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"disqusTitle": "How Much Does It Cost to Have a Baby in California? ",
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"content": "\u003cfigure id=\"attachment_17229\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/shingo/5938064111/sizes/l/\">\u003cimg class=\"size-large wp-image-17229\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/5938064111_04af369bb9_b-640x425.jpg\" alt=\"(Shingo/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Did this baby's hospital charge $3,300 or $33,000 for delivery -- or somewhere in between? (Shingo/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The most common reason for hospitalization in the United States is childbirth. A new study published Thursday adds to the\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\"> depth\u003c/a> of\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/08/how-much-would-you-rather-pay-for-that-procedure-170000-or-43000/\" target=\"_blank\"> research \u003c/a>on \u003ca href=\"http://content.time.com/time/magazine/article/0,9171,2136864,00.html\" target=\"_blank\">cost variation\u003c/a> in the American medical system.\u003c/p>\n\u003cp>In \u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\">the study\u003c/a>, researchers at U.C. San Francisco looked at 110,000 uncomplicated births across California and found that hospital charges for a vaginal delivery ranged from $3,296 to $37,227 and for a caesarian section the range was $8,312 to $70,908.\u003c/p>\n\u003cp>For health policy researchers, this is not a big surprise, said lead author Dr. Renee Hsia, an associate professor of emergency medicine at UCSF, but \"most people that aren't familiar with health care variation would be surprised and distressed.\"\u003c!--more-->\u003c/p>\n\u003cp>Hsia's team looked at many variables that could account for variation -- things like how sick patients might be or cost of living in one area versus another. \"Even after controlling for patient, hospital and market characteristics, we found significant variation,\" Hsia said.\u003c/p>\n\u003cp>In the study, published in BMJ Open, researchers concluded that they could only account for about one-third of the variation in charges. \"This implies,\" the authors write, \"that the variation is a result of either (1) unobservable hospital characteristics or (2) pure noise.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Before we go any further, let's get some terms straight. Few hospitals are paid what they \"charge.\" If the patient has insurance, the insurer pays whatever rate it negotiated with the hospital for the procedure. But if you're uninsured, Hsia says, you are in a tough spot. Even with the implementation of the Affordable Care Act, lack of health insurance is a continuing problem.\u003c/p>\n\u003cp>\"We still have 30 million uninsured who will see the real bill and who will face the real charges of that bill,\" Hsia said. She acknowledged that some of them may get discounts, but added \"50 percent of a ridiculous amount is still a ridiculous amount\" of money.\u003c/p>\n\u003cp>Jan Emerson-Shea of the California Hospital Association took issue with the study as a whole and the point about the uninsured in particular. She pointed to a \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/Hospitals/FairPricing/HSC127400_CharityCarePoliciesSB350.pdf\" target=\"_blank\">California law\u003c/a> that requires hospitals to provide either free or discounted care to many uninsured patients.\u003c/p>\n\u003cp>\"If you're uninsured, state law prohibits you from being billed on charges, assuming you fall within income guidelines,\" Emerson-Shea said. \"In most cases, patients would fall into an income category that would qualify them for free care or a discounted amount.\"\u003c/p>\n\u003cp>In an email Hsia called the law a \"great effort and important Act\" but said it does not solve everyone's problems of high hospital bills. In her email she noted two points in particular:\u003c/p>\n\u003cblockquote>\n\u003cdiv>1) It only applies to those who are \"financially qualified.\" You have to make under 350% of the federal poverty level to qualify. So for a single person who makes more than $40,000, if you get a hospital bill of $30,000, you are not going to get a discount.\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>2) There is no specific language stating what discount the hospitals must provide.\u003c/div>\n\u003c/blockquote>\n\u003cp>But one thing Emerson-Shea and Hsia agreed on was that the opaque pricing system doesn't work. \"We acknowledge there's variation in hospital charges for a multitude of reasons,\" Emerson-Shea said. \"It's part of the broken health care system that we've had in this country for several decades.\"\u003c/p>\n\u003cp>\"I think it would be in everyone's interest to have a more rational system of hospital pricing,\" Hsia said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This post has been updated to clarify Dr. Hsia's comments on hospital discount programs.\u003c/strong>\u003c/em>\u003c/p>\n\n",
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"excerpt": "The most common reason for hospitalization in the United States is childbirth. A new study published Thursday adds to the depth of research on cost variation in the American medical system.\r\n\r\nIn the study, researchers at U.C. San Francisco looked at 110,000 uncomplicated births across California and found that hospital charges for a vaginal delivery ranged from $3,296 to $37,227 and for a caesarian section the range was $8,312 to $70,908.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17229\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/shingo/5938064111/sizes/l/\">\u003cimg class=\"size-large wp-image-17229\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/5938064111_04af369bb9_b-640x425.jpg\" alt=\"(Shingo/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Did this baby's hospital charge $3,300 or $33,000 for delivery -- or somewhere in between? (Shingo/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The most common reason for hospitalization in the United States is childbirth. A new study published Thursday adds to the\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\"> depth\u003c/a> of\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/08/how-much-would-you-rather-pay-for-that-procedure-170000-or-43000/\" target=\"_blank\"> research \u003c/a>on \u003ca href=\"http://content.time.com/time/magazine/article/0,9171,2136864,00.html\" target=\"_blank\">cost variation\u003c/a> in the American medical system.\u003c/p>\n\u003cp>In \u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\">the study\u003c/a>, researchers at U.C. San Francisco looked at 110,000 uncomplicated births across California and found that hospital charges for a vaginal delivery ranged from $3,296 to $37,227 and for a caesarian section the range was $8,312 to $70,908.\u003c/p>\n\u003cp>For health policy researchers, this is not a big surprise, said lead author Dr. Renee Hsia, an associate professor of emergency medicine at UCSF, but \"most people that aren't familiar with health care variation would be surprised and distressed.\"\u003c!--more-->\u003c/p>\n\u003cp>Hsia's team looked at many variables that could account for variation -- things like how sick patients might be or cost of living in one area versus another. \"Even after controlling for patient, hospital and market characteristics, we found significant variation,\" Hsia said.\u003c/p>\n\u003cp>In the study, published in BMJ Open, researchers concluded that they could only account for about one-third of the variation in charges. \"This implies,\" the authors write, \"that the variation is a result of either (1) unobservable hospital characteristics or (2) pure noise.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Before we go any further, let's get some terms straight. Few hospitals are paid what they \"charge.\" If the patient has insurance, the insurer pays whatever rate it negotiated with the hospital for the procedure. But if you're uninsured, Hsia says, you are in a tough spot. Even with the implementation of the Affordable Care Act, lack of health insurance is a continuing problem.\u003c/p>\n\u003cp>\"We still have 30 million uninsured who will see the real bill and who will face the real charges of that bill,\" Hsia said. She acknowledged that some of them may get discounts, but added \"50 percent of a ridiculous amount is still a ridiculous amount\" of money.\u003c/p>\n\u003cp>Jan Emerson-Shea of the California Hospital Association took issue with the study as a whole and the point about the uninsured in particular. She pointed to a \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/Hospitals/FairPricing/HSC127400_CharityCarePoliciesSB350.pdf\" target=\"_blank\">California law\u003c/a> that requires hospitals to provide either free or discounted care to many uninsured patients.\u003c/p>\n\u003cp>\"If you're uninsured, state law prohibits you from being billed on charges, assuming you fall within income guidelines,\" Emerson-Shea said. \"In most cases, patients would fall into an income category that would qualify them for free care or a discounted amount.\"\u003c/p>\n\u003cp>In an email Hsia called the law a \"great effort and important Act\" but said it does not solve everyone's problems of high hospital bills. In her email she noted two points in particular:\u003c/p>\n\u003cblockquote>\n\u003cdiv>1) It only applies to those who are \"financially qualified.\" You have to make under 350% of the federal poverty level to qualify. So for a single person who makes more than $40,000, if you get a hospital bill of $30,000, you are not going to get a discount.\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>2) There is no specific language stating what discount the hospitals must provide.\u003c/div>\n\u003c/blockquote>\n\u003cp>But one thing Emerson-Shea and Hsia agreed on was that the opaque pricing system doesn't work. \"We acknowledge there's variation in hospital charges for a multitude of reasons,\" Emerson-Shea said. \"It's part of the broken health care system that we've had in this country for several decades.\"\u003c/p>\n\u003cp>\"I think it would be in everyone's interest to have a more rational system of hospital pricing,\" Hsia said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This post has been updated to clarify Dr. Hsia's comments on hospital discount programs.\u003c/strong>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Governor's Budget Includes $670 Million for Medi-Cal; Preserves Provider Rate Cuts",
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"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_9899\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-e1389301025994.jpg\">\u003cimg class=\"size-large wp-image-9899\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-620x443.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"620\" height=\"443\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The governor's budget is out and for the first time in years, California is \u003ca href=\"http://ww2.kqed.org/news/2014/01/09/happy-days-are-here-again-brown-unveils-106-billion-budget-draft/\" target=\"_blank\">expecting a multibillion dollar tax surplus\u003c/a>. The governor is proposing a $8 billion in increased spending, with $670 million earmarked to expanded benefits under Medi-Cal.\u003c/p>\n\u003cp>The expanded benefits include mental health, substance use disorder, adult dental, and specialized nutrition services.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\">his proposal,\u003c/a> Brown noted that Medi-Cal is the \"budget's second largest program.\" In keeping with his approach to being fiscally prudent, Brown included a warning about health care inflation and implementation of the Affordable Care Act. From his budget:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>As the state implements federal health care reform, budgetary spending will become even more dependent on the rate of health care inflation. If this inflation rises faster than expected, annual General Fund spending could quickly rise by hundreds of millions of dollars.\u003c/p>\u003c/blockquote>\n\u003cp>Brown noted that the state's expansion of Medi-Cal, done as an option under the Affordable Care Act, as well as the shift of children from the Healthy Families program to Medi-Cal, means that the state's Medi-Cal caseload will expand just over 10 percent in the next budget year -- from 9.2 million to 10.1 million people. \"The Medi-Cal caseload is expected to be approximately 24 percent of the state's total population,\" the governor notes.\u003c/p>\n\u003cp>The governor is also calling for a 6.4 percent increase in funding for In-Home Support Services, an area that faced significant cuts -- and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/20/settlement-called-less-harmful-for-in-home-support-recipients/\" target=\"_blank\">court battles over the cuts\u003c/a> -- in recent years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One area that is drawing the frustration of advocates is rate cuts to Medi-Cal providers. in 2011, in the depths of the recession, the legislature passed \u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0051-0100/ab_97_cfa_20110316_204703_asm_floor.html\" target=\"_blank\">AB 97\u003c/a> which called for 10 percent cuts in rates to most Medi-Cal providers. These cuts were also the subject of a long court battle, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\">finally resolved\u003c/a> last summer, and the state had been planning to collect the cuts retroactively. In his budget, the governor indicated the \"retroactive recoupments\" would be forgiven.\u003c/p>\n\u003cp>But the cuts themselves will go forward, resulting in more than $280 million in general fund savings over the next budget year, the governor estimates. In a coincidence, many of those cuts \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/01/09/long-fought-medi-cal-provider-rate-cuts-take-effect/\" target=\"_blank\">take effect today\u003c/a>.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer group Health Access took issue with the continuation of the provider rate cuts, saying that the state should \"cancel the Medi-Cal rate reduction altogether.\" He noted that health and human services has suffered $15 billion in cuts in recent year, many of which have not been restored. \"The level of services for California should not be set at the level of resources available during the worse recession since the Great Depression,\" Wright said in a statement. \"There needs to be some balance between frugality and needed investments for the future.”