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By Erin Lieber

I recently wrote an article entitled “Life, Liberty, the Pursuit of Happiness…and health care?”, which posed the question: Is health care a right?

This question becomes even more important now that the House of Representatives has passed their health care reform bill. Here’s a quick snapshot of how it went down: President Obama arrived at Capital Hill to urge members of the House to pass a broad health care reform bill and vote for the biggest change in health policy the U.S. has seen in decades. The bill passed by a narrow margin of 220 votes to 215, with the support of only one Republican, Rep. Joseph Cao of Louisiana.

The Bill, in current form includes, but is certainly not limited to:
-Creation of insurance exchanges to provide coverage to those not insured by their employers
-Creation of a public option to compete with the private companies on the exchange
-Mandates for individuals to have insurance coverage
-Subsidies for those making less than $88,000 per year to purchase coverage
-Surcharges on taxpayers who earn more than $500,000 or $1,000,000 a year
-Requirements for businesses to cover employees
-Acceptance of preexisting conditions by insurance companies
-$400 billion (at least) in Medicare and Medicaid cuts to pay for the one trillion dollar reform over ten years

What a lot of people don’t realize is that while we know that the bill barely passed, what is encouraging is that only 26% of voters in the House felt it should pass “as is”, without significant change. It is also important to note that what may have pushed the votes over the edge to pass the bill was an inclusion that anyone receiving government subsidies could not use it on abortion related services, therefore garnering some of the conservative vote.

So, what’s next? In the next few weeks we will likely see the Senate struggle with the changes to this bill and the abortion clause. President Obama has suggested he would like to have a bill on his desk by the end of the year. Stay Tuned.

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By: Erin Lieber

The debate over health care reform in the U.S. is quickly transitioning from concept to reality. Just this past week Nancy Pelosi unveiled the House health care reform bill, weighing in at just under 2,000 pages and just under one TRILLION dollars. Whether or not this marks the progress, it certainly marks a milestone in the health care debate. A very real bill is now on the table – Affordable Health Care for America Act – H.R. 3962. As we think about the changes health care reform may bring and how they will affect us, a fundamental question needs to be addressed: What exactly is health care?

The United States was exposed to our first, albeit loosely based, health insurance policy in 1929 when a group of teachers made a deal with a Texas hospital to pay a fixed price of $6.00 in exchange for 21 days of hospitalization. Since then we have seen many changes in our health care delivery system and the multifarious efforts have certainly become more complex as we survey the health care situation 80 years later. One thing that has not changed is the fundamental debate over where health care belongs, be it with private industry or government. To that end, the debate defining health care as a right or as privilege, has had staying power since the first insurance policy was put into effect. Whether or not health care is a “right” plays a very important role at the core of health care reform, and I encourage you to think about the following:  Is health care a right, a privilege, or something else entirely?

Walter E. Williams, the John M. Olin Distinguished Professor of Economics at George Mason University, has this to say about the definition of a right: “the historical definition of a right is something that can simultaneously exist among individuals, without incurring any additional cost or obligation to another, except for that of non-interference. Everybody has a right to speak freely, for my ability to speak or express my opinion imposes no cost or obligation on another, except perhaps the obligation of non-interference”.

Our Declaration of Independence states that “all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the pursuit of Happiness.” If we believe in the Declaration of Independence and the assertions put forward by our founding fathers, can we classify health care as a right? And why is it that we have to decide if health care is a right or a privilege? Maybe we should consider it a product or service like any other that we consume. What about all the people who choose not to be insured; young invincibles, for example, who make the personal choice to go without coverage and significantly inflate our total health care expenditures. And what about the 20% of people in the country, that research suspects could be insured under Medicaid and other government run programs and have not signed up? Does this mean then, that it is not their “right”, to go without coverage. And if health care is a right, whose duty is it to make sure every citizen has access to that right? These are very difficult questions that will vary greatly based on our ideologies and life experiences.

