Monday, July 06, 2009
BATON ROUGE — Gov. Bobby Jindal has approved a fiscal-care package for hospitals still reeling from hurricanes and the escalating costs of treating uninsured patients.
House Bill 879 is expected to compensate hospitals, including those in Houma-Thibodaux, for more than $212 million in hurricane-related losses stemming from Katrina and Rita in 2005 and Gustav and Ike last year.
the area of hurricane relief, the new law, authored by House Speaker Jim
Tucker, R-Terrytown, will direct $170 million to
The specific coastal hospitals to benefit haven’t been determined, said Charles Castille, undersecretary of the Department of Health and Hospitals.
Guidelines are still being drawn up, and the payout process will have to be approved by the federal government.
Castille said that could take about 90 days.
But he did say that institutions like Terrebonne General and Thibodaux Regional medical centers, as well as others in the region, “clearly qualify” for some assistance.
“We’re shooting to have everything done by September or October,” Castille said of the timeline for disbursing payments.
Uncompensated-care costs to hospitals are also an ongoing problem that affects facilities statewide and a dilemma addressed by the new law.
Uncompensated care takes place when hospitals provide care for patients who don’t have insurance or other financial means to pay.
The legislation calls for nearly $25 million to be directed to hospitals statewide to help deal with uncompensated care.
Castille said it’s likely Houma-Thibodaux hospitals also will qualify for this money.
Given the tight economy, Heath and Hospitals Secretary Alan Levine said the assistance couldn’t have come at a better time.
“With our federal health-care dollars in jeopardy at a time when the demand for health-care services is growing, the Legislature and the governor acted in a manner that helps stabilize hospital services and access to care statewide,” he said.
"Tulane should stop meddling, " Your
Opinions, June 26. As retired business manager of
To say that Tulane is "meddling" is unfounded and at the least reveals a lack of knowledge and understanding of what has existed for many years of cooperation.
I agree 100 percent with writer Daniel Poulin. Why should Tulane, a private university, have any input into what is LSU's domain? If Tulane commits half a billion dollars for its share of a new facility, then we can talk. It makes me furious that Tulane assumes it can rule taxpayers' money. I have been fuming for weeks over this issue.
The petition by the state's Office of Facility Planning and Control was submitted to the Governor's Office of Homeland Security and Emergency Preparedness, which has 60 days to review the document before deciding how to proceed.
FEMA rejected the state's initial appeal in May, which prompted the second round of appeals.
Louisiana Recovery Authority Executive Director Paul Rainwater said the state has the option of continuing its appeal or having the matter decided through a new arbitration process authorized by Congress. Rainwater said the state is waiting to learn the rules of the arbitration process before deciding which way to go.
the meantime, a group called Louisiana United for Healthcare Recovery, which
supports rebuilding Charity and disputes the validity of the state's claim,
released a letter it sent to President Barack Obama. The letter disputes a
letter that Rep. Anh "Joseph" Cao
hand-delivered to the president in April in which the congressman asserted
The group's letter to Obama was signed by retired Lt. Gen. Russel Honore; Dr. James Moises of Doctors for Charity Hospital; Monique Harden, co-director of Advocates for Environmental Justice; Tracie Washington of the Louisiana Justice Institute; and K. Brad Ott, a consumer representative on the Louisiana Health Care Consortium.
Cao said that when he informed Obama that Charity was "completely destroyed," he was referring to FEMA rules, which say that if a building is more than 50 percent damaged it is considered completely destroyed.
is how sausage is made at the Louisiana Legislature. Consider the successful
effort to create some protection for witnesses in criminal cases. Such a
program seems a timely idea given last weekend’s murder of Shelva Glasper, of
Not a single lawmaker voted against House Bill 33. But it almost died, a victim of political posturing.
was rescued — albeit in a much weaker form — literally at the last minute, by
robbing money from district attorneys and indigent defense counsel in
After being sworn in as the district sttorney for East Baton Rouge Parish in January, Hillar Moore III was immediately confronted with the killing of two witnesses in trials his office was prosecuting. He approached his friend, state Rep. Bodi White, R-Central, before the legislative session began in April with an idea of adopting for Louisiana, a state-level witness protection program like those working so well in other states.
