Wednesday, February 28, 2007
Today's Washington Post reports a terrible story that underscores the need for basic health care coverage, including dental coverage as well as better incentives for doctors and dentists to accept low-income patients. Until reading the story, I had not thought about how difficult it must be to find a dentist who accepts Medicaid even though I have had friends who worked in emergency rooms complain that too many people come to the ER for dental problems. Health care access depends not just on insurance coverage for a service but ensuring that there are individuals available to provide those services. Perhaps a cut in Medicaid reimbursement rates would not be the best idea . . . .
Thanks to Atrios for the cite.
Tuesday, February 27, 2007
The Governors and the White House are at odds over the future of the State Children's Health Insurance Program (S-Chip). The New York Times reports today that meetings between the Governors and President Bush show that they are not on the same page with regard to future money for the program.
In the session at the White House, when President Bush reported on progress of the war, governors pressed him to provide more money so they could guarantee health insurance for children. In response, administration officials said states should make better use of the money they already had.
Gov. Sonny Perdue of Georgia, a Republican, said afterward, “Health care for children ought to be a priority, irrespective of anyone’s views on the war.”
Georgia will exhaust its allotment of federal money for the Children’s Health Insurance Program within three months, Mr. Perdue said. Thirteen other states expect to run out by September, according to data released here at the winter meeting of the National Governors Association.
Governors said the Clinton and Bush administrations had encouraged them to expand children’s coverage and had granted waivers allowing them to cover parents and even some childless adults.
Having successfully expanded the health insurance programs in their states, some governors now suggest that the Bush administration is pulling the safety net out from under many children. In his budget this month, Mr. Bush said he wanted to return the program to its “original objective” of covering children with family incomes less than twice the poverty level. Budget documents note that 16 states cover children above that level and that “one state, New Jersey, covers children up to 350 percent of the federal poverty level.” A family of four is classified poor if its annual income is less than $20,650.
An influential member of Congress said Monday that he would not be taking up White House proposals to restrict eligibility and financing for the child health program.
“I have absolutely no intention of moving the president’s proposals through our subcommittee,” said the lawmaker, Representative Frank Pallone Jr., Democrat of New Jersey.
I guess the final veneer of the compassionate conservative has worn off . . . . More information on the program funding issues can be found at Stateline.org.
Just to wake up everyone up a bit - the Chicago Tribune reports on a recent gathering of scientists who are perplexed about women's sex lives. The article states,
To get an idea of just how much remains unknown about an area that directly affects most people's lives, you need to drop in on the International Society for the Study of Women 's Sexual Health.
Researchers presenting their findings at the society's sixth annual meeting are still trying to figure out which hormones and neurotransmitters make sexual arousal possible, where in the brain orgasm takes place, and which nerves control the genital organs. Much of their work is being done in rats.
Now we're sticking needles into different parts of the brain," said Dr. Irwin Goldstein, the Boston urologist who founded the multidisciplinary group. "Whatever pharmaceuticals are proven to help ... most likely will work in the central nervous system."
Clinicians, frustrated by the slow pace of sexual science, want effective treatments for patients brave enough to seek help--a small minority.
Although social scientists have been studying women's sexuality for decades, medical science did not become interested until the advent of Viagra in the late 1990s raised the possibility that female sexual problems might be treated by medication.
Viagra, which treats erectile dysfunction by increasing blood flow to the genitals, does not appear to work in women.
In fact, no drug has been approved in the U.S. for the disorder doctors call female sexual dysfunction. That may be understandable, given that experts aren't sure what female sexual dysfunction is--or even if it exists. . . . .
Since the 1960s, researchers have operated under a variation of the simple model proposed by William Masters and Virginia Johnson that says the human sexual response starts with desire, progresses through excitement or arousal and ends with orgasm. But experts argued that notion might reflect the experience of men more than women, many of whom don't see orgasm as a goal.
In recent years the field has moved toward a more complicated model based on the observation that many women go into a sexual encounter without being in the mood--perhaps they're seeking intimacy or hoping to please their partner--and may not really want sex until after they become aroused.
But it wasn't until very recently that anyone thought to test those theories by asking women.
Sand, who was awarded a prize for his innovative research, found that 57 percent of women felt a straightforward model best described their sexual experience. The 29 percent who endorsed the more complicated model were more likely to have sexual problems.
That made sense, Sand said, because Masters and Johnson recruited couples who liked sex a lot, while the more complicated model was based on the experiences of women with sexual complaints.
`We need to go back to the drawing board and come up with models that explain why some women have different sexual experiences, find out which models fit which women, so we can serve women more effectively when they have sexual concerns," Sand said.
It is great that scientists are taking women's sexual health seriously - I do have some concern that this interest is apparently fueled by the prospect of some pharmaceutical cure that could bring in lots of money. Thanks for Feministe for the link.
Monday, February 26, 2007
Saturday, February 24, 2007
I have not been posting much over the past months because my grandmother, age 92, fell and broke her hip shortly after Thanksgiving. She is doing much better but is still not back to her old self. She was living on her own and is back at home now with some daily visits from a nurse. We are now working on locating a new home for her. She is reluctant to move and lives in a small town that doesn't have very good nursing home or assisted living options - making things rather difficult. She is a wonderful woman that we love very much but also worry about living by herself. We are working through various options and hopefully all will work out for the best.
