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"disqusTitle": "Proposition 29: First Cigarette Tax Increase in 13 Years. Yes or No?",
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"content": "\u003cp>\u003cstrong>By Sarah Varney\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5939\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Cigarette_Ferran-Jorda_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5939\" title=\"(Ferran Jorda: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Cigarette_Ferran-Jorda_Flickr-300x225.jpg\" alt=\"(Ferran Jorda: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ferran Jorda: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>California voters are schizophrenic when it comes to regulating smoking. Polls show broad support for bans on smoking on sidewalks and public parks. Some cities have even outlawed smoking in apartment buildings.\u003c/p>\n\u003cp>But in 2006, the state's voters rejected a ballot measure to hike cigarette taxes. While California was once the most aggressive state in taxing cigarettes, the tax rate here is lower than that of 32 other states. At 87 cents a pack, California's cigarette taxes are 60 cents lower than the national average.\u003c/p>\n\u003cp>Proposition 29 -- on the ballot June 5 -- would change that. It would raise the tax on cigarettes to almost $2 a pack.\u003c/p>\n\u003cp>\u003ca title=\"http://www.lung.org/associations/states/california/about-us/leadership-staff-team.html\" href=\"http://www.lung.org/associations/states/california/about-us/leadership-staff-team.html\" target=\"_blank\">Jane Warner\u003c/a>, president of the American Lung Association of California, hopes voters will be game to raise tobacco taxes when they decide the fate of Prop 29. \"We've made this initiative very simple,\" she says. \"It was written by the American Lung Association, the American Cancer Society and the American Heart Association. It is very simple, very clear -- to save lives.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca title=\"http://www.cdc.gov/media/mmwrnews/2012/0329.html#1\" href=\"http://www.cdc.gov/media/mmwrnews/2012/0329.html#1\" target=\"_blank\">Centers for Disease Control has found\u003c/a> increasing the price of cigarettes reduces demand. Teenagers are especially sensitive to price, so if the tax is approved, fewer of them would pick up the habit. Right now about 12 percent of Californians smoke. That rate could drop significantly if Prop 29 is approved.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>There's also a financial bonus. The state’s \u003ca title=\"http://www.lao.ca.gov/ballot/2012/29_05_2012.pdf\" href=\"http://www.lao.ca.gov/ballot/2012/29_05_2012.pdf\" target=\"_blank\">Legislative Analyst Office\u003c/a> estimates the measure will provide more than $700 million dollars annually in revenue.\u003c/p>\n\u003cp>Some of the money will go to anti-smoking programs and enforcing tobacco laws. But the bulk of it will fund medical research on cancer and other tobacco-related illnesses. Warner says that’s only fair.\u003c/p>\n\u003cp>\"Those of us who don’t smoke in California, we’re paying the bill,\" Warner added. \"We’re paying billions of dollars in health care costs because of smoking and it is preventable.\"\u003c/p>\n\u003cp>If fewer people smoke, tobacco companies will lose money, and they’re spending mightily to stop Proposition 29. Phillip Morris, R.J. Reynolds, and others have, so far, poured $40 million into defeating the June ballot measure, more than five times their opponents.\u003c/p>\n\u003cp>Tobacco companies, though, are keeping a low profile. An R.J. Reynolds spokesman referred media calls to a coalition of \u003ca title=\"http://www.noon29.com/\" href=\"http://www.noon29.com/\" target=\"_blank\">anti-tax groups\u003c/a> which are the campaign’s public face. \u003ca title=\"http://cagop.org/boradofdirectorsinner.asp?z=5A5F\" href=\"http://cagop.org/boradofdirectorsinner.asp?z=5A5F\" target=\"_blank\">Tom Del Beccaro\u003c/a> chairman of the California Republican Party, says Californians can’t afford a higher tax burden than they already have. \"I’m fond of saying, If you can’t afford the mortgage, you shouldn’t be doing any additions to the house. This is an addition.\"\u003c/p>\n\u003cp>He says the funds dedicated to medical research would create a new state bureaucracy at a time when California can’t manage its current slate of programs.\u003c/p>\n\u003cp>\"Any new government program,\" Del Beccaro says, \"where you are taking money out of people’s pockets is only going to drag California down further. So quite apart from the specific issue, Californians can’t afford this.\"\u003c/p>\n\u003cp>\u003ca title=\"http://newamerica.net/user/94\" href=\"http://newamerica.net/user/94\" target=\"_blank\">Joe Mathews\u003c/a> is a fellow at the New America Foundation and an expert on California's initiative process. \"This is kind of the vanilla ice cream with chocolate on top that should pass by natural rights, but may not.\" The problem, he says, is the idea of having \"gold-plated\" programs while gutting core health programs is problematic for some voters.\u003c/p>\n\u003cp>\"I think that’s an argument that may have some traction politically,\" Matthews adds. \"It’s certainly an argument that has lot of merit policy wise.\"\u003c/p>\n\u003cp>Health groups say they’ve tried to raise the cigarette tax through the state legislature nearly three dozen times and have offered to put much of the money into the state’s general fund. Those efforts, the groups say, could never overcome Republican opposition to raising taxes, even one targeted at smokers.\u003c/p>\n\u003cp>The library at the University of California, San Francisco houses previously secret tobacco company documents made public as part of a historic industry settlement. There, professor of medicine and tobacco researcher \u003ca title=\"http://cancer.ucsf.edu/people/glantz_stanton.php\" href=\"http://cancer.ucsf.edu/people/glantz_stanton.php\" target=\"_blank\">Stan Glantz\u003c/a> points to a series of state-sponsored anti-smoking ads that parody the well-known Marlboro Cowboy.\u003c/p>\n\u003cp>\"One is a cowboy looking at his horse saying, 'Chemotherapy scares me Scout,'\" he described. \"Another one is two cowboys riding off into the sunset saying, 'I miss my lung Bob.'\"\u003c/p>\n\u003cp>During the 1990s, billboards like these blanketed the state. Now Glantz says, the cigarette tax has remained the same since 1999 but the cost of advertising has gone up. So ads like the cancer-stricken cowboys are rare.\u003c/p>\n\u003cp>\"When you're running a tobacco control program, especially a media campaign, if you have the world’s best ads and not enough money for people to see them, they don’t work.\"\u003c/p>\n\u003cp>With tens of millions of dollars going into the fight over the tobacco tax measure, it’s unlikely any California voter could avoid ads this election season.\u003c/p>\n\u003cp>\u003cstrong>Learn More \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>To see how California's cigarette rates compare to other states, visit KQED's \u003ca title=\"http://blogs.kqed.org/lowdown/2012/05/18/prop-29-should-smoking-in-california-be-more-expensive/\" href=\"http://blogs.kqed.org/lowdown/2012/05/18/prop-29-should-smoking-in-california-be-more-expensive/\" target=\"_blank\">The Lowdown.\u003c/a> The blog has non-partisan links to voter information, too.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.cdc.gov/media/mmwrnews/2012/0329.html#1\" href=\"http://www.cdc.gov/media/mmwrnews/2012/0329.html#1\" target=\"_blank\">Centers for Disease Control has found\u003c/a> increasing the price of cigarettes reduces demand. Teenagers are especially sensitive to price, so if the tax is approved, fewer of them would pick up the habit. Right now about 12 percent of Californians smoke. That rate could drop significantly if Prop 29 is approved.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>There's also a financial bonus. The state’s \u003ca title=\"http://www.lao.ca.gov/ballot/2012/29_05_2012.pdf\" href=\"http://www.lao.ca.gov/ballot/2012/29_05_2012.pdf\" target=\"_blank\">Legislative Analyst Office\u003c/a> estimates the measure will provide more than $700 million dollars annually in revenue.\u003c/p>\n\u003cp>Some of the money will go to anti-smoking programs and enforcing tobacco laws. But the bulk of it will fund medical research on cancer and other tobacco-related illnesses. Warner says that’s only fair.\u003c/p>\n\u003cp>\"Those of us who don’t smoke in California, we’re paying the bill,\" Warner added. \"We’re paying billions of dollars in health care costs because of smoking and it is preventable.\"\u003c/p>\n\u003cp>If fewer people smoke, tobacco companies will lose money, and they’re spending mightily to stop Proposition 29. Phillip Morris, R.J. Reynolds, and others have, so far, poured $40 million into defeating the June ballot measure, more than five times their opponents.\u003c/p>\n\u003cp>Tobacco companies, though, are keeping a low profile. An R.J. Reynolds spokesman referred media calls to a coalition of \u003ca title=\"http://www.noon29.com/\" href=\"http://www.noon29.com/\" target=\"_blank\">anti-tax groups\u003c/a> which are the campaign’s public face. \u003ca title=\"http://cagop.org/boradofdirectorsinner.asp?z=5A5F\" href=\"http://cagop.org/boradofdirectorsinner.asp?z=5A5F\" target=\"_blank\">Tom Del Beccaro\u003c/a> chairman of the California Republican Party, says Californians can’t afford a higher tax burden than they already have. \"I’m fond of saying, If you can’t afford the mortgage, you shouldn’t be doing any additions to the house. This is an addition.\"\u003c/p>\n\u003cp>He says the funds dedicated to medical research would create a new state bureaucracy at a time when California can’t manage its current slate of programs.\u003c/p>\n\u003cp>\"Any new government program,\" Del Beccaro says, \"where you are taking money out of people’s pockets is only going to drag California down further. So quite apart from the specific issue, Californians can’t afford this.\"\u003c/p>\n\u003cp>\u003ca title=\"http://newamerica.net/user/94\" href=\"http://newamerica.net/user/94\" target=\"_blank\">Joe Mathews\u003c/a> is a fellow at the New America Foundation and an expert on California's initiative process. \"This is kind of the vanilla ice cream with chocolate on top that should pass by natural rights, but may not.\" The problem, he says, is the idea of having \"gold-plated\" programs while gutting core health programs is problematic for some voters.\u003c/p>\n\u003cp>\"I think that’s an argument that may have some traction politically,\" Matthews adds. \"It’s certainly an argument that has lot of merit policy wise.\"\u003c/p>\n\u003cp>Health groups say they’ve tried to raise the cigarette tax through the state legislature nearly three dozen times and have offered to put much of the money into the state’s general fund. Those efforts, the groups say, could never overcome Republican opposition to raising taxes, even one targeted at smokers.\u003c/p>\n\u003cp>The library at the University of California, San Francisco houses previously secret tobacco company documents made public as part of a historic industry settlement. There, professor of medicine and tobacco researcher \u003ca title=\"http://cancer.ucsf.edu/people/glantz_stanton.php\" href=\"http://cancer.ucsf.edu/people/glantz_stanton.php\" target=\"_blank\">Stan Glantz\u003c/a> points to a series of state-sponsored anti-smoking ads that parody the well-known Marlboro Cowboy.\u003c/p>\n\u003cp>\"One is a cowboy looking at his horse saying, 'Chemotherapy scares me Scout,'\" he described. \"Another one is two cowboys riding off into the sunset saying, 'I miss my lung Bob.'\"\u003c/p>\n\u003cp>During the 1990s, billboards like these blanketed the state. Now Glantz says, the cigarette tax has remained the same since 1999 but the cost of advertising has gone up. So ads like the cancer-stricken cowboys are rare.\u003c/p>\n\u003cp>\"When you're running a tobacco control program, especially a media campaign, if you have the world’s best ads and not enough money for people to see them, they don’t work.\"\u003c/p>\n\u003cp>With tens of millions of dollars going into the fight over the tobacco tax measure, it’s unlikely any California voter could avoid ads this election season.\u003c/p>\n\u003cp>\u003cstrong>Learn More \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>To see how California's cigarette rates compare to other states, visit KQED's \u003ca title=\"http://blogs.kqed.org/lowdown/2012/05/18/prop-29-should-smoking-in-california-be-more-expensive/\" href=\"http://blogs.kqed.org/lowdown/2012/05/18/prop-29-should-smoking-in-california-be-more-expensive/\" target=\"_blank\">The Lowdown.\u003c/a> The blog has non-partisan links to voter information, too.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Governor's New Budget Slices -- Again -- Into Health Care",
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"content": "\u003cfigure id=\"attachment_5798\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/JerryBrownPensionOverhaul102811.jpg\">\u003cimg class=\"size-medium wp-image-5798\" title=\"(Max Whittaker: Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/JerryBrownPensionOverhaul102811-300x200.jpg\" alt=\"(Max Whittaker: Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Max Whittaker: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Governor Jerry Brown released his \u003ca title=\"http://www.kqed.org/news/story/2012/05/14/93966/gov_brown_revises_budget_proposal?category=politics\" href=\"http://www.kqed.org/news/story/2012/05/14/93966/gov_brown_revises_budget_proposal?category=politics\" target=\"_blank\">revised budget\u003c/a> this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .\u003c/p>\n\u003cp>Today the governor announced:\u003c/p>\n\u003cul>\n\u003cli>An additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes\u003c/li>\n\u003cli>Reductions to the \"Healthy Families\" program which covers children, effecting their access to health care. Potential savings are $48 million\u003c/li>\n\u003cli>Reducing In-Home Support Services hours by seven percent for a savings of $99 million\u003c/li>\n\u003c/ul>\n\u003cdiv>Anthony Wright of \u003ca title=\"http://www.health-access.org/\" href=\"http://www.health-access.org/\" target=\"_blank\">Health Access\u003c/a>, a statewide advocacy group said these cuts would effect virtually all Californians. \"These ugly cuts are a body blow to the health system on which we all rely,\" Wright said in a statement. \"These are the wrong cuts at the wrong time, during an economic downturn when Californians need this help the most, and when we need to get ready for health reform to maximize the benefit for our families and our state.\"\n\u003cp>In a conference call with reporters today, Secretary of Health and Human Services \u003ca title=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBioPDF.pdf\" href=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBioPDF.pdf\" target=\"_blank\">Diana Dooley\u003c/a> said the cuts to her agency were inevitable. \"The problem we have and always have in health and human services is this is where most of the spending is. The spending is in education and health and human services to a very large degree, and the only place you can cut back are the places where you are spending.\"\u003c/p>\n\u003cp>The governor's revised budget depends on voters passing his tax increase proposals expected to land on the November ballot. A poll last month by the Public Policy Institute of California showed 54 percent support for the governor's plans -- but tax increases require a two-thirds majority to pass. If his tax proposals do not pass, more cuts will be necessary to balance the state's budget.\u003c/p>\n\u003c/div>\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Governor Jerry Brown released his revised budget this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .\r\n\r\nToday the governor announced:\r\n\r\nAn additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes\r\nReductions to the \"Healthy Families\" program which covers children, effecting their access to health care. Potential savings are $48 million",
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"description": "Governor Jerry Brown released his revised budget this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .\r\n\r\nToday the governor announced:\r\n\r\nAn additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes\r\nReductions to the "Healthy Families" program which covers children, effecting their access to health care. Potential savings are $48 million",
"title": "Governor's New Budget Slices -- Again -- Into Health Care | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5798\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/JerryBrownPensionOverhaul102811.jpg\">\u003cimg class=\"size-medium wp-image-5798\" title=\"(Max Whittaker: Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/JerryBrownPensionOverhaul102811-300x200.jpg\" alt=\"(Max Whittaker: Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Max Whittaker: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Governor Jerry Brown released his \u003ca title=\"http://www.kqed.org/news/story/2012/05/14/93966/gov_brown_revises_budget_proposal?category=politics\" href=\"http://www.kqed.org/news/story/2012/05/14/93966/gov_brown_revises_budget_proposal?category=politics\" target=\"_blank\">revised budget\u003c/a> this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .\u003c/p>\n\u003cp>Today the governor announced:\u003c/p>\n\u003cul>\n\u003cli>An additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes\u003c/li>\n\u003cli>Reductions to the \"Healthy Families\" program which covers children, effecting their access to health care. Potential savings are $48 million\u003c/li>\n\u003cli>Reducing In-Home Support Services hours by seven percent for a savings of $99 million\u003c/li>\n\u003c/ul>\n\u003cdiv>Anthony Wright of \u003ca title=\"http://www.health-access.org/\" href=\"http://www.health-access.org/\" target=\"_blank\">Health Access\u003c/a>, a statewide advocacy group said these cuts would effect virtually all Californians. \"These ugly cuts are a body blow to the health system on which we all rely,\" Wright said in a statement. \"These are the wrong cuts at the wrong time, during an economic downturn when Californians need this help the most, and when we need to get ready for health reform to maximize the benefit for our families and our state.\"\n\u003cp>In a conference call with reporters today, Secretary of Health and Human Services \u003ca title=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBioPDF.pdf\" href=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBioPDF.pdf\" target=\"_blank\">Diana Dooley\u003c/a> said the cuts to her agency were inevitable. \"The problem we have and always have in health and human services is this is where most of the spending is. The spending is in education and health and human services to a very large degree, and the only place you can cut back are the places where you are spending.\"\u003c/p>\n\u003cp>The governor's revised budget depends on voters passing his tax increase proposals expected to land on the November ballot. A poll last month by the Public Policy Institute of California showed 54 percent support for the governor's plans -- but tax increases require a two-thirds majority to pass. If his tax proposals do not pass, more cuts will be necessary to balance the state's budget.\u003c/p>\n\u003c/div>\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Why Isn't Kaiser Less Expensive?",
