Op-Ed Pieces from The North Adams Transcript

Ecu-Health Care's Executive Director, Charles Joffe-Halpern, writes an ongoing op-ed column, for the North Adams Transcript. Below are his pieces from this past year, they include the following:

-The Health Care Bill and North Berkshire
-Enact the House health reform bill
- Why We Need Health Reform Now
-This is a Crucial Month for Health Reform
-Here Comes the Medicare Drug Plan 
-HealthCare and The American Dream
-Poverty Guidelines and Affordable Health Plans
-The State's Dental Crisis
-The Challenge of Hunger in Massachusetts
-Health Care and Self Resonsibility
-Human Dignity and Health Care
-Health Disparities
-Breast Health Screenings 

The Health Care Bill and North Berkshire

Saturday, April 15, 2006-The recently passed, landmark Massachusetts health care bill will have significant impact on the residents of North Berkshire and the rest of the commonwealth. While there are many components to the law, the key aspects that will affect area residents include the following:

* All Massachusetts residents will be mandated to purchase health insurance by July 1, 2007, as long as the insurance is affordable for them. Significantly, individuals not offered employer-sponsored health insurance will have access to private plans through a state administered program. For those individuals whose incomes are under 300 percent of the federal poverty guidelines ($29,400 for an individual, $39,600 for a family of two, $48,800 for three and $60,000 for four), their premiums will be on a sliding scale and will have no deductibles. Those over 300 percent of the poverty line will receive no premium assistance and they may have to pay deductibles.

* The bill also expands eligibility for employee participation in the current Insurance Partnership program from 200 to 300 percent of the poverty line. This program provides reimbursements to the self-employed and small businesses for the cost of health insurance.

* MassHealth guidelines for children will be increased from 200 percent of the poverty line to 300 percent of the poverty line.

* Businesses with 11 or more full-time equivalent employees who do not provide health insurance will have to pay an assessment of $295 a year. This will help pay for the care of their employees who will be relying on the state for assistance (this provision is expected to be implemented through an override of a line-item veto by the governor).

Much has been written both supportive and critical of the new legislation, and the views expressed are all valid. On the positive side, hundreds of thousands of low-income uninsured Massachusetts residents will finally have access to comprehensive health coverage. This is a remarkable achievement in this political landscape.

Chief among the concerns are: How will we determine what is affordable? Will the assistance to help lower-income individuals purchase coverage be adequate? How will individuals whose incomes are to high to qualify for help be able to afford health coverage? Will the health plans provide adequate coverage? And will the state have enough funds to maintain the program?

We won't know the answer to these questions until the law is fully implemented, and unlike the well-known television ad, there will be no "easy button."

What we do know is that in North Berkshire there are approximately 3,500 to 4,000 uninsured residents who will now be mandated to have health care. Reaching out to educate, provide guidance and help enroll these individuals into the new health insurance plans will be a challenging public health endeavor. It is critical that we be prepared to meet the demands of this historic task. Keep in mind, there has never been health insurance mandate in the history of the United States; we will be pioneers.

Since 1995, I have been the executive director of a non-profit organization that helps uninsured area residents access health care through the charitable voluntary efforts of the local medical community. While I am proud of what we have accomplished helping thousands of residents access health care, I am also acutely aware that our organization's efforts fall short. There is a limit to volunteerism, a limit to the numbers of individuals we can serve, and a limit to the services we can provide.

We frequently have to beg drug companies to provide our members with medications, and often we fail. And while grateful for the care they do receive, deep inside, our members understand they are not fully legitimate health care consumers.

For the last 11 years I have lived for this moment. The state of Massachusetts now holds the promise of providing legitimate health insurance coverage to a vast majority of state's uninsured, who previously went without care, incurred serious medical debt, or were reduced to asking for charity. While the implementation of this legislation must be monitored closely to insure the issues noted above are adequately addressed, we who work everyday with the uninsured realize this is a huge step forward.

Charles Joffe-Halpern is the executive director of Ecu-Heath Care and the president of the Board of Directors of Health Care for All in Boston. He can be contacted at cjoffehalpern@nbhealth.org

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Enact the House health reform bill

Tuesday December 20, 2005- Last month the Massachusetts state House of Representatives and state Senate passed separate pieces of health care reform legislation, both designed to reduce the number of uninsured residents.

