Common sense tells you if you can cut out all the administrative costs dealing with health care insurance companies and cut out the billions in profit, that we would save money with a single-payer health care system.

Our taxes would go up, but not as much as it costs us to obtain health insurance.

It's simple economics that government fails to recognize.

Sounds like a lot of payoffs are at work.

Edgar Assmann

New Orleans

http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1242106225265990.xml&coll=1

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Bill lets health-care workers reject objectionable services

The Advocate | 05.12.09

By SARAH CHACKO

Advocate Capitol News Bureau

Despite concerns that Louisiana residents could be refused a wide spectrum of medical aid, a House committee Monday approved legislation that would allow health-care employees to opt out of medical services they find objectionable.

Committee members also approved a proposed constitutional amendment to expand the state’s freedom of religion clause.

Under House Bill 517, any person, employer or entity would have the right to not provide health-care services that violate their religious or moral principles.

“The so-called right to choose has become the right to coerce people to act against their conscience,” said Dorinda Bordlee, vice president of the Bioethics Defense Fund.

The bill, sponsored by state Rep. H. Bernard LeBas, D-Ville Platte, was postponed last week amid concerns that its language was overly broad and would allow doctors to refuse life-saving procedures.

LeBas offered amendments to the bill Monday to include “abortion, dispensation of drugs affecting the reproductive process, artificial insemination, sterilization, artificial reproductive technologies, human embryonic stem cell research, human embryo cloning, fetal experimentation, euthanasia or physician-assisted suicide” in the services that could be refused.

State Rep. John Bel Edwards, D-Amite, said the amendments did not satisfy an agreement LeBas made last week to limit the bill to only those services.

Bordlee said she believed other services, like blood transfusions, were allowed under added language that would require health-care providers to provide emergency care.

Edwards said not all blood transfusions are done in emergency situations.

A private employer should not be required to keep an employee who refuses to do what is expected by the employer, Edwards said. Also, private employers are not required to offer these services, he said.

“The amendments offered today are more problematic than the bill’s original form,” Edwards said.

Edwards unsuccessfully attempted to amend the bill to limit services and apply the law only to state agencies.

Julie Mickelberry with Planned Parenthood said HB517 would apply not only to doctors, nurses and pharmacists but insurance companies and appointment schedulers as well.

“This puts the beliefs of medical providers first and patients’ health last,” she said.

Marjorie Esman with the American Civil Liberties Union also raised concerns that the bill would allow health-care providers to discriminate on the basis of race, sexual orientation and politics.

Edwards said after the meeting that many committee members told him they agreed with his concerns. But no one was willing to oppose the legislation because it was supported by the Louisiana Family Forum, he said.

“I’m very discouraged,” Edwards said.

The committee also approved House Bill 340, which would require the state to prove it has a compelling interest to infringe on the religious rights of state employees or agencies.

State Rep. Cameron Henry, R-Jefferson, said when the state constitution was written in 1974, legislators used the exact language in the U.S. Constitution to ensure the same freedom of religion protections.

But at that time, Henry said, the federal courts used a “compelling interest” test to judge whether a state’s interest outweighed a person or agency’s freedom of religion and religious expression.

Southern law professor Michelle Ghetti said that in 1990, the U.S. Supreme Court decided that unless the law specifically targets religion, the “compelling interest” burden does not apply.

If HB340 is passed by the Legislature, it would then have to be approved by voters.

http://www.2theadvocate.com/news/44759352.html

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Sebelius: Industry will keep promise to cut costs

The Times-Picayune | 05.12.09

The Associated Press

(AP) — WASHINGTON - Health and Human Services Secretary Kathleen Sebelius says she's confident health industry leaders will make good on their promise to slow the growth of medical care costs.

And she also suggested Tuesday that the Obama administration wouldn't hesitate to call them out if they retreat on the promise to slow spending growth by $2 trillion over the next 10 years.

Sebelius (seh-BEEL'-yuhs) was asked on ABC's "Good Morning America" what enforcement mechanism the administration would have if doctors, hospitals, insurers and other industry players renege on their promise to contain costs.

The Kansas Democrat responded that political pressure would be brought to bear, saying a significant aspect of Obama's election last November "was about changing the health care system."

http://www.nola.com/newsflash/index.ssf?/base/national-2/1242131108213000.xml&storylist=health

Community meeting today on planned closure of NOAH

The Times-Picayune | 05.12.09

A meeting will be held today in New Orleans to give the public an opportunity to voice opinions on the planned closure of the New Orleans Adolescent Hospital, an Uptown facility that provides outpatient and inpatient mental health services to minors and adults.

The meeting will be held from 6 to 8 p.m. in City Council Chambers and will be attended by members of the City Council, city administration officials, local mental health experts and organizations.

The evening meeting time was specifically chosen to accommodate people who work or are otherwise unavailable during the day.

Tonight's invited guests include Retired Judge Calvin Johnson of the Metropolitan Human Services District; Dr. Kevin Stephens of the City of New Orleans Health Department; Cecile Tebo of the New Orleans Police Department's Crisis Unit and other mental health care providers and experts.

The closing of NOAH is part of Gov. Bobby Jindal's proposed health care cuts.

Jindal wants to fold NOAH into a facility in Mandeville.

http://www.nola.com/news/index.ssf/2009/05/community_meeting_today_on_pla.html

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Pennington freezes raises

The Advocate | 05.12.09

By MARSHA SHULER

Advocate Capitol News Bureau

LSU’s Pennington Biomedical Research Center has put on hold merit pay raises for its employees.

