Man down

I'm boiling.

Yesterday out at "the Corner" I witnessed another example of the daily plight of the powerless who live on our very unforgiving streets.

As I sat in my car taking a phone call that lasted several minutes, an ambulance pulled up at the service station next door.  I noticed the ambulance, but could see no one to whom the crew was attending. By the time I finished my phone call, the ambulance was gone, but I noticed that the patient remained.

A very ill Hispanic gentleman sat leaned up against the outside wall of the service station building next door to the old house where I sit on Thursday afternoons.  He appeared to be semi-conscious and unresponsive.  His friend and protector, Joe, informed me that he had just been discharged from the hospital, but was clearly in trouble.  The ambulance had refused to transport him back to the hospital for reasons I couldn't understand.

I called 911 and requested that an ambulance return.

In a few moments, the ambulance with the same crew returned.

I insisted that they pick him up and take him back to the hospital.  The man was diabetic and now lying down flat on his back on the concrete pavement.

The crew went to work, placed the man on a stretcher and loaded him into the ambulance and drove away.

As they left, my homeless friends were relieved and hurt.

Why hadn't the ambulance crew responded to their pleas on behalf of their friend?

Why did I get the needed action and not them?

Why had the man been discharged from the hospital?

Was his fate all about money?

Was he "uninsured," not even receiving Medicaid? 

Was he undocumented and thus, fair game for being left to die on our streets? 

The situation left us with so many unanswered questions.

God help us!

Are we to conclude that there actually are expendable people today in our community?

Is power concentrated in almost exclusively in the hands and voices of people like me, but not my friends who are simply poor even though experts on the subject of poverty?

I need answers.

I'm steamed.

Health Insurance and employers

Paul Krugman offered up this data set last week in The New York Times. 

Sobering facts. 

For years I've wondered how long American corporations and business can continue to foot the bill for the nation's health care strategy.  The time is coming when thoughtful business leaders will join with consumers to drive forward a more comprehensive, sane plan for providing the health care benefits we all need. 

The Collapse of Employment-Based Coverage

Reed Abelson at Economix points us to a startling study on the effects of the Great Recession on health insurance. You can see similar trends in the Census data, but for whatever reason this survey — carried out by a highly reputable group — is even stronger. Here’s the key picture:

What this says is that the system that has provided workable insurance coverage to many (but not enough) Americans is coming apart at the seams. And this in turn means that if health reform goes down, we’re going to be looking at a wave of misery spreading across the land.

More on health care debate from T. R. Reid (Part 3)

The following from T. R. Reid's important book, The Healing of America:  A Global Quest for Better, Cheaper, and Fairer Health Care:

Even if we found good ideas in other countries, could the United States find the political will at home to use them? One basic political truth about American health care is that our system is strongly resistant to change. The vested interests that are doing well in the health business now – insurance companies, hospital chains, pharmaceutical companies – have blocked significant restructuring of our system (p. 22).

All the developed countries I looked at provide health coverage for every resident, old or young, rich or poor. This is the underlying moral principle of the health care system in every rich country – every one, that is, except the United States (p. 23).

Every country on earth faces difficult problems in providing medical care to its people. Nobody’s system is perfect. There are health care horror stories in every wealthy country – and they’re true… But for all of their problems, the other industrialized countries tend to do better than the United States on basic measures of health system performance: coverage, quality, cost control, choice. What are we doing wrong? (pp. 26-27).

When it comes to the essential task of providing health care for people, the mighty USA is a fourth-rate power (p. 28).

How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.

For all the money America spends on health care, our health outcomes are worse on many basic measures than those in countries that spend much less (p. 31).

The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care. . .

All the other developed countries have decided that basic health insurance must be a nonprofit operation. In those countries, the insurance plans – sometimes run by government, sometimes private entities – exist only to pay people’s medical bills, not to provide dividends for investors… The U.S. private insurance industry has the highest administrative costs of any health care payer in the world (pp. 36-37).

If insurance companies have to cover everybody who applies, they need to have everybody in the insurance pool to cover the costs. All other developed countries require both “guaranteed issue” and the “individual mandate.” The United States has neither (p. 38).

More on health care debate from T. R. Reid (Part 2)

As promised, here's more from the important book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T. R. Reid:

Our nation's healthcare system has become excessively expensive, ineffective, and unjust. Among the world's developed nations, the United States stands at or near the bottom in most important rankings of access to and quality of medical care. (pp. 8-9).

The thesis of this book is that we can bring about fundamental change by borrowing ideas from foreign models of health care. For me, that conclusion stems from personal experience. I’ve worked overseas for years as a foreign correspondent; our family has lived on three continents, and we’ve used the health care systems in other wealthy countries with satisfaction. But many Americans intensely dislike the idea that we might learn useful policy ideas from other countries, particularly in medicine. (p. 11).

