Where You Live Could Kill You Faster

SSM Population Health

SSM Population Health  Age-standardized annual probability of death among U.S.-born women aged 45–89 years.

New Orleans    Many of us live where we live, where work has brought us, or where family keeps us. Maybe we live where we have come to love the land or the local culture? Maybe we live where we managed to hang on to a house or bought a small piece in a patch where we thought we might want to spend lots of time someday or some summer when it was too hot, or winter when it was too cool. None of us probably include in the equation that by living one place or another we could literally be bringing reality to the expression, “I’m dying to live there!”

Sadly, studies are now emerging that go to the heart of why life expectancy has been lagging, particularly for American women, although American men are not gaining much time these days either. Looking at extensive population data, researchers are finding that discounting all other factors including wealth, employment, and marital status, where women live could mean life and death. Since where you live could also impact on issues like whether or not your state has favorable maternity and parental leave policies, this hits women particularly hard, and could take years off their lives. Social and economic scores were critical because advancing inequity where you live also is not just an issue of justice, but life itself.

In studies being published in SSM Population Health and reported by the New York Times, the residential life lottery ranks the states with the best scores as Hawaii, Nebraska, New Hampshire, North Dakota, South Dakota, and Vermont. Good news for them, but bad news for many of the rest of us, since other than Hawaii almost nobody lives in the other states on that list, and even fewer want to move there for goodness sakes. Other than Hawaii, these are also just about lily white states, which quickly brings us to the states with the worst scores and you can hear the sounds of “Dixie” playing in the background: Alabama, Florida, Louisiana, Mississippi, and New York. Huge income inequality accounts for New York being part of the New South. For women, the list was not much different. The best were Hawaii, Nebraska, North and South Dakota, and Minnesota made this list as well. Women hit hard luck in a different array of states though which included Nevada, Tennessee, Virginia, West Virginia, and Wyoming.

All of this is in spite of the creation of Medicaid and Medicare over the last 50 years, and even more recently the Affordable Care Act. Looking at the states in-and-out of Medicaid expansion didn’t solve the problem. In the worst list, only New York had expanded coverage until Louisiana just came onto the list. In the best, South Dakota and Nebraska rank high, but haven’t expanded while Nevada and West Virginia drag down even though they have.

All of which means there is no quick fix to this. It’s not a matter of just figuring out where the best hospital in your community might be. It’s got to be the pretty much the whole package of social and economic improvements to lengthen lives of both men and women.

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Obamacare is Delivering Some of the Goods in Poor States

Screen Shot 2016-08-14 at 10.37.59 AMNew Orleans   There are now some thirty states that have expanded eligibility for Medicaid under the Affordable Care Act. There are twenty states – and a lot of the Republican Congress — that are still dragging their wagons through the dirt, and, if researchers are right, putting their people under the ground as well.

Researchers connected with Harvard’s Public Health School conducted an important experiment. They surveyed people in Kentucky and Arkansas before Medicaid expansion in 2013, again after the first full year in 2014, and finally at the end of 2015 with another year under peoples’ belts. They used Texas as the so-called control state for comparison, since Texas refused to budge on the Obamacare Medicaid expansion for lower-income, working families. Bottom line: 5% more people in Arkansas and Kentucky, too very different states with different approaches on the expansion, felt that they were in “excellent” health compared to do-nothing-much Texas.

Reading about the researchers work on the Harvard Public Health website and its lead author, Dr. Benjamin Sommers, an assistant professor there, offered a good summary that goes deeper than 5%:

Sommers and colleagues surveyed approximately 9,000 low-income adults in Arkansas, Kentucky, and Texas from late 2013 to the end of 2015. The results showed that, between 2013 and 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with a much smaller change in Texas (39% to 32%). Expansion also was associated with significantly increased access to primary care, improved affordability of medications, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among people with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the number of adults reporting excellent health.

Debate over? Of course not. Many will wonder, and wait, until larger studies, including the government’s own, provide more data on whether or not people really are healthier or just feel healthier.

