Voters want solutions as health insurance costs rise sharply

By SUZANNE KING
Special to The Star

Working two jobs isn’t exactly the way Dave Coffman envisioned his retirement.

But that’s how it’s turning out.

“I’m working basically because of health care,” said Coffman, 62, a retired school principal who lives with his wife in Lee’s Summit.

Until they qualify for Medicare, they have to buy private coverage. For now, their insurance bills amount to around $1,000 a month — including long-term care insurance, dental insurance and a health plan that has a $2,500 deductible. If he weren’t working two part-time jobs, Coffman said, there would be no way he could afford it.

“I never once thought about health insurance before I retired,” Coffman said.

Now it’s never far from his mind.

Like many Americans, Coffman says that health care will be a top concern as he casts his ballot in November.

“I know that each of the parties has a (health care) plan, but definitely we need something to help provide insurance,” Coffman said.

Coffman doesn’t want to see socialized medicine, but he wants to see a government that forces health care providers to hold the line on costs and helps the people who can’t afford them pay their health care bills.

At a time when 45 million Americans lack health insurance, Coffman is hardly alone. Even people who are insured are paying more all the time. In the past four years, according to a report in the New England Journal of Medicine, insurance premiums have climbed 35 percent, to $4,400 for an individual policy and $12,000 for a family policy.

“When people say they’re worried about health care, they’re not worried about where they’re going to find a decent doctor or medical care — they’re worried about paying for it,” said John McDonald, senior state director for AARP Missouri.

Certainly health care is on the agenda of Democrat Barack Obama and Republican John McCain.

Both candidates want to see a system that provides more affordable coverage to more people. And both talk about the need to cut costs; to improve efficiencies, partly through the use of information technology; to promote preventive care; to reduce errors; and to rein in medical malpractice lawsuits.

But the candidates’ fundamental approaches are vastly different.

Under McCain’s plan, individuals, not employers, would carry the responsibility for choosing and paying for health care.

Obama wants to shore up the current employer-based system by mandating more coverage and providing more subsidies.

“It’s a choice between adjusting the financing mechanism or a system of mandates,” said Maggie Nelson, manager for federal government and industry relations with Cerner Corp., the North Kansas City-based health care information technology company.

The McCain plan

Experts agree that McCain’s proposal is the most radical.

The senator from Arizona proposes eliminating the current tax exemption for employer-paid health insurance premiums — meaning people with job-based coverage would pay income tax on the premiums their employers pay, which are tax-free today. In exchange, he would provide a $2,500 tax credit to individuals and a $5,000 tax credit to families to buy their own insurance.

McCain’s camp argues that the system would give consumers more control, allowing them to keep insurance as they move from job to job, for example, while at the same time making them more aware of the true cost of going to the doctor.

Teeth cleanings without the dentist

By Kelly Gadzala


He’s never had a cavity, but that hasn’t prevented Allan Levine from getting his teeth cleaned.

Still, the 30-year Yonge and Eglinton resident says he’s only ever spent a few minutes with his dentist while the rest of his dental checkup is spent with a hygienist.

“I have yet to understand why I see a dentist,” Levine says.

Levine recently tried out a teeth cleaning at the new flagship location of Independent Dental Hygiene Centres on Yonge St. at Eglinton Ave., which was performed by one of the centre’s dental hygienists.

As of September 2007, dental hygienists in Ontario can practice without being supervised by a dentist. They are qualified to perform procedures like teeth cleaning, polishing and whitening but cannot fill cavities or diagnose dental conditions.

“The hygienists were theoretically and practically practicing without the dentists anyway,” says co-founder Brian Price. “All our company is doing is enabling hygienists to be independent.”

Price says when the change was made, he called former business partner Howard Rocket and asked him to come out of retirement. Both dentists turned entrepreneurs, Price and Rocket founded the Tridont Dental Centres in the 1980s, which had 107 locations across Canada mainly in malls.

This new venture, Price says, will build on the accessibility and conveniences of the former business model, but will offer lower prices.

The centre is open evenings and weekends for a total of 70 hours a week, Price says. Subsequent centres will be built along the subways lines — six along Yonge and the remaining five along the Bloor line, he adds.

