 to 2005, favored a higher gas tax before going to Washington, and has been banging the drum loudly for it since he left. On his blog, Mr. Mankiw has formed the Pigou Club, named for Arthur C. Pigou, the British economist credited with introducing the notion that taxes could be used to correct imperfections in the market. The roster of what Mr. Mankiw calls “economists and pundits with the good sense to have publicly advocated higher Pigovian taxes, such as gasoline taxes or carbon taxes,” includes some of the usual suspects — Paul Krugman, a columnist for The New York Times, and Al Gore, for example — as well as unusual suspects like Gary S. Becker, the economics professor and Nobel laureate at the University of Chicago.

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Tuesday, February 14, 2012

“Transparency Reports” on Industry Payments to Physicians and Teaching Hospitals - — JAMA

“Transparency Reports” on Industry Payments to Physicians and Teaching Hospitals - — JAMA:

Thanks, again, Affordable Care Act...

Public awareness of industry payments to physicians and teaching hospitals in the United States is about to markedly increase. As required by the “Sunshine” provisions of the Patient Protection and Affordable Care Act, by September 2013 the Centers for Medicare & Medicaid Services (CMS) is to publish “transparency reports” that disclose these industry payments on a public website; the information must be “searchable,” “clear and understandable,” and “able to be easily aggregated and downloaded.”1​ Unlike most disclosures of physician-industry relationships to date, the reports will include the amounts of payments or other “transfers of value.” Payments large and small should be revealed, including the drug or device that the payment was related to.

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Not Running a Hospital: Do I get paid too much?

Not Running a Hospital: Do I get paid too much?:

"Here are the facts. As noted by the Globe, my total compensation was about $1 million in fiscal 2005. Of this, $650,000 was the base salary. Also, I was eligible for a 30% incentive compensation payment if the hospital achieved specified results for clinical quality, patient satisfaction, and financial performance. I received the full amount that year, $195,000. The rest of the million comprised payments made by BIDMC for life insurance and retirement. (Don't worry, there are no other perks, like cars or country club memberships!)

Now, some background on BIDMC: The hospital is a billion-dollar-a-year enterprise, about $800 million in clinical revenues and $200 million in research programs. Our annual capital budget is roughly in the range of $80 million. Last year, we raised $30 million in philanthropic donations from people in the community. We have facilities that cover about 3 million square feet. We see 50,000 emergency room visitors per year, 40,000 inpatients, and 500,000 outpatients. We have about 8,000 employees and about 800 doctors on staff. We are affiliated with six community health centers (one of which we own); several community hospitals and physician practices; and we own and run two off-site clinics in Chelsea and Lexington and one small community hospital in Needham.

So, if you were on my board, how would you set an appropriate salary?

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How the U.S. measures up to Canada's health care system | Worldfocus

How the U.S. measures up to Canada's health care system | Worldfocus:

"Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

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Will emphasis on screening be harmful to your health? - The Boston Globe

Will emphasis on screening be harmful to your health? - The Boston Globe:

"But a former government health researcher is concerned that political considerations are leading the Obama administration to lean too heavily on screening, which can have unexpected downsides. Dr. Kenneth Lin, a Washington, D.C.-based family physician who used to conduct research for the government agency that helped develop screening recommendations, wrote in a recent blog post that the government’s acronym PPIP — for put prevention into practice — should really stand for “prevention politics injures patients.’’

Those are fighting words, but Lin quit his job at the Agency for Healthcare Research and Quality last November after a meeting of independent experts to vote on recommendations for prostate cancer screening was unexpectedly delayed that month.

Lin blames politics and the maelstrom weathered by the Obama administration when those same experts — used by the government to set screening guidelines — downgraded mammography screening recommendations for women in their 40s, at just the time when the health care bill was being debated in Congress. The experts stop recommending routine screening of women in their 40s, leaving it up to women to decide with their doctors whether to have mammograms.

This touched off angry accusations that the government was trying to ration care to save money, and the furor ultimately led Congress to add specific wording to the bill stating that mammograms would be covered.

