What Are Lawmakers Afraid Of?

Published on November 17, 2009 in Jody Heymann. 0 Comments
Jody Heymann
Jody Heymann, Founding Director, Institute for Health and Social Policy, McGill University

Ensuring a floor of decent working conditions is crucial for the majority of Americans. 

For decades, we’ve debated whether the United States can afford to provide more family-friendly workplace policies and protections, and whether doing so will increase unemployment and harm our economic competitiveness.  

At the Institute for Health and Social Policy at McGill University, we set out to answer those questions through an eight-year study that examined policies, protections and supports in 190 of the world’s 192 countries. 

Through the study, we learned that the United States lacks many key work protections that are crucial for working adults and their families, and lags behind most of the 190 countries whose labor laws we examined. 

photo.blog.globalfloor.bookThe new study, Raising the Global Floor: Dismantling the Myth that We Can’t Afford Good Working Conditions for Everyone, found that:

• 164 nations guarantee paid annual leave; the U.S. does not.
• 163 nations guarantee paid sick leave; the U.S. does not.
• 157 nations guarantee workers a day of rest each week; the U.S. does not.
• 177 nations guarantee paid leave for new mothers; the U.S. does not.
• 74 nations guarantee paid leave for new fathers; the U.S. does not.

We also found that, globally, none of these working conditions are linked with lower levels of economic competitiveness or employment. In fact, many of these guarantees are associated with increased competitiveness. Of the world’s 15 most competitive countries, 14 provide paid sick leave, 14 provide paid annual leave, 13 guarantee a weekly day of rest, 13 provide paid leave for new mothers and 12 for new fathers.

Similarly, the majority of the 13 countries with consistently low unemployment rates provide paid annual leave (12), a weekly day of rest (12), paid leave for new mothers (12), paid sick leave (11), and paid leave for new fathers (9).

While the implications of guaranteeing decent work have always been important, they are particularly critical during the economic downturn that began in 2008 and that will likely affect United States workers for years to come.

So what are our lawmakers afraid of?  Now we know that the world’s most successful and competitive nations are providing the supports the United States lacks, without harming their competitiveness.  We can – and should – do better.

To learn more about the new study, visit www.RaisingtheGlobalFloor.org.

A Historic Moment…But at Women’s Expense

Published on November 10, 2009 in Debra Ness. 0 Comments
Debra Ness

Debra Ness

The health reform bill the House passed this weekend had some long-overdue advances — and an eleventh hour amendment so appalling it taints the entire bill.

The U.S. House of Representatives brought the nation one huge step closer to giving all Americans access to high quality, affordable care. We’ve been fighting for decades to get here, and it was an historic moment.

But the outrageous, reckless, and unnecessary restriction on abortion coverage — added at the eleventh hour by opponents of women’s right to choose — threatens to undermine the promise of reform and endanger women’s health and lives. It simply must not stand.

The Affordable Health Care for America Act (H.R. 3962) includes some real advances.   This bill’s greatest strengths include ending gender rating, limiting age rating and prohibiting discrimination on the basis of pre-existing conditions.  It is long past time for these disgraceful practices to end.  We are pleased that H.R. 3962 would extend these new federal rating rules to all individual and fully insured group markets.

The House bill also covers maternity care, well-woman and well-child visits, and cancer screening — and it includes no-cost language to let states expand access to Medicaid-covered family planning services without a cumbersome waiver process.�

We also applaud the provisions that will help lower-income families with the new obligation to buy health insurance, and support the expansion of the Medicaid national ‘floor’ to 150 percent of the Federal Poverty Level. But more must be done to ensure that affordable coverage is within reach for low- and moderate-income families.

But the inclusion of the Stupak-Pitts anti-choice amendment utterly taints this bill. Unless that amendment is removed, the promise of reform will ring hollow for women who will lose coverage for essential reproductive health care that we now have.

This is a historic opportunity that lawmakers must not squander by capitulating to the anti-choice extremists who would deny women coverage for basic reproductive health care.

Rx for Health Literacy

Published on October 30, 2009 in Jennifer Sweeney. 0 Comments
Jennifer Sweeney

Jennifer Sweeney

October is health literacy month and, as Congress debates the widespread challenges in health care, we also need to address the problem of low health literacy — an obstacle people face in doctors’ offices across the country everyday and one that has a big impact on health outcomes.

