NY considers Medicaid for transgender surgery

Letter to the Editor


San Francisco Chronicle
901 Mission St.
San Francisco, CA 94103
(415) 777-1111

September 30, 2011

Dear Editor:


Yesterday, you reported that New York is considering Medicaid for transgender surgery and therapy treatment which would cover various expenses for an already at risk population. I am ecstatic to hear such news because the needs LGBT community are often neglected, especially for low-income individuals that fall into this community.

Yet, there are still concerns that I have as an advocate for the health of the LGBT community. First, statistics on transgender population is typically limited or non-existent, not just in New York. In order to fully address disparities, we must know what our population looks like and what needs are demanded. Thus, I think it is pivotal to strengthen the efforts in collecting data to further reduce disparities for the overall LGBT community. In California, where hormone therapy and surgery are already offered to Medicaid patients, the Transgender Law Center offers great models of data collection for transgender communities.

Secondly, if and when this proposal passes, I would also like to see cultural sensitivity programs developed for physicians who are treating transgender individuals. Great stigma and misunderstandings about the transgender community still exists and physicians should be aware of how to meet the needs of this population. In other words, quality of care must be prioritize and also assessed periodically.

In brief, offering services is one part of the equation, but the other part is ensuring that we are sustaining these services and maintaining top-notch quality of care.


Sincerely,

Marwin Yeung

ARTICLE --> CLICK HERE

Health Insurers Push Premiums Sharply Higher

Letter to the Editor

New York Times

letters@nytimes.com

September 28^th, 2011

Dear editor,

The “Health Insurers Push Premiums Sharply Higher” (Abelston and Bernstein, Sept. 27^th) article was shocking given the nation’s increasing focus on universal healthcare. What was even more shocking was the comment made by the spokeswoman for Emblem, Ilene Margolin: “…I’m not saying this is pretty, but there were actuarially sound reasons.” Increasing health insurance premiums solely on the basis of actuarial calculations seems rather counterproductive and even inhumane given that the country’s economy is in recession and unemployment rates are soaring. It is stated that this increase will help insurance providers with the rebounding medical costs when the economy recovered. However, with medical care becoming increasingly unaffordable and companies hiring fewer people due to the cost of coverage, it seems that these high insurance premiums may become the cause of a worse recession.

Nevertheless, with the United States’ purely market based approach to health care, costs will continue to rise. Private insurances seem to be trapped in a quandary between maintaining affordable premiums and making a profit. That said it is time that the government stepped in an imposed policies that regulated health care costs like the health care system in Japan. This is a time when the country needs healthy and employed citizens to boost the economy and health insurances should not be an impediment to this need.

Sincerely,

Sivapratha Nagappan Chettiar

Original Article:

http://www.nytimes.com/2011/09/28/business/28insure.html?pagewanted=1&_r=1&ref=health

Two Boston hospitals mandating flu shots for workers

Letter to the Editor

The Boston Globe

P.O. Box 2378

Boston, MA 02107-2378

letter@globe.com

9/15/11

Dear Editor:

Yesterday, you ran an article called Two Boston hospitals mandating flu shots for workers. I support the mandates from both Public Health and Economics perspectives.

While Public Health experts cannot agree on a specific threshold of vaccination to achieve herd immunity, studies show that “70% of influenza infections in organ-transplanted patients and those with acute leukemia are [hospital acquired]” (Wicker, Sabine et al. 2009). Decreasing these infections through mandated immunization of hospital employees will decrease post-op complications and increase health outcomes.

From an Economics perspective, post-operation hospital acquired influenza has an opportunity cost of available beds and revenue generating services for new patients. For BIDMC, the opportunity cost easily outweighs the fixed cost of $180,000 needed to immunize 6000 employees assuming a total cost of $30 per employee.

To make an even bigger difference, this policy should be extended to all employees, contractors, and volunteers. This would protect patients from infection through touching contaminated surfaces like the flowers a nurse brings up from the gift shop volunteer. Ultimately, the mandatory policy is highly beneficial from a quality of care and a cost cutting perspective and I'm glad that it is being implemented.

Sincerely,

Diana Jin

ARTICLE: http://www.boston.com/news/local/massachusetts/articles/2011/09/14/two_boston_hospitals_mandating_flu_shots_for_workers/

Longevity Gene Debate Opens Trans-Atlantic Rift

My Letter to the Editor/Reaction to the piece:

Letter to the Editor

New York Times

letters@nytimes.com

September 22^nd, 2011

[ Dear Editor, ]

Challenging the effects of resveratrol on sirtuin is one debate; challenging whether this drug is worth the rise in health insurance premiums is another. As premiums begin to reflect longer life spans, I would advise more citizens transition from holding life insurance policies to investing in long term care or term policies. While these policies can protect citizens from their increased likelihood of getting an illness, they certainly don’t protect citizens from the inevitable change in a provider’s incentive, pay, and specialty. To play it one step further, if the drug were out on the market today, then is the United States prepared to care for the vulnerable or at least willing to seek preventative measures? The promising longevity gene offers many reasons for citizens to celebrate, but I can’t begin to fathom how short-lived this celebration will be once risk assessment consultants go back to work.

