Search posterous

Search all posts and users. Type a name, type a favorite song title, whatever! See what comes up.
  

More posterous blogs











More recommended blogs »

Here are posterous posts filed under healthcare...

Dave says...

For those who missed it, here is a link to the segment on CBS’s 60 Minutes program on end of life care in hospitals, named The Cost of Dying. It aired this past Sunday.

This is a powerful and thought-provoking look at a milieu I know all too well from work experience. Our nation spends tremendous sums in caring for its citizens’ last few weeks and months of life, with many suffering in ICU’s with tubes in just about every orifice, unable to speak, often with arms tied down lest any of those blessed tubes become dislodged. And, as the segment correctly points out, the lion’s share of the financial burden is borne by Medicare. Which means, dear reader, since Medicare is a government-run health plan, the costs are paid by you and me, and even more so by our descendants when we run up ever more massive deficits.

Therefore, there are both humanitarian and fiduciary reasons to do what we can to improve the situation. That said, there are also right and wrong ways to do it.

We as humans are called upon to respect and support human life. Death is a part of life. We should acknowledge the fact and work in our healthcare organizations to provide more humane, dignified, and peaceful settings for people to live their final days. Hospice and palliative care services are cost-effective but woefully underutilized. The televised segment hits on the point that many doctors are uncomfortable about surrendering to the grim reaper, and in so doing they rack up monstrous expenses that improve nobody’s health. We should help them learn how to have those difficult conversations.

I am privileged to know intensivists who are very skilled in this area. I have seen how they work with families and hospital staff to, shall we say, improve the quality of death for patients. We would benefit from having more physicians with this skill set.

Ultimately, while the healthcare team can help them let go and accept the reality of irreversible illness, the patient and family must be in control of the decision. This is a fundamental human right, one we dare not abridge.

I was disturbed by some of the comments made by one of the physicians in this story. My hackles were raised when I heard him say, “At the present time, it’s their right” to have all lifesaving measures performed, referring to patients and those who speak for them. The implication, confirmed later, was that he advocates removing the capacity for making that decision from those who should be making it. Rather, he believes there should be nationally-determined standards for what modalities should and should not be used. He actually said that such panels will make it much easier to issue across-the-board denials of care. My jaw dropped. (Sarah Palin, call your office!)

I’m sorry, but government-sponsored rationing of care is not going to help our financial predicament, and it certainly will be devastating to countless patients and loved ones. We need ways to rein in costs while preserving patient choice and improving their quality of life, whether that remaining life be measured in days or decades. Government has never shown any aptitude for managing even the most delineated processes efficiently or effectively. Think Postal Service, Amtrak, Cash for Clunkers, this season’s flu vaccines, and, yes, Medicare – which has cost us and our children’s children many times what was ever estimated.

I have just started reading a fascinating book by Steven Spear, Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win. A good portion of the book examines how top performing health systems manage to lead the pack. I will post a full review at a later time, but suffice it to say that the care innovations adopted by the “rabbits” profiled by Spear both improve quality of care and decrease cost – and, most notably for my current argument, not a single one of the innovations required or involved any sort of government intervention. As in all areas, in healthcare the free market can work, and it does when unrestrained by bureaucratic red tape and regulations.

Please view the 60 Minutes segment; it’s only 15 minutes long. Kindly comment on your impressions of the protagonists and any insights you are willing to share from your experiences – from either side of the bed rails.

Filed under: Healthcare

  What do you do for money, honey?