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New rules for health plans require clear summaries of benefits - Los Angeles Times

New rules for health plans require clear summaries of benefits - Los Angeles Times:

Moving to implement a much-anticipated consumer protection in the new healthcare law, the Obama administration issued regulations Thursday requiring health plans to describe what they cover in clear, standardized language that is understandable to consumers.

Starting this fall, insurers and employers that offer health coverage will have to provide a six-page form that summarizes basic plan information, such as deductibles and co-pays, as well as costs for using in-network and out-of-network medical services.

The forms will also include estimated out-of-pocket costs for two basic examples of care: delivering a baby and managing Type 2 diabetes.
The changes are designed to allow consumers to assess how much their care would cost under different insurance policies, and to simplify the process of evaluating health plans, a task that now can involve reviewing hundreds of pages published by insurers.
"One of the primary purposes of this is to ensure this apples-to-apples comparison across plans," said Steve Larsen, the senior Department of Health and Human Services official overseeing insurance regulation.
The simplified forms, known as the summary of benefits and coverage, were mandated by the healthcare law signed by President Obama in March 2010.
Many consumer groups and patient advocates feared that the administration would back away from the requirement after insurers and employer groups complained that developing the forms would be costly and burdensome.
Found this via a post from Wendell Potter at Huffington Post. He notes that some advocates are calling for an illustrative case of cancer in the examples as well. I agree, as this can be among the most devastating events to a family, in every way including financially.

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Monday, February 13, 2012

Opinion | The role of faith in health-care delivery | Seattle Times Newspaper

Opinion | The role of faith in health-care delivery | Seattle Times Newspaper:

As the Catholic Church has been widening its influence and reach in American health care, it also has been flexing its muscles in health-care policy. Recently, it asserted that it should not have to provide contraception coverage to employees at church-run hospitals or universities around the country even when those employees are not Catholic, and when a large share of their salaries are paid for by tax dollars that flow through broad-based medical programs such as Medicare and Medicaid.

Moving beyond health care, the Catholic Church is also asserting its influence in ways that seek to expand religious-freedom protections to include the freedom to take broad-based taxpayer money and then spend that money in a manner that discriminates against Americans who don't accept Catholic theology.

In Illinois, for example, the church recently asserted that its First Amendment right to freedom of religion is being compromised when its own discriminatory policies against gays make it ineligible for government contracts to find adoptive homes for children in need among well-qualified families, gay or straight.

In making these claims, the Catholic Church is seeking to transform a right that is vitally important — the freedom of people to decide for themselves which religion to follow without government interference or sponsorship — into a right for government support and funding for theology-based program implementation.

It's one thing to say that because you're using private funds, you don't have to provide services that violate religious conscience. It's another to accept public money in a market situation where "customers" don't have free choice, and make that same assertion.

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Despite the hype, some new drugs aren’t effective for patients - Healthy Living

Despite the hype, some new drugs aren’t effective for patients - Healthy Living:

For years, I frustrated the Tekturna representative who came to my office. I refused to write even one prescription. Our conversations each week were identical. I would argue that there are generic high blood pressure medicines that are cheaper and just as effective, but much more importantly, I would argue that Tekturna did not have any proof that it was truly beneficial.

To this claim, the representative was astounded that I did not agree with the glossy graphs that showed how much blood pressures were lowered for people on the drug. For me and my patients, though, lowering blood pressure is not nearly enough; we need to know that the drug protects against the problems, such as strokes, that are linked to high blood pressure.

Despite showing that Tekturna lowered blood pressures, no research trial ever documented that it reduces the risk of heart disease, stroke and death.

We treat high blood pressure to reduce the risk for heart attacks and strokes. Period. Lowering the numbers we see on the blood pressure cuff is nice, but stopping a stroke is what counts.

Dozens of generic blood pressure medicines reduce the risk of stroke, heart attack and death, but Tekturna had no such research evidence.


In the past, there have been many instances of drugs that move numbers (like blood pressure), but that can worsen clinical outcomes. Alpha-blockers, for example, were shown decades ago to cause increased numbers of deaths in heart failure patients despite powerfully lowering blood pressures.

