Democrat Ron Weiden and Republican Paul Ryan are pushing a plan to send the Medicare we know into a death spiral.  Medicare would become voucher system, with recipients receiving checks based on the premiums of the second-cheapest Medicare-HMO in an area.  Annual voucher increases would be limited to Gross National Product  growth plus one percent, far less than the historical growth rates of Medicare costs.  Medicare’s premiums would be higher than HMOs premiums, because Medicare would be forced to accept sicker, more expensive patients, who would not survive under HMOs managed care.  Medicare recipients would have to pay the difference between Medicare’s higher premiums and the vouchers based on the 2nd-cheapest-HMO plan, out of their own pockets, which would steadily drive healthier patients out of Medicare.  Medicare would fall into a death spiral of higher premiums, fewer, sicker patients, and less funding.  This plan was also promoted in the 2003 Medicare Modernization Act.  See http://tinyurl.com/7enm8eo .

New York Times, December 14, 2011

Lawmakers Offer Bipartisan Plan to Overhaul Medicare

By ROBERT PEAR

WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary.

The lawmakers aim to reshape the debate over the giant health insurance program by addressing concerns that have provoked fierce opposition to similar ideas in the past.

Just as important as the details of their proposal was the fact that the two were working together on an issue that both parties have exploited for political advantage.

In 2010, many Republicans won House seats — and the support of older voters — by arguing that President Obama’s health care law would damage Medicare. Democrats are hoping to retake the House by arguing that Mr. Ryan and other House Republicans are pushing for the privatization of Medicare, which they say could greatly increase costs for beneficiaries.

The new Wyden-Ryan proposal, by blurring the contrast between the parties on this issue, could make it more difficult for Democrats to win the argument.

The proposal would make major structural changes in Medicare and limit the government’s open-ended financial commitment to the program.

Under the proposal, known as premium support, Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.

Congress would establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide benefits of the same or greater value. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.

In addition, the growth of Medicare would be capped. In general, spending would not be allowed to increase more than the growth of the economy, plus one percentage point — a slower rate of increase than Medicare has historically experienced.

To stay under the limit, Congress could cut payments to providers and suppliers responsible for the overspending and could increase Medicare premiums for high-income beneficiaries, the lawmakers said.

The proposal is sure to come under fire from beneficiaries and Democratic lawmakers who see themselves as the pre-eminent defenders of Medicare.

For his part, Mr. Wyden said: “Medicare is the most important fiber in the social safety net. I would never do anything to shred it, weaken it or harm it in any way. Our proposal places traditional Medicare, long supported by progressives, alongside a menu of private alternatives that provide the choice and competition long supported by conservatives.”

Unlike the Ryan budget blueprint approved by the House in April, Mr. Ryan said, the new proposal would preserve the traditional fee-for-service Medicare program as an option for all beneficiaries. “Our proposal harnesses the power of competition to address the root cause of medical inflation,” said Mr. Ryan, the chairman of the House Budget Committee.

Democrats expressed concerns about the proposal based on policy and politics. A senior Democratic Congressional aide said, “This plan gives bipartisan political cover to Ryan and other Republicans against whom we have been waging a very successful political offensive.”

Short link to this post:  http://wp.me/p3xLR-sB

As Jack Rasmus explains below, four matters come before Congress in December that could raise all the Super Committee issues again, and lead to the same sort of fights as July’s battle over raising the debt ceiling: (1) continuing the 2% reduction in Social Security payroll tax another year, (2) extending unemployment insurance benefits, (3) another year’s ‘fix’ to the Alternative Minimum Tax, and (4) another delay in the 29% cut in doctors’ fees for serving Medicare patients. In addition, the Bush 2001 tax cuts to corporations and the rich are due to expire.

In the longer term, Rasmus shows below that Democrats continue to be more than willing to put Medicare and Medicaid on the chopping block, proposing $500 billion cuts over the next decade. (This is in addition to the $575 billion Medicare cuts already built into the Obama “Affordable Care Act”.)   Also see the November 25 NY Times article saying that following failure of the Super Committee, both Democrats and Republicans are calling for changing Medicare into a voucher system.

So yes, it is definitely a victory for us that members of the Super Committee were afraid to do the hatchet job that corporate and financial interests demanded. And yes, you do need to come to the San Francisco Federal Building at 7th & Mission Streets at 2 PM on Friday, December 2.

See a video with Jack Rasmus and others on the need to demonstrate December 2nd, and more about the action: http://tinyurl.com/84bau4d

“It’s the Tax Cuts, Stupid!
or:
Supercommittee Post-Mortems”

By Jack Rasmus
Copyright November 2011

The collapse of the Supercommittee’s effort to produce a joint package of recommendations for deficit reduction proves conclusively that for Republicans and their corporate allies that deficit reduction is, and always has been, a secondary objective. The primary objective is to protect and expand the Bush tax cuts.

From reports now leaking out it is apparent that Democrats on the Supercommittee had offered massive cuts to Medicare and Medicaid amounting to a minimum of $500 billion over the coming decade. Those cuts were in addition to the automatic $1.2 trillion automatic additional deficit cuts negotiated as part of last August’s Debt Ceiling Deal. That deal already had authorized $1 trillion in spending-only cuts. So the Democrats’ offer was the $1.2 trillion automatic deficit cuts-all spending about equally divided between defense and non-defense cuts-plus another $500 billion in Medicare-Medicaid matched by another roughly equal $500 billion in tax revenue increases.

The Republicans on the Supercommittee offered a different ‘mix’ of tax revenue and spending cuts. Their counter was $760 billion in Medicare-Medicaid cuts plus approximately $300 billion in tax revenue recovery. However, that tax revenue recovery was largely raised from increasing taxes on the middle class, by reducing the mortgage interest deduction and other middle class tax breaks. In addition, the Republicans required a further major tax break for the top personal income tax bracket and for the corporate income tax. Both currently are set at a 35% tax rate. Republicans proposed to reduce both to between 25%-28%. In other words, raise taxes on the middle class and give it to the rich and their corporations. And make seniors, retirees and the poor pay $760 billion in Medicare-Medicaid benefit cuts.

