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By Pattie Lockard
Executive Producer
Nurse Talk Radio

The Flu Shot Debate with NNU Co-president, Karen Higgins

Karen Higgins, RN, NNU Co-President

June 25, 2013

Flu shot controversy rages on. What do you think?  Nurse Talk took a Facebook poll this week and we got some very passionate answers. We will share this with you in the show. Very interesting—and no less interesting was a mainstream media newscast we’ll share. Fired for not getting a flu shot? One hundred and fifty at TriHealth, Cincinnati’s largest employer live to tell.

Use the links below to share this blog and radio segment.

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Coming Up on Nurse Talk Radio

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Nurse Talk Radio

Michael Lighty on the Keystone XL Pipeline

Michael Lighty, CNA/NNU Director of Public Policy

READ THE FULL PRESS RELEASE

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With the magnificent expanse of the Golden Gate Bridge as backdrop and pathway, nurses from across the U.S. rallied on Thursday to call an end to the Keystone XL Pipeline project, a ghastly effort to transport poisonous tar sands 1,700 miles from Canada to Texas, exposing hundreds of communities en route to calamitous spills, ruined water systems and deleterious health effects. Nurses also called for an end to the politics of austerity, one that puts the false choices – jobs through environmental degradation – before us. 

“Nothing related to Keystone XL is good for our families, our communities, or our planet,” announced Debra Burger, RN and NNU co-president from the rally stage.  “From extraction to transport to refining, tar sands oil will exacerbate our current health emergency….  This is a clear and present danger to public health.”

Burger spoke before a gathering of 1,500 nurses and environmental activists, including members of 350.org, Greenpeace, Credo Action, Sierra Club, Asian Pacific Environmental Network, Friends of the Earth, Rainforest Action Network  and others.  Their colorful signs told the story:  “Clean Energy Creates Jobs” and “One Planet, One People, No Pipeline”. 

Brenda Prewitt, RN and NNU member, traveled from Houston to join in.  She’s a pediatric nurse with 25 years on the job.  “We have a lot of kids with respiratory issues coming in everyday.  We have ozone alerts all the time.  Another pipeline increases the issues we already have.”

NNU opposes the Keystone XL Pipeline (KXL) because of the adverse health and environmental impact on communities along the proposed route, as well as how the emissions from tar sands will lead to climate change that affect public health more broadly.  

Earlier in the day, before nurses gathered for this year’s Staff Nurse Assembly in San Francisco, California Governor Jerry Brown acknowledged that climate change and inequality top the world’s agenda.  “There are no bigger issues today,” he said, “then the growth of inequality and the continued destruction of our environment.” He likened climate change to  “a tsunami coming at us.” 

“Of all the unions  I’ve been talking to,” said the California governor in a compelling salute to our members, “nobody has a better global vision than the nurses.”

A green economy makes dual sense: growing the economy and keeping communities healthy.  Approval of KXL would further entrench the corrosive power of the fossil fuel industry in distorting U.S. public policies.

Before the rally wrapped up and nurses and supporters headed across  the Golden Gate Bridge, as planned, to continue the protest against KXL, a spirited rendition of  “Heard It Through the Grapevine”  was delivered by Kat Taylor, CEO of One Pacific Coast Bank.  Her lyrics, “Heard It Through the Pipeline… Not much longer will you be my world” was a crowd pleaser.  Taylor saluted the “calling of nurses” and its “imperative of stopping the Keystone Pipeline”.  

SF climate activist, businessman  and Obama supporter Tom Steyer, is pressing the president to nix KXL. Steyer commissioned a study carried out by the Environmental Working Group that was released today in Washington, D.C.  It is a scathing indictment of tar sands, its extraction and transport.  The study sets out independent lab tests of a sample from a tar sands spill earlier this year in Arkansas that detected several highly toxic chemicals.  “A single sample of tar sands oil included chemicals that cause cancer in humans and produce serious and permanent birth defects in children,” said Renee Sharp, director of research of the Environmental Working Group. 

Among the chemicals detected in the sample were benzene, xylene, chromium and lead, which are known carcinogens and injurious to the nervous system, according to the study.

With kites hugging the air above the bridge, a sailboat beneath outfitted with banner, protesters cheering and chanting  — “We are unstoppable, A healthy world is possible! – nurses and supporters, a group extending hundreds of yards crossed the Golden Gate Bridge on its pathway.  Madison Davis, a college student and environmentalist from San Jose was there with the nurses.  “This is the one chance we have to stop major oil companies.  Obama is going to lose a large amount of support if he allows Keystone to be built.  It would be a tragic mistake,” she said.   “There is no other planet to go to.” 

Nurses and environmental activists from across the U.S. are joining hands this week to step up the message that there is still time to stop the Keystone XL Pipeline before it stops all of us.

Join us for a march across the Golden Bate Bridge in San Francisco Thursday, June 20, beginning with a noon rally at Battery East, near the Golden Gate Bridge Pavilion at Fort Point adjacent to the Bridge. (More details here.)