Regardless, how people feel may not answer the medical questions fully, but could start to provide answers for the political questions. As we find every day, particularly in the Age of Trump, people vote on how they feel, not based on the facts of the matter. If everything were equal, politicians would see that the trend line of how people feel about their own health and Medicaid expansion is now improving annually. If it continues along these lines, politicians will start playing “duck and cover” which might mean more expansion in the twenty holdout states.

There’s a big “if” though. These same politicians would actually have to care about the poor families that are the beneficiaries of Medicaid expansion, and believe, regardless of the evidence, that they vote, and that some of these poor are their voters.

It might be easier to deliver better healthcare than to convince elected officials of the value of the poor and their votes.

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Dutch Fight to Take Health Care Away from Private Insurers

Holland-plus-medicalBrussels   What is the old saying? Something like, I’ve seen the future and it is in the Netherlands at least when we are talking about the inevitable fight to come someday in the United States to seize control of our national health care programs from big health care insurers. On the way between Germany and Belgium, I had the opportunity to meet with several organizers and campaigners who have built a powerful effort in Holland on this issue and are finding the response amazing with the potential to dominate the campaigns in the country’s elections in the spring of 2017.

If you were paying close attention during the health care debates in recent years over the Affordable Care Act or Obamacare, as it is known popularly, you often heard about the health care insurance scheme in the Netherlands which was better in its broad coverage of the population but, unlike many other countries, was provided by private, rather than public, insurers. Meeting with the organizers, I came to understand the situation a bit better. Everyone pays the equivalent of about one-hundred euros or $112 per month to private companies for insurance. I was fuzzy on exactly how this part works but the fact that they mentioned that much of the Dutch public’s opposition was rooted in disgust at the millions and millions spent by the insurers in advertising and promotion leads me to believe that a family chooses an insurer for their coverage.

There’s also a hammer to the head in this program along the lines of the deductibles that come under Obamacare. Everyone has coverage and everyone pays, but when they actually use the insurance, they have to come up with another 385 euros or $429. For some reason it is called an “own risk” payment, since if you don’t need to buy medicine or go to the doctor, your monthly payments are more like a healthcare tax or donation, so that when you do utilize the system, this is more like an admissions fee. Similar to the US experience with high deductibles blocking utilization under Obamacare, estimates are that 20% of the Dutch people are avoiding accessing the healthcare system, even when they need it, because they cannot afford the additional payment.

So the campaign is seeking to get rid of that payment of course, but also to move to a national healthcare fund more along the lines of the national healthcare program enjoyed by other countries. The support for their campaign has surpassed all expectations, and that’s part of what brought us together in this exciting conversation. In less than two months about 60,000 people have signed up to support the campaign either online or directly, and, amazingly, almost half of them are taking the additional step of asking for an “action” package on steps they can take in their communities to build the campaign.

With elections happening in mid-March of next year, this campaign couldn’t have been timed any better, so if it continues to build momentum in the summer, this could be the issue that dominates progressive debate at every level during the election. Meanwhile, regional meetings throughout the country are also pulling in crowds double, triple, and quadruple of organizers’ expectations, more are set coming off the summer with big demonstrations and other actions planned in the fall. They are riding the whirlwind here, and while they are doing so, as I said earlier, they are running the pilot program that organizers in the United States and elsewhere will need to be studying and copying in order to deal with many of the same issues involving national – and better – healthcare in our countries.

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Is Their Hope for Obamacare?

77639392New Orleans     A federal court somewhere gave new hope to the haters that the subsidies the Affordable Care Act to lower income families might be blocked.  The Administration says they will win on appeal.  But, this is only one cloud of many in the building thunderstorm.

