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CLICK "SEARCH" ABOVE FOR MORE INFORMATION ABOUT THREE "CONTROVERSAL" HEALTH CARE ISSUES DISCUSSED IN EARLIER HCREI ARTICLES--ABORTIONS--BIRTH RATE AND BREAST CANCER
DEATH PANELS NEEDDED TO DECIDE "WHO/When" DOESN'T GET MEDICARE COVERAGE
From Drudge Report 5/10/2013
Republicans Are Refusing To Appoint Members To Obamacare's Most Notorious Panel Brett LoGiurato|May 9, 2013, 6:31 PM
One of the most politically intense fights over the Affordable Care Act was over the creation of the Independent Payment Advisory Board, infamously dubbed a "death panel" by Republicans during the 2010 elections.
AP
One of the most politically intense fights over the Affordable Care Act was over the creation of the Independent Payment Advisory Board, infamously dubbed a "death panel" by Republicans during the 2010 elections.
On Thursday, Republican House Speaker John Boehner and Senate Minority Leader Mitch McConnell signaled that they would keep working to keep opposition alive by doing everything they can to impede the board's implementation.
The two leaders wrote a letter to President Barack Obama, notifying him that they would not be submitting any recommendations to the panel because of their opposition to it and to the law in general.
Here's the relevant part of their letter explaining why they aren't offering any recommendations:
In order to allow supporters to claim that the law’s Medicare cuts would be realized in the future, it tasked IPAB with reducing payments to providers or eliminating payments for certain treatments and procedures altogether. These reduced payments will force providers to stop seeing Medicare patients, the same way an increased number of doctors have stopped taking Medicaid patients. This will lead to access problems, waiting lists and denied care for seniors.
The unfortunate result is that decisions which impact America’s seniors will be made in the absence of the democratic process, without the system of checks and balances that would normally apply to important matters of public policy. Yet your recent budget called for expanding IPAB by tasking it with making even larger cuts to Medicare than those called for in the health law, even though the trustees of the Medicare program have told us that IPAB’s provider cuts would be “difficult to achieve in practice,” because of the denied care that seniors would experience.
Though the move will likely play well for Republicans politically, it won't have much of an effect on the implementation of the health care law, at least for the foreseeable future, according to health care law professors.
The IPAB is set up to be a 15-member panel. Three members will be chosen by the Republican and Democratic leaders of the House and Senate, and the remaining three are chosen by Obama and the executive branch. All of the members have to be confirmed by the Senate.
But the IPAB is only needed if Medicare costs are projected to go beyond economic growth plus an additional percentage point in any given year, said Allison Hoffman, an assistant professor of law at UCLA. Right now, Medicare costs aren't growing fast enough to require the board to decide which cuts to make to Medicare providers.
"There's actually no work for the IPAB to do this year," Hoffman told Business Insider.
McConnell and Boehner's letter has "no impact on the ground," Hoffman said. "It's a protest move. You know — we're not going to cooperate with what the law says in this regard."
Get ready for the Internal Revenue Service to play a dominant role in health care. When Obamacare takes full effect next year, the agency will enforce most of the laws involved in the reform—even deciding who gets included in the health-care mandate.
"The impact of the IRS on health-care reform is huge," said Paul Hamburger, a partner and employee benefits lawyer at Proskauer.
"Other agencies like Social Security will be checking for mistakes, but the IRS is the key enforcer," Hamburger said. "It's also going to help manage who might get health care."
In its 5-4 ruling last year, the Supreme Court upheld the law's mandate that Americans have health insurance, saying that Congress can enforce the mandate under its taxing authority and through the IRS.
As a result, the agency has to administer 47 tax provisions under Obamacare. They include the right to levy a penalty against businesses and individuals who don't provide or acquire insurance. Noting that the IRS will collect the penalties, the decision labeled them a tax.
The IRS also has to determine how to distribute annual subsidies to 18 million people who make less than $45,000 a year and thus qualify for subsidies in buying health coverage, as well as how to deliver tax credits to small businesses that buy coverage for workers.
In addition, the agency will collect taxes on medical devices and a Medicare surtax on people making more than $200,000 a year, as well as conducting compliance audits of tax-exempt hospitals.
The financial burden for all this IRS enforcement is expected to total $881 million for fiscal years 2010 through 2013, according to the Treasury Department.
But former IRS Commissioner Douglas Shulman told Congress last year that he would need another $13.1 billion for the job in 2014. It's uncertain as to whether the funds will be forthcoming from Congress, which has cut the IRS's budget in each of the past two years.
One step the IRS has taken on health-care exchanges is drawing another round of lawsuits that accuse it of forcing more people into the system.
Each state has been offered the chance to set up its own health-care exchange to allow residents to buy insurance at lower cost and with some financial assistance. If states choose not to set up an exchange, the federal government will run them.
Twenty-six states have said they will not set up their own exchange; seven others have opted to help organize them but not fund them. Because the exchanges are federally funded, residents in those 33 states would not be eligible for federal subsidies. But the IRS stated last year that they would be eligible for health-care premium subsidies.
Individual and small business owners coordinated by the Competitive Enterprise Institute filed suit against the decision in federal court in Washington last week. It contends that the ruling would force more businesses and people (who would probably be exempt from the mandate without the subsidies) into buying health insurance and subsequent penalties if they failed to purchase it.
The agency has not responded to the lawsuit.
"The IRS has a lot on its hands when it comes to Obamacare," Hamburger said. "There will be some rough spots ahead. There really hasn't been anything like this in decades in terms of sweeping reform legislation."
It's not clear if the IRS is to blame for one rough spot that has been encountered.
Saying that it can't meet the 2014 deadline, the Obama administration is delaying parts of the program intended to provide affordable coverage to small businesses and their workers. Instead of a marketplace with choices in the 33 states with federally run exchanges, small businesses will be limited to a more costly single plan until 2015.
What the IRS can actually enforce also seems a difficult question.
The law severely limits the agency's ability to collect penalties. It can ask for the money, but there are no civil or criminal penalties for refusing to pay it. The IRS cannot seize bank accounts or dock wages to collect it. No interest accumulates for unpaid penalties.The law allows the IRS to withhold tax refunds to collect the penalty but only if someone overpaid taxes.
And the IRS is still working on procedures for taxpayers to prove they have insurance.
Some of Obamcare is in effect. Parents can keep their children on their health insurance plans until age 26. The 2.3 percent tax on those making more than $200,000 to help pay for Medicare expansion is also on the books.
Upcoming provisions include that insurers cannot refuse coverage for preexisting illnesses, as well the individual and business mandates.
"An estimated 27 million people will be eligible for health care by 2017, according to the Congressional Budget Office. That kind of number is going to put the IRS on the firing line, Hamburger said
SC House Approves Bill Criminalizing Enforcement Of ‘Obamacare’
May 3, 2013 10:45 AM
South Carolina Gov. Nikki Haley waves on stage during the Republican National Convention at the Tampa Bay Times Forum on Aug. 28, 2012 in Tampa, Fla. (credit: Chip Somodevilla/Getty Images)
COLUMBIA, S.C. (CBS Charlotte/AP) — The South Carolina House approved a bill Wednesday criminalizing the implementation of President Obama’s health care law in the state.
The Republican-controlled House voted 65-39 on the Freedom of Health Care Protection Act.
The act renders “null and void certain unconstitutional laws enacted by the Congress of the United States taking control over the health insurance industry and mandating that individuals purchase health insurance under threat of penalt
AN EXCITING BREAKTHROUGH IN THE SEARCH FOR A CAUSE FOR CANCER
NEW INSIGHT INTO CANCER PROVIDED BY DNA RESEARCH
By gina kolata
The New York Times 5/2/2013
"...Scientists have discovered that the most dangerous cancer of the uterine lining closely resembles the worst ovarian and breast cancers, providing the most telling evidence yet that cancer will increasingly be seen as a disease defined primarily by its genetic fingerprint rather than just by the organ where it originated...".
"...Another surprise was that the worst endometrial tumors [Uterus] were so similar to the most lethal ovarian and breast cancers, raising the tantalizing possibility that the three deadly cancers might respond to the same drugs...."
"...Jeff Boyd, executive director of the Cancer Genome Institute at Fox Chase Cancer Center, who was not involved with the new research, said the similarity among breast, ovarian and endometrial tumors was the best example yet of the idea that cancers are more usefully classified by their gene mutations than by where they originate...."
"...Though many scientists believe this view is correct, Boyd said, "It is very rewarding, I can't overstate it", to see it validated with real data...."
From the Director; Having served on Tumor Review Boards for near 40 years this report represents the greatest research breakthrough for a cause of Cancer, found during my career.
EXPECT GREAT CHAOS AS HEALTH OVERRHAUL IS IMPLEMENTED
by david brooks The New York Times 4/26/2013
It was always going to be difficult to implement Obamacare, but even fervent supporters of the law admit that things are going worse than expected.
Implementation got off to a bad start because the Obama administration didn't want to release unpopular rules before the election." Regulators have been working hard but are clearly overwhelmed, trying to write rules that influence the entire health care sector - an economic unit roughly the size of France. Republicans in Congress have made things much more difficult by refusing to provide enough money for implementation.
By now, everybody involved seems to be in a state of anxiety. Insurance companies are trying to put out new products, but they don't know what federal parameters they have to meet. Small businesses are angry because the provisions that benefited them have been put on the back burner. Health care systems are highly frustrated. They can't plan without a road map. Sen. Max Baucus, one of the authors of the law, says he sees a "huge train wreck" coming.
I've been talking with a bipartisan bunch of health care experts, trying to get a sense of exactly how bad things are. In my conversations with this extremely well-informed group of providers, academics and former government officials, I'd say there is a minority, including some supporters of the law, who think the whole situation is a complete disaster. They predict Obamacare will collapse and do serious damage to the underlying health system.
But the clear majority, including some of the law's opponents, believe that we're probably in for a few years of shambolic messiness, during which time everybody will scramble and adjust, and eventually we will settle down to a new normal.
What nobody can predict is how health care chaos will interact with the political system. There's a good chance Republicans will be able to use unhappiness with what is already an unpopular law to win back the Senate in 2014. Controlling both houses of Congress, they will be in a good position to alter, though not repeal, the program.
The law's biggest defenders will then become insurance companies and health care corporations. Having spent billions of dollars adapting to the new system, they are not going to want to see it repealed or replaced.
The Supreme Court decision made the Medicaid piece more complicated. The decision by many states not to set up exchanges made the exchange piece more complicated. The lines of accountability between, for example, state and federally run exchanges have grown byzantine and unclear. A law that was very confusing has become mind-boggling. That could lead people to freeze up. Insurance companies will hesitate before venturing into state exchanges, thereby limiting competition and choice. Americans are just going to be overwhelmed and befuddled. Many are just going to stay away, even if they are eligible for benefits.
Then there is the technical cascade. At some point, people are going to sit at computers and enroll. If the data process leoks like some 1990s glitchmonster, if information doesn't flow freely, then the public opinion hit will be catastrophic.
Then there is the cost cascade. Nearly everybody not in the employ of the administration agrees this law does not solve the cost problem, and many of the recent regulatory decisions will send costs higher. A study in California found that premiums could increase an average of 20 percent for people not covered by federal subsidies. A study by the Society of Actuaries found that by 2017 costs could rise 32 percent for insurers covering people in the individual exchanges, and as high as 80 percent in states like Ohio.
Then there isthe adverse selection cascade. Under the law, young, healthy people subsidize poorer, sicker and older people. But the young may decide en masse that it is completely irrational for them to get health insurance that subsidizes others while they are healthy. They'll be better off paying the fines, if those are even enforced, and opting out. Without premiums from the young, everybody else's costs go up even higher.
Then there is the provider concentration cascade. The law further in-centivizes a trend under way: the consolidation of hospitals, doctors' practices and other providers. That also boosts prices.
Overall, it seems likely that in some form or another Obamacare is here to stay. But the turmoil around it could dominate politics for another election cycle, and the changes after that - to finally control costs, to fix the mind-boggling complexities and the unintended consequences - will never end.
Law enforcement agencies are reporting a spike in health insurance scams across the country, many of which are preying on the public's confusion over the massive changes taking place in the nation's health care system.
By Jenny Gold, Kaiser Health News
MONDAY, April 22, 2013 (Kaiser Health News) — One recent morning, 86-year-old Evelyne Lois Such was sitting at her kitchen table in Denver when the phone rang. She didn’t recognize the phone number or the deep voice on the other end of the line. “He asked if I was a senior, and I said yes, and he said we are sending out all new Medicare cards and I want to make sure I have all of your statistics correct,” At first, the caller didn’t seem too fishy; he started by running through her address and phone number, just to make sure they were right. But then he read off a series of numbers and asked if it was her bank routing number. “I didn’t know really at the time whether it was or not, but I just said no. He said, well could you give it to me so I’ll have it correctly, and I said, well I’m not so sure about that. And he started to say something and I hung up.”
When the scammer tried calling her a second time, she hung up immediately, scribbled down the number from her caller ID and dialed Medicare to report the scam.
“I kind of thought it was funny at first, and then I thought, you know, how dare they?” says Such. “There are some seniors who aren’t well and don’t think as well as they used to, and it just made me angry that they would be victimized like this.”
Law enforcement agencies are reporting an increase in these sorts of health insurance scams across the country. Many of the fraudsters seem to be preying on the public’s confusion over the massive changes taking place in the nation’s health care system.
Seniors are often targets — they’re more likely to be home to answer the phone, and they tend to have retirement savings that scammers hope to tap. But they aren’t the only victims: The federal government received nearly 83,000 complaints of “imposter scams” last year — up 12 percent from the year before.
“America’s rife with health scams,” says James Quiggle, communications director at the Coalition Against Insurance Fraud in Washington, D.C. “Crooks are offering fake health coverage, stripped down policies masquerading as real coverage. They’re also selling … fake Obamacare coverage,” he explains.
Recent polls have found that well over half of Americans say they still don’t understand how the new health law will affect them. “Crooks are playing on that confusion. Confusion is a crook’s best friend,” says Quiggle.
“Fraudsters are as attuned to what’s going on in the news as anybody else,” says Lois Greisman, who runs the division of marketing practices at the Federal Trade Commission. “Before Katrina hit land, websites were up soliciting funds to help victims of Katrina. This is not a surprise; this is par for the course.” A program as vast as the health care overhaul makes for a dangerous twist on the regular scams, she adds.
Greisman and her team are working to take down the scams as quickly as possible, but there is an endless number; scammers range from just your average amateur looking to make a quick buck, to well-organized crime rings that mass-produce fraud.
“The first line of defense is don’t take a call from out of the blue from anyone who’s offering to help you navigate the new health care market,” cautions Greisman. “Those kinds of cold calls just shouldn’t take place, same thing with an unsolicited email, an unsolicited text.”
Many people see through those sorts of simple scams, says Sally Hurme, an elder law attorney at AARP. “But even if one in a thousand falls for the scam and gives up info or agrees to send information off to who knows where, they’ve made [the scammer’s] day. That’s what their job is,” says Hurme. As the Affordable Care Act ramps up, the country is likely to see more frequent insurance scams, and they’re likely to get more sophisticated, she adds.
Savvy senior Evelyne Lois Such offers this advice for others who get a suspicious call: “Don’t answer too quickly. Think about the answer you give them and what they’re asking.” And never give up and personal or financial information over the phone.
Better yet? Just hang up.
This article was produced by Kaiser Health News with support from The SCAN Foundation.
From the Director of HCREI Former Clinical Professor of Health and Medical Sciences. School of Public Health, UC Berkeley
I THINK THIS BEARS/NEEDS REPEATING
-----------------------------------
TURNING BACK TO FIND THE FUTURE ?
A majority of the American people are outraged by the "immoral conduct" in the corporate world, the "excessive" profits in the Pharmaceutical Industry and the "rising costs" and salaries reported by "privately operated" Managed Health Care Plans--as they watch their retirement plans "vanish"; find it "impossible" to afford life-preserving medicines and are expected to settle for a "diminishingquality "and quantity of the health care "provided" when they are in need.
Truth is, they supported the growth of a "private enterprise" managed health care system. The promise of "better health care at a lower cost" failed to materialize. In short, the new system put into place failed to deliver, They know they must look for an alternative.
With polls showing a majority [70%?] of Americans favor a Single Payer Health Care System [such as exists in Canada?] the federal government could take control of health care delivery with the formation of a new bureaucracy or with the current system in place but financed and controlled by government regulation..
In the event that a National Health Service is their choice, State Governments could function in an essential but subsidiary role. Quality Control issues would then be returned to Physicians now that it is apparent that cost control can only be achieved by a reduction in the utilization of services, the quality of the Providers who deliver that service and of the materials made available to them. In other words through "Rationing of goods and services".
A national health service might choose to function by expanding the existing Medicare structure to cover all age groups while using the State Agencies in place or the facilities of the private health Insurance Industry as it currently exists. Delivery of care, at the community level, would be under the direction of regional and local committees composed of consumers and provider who would be guided by federal regulation and a limited budget.
Comments that suggest "the Government doesn’t want it" should be dismissed. Federal Bureau records expressing the belief that Government control is needed to solve the nation’s health care delivery problems have been heard since 1972. [ref: Forward Plan Of Health, FY 1978-82, US Department of HEW, page 1, publ. August 1976]<P>
Providers [Doctors, Hospital Workers and other health care professionals] who would have resisted a takeover, then, are more likely to welcome it, now, as they become increasingly concerned with their financial survival rather than the provision of quality patient care.
This new health care system would try to avoid the errors committed by existing national systems, but if history is to be our guide, it's not likely that we would fare any better. The reality is that blood is red no matter where it’s spilled and pain is the same no matter when you get it or how you say it. All sick people are the same and so too is the help they require.
After visiting several nations to study their health care delivery systems, those in existence are very much alike as are the problems they encounter/create. The outstanding similarity in all is promptly delivered, non-emergency care of good quality is available, only, outside of the system, in private offices or hospitals, for cash or supplemental private health insurance. Formerly,this service was readily avaiable in all but one nation I visited, Canada. However, in 2006. a Canadian Provincial Supreme Court Ruling mandates that Canadian Citizens be allowed to purchase private health insurance, in addition to taxes, if they wish.<>
Wherever private health insurance is available the result is the creation of the "two tier system of health care that was expected to become unnecessary. One for the poor who cannot afford anything else and another for those who will pay additional money [beyond taxes] for better care. Should we expect it to be any different here in America?
"Corporate Care", now dominating our health care scene is proving to be unacceptable because of its primary concern with profit on the provider side competing with the demand for prompt and total care on the consumer side. In America, delivering health care with profit in mind or withholding needed services for budgetary reasons is unpalatable when dealing with sickness and dying ---even more so today when so many American feel that immediate access to high quality health care is their right.
Health care costs would continue to increase during a transition to any new system as patient enrollment increases and more sophisticated methods of diagnosis and treatments are discovered. In addition, under a National Health Service more administrative levels become necessary, some nations have nine, and each requires a budget that can be expected to increase every year. As a result, less money becomes available for patient care, waiting lines begin to form. This, the most visible form of rationing, is accompanied by other less visible forms of rationing currently in use by the, only twenty years old, "Corporate Care" model. Examples are longer waiting periods for necessary care by requiring pre-authorization or possible denial of necessary medicines and surgery, shorter hospital stays and, in the not too distant future, the likely denial of services because of unhealthy life styles, obesity, smoking and substance abuse].
Points for discussion
Traditionally, a "fee for service" system flourishes in a democratic society that is economically sound. Today, as both individual and corporate economic security decline demand for less costly health care intensifies without any less intensity in the belief that access to total health care is a right that should be guaranteed to all regardless of ability to pay. It is precisely this concept, "equal care for all regardless of ability to pay" that is causing many hospitals to close their doors, for lack of funds. It's effecting physicians as well. Many have been forced to look for salaried positions rather than continue in, or open an office for, the private practice of medicine.
A return to the era of the private practice of medicine, as I knew it, is unlikely in the near future, if at all, in light of the massive changes in Hospital and Medical Clinic design; reimbursement schedules that discourage solo private practice and the greater understanding of the cause and treatments of many diseases. Today, diagnosric procedures are better, yet more expensive to provide and treatment of disease more promising, yet more expensive to obtain. With this knowledge in mind, no matter what health care delivery system we choose slogans that suggest "Something for nothing" or "It will be better and cheaper" should be ignored.
I believe that American citizens cannot swallow the idea of RATIONING or PROFIT when it comes to health care. To support my position I read in this morning’s paper that a major hospital chain has agreed to treat two children with a rare immune disease. The only known treatment is experimental, will cost 600,000 dollars and will not cure the disease. The treatment carries a 30+ % mortality rate. In the same issue, an editorial writer argues that Medicaid [welfare] patients should have access to name brand medicines despite the increased cost. News obtained on the Internet reported a 13 percent increase in premiums, for employer-provided health care insurance, which will force some employers to discontinue providing that insurance unless they can demand that their employees pay more, such as a higher co-pay, when they use the insurance .
Traditionally, extra money made by hospitals, was used to guarantee their ability to make available to all of their occupants, "regardless of ability to pay", the very best care, when needed. Doctors were allowed to charge a generous fee for their effort to deliver "up to date and high quality care" to all of their patients, regardless of race, creed or religion, at any time of day or night when it was needed. In recent years, however, the Doctors and the Hospitals are portrayed as outrageously profit oriented.
The public demanded that changes be made and they are taking place. Fortunately or unfortunately, depending on your point of view, changes in such significant social services, as a nation's health care delivery system, are slow in their development. Our traditional system had been functioning, as such, for near one century. It cannot be changed overnight. Researchers who study such social phenomena tell us that three decades of trial and error are needed to place a new system. They describe an 80+ year cycles to find, use and then discard a total system. Interestingly, the USA and Great Britain are at a similar place but on different sides of a cycle [circle]. They, from my observation, are moving away from a National Health Service as we appear to be moving toward one.]
My Conclusions:
1. As the years pass, the public's demand for quality health care for all, regardless of one's ability to pay, diminishes as the rising cost coupled with an oppressive tax structure weakens their concern for the needs of the poor.
2. National health care systems employ a large number of citizens, estimated to be more than 5 million people in Great Britain. Though this may appear attractive, at first glance, it can later become the obstacle that makes the system impossible to change or remove when proven unsatisfactory [where else would you employ all those people?].
3. As the tax burden enlarges should the efficiency of the system decline, the private fee for service, practice of medicine returns [that's paying twice for the same thing]. For example, despite a U.S. Postal Service, UPS, Federal Express and other delivery services have become profitable..
4. Great societies reinvent the wheel when enough time passes for us to forget what a wheel looked like. For example: new "Corporate" health Planners are hiring Doctors and Hospitals to cover subscribers despite the fact that Blue Cross/Blue Shield and others were performing that function. Why didn't we fix what was in place, then, by demanding a reduction in premiums with a guarantee of coverage for everyone.
5. We are/were not spending more for health care than other major nations. They spend it differently and some had fewer Seniors, for many years, as a result of lives lost during WWII. Germany and Japan and Great Britain report that health care costs are rising rapidly.
6. I see an irony in the fact that many Americans act as if the Medical Profession invented the concept of greater personal satisfaction and financial reward for hard work and intellectual achievement. These rules of achievement have always been, and will never cease to be amongst the basic foundation stones of a free society operating in a free enterprise system. If such a nation chooses to abandon such principles it will be only a short period of time before they reappear.
Finally, the American public have/did enjoy the benefits of the greatest health care system that man has ever devised. Too many, however, have lost sight of that fact and are demanding that changes be made, and quickly. This is occurring despite the realization, by many health care professionals, that inordinate demands will soon be placed upon any new system we choose. Many of our younger citizens seem bent on their own destruction through poor nutritional habits, cigarettes, abuse of drugs and alcohol, and failure to protect themselves from deadly sexually transmitted diseases. [Now in the older age group Obesity and Diabetes are taking their toll.]
Ignoring these developments, our nation continues to be more concerned with reducing the cost of health care and getting rid of incompetent, greedy and dishonest Doctors. Pity, if it doesn't turn out that way. For, if we don't do it right, we will pay more, get less, and bad Doctors like bad people, won't go away either.
I believe "He who fails to learn from history is doomed to repeat it".So I ask, "Why do so many of us who hear those words think they must be meant for someone else.?"
Chapter 10 of "Health Care Reform-Facts and Fiction;" Publ.1998 by Vincent W. Cangello, M.D.,FACS,FACOG,FRSM Director , Health Care Reform Educational Institute Lincoln, California [www.healthcarereform.com] Former Clinical Professor of Health and Medical Sciences, School of Public Health. University of California, Berkeley [In the Private Practice of Medicine for more than 40 years]
Baucus warns of 'huge train wreck' enacting ObamaCare provisions
By Sam Baker - 04/17/13 12:33 PM ET
Sen. Max Baucus (D-Mont.) said Wednesday he fears a "train wreck" as the Obama administration implements its signature healthcare law.
Baucus, the chairman of the powerful Finance Committee and a key architect of the healthcare law, said he fears people do not understand how the law will work.
"I just see a huge train wreck coming down," Baucus told Health and Human Services Secretary Kathleen Sebelius at a Wednesday hearing. "You and I have discussed this many times, and I don't see any results yet."
Baucus pressed Sebelius for details about how the health department will explain the law and raise awareness of its provisions, which are supposed to take effect in just a matter of months.
"I'm very concerned that not enough is being done so far — very concerned," Baucus said....He pressed Sebelius to explain how her department will overcome entrenched misunderstandings about what the healthcare law does".
"Small businesses have no idea what to do, what to expect," Baucus said.
Citing anecdotal evidence from small businesses in his home state, Baucus asked Sebelius for specifics about how it is measuring public understanding of the law.
"You need data. Do you have any data? You've never given me data. You only give me concepts, frankly," Baucus told Sebelius.
Sebelius said the administration is not independently monitoring public awareness of specific provisions but will be embarking on an education campaign beginning this summer.
Baucus is facing a competitive reelection fight next year, and Republicans are sure to attack him over his role as the primary author of the healthcare law.
A messy rollout of the law's major provisions, months before Baucus faces voters, could feed into the GOP's criticism.
Wednesday's hearing wasn't the first time Democrats, including Baucus, have raised concerns about the implementation. But while other lawmakers have toned down their public comments as they've gotten answers from Sebelius, Baucus said Sebelius has not addressed his fears.
"I'm going to keep on this until I feel a lot better about it," Baucus told Sebelius.
A recent Kaiser Family Foundation poll found deep and persistent misconceptions about the healthcare law. Public awareness was highest for the most politically unpopular provisions, and many people wrongly believed the law contains provisions like a "death panel" to make decisions about end-of-life care.
Enrollment in the healthcare law's insurance exchanges is slated to begin in October, for coverage that begins in January. Baucus, though, said he's worried exchanges won't be ready in time.
"For the marketplaces to work, people need to know about them," Baucus said. "People need to know their options and how to enroll."
By RICARDO ALONSO-ZALDIVAR | Associated Press– 16 hrs ago
Associated Press/Manuel Balce Ceneta - Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner, left, accompanied by Health and Human Services Secretary Kathleen Sebelius, speaks during …morea news conference at the Health and Humans Services (HHS) Department in Washington, Wednesday, April 10, 2013, to discuss the Health Department's fiscal 2014 budget. (AP Photo/Manuel Balce Ceneta) less
Related Content Health and Human Services (HHS) …
WASHINGTON (AP) — Retired as a city worker, Sheila Pugach lives in a modest home on a quiet street in Albuquerque, N.M., and drives an 18-year-old Subaru.
Pugach doesn't see herself as upper-income by any stretch, but President Barack Obama's budget would raise her Medicare premiums and those of other comfortably retired seniors, adding to a surcharge that already costs some 2 million beneficiaries hundreds of dollars a year each.
More importantly, due to the creeping effects of inflation, 20 million Medicare beneficiaries would end up paying higher "income related" premiums for their outpatient and prescription coverage over time.
Administration officials say Obama's proposal will help improve the financial stability of Medicare by reducing taxpayer subsidies for retirees who can afford to pay a bigger share of costs. Congressional Republicans agree with the president on this one, making it highly likely the idea will become law if there's a budget deal this year.
But the way Pugach sees it, she's being penalized for prudence, dinged for saving diligently.
It was the government, she says, that pushed her into a higher income bracket where she'd have to pay additional Medicare premiums.
IRS rules require people age 70-and-a-half and older to make regular minimum withdrawals from tax-deferred retirement nest eggs like 401(k)s. That was enough to nudge her over Medicare's line.
"We were good soldiers when we were young," said Pugach, who worked as a computer systems analyst. "I was afraid of not having money for retirement and I put in as much as I could. The consequence is now I have to pay about $500 a year more in Medicare premiums."
Currently only about 1 in 20 Medicare beneficiaries pays the higher income-based premiums, which start at incomes over $85,000 for individuals and $170,000 for couples. As a reference point, the median or midpoint U.S. household income is about $53,000.
Obama's budget would change Medicare's upper-income premiums in several ways. First, it would raise the monthly amounts for those currently paying.
If the proposal were already law, Pugach would be paying about $168 a month for outpatient coverage under Medicare's Part B, instead of $146.90.
Then, the plan would create five new income brackets to squeeze more revenue from the top tiers of retirees.
But its biggest impact would come through inflation.
The administration is proposing to extend a freeze on the income brackets at which seniors are liable for the higher premiums until 1 in 4 retirees has to pay. It wouldn't be the top 5 percent anymore, but the top 25 percent.
"Over time, the higher premiums will affect people who by today's standards are considered middle-income," explained Tricia Neuman, vice president for Medicare policy at the nonpartisan Kaiser Family Foundation. "At some point, it raises questions about whether (Medicare) premiums will continue to be affordable."
Required withdrawals from retirement accounts would be the trigger for some of these retirees. For others it could be taking a part-time job.
One consequence could be political problems for Medicare. A growing group of beneficiaries might come together around a shared a sense of grievance.
"That's part of the problem with the premiums — they simply act like a higher tax based on income," said David Certner, federal policy director for AARP, the seniors lobby.
"Means testing" of Medicare benefits was introduced in 2007 under President George W. Bush in the form of higher outpatient premiums for the top-earning retirees. Obama's health care law expanded the policy and also added a surcharge for prescription coverage.
The latest proposal ramps up the reach of means testing and sets up a political confrontation between AARP and liberal groups on one side and fiscal conservatives on the other. The liberals have long argued that support for Medicare will be undermined if the program starts charging more for the well-to-do. Not only are higher-income people more likely to be politically active, they also tend to be in better health.
Fiscal conservatives say it makes no sense for government to provide the same generous subsidies to people who can afford to pay at least some of the cost themselves. As a rule, taxpayers pay for 75 percent of Medicare's outpatient and prescription benefits. Even millionaires would still get a 10 percent subsidy on their premiums under Obama's plan. Technically, both programs are voluntary.
"The government has to understand the difference between universal opportunity and universal subsidy," said David Walker, the former head of the congressional Government Accountability Office. "This is a very modest step towards changing the government subsidy associated with Medicare's two voluntary programs."
It still doesn't sit well with Sheila Pugach. She says she's been postponing remodeling work on her 58-year-old house because she's concerned about the cost. Having a convenient utility room so she doesn't have to go out to the garage to do laundry would help with her back problems.
"They think all old people are living the life of Riley," she said.
MEDICAID'S ADMINISTRATIVE COSTS PUTTING STATES AT RISK
From AAPS News Letter Vol. 69, no. 4, April 2013
Correspondence
Medicaid Fraud. To help plug a §500 million hole in New York's budget resulting from loss of the proceeds from its over-billing of Medicaid some SI 5 billion over 20 years, Gov. Cuomo is looking for new sources of federal taxpayers' money. Having been caught taking money from Peter's left pocket, the state now has its hand deep in Peter's right pocket looking for more money.
New York's per-resident Medicaid spending is nearly twice as high as Pennsylvania's and more than double that of California and the rest of the country, and it pays its nonprofit executives accordingly. Twelve executives at NY nonprofits financed primarily with Medicaid money made more than $500,000 each in 2011, and another 100 earned "excessive" salaries of more than 5200,000, according to the U.S. House Oversight and Government Reform Committee.
Calling the investigation of the overbilling a politically motivated "witch hunt," the Albany Times Union argues that "it would be unfair to hold the state liable for mistakes the federal government was entirely complicit in." No one went to prison, and the overbilling came to light only because a small-town newspaper, the Pougbkeepsie Journal, exposed it.
