Report on Interim LSU
Public Hospital says costs too high, efficiency too low
by Jan Moller, The TImes-Picayune
Granger / The Times-Picayune
A report found that LSU Interim
found that per-patient costs are far above national standards, the nursing
staff is top-heavy with administrators, operating rooms are under-used, and
purchasing services are poorly managed.
BATON ROUGE -- The Interim LSU Public Hospital "lacks
a broad vision and remains in a post-Katrina reactionary mode,"
according to a report that also found numerous management inefficiencies that
add up to $66 million a year.
Among other things, the report found that per-patient
costs are far above national standards, the nursing staff is top-heavy with
administrators, operating rooms are under-used and purchasing services are
The conclusions are contained in a 161-page assessment by
Alvarez & Marsal, the consulting firm that was
brought on board in January to oversee the hospital's day-to-day operations
and search for efficiencies.
If all the report's recommendations were to be
implemented, the hospital could reduce costs by $66 million next year and
take in $6.7 million in new revenue, for a total impact of $72 million, the
LSU provided the March 23 report, along with a 27-page
summary of the findings, to The Times-Picayune on Sunday in response to a
public records request.
The report comes as the Senate prepares to start work on
the $27 billion state budget, which includes $25 million in cuts to the seven
LSU charity hospitals operated by the Health Care Services Division. Dr. Fred
Cerise, who oversees health care operations for the LSU system, has said that
nearly all the cost-cutting will be absorbed by the New Orleans operations.
Timing is delicate
The report comes at a delicate time for the university,
which is hoping to replace the interim hospital with a $1.2 billion, 424-bed
hospital in lower Mid-City and is trying to fend off an attempt by House
Speaker Jim Tucker, R-Algiers, to transfer management of the New Orleans hospital
operations to an independent board.
LSU officials have long acknowledged the need for the
charity hospital system to become more efficient, and have said they plan to
run the new hospital in a more efficient manner. Testifying last month before
the House Appropriations Committee, Cerise said the New Orleans hospital was
overstaffed and plans to shed about 300 jobs as part of $24 million in budget
Formerly known as University
Hospital, the hospital was rebuilt
with federal dollars after it was flooded in Hurricane Katrina; it reopened
in November 2006 as the Interim
Hospital. With 2,500
staff members, 300 medical residents and fellows, and 400 nursing and allied
health students, the hospital serves as the main training ground for the LSU Health
in New Orleans.
Among the findings
in the report:
• "The hospital's staff struggle with the effects of
Hurricane Katrina and tend to think in 'recovery terms' instead of placing
greater emphasis on operational efficiency and cost-effectiveness." The
cost per patient per day, a key efficiency measurement, was $5,031 in New Orleans versus
$2,794 at similarly sized teaching hospitals.
• The hospital has far more employees, particularly
nurses, than dictated by national standards, and is overloaded with middle
managers. According to the report, there are 8.2 full-time employees per
occupied bed, compared to a national benchmark of six workers per bed.
• The report identified 126 nurses "with
administrative titles and without routine patient care responsibilities"
in an inpatient department that on an average day has 208 occupied beds.
"Higher than normal levels of nurse managers leads to
role conflict and less accountability throughout all positions, with a
significant cost to the organization," the report found.
• The New Orleans
hospital has a 3-to-1 nurse/manager ratio; the report said the normal ratio,
"even in heavily administrative organizations," should be 8-to-1.
• Simply adjusting overall employment levels to reflect
the national standard would save $46 million a year in payroll costs, and
also would lead to the elimination of 659 full-time positions. Reducing
staffing to seven workers per occupied bed would save $25 million and
eliminate 355 jobs.
• The hospital does not have a system in place to measure
worker productivity, according to the report.
• The university's system for buying and tracking
equipment supplies is "poorly organized, operates out of multiple
locations, has cumbersome work flow processes and is minimally
automated," the report found. Accountability often is lacking, and many
department managers are unaware of how much money has been spent on supplies.
Proactive versus reactive
The report recommends closing the 63,480-square-foot,
off-site supply warehouse, eliminating 20 jobs. According to the report, the
state still has not made permanent repairs to the warehouse's electrical
system, which failed during Katrina. Instead, power is being supplied by a
rented diesel generator costing about $40,000 per month.
Similarly sized hospitals dedicate between 5,000 and 7,000
square feet for supply storage, according to the report, and have more than
twice the inventory turnover rate. The slow turnover rate means some
materials expire or become obsolete before they can be used, according to the
"It is apparent that the Materials Management staff
are unable to apply basic supply chain practices, strategies, principles and
concepts (i.e., identification of inventory turnover rate and ways to affect
it) because the staff remain in a constant reactive mode addressing
day-to-day needs," the report said.
• The hospital's top administrators should be more
vigilant in monitoring contracts, with an eye to determining whether the
services can be performed more efficiently in-house. As an example, the
report cites a $2.6 million annual contract with an outside vendor, signed
after Katrina, to have the floors cleaned. The report found that the same
services, performed in-house, would cost $1 million per year.
• Although the report praises the dedication of operating
room staff, it said the hospital does a poor job of making efficient use of
its 12 operating rooms. The average use of the operating rooms during the
prime-time hours of 7 a.m. to 3 p.m. was 55 percent, compared to an industry
standard of 70 percent to 80 percent.
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I can understand preservationists wanting to preserve the
old Charity Hospital building, which should be
redeveloped for reuse. But what I cannot understand is how people think that
by restoring Charity to a hospital, all the problems from the past will just
No one with insurance wanted to be taken to Charity unless
they have a gunshot wound or severe injury. Once the person recovered enough
they were immediately moved to Tulane, Touro,
Baptist, Ochsner or East
Jefferson. Is it fair to now require LSU to have some of these
same entities on its board?
It is totally unrealistic to expect the paying public to
be thrown into Charity
Hospital with prisoners
and psychiatric patients traipsing through public areas, which is the way
Charity was set up. One has to wonder how many of the complainers were ever
in the hospital as a patient.
Growing up in a medical family connected with LSU Medical
Center has given me
some insight into the problems with Charity. Going on rounds to area
hospitals with my father and working at Charity for a summer gave me a
different perspective. No one is addressing an important issue which is;
would the paying public start to go to Charity if it were redone as a
In addition, the Charity footprint does not meet the needs
of a growing, state of the art biomedical research center.
It is time to move forward and allow LSU to become an
innovative economic engine for our city.
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BATON ROUGE – Citing deep cuts to education and health
care they say were avoidable, two lawmakers from the Terrebonne-Lafourche
House delegation voted against Gov. Bobby Jindal’s
$27 billion spending plan Thursday, while most of their colleagues
rubberstamped the controversial budget without protest.
Sluggish energy prices and an ailing economy have left the
state with a $1.3 billion shortfall and the administration’s proposed budget
that takes effect on July 1 is a reflection of the inherent challenges –
among other reductions, more than 3,600 state jobs are slated for
“It’s an unfortunate situation, but it’s the hand that
we’ve been dealt and at this point in time and history that we must act
upon,” Appropriations Chairman Jim Fannin,
D-Jonesboro, told the House.
Opposing the administration’s bill were Reps. Damon Baldone, D-Houma, and Jerry “Truck” Gisclair,
D-Larose. Local lawmakers voting in favor of the spending plan were Reps.
