Community health care forum to be hosted by Olson

Olson has authored several health care bills in the Minnesota Legislature, including one to promote a small business pool for health insurance, but Tuesday’s forum will focus on national plans, not state plans.

The Obama transition team is asking for health care community discussions to be held between Dec. 15 and Dec. 31. The transition team will prepare a report from the discussions for Obama.

In the mean time, the forum “was specifically organized in response to a request that President-elect Obama made for community input meetings,” says Olson, DFL-Bemidji.

State Sen. Mary Olson would hold a community forum Tuesday in Bemidji, as part of a nationwide effort by President-elect Barack Obama to gain input on health care.

Health Care By and For the People

by Sarah van Gelder

The Obama transition team is asking you to help create a new health care policy. Really. Host a meeting, invite friends and associates, look at the Obama team's proposal, and let the transition team know what you decide. If you are among a lucky few, Senator Tom Daschle, Secretary-designate for Health and Human Services, may show up at your meeting.

This may be more important than it sounds. The key dividing lines over how to fix our country's broken health care system are becoming clear. It may take the same sort of grassroots involvement that got Obama elected president to keep the private insurance industry from hijacking the process as they have during previous reform efforts.

Here's one of the key decision points. The Obama plan calls for giving everyone the option of signing up for a public or private insurance plan. But according to The New York Times, the private insurance industry is lining up against that option. It's no small matter. According to a report released Wednesday by health policy analyst Jacob Hacker, having a public option could make the difference between a system that covers everyone and controls costs, and one that will continue to leave millions out while costs soar.

As Americans are painfully aware, our health care system is broken. 45 million Americans or more are without health care coverage. Half of all bankruptcies are caused, at least in part, by unaffordable health care bills. We're spending more—16 percent of U.S. GDP (gross domestic product) to cover 85 percent of our population, while Canada and France each spend less than 10 percent of GDP to cover everyone.

The harm to our economy of our backward health care system is especially evident today, as all three U.S. auto makers suffer from the competitive disadvantage of covering health care costs that their overseas competitors can leave to more effective government-run insurance programs.

Americans voted for change this November. But what system makes sense?

According to the research we did at YES! for our special coverage of health care reform, government involvement is critical. A majority of Americans agree—two out of three believe the government should provide national health care coverage, even if it would mean higher taxes. Other wealthy countries have adopted various methods, but a system like Canada's is one of the most efficient at providing good coverage for everyone while keeping a lid on costs. Under this system, the government is the insurer, but patients choose their doctors from private, public, or non-profit health care providers.

Having a public system is the way to cut bureaucracy and cost. But government involvement is where things get controversial. The private insurance industry opposes such a move. And some say that the switch to national insurance is too big a leap for Americans. People will be afraid to give up the coverage they know for an unknown system.

So the Hacker proposal, which was adopted in part by Barack Obama, may be the perfect compromise. Keep your private insurance if you want. But if you aren't covered, or if your premiums are too high, or your deductions and exclusions are too onerous, you can opt for the public insurance system. You would still choose your doctor. Subsidies would insure the plan is affordable to all. At the lowest income levels, it would be free.

Including a public system in our range of options is what it will take to control costs, and thus make sure everyone is included, according to Hacker. The private insurance industry has made a lot of money by excluding things that are expensive, shifting costs on to individuals and families by, for example, excluding pre-existing conditions, and working to write coverage only for those who are less likely to need health care. They have a big incentive to figure out how to exclude a treatment or test and little incentive to invest in our long-term health, since people tend to shift insurance companies over time. Their business, after all, is not keeping us healthy. It’s generating profits for shareholders.

Medicare has kept costs under control more effectively than either private insurance companies, or pools of private insurers, like those who contract with the federal government to provide health insurance to federal employees. According to Hacker's report, Medicare spending per enrollee increased only 4.6 percent per year from 1997 to 2006, while the cost of private insurance increased 7.3 percent each year during the same time period.

Innovations in the public sector have helped contain costs, and there are substantial additional savings to be had from better use of information technology, care coordination strategies, and databases of practices and outcomes, according to Hacker. And public health insurance agencies are in a better position to negotiate for reasonable prices from private health care providers.

The nonpartisan Lewin Group estimates that Hacker's plan would save the U.S. economy $1 trillion over 10 years, while covering 99.6 percent of Americans.

The Massachusetts system, enacted in 2006, is a stark example of what happens when there is no public option. Everyone in the state is supposed to be covered, but their choices are limited to private plans. Premiums have been rising 8 to 12 percent per year, which means the system will soon be out of reach of individual families, employers, and the state government.

A public option assures that there is a benchmark against which private companies must compete. Without such a benchmark, private companies have no incentive to contain costs or improve services.

It's hard to argue with giving people a choice.

But the health care industry is arguing. The New York Times says medical associations are encouraging their members to attend the health care discussion groups being organized by the Obama transition team around the U.S. Past efforts to reform the health care system stalled in the face of powerful health industry lobbyists with huge campaign war chests. Will the industry be as adept at dominating the health care policy discussion when it's happening in living rooms and coffee shops around the country?

Here's how President-elect Obama put it at his December 11 press conference:

Year after year, our leaders offer up detailed health care plans with great fanfare and promise only to see them fail, derailed by Washington politics and influence peddling.

If Obama is able to bring together ordinary Americans, who so clearly are desperate for change, and if they get as engaged in health care reform as they were in the bottom-up presidential campaign, perhaps this time we'll get the change we need. Maybe people power will overcome corporate power, and we'll finally be able to join the rest of the developed world who enjoy health care security.

So far, more than 4,000 meetings are scheduled around the U.S. Here's where you can sign up to lead a session. All the information you need is online, including the moderator's guide and instructions for reporting the results back to the transition team.

Note: If you are part of such a discussion, please let YES! know. We'd love to read your report and post a selection. Send us an email at editors [at] yesmagazine.org. Put the phrase "health care discussion" in the subject line.

Their Hollywood lifestyle turned to hatred and divorce... but 25 years later, a debilitating illness inspired an even deeper bondBy Glenys Roberts

Last updated at 12:44 AM on 13th December 2008

Our story began in the Sixties. His best friends were Michael Caine and Peter Sellers, Roger Moore and Princess Margaret. We holidayed in the South of France and weekended with the Queen’s photographer cousin, Lord Lichfield.

But it wasn’t Doug Hayward’s glamorous lifestyle that seduced me — I had just spent four years in Hollywood where I had seen a lot of high life. We bonded over an idealistic belief in the classless society.

Doug had proved it was possible for anyone to come from anywhere and make the most of their life. Brought up in a working-class home near Heathrow Airport, he went on to start a world-famous tailoring business. We married in 1970, had a daughter, Polly — and then everything went wrong. Perhaps it was the hectic pace of life, perhaps his obsessive work ethic. Or was it my determination not to be a stay-at-home wife?
Our divorce was bitter. We ended up in the High Court, and our daughter was made a ward of court. Though we continued living opposite each other and neither of us remarried, we barely exchanged a civil word for 25 years.

Then one day in 2004 he smiled at me in the street. ‘Has he buried the hatchet?’ I asked my — our — daughter.

‘Don’t be silly, Mother,’ she said. ‘He is becoming so dotty he thinks you’re someone else.’
Doug was diagnosed with dementiaWithin a couple of months my talented former husband had mysteriously blacked out and was taken to Accident & Emergency. Five specialist hospitals later there was a diagnosis. Doug — who had been so dynamic, so witty, so charming, so gentlemanly — had several sorts of dementia. He was not yet 70.
This ghastly disease is no respecter of persons. It strikes wherever it likes and each family has to deal with it as best they can. Doug had no close relatives other than my daughter, so I decided to support her early on by helping with his care.

But what had been a practical decision at the outset had a completely unexpected outcome. Dementia is often said to rob its victims of all personality. I didn’t find that. In many ways, my ex was still the same old Doug I had admired and fallen in love with.

When I first visited him in hospital, I had no idea what sort of a welcome I would get.

‘Do you know who I am?’ I asked him. ‘Yes,’ he said. ‘You are my former mother-in-law — but none of that matters any more.’ He could not find the right word for our relationship, but he wanted it to continue.

His illness often made him confuse his words, but with a little imagination it was easy to understand what he meant.

‘Can I get you on the “wild one”?’ he would say. He meant the mobile. ‘Where is the Moon?’ That’s what he called the house key because it caught the glint of the streetlight at night.
His vocabulary was quite charming, but there were many aspects of his illness that were not. The problems started as soon as he came back from hospital to the flat where he had lived alone since our divorce.

Already he was failing the MMSE — Mini Mental State Exam — which assesses capability based on the answers to questions such as ‘Who is the Prime Minister?’. Part of it was wilful failure — as a schoolboy Doug hated exams — but it didn’t change the facts.
He tried to light the bedclothes rather than the gas fireLeft to himself, he tried to light the bedclothes rather than the gas fire, and put food straight onto the burners on the kitchen stove without bothering with a pan. He scarcely knew his address any more, and couldn’t work out how to open the front door.