"title": "Why Isn't Kaiser Less Expensive?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_5723\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/KaiserPermanente05102012.jpg\">\u003cimg class=\"size-medium wp-image-5723\" title=\"(tedeytan: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/KaiserPermanente05102012-300x247.jpg\" alt=\"(tedeytan: Flickr)\" width=\"300\" height=\"247\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(tedeytan: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The federal health law aims to tackle the problem of high health care costs by providing financial rewards to providers who do a better job coordinating patient care. But one shining example of that future has been here in California for decades. It's \u003ca title=\"https://healthy.kaiserpermanente.org/html/kaiser/index.shtml\" href=\"https://healthy.kaiserpermanente.org/html/kaiser/index.shtml\" target=\"_blank\">Kaiser Permanente\u003c/a> which is often touted as the nation’s best hope for bringing health care costs more in line with other developed nations.\u003c/p>\n\u003cp>Kaiser rose out of a utopian, industrialist dream. During the 1930s and 40s,\u003ca title=\"http://www.californiamuseum.org/exhibits/halloffame/inductee/henry-j-kaiser\" href=\"http://www.californiamuseum.org/exhibits/halloffame/inductee/henry-j-kaiser\" target=\"_blank\"> Henry J. Kaiser\u003c/a> wanted to make sure the workers at his Richmond shipyard were steady and strong.\u003c/p>\n\u003cp>\u003ca title=\"http://xnet.kp.org/newscenter/aboutkp/bios/national/halvorson.html\" href=\"http://xnet.kp.org/newscenter/aboutkp/bios/national/halvorson.html\" target=\"_blank\">George Halvorson\u003c/a>, Kaiser's CEO, draws a direct link between Henry Kaiser's approach to building ships and his approach to designing a health system. \"When Henry built things he tended to assemble an entire team to build all the parts,\" he says. \"So when he started providing health care to his workers, he used that model which was to have a Kaiser hospital, Kaiser clinics.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">“They got to where they are, in part, by being the cost leader in the market. And they no longer are.”\u003c/aside>\n\u003cp>Kaiser Permanente opened its doors to the public in 1945 -- and offered health coverage that was considerably less expensive than conventional insurers like Blue Cross.\u003c/p>\n\u003cp>The strategy worked because it owned and operated its own hospitals and clinics and directly employed physicians.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But \u003ca title=\"http://www.chcf.org/about/staff/mark-smith\" href=\"http://www.chcf.org/about/staff/mark-smith\" target=\"_blank\">Mark Smith\u003c/a>, head of the \u003ca title=\"http://www.chcf.org/\" href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation,\u003c/a> says Kaiser Permanente is no longer the bargain it used to be. \"They got to where they are, in part, by being the cost leader in the market. And they no longer are.\"\u003c/p>\n\u003cp>Indeed, health care researchers and Kaiser’s biggest customers, say the price gap between Kaiser and other insurance companies has narrowed or closed altogether. One of those big customers is \u003ca title=\"http://www.calpers.ca.gov/\" href=\"http://www.calpers.ca.gov/\" target=\"_blank\">CalPERS\u003c/a>, the state agency that manages benefits for current and retired public employees. In recent years, CalPERS has negotiated premiums with\u003ca title=\"https://www.blueshieldca.com/home?seorefer=http%3A//www.google.com/url%3Fsa%3Dt%26rct%3Dj%26q%3Dblue%2520shield%26source%3Dweb%26cd%3D1%26ved%3D0CMcBEBYwAA%26url%3Dhttp%253A%252F%252Fwww.blueshieldca.com%252F%26ei%3DugysT5L8JIr-iQLQnOTECQ%26usg%3DAFQjCNFZ505bZNF3_gBnDkngBPeK2TAFuw%26sig2%3DjGX0rQ7UOufn2CP55TkXsg\" href=\"https://www.blueshieldca.com/home?seorefer=http%3A//www.google.com/url%3Fsa%3Dt%26rct%3Dj%26q%3Dblue%2520shield%26source%3Dweb%26cd%3D1%26ved%3D0CMcBEBYwAA%26url%3Dhttp%253A%252F%252Fwww.blueshieldca.com%252F%26ei%3DugysT5L8JIr-iQLQnOTECQ%26usg%3DAFQjCNFZ505bZNF3_gBnDkngBPeK2TAFuw%26sig2%3DjGX0rQ7UOufn2CP55TkXsg\" target=\"_blank\"> Blue Shield\u003c/a> that are less expensive than Kaiser, something nearly inconceivable in the past.\u003c/p>\n\u003cp>Smith says because Kaiser is both the insurer and the health care provider, the company hasn’t faced much competition. \"They’re not really pressed to be that much cheaper,\" he says. \"They’re kind of 'shadow pricing,' is what the economists would say. So if your competitor takes $4 to make a banana and it only takes you $2 to make a banana, you price your banana at $3.95 -- and you pocket the rest.\"\u003c/p>\n\u003cp>That’s a charge Halvorson vigorously denies. \"We’re at least 10 percent better everywhere. Sometimes we’re 15-20 percent less expensive.\"\u003c/p>\n\u003cp>Kaiser sets its rates, says Halvorson, based on how much it spends on patient care. It has nothing to do with what other insurers are charging. And he adds, Kaiser offers richer benefits than other plans. \"Everybody else is stripping their benefits package down. So they’re putting in higher and higher deductibles, and that’s just shifting the cost to the employee.\"\u003c/p>\n\u003cp>Since negotiations between health plans and employers are largely confidential and each insurance plan offers different services, it’s difficult to discern just how Kaiser fares against other companies. In documents filed with state regulators, Kaiser Permanente says the cost of running its entire operation increases by about 5 percent each year.\u003c/p>\n\u003cp>But some of Kaiser’s biggest customers –- companies that are household names in California –- say their premiums have jumped much higher, in some cases 20 percent.\u003c/p>\n\u003cp>\u003ca title=\"http://www.pbgh.org/about/pbgh-staff\" href=\"http://www.pbgh.org/about/pbgh-staff\" target=\"_blank\">David Lansky\u003c/a> heads the San Francisco-based Pacific Business Group on Health which represents large employers. \"Kaiser seems to have difficulty of explaining why their price is what it is,\" Lansky says. \"So they can’t explain it well to the benefits manager at a large company who then can’t explain it to his or her boss. Why should we keep Kaiser? Why is this price legitimate? If Kaiser can’t document their internal cost structure and pricing, then there’s a whole chain of mistrust that gets generated because of the lack of transparency and clarity.\"\u003c/p>\n\u003cp>The frustration seems to stem in part from the very trait that makes Kaiser so good at taking care of patients: it doesn’t price out procedures, tests and doctor’s visits on a menu of fees. These so-called fee schedules are often arbitrary. A procedure can cost a thousand dollars at one hospital and 10-thousand dollars elsewhere.\u003c/p>\n\u003cp>\"Fee schedules are a very primitive way to buy care,\" Halvorson says, adding that Kaiser's focus on patient outcomes is what matters. \"We have cut the rate of broken bones for our seniors by about 40 percent. And we do nine things for the seniors to cut the broken bones. Six of the nine things do not show up on the Medicare fee schedule.\"\u003c/p>\n\u003cp>Still, large employers say because Kaiser doesn’t price out its services, it’s difficult to know why premiums rise every year. One large employer, who was not authorized to speak publically because negotiations are confidential, told me Kaiser’s rate increases don’t seem to reflect changes in the use of Kaiser services.\u003c/p>\n\u003cp>David Lansky says Kaiser is much more efficient than other insurers and providers. For example, patients can avoid unnecessary office visits by talking with doctors over email. But Lansky says employers -- who pay the bills -- aren’t yet seeing the savings.\u003c/p>\n\u003cp>\"It’s a little bit of what we went through with the banks when they went to ATMs and stopped having tellers in the retail points of service. You’d think that would have lowered costs. Instead, we started seeing fees at the ATMs,\" Lansky says. \"A lot of us in health policy land have scratched our heads a bit and said, 'Well, why can’t Kaiser be a heck of a lot cheaper?'\"\u003c/p>\n\u003cp>\u003ca title=\"http://www.venrock.com/profile/99/?print=1\" href=\"http://www.venrock.com/profile/99/?print=1\" target=\"_blank\">Bob Kocher\u003c/a>, now a partner at the venture capital firm Venrock, served as a health care advisor to President Obama. Kocher is a big fan of Kaiser’s highly coordinated system. He says the Kaiser model was in the back of many policy makers minds when they pushed to include in the federal health law financial enticements for hospitals and doctors to essentially form Kaiser look-a-likes.\u003c/p>\n\u003cp>Still, Kocher says he hopes the Kaiser model would deliver steeper savings. \"How do we unleash that sort of pressure on price, to have them not be compelled to raise their prices by nine to 10 percent a year?\"\u003c/p>\n\u003cp>Kocher and other health policy experts suspect the pressure to compete might come when –- and if –- those Kaiser mini-me’s get off the ground.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Listen to the report:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "The federal health law aims to tackle the problem of high health care costs by providing financial rewards to providers who do a better job coordinating patient care. But one shining example of that future has been here in California for decades. It's Kaiser Permanente which is often touted as the nation’s best hope for bringing health care costs more in line with other developed nations.\r\n\r\nKaiser rose out of a utopian, industrialist dream. During the 1930s and 40s, Henry J. Kaiser wanted to make sure the workers at his Richmond shipyard were steady and strong.",
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"description": "The federal health law aims to tackle the problem of high health care costs by providing financial rewards to providers who do a better job coordinating patient care. But one shining example of that future has been here in California for decades. It's Kaiser Permanente which is often touted as the nation’s best hope for bringing health care costs more in line with other developed nations.\r\n\r\nKaiser rose out of a utopian, industrialist dream. During the 1930s and 40s, Henry J. Kaiser wanted to make sure the workers at his Richmond shipyard were steady and strong.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5723\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/KaiserPermanente05102012.jpg\">\u003cimg class=\"size-medium wp-image-5723\" title=\"(tedeytan: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/KaiserPermanente05102012-300x247.jpg\" alt=\"(tedeytan: Flickr)\" width=\"300\" height=\"247\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(tedeytan: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The federal health law aims to tackle the problem of high health care costs by providing financial rewards to providers who do a better job coordinating patient care. But one shining example of that future has been here in California for decades. It's \u003ca title=\"https://healthy.kaiserpermanente.org/html/kaiser/index.shtml\" href=\"https://healthy.kaiserpermanente.org/html/kaiser/index.shtml\" target=\"_blank\">Kaiser Permanente\u003c/a> which is often touted as the nation’s best hope for bringing health care costs more in line with other developed nations.\u003c/p>\n\u003cp>Kaiser rose out of a utopian, industrialist dream. During the 1930s and 40s,\u003ca title=\"http://www.californiamuseum.org/exhibits/halloffame/inductee/henry-j-kaiser\" href=\"http://www.californiamuseum.org/exhibits/halloffame/inductee/henry-j-kaiser\" target=\"_blank\"> Henry J. Kaiser\u003c/a> wanted to make sure the workers at his Richmond shipyard were steady and strong.\u003c/p>\n\u003cp>\u003ca title=\"http://xnet.kp.org/newscenter/aboutkp/bios/national/halvorson.html\" href=\"http://xnet.kp.org/newscenter/aboutkp/bios/national/halvorson.html\" target=\"_blank\">George Halvorson\u003c/a>, Kaiser's CEO, draws a direct link between Henry Kaiser's approach to building ships and his approach to designing a health system. \"When Henry built things he tended to assemble an entire team to build all the parts,\" he says. \"So when he started providing health care to his workers, he used that model which was to have a Kaiser hospital, Kaiser clinics.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">“They got to where they are, in part, by being the cost leader in the market. And they no longer are.”\u003c/aside>\n\u003cp>Kaiser Permanente opened its doors to the public in 1945 -- and offered health coverage that was considerably less expensive than conventional insurers like Blue Cross.\u003c/p>\n\u003cp>The strategy worked because it owned and operated its own hospitals and clinics and directly employed physicians.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But \u003ca title=\"http://www.chcf.org/about/staff/mark-smith\" href=\"http://www.chcf.org/about/staff/mark-smith\" target=\"_blank\">Mark Smith\u003c/a>, head of the \u003ca title=\"http://www.chcf.org/\" href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation,\u003c/a> says Kaiser Permanente is no longer the bargain it used to be. \"They got to where they are, in part, by being the cost leader in the market. And they no longer are.\"\u003c/p>\n\u003cp>Indeed, health care researchers and Kaiser’s biggest customers, say the price gap between Kaiser and other insurance companies has narrowed or closed altogether. One of those big customers is \u003ca title=\"http://www.calpers.ca.gov/\" href=\"http://www.calpers.ca.gov/\" target=\"_blank\">CalPERS\u003c/a>, the state agency that manages benefits for current and retired public employees. In recent years, CalPERS has negotiated premiums with\u003ca title=\"https://www.blueshieldca.com/home?seorefer=http%3A//www.google.com/url%3Fsa%3Dt%26rct%3Dj%26q%3Dblue%2520shield%26source%3Dweb%26cd%3D1%26ved%3D0CMcBEBYwAA%26url%3Dhttp%253A%252F%252Fwww.blueshieldca.com%252F%26ei%3DugysT5L8JIr-iQLQnOTECQ%26usg%3DAFQjCNFZ505bZNF3_gBnDkngBPeK2TAFuw%26sig2%3DjGX0rQ7UOufn2CP55TkXsg\" href=\"https://www.blueshieldca.com/home?seorefer=http%3A//www.google.com/url%3Fsa%3Dt%26rct%3Dj%26q%3Dblue%2520shield%26source%3Dweb%26cd%3D1%26ved%3D0CMcBEBYwAA%26url%3Dhttp%253A%252F%252Fwww.blueshieldca.com%252F%26ei%3DugysT5L8JIr-iQLQnOTECQ%26usg%3DAFQjCNFZ505bZNF3_gBnDkngBPeK2TAFuw%26sig2%3DjGX0rQ7UOufn2CP55TkXsg\" target=\"_blank\"> Blue Shield\u003c/a> that are less expensive than Kaiser, something nearly inconceivable in the past.\u003c/p>\n\u003cp>Smith says because Kaiser is both the insurer and the health care provider, the company hasn’t faced much competition. \"They’re not really pressed to be that much cheaper,\" he says. \"They’re kind of 'shadow pricing,' is what the economists would say. So if your competitor takes $4 to make a banana and it only takes you $2 to make a banana, you price your banana at $3.95 -- and you pocket the rest.\"\u003c/p>\n\u003cp>That’s a charge Halvorson vigorously denies. \"We’re at least 10 percent better everywhere. Sometimes we’re 15-20 percent less expensive.\"\u003c/p>\n\u003cp>Kaiser sets its rates, says Halvorson, based on how much it spends on patient care. It has nothing to do with what other insurers are charging. And he adds, Kaiser offers richer benefits than other plans. \"Everybody else is stripping their benefits package down. So they’re putting in higher and higher deductibles, and that’s just shifting the cost to the employee.\"\u003c/p>\n\u003cp>Since negotiations between health plans and employers are largely confidential and each insurance plan offers different services, it’s difficult to discern just how Kaiser fares against other companies. In documents filed with state regulators, Kaiser Permanente says the cost of running its entire operation increases by about 5 percent each year.\u003c/p>\n\u003cp>But some of Kaiser’s biggest customers –- companies that are household names in California –- say their premiums have jumped much higher, in some cases 20 percent.\u003c/p>\n\u003cp>\u003ca title=\"http://www.pbgh.org/about/pbgh-staff\" href=\"http://www.pbgh.org/about/pbgh-staff\" target=\"_blank\">David Lansky\u003c/a> heads the San Francisco-based Pacific Business Group on Health which represents large employers. \"Kaiser seems to have difficulty of explaining why their price is what it is,\" Lansky says. \"So they can’t explain it well to the benefits manager at a large company who then can’t explain it to his or her boss. Why should we keep Kaiser? Why is this price legitimate? If Kaiser can’t document their internal cost structure and pricing, then there’s a whole chain of mistrust that gets generated because of the lack of transparency and clarity.\"\u003c/p>\n\u003cp>The frustration seems to stem in part from the very trait that makes Kaiser so good at taking care of patients: it doesn’t price out procedures, tests and doctor’s visits on a menu of fees. These so-called fee schedules are often arbitrary. A procedure can cost a thousand dollars at one hospital and 10-thousand dollars elsewhere.\u003c/p>\n\u003cp>\"Fee schedules are a very primitive way to buy care,\" Halvorson says, adding that Kaiser's focus on patient outcomes is what matters. \"We have cut the rate of broken bones for our seniors by about 40 percent. And we do nine things for the seniors to cut the broken bones. Six of the nine things do not show up on the Medicare fee schedule.\"\u003c/p>\n\u003cp>Still, large employers say because Kaiser doesn’t price out its services, it’s difficult to know why premiums rise every year. One large employer, who was not authorized to speak publically because negotiations are confidential, told me Kaiser’s rate increases don’t seem to reflect changes in the use of Kaiser services.\u003c/p>\n\u003cp>David Lansky says Kaiser is much more efficient than other insurers and providers. For example, patients can avoid unnecessary office visits by talking with doctors over email. But Lansky says employers -- who pay the bills -- aren’t yet seeing the savings.\u003c/p>\n\u003cp>\"It’s a little bit of what we went through with the banks when they went to ATMs and stopped having tellers in the retail points of service. You’d think that would have lowered costs. Instead, we started seeing fees at the ATMs,\" Lansky says. \"A lot of us in health policy land have scratched our heads a bit and said, 'Well, why can’t Kaiser be a heck of a lot cheaper?'\"\u003c/p>\n\u003cp>\u003ca title=\"http://www.venrock.com/profile/99/?print=1\" href=\"http://www.venrock.com/profile/99/?print=1\" target=\"_blank\">Bob Kocher\u003c/a>, now a partner at the venture capital firm Venrock, served as a health care advisor to President Obama. Kocher is a big fan of Kaiser’s highly coordinated system. He says the Kaiser model was in the back of many policy makers minds when they pushed to include in the federal health law financial enticements for hospitals and doctors to essentially form Kaiser look-a-likes.\u003c/p>\n\u003cp>Still, Kocher says he hopes the Kaiser model would deliver steeper savings. \"How do we unleash that sort of pressure on price, to have them not be compelled to raise their prices by nine to 10 percent a year?\"\u003c/p>\n\u003cp>Kocher and other health policy experts suspect the pressure to compete might come when –- and if –- those Kaiser mini-me’s get off the ground.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Listen to the report:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lessons Learned from the War on Smoking, Applied to Obesity",