Gordon Dove, R-Houma; Joe Harrison, R-Napoleonville; and Dee Richard, I-Thibodaux.
“Considering the situation the state is in, I’m fine with
where we are in the budget process,” said Dove. “Of course, I’d like more
money for Terrebonne and Lafourche parishes, but we have to work with the
money that we have during a cash-strapped year.”
After seven hours of debate, House Bill 1, which includes
the budget, was sent to the Senate for further debate by a vote of 87-16.
Among the 29 rejected amendments was a proposal by Richard
to restore $50,000 for a dyslexia center at Nicholls State
University. He told
lawmakers that Nicholls was already suffering enough, but the House chose
against acting on the amendment.
Overall, the Thibodaux
campus could be facing a 20 percent reduction, or loss of $5.3 million. As
the House debated the budget, officials at Nicholls announced that it would
be eliminating women’s golf in anticipation of the cuts.
Restoring money that had been slashed from education
budgets seemed to be a theme Thursday as $13.5 million was injected into the
spending plan for college-level courses for high school students and upgrades
to public college libraries.
Another $79 million
was amended into the bill for hospitals using federal funds, but Leonard J.
Chabert Medical Center
in Houma is
still looking a $1.4 million reduction in the next fiscal year. Municipalities
and parish governments were also provided with a $7.5 million amendment for
local spending. There are likewise a number of local earmarks in the bill for
Terrebonne Parish Consolidated Government, including:
Terrebonne Association for Retarded Citizens; $70,000
Memorial Park; $20,000
Repairs from storm damage to the Tina Street Pump Station;
Repairs from storm damage to the Dularge
Fire District Station; $20,000
Repairs from storm damage to the Gibson-Devon Keller
Repairs from storm damage to the Schriever Senior Citizen
In all, lawmakers added roughly $11 million in pet
projects to the budget, but no substantive debate on the matter was had. The
House’s debate over budgeting priorities, though, did hit a fevered pitch
when the section housing the new deal for the New Orleans Saints was brought
up for discussion. A few lawmakers attempted to dismantle parts of the deal
that direct state money to the NFL franchise, but it went nowhere fast and
all of the related amendments were voted down.
Local lawmakers like Richard, Gisclair
and Baldone questioned who would really benefit
from the deal, especially when future budgets are expected to have deficits
that equal or surpass this year’s surplus.
The regular session is scheduled to adjourn on June 25.
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Opelousas Daily World | 05.18.09
There's plenty to gripe about when it comes to the current
legislative session and Gov. Bobby Jindal's
There are questions about budgeting priorities as we
continue to target higher education and health care disproportionately in our
There are questions about why we're trying to tackle so
many things from mandatory helmets to guns on campus when the only thing that
really matters is that looming budget deficit.
There is some sense of folks fiddling while Rome burns.
But, there's an interesting upside emerging this year, and
it's an interesting year for it to be happening.
Even with money as tight as it is, the parochialism that
has long haunted the halls of the state Capitol is being quietly snuffed out
in favor of a bigger-picture approach to moving the state forward.
Take support for the Pennington
Center in Baton Rouge. Technically an arm of the LSU
system, Pennington has received $70 million in one-time dollars since Jindal took office to upgrade its buildings and grow its
campus. Pennington is a world-renowned research facility in nutrition,
fitness, obesity and diabetes. It brings in hundreds of millions in research
dollars and some of the world's top researchers in the field.
It's not just good for Baton Rouge
or for LSU, it's good for the entire state, just as Lafayette's
LITE Center or the New Iberia
are good for the entire state. Jindal often has
used LITE as a backdrop for his stops in Lafayette. That is not a coincidence. He
has done the same at Pennington.
Focusing dollars on growing our academic and research
capacity regardless of what part of the state it is in will be important to
creating the economy of the future.
We only hope that Jindal will be
able to carry this focus into budget talks with the state's institutions of
higher education, which have the same mission. If the governor's intention is
to force an end to parochialism in our colleges and universities by hoping
higher education leaders build the same kind of priority system on quality
rather than quantity, he may need to give more direction, not less.
Otherwise, important research programs are at risk.
The state's waning parochialism has been given multiple
tests this year, and in every case, the bigger picture has won out.
We saw it in $50 million to save a chicken-processing
plant on one end of the state and $85 million to keep an NFL team on the
other. Both projects are moving through swiftly, and legislators from both
sides learned that questioning their brethren in need about priorities
doesn't do much good when the end game is the same - to keep Louisianians working.
And most recently, we saw it when House members stopped
any effort to strip money from coastal restoration projects to fund road
projects in individual members' districts. If there is anything that defies
parochialism, it is in coastal restoration and protection.
These are important steps forward. Now, it is incumbent on
the governor to make clear what the big picture for the state really is and
to ensure that every decision we're making is about that, not which part of
the state can deliver the most votes.
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Gov. Bobby Jindal wrote
persuasively in a November 2007 essay about the need for a fresh start in Louisiana. He was
newly elected and preparing to take office. His transition teams were
beginning to craft the new administration's strategies.
The governor already had clear ideas of what needed to be
accomplished. For one, he promised to toughen ethics laws and improve Louisiana's badly
tarnished reputation. For another, he said his administration would make the
state more attractive to businesses and invigorate the economy.
"Good jobs and exciting economic opportunities should
exist for every citizen right here at home, and .¤.¤.
should become a much-sought-after destination instead of a point of departure
for our best and brightest," he wrote.
His first special session as governor was devoted to
ethics reform. His second focused on long-needed business tax cuts.
That was a good start. But the current legislative session
is a different matter. This year he has given his blessing to a bill that
will make Louisiana
more hostile to businesses and to an array of legislation that makes the
state seem narrow-minded and uninviting.
And while the governor's desire not to increase taxes on Louisianians is a worthy goal, cuts he is proposing for
higher education could do long-term damage to the state's economic viability.
One of the most befuddling developments is Gov. Jindal's backing of legislation that would increase Louisiana's $75,000
homestead exemption. Even lawmakers seemed surprised when he gave his backing
to House Bill 485, which would tie the exemption to the consumer price index
The exemption is already the most generous in the nation
and raising it inevitably will lead to a bigger tax burden on businesses,
which will mean fewer job opportunities for Louisianians.
Increasing the exemption also would rob city and parish governments and
school systems of property tax revenue, which could lead to reduced services
or higher property tax rates or both.
As for state taxes, the Public Affairs Research Council is
urging the Legislature to reverse or at least delay the elimination of the
income tax reduction approved last year. Commissioner of Higher Education
Sally Clausen also is arguing for the delay to ease the intense budget pressure.
They're right. Lawmakers shouldn't have voted last year to
repeal the Stelly Plan, which raised income taxes
on higher earners in exchange for a reduction in sales taxes. The loss of
those revenues will result in a $360 million hit to the state budget next
Louisianians may be disappointed
not to get the break this year, but making deep cuts in state services on the
fly isn't smart -- and it isn't good for residents. Holding off on the Stelly repeal won't erase all of the
budget shortfall, but it would be enough to lessen the pain.
"Slashing revenue without presenting specific
proposals for cost-cutting . . . merely masquerades as a way to streamline
government," PAR said.
