Thursday, March 28, 2013

Strike Debt Kicks Off Second Debt Buy-Up With March for Universal Healthcare

A coalition of groups associated with Occupy Wall Street took to the streets of midtown Manhattan on Thursday evening calling for the abolition of the for-profit health care system in the United States and the creation of a government-run single-payer system. Around 70 protesters marched to four major health insurance companies to list their grievances with each corporation, often by comparing what they see as the wildly disproportionate salaries of CEOs with health costs for regular patients or the company’s average worker’s salary.

The march was part of a larger project that Strike Debt (which formed from the creative churn of Occupy) is implementing over the week to draw attention to medical debt, which the group sees as a national emergency. Strike Debt also announced that its latest round of a project known as the Rolling Jubilee has bought and abolished over $1 million in medical debt.

Activists handed out fliers on the march with statistics on just how damaging medical debt can be to households: “62% of bankruptcies are linked to medical bills” was featured prominently on the flier, as well as on a banner at the front of the march. Also on the handout was perhaps an even more surprising number: “78% of those who declared medical bankruptcy had insurance at the time they became sick.”

Strike Debt’s mission is to politicize and organize around personal debt, often by arguing that debt is not a moral failing but rather a societal problem that needs to be addressed and resisted collectively. One of the tactics, called Rolling Jubilee, involves buying “debt for pennies on the dollar, but instead of collecting it, abolish[ing] it.” The group buys debt on the open market the same way a collection agency would, but cancels the debt instead of collecting it. Funding comes from donors who contribute to the group through its website.

The first Rolling Jubilee took place in November of last year and “abolished” more than $100,000 of medical debt. The People’s Bailout, as it was called on Twitter, culminated in a telethon at a New York City music venue and garnered unusually positive press for an Occupy-related action.

The second and latest Rolling Jubilee resulted in an even larger amount of debt abolished: over $1 million, according to a post on the group’s website, for patients in Kentucky and Indiana. “The average debtor owed around $900,” the group wrote, “and we will be abolishing the debt of over 1,000 people.” Strike Debt is in the process of sending out letters to patients whose debt has been bought and abolished, as it did following the first Rolling Jubilee.

One of the most common questions asked of Strike Debt is whether it can buy and cancel specific people’s debt. The answer is no. There are no strings attached for the person whose debt has been bought, though many activists hope that someone on the receiving end of the Rolling Jubilee might throw a few bucks back in the pot � a way of paying it forward, as it were.

Thursday’s action began at Bryant Park around 4 PM with activists opening a dozen shredded umbrellas bearing the insignias of insurance companies, such as Cigna and Aetna. The broken umbrellas represented the activists’ beliefs that even those who have private insurance are often not fully protected by it.

In contrast, the marchers also opened a dozen intact umbrellas with the words “Medicare for all” � another phrase for single-payer � painted on them.

A physician named David, part of Physicians for a National Health Program (PNHP), addressed the crowd before the march. He railed against the high costs of medical care, lambasting the idea that the solution to the problem is complicated or somehow unknowable. “The answer is single-payer,” he said.

The protesters then marched to the offices of United Healthcare Group, Aetna, Blue Cross Blue Shield, and Cigna, chanting “Health care for people, not for profit” and “Bankrupt and broke, insurance is a joke.” The flier that activists handed out on the march claims that “the combined annual compensation for the CEOs” of those four companies “could buy and abolish almost 2 billion dollars of medical debt using the rolling jubilee model.”

Katie Robbins, also with PNHP, said the “flimsy insurance [that] people get in case they get sick is a contract that gets broken all the time,” referring to the many people in the US who have insurance but nevertheless are forced to pay huge medical bills. She said that her deductible was so high that virtually any medical procedure would leave her thousands of dollars in debt. She also said that, by her calculations, having a baby could put her as much as $10,000 in debt, adding “that’s not a great place to be.”

Wednesday, March 27, 2013

Strike Debt Kicks Off Second Debt Buy-Up With March for Universal Healthcare

A coalition of groups associated with Occupy Wall Street took to the streets of midtown Manhattan on Thursday evening calling for the abolition of the for-profit health care system in the United States and the creation of a government-run single-payer system. Around 70 protesters marched to four major health insurance companies to list their grievances with each corporation, often by comparing what they see as the wildly disproportionate salaries of CEOs with health costs for regular patients or the company’s average worker’s salary.

The march was part of a larger project that Strike Debt (which formed from the creative churn of Occupy) is implementing over the week to draw attention to medical debt, which the group sees as a national emergency. Strike Debt also announced that its latest round of a project known as the Rolling Jubilee has bought and abolished over $1 million in medical debt.

Activists handed out fliers on the march with statistics on just how damaging medical debt can be to households: “62% of bankruptcies are linked to medical bills” was featured prominently on the flier, as well as on a banner at the front of the march. Also on the handout was perhaps an even more surprising number: “78% of those who declared medical bankruptcy had insurance at the time they became sick.”

Strike Debt’s mission is to politicize and organize around personal debt, often by arguing that debt is not a moral failing but rather a societal problem that needs to be addressed and resisted collectively. One of the tactics, called Rolling Jubilee, involves buying “debt for pennies on the dollar, but instead of collecting it, abolish[ing] it.” The group buys debt on the open market the same way a collection agency would, but cancels the debt instead of collecting it. Funding comes from donors who contribute to the group through its website.

The first Rolling Jubilee took place in November of last year and “abolished” more than $100,000 of medical debt. The People’s Bailout, as it was called on Twitter, culminated in a telethon at a New York City music venue and garnered unusually positive press for an Occupy-related action.

The second and latest Rolling Jubilee resulted in an even larger amount of debt abolished: over $1 million, according to a post on the group’s website, for patients in Kentucky and Indiana. “The average debtor owed around $900,” the group wrote, “and we will be abolishing the debt of over 1,000 people.” Strike Debt is in the process of sending out letters to patients whose debt has been bought and abolished, as it did following the first Rolling Jubilee.

One of the most common questions asked of Strike Debt is whether it can buy and cancel specific people’s debt. The answer is no. There are no strings attached for the person whose debt has been bought, though many activists hope that someone on the receiving end of the Rolling Jubilee might throw a few bucks back in the pot � a way of paying it forward, as it were.

Thursday’s action began at Bryant Park around 4 PM with activists opening a dozen shredded umbrellas bearing the insignias of insurance companies, such as Cigna and Aetna. The broken umbrellas represented the activists’ beliefs that even those who have private insurance are often not fully protected by it.

In contrast, the marchers also opened a dozen intact umbrellas with the words “Medicare for all” � another phrase for single-payer � painted on them.

A physician named David, part of Physicians for a National Health Program (PNHP), addressed the crowd before the march. He railed against the high costs of medical care, lambasting the idea that the solution to the problem is complicated or somehow unknowable. “The answer is single-payer,” he said.

The protesters then marched to the offices of United Healthcare Group, Aetna, Blue Cross Blue Shield, and Cigna, chanting “Health care for people, not for profit” and “Bankrupt and broke, insurance is a joke.” The flier that activists handed out on the march claims that “the combined annual compensation for the CEOs” of those four companies “could buy and abolish almost 2 billion dollars of medical debt using the rolling jubilee model.”

Katie Robbins, also with PNHP, said the “flimsy insurance [that] people get in case they get sick is a contract that gets broken all the time,” referring to the many people in the US who have insurance but nevertheless are forced to pay huge medical bills. She said that her deductible was so high that virtually any medical procedure would leave her thousands of dollars in debt. She also said that, by her calculations, having a baby could put her as much as $10,000 in debt, adding “that’s not a great place to be.”

Friday, March 22, 2013

Colorado Doctors Treating Gunshot Victims Differ On Gun Politics

More From Shots - Health News HealthTalk Globally, Go Locally: Cellphones Versus Clean ToiletsHealthHow A Sleep Disorder Might Point To A Forgotten FutureHealthTuberculosis Cases In The U.S. Keep SlidingHealthColorado Doctors Treating Gunshot Victims Differ On Gun Politics

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Affordable Care Act at 3: Increased Savings for Seniors

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less -- or about $200 billion� in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely.� It means that those who count on Medicare -- our grandparents, parents, our friends, and neighbors � will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law�s closing of the prescription coverage gap known as �the donut hole.�

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: �I take seven different medications. Getting the donut hole closed � gives me a little more money in my pocket.�

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, �splitting pills, taking doses every other day, missing doses, stretching their medications.� �But he says this has begun to change with the savings resulting from the Affordable Care Act, and that�s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services -- such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits -- with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself.� She knows they struggle with the costs of staying healthy. �If it weren�t for the health care reform, many of our seniors would not get to a doctor,� to get a check up, Helen says. �It is expensive for us to keep good health.�

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they�re discharged. This also gives Medicare beneficiaries � and other taxpayers � more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

To learn more about how the Affordable Care Act is saving seniors on prescription drug costs by closing the donut hole coverage gap, visit www.hhs.gov/news/press/2013pres/03/20130321a.html

Follow Secretary Sebelius on Twitter at @Sebelius.