The House bill expands health coverage by raising income eligibility guidelines for MassHealth and creates a health insurance mandate requiring Massachusetts residents to have health insurance as long as they have access to an affordable plan.  The state would also encourage the development of new insurance products with generous subsidies provided to low to middle income residents to make these plans affordable.  The House bill also includes a requirement that employers who have 11 or more employees, who do not provide health coverage to their employees, would have to pay a 5% to 7% assessment of their payroll to help pay for the new subsidized health plans

It is important to realize that currently, employers who do provide health coverage to their employees are penalized by having to pay an extra surcharge on their health insurance premiums to help pay for the health care of uninsured workers. Under the proposed legislation, this penalty would be eliminated.  It is estimated that over 400,000 uninsured Massachusetts residents would be covered by the House bill.

The bill passed by the Senate, while also expanding coverage through the MassHealth program, is more limited in scope.  The bill does not include the individual mandate or the payroll assessment.  Policy experts suggest that about 75,000 uninsured residents would gain coverage through the Senate bill.

The House and Senate bills have now gone to a conference committee where differences will be hammered out, and a compromise bill will be sent back to both legislative chambers to be voted on again.   The agreed upon final bill will then be sent to the Governor.  It is expected this will happen within the next four weeks.

From the health care advocacy side there are understandable concerns that proposed insurance programs cover a significant number of the uninsured, that plans be comprehensive enough to cover the cost of needed health care, and should not impose prohibitive deductibles and premiums.  The business community claims the proposed payroll assessment will be too punitive for businesses that don't provide coverage. 

When studying the history of public policy, no piece of legislation has ever passed without a struggle, and whatever comes out of the conference committee will be no exception.  To put this in perspective, American industrial leaders fought hard against the minimum wage before it became law in 1938.  At that time President Franklin Delano Roosevelt warned that we should not let “calamity-howling executives” tell us that a minimum wage was going to have a disastrous effect on all American industry.   Can you imagine now not having a minimum wage?   In the early 1960’s the American Medical Association initially fought against the passage of Medicare, but where would our elders be now without the security of basic health coverage?

We who work with the uninsured on a daily basis cannot shield ourselves from seeing the effect that lacking health coverage has on individuals and families.  I am currently working with two uninsured women who are both cancer patients. Besides the trauma of the diagnosis and their uncertain futures, they are both facing the potential of overwhelming medical debt.  So not only are they being challenged by their illnesses, but they are also being stripped of their dignity by the financial consequences of being uninsured.  Both women would have health coverage under the bill passed by the House of Representatives.  Under the Senate bill, they would still be left uninsured. 

I cannot, in good conscience, tell these women they should wait for some mythical future, before we develop a “perfect” health care system that will satisfy all the health care stakeholders in the United States.  That health care system never will exist, there will always be trade-offs.  But, the Massachusetts state legislature now has potential of passing legislation that will bring relief to these two cancer patients, and to provide health coverage to the vast majority of the other 500,000 uninsured residents in Massachusetts. 

Let us now hope that the more expansive provisions of the legislation passed by the House of Representatives are included in the conference committee's recommendations.

Shame on us, if we lose this political window of opportunity.

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Why We Need Health Reform Now

Thursday, November 3, 2005 - The Massachusetts legislature stands poised to pass the most comprehensive health reform bill in our time.  Perhaps, no one understands the importance of this more than Geraldine Levy, a 56 year old woman from North Adams.  Geraldine is not provided health insurance at her job, and she was recently diagnosed with cancer.  She loves her work, but she recently had to reduce her hours as she started her chemotherapy.  Geraldine has applied for MassHealth, but she may or may not qualify depending if her situation merits her being considered disabled.   She doesn't want to be considered disabled, but she needs the health insurance.

It's not challenging enough that she has developed cancer, she now also has to contend with the possibility of incurring crippling medical debt.   Under the provisions of the bill being considered by the Massachusetts legislature, Geraldine would be able to purchase insurance at an affordable cost and she could pay attention to the task at hand: treating her cancer. 

The health care reform bill now being considered, "An Act Promoting Access to Healthcare", H.4463, would expand health care to the currently uninsured in the following manner:

-It creates a subsidized insurance program, called Commonwealth Care Health Insurance, for all adults whose income is less than 300% of the federal poverty guidelines (fpl).

