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SERIES: Healthcare in America #41, Marc Lavietes, MD, This Is the Bronx

by Dr. Marc Lavietes,  May 20, 2019

Life-enhancing Medical Devices

When my patient, Mr. B.W., told me his breathing-assistance machine had failed, you might (rationally) assume that replacing the life-enhancing medical device he’d been prescribed five years ago would be straightforward: it’s just a replacement machine, after all. You’d be wrong: the process of getting him a working machine has been fraught with multiple, almost insurmountable administrative obstacles. After six months, he still does not have it. This is his story — and the story of so many others.

Mr. B.W’s situation is hardly unique. I find myself spending as much time navigating an unrelenting and confounding insurance-payments maze to get my patients the treatments I prescribe as I spend with patients. Unlike patients with other chronic disorders, the patients I see rely on medical devices—necessary for them to live normal lives. But these devices are often not on the formulary of insurance policies, so I spend hours of every workday explaining medical necessity to insurance employees, most with no medical training, many who have their pay tied to their denying benefits.

For my entire professional career, I have been on the faculty in the pulmonary/critical care division, located in an area similar to the South Bronx, where asthma rates caused by pollution are among the highest in the nation….

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ARTICLE: Citizens' group presents forum on universal health care, Finger Lakes Times

May 17, 2019

This current legislation would provide universal health care coverage for all NY state residents based upon ability to pay. If enacted, this “Medicare for All” type coverage would affect all NY state residents. Her presentation includes explanations of what the NY Health Care Act is and is not, the extent of coverage, and how the cost would impact all residents in the state. It is important for all state residents to become familiar with this legislation which has passed the Assembly the last four years with a 2 to 1 margin for the past two years.

In 2018 nearly 50 percent of the state’s Senators endorsed the bill, only needing one more vote to come out of the Health Committee and go to a floor vote. With Senate passage, the bill would then go to the Governor’s desk for signing....

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LETTER: Health care for all would cut costs, George Simonson, Portland Press Herald

By George Simonson, May 16, 2019

Workers currently spend close to 40% of their incomes on health care in return for relatively poor outcomes.

A Maine legislative committee recently began considering eight innovative bills aiming at health care for all.

As a longtime Mainer originally from Connecticut and New York City, with family in Germany and clients around the world, I’ve given a lot of thought to how “people from away” take care of themselves. They do a better job than we do.

It’s about time for Maine – and America – finally to start giving serious thought to universal health care.

Some conservatives like to say, “Oh, we can’t have that. It’s too expensive, and nobody wants to pay high taxes like the Europeans do.” But in reality, the vast majority of Maine employees already have private health insurance premiums automatically deducted from their paychecks….

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SERIES: Healthcare in America #40, Barbara Baskind, This Is the Bronx

by Barbara Baskind,  May 13, 2019

Unsettling: Losing Your Health And Your Insurance

What happens when you are comfortably settled in the best possible situation for your illness and find out that your employer-based insurance suddenly stops covering you? What happens when you are told—after the fact—that the course of treatment prescribed for you will end in a matter of days? That’s my story. Let me begin at the beginning: a story that opens in a series of happy mid-life events. 

My friends always said I was the one who had it all. I was happily married to Jerry, the love of my life….

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SERIES: Healthcare in America #39, Daniel Lugassy, MD, This Is the Bronx

by Daniel Lugassy, MD, May 4, 2019

BOUNCE-BACKS: AVOIDABLE CATASTROPHES

Take two of these, and call me in the morning. But only if you can afford them.

I am an Emergency Medicine doctor. I care for anything and everything that’s ailing you; from a life-threatening chest stabbing to a nasty tiny splinter on the bottom of your foot. It may surprise you, but I find treating these conditions equally exhilarating. I love diagnosing and treating patients who often struggle to describe the unexpected or sudden. Nobody makes an appointment to come to the Emergency Department (ED). We are here 24/7/365, whenever you need us.

