Author: Fran Johns

General interest/Health/Money/Politics & Causes/USA
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More on Health Care: Where the Costs Are

by Fran Johns

A few interesting factoids were dropped into the health reform debate by New York Times writer Amanda Cox Tuesday:

In 2006, health care expenses among half the United States population totaled less than $800 per individual, according to the federal Agency for Healthcare Research and Quality.

For openers, that seems entirely reasonable. Would that we could actually care for the citizenry at $800 a pop. Keep reading.

But the expenditures were not uniformly distributed throughout the overall population. Spending was far higher among the elderly, the obese and people who identified themselves as unhealthy. Median spending in those groups totaled $2,300 per individual. Although these patients represent just one-third of the population, they accounted for almost 60 percent of health care spending.

I hate to stomp this nearly dead — oops, bad metaphor — horse even further into its grave, but a lot of us, given the chance to talk to our doctors about aggressive, invasive, often futile end-of-life treatments that are going to make our ends horrific might choose to go home and spend our remaining time with palliative care, at peace. A nifty way to cut that $2,300 back down to $800. But Senator Grassley and others think we should now allow those conversations.

The truth may be too obscured by the cleverly promoted lies, but the issue is about choice. Compassion. Comfort. Peace. Sanity. If anyone could get this truth across to seniors, that one critical segment of reform might still survive. And personally, I’d like to have the option of saving the rest of you taxpayers my $1,500.

via Making Sense of the Health Care Debate – Prescriptions Blog – NYTimes.com.

General interest/Health/Money/Politics & Causes/USA
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Health Policy: Is Altruism Dead?

by Fran Johns

Recently in this space the me-first word was brought up. (It does not abbreviate well.) Might as well say it out loud: health reform could surely be sunk by the Me-Firsters, those who would put personal desires above the greater good, whether those desires are for better pharmaceutical or insurance industry bottom lines or for some corner of personal coverage, senior or otherwise, that might be sacrificed in the future.

I am not above having those desires. My husband and I actually have a tiny bit of stock in a drug company thanks to some mergers and buyouts I do not pretend to understand (I also don’t mess with the family stock portfolio) and thus a decline could cost household income we can ill afford. Plus, I would hate having the excellent care I get from Kaiser (thank you, Medicare) curtailed and would be seriously bummed if suddenly stuck with paying 100% of my post-cancer meds. But if that, or something equally draconian, is what it will take to get health coverage for my currently-uninsured friends, I would like to go on record as supporting whatever we must do to get access for all. This is not noble, just minimally humane.

There are noble people out there, however. They sign up for Teach for America, they volunteer in nursing homes and day care centers and hospice programs, put in long hours at food banks or take to the streets in other, similarly un-chic endeavors.

Re the current health reform brouhaha, there are also noble people, or at the very least altruistic people, all over the country; you just don’t hear a lot about them. On August 19, for example, President Obama urged supporters of health reform to “speak facts and truth” in what he said was a “contest between hope and fear,” and tried once again to refute some of the misrepresentations still widely circulating. His comments were themselves fairly widely circulated. But unless you happened to run across them in this space you would not have known they were made to 140,000 members of faith communities and/or supporters of community-organizing nonprofits. The people of Sojourners, Faith in Action, PICO and other groups that put together the 40 Days for Health Reform conference call are not in it for personal gain; they happen to believe everyone in this country should have access to health care. The next day, Nancy Pelosi held a press conference reiterating her determination to keep a public option in the final health bill. But again, unless you happened to see it here you would not have known the event was sponsored by the San Francisco Interfaith Council with a lot of help from its friends in the San Francisco Organizing Project.

When the religious right goes on a tear against abortion or end-of-life choice (or for that matter, when the religious left goes head-to-head with its ideologically-opposed brothers and sisters) it makes news. When community organizers stage high-profile protests, the same thing happens. What does not make news is the enormous effort made by people of good will just to promote the common good — most recently, health reform.

Some opponents of Obama and his reform bills even have an altruistic bone or two. The reportedly calm, if badly misinformed, Bob Collier, featured in a front page New York Times article August 25, allowed that “we’ve got to do something about those people who can’t get insurance.” He qualified that later: “There has to be a safety net there. But I don’t want that safety net to catch too many people.” Somehow, Mr. Collier wants to separate out the “truly needy” from the “lazy and irresponsible people who play the system” and wouldn’t we all. The Times said that Mr. Collier gets his information from Fox News, Rush Limbaugh and Matt Drudge, none of whom I see as particularly altruistic. I would surely welcome him to True/Slant.

