veterans

Occupational Health News Roundup

kkrisberg — Tue, 07 Jun 2016 16:24:37 +0000

Occupational Health News Roundup

At Reveal, Jennifer LaFleur writes about the U.S. veterans who witnessed the country’s many nuclear weapon tests, the health problems they’ve encountered in the decades since their service, and their fight for compensation. One of the “atomic veterans” LeFleur interviewed — Wayne Brooks — said: “We were used as guinea pigs – every one of us. They didn’t tell us what it was gonna do to us. They didn’t tell us that we were gonna have problems later on in life with cancers and multiple cancers.” LaFleur writes:

All of the atomic vets were sworn to secrecy. Until the secrecy was lifted decades later, they could not tell anyone about their experiences. Even if they became ill, they could not tell doctors they might have been exposed to radiation.

Scientists had known from the earliest days of building the atomic bomb that radiation posed risks. Research found increased rates of certain cancers among the survivors of the Japanese bombings. It also showed that the children of survivors were more likely to have smaller heads and physical disabilities.

But there never was a coordinated attempt to study or track the health effects of radiation on the atomic vets or their children.

“They never used the knowledge that they could have gotten from us,” Brooks said. “They could have watched us all our lives and seen what it did, but they didn’t. They dropped us like a hot potato.”

LaFleur also reports about impacts on the families of atomic veterans. She interviewed Navy veteran Lincoln Grahlfs, 93, an atomic vet who was assigned to work a series of nuclear tests in the Marshall Islands. She writes of Grahlfs:

He knows that he is fortunate to be alive, despite health problems that include several bouts with skin cancer and prostate cancer over the years.

Grahlfs gets about $650 per month in compensation for skin cancer. He applied for compensation in August 2012, though it took nearly two years for the money to show up.

His bigger concern is what his exposure might have done to his children and grandchildren.

Grahlfs’ daughter suffered from endocrine problems throughout her teenage years and died of a malignant brain tumor in 1996 at 46. One son has bipolar disorder. Another has Addison’s disease, a rare adrenal condition. His granddaughter was born with a deformed foot.

“That’s a pretty full plate for somebody who never had any history of any of these things in my family,” Grahlfs said.

To read the full investigation, visit Reveal.

In other news:

The Hill: Lydia Wheeler reports that the Department of Labor is proposing new rules to improve miner safety. The proposed rules would require mining companies to examine the worksite before miners begin working and notify miners of any issues that may impact their safety and health. The examination records would then be made available to federal inspectors and worker representatives. Wheeler writes: “Under current (Mine Safety and Health Administration) standards, a workplace examination can be conducted at any time during a shift. But the rules in place now do not specify what information should be included or require mine operators to promptly notify miners when adverse conditions are found.“

Washington Post: Aaron Davis reports that the District of Columbia City Council has approved a measure to raise the city’s minimum wage to $15, and the city’s mayor is expected to sign it into law. Currently, D.C.’s minimum wage is $10.50; the new law would up that wage to $15 by 2020, after which increases would be automatic and tied to inflation. Tipped workers’ base rate would rise from $2.77 to $5, and employers would have to make up the difference if a worker’s tips don’t get him or her to the $15/hour mark. Davis writes: “But representatives of the Restaurant Opportunities Center said they were not ready to abandon the goal of a $15 minimum for restaurant workers. Kennard Ray, a spokesman for the group, said he was disappointed that D.C. lawmakers had ‘chosen again to leverage some low-wage workers against others’ to make a deal on minimum-wage law.”

New York Post: Emily Saul reports that a construction company owner is now facing manslaughter charges in the death of worker Vidal Sanchez Ramon, 50, who fell from the sixth floor of a commercial building site in Coney Island. Local building codes require that workers wear harnesses and that elevated working areas have protective rails — both of which were not the case at the building site where Ramon died. Saul reports: “A hardworking man died tragically and unnecessarily because proper safety measures were not taken to protect his life,” Brooklyn DA Ken Thompson said in a statement. “As buildings go up all over Brooklyn, we owe it to every construction worker to make sure that they don’t lose their lives due to short cuts on safety.”

Gawker: The online media outlet published a first-person account of an Amazon worker in California who worked in a “cross dock” warehouse, which is devoted to preparing products for other vendors. (This is in contrast to an Amazon fulfillment center, where workers fulfill actual customer orders.) The anonymous worker writes about having to make “rate” — or unpacking and repacking a certain number of products per hour. At first, the worker writes, the rate was 85, but then it rose to 180. According to the article: “Rate was constant. Rate was on you all day. If you went to the bathroom, that lowered your Rate. If your boss came by to see how you were doing, that distraction lowered your Rate. If you ran out of bags and had to go get new ones yourself, that lowered your Rate. If you cut yourself on a box cutter or pinched a finger in the conveyor belt right next to you or something, and had to go to the on-site Amcare office (like a school nurse’s office, and equally as competent), well, you were still on Rate, and that lapse in work lowered your Rate.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

kkrisberg Tue, 06/07/2016 - 12:24

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cancer

department of labor

government

labor rights

Occup Health News Roundup

Occupational Health & Safety

Public Health - General

safety

Toxics

War/Veterans

workers' compensation

workers' compensation

Study documents links between sexual trauma, suicide among veterans

kkrisberg — Fri, 03 Jun 2016 09:51:09 +0000

Study documents links between sexual trauma, suicide among veterans

In the first large-scale study of its kind, researchers report that sexual trauma is indeed a risk factor for suicide among military veterans and are calling on veteran health providers to continue including such trauma in suicide prevention strategies.

Published in June in the American Journal of Preventive Medicine, the study is the first large-scale, population-based investigation into whether military sexual trauma is a risk factor in suicide-related mortality. To conduct the study, researchers with the Veterans Affairs system analyzed data on millions of veterans who received outpatient services and were screened for military sexual trauma via the Veterans Health Administration (VHA) between October 2007 and September 2011. Within the VHA, military sexual trauma is defined as sexual assault or repeated, threatening sexual harassment during military service.

In fiscal year 2013 alone, the study reported, the VHA provided sexual trauma-related mental health services to more than 71,000 patients. Study co-authors Rachel Kimerling, Kerry Makin-Byrd, Samantha Louzon, Rosalinda Ignacio and John McCarthy write:

Veterans are at increased risk of suicide relative to the general adult U.S. population, prompting a focus on the conditions and experiences that account for this excess risk among veterans. Mental health conditions, including substance use disorders, mood and anxiety disorders, post-traumatic stress disorder, and schizophrenia are reliably associated with suicide risk among veterans and recent-era service members. … Little is known about other military experiences that may increase risk for suicide mortality, such as military sexual trauma.

Overall, 2.2 percent of the nearly 6 million male veterans and about 350,000 female veterans included in the study reported military sexual trauma when screened — or about 1 percent of men and more than 21 percent of women. Veterans who reported such trauma were more likely to be female, younger, more likely to live in rural communities and more likely to receive a mental health diagnosis such as depression, substance abuse or post-traumatic stress disorder. Suicide rates were higher among both men and women who screened positive for military sexual trauma, and the study found such sexual trauma to be a risk factor for suicide even after adjusting for variables such as age and mental health illness.

Researchers found that among men, suicides attributable to military sexual assault during the study period ranged from 0.29 percent to 0.69 percent; for women, it ranged from about 10 percent to 19 percent. Among those veterans who reported sexual trauma, those who died by suicide were much more likely to have been treated for mental health issues related to such trauma. Researchers also wrote that military sexual trauma may “negate the protective effect of female gender on suicide risk, where women who experienced (such trauma) showed similar risk of suicide over time as the average male VA user.”

The study noted that the VHA has launched a number of efforts to create linkages between suicide prevention and mental health services and those military members who’ve reported sexual trauma. However, researchers wrote that these new results underscore the importance of continuing and strengthening such collaborations.

“Further assessment regarding suicide ideation and attempts among veterans who have experienced (military sexual trauma) will help to inform optimal points of intervention, such as primary care, to address suicide risk in these veterans,” the study stated.

To download a full copy of the new study, visit the American Journal of Preventive Medicine.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

kkrisberg Fri, 06/03/2016 - 05:51

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government

Public Health - General

Make love, not war.
And never mix the two.
.............
Any stats on WWII or even the Vietnam Conflict?

It would be interesting to know if any statistics were ever collected on the women who have worked in combat situations. Pilots, couriers, nurses, staff of all varieties.

However, given the nature of the military, it is unlikely that data on sexual assault was ever collected.