When someone returns we often call this a “bounce-back”; it triggers us to dig deeper and ask; did we miss something or did a complication of the initial presenting condition develop. But, frustratingly and all too often, the reason for the patient “bouncing back” with an emergent condition seem to be completely preventable. Most of my patients are covered by some form of healthcare insurance. Sometimes I see them return to the ED because, as “good” as they believed their insurance to be, it wasn’t good enough. Here are three stories describing patients whose lives were endangered because financial obstacles prevented their getting prescribed care…

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SERIES: Healthcare in America #38, Julie Quest, This Is the Bronx

by Julie Quest, April 29, 2019

Profits And Patient Crises

As readers who have been following our healthcare stories might notice, there is a gap in our current system for patients with private insurance, and most others. When medications prescribed by doctors are not on the insurance “formulary,” patients must pay “out of pocket.” Recent studies report 73% of insured patients cut back on food or needed household items to pay for prescribed healthcare, almost half of insured patients have trouble paying out-of-pocket costs, and a quarter skip prescriptions because of cost.

Let us be clear: these are needed medications for acute or chronic conditions. When patients cannot afford them and don’t take them, many end up in a medical emergency, sometimes so dire their lives are threatened — as described in earlier stories, and in next week’s story, which focuses on the extortionate costs of generic drugs described below: patients with controllable ailments “bounced back” into emergency surgery and the ICU.

AREN’T PRESCRIPTION DRUGS SUBJECT TO MARKET FORCES?

Healthcare is often mistakenly described as a “market,” where industry profits and patient needs can co-exist — like markets for automobiles or cell phones — where competition between providers will lower costs and improve quality. But markets only operate this way when they are “efficient,” meaning that accurate, credible, reliable information about products and warranties exists. Healthcare, by its nature, isn’t like this. …

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RADIO: Capital Pressroom The NY Health Act, Tim Williams, WCNY

Interview by Tim Williams, with Dr. Roona Ray and Mahima Iyengar, May 3, 2019

With just over twenty schedule legislative days remaining, activists are continuing to push for passage of the New York Health Act. Dr. Roona Ray, a New York City family physician and Board Member of Physicians for a National Health Program of Metro New York, and Mahima Iyengar, a medical student at the University of Rochester School of Medicine and Dentistry and Co-President of Rochester’s chapter of Students for a National Health Program, explained why they are pushing for a Medicare for all program to come to New York.

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ARTICLE: What does universal healthcare mean for New Yorkers? Andrea Leonhardt, Brooklyn Reader

By Andrea Leonhardt, May 3, 2019

What Does Universal Health Care Mean for New Yorkers? Persaud Explains at East Bklyn Forum

The NY State Senate is currently mulling over a single-payer system that would eliminate co-pays and cover all New Yorkers

State Senator Roxanne J. Persaud hosted on Thursday a community forum to discuss how the New York Health Act, a proposed universal health care bill, would affect New Yorkers.

She was joined at the Jewish Community Council in Canarsie by fellow Senator Gustavo Rivera, sponsor of the NY Health Act, and a panel of health care professionals including Dr. Sandra R. Scott, Emergency Medicine physician at Brookdale Hospital; Dr. Donald Moore, a physician at New York Methodist Hospital;  Ari Moma, R.N , a member of The NYS Nurses Association; and Velda Jeffrey of labor union 1199SEIU.  

If passed, Senator Rivera’s bill would establish a single-payer-based, universal health care system in New York State where all citizens would receive comprehensive health care coverage, founded through an equitable new tax structure based on income....

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ARTICLE: Rally Pushes Support for New York Health Act, Andrew Freeman, Spectrum (Rochester)

By Andrew Freeman, May 1, 2019

A rally took place in downtown Rochester Wednesday to drive support for legislation that would create universal health care statewide.

  • Dozens of Rochesterians rally for statewide universal health care
  • Supporters shared their personal stories
  • Bill will be up in a public forum in two weeks

And those that attended shared their stories related to health care. Kristin Reisch’s now 10-year-old daughter Anna was born with several chronic health conditions, including three heart defects.

“My daughter spent the first several years of her life in and out of hospitals, racking up before she was 7 months old half a million dollars in medical debt,” Reisch said.

Luckily they had employer health insurance, though Reisch says that was a privilege she knows not everyone in the state has.

And that’s what brought her to Washington Square Park Wednesday, to rally in support of the New York Health Act — legislation that would create universal health care in the state.

