Video:
Watch the Story
NEW ORLEANS – It's an important
step in a lengthy journey. Nearly 180 LSU medical students received their
white coats Saturday afternoon, marking the official start to their second
year in the program.
For
the Pressley twins from Slidell,
it's part of a lifelong dream to one day become
doctors in the city they love.
“I
know that there's a great need for people in health care, and one of the
things that attracted me was Charity Hospital, and just the health care we
have here," said Angela Pressley, a Slidell native.
But
the students are moving forward at a time when plenty of questions surround
the future of medical education in New
Orleans. Charity
Hospital still sits
dormant, and LSU's interim hospital continues carrying the load nearly four
years after Hurricane Katrina. This, while plans to build a $1.2 billion
replacement hospital, part of a new medical corridor, are up in the air.
For
officials like Dr. Steve Nelson, dean of the LSU School of Medicine, it's a
waiting game.
“What
we're still hoping for, is the governor and administration will approve, as
they have verbally said support for the new facility," Nelson said.
But
with uncertainty over funding for the project and heavy criticism from those
who believe Charity should be rebuilt, the outcome is tough to predict.
The
variables don't seem to weigh on these students, though, as most say they're
focused primarily on studying.
"Whether
or not we're in one hospital or the other, you know, that decision is made by
people other than us,” said Daniel Eads, a second year student from Slidell. “But we're just
looking for the opportunity to work with the patients here in New Orleans.”
Ariana Beck agrees.
"It's
always kind of a thing in the back of our minds, I guess, but whatever they
choose to do, as long as we can have that good clinical experience and work
with patients, we're happy that way," she said.
Down
the road, however, the med students will face with tough decisions: where to
go through residencies and internships.
Keeping
them in Louisiana
is a top priority for LSU officials. Nelson said the retention rate is
currently around 70 percent – much higher than just a few years ago, when
nearly half of the students continued their studies elsewhere.
He
said students like the ones receiving their white coats Saturday add another
layer of positivity.
"Looking
at their GPA's and their grades and how they perform on standardized testing,
they're among the best we've attracted," Nelson said. "We still get
the brightest in the state of Louisiana.
They're optimistic. They're excited about the future."
Officials
also tout the new $110 million cancer center, which is under construction
now.
The
facility will bring students and doctors from LSU and Tulane University
together for cancer research.
http://www.wwltv.com/topstories/stories/wwl080209cbmedschool.9f28e35b.html#
[BACK TO TOP]
Among
the criticisms of a health-insurance “public option” is that such a
government plan would negatively impact the health-care “marketplace.”
However, just the fact that we talk about health care as a “marketplace”
shows the extent to which the insurance industry has set the terms of this
discussion, because when you think about it, this concept makes about as much
sense as a “national defense marketplace” or “highway construction
marketplace.”
Why, in our “nonsocialist” country, do we tolerate
so much government involvement in national defense and infrastructure?
Because at some point, we decided these are essential public goods whose
delivery cannot be left to the vagaries of the marketplace. And somehow, we
also decided (or, more likely, were influenced to decide) that health care
does not meet that same threshold.
Of course, most opponents of the public option don’t really believe human
health is less important than fixing potholes. More likely, they are
responding to pressure from the insurance industry, which sees its
profitability threatened by competition from the government.
According to the American Medical Association, 94 percent of U.S.
insurance markets meet the Justice Department’s definition of “highly
concentrated,” meaning one or two companies control the health insurance
market in a given area and are thus able to control premium levels, benefit
packages and payments to providers.
Analysis of the AMA data by the national grass-roots organization Health Care
for America Now, found that Blue Cross and Blue Shield of Louisiana’s Baton
Rouge market share is 67 percent, with UnitedHealth Group Inc. a distant
second at 15 percent; these two companies together thus control 82 percent of
our local health-insurance market. If you had that kind of power, would you
want to give any of it up?
Thus insurance interests run TV commercials warning of a “government
bureaucrat” coming between us and our doctor — as if we don’t now routinely
see bureaucrats from the profit-driven insurance industry interfering in our
care.
Personally, I prefer the nonprofit bureaucrat from the government to the one
motivated to increase his company’s profits and help his own job security by
looking for reasons to deny my coverage.
It’s really quite stunning how we as a country accept a proposition as
morally dubious as “health care for profit.”
I think most of us instinctively know there’s something wrong with
that, but we’re so used to combing through lists to see if our “provider” is
“in-network,” or trying to figure out our “co-pay,” that we no longer
question the present system.
Thus, the insurance companies not only determine our health care but — more
disturbingly — have succeeded in influencing how we think, what we expect and
what we believe is possible.
