Safeway carrot-stick plan a boon to reform

There was a little local pride in a key segment of the Senate Finance Committee’s health care bill reported today by Andrew S. Ross of the San Francisco Chronicle:

It’s not every day a local grocery has a congressional amendment named after it. Such an honor has been bestowed on Pleasanton’s Safeway Inc., whose stick-and-carrot health insurance program is the model for a “wellness provision” in a health care reform bill that passed the Senate Finance Committee last week by an unusually bipartisan 18-4 vote.

“Yes, it’s quite fair to call it the ‘Safeway amendment,’ ” said a spokesman for Sen. John Ensign, R-Nev., who co-sponsored the amendment with Sen. Tom Carper, D-Del. “He’s a big advocate of the Safeway program.”The provision, designed to “incentivize Americans to lead healthy lifestyles in order to lower their overall health care costs,” would allow companies with self-insurance programs to reward employees with bonuses and/or premium reductions of up to 50 percent if they follow health guidelines, like undergoing regular screenings, quitting smoking, losing weight, taking cholesterol-reducing medications and so on.

While some question the accuracy of reported cost savings, the measure has strong support among key politicians up to and including President Obama.

As a beneficiary of Kaiser‘s “wellness” program — a constant push toward healthy lifestyles and preventive medicine — I hope this piece of the legislation stays. As long as he’s not going to resign, Senator Ensign might as well be doing something useful over there.

via Safeway plan part of Senate health care debate.

Will Anti-Abortionists Sink Health Reform?

Already the right wing, Catholic officialdom and Sarah Palin have won their battle to make sure that I, and countless other millions, will likely die only after expensive, prolonged, futile, aggressive, undesirable treatment rather than peacefully at home as I choose. Now they want the generations younger to be sure that any accidental, criminal or otherwise unplanned pregnancy results in another unwanted child coming into this overpopulated world. An assault on health reform is their latest battleground. I am careful to say Catholic officialdom, because all of the lay Catholics I know, many of them Good Catholics, support both reproductive and end-of-life choice. I am careful to mention Sarah Palin just to prove I have absolutely no resentment over the fact that whereas I can’t interest publishers in my several excellent book projects, she has a planned first run of 1.5 million on her dashed-off memoir.

But back to the problem at hand. Writing in Tuesday’s New York Times, David Kirkpatrick presents the new scary problem:

As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

Never mind that Obama has promised that no federal funds will go for elective abortions, and the current policies would remain unchanged, here is a handy opportunity to make points with conservatives and throw a monkey wrench into the works of reform.

Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.

Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.

So it’s all about halting abortion — maybe — or all about halting reform — maybe — but some of us who simply, desperately, wish better care and a few decent options for our less-advantaged citizens are left to wonder what it’s really all about.

Abortion Fight Complicates Debate on Health Care – Readers’ Comments – NYTimes.com.

Boomers & the high cost of dying

As health reform slogs along, a few critical pieces are already gone for good — or for now, at least. One of the saddest is coverage for end-of-life conversations; one of the saddest elements of our culture in general and healthcare mish-mash in particular is the tendency to treat death as a curable disease. Timothy Egan, in a recent blog for the New York Times, makes an eloquent case for injecting a little reality into all this.

In the last days of her life, Annabel Kitzhaber had a decision to make: she could be the tissue-skinned woman in the hospital with the tubes and the needles, the meds and smells and the squawk of television. Or she could go home and finish the love story with the man she’d been married to for 65 years.

Her husband was a soldier who had fought through Europe with Patton’s army. And as he aged, his son would call him on D-Day and thank him – for saving the world from the Nazis, for bequeathing his generation with a relatively easy time.

That son, John Kitzhaber, knew exactly what his mother’s decision meant. He was not only a governor, a Democrat who served two terms in Oregon as it tried to show the world that a state could give health care to most of its citizens, but a doctor himself.

At age 88, with a weak heart, and tests that showed she most likely had cancer, Annabel chose to go home, walking away from the medical-industrial complex.

“The whole focus had been centered on her illness and her aging,” said Kitzhaber. “But both she and my father let go that part of their lives that they could not control and instead began to focus on what they could control: the joys and blessings of their marriage.”

She died at home, four months after the decision, surrounded by those she loved. Her husband died eight months later.

The story of Annabel and Albert Kitzhaber is no more remarkable than a grove of ancient maple trees blushing gold in the early autumn, a moment in a life cycle. But for reasons both cynical and clinical, the American political debate on health care treats end-of-life care like a contagion — an unspeakable one at that.

