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The Des Moines Register is arguing this morning that the “public deserves information about H1N1.”  If only that were what the Register was really after. 

Through hospitals, physicians and public health agencies, the public has access to plenty of information about H1N1.  That information has focused on the most important factors:  what the virus is and how to protect yourself from it. 

What Register editors and reporters want – really want – are the names and addresses of Iowans who have died from H1N1.  That’s part of the essential job of newspapers, to get the “who” and “where” of hot stories.  But it’s not the job of the Iowa Department of Public Health to provide that information, directly or indirectly. 

In its editorial, the Register tries to mask its intentions.  Recognizing that IDPH can’t legally release names and addresses of H1N1 victims, the editorial claims reporters want only “as much information as legally possible – not in the interest of gossip but in the interest of Iowans protecting themselves…”  Just how more information will make that happen, the Register never explains.  

But the editorial does go on to show the newspaper’s true colors, saying it’s no big deal if the public learns the names and addresses of the victim (“Some people will figure it out anyway…” the editorial shrugs), as long as IDPH doesn’t break the law (which, of course, would immediately make headlines).  Based on the Register’s standards, why not release information about each Iowan who contracts H1N1? 

Thankfully, IDPH doesn’t appear to be ready to play so fast and loose with this sensitive information.  IDPH has an obligation to protect that information, because there is nothing more personal and private than a person’s health records. 

But it’s more than just protecting people’s privacy.  IDPH’s primary mission is to protect the public.  That mission is not served by giving out more information about H1N1 fatalities.  In fact, it runs counter to that mission, because it feeds amateur speculation about how the virus is spread, where it exists and who might get it.  It might lead people to be even more lackadaisical about taking precautions, or it might lead people to overreact, to demand schools or workplaces be closed and individuals quarantined. 

To be sure, these could be real issues, but they are issues we trust the health care professionals at IDPH to address. 

Let IDPH do its important work, which does not include supplying newspapers with fodder for the next news cycle.

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A recent article in the New York Times illustrates the travails for one U.S. Senator as he finds himself between a health care reform rock and hard place.  The Senator is Florida’s Bill Nelson.  The rock is more than 1 million Florida senior citizens who enjoy spa-like services under Medicare Advantage.  The hard place is 50 million nonelderly uninsured individuals in the U.S., including more than 3.7 million in Florida. 

It’s a bit of a gut-check for Nelson, a Democrat, as he is forced to balance his loyalty to party and president against perhaps the most motivated voting bloc in the country.  And motivated they should be.  After all, Medicare spends an average of $8,794 a year on each Medicare enrollee (compared to $6,204 in Iowa) and an average monthly Medicare Advantage payment rate of $1,013 (compared to $752 in Iowa).  Clearly, Medicare Advantage has been a big hit in Florida, which is why it has a 28 percent market penetration, compared to barely 12 percent in Iowa. 

Just where Nelson is leaning is clear from the Times article, in which he declares, “It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare…I am offering an amendment to shield seniors from those benefit cuts.” 

Iowans, of course, have subsidized Medicare health benefits in Florida and other high-flying states for years, as Congress and the Centers for Medicare & Medicaid Services have allowed geographic disparity within Medicare to go unchecked, despite reams of data that show (1) it’s unnecessary and (2) it doesn’t benefit patients and, in fact, appears to detract from their quality of life, if not their overall health.  Speaking of “intolerable” – it’s doubtful that the Sunshine State Senator is aware that Florida is in the top 10 for Medicare spending and the bottom 10 for quality of care provided to Medicare beneficiaries. 

The good Senator gauges the situation by the e-mails and letters he has received, including, apparently, those coerced by Humana, one of Florida’s big Medicare Advantage insurers.  (Humana has since been taken to the CMS woodshed for using its Medicare Advantage database to further its political advocacy.)  What he should be looking at is why his state, home to the most expensive Medicare region in the country (Miami, at more than $16,000 per enrollee per year) is such a Medicare outlier.  That kind of guzzling at the public trough is bound to get you some well-deserved attention. 

It boils down to a basic question of equity.  Floridians are simply being asked to shoulder a small portion of what Iowans have hauled around since the Medicare Prospective Payment System was put in place.  Whether or not they choose to see the bigger picture and support a reformed national health care system that prioritizes patients – not just services – will depend a great deal on the words and actions of leaders like Senator Nelson and those who can, if necessary, neutralize him.

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Featuring hospital and health care headlines from the media and Web from September 19-25.