Friday, March 15, 2013

Medicare Open Enrollment: 4 Places to Look for Medicare Information

Whether it�s apple picking or Sunday afternoon football, there�s a comfort in things that happen every fall. Shorter days and cooler nights also mark the start of Medicare Open Enrollment. Between now and December 7, you can expect to hear about the choices, benefits, and lower overall costs you have when it comes to Medicare - many of them thanks to the health care law.� �

Open Enrollment is your chance to review your health care coverage and see if you need to make any changes, or if you are happy sticking with the plan you have.� The health care law extended the Open Enrollment period and made it earlier � giving you more time to make choices and giving Medicare time to process everything so your coverage starts without a hitch on January 1st.This year, you can make any changes as early as October 15.

Over the next few months, look around � you�ll find a wealth of information about your Medicare benefits .� Our Medicare Open Enrollment calendar tells you what to look for this fall, especially in these 4 everyday places:

1. �Your mailbox

Look through your mail carefully � you may get important notices from your current plan, Medicare, or Social Security about changes to your coverage or any extra help you may get paying for prescription drugs.

Also look for your Medicare & You handbook.� Like an old friend, it shows up around the same time every year. This year, it may be in your email inbox instead � if you decide to �go green� and asked to get it electronically. But whether it�s on your computer or on your bookshelf, now is the time to take it out and find out what�s new in Medicare.

You�ll also start to see brochures from companies that offer Medicare health and drug plans. Just remember, be smart about protecting your personal information and your identity � plans aren�t allowed to call or come to your home without an invitation from you.

2. �On your computer

Comparing your plan choices is important �and our Medicare Plan Finder makes it as simple as possible. Soon, you�ll be able to watch a video about how the Plan Finder works. Enter the drugs you take to find out how you can lower your costs, review a the plan�s star ratings to compare plans based on quality, and join a plan right online if you find one that meets your needs.

3. �In newspaper, newsletters, and magazines

Take a moment as you enjoy that morning coffee to read the Medicare information that�s out there.� You may find a local event � somewhere right around the corner with counselors to help you, like your State Health Insurance Assistance Program. Don�t miss the chance to get personalized help if you need it.

4. �On television and radio

At the end of one of those shorter days, as you relax in front of the television, you may see some advertisements or programming about Medicare plans and your new choices. You might also hear some advertisements on your way to or from work as you listen to the radio.

Now is the time to enjoy the choice and control you have over your health care coverage. Just like fall, Medicare Open Enrollment only comes once a year.

Note: This blog also appeared on The Medicare Blog.

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Thursday, March 14, 2013

Growing Support for Single-Payer in Oregon

An Oregon house bill sponsored by Rep. Michael Dembrow, D-Portland, is not expected to pass, but advocates claim momentum

Nearly a thousand people swarmed the front of the Oregon Capitol Building for the opening session Monday, demanding that Oregon become the second state to enact single-payer healthcare legislation, which would set up a government financing system to pay for and provide health care coverage and access for all Oregon residents.

Protestors at the Health Care for All Oregon rally hoisted signs, listened to speeches, heard woeful tales of the current health care system, and sang along to bluesman Norman Sylvester: �I don�t care what party you�re in, Democrat or Republican, we don�t need to fight, healthcare is a human right.�

�The brother said we don�t need a fight, but they�re going to fight us,� said Rep. Michael Dembrow, D-Portland, leading the crowd. Dembrow is the chief sponsor of the single-payer legislation, House Bill 1914. �We don�t necessarily need to fight back, we need to organize. Let�s go forward and organize this state, everybody in, nobody out.�

Dembrow said HB 1914 and companion legislation in the Senate already had 19 co-sponsors, all Democrats � eight more sponsors than its predecessor from the last session, HB 3510.

One of those new sponsors, Rep. Jennifer Williamson, D-Portland, said she supported the legislation because her sister was one of the thousands of Oregonians who each year file for bankruptcy under the weight of medical bills.

�I�ve been a legislator for three weeks now,� Williamson said. �The first bill I signed onto as chief legislator was a bill for universal healthcare.�

Dr. Paul Gorman, a member of Physicians for a National Health Program, said he ran a free clinic where a man came in complaining of pain in his abdomen. The man had no insurance and he put off seeing a doctor for a long time, allowing his pain to get worse and worse. �By the time he came to see us, his liver cancer was advanced, and he died.� Gorman said 500 Oregonians die each year because they don�t have insurance.

Health Care for All Oregon argued that while the Affordable Care Act signed into law by President Obama in 2010 does improve access for some people � expanding Medicaid and offering private health insurance subsidies to others � the single-payer advocates said the reforms were inadequate and would do little to rein in skyrocketing costs.

Single-payer healthcare would work similar to Medicare, with a single government fund paid for through taxes rather than paying premiums to several private companies.

HB 1914 isn�t expected to pass the Legislature or even come to the floor for a vote this session. But Dembrow expected to double the number of legislative sponsors and asked everyone in the crowd to lobby their representatives to support single-payer, hoping to find three more legislators by the end of the day.

The number of sponsors didn�t immediately grow to the goal of 22 legislators, but Marissa Johnson, an aide for Dembrow said they hoped to exceed that goal by the end of the week.

�We have interest from more than a handful of representatives and [Dembrow] will be following up with them today,� Johnson said.

Dembrow said at the rally he expected a million votes would be needed to pass a statewide measure while withstanding millions of dollars of negative advertising from groups like the for-profit private health insurance industry, which would be cut out of healthcare under the proposed system.

�The real work is not going to be done inside this building,� he said. �It�s going to be solved by a million people in Oregon, organized.�

�I think it�s going to take a lot of people stepping outside their comfort zones,� said Rio Davidson of Newport, who volunteered at the end of the rally handing out lists of legislators and asking people to contact their representatives. �Unfortunately, a lot of people who want single-payer are working low-wage jobs.�

Longtime advocate Betty Johnson said afterward that 60 organizations had been involved in the Health Care for All Oregon rally, and the group had recently hired a full-time field organizer. �Absolutely we are growing. We are organizing a number of chapters throughout the state,� she said.

Gov. John Kitzhaber has not shown support for single-payer, putting his energies instead into implementing a private health insurance exchange and transforming the healthcare delivery system through coordinated care organizations. Despite his position, Johnson said she hoped he would meet with single-payer advocates to discuss how it could work in tandem with the CCO model.

�He�s strengthening the delivery system,� Johnson said. �We really want to change the financing system. When we pass single-payer, the CCO system will work alongside it.�

Dembrow said there are restrictions in the federal Affordable Care Act that prevent states from passing single-payer laws without special permission before 2017. He lamented the added restriction, but said it also gave single-payer supporters three years to build support, get better organized, and develop a plan that would work for Oregon.

The state of Vermont enacted single-payer legislation in 2011 to cover all of its residents, but funding mechanisms are still being worked out and the state will also have to wait until 2017 to receive federal waivers.

Dembrow is introducing a second bill this session that would call on the Legislature to support a formal study of how single-payer would work in Oregon. Activists on Monday called on supporters to ask their legislators for public money, but Johnson said Dembrow believes the study could be paid for with private money.

Medicaid and the Affordable Care Act

The Affordable Care Act ensures that all Americans have access to quality, affordable health care.� It works with States to establish State-based Health Insurance Exchanges so that consumers have the ability to shop for coverage in a competitive marketplace and insurers are made to compete on the basis of cost and quality. And it takes important steps to make coverage more affordable for millions of people, families, and small businesses. To achieve this, the health law provides:

Tax credits for individuals and families purchasing coverage in the Exchanges with income from 133 to 400 percent of the Federal poverty level, as well as those ineligible for Medicaid with income between 100 and 133 percent of poverty.

