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on Mon, Dec. 29, 2003
RATIONING HEALTH CARE: No guidelines for vital health decisions
FIRST IN AN OCCASIONAL SERIES
Wall Street Journal
PHILADELPHIA — A former machine operator and part-time minister,
Angel Montanez Diaz, 69 years old, has spent 140 days in intensive
care at Northeastern Hospital so far this year. Suffering from dementia,
he needs a ventilator to breathe and a stomach tube to eat.
The hospital needs his bed. His stay has already cost about $280,000,
nearly half of which will end up as a loss for the hospital.
Who's going to decide what happens to Montanez Diaz? In England,
Canada and some other countries, a government health-care bureaucracy
would supply some guidelines. In the United States, the answer lies
in the hands of people such as Lorraine Micheletti.
The nurse manager in intensive care, Micheletti makes daily battlefield
decisions that influence whose lives should be prolonged and who
should leave the ICU. With her hospital facing a cost crunch, she's
under pressure to get patients out of the glass-walled unit quickly.
While she can't deny or withdraw care, she uses not-so-subtle means
to decrease patient stays. She cajoles doctors to move their patients
along. She pushes the hospital's pharmacy committee to relax guidelines
that require patients on certain drugs to stay in the ICU. She prods
families to let some very ill patients die with less medical intervention.
Without any official rules, she uses only her judgment from 27 years
of experience. "You get a feel for it," says Micheletti,
50, who mixes straightforward talk and a ribald sense of humor to
get her way. "Nine out of 10 times I'm right. Every now and
then I'm proven wrong. There are always a few cases that are miracles."
The word for what Micheletti does every day at this 173-bed hospital
is one of the big secrets of American health care: Rationing. Although
the United States spends far more per person on health care than
any other country, and it spends ever more each year, there aren't
enough doctors, drugs and dollars to do everything for everybody.
So who gets the care? And who makes these momentous, life-or-death
decisions?
There is no formal rationing system in the United States, with its
complex mix of private insurance and Medicare and Medicaid coverage,
plus 41 million uninsured people who pay for their own care or get
treated as charity cases. But in fact, health-care rationing occurs
every day in the United States, in thousands of big and small decisions,
made mostly out of sight of patients, according to rules that often
aren't applied consistently.
The people who make these decisions are harried doctors, Medicaid
functionaries, hospital administrators, insurance workers and nurses.
These are the gatekeepers of the American health-care system, the
ones forced to say "no" to certain demands for treatment.
LENGTH OF PATIENT STAYS CUT
Four years ago, Northeastern, the small Philadelphia hospital that
serves mostly lower-income residents, was losing money and in danger
of closing. To stay in business, administrators told the hospital
staff that, among other things, they must get patients out faster.
Since then, the average patient stay has been reduced from 4.9 days
to 4.6 days. This year, the hospital's goal is to bring the number
down to 4.2.
That puts a huge responsibility in the hands of Micheletti and her
26 nurses.
This spring, she considered the case of John Ems, a 79-year-old
former refrigerator-repair specialist. In April, he was admitted
to Northeastern with anemia and gastrointestinal bleeding.
After three weeks in the hospital, Ems went into cardiac respiratory
failure. Nurses and doctors revived him, but one of his lungs collapsed.
Patients in this condition can die quickly, or linger in intensive
care for a long time.
The next day, Micheletti talked to the nurse who was directly caring
for Ems, looked at his chart, and within minutes, she says, determined
his likely fate. She saw that he had a history of emphysema and
heart trouble. Considering the fact that he wasn't able to breathe
without a ventilator, and that his lung had collapsed, she concluded
Ems was going to die. Her goal, she says, became to prepare the
family to let go of him.
She urged Ems' nurse to talk to his family about not resuscitating
him or withdrawing care. "You should start having that conversation,"
she said.
That same day, Micheletti talked to the family herself. She motioned
to Ems' son, Tom, to join her outside the room where his father
lay.
Putting an arm around Tom Ems's shoulders, Micheletti asked if he
had thought about the kind of medical attention his father should
receive. She told him it was unlikely his father would ever come
off a ventilator, which meant he would probably need to go to a
nursing home, if he lived. "You have to think about what's
humane," she said.
