Tag: health care

Costa Ricans Live Longer Than We Do. What’s Their Secret?

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Álvaro Salas Chaves

Life expectancy tends to track national income closely. Costa Rica has emerged as an exception. Searching a newer section of the cemetery that afternoon, I found only one grave for a child. Across all age cohorts, the country’s increase in health has far outpaced its increase in wealth. Although Costa Rica’s per-capita income is a sixth that of the United States—and its per-capita health-care costs are a fraction of ours—life expectancy there is approaching eighty-one years. In the United States, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.

People who have studied Costa Rica, including colleagues of mine at the research and innovation center Ariadne Labs, have identified what seems to be a key factor in its success: the country has made public health—measures to improve the health of the population as a whole—central to the delivery of medical care. Even in countries with robust universal health care, public health is usually an add-on; the vast majority of spending goes to treat the ailments of individuals. In Costa Rica, though, public health has been a priority for decades.

The covid-19 pandemic has revealed the impoverished state of public health even in affluent countries—and the cost of our neglect. Costa Rica shows what an alternative looks like. I travelled with Álvaro Salas to his home town because he had witnessed the results of his country’s expanding commitment to public health, and also because he had helped build the systems that delivered on that commitment. He understood what the country has achieved and how it was done.

Decades ago, I worked in and around the medical community in New Haven, Connecticut. Never as a provider. Most often in one or another support system. I had many friends who were undergrads, graduate students, faculty…ranging from Yale Med School to their superb Public Health School. And it all reflected the characterizations in this article. Public Health in American politics has been and continues to be a lesser add-on to the “more important” medical care system. At best. If that’s changed, I’ll be pleased to hear about it.

Obamacare’s individual mandate is working

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❝The individual mandate is among Obamacare’s most hated provisions. About two in three of Americans think the requirement to buy health insurance is a bad idea.

But recent enrollment data shows that the mandate is working. The exact type of people the requirement was meant to target — young, healthy adults who might forgo coverage were it not for a government fine — signed up in record numbers this year.

❝Having a decent number of young and health people in the insurance pool is integral to making costs affordable for everyone, which is exactly why the mandate exists in the first place. And architects of Obamacare’s enrollment strategy say that talking about the mandate — something Obamacare supporters didn’t really start doing until 2015 — has been core to making it work…

❝”The first year we were concerned it would be interpreted as a negative message, possibly turning people off,” says Anne Filipic, who runs Enroll America, a national nonprofit focused on getting the uninsured signed up for the health law’s insurance expansion.

But 2015 was different. Survey research had shown that, despite the mandate’s unpopularity, reminding the uninsured of the fees they’d face for remaining uninsured was an excellent way to encourage them to buy coverage. The penalty rose from $95 in 2014 to $695 in 2016…

New data suggests the new message was successful. In 2015, people under 35 made up 35 percent of Healthcare.gov’s open enrollment sign-ups. In 2014, the number stood at 33 percent. What’s more: Healthcare.gov netted 980,000 new enrollees under 35 this year, a big increase over the 670,000 new sign ups last year…

❝”The increase in young people is very encouraging,” she says. “The fine is going up, and we’re three years into this now. So the repeated message, seeing friends and family get coverage, all those things are now starting to come together.”

Americans are funny. We’re supposed to hate government unless it benefits us directly. So, insurance – when required – is something we try to avoid even though we benefit as individuals as much as collectively by costs coming down as a result of a broader compass of coverage.

So it was with auto insurance. So it is with health insurance.

Now, if we can only get the cretins in Congress to move ahead on single-payer provisions and negotiated prescription prices.

In Mississippi, Obamacare rolls out on private wheels

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A custom-built bus with oversized windows is parked outside a health fair at the University Medical Center. The decal on its side reads, “Making Healthcare Reform Transparent.” Inside the bus are snacks, Wi-Fi and three booths where sales agents from the Humana health-insurance company sit behind laptops and explain the Affordable Care Act to uninsured people. They sign up customers, too.

