Drug Companies Refuse to Produce Generic, Less-Profitable Anti-Cancer Drug, Leading to Recurrence of Lymphoma.

Drug Companies Refuse to Produce Generic, Less-Profitable Anti-Cancer Drug, Leading to Recurrence of Lymphoma. This is a particularly eloquent illustration of the deadly effects of production for profits, rather than production for our needs. It also illustrates how the capitalists’ ownership of intellectual property (drug patents, in this case) is as toxic as their ownership of the factories, farms, hospitals etc, where we have to work to earn the money to buy back what we make in these places of employment. Bear in mind that the government pays for 80% of the research on drugs which the pharmacy companies then get patents on.

SF Chronicle, Thursday, December 27, 2012

Drug shortage, cancer recurrence linked

A drug given to lymphoma patients as a substitute for a chemotherapy medication that is in short supply has been linked in a study to an early recurrence of the cancer, according to a report released Wednesday that provides the first actual evidence of patient harm caused by a national shortage of drugs.

The shortage specifically includes older, generic medications needed for a wide range of uses such as cancer, surgery and pain management, say authors of the report, which involved Stanford University School of Medicine and Lucile Packard Children’s Hospital in Palo Alto.

“These are drugs that have gone off patent a long time ago. They are drugs that are all generic and they are quite cheap, so there’s not much incentive for the manufacturers to make them,” said Dr. Michael Link, professor of pediatrics at Stanford’s School of Medicine and senior author of the report.

Drug shortages throughout the country have been attributed to various factors, including problems in production, difficulties in getting raw materials, federal recalls and enforcement actions, and corporate decisions to discontinue making certain medications for lack of profit or other reasons.

From 2006 to 2011, the number of pharmaceutical drugs considered in short supply by the U.S. Food and Drug Administration jumped from 70 to 250. Some reports show that the drug shortage rate has slowed, but some drugs that at one point came off the short-supply list are in short supply once again, and many drugs have consistently remained scarce.

Behind the report

Wednesday’s report, led by researchers at St. Jude Children’s Research Hospital in Memphis and published in the New England Journal of Medicine, looked at more than 200 children, teenagers and young adults who had been enrolled in an ongoing national clinical trial to treat intermediate or high-risk Hodgkin’s lymphoma. This type of cancer, which accounts for about 6 percent of childhood cancers, originates from white blood cells called lymphocytes.

The trial focused on tailoring radiation therapy for patients, but had to be modified when one of the drugs used in the trial – an injectable drug called mechlorethamine, also known as Mustargen or nitrogen mustard – became unavailable in 2009. The shortage, brought on when production was moved to a new plant, forced researchers to replace mechlorethamine with a decades-old chemotherapy drug called cyclophosphamide, or Cytoxan.

Because cyclophosphamide is used almost interchangeably with mechlorethamine, researchers were not expecting much of a difference in outcomes for the patients, but while none of the patients died, the percentage of patients who remained cancer free two years after treatment fell from 88 to 75 percent.

“We were totally blindsided by the results,” Link said.

Study results end trial

Those who relapsed had to receive additional intensive therapy, which is associated with higher odds for infertility and other health problems. Researchers stopped enrolling new patients in the trials once the negative results from the substitute became apparent. The drug shortage was resolved in early November.

Hospital administrators, pharmacists and doctors have routinely found alternative medications when a preferred drug became hard to come by. But Link said his fellow physicians have long suspected that patients were being harmed by these substitutions.

The national drug shortage prompted new federal legislation this summer that requires drug manufacturers to report production interruptions and gives the FDA authority to speed approval of applications for drugs in short supply.

Maria Serpa, senior pharmacist at Sutter Medical Center in Sacramento and former president of the California Society of Health-System Pharmacists who was not involved in the St. Jude study, wasn’t surprised that the results showed patients were being harmed by the inability to get certain drugs. She said she regularly sees shortages of various drugs such as those used in anesthesia and to control pain.

“I don’t think the list is getting any smaller,” Serpa said, referring to the FDA’s shortage list. “What’s frustrating is the re-emergence of some of the older shortages from two or three years ago. This just seems to keep coming back.”

More information

For more information about the drugs in short supply, visit the U.S. Food and Drug Administration’s website: http://www.fda.gov/drugs/drugsafety/drugshortages/default.htm.

Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com

Read more: http://www.sfgate.com/health/article/Drug-shortage-cancer-recurrence-linked-4147866.php#ixzz2GGqG9Qaf

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Healthcare Crisis: Not Enough Specialists For The Poor, but Calif to Cut Medi-Cal Spending

Healthcare Crisis: Not Enough Specialists For The Poor

LA Times, December 15, 2012

With months-long waits for Medi-Cal patients to see specialists, some turn to emergency rooms — exactly what healthcare reform is banking on avoiding.

By Anna Gorman, Los Angeles Times

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

PHOTOS: Waiting in vain to be seen

“I want to see again,” he said. “I’ve been waiting a long time.”

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation’s healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E.) Clinic, where Lawrence’s problem was diagnosed, with the hope that they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in reducing medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

The healthcare overhaul includes initiatives aimed at reducing shortages of general medicine professionals but does little to increase the availability of specialists.

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients’ conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients like Lawrence moved up on waiting lists.

“Where needs are absolutely critical, we are able to work out special arrangements,” said Rise Phillips, chief executive of T.H.E. Clinic. “That is not the norm. That is, rather, the exception.”