There is a non-scandal brewing over the choice of words used to describe Louisiana Senator Mary Landrieu. Apparently, some talk radio hosts used a shocking term for her, and the liberal media jumped all over it like catnip. Cue the phony outrage:

Glenn Beck and Rush Limbaugh make deeply offensive comments on a near-daily basis on their respective radio programs. Mostly, I don't feel the need to draw attention to them. But yesterday both men crossed into completely unacceptable territory. Followers of the health-care debate will know that Louisiana Senator Mary Landrieu is high on the list of moderate Democrats who may ultimately vote against the bill. On Saturday, she was the second-to-last senator to lend her vote to a motion to open debate on the bill. Part of her motivation to consent came form a concession she successfully extracted from leadership $300 million to pluga gaping hole in Louisiana's budget, a state still suffering in the aftermath of Hurricane Katrina and the botched emergency response to that crisis. The formula that determines federal Medicaid funding counted one-time post-Katrina aid to Louisiana as an increase in household income, thus causing the budget shortfall. The funds will help cover medical costs for the poor and uninsured, which, in part thanks to Katrina, Louisiana has in spades. Landrieu says that Louisiana's Republican Governor Bobby Jindal had explicitly asked her to pursue these funds. Sources on Capitol Hill confirm that Jindal had been pressuring Landrieu on the issue for months.

Such a deal shouldn't be a surprise. Like it or not, it's routine practice on Capitol Hill to trade your vote for something that helps your state. That's just the cost of doing business in D.C. And yet Landrieu's actions prompted Beck and Limbaugh to call her a prostitute. Beck likened her to a high-class hooker, saying, "She may be easy, but she ain't cheap." Limbaugh dubbed her "the most expensive prostitute in the history of prostitutes." (Keep in mind though, that Landrieu still hasn't committed to voting for final passage of the health-care bill. She's openly declared that she still has reservations about the bill. Saturday's vote was simply about opening debate.)

What that makes here is a whore, not a prostitute. A whore has no scruples, and will do anything to get something from someone--hence, Landrieu is a whore for attention, and wants whatever she can get, and, like Lucy with the football, she'll take everything they give her and promise the moon and then give everyone the high hat. A prostitute has sex with people for money. Radio talk show hosts are whores for ratings. Everything they do is designed to create phony issues. Anyone who takes them seriously is not a serious person, in and of themselves.

The problem is, whore sounds worse than prostitute, and men can certainly be whores. Man-whores abound in places like Washington D.C. and you can scarcely go a few blocks without running over someone who is willing to whore themselves out to a lobbying firm, a head of state, a media company, or a tourist. We have a huge problem with men and women whoring themselves out for cash in Washington D.C. Don't hold your breath--no one cares and no one is doing anything about it.

It's never a nice thing to call someone names, however. It would be better if the good Senator simply acted like a responsible steward of her responsibilities and voted according to her own convictions. Did she have an internal struggle with the idea of voting to get money that might, in the long run, be better spent or not spent at all? Did she put self-interest ahead of the good of the country? She is there to represent her constituents; that she traded her vote to help them is what it is, and that is, a transaction for money. We sometimes put politicians in jail for that sort of thing, or perhaps I have that backwards. Can you trade your vote for money? Can you sell your vote as a U.S. Senator for $300 million dollars, even if none of it goes to you? Because, I can guarantee you, if $300 million dollars goes back to the state of Louisiana, a very small chunk of that is going to go right back to Landrieu is some way, either as a donation to her re-election campaign, as funds spent on something that benefits her business interests, or to hire people who will then owe her some sort of patronage favor.

All of her previous statements about honor and integrity are now the most laughable form of hypocrisy. She can be bought with legislation, and I guess that makes us a Republic.

Filed under: Health Care

8 Steps Obama Could Take to Save Food

November 20th, 2009  By Robyn O'Brien

The landscape of health has changed. No longer are our families guaranteed a healthy livelihood, not in the face of the current rates of cancer, diabetes, obesity, Alzheimer’s and allergies. In the words of Elizabeth Warren, Harvard University law professor who is head of the Congressional Oversight Panel, “We need a new model,” and we need a new food system. It’s our health on the line.