It’s an event that that will feature a land, sea and air protest that matches a triad of reasons to oppose the Keystone project – for health, economic, and, of course, environmental imperatives.

With massive pressure from the political and economic powerhouse fossil fuel industry mounting on the Obama administration to green-light KXL, the movement opposing the pipeline is also growing. Instead of a green light, they say, let’s have a green economy, as well as a safer environment and a healthier planet. Our planet, our health, nurses say.

Besides National Nurses United, the nation’s largest nurses’ union, participants and endorsers include 350.org, Friends of the Earth, the Sierra Club, CREDO, Greenpeace, and other environment and public health advocates.

For nurses, opposition to KXL starts with the health of our patients, our communities, and our families.

Climate change is a clear and present danger to public health. Carbon emissions are a major factor in intensifying climate change. Hazardous air pollutants emitted directly from coal-fired power plants have been linked to damage to the eyes and skin, impairment of neurological function and ability to learn, and pulmonary and cardiovascular disease. The EPA has determined that exposure to particulate matter is a cause of heart attacks, breathing problems and long-term respiratory illness including asthma, and reproductive, developmental, and cancer outcomes.

Higher air temperatures themselves can increase bacteria-related food poisoning, such as salmonella, and animal-borne diseases such as West Nile virus. Ground level ozone contaminants can damage lung tissue, reduce lung function, and increase respiratory ailments. Pakistani pediatricians recently said they are already witnessing a rise in vector-borne diseases including diarrhea, cholera, gastroenteritis, typhoid, and hepatitis due to environmental factors and the effects of climate change.

KXL would exacerbate this health emergency in a number of ways, prompting health concerns from the extraction, transport and refining of tar sands oil.

First, extraction of tar sands oil is far more difficult than conventional oil drilling. The massive amount of water needed to separate the extracted product, bitumen, from sand, oil and silt, is contaminated with toxic substances that when dumped infects clean water supplies. Communities living downstream from contaminated water have seen spikes in rates of rare cancers, renal failure, lupus, and hyperthyroidism. In one small community of just 1,200 residents, 100 have already died from cancer.

Second, leaks from the transmission of the heavy, corrosive tar sands, over America’s agricultural heartland over water aquifers, and rivers pose a major danger as evidenced recently by a major tar sands spill in Arkansas. Two months later, residents are still complaining of health problems and concerns about poisonous impacts on wildlife and the environment, reports the Natural Resources Defense Council. The rupture of a tar sands oil pipeline in Michigan in 2010 similarly caused widespread respiratory ailments and other health problems in communities adjacent to the spill.

Third, refining tar sands oil is dirtier than refining conventional oil and results in higher emissions of toxic sulfur dioxide and nitrous oxide. Pollutants from tar sands refineries are directly linked to heart and lung disease, asthma, cancer and other serious health risks, as well as emissions of sulfur dioxide and nitrous oxide which contribute to acid rain.

While the portrait of labor and environmentalists being at odds on KXL is a popular meme in some media corners, there are a growing number of unionists who are speaking out such as the Canadian union which represents thousands who actually work in the country’s tar sands operations.

Summing up their views succinctly, David Coles, president of the Communications, Energy and Paperworkers Union of Canada (CEP), said, “The Keystone XL is not good for the economy, it’s not good for the environment, it violates all kinds of First Nations rights.”

Yes, despite the illusory promises of thousands of jobs, the reality of long-term employment falls far short. Indeed, spending on renewal clean energy sources creates more than three times as many jobs as the same spending on fossil fuel production, says Robert Pollin, co-director of the Political Economic Research Institute at the University of Massachusetts Amherst.

Lastly, the somber reality of climate change by itself should inspire all of us to speak out against KXL.

NASA scientist James Hansen, a pioneer in climate research, has called the Keystone pipeline “the biggest carbon bomb on the planet.” Warming has already led to the loss of one-third of Arctic summer ice. Formerly rare super storms, like Hurricanes Katrina and Sandy and a recent Oklahoma storm called the “worst tornado in U.S. history,” have become far more common, as have major droughts and heat waves have produced devastating effects on food production and have caused tens of thousands of deaths.

Hansen says development of KXL could mean “game over” on climate change. But it’s not to late for all of us to act.

Kay McVay makes the 2013 Consumer Advocate Hall of Fame
Says advocacy group: www.ConsumerWatchDog.org

Kay McVay worked as a registered nurse in critical care for nearly four decades before retiring in 1995. She is a tenacious and effective champion of patients’ rights who was elected and served as the former Vice President, and then President of the California Nurses Association/National Nurses Organizing Committee from 1994 to 2003.

As a young girl growing up in Compton, California, school counselors discouraged her aspirations to become a nurse. The rest is history.

