Responding to the Need in Haiti

News continues to come in about the devastation in Haiti following yesterday's magnitude-7 earthquake. As Though we are still awaiting official estimates, it is possible that as many as 100,000 have died in this quake and thousands more are homeless. Schools and hospitals have also collapsed. This devastation is made all the more difficult to bear because Haiti, the poorest country in the Western Hemisphere, was still recovering from the deadly 2008 hurricanes when the quake struck. Our hearts go out to the people of Haiti as we learn more of the extent of their suffering and damage to their communities. 

At CHW, we all share a dedication to serve those in need that reaches beyond the borders of our communities and our nation. In that spirit, CHW is making a corporate donation of $50,000 to Catholic Relief Services to help with the immediate needs of the Haitian people and $50,000 to aid in the reconstruction of the St. Francis de Sales Hospital in Port Au Prince. We are also working with the California Nurses Association, which is organizing nurses for a medical mission to Haiti, to support the direct provision of care in the area.

If you would like to help with the relief effort, please contribute directly to one of the organizations working to bring relief to the victims. Below is list of a few relief agencies you may consider supporting.

Catholic Relief Services is the official international relief and development agency of the U.S. Catholic community. They are working to bring immediate relief to the victims of the earthquake, including food, water, and shelter.

The American Red Cross has made available all of the relief supplies from its warehouse in Panama which would provide for basic needs for approximately 5,000 families. In addition, it is deploying a disaster management specialist to Haiti, and has additional disaster specialists on standby if needed.

UNICEF will deploy essential aid – including safe water, sanitation supplies, therapeutic foods, medical supplies, and temporary shelter materials – as quickly as possible to assist with recovery efforts. The organization is also focusing on children who have become separated from their families to protect them from harm or exploitation.

In the coming days, we will all hold those touched by this terrible tragedy in our hearts and prayers.

Catholic Healthcare West Respecting Patient Wishes

A recent article in the San Francisco Chronicle may have caused some confusion and unwarranted concern about Catholic Healthcare West hospitals, as well as about a recent revision to the Ethical and Religious Directives for Catholic Health Care Services.

Let us be clear. Our mission calls us to provide quality, compassionate care to all in need. We protect the right of patients to refuse treatment and would never force a treatment on a patient. Sound medical decisions are always made on a case-by-case basis in light of a patient's wishes and condition.

The revision made to Directive 58 of the Ethical and Religious Directives essentially confirms and upholds the inherent dignity of every human person. It is based on that dignity that we presume in favor of providing a full spectrum of care, including nutrition and hydration, even to those in a very weak and debilitated state. This treatment is not a moral obligation, however, especially when the patient indicates s/he would not want it, or when the burdens of such treatment would outweigh the benefits. 

We encourage everyone to consider completing an advance medical directive that will help provide clarity of their personal intentions to the health care professionals who are dedicated to providing quality care.

Lloyd Dean's Statement on Health Reform

Over the Christmas break the Senate passed its health reform legislation, clearing the way for reconciling it with the House version of the bill. Here's a message from our President/CEO, Lloyd H. Dean, on the historic action:

“Throughout the past decade, Catholic Healthcare West has been a forceful advocate for national health care reform and universal health care. Everyone involved – our elected leaders, health care stakeholders and everyday Americans – recognizes that this effort has been a long, tough road. We would like to extend our sincere thanks to the women and men of the United States Senate for their courageous and historic vote approving national health care legislation.

“As a hospital system that cares for a population spanning 20 million people, we know firsthand how important it is to reform our nation’s health care system. We continue to recognize that this job is not yet completed and we urge the Congress and President Obama to continue their work until this task is complete.”

It is our hope that the Congress can come together to pass a health reform bill that includes universal access, improved quality, stable financing, and across the board accountability. 

A Charter for Compassion

Last year we told you about the 2008 Ted Award winner, Karen Armstrong. Her wish was to create a Charter for Compassion. That charter is now complete. See more here.

