Monday, June 20, 2005
The Washington Times is reporting:
Key Republicans, aiming to refocus the Social Security debate and unite their party, will introduce a new bill this week to create personal retirement accounts by using surplus Social Security funds the government currently spends on other programs.
"No one seems to be agreeing on how to fix Social Security in the long run, but they do agree that we should stop spending the Social Security surplus" on other programs, said Sen. Jim DeMint, South Carolina Republican, who plans to introduce the bill early this week with Republican Sens. Rick Santorum of Pennsylvania and Lindsey Graham of South Carolina.
"This bill is just designed to save the surplus. ... I think it's a way to move the debate forward," Mr. DeMint said.
In the last few days, we've made a couple of changes to the Elder Law Prof Blog that I wanted to mention. These changes include links to additional resources and other minor tweaks, as follows:
- Topical listings on the left side bar now include the following categories
- Selected Resources for Law Professors
- Federal Agencies
- Journals and Law Reviews
- Newletters and Blogs
- Law School Elder Law Clinical Programs
- Elder Law Related Student Writing Competitions
- I've refined the posting categories to include Medicare, Medicaid, and Social Security. Old posts won't be reclassified, but all new health care or pension and retirement postings will be classified in the more narrow category if appropriate.
If you know of a resource or blog item that you think I should include on the Elder Law Prof Blog, please feel free to let me know. I hope you're finding the blog useful. Don't be afraid to make it your home page. Special thanks to Joe Hodnicki, blog tech god.
'Hotel Rwanda' manager asks what you're doing on World Refugee Day
On this World Refugee Day, my heart is heavy for the refugees in Darfur, in Congo, in Burundi, in Somalia, all of whom are experiencing that terror - the hunger, the hopelessness of refugee life.
I ask that the nations of the world provide hope to these people right now. I have received a humanitarian award from the United Nations High Commissioner for Refugees for my part in helping 1,268 refugees stranded in the hotel I managed in Kigali during the 100 days of slaughter over 11 years ago. But I ask that the symbol of hope for today's refugees not be the long-ago action I took at a hotel, just trying to do my job. Rather, the nations of the world can and must provide hope to those people right now.
The UN should implement its resolution on Sudan and bring the war criminals before the International Criminal Court. An arms and oil embargo should be imposed. We know that the Sudanese weapons are bought with the profits from oil.
We know helping refugees is a temporary solution. The long-term solution is to hold the Sudanese government and militias accountable.
It's the responsibility of all of us to ensure that our governments stop genocides. We cannot allow them to evade their duty where thousands or millions perish. Otherwise, we will all be responsible for perpetuating the genocides that will inevitably occur in the future.
Ask a Canadian to define national identity and without doubt, public funding of universal healthcare will come up.
Canada's totally tax-funded healthcare and inexpensive drugs are important to its image of being different from its neighbor to the south. That's why a decision by the Supreme Court of Canada earlier this month striking down one province's ban on private health insurance is so momentous.
While the decision's impact on the other provinces is not yet clear, groups which both support or denounce the ruling agree it has the potential to change the face of healthcare in Canada.
The court ruled individuals should not be denied the right to buy private health insurance when the public system fails to provide reasonable service, as it found in the case of a patient who had to wait more than a year for hip surgery.
The court is right that private health insurance will not bring about the demise of public healthcare. Allowing the two approaches, as many Western democracies do, should not be seen as incompatible.
President Bush came to the Twin Cities on Friday to launch what he called a nationwide "grassroots effort to educate people" about Medicare's new prescription drug benefit.
The subsidy doesn't become available until Jan. 1, but Bush said it will require a "massive education effort" to persuade seniors to take advantage of it. That's why he's starting early, he said.
"We're here to say to the seniors who live here in Minnesota and around the country that Medicare has been strengthened, reformed and modernized," he told an invitation-only crowd of about 400 seniors, health-care providers and Republican partisans at the Maple Grove Community Center. It was a friendly crowd in the Republican suburb he carried with 57 percent of the vote in 2004.
The informal meeting - he sat on a chair on a stage surrounded by seniors - was his first stop outside Washington in what he promised would be many trips to call attention to the Medicare expansion he signed into law in 2003.
Bush said he was there to persuade seniors, many of whom are reluctant to accept change, that it's worth their while to fill out the government forms required to enroll in the program.
"This is a good deal," he said. "This isn't political talk. This is true."
Aspects of the "good deal" the President didn't mention:
–The law creating the benefit included no drug cost containment provisions
-CMS is prohited from negotiating discounts for Part D beneficiaries
– The law prohibits drug re-importation except from Canada, and permits re-importation only by wholesalers and pharmacists (NOT consumers) AFTER regs are promulgated. Current secretary of HHS Tommy Thompson says he doesn’t plan to issue any reimportation regs.
– States can’t use Medicaid-funded programs to pay for pharmaceutical assistance
- Part D premium increases are tied not to the CPI, but to increases in the costs of drugs used by enrollees. (!) Since the benefit was created, the estimated first year premium has risen from $35 (what beneficiaries were told at the end of 2003) to $37.23 (what they're being told now).