\u003c/p>\n\u003cp>The governor's budget continues the Coordinated Care Initiative, an effort to move the \"dual eligibles\" -- people eligible for both Medicare and Medi-Cal -- into a single health plan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Watch Gov. Jerry Brown's budget proposal\u003c/strong>:\u003c/p>\n\u003cdiv style=\"overflow: hidden\">\n\u003cdiv class=\"embedly\">\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FQqkTVdZzAY0%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQqkTVdZzAY0&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FQqkTVdZzAY0%2Fhqdefault.jpg&key=6c6e02c8c9d111e0ba664040d3dc5c07&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"480\">\u003c/iframe>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>\u003cspan class=\"embedly-powered\" style=\"float: right\">\u003ca title=\"Powered by Embedly\" href=\"http://embed.ly/code?url=http%3A%2F%2Fyoutu.be%2FQqkTVdZzAY0\" target=\"_blank\">\u003cimg src=\"http://static.embed.ly/images/logos/embedly-powered-small-light.png\" alt=\"Embedly Powered\">\u003c/a>\u003c/span>\u003c/p>\n\u003cdiv class=\"media-attribution\">\u003cspan>via \u003c/span>\u003ca class=\"media-attribution-link\" href=\"http://www.youtube.com/\" target=\"_blank\">YouTube\u003c/a>\u003c/div>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9899\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-e1389301025994.jpg\">\u003cimg class=\"size-large wp-image-9899\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-620x443.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"620\" height=\"443\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The governor's budget is out and for the first time in years, California is \u003ca href=\"http://ww2.kqed.org/news/2014/01/09/happy-days-are-here-again-brown-unveils-106-billion-budget-draft/\" target=\"_blank\">expecting a multibillion dollar tax surplus\u003c/a>. The governor is proposing a $8 billion in increased spending, with $670 million earmarked to expanded benefits under Medi-Cal.\u003c/p>\n\u003cp>The expanded benefits include mental health, substance use disorder, adult dental, and specialized nutrition services.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\">his proposal,\u003c/a> Brown noted that Medi-Cal is the \"budget's second largest program.\" In keeping with his approach to being fiscally prudent, Brown included a warning about health care inflation and implementation of the Affordable Care Act. From his budget:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>As the state implements federal health care reform, budgetary spending will become even more dependent on the rate of health care inflation. If this inflation rises faster than expected, annual General Fund spending could quickly rise by hundreds of millions of dollars.\u003c/p>\u003c/blockquote>\n\u003cp>Brown noted that the state's expansion of Medi-Cal, done as an option under the Affordable Care Act, as well as the shift of children from the Healthy Families program to Medi-Cal, means that the state's Medi-Cal caseload will expand just over 10 percent in the next budget year -- from 9.2 million to 10.1 million people. \"The Medi-Cal caseload is expected to be approximately 24 percent of the state's total population,\" the governor notes.\u003c/p>\n\u003cp>The governor is also calling for a 6.4 percent increase in funding for In-Home Support Services, an area that faced significant cuts -- and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/20/settlement-called-less-harmful-for-in-home-support-recipients/\" target=\"_blank\">court battles over the cuts\u003c/a> -- in recent years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One area that is drawing the frustration of advocates is rate cuts to Medi-Cal providers. in 2011, in the depths of the recession, the legislature passed \u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0051-0100/ab_97_cfa_20110316_204703_asm_floor.html\" target=\"_blank\">AB 97\u003c/a> which called for 10 percent cuts in rates to most Medi-Cal providers. These cuts were also the subject of a long court battle, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\">finally resolved\u003c/a> last summer, and the state had been planning to collect the cuts retroactively. In his budget, the governor indicated the \"retroactive recoupments\" would be forgiven.\u003c/p>\n\u003cp>But the cuts themselves will go forward, resulting in more than $280 million in general fund savings over the next budget year, the governor estimates. In a coincidence, many of those cuts \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/01/09/long-fought-medi-cal-provider-rate-cuts-take-effect/\" target=\"_blank\">take effect today\u003c/a>.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer group Health Access took issue with the continuation of the provider rate cuts, saying that the state should \"cancel the Medi-Cal rate reduction altogether.\" He noted that health and human services has suffered $15 billion in cuts in recent year, many of which have not been restored. \"The level of services for California should not be set at the level of resources available during the worse recession since the Great Depression,\" Wright said in a statement. \"There needs to be some balance between frugality and needed investments for the future.”\u003c/p>\n\u003cp>The governor's budget continues the Coordinated Care Initiative, an effort to move the \"dual eligibles\" -- people eligible for both Medicare and Medi-Cal -- into a single health plan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Watch Gov. Jerry Brown's budget proposal\u003c/strong>:\u003c/p>\n\u003cdiv style=\"overflow: hidden\">\n\u003cdiv class=\"embedly\">\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FQqkTVdZzAY0%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQqkTVdZzAY0&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FQqkTVdZzAY0%2Fhqdefault.jpg&key=6c6e02c8c9d111e0ba664040d3dc5c07&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"480\">\u003c/iframe>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>\u003cspan class=\"embedly-powered\" style=\"float: right\">\u003ca title=\"Powered by Embedly\" href=\"http://embed.ly/code?url=http%3A%2F%2Fyoutu.be%2FQqkTVdZzAY0\" target=\"_blank\">\u003cimg src=\"http://static.embed.ly/images/logos/embedly-powered-small-light.png\" alt=\"Embedly Powered\">\u003c/a>\u003c/span>\u003c/p>\n\u003cdiv class=\"media-attribution\">\u003cspan>via \u003c/span>\u003ca class=\"media-attribution-link\" href=\"http://www.youtube.com/\" target=\"_blank\">YouTube\u003c/a>\u003c/div>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Long-Fought Medi-Cal Provider Rate Cuts Take Effect",
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"content": "\u003cfigure id=\"attachment_17094\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/californiamedicalassociation/8978559463/sizes/l/\">\u003cimg class=\"size-large wp-image-17094\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/8978559463_6e3a52ef6d_b-640x425.jpg\" alt=\"Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A long-awaited and much-feared ten percent rate cut goes into effect Thursday for doctors and clinics reimbursed through Medi-Cal –- the state’s health insurance for low-income patients. This comes at the same time the federal health overhaul is expanding that program to as many as 2 million Californians.\u003c/p>\n\u003cp>Provisions of the Affordable Care Act will protect primary care doctors from the cuts for the next two years, but specialty doctors that treat the poor are bracing for the hit. Many physicians in dermatology, neurology, cardiology, and urology will now be losing money on every Medi-Cal patient they see. Some will have no choice but to turn low-income patients away.\u003c/p>\n\u003cp>“Bottom line, they cannot continue to provide care for below the cost of care,” says Shannon Smith-Crowley, a lobbyist who works closely with the California Medical Association.\u003c!--more-->\u003c/p>\n\u003cp>She says the situation could be especially dire for clinics that have a heavy load of low-income patients –- some may be forced to close: “There’s no way that a lot of those practices can keep their doors open. It simply does not pencil out,” she says. “It’s really, really scary.”\u003c/p>\n\u003cp>Doctors are also worried about having to pay back years’ worth of retroactive cuts, dating back to 2011 when they were first signed into law. The state was in financial turmoil then. But now the fiscal picture is much improved and clinics have been pressuring lawmakers to reverse the cuts. Democrats have drawn a budget blue print that does just that.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Gov. Jerry Brown is expected to release his budget later Thursday, and early indications are that he will rescind the retroactive cuts. Advocates are hopeful.\u003c/p>\n\u003cp>“California does have a surplus,” says Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “I’m hoping that he’ll feel less need to continue cutting the Medi-Cal program and that we can just catch our breath.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Doctors will be competing with advocates from a range of other causes, including education and the environment, who all want to see funds reinstated to previously slashed programs. If Brown does reduce or reverse the Medi-Cal cuts, the changes would have to be approved by the state legislature and the federal Centers for Medicare and Medicaid Services.\u003c/p>\n\n",
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"excerpt": "A long-awaited and much-feared ten percent rate cut goes into effect today, January 9, for doctors and clinics reimbursed through Medi-Cal – the state’s health coverage for low-income patients. This comes at the same time the federal health overhaul is expanding that program to as many as 2 million Californians.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17094\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/californiamedicalassociation/8978559463/sizes/l/\">\u003cimg class=\"size-large wp-image-17094\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/8978559463_6e3a52ef6d_b-640x425.jpg\" alt=\"Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A long-awaited and much-feared ten percent rate cut goes into effect Thursday for doctors and clinics reimbursed through Medi-Cal –- the state’s health insurance for low-income patients. This comes at the same time the federal health overhaul is expanding that program to as many as 2 million Californians.\u003c/p>\n\u003cp>Provisions of the Affordable Care Act will protect primary care doctors from the cuts for the next two years, but specialty doctors that treat the poor are bracing for the hit. Many physicians in dermatology, neurology, cardiology, and urology will now be losing money on every Medi-Cal patient they see. Some will have no choice but to turn low-income patients away.\u003c/p>\n\u003cp>“Bottom line, they cannot continue to provide care for below the cost of care,” says Shannon Smith-Crowley, a lobbyist who works closely with the California Medical Association.\u003c!--more-->\u003c/p>\n\u003cp>She says the situation could be especially dire for clinics that have a heavy load of low-income patients –- some may be forced to close: “There’s no way that a lot of those practices can keep their doors open. It simply does not pencil out,” she says. “It’s really, really scary.”\u003c/p>\n\u003cp>Doctors are also worried about having to pay back years’ worth of retroactive cuts, dating back to 2011 when they were first signed into law. The state was in financial turmoil then. But now the fiscal picture is much improved and clinics have been pressuring lawmakers to reverse the cuts. Democrats have drawn a budget blue print that does just that.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Jerry Brown is expected to release his budget later Thursday, and early indications are that he will rescind the retroactive cuts. Advocates are hopeful.\u003c/p>\n\u003cp>“California does have a surplus,” says Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “I’m hoping that he’ll feel less need to continue cutting the Medi-Cal program and that we can just catch our breath.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Doctors will be competing with advocates from a range of other causes, including education and the environment, who all want to see funds reinstated to previously slashed programs. If Brown does reduce or reverse the Medi-Cal cuts, the changes would have to be approved by the state legislature and the federal Centers for Medicare and Medicaid Services.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Shopping for a Doctor or Hospital? Expanded Website Helps You Compare",
