Sean Braisted critiques Harold Ford Jr.'s American Center for Cures proposal and wonders how it's different from the National Institute of Health. Good question.

Sen. Corker has a plan to provide all Americans with health insurance. Read about it at KnoxViews...

The Donkey’s Mouth: So, is Tracy trying to argue — in contrast to what everyone knows — that the rural areas of Tennessee have more doctors than they can use or is he trying to argue that quality health care is more important to animals than it is to humans?

Sen. Joe Haynes (D-D-Goodlettsville) will introduce the Healthy Families Act to the Senate Commerce, Labor, and Agriculture Committee tomorrow (April 15) at 1:00 PM CDT, 2:00 PM EDT. (Watch it live via video streaming.)

SB3773 requires that companies with 25 or more employees provide annual paid sick leave for their employees. Such leave may be used to address the employee's medical needs or the medical needs of the employee's immediate family.

Commenting on the bill, Sen. Haynes said "Parents of sick children and the children of sick and elderly parents should know that they can take time off work to care for their loved ones. And they should be able to do this without fear of losing their jobs."

The Healthy Families Act is co-sponsored by Sen. Steve Roller, D-McMinnville, and Sen. Doug Jackson, D-Dickson.

This is a good bill, considering that so many families have two working parents these days, not to mention the growing number of single-parent families.

Expect opposition from Republicans, who talk the talk about family values but don't walk the walk when corporate special interests override family values.

Which doesn't make much sense if you think about it. Healthy employees with healthy, happy families are good for business. What's the point of forcing employees to come to work and go through the motions when they are sick or worried about their loved ones just so they can pay their bills?

Better to give employees the time off they need, so they can return healthy and focused and ready to work. Retaining good employees is always more cost-effective than turnover. Republicans who argue otherwise aren't very good business people, and aren't as "business friendly" as they claim to be.

UPDATE: The bill failed in committee. Sean Braisted has more.

Knoxville News Sentinel: People without insurance are dying

In Tennessee between 2000-2006, the report said, more than 3,600 people 25-64 years of age died as the result of a lack of health insurance. Uninsured people are 25 percent more likely to die prematurely than adults with private insurance.

This is a disgrace.

Republicans on the Senate Education Committee voted down the "Tennessee Rural Health Act" (SB4099/HB4130) this morning -- 4 aye, 2 nay, 3 present not voting. All four Democrats on the committee voted in favor.

The program is supported by the Tennessee Medical Association, Tennessee Nurses Association, Tennessee Academy for Physicians Assistants, Tennessee Dental Association, and the Tennessee Optometrists Association.

Mark Brown, Communications Director for the Tennessee Senate Democratic Caucus, said "Jim Tracy and the Senate Republicans obviously believe that Bedford, Moore, and other rural Tennessee counties don't need qualified medical professionals."

According to the Knoxville News Sentinel, the bill that would limit damages in abusive nursing home cases and allow nursing homes to require residents to give up their right to a civil jury trial has failed in the House Civil Practice Subcommittee.

From the article:

Steve Flatt, senior vice president for National HealthCare Inc., said nursing homes and their patients are in "a precarious situation" because of lawsuit costs.

Refer to this previous discussion to see why this remark would be laughable if it weren't so serious.

Have you heard? It's in the news just today.

Trustees for the government's two biggest benefit programs warned Tuesday that Social Security and Medicare are facing "enormous challenges," with the threat to Medicare's solvency far more severe.

Of course, if they weren't reducing taxes during war time, if they weren't bailing out investment banks to the tune of $30 Billion, if they weren't determined to continue a war that costs around $12 Billion a month, if they weren't determined to not have citizens sacrifice just a little during war time, the challenge might not be so enormous.

The TN GOP's weekly hit piece touts "key health care reform proposals" to provide seniors "more options" for long-term health care.

They are taking credit for reforms Gov. Bredesen has been pushing for, while accusing him of offering "no specifics, no money and no real plan" and paying only lip service themselves.

Chattanoogan.com:

Tennessee Receives $11.2 Million In Merck Settlement

Tennessee Attorney General Bob Cooper today announced Tennessee received $11.2 million this week as part of two separate settlements with drug manufacturer Merck Corp., Inc. resolving allegations the company failed to pay Medicaid rebates.

"This is a significant recovery for our Medicaid program," Attorney General Cooper said.