Kay played a pivotal role in transforming the CNA from a nurse management-led organization to one focused strongly on nurse and patient advocacy. Under her leadership, CNA pioneered the HMO patients’ rights movement and grew to become the most effective labor union in America.

Kay presided over many prominent legislative campaigns, most notable CNA’s historic victory in 1999 to establish the toughest RN-to-patient staffing ratios in California hospitals—now a model for the rest of the nation.

Kay also led a series of watershed strikes from 1996 to 1998 to achieve standards that Kaiser nurses can enjoy today.

Kay is considered a fearless model of the registered nurse as a patient advocate: confronting hospital mangers, industry consultants, and politicians who sacrifice patient care protections for corporate profits. She has been an outspoken leader in the battle to assure guaranteed healthcare for everyone in the U.S. through an expanded Medicare for all system, and opposing cuts to bedrock civil society programs like Social Security.

The last 17 years of Kay’s career were spent working in the intensive care unit at Kaiser Permanente in Martinez, California. McVay began her involvement with the CNA/NNOC in 1978 when she became the chief nurse representative at the Martinez facility.

As president emeritus, McVay remains immersed in RN issues and is currently the chair of the nascent CNA/NNOC retirement program.

If any registered nurse can be said to symbolize the new face of nursing, it’s Kay McVay.

Please watch and share this inspiring video/blog about Kay McVay with other RNs.

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What is the Keystone XL Pipeline project?

The Keystone project is a controversial proposal for a 1,700 mile pipeline to send 900,000 barrels every day of one of the world’s dirtiest fuels, tar sands oil from Alberta, Canada to Gulf Coast refineries in Texas. Major oil and other fossil fuel corporations in the U.S. and Canada, joined by other Wall Street interests and the federal and state politicians they influence are promoting the plan.

Opponents include every prominent environmental organization, other climate change activists, many farmers, ranchers and community leaders along the path of the proposed pipeline, First Nations leaders, most Canadian unions, and some U.S. unions, including NNU and the Amalgamated Transit Union.

The Obama administration, which has final authority become the proposal crosses international borders, has delayed approval of the project, but is expected to make a final decision soon.

Why does NNU oppose the Keystone XL Pipeline?

NNU opposes the Keystone XL Pipeline because of the adverse health and environmental impact on communities along the proposed route, as well as how the emissions from tar sands will severely exacerbate climate change which affects public health more broadly.

NNU is also concerned about the overall effects of Keystone XL on the long term environmental, economic, and social consequences of climate change, the need for promoting a green economy for economic and health purposes, and how approval of the pipeline would further entrench the corrosive power of the fossil fuel industry in distorting U.S. public policies.

What are the health risks posed by the Keystone XL pipeline?

First, extraction of tar sands oil is far more difficult than conventional oil drilling. The massive amount of water needed to separate the extracted product, bitumen, from sand, oil and silt, is contaminated with toxic substances that can not be returned to any water source that may end up in human drinking water. Nearly all is dumped in large pools that are home to cyanide, ammonia and other toxic substances which are already infecting neighboring clean water supplies. Communities living downstream from the ponds have seen spikes in rates of rare cancers, renal failure, lupus, and hyperthyroidism. In one small community of just 1,200 residents, 100 have already died from cancer.

Second, leaks from the transmission of the heavy, corrosive tar sands, over America’s agricultural heartland over water aquifers, and rivers pose a major danger. The pipeline would cross six states and major U.S. rivers. In 2010, a tar sands oil pipeline ruptured near Marshall, Mi. The diluted bitumen, a degraded form of petroleum, traveled 40 miles down the Kalamazoo River to Morrow Lake. More than a month later, state officials found that half of the residents in communities along the river reported respiratory ailments and other symptoms associated with the spill. In 2011, TransCanada pipeline spills and ruptures occurred in North Dakota and Montana. On March 29, 2013, an Exxon Mobil pipeline with tar sands oil ruptured near Mayflower, Ark. Two months later local residents continue to complain of health problems, including persistent coughs and headaches, and independent water and air tests have shown elevated levels of contaminants.

Third, refining tar sands oil, notes Friends of the Earth, is dirtier than refining conventional oil and results in higher emissions of toxic sulfur dioxide and nitrous oxide. Pollutants from tar sands refineries are directly linked to heart and lung disease, asthma, cancer and other serious health risks, as well as emissions of sulfur dioxide and nitrous oxide which contribute to acid rain. More than 40 percent of Americans live in areas adversely affected by air pollution with levels of particle pollution that can cause higher incidents of asthma, heart attacks, and premature death.

Carbon emissions are a major factor in intensifying climate change. Higher air temperatures can increase bacteria-related food poisoning, such as salmonella, and animal-borne diseases such as West Nile virus. Ground level ozone contaminants can damage lung tissue, reduce lung function, and increase respiratory ailments.

Pediatricians have said they are already witnessing a rise in vector-borne diseases including diarrhea, cholera, gastroenteritis, typhoid, and hepatitis due to environmental factors and the effects of climate change.