8 Steps Obama Could Take to Save Food:

1. Evenly distribute government moneys to all farmers. The current system allocates the lion share of our tax dollars (approximately $60 billion) to farmers growing crops whose seeds have been engineered to produce their own insecticides and tolerate increasing doses of weed killing herbicides. As a result, these crops, with a large chemical footprint, are cheaper to produce, while farmers growing organic produce are charged fees to prove that their crops are safe and then charged additional fees to label these crops as free of synthetic chemicals and “organic”. If organic farmers received an equal distribution of taxpayer funded handouts from the government, the cost of producing crops free from synthetic chemicals would be cheaper, making these crops more affordable to more people, in turn increasing demand for these products which would further drive down costs.  If we were to reallocate our national budget and evenly distribute our tax dollars to all farmers, clean food would be affordable to everyone and not just those in certain zip codes.

2. Reinstitute the USDA pesticide reporting standard that was waived under the Bush administration. In 2008, the USDA waived pesticide reporting requirements (a procedure that has been in place since the early 1990s) so that farmers and consumers would know the level of chemicals being applied to food crops. Given a report just released that reveals a 383 million pound increase in the use of weed killing herbicides since the introduction of herbicide tolerant crops in 1996 and the potential impact that this glyphosate containing compound is having on both the environment and on our health, perhaps the “don’t ask, don’t tell” policy assumed under the previous administration should be reversed.

3. Reinstate the pre-Bush administration dollar value that the EPA places on the life of every American. in May 2008, the Bush administration lowered the value placed on the life of every American by almost $1 million, benefiting corporations who use this figure in their cost benefit analyses, marking down our lives from $7.8 million to $6.9 million the same way a car dealer might markdown a “96 Camaro with bad brakes. The EPA figure is used to assess corporate liability when a company’s actions put a life at risk. While this figure benefits the corporations conducting the cost benefit analysis when assessing the health impact of their chemicals, the costs of these chemicals are being externalized onto the public in the form of health care costs.

4. Allow public debate over the nomination of pesticide lobbyist, Islam Siddiqui for Chief Agriculture Negotiator at the office of the United States Trade Representative. As addressed in a letter sent to Chairman Max Baucus and Ranking Member Charles Grassley of the Senate Finance Committee, Islam Siddiqui, nominated for Chief Agriculture Negotiator at the office of the United States Trade Representative, was formerly employed by CropLife America, whose firm challenged Michelle Obama’s organic garden, has consistently lobbied the U.S government to weaken international treaties governing the use and export of toxic chemicals such as PCBs, DDT and dioxins, and blocked international attempts to help regulate pesticides that increasingly linked to chronic skin and respiratory problems, birth defects and cancer in our community. Given that a growing body of scientific evidence supports the theory that chemicals in our food are contributing to the rise in health problems, particularly in children, the appointment of an industry lobbyist to export our challenged food system to the rest of the world may be in the best interest of agrichemical corporations but consideration should also be given to the health implications that these novel chemicals, proteins and allergens may have.

5. Encourage climate change advocates like Al Gore to discuss Pesticide Use by Big Ag and its Chemical Footprint. While speaking openly about the petroleum industry’s impact on global warming, leading environmental advocates like Al Gore have been quiet about the chemical contribution that the recent introduction of crops genetically engineered with pesticidal toxins play on global warming despite scientific evidence from the Royal Society of Chemistry highlighting their impact. Since the Clinton Administration’s introduction of biotech crops designed and engineered to both withstand increasing doses of weed killing chemicals and produce their own insecticides, new reports based on USDA data, show a 383 million pound increase in the chemicals being applied to these crops since their introduction in 1996. According to the Royal Society of Chemistry, “growing biofuels is probably of no benefit and in fact is actually making the climate issue worse” given that glyphosate, being applied in increasing doses to these crops, breaks down into nitrogen.