But Gov. Jindal seems intent on
sticking to his budget-cutting plan. His budget calls for $219 million in
cuts to higher education, which university officials say will lead to
layoffs, fewer class offerings and diminished support for sports and cultural
programs like the Pulitzer Prize-winning LSU Press. The LSU System would have
to cut $102 million, including the potential loss of 225 jobs at the University of New Orleans.
There is waste in higher education, no doubt, but such
abrupt and extensive cuts give no assurance that needless programs will be
eliminated and important ones will be saved. That needs to be done in a more
deliberate manner than the current financial free fall will allow.
Fiscal woes aren't the only threat this year. Gov. Jindal's support of a bill to allow students and staff to
carry concealed weapons on campus is misguided and could well discourage some
parents from sending their children to college here.
Beyond the danger to individual students posed by the
bill, the message it sends about Louisiana
is the wrong one. So is the mean-spirited effort by some lawmakers to forbid
gay adoptive parents from other states to get an updated birth certificate
for children who are born here -- a measure that will hurt Louisiana
Gov. Jindal rightly focused in
his campaign on creating a better image for Louisiana. His ethics session was a step
toward that. His administration's professional handling of big business deals
like the new Saints' agreement also is encouraging.
But increasing the homestead exemption, arming college
students and making it difficult for children without parents to start a new
life move us backwards. That may play well with some constituents and with a
targeted national audience.
But it isn't good for Louisiana.
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By SANDY DAVIS
Advocate staff writer
Gus Kousoulas is quick to tell a
visitor that LSU’s School of Veterinary Medicine is not just about treating a
sick dog or horse — it’s also about finding treatments for infectious
diseases in humans, including swine flu.
of Veterinary Medicine
created the Division of Biotechnology and Molecular Medicine — BIOMMED — eight years ago
to do that research, said Kousoulas, BIOMMED
“We’re a bona fide research center with a primary focus on
infectious diseases,” he said. “We’re at the forefront of endemic diseases
A lot of the infectious diseases they study are ones that
an animal transmits to a human, such as swine flu, West
Nile virus and Lyme disease.
Most recently, the center’s researchers focused on the
H1N1 virus that recently threatened to become a pandemic.
“The reality is we cannot respond fast enough by getting a
vaccine out there. It takes at least six months for that to happen,” Kousoulas said.
The problem with flu viruses, Kousoulas
said, is they can change very quickly.
“If the avian flu and human flu infect a pig, the pig
becomes a mixing vessel. The viruses mix in the pig, and a new virus comes
out,” he said. “Because it changes so fast, it is highly possible that a new
virus evolves that is highly virulent in humans.”
Companies that produce vaccines are now faced with a
dilemma: should they produce vaccines for seasonal flu, swine flu or both, Kousoulas said.
“If we produce both vaccines, then we will have to produce
much less of each, which means not everybody could be immunized,” he said.
Another fear is that swine flu will mutate so much that
the new vaccine would be useless by fall, Kousoulas
“We’re really helpless in all of this,” he said. “We can
only contain it partially through antiviral medicines and vaccines.”
There are only two antiviral medications on the market
that work — Tamiflu and Relenza,
And flu viruses are known for becoming resistant to
“These drugs are really not a panacea, they’re not an
antibiotic that will cure you,” he said. “A lot of strains of the flu have
become resistant to Tamiflu. Flu viruses become
more resistant the more the medications are used.”
With summer beginning, the flu season is fading, Kousoulas said.
“Now we’re all holding our breath to see what happens in
the Southern Hemisphere with the swine flu and what happens in the fall,” Kousoulas said.
One of the more interesting aspects of swine flu that
BIOMMED is looking into is where did it actually originate.
“We think it actually began in either New Zealand or China,” Kousoulas
Beyond doing its own research, BIOMMED also does research
for other companies that are developing treatments for infectious diseases.
Currently, they’re doing research for a company out of Norway
that has extracted a compound from blue-green algae.
That extract was fed to mice infected with a more virulent
strain of swine flu and the flu symptoms were relieved in about 20 to 30
percent of the mice, he said.
In addition to actual research work, he said BIOMMED was
created as a catalyst to bring in large amounts of research funding from
outside the state.
Apparently, that worked.
“Over the last five years, we have brought over $40
million of National Institutes of Health funding and we are poised to
continue to do that over the next five years,” Kousoulas
About $10 million of the NIH funding was earmarked to
create a center for experimental infectious disease research.
“What that means is we’re interested in every virus or
bacterium that could infect animals or a human,” he said.
In the midst of these efforts, though, BIOMMED is facing
“If that happens, there will be a lot of us who will be
looking for greener pastures,” Kousoulas said.
He said a highly competitive faculty brings a lot of
funding to the state.
“I suspect we’re as good or better at bringing in
out-of-state funding as Pennington,” Kousoulas
BIOMMED actually needs to hire new people, he said.
“But when you have cuts, what can you do?” Kousoulas asked. “We’re at a standstill which means we’re
BIOMMED is also working on some of its own products.
“But we haven’t filed for patents yet,” Kousoulas said. “It’s very competitive between companies
and scientists who are developing all of these things.”
In addition, BIOMMED has spun off a for-profit company, Thevac Biotech.
“The idea is to be able to produce (lab products) for
research but also ultimately to produce vaccines and therapeutics in
collaboration with the LSU School of Veterinary Medicine,” Kousoulas said.
He said the company is in its very early stages and one of
the many pluses is it will provide employment for the scientists who graduate
For now, Kousoulas is worried
that with the budget cuts, some of the more talented researchers will leave.
“The high-end kind of research that we do should be
preserved,” he said. “We need to be supported.”
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The Associated Press
(AP) — BATON ROUGE, La.
- Louisana health officials say the number of
confirmed swine flu cases in the state has risen to
The latest cases include seven confirmed Thursday in
Plaquemines Parish and three from St. Charles Parish that were confirmed
Thursday and Friday.
State health department spokesman Rene Milligan says the
virus does not appear to be spreading rapidly within Louisiana. So far, about 2,800 specimens
have been tested.
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By DOUG SIMPSON
BATON ROUGE, La. (AP) — When two first-year French horn
players in Southern University's marching band were beaten so badly they had
to be hospitalized in intensive care, it exposed a dirty secret: Hazing isn't
reserved for fraternities.
At least one expert says the beatings are a growing
problem at historically black colleges, where a spot in the marching band is
coveted and the bands are revered almost as much as the sports teams for
which they play their rousing fight songs.
"It's something that deserves more attention,"
said Walter Kimbrough, president of Philander
in Little Rock, Ark., who has researched band hazing cases
at historically black colleges nationwide and has been called as an expert
witness in more than a dozen court cases involving hazing.
"And I'm just talking about violent cases — there
could be a ton of those silent cases, the ones that could have been reported
but weren't," he said.
Kimbrough estimated that 15 percent of the country's 80
historically black colleges have had violent hazings
among band members over the past few years. He's found that brutal band hazings are not restricted to predominantly black schools
but do crop up as a problem among bands that have cliques or subgroups that
operate like fraternities — but without school authorization.
The victims at Southern apparently were seeking membership
to "Mellow Phi Fellow," a fraternity-like subgroup of the French
horn section, according to investigators.