Kitzhaber, having seen the absurdities of the system — Medicare would pay hundreds of thousands for continuing treatments but not $18 an hour for an in-home caregiver to help her die as she chose — was among the thousands of us who were distressed to see the debate get sidetracked by misinformation and outright lies. He knows the truth: that changing the way we treat dying people is the only way real economies and compassionate reform will happen. He is not only a politician, currently running for a third term as governor of Oregon, the state that has shown us the way, but a physician. And he’s smack in the middle of the Baby Boomer generation. Egan cites the recent Newsweek cover article by Evan Thomas, “The Case for Killing Granny,” and its on-target line about this being the elephant in the room, “Everybody sees it, but nobody wants to talk about it.

John Kitzhaber, M.D., politician, and son who watched both parents die in a dignified way, cannot stop talking about it. His parents’ generation won the war, built the interstate highway system, cured polio, eradicated smallpox and created the two greatest social programs of the 20th century — Social Security and Medicare.

Now the baton has been passed to the Baby Boomers. But the hour is late, Kitzhaber says, with no answer to a pressing generational question: “What is our legacy?”

The Way We Die Now – Timothy Egan Blog – NYTimes.com.

Some Women's Views of Health Reform

First Lady Michelle Obama is making the news in support of her husband’s health plan, hoping to tap into the energies of one group who voted for Obama in large numbers: women. Reform is everyone’s concern, but in many ways it occupies a specific gender niche. As reported by Voice of America’s Kent Klein,

Mrs. Obama says health care reform is a women’s issue. “Women play a unique and increasingly significant role in our families.  We know the pain, because we are usually the ones dealing with it,” she said. The first lady spoke Friday to a gathering of women near the White House, and said the state of the U.S. health care system is unacceptable. “For two years on the campaign trail, this was what I heard from women:  That they were being crushed, crushed by the current structure of our health care.  Crushed,” she said.

A host of women’s groups, blogs, newsletters and web writers have also recently joined in. Posting in the National Women’s Law Center blog, Outreach Manager Thao Nguyen told the poignant story of hearing from a friend that she’d just married her long-time hesitant boyfriend. The marriage news was good news, but its terms took the joy out: having lost her job, it was the only way she could get health insurance.

Her point seemed so logical, but the entire idea was couched in such an insane reality I was simply speechless. Lucy is in her early 30s but she has a pre-existing condition so buying individual health insurance and the unfair, overpriced premiums that come with it was out of the question. Lucy has been living with Dan for 10 years, but unfortunately, he works for a company that doesn’t offer domestic partner benefits.

I couldn’t help but think: is this what our broken, unstable health care system means for millions of Americans around the country? As the economy continues to struggle, employers continue to shed jobs, and every day 14,000 more Americans wake up realizing that they are now uninsured and just one illness away from financial ruin. Are reluctant bachelors around the country going to put away their Megan Fox posters, cancel the “poker nights” (aka X-Box marathons we’re on to you), and start settling down?

My own run-in with healthcare weirdness is minor in comparison to most, but I still remember the shock. Making a routine call to renew the prescription for a bone-building drug I had taken for years to stave off osteoporosis, the message center person said she probably should warn me that rather than the $24 co-pay I’d been having per quarter my cost would now be $230. I do need these bones, but couldn’t see them worth $920 a year. I hung up and started drinking more milk. Had to get breast cancer, for which I now take a covered post- cancer drug which my oncologist prescribes… mainly to keep my bones healthy. Something is bizarre here.

Or maybe we women might bend the old macho adage a little: It’s broke, fix it.

VOA News – Michelle Obama Joins Health Reform Campaign.

Healthcare: Could We Get A Moral Commitment?

Is there a simple way to get universal healthcare in this country? In a word, yes. Or rather, in two words: moral commitment. If we were to make a moral commitment to what is, after all, only the fair, humane, equitable thing to do, author/reporter T. R. Reid told an audience at San Francisco’s Commonwealth Club today, there would be no problem.

Reid, a reporter for the Washington Post, documentary film maker and NPR commentator, was in town to promote his new book, “The Healing of America: A Global Quest for a Better, Cheaper and Fairer Health Care .” In it he tells the story of his journey around the world in the company of a painful shoulder, consultations about which were his introduction to personal encounters with health care systems of every sort. He also met with government representatives and policy makers across several continents.  It is an informative and highly readable (no pun intended, that’s just an appropriate adjective) book.