Beatrice Winkler,
finance, Baton Rouge
http://www.2theadvocate.com/opinion/52314282.html
[BACK TO TOP]
Students
at both New Orleans
medical schools are heading into the new academic year with symbols of their
profession: white coats.
LSU
School of Medicine gave white coats to 177 second-year students Saturday
during a ceremony at Xavier University's University Center.
Speakers were the dean, Dr. Steve Nelson, and Dr. Angela Johnson, an
assistant professor of medicine.
The
177 first-year students at Tulane University School of Medicine will get
theirs today in a 10 a.m. ceremony in the New Orleans Hilton's Grand
Ballroom. Dr. Norman McSwain, a surgery professor
and renowned trauma surgeon, will be the principal speaker.
This
year, Tulane marks its 175th birthday. Scheduled to cut an anniversary cake
at the event is Dr. John Sabatier, a member of the medical school's Class of
1938.
http://www.nola.com/news/t-p/metro/index.ssf?/base/news-34/1249276828277180.xml&coll=1
[BACK TO TOP]
The Shreveport Times | 08.02.09
Summer
jobs at LSU Health Sciences Center-Shreveport exposed high school and college
students to both tedious and touching aspects of health care.
The
students participated in the Jumpstart and Undergraduate Apprentice programs,
which are part of the Partnerships in Science Pipeline developed by LSUHSC-S
Multicultural Affairs Director Shirley Roberson.
Students
in both programs engage in hands-on research in a variety of departments at
the Health Sciences Center.
They present their findings at a wrap-up session open to the public.
Chynna Coleman, 17, analyzed hundreds of
psychiatric patient registration records to see whether people's payment
status was coded correctly. In the process, she helped the health sciences
center get reimbursement for some services.
"It
was long and tedious," Coleman said. "I didn't really understand
how (payment) worked. Now I do."
Cornelious Blalock, 16, learned
how doctors' attitudes can influence a patient's well-being while researching
Parkinson's disease. His work included helping with support groups for people
with Parkinson's.
"I
had no idea what Parkinson's disease was when I started," Blalock said.
"One thing we learned was that most couples have more of a togetherness when one of the people has Parkinson's
disease."
Blalock
said a career in science always interested him, but that he's now considering
going into neurology because of his experiences in the Jumpstart program.
Roberson
started the pipline program more than 25 years ago
with informal internships in her research lab at LSUHSC-S. The pipeline
evolved into a series of programs that offers science education for everyone
from kindergartners to first-year medical students.
The
programs lost federal funding in 2006, but the health sciences center decided
to keep the pipeline alive. Roberson had to cut back on the number of
students in most of the programs and eliminate stipends for a program that
helps first-year medical students brush up on science and math.
"What
I'm looking at now to expand the program is private money," Roberson
said. "I'm looking at contacting family members of former students and
maybe former students who are doctors now."
http://shreveporttimes.com/article/20090802/NEWS01/908020319/Science-pipeline-gives-students-hands-on-exposure-to-health-careers
[BACK TO TOP]
Jardon:
Exercise your rights to improve health, care
Alexandria Town Talk | 08.02.09
An
e-mail about the health-care reform bill was forwarded to me the other day.
The original sender was a guy who actually to read the bill. He pointed out
some things in it he disliked.
I,
too, am plodding through the thousand-plus-page bill. If you have not read
it, I suggest you do so before blindly allowing this bill to become law.
The
e-mail writer said, "Remember, the government cannot give anyone
anything that it has not first taken away from someone else!"
That made me stop and think. I'm not
sure I'd explain things just that way, but it is important to remember that
government does not exist without us. It has no power except that which we
give it.
If
we don't demand limited government now, however, we are going to wonder what
happened when we no longer have the power to do so.
If
we continue to turn over our rights and freedoms so government can "take
care of us," we'll have only ourselves to blame.
I've
already discovered several serious problems in House Resolution 3200, the
health-care reform legislation. I was going to point some out, but you should
read it for yourself.
As
you read, take note of all the places that the "Health Choices
Commissioner" has the power to specify criteria, make decisions and
define things. That's a lot of power in one person's hands.
Then
write or call your congressmen and demand that they read it. Ask them if they
really understand it all. It's doubtful.
This
legislation is about government control. It is about rationing health care.
It is about taking choices from individuals.
State
Sen, Joe McPherson, D-Woodworth, was on a much better track with his
Louisiana Health First legislation, passed as the Health Care Reform Act of
2007. The goal was to provide evidence-based, quality-driven health-care
services that are affordable and sustainable to people eligible for Medicaid
and for low-income people -- the populations that include most of the people
who are involuntarily uninsured.
The
legislation offered a model for the delivery of health care, using health
information technology and setting quality measures.