Anyone who dares to say that other countries do something better than we do is likely to be labeled unpatriotic or anti-American… The real patriot, the person who genuinely loves his country, or college, or company, is the person who recognizes its problems and tries to fix them. (p. 13).

Eisenhower’s strategic plan envisioned months of painful slogging across a shattered German countryside. But then his forward commanders reported an amazing discovery: a broad ribbon of highway, the best road system anybody had ever seen, stretching straight through the heart of Germany. This was the autobahn network… “I decided, as President, to put an emphasis on this kind of road-building.” (President Eisenhower – which led to the “Dwight D. Eisenhower System of Interstate and Defense Highways” – the Interstate Highway System). Eisenhower, the pragmatic commander, was willing to borrow a good policy idea, even if it had foreign lineage. (pp. 14 & 15).

Each nation’s health care system is a reflection of its history, politics, economy, and national values. (p. 16).

More to come. . .

Health care challenges concern communities

If you read The Dallas Morning News, you may have seen the articles in Sunday's edition (May 17, 2009) addressing the health care challenges facing the nation and our communities.

Included in the newspaper version of the report was a interview with several of us who work in the health care space. You can read the "virtual roundtable" discussion here.

Also, in the feature report were the stories of individuals in our community and how they are handling their particular challenges with gaining access to affordable health care options. One of our Project Access Dallas patients was featured. Read this story here.

Health and wellness challenges affect our communities all across the Metroplex and shape our work as we attempt to make things better for individuals and neighborhoods.

Your ideas welcomed.

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Failing Texas communities

I've always felt that making a profit on health care services, especially for the poor and most vulnerable, just didn't pass the ethical "sniff test." I know I'm likely in the minority on this one, or maybe not.

Tell me how you feel about it.

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Several years ago, I got into a conversation with a very bright young business man. Somehow the subject of universal health care came up.

I'll never forget his words, "Some people actually believe that health care is a basic human right. Can you believe that? That everyone is entitled to health care?"

I also remember that our talk came to fairly speedy end after I voiced my opinion about the matter.

What do you think?

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Along these lines, hats off to The Dallas Morning News for its four-week series, "State of Neglect." You can get to the ongoing report here. The timing is perfect just as the Texas Legislature prepares to open its 2009 session.

So far the report reveals how the State of Texas has aggressively "outsourced" health benefits coverage for the poor, the disabled and the elderly to the private, for-profit insurance industry--in this case, Evercare of Texas, a division of UnitedHealth Group. To say that the company has under performed would be a great understatement. If you live in Texas, you'll want to read the report.

The result of this outsourcing has been neglected patient care, an incredible lack of responsiveness, inferior services for those who need them most and amazing profit for corporations and lobbyists who work on their behalf.

Here's how the Dallas Morning News sums things up:

"This month the Texas Legislature will open its 81st session with a $10 billion budget surplus. Many leaders have called this the happy result of a state government that keeps taxes low and regulation light, and that makes Texas, for the vast majority of its residents, a great place to live.

"Unless you are hospitalized. Or buy insurance. Or breathe the air. Or engage in any other daily activity that requires state oversight. . . .

"Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors."

Frankly, the entire situation in Texas in the health and human services sector is an on-going disaster. Reform is needed, comprehensive, radical reform.

It is time we all called for better outcomes for everyone.

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Don't count the uninsured: problem solved!

Almost 50 million Americans enter each new day without health insurance coverage of any kind. That fact concerns the vast majority of health care and public health experts.

But, not everyone agrees.

Like President Bush, some people believe that since emergency departments across the nation cannot refuse to treat anyone who shows up in their waiting rooms, everyone enjoys health care "coverage."

This includes Dr. John Goodman (PhD, not MD). Here's what the good professor has to say about the uninsured:

"The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American [even illegal aliens] as 'uninsured.' "

Steve Blow did a feature column in The Dallas Morning News on Goodman last week. Read his entire story here.

Goodman has been a high level advisor to politicians who make decisions about health and wellness issues in our nation.

When I first read Blow's report, my mind shifted immediately to patients who come to our Community Health Services building here at Central Dallas Ministries.

I can't forget one hard working father who battled kidney stones. Uninsured, he went to the ER of a major hospital in town. The hospital treated him with pain killers and antibiotics. They never hospitalized him because they didn't have to. The law requires treatment on an emergency basis, not ongoing treatment for "self-payers" like him. By the time he reached our doors he was in the midst of end-stage renal failure.

We went to work to get him a kidney transplant and helped negotiate the rate and raise the cash to pay for the procedure that saved his life, sent him back to his family and to work. We were glad to help. But our response is not a replicable model for health care.