Hygienists like working in the new-style clinic as it allows them to spend more time educating their patients about how to take care of their teeth.

“So far I feel I can practice dental hygiene the way it was meant to be practiced,” says Amina Zaidi, senior hygienist with the centre.

She has been in the dental field since 1995, including six years as a hygienist in a private practice.

“We’re not bound by a tight schedule or a production mentality,” she says, adding that, though not discussed openly, some dentist offices have quotas per hour.

Levine, who is without dental insurance, says he was attracted to the concept primarily because of the cost. But at his appointment, he says he appreciated the relaxed environment and the fact that he could watch a computer screen mounted on the wall that showed what the hygienist was doing.

He also left with specific instructions about which teeth he needs to floss better instead of just a general reminder to do it, he says.

“It’s rare you go do something like this and actually remember it.”

Smile Please !

The morale of healthcare employees can directly affect the quality of service and customer care being provided. However, have Indian hospitals started to view morale boosting measures as seriously as they need to? Finds out Sonal Shukla

In an interesting study done by largest research organisation in the world specialising in mental illness, the US based National Institute of Mental Health, at least one in four employees in healthcare endure an episode of significant psychological illness during their prime working years and in any given year, more than one in 10 will experience clinical depression. Moreover, for some occupational categories the risks are even greater. Physicians, nurses, chiropractors, health technologists and dentists have higher-than-average suicide rates. Health technologists, licensed practical nurses, clinical laboratory technicians, nurses aides, registered nurses and dental assistants had among the highest rates of hospitalisation for mental disorders in one study of 130 job classifications. While there are no official estimates for Indian healthcare employees, but indeed they would indeed share the same story.

As levels of competition have grown manifold, there is a pressing need to give a lot of emphasis on the quality of service which has translated into greater stress for all healthcare staff. The uniqueness of this industry is that employees are forced to face the stark realities of life and death, 24x7, under tremendous physical exertion, irrespective of time, date or day or of any turbulence in their own personal lives. Any lack of effective and timely efforts in keeping employee spirits and morale high therefore leads to a steady dip in their performance. Says Dr BK Rao, Chairman, Sir Ganga Ram hospital, New Delhi, "HR managers, particularly those responsible for healthcare facilities, face a major daily challenge in boosting the morale of all staff. Research on motivation has shown us that if you want to improve the experience of patients and the reputation of your service, pushing already motivated people to become even more so is crucial."

However, an averagely intelligent HR audit can immediately diagnose this drop in productivity, according to Shrabani Basu, Management Consultant and Corporate Trainer, This is because, it is only to a certain extent, possible to truly 'cure and care' for a patient in all its entirety, only by technical brilliance. A huge chunk of the patients' well being largely depends upon the mental and emotional makeup and well being of the employees of a hospital, that are directly reflected in their concerted emotional and behavioural efforts towards patients. "We all know, in hospitals, it is very important that a patient has to be taken to a high level of 'feel good' domain, which actually affects his responses to drugs and clinical processes towards recovery. To attain this very difficult task of making a patient feel very assured of being well taken care of clinically, is actually largely dependant on his emotional well being along with clinical excellence," she adds.

Pressing Need

The healthcare staff constantly faces tremendous physical and emotional pressure and the nature of the industry makes it even more extracting. Doctors and healthcare staff are not only under pressure from a professional point of view but also psycho-socially as patients and their family members share with them their concerns and grief. While this kind of interaction does give a special dimension to the relationship, but the fact remains that it takes a heavy toll on doctors and healthcare workers. Malcontent employees can even create a sense of gloom and doom in the workplace. In many cases their negative attitude can get transferred to other staff members and bring about low productivity. "The morale of all healthcare workers is especially important since they are dealing with human lives. It also has a direct impact on patients who are already in a troubled state of mind and tend to be more susceptible and affected by the attitude of the healthcare worker dealing with them. Hence, morale boosting becomes extremely essential for a healthcare worker," states Suyash Borar, COO, BM Birla Heart and Research Centre (BMBHRC), Kolkata. Incidentally, healthcare workers, irrespective of their professional stream, are trained and mentored from inception to keep a safe distance from letting the impact of this relationship affect their professional judgment and thereby their overall productivity. However according to experts demarcation between the beneficial involvement with the patient and/ or family for treatment and rehabilitation purposes and cross over to the limit which affects the healthcare staff itself is quite thin; and it is here that they have guard themselves against such possibility." Generally, the care provider scheduling, is done in such a manner that person's duty schedule should avoid building any disturbing relationship between him/ her and the patient. However it is easier said than attained. After all, the staff are also human, it is the humane angle which is playing a predominant role at this juncture." opines Dr Praneet Kumar, Chief Operating Officer, Fortis Escorts Hospital, Jaipur and Director - Quality Assurance, Fortis Healthcare Limited. Therefore in addition to scheduling, seniors in each stream who are sensitive and mature enough to sense any such situation very early, usually intervene. The intervention could be just a simple counseling session(s) for the affected staff to removing the employee from the care giver team or even forced leave of absence at times. All the above actions help prevent or at least minimise any chances of productivity decrease of the individual staff. "What is more important here is the quality of decision making that needs to be protected and therefore it becomes important to institute mechanisms that do not allow the staff to drift into developing emotional relationships that can be counterproductive," adds Dr Kumar.