According to the Institute of Medicine (IOM), 90 million people in the United States, nearly half the population, lack the ability to read, understand, and act on health care information. Low health literacy skills are often a result of limited literacy skills, generally. Consider this daunting dose of reality: One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most healthcare materials are written above the 10th grade level. And while low health literacy affects people of all education and income levels, older people, non-whites, immigrants, and those with low incomes are more likely to have trouble reading and understanding health-related information.

Health literacy is defined as the degree to which someone is able to obtain, process, and understand health information in order to make the best health decisions. These are the skills that everyone needs in order to do things like fill out medical and insurance forms, follow medication instructions, and understand the doctor’s orders for before or after surgery.

Schools and hospitals around the country are raising awareness about health literacy month this October because the impact on individuals and families is considerable and, as usual, any stigma linked to a specific struggle will only exacerbate the problem. In this case, many patients are embarrassed to ask their health care providers to explain health information and, as a result, they are less likely to follow prescribed treatment, more likely to experience medication errors, and often don’t seek preventive care. Beyond the impact on individuals and families, low health literacy takes a toll on our health care system too — adding approximately $50 to $73 billion in health care costs, according to the IOM.

The good news is that positive change is within our reach. Health care providers can help by avoiding acronyms and technical medical terminology when possible. And since one of the biggest barriers to addressing the problem is actually identifying patients who are struggling to understand health information — providers should ask every patient questions to determine if they need help.

And (not that we needed another reason besides improving health to invest in tackling this problem) we’re now seeing that improving health literacy rates could also enhance people’s frame of mind. According to a recent study, researchers from the University of Alabama at Birmingham’s Center for Education and Research on Therapeutics (CERT) and the University of Oklahoma have actually found a positive correlation between health literacy and personal levels of happiness. The study revealed that happiness scores increased steadily with higher levels of health literacy even after controlling for demographic variables, poverty levels, and self-reported health.

As we’ve learned during the course of the current health care debate, the solutions we need in order to improve the health and well being of families across the country come in many shapes and sizes. Broad systemic changes, many of which we’ve seen proposed in Congress in the past year, are going to be necessary. But those changes must be underpinned by strategies — like improving health literacy — that can help ensure patients benefit from health reform. To learn more about what you can do to help tackle the problem of low health literacy, please visit the Department of Health and Human Services’ (HHS) Health Literacy Improvement page.

What Did You Just Sign?

Published on October 26, 2009 in Sharyn Tejani and Workplace Fairness. 0 Comments
Sharyn Tejani

Sharyn Tejani

Every day, women’s rights and civil rights groups work to improve the laws that govern our lives. And several times each day, workers sign away their right to enforce those laws in court.

Workers, of course, have no choice — if they don’t sign, they won’t get the job or risk losing their job.

Despite this blatant imbalance of power, courts routinely enforce what workers sign, and workers who are sexually harassed, fired for their race, or refused a reasonable accommodation for their disability find out too late that they can’t go to court to vindicate their rights. Instead, they have to go through a secret arbitration process where the person making the decision relies on the fact that employers hire them to hear these types of cases, the federal rules of evidence may not apply, damages that are in the statute don’t have to be given, and any decision is kept secret.

But some workers have the courage to take this system public — and hopefully you have already heard the story of one of them: Jamie Leigh Jones.

In 2005, Jones, a former employee of Halliburton/KBR, was viciously assaulted, gang raped, and sexually harassed by co-workers while working for Halliburton in Iraq. After she reported the attack, Halliburton locked up Ms. Jones in a shipping container with an armed guard out front. She was only able to contact her family after convincing her guard to lend her his cell phone.

Her dad got in touch with a Republican Congressman who got her help. Upon her rescue from Iraq and her return to the States, Ms. Jones filed a lawsuit against Halliburton for the appalling harm she endured. Halliburton insisted that Ms. Jones submit her claims to forced arbitration, because when she started working for them, she had signed an agreement to not bring claims against the company in court.

Four years after the attack, the Fifth Circuit ruled that Ms. Jones’ sexual assault claims could proceed to court, but that her sexual harassment claims could be forced into arbitration. So only now, four years later, a court will hear part of Ms. Jones’ case. Here is the testimony she gave in front of a Senate committee this month.

Ms. Jones’ case has become well known thanks to her willingness to go public — and thanks to Senator Al Franken, who is working to make sure that the Department of Defense does not spend our tax payer dollars to support companies that make their workers sign this type of agreement. See him talking about the Amendment he introduced to stop this here.

Sixty-eight Senators — including all the Republican women — voted for it. (See how your Senator voted.)

