Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Healthcare’ Category

Study Calls On Obama to Withdraw Legal Memo That Allows Faith-based Charities to Discriminate

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Wow. This gets it out in the open.

Written by LeisureGuy

10 May 2016 at 1:01 pm

Interesting! Hillary Clinton says, “Bernie’s right.”

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Perhaps not in so many words, but pretty damn loudly.

Maybe we should consider whose ideas are popular. But that, of course, lets in Trump.

At any rate, interesting news development when you think on it. From the article:

Although Mr. Sanders viewed Mrs. Clinton’s latest health care proposal as progress, he said on Tuesday that it was not sufficient.

”Secretary Clinton’s proposal to let the American people buy into Medicare is a step in the right direction, but just like her support for a $12 minimum wage, it is not good enough,” Mr. Sanders said in a statement that described her idea as “Medicare for some.”

Written by LeisureGuy

10 May 2016 at 12:42 pm

The shelter that gives wine to alcoholics in a program of harm reduction

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Harm reduction is something that those who see things in black and white do not like. It’s similar in this respect to teaching teens about sex and making sure they have access to contraceptives and are immunized against HPV. Those who see things in black and white hate such programs. Better, they say, that teens abstain from sex altogether. Well, possibly, but that will simply not happen. And if teens are going to be sexually active, it’s better to take steps to reduce harm than to allow the harm to happen. The problem is that this does not fit well the absolutist mind, which can grasp only total abstinence or a wanton and dissolute lifestyle. The part in between, in which virtually everyone is found, is invisible to them.

So a shelter that recognizes that some people are alcoholics (which they are) and takes steps to minimize the harm that they suffer is a very good idea—and it does work.

I highly recommend this article by Tina Rosenberg in the Guardian. It begins:

n a grey January morning at 9.15, residents of the Oaks shelter for the homeless started lining up, coffee mugs in hand, at a yellow linoleum counter. At half past the hour, the pour began. The Oaks’ residents are hard-core alcoholics. They line up to get what most people would consider the very last thing they need: an hourly mug of alcohol.

Dorothy Young, the Oaks’ activities coordinator – a stocky, always-smiling middle-aged woman who is part cheerleader, part event planner, part warden, part bartender – stood behind the counter at a tap that dispenses cold white wine. She poured a measured amount of wine into each cup: maximum seven ounces at 7.30am for the first pour of the day, and five ounces each hour after that. Last call is 9.30pm.

The pour is calculated for each resident to be just enough to stave off the shakes and sweats of detox, which for alcohol is particularly unpleasant – seizures from alcohol deprivation can be fatal. The pour is strictly regulated: Young cuts off anyone who comes in intoxicated. They won’t be given another drink until they sober up.

The Oaks is a converted hotel next to a pawnshop, in Carlington, a working-class neighbourhood on the west side of Ottawa, Canada. When residents first arrive, they tend to drink the maximum, every hour, every day. Many also drink whatever they can buy or shoplift outside the building. For most, this gradually changes. They stop drinking outside, begin to ask for fewer ounces, skip pours or have a “special pour” of watered-down wine. Two residents get several hours’ worth at a time to take up to their rooms and ration out themselves. One man gave up alcohol but gets an hourly pour of grape juice, to stay part of the group.

Ten of the Oaks’ residents are mental health patients and don’t get the pour – just fewer than 50 others do. A few are women or younger men, but the majority are men in their 50s; it often takes several decades of drinking before people seek a different life and land here. Standard clothing in January was flannel pyjama bottoms and slippers with a down jacket. Many have long beards, dishevelled hair, and no front teeth – alcohol will do that. Most are sick. Years or decades of drinking have left them with liver, heart and brain damage that will never be reversed. A nurse is on site 40 hours a week. At least once a week and whenever necessary, a doctor and specialist nurses come to see patients. Young leads physical stretching groups, a book club, shopping trips and outings; Little Ray’s Reptile Zoo was a recent hit.