New York State did recoup $535 million in Medicaid funds, including 5146 million from GlaxoSmithKline for drug marketing and pricing. While government has many sharp tools to recoup money from physicians and private entities, it claims to lack the tools to get the money back, or that it might be prohibitively expensive, if the fraud involves $120 million illegally paid to care, for prison inmates or illegal immigrants . Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY -------------------------------------------------
Pouring Gasoline on a Crisis. Steven Brill's lengthy article "Bitter Pill: Why Medical Costs are Killing Us" in the Mar 4 issue of Time (
http://tinyurl.com/afcvpxa) is a data gold mine that outs "not-for-profit" hospitals for what they are—medical mercenaries. It does not, however, mention the uncompensated care scam, PPO cartels, and repricing schemes—or the role of the federal government and crony capitalism in creating the whole disaster. It even touts Medicare as a model of efficiency! None of the facts are new, and I am convinced that the reason the piece appeared now is to fuel the movement toward single payer. Even Karl Denninger (http://networkedblogs.com/IQUub), who does a masterful job of demolishing the Wall Street Journal's reaction to Brill, leaves out the Hill-Burton Act and its devastating effects. We need a free market, not the final solution that would massively benefit big hospitals (http://tinyurl.com/d98wa3s). G.Keith Smith M.D., Oaklahoma City, OK.
For more information ; American Assoc.of Physicians and Surgeons, Tuscon AZ. www.aapsonline.com
As many doctors struggle to keep their practices financially sound, some are buckling under money woes and being pushed into bankruptcy.
It's a trend that's accelerated in recent years, industry experts say, with potentially serious consequences for doctors and patients. Some physicians are still able to keep practicing after bankruptcy, but for others, it's a career-ending event. And when a practice shuts its doors, patients can find it harder to get the health care they need nearby.
Chapter 11 bankruptcy filings by physician practices have spiked recently, noted Bobby Guy, co-chair of the American Bankruptcy Institute's health care committee, who tracks bankruptcy trends tied to distressed businesses. Guy said there were at least eight filings in recent weeks, which he said was "very unusual."
Five years ago, Plantation, Fla.-based bankruptcy attorney David Langley didn't have a single doctor as a client. Since then he's handled at least six bankruptcy cases involving doctors. Two current clients -- an orthopedic surgeon and an OB/GYN -- also are in bankruptcy.
None of his physician clients had malpractice lawsuits that landed them in dire financial straits. All are "top-notch doctors," he said.
The weak economy has taken a toll on doctors' revenue, as consumers cut back on office visits and lucrative elective procedures, said Guy, a bankruptcy attorney in Nashville with Frost Brown Todd LLC.
Doctors also blame shrinking insurance reimbursements, changing regulations, and the rising costs of malpractice insurance, drugs and other business necessities for making it harder to keep their practices afloat.
Oncologist Dr. Dennis Morgan had a profitable solo practice in Enfield, Conn., for years. Revenues began to fall, he said, when reimbursements for treatment and drugs to oncologists started shrinking. He made cutbacks, but he began having trouble meeting expenses, and his business debt grew. Critical chemotherapy drug and medical supplies providers "eventually cut me off," Morgan said.
In June 2011, his practice, in a medically underserved area, filed for bankruptcy. It had hundreds of chemotherapy patients at the time.
For the next two years, his role became "that of a captain of a sinking ship managing the allocation of life boats until rescue arrived," he said. He redirected patients to other doctors and area hospitals. Early last year, he stopped practicing medicine.
Having a cancer practice close can be "debilitating" to a community, said Morgan. "If you have to travel one or two hours to get treatment and you have no one to go with you, it becomes a matter of getting care or not getting care," he said.
Primary care doctors face similar challenges. Langley recounts one client, a solo practitioner in an underserved area of Broward County, Fla., whose patients were mostly on Medicare or lacked insurance.
As the economy worsened in the wake of the recession, fewer patients could afford to come in. Cash payments and reimbursements dropped. To come up with money to keep the practice going, she took a second job at a hospital. Still, her debt ballooned. She fell behind on state tax payments.
The Obama administration now says a special system of exchanges designed to make it easier for small businesses to provide insurance will be delayed an entire year -- to 2015.
"Lots of small businesses struggle with providing insurance for their workers so this was supposed to facilitate it and make it easier for small business to do this," said Jim Capretta of the Ethics and Public Policy Center. "It was a huge portion of the sale job. When they passed the law in 2010 there were many senators and members of Congress who were saying 'I am doing this because it's going to help small businesses.'"
The exchanges were designed to give workers a range of choices supported by dollars from their employers. But now they will have only one choice until 2015, which could mean they can't shop for insurance that includes their current providers. Capretta said the administration is "way" behind schedule.
Since insurance is more expensive for small businesses, many of which have no obligation under the law to provide coverage, analysts now fear many might just stop trying and let workers go on the soon-to-be-launched state exchanges.
Sara Teppema of the Society of Actuaries -- which did an exhaustive study of ObamaCare -- said that "even if it's just a small change of people who are leaving the employment-based insurance and coming into the individual insurance market, their costs and their numbers will overwhelm those who are currently uninsured."
That means costs would increase.
Meanwhile, 79 senators including several liberal lawmakers recently voted to repeal a new tax on medical devices contained in the health care law following a similar vote in the House.
"The House and the Senate agreeing? This is a harmonic convergence, it doesn't happen," said former Democratic Sen. Evan Bayh. "But on this it's happened because the adverse consequences to our economy and the quality of health care are so apparent."
The two separate votes have not become law but show widespread opposition to the 2.3 percent sales tax on medical devices. Critics say the law is unfair to the industry since it's a tax on gross sales -- meaning it adds up to a much bigger percentage of a company's profits.
But supporters such as Paul Van de Water of the Center for American Progress oppose any repeal.
"I think that repealing the device tax would be irresponsible. We need the revenue and it's not going to be a job killer," he said.
The theory was that ObamaCare would insure 30 million more people and that device makers, like pharmaceutical companies, would get lots of new customers and a steady stream of new revenue to make up for the tax. Van de Water predicted that would still happen.
"These device manufacturers are for the most part going to be getting a large increase in business thanks to health reform, thanks to ObamaCare," he said.
But the CEO of one company said that's not true for the 7,000 small companies with 400,000 employees who make a wide range of devices.
Christine Jacobs of Theragenics said: "We make widgets -- hips, knees, stents, pacemakers, and implants, even, for prostate cancer. Those widgets tend to be used by people that are elderly. As the body parts wear out, we're needed."
But Jacobs notes that most people whose body parts wear out are already on Medicare, so ObamaCare does not provide a new revenue stream for her company -- only financial pain.
"In the case of a small company, that medical device tax is equal to our R-and-D budget for this year," Jacobs said.
Bayh said in his own state of Indiana, one company planned to open up to five facilities over the next five years but had to scrap those plans because of the "uncertainty created by this tax."
Jacobs said the huge multinational device makers might be able to handle the burden but not the small companies.
"It's just such a disproportionate burden for little guys," she said. "Because we're all being told that it's the little companies that create the jobs. And that's not message that we're getting."
The tax will even be applied to sutures used on pets that Theragenics developed for the veterinary market.
She sought FDA approval to demonstrate the quality of her products. But now she said "it's hard for me not to get frosted on this one" -- she explained that whoever wrote the regulations said "if you have FDA approval, you will be taxed."
President Obama has vowed to veto any repeal of the tax, but Bayh notes that 79 votes in the Senate would be more than enough to override any veto.
“Obamacare” looks increasingly inevitable, but one lawsuit making its way through the court system could pull the plug on the sweeping federal health care law.
A challenge filed by the Pacific Legal Foundation contends that the Affordable Care Act is unconstitutional because the bill originated in the Senate, not the House. Under the Origination Clause of the Constitution, all bills raising revenue must begin in the House.
The Supreme Court upheld most provisions of the act in June, but Chief Justice John G. Roberts Jr. took pains in the majority opinion to define Obamacare as a federal tax, not a mandate. That was when the Sacramento, Calif.-based foundation’s attorneys had their “aha” moment.
“The court there quite explicitly says, ‘This is not a law passed under the Commerce Clause; this is just a tax,’” foundation attorney Timothy Sandefur said at a Cato Instituteforum on legal challenges to the health care act. “Well, then the Origination Clause ought to apply. The courts should not be out there carving in new exceptions to the Origination Clause.”
The Justice Department filed a motion to dismiss the challenge in November, arguing that the high court has considered only eight Origination Clause cases in its history and “has never invalidated an act of Congress on that basis.”
The challenge citing the Origination Clause isn’t the only lawsuit against Obamacare, but it is the only one that has the potential to wipe out the entire act in one fell swoop. Other claims, notably the freedom-of-religion cases dealing with the birth control requirement, nibble at the fringes but would leave the law largely intact.
In their brief, attorneys for the Justice Department argue that the bill originated as House Resolution 3590, which was then called the Service Members Home Ownership Act. After passing the House, the bill was stripped in a process known as “gut and amend” and replaced entirely with the contents of what became the Patient Protection and Affordable Care Act.
Using H.R. 3590 as a “shell bill” may be inelegant, but it’s not unconstitutional, according to the government motion.
“This commonplace procedure satisfied the Origination Clause,” said the brief. “It makes no difference that the Senate amendments to H.R. 3590 were expansive. The Senate may amend a House bill in any way it deems advisable, even by amending it with a total substitute, without running afoul of the Origination Clause.”
The brief cites a number of cases in which courts upheld shell bills, but foundation attorneys counter that those rulings involved the Senate substitution of one revenue-raising bill for another.
“Here, by contrast, it is undisputed that H.R. 3590 was not originally a bill for raising revenue,” said the Pacific Legal Foundation lawsuit. “Unlike in the prior cases, the Senate’s gut-and-amend procedure made H.R. 3590 for the first time into a bill for raising revenue. The precedents the government cites are therefore inapplicable.”
The Justice Department also points out that the court has allowed revenue bills to originate in the Senate if the money raised was incidental to the bill’s mission.
The Affordable Care Act’s central purpose is to “improve the nation’s health care system,” and it fulfills that goal “through a series of interrelated provisions, many, if not most, of which have nothing to do with raising revenue,” said the government brief.
BUT OFFICIALS SAY REPORT IGNORES TAX CREDITS, SPECIAL PAYMENTS
HIGHER
CLAIMS PROJECTED
The Affordable Care Act is expected to cover more than 32 million uninsured Americans. But financial risk analysts project that medical claim costs in the individual market, which drive premiums, will increase in most states.
Associated Press
Medical claim costs filed by individual policyholders could rise as much as 62 percent over the next four years in California under the Affordable Care Act, according to a study released Tuesday by the nation's leading group of financial risk analysts.
The costs are the biggest driver of health insurance premiums and could mean higher prices for residents who will buy individual policies through California's health benefit exchange.
The study by the Society of Actuaries stated that the increase will be in large part because sicker people will join the individual insurance pool. The report does not project medical claim costs for employer-sponsored plans, which cover the majority of workers.
In California, the study estimated that medical claim costs will rise 62 percent by 2017. If the state had not accepted an expansion of Medic-aid, the cost increase would be smaller, about 55 percent
U.S. Health and Human Services Secretary Kathleen Sebelius and the Obama administration questioned the design of the study, saying it ignores tax credits to help people pay premiums and special payments to insurers who attract more of the sick
Sebelius said that it's difficult to compare catastrophic plans being sold today to the comprehensive coverage that individuals will get under the law starting next year.
Officials at Covered California, the state's health exchange, echoed that sentiment Tuesday. "The study is misleading because it does not consider the impact of the federal subsidies, which we believe will reduce overall costs by as much as 60 to 90 percent for millions of California residents," said Oscar Hidalgo, spokesman for Covered California.
"In addition, having a health plan marketplace with considerable purchasing power, such as Covered California, has a positive impact on rates that is not factored into this report."
About 5.6 million Califorians under age 65 are uninsured, according to a model of insurance markets known as the California Simulation of Insurance Markets. The state estimates that more than 4 million people will purchase private coverage through Covered California by 2019.
The remaining 1 million are ineligible due to their immigration status
OPEN"..."new polling suggests that his namesake is "...now even less popular than it was at the time of its passage "Demoocrats rammed Obamacare through Congress "...in open defiance of public opinion, and an incensed citizenry responded by giving Republicans their biggest gains in the House of Representatives since before World War II. Now, coinciding with tomorrow’s 3-year anniversary of President Obama’s signing Obamacare into law, new polling suggests that his namesake is now even less popular than it was at the time of its passage.
According to the Kaiser Health Tracking Poll for March, only 18 percent of Republicans, 31 percent of independents, and 58 percent of members of Obama’s own party, have a favorable opinion of Obamacare. Overall, Kaiser’s polling indicates that only 37 percent of Americans like Obamacare — down 9 points from Kaiser’s tally in the month immediately following Obamacare’s passage.
By about 2-to-1 margins, Kaiser’s respondents now say that, under Obamacare, they expect the cost of American health care to rise (55 percent), rather than fall (21 percent), and the quality of American health care to fall (45 percent) rather than rise (24 percent). By more than 3-to-1 margins (57 to 16 percent on costs, 55 to 18 percent on quality), independents share these same low expectations for life under Obamacare.
Moreover, Kaiser adds, “The intensity of opinion on the law still lies with the GOP.” It writes, “About half of Republicans (53 percent) say they have a very unfavorable view, compared to three in ten Democrats (31 percent) who say they have a very favorable view” (italics in original)...".
"...If even Kaiser is showing these results, one can say with confidence that Obama’s centerpiece legislation is, indeed, unpopular. Kaiser has always been an outlier poll, finding support for Obamacare when it was almost impossible to glean elsewhere. In April 2010, in its first post-passage poll, Kaiser showed more support for Obamacare than opposition to it (by a 6-point margin — 46 to 40 percent). That same month, RealClearPolitics showed 11 polls on Obamacare. All 11 showed it to be unpopular, with the average margin of opposition being 13 points — a 19-point swing from Kaiser’s polling. Yet, three years later, even Kaiser’s polling now shows Obamacare to be held in low esteem. .."
Report: 336 Million Abortions Under China’s One-Child Policy
by Steven Ertelt | Beijing, China | LifeNews.com | 3/15/13 4:58 PM
The health ministry in China released figures yesterday showing 336 million abortions have been carried out in the Asian nation since it first implemented the one-child population control policy.
Started in 1980, the policy, which prohibits most Chinese couples form having more than one baby and limits rural residents to two, has resulted in severe human rights abuses. Family planning officials frequently jail couples who refuse to comply, sentence them to house arrest or labor camps, revoke jobs or governmental support, use physical harassment or violence and often target other family members.
Official statistics showed that in addition to the terminations, Chinese doctors have sterilised 196 million men and women since 1971.
Perhaps unexpectedly, most people in China support the one-child policy, believing that the country would have suffered an impossible drain on food and resources without it, according to a 2008 survey by the Pew Research Centre, which found more than three in four Chinese were in favour.
There are more than 13 million abortions a year, or 1,500 an hour, in China, according to government researchers, who blame the high figure on a lack of sex education.
Fewer than ten per cent of sexually active couples regularly use condoms, according to the state-run Science and Technology Research Institute. By comparison, there are roughly 11 million abortions each year in India.
China’s demographics have been dramatically skewed by strict family planning. Last year, the working age population shrank for the first time in 50 years, a serious threat in an economy built on a huge pool of cheap labour
LARGE INCREASE IN COST OF HEALTH CARE INSURANCE EXPECTED
From The Sacramento Bee 3/14/2013
Health care overhaul could wallop some folks' wallets
MILLIONS MAY SEE RATES RISE 20% TO 100%, INSURERS SAY
by tom murphy Associated Press
Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people.
The nation's big health insurers say they expect premiums - or the cost for insurance coverage - to rise 20 percent to 100 percent for millions of people because of changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.
Mark Bertolini, CEO of Aetna Inc., one of the nation's largest insurers, calls the price hikes "premium rate shock."
"Weve done all the math, we've shared it with all the regulators, weve shared it with all the people in Washington that need to see it, and I think it's a big concern," Bertolini said during the company's annual meeting with investors in December.
To be sure, there will be no across-the-board rate hikes for everyone, and there's no reliable national data on how many people could see increases. But the biggest price hikes are expected to hit a group that represents a relatively small slice of the insured population. That includes some of theroughly 14 million people who buy their own insurance as opposed to being covered under employer-sponsored plans, and to a lesser extent, some employees of smaller firms.
The price increases are a downside of President Barack Obama's health care law, which is expected to expand coverage to nearly 30 million uninsured people. The massive law calls for a number of changes that could cause premiums for people who don't have coverage through a big employer to rise next year - at a time when health care costs already are expected to grow by 5 percent or more:
• Changes to how insurers set premiums according to age and gender could cause some premiums to rise as much as 50 percent, according to America's Health Insurance Plans, or
A new tax on premiums could raise prices as much as 2.3 percent in 2014 and more in subsequent years, according to a study commissioned by AHIP. Policyholders with plans that end in 20l'4 probably have already seen an impact from this.
Requirements that insurance plans in many cases cover more health care or pay a greater share of a pa- tienf s bill than they do now also could add to premiums, depending on the extent of a person's current coverage, according AHIP.
The Obama administration says the law balances added costs in several ways, including tax credits that will reduce what many consumers will pay..."
ATLANTA (CBSMiami) – An antibiotic-resistant family of bacteria continues to spread throughout the U.S. health care system and is now prompting warnings from the Centers for Disease Control and Prevention.
The bacteria, Carbapenem-Resistant Enterobacteriaceae (CRE), kill up to half of the patients who get the bloodstream infections from the disease. The disease has evolved a resistance to carbapenems, also called last-resort antibiotics.
In addition, the CRE bacteria can reportedly transfer its resistance to other bacteria within its family. The transfer of resistance can create additional life-threatening infections for patients in hospitals, longer-term health care facilities, and possibly otherwise healthy people, according to the CDC.
The CDC said almost all CRE infections occur in people receiving “significant medical care in hospitals, long-term acute care facilities, or nursing homes.”
“CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections,” said CDC Director Tom Frieden, M.D., M.P.H. “Doctors, hospital leaders, and public health, must work together now to implement CDC’s “detect and protect” strategy and stop these infections from spreading.”
According to numbers from the CDC, almost 200 hospitals and long-term care facilities across the nation treated at least one person infected with the CRE bacteria. The CDC’s Vital Signs report said that the percentage of CRE increased by fourfold over the last decade and that one particular form of CRE, a resistant form of Klebsiella pneumonia, has increased sevenfold.
Still, according to the CDC said the disease is preventable by: enforcing use of infection control precautions, grouping patients with CRE together, having facilities alert each other when patients with CRE are transferred, and using antibiotics wisely among other recommendations.
The CDC said the disease can be controlled through coordinated efforts. It cited a long-term care facility in Florida that worked with the CDC and dropped the percentage of patients getting CRE from 44 percent to zero.
OVERHAUL OF MEDICAL CARE DELIVERY NOW IN DISCUSSION
From Sacramento Bee 2/25/2013
BERKELEY FORUM
Execs call for health industry overhaul
COALITION REPORT SEEKS CHANGES TO REIN IN EXPENSES
by cynthia H. craft
ccrqft@sacbee.com
California's health industry heavyweights, warning that insurance premiums will soon consume a third of people's incomes, today threw their weight behind a plan to revamp the health care delivery system.
Many in the state will still rely on tax-supported clinics despite a health care overhaul.
A dozen CEOs from health care providers and insurers spent the past year participating in an unprecedented, collaborative effort with public policymakers and health care researchers, dubbed the Berkeley Forum and based at UC Berkeley School of Public Health.
The result: a report that contains a variety of proposals for changing health care delivery and also stresses the need for Califor-nians to take more responsibility for staying healthy.
"For the first time, the key actors who deliver and pay for our health care have come together to support a road map for fundamental change in how we buy and provide health care services," Stephen Shortell, the forum's chair and dean of the UC Berkeley School of Public Health, said in a prepared statement.
In the report, the forum participants committed to working together and with others to establish new regulations to revamp the HEALTH CARE WHO WAS AT THE MEETING?
The industry participants in the Berkeley Forum included:Pam Kehaly, president of Anthem Blue Cross--Bruce Bodaken, chairman and president of Blue Shield of California--Paul Markovich, CEO of Blue Shield of California--Thomas Priselac, president of Cedars-Sinai Medical Center--Lloyd Dean, CEO of Dignity Health--Jay Gellert, president of Health Net--Robert Margolis, CEO of HealthCare Partners--George Halvorson, CEO of Kaiser Permanente--Barry Arbuckle, CEO of MemorialCare Health System--Bart Asner, CEO of Monarch HealthCare--Michael Murphy, president of Sharp HealthCare--Patrick Fry, president of Sutter Health
Without major change, the forum members warned, people who receive coverage through their employers could end up spending a third of their income on premiums within 10 years. Already, atypical Califor-nian spends an average of $23 a day, every day, on health care, factoring in premiums and taxes and unreimbursed expenses, the report said.
One major change the group proposes: a shift from a traditional "fee-for-service" model, under which health providers bill for each test or procedure, to a model in which companies budget a certain amount of money to spend for each patient.
The idea is to eliminate the incentive to treat patients with more tests and procedures than they need, the report said.
"If the insurers spend more than their target, they are at risk for covering that added expense," Shortell said. "That's why we were surprised to the extent that these folks said: 'Bring it on.'"
The report also emphasized the need for more integrated care, a seamless approach to health coverage in which access to primary care doctors and specialists is well coordinated. In California, such an approach is most fully used by Kaiser Permanente.
Together, those two major shifts could save California $110 billion - or $800 per household annually - over the coming 10 years, the report said.ix added initiatives target populations and conditions that account for a disproportionate share of health care spending. A primary ioal: Get Californians to be more active.
Cost-cutting is particularly important given that the Affordable Care Act in 2014 will cover about 2 million more uninsured Californians, adding an estimated 5 percent to the overall cost of providing health care. "The Affordable Care Act is a tipping point toward this call to action," said Richard Scheffler, vice chair of the Berkeley Forum and a professor at UC Berkeley. "When you add 2 million people, it puts a lot of pressure in the health care system."
Overall, Californians use fewer health care resources than do people in the rest of the country. One reason for this may be the higher cost for an overnight stay in a California hospital - 30 percent more than the national average - as well as the higher general cost of living, which the report said is 34 percent more than the national average.
That higher cost of living, plus low supply of health care workers, accounts for increased costs such as higher wages for nurses, for example, which run about 36 percent more than those elsewhere in the country, the report said.
But if the majority of Californians took steps to take better care of themselves, the need for high-priced care could become less urgent. Taking personal responsibility for one's own health is not far behind cost-cutting in the priorities of health care changes.
The top spenders in the health care system amount to only 5 percent of the population. But that 5 percent accounts for 53 percent of the state's health care expenditures, the report found.
These patients are more likely to be older, to be obese, and to have chronic conditions such as high blood pressure, heart disease, high cholesterol, diabetes, joint pain and arthritis, the report said.
Simply put, participants said Californians should "collectively" create a health culture. A critical part of this involves creating environments where people are eating healthier foods in smaller portions and getting exercise, especially walking.
"We need to reduce the burden of illness on the health care system," said Shortell. "It's important that we design communities and schools to increase and encourage physical activity."
The participants stressed that the report does not favor any particular model of business, such as HMOs or PPOs. But it does note that California can be a leader for the rest of the nation, in part because the state has seen high enrollment in HMOs, which use budgets and emphasize prevention and wellness.
"If the insurers spend more than their target, they are at risk for covering that added expense. That's why we were surprised to the extent that these folks said: 'Bring it on." Call The. Bee's Cynthia H. Craft, '(316)321-1270.
--------------------------------------------------- From the Director; I believe,the pledge (stated above) will result in the use of "waiting lines" for the care one needs. It's the simple and most effective form of health care cost control, in use around the world .
It's a grim estimate often cited by public health officials: About a fourth of all people will experience a mental illness or disorder at some time in their lives.
Apply that formula to the 2.15 million people in the four-county Sacramento region and you get 537,500 residents who, theoretically, may need mental health care at some juncture.
Is our health care system prepared to handle behavioral health needs of this magnitude?
Hardly, according to a blue-ribbon panel of experts assembled for a round-table discussion last week at the Sierra Health Foundation.
Convened by U.S. Rep. Doris Matsui and state Senate President Pro Tern Dar-rell Steinberg, the meeting was the first in a series of discussions aimed at improving public access to mental health services.
The group included representatives from major health plans, mental health program executives, physicians, a child psychiatrist and top officers from nonprofit advocacy groups.
Participants 'took a step back to ask fundamental questions: How can people access the mental health care that's already available in the community? How can hospitals be encouraged to hand off behavioral health patients- SERVICES I Page B5
From the Director; During my stay in a major nation, working with a primary care physician, I learned that 6 Psychotherapist were responsible for the mental care of one million residents. The annual budget could provide no more.
NEW HEALTH CARE LAW FAILING SOME PATIENTS WITH PRE-EXISTING DISEASES
WASHINGTON POST TO Drudge Report 2/16/2013
Funds run low for health insurance in state ‘high-risk pools’
By N.C. Aizenman, Published: February 15 | Updated: Saturday, February 16, 9:50 AM
Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from a program designed to help them because funding is running low.
Obama administration officials said Friday that the state-based "high-risk pools" set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state.
But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected.
"We’re being very careful stewards of the money that has been appropriated to us and we wanted to balance our desire to maximize the number of people who can gain from this program while making sure people who are in the program have coverage," said Gary Cohen, director of the Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight. "This was the most prudent step for us to take at this point in time."
The program, which was launched in summer 2010, was always intended as a temporary bridge for the uninsured. But it was supposed to last until 2014. At that point, the health-care law will bar insurers from rejecting or otherwise discriminating against people who are already sick, enabling such people to buy plans through the private market.
From the start, analysts questioned whether the $5 billion that Congress appropriated for the Pre-Existing Condition Insurance Plan — as the program is called — was sufficient.
Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive.
But it was also because the pools are open only to people who have gone without insurance for at least six months. The result is that, while only about 135,000 people have gotten coverage at some point, they are proving far more costly to insure than predicted.
Many people who are uninsured go untreated, exacerbating their medical problems. When they finally do get coverage through a high-risk pool, they are in immediate need of expensive care.
"What we’ve learned through the course of this program is that this is really not a sensible way for the health-care system to be run," Cohen said.
Of the original $5 billion, about $2.36 billion remains available for the last three quarters of 2013 — enough only to continue coverage for those already in the pools, according to administration estimates.
The law gave states the option of either administering their pools directly or allowing federal authorities to operate them. In 27 states that have chosen direct management, applications for new enrollment can be accepted only through March 2. In 23 states and the District, where the pools are operated by the federal government, only applications received through Friday will be considered.
Obama administration officials said they did not have estimates for how many more people would have sought coverage through the pools beyond then. But Cohen said that new enrollment has averaged about 4,000 people per month in the past several months, suggesting that the figure could number in the tens of thousands.
Asked why the administration has not requested additional money from Congress to keep the program open — admittedly a tough sell in the current political and budgetary environment — Cohen said, "My responsibility is to work with the appropriation we have."
About 129 millionpeople nationwide have a medical condition or prior illness that would make it hard for them to buy their own insurance plan.
Large numbers of them can and still do obtain full coverage through employer-sponsored plans, which generally do not treat sick people differently.
An additional 215,000 people are insured through separate high-risk pools that 35 states fund through their own budgets — although the policies often do not pay for treatment of the person’s preexisting illness, only covering new illnesses the person may develop.
Between 9 million and 25 million people with preexisting conditions are uninsured, depending on the estimate.
Among those stunned by Friday’s news was a 61-year-old Virginia woman who is battling stage-four breast cancer. The woman, who asked to be identified by her middle name, Joyce, because she wants to keep her illness private, is self-employed and had bought her own insurance for years.
Late in 2010, however, the insurer that Joyce was using pulled out of Virginia. She was healthy at the time. But when she applied to other companies, she was told that because she had been diagnosed with— and successfully treated for — an earlier breast cancer, she was ineligible for coverage.
Joyce said she was unaware of the high-risk pools at the time and remained ignorant of the option even as she was diagnosed with her current cancer. As the disease has progressed, the cost of her treatment has skyrocketed. The latest expense, a 10-week course of chemotherapy that she expects to total about $30,000, as well as additional tests that could top $8,000, has forced her to dip into her retirement savings.
It is only in the past several weeks that Joyce learned of the high-risk pool, and she was on track to finalize her application Sunday.
On Friday, she scrambled to get it in by the unexpected new deadline. She said the computer system appeared to accept her entries, but she will be on tenterhooks until she finds out for sure.
"I feel like the rug has been pulled out from under me," Joyce said. "On every level, this is just beyond discouraging."
Study: Lower-salt diets would Save at least 500,000 in decade
BY melissa healy Los Angeles Times
WASHINGTON - Steadily reducing SODIUM in in food sould save a half-million Americans from dying premature deaths over a decade, Says a new study.
I And a more abrupt reduction to 2,200 milligrams per ay - a 40 percent drop from current levels - could boost fie tally of lives saved over 10 years to 850,000, researchers have projected.
The new estimates, published Tuesday in the American Heart Association's journal Hypertension, are the results of three separate teams crunching the numbers at the request of the Centers for Disease Control and Prevention. Researchers from the University of California, San Fransisco; Harvard University's School of Public Health; and Simon Fraser University in Canada came at their estimates independently, but Iheir results converged.
If the average daily sodium intake of Americans were to drop instantaneously to 1,500 imlligrams per day - a steep drop to a level considered "ideal" - as many as 1.2 million premature deaths could be averted over the course of a decade, the teams agreed.
Americans consume about 3,600 milligrams of sodium daily - roughly 40 percent above the "slightly less ambitious" interim goal posted by the researchers - and much of that is hidden in processed foods such as soups, cereals, bread and soups. While the link between sodium intake and high blood pressure is much debated, research strongly suggests that high-sodium diets can push blood pressure above safe limits and exacerbate high blood pressure, and that lowering sodium consumption tends to lower blood pressure. That is important, because about 45 percent of cardiovascular disease in the United States is attributed to high blood pressure.
The researchers called efforts to reduce average American sodium intake by 40 percent "a daunting task that will likely require multiple layers of interventions." Food industry experts and public health officials have been meeting in recent years to secure steady, small reductions in the sodium content of processed foods - reductions they believe that consumers might not even notice.
But even a small, steady reduction in average daily sodium consumption - the equivalent of one-twentieth of a teaspoon of salt less each year - could avert 280,000 to 500,000 deaths per year, the researchers concluded.
How big of an effect would that be? If lower-salt diets could avert 500,000 deaths in the span of a decade, that would be like curing colorectal cancer, which claims just over 50,000 lives per year. It would be just a little less life-saving than preventing all annuals deaths in the United States attributed to influenza and pneumonia (about 53,000 in 2007). And it would be far more effective at reducing premature death'than if the yearly number of automobile fatalities (almost 34,000) went to zero.
"No matter how we look at it, the story is the same - there will be huge benefits to reducing sodium," said Pam Coxson, a UC San Francisco mathematician who is the study's lead author.
Patients of the TB center in Khayelitsha, South Africa, wait to see doctors, March 23, 2009. Tuberculosis is a contagious lung disease that spreads through the air, including through coughing and sneezing.
In a patient's fight against tuberculosis—the bacterial lung disease that kills more people annually than any infectious disease besides HIV— doctors have more than 10 drugs from which to choose. Most of those didn't work for Uvistra Naidoo, a South African doctor who contracted the disease in his clinic. For those who contract the disease now, maybe none of them will.
A new paper published earlier this week in the Centers for Disease Control and Prevention's Emerging Infectious Diseases journal warns that the first cases of "totally drug-resistant" tuberculosis have been found in South Africa and that the disease is "virtually untreatable."
Like many bacterial diseases, tuberculosis has been evolving to fend off many effective antibiotics, making it more difficult to treat. But even treatable forms of the disease are particularly tricky to cure; drug sensitive strains must be treated with a six-month course of antibiotics. Tougher cases require long-term hospitalization and a regimen of harsh drugs that can last years
PREPARE FOR A DOCTOR SHORTAGE IN CALIFORNIA AND IN?
From the Sacramento Bee 10/22/2012 New CMA leader sees rapid health care changes By Cynthia H. Craft ccraft@sacbee.com
Dr. Paul Phinney, President of the California Medical Association, says. "In health care, it's a really, really tumultuous period." A health care overhaul is like the rumble that occurs nanoseconds before a powerful earthquake hits. It foretells of seismic shifts to come in the expansive health care delivery landscape.
Expect consumers to be more proactive and hospitals to work to improve their outcomes. Insurers will adjust to consumer protections and doctors will face new economic realities.
