The Social Medicine Portal

Free Legal Services for Vietnamese & Cambodian Immigrants in the Bronx

As a follow-up to our post last month on the Justice is Healing Campaign we were asked by community organizer Minh Ha Nguyen to post this information about free legal services available to Cambodian and Vietnamese immigrants living in the Bronx.

CAAAV and NMCIR-Bronx Project have partnered to provide FREE

Immigration Consultation
US Citizenship Application
Low-cost Adjustment of Status
Low-cost Family-based Petitions

Where: CAAAV  Office, 2473 Valentine Ave.
(Fordham Rd. at 188th St.), Bronx, NY 10458
(Available by the BX 12 bus)
When:    Last Wednesday of every Month
(July: Wed 28th, August: Wed 26th, Sep Wed 30th)
Time:  10 am- 2pm
Email: ylp@caaav.org
Phone: (718) 220-7391 ext.16,

For Vietnamese: Minh-Hà, For Khmer: Chhaya

Please note that if you are at least 50 years old and have lived in the US as a legal permanent resident for 20 years or if you are at least 55 years old and have lived in the US as a legal permanent resident for 15 years you are eligible to take the Citizenship Exam in your native language and the exam is oral – not written

CAAAV kết hợp NMCIR-Bronx Project
cung cấp dịch vụ
FREE- miễn phí
về
Tư vấn Luật Di trú
Hồ sơ xin Nhập Tịch
Hồ sơ xin Thẻ Xanh (lệ phí thấp)
Hồ sơ xin Bảo Lãnh Thân Nhân (lệ phí thấp)
Địa điểm:    Văn phòng CAAAV
2473 Valentine Ave.
(Fordham Rd. và 188th St.), bus Bx12
Bronx, NY 10458
Thời gian:    Thứ Tư cuối cùng mỗi tháng
(Tháng 7: ngày 29, Tháng 8: ngày 26, Tháng 9: ngày 30)
10:00 sáng – 2:00 chiều
Email: ylp@caaav.org
Phone: (718) 220-7391 ext.16
Tiếng Việt: Minh-Hà  Tiếng Khmer: Chhaya

posted by Matt Anderson, MD

Action alert: The Congressional Budget Office must score single payer bills

From Health Justice

PLEASE ASK THE FOLLOWING LEGISLATORS TO HAVE THE CONGRESSIONAL BUDGET OFFICE – CBO – SCORE THE SINGLE PAYER BILLS (HR 676 AND S 703).

The CBO takes its orders from Congress, specifically the leadership, (House Speaker and Senate Majority Leader), as well as the chairs of various committees. These legislators have the power to have the single payer bills scored–contact them and send a fax:
http://www.1payer.net/faxapp/senders/add/cid:6

Finance (H-Barney Frank, D. Massachusetts; S-Max Baucus, D. Montana)
Health, Education, and Labor (S-Ted Kennedy, D. Massachusetts)
Budget (H-John Spratt, D. South Carolina; S-Kent Conrad, D. North Dakota)
Appropriations (H-David Obey, D. Wisconsin; S-Daniel Inouye, D. Hawaii)
Ways and Means (H-Charles Rangel, D. New York)
Energy and Commerce (H-Waxman, D. Los Angeles)

Action alert: One million letters in support of single payer health care.

Million Letters for Health Care Campaign (to forward this invitation to friends click here).

Print Your Letter to send to your U.S. Representative to help get Single-Payer

… and then consider doing “extras”: making a quick toll-free phone call(s)… sending a free fax … and/or sending a copy of your letter to President Obama

If you are unable to print & send a letter monthly because you have an access difficulty (such as normally having no printer), you can please go here. If you have any questions or concerns about sending letters by U.S. Mail to the U.S. Congress, please go here.

Preparations: sign up for the letters campaign by signing up to get monthly reminders.
The reminders occur on or near the first of each month by e-mail (or, if needed, by telephone).

1. Review the list of one-sentence suggested notes from your current monthly reminder.
2. Print your starting point letter: a prepared, addressed letter to your U.S. Representative.
   

   Access your letter, below, by selecting your state, then district.

3. Optionally add a short hand-written note. If you use one of the suggested notes, feel free to change it to make it uniquely yours, but the shorter the better.
4. Complete and mail your letter.
   • Date and sign it.
   • Print your name and address.
   • Mail it via the U.S. Mail to your U.S. Representative at the address on the letter.
5. Consider doing the “extras”.

Bronx Farmers’ Markets: Summer of 2009

As a follow-up to our earlier post on nutrition in New York City (Feast or Famine) our colleague Renee Shanker sent us an updated list of Farmers’ Markets in the Bronx (see link).  For a complete list of farmers’ markets supported by the New York City Department of Health visit this link.

posted by Matt Anderson, MD

A day in the life of a primary care physician: prior authorizations, denials, and delays in treatment.