In the meantime, I wanted to link to this recent post at Firedoglake concerning Medicare and Walter Reed but also mentioning Medicare's nursing home compare website - a very help site if you need to find a nursing home.
Friday, February 23, 2007
As you know, early last year South Dakota enacted an extremely restrictive abortion ban (abortion permissible only to save a woman's life, no exceptions for rape or incest) that was later overturned by the South Dakota voters in November. In response to the voters, the state legislature attempted to pass another abortion ban. This new legislation, that contained exceptions for rape, incest and life-threatening conditions, has failed to pass the Senate Affairs committee on an 8 to 1 vote. For more information and some of the recent history of South Dakota's abortion bans, see TalkLeft.
My Health Law class just finished our segment on informed consent and now I find this article. Ezra Klein posts on American reading and the need to make medical information more accessible so that people can make necessary choices about their health care. He cites to a recent Washington Post article discussing the low health literacy in the United States and quotes it saying:
A 1999 report by the American Medical Association found that consent forms and other medical forms are typically written at the graduate school level, although the average American adult reads at the eighth-grade level.
Yikes! Eighth grade!! The Washington Post article continues:
Earlier this month a Chicago-based organization known as the Joint Commission, which accredits the nation's hospitals and clinics, unveiled a list of 35 recommendations to address the problem, which is estimated to cost taxpayers $58 billion annually. Among the recommendations developed by a panel of experts: adoption of communication techniques proven to be effective with patients, simplification of jargon-laden consent forms, and development of patient-friendly navigation signs, which may include the use of pictures or icons that are also recognizable to non-English speakers.
Low health literacy "is a silent epidemic that threatens the quality of health care," said Dennis O'Leary, commission president. Too many physicians and administrators, he said, fail to grasp the dimensions of a problem that affects every aspect of medical care and is a major impediment to patient safety. In some cases, cultural and language differences are a barrier, but experts emphasize that the majority of those with low health literacy are native-born and white.
Interest in health literacy comes at a time when Americans are expected to assume ever-greater responsibility for their care and are discharged from hospitals sicker and quicker, experts agree. Many patients are expected to comply with sophisticated drug regimens, to adjust or calculate medication doses or to manage complicated equipment with little training and less supervision. A comprehensive national assessment of adult literacy conducted in 2003 by the U.S. Department of Education found that 43 percent of adults have basic or below-basic reading skills -- they read at roughly a fifth-grade level or lower -- and 5 percent are not literate in English, in some cases because it is not their first language.
The Washington Post article is an interesting (and sad) read.
Thursday, February 22, 2007
The horrific treatment that many returning veterans received at Walter Reed Hospital was recently exposed by the Washington Post in a series of articles. They are an amazing tale of neglect and bureaucratic mess. Here is the PBS News Hour discussion of the Hospital conditions as well as some information on future fixes for the hospital.
As you are all well aware, law year, the FDA approved the cervical cancer vaccine HPV, manufactured by Merck. This was an important break through and public health experts began to focus on how to encourage the use of the vaccine, which is best provided at a young age. Last month, Texas Governor Rick Perry mandated the vaccine for all Sixth grade girls (11-12 year olds). His move has met some resistance from the state legislators. Now, other public health officials and state representatives across the country are re-considering how to handle the distribution of the vaccine. Unfortunately, there is the argument that this vaccine will encourage young women to have sex, but that is not all -- Merck, with a potentially large profit-motive, has been very aggressive about encouraging the mandate for the vaccine and that has made some public health officials uneasy (the drug is not cheap). National Public Radio's Morning Edition had a brief spot on the controversy this morning, featuring Professor Larry Gostin. I am not sure what the best answer is in terms of how to make the public most comfortable with this important and potentially life saving vaccine. Hopefully, Merck's behavior will not cause states to back away from considering the best way to ensure that as many young girls receive the vaccine as possible.
Thursday, February 15, 2007
Barbara Ehrenreich, the author of "Nickel and Dimed" an investigation on the impact of welfare reform on the working poor, writes about the plight of the underinusured for the Huffington Post today. She discusses a letter that her son wrote to the CEO of the Daughers of Charity Health System concerning the charges for a recent hospital stay. In her column, she states,
I don't usually share the family mail, but this letter from my son Ben to the CEO of the curiously named "Daughters of Charity Health System" illustrates two important issues: (1) how inadequately covered many insured people are, and (2) how the medical system shamelessly gouges us. Yes, we need universal health insurance, and United Professionals, the new organization I helped create, energetically advocates for it. But universal health insurance won't work, at least not for long, if the medical system treats it as an open vein gushing with profits.
The odd thing is that many politicians and pundits believe that the only way to control health costs is to get consumers to limit their consumption of health care - as if an appendectomy, for example, was a kind of self-indulgence. In my son's case, we have someone who is vividly aware of his health care costs, if only because he bears so much of them. His letter is not only an individual complaint but an act of good citizenship. We all need to be prepared to blow the whistle on medical larceny.
But where are the regulatory agencies that should or could be watching for this kind of thing? How can we build price controls into universal health insurance in a way that does not limit necessary health care, or fall unfairly on the poor? Obama, Hillary, John and the rest of you: Do you have some answers for us?
The letter details the charges that her son incurred as a result of his hospital stay. I must admit they seem quite high and the fact that medical professionals in the area have noted the hospital charges as excessive is rather troubling.