“In the Health Care Fight, a Political Focus on Jobs, With No Simple Answers - New York Times” plus 1 more

In the Health Care Fight, a Political Focus on Jobs, With No Simple Answers - New York Times

Posted: 15 Jan 2011 09:05 PM PST

WASHINGTON — As Republicans choreograph a House vote to repeal President Obama's health care overhaul this week, no charge has stung Democrats more than the argument that the new law will "kill" jobs in an economy wobbling back to life.

In the fight over whether the law will create or destroy jobs, both political parties cite evidence to support their claims. But many economists say the effect on jobs is likely to be modest — neither so negative as Republicans assert nor so positive as Democrats contend.

In any event, economists say, the impact on jobs — a hot political issue now — is not a particularly good standard to use in evaluating a complex law that will affect one-sixth of the economy and almost every American.

For many experts, a more significant test is whether the law will slow the growth of health costs and provide greater value to consumers, taxpayers and employers in return for the $2.5 trillion a year they spend on health care.

"The effect of the law on jobs is likely to be modest," said Katherine Baicker, an economic adviser to President George W. Bush who is now a professor of health economics at Harvard. "The most important effects of the law will be on health costs and coverage and the efficiency of the health care system, not on jobs."

Economists tend to agree that the law could lead some employers to hire fewer low-wage workers, as the nonpartisan Congressional Budget Office has said. But, they add, if the law eventually slows the growth of health costs, it could leave employers with more money to spend on expanding their businesses and even on hiring.

Health care jobs have been growing for years, and many experts say the trend is likely to continue if, as the budget office has projected, more than 30 million people gain coverage.

Republicans say the law will discourage hiring and employment because it will impose additional payroll costs and taxes on many businesses.

The shaky economy and the health care law, passed on party-line votes in both houses of Congress, are separate political issues. But they could become a combustible mix in the 2012 presidential campaign if unemployment remains high and Republicans gain traction with their argument that the health care law is adding to the problem.

White House officials, aware of the political risks, portray the law as an engine of economic growth that could create more than 300,000 jobs by reining in the cost of employee health benefits.

Starting in 2014, employers with 50 or more employees will be required to pay penalties if they do not offer insurance — or if their coverage does not measure up to federal standards — and if at least one worker gets a federal subsidy to help buy insurance. Companies that provide skimpy health benefits or none at all could thus incur substantial costs.

At least one-fourth of workers are in small businesses that will be exempt from the penalties, the Congressional Research Service says, and the desire to keep that exemption could influence the behavior of some business owners.

Tony Gagliardi, director of the Denver office of the National Federation of Independent Business, said many proprietors had told him: "If I have 49 employees, I am not going to hire the 50th one. The government has removed the incentive for me to create jobs over that threshold."

(Whether the threshold is at 50 or 51 employees is not entirely certain. "There is an inconsistency in the law" that may need fixing, the Congressional Research Service has said.)

The law's defenders say several factors will limit its impact on jobs. Employers will have several years to adjust to many of its incentives and requirements. Most large companies already provide health benefits to employees. And many small employers can obtain tax credits to help defray insurance costs for several years.

Economists say the new costs — including those for new health benefits and penalties — will, over time, generally be passed on to workers, through reductions in wages or other compensation.

"However," the Congressional Budget Office says, "firms generally cannot reduce workers' wages below the minimum wage," now $7.25 an hour, and this "will probably cause some employers to respond by hiring fewer low-wage workers."

Alternatively, the budget office said, the law may create incentives for some employers to use more part-time workers, because they will not be counted in calculating the amount of penalties.

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Shots or not? Some parents balk as health officials turn up heat for vaccinations - MLive.com

Posted: 16 Jan 2011 04:57 AM PST

Published: Sunday, January 16, 2011, 8:00 AM Updated: Sunday, January 16, 2011, 9:25 AM

KALAMAZOO — Several area pediatricians have stopped accepting families who won't have their children vaccinated.

Parents who want to opt out of vaccinating their schoolchildren must make their case to the county health department nurse.