The national debate on health reform has uncovered innumerable “health care horror stories” in which cancer patients worry more about their bills than their malignancy or where pregnant women are laid off and dropped from their insurance soon before their due date.  These stories are tragic, and unconscionable for the richest country in the world, however, as a physician, this is not my typical experience.  Instead, what I see every day is patients with private health insurance who cannot afford the copays for their medications, delays in treatment as I grovel for prior authorization with a non-physician utilization reviewer, and patients stuck with huge bills for routine services that they thought they were covered for.

In my practice, patients have a mix of private and public coverage.  While I work with some extremely impoverished patients who qualify for public insurance through Medicaid, it is the people with employee sponsored private insurance who are most at risk for roadblocks to care.  As a primary care physician, it is hard enough to fit all of the recommended screening, health education, and chronic disease management that complex patients need into a fifteen minute visit.  When the burden of battling with insurance companies is added to the equation, there is no way that I can succeed.  My patients, especially the ones with private insurance, are forced to deal with the high copays, denials of claims, and delays in care.

Reflecting on the past week, a bunch of cases come to mind.  While these stories may lack drama, it is nonetheless troubling to me how frequently my treatment recommendations are impeded by difficulties with health insurance.  And I am sure my patients are not alone in suffering the consequences:

Ms. D, came in Wednesday.  She has high blood pressure and very high cholesterol.  I had not seen her in over six months, but she works a demanding job, so I figured that she had just been busy.  In the office, we did not talk about her blood pressure.  We did not talk about diet and exercise.  She had not followed up for so long because at the prior visit I had sent her for an echocardiogram of the heart and she was billed $800 for the test.  Her insurance would only cover $200.  We spent the entire visit talking about how she could not afford to pay this bill.  I just don’t get it.  She has private health insurance.  She was having symptoms that had been worsening over several visits and needed further evaluation – exercise intolerance and palpitations.  Now, she is receiving daily letters from a collections agency, and she is frightened to come to the doctor because of the bills that may show up in the mail.

Mr. D, a security guard with diabetes, hurt his knee while fishing and had severe pain and swelling.  When I initially saw him a few weeks ago, there did not seem to be any major structural damage to the ligaments, so I recommended a conservative approach with rest, ice, and anti-inflammatory medications.  Now, several weeks later, the pain and swelling had not subsided, so I ordered an MRI to evaluate for more subtle damage to the knee.  After several attempts at prior authorization, the private insurance company refused to pay for the test.  Baseball players get MRIs the same day for any bump or bruise, but even going through the appropriate prior authorization process, I could not order an MRI for my patient with private health insurance.  I am not looking forward to all the phone calls that it will require to protest this denial of necessary diagnostic test.

On Thursday, Mr. F came in to have his blood checked.  He requires blood thinners to prevent recurrence of blood clots which could be fatal.  He has twice previously had clots in the blood vessels of his calves, and he once had a blood clot travel to his lungs.  He has a clotting disorder that makes any break in treatment with the blood thinners extremely dangerous.  Warfarin is an effective and inexpensive blood thinner, but it requires frequent monitoring because its activity is affected by numerous interactions with other medications and foods.  His blood test showed that the warfarin was not doing its job, so I recommended an increased dose.  It takes about three days for the dosage change to have a full effect, so I also recommended injectable blood thinners, which act more rapidly, until we could demonstrate that his warfarin had reached a therapeutic level.  However, he could not afford the copay for the injectable blood thinner, so he must hope that he does not develop another blood clot as we wait for the higher dosage of warfarin to take effect.

Yesterday, I saw Ms. E for a follow up appointment.  She is only in her 30s but has already had major back surgery for a disk problem.  She stands for six hours a day at work and has recently had worsening of her back pain.  Her spine specialist had recommended physical therapy, instead of a repeat operation, but she cannot go because her private insurance company requires a copay for every session.  She has been unable to work because of the worsening pain, so she cannot afford these copays and has not been able to follow the treatment plan.  I do not want her to become dependent on pain killers, but since the treatment recommended by her orthopedist is not a realistic possibility, we are running out of options.

I could fill many pages with stories like these of my patients whom are hard working, have private health insurance through an employer, but just cannot get the care that they need, because of unreliable coverage.  It frustrates me that executives of health insurance companies spend millions on advertising to disparage public health insurance, and Republican politicians are stone walling meaningful health care reform because they are afraid that a public health insurance option would put private health insurance companies out of business.  I do not care who provides health insurance for my patients.  Whether they have public or private insurance, I just want them to get the best care possible.  If private health insurance companies provide a high quality product, they will not be “forced” out of business by a public plan.  It makes sense that competition between a public plan and private plans would lower costs, improve quality, and guarantee an option to those who do not have employer sponsored coverage.  As a physician, I need to advocate for my patients.  Private health insurance companies have thousand of lobbyists and millions of dollars to spend.  So why do these companies need so many politicians, including Democrats, advocating for them as well?  This is not about ideology.  It’s about patients who cannot afford their medications or who face bankruptcy due to medical bills.  We need meaningful change and we need it now.