            Insurance companies and those that follow them are almost universally saying that there will be significant price hikes in 2017.  Others are dropping by the wayside, largely because of their own bad pricing and marketing decisions, but nothing keeps them from finger pointing as they leave.  In many ways this was predictable.  As the signature legacy of President Obama, they are smart enough to wait until his long goodbye transitions into whatever and both he and Congress are lame ducks caught in a quacking stalemate, and roll up heavy on Clinton or Trump with the fait accompli

            Clinton has flirted towards the left with a vague proposal to potentially allow people 50 or 55 years of age to “buy into” Medicare, which would expand the coverage to millions more, if they have the money.  What it would still not do is solve any of the problems that continue to weigh heavily on Obamacare.

            Drug prices have continued to rise for example.  In fact, drug profiteering still seems a winning business plan despite the problems with Valeant and profiteers. 

            Charity requirements for nonprofits are still largely more pretense than policy.  Modern Healthcare reported 7 of the 10 most profitable hospitals of the top one-hundred in the country, according to a researcher at John Hopkins, were tax exempt nonprofits.  The three most profitable for profits were all part of the HCA chain and all three were in states like Texas and Florida that have not extended coverage under Obamacare.  Nonprofits were very well represented in the top 100, including Herman Memorial which has been the target of campaigns by Local 100 United Labor Unions and community allies in Houston and Ochsner, headquartered in New Orleans, which has also been called out for its miserly charity record.

            Emergency room doctors are reporting that half or more of the patients they are seeing are coming in late and with insurance, but had delayed seeking care because of the astronomical level of their deductibles, equivalent to having no insurance at all.   Employers of lower waged workers continue to develop such minimal coverage programs with impunity.  The coming year will see an even higher level of penalties appropriated against lower income workers who are running from the cost, deductibles, and copays, but will be caught by the mandated penalties.

            The bottom line is that, like any major piece of new potentially groundbreaking, safety net legislation there are problems.  There are pieces that beg to be fixed.  Meanwhile the deadlock in Congress simply lets the sores fester and pain endure without stepping up and fixing what is broken.  Health care continues to be a political football, as politicians maintain the fiction that this is all part of the game, rather than coming to terms with the fact that for many low and moderate income families, it’s life and death.

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Hillary: Forget the Young Women, Go for the Moms

Lucia McBath, left, mother of Jordan Davis, and Maria Hamilton, mother of Dontre Hamilton, react as Sybrina Fulton, mother of Trayvon Martin, talks about her son next to Democratic presidential candidate Hillary Clinton during a rally at the Central Baptist Church in Columbia, S.C. Image: Jacquelyn Martin/Associated Press Juana_summers By Juana Summers Feb 23, 2016

Lucia McBath, left, mother of Jordan Davis, and Maria Hamilton, mother of Dontre Hamilton, react as Sybrina Fulton, mother of Trayvon Martin, talks about her son next to Democratic presidential candidate Hillary Clinton during a rally at the Central Baptist Church in Columbia, S.C. Image: Jacquelyn Martin/Associated Press

New Orleans    Hillary Clinton is having well-documented problems appealing to young women. Backers like Gloria Steinem have been no help to her. She can talk about student loans and the need to get a woman elected, but where she’s getting traction, very cleverly, is with the “moms,” and if we were whispering advice in her ear, it would have to be: “do more of that, sister!”

Brilliantly, she seems to have reached out and courted African-American mothers of young men shot by police. The Times detailed her outreach, and it’s a textbook example of the advantage of a well-organized internal campaign organization and uber-professional campaign staffers. She sent them handwritten notes on Christmas cards about their losses. She followed up with other hand-written notes. She got some of them together for a 3-hour dinner in Chicago, and this wasn’t a Michelle Obama healthy sprouts special, this was old time, down home, Southern cooking, featuring pork chops, fried okra, and apple pie. She did what she does best as the every diligent, super-student in the room, listening and taking notes while they told their stories. She put them on the road together to appear at meetings and rallies, where she smartly introduces them to much better applause than she gets on her best lines. OK, sure the story was planted with the Times and pushed along and facilitated by the campaign, but that also proves my earlier point about how well organized and professional her campaign has the ability to be. Undoubtedly, this kind of outreach has been pure gold in sending her message, silently and with strength, to the African-American community. Who wants to see another grinning politician or wannabe, if you can stand in applause for sister in pain?

