New Orleans  

Spokespeople and statements for Komen claimed that they had created a new policy rule which disqualified Planned Parenthood:

A spokeswoman for the Komen foundation, Leslie Aun, told The Associated Press that the main factor in the decision was a new rule adopted by Komen that prohibits grants to organizations being investigated by local, state or federal authorities. Ms. Aun told The A.P. that Planned Parenthood was therefore disqualified from financing because of an inquiry being conducted by Representative Cliff Stearns, Republican of Florida, who is looking at how Planned Parenthood spends and reports its money.

On its face the so-called “rule” is ridiculous.  Virtually any organization at any time anywhere within this definition could be experiencing some kind of investigation “by local, state or federal authorities.”  Think about it.  The simplest charge before the EEOC, NLRB, DOL Wage and Hour Division, EPA, or OSHA, as well as any of the various levels of health departments required to do routine inspections and certifications of clinics, and on and on and on all could be used to claim a disqualification of an agency from support by the Komen Foundation.  Frankly, when the IRS routinely investigates the tax exempt status of Komen, technically, they shouldn’t be able to fund themselves.

The whole notion of such a rule is absurd, which inevitably lends credibility to PPA’s President and CEO Cecile Richards’ claim that they folded like a cheap skirt because of “bullying by right wing groups.”  Who will do the breast exams for poor women and others offered by Planned Parenthood under this assault?   No one, not that Komen seems to care.  The Komen operation’s sister whose own cancer supposedly inspired the organization of this pink parade would be rolling over, unfortunately, in her grave!

Further the Times seems to have a lead on the “smoking gun” leading to this attack:

…in December, LifeWay Christian Resources, which is owned by the Southern Baptist Convention, said it was recalling a pink Bible it was selling at Walmart and other stores because a dollar per copy was going to the Komen foundation and the foundation supported Planned Parenthood.

This is hateration pure and simple.

Thank goodness for Cecile standing up and shouting out.  $700,000 plus won’t cripple Planned Parenthood, but on the other hand this decision should point all of the rest of us who care about health needs and the tragedy of breast cancer some other direction than the Komen Foundation if we really care about women.

New Orleans

Unfortunately, despite the rave reviews one could feel the double edged knife of the coming health care regime sending contradictory messages about care for at risk populations.  On one hand these programs are being driven by an emerging Medicare rule that will bar reimbursement for any hospital readmission within 30 days of a discharge if it is established to have occurred from “a preventable repeat of the previous diagnosis.”  On the other hand existing rules only allow reimbursement if a paramedic actually gives someone a ride to the emergency facility.  The bottom line is that preventive care extends life, most importantly, and saves money, which is also very important, but all of the bean counters know that having the paramedics out there in the community is unpaid in the sense of unreimbursed.

In such a situation how many cities and counties are really going to take this very important and much needed step in preventive care?  Damned few, I’ll wager, unless this cash flow is right sized.

New Orleans

“Federal law says Medicaid rates must be ‘sufficient to enlist enough providers’ so that Medicaid beneficiaries have access to care to the same extent as the general population in the area.”

In other words the law is clear that you cannot discriminate in health care coverage, the decisions of life and death, against the poor.
The Obama Administration, seeking the cowards’ cave, argues that enforcement of that unambiguous standard should be the “exclusive responsibility” of federal health officials.  The Congressional caucus and anyone else caring two cents about the 55,000,000 who are covered under Medicaid, know that the feds simply do not have the resources or bureaucracy to police all of the standards in 50 states down to the nap, so they want poor people to be able to sue California and others when they are chumped and cheaped out.  In past presidential administrations such lawsuits were not greeted with universal cheer, but they were recognized as having a vital role in securing the standards of health care and protecting the poor.
What is the political equation which makes it acceptable for the Obama Administration to aid and abet discrimination against the poor and encourage by passivity killing them with neglect?

New Orleans

Ezekiel Emanuel, a doctor, former White House advisor, and about to be UPenn professor was attention getting in his own way noting:

“Of the 34 generic cancer drugs on the market, as of this month, 14 were in short supply. They include drugs that are the mainstay of treatment regimens used to cure leukemia, lymphoma and testicular cancer. As Dr. Michael Link, the president of the American Society of Clinical Oncology, recently told me, ‘If you are a pediatric oncologist, you know how to cure 70 to 80 percent of patients. But without these drugs you are out of business.’”

Get this:  people are dying because they can’t get cheaper druges!

Emanuel argues that ending the doctor/drug scam of “buy and bill,” where docs passed on all costs without concern or conscience to Medicare forcing Congressional reform through the Medicare Prescription Drug, Improvement and Modernization Act under George W. Bush in 2003 led to this problem.  When effective drugs went generic accompanied by price falls of up to 90%, manufacturers were forced to go with the “average selling price” plus 6% for handling, so greed being what it is, moved on to greener more lucrative pastures leaving people dying behind them.  You just know that when there is a scarcity and Medicare is involved that it is the poor who are inevitably experiencing the brunt of this shortage, though Emanuel does not make that point.

