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Urban Issues: Healt Care


URBAN ISSUES - HEALTH CARE


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John Edwards

Edward’s health care plan would cover an additional 21 million Americans at a cost of $53 billion per year. He would require that every American under the age of 21 has health insurance. Parents would have the primary responsibility to insure their children, but he would provide tax credits to help them pay for it. He would also expand existing programs for small businesses and employees between jobs.

John Kerry

Kerry’s health care plan would cover 27 million uninsured Americans. Kerry proposes allowing every American access to the healthcare plan currently offered to federal employees. He would reimburse employee health plans for the most expensive cases. He also plans to spend $72 billion over five years to offer health coverage for low-income people and children.

Dennis Kucinich

Kucinich would replace the current health care system with a national health insurance policy. He would finance it with a 7.7 percent tax on employers. It would be similar to the Canadian system. The plan to give all Americans health care coverage would cost an estimated $1.5 trillion a year.

Al Sharpton

Sharpton would create a national health care plan that is publicly financed by the government through taxes on the wealthiest Americans.

George W. Bush

In 2003, President Bush signed into law the most sweeping changes to Medicare since the creation of program in 1965. As part of the reforms, he added a prescription drug benefit for senior citizens. Health experts are still divided on what these changes will mean for New York City in the long term. For the future, Bush advocates for greater patient choices and $117 billion in tax breaks to help the uninsured pay for health care.

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GOTHAM GAZETTE’S RELATED ARTICLES


• Urban Agenda: Health Care
• Medicare Reforms and New York City

 

Death In New York City


Many New Yorkers think of their city as tough, rough, and a tad more perilous than most; a place where armed muggers lurk in ambush, bike messengers and speeding cabbies mow down pedestrians, air conditioners and giant chunks of ice occasionally fall from high buildings to sidewalks below, peeling lead paint tempts infants, and the air quality downtown is more suspect than ever.

But while the city certainly presents some hazards to life and limb, the health department's annual report on registered deaths and causes of death, as well as other vital data, actually reveals that the number of deaths in the city reached a historic low in 2002, infant mortality rates were also at an all-time low, and the life expectancies of New Yorkers were longer than ever before – longer, in fact, than the national average.

The city's Department of Health and Mental Hygiene released the 67-page report, the Summary of Vital Statistics for 2002 (available in pdf format), on January 30. The year 2002 is the most recent for which data was compiled and analyzed; because the annual report is a formidable undertaking, it tends to lag a year or two behind the year of its release.

2002 saw 59,651 deaths recorded in the city, down from 62,964 in 2001. If not for the 2,746 deaths from the World Trade Center disaster, 2001 would have set the previous record for lowest number of deaths in the city. And even if one excludes the World Trade Center deaths from the 2001 total, there was still a decline in deaths of about one percent from 2001 to 2002, continuing a trend that started in the 1990s.

Infant Mortality at All-time Low

One factor driving the decline in the city's death rate was that infant mortality in the city reached an all-time low in 2002, at six infant deaths for every 1,000 live births. As recently as 1990, the infant mortality rate had been twice that high. The New York City rate was also lower than the national average in 2000 (the most recent year national data was available), which was 6.9 deaths per 1,000 births.

 

But since the report breaks down the city's deaths by ethnicity and location as well as age, cause, and gender, it also makes it clear that infant mortality varies dramatically among ethnic groups and neighborhoods. As the health department notes in a separate statement about the 2002 infant mortality numbers, the infant mortality rate is a critical indicator of a given community's social welfare. It reflects the health of the mothers before, during, and even after pregnancy, as well as the accessibility and quality of local healthcare services. Among the factors that the health department cites as influencing infant mortality rates are the mother's access to prenatal care and the quality of such care; her overall health; her socio-economic status; her stress level during pregnancy; her use of alcohol, tobacco, and other drugs during pregnancy; and the infant's birth weight (which can be affected by all of the preceding). It is unsurprising though grim news that babies born in the Brownsville section of Brooklyn have infant mortality rates of 10.3 per 1,000 births, 50 percent higher than the city average; or that black babies are more likely to die than white.

Dr. Thomas Frieden, the health department's commissioner, emphasized the need for more to be done to eradicate these variances in infant mortality among different ethnicities and geographic locations around the city. “Six-point-zero is the lowest rate ever in the city's history, and continues a longterm trend of declining infant mortality rates in New York City," Frieden said. "However, unacceptably high disparities persist in some communities. We will address these disparities by targeting resources to those communities in greatest need and connecting at-risk women to available services.”

New Yorkers Living Longer

Not only have death rates declined, but New Yorkers' life expectancy has increased markedly over the past decade. Average life expectancies are the highest in New York City's history, and for the first time in 60 years New Yorkers are living longer than other Americans (77.6 years in New York vs. 77 years nationally). The life expectancy for girls born in the city in 2000 is 80.2 years, an increase of 3.2 years from 1990. Life expectancy for boys born in the city in 2000 is 74.5 years, a dramatic increase of almost seven years from 1990, when a newborn boy could on average expect to live only 67.7 years. The report indicates that this lengthening of New Yorkers' life expectancies is mostly due to the decline in the number of deaths from HIV/AIDS and homicide (2,300 combined in 2002, a quarter of what they were in certain years over the last decade). The marked decline in infant mortality is also a factor.

But Much Room for Improvement

Large and troubling disparities exist among different ethnic groups in life expectancy also. The average male African-American in New York can expect to die almost six years younger than a (non-Hispanic) white male. Black women's life expectancy is 3.7 years shorter than white women's. There has been a narrowing of these gaps in the past decade – in 1990, the difference in life expectancy between black and white males in New York was an appalling ten years (60 years for blacks vs. 70 for whites). Among women, the black-white gap a decade ago was 5.7 years. Happily, the life expectancies of all three of the racial groups tracked – Hispanic, non-Hispanic white, and black-- have lengthened; African-American New Yorkers' have increased the most, which is why the gap has narrowed. Between 1990 and 2001, black men's life expectancy increased by nine years and black women's by five years; whites' increased too, but by half as much -- five years for men and 2.5 years for women.

 

While acknowledging the narrowing of the gaps as progress, health department commissioner Frieden nonetheless called the remaining disparities "unacceptable." Indeed, despite the record-breaking lows represented by the latest citywide mortality figures, Frieden emphasized the need for future improvements as much as he did the progress that has taken place.

“More than eighteen thousand New Yorkers died [in 2002] before they reached age sixty-five," he said. "Most of these deaths were preventable." More than half of the under-65 deaths were due to only three causes -- cancer, heart disease, and HIV/AIDS – all of which Frieden considers preventable, at least in that age group. "Nearly one out of six New Yorkers who died was killed by tobacco," he added. Tobacco use was implicated in many of the cancer and heart disease deaths; for example, nearly 20 percent of the cancer deaths were from lung cancer, and as much as 90 percent of lung cancer has been shown to result from tobacco use.