The three told investigators that on Nov. 27, 2008 — two days
before the band performed at Southern's annual
Bayou Classic football game against Grambling State in the Louisiana
Superdome — they gathered at the off-campus home of one of their bandmates, where they were blindfolded, doused with water
and beaten with a board.
One of the victims elected to stop the ritual after being
hit with a board more than 50 times and later identified the suspects,
The other two kept going, and were beaten so badly they
risked organ failure and were hospitalized for several days in intensive
care. They are recuperating, District Attorney Hillar
The University of Wisconsin-Madison last year briefly
suspended its marching band after allegations that underclassmen were forced
to drink huge amounts of alcohol.
One of the worst cases concluded when a former band member
at historically black Florida A&M University
won a $1.8 million award in 2004 after suffering kidney damage because of a beating
with a paddle. A jury found five former band members liable in that suit. The
victim also settled with the school for an undisclosed amount.
Competition is intense among college bands,
and Southern — with 190 members — in particular prides itself on the quality
of its shows. There are tryouts for the band, known for its athleticism and
synchronized dancing, which travels with the teams and performs around the
"What makes the football games ... is the band,"
said Angel Askew, 19, a Southern freshman from Mesa, Ariz.
"A lot of people, to be honest, don't even watch the football games.
They just wait for the next song the band's going to play."
Leslie Hicken, the director of
bands at Furman University in Greenville,
S.C., and a division president
of the College Band Directors National Association, said hazing often occurs
within sections of bands as new members seek approval from senior members who
had been through the rituals in years past. New members are reluctant to
report it, fearing they would lose their peers' respect, he said.
"The sections are encouraged by everyone to have
their own kind of bonding experience," Hicken
said. "I can see where, if not monitored, it could get out of control.
We're talking about college students here — things are going to evolve on
The seven defendants in the Southern case originally faced
felony charges of aggravated battery and "ritualistic acts" that
carried prison sentences of up to 50 years. A plea deal was proposed this
past week that would give the seven defendants — ranging in age from 20 to 23
— probation instead of prison time if they plead to lesser charges. Southern
suspended all seven indefinitely.
"Hopefully this is just an isolated incident, and one
that Southern surely wants to address, because they don't want this,"
Moore, the prosecutor, said.
Southern, with an enrollment of about 7,400, has forced
every member of the 180-member "Human Jukebox" to reapply for their
spots in the band and sign an anti-hazing pledge, said school spokesman Ed
The university had no comment on the proposed plea
Danielle Winger, 21, a junior from New Orleans, said she has friends in the
band and doubts violent hazing is widespread.
"I can honestly say, I've never seen someone walking
around with black eyes, or broken arms," Winger said. "I think this
was just boys being boys."
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The Associated Press
(AP) — WASHINGTON
- It's the toughest question of all in the debate over revamping the health
care system-how to pay for expanding coverage to nearly 50 million uninsured
Ask lawmakers about raising taxes and the responses range
from emphatic opposition to noncommittal statements about "putting
everything on the table."
Cutting costs is a popular idea, but few experts think
enough savings can be wrung from the system to expand coverage to so
many-despite pledges from medical providers.
Undaunted, Congress is forging ahead, but with no
consensus in sight. Few of President Barack Obama's proposed tax increases
have been well received on Capitol Hill, and there aren't many popular ideas
coming from lawmakers, either.
Democrats, who have been fighting the tax-and-spend label
for decades, are very much aware of what happened the last time a Democrat
won the White House and a Democratic-controlled Congress voted to raise
taxes. It was l993, and Republicans won control of Congress the following
"Ever since then they've been especially scared to
deal with these difficult issues," said Eugene Steuerle,
a Treasury official under former President Ronald Reagan.
Obama says his goals are to rein in costs, guarantee
choice of health plans and doctors, and ensure that all Americans have access
to affordable coverage. But guaranteeing coverage for all could cost $1.5
trillion over the next decade, which has some advocates concerned that
Congress will pass a plan that falls short.
Medical providers have pledged to find $2 trillion in
savings over the next decade, but much of that money will be needed to keep
premiums from skyrocketing for those who already have coverage.
"So far, nothing tough has been done," said
William Gale, co-director of the Tax Policy Institute, a Washington think tank whose research was
often cited by Obama during the presidential campaign.
Rep. Charles Rangel, chairman of the tax-writing House Ways and
Means Committee, said Congress "absolutely" has the will to raise
taxes to pay for health care reform.
"Cut costs, raise revenue," the New York
Democrat said. "Closing loopholes could be considered raising taxes,
But Rangel is one of the few lawmakers to openly embrace
tax increases. Today's Democratic Congress is, after all, very different from
the one that helped former President Bill Clinton raise taxes in 1993 to
reduce federal budget deficits. Democrats retook Congress in 2006 and
expanded their majority in 2008 in part by electing moderates in
Many of those newly elected Democrats are wary of voting
to raise taxes, especially when they are unlikely to get any Republican
"If you are a first- or second-term Democrat, why on
earth would you want to vote in July or August 2009 for a tax increase that
the president doesn't want to have take effect until 2011?" asked Clint
Stretch, managing principal of tax policy at Deloitte Tax. "You've just
handed your opponent an extra year to campaign that you're a big-tax
House Speaker Nancy Pelosi has pledged to pass a health
care reform bill this summer. Her take on taxes: "We're putting
everything on the table."
Obama's proposal targets high-income families by reducing
their tax deductions, including those for mortgage interest and charitable
donations, for individuals making more than $200,000 and couples making more
The proposal would raise about $276 billion over 10 years
as part of a "down payment" for health care reform, but key
Democrats have said they worry it would hurt charitable organizations.
One critic has been Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee. Baucus has been
working for months on a plan that would tax at least some health benefits
provided by employers. Employer provided health insurance is currently
Obama, however, opposed a similar plan offered by his
rival in the presidential election, Sen. John McCain,
R-Ariz. Baucus' plan is getting no better reaction
from fellow Democrats in the House.
"I think it was a bad idea when John McCain proposed
it and I think it's a bad idea today," said Rep. Mike Ross, D-Ark., who
chairs the health care task force for the conservative "Blue Dog"
A nutrition group has proposed a series of sin taxes to
help pay for health care, including a tax on soft drinks that got a lot of
attention at the Capitol. The group, the Center for Science in the Public
Interest, said reducing soft drink consumption would "help slow the
The proposal prompted objections from the beverage
industry, and even Clinton, who said in a broadcast interview that Congress should
focus on containing costs rather than raising taxes.
of course, remembers how hard it was to craft a massive health care overhaul
when he was president. It went about as well as the 1994 elections did for
[BACK TO TOP]
The Associated Press
(AP) — WASHINGTON - It
may be riskier on the lungs to smoke cigarettes today than it was a few
decades ago-at least in the U.S.,
says new research that blames changes in cigarette design for fueling a certain
type of lung cancer.
Up to half of the nation's lung cancer cases may be due to
those changes, Dr. David Burns of the University
of California, San Diego, told a recent meeting of tobacco
It's not the first time that scientists have concluded the
1960s movement for lower-tar cigarettes brought some unexpected consequences.
But this study, while preliminary, is among the most in-depth looks. And
intriguingly it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia even though both
countries switched to so-called milder cigarettes at the same time.