"title": "Lessons Learned from the War on Smoking, Applied to Obesity",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_5650\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/NoSmokingSign_DaveWhelan_Flickr_05072012.jpg\">\u003cimg class=\"size-medium wp-image-5650\" title=\"Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/NoSmokingSign_DaveWhelan_Flickr_05072012-300x214.jpg\" alt=\"Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Expect to hear a lot about obesity prevention in the coming days. A \u003ca title=\"http://theweightofthenation.hbo.com/themes/what-is-obesity\" href=\"http://theweightofthenation.hbo.com/themes/what-is-obesity\" target=\"_blank\">four-part HBO documentary\u003c/a> about the obesity crisis debuts next week. Today, the Centers for Disease Control opened \u003ca title=\"http://www.weightofthenation.org/\" href=\"http://www.weightofthenation.org/\" target=\"_blank\">a major conference\u003c/a> examining strategies to help Americans with this significant health challenge. At a \u003ca title=\"http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_33853-stamped2.pdf\" href=\"http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_33853-stamped2.pdf\" target=\"_blank\">report\u003c/a> released this morning, researchers said obesity prevalence will increase about 33 percent in the next 20 years -- climbing from one-third of Americans affected now to a 42 percent rate by 2030.\u003c/p>\n\u003cp>And believe it or not 42 percent is good news -- that's down from the 50 percent estimated in prior years.\u003c/p>\n\u003cp>Despite first lady Michelle Obama's \u003ca title=\"http://www.letsmove.gov/\" href=\"http://www.letsmove.gov/\" target=\"_blank\">Let's Move\u003c/a> campaign and its greater attention on childhood obesity, many public health leaders are frustrated with slow progress and say more must be done. They call for a different approach, using strategies similar to those used in the anti-tobacco movement. It was only after anti-tobacco advocates embraced community-based activism that smoking rates began to drop from a high of 42 percent in the mid-1960s to just over 19 percent today, they say.\u003c!--more-->\u003c/p>\n\u003cp>Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, some public health experts argue.\u003c/p>\n\u003cp>Kaiser Health News published \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/May/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/May/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx\" target=\"_blank\">a lengthy piece\u003c/a> examining the strategies and hurdles in adopting such action. State of Health excerpts from the article's eight points:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Children are central\u003c/strong>. The vast majority of people who use tobacco take up the habit as teenagers, and one-third of kids who smoke daily will eventually die prematurely of tobacco-related illnesses, according to the Campaign for Tobacco Free Kids.\u003c/p>\n\u003cp>The health impact of obesity is similar: seriously overweight children are at greater risk of developing a multitude of health problems that can continue through adulthood, including diabetes, liver disease, heart disease, joint problems and asthma, and are more likely to become obese adults, a wide body of research has demonstrated.\u003c/p>\n\u003cp>Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns.\u003c/p>\n\u003cp>\u003cstrong>Changing social norms is the goal\u003c/strong>. \u003ca href=\"http://whsc.emory.edu/home/about/leadership/bio-jeffrey-koplan.html\" target=\"_blank\">Dr. Jeffrey Koplan\u003c/a>, former head of the CDC and vice president for global health at Emory University in Atlanta, remembers smoking a pipe while writing up patient notes at a prestigious New York hospital in the 1970s. (He gave up the habit more than 30 years ago.)\u003c/p>\n\u003cp>Today, that would be inconceivable: Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread and anti-smoking policies are in place at hospitals, workplaces, and venues across the country.\u003c/p>\n\u003cp>Koplan is convinced the same shift in social norms is called for -- and achievable -- when it comes to childhood obesity. \"Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed,\" he said. It isn’t going to be easy and it isn’t going to be fast, but \"we’re dealing with a population that would like to be thinner and that works in our favor,\" he said.\u003c/p>\n\u003cp>\u003cstrong>We can’t just say no to food\u003c/strong>. \"Tobacco we can get rid of entirely. ... But we have to eat to live and make terms with food as the enemy,\" said Dr. David Katz, director of \u003ca href=\"http://www.yalegriffinprc.org/\" target=\"_blank\">Yale University’s Prevention Research Center\u003c/a>.\u003c/p>\n\u003cp>That makes curbing childhood obesity a much more complicated issue than tobacco use, Katz and other experts agree. The message to kids and their families can’t be \"stop, don’t do this,\" which is clear and easy to understand. Instead it has to be \"make good choices, do this in moderation, set boundaries,\" a message that is considerably more difficult to convey.\u003c/p>\n\u003cp>\u003cstrong>There is no second-hand smoke equivalent\u003c/strong>. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous.\u003c/p>\n\u003cp>\"The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people’s intolerance of smoking and their willingness to see the government take action,\" said \u003ca href=\"http://publichealth.gsu.edu/722.html\" target=\"_blank\">Michael Eriksen\u003c/a>, director of the Institute of Public Health at Georgia State University.\u003c/p>\n\u003cp>There is no equivalent in the fight against obesity. \"Your being obese does not affect me in the same direct way,\" Eriksen said.\u003c/p>\n\u003cp>\u003cstrong>The role of industry is less clear\u003c/strong>. In the anti-tobacco fight, tobacco companies were painted as an enemy willing to lie and manipulate the American public for the sake of profits. In turn, the demonization of Big Tobacco -- made possible by bitterly fought lawsuits and the release of thousands of company documents -- cultivated a common sense of threat.\u003c/p>\n\u003cp>By contrast, public health advocates aren’t willing to turn food and beverage into enemies in the fight against obesity.\u003c/p>\n\u003cp>\"With obesity (as compared to tobacco), there’s a much more nuanced relationship with industry,\" said \u003ca href=\"http://www.rwjf.org/about/staffbio.jsp?id=980\" target=\"_blank\">Dr. James S. Marks\u003c/a>, director of the health group at the Robert Wood Johnson Foundation. Food and beverage manufacturers, restaurants, and grocery stores all have a vital role to play in making healthier food more widely available, he noted.\u003c/p>\n\u003cp>\"We can’t regulate our way out of this,\" said \u003ca href=\"http://healthyamericans.org/pages/?id=67\" target=\"_blank\">Jeff Levi\u003c/a>, executive director of the Trust for America’s Health. \"We need to work with industry cooperatively to help change consumers’ tastes and habits.\"\u003c/p>\n\u003cp>Others are much less certain that the food and beverage industry can be trusted to be helpful partners.\u003c/p>\n\u003cp>\"Some companies are making huge profits off obesity,\" said \u003ca href=\"http://www.urban.org/bio/StanDorn.html\" target=\"_blank\">Stan Dorn\u003c/a>, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., \"and I worry that people who are focused on anti-obesity strategies aren’t being tough enough on them.\"\u003c/p>\n\u003cp>\u003cstrong>Learn More from KQED's Quest:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cembed src=\"//ww2.kqed.org/quest/wp-content/uploads/sites/35/jw-player-plugin-for-wordpress/player/player.swf\" height=\"360\" width=\"640\" allowscriptaccess=\"always\" allowfullscreen=\"true\" flashvars=\"&bandwidth=2841&controlbar=over&dock=false&file=602a_kidsheart.flv&image=http%3A%2F%2Fscience.kqed.org%2Fquest%2Ffiles%2F2012%2F04%2F602A_Mariah_Mitchell_smells_mint_12-7-11_GQ_resized.jpg&gapro.accountid=UA-1538528-1&gapro.height=360&gapro.pluginmode=FLASH&gapro.trackpercentage=true&gapro.trackstarts=true&gapro.tracktime=true&gapro.visible=true&gapro.width=640&gapro.x=0&gapro.y=0&plugins=gapro-1&skin=http%3A%2F%2Fscience.kqed.org%2Fquest%2Fwp-content%2Fplugins%2Fjw-player-plugin-for-wordpress%2Fskins%2Fglow.zip&streamer=rtmp%3A%2F%2Fkqed-flash02.streamguys.us%2Fquest%2F&viral.allowmenu=true&viral.bgcolor=0x333333&viral.fgcolor=0xffffff&viral.functions=embed&viral.matchplayercolors=true&viral.oncomplete=false&viral.pluginmode=FLASH\">\u003c/embed>\u003c/p>\n\n",
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"excerpt": "Expect to hear a lot about obesity prevention in the coming days. A four-part HBO documentary about the obesity crisis debuts next week. Today, the Centers for Disease Control opened a major conference examining strategies to help Americans with this significant health challenge. At a report released this morning, researchers said obesity prevalence will increase about 33 percent in the next 20 years -- climbing from one-third of Americans affected now to a 42 percent rate by 2030.\r\n\r\nAnd believe it or not 42 percent is good news -- that's down from the 50 percent estimated in prior years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5650\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/NoSmokingSign_DaveWhelan_Flickr_05072012.jpg\">\u003cimg class=\"size-medium wp-image-5650\" title=\"Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/NoSmokingSign_DaveWhelan_Flickr_05072012-300x214.jpg\" alt=\"Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Expect to hear a lot about obesity prevention in the coming days. A \u003ca title=\"http://theweightofthenation.hbo.com/themes/what-is-obesity\" href=\"http://theweightofthenation.hbo.com/themes/what-is-obesity\" target=\"_blank\">four-part HBO documentary\u003c/a> about the obesity crisis debuts next week. Today, the Centers for Disease Control opened \u003ca title=\"http://www.weightofthenation.org/\" href=\"http://www.weightofthenation.org/\" target=\"_blank\">a major conference\u003c/a> examining strategies to help Americans with this significant health challenge. At a \u003ca title=\"http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_33853-stamped2.pdf\" href=\"http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_33853-stamped2.pdf\" target=\"_blank\">report\u003c/a> released this morning, researchers said obesity prevalence will increase about 33 percent in the next 20 years -- climbing from one-third of Americans affected now to a 42 percent rate by 2030.\u003c/p>\n\u003cp>And believe it or not 42 percent is good news -- that's down from the 50 percent estimated in prior years.\u003c/p>\n\u003cp>Despite first lady Michelle Obama's \u003ca title=\"http://www.letsmove.gov/\" href=\"http://www.letsmove.gov/\" target=\"_blank\">Let's Move\u003c/a> campaign and its greater attention on childhood obesity, many public health leaders are frustrated with slow progress and say more must be done. They call for a different approach, using strategies similar to those used in the anti-tobacco movement. It was only after anti-tobacco advocates embraced community-based activism that smoking rates began to drop from a high of 42 percent in the mid-1960s to just over 19 percent today, they say.\u003c!--more-->\u003c/p>\n\u003cp>Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, some public health experts argue.\u003c/p>\n\u003cp>Kaiser Health News published \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/May/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/May/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx\" target=\"_blank\">a lengthy piece\u003c/a> examining the strategies and hurdles in adopting such action. State of Health excerpts from the article's eight points:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Children are central\u003c/strong>. The vast majority of people who use tobacco take up the habit as teenagers, and one-third of kids who smoke daily will eventually die prematurely of tobacco-related illnesses, according to the Campaign for Tobacco Free Kids.\u003c/p>\n\u003cp>The health impact of obesity is similar: seriously overweight children are at greater risk of developing a multitude of health problems that can continue through adulthood, including diabetes, liver disease, heart disease, joint problems and asthma, and are more likely to become obese adults, a wide body of research has demonstrated.\u003c/p>\n\u003cp>Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns.\u003c/p>\n\u003cp>\u003cstrong>Changing social norms is the goal\u003c/strong>. \u003ca href=\"http://whsc.emory.edu/home/about/leadership/bio-jeffrey-koplan.html\" target=\"_blank\">Dr. Jeffrey Koplan\u003c/a>, former head of the CDC and vice president for global health at Emory University in Atlanta, remembers smoking a pipe while writing up patient notes at a prestigious New York hospital in the 1970s. (He gave up the habit more than 30 years ago.)\u003c/p>\n\u003cp>Today, that would be inconceivable: Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread and anti-smoking policies are in place at hospitals, workplaces, and venues across the country.\u003c/p>\n\u003cp>Koplan is convinced the same shift in social norms is called for -- and achievable -- when it comes to childhood obesity. \"Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed,\" he said. It isn’t going to be easy and it isn’t going to be fast, but \"we’re dealing with a population that would like to be thinner and that works in our favor,\" he said.\u003c/p>\n\u003cp>\u003cstrong>We can’t just say no to food\u003c/strong>. \"Tobacco we can get rid of entirely. ... But we have to eat to live and make terms with food as the enemy,\" said Dr. David Katz, director of \u003ca href=\"http://www.yalegriffinprc.org/\" target=\"_blank\">Yale University’s Prevention Research Center\u003c/a>.\u003c/p>\n\u003cp>That makes curbing childhood obesity a much more complicated issue than tobacco use, Katz and other experts agree. The message to kids and their families can’t be \"stop, don’t do this,\" which is clear and easy to understand. Instead it has to be \"make good choices, do this in moderation, set boundaries,\" a message that is considerably more difficult to convey.\u003c/p>\n\u003cp>\u003cstrong>There is no second-hand smoke equivalent\u003c/strong>. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous.\u003c/p>\n\u003cp>\"The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people’s intolerance of smoking and their willingness to see the government take action,\" said \u003ca href=\"http://publichealth.gsu.edu/722.html\" target=\"_blank\">Michael Eriksen\u003c/a>, director of the Institute of Public Health at Georgia State University.\u003c/p>\n\u003cp>There is no equivalent in the fight against obesity. \"Your being obese does not affect me in the same direct way,\" Eriksen said.\u003c/p>\n\u003cp>\u003cstrong>The role of industry is less clear\u003c/strong>. In the anti-tobacco fight, tobacco companies were painted as an enemy willing to lie and manipulate the American public for the sake of profits. In turn, the demonization of Big Tobacco -- made possible by bitterly fought lawsuits and the release of thousands of company documents -- cultivated a common sense of threat.\u003c/p>\n\u003cp>By contrast, public health advocates aren’t willing to turn food and beverage into enemies in the fight against obesity.\u003c/p>\n\u003cp>\"With obesity (as compared to tobacco), there’s a much more nuanced relationship with industry,\" said \u003ca href=\"http://www.rwjf.org/about/staffbio.jsp?id=980\" target=\"_blank\">Dr. James S. Marks\u003c/a>, director of the health group at the Robert Wood Johnson Foundation. Food and beverage manufacturers, restaurants, and grocery stores all have a vital role to play in making healthier food more widely available, he noted.\u003c/p>\n\u003cp>\"We can’t regulate our way out of this,\" said \u003ca href=\"http://healthyamericans.org/pages/?id=67\" target=\"_blank\">Jeff Levi\u003c/a>, executive director of the Trust for America’s Health. \"We need to work with industry cooperatively to help change consumers’ tastes and habits.\"\u003c/p>\n\u003cp>Others are much less certain that the food and beverage industry can be trusted to be helpful partners.\u003c/p>\n\u003cp>\"Some companies are making huge profits off obesity,\" said \u003ca href=\"http://www.urban.org/bio/StanDorn.html\" target=\"_blank\">Stan Dorn\u003c/a>, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., \"and I worry that people who are focused on anti-obesity strategies aren’t being tough enough on them.\"\u003c/p>\n\u003cp>\u003cstrong>Learn More from KQED's Quest:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cembed src=\"//ww2.kqed.org/quest/wp-content/uploads/sites/35/jw-player-plugin-for-wordpress/player/player.swf\" height=\"360\" width=\"640\" allowscriptaccess=\"always\" allowfullscreen=\"true\" flashvars=\"&bandwidth=2841&controlbar=over&dock=false&file=602a_kidsheart.flv&image=http%3A%2F%2Fscience.kqed.org%2Fquest%2Ffiles%2F2012%2F04%2F602A_Mariah_Mitchell_smells_mint_12-7-11_GQ_resized.jpg&gapro.accountid=UA-1538528-1&gapro.height=360&gapro.pluginmode=FLASH&gapro.trackpercentage=true&gapro.trackstarts=true&gapro.tracktime=true&gapro.visible=true&gapro.width=640&gapro.x=0&gapro.y=0&plugins=gapro-1&skin=http%3A%2F%2Fscience.kqed.org%2Fquest%2Fwp-content%2Fplugins%2Fjw-player-plugin-for-wordpress%2Fskins%2Fglow.zip&streamer=rtmp%3A%2F%2Fkqed-flash02.streamguys.us%2Fquest%2F&viral.allowmenu=true&viral.bgcolor=0x333333&viral.fgcolor=0xffffff&viral.functions=embed&viral.matchplayercolors=true&viral.oncomplete=false&viral.pluginmode=FLASH\">\u003c/embed>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "High-Deductible Health Plans: Health Access or High Risk?",
"title": "High-Deductible Health Plans: Health Access or High Risk?",