What New Yorkers Died of in 2002

The morbid or the merely curious can learn from the report that the five leading causes of death for New Yorkers, factoring in all age groups, were the same in 2002 as in 2001 –heart disease, cancer, flu/pneumonia, stroke, and HIV/AIDS, in descending order. For the sub-group of New Yorkers who died before age 65, the five leading causes of death were cancer (most commonly lung cancer, which accounted for more than twice as many deaths as the next two most common fatal cancers, breast and colon); heart disease; HIV/AIDS; psychoactive substances (either by overdose/poisoning or cumulative, long-term health damage); and finally accidents, including car accidents, falls, accidental poisonings (other than by drugs and alcohol), and other fatal mishaps.

 

They might also be interested to know that the prevalence of the causes of deaths differed by gender. Cancer was clearly the biggest killer of women who died before 65, accounting for slightly more than a third of these deaths; while heart disease tied with cancer for the leading cause of death of men under 65, each killing 22 percent of the total.

And the fact that the third leading cause of death among city residents, especially those over age 75, is the flu may come as a surprise to the many New Yorkers who think of it as just another of winter's commonplace ordeals, unpleasant but not especially dangerous. Flu can quickly prove deadly, however, if it progresses into a more serious illness such as pneumonia. Those obsessing about West Nile Virus (which caused a total of three fatalities in 2002) and Lyme Disease-carrying ticks in the Hamptons would do better to get an annual flu shot than to waste more time worrying about exotic but rare and/or less lethal diseases.

No New Yorker, by the way, had died of mad cow disease as of 2002.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF

The Governor's Misguided Health-Care Cuts


Governor George Pataki’s proposed budget for health care is a devastating package that is especially cruel and insensitive to working people and their families and takes funds away from patient care. It would cut health care spending in the state by more than $1.45 billion, including direct cuts to Medicaid and increased taxes on nursing homes, hospitals, and home care agencies. The New York City health care system alone would lose over $875 million.

Many think of Medicaid as a program for poor adults. But 70 percent of Medicaid spending pays for care for the elderly and disabled, and half of the rest is for children. Medicaid reimbursements keep our hospitals, nursing homes, home care agencies, and community health centers afloat.

In previous budgets, the governor mainly tried to cut funding to health care providers, making it harder for them to serve all of us. But this year, his cuts would take coverage and services away from hundreds of thousands of less politically powerful people -- working people, the elderly and disabled adults.

TARGETTING LOW-WAGE WORKERS
Family Health Plus, the Medicaid expansion that covers low-income working adults (e.g. a family of three with a gross income under $23,000 a year) , is targeted for cuts. Governor Pataki proposes that anyone who works for a company with more than 50 employees, or who has had health coverage within the last 12 months, would be ineligible for Family Health Plus. So, an under-paid Wal-Mart worker who cannot afford health benefits would be barred.

The administration says it is doing this because large companies should provide coverage for their workers. And they should. But why penalize the workers? Does the governor think that people with low-wage jobs at big companies have the leverage to make their employers provide affordable coverage?

The budget would require people covered by Family Health Plus to pay part of the cost for doctor visits, hospital stays and even ambulance services, increasing costs for taxpaying New Yorkers who are barely above poverty. And people on Family Health Plus would no longer be covered for going to the eye doctor or dentist.

HARDER TO GET LONG-TERM CARE
The budget would make it harder for senior citizens to qualify for Medicaid coverage for long-term care (nursing home or home care). People needing such care must spend any assets they have above a certain amount on their care before Medicaid steps in. If the person transferred assets to someone else (e.g. a family member) before applying, Medicaid counts the value of those assets as if the person still had them for three years after the transfer. The governor would extend the look-back to five years back from the date of application (not the date when the asset had been transferred). So, if an elderly person pays for a grandchild’s college education and four years later goes into a nursing home this year, the governor would deny that person Medicaid for five years.

Supposedly this would keep people who can afford their own care from taking advantage of Medicaid. Actually, it would require people of modest means to impoverish themselves to pay for care or would pressure family members to give up their careers to care for an elderly relative. People who can afford lawyers can use trusts and other arrangements to get around these proposals.

It is ironic. If you are very wealthy and die, Republicans want you to be able to leave your entire fortune to your family without any estate tax. But if you are middle class and frail, they want you to spend your life savings on health care, leaving you with little or nothing to pass on to your family.

COST OVER QUALITY IN DRUGS
The governor is in the right ballpark in proposing a preferred drug list for Medicaid. The only Medicaid providers whose rates of payment are virtually unregulated by New York’s Medicaid program are the drug companies. Now, the governor has proposed a preferred drug list for Medicaid. A preferred drug list/prior authorization program – if done right – can dramatically reduce what we pay to drug companies. It can encourage doctors to focus on effectiveness and cost, without restricting their patients’ access to needed drugs. But the Pataki proposal gives too much weight to cost rather than quality in determining what drugs would go on the preferred list and would allow state bureaucrats to override a physician’s judgment on what drug to prescribe a patient. In upcoming budget talks, the Assembly will work to negotiate a good system.

RED TAPE
The budget refers vaguely to promoting "case management" of "high-cost cases." Effective management can mean better care and lower cost, but it can only be done if a patient is covered by a plan over an extended period of time. Today, people are constantly dropped from Medicaid only to re-enroll months later, because of outdated bureaucratic requirements. The Assembly has fought to cut red tape to promote stable coverage and better management of care. The governor opposes these reforms.

THE CALIFORNIA QUESTION
People often, for example, ask why New York spends so much more than California per Medicaid recipient. The implication is that we must be spending money we don’t need to. But there are good and important reasons for the difference.

For one, New York has shifted most of its mental health spending into Medicaid. We are smart to do that, because the federal government helps us pay for Medicaid. California does not do that, so its state and local governments end up paying the whole bill.

We provide good care for elderly and disabled patients, including much more home health care than California. If we did not, many New Yorkers would receive no care, become impoverished paying for care, or their family members would have to disrupt careers to care for them.

New York’s payments to hospitals, nursing homes, home care agencies, and health centers are more closely related to the real cost of providing care than California. That supports the health care system that we all depend on. If funding is cut -– whether by Medicaid cuts or more patients being uninsured –- then staffs will be reduced and services stretched thinner. Even the wealthiest patient will get poorer quality care, and lives will be in jeopardy.

California’s Medicaid program is actually one of the worst in the country –- spending less per recipient than any state, including Mississippi. New York’s Medicaid spending is not much different from neighboring states like Connecticut, New Jersey and Massachusetts.

In health care, as in education and other human services, cutting is not reform. The real solution to the inefficiencies and inequities in health care and health care financing is to move toward universal coverage with broad-based public financing. Governor Pataki’s proposed budget is a major step in the opposite direction.


Richard Gottfried is a member of the New York State Assembly. A Democrat from Manhattan, he is chair of the Assembly’s Committee on Health.

A Bill That Helps End Lead Poisoning


Injuries to children from lead paint cause irreparable harm - brain damage that is irreversible, nervous system disorders, delays in development, and many other permanent conditions. Lead poisoning robs vulnerable children of the potential to become all they might be, and particularly afflicts children of color, who represent nearly 95 percent of the victims in New York City, according to a report (in pdf format) by the Department of Health and Mental Hygiene.