Now we’re working to make sure that the Franken Amendment survives the negotiations between the House and the Senate as this legislation is reconciled, and that efforts to weaken it fail.

How can you help? Call your Representative and Senators at 202/224-3121 and tell them you support the Franken Amendment to the DOD Spending Bill because you want your tax money spent with companies that treat workers fairly. And educate yourself about the dangers of mandatory arbitration here.

The Evidence is There: Better Coordinated Care Makes Sense and Saves Money. Duh.

Published on October 14, 2009 in Campaign for Better Care, Christine Bechtel and Health Care. 0 Comments
Christine Bechtel

Christine Bechtel

This just in.  What health care experts have suspected for some time has been demonstrated by a new study published in the American Journal of Managed Care: patients who can rely on a coordinated system where their providers talk to each other, their medical information is available electronically, and they have improved access to doctors and nurses – have better health outcomes.

Quick Fact: What is a Patient-Centered Medical Home?

A “medical home” — aka: “patient-centered medical home”— is a medical office or clinic where a team of health professionals work together to provide a new, expanded type of care to patients. It’s not an institution or nursing home, but a medical office or clinic that offers coordinated, comprehensive primary care that is personal and focused on making sure the patient’s health care needs are met.

The study compared four components – patient experience, quality of care, costs, and staff burnout – at a pilot patient-centered medical home (PCMH) in Seattle.  The outcome is compelling. 

Patients at the PCMH fared far better than patients at control sites in some significant ways.  After 12 months, patients at the PCMH had 29 percent fewer visits to the emergency room and 11 percent fewer hospitalizations.   These patients reported higher levels of satisfaction with their care and took a more active role in their own health care through regular communications with doctors and more participation in patient groups and self-management workshops.  These outcomes are good for patients, good for providers, and good for our nation’s pocket book. 

Another reason the medical home model is so promising?  Staff burnout (a long-time problem for primary care clinics that threatens the important role they play in preventing disease and keeping people healthy) was significantly less after one year at the PCMH.  Only 10%  of staff reported high burnout compared to 30% at the control sites.

And– because we love it when higher quality of care makes financial sense too – even though the PCMH had some significant initial start-up costs, those costs were recouped quickly (after one year).  The study estimates this is because of savings from fewer emergency visits and hospitalizations.   From the patient’s perspective, there was no detectable difference in cost between the PCMH and the control sites; meaning the PCMH was providing better care and patients were getting better outcomes and it didn’t cost them more.

But of course there’s bad news – there always is.  The problem is that all those savings generated by the PCMH didn’t actually accrue to the same people who made the wise investment in the first place.  For example, reduced hospitalizations are a worthy outcome, but those savings don’t benefit the PCMH directly; they really save health plans money.  That’s a function of the way we currently pay for health care, which promotes fragmentation over coordination and leaves patients feeling as though they’re a collection of body parts instead of the whole person they really are.

Evidence like this should play a central role in re-organizing health care payment and delivery systems in this country.  As Congress debates the future of health care, we must make sure that the way we pay for and deliver care helps every patient receives the high quality, coordinated care they deserve. 

For more information about the Patient-Centered Medical Home and how you can help advance this exciting new model of care in your area, click here.

The Costs of Family Caregiving in an Aging Society: What Is Your Experience?

Published on October 5, 2009 in Campaign for Better Care, Health Care and Lynn Feinberg. 2 Comments
Lynn Feinberg

Lynn Feinberg

Everyone I know has at least one personal story about the overwhelming stress and frustration in trying to arrange, coordinate or provide the best possible care for an aging parent, spouse, grandparent, other older relative or friend, not to mention the spiraling costs of health care.

More than three decades of research clearly show that family caregiving is a public health issue — that family members who provide care to older adults with chronic or disabling health conditions are themselves at risk — emotionally, physically and financially — particularly when the care is for a loved one with Alzheimer’s disease or another form of dementia.

Given our current economic recession, the financial aspects of family caregiving can be particularly distressing for the estimated 34 million Americans — most of whom are women — who provide care for an older (50+) family member or friend. The financial strain on this group, as they try to manage work, family, and caregiving responsibilities, was highlighted in a recent article in the New York Times. “Taking Care of Parents Also Means Taking Care of Finances” describes the growing numbers of Americans who are facing the “financial squeeze that can come from caring for elderly parents.”