This would not be like the federal handling of “Goodfella” Henry Hill, who in return for court testimony against fellow mobsters, got to live under a new name in some secret Southwestern state suburb complaining about the quality of the tomato sauce and pasta.
points out the drug gangs that fuel much of the violence in
the same time, and unbeknownst to White, state Rep. Walt Leger III, D-New
Orleans, was studying witness protection models that different states use. He
Leger and White joined forces — a Democrat and a Republican, one an über-Jindalista, the other, not so much.
HB33, which Leger drafted, spells out how a newly-created Louisiana Witness Protection Services Board would take applications by prosecutors across the state and decide which cases would receive how much state witness protection support. White said the hope is that once the state has a program running, then the federal government would contribute money to allow for more witnesses to take part.
wanted about $500,000 to set up the organization and to start protecting some
witnesses. White arranged for moving $250,000 from a pool of unused money in
a not-very successful plan to attract insurance companies to do business in
The Senate and the House, meanwhile, were bickering over how best to address the $1.3 billion dip in state revenue.
Hoping to bring the House to the negotiating table, senators tied their spending cuts to passing legislation for raising revenue.
Jindal showed the Senate what-for and in one grand exercise of line-item vetoing, struck all spending contingent on other plans, which included witness protection.
Leger said top Jindal aides assured him the next day that witness protection was just caught up in Jindal’s political gesture and that the money would be returned.
come the morning of June 25, the last day of the legislative session, Leger
and White recalled the shock of learning that witness protection had been
overlooked. They spent the remaining few hours of the session scrambling for
dollars. Leger said he was able to shift some money from an appropriation
that would have hired an additional prosecutor and another indigent defense
“It’s not enough, but it’s a start,” said Leger.
Major committees in Congress are moving quickly — some would say too quickly — on legislation that will have a great impact on our health and our pocketbooks.
The bills that are advancing are quite momentous. If they were being shaped by sound, well-researched analysis, perhaps the proposals wouldn’t be as scary.
Unfortunately, much of the health-care and energy legislation is being developed more by deal-cutting than by what works in the real world.
The health-care legislation is a prime example. The cost estimates for the bills being shaped in various committees range from $1 trillion to $3.5 trillion over a 10-year period. With the budget deficit for next year already slated to be almost $2 trillion, even the spend-happy Congress is under pressure to pay for whatever is proposed and not simply add the cost to the ever-increasing federal deficit.
One of the major taxes being discussed to pay for the health-care bills is a tax on employer-provided health insurance. Such a tax could raise almost $500 billion to offset the cost of covering more of the uninsured and underinsured.
The problem is, it could blow a hole in the foundation of our health-care system that is based on coverage paid for all or in part by employers.
Some of the loudest critics of this tax proposal are the labor unions that have negotiated contracts with Cadillac for benefits largely paid for by their employers. The staunch opposition of the unions is leaving its mark. One of the major Senate proposals now calls for creating an exemption from this tax for — you guessed it — labor unions.
If such a plan passes, non-union workers could be subject to having their employer-provided health-insurance-premium payments taxed as ordinary income. That means in addition to the regular income-tax rate they are subject to applying to this benefit, they would have to pay Medicare and Medicaid taxes on the amount as well. Their employers would also have to pay their share of the Medicare and Medicaid taxes. Non-union employers and employees would have to pay the tax while their union counterparts would escape the burden.
Substituting politics for sound policy decisions is very much at play with the energy legislation under consideration in Congress as well.
Speaker of the House Nancy Pelosi is determined to have “cap-and-trade” legislation — it would limit carbon-dioxide emissions and drive up energy costs — enacted by the end of summer.
But Pelosi and Company ran into a wall of opposition from many members of their own Democratic Caucus, including Charlie Melancon of Napoleonville, who are concerned about the economic impact of the legislation on their constituents.
Particularly upset are farm-state Democrats who believe the legislation could jeopardize their re-elections.
