Health and Disability

Although Medicare helps to pay for many important health care services, including hospitalizations, physician services, and prescription drugs, people on Medicare generally pay monthly premiums for physician services (Part B) and prescription drug coverage (Part D).  Medicare has relatively high cost-sharing requirements for covered benefits and, unlike typical large employer plans, traditional Medicare does not limit beneficiaries’ annual out-of-pocket spending.  Moreover, Medicare does not cover some services and supplies that are often needed by the elderly and younger beneficiaries with disabilities—most notably, custodial long-term care services and supports, either at home or in an institution; routine dental care and dentures; routine vision care or eyeglasses; or hearing exams and hearing aids.

Many people who are covered under traditional Medicare obtain some type of private supplemental insurance (such as Medigap or employer-sponsored retiree coverage) to help cover their cost-sharing requirements.  Premiums for these policies can be costly, however, and even with supplemental insurance, beneficiaries can face out-of-pocket expenses in the form of copayments for services including physician visits and prescription drugs as well as costs for services not covered by Medicare.  Although Medicaid supplements Medicare for many low-income beneficiaries, not all beneficiaries with low incomes qualify for this additional support because they do not meet the asset test.

Unfortunately the problems with VA medical care will provide ammunition to politicians who oppose replacing Obamacare with a simple single-payer system, “Medicare for all.” Although the Affordable Care Act made no changes to veterans’ medical benefits, critics of Obamacare have already seized the opportunity to charge that “government-run health care doesn’t work – just ask a veteran.”

Of course, the problems with veterans’ benefits do not prove that “government health care” doesn’t work. Medicare, for example, is a government program and it works quite well, with none of the problems afflicting Veterans Affairs facilities or, for that matter, Obamacare.

A key difference between Medicare on the one hand and veterans’ benefits and Obamacare on the other hand, is that Medicare patients can go to virtually any doctor or hospital in the country, most of which are not operated by the federal government. The VA has only limited facilities, not always conveniently located and insurance policies sold under Obamacare often severely restrict the doctors and hospitals people can go to.

Medication errors cause at least one death every day and injure approximately 1.3 million people annually in the United States. Medication mishaps can occur anywhere in the distribution system:

• prescribing,
• repackaging,
• dispensing,
• administering, or
• monitoring.

Common causes of such errors include:

• poor communication,
• ambiguities in product names, directions for use, medical abbreviations or writing,
• poor procedures or techniques, or
• patient misuse because of poor understanding of the directions for use of the product.

In addition, job stress, lack of product knowledge or training, or similar labeling or packaging of a product may be the cause of, or contribute to, an actual or potential error.

Estimates of Medicaid spending developed from Centers for Medicare & Medicaid Services (CMS) data sources suggest wide variation among states in Medicaid spending per enrollee, overall and for each of four main eligibility groups—children, adults, disabled, and aged.

On July 2, the White House Council of Economic Advisers (CEA) issued a report, Missed Opportunities: the Consequences of State Decisions Not to Expand Medicaid, which details the impact of states’ decisions to not expand Medicaid under the Affordable Care Act. We are talking about a lot of people whose health care needs are put at risk because the 24 States have refused to expand Medicaid: 1. Preventive health care will not occur each year - a. for 214,000 women between the ages of 50 and 64 who would have received mammograms; b. for 345,000 women who would have received pap smears, and c. for 829,000 men and women who would have received cholesterol-level screenings. 2. Also, 651,000 people who would have received “all needed care” they felt they needed during the year. 3. If Medicaid had been expanded in every State, an additional 1.4 million people would likely have had a primary care visit at a physician’s office. See Chart #2 below for a breakdown by State. Real people, real lives, real injuries. Becausee these 24 States have not accepted Medicaid expansion, 255,000 people risked facing catastrophic out-of-pocket medical expenses which would have otherwise been covered with Medicaid.

I have no absolute religious objection to assisted dying. And as surveysseem to show, nor do most religious people. But I do have a serious anxiety that we hugely underestimate the emotional complexity of giving patients this choice. For what it says to many people who are dying (and because of that, often exhausted and confused) is that it is now within their power to relieve the emotional distress of those who surround them. It presents the dying with the option of giving their loved ones the gift of their simple swift end. And thus it opens up an emotional minefield of second-guessing and lonely choices. Lonely? Yes, because my loved ones are never going to accept the relief of their distress as a good enough reason for me to choose assisted suicide. That would be hugely guilt-inducing. So if I make the decision to end it all because of them, I can never tell them why.

When the moral history of the 21st century comes to be written, I predict we will look back with horror at how the word choice became a sort of cuckoo in the nest, driving out all other values. This week, in an editorial, the BMJ decided that patient choice now trumps the Hippocratic oath. The moral language of the supermarket has become the only moral currency that is accepted. Which is why, for me, assisted dying is the final triumph of market capitalism: we have become consumers in everything, even when it comes to life and death. And as history demonstrates, the losers in this equation are always going to be the most vulnerable.

Cigarette smokers are more likely to commit suicide than people who don't smoke, studies have shown. This reality has been attributed to the fact that people with psychiatric disorders, who have higher suicide rates, also tend to smoke. But new research at Washington University School of Medicine in St. Louis finds that smoking itself may increase suicide risk and that policies to limit smoking reduce suicide rates.

"Our analysis showed that each dollar increase in cigarette taxes was associated with a 10 percent decrease in suicide risk," said Grucza, associate professor of psychiatry. "Indoor smoking bans also were associated with risk reductions."

The health care community is not doing enough to track and prevent widespread harm to patients, and preventable deaths and injuries in hospitals and other settings will continue unless Congress takes action, medical experts said today on Capitol Hill.

"Our collective action in patient safety pales in comparison to the magnitude of the problem," said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. "We need to say that harm is preventable and not tolerable."

Dr. Ashish Jha, a professor at the Harvard School of Public Health, said patients are no better protected now than they were 15 years ago, when a landmark Institute of Medicine report set off alarms about deaths due to medical errors and prompted calls for reform.

"We can't continue to have unsafe medical care be a regular part of the way we do business in health care," Jha said.

Thomas, a former executive assistant, had been given so many heavy-duty medications, including illegally administered antipsychotics, by the Ventura Convalescent Hospital in November of 2010 that she could no longer function. If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.

"Yes, my mom had Alzheimer's, but she wasn't out of it when she went into the nursing home. She could dress and feed herself, walk on her own. You could have a conversation with her," says Levine. "My mother went into Ventura for physical therapy. Instead, she was drugged up to make her submissive. I believe that my mother died because profit and greed were more important than people."

A Ventura County Superior Court judge agreed that Levine had a legitimate complaint against the nursing home. In May, attorneys from the law firm Johnson Moore in Thousand Oaks, Calif., joined by lawyers from AARP Foundation, agreed to a settlement in an unprecedented class-action suit against the facility for using powerful and dangerous drugs without the informed consent of residents or family members. "It is the first case of its kind in the country, and hopefully we can replicate this nationwide," says attorney Kelly Bagby, senior counsel for AARP Foundation Litigation.