The TAP-IN Blog

A trillion here, a trillion there. Money to cover universal health care.

The amount of money being loaned, lost, borrowed and blown is beyond comprehension. Bailouts and deficits are now counted in the trillions of dollars. This after we'd had our minds exploded by the hundreds of billions spent on the war in Iraq. Not that sum pales in comparison.

So the shock of an estimate of $1.5 trillion over the next decade to pay for universal health care is buffered just a little bit. This number was arrived at by health care experts who advocate such a plan, but the Obama administration is not putting out such figures, obviously concerned that they would upset too many people.

On the other hand, has anyone come up with an estimate for the cost to all of us of having over 50 million people uninsured for those same 10 years?

Health Workforce Solutions Now Available on the Web

It's not only our free clinics that are understaffed these days. The entire health care system is seeing critical shortages of doctors, nurses and allied health care workers, all across the country.

The U.S. Department of Health and Human Services now provides a Web site called the Health Workforce Information Center (HWIC) where you can find "information on health workforce solutions in one centralized and easy-to-access online location."

Funded by the U.S. Department of Health and Human Services Health Resources and Services Administration and operated by the University of North Dakota (UND) School of Medicine and Health Sciences, the center will offer the latest on health workforce programs and funding sources; workforce data, research and policy; educational opportunities and models; and news and events, also available through e-mail updates.

Visitors will have a broad range of publications and other resources at their fingertips. The site also offers free, customized assistance from information specialists (digital librarians), who will search databases on workforce topics and funding resources, furnish relevant publications, and connect users to workforce experts and federal programs, among others.

“Many people in government and private and nonprofit organizations need access to the type of quickly assembled, user-friendly data the center will make available,” said Kristine Sande, HWIC deputy director at the UND School of Medicine and Health Sciences. “Accurate information on the health workforce will be vitally important in the ongoing health care debate, and we provide a way for individuals to get it from a single, trusted source.”

TAP-IN Launches in Cleveland

Area Program Looks to Recruit Retired Medical Professionals, Respond to Uninsured

CLEVELAND, Oct 14, 2008 /PRNewswire via COMTEX/ -- As the number of uninsured reaches 46.6 million nation-wide, the demand for free health clinics that rely on healthcare professionals to donate their time rises. According to a Families USA report released in September 2008, family health insurance premiums in the state rose by 76.4 percent, while median earnings only rose by 8.9 percent. This trend puts many more Ohio residents at risk of joining the ranks of the uninsured and increases the demand for free clinic services. These clinics are in great need of primary care physicians, specialists, dentists, nurses, pharmacists, psychiatrists, and social workers to provide the comprehensive healthcare that area residents would otherwise, not receive. At the same time clinics are faced with a downward trend in volunteerism among younger, actively participating clinicians. That's where a non-profit program called TAP-IN, www.tap-in.org, funded by The American Health Initiative, aims to fill in the gap.

TAP-IN is reaching out to connect the area's retired and semi-retired health professionals with those who need them. TAP-IN does this by assisting the nation's highest-quality free clinics to help meet the critical needs of their communities, by engaging health professionals living in and around them.

TAP-IN, which currently operates in the states of Virginia, North Carolina and Georgia, chose Cleveland due to the well established network of free clinics already in place and the concentration of retired health professionals in the greater metropolitan area. TAP-IN is currently working with three clinics in the area: The Free Medical Clinic of Greater Cleveland, North Coast Health Ministry, and the Lorain County Free Clinic.
Using the volunteer services of TAP-IN Clinicians provides benefits to both clinics and clinicians:

-- Free clinics gain access to a pool of experienced clinicians to help meet their volunteer needs and expand services to the uninsured.
-- The uninsured in the community, particularly those with chronic diseases, are provided increased access to care by experienced clinicians.
-- The community safety net is strengthened, and demand on already strained hospital emergency rooms and private physician offices is reduced, while achieving significant and quantifiable savings.
-- Healthcare professionals are provided an opportunity to engage once more in a meaningful way by doing what they do best -- practicing their chosen profession in an enjoyable and rewarding environment without the hassles of administrative paperwork.

