May 25, 2012 | 10:52 AM | By

No Death Panel Debate–Mass. Senate OKs “Palliative Care Awareness”

By Martha Bebinger, Kaiser Health News

(Ryan Wilcox: Flickr)

(Ryan Wilcox: Flickr)

It’s been almost three years since Sarah Palin claimed that end-of-life care options could turn into death panels.

But last week, with no discussion, legislators avoided a minefield that exploded repeatedly during the national health care debate. With a quick call of the ayes and nays, the Massachusetts Senate approved Amendment no. 121, “Palliative Care Awareness.” It requires that physicians and nurses in Massachusetts must talk to terminally ill patients about their end of life options, their risks and benefits and how best to manage their symptoms and pain.

Senate Republican leaders confirm that they have no objections … and it’s also supported by one of the state’s leading right-to-life groups.

In 2006, Massachusetts passed statewide health insurance reform which requires nearly every resident to carry health insurance. It’s considered a model to the feds’ Affordable Care Act.

Since then, Massachusetts has been implementing its plan. Counseling advocates say they won’t let Palin’s interpretation of end-of-life care derail their mission.

“The national controversy about death panels — what AARP called lies about death panels — is completely misguided,” said Dr. Lachlan Forrow, who directs ethics and palliative care programs at Beth Israel Deaconess Medical Center. “In Massachusetts we can unite and show how to do it right.” Continue reading →

FILED UNDER: Policy, End of Life Care, Massachusetts Health Care Reform
May 24, 2012 | 3:47 PM | By

Meet the New Costs, Same as the Old Costs

By David Gorn, California Healthline

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

After more than a year of battling over eliminating and then restructuring adult day health care coverage for Medi-Cal beneficiaries, California’s budget for delivering that care is similar to what it was before all the haggling started.

The Community-Based Adult Services program grew out of a lawsuit challenging the state’s proposal and replaces the Adult Day Health Care program. CBAS will provide services to 80 percent of previous ADHC beneficiaries and is funded at a similar level to the original program.

“The original budget for ADHC was $170 million, and the current CBAS budget is

“I guess I just don’t understand why we had to go through all of this.”
$155 million,” said Lydia Missaelides, executive director of the California Association of Adult Day Services. “That means you’re looking at roughly the same cost to provide the same services to 80% of the beneficiaries.”

Of course, that doesn’t count the expense of legal battles, or the daunting number of man hours spent designing and implementing a new system, not to mention the constant arguing and debating over more than a year, she said. Missaelides sighed at the idea of it. Continue reading →

FILED UNDER: Money, Policy, Adult Day Health Care, Medi-Cal
May 24, 2012 | 1:45 PM | By

Perhaps the Most Vulnerable … Budget Cuts Hit Mentally Ill Especially Hard

(Lauren Whaley: CHCF Center for Health Reporting)

(Lauren Whaley: CHCF Center for Health Reporting)

In a series they’re calling “Mental Breakdown” the Modesto Bee collaborated with the Center for Health Reporting in a sobering look at how state and county cuts are devastating county mental health departments — by focusing close to home in the Central Valley’s Stanislaus County. Modesto is the county seat of Stanislaus.

Reporters describe people with mental illness who should be in state mental hospitals instead spend weeks in local jails, waiting for beds. Hospital emergency rooms have seen a dramatic increase in mentally ill patients. In all likelihood, counties across California are feeling the same impact.

But the series also speaks of hope. With the right treatment, even people with the most serious mental illnesses can do well — as this short video between father and daughter attests:

You can read more about Matt Freitas and the work he does in his clinic here.

FILED UNDER: Place Matters, Policy, Mental Illness
May 23, 2012 | 1:21 PM | By

Powerful Videos in HIV Awareness Campaign

By Marnette Federis

"Then my 25th birthday came. I never thought I would make it this far," says Filipino-American Henry Ocampo in his video "Parachute."

"Then my 25th birthday came. I never thought I would make it this far," says Filipino-American Henry Ocampo in his video "Parachute."