A new law, which the New York City Council is expected to enact this week, is the product of many lessons learned in the struggle against pediatric lead poisoning in the decades since the city first banned lead paint in 1960. Yet when the council members vote, it will be in defiance of Mayor Michael Bloomberg, who vetoed the bill (in pdf format) in December. He was wrong to do so.

A CONTINUING AFFLICTION

"Childhood lead poisoning remains a significant public health problem in New York City," according to the New York City Department of Housing Preservation and Development(in pdf format) "Over the last five years, more than 35,000 NYC children have been newly identified as having elevated blood lead levels." In fact, the numbers may be far higher, since less than a third of children are actually tested, according to the Health Department (in pdf format).

According to studies(in pdf format) by Dr. Philip Landrigan of Mt. Sinai Medical Center, the social costs of childhood lead poisoning in New York City alone are in excess of $1.27 billion a year.

 

THE OLD LAWS

The history of efforts to combat this problem is long and convoluted, some of it detailed online by the New York City Coalition to End Lead Poisoning . In 1982, the city passed Local Law 1, which required the abatement of all lead paint, in any condition, in homes where young children reside. While many experts believe that full abatement is, in the long term, the best way to prevent lead poisoning, and in the long run more cost-effective, there were concerns about the immediate costs of such an effort.

The 1982 law was replaced by Local Law 38 in 1999. That law was criticized by virtually every expert in the field as far too constrained, limiting landlord responsibilities only to peeling paint, and leaving out lead dust and the conditions that cause lead dust.

Indeed, the failure of the law to consider lead dust was a key reason why the state’s highest court, the New York Court of Appeals, last year struck down Local Law 38, after declaring that the "numbers of New York City children with elevated blood lead levels remain alarmingly high."

The high court's decision gave new impetus for the City Council to re-examine the current lead poisoning prevention policies, and on December 15, 2003, by a vote of 44 to 5, the council passed a new lead poisoning prevention bill, Intro 101A. The mayor vetoed it later that month.

THE NEW LAW

The new bill represents, in significant part, an attempt to find a middle ground between the 1982 law (which is the law under which the city began operating again starting last year ) and the now nullified 1999 law.

The overall approach of the new bill is to recognize that if landlords are going to be permitted to leave lead paint in place, they must be proactive in assuring that the lead remains in a condition that is not immediately hazardous to the occupants. Thus, while the new law will not require the 1982 law’s full abatement, it will continue the mandate that owners maintain a safe dwelling at all times, using their knowledge of the particular characteristics of the buildings they manage. And more specifically, it requires that work involving repairs or disturbance of lead paint always be done by properly trained personnel using safe work practices. They must be particularly mindful of lead dust, which is so highly toxic that a particle less than the size of a grain of coffee sweetener is sufficient to inflict brain damage on a child.

Under the new law, landlords will be required to actively ascertain whether children under the age of seven reside in multiple dwellings units (as under the window guard law) and if so, must inspect those units at least once a year (and more often if necessary) for lead hazards, and promptly and safely correct them. Lead hazards can include not just peeling paint, but also "friction surfaces" (painted surfaces that bind and rub), "impact surfaces" (painted surfaces that get damaged by banging), and "chewable surfaces" (those that teething infants are mouthing). Lead dust is also a defined hazard, and peeling lead paint in common areas must also be corrected.

 

RESPONDING TO THE CRITICS

The arguments of the mayor and other opponents of the bill, such as Julia Vitullo-Martin of the Manhattan Institute writing in Gotham Gazette in December, seem to be based on misstatements of the plain language of the law, as well as wholly unsubstantiated scaremongering. We have written a detailed point-by-point response to Vitullo-Martin’s article, and a response to the mayor's veto. In general, they are claiming that requiring landlords to maintain their rental properties so as not to be hazardous to the occupants will result in buildings that become poorly maintained or even abandoned. This is Alice-in-Wonderland reasoning -- requiring something to be safe will make it unsafe -- and is reminiscent of arguments undoubtedly made at every juncture in the history of housing reform in New York, going back to the requirement of indoor plumbing and adequate air and light when the tenement laws were reformed a century ago. As in the past, these will prove to be unfounded.

Equally unfounded are assertions that the bill will make conscientious, responsible owners liable. The problem has never been conscientious owners -- by definition they don't poison children, and one can't be held liable unless there is a victim. While the number of children lead-poisoned each year remains shockingly high, it is still a relatively small percentage of the potential threat; the city estimates there are 300,000 apartments with both some lead painted surfaces and young children in residence. Thus, it is readily apparent that most landlords already are capable and diligent in keeping their buildings in safe repair, and careful, responsible property owners should have no reason to fear the new law. The problem, rather, is the reckless or negligent landlords who cause great injury to our children, and who should continue to be accountable for the consequences. What possible social policy is advanced by changing ours law to immunize them?

It is national policy(in pdf format) that childhood lead poisoning be eliminated by 2010. Given that New York City was one of the first jurisdictions in the nation to ban lead paint, New Yorkers should be seeking to achieve that goal even earlier. Intro 101A is a major step in that direction.

--Matthew Chachère and Andrea Rodriguez are staff attorneys at Northern Manhattan Improvement Corp. Legal Services, which represented the plaintiffs in the lawsuit that overturned Local Law 38 of 1999 (NYCCELP v. Vallone).

 

 

The New Medicare Law - Will It Help or Hurt?


President George W. Bush signed into law in December, 2003 the most sweeping changes to Medicare since the 1965 creation of the federal health insurance program for people over 65 (as well as some disabled persons under 65). The most significant - and controversial - element of the new law is the addition to Medicare of prescription drug coverage.

The $400 billion Medicare Prescription Drug Modernization Act has generated bitter conflict throughout its progress into law, with supporters claiming it will greatly help the 40 million seniors on Medicare to pay for the medications many of them rely on, and critics fearing that the plan will mainly benefit the drug companies and the private insurers and plans that will deliver the Medicare benefit. They even suggest that it is a first step towards the dismantling of Medicare. The bill squeaked through Congress by the narrowest of margins - according to a CNN.com report, in the House of Representatives the vote was running against the bill 218 to 216 until Bush himself made a series of last-minute telephone appeals to members, and slid to victory with 220 for and 215 against.

Now that the bill is law, health care experts and advocates for the elderly seem as divided as ever about whether it will benefit or hurt most present and future Medicare recipients. Indeed, with provisions having been added to and removed from the bill until the last possible moment, and many of them discreetly buried in the nearly 700 pages of drug-plan legislation, both the analysts and those charged with implementing the plan are still figuring out exactly what the law says. Answers to these questions are likely to be slow in coming, since most of the new legislation's provisions will not take effect immediately -- the drug plan, for instance, not until 2006. (Starting this spring, however, Medicare enrollees will be able to purchase prescription-drug discount cards for $30 or less that are expected to save them 10 to 25 percent.)

"The short-term impact in New York is not likely to be dramatic," says James R. Tallon, president of the United Hospital Fund, a federated charity (the nation's oldest) that researches and analyzes health care issues in New York City and issues public-health grants. "There will be some benefit to the hospitals, especially rural hospitals, like those upstate. They used to be reimbursed less than urban hospitals, on the assumption that their costs were lower; now much of that gap has been closed. Hospitals in New York City probably won't be affected that much."