-Expands MassHealth to include all adults whose incomes are under 100% of the fpl.

-Expands MassHealth coverage to parents of children up to 200% of the fpl.

-Expands MassHealth to include all children up to 300% of the fpl.

-The bill mandates that all Massachusetts residents have health insurance, but there would be no penalty if affordable insurance products are not available to them.

-It is predicted that this legislation would provide health coverage to 95% of the currently uninsured.  In these times, this would be a remarkable and long over-due achievement.

Perhaps the primary contention over the passage of this bill is the mandate that employers who have 11 or more employees will have to pay a 5% to 7% payroll assessment to help pay for the new Commonwealth Care Plan.  For companies who provide health coverage to their employees, this assessment would be reduced and in many situations eliminated. 

It is important to realize that currently, employers who provide health coverage to their employees pay an extra surcharge on their health insurance premiums to help pay for the health care of the uninsured.  Employers who don't offer health coverage to their workers are exempt from this surcharge. The challenge, as House Speaker Salvatore DiMasi stated earlier this week, is how to hold employers who don't provide health coverage more accountable, and not harm businesses who do cover their workers.

In Massachusetts, political opportunities to implement serious health care reform come along about once every ten years  And in this decade, this is now that moment.  Despite an improved economy, there are now over 500,000 uninsured residents in Massachusetts, this includes over 50,000 uninsured children! 

There is no argument that health care reform is greatly needed in Massachusetts, and we should also realize that no piece of health reform legislation will please every stakeholder.  But, we should also understand that the bodies of the uninsured will not wait another ten years before they get sick or injured; Geraldine Levy knows this all too well. 

Harvard University's Robert Blendon, the well respected pollster in the field of health policy, recently observed that if we are to make any progress in implementing health care reform, every stakeholder will have to give in a little and no one will get exactly what they want.  For the sake of Geraldine Levy and the other 500,000 uninsured residents throughout Massachusetts, it would be unconscionable to lose this moment. 
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This is a Crucial Month for Health Reform

Wednesday, October 19, 2005 - Americans like to help people who work hard and play by the rules.  This was reinforced for me this past weekend when I was gathering signatures for a ballot initiative that would significantly expand public health insurance to many of the approximately 530,000 Massachusetts residents who are currently uninsured.  If enough signatures are raised, then the ballot will be presented for voter approval in November 2006.  When I asked people to sign, most did not hesitate and signed immediately.  But a few balked, wanting to know first if the ballot initiative would help those who work and is not just a hand-out.  The answer is a resounding yes.

The key provisions of the ballot initiative, titled the Massachusetts Quality Affordable Health Care Act (MassACT) will include the following:

-Provide sliding-scale premium assistance to moderate-income families struggling to afford health care costs.

-Provide health coverage to children and many low-income workers not offered health care through their employers.

-Help small businesses provide coverage by expanding the Insurance Partnership program, which provides small businesses and their lower-income employees with subsidies to help pay for health insurance.

-Make our health system fair by funding expanded coverage through an affordable assessment on firms that refuse to provide coverage to their workers.

-Lower health costs and improves health through increasing the cigarette tax by 60 cents to reduce smoking and to fund affordable coverage.

-Reduce health insurance premiums by ending a surcharge now tacked onto premiums to pay for uninsured patients who get care in emergency rooms and other sites.

This past Sunday the Boston Globe reported that some of the provisions of MassACT are being considered in a bill that is expected to be approved by the legislature in the next few weeks and presented to the Governor by November 16th.  But the question is: will the legislation being proposed this month provide true health security for a significant number of the approximately 530,000 uninsured Massachusetts residents?   The consequences of this cannot be overstated.

Given the steadily escalating cost of health care, an increasing number of lower-income workers are either not offered health coverage at work or they cannot afford the increased premium costs that are being passed on to them.  This explains why there are over 100,000 more uninsured Massachusetts residents now than four years ago.  What will it take to stop the bleeding?

It is important to realize that 80% of uninsured families have at least one member who works full-time.  Those most vulnerable to not having health coverage include, restaurant workers and other workers in the service industry, the self-employed, those who work for small businesses, young workers between the ages of 19-25, and individuals who are single.  This past week I interviewed a woman who works full-time for a fast food restaurant as a crew worker, she explained that unless you are management, the company does not offer health benefits. 