What these maneuvers by both parties shows is the following:

First, Republican’s top priority is shielding the Bush tax cuts. Those cuts cost the U.S. budget a minimum of $2.9 trillion last decade. Another $450 billion in extensions 2010-12. And a projected $2.2 to $2.7 trillion if extended for another decade. By proposing further tax cuts for the top income brackets and corporations, it is clear Republicans aren’t all that concerned about the deficit and debt in fact. They are focused on protecting and further cutting taxes for the rich and their corporations. What’s new in their position, revealed by the Supercommittee’s machinations, is that they now propose that not only seniors and the poor pay more for continuing (and expanding) those tax cuts, but that now the middle class will also have to pay for them with more tax hikes.
Second, it is clear the Democrats continue to be more than willing to put Medicare-Medicaid on the chopping block. They proposed $500 billion cuts last June, in the secret negotiations between Vice-President, Joe Biden, that broke down. They repeated that offer in July as President Obama offered the same as part of a ‘grand deal’ that also imploded. Obama subsequently offered up front $320 billion in Medicare-Medicaid cuts last September 19 as an enticement to get Republicans to agree to his $447 billion third recovery plan. And just a few weeks ago, the Democrats again proposed $500 billion. In other words, the Democrats have repeatedly offered massive cuts in Medicare-Medicaid. They will likely continue to do so in the coming months.

Third, the sticking point between the two is not whether Medicare-Medicaid will eventually be cut, but only when. Nor is the amount of these cuts really in question. It will be between $500 billion and $1 trillion when it happens-and it eventually will happen.

Fourth, the real bottleneck is the Bush tax cuts and Republican efforts to not only protect those cuts but extend them as well, even if now at the expense of the middle class.

What the breakdown of the Supercommittee’s efforts shows is that the Republicans calculated they would have a better chance at extending the $2.2 trillion Bush tax cuts for another decade by deferring the vote on their extension until next fall, 2012, in the midst of the final months of the 2012 election campaign.

Republicans no doubt looked beyond November 23 and see several legislative ‘choke points’ that will enable them to extract more spending cut concessions from the Democrats without having to give up on the Bush tax cuts. The first of such ‘choke points’ will come next month, in December 2011.

There are four major legislative bills that Democrats and Obama desperately want that will have to be decided by Congress before the end of 2011. The first has already been raised by Obama: continue the 2% payroll tax deduction for workers another year. That will cost another $112 billion to the budget and deficit this coming year. A second is an extension of unemployment benefits for millions of more workers, whose benefits run out at year end. That’s another $55 billion cost. The third is yet another year ‘fix’ to the Alternative Minimum Tax, AMT, which impacts the upper middle class who earn more than $150,000 a year. That’s another $70 billion cost. The fourth is also another delay in the 29% cut in doctors’ fees for serving medicare patients. That’s tens of billions more cost to part B medicare spending. We’re talking here about at least another $250 billion. If these bills are not passed, it will mean a major hit to GDP and the economy in the first quarter 2012, for an economy already extremely fragile and susceptible to a double dip early next year. In fact, the Federal Reserve now predicts the likelihood of a double dip occurring in the US economy early next year is now greater than 50%.

The Republicans will especially drive a hard bargain, and extract more than a ‘pound of legislative flesh’, in exchange for agreeing to pass the extension of unemployment benefits and the payroll tax cuts for another year. They will demand more spending-only cuts, likely to include Medicare-Medicaid, and also likely demand that the $450 billion in defense spending cuts mandated in the $1.2 trillion automatic deficit reduction are removed from the $1.2 trillion. Obama will be hard pressed not to agree to remove the defense spending cuts if he wants his payroll tax cut and unemployment benefits extensions passed before year end 2011. Obama and the Democrats will be desperate in an election year to have the unemployment benefits and payroll tax extended, as well as the AMT ‘fix’ which otherwise would impact the ‘independent voters’ heavily that he is courting heavily in the coming election. The Republicans know all this, and will push to extract cuts in spending at least equal to the $250 billion cost for these various measures coming up in December 2011.

Republicans may also get another opportunity in early 2012 to extract spending cuts without having to touch their Bush tax cuts. According to last August’s debt ceiling deal, that reduced spending by $1 trillion immediately and the $1.2 trillion additional automatic cuts that will now go into effect, there would be no further need to raise the debt ceiling until after the November 2012 elections. That was the trade-off for the $2.2 trillion in spending cuts that the Obama administration and Democrats in Congress agreed to: i.e. no more debt ceiling crises in exchange for the $2.2 trillion in spending-only cuts. But the debt ceiling issue may still re-emerge before the elections, and maybe even as early as this spring 2012.

As part of the August 2011 deal the U.S. Treasury is authorized to raise another $400 billion or so this spring and increase the debt ceiling by that amount. But it the economy retreats in early 2012, as many now increasingly predict, that will mean less federal tax revenues than originally projected and a larger budget deficit in 2012 than originally forecast. That might potentially reintroduce the need to raise the debt ceiling again in mid-2012 even more than projected last August. If this scenario unfolds, the Republicans will have yet another ‘bite at the apple’ of deficit cutting. That’s in addition to the four bills coming up next month costing $250 billion, for which Republicans will demand at least an equivalent spending cuts elsewhere to fund.

So look for the issue of cutting Medicare-Medicaid to continue to be on the negotiating table despite the Supercommittee’s recent breakdown. The Supercommittee may fade away, but not the fundamental issues behind it. Those issues are the continuing weak US economy and its impact on deficits, the intense commitment by the Republicans, corporations, and the wealthiest 1% to protect their Bush tax cuts ‘at all costs’, and the repeated willingness of Obama and the Democrats to offer up Medicare-Medicaid as a bargaining chip.

The Republicans are in the preferred bargaining position going forward. They will try to cash in on some of Democrats’ repeated offers to cut Medicare-Medicaid by $500 billion-first in exchange for agreeing to pass the $250 billion in bills in December and thereafter potentially in the spring should the debt ceiling issue raise its ugly head again.