The
act states that "Louisiana Health First will consist of a medical home
system of care that is patient-centered, continuum of quality-driven,
integrated and accessible health care services. The medical home system of
care may consist of public, private or public and private providers,
including primary and preventive care, speciality
services, hospital care, access to prescription drugs and basic dental care.
"Health
information technology is the second major component of the Health Care
Reform Act of 2007. HIT will promote evidence-based clinical practices,
interconnect clinicians, personalize health care, and improve population
health and patient safety."
The
act calls for the latest technology to monitor patients with ongoing
conditions. If we can keep them well, we can cut down on higher-cost crisis
care.
If
we use the latest technology to do so, patients are required and encouraged
to take a more proactive approach in keeping their condition under control.
Louisiana
Health First also would help to change the mind-set of going to the emergency
room for everything -- by connecting people with primary-care physicians and
teaching them to practice preventive medicine.
This
kind of reform can take place at the state level. Educating people to take
better care of their health can be done without socializing health care.
If
we take a healthful approach from the beginning, and maintain it, we will cut
the costs of treatment and insurance.
People
will be happier, too.
Allowing
government to take over health care is not the answer. We should empower
people with information, options and access to what they need.
Cynthia
Jardon, editorial page editor of The Town Talk,
lives in Alexandria.
http://www.thetowntalk.com/article/20090802/OPINION/907310318
[BACK TO TOP]
The Washington Times | 08.03.09
First
of three parts
NEW ORLEANS | Using his hands,
Adam Graff pushed the "floodwater" away from the frantic woman's
face.
It
calmed her momentarily, but she could still see the brown agitated water, she
could feel it rising again, back over her waist, up to her neck, and she
cried for help.
Mr.
Graff, a mental health technician, gently lifted her chin and assured her
that she was in an airtight police van, and he was taking her to a place
where the water couldn't reach her: the mental ward at University Hospital.
In
her mind, she was drowning in the fury of Hurricane Katrina's floodwaters — a
flashback from nearly four years ago when she spent three days in water up to
her waist.
Such
dramatic scenes are near-daily experiences for Mr. Graff, a member of a
special New Orleans Police Crisis Unit, the only one of its kind in the
nation, that responds to 911 calls and transports mental patients to
hospitals.
The
unit is fighting a worsening crisis of Katrina-related mental illness that
most Americans know nothing about.
"No
one sees this on a daily basis like we do. This is all we do. It's a
three-ring circus, and I've got a front-row seat," Mr. Graff said.
Almost
four years after the massive hurricane inundated much of New Orleans and killed about 1,800 people,
millions of words have been written about the devastating physical damage to
the city, and hundreds of millions of dollars have been spent on the fitful
efforts at reconstruction.
But
almost nothing is said — and relatively little has been spent — on a more
silent wreckage: the health of New
Orleans residents who were pushed over the edge by
the terror and turmoil of the storm and have been unable to recover,
emotionally or mentally.
The
Washington Times spent more than three weeks on the streets of New Orleans this spring
chronicling the crisis. Reporters and a photographer traveled with the police
crisis unit and conducted scores of interviews with victims, their families
and the front-line responders.
In
a city that has famously grappled with mental illness for decades, caregivers
on the front lines say the problem has grown exponentially since Katrina —
and that the number of sufferers still in need of help easily runs into the
thousands. Despite the rising scourge, the number of available hospital beds
to treat the mentally ill in New
Orleans has decreased by more than half. Locals have
coined their own name for the mostly silent crisis: post-Katrina stress
disorder.
"We
all kind of crazy after Katrina," said Judge Arthur L. Hunter, who
presides over a special court that reviews the cases of patients who were
legally committed to hospitals or now getting treatment.
Many
of the new patients held down jobs and led productive lives before the
legendary storm. Now they wander the city's streets, living from handouts or
what they can pick from garbage cans. They sleep amid filth and squalor in
some of the 70,000 derelict buildings that still await rehabilitation or the
wrecker's ball, or threaten suicide and act out with sudden panic or rage
inside their own homes.
Mr.
Graff recounted one crisis call about a 40-year-old man who had beaten the
family dog to death. "It's the first catatonic case I've ever seen,"
Mr. Graff said. "His family said he would sit on the levee and stare at
the water for hours, or sit at home and stare at the floor. He had no history
of mental illness, but his mom said he was depressed." He wasn't that
way before the storm, the family insisted.
Even
before the storm, New Orleans
billed itself as "the city that care forgot." Estimates by city
health agencies and a survey by the World Health Organization put the number
of mentally ill as high as 15 percent or 16 percent before Katrinain the Gulf region. That figure soared after the
August 2005 storm.
The
Centers for Disease Control and Prevention reported that half the adults
still living in New Orleans
seven weeks after the storm had clinically significant psychological
distress. One year after Katrina, the WHO survey found, the ratio of Gulf Coast
residents with mental issues had shot up to 31.2 percent.