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ARTICLE: What happened to NY’s plans for single-payer healthcare? Raina Lipsitz, The Nation

By Raina Lipsitz, May 2, 2019
The Albany machine is working to torpedo the New York Health Act—again.

New York’s Democratic voters sent a new class of true-blue legislators to Albany in 2018. With the governor’s office and both houses of the state legislature firmly under Democratic control—and a raft of progressive bills rapidly signed into law—many hoped this would be the year New York finally enacted single-payer health care.

Health care was, after all, a top concern of voters in 2018, and support for single-payer legislation is strong and growing. One 2018 article suggested that even those running in mixed districts got the message: “Democrats in Swing Districts Run on, Not From, Single-Payer Health Care.”

Yet recent reports indicate that the New York State Senate has no plans to vote on legislation this session, preferring to hold more hearings on a bill that has been proposed in the legislature since 1992….

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SERIES: Healthcare in America #38, Julie Quest, This Is the Bronx

This is part of an ongoing series in which Bronx writers share their personal stories on the state of healthcare in America.

By Julie Quest, April 29, 2019
Profits And Patient Crises

As readers who have been following our healthcare stories might notice, there is a gap in our current system for patients with private insurance, and most others. When medications prescribed by doctors are not on the insurance “formulary,” patients must pay “out of pocket.” Recent studies report 73% of insured patients cut back on food or needed household items to pay for prescribed healthcare, almost half of insured patients have trouble paying out-of-pocket costs, and a quarter skip prescriptions because of cost.

Let us be clear: these are needed medications for acute or chronic conditions. When patients cannot afford them and don’t take them, many end up in a medical emergency, sometimes so dire their lives are threatened — as described in earlier stories, and in next week’s story, which focuses on the extortionate costs of generic drugs described below: patients with controllable ailments “bounced back” into emergency surgery and the ICU.

Aren’t Prescription Drugs Subject to Market Forces?...

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ARTICLE: Bona’s hosting Len Rodberg talk on NYS single-payer healthcare, MDJ Online

April 27, 2019
BONAVENTURE, N.Y. — St. Bonaventure University is hosting a free public presentation Wednesday, by Dr. Leonard Rodberg on the economic costs and benefits of setting up a single-payer healthcare system for New York state.

The program is set for 7 p.m. in the Walsh Science Center Auditorium and will include time for questions from the audience.

Rodberg is professor of urban studies at Queens College/CUNY in New York City, where he has served on the faculty since 1981.

Rodberg has written and spoken extensively over the years about the American healthcare system, focusing most recently on the New York Health Act. His talk will address the most contentious issue surrounding the bill: its potential cost.

The New York Health Act has been approved by wide margins in the New York State Assembly for the last several years before stalling in the Republican-controlled State Senate. Now that the Democrats have a majority in the Senate, the bill has a stronger chance of being approved during the current legislative session.

If the bill passes, New York will become the first state in the nation to move toward implementation of a state single-payer system, making it a model for similar programs that could affect the entire nation.

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ARTICLE: Senate won't vote on single-payer before hearings, LaMantia, Crains Health Pulse

By Jonathan LaMantia, April 25, 2019

More than four months after Democrats assumed a majority in the state Senate, movement on a single-payer health system has been slow to materialize.

State Sen. Gustavo Rivera, chair of the Senate health committee, said Wednesday the committee would wait until hearings on the bill are held around the state before voting to advance it. Rivera hopes to schedule a joint hearing of the state Legislature on the topic before the end of the session in mid-June and said a schedule for the hearings would be announced "imminently."

"The Senate has never really looked at it deeply," Rivera said. "Some of my colleagues that are new have some serious concerns and questions to ask about it. I want to make sure we get through all of it. What we're trying to do here is to fundamentally restructure how health care is delivered in the state of New York. When we do it, we've got to do it right."

His comments came after speaking at a City & State event at Baruch College, which served as the latest venue for debate on the bill. Rivera and Assemblyman Richard Gottfried spoke in support of the New York Health Act. Eric Linzer, president and CEO of the state Health Plan Association, argued in opposition.