If something is working, why not do more of it? Hillary should double-down on the “mom” vote. Heck, they vote more than young women anyway, when push comes to shove.

But, why not do more and prove to the rest of us that you will be our standard bearer?

Why not argue more aggressively for family leave that means something? Not just some unpaid leave if you’re lucky enough to work for a big company, but real leave for pregnancy with support and pay for everyone?

Why is Clinton not making paid sick leave a bigger issue for working mothers – and fathers! There’s increasing support for such leave in statehouses and cities, why not carry that banner?

And, here’s the kicker? Isn’t it finally time to talk about universal daycare? The advantages are immense: job creation, more women in the workforce, less loss of working hours, earlier education of children, huge financial savings for families, reduced inequality, and just plain peace of mind. You want moms – and a heck of a lot of dads – then finally fix daycare and take it out of the shadows of always low-waged and often informal employment and create something that supports families and children. Moms would crowd the rallies and stand in line for a candidate really committed to delivering on this issue.

And, besides we should all whisper to Secretary Clinton, universal adequate and affordable daycare for children is a core feminist issue. Surprise yourself, go one-hundred percent for the moms, and see if positions like these, sincerely felt and strongly argued, don’t bring even young women to your side as well.

***

Please enjoy The Jayhawks’ Quiet Corners & Empty Spaces.  Thanks to KABF.

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Draining Bloated Drug Prices

Little Rock  Something big is happening among drug companies. They aren’t exactly on the run, but they are at least feeling the heat, so there may be hope for the rest of us.

Let’s look at how the evidence is starting to add up:

  • Turing Pharmaceuticals and its CEO have become the face of exploitation as he testifies before Congress on video screen from jail on stock manipulation charges after having become the picture of greed by upping the price of rare, minimally manufactured drugs for specific diseases by predatory multiples.
  • Valeant, a high flying drug company that assembled its meteoric rise by buying other companies and drugs in recent years has suffered an almost 50% meltdown of its value recently, pushed out its CEO and finance people for suspected earnings misstatements, and shattered the reputation of William Ackerman, a previously highflying private equity mogul who has also lost a fortune and has joined their board to try to stop the bleeding.
  • Anthem, the insurance company, is suing Express Scripts, the prescription drug middleman for $15 billion in damages in a huge pot-calling-the-kettle-black suit alleging that they violated their contract by piling on excessive charges through “unduly high pricing” and “an obscene profit windfall.” This is rich because usually when consumers buy drugs there is already a margin for the benefit manager larded into the price, so we’re really the ones paying. Anthem is charging that there is about $13 billion in such overcharges wrapped into the life of their contract. It’s little mystery that even though Anthem is crying like a stuck pig, the real victim here is the final customer: us!
  • Meanwhile giant drug purveyor, Lilly, is barking up one tree after another complaining about proposals from President Obama under the Affordable Care Act and others from Hillary Clinton and Bernie Sanders that would try to assign the research and development costs from the drug companies to specific drugs in order to rein in pricing. The company’s argument is that, hey, we spent almost $5 billion on R&D about 10% of all R&D spent in the pharmaceutical industry, and it wants us all to shut-up and accept their word rather than coming up with an assessment of drug-by-drug figures on their expenditures. Right, like they don’t do this in-house and already know, huh? They are the cause though that leads to this effect. If they didn’t arbitrarily inflate the costs of drugs against the desperate needs of the sick in their market, this wouldn’t be an issue. What goes around, comes around.

Ok, these are small signs often nestled in the business pages of local and national newspapers, but it’s spring, a season of renewed hope, so let’s take a deep breath and hope that these are real signs that finally a level of rationality may finally be imposed on the predatory pricing schemes of drugs that literally mean the difference between affording life or choosing death.

Facebooktwittergoogle_plusredditpinterestlinkedinmail