A History of Health Care Reform

We believe that access to quality health care is as essential to social well being as the availability of food and shelter. It has always been our position that meaningful health care reform must include universal access, a viable and stable financing system, increased attention to the quality of care, and across-the-board accountability.

Over the past sixty years, many solutions have been offered to reform the nation's health care system - a system characterized today by rapidly rising costs and a growing inability of people to pay for it. The New York Times takes a long look at the history of health care reform, from Teddy Roosevelt's campaign promise of national health insurance to the current debates.

Time and again, national reform proposals have been introduced and scrutinized primarily for their fiscal impact. Each time, these proposals have failed to achieve the support necessary to be implemented. We believe fiscal analysis alone is insufficient to the task of reform. As an alternative, we believe the central question of the debate should be: When considering how to provide for the health care needs of its members, what should be expected of a compassionate society? We are taking this position to our local, state, and federal leaders every day to develop a solution that provides quality, compassionate care for all in need.

Our mission calls us to expand access to quality health care to all in need. Every day we see the impact of our broken health care system. The status quo is simply not an option.

The Face of the Uninsured

The Sacramento Bee puts a face on the uninsured with their special feature on the plight of Tony Andrade, 47, who was diagnosed with bladder cancer. His medical bills have swelled into the tens of thousands of dollars and the calls from bill collectors keep coming. Nearly four years ago, he lost his home when he could not keep up with the payments.

In many ways, Andrade, 47, is the Everyman of President Barack Obama's push for overhauling the country's health care system: working, but for low wages, without health benefits – in the company of 37 million employed Americans who are uninsured. When Andrade first noticed the drops of blood in his urine he made a choice familiar to the uninsured – he went to an ER that he knew by law would have to see him whether he could pay or not. Like many of California’s 7 million uninsured, Andrade earns too much to qualify for Medi-Cal, the state's version of Medicaid, but too little to buy insurance on his own.

Andrade knows something is afoot in Washington, but feels disconnected from the political debate. He suspects any help it brings won't come soon enough to pull him out of this mess. Though he did qualify as medically indigent and was able to have the tumor removed through a county program, he soon discovered that the cancer had spread to surrounding tissue and that more surgery was needed. And then, another setback. The contract between Andrade's doctor and the county is under review, caught up in the county's budget woes. His surgery is on hold again.

Read the whole story. It's worth the time. It's a good reminder about why we need health care reform.

Comparing the Health Plans

Over the weekend the House of Representatives narrowly passed a health care reform bill that would cost approximately $1.1 trillion over 10 years and insure approximately 36 million Americans who currently do not have coverage. The action now turns to the Senate Conference Committee, where the work begins to consolidate the House and Senate bills.

For some assistance in understanding the differences that need to get worked out, the New York Times offers a helpful interactive web page. We offer an example below:

Require nearly all Americans to carry health insurance or pay a penalty

House version
Would include mandate.

Penalty: 2.5 percent of adjusted gross income over a certain level, which is $9,350 for singles and $18,700 for couples.

Exempt those with incomes below the above-mentioned thresholds, American Indians, people with religious objections and people who can show financial hardship.

Senate Health Committee
Would include mandate.

Penalty: Up to $750 a person a year.

Exempt American Indians and those who can show financial hardship.

Senate Finance Committee
Would include mandate.

Penalty would be phased in gradually: $200 a person in 2014; $400 in 2015; $600 in 2016; and $750 in 2017.

Exempt American Indians, people with religious objections, those who can show financial hardship, households with incomes lower than 133 percent of the federal poverty level ($29,327 for a family of four) and people who would have to pay more than 8 percent of their income to buy the lowest cost plan available to them.

White House
Open to a mandate as long as people who cannot afford insurance are exempt. During the campaign, President Obama proposed mandates for children only.

“I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it.” (Letter to Senate leaders, June 3)

Interest groups
America’s Health Insurance Plans, the insurers’ lobby, supports individual mandates. But the trade association says the penalties for going without coverage are modest under the Senate Finance Committee’s bill. This creates “a powerful incentive for people to wait until they are sick to purchase coverage,” and could drive up insurance premiums, the group has warned.