Sunday, June 19, 2005
The Terri Schiavo case and end-of-life issues grabbed the spotlight as about 1,000 abortion foes gathered Thursday for the National Right to Life Committee's annual convention.
Sessions on euthanasia and other end-of-life dilemmas -- such as "Can Grandma be starved against her will in your state?" -- were sprinkled throughout the three-day conference, among perennial topics including testimonials on surviving unplanned pregnancies and strategies for more effective anti-abortion lobbying.
The movement against abortion has always connected abortion and euthanasia, but the Schiavo case pushed end-of-life issues much higher on the agenda.
"The Terry Schindler-Schiavo case has galvanized the grassroots," said Burke Balch, director of a medical ethics center affiliated with the National Right to Life Committee.
O'Steen and Balch are urging people to make up living wills specifying that they want food, water and medical treatment if they wind up incapacitated. They're also pushing for legislation in 40 states where they say hospitals can terminate treatment of patients who had specified their wishes for medical intervention and nourishment.
Minnesota is not among those states.
Abortion rights advocates said such end-of-life decisions should remain private and out of the realm of politics.
"This is a case of a very tragic family situation, and no politician should be involved in that family's decision," said Nancy Keen, executive director of NARAL Pro-Choice America, who was in the Twin Cities to promote more sex education and access to birth control, which she said would reduce unplanned pregnancies and lead to fewer abortions.
Friday, June 17, 2005
Shaping Policy and Practice to Improve the Population's Health
Daniel J. Friedman, Edward L. Hunter and R. Gibson Parrish, eds.
Kaiser Family Foundation Vice President Larry Levitt co-authored (with Georgetown University's Judy Feder) “Why Truth Matters: Health Statistics in Health Policy,” a chapter in a new book from Oxford University Press that explores the role of statistics in health reform debates in the U.S. The book, “Health Statistics: Shaping Policy and Practice to Improve the Population’s Health,” provides a comprehensive account of the concepts of health statistics.
Here's the table of contents of the compilation.
Section 1: Defining Health Statistics: Context, History, and Organization1. Health Statistics: Definition and Conceptual Framework2. Health Statistics in Historical Perspective3. The Health Statistics EnterpriseSection 2: Collecting and Compiling Health Statistics4. Health Statistics from Notifications, Registration Systems, and Registries5. Health Surveys6. Administrative Health Data7. Health Statistics from Non-Health Sources8. Standards and Their Use in Health Statistics9. Linking, Combining, and Disseminating Data for Understanding the Population's HealthSection 3: Using Health Statistics10. Using Health Statistics: From Data to Information to Knowledge11. Why Truth Matters: Health Statistics in Health Policy12. Health Statistics in Public Health PracticeSection 4: Identifying Current and Forthcoming Issues in Health Statistics13. Population Health Monitoring14. Privacy, Confidentiality, and Health Statistics15. New Technologies, the Internet, and Health Statistics16. Modeling Health -- the Role of Simulation Models in 21st Century Health Information SystemsSection 5: Transforming Health Statistics through New Conceptual Frameworks17. Recent Developments in Health Information: An International Perspective18. From Health Statistics to Health Information Systems: A New Path for the 21st Century19. Population Health: New Paradigms and Implications for Health Information20. Health Statistics and the National Health Information Infrastructure: A View from the United StatesSumming Up: Towards a 21st Century Vision for Health Statistics
DHHS OIG REPORT: "Consecutive Medicare Inpatient Stays," (US Department of Health and Human Services, Office of Inspector General, OEI-03-01-00430, June 2005, .pdf format, 21p.).
This inspection found that 20 percent of sequences of three or more consecutive Medicare inpatient stays were associated with quality of care problems and/or unnecessary fragmentation of health care services across multiple inpatient stays. Quality of care problems were defined as patient care that did not meet professionally recognized standards, medical errors, or accidents. Unnecessary fragmentation of services involved cases in which care provided across sequences of multiple inpatient stays may have been necessary and appropriate, but should have been consolidated to fewer stays. Medicare paid an estimated $267 million for these sequences of stays in Fiscal Year 2002. This inspection also found that 10 percent of individual stays within consecutive inpatient stay sequences were associated with poor quality of patient care. OIG recommended that CMS direct Quality Improvement Organizations and fiscal intermediaries, as appropriate, to monitor the quality, medical necessity, and appropriateness of inpatient services provided within the types of sequences of consecutive Medicare inpatient stays that we included in our review.
CMS concurred with OIG's findings, but stated that periodic reviews of sequences of consecutive inpatient stays are not warranted.
[That CMS!! Always looking out for its constituents' best interests! --Ed.]
From the POPULATION REFERENCE BUREAU: "The Future of Social Security," by Christine Himes (June 2005, HTML format).
MMWR_ ARTICLE: "QuickStats: Percentage of Hospital Discharges and Days of Care, by Age Group --- United States, 2003" (US Centers for Disease Control, _Morbidity and Mortality Weekly Report_, Vol. 54, No. 23, Jun. 17, 2005, HTML and .pdf format, p. 584).