Medicaid for most Americans with income below 133 percent of the federal poverty level (about $15,000 for an individual, $20,300 for a couple).�

In carrying out the law, we need to make sure Americans can easily understand their coverage options and their eligibility for premium tax credits based on their income. �Many people and families receive income from a variety of sources. For example, some people receive Social Security benefits in addition to income they may earn at their job.� Long-standing tax law excludes a portion of Social Security benefits from income to reduce seniors� tax bill.� The income definition used in the health care law for tax credits and Medicaid also uses this exclusion, creating something known as your �modified adjustment gross income.��

Medicaid is a vital program, providing health benefits to nearly 50 million Americans, most of them with very low incomes including women and their children, people with disabilities, and many seniors who are living in nursing homes. That�s why we have worked with States to keep costs down and sustain coverage in the program as the economy is recovering.� And that�s why we are fighting efforts in Congress to end Medicaid as we know it and replace it with a block grant.

However, we are concerned that, as a matter of law, some middle-income Americans may be receiving coverage through Medicaid, which is meant to serve only the neediest Americans.� We are exploring options to address this issue, so that we can use taxpayer dollars responsibly while ensuring that all Americans have access to affordable, high quality health insurance coverage.

Note: this blog was updated on June 22.

Wednesday, March 13, 2013

'We Shouldn't Have To Live Like This'

March 13, 2013

Listen to the Story 7 min 47 sec Playlist Download Transcript   Hide caption Linwood Hearne, 64, and his wife, Evelyn, 47, stand near Interstate 83 in Baltimore where they have slept on and off for the past four years. According to the local nonprofit Health Care for the Homeless (HCH), a growing percentage of homeless patients nationally are 50 or older, with complex mental and physical conditions. Previous Next Kainaz Amaria/NPR Hide caption Evelyn displays her bag of prescription medications, which she says are for asthma, chronic obstructive pulmonary disease and depression. HCH offers comprehensive services, including medical care, prescription subsidies, mental health services, housing assistance, and access to education and employment. Previous Next Kainaz Amaria/NPR Hide caption Linwood has long suffered from schizophrenia and admits that he was evicted from public housing after stabbing a neighbor in a fight. Many of the city's chronic homeless have criminal records, which makes it harder to get employment. "I'm getting older, and being out on the streets plays with my mental stability," he says. Previous Next Kainaz Amaria/NPR Hide caption Meredith Johnston, HCH's director of psychiatry, meets with Linwood once a month to review his medications and screen for behavioral symptoms. "Getting into housing will be a huge stabilizing change for Linwood and Evelyn," Johnston says. Previous Next Kainaz Amaria/NPR Hide caption HCH also runs a convalescent floor in a nearby shelter where patients can recover from fractures or recent surgeries. Susan Zator, a community nurse for more than 41 years, bandages 66-year-old William Jones' foot injury. Zator says this service is vital for homeless men and women who cannot recover properly while living on the street. Previous Next Kainaz Amaria/NPR Hide caption Physician assistant Jean Prevas tends to Jones' leg wound. Many aging homeless suffer from ailments not readily visible to outsiders. Medical conditions often go untreated and escalate into more acute health problems. Previous Next Kainaz Amaria/NPR Hide caption Albert Monroe and many others sleep on the porch and under the bright lights of the HCH clinic. Many say it's safer than sleeping under the highway or in city shelters, where theft and violence aren't uncommon. Previous Next Kainaz Amaria/NPR Hide caption Paul Behler, 59, and Tony Simmons, 51, leave a shelter where residents have to be out at 5 a.m. HCH also cultivates potential advocates still struggling to get back on their feet, like Behler and Simmons. Previous Next Kainaz Amaria/NPR Hide caption Behler lost his job as a piano tuner and has been living in shelters for a year and a half. "I'm going to find the way back," he says, "and part of this lobbying effort is making inroads in that respect." The two pass time at a 24-hour Dunkin' Donuts before HCH opens for the day. Previous Next Kainaz Amaria/NPR Hide caption Behler and Simmons take up issues on behalf of the homeless population. Here, they discuss Maryland House Bill 137, which calls for proof of identification at polling places, before going to a hearing in Annapolis. Simmons argues that many homeless have lost their IDs but shouldn't be disenfranchised. Previous Next Kainaz Amaria/NPR Hide caption Simmons irons a dress shirt at his storage unit, which he shares with three other homeless men, in preparation for the hearing. A father of three, he became homeless after a 2011 drug arrest and has been staying in shelters for 14 months. Previous Next Kainaz Amaria/NPR Hide caption Simmons, now clean for more than two years, lost his family and says he's too ashamed to go back home. "I have to find my own way now," he says. "This is my way." Previous Next Kainaz Amaria/NPR Hide caption Simmons hugs Evelyn inside HCH. He has been trying to help the Hearnes and many others get off the streets. Previous Next Kainaz Amaria/NPR

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If aging is not for sissies, that's especially true if you're homeless. You can be on your feet for hours, or forced to sleep in the frigid cold or seriously ill with no place to go. But, increasingly, the nation's homeless population is getting older. By some estimates, more than half of single homeless adults are 47 or older.

And there's growing alarm about what this means � both for the aging homeless and for those who have to foot the bill. The cost to society, especially for health care and social services, could mushroom.

As in many cities across the country, there are plenty of homeless people in Baltimore, Md., � about 4,000 by the latest count. In the early morning hours, dozens of bundled-up men, carrying backpacks and duffle bags, emerge from an unmarked door next to a parking garage downtown.

This is the city's overflow homeless shelter for men, and the residents need to be out by 5 a.m., before office workers start to arrive downtown for the day.

Paul Behler, 59, says he's been homeless for about a year and a half, ever since he lost his job as a concert piano tuner and restorer. Behler says some days he feels like he's 70 years old.

"Haven't got to 80 yet, thank Lord," he laughs. Still, he says he had to go to the hospital emergency room recently because he had a bout of severe tendonitis and couldn't walk without a cane.

The emergency room is a frequent destination for the homeless in every city across the U.S. The list of ailments for those living on the streets is long � blood clots, chronic pain, exposure, diabetes. It's even longer for those in their 50s and 60s, which is considered elderly when you're homeless. The life expectancy is only 64.

On a recent chilly morning, some men head from the Baltimore shelter to their jobs, as cooks or handymen. Others go to the city's day shelter to get warm.

Still others head to a nearby clinic, run by a non-profit group called Health Care for the Homeless, which opens at 7:30 a.m. About a dozen people spent the night outside the clinic sleeping on the concrete steps. It's something of a safe haven.

“ Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach.- Yvonne Jauregui, nursing services coordinator Here, as in similar clinics across the country, a growing percentage of patients are 50 and older. Nursing services coordinator Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive. "Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach," she says. Jauregui notes dental care as an example. She says it's not a priority at all. "It's until, 'I can't chew because my tooth hurts so bad and the tooth needs to come out' � that's when we see them," she says. And that makes treatment a lot more difficult. There are other challenges for the homeless. Diabetics have nowhere to refrigerate their insulin. They're not allowed to bring syringes needed for such medication into homeless shelters. Medication is often stolen. And sometimes those with serious foot and leg problems can't get to a doctor. Source: Analysis of U.S. Census data by Dennis P. Culhane Credit: NPR "They are prone to having a lot of foot issues," says Jauregui. "Plus, it's like their primary mode of transportation." Sixty-four-year-old Linwood Hearne is a case in point. He and his wife have been homeless for four years. "I can't balance myself. I can't walk well. I'm getting very forgetful," Hearne says. "I have prostate cancer I have a lot of mental problems that's going on with me. I'm a paranoid schizophrenic. I suffer from manic depression." Dennis Culhane, social policy professor at the University of Pennsylvania, says individuals like Hearne are increasingly common. "We're looking at a group of people who are sort of prematurely reaching old age," says Culhane, who's done extensive research on demographics and homelessness. He says the growth in the aging homeless population is due largely to one group � younger baby boomers � those born between 1955 and 1965. He notes that they came of age in the late '70s and '80s, amid back-to-back recessions and a crack cocaine epidemic. Culhane says individuals in this age group are almost twice as likely as those in other age groups to be homeless. "These are folks who have been living on the margins, in and out of jail, in and out of shelters, in and out of treatment programs for the last thirty, thirty five years," he says. Culhane says people are just coming to grips with what that means. A few communities have started to build special housing for the elderly homeless. Baltimore and other cities are also trying to get those most likely to die on the streets into permanent supportive housing. But funds are limited. Enlarge image i

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Culhane and other experts say it's going to cost a lot more to do nothing. "It's cheaper to have them in housing, than it is to have them be homeless," he says.

