Health Worries Rising for D.C. Latinos; Proposed Clinic Closure, New U.S. Rules Put Pressure on Providers - The Washington Post

At the Clinica del Pueblo (the People's Clinic) in NorthwestWashington, the telephone rings every few seconds, but thereceptionist tells callers in Spanish that no appointments areavailable for six weeks. Patients have to climb three flights to getto the clinic, where nurses and volunteer medical students examinethem in closet-sized cubicles among stacks of files and shelves ofmedicine.

'We are open six days a week, 12 hours a day, and we use upevery available space,' said Andrew Schamess, the private, nonprofitclinic's only full-time physician. 'But we have to turn away farmore people than we can see, often with serious problems. It breaksyour heart every time.'

Health Canada "passes the buck" on diabetes drug, researcher charges - CMAJ: Canadian Medical Association Journal

Health Canada's decision to restrict the use of the diabetes drug rosiglitazone (Avandia) does not go far enough and simply places the responsibility for its safe usage on doctors, a leading critic charges.

'My take is that Health Canada passed the buck to front-line clinicians,' says Dr. David Juurlink, a scientist with the Institute of Clinical Evaluative Science and the head of clinical pharmacology and toxicology at the Sunnybrook Health Sciences Centre in Toronto, Ontario.

Health Canada posted a 'Dear Doctor' letter from rosiglitazone's manufacturer GlaxoSmithKline Inc. on Nov. 19 which advises physicians to restrict the use of Avandia to those patients for whom all other treatments to control their blood sugar have failed or are not appropriate. In addition, Health Canada now requires doctors to get patients who continue to take rosiglitazone to sign a consent form stipulating that they are aware of the potential risks.

'They've complicated the lives of patients and doctors with a consent form,' says Juurlink, who had urged suspension of the drug (www.cmaj.ca /cgi/doi/10.1503/cmaj.109-3268). 'To me, it's an ineffective and weak-kneed response.'

Health Canada's advisory mirrors that of the United States Food and Drug Administration (FDA), which after conducting hearings into the safety of rosiglitazone in September voted to allow the drug to remain on the market, although with similar tight restrictions. The drug has been implicated in increased cardiovascular events, such as heart attack and stroke.

The FDA also halted a clinical trial, known as TIDE (Thiazolidinedione Intervention with Vitamin D Evaluation), which was to have compared rosiglitazone to pioglitazone and standard diabetes drugs.

Juurlink believes Health Canada should have followed the lead of the European Medicine Agency, which pulled rosiglitazone off the market.

'The Europeans did the right thing,' says Juurlink, who conducted a large study comparing rosiglitazone with pioglitazone, another diabetes drug. 'What we have is a regulator that's unwilling to take decisive action, in this case on a drug that not a single Canadian patient needs. Why can't they simply have the guts to pull a drug from the market?'

Health Canada declined interview requests but in a written response states that 'no decision to remove a product from the market is taken lightly; it is based on a thorough review of the scientific evidence and scientific evaluation of the product's benefits and risks to Canadians.'

Health Canada reviewed scientific data and Canadian adverse reaction reports, as well as 'other information,' the department added.

'Should new safety information arise, Health Canada will take appropriate action as necessary,' the department writes, adding it is tracking adverse cardiovascular events associated with rosiglitazone, as well as doctors' prescribing patterns.

Many doctors are unaware of the Health Canada restrictions and are continuing to prescribe rosiglitazone, says Juurlink. 'I've had three patients in the last month come in on a formulation of rosiglitazone. Clinicians are too busy to read everything that comes across their desk from Health Canada. They don't listen to what Health Canada has to say unless Health Canada actually does something.'

Juurlink's contention that physicians' do not uniformly react to regulatory advisories is supported by data from IMS Health's National Prescription Audit and the Xponent Database. The data was published in an opinion piece that asserts there were regional variations in rosiglitazone prescribing following the FDA's 2007 'black box' warning about increased cardiovascular risks associated with use of the drug (N Engl J Med 2010; 363:2081-84). While overall use dropped dramatically, rosiglitazone was still prescribed more in some states, such as Oklahoma, than others, such as North Dakota.