- Aaron Fox, MD

Single payer is on the table!

^{Posted on June 24, 2009}

Testimony of Quentin Young, M.D., to the House Ways and Means Committee

[The following testimony is the prepared text of the remarks given by Dr. Quentin Young at a hearing on health care reform conducted by the House Ways and Means Committee on June 24 in Washington.]

Testimony of Quentin D. Young, M.D., M.A.C.P., national coordinator, Physicians for a National Health Program

Mr. Chairman, members of the Committee, thank you for giving me the opportunity to comment on the proposal that has emerged from the three key House committees and to articulate the single-payer alternative. I am national coordinator of Physicians for a National Health Program, an organization of 16,000 American physicians who support single-payer national health insurance. Our organization represents the views of the majority of U.S. physicians, 59 percent of whom support national health insurance.

I wish to make two points to the Members of this Committee. The first is that the best health policy science, literature, and experience indicate that the Tri-Committee proposal will fail miserably in its purported goal of providing comprehensive, sustainable health coverage to all Americans. And it will fail whether or not it includes a so-called “public option” health plan.

The second point I wish to make is that single-payer national health insurance is not just the only path to universal coverage, it is the most politically feasible path to health care for all, because it pays for itself, requiring no new sources of revenue.

The difference between single payer and the Tri-Committee proposal could not be more stark: single-payer has at its core the elimination of U.S.-style private insurance, using huge administrative savings and inherent cost control mechanisms to provide comprehensive, sustainable universal coverage.

The Tri-Committee discussion draft preserves all of the systemic defects inherent in reliance on a patchwork of private insurance companies to finance health care, a system which has been a miserable failure both in providing health coverage and controlling costs. Elimination of U.S.-style private insurance has been a prerequisite to the achievement of universal health care in every other industrialized country in the world. In contrast, public program expansions coupled with mandates, like those in the Tri-Committee proposal, have failed everywhere they’ve been tried, both domestically and internationally.

First, because the discussion draft is built around the retention of private insurance companies, it is unable — in contrast to single payer — to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick.

A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

Second, because the discussion draft fails to contain the cost control mechanisms inherent in single payer, such as global budgeting, bulk purchasing, negotiated fees and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered under the discussion draft will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Virtually all of the reforms contained in the discussion draft have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked — for one year, until rising costs sank it.

The inclusion of a so-called “public option” cannot salvage this structurally defective reform package.

A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan. A quarter-century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field.

Despite strict regulation, private insurers have successfully cherry-picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as a single-payer system for seniors but has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill.

The $1 trillion price tag on the Tri-Committee proposal already threatens to capsize our new President’s flagship initiative. In contrast, single payer avoids these hazardous political waters entirely because it requires no new sources of funding.

In tumultuous economic times, single payer is the only fiscally responsible option. Two-thirds of the American people support it. The majority of physicians are in favor of it, as are the U.S. Conference of Mayors, 39 state labor federations and hundreds of local unions across the country. Millions of Americans are mobilized to struggle for single payer, but your leadership is crucial. I hope this Committee will see fit to provide it.

Thank you.

Update from US students studying medicine in Cuba (June 2009)

Here is the latest update from from Joanna Mae Souers, one of the US students studying medicine on scholarship in Cuba:

June 2009

Today there are 148 American students studying medicine at the Latin American School of Medicine in Havana.  They study within Cuba’s world-renowned system of universal health care.  Despite Cuba being a “poor” country, the World Health Organization (WHO) ranks the Cuban system among the top 10 in the world.  They study thanks to a scholarship provided within the same system of humanitarian medical  solidarity that has placed more than 21,000 Cuban doctors in poor third-world countries.

The 148 students originate from some of America’s poorest and most medically under-served communities. After graduating they plan, in line with the encouragement of the Cuban Government and our own Congressional Black Caucus, to serve the very same under-served communities from which they came.

As students attending ELAM we, have been given an opportunity to do something that has never been done before. On July 26, 2009, 12 American students from ELAM will board an RV for a road-trip of the Southwestern United States. Together we will spend two weeks as humble guests visiting Native American reservations, neighboring communities, hospitals and colleges to spread the word about our medical school opportunity and foster an exchange of information between all participating groups.