It will be up to the California Medical Association to guide its member physicians through the jumble of changes. Dr. Paul Phinney, the new president of the CMA, is a pediatrician at Kaiser Permanente in Sacramento. He will help plot the course through coming challenges that confront the state's physicians.
How would you characterize the professional road ahead for doctors?
We live in turbulent and uncertain times that very likely will produce the most rapid change in the delivery of health care that we've * seen in decades. In health care, it's a really, really tumultuous period. The Affordable Care Act, in some way, is responsive to these times.
How we deliver health care is shifting quickly. Physicians will enter into new sorts of arrangements - away from the traditional solo practice, which may or may not still thrive.
What will those arrangements look like?
Because the medical economic consequences are different, we will see doctors joining large health care delivery groups that have some clout. A major trend is integration. Examples of it are already out there, like the system at Kaiser Permanente, which is very integrated and coordinated.
There's a lot of consolidation, with doctors looking to link up with others in order to survive. That's happening very swiftly. Doctors are looking for ways they can do what they want, which is to take high-quality care of patients and also bring home a paycheck after paying their staff.
Is the bottom line really that problematic?
As the cost of providing health care continues to rise, the pressure on reimbursement rates for solo physicians is downward and significant. A study in 2008 showed California ranking last in the nation in the amount that doctors are reimbursed (by the state through Medi-caidThe state spends about $3,300 per Medi-Cal beneficiary, whereas the national average is $5,300. We're not only way low when compared to the rest of the nation, but when you add in the high cost of doing practice in California, we're exceedingly low.
Why are Medi-Cal reimbursement rates so low?
The state just doesn't have the money and has not taken full advantage of federal funds. Medi-Cal care ends up being something that most doctors do as charity care.
What about the concierge doctor trend? Is that going to grow bigger?
It meets the needs of a very select group of patients, those who can afford to pay on top of what they spend for catastrophic coverage for hospitalization. These are patients who pay a $1,500 to $2,000 annual fee to have access to a specific doctor 24/7 throughout the year.
But it doesn't solve the problems of health care delivery. I don't see it becoming dominant. One of the prominent concepts in health care reform is for providers to establish a "medical home" model for patients.
What does that mean?
It's a place or practice where you can go to meet your medical needs in the larger sense - and that of course is different for everybody. It depends on your age, on what conditions you're either bom with or born to develop. So the medical home is a primary care setting thaf s your first stop in coordinated care.
Unfortunately, many people use the emergency room as their primary medical home - a very, very expensive proposition. I would argue that thaf s really an example of not having a medical home.
Can you address the doctor shortage, if there is one?
There is a doctor-shortage problem. A study looked at the issue and concluded that, going forward, the aging physician population combined with millions of newly insured people creates a perfect storm.
If s a perfect storm of conditions all pointing in a direction that no doubt will aggravate the physician shortage - particularly in primary care.
How do you grow the physician workforce?
No. 1, you can increase the number of slots in medical schools. No. 2, you can start new schools, but they're having an incredibly tough time getting the funding to get off the ground.
These steps might produce another 100 to 150 doctors a year.
You can also create mentorship programs. In San Joaquin County, there's a program where they bring in high school students for a week. It's almost like a pre-intemship. Being a mentor is a very important role for physicians because you work with the people coming up, guiding them and teaching them. In medicine you have the added layer that these are the kids who will be our physicians of the future.
What's your main message to your colleagues as the new head of the CMA?
If s really important that physicians are involved in providing input and guidance as health care reform moves along. Because we want to have a system thaf is patient-centric, not profit-centric in which quality is really high and constantly increasing.
And we want the system to be evidence-based-driven and universally accessible to everyone, not just those who can afford it. Those are the things we strive for.
Dr. Benjamin Carson Addresses National Prayer Breakfast, Criticizes Obamacare
Famed Baltimore neurosurgeon Dr. Benjamin Carson addressed the National Prayer Breakfast on Thursday morning on healthcare. Dr. Carson often criticized Obamacare and government intrusion in healthcare while President Obama sat in the audience. Dr. Carson encouraged a program where newborn babies are given health savings account as an alternative to Obamacare.
DR. CARSON: What we need to do is come up with something simple. And when I pick up my Bible, you know what I see? I see the fairest individual in the universe, God, and he's given us a system. It's called a tithe.
We don't necessarily have to do 10% but it's the principle. He didn't say if your crops fail, don't give me any tithe or if you have a bumper crop, give me triple tithe. So there must be something inherently fair about proportionality. You make $10 billion, you put in a billion. You make $10 you put in one. Of course you've got to get rid of the loopholes. Some people say, 'Well that's not fair because it doesn't hurt the guy who made $10 billion as much as the guy who made 10.' Where does it say you've got to hurt the guy? He just put a billion dollars in the pot. We don't need to hurt him. It's that kind of thinking that has resulted in 602 banks in the Cayman Islands. That money needs to be back here building our infrastructure and creating jobs.
DR. CARSON: Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account to which money can be contributed -- pretax -- from the time you're born 'til the time you die. When you die, you can pass it on to your family members, so that when you're 85 years old and you got six diseases, you're not trying to spend up everything. You're happy to pass it on and there's nobody talking about death panels.
Number one. And also, for the people who were indigent who don't have any money we can make contributions to their HSA each month because we already have this huge pot of money. Instead of sending it to some bureaucracy, let's put it in their HSAs. Now they have some control over their own health care.
NEW STUDY; HEALTH CARE COSTS DURING REFORM WILL RISE
From Health Affairs Bethesda Maryland 6/11/2012
US Health Spending Projected to Grow an Average of 5.7 Percent Annually through 2021
CMS Predicts Modest Growth For 2012-2013, With Spike In 2014 From Expanded Health Coverage
Bethesda, MD -- New estimates released today from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project that aggregate health care spending in the United States will grow at an average annual rate of 5.7 percent for 2011 through 2021, or 0.9 percentage point faster than the expected growth in the gross domestic product (GDP). The health care share of GDP by 2021 is projected to rise to 19.6 percent, from its 2010 level of 17.9 percent.
By 2021, government spending at all levels for health care is projected to reach nearly 50 percent of total national health expenditures, with the federal government accounting for approximately two-thirds of that share.
and will also be published in the July issue. The full article provides an analysis of how Americans are likely to spend their health care dollars in the coming decade, with projections for spending by different sectors, payers, and sponsors.
The projections reflect various factors that can affect health care spending, including an aging population. Relatively slower economic growth is also expected to affect spending on health care, with modest growth in disposable personal incomes, insurance coverage, and employment rates all limiting expenditures through next year. "The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," says Sean Keehan, the lead author of the study. "However, other factors such as Medicare payment cuts under current law and the patent expirations of several top-selling brand-name drugs have led to projected health spending growth staying at about 4 percent during this period."
The major effects of the Affordable Care Act on overall spending levels are expected to be felt most acutely in 2014. The coverage expansions associated with the Affordable Care Act for Medicaid and private health insurance are expected to increase the growth rate for health spending to 7.4 percent in 2014, with notable increases in spending on physician services and prescription drugs by the newly insured. Throughout the latter half of the projection period, incomes are expected to be higher, and a large number of baby boomers are anticipated to be receiving coverage under Medicare. Among others, these factors are expected to drive health spending up around 2 percentage points faster than overall economic growth by 2020, consistent with trends in the United States for about the past thirty years.
Key national health expenditure projections for specific timeframes include the following:
2011 (final data to be available in January 2013)
Preliminary assessments indicate a continued near-historic low of a 3.9 percent growth rate in spending, with total expenditures of $2.7 trillion and a stable share of GDP at 17.9 percent.
Health spending financed or sponsored by federal, state, and local governments is estimated to have grown 6.4 percent, and to have reached $1.2 trillion. Health spending by businesses, households, and other private sources is estimated to have risen just 1.9 percent in 2011, and to have reached $1.5 trillion.
2012-2013
National spending on health care is projected to grow 4.2 percent in 2012, and then slow to 3.8 percent growth in 2013 (due in part to the 30.9 percent reduction in Medicare physician payment rates called for under current law).
Growth in prescription drug expenditures is expected to slow from 3.9 percent in 2011 to 2.9 percent in 2012, and then to 2.4 percent in 2013, as several top-selling blockbuster drugs lose patent protection.
2014
As the major provisions of the Affordable Care Act go into effect in 2014, including health care coverage expansions, projected growth in spending is 7.4 percent, compared to 5.3 percent growth without these reforms.
Many of the 22 million newly insured are anticipated to be generally younger and healthier, and are expected to devote a larger share of their health care spending to prescription drugs and physician and clinical services, and a smaller share to hospital spending.
The Affordable Care Act is also expected to influence growth rates for the major payers, with a rise in private health insurance spending to 7.9 percent and a decrease in individual out-of-pocket spending by 1.5 percent.
Medicaid enrollment is expected to increase by 19.6 million people in 2014, with total Medicaid spending projected to grow 18 percent.
2015-2021
National health spending is projected to grow at an average rate of 6.2 percent per year for this period. Medicare expenditures are projected to grow an average of 6.8 percent per year for 2015 through 2021.
Medicaid expenditures are projected to grow at an average rate of 7.4 percent per year, as total enrollment in the program is expected to reach 85 million. Medicaid is projected to account for about 20 percent of all health expenditures, an increase of about 5 percentage points over the 2010 share.
The Affordable Care Act's tax on high-cost employer-based insurance plans will take effect in 2018, and is expected to place further downward pressure on private health insurance premium growth.
In addition to examining the effects of national health reform legislation, the report discusses the impact of higher cost sharing on private health insurance and out-of-pocket health spending. It also examines the effect on Medicare and physician health spending growth if the significant reduction in Medicare physician payment rates in 2013 under current law is overridden.
About Health Affairs : Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at www.healthaffairs.org.
From the Director: In Canada, England and Cuba citizens are now encouraged to seek care from private practitioners.
During a recent trip to Russia I learned that people were delighted with the re-growth of private practice.
To my knowledge, despite the existance of governmment provided health care, the use of private practitioners has never been discouraged in Japan, Germany or Sweden.
President Obama's Food and Drug Administration has caused "a public health crisis" -- a prescription drug shortage over the past two years -- by increasing the number of threats issued to raid and close drug manufacturing plants, according to House investigators.
"This shortage appears to be a direct result of over-aggressive and excessive regulatory action," House Oversight and Government Reform Committee Chairman Darrell Issa, R-Calif., said in a statement. "These drugs can save lives and keep people who need them living healthy lives. The FDA is failing to ensure the availability of quality products."
President Obama signed an executive order last year to help the FDA anticipate drug shortages while knocking Congress for failing to pass his preferred legislation on the issue. "Congress has been trying since February to do something about this," Obama said in November. "It has not yet been able to get it done . . . we can't wait."
The committee report concluded that a significant portion of the drug shortage is a problem of the Obama administration's making. "Among shuttered manufacturing lines that occurred over the previous two years, the committee’s review did not find any instances where the shutdown was associated with reports of drugs harming customers," the report says, noting a 30 percent drop in the manufacture of certain prescription drugs at the largest manufacturers in the country.
Instead, the drug shortage crisis began in 2010 after the FDA began sending letters to companies found to be in violation of a given rule, in which the company was warned that "failure to promptly correct these violations may result in legal action without further notice including, without limitation, seizure and injunction."
The FDA sent just 474 such letters in 2009, but that number spiked to 1720 in 2011. "A common sense approach to regulations must be restored at the FDA," the committee report advised, calling for more targeted measures to induce company compliance with regulations. "Agency protocols shouldbe revised so that the agency is required to consider the implications of its actions on the nation’s supply of critical drugs."
CALIFORNIA PROCEDING WITH LEGISLATION FOR OBAMA CARE
Health exchanges moving forward
LATEST GRANT TO HELP STATE SELL INSURANCE PLANS IN 2014
by cynthia H. craft
ccrqft@sacbee.com
Bolstered by a federal grant of $674 million on Thursday, Covered California outlined an agenda to keep the state health exchange on pace for a full-scale launch on Jan. 1,2014.
California's nascent health-insurance shopping site faces a complex and expensive ramp-up process as it seeks to sign up customers from throughout the state's diverse communities.
Officials Thursday laid out an action plan for outreach that includes signing up translators fluent in the 13 Ian-
guages common in the Golden State.
Because California's land mass is so huge, Covered California expects to develop seven geographical exchanges reflecting different markets in Sacramento, Northern California, the Greater Bay Area, the San Joaquin Valley, the Central Coast, Los Angeles and the rest of Southern California.
Covered California executive director Peter Lee noted at the organization's monthly meeting Thursday that development of the exchange may not always go smoothly.
"We will get things wrong as we go," Lee said. "But we will make them right as quickly as we can.
"Fifty years ago, Medicare was launched," Lee said. 'We have to think of the long view and believe we will be around for a long time to come."
In the months leading up to next New Year's Day, Covered California will use some of the new federal funds to develop a fully operational Web portal where consumers can shop for insurance policies.
Before that, though, the organization will have scoured health plans to find those meeting its standards for quality.
The goal is to eventually offer consumers apples-to-ap-ples comparisons of health plans for purchase on the exchange's website.
With Thursday's infusion of federal funds, Covered California will have received nearly $1 billion in federal grants - starting from the first $1 million startup grant in 2010 when California became the first state in the nation to jump aboard the federal Affordable Care Act
By the year 2015, the excchange must be self-sufficient and able to sustain itself financially.
To that end, Covered California is looking for donations from community volunteers, houses of worship, foundations and philanthropists to help its bottom line.
When it comes to signing up an expanded population for Medi-Cal, outside funding will have to be found since the state budget is off-limits for such uses.
As for the structure of the overall product, a recent report to the governor and Legislature reveals that Covered California is moving forward with a decidedly simple concept in its plan to hook consumers.
Call it, prosaically, the "metal level" plan.
The report explains: "Every insurance policy offered inside and outside the Covered
California marketplace will be given a 'metal rating' - platinum, gold, silver or bronze -based on 'actuarial value' calculations."
In other words, if you want to buy insurance through the state's health exchange, you'll be able to choose among a platinum rating for 90 percent coverage; gold for 80 percent coverage, silver for 70 percent coverage, or get frugal and go for the bronze plan for 60 percent coverage.
If you settle on the bronze, mind you, you'll have to pay 40 percent of the costs out of pocket if you get sick Conversely, a platinum plan leaves you picking up the tab for just 10 percent of your bill - but you'll likely pay quite a bit more overall for the policy.
CDC: New version of stomach bug causing US illness
Posted: Jan 24, 2013 9:13 AM PST Updated: Jan 24, 2013 9:13 AM PST
By MIKE STOBBE AP Medical Writer
NEW YORK (AP) - Health officials say a new strain of stomach bug that's sweeping the globe is taking over in the U.S.
In the last four months, more than 140 outbreaks in the U.S. have been caused by the new Sydney strain of norovirus. These kinds of contagious bugs cause bouts of diarrhea and vomiting.
The new strain may not be unusually dangerous; some scientists don't think it is. But it is different, and many people might not be able to fight off its gut-wrenching effects.
It often spreads in places like schools, cruise ships and nursing homes. The new strain was blamed for a recent outbreak on the Queen Mary 2.
The Centers for Disease Control and Prevention reported on the new strain Thursday.
Vladimir Putin hires Boyz II Men to boost the Russian birth rate. Authoritarians know how to have fun
By Tim StanleyWorld Last updated: January 31st, 2013 London Daily Telegraph
Putin has decreed that each Russian family should include at least 3 children
"...One thing you can’t take away from authoritarian regimes is their sense of pizzazz. Every policy problem is approached with a mix of seriousness and show business, elevating even the most mundane issue in to high art. Therefore it’s no great surprise to read that Vladimir Putin’s solution to Russia’s demographic challenge is to hire 1990s vocal group Boyz II Men to promote increased fertility. Why Boyz II Men? I can only guess that East 17 are busy promoting fallout shelters in North Korea.
The story comes from the Moscow Times, which writes: “The stylish trio of Boyz II Men, the most successful R&B group of all time, is coming to Moscow on Feb 6. The group will perform a selection of their classic and new romantic ballads, hopefully giving Russian men some inspiration ahead of St. Valentine's Day.” The Times insists that the band will be lending their “powerful voices” to Putin’s fertility campaign. Whether or not the Russian kingpin personally got on the phone, tracked down their agent and demanded that they “do the show right here” is pure speculation on the newspaper’s part. It’s a little hard to believe … but it’s also not impossible to imagine.
For Putin has declared war on empty cots with classic Putin bravado. He’s often insisted that having lots of babies is key to Russia’s internal security, to Russia becoming more “influential” on the world state. Why have a great democracy or a flourishing economy when you can simply outnumber everyone else? Putin puts the desirable figure at three babies per household and, in 2007, one province helped things along by declaring a Day of Conception. The idea was that if Russians got the day off work then they might stay at home, put on some Boyz II Men, close the curtains and help bring back the good old days of Soviet hegemony. Women who gave birth 9 months later could win a refrigerator. And they say that romance is dead? C
Hospital superbugs such as MRSA are some of the best know antibiotic-resistant diseases, but MPs were warned about infections such as gonorrhea and TB that affect the general population. Photograph: Getty Images
Britain's most senior medical adviser has warned MPs that the rise in drug-resistant diseases could trigger a national emergency comparable to a catastrophic terrorist attack, pandemic flu or major coastal flooding.
She described what she called an "apocalyptic scenario" where people going for simple operations in 20 years' time die of routine infections "because we have run out of antibiotics".
The register was established in 2008 to advise the public and businesses on national emergencies that Britain could face in the next five years. The highest priority risks on the latest register include a deadly flu outbreak, catastrophic terrorist attacks, and major flooding on the scale of 1953, the last occasion on which a national emergency was declared in the UK.
Speaking to MPs on the Commons science and technology committee, Davies said she would ask the Cabinet Office to add antibiotic resistance to the national risk register in the light of an annual report on infectious disease she will publish in March.
Davies declined to elaborate on the report, but said its publication would coincide with a government strategy to promote more responsible use of antibiotics among doctors and the clinical professions. "We need to get our act together in this country," she told the committee.
She told the Guardian: ""There are few public health issues of potentially greater importance for society than antibiotic resistance. It means we are at increasing risk of developing infections that cannot be treated – but resistance can be managed.
"That is why we will be publishing a new cross-government strategy and action plan to tackle this issue in early spring."
The issue of drug resistance is as old as antibiotics themselves, and arises when drugs knock out susceptible infections, leaving hardier, resilient strains behind. The survivors then multiply, and over time can become unstoppable with frontline medicines. Some of the best known are so-called hospital superbugs such as MRSA that are at the root of outbreaks among patients.
"In the past, most people haven't worried because we've always had new antibiotics to turn to," said Alan Johnson, consultant clinical scientist at the Health Protection Agency. "What has changed is that the development pipeline is running dry. We don't have new antibiotics that we can rely on in the immediate future or in the longer term."
Changes in modern medicine have exacerbated the problem by making patients more susceptible to infections. For example, cancer treatments weaken the immune system, and the use of catheters increases the chances of bugs entering the bloodstream.
"We are becoming increasingly reliant on antibiotics in a whole range of areas of medicine. If we don't have new antibiotics to deal with the problems of resistance we see, we are going to be in serious trouble," Johnson added.
The supply of new antibiotics has dried up for several reasons, but a major one is that drugs companies see greater profits in medicines that treat chronic conditions, such as heart disease, which patients must take for years or even decades. "There is a broken market model for making new antibiotics," Davies told the MPs.
Davies has met senior officials at the World Health Organisation and her counterparts in other countries to develop a strategy to tackle antibiotic resistance globally.
Drug resistance is emerging in diseases across the board. Davies said 80% of gonorrhea was now resistant to the frontline antibiotic tetracycline, and infections were rising in young and middle-aged people. Multi-drug resistant TB was also a major threat, she said.
Another worrying trend is the rise in infections that are resistant to powerful antibiotics called carbapenems, which doctors rely on to tackle the most serious infections. Resistant bugs carry a gene variant that allows them to destroy the drug. What concerns some scientists is that the gene variant can spread freely between different kinds of bacteria, said Johnson.
Bacteria resistant to carbapenems were first detected in the UK in 2003, when three cases were reported. The numbers remained low until 2007, but have since leapt to 333 in 2010, with 217 cases in the first six months of 2011, according to the latest figures from the HPA.
Two years after Obama signed the Affordable Care Act (ACA or ObamaCare), and just prior to the Supreme Court oral arguments on its constitutionality, the Administration is planning a media blitz about its "free" "preventive" care for seniors and women, and restrictions on insurance. Meanwhile, opposition grows as people begin to learn more about "what's in it."
The Congressional Budget Office doubled its 10-year cost estimate to $1.76 trillion (NCPA 3/15/12).
The cost of guaranteed-issue and community-rating mandates is estimated to reach $280 billion over the next decade; elimination of out-of-pocket coverage limits, $51 billion; keeping 26-year-old "children" on parents' policies, $77 billion (Sally Pipes 2/6/12).
Federal and state Medicaid spending would soar from $400 billion to $800 billion by 2022 (ibid.).
As "grandfathered" plans are dropped, 42% of California employees have lost their pre-ACA coverage. California premiums increased a mean of $1,310 per family last year alone (Chris Jacobs, RPC 1/5/12).
Waivers were granted to more than 1,200 companies by January (Daily Mailer 2/13/12).
In contrast to two pages of new agencies under FDR's New Deal, which transformed America, just one bill, the ACA, has more than 100 new boards and commissions (
Business owners will pay $4 billion more in taxes under President Obama’s Affordable Care Act (ACA) than the Congressional Budget Office had previously expected.
"According to the updated estimates, the amount of deficit reduction from penalty payments and other effects on tax revenues under the ACA will be $5 billion more than previously estimated," the CBO reported today. "That change primarily effects a $4 billion increase in collections from such payments by employers, a $1 billion increase in such payments by individuals, and an increase of less than $500 million in tax revenues stemming from a small reduction in employment-based coverage, which will lead to a larger share of total compensation taking the form of taxable wages and salaries and a smaller share taking the form of nontaxable health benefits."
In short, CBO revised the Obamacare tax burden upward by $4 billion for businesses and $1 billion to $1.5 billion for individual workers.
CBO couldn’t help but bump into Chief Justice John Roberts controversial decision uphold the individual mandate as a constitutional exercise of Congress’s taxing power. The report dubs the individual mandate a "penalty tax" — that is, "a penalty paid to the Treasury by taxpayers when they file their tax returns and enforced by the Internal Revenue Service."
PEDIATRICIANS HESITATE TO QUESTION FAMILIES WITH GUNS?
From the Sacramento Bee 12/31/2012
Health care law restricts gun data
CRITICS DECRY NRA'S HISTORY OF PUSHING FOR RESEARCH LIMITS
by peter wallsten and tom hamburger Washington Post
WASHINGTON The words were tucked deep into the sprawling text of President Barack Obama's signature health care overhaul. Under the headline "Protection of Second Amendment Gun
Rights" was a brief provision restricting doctors' ability to gather data about their patients' gun use - a largely overlooked but significant challenge to a movement in American medicine to treat firearms as a matter of public health.
The language, pushed by the National Rifle Association in the final weeks of the 2010 debate over health care and discovered only in recent days by some lawmakers and medical groups, is drawing criticism in the wake of this NBA month's massacre of 20 children and six educators in New-town, Conn. Some public health advocates, worried that the measure will hinder research and medical care, are calling on the White House to amend the language as it prepares to launch a gun-control initiative in January.
NRA officials say they requested the provision out of concern that insurance companies could use such data to raise premiums on gun owners. Its Senate supporters say they did not intend to interfere with the work of doctors or researchers.
But physician groups and researchers see the provision as part of a decades-long strategy by the gun lobby to choke off federal support for studies into firearms injuries, which may soon overtake motorvehi-cle accidents as a leading cause of U.S. violent deaths.
The research restrictions began in the 1990s, when the NRA urged Congress to cut funding for the Centers for Disease Control and Prevention's division that studied firearms violence. In 1996, Congress sharply limited the agency's ability to fund that type of research.
More limits came last year in a spending bill setting restrictions on the National Institutes of Health after complaints from gun rights advocates about an NIH-backed study drawing links between alcoholism and gun violence. The provision, added by Rep. Denny Rehberg, R-Mont, prohibits the NIH from spending money to "advocate or pro-, mote gun control" - language that researchers say does not explicitly forbid studies but sends a signal to federal research agencies to steer clear of the topic.
The NRA push has extended into state capitals, as well, with Florida lawmakers last year crafting a plan to impose jail time on doctors for inquiring about their patients' gun ownership.
Gov. Rick Scott, a Republican, signed a scaled-back version of the proposal, requiring health care workers to "refrain" from asking patients about their ownership or possession of firearms unless the providers believe "in good faith" that such information would be relevant A federal judge this year declared the law unconstitutional and blocked its enforcement, but the ruling was appealed by the state and is under review.
Physician groups and public health advocates say the cumulative effect of these restrictions undercuts the ability of the White House and lawmakers to make the case for new laws, such as an assault weapons ban, in the face of foes who claim there's no evidence that such measures are effective. Advocates for regulating guns lament that reliable data are limited in part because physicians and researchers who could track these patterns are being inhibited.
"This illustrates the fact that the NRA has insinuated themselves into the small crevasses of anything they can to do anything in their power to prohibit sensible gun-safety measures," said Denise Dowd, an emergency care physician at a Kansas City, Mo., children's hospital and an adviser on firearms issues to the American Academy of Pediatrics. Dowd called the provision in the health care bill "pretty outrageous," saying it risked creating a sense among doctors that "this is dangerous information to collect."
The pediatricians group last week submitted a strongly worded letter to the Obama administration saying that pediatric advocates 'Vehemently reject" the health care law's gun provision.
The group notes that the provision runs counter to guidelines included in other sections of the bill that ask family doctors and pediatricians to inquire about the presence of guns in patients' homes, along with other potential dangers, such as mold, lead, cigarette smoke and a lack of smoke detectors.
In a separate letter sent last week to Vice President Joe Biden, who is heading Obama's post-Newtown gun-control efforts, a coalition of child advocacy groups urged the administration to "renew efforts to apply science to gun safety," demanding that Congress "immediately reverse all existing statutory bansonfire-arm-related research and to embark on a wide-ranging effort to fund effective gun-related research, including the collection and publication'of data on gun violence."
The provision says that the health care law "may not require the disclosure or collection of any information" relating to the "presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property." Further, the measure says the law cannot be used to "maintain records of individual ownership or possession of a firearm or ammunition." It adds that the price of health coverage may not be affected by the ownership or use of guns.
An NRA spokesman, Andrew Arulanandam, defended the research restrictions dating to the 1990s, saying the "so-called studies were a bid to push a political agenda" with taxpayer dollars.
As for the Obama health care overhaul provision, Arulanandam said the group requested the language in response to concerns that insurance carriers might use data collected as part of the law to "discriminate"
"...A BID to save nearly £3billion by slashing appointments with a doctor and treating patients via computer will put lives at risk, ministers were warned..."
UK NEWS
END OF THE DOCTOR'S SURGERY
Sunday November 25,2012
By Ted Jeory
A BID to save nearly £3billion by slashing appointments with a doctor and treating patients via computer will put lives at risk, ministers were warned.
Health Secretary Jeremy Hunt is planning a technological revolution that could spell the end of the traditional doctor’s surgery.
A new system of “virtual clinics” is being planned in which GPs connect with patients via iPads and Skype, an idea that NHS bosses are importing from India.
The reforms would save £2.9billion “almost immediately” and improve the lives of most patients, for example by avoiding the need to find child care during appointments, Health Minister Dr Dan Poulter said last week.
However, critics are concerned the initiative would create a two-tier NHS in which the less technologically able, particularly the elderly, would be left behind.
Shadow Health Secretary Andy Burnham called the plan “dangerous”, while Age UK said cutting the number of personal appointments would erode the vital trust between doctor and patient.
The ideas, contained in a Health Department report called Digital First, include arming community nurses with iPads in rural areas and making more use of Skype video calling between GPs and patients. There will be more online assessments “augmented” with video calls.
Mobile phone “apps” will be used to access lab reports and health records and negative test results will be sent by text messages rather than delivered in person. Mr Hunt, who made a fortune by creating an internet company, believes that while mobile broadband technology is revolutionising most walks of life, there is a problem once people encounter the relatively antiquated systems of the NHS.
The Government is trying to fill a £20billion NHS funding gap and health chiefs want to reduce “needless” appointments that clog up staff time. ________________________________________________________
In a Westminster debate last week, Dr Poulter said 15 million people with long-term conditions accounted for 70 per cent of all in-patient beds. “Many such hospital stays could be avoided through better better use of mobile technologies, to prevent people from becoming so unwell in the first place that they need to be admitted to hospital.
“We need to harness and better utilise more types of technology such as telehealth and mobile technology to support people better in their own homes and to drive down the cost of care.
“About one-third of patients do not necessarily need a face-to-face GP appointment.” In a statement to the Sunday Express, he stated: “It is important to stress that patients who are unwell and need to see their GP will still always have quality face-to-face time with them.
“The Government also recognises that not everyone, particularly frail older people, will have easy access to the internet.”
However, Age UK’s boss Michelle Mitchell warned: “Many people of all ages still prefer human contact.
“It also gives the medical professional the chance to recognise health issues that may not be obvious from a distance.”
Katherine Murphy, chief executive of the Patients Association, said: “The telehealth agenda must be driven by a desire to improve clinical outcomes and patient care, not the Government’s plans to save £20billion.”
Mr Burnham warned: “Older people who don’t have access to the internet will lose out.”
"...To replicate the HIE today would cost $1 billion, estimates Robert H. Brook, M.D., Sc.D. of RAND. This is the amount allocated to the Patient-Centered Outcomes Research Institute (PCORI), which is not permitted to collect cost data, but only effectiveness data on already existing tests or therapies, or means of communication, such as telephone v. email (JAMA 11/9/11).
As Dean Clancy of Freedom Works points out, all healthcare reform boils down to two options: HMOs or HSAs (cost sharing) (http://tinyurl.com/9gdqqhq). Greg Scandlen discusses sav- ings potential (http://tinyurl.com/942tx6j), and John Good- man outlines advantages and disadvantages of existing options
while noting that newly announced ACA regulations threaten their very existence (http://tinyurl.com/9eqeknr). HSA enrollment has reached nearly 14 million, increasing 18% in the past year (http://tinyurl.com/9vkoyqm).
There is plenty of evidence about the adverse effects of HMOs and the central planning ideas of Emanuel et al. (op. cit), writes Scandlen (http://tinyurl.com/bm9g7s8). One of the new "Gang of 23," Stuart Altman, reminisced in 2001 that he was chief healthcare regulator in the U.S. at age 32, when healthcare spending consumed 7.5% of GDP. Dramatic remedies started with Nixon's wage and price controls in 1971.
Waste at the Top
The 30% is somehow connected with the provision of medical items or services, but a huge proportion of revenue in the "healthcare" industry is used for purposes that provide no care whatsoever. Care is paid for from what trickles down. Stanley Feld, M.D., estimates that the health "insurance" industry takes 65% of the healthcare dollar. While it is claimed that Medicare administrative cost is only 2.5%, that is the amount paid to CMS to administer the outsourcing of administrative services to private carriers—which absorb 65%. The process is complicated on purpose, writes Dr. Feld (http://tinyurl.com/9ywqt3y).
Comparing prices posted at www.surgerycenterok.com with other hospitals' prices suggests that waste may be far more than 30%—in some cases as much as 90%. ACA protects the third parties' cut, and redistributes 30% of care.
Bolstered by a federal grant of $674 million on Thursday, Covered California outlined an agenda to keep the state health exchange on pace for a full-scale launch on Jan. 1,2014.
California's nascent health-insurance shopping site faces a complex and expensive ramp-up process as it seeks to sign up customers from throughout the state's diverse communities.
Officials Thursday laid out an action plan for outreach that includes signing up translators fluent in the 13 lan
guages common in the Golden State.
Because California's land mass is so huge, Covered California expects to develop seven geographical exchanges reflecting different markets in Sacramento, Northern California, the Greater Bay Area, the San Joaquin Valley, the Central Coast, Los Angeles and the rest of Southern California.
Covered California executive director Peter Lee noted at the organization's monthly meeting Thursday that development of the exchange may not always go smoothly.
"We will get things wrong as we go," Lee said. "But we will make them right as quickly as we can.
"Fifty years ago, Medicare was launched," Lee said. 'We have to think of the long view and believe we will be around for a long time to come."
In the months leading up to next New Year's Day, Covered California will use some of the newfederal funds to develop a fully operational Web portal where consumers can shop for insurance policies.