"While it's true that 95% of New Yorkers have some form of health coverage, millions of New Yorkers with health coverage either go without needed health care or suffer financial hardship in order to get it," Gottfried said during the event.

The bill would cover medical expenses and long-term care for all New Yorkers, including undocumented immigrants, with no requirement that residents pay premiums or co-pays. The current version, introduced in February, lacks a tax structure to fund the bill. Its sponsors have said taxes on earned income and non-payroll income, such as capital gains, would be progressive. Earned income below $25,000 would be exempt.

A Rand Corp. analysis conducted last year on an earlier version of the bill estimated its cost would be about $159 billion in 2022.

Linzer said the state should focus on other policies, such as improving outreach to people eligible for government insurance programs and expanding subsidies to buy insurance.

"The focus ought to be, how do we get to that 5%" who are still uninsured, Linzer said. He also warned of "significant cuts that would have to come in provider reimbursement rates."

Gottfried countered that the bill requires the state to pay providers fees tied to the cost of offering health care and maintaining an adequate supply of services.

In a national poll released Wednesday by the Kaiser Family Foundation, 31% of respondents said implementing a national Medicare-for-all plan should be Congress's top priority, with an additional 26% saying it is "important but not a top priority." The most commonly selected top priorities were lowering prescription drug costs and continuing the ACA's protections for people with pre-existing conditions, at 68% and 64%, respectively.

Even if the Legislature approved the bill today, Rivera noted, it would take years to implement. That raises the question of how New York will proceed as some Democratic presidential candidates promote a federal Medicare-for-all program that could be implemented should one of the contenders take the White House in 2020.

"If we manage to get a national Medicare-for-all program, God bless America. We don't have to do this. The best choice is to do it nationally," Rivera said. "Because a national solution is not forthcoming, people in my communities in the Bronx and communities all over the state are getting sick. They're still going broke. They're still uninsured or underinsured, and we need to fix that. So that's why we're pushing forward on this."

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VIEW: Single-payer health insurance would boost small businesses, Derek King, Buffalo News

By Derek King, April 23, 2019

I am the owner of a small business, and I am frustrated by private health care insurance.

Everyone knows that without insurance, any health care crisis can become a financial crisis. What most people don’t know is that insurance may not protect you. Worse, they don’t understand how it harms small businesses.

On a personal level, severe throat problems forced me to go to the emergency room twice in six months while I was on my mother's health insurance seven years ago. The first time, a surgeon drained a painful cyst. Then, to stop recurrence, another removed my tonsils. Despite being insured, it took me four and a half years to pay those bills.

On a professional level, when my consulting firm began hiring employees, I wanted everyone in our company to have good insurance coverage. It’s the ethical thing to do. It’s also practical: It reduces our competitive disadvantage against bigger companies…

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LETTER: Single-payer health care would be better, Brian Rhodes, Newsday

By Brian, Rhodes, April 22, 2019

The article “Blue Cross drops LI cancer care provider” [News, April 16] brings to light the necessity for a single-payer insurance system in America. The article reports that as of June 1, New York Cancer & Blood Specialists will no longer be in the Empire BlueCross BlueShield network.

Imagine a cancer patient who is comfortable with and trusts his or her doctor, but can no longer get care from that provider because his or her insurance company says so. Empire did not specify a reason for the change, except that it was “a result of our regular network review.” My hope is that this is not merely about profits. It’s time to take insurance companies and the desire for profits out of health care so people can decide what doctor they want to see without interference from a third party.

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SERIES: Healthcare in America #37, Tom Behr, This Is the Bronx

This is part of an ongoing series in which Bronx writers share their personal stories on the state of healthcare in America.

By Tom Behr, April 21, 2019

I serve in a healing profession. As a therapist, I treat patients with chronic depression, sometimes caused by chronic illness — while I myself am chronically (and progressively) ill.

My days are spent helping patients learn new “dance steps” to better navigate their world. Unlike the legendary Fred Astaire, whose Hollywood films hid all ballroom errors with careful edits, my clients focus on resilience: learning to constantly regain rhythm and place after every misstep.

Like Ginger Rogers, who enabled Astaire’s success, I take pride in all my heroic “dancing partners,” as they regain the grace of navigating their ballrooms, but my increasingly fragile physical condition worries me. Will treatment expense sideline me as a “dancing” partner before my illness does?

