Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Weekly Pulse: Egg Salad Surprise! Congress Votes to Clean Up Food Supply

by Lindsay Beyerstein, Media Consortium blogger

It’s a Christmas-week miracle! The Senate, in a vote that astonished everyone, brought the Food Safety and Modernization Act back from the dead on Monday, as Siddhartha Mahanta reports in Mother Jones. The bill, which will enact tougher consumer protections against E. coli and other deadly contaminants in staples like eggs and peanut butter, died in the Senate last week when the omnibus spending bill it had been folded into kicked the bucket.

At Grist, Tom Philpott explains the initial demise, and the basis for the ultimate resurrection of the bill. The House passed the bill on Tuesday, having already passed it twice before.

President Obama is expected to sign the bill into law, which will usher in the first major overhaul of the country’s food safety system in more than 70 years. Food poisoning strikes 48 million Americans (1 in 6), lands 128,000 in the hospital, and kills 3,000 ever year, according to CDC figures released last week. Now that’s something to talk about with your relatives around the holiday dinner table.

Wisconsin clinic backs off 2nd trimester abortion care

A clinic in Wisconsin has reneged on its commitment to provide second trimester abortion care, as Judy Shackelford reports in The Progressive. Shackelford is outraged that the Madison Surgery Center walked back on its promise to patients. She knows first hand how important later term abortion access can be.

Shackelford found herself in need of a second trimester abortion when she developed a blood clot in her arm during her second, much-wanted pregnancy. She decided to terminate rather than risk leaving her 7-year-old son motherless. It was hard enough to find an abortion provider when she needed one, but if she needed the procedure today, she would have nowhere to turn.

Teen birth rate at record low

The birth rate for women ages 15-19 fell to 39.1 per 1000 between 2008 and 2009, the National Center for Health Statistics announced Tuesday. Many commentators, including Goddessjaz of feministing attribute the drop to the recession. The economy seems to be an important factor because birth rates dropped in all age groups, not just among teens.

Predictably, proponents of abstinence-only-until-hetero-marriage are trying to take credit for the falling birth rate. It’s not clear why they think ab-only is finally starting to work after years of unrelenting failure. Perhaps it was Bristol Palin’s electrifying performance on “Dancing With the Stars”?

Get the government out of my Medicare

We’ve become accustomed to the ironic spectacle of senior citizens on Medicare-funded scooters decrying the “government takeover of health care.” Medicare is wildly popular, even among those who decry “socialized medicine.” When the Affordable Care Act is finally implemented, it won’t feel like a government program, either. Paul Waldman of The American Prospect wonders if this “private sector” feel will undermine support for the program:

The Republican officials challenging the ACA in court have characterized its individual insurance mandate as an act of tyranny ranking somewhere between the Stalinist purges and Mao’s Cultural Revolution. But in the “government takeover” of health care (recently declared the 2010 “Lie of the Year” by the fact-checking site PolitiFact), Americans will continue to visit their private doctors to receive care paid for by their private insurance companies. The irony is that if the ACA actually were a “government takeover,” people would end up feeling much better about government’s involvement in health care. But since it maintains the private system, conservatives can continue to decry government health care safe in the knowledge that most people under 65 won’t know what they’re missing, or in another sense, what they’re getting.

If people don’t realize that they’re benefiting from government programs, they are less likely to support those programs. In an attempt to deflect Republican criticism, the Democrats assiduously scrubbed as much of the aura of government off of health reform as they could. This could prove to be a disastrously short-sighted strategy. If health reform works, the government won’t get the credit, but rest assured that if it fails, it will take the full measure of blame.

Funding for community health centers at risk

One of the lesser-known provisions of the Affordable Care Act was to expand the capacity of community health centers (CHCs) from 20 million to 40 million patients by 2015. This extra capacity will be key for absorbing the millions of previously uninsured Americans who are slated to get health insurance under the ACA.

CHCs have been praised by Democrats and Republicans as an affordable way to provide quality health care. However, state budget crises are threatening to derail the plan, as Dan Peterson reports for Change.org. States must contribute to the program in order to qualify for federal funding. However, state funding for CHCs has plummeted by 42% since 2007. So far this year, 23 states have cut funding for CHCs and eight have slashed their budgets by 20% or more.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Somewhere in America

Senate delay on stimulus 'irresponsible': Obama

copyright © 2009 Betsy L. Angert.  BeThink.org

Somewhere in America, a man loses the job he has held for more than thirty years.  Somewhere in America, a woman cleans out the office she had occupied for close to a decade.  Elsewhere in the United States, a teen unsuccessfully tries to find work.  He knows he needs to help his Mom and Dad; each toiled in the factory that closed just down the street.  A young woman searches for a professional position, just as she has for the two years since she graduated form the University.  Each of these individuals is not startled by the headline, Economy Shed 598,000 Jobs in January.   All ask, where have the "experts," Economists, and elected officials been?

There's more...

Revised Estimates? You mean there's more of us?

(Proudly Cross-Posted at Clintonistas for Obama)

So, I was perusing the local news, and ran across a story about some new math coming out of the International AIDS Conference, currently being held in Mexico City.

CBS13 is reporting:

The country had roughly 56,300 new HIV infections in 2006 -- a dramatic increase from the 40,000 annual estimate used for the last dozen years.

While the CDC doesn't think that their "New Math" will dramatically increase the total projected number of infections in the US, they do feel it a failure in prevention efforts.