Meanwhile, the FDA and Health Canada's restrictions on rosiglitazone use strengthen the position of plaintiffs in a class action lawsuit against Glaxo- SmithKline, says Saskatchewan lawyer Tony Merchant. 'We're feeling better about the case and the strength of the case as a result of Health Canada's decision.'

Of the 500 patients or their families who have contacted Merchant's firm, about 50 cases have involved a death, Merchant says. Although the drug company has settled some rosiglitazone lawsuits in the US, they have not made settlement offers in Canada. - Laura Eggertson, Ottawa, Ont.

[Sidebar]

Studies have linked the use of rosiglitazone with increased cardiovascular events, such as heart attack and stroke.

[Author Affiliation]

Laura Eggertson, Ottawa, Ont.

Mental Health Care Scarce in Rural Areas; Traveling Social Workers and Psychologists, New Technology Bring Services to Far-Flung Clients - The Washington Post

When Margie Whichard looks out the windows of her centralVirginia trailer just beyond the Appalachians she sees miles oftrees and fields. The loudest sound she hears is the clucking ofchickens from her barn. The nearest town, Dillwyn, is 15 miles awaydown a narrow, windy highway.

Months ago, events in Whichard's life triggered a depressionthat made her feel her world was collapsing. She sought counseling,but the nearest mental health professional was more than an hour'sdrive from her home. The time and expense of traveling made regulartherapy impossible, and Whichard struggled on her own.

Child health and human capital.(Research Summaries) - NBER Reporter

When economists use the phrase 'human capital' it generally means 'education.' But one's health can also be viewed as a form of capital. Both education and health are strongly influenced by 'family background' which is commonly measured using parent's education and income. Much of my research over the past decade seeks to evaluate the effect of public programs designed to improve the outcomes of children from disadvantaged backgrounds. In my forthcoming book, The Invisible Safety Net: Protecting the Nation's Poor Children and Families, I argue that while the cash welfare system receives more attention, elements of a largely invisible safety net of in-kind programs have proven remarkably effective in improving the lives of poor children. (1)

Intervention Programs

For example, my work with Eliana Garces and Duncan Thomas shows that Head Start (a pre-school intervention for poor children) improves long-term outcomes for disadvantaged children, although it does not bring these children up to the level of their more advantaged peers. Using a special supplement to the Panel Study of Income Dynamics, we ask whether children who attended Head Start had better outcomes (on a range of measures) than their own siblings who did not attend. We find that among whites, children who attended Head Start were about 25 percent more likely to have completed high school than their siblings who did not. Among African-Americans, the Head Start children were half as likely to have been booked or charged with a crime. This is the first study to show a lasting effect of Head Start. (2)

Still, programs like Head Start remain 'black boxes' in that we know little about exactly why they work. It is possible that much of the beneficial effect of Head Start is not through explicitly educational interventions but rather through mandates to improve nutrition, link families with community services, and increase utilization of preventive health care. (3)

Head Start's emphasis on getting children into care remedies an important limitation of programs that focus primarily on extending health insurance via such programs as Medicaid or the State Child Health Insurance Program (SCHIP). Lack of health insurance remains an important issue, but is not the major determinant of child health. One reason is that providing eligibility for health insurance does not always lead people to use care appropriately. In a broader review of the 'take up' of social programs, I discuss the low take-up rate among individuals eligible for public health insurance; this is an important social problem that reduces the use of preventive care and may increase the use of expensive palliative care. (4)

SES and Child Health

Maternal education is one important determinant of take-up and of other health behaviors. However, it has been difficult to demonstrate this relationship empirically because maternal education is a choice. To tackle this problem, Enrico Moretti and I compiled data on openings of two- and four-year colleges between 1940 and 1990. We used data about the availability of colleges in the woman's county of residence in her seventeenth year as an instrument for her education at the time of her child's birth. We found that higher maternal education does improve infant health, as measured by birth weight and gestational age. It also increases the probability that a new mother is married, reduces parity (birth order), increases use of prenatal care, and reduces smoking, thus suggesting that these are important pathways for the ultimate effect on health. (5)