Morale boosting methods also can go a long way in helping retain the staff. "Issues like attitude of managers towards their subordinates, working conditions, pay, safety, feeling of unfair treatment, lack of recognition, fear of superiors, if all these issues can be dealt intelligently we will definitely be able to retain our employees," feels Anthony Handa, Manager— Personnel, Ruby Hall Clinic. While it is a reality that healthcare staff is currently suffering from a sort of 'compassion fatigue,' not many groups are focusing towards morale boosting. But nevertheless, there are Groups who have taken a small yet positive step forward in this direction. Jaipur based Fortis Escorts Hospital is a case in point. It has created social forums that outline and formulate indoor and outdoor sports activities that are regularly utilised by all, without any differentiation between staff categories. While, this helps in de-stressing the staff, it also helps team building and bonding. The hospital initiated ten day sports meet from this year which the staff managed to attend even after performing their primary duties. Similarly, the entire staff of the hospital was gifted a souvenir— a silver coin with the name of hospital and date of first anniversary as a token of remembrance. "These are few of the activities that we have undertaken that affects the entire staff. Actually, morale boosting activities or for that matter any such intervention for development of soft skills has to remain responsive to changing dynamics and we at Fortis Group invest a lot of time and resources to enable it," shares Dr Kumar. Like Fortis Escorts, there are others like Kolkata-based BM Birla Heart Research Centre, Jaslok Hospital and Research Centre, Mumbai; P D Hinduja Hospital, Mumbai; KG Hospital and Post Graduate Medical Institute, Coimbatore, Max Healthcare in Delhi, Bangalore based Global Hospitals who feel that morale boosting in healthcare is the need of the day and have taken steps to implement some noteworthy measures in this area.

New clinic will offer vital dental services to low-income families

Winchester — Uninsured children with teeth full of rot will soon get the relief they need from a new downtown dental clinic.

“New” is relative, though — the clinic will operate in the same space as the Free Medical Clinic of Northern Shenandoah Valley at 301 North Cameron St.

Because the free clinic cannot receive financial compensation under Virginia by-laws, a separate nonprofit called the Dental Clinic of Northern Shenandoah Valley was created so that the dental clinic could receive Medicaid.

The dental facility will begin examining patients from Winchester, Frederick County, and Clarke County at the end of September.

The dental clinic’s ability to accept Medicaid will provide sustainable funding for services previously unavailable to most uninsured families in the area, said Vicki McClelland, executive director of both the Free Medical Clinic and the new dental clinic.

Previously, low-income individuals with severe pain could find help only on Thursday nights at the Free Medical Clinic. Volunteer staffing was limited, and even emergency cases needed to be scheduled in advance.

The new dental clinic will alleviate some of the backlog, allowing dentists to serve “true emergency cases” more easily, McClelland said.

Most private dentists don’t accept Medicaid or FAMIS — Virginia’s health insurance program for children — because of low reimbursement.

The need for the Dental Clinic of Northern Shenandoah Valley has gone unanswered for years in area, McClelland said.

She called the existing situation a “crisis” for local uninsured, low-income families who have been unable to find their children a dentist who accepts Medicaid.

