Dr. John Lombardi
The LSU Board of
Supervisors commissioned a study that pointed to high costs and low
efficiency at the LSU Interim Public
Hospital in New Orleans, which is a temporary facility
in light of the destruction of the old "Charity" hospital.
Management
consultants identified more than $66 million in potential savings at the
facility, which annually trains more than 300 medical residents and operates
the New Orleans area's only Level One
Trauma Center.
The study called for eliminating hundreds of jobs and imposing zero-based
budgeting in staffing every department.
More importantly,
the analysis called for hospital administrators and staff to move away from a
"reactionary approach" and adopt a "business-oriented,
fiscally responsible" strategy for providing quality care and medical
education.
Governance by
committee at an academic teaching hospital supported by state and federal
taxpayers' dollars is pure folly. The study reported the daily cost of taking
care of a patient at the Interim Hospital is $5,031 per day versus $3,766 per day at
similarly sized U.S.
teaching hospitals.
In meeting its
responsibility to the taxpayers and medical education, LSU has ordered $24
million in spending cuts during the next year and is cutting more than 300
jobs from the payroll.
Dr. John Lombardi
LSU System President
http://www.theadvertiser.com/article/20090603/OPINION03/906030311
[BACK TO TOP]
Jindal
Wants More Details About Bond Plan for New LSU Hospital
By Jim Watts
DALLAS - Louisiana Gov.
Bobby Jindal said a more detailed business plan is
needed for a proposed state hospital complex in New
Orleans that would replace storm-damaged Charity Hospital.
Jindal said he supports the
proposal by Louisiana
State University
for a 424-bed hospital in the Mid-City area. However, he told reporters on
Monday that the current business plan is too vague about how the hospital
would generate sufficient revenue for debt service on revenue bonds that
would finance much of the $1.2 billion project.
"It would be impossible to sell those bonds necessary
to complement the available federal and state dollars without a detailed
business plan that would be acceptable to the investors that would have to
buy the bonds," Jindal said at the news
conference. "The plan needs to show where the revenues are coming from,
how the hospital will be operated, and how this hospital will be
self-sufficient."
The Legislature's Joint Budget Committee last year
approved a financing plan for the LSU hospital that includes $492 million
from the Federal Emergency Management Agency for damages to Charity Hospital
from Hurricane Katrina, $300 million of proceeds from state general
obligation bonds that support the capital outlay budget, and $400 million of
debt supported by the hospital's future operating revenues.
Jindal said that while the new
facility would continue to receive state and federal funding for indigent and
elderly care, the university needs to show how it would attract sufficient
paying customers to support the revenue bonds.
"It would be to LSU's benefit to present a more
detailed business plan," he said. "The only way they will be able
to go to the bond market is with a much more detailed plan than they have
today."
Louisiana Treasurer John Kennedy said he agreed with Jindal on the need for a more detailed business plan.
Kennedy supports a bill that would prohibit the state from acquiring land for
the LSU hospital project until the Joint Budget Committee approves the
financing
Kennedy said the current plan assumes the new hospital
will have double the number of paying customers that Charity served, without
specifying how that will occur. In addition, he said, changes in federal health
care policy could have significant effects on the LSU hospital.
"Congress and President Obama are talking about
spending $1 trillion over the next 10 years to provide coverage to uninsured
patients," the treasurer said. "If these patients have insurance
and can go to any hospital they want to, how can this plan assume this
hospital will attract 80% of them? The current plan is a little weak on some
of these issues."
The new facility would be one of the 10 state hospitals
that provide indigent care and serve as centers for medical education in Louisiana. It would be
the primary teaching center for medical students and post-graduate residents
at LSU, Tulane University, and other New Orleans-area
universities.
FEMA has raised its estimate of the reimbursable damages
to 70-year-old Charity from the original $23 million to the latest offer of
$150 million, some $350 million less than the state is seeking.
The Louisiana Office of Facility Planning and Control and
LSU have appealed the FEMA assessment. The appeal maintains that damage to
Charity from flooding caused by Katrina exceeds 50% of the replacement cost
of the building, making it eligible for full replacement costs of $491.8
million.
The university said if FEMA does not provide the full
reimbursement, the hospital project would not be viable.
http://www.bondbuyer.com/
[BACK TO TOP]
John Koerner
Re: "LSU
willing to share hospital power," Page 1, May 13.
Tulane has been
involved in Charity
Hospital for 175 years
and has never been accused of a conflict of interest. It is shocking that
this accusation would be made by LSU, given the long working relationship
between the two universities.
Tulane has not
asked for any significant control in the new hospital. Its only request is to
maintain its historical role to treat indigent patients and to preserve its
residency and training programs, which benefit the citizens of New Orleans and the
entire state.
Advertisement
House Bill 830
would also make sure the hospital is led by a group of individuals who have a
demonstrated track record of successfully managing a hospital. As a
businessman I know how important it is to hire the most experienced and
talented professionals to lead your organization.
