I am just thrilled watching and seeing Pope Francis hugging children and touching and affirming seniors. On his way out of St. Patrick’s Cathedral last night, he stopped to talk with an elderly woman who was seated, perhaps in a wheelchair. Anderson Cooper of CNN mentioned how he was moved seeing that. And of course, the Pope always hugs the kids and promotes the importance of families and generations. That sense of family and caring for all members is why I named this blog Generations of New York.
It was so wonderful to hear the Pope mention the elderly and children in his address before Congress yesterday. Here is what he said:
I would also like to enter into dialogue with the many elderly persons who are a storehouse of wisdom forged by experience, and who seek in many ways, especially through volunteer work, to share their stories and their insights. I know that many of them are retired, but still active; they keep working to build up this land. I also want to dialogue with all those young people who are working to realize their great and noble aspirations, who are not led astray by facile proposals, and who face difficult situations, often as a result of immaturity on the part of many adults. I wish to dialogue with all of you, and I would like to do so through the historical memory of your people.
When was the last time you heard an American politician talk about seniors or even talk this way at all about the generations? All four of my grandparents were immigrants from southern Italy and they had a big influence on my life. The Pope’s kindly, loving demeanor and his Italian-Spanish accented English bring back memories of them for me. And his embrace of all humankind, especially the poor and the vulnerable is the guidestar for our public policy and personal relationships.
Hillary Clinton, Senator Bernie Sanders and other political leaders are saying they will push for Medicare to negotiate prices for prescription drugs in light of outrageous increases for old drugs reported this week. The New York Times reported on a 5000% increase in a drug produced by Turing Pharmaceuticals taken over by a former hedge fund manager. The drug, Daraprim, used to treat a parasitic infection went from $13.50 per table to $750. The drug has been around for 62 years. By the end of the day yesterday, Turing was backing off on the size of the price increase.
Meanwhile here in Albany the Capital District Physicians Health Plan (CDPHP), a nonprofit managed care plan which offers Medicare is asking state legislators to pass a bill that would require drug companies to reveal expenses for marketing, lobbying, along with research and development. The Albany Times Union reports this morning that CDPHP CEO John Bennett commented, “Left alone drug costs will bankrupt our system.” The company said the price of albuterol, an asthma inhaler jumped from $11 to $434 per inhaler.
It should be noted that the wholesale price is not what patients or what plans pay. They do negotiate to get better prices and patients pay co-payments. However, if the prices even go up significantly though not to the outrageous level, patients end up with higher co-pays which can reach $50 or more dollars or can be a percentage of the total cost.
It used to be just a decade ago that drug companies would justify high costs as necessary to pay for research and development costs. It is hard to see anything but outright greed though when an old drug which is bought by a new company has its price raised by hundreds per tablet. What is the justification for that other than a get rich quick scheme? It is very short-sighted though because you have to have customers able to pay. The average health consumer can’t so government and health plans are left to pay and, they are going to resist, forcing the drug companies to back off.
If government can’t negotiate prices this is what happens, prices that are as high as the market will bear. However, drug companies trying to gouge the public are politically out of touch if they think they can get away with it without a backlash. There may not appreciate the politics of it but they ought to understand that politics effects their bottom line as they watched they stock prices drop this week when politicians started talking about controlling prices in government programs.
California Governor Jerry Brown has a bill on his desk that would make California the fifth state in the country to all terminally ill person to end their own lives assisted by drugs prescribed by a doctor. He must act on it in the next few days or it automatically becomes law. Brown’s position is unknown though media reports say he was concerned that the bill passed in a special session. The bill passed the California Assembly last week by a 47-34 vote. It had passed the California Senate earlier. The bill allows persons who are determined by medical personnel to have less than six months to live to end their lives. The bill describes the consent by the person seeking to end their life and other issues related to witnesses.
There have been a number concerns expressed about right to die laws. One is to make provisions for mental health counseling to persons who may be depressed and choose to end their lives. Another concern is the disposition of the lethal drugs which may be given and never used or be left over. Also, a doctor in Oregon has noted that the law there has changed the relationship between doctors and some older patients who are concerned about “death doctors” as some call those doctors known to be involved in helping a person end their life. Opponents of the California law argued that the poor, vulnerable and elderly could be pressured by family members to take their lives rather than pursue more aggressive treatments. Advocates say the bill gives persons in pain a choice on how and when to end their suffering.
Opponents of the bill led by the Catholic Church, disability organizations and hospice supporters argue that hospice care can provide comfort to dying persons. Oregon passed the bill last year . Vermont, Montana and Washington State also allow persons to end their lives. A New York bill sponsored by Assemblywoman Linda Rosenthal and Senators Diane Savino and Brad Hoylman is expected to be more vigorously pushed in 2016. Opponents are holding a training on the issue in Albany on November 7th to prepare to defeat the bill.
An effort to pass a ballot measure in Massachusetts on this issue narrowly failed in 2014. Interestingly, the rural areas of the state supported the measure but the eastern, more urban areas voted against it, seemingly reflecting stronger influences by religious and ethnic factors in those areas and perhaps a more libertarian approach in smaller towns.