Doctors could gradually withdraw medical care and make his father
comfortable on a morphine drip until he died, Micheletti told Tom
Ems. Or they could leave everything in place but not resuscitate
him if his heart stopped. A laid-off trucker who delivers pizza
for a living, Tom Ems grew tearful. He told Micheletti his father,
a warm, patient person, had lived with him his whole life and was
the primary caretaker for the grandson at his bedside.
A few days later, John Ems' blood pressure plummeted. Nurses asked
for permission to stop his blood-pressure medication and not to
resuscitate him if his heart stopped beating. Tom Ems says he agreed
because doctors told him his father was likely brain dead. Without
the medicine, John Ems' heart stopped beating. A few minutes later,
he was dead.
FINANCIAL INCENTIVES GIVEN
Born in the Philippines, Micheletti came to the United States in
1977 and has worked at seven hospitals, rising from staff nurse
to nurse manager, mostly in intensive-care units. Her current post
pays $76,500 a year and provides regular hours, allowing her to
spend time with her family.
Since Northeastern — one of five hospitals operated by Temple
University Health System, a nonprofit group in Philadelphia —
put in place its turnaround plan three years ago, its fortunes have
improved. In 2002, it posted a profit of $2.6 million, on an operating
budget of $85 million. For meeting financial goals and improving
patient satisfaction, each hospital employee got a $300 bonus. Managers,
including Micheletti, got a $2,000 bonus.
Despite the financial incentives, Micheletti sometimes finds herself
fighting to keep a patient in the ICU.
Sam Buoncristiano, a 55-year-old junkyard owner, came to her unit
in May after suffering a heart attack. He needed special tests to
determine if his arteries were blocked. Northeastern doesn't perform
these tests but offered to arrange for him to be transferred to
another hospital. Buoncristiano wanted to go home first.
Micheletti was convinced his arteries were dangerously clogged because
he continued to have chest pain.
At the urging of Micheletti and a doctor, Buoncristiano agreed to
stay. When he later went on to another hospital, doctors found he
had a blocked artery and inserted a stent to prop open the passageway.
He is now back at work and credits Micheletti for "treating
me real good."
While Micheletti has worked hard to decrease the average patient
stay this year, one person can throw off her numbers.
"You can eat up all of your profits if one or two patients"
lingers in the ICU, she says.
Angel Montanez Diaz was living with his wife and working at a corrugated-box
company when his dementia set in during the early 1990s. The part-time
minister led services several days a week and taught Sunday school
at the First Christian Missionary Church, which serves Philadelphia's
Hispanic population.
When his dementia grew severe, his wife and two adult children had
trouble taking care of him. His brother offered to take over. A
retired charter pilot, Moises Montanez Diaz says he was home anyway,
taking care of his grown son, who is wheelchair-bound.
In May 2002, Angel choked on some food and went to the emergency
room at Northeastern. He developed complications. After two months
in the hospital, he was sent to a rehabilitation center and later
to a nursing home.
On Valentine's Day this year, Angel Montanez Diaz showed up at Northeastern
ICU, with intestinal bleeding and pneumonia. As soon as he seemed
stable, Micheletti pushed to move him back to the nursing home.
Moises, now Angel's legal guardian, didn't want him returned to
the nursing home because he thought the care was inadequate.
To get him out, hospital officials started calling around trying
to find a nursing home to accept him. It was a big problem.
RATIONING AT NURSING HOMES
Nursing homes also ration care. They have little incentive to take
very sick patients, because, in many cases, they receive a fixed
reimbursement rate from insurance, which doesn't cover the full
cost of the care.
The hospital eventually found a nursing home to accept Montanez
Diaz, but he was shuttled back to the hospital several times with
fevers and infections.
When he kept coming back to the ICU, Micheletti began prodding Moises
to stop keeping him alive. Montanez Diaz was in chronic pain, mentally
incompetent and unable to breathe or eat. "That's not Angel
in there," she told the brother. "That's just a shell
of him." Moises began to cry.