Tulane is
supporting Rep. Jim Tucker's House Bill 830, which embraces independent oversight,
public accountability, inclusion and appropriate fiduciary and other
safeguards that will ensure that the public hospital can achieve its
potential, and that public funds are properly used.
Why is LSU or any
other institution unwilling to embrace these principles, which are in the
interest of the public good?
The answer to that
question is likely to suggest where the real conflicts lie.
John Koerner
Emeritus Member
and Past Chair
Board of
Administrators
Tulane University
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1244006456182170.xml&coll=1
[BACK TO TOP]
Posted by James
Gill, Columnist
Pearls before
swine is putting it mildly. The sparkling intellects of LSU offer New Orleans a lifeline,
but the populace is too stupid and backward to be roused from its torpor.
Time is running out to get the rabble in line.
So says LSU
President John Lombardi, who nevertheless remains determined to save New Orleans from
itself. Lombardi is just the man for the job, being, as he is fond of
pointing out, from the efficient north.
Lombardi got on
his hind legs in New Orleans
last week to rally the LSU troops in support of the "major academic
medical center" proposed for a vast tract in Mid-City. Lombardi's plans
to win over the doubters evidently do not include a charm offensive.
He has "never
met a place like this, " where people speak in
a "code" he neither understands nor wishes to understand. He
doesn't know from "krewe." The city does
not contain "as many sensible people" as he had hoped -- sensible
people, of course, being those who agree with him.
New Orleans is "on the edge" and Lombardi is
offering it one "last opportunity to be a competitive, high-powered
American city." But he is up against idiots who want to "preserve
old New Orleans in amber,
" and force LSU to revamp and reopen the old Charity Hospital.
It is imperative
that the issue be "settled this year, "
and the "Legislature needs to get out of our way." Lombardi has all
the answers, and he has no patience with lesser intellects.
He may well be
correct that his medical complex would not only provide care for the
uninsured, but bring in the paying patients, re-establishing New Orleans as a major training center and
creating good jobs out the wazoo. Right now New Orleans is losing out to Houston,
Birmingham and even, an aghast
Lombardi told his audience, Arkansas.
But if the
medical-complex proposal does provide what Lombardi calls a chance "to
transform" a city he despises, LSU is hardly the ideal institution to
take the lead. Smug and supercilious academics are always hard to love, all the more so if they don't talk straight.
Hardly a week goes
by without a story in the paper about the arrest of some wretch who submitted
a fraudulent FEMA claim after Katrina. Try to pocket an illicit couple of
grand and the feds will haul you off pronto.
LSU, of course,
would never do that. It doesn't deal in such small sums. For a few hundred
million, however, it will let its superior imagination run riot. In seeking
the full replacement cost of $492 million for Charity, LSU provided an
account of the storm damage that was wildly exaggerated.
Doctors and
military personnel who worked at the hospital immediately after the storm
have testified that the hospital had been readied for re-use within weeks,
and have produced photographs to prove it.
But LSU told a
tale of terminal destruction in hopes of grabbing the maximum loot. FEMA was
smart enough to see through the misrepresentation, setting fair compensation
at $150 million.
Far from being
embarrassed by its duplicity, LSU still hopes to get the full $492 million on
appeal. Lombardi told his audience that the feds "owe" the state
that much and that it is "the critical linchpin point amount." Does
that mean the medical complex won't happen unless LSU can pull the wool over
FEMA's eyes? That must be a challenge even for the geniuses who run LSU.
It may not be
enough anyway, for LSU will still need to borrow at least $400 million, and
state Treasurer John Kennedy said last week that bond underwriters will laugh
LSU out of the room when they see its business plan for the medical complex.
Kennedy uttered
those unkind words just hours before Lombardi addressed the troops, assuring
them that the business plan had, in fact, been "validated by every smart
consultant in the western world." You'd have to be as dumb as Lombardi
thinks we are to believe that.
Gov. Bobby Jindal isn't. The LSU plan, he declared Monday, is inadequate.
http://blog.nola.com/jamesgill/2009/06/james_gill_lsu_trying_hard_to.html
[BACK TO TOP]
By MARSHA SHULER
Advocate Capitol
News Bureau
A proposed ban on
smoking in bars, casinos and other gambling establishments was rejected in
the House on Tuesday.
The House
overwhelmingly rejected the legislation when only 29 representatives voted
for the ban while 71 voted against it.
Similar
legislation, Senate Bill 186, is awaiting action in a House committee after
the Senate approved it 22-10 on May 28.
The lopsided House
vote indicates an expansion of the smoking ban could be dead for the
legislative session, since the measure must win approval in both chambers.
House Bill 844’s
sponsor state Rep. Gary Smith, D-Norco, said the legislation would create an
“equal playing field” with restaurants, where smoking is already prohibited.
The ban would also
help protect people’s health, particularly employees who are exposed to
second-hand smoke, which is the third-leading cause of preventable death in Louisiana, Smith said.