Among
those most directly affected, the numbers are even worse. When the Federal
Emergency Management Agency surveyed families still living in trailers and
hotel rooms in Louisiana
in February 2006, it found 44 percent suffering from significant
psychological distress.
Those
numbers have overwhelmed the treatment capacity of a city that was
hard-pressed to cope before Katrina.
Before
the storm, New Orleans
had 10 public and private hospitals with more than400 beds available for
inpatient treatment of the mentally ill. Today, there are just seven
hospitals operating with fewer than 170 beds. Some of those beds are located
in trailers outside the hospital facilities.
The
number is about to shrink further with the scheduled Sept. 1 closing of the
New Orleans Adolescent Hospital (NOAH), the only public hospital still
providing inpatient services for the mentally ill. When its facilities are
moved 40 miles away to Mandeville,
La., the city will be down to
just 133 beds.
Volunteers
step in
The
storm has also taken its toll on the New Orleans Police Department Crisis
Unit, an extraordinary crew of volunteers augmented by paid professionals who
respond to police calls of attempted suicides or crimes committed by the
mentally ill.
Established
in the 1970s as a joint venture between the NOPD and the office of Louisiana
Health and Hospitals-Division of Mental Health, the unique unit had about 50
volunteers before Hurricane Katrina struck. When the storm abated, only a
dozen came back.
Since
then, the unit has been built back up to 30 volunteers who, in the past 12
months, have handled more than 400 calls for incidents involving
schizophrenics, nearly 600 calls for people diagnosed with bipolar disorder,
depression or schizoaffective disorder, and 500 people whose suspected mental
illness had not been diagnosed.
On
occasion, they work alongside Unity of Greater New Orleans, a coalition of
nonprofit and government agencies founded in 1992 to deal with homelessness
in the city. Unity volunteers have taken it upon themselves to make their way
through the city's labyrinth of derelict buildings, stepping over shards of
glass and dodging dangling electrical wires in search of squatters — a great
many of whom are mentally ill.
"I'm
the only social worker in the country who goes to work wearing steel-toed
boots," said Mike Miller, a Unity volunteer who along with his colleague
Shamus Rohn led a Times reporter and photographer
through a search of the lightless, mold-draped interior of an abandoned
hospital where the sick and troubled once were saved but now hide in
confusion and fear.
They
find their way to the fourth floor, which once held dormitory-style rooms for
on-call doctors and nurses, following a trail of jagged liquor bottles past
an abandoned wheelchair and forgotten cell phones strewn on the floor. The
phones are plugged into chargers that are no longer attached to any
electrical outlet.
The
basement is still flooded from the epic storm.
Room
after room reveals the remains of the post-Katrina apocalypse: hospital beds
stacked on top of one another, operating-room walls spray-painted with
obscenities, piles of plaster everywhere.
Unseen
items go "crunch" beneath their boots.
Rooftop
view
One
night in late May, Mr. Miller and Mr. Rohn
encountered Michael Palmer, a recently unemployed heroin addict who said he
suffers from depression. He lives in one of the abandoned dorms with no
electricity, water or air conditioning. During his years of squatting in the
hospital, he found a key for the room, which he keeps locked during the day
while he ventures into the city to search for food and drugs. A burning
candle illuminates his clothing hung on an IV stand.
Mr.
Palmer led the Unity workers onto a rooftop terrace to share his panoramic
view of the city and to discuss his situation. He said he needs a job. He
needs a place to live. He needs his life back.
"Yes,
I get depressed, it affects you mentally. How … did I get in this
situation?" Mr. Palmer mused.
They
were joined on the rooftop by Alan Gele, a
53-year-old man who wore his baseball cap turned backward, a bicycle lamp
strapped to his head and a beer in his hand.
"I'm
tired of living like a bum. I need to get the hell outta
here," Mr. Gele said.
He
recounted an episode 10 days earlier, when Mr. Palmer overdosed on heroin.
Mr. Gele dragged the man down four flights of
stairs to the sidewalk, where he could be picked up by an ambulance and taken
to a hospital.
The
social workers told the two men about vouchers provided by Congress that
should be available this summer to subsidize their housing needs. The men
declined, saying there are others who need the help more. Besides, they said,
they have no jobs to make up the rest of the rent.
Mr.
Miller and Mr. Rohn promised to bring the men food
the following day, and then moved on to search more buildings. Days later,
Mr. Gele was severely beaten and hospitalized.
"In
reality, we are completing the last search and rescue work in the aftermath
of the storm," said Martha J. Kegel, executive
director of Unity. "Mike and Shamus are the only two people still
looking for them. …
"We've
been forced since Katrina into doing things we would never dream of
doing," she added. "It's slow, pain-slogging work to rescue them
this way. No other city in America
is doing it, but that's where our focus should be."