Health professionals can learn about and register for the program through the Web site www.tap-in.org or by calling 877-605-3250. Interested volunteers will be matched with clinic needs, ideally leading to agreement between the volunteer and clinic to proceed. Program participants will have access to an online community to share ideas, interests and experiences.

TAP-IN.org was founded by The American Health Initiative ( www.americanhealthinitiative.org) to provide a program to help meet critical needs of free clinics through the volunteer engagement of senior health professionals to care for the uninsured. Intended to be a national program, TAP-IN was introduced in the Spring of 2006 in Virginia and North Carolina in partnership with both the Virginia and North Carolina Free Clinic Associations. The program is supported by a two-year initiating grant from The Atlantic Philanthropies.

A Profile of the Uninsured in Minnesota

A writer for Minnpost.com did some research and focused on the artist community in the state to debunk some commonly held beliefs about who make up the ranks of the uninsured in the state. In an article titled Just who are the uninsured in Minnesota?, Casey Selix interviewed the executive director of St. Paul-based Springboard for the Arts to flesh out a profile that counters the conception that many people seem to have formed of their uninsured neighbors.

Artists are mostly self-employed, creative workers whose income levels don't allow 14 percent of them to pay for health insurance. One of the most important functions of Springboard has become health care research, finding affordable access to preventative treatments and screenings for artists who, at best, can afford to pay for policies covering only catastrophic care. In addition, Springboard is working with a local community clinic to provide vouchers to help artists pay for health care services, and sponsors periodic "health fairs" where artists can get flu shots and other preventative screenings.

Like others in the estimated 7.2 percent of Minnesotans without health insurance, artists are subject to stereotyping. The reporter's research found the following to be true about the state's uninsured, contradicting public generalizations:

• The uninsured are not slackers.
• They're not primarily people of color and immigrants.
• They're not all low-income.
• They're young, yes, but not necessarily invincible.
• MinnesotaCare and public assistance aren't sure bets.

Supportive funding for community clinics

The essential value of community clinics as healthcare refuges for the uninsured is being demonstrated by the funding being channeled their way by hospitals and health insurance corporations. Here are a few recent examples:

• In Lehigh Valley, Pennsylvania, three hospitals are "collaborating on a plan to bring more money, staff and patients to four medical clinics serving the poor and uninsured." The hospitals secured a state grant of $450,000 and have set up a non-profit corporation with the intention of creating "federally qualified health centers" that can receive federal money to augment their operational budgets.
• Blue Cross Blue Shield of Michigan announced that 42 clinics across the state will share $1 million in grants. The clinics provide free or discounted care to 90,000 uninsured Michigan residents.The funding helps the clinics purchase medications and expand services like dental care. Since 2005, the Blues have donated $4 million to the clinics.
• Blue Shield of California Foundation is allocating $7.1 million to approximately 200 community clinics through its annual Community Clinic and Consortium Core Support Initiative. This initiative will help support safety net organizations that provide medical services to millions of uninsured

Ohio Governor Creates Senior Civic Engagement Council

Ohio Governor Ted Strickland created the council by executive order to help make best use of its growing resource of citizens over 55. The object is to "enrich the possibilities for older Ohioans to stay employed, to do volunteer work, and to take advantage of educational opportunities."

In announcing his action, Strickland noted that the new council will ''work to keep (older adults) active and engaged in their communities and careers, as well as help employers prepare for changing workforce needs.''

It's just a smart move that deals positively with the reality that an average of 12,000 Ohioans turn age 60 every month, and that these older Ohioans are still able to ''enjoy vibrant, productive and independent lives.''

It also recognizes that the state's traditional ''working age'' population is projected to grow by only 224,000 by the year 2015, while Ohio's population of citizens age 55 and above will grow by 552,000. That differential means that businesses will need to rely on the 55 and older crowd to find the workers they need. These older workers, with their reservoir of life and work experiences, will also be a great asset in training Ohio's future business leaders, the governor's order noted.