[ Sincerely,

Suneeta Israni ]

In reference to “Longevity Gene Debate Opens Trans-Atlantic Rift” published on September 21, 2011 and authored by Nicholas Wade <http://www.nytimes.com/2011/09/22/science/22longevity.html?_r=1&ref=health>

“Million Young Adults Get Health Coverage under Law"

Letters to the Editor

San Francisco Chronicle

901 Mission St.

San Francisco, CA 94103

September 22, 2011

Dear Editor,
I greatly appreciated yesterday’s article “Million Young Adults Get Health Coverage under Law.” The fact that the number of insured young people has declined since the passage of Obama’s healthcare reform is evidence that the reforms are working and making an impact on people’s lives. As a 22-year-old student, I am very grateful that I will be able to stay on my parents’ insurance plan for another four years. Finding a job in this economy will be hard enough; I am not so naïve to think that I will be able to find a job offering healthcare quickly. While this provision of the healthcare reform is a great help to me and many other young Americans, there are still far too many who are uninsured – 49.9 million in 2010.1 What many people do not realize is that if more Americans had access to preventative care and treatment when they need it, we would be a more productive country with lower chronic disease costs. We must strenuously defend the Patient Protection and Affordable Care Act against those who wish to limit Americans’ access to healthcare and indeed continue pushing for further reforms to ensure the economic viability of our healthcare system.

Sincerely,

Mara Constantine

1 U.S. Department of Health and Human Services. Assistant Secretary for Planning and Evaluation. Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey. Sept. 2011. Web. 22 Sept. 2011.

(Here is the link to the article to which I am referring: http://articles.sfgate.com/2011-09-21/news/30183169_1_young-adults-health-insurance-adult-children)

NY Times-Letter to Editor

Letter to the editor

New York Times

letters@nytimes.com

September 19^th, 2011

Dear editor,

“A Mother’s War on Germs at Fast-food Play Lands” (Marc Lacey, Sept. 17^th), reports CDC spokeswoman Bernadette Burden saying, “the federal agency would get involved only if officials were concerned about a major disease breakout.” I disagree with this action and cannot believe that the CDC has not taken appropriate measures to address such unsanitary conditions. As a community member, it bothers me to know that children are exposing themselves to risks, when they should be enjoying a harmless activity. In addition, the NYU School of medicine tested 12 playgrounds in 4 major cities and found feces, salmonella, hepatitis A, and E.coli—all of which are harmful to a child [1]. Instead of waiting for a “major disease breakout” we should take preventive actions that avoid harm, such as a set of guidelines that enforce checking play areas regularly by health departments/sanitation agencies to ensure cleanliness.

Sincerely,

Paola Garcia

Website: http://www.nytimes.com/2011/09/18/us/a-mothers-war-on-germs-at-fast-food-playgrounds.html

[1]“Protect your child from playground germs”. Consumer Reports: Expert, Independent, and Nonprofit. Retrieved from: http://news.consumerreports.org/baby/2008/12/protect-your-ch.html on September 19th, 2011

Sample Letter to the Editor

Letters

Sunday Dialogue: Curing the Health System

Published: August 27, 2011

A letter on Wednesday urging a single-payer health plan, rather than individual mandates, set off an outpouring of reaction.

The Letter
To the Editor:
In “Will Health Care Reform Survive the Courts?” (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that “reforms would work far less well without an individual mandate” that requires citizens to buy health insurance or pay a penalty.
I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress’s power to mandate purchase of private products sold at a profit is disputable, but Congress’s power to tax is not.
Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don’t use mandates that allow insurers to charge different prices for different people.
These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.
There is no need to experiment with mandates. Convert our current health care system into a national health plan.

SAMUEL METZ
Portland, Ore., Aug. 21, 2011
The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.

 
Readers React
 
Dr. Metz is spot on with his advocacy of a single-payer plan instead of the individual mandate.
Sadly, despite the success of Medicare — a single-payer system that politicians tamper with at their peril — the “just say no” climate in Washington, fostered by Republicans who place ideology over country, took that option off the table and left us with an alternative that not only raises legal questions but also fails to address the real threat: the escalating costs of health care.
That said, the health care plan that the politicians have given us, which extends protection to millions of uninsured, is better than no plan at all.
After decades of talking about reform, we finally have a plan in place. With luck, a day will come when the political will for a single-payer system exists.
Until then, let’s do our best to make the plan we have work.
JAY N. FELDMAN
Port Washington, N.Y., Aug. 24, 2011


Dr. Metz is right that a single-payer system would be better than an individual mandate. But he does not mention that Medicare, although it is a single-payer, tax-supported system, still cannot control costs and will soon be bankrupt. A national health plan that controls costs needs to reform the way doctors are paid and are organized in practice.
This is how doctors, if they are really “mad as hell,” could help. They should join salaried multispecialty, not-for-profit group practices that can accept capitated prepayment for comprehensive care instead of fee for service, and can provide good, cost-effective care that supports primary-care doctors working in close collaboration with specialists.
ARNOLD S. RELMAN
Cambridge, Mass., Aug. 24, 2011
The writer, a physician, is professor emeritus of medicine and of social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.

 
Dr. Metz’s call for single-payer national health care imposes costs on taxpayers rather than directly on those being served. Patients are not charged more for services they value the most or are more costly to provide. Tax bills simply rise in sync with something else like income, property or sales.
It takes no leap of faith to understand how this will affect demand for health care. Anyone who has dined at a fixed-cost food buffet knows the outcome of not directing price with food portions.
It is tempting to believe that government will fairly and efficiently make these choices for us, but experience suggests otherwise. Dr. Metz appears to anticipate this problem given his suggestion that Congress’s power to tax is indisputable and so government will predictably raise taxes to pay for growing demand for health care.
MICHAEL L. MARLOW
San Luis Obispo, Calif., Aug. 25, 2011
The writer is a professor of economics at California Polytechnic State University, San Luis Obispo.