Worth reading: Veterans' health, Medicare data, and public-health challenges in West Virginia

lborkowski — Mon, 14 Apr 2014 12:23:31 +0000

Worth reading: Veterans' health, Medicare data, and public-health challenges in West Virginia

The Washington Post's After the Wars series offers an in-depth look at the challenges facing veterans returning from Iraq and Afghanistan. This past week, it's featured Rajiv Chandrasekaran's "The Other Wounds," about veterans' injuries and illnesses that aren't the direct results of enemy attacks, and Stephanie McCrummen's "The Choice," about one of the difficult decisions facing survivors of military sexual assault.

An unprecedented release of Medicare data has allowed for a lot of reporting on how much Medicare pays physicians; Puneet Kollipara rounds up several articles in Wonbook. Two relevant op-eds I especially like are Charles Orenstein in the Los Angeles Times explaining what the data can and can't tell us and Catherine Rampell in the Washington Post reminding us who really pays for Medicare.

A few more recent pieces worth a look:

Evan Osnos in the New Yorker: Letter from West Virginia: Chemical Valley: The coal industry, the politicians, and the big spill

Kimberly Johnson in Aljazeera America: As coal fades in West Virginia, drugs fill void

Paul D. Thacker at Slate: How to Handle FDA Rejection: Women’s groups are calling the FDA sexist for not approving female Viagra. They are so wrong.

Ellen Goodman at Health Affairs Blog: It’s Always Too Soon Until It’s Too Late: Advanced Care Planning With Alzheimer’s

lborkowski Mon, 04/14/2014 - 08:23

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Public Health - General

Fireworks!! foe, not fun for veterans with PTSD

cmonforton — Wed, 03 Jul 2013 23:10:45 +0000

Fireworks!! foe, not fun for veterans with PTSD

Is it unpatriotic to dread the Fourth of July? I wonder if some U.S. veterans do, in fact dread Independence Day because of the bottle rockets, shot missiles and other fireworks set off to mark the occasion.

NBC News contributor Bill Briggs wrote last year about Iraq War veteran Pete Chinnici, 26, who is "yanked backward in time to an unfriendly, unpredictable, violent land," when neighborhood kids play with firecrackers. Briggs quotes Dr. John Hart of the Center for BrainHealth at the University of Texas at Dallas:

“Fireworks hit right in the heart of these causes [PTSD triggers.] Here’s an explosive-looking thing and a loud noise. What they’ll feel when they hear or see fireworks is mostly fear, a sense of threat as they did during combat when the IED went off or when the Humvee blew up.

Among all U.S. veterans, estimates of the prevalence of reported PTSD ranges from 10-25 percent. For the Iraq and Afghanistan wars alone, there are 2.4 million U.S. veterans. Veterans of other wars feel the effects of fireworks, too. Vietnam veteran Ken Kalish explained on Minnesota Public Radio why you don't see veterans at fireworks shows:

"Anyone who's been in combat knows that almost every time we heard those sounds ... it was either because they were trying to kill us or because we were trying to kill them. Those of us who've been in combat don't like to make a big deal out of it, but next time you're in the park watching fireworks, take a look around. A lot of veterans -- as patriotic as they come -- won't be there."

The blog EcoMerge offers suggestions on ways to reduce the impact of fireworks on those suffering from PTSD.

Consider viewing public firework displays instead of setting ones off in your neighborhood.
Talk with Veterans in your neighborhood to see if any particular fireworks are upsetting.
Let neighbors know what time you will be setting off fireworks and for what length of time.
Refrain from setting off fireworks at unexpected times during the day.
Choose a location that will be least likely to disturb vets.
Minimize the amount of fireworks that you set off.

The National Fire Protection Association and the American Academy of Pediatrics' teamed up to form the Alliance to Stop Consumer Fireworks. They argue that fireworks displays should be organized and managed by trained professionals, not neighborhood fire bugs. Bans on fireworks from consumers would reduce dismemberment, vision loss, burns, scarring and housefires caused by the pyrotechnics. For veterans and others suffering from PTSD, a ban on consumer fireworks would provide some relief. They wouldn't have to dread and suffer the consequences of impromptu blasts of fireworks in their neighborhoods, while taking steps to avoid the noise from their town's scheduled public fireworks displays.

cmonforton Wed, 07/03/2013 - 19:10

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If your readers do, indeed, Support the Troops, they will please heed your advice and watch fireworks at designated displays this year. Already, many of us have come home or worse! been awoken by the pop! pop! pop! of neighborhood fireworks. I know they are all in good fun and for your family, but please consider ours. Our children cannot understand why this fun, patriotic holiday sends us running to our bedrooms and basements. Why the merry Bang! of your explosive shakes us to our core and we cease to function. Please, consider your veteran and service member neighbors and please, please stick to sparklers. We beg you.

It's also the element of chaos which tends to have most impact on those with a heightened threat-awareness.

If you ask me fireworks tend to have comparable effects on people with non-combatant PTSD or other fear-related disorders.

How about showing some respect for veterans, and others, who find fireworks distressing, and just not participate in the practice at all?
In most states in Australia, private use of fireworks has long been banned, mainly to prevent the accidents that saw many children suffer burns, lose fingers and damage hearing each year. I know, how nanny-state, civil-liberties infringing of us! Fortunately, we prefer our children alive and unharmed.

I was in a car accident once. Should people talk to me about minimising the impact of them driving cars in my neighborhood?

more than once i have been out of the house shouting and cursing at people who keep shooting off fireworks late into the night.years ago the noise would set me off during the day but it's quiet thats broken by bang-bang-bang that gets me angry.
i never feel like hiding out but go on the attack to make them stop.

We might manage to have some sympathy for "man's best friend," too. I just spent the Fourth of July holding a terrified terrier, and more than half of the dog owners I talked to afterward reported similar experiences. The last fireworks display I saw scared a bunch of herons and egrets into an unaccustomed night flight. For wildlife, pets, AND suffering veterans, we could do without fireworks -- private and public.

You forget pets, especially dogs. Most are terrified. Mine exhibits aggression/ fear. Nothing works, tried from thundershirt to Xanax. Tried to drive away, no place to hide from loud, commercial grade, banging noise, now allowed in Michigan. Noise regulations are not enforced and it has been going on for a week past midnight and even during the day.

At the risk of the opprobrium, I believe it is the responsibility of the tiny minority of people suffering from PTSD to *protect themselves* from triggers. That goes for the owners of dogs with fireworks (and probably thunder) sensitivity.

The 4th of July is nationally associated with booms and bangs and fireworks and flashes. If you cannot tolerate the triggers, get yourself someplace where it's not as loud. If that's not possible, tranquilize yourself if that works. You can always approach your neighbors and see if you can get some consideration, but there could be consequences in how they treat you in the future.

If you're a pet owner, you might look into a Thundershirt for your dog, or tranquilizers if they suffer that much.

@Dan:
To some extent, I agree with you that folks should protect themselves. Still, with so many vets coming home now, it's worth it to at least make the public aware of the issue.

The problem with trying to protect oneself is, it's not just the actual 4th. Around here, (in a state where it's actually illegal for private citizens to use fireworks) the banging went on unpredictably for days before and after the holiday. I have no idea where one could possibly go to get away from it. The public displays are at least scheduled in advance, so that one can plan to avoid or endure them.

I am against fireworks too. I was in a terrible car accident directly before last year's July 4th celebration, and i spent a week on the couch in darkness, huddled up and petrified. A city dwelling person cannot escape the noises that time of year, and it didn't occur to me until later i could have flown to my parents' rural home and hidden.

And a car accident is only a small percentage of the trauma that actual combat must be. If i was that upset, i can't imagine how much worse it is for someone with actual PTSD. I cannot fathom that we willingly and deliberately put people through the tortures that we do in the name of recreation.

Most dogs will be far less fearful of noise if they are exposed to a wide variety of places, people, and sensory stimuli as puppies and shown by their owners' reactions that those things aren't frightening. At our local fireworks display this year the people sitting in front of us had a big white dog who appeared to be grooving on the experience. We raised our cat in a loud rackety home from the get-go and she tolerates or ignores our neighborhood's illegal fireworks, vacuum cleaners, and practically every other type of commotion (except that she recognizes loud storms to be dangerous). Many other cats are naturally too skittish to raise this way, but when I see a dog that's afraid of everything I always suspect that it's led a pretty limited life and/or has owners who are also afraid of everything.

I can force myself to celebrate the fourth, but what I thought before a cry for attention with the whole firework ptsd issue. I now understand. It causes agitation real bad for me. My neighbor sets off random bottle rockets year round, and I wanna shoot the bottle as he's lighting one off so badly but of course it would prolly not look so good. Im already feared for things that im not capable of just because of my "P.T.S.D." "Watch out for him hes bee to Combat so he might just go do the crazy vet thing" Im so over the stigma!