Last month, a clinical trial of Tekturna (the ALTITUDE trial) was stopped before it was completed. In trying to measure if Tekturna reduced the risk for heart attack and stroke, researchers discovered that Tekturna significantly increased the risk of stroke, kidney complications and problems with blood potassium levels.

The drug actually caused patients harm in comparison with generic alternatives, so the manufacturer recently stopped marketing it.

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Sunday, February 12, 2012

President Obama Announces Accomodation on Birth Control - NYTimes.com

President Obama Announces Accomodation on Birth Control - NYTimes.com:

Just had to get this great Antonin Scalia quote up here...

It’s a law of politics that when you’re losing the debate, you change it. So with the economy improving and President Obama rising in polls against his likely general election opponent, Mitt Romney, it’s not surprising that the Republicans went looking for an inflammatory social issue. They came up with contraception, which apparently is really controversial even though 99 percent of women rely on it at some point in their lives.

I’m referring, of course, to the ridiculous brouhaha over the new health care rule mandating that businesses provide insurance coverage for birth control. The original version exempted religious institutions, like Catholic churches, but not religiously affiliated ones, like Catholic universities, that cater to the general public.

That concession wasn’t good enough for the U.S. Conference of Catholic Bishops. Along with such opportunists as House Speaker John Boehner and Rick Santorum, they claimed the president was disregarding the First Amendment and assaulting religious freedom. The idea was to paint Mr. Obama as irreligious, and to chip away at the health care reform law in the process. I guess they were unaware of the 1990 Supreme Court decision Employment Division v. Smith, which established that religious liberty doesn’t trump an otherwise neutral law. As Justice Antonin Scalia, that notorious atheist, wrote: “To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself.”

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Friday, February 10, 2012

Are Conservatives More Fearful Than Liberals? | Tea Party and the Right | AlterNet

Are Conservatives More Fearful Than Liberals? | Tea Party and the Right | AlterNet:

Their political advisers must understand a psychological phenomenon that researchers have been studying for some time now: conservatives appear to be motivated by fear in a way that liberals are not. An expanding body of research suggests that Republicans and Democrats differ on some fundamental level in how they respond to positive and negative stimuli. A new study, published in the journal Philosophical Transactions of the Royal Society B, adds even more evidence to the theory that these two groups quite literally see the world differently.

Researchers at the University of Nebraska at Lincoln showed people a series of photos — some endearing, some disgusting — and then measured their physiological and cognitive reactions. Conservatives, in keeping with past literature, reacted more strongly to the negative images, and liberals strongly to the positive ones.

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Wednesday, February 8, 2012

Fair Enough? Inviting Inequities in State Health Benefits — NEJM

Fair Enough? Inviting Inequities in State Health Benefits — NEJM:

How much leeway should HHS allow in benefits programs?

I believe that the HHS proposal reflects an inadequate view of equality. A better approach would be to establish uniform standards so that all Americans would have access to the same high-quality goods and services.5 Such a policy could mean the difference between life and death, and it has been well tested and long debated. Indeed, this solution is grounded in the Aristotelian principles of vertical and horizontal equity. Vertical equity calls for different quantities and intensities of goods and services for persons with different needs. For example, patients with conjunctivitis and those with glaucoma need different treatments to restore normal ocular function. Horizontal equity demands that persons with the same needs receive the same treatment. Providing such persons disparate care — as might well happen under the flexible system established by HHS — represents horizontal inequity.

Those who object to the uniform-standards solution will counter that it idealistically and naively seeks, as measures of fairness, the same health outcomes and the same amounts of care for everyone. In fact, however, it is based on the principle of proportionality — the notion that similar cases should be treated similarly and different cases differently, in proportion to their differences. Medical cases in which the health needs are the same are deemed alike; those in which the health needs are different are considered unalike. Such a solution would also require that health care be provided in keeping with medical necessity and medical appropriateness and that patients and their doctors — not state insurance exchanges, state governments, or private health plans — be the ones to make such assessments, within the scope of national standards.