Yet he was determinedly independent and did not want to acknowledge any of this. Only recently he had been driving his car all over the country and as far as he was concerned he was going to continue. That meant we had to confiscate his car keys.
He hated this assault on his personal freedom and lost no opportunity to blame Polly and I. His aggression particularly upset our daughter.

She wanted to remember him as the supremely energetic father he had been, the life and soul of the party, the man who always had an amusing tale to tell, who knew the words to all the early Broadway and Hollywood songs by heart. To her, it seemed as if all the attractive parts of his personality had been excised, leaving him on a constant collision course with anyone who wanted to help him.

He couldn’t even take care of the new dog that had replaced his beloved Burt, a Jack Russell of some repute, who’d had his own Doug Hayward tailored jacket and obituary in the national press.
Doug felt he'd lost all quality of lifeBurt had been the runt of the litter, content even as a puppy to sit at home because he was allergic to trees and grass, thus perfect for an ailing owner. Jack, the newcomer, was an enormous, bounding thing who never sat still. He had to be rehoused and Doug concluded that was the end to any remaining quality of life.

He was so depressed that we did not have the heart to tell him he was never going to get better. He must have suspected it himself, so perhaps there was no point.

Some doctors, as well as most friends, seemed to take the view that he would be better off dead, but I couldn’t agree.

I tried to cheer him up by telling him doctors would one day discover a cure for Alzheimer’s and that I wanted him to be around to benefit when the breakthrough was made. We genuinely hoped it would come in time. But what was to happen to Doug in the meantime?

The choice was stark: he went into care or we funded 24-hour carers to look after him in the flat he loved, above the Mayfair tailoring business he’d created. He begged my daughter never to send him away, and so we decided he should live at home as long as possible — and, ironically, because of his frugal upbringing, we managed this.
In his heyday, Doug dined out on stories of his penny-pinching, which in his witty way he made seem utterly charming — an inevitable consequence of his working-class background.
We went as far as California for help - but found nothingIt meant he had saved what he earned for just such a rainy day, and my daughter, who had power of attorney, was determined to use his money for his benefit. His one extravagance had been top-of-the-range health insurance, so he could have the best medical advice the instant he needed it.

Not that anyone had the faintest idea what was the best way forward. Doug went as far as California and Barbados to try to find a cure while he was still able, but he found nothing.

Fortunately, we knew a brilliant Catholic geriatrician who shared my view that where there’s life there’s hope. Dr Keet’s answer to every problem was: ‘Keep your nerve and play it by ear.’

He was willing to come out at all hours, at a moment’s notice, to switch Doug’s medication and mastermind a cocktail of calming drugs alongside health supplements, including acknowledged brain food such as royal jelly and fish oil.

Doug was given Aricept, about the only drug that improves the memory of Alzheimer’s patients. The NHS refuses to provide it until a patient reaches the later stages of the disease. What a tragedy it is that they do not make the drugs we used routinely available to all dementia patients.

The NHS may do many good things, but it is difficult to understand why the diseases of the old are so underfunded when every drunk or drug addict who ends up in A&E on a Friday night is guaranteed sympathetic treatment.

Unlike drink and drugs, old age is not a lifestyle choice. Certainly, no one would choose to end their days as vulnerable as a newborn child — incapable of comprehension, of articulating their basic needs or controlling their bodily functions.

Doug couldn't tell us the problem, but he was terrifiedSo how do you find a reliable companion for someone in this state? At the start, we tried to save agency commission by answering adverts ourselves, only to find that private individuals are entitled to little information about prospective employees because of data protection.

In the end, we turned to a leading agency, on the basis they would never let us down. It was expensive, and although they found us several very good carers, there were some who were unsuitable — including one who seemed to be ill-treating my ex.
Doug couldn’t tell us what was wrong, but was plainly terrified of the man. Eventually, we found two wonderfully loyal carers who had worked for families we knew. We were fortunate, too, that Doug’s many friends were so helpful. They invited him to watch football on TV, especially when his team, Chelsea, was playing. They joined him at his gym, run by Annabel’s owner, Mark Birley.

Most lunch-times they took him to one of the many restaurants near his Mayfair shop. Doug usually rose to the occasion when he was in company, though his attention span was shortening.

He didn’t say much on those outings, but ate his favourite pasta and could even have a glass of wine. He liked to drop into his shop, too, and his eye for a well-cut jacket and his uncanny intuition were as sharp as ever.

Sometimes I took him to the cinema. We saw his friend Clint Eastwood’s Million Dollar Baby together. Doug, an avid movie fan, was still able to follow the most obscure plot and deliver an opinionated verdict.
We might as well still have been marriedSometimes we took him out in the car. He would sit next to me convinced he knew the way, ordering me to ‘Turn right, turn left’ and accusing me of being completely useless. We might as well still have been married.

Sometimes I took him for a walk in the park. Usually he loathed exercise, but once he struck out further and further only to bolt for home without warning, heading for the traffic. Doug, who had been a skilled footballer in his day, was still a strong runner. I only just managed to catch up and distract him in time. But our boldest idea was to take Doug, who loved the sun, back to the South of France where he and I had spent one of our first holidays together on Peter Sellers’ yacht.

Two years ago, my daughter found a house for rent near Nice where all Doug’s actor friends had holiday homes. We asked him whether he wanted to go — you did not tell my former husband what to do, even though he was ill. He said ‘Yes’ without hesitation, adding rather forlornly: ‘Do you think I can?’

That made us doubly keen — and determined nothing should go wrong. We planned the outing with military precision, invited a rota of my daughter’s friends to keep an eye out for him, and booked his doctor and the carer on our flight, just in case.

We reckoned without the August 2006 terrorist alert and all the added airline security procedures. In those first weeks you were not even allowed to take a lipstick on board, still less any liquid.

Doug, shaking with nerves, but still his old, proud self, refused to use a wheelchair, and stood in a queued for security for two hours without even being allowed a drink. When we finally got on the plane, he was in a foul mood. He hated the airline food, hated his seat, hated me for sitting next to him.
The holiday was a spectacular success
Then there was the first of many magical moments. We were just about to cross the coast of France at Antibes. Ahead lay the Mediterranean bathed in August sun. ‘Look out of the window,’ I said.

He looked grumpily down and then turned to me with a look of sheer childlike delight on his face: ‘I know where we are,’ he said. ‘He goes right out there and turns left and then he lands in Nice.’ He meant the pilot, and Doug was right.

The holiday was a spectacular success. He loved the bedroom my daughter had chosen for him because it was exactly like his room at home. He loved the garden, and for the first time in his life took an interest in flowers — which he asked to have planted in the garden of his English country house. We took him to lunch parties at the
beach and to all the old haunts.

Of course, there were nerve-racking moments. There was the time, five minutes after we arrived at the house, when he locked himself in the loo and we couldn’t get him out for an hour and a half.

There were the many times he tried to dive into the shallow end of the swimming pool and hated us for stopping him. Then there was the day he finally walked down the steps into the water with my daughter, launched himself into the pool and swam two lengths. Everyone burst into tears. We had never thought we would see him do that again.
When we returned to Britain, we planted the flowers he wanted in the garden of his country home near Henley, but Doug never saw them. He gave up spending weekends there because he saw frightening hallucinations lurking in the shadows.

Brought together by his illness
There was no use trying to dispute these visions — they were real people to him, and so we talked to them, as he did. On one occasion, our carer even laid the dinner table for the three make-believe women who seemed to keep him constant company.

Brought together by his illness, we spent the last four Christmases as a family for the first time since the Seventies. In the old days we used to spend them with Joan Collins.

At our first reunion, the cast list was the carer, the doctor, Polly and 12 firemen from the local fire station. They were there to cope with a fridge that had exploded after Doug — who had lost his sense of smell — failed to notice it had been leaking highly flammable ammonia.

And for the first time ever, I had managed to persuade Doug to come to the supermarket with me. He had never been a New Man. If there was no one to make a cup of tea for him, he threatened to leave home. In the old days, he had always overseen the festivities, on the principle that I would never get it right, and so he gladly rifled the supermarket shelves of poinsettias and mince pies, and was in a great mood.
We kept up the outings almost to the end. He sat in a seat of honour when Michael Parkinson was taping one of his last shows featuring Michael Caine and Tony Bennett. ‘None of us would know each other without Doug,’ Parky said. ‘He introduced us and we are all wearing his suits.’

I don’t think Doug cried, but I did. By then, he could rarely find the right words, despite knowing exactly what he wanted to say. Sometimes he even talked about his business. ‘Oh, I can’t say it,’ he would flounder in despair. Then I would voice what I thought were his sentiments. When I got it wrong, he was ferocious, but when I got it right, his relief was obvious.
Coming to terms with his disease
It even seemed to me that he came to terms with his disease after he bonded with a Nigerian part-time carer who told him: ‘We say in our village you must love every stage of life because even old age and illness has its compensations.’ You never know where help is going to come from.
This time last year, my daughter got married and Doug was in church with all the other guests. Then, on New Year’s Eve, which would have been our 38th wedding anniversary, I asked him out to a champagne dinner. Doug only ever did what he wanted, so when he accepted enthusiastically, it showed how far our relationship had come. In February, he started failing and finally had to go into care.