"What do you do with this patient?" an exasperated Micheletti
said later. "We can't send him home because he needs too much
care. He comes down with pneumonia very quick. His skin breaks down
because it's very fragile. And yet his brother is not ready to let
him die."
On July 29, Moises arrived at the hospital at 10 a.m. to find his
brother gone. He had been sent to another nursing home.
When he stopped by her windowless office that day, Micheletti hoped
Moises would thank her and the staff for caring for his brother
for so long. Instead, she says, he came up to her, smiled and said:
"So you finally got rid of him." She lost her temper,
she says, and responded, "Yes, we got rid of him."
Later, she said she understood Moises's devotion to keeping his
brother alive, particularly when she watched the two men interact.
He knows his brother is somewhere in there, and he can still get
to him."
------------------------------------------------------------------------
© 2003 Pioneer Press and wire service sources. All Rights Reserved.
http://www.twincities.com
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on Tue, Dec. 30, 2003
Medicare's little-known gatekeepers
BY LAURIE McGINLEY
Wall Street Journal
SECOND
IN AN OCCASIONAL SERIES
TUCSON, Ariz. — One evening in 1986, while Chris Erringer was
sitting in his Toyota Land Cruiser, a stranger approached him and
shot him under the right eye.
Erringer jumped out of the truck, lunged at his assailant and collapsed.
The gunman shot him in the back, stole his money and fled, Erringer
says. When he came to, "nothing worked."
The attack left Erringer a quadriplegic, with painfully knotted
back and neck muscles. His only relief: shots of a mild anesthetic,
which his doctors administered twice a month. Erringer, who was
left unable to work and lived on Social Security disability benefits,
depended on Medicare to pay for the treatments.
Then, in September 1999, came a letter that would change his life
again. Medicare would no longer cover the injections. "It didn't
really explain why," he says. "It just said no."
Erringer continued to get the trigger-point injections, as they're
known, but only once a month, or sometimes less. He cut down on
the shots in case Medicare rejected his doctors' appeal and he ended
up getting stuck with the whole bill.
Because of the pain, he mostly sat in his wheelchair "like
a rag doll," says Larry Shepherd, a friend and Erringer's legal
guardian. "I kept wondering," says Erringer, now 44 years
old, "why did Medicare do this out of the blue?"
Finding the answer took Erringer more than a year of frustrating
arguments and appeals, a legal crusade that turned into a class-action
suit. The decision-makers, it turned out, weren't in the massive
Baltimore headquarters of the federal Centers for Medicare and Medicaid
Services. The real authority lay in the hands of a North Dakota
insurance company — one of the hidden gatekeepers of American
medicine who ration health care.
About two dozen of these government-contracted insurers handle the
claims for doctor visits and hospital outpatient procedures submitted
to the $250 billion-a-year federal program. The Medicare agency,
commonly known as "CMS," sets national policies on coverage
for some items, including expensive new technical advances. But
the agency gives the insurers — whose territories cover multiple
states — broad authority to lay down local rules on what Medicare
will cover. The result: Decisions on everything from trigger-point
injections to psychiatric services are in the hands of the insurers
and their little-known medical directors.
Those decisions can vary widely from region to region, creating
a patchwork of rules that sometimes angers doctors and patients.
In the late 1990s, dermatologists howled as medical directors in
Florida and elsewhere restricted the treatment of certain skin lesions
that can be precursors to skin cancer. In 2001, CMS issued a national
ruling lifting the restrictions.
Meanwhile, when meetings are called to consider these local policies,
they're attended mostly by doctors and manufacturers pushing for
approval of services and devices. A Medicare spokesman notes that
insurers announce the meetings on the Internet and elsewhere, but
"the general public doesn't show up for these things."
Erringer's fight for answers offers a window into how these insurers
regulate and sometimes restrict medical care — often with policy
rulings that most patients and many doctors weren't aware of until
a claim is denied.
CONTAINING COSTS
"It's rationing. It's a way to limit things," says Grant
Bagley, a former top Medicare coverage official who now represents
manufacturers, providers and beneficiaries as a partner at the Arnold
& Porter law firm in Washington.
Tom Scully, the administrator of CMS, sharply disputes that notion,
as does the insurer that cut back on coverage for Erringer. The
medical directors, Scully says, "have no economic incentive
to deny coverage for anything. They are trying to do the right thing."
