Hub & Spoke

Dr. Walker to Resign from American Academy of Family Physicians

Just saw a media advisory from Contra Costa County's health department announcing that to protest a deal recently struck between Coca-Cola and the American Academy of Family Physicians, Dr. William Walker - the county's Health Director - will be withdrawing his membership from the association. 

Press conference is set for Wednesday at 12:15 at CCRMC in Martinez.  

Here's a good summary from NPR on the Coke-AAFP alliance, noting that the doctor's assn will be paid "in the strong six figures" and will use the funds to teach people how to incorporate soft drinks into a healthy lifestyle.  

In the press release, Dr. Walker draws an apt comparison between the Coke-AAFP deal and doctors' endorsements of cigarette health in the 50's.  

For my part, I think Coke should consider continuing its PR blitz - clearly geared to head off soda tax proposals - by putting its famously rotund Santa Claus icon on a diet.  What better way to demonstrate to kids how healthy it is to guzzle liquefied corn sugar by the liter than by posing a slimmed down St. Nick with that famous Coke bottle in hand?

After all, as the company itself claims, Coca-Cola's done as much as anybody to create and solidify our image of the man from the North Pole.  I'll leave you with these words from the official Coke website:

Most people can agree on what Santa Claus looks like -- jolly, with a red suit and a white beard. But he did not always look that way, and Coca-Cola® advertising actually helped shape this modern-day image of Santa.... Through the centuries, Santa Claus has been depicted as everything from a tall gaunt man to an elf.... For inspiration, [Coke artist] Sundblom turned to Clement Clark Moore's 1822 poem "A Visit From St. Nicholas"... Moore's description of St. Nick led to an image of Santa that was warm, friendly, pleasantly plump and human. For the next 33 years, Sundblom painted portraits of Santa that helped to create the modern image of Santa -- an interpretation that today lives on in the minds of people of all ages....  

TCE Report on DRA Citizenship Verification Provokes Hot-Tempered Tirade (by me)

The California Endowment and the California HealthCare Foundation are out with a new study of the impact of the citizenship verification requirements under Medi-Cal.  

It’s a succinct summary of on-site interviews conducted across 6 California counties, including – notably – Contra Costa.  

The report finds that results are mixed.

If I were an anti-illegal immigrant zealot, I’d focus on the part of the study that makes the so-called ‘DRA requirements’ look reasonable.  For example, that with rare exceptions, the citizenship checks have not resulted in denial of needed medical services to existing enrollees or applicants.  

If I were not an anti-illegal immigrant zealot, I would retort that perhaps the reason that citizenship verification has not resulted in denial of services is that IT’S A HUGE WASTE OF TIME demonstrated by the fact that not one person interviewed for the report could point to a single example of a Medi-Cal enrollee or applicant misrepresenting her citizenship status.   

Not only that, I (as a now increasingly impassioned non-anti-illegal immigrant zealot) would say, IT’S ALSO A HUGE WASTE OF MONEY because if there isn’t a fraud problem to begin with, then there’s no point in dumping hundreds – probably thousands – of hours of county staff time in implementing a program to catch fraud.  

I would finish my fuming non-anti-illegal immigrant rejoinder by noting that at a time when Contra Costa’s human services department is really hurting for funds, cutting staff and increasing remaining staff’s caseload, forcing it to comply with a time-consuming and utterly meaningless program means that there are fewer resources to do what they come to work to do in the first place: help people in need enroll in services that can help.  

All that said, I think perhaps the best part of the report is when it states matter-of-factly that when it designed the citizenship check requirements, the federal government estimated that it would take Medi-Cal clients 10 MINUTES to obtain and present their birth certificates to county offices.  

Ten minutes.  Some mornings, it takes me 10 minutes to find my wallet and keys.  