We decorated his room exactly like the one at home, and then I went away for a short Easter break confident he did not know anyone any more and had no idea of his whereabouts. Wrong. When I came back he was sitting in his chair with a tartan rug from his shop over his knees. ‘Where have you been, then?’ he said. It wasn’t so much an accusation as an acknowledgement.

He died three weeks later. But I could not have anticipated what happened next. ‘You take his ashes, Mum,’ my daughter said. ‘He’d like that.’

I put them on the piano he gave me in the old days. Then our musical tastes had differed wildly — he liked Thirties ballads, I liked Janis Joplin. This time I played him Rodgers and Hart’s 1935 love song with its wonderful refrain: ‘I know it’s over and yet... it’s easy to remember, but so hard to forget.’

3-year-old Payton Thornton finds hope in experimental stem cell transplant for rare skin disorder

By Brett Buckner
Staff Writer
12-07-2008

WHITE PLAINS — Payton Thornton wants what every 3-year-old boy wants — to play tee-ball and wear flip-flops in the summer, to have a puppy like the one in Old Yeller and be able to wrestle with his big brother.

But because of a disease with a big name, Payton is denied those things.

It's called epidermolysis bullosa, or EB. It affects about 20 out of 1 million births, but the most severe form, recessive dystrophic EB, which is the kind Payton was born with, occurs about twice in 1 million births.

Payton's parents, Joy and Reid Thornton, don't pay attention to statistics.

"The numbers don't matter," Reid says, as Payton balances like a gymnast between his knees. "Payton's tough, tougher than most grown-ups I know."

Children born with EB are missing collagen VII, a protein that helps layers of skin stick together. Friction — from a hug to a fall — can cause blisters the size of water balloons. His toes are "mittened," fused together and the same thing could happen to his fingers.

The lining of his stomach is fragile as butterfly wings. Simply eating an Oreo cookie could rip his esophagus. Payton gets extra nutrition through his "special bellybutton" — a port in his stomach connected to a feeding tube.

"That's where my milk goes," he says, tapping on his stomach. "But I can't really taste it."

If nothing is done to help his skin heal, he will likely develop an aggressive form of skin cancer. Children with Payton's form of EB rarely live to see their 20th birthday.

And yet Payton doesn't do without much.

A few weeks ago, his grandfather bought him a green, kid-sized four-wheeler. Though it's slower than the red one his older brother, Parker, rides, it "goes fast enough," Payton says. And he'll prove it … in the living room.

"It goes like this," Payton says, stretching out his bandaged arms and gripping the imaginary handlebars with tiny pink fingers. "VRRRrrrrrroooommmmm!!!"

Watching him race across the linoleum making motorcycle noises, it's hard to feel sorry for Payton.

But there are just as many bad days — days of four-hour baths to clean bleeding sores and of 18-gauge needles used to pop his blisters, there are the medications he takes to fight infection and the gentle hands in latex gloves that change his bandages.

Though pain is all he's ever known, hope is a lesson Payton is starting to learn … perhaps sooner than anyone imagined.


Time to wait
It was well after midnight in early November 2007, when Joy read the story about a 2-year-old with EB named Nate Liao.

On Oct. 19, 2007, doctors at the University of Minnesota transplanted bone marrow and umbilical cord blood, both rich in stem cells, from his healthy brother through a catheter in Nate's chest and into his bloodstream.

Within months, the boy's body was producing collagen VII. His scabs and blisters started to heal. The bandages came off, and he was eating regular food.

The procedure was performed by Dr. John Wagner, head of the pediatric Blood and Bone Marrow Transplantation Program and director of the Stem Cell Institute at the University of Minnesota.

Joy wanted her son to have the same transplant. So she began a yearlong siege of letters, e-mails and phone calls to Wagner's office. Last month, the family flew to the University of Minnesota where Payton was evaluated by the transplant team and accepted into the experimental program.

"When just looking at his body surface, Payton's case is obviously severe and worse than most I've seen," Wagner says via cell phone on his way to a convention in San Francisco. "But his overall health is good and strong."

For three days, the family toured the hospital and the bone marrow transplant wing. They saw the germ-free rooms where Payton will spend upward of six months because of the chemotherapy that will leave his body "profoundly immune suppressed," Wagner says.

But every room has a TV and a Wii game system, which impressed Payton almost as much as his first airplane ride.

Joy was overwhelmed to finally meet the doctor she'd read about and watched on Good Morning America talking about this miraculous new procedure to help kids with EB.

"It was amazing, just to hear someone talking about a cure," she says. "When we talked to doctors before, no one ever gave us any real hope. Dr. Wagner changed all that."

For as much optimism as this treatment has created, it's important to remain cautious, says Geri Kelly-Mancuso, a nurse educator for the Dystrophic Epidermolysis Bullosa Research Association of America (DEBRA).

"I'm very leery of the word 'cure'," she says from her Cincinnati office. "If … there's a lot of ifs involved. If the procedure works for a specific subtype of EB with a specific mutation, it may not work for everyone with EB. But the good news comes in that the research is being done.

"Good news is rare for a disorder that disfigures and destroys so many lives."

During their visit, Payton underwent four biopsies to establish a baseline for his specific form of EB and to help find a cord blood donor.

But finding a donor wasn't going to be the hard part. The real fight was going to come from the insurance company, which was unlikely to cover such an experimental procedure. Wagner prepared the Thornton's for a lengthy process that he expected to last months if not years.

The transplant alone will cost $500,000.

"I knew, somehow, it would work itself out," Reid says. "We've been through too much to let money hold us back."

Three weeks later, on the day before Thanksgiving, Joy came home from dropping Parker off at school. As soon as she opened the door, the phone started ringing. On the other end was Karen Foster, transplant coordinator from Blue Cross/Blue Shield with incredible news.

Against all odds, they had been approved. Blue Cross/Blue Shield agreed to cover Payton's transplant.

"I was so excited and relieved," Joy says. "We were all speechless. Nobody saw it coming, and now it's all happening so fast."

Many more obstacles lay ahead, but finding an unrelated cord blood match for Payton won't be one. That will be "very quick," Wagner says, adding that it could take only a few weeks. But he doesn't want to rush.

"Could we go immediately to transplant with Payton? Yes, we could," he says. "We know we have good donors. We also know that Payton's in good condition — he's young and isn't malnourished as so many children with EB are. So I think we should delay for now; see what can be learned from the others who can't wait.

"Payton has time."

Wagner is quick to add that if for some reason Payton's health suddenly deteriorates, the transplant team is prepared.

"We're ready to go at any time," he says.

But this will never be a risk-free procedure. Wagner is honest about the real dangers lurking behind what so many are hailing as a miracle.

"There will be deaths," he says. "But the only reason parents see this as a real choice is because the disease itself is so bad. These kids can't have a normal life or a normal life expectancy.

"We know it can work. It just takes time … and funding."

That's the reality Joy and Reid continue to face. Before the actual transplant, Payton will have to make several trips back to Minnesota for more tests — with airfare alone costing upward of $2,000, which Joy and Reid have to pay "out of pocket" — not to mention the six or more months he'll have to live in isolation following chemo treatment.

But those are worries for another day. For now, they'll all go on living as normal a life as possible, which won't be a problem — at least for Payton.

Outside their house, where the open farmland seems to stretch on forever, Payton revs the engine of his four-wheeler. But he can only ride as fast as the rope in his father's grip will allow.

Trotting behind, ready to pull the motorcycle to a stop if Payton starts going too fast, Reid tries hard to keep up. But Payton never bothers looking back. He just grins and blinks against the cold breeze blowing in his face.

"He's really just like any other little boy," Joy says, laughing as Reid tries not to slip in the mud. "And that's all we want for him to be."

Mind the gap - UK goes unprotected says Barclays

Written by Barclays Bank
Monday, 01 December 2008

Despite the level of fear surrounding unemployment and debts in the current environment, research pubiished by Barclays Financial Planning shows a worrying trend of people not providing themselves and their families with a safety net.

Over half of people in the UK are worried about being able to maintain their outgoings within the next 12 months, pushing essential safety nets like income protection and critical illness cover to the bottom of their priorities. Results show, nearly half (47 per cent) of UK adults have no protection policies4 in place whatsoever to protect them and their families in the event of losing their income, health issues or even death.

The safety net gap:

· 52 per cent have no life insurance
· 75 per cent have no critical illness cover
· 78 per cent have no income protection cover

Those aged between 35 and 54 often have the most responsibilities in terms of dependants and outgoings, but showed a large gap in their protection cover, with 45 per cent having no life cover and 74 per cent with no income protection insurance.