As the November 2012 election grows nearer, Democrats’ resolve not to extend the Bush tax cuts another decade will also undoubtedly weaken. Republicans count on chipping away at Medicare-Medicaid and other spending over the coming year, while bidding their time for the best timing to extend the Bush tax cuts for another decade.

It’s no wonder, therefore, that the Republicans on the Supercommittee were more than willing to allow the Supercommittee to implode. They can protect their tax cuts better, and extract spending cuts more effectively, by going at it piecemeal over the coming year.

Jack Rasmus
November 22, 2011

Jack is the author of Epic Recession: Prelude to Global Depression, May 2010, and the forthcoming Obama’s Economy: Recovery for the Few, February 2012, both published by Pluto Press and Palgrave-Macmillan. He is also author of the just published 35pp. pamphlet, An Alternative Program for Economic Recovery, which can be purchased from his website: www.kyklosproductions.com. His blog is jackrasmus.com

short link to this post:  http://wp.me/p3xLR-ss

Capping and even cutting Medicaid and Medicare spending while allowing costs to rise to accommodate insurance, drug, and hospital profits means that government and its corporate partners are tossing away the notion of equal care for seniors, children, people with disabilities, and low-income workers.

New York Times, Thursday, August 18, 2011

Cuts in Health Care May Undermine Role in Labor Market

By REED ABELSON and KATIE THOMAS

Even during months of stubborn unemployment, the health care industry has provided a solid underpinning, reliably adding jobs in an otherwise dismal environment.

For example, hospitals, nursing homes and the like added about 430,000 jobs during the recession, as the country shed 7.5 million jobs. With the latest government reports showing a meager overall gain of 117,000 jobs in July, health care remained a significant contributor with an additional 31,000 jobs for the month, a tad higher than an average monthly addition of 25,000 health jobs in the last year. Hospitals, which had a slight decline in June, added 14,000 jobs in July.

While few experts can predict how the stock market’s gyrations and government cutbacks this month will affect the health industry, several health industry analysts warn that the sector is showing signs of economic sluggishness that has long kept other business sectors beleaguered.

The situation has led many in the health industry to caution that it cannot be relied upon to keep hiring workers. “It’s not realistic to believe that we’re going to continue to generate job growth when you’re speaking about Medicare and Medicaid reductions in the hundreds of billions of dollars over the next few years,” said Daniel Sisto, president of the Healthcare Association of New York, which represents the state’s hospitals and health systems.

Companies that rely on government spending have been bracing for deeper reductions, and President Obama recently alluded to another round of belt-tightening from one of the industry’s bedrock payers — Medicare.

Signs of a gloomier outlook have been surfacing in various spots, from a slowing in new construction plans to falling share prices of nursing home companies to announced layoffs among hospital support staff.“Nobody is sure what will happen,” said Alan M. Garber, a physician and health policy expert at Stanford. The cuts in government programs like Medicare and Medicaid, and pressure to reduce costs, are thwarting health care employers in trying to meet the rising demand for their services.

“The health care industry is facing greater uncertainty than in any time in memory,” Dr. Garber said.

Yet even though economists and other experts still predict increasing demand for health care as the population ages, with an accompanying demand for job growth, health care officials and executives cite a daunting cascade of recent events as reasons to reassess any expansions.

They point to Congress’ intent to reduce spending, economically depressed states struggling to deal with a rash of cuts in Medicaid programs and the continued uncertainty of financial costs that will be imposed by the federal health care law, including contradictory lower court decisions about the constitutionality of various provisions.

A survey by the Conference Board, a business research group, found that help-wanted ads for health care providers and technicians fell by 61,200 listings in July.

In Florida, for example, health care led the state in job gains during the recession — it was the only industry that did not lose jobs during that time. But since September of last year, the leisure and hospitality industry has been adding more jobs, according to a state economist.

The Palo Alto Medical Foundation, a large physician group in Northern California that employs 5,500 people, including 1,000 doctors, says it has no plans to add many more people in the near future. “Really our focus these days is to do more with the assets we have,” said Cecilia Montalvo, the vice president for strategic development for the medical group.

Hospitals also appear to be slowing the pace of building, as projects begun before the recession started are now being completed. The volume of tax-exempt debt for hospitals in the first half of the year has fallen by nearly half from a year ago, said David Johnson, a managing director at BMO Capital Markets. “We’re overinvested in hospitals and hospital beds,” he said.

The University of Michigan Health System, for example, is adding some 560 jobs as a result of new children’s and women’s hospitals it plans to open soon and an expansion of its emergency department. But Doug Strong, who heads the system’s hospitals, said his overall goal is to shrink his work force in future years as he tries to make the system more efficient.

While he expects the demand for health care services to rise, he believes he needs to deliver that care with fewer people at less cost. “I think that is what the nation is asking of all of us,” he said.

The impact of state cuts in Medicaid are already being felt in doctor’s offices, hospitals, nursing homes and home health agencies around the country. Hospitals experienced reductions in Medicaid reimbursement in 37 states for next year’s budgets, according to Lisa Goldstein, an analyst at Moody’s, who predicts further cuts.

At the Elliot Health System in Manchester, N.H., the seemingly abrupt decision by state lawmakers to sharply reduce hospital reimbursements led the hospital to recently lay off 182 people.

“For the last 10 years, we’ve been pretty stable and we’ve been able to grow,” said Elliot’s chief executive, Doug Dean. But faced with the loss of millions of dollars in Medicaid revenue that would wreak havoc on the coming hospital budget, Mr. Dean said he had no choice but to cut jobs. “It was simply because of the economics of Medicaid,” he said. Elliot is among a group of hospitals filing a lawsuit to stop the cuts.

Health care employers are also confronting cuts to the federal Medicare program. In July, nursing home operators learned their reimbursements would be cut by 11 percent in October, and hospitals expect further reductions in what they are paid under the new health care law as well as in future efforts to reduce the federal deficit.

Still, these continue to be boom times in many corners of the industry. Partners in Care, a New York nonprofit provider of home health care services, is hiring so many home health aides that it recently opened a second training center to handle the flood of new employees.

