Pelosi Reaffirms Public Option, Insurance Reform; Healthcare "A Moral Imperative"

House Speaker Nancy Pelosi, addressing a Chamber of Commerce-sponsored Health Summit in San Francisco this morning about Obama’s health reform, stressed elements of the three House bills that might seem palatable to her audience: cost containment, IT design and integration with existing systems to create universal access to care. But she did not back down on a few other consistent statements such as the assertion that no bill will pass the House without a public option.

“We will invest in medical research and technology,” Pelosi said; and will incorporate elements such as electronic medical records for individuals to speed care.

It was clear there were mixed levels of support for reform in her audience. California Pacific Medical Center CEO Warren Browner MD, MPH drew muted chuckles and no boos with a throw-away comment that President Obama had “spent more time on choosing a dog” than on crafting a health policy. CPMC, a Sutter Health Affiliate, was presenting sponsor of the event.

Speaker Pelosi, though, hammered away at the primary intentions of reform: “improve quality, expand coverage and contain costs” while providing universal access to quality healthcare. “We will,” she said, focus on “quality, not quantity; wellness of the person not utilization (of facilities and technologies); value, not volume; and a commitment to prevention and wellness.”

San Francisco Mayor Gavin Newsom addressed the gathering earlier, touting the success of his “Healthy San Francisco” universal coverage program now in its second year. An independent Kaiser Family Foundation poll recently showed Healthy San Francisco to have a 94% approval record, prompting City/County Department of Public Health Director Mitch Katz, MD to ask when any program of any sort had ever gotten a 94% approval record. Citing the need for protection of such elements as in-home services in an aging population, Newsom said the program’s success was attributable largely to partnerships with local hospitals, clinics and medical facilities (CPMC is one), specifically singling out Kaiser Permanente, which signed on in July. The program does not offer a national model, Newsom said, but has many elements a national plan could adopt. Healthy San Francisco includes things that might not get into a national bill but are favorites with wellness proponents: community organic gardens, city-funded salad bars in schools and an ad featuring a soda-equipped young boy admitting to “a drinking problem.” Another key to the program’s success, Newsom said, is its ultra-simple one-page enrollment form.

Pelosi insisted that the final bill will include “insurance reform: no refusal based on pre-existing conditions, no co-pay for prevention, no cut-offs.”

And the major themes were reiterated: “As President Obama has said, universal healthcare is a moral imperative,” she said; “we are the only country in the developed world without it. I say to those who would have us do a little bit, and another little bit, and another little bit — Lyndon Johnson settled for half a loaf; this is the other half of the loaf.”

Healthcare: Sorting Fact from Fiction

House legislation on health reform is a win-some-lose-some proposition for those over 65. Especially, as outlined in The New York Times yesterday, when it comes to Medicare drug benefits.

Medicare beneficiaries would often have to pay higher premiums for prescription drug coverage, but many would see their total drug spending decline, so they would save money as a result of health legislation moving through the House, the Congressional Budget Office said in a recent report.

Premiums for drug coverage would rise an average of 5 percent in 2011, beyond the level expected under current law, and the increase would grow to 20 percent in 2019, the budget office said.

“However,” it said, “beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost-sharing).”

The Congressional Budget Office report set off an immediate battle between Republicans and Democrats, each side eager to convince seniors — those vocal voters — that the other was representing the devil incarnate. Republicans swear the House bill will threaten Medicare beneficiaries in order to cover the uninsured, Democrats say the bill will help them by eliminating a gap in Medicare drug coverage.

On this particular segment of the impossibly complex bill, maybe seniors would do well to listen to their own purported champion:

Nancy LeaMond, an executive vice president of AARP, the lobby for older Americans, welcomed the report as evidence that “health care reform will lower drug spending.”

“Opponents of reform may use today’s projections to try to stall reform,” Ms. LeaMond said, “but we hope they will look at all the facts before jumping to a false conclusion.”