The Waxman-Markey bill cannot pass without those key votes. So what happened? Deals were cut to placate the concerns of some but left the constituents of other congressmen, many in “red states,” on the hook for paying potentially huge increases in energy costs.
This is no way to run a railroad. If a complete revamp of the nation’s health-care system is a necessity, then everyone — union members included — should have to pick up the huge cost of paying for it.
If significantly increased energy costs are the price that must be paid for reducing carbon-dioxide emissions, then everyone in every region of the nation should have to bear those costs.
There are sound reasons for opposing both the “cap-and-trade” legislation and the health-care bills. Playing politics with who gets the bill for them only adds fuel to the fire.
Dan Juneau is president of the Louisiana Association of Business and Industry, the state’s largest business lobby. You can reach him at (888) 816-5224 or firstname.lastname@example.org.
Fate of 6 Shriners hospitals in the balance
By Sig Christenson - Express-News
future of Shriners Hospitals for Children in
by the recession, Shriners gathered in San Antonio
will consider a resolution that would close hospitals in Shreveport, La.,
Spokane, Wash., Greenville, S.C., Erie, Pa., Springfield, Mass., and
Galveston. The recession and Hurricane Ike ravaged the
Shriners will vote this week in a meeting that will be closed to the public, media and even some members. Their decision will be revealed in a press conference Thursday.
“We've never had an economy turn this severely this quickly, and it's affected us just like it's affected everybody else,” said Bob Jett, who helped plan this year's conference. “It's hit us all very deeply. It's unprecedented.”
Shiners Hospitals for Children has grown from one hospital 87 years ago to 22 in 2008. An $8 billion endowment had funded those hospitals, which provide free care for children with burns, orthopedic problems, cleft and lip palate deformities and spinal cord injury rehabilitation.
Shriners say their endowment has fallen to $5
billion. The Associated Press reported in April that the
“It's not surprising given the recession and the difficulty that nonprofits are having fundraising,” said Mayor Julián Castro, who addressed the Shriners, meeting here for the first time since 1993.
The San Antonio Convention & Visitors Bureau said the five-day gathering of 6,500 Shriners could generate $6.755 million in spending, while the Shriners put it at $7.5 million.
The CEO of Shriners Hospitals for Children, Ralph Semb, told the AP last spring that the group would “probably be out of the hospital business” in five to seven years if no action were taken. Semb didn't talk with the San Antonio Express-News, but Jett, the director general of the session, gave little hint of what could come next.
“Action has to be taken to recognize and deal with the situation. I'm not sure I'd use the term ‘drastic,'” he said. “We've just got to address the situation.”
Shriners were cautious when interviewed.
Knudsen, 72, of
By PAUL KRUGMAN
The Congressional Budget Office has looked at the future of American health insurance, and it works.
A few weeks ago there was a furor when the budget office “scored” two incomplete Senate health reform proposals — that is, estimated their costs and likely impacts over the next 10 years. One proposal came in more expensive than expected; the other didn’t cover enough people. Health reform, it seemed, was in trouble.
But last week the budget office scored the full proposed legislation from the Senate committee on Health, Education, Labor and Pensions (HELP). And the news — which got far less play in the media than the downbeat earlier analysis — was very, very good. Yes, we can reform health care.
Let me start by pointing out something serious health economists have known all along: on general principles, universal health insurance should be eminently affordable.
After all, every other advanced country offers universal coverage, while spending much less on health care than we do. For example, the French health care system covers everyone, offers excellent care and costs barely more than half as much per person as our system.
And even if we didn’t have this international evidence to reassure us, a look at the U.S. numbers makes it clear that insuring the uninsured shouldn’t cost all that much, for two reasons.
First, the uninsured are disproportionately young adults, whose medical costs tend to be relatively low. The big spending is mainly on the elderly, who are already covered by Medicare.
Second, even now the uninsured receive a considerable (though inadequate) amount of “uncompensated” care, whose costs are passed on to the rest of the population. So the net cost of giving the uninsured explicit coverage is substantially less than it might seem.