Alison Tattersall, Head of Customer and Proposition at Barclays Financial Planning said: "When finances are tight it is often responsibilities like protection policies that fall to a lower priority, and of course these policies protect outcomes that people don't want to think about. But people must consider the financial consequences of what would happen if they were unable to work, or their dependants situation if they died, it would be far worse than any concerns they currently have over struggling to meet their outgoings.

"Our research indicates that a large number of people are without any protection at all, or that they don't realise they have any policies in force. Both are equally as worrying, especially the current climate."

When looking at what other safety nets people could be relying on, the research reveals that 60 per cent of people admit to having nothing saved, having less than one month's salary in the bank, or not knowing what they have in savings at all. Worryingly the report also reveals that nearly 40 per cent of people don't receive benefits such as sick pay, death in service or health insurance, or simply do not know if they would be entitled to them. Coupled with 81 per cent of people not knowing what they would receive in benefits from the state if they were too ill to work, it shows that many people haven't thought through their plan b.

Alison Tattersall continues: "This is a worrying trend. People need to know what their state and employee benefits are before they are able to plan their protection needs properly.

"Over half of people that do have protection policies said they did not take advice or did not know if they had taken advice when buying their cover, and over 70 per cent do not know or only have a rough idea what level of payout their policies would give them if a claim was made. This could clearly mean people end up without the right cover for their needs, which is often just as bad as having no protection at all. We urge people to seek professional advice and review the level of protection insurance they have to cover themselves or their family."

Medical Alert: All will feel the pain if hospitals lose substantial funding

Posted by Post-Standard Editorial Board November 28, 2008 5:02AM

Gov. David Paterson has laudably taken on the difficult but necessary task of cutting a state budget that is billions of dollars out of balance. But the size of his proposed cuts in Medicaid payments to hospitals could end up doing more harm than good.

The governor wants to cut more than $500 million in Medicaid in the 2008-09 budget alone, with more cuts predicted for the following budget year. Those cuts would take their toll on hospitals.

As the CEOs of Crouse, Community General, St. Joseph's and University hospitals pointed out at a Post-Standard editorial board meeting last week, hospitals serve as the primary medical safety net in the region. They are bound by the law to provide care for whomever comes through their doors -- and the numbers continue to climb as people lose jobs and health insurance and the local elderly population increases.


Patient volume already has increased 22 percent between 2003 and 2007 at the four hospitals, and the hospitals are feeling the strain. If things get much worse, one CEO said, he could foresee patients waiting up to 15 hours for care in the emergency rooms.

Yet hospitals are left to figure out how to absorb the growing numbers of patients -- a problem that can be traced back to the nation's inadequate health care delivery system -- while dealing with million-dollar cuts in their budgets. The four Syracuse hospitals stand to lose nearly $17 million over the next two years under Paterson's proposed cuts.

Hospital executives say they have managed to get by -- they don't have a choice -- but can't continue to operate with fewer funds and more patients.

New Yorkers who have health insurance may mistakenly believe that inadequate Medicaid reimbursements only affect low-income patients. But as one CEO explained, hospitals don't have "insured beds" and "Medicaid beds." They don't have a system that allows people with health insurance to skip the line in the emergency room. If an ER is backed up because it cannot handle all of the incoming patients, or the hospital doesn't have enough beds, insured patients will be just as affected as those without insurance. People who don't think so need only visit an emergency room.

The governor said that when it came to budget cuts, nothing was off the table. But the governor has consistently left one revenue-raiser off the table: He won't consider a millionaire's tax that would be temporarily placed on those with higher incomes -- as was done successfully under Gov. Pataki in 2003. The Assembly has passed such a measure, but it was rejected by the Senate.

Wealthy people would feel a pinch from such a tax. If a disproportionate share of the burden falls on hospitals, every New Yorker will eventually feel the pain.

She did it for love

Out of love for her then ailing husband, sales development manager Sheryl Fong gave him one of her kidneys four years ago.

Church pastor Kenneth Fong has since recovered.

The operation and hospitalisation fees for her alone cost more than $20,000. Because her insurance policy does not cover 'elective surgery', that had to be paid in cash.

Mrs Fong, 38, quit her sales manager job which paid her a comfortable salary of $7,000 a month so that she could take time to recuperate after the operation.

She remained jobless for four months before she found a new job as a sales development manager.

For six months after her operation, she had to go for monthly health check-ups at the hospital. Each check-up cost her more than $100, which she had to foot.

Today, she still has to go for annual blood and urine tests to ensure her single kidney is functioning well. The tests set her back by about $100 each time.

Despite the immense physical and financial sacrifices that she had made, Mrs Fong said that she has been more than compensated.

Mr Fong, 43, received a new lease of life and she got her life back, too. When he was ill, she used to have to nurse him day and night.

She finds it hard to imagine someone going through the same ordeal for a stranger.

'It will certainly help if the altruistic donor is reimbursed for surgery costs,' she said.

'It is not fair to the donor if after donating an organ, he still has to settle a huge debt for the surgery fees.'

She added: 'But the compensation should not be seen as a payment. There should be no price tag on the gift of life. It is priceless.'

Hughson couple's burden eases as husband gets a new job

By Eve Hightower
ehightower@modbee.com

Along with 1.4 million other Californians, Jerry King was out of work, applying for every job he could and looking for a break when The Modesto Bee wrote about him in September.

King finally got that break three weeks ago, when his old boss at Beck Properties called with a job offer for King and his wife, Debra.

"It's like a big, big rock was taken off of me," said King, a former home warranty representative.

King had been looking for a job for 17 months before his old boss called. As the unemployment numbers rose, he turned in hundreds of applications.

At the same time, his wife was recovering from cancer. Then she discovered another lump in her breast. With no health insurance, they sold their house to pay for medication. Meanwhile, the special medical aid she was getting was coming to an end.

Though faced with all of that, King had only good things to say about his former employer when interviewed for the story about his job search two months ago.

"They kept me as long as they could," he said then.

That loyalty and King's reputation as a hard worker won Mario Guerra's attention when he read the article in The Bee.

"There's only so much we can do in this economy. We can't help everyone, but I knew I could help them," said

Guerra, King's boss. "Jerry has always done a good job for us. So when this job came up, I thought of him."

Now Jerry and Debra King manage and maintain 592 storage units and moving trucks for B&R Self Storage in Stockton, which is owned by Beck Properties. The couple's new job comes with full health care benefits and a rent-free apartment.

"We're well taken care of. They're doing everything to make us feel comfortable," King said with a smile. "The bottom line is: Don't give up."

Guerra is glad to have King back.

"We go through life and just run across people and keep going. That article reminded me what a good guy Jerry is. We're all out there trying our best to find success. That's OK, but right now we need to take care of each other," he said.

Companies don't want to lose good people, he said. But their choices are limited in a bad economy. To stay alive, some companies have to lay off even their best employees. That doesn't mean they'll forget them.

"There's always a chance you'll be hired back after all this," Guerra said.

Debra King said it couldn't have happened at a better time.

"We never thought we'd be in such a bad situation. And Jerry was trying so hard to find work," she said. "There were times we didn't even have food. We had nothing."

Those times are behind them now, but the Kings realize they still would be in their Hughson mobile home fretting about medical bills had Guerra forgotten about his former employee.

"We got real lucky. A lot of good people are still out there feeling bad about not finding work," Jerry King said. "We just finally got a break. We're all looking for a break."

Bee staff writer Eve Hightower can be reached at ehightower@modbee.com or 578-2382.

Voters want solutions as health insurance costs rise sharply

By SUZANNE KING
Special to The Star

Working two jobs isn’t exactly the way Dave Coffman envisioned his retirement.

But that’s how it’s turning out.

“I’m working basically because of health care,” said Coffman, 62, a retired school principal who lives with his wife in Lee’s Summit.

Until they qualify for Medicare, they have to buy private coverage. For now, their insurance bills amount to around $1,000 a month — including long-term care insurance, dental insurance and a health plan that has a $2,500 deductible. If he weren’t working two part-time jobs, Coffman said, there would be no way he could afford it.

“I never once thought about health insurance before I retired,” Coffman said.

Now it’s never far from his mind.

Like many Americans, Coffman says that health care will be a top concern as he casts his ballot in November.

“I know that each of the parties has a (health care) plan, but definitely we need something to help provide insurance,” Coffman said.

Coffman doesn’t want to see socialized medicine, but he wants to see a government that forces health care providers to hold the line on costs and helps the people who can’t afford them pay their health care bills.

At a time when 45 million Americans lack health insurance, Coffman is hardly alone. Even people who are insured are paying more all the time. In the past four years, according to a report in the New England Journal of Medicine, insurance premiums have climbed 35 percent, to $4,400 for an individual policy and $12,000 for a family policy.

“When people say they’re worried about health care, they’re not worried about where they’re going to find a decent doctor or medical care — they’re worried about paying for it,” said John McDonald, senior state director for AARP Missouri.

Certainly health care is on the agenda of Democrat Barack Obama and Republican John McCain.