Miss a scheduled immunization and you can expect a reminder by mail, text message or Twitter.

A growing number of parents are refusing to immunize their children, and diseases thought long gone are making a comeback. So local doctors, school districts and health officials are toughening their stance on vaccinations.

"As medical professionals, we feel very strongly that vaccinating ... is absolutely the right thing to do for all children and young adults," said Dr. Allan Lareau, of Bronson Rambling Road Pediatrics, in Kalamazoo.

But opponents aren't backing down — many feel just as strongly that their children are at greater risk from the shots than from the diseases they prevent.

The trend

In the 2009-10 school year, 8,807 Michigan children were excused from public school vaccinations because their parents didn't want them to have the shots.

Jennifer Sonnenberg, whose older children attend Portage Public Schools, is one of those parents.

Sonnenberg relies on a low-sugar diet, generous doses of apple cider vinegar and other practices geared to bolstering natural immunity, to keep her six children strong and healthy. It's a regimen she said worked well for her and her siblings growing up in Kalamazoo and one she plans to use for her seventh child,too, who is on the way.

Polio, mumps, measles — Sonnenberg, 29, said those diseases were before her time. Her generation's parental nightmares are autism, learning disabilities and other mysterious developmental problems that are on the rise, with causes unknown.

Sonnenberg does have one friend, she said, who was left paralyzed by a bad reaction to a DPT (diphtheria, pertussis, tetanus) shot.

Weighing the odds for her own children, she believes "the chances of receiving a side effect (from vaccination) is much greater than getting the disease itself — which in my opinion is still too great.

"I don't think anyone should be immunized," Sonnenberg said. "It's like a time bomb waiting to go off."

Pediatrician Eric Slosberg, of Borgess ProMed in Richland, said he hears those kinds of comments a lot from young parents.

"It's very frustrating; to be frank, it's like talking to a brick wall," said Slosberg, 60. "Polio's not concrete to them. They haven't seen with their own eyes what can happen if the immunity of the community wanes."

He said he remembers the terror of polio and neighbor kids left in iron lungs. He has seen the birth defects caused by rubella and has cared for babies dying in the spasms of whooping cough.

"These are things," he said, "we can now prevent."

Weighing the risks

The idea of introducing germs, even minuscule fragments of germs, into tiny infants and healthy children has never been an easy sell.

Opposition to vaccination has been reported throughout its history. But when epidemics are raging, the odds fall easily in favor of prevention. People stood in long lines to get last year's H1N1 influenza shots, for instance.

Those concerns change over time as vaccines do their work and diseases disappear from community awareness.

"That's the challenge that we face," said Joel Blostein, a vaccine preventable disease epidemiologist with the Michigan Department of Community Health.

"When diseases themselves are very rare, (parents shift their) focus to very rare, adverse events and reactions."

For instance, Lareau said, some parents believe vaccines or their ingredients may cause autism, a notion that surfaced following a 1998 British study recently debunked as fraudulent.

"Based on all available literature, evidence and current studies, there is no evidence to support that vaccines cause autism or other developmental disabilities," Lareau said. "It's way beyond a reasonable doubt at this point — vaccines are not a cause of autism."

Another fear often raised by parents, Lareau said, concerns the increasing number of available vaccines — up to 28 shots preventing more than a dozen diseases administered in a child's infancy and preschool years, and more for older children.

Parents wonder, he said, "Are we possibly overloading the child? The answer is no."
Lareau said modern vaccines are far more sophisticated than those of even a generation ago.

The difference, he said, "is dramatic. There is actually less of a load to a child's immune system now than there was a generation ago (when there were) far fewer shots."

Even with children receiving dozens of vaccinations, Lareau said, pediatricians are reporting far fewer calls about even mild reactions, such as irritability and fever. In his 33 years as a pediatrician, Lareau said, he has never once seen a serious reaction from a vaccine.