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

The challenge can be seen in Belinda De Leon’s cubicle in a small, windowless back corner of T.H.E. Clinic. A referral specialist, De Leon spends her days trying to speed up appointments for the center’s clients — and fielding calls from patients wanting to know how much longer they have to wait. At any given time, she’s juggling more than 1,000 pending referrals.

One involves uninsured housekeeper Juana Barrera. Barrera, 45, has been waiting since April 2011 to see a gastroenterologist and get a colonoscopy. She has had bleeding off and on and recently started having pain in her stomach.

On a recent visit, she told De Leon she is scared to wait any longer. But she can’t afford to pay for the test out of pocket. “I’m hoping it’s not anything like cancer,” she said.

De Leon promised to update Barrera’s referral paperwork to indicate she is experiencing pain. “Hopefully that will help,” she said.

Waits for specialist appointments vary dramatically, depending on the type of specialist needed. Patients willing and able to travel across L.A. County to specialty clinics may be able to see a doctor within a month or two. Others who lack transportation and must go to a nearby facility can wait up to a year for a dermatologist or neurologist and up to 18 months for a cardiologist or ophthalmologist.

The county is trying to make the system more efficient, reduce wait times and ensure that those who don’t need more advanced care don’t overburden the system, said Mitch Katz, head of the L.A. County Department of Health Services. County officials risk losing newly insured patients, along with government funding, if they can’t find ways to reduce the bottleneck.

One focus is using technology to improve communication and better screen patients. A pilot program, for example, is allowing primary care doctors at community and public clinics to quickly transmit patients’ medical information via computer to a public health specialist for a consultation.

The electronic consults are streamlining referrals and helping clinic doctors make better treatment choices, said Louise McCarthy, executive director of the Community Clinic Assn. of Los Angeles County.

During an August visit to T.H.E. Clinic, Lawrence saw nurse practitioner Sandeep Lehil for the first time. He told her he was controlling his diabetes with medication and a modified diet. But his vision wasn’t getting any better.

“My eyes are really bad,” he told Lehil. “I can barely see.”

Lawrence’s medical record showed that he wouldn’t be seeing an ophthalmologist for many months.

“That’s a long time to live with blurry vision,” Lehil said.

“By that time, I’ll be blind maybe,” Lawrence responded.

Lawrence, who has a soft voice, an accent and a lanky frame, arrived in the U.S. nearly 20 years ago to pick apples, and overstayed his visa. He can’t work or drive, and he relies on others to cook meals to avoid burning himself. His immigration status prevents him from getting health insurance or unemployment benefits. He lives with a friend, spending most days listening to a television he can barely see. When the phone rings, he lifts it almost to his nose to see who is calling.

In mid-October, Lawrence was back at the clinic and saw a different, fill-in doctor who knew nothing about his situation, nor when his surgery would be scheduled. “You haven’t received any notice?” asked physician David Hwang. “No, not yet,” Lawrence answered, adding that he checks his mailbox every day.

De Leon, the referral clerk, later gave Lawrence unwelcome news: The wait to see an ophthalmologist at the county’s Harbor-UCLA Medical Center was still about a year. She said she was trying to get him an appointment elsewhere sooner.

Weeks later, Lawrence took matters into his own hands. With the help of a friend, he took three buses to reach the emergency room at Los Angeles County/USC Medical Center northeast of downtown. He waited several hours but finally saw an emergency room physician, who managed to get him an appointment the next day with an eye doctor.

“You have to do what you have to do,” Lawrence said.

At the medical center’s specialty clinic, ophthalmologist Simon Bababeygy told Lawrence his cataracts probably were caused by his diabetes, high blood pressure and high cholesterol.

He described the surgery he would perform, on one eye at a time. And he spoke the words Lawrence had been waiting for: He should be seeing much more clearly by the end of the year.

Preparing for the surgery, doctors got an abnormal result on a heart test. Now, Lawrence has to wait to see a county cardiologist before going back to Bababeygy to schedule the eye operation. He has no idea how long that could take.

“Every time, it’s something else,” he said. “My eyes are getting worse. And now it’s my heart.”

anna.gorman@latimes.com

Times staff writer Anna Gorman reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.

Copyright © 2012, Los Angeles Times

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LA Times, December 13, 2012

Court Ruling Could Cut California Spending On Medi-Cal

A 9th Circuit appeals panel decides California can reduce its Medi-Cal reimbursements to doctors, pharmacies and others. Providers say the doctor shortage will worsen.

By Maura Dolan and Chris Megerian, Los Angeles Times

SAN FRANCISCO — In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.

Lynn S. Carman, an attorney for a group of pharmacies, said the decision would be costly for providers, worsen the doctor shortage and would be appealed.

“If this decision stands it will not only destroy the Medicaid program in California, but it will destroy the Obamacare program for millions of Americans who are now being shoved into the Medicaid program under the Affordable Care Act,” Carman said.

“They will not be able to obtain quality healthcare or access to services because providers cannot provide services at less than what it costs to furnish them,” Carman said.

The ruling could make it considerably easier for the state to close its budget gap.

The state is facing a $1.9-billion deficit next year, although Proposition 30′s temporary tax hike and an improving economy are projected to shift the state back into surpluses in the near future.

Medical providers said Thursday that the cutback should be lifted now that the state’s fiscal outlook has improved. The ruling can be applied retroactively to June 1, 2011.

“Now that the state has money, it would be like Scrooge for Gov. Brown not to pass a bill to eliminate at least the retroactivity part of it,” Carman said.

