Tag: Health care

California/Health/Lifestyle/Politics & Causes/seniors/USA
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An elder revolution? It's possible

by Fran Johns

If you are over 50, or plan to be over 50 at some future date, you have just been issued a challenge. You might call it a leadership alert.

New York Times columnist David Brooks, who does have a good head on his shoulders, yesterday published an interesting column advancing the theory that real social change will come from the geezer generation. Those at the time of life traditionally perceived as fuzzy, withdrawing and passive. Or at best, the time of life in which most are inclined to let the young folks do the heavy lifting. But those times, Brooks maintains, have changed.

Citing studies undertaken over past decades, Brooks explains that the geezer generation (in which I am a fully accredited member) is now understood to be not so dimwitted and inept as long thought. Beyond new research that shows brains can continue to thrive and develop into one’s late years, people who had been studied over a 50-year period proved to be increasingly outgoing, self-confident and compassionate.

That’s the good news.

The bad news is that we geezers — a population about to boom as the Boomers hit Medicare age — are eating up a way disproportionate share of the GDP. So pensions are going to keep getting money that would better be spent on education, taxes will go to fulfill earlier promises, etc.

Then, though, Brooks turns it all around a new corner:

In the private sphere, in other words, seniors provide wonderful gifts to their grandchildren, loving attention that will linger in young minds, providing support for decades to come. In the public sphere, they take it away.

I used to think that political leaders could avert fiscal suicide. But it’s now clear change will not be led from Washington. On the other hand, over the past couple of years we’ve seen the power of spontaneous social movements: first the movement that formed behind Barack Obama, and now, equally large, the Tea Party movement.

Spontaneous social movements can make the unthinkable thinkable, and they can do it quickly. It now seems clear that the only way the U.S. is going to avoid an economic crisis is if the oldsters take it upon themselves to arise and force change. The young lack the political power. Only the old can lead a generativity revolution — millions of people demanding changes in health care spending and the retirement age to make life better for their grandchildren.

It may seem unrealistic — to expect a generation to organize around the cause of nonselfishness. But in the private sphere, you see it every day. Old people now have the time, the energy and, with the Internet, the tools to organize.

The elderly. They are our future.

We could start by convincing seniors to ignore the scare tactics of their conservative friends and support health reform. Mount a movement for what is morally right: health care for all Americans. Their grandchildren will thank them.

Not being a community organizer myself, I don’t know how to start this campaign. But if you have any suggestions I’ll join the movement.

Op-Ed Columnist – The Geezers’ Crusade – NYTimes.com.

California/Environment/Health/Politics & Causes/seniors/USA
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Democrats have a survey too — they just don't call it a Census

by Fran Johns

In the interest of fair-and-balanced commentary in this space, we want to report receipt of an Official Document from the Democrats. This one, unlike that decidedly suspect missile from the Republicans last week, does not advertise itself as an Official Census Document and does not raise the fear level to code red. It advertises itself as a 2010 Priority Issues Survey, which, in fact, it is.

The envelope, though, does bear the admonition: Do Not Tamper. We wonder who’s been tampering with Democratic issues, other than the hapless invaders of Louisiana Senator Mary Landrieu’s office. We’re not even sure how one can Tamper with an Official Document.

Nevertheless. Because the Democratic Party Headquarters bothered to send a fairly straightforward questionnaire, with a minimum of weighted sentences, below are listed a few considered responses to this “opportunity to help shape Democratic priorities and build a brighter future for America.” You are invited to send your own answers to www.dccc.org, even if you lack an Official Survey Registration number, and we’ll see who’s paying attention. One citizen’s response:

Yes, I believe waterboarding is torture and the U.S. has a moral responsibility to not engage in or condone any form of torture.

Yes, every American should be guaranteed access to affordable, quality health care.

No, I don’t support privatization of Social Security, but Yes, the Medicare prescription benefit plan should be reformed so the government can negotiate lower drug prices with big pharmaceutical companies. (Good luck with that, government.)

Yes, the federal government would do well to provide more assistance to Americans who want to continue their education beyond high school. Cutting student loan interest rates, increasing college tuition tax deductions, increasing Pell grants – all sound good to me.

