Lead control: An investment with economic (and health) returns

Today marks the start of National Lead Poisoning Prevention Week (NLPPW), led by the CDC every year during the last full week of October.  But this year’s campaign is making the usual, costly mistake: it’s treating the prevention of childhood lead poisoning like an education issue, when really, it’s an economic issue. 

According to an in-depth analysis by the Economic Policy Institute, every $1 spent on controlling lead hazards results in a return of $17–$221 in reduced health care costs, higher lifetime earnings, tax revenue, reduced spending on special education, and significantly reduced criminal activity.  Emerging from the worst recession in generations, increased spending on lead control would be a smart investment for the economy, public health, and social justice.

Lead poisoning is thought to be the most preventable of pediatric health problems in the U.S., yet remains one of the most common.  The enduring prevalence of lead-based paint hazards in homes built before 1978 is primarily responsible.  This year’s NLPPW strategy, "Lead-Free Kids for a Healthy Future," advises parents to have a certified inspector check for lead hazards in older homes and encourages them to take young children to a doctor for blood lead level testing.


It’s time to start over on long-term care

Last week, the Obama administration halted implementation of the new federal long-term care insurance program – the Community Living Assistance Services and Supports (CLASS) initiative, which had been tucked into health care reform legislation. It is disappointing, but not surprising that the administration was unable to design a financially self-sustaining, voluntary long-term care insurance program. The unusual legislative journey of the Patient Protection and Affordable Care Act, which had no House-Senate conference to clean up the bill, left CLASS with statutory limits that proved unworkable. Without mandatory participation or some other way of achieving near universal participation, the program did not stand a chance.
The administration’s inability to implement CLASS does not endanger the Affordable Care Act (ACA), which will still extend health coverage to 32 million uninsured people by 2016. According to the Congressional Budget Office, the ACA will reduce the deficit by $127 billion even without CLASS. The success of the Affordable Care Act depends more on how HHS uses its broad discretion to formulate rules for accountable care organizations, medical homes and state health insurance exchanges. If the administration was given as much discretion over CLASS as it has over other provisions in the ACA, the news last week would have been quite different.
In the absence of CLASS, Medicaid will continue to be our de facto long term care public policy. State Medicaid programs that require near, if not actual, impoverishment are, as others have said, like having an insurance policy with a deductible that is all your wealth.


Anti-Choice bill does imperil women's lives

Last week’s vote on the anti-abortion measure, H.R. 358, was a disappointing new low for the House.  The heated debate occasioned dueling letters by Rep.’s Jan Schakowsky (D.-Ill.) and the bill’s author, Rep. Joseph Pitts (R.-Penn.), about whether the bill would allow institutions and doctors to refuse to provide care even in life-threatening emergencies.

    At issue are patient protections from an anti-“patient dumping” law, the Emergency Medical Treatment and Active Labor Act (EMTALA). Schakowsky’s letter noted that the “bill would, in effect, strip EMTALA of its power to ensure that women in emergency situations receive abortion care at hospitals by making their right to health care secondary to the hospital’s ability to refuse to provide abortion care.” Pitts, on the other hand, claimed that because EMTALA refers to “unborn child,”  “EMTALA currently recognizes both lives.”

    Who’s right? Schakowsky is, by a mile.  EMTALA uses “unborn child” in three places; all make clear that a hospital seeking to transfer a woman in “active labor” must assess health risks from the transfer for both the woman in labor and the child she will deliver.  The law does not confer a freestanding interest in the health of an “unborn child” that allows hospitals to deny care to a woman experiencing a miscarriage.  If it did, the Pitts bill would be superfluous.


Momentum for global health security

Amidst contentions over Palestinian statehood, a walkout by delegations during the Iranian president’s address, and  the challenges of reinvented governments, a revolutionary moment for global health security snuck by virtually unnoticed at the 2011 United Nations General Assembly. On September 21st, President Obama delivered his address to the Assembly.  After touching on a range of foreign policy concerns, he said:
“To stop disease that spreads across borders, we must strengthen our system of public health. We will continue the fight against HIV/AIDS, tuberculosis and malaria. We will focus on the health of mothers and of children. And we must come together to prevent, and detect, and fight every kind of biological danger -- whether it’s a pandemic like H1N1, or a terrorist threat, or a treatable disease. This week, America signed an agreement with the World Health Organization to affirm our commitment to meet this challenge. And today, I urge all nations to join us in meeting the [WHO’s] goal of making sure all nations have core capacities to address public health emergencies in place by 2012. That is what our commitment to the health of our people demands.”


Congress needs to work together to provide quality Medicare for patients

Anyone who has ever witnessed a patient in a medical crisis knows the team approach necessary to saving a life. During these critical, life or death moments, the entire medical team of doctors, nurses and other healthcare personnel jumps into action, with each member playing a crucial role in helping the patient survive.
Today, as our elected officials struggle to revive an ailing economy and stop a hemorrhaging healthcare system, I am reminded of how essential teamwork will be to this process. True, Congress’ 12 “Super Committee” members will do the lion’s share of work in identifying solutions, but each and every health care provider group can do its own part to help save the system. To that end, the kidney care community believes it is important for Congress to avoid damaging across-the-board cuts to Medicare’s End Stage Renal Disease (ESRD) program while considering policies that protect patients and save taxpayers’ money.
Across-the-board cuts, like those that will occur if the Super Committee fails to reach agreement and “sequestration” triggers automatic cuts to all providers of up to two percent, will be particularly harmful to individuals on dialysis.  Dialysis patients, typically very ill and often poor, are among the most vulnerable patients in the Medicare program.  These Medicare beneficiaries rely on dialysis treatments three times a week to live.  Because Medicare becomes available to individuals of all ages upon diagnosis with kidney failure, approximately 80 percent of all dialysis patients are Medicare beneficiaries.   Forty percent of that population are “dual eligibles,” meaning they also qualify for the Medicaid program for indigent care.  So, funding cuts in Medicare have a direct and negative impact on care for patients.