The cost of the Iraq war

lborkowski — Mon, 19 Dec 2011 13:48:11 +0000

The cost of the Iraq war

J. Freedom du Lac reports in the Washington Post that Army Spec. David Emanuel Hickman, killed by a roadside bomb in Baghdad on November 14th, was the 4,474th US servicemember to be killed in Iraq. With all the US troops now gone from Iraq, Hickman's death may well be the last servicemember fatality directly attributed to this conflict. The number of Iraqi deaths is much higher and much less precise; the Iraq Body Count website puts it between 104,122 and 113,700. And as a 2009 American Public Health Association policy statement points out, the consequences are greater than death alone. Here's the statement's discussion of other harms to soldiers (footnotes omitted):

Although morbidity resulting from war and conflict is perhaps even more difficult to quantify than mortality, clearly the number of injuries dwarfs the number of deaths. For example, without even considering civilians, the official number of fatalities among US armed forces in the current Iraq War exceeds 4,200, whereas injuries as of February 2009 exceed 30,0006 (although some estimates indicate the number of injured may be as high as 60,000). High-tech body armor used by western militaries and improved battlefield medicine have saved lives that might otherwise have been lost, but survivors have more severe and multiple injuries (now called polytrauma), such as amputations and traumatic brain injury, which result in a range of effects, including dizziness, blurred vision, headaches, seizures, trouble with memory, loss of coordination, sleep disturbance, and behavior or mood changes. Combat exposure to a variety of substances causes new and unexplained problems; for instance, the US Research Advisory Committee on Gulf War Veterans' Illnesses only recently confirmed that Gulf War syndrome is a recognized condition experienced by more than 175,000 veterans of the 1991 Gulf War, likely caused by use of pyridostigmine bromide, to protect against nerve gas, and the use of pesticides.
Psychological harm inflicted on combatants includes posttraumatic stress disorder (PTSD), depression, alcohol misuse, and anxiety disorders, all of which can persist for years after the end of combat. Additional injury or even death can result from violent behaviors associated with PTSD in combat veterans, including intimate partner violence and suicide. Although PTSD has been clinically defined only since the Vietnam War, mental illness secondary to conflict exposure is not new; the US military lost more than 500,000 combat personnel resulting from psychiatric collapse in World War II. More recently, rising suicide rates among US military personnel have been reported at epidemic levels: 24 soldiers committed suicide in January 2009, the highest monthly suicide total since recording began in 1980 and exceeding the number of combat deaths during the same month.

Advances in medical care have allowed soldiers to survive horrific injuries, but the US record on taking care of veterans once they've been released from hospitals is much less impressive. Traumatic brain injuries, PTSD, and other less-visible conditions have not always been diagnosed and treated as promptly and fully as wounds that bleed. In an interview last year, Secretary of Veterans Affairs Eric Shinseki told USA Today that disability claims processing has been improved but that 30% of claimants still wait several months for much-needed payments. The physical, emotional, and financial hardships can tear apart veterans' families.

And as the APHA policy statement explains, war can have far-reaching public health impacts:

Health Care and Health-Supporting Infrastructure
Infrastructure crucial to health and well-being is often targeted and destroyed during war, including health care facilities, electricity-generating facilities, water treatment and sanitation systems, transportation and communication systems, and food supply systems. In addition to the destruction of health care facilities, health care services break down when drug supplies are interrupted and health care workers migrate or die. ... The effects continue after conflicts, when government funding for health is compromised, and the training system for new health workers is weakened or stopped. Addressing these damages, however, is rarely a priority in peace-making activities and postconflict reconstruction.

In addition, emergency situations call for a radical readjustment in the approach to health care provision and survival support that goes beyond standard health care infrastructure. Vulnerable populations--the very young and very old, women, and those ill or disabled--experience a multifold risk of morbidity and mortality. The need for active outreach and provision of basic human needs, including food, shelter, clothing, and sanitation, demands urgent attention by multiple sectors as well as negotiation at political and international levels.

...

Environment
The environmental impact of war is severe and long lasting. Combatants destroy fields and forests, contaminate or divert water supplies, and release pollutants through fires. Military equipment uses nonrenewable resources and emits pollutants, such as carbon monoxide; diesel particles; and oxides of nitrogen, hydrocarbons and sulfur dioxide. The production and testing of weapons has caused severe pollution and habitat destruction, with continued pressure to expand testing throughout the world while undermining species protection safeguards. Approximately 80 million antipersonnel landmines in 80 countries account for 15,000 deaths and many severe injuries each year and make large land areas uninhabitable and unusable. Nuclear facilities produce chemical and radioactive waste, and nuclear weapons testing results in significant environmental contamination and increased incidence of some types of cancer. Battlefields are often condemned as dangerous wastelands because of their legacy of unexploded or toxic munitions and dangerous abandoned equipment. The production and use of chemical and biological weapons can also contaminate the environment and affect living beings.

One environmental health concern in Iraq (and Afghanistan) is the practice of using huge burn pits on military bases to dispose of all kinds of waste. As J. Malcolm Garcia documented in a Guernica article on burn pits in Afghanistan, fumes from the burn pits worry not only the servicemembers and civilians working on the bases, but the local residents

Now that US military operations in Iraq have officially ended and troops have departed, we can calculate what the US spent over nearly nine years. But that number will not represent the true cost of the war, which veterans, families, communities, and both the US and Iraq will be paying for many years to come.

lborkowski Mon, 12/19/2011 - 08:48

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Environmental health

Occupational Health & Safety

Who's Paying for Gabrielle Giffords' Rehabilitation?

lborkowski — Thu, 16 Jun 2011 15:11:50 +0000

Who's Paying for Gabrielle Giffords' Rehabilitation?

It's wonderful to hear what substantial progress US Representative Gabrielle Giffords has made in recovering from the traumatic brain injury she sustained from being shot in the head in January. As the Associated Press reported this morning, Giffords has spent the past five months in a rehabilitation facility and has regained some of her speaking ability. Now she'll move to the suburban Houston home of her husband, astronaut Mark Kelly, and continue daily intensive therapy on an outpatient basis. While at home, she'll have round-the-clock help from a home care assistant.

On hearing about the 24-hour-assistance Giffords will receive, Celeste and I both had the same questions: Is her insurance paying for this? It turns out that Representative Giffords' office has addressed this question - while noting that many other traumatic brain injury patients wouldn't get the same extensive rehabilitative services.

In an April 7th news release, Giffords Legislative Assistant Lauren Alfred stated, "Congresswoman Giffords was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act."

The Department of Labor website explains that FECA is administered by DOL's Office of Workers' Compensation Programs. The "Injury Compensation for Federal Employees" publication (CA-810) describes the entitlement this way:

The FECA at 5 U.S.C. 8103 authorizes medical services for treatment of any condition which is causally related to factors of Federal employment. No limit is imposed on the amount of medical expenses or the length of time for which they are paid as long as the charges represent the reasonable and customary fees for the services involved and the need for the treatment can be shown.

Federal employees are entitled to all services, appliances, and supplies prescribed or recommended by qualified physicians that, in the opinion of OWCP, are likely to cure, give relief, reduce the degree or the period of disability or aid in lessening the amount of monthly compensation. Medical care includes examination, treatment and related services such as medications, hospitalization, as well as transportation needed to secure these services. Preventative care may not be authorized, however.

The ultimate generosity of compensation will depend on a judgment made by OWCP about the utility of treatment, but there's certainly nothing in here to preclude a year or more of daily intensive therapy.

Varying Coverage of Rehabilitative Services
Back in April, the Houston Chronicle's Zain Shauk addressed the question of how much Giffords' rehabilitation might be costing and whether most people's insurers would cover it:

Giffords currently benefits from broad coverage through federal workers compensation because she was shot in the head Jan. 8 while meeting with constituents in Tucson, Ariz. The type of acute rehabilitation she receives - involving speech, occupational and physical rehab - costs about $8,000 a day, according to the Brain Injury Association of America. Post-acute rehabilitation can range in cost from $600 to $2,500 daily. The expenses leave the treatment options well out of reach for most patients whose insurers won't pay for the services.

While some insurers cover traumatic brain injury treatment, their limits on some rehab services often leave patients stagnant at times when they could be rapidly recovering, advocates say.

... About 80 percent of the recovery from a severe brain injury generally takes place within the first six months after the injury, and is more rapid early in the process, said Dr. Guy Clifton, a clinical professor of neurosurgery for the University of Texas Health Science Center in Houston and author of a book on health care costs.

Patients who have limited or no coverage are often forced to return home and end up recovering more slowly. Many wind up in nursing homes, said Jane Boutte, president of the Brain Injury Association of Texas.