"The most likely explanation for it is a change in
the cigarette," Burns said in an interview-and he cited a difference:
Cigarettes sold in Australia
contain lower levels of nitrosamines, a known carcinogen, than those sold in
That's circumstantial evidence that requires more
research, he acknowledged.
But anti-smoking advocates are citing the study as
Congress considers whether the Food and Drug Administration should regulate
tobacco, legislation that would give the agency power to decide such things
as whether to set caps on certain chemicals in tobacco smoke.
Smokers once tended to get lung cancer in larger air
tubes, particularly a type named "squamous
cell carcinoma." Then doctors noticed a jump in adenocarcinoma,
which grows in small air sacs far deeper in the lung. Initial studies blamed
introduction of filtered, lower-tar cigarettes. When smokers switched, they
began inhaling more deeply to get their nicotine jolt, pushing cancer-causing
smoke deeper than before.
Burns' study, presented at a meeting of the Society for
Research on Nicotine and Tobacco, took a closer look. He compared smoking
behaviors of different age groups over four decades-how much they smoked,
when they started, when they quit-and how cancer-risk changed.
The risk of squamous cell
carcinoma stayed about the same over those years, Burns found. But adenocarcinoma rose. It makes up 65 percent to 70 percent
of newly occurring U.S.
lung cancer cases, but no more than 40 percent of Australia's lung cancer, he said.
While the nation's total lung cancer cases have inched
down as the number of smokers has dropped in recent years, the study suggests
an individual smoker's risk of getting cancer is higher.
It's well known that cigarettes differ from country to
country, because of different tobacco crops grown locally and smokers'
varying tastes. Nitrosamines are a byproduct of tobacco processing and levels
vary for several reasons, including differences in curing practices.
Australian cigarettes contain about 20 percent of the
nitrosamine content of U.S.
cigarettes, making the chemical a prime suspect, concluded Burns, who has
been scientific editor of several surgeon general reports on tobacco.
That doesn't rule out a role for deeper inhaling,
cautioned Dr. Michael Thun of the American Cancer
Society: "There's several strong suspects in
the lineup. They may have acted in combination."
Philip Morris USA spokesman David Sutton called the study
speculative and hard to evaluate until it's published in a medical journal,
something Burns plans to do.
Still, Philip Morris, which supports FDA tobacco
regulation, began taking steps with its growers in 2000 that have yielded
"significantly lower" nitrosamine levels in recent years' supplies,
Be careful in assuming lower-nitrosamine cigarettes are
less lethal, said Dr. Neal Benowitz of the University of California,
a well-known tobacco expert. Lung cancer is only one
of tobacco's many risks-it causes heart disease and other killer diseases,
"If you reduce someone's (lung cancer) risk by 10
percent, that's not really meaningful for an individual," he said.
"The goal still is to get them to stop."
[BACK TO TOP]
Medical expert Dr. Brobson Lutz
talks about what New Orleanians can do if they have
mental health questions as the state talks about cutting budgets, including
in the health industry.
[BACK TO TOP]
The New York Times | 05.18.09
By PETER JARET
Cataracts occur when the eye’s natural lens becomes cloudy
Cataracts don’t harm the eye but can progressively impair
Cloudy lenses can be removed and replaced with artificial
lenses designed to correct a range of vision problems.
With a variety of new replacement lenses on the market,
it’s wise to talk to your eye doctor about your options.
Like bum knees and crow’s feet, cataracts are the price we
pay for getting older. Cataracts form when the normally transparent lens of
the eye turns cloudy. At least three out of five people over age 60 will
eventually develop them. Today, thanks to a steady march of advances,
cataract replacement surgery often gives people better vision than they’ve
had in years.
Progress in the field has been nothing short of
astonishing, experts say, starting with the development of artificial lenses
about 30 years ago.
“In the early days, all we could do was remove
the cataractous lens,” said Dr. Peter R. Egbert,
director of the Cataract Service at Stanford University.
“Patients ended up with no lens in their eye to focus and had to wear very
thick glasses to see. Nobody was happy with the results.”
Patients can now choose from a wide range of artificial
lenses. The most common are monofocal lenses, which
focus vision at a single distance, the way a pair of standard glasses does.
Before surgery, ophthalmologists test the eyes to choose the best prescription
for the artificial lens, based on whether patients are nearsighted or
farsighted or have normal vision.
Multifocal lenses, designed to
focus both up close and at a distance, are a newer option. They are
particularly appealing because by the time people develop cataracts, usually
starting in their 60s, most suffer from presbyopia
and require reading glasses. Presbyopia occurs when
the body’s natural lens stiffens with age and eye muscles can no longer focus
it for close vision.
Techniques to insert the new lenses have also been
refined. In the past, doctors had to make a relatively large incision in the
clear capsule that contains the natural lens. Now a technique called phacoemulsification breaks up the damaged lens so it can
be removed in fragments through a much smaller opening. Replacement lenses
are made of a material pliable enough to be rolled up and inserted through
the opening. Once inside, they unfold to fill the capsule. The entire
procedure usually takes less than 30 minutes and is typically performed using
an anesthetic eye drop.
Monofocal lenses, which have
long been in use and are covered by insurance, remain the most common choice
of replacement lens. But multifocal lenses are growing in popularity.
A variety of multifocal brands are available, but they all
work in one of two basic ways. One design presents two images to the retina,
one focused close and the other at a distance. The brain then chooses which
one to “see.” The second design, called an accommodating lens, incorporates a
kind of hinge that allows eye muscles to focus the lens either near or far.
“For people who wear bifocals, the new lenses can mean
being much less reliant on glasses, and in some cases eliminate the need for
them entirely,” said Dr. David F. Chang, a clinical professor of
ophthalmology at the University of California, San
Because these so-called premium lenses are not considered
medically necessary, they aren’t covered by Medicare or private insurance.
The additional cost can run up to $3,000 per eye.
Another new artificial lens design, called a toric lens, corrects astigmatism, which is caused by an
abnormal curvature of the cornea. Like multifocal lenses, they are considered
premium lenses and aren’t covered by most insurance plans.
Joan Gallien, 68, of San Jose, Calif.,
is among the many patients who have paid the extra money for premium lenses.
She said she “couldn’t be happier” about no longer needing to rely on glasses
for distance or reading.
But there are drawbacks. Patients sometimes complain about
seeing haloes around lights at night. In addition, multifocal lenses designed
to present two images to the retina can decrease contrast, making it more
difficult to see in dim light.
“The haloes are definitely there, especially around traffic
lights and headlights,” Ms. Gallien said. “They’re
kind of frustrating. I try not to drive at night.”
Some doctors believe the drawbacks outweigh the benefits,
especially because the majority of patients end up having to wear reading
glasses for very fine print.
“I definitely tell my patients about multifocal lenses,
but I don’t recommend them myself,” Dr. Egbert said. “The fact is, I wouldn’t want one in my eye.”
Other specialists are more enthusiastic.
“Occasionally people do notice decreased contrast and
rings around lights at night,” said Dr. Marian Macsai,
professor and vice chairman of the department of ophthalmology at
Northwestern University Feinberg School of Medicine. “But in the hundreds and
hundreds of patients who’ve opted for these lenses, I haven’t had anyone ask
me to take them out. They’re very happy with the results.”