“It’s a movement
across the nation, not just at the whim of legislatures. It’s because there
are serious health effects,” Smith said.
Opponents argued
the ban would hurt businesses, particularly casinos, and potentially reduce
state revenue at a time when government’s coffers are hurting.
Some argued the
proposed ban would be more government intrusion into what should be business
owners’ decisions on what’s best for them and puts up another barrier to an
individual’s right to smoke.
“What happened to
free enterprise?” asked state Rep. Reed Henderson, D-Chalmette.
“We still have
one-fourth of our population who still smoke. What about their rights?” asked
state Rep. Rick Nowlin, R-Natchitoches.
HB844 would have
extended a state smoking ban to cover bars and gambling facilities, including
land and riverboat casinos, video poker parlors and racetracks.
It would have
expanded a state law adopted in 2006, which banned smoking in restaurants,
public buildings and other areas open to the public.
Restaurants have
complained the law puts them at a disadvantage because smoking is still
allowed in bars that serve food.
Prior to the HB844
vote, the House rejected a series of amendments that would have done away
with or watered down the anti-smoking law.
State Rep. Jeff
Arnold, D-New Orleans, wanted to give the owners of all establishments with
Class A liquor licenses, which would include restaurants, the option of
deciding whether to allow smoking. That proposal went down.
State Rep. Mert Smiley, R-St. Amant,
proposed grandfathering all currently operating businesses with the smoking
ban kicking in for new enterprises. That also died.
State Rep. Neil
Abramson, R-New Orleans, suggested delaying the smoking ban for five years to
give businesses time to adjust.
The House killed
the five-year delay but later approved a proposal to have the ban kick in Aug. 15, 2010,
instead of Aug. 15 of this year as planned. Rep. Walker Hines, D-New Orleans,
said it would give bars time to construct outdoor patios for smokers.
Here’s how the
HB844 legislation to ban smoking in bars and gambling establishments.
Voting FOR the
smoking ban (29): Rep. Arnold, A. Badon, Baldone, Barrow, T. Burns, Carter, Cromer, Dove, Downs,
Ellington, Ernst, Fannin, Foil, Greene, Guillory,
Henry, Hill, Hines, Hoffmann, M. Jackson, R. Jones, Leger, Monica, Peterson,
Pope, G. Smith, J. Smith, St. Germain and Stiaes.
Voting AGAINST the
smoking ban: Speaker Tucker and Reps. Abramson, Anders, Armes,
B. Badon, Barras, Billiot,
Brossett, Burford, H.
Burns, Burrell, Carmody, Chandler, Chaney, Connick, Cortez, Danahay,
Dixon, Doerge, Edwards, Franklin, Gallot, Geymann, Gisclair, Guinn, Hardy, Harrison, Hazel, Henderson,
Honey, Howard, Hutter, G. Jackson, Johnson, S.
Jones, Katz, Kleckley, LaBruzzo,
Landry, LeBas, Ligi,
Little, Lopinto, McVea,
Mills, Montoucet, Morris, Norton, Nowlin, Pearson, Perry, Ponti,
Pugh, Richard, Richardson, Richmond, Ritchie, Robideaux,
Roy, Schroder, Simon, Smiley, P. Smith, Talbot, Templet,
Thibaut, Waddell, White, Williams, Willmott and Wooton.
NOT VOTING (4):
Reps. Aubert, Champagne, LaFonta
and Lambert.
http://www.2theadvocate.com/news/46776422.html
[BACK TO TOP]
by Bill Barrow, Robert Travis Scott and Jan Molle
BATON ROUGE -- Louisiana
senators have a fundamental political choice today: Yield to the governor and
a House majority or carve out an independent position, knowing it could be a
loser in the end.
At issue is the proposal to freeze personal income tax
deductions for three years, effectively delaying about $120 million in tax
breaks in an effort to ward off cuts to Louisiana colleges and universities.
Senate Bill 335 is sponsored by Sen. Lydia Jackson, D-Shreveport, but it
carries the public backing of Senate President Joel Chaisson,
a Democrat, and Senate budget chairman Mike Michot,
a Republican.
Yet Gov. Bobby Jindal has told
lawmakers he'll back no such move. And a majority of House members have signed
a statement expressing their opposition, as well, making it almost certain
that the final 2009-10 budget won't include the maneuver.
But the rules of politics suggest that the leverage each
side carves out in the debate could be what matters at this point. It's worth
noting that Jindal began the session saying he
wouldn't be willing to tap the rainy day savings account to ease budget cuts
this year, only to ease off that absolute position just days after Chaisson, Jackson and Michot
presented their united front.
Elsewhere on the budget, the Senate Finance Committee is
expected to add its amendments to the $27.9 billion spending plan and send it
to the floor after more than three weeks of hearings (and occasionally testy
exchanges with administration officials). With tax increases practically off
the table, the main question is how much of the shortfall in higher education
can be filled, and what money will be used to fill it. A likely scenario is
the one Jindal outlined at his Monday news
conference: using $50 million from the rainy-day fund, which would then be
replaced with money from a tax-amnesty program.