The relevant insurance can differ if a person is injured on the job (as Giffords was) and covered by a workers' compensation program as opposed to getting hurt while going about daily life and being covered by an insurance plan. Those who are uninsured could get emergency care, but probably not the kind of extensive rehabilitation Giffords has received. I was curious about what my health insurance would cover if I sustained a brain injury as traumatic as Giffords', so I pulled up the summary plan description for my insurance, which is sponsored by my employer. My plan will cover:

90% of the cost of up to 100 days per calendar year of "inpatient rehabilitation facility services" at an in-network facility (or 70% of the cost at an out-of-network facility);
100% of the cost, minus a $35 per-session co-payment, of up to 60 visits per calendar year of outpatient physical, occupational, and speech therapy combined (or 70% of the costs for an out-of-network provider); and
100% of the costs of up to 100 home health care visits per calendar year - but this is *only* for services ordered by a physician, and the definition doesn't include assistance with feeding, dressing, bathing, etc.

Even when rehabilitation services in general are covered, some specific types of therapy might not be. In a USA Today article, Steve Sternberg reports that cognitive therapy, "a collection of intensive exercises that improve cognitive function," is considered experimental by some insurers and therefore not covered. A ProPublica/NPR investigation found that five of twelve major carriers (mine included) will cover cognitive rehabilitation therapy for head trauma.

The news release from Giffords' office and the USA Today article mentioned above were both written about a letter that Representative Giffords' staff sent to Health and Human Services Secretary Kathleen Sebelius. The new healthcare law includes a requirement (effective in 2014) that new insurance plans for individuals and small businesses cover "essential benefits," which are broadly defined in the legislation and will be more specifically defined by the Secretary of HHS. Giffords' staff wants that essential benefits package to include rehabilitation like the services Giffords has been receiving:

We believe it is imperative that all Americans with TBI have access to the same full continuum of medical treatment that Congresswoman Giffords has been so fortunate to receive. We urge you to ensure that all Americans have access to such care by defining it as part of the essential benefits package included in the Patient Protection and Affordable Care Act.

Sebelius and her staff face a tough job in defining these benefits. Dozens of stakeholders are pushing for a range of specific treatments to be included, but the more requirements insurers face, the higher premiums will be.

On-the-job Injuries
Many workers who are injured on the job, as Giffords was, are eligible for workers' compensation. This isn't true for all workers, though. In Texas, employers aren't even required to carry workers' compensation insurance; in Kentucky, employers in the agriculture sector are exempt from the requirement. And employees who are technically classified as independent contractors, or who are paid off the books, often don't have access to workers' compensation or other types of insurance available for regular employees.

Like health insurance benefits, workers' compensation benefits vary widely. (I'm focusing on medical and rehabilitation benefits here, but disability benefits are also extremely important to injured workers and their families.)

When I think about jobs in which workers are at high risk of traumatic brain injuries, troops serving in Iraq and Afghanistan are the first to come to mind. Earlier this year, T. Christian Miller of ProPublica and Daniel Zwerdling of NPR published an in-depth report on the refusal of Tricare, the health plan for troops and many veterans, to cover cognitive rehabilitation therapy:

Tricare, an insurance-style program covering nearly 4 million active-duty military and retirees, says the scientific evidence does not justify providing comprehensive cognitive rehabilitation. Tricare officials say an assessment of the available research that they commissioned last year shows that the therapy is not well proven.

But an investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study "deeply flawed," "unacceptable" and "dismaying." One top scientist called the assessment a "misuse" of science designed to deny treatment for service members.

Tricare's stance is also at odds with some medical groups, years of research and even other branches of the Pentagon. Last year, a panel of 50 civilian and military brain specialists convened by the Pentagon unanimously concluded that cognitive therapy was an effective treatment that would help many brain-damaged troops. More than a decade ago, a similar panel convened by the National Institutes of Health reached a similar consensus. Several peer-reviewed studies in the past few years have also endorsed cognitive therapy as a treatment for brain injury.

Miller and Zwerdling note that a few military and veteran facilities provide cognitive rehabilitation therapy, but most lack the capacity to provide full programs.

Giffords' staff has also pressed for improving coverage of rehabilitation for members of the military suffering from traumatic brain injuries. A May 13th news release explains:

Several initiatives proposed by the office of U.S. Rep. Gabrielle Giffords were included yesterday when the House Armed Services Committee approved an authorization bill for the Department of Defense.

Among the initiatives in the FY 2012 National Defense Authorization Act proposed by Giffords' staff is one that would require the Defense Department to develop guidelines for the post-acute rehabilitation of traumatic brain injuries.

... "Congresswoman Giffords is receiving excellent medical treatment," said Pia Carusone, chief of staff to Giffords. "She was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act. The members of the military who step forward to serve our nation deserve no less if they suffer a traumatic brain injury."

... Under current law, the Defense Department must establish guidelines for TBI treatment before it can cover comprehensive TBI rehabilitation under Tricare. The initiative proposed by Congresswoman Giffords' staff would start that process of establishing guidelines.

Intensive therapy in the months following a severe injury can make the difference between returning to work and a lifetime of disability -- and between living independently and needing constant caregiving. The federal Office of Workers Compensation might feel inclined to cover such therapy generously in the hopes that a big investment now will reduce the payments they might have to make over the rest of an injured federal worker's life if he or she doesn't recover substantially. Health insurance companies don't face the same incentives; if I fall off a bike and sustain a brain injury so severe that I can't work any more, my insurer is on the hook for my medical bills (including the number of days of therapy allowed under my plan) but not for any disability payments I might be entitled to.

What I don't understand is why the Department of Defense wouldn't invest in more-extensive rehabilitation for brain-injured soldiers in order to reduce the disability payments it'll have to make in future years. Is it because the federal budget process focuses more on the short-term numbers, and people figure they'll just deal with massive disability expenditures later (when there might be fewer troops deployed and higher tax revenues)? Is it because the system just isn't equipped to deal with an enormous influx of wounded veterans needing extensive rehabilitation? Does the Pentagon just have a million problems to address, and this one hasn't made it to the top of the necessary priority list?

When I do the mental math - including the costs that are hard to quantify - it makes sense to invest in rehabilitation for patients with traumatic brain injuries. But the answer will vary depending who's doing the calculations and who's paying the bills.

lborkowski Thu, 06/16/2011 - 11:11

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Gabrielle Giffords

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What fucking business is it of yours?

Given that the kind of care we get in the US varies significantly depending on what kind of insurance we have, it's a relevant question. And since Giffords' office has issued multiple news releases pointing out that she's getting better care than people with other kinds of insurance would, I'm pretty confident that she wants people to be thinking about this.

Great perspective. Of course our troops should get full care for their injuries. One assumed that was already the case -- which is why shining a light on these matters is a good thing. We should all check our own insurance benefits -- I wonder what would be the cost of a supplemental policy to achieve the kind of coverage Giffords has for all situations?

As a civil servant, I've been made painfully aware recently that every tom, dick, and harry feels it's important to poke their nose into my promotion potential, compensation levels, benefits, and every other aspect of my life as a civil servant (and much of my personal life as well).

I don't disagree with the right of the public that's paying my salary to understand in depth all aspects of what they're paying for. I don't always agree with the conclusions people reach, but I recognize that every taxpayer has the right to ask the questions.

As a taxpayer (though not a constituent of Rep. Gifford's, I feel entitled to understand as much about her compensation and benefits package as tom, dick, and harry know about mine. Rep. Gifford is an elected official, compensated by public funds. So the question is legitamite.

At the end of the day there is also a significant question as to whether or not everyone everywhere ought to receive the level of care Rep. Gifford has. The answer (as highlighted in the article) under the current system is ABSOLUTELY NOT. The article also points out that Obamacare (like it or hate it) provides an opportunity to change that answer starting in 2014 -- the article also points up the consequences of making such a decision (higher premiums, expectation that other treatments will also be specifically required...).

Unstated in the article, but implicit to the discussion, is the following question: Intensive, hugely expensive (but effective) treatments -- in a constrained resource environment, how do we determine who's worth the investment?

That is a downright nasty question. No doubt. But right now, we answer that question on the basis of wealth and gainful employment. Rep. Giffords is in a position and possesses the means to ensure that she is able to receive this intensive therapy and treatment. The author of the article, Ms. Borkowski reveals that her current circumstance supports a much lower level of support for such therapies. For me personally, as a civil servant, if receiving such an injury on the job, I would be covered in the same manner as Rep. Giffords - however off the job, such treatment would promptly bankrupt my family and jeapordize my 3 children's futures. This happened to my brother-in-law.

It is not a fantasy, a joke, or a hypothetical. Depending on your health insurance, you are one injury from total ruin. Everything you've worked for, your children's future. Everything.

So it is my business to understand when and whether our elected officials enjoy the same level of paralyzing fear for their future that the rest of us do (when we think about it too hard).