For the governor, Medi-Cal cuts could serve one policy aim at the expense of another.

Balancing the budget has been Brown’s first priority since taking office, and cutting healthcare — the state’s second-biggest cost after education — has been key to his fiscal goal.

But at the same time, he has wanted California to be out front in healthcare reform, and lead the country in efforts to put the federal law into place.

A spokesman for Gov. Brown released a statement Thursday that implied that Brown was inclined to put his budget priorities first, and was not likely to rescind the cuts.

“Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs,” the spokesman wrote.

In a ruling written by Judge Stephen S. Trott, appointed by President Reagan, the panel said the lower court injunctions were unwarranted because the federal government had approved the cuts.

“Neither the State nor the federal government ‘promised, explicitly or implicitly,’ that provider reimbursement rates would never change,” Trott wrote.

California has estimated that the 10% cut to medical providers and pharmacies would save the state $50 million a month.

Medi-Cal typically covers families and disabled Californians. The federal law will extend its coverage to single, childless adults beginning in 2014.

The California Medical Assn., which joined dentists, pharmacists, medical suppliers and medical response companies in trying to block the cutbacks, urged Brown to repeal them.

Dr. Paul R. Phinney, president of the doctors’ association, said the cuts shrink the number of providers who could afford to serve both existing Medi-Cal patients and the new ones who could become eligible for coverage in 2014.

“We need to ensure that health insurance isn’t just an empty promise for these patients,” Phinney said.

According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.

Dr. Ted Mazer, a San Diego ear, nose and throat surgeon, said he had to stop taking fee-for-service Medi-Cal patients several years ago because the reimbursements didn’t cover his costs and Medi-Cal patients were inundating his practice.

“So few doctors will see Medi-Cal patients that I was seeing them from the Mexican border to Riverside County to Orange County,” said Mazer, an officer of the California Medical Assn. “The reimbursement costs are so poor they don’t even cover costs, let alone pay for the administrative hassle. I can only see so many until I go under.”

Chris Perrone, deputy director of the foundation, said Thursday’s ruling will make it harder to block rate cuts in the future.

“The hurdles for people who want to block these rate cuts are little higher,” said Perrone.

maura.dolan@latimes.com

chris.megerian@latimes.com

Dolan reported from San Francisco and Megerian from Sacramento.

Times staff writer Anna Gorman contributed to this report.

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“Everybody In! Nobody out!” Means No Exclusion of Undocumented Immigrants

Since its inception, Single-Payer healthcare’s most enduring rallying theme has been “Everybody In!  Nobody Out!”  This vision, which resonates with our most basic striving for equality, is being challenged now, as progressives and sections of labor rally behind Bernie Sanders’ new single-payer law, S.915, which contains the fatal flaw of excluding undocumented immigrants.  (Section 102, Universal Entitlement)  Single Payer has always been about EQUAL, comprehensive, accessible, affordable, economical healthcare for EVERYONE.  The damage the working class would suffer from passing this bill as is, and splitting us into “legal” and “not legal” groupings, would negate any advances that would be made by getting rid of  insurance companies.

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: http://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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Obama shields states cutting Medicaid doctor payments

Bipartisan attack on Medicaid, healthcare for low-income children, seniors and workers.

• 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.

New York Times, May 28, 2011
Administration Opposes Challenges to Medicaid Cuts

By Robert Pear

WASHINGTON — Medicaid recipients and health care providers cannot sue state officials to challenge cuts in Medicaid payments, even if such cuts compromise access to health care for poor people, the Obama administration has told the Supreme Court.

States around the country, faced with severe budget problems, have been reducing Medicaid rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers.

Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid recipients have access to care to the same extent as the general population in an area.

In a friend-of-the court brief filed Thursday in the Supreme Court, the Justice Department said that no federal law allowed private individuals to sue states to enforce this standard.

Such lawsuits “would not be compatible” with the means of enforcement envisioned by Congress, which relies on the secretary of health and human services to make sure states comply, the administration said in the brief, by the acting solicitor general, Neal K. Katyal.

In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them.

But, the Justice Department said, the Medicaid law’s promise of equal access to care is “broad and nonspecific,” and federal health officials are better equipped than judges to balance that goal with other policy objectives, like holding down costs.

The administration expressed its views in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958.

In 2008 and 2009, the California Legislature passed several laws reducing Medicaid payment rates. Recipients and providers challenged the cuts in court, arguing that the California plan violated — and was pre-empted by — the federal Medicaid statute.

The law does not explicitly allow such lawsuits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the supremacy clause of the Constitution, which makes federal law “the supreme law of the land.” In reducing payment rates, the appeals court said, California violated the requirements of federal Medicaid law and threatened access to “much-needed medical care.”

California appealed to the Supreme Court, which is likely to hear oral arguments in the fall, with a decision by next spring.

Consumer advocates were dismayed by the administration’s position, which they said undermined Medicaid recipients’ rights and access to the courts.

“I find it appalling that the solicitor general in a Democratic administration would assert in a Supreme Court brief that businesses can challenge state regulation under the supremacy clause, but that poor recipients of Medicaid cannot challenge state violations of federal law,” said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, who is usually sympathetic to the administration.

Representative Henry A. Waxman of California, the senior Democrat on the Energy and Commerce Committee and an architect of Medicaid, said the administration’s brief was “wrong on the law and bad policy.”

