Monthly Archives: May 2012

Quick Read / Opinion: Why The Supreme Court Should Uphold the Affordable Care Act

The Supreme Court will probably decide on the constitutionality of the Patient Protection and Affordable Care Act at the end of June. The big question on the table is, can the federal government mandate people to buy health insurance? Law professor Eric Segall of Georgia State University and  Associate Professor of Pediatrics Aaron E. Carroll of Indiana University believe they can — and they lay out the reasons why.

The Supreme Court’s decision on the constitutionality of the Affordable Care Act (ACA) will likely be handed down on the last day of this year’s term. If the Court finds that the ACA-either in whole or in part-violates the Constitution, the health care industry will be shaken to its core.

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New Health Care Jobs: How Healthy?

(US Navy: Flickr)

Hospital team moves patient from one bed to another. (U.S. Navy: Flickr)

California stands to reap tens of thousands of jobs because of the federal health care overhaul — according to a new report [PDF] by the Bay Area Council Economic Institute (BACEI).

Researchers compared the state’s 2010 workforce to what it might have been if the Affordable Care Act had been fully implemented in that year. They concluded that once the ACA is fully in place in 2014 almost 99,000 new jobs will be created as a result of the law, most of them in Southern California. The Sacramento Valley will see the largest increase rate: a 1.3 percent boost in job opportunities.

But ironically, health care jobs are not always healthy for the worker. Odd hours, ergonomics, and environmental factors contribute to specific risks for hospital and clinic workers.

By its nature health care is a 24-hour enterprise. Dr. Catherine Lau works nights almost exclusively as director of Nighttime Hospitalist Service at the UC San Francisco Medical Center. In an interview Lau said that while she appreciates the quiet, it can be “a little disorienting” to work at night in a windowless space. Shift-working nurses show higher rates of breast cancer, obesity and type 2 diabetes. Continue reading

From Healthy Families to Medi-Cal: Kids’ Health Care Access in Jeopardy

By Stephanie Snyder, California Watch

Low-income children in rural California are in danger of losing their doctors and health care plans under Gov. Jerry Brown’s budget proposal, state lawmakers, doctors and health advocates say.

The governor is proposing to transfer nearly 900,000 children enrolled in Healthy Families, the state’s Children’s Health Insurance Program, to Medi-Cal – a program aimed at serving the state’s poorest families, seniors and disabled residents.

One major concern is that many doctors who accept children in the Healthy Families program do not accept Medi-Cal, because of Medi-Cal’s lower reimbursement rates.

While combining the two programs might be a painless transition for children in urban areas with doctors who typically provide care to both Healthy Families and Medi-Cal patients, the transfer could make it tough for families in rural areas to find doctors who accept Medi-Cal.

“In the more rural areas or outlying areas, there would be quite a loss or quite a strain,” said Stuart Cohen, a San Diego pediatrician and California chairman-elect for the American Academy of Pediatrics. “Access to care would be a huge issue.” Continue reading

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

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

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.

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

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.

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.

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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.”

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