Other big questions include how much senators will set
aside for pet projects and other hometown priorities, and how they plan to
make up the $30 million deficit that was recognized last month by the Revenue
Estimating Conference.
In a budget side show, senators are debating a handful of
tax credit bills, with another potential dust-up -- however slight -- with Jindal. The Senate version proposes raising the state
corporate income tax credit for filmmakers from 25 percent to 30 percent,
while the governor's version in the House leaves the current rate in place.
When senators aren't haggling over money today, they'll be
talking Chinese dry wall, which is believed to be the source of some health
problems for people who have installed the product in their residences. A
bill by Sen. Julie Quinn, R-Metairie, would allow homeowners who used the
material to sue the manufacturers, distributors and sellers.
In the House, lawmakers continue to give new life to old cliches. Not the one about lawmaking and sausage. No, the
appropriate observation here is that legislating is like pulling teeth. The
question is whether lawmakers will continue to allow dentists to do it in a
schoolhouse.
House Bill 844, which started out as a ban on school-based
mobile dental clinics, is again up for debate today. A set of proposed
amendments would direct the Louisiana Board of Dentistry to draw up new rules
outlining who can set up school-based clinics and how they must operate.
Critics of the bill have said throughout the session that the dentistry board
is the proper venue for the debate, so the amendments would appear to reduce
the temperature on what has been one of the session's most heavily lobbied
instruments.
In other action, a lobbying effort is under way in to pass
a resolution for Louisiana
to ratify the Equal Rights Amendment, which says equality of rights shall not
be denied or abridged on account of gender. The legislation was passed by
Congress in 1972, and since then, 35 states have ratified it, three short of
the three-fourths majority of states needed to make an amendment to the U.S.
Constitution. Although the ERA is 27 years past its
congressionally extended time limit for ratification, its supporters say
there are legal precedents that would allow Congress to extend the time limit
again.
The Louisiana Campaign for Equal Rights Amendment, with a
Web site at La-4-equity.us, plans to lobby the Legislature on Tuesday. State
Sen. Yvonne Dorsey, D-Baton Rouge, plans to present the resolution in a
Senate judiciary committee Monday.
Also, over at the Claiborne building at 9 a.m., the Civil
Service Commission is expected to vote on its newly proposed rules. Several
state lawmakers in support and perhaps some state employees in protest are
planning to show up. With prodding from the governor and state lawmakers, the
state Civil Service Commission is looking at changes to government handling
of layoffs, bumping, job classifications and merit pay increases, with an eye
toward giving agency managers more leeway in job assignments and
descriptions, especially during a period of layoffs, and to eliminate the
practice of agencies routinely granting annual 4 percent merit pay increases
without proper performance reviews.
In the Senate Health and Welfare Committee today, senators
will hear the proposed health-provider conscience protection bill and
controversial birth certificate legislation that is opposed by the gay rights
community.
In the media:
Louisiana does its best New Hampshire
impression, with House members saying no helmets should be required for
motorcyclists.
And after riding to a casino or bar without a helmet, feel
free to light up.
But when you go to parades, leave the gun at home.
There are no guns involved, but state Superintendent Paul Pastorek could use a helmet as he continues getting
trounced by local school boards.
In the Times-Picayune, columnist James Gill takes LSU
System President John Lombardi to task for his latest remarks on the proposed
teaching hospital. Here's guessing Lombardi won't be grand marshal for any
Carnival parades any time soon.
The Business Report's J.R. Ball is mad at just about
everyone connected to higher education and thinks it's high time the governor
stopped flapping his lips and did something about it.
The Lafayette Independent joins the parade of publications
piling on the governor about the cuts to colleges.
But legislators are much happier with the administration
this year, because chief of staff Timmy Teepell now
comes to work in a suit.
http://www.nola.com/politics/index.ssf/2009/06/capitol_showdowns_today_on_tax.html
[BACK TO TOP]
St. Charles hospital moving ahead
By Matt Scallan
River Parishes
bureau
A deal to build an
assisted living center in Luling using parish-owned
land has gotten the unofficial green light from the state attorney general's
office, the Parish Council was told Monday.
"We're just
waiting for the official opinion," Federico Martinez Jr., CEO of St.
Charles Parish Hospital, told the council.
In April, the
hospital's board of directors chose D.C. Schonberg and Associates to develop
and operate the facility on six acres along Ashton Plantation Boulevard that the
hospital bought for the project in 2006.
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Martinez said the Schonberg firm, which owns and
operates five similar facilities, plans a 60-unit facility that eventually
could include a unit for people with Alzheimer's disease.
Martinez said hospital officials met with Attorney
General Buddy Caldwell and his staff because the deal effectively involves a
parish investment in a private venture.
"But we were
told that what we're doing constitutes economic development. Governments do
this all the time," Martinez
said.