How would the Keystone XL Pipeline affect climate change?

According to a recent US Environmental Protection Agency (EPA) assessment, tar sands well-to-tank emissions are approximately 82 percent higher than conventional oil. If the U.S. were to import 3 million barrels per day of tar sands, just replacing the equivalent of conventional oil, it would be the equivalent of adding more than 22 million passenger cars to the road – with an substantial impact on climate change.

Leading climate change activist Bill McKibben says burning all the oil in those tar sands would nearly double the atmosphere’s concentration of carbon dioxide. NASA scientist James Hansen, a pioneer in climate research, has called the Keystone pipeline “the biggest carbon bomb on the planet” and warned its development would mean it was “game over” on the climate front. “Stopping Keystone,” says McKibben, “will buy time” for a transition to renewable sources.

A public letter by dozens of prominent scientists following a draft U.S. State Department review of KXL this spring said, “Our scientific judgment is that the actual and potential environmental damage are sufficiently severe to reject the Keystone XL pipeline in order to protect the climate, human health, and the multiple ecosystems this project threatens.”

What effects are we already seeing from climate change?

Warming has already led to the loss of one-third of Arctic summer ice and made the oceans 30 percent more acidic. Formerly rare super storms, like Hurricanes Katrina and Sandy and a recent Oklahoma storm called the “worst tornado in U.S. history,” have become far more common, as have major droughts and heat waves which produce devastating effects on food production and have caused tens of thousands of deaths.

Scientists worry that the rapid pace of climate change may soon become irreversible due to the warming that has already occurred. Further, economic commitments to new physical infrastructure required for additional fossil fuel development, including refinery capacity, power stations, and pipelines – what some call “carbon lock-in” – will make economic pressure and political pressure to slow or reverse climate change financially and politically untenable.

Don’t some unions support the Keystone Pipeline project?

Building trades construction unions support the pipeline, and are actively lobbying for it, under the premise it will create badly needed jobs for their members – and the vague promise that corporations promoting the pipeline will reward them with future deals in exchange for their partnership in campaigning for the pipeline.

But the actual number of jobs that will be created is far less than has been claimed by the industry and the unions. Nearly all the employment is temporary, construction jobs. Once the project is built, the number of people needed to operate and maintain the pipeline may be as few as 20, concedes the U.S. State Department.

Moreover, as fossil fuel production has become more capital intensive, employment in the sector has fallen, according to a 2012 report by the International Labor Organization and the United Nations Environment Program. In the U.S., for example, coal production has increased by one-third since the 1980s, but employment has fallen by 50 percent.

Far more jobs would be created by converting to a green economy, notes economist Robert Pollin. Every $1 million spent on renewal clean energy sources, he calculates, creates 16.8 jobs, compared to just 5.2 jobs created by the same spending on fossil fuel production.

A number of unions, including NNU, the Amalgamated Transport Union (ATU), transport workers, and others in the U.S. oppose the pipeline, as does the union representing bitumen workers in Canada whose president, David Coles, said, “The Keystone XL is not good for the economy, it’s not good for the environment, it violates all kinds of First Nations rights.”

Finally, advocating for the Keystone Pipeline puts unions in collusion with many of the most anti-union corporate interests in the U.S., such as the oil billionaire Koch Brothers, the American Petroleum Institute, and energy corporations generally.

Approval of the Keystone Pipeline would not only hasten the damage of climate change, it would also further enrich and entrench the economic, social, and political power of the fossil fuel industry, the primary beneficiaries of the pipeline.

Why should nurses be concerned about the influence of the fossil fuel industry?

Fossil fuel corporations have exerted enormous economic and political influence over the U.S. and global economies promoting what the Global Labor Institute calls an “extreme energy” agenda that has substantial, mostly adverse, effects on public health, the economy, the environment, workers, and local communities.

In the U.S., fossil fuel corporations are one of the two most powerful corporate sectors along with finance, symbolized by the nearly $1 trillion in profits racked up by the top five oil companies. They utilize that wealth to wield substantial clout with policy makers that leads to tax breaks, demands for deregulation and cuts in public protections, and sway over other economic and political policies.

This clout is especially troublesome considering fossil fuel companies are among the nation’s worst polluters, with severe consequences for health. Their tax evasion distorts budgets and deprives federal and state governments of needed revenue which undermines social program funding. Major fossil fuel executives, like the Koch Brothers, are directly linked to attacks on worker’s rights and other far right social and political causes.

Globally, fossil fuel corporations have blocked development of cheaper, more sustainable, less environmentally destructive energy sources, and exacerbate economic inequality, widespread poverty, and under development while being a major cause of harmful climate change.

Aren’t fossil fuels diminishing, reducing their long term viability and adverse corporate influences?

No. More than half of new energy demands are met by coal. New technologies are assisting the development of fossil fuels from sources such as tar sands, shale, and through extraction methods such as fracking. Under current trends, fossil fuels will still meet more than three-fourths of all energy needs by 2035. Renewable sources, such as wind and solar, make up less than 5 percent now.