But the people cited above, people in faith communities (including many I disagree with and some I can’t pronounce), progressive nonprofits, community organizing groups and others just roaming the streets being kind, these people seek access to health care for everyone without worrying about who deserves it and who does not. A great many of them worked hard to put Obama in office, and are now working hard for health reform for no reason other than it is the right thing to do for someone else. Might be unrealistic but they keep at it.

My money is still on those people.

General interest/Health/Money/Politics & Causes/USA
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Fear-Based Health Policy

by Fran Johns

Today’s New York Times features a number of stories about the proposed health reform bills, with one interesting thread: fear. Fear of “rationing,” fear of excessive costs, fear of the unknown, fear of the future. Take just the first, for example –

“Rationing.” It is what many people say they fear most from an overhaul of the health care system — the prospect of the federal government’s limiting the medical care they can receive.

Even some people who now have private health insurance through their employers have expressed this concern in opinion polls and public forums. They say they worry that the enormous price tag for providing care to tens of millions of additional Americans will eventually force everyone else to make do with less.

Of course it’s not a reasoned fear; rationing ‘s not going to happen any time soon. But somewhat like the tossing out of the utterly false “death panel” phrase, the R-word works to solidify the base for those who want no reform at all. And for some who simply want Obama to fail.

Aren’t the stakes a little too high?

Policy Experts Call Fear of Medical Rationing Unfounded – NYTimes.com

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General interest/Health
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Food, Gluten & Lifestyle Changes

by Fran Johns

I have pretty much done it all, gustatorily or libationally speaking: alcoholism, teenage fad diets (well, a long time ago, but trust me, they are still the same), brief descents into the pit of fast food, and now — Celiac Disease. Celiac Disease, forheavenssakes. It’s genetic. Where has it been all these years? And who, suddenly, are all these other CD people? If you aren’t one, you probably know one.

Dietary seasons, I have come to believe, are like life cycles, the ebbs and flows of some immutable tide built into our systems. As a kid, I didn’t like oysters, an incredible stupidity when my cousins lived a short drive away on the Chesapeake Bay. Bush (the grown-up one) banned broccoli from the White House, although it is surely the side dish to oyster dinners at the tables of the goddesses; perhaps he has now gained understanding. My children, I am sorrowful to admit, grew up on Hamburger Helper and Chuck Wagon Casserole through cycles of their mother’s chaos. And here they are, fitness buffs and gourmet cooks with healthy families, looking fondly back on their culinary childhoods.

I have now entered the Celiac Age. This affliction does not necessarily correspond with the Golden Years, one of the least appealing and often inaccurate descriptives of aging. Celiac Disease is not even a respecter of age. A colleague of mine has a teenage daughter who was so severely celiac as an infant they thought they might lose her before the diagnosis was made. She now sings with a chorus that travels in Europe periodically, so Stewart can translate the diet into seven languages if you need him to.

Recent estimates are that as many as 1 in 100 Americans have CD, with a large percentage of them as yet undiagnosed. I won’t bore you with the symptoms, some of which are quite gastrointestinal and unpleasant; mine were just sudden weight loss and anemia. But what they all translate into is you can’t eat gluten. Gluten is found in wheat, barley, rye and oats and right away you can see donuts are out. CD is an autoimmune disease, so they’re out forever. On the other hand, we should all sign up for something that can be cured through the simple act of eliminating one thing from one’s diet. And if you consider what CD people can eat: meat, fish, vegetables, fruit, ice cream, chocolate candy, meringue cookies, frozen coffee drinks…

Still, we CD people have our moments of pitifulness. My latest was in a posh restaurant up the street at which I was told that everything on the dessert menu contained gluten, because they put gluten even into their ice cream so they can make fancy little plops. They have already received my e-mail about that 1 in 100 business. Actually, being asymptomatic now that I’m taking all these vitamins, I could eat that loaf of bread (it belongs to my husband) over there and never know the difference. But Dr. Yeo would know. Dr. Yeo watches the lab test results and they do not lie. And in truth, I need my bones, which don’t get their calcium if I cheat.

