Saturday,
January 3, 2009
Real
problem is lack of insurance, not hospital collections
(Baltimore Sun)
A New Cigarette
Hazard: ‘Third-Hand Smoke’
(New York Times)
Real
problem is lack of insurance, not hospital collections
By Carmela
Coyle
Baltimore
Sun Commentary
Saturday,
January 3, 2009
It's a sad
fact that because we lack health insurance coverage for everyone in this
country, hospitals often find themselves with stacks of unpaid patient
bills. Certainly, no one likes to receive a letter or phone call from a bill
collector. And no one wants to spend a day in court disputing hospital
charges.
Yet those to
whom money is owed, including hospitals, couldn't survive if all those bills
went unpaid. At the same time, hospitals aren't anxious to litigate: A very
small percentage of disputes over hospital bills actually make it to the
courtroom. More than 6 million patients are cared for each year in Maryland
hospitals.
That's one
of several important points missing from The Baltimore Sun's series "In
Their Debt." Less than one-half of 1 percent of those patients end up in
court. The rest of these individuals pay their bills on time or work out a
payment plan with the hospital.
A second
missing piece: In most cases, the reason these cases end up in court is not
because of mean-spiritedness but because of a lack of communication.
Patients who come to Maryland's hospital emergency departments are cared for
first - regardless of their ability to pay - as required by law. They are
seen by a doctor and their condition is treated. Only after patients receive
care is information collected regarding their insurance coverage or
information that might help qualify them for financial assistance.
Every
hospital in Maryland provides charity care to patients with limited means.
That totaled $260 million last year. Hospitals provided an additional $600
million in care to those who could not or would not pay their bills.
Hospitals
regularly find patients who are eligible for Medicaid or other programs yet
don't know it. But unless patients talk with the hospital and provide
important financial information, hospitals can't connect them with those
resources.
It's also
true that many people who have the ability to pay try to evade their legal
obligations. That's not fair to everyone else.
If there
were a magic machine that gave us information on a patient's financial
status, hospitals could correctly identify and work with patients of limited
means who need assistance as opposed to those who want a free ride. But no
such machine exists. The Baltimore Sun series suggests hospitals shouldn't
pursue patients because hospitals already get reimbursed for unpaid bills
through Maryland's hospital rate-setting system. Yet every unpaid bill means
higher costs for the rest of us.
Indeed, if
hospitals did not pursue unpaid bills, what incentive would any of us have
to pay for health care? Why buy health insurance? The entire health care
system would collapse.
Under
Maryland's unique hospital rate-setting law, a state panel uses a formula
each year to determine how much to reimburse hospitals for uncompensated
care. Because it is a formula based on what is expected to happen in the
coming year, those reimbursements can be high one year and low the next. Yet
over a period of time, it averages out. In fiscal year 2007, Maryland
hospitals received less than the actual cost of delivering free health care.
All paying
patients in Maryland share equally in supporting this worthwhile objective
through charges on their bills. In other states, these rates are buried in
markups that hospitals charge, which adds about 34 percent to the cost of
care. That doesn't happen here. Our hospital markups are about 8 percent.
However, if hospitals made no bill-collection efforts, those charges would
be far higher.
The crux of
the problem is that 800,000 people in our state lack adequate health
insurance. Employers have tried to cope with high insurance costs by cutting
benefits or increasing what employees pay. In some cases, workers are now on
the hook for thousands of dollars of out-of-pocket expenses they can't
afford. In this recession, many more people will lose their jobs and their
health coverage. But people still get sick; they still need hospital care -
with or without insurance.
Gov. Martin
O'Malley and the Maryland legislature have made tremendous strides and set
our state apart from others by expanding health care coverage to more
low-income families. Maryland's hospitals have fought for and long supported
those efforts. Still, significant gaps remain.
Hospitals
continue to provide medical treatment first and work out the payments later.
We believe patients should be treated with compassion, from the bedside to
the billing office. News stories over billing disputes distract from the
real problem. Without a national policy to provide health care coverage for
all, the chasm between people's health needs and their ability to pay will
grow. That dumps the problem at hospitals' front door, leaving them with the
task of patching together care and coverage one patient at a time - a far
less than ideal scenario.