Pennington is the first state agency to receive state Civil Service approval for the step. The research facility is suspending raises as part of a plan to offset $2.4 million in proposed cuts to its budget for the fiscal year that begins July 1.

The freeze on merit pay would affect 452 classified and unclassified Pennington employees, said Ralph Underwood, Pennington’s associate executive director for administration and finance.

Civil Service official Judy McGimpsey said Pennington is the only agency so far that is using the non-payment of merit pay as a layoff alternative for the fiscal year that begins July 1.

“Our staff has been in conversation with many agencies about options,” McGimpsey said. But no others had been filed as of Monday, she said.

The state Civil Service Commission has a proposal on its June meeting agenda that would eliminate merit pay raises for all classified state employees for the upcoming fiscal year

“If the commission approves the rule change, it will not be necessary for agencies to submit individual plans to withhold merits for fiscal year 2009-10,” McGimpsey said.

Pennington spokesman Glen Duncan said the decision to scrap merit pay raises came as the Perkins Road facility looked at all avenues “to protect our science and competitiveness of science and protect as many jobs as we could.”

“We went through every part of our cost stream” from air conditioning and heating expenses to faculty resignations, Duncan said.

Withholding or reducing merit pay, furloughs and reductions in work hours are among the options available to state agencies to avoid layoffs in times of financial problems.

The commission is considering action that would require all state agencies to withhold the 4 percent merit pay increases granted on an employees anniversary date.

Already the proposed $27 billion state budget bill includes language that would bar the granting of the raises, but the actual move takes Civil Service Commission approval.

Often in tough budget times, state agencies are not given the funding to cover the pay raises but are allowed to cut in other areas to generate the funding. The commission and the budget action would eliminate that as an option for some 60,000 rank-and-file state employees protected by Civil Service.

Currently agencies are required to submit a letter documenting their request for approval by the Civil Service executive director prior to the effective date of any layoff avoidance action, McGimpsey said.

http://www.2theadvocate.com/news/44758812.html

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Bill would ban mobile dentistry clinics at school

The Times-Picayune | 05.12.09

The Associated Press

(AP) — BATON ROUGE, La. - A divisive proposal that would ban mobile dental clinics in schools comes up for a second round of discussion in the House Health and Welfare Committee.

The committee delayed action last week because lawmakers had unanswered questions. Lawmakers are scheduled to hear the bill again Tuesday.

The mobile dental clinics have provided care to thousands of poor Louisiana children on school campuses. But supporters of the ban say they are unsanitary and unsafe.

Opponents say the clinics bring care to children who otherwise might never see a dentist. And they claim the bill is a bid by some dentists to get more money for themselves, now that the state has increased reimbursement rates for dental work through the Medicaid program.

http://www.nola.com/newsflash/index.ssf?/base/national-14/124212308371850.xml&storylist=louisiana

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Taking dental care to students, schools faces opposition

WWLTV | 05.12.09

Watch the video: http://www.wwltv.com/video/news-index.html?nvid=360661

A plan to take dental care to students at schools is facing opposition, citing improper settings and poor facilities.

11 new swine flu cases confirmed in state

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11 new swine flu cases confirmed in state

The Advocate | 05.12.09

By SANDY DAVIS

Advocate staff writer

State health officials announced Monday that 11 more cases of swine flu were confirmed by the Centers for Disease Control and Prevention, bringing the total in Louisiana to 20 confirmed cases in 11 parishes.

“As we expected, our state has additional confirmed cases of H1N1 flu,” Alan Levine, secretary for the state’s Department of Health and Hospitals, said in a DHH news release.

The 20 confirmed cases of swine flu involve: 14 in Lafayette Parish, three in Lafourche Parish, and one each in Ascension, Orleans and St. Landry parishes.

There are still 29 samples from suspected cases in Louisiana waiting to be tested at the CDC’s Atlanta lab.

“Our staff and public health experts remain watchful and continue to work with health-care providers statewide on tracking this virus,” Levine added.

But it’s going to be more difficult to track the disease after the CDC and DHH changed their guidelines Thursday.

The two health agencies now advise that people who have mild flu symptoms do not need to go to the doctor, and should not be tested for swine flu.

Unless people have a severe case of the flu, they will not be given a prescription for the anti-viral medications Tamiflu and Relenza, health officials have said.

“It is expected that most people with novel H1N1 will recover without needing medical care, or testing to see if they have H1N1 flu,” the news release says.

CDC and DHH, however, did say those at high risk for complications from the flu, including pregnant women, the elderly or the very young and people with chronic illnesses, should seek medical care if they have flu symptoms.

“CDC and DHH are recommending antiviral treatment of H1N1 flu only for hospitalized patients with confirmed or suspected H1N1 flu, or those patients who are at higher risk for seasonal influenza complication,” according to the news release.

The CDC describes the H1N1 virus as a flu of “swine origin” that was first detected in April.

The United States finally surpassed Mexico, where it is believed the virus started, in the number of confirmed cases of swine flu.

As of 11 a.m. Monday, there were 2,600 cases in the U.S. reported in 43 states plus the District of Columbia, according to the CDC Web site.

There are 4,762 cases reported worldwide, including 1,626 in Mexico and 284 in Canada, according to the World Health Organization’s Web site.