But getting housing isn't easy for those with limited means. And Hearne, like lots of people living in the streets, has a history marred with mistakes.

He was evicted from public housing years ago because he stabbed a neighbor in a fight. But he says he's already served his sentence � a three-year probation � and shouldn't be condemned to life, and maybe death, on the street.

Hearne and his wife have slept outside for much of the past four years, mostly under a highway across from the Health Care for the Homeless clinic. There are blankets, bags and mattresses stacked there, along a cement wall, and a few white buckets used as urinals. About two dozen people sleep there every night.

"I know it looks terrible, but this was our home," Hearne says. "We shouldn't have to live like this."

With that, he leans over to pick something up off the ground. It's a penny.

"A penny a day keeps the doctor away, right?" he asks. "That's what they say."

What they really say is that it's good luck. And maybe it worked. Health Care for the Homeless later found Hearne and his wife a new place to live.

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Tuesday, March 12, 2013

Dr. Biden: October Is the Time for Each of Us to Consider the Role We Can Play in Combating Breast Cancer

October is Breast Cancer Awareness month, and it�s an important time to consider the role that each of us can and must play in combating this disease.�Far too many of us have lost a loved one to breast cancer � or seen a neighbor or a colleague endure painful treatments or a long battle with the disease.

We know that early detection can make all the difference.�And I am proud to be a part of an Administration that is working hard to ensure that affordable and accessible preventive care is a reality. Thanks to the health reform law, the Affordable Care Act, most private health plans and Medicare cover women�s preventive health care � such as mammograms and screenings for cervical cancer �with no co-pays or other out-of-pocket costs. This year to date, 3.8 million women in traditional Medicare have received a free mammogram.��

Last week, Secretary of Health and Human Services Kathleen Sebelius, Jennifer Aniston, and I toured a state-of-the-art breast health center in Northern Virginia.�We met with committed health professionals as well as with women who shared personal stories about their battles with breast cancer.�

There is no question that we have a lot of work ahead of us � but I will say that we were all inspired and hopeful after the visit. Please take a minute to see some highlights of our visit, and hear first-hand from some of these inspiring women.�

Forward this video to your loved ones, together we will win this fight!

Note: This blog also appears on the White House Blog

Sunday, March 10, 2013

Winning Medicare for All? “I Like Our Chances”

Despite insights, Time magazine’s cover story falls short on remedy

In his recent Time magazine article, Steven Brill paints a vivid and rather depressing picture of the perverse malfunctioning of our health care system � overpriced and technology-addicted � and he acknowledges some of the advantages of Medicare.

Sadly, however, he shies away from an endorsement of the obvious solution: an improved Medicare for all, i.e. single-payer national health insurance.

I�ll come back to that a little later. However, let me first say that Brill masterfully illuminates much of what�s wrong with U.S. health care.

Take, for example, the �chargemaster� list: an archival, bizarrely hyper-inflated price list in each hospital based on some long-lost secret formulas and automatically inflated over time.

As a physician and health policy researcher, I�ve long known about the massive charges offered to non-contract payers (read: individuals not covered by a public or private insurer), charges that are completely meaningless for costing studies because they�re almost never paid in full and don�t represent the real resources used to provide care. However, what Brill lays out brilliantly (pun intended) is the following:

Some very poor (lower-middle income) people actually do pay the sky-high chargemaster rates. There is a cottage industry (growing, I�m sure, if nothing else due to this article) to help those hapless souls negotiate steep discounts on these ridiculous bills. Hospital administrators either refuse to discuss the chargemaster list or offer up the most heinous, transparently nonsensical justifications for using it. Perhaps worst of all, the CEOs of large not-for-profit providers are paid literally millions of dollars (OK, not tens of millions like big for-profit companies, but still �), thereby introducing into a supposedly public-good-oriented setting the compensation (and marketing) tone of for-profit industry. When these not-for-profits list their �charity� care they value it at the price levels in the chargemaster, even though the cost to produce those services is less than 10 percent of the chargemaster price.

In these and other instances, Brill performs an outstanding public service. However, he regrettably stops short (or his editors stopped him short) of explaining why a single-payer health care system is the only effective remedy for the mess we find ourselves in today. This despite the fact that much of what he says would lead you directly to that conclusion.

He goes so far as to quote others, including John Gunn, Sloan-Kettering�s chief operating officer, who says, �If you could figure out a way to pay doctors better and separately fund research � adequately, I could see where a single-payer approach would be the most logical solution. � It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.�

Yet Brill characterizes single payer, the most logical solution, as �unrealistic� and fraught with the danger of government overreach and intrusion, summarily dismissing it. Need we mention insurance-company overreach and intrusion in the doctor-patient relationship? Need we note the freedom of Medicare beneficiaries to choose their own doctor and hospital, something that would also characterize a single-payer system?

Incidentally, Brill sharply undervalues the government role in paying for health care. He says that the federal government pays $800 billion per year out of our $2.8 trillion health bill, with the remainder mainly picked up by private insurers and individuals.

The $800 billion federal spending on Medicare and the federal portion of Medicaid is right. However, when you add in other federal programs, the state portion of Medicaid, other state and local programs, health insurance for government employees, and tax subsidies, the total government contribution is over 60 percent of total health spending, and rising. Our government already spends enough to pay for universal single payer!

Single-payer health reform is clearly the answer. We need to create the meme and the momentum and the aura of inevitability to do the right thing � despite the opposition of individuals and organizations with massive vested financial interests in the private health industry. They can be overcome.

Think Lincoln and the 13th amendment. As he said (or at least Daniel Day-Lewis said in the movie), regarding prospects of passing the amendment out of Congress, despite doom-saying by his advisers � �I like our chances� (slight smile).

I like our chances on single payer because it�s now so obvious how irremediably broken our system is, and the house of cards will eventually fall. It�s all about perseverance and timing.

James G. Kahn, M.D., M.P.H., is a professor at the Philip R. Lee Institute for Health Policy Studies, Global Health Services, and the Department of Epidemiology and Biostatistics, all at the University of California, San Francisco. He is also past president of the California chapter of Physicians for a National Health Program.

We Can’t Wait Update: Advancing Innovation in Health Care

From the electric light bulb to the Internet, American innovations have made lives better for people in this country and all over the world.

The kind of work we�ve done to advance technology, communication and so many other aspects of people�s lives is about to get a jump start in health care, thanks to today�s announcement of 26 Health Care Innovation Awards. The awards are part of our We Can�t Wait initiative.

�What America does better than anyone else is spark the creativity and imagination of our people," said President Obama during his 2011 State of the Union address, and that�s exactly what the Health Care Innovation Awards aim to do.� These awards provide our most creative minds�whether they�re health care professionals, technology innovators, community-based organizations, patients� advocacy groups, or others�with the backing they need to build the strong, effective, affordable health care system of the future.� These are 26 unique projects, tailored to the needs of patients by local doctors, hospitals, and other leaders in their communities.

These awards will save $254 million over the next three years by testing innovative approaches to improve the quality of health care and prevent disease and illness. And we�re just getting started. We�ll announce another round of innovation awards in June.

Awardees are chosen not only because they had innovative strategies to get health care to some of our hardest to reach populations, but also because their programs are expected to help expand the well-trained health workforce we need for a strong and resilient economy, which is essential for quality care.

One of these projects is Emory University�s example of ingenuity�a collaboration that trains health professionals and uses tele-health technology to link critical care units in rural Georgia to critical care doctors in Atlanta hospitals.� The project aims to save money and improve the quality of care by reducing the need to transfer patients from rural hospitals to critical care units in Atlanta.

The Health Care Innovation Awards are investments in American innovation.� These new awardees represent America at its best.� We�re proud of the organizations that are part of this group, and�given the thousands of proposals that poured in when we first announced this program�we�re sure we�ve only scratched the surface of our ability to transform health care with this first set of awards.

Saturday, March 9, 2013

The questions our healthcare debate ignores

By Joe Conason for Salon.com–

As President Obama issued his call for reform of American healthcare, he must have been gratified to hear so many professions of good faith and civility from the political and commercial interests that have always opposed change. The health insurance lobbyists as well as the politicians who serve them all promised that this time would be different.