“I am bitterly disappointed that President Obama would accept the position of the acting solicitor general to file a brief that is contrary to the decades-long practice of giving Medicaid beneficiaries and providers the ability to turn to the courts to enforce their rights under federal law,” Mr. Waxman said. He said that he and other Democratic lawmakers planned to file a brief opposing the administration’s view.

By contrast, many state officials agree with California and the Obama administration.

The National Governors Association and the National Conference of State Legislatures filed a friend-of-the-court brief endorsing California’s position that Medicaid recipients and providers could not sue.

In a separate friend-of-the-court brief, Michigan and 30 other states went further. “Allowing ‘supremacy clause lawsuits’ to enforce federal Medicaid laws will be a financial catastrophe for states,” they said.

Medicaid is financed jointly by the federal government and the states. The number of recipients and the costs increased sharply in the recent recession and will increase further with the expected addition of 16 million people to the rolls under the new federal health care law.

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Shortages of key drugs endanger patients. Free market to blame.

“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.”  … 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.”

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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What is the Fiscal Commission Co-Chairs’ Plan About?

What is the Fiscal Commission Co-Chairs’ Plan About?

Starting in less than a year (Oct. 1, 2011) when unemployment is supposedly back to normal, the Simpson-Bowles plan reduces projected deficits through 2020 by nearly $4 Trillion.  Spending cuts are twice revenue increases. (Extending all Bush tax cuts over same period would do the same deficit reduction.)    Not bailing out banks would have reduced deficit $1.5 trillion.   Discretionary spending under Congress’ control accounts for only 10% of deficit.  This will throttle any chances of lowering unemployment.  Most of deficit is caused by the recession, which the Co-Chairs’ plan will make worse, causing worse deficits.

Here are some of the pieces of the Co-Chairs’ plan:

Permanently Shrinks All Government Services by capping federal revenues at 21 pct of the GDP. The sum of Health, Education, Housing, Jobs Programs, Infrastructure Rebuilding, Social Security, and even military spending could never exceed 21% of GDP. This is less than spending from 1980-2008, when no baby boomers were starting Social Security and Medicare.

No repealing of Bush Tax Cuts for the Rich, no tax on stock or bond transactions, no eliminating the cap on Social Security Payroll taxes, no end of wars.  Instead,

Tax cuts for corporations and the rich; Tax increases for the middle class and the poor. Corporate tax rate is reduced from 35% to 26%.   The Individual rate for the richest is reduced from 10% to 8%.  There is a permanent extension of corporate tax credits for research.   There is a reduction or elimination of Mortgage Interest Deduction (while the housing market is still in disaster), and elimination of deductions for State and Local Taxes paid, contributions to your private retirement account, for charitable contributions,  and elimination of the Child Tax Credit.   Students must pay loans while still in school,   There’s a 15 cent/gallon gas tax, As Krugman says, “”(it) clearly represents a major transfer of income upward, from the middle class to a small minority of wealthy Americans.”

Social Security: Raises Retirement Age, Reduce benefits for middle-income recipients, Reduce Cost-of-Living Raises,  Moves Social Security from a universal plan toward a welfare plan:

• Payroll tax cap raised to increase covered workers from 86% to 90% of workers by 2050! Even then, the rich don’t pay!

• Cut benefits of middle-income earners: Half of Social Security recipients, who had earned above ($34,500), would be considered “high-income earners” and would be have their benefits cut from 17-36% depending on income, for example a 25% cut for people who had earned $43,000.

• Raise Retirement Age: For full benefits, retirement age is raised from 67 to 69, an average 13% benefit cut; that discriminates against poor, who start working earlier and die earlier. To get partial benefits, retirement age is raised from 62 to 64, meaning two more years of poverty for seniors whose bodies are worn out or who can’t find jobs.

• Reduce Cost-of-Living Raises: Raises would be based on new “chained CPI” inflation formula, .3% lower than now,  based on our alleged ability to switch to cheaper alternatives for goods and services that get priced beyond our means. What about, healthcare, which rose 4.2% last year while the regular CPI rose 1% .  By 2030, the COLA cuts would be a benefit cuts between 5-20% depending on income.

• Means Testing, moving toward a welfare model of Social Security: Instead of raising the payroll tax cap so the rich pay the same as us on all their income, the Co-Chairs’ plan raises the payroll tax rate on the small portion of their income that’s taxed.  This undermines widespread support for the current, universal insurance model that has withstood 75 years of attacks.

• Deficit Commission admits Social Security doesn’t increase deficit, so “savings” aren’t counted toward deficit reduction.  “Cuts are being made for Social Security’s own good.”

Medicare: Accelerate and intensify the cuts to Medicare that are in Obama Health Plan. (Increases in Medicare and Medicaid costs, are of course, the real drivers of increased future government expenses, and  single-payer, improved, expanded Medicare for All, is the only solution.  The Obama Plan greatly increases healthcare costs, and shifts the cost onto working families, particularly on Medicare.)

• Federal health spending is supposed to be cut one-third by 2040, but no plan given.

• The “Cadillac Insurance Tax” (a tax on insurance plans without ruinous deductibles or co-pays) would apply to less adequate insurance plans also.

• Cuts in healthcare for veterans: “Modernize the Tricare health system” to increase premiums and co-pays for healthcare for vets.

• It speeds up Obama Plan’s cuts to Medicare Advantage plans and charity hospitals that will serve the 23 million remaining uninsured, including all undocumented immigrants.