Its staff of aides has grown from close to 5,800 in 2006 to about 9,200 today. In June, the group, which is part of the Visiting Nurse Service of New York, hired 374 new people, the second-biggest month in its history.

Jay Conolly, vice president of human resources at Partners in Care, said his group is benefiting, not just from the growing elderly population, but also from the consolidation of nursing homes and hospitals in the New York area and a heightened interest in low-cost alternatives to inpatient care. The Bureau of Labor Statistics has predicted that jobs will grow faster in the home health care area than in any other section of the health care industry.

“There’s never been enough home health aides, and there never will be,” Mr. Conolly said.

And many expect that when the economy finally does rebound, hiring will, again, take off, especially when more people are expected to be insured under the federal health care law. Geraldine Bednash, chief executive of the American Association of Colleges of Nursing, expects there is pent-up demand for their services, especially for nurse practitioners and nurse midwives, who would work in primary care. “We are going to see this huge onslaught of need for nurses,” she said. “So we’re in a blip, that’s all.”

There are some who wonder whether the country should continue to rely on health care as a stalwart supplier of new jobs. If spending on health care continues at its current pace, it will choke out other vital sectors and end up hurting the rest of the economy, said Joshua Shapiro, chief United States economist at MFR Inc. “I think the path that we’re on now is clearly unsustainable,” he said.

Tom Torok contributed reporting.

Short link to this post:  http://wp.me/p3xLR-sm

On July 24, President Obama was twisting arms to get Congress to agree to huge debt reductions that would cripple Social Security, Medicare, and Medicaid.

Angry defenders of these programs responded by staging a noisy demonstration outside the Obama Campaign’s Oakland California headquarters, where a training session was under way to organize volunteers into the 2012 campaign machine.

We tried to get inside to speak to the volunteers and explain that 80% of the people say they don’t want our programs cut, and that corporations and the rich should be taxed to solve the debt.  During the standoff, we got many leaflets inside. You can read the leaflet here. After we went outside and began our demonstration, one volunteer came out and said we were right, that she’d tried to talk with the people inside, and she was disgusted that the Campaign was determined to go ahead with their agenda and wasn’t willing to listen to why our programs need to be saved.

Fighting to save Social Security has been much harder this year than in 2005 when Bush tried to privatize it. A big reason is that now the proposed cuts, which are much worse, are being pushed by a Democratic president, causing many to be reluctant to fight back. We need to get over this hesitation, not only in word, but also in deed. Today’s small demonstration was a start.

short link to this post:  http://wp.me/p3xLR-sc

I would like to present a resolution that was submitted to the American Public Health Association in response to the Obama Health Plan’s exclusion of undocumented immigrants.  In the year before the American Public Health Association (APHA) had its 2010 annual meeting on the theme of “Social Justice,” a massive health reform law had passed which totally excluded some 12 million undocumented immigrants. And while immigrants had been hoping for far-reaching reforms and a measure of long-delayed justice, harassment and deportation of undocumented immigrants had markedly increased.  In response, members of the Health-Not-War group at APHA proposed the following resolution to send an unequivocal message that this is intolerable to us as human beings and as public health workers.

Opposing the Exclusion of Undocumented Immigrants from Health Care Reform

November 5, 2010

The American Public Health Association,

Noting that this March, 2010, Congress passed and the President signed a massive Patient Protection and Affordable Care Act (PPACA), which not only leaves at least 23 million uninsured¹, but explicitly excludes ALL undocumented immigrants,¹ and,

Noting that the PPACA even forbids undocumented immigrants from using their own money to buy health insurance at discounted prices through the exchanges,² and,

Noting that, of all groups, undocumented immigrants have arguably the greatest need of having healthcare expanded to them because:

FIRST: Undocumented immigrants are twice as likely to be uninsured as documented immigrants,³ and,

SECOND: Undocumented immigrants are generally excluded from Medicaid and SCHIP by federal law, and state-funded exceptions to this pattern will become rarer as state budgets languish. Moreover, most undocumented immigrants must wait five years after gaining legal residency to apply for Medicaid and SCHIP.⁴

THIRD: Undocumented immigrants’ future access to healthcare will be more challenging because  (1) increasing raids⁵ and deportations⁶, Arizona’s SB 1070⁷, and the Secure Communities Initiative⁸ are likely to make undocumented immigrants more fearful of registering at health facilities and traveling to them, (2) State and County budget cuts are eliminating health services for  undocumented immigrants⁹, (3) Anti-immigrant groups are pressing jurisdictions to withdraw health services from undocumented immigrants¹⁰, and (4) Legislators are considering withdrawing citizenship from US-born children of undocumented immigrants, compromising their children’s access to healthcare as well as overturning a 150-year old constitutional right,¹¹ and,

FOURTH:  Many of the factors contributing to poor access to healthcare for immigrants in general are worse for undocumented immigrants, such as immigrants’ fears of presenting at health institutions, immigrants’ increasing unemployment rates combined with the higher cost of buying individual insurance, and health institutions’ fear of losing funding for treating immigrants.   Even among the insured, immigrants’ and their children’s access to ambulatory and emergency care is worse than that of citizens,¹² and,

FIFTH: Future funds for hospitalization of the uninsured, including undocumented immigrants, will be reduced, as PPACA reduces Medicare and Medicaid Disproportionate Share Hospital payments to hospitals serving the uninsured. Though these hospitals’ burden of uninsured will drop over time, PPACA specifies DSH payments must drop faster¹³, and Center for Medicare & Medicaid Services Chief Actuary estimated that the combined reductions at $64 billion over ten years.¹⁴

SIXTH: Reducing undocumented immigrants’ already poor access to healthcare is particularly dangerous and morally indefensible in light of their increased rates of injury, illness¹⁵, and death¹⁶ from hazardous  occupations¹⁷ and housing¹⁸, compounded with their vulnerability to deportation if they report dangerous conditions or seek treatment.