What are the public health effects of fossil fuel production and policies?

Public health costs in the U.S. alone are pegged at more than $120 billion every year according to the National Academy of Sciences. Fossil fuels generate pollution that contaminates our air, rivers, lakes, oceans, and food supply, and has substantial harmful health impacts.

Hazardous air pollutants emitted directly from coal-fired power plants have been linked to damage to the eyes and skin, impairment of neurological function and ability to learn, and pulmonary and cardiovascular disease. The EPA has determined that exposure to particulate matter is a cause of heart attacks, breathing problems and long term respiratory illness including asthma, and reproductive, developmental, and cancer outcomes.

What is the impact of fossil fuel production on worker and public safety?

Today millions suffer from the effects of fossil fuel pollution, especially in communities close to mines, oil and gas wells, pipelines, power stations, and transport routes.

Accidents, such as the BP Deepwater Horizon and Exxon Valdiz spills, and the Massey Corporation’s West Virginia Big Branch mining disaster, have become more common, in part because of the political influence of the fossil fuel industry in promoting deregulation and less rigorous safety inspections.

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Select Sources:

“Resist, Reclaim, Restructure: Unions and the Struggle for Energy Democracy. Global Labor Institute, Cornell University, October, 2012

“Say No to Tar Sands Pipeline: Proposed Keystone XL Pipeline Project Would Deliver Dirty Fuel at a High Cost,” National Resources Defense Council, March 2011

“Back to Full Employment,” Robert Pollin, Boston Review, MIT Press, Cambridge, Mass., 2012

Keystone XL Pipeline. The Basics. Friends of the Earth.

Exposed: Canadian Oil and Gas Workers, Many Unions, Now Oppose Keystone XL Pipeline, Nation of Change, May 31, 2013

“Big Oil’s Monopoly Money: Ending $1 Trillion in Fossil Fuel Subsidies Requires Breaking Industry’s Political Influence,” Peter Lehner, National Resources Defense Council, June 22, 2012

“Emissions of Hazardous Air Pollutants from Coal-fired Power Plants,” American Lung Association, March, 2011

Arkansas pipeline spill casts shadow over Keystone XL, Los Angeles Times, June 6, 2013

Two Months Later, Arkansas Residents Still Hurting From ExxonMobil Tar Sands Spill, Rocky Kistner, Huffington Post, June 3, 2012.

“What tar sands and the Keystone XL pipeline mean for climate change,” The Guardian (UK), August 23, 2011.

“NASA’s Hansen Explains Decision to Join Keystone Pipeline Protests,” Inside Climate News, August 29, 2011.

“A Presidential Decision That Could Change the World: The Strategic Importance of Keystone XL,” Michael Klare, The American Empire Project, February 11, 2013.

“Keystone’s Thousands of Jobs Fall to 20 When Pipeline Opens,” Bloomberg, February 13, 2013.

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The burden of cutting costs is on patients, not corporate healthcare profiteering.

With the one-year anniversary of the Supreme Court ruling upholding the Affordable Care Act near, it’s time to ask if the decision to put the burden of cutting costs on patients, not corporate healthcare profiteering, is the fatal flaw in the plan.

The law’s tepid cost control measures targeted at healthcare spending that is gobbling up an increasing percentage of the economy and pricing more people than ever out of access to care have been widely viewed as the ACA’s biggest pitfall.

But from the outset, the Obama administration dismissed the most effective means to reduce costs by a) refusing to consider a single payer alternative that combines genuine universal coverage not based on ability to pay with global budgeting, b) rejecting a proposal to authorize the federal government to negotiate bulk purchasing (a concession to the drug companies), and c) failing to regulate price gouging by hospitals, drug companies, insurers and other healthcare corporations.

Those fateful decisions left only one option for significant reduction of overall health expenditures  – saving money in the delivery of care by shifting costs to those who use health services and discouraging them from getting care even if they have insurance. 

Perhaps that’s not surprising given the decision to craft the ACA in concert with pharmaceutical, insurance, hospital, and Chamber of Commerce lobbyists, and, as recently reported, top Wall Street investment firms and hedge fund executives. 

Here are several ways the ACA shifts the hardship of cost cutting to those who need care, and promotes delivery models that result in limiting care, even among those with health insurance.

1.      What they’re not telling us about the exchanges

The ACA health exchanges are marketplaces set up to enable the uninsured who the law requires to buy private insurance or pay a financial penalty to choose among competing private insurance and qualify for a federal subsidy to cover some of the costs. 

But premiums, deductibles, co-pays and other fees can run to thousands of dollars. Even in the cheapest plans buyers are expected to pay 40 percent of the cost. Subsides may not make these plans “affordable.” 

Many younger, healthier people are likely to select the cheapest plan, one outside the exchange with fewer covered services, or just go without coverage entirely and pay the fine.