6. Update the Consumer Protection and Food Allergen Labeling Act to inform consumers of these newly engineered corn allergens. The recent engineering of novel food proteins and toxins into the US food supply has enhanced profitability for the food industry by allowing commodities like corn to produce their own insecticides. As a result, corn is now considered an insecticide and regulated by the EPA .  For this same reason, this corn has been either banned or labeled in products in other developed countries because the new toxins and novel allergens that it contains have not yet been proven safe. Despite the lack of evidence, this corn is in the American food supply. The increase in the rate of food allergies as demonstrated in the December issue of Pediatrics and the growing number of people with this condition- whose bodies recognize food as “foreign” and launch inflammatory reaction in an effort to drive out these “foreign” food invaders, speaks to the need to update and amend the food allergen labeling act to label these newly engineered genetically enhanced proteins and allergens as governments around the world do.

7. Ask the SEC to join the Department of Justice in its investigation into trade practices in agrichemical industry. As the Department of Justice begins its investigation into the impact that Monsanto’s monopoly is having on farmers, their financial situation and the food supply, research out of the USDA highlights that the biotech industry is not delivering on what some are calling their “hype-to-reality ratio”. As farmers are charged premiums for seeds that have been engineered to produce greater yields, research out of the USDA, Kansas State University shows that these products are not delivering as promised, directly impacting the cost structures of farmers in a razor to razorblade scenario. As farmers purchase genetically modified seeds in the hopes that they will increase yields and drive down cost structure and their dependency on weed killers, studies now suggest that since the introduction of the “razor”, these biotech crops introduced 13 years ago, farmers are actually spending more on the “razorblade”, the herbicides and weed killers required to manage them, driving farmers debt to asset ratios to record levels. Given that Monsanto’s CFO, Treasurer, Controller are all leaving the company by year end, the Securities and Exchange Commission could interview these three exiting executives and learn more about the financial predicaments of Big Ag’s customers, the farmers, and the greater ramifications that this monopoly will have on food prices.

8. Appoint a Children’s Health Advisor to serve on the USDA’s National School Lunch Program. The landscape of children’s health has changed. No longer are the American children guaranteed a healthy childhood, not in the face of the current rates of obesity, diabetes and allergies. Perhaps it is time that we follow the lead of governments in other developed countries and create a Chief Advisor for Child and Youth Health whose responsibilities might include, but not be limited to, serving in an advisory capacity to the USDA on the National School Lunch Program. Under the USDA’s current budget for the National School Lunch Program of approximately $8.5 billion (in comparison the Pentagon’s 2009 budget $600 billion), less than a dollar is available per meal for the purchase of healthy food once overhead costs are taken out. Given that 1 in 3 American children now has allergies, ADHD, autism of asthma and according to an October 2008 study from the Centers for Disease Control, 1 in 3 Fourth graders is expected to be insulin dependent by the time they reach adulthood. As a result, dietary concerns are becoming increasingly prevalent for the estimated 30.9 million children and approximately 102,000 schools and child care institutions that participate in the National School Lunch Program. Given that increasing scientific evidence points to the roles that environmental insults like synthetic growth hormones in milk and trans fats in processed foods are having on our health, investing in a children’s health advisor may provide long term benefits to the future of our health care system .

It’s our food system on the line.  And if our children are any indicator, our health and the economic burden that it presents are on the line, too.del.icio.usYahoo! Buzz

According to the New York Times, Robyn O'Brien is "food's Erin Brockovich." As the founder of AllergyKids, an organization designed to protect the 1 in 3 American children with autism, allergies, ADHD and asthma, Robyn has appeared on Good Morning America, CBS Evening News with Katie Couric and CNN highlighting the role that chemicals in our food supply are having on our health. Born and raised in a conservative Texas family on supply side economics and the Wall Street Journal, Robyn earned a Fulbright Fellowship, an MBA and served as an equity analyst on a multibillion dollar fund prior to moving to Boulder, Colorado with her husband and four children. She is the author of the book, The Unhealthy Truth: How Our Food Is Making Us Sick and What We Can Do About It.

 

 

Filed under: Health Care

useddemocrat says...

If they really get this Healthcare thing passed, and history is now on their side... then here comes the TAX PAIN!