Mississippi is the poorest, sickest state in the nation, and most insurance companies have avoided it altogether, preferring to do business in more profitable markets. In 36 of Mississippi’s poorest counties, no insurance companies were offering plans that meet ACA guidelines until the Obama administration intervened and asked Kentucky-based Humana to help fill in the gaps. Humana had two of these buses built to spread awareness and drum up business. They’re zigzagging around the state on a tour called Covering Mississippi. So far they’ve traveled 7,000 miles, and the agents have seen more than a thousand people…

Nowhere else in America has a greater need for affordable, accessible health care. Mississippi has the lowest life expectancy in the country, the highest rates of obesity and diabetes, and an infant mortality rate closer to Sri Lanka’s and Botswana’s than to the rest of the United States’. Heart disease is epidemic, and nearly 20 percent of the state’s population — some 511,000 people — were uninsured when President Obama signed the Affordable Care Act last March…

When the ACA was written, the law required all the states to expand Medicaid. Low-income people who weren’t poor enough to get existing Medicaid would be covered. Then the Supreme Court decided that states had the right not to expand Medicaid. Mississippi, led by Republican Gov. Phil Bryant, who has described Obamacare as “an assault on the liberty of American citizens,” was one of two dozen states to exercise this right. That left an estimated 300,000 Mississippians with no prospect of health insurance.

Just in case you still labor under the misapprehension that today’s conservatives actually care crap about working people, working poor, poor people. Decades of hatred rooted in racism support a political structure not only tied to elitism; but, willing and able to destroy the lives of people without power.

Mississippi is the worst example of this kind of criminal politics, a gangster economy, corrupt and ready to lie about everything from the weather report to school menus to maintain power for the racist elite.

The classic Southern Strategy of deluding white people into believing that because they are better off than Black folks – they are better off in general – has never changed. It wandered over from Dixiecrat Democrats to Nixonian Republicans. Stupid still trumps ignorance. But, then, that’s been the premise of the Confederacy and States’ Rights since we started the long march towards democracy in 1775.

Germany “exporting” old and sick to eastern Europe and Asia

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German pensioners in Berlin

Growing numbers of elderly and sick Germans are being sent overseas for long-term care in retirement and rehabilitation centres because of rising costs and falling standards in Germany.

The move, which has seen thousands of retired Germans rehoused in homes in eastern Europe and Asia, has been severely criticised by social welfare organisations who have called it “inhumane deportation”.

But with increasing numbers of Germans unable to afford the growing costs of retirement homes, and an ageing and shrinking population, the number expected to be sent abroad in the next few years is only likely to rise. Experts describe it as a “time bomb”.

Germany’s chronic care crisis – the care industry suffers from lack of workers and soaring costs – has for years been mitigated by eastern Europeans migrating to Germany in growing numbers to care for the country’s elderly.

But the transfer of old people to eastern Europe is being seen as a new and desperate departure, indicating that even with imported, cheaper workers, the system is unworkable…

Researchers found an estimated 7,146 German pensioners living in retirement homes in Hungary in 2011. More than 3,000 had been sent to homes in the Czech Republic, and there were more than 600 in Slovakia. There are also unknown numbers in Spain, Greece and Ukraine. Thailand and the Philippines are also attracting increasing numbers.

According to Germany’s federal bureau of statistics, more than 400,000 senior citizens are currently unable to afford a German retirement home, a figure that is growing by around 5% a year.

The reasons are rising care home costs – which average between €2,900 and €3,400 (£2,700) a month, stagnating pensions, and the fact that people are more likely to need care as they get older.

With Germany’s population expected to shrink from almost 82 million to about 69 million by 2050, one in every 15 – about 4.7 million people – are expected to be in need of care, meaning the problem of provision is only likely to worsen.

German politicians have shied away from dealing with the subject, largely due to fears of a voter backlash if Germany’s state insurers are seen to be financing care workers abroad to the detriment of the domestic care industry.

There are about 47 different topics one can entertain for discussion here. For a sound, political decision, only 2 questions need to be addressed:

1. Standards must be devised that fit other culture, other systems. I presume the essentials already exist – so, there ain’t much to be worked out.

2. Moving to a facility abroad should only be voluntary – and the right of return within a reasonable time period must be absolute.

Everything else is up for keeping a couple thousand civil servants and social scientists employed in discussion.