• It strengthens the Independent Payment Advisory Board beyond its already-sweeping powers to cut Medicare payments to hospitals, doctors, equipment suppliers etc

• It pushes Malpractice Reform, “tort reform,” to limit the ability of people to sue for damages in cases of medical malpractice.

• Federal payments for Medicaid (Medi-Cal in Calif.) would be a fixed amount per year, no matter how much care was needed by poor patients in that state, making states cut their programs.  Old or sick Medicaid patients needing long-term care would have to pay more of costs.

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Workers Fed Up With Obama-Demo Healthcare Reform “It’s worse than NAFTA.”

Labor Notes, January 20, 2010

Anger over Health Care Bill Creates Uncertain Future

By Jane Slaughter

A Massachusetts local union president called it before the January 19 vote for senator: “I’ve never seen this much anger at the Democrats from union people,” said Jeff Crosby, president of a General Electric factory local near Boston, as he prepared a last-minute leaflet to hand out in the plant. “It’s worse than NAFTA.”

Top union leaders had bargained a compromise slowing down the health care benefits tax President Obama insisted on, but it was not enough to placate union members—and others—infuriated that Obama had broken his campaign promise not to tax benefits.

Crosby said his members were threatening to vote Republican to stop the tax, since 60 Democratic senators and no Republicans had voted for it. In Massachusetts’ special election they chose empty-suit Republican Scott Brown over a Democrat bound to cement the benefits tax in place.

In a Suffolk University poll conducted a week before the election, union-household voters in Massachusetts reported only 45 percent support for the Democratic candidate; union voters nationally backed Obama by 60 percent in 2008.

According to those on a January 14 conference call with AFL-CIO President Rich Trumka, Massachusetts state fed President Bobby Haynes exploded in anger, blaming top union leaders for a terrible health care bill and for losing the Massachusetts election—and thus the Dems’ 60th Senate seat, needed to ensure the health care bill’s passage (and the rest of labor’s agenda, labor law and immigration reform).

Obama took a hands-off approach to the content of the bill as it crept through Congress. He didn’t insist on a public option nor a strong employer mandate to provide insurance. It was hard not to notice that the only issue on which he took a hard stand was taxing benefits.

At his meeting with a dozen labor leaders at the White House January 11, Obama was firm that a tax on benefits was a must-have—despite his campaign promise to the contrary. “We have a lot of video clips,” said Machinists President Thomas Buffenbarger.

Although the benefits tax was not the only issue on Massachusetts voters’ minds (the faltering economy was the No. 1 concern in the Suffolk poll), it was one of the clearest examples of the Obama administration’s tilt away from working class voters, beginning with the bank bailout.

Trumka too had predicted that the health care mess would backfire on Democrats. In a January 11 speech at the National Press Club, he said, “In 1992, workers voted for Democrats who promised action on jobs, who talked about reining in corporate greed, and who promised health care reform. Instead, we got NAFTA, an emboldened Wall Street—and not much more. [In 1994] there was no way to persuade enough working Americans to go to the polls when they couldn’t tell the difference between the two parties.”

NAFTA, which dealt a heavy blow to U.S. manufacturing, was voted up by Congress in 1993 after intense cajoling by President Clinton, garnering the votes of 102 House Democrats. Clinton lost the Democratic majority in Congress the next year—and never got it back.

LET’S MAKE A DEAL

As the likely House-Senate compromise took shape in early January, it appeared certain that if the bill passed, people with good (or just expensive) benefits would face a steep 40 percent tax likely to push them into inferior plans.

So labor leaders reached a deal with White House negotiators January 14 that accepted the tax they’d previously declared unacceptable. The deal announced by Trumka and his counterparts at Change to Win and the National Education Association would have exempted those in union-negotiated plans and state and local employees from the tax until 2018.

It also would have raised the threshold at which the tax kicked in for many other plans: those containing significant numbers of women, older workers, or retirees age 55 and up, or those in high-cost states, the latter affecting more than 38 million workers. Those provisions would have delayed those groups’ hit as well.

Trumka’s goal was to exempt as many people as possible, union and non-union, from ever paying the tax, though only the velocity of health care cost inflation would have proved how successful he was.

“Most of the 31 million insured employees who would be hit by the excise tax are not union members,” Trumka noted before the deal was struck. But in the end unions bought extra time for their members at the cost of making themselves look self-interested. The deal will create awkward moments for union health care activists who’ve spent years trying to build broad coalitions.

STILL OPPOSED

Not all top union leaders backed the compromise plan. Buffenbarger told Labor Notes his members at Boeing, Lockheed Martin, and General Dynamics were already over the $23,000 threshold at which the tax would originally kick in.

“No bill is better than this bill,” Buffenbarger said. “We don’t care what the amount is that they peg it to: because of inflation, whatever number will be gobbled up pretty quickly.”

Firefighters President Harold Schaitberger said his union didn’t ask for the bill’s special, higher threshold for first responders, $26,000 rather than $23,000. The provision was worthless, he said, because most of his members are pooled in larger municipal plans, with no mechanism to segregate them out. “We’re not going to buy into a special deal for us,” Schaitberger said.

The Steelworkers’ Leo Gerard backed the compromise, telling Labor Notes he was thinking about Senator Jim DeMint, “that right-wing nut from one of the Carolinas,” who’s said he wants to make health care Obama’s Waterloo.

“We have to do everything to make sure we get a good bill so we can move forward with the rest of the president’s agenda as quickly as possible,” Gerard said.

Insiders say Trumka sold his compromise by arguing that health care reform had to get done so Congress could tackle long-delayed labor law reform—the Employee Free Choice Act.