Iowa Headlines 

Iowa Poll: 47% oppose health care reform effort
While  Iowans tend to oppose the congressional reform effort in general, most say they like specific reform ideas, such as health care co-ops, a national insurance exchange, a requirement that employers offer policies, and a requirement that U.S. residents have coverage.  Even one of the most controversial proposals, to create government-run “public-option” insurance plans, draws support from a slight majority. Iowans oppose only one of the six specific options noted by the poll – the idea of cutting payments to doctors and hospitals.  (September 25, 2009, Tony Leys, Des Moines Register

Couple Gets Married in Hospital’s ICU
Last week Cathy Troll ended up at St. Luke’s Hospital after complications from her lung cancer treatment, she’s been in the Intensive Care Unit since she arrived.  With a week until the wedding, Leeann’s plans quickly changed.  (September 20, 2009, Justin Foss, KCRG-TV) 

Hospital plans nearly complete
An artist’s drawings of how the new Belmond Medical Center will look were presented to the Belmond City Council Monday night. Since the hospital is city-owned, the council was asked to give the final approval to an application for low-interest funding from the United States Department of Agriculture Rural Development.  (September 24, 2009, Belmond Independent

New CCMH building walls to go up late fall
Although not immediately apparent at the site of the replacement Crawford County Memorial Hospital on the west side of Denison, amongst the dirt work necessary for paving and utilities, the footings are already being laid for the new building.  (September 19, 2009, Emma Struve, Denison Bulletin Review

Recession squeezes seniors’ meals, bills
Seniors sit among the recession’s greatest casualties because of higher medical insurance costs, reduced retirement savings and a stagnant housing and employment market, according to an AARP report released Tuesday.  The report noted that applications for retirement benefits are 9 percent greater than expected for this fiscal year.  The cost of medical care rose by 3.3 percent between August 2008 and last month.  (September 23, 2009, Grant Schulte and Jason Pulliam, Des Moines Register

Hospitals weigh limiting visits to newborns
Grandmas and grandpas, brothers and sisters, family friends and well-wishers could all be banned from the maternity wards at Des Moines hospitals this fall because of concerns that they might bring the H1N1 flu virus in with them.  The area’s two main hospital chains are considering new limits on visitors if the flu outbreak worsens. Under the proposed rules, only immediate family members would be allowed in the birthing centers, and siblings younger than about 14 would not be allowed in.  (September 21, 2009, Tony Leys, Des Moines Register) 

U.S.  Headlines 

Is the Mayo Clinic a model or a mirage? Jury is still out
A battle is underway among health-care experts and lawmakers over whether Mayo’s success can be so easily replicated.  Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.  (September 20, 2009, Alec MacGillis and Rob Stein, Washington Post)                                     

The way we die now
For reasons both cynical and clinical, the American political debate on health care treats end-of-life care like a contagion – an unspeakable one at that.  (September 23, 2009, Timothy Egan, New York Times

Provena makes spirited defense of charity care, tax status to Illinois court
The Illinois Supreme Court heard 55 minutes of arguments over how much charity care a hospital should provide and whether it should go beyond providing free medical services. The case pits Provena Covenant Medical Center in Urbana against the state Department of Revenue.  At the heart of the state’s argument in keeping Provena from being exempt from property taxes is a level of free care it provided in 2002 when the state Department of Revenue said the hospital’s charity care was less than 1 percent of its revenue. (September 23, 2009, Bruce Japsen, Chicago Tribune

Doctor-owned hospitals a lucrative practice, though opinions split on benefits
The American Hospital Association wants to ban doctors from referring patients to hospitals they own, because “the effect on health delivery and costs in communities can be devastating.”  Yet Baylor Health Care System says doctor-owned hospitals, like its Baylor Medical Center at Frisco, can serve patients better because they focus on doing a few things extremely efficiently and well.  (September 21, 2009, Gary Jacobson, Dallas Morning News

Those who can’t pay for care costing millions for those who can
Because the uninsured can’t afford to buy individual insurance, they accept charity care, putting even more pressure on the premiums paid by those with insurance.  In just three years – from 2005 through 2008 – charity care spending in North Carolina grew from $338 million to $624 million.  (September 19, 2009, James Gallagher, Triangle Business Journal)

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Iowa is well represented among the Top 50 Hospital Blogs that was pulled together by Nurseblogger.  The 50 blogs includes categories for hospital blogs as well as blogs from children’s hospitals, specialty hospitals, hospital work-related, hospital associations, hospital CEOs, hospital patients and companies and organizations related to hospitals.

In Iowa, Knoxville Hospital and Clinics was listed among the best hospital blogs.  The blog penned by Todd Linden, CEO of Grinnell Regional Medical Center, is also listed, and so is IHA’s blog

As for Nurseblogger…well, we’re not exactly sure who or what this is, although it seems to have something to do with helping nurses earn their bachelor’s degrees.  But they do seem to know health care and good hospital-related blogging when they see it.