Further, small businesses can buy coverage for employees through the exchanges, but the premium and co-pay subsidies will not cover family dependents, a huge hole that will leave many uncovered. 

Insurers offering lower rates the first year in hopes of acquiring many new customers are likely to raise rates later, as has occurred in Massachusetts, the model for the ACA. A recent study in the journal Health Affairs found that 38 percent of families buying plans through the Massachusetts exchange reported a financial burden and 45 percent said costs were higher than they had expected.  

2.      The high cost of taxing health benefits

For the first time, the law will tax health benefits beginning in 2018 through the misnamed “Cadillac tax” a 40 percent excise tax on comprehensive health plans. The inevitable result will be fewer employers offering good health benefits, and far more people pushed into skeletal, high deductible plans with far less coverage and much higher out-of-pocket costs. The New York Times just reported that 17 percent of employers this year are stepping up cost shiftingfive years before the tax goes into effect.

3.      An incentive to employers to cut coverage or full-time jobs

Under the ACA employers with 50 workers or more must offer coverage to full time employees or pay a fine, but not to part-timers. Nurses and other workers are increasingly in battles with employers who are demanding elimination of coverage for part time employees, citing the ACA as their pretext. Regal Entertainment, Papa John’s and other companies are reducing workers’ hours to under 30 per week.   

4.      The wellness scam

“Wellness” programs that enable businesses to transfer more healthcare costs to workers with “unhealthy” factors like smoking or high blood pressure or cholesterol levels are rapidly spreading, actively encouraged by the ACA which offers premium discounts to participating employees.  However, health disorders are as likely to derive from chronic or genetic conditions as “life style choices” and economic factors which have a disproportionate impact on the poor.

The cost reductions also fall far short of the hype. The federal government apparently buried a report it mandated for the ACA from the Rand Corporation on wellness programs which showed the overall savings are, at best, modest. 

The programs make insurance unaffordable for some workers, and “keep the sickest workers from affording the care they need,” said Alan Balch, vice president of the Preventive Health Partnership, an alliance of the American Cancer Society, the American Diabetes Association, and theAmerican Heart Association.

1. 5.   Self-rationing on the rise

With its weak controls on pricing practices by the insurers and hospitals, and encouraging cost shifting and high deductible plans, the ACA provides no relief for those who postpone needed care because of the high price tag.

A survey by the Centers for Disease Control and Prevention just released in early June found that 20 percent of Americans, or 54.2 million people in 2011 said their families had difficulty paying for health care services including physician visits, hospital procedures and medications within the prior 12 months. 

Among the effects, people delay getting care include less containment for the spread of infectious diseases and more people ending up in emergency rooms.  ER visits as the point of entry for patients to needed healthcare have been on a big upswing, a worrisome trend for the increased pain and suffering for patients and the overall health expenditures.  

6.      New barriers to care

If Massachusetts is the political model of the ACA, the industry model is Kaiser Permanente by combining the roles of insurance company and medical provider with its network of hospitals and clinics.

As ACA implementation nears, Kaiser has stepped up practices once associated with the worst abuses of HMOs. These include delaying medical appointments, restricting hospital admissions, and rapid discharge of patients from the hospital care to other settings.

These include sending people home where the care burden is placed entirely on family members, or to outpatient facilities or nursing homes that have fewer regulations and fewer, typically lesser skilled, lesser paid staff where the patients receive less care than in hospitals.

Other industry giants hope to follow this path, enrolling new members who are required to buy insurance, while they are more directly able to control their expenditures for care and can more easily slash spending. The ACA encourages care cutting practices through several mechanisms, including financial penalties for hospital re-admissions, an incentive to keep people out of the hospital, and rewarding providers who divert patients to outpatient clinics.

7.      A tale of the 31 million

More than 48 million people are currently uninsured. A new study in Health Affairs estimates that even after full ACA implementation up to 31 million of those will still be without coverage. 

That starts with the 14 states and counting who have rejected the expansion of Medicaid, the single most important provision in the ACA for expanding healthcare access, (with the help of the Supreme Court ruling gutting the federal sanction for opting out). Others will lose their employer-sponsored coverage due to the ACA taxes on employers, the provision excluding dependent coverage for small businesses that enter the health exchanges, and all of those who will still find insurance far too costly to buy, especially in a recession that has never ended for millions of people. 

Political posturing by those on the right opposed to any reform of our broken healthcare system and the bunker mentality of liberal allies of the Obama administration who for their own partisan reasons tend to gloss over serious flaws in the “legacy” law of the Obama years have obscured the reality that our healthcare crisis is far from over and in desperate need of more systemic overhaul.

Studies this year alone show the U.S. ranks last among 17 major industrial nations in life expectancy,  but is ahead of the others in first-day infant mortality rates. That will not end with the ACA.

Nurses will continue to make the case for joining the community of nations with a genuinely universal national or single payer healthcare system based on individual patient need, not corporate profits.