Danger
amid chaos
Mr.
Miller said he has searched 1,200 abandoned buildings since Unity
successfully closed two homeless camps. One with 300 homeless at Duncan Plaza in front of city hall was closed
in December 2007. A second camp, closed in July 2008, had sprawled beneath
the underpass of Interstate 10 on Claiborne
Avenue.
Unity
wiped out the camps by providing housing to the nearly 500 people living
there in tents and sleeping bags, with no toilets or water.
"It
was just awful," Ms. Kegel said. "Drug
dealers moved in, and there was a lot of crime and abuse of women. It got so
bad no one would go in without police."
Dr.
Craig Coenson, medical director at Metropolitan
Human Services District, learned firsthand about the danger. His agency
coordinates community services to address mental health, addictive disorder
and developmental disability needs in Orleans,
St. Bernard and Plaquemines parishes.
He
also volunteers his time to go on the late night missions with Unity and
sometimes encounters his own patients, including one man who panhandled by
day to feed his cat.
"To
really understand the system, I wanted to go out and see what they do and
where we are missing the boat," Dr. Coenson
said. "The number of abandoned buildings, businesses, libraries and
schools where sports trophies are still in the cabinets, it was an
eye-opener."
In
one school, Dr. Coenson and the volunteers from
Unity found a couple living in the library. She was dying of cancer and her
boyfriend worked during the day to buy her beer to ease the pain. In another
school, they found an old man huddled in a closet.
Another
school was "home" to 20 to 30 transient teenagers with reputations
of violence, often called "gutter punks." The social workers said
they no longer approach that property.
"It
is dangerous but it's for a good cause. Somebody has to do it," Dr. Coenson said.
"That's
what outreach is all about. They aren't going to come to you."
While
Unity tries to save people from homelessness, the NOPD Crisis Unit often must
save people from themselves, like Ella Monroe. She wanted to kill herself.
"I
was not like this, I never been like this before," she tells a crisis
unit volunteer as she is transported her from her neighborhood in the Upper
9th Ward to University
Hospital.
That's
a phrase that Cecile Tebo has heard over and over
in the four years since Katrina. As administrator of the crisis unit, she
supervises the volunteers as they respond to about 240 police calls a month.
"We're
dealing with a population that is so exhausted in their own mental illness —
you have families that are so exhausted as they
crawl their way through this broken system, they cannot advocate for
themselves," Mrs. Tebo said.
Now
it's up to the community to do that for them, she said.
Crisis
unit in action
At
2 p.m. on June 4, the unit arrived at Mrs. Monroe's home. She sais she already had
downed a six-pack of beer.
"I'm
depressed, I don't know what goes on in my brain, it just scares me,"
the 46-year-old woman said. "I try to fit in the world and be normal,
but I'm scared of people."
"I'm
scared of you right now," she told Jamie Runyan,
an engineer and a volunteer in training.
Mrs.
Monroe said she suffers from depression and hallucinations and hears voices
that tell her she does not deserve to live.
She
told Ms. Runyan that before the unit arrived, she
had a razor blade and was going to "cut my arm."
She
said she was institutionalized at NOAH for three months when she was a
teenager and that there is a history of mental illness in her family.
"My
grandmother had everything," said Mrs. Monroe, who said her illness got
worse after Katrina.
Then
she began a mantra she would repeat over and over during the 10-minute ride
to the hospital.
"I'm
tired, I'm tired, I'm tired," she said, rocking back and forth.
Once
in the parking lot, Ms. Runyan wrapped up her
interview with Mrs. Monroe with a few last questions.
"Why
should you care? This is just your job," Mrs. Monroe said.
When
told Ms. Runyan is a volunteer for the crisis unit,
Mrs. Monroe grew silent for a few moments, then
blurted out: "Are you for real?"
Mrs.
Monroe's large dinner ring and stone-studded sandals set off the metal
detector at the hospital, where a looming sign warns "no weapons"
allowed.
Mr.
Graff of the crisis unit held Mrs. Monroe's hand as he led her through the
crowded emergency room and into a private triage room.
She
was crying and didn't want to talk to the nurse, but Mr. Graff told her that
was the only way they could help her get better.
Afterward,
Mr. Graff led her into the mental ward's holding area, guarded by a police
officer, the last stop for Mrs. Monroe before she was herded into one of two
trailers across the street.
She
covered her face and started sobbing. Mr. Graff put his hands on her
shoulders and told her she was safe. Then she whispered something into his
ear.
"All
she wants is to be normal again," Mr. Graff said.
"What's
normal?" he asked.