The point he does make though is somewhat disturbing though:

“You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable. Most of Europe, where brand-name drugs are cheaper than in the United States, while generics are slightly more expensive, has no shortage of these cancer drugs.”

Well, uh, actually you do have to be a “cynical capitalist,” I’m afraid and certainly not a medical ethicist, as Emanuel is now pretending to be.  His recommendation:  let them charge the average selling price plus a 30% profit margin.  I think this is precisely what “cynical capitalists” would advance:  a guaranteed cost plus contract by the government!

But, no, he gets even more cynical than this.  Emanuel proposes an even more “radical” solution:  “take Medicare out of the generic cancer drug business entirely.”  His plan is that Medicare would stop paying for generics and they would then be covered by a “private pharmacy plan.”  Who exactly can afford supplemental drug plans?  Categorically not the poor!  This guy is going to teach medical ethics?  Preposterous!!

Here’s a more radical solution.  Let the government create a cheap and forgivable loan program to allow potential drug manufacturers willing to live on average selling price plus 6% to supply the market.  That’s a real jobs program, and there are few communities who wouldn’t love to have the relatively environmentally safe and sound drug manufacturing work.

Or if you want to be more radical, let the government itself start manufacturing generics to save lives of the poor and any of the folks Emanuel cares about.  Ironically, it would even save money by reducing the cost of cancer care reimbursed by Medicare, thereby creating a win-win solution.

But, now I’m sounding like a cynical capitalist, I suppose.

New Orleans

A study “The Oregon Health Insurance Experiment: Evidence from the First Year,” by a baseball team full of academics (Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, The Oregon Health Study Group) was published by the National Bureau of Economic Research this week and reported by Gina Kolata in the New York Times. In 2008 the professors jumped on the once-in-a-lifetime policy disaster and statistical goldmine.  Oregon had approved a statewide healthcare Medicaid plan for low income families but did not have the dollars to put the whole show on the road.  In a novel, random solution, the state held a lottery and chose the 10,000 winners, who received the insurance, from the 80000 odd folks who were eligible and therefore equally poor.  The profs then surveyed the winners and measured the outcomes compared to the losers.  It is important to note that Oregon was able to provide insurance to everyone in 2009.

According to the Times:

“Those with Medicaid were 34 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital.   Women …were 60 percent more likely to have mammograms…20 percent more likely to have their cholesterol checked…70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.”

There was also a 25% increase in the numbers who said their health had improved to good or excellent, and “they were 40 percent less likely to say their health had worsened….”

Bam!  Debate over about the benefits of the poor having full health coverage is over!  Yes, people will use it, get better, feel better, and have less medical debt.

Couple this study with the finding I discussed yesterday on the number of people killed annually by inequitable access to services, including health, and this ought to be open and shut on what is indisputably a life-and-death decision.

Who’s ready to have their vote counted now?

“Approximately 245000 deaths in the United States in 2000 were attributable to low education, 176000 to racial segregation, 162000 to low social support, 133000 to individual-level poverty, 119000 to income inequality, and 39000 to area-level poverty.”

That’s 874000 people dying per year directly due to social issues.   400,000 people in the same kind of studies have deaths attributable to smoking.  300,000 annually die from factors attributable to obesity.  193,000 die of heart attacks.  Those three recognized causes to death cumulatively are equivalent to what essentially poverty, inequity, and injustice are flat-dead killing.  In the vast majority of situations these are things our society could solve if we choose to do so.

Much of this comes down to the question of equity.  The inability to make sure that there are equitable educational opportunities, health access, basic community services, support for children, elderly, differently able, and the mentally unstable, stress, unhealthy behavior and diet, and the list goes on, and there’s no pretending anymore, if nothing is done, it kills people.  Lots of people!  874000 deaths in 2000 might be over a 1,000,000 deaths today!
These figures are almost too hot to handle.  Thanks to Nicholas Bakalar and the New York Times we found the story buried in the Science Section under a mamby-pamby headline:  “Researchers Link Deaths to Social Ills.”  As they say in organizing, Bakalar even “swallowed the ask.”  He didn’t even mention the 874000 deaths.   Reading the Times article, I – and all other readers – thought it was shocking because Dr. Galea was quoted saying “… if 291,000 deaths are due to poverty and income inequality then those things matter, too.”   Well, yeah!  But, all Galea was doing was aggregating the last three of the six factors, income inequality, individual and area-poverty for a subtotal of 291K.  The whole story was almost three times as shocking, but you wouldn’t know unless you followed the Times back to the webpage for the American Journal of Public Health.
We have to stop running from all of this and face the facts that we are a society willing to allow the rich, essentially to get away with murder, and tolerate almost a million deaths of the poor annually because of our unwillingness or inability to force America to live up to its promise and ideals about equity for all.  We have always known that poverty was killing people.  Now, thanks to the work of Dr. Galea and others, we are going to be able to put a pretty tight number on how many die every year because of our inability to right these wrongs as a people.