Karen Higgins is a registered nurse and co-president of National Nurses United, the largest U.S. union and professional association of nurses.

Registered Nurse Thorild Urdal told the Oakland City Council recently how she sees patients struggling everyday to survive during these tough economic times. They’re delaying healthcare, rationing medication or not buying medication at all.

“I see them coming in worse and worse shape, “ the Alta Bates Medical Center nurse said.

That’s why Urdal and her fellow nurses are calling for a Robin Hood Tax to help our communities recover from the economic crisis caused by Wall Street.

On Tuesday, they sought the city council’s support for U.S. Rep. Keith Ellison’s H.R. 1579, the Inclusive Prosperity Act, which embodies the Robin Hood Tax.

It’s a small tax – 0.5 percent on the sale of stocks and lesser rates on bonds, derivatives and currency trades.

The tax can raise up to $350 billion a year that can go toward funding healthcare, education, jobs, housing and retirement and help fight climate change and HIV/AIDS.

After hearing from the nurses, council members voted unanimously to support Ellison’s bill.

Earlier in the day, nurses and other community members held a “Robin Hood Faire” outside Oakland City Hall.

The event was part of a week of actions by California Nurses Association and other labor and community groups to call for Oakland leaders stand up to Wall Street and corporate interests.

At the fair, Robin Hood Tax campaigners wore Robin Hood hats and educated passersby about Wall Street sales tax.

They gave out “Wall Street dollars,” which represented new revenue the tax would generate. People could put the fake bills in bags marked with critical goals of the Robin Hood Tax campaign, including “Medicare for All,” “End Global AIDS/HIV,” “Retirement Security,” “Quality Education,” “Affordable Housing,” “Living Wage Jobs” and “Reverse Climate Change.

Three-year-old Isiah Player stuffed his Wall Street dollar in the bag for education.

“I think the Robin Hood Tax is a great idea, especially for education,” Isiah’s mother, Judith Barajas, said after learning about the tax. “I talk to him about how education is so important.”

Judith doesn’t want her son to see her struggles. She fears getting sick because she lost her healthcare when she was laid off. The two don’t have a permanent place to live – often staying with friends and family. She wants to finish her college degree at St. Mary’s College but is already swimming in student debt.

“It’s just hard out here,” she said as she watched her son play with a blue balloon tied to his wrist. “Robin Hood Tax sounds like it can help.”

If there is one problem that symbolizes the ongoing national healthcare emergency, it is the rampant price gouging in the healthcare industry that continues to price too many Americans out of access to care and into financial ruin.

Not only is the problem not solved by the Affordable Care Act, but it is a likely reason many will continue to demand more effective reform, as in expanding and extending Medicare to cover everyone.

Predatory pricing practices can be found nearly everywhere in healthcare, by the drug companies, insurance companies, medical suppliers, outpatient clinics, boutique medical services, and many others as chronicled this spring in Time magazine

U.S. hospitals are among the biggest abusers, as illuminated in recent data released by Medicare on hospital charges for a variety of common procedures as well as brand new findings by the Institute for Health and Socio-Economic Policy, the research arm of the National Nurses United, based on Medicare cost reports. (See charts here)

The nurses’ data augments the Medicare findings, and goes the next step, illustrating a trend of rising high hospital charges while providing context to a very ugly picture and the deplorable impact on anyone who needs healthcare.

Here’s the sobering numbers:

• U.S. hospitals charge on average $331 dollars for every $100 of their total costs, in statistical terms a 331 percent charge to cost ratio.

• While hospital charges over costs have been climbing steadily over the past 15 years – the charges took their biggest leap ever in 2011- a 22 point vault.

• From 2009 to 2011 (the most recent year for which the data is available), hospital charges lunged upward by 16 percent, while hospital costs only increased by 2 percent.

• U.S. hospital profits, pushed upward by the high charges, hit a record $53.2 billion, while nurses see more and more hospitals cutting patient services and limiting access to care.

• One case study is California where hospitals soared past the national average with a charge to cost ratio of 451 percent, or $451 for every $100 of costs.

That similar pricing practices occur elsewhere in the healthcare industry is hardly an excuse for the private hospitals to act more like Wall Street corporations than responsible, community based institutions. It should be no shock that the lowest charges are by government-run hospitals that operate in public, not in secret, and have far more accountability and transparency.

Hospitals ought to act as responsible providers of needed medical care, not loan sharks. Piling up profits in large part by jacking up prices is at sharp odds with the glossy feel good ads from hospitals we see so often on our TV screens, newspaper pullouts, sponsorship of sports teams, and on mass transit placards.

Hospital lobbyists have tried for years to convince us all that predatory pricing policies don’t matter. These are just “list” prices that few people actually pay, they claim, and it is a random phenomenon that two hospitals in the same city, or even on the same block, might have widely varying prices for similar patient services.

But the grotesque reality tells a different story.