There have been 53 deaths from H1N1 in four nations: 48 in Mexico, three in the U.S.; and one each in Canada and Puerto Rico, according to the WHO Web site.

http://www.2theadvocate.com/news/44759247.html

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Parish has first confirmed swine flu case

Daily World | 05.12.09

By Mike Hasten

The Louisiana Department of Health and Hospitals announced Monday that 11 more cases of H1N1 influenza, commonly known as swine flu, have been confirmed, including the first confirmed case in St. Landry Parish.

Of the other 10 new cases, seven are from Lafayette Parish, the site of the initial outbreak in the state, with the other three from Lafourche Parish.

DHH officials said they are also looking at another 29 probable cases, including an additional case in St. Landry Parish.

"As we suspected, our state has additional confirmed cases of the new H1N1 flu," said Alan Levine," secretary of the Department of Health and Hospitals in a news release. "While this new flu strain has proven to be milder than first thought, we continue to encourage all Louisianans to practice good hygiene to help prevent the spread of germs and illness."

Levine said his staff and public health experts will "continue to work with health care providers statewide on tracking this virus."

The new cases bring the state total of confirmed H1N1 virus to 20, up from nine. Another 29 "probable" cases have been sent to the CDC for testing, with the addition of seven new ones sent this past weekend. The seven new ones are from Plaquemines (3), St. Charles (2), and one each from Vermilion and Jefferson parishes.

Levine said it is expected that most people with novel H1N1 flu will recover without needing medical care or testing to see if they have H1N1 flu.

DHH and the CDC were at first concerned about the flu because it was new and they were not sure how seriously it would affect victims. He said people should still take precautions to try to avoid contracting the flu.

The state has obtained a machine to do its own testing of possible H1N1 cases but until the CDC certifies its results, samples will still be sent to Atlanta.

http://www.dailyworld.com/article/20090512/NEWS01/905120310/1002/Parish+has+first+confirmed+swine+flu+case

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College tuition going up

The Advocate | 05.12.09

By JORDAN BLUM

Advocate Capitol News Bureau

Louisiana’s public colleges will increase tuition by up to 5 percent in the fall for the second consecutive year, the Joint Legislative Budget Committee decided Monday.

The tuition raises represent the second of four years of tuition increases that were approved last year by the Legislature. The joint panel of members of the House and Senate fiscal committees must give additional consent each year.

State Commissioner of Higher Education Sally Clausen said the increases would range from $40 per year at Louisiana Technical College campuses to $254 a year at LSU. With the 5 percent, LSU would cost $5,340 per year.

Every university and many two-year schools are expected to take the full 5 percent, including a $93 price increase at Baton Rouge Community College boosting costs to $1,947 a year.

However, a handful of community colleges such as South Louisiana Community College and River Parishes Community College only qualify for 3 percent or 4 percent because of the closeness in cost to their peers.

State Rep. Karen Peterson, D-New Orleans, said she opposes “taxing” students with tuition increases, but realizes colleges have few other options because of budget cuts.

“I’ve repeatedly tried to redirect state dollars (to higher education) in the last two weeks,” Peterson said of her frustrations in getting more state dollars for colleges.

“That’s what this is — a tax on students to fill a need in higher ed,” Peterson said. “I guess we don’t have any alternatives.”

The state budget has set aside an extra $7 million in funding increases for merit-based TOPS scholarships — Taylor Opportunity Program for Students — to compensate for the cost boosts.

Donnie Vandal, Board of Regents deputy commissioner for finance, said about 43,000 of the state’s 200,000 public college students are on TOPS, including most incoming LSU students. Many students not on TOPS are ineligible because they are graduate students, part-time, out-of-state or simply lacked the necessary test scores and grades, he said.

Clausen said federal, need-based Pell grants are on the rise and the state has need-based Go Grants. So middle-class students who do not qualify for TOPS are the most affected by tuition increases.

Statewide, the tuition increases would result in $29 million in extra revenue for public colleges, Clausen said.

Gov. Bobby Jindal proposed $220 million in cuts to colleges for the coming fiscal year because of declining state revenue — a loss of about 15 percent of state funds for colleges.

The cuts currently stand at $160 million after adjustments were made last week by the House Appropriations Committee. But the budget bill still must travel through the House floor and the Senate.

College leaders have warned the cuts will lead to lots of layoffs, academic program eliminations and larger class sizes. Clausen said more information is being provided Wednesday to House members.

Among the additional information, Clausen said, she will propose a plan that guarantees admission into public universities for students who graduate from community colleges.

When pressed, Clausen said top college leaders are considering pay cuts.

Clausen noted that only Florida has consistently had cheaper tuition costs than Louisiana in the South. But Florida is increasing tuition statewide by at least 8 percent and up to 15 percent.

LSU System President John Lombardi said campuses also are considering student fee increases in the few areas that do not require two-thirds legislative approval.

Lombardi said LSU campuses are considering increases in on-campus housing costs, utility surcharges and health center fees.

State Sen. Francis Thompson, D-Delhi, discussed the option of using state rainy day funds to help colleges, an idea that Jindal opposes.

“Would you consider us in a rainy-day situation at this point?” Thompson asked.

“I think it’s storming,” Clausen said, not missing a beat.

“We’re worried about in two years when it’s going to be a tsunami,” said state Rep. Kevin Pearson, R-Slidell, referring to when federal stimulus aid runs out and cuts could hypothetically worsen.

State Sen. Jack Donahue, R-Covington, said college leaders are being “too nice” in warning of the severity of the cuts.