Diminishing community's protection

Courtesy PHOTO / Sonnenberg FAMILY No shots for us: Jennifer and Jeremy Sonnenberg rely on a healthy diet and nutrition supplements -- not vaccinations -- to boost the immune systems of their children, Holly, 10, Gideon, 9, Sawyer, 7, Saidy, 5, Eli, 4, and Roman, 18 months.

Sonnenberg is unconvinced.

She said she respects the choice of other parents to vaccinate if they wish — so why can't doctors and other parents respect her right, protected by law, to make choices for her own children?

Statewide, only about 4 percent of all children did not get vaccinated last year. The breakdown: Parents who oppose vaccination on philosophical grounds (8,807 children); families whose religious convictions bar vaccination (1,801 children), and those with children whose medical conditions don't allow vaccinations (1,627).

But even small clusters of unvaccinated children can harbor diseases that threaten others. The health of a community depends on community compliance so that germs have no place to flourish, a concept called "herd immunity," said Jackie Skelton, a public health nurse with the Allegan County Health Department.

That absence of disease creates a protective bubble around the vulnerable — infants too young to be immunized, children with diseases or allergies that prevent their safe immunization, and children whose vaccinations perhaps didn't fully work.

"I have kids in my waiting room with leukemia, premature infants in my waiting room," who could be at risk from unvaccinated children harboring disease, Slosberg said.

Adults whose own childhood immunity has waned, cancer patients, visitors from other countries — everyone benefits from herd immunity, Skelton said.

Michigan maintains its herd immunity by requiring children in public schools and daycare centers to show proof they are up to date on their immunizations at different times — before they enter licensed daycare and kindergarten, again at sixth grade, or at any time they transfer in from another district. Parents are allowed to exempt their children from vaccination on medical or religious grounds. Michigan is one of 20 states where parents may also opt out of vaccinating, without giving a reason.

If unvaccinated children never fall ill, doctors say, it's because they, too, benefit from herd immunity.

"It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given," Lareau said.

Parents who rely on the strength of that herd immunity without accepting their part in it — those who refuse to vaccinate or delay vaccinations — "punch more holes in that blanket of protection," Skelton said.

More than a dozen national studies trace recent outbreaks of preventable disease back to pockets of unvaccinated children in areas where vaccination coverage had declined because enough people in those communities had opted out, Blostein said . One study, of school-age children in Michigan during outbreaks of pertussis between 1991 and 2004, showed "significant overlap" between areas with the most exemption waivers and locations of pertussis cases.

"You can talk to any pediatrician and they will tell you the same thing — this is a huge problem for us," Slosberg said.

Countering the trend

Kevin Dombkowski, an epidemiologist at the University of Michigan, has worked with local health departments to study ways to prompt parents by mail, e-mail or text messages to get their children vaccinated if they are overdue for their shots.

"There's a need for constant vigilance. It's not like we solved the problem and we're done," Dombkowski said.

In Kalamazoo County, the waiver rate is holding steady at about 2 percent in grades K-12, which is below Michigan's waiver rate.

Public schools in Allegan and Kalamazoo counties now require parents who want to opt out of immunization to a talk to a public health nurse before they are allowed to sign the waiver exempting their children from vaccination. In Van Buren and Cass counties, a nurse reviews waivers and will contact parents who object for reasons other than religious or medical.

"We have always reviewed the waivers, but we have been making a more concerted effort" to make sure families have accurate information given the trend away from vaccination, said Suzanne Bailey, director of nursing at the Van Buren Cass Health Department.

"There's a lot of information out there that is very misleading," said Dawn Smith, immunization coordinator for Kalamazoo County Health and Community Services.

When Sonnenberg was told a new law required her to meet with a nurse if she wanted to waive vaccination, she looked into the matter and found no such law. When school officials conceded it was a new policy, not law, she said she refused to comply.

"I was 18 when I had my first daughter," Sonnenberg said, "and the doctors said: 'You are essentially going to kill your child.'

"I think it is unfair that people get pressured to do what doctors and researchers think is best. I think this is taking away our rights again."

Contact Rosemary Parker at rparker@kalamazoogazette.com or 269-388-2734.

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Sunday, January 16, 2011