Tag: Barack Obama

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.

General interest
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Insuring the Uninsured: A No-Brainer

by Fran Johns

I’ll call her Joan. She is 61 years old, working in real estate and living comfortably in an upscale rental apartment thanks partly to rent control. She has a small 401k and a small, steady income from shared family ownership in a stable investment property. But the real estate business, you may have heard, hasn’t been wonderful lately. Joan lives frugally, gives of her time and resources to community nonprofits and is highly respected in business and social groups. She has no health insurance.

“I would if I could,” she told me some time ago. “But it’s either buy insurance or buy dinner. I’m fond of eating.” Twice in the past year Joan has had to have medical treatment; once for a nasty wound in a bike accident, once for an infection that required an overnight hospital stay. She went to the only place available, the understaffed emergency room of a crowded public hospital. Who picked up the tab? You and I. I am happy to do so, for Joan and everyone else who winds up in these predicaments. But come on, it’s not exactly cost-effective.

Expanding coverage to those currently uninsured is only one segment of this moving-target health reform; I hope it doesn’t get lost the way other key elements seem to be straying from the scene. People like Joan would be the first to purchase insurance through any reasonably-priced plan. Unfortunately, I don’t see many insurance companies eager to offer such a thing, and I don’t know where many of the currently uninsured will go if the public option comes off the table.  There were some 47 million uninsured at the latest count. Add to those the swiftly-rising numbers of independent contractors and freelancers of all sorts.

Getting non-emergency care out of the nation’s emergency rooms seems an enlightened thing to do… if we could just have a little more light and less heat in the discussion.

General interest/Health/Money/Politics & Causes/USA
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Tracking Down a Rumor

by Fran Johns

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.

Health/Politics & Causes
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Health Care that Works: Integrated Medicine

by Fran Johns
President Obama speaks at a Portsmouth, NH event on August 11 (Darren McCollester/Getty)
President Obama speaks at a Portsmouth, NH event on August 11 (Darren McCollester/Getty)

Last night’s NewsHour included a segment that gives me hope: a clip of President Obama citing integrated medical systems that are actually working, followed by an excellent in-depth piece on the Billings MT clinic that proves the point. Billings is only one of such examples.

How do they work? By getting everybody under one roof and coordinating patient care. By letting different specialties work together, rather than sending a patient from one to another to another. By compensating doctors with salaries. This last is a sticking point: if you own a piece of the MRI business, for example, you might just be inclined to order more MRIs. Or you’re tied to the work-harder-get-richer principle. But more and more doctors seem interested in having a life, in not being on call 24 hours a day, in earning good money (integrated system compensations compare well with private practices) while focusing on patient care — without over-prescribing and over-ordering to guard against getting sued.

Why does this make such good sense? Because most patients (not all) sing its praises. Because integrated care saves money by keeping people healthier, reducing unnecessary procedures, keeping people out of hospitals… the list goes on.

My oncologist retired a year after a 2006 breast cancer episode. I went to meet my new choice on the 8th floor of Kaiser Medical Center in March, 2008. She looked at lab tests (2nd floor), spotted anemia, said I shouldn’t be anemic, ordered colonoscopy/endoscopy. G.I. doc (2nd floor) found celiac disease in June, connected me to nutritionist (across the street) and to endocrinologist (6th floor) who helped me design diet plus vitamins etc so I’m healthy again. Physical therapist (4th floor) discussed fitness plans. All of these specialists, my surgeon (2nd floor) and my primary care doc (4th floor) are friends. All respond to frequent e-mails within 24 hours, saving multiple calls and appointments. All post test results, etc on my personal web page. Thus, over a 3-year period: one overnight hospitalization for mastectomy, one out-patient procedure, a reasonable number of appointments, healthy patient.

Not everybody loves Kaiser, or the other clinics being studied. But it’s a model that works.

General interest
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Grassroots Healthcare Reform

by Fran Johns

If we get a health reform bill, it may be thanks in part to a push from the ground up. That belief is leading to a variety of grassroots support endeavors.

At a hospital-sponsored town hall meeting on the issue this week in San Francisco attendees were invited to take the microphone to tell their stories. Probably a bad idea at any meeting, since such an invitation guarantees off-point rambles and rages and this one certainly proved the point — but there were enough horror stories to assure everyone that our current non-system is a train wreck.

A cardboard cut-out of President Obama stood at the back of the room (there was a lot of photo-op going on before things got started) and the promise was that videos of the stories would go straight to Washington to help speed passage of the hoped-for health reform bill.

Participants told of needed care that couldn’t be found, needed drugs that couldn’t be bought and the widespread suffering of the un- or under-insured. A panel of local experts presented aspects of the hoped-for national plan and spoke of San Francisco’s own moderately successful effort to provide health coverage for all.

Speakers were asked to keep their remarks to under three minutes, another dictum doomed to failure, and a few did. My own plea (one minute, forty seconds) was for inclusion of some guarantee/protection of individual choice at the end of life. It stemmed from working for many years (as I still do) with terminally ill adults who seek options including hastening their dying. It was tempered in deference to the hosts, since St. Francis is a member of Catholic Healthcare West and the opposition of the Catholic Church was largely responsible for defeat of a widely popular physician aid-in-dying bill that narrowly failed in California two years ago. And the likelihood of such a controversial issue getting into the massively complex bill we may or may not get is somewhere between slim and none, but what the heck. With Mr. Obama standing there, I couldn’t resist.

At similar gatherings around the country, I suspect the message and the messengers are much the same. Health reform is a national need that translates in millions of heartbreaking individual stories.

My personal favorite message came from panel member Catherine Dodd, PhD, RN, District Chief of Staff for Nancy Pelosi in her pre-Speaker days. Dodd explained the current three-fold status (two in the Senate and one in the House) of the healthcare bill and defended its  probable cost. Then she threw out one new number: 19.7. After everyone had let 19.7 sink in, she told us that is the number of years it has taken this country, every time a health reform bill has been floated, to bring it up again. “We can’t afford another 19.7 years,” she said. I think she’s right.

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