“We have enough money in this state,” he said. “I think it’s going to the wrong places.”

The tuition increase was approved by a 21-3 vote. State Sens. Nick Gautreaux, D-Meaux; Lydia Jackson, D-Shreveport; and Ed Murray, D-New Orleans, voted against it.

Tuition increases

Anticipated tuition increases for the fall (annual tuition and fees costs included):

LSU: $5,086 to $5,340

SOUTHERN UNIVERSITY: $3,906 to $4,101

UNIVERSITY OF LOUISIANA AT LAFAYETTE: $3,632 to $3,814

SOUTHEASTERN LOUISIANA UNIVERSITY: $3,401 to $3,571

NICHOLLS STATE UNIVERSITY: $3,771 to $3,960

UNIVERSITY OF NEW ORLEANS: $4,306 to $4,521

LOUISIANA TECH UNIVERSITY: $4,941 to $5,188

MCNEESE STATE UNIVERSITY: $3,423 to $3,594

NORTHWESTERN STATE UNIVERSITY: $3,649 to $3,831

LSU AT SHREVEPORT: $3,687 to $3,871

UNIVERSITY OF LOUISIANA AT MONROE: $3,812 to $4,003

GRAMBLING STATE UNIVERSITY: $3,816 to $4,007

LSU AT ALEXANDRIA: $3,402 to $3,572

SOUTHERN UNIVERSITY AT NEW ORLEANS: $2,989 to $3,138

LSU HEALTH SCIENCES CENTER AT NEW ORLEANS: $13,361 to $14,029

LSU DENTAL SCHOOL: $11,430 to $12,002

LSU HEALTH SCIENCES CENTER AT SHREVEPORT: $10,983 to $11,532

BATON ROUGE COMMUNITY COLLEGE: $1,854 to $1,947

RIVER PARISHES COMMUNITY COLLEGE: $1,976 to $2,055

SOUTH LOUISIANA COMMUNITY COLLEGE: $1,936 to $2,013

DELGADO COMMUNITY COLLEGE: $2,002 to $2,082

NUNEZ COMMUNITY COLLEGE: $1,858 to $1,951

FLETCHER TECHNICAL COMMUNITY COLLEGE: $1,552 to $1,630

SOWELA TECHNICAL COMMUNITY COLLEGE: $1,522 to $1,598

LSU AT EUNICE: $2,355 to $2,426

BOSSIER PARISH COMMUNITY COLLEGE: $1,848 to $1,940

SOUTHERN UNIVERSITY AT SHREVEPORT: $2,318 to $2,388

LOUISIANA DELTA COMMUNITY COLLEGE: $2,078 to $2,161

LOUISIANA TECHNICAL COLLEGE: $804 to $844

http://www.2theadvocate.com/news/44759647.html

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'Conscience in health care' bill advances

The Times-Picayune | 05.11.09

by Bill Barrow, The Times-Picayune

BATON ROUGE -- A House panel gave overwhelming approval Monday to two measures pitched as protections of religious freedom, with the more controversial designed to give legal protections to workers in the medical field who refuse to provide certain services -- some related to contraception -- because of their beliefs.

House Bill 517 by Rep. Bernard LeBas, D-Ville Platte, cleared the Civil Law & Procedure Committee without a dissenting vote, but not without questions and debate over whether it will restrict access to health-care services and information.

"This bill puts the beliefs of medical providers first and the medical needs of patients last," Julie Mickelberry of Planned Parenthood said.

Mickelberry said the bill's wording is vague and could extend protections beyond doctors and nurses to a much wider range of people with a hand in the health-care system, including office schedulers and insurance claim processors.

Dorinda Bordlee, an attorney for the Bioethics Defense Fund, countered that the proposal, which has the backing of some clergy, allows people of faith to work as medical professionals without being forced to administer drugs or procedures that violate their moral codes.

The bill, which LeBas revised after a week of private negotiations, would provide civil immunity and job protection to private and public employees who decline a certain list of procedures out of "sincerely held religious belief or moral conviction."

The new version states that the services covered would include "but (not be) limited to abortion, dispensation of drugs affecting the reproductive process, artificial insemination, sterilization, artificial reproductive technologies, human embryonic stem cell research, human embryo cloning, fetal experimentation, euthanasia or physician-assisted suicide."

The bill now goes to the full House.

The debate comes amid a similar policy skirmish at the federal level.

President Barack Obama earlier this year rescinded a late-hour executive order from President George W. Bush touted by social conservative as strengthening the "conscience protections" for medical workers. Bush's order would have cut off federal financing for thousands of state and local governments and health care entities if they did not accommodate workers who refuse to participate in care they felt violated their moral or religious beliefs.

Rep. John Bel Edwards, D-Amite, sought an amendment that would have trimmed the list of included services. The amendment, which failed 10-3, would have addressed the concerns from Mickelberry and others that that the reference to reproductive drugs is so broad to include not only abortion-inducing drugs, but also the so-called "morning after pill" that prevents pregnancy and regular contraception.

Edwards also wanted to apply the law only to public employees. Bordlee said that would leave out thousands of workers in the state's widely spread Catholic and Baptist health-care facilities.

Louisiana law already mandates that no medical professional can be forced to participate in or perform an abortion.

Separately, the committee endorsed a constitutional amendment from Rep. Cameron Henry, R-Jefferson, that would expand the state's religious freedom protections, which now mirror the "establishment clause" in the First Amendment to the U.S. Constitution.