It is my business to help evaluate whether we, as a civilization, can afford this level of care for everyone, or whether our current oligopoly-privilege arrangement is the best we can afford. Or is there an argument that EITHER we all ought to be entitled to this level of care, OR that the costs from such care should be reallocated to providing more basic services to a much larger portion of the population.

This is public policy. This is health care ethics. This is basic decency and fairness.

So go the fuck to bed.

It is a legitimate question relating to public policy discussions regarding the cost, availability, and scope of health care coverage.

One factor that is often overlooked in the health care debate is that modern medicine can deliver amazing outcomes when enough resources are made available. Gabrielle Giffords recovery is a testament to that.

No one wants to talk about rationing health care, but how do you balance the ability of modern medicine to offer "miracles" (for want of a better word) with the reality that such making such "miracles" widely available would bankrupt even the wealthiest of nations. Insurance works on a shared risk principle. If only 1 in 10,000 people get cancer, 10,000 people can pool their money and their risk and provide reasonable coverage to the 1 in a 10,000 who gets the disease. That principle doesn't work when everyone becomes a candidate for joint replacements, bypass surgery, organ transplants, and any of the other thousands of diseases and conditions that an be treated by modern medicine. No one is immune from aging. Modern medicine keeps most of us healthy to old age---and old age is where the need for and the cost of health care begin to skyrocket.

People want access to the best of modern medicine because it works. It also costs dearly

I agree with that statement what business is it of yours!? Come on people....

Daniel and Sarcastico, you've both hit on a question that was on my mind as I wrote this but something I decided not to get into in this particular post. When we have extremely effective but extremely expensive treatments (as we do now) and a finite pool of money to pay for them, who gets them? As Daniel points out, we currently decide "on the basis of wealth and gainful employment" - and, I would add, based on whether one has Medicare.

There are other possibilities, none of which is perfect. The UK's national health system includes an agency that evaluates the cost-effectiveness of interventions - basically, figuring out whether the cost per additional healthy year of life the intervention's likely to provide falls within a predetermined threshold. (There are proposals to alter it, but as far as I know this system is still in place.) Many countries place limits on the prices pharmaceutical companies can charge, which would address issues with some of the hideously expensive chemotherapy drugs - although companies might not be so eager to invent new drugs if they didn't have the possibility of charging exorbitant prices for them in the US.

One of the challenges of the US system is that private insurers make decisions about coverage, but they're not the ones bearing many of the costs of disability or bankruptcy that, as Daniel points out, can jeopardize a family's future. In fact, since people change jobs (and therefore insurance plans) so often, insurers may not even reap the benefits of prevention efforts that pay off a decade later. In the UK, you still might get public officials making decisions with short-term interests foremost in their minds, but at least the government that bears the cost of the healthcare will also bear the cost (directly and indirectly) if people are disabled or bankrupted because they can't get affordable, high-quality care.

I don't see the US moving to a nationalized healthcare system any time within the next couple of decades, but we have to do something about the growth of healthcare costs by then because the growth curve is unsustainable. We can do this more thoughtfully than we do now, or we can watch the gap between the privileged and not-privileged widen even more.

I assume Giffors has INSURANCE just like the rest of congress. I doubt if she is on Medicare.

At any rate, stop peddling communism and your fascist death trap oriented socilaized medicine scam. If you like socialized medicine and other tyrant run forms of government, then please, by all means, MOVE to a place where it is used.

As a concerned citizen for the well being and survivla of traditional America, I so move to make socialism a crime of treason punishable by deportation and/or inprisonment depending on the severity of your crime.

Socialism/communism is not free speech, it is a desire of the few to control the many. More people have died in communism regimes than in free sovereign countries. That is a fact that cannot be disputed.

More people have died under communist helath care systems in one year than have died under America's system since the system has existed. Another fact.

Your system fails. Your system favors killing off the elderly and focuses on infanticide measures as well as so called prevention like dangerous forced vaccinations. Under a real system, nothing is forced, infanticide is illegal, and the elderly are taken care of.

Besides under socilaism, the individual dies. Free men are no more becuase the "collective" has taken over. It always about the collective when the individual should be treated.

Your socilaized medicine will bankrupt america. But, then again, that might be the plan all along. If liberturds bankrupt the system, then the whole world can be one big happy collective government family. right?

Good luck with that fantsy. Jesus will terminate it when he comes back along with thise who implemented it.

The left needs to stop focusing on groups and focus on the individual sovereign free person. No one want to belong to a groups of collective jackasses whose only goal is to kill off other to save the collective some chump change that the government should not have access to in the first place.

I would change my mind about the evils of socialized medicine if the left would allow for an opt out plan. That is, anyone who wishes not to participate, can opt out. That means, you do not collect money from me and I do not paerticipate in your services. If only we could opt out of social security and medicaid. I would. My money would be better spent and I would have lots of mny for retirement and health. Then again, leftists revolutionaries hate when people can take care of themselves and not depend on government. I guess that's what answers my question on the opt out plan. We can't have the peasants taking care of themselves and be self-sustaining now can we?

This is a question that should never have to be asked in a first-world country. The fact that it does ought to strike everyone as an obscenity.

Josh, I agree that it is an obscenity. But America has grown its population of people like "Medicien man" and the not-quite-as-obnoxious but equally oblivious SJ and "brittni" -- so to be honest, I can only see the situation getting more and more precarious for the majority of the population in the US, not better.

My brother was in a car accident about 5 years ago which left him with a traumatic brain injury. He was profoundly stupid about claiming from the insurance of the guy who hit him, his own fault there, but he was also completely without medical insurance of his own as he and his wife are small business owners and paying for their own medical insurance would have been so expensive that they wouldn't have been able to keep their business afloat! So I got to see what recovery from brain injury looks like when you get nothing at all beyond lifesaving care, and it ain't pretty.

Unlike my brother, I live in the UK. The NHS has its problems, no doubt about that, but having first-hand experience of both the US and the UK system, I can quite confidently say that the UK system is infinitely less broken than the US system, and I am never going back.

I also find it ironic just how little awareness people like "Medicien man" have of the fact that they are parroting the AMA party line of the 1950s, when the AMA were running quite an intensive propaganda campaign to prevent the US from setting up any sort of system like the NHS because they were afraid that it would hit doctors' profits.

Daniel and Sarcastico, you've both hit on a question that was on my mind as I wrote this but something I decided not to get into in this particular post. When we have extremely effective but extremely expensive treatments (as we do now) and a finite pool of money to pay for them, who gets them?

Liz, that question is the elephant in the room that no one wants to talk about. It is easy (and necessary) to talk about cost/benefit analysis on a rational, intellectual level. That changes, however, as soon as a spouse, child, parent, or other loved one gets sick. Everyone wants the Gabrielle Giffords solution-- a blank check for the best doctors, the best hospitals, and the best care available.
The reality is that no entity, public or private can provide 100% of the population, 100% coverage for 100% of their lives. How you balance those two opposing options is the question that needs to be answered. I don't have a clue what the answer is.

I am sure I will draw Medicien man's ire for saying I support the availability of a Dr Kevorkian option. Medicine can often sustain life without providing any reasonable hope for a quality of life. When I get to the point that I know my life is coming to an end, I want the option to be able to leave this world on my own terms--to be able to say good bye to family and friends while I still have some semblance of mind and body. That is a separate issue, but one that is always brought into play by the raving right--that controlling costs puts us on a fast train to mandatory euthanasia. Every discussion on controlling costs is answered by the specter of government or insurance bureaucrats sentencing your loved one to die by denying them life saving care.

I am sure the solution is easy in Medicien man's fantasy world where congressional health insurance is somehow not government funded health care and where "INSURANCE" is somehow magically exempt from cost constraints. For those of us who inhabit reality, and believe in working towards solutions, the discussion needs to take place.

I think that health care reform is a great idea. I have type 1 diabetes and for me to get insurance, it was a nightmare until I found "Penny Health Insurance" search for them online and you can get affordable health insurance instantly.

Would just like to point out that had Giffords been some Joe off the street, her insurance would've run out by now and they would've kicked her to the curb. http://bit.ly/lxbgd5

This so wonderful for her and her family and once she gets home she will recover so much faster all the way around.She has such a beautiful smile and I hope she will come back fully but we all have to very patient. http://bit.ly/lxbgd5

I wonder sometimes at those in the US who rail against "socialised medicine": do they actually know how expensive and inefficient healthcare provision currently is in the USA compared to other countries where healthcare is publicly provided? Do they think that it is somehow cheaper (let alone more humane) to deny people the chance to get back to work, to raising their families, and to contributing to their communities, simply because they happened to have an employer who managed to squirm out of (or possibly couldn't even afford) suitable workers' health insurance? What do they think the current situation says about the US as a civilised society?