Harvard Doctor turns hedge fund profiteer, then, convict – after sentence for insider trading

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From the age of six, Joseph F. “Chip” Skowron III aspired to be a doctor. At Yale, he earned both a medical degree and a doctorate in molecular and cellular biology, then qualified for Harvard’s elite, five-year residency program. Three years in, Skowron quit medicine for Wall Street. He and two partners started a group of health-care investment funds under the auspices of FrontPoint Partners LLC, a hot new property in the exploding world of hedge funds.

Skowron was soon making millions of dollars a year. He built a gabled, 10,000-square-foot home on three acres in the nation’s hedge-fund capital, Greenwich, Connecticut. He assembled a small fleet of pricey cars, including a 2006 Aston Martin Vanquish and a 2009 Alfa Romeo Spider 8C. He also spent vacation time engaged in Third World humanitarian causes…

Today, Skowron…is serving a five-year term for insider trading at the federal prison at Minersville, Pennsylvania. At FrontPoint, Skowron lied to his bosses and law enforcement authorities, cost more than 35 people their jobs and stooped to slipping envelopes of cash to an accomplice. FrontPoint is gone. Morgan Stanley, which once owned FrontPoint, is seeking more than $65 million from Skowron, whose net worth a year ago was $22 million. Until he’s a free man, his wife of 16 years will have to care for their four children and Rocky, their golden retriever, on her own…

Health care has become America’s sweet spot for insider traders like Skowron. Among researchers, physicians, government officials and corporate executives, the lure of easy money in health-care insider trading has become epidemic. Since 2008, about 400 people were sued by regulators or charged with insider trading; of those, at least 94 passed or received tips involving pharmaceutical, biotechnology or other health-care stocks.

RTFA for the cautionary tale of humanitarian physician – turned scumbag profiteer, insider trader on Wall Street.

End-of-life health care is important, folks

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Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want…

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care.

The health care professional then signs a single-page medical order telling emergency medical personnel and other health care providers what to do if the patient is incapacitated. In most states, the patient or surrogate must also sign the medical order to indicate informed consent. The orders are conspicuously highlighted in a patient’s electronic medical record and follow patients from one setting to another — such as a hospital emergency room or nursing home — so that any health professional handling the case will know what interventions the patient might want…

No matter what the death-panel fearmongers say, end-of-life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want. In some cases, that could well mean the request to be spared costly tests, procedures and heroic measures that provide no real medical benefit.

RTFA for a broad understanding of your rights. It’s easy to drag your feet and put off a living will. The prospect ain’t exactly thrilling. But, do it – pay attention to the suggestions in this article and push your physician to cooperate if they must be pressed. Most are already ahead of you on this question.

107 health care professionals busted for health care fraud

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More than 100 people are charged in what authorities say is the largest one-day takedown ever for Medicare fraud. A federal health care fraud strike force conducted raids in seven cities, targeting more than $450 million in alleged false billing.

At a news conference in Washington, D.C., to announce the arrests, Attorney General Eric Holder said they “underscore the Justice Department’s determination to move aggressively in bringing to justice those who would violate our laws and defraud the Medicare program for their personal gain.”

The arrests are the latest in a three-year crackdown on health care fraud, which is estimated to cost taxpayers between $80 and $160 billion per year. Authorities recovered a record $4.1 billion last year.

The 107 people charged Wednesday include doctors, nurses and other health care professionals in seven cities: Miami, Tampa, Chicago, Detroit, Houston, Los Angeles and Baton Rouge.

In addition, the government has suspended payments to 52 provider organizations the individuals are associated with. Health and Human Services Secretary Kathleen Sebelius said the operation, including the arrests and the cutoff of payments, is part of an effort to get ahead of fraud instead of relying on the old “pay-and-chase” model.

“Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” Sebelius said.

Bravo. Nice to see one portion of Obama’s program for digital medical records being used to arrest the crooks gaming the system.

U.S. comes in last of 19 countries in preventable death ranking

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France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations…

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs…

“I wouldn’t say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don’t, I think that’s the main problem, isn’t it?” Ellen Nolte said in a telephone interview…

France did best — with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people…Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people…

After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.

The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings…

“It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance,” Commonwealth Fund Senior Vice President Cathy Schoen said.

“The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference,” Schoen added in a statement.