House Bill 340 would add, among other details, that, "No person under the color of law shall burden the free exercise of religion, even if the burden results from a rule of general applicability, unless the government proves that it has a compelling governmental interest in infringing upon the specific expression, act, or refusal to act at issue."

Gene Mills of the Louisiana Family Forum said the change is needed to counter growing threats to religious expression in the United States. He did not provide any examples.

http://www.nola.com/politics/index.ssf/2009/05/conscience_in_health_care_bill.html

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"Frequent Fliers" use emergency room on insured patients' dime

WWLTV | 05.11.09

Paul Murphy / Eyewitness News

NEW ORLEANS – The sign may say "emergency room," but hospital administrators say most of the patients who visit the E.R. don't need urgent medical care.

Video: Watch the Story

“They come to the emergency department because they couldn't get an appointment that was convenient to their schedule with their regular physician, or they don't want to wait,” said Eva Morris, a registered nurse at Touro Infirmary.

“It's easy coming to the emergency department,” agrees Ochnser Clinic Foundation Dr. Joseph Guarisco. “Access is good. We're open 24 hours a day. It's convenient. So there are a lot of drivers that bring patients to the emergency department.”

Some of the patients are what the hospitals call "frequent fliers."

Last year the most frequent visitors hit the emergency room at both East Jefferson General Hospital and Ochsner Hospital 48 times. Touro reported 31 times; West Jefferson Medical Center, 23 times; and a whopping 171 times at the LSU Interim public Hospital.

“There's always those that you can predict on a really, really cold night or really, really rainy day, they're going to seek refuge in the emergency department,” Touro nurse Eva Morris said. “Because there's always a controlled climate, there's always food, and there's always a soft bed for them.”

“Roughly one in five people that come into the emergency room, at least post-Katrina, at the time of their presentation, is unable to pay,” said Angela Greener, the chief administrative officer at West Jefferson Medical Center.

Britney Rodriguez's mother is one of those who is unable to pay. She said that's what brought her to West Jefferson's emergency room.

“Basically, she has no job, which means no health insurance, so she doesn't see her doctor on a normal basis. So if anything's wrong, the first place to come really is the emergency room,” Rodriguez said.

According to a recent study by the Kaiser Family Foundation, the most frequent visitors to emergency rooms are the poor, elderly and chronically ill.

“When you come to the emergency room, it's kind of a ‘bill you later’ kind of thing, you know,” Rodriguez said. “If you go to a private practice, you have to pay up front, which a lot of people don't have the money to do. People who don't have coverage, don't have the money to pay upfront.”

So who pays for the frequent fliers who can't?

“As we know, patients with insurance, subsidize those patients without insurance. That's how it's paid for right now,” said Dr. Guarisco of Ochsner.

Guarisco said, by law, emergency rooms have to treat every patient who walks through the door, regardless of their ability to pay. He also said it's important not to prejudge patients, even if they're frequent visitors.

“The migraine headache can be internal bleeding. The chronic belly pain could one day be appendicitis,” Guarisco said. “Patients with chronic medical conditions or who come here frequently with non-urgent conditions some day at some point, they will have an emergency.”

Angela Greener at West Jefferson said that doesn't mean patients should use the E.R. as a substitute for their family doctor.

“Don't plan on coming to the emergency room if you don't have a true emergency,” she said. “If you have a sore throat and you know that's it's not a true life or limb threatening emergency, you're going to be here for quite a while and unfortunately, you're also going to take up time from patients that are sicker that really do need to come into the hospital.”

Eva Morris at Touro said there are huge costs that come with unnecessary emergency room visits.

“Diagnostics, including CT’s, x-rays, lab work, all of those can amount to $5000 or more per visit,” Morris said.

Guarisco said the metro area needs more community based medical clinics that offer patients the same convenience as emergency rooms.

“That is extended hours, easy access, friendly atmosphere,” he said. “I would think they would achieve success by providing the same things that patients look for in the emergency department, which is access beyond the 8-to-5.”

Rodriguez said her mother would prefer to see a regular doctor than visit the E.R. every time she needs to refill her medication.

“It's better for everyone if everyone has health insurance and everyone can go to a regular doctor. That means lower fees, lower medical insurance for everybody.”

The average emergency room bill in the New Orleans area is about $1400 per visit.

Grounding the frequent fliers could save the state hospitals and patients millions of dollars a year. Louisiana ranks third in the nation in per capita emergency room use. According to a recent report from the Commonwealth Fund, the state is the worst in the nation for avoidable hospital uses and costs.

http://www.wwltv.com/topstories/stories/wwl051109cbfrequentflier.189e90ad.html

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What Payback? Jindal Gets His Way

LaPolitics | 05.11.09

John Maginnis

Oh, the world of hurt Bobby Jindal was supposed to be in by now.

A month ago, his constant coast-to-coast fundraising was straining the patience of even his friends, who wished aloud that he were spending more time at home dealing with the state's problems. And there were plenty of those, mostly linked to a gaping budget deficit, which promised to make his first legislative fiscal session a miserable one. Add to that, lawmakers, still harboring grudges for his vetoes of their pay raise and scores of local projects last year, were said to be lying in wait for payback.

It looked like an ominous session indeed for the governor, until it began, when the scene at the Capitol snapped back to the old reality. In the first two weeks, the governor's staff efficiently snuffed out or sidetracked bills the administration opposed, advanced ones it liked and easily fended off legislators' initial budget raids on his economic development mega fund.