We’re not the only ones who think so. As Glenn Melnick, a USC health economist, told a reporter, “If (hospital prices are) meaningless how come hospitals spend all this money on consultants to raise them? Why haven’t they stayed flat for the past 15 years? Why do hospitals keep raising them if they have no impact?”

While it is true that major payers seldom pay the list price, hospitals typically bargain with insurance companies over reimbursements. Anyone who has ever bought a car knows that the higher the list price, the more you end up paying. That’s true with hospital charges as well.

The inevitable result is insurance companies respond by ratcheting up their charges to employers and individuals. In California, for example, since 2002, premiums have risen 170% — more than five times the inflation rate, as noted in a California Healthcare Foundation survey last month.

An alarming, if predictable ripple effect follows. As the CHF survey noted, in the past decade, the percentage of California employers providing health coverage dropped from 71 to 60 percent; 21 percent said they’d increased workers’ co-insurance premiums while 17 percent said they had reduced benefits or increased other out of pocket costs. More than one-fourth of workers in small firms have deductibles of $1,000 or more on their health plan.

Then there’s the uninsured who do not have the collective clout to bargain down the list price. Hospitals say they write off a lot of those bills, but clearly not all of them. How many distressing stories have we all heard about patients staggered by $50,000 or $100,000 un-payable medical bills while being hounded by the hospitals or bill collection agencies to pay up.?

Patients and families, even those paying for insurance, have a stark choice. Use your health coverage and get socked with huge out of pocket costs that may mean choosing between medical bill or filling prescriptions and housing costs, food, or other necessities, or facing financial calamity, or forgo needed care.

As the Washington Post recently noted, the Affordable Care Act has not ended the deplorable story of medical bills accounting for more than half of all personal bankruptcies in the U.S.

Even many of those now paying for health insurance either through their employer or as individuals, or who will be required to buy insurance under the ACA, choose not to use it because of the high co-insurance, deductibles, co-pays, and all the add ins that get thrown in by the hospitals, such as professional fees, facility fees, pathology fees, anesthesia fees, and so on.

A 2011 Commonwealth Fund study found that the U.S. stands out among high income countries with as many 42 percent of Americans skipping doctors’ visits, recommended care, or not filling prescriptions due to cost.

Consequently, people end up in emergency rooms for medical problems that should have been resolved earlier at far less cost and pain. It is also why two recent reports disclosed that the U.S. has the lowest life expectancies and the highest first day infant death rate among major industrial countries.

It’s long past time to fix this nightmare, and sadly the ACA won’t meet that test. At a minimum we need to crack down on price gouging by all the corporations that control our health, with real penalties for lack of compliance.

But a longer vision is needed. Replace our profit focused health care system with one based on patient need and quality care as all those other countries with national or single payer systems that surpass us in access, quality, and cost, have long figured out.

Call on the California legislature to:

• Hold California private non-profit hospitals accountable to actually meet their obligation to provide charity care and community benefit in exchange for the billions of dollars they receive in subsidies as a result of their tax exempt status.

The California Assembly Appropriations Committee suspense file hearing will decide the fate of a CNA sponsored bill on May 24th.

Charity Care Accountability

AB 975, by Assembly members Bob Wieckowski of Fremont and Rob Bonta of Oakland takes on the abuse of charity care obligations by many of California’s biggest nonprofit hospital chains, like Sutter and Kaiser, that are rewarded with nearly $2 billion in tax exempt benefits beyond what they return to communities.

AB 975 would

• Clearly define charity care to ensure it is care for the poor, not marketing, cutting of services or other schemes, and redefine genuine community benefit, and assure greater public transparency.

TAKE ACTION!

Contact Assembly Appropriations Committee before May 24th, and tell them:

“I’m a nurse and a member of CNA (or a patient) and I pass AB 975 off the suspense file which will improve healthcare delivery and transparency in California.”

Appropriations Committee Members:

Chairman Mike Gatto (Glendale/Los Angeles) P. 916-319-2043 email 

Assembly Member Raul Bocanegra (San Fernando Valley) P.9 16-319-2039 email

Assembly Member Steve Bradford (Gardena/South Los Angeles County) P. 916-319-2062 email

Assembly Member Ian Calderon (Whittier) P. 916-319-2057 email

Assembly Member Nora Campos (San Jose) P. 916-319-2027 email

Assembly Member Susan Eggman (Stockton) P. 916-319-2013 email

Assembly Member Jimmy Gomez  (Echo Park/Los Angeles) P. 916-319-2051  email

Assembly Member Isadore Hall (Compton/South Los Angeles) P. 916-319-2064 email

Assembly Member Nate Holden (Pasadena) P. 916-319-2041 email

Assembly Member Richard Pan, M.D. (Sacramento) P. 916-319-2009 email

Assembly Member Bill Quirk (Hayward) P. 916-319-2020 email

Assembly Member Shirley Weber (San Diego) P. 916-319-2079 email

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