In subsequent work, Moretti and I created a unique longitudinal dataset of California births from the 1960s to the present in order to investigate the relationship between maternal income (measured at the time of the mother's birth and at the time of the child's birth), maternal birth weight, and the child's birth weight. We used names and birth dates to link the records of mothers and children and also identified mothers who were siblings. We showed that there is a strong inter-generational correlation in the birth weight of mothers and children, but that a measure of household income at the time of the mother's birth is also predictive of low birth weight in her child. Our most interesting finding is that there is an interaction between maternal low birth weight and maternal poverty in the production of child low birth weight. Together these findings suggest that inter-generational correlations in health could play a role in the inter-generational transmission of income. Parent's income affects child health, and health at birth affects future income. (6)

The relationship between family income and child health starts at birth but grows stronger as children age, even in countries with universal health insurance such as Canada. Using a panel of Canadian children, Mark Stabile and I show that the health of poor children relative to that of richer children worsens with age, just as it does in the United States. We argue that this deterioration may be related to a higher 'arrival rate' of negative health shocks among poor children. For example, poor children are more likely than richer ones to have new chronic conditions diagnosed at virtually all ages, and they are also more likely to be hospitalized. (7) Perhaps surprisingly, in our data, both rich and poor children were equally likely to recover from any given health shock. Identifying the sources of these health shocks and policies that may prevent them is an important avenue for future research.

Threats to Child Health

One example of a negative health shock not prevented by conventional medical care is unintentional injuries. Such injuries are a leading cause of death among children over the age of one in the United States. Joseph Hotz and I show that accident rates are responsive to child care policy--they are lower among children in care when the care givers are more educated--although stiffer child care regulations may also increase accident rates among children pushed out of regulated care by higher prices. (8)

Pollution is another factor that affects disadvantaged children disproportionately. In our study of the effects of air pollution in California on infant health, Matthew Neidell and I find that the most polluted zip codes have 50 percent more mothers who are high school dropouts than the least polluted ones. This complicates our attempts to identify the causal effect of pollution. We use individual-level vital statistics data to investigate the effects of criterion air pollutants on infant mortality, fetal deaths, low birth weight, and prematurity. Our models are identified using within-the-zip-code level variation in pollution levels that remains after controlling for seasonal patterns and weather. We find that the reductions in carbon monoxide (CO) and particulates (PM10) that occurred over the 1990s saved more than 1,000 infant lives in California. (9)

Nutrition is a key determinant of health that is receiving increasing attention, given an 'epidemic' of obesity and obesity-related diseases such as diabetes. I have examined the determinants of child nutrition in a series of studies with Jayanta Bhattacharya, Steven Haider, and Thomas Deliere. We find that poverty is an important predictor of nutritional outcomes among preschool children, but not among school-aged children. However, 'food insecurity' (missing meals or being afraid that there will not be sufficient money to buy food) is not predictive of poorer nutritional outcomes among either group of children (although it could be viewed as a bad outcome in itself). Nevertheless, there are many children with nutritional deficiencies, even among those who consume too many calories. (10)

Using data from the National Health and Nutrition Examination Surveys, we also find that poor families reduce expenditures and calories consumed in response to cold weather shocks (a 'heat or eat' effect), although we find no evidence that this affects the quality of the diet. Despite recent concerns about inadequacies in child nutrition programs, we find that the School Breakfast program improves the quality of children's diets. (11) Taken as a whole, these studies suggest that there is a link between poverty and poor child nutrition that is mitigated by the food safety net that is in place, particularly for school aged children.

