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April 25, 2013 | 10:01 AM | By

Boston ER Doctor Finds Marathon Memories Hard to Shake

By Leana Wen, for NPR

(Jim Rogash/Getty Images)

(Jim Rogash/Getty Images)

I have a recurring nightmare where I am performing CPR on a patient who turns out to be my husband.

Last Monday, my nightmare nearly came true.

It was 2:50 p.m., and the Massachusetts General Hospital ER was filled to capacity.

In the section where I was working, my patients were critically ill, with strokes, heart attacks and overwhelming infections. Even the hallways were packed with patients receiving emergency treatments.

A call over the loudspeakers announced that there had been two explosions. Many people were injured. That’s all we knew.

Screams mixed with ambulance sirens. The loudspeaker sounded again and again, announcing that more patients were on their way.
Doctors, nurses and transporters disconnected monitors and rushed to send every patient to other areas of the hospital.

As we cleared the emergency room, there was a second call. These were bombings. There were fatalities and dozens, maybe hundreds, of injured. How many were coming to Mass General? Nobody knew.

Three minutes later, the doors flew open. Stretchers came, one after the other. Some victims had no pulse and weren’t breathing. Others had legs blown to shreds. All were covered with blood and soot.

The ER smelled of burnt flesh, and each stretcher left behind a fresh trail of blood. Continue reading →

FILED UNDER: Boston Bombings, Emergency Medicine
April 22, 2013 | 10:24 AM | By

Sacramento Native and Her Husband Face Amputation, Rehab Together After Boston Bombings

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica's Facebook page)

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica’s Facebook page)

A week after the Boston Marathon bombing, only the most seriously injured are still hospitalized. Sacramento native Jessica Kensky Downes and her husband Patrick are among them. As Martha Bebinger of WBUR reports, the couple were at the finish line when the explosions ripped through the crowd. Patrick and Jessica both each lost the lower part of their left legs.

From WBUR:

Friends are having a hard time reconciling this news with memories of the joyful pair who married just last August.  Smiles in photos of Jessica and Patrick jump off the screen.

“But that’s not just a photograph,” says Leslie Kelly, who watched Jessica grow up just outside Sacramento, Calif.  “Those two are the happiest, most optimistic, wonderful people,” continues Kelly, which provides “a real good foundation for both of them going forward.” Continue reading →

FILED UNDER: Boston Bombings
June 29, 2012 | 11:51 AM | By

Will Employers Start Dropping Employees From Health Plans? Discuss.

Will employers stop covering employees and push them to the exchanges once they are set up in the 50 states? (STAN HONDA/AFP/GettyImages)

Now that the future of the Affordable Care Act has been decided – to some degree – the debates over what it means have begun.

Does the act potentially impose a tax on Americans or a penalty? Will the health care system become uniformly robust, or will it put a huge burden on physicians in private practice?

And another biggie that you’ll be hearing about:

The Chronicle has a piece this morning, with a link to a report in McKinsey & Company, which suggests: YES, given the opportunity, employers will stop offering coverage. But in Massachusetts, which has a similar law already in place, that hasn’t been the case.

Who is right? Probably this report from the Commonwealth Fund that sorts through a number of studies and concludes it will be hard to know how it will shake out until large employers are eligible for the health exchanges in 2017.

Studies and surveys on the subject aren’t hard to find, but they are hard to reconcile. Just since June 2010, there have been at least seven surveys on the subject.1 So, will 2.7 percent of employers drop coverage as this survey suggests? Or will 18.8 percent drop coverage, as this survey, conducted one month later, suggests? Or were researchers at RAND correct when then calculated in late 2010 that employers would offer coverage to an additional 13.6 million workers once the exchanges, penalties, and various subsidies are all up and running?2

Let the debates begin.

FILED UNDER: Policy, Reform, Employer insurance, health exchanges
June 28, 2012 | 7:03 AM | By

Supreme Court Watch: Decision on Health Care Expected Shortly

We’re closely monitoring the events at the Supreme Court. The Justices will enter the courtroom momentarily. The health care decision will likely be the last of those issued today, according to scotusblog.com.