Thank you for your very informative and thorough article. I have a brother who has lived with traumatic brain injury for 30 years now. You have raised some great points. People do not realize just how much these services cost and the FACT that MOST insurance does not cover any or all of the services you described throughout the rehabilitation process. He also has workmen's comp, however, it isn't all roses dealing with workmen's comp to get services paid for in a timely fashion.

As a person on Medicare, I do not get anything even close to the care my brother has received. I just had a liver resection and most of my rehabilitation has been limited to the doctors and nurses saying I would know intuitively when to do things. This is pathetic. I am a lay person, what would I know about this process.

Our Medicare system is NOT the wonderful benefit most people think it is. Thank God I have it or I would have NO care at all. I pay my premium for that and $500 for a supplement. Then there is Medicare D. All in all it leaves me no money for a life outside of my disability.

Those who would call this socialism have NO idea what the word even means and how it applies to the REAL world.

My son had a tramic brain injury 3 years ago this month. he was and still is a state employee, and he did not recieve benefits like this we had to fight to get his (inpatient)rehad for as long as he had it(2 1/2 weeks). 3 years later we are fighting again to get more rehad care that is needed. So for her to get everything paid and as exstensive as she is getting it is not fair. we lost everything to keep my son alive after his brain injury and seems like every where we turn to is a dead end.and I have a question who is picking up her corba payment? since she has been out of work this long inorder to keep her medical care the full preium has to be paid until she returns to works .

I am a federal worker, and if I am injured on the job, workers comp only payback part of my time away from work....is this the case for the congress woman? I would lay money on the table that she is not being charged for sick leave like the rest of us fed's and is drawing her full paycheck......they do not play by the same rules as the worker-bee federal employees.

Congresswoman Giffords treatment by the Department of Labor Ofice of Workers Compensation is so unlike the average Federal employee injured on the job so as to be alien and unrecognizable. Most injured Feds are denied initial surgery and treatments, never mind the immediate approvals for specialized care that she has recieved from the best facilities. most injured Feds would have been fired from their jobs for being unable to perform their essential duties. I agree with RMM she is not using her sick leave and unlike other Feds who have to wait months for compensation approval she probaly has no worries in this regard. There is a Senator from Maine who wants to lessen the compensation benefits of injured Feds. i suggest she ask the Congresswomen to co-sponsor her bill in the House. This is a straight up example of the Orwellian - all animals are equal, some are more equal than others. She (her ofice) can do something about this system but I dare say they will not are are happy just getting the royal treatment so to say. This is not nice to say but it is true. I wish her only the best in all regards.

The questions posed are valid ones. The answers were accurate and open. The type scope and duration of care is a concern to all, all pay for it.

As a person that has suffered a non-work-related brain injury, I wanted to add personal perspective to this piece. As a result of my injury I lost my job, I lost my ability to care for myself, I lost everything. I had health insurance that was too expensive for me to pay, and although Victims of Violent Crime picked up the tab for the premiums for a while, in the end my "Cobra benefits" ran out. Any personal savings I had were drained, any personal property that i owned of value was sold to keep me afloat until agencies decided I was poor enough to qualify for Medicare and SS. I was essentially bankrupted for the sake of help. This makes no sense to me. While I waited for agencies, doctors, specialists, I became depressed and rather hostile. I think this could have been avoided if I had been allowed to qualify whilest I maintained personal property, and allow me to do simple things like pay off creditors rather than have to go through the humiliation of having them place judgements against me for bills I had been paying in good faith up until I was assaualted by a burgler in my own home.
I am hoping that the cause that I have fought for for twenty three years will impact Ms. Giffords as well. Although I am not from her district, I have met here several times. I live in Tucson now, I am glad that I did not live here when I was assaulted as I have seen far worse treatment of victims here than where I was assaulted. This state's medicare program is much more tedious and complicated and most times it is too complicated for victims of brain injuries to navigate...they are very rare and fortunate to be represented by a patient advocate or a case manager. the latter only happens if they are accepted into AHCCCS (Medicaide program for Arizona). The victims assistance laws and department as a whole are smaller and less than adequately funded and staffed.
As for the Veteran's Administration; it is clogged with non-essential personnel, and although they mean well, are not equipped or trained to handle the new regiment for brain injury care. Hyperbaric Oxygen treatment of brain injured peoples is not a standard course of treatment under Medicare/aide or VA; even though it has been integrated into standard treatment in places like Austrailia for more than a decade. I can honestly say that after years of suffering hyperbaric O2 treatments made all the difference for me; however the treating physician ate the cost of my treatment in order to facilitate my recovery. (There are people out there that see potential for recovery and act on it as the gift of recovery from one person to another; I am eternally grateful!)
Knowing what I do know of Ms. Giffords, she will continue her quest for recovery to her highest potential of recovery. I also know that revising the medicare coverage treatment plans for brain injuries will be on her "to do list"!
it is also possible that some of her treatment is being paid for from other sources, for instance, she IS the wife of another federal employee. I personally hold no grudge that Ms. Giffords is getting what others (including myself) did not. I think that her case stands as a legal precident for other individuals to receive what they need; whether or not they are a federal employee. Certainly she is not the first to receive what some are calling "the royal treatment", case in point: the secret serviceman that took a bullet for Pres. Ford, and a certain Sen. from Arizona that received the same treatment when her returned home from Viet Nam.
I ask "why should we be working to reduce the amount of treatment for certain individuals when we could be working to increase the amount of treatment for all individuals?" Please comment on negativity that is immediately followed by well wishes as well.

Someone asked about COBRA, but that's not an issue in this case, because Giffords is still a member of Congress, so she still gets her salary and benefits. (Unlike most salaried jobs, members of Congress won't be fired for not showing up. It may affect their chances of reelection, but probably not in this case, given why she isn't on the House floor or at committee meetings or such.)

I got worker's comp, and I had full coverage for an on-the-job back injury. They paid over $50,000 of my medical bills, and I was back at work full-time 4 weeks after surgery (the worker's comp folks were shocked LOL). The only requirement was a free second opinion by their doctor (took all of five minutes to confirm what my doctor said).

She is entitled to worker's comp like every other employee. Anyone who says otherwise doesn't have a clue; it is nothing to do with the taxpayer's or not.

There is no such thing as a "finite amount of money" for coverage. She is relatively fit right now, even considering the TBI. Imagine if she needed 24/7 care like completely disabled people need (and get if it is worker's comp).

Another point: "patients with little or no coverage" is meaningless as a comparison, worker's comp insurance is mandated by Federal law. Yes it would stink if she was unemployed and cracked her skull open, and didn't have insurance, and yeah Medicaid would probably not help her too much, but that is a poor comparison.

Those people, who use our unequal system of healthcare to disparage currently successful efforts by President Obama to address the very claims of Ford, Chrysler, AND GM that ever-increasing costs for health care were a major reason they all 3 were facing bankruptcy,should 1) listen to the president of Dartmouth, who helped build a medical delivery system in Rwanda and is working to do the same in Haiti, where his developed system can provide the same, quality cataract surgery, for 1/1,000th of the current cost in the US! Our system is out of control and out of balance, as this report clearly and accurately shows. There are people, who receive special advantage, for whatever reasons! In a just society this SHOULD NOT BE THE CASE! And those people using the term, "Obamacare" for this effort 2) MUST look into their historical records to find out that President Nixon offered the FIRST LEGISLATION to address public access to affordable health care and accurate, independent reports note that the Nixon offering was very close to what was approved, after every president since Nixon has tried, unsuccessfully, to submit legislation addressing this issue, by our current President! AND 3) a national health care program was first suggested by Harry Truman after WWII. PLUS 4) prior to his death Ted Kennedy said that after he opposed the Nixon legislation, Ted Kennedy "rued the day" he voted against this, as Ted Kennedy then fought for the next 40+ years to try and get similar, much-needed legislation passed by working with every president after Richard Nixon to try and accomplish this feat!

Why is the real question never answered?
What has it cost us taxpayers,to date, to keep Giffords alive?

