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President Obama has just signed a historic piece of legislation that will bring near-universal healthcare coverage to our country within the next few years. It’s most important achievement will be to cover 32 million people are currently uninsured. In her speech before the House’s vote on the bill, Speaker Nancy Pelosi reminded her colleagues of a letter to President Obama that Senator Edward Kennedy wrote before he died:

Senator Kennedy wrote that: ‘Access to health care is the great unfinished business of our society.’  That is, until today.

This legislation doesn’t reform our healthcare system, but it corrects some of the most shameful aspects of it. It creates important mechanisms to make insurance affordable and start controlling cost growth. The bill has plenty of shortcomings, but so did Medicare and Social Security when they were first created. Those two programs have since been improved, and today they allow millions of people to stay healthy, active, and engaged in society.

In a speech to House Democrats before their historic vote on the bill, President Obama gave a useful summary of what this legislation will (and won’t) do and which changes will take effect this year:

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Healthreform.gov has compiled examples of some insurers hiking their premiums by scary amounts (footnotes omitted):

Anthem Blue Cross of California announced that its individual market premiums would rise by as much as 39 percent in the coming months. … Anthem of Connecticut requested an increase of 24 percent last year, which was rejected by the state. Anthem in Maine had an 18.5-percent premium increase rejected by the state last year as being “excessive and unfairly discriminatory” – but is now requesting a 23-percent increase this year.

In 2009, Blue Cross/Blue Shield of Michigan requested approval for premium increases of 56 percent for plans sold on the individual market. Regency Blue Cross Blue Shield of Oregon requested a 20-percent premium increase…. And rates for some individual health plans in Washington increased by up to 40 percent until Washington State imposed stiffer premium regulations.

The Anthem California story seems like it may be headed towards a happy ending – but not because we have a policy in place to prevent huge premium increases.

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The New York Times has translated President Obama’s 2011 budget into an interactive graphic that shows at a glance where our money’s going. With totals of $738 billion each, National Defense and Social Security account for one-third of the block. Medicare ($498 billion) and Income Security ($560 billion) dominate the middle section.

Color-coding identifies areas where spending is projected to either rise or fall. A projected drop in income security programs (unemployment, food stamps, etc) and grants to state Medicaid program suggests that the administration expects that the need for such programs will drop as the economy improves, and/or Congress won’t approve another stimulus package with additional funding for these benefits.

Perhaps the most important lesson from this graphic comes when you click on the “Hide Mandatory Spending” button.

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In a historic achievement, 60 Senators have agreed to a healthcare bill that will dramatically expand health insurance coverage and curb some of the insurance industry’s worst practices. Getting agreement between the Senate and the House, which has passed its own healthcare bill, will still be an arduous process, but the chambers agree on most essential elements, and this is the farthest Congress has come in decades towards fixing our healthcare system’s serious problems. (If you want to compare the House and Senate bills, the Kaiser Family Foundation has a handy comparison tool.)

Here’s a quick summary of what the Senate bill does and why it’s worth passing:

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The American Public Health Association (APHA) sent a letter to President Obama urging support from the White House on CDC guidelines on N95 respiratory protection for healthcare workers from the H1N1 virus.   APHA OHS Section members learned last week that three organizations—Society for Healthcare Epidemiology of America (SHEA), Infectious Disease Society of American (IDSA), Association of Professionals in Infection Control and Epidemiology (APIC)—-asked President Obama to intervene in federal OSH policy, specifically to:

  • modify the federal PPE guidance to allow the use of surgical masks (instead of N95′s) for routine H1N1 patient care; and
  • institute an immediate moratorium on the enforcement of OSHA’s requirements for healthcare facilities related to the use of N95 respirators in relation to H1N1 influenza.         

APHA politely rebutted these ideas:

“We support the efforts of public health agencies such as HHS, CDC, NIOSH, DOL and OSHA to engage the National Academy of Sciences’ institute of Medicine to full examine the evidence that has lead to sound federal public health policy.  Thank you for your support for sensible, evidence based policies for protecting healthcare workers and the public.”    