Labor’s weakness throughout the health care reform process put a question mark over EFCA anyway, and even the question mark lay in tatters after the Massachusetts election.

Buffenbarger—who backed Hillary Clinton in the primaries—was a pessimist in any case. “We’re not going to get EFCA anyway,” he said. “It’s an election year. No way they’re going to touch it.”

TURN TO THE STATES

One bright spot could emerge from this winter’s health care debacle: union members not pushed into the arms of the tea-partiers could become convinced that “Medicare for All” is the only solution.

“It may mean more people are apt to be engaged on single payer because they’re getting hit themselves,” said Lenny Potash, a retired AFSCME member and co-chair of the Labor Taskforce for Universal Healthcare in Los Angeles.

Activists in California and Vermont have already begun serious work on state single-payer efforts.

The Vermont Workers Center turned out 350 people to legislative hearings January 12 to testify for the state’s single-payer bill. Senator Bernie Sanders was followed by union nurses.

The center, the state’s Jobs with Justice affiliate, began organizing in earnest last year: a rally of 1,000 at the State Capitol on a work day; organized committees in every county; a dozen regional hearings. The result, says co-chair Traven Leyshon, is that “we have changed what’s politically possible. As recently as September the legislature said they couldn’t be bothered with single payer.”

All Democratic candidates for governor next fall say they support single payer (though Leyshon recalls former Governor Howard Dean, who “was always for single payer till the day he became governor”). The Democrats and the Progressive Party together have a veto-proof two-thirds majority in both houses.

A new single-payer bill, just introduced by a Progressive legislator, includes a just transition for insurance company workers and others who would lose their jobs under a single-payer system. The legislation was written so as to survive legal challenges.

SINGLE PAYER IN ONE STATE

California activists will back a single-payer bill starting this month, though Governor Arnold Schwarzenegger, who’s in his last year, is certain to veto it for the third time (similar bills passed in 2006 and 2008). The campaign kicked off January 11 with 1,000 members of the California Health Professional Student Alliance and others rallying in Sacramento.

Michael Lighty of the California Nurses Association explained that winning single payer is a multi-year project: heavy education this year, electing a Democratic governor who won’t veto single payer this fall, passing a new bill, taking the measure to the voters in a referendum. The media campaign alone could cost as much as $20 million.

What about the cost, in a state that’s broke? Cate Engel of the Labor Taskforce for Universal Healthcare said the bill ultimately would save California billions of dollars, by reducing administrative costs and using the state’s mammoth purchasing power to force drug and equipment prices down.

What about California unions that haven’t backed single payer—or ditched the idea before the fight even began, citing “political viability”? Well, said Lighty, “we saw what happened on the national level when they went for public option over single payer because of viability.”

Bill Bryce is the Jobs with Justice organizer in Detroit. He’s shaking his head over the lost opportunities of 2009—the year when Obama rode in on a wave of hope for change and corporations were in disgrace because of the financial fiasco.

“You’re the president, you appear on TV and say, ‘I have a suggestion, let’s tax Wall Street bonuses at 50 percent and defray the cost of health care,’” Bryce said. “If this was not the time to take on the insurance companies and the banks, just when will that time come?”

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Haiti Didn’t Become a Poor Nation All on Its Own — The U.S’s Hidden Role

AlterNet, January 15, 2010

Haiti Didn’t Become a Poor Nation All on Its Own — The U.S’s Hidden Role in the Disaster

In the hours following Haiti’s devastating earthquake, CNN, the New York Times and other major news sources adopted a common interpretation for the severe destruction: the 7.0 earthquake was so devastating because it struck an urban area that was extremely over-populated and extremely poor. Houses “built on top of each other” and constructed by the poor people themselves made for a fragile city. And the country’s many years of underdevelopment and political turmoil made the Haitian government ill-prepared to respond to such a disaster.

True enough. But that’s not the whole story. What’s missing is any explanation of why there are so many Haitians living in and around Port-au-Prince and why so many of them are forced to survive on so little. Indeed, even when an explanation is ventured, it is often outrageously false such as a former U.S. diplomat’s testimony on CNN that Port-au-Prince’s overpopulation was due to the fact that Haitians, like most Third World people, know nothing of birth control.

It may startle news-hungry Americans to learn that these conditions the American media correctly attributes to magnifying the impact of this tremendous disaster were largely the product of American policies and an American-led development model.

From 1957-1971 Haitians lived under the dark shadow of “Papa Doc” Duvalier, a brutal dictator who enjoyed U.S. backing because he was seen by Americans as a reliable anti-Communist. After his death, Duvalier’s son, Jean-Claude “Baby Doc” became President-for-life at the age of 19 and he ruled Haiti until he was finally overthrown in 1986. It was in the 1970s and 1980s that Baby Doc and the United States government and business community worked together to put Haiti and Haiti’s capitol city on track to become what it was on January 12, 2010.

After the coronation of Baby Doc, American planners inside and outside the U.S. government initiated their plan to transform Haiti into the “Taiwan of the Caribbean.” This small, poor country situated conveniently close to the United States was instructed to abandon its agricultural past and develop a robust, export-oriented manufacturing sector. This, Duvalier and his allies were told, was the way toward modernization and economic development.

From the standpoint of the World Bank and the United States Agency for International Development (USAID) Haiti was the perfect candidate for this neoliberal facelift. The entrenched poverty of the Haitian masses could be used to force them into low-paying jobs sewing baseballs and assembling other products.