We are a nation of whores and back stabbers.
As a federal law enforcement officer who was severely injured in the line of duty, I see that the People we worked for, protecting and serving, would just as rather see us rot in hell if we are injured in the line of duty.
If any of you had balls you would have joined the military service and served alongside fellow solders and served alongside members in embassies that were blown up.
How dare anyone post comments here about injured federal employees serving our country or state and local police, fire and emt's.
How soon we forget 9/11.
How soon we forget those that are suffering from injuries that have turned our lives around while protecting and serving citizens of this country.
We are truly a nation of cowards, back stabbers and whores.
Lieberman and Collins, who sit on the super committee, are just about ready to throw severely injured federal employee's and our families to the street. Many of us will become homeless and destitute. This country should be proud to have these people serve you.
And the hell with every federal employee who fought alongside US solders, blown up in US Embassies and federal law enforcement officers that were shot, stabbed and assaulted on US soil.
If only I knew what I know now......I would have never served my country for almost 30 years. I would have chosen a safe profession.
I am amazed how much of this article is driven by a lady who was shot in the head while she was working as a federal congresswoman.
There was no mention that we should prey she recovers.
Most of you are jealous of Gifford because she is being afforded medical coverage and you might not have any.
Instead if being jealous of us join your federal, state or local police, fire or emt's and be alongside us when we are attacked, assaulted, shot, fighting fires, attending to injured and DOA's and some of us are killed while we are doing our jobs for your ungrateful nation.
How times have changed in my 30 years of being a federal, state and local law enforcement officer.
How this nation forgot Federal COrrection Officer Pepe who was stabbed in the eye and suffered a permanent brain injury by the 1993 perp from the WTC bombing.
Shame on you!!!!!

Oh please, if Obama care is so good then why has over 1500 unions and pet corporations/company's of the White House opted-out. Gee I wonder who will pick up the slack for them. Plus they got their staffers off the Obama plan too. Also, stop talking about the police, firemen, emt's and our Military,unfortunately, they do NOT get the same medical Attention or benefits Mrs. Gifford gets. (WHY NOT) Of course we should pay them and take care of them. But why do we have to pay for Congressmen/women, Senators and TEACHERS that do very little and get lifetime paychecks and the BEST MEDICAL and COMPENSATION we Will NEVER SEE1. Stop trying to sell your lies. America has woken up from our lazy selves, we will see you in 2012.

I have every right to complain that of course our RULING elites make sure that they get the BEST of everything while we the taxpayers pick up the tab. They specifically EXCLUDED themselves from nobamacare to make sure that this continues while the rest of us will struggle with worse and worse care and more and more buraucracy.....try getting thru 250,000 pages of Federal regulations to be allowed to go see a doctor. I have lived under the UK socilaized rationed healthcare system and it is heartbreaking and almost 3rd world in what is provided....coming soon to American...thanks obama and his idiots slaves/voters/welfare and union parsasites who do not have brains and can only spew Democrat/socialist/ parasite talking points!

So we ALL used to be able to get healthCARE and most had insurance we were happy with...obama and the corrupt Dems and unions have now made sure that most of us will have insurance we cannot afford and do not like but few of us will actually receive adequate healthCARE....wake up people just having government insurance doesn't mean get good care!How many of you would move out your private home and live in the government projects instead....well thanks to obama that is just what obmamcare by law has forced everyone in the country to do as regards to your healthcare.....well except the president and Congress...they exempted themselves from the monstrosity they forced on us! I despise them all as should everyone.

Ah, I love the smell of sockpuppets in the morning...it smells like...tinfoil hats!

I'm curious as to which provisions of the Affordable Care Act are going to cause the problems the above commenters are claiming it will bring on. For the 70% of us who have large-group insurance, insurers will have to be spending 85% of premium dollars on patient care and quality improvement, and the Congressional Budget Office projects that our premiums will not be substantially different from what they would be under the status quo.

The people who will really notice a difference are those in the individual market - many of whom couldn't get affordable insurance (especially not for covering pre-existing conditions) under the status quo. CBO estimates that insurance premiums in the individual market will be 10-13% higher than they would be otherwise, in part because insurers will be covering people they'd excluded before (but also more healthy people who didn't buy insurance until required to do so). However, they also estimate that more than half of the people buying these policies will receive subsidies for the premiums, which will make the costs substantially lower than what they'd be under the status quo. Some people will end up paying more than they would have if the legislation hadn't passed, but they'll have added protections against their insurers rescinding coverage or refusing to cover certain treatments.

Private insurers will still be providing coverage to those who aren't covered by a government program like Medicare or Medicaid. This is very far from socialized medicine (except for Medicare recipients, most of whom seem to want to keep their coverage).

I agree that it is a good question to ask. I am the mother of a child who is thankfully a long term cancer survivor. However, his journey included severe neurotoxic reactions to the chemo he received. Did i mention he was only 2 years old at the time??? He was invited to partcipate in cognitive rehab (at the same facility congresswoman giffords received treatment) at the time of the injury but was unable to as he was still in the middle of treatment for the cancer. When he was finally able to participate, we were informed by our insurance company that this type of rehab was not covered. We couldn't afford to pay for it out of our pocket as we were already struggling to pay for the other services that our insurance company had denied like physical therapy for my son to help him walk again. The initial chemo left him paralyzed. After only 30 outpatient therapy sessions we were told that he had utilized all of his therapy benefits. We did everything possible to appeal the decision of the insurance company, but lost! My son was barely on his feet again and needed more therapy!! Two years later the same insurance company decided that maybe he did need therapy afterall and started paying for it again......that is until "fear"of obamacare hit them and they hired an extenal review company to evaluate their policies to look for anything they could use to start denying coverage to their policyholders.....this was done to cut there costs and preserve their profits! What I'm getting at is this....don't think that just because you work hard and pay your insurance premiums that you will be covered if you actually NEED your insurance! And forget about fighting insurance companies if you are denied coverage...they are heartless!! We need changes to our healthcare system including more restictions on commercial healh insurance companies so that the battles we face against them are at least fair!!!

Mary, I'm very sorry to hear about your family's situation, and I'm afraid there are many more cases like yours. You may want to see if your state has a consumer assistance program for healthcare issues, because some of these programs will help consumers appeal denials by insurers.

Federal Employees do not really "pay" Federal Taxes because their salaries come from non-federal employee taxpayers. The IRS could reduce their labor and pass the savings on to real taxpayers by not taxing Federal employees in the first place so they don't have to do the paperwork. This of course should not apply to Federal Employees that receive income from other sources.

also, her husband is a fucking ASTRONAUT, so I think they're going to be okay, financially.

Oh my husband was a Federal Employee when he had a head trauma injury. The insurance was just excellent if you want to stand on the phone all day and scream. It was not the insurance that almost kill him it was the employers who were after him after the recovery. They harassed him until he was forced from his position. He was demoted from being employee of the year to a job he knew nothing about and eventually fired. He had to litigate to receive compensation. An attorney received most of that, but it was the principal as much as the win. He was a NAF employee. He received no retirement and we are now headed toward a homeless situation. Great plan working for the government. They stress you out forbid if you become ill. Then they fire you for not meeting their golden benchmark!

Dave -- there is this perception that astronauts are rock stars, but they are actually not. We can probably blame the early astronauts for that; they weren't excessively well paid, but they got a lot of perks from banks, real estate companies, and auto manufacturers who saw a marketing potential in serving astronauts. (NASA subsequently put a stop to that, feeling it gave entirely the wrong impression.) Their pay depends on who they work for (NASA, the military, a foreign space agency, etc), their level of seniority, and their level of experience. For a civilian astronaut employed directly through NASA, the pay ranges from about $65K to $110K a year (grades GS-12 through GS-13 on the federal government's pay schedule; actual pay depends on location and is factored the same for all government civil service employees). Most could make more money in private industry, and generally go on to do so after they retire from the astronaut corps; if look at the executive boards of many rocket companies, you'll notice a lot of retired astronauts -- and they make a lot more in that capacity. Nobody becomes an astronaut for money; they do it to fly a rocket into outer space.

Mark Kelly is retired now, but he was not a civilian astronaut; he was employed through the US Navy, and retired with the rank of Captain. I believe this gave him, prior to retirement, a base pay of about $115,000 a year -- the base pay of an O-6 with 22-24 years of service. So he earned more than most civilian astronauts, but a rate comparable to any O-6 with that much service. He currently is not employed, and is living off of his pension and fees earned on speaking engagements and books. I'm not sure what his pension is, but I believe it's generally 50% of base pay if you last at least 20 years before honorable discharge, which means he'd currently be getting $57,500 per year (before taxes) from that.

Gabby Gifford, IF HEAR THAT NAME ONE MORE TIME I am going to scream. I received a traumatic brain injury because some jerk was not paying attention in his car. He hit me HARD. I also have a back injury.
Getting My Insurance or his to pay is not happening. We are going broke trying to get the proper treatment.
I’m thinking “THE PEOPLE” should vote on what coverage congress gets to have, not congress. I want what she has. QUIT RUBBING IT IN MY FACE. We work hard pay our bills, taxes, insurance premiums.
Seriously.

I was looking this info up for a paper I am writing (which happens to be about the descrepancy between the care provided to those in our government verses those in our military) and I almost choked upon reading some of these responses. Particulary that of Cathy Curry on Nov 17.
Ms. Curry, I am a teacher, and a veteran and I volunteer with the crisis response team via the fire department. I have but one thing to say to you....you really should educate yourself before you spout crap!!