This case was handled by the Tennessee Attorney General's Office, the Tennessee Bureau of Investigation Medicaid Fraud Control Unit and the TennCare Bureau.

According to the article, the payment is part of nationwide settlements totaling $649 million.

A couple of interesting bills in the Tennessee General Assembly this week aim to fund training more teachers and health care professionals. From the TN Senate Dems:

SB4099/HB4130, sponsored by Sen. John Wilder, D-Mason, Sen. Roy Herron, D-Dresden, and Sen. Steve Roller, D-Morrison, creates a loan-forgiveness program for Tennessee students studying to become designated types of health care professionals that agree to practice in rural and other underserved areas across the state. Students that enter the program will agree to practice medicine in a "health resource shortage area" for one year for each year of educational funding provided by the program. Recipients will be required to repay all funds received under the program if they fail to practice medicine in a health resource shortage area for the full time required. Health resource shortage areas are designated as such by the Tennessee Department of Health's Office of Rural Health.

SB3229/HB4165, sponsored by Sen. Andy Berke, D-Chattanooga, earmarks lottery proceeds for a scholarship program targeting Tennessee students studying to become teachers. In order to receive TQTF funding, a student must agree to teach for at least three years in a Tennessee public school after gaining their teaching license. Recipients will be required to repay all funds received under the program if they fail to teach for three years or if they fail to obtain their teaching license.

Democrats in the state legislature are going about the work of lifting Tennessee up from the bottom of national rankings on health care and education.

Meanwhile, Stacy Campfield (R-Knoxville) accuses legislators of wasting time while wasting the legislature's time with his own frivolous stunt legislation.

But is it really?

I have taken on a project as a consulting writer for Tennessee with a national nonprofit. I will be gathering stories about how health care and legal issues contribute to the cumulative problems of poor children, particularly children of color. The stories will be put in narrative form, with emphasis on the child’s viewpoint. I was given numerous leads by the nonprofit, but thought it wouldn't hurt to seek out some more leads. If you know of someone personally who might be willing to share their story, or if you know someone who works with this population, please contact me privately with their contact info.

I've copied over below issues that are of particular concern. From my end, I’m especially concerned about the big picture – how they got to this point and what happens after this point. The information will eventually be used to help develop policy and legislation at the state and national level.

Thanks,
Pam

o Pre-natal care/low birth weight
o Lack of health insurance coverage
o Red tape (being dropped from insurance, difficulty enrolling, etc.)
o Insufficient health benefits
o Aging out of system
o Medicaid versus SCHIP coverage issues
o Lack of access to a health care provider
o Mobility of health insurance/care(state-to state)
o Eligible but not enrolled for any health benefits
o Education
o Child care
o School drop out
o Juvenile detention/criminalizing children at younger ages
o Health and mental health
o Substance Abuse
o Abuse and neglect
o Poverty
o Homelessness
o Girls in the Pipeline
o Child gun deaths
o Single parents
o Grandparents raising grandchildren needing support
o Alternatives to the streets
o § Community supports
o § Mentors
o § Positive role models

Tennessee lawmakers have introduced a tort "reform" bill aimed at protecting nursing home operators from lawsuits. The bill (SB4075/HB4053) would:

• Require lawsuits against long-term care facilities involving health-related services to be brought solely as medical malpractice action (see separate post about what they want to do to "malpractice" lawsuits)

• Allow operators to require patients to waive their right to a jury trial as a condition of admission

• Limit non-economic damages to $300,000

According to Medical News Today, a prominent nursing home operator says the legislation is needed because of personal injury lawyers driving up the cost of liability insurance:

"The average annual cost of items like liability insurance, legal services and other liability-related issues is now $500,000 per Tennessee nursing home - enough to hire and pay for 10 new nurses," said Steve Flatt, senior vice president of development for National Healthcare Corp., an operator of several Tennessee nursing homes.

"The problem is that our laws right now allow the filing of limitless lawsuits claiming tens of millions of dollars in damages," Flatt said. "The result is that the big- money personal injury lawyers from Texas and Florida have been arriving regularly to pelt our courts with lawsuits."

Raise your hand if you think nursing homes will use any savings from this legislation to hire more nurses.