We try not to complain. Still, having given up pies, cakes, cookies, brownies, donuts and sticky buns I did manage to regain the lost weight and another uninvited 4 pounds. There is no justice. Tomorrow: a view of risk/benefit wine drinking.

Politics & Causes
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Pelosi Sticks With Public Option

by Fran Johns
Speaker Nancy Pelosi at a gathering of interfaith leaders in San Francisco today (Justin Sullivan/Getty)
Speaker Nancy Pelosi at a gathering of interfaith leaders in San Francisco today (Justin Sullivan/Getty)

House Speaker Nancy Pelosi held a press conference in San Francisco this morning at which she reiterated her commitment to a public option in the health reform bill and expressed hope, though with somewhat  lowered optimism, for coverage of end-of-life conversations. She did get in a dig at opponents of the latter: In response to a question about whether voluntary reimbursement for discussion of end-of-life care would stay in the bill, Pelosi said, “You know, the language is almost exactly the same as what the Republicans put into the prescription drug bill.”

The press conference, hosted by the San Francisco Interfaith Council, was an apparent reinforcement of the Democrats’ strategy of  broadening health reform support among members of religious communities. With leaders from the San Francisco Bay Area Christian, Muslim and Jewish communities arrayed behind her, the Speaker made repeated references to health care for all being a moral issue. Responding to the above question, she said, “People of faith, people in healthcare” and others know that “it makes life better if a person has expressed his or her own wishes. The key to this is that it is voluntary; it serves the purpose of saying what is your wish, rather than someone else having to make a decision you might not want. I don’t know what will happen (to the provision); I surely hope it will stay in.”

Pelosi was unequivocal, however, in her response to questions about the public option and to one reporter’s comment that “some Democrats and liberals are frustrated because it seems you are caving in to the far right.” “Is that you?” she repeated, pointing to herself. “The public option is the best way to go. If anybody can come up with a better alternative we’ll consider it. But the President is not backing off. The co-op might work in some states and that’s fine.  There is no way I can pass a bill on health reform without the public option.”

Pelosi was equally emphatic about her intention to retain the 400% of poverty measurement. Hesitantly using the term “seniors,” she said that many people between the ages of 50 and 65 have lost jobs, or may be making just $30,000 to $40,000 per year, and cannot afford needed medical care or prescription drugs. “I believe we have to have the 400% of poverty for them.”

Would the Democrats accept a scaled-down version of health reform? Pelosi repeated her litany of what is needed: reduced costs, improved quality, expanded coverage, affordable care for all; “What are you going to give up? At the end of the day, this is what we must have. And we must have reform of the insurance industry.”

In the small, carefully selected audience assembled at St. James Episcopal Church where her children attended preschool, Pelosi was on her own turf and among friends.  And she was characteristically upbeat. “Have we lost control of the debate? I disagree. I have 218 votes, and expect to have more. I am optimistic, and the President is committed to change.”

General interest
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Rallying the Faithful for Health Reform

by Fran Johns

President Obama sought to strengthen support for health reform among one of his core constituencies Wednesday afternoon, the community of believers. He served as keynote speaker of sorts, in a conference call with some 140,000 members of faith communities around the country. The call sponsor’s title, 40 Days for Health Reform, suggests those communities are mobilizing for action. 40 Days for Health Reform includes progressive interfaith groups PICO National Network, Sojourners, Faith in Public Life and Faithful America; and Catholics in Alliance for the Common Good. Web sites of the first four list members as adherents of faith traditions including Christianity, Judaism and Islam.

Urging his listeners to “spread facts and speak truth,” Obama said social change has always involved “a contest between hope and fear.” He reviewed some of the more glaring misrepresentations that have been made by opponents of reform — government take-over, “death panels,” funding for abortions — labeling them “ludicrous,” and said the response to “not wanting government bureaucrats meddling with your healthcare” is that “we don’t want insurance bureaucrats meddling with your healthcare.” There were no surprises, or new ideas floated. Director of White House Policy Council Melody Barnes fielded a few pre-selected questions from listeners but dodged any, such as one direct query about a public option, of substance. Still, among a small group of listeners surveyed after the call everyone was enthusiastic about the happening. “Nobody’s expecting policy pronouncements on a conference call,” said one; “what we need is just the recognition of how many good people want good health reform now.”