Let me say this....I do not agree that those in the government should get the services they seem entitled to while the rest of society gets what can be afforded or what is left over. But my real issue is your comment about teachers. As a teacher for the last 13 years, I can assure you we do not make what you assume we do and insurance is by no means a good thing. I am blessed in that my insurance is through my husband's job. However, I have friends that are paying upwards of $350.00 a paycheck for a family of three to be insured, and we have not had a pay raise in 4 years. It is this lack of education on the part of society who make the assumption that teachers are spoiled, greedy and selfish that pisses me off!!! I spend my vacations taking classes and going to conferences or other trainings (many out of my own pocket)to continue to educate children. I spend my money on supplies that are otherwise not available. I spend my evenings and many weekends grading and holidays preparing for return to school. I can pretty much guarantee that you don't take your job home with you, nor does the majority of society. I am among the lowest paid and least appreciated and I work my tail off to see to that children get the best I have to offer, many times having to compensate for what children are or are not getting at home, such as dealing with parents who are not home, view their children as a hindrance or inconvenience, drink, abuse them, and in 3 cases in my career that I am aware, children whose parents have murdered!!. So your uneducated assumptions really make me angry. Next time you want to spout this garbage, keep it to yourself!! I am sick to death of those who make assumptions about that which they have no knowledge.

Gabrielle deserves all the medical service that money can buy. Many other congress men and women gets the same treatment with the merits that Gifford had in terms of being a good and honerable servant to her constituents. Two things: 1) despite asking for a dollar figure for Giffords treatment no answer 2) the 500 congressmen and armed forces members continually provide testimonials to talk shows and media about how great the medical system is. The only catch is that these testimonials are based on the privilege of access to the all you can eat buffet of government provided health care package. This is misuse of their elected position to proved lies on TV. There are 300 million people suffering under the gruel fact of 16% of GDP escaping to shareholders of UHC, Kaisers, Blue shield big pharma and the likes. Misery defined. None of your bussines? Lying due to seeing nothing but ones own content is a crime (=misconduct).

Memorial Day

lborkowski — Mon, 30 May 2011 18:19:58 +0000

Memorial Day

This Memorial Day, I haven't just been thinking of those who died in combat, but also of those who've died because of combat. This morning's NPR story about 23-year-old Ivan Lopez, who struggled with PTSD after returning home and then became the 14th Pennsylvania Guardsman since 2003 to die by his own hand, is just one reminder of the brutal cost of war.

lborkowski Mon, 05/30/2011 - 14:19

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Honoring Veterans by Taking Care of Them

lborkowski — Thu, 11 Nov 2010 14:06:10 +0000

Honoring Veterans by Taking Care of Them

While Veterans Day is an opportunity to thank veterans for their service, it should also be a time to consider how well we're doing at taking care of veterans who've suffered physical or mental damage as a result of their service.

Our country wasn't sufficiently prepared to handle the toll that operations in Iraq and Afghanistan would take on our servicemembers. We can be grateful that battlefield medicine has improved, and that those like Marine Cpl. Todd Nicely can survive severe injuries (requiring a quadruple amputation in his case) and get advanced prosthetic limbs and extensive physical therapy. When it comes to less-visible wounds like traumatic brain injury and PTSD, though, there are far too many stories of misdiagnoses and inadequate treatment.

The military has made progress in terms of acknowledging the mental toll of war and providing help to those who need it, but the strain of multiple, closely spaced deployments is intensifying.

In an interview with USA Today, Secretary of Veterans Affairs Eric Shinseki acknowledged that although the VA has made important changes to speed up the processing of disability claims, 30% still wait several months. One challenge is that the claims are pouring in, with a million new claims last year alone.

In an interview with NPR's Steve Inskeep, Shinseki highlighted one particular improvement that's good for servicemembers: if someone served in a combat zone and is diagnosed with PTSD, the presumption that the condition was service-related is automatic. Previously, the relationship between service and PTSD had to be substantiated - and some claims were denied.

So, while we try to express our gratitude on Veterans Day, let's also remember that our country can - and must - show gratitude by providing care and compensation to those who've given so much.

lborkowski Thu, 11/11/2010 - 09:06

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Occupational Health & Safety

Eric Shinseki

PTSD

veterans

I completely agree with this post and I believe that the poor medical care some veterans receive after their time overseas is unacceptable. It is frustrating to see people who have risked life and limb in the name of our country rewarded by our government with sub par health care. To know that there are veterans suffering from injury or disease from past wars and they are left behind by the care they were given by the government is disheartening. It leaves me thinking that if our government can not even get sufficient health care to veterans that only make up a handful of Americaâs population, how is the government going to get health care to the rest of America. These veterans deserve good health care more than most, the least the government could do is give it to them.

Occupational Health News Roundup

lborkowski — Thu, 22 Jul 2010 14:42:35 +0000

Occupational Health News Roundup

The Oregonian's Julie Sullivan has been following the story of the National Guard troops who were exposed to the carcinogen hexavalent chromium at the Qarmat Ali water plant in Iraq - which contracting giant KBR was tasked with rebuilding. (Oregonian stories are here; also see our past posts on the subject here, here, and here.) Now, Sullivan reports, US Representative Earl Blumenauer of Oregon has sent a "sharply worded" letter to Secretary of Defense Robert Gates asking for details about an immunity deal that KBR reportedly struck with the Department of Defense. Twenty-six Oregon Army National Guard veterans who were stationed at Qarmat Ali are suing KBR in the US District Court in Portland, claiming the company knowingly or negligently exposed them to a carcinogen; word of KBR's immunity agreement came from a deposition in the case:

But during a June 22 deposition in the Portland case, Chris Heinrich, a Texas attorney for KBR, revealed his company had performed contingency planning in 2002 that identified hazards in the Iraqi oil fields, well before the invasion.

After KBR had signed its no-bid Restore Iraqi Oil contract and as the coalition invasion was taking place in March 2003, Heinrich said he went to the Pentagon himself to demand immunity for KBR's restoration work. Heinrich told Army officials that KBR refused to do the job unless granted "broad coverage." KBR required that the U.S. Treasury -- taxpayers and not the contractor -- pay for any property damage, injury or death of any soldier or civilian working at a KBR site. That applied even if the harm resulted from KBR negligence.

"We proposed some language that we preferred to have in terms of the indemnification," Heinrich said, adding that the agreement was typed up during that single meeting with an Army attorney. Heinrich said an amended contract was signed shortly afterward by the secretary of the army -- at the time Tom White -- or someone at the "secretariat level."

In his letter to Secretary Gates, Blumenauer requests that DoD provide a copy of its contract with KBR, a list of other contractors granted indemnification, and information about the taxpayers' financial burden resulting from indemnity agreements. He also asks "whether Congress was notified when the Department entered into contracts that burdened US taxpayers with the risk and legal responsibility for the actions of private contractors." (Full text of the letter is here.)

In other news:

Washington Post: Senior military commanders are shifting toward an attitude that post-traumatic stress disorders and traumatic brain injury are combat-related injuries that should get immediate treatment.

Charleston Gazette: OSHA issued six serious violations and a fine of $43,000 to DuPont Co. over workplace safety violations at the company's Belle, WV plant, where worker Danny Fish was killed by a phosgene leak in January.

Marketplace: Despite Egypt's laws against children under 15 working in fields, it's not hard to find young children laboring in the country's cotton fields, some of them spraying pesticides.

CIDRAP: The Infectious Diseases Society of America recommends that the Centers for Disease Control and Prevention revise their guidelines for controlling flu in healthcare settings to make influenza vaccination mandatory for healthcare workers.

Washington Post: A construction worker who was installing a balcony railing at an Arlington, VA hotel fell seven stories to his death.

lborkowski Thu, 07/22/2010 - 10:42

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Confined Space @ TPH

Occupational Health & Safety

Old brains, depressed brains, new viruses, returning salmon, and never ever healthcare reform

ddobbs — Tue, 08 Sep 2009 09:56:19 +0000

Old brains, depressed brains, new viruses, returning salmon, and never ever healthcare reform

From my wanderings. We'll start with the happy stuff

Salmon return to Paris! (photo: Charles Bremner, deep in Paris)

Mind Hacks tours some really old brains.

Zuska speaks wisely of health care reform.

The Guardian serves up some glass viruses (smallpox is pictured above).

Neuroskeptic covers a paper that is both encouraging, in its finding that EEG seems to predict antidepressant response, and infuriating, in that it withholds the information anyone else would need to replicate it. NOT GOOD.

The Wall Street Journal checks out cool tools to track the flu.

ddobbs Tue, 09/08/2009 - 05:56

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