Noting that measures taken to deny healthcare to undocumented immigrants often result in citizens losing healthcare also, as exemplified by the 2004 cancellation of Colorado’s Presumptive (Medicaid) Eligibility program, which had allowed pregnant women to receive prenatal care while their Medicaid applications were being processed. The entire program was eliminated because about half of the women were found to be ineligible by immigration status. Citizen and immigrant women alike were put at risk, as well as their unborn children.¹⁹

Noting that  APHA has taken a clear positions against withholding medical care from undocumented immigrants in its resolution 2001-23, which “Urges the President and the Congress to oppose denial of eligibility for programs providing nutritional, prenatal, public health, medical care, and behavioral health benefits and services to any person residing in the United States on the basis of her or his immigration status”;²⁰  its resolution 9501, which “Opposes any mandates and initiatives that would limit access to public health interventions and health services for undocumented and documented immigrants and their children;”²¹ and its resolution LB04-07, which “Deplores and warns against measures curtailing, eliminating, or disrupting health care to undocumented immigrants.”²²

And finally, noting that the recent passage of this massive Health Reform law that explicitly and categorically excludes the grossly underserved undocumented immigrant population presents public health advocates with a grave challenge,

Therefore, the American Public Health Association

1.  Calls on the President, and Congress to end the exclusion of healthcare for undocumented immigrants from Health Reform, and

2.  Calls on the President and Congress to support health reform that provides equal, comprehensive, affordable, accessible healthcare for every person, regardless of their status of health, employment, income, or legalization,  and

3.  Calls on the President and Congress to assure that community health centers receiving $11 billion of dollars of federal aid over the next five years through the PPACA²³ continue to give undocumented immigrants comprehensive health care, and

4.  Encourages public health advocates to attend future events on immigration reform (public rallies, demonstrations, press conferences and the like) with the demand of comprehensive, affordable, accessible medical care for all immigrants, regardless of legalization status.

References:

1.  Kaiser Health News. Some Will Remain Uninsured After Reform. Available at: http://www.kaiserhealthnews.org/Stories/2010/March/24/Some-Will-Remain-Uninsured.aspx.   Accessed October 3, 2010.

2.  Lewin Group.  Patient Protection and Affordable Care Act (PPACA): Long Term Costs for Governments, Employers, Families and Providers.   Available at: http://www.lewin.com/content/publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.  p. 22.  Accessed October 3, 2010.

3.    Pew Hispanic Center.  Hispanics, Health Insurance and Health Care Access.   Available at: http://pewresearch.org/pubs/1356/hispanics-health-insurance-health-care-access.  Accessed October 3, 2010.

Working Immigrants.  Health uninsured rates among immigrants: far higher.  Available at: http://www.workingimmigrants.com/2009/08/health_uninsured_rates_among_i.html.  Accessed October 3, 2010.

4.   Kaiser Commission on Medicaid and the Uninsured,  Summary: Five Basic Facts on Immigrants and Their Health Care.   Available at: http://www.kff.org/medicaid/upload/7761.pdf.  Accessed October 3, 2010.

5.   Coalicion de Derechos Humanos.  Massive ICE sweep terrorizes Arizona communities following state passage of anti-immigrant profiling law.   Available at: http://www.derechoshumanosaz.net/index.php?option=com_content&task=view&id=166&Itemid=1.  Accessed October 3, 2010.

6.   Common Dreams.  Obama Administration Immigration Deportations Exceed Bush’s Record.   Available at: http://www.commondreams.org/print/56327.  Accessed October 3, 2010.

7.   Arizona Daily Star, National Physician Groups Condemn Arizona SB 1070.  Available at: http://azstarnet.com/news/blogs/health/article_ca3a8c46-62c6-11df-9a0a-001cc4c002e0.html.  Accessed November 3, 2010.

8.   San Francisco Immigrant Legal and Education Network.   San Francisco Immigrant Legal And Education Network Opposes The Implementation Of The Dangerous Secure Communities Program In San Francisco.   Available at: http://www.sfimmigrantnetwork.org/comments/sfilen_opposes_implementation_of_secure_communities_program_in_san_francisc, Accessed October 3, 2010.

9.   New York Times.  Reprieve Eases Medical Crisis for Illegal Immigrants.   Available at: http://www.nytimes.com/2010/01/06/us/06grady.html.  Accessed October 3, 2010.

Kaiser Daily Health Policy Report.  Economic Recession Forcing Local Health Departments To Reduce Services to Undocumented Immigrants.   Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57497.  Accessed October 3, 2010.

New York Times,   Immigrants Facing Deportation by U.S. Hospitals.   Available at: http://www.nytimes.com/2008/08/03/us/03deport.html?_r=1&hp=&pagewanted=all.  Accessed October 3, 2010.

10.   Washington Independent.   Anti-Immigration Activists See Opportunity in Health Care Debate.  Available at: http://washingtonindependent.com/55044/anti-immigration-activists-see-opportunity-in-health-care-debate.   Accessed October 3, 2010.

11.   Newsweek Magazine.  The Next Front on Immigration.   Available at: http://www.newsweek.com/2010/08/01/the-next-front-on-immigration.html.  Accessed October 3, 2010.

Politico.  John McCain backs citizenship hearings.  Available at: http://www.politico.com/news/stories/0810/40589.html.  Accessed October 3, 2010.

12.   Health Affairs.  Left Out: Immigrants’ Access to Health Care and Insurance January/February 2001.   Available at: http://www.projectshine.org/files/shared_images/Left_Out.pdf ,   Accessed October 20, 2010.

13.   The Hospital & Healthcare Association of Pennsylvania.  The Patient Protection and Affordable Care Act

(PPACA) of 2010 and the Health Care and Education Affordability Reconciliation Act (HCEARA) of 2010. Available at: http://www.haponline.org/downloads/HAP_Summary_2010_PPACA_HCEARA_April2010.pdf.  Accessed November 4, 2010.

14.  Centers for Medicare & Medicaid Services. Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended.  Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf.  Accessed November 4, 2010.

15.  Moure-Eraso R,  Friedman-Jimenez G.  (2004) Occupational health among Latino workers: a needs assessment and recommended interventions.  New Solutions. 14/4:319-47.  Available at: http://www.nap.edu/openbook.php?record_id=10641&page=129.  Accessed November 4, 2010.