He said the
project will create 50 full-time jobs and will provide a service for
residents. There is a waiting list for similar facilities around the New Orleans area, he
said.
"We've had so
many calls from parish residents about this," Martinez said.
Martinez said he expects the final agreement
between the hospital and the firm to come up for approval later this month or
in July, depending on when the attorney general's opinion arrives.
Under the terms of
the agreement, the parish will turn the property over to the developer once
the firm secures financing, Martinez
said.
In other action,
the council approved a $795,000 project to replace 1.6 miles of 8-inch water
lines along Old Spanish Trail with a 12-inch line. The new line will run from
Paul Maillard
Road to 4th Street in Boutte.
"It's going
to dramatically improve flows to that entire community," Waterworks
director Robert Brou said.
The next project
is to replace a 1.7-mile segment between 4th and Audubon streets, completing
improvements to the line that runs to Des Allemands.
http://www.nola.com/news/?/base/news-1/1243948809299470.xml&coll=1
[BACK TO TOP]
New Orleans CityBusiness | 06.02.09
by Richard A.
Webster Staff Writer
BATON ROUGE --
Brian Keller has been promoted to senior vice president and chief marketing
officer at Blue Cross and Blue Shield of Louisiana. Keller, who has been with
the company since 1996, is a New Orleans
native and a graduate of Tulane
University's A.B.
Freeman School of Business. He discusses the future of health care coverage
in New Orleans.
What role has the
insurance companies played in the rising costs of health care?
"The industry
ruined itself when years ago we introduced HMOs and gave everyone co-pays
saying, 'This is the route you go.' Doing that we lost the transparency of
what things cost. If you're on a co-pay you don't care if the x-ray you're
getting costs $200 at one place and $500 at another because all you have to
do is pay $20.
"We've taken
the consumer out of medical care completely. If you have a high deductible,
however, you become better aware of what things cost and that can have a
positive effect. We need to move to a consumer model for the little things so
you can make decisions that are financially better for you. That way you save
yourself money and also the insurance company and employer.
"My role will
be pushing for transparency, working with hospitals and doctors and
pharmaceutical vendors to share this information so people know what things
cost and can make better decisions."
What are some of
the main obstacles so far as reducing the ranks of the uninsured?
"People in Louisiana can get
quality care for free so it's difficult in talking people into getting
insurance. If they get into an accident or are severely ill now, they can
always go to a hospital and receive free treatment. Unless there's a huge
systemic shift in how we fund health care for the uninsured, we'll always
have a fairly severe uninsured population.
"You also
have a certain percentage of the population who can't afford insurance but
make too much money for Medicaid. And then you have the 20-year-olds, or as
we call them, the Invincibles who feel 10-feet tall
and bulletproof. They can afford insurance and it's extremely affordable. A
20-year-old male can get great coverage for $100 a month, but they may see
that as four cases of beer or two nights out. So they decide against
insurance since nothing is going to go wrong anyway.
"We need to
market directly to them. I guess I need to learn how to Twitter and Facebook."
How can New Orleans decrease
its health care costs?
"We need to
focus more on wellness. We live by the 80/20 rule — 20 percent of our members
spend over 80 percent of our health care dollars because they don't take care
of themselves. The real savings is trying to keep other 80 percent from
moving into the 20 percentile range.
"Louisiana is No. 1 in
the country diabetes, No. 2 in heart disease and in the top five in
cholesterol. It's our food and lifestyle. There are a lot of health care
dollars that aren't accident related and are conditions we bring on
ourselves.
"We can push
harder to put more wellness things in place so people can keep themselves
healthier."
How has Blue Cross
Blue Shield encouraged its own employees to embrace better health and
wellness?
"We pushed
health fairs and tests and we got pitiful participation, even though we're a
health insurance company. So we said if you don't participate, you'll pay an
extra $25 a month for insurance. So now we have 98 percent participation, up
from 20 percent. The stick worked better than the carrot.
"It was
either show up four times a year to a health fair, visit a wellness coach and
have your glucose and blood pressure checked, or pay
more per month. And it really made a difference.
"People
didn't realize they were borderline diabetic or hypertensive. People said, 'I
do need to take better care of myself, watch what I eat and go to a doctor.'
It's the awareness portion of it.
"So now we
can take what we've done to our own employees and make a push to our larger
employers."
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25055
[BACK TO TOP]
by Atul Gawande
This is a
disturbing and perhaps surprising diagnosis. Americans like to believe that,
with most things, more is better. But research suggests that where medicine
is concerned it may actually be worse.
For example,
Rochester, Minnesota, where the Mayo Clinic dominates the scene, has
fantastically high levels of technological capability and quality, but its
Medicare spending is in the lowest fifteen per cent of the country—$6,688 per
enrollee in 2006, which is eight thousand dollars less than the figure for McAllen.
Two economists
working at Dartmouth,
Katherine Baicker and Amitabh
Chandra, found that the more money Medicare spent
per person in a given state the lower that state’s quality ranking tended to
be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were
near the bottom of the national rankings on the quality of patient care.