Thursday, June 16, 2005
Prof. Alta Charo, Elizabeth S. Wilson - Bascom Professor of Law and Bioethics at the University of Wisconsin at Madison, has just published a perpective piece in The New England Journal of Medicine entitled The Celestial Fire of Conscience — Refusing to Deliver Medical Care. Here's an excerpt:
Apparently heeding George Washington's call to "labor to keep alive in your breast that little spark of celestial fire called conscience," physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care. Largely as artifacts of the abortion wars, at least 45 states have "conscience clauses" on their books — laws that balance a physician's conscientious objection to performing an abortion with the profession's obligation to afford all patients nondiscriminatory access to services. In most cases, the provision of a referral satisfies one's professional obligations. But in recent years, with the abortion debate increasingly at the center of wider discussions about euthanasia, assisted suicide, reproductive technology, and embryonic stem-cell research, nurses and pharmacists have begun demanding not only the same right of refusal, but also — because even a referral, in their view, makes one complicit in the objectionable act — a much broader freedom to avoid facilitating a patient's choices.
Adjunct Prof. Richard Hechler (Golden Gate, University of San Francisco) was recently quoted in an article in the San Francisco Chronicle in connection with an unusual case involving elder abuse and exploitation by a hard core gang of drug dealers; the story was later picked up by the New York Times.
Here's an excerpt from the story.
Even in her 80's, Ellen Gutierrez made friends easily, her neighbors said. She had a quick smile, a generous spirit and a penchant for welcoming visitors to the Mission Street apartment she has called home for 20 years. Her friends said the tidy abode was brimming with photographs of a sister, nephews and the husband she buried years ago.
But sometime in the past year or two, Mrs. Gutierrez, 84, befriended the wrong people.
Some say loneliness led her astray. Others blame possible dementia. The authorities suspect that Mrs. Gutierrez was the target of six men and women who moved into her apartment, even eating her specially delivered meals, and turned it into what the authorities call a drug den.
The police entered the second-floor apartment in the city's Mission District on May 18, removed Mrs. Gutierrez and arrested the six suspects, believed to be members of a criminal street gang. The police found the place in shambles.
Gang graffiti covered the walls, and the rooms were littered with drug paraphernalia, the authorities said. A bed pillow was filthy, and a portable toilet was full. Mrs. Gutierrez, who the police said appeared unharmed, was taken to San Francisco General Hospital, where she was admitted to a locked psychiatric ward. She remains there and was not available for comment.
The case has shocked San Francisco and led many residents and elected officials to question how it could have been allowed to happen. Advocates for the elderly said it was a vivid reminder that crimes against the elderly are increasing.
Since the initial arrests, the police have declined to answer questions about the case. The district attorney filed a complaint on May 19 against the suspects: a 17-year-old boy; two women, ages 22 and 23; and three men, ages 21, 22 and 23. They were variously charged with elder abuse, criminal street gang activity, operating a drug den, gun possession, burglary and possession of methamphetamine.
Richard B. Hechler, the assistant district attorney in charge of the case, said: "We believe one or two of the female suspects offered to provide some kind of care. They then were either invited, or insinuated themselves, into the apartment."
From The Hill:
At a Senate Finance Committee hearing yesterday, Govs. Mark Warner (D-Va.) and Mike Huckabee (R-Ark.) unveiled a proposal aimed at giving states more flexibility in administering Medicaid.
The plan attracted immediate criticism from Democrats who said the governors' recommendations were too narrow in scope and did not address fundamental flaws in the nation's healthcare system.
Warner and Huckabee, speaking on behalf of the National Governors Association (NGA), said that all of the recommendations presented had won the unanimous support of the 50 governors, who have made Medicaid reform a top priority this year.
The governors propose to give the states more leeway in crafting policies to increase the efficiency of the program, particularly in the areas of prescription-drug costs and long-term care, two of Medicaid's biggest expenditures. The NGA envisions expanding the use of generic drugs and making it harder for the elderly to transfer assets to their children to become eligible for long-term-care assistance.
Wednesday, June 15, 2005
Elder Law Prof. Larry Frolik (Pittsburgh) is quoted in the new issue of Time. In the article "Who Cares More for Them", on boomers caring for their aging parents, and the sibling rivalries that can flare up as a result, Frolik says:
"We have an unexpressed wish that our parents will someday acknowledge the injustices done us," Someday Mom will understand that I'm as smart as my rich older brother or will finally admit, 'Honey, your husband's really a swell guy.'"
Frolik one of the nation's leading scholars in the field of elder law, and the author of a casebook, a treatise, and many other books, articles, and essays on various aspects of the subject.
Newspapers around the world report the story:
Schiavo Autopsy Shows Massive Brain Damage, Guardian Unlimited
Schiavo autopsy finds "massive" brain damage, no abuse
Schiavo's autopsy shows profound brain damage, blindness
Schiavo Autopsy Shows Massive Brain Damage