Before that, though, the organization will have scoured health plans to find those meeting its standards for quality.
The goal is to eventually offer consumers apples-to-apples comparisons of health plans for purchase on the exchange's website.
With Thursday's infusion of federal funds, Covered California will have received nearly $1 billion in federal grants - starting from the first $1 million startup grant in 2010 when California became the first state in the nation to jump aboard the federal Affordable Care Act.
By the year 2015, the exchange must be self-sufficient and able to sustain itself financially.
To that end, Covered California is looking for donations from community volunteers, houses of worship, foundations and philanthropists to help its bottom line.
When it comes to signing up an expanded population for Medi-Cal, outside funding will have to be found since the state budget is off-limits for such uses.
As for the structure of the overall product, a recent report to the governor and Legislature reveals that Covered California is moving forward with a decidedly simple concept in its plan to hook consumers.
Call it, prosaically, the "metal level" plan.
The report explains: "Every insurance policy offered inside and outside the Covered
California marketplace will be given a 'metal rating1 - platinum, gold, silver or bronze based on 'actuarial value' calculations."
In other words, if you want to buy insurance through the state's health exchange, you'll be able to choose among a platinum rating for 90 percent coverage; gold for 80 percent coverage, silver for 70 percent coverage, or get frugal and go for the bronze plan for 60 percent coverage.
If you settle on the bronze, mind you, you'll have to pay 40 percent of the costs out of pocket if you get sick Conversely, a platinum plan leaves you picking up the tab for just 10 percent of your bill - but you'll likely pay quite a bit more overall for the policy.
The Supreme Court has opened the door to a new challenge to President Barack Obama's sweeping health care reform law, just five months after upholding the law's individual mandate in a dramatic 5-4 decision.
The 4th U.S. Circuit Court of Appeals threw out the case last year, saying the university couldn't challenge the employer mandate before it went into effect. The university argues that employers cannot be compelled to provide health insurance under the Commerce Clause, and that religiously affiliated institutions in particular should not be made to. (The university argues that some of its funds could end up indirectly financing abortions under the employer mandate, which would violate its religious principles.) The Supreme Court decided last June that individuals could be required to buy insurance under the law or pay a penalty, but did not specifically address the employer question.
The suit is not the first to challenge the health care law on the grounds that it violates employers' religious freedom. More than 40 lawsuits have been filed opposing the birth control mandate of the law, arguing that employers who object should not have to provide plans that cover contraception because it violates their First Amendment rights. Many of the suits are from religiously affiliated universities, but a few private businesses, including the crafts chain store Hobby Lobby, have also joined in. (Liberty has filed a separate suit addressing the contraception mandate.)
Adults who do not have health insurance and large employers who do not provide it will gradually begin paying fines starting in 2014.
Correction: An earlier version of this article incorrectly stated that the Liberty University suit directly challenged the birth control mandate in addition to the employer mandate.
OBAMA HEALTH CARE REFORM LAW--MORE HURDLES TO CLIMB
From AAPS News Letter Vol. 68, no.8, August 2012
Medicaid Expansion Limited
In a 7-to-2 vote, the U.S. Supreme Court limited ObamaCare's expansion of Medicaid, in the case brought by 26 states and the National Federation of Independent Business (NFIB v. Sebelius).If states do not comply with new requirements, the federal government can only withhold new funding; it cannot withdraw all federal funding to the program.
"This is an important victory'," states AAPS General Counsel Andrew Schlafly. It was also unexpected. Academic commentators, also in the NEJM, wrote that constitutional challenges to the ACA were baseless. Some predicted that federal courts would impose Rule 11 sanctions for bringing a frivolous challenge.
Gov. Rick Scott of Florida immediately announced that his state would not expand Medicaid eligibility to 133% of FPL, and he was joined by six other Republican governors. They would ultimately save their states' taxpayers billions of dollars. While the costs of the expansion would initially be borne by federal taxpayers, these funds would start to phase out in 2017 (Michael Tanner, NRO 7/4/12 (http://tinyurl.com/76afqcz).
Justice Roberts opined that the expansion meant that Medicaid was "no longer a program to meet the health care needs of the neediest among us but an element of a national plan to provide universal health insurance coverage." He concluded that states could not have agreed to this drastic change.Questions on State Exchanges
Some persons who would be eligible for inclusion in an expanded Medicaid program would qualify for federal subsidies in the state insurance exchange—if the state establishes one. At least five governors have explicitly refused to set one up (Scott of FL, Perry of TX, Jindal of LA, Lynch of NH, and Walker of WI). As many as 35 states have not yet taken steps necessary to establish an exchange.If the state does not set up its own exchange, the federal government has the authority, but so far no funding, to create one. However, a little-noticed provision in the law allows subsidies to flow only through state exchanges. It is those subsidies that trigger the penalty on employers who do not provide acceptable coverage. Thus, states could block the employer mandate by refusing to set up an exchange (Tanner, op. cit).
Despite the law, the IRS has drafted a rule extending the tax credit to federal exchanges. Employers would have standing to challenge this. Rep. Phil Roe (R-TN) and Rep. Scott Desjarlais (R-TN) have introduced a law to void the IRS rules.
ObamaCare's claim to extend insurance to the uninsured relies heavily on the Medicaid expansion and the exchanges. Thus, states have the power to make the law unworkable. By so doing, they could not only protect their own budget but potentially save federal taxpayers $1.5 trillion over the next decade, Tanner writes.Constitutional Limits to Coercion
The decision in NFIB v. Sebelius is the first time the U.S. Supreme Court has voided a provision of a law on the grounds that a federal "incentive" has breached an invisible boundary and become unacceptably coercive. While applied only to the Medicaid expansion in this decision, this boundary might be better defined in future litigation.
Justice Roberts acknowledged that "to permit Congress to impose a tax for not doing something" could be troubling. He cites a precedent that "there comes a time in the extension of the penalizing features of the so-called tax when it loses its character as such and becomes a mere penalty with the characteristics of regulation and punishment."He opines that with the "shared responsibility payment" it is not necessary at this point to define the precise point at which "an exaction becomes so punitive that the taxing power does not authorize it."
The ACA does not brand a person as a criminal for failing to buy qualified insurance; it gives him the "lawful choice," "so long as he is willing to pay a tax levied on that choice." Justice Roberts indicates that he thinks the tax is relatively small.
While acknowledging the existence of constitutional limits on taxation, Roberts apparently ignores the "Origination Clause," that tax bills must originate in the House of Representatives (not in the Senate and clearly not in the Supreme Court),and explicitly denies that the ObamaTax is a direct tax that must be apportioned. (A direct tax is imposed on individuals, rather than on products or activities.) He declines to specify what type of tax it is.
To accomplish its purpose, the "ad hoc" ObamaTax would have to be much larger. How much larger could it be?Still Unconstitutional
The decision in NFIB v. Sebelius is the worst since Kelo v. City of New London (2004), writes Joel Pollak. In Kelo, the Court ruled that a government may seize private property under eminent domain—for the benefit of another private property owner."The two decisions are, in fact, related since Obamacare forces individuals to pay a private insurance company..., ostensibly for the greater public good" (http://tinyurl.com/61ha5jg).
The ObamaTax is unique in that it operates to fund private businesses as much as to fund the federal government. Take your pick. "It's the first time Fascism has been upheld...by the U.S. Supreme Court" (Nathaniel Darnell, American Vision 7/6/12, http: //tinyurl.com/7fr4453).
The Court did not address how the ACA violates the Takings Clause because litigators did not bring it up. But AAPS has, in our lawsuit that has been on hold pending this decision.
"Today's ruling begs the question of whether government can tax someone for refusing to give property to someone else," writes AAPS General Counsel Andrew Schlafly. "ObamaCare imposes that kind of redistribution of wealth: compelling citizens to purchase overpriced insurance for the benefit of overpaid executives." Now that the Court has ruled that the federal government cannot force citizens to buy insurance, it should follow that they also cannot be forced to pay a tax for not purchasing something if they choose not to.
Harrison Schmitt, former U.S. Senator and Apollo 17 astronaut, discusses numerous Constitutional problems with ObamaCare on http://americasuncommonsense.com (52. Healthcare and the Constitution #4, 7/9/12). He includes violation of the Takings Clause, of religious liberty, and of the right of patients and physicians to associate freely. He also draws attention to the "Obamacare Army" (Regular Corps and Ready Reserve Corps) for "both routine public health and emergency response missions." This will be under direct command of the President and independent of the Dept. of Defense, the National Guard, or local enforcement agencies.
Democrats are exulting in their narrow victory on Nov 6, saying that ObamaCare is "now a certainty," and the "best is yet to come" as they implement their glorious promises of healthcare for all. The fact is, however, that key parts of the Act are not in effect yet and may be blocked at the state level.
State Exchanges
The deadline for notifying the Dept. of Health and Human Services (HHS) of the state's intention to set up a state-managed exchange has been extended from Nov 16 to Dec 14. A number of states have refused, and others are delaying a decision until HHS spells out essential benefits and other rules. As of late September, only 19 states had begun setting up exchanges or had agreed to do so (Kaiser Health News 11/9/12).
Gov. John Kasich of Ohio wrote that "due to costs and lack of control that states have under the law, operating a state-based exchange clashes with the...values that we would like to pursue."
Gov. Rick Perry of Texas wrote that "it would not be fiscally responsible to put hard-working Texans on the financial hook for an unknown amount of money to operate a system under rules that have not even been written."
Louisiana gave notice on Mar 23, 2011, that it would not assume the risk of building an exchange under the Patient Protection and Affordable Care Act (PPACA), and on Nov 16, 2012, sent a letter to Secretary Sebelius detailing still-unresolved questions about its legality (http://tinyurl.com/bmttslh).
"The full extent of damage the PPACA causes to small businesses, the nation's economy, and the American health care system will only be revealed with time. The State of Louisiana has no interest in being a party to this failure by implementing a state based exchange."
Although originally proposed by conservatives as a mechanism to give workers a wide range of choices in a defined-contribution program, the exchange idea is perverted in ObamaCare. It is turned into a means of distributing subsidies, and shoehorning customers into a narrow range of government-approved choices, writes Avik Roy (Forbes 11/19/12).
Exchanges will force millions of Americans into coverage more expensive than that which they currently own, he states. And "there's almost no point in states setting up their own exchanges because states have no flexibility to improve on Obamacare's creaky design" (http://tinjrurl.com/c9bt457).
"Running the exchanges would be an administrative nightmare for states," write James Capretta and Yuval Levin, "requiring a complicated set of rules, mandates, databases and interfaces to establish eligibility, funnel subsidies, and facilitate purchases."
By refusing to create exchanges, states can effectively repeal much of the law, sparing citizens from the job-killing employer mandate, assaults on religious liberty, and in some cases the individual mandate (1^/11/19/12, http://tinyurl.com/dxu9qvx).
"The Exchange will create an unprecedented tracking system," writes Twila Brase of the Citizens' Council for Health Freedom. All state exchanges will funnel private data into the Federal Data Services Hub to at least five federal agencies and myriad state databases (http://tinyurl.com/d5pasfd).
Health Insurance Rules
On Nov 20, HHS released long-awaited proposed rules, including 13} pages related to the health insurance market and rate reviews (http://tinyurl.com/bs59f7z).
"The floodgates are open for untold amounts of regulation in the next few months," writes Steven Bassett. "The Burden Sharing Ministries may become a refuge for many."
While an accurate assignment of risk based on age would give at least a six-fold premium difference, only a 3:1 ratio is allowed. There is a single age band from 0-20 years, and one for age 64 and older. From 21—63, premiums vary every year. ObamaCare is a steep levy on young people, even though 55% of uninsured Americans are under age 35, principally because health insurance is already too expensive. Avik Roy's translation of HHS statements is: "We will drive up the cost of health insurance for most people, and spend lots more tax money in order to hide that fact from voters" (Forbes 11/21/12, http://tinyurl.com/bv5z95e).
Subsidies vary with income, and changes are to be monitored by the IRS with unknown frequency. People could find themselves having to pay back a subsidy, writes John C. Parker. A $6,000 increase in income could mean the loss of $10,000 in health insurance subsidies. Divorce may be the only option for obtaining affordable insurance for children and the lower-income spouse (WSJ 10/31/12, http://tinyurl.com/cdlq7gu).
Doomed to Failure
Even the election may not have saved ObamaCare. When people learn of its impact, Obama's popularity might not last long post inauguration, despite a massive public "awareness" campaign (http://tinyurl.com/b62zkoc).
There are such serious flaws that Democrats will have to perform major surgery even if Republicans do nothing, writes John Goodman (http:// tinyurl.com/benp8ry). Implementation as written is impossible, some say. The Administration may try to delay it to avoid massive embarrassing failure. If it follows the script of Soviet Five-Year Plans, watch for witch-hunts for wreckers and saboteurs.
(CNSNews.com) - The first private business owner to sue the Obama administration over its contraception mandate has won a small victory in the larger battle to preserve his religious liberty:
A federal appeals court panel on Wednesday temporarily blocked the Obamacare mandate from taking effect against the Missouri business owner, pending the the outcome of the appeals process.
A three-judge panel of the U.S. Court of Appeals for the Eighth Circuit granted a motion for a preliminary injunction filed on behalf of Frank O'Brien and O'Brien Industrial Holdings of St. Louis, which runs the Christy family of companies.
O'Brien, a Roman Catholic, says his religious beliefs guide the operation of his business, which employs 87 people. On its website, the holding company says its mission "is to make our labor a pleasing offering to the Lord while enriching our families and society." The holding company operates Christy Catalytics, Christy Industrial Services, Christy Minerals Company, and the Christy Refractories Company.
“By granting our motion, the appeals court blocks the implementation of the HHS mandate and clears the way for our lawsuit to continue – a significant victory for our client,” said Francis Manion, Senior Counsel of the American Center for Law and Justice, which sued on O'Brien's behalf.
"The order sends a message that the religious beliefs of employers must be respected by the government. We have argued from the beginning that employers like Frank O'Brien must be able to operate their business in a manner consistent with their moral values, not the values of the government. We look forward to this case moving forward and securing the constitutional rights of our client.”
The temporary injunction issued Wednesday is the first decision from an appeals court in the litigation challenging the Health and Human Services mandate, which requires employers to purchase health insurance for their employees that includes coverage for contraceptives, sterilization, and abortion-inducing drugs.
In October, a federal district court judge granted the Obama Administration's motion to dismiss O'Brien's lawsuit. The ACLJ immediately filed an appeal with the U.S. Court of Appeals for the Eighth Circuit, leading to the temporary order issued on Wednesday.
Until O'Brien filed his lawsuit, only religious organizations or institutions had challenged the mandate.
In addition to the O’Brien case, the ACLJ has filed two other direct challenges to the HHS mandate and it has filed amicus briefs backing other challenges in more than a dozen pending cases.
IRS DESCRIBES NEW HEALTH CARE COVERAGE FOR EMPLOYEES
From the Sacramento Bee 1/1/2013
Ruling clarifies health coverage ?
DEPENDENTS' PLAN NEED NOT BE AFFORDABLE
by robert pear The New York Times
WASHINGTON - "...In a long-awaited interpretation of the new health care law, the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers.
The requirement for employers to provide health benefits to employees is a cornerstone of the new law, but the new rules proposed by the Internal Revenue Service said that employers' obligation was to provide affordable insurance to cover their full-time employees, and offers no guarantee of affordable insurance for a worker's children or spouse.
To avoid a possible tax penalty, the government said, employers with 50 or more full-time employees must offer affordable coverage to those employees. But, it said, the meaning of "affordable" depends entirely on the cost of individual coverage for the employee, what the worker would pay for "self-only coverage."
The new rules, to be published in the Federal Registry, create a strong incentive for employers to put money into insurance for their employees rather than dependents. It is unclear whether the spouse and children of an employee will be able to obtain federal subsidies to help them buy coverage - separate from the employee through insurance exchanges being established in every state. The administration explicitly reserved judgment on that question, which could affect millions of people in families with low and moderate incomes.
Many employers provide family coverage to full-time employees, but many do not Family coverage is much more expensive, and the employee's share of the premium is typically much larger.
In 2012, according to an annual survey by the Kaiser Family Foundation, premiums for employer-sponsored health insurance averaged $5,615 a year for single coverage and $15,745 for family coverage. The employee's share of the premium averaged $951 for individual coverage and more than four times as much, $4,316, for family coverage.
Starting in 2014, most Americans will be required to have health insurance. Low-and middle-income people can get tax credits to help pay their premiums, unless they have access to affordable coverage from an employer.
In its proposal, the IRS said, "Coverage for an employee under an employer-sponsored plan is affordable if the employee's required contribution for self-only coverage does not exceed 9.5 percent of the employee's household income."
The rules, though labeled a proposal, are more significant than most proposed regulations. The IRS said employers could rely on them in making plans for 2014.
The law says an employer with 50 or more full-time employees may be subject to a tax penalty if it fails to offer coverage to "its full-time employees (and their dependents)." Employers asked for guidance, and the Obama administration provided it, saying that a dependent is an employee's child younger than 26.
"Dependent does not include the spouse of an employee," the proposed rules say.
Thus, employers must offer coverage to children of an employee, but do not have to make it affordable. And they do not have to offer coverage at all to the spouse of an employee.
The administration said that the rules which apply to private businesses, nonprofit organizations and state and local government agencies would require changes at many work sites.
"A number of employers currently offer coverage only to their employees, and not to dependents," the IRS said. "For these employers, expanding their health plans to add dependent coverage will require substantial revisions to their plans."
In view of this challenge the agency said it would grant a one-time reprieve to employers who fail to offer coverage to dependents of full-time employees, provided they take steps in 2014 to come into compliance.
Under the rules, employers must offer coverage to employees in 2014 and must offer coverage to dependents as well, starting in 2015. The new rules apply to employers that have at least 50 full-time employees or an equivalent combination of full-time and part-time employees.
A full-time employee is a person employed on average at least 30 hours a week And 100 half-time employees are considered equivalent to 50 full-time employees..."
Cash Deposits = a Felony. Government has been busy attacking honest, hard-working dairy farmers under the Bank Secrecy Act for depositing cash in the bank. They have been threatened with felony charges for accommodating a teller who said that the bank could avoid paperwork if the amount was below SI0,000. The government has seized entire accounts and settled with farmers for half. Those who exercise their First Amendment right to complain may get hammered even more severely (
http:// HYPERLINK "http://tinyurl.com/74rkcde"tinyurl.com/74rkcde). Meanwhile, government allows money-laundering schemes involving hundreds of millions of dollars, likely related to terrorist organizations, to go on for years {Buffalo News 7/18/12, http://tinvurl.com/cr8avfq). Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
EPO = HMO = Fraud. An HMO is an insurance-in-name-only product. Patients in HMOs have health cards that authorize them to see a doctor whose job is to deny them medical care (as opposed to cheap "wellness" care). Now that people have this figured out, the big insurance lobby tried to push a bill that assigned HMOs new alphabet letters standing for "exclusive provider organizations"—which provide no out-of-network benefits. Two alert Oklahoma legislators stopped it. G. Keith Smith, M.D., Oklahoma City, OK
No, You Can't Keep Your Doctor. The greatest tragedy of ObamaCare may be losing prematurely a generation of the most highly trained, skilled physicians in history to a health overhaul that Americans tried so hard to stop. Even without the mass exodus of 360,000 that were thinking of quitting according to an Investor's Business Daily poll, the Association of American Medical Colleges expects a shortage of about 160,000 physicians by 2025. Grace Marie Turner, Galen Institute
CMS Lied to Me. CMS/Medicare told me that form 1490S is for requesang reimbursement. It is not. It is rather a way to get the consumers to snitch on their doctors without knowing that that is what they are doing. The Medicare system is sick. The very second that I turned 65 and collecting Social Security they started collecting payments for Medicare and started dictating whom I could see and what services that I need and the medication that I take (even though they don't pay a cent for it). This last week I had some pre-cancers burned off, and I am afraid that Medicare won't pay for those. I asked the doctor about things that Medicare won't pay for. He was very tight-lipped about it and left the room as soon as he could without answering me. Wow, even doctors that give in to Medicare won't talk about what services they are allowed to offer This system is horrible. Thomas Leonard, Livermore, CA
ObamaCare Changes Medicine. Americans should be concerned that they are being asked to suffer longer and die earlier to serve the "common good." They should be angry that their doctors are being transformed from professionals they can trust to cogs they may need to fear as rationing agents for the state. David McKalip, M.D., St. Petersburg, FL
Why "Healthcare" Costs So Much. Decades ago we bought medical care. We paid at the time of service for what we needed— no wondering about what was "covered." Now we buy "healthcare," which really means we are buying payments. With a "medical loss ratio" of 80%, 20% is lost immediately. Since premiums also finance contraception, wigs for cancer patients, and counseling for drug addicts, more than likely 40% is not paying for medical care. Since so many people are needed for billing and administrative functions, the average practice has an overhead greater than 60%, so that in many cases out of $100 in premium, only $16 or less actually goes to the doctor providing care Ralph Weber, C.L.U., Murfreesboro, TN
Low Fine, by Design. Deloitte estimated that 10% of employers are going to drop health benefits (http://tinyurl.com/ca9c51c). I think that is a serious underestimate. Faced with a choice of a $2,000 fine or a $14,000 to $16,000 cost for insurance, it doesn't take calculus to figure out the net benefit of dumping employees into the government system. It looks as though the intention is to expand the government program and destroy the private market. John Dale Dunn, M.D., J.D., Fort Hood, TX
Bizarre ACA Rules. About 3 million people may be affected by the Supreme Court's ruling that ACA's attempt to force states to expand Medicaid is unconstitutional. Say you head a family with a low income. ACA would have forced you onto a second-rate, care -denying program (Medicaid). The Supreme Court may have saved your life. If your state doesn't raise the income level for Medicaid eligibility, you might be able to get private insurance in an Exchange—but only if your income is at least 100% of poverty ($23,050 for a family of four). There is a new no man's land donut hole. This might be the only example in which it could be to your advantage to lie to the IRS, claiming that your income is higher than it is. As to getting private insurance outside the Exchange, you probably can't—the insurers, the brokers, and the market are going away (http://tinyurl.com/busnwz3). John Goodman, Ph.D., National Center for Policy Analysis
MANY PRIMARY CARE DOCTORS [GPs} ARE LIMITING THEIR CARE TO OFFICE ONLY
American Medical Students who choose to be Primary Care Physicians or General Practitioners are (as is done in the UK)
"...taught to respect the limits of their ability and to seek the benefit of consultation with medical and surgical specialists whenever needed. This should be allowed even if the PCP just wants to be sure he/she is doing the right thing. This so called "Curb Side Consultation" obtained in a hospital corridor, the lunchroom or over the telephone represents a corner stone in American medicine. It's being destroyed by the "PCP/gatekeeper" idea of managed care.
A review of British medical history on this matter of Specialist referrals is helpful in that it clearly shows any reduction of communication between primary care physicians and their consultants leads to the separation, and eventual isolation of the primary care physicians. This guarantees a reduction in the quality of care they can provide to their patients.
Frank Honigsbaum, MD, an American physician, studied this phenomenon and wrote, "To the worid outside, the medical profession, in England, appears to form a unitary whole, but within its' ranks there appears a deep schism. Doctors everywhere are divided into two main classes - General Practitioners and Specialists - the gap between them grows wider each year". He emphasized that the ongoing intellectual partnership and exchange of knowledge occurring between the generalists and specialist (the traditional practice in the U.S.) keeps the quality of medical care at its best. If this partnership is disturbed, as did occur in the British National Health Service, the quality of care diminishes throughout the system, especially at the primary care level. This separation is continued and aggravated when government directives increase the annual income of one group and not the other. This is politically astute in that it discourages attempts by the medical profession to develop unity within its ranks. [A recent decision reimburses only GP's who make house calls and prescribe preventive measures for their patients..."
From: Division in British Medicine Report (Kogan Page Ltd.) London, 1979.
HEALTH CARE REFORM: TURNING BACK TO FIND THE FUTURE
A majority of the American people are outraged by the "immoral conduct" in the corporate world, the "excessive" profits in the Pharmaceutical Industry and the "rising costs" and salaries reported by "privately operated" Managed Health Care Plans--as they watch their retirement plans "vanish"; find it "impossible" to afford life-preserving medicines and are expected to settle for a "diminishingquality "and quantity of the health care "provided" when they are in need.
Truth is, they supported the growth of a "private enterprise" managed health care system. The promise of "better health care at a lower cost" failed to materialize. In short, the new system put into place failed to deliver, They know they must look for an alternative.
With polls showing a majority of Americans favor a Single Payer Health Care System [such as existed in Canada] the federal government could take control of health care delivery with the formation of a new bureaucracy or with the current system in place but financed and controlled by government regulation..
In the event that a National Health Service is their choice, State Governments could function in an essential but subsidiary role. Quality Control issues would then be returned to Physicians now that it is apparent that cost control can only be achieved by a reduction in the utilization of services, the quality of the Providers who deliver that service and of the materials made available to them. In other words through "Rationing of goods and services".
A national health service might choose to function by expanding the existing Medicare structure to cover all age groups while using the State Agencies in place or the facilities of the private health Insurance Industry as it currently exists. Delivery of care, at the community level, would be under the direction of regional and local committees composed of consumers and provider who would be guided by federal regulation and a limited budget.
Comments that suggest "the Government doesn’t want it" should be dismissed. Federal Bureau records expressing the belief that Government control is needed to solve the nation’s health care delivery problems have been heard since 1972. [ref: Forward Plan Of Health, FY 1978-82, US Department of HEW, page 1, publ. August 1976
Providers [Doctors, Nurses, Hospital Workers and other health care professionals] who would have resisted a takeover, then, are likely to welcome it, now, as they become increasingly concerned with their financial survival as well as the proper provision of quality patient care.
My Conclusions:
1. As the years pass, the public's demand for quality health care for all, regardless of one's ability to pay, diminishes as the rising cost coupled with an oppressive tax structure weakens their concern for the needs of the poor.
2. National health care systems employ a large number of citizens, estimated to be more than 5 million people in Great Britain. Though this may appear attractive, at first glance, it can later become the obstacle that makes the system impossible to change or remove when proven unsatisfactory [where else would you employ all those people?].
3. As the tax burden enlarges should the efficiency of the system decline, the private fee for service, practice of medicine returns [that's paying twice for the same thing]. For example, despite a U.S. Postal Service, UPS, Federal Express and other delivery services have become profitable..
4. Great societies reinvent the wheel when enough time passes for us to forget what a wheel looked like. For example: new "Corporate" health Planners are hiring Doctors and Hospitals to cover subscribers despite the fact that Blue Cross/Blue Shield and others were performing that function. Why didn't we fix what was in place, then, by demanding a reduction in premiums with a guarantee of coverage for everyone.
5. We are/were not spending more for health care than other major nations. They spend it differently and some had fewer Seniors, for many years, as a result of lives lost during WWII. Germany and Japan and Great Britain report that health care costs are rising rapidly.
6. I see an irony in the fact that many Americans act as if the Medical Profession invented the concept of greater personal satisfaction and financial reward for hard work and intellectual achievement. These rules of achievement have always been, and will never cease to be amongst the basic foundation stones of a free society operating in a free enterprise system. If such a nation chooses to abandon such principles it will be only a short period of time before they reappear.
Finally, the American public did enjoy the benefits of the greatest health care system that man has ever devised. Too many, however, have lost sight of that fact and are demanding that changes be made, and quickly. This is occurring despite the realization, by many health care professionals, that inordinate demands will soon be placed upon any new system we choose. Many of our younger citizens seem bent on their own destruction through poor nutritional habits, use of tobacco products, use/abuse of drugs and alcohol, together with their failure to protect themselves from deadly sexually transmitted diseases.
Ignoring these developments, our nation continues to be more concerned with reducing the cost of health care and getting rid of incompetent, greedy and dishonest Doctors. Pity, if it doesn't turn out that way. For, if we don't do it right, we will pay more, get less, and bad Doctors like bad people, won't go away either.
Since I believe, "He who fails to learn from history is doomed to repeat it", I askmyself, "Why do so many of us who hear those words act as if they must be meant for someone else.?"
Vincent W. Cangello, M.D.,FACS,FACOG,FRSM Director , Health Care Reform Educational Institute Lincoln, California [www.healthcarereform.com]
Excerpts taken from: Chapter 10, Health Care Reform Facts and Fiction, publ. 1998. author, Vincent W Cangello MD
In a move that has irked medical groups and delighted patient advocates, states including California have begun passing laws requiring clinics that perform mammograms to tell patients whether they have something that many women have never even heard of: dense breast tissue.
Women who have dense tissue must, under those laws, also be told that it can hide tumors on a mammogram, that it may increase the risk of breast cancer and that they should ask their doctors if they need additional screening tests, like ultrasound or MRI scans.
The issue is pitting angry patients against the medical establishment. Advocates say women have a right to know, but medical groups argue that the significance of tissue density is uncertain and that reporting it may panic women and lead to an avalanche of needless screening tests and biopsies.
Laws requiring disclosure have been passed in Connecticut, Texas and Virginia, and most recently in California and New York, where they will take effect next year. A bill calling for a federal law has been introduced in the House.
The laws owe their existence mostly to Nancy M. Cappello, 59, of Woodbury, Conn. She was not told that she had dense breast tissue until after doctors found an advanced cancer that mammograms had missed
She took her story to legislators, and in 2009, Connecticut became the first state to require that women be told if they have dense breasts and that insurance companies cover ultrasound scans for those women.
"I want to help other women," said Cappello, formerly the state's chief of special education. "I can't help myself. My cancer should have been detected at a much earlier stage."
"Dense" breasts have a relatively high proportion of glandular or connective tissue, which blocks X-rays. Non-dense breasts have more fat, which X-rays penetrate easily. Overall, about 40 percent of women who have mammograms have dense breast tissue. It is not abnormal, just one of nature's variations.
Younger women are more likely to have dense tissue, but as many as 25 percent of older women do, too. Density cannot be judged by touch; it shows up only on mammograms.
For many women, the legislation will bring about a big change. Though some radiologists already tell women about density, in most cases the letters sent to patients about mammogram results do not mention it.
Though some doctors favor the laws, others resent them, and professional societies of radiologists, gynecologists and cancer experts have raised medical concerns.
The medical groups say testing a woman she has dense breasts may not help her and might even do harm by propelling her into extra tests, biopsies and possibly even unnecessary treatment. The groups argue that identifying dense breast tissue is subjective, and so two doctors reading the same mammogram may rate the tissue differently. And information about density may confuse women, scare some needlessly and give others a false sense of security, the groups say.
The National Cancer Institute calls dense breasts "a strong risk factor for developing breast cancer." Various studies have estimated that compared with other women, those with dense breasts are two to six times as likely to develop breast cancer.\
From the Director: Further studies of this nature would require 5 and then 10 years of followup to be useful and then not necessarily conclusive. Women should be brought into this debate.
SOME GENERIC DRUG MANUFACTURERS UNDER INVESTIGATION
Concern rising on drug quality
MAKERS SLOW PRODUCTION AS FDA WARNS SIX ON VIOLATIONS
By Katie Thomas The New York Times
"...Weevils floating in vials of heparin. Morphine cartridges that contain up to twice the labeled dose. Manufacturing plants with rusty tools, mold in production areas and - in one memorable case - a barrel of urine.
These recent quality lapses at big drug companies show that contamination and shoddy practices extend well beyond the loosely regulated compounding pharmacies that have attracted attention because of their link to a meningitis outbreak.
In the past three years, six of the major manufacturers of sterile injectable drugs -which are subject to rigorous inspections by the federal government, as opposed to compounding pharmacies, which are generally overseen by the states - have been warned by the Food and Drug Administration about serious violations of manufacturing rules.
Four of them have closed factories or significantly slowed production to fix the problems. Nearly a third of the industry's manufacturing capacity is offline because of quality issues, according to a congressional report.
The shutdowns have contributed to a shortage of critical drugs, and compounding pharmacies have stepped into the gap as medical professionals scramble for other sources.
But several serious health scares have been traced to compounding pharmacies in recent years. Health officials said Wednesday that 19 people have died from meningitis in an outbreak traced to a contaminated steroid made by the New England Compounding Center in Massachusetts.
Supplies of the steroid, methylprednisolone acetate, became short earlier this year after two generic manufacturers, Teva and Sandoz, stopped making it.
Regulators and manufacturers both note that a majority of sterile injectable drugs -products such as chemotherapy drugs and anti-seizure drugs like diazepam - sold in the United States are safe and of high quality. Still, several industry observers and former plant employees said that the recent quality issues are troubling and that manufacturers have been reluctant to fix problems because stopping production is too costly in a business where profits are driven by volume. Many basic drugs sell for less than a dollar a vial and are made in batches of tens of thousands of vials, run on lines that can operate up to 24 hours at a time.
