Tax-Supported Health Insurance

Grady

2007-12-02T15:48:00.000-05:00

I shouldn't be blogging today. The semester is almost over and I've got more work to do than I can fathom.

But today, while working on my Op-Ed piece for our Health and Medical Journalism class, I began reading a string of articles at the AJC about Grady Hospital in Atlanta.

I first heard about Grady when my friend Elga was working as a Nurse in the Emergency Room. The stories she told were not for the faint of heart.

Located in Atlanta, with the best of only four trauma units in the state, 50% of Grady patients are covered by Medicaid. Apparently it is quite a zoo there, both patient-wise and administration-wise. My friend Elga lived in dread of full moon shifts in the E.R.

I've been reading about Grady's gradual slide into debt and disrepair for many years now. The more I read, the more confused I get about what the problems are and what the solution is.

The one thing I do know is that the people of Georgia want and need Grady hospital to survive. Grady is a medical home for many Atlantans in the same way that Charity hospital in New Orleans was for those Citizens.

More importantly, I discovered from the AJC articles, Grady is the States largest teaching hospital.

"Without it, the Morehouse School of Medicine, tasked with the mission of training doctors to work in underserved areas of the state, would not exist."--According to Mike King of the AJC

Our states largest teaching hospital is teetering on the verge of collapse. Why?

Aren't we all the same country?

2007-12-01T16:56:00.000-05:00

If I live in the United States, why should my health care options here in Georgia be poorer than those of someone living in Massachusetts?
Why should I have less access to resources that would improve my health?

Read the Quote Below and Follow the Links

2007-11-26T19:26:00.000-05:00

“The sad reality is that the uninsured don’t just struggle with costs themselves, they impose costs on the rest of us,” Mrs. Clinton said in September. “It’s a hidden tax: the high cost of emergency room visits that could have been prevented by a much less expensive doctor’s appointment, the cost of unpaid medical bills that lead insurance companies to raise rates on the rest of us.”

I took this from an article in last Sunday's New York Times "Massachusetts Faces a Test on Health Care."

Want more info on the Presidential Candidates Plans for Health Care?

Check out these websites:

NYTimes

The Association of Health Care Journalists

The Kaiser Family

Lessons from New Orleans: Part 1

2007-11-25T18:44:00.000-05:00

Two weeks ago, during a research and reporting tour of New Orleans, I visited the former Charity hospital facilities. One of the first things I noticed about the empty building was the air conditioning units bulging out of the upper floor windows. Did they use electric heaters and portable radiators in the winter too?

Although the building had been ailing t for many years, damage from the flood is what ultimately caused the building to be closed, according to Diana Pinkley a representative from Women of the Storm, and our tour guide. The top two floors had actually been closed for longer than she could remember.

Two years after Hurricane Katrina, what remains of the Charity Hospital has been relocated to a nearby interim location. Meanwhile, the former building still stands as government officials debate whether to reopen or relocate.

But when it was open, two years ago, the window units were used. Not just one or two, but dozens of them.

Anybody who’s ever used one knows they are indeed a poor solution: dripping, rattling, energy guzzlers with little to no thermostat control—the quick fix to cooling emergencies here in the south.

For me, looking at such flimsy equipment being used at a hospital, they are a symbol of just how bad our healthcare has become here in the U.S. The window units were like seeing a Band-Aid on the building. Ailing people were treated in ailing facilities funded by an ailing medical system.

For years Charity was the preferred medical home of those without insurance. If you don’t have health insurance or money in the bank, you go to emergency rooms knowing that you won’t be turned away. So, like every emergency room around the country Charity struggled with how to fund facilities and care for those who couldn’t pay.

There are at least 45.8 million people, or approximately 16% of the population without insurance, according to the 2005 U.S. Census Bureau. With no other place to go, these people will continue to seek medical care at their local emergency rooms. As the number of uninsured people continues to increase, without a drastic change in our healthcare system, Band-Aids will not be enough; our hospital systems will continue to degrade.

2007-11-05T22:06:00.000-05:00

More thoughts on rationing

2007-10-25T18:29:00.000-04:00

I was re-reading the blog I posted below and realized how informational it sounded. The thing is, as I wrote it, it was all something of a revelation to me.

See, I've never really thought about health care as something that needed to be rationed. I just assumed it was a distribution problem.

What's the difference between distributed and rationed? Rationing implies that there is a fixed amount to be divided, whereas distributing is only about dividing.

