Exploring the Connections

What Would Jesus Insure?

by Lindsay Beyerstein
The Media Consortium, April 22, 2010

Religious right-watcher Sarah Posner reports on so-called Christian health care-sharing ministries in the American Prospect. Health-sharing ministries (HCSM) bill themselves as godly alternatives to health insurance. HCSM are groups of Christians who promise to cover each other's heath care costs. About a hundred thousand people nationwide belong to these collectives. The Alliance of Health Care Sharing Ministries and its army of lobbyists convinced Senate lawmakers to exempt HCSMs from health care reform's individual mandate.

Obliterating Patient Privacy

According to Posner, anti-reform conservatives are talking up these groups because they see them as a way to undermine the individual mandate. But if you think HCSM are a convenient loophole to avoid paying for insurance, think again. Posner describes the criteria for joining Samaritan Ministries International (SMI), one of the largest HCSM:

To join the HCSM, applicants must agree to a statement of faith that they are a "professing Christian, according to biblical principles" set out in Romans 10:9-10 and John 3:3. They must agree to adhere to guidelines that include no sex outside of "traditional Biblical marriage," no smoking or drugs, and mandatory church attendance.

SMI members pay their own health care costs out of pocket and seek reimbursement from the group. What about privacy? In order to get reimbursed, they have to publish their health care "needs" in a monthly newsletter and hope someone sends cash. Lifetime benefits are capped at $100,000. Members waive their right to sue for any reason. SMI won't cover treatment for sexually transmitted diseases, addictions, or the pregnancies of single mothers.

It doesn't take a genius to see that this free-for-all won't end well. You can't just start a quasi-health insurance scheme in your garden shed and expect it to work out. Real insurance companies are subject to oversight to make sure that they have enough money on hand to cover their claims. Who knows what HSCM are doing with people's money? These outfits have all the disadvantages of private insurers and none of the benefits. Members are a single major illness away from bankruptcy.

Bartering for Health Care?

Speaking of wacky alternatives to health insurance, Sen. Harry Reid's (D-NV) main Republican challenger, Sue Lowden, insists that patients can pay for their health care via a barter system, as Rachel Slajda reports for TPMDC. Great! How many chickens for an appendectomy?

Medicare Expansion Doesn't Equal Bankruptcy

At Mother Jones, Kevin Drum debunks the latest right-wing myth about health care reform, that Medicare expansion will bankrupt the states. States pay part of the cost of Medicare, so it's true that any expansion of the program will cost the states some money. However, the talking point is that the expansion will push state budgets to the breaking point. That's false.

Drum explains that the health care reform bill exempts states from the extra cost until 2016. Even after that, the costs to the states will be minimal:

[Health care reform] won't cost states an extra dime through 2016, by which time our recession will presumably be over, and even after that states will only pay for a tiny fraction of the increased costs. As CBPP points out, states will pay about 4% of the total costs of Medicaid expansion over the next ten years. This represents an increase in overall state Medicaid spending of slightly over 1%.

Abortion and "Convenience"

Jessica Valenti of Feministing has been taking on manipulative, anti-choice ads in the New York City subway. These ads are sponsored by an anti-abortion group. They feature various distraught-looking models staring wistfully into space. The tagline is "Abortion Changes You." The message is that if you have an abortion, you will be a guilt-racked wreck for the rest of your life. Some feminist with a wry sense of humor and a little glue pasted in another sentence on the ad (pictured above): "Now I can go to college and fulfill my dreams."

Anti-choice blogger Lori Ziganto was scandalized by the anonymous culture jammer's message. She sneered at the idea that women's lives and hopes actually matter: "Want to go to college, but there is a pesky baby growing inside of you? Abort! A life is far less important than your co-ed fun and career plans, right?"

Valenti's response: "It isn't that anti-choicers don't understand why women get abortions – it's that they care so little about women's lives that any reason given to obtain an abortion is seen as "convenient." Some things that are convenient: Providing for your existing children. Going to college. Having enough money to eat, pay rent, keep the electricity on. Not dying."

HSCMs and the subway ads are part of an enormous rift in contemporary politics: Opponents of health care reform say that they're defending freedom, but in reality, they're advocating control.

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Washington prayer vigil rallies Senate support for affordable heath-care reform

by Lynette Wilson

Episcopal Life Online, November 19,2009

[Episcopal News Service] Shortly before Senate Majority Leader Harry Reid held a press conference Nov. 19 to celebrate the long-awaited health reform legislation unveiled Nov. 18, pastors and lay leaders from states with senators whose votes are seen as crucial to the outcome of reform gathered outside the Capitol Building to pray for continued progress on legislation to extend affordable coverage to families.

