My friend Kelly over at the VSJ just posted a story about another friend of ours, Chuck. Rather than provide a short comment in her blog, I thought I’d comment on Chuck’s Story here.

Speaking as someone who once sat in that chair at a home health care agency submitting requests to Medicaid I’d like to shed some light on the problem here.

The problem is not with the concept of Medicaid. Medicaid, as originally intended, provided a life line to the poor and disabled to obtain health care. However, thanks to partisan cost-cutting by Republicans on a national and state level the program is but a shell of what it once was, with myraid rules and accountability to prevent fraud and yearly caps on treatment costs.

In Florida, the greatest change to Medicaid occurred in 2005 when then Gov. Jeb Bush rammed the “privatization” of Medicaid through the state’s legislature. Bush’s Medicaid Czar, Alan Levine, an insurance company lobbyist, devised a haphazard plan to hand the entire system over to the insurance companies to manage.

The resultant changes have resulted in loss of care to thousands of patients, refusal to honor payments to providers, and the subsequent refusal of physicians to treat Medicaid patients. Why provide care when it might be months, even years, to be reimbursed for your service?

A report by the Kaiser Foundation highlighted the failures of the proposed changes to Florida Medicaid to deaf ears. It’s funny how many of the items cited are the same talking points Republicans are using today to spread misinformation on President Obama’s proposed health care reform:

Florida’s waiver moves away from the traditional insurance concept of shared risk to individual risk. The state plans to use historical utilization data to develop individual risk scores to reflect health care needs to derive the premiums allotted to individuals. Therefore, the accuracy of the scores will be critical to assuring whether individuals can access adequate coverage.

You see, Kelly, Chuck’s problems are indicative of why health care reform is needed. President Obama’s plan will not only allow Chuck the opportunity to obtain health care through a Private Option, it will also streamline Medicaid to provide a uniform program without all the fraud and mismanagement so prevalent today – thus saving millions of dollars.

And allowing Chuck to receive the proper care he needs.

Gavin Yamey, the Senior Magazine Editor of PLoS Medicine, is currently on sabbatical from the journal after being awarded a “mini-fellowship” from the Kaiser Family Foundation to undertake a project as a reporter in East Africa and Sudan.

In this, his latest blog, Gavin writes from the Kenyan Coast, detailing the difficulties truly rural communities face in obtaining medical care.

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Far from the reach of global health programs

I’m on the Kenyan coast, the last leg of my fellowship in global health reporting.  One of the many privileges of my trip is that I’ve experienced the opportunities and massive challenges in delivering health tools to those known as the “hard to reach.”

Isolated rural communities, with no roads to or from them.  Lakeside villages that can only be reached by epic boat journeys.  None have electricity, running water, or sanitary means for disposing of excrement.  I’ve traveled with researchers and NGOs and seen the kinds of obstacles that global health programs are up against.  Countless times I’ve heard public health professionals here in Africa say to me, off the record, that they wish the folks in Geneva or Washington DC, those spearheading the global campaigns, would come and see what “hard to reach” looks like.

I’ve learned a new expression: “tarmac tourism.”  It refers to Western health experts visiting the poor world, but sticking only to the well developed places with tarmac roads.

There’s virtually no tarmac in southern Sudan (which was the first leg of my journey), just one or two patches of it in a few towns such as Juba, the capital.

If you leave the tarmac, and drive for several hours in a Toyota Land Cruiser, the pot holes will crush your bones.  Along the way, you’ll see the most fragile houses of mud and straw; there’s nothing permanent, nothing solid, a legacy of a 22-year civil war.  If you go and visit a community health center, you’ll see that it is just an empty hut, with no medicines or equipment, nothing to offer.

In one “hard to reach” village in the state of Northern Bahr El Gazal, where only 1% of children go to school, I spoke with the community leaders.  Two women had just bled to death in childbirth.  There was no transportation to get the women to the nearest hospital.  There’s a car in the village, but there was no money to pay the driver.

I kept hearing, throughout my trip, that southern Sudan has the world’s highest maternal mortality rate, but it was only away from the tarmac that the reality hit home.