Both candidates want to see a system that provides more affordable coverage to more people. And both talk about the need to cut costs; to improve efficiencies, partly through the use of information technology; to promote preventive care; to reduce errors; and to rein in medical malpractice lawsuits.

But the candidates’ fundamental approaches are vastly different.

Under McCain’s plan, individuals, not employers, would carry the responsibility for choosing and paying for health care.

Obama wants to shore up the current employer-based system by mandating more coverage and providing more subsidies.

“It’s a choice between adjusting the financing mechanism or a system of mandates,” said Maggie Nelson, manager for federal government and industry relations with Cerner Corp., the North Kansas City-based health care information technology company.

The McCain plan

Experts agree that McCain’s proposal is the most radical.

The senator from Arizona proposes eliminating the current tax exemption for employer-paid health insurance premiums — meaning people with job-based coverage would pay income tax on the premiums their employers pay, which are tax-free today. In exchange, he would provide a $2,500 tax credit to individuals and a $5,000 tax credit to families to buy their own insurance.

McCain’s camp argues that the system would give consumers more control, allowing them to keep insurance as they move from job to job, for example, while at the same time making them more aware of the true cost of going to the doctor.

Patients to be given right to 'top up' NHS treatment by buying private drugs

By Tamara Cohen

Patients will be allowed to top up their Health Service treatment with drugs bought privately in a U-turn by the government, it was reported last night.

Alan Johnson, the Health Secretary, is said to be poised to relax the ban on patients paying for life-extending treatments while receiving NHS care.

Until now ministers have refused to allow individuals to combine NHS and private treatments saying such a move would undermine the ethos of the Health Service.


But Mr Johnson has been under pressure to reform the system after experts ruled it to be unsustainable.

A source told The Times that ministers hope an independent review of the issue next month will help to make the case for change.

‘Whatever is recommended won’t satisfy everyone. There is no magic bullet that resolves this very difficult issue’, a senior figure told the newspaper.

A Department of Health spokesman last night played down the reports, saying ministers had launched a review in July looking into the issue.

‘The review will report back in October. Ministers are looking into this but no decisions have been made’, she said.

It is understood there will be reforms made to the system under which local NHS committees decide which patients are exceptional cases, and can receive drugs not yet approved by NICE.

Professor Mike Richards, the national cancer director, is conducting the review into ‘co-payment’.

Mr Johnson agreed to reconsider the issue in June after a series of reports about patients who were refused NHS care after buying drugs for cancers of the kidney, bowel, lung, breast and multiple myeloma.

There was a public outcry over the death in March of Linda O”Boyle, a grandmother who was denied free NHS treatment after buying a drug to treat her bowel cancer.

If top-ups are allowed, these are likely to be capped, and patients may also have to pay for any associated costs incurred by the NHS such as treatment for side effects.

Any changes would be accompanied by measures to speed up the approval process for new drugs and make them cheaper, the source added.

The National Institute for Health and Clinical Excellence assesses the cost-effectiveness of new medicines and recommends whether they should be provided by the NHS in England and Wales.

Where it has turned down a drug, or has yet to make a decision, patients can appeal to their local NHS primary care trust to be treated as an exceptional case.

Those who favour top-ups argue that a postcode lottery already exists where patients in some areas are granted treatments that could extend their lives while others are not.

Earlier this month, the King’s Fund, a health policy think tank called for patients to be allowed to pay for top-up drugs to stop the creation of a black market in cancer drugs.

Professor Karol Sikora, a leading cancer specialist who supports top-ups, said: “This situation cannot go on, it’s against natural justice.’

But some doctors, MPs and the Royal College of Nursing argue allowing wealthier patients to purchase better care will lead to a two-tier system based on ability to pay rather than clinical need.

Professor Richards said that he was in discussions with patient groups NHS staff, pharmaceutical companies and the insurance industry over which patients would be willing to pay for extra care.

Push on for insurers to share autism costs

DOVER - Because of his severe autism, the cost of educating 5-year-old Jack Ursitti runs $100,000 a year. But unlike expenses with most medical conditions, the bills for treating him will be borne by Dover schools and the rural town's taxpayers - not his family's medical insurance.

Now, the nation's largest autism advocacy group, Autism Speaks, is planning a legislative push in 20 states, including Massachusetts, to require private insurance companies to pay a portion of the intensive, expensive educational treatments that many medical professionals say are a child's best chance to overcome, or just learn to cope with, profound and lifelong developmental and learning disabilities.

Similar laws have passed in the past several months in Arizona, Florida, Louisiana, and Pennsylvania requiring private insurers to pay toward a variety of therapies, including applied behavior analysis. That system, known as ABA, involves a weekly regimen of more than 30 hours of intense, often one-on-one, positive reinforcement techniques for teaching children how to speak, play, learn, and function in the world.

But private insurers are balking at the proposed requirement, especially coverage of the specialty ABA programs, which they say are relatively new and unproven, and not effective for all children. ABA teachers are not licensed in many states, and insurers contend that the therapy system is still too new to be regulated sufficiently.

Requiring insurers to pay for educating autistic children would "drive up costs for everyone," said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, an industry group representing 12 health plans operating in the Commonwealth.

Health insurers should not be dragged into the educational arena, particularly to pay for ABA classes, she added. "In a sense, it's asking for a blank check for therapies that we'd want more evidence to prove are really effective," Buyse said.

But parents of autistic children are determined to get their youngsters into programs that offer even a glimmer of hope. They also want to shift society's perceptions of autism.

"If my son couldn't hear and needed a cochlear implant, we wouldn't be asking the school system to take responsibility," said Jack's mother, Judith, coordinator of the New England lobbying effort for Autism Speaks. "As a society, we have to acknowledge that autism crosses a line from an educational issue to a medical one. Jack was diagnosed by a neurologist, not a schoolteacher."

Richard DeRoo of Reading, a software engineer whose 11-year-old son, Evan, has autism, said parents are desperate for more financial help.

Since his diagnosis at age 3, Evan has needed extensive behavior, speech, physical, and occupational therapy, his father said. The family paid for some of that care out-of pocket at a cost of $25 to $50 per hour.

Legal Things for peace of mind

Today the Zen Habits blog talks about five legal things for peace of mind and I want to talk about four of them.

First of all, get a will done. While you may not have to worry about it after you're passing do not put your family through having to figure out what to do with your stuff and money after you are gone.

My Uncle on my mother's side passed away only a few weeks before my father and the stress of dealing with my Uncle may have been something that pushed my father over the edge. My Uncle did not have a lot, a worthless piece of land near Kingman, Arizona which might have been worth something in a few years, a run down trailer and a $1000 car.

However, because he did not leave a will and he had no children, several members of the family fought over every little piece he had. It even came down to fighting over the genological records that my uncle had. In fact, several members of the family have not talked to each other since because of all the strife it created. Do a will!!

Next up is to have a living will. You never know what might happen and people need to know what to do. After my mother had a stroke a couple of years ago, I was left with making all the decisions about her health. She was suffering from Dementia so she could no longer make the decisions and never had a living will so once again the family started fighting. Everyone knew what was best and all seemed only to care about what was best for them, not for our mother. If she had made out a living will we would had known her wishes and carried them out.

Next up is to get the insurance you need so you do not have any worries if something happens. Even if you're renting your present office, home, or store make sure you are fully covered. Also, get Errors & Omissions insurance if you work in a business that is giving advice or doing services that people may be unhappy with the services no matter how hard you try and will try to sue.

Finally separate your business from your personal assets. Set up a corporation or a limited liability business entity to shield your personal assets incase of a fore mentioned lawsuit.

The most important thing is to get the proper legal advice in each of these areas so you do what is best for you.

Health Care’s New Entrepreneurs

Innovators are bringing consumer-oriented medicine to market, with promising results.

For seriously ill patients, American health care is second to none. Our commitment to innovation is unmatched; our researchers have won more Nobel Prizes for medicine than all other countries’ combined; our biotech and pharmaceutical industries, thanks partly to lavish federal funding for basic science research, are the envy of the developed world. So lopsided is the field that thousands of European scientists have relocated to companies in the U.S., where they have a better chance of transforming cutting-edge research into lifesaving new medicines.

But American health care is also much more confusing, impersonal, and expensive than it needs to be. Conflicting opinions from doctors and insurers often strand patients with complex diseases in a medical maze. Many primary-care physicians, frustrated with red tape and puny reimbursements, limit the number of Medicare and Medicaid patients whom they see, or they drop out of the profession altogether. Adding insult to injury, employers and employees face seemingly endless cost increases, with health-insurance premiums rising much faster than inflation or income.

Thankfully, entrepreneurs are finding ways to bring innovative, consumer-oriented health care to market—simplifying medical decisions, reinvigorating primary care, and lowering health-care costs. From health insurance to DNA-driven medicine, American health care is experiencing a revolution from below that promises to improve quality, lower costs, and empower people to control their own health care.