"Today we mark another key moment in this historic debate for families," said the Rev. Claudia Hollinger, a deacon at St. Jude's Episcopal Church and clergy leader with Flint Area Congregations Together in Flint, Michigan. "The legislation that Senator Reid announced would extend coverage to 31 million, ban insurance companies from denying coverage based on pre-existing conditions, and help small businesses deal with rising health care costs, all while reducing the deficit by $127 billion. The bill is not perfect and we still have work to do to make coverage affordable to all families, but it is an important step forward."

In addition to the prayer event, which was sponsored by PICO National Network and Faith in Public Life, the clergy and lay leaders who traveled to D.C. from Louisiana, Nebraska, Colorado, Michigan, New York and Vermont were scheduled to meet with their senators' offices.

Susan Reid, of Christ Episcopal Church in Montpelier, and a member of Vermont Interfaith Action, made her second trip to D.C. on behalf of health-care reform for the Nov. 19 prayer vigil and Senate office visits.

"I ended up working with my local parish on health care issues," she said in a telephone call following Reid's press conference. "The stories that people have told us compelled me to come down to D.C. to make sure people get the health care they need."

Through her work with Vermont Interfaith Action and PICO, Reid has encountered many people who have lost not only their jobs, but their heath care, she said.

"I feel hopeful," Reid said, when asked what she thought of Reid's plan. "The legislation may not be perfect, but it's a step toward helping families to not live in fear."

As of Nov. 18, Senate Democratic leaders were "trying frantically" to secure some of the 60 votes needed to begin debate on the legislation, according to news reports. The House passed its version of the health care bill earlier this month.

Over the coming weeks, PICO National Network, Catholics in Alliance for the Common Good, Interfaith Worker Justice, Catholics United and other faith allies will be holding religious leader conference calls and meetings with Senator Mary Landrieu of Louisiana, Senator Kent Conrad and Senator Byron Dorgan of North Dakota and Senator Ben Nelson of Nebraska's chief of staff, urging them to support reform and highlighting the devastating impact on families in their states if reform fails to pass.

The Episcopal Church has passed resolutions on numerous occasions stating that all people should have access to quality affordable health care. Most recently, July's General Convention passed several health care-related resolutions (C071, D048 and D088) in support of universal access to quality and affordable health care in the United States and called on Congress to pass comprehensive health-care reform this year.

In September, seven Episcopal bishops, working together as "Bishops Working for a Just World," made their annual trip to Washington, D.C., to lobby Congress on health care and immigration reform, as well as stricter environmental protection.

The Episcopal Public Policy Network has issued appeals urging church members to contact their elected officials in support of health care reform.

"All year long, people in thousands of faith communities across America have been praying hard for reform that helps them deal with the rising cost of health care," said the Rev. Frederick McCullough, pastor of St. John AME in Omaha, Nebraska. "They've been praying that our leaders in Washington put aside partisan politics and work together to make health care more affordable for their families."
 
The Rev. Erik Karas, pastor of Faith Lutheran Church and a member of PICO Colorado in Eaton, Colorado, summed up the event by saying, "Next week, when many in America will gather to give thanks for all that we are blessed with, we pray that we will also be able to give thanks for the courage, the wisdom and compassion exhibited by our leaders in Washington at this crucial moment in our country's history."

-- Lynette Wilson is interim editor of Episcopal Life.

Race still matters

Editor's Desk, The Christian Century
October 20, 2009

Was former president Jimmy Carter identifying the elephant in the room or seeing a phantom when he charged that much of the opposition to President Obama's health-care reform is motivated by racism? Whatever the wisdom of Carter's comments, Obama himself has refused to be drawn into the debate. Obama said he'd prefer to think that the election of a black man as president is the true measure of where the country stands on race.

Besides, Obama said, any president's effort to make significant political changes, especially during an economic crisis, will spark strenuous resistance. Franklin Roosevelt, for example, was labeled a communist when he introduced his New Deal legislation.

It is a sign of some social progress that Obama's critics are quick to vehemently deny being racists. Racism of a blatant kind is now impolitic. However, researchers Marc J. Hetherington and Jonathan D. Weiler have evidence that Carter is on to something. They analyzed a late 2008 survey that asked people if they favored a government-run health-care system, a system like the one we have now, or something in between. The same survey also asked four questions on race designed to measure racial resentment. The findings revealed a strong correlation between racial resentment and opposition to health-care reform. They say that no such correlation existed in the 1990s when the Clinton administration was making a similar effort at health-care reform.