Sadly, our friend's case is not all that unusual. Emergency rooms were not designed to serve as "medical homes" to millions of uninsured Americans.

Then, what about prevention? You know, regular checkups that often lead to early detection. What about medications that can extend life and control the chronic conditions so many of us suffer with.

From a cost benefit analysis, this preventive strategy saves everyone lots of money.

Dr. Goodman, you've got to be kidding!

We need to do much, much better. All we lack currently is the will and the courage.

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New partnership means better access to better meds for the working poor in Dallas

Last Wednesday, Central Dallas Ministries (CDM) and CommuniCare, a non-profit organization in South Carolina, unveiled an exciting new partnership that will bring new prescription medicine benefits to thousands of low-income patients.

All of the major pharmaceutical companies in the United States have "indigent patient" medication programs that offer free medicines to low-income patients who qualify. The challenge with these programs has been with the procurement process. Until now, the process involved a physician or other medical staff being required to complete a rather long and tedious application every time a medication was prescribed. The time and administrative paper work requirement made the programs difficult to use, especially for clinics like ours that serve thousands of patients with a limited staff and few volunteers.

CommuniCare, under the leadership of Ken Trogdon, has worked hard over the past several years to develop a relationship with all of the major pharm corporations and a new process of accessing the indigent drug program. Thanks to CommuniCare, now our patients will need to qualify for such programs by means of one annual application and a $20 registration fee. One form and one fee for any and all prescriptions from any of the companies with the programs--huge improvement!

The outcomes for CDM and our patients are exciting. State of the art medications will now be available to patients at no cost beyond the registration fee, a fee we pay when patients cannot. We will achieve significant cost savings that will allow us to purchase more medications that are affordable and treat more patients in our clinic.

Beyond the benefit to CDM, as the new process is perfected here, we hope to "roll it out" across the Dallas area among our indigent health clinic partners.

This new development promises to have major positive consequences for the uninsured working poor men, women and children who come to us for care, as well as for our other partners who face similar challenges.

We are grateful to our partners at CommuniCare who are moving outside the state of South Carolina for the first time in this new initiative. As Ken says, "If we can make this work in Texas, we can make it work anywhere in the nation."

Thanks also to Dr. Jim Walton, Vice-President of Health Equity for the Baylor Health Care System and CDM Board member, for his tireless efforts in seeing this new partnership become a reality.

To view a WFAA Channel 8 television news report on our press conference announcing the new partnership just click on this link:

http://www.wfaa.com/video/index.html?nvid=232336&shu=1

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Health Care, Justice, Profit and Racism

"The fact that we don't have universal healthcare is racist."

Vijay Prashad, Associate Professor of International Studies, Trinity College and author of Keeping Up With the Dow Joneses

"The fundamental issue is that we cannot continue to have a healthcare system with profit as its primary goal and expect it to help people become healthy."

Praxis News & Notes (Fall 2003)
The Praxis Project, Washington, DC

Some important facts on SCHIP

Recently, Congress passed and the President vetoed a new version of the State Children's Health Insurance Program (SCHIP).

As Congress prepares for another vote in an attempt to override Mr. Bush's veto, several important facts should be kept in mind.

1) The bill under discussion will provide health insurance coverage for almost 4 million more children.

2) The bill targets only low-income children. The bill’s new cap is set at a maximum of 300% of the Federal Poverty Level or just under $62,000 gross pre-tax income (not net income) for a family of 4. The states have the option of setting their own cap levels. Only 600,000 of the 3.8 million new children gaining coverage under the bill are not currently eligible and would become eligible due to the proposed funding expansions if states so chose. Anyone who tries to pay for private or employer sponsored health plans understands that income at 300% of poverty does not guarantee a family will be able to afford coverage.

If you believe the Congressional Budget Office, 84% of the children gaining coverage under the bill are either on the program now (but without the new money would have to be cut from the program for lack of funding) or are eligible now but not enrolled.

3) Contrary to some opposition propaganda, the bill reforms previous versions of SCHIP and cuts out adults. There will be no waivers under the new SCHIP legislation allowing for the provision of coverage for parents. Those states that have received such waivers in the past will have to transition parents to a separate program with a lower federal match. Further, the bill prohibits coverage for childless adults. States providing coverage in the past for childless adults under SCHIP will no longer be able to do so.

According to our friends at the Center for Public Policy Priorities (http://www.cppp.org/) "if the number of uninsured children grows this year at the same rate as last year, nearly 2,000 additional children will become uninsured every day."

Contact your U. S. Representative and each of your U. S. Senators to urge a vote for SCHIP when it comes up for a vote in the near future.

A vote for SCHIP is a vote for the health of America's children.