(Click
on the link to read the entire article.)
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
[BACK TO TOP]
The New York Times | 06.02.09
By DONALD G. McNEIL Jr.
The World Health
Organization said Tuesday that it was moving closer to declaring swine flu a
worldwide pandemic.
The disease has
reached 64 countries, and there have been dozens or hundreds of cases in
several nations outside North America, including Britain,
Spain, Japan, Chile
and Australia.
The Southern
Hemisphere countries are now of chief interest because their winter flu
season is just beginning and another strain of the H1N1 virus, widespread
last winter, was resistant to the antiviral drug Tamiflu.
To raise the flu
alert to its highest level, Level 6, the W.H.O. would need to find evidence
of widespread “community transmission” — meaning beyond travelers, schools
and immediate contacts — on two continents. Dr. Keiji
Fukuda, the agency’s chief of flu, said that finding had not been made.
The agency is
debating new rules for assessing global disease outbreaks. If it declares a
Level 6 pandemic, Dr. Fukuda said, it may add a caveat indicating that the
virus is not very lethal. The flu has been blamed for only 117 deaths.
Still, measuring
severity can be tricky because the same flu virus may theoretically kill far
more people in a poor country with widespread malnutrition and AIDS than it
does in a wealthy, well-fed nation.
No cases have been
reported anywhere in Africa. Historically,
there has been little flu surveillance on the continent, which has many more
serious diseases to track, though South Africa has a laboratory
that regularly reports cases to the W.H.O.
In the United States,
the flu finally reached all 50 states this week. It has been blamed in at
least 19 deaths.
But it has spread
very unevenly across the country. For example, flu has closed many New York City schools, but the virology lab at the University of California,
San Francisco, has not found a positive flu
sample in the Bay Area in weeks, even though the country’s first identified
case was in Southern California in April.
Seasonal flu shots
appear to offer no protection against swine flu. Scientists from the National
Institute for Infectious Diseases in Tokyo looked at 43 laboratory-confirmed
cases from Kobe and reported this week that those who had been vaccinated did
not seem to get swine flu less often than other patients. The observations
confirmed what American scientists had found in blood tests in the lab.
http://www.nytimes.com/2009/06/03/health/policy/03flu.html?ref=health
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The New York Times | 06.02.09
By Anne Underwood
An elderly
passenger disembarks from an Australian cruise ship.Greg
Wood/AFP An elderly passenger disembarks from an Australian cruise ship on
Monday after an outbreak of AH1N1 flu. The epidemic has not taken the toll on
seniors that many experts feared it might.
Any new disease is
cause for concern, especially when it’s potentially fatal. But the AH1N1
swine flu has confounded expectations by proving unusually benign for the
elderly.
Of 538 confirmed
cases of AH1N1 in New York City,
only six have occurred among people ages 65 and over. “Normally flu would go
right through long-term care facilities,” said Dr. Stephen Morse, professor
of clinical epidemiology at Columbia
University. “In a
normal year, the elderly would have a much greater risk.”
This is no normal
year. Preliminary evidence suggests that many older people may have residual
immunity to the new flu virus because they were exposed to similar H1N1
viruses that circulated decades ago, before 1957. If so, that’s great news
for both the elderly and their caregivers.
Still, Mayor
Michael Bloomberg has consistently emphasized that all of the city’s AH1N1
flu fatalities have involved “underlying conditions” that exacerbated each
victim’s risk. The list of conditions is long enough to worry almost any
elderly person and includes heart disease, lung disease, diabetes and a weakened
immune system. Even obesity is now being discussed as a condition that can
lead to complications for this flu.
“The whole purpose
of such a list is to help people predict [who needs special treatment],” said
Dr. Morse. “This list is so long, all it tells you is
that if you have the flu and you’re in anything other than perfect health,
you should watch carefully.”
Translation for
caregivers: Though the elderly have largely been spared, keep an eye out for
flu symptoms and act quickly if any emerge.
New York City’s Department of Health and Mental Hygiene
has put together an extensive fact sheet on AH1N1 (PDF). Among other
information, it lists guidelines for treating those at higher risk for
complications, including anyone 65 or older.
In the case of
“influenza-like illness (PDF)” (meaning a fever of at least 100.4 degrees
Fahrenheit, accompanied by a cough or sore throat), call the doctor right
away. Antiviral medicine can turn a potentially serious illness into a mild
one — especially if you start treatment within the first 36 to 48 hours. The
doctor can phone in a prescription for Tamiflu if
the patient meets the criteria.
If flu-like
illness is accompanied by severe symptoms — for example, difficulty
breathing, chest pain or dizziness — forget about risk factors and head for
the hospital. (Absent serious symptoms, don’t bother. Going to the hospital
won’t bring better care. It will just burden already overwhelmed emergency
rooms.)