Today, we shop for cut-rate hotels on Travelocity, bargain for airfares on Priceline, and seek reliable information on everything from computers to flat-screen TVs at CNET. The same information explosion is occurring in health care. Dozens of websites, such as WebMD, Revolution Health, and eHealthInsurance, now offer consumers up-to-the-minute information on medical conditions, drugs, and insurance options, as well as basic quality information on doctors and hospitals. Internet-savvy patients can walk into their doctors’ offices knowing more about the latest treatments than their physicians do.

Critics counter that health care is more complicated than hotels. Without someone to help manage complex information, they point out, patients may find themselves overwhelmed by options, fall prey to snake-oil salesmen, or fail to see that they have received incorrect diagnoses or poor treatment plans. But where critics see a problem, entrepreneurs see an opportunity. Companies are finding ways to make even the most complicated medical decisions simpler for patients.

Take the Boston-based firm Best Doctors, founded in 1989 by Harvard Medical School professors. Best Doctors uses peer evaluations of physicians—polling 50,000 doctors worldwide in 400 medical specialties—to identify leading medical experts and then makes them available to 10 million patients in 30 countries. Normally, insurance companies limit patients’ access to specialists by requiring prior authorization for referrals, limiting access to preferred networks, or asking patients to pay more out of pocket. Patients whose employers offer Best Doctors, on the other hand, can go directly to the firm without prior authorization whenever they have serious medical problems and need help making decisions.

One such patient is John de Beck, a California teacher diagnosed with prostate cancer. De Beck faced a dizzying array of options, from cutting-edge robotic surgery to more traditional surgical, hormone, and radiation treatments. Since his employer had contracted with Best Doctors, John immediately had access to a “handler” who got John’s permission to send his medical records—including original biopsy slides and CT scans—to a Best Doctors clinical team. The team wrote a synopsis of John’s case and sent it to a leading Harvard expert on prostate cancer. Within a few weeks, John and his doctor got a binder from the expert that examined and explained his treatment options and made a personal recommendation for him.

Over the next year, John consulted with Best Doctors every time he needed to make a key decision about his treatment—for example, getting another opinion from a University of Chicago expert about a new type of radiation treatment, proton therapy. The depth of the reviews—and the fact that they came from leading experts who had no stake in his case—proved invaluable. “I can’t imagine, with the income that I’ve got, to be able to even find . . . somebody to personally review my case and write a personal diagnosis,” de Beck says.

“We trust patients to self-select,” Best Doctors president Evan Falchuk explains. “When they feel uncertain about something, they have the most interest in making sure things go right.” Falchuk hopes that Best Doctors is part of a growing trend toward more consumerism in health care—even in single-payer systems like Canada’s. “Even government-run systems are suffering from the same cost trends we are,” he says. Consequently, they are searching for ways to share costs with people, “and as the financial burdens fall more on individuals, those individuals want control.”

Marcus Welby, M.D. last aired on ABC in 1976. Fast-forward 30 years or so, and think about the prime-time doctor dramas that have replaced it: ER, Grey’s Anatomy, House, Scrubs, and Nip/Tuck. The folksy primary-care doctor familiar to patients a generation ago has all but vanished from America’s primary cultural medium, television—and this reflects his real-life decline. Insurance reimbursements, and especially Medicare, may pay primary-care physicians only a small fraction of the actual costs of treating patients, especially after one takes into account rising demands on doctors’ time and dramatically increased administrative overhead. Consequently, many doctors are retiring or avoiding primary care. In reality, as on television, hospital emergency rooms and expensive specialists are replacing them.

Personal relationships between primary-care doctors and patients foster long-term health and keep health-care costs in check, so this is an unwelcome development. And it could hardly come at a worse time. The need for primary care will rise rapidly in the years ahead as tens of millions of aging baby boomers develop serious chronic ailments ranging from heart disease to diabetes to cancer. The nation’s over-65 population will double by 2030; the American Academy of Family Physicians, however, reports that from 1997 to 2005, the number of med-school graduates entering primary-care residencies dropped 50 percent.

Policymakers compound the problem by advocating universal insurance schemes that would inject millions more patients into the system without fixing any of its underlying problems. In July 2007, the Wall Street Journal reported that many Massachusetts residents were having trouble finding primary-care providers, even as the state embraced a universal insurance mandate that could thrust 550,000 previously uninsured residents into overcrowded doctors’ offices. The Massachusetts Medical Society found that for new patients, the average wait to see an internist was up 57 percent since the previous year, to more than seven weeks.

Primary-care doctors’ woes are severe in the rest of the country, too. “Most physicians out there are in networks, meaning that they accept insurance and are held to the reimbursement schedules currently available to them,” says Kevin Kelleher, a Virginia doctor. And insurance rewards procedures—tests and surgeries—much more handsomely than it does working with patients on the prevention and management of chronic disease. The result: as reimbursements have flatlined or even declined, the traditional family practice has evolved into a high-volume, prebooked business in which physicians have just a few minutes to spend with each patient. “Double booking has become extremely common in the last six or eight years,” Kelleher observes. “Doctors don’t have any quality time to spend with their patients. . . . They’re lucky if they can address a current pressing health issue, let alone discuss prevention.”

Instead of waiting for the system to change, some physicians are changing the system. In 2004, in Reston, Virginia, Kelleher and Mark Vasiliadis founded Executive Healthcare Services, where clients receive a full range of preventive, primary-care, and acute treatments for a flat monthly fee of $150 to $450, depending on the size of their families. There are no contracts; if EHS clients don’t feel that they’re getting value for their money, they can leave. Kelleher says that EHS’s patient-retention rate is about 98 percent.

This out-of-pocket payment model counters some of the system’s perverse incentives. “We can very frequently just discuss problems on the phone with patients, since 90 percent of the diagnosis traditionally comes from their history,” Kelleher points out. “If someone calls with elbow pain, I can spend 15 minutes on the phone with them. I don’t have a financial impetus to get them into my office.”

Comparatively high prices allow EHS to operate with just 300 patients or so, a stark contrast with the 2,500 patients whom the average primary-care doctor must serve in order to turn a profit after low insurance reimbursements. EHS’s enviable scale won’t work nationwide, Kelleher admits, but he thinks that components of his program could be modified to accommodate larger practices and lower prices. For instance, patients could bolster their current insurance reimbursements with a flat monthly fee—maybe as little as $20—and in exchange receive enhanced primary-care access (longer appointments, say) from doctors with somewhat smaller practices.

Further, filing claims with insurance companies is so time-consuming and expensive that doctors could lower prices—perhaps by 20 to 30 percent or more—simply by offering more basic services on a cash basis. Primary-care physicians in this type of system would likely see fewer patients every day but could offer them more time and attention. Some observers have derisively called this “concierge medicine.” But it would be more accurate to say that Kelleher and his colleagues have embraced a primary-care model that puts the doctor-patient relationship first—where it used to be.

This model seems to be gaining traction with frustrated patients and doctors. Last October, one West Virginia doctor made national news when the Wall Street Journal chronicled his prepaid primary-care plan. Vic Wood offers the 100 or so patients in his plan unlimited primary and urgent care, basic diagnostic tests, and many generic drugs for a monthly fee ranging from $83 for an individual to $125 for a family.

One patient is a private music teacher who, before joining Wood’s plan, had gone without health insurance for four years because his wife’s health insurance would have cost him $400 a month. Wood diagnosed him with high cholesterol and is treating him, with excellent results. A local business started offering Wood’s clinic as a benefit, switched to a major medical plan with a high deductible, and saw its monthly premiums drop by $4,000. The firm’s health insurer lowered its rates the following year, noting that workers “required less time in the hospital and used Dr. Wood’s clinic for nearly all of their primary care,” reported the Journal.

Wood’s clinic isn’t without its detractors, particularly among insurance companies that see prepaid physician plans as competition. But it hasn’t deterred him. “I’ll sign up one patient at a time if I have to,” Wood told the Journal. “I can’t see my practice surviving for the next 10 years without this model.”

Henry Ford didn’t invent the automobile. He just found a way to mass-produce it, allowing him to sell an affordable, reliable form of transportation to middle-class Americans. Can twenty-first-century entrepreneurs do the same for health care, which seems defined by expensive, labor-intensive services? In a word, yes—by “unbundling” inexpensive services from expensive settings like hospitals and by moving from a reactive medical model that treats already sick patients (very expensive) to a predictive, personalized model that monitors patients for disease predispositions and keeps them healthy (far cheaper).

Wal-Mart, for all the fire that labor activists direct at it, is quickly becoming the Henry Ford of health care. It took a bold stride into health-care markets in 2006, rolling out a Florida pilot program offering dozens of generic drugs at just $4 for a month’s supply. The program quickly spread to other states and added many new generics, including medicines for glaucoma, attention deficit disorder, fungal infections, and acne. As of May 2008, Wal-Mart estimates, the program has saved consumers over $1 billion in prescription drug costs. Competitors like Target and Kroger have rushed to match its offerings.