And if the name National Healthcare Corp. rings a bell, it's probably because of the tragic nursing home fire at one of their facilities in Nashville that claimed sixteen lives. The deaths resulted in more than 30 lawsuits.

The company has been the target of other lawsuits alleging abuse and neglect, including a Warren Co. case in which the jury awarded $4.1 million in compensatory damages and $28.9 million in punitive damages, which were later reduced to $163,000.

The company was also the target of a probe into massive Medicare fraud. They settled with the U.S. Department of Justice for $27 million.

Instead of allowing special interests to influence legislation, Tennessee should pursue better regulation and oversight of nursing homes to protect the safety and dignity of patients in these facilities. Who lobbies for the people?

I'm not an accountant and don't pretend to be one. It is an amusing time of year for those of us who have to review at least some of the new tax changes.

Why is it the Feds are increasing the business mileage deduction by two cents per mile but decreasing the medical mileage deduction by one cent per mile?

Beginning Jan. 1, 2008, the standard mileage rates for the use of a car (including vans, pickups or panel trucks) will be:

• 50.5 cents per mile for business miles driven;
• 19 cents per mile driven for medical or moving purposes; and
• 14 cents per mile driven in service of charitable organizations.

The new rate for business miles compares to a rate of 48.5 cents per mile for 2007. The new rate for medical and moving purposes compares to 20 cents in 2007. The rate for miles driven in service of charitable organizations has remained the same.

Just one more way the Feds are sticking it to the individual and aiding business.

Sen. Paul Stanley (R-Memphis) has introduced "tort reform" bill SB2929, which limits medical malpractice awards to $250,000 for "noneconomic" damages, and reduces economic damages related to lost income by the amount of any unemployment, social security, or other benefits the victim might receive.

Victims would also have to specify the amount of damages they are seeking to recover. The amount is not disclosed to the jury, and if I read it correctly, the victim may not collect more than that amount even if the jury awards higher damages. It also allows payment of damages in installments.

The bill also limits the victim's contingent attorney fees, and allows a judge to set the fees. It places restrictions on expert testimony. It requires the victim to file an expert affidavit and medical records setting out the specifics of the claim. If the claim is dismissed because of a faulty or "bad faith" affidavit, the defendant is entitled to damages. The bill also requires the victim to file a HIPPA release that allows the defendant to access any of the victim's medical records, including mental health and drug/alcohol abuse treatment records, whether or not they are related to the claim.

The bill also eliminates the term "malpractice" and replaces it with "health care liability action" throughout Tennessee law.

The intent of this legislation is to make it harder to file a claim, harder to prove a claim, and harder to collect damages if they are awarded. It also increases the victim's financial risk in filing a claim, makes it harder for a victim of lesser means to get an attorney to represent them, and reduces a jury's power to award appropriate damages.

In short, it's a bad bill. It was a bad bill when it was introduced in the last session, and here's why.

Where's the bill to protect patients from incompetent doctors and negligent hospitals? Where are the bills to improve patient safety and outcomes? Where's the bill to make all malpractice and regulatory actions public and easily accessible so consumers can make informed choices about their health care and providers?

These steps would do more to reduce medical malpractice and the associated costs than trying to pretend it doesn't happen and make it disappear through hocus pocus "tort reform" legislation.

You should contact your state senator and representative and let them know this is a bad bill for health care consumers and ask what they are doing to promote patient safety.

From the Knoxville News Sentinel, $150M revenue shortfall covered:

Most of a projected revenue shortfall for the current year will be covered by unspent money in the Cover Tennessee program and TennCare plus $44 million in general cuts to most state agencies, Finance Commissioner Dave Goetz said Tuesday.

[..]

Further, TennCare spending will be about $45 million less than projected when the budget was enacted last year, primarily because delays in obtaining a new federal government waiver to bring some "medically needy" people back on the rolls, Goetz said.

Also, the state now expects to spend $37 million less than planned on its Cover Tennessee insurance program, primarily because fewer people have enrolled than anticipated.

I guess the State of Tennessee is lucky to have so many sick and "medically needy" people so we can balance the budget by denying them health care. On the other hand, the uninsured problem must be solved if few people are signing up for Cover Tennessee.

The following table summarizes the basic elements of a plan that would provide affordable, portable, universal health insurance to all Americans, and indicates whether the candidate's proposals include that element.