"Over the long term, we're just not sure what will happen," he says.

PRESCRIPTION DRUG COVERAGE

For those Medicare recipients who currently have no prescription drug coverage at all, something is clearly better than nothing. Some aspects of the new prescription drug provisions do look good on paper, at least for those seniors with especially high drug costs and/or very low incomes. The benefit will cover 95 percent of the cost of drugs for people with $5,100 or more in drug costs. And for the 11 million or so Medicare recipients whose income is less than about $13,000 for individuals (or $17,500 for couples), it will pay almost the full cost of prescription drugs, with no premiums or deductibles. Those with incomes no more than 50 percent above the federal poverty level will pay sliding-scale premiums and a modest deductible of $50.

However, the benefit is stingier for seniors who do not fall into the above categories. These seniors must pay the first $250 of their drug costs out of pocket. Medicare would then pay 75 percent of costs up to a limit of $2,250. At that point payments would stop altogether until/unless the beneficiary's costs reach the $5,100 mark, and the 95-percent coverage kicks in. Enrollees will still be required to pay their premiums, estimated at about $35 a month, throughout this $2,850 gap in coverage.

Groups such as the National Committee to Preserve Social Security and Medicare and the Medicare Rights Center and public officials such as Senator Hillary Clinton, have expressed serious concern that the new law does not allow the government to negotiate drug prices with the drug companies, even though it does so for other health care programs like the Veterans Administration's, and such negotiations have been vital in keeping costs down. Spending on prescription drugs in the U.S. has been increasing by over 15 percent annually for several years; critics of the Medicare plan say that with no price controls, by 2006 and beyond seniors will be spending more with the insurance than they do now without it.

NEW CAP ON CONTRIBUTIONS

The new law also allows the government for the first time to cap its general contribution to Medicare. And the $400 billion in federal funds set aside for the Medicare changes over the next ten years will not all go to pay seniors' drug costs; a quarter of it is earmarked for subsidies to private enterprises like the HMOs, PPOs, and other private providers who will administer the drug coverage, and to the companies that will be needed to perform the complex task of coordinating benefits. With costs escalating and the federal contribution capped, the result might well be higher premiums and the shifting of other costs to Medicare enrollees.

"I'm skeptical about these so-called market-driven initiatives," says James Tallon. "The administration used phrases like offering seniors more 'choice' and 'flexibility' in choosing providers, but these words really are euphemisms for cost-sharing. One thing we do know is that the private health care market has higher administrative costs than the federal programs, and its reflexive strategy tends to be to pass on the higher costs to the insured."

"When costs go up, and costs are going to go up, the seniors and the disabled are going to pay for it," says Judy Wessler, director of the Commission on the Public's Health Systems, a New York nonprofit that advocates for affordable health care for all residents. "And the legislation leaves very clear holes, holes that people will fall through. A lot of these holes came out only after the bill was passed. Lots of things have come out since that raise red flags and concerns. The law is very problematic, and a big disappointment to those of us who have been waiting so long for Medicare drug benefits."

BENEFITING OR HURTING NEW YORKERS?

It remains far from clear whether the new plan will end up, on balance, benefiting or hurting the 2.7 million current Medicare recipients in New York State.

"One big question, especially for low-income people, is how the new plan is going to be administered, and how confusing the new options and changes will be," says Tallon. "One of the things we have learned, historically, is that the implementation of a new program this big typically involves complexities that far exceed anything the legislators foresaw. These added complexities are a big problem for people. They are confusing even to health care administrators. If English is not your native language, or you're not skilled at dealing with bureaucracies, you can get completely lost in the shuffle.

"Another big issue is, how is this bill going to connect to existing programs like EPIC [Elderly Pharmaceutical Insurance Coverage], New York's state-run pharmaceutical assistance program, and Medicaid and private retiree programs?"

Tallon is not alone in his concern; many of the plan's opponents and critics predict that seniors will actually end up paying more for prescription drugs when that part of the law goes into effect, particularly if the new Medicare coverage means they lose their eligibility for other, more generous prescription-drug plans such as state-run pharmaceutical-assistance programs or an employer's retiree plan.

New York State's Elderly Pharmaceutical Insurance Coverage program (EPIC), for example, currently provides prescription drug benefits at very low cost to about 320,000 seniors. Notably, the program's eligibility requirements are much less stringent than those set by the new Medicare plan for full coverage of drug costs. For seniors with individual incomes under $20,000 (or married seniors with total income under $26,000), the state program's fees are also generally much lower than the premiums for the Medicare drug plan. A senior with an income of $14,000 who is enrolled in the state program pays an annual fee of $60; a senior with the same income would pay premiums totaling $420 a year for the Medicare plan. EPIC covers almost all prescription drugs, which will almost certainly not be the case with Medicare benefits delivered by a myriad private providers. It imposes no deductible for individuals with incomes under $20,000 or couples with incomes under $26,000.

A Jan. 4 New York Times article reports that both Democrat and Republican state legislators are worried that coordinating the two programs will be extremely complicated and confusing to seniors eligible for both, and some fear that the Medicare plan will provide an excuse for greatly diminishing or eliminating the state program.

Also, under the new law, the 219,000 low-income seniors in New York who qualify for both Medicare and Medicaid will lose their eligibility for the Medicaid prescription coverage and be covered only by the Medicare plan. Whether the forced change from the Medicaid to the Medicare drug plan will benefit or hurt them depends, like so much else, on how the Medicare provisions play out; something which will remain unknown at least until 2006, and probably a good while longer.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Flu; Abuse; Lead Paint


The flu season has reached epidemic levels and has yet to reach its peak, despite a drop-off in cases in some states. Nationwide, nearly four dozen children, about half of them under the age of five, have already died this flu season, which began in November and typically runs into March. New York City doctors, hospitals and pharmacists report quickly rising numbers of flu cases, particularly among children and the city has asked doctors to prioritize vaccines for those with the highest risk. That means the elderly, people with compromised immune systems, pregnant women and children, particularly those under two years of age.

Doctors are calling this the most intense flu season for children since the Hong Kong flu of 1968-69. New York City is reporting widespread activity and the number of reported flu-like illnesses, such as pneumonia, continues to rise, as do deaths from these illnesses.

People with chronic conditions such as asthma and diabetes, from which many New York City children suffer, are at increased risk for complications from the flu. Children with the flu are also at particular risk for ear and sinus infections; it's the bacterial illnesses that can lead to hospitalization and death, although death from influenza is rare for children, an average of 92 annually. This season is worse than usual because two of the three strains currently spreading are particularly harsh, and A/Fujian, one of the more virulent strains, was not included in this year's vaccine. Fujian has the strongest link to severe illness and deaths of children and teens.

ABUSE CHARGED AT THE EDWIN GOULD ACADEMY

Six current and former students of the Edwin Gould Academy in Rockland County have filed a civil suit against the school, charging that the staff beat them and slammed them into walls, broke bones, smoked marijuana in front of them and came to work intoxicated. At least one teen was being injected with Thorazine, an anti-psychosis drug, without parental consent or knowledge, says the suit.