He also demonstrated a grasp for the art of the deal by proposing creative terms for a new long-term contract with the New Orleans Saints while at the same time pushing approval of spending $50 million to save a chicken processing plant in Northeast Louisiana. The two are not connected, but politically they are wed, with regional support for each neutralizing opposition to the other. The unspoken linkage of the two makes for a pretty slick deal, worthy of Edwin Edwards, and it's even legal.

What did Jindal do to reassert his influence and authority over a resentful Legislature? Why, he showed up, which is pretty much all that's needed in a political system that affords so much power to a governor when he acts like one.

Democrats outnumber his Republicans, especially in the Senate, but partisanship has yet to come into play in this session. The most direct challenge to Gov. Jindal's fiscal policy, the proposed cigarette tax to restore healthcare cuts, has not unified Democrats.

They will band together more to challenge his refusal to accept $98 million in added unemployment benefits from the federal stimulus package, but supporters concede it won't be enough to overcome his promised veto.

The issue that is causing Jindal the most trouble, at least in the public prints, comes at the hands of two Republicans. He has strongly opposed identical bills by Rep. Wayne Waddell of Shreveport and Sen. Robert Adley of Benton to make public more records in the governor's office, which is currently rated among the least transparent in the nation.

The governor's broad exemption from the public records act predates Jindal, but it perfectly suits his control personality that is reflected in his protective, insular staff.

Legislators and his contributors learned quickly not to expect return phone calls from the governor. He talks to people when he needs them, not the other way around.

Formalizing any more access to his office is not in his interest. The legal contortions New Orleans Mayor Ray Nagin is going through fighting the release of his schedule and e-mail probably makes the governor all the more careful to not let down his public records shield.

Now if legislators were truly seeking revenge for Jindal's veto of their payraise, they would pass a public records law opening up his office like a sardine can.

That they haven't suggests the notion of veto payback is vastly overstated. Legislators may still resent his nixing their raises, but some concede he did them a favor. What if they were pulling down $50,000+ in total compensation while considering big budget cuts that would force layoffs in higher education and healthcare? Half of them would be facing recall petitions and harboring little hope of re-election. The mistake he and they both made was in forming their secret pact, which intense public anger, acting as a force majeure, nullified.

Lawmakers might still pass a public records bill Jindal doesn't like, or find some other vote on which to stick him. But most of them, when it gets right down to it, want to stay in the governor's good graces, even if he ignores them most of the time.

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Obama’s Push for Health Care Cuts Faces Daunting Odds

The New York Times | 05.11.09

By ROBERT PEAR

Doug Mills/The New York Times

“This is a historic day, a watershed event,” said the president, after a meeting with a range of leading health-care providers.

WASHINGTON — President Obama engineered a political coup on Monday by bringing leaders of the health care industry to the White House to build momentum for his ambitious health care agenda.

Mr. Obama pronounced it “a historic day, a watershed event,” because doctors, hospitals, drug makers and insurance companies voluntarily offered $2 trillion in cost reductions over 10 years. The savings, he said, “will help us take the next and most important step — comprehensive health care reform.”

Robert Gibbs, the White House press secretary, said Mr. Obama had told the health care executives, “You’ve made a commitment; we expect you to keep it.”

If history is a guide, their commitments may not produce the promised savings. Their proposals are vague — promising, for example, to reduce both “overuse and underuse of health care.” None of the proposals are enforceable, and none of the savings are guaranteed. Without such a guarantee, budget rules would normally prevent Congress from using the savings to pay for new initiatives to cover the uninsured. At this point, cost control is little more than a shared aspiration.

Still, the event was significant. There was something in it for Mr. Obama, and something for the industry — though not necessarily the same thing. Their interests overlap but do not coincide.

For Mr. Obama, the White House meeting was an opportunity to showcase his consensus-building approach, in contrast with the confrontational style of Hillary Rodham Clinton, who at this point in her husband’s first term attacked “price gouging, cost shifting and unconscionable profiteering” by the industry in a speech to union members.

Mr. Obama is not cracking the whip on the health care industry so much as wooing it, just as he said he would in the campaign.

For the health care and insurance executives, the savings initiative helps them secure a seat at the table where many decisions about their future will be made in the next year. They also ingratiated themselves with Democrats in the White House and Congress who are moving swiftly to reshape the nation’s health care system.

“We came together in a serious way a couple of weeks ago,” said David H. Nexon, senior executive vice president of the Advanced Medical Technology Association, one of the six health care industry groups that promised to lower costs. “Health care reform is moving very fast. We want to make sure it comes out in a way that’s workable and sustainable.”

Dennis Rivera, coordinator of the health care campaign of the Service Employees International Union, led efforts to bring the industry groups together, with help from Nancy-Ann DeParle, director of the White House Office of Health Reform.

The consensus-building approach has already yielded some results. Insurance executives have offered to end certain underwriting practices, like refusing to cover individuals with pre-existing conditions or charging women higher rates than men, and they have invited Congress to impose stringent, uniform federal regulation on their industry. But even as insurers and health care providers stand shoulder to shoulder with Mr. Obama in vowing to slow the growth of health spending, they oppose him on other fronts. For example, insurance companies are opposed to a new government-sponsored health plan, which Mr. Obama supports but insurers fear could drive them out of business.