But some advocates complain that CDC's annual spending on HIV prevention in the United States has been held to roughly $700 million since 2001, while costs have risen. (That's about 3 percent of what the federal government spends on AIDS; much of the rest is on medicines, health care and research.)

This figure is VERY small, considering the total number of ASO's out there that are doing harm reduction programs.  We, as a society, need to drastically increase our investment in protecting our future generations from this epidemic.

While both Sen. Clinton and Sen. Obama have signed onto the National AIDS Strategy, we need to hold their feet to the fire to ensure they keep their committment past this election cycle.  

That's why I'm proud to be working with the Campaign to End AIDS on their Stand Against AIDS action in Oxford, MS the 3 days leading up to the first Presidential Debate.  Sen. Obama's people will be attending a Town Hall meeting the day before the Debate with our participants, and the C2EA is working to get McSame's people there too. We're pretty sure, however, that McSame doesn't really care about AIDS in America .... just like the Bush Administration's current stance.

As y'all can see, this is a pet issue for me, as I am living with HIV.  Hopefully, the next administration will do more to help prevent the virus from spreading, and will work to shore up both continuing care for those of us with HIV/AIDS, and working even more agressively towards both a Therapeutic and Preventive Vaccine.

Just my 2 Cents - comments welcome

Dizzy

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Workplace Safety- Lets make this a PRIORITY for the Democratic Party NOW

The New York Times had an op-ed yesterday,

"The Working Wounded"
- reminding me of an issue that I have always thought the Democrats SHOULD stand for, but which seems strangely to have disappeared in this election year.

Workplace Safety. Legislating improved safety rules for the millions of working people in this country, so they can work without fear of death or serious injury while they are doing their jobs.

The article has a number of startling facts in it which should make us realize that in the current global climate, compared to many other developed countries (some of which have been making real progress) we in the US are basically going backwards by ignoring changes in global attitudes and expectations on issues like worker safety. The level to which we ignore safety violations is absolutely appalling. It is a national disgrace.

Not only have important and necessary changes been postponed, and some rules even rolled back, but during the Bush Administration, the agencies enforcing safety have also had their budgets slashed, sending a message to the worst kinds of employers that they 'could get away with murder', literally.

For example, read this segment of the op-ed piece (summarized digitally from the NYT article)


"Mr. Elias wanted his workers to clean out a 25,000-gallon
tank that contained cyanide waste.  He refused to test the
air or the waste inside the tank.  He ignored the pleas of
his workers for safety equipment.  When the workers
complained of sore throats and difficulty breathing, Mr.
Elias told them to finish the job or find work somewhere
else.

Mr. Dominguez, a 20-year-old high school graduate, wanted to
keep his job.  Wearing just jeans and a T-shirt, he used a
ladder to descend into the tank.  Two hours later, covered
in sludge and barely breathing, he was removed from the
tank, a victim of cyanide poisoning at the hands of a
ruthless employer who would blame his "stupid and lazy"
employees for the incident.

The Justice Department opened a criminal investigation of
Evergreen Resources.  I was one of the lead prosecutors on
the case.  We quickly discovered that we had a major
problem.

My colleagues and I were shocked to learn that an employer
who breaks the nation's worker-safety laws can be charged
with a crime only if a worker dies.  Even then, the crime is
a lowly Class B misdemeanor, with a maximum sentence of six
months in prison.  (About 6,000 workers are killed on the
job each year, many in cases where the deaths could have
been prevented if their employers followed the law.)
Employers who maim their workers face, at worst, a maximum
civil penalty of $70,000 for each violation.

We ended up prosecuting Mr. Elias for environmental crimes,
and he was sentenced to 17 years in prison.  I later became
chief of the Justice Department's environmental crimes
section, and we started an initiative -- based on this case
and others like it -- to seek justice when workers were
seriously injured or killed during environmental crimes.  We
prosecuted some of the largest companies in America.  But in
cases where 'no environmental crimes were committed', we often
could not prosecute.

Employers rarely face criminal prosecution under the
worker-safety laws.  In the 38 years since Congress enacted
the Occupational Safety and Health Act, only 68 criminal
cases have been prosecuted, or less than two per year, with
defendants serving a total of just 42 months in jail.
During that same time, approximately 341,000 people have
died at work
, according to data compiled from the National
Safety Council and the Bureau of Labor Statistics by the
A.F.L.-C.I.O.

It is long past time for Congress to change the law.  First,
Congress should amend the Occupational Safety and Health Act
to make it a crime for an employer to commit violations that
cause serious injury to workers or that knowingly place
workers at risk of death or serious injury.  Whether good
fortune intervenes and prevents harm to workers should not
determine whether an employer commits a crime.

Congress should make it a felony to commit a criminal
violation of the worker-safety laws, and the penalties for
lawbreakers should be stiffened.  The maximum sentence ought
to be measured in years, not months.

Congress also should change the worker-safety laws so that
ignorance of the law is no longer a defense.  Employers have
a duty to know their responsibilities under the Occupational
Safety and Health Act.

Finally, Congress should make clear who can be prosecuted.
Some courts have held that prosecution is limited to
companies and their owners.  Supervisors who order workers
to break the law, as well as responsible corporate officers
who fail to stop violations that they know are occurring,
should also be held criminally responsible, just as they are
under most other federal laws.

Most companies care about protecting their workers.  But
without a serious threat of criminal enforcement, more
workers will be put at risk by companies that put profits
before safety."

There's more...

Diaries

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