The residential school for troubled, abandoned and abused children, located in Spring Valley, is publicly funded as a special school district of the state. It educates up to 200 children ages 12 to 20, most of whom are from New York City. The school's mission is to provide a safe environment in which children can get an education and a new start. The lawsuit was filed in December in the State Supreme Court in the Bronx; the students in the suit reside in Brooklyn. The suit asks unspecified damages.

The school's superintendent said that state officials had investigated abuse allegations and that some of the named staffers had been fired.

CITY COUNCIL PASSES LEAD PAINT BILL

The New York City Council passed a controversial lead paint bill that makes landlords responsible for lead paint and requires them to remove under a stringent schedule.While many in health and social services are in favor of the bill, others are opposed, including non-profit housing developers. They say lead paint is only one of many problems in the housing stock and this bill be result in the reduction of housing renovation in low and moderate-income neighborhoods.

The mayor vetoed the bill on December 20, saying that it could actually harm families with children because landlords will be reluctant to rent apartments to families with small children. The City Council is expected to override his veto.

Sasha Nyary, formerly on the staff of Life Magazine, edits the newsletter of The Fifth Avenue Committee, a community-based organization.

 

 

 

 

 

 

 

 

 

 

The Lead Paint Bill


 
Catalina Pena and her two sons. High lead levels were found in their Washington Heights apartment.

To many advocates in health and social services, lead contamination poses an unacceptable threat to the welfare of young children, particularly in low-income neighborhoods. To many housing advocates, lead is but one of several serious health-related dangers common to poorly maintained, deteriorated buildings. These two different points of view are at odds in the contentious debate over the City Council's Childhood Lead Poisoning Prevention Act of 2003. The bill, which the City Council passed into law on Monday, December 15, holds landlords responsible for the presence of lead paint and lead dust and sets up a stringent schedule for inspection, removal, and clean-up.

In support of this bill, many advocates urge the eradication of lead wherever it is found -- particularly in the older buildings of what has come to be called the "lead belt," which runs from Bedford-Stuyvesant, East Flatbush, Williamsburg, and Fort Greene north into Jamaica, Queens.

These largely minority lead-belt neighborhoods have a disproportionately high rate of childhood lead poisoning. Indeed, nearly all of the city's children identified as suffering from lead poisoning -- which can cause immune-system and neurological deficiencies as well as amnesia and kidney disease -- are black, Hispanic, or Asian, and most are from low-income households.

Many housing developers, however, including distinguished nonprofit groups like Phipps Houses and the Settlement Housing Fund, oppose the bill, saying that it will reduce investment in low and moderate-income neighborhoods. They argue that the rehabilitation of older housing stock, which contain many health hazards, should take priority over any single issue, even one as serious and explosive as lead.

What's more, they fear that in making landlords solely responsible for the existence of lead-based paint, the bill is setting excessively high and misplaced legal standards of liability. Tenants and tort lawyers will have a clear path to sue property owners, even those who are not at fault.

They maintain that the 1999 law, called Local Law 38, basically worked well.

It eliminated the 1982 law's hazardous directive to abate intact lead paint while adding powerful provisions for safe work practices in lead removal. It required owners of buildings constructed before 1960 to determine if children under age six lived there and to conduct annual inspections for lead paint hazards if they did.

Local Law 38 was struck down in October 2000 by New York State Supreme Court Judge Louis York, who agreed with the Coalition to End Lead Poisoning and the New York Public Interest Research Group that the City Council had passed the law without the state-mandated review of what its environmental effects might be.

PAST SUCCESSES

Most everyone agrees that the national lead clean-up of the 1970s -- that banned leaded gasoline, lead oxide in paint, and lead in pipe solder, food storage cans, pottery, and toothpaste -- has been an environmental success story. The steep declines in the incidence of childhood lead poisoning back this up.

The federal government's official "level of concern" –- the level of lead in children at which parents are advised to seek medical treatment for the youngster –- has dropped steadily. In 1960 parents were urged to have children medically treated if the lead level in their blood tested at 60 micrograms per deciliter or more. Many children in those high-lead days tested at these levels. By 1985, children were treated if they tested at 25 micrograms. In 1991, the Centers for Disease Control and Prevention (CDC) reduced the level to 10, where it has basically remained.

Yet many experts are uneasy. Most people retain about 70 percent of all the lead they've ever ingested, says Roger Bason, an environmental consultant and adjunct professor at Columbia University. In this way, it resembles calcium rather than the many toxins that the body eliminates. A child's relatively small size and rapid metabolism exacerbate the problem. So you really do want to avoid it, Bason says.

But the problem was never really lead chips, says Bason, as the City Council's 1999 law assumed. It was paint dust, which can be created constantly by swinging doors and opening and shutting windows. That dust then gets on things, and because small children put so many things in their mouths, they can then ingest the lead.

Most everyone agrees that the bill before the council has taken an important step by identifying lead dust. But what is the best way of ameliorating the problem and improving the health of young children?

LANDLORD LIABILITY

No one contends that landlords did anything illegal, immoral, or even stupid to create the existing problem. Until 1960 lead-based paint was used routinely as an interior and decorative paint -- even on children's furniture, playpens, and toys -- in houses, schools, and playgrounds.

Nonetheless, if a child is tested and found to have elevated blood levels in his or her blood, the council bill declares landlords responsible for that lead content regardless of the real reason for the problem, a claim more important to litigation than to a child's health. The Department of Health says that of New York City's roughly 5,000 cases of children with elevated lead levels, some 1,250 involve a foreign-born child. Of children with the most serious condition, less than half could be confidently traced to paint, rather than to the many other potential causes, including contaminated dishes and pottery.

But, of course, the source of the lead is the entire game. A child in an otherwise lead-free apartment who is eating hot food off traditional Mexican plates may well become ill, with no landlord responsibility. But the council bill assumes --and stipulates as legal fact -- that any elevated lead level is due to lead paint in the residence.

Further, Commissioner Thomas Frieden testified that the bill inadequately distinguishes between apartments with high and low risks of lead paint exposure. Forcing removal of lead paint in relatively safe buildings can do more harm than good by exposing children to hazards where none had existed, he said. That is because intact lead paint is susually not a problem, but the danger of lead often lies in its disturbance.

The bill even establishes a presumption that lead paint is present in all pre-1960 apartments unless the landlord proves otherwise. As Joseph Strasburg, president of the Rent Stabilization Association, wrote in the New York Post, the bill's "presumption" clause makes it hard for a property owner to fight a lawsuit even if there is no lead paint in the apartment. He says that city data show that more than 75 percent of presumptive lead paint violations in the past two years were issued in error.

NO REHAB AHEAD

Under the bill, any rehabilitation will trigger lead testing. This, combined with high liability, could be catastrophic for the ongoing rehabilitation of the city's housing stock, particularly in poorer neighborhoods. In many cases, under the bill, existing paint would have to be stripped.

"If you create a regimen by which it's impossible to renovate, you're going to do enormous damage," says Michael Lappin, president of the Community Preservation Corporation, the consortium of banks that has financed much of the housing rehabilitation in older neighborhoods. "The council's liability standards will make it very hard for even the most responsible owners to defend themselves. This bill will be a Petri dish for law suits, which will have the effect of jeopardizing insurance for rehabilitation in older neighborhoods."