(It is interesting to note that the root of rationing is from Latin ratio: to reason.)

So the idea of health care being limited or the need for it to be divided out in specific, more reasonable ways is something that hasn't fully sunk in for me yet.

Why is health care limited? Why can't we all have access to it?

Covering this beat has got me thinking too hard about this stuff.

Some thoughts on Rationing

2007-10-22T10:17:00.000-04:00

All health care is rationed in some way.

In the U.S. health care is rationed based on income: if you have the money you get it, if you don't, you won't.

This is Not how it is done in most developed countries. Almost all developed countries in the world provide some form of Universal health care.

Universal health care means that all residents of a country have access to health care regardless of income level.

According to a study published by the Institute of Medicine, approximately 18000 Americans die every year because they don't have health insurance.

In 2000 the World Health Organization published a report assessing the Worlds health Systems. Did you know that the U.S. ranks 37th out of 191 countries? That's below Saudi Arabia, Columbia, Singapore and Morocco to name a few.

Here is a quote from the report:
"The impact of failures in health systems is most severe on the poor everywhere, who are driven deeper into poverty by lack of financial protection against ill- health, the report says."

Bush passes the buck to congress

2007-10-16T21:56:00.001-04:00

Remember when I wrote that the VA is oft touted as the best of the tax-supported/socialized health care systems?

Well, even President Bush thinks it needs a little fixing.

Check out this article published in the AJC today: Bush Asks Congress to Fix VA System

Who is entitled to health care?

2007-10-16T13:57:00.000-04:00

I received a mass email today announcing a gathering to protest Bush's veto of the SCHIP renewal plan. It's being advertised as a candlelight vigil for tonight (Tuesday, Oct. 16th) at the UGA arches at 5 p.m.

In general I think it is an interesting thing to stage a protest about health care.

I know there have been protests about the VA health care system. But the VA system is an entitlement program. Can you imagine a Medicaid or Medicare protest?

On that note, I've been thinking a lot lately about the word entitlement. Entitlement programs include Medicaid and Veterans health care. These are programs that citizens have earned through service or payment.

SCHIP covers children. They are basically too young to have 'earned' health care coverage and have no way of acquiring it on their own. Does this mean they are less entitled to it than Senior citizens and veterans?

Who is entitled to health care? Why?

Medicare & Health Workforce Issues

2007-10-08T09:05:00.000-04:00

The health workforce shortage has long been on the radar of those who pay attention to medical issues in the U.S..

But I'm just starting to see the connection to tax-supported health care. As mentioned in this article published at the Detroit Free Press. "About 25% of Medicare patients seeking a new primary care physician already have problems finding one, according to MedPAC, the commission that advises Congress on Medicare."

This problem isn't going to go away easily.

The bigger the population, the less physicians who will have access to them? I'm guessing its probably not going to be the people holding tax-funded health insurance cards.

While most of us are too young to have really thought much about Medicare, this will affect us too. Here is a loose explanation:

Medicare is not only for the poor. The original idea behind Medicare is that we would pay a little into the system with each paycheck and then when we retire we have health care. Sounds good to me. But people began realizing that Medicare didn't cover as much care as they needed. for instance it doesn't cover things like nursing homes or extended care facilities in general. So those who can afford to do so put their money into other retirement health plans.

There has already been much debate over how to fix Medicare.

Under the Republican administration changes were made to privatize both the Medicare and Medicaid providers systems. (Basically this meant that if you had Medicare or Medicaid you could chose between several HMO type companies to be your health care provider.)

But, surprise, "Medicare Audits Show Problems in Private Plans."

According to the New York Times article written by Robert Pear, "The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

What to do?

For those of you who pay attention to politics

2007-10-03T16:03:00.000-04:00

I found a short interesting blog at the NYTimes website about how the veto might impact the upcoming elections.

Bush vetoed the SCHIP expansion plan this morning.

2007-10-03T15:50:00.001-04:00

"The compromise bill provided an additional $35 billion in funding over the next five years and brought total spending on the program to $60 billion. The additional funding would have been paid for by a 61-cent-per-pack increase in the tobacco tax."
Read more about it at CNN.com or Here at the Kaiser network.

Not really my beat, but I'm posting it anyway

2007-10-01T21:39:00.000-04:00

With healthcare reform proving to be one of the key issues in the upcoming election the Kaiser family has launched a new website: health08.org. It should give you more information than you can digest about health care issues and presidential candidates.