When
the crisis unit returned to the hospital with another patient at 6:30 p.m.,
Mrs. Monroe was still waiting on a trailer bed.
Mrs.
Tebo later described her frustration with the
inhospitable trailers.
"It's
like a really bad zoo with animals curled up in the corner," she said.
Where
to go?
A
16-year-old Algiers
teenager was already handcuffed in the back seat of the police cruiser when
the crisis unit arrived just after 10 a.m. on June 1.
The
teenager, whose name cannot be published because he is a juvenile, banged his
head repeatedly on the hood of the car after officers removed him for
transfer to the crisis unit van.
Mr.
Graff removed the metal handcuffs and secured a worn brown leather restraint
that snuggled the man around the waist, and bound his wrists to his sides.
The
police said the teen was trying to break into his older, and much larger,
brother's bedroom wielding a butcher knife after they had argued over what to
have for breakfast.
The
officers said it wasn't the first time they had responded to calls at this
address.
The
teen's mother, who suffers from schizophrenia and bipolar disorder, said her
son takes medication for attention-deficit (hyperactivity) disorder and
another medication prescribed for schizophrenia, and that he had taken his
last dose the previous night.
But
once inside the crisis unit van and secured into the rear seat, the youth
challenged his mother, who was riding in the front with Mrs. Tebo.
"All
the dope and all the weed she's selling, she should
not be talking," the teen said. "If you were paying attention, you
would know that I haven't taken my medicine in three months."
Mrs.
Tebo informed the mother that her son might not be
able to get treatment in the future at NOAH. The state is closing the
hospital, forcing patients to travel to the other side of Lake
Pontchartrain, 40 miles away.
"Would
you be able to be a part of your child's health care there?" Mrs. Tebo asked.
The
mother does not speak; she shakes her head "no."
•
Tomorrow: A system overwhelmed and shrinking in size.
http://www.washingtontimes.com/news/2009/aug/03/mentally-ill-struggle-in-post-katrina-new-orleans/
[BACK TO TOP]
This
story comes from our partner NPR
This
is a transcript of NPR host Linda Wertheimer's
interview with Billy Tauzin on July 30, 2009. It begins with Ms. Wertheimer's introduction:
Related
Audio
Morning
Edition
One
major player in the health care debate: the pharmaceutical industry. Last week,
NPR reported that PhRMA, the Pharmaceutical
Research and Manufacturers of America, spent $40 million lobbying Congress
this spring.
PhRMA got an early deal to take key items
off the table, like importing drugs from Canada, the government’s ability
to negotiate drug prices. And PhRMA agreed to drug
discounts totaling $80 billion over 10 years to help lower health care costs.
Former Louisiana Congressman Billy Tauzin is PhRMA’s
president and CEO. I asked why PhRMA supports a
health care overhaul now.
Mr.
BILLY TAUZIN (President and CEO, Pharmaceutical Research and Manufacturers of
America): Because it needs to get done. I mean, we agree with the president.
This is not only just a moral imperative that we make sure people in this
country have good insurance and access to these products that can keep them
out of the hospital and keep them healthy, but we also believe it's an
economic imperative now. And the studies we have indicate that if we do
nothing now, this country is going to get sicker and poorer and less
competitive in the world.
WERTHEIMER:
Your organization jumped out early on the health care bill and went straight
into the White House and began negotiations on certain big issues that you
wanted to be sure you knew what you were going to get going in. Was that the
right decision?
Mr.
TAUZIN: Oh, absolutely the right decision. We had the opportunity to be
first. I’ve always believed that you get ahead of issues. You don’t wait for
them get ahead of you.
WERTHEIMER:
Why?
Mr.
TAUZIN: Why? Because, again, if we had a better chance, we could actually
wrestle some of these difficult issues to the ground and we would know in
advance what our exposure was in the process, settle some of the difficult
issues that we faced. And that all made good sense to us.
WERTHEIMER:
One of the things that you negotiated with the White House was that there
would not be a big fight over importing drugs from Canada at lower costs. And there
were other issues that you wanted to be sure that the president was not going
to get in your way on.
Mr.
TAUZIN: Well, wait. I mean, you made an assumption. Let me hopefully clarify
that. We negotiated our contribution, a total $80 billion. I can tell you the
president wanted more and we wanted less. And some have said, 'oh, that’s a sweet
deal.' Twice the proportionate share of our marketplace against the cost of
the bill is not a sweet deal. That’s a heavy burden. It will mean less money
spent on research in the next 10 years, and that’s not good. It’s going to be
a heavy price. And we’re going to indeed have some real difficulty with some
companies.
WERTHEIMER:
Do you think that you can keep it at that level? Do you think it’ll go up?
The leadership in Congress has suggested that maybe you're not thinking about
doing enough.
Mr.
