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Hidden Price Of That Succulent Lobster: Health Woes Of Stoic Lobstermen

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

By Richard Knox

Mainer Jon Rogers started lobstering 47 years ago at the age of 10, when he’d go out on his grandfather’s boat.

Ask him about his health and he says, “No worse than anyone else who uses his body in his work. My hips are sore, my knees are sore, my shoulders are sore, my back is sore. I get up every day and it takes me awhile to get going. I hurt every day.”

But Rogers, who lives on a skinny, south-pointing finger of land in Casco Bay called Orr’s Island, doesn’t go to the doctor much. “I never really complained about too much unless I was really hurting,” he says.

“I’d schedule a doctor’s appointment with all the intentions of going,” Rogers says. “But if there was an opportunity to haul traps for a few days, I’d set aside the doctor’s appointment and go haul traps.” This summer he’s running 800 traps, which means his days starts around 5:30 a.m.

Rogers appears to be pretty typical of Maine’s 5,000 lobstermen, and of all 9,000 people who work in the state’s fishing industry.

“They work really hard and have a lot of chronic diseases,” says Miranda Jo Rogers, Jon’s daughter. “These people have a stoic mentality — they don’t seek health [care] until they really need it. So there are no really positive role models on how to be proactive and keep healthy.”

Lobsterman Jon Rogers with med-student daughter Meredith Jo Rogers, who is studying the health of lobster harvesters. (Courtesy)

Lobsterman Jon Rogers with med-student daughter Miranda Jo Rogers. (Courtesy)

Miranda Rogers aims to do something about that. Although she’s still a Tufts Medical School student, she’s taken on a project she expects will take her to graduation and beyond — maybe decades beyond.

“I am happily indebted to the community that raised me, and I wish to make a long-lasting difference in Maine,” she wrote recently to the state’s lobster harvesters, asking them to fill out a 24-page questionnaire on their health.

It will be the most complete look ever at the health of a difficult-to-reach population with special health care needs, low rates of health insurance and high skepticism of outsiders.

“Up and down the coast, the commercial fisherman is very talkative on his own turf, but it’s a very secretive bunch and not that trusting,” Jon Rogers says. Continue reading

Cautious Optimism That New State Insurance Site Will Work

connector

An image from a previous interface for the Connector.

The first test of a new Massachusetts health insurance website was a success, a top state official says, leaving him cautiously optimistic that it will be up and running for a critical Nov. 15 deadline. That’s Opening Day for anyone who plans to buy insurance through the Health Connector, or is seeking free or subsidized coverage.

But Maydad Cohen, a top aide to Gov. Deval Patrick, says he’s not sure yet if the site, developed by hCentive, will be ready. So the state will continue to build out both a state and federal option for one more month. If the hCentive site clears a second test in early August, Massachusetts will drop plans to merge with the federal HealthCare.gov for 2015. Work would continue on the state site so that it would be ready for 2016.

Cohen is scheduled to update the Connector board Thursday morning, two months after the state gave up on the idea of trying to fix a site built by Canada-based CGI that never worked.

Some 230,000 residents who could not sign up for insurance online were placed in a temporary coverage plan because the state could not figure out what, if any, insurance assistance program they might qualify for. Each of those men and women will have to a reapply through a new site this November. And 101,000 residents who qualified for subsidized coverage last year, and whose plans have been extended this year, will also have to apply again.

Cohen says the cost of building out two options will be less than the original $121 million estimate, but he can’t say how much. An update on how much the state is spending to keep 230,000 people in temporary coverage is expected at Thursday’s board meeting.

Vox: How Mass. ‘Screwed Up Obamacare’ (The Website)

(RightBrainPhotography/flickr)

(RightBrainPhotography/flickr)

Just to be clear, in defense of Massachusetts: The state did not screw up Obamacare itself, and its record on health insurance coverage for our residents remains the best in the nation. Massachusetts screwed up — in fact, you could use harsher language than that — the health-insurance marketplace website that was part of Obamacare, as WBUR’s Martha Bebinger has been covering for months.