I can't decide which is worse, Healthcare reform (deform is more like it), or Eric Holder. Maybe Eric Holder is worse. Yes higher taxes is less damaging than the foolish Eric Holder.

 

Filed under: Healthcare

S.O.S. says...

By LYNSI BURTON

Hearst Newspapers

WASHINGTON — In a bid to win support from fence-sitting moderate Democratic senators, the Senate leadership has included provisions in its healthcare proposal that would bar any aid to illegal immigrants and would restrict assistance to immigrants residing legally in the United States.

Senate Majority Leader Harry Reid needs the support of all 58 Democrats and both independent senators in a procedural showdown vote today on whether he can block a Republican filibuster that would kill the health bill.

The result: Moderate-to-conservative Democratic senators such as Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana, along with independent Joe Lieberman of Connecticut, effectively have veto power over the bill.

Like the recently approved House version of healthcare reform, the Senate bill would deny federal subsidies to help undocumented immigrants buy insurance. But the Senate bill would also bar undocumented immigrants from participating in health insurance exchanges even if they pay full price with their own funds.

The Senate would also impose a five-year waiting period before legal immigrants who are not citizens could gain access to any federal health insurance subsidies.

The concessions to immigration critics have shaken Latino rights groups, who have strongly backed Democratic attempts to overhaul the American healthcare system.

"Diseases know no boundaries," said Elena Rios, president of the National Hispanic Medical Association. "The best idea would be to have everyone have healthcare."

Hispanics in the House — there are none in the Senate — are furious. Rep. Luis Gutierrez, D-Ill., calls the Senate provisions "mean-spirited" and "dehumanizing."

Some medical providers in cities like Houston contend that taxpayers would be the ultimate victim of any plan that keeps immigrants away from primary doctors and instead funnels them to public hospitals’ emergency rooms.

"Those problems are not going to go away" unless immigrants obtain access to primary-care physicians rather than using emergency rooms as a first resort, said David Lopez, CEO of the Harris County Hospital District. "I think it needs to be addressed now."

Texas has the highest number of uninsured immigrants in the U.S. Of the 6 million or so uninsured residents in Texas, about 1.5 million are not citizens, said Anne Dunkelberg, associate director of the Center for Public Policy Priorities in Austin.

Looking for comments?

Filed under: health care

Michael says...

(11/20/09) -- Even if you had a stroke or other brain injury years ago, you may be able to start healing in the comfort of your own home.

HealthFirst reporter Leslie Toldo tells us about a new device a Saginaw woman helped design.

 

First time I've heard about this device; Bioness makes a unit for hands and arms, too, but I'm not ready for it yet. See video at the source.

 

 

Filed under: Health Care

Michael says...

A man should be careful talking about mammograms. But the report issued this week by a panel of doctors who recommended less frequent testing for breast cancer in women under 50 comes as Congress and the country debate health care coverage.

Since the report came out, news accounts and blogs have featured hundreds of personal stories from women in their 40s who say—just this bluntly—that these new guidelines would have killed them by letting their cancer grow without detection.

I know enough about mammograms to know that they're not marshmallow treats. They're painful and humiliating tests that squash a woman where it hurts most. Most men—myself included; maybe even Daniel Craig included—would cringe to have a mammogram.

And when the results are what they call "false-positive," a week or more of worry and anxiety follow, along with a stinging biopsy. It's good news if nothing is found, but still a punishing experience. I can understand why a lot of women would almost welcome a medical excuse to avoid an annual mammogram.

The Washington Post ran a piece Friday by two physicians who worked with the doctor's task force. Douglas Kamerow at Georgetown University, and Steven Woolf, at Virginia Commonwealth, defended their recommendation, noting that every 1,900 screenings in women ages 39 to 49 produced just one case in which cancer was discovered and arrested.

They suggested that between bad results and biopsies, annual tests lead to a lot more worry and pain than cures. And, yes, cost a lot of money that might be directed elsewhere.