The costs can be significant. Caregivers to persons age 50 and older spent an average of $5,531 per year out-of-pocket in 2007 for expenses ranging from household goods, food and meals, travel and transportation costs, to medical care co-pays and prescription medications.

According to a recent study by the National Alliance for Caregiving and Evercare, family caregivers have experienced the economic downturn in major ways. Consider these sobering statistics:

  • 50% of working caregivers (that is, those who have worked at some point while providing care in the past 12 months) said they were less comfortable taking time off from work to provide care;
  • One in three working caregivers said they had to work more hours or get another job;
  • One in six (15%) said that the economic downturn has caused them to lose their job or be laid off;
  • Six out of 10 caregivers who reported increasing their out-of-pocket spending for caregiving also reported having difficulty paying for their own basic care needs; and
  • 63% say they are saving less for their own retirement.

When it happens to you, when it becomes a personal issue in your own family, you are more likely to act.

For years at the National Partnership, we have talked about helping Americans meet the dual demands of work and family. A lot of people think about working parents when they hear those words, but millions of working people in this country are caring for frail, older relatives. The time has come to organize family caregivers as a strong and powerful force for meaningful and lasting change.

Stories about the real-life experiences of older adults and their family caregivers can help increase attention to the urgent need for better and more affordable, coordinated care.

Please take a moment to share your personal story about your caregiving experiences for an aging relative or friend.

Your story can make a difference!

Does Your Child Care Center Provide Paid Sick Days?

Published on September 28, 2009 in Karen Pesapane and Work & Family. 0 Comments
Karen Pesapane

Karen Pesapane

The Centers for Disease Control and Prevention keeps updating its guidelines to help child care and early childhood programs - - and all of us - - respond to influenza during the 2009-2010 flu season.

Guidelines for providers include separating children with signs of illness from healthy children until the ill child can be picked-up, and not allowing children back to school until 24 hours after their fever naturally subsides.

Secretary of Health and Human Services Kathleen Sebelius unveiled a new PSA featuring Elmo practicing sneezing into his arm and went on record saying “If your child comes down with the flu, we hope you plan to keep them home and not share this with their playmates.”

It’s been said enough over the past few weeks that I think we all get it. Staying home when feeling sick is one of the best ways to prevent the spread of illness.

But for all the recent emphasis on keeping sick kids home, I wondered if my 2 year-old son’s child care teachers were sick, would they stay home? Could they stay home?

So I did the unthinkable and I asked the director of my son’s child care if teachers are able to stay home when they are sick without losing pay or worrying about job security. I was delighted to learn that the teachers at my son’s child care have a paid leave package that covers sick days, and that they also allow longer tenured employees (who earn more leave than newer employees) to transfer their leave hours to colleagues who may need them.

But I know the child care industry does not typically provide workers with paid sick days.

Case in point, my mother recently retired after 25 years of teaching child care in Connecticut. She told me recently how relieved she is that she retired when she did, because she never had any sick days. She shudders to think how any teachers in the same situation this flu season will not be able to follow the CDC’s advise and stay home when they are sick.

Unfortunately, the national emphasis on staying home when sick is neglecting to acknowledge the fact that millions of workers in this country don’t have a single paid sick day. If they stay home, they get no pay. This isn’t exactly a great time to be losing income, especially for working families.

We all need a reality check.

Ask your child care provider, or the barista at your favorite coffee joint, or the worker preparing your lunch order, or working members of your family: “Can you afford to stay home if you feel sick?”

If they say no, ask them to tell their leaders in Congress that we need a minimum standard of paid sick days in this country.

No Progress on the Wage Gap…Again!

Published on September 14, 2009 in Sharyn Tejani and Workplace Fairness. 0 Comments
Sharyn Tejani

Sharyn Tejani

It is official. Women are still getting short-changed when it comes to our wages. Last week, the government released information on pay and gender.

Even in 2009, we are not receiving equal pay for equal work.

A woman working full time is still paid only 77 cents to a man’s dollar in this country. So a woman has to work all of 2009 and into April 2010 to be paid as much as a man was paid in 2009 for equal work.

Alarmingly, we saw virtually no improvement this year. The wage gap is about the same as last year. The rate of progress is glacial; at the rate of improvement we were seeing before this stagnation, equal pay would come sometime in 2058 – and now the “progress” has slowed down!

The lack of any improvement in closing the wage gap is especially frightening given data showing how badly women need equal pay. The economic downturn has caused enormous job losses, especially among men—meaning that more and more families are solely dependent on the income women are bringing in. When women are not paid fairly, families suffer.