But USAID had plans for the countryside too. Not only were Haiti’s cities to become exporting bases but so was the countryside, with Haitian agriculture also reshaped along the lines of export-oriented, market-based production. To accomplish this USAID, along with urban industrialists and large landholders, worked to create agro-processing facilities, even while they increased their practice of dumping surplus agricultural products from the U.S. on the Haitian people.

This “aid” from the Americans, along with the structural changes in the countryside predictably forced Haitian peasants who could no longer survive to migrate to the cities, especially Port-au-Prince where the new manufacturing jobs were supposed to be. However, when they got there they found there weren’t nearly enough manufacturing jobs go around. The city became more and more crowded. Slum areas expanded. And to meet the housing needs of the displaced peasants, quickly and cheaply constructed housing was put up, sometimes placing houses right “on top of each other.”

Before too long, however, American planners and Haitian elites decided that perhaps their development model didn’t work so well in Haiti and they abandoned it. The consequences of these American-led changes remain, however.

When on the afternoon and evening of January 12, 2010 Haiti experienced that horrible earthquake and round after round of aftershock the destruction was, no doubt, greatly worsened by the very real over-crowding and poverty of Port-au-Prince and the surrounding areas. But shocked Americans can do more than shake their heads and, with pity, make a donation. They can confront their own country’s responsibility for the conditions in Port-au-Prince that magnified the earthquake’s impact, and they can acknowledge America’s role in keeping Haiti from achieving meaningful development. To accept the incomplete story of Haiti offered by CNN and the New York Times is to blame Haitians for being the victims of a scheme that was not of their own making. As John Milton wrote, “they who have put out the people’s eyes, reproach them of their blindness.”

Carl Lindskoog is a New York City-based activist and historian completing a doctoral degree at the City University of New York. You can contact him at cskoog79@yahoo.com

Also see “Why is Haiti Poor?”

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Nelson Proposes Eliminating Medicaid Expansion or Letting States Opt Out

Health bill holdout Sen. Ben Nelson has been criticized for accepting the “Cornhusker kickback,” permanent federal payment for Medicaid expansion for his state of Nebraska as payment for his yes vote on the Senate health bill.  In reaction, “Nelson said Thursday that if he can’t secure a similar deal for every state, he wants states to be freed from paying the cost of Medicaid expansion. That could mean eliminating the provision, finding another way to pay for it or allowing states to opt out.” For millions of the poorest US residents, expansion of Medicaid is the only benefit they get from ObamaCare, and now they’re working to undo even that.

Associated Press, January 7, 2009

Nelson says he wants Medicaid deal for all states
By TIMBERLY ROSS, Associated Press Writer

OMAHA, Neb. – Sen. Ben Nelson said Thursday he has asked Democratic leadership to extend to all states the extra Medicaid funding promised to Nebraska in the health care reform bill.

The Democrat wouldn’t say who he has spoken to regarding the so-called “Cornhusker Kickback” but that he would see to it that Nebraska doesn’t get a special deal.

“At the end of the day, whatever Nebraska gets will be available to all states,” Nelson said during a conference call with reporters.

Nelson provided the crucial 60th vote that brought the reform bill to the full Senate after winning concessions to limit the availability of abortions in insurance sold in newly created exchanges. Among other things, he was promised federal funding to cover Nebraska’s entire cost of a Medicaid expansion included in the bill. Other states will have to begin picking up a portion of the added expanse beginning in 2017.

Nelson has said he didn’t ask for special treatment for his state.

Nebraska wasn’t alone in getting Medicaid breaks. Vermont, Louisiana and Massachusetts also got help with their programs.

Nelson said Thursday that if he can’t secure a similar deal for every state, he wants states to be freed from paying the cost of Medicaid expansion. That could mean eliminating the provision, finding another way to pay for it or allowing states to opt out.

“States that are concerned about Nebraska getting something that they’re not getting should rest at ease,” Nelson said. “That’s not going to happen.”

California Gov. Arnold Schwarzenegger on Wednesday urged the state’s lawmakers to vote against the reform measure unless they can negotiate a special deal for more Medicaid money. Thirteen state attorneys general also have threatened to sue if Nebraska’s extra Medicaid funding were not removed from the measure in conference committee.

Nelson said Thursday that he expects all states will get extra Medicaid funding, but he wouldn’t speculate on whether he’d vote against the reform measure if Nebraska was still singled out.

The senator said his top concerns about the bill continue to be making sure federal money won’t pay for abortions and the exclusion of a government-run insurance plan.

“Those were the two dealmakers — or deal-breakers,” he said.

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Health reform bills endanger children’s healthcare

Citizen children of immigrant families would lose coverage under House healthcare bill.

Also, low-income families would be forced onto unaffordable private coverage from employers.

The Children’s Health Insurance Program (CHIP) is one of the few success stories, where coverage has actually expanded. The Senate bill would give CHIP a temporary reprieve, extending federal financing through 2015, two years past its current expiration date, but the House bill would end CHIP and redirect the millions of children either to Medicaid or to the new health insurance exchanges.  14% of families whose citizen children get healthcare through government programs would lose that coverage because the parents have mixed immigration status, and both Medicaid and the exchanges exclude aid to undocumented immigrants.   In addition, low-income families using CHIP would lose healthcare for their children because they would not be able to afford the deductibles and co-pays of private insurance their employers provide.  Medicaid currently provides more comprehensive coverage that CHIP, but Medicaid’s lower payments to doctors and hospitals plus anticipated state budget shortfalls threaten patient access in the future, though the House bill calls for higher provider payments.