Putting these observations
together, what sounds at first like a daunting prospect — extending coverage
to most or all of the 45 million people in
Now, about those specifics: The HELP plan achieves near-universal coverage through a combination of regulation and subsidies. Insurance companies would be required to offer the same coverage to everyone, regardless of medical history; on the other side, everyone except the poor and near-poor would be obliged to buy insurance, with the aid of subsidies that would limit premiums as a share of income.
Employers would also have to chip in, with all firms employing more than 25 people required to offer their workers insurance or pay a penalty. By the way, the absence of such an “employer mandate” was the big problem with the earlier, incomplete version of the plan.
And those who prefer not to buy insurance from the private sector would be able to choose a public plan instead. This would, among other things, bring some real competition to the health insurance market, which is currently a collection of local monopolies and cartels.
The budget office says that all this would cost $597 billion over the next decade. But that doesn’t include the cost of insuring the poor and near-poor, whom HELP suggests covering via an expansion of Medicaid (which is outside the committee’s jurisdiction). Add in the cost of this expansion, and we’re probably looking at between $1 trillion and $1.3 trillion.
There are a number of ways
to look at this number, but maybe the best is to point out that it’s less
than 4 percent of the $33 trillion the
So fundamental health reform — reform that would eliminate the insecurity about health coverage that looms so large for many Americans — is now within reach. The “centrist” senators, most of them Democrats, who have been holding up reform can no longer claim either that universal coverage is unaffordable or that it won’t work.
The only question now is whether a combination of persuasion from President Obama, pressure from health reform activists and, one hopes, senators’ own consciences will get the centrists on board — or at least get them to vote for cloture, so that diehard opponents of reform can’t block it with a filibuster.
This is a historic opportunity — arguably the best opportunity since 1947, when the A.M.A. killed Harry Truman’s health-care dreams. We’re right on the cusp. All it takes is a few more senators, and HELP will be on the way.
Tuberculosis: TB Vaccine Too Dangerous for Babies With AIDS Virus, Study Says
By DONALD G. McNEIL Jr.
The vaccine against tuberculosis that is routinely given to 75 percent of the world’s infants is too risky to give to those born infected with the AIDS virus, says a new study published by the World Health Organization. It recommended that vaccination be delayed until babies can be tested.
Calmette-Guérin vaccine, known as BCG, protects
children well against deadly tuberculous
meningitis, though it does less well against the lung form. It has been in
use since 1921, and children in many countries — though not the
But because it is a live vaccine, a weakened strain of bovine tuberculosis, it can cause its own problem — “disseminated BCG disease,” a type of bacterial infection that can rage through the body. It is fatal in more than 70 percent of cases.
In countries like South Africa, where both tuberculosis and mother-to-child transmission of the AIDS virus is common, the vaccine gives infected children almost no protection against tuberculosis and instead may kill them with BCG disease, the authors found. The study, done in three South African pediatric hospitals, was complex because BCG disease and tuberculosis can look identical, so each infection had to be cultured.
Although they recommend delaying vaccination, the authors acknowledge that will not be easy. In poor countries, babies are often not brought back at 6 weeks for a test and 10 weeks for a shot. So the dangerous practice of vaccinating every baby may continue, because it protects the uninfected ones.
By LESLEY ALDERMAN
IF you’re one of the millions of people who are dieting right this minute, or even thinking about it, here’s some good news: you don’t have to throw a lot of money at the problem to see results. In fact, you may not have to spend much at all.
Every year consumers spend billions of dollars on supplements, diet foods, books and meal replacements. But the truth is that success depends not so much on what diet plan you choose or what program you join.
“What matters most is your
level of motivation and your willingness to change,” says Kelly D. Brownell,
a psychologist and director of the
A study published in the Feb. 26 issue of The New England Journal of Medicine, for instance, compared four popular diets and found they all produced similar results. After two years, the dieters in each group lost an average of nine pounds. Notably, the dieters who attended more counseling sessions lost a little bit more, which may support the notion that behavior is more important than diet alone.