As we approach the one month mark in our countdown to departure we are motivated, poised, and excited about the road ahead us.  We are busy preparing for the exchange; writing up the material we hope to present, learning about the different communities we plan to visit and organizing our curriculum of exchange with guidance from our community liaisons.  So far we hope to visit with the following communities and organizations:

• The Oakland Health Fair, California
• Bay Area Native American Health Center, California
• California Consortium for Urban Health
• La Clinica de la Raza, Oakland, California
• California City College
• University of California at Berkley
• Fresno Clinic, California
• Fresno City College, California
• Los Angeles Indian Health Services, California
• Arizona Indian Health Services
• Windowrock, Arizona
• Gallup, New Mexico
• One Hope Clinic, Albuquerque, New Mexico
• Acoma Pueblo, New Mexico
• Pueblo Indian Cultural Center, New Mexico
• Pajarito Mesa, South Valley, New Mexico
• Santo Domingo Pueblo, New Mexico
• Shiprock, New Mexico

As students, we want to thank the following individuals and organizations for all of their support and guidance during the process of organizing this exchange.

• IFCO Pastors for Peace
• Native American Health Center (Martin Waukazoo)
• Office for Community Health, UNM Health Sciences Center (Dr. Art Kaufman & Dr. Julie Sierra)
• Center for Native American Health, UNM (Dr. Gayle Chacon)
• SWOP (Robby Rodriguez & Louise Head)
• Native Health Initiative (Dr. Anthony Fleg)
• Dr. Stephen Dahmer
• The Office of Congresswoman Barbara Lee

We extend a special thank you to all of our donors and supporters for making this exchange possible, and we want to encourage further support.  We are just short of meeting our proposed budget and we hope to make that happen to make this tour possible!  We need your support, please check out our link (http://www.medicc.org/ns/index.php?s=30&p=4) and donate now!

Visit our website www.saludswexchange.org for more information on the exchange!

sent in by Joanna Mae Souers
Escuela LatinoAmericana de Medicina
Carretera Panamericana
KM 3,5
Santa Fe, Playa
Ciudad de la Habana, CUBA
CP 19108

Trudy Lieberman’s series on health care reform

Trudy Lieberman directs the health and medical reporting program in the graduate school of journalism at City University of New York, and is a longtime contributing editor to the Columbia Journalism Review. Her reporting on single payer’s silencing by the corporate media is among the best I have read. And her style is funny and her op-eds extremely up to date.

For her excellent series on Max Baucus rhetorical (and other) devices to undermine any attempt for real health care reform click here.

Her piece on Celinda Lake, the mind behind the Democrats’ health care campaign, is a true gem.

Below goes a selected paragraph:

“First there was Frank Luntz. Now, Celinda Lake is trying to do for the Dems what Luntz did for the GOP. Lake, a longtime Democratic strategist, has been hard at work crafting the right words and phrases to persuade the public that Dems really do have their best health care interests in mind. For months, politicians, advocates, and especially the president have talked about “affordable, quality” health care—a Lake-fashioned phrase that has caught on big time. Reporters have repeated these words without providing any context about what they mean—that is, if they mean anything. Insurance premiums lower than $12,000? A guarantee that your doc will never make a mistake? Take your pick. Those words are as hollow as a straw. They’re supposed to be.”

For the truth about universal health care US style, the 2006 Massachusetts experiment, click here.

For Ms Lieberman’s complete archive click here.

Why the fear? Health care rationing is already here.

Action alert: Rallies for Single Payer Gathering Steam Around the Nation

Picket Health & Human Services Secretary

Kathleen Sebelius

for Single Payer Healthcare

11am Mon., June 22

SF Fairmont Hotel – 950 Mason

J

Dear Single Payer Activist,

Please picket with us on Monday, June 22, from 11am to 12:15 at a $500 luncheon featuring Health and Human Services Secretary Kathleen Sebelius.

The picket will be at San Francisco’s Fairmont Hotel at 950 Mason.  On June 16 on NPR radio Sebelius said

Interviewer: Can you say flat out it’s just never going to be single-payer health insurance, and we’re going to try to write it, if we can, so that itwon’t ever be?

Secretary Sebelius: “Oh I think that’s very much the case,…”

http://www.npr.org/templates/story/story.php?storyId=105442888

Please let us know if you can picket on Monday, if you can call our phone tree, and if your organization can endorse the picket.  At this moment, the California Alliance for Retired Americans, the California Nurses Assn., the SF Gray Panthers, and Single Payer Now have endorsed.

__ I plan to attend the picket.

__ I can help call our phone tree.

__ My organization _________ endorses the picket.

__ I have forwarded this alert.

Don Bechler

Chair – Single Payer Now

415-695-7891

email: dbechler@value.net

Suggested signs include:

Healthcare Yes!  Insurance Companies No!

Support HR 676!

Stop Banning Discussion of Single Payer Legislation!

Put Single Payer on the Table!