"title": "Shopping for a Doctor or Hospital? Expanded Website Helps You Compare",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17058\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/afeman/22931745/sizes/l/\">\u003cimg class=\"size-large wp-image-17058\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/22931745_d26b74bb6c_b-640x480.jpg\" alt=\"(Andrea Marutti/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Andrea Marutti/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Say you want to buy a car. One of the first places you might think about going for ratings and reviews is Consumer Reports. For decades, the magazine has published reviews of all manner of consumer products.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We want to level the playing field\" for consumers. \u003c/aside>\n\u003cp>You might not know it, but Consumer Reports also publishes reviews on hospitals and physician groups. Starting Wednesday Californians can access that information -- free -- on \u003ca href=\"http://www.calqualitycare.org\" target=\"_blank\">CalQualityCare.org\u003c/a>, a website run by the nonprofit California HealthCare Foundation (CHCF). This site already features reviews of hospitals and nursing homes.\u003c/p>\n\u003cp>Launching just days after Jan. 1, when new insurance took effect for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/27/missed-the-monday-obamacare-deadline-you-can-still-enroll/#more-16914\" target=\"_blank\">hundreds of thousands of Californians\u003c/a> via the Covered California marketplace, the revamped site offers consumers information to help them choose hospitals, nursing homes and doctor groups.\u003c/p>\n\u003cp>\"Making this information easy to digest for the consumer is so key,\" said Andy Krackov, senior program officer for CHCF. Previously, the foundation had maintained separate websites for hospitals and long-term care facilities. In this new partnership with Consumer Reports, CHCF has merged its separate websites to create a one-stop resource for comparison data. The site has no advertising.\u003c!--more-->\u003c/p>\n\u003cp>While consumers might find it ideal to look up ratings on specific physicians, Dr. John Santa, the medical director of Consumer Reports Health, promptly pointed out the challenge in going to that level of detail. \"There's 500 cars we rate. We rate 5,000 hospitals, but 900,000 physicians (in the U.S.) is daunting,\" he said. Still, the group your doctor practices in \"is a big deal, because a lot of your care gets delivered\" by others in the practice, not just other physicians -- but nurses and medical assistants, too.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While the hospital and nursing home ratings leverage data that show outcomes -- including hospital readmission rates, death rates and wait times in emergency departments (just to name a few) -- the physician group ratings derive solely from patient surveys, a limited measure.\u003c/p>\n\u003cp>Santa pointed out that the \"holy grail\" of physician ratings would be to include three factors: patient experience information, measurements showing \"how good they are as clinicians,\" meaning how well they keep you healthy or care for you when you are sick and, finally, cost of care.\u003c/p>\n\u003cp>The collection of ratings information is \"a journey, not a destination,\" Santa said, and added that he hoped that his group might be able to gather metrics in those three key areas by 2015.\u003c/p>\n\u003cp>\u003ca href=\"http://survey.consumerreports.org/wix1/p2857830071.aspx?&eff=95?\" target=\"_blank\">Visitors can fill out a survey \u003c/a>on their own doctor, a step toward creating a database of reviews at the individual doctor level. But user beware: When I tried it out on my own doctor, the address it showed was not the one where he practices. It turns out it was the address for the medical group itself.\u003c/p>\n\u003cp>Krackov said the upgraded CalQualityCare.org website \"aligns nicely\" with the \"open data\" movement. The more governments make data more available, it also opens up opportunities for other parties to \"innovate with this data,\" he said. Those groups could be entrepreneurs, community activists or even journalists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From Santa's perspective, the site also aligns with the Consumer Reports mission. \"We want to level the playing field,\" he said. \"We're doing exactly what the founders of Consumer Reports wanted to do in the '30s. They felt like advertising and promotion would be bad for consumers. … Given that health is filled with advertising and promotion now, it's a great era for us.\"\u003c/p>\n\n",
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"excerpt": "Say you want to buy a car. One of the first places you might think about going for ratings and reviews is Consumer Reports. For decades, the magazine has published reviews of all manner of consumer products.\r\n\r\nYou might not know it, but Consumer Reports also publishes reviews on hospitals and physician groups. Starting Wednesday Californians can access that information -- free -- on CalQualityCare.org, a website run by the nonprofit California HealthCare Foundation (CHCF). This site already features reviews of hospitals and nursing homes.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17058\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/afeman/22931745/sizes/l/\">\u003cimg class=\"size-large wp-image-17058\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/22931745_d26b74bb6c_b-640x480.jpg\" alt=\"(Andrea Marutti/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Andrea Marutti/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Say you want to buy a car. One of the first places you might think about going for ratings and reviews is Consumer Reports. For decades, the magazine has published reviews of all manner of consumer products.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We want to level the playing field\" for consumers. \u003c/aside>\n\u003cp>You might not know it, but Consumer Reports also publishes reviews on hospitals and physician groups. Starting Wednesday Californians can access that information -- free -- on \u003ca href=\"http://www.calqualitycare.org\" target=\"_blank\">CalQualityCare.org\u003c/a>, a website run by the nonprofit California HealthCare Foundation (CHCF). This site already features reviews of hospitals and nursing homes.\u003c/p>\n\u003cp>Launching just days after Jan. 1, when new insurance took effect for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/27/missed-the-monday-obamacare-deadline-you-can-still-enroll/#more-16914\" target=\"_blank\">hundreds of thousands of Californians\u003c/a> via the Covered California marketplace, the revamped site offers consumers information to help them choose hospitals, nursing homes and doctor groups.\u003c/p>\n\u003cp>\"Making this information easy to digest for the consumer is so key,\" said Andy Krackov, senior program officer for CHCF. Previously, the foundation had maintained separate websites for hospitals and long-term care facilities. In this new partnership with Consumer Reports, CHCF has merged its separate websites to create a one-stop resource for comparison data. The site has no advertising.\u003c!--more-->\u003c/p>\n\u003cp>While consumers might find it ideal to look up ratings on specific physicians, Dr. John Santa, the medical director of Consumer Reports Health, promptly pointed out the challenge in going to that level of detail. \"There's 500 cars we rate. We rate 5,000 hospitals, but 900,000 physicians (in the U.S.) is daunting,\" he said. Still, the group your doctor practices in \"is a big deal, because a lot of your care gets delivered\" by others in the practice, not just other physicians -- but nurses and medical assistants, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While the hospital and nursing home ratings leverage data that show outcomes -- including hospital readmission rates, death rates and wait times in emergency departments (just to name a few) -- the physician group ratings derive solely from patient surveys, a limited measure.\u003c/p>\n\u003cp>Santa pointed out that the \"holy grail\" of physician ratings would be to include three factors: patient experience information, measurements showing \"how good they are as clinicians,\" meaning how well they keep you healthy or care for you when you are sick and, finally, cost of care.\u003c/p>\n\u003cp>The collection of ratings information is \"a journey, not a destination,\" Santa said, and added that he hoped that his group might be able to gather metrics in those three key areas by 2015.\u003c/p>\n\u003cp>\u003ca href=\"http://survey.consumerreports.org/wix1/p2857830071.aspx?&eff=95?\" target=\"_blank\">Visitors can fill out a survey \u003c/a>on their own doctor, a step toward creating a database of reviews at the individual doctor level. But user beware: When I tried it out on my own doctor, the address it showed was not the one where he practices. It turns out it was the address for the medical group itself.\u003c/p>\n\u003cp>Krackov said the upgraded CalQualityCare.org website \"aligns nicely\" with the \"open data\" movement. The more governments make data more available, it also opens up opportunities for other parties to \"innovate with this data,\" he said. Those groups could be entrepreneurs, community activists or even journalists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From Santa's perspective, the site also aligns with the Consumer Reports mission. \"We want to level the playing field,\" he said. \"We're doing exactly what the founders of Consumer Reports wanted to do in the '30s. They felt like advertising and promotion would be bad for consumers. … Given that health is filled with advertising and promotion now, it's a great era for us.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Think the U.S. has the greatest health care system in the world?\u003c/p>\n\u003cp>Over at \u003ca href=\"http://theincidentaleconomist.com/wordpress/healthcare-triage-survival-vs-mortality-rates/\" target=\"_blank\">The Incidental Economist\u003c/a>, pediatrician, blogger and health researcher Aaron Carroll has posted a terrific video explaining why survival rates are not the best way to compare how well the U.S. system is doing against that of any other country. Check it out:\u003c/p>\n\u003cdiv>\n\u003cdiv class=\"embedly\">\n\u003cp>\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FgNiORew3uRY%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DgNiORew3uRY&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FgNiORew3uRY%2Fhqdefault.jpg&key=6c6e02c8c9d111e0ba664040d3dc5c07&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"360\">\u003c/iframe>\u003c/p>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp> \u003c/p>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>Here's the takeaway: the mortality rate is the number of people who die every year of a given cause in a specific number of people (often 100,000). The survival rate is how many people are still alive at a specific time after diagnosis.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Survival rates, Carroll explains, can be lengthened by preventing death, curing an illness or ... diagnosing the disease earlier.\u003c/p>\n\u003cp>As he explains it, suppose there were a dread disease, cancer of the thumb. No one could detect it until they felt a lump. All got chemo, but four years later, anyone who got it was dead. That's a five-year survival rate of zero.\u003c/p>\n\u003cp>Now suppose you had a super-duper scanner that could find that cancer of the thumb at the very first cell, say, five years before the patient would have felt a lump. The patients all get chemo. In other words, the treatments are unchanged. But the patients still all die four years after they would have felt the lump.\u003c/p>\n\u003cp>The five-year survival rate is close to 100 percent, but the mortality rate is unchanged.\u003c/p>\n\u003cp>Carroll also does a nifty comparison of breast cancer and prostate cancer in the U.S. and Great Britain. Sure, U.S. survival rates of both diseases beat the Brits. But, mortality rates? Not so much.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Here's the takeaway: the mortality rate is the number of people who die every year of a given cause in a specific number of people (often 100,000). The survival rate is how many people are still alive after a specific time after diagnosis. \r\n\r\nSurvival rates, Carroll explains, can be lengthened by preventing an illness (good), curing an illness (good) or diagnosing the disease earlier.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Think the U.S. has the greatest health care system in the world?\u003c/p>\n\u003cp>Over at \u003ca href=\"http://theincidentaleconomist.com/wordpress/healthcare-triage-survival-vs-mortality-rates/\" target=\"_blank\">The Incidental Economist\u003c/a>, pediatrician, blogger and health researcher Aaron Carroll has posted a terrific video explaining why survival rates are not the best way to compare how well the U.S. system is doing against that of any other country. Check it out:\u003c/p>\n\u003cdiv>\n\u003cdiv class=\"embedly\">\n\u003cp>\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FgNiORew3uRY%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DgNiORew3uRY&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FgNiORew3uRY%2Fhqdefault.jpg&key=6c6e02c8c9d111e0ba664040d3dc5c07&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"360\">\u003c/iframe>\u003c/p>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp> \u003c/p>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>Here's the takeaway: the mortality rate is the number of people who die every year of a given cause in a specific number of people (often 100,000). The survival rate is how many people are still alive at a specific time after diagnosis.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Survival rates, Carroll explains, can be lengthened by preventing death, curing an illness or ... diagnosing the disease earlier.\u003c/p>\n\u003cp>As he explains it, suppose there were a dread disease, cancer of the thumb. No one could detect it until they felt a lump. All got chemo, but four years later, anyone who got it was dead. That's a five-year survival rate of zero.\u003c/p>\n\u003cp>Now suppose you had a super-duper scanner that could find that cancer of the thumb at the very first cell, say, five years before the patient would have felt a lump. The patients all get chemo. In other words, the treatments are unchanged. But the patients still all die four years after they would have felt the lump.\u003c/p>\n\u003cp>The five-year survival rate is close to 100 percent, but the mortality rate is unchanged.\u003c/p>\n\u003cp>Carroll also does a nifty comparison of breast cancer and prostate cancer in the U.S. and Great Britain. Sure, U.S. survival rates of both diseases beat the Brits. But, mortality rates? Not so much.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Blunt, But True: Brain Death Is Death",