TAUZIN: Well, I just explained to you why I think we’re doing more than
enough. We’re doing a lot more than some of the other sectors
proportionately. Yeah, everybody thinks we’re 50, 70 percent of the health
care spending. We’re not. We’re 8 percent. The reason they think it’s higher
is because of the high co-pays. If every time you had to pull money out of
your pocket to buy a medicine - when your Blue Cross
covers your hospital - you think it must be medicine’s driving the cost of
health care. It’s not.
If
you took all the profits away from all the pharmaceutical companies in America,
all of them, every bit, so there’d be no more money for research, no more
money for investors, you’d end up with a one-and-a-half percent reduction in
health care costs. It’s not the big pocket of money people think it is.
WERTHEIMER:
National Public Radio has a poll out that shows that approval of the
president's health care plan has slipped, that more people disapprove than do
approve now. I mean, it’s still quite close, but do you think this thing can
be done?
Mr.
TAUZIN: Yeah. It will not be what everybody wants. It never is. But, it will,
I believe, be a huge and substantial step toward covering the Americans who
are not covered and changing the course of health care in America toward real prevention
and disease management rather than just damage control. That’s the big pieces
we’ve got to do. If we can do that, we'll control costs long- term. You will
have a healthy America.
You will have a more productive America,
and you will have literally a wealthier America.
WERTHEIMER:
Would you have a wealthier pharmaceutical industry?
Mr.
TAUZIN: I can't predict that. I can only tell you that we'll do okay.
WERTHEIMER:
Mr. Tauzin, thank you so much.
Mr.
TAUZIN: Oh, always a pleasure.
WERTHEIMER:
Billy Tauzin is the president and CEO of PhRMA,
which represents most of the brand name prescription drug companies.
http://www.kaiserhealthnews.org/Stories/2009/August/03/npr-Tauzin-interview.aspx
[BACK TO TOP]
Landmark Massachusetts health reforms showing cracks in access,
coverage
Amednews.com | 08.03.09
Lawsuit
charges that the state weakened its safety net to pay for reform. Meanwhile,
lawmakers propose closing a budget deficit by rolling back some coverage.
By Amy Lynn
Sorrel and Doug Trapp, AMNews staff. Posted Aug. 3,
2009.
Health
system reform is hitting a few snags in Massachusetts at a time when many
policymakers are eyeing the state for clues as to how federal reform efforts
could play out.
A lawsuit by
Boston Medical
Center alleges that the state has
significantly underfunded the safety net hospital to finance expansions of Massachusetts' 2006
universal coverage initiative. Meanwhile, budget shortfalls threaten coverage
for legal immigrants and others insured under the reforms.
The BMC
lawsuit, filed July 15 in Suffolk Superior Court, accuses the Executive
Office of Health and Human Services of illegally cutting the hospital's
Medicaid payments and redistributing the money. It also alleges that health
officials inappropriately funded new coverage expansions by diverting a
portion of money set aside to maintain safety net hospital funding levels
during the transition to the universal program.
BMC serves
the lion's share of the state's Medicaid patients, as well as a significant portion
of the uninsured and those covered under Massachusetts' Commonwealth Care, the
health insurance plan for low-income individuals. Commonwealth Care offers
free coverage to residents earning up to 150% of the poverty level, and
subsidized coverage to people earning between 151% and 299% of poverty. Those
with incomes 300% of poverty and higher can purchase unsubsidized insurance
through a private plan exchange.
The case
serves as a warning for national health reformers, said Larry S. Gage,
president of the National Assn. of Public Hospitals & Health Systems.
"To the extent Congress is looking to achieve savings from Medicare and
Medicaid to help pay for expanded coverage, they have to do it carefully and
with clear attention to the relationship between payments and current
services."
Systemic
problems
Even if Massachusetts officials restored the $127 million in
supplemental funding BMC says it is owed, systemic problems would remain with
how the state is setting payment rates, said Donald K. Stern, a former U.S. attorney for Massachusetts who is representing BMC.
State law
requires that disproportionate share hospitals be paid based on their actual
financial needs. But Stern said health officials are illegally redistributing
Medicaid funds based on statewide hospital cost averages.
As of June
2009, Commonwealth Care had 176,000 enrollees.
The reform
law promised to raise Medicaid rates, not cut them, he said. While some
hospitals have seen increases, BMC estimates that the changes will cost the
facility, the state's largest safety net hospital, $181
million by 2010.
"There
has to be a fix for this, and we don't want it to take money out of [other
hospitals'] pockets," Stern said. "But to the extent Medicaid rates
are too low, that's something everyone can get behind."
Massachusetts
Health and Human Services Secretary JudyAnn Bigby, MD, said in a statement that she was confident her
office acted appropriately and would prevail in the lawsuit. "At a time
when everyone funded and served by state government is being asked to do more
with less, BMC has been treated no differently."