Our politicians have been promising us universal healthcare all the way back to Harry Truman and the 1948 elections. He didn’t even introduce a healthcare bill after he was elected.

Now we have a halfass measure that provides some improvement and cost reductions. Cost reductions I’ve already experienced in Medicare. The halfass part comes from the original Republican individual mandate instead of a single payer program.

No matter. Republicans will be campaigning this Fall against the plan they originally introduced – and didn’t oppose until President Obama adopted it.

Democrats are afraid of a complete universal single payer program – afraid they might lose campaign contributions from insurance companies. Republicans share the paranoia and trump it with the number of their own breed in bed with pharmaceutical companies and healthcare chains.

Obama rejects Roman Catholic Church plea for exemption from insurance covering birth control

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The Obama administration said Friday that most health insurance plans must cover contraceptives for women free of charge, and it rejected a broad exemption sought by the Roman Catholic Church for insurance provided to employees of Catholic hospitals, colleges and charities.

Federal officials said they would give such church-affiliated organizations one additional year — until Aug. 1, 2013 — to comply with the requirement. Most other employers and insurers must comply by this Aug. 1…

Since I’m a devout member of the Church of the Flying Spaghetti Monster can I get a similar one-year dispensation, say, from paying my income tax?

The rule takes a big step to remove cost as a barrier to birth control, a longtime goal of advocates for women’s rights and experts on women’s health.

In announcing details of the final rule on Friday, Kathleen Sebelius, the secretary of health and human services, said it “strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.”

“Scientists have abundant evidence that birth control has significant health benefits for women,” Ms. Sebelius said, and “it is documented to significantly reduce health costs.”

Catholic bishops issued a statement saying…“Blah, blah, blah, bladiddy-blah, blah, blah!”…

Continue reading →

Brooklyn Democrat pleads guilty in corruption case

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Photo taken when Kruger was surrendering to the FBI
Daylife/AP Photo used by permission

State Senator Carl Kruger, who for months had insisted on his innocence, pleaded guilty on Tuesday to federal corruption charges, admitting that he conspired to accept nearly $500,000 in bribes, which prosecutors have said supported a lavish lifestyle.

Mr. Kruger, an influential Democrat and 16-year legislator, stood before Judge Jed S. Rakoff in United States District Court in Manhattan and pleaded guilty to four of the five counts in the indictment against him. He sobbed and mumbled unintelligibly as he admitted his crimes. The charges included two counts of fraud conspiracy, for which he could face up to 20 years in prison each, and two counts of bribery conspiracy, which carry a maximum term of five years each…

The broad corruption investigation, which also resulted in the arrests of Assemblyman William F. Boyland Jr., two hospital executives, a lobbyist and a developer, indicated that Mr. Kruger used the money to live beyond his means; a prime example of that, prosecutors said, was his mansion in Mill Basin, Brooklyn, where he lived with two gynecologist brothers and their mother…

And the schemes were lucrative, according to the charges. Mr. Kruger collected at least $1 million in bribes, the authorities initially said, in return for all manner of political favors, like helping hospitals seeking to merge, getting state money for real estate developers and even expanding the business hours of liquor stores. The bribes, according to prosecutors, financed a four-door Bentley Arnage and the Mill Basin home, which was originally built for a boss of the Luchese crime family…

Mr. Boyland, a Democrat, who was tried separately before Judge Rakoff last month, was acquitted of conspiring to take $175,000 in bribes in return for using his influence on behalf of a health care organization that operates hospitals in Queens and Brooklyn…

In September, another defendant, David P. Rosen, the former chief executive of the health care organization, MediSys, was convicted of conspiring to bribe Mr. Boyland — as well as Mr. Kruger and a third legislator, Anthony S. Seminerio, a Democratic assemblyman from Queens — in return for favorable treatment for MediSys.

Poisonally, I would throw away the key. This man crapped on the voters who elected him. He conspired to break the law to benefit medical corporations feeding off the healthcare of Brooklyn taxpayers.

My only regret is that the scumbags who lobbied the healthcare changes to drug regulations through Congress for George W. Bush – before officially going to work for the Pharmaceutical industry – aren’t going to be sharing a cell with Kruger.