But so far,
fortunately, there has been little reason for caregivers to call either the
doctor or the E.R.
That could change
if the virus grows more virulent as it moves through the Southern hemisphere
in the coming months, as many scientists fear. “We’re back to watching and
waiting,” said Dr. Morse. But for now, breathe a sigh of relief. Things could
be much worse.
http://newoldage.blogs.nytimes.com/2009/06/02/elderly-faring-better-than-expected-with-new-flu/?ref=health
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The New York Times | 06.02.09
By RONI RABIN
Teenagers whose
parents have a history of depression are at particularly high risk of
becoming depressed themselves. Now, a large clinical trial has found that a
group cognitive behavioral program that teaches coping and problem-solving
skills to such high-risk teenagers can reduce the risk.
But, the study
also found, the success rate of the prevention program varied greatly
depending on the mental health status of the teenagers’ parents at the time
they began intervention. The program was much more effective than standard
care if the parents were also not depressed when the intervention began.
The study was
published in this week’s Journal of the American Medical Association.
“Were we
surprised?” said Judy Garber, a professor of psychology and human development
at Vanderbilt University. “No. There is evidence in
the literature that kids don’t respond as well to treatment if the parent is
depressed.”
John Weisz, a professor of psychology at Harvard University
who was not involved in the trial, said the results might help identify the
best candidates for the prevention program.
http://www.nytimes.com/2009/06/03/health/research/03teens.html?_r=1&ref=health
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The New York Times | 06.02.09
By REED ABELSON
The insurance
industry says it wholeheartedly embraces a health care overhaul, promising
Congress and the president that it will make it much easier for individuals
to buy insurance on their own.
Insurers, for
example, have agreed to sell policies even to people with pre-existing
medical conditions, and to stop basing prices on how healthy or sick someone
is. These sweeping concessions would help legislators achieve their goal of
putting health coverage within reach of many of the nearly 50 million individuals
who currently have none.
But so far, the
industry has made no such promises about another segment of the health
insurance market, one responsible for many people being uninsured in the
first place: the market for small employers. By some estimates, about half of
the nation’s uninsured are people who are self-employed or work for a small
business.
In other words,
policy analysts and others say, unless the insurance industry is willing to
give some of the same ground to small businesses that they have ceded to
individual policy holders, a big part of what is wrong with the nation’s
health care system may not get fixed.
More than 40
percent of the private American labor force works for companies with fewer
than 100 workers. Leaving small businesses out of the federal effort to
overhaul health care would be “a big hole in any reform proposal,” said Karen
Davis, president of the Commonwealth Fund, a nonprofit health care research
group that advocates significant changes to the current system.
Employer-provided
medical insurance remains the bedrock of the nation’s health care system. And
yet, while most big employers still provide health benefits, soaring premiums
have meant many small businesses can no longer afford to cover their workers.
But the small-employer market remains one of the most profitable segments of
health insurance, which may be why the industry is not eager to overhaul this
lucrative part of the business.
Lobbyists for
small employers argue that Congress should be forcing the same concessions
from insurers in the small-business market that the industry has promised in
the individual market.
“For us, there is
a huge issue in not only addressing just one of the broken markets, but two
of those broken markets,” said Michelle Dimarob, a
lobbyist for the National Federation of Independent Business, a trade
association for small companies.
The insurance
industry’s main trade association, meanwhile, is notably silent on the issue.
And individual insurance companies seem divided.
Some large insurers,
like Aetna and Cigna, say they would
generally support similar federal rules for both the individual and
small-business markets. “We need to be relatively consistent,” said H. Edward
Hanway, Cigna’s chief executive.
But one of the
biggest insurers, WellPoint, opposes changing the way coverage is sold to
small employers.
“Those markets
generally work today,” said Bradley M. Fluegel, the
chief strategy officer for WellPoint, which is a big operator of Blue Cross
plans and a major player in the small-business market. “They are well
regulated by states today.”
Small employers do
not necessarily agree.
“We face almost
the same challenges as individuals,” said Michael Boucher, who runs his own
landscape architecture firm in Freeport,
Me. He provides coverage to
more than a dozen people, paying $1,100 a month for a worker with family
coverage.
Much of the
Congressional talk about health care has not yet focused on what federal
oversight, if any, might be necessary for the small-business market.
Proposals before the Senate Finance Committee seem to envision the same kind
of rules for both the individual and small-business markets. And some House
members seem to lean in that direction, too.
“For small
businesses already under enormous financial strain, rising health care costs
simply add more pressure,” said Representative Nydia M. Velázquez, a New York
Democrat who heads the House committee on small business and plans to hold
hearings on the topic on Wednesday. “Meaningful health care reform will need
to include small-group market reform.”
She favors giving
small employers additional tax credits for offering health benefits, and
letting them form purchasing pools to obtain cheaper coverage from insurers.
What Congress
finally comes up with, of course, is still anyone’s guess.