How well the lenses work depends in part on how healthy
the eye is, said Dr. David M. Brown, assistant professor of ophthalmology at
The Methodist Hospital, Weill College of Medicine in Houston, where he specializes in retinal
“Since many multifocal lenses cut down on the amount of
light reaching the retina, they aren’t recommended for people with macular
degeneration or diabetic retinopathy, which already make it difficult to see
in low light,” Dr. Brown said. “People with a family history of macular
degeneration or diabetes should be informed that should they develop macular
disease, they may have more difficulties functioning with multifocal lenses.”
Like presbyopia, retinal
problems become more common with age, limiting the number of candidates for
Most eye specialists expect multifocal lens designs to
improve. One approach under development is a plastic gel that would be
injected into the capsule that held the original lens and would form a highly
pliable new lens.
Monofocal lenses, meanwhile, are
already so refined that the results for many patients are dramatic.
“You can have someone who’s very nearsighted, who
basically can’t see until they reach for their glasses in the morning,” said
Dr. Stuart McKinnon, director of ophthalmology and neurobiology at Duke
University School of Medicine. “You do cataract surgery and afterwards they
can see perfectly. We’ll do surgery on one eye, and afterwards they come and
say, “I never realized. Let’s get the other eye done.’ ”
[BACK TO TOP]
New York Reports Its First Swine Flu Death
The New York Times | 05.17.09
By ANEMONA HARTOCOLLIS
An assistant principal at a New York
City public school died of complications from swine flu in an
intensive care unit of a Queens hospital on Sunday
night, the first death in New
of the flu strain that has swept across much of the world since it was first
identified in April.
Hours before the death of the assistant principal,
Mitchell Wiener, city officials announced that five more Queens schools had closed.
On Friday, Dr. Daniel Jernigan, head of flu epidemiology
for the federal Centers for Disease Control and Prevention, said there had
been 173 hospitalizations and 5 deaths reported to the agency. But he
emphasized that most cases in the United States — possibly “upwards
of 100,000” — were mild.
the number of swine flu cases soared over the weekend, and authorities closed
more than 1,000 schools and kindergartens .
Mr. Wiener’s death, which came five days after he entered
the hospital and three days after his school, Intermediate School 238 in
Hollis, Queens, was shut down by health officials, raised the level of
concern among the public, especially parents, but health officials played
down the significance of the death to public policy.
Health officials said Sunday that the death was not
surprising, since even in a normal flu season, thousands of victims die of
complications from the disease.
Mr. Wiener had a history of medical problems that may have
put him at greater risk, the officials said. His family said that he had
suffered from gout but that it was under control with medication.
The city’s health commissioner, Dr. Thomas R. Frieden, called the death “terribly tragic,” and said,
“Our heart goes out to the family and to the community.”
“We are now seeing a rising tide of flu in many parts of New York City,” Dr. Frieden said. But he added: “Nothing we’ve seen so far
suggests that it’s more dangerous to someone who gets it than the flu that
comes every year. We should not forget that the flu that comes every year
kills about 1,000 New Yorkers.”
Mr. Wiener, 55, had been “overwhelmed” by the illness,
despite beginning a course of treatment with an experimental drug, Ribavirin, after he failed to respond to other antiviral
drugs, according to Ole Pedersen, a spokesman for Flushing Hospital
where Mr. Wiener had been a patient since Wednesday.
After an early period of high alert when the virus was
first detected in New York City,
officials had more recently toned down their concern, leading Mr. Wiener’s
family to lash out on Friday.
His wife, Bonnie, a reading teacher, blamed the city for
failing to act sooner to close the school where she and her husband both
worked. “I know we have a duty to educate the children of New York,” Ms. Wiener, who is not sick,
said on Friday. But, she added, “something just doesn’t fit right.”
Late last week, the city closed five schools in Queens and
one in Brooklyn, after five cases of swine flu were confirmed, including that
of Mr. Wiener.
The city said on Sunday that it was closing the five
additional schools because of the large number of children coming down with
flulike symptoms like fever and coughing. That brought the number of schools
closed in New York City
to 11 since Thursday and to at least 15 since the virus was identified in
Jessica Scaperotti, a
spokeswoman for the New York City Department of Health and Mental Hygiene,
said that there were no more confirmed cases of swine flu but that the
department had decided to close the schools because of “unusually high and
increasing levels of influenzalike illness.”
A total of 105 students were documented with flulike
illness at Middle School 158 in Bayside, Our Lady of Lourdes in Queens Village
and a building in Flushing that houses three
schools with a total of 1,320 students, including Intermediate School 25. All
of the schools will be closed beginning Monday for at least five days, the
“We are evaluating the situation and looking at all
schools in New York City
and making decisions on a case-by-case basis,” Ms. Scaperotti
In a statement, Mayor Michael R. Bloomberg asked New
Yorkers to keep Mr. Wiener’s family “in their thoughts and prayers.” The
mayor added, “He was a well-liked and devoted educator, and his death is a
loss for our schools and our city.”
Ernest A. Logan, president of the principals’ union,
called Mr. Wiener “the truest kind of educational leader, unsung, yet
absolutely dedicated to his students, his teachers and fellow
Chancellor Joel I. Klein and Randi Weingarten, president
of the teachers’ union, were among the many officials who offered
condolences. Ms. Weingarten said the death was a reminder of the need to
monitor schools for flu outbreaks.
Mr. Wiener was hired as a teacher at Intermediate School
238 in September 1978, after working as a substitute teacher in the city six
months. He became assistant principal of the school in July 2007.
Several former students of Mr. Wiener’s
gathered outside I.S. 238 on Sunday to remember him. They left flowers and
candles on the steps and wrote “RIP Mr. Wiener” in black marker on the door.
“He knew every kid’s name” said Byron Lopez, 32, a former
student who is now a commercial real estate appraiser. He recalled his
teacher’s constant refrain: “Get to class, Byron. You’re going to be late.”
He said he had stayed close to his teacher since leaving the school after
Mr. Lopez still lives in the neighborhood, where he said
many people believed the city waited too long to close the school.
In one shift in the way the city was responding to the
disease, hours before Mr. Wiener’s death, the health department issued a
statement urging New Yorkers who suffered from underlying health issues like
emphysema, diabetes or asthma and who were exposed to the flu to see their
doctors to determine whether they should take antiviral drugs as a
Dr. Frieden said Sunday that
city officials did not expect to stop the flu from spreading at this point.
But he said that the school closings and the warnings to people with
underlying health conditions were an attempt to keep people from getting
seriously ill, as Mr. Wiener had.
“At this point our goal is not to stop the spread of flu,
because that’s like stopping the tide from coming in or going out,” Dr. Frieden said. “We have been concerned by the emergence of
a novel virus, and for people with underlying conditions, it’s very important
to get treated promptly.”
On Friday, Dr. Frieden was named
by President Obama to head the federal Centers for Disease Control and
Prevention, where he will have to make critical decisions about how to deal
with the spread of the disease. He starts in June. He has urged the federal
government to mount a Manhattan
Project-type effort to develop a vaccine.
One of Mr. Wiener’s three sons, Adam, said about an hour
after his death that the family was too devastated to talk. “Out of respect
to my family, not right now,” Adam Wiener said. “We can’t talk about this
Dr. Scott A. Harper, a medical epidemiologist with the
health department’s Bureau of Communicable Disease, said that since swine flu
was detected in New York,
there have been 178 confirmed cases, with a vast majority of cases going
undiagnosed. “The first hint that it was here was in a school, so we’re not
surprised to see activity in schools continuing,” he said.