Indeed, the issue here isn't "greedy" insurers limiting
health care to pocket extra profit. The insurers are paid by the
number of claims they process, regardless of whether the claims
are accepted or rejected, and Medicare covers about 99 percent of
the procedures and items submitted for claims, according to the
GAO report.
The local policies are one of the few brakes in a program that costs
more every year, and will cost even more when the baby-boom generation
retires. Without local rules on coverage, says Scully, "spending
would be higher because nobody would ever say no, and it would be
ludicrous." He argues, moreover, that the local policies provide
needed flexibility for regional variations in medical practice.
At the same time, he's encouraging medical directors across the
country to work together more to make their policies more consistent.
PAIN RELIEF
Like many people who are paralyzed, Erringer has intractable chronic
pain called myofascial or "referred" pain. It starts in
the right shoulder where there are weak muscles between the active
and inactive muscle areas, but can radiate to different parts of
the body. "It can be both shoulders and neck," he says.
"I'm just a rack of pain sometimes. When I'm moving, it hurts
all the time."
For Erringer's muscle spasms, starting at "trigger points"
in his neck and back, doctors prescribed physical therapy, epidural
injections and running electrical current through the muscles.
The only thing that worked was injections of the anesthetic Marcaine,
and occasional steroids, which he no longer gets. Every two or three
weeks, doctors would inject the anesthetic, often in several different
shots, directly into his tightly knotted muscles. Relief lasted
about 10 days.
Then, in September 1999, came the letter from Noridian Administrative
Services, an insurer in Fargo, N.D., that handles Medicare claims
in Arizona. Noridian handles more than 56 million claims a year
from 11 states.
Erringer's four injections from August 1999, which totaled $157.25,
had been denied. "The information we have in your case does
not support the need for this many visits or treatments," the
letter said, without further explanation.
Erringer felt panicky and confused. "I wasn't faking,"
he says. "Who would want needles stuck two inches deep in knotted-up
muscles unless they needed it?"
Noridian subsequently refused to pay for the trigger-point injections
— totaling almost $1,100 — that Erringer got from August
1999 through early February 2000. He and his doctors appealed. Noridian
personnel in Fargo, N.D., turned down the first two appeals.
Traci Arzt, the Noridian hearing officer who denied the second appeal,
wrote in her decision that Erringer's file didn't show the medical
necessity of more than 12 shots a year. "There was no indication
that you were showing improvement from these injections," she
wrote.
Erringer, who lives on Social Security disability benefits of about
$660 a month, was furious. The medical necessity of the shots had
never been called into question before, and nobody had ever asked
if he were "showing improvement." He says he finds the
whole idea of improvement ludicrous, given his condition.
He contacted Sally Hart, of the Arizona Center for Disability Law
and Center for Medicare Advocacy in Tucson. Hart studied the rejection
letters and found a valuable clue. The denials were based on a new
"local medical review policy" — one of the most contentious
features of the Medicare system.
LEGAL BATTLE
Hart got a copy of Noridian's policy on trigger-point injections
and appealed to the Social Security Administration, whose administrative-law
judges handle Medicare appeals if a patient wants to go beyond the
insurance company decision.
Six months later, at an August 2001 hearing in Tucson, administrative
law judge James Lawwill sided with Erringer and ordered Noridian
to pay the bill for the past claims. All other methods of treatment,
he later wrote in his decision on the case, "have been unsuccessful
in controlling his intractable pain."
While pursuing the administrative appeals, Hart brought a class-action
suit against the government in federal district court in Tucson.
The suit, filed jointly with lawyers at the Center for Medicare
Advocacy in Willimantic, Conn., was intended to force Medicare to
notify beneficiaries when claims are denied because of a local policy
change, so they can appeal more effectively. Medicare agreed last
fall to make the change nationwide as part of a settlement.
Still, there was one question Erringer couldn't answer. Why did
Noridian change its policy in the first place?
Insurers may adopt local medical policies if they see a problem
that suggests overuse of a specific service or a "significant
risk" to the Medicare trust funds. That's what happened with
the trigger-point injections, says Dr. William Mangold, a Noridian
medical director in Phoenix.