Weighted question next: How concerned are you about the environmental damage resulting from last-minute Bush Administration maneuvers to weaken laws like the Clean Air Act, Clean Water Act and Endangered Species Act. Well, since I happen to agree, pretty darned concerned.

Slightly different phraseology question: How serious a threat is global warming? Thanks for not asking, as the Republicans did, if I believe it’s real. I’ll go with Very Serious.

That’s about it for the Democrats. They do also provide a postage-paid envelope, and they also invite your contribution.

If the Independents have an Official Survey going, it will be duly reported in this space.

California/General interest/Health/Medicine
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The doctor is in… cyberspace

by Fran Johns

Getting health care — whatever happens with the health care bill — is no longer just a matter of getting to the doctor. Issues of comfort, efficiency and cost control increasingly point to the use of telemedicine, which is coming, ready or not. And one recent report suggested the medical profession isn’t ready. Pauline Chen, M.D. , writing recently in the New York Times, cited resistance by doctors and nurses alike to what some consider long-distance health care.

Telemedicine has the potential to improve quality of care by allowing clinicians in one “control center” to monitor, consult and even care for and perform procedures on patients in multiple locations. A rural primary care practitioner who sees a patient with a rare skin lesion, for example, can get expert consultation from a dermatologist at a center hundreds of miles away. A hospital unable to staff its intensive care unit with a single critical care specialist can have several experts monitoring their patients remotely 24 hours a day.

But despite its promise, telemedicine has failed to take hold in the same way that other, newer, technologies have. Not because of technical challenges, expense or insufficient need. On the contrary, the most daunting obstacle to date has been a deeply entrenched resistance on the part of providers.

Tech industry writer/elder care advocate Laurie Orlov thinks those concerns are a thing of the past. Since data was gathered for the study Dr. Chen cited, Orlov points out in her Aging in Place Technology blog, doctors, patients and technology have come a long way. “Forget the JAMA study”, Orlov says, “here come the virtual visits.”

Medical practices, hospitals, clinics are well aware of a much-changed world and consumer health care costs that can be breathtaking. American Well’s virtual visit platform use is growing, as are other virtual platforms discussed in our 2009 Calibrated Care report. They have read about transformation of self-care and virtual visits in Denmark. Given the geographic distribution of people — and the distance required to get to doctors in some states and rural areas, given the availability of technology that was barely known or completely unknown in 2006, these are going to happen, reimbursement has begun, criteria for the use has emerged, and the JAMA study (and its much-syndicated press coverage) is already irrelevant.

On a technologically lower level is the use of PC programs long in place for Kaiser patients. They haven’t asked for a testimonial, but here’s one, with enthusiasm. The e-mail your doctor program allows doctor-patient communication at the convenience of each (my primary care doc, oncologist and other specialists almost all answer queries within 24 hours or less); test results are posted immediately and can be viewed via charts or graphs to show how you’re doing; drug information or other Q&A’s are immediately accessible through personal accounts. All of the above save time, money and patient angst.

Doctors in cyberspace could be good medicine indeed for U.S. health care.

California/Health/Politics & Causes/seniors/USA/Women
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Taking on MoveOn

by Fran Johns

I am a certified MoveOn supporter. Though I had to opt out of the e-feeds because my Inbox overfloweth, I have sent money, forwarded news, heeded their messages.

But enough is enough. They are pushing for measures we should have, but won’t get today. I am coming down on the side of those who say just get us a bill. In the words of Washington Post editorial writer E. J. Dionne — in a column today aptly titled Don’t scream: organize:

Instead of trying to derail the process – exactly what conservative opponents want to do – those on the left dissatisfied with the Senate bill should focus their efforts over the next few weeks on getting as many fixes into it as they can.

What we have in the Senate bill is a mishmash of stuff we didn’t want, along with the absence of stuff we did. Ridiculous obstacles to a woman’s right to choose to have an abortion — write two checks every month just so Ben Nelson can get benefits in perpetuity for Nebraska and maybe we’ll satisfy the U.S. Conference of Catholic Bishops in the bargain? — piled on top of other obstacles for the poor and benefits for the rich (read: Big Pharma.) But come on, folks, it’s a bill. If we get a bill, it can be improved. If we fail, it’ll be another generation of a punitive, non-working “system” of health care before we get this far again. By then there will be other Joe Liebermans eager to grab the spotlight and claim the power to derail every other beneficial detail. I’ll be dead, but I plan to haunt you.