Gravel also has a plan that involves "vouchers" paid for with a "national sales tax" that would cover everyone, but it is short on details and you have to sit through a rambling YouTube video to even get that much info.

While Kucinich is considered a "fringe" candidate, his is the only plan that includes all the elements, and his is the only plan that has actually been introduced into Congress (HR676).

Kucinich's proposal (which is to basically end traditional health insurance and open Medicare up to all Americans) is also the only plan that would remove employer-provided insurance from the equation, and for that reason is the only fully portable plan. While the others offer alternatives to employer-provided insurance, they focus on perpetuating the current system of employer-provided health insurance, which by definition is not portable if you change jobs or lose your job.

There is also a distinction between "universal coverage" and "universal access". Only Kucinich's plan and the other plans that are mandatory would provide universal "coverage". Plans such as Obama's and Biden's would provide universal "access."

Contrary to scary propaganda disseminated over conservative "news" and talk radio channels, none of the Democratic candidate's proposals involve "socialized medicine", and none take away any choice of providers (unless you are in an HMO or PPO plan v. a fee for service plan, which is exactly the same as it is now). The top-tier candidates all let you keep your current insurance if you prefer, and offer more options for the unemployed, the self-employed, low-income families, and the uninsured.

Following are summaries of the Clinton, Edwards, and Obama proposals:

Families USA (a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans) recently published a study they commissioned to determine how many Americans are spending more than 10% of pre-tax income on healthcare and how many are spending more than 25% on healthcare.

Excerpts from the study:

• One in four Americans (23.2%) under the age of 65 (over 61 million persons) will spend more than 10% of pre-tax income on healthcare costs in 2008.
• In Tennessee the rate of 24.4% is above the national rate.
• 82.4% (50.7 million) of these people (4 out of 5) have health insurance.
• Nearly half of these American are middle-class wage earners ($30,000-75,000 per year). Over 1/3 earn less than $30,000 per year.

• Nearly 6.7% of Americans under the age of 65 (nearly 18 million persons) will spend more than 25% of pre-tax income on healthcare costs in 2008.
• Again, in Tennessee the rate of 7.6% is above the national rate.
• 75.8% (13.5 million) of these people (3 out of 5) have health insurance.
• One-third of these American are middle-class wage earners ($30,000-75,000 per year). Nearly 2/3 earn less than $30,000 per year.

Approximately 47 million Americans don't even have healthcare coverage.

The information is a little startling, although not unexpected.

When will the US meet the healthcare needs of its citizens? When will the US become as progressive regarding healthcare as nearly every other developed country? Do you even care?

H/T Orlando Sentinel

Bad breath leads to suspension.

In his defense, one of the residents in the building says, "His job, which he does well, is opening the door — not to be opening his mouth,".

In other words, don't talk to me, just open the d@%# door.

In a new ad, John Edwards "threatens" Congress.

But if you don't pass universal health care by July of 2009 — in six months — I'm going to use my power as president to take your health care away from you.

Harry Reid "threatens" the President.

If Bush vetoes the bill, "then the president won't get his $50 billion," Reid, D-Nev., told reporters at a Capitol Hill news conference.

Yahoo (AP) headlines are beginning to rival the local newspaper and cable news. Who's afraid? I'd guess not Congress or the President.

Medicare prescription drug coverage is changing and millions of elderly citizens will possibly have to change their coverage.

Nearly 2 million low-income Medicare participants could be switched to different insurance plans for their prescription drug coverage next year.

Millions more will have to shop around if they want to avoid double-digit increases in their monthly premiums.

Here is a summary of some of the changes (e.g. premiums up, cost sharing up, coverage in the “Donut Hole” gap is down, etc.).

According to this report in the Kingsport Times News, Tennessee trial courts awarded only $4.9 million in medical malpractice damages in 2006, and there were $100.2 million in settlements out of court. Both figures were down significantly from 2005.

According to US Department of Health and Human Services esitmates and projections, health care expenditures in Tennessee were $37 billion in 2006, meaning that malpractice claims paid were about 0.0000003% of health care costs in Tennessee, if my math is correct and I'm interpreting all this information correctly.

Meanwhile, medical malpractice insurance companies collected $345 million in premiums, and had $794.8 million in reserves according to the article.

It sounds to me like medical malpractice insurance is driving up the cost of health care, not runaway juries and trial lawyers.