While we all smile at the whispered truth that Ginger Rogers did everything Fred Astaire did, but backwards and in high heels — my story is about the ill treating the ill, and it hurts too much to laugh….

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RADIO: Medicare for All NYS? It Has a Ways to Go, Mike Desmond, WBFO, Buffalo NPR

Interview by Mike Desmond, WBFO, April 16, 2019

There are a lot of building issues in the run-up to the 2020 presidential campaign. Among Democrats, one major issue is Medicare for All. Moday night, a group in Orchard Park talked about New York State's proposed version, the New York Health Act.

The proposal has gone through the State Assembly the last four years and with Democrats taking control of the State Senate, it is likely to pass that house. Then it is up to Gov. Andrew Cuomo to decide if a single-payer health plan would come to New York.

Cost of the plan isn't clear. It would be paid for with all of the federal healthcare money that comes into the state and with a progressive income tax, possibly all replacing the property taxes that help pay for Medicaid.

Lawyer Kevin Ketchum said the plan would replace all private health insurance and be paid for with federal dollars and a progressive state income tax structure….

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ARTICLE: Healthcare breaking the bank for school districts, Colleen Wilson, Rockland Westchester

By Colleen Wilson, Apr 15, 2019

As if crafting school district budgets in the tax-cap era wasn’t already a challenge, a new report has found that districts' health care costs are soaring — and they're not decreasing any time soon.

Since 2013-14, employee health care costs have risen almost 23% for New York's school districts, eclipsing the rates of inflation and state aid increases, according to the state Association of School Business Officials.

School systems in the Hudson Valley saw health care costs increase 8.6% from 2017 to 2018, the largest one-year regional increase in the state.

While health health care costs are growing nationally, they will be uniquely “unsustainable” for school districts, according to Michael Borges, executive director of the ASBO and an author of the study….

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LETTER: Taxpayer-funded health care system would benefit all, Thomas Koshy, Kingston Daily Freeman

By Thomas Koshy, Apr 10, 2019

I am a retired physician, practiced in Kingston for more than 30 years, and plan to live and die here. I am interested in a viable medical system.

I spoke to Saugerties Chamber of Commerce two years back, supporting a single-payer system for New York, now known as the Health Act that is pending approval in state Senate….

As a physician, I believe a single-payer system can and must be put in place. I am a senior citizen covered by Medicare and Medicare supplement, paid from my pocket. I am happy with the coverage. Many seniors who have Medicare cannot afford to pay for supplement from their fixed income….

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VIEW: New York Health Act example of strong state government, Nick Turner, Daily Orange

By Nick Turner, April 8, 2019

Necessary services can seem out of reach to American citizens because the federal government cannot agree on how to provide them. The proposed New York Health Act, is an example of how state governments can take action and make decisions that help their citizens.

While there is gridlock in our federal government, state and local governments can provide an avenue for voters to have their voices heard. The New York Health Act represents a major policy reform that would provide something the federal government currently can’t. The New York Health Act would give health care to every New York citizen through a public fund.

“I think the lack of federal action to guarantee healthcare is certainly a motivation for a state like New York to pursue it,” said Katie Robbins, director of Campaign for New York Health, in an email. …

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VIEW: Medicare Is the Most Sensible Way to Fix Health Care, Gerald Friedman, Common Dreams

I've spent decades studying US health care. Time to get real: Medicare for All is the only reasonable path to controlling costs and covering everyone.

By Gerald Friedman, April 8, 2019

There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.

We all recognize that the status quo isn’t working. We spend more per person than any other country on health care, but we aren’t getting any bang for our buck. We have lower life expectancy, higher infant mortality rates and more preventable deaths, and too many personal bankruptcies are due at least in part to medical bills. …

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SERIES: Healthcare in America #36, Ana Gordon, This Is the Bronx

This is part of an ongoing series in which Bronx writers share their personal stories on the state of healthcare in America.

By Ana Gordon, April 7, 2019

Doctor Diagnosis to Patient on Medicare: “You’re too old.”