When sitting in a physician's office recently, I looked up to see a sign which read: "Health New England members are now welcome here!"   I immediately began to question, so who is not welcome here?  Isn't the first question asked at a doctor's office: "what is your health insurance?" But, we really can't blame medical providers for this, doctors and their staff need to be paid, too.

In ten years of interviewing the uninsured, people consistently report they avoid seeking treatment when sick or even injured, because they can't afford exorbitant medical costs.  A young woman who had delayed seeking care for what turned out to be blood clots in her lungs shared with me that she had delayed seeking treatment because "she was the kind of person who likes paying her bills."  Of note, over one-half of all personal bankruptcies in the United States are a result of unpaid medical bills.  Given the demands of meeting a family's budget, without health insurance, one cannot be said to feel "welcomed" in a doctor's office.  In reality, the uninsured know they are considered illegitimate health care consumers.

It is now accepted that without government intervention, the numbers of uninsured will only continue to increase.  This month the Massachusetts legislature can remedy this situation by passing a bill that provides coverage for a significant number of uninsured residents.  If the legislation being developed this month falls short, then through the MassACT ballot initiative, the voters will decide the issue for themselves next November.

It is time to make workers who are not provided health insurance through their employers, truly welcome in doctors offices throughout Massachusetts.
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The State's Dental Health Crisis

Thursday, March 31, 2005 - This past year, the Massachusetts Society for the Prevention of Cruelty to Children released a disturbing report revealing that dental decay is now the most widespread chronic childhood disease -- five times more common than asthma and seven times more common than hay fever. The report shows the prevalence of dental disease falls disproportionately on children covered by MassHealth, the state's health insurance program that covers one out of every four children in the Massachusetts.

The seriousness of this critical problem cannot be overstated. Consider these findings from a survey of third graders in Massachusetts: 65 percent of children on MassHealth had a history of dental disease, 40 percent had untreated decay and 16 percent of these children had urgent needs requiring immediate care.

The MSPCC report emphasizes how critical this problem is for all children: "The implications of untreated dental illnesses are serious and can be permanent. Significant tooth decay, pain, or infection can inhibit learning, speech, and eating, leading to problems in school, negative self-image, and poor nutrition. More than 51 million hours nationwide are lost each year due to dental-related illnesses."

A U.S. Department of Health and Human Service study adds: "Oral infections and disease in childhood have been linked to increased risk for future decay, and chronic oral infections are associated with an array of other health problems later in life such as heart disease, diabetes, and unfavorable pregnancy outcomes."

The reasons for the children's oral health crisis in Massachusetts have been well documented by a statewide Oral Health Advocacy Task Force of dental and healthcare leaders, and academicians. The Task Force notes that while over 450,000 children are eligible for MassHealth dental benefits, fewer than 15 percent of Massachusetts' dentists accept MassHealth members. The result is that an appalling 70 percent of enrolled children do not have access to care.

Dentists from North Berkshire tell me that they see children whose parents drive over two hours for an appointment, because no MassHealth dentist in their area is available to treat them.

Dentists give a number of reasons for not participating in the MassHealth program. This includes cumbersome administrative procedures and inadequate reimbursement rates that have been far lower than private rates. In addition, because of current regulations, they cannot limit the number of MassHealth patients they see, thus putting them at risk of becoming overwhelmed with new MassHealth patients seeking services.

Recently, important first steps have been taken to address this urgent problem:

* Gov. Romney has proposed allowing dentists to cap the number of MassHealth patients that they would have to accept. But, now the Legislature must also agree to approve this.

* The state recently increased reimbursement rates for dentists participating in MassHealth. But the rate is still lower than the median rates of the private market and there is real concern that these rates will not attract a meaningful number of new dentists into the program.

* Based on a review of upcoming reports, the Legislature must decide whether or not to allocate the funds necessary to put into place a third-party administrator to run the MassHealth dental program. This would remedy the current administrative struggles that dentists experience. Implementing a third-party administrator is considered crucial if we are to be successful in recruiting more dentists into the program.

Addressing the children's dental crisis will require a long-term commitment involving expanding access to preventative care and treatment, oral health education, nutrition, and expanding fluoridation initiatives. But the next 12 months will be critical in determining whether or not we will be making real progress toward addressing this long overlooked children's health struggle.