I encourage everyone who reads this to give some thought to whether you feel health care is a right, a privilege, some hybrid of both, or something else completely.  As we all try to understand the health care debate, you may find this is a very good place to start.

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by Dr Miriam Carasa EdD, RN, CNA

Our NY Attorney General Andrew Cuomo announced this week a nationwide reform of the consumer reimbursement system for “out of network” health care charges. This significant achievement is the result of  Attorney General Cuomo’s healthcare reform investigation into the  database that was used by insurers nationwide to set reimbursement rates when patients went out of network for health services. This investigation discovered that  the Ingenix database used to set the rates for out of network reimbursement is owned by  one of the largest insurers in the nation. Conflict of interest or coincidence?

Flickr: The Third Estate Sunday Review

The investigation uncovered that the “ usual and customary” rates set by Ingenix were set in such a way that the consumers were forced to pay more than they should have. The rates were set low , so companies could underpay patients for out of network services.

Thanks to Attorney General Cuomo, this deplorable situation will very soon become a thing of the past. Beginning in January every national and regional health insurer operating in New York state will end their use of the Ingenix database and instead will have to use a new independent database.

This new , and independent data base will be created by a not for profit research network headquartered at Syracuse University, also designed as part of Attorney General Cuomo reform plan. The independent database will also have a website where for the first time the people of New York will be able to compare prices before choosing their doctors.

As a health care consumer and a proud member of the baby boomers  I am delighted with the news.

Thank you Attorney General Cuomo!

Flickr: Greg Timm

by Dr Miriam Carasa EdD, RN, CNA

Enough is Enough!

The latest health care related budget cuts proposed by Governor Paterson may go into effect on November 15, they will be the seventh round of similar cuts since 2007. The impact, added to the effects of all the previous cuts  could seriously endanger the ability of New York hospitals, nursing homes, and home care agencies to continue to provide health care to the people of New York. That is why New Yorkers need to act, and act now against the cuts!  Our elected officials need to hear from us New Yorkers that health care is a right and not a privilege. If all New Yorkers band together and send the same message, loud and clear, we can make a difference!

As a health care worker, I am contacting our elected officials to protest against the cuts, for the sake of our patients, and for the sake of being able to continue to provide the kind of health care I believe in.

As our colleagues from Greater New York Hospital Association and 1199 SEIU are saying:

“ Enough is Enough. No More Healthcare Cuts. Our Patients Deserve Better.”

Say No to the Governor’s proposed Healthcare cuts.

NY is just the start-

 By J. Dabbraccio RN, MSN

Have you recently gone to a chain restaurant such as McDonald’s or Starbucks and noticed calories posted on the menu board? Were you delighted or upset to see this? Did you know New York City was the first place in the country to require calorie posting on chain restaurants and our government now wants to mandate it to be adopted nationwide? What did we all learn from this experiment? Did people choose healthier foods after knowing how many calories they were about to consume? Did people even notice that the calories were posted?

A recent New York Times article talks about a study performed by several professors at New York University which tracked 1,156 customers at four fast-food chains (McDonald’s, Wendy’s, Burger King and Kentucky Fried Chicken). The study “found that about half the customers noticed the calorie counts. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result. But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect in July 2008. Orders had a mean of 846 calories after the labeling law took effect. Before the law took effect, it was 825 calories.”

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I believe posting calories on menus is a good health initiative and will have a greater effect long term on people who were already monitoring their own health and diet intake prior to this initiative. The truth is that the majority of people who do eat out usually pay more attention to price of meal instead of the calories. Unfortunately, healthy meals are not cheap. Most people want to get the most out of their dollar when ordering out. If you do not have money to make the right healthier choice, then caloric information is irrelevant.

Also, do people really understand the meaning of calories? Do you know how many calories to consume per day for your needs? Most people do not.