But amid all the reassuring blather, certain fundamental questions were not asked, as usual, because merely posing them might discomfort those same special interests and political leaders. Why do we spend so much more on healthcare, per capita, than other developed countries? Why do we achieve worse outcomes on several important measures than countries that spend far less? Why do we spend up to twice as much per person as countries that provide universal coverage while leaving as many as 50 million Americans without insurance?

The salience of those questions has grown over the past several decades, ever since President Truman first sought to create a universal health benefit program that resembled systems in Europe. Last month, the Paris-based Organization for Economic Cooperation and Development issued the latest in a long series of reports on our wasteful and cruel practices that ought to awaken a sense of national embarrassment. This highly topical study carried a deceptively bland title: “Healthcare Reform in the United States.” Naturally, the mainstream media and punditry ignored its findings (although OECD reports promoting free trade often receive wide coverage).

Continue reading the full article.

New Report Shows Slower Medicaid Spending Growth

The 2012 Medicaid Actuarial Report released today contains good news. �It shows that Medicaid benefits spending per beneficiary is estimated to have decreased by 1.9% from 2011 to 2012. �This decline in per beneficiary spending is virtually unprecedented. �Except in 2005-2006, when the cost of prescription drugs for Medicaid-Medicare dual beneficiaries shifted to Medicare Part D, Medicaid spending per beneficiary has never declined from one year to the next in the 47-year history of the program.� Health care spending growth has generally been slow over the past few years, but Medicaid spending growth in 2012 is well below spending growth in the rest of the health care economy.

These results can be interpreted to suggest that Medicaid programs managed spending growth more effectively than did other payers in 2012. �And that states have substantial flexibility to manage Medicaid spending growth.

Projected spending growth per beneficiary over the next decade is only 3.2% per year, less than the rate of growth of the per capita Gross Domestic Product, and lower than projected growth in overall per person health spending. �As a result of Medicaid expansion in 2014, a larger proportion of Medicaid beneficiaries will be relatively low cost healthy adults, and a smaller proportion will be relatively high cost disabled and aged beneficiaries, and the changing mix of Medicaid beneficiaries accounts for part of the reason that projected Medicaid spending growth is so slow.� But even focusing separately on projected rates of growth for children, adults, disabled and aged beneficiaries, the projections show a program with modest expenditure growth per person.

Furthermore, largely because of the decrease in Medicaid spending and a slower growth rate than was assumed last year, in this year�s report projected spending in 2020 is fully 14% lower than the projection made in last year�s report.�

There are very strong financial and economic arguments in favor of states expanding Medicaid eligibility to 133% of the federal poverty level. �From 2014 through 2016, 100% of the costs of covering newly eligible people will be paid by the Federal government, with that percentage gradually decreasing to 90% by 2020.� That means that over the next decade more than 90% of the total costs for newly eligible people will be paid for by the Federal government, representing substantial new flow of Federal funds to hospitals and other health care providers in states that choose to expand.� This will undoubtedly lead to more jobs and tax revenue, as well as improved health and financial security for millions of newly insured low-income workers.�

While the baseline assumption in today�s report is that, in 2015, 65% of newly eligible Medicaid beneficiaries will live in states that have chosen to expand Medicaid, today�s report underscores substantial uncertainty about state decisions. We remain optimistic that, over time, all states will recognize the health, financial, and economic benefits of extending Medicaid.� These new data suggest just how effectively the Medicaid program manages spending growth, and is well positioned to accommodate future beneficiaries.

To read today�s report on the financial outlook for Medicaid, visit: http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Actuarial-Report-on-Financial-Outlook-for-Medicaid.html

And for a letter from Secretary Sebelius to governors detailing more information on the flexibility states have in designing their Medicaid programs, see:� http://medicaid.gov/State-Resource-Center/Events-and-Announcements/Downloads/Markell-and-Fallin-Letter.pdf (PDF - 223 KB)

Friday, March 8, 2013

For Midwife, 71, Delivering Babies Never Gets Old

March 6, 2013

Listen to the Story 7 min 31 sec Playlist Download Transcript  

Editor's Note: This video contains a scene of childbirth that includes graphic imagery and explicit language.

Credit: John W. Poole/NPR

Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce.

Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be.

Sparling founded an obstetrics and gynecology practice called Womancare 31 years ago. During her career, she has delivered around 2,000 babies. Last year, she decided she'd retire from that part of her job, though she continued to see patients in the office. She didn't miss being on call � the person who's awakened in the middle of the night when a patient goes into labor.

"When you're on call, you just can't really plan for anything. You just need to be available, both physically and your heart and soul available, to do midwifery work. And when it's an unknown, I think it's a little bit more draining," Sparling says.

A few months ago, one of the other midwives in her practice had to take an extended medical leave. So Sparling had to go back to being on call.

Enlarge image i

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

"It would be horrible if I had to do this and stay up all night and didn't love what I do," she says.

'A Wonder To Behold'

It's just past daybreak at the hospital's birth center, and Sparling has been here since 4 a.m. with patient Amanda Trujillo, who is about to deliver her third baby. It's her second with Sparling as her midwife. The two are comfortable with each other. The atmosphere is relaxed. Sparling tells Trujillo to just be patient a little while longer.

When Sparling leaves Amanda and goes out to the nurses' station in the birth center, her spiky white hair sets her apart from her younger colleagues. Nurse Kathy Clarkson makes a point of telling her she was missed during her brief semi-retirement.

"We're glad that you're back working again, Dian," Clarkson says. "When you retired, we were all crying."

Nurse Julie Christin says that as a midwife, Sparling works more closely with women in labor than do most MDs.

"Physicians rely on us to do a lot of the labor support," Christin says. "But Dian spends a lot of time with her patients when they're in labor. I like that, because then she's involved and can make decisions quicker, and does what the patient wants to do, which is good."

Sparling is "in tune with them emotionally as well as physically," Clarkson says.

And then it's time for Sparling to get back in tune with Trujillo, who's ready to start pushing. Her husband, Isaiah, supports one leg, and delivery nurse Keri Ferguson supports the other.

“ It would be horrible if I had to do this and stay up all night and didn't love what I do.- Certified Nurse Midwife Dian Sparling As Amanda Trujillo works, her husband, Sparling and Ferguson cheer her on and report on the baby's progress. First his head emerges. Then his shoulders. And finally, there is a new little person named Samuel in the world, though at nearly 9 pounds, maybe not so little. "There he is, Amanda," Sparling says. "Reach down here and grab your baby." Samuel is born just before 10 a.m. Sparling has been at the hospital for six hours. And she's jazzed. "People have asked me, 'Does this feeling after a delivery ever get old?' Absolutely not," she says. "It's a wonder to behold, and my adrenaline stops pumping about two hours after a delivery. And then I can go to sleep." But it takes her twice as long to recover from an all-nighter as it used to. Her closest friends worry about her. Sparling is long divorced. Her two sons live back East, so this group of friends are the ones she refers to as her "support people." "We think she should be retired, but she doesn't think she can," says Sparling's friend, Wayne Peak. "She's our age and we're retired and we like to travel and relax a whole bunch, and she's on call and has to stay up in the middle of the night and deliver babies. That's not good." More In This Series Working Late: Older Americans On The Job When A Bad Economy Means Working 'Forever' Working Late: Older Americans On The Job For One Senior, Working Past Retirement Age Is A Workout Working Late: Older Americans On The Job At 85, 'Old-School' Politician Shows No Signs Of Quitting

Another friend, Nancy Grove, says she was not happy when Sparling first told her she was going back to being on call.

"Once I stopped thinking about myself and started thinking a little more about Dian, I really wanted to support her in what she wants to do, needs to do, because she's a very valuable asset in our community," Grove says.

A Line In The Sand

Sparling has reassured her friends that she will not keep delivering babies forever. In a way, she longs for retirement � from deliveries, from the office, from work. But that would mean finding someone to take over her practice and run it the way she believes it should be run. For instance, no patient is turned away because of lack of insurance or inability to pay.

"The truth of the matter is this is not a money-making business," Sparling says. "It makes our salaries. It makes our health care insurance payments for ourselves, it pays for our malpractice insurance, which is required by the state and also by our hospital. We can exist and pay for ourselves, but it doesn't make money."

Sparling says that at 71, she realizes time is not on her side. As much as she loves her work, she wants to pursue the other pleasures of life.

"One of which is travel. There are so many places in the United States and the world that I would love to go," Sparling says. "And one is taking piano lessons. I was given a piano at age 7 by my grandmother, and really never made proper use of it and practice. And you need time to do that."