The pour is what makes the Oaks different from every other well-run facility of its kind. It solves the residents’ most urgent problem: where can I get a drink? Virtually all the clients have tried to quit, over and over, and failed. They have spent decades drinking themselves into a stupor each day. One man was taken to A&E 109 times in six months. Another was picked up by the police or paramedics 314 times in one year. They have caused enough chaos and disorder that they have been kicked out of, or barred from Ottawa’s other shelters. Before being accepted at the Oaks, if they could not beg or collect enough empty bottles to recycle to buy booze, many shoplifted rubbing alcohol or Listerine. Some shelters started filling their hand-sanitiser dispensers with soap, because residents drank the rub for the alcohol it contains.

“We have guys with wounds with worms in them,” said Kim van Herk, a psychiatric nurse with Ottawa Inner City Health, an organisation formed 15 years ago to address the needs of the city’s hardest-to-reach homeless people, many of whom are alcoholics.

“And that’s our priority, but it’s not their priority,” added Amanda MacNaughtan, a nurse coordinator.

“They are so dependent on alcohol that it’s their most basic need,” said Van Herk. “If that need is not being met, nothing else matters for them. It’s hard for other people to get their minds around how severe their addiction is – they feel like they’re going to die. But once that need is met for them, they can start looking at other parts of their life.”

The pour creates trust: here is a system that understands residents’ needs. This system loosens them from their drinking friends. It keeps them away from Listerine. Without the pour, they would stay outdoors, begging or stealing, in danger of losing their feet to frostbite. Indoors, they take their medicine, see their doctors and mental health workers, eat actual food, re-establish contact with their families. Giving free booze to homeless alcoholics sounds crazy. But it may be the key to helping them live a stable life. . .

Continue reading.

Do read the whole thing. It’s fascinating. The political issues were big, of course, but so were regulations passed for normal drinking establishments. The solution:

There were also legal hurdles. “To the Liquor Licensing Board, we looked like a drinking establishment – but we could never get a liquor licence,” said Turnbull. For example, the cost of putting in a sprinkler system would have been prohibitive. A police sergeant, who was part of the group forming Inner City Health, came up with the solution. The law gave Ontario residents the right to make wine or beer in their own homes and gather to appreciate it – no licence necessary. The MAP was the residents’ home. They could make wine – with a little help from the staff. (More than a little, actually.) And gathering to appreciate it would not be a problem.

Today the wine for both the MAP and the Oaks – which opened a decade later to provide long-term housing for MAP graduates – is made at the Oaks. The winemaking room off the lobby is lined with 25 grey plastic barrels (and kept well-locked). The Oaks staff buy bags of ready-made white wine concentrate – the red turned out to be stronger and got people drunk – then add water and yeast. The residents help by cleaning the barrels and doing other jobs, always closely supervised. Overhead pipes take the wine to the pour counter tap, and staff members drive containers of wine across town to the MAP.

The wine is just about drinkable – probably more so if you’re used to hand sanitiser. “A lot of our clients prefer quantity over quality,” said Bartolo.

Written by LeisureGuy

5 May 2016 at 11:05 am

More than disappointing: Prominent Democratic Consultants Sign Up to Defeat Single Payer in Colorado

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I feel betrayed more than disappointed. Lee Fang reports in The Intercept:

Influential Democratic consultants, some of whom work for the Super PACs backing Hillary Clinton, have signed up to fight a bold initiative to create a state-based single-payer system in Colorado, according to a state filing posted Monday.

Coloradans for Coloradans, an ad-hoc group opposing single payer in Colorado, revealed that it raised $1 million over the first five months of this year. The group was formed to defeat Amendment 69, the ballot measure before voters this year that would change the Colorado constitution and permit a system that would automatically cover every state resident’s health care.

The anti-single-payer effort is funded almost entirely by health care industry interests, including $500,000 from Anthem Inc., the state’s largest health insurance provider; $40,000 from Cigna, another large health insurer that is current in talks to merge with Anthem; $75,000 from Davita, the dialysis company; $25,000 from Delta Dental, the largest dental insurer in the state; and $100,000 from SCL Health, the faith-based hospital chain.

Under the new system, there would be no health insurance premiums or deductibles, and all health and dental care would be paid for by the state through a new system called ColoradoCare. The plan calls for raising $25 billion through a mix of payroll taxes, along with bringing down costs through negotiations with providers.