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"content": "\u003cfigure id=\"attachment_17011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/200281093-001-e1388799719694.jpg\">\u003cimg class=\"size-large wp-image-17011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/200281093-001-640x649.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"649\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been more than three weeks since 13-year-old Jahi McMath was \u003ca href=\"http://ww2.kqed.org/news/2013/12/23/new-medical-tests-ordered-for-brain-dead-oakland-girl\" target=\"_blank\">declared brain dead \u003c/a>after what appeared to be a tonsillectomy at Children's Hospital Oakland. In the interim, the family has battled the hospital to keep McMath's body hooked up to a ventilator while they have searched for a facility willing to accept her. Friday morning, at a hearing in Alameda Superior Court, the two sides seem to have come to \u003ca href=\"http://ww2.kqed.org/news/2014/01/03/jahi-mcmath-release/\" target=\"_blank\">an agreement\u003c/a> that the family can possibly remove her, as long as they accept full responsibility for her.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This isn't a patient with a bad prognosis. This is about someone who died. And what the family is hoping for ... is resurrection.\"\u003c/aside>\n\u003cp>But none of this changes the sad fact that Jahi McMath is dead, as experts patiently explained on \u003ca href=\"http://www.kqed.org/a/forum/R201312301000\" target=\"_blank\">KQED's Forum\u003c/a> earlier this week.\u003c/p>\n\u003cp>David Magnus, director of Stanford's Center for Biomedical Ethics, pointed to six separate independent evaluations that have all come to the same conclusion, that McMath is \"medically dead, she is legally dead.\"\u003c!--more-->\u003c/p>\n\u003cp>And here we get into how language does not clarify, but instead causes confusion. \u003ca href=\"https://www.google.com/search?client=safari&rls=en&q=McMath+life+support&ie=UTF-8&oe=UTF-8\" target=\"_blank\">Too often\u003c/a>, McMath is referred to as being on \"life support.\" But David Greer, professor of neurology at Yale's School of Medicine, says that is not an appropriate term in this case. \"She is legally dead,\" he explained. \"They are simply ventilating a body — or a corpse if you will — and putting oxygen through tissues. ... Of course, that was never the intention for these machines, just to preserve organs in this setting.\"\u003c/p>\n\u003cp>The concept of brain death \"is not a cutting-edge area of law,\" Magnus said. According to the \u003ca href=\"http://www.uniformlaws.org/ActSummary.aspx?title=Determination%20of%20Death%20Act\" target=\"_blank\">Uniform Law Commission\u003c/a>, the concept of brain death was first established in 1978 when it became clear \"that legal recognition only of traditional criteria — which rely on measuring cessation of respiration and circulation — would no longer suffice.\" In 1980, the Uniform Determination of Death Act, identified \"cardiorespiratory and brain death in accordance with the criteria the medical profession universally accepts.\" Brain death is specifically defined as \"irreversible cessation of all functioning of the brain, including the brain stem.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Over and over, host Dave Iverson and the Forum guests reiterated that this was a tragic case, that their hearts went out to the family, that losing a child is so difficult to accept. But the medical intervention going on is not benefiting Jahi, Magnus said. \"She's gone. She passed away. … What we need to do is focus on the family now.\"\u003c/p>\n\u003cp>Magnus and Greer also specified the difference between someone who is \"comatose,\" or in a \"persistent vegetative state.\" Someone who is comatose is unconscious, but very much alive. Someone in a persistent vegetative state has severe brain damage and cannot interact any more. But they can breathe on their own, and they have sleep and wake cycles. This was the case with \u003ca href=\"http://en.wikipedia.org/wiki/Terri_Schiavo_case\" target=\"_blank\">Terri Schiavo\u003c/a>. \"Terry Schiavo was alive,\" Magnus said. \"She had a horrible prognosis.\" He acknowledged the debate about \"who decides under those circumstances what should be done.\"\u003c/p>\n\u003cp>But the Schiavo case is \"fundamentally different,\" he said, from a patient who has passed away. In McMath's case, \"this isn't a patient with a bad prognosis, this isn't a patient who is highly unlikely to recover. This is about someone who died. And what the family is hoping for is a miracle. ... What they're hoping for is resurrection.\"\u003c/p>\n\u003cp>On this idea of resurrection, I found fascinating reading about McMath's case from Catholic theologians. \"Brain death is an acceptable means of determining death even from a 'pro-life' religious perspective,\" writes Beth Haile for \u003ca href=\"http://catholicmoraltheology.com/what-are-we-learning-from-the-jahi-mcmath-case/\" target=\"_blank\">Catholic Moral Theology\u003c/a>. \"Brain death criteria are acceptable according to the magisterial authority in the Roman Catholic Church.\"\u003c/p>\n\u003cp>And then she addresses the question of a miracle head-on:\u003c/p>\n\u003cp>\"Of course, God can work a miracle. But prudential medical decisions cannot be made based merely on the hope that God might choose to act miraculously.\"\u003c/p>\n\u003cp>Haile echoed the guests on Forum, who said the family needs more support to address their grief. From her post:\u003c/p>\n\u003cblockquote>\u003cp>They need to grieve their daughter, not fight for an unrealistic hope of recovery. The pro-life community needs to step up to the task here and make it clear that valid determinations of death, as it appears this one is, are not “anti-life” moves made by death panels, but scientifically and morally valid ways of recognizing a great tragedy.\u003c/p>\u003c/blockquote>\n\u003cp>To learn more about how medical professionals define brain death and to hear more about helping families cope with grief during a crisis, listen to Forum:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/127165653\" params=\"color=ff6600&auto_play=false&show_artwork=true\" width=\"100%\" height='166' iframe=\"true\" /]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/200281093-001-e1388799719694.jpg\">\u003cimg class=\"size-large wp-image-17011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/200281093-001-640x649.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"649\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been more than three weeks since 13-year-old Jahi McMath was \u003ca href=\"http://ww2.kqed.org/news/2013/12/23/new-medical-tests-ordered-for-brain-dead-oakland-girl\" target=\"_blank\">declared brain dead \u003c/a>after what appeared to be a tonsillectomy at Children's Hospital Oakland. In the interim, the family has battled the hospital to keep McMath's body hooked up to a ventilator while they have searched for a facility willing to accept her. Friday morning, at a hearing in Alameda Superior Court, the two sides seem to have come to \u003ca href=\"http://ww2.kqed.org/news/2014/01/03/jahi-mcmath-release/\" target=\"_blank\">an agreement\u003c/a> that the family can possibly remove her, as long as they accept full responsibility for her.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This isn't a patient with a bad prognosis. This is about someone who died. And what the family is hoping for ... is resurrection.\"\u003c/aside>\n\u003cp>But none of this changes the sad fact that Jahi McMath is dead, as experts patiently explained on \u003ca href=\"http://www.kqed.org/a/forum/R201312301000\" target=\"_blank\">KQED's Forum\u003c/a> earlier this week.\u003c/p>\n\u003cp>David Magnus, director of Stanford's Center for Biomedical Ethics, pointed to six separate independent evaluations that have all come to the same conclusion, that McMath is \"medically dead, she is legally dead.\"\u003c!--more-->\u003c/p>\n\u003cp>And here we get into how language does not clarify, but instead causes confusion. \u003ca href=\"https://www.google.com/search?client=safari&rls=en&q=McMath+life+support&ie=UTF-8&oe=UTF-8\" target=\"_blank\">Too often\u003c/a>, McMath is referred to as being on \"life support.\" But David Greer, professor of neurology at Yale's School of Medicine, says that is not an appropriate term in this case. \"She is legally dead,\" he explained. \"They are simply ventilating a body — or a corpse if you will — and putting oxygen through tissues. ... Of course, that was never the intention for these machines, just to preserve organs in this setting.\"\u003c/p>\n\u003cp>The concept of brain death \"is not a cutting-edge area of law,\" Magnus said. According to the \u003ca href=\"http://www.uniformlaws.org/ActSummary.aspx?title=Determination%20of%20Death%20Act\" target=\"_blank\">Uniform Law Commission\u003c/a>, the concept of brain death was first established in 1978 when it became clear \"that legal recognition only of traditional criteria — which rely on measuring cessation of respiration and circulation — would no longer suffice.\" In 1980, the Uniform Determination of Death Act, identified \"cardiorespiratory and brain death in accordance with the criteria the medical profession universally accepts.\" Brain death is specifically defined as \"irreversible cessation of all functioning of the brain, including the brain stem.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Over and over, host Dave Iverson and the Forum guests reiterated that this was a tragic case, that their hearts went out to the family, that losing a child is so difficult to accept. But the medical intervention going on is not benefiting Jahi, Magnus said. \"She's gone. She passed away. … What we need to do is focus on the family now.\"\u003c/p>\n\u003cp>Magnus and Greer also specified the difference between someone who is \"comatose,\" or in a \"persistent vegetative state.\" Someone who is comatose is unconscious, but very much alive. Someone in a persistent vegetative state has severe brain damage and cannot interact any more. But they can breathe on their own, and they have sleep and wake cycles. This was the case with \u003ca href=\"http://en.wikipedia.org/wiki/Terri_Schiavo_case\" target=\"_blank\">Terri Schiavo\u003c/a>. \"Terry Schiavo was alive,\" Magnus said. \"She had a horrible prognosis.\" He acknowledged the debate about \"who decides under those circumstances what should be done.\"\u003c/p>\n\u003cp>But the Schiavo case is \"fundamentally different,\" he said, from a patient who has passed away. In McMath's case, \"this isn't a patient with a bad prognosis, this isn't a patient who is highly unlikely to recover. This is about someone who died. And what the family is hoping for is a miracle. ... What they're hoping for is resurrection.\"\u003c/p>\n\u003cp>On this idea of resurrection, I found fascinating reading about McMath's case from Catholic theologians. \"Brain death is an acceptable means of determining death even from a 'pro-life' religious perspective,\" writes Beth Haile for \u003ca href=\"http://catholicmoraltheology.com/what-are-we-learning-from-the-jahi-mcmath-case/\" target=\"_blank\">Catholic Moral Theology\u003c/a>. \"Brain death criteria are acceptable according to the magisterial authority in the Roman Catholic Church.\"\u003c/p>\n\u003cp>And then she addresses the question of a miracle head-on:\u003c/p>\n\u003cp>\"Of course, God can work a miracle. But prudential medical decisions cannot be made based merely on the hope that God might choose to act miraculously.\"\u003c/p>\n\u003cp>Haile echoed the guests on Forum, who said the family needs more support to address their grief. From her post:\u003c/p>\n\u003cblockquote>\u003cp>They need to grieve their daughter, not fight for an unrealistic hope of recovery. The pro-life community needs to step up to the task here and make it clear that valid determinations of death, as it appears this one is, are not “anti-life” moves made by death panels, but scientifically and morally valid ways of recognizing a great tragedy.\u003c/p>\u003c/blockquote>\n\u003cp>To learn more about how medical professionals define brain death and to hear more about helping families cope with grief during a crisis, listen to Forum:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/127165653&visual=true&color=ff6600&auto_play=false&show_artwork=true'\n title='https://api.soundcloud.com/tracks/127165653'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Check Your Blood Pressure, (Unwittingly) Sell Your Contact Information",
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"content": "\u003cfigure id=\"attachment_16962\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8020_SoloHealth-scr-e1388422966166.jpg\">\u003cimg class=\"size-large wp-image-16962\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8020_SoloHealth-scr-640x487.jpg\" alt=\"(April Dembosky/KQED)\" width=\"640\" height=\"487\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don't want to rely solely on state or federal websites to find them. Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.\u003c/p>\n\u003cp>One of these kiosks sits in aisle ten of a Safeway grocery store in a city near San Francisco. It’s nestled next to the shelves of antacid and cold medicine. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. There’s a big plastic seat and foot rest for measuring weight and body mass index, a window for testing vision, and a blood pressure cuff.\u003c/p>\n\u003cp>\"Make sure the cuff comes up above your elbow,\" says an attractive brunette on screen. She is wearing a white lab coat, and her hair is pulled back in a tight bun. She asks a lot of personal questions throughout the session, like “Do you have a blood relative who was told they have a heart problem?” Or, “During the past 30 days, how many days have you felt sad or depressed?”\u003c!--more-->\u003c/p>\n\u003cp>The machines are owned by a company near Atlanta called SoloHealth. It started installing the kiosks in Walmart and other retail stores in 2008 to give people a way to keep better track of their health. Today there are more than 3,500 SoloHealth stations across the U.S. and the company plans to install another 1,500 this year. The company says more than 12,000 Californians use one every day.\u003c/p>\n\u003cp>SoloHealth first made money by selling ads for pharmacy items displayed near the kiosks. But in the era of health care reform, the company happened upon a new business model. All the data it has collected about people’s health, diet, and family disease history is suddenly very valuable to health insurance companies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“As much as we’ve moved to the market, the market has really moved to us,” says Bart Foster, CEO of SoloHealth. “We’re able to provide much more detailed information than the health plans even know what to do with today.”\u003c/p>\n\u003cp>In this case, providing means selling information about people who have used SoloHealth kiosks. For now, SoloHealth is selling just names, email addresses and phone numbers to insurers who want to market health plans directly to consumers. In the past, insurers sold most of their plans through large employer contracts. Now that all Americans are required to have insurance by March 31 or pay a penalty, insurers are looking for new ways of finding potential customers, and competing with each other to get their attention. Anthem Blue Cross is one of them. It brokered an exclusive agreement with SoloHealth to be the sole insurance company featured on kiosks throughout California.\u003c/p>\n\u003cp>“We know that engaging consumers early and engaging them with our messaging helps improve the chances of them choosing Anthem as their health plan,” says spokesperson Darrel Ng.