The Food and Drug Administration is warning U.S. consumers that the vast majority of Internet pharmacies are fraudulent and likely are selling counterfeit drugs that could harm them.
The agency on Friday launched a national campaign, called BeSafeRx, to alert the public to the danger, amid evidence that more people are shopping for their medicine online, looking for savings and convenience.
Instead, they're likely to get fake drugs that are contaminated, are past their expiration date or contain no active ingredient, the wrong amount of active ingredient or even toxic substances such as arsenic and rat poison. These products could sicken or kill people, cause them to develop a resistance to their real medicine, cause new side effects or trigger harmful interactions with other medications being taken.
"Our goal is to increase awareness," FDA Commissioner Dr. Margaret Hamburg told the Associated Press, "not to scare people away from online pharmacies. We want them to use appropriate pharmacies."
That means pharmacies that are located in the U.S., are licensed by the pharmacy board in the patient's state and have a licensed pharmacist available to answer questions. In addition, the pharmacy must require a valid doctor's prescription for the medicine. Online drugstores that claim none is needed, or that the site's doctor can write a prescription after the customer answers some questions, are breaking the law
Research by the Nationalssociation of Boards of Pharmacy, which represents the state pharmacy boards, found that of thousands of online pharmacies it reviewed, only about 3 percent follow state and federal laws. In fact, the group's website, www.
nabp.net, lists only a few dozen Internet pharmacies that it has verified are legitimate and following the rules.
Most consumers don't know that. An Internet survey, conducted by the FDA in May, questioned 6,090 adults. It found that nearly one in four Internet shoppers has bought prescription drugs online, and nearly three in 10 said they weren't confident they could do so safely.
The campaign comes after some high-profile cases of counterfeit drugs reaching American patients earlier this year.
In February and again in April, the FDA warned doctors and cancer clinics around the country that it had determined they had bought fake Avastin, a pricey injectable cancer medicine, from a "gray market" wholesaler. The fake Avastin vials originated in Asia or Eastern Europe and were transferred through a network of shady wholesalers before being sold to clinics by a wholesaler claiming to be in Montana.
In another case, the FDA issued a warning in May after learning consumers shopping on the Internet had bought fake versions of generic Adderall, a popular medication for attention deficit hyperactivity disorder.
No deaths or serious injuries have been linked to those fakes, but Hamburg notes that when drugs don't help patients get better, doctors usually blame the disease or assume a different medicine is needed. That means most fakes aren't detected.
So the FDA which has put increasing focus on the counterfeiting problem, on Friday launched a website, www.
FDA.gov/BeSafeRx, that shows consumers how to determine whether an online pharmacy is safe.
Many rogue pharmacies claim to be in Canada - because Americans know medicines are cheaper there and assume that's why they're getting a deal. Many fraudulent sites even put the word Canada in their name, or display the Canadian flag prominently on the site. Their Web storefronts are slick and look professional. And they all offer prices that are unbelievably low. "If the low prices seem too good to be true, they probably are," Hamburg said.
Drugmaker fraud cases rising, report says
By Matthew Perrone Asociated Press WASHINGTON - Federal and state prosecutors have collected more than $30 billion from drug companies for alleged fraud and illegal marketing over the last 20 years, according to a new report by consumer advocacy group Public Citizen.
The report shows that state attorneys are increasingly following the lead of federal prosecutors in seeking multimillion-dollar settlements with drugmakers such as GlaxoSmithKline and Eli Lilly & Co. Analysis by Public
Citizen found that state governments have collected $3.7 billion from drugmakers since 2009, or roughly six times more money than in the previous 18 years combined
Overcharging state health plans like Medicaid was the most common allegation, while unapproved drug marketing was the most costly, the group says.
Drug companies are permitted to market drugs only for uses that have been approved by the Food and Drug Administration. In recent years the Department of Justice and state attorneys general have increasingly pursued cases of off-label marketing, or promoting drugs for unapproved uses.
Governments are spending more on prescription drugs as programs like Medicare and Medicaid swell with aging baby boomers. That increased spending has attracted scrutiny from investigators looking to recover taxpayer dollars.
"It should come as no surprise that states facing Medicaid budget shortfalls are finally deciding to root out fraud that has likely cost their taxpayers billions of dollars over the years," said Dr. Sammy Almashat, a researcher with Public Citizen.
State and federal attorneys have collected $6.6 billion through mid uly this year, setting a new record for settlement totals in a single year.
Three drug companies have paid two-thirds of the financial penalties collected since November 2010: GlaxoSmithKline, Johnson & Johnson, and Abbott Laboratories. In July, British drugmaker Glaxo-SmfthKline agreed to pay $3 billion in fines - the largest health care fraud settlement in U.S. history - for criminal and civil violations involving 10 drugs, including the diabetes pill Avandia.
Eli Lilly & Co. and Pfizer Inc. have also paid penalties of more than $1 billion in recent years to settle allegations of improper marketing.
The Pharmaceutical Research and Manufacturers of America's Vice President Matt Bennett responded to the report in a statement: "Our member companies devote significant resources to internal compliance programs and thorough investigations of any reported misconduct - activities that complement the government's enforcement efforts."
Updates below on the U.S. Supreme Court decision in the OBAMACARE LITIGATION By Andrew Schlafly LLD Legal Counsel to AAPS
AAPS filed 8 amicus briefs in the ObamaCare litigation, and a motion to intervene, and has its own lawsuit pending - which now appears more important than ever.
The Court ruled, "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. ... In this case, however, it is reasonable to construe what Congress has done as increasing taxes ...."
Upheld, by a 5-4 vote, as a tax! The Chief Justice provided the swing vote. A majority felt that the mandate is not constitutional under the Commerce Clause: "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause." But the Court then ruled :it is reasonable to construe what Congress has done as increasing taxes." The four dissenting Justices felt that ObamaCare is unconstitutional in its entirety, whether it is called a tax or not.
This is an enormous disappointment. Insurance company stocks are down on the news ... but hospital stocks are up. Now hospitals are even more of a problem for the practice of private medicine.
Limited by ruling that the federal government can only withhold new funds if states do not require compliance with the new requirements, rather than the federal government cutting off all Medicaid funding
Is the penalty in ObamaCare a "tax" such that the Tax Anti-Injunction Act prevents review of ObamaCare until after the penalties (taxes) are collected in 2014? The Tax Anti-Injunction Act states that gno suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is the person against whom such tax was assessed.h
During oral argument, not one Supreme Court Justice suggested that the Court could not rule immediately on the constitutionality of the individual mandate!
The argument concerned an effort to recharacterize the penalty for not purchasing health insurance as a "tax". If the penalty is a tax, then the Tax Anti-Injunction Act might apply to prevent court review until after the tax is collected in 2014 or 2015.
Even two Democrat-appointed Justices seemed to reject the argument of ObamaCare supporters that the penalty is a "tax" that would preclude Court review at this time:
"Here, they did not use that word tax," Justice Stephen Breyer observed in reference to what lawmakers said and intended.
"This is not a revenue-raising measure," Justice Ruth Bader Ginsburg also said.
Some concern had been expressed that Justice Antonin Scalia might prefer to limit Court jurisdiction over ObamaCare at this time, but he also suggested by his questioning that there was no obstacle presented by the Tax Anti-Injunction Act to deciding at this time whether ObamaCare is constitutional.
Is the individual mandate, which requires nearly everyone to purchase health insurance, constitutional?
At oral argument, Justice Anthony Kennedy asked questions suggesting that he is concerned about the impact of the mandate on individual liberty.
Justices Anthony Kennedy, Antonin Scalia and Samuel Alito, and Chief Justice John Roberts -- who would comprise a majority along with Justice Clarence Thomas -- asked questions implying that they are very skeptical that the Individual Mandate is constitutional:
"The federal government is not supposed to be a government that has all powers. Itfs supposed to be a government of limited powers." - Justice Scalia's comment to the government attorney who is defending the mandate. Justice Scalia also said, gYoufre not regulating health care. Youfre regulating insurance." Justice Scalia also echoed a concern raised by Senator Tom Coburn during a Senate confirmation hearing for now-Justice Elena Kagan, asking if government can force people to purchase broccoli.
Justice Alito observed, "the mandate is forcing these people to provide a huge subsidy to insurance companies." The Individual Mandate compels healthy young persons to pay for care "that will be received by somebody else," Justice Samuel Alito stated. Justice Alito also suggested that if the federal government could require people to purchase health insurance, then they could even require people to buy burial insurance.
The Individual Mandate is telling someone gthat it must act. That changes the relationship of the government to the individual in a fundamental way.h - Justice Kennedy's comment to the government attorney. Justice Kennedy then asked the Obama Administration attorney to satisfy a "very heavy burden of justification" to demonstrate that the Constitution authorizes Congress itself to alter the relationship of government to the individual.
Chief Justice John Roberts observed, "Once youfre into interstate commerce and can regulate it, pretty much all bets are off." "Can the government require you to buy a cell phone?h because people may need one to seek emergency aid, Roberts asked.
Is the individual mandate severable from ObamaCare, such that the remainder of ObamaCare can be upheld even if the individual mandate is unconstitutional?
At oral argument, a majority of the Court (the five Justices on the conservative side) appear to favor invalidating substantial portions of ObamaCare, assuming the Individual Mandate is found to be unconstitutional, and at least four Justices (sans Kennedy) appear to favor invalidating all of ObamaCare:
Justice Samuel Alito pointed out that if legislative intent is the issue, then ObamaCare would not have passed at all without its Individual Mandate. So if the Individual Mandate is unconstitutional, then all of ObamaCare should be invalidated. Moreover, Justice Alito echoed the concern of Justice Kennedy that it would be unfair to force insurance companies to comply with other costly aspects of ObamaCare without the subsidy of the Individual Mandate.
Justice Antonin Scalia expressed concern about "legislative inertia" as a need to declare the entire bill unconstitutional, because Congress may not act quickly to correct problems with a partial upholding of the law.
Chief Justice John Roberts inferred a key concession by the Obama Administration attorney that if the Individual Mandate is unconstitutional, then the requirement that insurance companies accept pre-existing conditions must be invalidated also. The Chief Justice also expressed concern about opening the door to new litigation if parts of ObamaCare were left in place without the Individual Mandate. And he repeated the justifications implied by Justices Scalia and Alito for invalidating the entire law. Earlier, perhaps offering an easy-to-answer question to our side, he observed that portions of the law have "nothing to do" with the Individual Mandate, and that Congress would have enacted those portions regardless (e.g., black-lung benefits). But the predictable response was that this benefit was a sweetener added to pass the controversial bill, and this sweetener may not have passed on its own. An added bonus during questioning was when Chief Justice Roberts asked if ObamaCare should survive if the Medicaid expansion provision is invalidated, a point that AAPS has emphasized in arguing for invalidation of ObamaCare based on its unconstitutional expansion of Medicaid.
Justice Kennedy, widely peceived to be the swing fifth vote, declared that "leaving just part of the act might be more extreme than striking the whole thing." And he clearly expressed his concern that salvaging parts of ObamaCare would impose a burdensome "risk" on insurance companies "that Congress never intended." In addition, Justice Kennedy questioned whether the Court has the competence or expertise to pick and choose in excruciating detail what should survive in the complex law. But he also asked more general questions about which legal test should be applied in order to divine the congressional intent about severability.
The liberal wing of the Court, consisting of four Justices, appeared solidly in favor of salvaging parts of ObamaCare:
Justices Ruth Bader Ginsburg and Elena Kagan, who likely would uphold the Individual Mandate, indicated their view that other portions of the law should be upheld even if the mandate is invalidated. But these Justices indicated that the three key provisions of ObamaCare (the individual mandate, community rating and guaranteed issue) are linked such that if the Individual Mandate is invalidated, then the other two provisions should likely be invalidated too).
Justice Stephen Breyer suggested that complex issues about which parts of ObamaCare to salvage could be remanded back to district court, or to a special master, but this suggestion seemed to lack support by a the majority of the Court.
Sonia Sonia Sotomayor -- who asked the first question during oral argument -- inquired of our side, "Why shouldn't we let Congress" make these decisions. "What's wrong with leaving it in the hands of people," and "not us?" The attorney for the states, Paul Clement, responded that if the Individual Mandate is invalidated, then the entire law is nothing more than a "hollowed-out shell."
Bottom line: all of the key parts of ObamaCare seem likely to be invalidated. Moreover, as a practical matter, it would be an almost impossible task for the Court to pick and choose what to uphold among the mammoth law, given the likelihood that key parts of it depend on the unconstitutional mandate. Justice Scalia said it would be "totally unrealistic" for the Court to try to salvage parts of the 2,700-page ObamaCare, assuming the mandate is unconstitutional.
Prior to the argument: News outlets are reporting that outside the Court a small group of supporters of ObamaCare (20) outnumbered a smaller group of opponents of the law (10).
Is this requirement in ObamaCare constitutional: States must either expand Medicaid or lose their Medicaid funding?
At oral argument, Justices from the liberal side of the Supreme Court frequently interrupted the attorney for the states with questions suggesting that there are at least four strong votes for upholding the Medicaid expansion. The states' attorney had a difficult time under the questioning, and resorted to asking the Supreme Court to set a new precedent. "Establish a beachhead, say that coercion matters," the states' counsel said as he weakly tried to wind up his argument (but the argument extended past his allotted 30 minutes due to even more questioning). But asking the Supreme Court to make a new precedent is the weakest argument on which to rely.
Justice Elena Kagan, who worked for the Obama Administration before being nominated by President Obama to the U.S. Supreme Court, almost immediately asked the states' attorney, "Why is a big gift from the federal government a matter of coercion? It's just a boatload of federal money. It doesn't sound coercive to me, let me tell you."
Justice Stephen Breyer emphasized that the federal government (Health and Human Services Secretary) can only act reasonably in excluding a state from the Medicaid program, and rhetorically asked the states' counsel, "Now, does that relieve you of your fear?" (of states being kicked out of the Medicaid program if they do not agree to the expansion). The response was no, because ObamaCare seems to give the federal government broader powers to exclude states. Indeed, the states' counsel pointed out, HHS officials have already implied to states that they might have to drop out (at an enormous cost to the states) if they did not accept the broad new expansion of the Medicaid program.
Justice Ruth Bader Ginsburg pointed out that only 26 states challenged the Medicaid expansion, and suggested it would be unfair to invalidate it for the remainder who do want to participate in it.
The conservative Justices offered little support for the states' counsel during his or the government's argument:
Justice Samuel Alito had the strongest statements against the Medicaid expansion, expressing the need for meaningful limits on federal coercion of states.
Chief Justice John Roberts suggested that the states had already agreed, based on their participation in Medicaid so far, to more conditions by the federal government as part of the Medicaid expansion in ObamaCare. Indeed, the Chief Justice suggested, the states have little basis for being surprised if the strings are later pulled back by the federal government, which would leave the states stuck with the enormous expense of covering far more poor people.
Justice Antonin Scalia invited the states' counsel to continue his argument despite the frequent interruptions, commenting that the Supreme Court has been "on pins and needles here" during the intense argument. Justice Scalia then shifted to humor over substance, asking the states' attorney whether he noticed that the 26 states opposing the law had Republican governors while the others were led by Democrats (N.B. that's not entirely true, as both New Mexico and New Jersey have Republican governors who declined to challenge the law.)
Welcome to FreeMediPedia. Free refers to freedom in medicine, medicine dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine, free from interference by government and insurance company bureaucrats. This is a project of the Association of American Physicians and Surgeons, the voice for private physicians since 1943. The motto of AAPS is Omnia Pro Aegroto which means "All for the Patient."
"...When prosecutors earlier this year filed murder charges against a physician for prescribing to patients who overdosed,. Los Angeles County District Attorney Steve Cooley said he was also sending a message to other "Dr. Feel-goods" who over-prescribe.
"Enough is enough," he said. "Doctors are not above the law."
But in the months since Rowland Heights physician Hsiu-Ying "Lisa" Tseng was charged, there has been a growing debate among medical professionals about whether prosecutors went too far by alleging murder.
Some physicians fear the crackdowns in Los Angeles and other parts of the country could have a chilling effect on the way doctors work and end up making patients suffer needlessly. They also worry authorities are holding doctors criminally liable for the behavior of their patients.
"The question is whether this is a criminal act or medical malpractice," said Dr. Marshall Morgan, chief of emergency medicine at UCLA Medical Center. "The concern that I have as a physician is that it's a slippery slope."
Dr. Kimberly Lovett, who teaches at the UC San Diego School of Medicine, said the Tseng case became a hot topic of conversation at a recent discussion about prescribing opiates among physicians in San Diego. Some doctors expressed fear the prosecution would make them think twice before prescribing pain medication even when it is necessary, Lovett said...."
AAPS NEWS AMERICAN SSOCIATION OF PHYSICIANS AND SURGEONS¡Volume 68. no. 9 September 2012
Most Americans believe that physicians "swore an oath" to do them no harm. If the physician is younger than about 60, this is probably not true. He may have sworn to "a Hippocrat/V oath," but almost certainly not to the Oath of Hippocrates. Most of these do not contain the word "harm," and most state or imply that the physician has a duty to an entity higher than the patient¡ª society or the state (http://tinyurl.com/9ks4sc4,
NEWSPEAK: If he is managed-care network, he has almost certainly signed a contract with an Enrollee Hold Harmless Clause. The EHHC cannot be voided, superseded, or abrogated. Its purpose is to protect the insurer from harm. Its effect is to give the managed-care industry complete control over the practice of medicine, and to destroy two of three paths to access to care (AAPS News, July 2012): cash (direct payment) and catastrophic insurance. When trying to understand the issues, remember that we live in an Orwellian world of Newspeak and doublethink. Red stands for conservative instead of radical (Mark Helprin, "The Hunt for Blue October," WSJ 7/20/12, http://tinyurl.com/9fmwdh5). "Insured" means covered, which means captured. "Free market" is often taken to mean managed (controlled, unfree) care. "Not for profit" means not show a profit. "Ensuring access" means erecting barriers. A "right" coming from government is really a privilege that can be withheld by government. And most "health insurance" is definitely not insurance. Third-Party Payment versus Insurance The difference between true casualty insurance and health plans is obvious from looking at advertisements. Allstate has a "mayhem" series, showing, for example, a town devastated by a tornado and asking "Are you in good hands?" Health "insurance" ads, on the other hand, feature smiling, healthy people¡ªnot cancer patients. Your plan is there for you¡ªwhen you don't need it. With casualty insurance, your premium is based on actuarial risk. The insurer is contractually obligated to pay for events that occur while the policy is in force, and is required by law to accumulate the reserves to do so. It has to pay even if you stop paying premiums while your roof is being repaired. If you switch policies, the new one is not required to pay for pre-existing damage. With a health plan, the insurer's obligation is open-ended; it promises to pay for all "necessary and appropriate" care. With guaranteed issue and community rating, it can't price for or exclude pre-existing conditions, and with the new rules on the medical loss ratio, it will be more difficult to accumulate reserves. Thus, health plans are more like a "pay-go" system than a plan of saving for a rainy day.
Solvency Means the Ability to Say No The payout on car insurance is limited by the total value of your car, and the maximum liability coverage. One illness can cost much more than a car, and with ObamaCare no lifetime coverage limits are allowed. So how can health plans stay solvent? The key is the EHCC, which state law requires in provider contracts. This keeps providers from accepting payment from anyone for "covered" care that is denied on the grounds that it is unnecessary or inappropriate. Although the plan cannot practice medicine, and thus cannot define "necessary," contracted providers will almost always agree with the plan's determination. To do otherwise means that they cannot be paid for the service¡ªand worse, risk expulsion by the plan or by their hospital. Unless the patient can find a noncontracted physician willing to perform the service, it will not be available. Once a plan functionary decided that "given Sandy's age and her condition, the cost of the care being prescribed can't be justified," no one would provide the care¡ªdespite her husband's offer to pay¡ªand Mrs. Lobb died. As Frank Lobb explains in his book The Great Health Care Fraud (see fall issue of J AmerPhys Surg), self-payment threatens the plan's solvency. If the care is provided by a physician whose license requires him to render only care that is appropriate, that is evidence that the plan violated its promise to provide all necessary and appropriate care. Subscribers might then have grounds to sue the plan for reimbursement.
The Death Panel Equivalent in ObamaCare and Medicare Government rationing means that you can't legally buy more than your permitted share. When single-payer advocates say that we ration now, they are largely correct if there is a provider contract with managed care, even if they don't explain why. Medicare Part B recipients can't pay Medicare providers outside the system. With Medicare Advantage their Medicare benefit is turned over to the plan. Few notice the restrictions now¡ªbut the squeeze from exploding enrollment and tightened budgets will change that. Will the Ryan Medicare reform simply funnel "premium support" directly into the coffers of plans with EHHCs?
Insurance is supposed to protect people from bankruptcy. But health plans protect themselves from bankruptcy by seizing control and turning captive doctors into death panels.
WASHINGTON (AP) — The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, the influential Institute of Medicine said Thursday in a report that ties directly into the presidential campaign.
President Barack Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk. But the counter-intuitive finding from the report is that deep cuts are possible without rationing, and a leaner system may even produce better quality.
"Health care in America presents a fundamental paradox," said the report from an 18-member panel of prominent experts, including doctors, business people, and public officials. "The past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures, and management of conditions that previously were fatal ...
"Yet, American health care is falling short on basic dimensions of quality, outcomes, costs and equity," the report concluded.
If banking worked like health care, ATM transactions would take days, the report said. If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other. If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying.
If airline travel were like health care, individual pilots would be free to design their own preflight safety checks — or not perform one at all.
How much is $750 billion? The one-year estimate of health care waste is equal to more than ten years of Medicare cuts in Obama's health care law. It's more than the Pentagon budget. It's more than enough to care for the uninsured.
Getting health care costs better controlled is one of the keys to reducing the deficit, the biggest domestic challenge facing the next president. The report did not lay out a policy prescription for Medicare and Medicaid but suggested there's plenty of room for lawmakers to find a path.
Both Obama and Romney agree there has to be a limit to Medicare spending, but they differ on how to get that done. Obama would rely on a powerful board to cut payments to service providers, while gradually changing how hospitals and doctors are paid to reward results instead of volume. Romney would limit the amount of money future retirees can get from the government for medical insurance, relying on the private market to find an efficient solution. Each accuses of the other of jeopardizing the well-being of seniors.
But panel members urged a frank discussion with the public about the value Americans are getting for their health care dollars. As a model, they cited "Choosing Wisely," a campaign launched earlier this year by nine medical societies to challenge the widespread perception that more care is better.
"Rationing to me is when we are denying medical care that is helpful to patients, on the basis of costs," said cardiologist Dr. Rita Redberg, a medical school professor at the University of California, San Francisco. "We have a lot of medical care that is not helpful to patients, and some of it is harmful. The problem is when you talk about getting rid of any type of health care, someone yells, 'Rationing.' "
More than 18 months in the making, the report identified six major areas of waste: unnecessary services ($210 billion annually); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion). Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion.
Examples of wasteful care include most repeat colonoscopies within 10 years of a first such test, early imaging for most back pain, and brain scans for patients who fainted but didn't have seizures.
The report makes ten recommendations, including payment reforms to reward quality results instead of reimbursing for each procedure, improving coordination among different kinds of service providers, leveraging technology to reinforce sound clinical decisions and educating patients to become more savvy consumers.
The report's main message for government is to accelerate payment reforms, said panel chair Dr. Mark Smith, president of the California HealthCare Foundation, a research group. For employers, it's to move beyond cost shifts to workers and start demanding accountability from hospitals and major medical groups. For doctors, it means getting beyond the bubble of solo practice and collaborating with peers and other clinicians.
"It's a huge hill to climb, and we're not going to get out of this overnight," said Smith. "The good news is that the very common notion that quality will suffer if less money is spent is simply not true. That should reassure people that the conversation about controlling costs is not necessarily about reducing quality."
The Institute of Medicine, an arm of the National Academy of Sciences, is an independent organization that advises the government.
From the Director: In my opinion,after visiting Nations with Government Health Care, their failure was largely due to overuse and abuse, of the system, by both providers and recipients which led to long waiting lines. Co-payments for medicines,and sevices, origionally avoided, became necessary,and proved to be of benefit to all.
The purchase of private health insurance was encouraged,to shorten long waits for care, and, in some cases the care rendered was "part-paid for" by the Government.
VICE PRESIDENT CANDIDATE WANTS A DEBATE ON THE FUTURE OF MEDICARE
Paul Ryan to Obama on Medicare debate: Bring it on
By Chris Moody, Yahoo! News | The Ticket – 5 hrs ago- 8/15/2012
OXFORD, Ohio -- Republican vice presidential candidate Paul Ryan weighed into the ongoing debate over Medicare at a public rally here Wednesday, inviting a public argument about the future of the program.
"The president, I'm told, is talking about Medicare today," Ryan told supporters at Miami University, where he graduated from college. "We want this debate. We need this debate. And we will win this debate."
That "debate" so far has been a messy one, keeping independent fact checkers busy ever since Ryan proposed a plan in 2010 to restructure Medicare into a system that provides subsidies to seniors to buy health care on the private market.
Democrats have seized on Mitt Romney's decision to choose Ryan as a running mate, arguing that the budget plan he proposed as House Budget Committee chairman would "end Medicare as we know it," a claim that a fact checking group rated the "Lie of the Year" in 2011. Meanwhile, Ryan repeated on Wednesday an attack that Romney has used regularly on the stump: that Obama "raided" more than $700 million from Medicare to pay for the 2010 federal health care law. That claim was rated "mostly false" by the same fact checking group, which pointed out that the health care law slows the projected growth of spending in the Medicare program in part by slimming the Medicare Advantage program and paying hospitals less for not meeting federal standards.
In his speech at the Miami University, Ryan also knocked Obama by using a toned-down version of a line Romney used earlier, accusing Obama of running a campaign of "hate."
"President Obama is out of ideas," Ryan said, "and that is why his campaign is based on anger and division."
Correction, 9:45 p.m. EDT: An earlier version of this post referred to Miami University as University of Miam
Business owners will pay $4 billion more in taxes under President Obama’s Affordable Care Act (ACA) than the Congressional Budget Office had previously expected.
"According to the updated estimates, the amount of deficit reduction from penalty payments and other effects on tax revenues under the ACA will be $5 billion more than previously estimated," the CBO reported today. "That change primarily effects a $4 billion increase in collections from such payments by employers, a $1 billion increase in such payments by individuals, and an increase of less than $500 million in tax revenues stemming from a small reduction in employment-based coverage, which will lead to a larger share of total compensation taking the form of taxable wages and salaries and a smaller share taking the form of nontaxable health benefits."
In short, CBO revised the Obamacare tax burden upward by $4 billion for businesses and $1 billion to $1.5 billion for individual workers.
CBO couldn’t help but bump into Chief Justice John Roberts controversial decision uphold the individual mandate as a constitutional exercise of Congress’s taxing power. The report dubs the individual mandate a "penalty tax" — that is, "a penalty paid to the Treasury by taxpayers when they file their tax returns and enforced by the Internal Revenue Service."
Personal Note: In the 1st part - be prepared to wait in long lines to get your medical service if we go the way of England and Canada - Government (National) Health Care.
Subject: FW: I thought you would find this interesting to put it mildly!
Subject: I thought you would find this interesting
A recent "Investor's Business Daily" article provided very interesting statistics from a survey by the United Nations International Health Organization.
Percentage of men and women who survived a cancer five years after diagnosis: U.S. 65% England 46% Canada 42%
Percentage of patients diagnosed with diabetes who received treatment within six months: U.S. 93% England 15% Canada 43%
Percentage of seniors needing hip replacement who received it within six months: U.S. 90% England 15% Canada 43%
Percentage referred to a medical specialist who see one within one month: U.S. 77% England 40% Canada 43%
Number of MRI scanners (a prime diagnostic tool) per million people: U.S. 71 England 14 Canada 18
Percentage of seniors (65+), with low income, who say they are in "excellent health": U.S. 12% England 2% Canada 6%
And now for the last statistic:
National Health Insurance? U.S. NO England YES Canada YES
The DRUDGE REPORT of 8/11/2012 presents a Video of Congressman Paul Ryan delivering a committee report to President Obama, on 2/25/2010, describing the estimated cost of financing the PPACA, tne health care reform law recently reviewed by the US Supreme Court. {The date of the presentation should not discourage your viewing this video since the new law has not yet required full financing). In my opinion, the report is one of the most comprehensive reports of the needed financing, to this date.
AAPS news OBAMA TAX American Association of Physicians aned Surgeons News Letter Volume 68, no.8August2012
"...ObamaCare had to stand otherwise all those backroom deals ("delicate balancing" in Court parlance) would have been voided. There might have been lawsuits over the billions of dollars already spent to implement its requirements {WSJ 6/26/12). Still worse, one might work backward to the precedents, or even to Social Security, Medicare, and Medicaid. Recall that Social Security survived a Supreme Court challenge on the basis of Congress's power to tax (AAPS News, June 2011).
Like Obama, the President's hero Franklin Roosevelt had different messages for the public and Congress (Social Security is insurance) and for the Court (it's not insurance; it's a gratuity).
Like Humpty Dumpty, the Court defines the meaning of words¡ªand beyond that, changes the meaning at will. Roberts "split the baby perversely by ruling it was not a tax under the Anti -Injunction Act, but it was a tax for taxing and spending purposes," writes David Yerushalmi, senior counsel of the American Freedom Law Center.
Four Justices would've overturned the whole of the ACA, with its massive intrusions into medicine and the insurance market, on the basis of the unconstitutionality of the mandate and the lack of severability. But Roberts's one-man opinion on the word "tax," added to four liberal Justices' votes for upholding the mandate, saved the entire structure.
A Choice, Not a Mandate
Five of nine Justices held that a mandate to purchase insurance would be an impermissible expansion of the Commerce Clause. Since it can't, constitutionally, be a mandate, then it isn't, reasoned Roberts. "While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful." If someone chooses to make the "shared responsibility payment" to the IRS, he has fullv complied with the law, states Roberts, and "the Government agrees with this reading." Thus, Americans who do not fall under an exclusion or an exception have a choice: pay a private entity, or pay the government. [Are both taxes?]
A Tax, Not a Penalty
If something is not unlawful, it is not proper to attach a penalty to it, Roberts opines, therefore the choice is not really a penalty, no matter what the law calls it. "First, for most Americans, the amount due will be far less than the price of insurance, and, by statute, it can never be more. It may often be a reasonable financial decision to make the payment rather than buy insurance [emphasis added]. Second, the individual mandate contains no scienter requirement. Third, the payment is collected solely by the IRS through the normal means of taxation¡ªexcept that the Service is not allowed to use those means most suggestive of a punitive sanction, such as criminal prosecution."
Something cannot be both a penalty and a tax. Supreme Court precedents going back to the 1920s define penalties and taxes as mutually exclusive (1/6/2312).
By the "duck test" (if it looks like a duck, ...) the mandate is clearly a fax. Everyone who claimed it wasn't lied, and it didn't take a Supreme Court ruling to prove it, writes Frank Salvato (http://tinyurl.com/7e27fb9).
The IRS will police the ACA, which "includes the largest set of tax law changes in 20 years," according to the Treasury inspector general who oversees the IRS. It is expected to spend nearly $1 billion on the law from 2010 to 2013. The IRS will assess the penalty/tax on non-exempt persons who do not have adequate proof of insurance, but it is not clear how it will enforce payment, since it does not have the authority to levy a penalty or charge interest for nonpayment of the penalty/tax. It can withhold refunds (77% of filers are due a refund) or send scan' letters (AP 7/7/12, http://tinyurl.com/6nlflud). Or it can credit the Obama penalty/tax first, then seize assets for failure to pay the rest of the income tax (http://tinyurl.com/7u2vlle).
20 New or Higher Taxes
The ACA tax increase is calculated to amount to $525 billion or more between 2010 and 2019. Middle-class Americans and small businesses will pay 75% of it. Besides the mandate/tax, the ACA includes: an excise tax on charitable hospitals; a tax on innovator drug companies; codification of the "economic substance doctrine" (by which the IRS can disallow legal deductions); limitations on health savings accounts (HSAs), flexible spending accounts (FSAs), and health reimbursement accounts (HRAs); raising the threshold for deductibility of medical expenses from 7.5% to 10% of AGI; a surtax on investment income; a hike in the Medicare payroll tax; the employer mandate tax; the "Cadillac" insurance tax; and more (http://tinyurl.com/8xdblgp).