But that’s just a headline quibble. Sarah Kliff’s Vox feature today — How Massachusetts Screwed Up Obamacare — provides some answers to the many of us who still feel baffled by the state’s ability to go from top of the class nationally on health insurance to the Obamacare dunce corner. The most memorable quote, from former Connector chief Jon Kingsdale: “”In some ways it’s harder to rehab your house when you’re still living it.”  And the basic explanation:

The state spent years trying to build what they hoped would be the country’s most advanced marketplace. What got in their way, state officials and outside experts say, were poor management, a too-ambitious agenda, and a failed relationship with its main technology vendor, CGI — the same company that managed the failed launch of healthcare.gov.

Massachusetts’ prior experience running an exchange may have turned into a distinct disadvantage, some say: it led the state to underestimate how different — and challenging — building an Obamacare exchange would be.

Obamacare Preview? Mass. Studies Find Some Hospital Use Stays Same

(firemind/flickr)

(firemind/flickr)

Today is an Obamacare milestone: the end of the first enrollment period for new insurance plans the health care law spawned. More than 6 million previously uninsured people have signed up for private plans and 4 million more for Medicaid, The New York Times reports.

Opposition and skepticism remain, the Times says.

Yet beneath the loud debate, the law is quietly starting to change the health care landscape. In Kentucky alone, more than 350,000 people — about 8 percent of the state’s population — have signed up for coverage. Insurers and medical providers are reporting steady demand from the newly covered for health care, ranging from basic checkups to complex surgical procedures.

As that landscape changes, now seems a good time for a couple of reality-check studies from Massachusetts (yes, the state website has been messed up, but we did go through the current Obamacare stage of new enrollments years ago). They find that in certain ways — emergency room usage and readmission rates — expanded insurance coverage may not change health care, at least not immediately.

A study just out today in the medical journal BMJ finds that increasing health coverage does not quickly bring down readmissions — those unfortunate cases of patients who quickly bounce back into the hospital soon after being discharged. The hope is that having insurance and thus regular medical care will reduce those expensive readmissions. From the press release:

Boston—In a first of its kind retrospective study, Boston University School of Medicine researchers have found that providing health insurance coverage to previously uninsured people does not result in reducing 30-day readmission rates. The study, which appears in the British Medical Journal, used data on actual (versus self-reported) use of care and also found no change in racial/ethnic disparities in this outcome, despite a markedly higher baseline of uninsured among African-Americans and Hispanics in Massachusetts.

According to the researchers there are several possible explanations for their findings. For example, following health reform in Massachusetts, newly insured individuals were more able to seek medical attention after a hospital admission, which in turn may have uncovered medical problems requiring readmission. Another reason may be the inability to access a personal doctor in the state due to the primary care physician shortage, which has been well documented since 2006.

Other studies in Massachusetts have shown that access to care improved less than access to insurance, as many newly insured residents who obtained Medicaid or state subsidized private insurance still reported cost-related access barriers.

The conclusion: Expanding insurance coverage isn’t enough. Dr. Karen Lasser of the Boston University School of Medicine, the paper’s lead author, emailed that we also need to “reduce financial access barriers to care (e.g. copays), increase reimbursement rates for new insurance plans (so that more physicians accept these forms of insurance), implement medication reconciliation and patient coaching, improve disease management and coordination of care, and provide hospital based incentives to reduce use of inpatient services. Interventions could also tackle the shortage of primary care providers in MA.”

Meanwhile, another recent study, released last week, reported that, contrary to hopes that increased insurance coverage would cut expensive emergency-department use, the Massachusetts experience is that ER use slightly rose after health are reform. Continue reading

Christopher Lydon Is Back On WBUR — And Talking Health Care

Christopher Lydon

Christopher Lydon

Mark your calendar (that is, set a smartphone alarm) to tune your dial (that is, set your tablet to livestream WBUR.org) tonight. It’s old news that the lively intellect of Christopher Lydon is back on WBUR, but the fresh news is that tonight, he’s going to be talking health care, with some lofty interlocutors (uh oh, my anticipation seems to be making me channel his vocabulary…) From Radio Open Source:

We’d love to begin the show with some vox pop, as we call it. Please call 617 353 0692 and leave a short message that we can use at the top of the program. Here’s the question: Speaking as a patient, and think of your own health, how is the modern “miracle” medicine working for you?