\u003c/p>\n\u003cp>As a part of that plan, SoloHealth added a new service to its machines in October offering help with understanding the Affordable Care Act.\u003c/p>\n\u003cp>“If you would like to learn more about the upcoming changes to the health care system and how they affect you\" a male voice now says to visitors at the kiosks, \"select the 'continue' button at the bottom of the screen.\"\u003c/p>\n\u003cp>A drawing of a doctor with a stethoscope around his neck flashes and the voiceover says, “We can have an experienced professional reach out to help you find the plan that meets your specific needs.”\u003c/p>\n\u003cp>But what the friendly voice doesn’t make clear is that the “experienced professional” who will follow up is not a doctor or SoloHealth representative, but an insurance broker. That is only explained after the customer enters his or her name and email.\u003c/p>\n\u003cp>Privacy advocates say this is misleading.\u003c/p>\n\u003cp>“Consumers have every reason to be shocked this is happening,” says Pam Dixon, executive director of the nonprofit World Privacy Forum based in San Diego.\u003c/p>\n\u003cp>She says most consumers don't understand that their information is being sold. While there is a two-page health privacy disclosure, it can only be viewed by clicking a blue button at the bottom of the screen. Whether customers read it or not, they agree to all the terms when they hit a separate green button. Dixon says that’s not good enough.\u003c/p>\n\u003cp>“The fact that they’re not being told in a clear, conspicuous and prominent manner is problematic,” she says.\u003c/p>\n\u003cp>SoloHealth says it is reviewing the customer experience of its kiosks.\u003c/p>\n\u003cp>But in the wake of partnering with insurance companies SoloHealth has made another recent change. Until a couple weeks ago, the company's comprehensive privacy policy -- the policy that governs what the company can do with the data it collects -- wasn't on the machine. There was a web address provided, but since there was no internet connection at the kiosk, there was no way to actually read it. At first, SoloHealth said it was too cumbersome to scroll through the information on the small kiosk screen. But then, in mid-December, the company added the full policy to its machines. SoloHealth said the change was to improve transparency.\u003c/p>\n\u003cp>“We work with retail partners, our attorneys, and our corporate sponsors to make sure that we’re totally buttoned up,” says Foster, SoloHealth's CEO. “We have a number of very large companies that have looked at this and are very comfortable with where we are.”\u003c/p>\n\u003cp>But some consumers aren’t very comfortable. Stacey Winn has been using the kiosk at her local supermarket for the last six months to track her blood pressure. She doesn't remember ever seeing a privacy policy, even when she visited late last month. What she did notice for the first time were ads for a health insurance plan. Now she feels uneasy about her blood pressure records, weight, age, and ethnicity details being stored in the company’s database.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I wonder now what they’re doing with that information when I hadn’t really wondered that before,” she says. “There’s a saying that if a service is offered for free then you’re actually the product that’s being sold, and I think that this is turning into an example of that.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16962\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8020_SoloHealth-scr-e1388422966166.jpg\">\u003cimg class=\"size-large wp-image-16962\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8020_SoloHealth-scr-640x487.jpg\" alt=\"(April Dembosky/KQED)\" width=\"640\" height=\"487\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don't want to rely solely on state or federal websites to find them. Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.\u003c/p>\n\u003cp>One of these kiosks sits in aisle ten of a Safeway grocery store in a city near San Francisco. It’s nestled next to the shelves of antacid and cold medicine. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. There’s a big plastic seat and foot rest for measuring weight and body mass index, a window for testing vision, and a blood pressure cuff.\u003c/p>\n\u003cp>\"Make sure the cuff comes up above your elbow,\" says an attractive brunette on screen. She is wearing a white lab coat, and her hair is pulled back in a tight bun. She asks a lot of personal questions throughout the session, like “Do you have a blood relative who was told they have a heart problem?” Or, “During the past 30 days, how many days have you felt sad or depressed?”\u003c!--more-->\u003c/p>\n\u003cp>The machines are owned by a company near Atlanta called SoloHealth. It started installing the kiosks in Walmart and other retail stores in 2008 to give people a way to keep better track of their health. Today there are more than 3,500 SoloHealth stations across the U.S. and the company plans to install another 1,500 this year. The company says more than 12,000 Californians use one every day.\u003c/p>\n\u003cp>SoloHealth first made money by selling ads for pharmacy items displayed near the kiosks. But in the era of health care reform, the company happened upon a new business model. All the data it has collected about people’s health, diet, and family disease history is suddenly very valuable to health insurance companies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“As much as we’ve moved to the market, the market has really moved to us,” says Bart Foster, CEO of SoloHealth. “We’re able to provide much more detailed information than the health plans even know what to do with today.”\u003c/p>\n\u003cp>In this case, providing means selling information about people who have used SoloHealth kiosks. For now, SoloHealth is selling just names, email addresses and phone numbers to insurers who want to market health plans directly to consumers. In the past, insurers sold most of their plans through large employer contracts. Now that all Americans are required to have insurance by March 31 or pay a penalty, insurers are looking for new ways of finding potential customers, and competing with each other to get their attention. Anthem Blue Cross is one of them. It brokered an exclusive agreement with SoloHealth to be the sole insurance company featured on kiosks throughout California.\u003c/p>\n\u003cp>“We know that engaging consumers early and engaging them with our messaging helps improve the chances of them choosing Anthem as their health plan,” says spokesperson Darrel Ng.\u003c/p>\n\u003cp>As a part of that plan, SoloHealth added a new service to its machines in October offering help with understanding the Affordable Care Act.\u003c/p>\n\u003cp>“If you would like to learn more about the upcoming changes to the health care system and how they affect you\" a male voice now says to visitors at the kiosks, \"select the 'continue' button at the bottom of the screen.\"\u003c/p>\n\u003cp>A drawing of a doctor with a stethoscope around his neck flashes and the voiceover says, “We can have an experienced professional reach out to help you find the plan that meets your specific needs.”\u003c/p>\n\u003cp>But what the friendly voice doesn’t make clear is that the “experienced professional” who will follow up is not a doctor or SoloHealth representative, but an insurance broker. That is only explained after the customer enters his or her name and email.\u003c/p>\n\u003cp>Privacy advocates say this is misleading.\u003c/p>\n\u003cp>“Consumers have every reason to be shocked this is happening,” says Pam Dixon, executive director of the nonprofit World Privacy Forum based in San Diego.\u003c/p>\n\u003cp>She says most consumers don't understand that their information is being sold. While there is a two-page health privacy disclosure, it can only be viewed by clicking a blue button at the bottom of the screen. Whether customers read it or not, they agree to all the terms when they hit a separate green button. Dixon says that’s not good enough.\u003c/p>\n\u003cp>“The fact that they’re not being told in a clear, conspicuous and prominent manner is problematic,” she says.\u003c/p>\n\u003cp>SoloHealth says it is reviewing the customer experience of its kiosks.\u003c/p>\n\u003cp>But in the wake of partnering with insurance companies SoloHealth has made another recent change. Until a couple weeks ago, the company's comprehensive privacy policy -- the policy that governs what the company can do with the data it collects -- wasn't on the machine. There was a web address provided, but since there was no internet connection at the kiosk, there was no way to actually read it. At first, SoloHealth said it was too cumbersome to scroll through the information on the small kiosk screen. But then, in mid-December, the company added the full policy to its machines. SoloHealth said the change was to improve transparency.\u003c/p>\n\u003cp>“We work with retail partners, our attorneys, and our corporate sponsors to make sure that we’re totally buttoned up,” says Foster, SoloHealth's CEO. “We have a number of very large companies that have looked at this and are very comfortable with where we are.”\u003c/p>\n\u003cp>But some consumers aren’t very comfortable. Stacey Winn has been using the kiosk at her local supermarket for the last six months to track her blood pressure. She doesn't remember ever seeing a privacy policy, even when she visited late last month. What she did notice for the first time were ads for a health insurance plan. Now she feels uneasy about her blood pressure records, weight, age, and ethnicity details being stored in the company’s database.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I wonder now what they’re doing with that information when I hadn’t really wondered that before,” she says. “There’s a saying that if a service is offered for free then you’re actually the product that’s being sold, and I think that this is turning into an example of that.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "After Years of Budget Cuts, More Psychiatric Resources Coming",
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"content": "\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"excerpt": "Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\r\n\r\nFox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How California's Mentally Ill Children Suffer – Few Hospital Beds Statewide",
"title": "How California's Mentally Ill Children Suffer – Few Hospital Beds Statewide",
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"content": "\u003cp>\u003cstrong>\u003cem>\u003c/em>\u003c/strong>\u003cem>CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez's granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself -- cutting her arms and swallowing things -- before she was 10. Soon, says Ramirez, she couldn't let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”\u003c/p>\n\u003cp>Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”\u003c/p>\n\u003cp>Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She was also very anxious. The girl couldn't leave the bathroom if there was water in the tub. A wrinkled bedspread could ruin her day. By the time she was 12 she was taking medication and seeing a therapist. But she was not getting better.\u003c/p>\n\u003cp>Then one day she stabbed herself. Ramirez rushed her to a psychiatric emergency service, where she remained for days.\u003c/p>\n\u003cp>“It had been five days, and she was not getting helped,” says Ramirez. “She was confined. There was no intervention, there was no therapy, there were no services. There was nothing.“\u003c/p>\n\u003cp>Finally the girl was admitted to a child psychiatric facility.\u003c/p>\n\u003cp>\u003cstrong>No Regional Planning\u003c/strong>\u003c/p>\n\u003cp>Liz Stallings is the chief operations officer at John Muir Behavioral Health Center in Contra Costa County and expert on child mental health care. She, says the scarcity of hospital beds is a problem throughout California. “We have 12 child beds here at John Muir Behavioral Health, and they are occupied all the time from all over the state,” says Stallings.\u003c/p>\n\u003cp>Stallings, a psychiatric nurse, also chairs the California Hospital Association Center for Behavioral Health. The CHA has been sounding an alarm over the steady loss of hospital beds for adult and child psychiatric emergencies. In the entire state there are now fewer than 100 beds reserved for children 12 and under. Most of those beds are in the Bay Area or the Los Angeles basin; the overwhelming majority of California's 58 counties have no beds at all for your children experiencing a psychiatric emergency.\u003c/p>\n\u003cfigure id=\"attachment_16767\" class=\"wp-caption alignleft\" style=\"max-width: 269px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16767 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-16-at-9.25.34-PM-300x334.png\" alt=\"In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\" width=\"269\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\u003c/figcaption>\u003c/figure>\n\u003cp>This didn't happen overnight, according to Stallings. Lawmakers decentralized mental health care in the 1990s, which gave counties more local control -- at the expense of regional planning. Both private and county hospitals started closing psychiatric wards to save money. “There is no planning process,” says Stallings. “They just expect me to absorb these patients.”\u003c/p>\n\u003cp>Since John Muir's beds are always occupied, local children can wind up stalled in the ER, like Ramirez' granddaughter. Or they are sent far away, where their parents can't visit or attend family therapy.\u003c/p>\n\u003cp>It's a problem officials in some counties are working to address.\u003c/p>\n\u003cp>Gail Price was appointed to the Santa Clara County Mental Health Board after her own son's psychiatric emergency. Now she co-chairs of the Family, Adolescents & Children’s Committee At 17 he had an episode of bipolar mania, which took the entire family by surprise. “It is very anxiety-producing, and most people are not prepared for this,” says Price.\u003c/p>\n\u003cp>Price was shocked to find that wealthy Santa Clara County doesn't have a single hospital psychiatric bed for adolescents. So she rallied all her connections and finally got her son admitted to a hospital about an hour away. He’s doing better now, but Price never forgot the experience. “We're comfortable. We speak English; we have transportation and resources. We were very fortunate, but I often think of individuals who did not have the advantages we had,” says Price.