New Orleans

I am equally suspicious of doctors that display, advertise, and then recommend, i.e. prescribe, supplements and vitamins in their offices as part of treatment and care in order to fatten their pocketbooks even though there may be cheaper and generic alternatives.  When I hear that such doctors are not processing insurance claims for their patients to me that is a neon flashing warning light that these are pocketbook doctors rather than medical doctors and the only pain they are alleviating is whatever you may have had by sitting on a wallet with too many dollar bills.  They clearly know that their “vitamins” will not be covered by insurance nor is it likely that most of their care will be, and they are therefore simply involving themselves in predatory practices on their desperate patients.   Perhaps that example is too easy to stop, but the point is that no one is really regulating doctors now but their own medical boards and that is no regulation at all.

There have long been warning signs on doctor owned and investor owned hospitals and whether or not they are within miles of the Hippocratic Oath of “doing no harm,” especially when it comes to separating out the patient’s best interest from the doctor’s self-interest.  The problem remains that doctors are making the referrals to hospitals where they practice, so the patient becomes a “captive market” and anytime that happens, abuses are going to proliferate.

Even as future healthcare is being debated, there’s no reason for the Senators, feds, and states not to step up and do the jobs they should be doing of providing some public accountability and protecting the public from health care predators wearing white coats.  It’s a life or death matter!

Toronto

This would seem to be an “ah ha!” moment, it seems so obvious.   In union organizing and administration it has long been an understood fact in the tension between organizing model and service model unions that the same rough distribution of resources, if not more, are true in membership maintenance:  1% of the members require 30 to 50% of the contract administration and grievance handling resources.  In community organizing among lower income families I was introduced to the insights about “multi-problem” families virtually from the day I hit my first doors with welfare rights in Springfield, Massachusetts.  I would run into other organizers in Boston who had gone to social work schools and they would joke about it all the time in a general way before computers allowed any of us to understand what such families said about gridlocks in resource and personnel distribution.  Inevitably changing such patterns caused huge conflict, because inexperienced organizers would get drawn into virtually personal service relationships with particular members or leaders, which might have seemed a good idea to them when they were trying to win trust “on the cheap,” but always caused conflict when more real organizing programs more equitably distributed staffing to goals and membership production, rather than individual leader or member service.  My memory of “firing” a volunteer when I began in Arkansas, upon realizing he had become little more than the chauffeur, lender, and problem solver for one old leader, made it possible to work with everyone, but was something the “leader” never forgave me for!

The community organizing opportunity around health issues here is also obvious.  Gawande tells several stories where the data led health care folks to sets of buildings where the 1% usually lived right down to the point where it was possible to identify the top couple of buildings that generated costs that could run to $60,000 per resident annually.  Stepping back there are few community organizers without computers who couldn’t identify the likely medical hot spots just from shoe leather already exhausted over the years.  Even union organizers who have done a lot of house visits know the areas where on every drive of lower waged workers you always have 5 to 10 visits, because of section 8 congregations, low rents, no deposit policies, and so forth in some complexes.  A couple of senior high rises quickly come to mind in different cities.  And, if we didn’t already know, it wouldn’t take but a couple of hours standing in front of any public hospital and talking to ambulance drivers or doctor shuttle drivers for them to tell you where they do the bulk of their business.

So why would we care?  We don’t necessarily gain immediately from cost reductions in the way the hospitals or health plans might, but that’s only half of the equation.  Forcing hospitals and health plans to adopt targeted programs delivers better health care and organizing the residents of the health care hot spots to demand such a program would create tangible results in terms of increased medical and related social services delivered on the spot.  In one case Gawande wrote of a building where a hospital located an on-the-spot clinic for example.  People might not be willing to organize to live longer and better, but we could definitely organize them to demand – and win – more and better health care services.

And, that’s not all.  It turns out, if Gawande, is right about where health care may be going, our very organizing could move the needle on which hospitals survive and which die, based on their attentiveness to our demands in this area.  He writes about the experience of Denmark’s health care system which has already retooled along cost and capacity terms, leading to a downsizing of institutions which might have as few as 25% surviving when the shakeout is finished for “industrial health care.”  It is clear that this is the basic incentive for the hospital administrator in Atlantic City.  He wants to end up as one of the survivors.

For the campaign targets that “get it,” our winning could mean their survival, and targets that move to partners will mean that effective organizing allows us to leverage more community benefits.

It would be nice if we could win simply with the argument of saving lives, but the stories of doctor pushback in the article are also instructive.  There are a lot of folks who are benefiting now because they get paid well to manage a broken system.  Organizing in this way around health care with a localized focus, we could not only change the system, benefit our community, create more equity, but also save lives.   What a win!

This is a campaign calling out to all organizers