Motivation, though, is not always easy to come by — especially when it involves changing habits. Some people may need a little help to kick-start a weight-loss regimen, whether that means following a popular diet or enrolling in an organized program. Your goal, though, should not be short term.
“Keeping weight off permanently is a lifelong process,” says James O. Hill, a psychologist and a founder of the National Weight Control Registry (www.nwcr.ws), a database of 6,000 people who have lost weight and kept it off.
How ready are you? The more committed you are, the less you will need to spend. Try the no-money down, do-it-yourself approach first. If that doesn’t work, or you know you need more structure, move on down the list below.
$0.00 D.I.Y. If you’re highly motivated but low on cash, this approach is for you. You will need to reduce the calories you consume, increase the amount you exercise and learn new eating habits.
Your primary care physician can give you basic guidelines for a healthy, low-calorie diet. You can also look at the dietary advice on the Weight-Control Information Network, a site developed by the National Institutes of Health (win.niddk.nih.gov), Mr. Brownell suggests.
Your new diet should include as much fresh food as possible, especially items high in fiber and low in fat. If you already eat well, you can just reduce your portion sizes. Weigh yourself regularly to keep track of your progress and try to get 30 to 40 minutes of exercise a day.
Hard? Yes. Possible? Of
course. About half of the members of the National Weight Control Registry
lost weight on their own, says Mr. Hill, who is also the director of the
Center for Human Nutrition at the
$ BUY A GUIDE BOOK For just
$20 or so, a book can give you some inspiration and wise advice. If you want
a plan to follow, try “The South Beach Diet” (St. Martin’s
Another good book is “The Volumetrics Weight-Control Plan” (HarperTorch, 2002), which explains how to build a diet around foods that make you feel full.
Chronic dieters should read the new book by a former chief of the Food and Drug Administration, Dr. David Kessler, called “The End of Overeating: Taking Control of the Insatiable American Appetite“ (Rodale, 2009). In it, Dr. Kessler explains why and how we get hooked on unhealthy food.
“When I was a kid, we ate three meals a day,” he said in an interview. “Now fat, sugar and salt are on every corner 24/7. It’s become socially acceptable to eat bad food all day long.” In his book Dr. Kessler explains how our brains become wired to crave unhealthy food and provides tips to help control your impulses.
Mr. Hill’s book, “The Step Diet” (Workman, 2004), is ideal if you’re determined to keep weight off.
$$ JOIN A GROUP Formal organizations like Weight Watchers and Jenny Craig can provide support, education and a healthy dose of peer pressure.
Weight Watchers is a good place to start, because it’s relatively inexpensive. You’ll pay an initial fee of $15 to $20, and then $13 to $15 for each weekly meeting. In exchange, Weight Watchers will teach you how to use its points system and provide you with that all-important weekly weigh-in.
Jenny Craig is more expensive, but may suit those who need one-on-one guidance. A yearly membership costs $399, and an additional $83 a week, on average, for Jenny’s Cuisine meals. “There’s not much evidence, though,” Mr. Brownell says, “that programs that provide meal replacements are more effective than those that don’t.”
$$$ TRY A HOSPITAL PROGRAM If you need to lose a substantial amount of weight and have a condition like diabetes, you might want to invest in a hospital-sponsored weight-loss program.
“You’ll get individualized help from people who are quite knowledgeable,” Mr. Brownell said.
Most people stay with the program for several months or longer. It’s costly, but a medically monitored program may be more effective for those who are obese and who have related health conditions, says the program’s director, Dr. Lawrence J. Cheskin.
PRICELESS: KEEP IT OFF If you become one of the lucky losers, you’ll need to fight hard to protect your losses. One way is to exercise — a lot.
“Diet is a key for losing weight,” Mr. Hill said. “But physical activity is the key for keeping it off.”
To maintain their weight, members of the National Weight Control Registry ideally exercise 30 to 60 minutes a day. Another key is to enlist the support of family and friends. If your buddies are mocking you for eating a salad while they’re inhaling beer and pizza, Mr. Hill said, it’s going to be tough to succeed.
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