Hospital Sunday night,
Mary S. Meguerditchian, 60, whose husband has been
recovering from a stroke on the same floor as Mr. Wiener, said the family had
seemed optimistic about Mr. Wiener’s chances on Saturday. But on Sunday Ms.
Wiener had told her that a “special vaccination” had been administered to Mr.
Wiener, “but it didn’t work,” Ms. Meguerditchian
Ms. Meguerditchian said she
heard Ms. Wiener cry out from inside the Wiener family’s special waiting room
as doctors told them that Mr. Wiener had died.
“I was crying too,” Ms. Meguerditchian
said. “It’s like my family because I was with them the whole time. I feel
very bad. It’s very hard for the wife and for the kids.”
She said that being exposed to the family of a swine flu
victim had left her and her family frightened for their own health.
“Every minute we wash our hands,” she said.
The swine flu outbreak in New York
was first reported to city health officials on April 23 by a school nurse,
Mary Pappas, at St. Francis
Preparatory School in Fresh Meadows, Queens. Over the next few days, hundreds of students
became ill as the flu spread rapidly among students and teachers at the
school, which was closed for about a week. An
investigation by the city’s health department traced the likely origin of the
illness to several students who had visited Cancún, Mexico, the center of the virus,
during spring break.
Reporting was contributed by Russ Buettner,
David W. Chen, Javier C. Hernandez, A. G. Sulzberger, Rebecca White and Karen
[BACK TO TOP]
By MARILYNN MARCHIONE, AP Medical Writer
health officials are seeing a surprisingly high number of cases of ordinary,
seasonal flu at a time when the flu season typically peters out.
About half of people recently testing positive for the flu
have the new swine flu virus, Dr. Daniel Jernigan of the Centers for Disease
Control and Prevention in Atlanta
The rest have seasonal flu, which is still causing
widespread or regional illness in about two dozen states, "something
that we would not expect at this time," he said. "We would be
expecting the season to be slowing down or almost completely stopped."
The higher numbers of seasonal flu cases do not seem to be
just because health officials are looking harder this year because of worries
about swine flu, Jernigan said. A network of doctors who track how many
patients are coming in with flulike symptoms, plus evidence from school
outbreaks and lab testing, points to more flu — not just more reporting, he
In the United
States, there are now more than 4,700
probable and confirmed cases of swine flu, and 173 hospitalizations and four
deaths, Jernigan said. The tally doesn't include a fifth death that Texas officials said
Friday was due to swine flu.
"The H1N1 virus is not going away," Jernigan
said. The virus "appears to be expanding throughout the United States"
and poses "an ongoing public health threat," he said.
Swine flu continues to affect more
younger people — those ages 5 to 24 — and CDC is still seeing
relatively few cases in older people.
"That may be just a matter of time" until the
virus spreads to that population, or it may prove to be a difference in the
virus or its effect on various groups, he said.
Officials are still monitoring the situation in Mexico,
where the outbreak began. However, the CDC's quarantine chief, Dr. Martin Cetron, said the agency was downgrading its warnings
about travel to Mexico.
The CDC had urged people to avoid nonessential travel to that country, but
that was changed Friday to just a precaution for people at high risk of flu
The fifth U.S.
death attributed to swine flu was reported Friday in a 33-year-old Texas man who died May
5 or May 6 after becoming sick a few days earlier. Corpus Christi-Nueces
County Health District's Dr. William Burgin Jr. said the man had medical
conditions, including heart problems, that made it
tougher for him to fight a viral illness. The victim's name was not released.
It was the third swine flu death in Texas. Other deaths occurred in Washington and Arizona.
In New York City, three
public schools in the borough of Queens were
closed after hundreds of children were sent home sick this week, and a city
official said Friday that three more schools would be shut down after
students developed flu symptoms. At one school, Susan B. Anthony middle
school, there were five confirmed cases of swine flu, including a 55-year-old
assistant principal hospitalized in critical condition.
Outgoing City Health Commissioner Dr. Thomas Frieden said Friday that the large clusters of apparent
swine flu cases at the schools were "a little surprising," but
added: "So far it doesn't appear to be causing more severe illness than
"We don't know how far it will spread, how wide it
will spread, how long it will spread," said Frieden,
who on Friday was named director of the CDC.
As he spoke, maintenance workers at the schools scrubbed
desks, floors and door handles Friday. At one middle school, where 241
children were out with flulike symptoms Thursday, a worker in a mask was seen
mopping down the cafeteria.
Addressing criticism that the schools should have been
closed sooner, Mayor Michael Bloomberg said, "We have to make decisions
on each school individually. ... Our children need more time in school, not
New York City's first swine
flu outbreak occurred when hundreds of teenagers at a Roman Catholic high
school began falling ill following the return of several students from
vacations in Mexico.
[BACK TO TOP]
The New York Times | 05.15.09
By LESLEY ALDERMAN
OH, the glory of being your own boss: the freedom, the
creativity, the jeans-only dress code. And then there’s the dreary stuff —
like finding and paying for your own health insurance.
Denise Spatafora, an author and
career and life coach who has been self-employed for 20 years, says it used
to be that “dealing with insurance was just part of what it meant to be an
But when Ms. Spatafora had to
find a new policy this year for herself and her family, she was shocked.
“Prices are through the roof,” she said, “and all the doctors I love don’t
take insurance anymore.”
She lives in Manhattan, and
people in New York
State pay some of the
highest health insurance premiums in the country, increasing by 13 to 15
percent annually for nearly a decade.
Fortunately for Ms. Spatafora,
because she is a sole proprietor she is eligible for plans that cost
considerably less than an individual would pay in New York. With the help of a broker, Aaron
Lindskog, Ms. Spatafora
found a family plan from Emblem Health that comes with a relatively high
deductible of $5,000, but costs just $487 a month.
“My family is healthy,” says Ms. Spatafora,
who is the author of “Better Birth” (Wiley, 2009). “This coverage is just for
But strategies suitable for New York do not necessarily work in other
states. Some places, like Florida,
allow a “group” to consist of just one person. That means sole proprietors
can buy insurance in the small-group market without being screened for health
issues. But it also means that small-group insurance in Florida may be more expensive than
individual plans that can provide a price break for good health.
“When you’re self-employed, you’re straddling two distinct
markets: the individual and the group market,” notes Janet Trautwein, chief executive of the National Association of
Health Underwriters, an organization of health insurance agents, brokers and
Those two markets vary depending on where you live. And
so, if you are self-employed and in the market for a new plan, or you need to
upgrade an old one, you should learn about the rules in your state. (You can
find a link to your state’s insurance department at the National Association
of Insurance Commissioners site, www.naic.org/state_web_map.htm.)
Then consider the following, before you make a choice:
ASSOCIATION PLANS Professional organizations and local
chambers of commerce typically offer good options for the self-employed —
especially in expensive markets like New
When Larry Smith left his full-time job in 2005 to start
SMITHMag.net, an online magazine, he called dozens of insurers. “The options
were lousy and outrageously expensive,” recalled Mr. Smith, who lives in Brooklyn. “Clearly, I had to find a way to replicate
the advantages of being part of a larger whole.”