Oh and you're wondering what happened with SCHIP? Did it expire?

I found an article over at the kaisernetwork.org site about it. Apparently, President Bush signed a stop-gap legislation to temporarily expand the program--until Nov. 16th.

You can't avoid reading about this topic these days

2007-09-30T13:52:00.000-04:00

There were several articles of interest in last Fridays New York Times.

The first article was about the “Democrat’s Build Plan to Override Health Bill Veto.”

Part of their plan involves pointing out how much money President Bush wants to spend on Iraq and comparing it with the lesser amount being requested for the SCHIP program. What is the amount? According to the article, the cost comparison is $333 million per day for Iraq vs. $19 million per day for the State Children’s Healthcare Plan.

Democrats are also using a very powerful emotional ploy, having a handsome twelve-year-old kid--one who has benefited from SCHIP--deliver their message.

On another related note, have you noticed the words “socialized medicine” being tossed around an awful lot in the discussion of tax-supported health care?

Grassley, an Iowa Republican who supports the SCHIP renewal bill, equates shouting “socialized medicine” with shouting, “fire” in a crowded theatre.

"The Socialists Are Coming! The Socialists Are Coming!” is an op-ed piece by Philip Boffey that also appeared in last Fridays NY Times.

Boffey points out that our military and veterans’ hospitals are actually socialized medicine. He goes on to say that, “Politicians who deplore government-run health care for average Americans are only too happy to use it themselves.” These politicians include President Bush who has denounced the SCHIP program as socialized medicine.

One other interesting point of the article I had not previously considered is that Medicare is one-step less socialized than the VA system. The government pays for the care but private facilities deliver it.

And if you are not saturated with information about health care by the end of those two articles you can read the third article that also appeared in the NYT last Friday.

“The Battle Over HealthCare” breaks down the healthcare plans of various political hopefuls.

Finally, a much easier to read comparison is available over here at the Economist website: “If at first you don’t succeed.”

The article has a quick glance chart comparison of healthcare plans being promoted by Democratic presidential candidates.

GA Representatives vote on SCHIP

2007-09-27T13:57:00.000-04:00

Georgia Votes on SCHIP

Here's a short article from the Atlanta Journal Online about SCHIP.

Basically it says that GA congressional votes were split along party lines--republicans-no, democrats-yes--with the exception of one Macon Democrat.

The article is a quick easy read. One of the interesting things I learned, was that the proposed SCHIP renewal/expansion would be funded by an increase in the federal tobacco tax! The article reports that GA Rep. Hank Johnson insinuates this is the reason Bush is promising to veto the bill

Doctors refusing to see Medicaid & Medicare patients

2007-09-25T08:41:00.000-04:00

I haven't seen this in the local news lately, but it's still relevant.

Many doctors simply won't accept Medicaid or Medicare patients anymore. Even those that are on the list of approved doctors, the list that is supplied by Medicare & Medicaid, often turn away new patients.

This means that even people who qualify for and have gone through all the processes of applying for these programs are often still denied healthcare.

Now, imagine a national health insurance program that covers all classes of citizens. And imagine a middle or upper class citizen being turned away for healthcare.

Some of the opponents of a national healthcare plan, fear that the problems that plague Medicaid and Medicare will simply be maginified on a national level, a level that includes the middle class as well.

Here is an article from last years San Diego Tribune: Physicians Turning away new patients
Here is a more recent article posted on a Wall Street Journal Blog last July of 2007: Doctors aren't In for Medicaid Patients

More news about SCHIP

2007-09-24T12:14:00.000-04:00

Here is another article from the NY Times today about the threatened veto of the SCHIP. With only a few days to go, it's all over the news.

September 30th is the date I'm watching

2007-09-24T09:19:00.000-04:00

That is the date that the old State Children's Health Insurance Program is set to expire. This is the plan that supports Peachcare in GA and similar programs across the nation.

President Bush plans to veto a bill to renew the program. According to the Los Angeles Times today, if he vetoes this bill 800,000 children will be without health insurance.

Bush accuses the renewal plan of expanding the coverage to middle class families instead of focusing on low-income families as originally planned.

The LA Times lists the average cost of family health insurance at $12000 a year. The SCHIP program was to cover families who make twice what's listed as the federal poverty level. This is approximately $40000 for a family of four. All of these figures are from the LA Times article.