Senator Charles E. Schumer of New York, the third-ranking Democrat in the Senate, welcomed the industry’s cost-cutting commitment as “a good-faith gesture.” But he said, “It does not mitigate the need for a public plan option in our health care reform bill.”

In addition, insurers and health care providers are lobbying strenuously against cuts in their Medicare payments that would produce savings of the type they profess to want. Insurers are fighting Mr. Obama’s proposal to cut payments to their private Medicare Advantage plans by a total of $176 billion over 10 years. Doctors are pleading with Congress not to cut costs at their expense, in particular by allowing a 21 percent cut in their Medicare fees scheduled to occur in January. Pharmaceutical companies and makers of medical devices worry that new products may have to pass a cost-benefit test before being approved for coverage under Medicare.

To fulfill Mr. Obama’s campaign promise of offering affordable coverage to all, cost control is a political, as well as an economic, necessity. By their own account, Democrats will have difficulty financing coverage for more than 45 million people who are uninsured. The task would be virtually impossible — and new social insurance programs would be unsustainable — if health spending continued to increase at the currently projected rate of 6.2 percent a year for a decade.

The industry says it can shave 1.5 percent off the annual rate of growth through voluntary efforts. But similar efforts to control health costs have been rolled out in the past, without much of a long-term effect.

Henry J. Aaron, a health economist at the Brookings Institution, said that when he heard the industry’s promises on Monday, “I had a Rip van Winkle moment, as if I had fallen asleep in 1977 and woke up again this morning.”

Mr. Aaron served in the administration of President Jimmy Carter, whose proposal for hospital cost controls prompted the industry to undertake a short-lived “voluntary effort.”

After President Bill Clinton proposed an overhaul of the health care system in 1993 and 1994, the growth of health spending slowed, only to surge a few years later.

Drew E. Altman, the president of the Kaiser Family Foundation, offered a historical perspective spanning nearly four decades.

“Neither managed care, nor wage and price controls, nor regulation, nor voluntary action nor market competition has had a lasting impact on our nation’s health care costs,” Mr. Altman said. “Reformers should not overpromise.”

Industry groups sounded constructive and positive on Monday, but the real test will come in a few weeks when lawmakers unveil detailed legislative proposals. “Will they still be supportive?” Mr. Altman asked. “Or will they revert to form and protect their turf?”

Rather than gambling on the answer, some lawmakers want to establish an enforcement mechanism, which would take effect if the industry’s voluntary steps did not slow health spending by a specified amount.

Such cost-control devices have proved spectacularly ineffective in limiting the growth of Medicare spending on doctors’ services.

http://www.nytimes.com/2009/05/12/us/politics/12health.html?ref=health

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Most Women Struggle With Rising Health Care Costs

HealthDay | 05.11.09

By Kathleen Doheny

MONDAY, May 11 (HealthDay News) — Even before the slowdown in the economy began, women were more likely than men to have trouble meeting rising health-care costs to get the care they need.

So finds a report released Monday by the nonprofit research foundation The Commonwealth Fund.

More than half of women surveyed said they had problems getting care because of cost issues, including skipping a needed medical test, prescription medication or other treatment.

“What it shows is that getting and paying for health care is an even bigger problem for women than for men,” said report co-author Michelle Doty, director of survey research for the organization.

The study is based on data from The Commonwealth Fund’s 2007 Biennial Health Insurance Survey, which polled more than 3,500 adults aged 19 and older in the United States. The latest findings focus on 2,616 adults, aged 19 to 64.

The survey found that seven out of every 10 working-age American women (64 million women) either had no health insurance, insufficient health care coverage, trouble paying medical bills or a lack of access to needed health care due to cost.

Overall, 52 percent of working-age women surveyed said they had problems accessing needed health care due to costs, compared to 39 percent of men. For example, prohibitive costs meant that women often did not fill a prescription, did not see a specialist when recommended, skipped a test or treatment or follow-up visit that was recommended, or did not see a doctor or other health-care professional even though they had a medical problem.

Medical bills tend to plague women longer than they do men, as well. “Women are more likely than men to be paying off health care bills over time,” Doty said. “Forty-five percent of women had problems with medical bills, compared to 36 percent of men.”

“Most surprising is, all these problems are so pervasive across all income levels,” Doty said. For instance, she said, 34 percent of women with a family income of $60,000 or more did not get the care they needed.

Women also reported that they are less likely than men to get employer-provided health-care coverage, Doty said, sometimes because they work part time.

Health-care costs impact women to a greater degree than men, in general, the study authors said, because women have lower average incomes and higher out-of-pocket health costs than men. They also use the health-care system more often.

Other experts in women’s health care said the report rings true with their own research.

“The findings in the issue brief underscore the persistent problems with adequate access and coverage to health-care services that women experience,” said Roberta Wyn, associate director of the University of California Los Angeles Center for Health Policy Research.

“The percent of women with inadequate health coverage, experiencing problems with medical bills or debt, and forgoing needed care is staggering and these data were collected in 2007, before the recession hit,” Wyn noted. She said the findings underscore the urgency to expand health-care coverage and access, a move that was seconded by the study authors.

The findings “echo a long line of research showing that women face a great burden from medical bills due to both their greater health-care needs and higher out-of-pocket costs,” said Chloe Bird, senior sociologist at the Rand Corp. and author of Gender and Health: The Effects of Constrained Choice and Social Policies.

The problem with access to health insurance for women has been worsening since 1980, Bird said, citing other research.