Our guests in this conversation (9 p.m. Thursday, January 16th on WBUR, Boston at 90.9 FM) will include Dr. Tom Lee, former CEO of Partner’s Healthcare, professor at Harvard Medical School and author of “Eugene Braunwald and the Rise of Modern Medicine”; Dr. Don Berwick, pediatrician and candidate for governor in Massachusetts; and cardiologist Eugene Braunwald.

The Rise of Modern Medicine: do you think of the miracle tech that has made death by heart attacks a rarity? Or do you think of a money-driven industry that’s made heroes out of hospitals at a huge price to patients and the national economy? Dr. Tom Lee makes it a history lesson that unfolded over the last 50 years in Boston. What happened to health in healthcare?

The conversation has already begun in the comments, including this one:

I’ve been in the healthcare business for 25 years as a sales representative. The buildings keep getting bigger, the administrations more dense, the regulation more arcane…There is so much money thrown at healthcare; how could this NOT happen?

Listeners, would love to hear afterward what you think.

Want Better, Cheaper, More Seamless Health Care? Ask Me How

Dr. Myechia Jordan (Courtesy)

Dr. Myechia Minter-Jordan (Courtesy)

By Dr. Myechia Minter-Jordan
Guest contributor

Dr Myechia Minter-Jordan is president and CEO of the Dimock Center, a nationally recognized community health center in Roxbury.

Growing up, I always knew I wanted to be a doctor. I remember being fascinated by all the cool gadgets in the doctor’s office, from the cold feeling of the stethoscope on my skin as the doctor listened to my breathing, to the funny feeling as my doctor tapped my knee with the small hammer to test my reflexes. It always felt exciting to me, even when we had to make two or three visits to separate clinics for doctor’s appointments and medical care. As a young child, it seemed like an adventure.

What I didn’t realize was that it was not an adventure for my parents. They often had to take multiple days off of work to go to those appointments and they weren’t happy about it. They ran in circles giving the same information over and over to different nurses and doctors, receiving few helpful results. They often left those appointments more frustrated and perplexed than when we arrived.

Now, as an adult and a doctor reflecting back on those times, I can say with certainty that my family’s primary care provider never spoke with our dentist and eye doctors about our health and wellness. My mother’s OB-GYN never communicated directly to our pediatrician about her care or anticipated my needs as a new infant. Fragmented, clunky and often disempowering, that was our health care system then in many ways. And it still is now.

Why are there not more people knocking at my door to learn from our model of care?

Throughout its history, our health care system became increasingly disjointed, and we are now faced with the reality that we must seek alternate models that are centered on the patient. We must seek models that are streamlined, efficient, less expensive and more empowering for the patient. We need models that enhance communication among providers about the patient and their health care experience. And we need to improve the collective health of our communities.

In other words, we need a model that has existed in our country since 1965: the community health centers.

Here’s what community health centers offer: Continue reading

Dr. Tim’s ‘Truth About Obamacare’ Podcast: Jan. 1 As Decisive Moment?

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

What just happened? That is, Jan. 1. 2014, has long been the date most commonly mentioned as the moment when Obamacare really kicks in. So now that 2014 is launched, what has really changed?

Dr. Timothy Johnson, retired medical editor for ABC News and author of ”The Truth About Getting Sick in America,” focuses on that question in his latest ‘Truth About Obamacare’ podcast, above. He discusses it with his regular guests: John McDonough, a professor at the Harvard School of Public Health; Dr. Gail Wilensky, a health official under the first President Bush; and Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Levitt offers a brief summary of where Obamacare now stands: the expected December surge in enrollment has yielded 2.1 million people who picked a private plan for health insurance coverage, and 3.9 million people who qualified for Medicaid, he said. And he expects to see a much bigger surge as time for sign-up runs out in March.

So did the world actually change as of Jan. 1? Dr. Johnson asks John McDonough.

I’d sum up McDonough’s answer as “Hell, yes.”  Most people aren’t aware of the significance of what happened, he says, but “I find it hard to compare another single date in terms of change to our health care system actually taking effect.” He highlights four major changes: Continue reading

Come On, Massachusetts, Get This Pregnant Woman Covered

UPDATE 1/9:
Jessica Stanford is now on MassHealth and has her first prenatal visit next week. She says she qualified for free coverage because she’s pregnant. Her husband still doesn’t know if he has temporary coverage and hasn’t been told if he qualifies for a ConnectorCare plan. That’s frustrating, says Jessica, “but we do not need to spend time fighting that battle. Our priority was to make sure I could see a doctor as soon as possible.”