Carol Lamberg, executive director of the Settlement Housing Fund, which operates 22 buildings providing over 7,500 units of affordable housing, said, "This bill is unworkable on its face. The schedules set up for removal are much too tight, much tighter than anywhere else. Plus, if we can't get insurance we will have to shut down."

That, says Lappin, could be disastrous for the health of children. "Health-related renovations don't just involve paint," he points out. "Renovations that replace plumbing and correct fire and safety violations are every bit as important as paint issues."

The housing producers fear that renovation with tenants remaining in occupancy, which is how most moderate rehabilitation is done, will become almost impossible under the bill because of the requirement that existing paint be removed. Frank Braconi, executive director of the Citizens Housing & Planning Council, notes that their "alarm is born of the reality that they have to schedule these rehabilitation with real contractors, real lawyers, real families."

The bill's advocates scoff, saying that landlord groups had opposed the 1999 bill as well.

This much is clear, however: The millions of dollars that will now be put into lead clean-up will not be invested in basic housing rehabilitation. Increasing the costs of rehabilitating apartments for current residents will deter investment and reduce the amount of rehabilitation actually done. If rehabilitation is slowed down or even halted, more children will live in lead-contaminated apartments -- precisely the opposite of what the bill's sponsors hope to achieve.

Julia Vitullo-Martin is a senior fellow at the Manhattan Institute.

Related Article:

Lead Poisoning by Tracy Middlekauf

Flu


The recent chilling plunge in temperatures has been a rude reminder to New Yorkers that, yes, it really is winter. And, yes, unfortunately, flu season has arrived, and this month will be in full swing. (Although the full flu season runs from about October to April, in past years influenza infection has peaked in December or January and continued at its highest levels through early March.) City health officials recently reported that the flu, which this year arrived in New York City on schedule in October, has now spread to all five boroughs, with the number of cases on the rise, as expected.

The flu is dangerous -- not usually to healthy younger adults; but to the elderly; those with challenged immune systems, such as people with HIV, sufferers from serious chronic illnesses such as diabetes and other underlying medical conditions; and young children (generally, those under age five). Although many people think of it as no more than something like a bad cold -- a week or so of coughing, fever, feeling rotten, and perhaps some missed days at the office -- the flu and its complications are, in fact, a leading cause of death in the U.S. In 2001, approximately 36,000 Americans died from the flu. In New York City alone, there were over 2,000 flu-related deaths.

The Commissioner of the New York City Department of Health and Mental Hygiene, Dr. Thomas R. Frieden, is urging New Yorkers -- particularly those with underlying medical conditions, those over the age of 50 and especially those over 65 -- to get the flu shot. "With flu activity increasing markedly in New York City over the past week, now is the time to get a flu shot. There is plenty of vaccine to go around, and you can't get the flu from a flu shot," Frieden stated. "You need this year's flu shot to protect against this year's flu. Get vaccinated now and enjoy a flu-free winter." The health department also notes that new scientific studies of flu vaccination in people over the age of 65 demonstrate that the flu shot cuts in half their risk of illness, hospitalization, and death.

What Exactly Is the Flu?

The flu, or influenza, is a viral infection of the nose, throat, bronchial tubes and lungs. There are many different strains of the flu virus, which tend to change each year. (This is why last year's flu shot won't necessarily protect you from this year's flu.)

Influenza is highly contagious and is easily transmitted through contact with droplets from the nose and throat of an infected person who has been coughing and sneezing.

Typical symptoms include headache, fever, chills, cough, sore throat and body aches. Although most people are ill for only a few days, some people will develop much more serious illnesses, such as pneumonia, and may need to be hospitalized.

Who Should Get A Flu Vaccination?

Most people could benefit from the flu shot, but according to health officials, certain groups are at an increased risk for serious illness with influenza and should definitely get it unless there is a medical reason not to (such as having had an allergic reaction to a previous flu shot or to eggs, or a history of a disorder called Guillain-Barre Syndrome).

These groups include:
· all people 50 years of age and older;
· adults and children with long-term heart or lung problems;
· residents of nursing homes;
· residents of other institutions housing patients of any age who have serious long-term health problems;
· people who have kidney disease, cystic fibrosis, diabetes, anemia, severe asthma, cancer, immunological disorders (such as HIV infection or AIDs), or other medical conditions for which they are under the close supervision of a doctor;
· pregnant women who will be in the second or third trimester of pregnancy during the flu season;
· household contacts of high-risk people;
· health care workers who provide care to high-risk patients;
· employees of nursing homes, chronic care facilities, assisted living and other residences who have contact with persons at high risk; and
· children aged 6-23 months, when feasible.

It is NOT, persistent false rumor to the contrary, possible to get the flu from a flu shot. Only dead viruses are used in the flu vaccine. A minority of people who get the shot may experience a day or two of pain around the injection site, achiness, or even fever, but this is simply a mild reaction to the shot, not the flu; and the symptoms are much less unpleasant, dangerous, and lasting than an actual case of the flu, which can last up to two weeks (or more, if complications develop).

More information on influenza and the flu shot can be found at the city health department's flu information website, which include a flu fact sheet, detailed information on who should and should not receive the vaccine, and the city's Flu Vaccine Facility Locator (see below).

Where New Yorkers can get the flu shot

You can get the flu shot from your doctor or primary care provider, and the city also offers seven walk-in immunization centers citywide. There are sites in all five boroughs that offer vaccinations for free or at low cost to the needy. Public hospitals, clinics, and senior-citizen centers offer the vaccine throughout the city. To find a site near you, you can use the city health department's Flu Vaccine Facility Locator, which allows you to search for a facility by borough, name, zip code, or clicking on an interactive map. Information provided includes the facility's type (hospital, walk-in clinic, senior center), its address, the days and hours the vaccine is being offered, and how much, if anything, the shot costs.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mentally Ill, Chemically Addicted - And Stuck In Jail


When Prisoners Come Home, Gotham Gazette's Social Services topic page update for January, painted a disturbing picture of how much support released prison and jail inmates need to have a chance at productive lives on the outside, and how little New York City and New York State tend to give them.

Now, several legal advocacy groups, including the New York-based Urban Justice Center and the Legal Aid Society of New York, are pointing out how the state fails one of its most vulnerable and fragile groups of newly released prisoners - those with both serious mental illness and a substance abuse problem. On October 21, the groups filed a federal lawsuit on behalf of the hundreds of seriously mentally ill New York City parolees who their advocates say are unfairly denied community-based mental health and substance abuse services each year, often remaining in jail for many additional months for no more reason than a lack of community treatment slots that they can be referred to.

The suit charges that the state is illegally discriminating against these "dual-diagnosis" parolees -- who are mentally ill as well as having substance abuse problems -- because there are many more residential treatment programs available for parolees with substance abuse problems only; and these parolees are typically released days, not many months, after state officials agree they need treatment and not more jail time.

Dually-diagnosed parolees are generally only eligible for so-called MICA (Mentally Ill, Chemically Addicted) programs, of which there are far fewer in the city. Empty beds in these programs are a rarity. One of the key aims of the lawsuit is to force the state to increase the number of, and parolees' access to, these programs.