Reid outlined the four primary models of health care currently in existence on our small planet, each with different versions of who pays and who provides. In Britain’s socialized medicine model, health care is the government’s job and it does both. A “mirror image” of this plan is that put into place in Germany shortly after the country was established in the late 18th century, a “National Health System” in which the providers — doctors, clinics, etc. — are private but the payer — government — is public. Workers are covered through their employers. One advantage to both, Reid points out, is that everyone buys into preventive care. He told of British ads asking passersby if their feet hurt, and urging them to visit a podiatrist right away if so; “It’s free.” Or commercials featuring a coughing “Mum” and giving a phone number to call so a nurse may visit. “It’s free.” Each is aimed at diagnosing other illnesses early, and/or preventing the spread of disease.

The Canadian Medicare (that’s where Lyndon Johnson got the name for our elder care) system now copied by Australia, Taiwan and others would have had Reid waiting an long as a year for consultation and treatment of his shoulder. Although he proclaimed his pain to be a very present issue, it was not seen as an urgent need to the primary care doctor he consulted. It is this often extensive wait for non-urgent care that is most criticized (especially by Americans) about the Canadian system. But Reid got a Canadian answer to that. “We Canadians,” he was told, “don’t mind waiting, as long as rich Canadians have to wait as long as poor Canadians.”

The fourth model cited is the out-of-pocket model, which Reid illustrated with a story of climbing a mountain in Nepal to seek shoulder relief. At the top of the mountain, in an extremely simple one-room building with its four walls painted in four different colors, the doctor explained his payment was generally in whatever the patient could afford. Someone relatively well off might pay in funds, others in whatever they had. Many of the patients could pay only by painting the facility, the doctor said; they seldom had the same color of paint, and thus the many-hued room.

“We have them all,” Reid told a hushed audience: Native Americans and veterans have the British/NHS; over-65, the Canadian Medicare; working people, Germany’s system. But 40+ million Americans have medical care equivalent to Afghanistan or Angola, and tens of thousands of Americans die every year because they cannot afford medical care.

One audience member called Reid on that issue, saying hospitals were required to treat people who came to them, but he was not backing down. True, he replied, if someone is actively dying or about to give birth, hospitals cannot turn him or her away. But for cases (such as one cited at the beginning of The Healing of America) of lupus, or diabetes, or in countless other instances, the inability to pay for necessary care causes ongoing pain and death for thousands.

Other audience questions raised the illegal immigrant issue. In most countries, it simply would not be an issue, he said. Citing Britain as an example, he said “you get (care) whether you’re a citizen or not.” Reid also said the public option is a non-issue elsewhere, because “you don’t need it.” And he threw in another few illustrations that argue for reform: In Britain, you have to cover everyone, you have to pay every claim, and you have to pay every claim fast. In Switzerland, if a claim is not paid within five days, the next month’s premium is free. In Germany you have a choice of well over 100 insurance companies; if you don’t like one, you simply switch to another.

Having set out to answer the question of how other countries provide health care for all of their citizens, Reid said he then turned to the why. Why every other wealthy, industrialized, developed country in the world has universal coverage and the U.S. does not. Others have it, he said, because “they think it’s fairer, equitable, humane, just — and these are moral issues. Health care reflects a country’s moral values.”

It was clear that Reid, like most in his audience, sees the U.S. as having moral values. “If we had the political will,” he commented, “other countries could show us the way.”

But the author was pessimistic about the possibility of universal care coming out of the current reform efforts. Asked how it might somehow come to the U.S., he said it could well be the way Canada’s plan came about; “we might get it state by state.” The Californians listening might have taken heart. Twice that state has passed single payer plans, only to have them vetoed by their governor. Reid suggested that other states might also be ready to implement statewide health coverage.

As to his painful shoulder, its current status was not given. Presumably, it will be necessary to read the book to find out.

Health Reform Geezer Gap

At least one more old geezer — we are legion — is fed up with the Medicare generation getting all the blame for opposing health reform. James Ridgeway writes in his Unsilent Generation blog today that

This health reform debate is about substituting a phony intergenerational war for what ought to be class war – pitting the old against the young, instead of pitting the rich against the poor, or the corporations against the little guy. There WILL be cuts to Medicare, and everyone says this has to happen to keep Medicare from going bankrupt before younger people get to use it. But in fact, if pols were willing to cut the profits of insurance and drug companies, there would be enough for everyone–we could have Medicare for all.

Which does certainly cut to the chase. Ridgeway cites his own earlier writing that applied Dean Baker’s chutzpah definition to today’s economy.