He found a good proxy by joining MediaBistro.com, a New
York-based organization for media professionals. For a $55 annual fee, he was
able to join an Oxford
plan that charges $333 a month for individual coverage. Considering that the
average monthly rate for an individual in New York
is $900, according to the New
department of insurance, Mr. Smith scored a good deal.
MediaBistro.com offers well-priced individual or family
coverage through a group plan to New Yorkers and discounted plans to those
outside the state (www.mediabistro.com/insurance). The Freelancers Union
(www.freelancersunion.org/insurance) also offers insurance to independent
workers, but you must earn income in one of their approved industries.
Beware, though, of organizations that are created simply
to sell insurance, Ms. Trautwein said. “Each year
we come across dozens of scams,” she said. “Make sure it’s a bona fide
association, and there is a decent insurer in the background.”
HEALTH INSURANCE BROKERS An independent broker represents
several insurers and can match you with the company that offers the best rate
and coverage. An experienced broker can help you figure out your priorities
(H.M.O.? P.P.O.? high-deductible plan?) and explain what is available in your locale. A broker can
also provide continuing support after you purchase the policy.
Having trouble with a claim or confused by out-of-network
rules? Your broker can decode the arcane lingo and help you settle disputes.
What’s more, because brokers earn their fees from insurers, they don’t charge
To find a broker in your area use the Find an Agent
feature on the National Association of Health Underwriters site
Once you have a few names, quiz them about their expertise
and whether they serve multiple carriers. The best broker for you is one that
is familiar with your situation, knows about various plans, and is not just a
shill for a couple of companies.
If you want to take a do-it-yourself approach, try an
Internet brokerage site like ehealthinsurance.com, which can help you compare
policies and prices in your area.
CONSIDER A PART-TIME JOB If you are an entrepreneur
working 70-hour weeks, this may not make sense for you. But if you are a
painter or novelist with more time than money, or you have a health condition
that makes it difficult to find affordable coverage, a part-time job can keep
you out of debt.
Nearly 80 percent of large companies offer benefits to
their part-time employees, according to the consulting firm Hewitt Associates.
Employees at Starbucks who work 20 hours or more a week, for example, are
entitled to health care coverage that includes prescription drug and mental
health benefits, as well as other perks. Trader Joe’s and Barnes and Noble
are among other companies offering health coverage to part-timers.
DISABILITY INSURANCE Health insurance can protect you only
so far. If you become ill and cannot work, you will need insurance to help
replace your lost income — especially if you are the main breadwinner.
“If I were starting out today,” says Mickey Lyons, owner
of The Medical Link, a benefits consulting firm in Manhattan, “I’d get a high-deductible
health plan and a disability plan that replaced 50 percent of my income.”
Mr. Lyons is in the business of selling insurance, of
course, but his point makes sense. After you have spent years building up
your business, you do not want a broken arm or a bout with cancer to derail
[BACK TO TOP]
The New York Times | 05.15.09
By ROBERT PEAR
WASHINGTON — The government could rein in aggressive
marketing practices of health insurance companies, regulate their premiums
and allow workers to drop out of group health plans to seek a better deal on
their own under legislation being developed by leading Democratic senators.
The Senate proposals, which emerged this week, are broadly
similar to ones being drafted by the chairmen of three House committees.
Democrats in both houses would vastly expand federal regulation of insurance
to guarantee that all Americans have access to affordable coverage, a top
priority of President Obama.
Lawmakers have not figured out how to pay for their
proposals, which could easily cost more than $1 trillion over a decade. And
they have not resolved the politically explosive question of whether to
create a public insurance program, to compete with private insurers.
But after a week of intense discussions, in which members
of the House and the Senate immersed themselves in the details of health
care, Democrats began to line up in favor of several basic ideas.
Under the Senate proposals, everyone would be required to
carry insurance. The requirement would take effect in 2013, but exemptions
would be allowed for illegal immigrants and people with religious objections.
In addition, most employers would be required to offer
insurance to their full-time workers, or else pay a special tax. The
government would set minimum standards for benefits, including doctors’
services, hospital care and prescription drugs. All insurers would have to
offer four levels of coverage: lowest, low, medium and high.
Insurers “could not include lifetime limits on coverage or
annual limits on any benefits,” a detailed options paper from the Finance
Under the Senate plans, the federal government would
regulate the marketing of commercial insurance to families and employers,
just as it regulates sales of managed care plans to Medicare beneficiaries by
companies like Aetna, Humana and
While the House has not made as much progress as the
Senate, House Democrats agree with their Senate colleagues that the government
should establish a national health insurance exchange, or marketplace, where
people could buy coverage, using standard application forms. All insurers
would have to participate in the exchange, and the government would post
“quality ratings” on a Web site.
Consumers could sign up for insurance at hospitals,
schools, Social Security offices and state departments of motor vehicles.
Senator Max Baucus, the Montana Democrat who is chairman
of the Finance Committee, said the exchange would “make purchasing health
insurance easier and more understandable.”
Under the Democratic proposals, the government would offer
tax credits to help people buy insurance. The credit would be available to
people with incomes up to four times the poverty level ($88,200 for a family
The government would also provide tax credits to help
small businesses buy insurance for employees. The credit would be available
to businesses with up to 25 employees, and businesses with the lowest-wage
workers would get more aid.
Under the Senate proposals, the government would regulate
not only insurance products, but also the marketing of insurance and sales
commissions paid to insurance agents and brokers.
The Democrats would “ensure compliance” with the new
requirements in several ways.
Taxpayers would have to report their health insurance
coverage on their federal income tax returns. Under the main Senate proposal,
the penalty for not being insured would be an excise tax, which could be as
high as 75 percent of the premium for the lowest-cost health plan available
in the area where a person lives.
Under the proposal, all employers with more than $500,000
in total payroll would have to offer insurance to full-time workers or “pay
an assessment,” in the form of a new excise tax.
An employer offering insurance would have to pay at least
50 percent of the premium. An employer not offering insurance would have to
pay the excise tax, which would increase with a company’s payroll, so the
largest employers might pay $500 per employee per month.
More than 160 million Americans receive health insurance
through employers, the principal source of coverage for people under 65.
One of the most notable features of the Senate proposals
is that workers could drop out of an employer’s group health plan and buy
private insurance on their own, outside the workplace. The employer’s normal
contribution for a worker would be paid to the insurance exchange.
Democrats said that people dropping out of employer plans
would, in many cases, be eligible for tax credits to defray their premiums.
Employers worry that this feature would destabilize the
health plans they provide to employees.
“If people can opt out of employer-sponsored insurance and
get a tax credit, that will lead to a death spiral for
employer-sponsored plans,” said James P. Gelfand,
senior manager of health policy at the United States Chamber of
“People who are sick will stay in employer plans, and many
young, healthy people will opt out,” Mr. Gelfand
The Democratic proposals would expand Medicaid to cover
additional low-income families with children. And the federal government
would require states to increase Medicaid payment rates for doctors and
hospitals, which are often much lower than rates paid by Medicare and commercial
Democrats said they had not decided on the precise income
limits, and they are still trying to figure out whether Medicaid recipients
could buy coverage through the insurance exchange.
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