16.   Richardson, S. Fatal work injuries among foreign-born Hispanic Workers. Monthly Labor Review, October, 2005.   Available at:  http://www.bls.gov/opub/mlr/2005/10/ressum.pdf.   Accessed on November 4, 2010.

17.   APHA Policy Statement 2005-4: Occupational Health and Safety Protections for Immigrant Workers.  December 14, 2005.  Especially see Richardson S, Ruser J, Suarez P. Hispanic Workers in the United States: An Analysis of Employment Distributions, Fatal Occupational Injuries, and Non-fatal Occupational Injuries and Illnesses in National Research Council: Safety is Seguridad. Washington, D.C., National Academies Press, 2003.  Available at: http://www.nap.edu/openbook.php?record_id=10641&page=48  and http://www.nap.edu/openbook.php?record_id=10641&page=57.  Accessed November 4, 2010.

18.   Robert Wood Johnson Foundation.  Living in America: Challenges Facing New Immigrants and Refugees.  Available at: www.rwjf.org/files/publications/other/Immigration_Report.pdf.  Accessed November 4, 2010.

19.   Wall Street Journal.   Prenatal Care Is Latest State Cut In Services for Illegal Immigrants.   Available at: http://www.uniset.ca/naty/maternity/wsj_imm_med.htm.  Accessed October 3, 2010.

20.   APHA Policy Statement 2001-23: Protection of the Health of Resident Immigrants in the United States.  Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=262.   Accessed October 3, 2010.

21.   APHA Policy Statement 9501: Opposition To Anti-Immigrant Statutes.   Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=96.   Accessed October3, 2010.

22.   APHA Policy Statement LB04-07: Responding to Threats to Health Care for Immigrants.  November 9, 2004.

23.   PPACA Health Care Reform Timeline.   Available at: http://stabenow.senate.gov/healthcare/Health_Care_Timeline.pdf.  Accessed October 3, 2010.

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]]> http://mlyon01.wordpress.com/2011/06/26/everybody-in-nobody-out-means-no-exclusion-of-undocumented-immigrants/feed/ 0 mlyon01 http://mlyon01.wordpress.com/2011/06/22/how-the-imposed-muni-contract-would-hurt-drivers-and-the-public/ http://mlyon01.wordpress.com/2011/06/22/how-the-imposed-muni-contract-would-hurt-drivers-and-the-public/#comments Wed, 22 Jun 2011 11:24:57 +0000 mlyon01 http://mlyon01.wordpress.com/?p=1724 ]]> Collective Bargaining:  According to Prop G, if drivers reject a contract, it goes to binding arbitration.

• Proposition G specifies the arbitrator must consider the good of the system but says nothing about the good of the drivers or the public.    For example, MUNI drivers rejected the recent contract by a 2-1 vote, yet within days the Arbitrator imposed the very same contract on the drivers.  This is negotiating with a gun at your back.

• Prop G is San Francisco’s version of Wisconsin, effectively eliminating collective bargaining.  Prop G was paid for by the same business interests that cause MUNI’s ongoing financial crisis by avoiding paying taxes or fees to support MUNI operations.

Part Timers: 7.5% of MUNI’s 2,200 full-time drivers can be replaced with part-time drivers.

• This would give MUNI the flexibility to cut 3,300 driving hours each week in mid-day, night, and weekend runs, while still supplying downtown business’s demand for peak-hour downtown corridor service. 80% of MUNI operations already serve downtown business’ interests, bringing in customers and workers.

• The loss of mid-day, night and weekend service would affect seniors, people with disabilities, school kids, and low-wage service workers.  Many are minority and immigrant.   Seniors, people with disabilities, and kids need this service to shop, go to doctor appointments, go to senior centers, and visit family and friends.  Workers in hotels and restaurants typically start or end work early in the morning or late in the evening.  They cannot afford taxis.

Health and Safety:

• Drivers would have no more say in how MUNI runs on health and safety issues.  Drivers would loose their right to protest overly stressful schedules on health and safety grounds, a right they had for 40 years.   This is in spite of years of world-recognized research by SF General doctors showing stress causes high blood pressure in MUNI drivers. Drivers could also no longer protest use of unsafe equipment.  This puts the public, especially seniors, in danger, particularly in cases of unreliable or grabby brakes, or malfunctioning chair lifts or fatigued drivers.  MUNI is trying to fire drivers who complain about unsafe equipment, showing MUNI’s determination to continue using it.

• Drivers would no longer have input into investigation of accidents. Instead of fixing unsafe schedules or equipment, MUNI can just blame the driver, and go on as before.  The decision of the management-appointed “Transit Safety Professional” cannot be appealed or reviewed, and drivers can be fired after a second accident judged preventable.

• Drivers could no longer take health or safety issues to an outside arbitrator.

Make Downtown Business Pay:

Despite MUNI’s decades-long financial crisis, downtown businesses pays nothing to MUNI for having their customers and workers brought to them.

• They pay no annual tax or fee to help support MUNI.

• Newly constructed commercial buildings are supposed to be charged a one-time Transit Impact Development Fee, but this fee is limited to downtown buildings, the fee has not been raised in years, it applies only to certain kinds of buildings, and there a frequent waivers.

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• The GOP’s justly-hated Ryan Plan puts states’ Medicaid programs on an ice floe, because it caps federal payments to states regardless of states’ needs (“block-granting”), and also gives states the rights to cut their Medicaid programs in defiance of federal standards of of who must be eligible and what services must be covered. 
• But Democrats have also attacked Medicaid, beginning with the Clinton administration, which granted states huge numbers of waivers to the federal requirements.  Now the Obama administration is shielding states that are cutting their Medicaid programs by saying Medicaid patients and doctors cannot sue states for reducing doctor payments, even if such cuts cause a reduction in the number of doctors serving Medicaid patients to the point where patients cannot access care.
• California has among the lowest Medicaid payments to doctors and pharmacies in the nation, and among lowest Medicaid doctor-to-patient ratios in the country.  Doctors, pharmacies, and patient advocates, including San Francisco and Sacramento Gray Panthers, sued California in response to Schwarzenegger’s 10% cuts to Medi-Cal.  Brown’s budget includes and additional 10% cut.  The suit has worked its way up to the Supreme Court, and it is this context that the Obama administration has submitted a brief saying states cannot be sued for cutting their Medicaid programs.
• Democrats and Republicans are unified in their determination to cut our programs.  Medicare and Medicaid were won in the in the streets in the 1960s, and that is where they must be defended now.