\u003c/p>\n\u003cp>Some of the hospital closures were done with the best intentions: public health officials and some mental health advocates insist psychiatric patients respond better to treatment in community settings, instead of being locked in a hospital. Price says that may be true for stable patients, but in a real emergency such as her son’s, Price says people need more structured intervention. Not only that, she adds, budget cuts have left most county services, including mental health, in tatters. “Frankly, I think it's a lack of political will,” says Price. “The data's there, and it's clear we have a moral responsibility to do something.”\u003c/p>\n\u003cp>When mental illness is treated, people can recover. But left untreated, their jobs and relationships can suffer. Many people with a serious mental illness wind up homeless or in jail. Earlier this year, state lawmakers recognized that after years of deep budget cuts, they needed to shore up the mental health system. Under the leadership of Sen. Darrel Steinberg, (D-Sacramento), the legislature approved $206 million in new mental health funding.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable and the people who can help somebody get from those settings to a place where they can begin to get help,” says Steinberg.\u003c/p>\n\u003cp>Ramirez's granddaughter now lives in a psychiatric residential program for teenagers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the second of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\" rel=\"noopener noreferrer\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\" rel=\"noopener noreferrer\">psychiatric inpatient services for adults\u003c/a>. In part three, Korry looks at how \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/18/after-years-of-decline-more-psychiatric-resources-coming/\" target=\"_blank\" rel=\"noopener noreferrer\">new mental health fundin\u003c/a>g will be implemented.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"description": "CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez’s granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information. By Elaine Korry Maria Ramirez began caring for her",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>\u003cem>\u003c/em>\u003c/strong>\u003cem>CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez's granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself -- cutting her arms and swallowing things -- before she was 10. Soon, says Ramirez, she couldn't let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”\u003c/p>\n\u003cp>Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”\u003c/p>\n\u003cp>Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She was also very anxious. The girl couldn't leave the bathroom if there was water in the tub. A wrinkled bedspread could ruin her day. By the time she was 12 she was taking medication and seeing a therapist. But she was not getting better.\u003c/p>\n\u003cp>Then one day she stabbed herself. Ramirez rushed her to a psychiatric emergency service, where she remained for days.\u003c/p>\n\u003cp>“It had been five days, and she was not getting helped,” says Ramirez. “She was confined. There was no intervention, there was no therapy, there were no services. There was nothing.“\u003c/p>\n\u003cp>Finally the girl was admitted to a child psychiatric facility.\u003c/p>\n\u003cp>\u003cstrong>No Regional Planning\u003c/strong>\u003c/p>\n\u003cp>Liz Stallings is the chief operations officer at John Muir Behavioral Health Center in Contra Costa County and expert on child mental health care. She, says the scarcity of hospital beds is a problem throughout California. “We have 12 child beds here at John Muir Behavioral Health, and they are occupied all the time from all over the state,” says Stallings.\u003c/p>\n\u003cp>Stallings, a psychiatric nurse, also chairs the California Hospital Association Center for Behavioral Health. The CHA has been sounding an alarm over the steady loss of hospital beds for adult and child psychiatric emergencies. In the entire state there are now fewer than 100 beds reserved for children 12 and under. Most of those beds are in the Bay Area or the Los Angeles basin; the overwhelming majority of California's 58 counties have no beds at all for your children experiencing a psychiatric emergency.\u003c/p>\n\u003cfigure id=\"attachment_16767\" class=\"wp-caption alignleft\" style=\"max-width: 269px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16767 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-16-at-9.25.34-PM-300x334.png\" alt=\"In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\" width=\"269\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\u003c/figcaption>\u003c/figure>\n\u003cp>This didn't happen overnight, according to Stallings. Lawmakers decentralized mental health care in the 1990s, which gave counties more local control -- at the expense of regional planning. Both private and county hospitals started closing psychiatric wards to save money. “There is no planning process,” says Stallings. “They just expect me to absorb these patients.”\u003c/p>\n\u003cp>Since John Muir's beds are always occupied, local children can wind up stalled in the ER, like Ramirez' granddaughter. Or they are sent far away, where their parents can't visit or attend family therapy.\u003c/p>\n\u003cp>It's a problem officials in some counties are working to address.\u003c/p>\n\u003cp>Gail Price was appointed to the Santa Clara County Mental Health Board after her own son's psychiatric emergency. Now she co-chairs of the Family, Adolescents & Children’s Committee At 17 he had an episode of bipolar mania, which took the entire family by surprise. “It is very anxiety-producing, and most people are not prepared for this,” says Price.\u003c/p>\n\u003cp>Price was shocked to find that wealthy Santa Clara County doesn't have a single hospital psychiatric bed for adolescents. So she rallied all her connections and finally got her son admitted to a hospital about an hour away. He’s doing better now, but Price never forgot the experience. “We're comfortable. We speak English; we have transportation and resources. We were very fortunate, but I often think of individuals who did not have the advantages we had,” says Price.\u003c/p>\n\u003cp>Some of the hospital closures were done with the best intentions: public health officials and some mental health advocates insist psychiatric patients respond better to treatment in community settings, instead of being locked in a hospital. Price says that may be true for stable patients, but in a real emergency such as her son’s, Price says people need more structured intervention. Not only that, she adds, budget cuts have left most county services, including mental health, in tatters. “Frankly, I think it's a lack of political will,” says Price. “The data's there, and it's clear we have a moral responsibility to do something.”\u003c/p>\n\u003cp>When mental illness is treated, people can recover. But left untreated, their jobs and relationships can suffer. Many people with a serious mental illness wind up homeless or in jail. Earlier this year, state lawmakers recognized that after years of deep budget cuts, they needed to shore up the mental health system. Under the leadership of Sen. Darrel Steinberg, (D-Sacramento), the legislature approved $206 million in new mental health funding.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable and the people who can help somebody get from those settings to a place where they can begin to get help,” says Steinberg.\u003c/p>\n\u003cp>Ramirez's granddaughter now lives in a psychiatric residential program for teenagers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the second of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\" rel=\"noopener noreferrer\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\" rel=\"noopener noreferrer\">psychiatric inpatient services for adults\u003c/a>. In part three, Korry looks at how \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/18/after-years-of-decline-more-psychiatric-resources-coming/\" target=\"_blank\" rel=\"noopener noreferrer\">new mental health fundin\u003c/a>g will be implemented.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sharp Drop in Psychiatric Beds Leaves Severely Mentally Ill With Few Places to Go",
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"content": "\u003cfigure id=\"attachment_16713\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-e1386982312190.jpg\">\u003cimg class=\"size-large wp-image-16713 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-640x480.jpg\" alt=\"Carole Ford (Elaine Korry/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carole Ford of Lakeport, seen here in front of the community health center she runs, was often taken to hospitals far from her Lakeport home to treat her mental illness. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's another 2 to 3 hour drive.”\u003c/aside>\n\u003cp>But Ford, 71, hasn't always been so content. She had a traumatic childhood and many bouts of depression. As a younger adult adult she often felt suicidal. She recalls being dragged away to the hospital in Lake County, where she says she felt like she was dumped. There was no psychiatrist or therapist; no peer support or services of any kind.\u003c!--more-->\u003c/p>\n\u003cp>Ford was often forced to wait in the emergency room for hours for an evaluation, suffering all the while. “First of all, you hate feeling the way you're feeling -- horrible, and you can't face life.” She adds, “You're there, waiting, sort of alone in your emotions. It definitely added to my anxiety.”\u003c/p>\n\u003cp>By the time county behavioral health workers arrived for evaluations, Ford was often so upset that she was perceived to be in danger of hurting herself. So crisis workers ordered her to be hospitalized -- more than once -- without her consent for a three-day hold. Ford says it was the last thing she wanted. But it wasn't a matter of admitting her to the hospital affiliated with the emergency room. That hospital had no beds for psychiatric patients. Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's usually like another 2 to 3 hour drive,” says Ford. “Waiting, you're in limbo.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Finally, Ford says, she would be dropped off, frightened and alone, at some unfamiliar place several counties away. “The door is locked behind you and here you are, surrounded by a bunch of strangers,” says Ford. “It was horrifying.”\u003c/p>\n\u003cp>\u003cstrong>Shortage of Acute Psych Beds\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_16710\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16710 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-13-at-4.42.45-PM-300x314.png\" alt=\"Screen Shot 2013-12-13 at 4.42.45 PM\" width=\"286\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The counties colored white have no inpatient psychiatric services of any kind, according to the California Hospital Association which created this map from state data.\u003c/figcaption>\u003c/figure>\n\u003cp>The guiding principle of medicine is to do no harm. Yet, advocates for people with mental illness say they go through this sort of ordeal all the time. Some lawmakers concede there's a problem. “There are still significant holes in the system and at or near the top of the list is the shortage of acute psychiatric beds,” says Darrel Steinberg, the President Pro Tem of the California Senate.\u003c/p>\n\u003cp>Steinberg, the author of the\u003ca href=\"http://www.dmh.ca.gov/prop_63/mhsa/\" target=\"_blank\"> Mental Health Services Act\u003c/a>, and other key legislative reforms, says it wasn't supposed to be this way.\u003c/p>\n\u003cp>Advocates for reform wanted to move mental health treatment from locked hospitals to less restrictive, and less costly, community settings. The reform movement goes back to the 60s. People with schizophrenia or bipolar disorder who were once locked away in state asylums now often live with their illnesses in the community. But that reform movement may have gone too far too fast, some advocates say. Over the last 15 years, psychiatric facilities have closed in record numbers. California lost one in three hospital beds once reserved for behavioral health emergencies. At the same time funding shifted from inpatient to outpatient treatment, the system of community care never got fully built.\u003c/p>\n\u003cp>A wave of corporate hospital closures and county budget cuts resulted in California losing about 4,000 hospital beds once reserved for psychiatric emergencies. Some areas were hit harder than others. Most of the rural northern and Sierra counties have no inpatient mental health services at all.\u003c/p>\n\u003cp>\u003cstrong>\"We Do Medical Care Here\"\u003c/strong>\u003c/p>\n\u003cp>At Sutter Lakeside Hospital, in the county seat of Lakeport, you can have back surgery, or give birth, but chief administrator Siri Nelson says if you're hallucinating or suicidal, then you're out of luck. “We're not a psychiatric facility,” says Nelson. “We do medical care here.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Serious mental illness is a brain disorder which also requires proper medical care. But Nelson says there simply isn't enough demand in this small county of 65,000 people to make a psychiatric unit profitable. And that calculation affects a wide array of other county services.\u003c/p>\n\u003cp>Because there are no local beds, last year Fire Chief Willie Sapeta had to transport 200 patients out of Lake County for psychiatric treatment. “Those transports can be a four-hour turnaround time to as much as a 10- or 12-hour turnaround,” he says, “when we've had to go to Salinas or up into Humboldt or Del Norte County.”\u003c/p>\n\u003cp>And it's not just paramedics who are affected. If the patient is considered potentially dangerous, then law enforcement has to step in. Sheriff's deputies have had to monitor patients in the emergency department for 10 to 12 hours at a time before a county behavioral health worker arrives.\u003c/p>\n\u003cp>Lt. Chris Chwialkowski, with the Lake County Sheriff’s Department, says the wait is a hardship for the patient, but also for his department. “If that deputy is on overtime, you're talking about time-and-a-half,” says Chwialkowski. \"If that deputy's not on overtime, then you're taking a deputy off the street.”\u003c/p>\n\u003cp>It's a bad situation all around, says Kristy Kelly, behavioral health director for Lake County. “It's difficult for law enforcement because they may have to stand by to make sure that it's safe,” she says. “It's difficult for the ER because that's their patient and they want to move their patients on. It's difficult for the Mental Health Department because we're trying to find a placement and we're calling and calling and calling and calling, and we're getting a lot of nos.\u003c/p>\n\u003cp>With the scarcity of beds, the moment one patient is discharged from a psychiatric bed, another is moved in. So the timing has to be just right for Kelly’s people to find a vacant bed. “We just keep calling until we get a yes,” says Kelly.\u003c/p>\n\u003cp>Back at The Bridge, Ford described how she found peace. About 15 years ago, she reached out to self-help groups and embarked on what she calls a spiritual path. She is much more settled now and says it's been years since she was hospitalized.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125135790&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Editor's note: This is the first of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org\" target=\"_blank\">The California Report.\u003c/a> \u003c/em>\u003c/p>\n\n",