A state legislative staff member once shared with me that, as a child, her family relied on MassHealth as their source of insurance. Fortunate enough to have access to a dentist, she shuddered to think what may have happened if she wasn't able to receive this necessary care during her childhood.

A fourth of all children in Massachusetts will now depend on the Legislature to strengthen the MassHealth dental program, so they too can have access to basic dental care.

Thursday, March 17, 2005 - Recently, the Washington Post reported that Tennessee Governor Phil Bredesen, when announcing that he was cutting 323,000 low-income residents from the state's Medicaid program, belittled Tennessee's Medicaid recipients "for making lifestyle choices to work for small businesses that do not offer insurance rather than finding jobs with the state or large companies that do. His attitude is shared by many, and this has consequences here in Massachusetts.

Employer-sponsored health insurance, the primary mechanism for acquiring health insurance, began in World War II when businesses faced both a labor shortage and mandated wage-controls, so they started providing health insurance benefits to attract needed workers.  

Over the past 25 years though, as a result of changing labor trends and the greatly increased cost of health care, the number of uninsured Americans has steadily climbed.   During this same time, the number of individuals working in small and medium-sized businesses has also increased, while the number of workers employed in large establishments has notably declined.  The proportion of Americans with employer health coverage subsequently dropped from 67% to 61%.  Surprising to many, six out of ten uninsured Americans are now full-time workers. 

We should remember that the adoption of employer-sponsored health coverage was a historical accident.  And while gaining affordable health coverage through employers is consistent with society's desire to reward individuals for working hard and being self-reliant, with 45 million uninsured Americans, we can no longer depend on employers to deliver on this promise. 

For years, the public has been shielded from understanding the true cost of health care, and even those close to the field can keep themselves in the dark.  Recently a consultant to a major health insurance company called me for advice on purchasing health insurance for his daughter.  When I gave him the quote of $260 for a 22 year-old woman, he cried out “are you kidding me, that’s outrageously high!”  In Massachusetts a typical family plan would cost over $1,000.00 a month. 

It is generally accepted that the only way the growing number of uninsured working families will be able to obtain health coverage is by expanding public health programs.  But do we have the will to do so?

Paul Feldstein, in his instructive text, “The Politics of Health Legislation,” recognizes that historically, middle-class voters have agreed to fund public health programs when they believe those who benefit from these programs are “deserving” of their support.  He explains, deserving means that the beneficiaries are similar to those of the middle class but because of unfortunate or temporary circumstances, they find themselves in need of public support.

Significantly, even public policy makers are also influenced by personal experience, as much as any other factor.  An example of this is Republican Senator Pete Domenici from New Mexico who is a fiscal and social conservative, he is no bleeding heart and certainly no social activist.  But Senator Domenici has a daughter with schizophrenia.

For years he fought side-by-side with the late liberal Senator Paul Wellstone to enact legislation that would force health insurers to treat mental and physical illnesses equally, so those with mental illness could gain more services.  Health insurers and business leaders fought hard against him. He too would have opposed this legislation, if he did not have a daughter with schizophrenia.  Important political decisions of national importance really are this personal.

Perhaps what is needed in the health care debate is a better understanding of what the uninsured really experience.  While there are always exceptions, the vast majority of the low-income working uninsured identify with the middle class, embracing the same desire for self-reliance and financial security.  But, contrary to Tennessee Governor Bredesen’s polarizing comments, not everyone can work for a large business that offers health benefits, and this should not be seen as their moral failure. 

This is a critical year in Massachusetts, this past December major legislation was filed that will expand health coverage to thousands of the state’s uninsured unable to obtain health benefits at work.  Supported by a broad-based coalition of health care organizations, this is the best opportunity in over ten years to bring health coverage to these families.  We just need the will to do so.

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The Challenge of Hunger in Massachusetts

 Thursday, March 3, 2005 - Shirley Clapper, the Director of Berkshire North WIC, recently described how a young mother came to her office and revealed that she was giving her infant daughter six bottles of tea a day, because she couldn’t afford to give her formula. 

 This is not a rare occurrence.  A newly released U.S. Department of Agriculture report indicates the number of Americans experiencing hunger rose a stunning 26% between 1999 and 2003.  The National Anti-Hunger Organizations (NAHO), reveals the irony that the proportion of undernourished people in developing nations has been cut in half, but among industrialized countries, the United States, the largest and most efficient food producer in the world, is the only nation that still tolerates widespread hunger within its borders. 