Drug companies and insurers could benefit from mandates, which could provide millions of new customers.

Labor unions and consumer groups support mandates for individuals as long as employers are required to help pay for coverage.

Facing Higher Health Costs

In the health care reform debate, the escalating cost of health care is cited as one of the primary reasons for reform. And the rapid rise in the cost of health care is often attributed to the reimbursement model and that people who receive health insurance through an employer or through the state are insulated from the actual price tag for the care they receive. Many contend that if more consumers were directly responsible for a larger portion of the cost of care, then they would influence the marketplace and costs would go down. However, some consumer advocates insist that if employees shoulder a greater share of cost, then they will avoid preventive care and drive costs up, in addition to being unable to afford the care they need.

An article titled “Employees face 'shockingly higher' health costs” by Parija Kavilanz posted today on CNNMoney.com examines the growing trend of employers shifting the cost of health coverage to employees.

It's open enrollment time at work. Prepare yourself. Starting in 2010, your employer is making sure that when it comes to paying for your health care, you're going to be sharing much more of the burden.

"The headline is greater cost sharing," said Tom Billet, senior consultant with human resources consultancy Watson Wyatt. "That means higher [employee] contributions, higher deductibles, or both," he said.

In 2010, employers are "putting everything on the table," implementing benefit changes aimed at making workers more aware of the actual cost of services," said Paul Fronstin, director of the health research program at the Employee Benefit Research Institute (EBRI), a public policy research group.

Barry Schilmeister, health care consultant with Mercer, a global firm specializing in employee benefits, agrees.

"Most people are shielded from the true cost of care because all they pay when they go to the doctor is a $15 to $20 co-pay," he said. "To me the catch phrase in 2010 will be 'Taking responsibility.' "

Consumer advocates, however, aren't thrilled with these declarations.

"We recognize that this is a hard economy," said Cheryl Fish-Parcham, deputy director of health policy with Families USA, a health care consumer advocacy group.

"We know that medical debt is growing. We know that [employer-based] coverage is thinning," said Fish-Parcham. "This is a really difficult environment for everyone. That's why we're all looking forward to health reform."

…

Higher out-of-pocket costs
"Employers and employees will face shockingly higher [health care] costs," warned Helen Darling, president of the National Business Group on Health, whose members include Fortune 500 companies such as American Express, Coca-Cola and IBM.

Companies are raising deductibles, co-payments and employee out-of-pocket limits. "In better economic times, employers are better able to shoulder the [health care cost] burden. Not as much now," said Billet, who estimates that costs could increase between 10 to 20% for insured workers.

Besides the economy, Billet said other underlying factors driving up health care costs include aging of the population, greater use of technology in health care and government cost-shifting.

"Medicare and Medicaid typically pays providers less than the actual cost of care," he said, adding that providers make up the difference by raising their rates to their insured clients.

Co-pay to co-insurance
Darling said companies have been shifting over the past five years from a co-pay, a flat dollar fee ranging between $10 and $35 that employees pay at each doctor visit, to a to co-insurance model.

With co-insurance, employees pay a percentage of the total medical expense. Experts say co-insurance rates are typically split 80-20 or 70-30 between the health plan and the insured worker.

"By changing to co-insurance, people are more aware of costs and the hope is that they'll be more careful about how they spend their [health care] dollars," said Schilmeister.

Billet, whose corporate clients include Time Warner, the parent company of CNNMoney.com, said co-insurance used to be the norm prior to the advent of health management organizations (HMO). "So it's almost like a back to the future," he said. Time Warner is shifting from a co-pay to a co-insurance model next year.

…

Consumer-directed health plans
About 20% of large employers offer consumer-directed health plans (CDHP), up sharply from 14% last year, according to Mercer.

These plans, which couple catastrophic illness coverage with employee-funded health savings accounts (HSA) or health reimbursement accounts (HRA), are 20% less expensive than traditional preferred provider organizations (PPOs) and HMOs, said Schilmeister. CDHPs usually have much lower premiums, although the deductibles are higher than other options. Some employers do help workers with the high deductibles by contributing money into their HSAs.