Connector 1

Jessica Stanford of Sharon, Mass., is 40 and newly pregnant. She’d really like to see a doctor soon because she’s had several miscarriages and developed gestational diabetes during her last pregnancy. But she doesn’t have health insurance and is worried about racking up medical bills.

Stanford applied for subsidized coverage in early December. She keeps calling the Connector to find out about her enrollment status. One customer rep told Stanford she could take her application number to a doctor’s office for proof that the state will cover her, at least temporarily, but Stanford wants something more certain.

The Connector says it has extended coverage, through March, to 254,000 residents who applied for free or subsidized insurance and all residents who have had government backed coverage.

The agency is sending out letters explaining a temporary coverage plan that begins today (Jan. 1) for 22,371 residents who, like Stanford, are applying for the first time. Continue reading

The Great Healthcare.gov Mistake: Having An ‘Older Accountant’ Create It

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14, (AP)

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14. (AP)

By Michael Doonan
Guest contributor

The Center for Medicare and Medicaid Services is the behemoth federal agency that, despite limited resources, does a pretty good job of carrying out its core mission: running programs that provide health insurance for older and poorer Americans.

Expecting that this agency can also run the federal health insurance exchanges for Obamacare, however, sets it up for trouble right from the start.

The failure to locate accountability in the appropriate hands helps explain the Website debacle and anemic early enrollment, if not the president’s early miscue that everyone would be able to keep their current health insurance.

CMS simply does not know how to regulate health insurance for individuals and small business at the state level. Case in point: The agency’s previous troubles implementing insurance reforms that were part of the Health Insurance Portability and Accountability Act of 1997 (HIPAA), which, among other things, stipulated that the federal government would step in if a state was non-compliant.

Michael Doonan (Photo: Mike Lovett)

Michael Doonan (Photo: Mike Lovett)

This was like telling your kids to clean their rooms or else you will do it for them — and in the end, national regulations turned out to be weak and ineffectual.

Turned out CMS didn’t know much about the range of health plans and insurance products in certain states. Federal officials were more scared of taking over state regulation than the states. As a result, they begged the states to comply and bent over backwards in the regulations to find any state “effort” acceptable.

With the roll out of the federally mandated health exchanges, it is déjà vu all over again. Continue reading

Dr. Tim Johnson’s ‘Truth About Obamacare:’ Is The Law Doomed?

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

“Tumultuous,” is how Dr. Timothy Johnson describes the recent roll-out of Obamacare in his latest podcast. (Click on the “play” arrow above right to listen.) And that’s not nearly strong enough, he adds. “Many people are saying Obamacare is doomed,” in the wake of all the current Website and insurance problems, he says.

Is it? Dr. Johnson, retired medical editor for ABC News and author of ”The Truth About Getting Sick in America,” discusses the outlook with his regular podcast guests: John McDonough, a professor at the Harvard School of Public Health; Dr. Gail Wilensky, a health official under the first President Bush and Larry Levitt, a senior vice president at the Kaiser Family Foundation.

The first answer to the “Is it doomed?” question comes from McDonough, who offers a clear “no.”

“I’m just dumbfounded by the media’s unbelievable hyperventilation about every small detail and the implications it has for the law as a whole and Obama’s presidency and the fate of the republic,” he says. “This is on track to open up affordable coverage for tens of millions of Americans starting Jan. 1. Once we get past Jan 1, i don’t believe there’s any retreat…and I think we will get through this difficult patch.”

Wilensky agrees that the law is not doomed, but adds:

“There is a problem, and it’s not just that people are having great difficulty accessing the Website, some of whom are at risk of losing their individually purchased insurance by the end of the December….The most serious issue is that there has been a real loss in trust in the president, and that is way more of an issue than the hiccups that have gone on with regard to the Website. When people don’t feel like they can trust what their president says, it has ramifications far greater than the Affordable Care Act. And wait until people discover the second part of the president’s pledge — ‘And if you like your doctor you can keep your doctor’ — isn’t true either, not for a lot of people. That’s the next shoe that’s going to fall.”

Listen to the full podcast above, and check out Dr. Johnson’s previous Obamacare podcasts here, here and here.