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"content": "\u003cfigure id=\"attachment_5624\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PIggyBankStethoscope_05042012.jpg\">\u003cimg class=\"size-medium wp-image-5624 \" title=\"Check the health of your savings account when you sign up for a high-deductible health plan. (401k_Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PIggyBankStethoscope_05042012-300x295.jpg\" alt=\"Check the health of your savings account when you sign up for a high-deductible health plan. (401k_Flickr)\" width=\"300\" height=\"295\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Check the health of your savings account when you sign up for a high-deductible health plan. (401k: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Health care costs are skyrocketing and premiums along with them forcing some employers -- especially small businesses -- to drop coverage altogether. But others are moving to \"high-deductible health plans.\" Five times as many businesses offer high deductible health plans as in 2005, according to the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>But how do these plans play out for employers -- and workers themselves?\u003c/p>\n\u003cp>Kelley Weiss of the \u003ca title=\"http://centerforhealthreporting.org/article/more-small-businesses-try-high-deductible-health-plans874\" href=\"http://centerforhealthreporting.org/article/more-small-businesses-try-high-deductible-health-plans874\" target=\"_blank\">Center for Health Reporting\u003c/a> found unpleasant surprises for both owners and employees. Six years ago, Casey Coonerty-Protti took over her family's business --\u003ca title=\"http://www.bookshopsantacruz.com/\" href=\"http://www.bookshopsantacruz.com/\" target=\"_blank\"> Bookshop Santa Cruz\u003c/a> -- a 46 year institution in the heart of downtown. Between the lagging economy and pressure from online books, maintaining a bookstore is not easy. Protti has struggled to continue to offer health insurance. When she started, her company offered a $2,000 deductible, but she's had to steadily increase the amount of the deductible to $5,000.\u003c/p>\n\u003cp>From Weiss' report:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>“So we’re putting in high-deductible plans and we’re saving absolutely nothing from it,” Protti says. “We’re actually increasing our costs to provide a lesser service.”\u003c/p>\n\u003cp>Another small business owner has a different perspective on high-deductible health plans. Anne Lesemann is the co-owner of \u003ca href=\"http://www.campbowwow.com/hb/us/ca/rosevillehb/\" target=\"_blank\">Home Buddies\u003c/a>, a pet care service in the Sacramento area.\u003c/p>\n\u003cp>She says her company will spend less than $4,000 this year to cover insurance for herself, the other owner and one employee. For her business, she says, that’s not too bad. But when she thinks of it like a patient, she admits the $5,000 deductible doesn’t look so good.\u003c/p>\n\u003cp>“The high deductible plans were marketed as something that would make me a savvy consumer about health care. But that hasn’t occurred,” Lesemann says.\u003c/p>\n\u003cp>Even though she knows better, Lesemann has been delaying going to the doctor because she doesn’t trust what’s covered and what’s not. Lesemann learned this over the years by having a variety of high-deductible health plans. One time she says she got a bill for a $1,000 after having a colonoscopy screening that she thought was a free preventative service.\u003c/p>\n\u003cp>Confusion over coverage and delaying care is pretty standard with high-deductible health plans, says \u003ca href=\"http://www.healthpolicy.ucla.edu/Bio.aspx?staffID=152\" target=\"_blank\">Dylan Roby of the UCLA Center for Health Policy Research\u003c/a>. From a cost perspective, when people don’t go to the doctor he says no one has to pay for it. For cash-strapped companies in California saving money is an attractive option.\u003c/p>\u003c/blockquote>\n\u003cdiv>Roby also warns that consumers should look deeper than the amount of the deductible itself when considering the true cost of a high deductible health plan. Even after the deductible is paid, consumers are still on the hook for co-insurance -- which can be 20 percent of lab tests or imaging like MRIs or x-rays.People with high-deductible plans can set aside pre-tax money in h\u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/11/04/faqs-of-health-savings-accounts/\" href=\"http://ww2.kqed.org/stateofhealth/2011/11/04/faqs-of-health-savings-accounts/\" target=\"_blank\">ealth savings accounts\u003c/a>, but only about a third of people have set these up, says Roby.\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cdiv>Weiss wrote a companion blog post with \u003ca title=\"http://centerforhealthreporting.org/blog/consumers-guide-high-deductible-health-plans875\" href=\"http://centerforhealthreporting.org/blog/consumers-guide-high-deductible-health-plans875\" target=\"_blank\">consumer tips\u003c/a>for high-deductible health plans.Weiss' story first aired on The California Report. You can listen here:\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630d.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630d.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Health care costs are skyrocketing and premiums along with them forcing some employers -- especially small businesses -- to drop coverage altogether. But others are moving to \"high deductible health plans.\" Five times as many businesses offer high deductible health plans as in 2005, according to the UCLA Center for Health Policy Research.\r\n\r\nBut how do these plans play out for employers -- and workers themselves?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5624\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PIggyBankStethoscope_05042012.jpg\">\u003cimg class=\"size-medium wp-image-5624 \" title=\"Check the health of your savings account when you sign up for a high-deductible health plan. (401k_Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PIggyBankStethoscope_05042012-300x295.jpg\" alt=\"Check the health of your savings account when you sign up for a high-deductible health plan. (401k_Flickr)\" width=\"300\" height=\"295\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Check the health of your savings account when you sign up for a high-deductible health plan. (401k: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Health care costs are skyrocketing and premiums along with them forcing some employers -- especially small businesses -- to drop coverage altogether. But others are moving to \"high-deductible health plans.\" Five times as many businesses offer high deductible health plans as in 2005, according to the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>But how do these plans play out for employers -- and workers themselves?\u003c/p>\n\u003cp>Kelley Weiss of the \u003ca title=\"http://centerforhealthreporting.org/article/more-small-businesses-try-high-deductible-health-plans874\" href=\"http://centerforhealthreporting.org/article/more-small-businesses-try-high-deductible-health-plans874\" target=\"_blank\">Center for Health Reporting\u003c/a> found unpleasant surprises for both owners and employees. Six years ago, Casey Coonerty-Protti took over her family's business --\u003ca title=\"http://www.bookshopsantacruz.com/\" href=\"http://www.bookshopsantacruz.com/\" target=\"_blank\"> Bookshop Santa Cruz\u003c/a> -- a 46 year institution in the heart of downtown. Between the lagging economy and pressure from online books, maintaining a bookstore is not easy. Protti has struggled to continue to offer health insurance. When she started, her company offered a $2,000 deductible, but she's had to steadily increase the amount of the deductible to $5,000.\u003c/p>\n\u003cp>From Weiss' report:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>“So we’re putting in high-deductible plans and we’re saving absolutely nothing from it,” Protti says. “We’re actually increasing our costs to provide a lesser service.”\u003c/p>\n\u003cp>Another small business owner has a different perspective on high-deductible health plans. Anne Lesemann is the co-owner of \u003ca href=\"http://www.campbowwow.com/hb/us/ca/rosevillehb/\" target=\"_blank\">Home Buddies\u003c/a>, a pet care service in the Sacramento area.\u003c/p>\n\u003cp>She says her company will spend less than $4,000 this year to cover insurance for herself, the other owner and one employee. For her business, she says, that’s not too bad. But when she thinks of it like a patient, she admits the $5,000 deductible doesn’t look so good.\u003c/p>\n\u003cp>“The high deductible plans were marketed as something that would make me a savvy consumer about health care. But that hasn’t occurred,” Lesemann says.\u003c/p>\n\u003cp>Even though she knows better, Lesemann has been delaying going to the doctor because she doesn’t trust what’s covered and what’s not. Lesemann learned this over the years by having a variety of high-deductible health plans. One time she says she got a bill for a $1,000 after having a colonoscopy screening that she thought was a free preventative service.\u003c/p>\n\u003cp>Confusion over coverage and delaying care is pretty standard with high-deductible health plans, says \u003ca href=\"http://www.healthpolicy.ucla.edu/Bio.aspx?staffID=152\" target=\"_blank\">Dylan Roby of the UCLA Center for Health Policy Research\u003c/a>. From a cost perspective, when people don’t go to the doctor he says no one has to pay for it. For cash-strapped companies in California saving money is an attractive option.\u003c/p>\u003c/blockquote>\n\u003cdiv>Roby also warns that consumers should look deeper than the amount of the deductible itself when considering the true cost of a high deductible health plan. Even after the deductible is paid, consumers are still on the hook for co-insurance -- which can be 20 percent of lab tests or imaging like MRIs or x-rays.People with high-deductible plans can set aside pre-tax money in h\u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/11/04/faqs-of-health-savings-accounts/\" href=\"http://ww2.kqed.org/stateofhealth/2011/11/04/faqs-of-health-savings-accounts/\" target=\"_blank\">ealth savings accounts\u003c/a>, but only about a third of people have set these up, says Roby.\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cdiv>Weiss wrote a companion blog post with \u003ca title=\"http://centerforhealthreporting.org/blog/consumers-guide-high-deductible-health-plans875\" href=\"http://centerforhealthreporting.org/blog/consumers-guide-high-deductible-health-plans875\" target=\"_blank\">consumer tips\u003c/a>for high-deductible health plans.Weiss' story first aired on The California Report. You can listen here:\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630d.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630d.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Rural California Hospitals Slow to Digitize",
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"content": "\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5596\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5596\" title=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr-300x308.jpg\" alt=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" width=\"292\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fall colors in Quincy. (Somesh Kumar: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>High in the Sierra in the town of Quincy, doctors at \u003ca title=\"http://www.pdh.org/\" href=\"http://www.pdh.org/\" target=\"_blank\">Plumas District Hospital\u003c/a> are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\u003c/p>\n\u003cp>Plumas District joins a digitizing trend at least partially sparked by financial incentives in the\u003ca href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\"> federal health care law\u003c/a>. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”\u003c/p>\n\u003cp>But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.\u003c/p>\n\u003cp>While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent \u003ca href=\"http://content.healthaffairs.org/content/early/2012/04/19/hlthaff.2012.0153.full\">nationwide report\u003c/a> confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->That lag has a direct effect on the five million Californians who live in rural areas. Only about half of the state’s \u003ca title=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" href=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" target=\"_blank\">293 designated rural health centers \u003c/a>are already using or in the process of implementing an EHR system, according to a recent \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?\">report\u003c/a> by The California Healthcare Foundation (CHCF).\u003c/p>\n\u003cp>Resources are an issue. In California, large clinics are more likely to use EHRs than small clinics. Many rural clinics are feeling financially unstable, CHCF wrote, and limited resources are the most important obstacle to increased adoption of EHRs. Initial purchase cost is the biggest barrier cited by rural hospitals, although the perceived cost and difficulty of implementing an EHR system was a close second, CHCF reported.\u003c/p>\n\u003cp>There is a federal financial incentive, but there are other reasons to digitize, too. Lafferty said trading paper files for digital can result in a more complete medical record. EHR software makes charting, billing and ordering labs easier because “it prompts the physician” to record information in a very specific format. “It’s readable and more consistent,” Lafferty said.\u003c/p>\n\u003cp>EHRs improve the collaboration with providers who are at a distance -- a great advantage in rural areas of the state. Plumas patients in need of specialty care travel to Chico or Reno “a lot,” said Lafferty, but now their medical records can go with them on a thumb drive. Most rural clinics with EHRs use them to record and track patient information; more than half also order and track prescriptions and lab tests electronically, according to the CHCF report. These functions were among the most easily adopted at Plumas and are \u003ca href=\"http://weill.cornell.edu/news/releases/wcmc/wcmc_2011/05_25_11.shtml\">likely to save time and reduce errors\u003c/a>.\u003c/p>\n\u003cp>Although high speed Internet access has improved in recent years, a persistent challenge in rural parts of the state is the relative \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?view=print\">shortage of IT professionals\u003c/a>. Lafferty said “many pieces came together” to create the strong IT staff working on EHR implementation. The Plumas Hospital's in-house information systems director, for example, “has spent countless hours” on the project, he said.\u003c/p>\n\u003cp>And additional tech support? “Well, it’s not too hard to recruit,” Lafferty said, “because this has got to be one of the most gorgeous places in California.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Lafferty acknowledged that updating the care delivery systems at Plumas District presented challenges. “It’s a culture change,” he said, “but it’s the right choice for the future.”\u003c/p>\n\n",
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"excerpt": "High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\r\n\r\nPlumas District joins a digitizing trend at least partially sparked by financial incentives in the federal health care law. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5596\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5596\" title=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr-300x308.jpg\" alt=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" width=\"292\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fall colors in Quincy. (Somesh Kumar: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>High in the Sierra in the town of Quincy, doctors at \u003ca title=\"http://www.pdh.org/\" href=\"http://www.pdh.org/\" target=\"_blank\">Plumas District Hospital\u003c/a> are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\u003c/p>\n\u003cp>Plumas District joins a digitizing trend at least partially sparked by financial incentives in the\u003ca href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\"> federal health care law\u003c/a>. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”\u003c/p>\n\u003cp>But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.\u003c/p>\n\u003cp>While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent \u003ca href=\"http://content.healthaffairs.org/content/early/2012/04/19/hlthaff.2012.0153.full\">nationwide report\u003c/a> confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->That lag has a direct effect on the five million Californians who live in rural areas. Only about half of the state’s \u003ca title=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" href=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" target=\"_blank\">293 designated rural health centers \u003c/a>are already using or in the process of implementing an EHR system, according to a recent \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?\">report\u003c/a> by The California Healthcare Foundation (CHCF).\u003c/p>\n\u003cp>Resources are an issue. In California, large clinics are more likely to use EHRs than small clinics. Many rural clinics are feeling financially unstable, CHCF wrote, and limited resources are the most important obstacle to increased adoption of EHRs. Initial purchase cost is the biggest barrier cited by rural hospitals, although the perceived cost and difficulty of implementing an EHR system was a close second, CHCF reported.\u003c/p>\n\u003cp>There is a federal financial incentive, but there are other reasons to digitize, too. Lafferty said trading paper files for digital can result in a more complete medical record. EHR software makes charting, billing and ordering labs easier because “it prompts the physician” to record information in a very specific format. “It’s readable and more consistent,” Lafferty said.\u003c/p>\n\u003cp>EHRs improve the collaboration with providers who are at a distance -- a great advantage in rural areas of the state. Plumas patients in need of specialty care travel to Chico or Reno “a lot,” said Lafferty, but now their medical records can go with them on a thumb drive. Most rural clinics with EHRs use them to record and track patient information; more than half also order and track prescriptions and lab tests electronically, according to the CHCF report. These functions were among the most easily adopted at Plumas and are \u003ca href=\"http://weill.cornell.edu/news/releases/wcmc/wcmc_2011/05_25_11.shtml\">likely to save time and reduce errors\u003c/a>.\u003c/p>\n\u003cp>Although high speed Internet access has improved in recent years, a persistent challenge in rural parts of the state is the relative \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?view=print\">shortage of IT professionals\u003c/a>. Lafferty said “many pieces came together” to create the strong IT staff working on EHR implementation. The Plumas Hospital's in-house information systems director, for example, “has spent countless hours” on the project, he said.\u003c/p>\n\u003cp>And additional tech support? “Well, it’s not too hard to recruit,” Lafferty said, “because this has got to be one of the most gorgeous places in California.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Lafferty acknowledged that updating the care delivery systems at Plumas District presented challenges. “It’s a culture change,” he said, “but it’s the right choice for the future.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Cash-Only Practices: Better for Patients or Just Better for Doctors?",