Of course: what if you are that one woman in 1,900? Or that one woman is your wife or mother? And if you screen just 1 million women between the ages of 39 and 49, statistics suggest you may catch cancer before it can grow in 526 women.

Maybe we shouldn't be shocked, shocked to think some doctors might find the chance to save one life in 1,900 to be small result for so much effort. A lot of us play with our odds of survival by smoking, overeating, or talking on the phone while driving.

People on all sides of the health care debate like to talk about how money can be saved in their particular plan by reducing the number of medical tests that seem redundant or unnecessary. This week, we may have seen what happens when someone suggests a way to actually do that. A lot of people decide they can't live with that.

Thank you, Scott.

Filed under: Health Care

Michael says...

There is no question more women than ever before are surviving breast cancer. This is happening because of early screening and better and more aggressive treatment. So I was absolutely shocked today to hear that the United States Preventive Services Task Force (a committee appointed by the U.S. Department of Health and Human Services) is now recommending that women do not get regular mammograms until their fifties and even then limit screening to every other year. In addition they are suggesting that breast self exams not be taught. ARE THEY CRAZY?

There is no way to completely express my feelings about this. I was diagnosed with stage 3 breast cancer at the age of 44, and the tumor was discovered through self breast exam and confirmed through a mammogram. This was only 18 months since a previous mammogram that was negative. My story is not unique.

I am wondering if the members of the Preventive Services Task Force have been living in a cave for the past decade. We have come so far. We can predict breast cancer through genetic screening. We have digital imaging along with mammograms to help detect tumors earlier. Efforts to raise breast cancer awareness and research funds is amazing. What on earth is this group thinking?  It all sounds so backwards, especially now that we are seeing some progress on health care reform.

This is an assault against women. There is no other way to describe it. Although breast cancer strikes men as well, breast cancer is identified as a woman’s disease and these guidelines are targeted at women’s health.

I am angry and I hope you are too. I will be contacting my representatives and I intend to be relentless.

Kathy-Ellen

I think that last suggestion is the important one--make sure Congress hears from you that this recommendation should not be implemented.

Filed under: Health Care

Jim says...

You've heard the expression that some people spend all their time fighting the last war. We are seeing this again with H1N1

The last time the US government faced an H1N1 epidemic (in the 1970s) they pushed mandatory vaccine at much of our populous. This was to the avoid a repeat of the 1919 Spanish Flu pandemic. Unfortunately, it lead to many side adverse events (quickly ending the mandatory vaccinations).

For the next 20 years public policy schools taught this case as a Public Policy Risk Management Exercise (I studied mine in 1995). The exercise made heavy use of Bayesian analysis, encouraging students away from the extremes of "mandatory evacuation" and "doing nothing" moving towards a "wait and see" approach of producing and distributing vaccine and holding to see what happens. We are now seeing the results of this in practice -- but with some extra cost-benefit analysis thrown in. As a result, we have vaccine shortages and lots of finger pointing.

It will be curious to see how this Study Case is updated and what the new recommended answer will be. Hopefully it will be something 21st century-based that leverages the Internet to get feedback from citizens to determine how much vaccine to make.

Filed under: Healthcare

This NPR story is a breath of fresh air. Nearly all of the media coverage of the effort to pass health care reform focuses on the political process: How many votes in committee, timelines, poll numbers, bi-partisanship, 'oh-snap!' back-and-forth soundbites, right-wing troll death panel comments, etc etc etc.

Meanwhile, little or no effort is made to cover the nuts and bolts of why, exactly, we spend so much more on health care per capita than any other nation. Where is all that money going? And why is it going there? This NPR story is a terrific piece of journalism - reporter Hana Jafiwal actually investigates the pricing and cost structure behind MRI's, and why they cost so much more in the US as compared to Japan.

Alone, the story is educational, but still mostly a curiosity. What we need is an ongoing thread of reporting like this and media coverage of the mechanics of our health care infrastructure, so that we can collectively understand the root causes and structural issues that have driven us to the brink of health care disaster.

Filed under: health care