The new data also show that as poverty rates are increasing, women on their own—single women, divorced women, widows—are experiencing very high rates of poverty. Women of color in that group are even worse off. Again, the lack of equal pay has devastating effects for these women and for the families they support.

What keeps the pay gap going? Study after study that controls for factors that go into wages—education, experience, occupation—fails to explain it. The only conclusion possible is that equally qualified men and women are being paid different wages for the same work. In other words, discrimination persists.

And unequal pay begets more inequality. Salaries at a new job often reflect past salaries; retirement benefits are a percentage of salary, as are Social Security payments. So a woman who is being paid less now because of discrimination will probably be paid less at her next job and she will certainly be paid less when she retires.

Most employers have policies that prohibit workers from talking about their wages, which keeps women in the dark about these inequities. To fix these problems, we need the Senate do what the House has done—pass the Paycheck Fairness Act. This new law will make it harder for employers to defend unequal pay decisions, given victims of unequal pay more remedies, and help stop employers from retaliating against workers who share salary information.

Or we can just wait for April 2058.

President Obama has spoken. This is your moment!

Published on September 10, 2009 in Debra Ness and Health Care. 0 Comments
Debra Ness

Debra Ness

President Obama delivered a powerful and passionate speech on health insurance reform.

It was a resounding call to get it done right, and get it done right now.  

It is safe to say the silly season is officially over.

America’s families are counting on lawmakers to fix our broken health care system this year. And their need for reform is urgent and indisputable. 

The vast majority of Americans — including patients, providers, and caregivers — recognize that the status quo is unsustainable and unacceptable. 

Thousands of National Partnership supporters like you and millions of people nationwide have spoken out because they know we need meaningful reform that makes quality, affordable care a reality.

The cost of inaction to women and families across the country is too great.  

The President called for urgently-needed reforms to the insurance market so that people can count on their health care benefits when they need them the most, regardless of their age, gender, or a pre-existing condition. He also recognized the need to transform our current system into a pay-for-value rather than a pay-for-volume system in order to finally deliver comprehensive, coordinated and quality health care.

The public is counting on Congress to pass a health insurance reform package this year that will finally give them stability and security when it comes to their health and the health of their loved ones. 

And, despite a vocal minority intent on playing politics with health care, we are closer than ever before to reform that lowers costs, guarantees coverage, and provides more choice for all Americans.

Now is the time to answer the President’s call by putting politics aside and working towards a goal we all share — healthy futures for America’s families. 

There is more momentum now than ever to make it happen.

I encourage you to take action today —and demand that Congress get it done right … and get it done right NOW!

Virginia is for … Moms-to-be: New On-Line Tool Helps Expecting Parents Choose Hospitals, Doctors

Published on September 9, 2009 in Health Care and Lee Partridge. 0 Comments
Lee Partridge

Lee Partridge

You’re pregnant, your first language is Vietnamese, and you’d like to find an obstetrician who speaks your language. You had your first baby by emergency C-section, in another state, but you want to try to deliver the second vaginally, and you’d like to find a doctor who seems to use C-sections sparingly. Or you want very much to breastfeed your baby, and you’d like to deliver at a hospital with lactation consultants available.

If you live in the state of Virginia, you’re in luck, because the Virginia Health Information (VHI) organization has just released a Web-based, interactive consumer guide to obstetrical care that has just the data you need.

VHI is a private, non-profit organization that was started in 1993 and works with Virginia health care providers, the state government, and the research community to develop health-related databases that support quality health care. The obstetrics guide is the product of several years of work with a special task force and aims to give consumers a balanced picture of what they can expect, what questions they should ask, and information they would find useful in making choices of providers. It allows you to compare hospitals and compare physicians in multiple ways. It also contains a very useful short discussion of clinical issues and a glossary of terms.

Whether you live in Virginia or just want to look at it (wistfully) as a model for your own community, you can find it here. Once there, in the comparison sections, you can search by hospital, by region, and by physician name. The hospital and physician segments also include risk-adjusted performance evaluations on their c-section rates, episiotomy rates, and cost of care. And don’t miss the hospital services data under Prenatal Services tab 5. That’s where you can find the really cool tips – like which hospitals offer music therapy, birthing balls, or maternal massages to assist you during labor!

Virginia Health Information’s new consumer guide to obstetrical services is a great example of transparency in health care information. It’s exactly the type of tool we need to empower consumers in their health care decision-making and improve health care delivery and quality all across the nation.