The findings offer a clear message to younger women, Bird said: If you do manage to acquire health-care coverage, take advantage of it and “recognize the importance of investing in your health.”

http://news.health.com/2009/05/12/most-women-struggle-with-rising-health-care-costs/

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Do Everybody a Favor: Take a Sick Day

The New York Times | 05.11.09

By ANNE MARIE VALINOTI, M.D.

My patient was a 25-year-old man. He sat on the examination table, the picture of misery, coughing, red-eyed and shivering. His fever was 103. An interview and an examination suggested influenza (the rapid diagnostic test for flu wasn’t available at that time), but there was little I could offer him, other than ibuprofen and some homespun advice.

“Go home and get to bed,” I told him.

He looked at me. “Bed? I’ve got to get back to work.” He put on his jacket and power tie and headed back to Wall Street.

I was appalled. Work in that condition? How could he even think straight with that fever? Whom else would he infect along the way?

Still, a tiny part of me was filled with admiration. Here was a tough guy. No reason to let minor delirium keep him from doing his job.

I had recently finished my residency, three years immersed in the culture of house officer training. Of all the sins an intern or resident could commit, the worst was to call in sick, for it meant somebody else would have to do your work — extra patients to admit, phone calls to make, IVs to insert, emergencies to deal with.

As a resident, my greatest pride was in never having missed a day for illness. I’d drag myself in and sniffle and cough through the day. Once, I’m embarrassed to admit, I trudged up York Avenue to the hospital making use of my own personal motion sickness bag every few blocks while horrified pedestrians looked on.

Now, though, I see the foolishness of this bravura. And I confront it almost daily in my primary care practice. No one can miss a day — a minute, even — of work, carpooling, volunteering, vacation, anything. “I don’t have time to be sick!” my patients wail. Everyone must soldier on, leaving sick days to those with less important things to do.

And many patients aren’t satisfied with sympathy and friendly advice. They have come to the office for that little piece of blue paper, the antibiotic prescription. “I would never ask for this under normal circumstances,” I’m told — except (pick one) I’m getting married tomorrow; leaving for a month in the Amazon; having 25 houseguests for the weekend.

Never mind that antibiotics are useless in treating colds and viral illnesses, and that they have their own dangers and side effects. Some doctors will write the prescription just to get on with their day.

I have done this and know plenty of other physicians who have — much as we may resent being bullied and feel we’ve failed in our duty to “first, do no harm.” In fact, we may very well be doing harm. Beyond the possible side effects and allergic reactions, the nonchalant use of antibiotics in the community has helped lead to the rise of the drug-resistant bacteria known as superbugs.

“Clearly, the overprescribing of antibiotics in doctors’ offices, clinics and other community settings contributes to the problem of antibacterial drug resistance,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease, told me in an e-mail message. “Because most bacteria multiply rapidly, they can quickly evolve and develop resistance to antimicrobial drugs. Overusing or misusing antibiotics can make resistance develop even faster.”

If the swine flu epidemic ever swings into full gear, I will be prepared for the onslaught of ill patients. I will educate them about the appropriate use of antibiotics. I will provide symptomatic relief when I can. And I will let them know it’s O.K. to be sick. It’s O.K. to stay home from work, pull up the covers and drink gallons of hot tea all day. Maybe for an entire week.

And believe me: if you show up to work sick these days, you are not going to earn anyone’s admiration.

Anne Marie Valinoti is an internist in northern New Jersey.

http://www.nytimes.com/2009/05/12/health/12case.html?_r=1&ref=health

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Therapy Dogs May Fetch Hospital Germs

The New York Times | 05.11.09

Andrea Mohin/The New York Times

Both human and canine hospital visitors can pick up germs from patients’ rooms.

A new study of pet therapy dogs shows just how easily hospital germs can be transmitted to visitors.

Canadian researchers studied 26 therapy dogs who visited patients in hospitals or long-term care facilities. Before and after each visit, a dog’s forepaws and the hands of its handler were tested for three bacteria that commonly cause hospital infections — Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci and Clostridium difficile. To detect whether a dog was carrying germs on its fur, the researcher also sanitized her hands, petted the dog and had her hands tested for the pathogens.

None of the dog paws, handlers or the researcher tested positive for the bacteria before the hospital visits. But after the hospital visits, two of the dogs were contaminated. One dog, a greyhound, had C. difficile on its paws. Another dog, a pug, appeared to pick up MRSA on its fur. (MRSA was found on the hands of the investigator after she petted the dog upon its return.)

So how did the dogs end up as carriers of the risky germs? The dog with C. difficile had shaken paws with several patients. The pug with MRSA on its fur had spent time in patients’ beds and was kissed repeatedly by two patients. The findings were reported in a letter published in The Journal of Hospital Infection.

The study shows how easily germs can travel in and out of health care settings and the importance of vigilant hand washing. Compared to human visitors, animals typically visit a larger number of patients and staff members and walk bare-pawed on hospital corridors, possibly making them more likely to pick up germs. However, countless numbers of people who visit hospitals regularly shake hands, hug and kiss, and sit on hospital beds in patients’ rooms.

“It’s unrealistic to think that we can sanitize an animal visitor’s body between patients,” said investigator Sandra Lefebvre of the University of Guelph’s Ontario Veterinary College. “But we can and do ask human visitors to sanitize their hands so they don’t spread germs.”

http://well.blogs.nytimes.com/2009/05/11/therapy-dogs-and-hospital-infections/

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