In the fall of 1998, TransAmerica Occidental Life Insurance Co.,
which analyzed claims trends for Noridian, brought Mangold and his
five fellow medical directors a problem. In analyzing claims to
look for trends in demand, TransAmerica noticed a substantial increase
in trigger-point injections. So TransAmerica suggested restricting
coverage to one injection a month in most cases. The policy added
that patients with chronic pain might need more shots if there were
strong evidence of medical need.
Mangold and the other Noridian medical directors adopted the injection
policy, effective July 1, 1999. The change was published in a newsletter
sent to doctors who participate in Medicare. Erringer's doctors
say they didn't see the announcement because they're inundated with
information.
For now, Erringer continues to get shots just once a month and endure
the pain when the effects wear off. Noridian covers the injections,
but he's afraid it would ignite another battle if he were to try
for more shots. Indeed, Noridian's newest policy, adopted in August
2002, is tougher than the previous one; citing a new study, it generally
limits patients to injections every other month, although it says
more are permitted with proof of medical need.
RATIONING HEALTH CARE:
Second in an occasional series
------------------------------------------------------------------------
© 2003 Pioneer Press and wire service sources. All Rights Reserved.
http://www.twincities.com
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------------------------------------------------------------------------Posted
on Mon, Jan. 12, 2004
Hospital sets strict rules to limit costs
BY BERNARD WYSOCKI JR.
Wall Street Journal
RATIONING HEALTH CARE: FOURTH IN A SERIES
GALVESTON, Texas — Dr. Joan Richardson, chief medical director
at the hospital of the University of Texas Medical Branch, faced an
agonizing decision: Should she approve a $1,500 drug for a 52-year-old
woman with metastatic breast cancer?
The patient had no money, no insurance and rapidly fading hope. Three
powerful cancer drugs had failed to help her. A fourth, exemestane,
offered a slim chance, but strict rules at the hospital barred the
drug from being given to patients who couldn't pay for it. Richardson
would have to authorize the money to come from a $25,000-a-month drug
fund for indigents — meaning some other poor person who needed
a costly drug might not get it.
Richardson, 59, approved just one exemestane treatment. "Unless
this patient really improves, this is the end of the road," she
said. The hospital says it's too early to tell if the drug is working.
The rules restricting drugs at this 795-bed hospital are part of a
bold experiment in allocating health care at a time of rising costs.
In most other U.S. medical centers, decisions about who gets scarce
resources such as expensive drugs and surgical procedures are often
made with few formal guidelines for doctors and nurses on how to help
their patients while hewing to budget restrictions.
But the University of Texas Medical Branch (UTMB) has developed a
detailed policy to help determine exactly who gets treated and who
doesn't. Its rules require that patients undergo financial screening
before they can be admitted and that virtually everybody pay a fee
before seeing a doctor.
For patients who are poor or uninsured, the rules restrict or proscribe
the use of certaintreatments. The system empowers certain decision-makers,
such as Richardson, to make exceptions to the rules but usually within
a specific budget.
THE BOTTOM LINE
Unlike most hospitals, UTMB also is blunt about its need to limit
services on financial grounds. "We are rationing," says
Dr. John Stobo, UTMB's 62-year-old president and chief executive.
The hospital's rationing system — dubbed "DAMP" for
"Demand and Access Management Program" — has helped
its bottom line. Five years ago, UTMB was headed for an $80 million
budget deficit. Last year, it posted a modest budget surplus. But
the rules have hit its hometown hard.
UTMB, a sprawling complex that includes a medical school and a nursing
school, is the only hospital in Galveston, a port city of 55,000 that
has fallen on tough times. Under the rationing rules, UTMB has cut
back on admissions of uninsured patients, who are then forced to defer
or forgo treatment. Before DAMP was instituted, in 1998, about 26
percent of UTMB's patients were uninsured. Today, that figure is 17
percent. In the hospital's emergency room — which by federal
law can't turn away anyone who claims to need immediate care —
the waiting time has stretched to as long as five hours or even longer.