Gavin Yamey

Two reports to download. The first is an overview of spending on the Medicare program, how the program is financed, and Medicare’s future financial outlook. It includes the latest available data on Medicare financing. http://www.kff.org/medicare/upload/7305-04-2.pdf

The second report is Update on Medicare Spending and Financing and Highlights from the 2009 Medicare Trustees’ Report funded by the Kaiser Foundation, May, 2009. It incorporates data from the 2009 Medicare Trustees’ Report. This report examines the fiscal challenges facing the Medicare program as well as the public’s views on confronting them. The report: http://www.kff.org/medicare/upload/7905.pdf

Local Real Estate Fund Hits Wall

 According to an article in the Saturday edition of the Oregonian, SKB will be halting all payments from a private equity fund to investors.  SKB (ScanlanKemperBard Companies) is a well-known real estate firm with a portfolio of properties covering the West Coast. SKB was in the news last September for the sale of four commercial properties that included the American Bank Building in downtown Portland for just over $63M.   This recent announcement is a significant change in position from just one year ago, when SKB was successfully raising money for a new fund and demonstrates how the economic conditions are rapidly spreading beyond banking and the automotive industry.  

TechDex (apps|provider|hardware|var)

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J/FIT.com – 900 Tech Center Dr.  Bldg 28 | 4,000 SF

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HealthDex (hospital/provider|managed care|product provider)

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Senior Info Center – River Forum 1 | 4380 SW Macadam Ave. | 1,118 SF

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Legacy Health System – Pollock Building | 412 “A” Ave. | 7,300 SF

Westlake Chiropractic – Westlake Village | 14511 Westlake Dr. | 1,872 SF

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Kaiser Foundation – One Town Ctr | 10163 SE Sunnyside Rd. | 6,806 SF

Parrott Creek Child/Family Svs – 1001 Molalla Ave. | 2,443 SF

A new law was signed by Acting Governor Richard J. Codey last Wednesday in N.J. that will take effect in six months.  It requires that HIV testing become a part of routine prenatal care.  Some say this law will put New Jersey at the forefront of the national fight against HIV transmission to babies.

“We can significantly reduce the number of infections to newborns and help break down the stigma associated with the disease,” Codey said. “For newborns, early detection can be the ultimate lifesaving measure.”

The New Jersey bill will allow women to opt out of the routine testing, but newborns will be required to be tested when the mother has tested positive or her HIV status is unknown.

The American Civil Liberties Union and some women’s groups contend the bill deprives women of authority to make medical decisions.

According to the Kaiser Foundation, New Jersey is ranked third highest in the nation for female AIDS cases.

Arghh, the American public, they’re a fickled lot, captain.

In a previous post I called your attention to the Kaiser Foundation Health Tracking Poll revealing that 50 percent of respondents said they didn’t know, or couldn’t name, or that none of the candidates represented their views on health care. Well now we know why. With everybody shouting that the system is totally broken, half of the American public are sort of happy with the health care system we’ve got. At least that’s according to Gallup’s annual health care survey.

What are we going to do with these guys? Don’t they read the papers? Do they live in this country?

And listen to this:

Eighty-three percent of Americans rate the quality of health care they receive as excellent or good, while 15 percent rate the quality as poor. Seventy percent say their health care coverage is excellent or good.

I am not making this up. Ok, there’s a 3 percent error rate, but even so. Amazing.

At least they’re not happy with the cost of care. But as the pollster says a “surprisingly large number are content with the health insurance and health coverage they currently have.”

Now those in the business of actually delivering care have always had a sneaky suspicion that this level satisfaction has been there all along. But there is a fear in the current climate to come out and say it. Got to avoid seeming self serving. Now, however, the American public has now spoken the unspeakable — or at least its voice has been channeled by Gallup.

The importance of these numbers is that people will resist change if it means giving up what they now see as valuable. That will mean some kind of compromise for health care reform that makes sense. Get too ideological, and they will walk away from the deal.

We’ve been keeping our eye on this question from the ongoing Kaiser Foundation health tracking polling for some time on the public opinion about the presidential candidates and health care:

“Thinking about all the candidates for president in 2008, regardless of political party or who you intend to vote for, which candidate BEST represents your views on health care?”

The latest October poll indicates that 50 percent of respondents say that they don’t know, can’t name or none of the candidates represent their views. Now the good news — at least I think it’s good news — is that number is down from 59 percent in June indicating that a few more Americans see at least one candidate as speaking for them about health care. (23 percent say that’s Hillary).

So this little fact this may demonstrate a few things:

• Half of the public still hasn’t yet found quite the right voice speaking for them — thus having a secret undiscovered position
• They are confused or lack knowledge about the candidates’ positions
• They don’t care
• They still do not know their own mind about what to do

I go for the all of the above, especially the last one.

In any case, the candidates face the prospect of either continuing to try to stumble on the mother lode of public opinion about health care through trial and error, or, giving up on that, beating public opinion into submission through sheer ideological volume and repetition. The better course, although more difficult and risky, would be to help the public think through what it wants. That may be too much to ask, however.