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General interest/Health/Money/Politics & Causes/USA

September 2, 2009

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.”

General interest

August 31, 2009

What to do about Mom?

by Fran Johns

My friend Joan is distressed about her mother. Joan – that’s an alias, we both value her privacy – lives quite near her parents, visits regularly, helps out with finances, health issues and everyday needs. They are in their late eighties. Other siblings live in other states. Until recently everything was fine; now the parents are in separate areas of their assisted living residence, Joan’s mother is in frequent despair and need. What’s a daughter to do?

This story is being repeated thousands of times every day across the country. Only this story has a peculiar twist: Joan’s parents did everything right. They lived frugally, planned ahead, raised their children to be successful and independent, moved early into a retirement community which offers care through illnesses minor and terminal. With Joan’s help they kept their affairs in order, including updated advance directives. (You don’t have your advance directives done? Horrors. Let me know and I will be at your door, cyberspacially speaking, to walk you through them immediately.) Joan’s parents were among early advocates for advance planning and end-of-life choice.

Joan comments: “Frankly, Mother is tired of being alive. She’s not depressed, just ‘finished’, especially as she sees these slow declines in her quality of life as a steady and inevitable progression. Her greatest desire would be to have a massive stroke and not survive. But then her greatest nightmare would be to have a stroke and live . . . Even with the best advanced directives reflecting her choices, that’s a fine line to navigate.”

The moral of this story is that no amount of planning and preparation can guarantee the kinds of last months and years we might want. My own mother died peacefully at home, followed 20 years later by my father, same story. But that was in 1967 and 1987, in the small town of Ashland, Virginia where they had lived since 1939. The town looked after them; their out-of-state daughters merely visited and counted their blessings. Towns and neighborhoods like Ashland are in diminishing supply.

But all is not gloom and doom; this writer is constitutionally unable to write doom and gloom. Joan is at least clear about her parents’ wishes, and her parents have good care plus all allowable precautions: DNR orders, POLST forms, understandings with their medical professionals. Most of these are possible for today’s Boomers and their Beyonder parents; if you can’t find them I’ll happily tell you how. Joan’s parents are also in housing of their choice. And those choices are many: co-housing, retirement communities, assisted living facilities, many of them available to middle and low income Americans. Anyone over 50 who thinks he or she should postpone considering all of these issues, documents and choices until next year is delusional. Essays re housing choices have appeared in earlier Boomers and Beyond posts; others will follow. The secondary moral of this story is that without planning, late years can quickly turn into hell for elderly parents and adult children alike.

What we don’t have, of course, is health care such as Joan’s parents still enjoy for others who need it. The thing is, we can.

Politics & Causes

August 20, 2009July 24, 2010

Pelosi Sticks With Public Option

by Fran Johns

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

August 20, 2009

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

August 19, 2009

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

August 18, 2009

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

August 11, 2009

Straight Talk Q&A on Health Reform

by Fran Johns

One of the best fact-checks re health reform I’ve seen lately was just sent out by Ricardo Alonso-Zalvidar for the Associated Press:

Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a “death panel.” Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar would instead authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes. Here are some questions and answers on the controversy:

Q: Does the health care bill promote “mercy killing,” or euthanasia?

A: No.

Q: Then what’s all the fuss about?

And here’s where it all started:

A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

Alonso-Zaldivar covers all the basics in this brief, to-the-point article. My personal favorite opinion is also in there. It’s a comment made by Monsignor Charles Fahey, 76, a Catholic priest currently chairman of the board of the National Council on Aging:

“What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini – then let me go.”

Maybe we should put that martini provision in the bill.

via Health care overhaul bill Q&A.

General interest/Health/Politics & Causes/USA

August 10, 2009

Justice Souter's Retirement Housing

by Fran Johns

It turns out not even Supreme Court justices are exempt from the dilemmas of senior housing. Too many steps? Too many books? What’s a retiree to do?

When he retired from the Supreme Court in June, it was expected that Justice David H. Souter would return to his beloved family farmhouse in Weare, N.H., a rustic abode with peeling brown paint, rotting beams and plenty of the solitude he desired. While the new home is only eight miles from his rustic farmhouse, the two could be worlds apart.

But Justice Souter, an individualist on and off the bench, decided to move.

On July 30, he bought a 3,448-square-foot Cape Cod-style home in neighboring Hopkinton listed at $549,000. The single-floor home, for which he paid a reported $510,000, sits on 2.36 well-manicured acres.

This is not going to work for the downsizers who don’t have access to a cheap, reliable lawn service. But it’s easy to pinpoint a few of Justice Souter’s upgrades in the downsize:

The farmhouse has no phone lines; the Hopkinton house has “multiple,” according to the real estate listing. The farmhouse’s lawn was spotted with brown; the Hopkinton house has a verdant lawn and neatly trimmed hedges. And for Justice Souter, 69, who is known to be a fitness buff, there is a home gym as well as a spa bath.

Or, he can just mow his own lawn. The core issue, however, is closer to those reported by hundreds who are opting for retirement apartments, urban condos and other housing choices mentioned in earlier columns.

Justice Souter told a Weare neighbor, Jimmy Gilman, that the two-story farmhouse was not structurally sound enough to support the thousands of books he owns, according to The Concord Monitor, and that he wished to live on one level.

Perhaps Justice Sotomayor will want to keep a lid on her library shelves.

Off the Bench, Souter Leaves Farmhouse Behind – NYTimes.com.