And there, some would suggest, is the problem. The facts have been virtually obscured by misstatements, misrepresentations and outright lies. Death panels? A lie that served its scary purpose. Rationing? It’s already here, folks; it’s done by insurance companies that deny coverage in sometimes arbitrary ways. Socialized medicine? Hello? Does anyone over 65 remember those screams before Medicare was signed into law in ’65? When half the population over 65 had no insurance coverage at all?

Set aside the fact that providing healthcare for all is simply the right thing to do. Millions of American seniors (whether you begin that definition at 65, 60 or — to their horror as it sometimes happens — 55) were motivated to support President Obama by not only their hearts but also their brains. If those brains can be called into play to sort fact from fear-mongering, we may yet get the health reform common decency requires of this otherwise civilized nation.

Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says – NYTimes.com

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More on Health Care: Where the Costs Are

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.

Health Policy: Is Altruism Dead?

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.

Fear-Based Health Policy

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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Counseling Improves Life's End. Surprise!

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.

Tracking Down a Rumor

Rumors come, and don’t seem to go. Jim Rutenberg and Jackie Calmes of the New York Times have weighed in again today with a few facts… just in case anyone is interested in facts:

The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks.

Advanced even this week by Republican stalwarts including the party’s last vice-presidential nominee, Sarah Palin, and Charles E. Grassley, the veteran Iowa senator, the nature of the assertion nonetheless seemed reminiscent of the modern-day viral Internet campaigns that dogged Mr. Obama last year, falsely calling him a Muslim and questioning his nationality.

Rutenberg and Calmes point out that the doggedly persistent rumor “was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists.

Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

This is the core of what all reasonable people know:

There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.

But as T/S Contributor Andy Geiger points out, the real issue in health reform is that people are suffering because they don’t have health coverage. Opponents to any reform at all have found a handy way to create this smokescreen by keeping everyone riled up with an utterly false rumor.

I’ve spent much of my adult life working for better end-of-life care, including being forever on a soapbox urging everyone, not just seniors, to consider their end-of-life options, have conversations, create advance directives and then get on with living. I strongly, fully support the good provision in the health care bills that may indeed now get cut.

But we need not to lose this forest for a tree. Rational people have got to continue fighting for a decent system, a decent bill.

False ‘Death Panel’ Rumor Has Some Familiar Roots – NYTimes.com.

End-of-Life Care is Losing to Lies

Here is some of the current worst news on health reform:

The Senate Finance Committee’s health care plan will not include provisions dealing with end-of-life care, now one of the more controversial topics in the health care debate, the committee’s top Republican said on Wednesday.

Senator Charles E. Grassley of Iowa said in a statement that the committee “dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”

If anyone knows misinterpretation, it’s Senator Grassley. He’s the originator of such enlightened parting phrases as the one he tossed out at an Iowa meeting Wednesday, about not wanting a health plan “that will pull the plug on grandma.” There is, of course, no grain of truth in that phrase, but its repetition does exactly what Sen. Grassley and his ilk wish: whip the opposition to any real reform into an emotional, unthinking frenzy. And they are winning the war against reason one battle at a time.

A Senate Finance Committee aide confirmed that the panel was not discussing end-of-life measures, adding that they were “never a major focus” of the committee’s negotiations.

House committees have passed legislation that would provide Medicare coverage for optional counseling sessions on end-of-life services.

But as people like Senator Grassley, and former N.Y. Lt. Governor Betsy McCaughey who sought fame and perhaps fortune by starting this whole flap, keep the country inflamed with misinformation the chances of decent legislation rising from these ashes grow dim.

The hopeless optimists of the land continue to believe that calls and letters and e-mails of sanity will convince our legislators that the country will rally around a decent bill… but Mr. Grassley and Ms. McCaughey are making optimism difficult.

via Senate Bill Will Not Address End-of-Life Care – Prescriptions Blog – NYTimes.com.