New York Times, January 4, 2010

Program for Children Has Uncertain Future

By DAVID M. HERSZENHORN

WASHINGTON — As Democratic Congressional leaders work to merge the House and Senate versions of major health care legislation, a big question is what they will do about the Children’s Health Insurance Program, which now provides coverage to more than nine million children and pregnant women and is expected to cover more than 14 million by 2013. Chip Somodevilla/Getty Images Senator John D. Rockefeller IV, Democrat from West Virginia.

The Senate bill would preserve the program, known as CHIP, and would extend federal financing through 2015, two years past its expiration date under current law. Two Democrats, Senators John D. Rockefeller IV of West Virginia and Bob Casey of Pennsylvania, fought hard to protect CHIP in the bill.

The House bill, by contrast, would end CHIP and redirect the millions of children either to Medicaid, the federal-state insurance program for the poor, or to new health insurance exchanges where moderate-income Americans would be able to buy private coverage using new federal subsidies to help offset the cost.

Unlike many of the issues facing Senate and House negotiators, the question of what to do with CHIP is not just a cerebral policy point. In recent years, states have made huge strides in covering children, particularly those in low- and moderate-income families, and experts say those gains could be put at risk.

“Attention must be paid to the possibility that some children who lose CHIP coverage could fall through the cracks and become uninsured,” Genevieve M. Kenney and Allison Cook wrote last month in a brief prepared for the Urban Institute, the Washington research group.

Some House Democrats, including Representative Henry A. Waxman of California, the chairman of the Energy and Commerce Committee and a lead author of the health care legislation, have said it is difficult to defend a stand-alone government insurance program for children once subsidies are available for entire families.

In Transition, Risks

But many children’s health advocates cite numerous risks. Simply shifting children from one program to another could result in some losing coverage, even on a temporary basis. And there is a chance that parents, even with new subsidies, will find coverage unaffordable and choose not to buy it for themselves or their children, despite a new mandate in both bills that nearly everyone obtain coverage.

Then there are more complicated situations, like those of children whose parents have mixed immigrant status. Under both the Senate and House bills, illegal immigrants would not be eligible for the insurance subsidies.

Some experts project that as many as 14 percent of children with health care through government programs come from such families. And while the bills would provide for the creation of child-only insurance policies, it is unclear how those policies would work and whether children would face difficulties obtaining coverage that way.

The bills also seek to push people with access to employer-sponsored health insurance to buy it, allowing exemptions only for families for whom such coverage would be extremely expensive. Many low-income workers already choose to enroll their children in CHIP because private coverage is too costly.

“The country has made remarkable progress in covering kids in recent years because of the success of CHIP and its companion program, Medicaid,” said Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University. “It would be a major problem if health reform undercut these gains by shutting CHIP down too abruptly or by moving kids into coverage that isn’t as affordable and as well-designed to get them the care they need to develop and grow.”

In an effort to tilt the debate in favor of maintaining CHIP as a standalone program, Mr. Rockefeller and Mr. Casey prevailed upon the Senate majority leader, Harry Reid of Nevada, to include two more years of federal financing — through 2015 — which would serve as a bridge beyond the creation of insurance exchanges, where people would be able to buy subsidized private coverage.

Under the Senate bill, state-based exchanges would begin in 2014. The House bill calls for a national insurance exchange to begin in 2013.

Factoring in Medicaid

Tied directly to the question of CHIP’s future is the proposed expansion of Medicaid to include many more low-income Americans, particularly childless adults.

Medicaid would grow under both measures, with eligibility expanded to individuals and families earning up to 133 percent of the federal poverty level (currently about $29,327) under the Senate bill, and up to 150 percent of the poverty level ($33,075) under the House bill.

States have generally expressed apprehension about the proposed Medicaid expansion, because they would eventually share in the cost of covering new enrollees. Medicaid generally provides more comprehensive coverage than CHIP, but potentially offers fewer choices of doctors and other health providers because of Medicaid’s low payment rates. States currently must provide Medicaid coverage to all children through age 5, from families earning up to 133 percent of the poverty level, and to children ages 6 to 18 with family income up to 100 percent of the poverty level.

The House bill, in addition to more broadly expanding Medicaid eligibility, would also increase payment rates for primary care physicians — a step that many health advocates say is needed to improve access to providers for children and adults. The Senate bill does not increase Medicaid payment rates.

In a statement after the Senate adopted its health care bill on Dec. 24, Dr. Irwin Redlener, president of the Children’s Health Fund, a New York-based advocacy group, praised the preservation of CHIP, but criticized the Senate bill for not lifting Medicaid payment rates. “Unfortunately, the Senate bill fails to improve reimbursement rates for Medicaid providers and omits a provision to automatically enroll otherwise uninsured infants, both of which were in the House bill,” Dr. Redlener said.

The Fight Ahead

Mr. Rockefeller, in an interview just before the Senate adopted its bill, said that he was prepared to battle against his colleagues in the House to preserve CHIP in the final health care legislation. “I am not going to drop kids,” he said.

But Mr. Rockefeller also said he was optimistic that House Democratic leaders, however reluctant, would make the adjustments needed to get the final legislation through the Senate, where Democrats cannot afford to lose a single vote.

“The House doesn’t like the Senate, anyway,” he said. “I don’t blame them.”

See “Powerful Special Interests Should Not Trump Children’s Health Needs.”

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