There needs to be a full public debate on the New York bill so that advocates for it justify why hospice care and the use of drugs legally prescribed should not be fully utilized.
A big Medicare issue in recent years has been the proliferation of situations where patients were not “admitted” to a hospital but are put into “observation status.” This situation did not just happen because hospitals determined that fewer people were as sick as in the past and didn’t need to be admitted. Rather, it was caused by overzealous audits by Medicare private contractors looking for fraud and being paid for recovery of funds who would retroactively deny reimbursement for admissions they later didn’t think were appropriate. Hospitals were also facing penalties for two many re-admissions. So, they started putting more and more people in observation status.
This large increase has led to a lawsuit filed by the Center for Medicare Advocacy and hundreds of complaints of people who had to pay thousands of dollars for short term nursing home rehabilitation. The most notable case was one I worked on and involved Ike Cassuto of Columbia County near Albany. Mr. Cassuto was a World War II bomber pilot who flew over 30 missions into Germany. He was still working as an attorney at age 88 in Albany back in 2011 when he fell and fractured his pelvis on a city street. He went into an Albany hospital and stayed more than three nights but was in observation status and not admitted. Medicare requires a three night stay, admitted into the hospital, in order to pay for the short term nursing home rehab. Mr. Cassuto ended up paying over $6,000 of his own money for his stay.
This case got coverage on the front page of the Albany Times Union and Senator Charles Schumer came to Albany and held a press conference with the Cassutos when he announced some legislation to change the rules. Nothing has happened on the legislative front to change things. Here in New York State Senator Kemp Hannon and Assemblywoman Crystal Peoples-Stokes led the effort with New York Statewide Senior Action Council to get a bill passed that requires hospital to now notify patients of their status within twenty hours after they are in the hospital.
Medicare has been tinkering and working on some flexibility. It put in place a “two midnight rule” that said that a patient should be considered admitted if he or she stayed two nights in the hospital. There were complaints from the hospitals about this being too rigid. Now, Medicare is seeking further changes to allow doctors more flexibility in determining whether a patient should be admitted. And, they have put the quality improvement organizations that they contract with in charge of the reviews, starting this October and reserved the private auditors only for reviews of hospitals with large numbers of admissions denials. That is a good move, but all of this seems like a lot of bureaucratic wrangling when a better solution seems already at hand.
It seems long past time that all this should be resolved. While all this going on, Medicare is moving away from the fee for service model and plans to give most payments to providers as “accountable care organizations” which work together to treat all of a patient’s medical needs, including following up with care coordination to prevent re-admissions. For example when Mr. Cassuto went into the hospital and then needed rehabilitation in a skilled nursing facility for a short period of time, all of the providers should be paid a fee for caring for his whole illness. In other words, all the rules about how long a person stayed in hospital and whether they didn’t stay long enough for Medicare to pay for the rehab would no longer be relevant. That is the way this should be resolved. You can’t talk about “accountable care” and “care coordination” and “treating the patient” while maintaining a set of payment rules that treat separately each payment to the doctor, hospital and nursing home for the same illness. It’s a ridiculous situation that continues to harm patients financially – the same patients who have paid into Medicare all their lives and should be able to count on it when they are in need of hospital care and short term rehabilitation.
Here is a link to the latest CMhttps://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-01-2.htmlS release on this issue and changes being implemented
Eric Kingson, the co-founder of Social Security Works, who has been active on retirement issues throughout his career is entering the race for the 24th Congressional district in central New York. Eric has been a professor of social work at Syracuse University and has been active in national retirement issues. In 2009 he became co-director of Social Security Works, a national advocacy organization to fight privatization efforts and to promote an increase in benefits for lower income retirees. He has been a regular speaker and senior and Social Security events across the state.
Eric has never run for office before and will have to win the Democratic nomination to face Congressman John Katko, a first term Republican. The district is listed as one of the top priority races for both political parties because it has turned over in each of the last four elections. Katko defeated Democratic incumbent Dan Maffei in 2014 who defeated Republican Ann Marie Buerkle in 2012. She had defeated Maffei in 2010. The district is centered in the Syracuse area and includes Oswego, Auburn and run along Lake Ontario to the eastern suburbs of Rochester.
With the unlimited spending allowed by the Citizens United Supreme Court decision, expert super PACs on both sides to be spending lots of money to win this seat. I am glad Eric is running with his message on Social Security, tax reform and inequality. I spoke on senior issues on conference calls a number of times to his classes at Syracuse University.
For more information about Eric’s campaign, go to erickingson.com
I also want to commend the work of another friend today. Lilliam Barrios-Paoli who was Commissioner of the New York City Department for the Aging when I was the State Office Director is leaving her most recent post as Deputy Mayor for Human Services. Mayor Di Blasio asked to take that post and she served, as always as a consummate professional but also a person with a heart. She was one of the best administrators you could have, who always sought to dig down and figure out how to resolve problems and make government programs work better. She is retiring and will be the board chair of the New York City Health and Hospitals Corporation.