"title": "Cash-Only Practices: Better for Patients or Just Better for Doctors?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5421\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/IMG_0050.jpg\">\u003cimg class=\"size-medium wp-image-5421 \" title=\"Patient Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey.\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/IMG_0050-300x225.jpg\" alt=\"Patient Jayaludchemy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey.\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey. (Kamal Menghrajani)\u003c/figcaption>\u003c/figure>\n\u003cp>Some wealthy patients pay thousands of dollars each month to keep a personal physician on call at all times. In case of emergency, the patient can quickly access a doctor who knows them well and who they trust to make good medical decisions.\u003c/p>\n\u003cp>Now this \"concierge medicine\" model is being scaled down to reach people with more modest financial resources. One such practice that’s starting up in Northern California is called \u003ca title=\"http://www.medlion.com/\" href=\"http://www.medlion.com/\" target=\"_blank\">MedLion\u003c/a>. Started in Monterey by \u003ca title=\"http://www.medlion.com/our-physicians/\" href=\"http://www.medlion.com/our-physicians/\" target=\"_blank\">Dr. Samir Qamar\u003c/a>, the practice is offering what he calls \"direct primary care.\" Patients see their doctor for advice on treating the flu or a chronic illness. The doctor takes on fewer patients overall -- about half that of a typical primary care provider -- and presumably have more time to spend with each one.\u003c/p>\n\u003cp>But this sort of care comes at a cost. These practices do not accept insurance, meaning patients must pay cash in order to be seen. In MedLion’s case, there is a monthly fee to buy a spot on the doctor’s limited roster, and an additional $10 fee for each office visit. For everything else, the patient pays out of pocket -- including basics like x-rays and blood tests.\u003c!--more-->\u003c/p>\n\u003cp>I went to Monterey to speak with Dr. Qamar and his wife, Dr. Hisana Qamar. She is also a family physician and her traditional practice is transitioning to the MedLion model. For now, that means she no longer accepts \u003ca title=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\" href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\" target=\"_blank\">Medi-Cal\u003c/a> or \u003ca title=\"http://www.medicare.gov/default.aspx\" href=\"http://www.medicare.gov/default.aspx\" target=\"_blank\">Medicare\u003c/a>, but continues to accept commercial insurance plans which have higher reimbursement rates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When she stopped accepting Medi-Cal and Medicare back in February, her patients had to make a choice: Either they could pay the monthly fee, plus $10 for each office visit, to stay in her practice – or they needed to find a new doctor.\u003c/p>\n\u003cp>Jayaledchumy Yogaratnam is 76 and has been a patient of Dr. Hisana Qamar’s for three years. She decided to stay. She used to get her care at a clinic that accepted Medicare, but she found her experience there frustrating and would be reluctant to go back. In addition to crowded waiting rooms, she said the wait to see her doctor was long -- “sometimes even 3 hours.”\u003c/p>\n\u003cp>Yogaratnam also felt rushed by the doctors there, which is not the case with Dr. Hisana Qamar, she says. “It's not like a doctor's office for me - it's just like going to visit someone, visit a friend,” Yogaratnam said. She says she and her family can afford the out-of-pocket expenses, so, for her, staying with the practice is worth the additional cost.\u003c/p>\n\u003cp>Founder Dr. Samir Qamar says he started this practice model because he wanted people without insurance to have access to low-cost primary care. But for \u003ca title=\"http://www.chcf.org/about/staff/sophia-chang\" href=\"http://www.chcf.org/about/staff/sophia-chang\" target=\"_blank\">Sophia Chang\u003c/a>, an Internal Medicine physician at \u003ca title=\"http://www.ucsf.edu/\" href=\"http://www.ucsf.edu/\" target=\"_blank\">UC San Francisco\u003c/a> and an expert in health care delivery, this model misses the mark.\u003c/p>\n\u003cp>“It’s clearly the answer to people who have means and essentially want a different tiered system. It’s clearly not the answer if we want to provide population health and if we want to provide good health care to Americans across the board,” said Chang.\u003c/p>\n\u003cp>One way to understand some of the complications of this model is to follow the money.\u003c/p>\n\u003cp>Let’s take the example of an uninsured patient with high blood pressure who needs to see her doctor every three months. That’s four primary care visits every year. Under the old model, the patient could visit Dr. Qamar for a flat fee of $99 cash per office visit (remember, she doesn’t have insurance and would be paying out of pocket). So that’s $99 for four visits each year, or $396.\u003c/p>\n\u003cp>Now, under the MedLion model, the same patient must pay $59 every month, in addition to the $10 fee for each of her four visits. That comes out to $748 dollars per year.\u003c/p>\n\u003cp>That’s almost double what this uninsured patient would have paid before to see the same doctor.\u003c/p>\n\u003cp>Under this model, doctors make more money and see fewer patients. That is alluring to many physicians in Northern California, and some doctors in less affluent areas such as Fresno, Watsonville, Salinas, and Bakersfield are already switching their practices to this new format. Once they convert to the MedLion model, they will no longer see patients with Medicare or Medi-Cal, and they will see fewer patients overall – potentially worsening the shortage of primary care doctors in these poorer areas. For those patients who cannot afford to pay the monthly fees, it is unclear where they will seek care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to spreading the model here in California, Dr. Samir Qamar is consulting with physicians on the east coast to get them on board with this style of practicing medicine. Retainer-based practices like MedLion would be allowed by the \u003ca title=\"http://www.healthcare.gov/law/full/\" href=\"http://www.healthcare.gov/law/full/\" target=\"_blank\">Affordable Care Act \u003c/a>if patients also have catastrophic insurance to cover things like surgery or chemotherapy, so the cash-only practices could grow in popularity.\u003c/p>\n\n",
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"excerpt": "Some wealthy patients pay thousands of dollars each month to keep a personal physician on call at all times. In case of emergency, the patient can quickly access a doctor who knows them well and who they trust to make good medical decisions.\r\n\r\nNow this \"concierge medicine\" model is being scaled down to reach people with more modest financial resources. One such practice that’s starting up in Northern California is called MedLion. Started in Monterey by Dr. Samir Qamar, the practice is offering what he calls \"direct primary care.\" Patients see their doctor for advice on treating the flu or a chronic illness. The doctor takes on fewer patients overall -- about half that of a typical primary care provider -- and presumably have more time to spend with each one.",
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"title": "Cash-Only Practices: Better for Patients or Just Better for Doctors? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5421\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/IMG_0050.jpg\">\u003cimg class=\"size-medium wp-image-5421 \" title=\"Patient Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey.\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/IMG_0050-300x225.jpg\" alt=\"Patient Jayaludchemy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey.\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey. (Kamal Menghrajani)\u003c/figcaption>\u003c/figure>\n\u003cp>Some wealthy patients pay thousands of dollars each month to keep a personal physician on call at all times. In case of emergency, the patient can quickly access a doctor who knows them well and who they trust to make good medical decisions.\u003c/p>\n\u003cp>Now this \"concierge medicine\" model is being scaled down to reach people with more modest financial resources. One such practice that’s starting up in Northern California is called \u003ca title=\"http://www.medlion.com/\" href=\"http://www.medlion.com/\" target=\"_blank\">MedLion\u003c/a>. Started in Monterey by \u003ca title=\"http://www.medlion.com/our-physicians/\" href=\"http://www.medlion.com/our-physicians/\" target=\"_blank\">Dr. Samir Qamar\u003c/a>, the practice is offering what he calls \"direct primary care.\" Patients see their doctor for advice on treating the flu or a chronic illness. The doctor takes on fewer patients overall -- about half that of a typical primary care provider -- and presumably have more time to spend with each one.\u003c/p>\n\u003cp>But this sort of care comes at a cost. These practices do not accept insurance, meaning patients must pay cash in order to be seen. In MedLion’s case, there is a monthly fee to buy a spot on the doctor’s limited roster, and an additional $10 fee for each office visit. For everything else, the patient pays out of pocket -- including basics like x-rays and blood tests.\u003c!--more-->\u003c/p>\n\u003cp>I went to Monterey to speak with Dr. Qamar and his wife, Dr. Hisana Qamar. She is also a family physician and her traditional practice is transitioning to the MedLion model. For now, that means she no longer accepts \u003ca title=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\" href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\" target=\"_blank\">Medi-Cal\u003c/a> or \u003ca title=\"http://www.medicare.gov/default.aspx\" href=\"http://www.medicare.gov/default.aspx\" target=\"_blank\">Medicare\u003c/a>, but continues to accept commercial insurance plans which have higher reimbursement rates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When she stopped accepting Medi-Cal and Medicare back in February, her patients had to make a choice: Either they could pay the monthly fee, plus $10 for each office visit, to stay in her practice – or they needed to find a new doctor.\u003c/p>\n\u003cp>Jayaledchumy Yogaratnam is 76 and has been a patient of Dr. Hisana Qamar’s for three years. She decided to stay. She used to get her care at a clinic that accepted Medicare, but she found her experience there frustrating and would be reluctant to go back. In addition to crowded waiting rooms, she said the wait to see her doctor was long -- “sometimes even 3 hours.”\u003c/p>\n\u003cp>Yogaratnam also felt rushed by the doctors there, which is not the case with Dr. Hisana Qamar, she says. “It's not like a doctor's office for me - it's just like going to visit someone, visit a friend,” Yogaratnam said. She says she and her family can afford the out-of-pocket expenses, so, for her, staying with the practice is worth the additional cost.\u003c/p>\n\u003cp>Founder Dr. Samir Qamar says he started this practice model because he wanted people without insurance to have access to low-cost primary care. But for \u003ca title=\"http://www.chcf.org/about/staff/sophia-chang\" href=\"http://www.chcf.org/about/staff/sophia-chang\" target=\"_blank\">Sophia Chang\u003c/a>, an Internal Medicine physician at \u003ca title=\"http://www.ucsf.edu/\" href=\"http://www.ucsf.edu/\" target=\"_blank\">UC San Francisco\u003c/a> and an expert in health care delivery, this model misses the mark.\u003c/p>\n\u003cp>“It’s clearly the answer to people who have means and essentially want a different tiered system. It’s clearly not the answer if we want to provide population health and if we want to provide good health care to Americans across the board,” said Chang.\u003c/p>\n\u003cp>One way to understand some of the complications of this model is to follow the money.\u003c/p>\n\u003cp>Let’s take the example of an uninsured patient with high blood pressure who needs to see her doctor every three months. That’s four primary care visits every year. Under the old model, the patient could visit Dr. Qamar for a flat fee of $99 cash per office visit (remember, she doesn’t have insurance and would be paying out of pocket). So that’s $99 for four visits each year, or $396.\u003c/p>\n\u003cp>Now, under the MedLion model, the same patient must pay $59 every month, in addition to the $10 fee for each of her four visits. That comes out to $748 dollars per year.\u003c/p>\n\u003cp>That’s almost double what this uninsured patient would have paid before to see the same doctor.\u003c/p>\n\u003cp>Under this model, doctors make more money and see fewer patients. That is alluring to many physicians in Northern California, and some doctors in less affluent areas such as Fresno, Watsonville, Salinas, and Bakersfield are already switching their practices to this new format. Once they convert to the MedLion model, they will no longer see patients with Medicare or Medi-Cal, and they will see fewer patients overall – potentially worsening the shortage of primary care doctors in these poorer areas. For those patients who cannot afford to pay the monthly fees, it is unclear where they will seek care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to spreading the model here in California, Dr. Samir Qamar is consulting with physicians on the east coast to get them on board with this style of practicing medicine. Retainer-based practices like MedLion would be allowed by the \u003ca title=\"http://www.healthcare.gov/law/full/\" href=\"http://www.healthcare.gov/law/full/\" target=\"_blank\">Affordable Care Act \u003c/a>if patients also have catastrophic insurance to cover things like surgery or chemotherapy, so the cash-only practices could grow in popularity.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Mammogram Research for Women in Their 40s",
"title": "New Mammogram Research for Women in Their 40s",
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"content": "\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons.jpg\">\u003cimg class=\"size-medium wp-image-5549\" title=\"(Photo: U.S. Navy)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>It's hard to believe that a one in a hundred risk of something bad happening would generate so much heated debate, but that's where we're at when it comes to the question of mammograms for women in their 40s. Since breast cancer is a disease which risk increases with age, the clear cut off point for mammography has been age 50. Mammography will find cancer in women in their 40s, but will carry a much higher risk of false positives.\u003c/p>\n\u003cp>Specifically, a 40-year-old woman has a 1.5 percent chance of developing breast cancer at some point during her 40s. The 1-in-8 chance repeated so frequently is over a lifetime -- up to age 80.\u003c/p>\n\u003cp>While mammography is the best tool we have in detecting breast cancer, it's not a perfect test. Mammograms will pick up abnormalities that are not breast cancer. The problem is that doctors can't say definitively these abnormalities are benign without further testing. Sometimes that means having an additional mammogram, sometimes women must then have a biopsy. In the meantime, many of these women are worrying.\u003c!--more-->\u003c/p>\n\u003cp>The when-to-start mammography debate has been going on for \u003ca title=\"http://www.nytimes.com/1993/02/26/us/studies-say-mammograms-fail-to-help-many-women.html\" href=\"http://www.nytimes.com/1993/02/26/us/studies-say-mammograms-fail-to-help-many-women.html\" target=\"_blank\">almost twenty years\u003c/a>. More recently, in 2009, the\u003ca title=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\"> U.S. Preventive Services Task Force\u003c/a> re-ignited the debate when it stopped short of making an explicit recommendation that women in their 40's be screened and instead said that the decision was an \"individual one.\"\u003c/p>\n\u003cp>Today two studies in the \u003ca title=\"http://www.annals.org/content/156/9/609.abstract\" href=\"http://www.annals.org/content/156/9/609.abstract\" target=\"_blank\">Annals of Internal Medicine \u003c/a>have some hard data to help individual women make that decision. In a review of 9.5 million mammograms from across the country, researchers say that two groups of women in their 40's are at increased risk of developing breast cancer. These two risks are a close family relative with breast cancer -- a mother, sister or daughter --- and extremely dense breast tissue.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These risk factors put 40-49 year old women at the same risk of developing breast cancer as women in their 50's -- 2.5 percent over the decade-- and researchers say have crossed the \"tipping point\" where the benefit of mammography outweighs the possible harms of false positives. \"The main takeaway,\" says Dr. Karla Kerlikowske of U.C. San Francisco and a co-author of both studies, \"is that we need to move in the direction of what’s been coined 'risk-based screening' where whether you have a mammogram or not is not just based on your age, but based on your overall risk of breast cancer.\"\u003c/p>\n\u003cp>But talk to just about any woman and they will tell you of the 40-something they know with breast cancer. Soon enough the discussion becomes very emotional.\u003ca title=\"http://pressroom.cancer.org/index.php?s=18&item=40\" href=\"http://pressroom.cancer.org/index.php?s=18&item=40\" target=\"_blank\"> Dr. Otis Brawley\u003c/a>, Chief Medical Officer of the American Society, wrote an accompanying \u003ca title=\"http://www.annals.org/content/156/9/662.full\" href=\"http://www.annals.org/content/156/9/662.full\" target=\"_blank\">editorial\u003c/a> in the \u003cem>Annals \u003c/em>addressing maximizing benefits and minimizing harms. \"Risk-based screening can refocus efforts onto the women who are most likely to benefit from screening,\" he writes. \"This would not be a reduction in resources used; it would be a more effective use of resources. Risk-based screening has the potential to save more lives than our current practice.\"\u003c/p>\n\u003cp>Still, at least for the time-being, the American Cancer Society continues to recommend \u003ca title=\"http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" href=\"http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">annual mammograms\u003c/a> for women starting at age 40.\u003c/p>\n\u003cp>\u003ca title=\"http://mydoctor.kaiserpermanente.org/ncal/provider/susankutner/resources/dc/article?article=article_177803.xml&contentTitle=Telephonic%20Wellness%20Coaching\" href=\"http://mydoctor.kaiserpermanente.org/ncal/provider/susankutner/resources/dc/article?article=article_177803.xml&contentTitle=Telephonic%20Wellness%20Coaching\" target=\"_blank\">Dr. Susan Kutner\u003c/a> is Chair of the Northern California Kaiser Breast Care Task Force and was not involved with the studies. She welcomes the new data. \"What these articles address is there are some women ages 40-49 who would benefit from screening,\" she told me. \"Personalizing their screening based on their risk is really important, and that's what we're learning as we analyze this data.\"\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003cbr>\n\u003cstrong>\u003c/strong>KQED's Forum addressed the new research today. You can listen to the program here:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201205010930.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201205010930.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "It's hard to believe that a one in a hundred risk of something bad happening would generate so much heated debate, but that's where we're at when it comes to the question of mammograms for women in their 40's. Since breast cancer is a disease which increases with age, the clear cut off point for mammography has been age 50. Mammography will find cancer in women in their 40s, but will carry a much higher risk of false positives.\r\n\r\nSpecifically, a 40 year old woman has a 1.5 percent chance of developing breast cancer at some point during her 40s. The 1-in-8 chance repeated so frequently is over a lifetime -- up to age 80.",
