Medicare for All, is it time?
I haven’t wanted to comment on the proposals from the politicians because it was clear to me that they were getting their marching orders from the policy wonks who only rehash the same mis-disinformation and lies told about the problems in the US Health System.
In the article below, the focus groups tell me that I was right. That only by changing the health delivery system, and not just the payment of premiums system, can we get the quality and access data we need to improve the system. Government’s role is to collect taxes and spend the money to reach certain goals. They do not create programs, they simply fund programs that are brought to the table.
Just because those over 65 get Medicare, if they contributed the required amount, doesn’t mean that Government has anything to do with designing the health delivery system. They simply fund it. There are still out of pocket costs with Medicare, which encourages people to choose to forego straight Medicare and to have their Medicare premiums sent to an Advantage Plan run by an insurance company. What difference will it make in the system if all health care dollars are funneled through insurance companies? We will still have the insurance company’s favorite managed care tool to contend with, cost shifting.
In 1989, Communications Workers of America went on-strike because NYNEX wanted the employees to pay for their health benefit premiums. The slogan was “Fight Against Cost Shifting.” Up to this point, the workers were given a Medicare for All type plan, where the employer paid into a fund to cover the cost of claims. The strike led to the creation of the health reform movement, that culminated in the proposed Clinton Health Plan. The idea was to take health care decisions out of the hands of employers, who at that time were funding most health insurance coverage, so that people would not lose their coverage if they changed jobs. The plan described how premiums would be paid, either by employers of individuals into a Federal plan, similar to what we have under the ACA. When the Clinton Plan failed to pass, mostly because of the insurance industry’s mis-disinformation campaigns, the movement took up the slogan, Medicare for All to try to simplify the funding mechanism to the public. But, this was before Managed Care and Advantage Plans. This was also before Medicaid and Medicare funding were combined, so that funding was no longer based on who contributed.
This is why the hopes for an accountable plan design is not coming to fruition through the ACA. The system remains fragmented with out universal quality measures. When we talk about agreeing with Bernie or any of the possible candidates, we need to be sure of their understanding of the problem or we may vote them in only to find out they they use the same tired excuses as we found with the ACA.
Axios
June 3, 2019
Voters are tuning out the health care debates
By Drew Altman
There’s a big disconnect between the health care debates that dominate Washington, the campaigns and the politically active — where all of the talk is about sweeping changes like Medicare for All or health care block grants — and what the voters are actually thinking about.
The big picture: In our focus groups with independent, Republican, and Democratic voters in several swing states and districts, the voters were only dimly aware of candidates’ and elected officials’ health proposals. They did not see them as relevant to their own struggles paying their medical bills or navigating the health system.
Details: We conducted six focus groups in three states (Texas, Florida, and Pennsylvania), facilitated by Liz Hamel, the Kaiser Family Foundation’s Director of Polling and Survey Research. Each one had eight to 10 people who vote regularly and said health care will be important in their presidential vote in 2020.
The highlights:
* These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
* Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
* When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
* When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
* When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
* They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.
Between the lines: Most voters in these groups don’t seem to see the current health reform proposals on either side of the aisle as solutions to their top problems: paying for care or navigating the health insurance system and red tape.
* That, combined with a general distrust of politicians, can make these voters wary of any plan that sounds just a little too good to be true to them.
The bottom line: For most voters, the debate will be more meaningful when they see stark differences on health between the Democratic nominee and President Trump in the general election. Then they may be able to focus more on what differences on health reform mean for the country and their daily lives.
It’s never too late to live.
Below is an article featuring one of my clients by Alan Magill, Director of Recreation at Ateret Avot senior home. Kurt contacted me when he was just about to be placed in a nursing home. He still had enough gumption to call out for help, knowing that active life was not over for him. It turned out that Kurt’s home care aide had been helping herself to his social security and pension payments for over a year. For years, he remained isolated in a senior citizens apartment, without proper nutrition or personal care, being admitted often to the hospital. Kurt’s only relative, a nephew tried to help. But Kurt was always very independent and as many seniors can get, he was paranoid about losing control. Finally, the hospital discharged him to a nursing home for placement.
Initially, Kurt was evaluated as having severe memory loss by the nursing home. Once it was determined that he was not Medicaid eligible, Kurt was accepted by Atria Kew Gardens Life Guidance program, together with 12/12 private aides, which we arranged through Senior Helpers. Kurt spent most of his time in his room, alone with the aides, looking through old books and talking to himself. He did not want to participate in any of the group activities, obsessing about news clippings and trying to dominate the conversation with some point he needed to make. Although he was well cared for at Atria, it was obvious that he was very unhappy and talked often about feeling sick and dying.