I'm curious what $40000 for a family of four breaks down to on a daily basis, or a monthly basis. How much money is this per person? Is this middle class? I wonder what a family of four can buy a year---house-wise, education-wise, clothing-wise, and food-wise---on this amount of money. What if that family of four lives in an urban area with a higher cost of living?

Healthcare then and now

2007-09-20T13:44:00.000-04:00

I've been watching the Clinton's campaign for national healthcare for many years now. As an uninsured 20 year old, I voted for Bill Clinton when he originally ran for office, primarily because of his stand on healthcare.

For those of you too young to remember, you can read Wiki's information on the history here.

Now, in my 30's, I'm watching Hilary campaign. I was pleased to see her reintroduce a healthcare plan.

However, Elizabeth Edwards, the wife of presidential candidate John Edwards is in the news today accusing Hilary of stealing her husbands healthcare plan. You can read the article here if you are interested.

It all seems rather silly to me. Is the Edwards' plan that much better that Hilary would have to steal it? And who cares? If the Clinton's have been pushing their healthcare plan publicly for so many years why would they need to go steal one?

Not to get too political here. But I found an article written by Hilary Clinton on healthcare and originally published in the New York Times in April of 2004. It's a long read. But, I'm pretty sure Hilary Clinton doesn't need to rip off all of her ideas for a healthcare plan. I especially like her ideas for expanding the State Children's Healthcare Insurance Program.

Prison Healthcare

2007-09-20T13:35:00.000-04:00

The Los Angeles Times ran an article today, discussing substandard prison healthcare in California after several inmate deaths.

Although not something we think about often, prison healthcare is still tax-supported healthcare.

According to the article, asthma is apparently the leading cause of preventable deaths in prison.

I know that prison healthcare is almost always substandard, but ASTHMA!

Diabetes: The Disease that Could Sink Medicare

2007-09-11T17:30:00.000-04:00

This article came out in the AJC on Monday. It's hard to imagine that diabetes and obesity are such epidemics in the U.S..

(For those of you who don't know, medicare is the health insurance program for people 65 years of age or older. Medicare is not based on income. If you worked for at least 10 years in Medicare covered employment before retirement you are eligible. There are other rules and exceptions, but generally Medicare is for the elderly in our country.)

As the article states, the incidence of diabetes does tend to increase with age. But it's still staggering to contemplate that so much medicare funds are being spent on diabetes alone.

What's even more staggering is that 90-95% of all diabetes cases are type-2.

Type-2 is, if not preventable, at least deterable, through diet and exercise. It's something people tend to develop, they may have a propensity for it, but are not born with it. And I'm speaking from personal knowledge here.

This is an example of where spending more money on health and diet education would possibly save the government and tax payers more money.

An Update on Peachcare

2007-09-08T16:11:00.000-04:00

According to Medical News Today, in July, Peachcare rescinded the enrollment freeze enacted last March. They plan to limit the enrollment to 295,000 and reassess their financial situation on September 30th of this year. If congress fails to renew SCHIP the program will be suspended.

What is Peachcare?

Peachcare is a health care program available to uninsured children living in GA. Children who's parents make too much money to make them eligible for Medicaid, but nonetheless are financially unable to afford insurance may qualify. Peachcare participants often pay a small premium towards their health care.

Peachcare is important for those families who live on the edge of poverty. Health insurance sometimes means the difference between climbing out of poverty or falling back into it.

What is SCHIP?

Congress approved The State Children's Health Insurance Program in 1997 to expand health coverage for low-income families. It is a state administered program, separate from Medicaid, and funded with a larger percentage of federal funds than Medicaid.

This article, "The Middle-Class Welfare Child Next Door" published in July in The Heritage Foundation Press is an attack on the SCHIP program. The article claims that the SCHIP program far from providing coverage to low-income children is just part of a greater scheme to eventually impose a federally run healthcare program "one middle class child at a time."

Paul Krugman, writing for the New York Times published a response to this article, "A Socialist Plot ." Krugman accused the Heritage Foundation of diverting public sympathy away from the truly needy through the "old welfare queen in her Cadillac strategy." Krugman points out that both education and health care are essential to, "give everyone the same shot." And that free (tax-supported) education is an accepted benefit provided by the Federal government to all American citizens of any class. Furthermore, since we guarantee education to all children why shouldn't we provide health care to all classes?