The call was clearly designed to rally and encourage the troops of the faithful. And those troops, many weary of watching debate co-opted by the religious right, may indeed now be reinvigorated. Most of the call was taken up with prayers or comments from religious leaders, or stories of tragedies caused by the current healthcare disarray. There were plenty of Biblical touchstones — the call lasted for 40 minutes — for listeners of Abrahamic faith traditions, and more than one of the speakers expressed the certainty that it is God’s will for all of His (or Her) creatures to have affordable, quality healthcare. Sponsoring organizations and participating individuals are gearing up for action in the weeks ahead toward that end.

The call can be heard on the 40 Days for Health Reform site. It may not change any Republican minds, but it does indeed claim a pretty powerful ally for the cause.

Health/Money/Politics & Causes/USA
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Counseling Improves Life's End. Surprise!

by Fran Johns

Knowledge, care and compassion really do bring peace. Why should this be a surprise? And why should a few strident opponents prevent those approaching life’s end from having this benefit?

A study appearing in today’s Journal of the American Medical Association points out the benefits of end-of-life counseling, although the widespread misinformation loose in the land may have doomed what should be a significant piece of health reform.

As a political uproar rages over end-of-life counseling, a new study finds offering such care to dying cancer patients improves their mood and quality of life.

The study of 322 patients in rural New Hampshire and Vermont also suggests the counseling didn’t discourage people from going to the hospital.

The Senate bill provision axed by Finance Committee chair Charles Grassley would have allowed coverage for conversations with physicians about things like hospice care, advance directives and treatment options.  But to opponents of reform, it was a handy attack mechanism. They enlisted a few standard bearers like former Alaska Gov. Sarah Palin and media darling Rush Limbaugh to twist the issue into menacing “death panels,” and in no time at all Sen. Grassley had his excuse to excise.

Losers in this are all of us. Eventually, 100% of us will die. Aggressive treatment and expensive, futile procedures are common today to that experience; compassion and peace are harder to come by.

In the new study, trained nurses did the counseling with patients and family caregivers using a model based on national guidelines. All the patients in the study had been diagnosed with terminal cancer. Half were assigned to receive usual care. The other half received usual care plus counseling about managing symptoms, communicating with health care providers and finding hospice care.

Patients who got the counseling scored higher on quality of life and mood measures than patients who did not.

Could someone please get this information to Sarah Palin?

Study: End-of-life advice aids terminally ill.

General interest
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Public Option Dead? Barbara Lee Says No

by Fran Johns

You think the public option for health coverage is dead? Try telling that to Congresswoman Barbara Lee. Never known for going along (she was the lone member of Congress to vote against giving President Bush a virtual blank check to go to war after 9/11) or for mincing words, she wants it known that no health reform battle — other than that for single-payer — is over.

“It’s all about give and take,” she said tonight; “we gave single payer.”

The Representative from California’s 9th District was at San Francisco’s Commonwealth Club to talk about her new book, Renegade for Peace and Justice.  But the conversation with KQED TV host Belva Davis and the Q&A session with a largely friendly audience tilted immediately, and  heavily, toward health reform. Has the Administration lost control of the debate? Not in Lee’s opinion. “Mainstream media coverage has been very biased,” she observed in opening the Q&A session. “The focus has been on the ruckus made by a small percentage of people, who probably didn’t vote for President Obama. I didn’t see CNN covering my Town Hall meeting.”

Because “we spent over a trillion dollars on this war that didn’t have to be fought,” Lee said, the issue of health reform is now “all about choice, and about competition.” And before either of those get to the public, congressional give-and-take will lead to a final bill. As current Chairwoman of the Congressional Black Caucus and member of several powerful committees, Lee expects to play an active part in that process. “We will insist on a bill that has a strong public option,” she says. “At least 60 members are saying the public option is key to their support.”

The new book was enjoying brisk sales, but health reform comments drew the loudest applause. One audience member told me at the end of the event that “Congresswoman Lee won’t ever get medals for moderation, but I’m not throwing in the towel if she’s not.” We were both leaving a few minutes before the final gavel; he said he was on his way home to start sending out more e-mails.

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