Dionne points out that the House bill is superior, the two bills will now have to be reconciled, and there will be future opportunities to build on this beginning.

Enactment of a single bill will not mark the end of the struggle. It will open a series of new opportunities. It’s a lot easier to improve a system premised on the idea that everyone should have health coverage than to create such a system in the first place. Better to take a victory and build on it than to label victory as defeat.

Successful political movements prosper on the confidence that they can sustain themselves over time so they can finish tomorrow what they start today. At this moment, rage is understandable, but hope is what’s necessary.

Progressives – don’t scream: organize.

Health/Politics & Causes
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Figuring out Joe Lieberman

by Fran Johns

New York Times columnist Gail Collins offers a few choice answers to today’s most pressing question: ‘What is it with Joe Lieberman?’

Lieberman’s apparently successful attempt to hijack health care reform and hold it hostage until it had been amended into something that liberals couldn’t stomach has mesmerized the nation’s political class. This was, after all, a guy who has been a liberal on domestic issues since he was a college student campaigning for John F. Kennedy. A guy who was in favor of the public option, of expanding Medicare eligibility, until — last week.

The theories about Why Joe Is Doing It abound. We cannot get enough of them! I have decided to start a rumor that it all goes back to the 2004 presidential race, when Lieberman not only failed to win any primaries, but was also bitten by either a rabid muskrat or a vampire disguised as a moose.

Other than that, my favorite explanation comes from Jonathan Chait of The New Republic, who theorized that Lieberman was able to go from Guy Who Wants to Expand Medicare to Guy Who Would Rather Kill Health Care Than Expand Medicare because he ‘isn’t actually all that smart.’

It’s certainly easier to leap from one position to its total opposite if you never understood your original stance in the first place, and I am thinking Chait’s theory could get some traction. ‘When I sat next to him in the State Senate, he always surprised me by how little he’d learned about the bill at the time of the vote,’ said Bill Curry, a former Connecticut comptroller and Democratic gubernatorial nominee.

Collins favors the not-that-bright theory (‘in part because it’s as good an explanation as any, and in part because it will definitely drive Lieberman nuts’), but she provides greater insight by drawing the comparison between the records of failed national candidates Al Gore and John Kerry, who moved on to useful pursuits, and those of John McCain and Joe Lieberman who are ‘work(ing) out barely suppressed rage by attacking things (they) used to be for.’

Maybe the difference comes from self-image. Lieberman and McCain both thought of themselves as ‘character’ candidates whose success was due to the love and trust of the public, and whose ultimate failure was the work of evil forces beyond their control. Kerry and Gore never believed their success was due to their innate likability. When they lost the presidency, a part of them probably shrugged and remembered that they weren’t all that popular in prep school, either.

Politicians switch direction all the time, but the Lieberman experience has been weird because he doesn’t seem to feel as though he’s changed. He bounds around happily, doing the talk shows, confident that he’s the same independent-minded independent who believes in independence as always. Observers who have known him for a long time feel as though they’re living out a scene in a science-fiction movie when the guy who’s just been bitten by the vampire-moose comes home and sits down to dinner, unaware that he’s sprouting antlers.

I used to cover Lieberman when he was the majority leader of the State Senate in Connecticut. We got along very well, except for one interview, during which he talked about working for J.F.K., and how he kept a Mass card from Robert Kennedy’s funeral to remind him of the principles to which he had dedicated his career. Showing me the card, he remarked casually that he hadn’t looked at it for some time.

I wrote an article using the neglected Kennedy card as a metaphor for Lieberman’s fall from his old ideals into the pragmatic politics of a party leader. He was outraged and wounded, and I believe I apologized.