I found Krugman's article to be an interesting response. We provide schools for all classes of children, why not provide health care? Is health care considered less important that education? Or does the majority of the U.S. believe we should be providing education either?

I hope you will read both articles and let me know what you think.

Visiting the Local VA health clinic

2007-09-07T16:25:00.001-04:00

Of the tax-supported health care systems, the U.S. Veterans Affairs health care program is oft touted as the exemplar of a good government run health care system.

The Veterans Administration was originally founded to care for veterans who had served for a length of time in active duty. Currently VA health care is available to active military, veterans who have served in active duty and some other former servicemen and women who qualify under VA rules.

This afternoon I visited the “Athens Community Based Outpatient Clinic” a branch of the VA Medical Center based in Augusta GA. The facility provides primary care and mental health services to the estimated 35000 veterans in the NE GA area.

Until the Clinic was built a year ago, local Veterans had to travel two hours to the Augusta Medical Center for health visits.

Veterans with specialized health concerns, women’s health issues, surgeries and dental appointments still travel to Augusta.

After making several unsuccessful calls to arrange a walk-through or an interview at the clinic, I stopped by the clinic this afternoon hoping to speak with someone and to get a sense of the place.

Firstly, for a community based clinic the facility is located on Hwy 29 in Madison County outside of Athens. There have been some talks of opening another clinic in the former Navy school property in Athens, but no formal agreements have been made.

The facilities had ample parking and from the outside appeared fairly modern and clean. The only exception was a pile of building supplies and debris on one side of the parking lot. Later one of the patients in the waiting room explained that the clinic was still in construction.

A sign on the wall advertised that a Van to the Augusta hospital is available twice a week. Rules for riding the bus were as follows:

Have a scheduled appointment
Have no other means of transportation
Have no funds for travel
Agree to be transported directly to and from Augusta VAMC
Are independently mobile or able to transfer

I wondered what sort of proof they required. I also wondered how someone with no means of transportation was able to get all the way out Hwy 29 to catch the VA van.

The waiting room was full and the single receptionist explained that there was not a resident chief of staff or director ‘in charge’ at the Athens clinic. He explained that the local clinic was run by the VA Medical Center in Augusta GA. None of the nurses or physicians would agree to talk to me except to say that they were always very busy. He did provide the name of a chief nurse at the Augusta hospital that he thought might speak with me.

Early morning food for thought

2007-09-04T07:29:00.000-04:00

I came across this quote while reading an article for one of my journalism classes. Marjorie Williams, a former contributing editor for Vanity Fair wrote a story about her trials with Cancer in an article entitled, "A Matter of Life and Death."

In this particular excerpt Marjorie is mentioning how fortunate she is to have access to an appointment at one of the best cancer clinics in the nation due to her particular status in life. She died in 2005.

"These are the kinds of appointments, I was to learn, that some people wait weeks or even months for. I say that not in the spirit of boast, only as a reminder that in this way, as in most others, medicine is unfair--rationed in fundamentally irrational ways. But when your own time comes, you will pull pretty much every string available to get what you need."--Williams

Beginning My Investigation

2007-09-03T11:02:00.000-04:00

"Welcome to Peachcare for Kids Online application, Where affordable health insurance is available to Georgia's uninsured children." (www.peachcare.org)

In 1999 many Georgia families rejoiced as Peachcare became available. Peachcare offered health insurance for children who do not qualify for Medicaid but still live at or below a certain poverty level.

It was a relief to the working poor, the families on the edge, families you probably know.

Then in February of 2007 Georgia's Peachcare program announced that it would freeze enrollment due to budget shortfalls (http://www.medicalnewstoday.com/articles/62884.php)

The debates followed: What would happen to those children who still needed health insurance? Who's to blame for the lack of funding? Are physicians improperly billing the system? and Why? Is tax-supported health insurancenecessary? What are the other options?

It is no understatement to refer to Tax-Supported Health Insurance as a tangled web.
In order to make some sense of the topic, I began to explore the history of community health care.

The United States Social Security Administration website provides some
interesting historical information regarding tax-supported health
insurance in an introductory article on the topic:
http://www.ssa.gov/history/corningintro.html.

It is especially intriguing to note that the article traces the first "broad-gauged
compulsory health insurance law" to Prussia in 1854. There is even some
mention of early Greek city states providing health care to the poor.