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Featuring hospital and health care headlines from the media and Web from September 12-18.

Iowa Headlines

 Few counties benefit from Iowa health care program
A state program offering health care to low-income adults without children is serving thousands of people who have never had health insurance, but more than half of those enrolling are from six Iowa counties.  That’s because people seeking care can only go to the University of Iowa Hospitals and Clinics in Iowa City, except those who live in Polk County, who can seek a waiver to seek treatment at a Des Moines hospital.  (September 13, 2009, Nigel Duara, Chicago Tribune/Associated Press) 

Hospital ranks high nationally in care, value
St. Anthony Regional Hospital is celebrating its high national rankings for quality and affordable care.  A new study of more than 4,500 acute-care hospitals in the U.S. ranks the Carroll facility 24th in the U.S. in patient satisfaction, 75th nationally in value, and sixth in Iowa and 11th in a five-state Midwest region for value.  (September 16, 2009, Butch Heman, Caroll Daily Times Herald

Large crowd shows support for Cherokee MHI
Tuesday was the day that the State Legislature’s special Task Force came to the campus of the Cherokee Mental Health Institute – the first of four evaluation visits they will make to the state’s four mental health institutes.  Following the conclusion of their fourth visit, the task force will make a recommendation to the Iowa legislature to possibly close one of the four.  (September 17, 2009, Dan Whitney, Cherokee Chronicle Times

Congress should extend help with Medicaid
Iowa is facing a shortfall of between $900 million and $1 billion for the next budget year, and has about $133 million left in stimulus money. Everyone knew federal help was temporary, and there is likely little political will in Washington for passing another stimulus package.  But one provision Congress should consider extending is an increase in the federal matching rate for Medicaid.  (September 15, 2009, Des Moines Register

Health care reform: Loebsack supports House bill
Facing a skeptical crowd in Keokuk Saturday, U.S. Rep. Dave Loebsack supported the key provisions of a health care reform bill passed by the U.S. House of Representatives earlier this summer.  (September 14, 2009, Steve Dunn, Keokuk Daily Gate City

U.S.  Headlines 

Baucus pleases few with health care reform bill
His fellow Democrats shuddered and Republicans sneered when Sen. Max Baucus unveiled legislation to remake the health care system.  Now, the chairman of the Senate Finance Committee gamely insists that it can pass the Senate, core provisions intact. That’s precisely what many Democrats are hoping to avoid, and not even an attempt to choreograph a display of unity after a closed-door meeting could obscure it.  (September 18, 2009, David Espo, Washington Post

Illinois health plan is months behind on payments to doctors, hospitals
With the state’s budget in disarray, Illinois is more than six months behind in sending payments to doctors and hospitals that are due money from a state-funded health insurance plan. Left without payment for so long, some providers have grown anxious and employed debt collectors to apply some pressure. (September 15, 2009, Jon Yates, Chicago Tribune

Study gives high marks to retailers’ clinics
Walk-in medical clinics run by CVS, Wal-Mart and other retailers provide care for routine illnesses that is as good as, and costs less than, similar care offered in doctors’ offices, hospital emergency rooms and urgent care centers, according to a new Rand Corp. study.  The cost savings over emergency rooms, in particular, was quite dramatic.  (September 15, 2009, Margaret Shapiro, Washington Post

50 million new patients? More primary docs a must
As Massachusetts’ experience shows, extending healthcare to 50 million uninsured Americans will only further stress the system and could force many of those newly insured back into costly emergency rooms for routine care if they can’t find a primary care doctor.  To keep up with the demand for primary care doctors, the country will need to add another 40,000 to the existing 100,000 doctors over the next decade or face a soaring backlog, according to officials from the American Academy of Family Physicians.  (September 14, 2009, Steve LeBlanc, Associated Press

Hospital board wonders how it failed to notice scheme to inflate contracts
When MetroHealth System Board Chairman Bill Gaskill speaks publicly of the federal charges against a former executive of the county-owned hospital, he calls that person a criminal and the situation “dark and tragic.”  (September 13, 2009, Sarah Jane Tribble, Cleveland Plain Dealer) 

Maryland reins in hospital costs by setting rates
In the fight over a health-care overhaul, Maryland’s experience with setting hospital rates suggests the federal government could realize savings on health spending, but at a price of more regulation for health providers.  (September 14, 2009, Jane Zhang, Wall Street Journal

Young adults likely to pay big share of reform’s cost
As health care legislation advances through Congress, young adults are emerging as a significant beneficiary of reform, but they are also likely to play a major role in funding. A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage.  For many of those people, healthcare reform would offer relatively inexpensive individual policies. The trade-off is that young people would require individuals to buy at least minimal coverage.  (September 16, 2009, Shailagh Murray, Washington Post)

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