Collins is now taking back that apology. I think it is Joe Lieberman who needs to apologize to the American people. We voted for health reform, we’ve watched the key parts get tossed for the likes of those insurance folks who so strongly support him, and now we’re feeling a little helpless as he enjoys his position of fame and glory and power.

Lieberman may not be that smart, and he’s certainly not wise. Unfortunately, he is shrewd.

Op-Ed Columnist – Sorry, Senator Kerry – NYTimes.com.

General interest
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Health Bill Should not Pit Women against Seniors

by Fran Johns

The health care issue is, one would think, too important for partisan games pitting one group against another. Especially when huge portions of each group are one and the same. But as Robert Pear and David M. Herszenhorn report in today’s New York Times, that seems to be happening.

In a day of desultory debate on sweeping health care legislation, senators appealed to two potent political constituencies on Tuesday, with Democrats seeking additional medical benefits for women and Republicans vowing to preserve and protect Medicare for older Americans.

The Democrats’ first amendment, offered by Senator Barbara A. Mikulski of Maryland, would require insurers to cover more screenings and preventive care for women, with no co-payments.

‘Women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won’t pay for it unless it is mandated by state law,’ Ms. Mikulski said.

I met with my oncologist two days ago and decided to have a mammogram. It’s been two years since the last one. She and I agree that, having had breast cancer in 2006 and breezed through a mastectomy, and being fit and healthy overall, my particular situation suggests the potential benefits — catch another cancer early, gain another good decade or so of life — outweigh the risks.  This is what the whole thing is about: every woman is different, every woman should be allowed to decide, with her doctor, on screening and preventive care. The Mikulski amendment will insure that can happen, whatever one’s age and circumstances.

The first Republican proposal, offered by Senator John McCain of Arizona, would strip the bill of more than $450 billion of proposed savings in Medicare. The savings would curb the growth of Medicare payments to hospitals, nursing homes, health maintenance organizations and other providers of care.

‘The cuts are not attainable,’ Mr. McCain said. ‘And if they were, it would mean a direct curtailment and reduction in the benefits we have promised to senior citizens.’

Senators said that debate on the bill, which embodies President Obama’s top domestic priority, would last for several weeks and perhaps continue into January. A vote on Ms. Mikulski’s amendment has not been scheduled but could come Wednesday.

The health care bill would require most Americans to carry insurance. It would subsidize coverage for people with moderate incomes, expand Medicaid and create a government insurance plan, which would compete with private insurers. The House passed a similar bill last month.

Ms. Mikulski’s proposal was prompted, in part, by the recent furor over new recommendations from a federal task force that breast cancer screenings begin later for many women.

The Senate majority leader, Harry Reid, Democrat of Nevada, hailed Ms. Mikulski’s proposal, saying: ‘The decision whether or when to get a mammogram should be left up to the patient and the doctor. That decision should not be made by some bureaucrat, a member of Congress or someone they’ve never met.’

As health costs and insurance premiums rise, Mr. Reid said, ‘more women are skipping screenings for cervical and breast cancer, and doctor visits that can catch problems like postpartum depression and domestic violence.’

Votes on the Mikulski amendment will show whether Republicans “truly want to improve this bill or just want to play games, stall,” Mr. Reid said.

Ms. Mikulski said her proposal would ‘shrink or eliminate the high cost of co-payments and deductibles’ for women who receive screenings for cancer, heart disease, diabetes and other conditions.

Senator Kay Bailey Hutchison, Republican of Texas, criticized the proposal, saying it would ‘allow yet another government agency to interfere in the relationship between a woman and her doctor.’

No, Senator Hutchison, the government isn’t interfering in my relationship with my doctor, nor will it do so by insuring other women’s choices and coverage.

Republicans argued that the bill would be paid for on the backs of older Americans.

‘We are receiving incredible and overwhelming response from seniors all over America,’ Mr. McCain said. ‘They paid all their working lives into the Medicare trust fund, and now they’re in danger of having $483 billion cut out of it.’

Mr. McCain’s proposal would effectively cripple the bill, because Democrats are relying on savings in Medicare to help offset the cost of providing coverage to more than 30 million people who are now uninsured.