Sparling has given herself deadlines for retiring before. None have stuck. But she's still trying.

"And now I guess I can draw a line in the sand and say it's going to be [at] 75, I will no longer be seeing patients in the office," she says.

But she acknowledges that maybe a line in the sand isn't the best metaphor. She says, "you know how sand flows."

Share Facebook Twitter Email Comment More From Working Late: Older Americans On The Job Around the NationFor Midwife, 71, Delivering Babies Never Gets OldAround the NationAt 85, 'Old-School' Politician Shows No Signs Of QuittingAround the NationWhen A Bad Economy Means Working 'Forever'EconomyWorking Late: In Tough Economy, Retirement Gets Pushed Back

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For Midwife, 71, Delivering Babies Never Gets Old

March 6, 2013

Listen to the Story 7 min 31 sec Playlist Download Transcript  

Editor's Note: This video contains a scene of childbirth that includes graphic imagery and explicit language.

Credit: John W. Poole/NPR

Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce.

Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be.

Sparling founded an obstetrics and gynecology practice called Womancare 31 years ago. During her career, she has delivered around 2,000 babies. Last year, she decided she'd retire from that part of her job, though she continued to see patients in the office. She didn't miss being on call � the person who's awakened in the middle of the night when a patient goes into labor.

"When you're on call, you just can't really plan for anything. You just need to be available, both physically and your heart and soul available, to do midwifery work. And when it's an unknown, I think it's a little bit more draining," Sparling says.

A few months ago, one of the other midwives in her practice had to take an extended medical leave. So Sparling had to go back to being on call.

Enlarge image i

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

"It would be horrible if I had to do this and stay up all night and didn't love what I do," she says.

'A Wonder To Behold'

It's just past daybreak at the hospital's birth center, and Sparling has been here since 4 a.m. with patient Amanda Trujillo, who is about to deliver her third baby. It's her second with Sparling as her midwife. The two are comfortable with each other. The atmosphere is relaxed. Sparling tells Trujillo to just be patient a little while longer.

When Sparling leaves Amanda and goes out to the nurses' station in the birth center, her spiky white hair sets her apart from her younger colleagues. Nurse Kathy Clarkson makes a point of telling her she was missed during her brief semi-retirement.

"We're glad that you're back working again, Dian," Clarkson says. "When you retired, we were all crying."

Nurse Julie Christin says that as a midwife, Sparling works more closely with women in labor than do most MDs.

"Physicians rely on us to do a lot of the labor support," Christin says. "But Dian spends a lot of time with her patients when they're in labor. I like that, because then she's involved and can make decisions quicker, and does what the patient wants to do, which is good."

Sparling is "in tune with them emotionally as well as physically," Clarkson says.

And then it's time for Sparling to get back in tune with Trujillo, who's ready to start pushing. Her husband, Isaiah, supports one leg, and delivery nurse Keri Ferguson supports the other.

“ It would be horrible if I had to do this and stay up all night and didn't love what I do.- Certified Nurse Midwife Dian Sparling As Amanda Trujillo works, her husband, Sparling and Ferguson cheer her on and report on the baby's progress. First his head emerges. Then his shoulders. And finally, there is a new little person named Samuel in the world, though at nearly 9 pounds, maybe not so little. "There he is, Amanda," Sparling says. "Reach down here and grab your baby." Samuel is born just before 10 a.m. Sparling has been at the hospital for six hours. And she's jazzed. "People have asked me, 'Does this feeling after a delivery ever get old?' Absolutely not," she says. "It's a wonder to behold, and my adrenaline stops pumping about two hours after a delivery. And then I can go to sleep." But it takes her twice as long to recover from an all-nighter as it used to. Her closest friends worry about her. Sparling is long divorced. Her two sons live back East, so this group of friends are the ones she refers to as her "support people." "We think she should be retired, but she doesn't think she can," says Sparling's friend, Wayne Peak. "She's our age and we're retired and we like to travel and relax a whole bunch, and she's on call and has to stay up in the middle of the night and deliver babies. That's not good." More In This Series Working Late: Older Americans On The Job When A Bad Economy Means Working 'Forever' Working Late: Older Americans On The Job For One Senior, Working Past Retirement Age Is A Workout Working Late: Older Americans On The Job At 85, 'Old-School' Politician Shows No Signs Of Quitting

Another friend, Nancy Grove, says she was not happy when Sparling first told her she was going back to being on call.

"Once I stopped thinking about myself and started thinking a little more about Dian, I really wanted to support her in what she wants to do, needs to do, because she's a very valuable asset in our community," Grove says.

A Line In The Sand

Sparling has reassured her friends that she will not keep delivering babies forever. In a way, she longs for retirement � from deliveries, from the office, from work. But that would mean finding someone to take over her practice and run it the way she believes it should be run. For instance, no patient is turned away because of lack of insurance or inability to pay.

"The truth of the matter is this is not a money-making business," Sparling says. "It makes our salaries. It makes our health care insurance payments for ourselves, it pays for our malpractice insurance, which is required by the state and also by our hospital. We can exist and pay for ourselves, but it doesn't make money."

Sparling says that at 71, she realizes time is not on her side. As much as she loves her work, she wants to pursue the other pleasures of life.

"One of which is travel. There are so many places in the United States and the world that I would love to go," Sparling says. "And one is taking piano lessons. I was given a piano at age 7 by my grandmother, and really never made proper use of it and practice. And you need time to do that."

Sparling has given herself deadlines for retiring before. None have stuck. But she's still trying.

"And now I guess I can draw a line in the sand and say it's going to be [at] 75, I will no longer be seeing patients in the office," she says.

But she acknowledges that maybe a line in the sand isn't the best metaphor. She says, "you know how sand flows."

Share Facebook Twitter Email Comment More From Working Late: Older Americans On The Job Around the NationFor Midwife, 71, Delivering Babies Never Gets OldAround the NationAt 85, 'Old-School' Politician Shows No Signs Of QuittingAround the NationWhen A Bad Economy Means Working 'Forever'EconomyWorking Late: In Tough Economy, Retirement Gets Pushed Back

More From Working Late: Older Americans On The Job

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Thursday, March 7, 2013

Olympic Hopeful Works To Improve Bone Marrow Registries

More From Shots - Health News HealthShrimp Trawling Comes With Big RisksHealthTo Make Mice Smarter, Add A Few Human Brain CellsHealthTo Save A Life, Odds Favor Defibrillators In CasinosHealthHear That? In A Din Of Voices, Our Brains Can Tune In To One

More From Shots - Health News

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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“I Prefer Single-Payer, But …. “

The Selling of Single-Payer Features

�Start off on high ground but end up somehow crawling��
–Bruce Springsteen, The Big Muddy

The farce in Washington DC called health care reform makes the blood of single-payer supporters boil. That the Obama administration has crafted and is trying to push through an unfathomable, over one-thousand page piece of shit legislation that in no way ends the health care crisis, and in fact, strengthens the power and position of the private insurance industry, should not be surprising. Obama sold out on the single-payer solution the moment he decided to run for the presidency and accepted campaign contributions from both the insurance and pharmaceutical industry.

That the voice of single-payer (SP) has been blacked out nationally (documented by Fairness and Accuracy in Reporting) also makes our blood boil. It�s as if our movement doesn�t exist. But it does. There are hundreds of grassroots SP organizations all across the country engaging in public activism and protest, we just don�t get press.

Only John Conyers single-payer legislation, HR 676, The United States National Health Care Act, fundamentally restructures health care, guarantees it to the entire population (the undocumented, too) and is fully funded. No other piece of legislation is as comprehensive. How many Americans know about this amazing, life-transforming bill that delinks employment from insurance and abolishes the despised health insurance industry? Has there been a front page story or major magazine interview with Congressman Conyers? There�s been virtually no stories about labor�s support for HR 676, despite the fact it�s been endorsed by 554 union organizations in 49 states and by 130 Central Labor Councils. But we heard plenty when Andy Stern, the president of the SEIU sat down with Lee Scott, the CEO of Wal-mart to discuss solutions to the nation�s health care crisis. Those two are experts on providing health care to workers? What about the nurses and doctors who support single-payer and got dragged out of, and arrested in Max Baucus�s senate hearings in Washington, DC? If doctors and nurses had been arrested for any other political issue it would have been the lead story in every newspaper and online edition. Doctors and nurses never deliberately get arrested — that�s news!