How About a "Retired Healthcare Professionals Corps"?

I just ran across a paper published this past January on Brookings, the Web site of the Brookings Institution. The paper's authors - Hugh B. Price, Senior Fellow, Economic Studies and Oliver Sloman, Senior Research Assistant, Economic Studies - elaborate on a very passioned appeal for the volunteer services of a mass of retired doctors, nurses and other medical specialists. The paper is titled Mobilizing Retired Physicians to Fight Childhood Obesity.
 

Just as Tap-In emphasizes the urgency for staffing community clinics with retired healthcare professionals, this paper sees the current wave of childhood obesity as an issue that can't wait long for such engagement.

The authoritative Robert Wood Johnson Foundation argues that childhood obesity is one of the most urgent and serious health threats confronting our nation. The epidemic afflicts and endangers members of every race and ethnic group, as well as all income levels and in every region of the country. During the past four decades, obesity rates have soared nearly fivefold among children between the ages of 6 and 11. More than one-third of children and adolescents are overweight or obese. In raw numbers, that’s nearly 25 million kids and teenagers. As the Foundation warns, if our nation fails to reverse this ominous trend, we’re in danger of raising the first generation of American children who will live sicker and die younger than the generation before them.

Thus, the paper's authors examine a range of possible actions that could be taken to arrest the trend, concluding that direct education of obese children and their families would be the most effective and immediate route.

The answer, in my view, is to deploy vastly more healthcare professionals, namely doctors, nurses and nurses’ aides, physical fitness specialists and so forth to help children and their families cope with and overcome obesity. The self-evident way to do this is to train, employ and pay them to play this critical role. That would be a costly proposition, however, and perhaps not the option of first resort, especially given the severely strapped fiscal climate at the federal, state and local levels.

And here is where the authors have an idea very similar to the one that inspired the founders of Tap-In, the difference being that the paper envisions the roles of the reactivated retired healthcare professionals as primarily educational, while Tap-In see the healthcare professional actually practicing their craft.

My idea is to mobilize retired physicians and healthcare workers to serve their country by joining in a crusade to combat childhood obesity, especially in those communities and among the children where the problem is most acute. They could be deployed to schools, YWCAs, Boys and Girls Clubs, community centers, neighborhood clinics, childcare centers, churches and other venues where they can establish and sustain regular contact with children and, equally important, their families. The YMCA, which recently unveiled a new strategic plan which envisions it as America’s paramount fitness and anti-obesity crusader, would be a natural partner for a national/local initiative like this because of its institutional commitment, its presence in communities across the country and its fitness facilities on site.25

Our nation's healthcare professionals who have retired or are on the cusp of retiring constitute a potentially vast resource that could be tapped. According to the National Association of Retired Physicians, 250,000 doctors are age 55 or over. As these baby boomers wind down their practices, many undoubtedly will have the interest, energy and public spiritedness to contribute their time and expertise to a pressing cause like combating childhood obesity.

There are plenty of precedents for mobilizing retirees to help under-served patients. In Boston, a program known as Bedside Advocates recruits retired doctors, nurses, physicians’ assistants, and even lay people to help patients stay on their medications and navigate the healthcare system. Retired doctors, nurses, social workers and dietitians in Ft. Lauderdale, FL, staff a so-called MediVan for the elderly on a rotating basis. In Sarasota, FL, retired doctors and nurses operate a 24-hour clinic called the Senior Friendship Centers Health Service. Retired physicians also started a free health clinic, aptly known as Volunteers in Medicine (VIM), in Hilton Head, SC.

The authors take the idea further, describing one potential path to implementing a large-scale recruitment drive and deployment of retired doctors, nurses, dietitians and other specialists.

Several approaches to mobilizing retirees come to mind. One way is to encourage inspired local efforts that train their resources on overweight and obese children. Another is to call upon states to take the initiative.