Unlimited Power
The Court has placed a limit on the expansion of the Commerce Clause. Instead, we have an infinitely elastic power of the government to tax behavior, inactivity, or mere existence..."
For more information on this editorial AAPS News, Volume 68, no.8August2012 www.aapsonline.org
From Sacramento Bee 8/3/2012 Nurses could provide care to influx of insured patients
By Chad Terhune Los Angeles Times
LOS ANGELES - "...If you think if s hard getting a doctor's appointment now, just wait until 30 million more Americans join the line.
By 2020, the United States faces an estimated shortage of 40,000 primary-care doctors with no way to remedy that in just a few years.
As a result, more consumers may soon find themselves getting their checkups and help in managing their high blood pressure, heart disease or diabetes at the local pharmacy or Wal-mart as the Affordable Care Act extends health insurance to 30 million people and puts unprecedented strain on an already fragile network of primary care.
Pharmacy giant CVS Caremark Corp., Target Corp. and other retailers are aiming to help alleviate the doctor shortage with hundreds of walk-in clinics run by nurses to treat ear infections and other routine ailments and increasingly help people suffering from chronic illnesses.
These companies, after struggling to turn a profit from these clinics for the last decade, are now eager to capitalize on an influx of newly insured patients.
"People could have long wait times to see a doctor as the federal law gets implemented in 2014, and that will drive more interest in these retail clinics," said Ateev Mehrotra, a researcher at the University of Pittsburgh School of Medicine and Rand Corp., a nonprofit think tank.
One of the Americans receiving coverage under the law is likely to be Silvana Washington, a 57-year-old home-health aide in Los Angeles with diabetes and hypertension.
Washington often waits as long as three hours to be seen at a county-run medical clinic that serves the uninsured. She said she would welcome more options, like getting her blood pressure checked during a weekend shopping trip.
Experts say it remains to be seen whether more clinics at the workplace or close to home just create more unnecessary care that drives the nation's $2.6 trillion medical tab even higher.
There are also concerns that a proliferation of these clinics will undermine efforts in the health care overhaul to better coordinate care, particularly for patients whose conditions are among the most complex and expensive to treat
These clinics are already popular with consumers who like the idea of strolling in for care with no appointment seven days a week. They are typically small operations adjacent to the pharmacy where one nurse practitioner may see patients and handle billing. There are no doctors on site.
Most health insurers consider these clinics an in-network visit, so people are responsible for their standard co-payment, and the uninsured may pay $70 to $90 for a visit
There are more than 1,350 in-store clinics nationwide, according to research firm Merchant Medicine, and that number could top 3,000 by 2016.
CVS MinuteClinic, which is the biggest retail clinic chain with nearly 600 locations, plans to open 100 clinics a year. Rival Walgreen Co. has more than 350 Take Care Clinics. Wal-Mart has nearly 150 in-store clinics, and Target is opening nine more this week, raising its total to 53.
These in-store clinics have performed well so far. Studies by Rand found that they provide care at costs that are 30 percent to 40 percent less than similar care provided at a physician's office and that the care for routine illnesses was of similar quality...."
(CNSNews.com) –Sixteen states have set a limit on the number of prescription drugs they will cover for Medicaid patients, according to Kaiser Health News.
Seven of those states, according to Kaiser Health News, have enacted or tightened those limits in just the last two years.
Medicaid is a federal program that is carried out in partnership with state governments. It forms an important element of President Barack Obama's health-care plan because under the Patient Protection and Affordable Care Act--AKA Obamcare--a larger number of people will be covered by Medicaid, as the income cap is raised for the program.
With both the expanded Medicaid program and the federal subsidy for health-care premiums that will be available to people earning up to 400 percent of the poverty level, a larger percentage of the population will be wholly or partially dependent on the government for their health care under Obamacare than are now.
In Alabama, Medicaid patients are now limited to one brand-name drug, and HIV and psychiatric drugs are excluded.
Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.
Speaking on C-SPAN’s Washington Journal on Monday, Phil Galewitz, staff writer for Kaiser Health News, said the move “only hurts a limited number of patients.”
“Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand,” Galewitz said.
“It only hurts a limited number of patients, ‘cause obviously it hurts patients who are taking multiple brand name drugs in the case of Alabama, Illinois. Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some,” he added.
Galewitz said the move also puts doctors and patients in a “difficult position.”
“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.
Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get.
“Some people say it’s a matter of you know states are throwing things up against the wall to see what might work, so states have tried, they’ve also tried formularies where they’ll pick certain brand name drugs over other drugs. So states try a whole lot of different things. They’re trying different ways of paying providers to try to maybe slow the costs down,” Galewitz said.
“So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues. And it’s a relatively recent thing, only in the last 10 years have we really seen states put these limits on monthly drugs,” he added.
For more information: Melanie Hunter(CNSNews.com) July 30, 2012
From the Director: The predicted unavoidables begin: ---the plan guarantees that you are eligible to get on line and wait your turn ---adding millions of recipients to the list necessitates cutting back on what will be avilable to all
US HOUSE OF REPRESENTATIVES VOTES TO REPEAL OBAMA HEALTH CARE REFORM LAW
Yahoo News 7/11/2012 By John Parkinson | ABC OTUS News – 3 hrs ago
Today when the House votes to repeal the Affordable Care Act, a vote decried by Democrats as a political charade, it will mark the 33 rd time that Republicans have acted to defund, dismantle or repeal the health care law .
Leading into the Supreme Court's health care decision on June 28, Speaker Boehner vowed to repeal anything that the Justices left standing.
"We've made it pretty clear and I'll make it clear one more time: If the court does not strike down the entire law, the House will move to repeal what's left of it," Boehner, R-Ohio, pledged the day before the ruling. "Obamacare is driving up the cost of health care and making it harder for small businesses to hire new workers."
Thirteen days after the historic decision upholding the law, Boehner and the House Republicans will make good on that promise and vote this afternoon to repeal the law in its entirety.
But facing a Democratic double road-block in the form of the Senate and White House, there is not a snowball's chance that this repeal will be signed into law.
So why will House Republicans take the vote?
"Hope springs eternal," Boehner said Tuesday. "This is not what the American people want. They want to be empowered to make decisions about their own health care and their family's health care. They don't want the government involved in this, and so we're going to continue to work to repeal this."
New Study Finds Sharp Slowdown In Imaging Use After 2005
Bethesda, MD -- Demand for new radiologists, one of the most sought-after specialists, began declining in 2007 because of a lessening increase in demand for imaging studies. According to a new study in Health Affairs, the growth in the use of magnetic resonance imaging (MRI) and computed tomography (CT) for patients in the United States slowed to between 1 and 3 percent per year between 2006 and 2009, ending a decade of growth that had exceeded 6 percent annually. This study, which analyzes potential reasons for this change in imaging use, was released today as a Web First; it will also appear in the journal’s August issue.
The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause
Lee heads health economics and reimbursement at GE Healthcare; Levy is a professor of urban economics at Massachusetts Institute of Technology and a lecturer at Harvard Medical School.
Levy’s work is supported by a Robert Wood Johnson Investigator Award.
The authors cited several policies that contributed to the slowdown. “We hypothesize that higher cost sharing, prior authorization, reduced reimbursements, and fear of radiation are, for different parts of the population, countering some of the nonmedical incentives to order an imaging study,” concluded the authors. “What has occurred in the imaging field suggests incentive-based cost control measures can be a useful complement to comparative effectiveness research when a procedure’s ultimate clinical benefit is uncertain.”
From the hcrei Director this research, started before the current health care reform law was passed , is in my opinion another example of fixing rather than replacing our century old and world admired health care delivery system.
About Health Affairs
Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at www.healthaffairs.org. The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.
Consumers across California will be getting rebate checks from their health insurers next week - one of the first tangible results of the federal health care overhaul.
About 1.8 million Californians will be getting money back, either directly or through a reduction in their monthly premium. The average California rebate: about $65 a family.
Nationally, about $1.1 billion in health care premium rebates - averaging $151 per family -will go out to 12.7 million consumers by Aug. 1.
"It could be a welcome surprise to folks," said Marta Green, spokeswoman with the state Department of Managed Health Care. "Anything that can make health care more affordable is positive for consumers."
The rebates stem from the so-called "80/20 rule" of the federal health care law, which requires insurers to spend 80 percent of their premium dollars on health care costs rather than marketing, salaries or other nonmedical REBATES I Page A12
From the Director: Federal laws of this nature might well have been used to preserve and repair our former private health care insurance costs rather than replace them as is currently being done.
From THE HILL NEWS ALERT on Drudge Report 7/14/2012 by Elice Bubeck
Federal trade regulators warned Friday that scam artists are using the healthcare law to ask for consumers' personal information over the phone.
The Federal Trade Commission (FTC) said that the illegal activity began after the Supreme Court ruled on June 28 to uphold the vast majority of the law.
Scam artists "say they're from the government" and use the Affordable Care Act as a hook to verify information, according to an FTC alert
"They might have the routing number from your bank, and then use that information to get you to reveal the entire account number," the alert stated. "Or, they'll ask for your credit card or Social Security number, Medicare ID, or other personal information."
Regulators urged consumers not to give out personal or financial information after unsolicited contact from someone who says they are with the government.
"If someone who claims to be from the government calls and asks for your personal information, hang up. It's a scam," the alert stated.
From the AAPS Journal of American Physiciian and Surgeons Summer 2012 Volume 17 Number 2
Understanding the Healthcare Bubble:How it Was Inflated and Why It Must Burst Andrew Foy M.D.
"...The Healthcare Bubble
Healthcare spending began to take off in 1965, when the government began subsidizing healthcare for the poor and elderly through Medicare and Medicaid. It expanded further as legislation, most notably the HMO Act of 1973, and regulatory policy shifted the responsibility of health maintenance from the individual to everyone in his insurance pool. This was accomplished through regulations requiring insurers to cover medical services (e.g. cancer screenings, pharmaceuticals, and a wide range of therapeutic and rehabilitative services) for conditions that were not insurable events but rather part of routine health maintenance.Throughout the expansion, out-of-pocket spending declined dramatically.
America's healthcare system today can best be described as "fascialist," a term coined by economics professor Thomas DiLorenzo, who writes: "Fascialism means an economy is part fascist, part socialist."9 Fascism is characterized by private enterprise that is comprehensively regulated and regimented by the state, ostensibly "in the public interest" (as arbitrarily defined by the state). A variant of fascism is "crony capitalism." Socialism started out meaning government ownership of the means of production, but it has come to mean egalitarianism promoted by progressive taxation and the institutions of the welfare state. According to DiLorenzo, "The problems of the American healthcare system are caused entirely by the fact that the government subjects the system to massive interventions, some of which are fascist in nature, while others are socialist."
Under the current system, consumers play virtually no role in shaping the pattern of resource use and assignment of resource rewards. The outputs produced, the methods of production employed, and the rewards given to the various owners of productivity are not dictated by healthcare consumers, but rather by government and industry lobbyists—the medical-industrial complex.
Prior to Medicare and Medicaid and the significant regulatory changes that followed, American medicine actually operated under near-capitalist conditions (it was never pure capitalism). I will term this the capitalist period of U.S. healthcare. During this time, individuals paid for the majority of medical goods and services out of their own pockets and used health insurance as a rational tool for mitigating financial risk posed by catastrophic events. Although still a relatively new concept, participation in private insurance plans was growing, and by 1960 nearly 75% of Americans had some form of private health insurance coverage.10 During this period, rapid advancements were being made in pharmaceuticals, diagnostics, and surgical techniques (e.g. the heart-lung machine, which made coronary artery bypass surgery possible). Furthermore, charitable institutions and hospitals run by religious groups and fraternal organizations such as the Freemasons, whose mission was to take care of the indigent, abounded. Most importantly, the price of medical goods and services remained remarkably stable
Inflation of the healthcare bubble corresponded with the change from the capitalist to fascialist model of U.S. healthcare, which was facilitated by going off the gold standard (see below). From the period 1990 to 2007 the cost of all items, as measured by the Bureau of Labor Statistics, rose by 159%, while housing rose 163% and medical care rose a staggering 216%." A recent study by the Kaiser Family Foundation found that between 1999 and 2011, health insurance premiums increased 168%, while workers' total earnings increased only 50%." Over that same time period, government spending on healthcare increased 240%, while GDP increased 62%." The Bureau of Labor Statistics (BLS) reported that over the last 50 years, the percentage of workers employed in private-sector healthcare has gone from 3% to over 11 %, and employment has continued to grow throughout the current recession.14 BLS further projects that "healthcare will generate 3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry" and that "the number of wage and salary jobs in pharmaceutical and medicine manufacturing is expected to increase by 6% over the 2008-18 period, compared with 11% projected for all industries combined...."
"...The author Andrew Foy MD is a Cardiology Fellow at Penn State Hershey Medical Center www.andrewfoy@gmail.com..."
LETTERS TO THE EDITOR FROM MEMBERS-PUBLISHED IN AAPS NEWSLETTER
From AAPS NEWSLETTER 7 July 2012
Correspondence
Cheese in the Medicaid Mousetrap. Secretary Sebelius has credited ObamaCare with a proposed rule that would bring Medicaid primary care fees in line with Medicare. CMS acting administrator Marilyn Tavenner said that the payment increase would help prepare primary care physicians for "increased enrollment as the healthcare law is implemented." Note that the increase is good for only two years even if the U.S. Supreme Court upholds the law. Physicians who take the bait may be trapped in the circumstance that they will take on more patients that they will have to care for at a loss when fees are cut—or face accusations of abandonment. Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
The Giant Hospital Bill (GHB). The GHB, which is enabled by the preferential tax treatment of employer-owned insurance, benefits many special interests. It maximizes the uncompensated care scam. It helps maintain the fictitious "not for profit" status of the hospital. It scares individuals into large groups, increasing profits for insurers. It maximizes re-pricing revenue. By providing evidence of the rising cost of medical care, it justifies higher and higher premiums, and thus higher commissions for brokers. Hiding true costs is critical for maintaining a command economy. Price transparency is essential for a free-market economy (http://tinyurl.com/7k8xxud). G. Keith Smith, M.D., Oklahoma City, OK
Over 75? Stay Well or Die. My Canadian cousins are being introduced to pre-kindergarten economics: if prices don't ration medical care, government will. As of 2013, patients over 75 in Ontario will receive major procedures only if approved by an Ethics Council—meeting during normal business hours. Already, patients who would have previously received dialysis are no longer being accepted. They will die soon.
Robert P. Gervais, M.D., Mesa, AZ
From the Director; Two. now unfamiliar, orders will become "often heard" in our future, as far as Senior Citizens are concerned.
1. "Not cost effective" 2."We didn't say you can't have it., we said, We won't pay for it.
Used repeatedly in nations with government controlled health care .
_________________________________________________
A Statement from AAPS Executive Director, Jane Orient, M.D. May 28 2012
This is a bleak day for America. The US Supreme Court has upheld a blatantly unconstitutional law of enormous scope that affects every American. The federal government has no constitutional authority to dictate how Americans shall pay for their medical care. It has no right to force them to turn over their earnings for the profit of private insurers or for the "public use," such as providing "free" services that a federal agency dictates people should have. It is most distressing that the Supreme Court has validated the corrupt, dishonest process by which this law was enacted: the "penalty" for noncompliance with the mandate was repeatedly said not to be a tax, until it suddenly became one.
As the Court said, it's up to the people: to repeal the law, defund it, and resist its implementation. States are not required to implement Exchanges or to take the bait for Medicaid expansion, and should not do so. Physicians are not required to sign up for "Accountable Care Organizations," and should not betray their patients by doing so.
President Obama's Food and Drug Administration has caused "a public health crisis" -- a prescription drug shortage over the past two years -- by increasing the number of threats issued to raid and close drug manufacturing plants, according to House investigators.
"This shortage appears to be a direct result of over-aggressive and excessive regulatory action," House Oversight and Government Reform Committee Chairman Darrell Issa, R-Calif., said in a statement. "These drugs can save lives and keep people who need them living healthy lives. The FDA is failing to ensure the availability of quality products."
President Obama signed an executive order last year to help the FDA anticipate drug shortages while knocking Congress for failing to pass his preferred legislation on the issue. "Congress has been trying since February to do something about this," Obama said in November. "It has not yet been able to get it done . . . we can't wait."
The committee report concluded that a significant portion of the drug shortage is a problem of the Obama administration's making. "Among shuttered manufacturing lines that occurred over the previous two years, the committee’s review did not find any instances where the shutdown was associated with reports of drugs harming customers," the report says, noting a 30 percent drop in the manufacture of certain prescription drugs at the largest manufacturers in the country.
Instead, the drug shortage crisis began in 2010 after the FDA began sending letters to companies found to be in violation of a given rule, in which the company was warned that "failure to promptly correct these violations may result in legal action without further notice including, without limitation, seizure and injunction."
The FDA sent just 474 such letters in 2009, but that number spiked to 1720 in 2011. "A common sense approach to regulations must be restored at the FDA," the committee report advised, calling for more targeted measures to induce company compliance with regulations. "Agency protocols should be revised so that the agency is required to consider the implications of its actions on the nation’s supply of critical drugs."
"....A group of public-interest researchers took on the veiled, confounding world of hospital pricing Thursday in a report that questioned why a common surgery cost $40,000 at one hospital in the Sacramento region and $17,000 at another.
Pressing for more transparency in hospital pricing, the study by the California Public Interest Research Group, a consumer watchdog organization, spotlighted wide disparities in the cost of surgeries statewide.
Among its findings, the study showed that the Sacramento region's price tag for common surgeries ran higher - 111 percent - than the state's median.
As health care costs continue to escalate, the study's results offer a glimpse into the erratic and hurly-burly nature of hospital pricing, said its authors. They also underscore the need to get medical spending under control if overall health care costs are to drop as envisioned by the federal health care overhaul....."
From the Director; Surgical charges vary as a result of the differences in what a hospital is capable/prepared to do for the different needs of the different patients; not all hospitals maintain Emergency Rooms and /services
These differences, must be maintained 24/7 [as they say]regardless of cost, such as "life saving"emergency cardiac procedures,Trauma Centers for serious injuries and brain surgery, as well as, Emergency Life saving surgical needs in their Maternity Division.
Smaller hospitals are not equipped to provide these extremely expensive services so the cost of what they do provide is lower
No two patients are the same. Hospitals that accept all/any patient regardless of need must charge higher fees because of their added cost in personnel and equipment --24/7.
NEW STUDY: HEALTH CARE COSTS WILL RISE AS REFORM DEVELOPS
From Health Affairs Bethesda Maryland 6/11/2012
US Health Spending Projected to Grow an Average of 5.7 Percent Annually through 2021
CMS Predicts Modest Growth For 2012-2013, With Spike In 2014 From Expanded Health Coverage
Bethesda, MD -- New estimates released today from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project that aggregate health care spending in the United States will grow at an average annual rate of 5.7 percent for 2011 through 2021, or 0.9 percentage point faster than the expected growth in the gross domestic product (GDP). The health care share of GDP by 2021 is projected to rise to 19.6 percent, from its 2010 level of 17.9 percent.
By 2021, government spending at all levels for health care is projected to reach nearly 50 percent of total national health expenditures, with the federal government accounting for approximately two-thirds of that share.
The findings can be accessed as a Health Affairs Web First article and will also be published in the July issue. The full article provides an analysis of how Americans are likely to spend their health care dollars in the coming decade, with projections for spending by different sectors, payers, and sponsors.
The projections reflect various factors that can affect health care spending, including an aging population. Relatively slower economic growth is also expected to affect spending on health care, with modest growth in disposable personal incomes, insurance coverage, and employment rates all limiting expenditures through next year. "The recent recession and the modest economic recovery have played a role in our projection of near historic lows in health spending growth through 2013," says Sean Keehan, the lead author of the study. "However, other factors such as Medicare payment cuts under current law and the patent expirations of several top-selling brand-name drugs have led to projected health spending growth staying at about 4 percent during this period."
The major effects of the Affordable Care Act on overall spending levels are expected to be felt most acutely in 2014. The coverage expansions associated with the Affordable Care Act for Medicaid and private health insurance are expected to increase the growth rate for health spending to 7.4 percent in 2014, with notable increases in spending on physician services and prescription drugs by the newly insured. Throughout the latter half of the projection period, incomes are expected to be higher, and a large number of baby boomers are anticipated to be receiving coverage under Medicare. Among others, these factors are expected to drive health spending up around 2 percentage points faster than overall economic growth by 2020, consistent with trends in the United States for about the past thirty years.
Key national health expenditure projections for specific timeframes include the following:
2011 (final data to be available in January 2013)
Preliminary assessments indicate a continued near-historic low of a 3.9 percent growth rate in spending, with total expenditures of $2.7 trillion and a stable share of GDP at 17.9 percent.
Health spending financed or sponsored by federal, state, and local governments is estimated to have grown 6.4 percent, and to have reached $1.2 trillion. Health spending by businesses, households, and other private sources is estimated to have risen just 1.9 percent in 2011, and to have reached $1.5 trillion.
2012-2013
National spending on health care is projected to grow 4.2 percent in 2012, and then slow to 3.8 percent growth in 2013 (due in part to the 30.9 percent reduction in Medicare physician payment rates called for under current law).
Growth in prescription drug expenditures is expected to slow from 3.9 percent in 2011 to 2.9 percent in 2012, and then to 2.4 percent in 2013, as several top-selling blockbuster drugs lose patent protection.
2014
As the major provisions of the Affordable Care Act go into effect in 2014, including health care coverage expansions, projected growth in spending is 7.4 percent, compared to 5.3 percent growth without these reforms.
Many of the 22 million newly insured are anticipated to be generally younger and healthier, and are expected to devote a larger share of their health care spending to prescription drugs and physician and clinical services, and a smaller share to hospital spending.
The Affordable Care Act is also expected to influence growth rates for the major payers, with a rise in private health insurance spending to 7.9 percent and a decrease in individual out-of-pocket spending by 1.5 percent.
Medicaid enrollment is expected to increase by 19.6 million people in 2014, with total Medicaid spending projected to grow 18 percent.
2015-2021
National health spending is projected to grow at an average rate of 6.2 percent per year for this period. Medicare expenditures are projected to grow an average of 6.8 percent per year for 2015 through 2021.
Medicaid expenditures are projected to grow at an average rate of 7.4 percent per year, as total enrollment in the program is expected to reach 85 million. Medicaid is projected to account for about 20 percent of all health expenditures, an increase of about 5 percentage points over the 2010 share.
The Affordable Care Act's tax on high-cost employer-based insurance plans will take effect in 2018, and is expected to place further downward pressure on private health insurance premium growth.
In addition to examining the effects of national health reform legislation, the report discusses the impact of higher cost sharing on private health insurance and out-of-pocket health spending. It also examines the effect on Medicare and physician health spending growth if the significant reduction in Medicare physician payment rates in 2013 under current law is overwridden. About Health Affairs
Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at www.healthaffairs.org.
GENEVA (AP) -"... A sexually transmitted disease that infects millions of people each year is growing resistant to drugs and could soon become untreatable, the World Health Organization said Wednesday.
The U.N. health agency is urging governments and doctors to step up surveillance of antibiotic-resistant gonorrhea, a bacterial infection that can cause inflammation, infertility, pregnancy complications and, in extreme cases, lead to maternal death. Babies born to mothers with gonorrhea have a 50 percent chance of developing eye infections that can result in blindness.
"This organism has basically been developing resistance against every medication we've thrown at it," said Dr. Manjula Lusti-Narasimhan, a scientist in the agency's department of sexually transmitted diseases. This includes a group of antibiotics called cephalosporins currently considered the last line of treatment.
"In a couple of years it will have become resistant to every treatment option we have available now," she told The Associated Press in an interview ahead of WHO's public announcement on its `global action plan' to combat the disease...."
FDA ORDERS LESS USE OF ANTIBIOTICS IN FARM ANIMALS
From Sacramento Bee 4/12/2012
Livestock drug rules stiffened
ANTIBIOTICS TO NEED PRESCRIPTION, FDA SAYS
By Gardiner Harris
New York Times
Farmers and ranchers for the first time will need a prescription from a veterinarian before using antibiotics in farm animals, in hopes that more judicious use of the drugs will reduce the tens of thousands of human deaths that result each year from the drugs' overuse.
The Food and Drug Administration announced the new rules Wednesday after trying for more than 35 years to stop farmers and ranchers from feeding antibiotics to cattle, pigs, chickens and other animals simply to help the animals grow larger. Using small amounts of antibiotics over long periods of time leads to the growth of bacteria that are resistant to the drugs' effects, endangering humans who become infected but cannot be treated with routine antibiotic therapy.
At least 2 million people get sick and an estimated 99,000 die every year from hospital-acquired infections, the majority of which result from such resistant strains. It is unknown how many of these illnesses and deaths result from agricultural uses of antibiotics, but about 80 percent of antibiotics sold in the United States are used in animals.
Michael Taylor, the FDA's deputy commissioner for food, predicted that the new restrictions would save lives because farmers would have to convince a veterinarian that their animals are either sick or at risk of getting a specific illness. Just using the drugs for growth will be disallowed, and it is hoped that this will cut their use sharply. The new rules will also make obtaining antibiotics more cumbersome and expensive.
'We're confident that it will result in significant reductions in agricultural antibiotic use," Taylor said. "That's why we're doing this."
Just how broadly farmers use antibiotics simply to promote animal growth is unknown. Some 80 percent of an tibiotics used on farms are given through feed, and an additional 17 percent are given in water. Just 3 percent are given by injection.
High-techCancer therapies spark hope at conference
By Marilynn MarchioneAssociated Press
CHICAGO - New research shows a sharp escalation in the weapons race against cancer, with several high-tech approaches long dreamed of but not possible or successful until now.
At a weekend conference of more than 30,000 cancer specialists, scientists reported: New "smart" drugs that deliver powerful poisons directly to cancer cells while leaving healthy ones alone.
A new tool that helps the immune system attack a broad range of cancer types.
Treatments aimed at new genes and cancer pathways, plus better tests to predict which patients will benefit from them.
"I see major advances being made in big diseases" such as breast and prostate cancers, said Dr. Richard Pazdur, cancer drug chief at the federal Food and Drug Administration, which on Wednesday announced a new policy intended to speed breast cancer drugs to the market
The field continues to move toward more precise treatments with fewer side effects and away from old-style chemotherapy that was 'like dropping a bomb on the body," he said. In fact, an emerging class of "smart bombs" was one of the most hopeful developments reported at the meeting of the American Society of Clinical Oncology.
These are two-punch weapons that combine substances | called antibodies, which bond with specific cancer cells, and toxins that' are too potent to be given by themselves. A chemical link holds them together until they attach to a tumor cell, releasing the poison inside it and killing the cell.
"This is a classic example of the magic-bullet concept" first proposed more than 100 years ago, said Dr. Louis Weiner,Director of Georgetown University Lombardi Comprehensive Cancer Center
In fact, an emerging class of "smart bombs" was one of the most hopeful developments reported at the meeting of the American Society of Clinical Oncology.
On Sunday, a large study showed that one such drug -Genentech's T-DM1 - delayed the time until cancer got worse in women with very advanced breast cancer. The drug also seems to be improving survival, although it will take more time to know for sure. So far, women on the new treatment were living more than a year longer than a comparison group of women who were given two other drugs.
Dozens of similar "smart bomb" drugs are in development. Pfizer Inc. plans today to report on one it is testing for certain types of lymphoma and leukemia. Only one such drug is on the market now -Adcetris, sold by Seattle Genetics Inc. for some less common types of lymphoma.
The other big news at the conference involved a very different approach: using the immune system to fight cancer.
For more than a century, doctors have been trying to harness its power, but tumorcells have cloaking mechanisms that have kept the immune system from recognizing them as "enemy" and going on the attack.
Bristol-Myers Squibb Co. has developed two drugs -one aimed at cancer cells and the other at key soldier cells of the immune system - to remove one of these invisibility cloaks. Two studies involving nearly 500 people found some tumor shrinkage in up to one quarter of patients with lung and kidney cancers as well as the deadly skin cancer melanoma. The treatments had less impact against colon and prostate cancer.
These are only early results and not survival comparisons or definitive tests, doctors warn.But Dr. Roy Herbst, medical oncology chief at Yale Cancer Center in New Haven, Conn., was hopeful."I haven't seen anything this good" for many years for treating lung cancer, he said. "I'd be very surprised if there wasn't some benefit" on survival, said Herbst, who has consulted for the drug's maker.
Decisions, Decisions: How High Court Could Rule on Health
By Peter Landers Wall Street Journal
The Supreme Court is ruling next week on the Obama health law. Of the many possible scenarios, here are the most likely four, shown in order of how much of the law would be struck down:
Scenario #1: The entire law is upheld.
After all is said and done, the high court may conclude—as the majority of lower courts did—that Congress was acting within its powers under the Constitution when it required most Americans to carry health insurance or pay a penalty. That provision was at the center of the two-year legal battle, and if it survives, the rest of the law is likely to stay as well.
Such a ruling would be a victory for Democrats and President Barack Obama, who had passed the biggest reworking to the health system since the creation of Medicare in the 1960s and faced the prospect of the court nullifying their effort. It would also avert disruption for hospitals, doctors and employers who have spent more than two years preparing for changes in the law.
Even in this case, however, the law would face an uncertain future. Republican presidential candidate Mitt Romney and GOP congressional leaders have pledged to repeal the law if they take control of Congress and the White House in November elections. And while Democrats would undoubtedly feel relief, a favorable ruling for the law could further energize voters who dislike it to support Republicans.
Scenario #2: The insurance mandate is struck down, but the entire rest of law stays.
This was the ruling of a federal appeals court in Atlanta last year, and the Supreme Court may choose to uphold it. In this scenario, the high court would conclude that Congress exceeded its powers with the requirement to carry insurance or pay a penalty. But it would judge that provision separable from the rest of the law.
This would be the worst-case scenario for insurance companies and set off a scramble for the Obama administration and supporters of the law to prove that it could still work. Unless Congress took further action, insurers would be required accept all customers starting in 2014–even those who are already sick–without imposing surcharges for pre-existing medical conditions. At the same time, the court’s ruling would mean people wouldn’t be required to carry health coverage. Insurers say that would lead to chaos in the market as people waited until they were sick to sign up for policies.
Politically, a ruling under this scenario would vindicate critics who called the Patient Protection and Affordable Care Act’s insurance mandate an unprecedented overreach of federal power. Mr. Obama would face an election in a little more than four months with the nation knowing that a core part of the law he signed in March 2010 was found to violate the Constitution.
Republicans would push ahead with plans to repeal the remainder of the law. Some Democratic supporters have argued that ways could be found to substitute for the mandate, perhaps through federal rule-making or state action. And Mr. Obama would be able to campaign on the law’s surviving consumer-friendly provisions.
Scenario #3: The mandate and two related provisions are struck down but the rest of the law stays.
At Supreme Court arguments in March, the Obama administration, fearing the market chaos in scenario #2, argued that the insurance mandate was inextricably linked to two other provisions. Those provisions require insurers to accept all customers and restrict the insurers from charging more based on a person’s medical history. The administration said if the mandate were struck down, the other two provisions should go too.
If the court adopts that position, it would mean that the principal aim of the law—expanding coverage to tens of millions of Americans—would be unlikely to be achieved. Republicans would feel vindicated and push to repeal the rest of the law.
While not as disruptive as scenario #2 for health insurers, this scenario would still create broad uncertainty in the health business. Many parts of the law would remain, including those setting up new marketplaces in 2014 where consumers can shop for policies and get subsidies for coverage. Companies with 50 or more workers would have to start offering a set level of health benefits in 2014 or pay a fine.
Supporters of the law have said those provisions could still function, but questions would be sure to arise whether the marketplaces were workable without the core of the law.
Scenario #4: The entire law is struck down.
If the high court concludes that the insurance mandate is unconstitutional, it may agree with challengers that the only path is to invalidate the entire law.
Such a ruling would unravel all the work by the health industry and local governments preparing for the law. It would be a painful blow to Mr. Obama and Democrats who spent so much time and political capital on their health-care overhaul. Yet it would also put pressure on Republicans. They could no longer talk about repealing what they term ObamaCare but would have to figure out what, if anything, to bring before Congress to replace it. Gerald F. Seib discussed Republican challenges in the event of a negative ruling here.
The law also includes many provisions far afield of health care, affecting chain-restaurant menus, tanning-salon taxes and breast-feeding in the workplace among other things. As Janet Adamy reported, if the entire law were struck down, the ripples would spread far.and wide.
California's birthrate tumbled last year to its lowest point since the Great Depression, new state figures show, yet another indication that the difficult economy is reshaping everyday life.