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"excerpt": "In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16713\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-e1386982312190.jpg\">\u003cimg class=\"size-large wp-image-16713 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-640x480.jpg\" alt=\"Carole Ford (Elaine Korry/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carole Ford of Lakeport, seen here in front of the community health center she runs, was often taken to hospitals far from her Lakeport home to treat her mental illness. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's another 2 to 3 hour drive.”\u003c/aside>\n\u003cp>But Ford, 71, hasn't always been so content. She had a traumatic childhood and many bouts of depression. As a younger adult adult she often felt suicidal. She recalls being dragged away to the hospital in Lake County, where she says she felt like she was dumped. There was no psychiatrist or therapist; no peer support or services of any kind.\u003c!--more-->\u003c/p>\n\u003cp>Ford was often forced to wait in the emergency room for hours for an evaluation, suffering all the while. “First of all, you hate feeling the way you're feeling -- horrible, and you can't face life.” She adds, “You're there, waiting, sort of alone in your emotions. It definitely added to my anxiety.”\u003c/p>\n\u003cp>By the time county behavioral health workers arrived for evaluations, Ford was often so upset that she was perceived to be in danger of hurting herself. So crisis workers ordered her to be hospitalized -- more than once -- without her consent for a three-day hold. Ford says it was the last thing she wanted. But it wasn't a matter of admitting her to the hospital affiliated with the emergency room. That hospital had no beds for psychiatric patients. Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's usually like another 2 to 3 hour drive,” says Ford. “Waiting, you're in limbo.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Finally, Ford says, she would be dropped off, frightened and alone, at some unfamiliar place several counties away. “The door is locked behind you and here you are, surrounded by a bunch of strangers,” says Ford. “It was horrifying.”\u003c/p>\n\u003cp>\u003cstrong>Shortage of Acute Psych Beds\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_16710\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16710 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-13-at-4.42.45-PM-300x314.png\" alt=\"Screen Shot 2013-12-13 at 4.42.45 PM\" width=\"286\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The counties colored white have no inpatient psychiatric services of any kind, according to the California Hospital Association which created this map from state data.\u003c/figcaption>\u003c/figure>\n\u003cp>The guiding principle of medicine is to do no harm. Yet, advocates for people with mental illness say they go through this sort of ordeal all the time. Some lawmakers concede there's a problem. “There are still significant holes in the system and at or near the top of the list is the shortage of acute psychiatric beds,” says Darrel Steinberg, the President Pro Tem of the California Senate.\u003c/p>\n\u003cp>Steinberg, the author of the\u003ca href=\"http://www.dmh.ca.gov/prop_63/mhsa/\" target=\"_blank\"> Mental Health Services Act\u003c/a>, and other key legislative reforms, says it wasn't supposed to be this way.\u003c/p>\n\u003cp>Advocates for reform wanted to move mental health treatment from locked hospitals to less restrictive, and less costly, community settings. The reform movement goes back to the 60s. People with schizophrenia or bipolar disorder who were once locked away in state asylums now often live with their illnesses in the community. But that reform movement may have gone too far too fast, some advocates say. Over the last 15 years, psychiatric facilities have closed in record numbers. California lost one in three hospital beds once reserved for behavioral health emergencies. At the same time funding shifted from inpatient to outpatient treatment, the system of community care never got fully built.\u003c/p>\n\u003cp>A wave of corporate hospital closures and county budget cuts resulted in California losing about 4,000 hospital beds once reserved for psychiatric emergencies. Some areas were hit harder than others. Most of the rural northern and Sierra counties have no inpatient mental health services at all.\u003c/p>\n\u003cp>\u003cstrong>\"We Do Medical Care Here\"\u003c/strong>\u003c/p>\n\u003cp>At Sutter Lakeside Hospital, in the county seat of Lakeport, you can have back surgery, or give birth, but chief administrator Siri Nelson says if you're hallucinating or suicidal, then you're out of luck. “We're not a psychiatric facility,” says Nelson. “We do medical care here.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Serious mental illness is a brain disorder which also requires proper medical care. But Nelson says there simply isn't enough demand in this small county of 65,000 people to make a psychiatric unit profitable. And that calculation affects a wide array of other county services.\u003c/p>\n\u003cp>Because there are no local beds, last year Fire Chief Willie Sapeta had to transport 200 patients out of Lake County for psychiatric treatment. “Those transports can be a four-hour turnaround time to as much as a 10- or 12-hour turnaround,” he says, “when we've had to go to Salinas or up into Humboldt or Del Norte County.”\u003c/p>\n\u003cp>And it's not just paramedics who are affected. If the patient is considered potentially dangerous, then law enforcement has to step in. Sheriff's deputies have had to monitor patients in the emergency department for 10 to 12 hours at a time before a county behavioral health worker arrives.\u003c/p>\n\u003cp>Lt. Chris Chwialkowski, with the Lake County Sheriff’s Department, says the wait is a hardship for the patient, but also for his department. “If that deputy is on overtime, you're talking about time-and-a-half,” says Chwialkowski. \"If that deputy's not on overtime, then you're taking a deputy off the street.”\u003c/p>\n\u003cp>It's a bad situation all around, says Kristy Kelly, behavioral health director for Lake County. “It's difficult for law enforcement because they may have to stand by to make sure that it's safe,” she says. “It's difficult for the ER because that's their patient and they want to move their patients on. It's difficult for the Mental Health Department because we're trying to find a placement and we're calling and calling and calling and calling, and we're getting a lot of nos.\u003c/p>\n\u003cp>With the scarcity of beds, the moment one patient is discharged from a psychiatric bed, another is moved in. So the timing has to be just right for Kelly’s people to find a vacant bed. “We just keep calling until we get a yes,” says Kelly.\u003c/p>\n\u003cp>Back at The Bridge, Ford described how she found peace. About 15 years ago, she reached out to self-help groups and embarked on what she calls a spiritual path. She is much more settled now and says it's been years since she was hospitalized.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125135790&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: This is the first of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org\" target=\"_blank\">The California Report.\u003c/a> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Does Climate Change Have to Do with Health? Plenty",
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"content": "\u003cfigure id=\"attachment_16665\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2860_smog-scr-e1386893175781.jpg\">\u003cimg class=\"size-large wp-image-16665\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2860_smog-scr-640x426.jpg\" alt=\"A smoggy sunset in San Diego. (Sandy Huffaker/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A smoggy sunset in San Diego. (Sandy Huffaker/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>When people think of climate change, they tend to think of it as a science and environmental issue. But climbing levels of greenhouse gases, particulate matter, and rising seas hurts more than the environment. It harms people's health, too.\u003c/p>\n\u003cp>“Climate change is one of greatest public health threats of our time,\" said Anne Kelsey Lamb of Oakland's Public Health Institute.\u003c/p>\n\u003cp>Lamb was talking to a roomful of her own in a gathering this week when some 100 public health professionals from around the state and beyond were in Oakland to learn more about the intersection \u003ca href=\"http://climatehealthconnect.org/resource/framework-climate-change-and-health-opportunities-action\" target=\"_blank\">between climate change and public health\u003c/a> — and what they can do about it.\u003c!--more-->\u003c/p>\n\u003cp>While it's impossible to tie any specific illness or death to climate change, it's easy to imagine how the worst effects of global warming harm health. Here are just a few examples: deaths related to heat waves (\u003ca href=\"http://www.cdph.ca.gov/HealthInfo/injviosaf/Documents/HeatPlanAssessment-EPIC.pdf\" target=\"_blank\">140 people died\u003c/a> in the 2006 heat wave in California); a warming planet also \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/16/doctors-expect-climate-change-to-worsen-lung-diseases/\" target=\"_blank\">leads to more pollen\u003c/a>, which aggravates asthma; and climate change \u003ca href=\"http://www.californiareport.org/archive/R201209120850/b\" target=\"_blank\">can mean more mosquitoes\u003c/a> and an easier spread of the diseases they can transmit.\u003c/p>\n\u003cp>Who will bear the brunt of these changes? Climate change \"threatens to exacerbate existing inequities,\" said PHI's Linda Rudolph, disproportionately impacting people who are poor and people of color.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rudolph is the co-director of PHI's Climate Change and Public Health Project, and she's aiming to start a movement. There's been \"no coherent strategy,\" she said, from the health community on climate change. \"There's a critical window of opportunity right now,\" she said. \"We can seize that opportunity to build a movement to reduce climate change and build healthy communities or stick our heads in the sand.\"\u003c/p>\n\u003cp>With that, she unveiled a \"framework\" to help public health professionals see where they could make a difference. Fair warning before you click, \u003ca href=\"http://climatehealthconnect.org/sites/climatehealthconnect.org/files/resources/ClimateHealthDiagram.Layer08.pdf\" target=\"_blank\">the framework\u003c/a> is something only a public health professional could love. Initially it made about as much sense to me as this \u003ca href=\"http://www.flickr.com/photos/13649621@N00/3428577561/in/photolist-6dYmEe-6eK1dA-6rM5dB-6w1XsR-6yE65A-6yE6mW-6ALHci-6ALHcr-6ALHcB-6BsPdV-6BwYpu-6EWQ7F-6HLjgt-6JAhtk-6JAhv8-6TxESg-6X4tnQ-77X5Vp-7fUBK6-7kthcR-83Ls38-9WqHt1-dA28AU-914syp-arx6kw-8NveDf-9bNS3g-bzicgi-dgHLq4-cDj4UW-8AUEkM-7Gq9T1-e3Z1ic-9YkiXE-eDUj5A-bYJoqG-aTnnBH-aTnr94-aTnwvx-aTnySM-9tEMnU-82aD43-7GnSmW-7MvJXU-buXryS-dBRxXp-cCb1Du-cJCPNb-827uEk-82aCzu-827vbF\" target=\"_blank\">circuit board\u003c/a>, but once Rudolph walked us all through it, I started to be able to follow the paths, too.\u003c/p>\n\u003cp>The main takeaway, Rudolph argued, is that there are all kinds of levers along the climate trajectory where public health folks can do their jobs and achieve \"co-benefits.\" For example, \"urban greening\" can lead to better air quality — but it also leads to higher property values and green space for physical activity, which both improve a neighborhood and give individuals the space to lead more active lives. Or think of getting people out of their cars urging them to bike or walk where they need to go. Fewer cars on the road means less air pollution — and people out of their cars and moving improves health.\u003c/p>\n\u003cp>\"The health co-benefits are a huge piece\" that needs more attention, said Dr. Ron Chapman, director of the California Department of Public Health.\u003c/p>\n\u003cp>Perhaps the greatest challenges come in moving \"upstream\" — toward policy and systemic changes, which can \"affect the root causes of climate change,\" Rudolph said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But it's not easily accomplished. This work is \"really complex, really challenging,\" Chapman said. But the more \"we've been able to tie climate change to health impacts, the more public health gets on board.\"\u003c/p>\n\n",