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"description": "It's hard to believe that a one in a hundred risk of something bad happening would generate so much heated debate, but that's where we're at when it comes to the question of mammograms for women in their 40's. Since breast cancer is a disease which increases with age, the clear cut off point for mammography has been age 50. Mammography will find cancer in women in their 40s, but will carry a much higher risk of false positives.\r\n\r\nSpecifically, a 40 year old woman has a 1.5 percent chance of developing breast cancer at some point during her 40s. The 1-in-8 chance repeated so frequently is over a lifetime -- up to age 80.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons.jpg\">\u003cimg class=\"size-medium wp-image-5549\" title=\"(Photo: U.S. Navy)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>It's hard to believe that a one in a hundred risk of something bad happening would generate so much heated debate, but that's where we're at when it comes to the question of mammograms for women in their 40s. Since breast cancer is a disease which risk increases with age, the clear cut off point for mammography has been age 50. Mammography will find cancer in women in their 40s, but will carry a much higher risk of false positives.\u003c/p>\n\u003cp>Specifically, a 40-year-old woman has a 1.5 percent chance of developing breast cancer at some point during her 40s. The 1-in-8 chance repeated so frequently is over a lifetime -- up to age 80.\u003c/p>\n\u003cp>While mammography is the best tool we have in detecting breast cancer, it's not a perfect test. Mammograms will pick up abnormalities that are not breast cancer. The problem is that doctors can't say definitively these abnormalities are benign without further testing. Sometimes that means having an additional mammogram, sometimes women must then have a biopsy. In the meantime, many of these women are worrying.\u003c!--more-->\u003c/p>\n\u003cp>The when-to-start mammography debate has been going on for \u003ca title=\"http://www.nytimes.com/1993/02/26/us/studies-say-mammograms-fail-to-help-many-women.html\" href=\"http://www.nytimes.com/1993/02/26/us/studies-say-mammograms-fail-to-help-many-women.html\" target=\"_blank\">almost twenty years\u003c/a>. More recently, in 2009, the\u003ca title=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\"> U.S. Preventive Services Task Force\u003c/a> re-ignited the debate when it stopped short of making an explicit recommendation that women in their 40's be screened and instead said that the decision was an \"individual one.\"\u003c/p>\n\u003cp>Today two studies in the \u003ca title=\"http://www.annals.org/content/156/9/609.abstract\" href=\"http://www.annals.org/content/156/9/609.abstract\" target=\"_blank\">Annals of Internal Medicine \u003c/a>have some hard data to help individual women make that decision. In a review of 9.5 million mammograms from across the country, researchers say that two groups of women in their 40's are at increased risk of developing breast cancer. These two risks are a close family relative with breast cancer -- a mother, sister or daughter --- and extremely dense breast tissue.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These risk factors put 40-49 year old women at the same risk of developing breast cancer as women in their 50's -- 2.5 percent over the decade-- and researchers say have crossed the \"tipping point\" where the benefit of mammography outweighs the possible harms of false positives. \"The main takeaway,\" says Dr. Karla Kerlikowske of U.C. San Francisco and a co-author of both studies, \"is that we need to move in the direction of what’s been coined 'risk-based screening' where whether you have a mammogram or not is not just based on your age, but based on your overall risk of breast cancer.\"\u003c/p>\n\u003cp>But talk to just about any woman and they will tell you of the 40-something they know with breast cancer. Soon enough the discussion becomes very emotional.\u003ca title=\"http://pressroom.cancer.org/index.php?s=18&item=40\" href=\"http://pressroom.cancer.org/index.php?s=18&item=40\" target=\"_blank\"> Dr. Otis Brawley\u003c/a>, Chief Medical Officer of the American Society, wrote an accompanying \u003ca title=\"http://www.annals.org/content/156/9/662.full\" href=\"http://www.annals.org/content/156/9/662.full\" target=\"_blank\">editorial\u003c/a> in the \u003cem>Annals \u003c/em>addressing maximizing benefits and minimizing harms. \"Risk-based screening can refocus efforts onto the women who are most likely to benefit from screening,\" he writes. \"This would not be a reduction in resources used; it would be a more effective use of resources. Risk-based screening has the potential to save more lives than our current practice.\"\u003c/p>\n\u003cp>Still, at least for the time-being, the American Cancer Society continues to recommend \u003ca title=\"http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" href=\"http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">annual mammograms\u003c/a> for women starting at age 40.\u003c/p>\n\u003cp>\u003ca title=\"http://mydoctor.kaiserpermanente.org/ncal/provider/susankutner/resources/dc/article?article=article_177803.xml&contentTitle=Telephonic%20Wellness%20Coaching\" href=\"http://mydoctor.kaiserpermanente.org/ncal/provider/susankutner/resources/dc/article?article=article_177803.xml&contentTitle=Telephonic%20Wellness%20Coaching\" target=\"_blank\">Dr. Susan Kutner\u003c/a> is Chair of the Northern California Kaiser Breast Care Task Force and was not involved with the studies. She welcomes the new data. \"What these articles address is there are some women ages 40-49 who would benefit from screening,\" she told me. \"Personalizing their screening based on their risk is really important, and that's what we're learning as we analyze this data.\"\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003cbr>\n\u003cstrong>\u003c/strong>KQED's Forum addressed the new research today. You can listen to the program here:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201205010930.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201205010930.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Steps Toward Lower Cost, Higher Quality Health Care",
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"content": "\u003cfigure id=\"attachment_5472\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/CalPERS_DoctorPatient_Vic_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5472\" title=\"(Vic: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/CalPERS_DoctorPatient_Vic_Flickr-300x200.jpg\" alt=\"(Vic: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Vic: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>No one seems to have a problem with shopping for the best price when it comes to a new computer or a car. But there's something about shopping for health care prices that seems \u003cem>different. \u003c/em>It's also a lot harder. Prices aren't transparent. The L.A. Times \u003ca title=\"http://articles.latimes.com/2012/apr/15/business/la-fi-adv-medical-prices-20120415\" href=\"http://articles.latimes.com/2012/apr/15/business/la-fi-adv-medical-prices-20120415\" target=\"_blank\">reported\u003c/a> earlier this month on the challenges individual patients can have in trying to find the best price.\u003c/p>\n\u003cp>At the same time, consumers have become more concerned about cost. According to the Kaiser Family Foundation, premiums for family coverage have more than \u003ca title=\"http://ehbs.kff.org/pdf/8226.pdf\" href=\"http://ehbs.kff.org/pdf/8226.pdf\" target=\"_blank\">doubled in the last ten years\u003c/a> -- 113 percent -- and the share the worker pays of the premium is up even more -- 131 percent.\u003c/p>\n\u003cp>The cost of health care has been going up, faster than the rate of inflation. The federal health care overhaul takes aim at this problem and seeks to \u003ca title=\"http://www.healthcare.gov/compare/partnership-for-patients/index.html\" href=\"http://www.healthcare.gov/compare/partnership-for-patients/index.html\" target=\"_blank\">lower cost and improve quality \u003c/a>of care at the same time. One program gaining traction is through focusing insurance design on value. For example, some plans \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx\" target=\"_blank\">reward healthy behaviors\u003c/a>, such as quitting smoking or exercising regularly.\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"http://www.calpers.ca.gov/\" href=\"http://www.calpers.ca.gov/\" target=\"_blank\">California Public Employees' Retirement System\u003c/a>-- or CalPERS -- is trying a different approach, one that looks at charges for a specific procedure across its entire population. And CalPERS has a big population of beneficiaries. It covers 1.6 million employees, retirees and their families. In 2008 CalPERS conducted an analysis of its claims database and learned it was paying $55 million a year in knee and hip replacements.\u003c/p>\n\u003cp>Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross -- which manages its PPO plans -- to examine the range of prices for these operations in California.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.\u003c/p>\n\u003cp>\"So we started asking ourselves,\" Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, \"what are we getting from the $110,000 surgery that we couldn't get from the $15,000 surgery?\"\u003c/p>\n\u003cp>That's when CalPERS turned to what's called a \"value based purchasing\" approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.\u003c/p>\n\u003cp>Of course, it's easy to shop on price, but what about quality? Donneson says Anthem used a \"quality scorecard\" to select only institutions which could deliver a high level of quality. When the program launched in early 2011, Anthem's list included UC San Francisco and Stanford.\u003c/p>\n\u003cp>On January 1st of this year, Blue Shield started a similar program with CalPERS. Blue Shield has a process for awarding a \"\u003ca title=\"http://www.bcbs.com/why-bcbs/blue-distinction/\" href=\"http://www.bcbs.com/why-bcbs/blue-distinction/\" target=\"_blank\">Blue Distinction\u003c/a>\" designation to hospitals that deliver \"quality healthcare.\" In order to earn the designation, \u003ca title=\"http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-overview.html\" href=\"http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-overview.html\" target=\"_blank\">hospitals must show \u003c/a>they have lower complication rates or hospital readmission rates, among other criteria.\u003c/p>\n\u003cp>\"The bottom line is that this is the kind of healthy competition that has not existed to a great extent in health care before,\" Bill Kramer of the \u003ca title=\"http://www.pbgh.org/index.php\" href=\"http://www.pbgh.org/index.php\" target=\"_blank\">Pacific Business Group on Health\u003c/a> told me. PBGH is a group of large employers working to improve health care quality and reduce cost.\u003c/p>\n\u003cp>CalPERS patients who choose one of these \"threshold price\" hospitals will pay only the deductible and copay for their hip or knee replacement. But if they choose a different hospital, they will have to pay whatever the differential is, out of pocket. If there's no hospital on the list within 50 miles of the patient's home, the patient is reimbursed for travel. But CalPERS wants to help its members avoid travel. \"We do want enough centers so there isn't a long distance to travel,\" said Donneson. \"That's why I'm working with both Anthem and Blue Shield to increase the hospitals on the list.\"\u003c/p>\n\u003cp>When CalPERS started the project, it was hoping for 16% savings. Donneson says a UC Berkeley team of health economists is working on an analysis of the 2011 claims which should be complete in June. Then CalPERS should know if their new approach is saving money.\u003c/p>\n\u003cp>In the meantime, we do know this: in the first half of 2011, Anthem Blue Cross received 246 claims for hip or knee replacement. A full 70 percent of those claims were below the $30,000 threshold price. The average price for operations done at hospitals on Anthem's list was $18,000 while the average cost for operations at hospitals not on the list was $34,000. And no one went to the hospital that charged $110,000, says Donneson. At the beginning of this year, CalPERS expanded its threshold pricing project to colonoscopy, arthroscopy and cataract surgery. The organization has no plans to add any other procedures next year. Just looking at cataract surgery -- the range for that procedure across the state was $1,600 to $8,000.\u003c/p>\n\u003cp>\"The future is here,\" says Kramer. \"We know some of the things that work, but it's not taken to scale yet. Pilots that work and spread them more quickly and more broadly -- that's the kind of thing that will drive system change and bring our costs down.\"\u003c/p>\n\u003cp>\u003cem>Editor's Note: Friday's \"The California Report Magazine\" devotes its 30-minute program to health care costs. It includes an examination of premium costs at Kaiser Permanente, catastrophic health care plans and an innovative home hospice alternative in San Diego. You can listen here:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "No one seems to have a problem with shopping for the best price when it comes to a new computer or a car. But there's something about shopping for health care prices that seems different. It's also a lot harder. Prices aren't transparent. The L.A. Times reported earlier this month on the challenges individual patients can have in trying to find the best price.\r\n\r\nAt the same time, consumers have become more concerned about cost. According to the Kaiser Family Foundation, premiums for family coverage have more than doubled in the last ten years -- 113 percent -- and the share the worker pays of the premium is up even more -- 131 percent. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5472\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/CalPERS_DoctorPatient_Vic_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5472\" title=\"(Vic: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/CalPERS_DoctorPatient_Vic_Flickr-300x200.jpg\" alt=\"(Vic: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Vic: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>No one seems to have a problem with shopping for the best price when it comes to a new computer or a car. But there's something about shopping for health care prices that seems \u003cem>different. \u003c/em>It's also a lot harder. Prices aren't transparent. The L.A. Times \u003ca title=\"http://articles.latimes.com/2012/apr/15/business/la-fi-adv-medical-prices-20120415\" href=\"http://articles.latimes.com/2012/apr/15/business/la-fi-adv-medical-prices-20120415\" target=\"_blank\">reported\u003c/a> earlier this month on the challenges individual patients can have in trying to find the best price.\u003c/p>\n\u003cp>At the same time, consumers have become more concerned about cost. According to the Kaiser Family Foundation, premiums for family coverage have more than \u003ca title=\"http://ehbs.kff.org/pdf/8226.pdf\" href=\"http://ehbs.kff.org/pdf/8226.pdf\" target=\"_blank\">doubled in the last ten years\u003c/a> -- 113 percent -- and the share the worker pays of the premium is up even more -- 131 percent.\u003c/p>\n\u003cp>The cost of health care has been going up, faster than the rate of inflation. The federal health care overhaul takes aim at this problem and seeks to \u003ca title=\"http://www.healthcare.gov/compare/partnership-for-patients/index.html\" href=\"http://www.healthcare.gov/compare/partnership-for-patients/index.html\" target=\"_blank\">lower cost and improve quality \u003c/a>of care at the same time. One program gaining traction is through focusing insurance design on value. For example, some plans \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx\" target=\"_blank\">reward healthy behaviors\u003c/a>, such as quitting smoking or exercising regularly.\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"http://www.calpers.ca.gov/\" href=\"http://www.calpers.ca.gov/\" target=\"_blank\">California Public Employees' Retirement System\u003c/a>-- or CalPERS -- is trying a different approach, one that looks at charges for a specific procedure across its entire population. And CalPERS has a big population of beneficiaries. It covers 1.6 million employees, retirees and their families. In 2008 CalPERS conducted an analysis of its claims database and learned it was paying $55 million a year in knee and hip replacements.\u003c/p>\n\u003cp>Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross -- which manages its PPO plans -- to examine the range of prices for these operations in California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.\u003c/p>\n\u003cp>\"So we started asking ourselves,\" Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, \"what are we getting from the $110,000 surgery that we couldn't get from the $15,000 surgery?\"\u003c/p>\n\u003cp>That's when CalPERS turned to what's called a \"value based purchasing\" approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.\u003c/p>\n\u003cp>Of course, it's easy to shop on price, but what about quality? Donneson says Anthem used a \"quality scorecard\" to select only institutions which could deliver a high level of quality. When the program launched in early 2011, Anthem's list included UC San Francisco and Stanford.