 In Massachusetts, the increasing number of undernourished families parallels the rest of the country.  Project Bread, a Boston based organization dedicated to reducing hunger, reports that: "the Commonwealth suffered a 6.2 percent decline in jobs between January 2001 and January 2004, the highest rate in the nation, and job losses and lower earnings have left many with inadequate resources to feed their families."  According to the USDA, 425,000 people in Massachusetts now lack access to adequate food.

 The consequences of hunger fall most heavily on children.  Brandeis University’s Center on Hunger and Poverty notes that: "Even moderate hunger among children can impede cognitive development and impair their capacities over a lifetime.  Hungry children score lower on standardized tests, miss more days of school, and have psychosocial and emotional health problems."   Lack of financial resources can also create obesity in children, as families stave off hunger with cheap high caloric foods with little nutritional value.

 This troubling reality, which Americans don't feel comfortable acknowledging, points to the reason why WIC (Women, Infants, and Children Nutrition Program) and Food Stamps are described as two of the most important governmental programs ever created in the country. 
WIC, administered in Massachusetts by the Department of Public Health, is a nutrition program that provides checks to purchase healthy foods, and nutrition and health education free of charge to Massachusetts families who qualify.  A key goal is to keep pregnant and breast feeding women, new parents, and kids under five healthy.  They also conduct immunization screenings and provide referrals to other essential health care programs.  In Massachusetts, to be eligible for WIC a family of four can earn up to $34,872 a year. 

 The results of WIC have been impressive, women participating in WIC have improved pregnancy outcomes, and infants have better birth weights and are less likely to be premature.  Children enrolled in WIC are more likely to have regular medical care and immunizations, and they demonstrate better cognitive performance. 

 The Food Stamp Program, funded with federal dollars and administered in Massachusetts by the Department of Transitional Assistance provides eligible families with an average of $156 per month of food purchases.  Families with children may be eligible for food stamps in Massachusetts with incomes up to $37,704  for a family of four. 

 Despite the acknowledged need that families have for assistance, Project Bread notes that in 2001 Massachusetts had the lowest food stamp participation in the country, when only 45 percent of those eligible in 2001 were enrolled.   While participation has grown since then, reaching those who could benefit from the program remains a major challenge.

 There are a number of reasons why eligible families are not enrolled in either WIC or Food Stamps.  Many families aren't aware they are eligible, some are intimidated by the application process, and others don't want the stigma of receiving assistance.  This poses a difficult dilemma.  Job losses and reduced earnings leave many with a lack of resources to feed their families adequately, but at the same time, our desire for individual autonomy inhibits many families from seeking needed support. 

Ending hunger in Massachusetts and throughout the country needs to be addressed on many levels, but first we must work hard to ensure that programs such as WIC and Food Stamps are fully utilized.  In North Adams you can contact WIC at 663-3012, for Food Stamps contact the Department of Transitional Assistance at 663-1100.
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Human Dignity and Health Care

Thursday, February 17, 2005 - We health care advocates frequently try to convince the public that lacking health insurance is harmful.  We reveal how the uninsured can't afford primary preventative care, how illnesses go undetected and untreated, and consequently, how the uninsured can suffer serious medical consequences.  Perhaps though, we should bring attention to a time of life when the consequences of lacking health insurance can be even more disturbing.

Recently, I was asked to find services for an uninsured man in his 50's, struggling with quickly spreading cancer.  This man worked full-time in a small business where health insurance was not offered. His fellow workers described him as likeable and hard-working, his wife shared he was a caring and loyal husband.  As he was not eligible for any category of public health benefits, we enrolled him in our own program of volunteer physicians who lower their fees for uninsured residents.  

Regrettably, his cancer progressed.  His situation became even more frightening when, because he was uninsured, area medical providers could not find a surgeon, needed from out of the area, who would agree to treat him.  In our relatively small community it was the second time in recent years we struggled to find treatment for an uninsured cancer patient.

Fortunately, we  were able to locate a specialist across the state who agreed to perform the necessary surgery.  She is a member of a physician's group that participates in the state's free care pool.  It is a source of care still not generally known by the public or even the medical community.  While the surgery in the short term was successful, sadly his cancer spread and he was soon re-hospitalized. 