Currently, the filers of the suit say, a typical scenario involves a mentally ill parolee returned to jail - and then warehoused there -- for minor parole violations, such as missing appointments with their parole officers. The complaint claims that these violations are typically related to, if not directly caused by, the parolees' mental illnesses and co-existing substance-abuse problems. Even when, as frequently happens, their state parole officials decide that release and treatment for these parolees' illnesses would be more appropriate and effective, as well as better serving the interests of justice, than additional jail time, the re-imprisoned parolees tend to languish in jail for months waiting, often in vain, for one of the handful of state-funded treatment beds in the community that they might qualify for.

"I've met people who've had to wait a year to get out of jail again, even after their parole officers have determined that they need community treatment, not more jail. Six to nine months' wait is typical," said Heather Barr, an attorney with the Urban Justice Center. "And often in the end they don't even get the community beds they were waiting for - they're just released - eventually -- because no beds have come open. And then they end up back in jail for more parole violations that probably would have been avoidable if they'd gotten some help out there.

"And I've seen people who actually have to be kicked out of jail in the end, because they might be getting some kind of treatment in there, maybe psychiatric medications and some observation, which is better than nothing. Have you ever been to Rikers Island? It's a horrible, horrible place, but people have so few options, and such bad options, that even a cell in Rikers seems like something. They know they need continuing and/or better treatment and support to function outside in society, and there just is no treatment for them out there. There's no bed; there's no hope of a bed."

Barr said that there are probably a couple of hundred Mentally Ill Chemically Addicted beds in the city, but almost all are full at any given time. And parolees are discriminated against for admission, either deliberately or by default, she said.

"For instance, on one day this past September, there were 18 MICA beds open," Barr said. "Now, twelve of those beds were at places that won't accept parolees - they demand on-site interviews for admission and won't allow telephone interviews, and people in jail can't get to the places to be interviewed. That leaves six beds total for all the homeless people with mental illness and substance abuse problems, people with addiction problems just discharged from the psych wards, and so on, in New York City. And there's a big focus on providing treatment beds for the homeless, which is great, except parolees usually can't qualify on those grounds -- the rules say that if you weren't homeless before going to jail, you're not considered homeless for treatment-eligibility purposes -- even though many if not most of them have no place to live anymore when they get out of jail, which is pretty typical."

As for how these extra beds are to be paid for, Barr notes that it costs $70,000 a year to keep someone locked up at Rikers Island, but only about $12,000 to provide them with a year of residential treatment at a Mentally Ill Chemically Addicted program.

She says she's optimistic the coalition will win the suit - eventually. "Some of these cases can drag on for years," she said. "But it's so clear, in this case, that the state is denying people with specific disabilities the same care as others, like people with just substance-abuse problems, that we pretty much have to win. That's illegal. It violates the Americans with Disabilities Act, among other things."

The full text of the complaint (in PDF format)is available on the Web site of the Washington, D.C.-based Bazelon Center for Mental Health Law, another of the groups that filed the suit against Governor George Pataki and other New York officials.

The complaint is being brought specifically on behalf of two incarcerated parolees, William G. and Walter W., and the class that they represent of mentally ill parolees in New York City jails waiting for community treatment. The parole officers of both the two recommended MICA treatment for their serious, long-term mental illnesses (schizophrenia and major depression, respectively) with accompanying substance abuse problems. But the two have remained at Rikers respectively for seven and nine months to date, while they wait for the elusive MICA beds to open up. For Walter W., indeed, the wait could well be too long - the state's parole hearing officer in charge of Walter's case, while he agreed back in May that such treatment is the most appropriate option for Walter, has also said that if no such bed opens up, Walter will be sentenced instead to time in a state prison.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

 

 

 

 

 

 

 

 

 

 

 

 

 

A Push For A National Health Service?


Since this health column last reported on the plight of the millions of uninsured and under-insured people in New York and across America, the situation has, unfortunately, gotten worse.

Health care costs are soaring once again; insurance premiums are rising at double-digit rates; the economy, despite all the current administration's talk of a recovery, seemingly remains stalled in the doldrums; states are in fiscal crisis; and continuing layoffs have yanked from millions more Americans the employer-provided health insurance they once took for granted. A September 30 report from the U.S. Census Bureau revealed that, between 2001 and 2002, the number of uninsured Americans rose sharply (by 2.4 million) for the third year in a row. That means 43.6 million Americans, or more than 15 percent of the population, now lack even basic health coverage. Millions more are underinsured. In New York State, the percentage of uninsured is higher than the national average and the total well over three million people, most of them in New York City. According to the Institute of Medicine, already 18,000 Americans die every year because of inadequate insurance; as more lose their coverage, the numbers will rise.

But advocates of a universal national health system – at least, the optimists among them -- see promise amidst the general catastrophe. They are allowing themselves to hope that the erosion of health coverage among Americans who until recently considered themselves comfortably middle-class – and thought the lack of health insurance the problem mostly of a limited subclass of the impoverished, the disadvantaged, and the marginal -- will have real political repercussions in the forthcoming presidential elections and in the halls of Congress.

Voices ranging from liberal politicians to middle-class consumer groups to physicians can now be heard saying the same thing: that after decades of misfires – most famously Bill Clinton's messy failure ten years ago to achieve his campaign promise of universal health care – America, the last holdout, may finally join all the other countries of the industrialized world in adopting some form of national health insurance.

An NBC News/Wall Street Journal poll done in July did indeed find that health care costs ranked as Americans' top economic concern, cited by 24 percent of respondents. By contrast, only 16 percent cited high taxes as their main concern. The incumbent and the other would-be candidates in the next presidential election clearly feel pressure to respond. President George W. Bush and most of the major Democratic presidential contenders have each proposed health care reforms, ranging from Bush's plan for tax credits to help the uninsured buy insurance to the Democrats' various proposals to expand health coverage by rolling back Bush's tax cuts.

But all of these plans retain the basic forms of our current health insurance system -- for-profit hospitals and HMOs; private insurance companies that reap high profits and also spend considerable amounts (subsidized by the premiums of the insured) for marketing, overhead, executive salaries, and profit-sharing with investors; and great influence wielded by the hugely powerful and profitable pharmaceutical industry.

But a group of doctors has come up with a far more sweeping and radical plan, one which calls for a true one-payer, nationalized health service that would cover everybody, and that would (theoretically at least) redirect our vast health care expenditures from corporate coffers and back into health care services.

According to one of the proposal's authors, Chicago physician Dr. Quentin Young, American doctors have traditionally been conservatives when it comes to health care reforms, and they almost reflexively tend to oppose anything that smacks of government-administered health insurance. "But now even doctors are realizing that there's something worse than the government, and that's corporations," Dr. Young said. "Even people who have insurance, so-called 'good' insurance, are now finding their charges and coverage being questioned, because the insurance companies have discovered that simply not paying out claims is the best way to maximize their profits. Doctors can't provide their patients with the care they know is needed, and they're being harassed to death to justify what they do provide."