By Robert Pear

Civil Liberties under Attack

MayDay! MayDay! Civil Liberties Under Attack!
A SF Gray Panthers Program
Tuesday, May 17, 1 PM
Fireside Room, Unitarian Center
1187 Franklin Street (at Geary)

The extra-judicial killing of Osama Bin Laden has stimulated a flurry of right-wing radicals — Cheney for one — who now propose that torture be legalized. Congress is debating extension of the USA Patriot Act, for three years. The SF Gray Panthers will present a program on the Patriot Act and the Bill of Rights.

Hastily passed after 9/11, the USA Patriot Act is considered by many to be the greatest threat in decades to civil liberties and constitutionally-protected rights of free speech and protections against unwarranted searches and seizures. The Act was due to expire in February, but the Senate did not authorize renewal, so the Act was extended for debate until May 27.

The three most controversial sections of the Patriot Act are:

1) “Section 215,” allowing the government to seize records or “any tangible thing” from any person.

2) “Roving Wiretap” orders which do not have to specify the names or devices targeted.

3) a “Lone Wolf” provision which reduces legal protections for individuals alleged to be a threat.

SF Gray Panthers has opposed the USA Patriot Act from the beginning, hosting public informational meetings and participating in demonstrations against the Act. A list of Gray Panther articles on the Patriot Act is available at http://tinyurl.com/4yk7mdn .

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This is a perfect illustration of why the research, development, ownership and production of medicines must not be left in the hands of private businesses.  Drugs must be researched and produced according to our needs, not profit opportunities. Private companies must not be allowed to own patents on drugs. Despite spectacular advances in research techniques, companies’ profit-driven research has produced few significant advances.  It is virtually impossible to oversee private manufacture of medicines, and companies regard fines in response to tragic “accidents” as a cost of doing business.

Washington Post, Sunday, May 1, 2011

Shortages of key drugs endanger patients

By Rob Stein

Doctors, hospitals and federal regulators are struggling to cope with an unprecedented surge in drug shortages in the United States that is endangering cancer patients, heart attack victims, accident survivors and a host of other ill people.

A record 211 medications became scarce in 2010 — triple the number in 2006 — and at least 89 new shortages have been recorded through the end of March, putting the nation on track for far more scarcities.

The paucities are forcing some medical centers to ration drugs — including one urgently needed by leukemia patients — postpone surgeries and other care, and scramble for substitutes, often resorting to alternatives that may be less effective, have more side effects and boost the risk for overdoses and other sometimes-fatal errors.

“It’s a crisis,” said Erin R. Fox, manager of the drug information service at the University of Utah, who monitors drug shortages for the American Society of Health-System Pharmacists. “Patients are at risk.”

The causes vary from drug to drug, but experts cite a confluence of factors: Consolidation in the pharmaceutical industry has left only a few manufacturers for many older, less profitable products, meaning that when raw material runs short, equipment breaks down or government regulators crack down, the snags can quickly spiral into shortages.

“It seems like there were a lot of things happening with consolidations and quality issues and more things coming from overseas,” said Allen J. Vaida, executive director of the Institute for Safe Medicine Practices, a nonprofit group that helped organize a conference last fall to examine the issue. “It just reached a point where the number of shortages was slowly going up and up, and now we have a national crisis with this huge shortage of critical medications.”

While the dearth that has garnered the most public attention is — ironically — for a barbiturate that is hindering prisons trying to execute inmates, the scarcities are having a much broader impact on keeping people alive, especially in emergency rooms, oncology wards and intensive care units.

No one is systematically tracking the toll of the shortages, but reports are emerging of delayed treatments, anxious searches for desperately needed drugs, devastating injuries from mistakes and less-adequate drugs, and even possible deaths.

Federal regulators have been rushing to alleviate the shortages, sometimes helping firms resume production more quickly or approving emergency imports of supplies from overseas.

The Food and Drug Administration eased a shortage of the anesthetic propofol last year by allowing foreign importation, for example, and this year approved bringing in several other medications, including two cancer drugs.

“The types of products we’re seeing shortages of are really concerning,” said Valerie Jensen, who heads the FDA’s Drug Shortages Program. “This is affecting oncology drugs, critical-care drugs, emergency medicine drugs. We’re doing everything we can under our current authority to try to deal with this situation.”

In Congress, legislation has been introduced to address the problem. For example, a bill would require companies to notify the FDA in advance about anything that might cause a shortage and give the agency new powers to try to assuage them.

“We can’t put patients’ lives at risk simply because there’s some snafus in a process or a manufacturer decides it’s less profitable to make a certain drug,” said Sen. Amy Klobuchar (D-Minn.). “Patients deserve better than that.”

‘Very global supply chain’

Many of the shortages involve older, cheaper generic medications that are less profitable, causing many firms to stop producing them and leaving fewer sources. Most involve “sterile injectable” medications that are more complicated to produce and therefore are more prone to manufacturing problems.

In addition, drug companies increasingly rely on raw materials from other countries.

“We’ve certainly reached a very global supply chain for drug products, with the active ingredients typically made outside of the United States,” said Gordon Johnston, vice president for regulatory sciences at the Generic Pharmaceutical Association. “It could be Europe, India — some cases China. If there’s a problem at a facility in Italy or India, it leads to disruption of the drug supply in the United States.”

Some industry representatives blame part of the problem on increased oversight by the FDA, which has made drug safety a higher priority after coming under intense criticism for being too lax.