\u003c/p>\n\u003cp>On January 1st of this year, Blue Shield started a similar program with CalPERS. Blue Shield has a process for awarding a \"\u003ca title=\"http://www.bcbs.com/why-bcbs/blue-distinction/\" href=\"http://www.bcbs.com/why-bcbs/blue-distinction/\" target=\"_blank\">Blue Distinction\u003c/a>\" designation to hospitals that deliver \"quality healthcare.\" In order to earn the designation, \u003ca title=\"http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-overview.html\" href=\"http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-overview.html\" target=\"_blank\">hospitals must show \u003c/a>they have lower complication rates or hospital readmission rates, among other criteria.\u003c/p>\n\u003cp>\"The bottom line is that this is the kind of healthy competition that has not existed to a great extent in health care before,\" Bill Kramer of the \u003ca title=\"http://www.pbgh.org/index.php\" href=\"http://www.pbgh.org/index.php\" target=\"_blank\">Pacific Business Group on Health\u003c/a> told me. PBGH is a group of large employers working to improve health care quality and reduce cost.\u003c/p>\n\u003cp>CalPERS patients who choose one of these \"threshold price\" hospitals will pay only the deductible and copay for their hip or knee replacement. But if they choose a different hospital, they will have to pay whatever the differential is, out of pocket. If there's no hospital on the list within 50 miles of the patient's home, the patient is reimbursed for travel. But CalPERS wants to help its members avoid travel. \"We do want enough centers so there isn't a long distance to travel,\" said Donneson. \"That's why I'm working with both Anthem and Blue Shield to increase the hospitals on the list.\"\u003c/p>\n\u003cp>When CalPERS started the project, it was hoping for 16% savings. Donneson says a UC Berkeley team of health economists is working on an analysis of the 2011 claims which should be complete in June. Then CalPERS should know if their new approach is saving money.\u003c/p>\n\u003cp>In the meantime, we do know this: in the first half of 2011, Anthem Blue Cross received 246 claims for hip or knee replacement. A full 70 percent of those claims were below the $30,000 threshold price. The average price for operations done at hospitals on Anthem's list was $18,000 while the average cost for operations at hospitals not on the list was $34,000. And no one went to the hospital that charged $110,000, says Donneson. At the beginning of this year, CalPERS expanded its threshold pricing project to colonoscopy, arthroscopy and cataract surgery. The organization has no plans to add any other procedures next year. Just looking at cataract surgery -- the range for that procedure across the state was $1,600 to $8,000.\u003c/p>\n\u003cp>\"The future is here,\" says Kramer. \"We know some of the things that work, but it's not taken to scale yet. Pilots that work and spread them more quickly and more broadly -- that's the kind of thing that will drive system change and bring our costs down.\"\u003c/p>\n\u003cp>\u003cem>Editor's Note: Friday's \"The California Report Magazine\" devotes its 30-minute program to health care costs. It includes an examination of premium costs at Kaiser Permanente, catastrophic health care plans and an innovative home hospice alternative in San Diego. You can listen here:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204271630.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204271630.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Checks in the Mail: Millions to Receive $1.3 Billion in Health Insurance Rebates",
"title": "Checks in the Mail: Millions to Receive $1.3 Billion in Health Insurance Rebates",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By: \u003ca title=\"http://www.kaiserhealthnews.org/Reporters/ApplebyJ.aspx\" href=\"http://www.kaiserhealthnews.org/Reporters/ApplebyJ.aspx\" target=\"_blank\">Julie Appleby\u003c/a>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/April/26/insurance-rebates-mlr.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/April/26/insurance-rebates-mlr.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_5488\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MailinMailboxRobinDeGrassiJames_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5488\" title=\"(Robin DeGrassi James: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MailinMailboxRobinDeGrassiJames_Flickr-300x273.jpg\" alt=\"(Robin DeGrassi James: Flickr)\" width=\"300\" height=\"273\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Robin DeGrassi James: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that effectively limits what insurers can charge for administration and profits, \u003ca href=\"http://www.kff.org/healthreform/8305.cfm\" target=\"_blank\">a new study projects\u003c/a>.\u003c/p>\n\u003cp>Almost one third of people who bought their own insurance last year will get rebates averaging $127, according to an analysis of state data by the nonpartisan Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>\"This alone is not going to make health insurance affordable for large numbers of people, but it is getting excess administrative cost out of the system,\" says Larry Levitt, a study author.\u003c/p>\n\u003cp>The percentage of consumers and businesses in line for rebates varies widely by state. In Texas, for example, 92 percent of consumers who purchased individual policies are expected to get rebates because insurers spent too little of their premium dollars on medical care. But in Vermont, Rhode Island, Iowa and Hawaii, insurers are likely to owe less than 1 percent of consumers who bought policies on the individual market.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the federal law, insurers must spend at least 80 percent of premium revenues on medical costs or quality improvements; the remainder can go toward administrative costs, sales commissions and profits. If companies set premiums too high, \u003ca href=\"http://cciio.cms.gov/programs/marketreforms/mlr/index.html\" target=\"_blank\">rebates in the form of checks or discounts off future premiums\u003c/a> are due consumers and businesses by Aug. 1.\u003c/p>\n\u003cp>The requirement, aimed at holding insurers more accountable and slowing premium increases, went into effect last year and applies to all health plans, except those offered by self-insured employers. Insurers had criticized the rule as being too strict, while sales agents feared insurers would reduce their commissions.\u003c/p>\n\u003cp>The figures are based on the latest estimates insurers provided state regulators, so the actual rebate amounts may differ, according to the report's authors. The total dollar projection is similar to one released Wednesday by a Goldman Sachs analyst, but slightly lower than one made previously by the government, which had said rebates could be worth up to $1.4 billion.\u003c/p>\n\u003cp>Nationally, an estimated 3.4 million people who bought their own coverage are projected to receive rebates this year from 215 insurance plans, according to the study. The biggest dollar amounts are expected to go to consumers in Alaska, where per person rebates are expected to average $305, Maryland, $294, Pennsylvania, $243 and Idaho, $241. Insurers hit the spending targets for policies sold directly to consumers in several states, including Hawaii, Maine and the District of Columbia, so no rebates are expected for individual consumers there.\u003c/p>\n\u003cp>More than a dozen states sought to relax the standard for insurance sold directly to consumers, saying it would cause insurers to withdraw from their markets. The Obama administration \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/may/10/medical-loss-ratio-rebates.aspx\" target=\"_blank\">granted seven such requests\u003c/a>, choosing to phase in the requirement between now and 2014 in Georgia, Iowa, Kentucky, Maine, Nevada, New Hampshire and North Carolina.\u003c/p>\n\u003cp>Rebates averaging $76 per enrollee are projected to go to more than one quarter of small businesses nationally, covering an estimated 4.9 million people. When averaged by state, the biggest per-enrollee rebates will go to businesses in Alaska at $517 and Alabama, at $203 and Oregon, $172. No rebates will go to small businesses in eight states, where insurers met their spending targets, including Hawaii, Minnesota and North Dakota.\u003c/p>\n\u003cp>For the most part, insurers who offer coverage to large employers met the targets. Still, 19 percent of large employers, covering 7.5 million people, are likely to get rebates averaging $72 per member. Employers must use some or all of the rebate for the benefit of workers.\u003c/p>\n\u003cp>\u003ca title=\"http://www.ahip.org/\" href=\"http://www.ahip.org/\" target=\"_blank\">America’s Health Insurance Plans\u003c/a>, the industry trade group, said the spending rule could have unintended consequences, potentially causing some insurers to withdraw from certain markets and that it does not address the biggest reason for rising premiums – underlying health care costs.\u003c/p>\n\u003cp>“Moreover, the taxes, benefit mandates and other regulations in the health care reform law will cause premium increases that far exceed the value of any prospective rebates,” the group said in a written statement.\u003c/p>\n\u003cp>Ana Gupte, a senior health industry analyst at Sanford Bernstein, says insurers in some markets lowered premiums to avoid paying rebates, but others risked having to pay a rebate because they didn’t want to underprice their policies. Some insurers may have miscalculated – and thus owe a refund – because of lower-than-expected utilization of health care kept their medical costs below projections, she says.\u003c/p>\n\u003cp>Looking ahead, Gupte expects to see fewer rebates in future years \"because utilization (of medical care) will go back up, so the spread between pricing and cost will get narrower.\"\u003c/p>\n\u003cp>Still, Alexandria-Va.-based health industry consultant Robert Laszewski says the projected rebates are so small as to count mainly as a \"rounding error\" that most consumers won't even notice.\u003c/p>\n\u003cp>\"If it saved you $200 on a $10,000 premium, does it feel like your insurance is more affordable?\" asked Laszewski, a former insurance industry executive. He said some sales agents who saw insurers reduce their commissions as a result of the law have also begun charging clients a fee for helping them choose a policy.\u003c/p>\n\u003cp>But consumer advocate Timothy Jost, a professor at Washington and Lee University School of Law, says the goal was never to deliver large refunds.\u003c/p>\n\u003cp>\"The purpose isn't to generate rebates, but to force insurers to align their premiums more closely with their (medical) claims costs,\" says Jost. \"Each year, premium costs have gone up more than medical costs, so what the rule does is force insurers to be more efficient and, if they charge too much, to give some back.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: California data have not yet been reported, but should be available in the coming weeks.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that effectively limits what insurers can charge for administration and profits, a new study projects.\r\n\r\nAlmost one third of people who bought their own insurance last year will get rebates averaging $127, according to an analysis of state data by the nonpartisan Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By: \u003ca title=\"http://www.kaiserhealthnews.org/Reporters/ApplebyJ.aspx\" href=\"http://www.kaiserhealthnews.org/Reporters/ApplebyJ.aspx\" target=\"_blank\">Julie Appleby\u003c/a>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/April/26/insurance-rebates-mlr.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/April/26/insurance-rebates-mlr.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_5488\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MailinMailboxRobinDeGrassiJames_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5488\" title=\"(Robin DeGrassi James: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MailinMailboxRobinDeGrassiJames_Flickr-300x273.jpg\" alt=\"(Robin DeGrassi James: Flickr)\" width=\"300\" height=\"273\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Robin DeGrassi James: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that effectively limits what insurers can charge for administration and profits, \u003ca href=\"http://www.kff.org/healthreform/8305.cfm\" target=\"_blank\">a new study projects\u003c/a>.\u003c/p>\n\u003cp>Almost one third of people who bought their own insurance last year will get rebates averaging $127, according to an analysis of state data by the nonpartisan Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>\"This alone is not going to make health insurance affordable for large numbers of people, but it is getting excess administrative cost out of the system,\" says Larry Levitt, a study author.\u003c/p>\n\u003cp>The percentage of consumers and businesses in line for rebates varies widely by state. In Texas, for example, 92 percent of consumers who purchased individual policies are expected to get rebates because insurers spent too little of their premium dollars on medical care. But in Vermont, Rhode Island, Iowa and Hawaii, insurers are likely to owe less than 1 percent of consumers who bought policies on the individual market.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the federal law, insurers must spend at least 80 percent of premium revenues on medical costs or quality improvements; the remainder can go toward administrative costs, sales commissions and profits. If companies set premiums too high, \u003ca href=\"http://cciio.cms.gov/programs/marketreforms/mlr/index.html\" target=\"_blank\">rebates in the form of checks or discounts off future premiums\u003c/a> are due consumers and businesses by Aug. 1.\u003c/p>\n\u003cp>The requirement, aimed at holding insurers more accountable and slowing premium increases, went into effect last year and applies to all health plans, except those offered by self-insured employers. Insurers had criticized the rule as being too strict, while sales agents feared insurers would reduce their commissions.\u003c/p>\n\u003cp>The figures are based on the latest estimates insurers provided state regulators, so the actual rebate amounts may differ, according to the report's authors. The total dollar projection is similar to one released Wednesday by a Goldman Sachs analyst, but slightly lower than one made previously by the government, which had said rebates could be worth up to $1.4 billion.\u003c/p>\n\u003cp>Nationally, an estimated 3.4 million people who bought their own coverage are projected to receive rebates this year from 215 insurance plans, according to the study. The biggest dollar amounts are expected to go to consumers in Alaska, where per person rebates are expected to average $305, Maryland, $294, Pennsylvania, $243 and Idaho, $241. Insurers hit the spending targets for policies sold directly to consumers in several states, including Hawaii, Maine and the District of Columbia, so no rebates are expected for individual consumers there.\u003c/p>\n\u003cp>More than a dozen states sought to relax the standard for insurance sold directly to consumers, saying it would cause insurers to withdraw from their markets. The Obama administration \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/may/10/medical-loss-ratio-rebates.aspx\" target=\"_blank\">granted seven such requests\u003c/a>, choosing to phase in the requirement between now and 2014 in Georgia, Iowa, Kentucky, Maine, Nevada, New Hampshire and North Carolina.\u003c/p>\n\u003cp>Rebates averaging $76 per enrollee are projected to go to more than one quarter of small businesses nationally, covering an estimated 4.9 million people. When averaged by state, the biggest per-enrollee rebates will go to businesses in Alaska at $517 and Alabama, at $203 and Oregon, $172. No rebates will go to small businesses in eight states, where insurers met their spending targets, including Hawaii, Minnesota and North Dakota.\u003c/p>\n\u003cp>For the most part, insurers who offer coverage to large employers met the targets. Still, 19 percent of large employers, covering 7.5 million people, are likely to get rebates averaging $72 per member. Employers must use some or all of the rebate for the benefit of workers.\u003c/p>\n\u003cp>\u003ca title=\"http://www.ahip.org/\" href=\"http://www.ahip.org/\" target=\"_blank\">America’s Health Insurance Plans\u003c/a>, the industry trade group, said the spending rule could have unintended consequences, potentially causing some insurers to withdraw from certain markets and that it does not address the biggest reason for rising premiums – underlying health care costs.\u003c/p>\n\u003cp>“Moreover, the taxes, benefit mandates and other regulations in the health care reform law will cause premium increases that far exceed the value of any prospective rebates,” the group said in a written statement.\u003c/p>\n\u003cp>Ana Gupte, a senior health industry analyst at Sanford Bernstein, says insurers in some markets lowered premiums to avoid paying rebates, but others risked having to pay a rebate because they didn’t want to underprice their policies. Some insurers may have miscalculated – and thus owe a refund – because of lower-than-expected utilization of health care kept their medical costs below projections, she says.\u003c/p>\n\u003cp>Looking ahead, Gupte expects to see fewer rebates in future years \"because utilization (of medical care) will go back up, so the spread between pricing and cost will get narrower.\"\u003c/p>\n\u003cp>Still, Alexandria-Va.-based health industry consultant Robert Laszewski says the projected rebates are so small as to count mainly as a \"rounding error\" that most consumers won't even notice.\u003c/p>\n\u003cp>\"If it saved you $200 on a $10,000 premium, does it feel like your insurance is more affordable?\" asked Laszewski, a former insurance industry executive. He said some sales agents who saw insurers reduce their commissions as a result of the law have also begun charging clients a fee for helping them choose a policy.\u003c/p>\n\u003cp>But consumer advocate Timothy Jost, a professor at Washington and Lee University School of Law, says the goal was never to deliver large refunds.\u003c/p>\n\u003cp>\"The purpose isn't to generate rebates, but to force insurers to align their premiums more closely with their (medical) claims costs,\" says Jost. \"Each year, premium costs have gone up more than medical costs, so what the rule does is force insurers to be more efficient and, if they charge too much, to give some back.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: California data have not yet been reported, but should be available in the coming weeks.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Flame Retardants in Your Sofa: Seemed Like a Good Idea at the Time",
"title": "Flame Retardants in Your Sofa: Seemed Like a Good Idea at the Time",
"headTitle": "State of Health | KQED News",