Even more troubling are reports from the Southern Poverty Law Center on the resurgence of antigovernment militias, white supremacist groups and nativist vigilantes. One law enforcement agency has identified 50 new militia-training groups (one of them consists of former soldiers and police officers). The Internet has given these groups a new tool for promoting their cause. Videos of militia training events can be viewed on YouTube.

These far-right extremists were a threat in the 1990s, but they had faded away in recent years. Now they are back with a vengeance, perhaps because their primary target of hate—the federal government—is headed by a black man.

President Obama is wise to stick to the issues and to invite vigorous, civil debate on his proposals. But others have the responsibility to challenge racism when it surfaces. That means challenging Rush Limbaugh when he blames Obama for an incident in which black kids beat up a white kid on a school bus in Illinois—saying that this is what happens "in Obama's America." It means speaking out against those who fly the Confederate flag at antigovernment "tea party" rallies.

In the 1960s William F. Buckley Jr. helped the conservative movement become part of mainstream politics when he demanded that its leaders condemn the radical antigovernment organization known as the John Birch Society. A similar courage is needed on the part of conservatives, and others, to ostracize the racist elements of political life.

Stricter Conflict-of-Interest Guidelines Proposed for all Professional Medical Associations

by Deborah Brauser
Medscape Medical News

April 6, 2009 —Current guidelines on conflicts of interest between industry and professional medical associations (PMAs) should be updated with stronger recommendations and adopted by all PMAs, according to an article published in the April 1 issue of the Journal of the American Medical Association.

"PMAs play an essential role in defining and advancing health care standards," write David J. Rothman, PhD, president of the Institute on Medicine as a Profession and Bernard Schoenberg Professor of Social Medicine at the College of Physicians and Surgeons at Columbia University, New York City, and colleagues. "Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflicts of interests."

However, the authors write, the current PMA policies are not uniform and "lack stringency." The authors have identified several conflict-of-interest areas and have suggestions for new short- and long-term guidelines to address them. "The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps to forgo valuable activities. To maintain integrity, sacrifice may be required."

10 Recommended Guidelines

The 10 recommended guidelines cover general budget support from industry, national and regional conventions, industry funds for research by PMAs and members, industry funds for fellowships and training programs, guidelines committees, industry support of PMA publications, product endorsements, affiliated foundations, conflicts of interest for PMA presidents and board members, and guidance for PMA members.

In the area of industry support, the authors recommend working toward a complete ban on pharmaceutical and medical device funding, except for the income that comes from journal advertising and exhibit hall fees. "How can the public and the profession be certain that a PMA dependent on industry for support is being faithful to its mission of conducting educational programs and setting practice guidelines that reflect only the best scientific knowledge?" write the authors. "Such a dependency inevitably creates the perception and reality of conflicts of interest and jeopardizes public trust."

Recognizing that the goal of $0 will not be quickly attainable, Dr. Rothman and colleagues recommend an interim policy of working toward restricting support to no more than 25% of the PMA's operating budget.

For conferences and annual meetings, the recommendations include establishing additional safeguards for industry sponsorship of conference programs, having strict conflict-of-interest standards for program committee members, keeping exhibit hall space separate from scientific and educational areas, and discontinuing the practice of allowing branded items and other gifts to be distributed to members.

"Physicians ought not to be billboards for industry," said Dr. Rothman in an interview with Medscape Medical News. "Industry gives small gifts because they think that they have impact on physician decision-making. They're in the marketing business, and the reason why they give these gifts is that they want their name prominent in your world."

For PMA publications, the authors write that revenue from industry advertising can be acceptable as long as it is clearly identified as such, and that it should possibly be kept separate from scientific and educational content.

Strictest Recommendation: Boards Should Be Conflict-Free

One of the strictest recommendations is that an organization's president, officers, and board of trustees should all be conflict-free during their tenures, and not just disclose their conflicts. "The reputation of a PMA is often based on the quality and integrity of its leaders," write the authors. "They speak for the organization and are most visible to the public and the profession. Therefore, it is essential that [they] be held to the highest standards in avoiding conflicts of interest."

They explain that this means that no personal income and no research support should be derived from industry for a 2-year period before the president, officers, and board of trustees officially take office and through the duration of their tenure. "This may require would-be office holders to delay assuming the leadership position until an already existing and multi-year grant expires," explain the authors. In addition, they recommend that all PMA executives and staff should be prohibited from accepting any gifts or favors, including travel.