For fifteen years I’ve been on Medicare, supplemented by an employee retirement plan, but co-pays and deductibles are so high I’ve stopped seeing my doctor every year for check-ups. It seemed that every check-up required more tests, more medications, more paperwork, and more money. 

I am a senior citizen on a fixed income who worries about how my expenses get higher every year. I don’t go to movies or restaurants. I don’t buy clothes. My dog, who is my constant companion, is my only luxury.

A few times in the past five years, I’ve had dizzy spells that worry me but my doctor can’t tell me why or how to stop them. The last time I saw him, he told me I’m old and he can’t explain everything that happens when you age. He made me so angry I decided to switch doctors, but, when I called my insurance people, I got such a headache from listening to music and being told that every nearby doctor I mentioned was out of network, I gave up. 

When your fears become real. . .

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LETTER: Right Track on Health, Henry Moss, Riverdale Press

By Henry Moss, April 7, 2019

In her recent story, Simone Johnson captures the growing popularity of the single-payer New York Health Act and the enthusiasm of supporters like Sen. Alessandra Biaggi.

However, it leaves the impression that older adults with Medicare Advantage plans, like Ms. Yona Bello quoted in the story, are doing just fine. The fact that the commercial insurance companies find them enormously profitable should make one suspicious.

Most don’t know that tax dollars are used to provide special subsidies to MA insurers so they can offer extra services, like optical and dental, with the aim of privatizing Medicare. And most aren’t aware that insurers market these plans primarily to healthier seniors with numerous disincentives for those with chronic and complex conditions, including restricted choice of primary care providers and poor access to specialists.

There also are limits on expensive treatments and steeper cost sharing…

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SERIES: Urgent Care Offers Lower Costs and Wait Times, Julia Rose Herman, Norwood News

By Julia Rose Herman of WFUV, March 31, 2019

Urgent Care Offers Lower Costs and Wait Times, But at a Price

As urgent care centers pop up across the Bronx, Dr. Barry Baker, a private practitioner, prefers the traditional physician-patient model. But it doesn’t mean he doesn’t keep one foot in the urgent care trend.

Dr. Baker, who has an office in Throggs Neck, always knew he wanted to go into private practice. “I saw an ad in The New York Times ‘Practice for Sale’–I contacted the husband and wife who owned the practice and they were on Castle Hill Avenue. They were practicing for 49 years and we got to have a nice relationship, and that’s how I ended up in the Bronx,” said Dr. Baker….

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SERIES: Meeting the Demand for Dental Work in Underserved Communities, Marina Kopf, Norwood News

By Marina Kopf of WFUV, March 15, 2019

Dr. Douglas York, CEO of the Union Community Health Center (UCHC) in the Belmont section of the Bronx, said the center’s waiting rooms for a dental check-up are always packed. They’re open six days a week and even some nights, hoping to get as many patients on their dentists’ chairs so they can utilize their services sometimes at no cost.

There’s a shortage of dentists in the Bronx, with 33 dentists per 100,000 people in the borough, about half the national average, according to data from the ADA and The Center for Health Workforce Studies. Dr. York said this creates problems for some patients.

“There’s a provider shortage, which means there’s an access issue,” he said.

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SERIES: At $1200 a Month, Managing Diabetes on Bronx Family Budget, Theresa Schliep, Norwood News

By Theresa Schliep, March 4, 2019
The Norwood News, WFUV Radio, and BronxNet Television present a five-part series on health-related struggles affecting residents of the Bronx.

Elbia Cabral of Highbridge knows a lot about insulin. She knows the different kinds of long-acting and short-lasting insulin, the cheap brands, and the pricier brands. It’s been a year and a half since 12-year-old Elizabeth was diagnosed with Type 1 diabetes. And it’s been an adjustment for the whole family….

As an added way of ensuring she stays healthy, the family adopted a diabetes assist dog, Flower, who can smell scents in Elizabeth’s blood sugar. They’ve also had to adjust their lives to afford the insulin and medication Elizabeth needs. At around $1200 a month, or $14,400 a year, her care competes with the price of rent in some neighborhoods…

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VIEW: Let’s Take Healthcare Off the Bargaining Table, Larry Brown, Portside

By Larry Brown, April 2, 2019

Union members enjoy some of the best health care that working-class Americans can expect to receive. Unions have fought long and hard to establish and maintain these benefits and they are justly proud of their achievements. In the absence of a national health plan, they have sacrificed much to negotiate a modicum of security for their members and their families.