Administration should deny bishops' request for a veto over women's healthcare

    You don’t ask a vegetarian where to get a great prime rib, or a teetotaler for a single-malt scotch recommendation.  You don’t ask a bald man where to get a stylish haircut.  So why would federal policymakers defer to a cadre of celibate men on the reproductive health services women need?
    As crazy as that sounds, that’s exactly what’s happening.  The chaste all-male club known as the U.S. Conference of Catholic Bishops has criticized the Department of Health and Human Services (HHS) for adopting a rule requiring health plans eliminate copays for contraception and other important women’s health services.  The HHS decision, issued in August, adopts the recommendation of a panel of medical experts convened by the prestigious Institute of Medicine. 
HHS has also asked for comments on a proposed rule exempting churches and other houses of worship from having to cover their employees.  But this exemption isn’t enough for the bishops.  Instead, they are seeking passage of a bill in Congress, the misleadingly titled, “Respect for Rights of Conscience Act,” which would allow every religiously affiliated institution, including schools, social-service providers, and even hospitals, to opt out of the coverage requirements (the bill’s co-sponsors, Rep. Jeff Fortenberry and Rep. Dan Boren previously proposed an anti-abortion law that would prohibit the federal government from subsidizing abortion coverage for date-rape victims or adult victims of incest).  Of course, the bishops themselves won’t be affected by their proposal to gut women’s preventive healthcare.


Medicaid: A lifeline for Latinos that cannot be on the chopping block

There was a bright spot in the U.S. Census data released this week.  While nearly a million more Latinos are wrestling with the ills of poverty, uninsurance has gone down in the Latino community.  The improvements are slight, but many assumed that even small gains couldn’t be possible, as record numbers of Hispanics grapple with the challenges of high unemployment rates, declining incomes, and smaller household budgets. 

The small improvements are due in large part to the role that public health insurance programs, like Medicaid and the Children’s Health Insurance Program (CHIP), play in the households of Latinos and other Americans.  There is, however, a serious concern on the horizon.  Come Christmastime, the recently appointed congressional Super Committee will design a federal budget plan hoping to steer the U.S. out of debt.  NCLR (National Council of La Raza) and numerous other civil rights groups fear that this conversation will be mired in politics about cutting spending for “less popular programs,” like Medicaid, regardless of the very real need that they serve.
Unlike other American communities, Latinos saw boosts in coverage in several areas of health insurance, with more of the population making promising gains in employer-based coverage and Medicare.  But the numbers for Medicaid and CHIP are truly striking and continue to demonstrate that these programs are a lifeline for the Hispanic community.  More than one in four (26.4 percent) Latinos access health coverage through Medicaid or CHIP.  Hispanic children benefit even more, with one in two (49.4 percent) receiving coverage through the programs. 

The robustness of Medicaid and CHIP not only serves as a buffer from uninsurance, but also helps many avoid the frequent challenges of high health care costs which can be especially debilitating when times are already hard.


Contagion and the need for health research

            The promos for the movie Contagion, the No. 1 box office hit last weekend, a thriller about the deadly spread of a killer virus and scientists’ race to stop it, is full of frightful scenes. One shows the shocked faces of Matt Damon and Gwyneth Paltrow. Another part flashes these words: “One touch. Transmission.”
Then: “One contact. Contagion.”
Fear and stars sell Hollywood movies, and Contagion has plenty of both. As people walk out of theaters after watching this movie, they will wonder: Could this happen? And if it could, how does the world prepare for such a chilling reality of an unchecked killer virus moving from person to person, city to city, country to country, infecting millions, maybe a billion?


The bully pulpit

The Department of Health and Human Services (HHS) recently decided to cease its calls for the resignation of drug maker Forest Laboratories' chief executive, Howard Solomon.

Understandably, American business leaders weren't keen on the Obama Administration telling them whom they could and couldn't hire.

But the feds made sure to emphasize that they would continue investigating and penalizing purported healthcare fraudsters, including "individuals who directly committed fraud as well as executives who were in a position of responsibility at the time of the fraud."

That's all well and good. But the scuffle between Forest Labs and HHS provides a preview of how the Obama Administration plans to deal with organizations that don't line up in support of its healthcare agenda -- namely, by punishing them. Last year, federal officials accused Forest Labs -- and a number of other drug companies -- of fraud against Medicare and Medicaid because of alleged misconduct in the marketing of their products to doctors. Instead of fighting the allegations, Forest opted to settle the case. The settlement saved the company from expensive litigation and unwanted media attention.


Out of stock: A different kind of drug crisis

Drug shortages are a real and serious crisis in health care with critical consequences to patient care.  It is bad and it is getting worse. Some essential drugs that patients urgently need are just not available.
More than 80 percent of hospitals say that drug shortages have caused delays in treating patients, according to a recent survey by the American Hospital Association.  The most serious shortages include the drugs used to put patients to sleep for surgery, relieve vomiting, pain, and anxiety, treat infection, correct electrolyte abnormalities, feed patients intravenously who can’t eat, and to treat cancer. 
For some of these patients -- especially those with cancer, newborns and children – the situation is critical.  Drugs used to treat and possibly cure cancers are in scarce supply or not available at all.   Life-saving drugs needed by newborns are in critical short supply or unavailable. Unfortunately there are few, if any, acceptable alternatives for either of these situations.
And so far, the crisis only seems to be getting worse.