Overall, "These proposals are likely to generate controversy and claims that they are too restrictive," the authors conclude. However, "These changes are in the best interest of the PMAs, the profession, their members, and the larger society. [PMAs] have such an important role to play in speaking for medicine, defining best practices, and promoting evidence-based decision making that they cannot allow relationships with industry to diminish the public's trust."

Dr. Rothman told Medscape Medical News that any medical association that issues practice guidelines should follow these recommendations. "This is not going to be a cake walk to go down to 25% of your funding and then to zero, and we don't expect it to happen overnight. But the first critical point is that [PMAs] have got to begin disentangling themselves from industry. Not because industry is a demon or bad, but because inevitably the marketing interests of industry can have a negative impact on the work that PMAs have to do. Our 2 main stands and what we're looking at are integrity in medical decision-making and public trust."

General Agreement With Recommendations

The current president of the American Academy of Family Physicians, Ted Epperly, MD, FAAFP, program director and chief executive officer of the Family Medicine Residency of Idaho, in Boise, told Medscape Medical News that overall, there are several good points in the article. "It's certainly a well-thought-out, well-written article that tackles a very important issue. And I think we can all certainly agree that we want to ensure for the good of the American public that there is transparency and openness in regard to how the profession of the pharmaceutical industry and the device manufacturers, etc, interface with the profession of medicine." Dr. Epperly and the AAFP were not involved with the designing the recommendations.

He agreed that separating journal advertising and marketing exhibits at conventions makes sense, as does stopping the giveaways. "There shouldn't be confusion of what's marketing and what's education. And we have actually made the correction at our meetings so that posters have been taken away from the promotional areas. As for the free items, it's a perception issue. Doctors don't need pens or tote bags with logos on them. I would agree that those ought to go."

Dr. Epperly also said he agrees that officers and committee members should not have any conflicts. "I have no problem with that, and I'm happy to say that I have been conflict-free. It's very important for someone in my position to not be taking any pharmaceutical or device money or any other money, quite frankly, while representing my academy and our members. I don't think it's asking too much for that to be the general direction everyone moves towards." However, he said that there may be room on boards for those who disclose stock information as long as they recuse themselves from any discussions or decisions having to do with a particular conflict.

As for industry funding, Dr. Epperly said, "I can't speak for other associations, but our academy is well below 25%. So I'm glad we're already in compliance with that number. And I know that we will continue to ratchet that down to be as small an amount as we possibly can."

Zero Funding Goes "Too Far"

However, he does not agree with the recommendation of working toward zero funding. "Quite honestly, to say that you can never collaborate in any way in which money exchanges hands for [continuing medical education] programming or things like that — ie, the zero that they want to get to — I think has gone a bit too far. It takes the potential for management of this interface between the 2 professions totally off the table. It just says that that won't be done. And I'm not quite sure that the academy agrees with that stance. The issue for us is that we believe that this can be managed. And we would not agree that commercial support is inherently negative and that it intrinsically creates conflict of interest."

Dr. Epperly continued, "I think it's okay to take pharmaceutical money as long as there are policies and procedures on how that's done and standards that are followed in how that money is utilized. For example, that the pharmaceutical companies can't direct who the speaker is, or the content has to pass through a program director who has to make those decisions following guidelines and standards.

"If the money was appropriately managed, I don't see it as a conflict of interest," Dr. Epperly said. "I see that as something being done to try to educate professionals for the patient's good in an appropriate way that is disclosed and monitored. I just think it's important to find the right balance, and anything that's too extreme on either end is probably not the right answer."

In addition to Dr. Rothman, the article's authors included physicians in leadership positions at the Council of Medical Specialty Societies, the American Medical Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Cardiology, the American Psychiatric Association, and the American College of Physicians. These authors participated as individuals and not as representatives of their organizations.

The work for the article was funded by the Pew Charitable Trusts. The authors and Dr. Epperly have disclosed no relevant financial relationships.

Deborah Brauser is a freelance writer for Medscape.

A public stigma with a high, hurtful price

Perceptions about mental illness do not match the reality.

Charlotte Observer, April 10, 2009

Here's a point missed in the anxiety over a frightening spurt of mass gun violence: Statistics show the majority of people who are mentally ill do not commit violence, and that the majority of people who commit violent crimes are not mentally ill.

Yet mental illness comes with a stigma in our culture that is costly, unhealthy and wrong. The perception of its victims as wackos or weak-spirited needs to change.

One in four adults will experience a serious mental disturbance in his or her lifetime. That's how pervasive mental illness is in the United States and in North Carolina, according to the National Mental Health Association.