More than half of all Americans still access health care through employment-based benefit plans. There is a myth that Americans love their health plans and want to preserve them at all costs. But providing an important public good like health care as a benefit linked to employment rather than as a right available to all is an accident of history. This linkage is not only a bad idea, it is also simply unsustainable.

No other advanced industrialized country links health care to employment like the U.S. does.

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SERIES: Healthcare in America #35, Sandra O. Rossoff, This Is the Bronx

This is part of an ongoing series in which Bronx writers share their personal stories on the state of healthcare in America.

By Sandra O. Rossoff, April 1, 2019

Today’s piece involves a retired licensed social worker on Medicare who reports how the system has not been adequate for her and how (when she was working) she saw how it failed her clients. 

Medicare Doesn’t Care 

Despite the fact that I am well beyond 65—and have Medicare–I have foregone regular check ups, mental health care, dental treatment and done without hearing aids. Each of these necessities are beyond my limited means. When I have sought treatment, the costs have been a burden. Some of the providers didn’t accept Medicare so I had to pay the bills out of pocket. I don’t have voluntary prescription drug care (Part D) because the premiums are so high that I am forced to ration my pharmaceutical intake. 

But primarily, the outcomes of the care I’ve received over the years has resulted in my present painful situation. When I suffered my first post-menopausal bone break,the hospital failed to recognize my osteoporosis, misdiagnosing my broken bone by not connecting this to a decrease in my bone density. During all these years since then, I have had two broken shoulders, two broken knees, two broken vertebrae, two broken ribs, a shattered femur, broken metatarsal, and a trimalleolar ankle break. I’ve been in treatment with a local bone treatment center, which is a research center. . Now I am on Prolia, which is a shot given twice a year at a prohibitive price. Luckily Medicare pays for it. But I had to wait until my doctor received prior authorization. My fear is that, under new rules suggested to save Medicare money under which certain drugs are protected, Prolia may no longer be approved. Fosimax costs much less and, while it prevents osteoporosis, it does nothing to treat the pain that I have It’s a pay or suffer approach to medicine. …

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LETTER: Chronic disease sufferers would benefit from NY Health, Rick Olanoff, Syracuse.com

By Rick Olanoff, March 26, 2019

Thank you, Rhett Cox, for sharing your concerns about the New York Health Act (“Single-payer health insurance would take away patient choice,” March 20, 2019). First, New Y Health will give you more choice in practitioners, both generalists and specialists. Diabetics, whose bodies change over time, need internists, endocrinologists and ophthalmologists to prevent this autoimmune disease from ravaging their bodies and depleting their finances. Twenty years ago, insulin and supplies cost about $1,000 per year. Today, it’s $8,000.

High costs cause almost 40 percent of New Yorkers with chronic diseases to use less medication than prescribed and delay seeing doctors.

Single-payer NY Health Act will solve that. How? It’s a payment system, not a delivery system. Just like with Medicare, doctors and hospitals will send their bills to the New York Health Trust, not to dozens of for-profit insurers. You (or your employer-based healthcare plan) will pay into the trust through a graduated tax.

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LETTER: NY Health Act would cover all, for less, Katie Barrett, Syracuse.com

By Katie Barrett, March 26, 2019

In response to the March 20, 2019, letter “Single-payer health insurance would take away patient choice,” by Rhett Cox.

As a bartender in the past, I spent many years listening to people’s worries. Health care is personal for almost everyone, myself included. My husband also has diabetes, and despite his being on Medicare, it cost us $6,700 last year. Like Mr. Cox, my husband’s life depends on daily treatment.

I have the cheapest insurance I can find with a $4,000 deductible. Last year, our added out-of-pocket approached $9,000 because I got sick. This year, I’ll try to avoid doctors, as most do when faced with bill after bill, above your monthly premium.

Working-class people, like us, are hurt the most. If anything really bad happens, we could lose all our savings or even our home…

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