The sea change in the public�s attitude toward government financed health care, however, has gotten press. A New York Times poll in June found that 72 percent supported a government-administered insurance plan � like Medicare for everyone under the age of 65. That poll also reported 64 percent believed the federal government should guarantee coverage to the entire population, i.e. health care should be a human right. Another interesting number: 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt. This is in stark contrast to President Obama�s position of tepid, incremental reform. Obama asserts if he was starting from scratch he might favor SP, but we aren�t so he can�t. He wants to build on the existing system and not �disrupt� the employment-based provision of health care. As if employment-based health coverage isn�t being massively �disrupted� by the economic depression that has laid off millions of workers and forced them down into the ranks of the 50 million uninsured.

But what is truly disgusting is how the �progressive� left has caved so quickly and cravenly, given up the fight for single-payer and support for HR 676. They have become the indignant foot soldiers, apologists and spinmeisters for Obama�s piece of shit legislation. They are betraying what they absolutely know to be true: the private insurance industry must be evicted in order to provide health care to everyone and end the fiscal crisis the multiple-payer system creates. Even the insurance companies know that according to revelations by Cigna whistleblower Wendell Potter. He reports the implementation of a single-payer health care system is what keeps the billionaire CEO�s of insurance companies and Karen Ignagni, the high priestess of America�s Health Insurance Plans (AHIP), awake at night cowering in fear and forced to spend 1.4 million dollars a day to make sure it doesn�t happen. They don�t fear a public option despite their protestations; they accept that due to the depth of the crisis, a few token compromises are in order to stay in business. It�s chump change and in exchange for perhaps losing a little market share, they�re going to get a mandate that legally obligates every person to buy their priced-to-make-profits �insurance products� or be financially penalized. If the Obama bill subsidizes the uninsured going into private plans, that�s millions of new customers to extract profits from and a transfer of taxpayer dollars into insurance industry coffers. The Massachusetts mandate madness gone nationwide.

First the �progressive� Democratic Caucus jumped the single-payer ship arguing without even launching a fight that HR 676 was not �politically viable.� A senior research associate with Physicians for a National Health Program (PNHP) told the following story. He gave testimony to the caucus on why the public option was flawed and to continue robust support for HR 676. He was appalled to learn staffers for caucus members were claiming the public option was the same as single-payer or would lead to single-payer. The staffers banned him from handing out information comparing the public option to single-payer. They tried to censor his speech but he gave it anyway. When members of the caucus asked questions staffers continually interrupted him.

Health Care for American (HCAN), Katrina Vanden Heuvel of The Nation, Robert Reich, Joshua Holland of Alternet, and a raft of other progressive political pundits are pumping out article after article attempting to explain away or marginalize the myriad problems with the public option: the gaps in coverage, the millions that will be left uninsured, and how to fund it so that it�s �deficit neutral.�

They often begin by declaring, �I�d prefer a single-payer system but�� But what?

Joshua Holland�s article titled, �We Need Clear Thinking: There Should Be No Clash Between Public Option and Single-Payer,� is the most recent and best example of giving up and selling out single-payer. He too confesses in the piece (three times!) he really is an advocate of single-payer, but � But what? Holland argues, �The public insurance/single-payer rift is a false dichotomy and is distracting us from the real fight.� Dead wrong. The so-called public option and SP as embodied in HR 676 stand in direct opposition to one another. The �real fight� is to pass HR 676. The �distraction� is the public option. Holland then goes on to undercut his argument even further by maintaining, �The proposal before us today, if done right – and the devil is most certainly in the details � achieve a hybrid public-private system with �some single-payer features�� Huh? We already have that system, it�s not working. Holland thinks eventually the public option will �achieve something approaching a single-payer system � through the back door.� I�m gobsmacked by Joshua�s naivet� or is it stupidity? Single-payer health care systems always come in through the front door. They don�t evolve into existence over time.

Secretary of Health and Human Services Kathleen Sebelius was asked about the public option, �Can you say flat out that it�s just never going to be single-payer health insurance?� She replied, �Oh, I think that�s very much the case.� She then went on to make the case which I won�t repeat here. When President Obama addressed the American Medical Association (AMA) he asserted, �What are not legitimate concerns are those being put forward that claim a public option is somehow a Trojan horse for a single-payer system�So when you hear the naysayers claim that I�m trying to bring about government-run health care, know this � they�re not telling the truth.�
We would do well to believe Obama and his fellow Democrats when they straight up tell us they are opposed to single-payer.

But Holland�s noxious line of reasoning goes even further. He posits the false notion that single-payer systems don�t really exist in other countries, but instead are �multiple-payers but with some single-payer features.� He cites Germany, Holland, Belgium and France as examples. This is simply not true. Elimination of U.S.-style private insurance, if it existed in the first place, has been a prerequisite to implementing a universal health care system in every country that has socialized health care. In each country the government guarantees coverage and pays for the majority of it, even though it might be privately delivered. Moreover, in none of these countries does the private insurance industry have the power, profits or influence they do in the United States. In some, they are allowed to feed around the edges of the system which can lead to problems. Ireland is an example. The private health insurer BUPA recently left the Irish market after a judge determined the company had unfairly skimmed healthier patients from the public system and ordered the company to make adjustment payments. Can you imagine that ever happening in the United States?

Holland thinks progressives need to �refocus the debate toward how much private sector involvement we want, what structure we might adopt for health care financed through the private sector in order to keep the insurance industry�s predations in check.� He acts as if all sides in the health care debate were sitting down as equals and had equal input. Progressive don�t even have a seat at the damn table. Holland sounds like Obama who tells us we have to keep the insurance companies �honest.�

This is a debate over fundamentals and ideology, not tactics on how to get to a single-payer system, despite Holland�s insistence it�s the other way round. Single-payer supporters aren�t fighting for a health care system designed to keep corporate killers predations in check, ensuring their honesty or �fair competition.� Why would anyone want to do that? Our movement is fighting to get rid of an industry that puts profits over patients once and for all and we have the audacity to believe we can do it.

We haven�t given up and we haven�t sold out.

It�s both better and honest to stand up and get arrested fighting for a piece of legislation you know will end unnecessary death and human suffering than to crawl and �advocate fiercely� as Holland is for a piece of shit legislation he knows will not.

Helen Redmond is a member of Chicago Single-Payer Action Network (CSPAN) and a licensed clinical social worker at Cook County Hospital and Clinics. She can be reached at: redmondmadrid@yahoo.com

Five Things People with Medicare Should Know

Do you have Medicare? Have questions about what the Affordable Care Act does for you?

Here are the five things people with Medicare should know about the law:

1. It makes prescription drugs more affordable.

If you enter the coverage gap known as the �donut hole,� you will receive a 50% discount when buying Part D-covered brand-name prescription drugs. This discount will be automatically applied at the counter of your pharmacy; you don�t have to do anything to get it. And over the next ten years, you will get additional savings until the coverage gap is completely closed in 2020.

2. It gives you preventive care services for free.

If you have Medicare, you can get free preventive screenings and services like colorectal cancer screening and mammograms. You can also get a free yearly wellness visit to develop and update your personal prevention plan based on current health needs. Again, these services are free: no co-pays or cost-sharing for you.

3. It provides incentives for your doctors to work together for you.

The law makes it easier for your doctors to work together by offering them support and resources for patient-centered care.� If you�re hospitalized, the new law also helps you return home successfully�and avoid going back�by helping to coordinate your care and connecting you to services and support in your community.

4. It strengthens Medicare Advantage.

If you have Medicare Advantage, you will be protected from large increases to your premiums or decreases in your benefits.� Medicare reviews changes to your plan before they happen to stop the ones that are unreasonable. Beginning in 2012, Medicare Advantage plans will have even more reason to improve the quality of care you receive.� Plans that have a rating of three stars or more on the quality rating system will receive a bonus, part of the national effort to improve quality.�

5. It helps ensure your access to care.

You can still choose your doctor. The law increases the number of primary care doctors, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments. Support for community health centers will increase, allowing them to serve some 20 million new patients.