The majority of these families have seen dental care as a luxury that simply wasn’t available to them when rent and food bills were due.

“People are falling through the cracks,” McClelland said. “They’re desperate. Even when parents are educated in preventive dental care, if they don’t have access to it, they’re going to go without.”

Soon, dental services at the Free Medical Clinic will be offered five days a week instead of one, and the dental clinic will be able to serve 100 people each week instead of eight.

About 2,000 adults and children will be served by the dental clinic at one time or another during the year, McClelland said.

It will be open Monday through Friday from 8 a.m. to 5 p.m., with a capacity for about 5,000 total visits per year.

A full-time dentist, two dental assistants, and an office manager will operate the facility Monday through Thursday, treating as many as 10 children and six adults per day. Volunteer dentists will staff the clinic on Fridays.

The dentists will perform preventive dentistry such as teeth cleaning, fluoride application, sealants, oral hygiene, and nutritional counseling, as well as restorative dentistry such as fillings and extractions.

The clinic will not provide dentures or partials, crown or bridge work, braces, or extensive oral surgery.

For the foreseeable future, volunteers will continue to treat adult patients Thursday evenings at the Free Medical Clinic’s Acute Dental Clinic. The “Keep That Smile” clinic will still operate on Fridays.

Dr. Alfred Phillips, 77, has volunteered at the Free Medical Clinic for 12 years. In 2003, he designed the dental space that the new clinic will be using with the vision that it would be “as good as any dental office, if not better.”

And it seems to have worked. The space is sleek and modern, complete with three chairs, a full array of dental equipment, and shiny tile floors.

“Everybody needs quality care,” he said, “regardless of their ability to pay.”

As a volunteer at the Free Medical Clinic, Phillips used to visit schools to examine students’ teeth. “It wasn’t unusual,” he said, “to see 5-, 6-, 7-year-olds with their primary [baby] molars rotted to the gumline.”

“These are kids that have been in pain — they can’t eat, they don’t get to sleep, and consequently that affects school work,” he said.

The Free Medical Clinic started out with a mobile van for dentistry in 1989, but it was discontinued because there wasn’t money to support it.

Before the grand opening of the new dental facility, the clinic’s staff hope to make the space more “children friendly” by bringing in some donated toys, puzzles, hanging mobiles, and a corner play area.

About 60 percent of the clientele will be 18 or younger, McClelland said.

Dr. Richard Taliaferro, chairman of the board for the dental clinic and a Free Medical Clinic volunteer for more than 17 years, said the new dental facility is “something we’ve dreamed about for a long time.”

“And it looks like it’s finally going to become a reality,” he said.

Families with children enrolled in Medicaid, FAMIS, or FAMIS PLUS can call 540-536-1684 for a screening at the Dental Clinic of Northern Shenandoah Valley.

Adults with an annual income of $12,000 or less for an individual, or $24,000 or less for a family of four, may also be eligible for the dental clinic’s services at a nominal fee.

...www.fmcwinchester.org

Away from the city

Theresa Fowler was up and dressed for work early Aug. 15, the day the mobile food pantry from Second Harvest Gleaners of West Michigan rumbled into the parking lot of Fifth Reformed Church on M-120 to pass out free food.

Fowler, who had a 10-hour work day ahead of her at the Wesco gas station on Maple Island Road outside Fremont, was in the Gleaners' line by 7 a.m.

The 46-year-old works 40 hours a week, extra if she can, and always on holidays when the pay is higher. Yet, to make ends meet, she has to rely on charity once a month to help put food on the table.

"I'm standing in line because I need help," Fowler said.

She had taken special care to get dressed that morning. Her shirt was pressed; her blue jeans rolled to capri-length; her hair already moussed and spiked into place.

"Can't be late for work," she said.

Her presence, the fact she was in a work uniform, waiting for food, preached a sermon all its own about the plight of Muskegon County's working poor -- people who have jobs but are struggling financially.

"Everyone here's got a story," Fowler said.

She looked up and down the line growing in number, everyone clutching a basket or empty box to fill with food. Some had been in line since before 5 a.m. Fowler was No. 61 in a line that grew to 218 by 10 a.m.