While most of the economic research on child health focuses on physical health, mental health may be much more important. The majority of workdays lost among adults are attributable to mental health problems, and many such problems have their roots in childhood. The best available estimates suggest that mental health problems may be much more prevalent among poor than among non-poor children, confounding attempts to measure the effects of mental illness per se. Stabile and I use nationally representative samples of U.S. and Canadian children to examine the medium-term outcomes of children with symptoms of Attention Deficit Hyperactivity Disorder (ADHD), the most common child mental health problem. (12)

Rather than relying on diagnoses, we use 'screener' questions administered to all children, and we use sibling fixed effects to control for omitted variables such as poverty. We find large negative effects on test scores and schooling attainments, and positive effects on the probability of being placed in special education. The effects are remarkably similar in Canada and the United States. Moreover, the effects are approximately linear, suggesting that even moderate symptoms have costs in terms of educational attainment. In contrast, physical health problems such as asthma are found to have insignificant effects. These results indicate that mental health conditions might well prove to be a 'missing link' between family background, child health, and educational attainments.

The Role of Health Insurance

Despite the key role of family background and non-medical threats to child health, most discussions of disparities in child health focus not on more general interventions, such as Head Start, but rather on the role of health insurance. I have continued to study Medicaid, the main system of public health insurance for poor women and children. Using individual-level vital statistics data, Jeffrey Grogger and I find that state welfare reforms prior to 1996 were associated with reductions in the use of prenatal care and with negative impacts on infant health, presumably because women who went off the welfare rolls were no longer automatically eligible for Medicaid coverage. (13)

Over the 1990s, most states switched their Medicaid caseloads from traditional fee-for-service to some form of Medicaid managed care (MMC). Like the managed care programs that cover most privately insured Americans, MMC restricts access to services in order to reduce costs. In the case of Medicaid patients, though, it has been argued that managed care might have some offsetting benefits for patients. For instance, it would guarantee access to providers who were contractually obligated to treat Medicaid patients, whereas under the fee-for-service system, many providers did not accept Medicaid.

However, incentives facing providers are complex and may result in many consequences that were not intended by legislators. John Fahr and I find that the introduction of MMC in California was accompanied by shifts in the composition of the Medicaid caseload away from black children, and that black children who lost coverage were subsequently more likely to go without doctor visits. Using a panel of all California births among mothers in the 1990s, Anna Aizer, Moretti, and I are able to follow mothers who were required to join MMC plans between births. We find that mothers forced to switch to MMC were more likely to delay prenatal care and to suffer adverse birth outcomes than other mothers. (14)

Aizer and I also examine estimates of 'network effects' in the utilization of public prenatal care services provided under the Medicaid program. We find that these effects are similar for first-time mothers and for second-time mothers who have already used prenatal care services. This suggests that the measured effects do not represent transmission of information about the services between network members, because mothers who have already used the services presumably know about them. Moreover, the estimated effects are much reduced when we control for the hospital of delivery. Perhaps surprisingly, women who live in the same neighborhoods, but who are from different ethnic groups, tend to deliver in different hospitals. These results suggest that it is the enrollment services provided by hospitals, and not the woman's 'network,' that facilitates access to Medicaid-sponsored prenatal care services. (15)

In summary, my research points to a holistic view of child human capital development that encompasses educational attainment, physical, and mental health, and seeks to explore the feedbacks between them. Interventions to reduce the transmission of poverty from one generation to the next could perhaps be improved if we understood these linkages better.

(1) Forthcoming from Princeton University Press, Spring 2006.

(2) E. Garces, D. Thomas, and J. Currie, 'Longer Term Effects of Head Start,' NBER Working Paper No. 8054, December 2000, and American Economic Review, 92, 4, September 2002, pp. 999-1012.

(3) J. Currie and M. Neidell, 'Getting Inside the 'Black Box' of Head Start Quality: What Matters and What Doesn't,' NBER Working Paper No. 10091, November 2003.

(4) J. Currie, 'The Take-up of Social Benefits,' NBER Working Paper No. 10488, May 2004, forthcoming in A. Auerbach, D. Card, and J. Quigley, eds. Poverty, the Distribution of Income, and Public Policy, New York: Russell Sage.