"content": "\u003cdiv>\n\u003cfigure id=\"attachment_5105\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/Sofa_Couch_FrankJania_Flickr_04162012.jpg\">\u003cimg class=\"size-medium wp-image-5105\" title=\"The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/Sofa_Couch_FrankJania_Flickr_04162012-300x225.jpg\" alt=\"The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Back in 1975, a pioneering law was passed to help prevent upholstered furniture from burning, as \u003ca title=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" href=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" target=\"_blank\">KQED's Amy Standen reports\u003c/a>. Technical Bulletin 117-- or \u003ca title=\"http://www.bhfti.ca.gov/industry/bulletin.shtml\" href=\"http://www.bhfti.ca.gov/industry/bulletin.shtml\" target=\"_blank\">TB 117\u003c/a> as it's known -- is now the regret of many scientists. Call it the law of unintended consequences. From Standen's post:\u003c/p>\n\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>Manufacturers meet this law by treating the foam with several different kinds of chemicals, up to two pounds of flame retardant chemicals in an average-size sofa, according to \u003ca href=\"http://eetd.lbl.gov/staff/donald-lucas\" target=\"_blank\">Don Lucas\u003c/a>, a flammability expert at Lawrence Berkeley National Laboratory.\u003c/p>\n\u003cp>Even though the law is specific to California, it affects furniture sold across the country. Major furniture dealers sell California-compliant products in all 50 states, and Canada.\u003c/p>\n\u003cp>The problem ... is that the chemicals don’t just stay inside the sofas. They turn up in \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21239062\" target=\"_blank\">household dust\u003c/a> and can be detected in human blood and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20079522\" target=\"_blank\">breast milk\u003c/a>. \u003ca href=\"http://www.ewg.org/reports/pbdesintoddlers\" target=\"_blank\">Toddlers\u003c/a> often have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/17035146\" target=\"_blank\">higher levels\u003c/a> of the chemicals in their bodies than adults do.\u003c!--more-->\u003c/p>\n\u003cp>\"One study found that the levels of PBDEs found in bodies of toddlers are similar to what you'd find in people who work in a recycling foam factory. That's two to ten times what you'd find in adults,\" says Ami Zota, a researcher with UCSF's \u003ca href=\"http://prhe.ucsf.edu/prhe/\" target=\"_blank\">Program on Reproductive Health and the Environment.\u003c/a>\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>Standen has plenty more detail about the politics of trying to change this law. But I'm trying to stay focused on the health aspects of her piece. Suffice it to say that legislators have tried to change the law five times. Five times they have failed.\u003c/p>\n\u003cp>To me, the most jaw-dropping part of Standen's piece is that the chemicals \u003cem>don't even prevent fires.\u003c/em>\u003c/p>\n\u003cblockquote>\u003cp>“Our conclusions were that we really don’t need the flame retardants in the foam in home furnishing,\" said Lucas. We don’t think the TB 117 standard is very good.”\u003c/p>\n\u003cp>The chemicals don’t work, he says, because fires don’t start inside sofas. They start on the surface of the sofa, on the fabric. California's flammability law, TB 117 law says nothing about the fabric, just the foam.\u003c/p>\n\u003cp>“Once the fabric catches on fire, the flame that the foam is exposed to is much larger than the flame in the test,” says Lucas.\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>So, now we have chemically-drenched foam on fire, and the anti-flame retardant folks have a new ally: firefighters.\u003c/p>\n\u003cblockquote>\u003cp>Tom O’Connor, a firefighter in San Francisco, says fires these days are a toxic soup of chemicals, thanks, in part, to chemically-treated furniture.\u003c/p>\n\u003cp>O'Connor, and others, believe they're seeing an epidemic of cancers among firefighters. San Francisco's Fire Department is one of several around the country participating in a \u003ca href=\"http://www.usfa.fema.gov/fireservice/research/safety/niosh_cancer_study.shtm\">study\u003c/a> of firefighters and cancer run by the \u003ca title=\"http://www.cdc.gov/niosh/\" href=\"http://www.cdc.gov/niosh/\" target=\"_blank\">National Institute for Occupational Safety and Health.\u003c/a>\u003c/p>\n\u003cp>If flame-retardant chemicals in furniture are part of the problem, says O'Connor, \"then obviously we want them out of the products of combustion, once we go into a burning building.\"\u003c/p>\u003c/blockquote>\n\u003cp>You can read or listen to Amy's complete story\u003ca title=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" href=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" target=\"_blank\"> here\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Back in 1975, a pioneering law was passed to help prevent upholstered furniture from burning, as KQED's Amy Standen reports. Technical Bulletin 117-- or TB 117 as it's known -- is now the regret of many scientists. Call it the law of unintended consequences. From Standen's post:\r\n\r\nManufacturers meet this law by treating the foam with several different kinds of chemicals, up to two pounds of flame retardant chemicals in an average-size sofa, according to Don Lucas, a flammability expert at Lawrence Berkeley National Laboratory.\r\n\r\nEven though the law is specific to California, it affects furniture sold across the country. Major furniture dealers sell California-compliant products in all 50 states, and Canada.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cdiv>\n\u003cfigure id=\"attachment_5105\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/Sofa_Couch_FrankJania_Flickr_04162012.jpg\">\u003cimg class=\"size-medium wp-image-5105\" title=\"The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/Sofa_Couch_FrankJania_Flickr_04162012-300x225.jpg\" alt=\"The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The average-sized couch contains up to two pounds of flame retardant chemicals. (Frank Jania: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Back in 1975, a pioneering law was passed to help prevent upholstered furniture from burning, as \u003ca title=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" href=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" target=\"_blank\">KQED's Amy Standen reports\u003c/a>. Technical Bulletin 117-- or \u003ca title=\"http://www.bhfti.ca.gov/industry/bulletin.shtml\" href=\"http://www.bhfti.ca.gov/industry/bulletin.shtml\" target=\"_blank\">TB 117\u003c/a> as it's known -- is now the regret of many scientists. Call it the law of unintended consequences. From Standen's post:\u003c/p>\n\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>Manufacturers meet this law by treating the foam with several different kinds of chemicals, up to two pounds of flame retardant chemicals in an average-size sofa, according to \u003ca href=\"http://eetd.lbl.gov/staff/donald-lucas\" target=\"_blank\">Don Lucas\u003c/a>, a flammability expert at Lawrence Berkeley National Laboratory.\u003c/p>\n\u003cp>Even though the law is specific to California, it affects furniture sold across the country. Major furniture dealers sell California-compliant products in all 50 states, and Canada.\u003c/p>\n\u003cp>The problem ... is that the chemicals don’t just stay inside the sofas. They turn up in \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21239062\" target=\"_blank\">household dust\u003c/a> and can be detected in human blood and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20079522\" target=\"_blank\">breast milk\u003c/a>. \u003ca href=\"http://www.ewg.org/reports/pbdesintoddlers\" target=\"_blank\">Toddlers\u003c/a> often have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/17035146\" target=\"_blank\">higher levels\u003c/a> of the chemicals in their bodies than adults do.\u003c!--more-->\u003c/p>\n\u003cp>\"One study found that the levels of PBDEs found in bodies of toddlers are similar to what you'd find in people who work in a recycling foam factory. That's two to ten times what you'd find in adults,\" says Ami Zota, a researcher with UCSF's \u003ca href=\"http://prhe.ucsf.edu/prhe/\" target=\"_blank\">Program on Reproductive Health and the Environment.\u003c/a>\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>Standen has plenty more detail about the politics of trying to change this law. But I'm trying to stay focused on the health aspects of her piece. Suffice it to say that legislators have tried to change the law five times. Five times they have failed.\u003c/p>\n\u003cp>To me, the most jaw-dropping part of Standen's piece is that the chemicals \u003cem>don't even prevent fires.\u003c/em>\u003c/p>\n\u003cblockquote>\u003cp>“Our conclusions were that we really don’t need the flame retardants in the foam in home furnishing,\" said Lucas. We don’t think the TB 117 standard is very good.”\u003c/p>\n\u003cp>The chemicals don’t work, he says, because fires don’t start inside sofas. They start on the surface of the sofa, on the fabric. California's flammability law, TB 117 law says nothing about the fabric, just the foam.\u003c/p>\n\u003cp>“Once the fabric catches on fire, the flame that the foam is exposed to is much larger than the flame in the test,” says Lucas.\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>So, now we have chemically-drenched foam on fire, and the anti-flame retardant folks have a new ally: firefighters.\u003c/p>\n\u003cblockquote>\u003cp>Tom O’Connor, a firefighter in San Francisco, says fires these days are a toxic soup of chemicals, thanks, in part, to chemically-treated furniture.\u003c/p>\n\u003cp>O'Connor, and others, believe they're seeing an epidemic of cancers among firefighters. San Francisco's Fire Department is one of several around the country participating in a \u003ca href=\"http://www.usfa.fema.gov/fireservice/research/safety/niosh_cancer_study.shtm\">study\u003c/a> of firefighters and cancer run by the \u003ca title=\"http://www.cdc.gov/niosh/\" href=\"http://www.cdc.gov/niosh/\" target=\"_blank\">National Institute for Occupational Safety and Health.\u003c/a>\u003c/p>\n\u003cp>If flame-retardant chemicals in furniture are part of the problem, says O'Connor, \"then obviously we want them out of the products of combustion, once we go into a burning building.\"\u003c/p>\u003c/blockquote>\n\u003cp>You can read or listen to Amy's complete story\u003ca title=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" href=\"http://science.kqed.org/quest/audio/the-political-firestorm-inside-your-sofa/\" target=\"_blank\"> here\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cstrong>By Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5032\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AdultDayCareMarin20120328.jpg\">\u003cimg class=\"size-medium wp-image-5032\" title=\"Proposed California Budget Cuts Threaten Adult Day Health Care\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AdultDayCareMarin20120328-300x208.jpg\" alt=\"Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)\" width=\"300\" height=\"208\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)\u003c/figcaption>\u003c/figure>\n\u003cp>Some people who care for vulnerable older adults are in dire economic straits, according to a new \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/caregiversfsapr2012.pdf\">study\u003c/a> [PDF] from the \u003ca title=\"http://www.healthpolicy.ucla.edu/\" href=\"http://www.healthpolicy.ucla.edu/\" target=\"_blank\">UCLA Center for Health Policy Research\u003c/a>.\u003c/p>\n\u003cp>Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFAQs.aspx#whatismedi-cal\">Medi-Cal\u003c/a>. As it turns out, those who get paid for this work may not be pulling in enough money to make ends meet.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthpolicy.ucla.edu/AskExpertDetails.aspx?expertId=30\">Geoffrey Hoffman\u003c/a>, a researcher at the Center and lead author of the report said, “These paid Medi-Cal caregivers have incomes that are quite low compared to other Californians, about half as much monthly household income.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">“This aging population [of caregivers] is going to lead to great burdens on the health care system.\"\u003c/aside>\n\u003cp>He continued, “A third of them do not have health insurance. A number of them live in poverty or near-poverty, and, among those, a third of them have what is called ‘food insecurity’ – not enough food to put on the table every month.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average -- close to minimum wage, and about two-thirds of the median income in California -- making it difficult for them to live on their earnings. Many believe that the value of the care they provide is much greater than what they earn, but monetary constraints have led California lawmakers to decrease financial support for these services.\u003c/p>\n\u003cp>\u003c!--more-->In 2011, the state budget cut the Medi-Cal caregiver reimbursement program – \u003ca title=\"http://www.dss.cahwnet.gov/cdssweb/PG139.htm\" href=\"http://www.dss.cahwnet.gov/cdssweb/PG139.htm\" target=\"_blank\">In-Home Supportive Services\u003c/a> – by 3.6 percent. State officials had also planned a 20 percent decrease in the number of hours a caregiver could work, but that cut has been blocked by a judge for now.\u003c/p>\n\u003cp>Hoffman worries these trends could affect the quality of care available to those who need assistance. “If the caregivers are having trouble putting food on their own table, then they’re not going to provide the type of care we want for our grandparents and our spouses in this state.\u003c/p>\n\u003cp>As these caregivers themselves begin to age, Hoffman said he is also concerned that those who are economically disadvantaged will end up costing the system more money later on, making it even more difficult for Medi-Cal and Medicare to stay solvent in years to come.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This aging population [of caregivers] is going to lead to great burdens on the health care system. So the sooner we address the problem today, the better off we are for our older adults’ health ... in the future.\"\u003c/p>\n\n",
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"excerpt": "Some people who care for vulnerable older adults are in dire economic straits, according to a new study [PDF] from the UCLA Center for Health Policy Research.\r\n\r\nHundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from Medi-Cal. As it turns out, those who get paid for this work may not be pulling in enough money to make ends meet.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5032\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AdultDayCareMarin20120328.jpg\">\u003cimg class=\"size-medium wp-image-5032\" title=\"Proposed California Budget Cuts Threaten Adult Day Health Care\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AdultDayCareMarin20120328-300x208.jpg\" alt=\"Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)\" width=\"300\" height=\"208\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)\u003c/figcaption>\u003c/figure>\n\u003cp>Some people who care for vulnerable older adults are in dire economic straits, according to a new \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/caregiversfsapr2012.pdf\">study\u003c/a> [PDF] from the \u003ca title=\"http://www.healthpolicy.ucla.edu/\" href=\"http://www.healthpolicy.ucla.edu/\" target=\"_blank\">UCLA Center for Health Policy Research\u003c/a>.\u003c/p>\n\u003cp>Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFAQs.aspx#whatismedi-cal\">Medi-Cal\u003c/a>. As it turns out, those who get paid for this work may not be pulling in enough money to make ends meet.\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthpolicy.ucla.edu/AskExpertDetails.aspx?expertId=30\">Geoffrey Hoffman\u003c/a>, a researcher at the Center and lead author of the report said, “These paid Medi-Cal caregivers have incomes that are quite low compared to other Californians, about half as much monthly household income.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">“This aging population [of caregivers] is going to lead to great burdens on the health care system.\"\u003c/aside>\n\u003cp>He continued, “A third of them do not have health insurance. A number of them live in poverty or near-poverty, and, among those, a third of them have what is called ‘food insecurity’ – not enough food to put on the table every month.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average -- close to minimum wage, and about two-thirds of the median income in California -- making it difficult for them to live on their earnings. Many believe that the value of the care they provide is much greater than what they earn, but monetary constraints have led California lawmakers to decrease financial support for these services.\u003c/p>\n\u003cp>\u003c!--more-->In 2011, the state budget cut the Medi-Cal caregiver reimbursement program – \u003ca title=\"http://www.dss.cahwnet.gov/cdssweb/PG139.htm\" href=\"http://www.dss.cahwnet.gov/cdssweb/PG139.htm\" target=\"_blank\">In-Home Supportive Services\u003c/a> – by 3.6 percent. State officials had also planned a 20 percent decrease in the number of hours a caregiver could work, but that cut has been blocked by a judge for now.\u003c/p>\n\u003cp>Hoffman worries these trends could affect the quality of care available to those who need assistance. “If the caregivers are having trouble putting food on their own table, then they’re not going to provide the type of care we want for our grandparents and our spouses in this state.\u003c/p>\n\u003cp>As these caregivers themselves begin to age, Hoffman said he is also concerned that those who are economically disadvantaged will end up costing the system more money later on, making it even more difficult for Medi-Cal and Medicare to stay solvent in years to come.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This aging population [of caregivers] is going to lead to great burdens on the health care system. So the sooner we address the problem today, the better off we are for our older adults’ health ... in the future.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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},
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/bbc-world-service",
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"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
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"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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},
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"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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},
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"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
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"order": 18
},
"link": "/podcasts/jerrybrown",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
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