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Is the White Working Class Coming Apart?—David Frum - The Daily Beast

Is the White Working Class Coming Apart?—David Frum - The Daily Beast: :

A piece by my favorite conservative, David Frum, taking apart a book by Charles Murray

1) It's historically wrong to describe the "founders' conception of limited government" as if there existed some group called "the founders" who broadly agreed a vision of government that more or less corresponded to contemporary libertarianism.

2) As a matter of fact, if you announce that there can exist no possible information that might change your mind about abortion, the death penalty, marijuana, same-sex marriage, and the inheritance tax, then yes you are an unreasonable person—or anyway, an unreasoning one. I've changed my mind about same-sex marriage as experience has dispelled my fears of the harms from same-sex marriage. If somebody could prove to me that marijuana was harmless or that legalization would not lead to an increase in marijuana use, I'd change my mind about marijuana legalization. And so on through the list.

3) But here's the most important point of all. I tramped through a lot of the same research that Charles Murray presents here when I wrote my history of the 1970s, How We Got Here.

As I looked backward and forward in time, however, I had to face this awkward fact: America became more culturally stable between 1910 and 1960 as it became less economically and socially libertarian. As it became more economically and socially libertarian after 1970, America became culturally less stable:

"The greatest generation was also the statist generation. Like them or loathe them, the middle decades of the twentieth century were an entirely anomalous period in American history. Never had the state been so strong, never had people submitted as uncomplainingly, never had the country been more economically equal, never had it been more ethnically homogeneous, seldom was its political consensus more overpowering."

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Tuesday, February 7, 2012

WWS 528c: Topics in Domestic Policy Analysis: Health Policy Reform

WWS 528c: Topics in Domestic Policy Analysis: Health Policy Reform:

Professor Paul Starr, Spring 2012

Requirements, Syllabus, and Reading List
Professor Starr wrote the seminal book, The Social Transformation of American Medicine, and is teaching this course this semester at Princeton. I put it here because of the excellent reading list and organization of the course. Thanks to Brad Delong's blog for pointing me to this.

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Robert F. Kennedy Quotes (Author of Thirteen Days)

Robert F. Kennedy Quotes (Author of Thirteen Days):

A nice collection of RFK quotes. I think this is my favorite.

“Too much and too long, we seem to have surrendered community excellence and community values in the mere accumulation of material things. Our gross national product...if we should judge the United States of America by that - counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for those who break them. It counts the destruction of our redwoods and the loss of our natural wonder in chaotic sprawl. It counts napalm and the cost of a nuclear warhead, and armored cars for police who fight riots in our streets. It counts Whitman's rifle and Speck's knife, and the television programs which glorify violence in order to sell toys to our children.

Yet the gross national product does not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile. And it tells us everything about America except why we are proud that we are Americans.”
― Robert F. Kennedy

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Why Public Employees Are The New Welfare Queens | The New Republic

Why Public Employees Are The New Welfare Queens | The New Republic:

But ask yourself the same question you should have been asking then: To what extent is the problem that the retirement benefits for unionized public sector workers have become too generous? And to what extent is the problem that retirement benefits for everybody else have become too stingy?

I would suggest it's more the latter than the former. The promise of stable retirement--one not overly dependent on the ups and downs of the stock market--used to be part of the social contract. If you got an education and worked a steady job, then you got to live out the rest of your life comfortably. You might not be rich, but you wouldn't be poor, either.

Unions, whatever their flaws, have delivered on that for their members. (In theory, retirement was supposed to rest on a "three-legged stool" of Social Security, pensions, and private benefits.) But unions have not been able to secure similar benefits for everybody else. That's why the gap exists, although perhaps not for long.

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Anti-Open Access Rises Again | The Scientist

Anti-Open Access Rises Again | The Scientist:

US Representatives Darrel Issa (R-CA) and Carolyn Maloney (D-NY) introduced a bill into the House of Representatives in mid-December that would roll back the National Institutes of Health Public Access Policy, which mandates that any published research that was funded by the federal science agency be submitted to the publically accessible digital archive PubMed Central upon acceptance for publication in journals. The bill, H.R. 3699, would also make it illegal for other federal agencies to adopt similar open-access policies.
Making your tax dollars go farther?