(5) J. Currie and E. Moretti, 'Mother's Education and the Intergenerational Transmission of Human Capital: Evidence from College Openings,' NBER Working Paper No. 9360, December 2002, and Quarterly Journal of Economics, VCXVIII, 4, November 2003, pp. 1495-532.

(6) J. Currie and E. Moretti, 'Biology as Destiny? Short and Long-Run Determinants of Intergenerational Transmission of Birth Weight,' NBER Working Paper No. 11567, August 2005.

(7) J. Currie and M. Stabile, 'Socioeconomic Status and Health: Why is the Relationship Stronger for Older Children?' NBER Working Paper No. 9098, August 2002, and American Economic Review, 93, 5, December 2003, pp. 1813-23.

(8) J. Currie and J. V. Hotz, 'Accidents Will Happen? Unintentional Injury, Maternal Employment, and Child Care Policy,' NBER Working Paper No. 8090, January 2001, and Journal of Health Economics, 23, 1, January 2004, pp.25-59.

(9) J. Currie and M. Neidell, 'Air Pollution and Infant Health: What Can We Learn From California's Recent Experience?' NBER Working Paper No. 10251, January 2004, and Quarterly Journal of Economics, CXX, 3, August 2005, pp. 1003-30.

(10) J. Currie, J. Bhattacharya, and S. Holder, 'Poverty, Food Insecurity, and Nutritional Outcomes in Children and Adults,' Journal of Health Economics, 23, 2, July 2004, pp. 839-62.

(11) J. Bhattacharya, J. Currie, T. DeLiere, and S. Holder, 'Heat or Eat? Income Shocks and the Allocation of Nutrition in American Families,' NBER Working Paper No. 9004, June 2002, and American Journal of Public Health 93 (7), July 2003, pp.1149-54. J. Bhattacharya, J. Currie, and S. Holder, 'Breakfast of Champions? The Effects of the School Breakfast Program on the Nutrition of Children and their Families,' NBER Working Paper No. 10608, July 2004, and Journal of Human Resources, forthcoming.

(12) J. Currie and M. Stabile, 'Child Mental Health and Human Capital Accumulation: The Case of ADHD,' NBER Working Paper No. 10435, April 2004, forthcoming in Journal of Health Economics.

(13) J. Currie and J. Grogger, 'Medicaid Expansions and Welfare Contractions: Offsetting Effects on Prenatal Care and Infant Health,' NBER Working Paper No. 7667, April 2000, and Journal of Health Economics, 21, March 2002, pp.313-35.

(14) J. Currie and J. Fahr, 'Medicaid Managed Care: Effects on Children's Medicaid Coverage and Utilization of Care,' NBER Working Paper No. 8812, February 2002, Journal of Public Economics, 89, 1, January 2005, pp. 85-108. A. Aizer, J. Currie and E. Moretti, 'Competition in Imperfect Markets : Does it Help California's Medicaid Mothers?' NBER Working Paper No. 10430, April 2004, forthcoming in Review of Economics and Statistics.

(15) A. Aizer and J. Cuttle, 'Networks or Neighborhoods? Correlations in the Use of Publicly-Funded Maternity Care in California,' NBER Working Paper No. 9209, September 2002, Journal of Public Economics, 88, 12, December 2004, pp. 2573-85.

Janet Currie *

REP. WALBERG OP-ED: 'GOP HEALTH CARE CARD' - US Fed News Service, Including US State News

Rep. Tim Walberg, R-Mich. (7th CD), has issued the following news release:

Families in Michigan and throughout America are concerned about the rising cost of health care. Costs continue to rise, emergency rooms are filled with the uninsured, and many Americans continue in jobs they may not enjoy just to keep their health insurance.

Our current health care system is fatally flawed, and right now more than 47 million individuals find themselves without coverage and millions more are underinsured. Now is the time to step forward with solutions that make health care more affordable and accessible, and place health-care decisions with medical professionals and patients.

For too long, according to polling data, the Republican Party has been 'losing' the health-care issue to the Democrats. This should not be the case, as Republicans are pushing for real common-sense solutions and credible reforms.