California families are looking at their personal finances, their job security, their prospects for the future - and increasingly deciding now is not the time to have a baby. Marriages are down, fore-closures are up, job openings are scarce and kids are expensive. The average cost of raising a child from birth to age 18 is about $225,000, federal data show.
"Alot of the people I see say, 'One (child) is enough: It's all I can afford,'" said Anna Peak, owner of Babies & Beyond, a children's-goods store in the Land Park section of Sacramento.
Other, more permanent changes also are taking place. The children of immigrantsare having fewer kids than their parents did. The population as a whole is getting older. Couples are waiting longer to start families.
Because of those patterns, the state will see strikingly low birthrates for the rest of the decade, said John Malson, acting chief of the state Department of Finance's demographic research unit.
Last year for the first time, California women gave birth at a rate that, over their lifetimes, would produce fewer than two births apiece, Malson said. In other words, they weren't producing enough
BABY BUST
The birthrate in California - the number of births per 1,000 people - has fallen to its lowest level since 1935. Births per 1,000 residents 25
1930 1940 1950 1960 1970 1980 1990 2000 2010
Sources: California Department of Public Health; U.S. Census Bureau; Centers for Disease Control and Prevention; Bee research For further information. www.preese@sacbee.com
From the Director: search "low Birth Rates" for other HCREI Builletins discussing the economic implications of this development..
Federal health officials rejected California's bid to charge Medi-Cal co-payments for everything from drugs to hospital visits, dealing a new blow to the state budget but relief to low-income patients and their providers.
Gov. Jerry Brown and lawmakers relied on mandatory Medi-Cal co-payments to save $511 million in last year's state budget and presumed that the state would continue saving in future years.
The plan to charge low-income Medi-Cal patients and let doctors refuse care for nonpayment was unprecedented for a state on such a wide scale. The charges ranged from $3 for "preferred" drug prescriptions to $5 for doctor visits and a maximum $200 on hospital visits. Medi-Cal serves about 8 million Californians, though patients also eligible for Medicare were exempt from co-payments.
The state was required to obtain approval from the Centers for Medicare & Medicaid Services (CMS) to implement its plan.
But CMS said in a letter Monday that it was "unable to identify the legal and policy support" for the change. Under the Social Security Act, a state must meet several tests in order to charge co-payments, which include "providing benefits to recipients of medical assistance which can reasonably be expected to be equivalent to the risks to the recipients."
Providers, such as physicians and dentists, and advocates for low-income Californians warned that a co-pay plan would hurt low-income patients by cutting access to health care. Providers felt it was a back-door cut in reimbursement rates, on top of a 10 percent reduction that a federal judge recently blocked, because the state put the burden on them to collect the co-pays or make the decision to refuse patients for nonpayment.
Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty, said Medi-Cal patients would have stopped using health care if faced with a payment requirement. She said research shows that un-deruse of preventive health care, rather than overuse of the system, drives up costs.
"When people with even a nominal co-pay are asked to pay $3 to $5, they're going to write off the health care system writ large," Cajina said.
"These are children going in for checkups, elderly people going in for care management When you really start thinking about a person on Social Security or a mom on CalWORKs bringing in $800 a month, asking them to pay $5 is a much bigger chunk out of their budget than it would be for other folks."
The governor's latest budget, which estimates a $9.2 billion deficit, acknowledges the lost savings in 2011-12. But it is relying on $575 million to help balance next year's budget, according to Department U Finance spokesman H.D. Palmer. The administration will appeal Monday's ruling with Health and Human Services Secretary Kathleen Sebelius, Palmer said.
Call Kevin Yamamura, Bee Capitol Bureau, (916) 326-5548. Follow him on Twitter @kyamamura.
From the Director: In Nations I have visited, with government control health care systems, a co-pay or small financial payment resulted in a reduction of abuse and unnecessary over-use of the system, benefitting all members, both providers and recipients
Bloomberg News MINNEAPOLIS - For three decades Gael Lander fought for her life against the same high blood pressure that contributed to her father's fatal heart attack and caused a series of debilitating strokes in her mother.
Now Lander's hard-to-treat hypertension is under control, the result of an experimental 20-minute procedure that cauterized nerves near her kidneys that control blood pressure. The nerves were seared using a catheter made by Medtronic Inc., the leader among dozens of companies developing similar products that may help re-energize the medical devices industry with a potentially multi-billion dollar new market.
Lander, a 68-year-old retired teacher from Melbourne, Australia, was the first person to undergo the operation in 2007. "I was a walking time bomb" before it, she said. "I now have peace of mind."
Since Lander's operation, 4,000 more patients with hypertension that drugs failed to control have also had the surgery, the vast majority with positive results.
Though the surgery hasn't been approved for use in the United States, its introduction in Europe and Asia is promising news for the more than 1 in 3 adults in the U.S., or 76.4 million people, and 1.2 billion worldwide, who suffer from hypertension.
About one-third of those with the condition, like Lander, don't respond to drug therapy, putting them at risk of crippling ailments and early death. And even those who are helped by drug treatment may eventually benefit from the procedure.
Medtronic, based in Minneapolis, and its rivals may generate $1.5 billion to $4.4 billion annually depending on the medical conditions the devices successfully treat, Ian Swanson, an analyst with the Millennium Research Group in Toronto, said.
"The treatment-resistant population alone is a lucrative one," Swanson said. "But the real excitement is in the fact that it's a much larger group if you can get to patients" with common hypertension.
The procedure could also pare down expenditures for hypertension drugs. More than 42 million people take drugs to curb hypertension in the United States alone, underscoring the potential size of the market.
In Lander's procedure, known as renal denervation, doctors slid Medtronic's catheter into an artery connected to the kidney, and then seared the nerves in the artery wall with radio-frequency energy. This quelled production of hormones that raise blood pressure by contracting blood vessels and promoting fluid retention.
Key to gaining entry to the United States will be the results of a study led by George Bakris, director of the hypertension center at the University of Chicago. It will look at the experiences of 532 patients, half of whom will undergo renal denervation while the others have a sham surgery that mimics it. The results are expected to be released next year, Bakris said.
Previous studies in Australia and Europe point to strong benefits. The initial Medtronic trial found 71 percent were helped by the treatment within six months.
HEALTH CARE'S NEW MANTRA Hospitals,doctors, insurers-working together. By Reed Abelson New York Times
Giselle Fernandez is only 17, but she has had more than 50 surgeries since she was born with a rare genetic condition. She sees a host of pediatric specialists, including an ophthalmologist, an endocrinologist and a neurologist at UCLA Health System. Her care has cost hundreds of thousands of dollars so far, and she will need special treatment the rest of her life.
While UCLA Health System has long prided itself on being at the forefront of treating patients like Giselle, it is now trying to dramatically lower the cost of providing that care. By enrolling young patients with complex and expensive diseases in a program called a "medical home", the system tries to ensure that doctors spend more time with patients and work more closely with parents to coordinate care. The program has cut emergency-room visits by slightly more than half.
The effort is part of a much broader ambition by UCLA Health System to reduce its costs by 30 percent, or hundreds of millions of dollars, over the next five years, according to Dr. David Feinberg, the system's president
"We have definitely found religion," he said. "fter years of self-acknowledged profligacy, hospitals, doctors and health insurers say there is an unprecedented effort under way to bring medical costs under control. Their goal is to slash the rate of growth in the nation's $2.7 trillion health care bill by roughly half to keep it more in line with overall inflation.
Private insurers, employers and government officials are providing urgency to these efforts, and the federal health care law passed two years ago helped accelerate them. Many observers say that even if the Supreme Court decides next month to declare the entire law unconstitutional, the momentum is likely to continue.
"Regardless of what happens to the law, the market will force the system to become more efficient," said Paul Keckley, the executive director of the Deloitte Center for Health Solutions, a research arm of the consultant Deloitte.
The drive to lower costs is resulting in numerous initiatives. UCLA Health System is scrutinizing its use of imaging performed on patients in the cardiothoracic intensive care unit.. Over the past year the average number of X-rays per patient each day was reduced to two from 10.
The Cleveland Clinic, another medical powerhouse that has little difficulty attracting patients and demanding high prices, is trying group visits for diabetic patients so more people can be seen at a lower cost. The clinic has started reminding surgeons about the $400 price of a unit of blood as a way of discouraging unnecessary transfusions, which along with other changes in patient care last year helped save $4 million.
The clinic's medical residents also can no longer order as many expensive tests as they want.
"What we're talking about is driving the value equation," said Dr. Delos Cosgrove, chief executive for the clinic.
Many of those involved say the impetus should come directly from hospitals and doctors.
"The medical community needs to transform care," said Dr. Thomas Simmer, the chief medical officer of Blue Cross Blue Shield of Michigan, the state's largest insurer. Blue Cross estimated that by collaborating with Michigan hospitals to share best practices, it achieved savings of $233 million over three years.
Despite the flurry of activity, many caution that these efforts may not succeed in saving money. And there are still many people within the industry who are wedded to the status quo, said Dr. Michael Cropp, the chief executive of Independent Health, an insurer in Buffalo, N.Y. Cropp has been vocal about the need to address rising costs.
"The mind-set shift is beginning, albeit too slowly," Cropp said.
Experts also warn that many of these initiatives will take time to work, especially because doctors and hospitals get more money the more tests and procedures they do. But there are also signs that insurers, which traditionally have focused on paying hospitals and doctors the least they can, are working much more closely, with providers to improve care.
In Michigan, for example, Blue Cross financed an effort to have the state's major hospitals compare results in areas like bariatric or general surgery so that they could reduce infection rates and surgical complications. The insurer never sees data that identify individual hospitals, and the hospitals met regularly to discuss how they can learn from one another to improve care.
The program's benefits extend far beyond Blue Cross' own customers, according to the insurer's calculations. Only a third of the savings was attributable to patients it insured. Unlike previous attempts by insurers to reward individual hospitals for quality and efficiency, the program tries to help all hospitals improve.
In other cases, health insurers are collaborating with hospitals and doctors through new models like accountable care organizations, which coordinate the care for a group of people.
In early 2010, Blue Shield of California teamed with a San Francisco-based hospital system, now Dignity Health, and a large medical group, Hill Physicians, to provide coverage for 40,000 members of the California Public Employees' Retirement System in Sacramento. Blue Shield promised to keep premiums flat the first year and increase them as little as possible afterward.
Simply by working together, the three were able to reduce the number of times patients had to be readmitted to ahospital by 15 percent Previously, the insurer, the hospital and the medical group had all assigned the same patient a case manager, but patients were still failing to schedule a follow-up visit with their doctor and not getting clear instructions about their care when they left the hospital.
"None of the case managers from the three organizations were talking to each other," said Paul Markovich, an executive vice president of Blue Shield.
In the end, the hospital was deemed responsible for follow-up care, despite the fact that it had the least incentive to prevent a patient from returning, he said.
"There's no way" before the program, "we could even contemplate doing that," Markovich said.
The hospital system says it is committed to more affordable care, which is why it agreed to work with Blue Shield in the first place.
"We do think there is aprob-lem with cost," said Michael Blaszyk, the chief financial officer for Dignity Health.
"Our goal was not to ramp up our profits," he said. "Our goal was not to lose money on this."
HEALTH INSURANCE MANDATE EXPOSED-A DOCTOR'S ANALYSIS
From the AAPS Journal Of American Physiciians and Surgeons Spring 2012.Volume 17 Number 1
Morton's Fork: Deconstructing the Case for an Insurance Mandate
G. Keith Smith, M.D.
After reading an article that advocates making people buy health insurance, you may feel deep down that forcing people to buy this product against their will is wrong. But many find it difficult to counter the arguments point by point.
An illustrative example is a recent editorial, "The Conservative Case for Healthcare Reform's Individual Mandate."1 Author Walter Zelman—who is obviously not a conservative—is listed as chairman of the Department of Public Health at California State University at Los Angeles, and chairman of the board of governors of LA Care, Los Angeles County's Medi-Cal Health Plan. He was a prominent member of the Clinton healthcare taskforce. He led cluster group I on "New System Organization." His article reflects assumptions and techniques commonly used by "healthcare reform" experts.
An argument that seems at first to be watertight or impenetrable may be achieved by omitting certain details, the inclusion of which would reveal the defects in logic. Attention is diverted by asking questions like the one asked by CNN's Wolf Blitzer: "What should happen when someone has no insurance and needs care they [sic] cannot afford?" Such questions are usually weighted with subtly biased terms and assume flawed premises, for example, that property rights are violable. Zelman and others who think like him apparently believe that there is no moral problem with denying you your wages to support someone else on Medicaid, or denying you the right to prioritize your family budget and forgo buying health insurance this yearor next.
The questioners also make false assumptions about the facts, as by basing estimates of the purportedly high cost of care on grossly inflated "chargemaster" rates. Huge but largely fictitious losses based on these rates are claimed to be passed on to us as taxpayers or medical bill payers at the hospital or clinic.
What may be perceived as the final rhetorical victory is often achieved by blurring the distinction between charity and theft, the difference between charitable care and the care funded by robbery of the taxpayers.
Zelman's three questions are: "First, why is it so troubling that the government is requiring responsible individuals to purchase what they would purchase anyway? Second, is it fair or appropriate to make the responsible pay more in order to protect the rights of the irresponsible? Third, what should be done when the principle of limited government clashes with that of individual responsibility? Or, put another way, is the principle of limited government so compelling that it should cause us to penalize the responsible and reward the irresponsible?"
It might at first seem that there is no escape from this rhetorical corner. Let us take the three questions in order.
Why is it so concerning that government is making me buy something that I would buy anyway? In fact, it is going to make us buy something that we would nor buy anyway: their brand of "health insurance." Moreover, if I'm going to buy it anyway, why is there any necessity for making me buy it?
The next question is basically whether it is fair to make some pay more for those who can't pay. The answer is no. Whatever happened to the idea of a mutually beneficial exchange? Why does another man's disease have to represent a pre-existing liability on my balance sheet or yours? Why does one man's motorcycle wreck mean my family can't go on vacation this year? If I want to help the unfortunate, that is another matter entirely. The hospital administrator's desire to extract money from me for a portion of someone else's bill through cost shifting is not acceptable, and that problem is easily solved with price transparency and market competition. Shouldn't patients be able to choose to go to places that do not cost shift?
The third question is in effect a rewording of the subheading of Zelman's article: "Would conservatives rather have government impose a financial requirement on people who choose not to buy healthcare, or have those who behave responsibly bear the financial burden of a few?"The form of this question is a Morton's Fork—a forced choice between undesirable alternatives.
The expression, which is related to tax collecting, is said to have originated with Archbishop of Canturbury John Morton in the 15th century. Morton said that a man who lived modestly was saving money and could afford to pay taxes, and that a man who lived extravagantly was obviously rich and could also afford taxes.
Zelman's second option, and indeed the whole argument, is based on the unstated assertion that healthcare is a right. The simple answer is that healthcare is not a right. It is a contradiction in terms to designate something as a right when exercising it results in violating someone else's rights. Exercising the right to healthcare, for instance, violates the property rights of another.
Another assumption of universal insurance advocates, which may be hard to see although it lies just barely beneath the surface, is that the financing of individual patients' medical care is a national problem.To educated people like Zelman, the doctrine of subsidiarity should not be unknown. Simply put, the government that governs the best, governs closest to home. Why are the various health challenges in Louisiana the problem of folks who live in Montana? Why not let each state or city deal with its own issues without the involvement of the federal government? Politicians in Washington, D.C., don't even have the ability or courage to deal with entitlement programs like Medicare and Medicaid that are bankrupting the whole nation. Why entrust them with everyone's access to medical care?
The situations in Louisiana and Montana are quite different. The state of Louisiana has a charity hospital system, the funding for which is partially derived from a tax paid by tourists staying in New Orleans hotels. If you do not wish to contribute in this way, you can stay away from those hotels. Montana would probably have to have a different method of financing. There is no end to the possible ways to deal with issues like this in various places and at different times. Zelman, like most radical socialists, appears to believe that his solution applies to all of us no matter where we live.
A highly developed ability to polish and spin can make the flaws in arguments hard to see. We need to expose the fallacies and the socialist agenda at every opportunity.
G. Keith Smith, M.D., an anesthesiologist, is co-founder of Surgery Center of Oklahoma in Oklahoma City. Contact: KSmith@surgerycenterok.com
. REFERENCE 1 Zelman W. The conservative case for healthcare reform's individual mandate. Los Angeles Times Nov. 20, 2012
As bacteria evolve to evade antibiotics, common infections could become deadly, according to Dr. Margaret Chan, director general of the World Health Organization.
Speaking at a conference in Copenhagen, Chan said antibiotic resistance could bring about "the end of modern medicine as we know it."
"We are losing our first-line antimicrobials," she said Wednesday in her keynote address at the conference on combating antimicrobial resistance. "Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units."
Chan said hospitals have become "hotbeds for highly-resistant pathogens" like methicillin-resistant Staphylococcus aureus, "increasing the risk that hospitalization kills instead of cures."
Indeed, diseases that were once curable, such as tuberculosis, are becoming harder and more expensive to treat.
Chan said treatment of multidrug resistant tuberculosis was "extremely complicated, typically requiring two years of medication with toxic and expensive medicines, some of which are in constant short supply. Even with the best of care, only slightly more than 50 percent of these patients will be cured."
Antibiotic-resistant strains of salmonella, E. coli, and gonorrhea have also been discovered.
"Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry," said Chan. "A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child's scratched knee could once again kill."
The dearth of effective antibiotics could also make surgical procedures and certain cancer treatments risky or even impossible, Chan said.
"Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy and care of preterm infants, would become far more difficult or even too dangerous to undertake," she said.
The development of new antibiotics now could help stave off catastrophe later. But few drug makers are willing to invest in drugs designed for short term use.
"It's simply not profitable for them," said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center in Nashville. "If you create a new drug to red cholesterol, people will be taking that drug every day for the rest of their lives. But you only take antibiotics for a week or maybe 10 days."
Schaffner likened the dilemma to Ford releasing a car that could only be driven if every other vehicle wasn't working.
"While we try to encourage the pharmaceutical industry to create new antibiotics, we have to be very prudent in their use," he said.
But there are ways to limit the potential for bacteria to develop antibiotic resistance: Use antibiotics appropriately and only when needed; follow treatment correctly; and restrict the use of antibiotics in food production to therapeutic purposes.
"At a time of multiple calamities in the world, we cannot allow the loss of essential antimicrobials, essential cures for many millions of people, to become the next global crisis," said Chan.
"This is going to have a huge impact on the way we think about breast cancer.... I think the whole landscape of research, discovery and treatment is going to change."
RAJU KUCHERLAPATI, a genetics professor at Harvard Medical School
By Eryn Brown Los Angeles Times
LOS ANGELES - Researchers have found a way to classify breast cancer tumors into 10 distinct categories ranging from very treatable to extremely aggressive, a major step on the way to the long-sought goal of precisely targeting therapies for patients.
The new categories, described in a study released Wednesday, should help scientists devise fresh approaches to treat some of the cancers and could spare many women the risks and pain of unnecessarily toxic treatments, oncologists said.
"If you belong to one group you need one therapy, and if you're in another you'll need another," said Dr. Carlos Caldas, a breast cancer geneticist at the University of Cambridge who helped oversee the research. For some women, he added, tumor typing might indicate that traditional chemotherapy isn't warranted at all.
"A lot of women are being overtreated," he said. "Can we spare them that?"
The study, published by the journal Nature, is the first of many expected in the coming months that will use genetic clues in breast cancer tumors to help refine categories of the disease, which strikes one in eight U.S. women.
Doctors like to say that breast cancer is not a single disease, but a range of them. But because they don't completely understand which therapies will work for a given tumor and why, they tend to err on the side of caution - administering treatments in cases in which they may provide little added benefit
This type of research could begin to change that, experts said.
"This is going to have a huge impact on the way we think about breast cancer," said Raju Kucherlapati, a genetics professor at Harvard Medical School who was not involved in the study. 'Together with other data coming out in the next few months, I think the whole landscape of research, discovery and treatment is going to change."
Clinicians already divide tumors into a few different types, and targeted treatments are available for some variations of the disease. For instance, women with tumors that test positive for a cancer-promoting protein called HER2 often respond well to the drug Herceptin, which isn't effective against other types of tumors.
But in a frustratingly high number of cases, scientists can't explain why one woman will respond to a given treatment and another woman won't - even though they both might have tumors that are estrogen-receptor-positive, for example.
'It's not a very precise art," Caldas said.
Hoping to hone the process, Caldas and colleagues from Britain and Canada analyzed the genetic signatures of samples from 997 tumors, examining how aberrations in DNA turned various genes on and off. They analyzed 2 million spots on the genome, focusing on differences in the number of times a string of DNA is repeated and on small gene variations known as single nucleotide polymorphisms, or SNPs. They also looked at RNA, which helps translate DNA instructions into proteins, to gauge gene activity.
Then they correlated that data with long-term health outcomes of the women from whom the tumors were removed, establishing a link between the genetic patterns and how tumors progressed. The analysis involved complicated number-crunching and took more than five years to complete.
In the end, the research team identified 10 distinct subtypes of breast cancer. They reinforced previously known groups and were able to make further distinctions within them.
For example, they found that tumors in two of the categories had very few DNA aberrations compared with those in other groups. Tumors in one of these categories were particularly vulnerable to immune system cells, and they had one of the best profiles for prognosis.
The team confirmed the validity of their categories by testing them in a separate group of 995 tumors.
Dr. John Glaspy, an oncologist at UCLA's Jonsson Comprehensive Cancer Center, added that the genetic analysis also sheds light on a fundamental question: How do cancers emerge? "It's an insight into how this whole thing works," he said. "Insight is the beginning of new treatment"
A Lung Cancer Screening Insurance Benefit Would Save Lives at Relatively Low Cost, says Health Affairs Study
If long-term smokers age 50 or more underwent careful CT screening and follow-up care, the cost per life saved would compare favorably with screening for cervical, breast, and colorectal cancers
Bethesda, MD -- Lung cancer screening would save thousands of lives at a relatively low cost if such tests were routinely covered by commercial insurers, according to a first-of-its-kind actuarial study in the April issue of Health Affairs.
Lung cancer causes more than 150,000 deaths each year, making it the most lethal cancer in the United States, according to the authors of the study. Yet most insurance companies do not offer coverage for lung cancer screening for high-risk individuals, even though these tests can pick up early stage tumors.
"These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer," said lead author Bruce Pyenson, an actuary and principal at the New York office of Milliman, a consulting and actuarial firm. "The evidence of the value of advanced screening technology for lung cancer has accumulated to the point where we can show very strong cost-effectiveness for the commercial population. We can also jump the needle on cancer mortality for the first time in years, and do so in a cost-effective manner."
This study examined the costs and benefits of providing lung cancer screening through widely available low-dose spiral computed tomography (CT) to smokers and long-term former smokers ages 50 to 64--people at high risk of developing lung cancer. Most private insurers do not cover this screening because the evidence on the cost-benefit front has been scarce or conflicting, until now.
The team of authors modeled insurer costs, assuming about 18 million people fell into that high-risk category and about half would get the screening if it were a covered benefit. Managed care reimbursement for a spiral CT, for example, can be as low as $180. Assuming costs around that level, the researchers found that the screening would cost insurance companies about $247 per member tested annually. When the total expense of screening was spread over the commercially insured population, the cost was under $1 per insured member per month.
The study found that, if such screening in place for the last 15 years, today 130,000 more people would be alive under age 65, plus additional people alive over age 65. The cost per life-year saved would be lower than screening for cervical and breast cancer and comparable to the cost per life-year saved of screening for colorectal cancer.
"This screening process offers a good value for the money and it saves lives," Pyenson said. "Late stage lung cancer is deadly, but if treated at early stage, survival is very good--that's what makes early detection so promising."
Just last year, for example, the National Cancer Institute published results from a large randomized controlled trial that showed that screening with a technology called computed tomography or CT scans can reduce the risk of dying from lung cancer. Such CT technology has rapidly evolved over the last 15 years and now can both identify small, suspicious nodules and be used to determine growth patterns that indicate likely malignancies, Pyenson said.
This study includes limitations. For example, the cost could be higher and the benefits lower if screening tests are not conducted according to best practice guidelines for price and follow-up.
Accordingly, the authors emphasize the importance of efficient implementation of lung cancer screening, including insurers' selection of high-quality providers; use of best practices for managing clinical aspects of screening, especially if lesions are found; and rigorous tracking of outcomes. "Rolling out lung cancer screening with embedded continuous quality improvement can prove how care breakthroughs and advanced technology do not have to feed cost escalation," Pyenson added.
In the United States, we have 2.3 doctors for every 1,000 people, but in places like Tanzania, Africa, there is only one doctor for every 20,000 people.
Our medical students and residents are increasingly committed to going to economically poor nations to volunteer and provide health care. They are willing to live in very primitive conditions in exchange for having a chance to do things in those countries that they could not do back home.
Their goals are to help people - and to expand their skills. Often, they provide care without the supervision of a qualified doctor. This frequently is at the urging of the local hospital or clinic where they really need people to provide care. When they return home, many tell stories of being the most experienced person at the site. Some are even asked to run a clinic or provide a special service.
To be frank while the trainees are well-intentioned, they are practicing above their skill levels. At home, we would not let them do these procedures, or make treatment decisions because they have not yet acquired sufficient skill and training. More important, treatment decisions that may work in the United States, where people receive follow-up testing and regular visits, might not work in a country where there's no transportation, no one oncall for emergencies and no continuity of care.
Some scholars of global health argue that students should treat patients in developing nations with exactly the same limitations they have back home. If they can't prescribe drugs at home or suture, they shouldn't do it elsewhere. They question the ethics of practicing medicine on people who have the misfortune to be poor.
Other scholars feel just as strongly that some care is better than no care, and medical students and residents should try all they can to help people as long as they feel comfortable and knowledgeable. A research paper in the Journal of Medical Ethics asked how local health-care providers feel about these foreign students coming down and practicing medicine above the level they would be allowed at home.
Interestingly, in this one study, the vast majority of local health-care providers wanted the students to do what they felt comfortable doing as long as it was medically necessary. It didn't matter to them whether or not they were supervised. For example, in many countries, the patients don't need doctors to prescribe medications such as antibiotics or pain killers or stomach treatments. Patients can just go and pick up the medicine at a local pharmacy.
So, if a medical student suggests a specific drug so that a person avoids a dangerous or ineffective altema tive drug, then
the patient is getting better care than he normally would. It didn't matter to the local providers that the students can'tdo the same at home.
To what standard should medical trainees be held? Should they work only at the same level they do at home? Are we taking advantage of people in other countries because they have no other alternative?
Share your opinions in the comment section of this column online or send them to Wilkes at the email address below.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.
Debbie Schork, a deli worker at a supermarket in Indiana, had to have her hand amputated after an emergency room nurse injected her with an anti-nausea drug, causing gangrene. She sued the manufacturer named in the hospital's records for failing to warn about the risks of injecting it. Her case was quietly thrown out of court last fall.
That result stands in sharp contrast to the Highly publicized case of Diana Levine, a professional musician from Vermont. Her hand and forearm were amputated because of gangrene after a physician assistant at a health clinic injected her with the same drug. She sued the drugmaker, Wyeth, and won $6.8 million.
The financial outcomes were radically different for one reason: Schork had received the generic version of the drug, known as promet-hazine, while Levine had been given the brand name, Phenergan.
"Explain the difference between the generic and the real one - it's just a different company making the same thing," Schork said.
Across the country, dozens of lawsuits against generic pharmaceutical companies are being dismissed because of a Supreme Court decision last year that said the companies did not have control over what their labels said and therefore could not be sued for failing to alert patients about the risks of taking their drugs.
Now, what once seemed like a trivial detail - whether to take a generic or brand-name drug has become the deciding factor in whether a patient can seek legal recourse from a drug company. The cases range from that of Schork, who wasn't told which type of drug she had been given when she visited the hospital, to people like Camille Baruch, who developed a gastrointestinal disease after taking a generic form of the drug Accutane, as required by her health care plan.
'Your pharmacists aren't telling you, hey, when we fill this with your generic, you are giving up all of your legal remedies," said Michael Johnson, a lawyer who represented Gladys Mensing, one of the patients who sued generic drug companies in last year's Supreme Court case, Pliva v. Mensing.
The Supreme Court ruling affects potentially millions of people: Nearly 80 percent of prescriptions in the United States are filled by a generic, and most states permit pharmacists to dispense a generic in place of a brand name. More than 40 judges have dismissed cases against generic manufacturers since the Supreme Court issued its rulingrlast June, including some who dismissed dozens of cases that had been consolidated under one judge.
Public Citizen, a consumer advocacy group, has petitioned the Food and Drug Administration to give generic companies greater control over their labels, a rule change that could allow users of generic drugs to sue, but the agency said earlier that it needed more time to decide.
"Congress can make this problem go away, and the FDA could, too," said Allison Zieve, the director of Public Citizen Litigation Group. A spokeswoman for the FDA declined to comment.saramentomenshealth.com
The Supreme Court's ruling has its roots in the Hatch-Wax-man Act, the 1984 law that opened the floodgates to generic drugs. That law allowed companies to skip the lengthy process required to approve new drugs if they could prove that the generic drug was equivalent to its brand-name counterpart.
LOS ANGELES - For generations of women, it has been an ingrained medical ritual: Get a Pap test every year.
Now two influential groups of medical experts say having cervical cancer screening once a year is not necessary and, in fact, should be discouraged.
Many women can wait as long as five years between screenings, the new guidelines say.
The call for screening cutbacks, released Wednesday, is based on evolving knowledge accrued during the past decade about human papillo-mavirus, or HPV, a common sexually transmitted disease that causes most cervical cancer, and the availability of an HPV test that shows whether a woman has been infected with the most common variants of the virus.
In recent years, advice on cervical cancer screening has varied widely among medical organizations, with experts recommending screening intervals ranging from one to three years and varying according to a woman's age and whether she is sexually active.
The fact that the two new documents are largely in agreement should reassure women and their doctors that experts have neared a consensus on what has been a controversial issue in prevention medicine, said Debbie Saslow, director of breast and gynecological cancer for the American Cancer Society, which led a consortium that was one of the groups issuing the guidelines.
"I think everyone is on the same page for the first time that I can remember," Saslow said.
By having both a Pap smear and an HPV test -known as co-testing women ages 30 to 65 can safely go five years between screenings if the results are negative, said Dr. Michael LeFevre, co-vice chair of the
U.S. Preventive Services Task Force, which published the other set of guidelines in the Annals of Internal Medicine.
This is the first time that co-testing has been formally recommended as an alternative to Pap smears alone, although some doctors have been offering the tests in tandem for some time.
Studies show the death rate for cervical cancer is not affected by lengthening screening intervals, LeFevre said, and the move would reduce the number of false-positive tests and unnecessary follow-up procedures.
"You can have fewer Pap smears and it is still as safe and effective," he said. "That is the product of science and what we've learned about HPV."
Both the U.S. Preventive Services Task Force and the consortium of medical groups led by the American Cancer Society continue to emphasize that Pap tests are important, however. More than 11,000 new cases of cervical cancer are diagnosed each year in the U.S. and about 4,000 women die from the disease, largely because they didn't get screened and their cancers were caught too late.
"If you look at cervical cancer today in the U.S., at least half of the women who get it have not been screened," LeFevre said.
"Extending out the interval to three years or five years doesn't mean, 'Gee, this must not be important'"
The new guidelines are the latest in a number of reports issued in recent years by the task force and other medical groups recommending fewer routine cancer screenings.
That's because emerging science shows test intervals can be safely lengthened, and doing so would reduce the distress caused by false-positives and harm resulting from unnecessary procedures.
From the Director; In my opinion. if 5 years becomes the rule each Pap Smear would have to be properly taken, properly prepared for transport to the Laboratory, properly stained and read by someone properly trained to read and interpret Pap Smears, then, properly recorded and delivered to the Physician and patient involved. An error in any one of the steps could result in the patient involved having a ten or more year period to develop and suffer with a Cancer of the Cervix of her Uterus.
Teen pot smoking jumps, survey says BIG INCREASE IN FREQUENT USE IS CALLED ALARMING
By Jennifer C. Kerr
Associated Press
WASHINGTON - More teens are smoking dope, with nearly one in 10 lighting up at least 20 or more times a month, according to a new survey of young people.
The report by the Partnership at
Drugfree.org, being released today, also said abuse of prescription medicine may be easing a bit among young people in grades nine through 12, but still remains high.
Partnership President Steve Pasierb says the mindset among parents is that ifs just a little weed or a few pills - no biggie.