Another low-price, low-tech step toward shrinking health-care costs is the emergence of convenient-care clinics like RediClinic and MinuteClinic, which are housed in larger retail stores like Wal-Mart, Target, and CVS. The first convenient-care clinic, QuickMedx (later renamed MinuteClinic), opened in Minneapolis–Saint Paul in 2000 after its founder, Rick Krieger, couldn’t find a doctor on short notice to administer a strep-throat test to his son. Wasn’t there a better way, he wondered, to get fast, convenient care for simple illnesses? “We are not talking about diabetes, cancer, or heart disease,” he told Harvard Business School researchers in 2002. “We are talking about colds, throat and ear infections.”

The convenient-care clinics all use a similar model: offer a list of simple, low-cost health-care services for the consumer who can’t see his regular physician or doesn’t have one. The clinics keep prices down by offering care from a skilled nurse practitioner under the oversight of a licensed physician. Instead of skipping care or going to an emergency room, patients strapped for time or money can just head for a local store. As of November 2007, some 800 convenient-care clinics were operating across the U.S., up from 62 in 2006, with hundreds more planned.

Despite their popularity with consumers, the clinics have met with opposition from some state medical societies and groups within the American Medical Association that feel that the clinics fragment health care by preventing patients from developing long-term relationships with primary-care physicians. Web Golinkin, RediClinic’s chief executive officer, believes that these concerns are greatly exaggerated. “The reality is that care is already fragmented,” he says. Further, millions of Americans don’t have primary-care physicians or have trouble accessing them, and millions more lack insurance; convenient-care clinics may not address all these patients’ needs, but they can at least get them routine care and provide an entry point into the broader health-care system. “We see a lot of patients who are outside of our scope of practice,” Golinkin acknowledges, “but we refer them back to their primary-care physicians if they have one and help them find one if they don’t.” He objects to the idea that patients must seek an expensive consultation for every medical condition: “Spending $200 or $250 to treat a consumer’s strep throat is not a sustainable model.”

Convenient-care clinics show a lot of promise, but state regulations that prohibit them outright or make it difficult for them to operate effectively are holding them back. “Probably the biggest hurdles are regulations of physician oversight of nurse practitioners,” says Golinkin. Most states require such supervision, but some take the principle to an extreme by requiring doctors to be on site at the clinics or by severely limiting the number of nurses they can manage at one time. These regulations drive up clinic costs, making them unprofitable.

Other states strictly regulate who can own and operate the facilities. According to the California HealthCare Foundation, California laws “require ownership by local physicians who operate the health care facility”; as a result, the CHCF notes, “there are very few clinic operators or clinics in California,” though MinuteClinic is trying to gain a foothold there. And even in California, promising early evidence suggests that convenient-care clinics, despite their scarcity, are changing the economics of basic health care. In May 2007, the Los Angeles Times reported that the state’s largest physicians’ association, HealthCare Partners Medical Group (with more than 500,000 patients), started posting prices—at a substantial markdown—for many common procedures, in a direct concession to competitive pressure from convenient-care clinics.

The really exciting strategies for controlling health-care costs are genetic technologies that will identify the tiny differences in DNA that make some people susceptible to various diseases, from diabetes to Alzheimer’s. Myriad Genetics reports $100 million in revenue for a test that has told 150,000 female customers whether they carry the BRCA gene, which puts them at increased risk of developing breast or ovarian cancer. Another company, Navigenics, offers a $2,500 test called Health Compass that screens consumers for 20 conditions, including diabetes, prostate cancer, and obesity. “In five years, we will have a very large number of these gene tests,” Kari Stefansson, who leads the biotech firm deCode Genetics, told Forbes, “and they will be frequently used, at least by an educated portion of the population who will want to know.”

Over the next 10 to 15 years, moreover, technology will offer Americans customized health-care solutions tailored to their individual genetic profiles—individualized regimens of exercise, diet, and drugs to ward off diseases far earlier and more effectively than is possible today. One small company that exemplifies the trends in personalized medicine is Genomas, which is exploring pharmacogenomics, or how drugs interact with people’s genes to produce different reactions. Many patients taking common drugs—statins for high cholesterol, for instance, or antipsychotics for mental illness—have adverse reactions that lead them to switch medicines repeatedly or to stop taking them altogether. These actions can lead to more expensive health complications, like heart attacks. Some experts estimate that about 2 million serious adverse drug reactions may occur every year, producing 100,000 deaths and billions of dollars in excess health-care costs. Genomas’s technology, which it calls PhyzioType, may help physicians and insurers predict common side effects and realize huge savings. (One study has found that effective genetic testing for a single blood-thinning drug, warfarin, could help patients avoid “85,000 serious bleeding events and 17,000 strokes annually,” reducing costs by $1.1 billion.)

The field remains in its infancy. Some voice concerns about the quality of the science linking newly discovered genes with complex conditions like heart disease or diabetes, and worry that fly-by-night companies will just hand patients test results without any counseling about what they mean. These concerns are legitimate but not insurmountable—and it’s easy to see how powerful market applications will emerge. Patients with a family history of chronic ailments like diabetes, heart disease, and cancer, for example, might gladly pay extra for an insurance package that included genetic counseling and guidance on which drugs were likely to offer the best outcomes and the least risk of dangerous side effects.

To unleash the full promise of these new technologies and business models, policymakers should deregulate the market for medical products and services while liberating consumer demand. Congress should give individuals the same tax deduction for the purchase of health insurance that employers now have. Also, because each state currently requires any insurer doing business in that state to cover certain mandated services—driving up the cost of basic health insurance—we should create a national market for health insurance, perhaps through an optional federal charter (as now exists for banks) or through direct cross-border sales. This increase in individually owned insurance and real market competition would encourage companies to offer a broad mix of new health-care services and insurance products that cater to consumers’ real needs at prices they can afford. As the insurance environment became defined by individuals purchasing their own portable coverage, employers, unions, and hospitals would become trusted health-care intermediaries and help patients navigate the system.

In 2003, Congress enacted a moratorium on Medicare payments to physician-owned hospitals that has since expired, though opponents keep trying to resurrect it. It should stay dead, thus encouraging health professionals to explore new venues for patient care and create new bundles of health-care services. Doctors, convenient-care clinics, and specialty hospitals could then compete for customers in a wide variety of health-care settings. There isn’t one store for electronics, and there’s no reason that there should be one venue, or just a few, for health care.

Today, you don’t have to pick up a science-fiction novel to envision the future of health care. Convenient-care clinics already offer a wide range of basic health-care services at affordable prices; more services—perhaps including genetic testing—are sure to follow, with the results flowing back to a patient’s primary-care physician in an electronic health record that is reliable, secure, and easy to use. Doctors who are now overwhelmed and underpaid will opt out of insurance for most basic services in return for prepaid primary-care agreements that offer patients more convenience and better care at affordable prices. Waiting at a doctor’s office or an emergency room for basic care will decline, replaced by access to your primary-care physician through e-mail and even cell phone. Entrepreneurs will mine reams of information to help devise state-of-the-art patient-care regimens for complex diseases like cancer, helping patients in small Iowa towns get the quality of care currently available only at academic hospitals in Boston or New York. Patients will pay for many more basic services out of tax-exempt health savings accounts (HSAs), driving continuous competition and innovation. Finally, advances in genetics will enable doctors to match patients with treatment regimens that give them the best chance of avoiding unwanted side effects and maximizing good outcomes.

In short, from HSAs to DNA, we’ll be matching the right treatment to the right patient at the right price, and we’ll be restoring patients to the center of medical decisions—which is where they belong.

Paul Howard is the director of the Manhattan Institute’s Center for Medical Progress and the managing editor of its web-based journal, Medical Progress Today.

Bristol Compressors Opens Medical Clinic For Its Employees

By Debra McCown
Reporter / Bristol Herald Courier
Published: August 23, 2008

BRISTOL, Va. – In a trend some say is the return of the company doctor, Bristol Compressors cut the ribbon Friday on an employee health clinic. The clinic will provide more convenient medical services to employees while saving them and the company money, said Holly Bays, manager of employee benefits for Bristol Compressors.

Bays said it will enable employees to develop a doctor-patient relationship so they won’t avoid the doctor when they need care. An added plus is that they won’t have to take vacation time to see a doctor.
“Our employees are very, very, very excited about this,” she said.

Bristol Compressors is the first company in the Tri-Cities region to open an on-site clinic like this one, said Chris Brown, chief executive officer of Integra Health Management, the Charlotte, N.C.-based company that will operate it.

But, he said, companies around the nation are doing the same.

Five years ago, fewer than 5 percent of companies with more than 1,000 employees had built or studied the idea of building a clinic, he said. Now, the figure is between 30 percent and 40 percent, he said.
“It just hasn’t taken off here in the Tri-Cities area yet, but we hope it will,” he said.

Representatives of other area employers, including large companies like Food City and Alpha Natural Resources, attended the ribbon-cutting and asked questions.