While Asian-American and Pacific Islanders have very low rates of HIV infection — in the single digits — they had the highest rate of increase in new HIV infections between 2001 and 2008. While other ethnic groups had declining infection rates, Asian-Americans and Pacific Islanders experienced a 4.4 percent increase.

What’s more alarming to many advocates is the low testing rates within the community. Less than one-third of Asian-Americans and less than half of Pacific Islanders have been tested for HIV. Experts estimate that many who have the virus delay getting tested. If they don’t get tested, they cannot be treated, potentially shortening their lives.

For many Asian-Americans and Pacific Islanders, the topics of sex and sexually transmitted diseases are taboo.
One reason why people do not get tested is the fear and stigma that surrounds HIV. For many Asian-Americans and Pacific Islanders, the topics of sex and sexually transmitted diseases are taboo. The burden of shaming one’s family and misconceptions about the disease are high, according to Cecilia Chung, newly appointed San Francisco Health Commissioner and noted advocate for HIV awareness.

“They still have … stereotypes about people living with HIV,” said Chung. “There are surveys where people think that people with HIV should not work at restaurants. … That’s pretty significant.” In addition, advocates say Asian American and Pacific Islander communities have been overlooked in national HIV/AIDS awareness campaigns. Continue reading →

FILED UNDER: Place Matters, HIV/AIDS Awareness
May 23, 2012 | 10:23 AM | By

PSA Debate on Morning TV: American Cancer Society vs. Basketball Coach

The debate about the U.S. Preventative Services Task Force giving the PSA test a “D” rating was all over the morning talk shows today. But perhaps the most interesting debate happened during a commercial break. While this clip did not air, CBS fortunately recorded it.

Watch as Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, and former basketball coach Digger Phelps, who has had surgery for prostate cancer clearly articulate the two opposing poles of the PSA test.

Hat/Tip to HealthNewsReview for blogging the video.

Near the end, Phelps passionately argues against “watchful waiting,” saying the idea of having cancer is too frightening to postpone treatment. Brawley starts to make the case for informed consent, but doesn’t have time to finish in this clip.

But this is exactly the paradox of going ahead and doing the test. Brawley estimates a million men have been needlessly cured of their prostate cancer– a disease men are significantly more likely to die with and not from.

This is what’s behind the U.S. Preventive Services Task Force recommendation: if you can’t live with doing nothing in the face of a prostate cancer diagnosis, then don’t have the PSA test in the first place. You are more likely to be harmed by the treatment–the harms range from incontinence, impotence and death.

FILED UNDER: Policy, You're the Boss, Overtreatment, PSA Test
May 22, 2012 | 2:03 PM | By

Quick Read: Stop Doing the PSA Test. Now.

A federal task force issued its final decision: no more routine PSA tests for men of any age. Dr. Otis Brawley, chief medical officer of the American Cancer Society told NPR’s Shots blog, “A goodly proportion of men who have localized prostate cancer actually have a disease that will never kill them if left alone. More than a million men were needlessly cured of their prostate cancer over the last 20 years.”


The PSA test should be abandoned as a prostate cancer screening tool, a government advisory panel has concluded after determining that the side effects from needless biopsies and treatments hurt many more men than are potentially helped by early detection of cancers.

Read more at: www.latimes.com

May 22, 2012 | 11:19 AM | By

Bill Would Make Vaccine “Opt-Out” A Little Tougher

(Jeff J. Mitchell: Getty Images)

(Jeff J. Mitchell: Getty Images)

California is one of 20 states that allows parents to “opt out” of vaccines for their children simply by signing a form. It’s called a “personal belief exemption.” But AB 2109 would change that. The bill has cleared the Assembly and is starting its path through Senate committees.

If the bill becomes law, parents who wish to refuse vaccines would first need to receive counseling from a licensed health professional about the risks and benefits of skipping immunizations for their children.