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"excerpt": "When people think of climate change, they tend to think of it as a science and environmental issue. But climbing levels of greenhouse gases, particulate matter, and rising seas hurts more than the environment. It harms people's health, too.\r\n\r\n“Climate change is one of greatest public health threats of our time,\" said Anne Kelsey Lamb of Oakland's Public Health Institute.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16665\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2860_smog-scr-e1386893175781.jpg\">\u003cimg class=\"size-large wp-image-16665\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2860_smog-scr-640x426.jpg\" alt=\"A smoggy sunset in San Diego. (Sandy Huffaker/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A smoggy sunset in San Diego. (Sandy Huffaker/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>When people think of climate change, they tend to think of it as a science and environmental issue. But climbing levels of greenhouse gases, particulate matter, and rising seas hurts more than the environment. It harms people's health, too.\u003c/p>\n\u003cp>“Climate change is one of greatest public health threats of our time,\" said Anne Kelsey Lamb of Oakland's Public Health Institute.\u003c/p>\n\u003cp>Lamb was talking to a roomful of her own in a gathering this week when some 100 public health professionals from around the state and beyond were in Oakland to learn more about the intersection \u003ca href=\"http://climatehealthconnect.org/resource/framework-climate-change-and-health-opportunities-action\" target=\"_blank\">between climate change and public health\u003c/a> — and what they can do about it.\u003c!--more-->\u003c/p>\n\u003cp>While it's impossible to tie any specific illness or death to climate change, it's easy to imagine how the worst effects of global warming harm health. Here are just a few examples: deaths related to heat waves (\u003ca href=\"http://www.cdph.ca.gov/HealthInfo/injviosaf/Documents/HeatPlanAssessment-EPIC.pdf\" target=\"_blank\">140 people died\u003c/a> in the 2006 heat wave in California); a warming planet also \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/16/doctors-expect-climate-change-to-worsen-lung-diseases/\" target=\"_blank\">leads to more pollen\u003c/a>, which aggravates asthma; and climate change \u003ca href=\"http://www.californiareport.org/archive/R201209120850/b\" target=\"_blank\">can mean more mosquitoes\u003c/a> and an easier spread of the diseases they can transmit.\u003c/p>\n\u003cp>Who will bear the brunt of these changes? Climate change \"threatens to exacerbate existing inequities,\" said PHI's Linda Rudolph, disproportionately impacting people who are poor and people of color.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rudolph is the co-director of PHI's Climate Change and Public Health Project, and she's aiming to start a movement. There's been \"no coherent strategy,\" she said, from the health community on climate change. \"There's a critical window of opportunity right now,\" she said. \"We can seize that opportunity to build a movement to reduce climate change and build healthy communities or stick our heads in the sand.\"\u003c/p>\n\u003cp>With that, she unveiled a \"framework\" to help public health professionals see where they could make a difference. Fair warning before you click, \u003ca href=\"http://climatehealthconnect.org/sites/climatehealthconnect.org/files/resources/ClimateHealthDiagram.Layer08.pdf\" target=\"_blank\">the framework\u003c/a> is something only a public health professional could love. Initially it made about as much sense to me as this \u003ca href=\"http://www.flickr.com/photos/13649621@N00/3428577561/in/photolist-6dYmEe-6eK1dA-6rM5dB-6w1XsR-6yE65A-6yE6mW-6ALHci-6ALHcr-6ALHcB-6BsPdV-6BwYpu-6EWQ7F-6HLjgt-6JAhtk-6JAhv8-6TxESg-6X4tnQ-77X5Vp-7fUBK6-7kthcR-83Ls38-9WqHt1-dA28AU-914syp-arx6kw-8NveDf-9bNS3g-bzicgi-dgHLq4-cDj4UW-8AUEkM-7Gq9T1-e3Z1ic-9YkiXE-eDUj5A-bYJoqG-aTnnBH-aTnr94-aTnwvx-aTnySM-9tEMnU-82aD43-7GnSmW-7MvJXU-buXryS-dBRxXp-cCb1Du-cJCPNb-827uEk-82aCzu-827vbF\" target=\"_blank\">circuit board\u003c/a>, but once Rudolph walked us all through it, I started to be able to follow the paths, too.\u003c/p>\n\u003cp>The main takeaway, Rudolph argued, is that there are all kinds of levers along the climate trajectory where public health folks can do their jobs and achieve \"co-benefits.\" For example, \"urban greening\" can lead to better air quality — but it also leads to higher property values and green space for physical activity, which both improve a neighborhood and give individuals the space to lead more active lives. Or think of getting people out of their cars urging them to bike or walk where they need to go. Fewer cars on the road means less air pollution — and people out of their cars and moving improves health.\u003c/p>\n\u003cp>\"The health co-benefits are a huge piece\" that needs more attention, said Dr. Ron Chapman, director of the California Department of Public Health.\u003c/p>\n\u003cp>Perhaps the greatest challenges come in moving \"upstream\" — toward policy and systemic changes, which can \"affect the root causes of climate change,\" Rudolph said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But it's not easily accomplished. This work is \"really complex, really challenging,\" Chapman said. But the more \"we've been able to tie climate change to health impacts, the more public health gets on board.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Health Insurance in the Bay Area Costs More Than in SoCal",
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"content": "\u003cfigure id=\"attachment_16504\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2629_goldengatebridge20121009-scr-e1386097321558.jpg\">\u003cimg class=\"size-large wp-image-16504\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2629_goldengatebridge20121009-scr-640x427.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at the New York Times, Elisabeth Rosenthal continues her terrific series on the high cost of health care in America. Tuesday's installment is a \u003ca href=\"http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?hp&_r=0\" target=\"_blank\">deeply-reported look \u003c/a>into the murky world of hospital prices, where a \"stitch tops $500,\" says the headline.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The lowest-cost silver-tier plan costs 26 percent more in Alameda County vs. Orange County.\u003c/aside>\n\u003cp>But it's where Rosenthal sets most of her reporting that makes the story a must-read for anyone in the Bay Area. She profiles patients receiving care at California Pacific Medical Center, a Sutter Health hospital -- and her piece indirectly brings up the question of higher health insurance premiums here.\u003c/p>\n\u003cp>These higher premiums were made evident when Covered California released its plans for all the 19 \"rating regions\" of the state. In Alameda County, for example, the \"silver tier\" premiums for a 40-year-old range from $317 to $365. In Orange County, the range is $252 to $290 and Kaiser coming in at a high of $332. In other words, the lowest-cost silver-tier plan is 26 percent more expensive in Alameda County vs. Orange County.\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, is quoted throughout the Times piece, and I called him Tuesday morning to talk about this NorCal vs. SoCal difference. \"I would say that hospital prices represent a disproportionate share of that differential,\" he said, and added that premiums are higher in the Bay Area even after accounting for the higher cost of living here.\u003c!--more-->\u003c/p>\n\u003cp>Why do hospitals matter so much? Because the Bay Area has a leader in hospital consolidation and development of hospital systems: Sutter Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Sutter is \"a pioneer -- in figuring out how to amass market power to raise prices and decrease competition,\" Melnick told Rosenthal.\u003c/p>\n\u003cp>To state the obvious, higher prices and decreased competition from hospitals leads to higher health insurance premiums. Remember that most Californians receive health insurance from their employers, but businesses are virtually powerless to negotiate better prices from insurers, because \"Sutter contracts include 'gag clauses' that prevent employers from knowing what rates have been negotiated by their insurers on their behalf,\" David Lansky told Rosenthal. He's CEO of the Pacific Business Group on Health, which represents 60 of the state's largest employers in health care negotiations.\u003c/p>\n\u003cp>\"Our members are very exercised about Sutter -- it has increased prices disproportionately,\" Lansky also said. \"Sutter has been successfully at leveraging their huge size in dictating not just price but contract terms.\" Rosenthal reports that when Sutter bought Oakland's Summit Hospital in 1999, \"rates there went up 29 percent to 72 percent, researchers found.\"\u003c/p>\n\u003cp>Melnick acknowledged that the physician market is less competitive here as well, but he said that hospitals are easier to study and document. Sutter has 25 hospitals in northern California. If Sutter has the only hospital in one community and an insurer must have it, Sutter insists the carrier take all 25, even if their prices in other, more competitive communities, are higher than the insurer wants to pay, Melnick said.\u003c/p>\n\u003cp>From the Times:\u003c/p>\n\u003cblockquote>\u003cp>“Hospitals are self-fueling, ever-expanding machines,” said James Robinson, an economist and professor of health policy at the University of California, Berkeley. “There is an infinite amount of stuff to buy — amenities, machines, new wings, higher salaries, more nurses.\" ...\u003c/p>\n\u003cp>The high prices have had a ripple effect across Northern California, allowing smaller hospitals to charge more as well. “Sutter is the tallest Sequoia and everyone goes up just underneath them a bit,” said Professor Melnick. He noted that hospital prices in California had more than doubled in the past decade, after adjustment for inflation.\u003c/p>\u003c/blockquote>\n\u003cp>But there's no correlation between higher prices and better care. \"In fact,\" Rosenthal reports, \"a recent study in the publication Annals of Surgery, a monthly review of surgical science, found that hospitals with the highest complication rates tended to have higher prices.\"\u003c/p>\n\u003cp>Pay more for worse care. This is American medicine.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16504\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2629_goldengatebridge20121009-scr-e1386097321558.jpg\">\u003cimg class=\"size-large wp-image-16504\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS2629_goldengatebridge20121009-scr-640x427.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at the New York Times, Elisabeth Rosenthal continues her terrific series on the high cost of health care in America. Tuesday's installment is a \u003ca href=\"http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?hp&_r=0\" target=\"_blank\">deeply-reported look \u003c/a>into the murky world of hospital prices, where a \"stitch tops $500,\" says the headline.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The lowest-cost silver-tier plan costs 26 percent more in Alameda County vs. Orange County.\u003c/aside>\n\u003cp>But it's where Rosenthal sets most of her reporting that makes the story a must-read for anyone in the Bay Area. She profiles patients receiving care at California Pacific Medical Center, a Sutter Health hospital -- and her piece indirectly brings up the question of higher health insurance premiums here.\u003c/p>\n\u003cp>These higher premiums were made evident when Covered California released its plans for all the 19 \"rating regions\" of the state. In Alameda County, for example, the \"silver tier\" premiums for a 40-year-old range from $317 to $365. In Orange County, the range is $252 to $290 and Kaiser coming in at a high of $332. In other words, the lowest-cost silver-tier plan is 26 percent more expensive in Alameda County vs. Orange County.\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, is quoted throughout the Times piece, and I called him Tuesday morning to talk about this NorCal vs. SoCal difference. \"I would say that hospital prices represent a disproportionate share of that differential,\" he said, and added that premiums are higher in the Bay Area even after accounting for the higher cost of living here.\u003c!--more-->\u003c/p>\n\u003cp>Why do hospitals matter so much? Because the Bay Area has a leader in hospital consolidation and development of hospital systems: Sutter Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sutter is \"a pioneer -- in figuring out how to amass market power to raise prices and decrease competition,\" Melnick told Rosenthal.\u003c/p>\n\u003cp>To state the obvious, higher prices and decreased competition from hospitals leads to higher health insurance premiums. Remember that most Californians receive health insurance from their employers, but businesses are virtually powerless to negotiate better prices from insurers, because \"Sutter contracts include 'gag clauses' that prevent employers from knowing what rates have been negotiated by their insurers on their behalf,\" David Lansky told Rosenthal. He's CEO of the Pacific Business Group on Health, which represents 60 of the state's largest employers in health care negotiations.\u003c/p>\n\u003cp>\"Our members are very exercised about Sutter -- it has increased prices disproportionately,\" Lansky also said. \"Sutter has been successfully at leveraging their huge size in dictating not just price but contract terms.\" Rosenthal reports that when Sutter bought Oakland's Summit Hospital in 1999, \"rates there went up 29 percent to 72 percent, researchers found.\"\u003c/p>\n\u003cp>Melnick acknowledged that the physician market is less competitive here as well, but he said that hospitals are easier to study and document. Sutter has 25 hospitals in northern California. If Sutter has the only hospital in one community and an insurer must have it, Sutter insists the carrier take all 25, even if their prices in other, more competitive communities, are higher than the insurer wants to pay, Melnick said.\u003c/p>\n\u003cp>From the Times:\u003c/p>\n\u003cblockquote>\u003cp>“Hospitals are self-fueling, ever-expanding machines,” said James Robinson, an economist and professor of health policy at the University of California, Berkeley. “There is an infinite amount of stuff to buy — amenities, machines, new wings, higher salaries, more nurses.\" ...\u003c/p>\n\u003cp>The high prices have had a ripple effect across Northern California, allowing smaller hospitals to charge more as well. “Sutter is the tallest Sequoia and everyone goes up just underneath them a bit,” said Professor Melnick. He noted that hospital prices in California had more than doubled in the past decade, after adjustment for inflation.\u003c/p>\u003c/blockquote>\n\u003cp>But there's no correlation between higher prices and better care. \"In fact,\" Rosenthal reports, \"a recent study in the publication Annals of Surgery, a monthly review of surgical science, found that hospitals with the highest complication rates tended to have higher prices.\"\u003c/p>\n\u003cp>Pay more for worse care. This is American medicine.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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