Upon discharge, the man was prescribed medication essential to controlling his escalating pain.  A 15-day supply of the medication would cost over $200.00, which the family could not afford.  Even with our assistance the family was already incurring mounting medical debt.  I then contacted the pharmaceutical company to apply for free medication.  Most pharmaceutical companies provide this assistance, but income-eligibility rules consistently change and the application process for most programs is difficult to navigate.

When I described the patient's situation to the company's representative, he explained to me that unless we could produce his previous year's tax statement, he would not be provided the medication.  Unfortunately, the forms were misplaced, and when we offered to produce more current proof of income, the company's representative would not budge.  I asked to speak with his supervisor, and after calling numerous times I eventually got through to her.  Using all the advocacy finesses I could muster, I finally convinced the supervisor to provide the patient with the needed medication.

Soon after discharge, the man's condition took a turn for the worse and he returned to the hospital, where he soon died.  I take some comfort in knowing that perhaps I helped this man die in a little less pain and that I helped his family incur less financial debt.  But, this experience reveals something quite insidious: that our health care system can force individuals to beg for medical care and beg for relief from pain during the most terrifying time of their lives.

***

With respect to individuals of all faiths, we will never be able to prove whether or not God exists.  But we do prove everyday that people exist, and as people, we form societies to determine how to allocate resources, including how to finance and deliver health care.  

Lawrence D. Brown and Michael S. Sparer, writing in Health Affairs , observe that in all other Western societies, national health insurance has “crucial moral underpinnings,” adding: “basic human dignity would be offended if any citizen declined to seek care for fear of financial consequences of doing so or faced financial stress as a consequence of getting care."

In this country, the political process moves slowly. We have much work to do if we are to see the day when no person, ever again, has to beg for medical treatment, or beg for relief from pain when struggling with a serious illness.   But work hard we must, I believe God would want us to.

Health Disparities: Our National Shame

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
Dr. Martin Luther King

 Thursday, February 3, 2005 - It is more clearly coming to the public’s attention, the most troubling, but underreported health care challenge in America is how to address the widening health care disparities that are incurred by racial and ethnic minorities, these include lack of health insurance, lower quality of care, and poorer health outcomes.  And this is a struggle about to get more difficult.

These are only a few of a number of alarming trends:

• African American, American Indian, and Puerto Rican infants have higher death rates than white infants and African-American infant mortality is 2.5 times higher than whites. African American children, ages 1-14 years of age, were roughly 3 times more likely than their white counterparts to be hospitalized for asthma, irregardless of income.

• The vaccination-coverage gap between white and African American pre-school children has widened each year for the series of vaccines recommended to prevent diphtheria, tetanus, pertussis, polio, measles, and influenza.

• African American women are more than twice as likely to die of cervical cancer than are white women and are more likely to die of breast cancer than are  women of any other racial or ethnic group.

• On average, Hispanic/Latino Americans are 1.5 times more likely to have diabetes than non-Hispanic whites of similar age. Mexican Americans, the largest Hispanic/Latino subgroup, are over twice as likely to have diabetes as non-Hispanic whites of similar age.

• African-American seniors are almost 4 times less likely than their Caucasian counterparts to receive needed coronary bypass surgery. And African American seniors are nearly 2 times less likely to receive treatment for prostate cancer.

Health disparities in the United States are fueled by a number pervasive conditions, including: the effects of poverty, community isolation, language barriers, bias, the lack of cultural diversity in the medical profession, and significantly, lack of health insurance coverage.  In 2003, over 33% of Latino’s and 18% of African Americans were uninsured, compared to 11% of whites without health coverage. 

Remarkably, despite the well-documented prevalence of racial and ethnic health disparities, until now there has been a strong will not to believe the seriousness of the situation.  The Kaiser Family Foundation observes: “There is limited awareness of disparities in health care on the part of the public or providers.  Most people believe that African Americans and whites generally receive equal quality health care.”   They add, that even physicians believe that disparities in health care are rarely, if ever due to race or ethnicity.  

*

As disturbing as health disparities are, health outcomes for minorities would be far worse without the critical support of Medicaid, the conjointly funded federal and state health insurance program covering 50 million Americans.  It is imperative to know that Medicaid covers one out of every four children and one-third of all births in the United States. 