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Monday, February 6, 2012

American Psychiatric Association - Health Reform

Health Reform:

No law as wide-ranging and complex as PPACA can satisfy all of the myriad concerns of psychiatrists, other physicians, health professionals, and patients. While PPACA is not perfect, APA’s Board of Trustees concluded that it warranted APA’s support. Among other provisions of importance to the practice of psychiatry, the law:

  • Extends coverage to 32 million more Americans;
  • Bars insurance companies from denying coverage based on pre-existing conditions;
  • Bars insurance companies from dropping coverage due to illness;
  • Requires insurance companies to permit enrollees to renew coverage;
  • Permits dependent children up to age 26 to be covered by their parents’ health insurance;
  • Includes mental health and substance use disorder treatment as part of the basic package of benefits in health insurance sold in state-based insurance “exchanges” created by the law;
  • Ultimately requires full parity for mental health and substance use disorder treatment in such insurance;
  • Establishes new Centers of Excellence for Depression and Bipolar Disorder;
  • Provides new research funding for postpartum depression and postpartum psychosis;
  • Ensures that patients with diagnoses of mental illness will be included in “health homes”;
  • Boosts funding for community mental health treatment options; and
  • Facilitates co-location of primary and mental health treatment centers

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Sunday, February 5, 2012

Report: Breast Cancer Death Rates Decline, but More Slowly Among Poor

Report: Breast Cancer Death Rates Decline, but More Slowly Among Poor:

A new report from the American Cancer Society finds that deaths from breast cancer in the United States continue to decline steadily. However, the decline has been faster for women who live in more affluent areas. Women from poor areas now have the highest rates of death from breast cancer.

“In general, progress in reducing breast cancer death rates is being seen across races/ethnicities, socioeconomic status, and across the U.S.,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “However, not all women have benefitted equally. Poor women are now at greater risk for breast cancer death because of less access to screening and better treatments. This continued disparity is impeding real progress against breast cancer, and will require renewed efforts to ensure that all women have access to high-quality prevention, detection, and treatment services.”
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Medical debts put patients at risk of financial collapse | Detroit Free Press | freep.com

Medical debts put patients at risk of financial collapse | Detroit Free Press | freep.com:

Frances Giordano found out she had lung cancer in June. After that, the bad news just kept coming.

First, she discovered that even with a good job and health insurance, her medical expenses were more than she could afford on disability.

Then she started slipping into debt, like millions of other Americans who don't have the cash to cover their medical bills. Hospitals expect to be paid promptly and offer little leeway to insured patients. Unpaid bills go to collection agencies, damaging a person's credit history for years.

Finally, she learned that fighting for her life was not her only battle or maybe even her toughest. When she finished her chemotherapy in December, she was fired. "Due to changes in business operations," wrote her employer of more than six years, "we can no longer hold your position open."

It arrived nine days before Christmas.

"I'm a good person," the 58-year-old Giordano said. "I worked hard. Isn't having cancer enough?"

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Saturday, February 4, 2012

Soaking the Poor, State by State | Mother Jones

Soaking the Poor, State by State | Mother Jones:

The Corporation for Enterprise Development recently released a scorecard for all 50 states, and it has boatloads of useful information. That includes overall tax rates, where data from the Institute on Taxation and Economic Policy shows that in the median state (Mississippi, as it turns out) the poorest 20 percent pay twice the tax rate of the top 1 percent. In the worst states, the poorest 20 percent pay five to six times the rate of the richest 1 percent. Lucky duckies indeed. There's not one single state with a tax system that's progressive.
Follow the link to see the chart with all the states.

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The States Doing The Most (and Least) To Spread The Wealth - 24/7 Wall St.

The States Doing The Most (and Least) To Spread The Wealth - 24/7 Wall St.:

24/7 Wall St. examined government spending by state in a number of categories to identify those that give the most and least in money and benefits to their residents. Our analysis has found that states that provide the most services and benefits have high income inequality. In order to finance these programs, the states that offer the most to their residents also have among the highest tax burdens in the country. While all income levels benefit from government assistance, the poor and the dispossessed benefit the most, in the form of welfare, medicare, and unemployment insurance.