Michael Ferracci, CEO of Appalachian Cast Products, said company clinics are likely to become a trend in this area.

“It has to, because health care ... it’s out of sight” said Ferracci, whose company employs about 130 people.

Bays said the clinic at Bristol Compressors will allow employees and their covered dependents – a total of about 2,400 people – to use the clinic for a $10 co-payment and receive a month’s supply of certain generic prescriptions for a $5 co-pay.

She said the hope is that by providing easy access to routine and preventive care, the company will reduce costly emergency room and urgent care visits.

All employees have access to health insurance through the company, she said, but some do not enroll. All of the company’s 1,029 employees, who earn an average wage of about $15 an hour, will be able to use the clinic, she said.

Human Resources Director Rick Nunley said in an era of skyrocketing health care costs, businesses no longer have the luxury of paying health insurance claims alone. They must take a longer term approach by investing in employee “wellness” and preventive care, he said.

“If you can have plans in place to address the issues of diabetes, hypertension and heart disease today, then you get to reduce your costs tomorrow,” he said.

The clinic opening is an encouraging sign for company employees, who have faced a many uncertainty in recent years after a series of layoffs drastically cut the company’s work force.

The company, whose future was up in the air until it was bought by KPS Capital Partners last year, remains one of Bristol’s largest employers.

Engineering Systems Administrator Charlotte Stewart said the idea for the on-site clinic came with the company’s new management.

“I think it’s a new concept to this area that a lot of us are unfamiliar with and looking forward to making it work,” Stewart said.

Dennis Stiltner, an engineering lab employee, likes the idea, too.

“It’ll save money for them and keep us a job, and save money for us, too, so it’s good all the way around,” he said.

Tinkerbell, Peter Pan, Cinderella & Alladin arrested in Disney Worker action

32 people including workers & some of the most notoriously sanitised & perfidiously evil warped stereotypes to have been implanted in the 20th century child's imagination were arrested in California on Friday "on a misdemeanor count of failure to obey a police officer and two traffic infractions." As we know Aladdin is a thief & it is no surprise LAPD finally cuffed him. But the others?

Ostensibly they had been taking part in continuing trade union action against Disneyland for contracted work, health benefits and so on - so forth.

There is no such thing as the average family, but if we believe that 2 hetrosexual adults with perfect teeth can spawn prepubescent replicas of themselves "one little son" and "one little daughter" than they pay $256 (= £137.29 or €174.21) for one day's admission.

Meanwhile the Disney corporation which shocked readers of Naomi Klein's "No Logo" for its excessive profits continue to rake in money. 2007/2008 Winter quarter profits were declared to hit a record high of $1.18 billion ( £632,840,000 or €802,996,000).

You would think one wish one a star which might come true is the hope that such a corporation could grant a contract. But the 2,300 approximate workers who are engaged in this struggle have worked since the end of January without contract. Disney also proposes permenantly denying health benefits to employees who work fewer than 30 hours or 5 days per week. The Trade Union representing the housekeepers, bellmen, bartenders, dishwashers, and cooks employed at the Disneyland, Grand Californian, and Paradise Pier hotels, says that free health insurance is really the only sweet thing about an otherwise bitter contract. Without a raise in the average hourly wage of $11.30 the Union says the workers of Disney will priced out of health potions & clean white teeth. They mightn't even afford diapers as the Americans call nappies for their spawn.

But beneath the dungeons of Disneyland California there is a lower level of acknowledged poverty. The minimum stage wage is set at $8.00 which allows a Disney worker to buy one healthy BigMac more per hour and pray the government of Schwarzenegger thinks to copy the UK and confiscate their fattened youth soon.

One In Five Young Men Screened For Prostate Cancer

A new study has shown that one in five American men in their 40’s underwent a prostate-specific antigen test (PSA) during the last year.

Published in the Sept. 15 issue of Cancer, the research highlights the difference in screening rates between young black males versus young white males.

Senior investigator Dr. Judd W. Moul from Duke University in Durham, North Carolina said, "Our findings for black men are discouraging. We've been encouraging black men to get screened at age 40 or 45 for more than a decade, yet only one-third of these high-risk men reported being tested."

In the case of prostrate cancer the blood levels of a protein called prostrate-specific antigen (PSA) usually rises. Doctors recommend a PSA screening by the age of 50 years for men though in the case of African American men or those with a family history of the disease, the American Cancer Society recommends prostrate cancer screening by the age of 45 years. The recommended testing age by the association drops to 40 years for men with two or more first-degree relatives with prostate cancer.

The study based on a 2002 survey of U.S. men in the age group of 40 plus, suggests that young black men are 2.4 times more likely to undergo a PSA test as compared to the white male, as were younger Hispanic males.The chances of having a PSA test increased with factors such as obesity, having a higher household income of $ 35,000 or more, and higher education level as well as health insurance cover and a relationship with a physician.

The rates of PSA screening for the last year were 22.5 % of men aged 40 to 49 and 53.7 % of older men though doctors feel black men should have more screening done as they are at a greater risk for prostrate cancer. The current rate of one out of three black men being screened was not good.

The study authors wrote, "Our study is the first to specifically examine PSA screening in younger men, which provides an important assessment of quality of care, especially for high-risk groups. Further investigation will be required to understand the impact of new risk-stratification strategies, with particular focus on the policy implications of potentially large increases in health-care resource use."

Obama, McCain take to airwaves to duel over Iraq, energy crisis

Barack Obama is vacationing in Hawaii, but he and Republican rival John McCain jockeyed yesterday on the airwaves.

Obama, giving the weekly Democratic radio address for the first time as party nominee, said that the past week gave "two stark examples of exactly what's wrong with Washington," a federal budget deficit that could reach nearly $500 billion last year, and a $79 billion surplus for the Iraqi government from windfall oil profits.

Obama said that McCain would continue President Bush's unfair tax policies by extending tax cuts for the wealthy, and would continue Bush's "open-ended commitment to the war in Iraq."

"Senator McCain talks about putting our country first, but he is running for a third term of the very same policies that have set our country back . . . I believe that we need to move in a new direction," Obama said.

McCain, in his own weekly radio address, again poked fun at Obama's reputation as a sterling orator - and suggests he lacks substance.

Noting that Obama burst onto the national stage at the 2004 Democratic convention and is expected to give "another celebrated performance" in Denver later this month, McCain said, "even the most stirring speeches are easily forgotten when they're short on content. Taking in my opponent's performances is a little like watching a big summer blockbuster, and an hour in, realizing that all the best scenes were in the trailer you saw last fall. In the way of running mates, Senator Obama should consider someone with a knack for brevity and directness, to balance the ticket."

McCain then faulted Obama for wanting to "forfeit" US military gains in Iraq, increase the size of government, and to raise taxes, but to not do enough to lessen the energy crisis.

"First there was his call for Americans to check their tires - which is common-sense advice, but hardly has the makings of a national energy strategy. If we can't drill our way out of the problem, it seems even more unlikely that we can inflate our way out of it."

"A serious energy plan involves a lot more yeses than nos," McCain argued, plugging his proposals for more offshore drilling, nuclear power, clean coal, and renewable sources.

FOON RHEE


Guaranteed healthcare is key plank for Democrats
PITTSBURGH - Democrats shaped a set of principles yesterday that commits the party to guaranteed healthcare for all, heading off a potentially divisive debate and edging the party closer to the position of Barack Obama's defeated rival, Hillary Rodham Clinton.

Obama, soon to be the Democratic nominee, has stopped short of proposing to mandate health coverage for all. He aims to achieve something close to universal coverage by making insurance more affordable and helping struggling families pay for it.

Advisers to Obama and Clinton both told the party's platform meeting they were happy with the compromise, adopted without opposition or without explanation as to how healthcare would be guaranteed.

In return for the guarantee, activists dropped a tougher platform amendment seeking a government-run, single-payer system and another amendment explicitly holding out Clinton's plan as the one to follow.

The party now declares itself "united behind a commitment that every American man, woman, and child be guaranteed to have affordable, comprehensive healthcare."

Under any system in play, most people would still put out money for health insurance as they do now, but they would get help when needed.

The 51-page platform draft showed the influence of Clinton's supporters not only in the extensive section on healthcare but in its assertions about the treatment of women. Some of her backers believed sexism dogged her campaign for the nomination.

An extensive section on women's rights is included and the votes she received in the primaries are described as "18 million cracks in the highest glass ceiling."

Democrats typically have a strong plank in favor of abortion rights; this year's version is stronger than usual. "The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman's right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right," it says.

Gone is the phrase from the past that abortions should be safe, legal and "rare."

The party also pledges to ensure access to adoption programs, prenatal and postnatal care, and income aid programs for expectant mothers.

The party also:

Promises "practical and humane immigration reform in the first year of the administration."

Favors restoration of the ban on assault-type weapons and other "reasonable regulation" that recognizes the constitutional right to own and use firearms.

Favors helping religious groups provide social services as long as "public funds are not used to proselytize or discriminate."