Now, this month it is expected the Bush administration will introduce legislation to restructure, and reduce critical funding to Medicaid.  This will force states to either lower the number of people eligible for the program, decrease health care benefits, or both. 

The proposal will be incorporated into what is known as the budget reconciliation process, and unlike most legislation of this significance, it cannot be filibustered. This means it can be accomplished with little discussion and largely unrecognized by the American public.

 Unless the administration's plan is stopped, the health care safety net for all lower-income Americans will be dangerously weakened.  And lower income Americans can least afford to have health benefits removed from them.

 Last week, Senator John Kerry launched an alternative proposal, to expand public health insurance benefits guaranteeing health coverage for all children in America.  In his presentation of the plan, Senator Kerry affirmed his belief that:  “The United States is a democracy that should set an example for the rest of the world.”  

 On many levels, it will take a committed and sustained effort to reduce health disparities in this country.  We must start by strengthening, and not weakening the health insurance program so vital to one-sixth of all Americans.   We can only hope the United States Congress has the will to make that effort, and resist going backwards.
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Breast Health Screenings: We need to do Better

January 20, 2005- Despite the increased public awareness of the need for early and ongoing screenings for breast cancer detection, one-third of all women in the United States are not receiving these services.  Consider the following statistics.

·          One in eight women in the United States will develop breast cancer in her lifetime.

·          While breast cancer risk is higher among women whose close blood relatives have this disease, 90% of all women with breast cancer have no family history of the disease.

·          In North Berkshire alone, an average of 40 women each year are newly diagnosed with breast cancer.

With the implementation of the REACH for Breast Health program at North Adams Regional Hospital there is no reason why any woman in North Berkshire cannot receive ongoing preventative breast health screenings.  REACH for Breast Health arranges for crucial screenings, education, and case-coordination for all women in North Berkshire regardless of income. 

Imaginis.org, a breast health resource web-site, urges: "Beginning at the age of 20 every woman should practice monthly breast exams and begin a routine program of breast health, including scheduling physician performed clinical exams at least every three years.  As a woman ages, her risk of breast cancer also increases. About 77% of women with breast cancer are over 50 at the time of diagnosis.  Beginning at the age of 40 all women should have annual screening mammograms, receive clinical breast exams each year, and practice breast exams every month."

The American Cancer Society adds:  “The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms.  Breast cancers that are found because they are causing symptoms tend to be relatively larger and are more likely to have spread beyond the breast.  In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast.”    

And most importantly:  “Finding breast cancer as early as possible greatly improves the likelihood that treatment will be successful.  There is no question that early detection tests for breast cancer saves many thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.”

Carol Guernsey RN, program manager of REACH for Breast Health, cites three groups of women who have a lower rate of screenings.  They include: the uninsured, lower-income women, and the elderly.  She gives the following reasons that woman avoid preventative exams:

·          Lack of funds to pay for the screenings.

·          Lack of education about the need for preventative care.

·          Fear of a mammogram hurting.

·          Fear of a positive finding.

·          Women are busy and let other things take priority.

 Psychologists have observed that the fear of a diagnosis of breast cancer is unique among diseases.  Breast Cancer.org, a non-profit educational site observes:  "Women may live with a fear of breast cancer for years, assuming that it's better to ignore or hide their feelings.   In fact the opposite is true. Expressing your feelings, and becoming active in understanding and managing your own personal risk of the disease, are more effective ways to handle fear."   The reality is women report being put at ease after screenings knowing their current health status.

The challenge now is to reach these women and help them overcome the barriers to receiving care, and in North Berkshire that's where REACH for Breast Health comes in.  For those who qualify, REACH provides free monthly health screenings, including breast examinations, blood pressure checks, diabetes screenings, and cholesterol checks.  In addition, for women over the age of 40, REACH will arrange for free mammograms, PAP smears and OBGYN exams through the Women's Health Network. 

For women who have a positive diagnosis, REACH for Breast Health helps to coordinate care among different  doctors and departments involved in breast cancer care, and provide ongoing information, guidance and support. 

 We are very fortunate to have REACH for Breast Health available to the women of North Berkshire.  To schedule an appointment for a women's health screening call Carol Guernsey at 664-5170.