AP Article Examines Demand for Clinic Services Now & Post-Reform

Just a quick post to share an article that came out on the wire yesterday - featuring community clinics here in Contra Costa/Solano and Nor-Cal.  It does a good job of covering the steep increases in demand for clinic services, our plans for growth in the next several years, and the role we'll play if/when national health reform passes (looking to Massachusetts' experience so far).  

Good news from Solano County's Board of Supes

Grand Jury Report: Rejected!

Good news from Solano County.  The Board of Supervisors on Tuesday voted unanimously to reject the Civil Grand Jury's recommendations to wall off public funding to community providers - like La Clinica North Vallejo - that provide services to patients regardless of their immigration status.  Follow this link for a video of the brief discussion on the topic, which featured a former Solano Coalition for Better Health board member speaking out in favor of La Clincia and Supervisor Reagan stating his personal thoughts on the matter, which despite his official vote are more along the lines of the Grand Jury's recommendations.  Scan ahead to 3:06 on the video player to start from the relevant part.  

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CA's healthcare system gets a D, but that's not the whole story

Today's Sac Bee runs a story on a new Commonwealth Fund study showing that California's health care system comes in 31st among 50 states and DC when scored on factors like access, prevention and treatment, avoidable hospitalizations, and healthy lives.  In other words, when scored on anything that matters, our healthcare system is - when compared to 60% of the states in the U.S. - sadly under-performing.  

Except, that's not quite true.  The 31st-out-of-51 rank is an average of over 30 indicators and masks where California does well - in leading healthy lives.

Here, we ranked number 5 overall.  Minnesota took first, and Hawaii second, if you were curious.  And with all that trudging through snow and hiking over volcanoes, respectively, I think their populations have an unfair advantage.  

Healthy living, in the study, is determined by a combination of mortality amenable to health care, infant mortality, breast cancer deaths, adults limited in activities, adults who smoke, children obese/overweight, and some others.  

These are important indicators not just of health but of overall good living and happiness.  I think it's interesting how a state like ours can rank so low when measured by our overall healthcare system but can finish in the top 5 when ranked by - frankly - how healthy we are.  

More evidence, I guess, that our state's and nation's health is determined by far more than how many hospitals or doctors or clinics we have.  Or, as the report itself says,

There is little question that health outcomes are heavily shaped forces both outside and inside the health care system. Income, education, and housing and work environments significantly influence the extent to which people are able to live healthy and productive lives. Other health determinants that are closely intertwined with cultural and socioeconomic factors also affect people’s expectations of and interactions with the health system.

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Millions remain uninsured under federal reform proposal

New York Times and others report this morning on the US Senate Finance Committee's health reform legislation - just recently scored by the Congressional Budget Office.  It's an $800 billion proposal (below the $1 trillion ceiling set by Obama) that would actually cut the deficit (another of Obama's edicts - not to raise the deficit - met).  

But here's what we have to remember: millions would remain uninsured (25 million, to be exact, the vast majority of whom would be US citizens), and the uninsured will still need places to go for health care.  

(Insert shameless plug for community clinic funding here.)  

Clinic Consortium Makes a YouTube Video on Healthcare Reform

We here at the Consortium have been frustrated - over the last several weeks - about the tone and tenor of the debate over national health care reform.  Too many distracting issues - like illegal immigration or a supposed government takeover of the free-market economy or, yes, those panels to knock-off granny - have been dominating the airwaves and flat-screens from New York to California.

For anyone who works in community healthcare, the basic issue is and should remain the fact that 46 million people in this country lack health insurance and thus proper access to medical care of all kinds. 

So in the grand tradition of the Internet Age, our response at the Consortium was to make a 5-minute YouTube video.  It focuses on the stories of 4 people in the Bay Area who deal with the realities of either not having insurance themselves, of not being able to afford it for their employees, or of working with people who are uninsured but in need of medical attention. 

We hope it will - in its own small way - help get the national conversation back on the right track as Congress buckles down to hammer out legislation in the next several weeks. 