Yet there arguably is a more logical, convenient and potentially scalable option. The Corporation for National and Community Service (CNCS) is the independent federal agency created in 1994 to bring the full panoply of domestic community service programs under the umbrella of one central organization. CNCS oversees AmeriCorps, VISTA and the Senior Corps. The latter connects roughly 500,000 volunteers aged 55 and older with people and organizations that need support. They serve as companions to senior citizens, mentors to youngsters, and supplemental staff and advisers to nonprofit groups. In addition to its established programs, CNCS’s assets include its federal standing and funding, programmatic credibility, history and tradition, administrative infrastructure, and state and local affiliations.

What about creating a Retired Healthcare Professionals Corps under the aegis of the Senior Corps? Its sole mission would be to combat childhood obesity at the community level. What would these volunteers do? I envision them focusing on: (1) keeping kids from becoming overweight and obese; (2) helping overweight and obese children lose weight and adopt healthier lifestyles; and (3) helping overweight and obese youngsters manage the chronic illnesses that may develop as a result of their condition. Accordingly, the services they provide might include: advising about fitness and wellness training; monitoring healthy eating habits, weight control, and stress management; maintaining appropriate cholesterol, blood sugar and blood pressure levels; providing screening and risk identification; regularly tracking of key health indicators; and referring youngsters for medical treatment, tests and prescriptions as need be.

A Retired Healthcare Professionals Corps - if such an entity were to be created - would serve more purposes than just childhood obesity. Such services are critical given the basic healthcare needs of millions of uninsured and underinsured families and individuals.

The paper then goes on to examine some of the "thorny issues" that such a "novel endeavor" would face, many of which are common to community clinics as they reach out for volunteer retired healthcare pros. The next step, as the paper describes it, will be a feasibility study. So far, I've found no evidence on the Web that such a study is underway, though the urgency would certainly seem to warrant it.

Cut in Medi-Cal Reimbursements Will Impact Clinics

A commentary I ran across on Mercurynews.com called my attention to the fact that, as part Governor Arnold Schwarzenegger's across-the-board 10% budget cuts, the state's Medi-Cal will also need to reduce its reimbursement payments to doctors. This will surely cause some number of doctors to restrict or eliminate patients they will be willing to treat. And where will these untreated people go? Many will certainly go to the same places that serve the totally uninsured.

The public health care safety net is fragile enough that a 10% cut in any of its interdependent elements can only further destabilize the entire system.

Funds Available to Train Boomer Volunteers

Maine has such a need for its boomer retirees to engage in public service that a $95,000 grant was just awarded to the Maine Community Foundation to be used to develop leadership training. Though all retirees have skills developed over their employed lifetimes, many of the public service jobs where volunteers are needed require other skill sets.

This reflects the need for some health care volunteers to learn new skills for use in community clinics that they may never have practiced before. And this situation demonstrates the need for a service like TAP-IN that can match health care skills with specific needs in community clinics.

Lotteries for Another Purpose: Health Care

The BBC reports this story about Oregon's new direction for covering more of its citizens for their health care. One Oregonian who may depend on drawing the right number is not happy that it's come down to gambling for the right to be taken care of.

"It's a symbol of how degraded our system is in this country that we are resorting to a lottery," she tells me.

"It's pathetic and repugnant at the same time... [but it's] a necessity because I don't earn thousands each month."

More than 90,000 are entered in the lottery to win th3 10,000 placements available. This is just a small percentage of the 600,000 uninsured people in the state.

Clinic director John Duke of the Outside In community clinic in downtown Portland, where doctors see 7,000 different patients a year (90% of whom have no health insurance) is also disgusted.

"I think it says it's a pretty sad state of the health care system in Oregon and in the nation as a whole," he says.

"I think the system is falling apart and it needs some radical deep change.

"This is a small Band-Aid. I think the best it can do is draw attention to the problem and maybe bring change in that way."

Even Oregon's Director of Human Services, Dr Bruce Goldberg, agrees that the program his agency is sponsoring is not a solution, but may call attention of national leaders to the desperate circumstances.

"I hope what they're working for is not a national lottery..." he says.

"I think it's an issue about how to use this as an example of what the problem is.

"I mean this is about real people and real people's lives."