Hospital officials say they had little choice. In the late 1990s,
uninsured patients were overwhelming the institution, and many didn't
pay their bills. UTMB, which was established in 1891 with a mission
to care for the poor, was also swamped by waves of low-paying patients
covered by Medicare, the federal program for the elderly, and Medicaid,
the state-federal program for the poor and disabled.
At first, Stobo, newly recruited from a top job at Johns Hopkins University
School of Medicine in Baltimore, reduced costs the traditional way:
He fired staff and mothballed beds. When he felt he could cut no further,
he took a more radical step. He appointed a committee of administrators,
doctors and midlevel staffers to codify a top-to-bottom system for
distributing services.
The committee, which came up with the acronym DAMP, set rules that
start at the front door: People without insurance must pay $80 before
they can see a doctor, unless they can prove they are indigent —
meaning they earn less than $2,800 a month for a family of four. In
that case, they qualify for a discounted fee of about $30. The discount
is also given to dependents, and UTMB rules stipulate that children
will never be turned away. But otherwise, anyone who shows up at UTMB
without the money is sent home, unless a doctor deems him or her sick
enough to be seen immediately.
FINANCIAL SCREENING
Under the rationing scheme, the first cut is made by people such as
Roslyn McCray, one of 17 financial screeners who scrutinize the income
and insurance of everyone seeking treatment. One afternoon last year,
McCray sat in a tiny office near the entrance to the UTMB outpatient
clinic and called up the computer records of John Paul Regini, a 48-year-old,
unemployed welder's helper who sat across from her.
It was the second attempt by Regini, who is uninsured and doesn't
qualify for Medicaid, to see a UTMB doctor. Two months earlier, he
had been referred to a UTMB internal medicine specialist by a county
health clinic, which had diagnosed him with high blood pressure. He
showed up without the upfront fee. The screener he saw at the time,
one of McCray's colleagues, suggested that Regini try to prove he
had little or no income in order to be eligible for the discount.
Then she suggested a way how: Get a notarized letter from his mother
stating that she supported him.
Before he was sent home, a doctor reviewed his file, as UTMB rules
require, and concluded his situation wasn't urgent enough for him
to be seen immediately.
Now Regini was back with the notarized letter and $30. McCray decided
the letter looked legitimate and approved his appointment to see a
doctor later that day. Regini says he was diagnosed with excess iron
in his blood and is awaiting further appointments.
UTMB also has strict rules for patients who have failed to pay a previous
bill, causing a "bad-debt flag" to pop up on the hospital
computer. These patients — currently a staggering 64,000 people,
or 7 percent of those in the hospital's records — are barred
from making an appointment with a doctor unless they qualify as indigent
or a doctor deems their case urgent.
PAST DEFICITS
Before the rationing program started, the UTMB pharmacy often gave
away drugs to poor Texans, many of whom drove hundreds of miles to
get them. In 1998, the pharmacy posted a loss of $12 million, and
a crackdown on drugs soon followed. A committee established a "gatekeeper"
list of expensive drugs, requiring doctors to get approval from high-level
faculty members before they could be used.
A few drugs — such as Xigris, Eli Lilly & Co.'s more-than-$6,000
medication for sepsis, a deadly syndrome associated with severe infections
— were so tightly restricted that only Richardson, the chief
medical director, could approve their use.
Despite the restrictions, the UTMB pharmacy posted a loss of $2.8
million in 2001. Dr. Karen Sexton, the chief operating officer, proposed
closing the pharmacy's outpatient service. After raising objections,
the pharmacy director, Kim Sergeant, suggested raising the amounts
patients must pay and discharging some uninsured patients with a 14-day
supply of drugs instead of a 30-day supply. That rule was adopted,
and the pharmacy met Sexton's goal of narrowing its losses by $1 million
last year.
In February, the state of Texas, facing a multibillion-dollar budget
deficit, forced UTMB to reduce its state-funded budget by $12 million
over the next six months, with further cuts of about $50 million likely
this year and beyond. With the cutbacks looming, Sexton began drawing
up a list of possible programs for elimination.