Someone asked the moderators there why healthcare is being decided on the last day of the term. The answer:

For one thing, it was only argued in late March and it often takes several months to write opinions in complicated cases. In addition, in big cases where there are multiple opinions, it takes a while for the dissents and concurrences to get written. Finally, the Justices often just take as much time as is available to polish their opinions in big cases.

For more on the possible implications for California see this excellent post by KQED’s Jon Brooks and Mina Kim.

FILED UNDER: Affordable Care Act, Health Care and the Supreme Court
March 29, 2012 | 10:26 AM | By

Full Audio & Transcripts: Supreme Court’s Oral Arguments on the Health Law

(Jessica Marcy: KHN)

(Jessica Marcy: KHN)

The Supreme Court’s historic hearings of the Affordable Care Act have wrapped up. The Court addressed four issues over the last three days and held a total of six hours of oral arguments.

Below is complete audio and transcripts from each set of arguments.

First, the court heard arguments about whether it can even consider the case now. Under the new law, the first penalties would be assessed in 2015 for those who do not purchase health insurance. An arcane 1867 law says people can’t sue over a tax until they pay a tax. Must the court wait until 2015 to decide whether the health law is constitutional?

You can listen to the 90 minutes of oral arguments here:

Play audio:
Audio player needs Flash9+ (download) and JavaScript.

Or read on for the complete transcript as well as audio and transcripts from the other arguments:
Continue reading →

FILED UNDER: Reform, Affordable Care Act, Health Care and the Supreme Court
March 28, 2012 | 3:15 PM | By

Court Considers Whether Entire Health Care Law Should Be Struck Down

By: KQED News Staff and Wires

(Jessica Marcy: KHN)

(Jessica Marcy: Kaiser Health News)

The Supreme Court signaled Wednesday that it could throw out other key parts of the Affordable Care Act if it first finds the individual insurance requirement unconstitutional.

On the third and last day of arguments, the justices appeared to accept the administration’s argument that at least two important insurance changes are so closely tied to the insurance requirement that they could not survive without it. Those two changes are the popular provisions that both require insurers to offer insurance to applicants with pre-existing conditions and also requires insurers to charge the same rates to people who are roughly the same age, regardless of their health.

Those changes should go, the Obama Administration argued, because without the individual mandate, people might wait until they’re sick before they signed up for coverage. Not enough people would be in the health insurance pool to spread risk. Ruin could come to the insurance market.

In short the Court faces three scenarios if it strikes down the individual mandate: Continue reading →

FILED UNDER: Reform, Health Care and the Supreme Court
March 28, 2012 | 12:15 PM | By

Audio/Transcripts of Supreme Court Hearings on the Fate of the Health Law

Updated 12:15pm PT

The Supreme Court heard two sets of oral arguments today in its final day of considering the health care overhaul. The second arguments were extended and wrapped up about an hour ago. In that session, the Court addressed the question:

Is the Medicaid expansion constitutional?

Remember that Medicaid is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving any federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states have challenged this requirement saying that withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion–including California–say that Congress can constitutionally attach such conditions under what’s known as the “Spending Clause.”

You can listen to the complete oral arguments about Medicaid expansion here:

Play audio:
Audio player needs Flash9+ (download) and JavaScript.

Or read on for the complete transcript … and for audio/transcripts of all the Court’s earlier sessions:
Continue reading →

FILED UNDER: Reform, Health Care and the Supreme Court
March 28, 2012 | 6:41 AM | By

Can Health Law Stand Without the Individual Mandate?

The constitutionality of the Medicaid expansion is also before the Court today.

(Image: Kaiser Health News)

(Image: Kaiser Health News)

WASHINGTON (AP) — The heart of the Obama administration’s health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.

The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.

The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress’ authority to require virtually every American to carry insurance or pay a penalty. Continue reading →

FILED UNDER: Reform, Health Care and the Supreme Court, Severability