The filing reveals that the anti-single-payer group has retained the services of Global Strategy Group, a Democratic consulting firm that has served a variety of congressional candidates and is currently advising Priorities USA Action, the Super PAC backing Clinton’s bid for the presidency.

Last month, Global Strategies Group circulated a polling memo that contends that the single-payer ballot measure can be defeated because voters “overwhelmingly reject” the idea.

But, the memo warned, the measure “has some traction with key groups,” including Democrats and millennials, and that the 2016 election year has proven difficult to predict. “[A] sustained campaign pointing out the many flaws in Amendment 69 is essential, especially in such an unpredictable environment,” the memo concluded.

After the memo appeared online last month, I called Andrew Baumann, the vice president of research at Global Strategy Group, to ask him about it, but said he could not reveal who had paid for it or why his firm was researching vulnerabilities with the single-payer initiative.

The filing shows that the firm was paid $58,000 by Coloradans for Coloradans for “consultant and professional services.”

A number of other Democratic firms have signed up to help defeat single payer, too. Hilltop Public Solutions, a firm managed by former campaign staffers to Barack Obama, was paid $45,000 by the group. Hilltop has also provided consulting services to Ready PAC, another Clinton-supporting Super PAC that eventually folded into the Clinton campaign.

The Trimpa Group, a consulting company run by Democratic strategist Ted Trimpa, also received a payment from Coloradans for Coloradans. . .

Continue reading.

Written by LeisureGuy

3 May 2016 at 12:02 pm

Extraordinarily clear potted history of healthcare reform in the US

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It was a long, hard slog.

Written by LeisureGuy

2 May 2016 at 9:02 pm

Home birth in the US is more dangerous than in other places

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Mainly because the government doesn’t require certification. (Note the importance of government regulation.) Amy Tuteur writes in the NY Times:

IS home birth safe? That depends on where you ask the question.

In much of the developed world, home birth is a fringe practice, at about 2 percent of births or less, for obvious reasons: Childbirth is inherently dangerous, and if an emergency occurs, the baby or even the mother may die. Indeed, in the United States, the switch from home birth to hospital birth over the 20th century was accompanied by a more than 90 percent decrease in neonatal mortality and nearly 99 percent decrease in maternal mortality. Antibiotics, blood banking, safe C-sections and neonatology have combined to change death in childbirth from common to rare.

But there are places in the world where home birth is relatively safe, like the Netherlands, where it is popular at 16 percent of births. And in Canada, where it appears safest of all, several studies have demonstrated that in carefully selected populations, there is no difference between the number of babies who die at home or in the hospital.

In contrast, home birth in the United States is dangerous. The best data on the practice comes from Oregon, which in 2012 started requiring that birth and death certificates include information on where the birth occurred and who attended it. The state’s figures show that that year, the death rate for babies in planned home births with a midwife was about seven times that of births at a hospital.

Many studies of American home birth show that planned home birth with a midwife has a perinatal death rate at least triple that of a comparable hospital birth. (The perinatal death rate refers to the death rate of babies in their last weeks in the womb and first week outside it.)

Could racial or economic differences, or poor prenatal care, explain this deadly difference between home births here and in Canada? No. The relevant statistic is again perinatal mortality, and on that measure, the countries are roughly equal.

The problem is that there are two types of midwives in the United States. The first, certified nurse midwives, called C.N.M.s, are perhaps the best-educated, best-trained midwives in the world, exceeding standards set by the International Confederation of Midwives. Their qualifications, similar to those of midwives in Canada, include a university degree in midwifery and extensive training in a hospital diagnosing and managing complications.

The other, certified professional midwives, or C.P.M.s, fall far short of international standards. One 2010 study of midwives published in The Journal of Perinatology found that home births attended by nurse midwives had double the neonatal mortality rate of hospital births attended by nurse midwives, while home births attended by C.P.M.s and other midwives had nearly four times that rate.

This second class of poorly trained midwives attend the majority of American home births. And yet they are legal in only 28 states; in the rest of the country, many practice outside the law.

They used to be called “lay midwives” or “direct entry midwives,” in recognition of their lack of formal medical schooling. That didn’t sound very impressive. In a brilliant marketing ploy, they created a credential — the C.P.M. — and awarded it to themselves. Many receive their education through correspondence courses and their training through apprenticeships with another C.P.M., observing several dozen births and presiding at fewer. How woefully inadequate is this education? In 2012 the requirements were updated to require proof of a high school diploma.