With memories of having to flee from Germany in 1939, running with his family through Europe, Africa and eventually landing in South America, Kurt speaks several languages and has lots of stories. After a few months at Atria, where Kurt’s medical and financial issues were addressed, Kurt told me about a rabbi, who he knew from South America and who was now in Queens, NY. The rabbi was more than happy to visit with Kurt and after many discussions, we were able to clarify Kurt’s situation. What Kurt wanted was to be in an environment where people could appreciate his stories, even on the tenth telling.
Alan Magill has a way of featuring each residents strengths during the course of the many activities focusing on Jewish life and history. I have seen people who look like they were asleep in their wheelchairs, start to sing and recite poetry or respond with an eloquent soliloquy upon hearing Alan call out their name.
Here is the article:
GETTING BACK by Alan Magill January 25, 2019
As appeared in the Jewish Connection Volume 12, Issue 9
There are things we do in our younger years that we enjoy, that are important to us, that we put aside for different reasons when we become adults. As the years go by, some may have a fleeting thought of that image of idyllic youth and yearn at some point to get back to it. Others may have it foremost in their mind and keep waiting for the opportunity for the free time to pursue it. For yet others, there can be nary a thought, but it could be in the subconscious, waiting to emerge.
One example of this is when teenagers of decades ago had the opportunity to learn Torah but then with increasing responsibilities of work and family, put it aside. But for those who still yearn for it, how sweet it is to get back to it.
I knew of a man, years ago, who lived in a Senior Home, who was a Holocaust survivor. He told the recreation director that he had a Yeshiva education but after the War, the desire to learn was taken out of him. Sixty years later something remarkable happened. Now blind, someone gave him a Torah tape to listen to. He took to it like a fish to water. His nishama was being touched in a meaningful way to an endeavor that had so, so long ago been important to him. More and more tapes were sent to him He could be seen on a daily basis sitting in the lobby with his earphone in the recorder with a big smile on his face.
You CAN go Home again. A cousin of mine, a lawyer, while in his 50s, had to clean out the house of an elderly family member who had passed away. He came across a Bible with the names of that man’s grandfather and his father’s name and other family names as well going back more than a century. My cousin, a very busy man with his career at the time, told himself while looking at that Bible, that one day when he had the time, he would dedicate himself to researching past generations to fill in and add depth to his family tree. This was not an endeavor he was going back to from his youth. But something that had tickled his fancy in middle age. And sure enough, he went back to that Bible when he retired and launched an international search for family members that went back to Poland in the late 18th century. And of course, moving forward. I was contacted, and was included in a publication he made along with hundreds and hundreds of cousins he found, a nice amount of which were at a family reunion he organized in Princeton, NJ. A true labor of love.
I was inspired by a woman I worked with in a senior home who in her late teens wanted to go to college, but it just did not fit into her family’s plans for her. No matter. When she was in her late 70s, she had no family planning for her, so she went back to a decades old dream and went to college and got her degree.
Pictured here is Kurt, a guest at Ateret Avot Senior Home, where I am director of recreation. You have to go back a number of decades when he went to the High School of Fine Arts in Montevideo, Uruguay, to see where he was immersed in artistic pursuits. Since then, over the years, he was an engineer and a teacher, and he has not done much painting over that time. And now, with Ateret bringing in an artist to lead a four part painting project of a mountain scene of nature, Kurt gets a chance to rekindle his interest as he is seen here starting the painting and showing his work after the first group.
Yes, there is a positive in developing new interests. But there’s a special kind of joy when you can rediscover a past interest. It’s like going back in time and shaking the hand of your youth.
Alan Magill can be reached at pr2hope@aol.com
To advertise in THE JEWISH CONNECTION call: 718.761.2626 • ads@jewishc.com
HIPAA as a cover up.
I am very proud to have participated in this informative, interactive training. It has already been very helpful to my work with patients in the hospital.
One of the things the training touched on was that HIPAA, the law that protects your privacy in regards to who you want your health information shared with, is often quoted as being the reason that your authorized representative cannot get answers to their questions when they are advocating for you. This week I had an experience that exemplified how this misuse of HIPAA can really hurt the patient.
My client, who was recently admitted to an assisted living facility from her home in another State and therefor did not have a signed NYS Health Proxy Form, was taken to the hospital after a fall. She did not want to go to the hospital, but her daughter was going with her, so we felt she should at least have it checked out. Before the daughter was asked anything about the patient’s health history, the hospital administered a shot of Haldol, an anti-psychotic. The daughter was shocked to see her mother in a catatonic state, especially since her mother’s diagnosis of Parkinson’s and prior hallucinations, which had been under control with medication, would have indicated that this type of drug should never have been administered.