I for one will not allow the Democrats to claim health care as their issue, especially since most Democrats support a government-run and taxpayer-funded single provider system in which Washington, D.C., bureaucrats would have ultimate decisionmaking authority over every American's medical coverage.

Supporters of this government-run health care approach claim it will provide every American with a level of health care coverage, but fail to elaborate on the actual quality of care that will be provided.Government-run health-care programs all over the world are failing to meet the needs of those who need coverage. According to Britain's Department of Health, nearly 900,000 Britons were waiting for admission to National Health Service hospitals at a given time in 2006. In other European countries with government-based health care, people can wait for weeks, months and even years for important, specialized treatments, such as heart surgery or chemotherapy.

Empowering bureaucrats through a 'Hillary-Obama Care' approach would provide the same level of compassion and customer service we have come to expect from the Internal Revenue Service. This kind of one-size-fits-all, Washington-based approach is wrong, and America needs a patient-centered health-care system that gives consumers direct control and choice over their health-care decisions.

With that goal in mind, recently I introduced the Making Health Care More Affordable Act (H.R. 5995). We hear a lot of radical promises from the other side, this bill offers common sense solutions that ties together six core reforms to make patient-centered, market-driven health care more affordable and accessible to all Americans:

(1) Provide a health-insurance tax credit: If Congress provides such tax credit of up to $2,500 for individuals and $6,000 for a family of four, health insurance will become more affordable for more Americans, and families will be able to take their health insurance with them when they switch jobs. Providing these tax credits will expand the health insurance market, make the current system more equitable, reduce the number of uninsured Americans and increase the available options, while using the market to bring down health insurance costs.

(2) Create association health plans: These plans allow small businesses to band together to increase buying power in the market. Such a reform would lower overhead costs for small businesses and reduce health care prices for employees.

(3) Make insurance purchasable across state lines: This will help create a national market for health insurance by having consumers, not bureaucrats, find the coverage that best suits consumer needs. Consumers should have access to all benefits and services available throughout the United States and this reform will allow a more efficient individual market.

(4) Build on Health Savings Accounts: These HSAs allow people to take control of their health-care decisions, make health insurance more affordable and increase choice. Though relatively new, HSAs offer consumers a wide range of benefits and are becoming increasingly popular as more Americans learn about how this individual ownership plan works. The number of Americans with HSAs increased 35 percent last year, meaning more than 6 million Americans are now seeing the benefits of consumer-based health care. HSAs will let more families build health care 'nest eggs.'

(5) Stop lawsuit abuse: Frivolous lawsuits are driving up costs of health care, thus limiting the number of physicians pursuing careers in certain specialties and forcing doctors to practice defensive medicine. My bill places a $250,000 cap on noneconomic damages and provides guidelines on how punitive damages are determined. For too long, trial lawyers have lined their own pockets by driving up health-care costs.

(6) Encourage health information technology: High-tech efficiencies, such as electronic health records, increase health care productivity, lower costs and reduce the potential for medical errors. In fact, a study by the nonpartisan Rand Corp. revealed widespread implementation of Health IT could save $162 billion in health-care costs and prevent 2.2 million undesired adverse drug reactions.Democrats are not the only party discussing the lapses in coverage, high costs and bureaucratic red-tape American families are dealing with every day. Republicans are offering real reforms so important health-care decisions can be made by families, not HMOs or the whims of Washington, D.C., bureaucrats.

The GOP should rally around a consumer-based heath-care plan like the one I introduced to counter the draconian command-and-control plans of Barack Obama and Hillary Clinton. My legislation will improve quality of care, empower people to take control of their own health care and create a positive, consumer-driven alternative to free up our health- care system from heavy handed government mandates.

Passing the Making Health Care More Affordable Act will bring necessary reform to our broken health-care system and provide needed, high-quality health coverage to more Americans.

Despite Flaws, Health Care Law Is Needed - St. Joseph News-Press

(CNN) -- With the Supreme Court set to hear oral arguments aboutthe constitutionality of the President Obama's health care law, morepatients than ever have been asking for my thoughts about healthreform.