Carmela
Coyle is president and CEO of the Maryland Hospital Association. Her e-mail
is
ccoyle@mhaonline.org.
Copyright
© 2009, The Baltimore Sun.
A New Cigarette Hazard:
‘Third-Hand Smoke’
By Roni Caryn Rabin
New York Times
Saturday, January 3, 2009
Parents who smoke often open a window or turn on
a fan to clear the air for their children, but experts now have identified a
related threat to children’s health that isn’t as easy to get rid of:
third-hand smoke.
That’s the term being used to describe the
invisible yet toxic brew of gases and particles clinging to smokers’ hair
and clothing, not to mention cushions and carpeting, that lingers long after
second-hand smoke has cleared from a room. The residue includes heavy
metals, carcinogens and even radioactive materials that young children can
get on their hands and ingest, especially if they’re crawling or playing on
the floor.
Doctors from MassGeneral Hospital for Children in
Boston coined the term “third-hand smoke” to describe these chemicals in a
new study that focused on the risks they pose to infants and children. The
study was published in this month’s issue of the journal Pediatrics.
“Everyone knows that second-hand smoke is bad,
but they don’t know about this,” said Dr. Jonathan P. Winickoff, the lead
author of the study and an assistant professor of pediatrics at Harvard
Medical School.
“When their kids are out of the house, they might
smoke. Or they smoke in the car. Or they strap the kid in the car seat in
the back and crack the window and smoke, and they think it’s okay because
the second-hand smoke isn’t getting to their kids,” Dr. Winickoff continued.
“We needed a term to describe these tobacco toxins that aren’t visible.”
Third-hand smoke is what one smells when a smoker
gets in an elevator after going outside for a cigarette, he said, or in a
hotel room where people were smoking. “Your nose isn’t lying,” he said. “The
stuff is so toxic that your brain is telling you: ’Get away.’”
The study reported on attitudes toward smoking in
1,500 households across the United States. It found that the vast majority
of both smokers and nonsmokers were aware that second-hand smoke is harmful
to children. Some 95 percent of nonsmokers and 84 percent of smokers agreed
with the statement that “inhaling smoke from a parent’s cigarette can harm
the health of infants and children.”
But far fewer of those surveyed were aware of the
risks of third-hand smoke. Since the term is so new, the researchers asked
people if they agreed with the statement that “breathing air in a room today
where people smoked yesterday can harm the health of infants and children.”
Only 65 percent of nonsmokers and 43 percent of smokers agreed with that
statement, which researchers interpreted as acknowledgement of the risks of
third-hand smoke.
The belief that second-hand smoke harms
children’s health was not independently associated with strict smoking bans
in homes and cars, the researchers found. On the other hand, the belief that
third-hand smoke was harmful greatly increased the likelihood the respondent
also would enforce a strict smoking ban at home, Dr. Winickoff said.
“That tells us we’re onto an important new health
message here,” he said. “What we heard in focus group after focus group was,
‘I turn on the fan and the smoke disappears.’ It made us realize how many
people think about second-hand smoke — they’re telling us they know it’s bad
but they’ve figured out a way to do it.”
The data was collected in a national
random-digit-dial telephone survey done between September and November 2005.
The sample was weighted by race and gender, based on census information.
Dr. Philip Landrigan, a pediatrician who heads
the Children’s Environmental Health Center at Mount Sinai School of Medicine
in New York, said the phrase third-hand smoke is a brand-new term that has
implications for behavior.
“The central message here is that simply closing
the kitchen door to take a smoke is not protecting the kids from the effects
of that smoke,” he said. “There are carcinogens in this third-hand smoke,
and they are a cancer risk for anybody of any age who comes into contact
with them.”
Among the substances in third-hand smoke are
hydrogen cyanide, used in chemical weapons; butane, which is used in lighter
fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and
even polonium-210, the highly radioactive carcinogen that was used to murder
former Russian spy Alexander V. Litvinenko in 2006. Eleven of the compounds
are highly carcinogenic.
Copyright 2008 New York Times.