[Material for this post drawn largely from information provided by the Center for Public Policy Priorities, Austin, Texas]

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Aging

I suppose I looked into my own future last Tuesday. What I saw left me with very mixed emotions.

Tuesday was moving day for my parents.

For over 30 years my mother and father have lived in the same wonderful home in Richardson, Texas. Before that, my growing up years were spent at another, much more modest Richardson house where we first moved in 1953.

I have incredibly fond memories of that time and of that house. My dad bought the vacant lot next door to the house and me and my buddies turned it into a ball field--football in the fall, baseball in the spring and summer and track year round! Mark Wallis, one of my best friends, and I played "Home Run Derby" on that field for hours at a time.

Fifty-four years in the same town. Believe it or not, they have had the same P. O. Box and the same phone number for all those years. Well, technically, in the early days their phone number had about 6 fewer numbers than today! We transferred the same number to their new home. Stability is something they have known very well across the years.

My dad is 87, my mom is 86.

They have enjoyed a really great life together. Next month they celebrate their 68th wedding anniversary. They have had their health problems over the past fifteen years or so, but have done very well until just recently.

Their house became more than they could manage. Their health has begun to decline markedly.

We've been talking about a move into a more "manageable environment" for a couple of years. My dad's last heart flare up and surgeries forced our hand.

As a result, on Tuesday they moved into an independent living facility in Richardson. It is a very nice, two-bedroom apartment with meals furnished, along with other important amenities.

They didn't want to move.

My approach was to keep them out of the actual moving process. We relocated furniture and other household items during the day. Once the place was set up as much like home as possible, we brought them over and let them come in for their first night.

My mother cried. My dad thanked us.

It was an emotional time beyond words.

For the past two weeks, as he had regained his strength, dad has rehearsed his career--his stint as the first full-time executive with City of Richardson (1953-1959) back when the population was about 1,200. The entire city staff included him, a water department worker and a sanitation worker.

He reviewed the details of his career with the private development company he helped build. Until his most recent hospitalization, he was still going to the office one day a week. The owner of the company and one of my dad's very best friends died about two years ago.

My mom has been worried, depressed and up and down. It is how she handles disruptions like my dad's health issues. Of course, she suffers with her arthritis and gout, as well as several other health-related issues that remain both troublesome and chronic. Night before last she entered the hospital for a blood transfusion and other treatment. We're hoping she gets to come home today after a couple of nights there.

It is a tough time emotionally, as well as physically. . . for all of us.

So many memories came flooding back during the past several days.

I've been so very blessed by my parents and by the life they provided me. It is hard seeing them near the end of their journey. They are blessed with everything they need to make the process as pleasant as it can be, I suppose. Pray for them.

Going through this experience forces me to consider my own future, should I live so long. It's definitely a mixed bag. But, overall, the positive far outweighs the momentary negative.

One thing stands out to me in a huge way: my privilege is overwhelming.

I am thinking of my parents again this morning.

I'm also thinking of the elderly poor who are at about the same juncture in life as my folks, but without all of the blessings and benefits.

Life is a mystery. But many things are very, very clear to me as I look back and forward.

One American city leads the way

"San Francisco to Offer Care For Every Uninsured Adult"

That was the eye-catching headline of Kevin Sack's report printed in the upper left corner on the front page of last Friday's edition of The New York Times (A1, 17).

The City of San Francisco now offers "Healthy San Francisco" to all 82,000 adults who have no insurance. After a two-month pilot period focusing on two community clinics in the Chinatown area, the initiative rolled out to every part of the city yesterday.

The program to provide health care coverage to all uninsured adults in San Francisco is paid for mostly by the city itself.

The rationale back of this bold move on the part of city leaders? Officials believe that the city can provide "universal and sensibly managed care to the uninsured for about the amount being spent on their treatment now, often in emergency rooms."

Sack's report documents the unique nature of San Francisco as a community, including its political atmosphere, compact geography, unified city-county government structure, and a network of public and community clinics, as factors contributing to the innovative and aggressive public policy benefiting the city's uninsured. Until November, enrollment of patients in the plan will be limited to those with incomes below the federal poverty level. After this initial period of enrollment, the program will be open to any uninsured adult living in the city. The goal is to sign up 45,000 during the first year. The city will test the capacity of its medical infrastructure as it expands the enrollment.

By forging stronger connections between public and community-based, non-profit clinics, the city hopes to create a strong system of managed care for the uninsured. The goal is to turn the readily accessible clinics into medical homes for the uninsured.

What a bold move by a great city!

Possibly San Francisco will discover the secrets to making available universal health care coverage to all Americans. One thing seems clear at this point: this city cares about all of its people and it is taking a reasonable approach to solving pressing "bottom line" problems at the same time.

Sounds like a win-win to me.