I practice primary care in southern New Hampshire near theMassachusetts border, which gives me a firsthand look at how healthreform has impacted my neighboring state. Despite flaws with theMassachusetts approach, and the president's Affordable Care Actwhich is modeled after it, I believe that health care reform needsto move forward.

Over the years, I have encountered too many cases of patients whoare inadequately served by our current health care model. Some oftheir stories are heartbreaking, others are deeply worrisome.

Some time ago, I had one middle-aged patient with diabetes, whomI'll call Mark, requiring high doses of insulin to control his bloodsugar. He faithfully saw me every three months, where I made carefulinsulin adjustments so his sugars wouldn't go too high or low. Butall of a sudden, he stopped coming. I didn't hear from him until ayear later, when I received a call from the emergency departmenttelling me Mark was found in a coma because of a critically highsugar level. Thankfully, he survived his hospital stay, and when hecame for a visit afterward he explained how he had lost his job, andthus, his health insurance. He couldn't afford to see me or buy hismedication.

According to the 2010 Commonwealth Fund survey, 72% of joblessAmericans said they couldn't afford to fill a prescription or obtainneeded medical tests. Worse, 40% said that medical bills forced theminto difficult financial decisions, such as depleting their savings,or being unable to pay for necessities like food, heat or rent.These are choices patients should never be forced to make.

But it's not only patients without insurance who suffer. Othersare in a situation like another patient of mine, whom I'll callLinda. She recently told me that her sister was diagnosed with coloncancer, a disease with a strong genetic component. I recommendedthat Linda have a colonoscopy. Unfortunately, her health insuranceplan had a deductible in the thousands of dollars, making acolonoscopy prohibitively expensive.

Last year, a study from the RAND Corporation, a nonprofit,nonpartisan research organization, found that families enrolled inhigh-deductible plans like Linda's cut back on health care that wasclearly beneficial, like cervical cancer, breast cancer and coloncancer screening. According to the study, 'these cutbacks couldcause a spike in health care costs down the road if people end upsicker and need more intensive treatment.'

The Affordable Care Act would help patients like Mark, byproviding him a way to obtain affordable health insurance regardlessof his job status. Beginning in 2014, health reform would expand theeligibility of Medicaid and provide federal tax credits to help buyprivate insurance. On average, 17% of the nonelderly populationnationwide would be helped, with numbers as high as 36 to 40% inparts of Florida, New Mexico, Texas, Louisiana and California. Andfor patients like Linda, health reform would prohibit cost sharingfor many preventive screening tests, including colonoscopies.

My support of the Affordable Care Act is tempered, however, by aserious flaw: Its benefits cannot be fully realized without a strongprimary care foundation. In the United States, the number ofspecialists to primary care doctors is about 70-30, a ratio that'sreversed in the rest of the world. That primary care deficit is afar bigger threat to health reform than if the Supreme Court were torule President Obama's law unconstitutional.

Having health insurance doesn't necessarily mean that you'll beable to see a doctor. In Massachusetts, more than 95% of residentshave health insurance, the highest in the country. However, a 2011Massachusetts Medical Society survey found that more than half ofprimary care doctors were not accepting new patients, while theaverage wait time for an appointment exceeded one month. When youconsider that health coverage will expand to 32 million Americans in2014, whether our strained primary care system can handle thatburden is a serious question. An inability to see a primary careprovider will force patients to already crowded emergencydepartments, where health care is often the most expensive.

The Affordable Care Act doesn't do nearly enough to make primarycare enticing, despite the anticipated shortfall of primary careproviders approaching 30,000 by 2015. Medical students, concerned bytheir average school debt approaching $160,000, often eschew primarycare in favor higher paying specialties. And the bureaucraticburdens of primary care, including paperwork and spending time onthe telephone refuting insurance company denials, are overwhelming.According to an Annals of Internal Medicine study, 30% of primarycare doctors considered leaving the field entirely, citing burnout,time pressures and administrative hassles.