They seem to believe they don’t need more training because they are “experts in normal birth.” As I often say, that makes as much sense as a meteorologist being an expert in sunny weather. Anyone from a taxi driver to a 12-year-old sibling can handle (and has handled) an uncomplicated birth. The only reason to have a trained attendant is to prevent, diagnose and manage complications, the very things that C.P.M.s never have to learn to do. . .

Continue reading.

And do read the whole thing. The situation in the US is very bad, and the contrast with how Canada handles the issue is striking.

Written by LeisureGuy

1 May 2016 at 10:55 am

For Nebraska’s Poor, Get Sick and Get Sued

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Paul Kiel reports in ProPublica:

Two years ago, the president of Credit Management Services, a collection agency in Grand Island, Nebraska, presented a struggling local family with the keys to a used 2007 Mercury Grand Marquis. To commemorate the donation, the company held a ceremony that concluded outside its offices, where the couple and their two young girls could try out their new car.

The family’s story was dire: their eight-year-old daughter’s failing kidney had led to multiple surgeries and a deluge of medical bills, according to an article in the local newspaper.

But CMS played another role in the family’s life, one the article didn’t mention. The company had previously sued the couple eight times over unpaid medical bills and garnished both of their wages. As recently as two weeks earlier, CMS had seized $156, a quarter of the girl’s father’s paycheck.

Shortly after the ceremony, CMS released the family from further garnishment, court records show. But just four months later, the company filed a motion to start up again. The couple, who did not respond to attempts by ProPublica to contact them, has since declared bankruptcy.

In almost any other state, such a barrage of lawsuits against a family in desperate financial straits would be remarkable. Not in Nebraska. There, debt collectors frequently sue over medical debts as small as $60 and a simple missed doctor’s bill can quickly land you in court.

Filing suit is one of the most aggressive ways to collect debt, but no one tracks how frequently it happens or to whom. An examination of Nebraska’s courts, however, shows that where debtors live can have an enormous, and unexpected, impact on the quantity and types of lawsuits.

Nebraska’s flood of suits isn’t merely a reflection of residents’ inability to pay their bills. About 79,000 debt collection lawsuits were filed in Nebraska courts in 2013 alone, according to a ProPublica analysis. In New Mexico, a state with a population, like Nebraska’s, of around two million, about 30,000 suits were filed. Yet by virtually any measure, households in Nebraska are significantly better off than those in New Mexico: Income is higher. Poverty is lower. And fewer families fall behind on their bills.

The reason for the difference is simple. Suing someone in Nebraska is cheaper and easier.

The cost to file a lawsuit in Nebraska is $45. In New Mexico, where suits are filed at about one-third the rate as in Nebraska, the fee for smaller debts starts at $77.

Nebraska lawmakers, of course, didn’t set out to turn the Cornhusker State into the Lawsuit State. Instead, it appears no one understood the consequences of having cheap court fees: Suing became an irresistible bargain for debt collectors. It’s a deal collectors have fought to keep, opposing even the slightest increase.

For debtors, unaffordable debts turn into unaffordable garnishments, destroying already tight budgets and sending them into a loop. “It’s just been a vicious cycle,” said Tanya Glasgow, a single mother in Lincoln, Nebraska who’s been sued several times. “It’s been horrible.”

“I resent the stereotype that these are not hard-working people” said Katherine Owen, managing attorney in Legal Aid of Nebraska’s Omaha office. “Truly the majority of them simply cannot afford it. That’s it.”

Lawsuits over medical debts are, of course, filed in other states, usually by hospitals. What makes Nebraska unusual is that almost all the suits are brought by locally owned collection agencies that pursue debts on behalf of medical providers. Although ProPublica found collection agencies filing suits in large numbers in other states, particularly Indiana and Washington, none could match the sheer volume in Nebraska.

It’s a difference that came as a surprise to researchers, consumer advocates, and collection professionals both in and outside of Nebraska. . .

Continue reading.

There’s lots more. It’s a long article.

Written by LeisureGuy

29 April 2016 at 5:51 pm


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