For more information, please check out the online brochure, Medicare and the New Health Care Law � What it Means for You. (PDF - 314KB)

Wednesday, March 6, 2013

Firefighters Prevail In Fight for Health Insurance

More From Shots - Health News HealthHear That? In A Din Of Voices, Our Brains Can Tune Into OneHealthWhy ER Docs In The Big Apple Won't Replace That Painkiller PrescriptionHealthInfections With 'Nightmare Bacteria' Are On The Rise In U.S. HospitalsHealthA Costly Catch-22 In States Forgoing Medicaid Expansion

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Tuesday, March 5, 2013

A Costly Catch-22 In States Forgoing Medicaid Expansion

More From Shots - Health News HealthInfections With 'Nightmare Bacteria' Are On The Rise In U.S. HospitalsHealthA Costly Catch-22 In States Forgoing Medicaid ExpansionHealthOften A Health Care Laggard, U.S. Shines In Cancer TreatmentHealthGot A Health Care Puzzle? There Should Be An App!

More From Shots - Health News

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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The Affordable Care Act Will Bring Down Costs

Over the last year, much of the attention on the Affordable Care Act has focused on reforms that are helping Americans get health coverage.� These provisions are already making a big difference in Americans� lives, from ending some of the worst insurance company abuses to giving many young people the freedom to stay on their parent�s health coverage plans until age 26.

But just as important, the Affordable Care Act is also bringing down health care costs for families, businesses, and government.

Let�s look at the facts:

The independent, non-partisan Congressional Budget Office � Congress�s official authority on the budget � estimates that provisions in the law will reduce the deficit by $143 billion over its first 10 years and by $1 trillion over the next two decades.

And the Medicare trustees recently reported that the Affordable Care Act has added eight years to the life of the Medicare Trust Fund.

How does it do this?

First, the law bolsters the Obama Administration�s historic effort to crack down on Medicare fraud that already returned a record $4 billion to the program in 2010.

Second, it puts an end to wasteful subsidies to private insurance companies.

Third, it provides a historic level of support for cutting-edge delivery and payment reforms, like Accountable Care Organizations and bundled payments, that allow doctors and nurses to deliver care more effectively.�

And that�s just the start.� As 272 of America�s top economists said in a letter earlier this year: �the ACA contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending.�

The health care law is also bringing down health care costs for America�s businesses.

Many small businesses are already taking advantage of tax credits in the new law that can cover as much as 35 percent of their health insurance premiums.�� In 2010 and 2011 alone, small businesses could save $6 billion.�� And that number will rise as we move towards 2014 when small businesses will be eligible for tax credits of up to 50% of their premiums.

Meanwhile, the claim that the Affordable Care Act gives large companies incentive to drop health coverage has been thoroughly debunked by several independent experts:

Here�s what the Rand Corporation said: "The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with fewer than 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges."

And here�s the Urban Institute: "Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform."

Most importantly, the law will help all businesses, large and small, by bringing down the cost of care.� For American companies whose international competition often spend 40 cents on health care for every dollar spent in the US, this will provide a much needed competitive boost.

Finally, the law will bring down costs for American families.

New Affordable Insurance Exchanges will level the playing field for individuals and families purchasing coverage in the health insurance market and allow families who have been locked out and priced out of the market to get affordable coverage.�

And for middle-class families that need help paying for coverage, the law also provides unprecedented tax relief that will cut the cost of insurance while guaranteeing access to basic health benefits.

In addition, the Affordable Care Act has given states new resources to review and reject huge premium hikes and told insurers to cut their administrative costs and spend the bulk of consumer premiums on health care, instead of advertising and large CEO bonuses.

We�re already seeing the fruits of that labor with a sharp slowdown in the growth of premiums in many states across the country.

For too long, Americans have watched health care costs skyrocket with no end in sight.� The Affordable Care Act will stabilize costs, reducing the deficit, helping businesses compete and invest, and freeing families from the fear that an illness or injury could send them into bankruptcy.�

That�s good for our health and our economy.

Monday, March 4, 2013

What the Health Law Means for the Latino Community

Across the country, more than 50 million Latinos are part of our communities, classrooms and workplaces. And thanks to the health care law, the Affordable Care Act, an estimated 5.4 million Latinos will gain insurance coverage by 2016 under the new law, according to an issue brief released by HHS today (go here to read it in Spanish). Just two years after it was passed, the health care law has already improved health outcomes and increased access to care for Latinos by:

Extending coverage to an estimated 736,000 Latino young adults under a provision that allows them to stay on their parents� health insurance until they turn 26,Expanding access to preventive services with no-cost sharing to an estimated 6.1 million Latino Americans with private insurance, andRequiring most health insurance plans to cover prevention and wellness services like cancer screenings, flu shots , and pap smears and mammograms for women, with no cost-sharing.

While 16.3 percent of Americans are currently uninsured, the percentage of Latinos without health insurance is even higher at 30.7 percent. As the law continues to be implemented:

Latinos of all income levels who would otherwise be uninsured will have access to health insurance through new Affordable Insurance Exchanges and as a result of expanded Medicaid coverage,Latino Americans suffering from a chronic disease�like the estimated 4.3 million Latino adults who are currently living with diabetes�will have access to new care innovations, like community health teams, that will help them manage their illness, andLatinos living in medically underserved areas will have access to new community health centers and preventive and primary care services.

To learn more about the impact of the Affordable Care Act on the health of the Latino community, join our Spanish-language Twitter chat today, April 10. You can join in the conversation starting at 2pm EST by following the #LaSaludLatina hashtag and at @HHSLatino.

You can read the issue brief in English here, and in Spanish here, For the fact sheet, visit this page.

6,000 Nurses Bring Robin Hood to Chicago

From National Nurses United –

More than 6,000 nurses and activists gathered at Daley Plaza in Chicago Friday to rock out with musician Tom Morello and call for a tax on financial speculation � a Robin Hood tax. This small sales tax on Wall Street trades could raise up to $350 billion a year in the U.S., money that American communities desperately need.

It’s time for Wall Street to start paying what all the rest of us pay,� Karen Higgins, RN, told a cheering crowd, many wearing red nurse scrubs and green Robin Hood caps. Higgins, who works as a registered nurse in Boston, is co-president of National Nurses United, the country�s largest registered nurses� union, which organized the rally.

As nurses, they see how the economy is hurting families and communities across the country. They understand the suffering Americans face every day � in healthcare, foreclosure, jobs, and education.

I’ve been a nurse for 38 years and I have never seen our communities in such disarray and in such suffering as I have in the last couple of years,� said Deborah Burger, RN, and NNU co-president. They got us into this mess and they have the money to bail us out.

Indeed they do — almost a quarter of the nation�s GDP � close to $4 trillion � sits in corporate coffers, the largest cash hoard in U.S. history.

We are here to protest all the people that are taking all the money out of our economy,� said Jean Ross, RN, and co-president of NNU. �We the 99 percent know what it�s about. We set an alarm. We work for a living. We don’t sit by a swimming pool and wait for our dividends to come in.

More than 100 organizations of community, environmental, labor, and health groups from around the world endorsed the event.

RoseAnn DeMoro, NNU�s executive director, thanked everyone for being there and gave a special shout-out to Occupy protesters.

�To all the community groups, the political groups, the non-profit groups that came out to support us — bless you,� DeMoro said. �It�s your voices that are going to make a difference in this country.

Also speaking at the rally was Tom Hayden, student activist during Chicago’s 1968 protests.

The rally ended with a performance by music legend Morello, who played with bands Rage Against the Machine and Audioslave, and is also known for his acoustic music as The Nightwatchman.

It�s an honor to be here today in my hometown of Chicago with the nurses union. I want to thank them for standing up for free speech, for standing up for economic justice, and standing up for me,� he said.

Morello�s reference was to a standoff between the nurses and the City of Chicago over a permit to assemble in Daley Plaza. The city changed the permit last week that would move the rally away from downtown Chicago. After nurses and the community protested, the city caved and allowed the rally to go on at the plaza as planned.

Before the rally, nurses attended an international panel discussion on global austerity and ways to fight back, including the Robin Hood tax.

It�s so important we have a strong Robin Hood tax campaign,� said J�rn Kalinski, Oxfam Germany director of lobbying and campaigns. �We need America to come around on this issue.

In addition to Kalinski, other speakers included:

Mi Jung Han, RN, Vice President, Korean Health and Medical Workers Union (South Korea), David Hillman, Coordinator, Stamp Out Poverty (UK), Rosa Pavanelli, President, Funzione Pubblica CGIL (Italy) and Vice President, European Federation of Public Service Unions (EPSU), Linda Silas, RN, President, Canadian Federation of Nurses Unions (Canada), and Brenda Cristina Morales, RN, Regional Coordinator, Sindicato Nacional de Trabajadores de Salud deGuatemala (SNTSG) (Guatemala) made presentations.