Recalibrating the Importance of Immigration in Healthcare Reform

The now-notorious etiquette breach by Rep. Joe Wilson - the guy who blurted out "You lie" to the President during his speech this week on healthcare reform - has (I think unfortunately) sparked a series of newspaper articles on public funding of healthcare services for undocumented immigrants.  

Today I woke up to three of this kind of article in California papers: here in the SF Chron, here in the Merc, and here in the Sac Bee.  

The SF Chron piece is most relevant to this region given that it - like the WSJ article of a couple weeks ago - features La Clinica North Vallejo and the critical civil grand jury report that we wrote about here.

I think the very publication of these articles overstates the actual importance of illegal immigration in the healthcare reform debate.  Of all the things we should be concerned about when it comes to improving our healthcare system, the (disproportionately low) use of medical services by undocumented immigrants should not be one of them.  

My favorite wonky quote on this issue comes from an NPR report I heard a while back:

"The economics aren't as great as they've been made out to be," says Paul Fronstin of the Employee Benefit Research Institute.  Fronstin says illegal immigrants are younger, and so generally healthier, than the overall population, and studies show they go to the doctor far less than the native born. He estimates their total share of the health care system at about 1 or 2 percent, with only a small slice of that paid for in public money. 

I feel like that pretty much sums it up.  1 to 2 percent of the healthcare system.

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Job Announcements

Brookside Community Health Center in San Pablo is looking for a new COO.  The job description/announcement is here.

Planned Parenthood is looking for a new center director for its site in Redding.  Click here for the announcement.

Planned Parenthood has also posted an opening for a grant writer.  Check it out here.

 

Beilenson Hearing in Contra Costa for Further Health Services Cuts

Just a quick, end-of-week reminder that September 15 is the date for Contra Costa's next Beilenson Hearing - the legally required hearing of the Board of Supervisors to consider a further series of health services program cuts.  

Here's the official county notice, which details the planned cuts.  

I'll be putting up a post with more analysis next week.  

Have a good Labor Day weekend, all!

Photo by erix!, distributed under a Creative Commons Attribution license

AB 1422 shows that bipartisan, consensus-based healthcare bills DO happen. In Sacramento of all places. Congress, take note.

Update 9/28: MRMIB passed regulations yesterday to suspend disenrollment of children from Healthy Families by another month, to November, while AB 1422 winds through the legislature.  The board also voted to raise various copays, as this blog post from the California Budget Project discusses.

Readers will likely have heard that the legislature's Democratic leaders, Karen Bass and Darrell Steinberg, are shepherding legislation through the State Senate to essentially save the Healthy Families Program.  

Yesterday, the bill - AB 1422 - passed the Senate's Rev & Tax and Health Committees, and I assume as I write this that today it's passed off of the Appropriations suspense file, sending it to the Senate Floor, where it's expected to pass easily.  Then it's back to the Assembly to make its way through committees there.  

The bill would assess a tax on Medi-Cal Managed Care Health Plans (like Partnership HealthPlan in Solano and Contra Costa Health Plan), use the tax revenue to draw down federal matching funds, route those funds to the Healthy Families Program, and reimburse the taxed health plans.  It would also raise Healthy Families preimums modestly and change some accounting provisions to allow California First 5 to contribute some of its reserves.  

It's an incredibly good idea, and I hope it will work as designed - to prop up Healthy Families while keeping the state and managed care plans whole.  (That last part is no doubt necessary to keep local initiative and COHS plans in support.)

What I find encouraging is that, so far, it's gotten Republican support even though it - technically - would raise a tax (verboten for the Republican caucus, as this year's budget negotiations made so painfully clear).  I'm encouraged not only because Republican votes are actually necessary for the bill's passage (it needs a 2/3 vote), but because it shows that even in the most partisan, bitterly divided political environment, Dems and Reeps can come together and do the right thing on health care.

Dear leaders in Washington, DC: please apply said lesson.  