The catatonic state lasted for weeks, with the doctors saying we should consider long term care placement in a nursing home. With advocacy from the daughter, who also happens to be an elder law attorney, and myself, we convinced the hospital physician to put in for a psychiatric evaluation. It was my feeling that the patient could benefit from a full discussion about medications that could balance her Parkinson’s medications with other medications for her confusion. The psychiatrist agreed that her confused state was much improved from the catatonic state she had been in upon being admitted. He suggested that we try other treatments quickly with the goal being to discharge the patient as soon as possible to normalize her surroundings. We left the hospital agreeing all around that this was the plan and even provided a commitment from a rehabilitation facility that they had a bed ready for the patient.
Two days later, thinking that the treatment had been underway and wondering when the patient would be transferred to the rehab facility, I received a call from the physician saying that he didn’t feel comfortable accepting the daughter and my verbal approval for the treatment and therefore, instead of proceeding as directed by the psychiatrist, he had gone to the legal department at the hospital. No treatment had been initiated. He now said that he would not proceed without speaking to the patient’s son, because since there was no Health Care Proxy Form he did not want to take my or the daughter’s approval to administer ADVIL, a commonly used over the counter medication for pain. This was ridiculous, first because the son had not been involved in the discussions with the doctors, and because the doctor had withheld beneficial treatment from the patient for some technicality which had already been approved by the daughter and in the presence of the psychiatrist and myself. This was especially egregious because the patient herself had been able to state her daughters full name and that I was the friend who was helping her.
We finally had to get the son on the phone to give his approval for his sister and I to make all necessary decisions for his mother. Not to mention that when we first wanted to talk to the doctor, he kept us waiting for two hours, and only came when we demanded to see the in-charge nurse who paged him, but taking direction from the training I had just completed, my next call would have been to the hospital administration to put in a complaint, or even a letter to the Department of Health.
Here is the section of the HIPAA law that talks about the problem, as shown on the US Dept of Health and Human Services https://www.hhs.gov/hipaa/for-professionals/faq/488/does-hipaa-permit-a-doctor-to-discuss-a-patients-health-status-with-the-patients-family-and-friends/index.html
The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient’s care or payment for health care. If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity may also share relevant information with the family and these other persons if it can reasonably infer, based on professional judgment, that the patient does not object. Under these circumstances, for example:
- A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital.
- A hospital may discuss a patient’s payment options with her adult daughter.
- A doctor may instruct a patient’s roommate about proper medicine dosage when she comes to pick up her friend from the hospital.
- A physician may discuss a patient’s treatment with the patient in the presence of a friend when the patient brings the friend to a medical appointment and asks if the friend can come into the treatment room.
Even when the patient is not present or it is impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person, a covered entity may share this information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b). Thus, for example:
- A surgeon may, if consistent with such professional judgment, inform a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide periodic updates on the patient’s progress and prognosis.
- A doctor may, if consistent with such professional judgment, discuss an incapacitated patient’s condition with a family member over the phone.
In addition, the Privacy Rule expressly permits a covered entity to use professional judgment and experience with common practice to make reasonable inferences about the patient’s best interests in allowing another person to act on behalf of the patient to pick up a filled prescription, medical supplies, X-rays, or other similar forms of protected health information. For example, when a person comes to a pharmacy requesting to pick up a prescription on behalf of an individual he identifies by name, a pharmacist, based on professional judgment and experience with common practice, may allow the person to do so.
A Patient Advocate’s Life
I am constantly asked how to get paid for being a patient advocate. The question should be, do I really want to be a “professional” patient advocate, or do I just want to volunteer my services. In this blog post for the Alliance of Professional Health Advocates, you will ask yourself the first questions that will help you to decide if you really want to be in business as an advocate.
Go to this page to see more about how a mentor can help you to start and build your own Patient Advocate business, https://healthadvocateprograms.com/blog/
Home care companies add value
This article from Carol Marak talks about ways that home care companies can add value to their services. “In June of 2017, I praised Congress for passing the bipartisan Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act.” Hooray for families! And on January 22nd, the US President signed into law the RAISE Family Caregivers Act. It’s the first step in creating a national strategy aimed at the relatives and partners who provide care.”
https://www.homehealthcareagencies.com/resources/hope-for-family-caregivers-who-give-so-much/
New Medicare Cards 2018
So you want to be a Patient Advocate.
This is a blog post on the Alliance of Professional Health Advocates Mentor Blog. Look at this link for other Mentor Blog posts and other resources if you are thinking of starting a Patient Advocate business.
https://healthadvocateprograms.com/building-a-team-to-help-your-clients/
Caryn talks helping others, help yourself.
Thank you, Joy Brown, Holistic Weightloss Coach and Trainer.
Navigating the Health System
Caryn Isaacs, Patient Advocate
This is my space for talking about health care and seniors. You can also see my “Almost Fiction” stories about people facing life challenges. For more about me and Patient Advocacy, go to my website, GetHealthHelp.com
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