The plan was developed by Physicians for a National Health Service (PNHP), an organization of 11,000 doctors, many of them prominent. Two former Surgeons General and a former editor of the New England Journal of Medicine lead the group, which went public with its so-called "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" at a press conference in New York in August. The next day, the proposal appeared in the Journal of the American Medical Association (JAMA 8/13/03), which some in the group see as a victory in and of itself, although a spokesman for the (generally conservative) American Medical Association said that the AMA itself still opposes a single-payer health care system. (The AMA has a long history of battling government-administered health insurance; for example, it opposed the creation of Medicaid in 1965.)

The plan, which has now been endorsed by more than 10,000 physicians, calls for a government-financed national health insurance system that would cover every American for all necessary medical care from infancy to death. (In essence, it would be like an improved, expanded version of Medicare, but available to all, not just the elderly and disabled.) Prescription drugs, mental health care, and long-term care would be covered. The government would administer the plan, but most doctors and hospitals would remain private, and patients would be free to choose any physician or hospital they wished. Health professionals would decide what services should be covered, based on the latest medical evidence. Private insurance companies would still exist, but could only provide insurance for services such as elective surgeries that would not be covered by the government plan.

The full text of the proposal, which contains further details and cost-savings analyses, can be read online here (In PDF format).

The proposal criticizes the incremental, piecemeal health reform plans offered by Bush and the main Democratic presidential hopefuls.

"Proposals that call for tax credits or that push seniors into private HMOs all retain the role of private insurers. They are doomed to failure, because they perpetuate administrative waste, and make universal coverage unaffordable," said Dr. Oliver Fein, chairman of the New York Metro Chapter of PNHP, who presented the proposal at the New York press conference.

The plan's authors claim that single-payer national health insurance, far from increasing health care costs, would save at least $200 billion each year by eliminating the high overhead, marketing, profits, and administrative costs that private, for-profit insurers divert money to (rather than spending it on actual health care services).

"We spend $1.6 trillion on health care each year, which is one-seventh of our Gross National Product. That would be a very high cost for an excellent health care system; and what we have is a rather poor one," Dr. Young said. "Compared to countries that spend far less than we do, America scores very poorly on the standard, accepted indices of public health."

But is America, the sole holdout among industrialized countries in terms of adopting a national health plan, ready for such sweeping change?

"Well, I'm old enough to remember the civil rights movement, and anybody who predicted that before it happened would have been laughed at as some utopian dreamer," said Young. "I would say that the conditions for mass social change are ripening. There's a vast discontent out there with the current system, whose weaknesses are being starkly exposed right now. It will take a monumental effort, and a change of administration, for this to happen, but I think in the end it will."

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

World Trade Center Health Registry


The city's health department has announced plans for what could become the largest public-health investigation ever: a comprehensive survey to follow the health of those people most directly exposed to 9/11's World Trade Center collapse and the subsequent clean-up efforts.

The launching of the World Trade Center Health Registry was announced at a September 5 press conference by the city's Health and Mental Hygiene Commissioner, Thomas R. Frieden, MD, and Dr. Henry Falk, Associate Administrator for the Agency for Toxic Substances and Disease Registry and the director of the federal Centers for Disease Control's National Center for Environmental Health.

"The effects of 9/11 are still being felt today by all New Yorkers, and all Americans. Hundreds of thousands of people from all walks of life were in the vicinity of the twin towers when they collapsed, and were exposed to a combination of smoke, dust, and debris.  We need to study the health of these people in order to understand the possible health consequences related to 9/11," said Dr. Frieden. "If you were there on 9/11, you are strongly encouraged to sign up for the WTC Health Registry."

Dr. Falk said, "The World Trade Center Health Registry will do what no other health survey is doing. It will record and measure the health impact of 9/11 in the broadest possible terms.  The Registry is a tool for giving us health data that could guide how we respond to this kind of disaster for generations to come.  The more people enroll - even if they feel perfectly healthy - the better our chances will be of understanding any health effects from this tragic event."

People in any one or more of the following categories are eligible to enroll in the registry, regardless of whether they have experienced any health problems:  

· People who were in a building, on the street, or on the subway south of Chambers Street on 9/11/01;
· Workers involved in the rescue attempts, recovery, or clean-up work at the World Trade Center site, and/or the associated recovery operations on Staten Island, at any time between 9/11/01 and 6/30/02;
· Students and staff at schools (pre-K to 12) or daycare centers south of Canal Street on 9/11/01; and
· People living south of Canal Street on 9/11/01.

If enough people enroll, city and federal health officials said, the registry could result in an investigation as much as five times the size of the one following the 1979 Three-Mile Island nuclear accident in Pennsylvania. That study tracked 38,000 people. Falk noted that the report based on the Three-Mile Island registry, which was issued last year and stated that people who lived near the nuclear plant showed no significant increase in cancer deaths, probably served to calm a population nervous about the unknown long-term health effects of the accident.

"I plan to enroll in the World Trade Center Health Registry, and I encourage all Battery Park City residents and workers who were here on 9/11 to step forward and enroll too," said Timothy S. Carey, CEO and president of the Battery Park City Authority, who was also present at the press conference.

To advertise the registry, which is being funded with $20 million in federal funds, the city health department says it will put posters in subways and commuter trains that read, "I was there September 11th." It will also use billboards, direct-mail solicitations, Internet ads, and brochures to urge people to step forward and enroll.

Officials stressed that all medical information collected from individuals will be kept strictly private and confidential, and that no medical examinations or tests will be required for participation.  People can drop out of the registry at any time.

Those who enroll in the registry will be asked to answer a 30-minute telephone survey of where they were on 9/11, how long they were in areas afflicted by smoke and fumes, and whether they have had any health problems since.  Registrants will be periodically contacted to report any health changes.  This information will then be compared with that of the general population, in order to identify any health problems possibly linked to 9/11.  Ultimately, findings drawn from the health registry should be able to allow researchers to observe patterns that may be invisible to individual physicians.

The announcement of the survey follows closely on recent revelations that the Environmental Protection Agency gave New Yorkers false assurances about air quality in the days after the terrorist attack.  But city health officials say that the registry was not launched in response to the recent accusations. Plans for the registry were first announced last year. The health registry's goal is to follow up with hundreds of thousands of people who were directly exposed to the aftermath of the twin towers' collapse, which produced choking clouds of dust, asbestos, smoke, and fire. It will re-contact registrants periodically over the next 20 years to track any changes in their physical or mental health. People exposed to the WTC aftermath have already reported symptoms of asthma, persistent cough, burning eyes, and other ailments presumably caused by the airborne contaminants that so thickly pervaded the downtown area in the days following 9/11/2001.

Officials said the registry will issue quarterly reports to inform the public about what it learns from the project. The reports will be posted online  www.wtcregistry.org. The first report is expected this fall.

The registry is a jointly funded effort of the New York City Department of Health and Mental Hygiene, the Agency for Toxic Substances and Disease Registry, and the Federal Emergency Management Agency (FEMA).  RTI International, a nonprofit research firm, will conduct the interviews. 

To find out more about the WTC Health Registry and the enrollment process, you can visit www.wtcregistry.org or call 311 or toll-free to 1-866-NYC-WTCR (1-866-692-9827).

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.



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