“As you know right now, FDA has taken a heightened approach towards drug safety,” said Maya Bermingham, senior assistant general counsel at the Pharmaceutical Research and Manufacturers of America. “FDA has stepped up inspections. The more you look, the more you may discover problems.”

While acknowledging that the industry needs to do a better job of coordination, some company officials said the agency should coordinate enforcement actions and drug shortage issues more closely to avoid administrative requirements that cause interruptions.

“We’re not sure how much of that is going on recently because we’ve seen more and more shortages in the industry. We think that maybe some of those coordination issues can be worked on,” said Joshua Gordon, vice president and general manager of specialty pharmaceuticals at Hospira, the largest producer of specialty generic sterile injectables.

Shortages of pre-loaded epinephrine syringes and propofol, for example, occurred when suppliers dropped out just as the FDA was demanding additional documentation, he said.

“They are very focused on taking quick and and aggressive action,” Gordon said. “We applaud the agency’s role in assuring quality, but it can slow things down significantly.”

FDA officials dispute that greater government oversight is a major factor, saying manufacturing problems were the cause of most shortages.

“There has not been a significant increase in domestic enforcement actions (seizure or injunction) for this class of products in recent years,” Jensen wrote in an e-mail.

‘Too many . . . will die’

Whatever the causes, many of the affected drugs are mainstays of medical care, such as the potent painkiller morphine, norepinephrine, which is commonly used in emergency rooms, and electrolytes, which are often given to patients in intensive care.

But shortages have been reported in many categories of drugs, including antibiotics, and drugs central to the treatment of many cancers, forcing oncologists to delay or alter carefully timed chemotherapy regimens.

“We have heard some horror stories where patients are really begging to get the drugs from other sources and where practices or institutions are forced to kind of triage patients and save the drugs for those — quote — most curable, where they have the best prognosis and using substitutes where there isn’t a cure possibility,” Michael Link, president-elect of the American Society of Clinical Oncology.

The drug cytarabine has caused the most concern and gotten the most attention because it is highly effective for treating several forms of leukemia and lymphoma but must be administered as quickly as possible, especially to patients with acute myeloid leukemia.

“With this drug they can be cured and without this drug too many of them will certainly die. That’s the simplest way to put it,” said Deborah Banker, vice president for research communication at the Leukemia & Lymphoma Society. “The disease progresses so rapidly that untreated patients can sadly die within days. There is no time for delay and no certainty of a good outcome if you can’t get a full dose.”

Many hospitals are running low, and some have run out completely. That has required many facilities to ration the drug, giving priority to those who need it most urgently.

“It’s so unbelievable,” said Mary Collins, 57, of La Crosse, Wis., whose husband, Michael, 66, had problems obtaining cytarabine to fight lymphoma. “A cancer diagnosis is a long, very, very stressful circumstance. And then to learn that a particular drug is no longer available to you and that there seems to be no formalized mechanism in place to correct it just makes it worse.”

Cytarabine’s scarcity was caused by hitches that two out of the three manufacturers hit in obtaining raw materials, as well as the discovery of crystals in some shipments.

The third manufacturer was unable to make up for the shortfall. Some of the problems have been resolved, however, and the FDA is working on importing the drug.

The shortages are forcing hospital pharmacists to juggle supplies and hunt for new sources. Many hospitals, including several contacted in the Washington area, say they are usually able to patch together solutions.

But some resort to paying inflated prices or buying from unfamiliar suppliers, increasing the risk they may be getting counterfeits.

“When it becomes clear that some drug may be in short supply or going into a shortage, what happens is sometimes there are unsavory folks — small distributors — who buy up whatever is left and sell it back at exorbitant prices,” said Roslyne Shulman, director of policy development for the American Hospital Association.

‘Panic in the pharmacy’

When shortages occur, physicians turn to less optimal alternatives or find out too late that the drug they need is unavailable. Mark Warner, president of the American Society of Anesthesiologists, described two calamities that occurred in the past year because of shortages. In one, a 16-year-old boy suffered brain damage because doctors did not have one muscle relaxer needed to treat a complication from jaw surgery.

In another, a middle-aged woman was left in a permanent vegetative state because doctors did not have the drug epinephrine after she experienced complications from heart surgery.

“These are tragic cases,” Warner said. “It’s one of those things most anesthesiologists in the country think about when they are driving to work every day. We don’t know where the shortages are and they come on very quickly. ”

Nurses and doctors responding to emergencies, meanwhile, are losing precious minutes when they must work with unfamiliar substitutes or recalculate dosages, increasing the chances of overdosing or under-dosing patients. One of the biggest problems is a shortage of syringes pre-filled with precisely measured doses.

“Grabbing the right medication out of a crash cart that’s already in a syringe is a big advantage over having to get out the syringe, get out the needle, get the medication and get the measurement right,” said Angela Gardner, an emergency medicine physician at the University of Texas Southwestern Medical Center in Dallas and immediate past president of the American College of Emergency Physicians. “Those minutes are lives.”

Many hospitals are recalibrating electronic medication delivery systems or preparing the correct doses ahead of time, especially for the emergency room, to minimize mistakes.

“We’ve been extremely fortunate using strategies in cooperation with our medical staff,” said Jay Barbaccia, head pharmacist at the Washington Hospital Center. “We’ve had a lot of panic and inconvenience but minimal, if any, impact on our ability to provide care. It makes my life miserable — the panic is in the pharmacy when we’re scrambling around to find alternatives.”

Nevertheless, a long list of errors and near-misses have been reported, including incidents in which patients required emergency care to save them.

At least two patients reportedly died from overdoses of hydromorphone they received because of a morphine shortage.

At least 19 patients were sickened and nine died in Alabama this year after being infused with a solution through their feeding tubes that was apparently contaminated with bacteria by a pharmacy using an unfamiliar ingredient because of a shortage.

The shortage occurred because the manufacturer had trouble getting the product’s packaging.

“It’s horrible. It’s something that shouldn’t have happened,” said Donald J. Mottern of Alabaster, Ala., whose 71-year-old mother was one of the victims. “We lost the matriarch of our family. The loss to our family has left each of us very hollow.”

© 2011 The Washington Post Company

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