Yet don't expect to see ready evidence of that statistic. Mass shootings by gunmen in North Carolina, Alabama and Binghamton, N.Y. show easy access to high-powered weapons and emotional instability can be a deadly mix. Yet those tragedies have also blurred understanding of an already misunderstood disease.

Think about it: One in four people suffer a disease such as depression or bipolar disorder. Chances are, that means a valued friend, neighbor or co-worker are among them.

Yet most people don't understand mental illness. Many are afraid of it. Many others just blame the person who is sick.

Those attitudes have consequences. Here are tangible ones:

• Funding for mental health ranks near the bottom in North Carolina's legislative priorities. Case in point: Key reforms enacted in 2001 were poorly thought-out and failed sick patients miserably. They focused more on saving money and shifting responsibility than on providing the safety net a vulnerable group needs.
• Insurance coverage for mental illness, despite the so-called mental health Parity Act, is skimpy compared to other coverage.

Wrong-headed attitudes make it hard for many who suffer mental illnesses to get the help they need until there's a crisis. It also gives politicians a ready excuse not to pay for strong public mental health resources.

Here's the irony: Treatment for most mental illnesses is effective when appropriately used. The NHA reports the success rate for treating clinical depression, for example, is 80 percent.

Yet when mental illness goes untreated, the price is high. The NMHA estimates the total yearly cost for mental illness in both the private and public sectors in the United States is $205 billion – but only $92 billion represents direct treatment cost. The rest is lost work hours and indirect costs.

Who gets hurt by letting a stigma persist unchallenged? Our friends, neighbors and co-workers who suffer, mostly in silence. And the rest of us, who pay.

When Don’t Smoke Means Do

New York Times, Editorial, November 27, 2006

Philip Morris has adopted the role of good citizen these days. Its Web site brims with information on the dangers of smoking, and it has mounted a campaign of television spots that urge parents, oh so earnestly, to warn their children against smoking. That follows an earlier $100 million campaign warning young people to “Think. Don’t Smoke,” analogous to the “just say no” admonitions against drugs.

All this seems to fly against the economic interests of the company, which presumably depends on a continuing crop of new smokers to replace those who drop out or die from their habit. But in practice, it turns out, these industry-run campaigns are notably ineffective and possibly even a sham. New research shows that the ads aimed at youths had no discernible effect in discouraging smoking and that the ads currently aimed at parents may be counterproductive.

That disturbing insight comes from a study just published in The American Journal of Public Health by respected academic researchers who were supported by the National Cancer Institute, the National Institute on Drug Abuse and the Robert Wood Johnson Foundation. Using sophisticated analytical techniques, the researchers concluded that the ads aimed directly at young people had no beneficial effect, while those aimed at parents were actually harmful to young people apt to see them, especially older teenagers. The greater the teenagers’ potential exposure to the ads, the stronger their intention to smoke and the greater their likelihood of having smoked in the past 30 days.

Just why the costly advertising campaigns produce no health benefits is a rich subject for exploration. The ads are fuzzy-warm, which could actually generate favorable feelings for the tobacco industry and, by extension, its products. And their theme — that adults should tell young people not to smoke mostly because they are young people — is exactly the sort of message that would make many teenagers feel like lighting up. (Trial testimony has made it clear that the goal of Philip Morris’s youth smoking prevention programs is to delay smoking until adulthood, not to discourage it for a lifetime.)

The most exhaustive judicial analysis of the industry’s tactics, by Judge Gladys Kessler of the Federal District Court for the District of Columbia, concluded that the youth smoking prevention programs were not really designed to effectively prevent youth smoking but rather to head off a government crackdown. They are minimally financed compared with the vast sums spent on cigarette marketing and promotion; they are understaffed and run by people with no expertise; and they ignore the strategies that have proved effective in preventing adolescent smoking. The television ads, for example, do not stress the deadly and addictive impacts of smoking, an emphasis that has been shown to work in other antitobacco campaigns.

Philip Morris says it has spent more than $1 billion on its youth smoking prevention programs since 1998 and that it devised its current advertising campaign on the advice of experts who deem parental influence extremely important. But the company has done only the skimpiest research on how the campaign is working. It cites June 2006 data indicating that 37 percent of parents with children age 10 to 17 were both aware of its ads and spoke to their children about not smoking. How the children reacted has not been explored. And somehow the company forgot to tell the parents, as role models, to stop smoking themselves.

Philip Morris, the industry’s biggest and most influential company, is renowned for its marketing savvy. If it really wanted to prevent youth smoking — and cut off new recruits to its death-dealing products — it could surely mount a more effective campaign to do so.