Still, Schilmeister said CDHPs probably make more sense for a healthy worker who doesn't utilize medical care frequently. Otherwise they can be expensive for employees.

"Be careful with these," said Fish-Parcham. "If employers aren't funding your HSA, it can become a huge problem especially for lower-income workers."

If employers increasingly shift health coverage costs to their employees, as those quoted in this article predict, what will be the impact on the cost and quality of health care in this country and the reform efforts in play in Washington?

A Different Kind of Public Option

Catholic Healthcare West co-led the task force that designed the nation's only public health care option for uninsured residents. It's not insurance in the traditional sense; it uses the medical home model to ensure that care is available (including hospitalizations) to all who need it.

The New York Times recently published a Q&A with William Dow, a health economics professor at the University of California, Berkeley, who is studying Healthy San Francisco. Here are a few excerpts:

Q. Healthy San Francisco is not a single-payer system, but it does seem to offer much more than is available to the uninsured in most U.S. cities. What were the origins of this program?

A. It was an initiative of Mayor Gavin Newsom and the San Francisco Board of Supervisors to provide universal access to health care for the uninsured.

Q. Has it done that?

A. There were about 60,000 uninsured adults in the city when Healthy San Francisco came into effect in July 2007. Since then, 45,000 have signed up.

Q. To be clear, this isn’t insurance per se.

A. No. The city is careful not to call it health insurance. It provides access only to health care within San Francisco and only at a specified set of providers, mostly safety-net providers. If you get sick outside the city, you’re in trouble. It’s more like an insurance plan with a geographically restricted network.

It started by covering only those under the poverty line. Then in January 2008, it expanded to those making up to 300 percent of the poverty level. Now that’s been extended to 500 percent of the poverty level, which qualifies the vast majority of uninsured individuals in the city. Five hundred percent would work out to an income of about $54,000 for an individual, or $110,000 for a family.

Q. What kind of fees do people have to pay to participate?

A. There is a participant fee, which is like a premium. Under 100 percent of the poverty line, you pay no participant fee. The next group — 100 to 200 percent of poverty — pay $60 per quarter, or $240 a year. That’s for an individual. It’s capped, so that no family has to pay more than 5 percent of income.

In addition, there is a co-pay of $10 for general care, $20 for specialty care, $5 for prescription drugs on the formulary, or $25 for those not on the formulary. For hospital admission, you have to pay $200. It’s not huge, but for those with the lowest income, it’s not trivial, so those under the poverty line are exempted from the co-pays.

Q. Are enrollees happy with the program?

A. The Kaiser Family Foundation did a survey and found people think they’re better off than they were before. Overall, 94 percent said they were satisfied with the program, which is quite impressive. But some of those people aren’t well informed about program restrictions. For example, about one-third did not know that the program does not provide access to care outside of San Francisco.

Q. How’s the quality of care?

A. The providers give high quality medical care. But the typical health-care user doesn’t rate health care on adherence to evidence-based medicine or the latest medical guidelines. They have different patient satisfaction metrics. The public has a perception that safety-net providers are lower quality because they have longer queues for service and a particular demographic uses them. These aren’t facilities that have invested in soaring atriums and beautiful physical plants. So the city is pleased that a few private providers, such as Kaiser Permanente, have now agreed to join the provider network.

Q. This obviously is a different type of public option than we’re discussing on the federal level. Do you see it as an alternative?

A. I’ve made the argument for that. The current versions of the public option in Congress are threatening to insurers. If a public option were designed to be attractive only to the lowest income individuals, it would be much less threatening to the health care industry. This could easily be accomplished by giving anyone the public option of buying into their state Medicaid program. It’s a very sensible way to craft a compromise around a public option, but it’s not gotten much traction at this point. Public-option supporters haven’t wanted to backpedal to something like this, but I fear that lower-income folks will lose out if we let the perfect be the enemy of the good.

Preventing the Spread

Prevent the spread of H1N1, this doctor's rap goes viral: