I once worked at a job where I ended up having to talk to some doctor's at the City Health Centers. I consider myself a pretty progressive guy. And, I have friends who don't have health insurance. But, you know what? I still only have a vague idea of what purpose the City Health Centers serve, what services they provide, etc. I really don't think the City (maybe by design?) does a very good job of publicizing them, at all.

With better outreach, the City could dramatically expand the number of uninsured people who would utilize them. As Brady suggested in his op-ed, any strategy should include the Health Centers having weekend and evening hours, for the huge numbers of uninsured who work during the week.

The full Fattah Health Care policy is available online here. The press release summary is available
here.

The insurance problem is addressed through pooled purchasing power. Fattah proposes a regular competitive bidding process to determine a single health insurance provider with specific insurance quality benchmarks built into the contract. He also proposes lowering the City's overall health care costs by coordinating free annual checkups to uninsured Philadelphians. This will cut down on emergency room visits by the uninsured.

Like many other college students, I will lose my healthcare coverage when I graduate. Actually, 71% of people aged 18-24 do not have healthcare. There are literally thousands of young people in Philadelphia who need insurance. The City of Philadelphia could do a lot more to provide this demographic with coverage.

Making sure that young people have healthcare is actually a great way to grow Philadelphia. Recent graduates could be attracted to the city by the presence of a robust effort to provide everyone with coverage. The next mayor should be sure to address this issue when addressing healthcare.
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http://benwaxman.com

Philadelphia would need to be VERY careful on how it goes about trying to insure people. The difference between legislation at the state and federal level verses the municipal level is, it is relatively easy for business to up and relocate in a city 5 miles away where it is cheaper to run a business.

For starters, the idea of "... there could be an piece of legislation that required low-wage employers provide healthcare coverage or pay higher taxes." is contradictory to what Philly needs to accomplish. We need to make the city MORE enticing to employers. The threat of more taxes or more stringent working benefits will threaten to decrease employment. People unemployed is even worse than underinsured.

Next, why waste city resources to deal with insurance issues when PA and the federal government are supposed to be addressing it? It is much better to have something paid for by the state and federal government that to continue to raid the Philadelphia citizenry.

In addition, trying to get more employers into the city helps solve a lot of the "I have no insurance because I graduated college" problem by actually having employment with benefits. Also, there is a completely different set of issues between uninsured at the poverty level and uninsured at the "I have a college degree" level. It seems to trivialize the more serious issue related to poverty.

I am all for Philadelphia trying to do what it can to make health insurance more efficient. I do not feel it is in the best interest of the City to develop some sort of socialistic health insurance plan that will be near impossible to administer and not be drained from people that do not pay into the Philadelphia revenue stream.

"An ounce of prevention is worth a pound of cure."

There are a few things about healthcare I do know:

(1) It is illegal to turn away an emergency. These people must be treated. It is federal law.

(2) Hospitals have historically been reimbursed for treating uninsured and emergency patients by government agencies. I think these reimbursements have drastically declined in the last 10 years or so.

Thus, as a matter of law, hospitals and doctors must treat emergencies. But, they often take a loss as a matter of doing so. It is time for health care providers, state and local social service agencies and other organizations to realize that while the treatment of emergencies are expensive--preventative medicine, including pre-natal care, screenings, routine doctor visits and even the prescribing of anti-biotics for a sinus infection is likely a cheaper alternative.

Based on the above, our local hospitals, agencies and insurance companies must come together and provide high quality medical services to treat the uninsured--preventatively, so that the need for more drastic, emergency medicine is limited.

I see this being started with a commitment from the medical community to provide pro bono services like checkups and simple appointments to uninsured patients. In exchange for particpating, however, we need to discern some benefit for medical groups or hospitals. That is a discussion that needs to be had. But, at this time only Doctors and Nurse Practioners can provide medical services. We have to see what they want and need and what they are willing to do.

But, a strategic partnership on preventative medicine may assist us in moving towards universal health care and allow people who desperately need to see a doctor, but do not have a traditional "emergency" to do so. Then, emergeny rooms are for just that--not patient visits.

Health care should be a basic right of all. And it should be provided in a national, single payer program.

Until we get there, the city could do more to provide people with health insurance or health care. And, if we can help businesses get health care at lower prices, than we would also encourage more of them to move to Philadelphia.

Here are three ideas that I have been working on and will post to my new campaign website, www.stier2007.com soon:

1. Create a large, city wide health insurance pool. The secret to lowering health insurance costs is to create a large block of people to be insured and then using that block to negotiate for lower priced insurance with, for example, Blue Cross. This would be attractive to Blue Cross because a large insurance pool has lower administrative costs and there would be no need for Blue Cross to advertise to attract these people. The city could negotiate with its unions, which are constantly faced with rising health care costs, to join together to create such a pool. (I should add that this will be tricky because the city’s workers have good health insurance now and shouldn’t be forced to take insurance that is not as good.) And then the school system and our colleges and universities could be invited to join. And then businesses in the city could join that pool, reducing their health care costs dramatically. The city would have to require that the insurance plans Blue Cross provides meet certain standards. (This proposal, I should add, is basically the same as a plank in Chaka Fattah’s platform. We are talking to the same expert in the field.)

2. Provide support for medical research in the city that also provides health care for people without insurance. A great deal of medical research requires large numbers of people to be included in a study. In some cases, this is necessary because researchers are trying to study diseases that are rare or that many not be noticed by people for many years, such as some congenital heart defects. In other cases, researchers are trying to study differences between people. For example, they might be trying to understand why some people respond to certain medicines in one way rather than another. It is possible to combine different research studies—indeed doing so would help reduce the costs of evaluating tens of thousands of people.

So my suggestion is that the city work with our local medical institutions to help coordinate this broad based research. The city should also provide some seed funding for research proposals, which is likely to matched many times over by government and private foundations. And, what the city should ask in return is, first, that free medical examinations be a routine part of the research protocols; and second, that the health centers receive funding from the research projects, both to carry out the research and to do follow up care for people who are found to be suffering from one disease or another.

By making Philadelphia a center of this kind of research we will bring more grant money to our impressive medical centers, thereby creating more jobs; provide better, and preventive, health care to those who are lacking it today; and reduce those awful waiting times at the health centers.

3. Integrate inpatient and outpatient mental health care with payment for psychiatric medicines. Community Behavioral Health is, in many respects, a very good system. But it has one glaring problem: the drugs mental health patients need are paid for out of one pot of money while inpatient mental health care is paid for out of a second pot. This is a serious problem.

Any psychiatrist will tell you that keeping psychiatric patients out of the hospital is always a good thing. When patients become so sick they need to be hospitalized, it takes a long time for them to recover to the point where they can live on their own or in supervised non-hospital settings. Once a psychiatric patient is hospitalized, he or she is more likely to be hospitalized again. And hospitalization is very expensive.

With new psychiatric medicines, hospitalization rates can be dramatically reduced. And, while those new psychiatric medicines are expensive, they are far cheaper than hospitalization. However the companies that manage the payment for psychiatric medicines have an incentive to push psychiatrists to use older, cheaper, and demonstrably less effective medicines. And, unless psychiatrists want to spend half their day advocating for their patients—and some do—the result is that we have more hospitalizations, sicker people, and our overall costs for caring for patients with severe and persistent mental illness is far higher than it needs to be.

The solution is to merge the two pots of money. They do that in other cities, such as Charlotte, NC, where all psychiatric care comes out of one pot of money and psychiatrists are evaluated in part on their ability to help their patients stay out of the hospital.

I think it's critical that the city improve emergency response coverage -- especially ambulances. there have been a ton of articles over the last two years describing the dismal condition of our ambulances, the insufficent number of vehicles and EMTs, the substitution of only partially qualified firemen for ambulances in some areas and situations... We need to get serious about making sure that people aren't ending up dead or diabled because of slow or inadequate response to health emergencies.

acm

"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has."
— Margaret Mead

Over three years ago, voters in this City overwhelmingly approved a charter change that mandated that the Mayor figure out a way to provide health care to all Philadelphians. As a result of that charter change, the Department of Public Health kicked off a year-long study, bringing together hospital executives, community activists, and academics to come up with a solution. That study acknowledged that the problem of the uninsured could only be truly cured at the national level, but suggested several ways that health care providers in the region could work together better too provide care to all. But what has actually happened to implement those suggestions?

One of the major issues that plagues the health care community (particularly acute care hospitals, but increasingly other providers as well) is the so-called 'technological arms race' that occurs when one hospital buys a three-dimensional ultrasound machine, and then everyone else has to buy one to stay competitive. What if the next Mayor made all the hospital executives in town sit down with him and declare detente in this arms race? What if, instead of racing to acquire the latest imaging technology, our major hospitals agreed to share it, and to invest the extra resources in jointly opening a free clinic?

On a more statewide basis, what if Pennsylvania let local communities weigh in on hospital transactions, as residents are able to do in other states? Last week, Tenet Healthcare announced that they were selling Graduate Hospital to the University of PA Health System, who plans to turn it into a rehab hospital. Does Philadelphia need one more rehab hospital? Or one less acute care hospital? Looking at the amount of money that Graduate has lost in recent years might lead you to conclude that we can live without it, but how do the residents of South Philly feel about having to travel further to get to the emergency room, or the maternity ward? The next Mayor could work with Governor Rendell to establish regional oversight of this kind of health care expansion or conversion, which would allow activists and academics to raise concerns about hospital closings (think MCP, or further out, Montgomery Hospital). Access to health care isn't just about health insurance--it's also making sure that there are providers in your community.

(Some of you know that I work on health care policy for SEIU District 1199P. Please don't mistake this comment, which is my personal opinion, for that of 1199P.)

We all know that the bulk of the city’s hospitals (all the area hospitals excluding those owned by Tenet Healthcare) are non-profit entities. As “institutions of public charity”, these hospitals are exempted from a wide range of taxes—local property taxes, sales tax, state and federal income tax—and have access to other financial benefits not enjoyed by for-profit businesses. I’ve done the math, these exemptions save hospitals millions of dollars each year. In return, nonprofit hospitals are expected to serve a charitable mission by providing “community health benefits”—free and reduced-price services that promote public health, including charity (free) care for those who need it. However when you compare the tax savings against what hospitals actually spend on community benefits, the reality is disgraceful. The same local hospitals that are pocketing tax dollars, are inconsistent in notifying patients of the availability of free care services, collecting inflated bills from uninsured patients and even going as far as to sue people for their unpaid bills…

Not doubt, this is a widespread problem, Philadelphia hospitals aren’t the only hospitals scamming the system. While this is a problem nation wide, there are things that the next mayor can do. Pennsylvania has an active history of challenging hospitals’ tax exemptions. I’ll spare you all the history lessons, but from 1985 (when the PA State Supreme Court created a 5-point test for property tax exemption) through 1997 (when Hospital Association of PA finally managed to pass a bill that protects hospitals) cities and towns across the state challenged the property tax exemptions of 175 hospitals. (That’s 175 of the 220 PA hospitals that existed at that time.) The storm of exemption challenges centered on a handful of common themes: excessive profit; inadequate care for the poor; and for-profit-like business practices.

No hospital permanently lost its exemption- but roughly a third of PA hospitals were forced to make payments in lieu of taxes (PILOTS) to their respective school districts and municipalities. Here in Philly, in 1994, then Mayor Rendell encouraged/urged/forced local non-profit hospitals to pay the city million of dollars annually to avoid losing their property tax exemptions. The agreement reached between Rendell and the hospitals established “charitable contributions” (either free services or monetary payments) of up to 40% of the hospital property tax assessment.

That was back in 1994. Has the agreement expired? Are the annual “contributions” used to provide affordable health care? Should the city ask for an increase in the negotiated “contribution”?

The health care crisis is complicated. By no means do I believe that we should be sucking local hospitals dry, but I do think that city officials should think seriously about enlisting all the resources available to help improve access to health care. In the end, is helping hospitals uphold their charitable mission all that bad?

Someone had mentioned universal healthcare at the municipal level in November and it was discussed back and forth for several pages.

http://www.phillyblog.com/philly/showthread.php?t=27346

The insurers and hospitals have gotten beaten up on here a lot. Now I KNOW some of you folks are reading this. Come on. You all have PR departments doing Google searches for your names every day.

Come out, come out wherever you are!!!

Maybe you think the City is screwing up your ability to provide the best care? Maybe you have a market-based miracle ready to kick in any day? Come out and give us the word!!!

I know the Delaware Valley Healthcare Council just released a report on all they have done to improve community health. They've also got testimony here on the hospital's role in covering the Uninsured. Help us understand your take!
Check out DVHC's Community Health & Hospitals reports here.

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BradyDale OnLine
The R.I.I.C. Blog
The Philadelphia Unemployment Project

We announced the Fattah Plan for a Healthier Philadelphia early because health care isn't a privilege. It's a right that every Philadelphian should have access to. Here are four ideas we'd like to implement to save taxpayers money while giving every Philadelphian access to quality, affordable health care.

Annual Check-Ups for every Philadelphian

Like Ben shared on this board, some Philadelphians haven't been to a doctor or dentist in years because of lack of insurance. We can solve that if doctors, nurses and nurse practitioners (both public and private) work together to provide annual check-ups. We did it in West Philly with National Guard medical personnel. We can do it throughout the city by mobilizing the city's medical personnel to provide these check-ups on designated days over the course of each year. It's called preventive health care, and it saves lives and money by catching sickness before it's too late.

Cutting Insurance Costs for City Employees = Big Taxpayer Savings
Over the last five years, the Municipal workforce shrunk by 7 percent and health care costs for that workforce went up by 60 percent. We can solve that. If the city unions came together with the city and negotiated a health care plan under a single insurer, through a competitive bid process, we could cut costs and save taxpayers millions. Cities like New York, Chicago and Boston all have achieved significant savings through this strategy. To reduce costs even further, we could follow the example of San Jose, which bids out its single contract every four years. By regularly re-bidding the contract, we would force insurance companies to compete for our dollars by giving us low rates on treatment, prescriptions and drug costs. Not only could we do it with city unions. We could bring in the School District and other large Philly-based employers to force costs down even more.

Low-Cost Prescription Drugs
We have major pharmaceutical companies in the region that provide free or reduced cost drugs to those who need them. We think more Philadelphians should know about these programs and utilize them. An innovative city government can work with the pharmaceutical community to make that happen. After all, charity starts at home.

Get Philadelphians to Use State and Federal Programs
There are state and federal health care programs that Philadelphians are qualified for, but don't know about. We can educate Philadelphians about them through the city's Department of Public Health, senior centers and social service agencies. Putting the word out about PACE, PACENET, Medicare, Medicaid, CHIP, Medicare Part B, Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary would allow people to get medical care and have it paid for without costing the city more money.

The full health care plan contains more ideas still. Ideas like improving our city clinics and expanding their hours. Some people say it would cost too much to do what we're proposing. We say it would cost more not to do it -- in sickness, in grief, and in preventable illnesses. The full Fattah Plan for a Healthier Philadelphia is available at http://www.phillyforfattah.com/health_care.asp. Please read it and respond here or on our blog - http://blog.phillyforfattah.com/ We'd love to know what you think.

Fattah for Mayor
http://www.phillyforfattah.com/

As a child advocate in the City I want to make sure we don't forget the nearly 400,000 children and adolescents who live in Philadelphia. Although we are extraordinarily lucky that the vast majority of these children are insurable, there is much the City can do to better meet the needs of our children.

- Increase investment in City Health Centers (longer hours, more staff). The City Health Centers are the backbone of Philadelphia's health safety net and must be adequately funded for both the children and adults in the City.
- Offer tax incentives to bring child psychiatrists to Philly. There is a shortage of child psychiatrists nationwide which results in long waiting lists for behavioral health evaluations and treatment. Children in our City who are in pain should not have to wait months to see a psychiatrist! The City could expand tax incentives beyond just new buildings as a way to recruit and retain needed health care professionals (this could also be used for dentists and other health care professionals)
- Increase the City's investment in lead poisoning prevention. In 2005, 7,600 children across the Commonwealth were poisoned by lead - over 3,400 of them in Philadelphia. We need additional funding for the City's Lead Program to clean the houses of poisened children and to prevent new children from ever becoming poisoned.
- Expand health case management services to pregnant and parenting youth so they can finish high school. 70% of pregnant and parenting youth drop out and need additional supports to finish their education.

These are just a few of the many ideas organizations like Philadelphia Citizens for Children and Youth are working on to improve the health and quality of life for our City's children.

While its great that we want to provide free health check ups and what not, that's only going to allow the treatment of an existing disease. I'd rather address the causes of disease and try to prevent the conditions that make the urban poor sick. Basically, the way I see it, the problem of urban healthcare is not the lack of access to insulin or some other expensive drug, the problem is the underlying conditions that cause the urban poor to be at-risk for developing diabetes or heart disease or asthma or whatever the disease is.

I have been trying to write a post on this subject over at Phillyville for several months now but it's just one of those subjects that have so many twists and turns and connections to other policies that, attempts to dovetail the idea into Ray's YPP Apprentice Challenge... well, I basically just need to get my act together and finish the damn post... which is ultimately about why Philadelphia should implement the horticultural equivalent of the mural arts program.

Anyway, most of the health problems typically associated with the inner city are the result of improper nutrition. Too much fast food and not enough freshly grown vegetables creates a population at risk for heart disease. A diet rich in high fructose corn syrup causes a population that going to have a ton of diabetics.

Banning trans fats is a great first step. But we need to go further. We need to address existing policies that, while good intentioned, are actually making the urban poor sick.

Take school breakfast - we can't keep handing our kids a fried donut every morning and not expect a large portion of these children to end up overweight and at-risk for diabetes. We need to teach children how to eat properly and we need to make good food accessible to the urban poor.

I know its not fancy but a bowl of oat meal or fresh yogurt would make Philadelphians healthier than free check-ups or any other whiz bang proposals regarding low-cost prescription drugs could accomplish.

______________________________
Phillyville

Come on, Soda is a good thing. No Soda gives me Project Learn flashbacks. You have been co-opted by the Hippy anti-soda crowd. By the way, I heard that since we left, they now let you have soda. Go figure.

Just kidding, of course.

Before I wax all reformist, is the deadline past for this thread?

Political Doc