The Debate Over Undocumented Immigrants & Healthcare

For those who didn't see it in today's California Healthline, the Wall Street Journal published a piece over the weekend entitled, "Illegal immigration enters the health-care debate," with the subtitle: "In California, funding is at stake for a clinic that treats patients no matter their status."  

The clinic in question is La Clinica North Vallejo, which we've blogged about before.  It's the newest La Clinica site, established with support from the entire community, most notably Sutter Solano and Kaiser Permanente and the County, as a way to ensure access to preventive services as an alternative to seeking care in the ER for nonurgent problems.  

The WSJ article takes as its jumping-off point the calls of a "watchdog group" for the Solano County Board of Supervisors to end public funding for the clinic because - the group contends - the clinic provides services to undocumented immigrants.  More on this "watchdog group" later.

The article itself does a good job of highlighting the usefulness of the North Vallejo clinic's proximity to area hosptials, quoting Sutter Solano CEO Terry Glubka on the expense of seeing nonurgent patients in the ER: "They were getting the most expensive care for what should be treated in a primary care facility."  And it ends with a nod to the fact that demand for care at North Vallejo is growing exponentially: "'We're swamped,' says Monique Sims, the clinic's manager."

If I had to quibble with the article, I'd say that it doesn't do a good enough job debunking the idea that "illegal immigration" is responsible for the growth in ER visits or the rise in medical costs overall.  As readers of this blog no doubt know, the evidence is just the opposite: immigrants use fewer healthcare services than US-born citizens and healthcare expenditures are substantially lower for immigrants.  One study published in the American Journal of Public Health found that "immigrants in every age group but 65 years and older had health care expenditures that were 30% to 75% lower than those for US-born persons." Also, it found that the rate at which immigrant children visit the ER is far lower than the rate at which US-born children do.

Regarding the so-called "watchdog group" whose recommendations about publicly-financed healthcare for immigrants sparked the article, I'll simply say this.  The group in question is the civil Grand Jury in Solano County, which published a very short, very flawed report several weeks ago.  The report is factually incorrect in several instances, and its recommendations are generally not well considered.  If you read the report, please also read this document, which lays out the factual case in response.  

Photo by takomabibelot, distributed under a Creative Commons Attribution license

Congressman Miller on Health Reform & A Community Rally to Protest State Cuts

A fun week; community clinics throughout the Bay Area pulled off coordinated, large-scale federal and state advocacy events to mark National Health Center Week 2009.  Wanted to post some pics of the work here in Contra Costa/Solano.

On Tuesday, both Boards of Supervisors proclaimed Health Center Week in their respective counties, and presented our member clinics with resolutions to that effect.  Here's a shot of Tanir (the Consortium's ED) with representatives of Planned Parenthood and La Clinica at the Solano Board meeting.

Later that morning/afternoon, the Consortium hosted Congressman George Miller (D - CA 7th) at our staff appreciation luncheon (click here for pics), where he received a Clinic Champion Award from us and spoke at length about the need for health reform, the status of the legislation in D.C., and the recent spate of highly contentious town hall meetings across the country.  His comments were - of course - spot on.  And he reiterated his support for community clinics and the medical home primary care model that we represent. 

The Congressman also accepted a pair of red boxing gloves from CCISCO, who encouraged him to keep fighting for health reform.  Mr. Miller joked that now Senator Barbara Boxer isn't the only person in Congress with a pair of gloves in her office on Capitol Hill.

On Wednesday, we switched our focus to the deep cuts made to healthcare programs in Sacramento.  Our Consortium worked with the Alameda and San Francisco consortia to organize a march from Lifelong Medical Clinic in downtown Oakland, through Frank Ogawa Plaza, to the State Building, where over 200 patients, staff, and community educators mourned the loss of life-saving programs like HIV/AIDS education and Healthy Families, and called for overturning the draconian state budget reductions.  We had great media turnout, and we're charged up for more advocacy around local, state, and federal health policy.  Check out our pics of the event here.  

Feel free to download any of these pics and share widely.