The classic definition of “chutzpah” is the kid who kills both of his parents and then begs for mercy because he is an orphan. The Wall Street crew are out to top this. After wrecking the economy with their convoluted finances, and tapping the US Treasury for trillions in bail-out bucks, they now want to cut Social Security and Medicare because we don’t have the money.

I am still with President Obama on paying for reform through elimination of waste and fraud, though that’s obviously not going to happen overnight and not going to pay for it all by a long shot. But Medicare’s going to survive, as will most Medicare recipients although we are all terminal. The moments of truth will come when the bargaining is over and we learn what the trade-offs really cost. That is, whether Big Pharma and insurance industry negotiations trump the public option, and other details still near and dear to many hearts.

So many trillions, so many sectors looking to save their own skins — or their own trillions, as the case may be — can boggle the mind quickly enough to send Jane Q. Public desperately in search of simplification, and blaming a generation is easy. The Medicares don’t want to lose their benefits, the Boomers worry that there won’t be enough for them (a legitimate worry, in fact) and the people who need health care get lost in the shuffle. Ridgeway fills in a lot of blanks. Check it out.

Hospital Safety 101: Didn't Mom Teach You to Wash Your Hands?

San Francisco Chronicle Washington Bureau writer Carolyn Lochhead reported today on a new idea somebody had about making hospitals safer: get folks to wash their hands. Hello?

The president of a leading medical standards organization announced a new program Thursday that is designed to improve health care safety practices, starting with a rigorous approach toward hand-washing by hospital staffers.

And this is serious business.

Hand-washing failures contribute to infections linked to health care that kill almost 100,000 Americans a year and cost U.S. hospitals $4 billion to $29 billion a year to combat, said Dr. Mark Chassin, who leads the Joint Commission, which sets standards and accredits hospitals and health care organizations.

Chassin’s announcement came after Hearst Newspapers published the results of an investigation, “Dead by Mistake,” which reported that 247 people die every day in the United States from infections contracted in hospitals.

Anyone who has ever come home from surgery with an infection, or more specifically anyone whose spouse has come home from surgery with an infection (nasty-wound-tending not having been fully explained in those for-better-or-for-worse lines) will applaud the new program, but it’s hard not to wonder what has taken the medical profession so long. Hospitals have found, Lochhead reports, that “caregivers washed their hands less than 50 percent of the time when they should.”

If there’s ever been a good example of potential savings to pay for universal health care, this is one to top the list. Consumers, we who would do well to wash our own hands when visiting or inhabiting hospitals, owe a debt of gratitude to the Joint Commission (and to Hearst Newspapers for the excellent ‘Dead by Mistake’ series.)

Maybe more sinks will be adorned with the sign that gave my husband and me a healthy chuckle during a recent visit to the Kaiser emergency room:

“Hand-wash unto others” it read, “as you would have them hand-wash unto you.”


Hospitals urged to strictly enforce hand-washing.

Public Option: the Single Payer Salve

Single payer proponents are still stung by the loss of their big issue to other big issues — or big players, if you will — but the prospect of a strong public option is the balm that may still salve that wound. This was one of the messages delivered by Giorgio Piccagli, President of the California Public Health Association, North and member of the Executive Board of the American Public Health Association at a panel discussion tonight sponsored jointly by OWL of San Francisco (The Voice of Midlife and Older Women) and the League of Women Voters of San Francisco. Audience members were urged to fight, among other things, for retention of the provision which would allow states to have single payer. (A California single payer bill passed the Senate Health Committee this spring and will be heard by the full Senate in 2010.)

Fellow panelist Debbie LeVeen echoed the call, saying a “robust public plan” must be national, to insure it’s large enough, must have authority to set prices and to bargain on drugs, and use the Medicare provider network.

Backing his call for reform with increasingly heard data such as sobering figures about uninsured Americans (45 million uninsured and another 50 million under-insured, for a total of about 1 in 3 of us) Piccagli said the lessons of the past 40 years include the fact that classical economics of supply and demand do not apply to health care: increasing the number of doctors, or competition among hospitals, only results in rising costs.

If the energies formerly tied to single payer can be channeled into a push for a public option some feel a viable reform bill will emerge. The San Francisco audience, many of whom were fervent proponents of single payer (which was endorsed by both OWL and the League of Women Voters) and most of whom are seasoned activists, left the room armed with cards to send appropriate legislators and plenty of ammunition to support their call now for a public option.

Said the third panelist, Co-Director of the Center for Policy Analysis Ellen Shaffer, about prospects for a robust public plan, “I think it’s up to us.”