Unlike large
companies, which tend to self-insure and can spread medical risks over a
large work force, small businesses typically rely on an insurer to help
assume that risk. And they buy that insurance much the same way individuals
currently do, in a market overseen by a patchwork of state regulations.
So small employers
are at the mercy of the same practices that make it hard for individuals to
obtain coverage — like insurers’ trying to avoid covering older people or
ones likely to run up high medical bills, and charging high prices for the
policies they do offer.
“We struggle every
year to find a way to make it work,” one small-business owner, Kelly Conklin,
said at a Congressional hearing in late April.
Mr. Conklin’s
woodworking company, Foley-Waite Associates, in Bloomfield, N.J.,
paid premiums of about $4,600 a month last year to cover 13 employees.
Foley-Waite picks up about three-quarters of that amount.
When his insurer
said this year that it would raise the premiums to about $6,000 a month, he
was forced to switch carriers, finding another policy for about $4,800 a
month.
The current system
is “designed to be expensive,” Mr. Conklin said.
As a result, fewer
small businesses are offering coverage — especially the very smallest
employers. About half of companies with nine or fewer workers do not provide
health benefits.
WellPoint says the
health care answer for the smallest businesses might be to group them with
people who buy coverage in the individual market.
The UnitedHealth
Group, by some measures the nation’s largest health insurer, agrees that the
very smallest businesses should operate under the same rules now being
proposed for individuals. But the company declined to discuss whether it
would favor changes for somewhat larger employers, in the absence of a
specific proposal in Washington
for handling small-business insurance.
Under the current
system, individual states determine how much more an insurer can charge one
small business than another, based on the relative health of each work force.
And it is the state that determines how much an insurer can raise rates from
one year to the next.
“There is a lot of
variation across states,” said Gary Claxton, an insurance expert at the
Kaiser Family Foundation. He also noted that many states lack the resources
necessary to actively enforce their rules.
Other insurers
that have not embraced changes are ones that, like WellPoint, operate Blue
Cross plans, which tend to be the largest players in a state’s small-business
market. The Health Care Service Corporation, a Blue Cross operator in big
states including Texas and Illinois, would not discuss its position
on the issue. The national association representing Blue Cross plans also
declined to comment.
Mr. Fluegel, the WellPoint executive, warned that if the
federal government intervened in the small-business market so that insurance
companies could no longer assign the highest premiums to employers with the
highest medical costs, insurers would be forced to spread the costs over all
their small-business customers. That could mean some small employers would end
up paying more for coverage than they do today, he said.
But Ms. Dimarob, of the independent business federation, says the
small-business market even now is “dysfunctional,” which is why she argues
that the federal government needs to step in and work with the states to
remake the market.
“If you truly want
to build off the strength of the employer-based system and want comprehensive
health reform and access to quality affordable health care,” she said, “why
would you only fix the individual market?”
http://www.nytimes.com/2009/06/03/business/smallbusiness/03insure.html?scp=1&sq=Health%20Insurers%20Balk%20at%20Some%20Changes&st=cse
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The New York Times | 06.02.09
By FELICITY
BARRINGER
A new appraisal of
existing studies documenting the links between tiny soot particles and
premature death from cardiovascular ailments shows that mortality rates among
people exposed to the particles are twice as high as previously thought.
Dan Greenbaum, the president of the nonprofit Health Effects
Institute, which is releasing the analysis on Wednesday, said that the areas
covered in the study included 116 American cities, with the highest levels of
soot particles found in areas including the eastern suburbs of Los Angeles
and the Central Valley of California; Birmingham, Ala.; Atlanta; the Ohio
River Valley; and Pittsburgh.
The review found
that the risk of having a condition that is a precursor to deadly heart
attacks for people living in soot-laden areas goes up by 24 percent rather
than 12 percent, as particle concentrations increase.
A variety of
sources produce fine particles, and they include diesel engines, automobile
tires, coal-fired power plants and oil refineries.
Comparing exposure
within the New York and the Los
Angeles metropolitan areas, the study found that the risks were
evenly distributed in the vicinity of New York
while some areas around Los Angeles, including
neighborhoods near the Ports of Los Angeles and Long Beach, had elevated health risks.
The extended
epidemiological analysis, which draws on data gathered from 350,000 people
over 18 years, and an additional 150,000 people in
more recent years, was conducted for the Health Effects Institute by
scientists at the University
of Ottawa.
The institute was
created by the Environmental Protection Agency and the industries that it
regulates with the goal of obtaining unbiased studies.
The link between
fine particles, the diameter of which is smaller than a 30th of a human hair,
and cardiopulmonary disease has been established for two decades, and the
E.P.A. has regulated such emissions since 1997. In 2006, despite mounting
evidence that the particles were deadlier than first thought, the agency
declined to lower chronic exposure limits.
The United States
Court of Appeals for the District of Columbia Circuit declared that decision
inadequate, and the Obama administration is now considering what level is
appropriate.
http://www.nytimes.com/2009/06/03/science/earth/03soot.html?ref=us
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