This senior would like to add a word to that “overwhelming response” Mr. McCain reports. I paid all my working life into Medicare (which, by the way, was not exactly a gift to America from the Republican party) and I want a decent health bill more than I want every penny of my Medicare coverage protected.

A lot of us have come to terms with the fact that the health bill we may get is a long way from the health bill we so fervently wanted. We are still hoping that something survives the attempts to sink it at any cost.

Senators Pitch to Women and Elderly on Health Bill – NYTimes.com.

California/General interest/Health/Politics & Causes/seniors/USA/Women
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Doctors making house calls? An old idea whose new time has come

by Fran Johns

Could house calls make a comeback? It’s already happening. The University of California at San Francisco, for one success-story example, started the UCSF-Mt. Zion Housecalls Program in 1999 with a philanthropic gift. Its original goal was to teach medical students about home care, but with the exploding need for primary care for homebound elders it has evolved into filling that need throughout San Francisco — while still teaching the new generation about house calls.

In an article in the San Francisco Chronicle, staff writer Victoria Colliver details some of the many advantages that such programs have.

June Hagosian’s brain tumor has made it difficult for the 77-year-old San Francisco woman to leave her house in recent years, keeping her mostly confined to her bed.

For someone like Hagosian whose medical needs require frequent doctor visits, that would usually pose a problem. But because of a program run by UCSF, the doctor comes to her. She has had to leave her bright yellow home in the Richmond District to go to the hospital just three times in the past seven years.

“This program has been so wonderful,” Hagosian said during a recent home visit with her physician, Rebecca Conant, director of UCSF’s Housecalls Program. “I wish everyone could have it.”

Conant, who had just 15 patients when she took over the program in 2001, is one of five part-time UCSF physicians who spend all their clinical time outside the office, traveling from home to home visiting frail and elderly patients. Housecalls currently serves nearly 100 San Francisco residents and has an eight-month waiting list.The Housecalls physicians visit patients whose conditions make it so hard for them to go to the doctor’s office that they might otherwise put off seeking medical care. By then, they would be so sick they would need an ambulance and end up in a hospital emergency room. The program takes patients regardless of whether they have insurance or an ability to pay, which separates it from private practices that offer home visits as a convenience but at an added cost.

UCSF’s 10-year-old Housecalls Program is an old idea that has gained new traction. Both the House and Senate versions of the health reform bills contain proposals to examine whether home-based care improves the health of chronically ill patients and saves the government money by reducing hospitalizations and ER visits.”There’s no question there is both a medical need and substantial cost savings to the Medicare program,” said Constance Row, executive director of the American Academy of Home Care Physicians.

The Department of Veterans Affairs’ Home-Based Primary Care program, which has been operating for more than two decades, has showed a 24 percent reduction in costs for those patients, and some studies suggest savings as high as 40 percent, Row said.

UCSF’s Housecalls Programs operates on an annual budget of $300,000, almost all of which is devoted to physician salaries. That’s an average cost of $3,000 per patient, which does not include the cost of hospital care when needed. Medicare spends a national average of $46,412 per patient over the last two years of life, when patients typically have several chronic illnesses, according to researchers from the Dartmouth Institute for Health Policy and Clinical Practice.

But new technology – the ability to X-ray patients using portable machines, conduct blood tests and provide other services using mobile devices – allows doctors to offer a much higher level of care in the comfort of the patient’s home.

Conant, an associate clinical professor at UCSF, said she uses mobile devices to aid in her patient care, but she finds home visits offer other advantages like allowing her to see patients’ physical environments, meet their caregivers and better understand what kind of care they need.

“Not only does that improve medical care, but it’s based in reality,” she said.

The UCSF program is not the only home-based primary care program in the Bay Area. Kaiser Permanente, for example, serves some 370 members in San Francisco as part of its 13-year-old Community Care Program, which is handled by physicians, nurse practitioners and social workers.

Reinstituting and reinforcing in-home care, considering the significantly improved care for patients and the reduced cost to the taxpayer, would seem a no-brainer. But brains are losing out to politics a lot these days.

via UCSF program shows house calls’ time returning.

General interest/Health/seniors/USA/Women
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New Cancer Guidelines: One Good Message

by Fran Johns

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

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