Gleaners trucks, filled with free food, make as many as 10 stops each month in Muskegon County -- but the one on Aug. 15 was unique. Most of the August sites were in the county's urban core. The one at Fifth Reformed Church, located at 2330 Holton not far from the U.S. 31 interchange, was "the farthest out" geographically. It drew residents from Dalton and Cedar Creek Townships, Twin Lake, Holton and homes considered on the "outskirts" of Muskegon County.

"It's tough," Fowler said. "Look around, nobody's job is safe anymore. People are struggling in the city, and out here, too."

Suddenly overcome with emotion, standing in the midst of so much apparent need, Fowler leaned on the shoulder of her next-door neighbor, Diane Blondeel, with whom she had come to the food truck -- and, for a few minutes, she cried her heart out. Her tears prompted a stranger to give up her place in line ahead of Fowler in order to comfort her.

"It's OK. You're a good person," the stranger said, patting Fowler on the shoulder.

Fowler worked to regain her composure, find her voice again.

"That's hard to say; hard to admit. I've always worked, always taken care of myself and my family," she said. "Saying it out loud: I need help. That's hard."

Fowler is caught, squeezed, forced by circumstances into a growing population of the "near" or "working poor." At least one-fifth of Muskegon County residents find themselves in a similar situations, unable to stretch paychecks already strained to the breaking point in precarious economic times.

Fowler, who has two adult children and a grandchild living with her, brings home about $250 a week. Her job includes health, dental and vision insurance "which keeps me going. I don't know what I'd do without that," she said.

"But I'm caught in the middle," Fowler said. "I work, so I don't qualify for (public assistance) from the state, but I don't make enough to get what I need, either."

Like a reliable vehicle, for instance, to get back and forth from work.

Fowler lives in a subdivision in Cedar Creek Estates on River Road in northeastern Muskegon Township on the border of Cedar Creek Township -- "where it's not quite city, but it's not country, either," she said. She doesn't have access to public transportation where she lives. No Muskegon Area Transit System buses go anywhere near her house. She has to drive wherever she goes -- to the grocery store, the drug store, the doctor, to work, even to the Gleaners truck delivery -- which quickly drains her pocketbook in an era of $4 a gallon gas prices.

She drives 30 miles round-trip to her job in an aging, unreliable Jeep she cannot afford to replace, even though the gas gauge is broken, and the engine is suspect. She cannot shift the car into reverse, so she has to carefully plot out her day's travels, or else waste time and gas.

At the same time, she cannot afford to move from her duplex in Creekwood Estates because her rent is determined on a sliding pay scale, "otherwise I don't know what I'd do," she said.

Divorced after 20 years of marriage, Fowler worked three jobs -- a 14-hour day was commonplace -- when her children were younger, just to support them.

"I've always stood on my own two feet," she said. "It's my pride that's hurt ... to have to ask for help now. I've never had to rely on anyone. I always said no matter what it took, even if it meant living in a tin can, I was going to support me and my kids. That's my job. I'm the mom."

Jane Johnson, director of Muskegon County's Department of Human Services, who has worked in the social service sector for more than 30 years, hears stories similar to Fowler's every day. They are the stories behind the statistics of a "nation in crisis," Johnson said. The majority of DHS clients receiving food, day care or emergency utilities assistance are employed.

"We're seeing people asking for help who've never been here before," Johnson said.

Fowler makes too much money to qualify for government assistance, but she cuts corners wherever she can, shopping yard sales. And once a month when the Gleaners' truck is scheduled to stop at Fifth Reformed Church, not far from where she lives, she stands in line for three hours -- or more -- with Blondeel, who is on disability, to receive whatever surplus food they have.

On Aug. 15, she went home with a laundry basket filled with bread and fresh cabbage, surplus sweet corn and tubs of sour cream, lettuce and a carton of soy milk. It is the only Gleaners' stop Fowler frequents. The others are simply too far away to seek out.

Living outside of Muskegon's urban center presents what Johnson called "complicators of distance," challenges that go beyond the skyrocketing cost of propane gas or fewer food pantries in the country.

Think of all the kids who take school buses home -- because there is no other transportation in the family -- and so they can't take part in after school activities. Think of the kids whose parents are having a tough time paying the electric bill, let alone finding the money for field trips, pay-for-play sports or driver education classes.