But Massachusetts' strong
safety net system was a key to facilitating the 2006 reforms, said Nancy
Turnbull, an associate dean in the Harvard School of Public Health's Dept. of
Health Policy and Management. Historically, those facilities have required
higher payment rates than other hospitals because they cannot balance costs
with a high volume of privately insured patients.
Contemplating
cuts
Tough
economic times have led the state to seek some cuts to its health reform
program.
Competition
and direct negotiation with insurers have produced some savings, but a
one-year state revenue decline of about $3.4 billion is prompting
Massachusetts Gov. Deval Patrick and state
lawmakers to consider more trims. The Legislature adopted a fiscal 2010
budget that would save $130 million by cutting Commonwealth Care coverage for
30,000 legal immigrants. Hospitals fear that ending coverage for legal
immigrants likely would lead some to seek care in emergency departments,
further straining their budgets.
People in Massachusetts who earn
up to 150% of the federal poverty level can get free insurance coverage.
Patrick
vetoed the immigrant care cuts in the budget on June 29 and has been working
with lawmakers and the Connector Authority -- which oversees the reforms --
on a compromise plan to maintain some basic coverage for immigrants.
Commonwealth Care had 176,000 enrollees on June 30.
Other health
care cuts have been finalized. The state expects to save $62 million in
fiscal 2010 by ending automatic enrollment for residents eligible for fully
subsidized health coverage, said Connector Authority spokesman Dick Powers.
The 2006
reforms included a promise to increase Medicaid pay for physicians to 90% of
Medicare rates by 2010. But tough fiscal conditions already have prompted the
Legislature to eliminate $33 million of the $540 million in physician pay
hikes scheduled by 2010, said Jennifer Kritz,
spokeswoman for the Massachusetts health office.
Gage, with
the National Assn. of Public Hospitals and Health Systems, said state
lawmakers' efforts to downsize coverage to close a budget deficit could place
additional pressure on the safety net.
But despite
bumps in the road, the state's reforms have cost it only an additional $100
million per year compared with pre-reform spending, said Andrew Bagley, the
Massachusetts Taxpayers Foundation's director of research. "I think
there is a sense that, generally speaking, they got most of this right."
Lessons for
Congress
Massachusetts may offer a window
into the future of national health reform. Democrats have incorporated key
parts of the Massachusetts
reforms into their legislation, including a health insurance exchange and an
individual insurance mandate.
Jon Kingsdale, PhD, the Connector Authority's director, said Massachusetts has
demonstrated that Congress cannot effectively change the entire nation's
health system in just one bill. The state's reform measure delegated many of
the key decisions to the Connector Authority.
Officials
are still adjusting the Massachusetts
program. The state is in the early stages, for example, of crafting a global
payment system that considers quality and outcomes instead of just volume.
Such changes are necessary to keep it sustainable in the long run, Kingsdale said, adding that the reforms will fail if the
state cannot limit the growth of private plan premiums.
Congress
should follow the example by adopting a strong framework for reform and
giving federal agencies clear goals and the flexibility to meet them, he
said. States also should have a say on the structure of local health
insurance exchanges. "I would guess an exchange in Mississippi
should be very different than an exchange in Massachusetts," Kingsdale
said.
ADDITIONAL INFORMATION:
Case at a
glance
Did Massachusetts health
officials illegally underfund a safety net hospital to finance universal
coverage reforms?
A trial
court could decide.
Impact: The
hospital says reductions in Medicaid payments and other funding could harm
its viability under a mandate that it take all patients, regardless of
ability to pay. The state says difficult economic times have forced everyone
to cut back.
Source: Boston Medical
Center v. Sec. of the Executive
Office of Health and Human Services, Suffolk
Superior Court, Massachusetts
Most, but
not all, covered
More than
97% of the Massachusetts
population is insured, the highest rate in the country, thanks to a universal
coverage initiative the state launched in 2006. But low-income residents
still are significantly more likely to be without coverage.
|
|
Uninsured
|
|
Total
population
|
2.6%
|
|
Earning
150% or less of federal poverty level
|
5.4%
|
|
Earning
151%-299% of FPL
|
5.1%
|
|
Earning
300%-499% of FPL
|
1.9%
|
|
Earning
500% or more of FPL
|
0.3%
|
Source:
Health Insurance Coverage in Massachusetts,
2008 Survey, Division of Health Care Finance and Policy (www.mahealthconnector.org/portal/site/connector/-menuitem.d7b34e88a23468a2dbef6f47d7468a0c/)
http://www.ama-assn.org/amednews/2009/08/03/gvl10803.htm
[BACK TO TOP]