Tax burden refers to the average amount a person pays in taxes as a percentage of his or her income. The Tax Foundation calculates each state’s tax burden by taking the total amount paid by the state’s residents in taxes, and dividing it by the total income of the state’s residents. Eight of the ten states that are most generous are among the top fifteen states with the highest tax burdens. New York, New Jersey, and Connecticut are all included on the list and also fill the top three slots for largest tax burdens in the country.

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PERRspectives: Perry Calls Texas' 46th-Ranked Health System Best in U.S.

PERRspectives: Perry Calls Texas' 46th-Ranked Health System Best in U.S.:

Everything, they say, is bigger in the Texas. So it is with the failure of the health care system. Leading the nation with a horrifying 25% of its residents uninsured, Texas ranked 46th in the Commonwealth Fund's 2009 scorecard of state health care performance. Nevertheless, that dismal performance was no barrier to Governor Rick Perry proclaiming that the Lone Star state has the best health care in the country.
The answer, of course, is quite poorly. While from 2007 to 2009 Texas nudged its way from a horrific 48th to a merely miserable 46th in the Commonwealth Fund rankings, the health care system there remains an ongoing calamity for its residents. Among the poster children for the failure of red state health care, Perry's state brought up the rear across the five indicators measured. When it comes to health care access and equity, Texas is dead last.

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Small thoughts - The 16 concerned scientists - who they are

Small thoughts - The 16 concerned scientists - who they are:

The WSJ apparently had an op-ed telling us "no worries" regarding climate change. And if there is anyone I trust to try to shine up horse manure on any subject to a gleaming sheen, it is the WSJ. The link above takes us to a review of who these concerned citizens are, but here is the gist of it:

If it’s an argument from authority these gentlemen want, it’s telling that “[d]espite seven months of intense effort to recruit physicists to sign a politically motivated petition disputing anthropogenic climate change, a mere, 0.45% of the American Physical Society‘s 47,000 members signed on.”
So 99 doctors tell you to quit smoking and get more exercise, but you listen to the one selling supplements instead.

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Friday, February 3, 2012

Address to the members of different Churches and Christian Communions, 14 September 1984

Address to the members of different Churches and Christian Communions, 14 September 1984:

"For instance, the needs of the poor must take priority over the desires of the rich; the rights of workers over the maximization of profits; the preservation of the environment over uncontrolled industrial expansion; production to meet social needs over production for military purposes."

John Paul II, at an address given in Canada in 1984.

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'How Many of You Expect to Die?' - NYTimes.com

'How Many of You Expect to Die?' - NYTimes.com:

The third option, death following extended frailty and dementia, is everyone’s worst nightmare, an interminable and humiliating series of losses for the patient, and an exhausting and potentially bankrupting ordeal for the family. Approximately 40 percent of Americans, generally past age 85, follow this course, said Dr. Lynn, and the percentage will grow with improvements in prevention and treatment of cancer, heart disease and pulmonary disease.

These are the elderly who for years on end must depend on the care of loved ones, usually adult daughters, or the kindness of strangers, the aides who care for them at home or in nursing facilities. This was my mother’s fate, and she articulated it with mordant humor: The reward for living past age 85 and avoiding all the killer diseases, she said, is that you get to rot to death instead.

Those suffering from physical frailty, as she was, lose the ability to walk, to dress themselves or to move from bed to wheelchair without a Hoyer lift and the strong backs of aides earning so little that many qualify for food stamps. These patients, often referred to as the old-old, require diapers, spoon-feeding and frequent repositioning in bed to avoid bedsores. Those with dementia, most often Alzheimer’s disease, lose short-term memory, fail to recognize loved ones, get lost without constant supervision and eventually forget how to speak and swallow.

What all of these patients need, Dr. Lynn said, is custodial care, which can easily cost $100,000 a year and is not reimbursed by Medicare. The program was created in 1965 when hardly anyone lived this long.

“We’re doing this so badly because we’ve never been here before,” Dr. Lynn said. “But the care system we’ve got didn’t come down from the mountain. We made it up, and we can make it up better.”

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