A calorie is defined as a unit of measurement which represents the energy in food. When you read something on a label that says 200 calories, it’s a method of describing how much energy your body could get from eating or drinking it. In simple terms, when your body requires fuel it burns the calories in food for energy. If you eat more calories than your body needs at any given moment, it doesn’t burn those calories but instead stores them as body fat which eventually can lead to weight gain. If your body burns more calories than you eat, then you may possibly loose weight over an extended period of time.

As a quick guide, your body requires about fifteen times your body weight in calories in order to fuel your basal metabolism. Below is a chart showing the recommended average daily calorie intake for each gender and age group:

Recently, calorie posting has entered the national health care reform debate. Do you think we need calorie counts on menus in chain restaurants across America? Do you it will impact the way we order and consume foods? Please post your response on HealthGavel and let our debate begin!

By: Erin C. Lieber

46 million uninsured? Maybe. Maybe not. This is a statistic that is consistently reported and constantly repeated. There is no contest that this is an extremely large number relative to the population of the United States, as it equates to almost 15% of the people in this country. However, have you ever found yourself wondering just how we account for this statistic that is used so often? If you happen to have better things to do than debate the validity of the reported number of persons without medical coverage, then you have come to the right place.

The issue of the uninsured and underinsured is a serious problem in this county that must be dealt with, however, that’s not the question. The question is: As a country, are we making health care decisions and plans for reform, based on accurate data? As with any intellectual argument, we have to ask ourselves a lot of questions in order to understand the health care debate and contribute to the solution. Here are a few things to think about regarding the “46 million” figure:

• Are they all citizens of this country?
• Are they uninsured because they have exercised their legal right not to have health insurance?
• Are they young “invincibles” that do not feel health insurance is a priority in this stage of their life?
• Are they uninsured because they switched jobs and are going through a standard trial period before receiving coverage?
• Are they eligible for government programs, such as Medicaid, although not signed up?

I urge you to do some digging and see what sorts of answers you get to these questions and any others you think of. I will share some of what I have come up with in an upcoming article and I look forward to your comments!

Flickr: Juliano Pavan

By Erin C. Lieber

Just like the cost of most goods and services in the U.S., the cost of health care is rising and quickly. What is fueling this increase is at the center of every health care reform debate that we see on TV and in the news. The National Coalition on Healthcare reports that National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending. However, healthcare is not like most other goods and services as it deals with the health and well being of ourselves and our families and an emotional attachment that is absent in the consumer experience of most other products.

For example, in May of 2008, when the price of gas went up past $4.00 in Chicago, informed consumers wanted to know the economics behind it, in other words, where was the money going? It was reported that 80 cents was going to city, state and federal taxes, and the rest was due to the price of oil and overwhelming economic factors correlating back to higher retail prices for consumers, providing us with an answer that was about as clear as mud. The reaction from consumers was to stop filling up their tanks as often or even at all, until prices went down.

I use this example of gas prices in the context of health care to really highlight the unique nature of health care as a consumer product and to instill the significance of developing a fundamental understand ing of the health care debate, so that you can make a difference. We are beginning to see similar consumer reactions to the rising cost of care as we did with the gas prices. People are actually going to see their doctors less or not at all, which of course leads to decreased prevention and more reactive and complicated treatments, which translate into increased expenses and rising costs.

Since our nation’s goal should be a healthier population, let’s try to inform ourselves as much as we can about the cost of health care in the United States, what’s fueling the rise and ultimately, what we can do about it to keep ourselves and our family’s healthy and contain costs. The following findings from PriceWaterHouseCoopers, “Factors Fueling Rising Health Care Costs 2008” provide us with a very granular and specific example of where our health care dollars go, by dissecting just one dollar and the increases we have seen in the cost of our health care premiums.

WHAT MAKES UP A HEALTHCARE DOLLAR? (Measured by increases over 2006-2007) (PriceWaterHouseCoopers, “Factors Fueling the Rising Costs of Health Care Costs, 2008).

Take a look at the following table and test some of your assumptions on why our health care premiums are increasing.