These concerns, however, shouldn't stall health reform. Instead,they need to be addressed as the Affordable Care Act is modified andimproved on in the coming years. Far too many patients can no longerafford to obtain basic care. It's their stories that have made merealize we desperately need to fix our broken health care system,and accept health reform despite its shortcomings. We cannot let thepursuit of perfection become the enemy of doing the right thing.

Patients like Mark and Linda need help now.

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PATIENT-CENTERED HEALTH CARE NEEDED TO FIX BROKEN SYSTEM - US Fed News Service, Including US State News

Rep. Tim Walberg, R-Mich. (7th CD), has issued the following column:

For years, Americans have looked to Congress for answers about the way health care is delivered in our country. Our current system is fatally flawed, and right now more than 47 million individuals find themselves without coverage and millions more are underinsured.

Two vastly different answers to our current health care crisis have emerged. One side is advocating for a single provider system in which Washington, D.C. bureaucrats would have the ultimate decision-making authority over every American's medical coverage.

Supporters of this government-run health care approach advocate its ability to provide every American with a level of health care coverage, but fail to elaborate on the actual quality of care this approach will provide. Government-run health care programs all over the world are currently failing to meet the needs of those who need coverage.

According to England's Department of Health, nearly 900,000 Britons were waiting for admission to National Health Service hospitals at a given time in 2006. In other European countries with government-based health care, people can wait for weeks, months and even years for important, specialized treatments, such as heart surgery or chemotherapy.

Empowering bureaucrats through a 'Hillarycare' approach would make visiting the doctor or going to the hospital similar to a trip to your local license branch. This kind of one-size-fits-all, Washington, D.C. based approach is wrong, and America needs a patient-centered health care system that gives consumers direct control over their health care decisions.

With that goal in mind, today I am introducing the Making Health Care More Affordable Act. This bill is a comprehensive solution that ties together six core reforms to make patient-centered health care more affordable and accessible:

1) Provide Health Insurance Tax Credit - If Congress provides a Health Insurance Tax Credit of up to $2,500 for individuals and $6,000 for a family of four, health insurance will become much more affordable and people will be able to take their health insurance with them when they switch jobs. Providing these tax credits will expand the health insurance market, make the current system more equitable, reduce the number of uninsured Americans and increase the number available options, while using the market to bring down the cost of health insurance.

2) Create Association Health Plans - These plans allow small businesses to band together to increase buying power in the market. Such a reform would lower overhead costs for small businesses and reduce health care prices for employees.

3) Allow individuals the option to purchase health insurance across state lines - This will help create a national market for health insurance by having consumers, not bureaucrats, find the coverage which best suits consumer needs. Consumers should have access to all benefits and services available throughout the United States.

4) Build on the success of Health Savings Accounts - HSAs allow people to take control of their health care decisions, make health insurance more affordable and increase choice. Though relatively new, HSAs offer consumers a wide range of benefits and are becoming increasingly popular as more Americans learn about how this individual ownership plan works. The number of Americans with HSAs increased 35 percent last year, meaning over six million Americans are now seeing the benefits of consumer-based health care.

5) Stop lawsuit abuse - Frivolous lawsuits are driving up costs of health care, thus limiting the number of physicians pursuing careers in certain specialties and forcing doctors to practice defensive medicine. My bill places a $250,000 cap on non-economic damages and provides guidelines on how punitive damages are determined. For too long, trial lawyers have lined their own pockets by driving up health care costs.

6) Encourage Health Information Technology - High-tech efficiencies, such as electronic health records, increase health care productivity, lower costs and reduce the potential for medical errors. In fact, a study by the RAND Corporation revealed that widespread implementation of Health IT could save $162 billion in health care costs and prevent 2.2 million undesired adverse drug reactions.

Unfortunately, many Americans do not have health coverage, and if they do, they often experience lapses in coverage, high costs and bureaucratic red-tape. Individuals and families need to be able to make important health care decisions without being denied by HMOs or the whims of Washington, D.C. bureaucrats.