Vaccination rates in California have been dropping in recent years, worrying public health officials. Ten infants died in a whooping cough outbreak in 2009.

“This is not about taking away the rights of parents to make decisions.”
“Democratic Assemblyman Richard Pan wrote the bill. He’s also a pediatrician and says parents’ decision not to vaccinate their own child puts others at risk too.

Very young children, infants may be too young to be immunized,” he told me in a recent interview. “People with cancer and on chemotherapy, people with HIV or AIDS … they cannot receive immunizations.”

Continue reading →

FILED UNDER: Place Matters, Policy, Childhood Vaccines
May 22, 2012 | 8:16 AM | By

Quick Read / Video: For the Uninsured, the Wait for Health Care

The independent documentary “The Waiting Room” was shot at Oakland’s Highland Hospital and is now making the rounds at film festivals across the country. Click through to the 5-minute short. It captures the power of what it means to be uninsured and trying to access health care through the emergency room of a large safety-net hospital.


This Op-Doc video, adapted from my feature-length documentary “The Waiting Room,” presents a composite day in the life of patients at Highland Hospital – edited from five months of filming in 2010.

Read more at: www.nytimes.com

May 21, 2012 | 11:39 AM | By

Poll: What’s It’s Like To Be Sick In America

By Richard Knox and Joe Neel, NPR News and Kaiser Health News

In the lull between the Supreme Court arguments over the federal health overhaul law and the decision expected in June, we thought we’d ask Americans who actually use the health system quite a bit how they view the quality of care and its cost.

Most surveys don’t break it down this way.

Source: NPR/Robert Wood Johnson Foundation/Harvard School of Public Health Poll. Credit: Alyson Hurt/Nelson Hsu, NPR

Source: NPR/Robert Wood Johnson Foundation/Harvard School of Public Health Poll. (Image: Alyson Hurt/Nelson Hsu, NPR)

When the results came back, we found that people who have a serious medical condition or who’ve been in the hospital in the past year tended to have more concerns about costs and quality than people who aren’t sick. No big surprise there.

But what was notable: 3 of 4 people who were sick said cost is a very serious problem, and half said quality is a very serious problem.

Nearly half of those with recent serious illness say they felt burdened by what they had to pay out of their own pocket for care.

The recently ill are more likely to say the cost and quality of care have worsened over the past five years, compared to people who weren’t sick.

Among people who’ve recently required a lot of care, significant proportions say their treatment was poorly managed, with nearly a third complaining of poor communication among their caregivers. One in eight believe they got the wrong diagnosis, treatment or test. Continue reading →

FILED UNDER: Policy, Reform
May 21, 2012 | 10:56 AM | By

Proposition 29: First Cigarette Tax Increase in 13 Years. Yes or No?

By Sarah Varney

(Ferran Jorda: Flickr)

(Ferran Jorda: Flickr)

California voters are schizophrenic when it comes to regulating smoking. Polls show broad support for bans on smoking on sidewalks and public parks. Some cities have even outlawed smoking in apartment buildings.

But in 2006, the state’s voters rejected a ballot measure to hike cigarette taxes. While California was once the most aggressive state in taxing cigarettes, the tax rate here is lower than that of 32 other states. At 87 cents a pack, California’s cigarette taxes are 60 cents lower than the national average.

Proposition 29 — on the ballot June 5 — would change that. It would raise the tax on cigarettes to almost $2 a pack.

Jane Warner, president of the American Lung Association of California, hopes voters will be game to raise tobacco taxes when they decide the fate of Prop 29. “We’ve made this initiative very simple,” she says. “It was written by the American Lung Association, the American Cancer Society and the American Heart Association. It is very simple, very clear — to save lives.”

The Centers for Disease Control has found increasing the price of cigarettes reduces demand. Teenagers are especially sensitive to price, so if the tax is approved, fewer of them would pick up the habit. Right now about 12 percent of Californians smoke. That rate could drop significantly if Prop 29 is approved.

Continue reading →

FILED UNDER: Money, Policy