The APHA letter was signed by the organization’s executive director, Georges Benjamin, MD, FACP, and Kate McPhaul, PhD, RN, chair of the APHA OHS Section.

It’s time for me to boast about the most amazing assembly of worker H&S researchers and activists: the OHS Section of the American Public Health Association.   We closed out our 95th year with the association adopting three progressive policy resolutions and electing Linda Rae Murray, MD, MPH as the next APHA president. 

First, CONGRATULATIONS! to the OHS Section’s own Linda Rae Murray who is a 30-year member of APHA—-the largest and most diverse public health organization in the world.  Dr. Murray is the chief medical officer for the Cook County (IL) Dept of Public Health, a general internist who practices at a south side Chicago community health center, and on the faculty at the Univ of Illinois Chicago in the Dept of Occupational and Environmental Health.

Linda Rae’s platform resonates with many of us in the OHS community: 

“If  we are going to make progress toward a healthy nation we have to overcome those issues which divide us: issues of racism, immigrant rights, gender discrimination and workers’ rights.  It is only through unity that we will have the strength to make the changes our country needs.”

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As is always the case at APHA, there are far too many fascinating presentations for one person to see – so I hope those of you who are also here in Philly will add comments about some of the sessions you’re attending and what you’re learning. Yesterday, I attended a session on health and safety in healthcare, which brought up some populations and scenarios that are too easily overlooked when discussing healthcare workers’ health and safety:

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High-profile issues like the public option and cost containment have been getting a lot of attention in the discussion about healthcare legislation, but there are less-noticed issues that are also important. Today, the Union of Concerned Scientists draws attention to the need to ensure the scientific integrity of the advisory committees that will be established to help federal agencies implement new healthcare laws.

In a letter signed by 20 organizations, UCS calls on the chairs of Congressional committees to require that advisory panels created by the new healthcare legislation actively seek out members without conflicts of interests, require disclosure of members’ names and backgrounds, and require that all information about each advisory panel, including a full audio or video record of each panel meeting, be accessible online.

Here’s the full text of the letter and the list of signatories:

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The CDC has designated this week as “Get Smart About Antibiotics Week,” and is encouraging state health departments and other groups to raise awareness about the appropriate use of antibiotics. As cold season begins, CDC reminds us that antibiotics don’t cure viral infections – and using antibiotics inappropriately contributes to the evolution of antimicrobial-resistant pathogens. The campaign targets parents, healthcare providers, and pharmacists with information about when antibiotic use is and is not appropriate. 

The New York Times’ Anahad O’Connor (whether intentionally or not) has done a big service to this campaign by telling readers that green nasal discharge doesn’t necessarily indicate a bacterial infection that would improve with antibiotics. The article highlights a study that randomly assigned children with green nasal discharge to receive an antibiotic or a placebo, and found the groups’ outcomes to be similar.  

While this particular CDC campaign focuses on the use of antibiotics for human illness, the agency also has a “Get Smart on the Farm” program promoting the appropriate use of antibiotics in livestock. Large-scale livestock producers often dose their herds routinely with antibiotics to promote growth, instead of reserving the drugs for actual cases of illness. Since many of the antibiotics they use are the same as or similar to the ones we use for human infections, livestock producers’ practices also affect humans’ ability to recover quickly and safely from infections. (Visit the Union of Concerned Scientists’ website for more on the problem and where U.S. policy stands.)  

In short, neither sneezing green snot nor raising a herd of animals automatically calls for antibiotics. We should all use antibiotics judiciously so they’ll work when we really need them.

Members of the Institute of Medicine’s (IOM) committee on respiratory protection for healthcare workers against novel H1N1 Influenza A write for the mainstream in this week’s New England Journal of Medicine. The two-page article is a fast read, with their bottom line recommendation to clinicians:

 “…reach for the N95 respirator [not a standard surgical mask] when confronting patients with influenza-like illnesses, particularly in enclosed spaces.”  

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