Cochlear implants, which can restore hearing to the deaf in 60 percent
to 80 percent of cases — but cost $78,000 and are only partly
reimbursed by even the most generous insurance plans — were among
the procedures she targeted. Under existing UTMB rules, only patients
who paid for the implant devices themselves, which cost about $20,000,
were allowed to receive them. Sexton believed doctors were being lax
in enforcing DAMP rules and were giving implants to too many patients
who couldn't pay for them.
In March, as Sexton weighed whether to eliminate the program, she
went for a walk on the hospital grounds and struck up a conversation
with a mother whose child had come to be examined for a cochlear implant.
"I was crying by the time I got to the front door," she
says. Meanwhile, the chairman of the otolaryngology department argued
that cochlear implants offered disabled people the hope of a normal
life, and he promised strict adherence to DAMP rules.
Sexton, a registered nurse with a Ph.D. focused on nursing care, struggled
with her decision. But she believed that as long as UTMB carried an
inventory of implants, sympathetic staff would be tempted to keep
doing procedures for nonpaying patients.
She halted all cochlear implants.
Wrestling with these issues is "frightening," she says.
"We're talking about losing muscle, not fat."
------------------------------------------------------------------------
© 2004 Pioneer Press and wire service sources. All Rights Reserved.
http://www.twincities.com |
20,000
LOSE COVERAGE FOR MEDICAL SUPPLIES
MINNESOTACARE CUTS HARD ON DIABETICS
Source: Associated Press
Cliff and Diane Tomoson are diabetics whose state-subsidized health
insurance used to lower their out-of-pocket cost for glucose testing
strips to $3 a box. But changes made to the MinnesotaCare program
to help balance the state's budget now mean the Tomosons face monthly
payments of $98 for the strips. And that doesn't take into account
the syringes and needles required by Cliff, who is insulin-dependent.
The budget cuts that went into effect Oct. 1 eliminated...
Get article fom archives
Published on November 26, 2003, Page B3, Saint
Paul Pioneer Press |
| |
|
------------------------------------------------------------------------Posted
on Thu, Jan. 15, 2004
Advisory group advocates universal health care
BY ROB STEIN
Washington Post
WASHINGTON — The United States must find a way to provide health
care coverage to all Americans by the year 2010, the National Academy
of Sciences recommended Wednesday.
Culminating the most detailed, authoritative examination of the pain
and suffering caused by America's uninsured, a committee of the academy's
Institute of Medicine for the first time formally recommended that
the nation guarantee health insurance for every citizen.
"The lack of health insurance for tens of millions of Americans
has serious negative consequences and economic costs not only for
the uninsured themselves but also for their families, the communities
they live in, and the whole country," concluded a 16-member committee,
composed of a diverse array of health policy experts.
"The situation is dire and expected to worsen. The committee
urges Congress and the administration to act immediately to eliminate
this longstanding problem."
The institute did not estimate what universal coverage would cost,
and it did not advocate a specific universal health plan. Instead,
it offered a "checklist" of five principles for assessing
proposals.
It said universal health insurance should be universal, continuous,
affordable, sustainable and should promote access to high-quality
health care.
While some criticized the report for a lack of specificity and for
not pressing for action sooner, overall it drew praise from across
the political spectrum.
Stuart Butler of the right-leaning Heritage Foundation called it "pretty
much on the mark," although he wondered what the committee meant
by minimum coverage and how much any solution might cost.
But the recommendation of universal coverage, unveiled on the day
that President Bush proposed building a space station on the moon
and sending humans to Mars, was not embraced by his administration.
"I just don't think it's in the cards," said Health and
Human Services Secretary Tommy Thompson. "I don't think that
administratively or legislatively it's feasible."
Previous institute reports concluded that more than 43 million Americans
lack health insurance and that:
• Uninsured Americans get about half the medical care of people
with insurance.
• About 18,000 Americans die unnecessarily each year because
they lack health insurance.
• Even when one family member is uninsured, the whole family
is at increased risk for suffering financial catastrophe because of
the expense of an illness or injury.
• The nation loses between $65 billion and $130 billion a year
because of poor health and premature deaths by uninsured Americans.
The Cox News Service contributed to this report.
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© 2004 Pioneer Press and wire service sources. All Rights Reserved.
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