'Parents are talking about cocaine and heroin, things that scare them," said Pasierb. Parents are not talking about prescription drugs and marijuana They can't wink and nod. They need to be stressing the message that this behavior is unhealthy."
Use of harder drugs - cocaine and metham-phetamine - has stabilized in recent years, the group's survey showed. But past-month usage of marijuana grew from 19 percent in 2008 to 27 percent last year.
Also alarming, says Pasierb, is the percentage of teens smoking pot 20 or more times a month. That rate went from 5 percent in 2008 to 9 percent last year, or about 1.5 million teens toking up that frequently.
Alex, 17, in Houston, says he started smoking pot at age 13, mostly on the weekends with friends. "I just liked being high," said Alex, who is in a recovery program and asked that his last name not be used. "I always felt happier. Everything was funnier and my life was just brighter."
Alex then started abusing prescription drugs at 14. He blacked out one day at school, got arrested and ended up in rehab. After being sober for two years, Alex slipped and smoked pot last month. Still, he says he hopes to work toward a more sober life.
The findings on marijuana track closely with those in a recent University of Michigan study sponsored by the National Institute on Drug Abuse, part of the National Institutes of Health.
That study also found marijuana use rising among teens the past few years, reversing a long decline in the previous decade.
The partnership study suggests a link between teens who smoke pot more regularly and the use of other drugs. Teens who smoked 20 times or more a month were almost twice as likely as kids who smoked pot less frequently to use Ecstasy, cocaine or crack.
Other findings:
One in 10 teens reports using prescription pain medication - Vicodin or OxyContin in the past year. Thaf s down from a peak of 15 percent in 2009 and 14 percent in 2010.
Just over half of Latino teens say they have used an illicit drug, such as Ecstasy or cocaine, in the past year. That compares to 39 percent for white teens and 42 percent for African American teens.
The Marijuana Policy Project, which advocates legalization, says making pot legal for adults might help cut teen usage.
"We definitely don't think that minors should be using marijuana any more than they should be drinking or using tobacco, but arresting people for doing that never stops minors," said Morgan Fox, a spokesman for the group.
"If we remove marijuana from the criminal market and have the market run by responsible business people that have an incentive to check IDs and not sell to minors, then we might see those rates drop again."
The Partnership's study was sponsored by the MetLife Foundation. Researchers surveyed 3,322 teens in grades nine-12 with anonymous questionnaires that the youngsters filled out at school from March to June 2011. The study has a margin of error of plus or minus three percentage points.
Based in New York, the Partnership at
Drugfree.org is formerly the Partnership for a Drug-Free America - perhaps best known for the "this is your brain on drugs" ads of the 1980s and 1990s.
The nonprofit group launched its new name in 2010 to position itself as more of a resource to parents and to avoid the misperception the partnership is a government organization.
CHICAGO - Less than a month old, Savannah Dannel-ley scrunches her tiny face into a scowl as a nurse gently squirts a dose of methadone into her mouth.
The infant is going through drug withdrawal and is being treated with the same narcotic prescribed for her mother to fight addiction to powerful prescription painkillers.
Disturbing new research says the number of U.S. babies born with signs of opiate drug withdrawal has tripled in a decade because of a surge in pregnant women's use of legal and illegal narcotics, including Vicodin, OxyContin and heroin. It is the first national study of the problem.
The number of newborns with withdrawal symptoms increased from a little more than 1 per 1,000 babies sent home from the hospital in 2000 to more than 3 per 1,000 in 2009, the study found. More than 13,000 U.S. infants were affected in 2009, the researchers estimated.
The newborns include babies like Savannah, whose mother stopped abusing painkillers and switched to prescription methadone early in pregnancy, and those whose mothers are still abusing legal or illegal drugs.
Weaning infants from these drugs can take weeks or months and often requires a lengthy stay in intensive care units. Hospital charges for treatment have soared from $190 million to $720 million between 2000 and 2009.
The study was released online Monday in the Journal ofthe American Medical Association.
Savannah is hooked up to heart and oxygen monitors in an Oak Lawn, 111., newborn intensive care unit. It nearly breaks her mother's heart. "It's really hard, every day, emotionally and physically," said Aileen Dannelley, 25.
Doctors say newborns aren't really addicted - which connotes drug-seeking behavior - but their bodies are dependent on methadone or other opiates because of their mothers' use while pregnant Small methadone doses to wean them off these drugs is safer than total cutoffs, which can cause seizures and even death, said Dr. Mark Brown, pediatrics chief at Eastern Maine Medical Center.
Newborn drug withdrawal is rampant in Maine, Florida, West Virginia, parts of the Midwest and other sections of the country.
Dr. Stephen Patrick, the lead author of the study and a newborn specialist at the University of Michigan health system in Ann Arbor, called the problem a "public health epidemic." University of Maine scientist Marie Hayes said her research suggests some affected infants suffer developmental delays in early childhood, but whether those problems persist is uncertain.
If s the 21st-century version of what was known as the "crack baby" epidemic of the 1980s. But some experts say that epidemic was overbldwn. And some think the current problem is exaggerated, too.
Carl Hart, an assistant psychiatry professor at Columbia University, noted that only a tiny portion of the estimated 4 million U.S. infants born each year are affected. Hart also said the study probably includes women who weren't abusing drugs during pregnancy, but were taking prescribed painkillers for legitimate reasons. He worries the study will unfairly stigmatize pregnant women "doing the right thing" by taking methadone to fight their addiction.
Dannelley was still abusing drugs early in her pregnancy but decided in December to quit, vowing: "I'm not going to go back to that lifestyle. There's a baby inside me."
Now she is trying to get her life back on track Estranged from her husband, she is living with her parents and just signed up for junior college nursing classes. She hopes to take Savannah home soon.
"I am doing so good for the first time in my life," Dannelley said.
THE AAPS ANALYSIS OF SUPREME COURT HEARING ON OBAMA'S HEALTH CARE REFORM LAW
From the Medical Director
READ THE AAPS ANALYSIS OF SUPREME COURT HEARINGS [3/26-28/2012] OF PRESIDENT OBAMA'S HEALTH CARE REFORM LAW AND MEDICAID See the lead article in the "NEWS YOU MAY HAVE MISSED" section of this website. [Too lengthy an article for this section]
More than 80 percent of the active ingredients for drugs sold in the United States are made abroad, mostly in a shadowy network of facilities in China and India that are rarely visited by government inspectors, who sometimes cannot even find the plants.
But after decades of failed attempts, the federal government and the generic drug industry have reached an agreement that is almost certain to pass Congress and will lead to routine inspections of these overseas plants, potentially transforming the enormous global medicine trade.
Under the landmark agreement, expected to be completed within weeks, generic drag companies, which make 75 percent of the prescription medicines sold in the United States, would pay $299 million in annual fees to underwrite inspections of foreign manufacturing plants every two years, the same frequency required of domestic plants.
Self-interest helped drive the agreement because the industry will not only get speedier approvals of new products as part of the deal but also may avoid scandals involving tainted medicines, which tend to hurt confidence in the entire industry.
At its present pace, the Food and Drag Administration would need more than 13 years to inspect every foreign drag plant exporting to the United States. Some plants have never been inspected, which saves them huge sums in cleanup and other compliance costs -an important reason that drug manufacturing is disappearing from the United States and that tainted-drug scandals occur.
In one infamous case, manufacturers in China deliberately substituted a cheap fake for the dried pig intestines used to make the blood-thinning drug heparin. The tainted drug was linked to 81 deaths and exposed tens of thousands of people to danger. The FDA never inspected the plants making the crucial ingredients.
"This agreement is epoch-making," said Guy Villax, chief executive of Hovione, a generic drug maker with plants in New Jersey, Europe and China. Supply chains for many generic drugs often contain dozens of middlemen and "are highly susceptible to being infiltrated by falsified" drugs, Villax said.
Margaret Hamburg, commissioner of the FDA, said she was pleased with the generic drug fee proposals.
"If a program along the lines of what the parties are working on is enacted by Congress, it would represent a real breakthrough," Hamburg said. "FDA's entire generic drug program would be placed on a much more stable footing."
The agreement will not affect the making of over-the-counter medicines or vitamins, whose global supply chains are even more vulnerable to tampering since government inspectors almost never visit their makers. Aspirin and vitamin C supplements, among others, are now made almost entirely in uninspected plants in China.
Nor will the agreement change the FDA's oversight of name-brand prescription medicines. Although branded drugs usually have more secure supply chains than gener-ics do, major pharmaceutical companies have moved aggressively into China in recent years and often rely on rarely inspected suppliers.
Federal officials for years have expressed concerns about the nation's growing reliance on sometimes mysterious foreign drag suppliers, but they had largely despaired of fixing the problem.
Congress has never given the FDA the money needed to inspect these plants, and for nearly two decades the generic drag industry resisted proposals to pay inspection fees.
The industry changed its stance for several reasons. First, the heparin scandal scared everyone. The fake ingredient was good enough to pass a sophisticated test, so the conspirators likely knew that deaths would result, reflecting a callous level of greed. And the government of China refused to allow the FDA to investigate,suggesting that the perpetrators were not only smart but politically well-connected.
Second, the generic drug industry is no longer a motley collection of struggling mom-and-pop companies. Years of consolidation have created giants like Israel-based Teva Pharmaceuticals that understand that their businesses depend on winning the confidence of patients and regulators alike, and they can afford to pay the fees needed to achieve that confidence.
Third, the industry finally gave up hope that Congress would appropriate enough money for the FDA to perform the job. .The agency's oversight of generics has floundered so badly that new applications to sell generics take a median of 31 months to be approved, and there are now 2,458 applications awaiting approval.
The new fees are expected to underwrite the hiring of enough reviewers to bring approval times down to 10 months and sharply cut the application backlog.
When the California Legislature passed the 2011-12 State Budget in June, they assumed a sizable ($10 billion) increase in revenue based on projections of an improving economy. But early projections show the state will face a $12.8 billion deficit for the coming fiscal year.
To account for the uncertainty of tax revenue, the Legislature included a set of automatic “trigger” cuts that would be implemented if revenues fell short. The trigger cuts were divided into two tiers, depending on how far revenues fell short.
On December 13, California Governor Jerry Brown announced that, while revenues are higher than last year, they are not high as projected. He therefore pulled the budget trigger on the “Tier 1” cuts.
Of the scheduled reductions, the extension of the March 2011 cuts to Medi-Cal managed care plans – expected to yield a $15 million reduction to the Medi-Cal program – is the most likely to affect physicians.
When the 10 percent cut was passed, the Program of All-Inclusive Care for the Elderly (PACE), Senior Care Action Network (SCAN) and AIDS Healthcare Foundation were exempted. They are now included in the cut. Doctors working with those plans may see reductions.
The official list of trigger cuts also includes the following:
$100 million to the University of California
$100 million to the California State Universities
$100 million to the Department of Developmental Services
$110 million to the In-Home Supportive Services program, including $100 million in service hour cuts, and $10 million for local anti-fraud efforts
$92 million to the Department of Corrections and Rehabilitation (CDCR)
$72.1 million in increased county charges for youthful offenders sent to CDCR
$30 million to the California Community Colleges backfilled with a $10 per unit fee increase
$23 million to the Department of Education related to childcare funding
$16 million to the California State Library related to library grants
$15 million to the California Emergency Management Agency related to local vertical prosecution grants
All of the cuts listed above were effective January 1, 2012.
January 3, 2012 (CNSNews.com) – According to its latest annual report, the Planned Parenthood Federation of America (PPFA) received $487.4 million in tax dollars over a twelve-month period and performed 329,455 abortions.
Marjorie Dannenfelser, president of the Susan B. Anthony List, a pro-life organization that lobbies Congress to defund Planned Parenthood, called the organization an "abortion giant."
"With over a billion in net assets and a business model centered on abortion and government subsidies, it is time for Planned Parenthood to end its reliance on taxpayer dollars," Dannenfelser said in a statement. "Despite an unprecedented effort by statewide and federal leaders to defund them, a wave of former employees willing to testify against them, and uniform agreement amongst Republican presidential candidates that they should be defunded, Planned Parenthood continues full-steam ahead."
"They are unwilling to answer to the pro-life American majority that wants out of this business," Dannenfelser said.
As reported earlier by CNSNews.com, a spokesperson with Planned Parenthood told Bloomberg’s Businessweek last year that 90 percent of government funding the organization gets is from the federal government or from Medicaid.
Mara Hvistendahl is worried about girls. Not in any political, moral or cultural sense but as an existential matter. She is right to be. In China, India and numerous other countries (both developing and developed), there are many more men than women, the result of systematic campaigns against baby girls. In "Unnatural Selection," Ms. Hvistendahl reports on this gender imbalance: what it is, how it came to be and what it means for the future.
In nature, 105 boys are born for every 100 girls. This ratio is biologically ironclad. Between 104 and 106 is the normal range, and that's as far as the natural window goes. Any other number is the result of unnatural events.
Yet today in India there are 112 boys born for every 100 girls. In China, the number is 121—though plenty of Chinese towns are over the 150 mark. China's and India's populations are mammoth enough that their outlying sex ratios have skewed the global average to a biologically impossible 107. But the imbalance is not only in Asia. Azerbaijan stands at 115, Georgia at 118 and Armenia at 120.
What is causing the skewed ratio: abortion. If the male number in the sex ratio is above 106, it means that couples are having abortions when they find out the mother is carrying a girl. By Ms. Hvistendahl's counting, there have been so many sex-selective abortions in the past three decades that 163 million girls, who by biological averages should have been born, are missing from the world. Moral horror aside, this is likely to be of very large consequence.
In the mid-1970s, amniocentesis, which reveals the sex of a baby in utero, became available in developing countries. Originally meant to test for fetal abnormalities, by the 1980s it was known as the "sex test" in India and other places where parents put a premium on sons. When amnio was replaced by the cheaper and less invasive ultrasound, it meant that most couples who wanted a baby boy could know ahead of time if they were going to have one and, if they were not, do something about it. "Better 500 rupees now than 5,000 later," reads one ad put out by an Indian clinic, a reference to the price of a sex test versus the cost of a dowry.
But oddly enough, Ms. Hvistendahl notes, it is usually a country's rich, not its poor, who lead the way in choosing against girls. "Sex selection typically starts with the urban, well-educated stratum of society," she writes. "Elites are the first to gain access to a new technology, whether MRI scanners, smart phones—or ultrasound machines." The behavior of elites then filters down until it becomes part of the broader culture. Even more unexpectedly, the decision to abort baby girls is usually made by womenIf you peer hard enough at the data, you can actually see parents demanding boys. Take South Korea. In 1989, the sex ratio for first births there was 104 boys for every 100 girls—perfectly normal. But couples who had a girl became increasingly desperate to acquire a boy. For second births, the male number climbed to 113; for third, to 185. Among fourth-born children, it was a mind-boggling 209. Even more alarming is that people maintain their cultural assumptions even in the diaspora; research shows a similar birth-preference pattern among couples of Chinese, Indian and Korean descent right here in America.
Unnatural Selection: Choosing Boys Over Girls and the Consequences of a World Full of Men
By Mara Hvistendahl PublicAffairs, 314 pages,
Ms. Hvistendahl argues that such imbalances are portents of Very Bad Things to come. "Historically, societies in which men substantially outnumber women are not nice places to live," she writes. "Often they are unstable. Sometimes they are violent." As examples she notes that high sex ratios were at play as far back as the fourth century B.C. in Athens—a particularly bloody time in Greek history—and during China's Taiping Rebellion in the mid-19th century. (Both eras featured widespread female infanticide.) She also notes that the dearth of women along the frontier in the American West probably had a lot to do with its being wild. In 1870, for instance, the sex ratio west of the Mississippi was 125 to 100. In California it was 166 to 100. In Nevada it was 320. In western Kansas, it was 768...."
From the Director: the complete review may be seen in the Articles On Health Care Reform Section of this website. Articles on Health Care Reform.
BREAST FEEDING STRONGLY RECOMMENDED FOR NEWBORN INFANTS AT KAISER HOSPITAL
Sacramento Bee 11/30/2011
HEALTH
Kaiser will encourage new moms to breast-feed
by grace rubenstein
Only a handful of hospitals and birthing centers across the United States meet the highest standards for encouraging new mothers to breast-feed their infants. Soon, all Kaiser Perma-nente facilities will join that distinct group.
"Astronomical" was how Richard Schanler of the American Academy of Pediatrics described the move, which Kaiser announced Tuesday.
"This is phenomenal that a hospital system is doing this," Schanler said.
A growing body of research shows that breast-feeding reduces newborns' risk of common ailments such as pneumonia, ear infections, upset stomach and diarrhea, said Schanler, chairman of the academy's section on breastfeeding and chief of neonatol-ogy at Cohen Children's Medical Center of New York
Longer term, he said, people who breast-fed as infants have a lower risk of diabetes, heart disease and obesity in adulthood.
But hospital practices are just starting to catch up to the research. Only 121 hospitals and birthing centers across the country meet the designation "Baby Friendly," a label created by the World Health Organization and UNICEF for sites that follow certain practices to promote breast-feeding. Worldwide, more than 19,000 medical facilities have earned the designation.
Kaiser announced Tuesday that by the start of 2013, all 29 of its birthing sites will meet at least one of two high breastfeeding standards.
REPORTING AN INCREASE IN CASES OF WHOOPING COUGH IN THE EAST
Whooping Cough Outbreak Spreads On Long Island; More Than 200 Cases Reported
Health Officials: Early Detection, Antibiotic Treatment Are Keys To Better Health
November 29, 2011 10:25 PM
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LINDENHURST, N.Y. (CBSNewYork) An alarming rise in a potentially fatal bacterial infection known as whooping cough has prompted a warning from the Suffolk County Health Department.
It's a tell-tale sign winter is coming for children and their colds.
But what is going around this year is a potentially fatal bacterial cough known as pertussis or whooping cough, reports CBS .
It's a chronic cough, almost a barking sound, that can last more than three months, and it is spread easily through droplets.
"My wife is on a bus, educational bus, so she is with kids all the time every day. But she hasn't been sick yet," local resident Steven Piering said Tuesday.
WCBS 880 Long Island Bureau Chief Mike Xirinachs On The Story. The whooping cough outbreak started with 13 cases in Smithtown on Long Island in June. Since then it has spread to more than a dozen districts in Suffolk County.
The most recent case of whooping cough involves a student at 5th Avenue Elementary in Northport, where 11 cases have already been reported. On Tuesday night, parents told CBS's Hazel Sanchez they are growing concerned.
"That's kind of scary. I wonder what's going on, why this outbreak started. What's going on?" one resident asked.
"They get colds at home. They bring it on the bus. They bring it to school. They're bringing it home," a school bus driver told WCBS 880 Long Island Bureau Chief Mike Xirinachs.
And what's particularly concerning to health officials is this most recent outbreak has the highest number of cases reported since 2006 when there were 110 for the year. Now it's 216 cases of whooping cough for the year so far.
What's causing this sudden and sharp rise in whooping cough has yet to be determined, said Dr. Dennis Russo with the Suffolk County Health Department. He said it might be as simple as more doctors are detecting and diagnosing it, or it could be an increase in some parent's decision to forgo vaccinating their kids.
"We like to have everyone vaccinated and create a cocoon effect, so that everyone around them is vaccinated and the disease is milder," Dr. Russo said.
"I'm not too concerned because my son has the vaccine," added Maria Sangiorgi of Lindenhurst.
Health officials said early detection and antibiotic treatment are the keys to better health and preventing the spread of whooping cough.
The majority of the students who have been infected with whooping cough had been immunized, which health officials said may account for their milder illness.
Babies who are not yet fully immunized are the most at risk of death from the infection.
From the Director: Get your Doctors advice on this matter,now!
Every year, more mothers in California deliver their babies by Caesarean section.
Thirty-three percent of births in California were performed by C-section in 2008, compared with 22 percent 10 years earlier. The upward trend is happening with mothers across the demographic spectrum, regardless of race, age or weight
The numbers come from a report released this week by the California Maternal Quality Care Collaborative, a Palo Alto-based group of government agencies, hospitals and physicians' associations from across the state.
Sometimes C-sections are medically necessary, as in breech births where the baby is oriented feet-down, the report said.
When they're not strictly necessary, surgical births raise "considerable" financial costs and risks of health complications for the mother, such as bleeding and infection, the report's authors wrote. They estimated the price of a C-section to be about 70 percent higher than for a vaginal birth.
Other oversight groups have weighed in on the Caesarean boom, which is happening nationwide. The Joint Commission, the national nonprofit that accredits hospitals, wrote in its standards: "There are no data that higher rates improve any outcomes, yet the C-section rates continue to rise."
The World Health Organization formerly pegged the ideal C-section rate at 10 to 15 percent of births, but last year erased that recommendation, saying simply that women should have the procedure if they need it
In California, rates of birth done by C-section vary widely from hospital to hospital. The CMQCC report found they ranged from 18 percent to over 50 percent at locations across the state. The Sacramento region came out below the state average, with around 28 percent of births done surgically.
The most likely reason for the variation, the report said, is differences in hospital policies and attitudes among doctors and nurses in the childbirth unit.
Changes in recent years have often made C-section the "path of least resistance" for mothers and doctors, the authors wrote. For example, physicians have grown more worried about being sued for malpractice, they said.
To ensure that C-sections are done only when necessary, the authors suggested that health care groups develop new measures of quality against which hospitals can check themselves.
They said the industry should rethink payment systems that give doctors andhos-pitals substantially more money for performing C-sections.
Call The Bee's Grace Ruben-stein, (916) 321-1270.
From the Director: No mention is made of the later age chosen by many new mothers for their first pregnancy. The possibility and occurrance of complications is much greater when compared to the younger age groups. New [working] mothers request/favor C-Sections for convenience, therefore, any subsequent pregnancy is likely/safer delivered by C-Section When waiting to a later age to have their first child, parental concern/fears become enormous. Liability concerns for the Obstetrician involved are real, not imagined.
By Nicholas Wade New York Times Medical researchers in Britain have successfully treated six patients suffering from the blood-clotting disease known as hemophilia B by injecting them with the correct form of a defective gene, a landmark achievement in the troubled field of gene therapy.
Hemophilia B, which was carried by Queen Victoria and affected most of the royal houses of Europe, is the fist well-known disease to appear treatable by gene therapy, a technique with a 20-year record of almost unbroken failure.
"I think this is a terrific advance for the field," said Dr. Ronald G. Crystal, a gene therapist at Weill Cornell Medical College. "After all the hype in the early 1990s, I think the field is really coming back now."
Gene therapy has had minor successes in very rare diseases but suffered a major setback in 1999 with the death of a patient in a clinical trial at the University of Pennsylvania, Another gene-therapy trial treated an immune deficiency but caused cancer in some patients.
The general concept of gene therapy - replacing the defective gene in any genetic disease with the intact version - has long been alluring. But carrying it out in practice, usually by loading the replacement gene onto a virus that introduces it into human cells, has been a struggle.The immune system is all too effective at killing the viruses before the genes can take effect
The success with hemophilia B, reported online Saturday in the New England Journal of Medicine, embodies several minor improvements developed over many years by different groups of researchers.
The delivery virus, carrying a good version of the human gene for the clotting agent known as Factor IX, was prepared by researchers at St Jude Children's Research Hospital in Memphis. The patients had been recruited and treated with the virus in England by a team led by Dr. Amit C. Nathwani of University College London; researchers at the Children's Hospital of Philadelphia monitored their immune reactions.
From the Director: Future possibilities of improved health/cure from many other diseases, such as Diabetes, becomes a reality.
In the course of a mere twenty years — from the early 1970s to the early 1990s — public policy whipsawed the American health care system endlessly back and forth at enormous cost in dollars and lives and no noticeable benefit.
It began with a massive national system of health planning designed to do precisely the wrong thing — reduce services at a time of growing demand due to the advent of Medicare and Medicaid. This was predicated on a bumper sticker slogan, “A Built Bed is a Filled Bed,” that was certifiably wrong both in theory and in practice. Health planning failed and was soon repealed.
Then we moved on to all-payer hospital rate setting at the state level that was adopted by thirty states despite the lack of evidence that it could work in anything but the highest cost locations. These, too, were repealed in all but one state (Maryland) because the regulations were “incomprehensible” according to one supporter and failed to work.
But most states retained some form of Certificate of Need regulations, which even the Department of Justice and Federal Trade Commission said failed to contain costs and were seriously anti-competitive. But that is exactly why the American Hospital Association supported these laws — they did not want to risk having to compete against more efficient rivals.
Then large employers got behind “business coalitions on health” that were based on the idea that sharp-penciled business executives could make doctors practice medicine more efficiently. Ultimately these efforts simply added yet another level of bureaucracy to a system that was already for too bureaucratic and did little to solve the problems of efficiency or cost.
Then the “policy community” discovered the “problem” of uncompensated care. After endless fretting and worrying about this new crisis, nothing happened and the level of uncompensated care, which was always a trivial amount of money, did not change a whit. When first discovered uncompensated care accounted for 6% of hospital costs and 13 years later it was still only 6% of hospital costs.
But the discovery of Uncompensated Care led to another discovery — the uninsured. Now here was an issue that would keep the policy community well-employed for decades and be the rationale for an entire bevy of new programs and initiatives. Yet over the course of the next two decades the level of non-insurance barely changed, in spite of all those programs. When it was first measured in 1987 about 84% of the population was insured and 16% uninsured. Twenty years later it was still 84% and 16%.
Of course, to effectively discuss the problem of the uninsured, policy makers would have to know something about insurance. Unfortunately, they learned just enough of the terminology to be dangerous. They completely misunderstood the meaning of ideas such as “risk pooling” and “adverse selection.”
But they had all the information they thought they needed to tell insurance companies how to run their businesses. They began by endorsing “mandated benefits,” which substituted the judgment of politicians for the buyers and sellers of health insurance in deciding what should and should not be covered in a health insurance policy. Over time over 2,000 specific laws would be enacted by the states. These laws did a lot to raise the price of coverage and make insurance less affordable, but the politicians were never blamed for these added costs. Only insurance companies were blamed.
But mandates did not address the “great problem” of the uninsured, so some progressive states went further. They adopted universal health programs of one sort or another. These programs were adopted with great fanfare by politicians and hailed by publications like the New York Times as great breakthroughs. But one-by-one they all failed and were repealed. In some cases they were never actually implemented or in other cases were repealed only after much damage, but the only thing truly “universal” about them was failure.
Then the states set out to “reform” their insurance markets, and once again ended up not “reforming” them but destroying them. See our posts on the NAIC small group reforms and the more ambitious individual market reforms in New Jersey and other states.
We haven’t yet mentioned The Federal HMO Act or ERISA because these laws wouldn’t have much impact on the market until the mid-1990s, but we will be getting to them in future posts.
All of this was done in a mere twenty years. All of it failed, but only after creating much turmoil and doing real damage to the health care system, the economy, and the lives of families. It all adds up to the greatest experiment in social engineering of our lifetimes.
You may have noticed in this sorry saga that all of it was pushed by academics and politicians, and all of it was imposed upon hospitals, doctors, employers, and insurance companies. Who is missing? The patient/consumer/employee/taxpayer.
All of it was a clash between powerful elite interests who simply used concern for “the folks” as an excuse to gain power. Nobody in this story trusted the people to make their own decisions or control their own destinies.
The pretext of their activities was to control health care costs, improve health care quality, and ensure access to health care services. All of this effort failed to have any impact whatsoever on any of that. The nation would have been better served had none of this happened.
ESTROGEN INDICATED AS A TREATMENT FOR "HOT FLASHES" DURING MENOPAUSE
Saturday, Nov. 5,2011 Sacramento Bee
Women: Mixed results for alternative therapy
QUICK HOT FLASH FACTS
According to the U.S. Centers for Disease Control and Prevention, more than 6,000 women reach meno pause each day, and the majority come to know the discomfort of hot flashes: the building rush of heat that centers in the chest and climbs to the face. The tiniest pang of nausea, followed by a sense of anxiety and unease. The red cheeks and sudden outbreak of sweat, followed by a chill that's just as sharp and startling as the body quickly cools back down.
While 80 percent of women have hot flashes, only 20 percent of the time are those hot flashes considered severe, involving profuse sweating, the face turning red, even sweating through the sheets at night.
Doctors used to tell patients that hot flashes could last for 12 months. Now they're more likely to say they'll continue for up to five years, and some women continue having them into their 70s and 80s.
Up to 45. percent of the time, hot flashes will recur in women when they discontinue hormone therapy but likely will be milder.
Many bioidentical hormones, which are identical to women's own hormones, are FDA-approved and widely prescribed for hot flash treatment. These include estra- diol patches and creams and some progesterone pills. But the American Congress of Obstetricians and Gyne cologists and most practitioners warn against the use of compounded bioidentical hormones, which are not FDA-regulated and can vary in quality and strength.
So what causes hot flashes anyway? Why do hor mone changes cause the hypothalamus, the part of the body that regulates body temperature, to go haywfre? Doctors don't yet know.
-Anita Creamer
"Low-dosage hormones are quite safe for women in their 50s who don't have contraindications, and they can be taken for several years. Hormones will definitely improve the hot flash situation."
DR. MARJERY GASS, executive director of the North American Menopause Society
A SEARCH FOR THE TRUE COST OF HEALTH CARE DELIVERY
The Voice for Private Physicians
AAPS news
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
Volume 67. no. 11 November 2011
HONESTY
What Does the Money Buy?From the accountants' reports, it is impossible to know what the term "healthcare services" really means. How many chest x-rays or physician visits were included, at what unit cost? Keep in mind that physicians' overhead for filing claims, checking eligibility, compliance activities, etc., is part of "healthcare services."
The best source we know of—perhaps the only source—for a list of all-inclusive package prices charged to self-paying patients for ambulatory surgical procedures is the website of Surgery Center of Oklahoma (www.surgerycenterok.com). These are true free-market prices. The Center gladly accepts them as payment in full, and patients are glad to pay them. Some patients had been quoted prices as much as ten times higher by other hospitals.
The astonishing conclusion is that often only 10% to 20% of the hospital's "chargemaster"price is needed to pay an efficient, excellent U.S. facility to perform the services, if unencumbered by insurance-related overhead or Medicare rules. What does the remaining 80% to 90% buy?
One answer is that almost nobody, aside from billionaires who aren't on Medicare (e.g. Arab sheiks), pays the full price. So why cite a grossly inflated price? Perhaps to generate huge paper "losses" in order to qualify for tax-exempt ("nonprofit") status or to collect government money for "uncompensated" care. Perhaps to create a margin for sharing with brokers or re-pricing services. Perhaps to "encourage" people to buy costly insurance to "protect" against charges they could afford if they were paying the same price as the plan. On a recent visit to Washington, D.C., Dr. G. Keith Smith was told that people might drop their insurance because a month or two of premiums would be enough to pay for many of the procedures on his Center's list!
And where is Medicare looking for savings? Not from the money-changers in the den of thieves in many of our temples of healing and associated health plans. Rather, in the 20% of the medical dollar that pays for physicians' services. The threatened 30% SGR-mandated cut could cut at most (0.3) (0.2) or 6% of Medicare expenditures, but 60% of physicians' payment for Medicare patients (if their overhead is 50%).
It is the truth that makes us free. One Center posting honest prices could be a national game-changer.
AAPS News, November 20111
From the Director: When I asked the representative of a government controlled health care sysem why his government [the lowest spender amongst several other nations] didn't allow more money for health care he replied "For every Dollar/Franc/Pound added 60% goes to Labor Unions, 30% to admisitrative costs leaving 10% for patient care. That would not solve our problems."
From the AAPS NEWSvol 67,no 11 November 2011 American Association of Physicians and Surgeons
HONESTY
"...Transparency" is the politicians' mantra, but it lacks the moral overtones of "honesty." Lack of transparency muddies, obscures, clouds, conceals, covers up, or complicates, resulting in misdirection and deception. It is, in a word, dishonest.
To have a free market, honesty is essential. Without honest prices, rational decisions are impossible.
One can determine the price of almost everything on the internet—except the true price of most medical services: that is, the price that is actually paid. When prices are freely available— for example, the price of gasoline posted prominently at service stations—and competition is permitted, there is downward pressure on prices, and eventually the variation in the price of comparable goods or services is fairly narrow. Yet the price of medical insurance or medical services seems to move ever upward, and variations even within the same region can be enormous.
We are buried in numerical data, but there can be no meaningful use of meaningless numbers..."
"....After 19 months of research, actuaries could not find a way to make the long-term care program in ACA fiscally sustainable, so Secretary Sebelius told congressional leaders: "I do not see a viable path forward for Class implementation at this time."
One economist estimated that the program would have to enroll more than 230 million people—more than the entire U.S. workforce—to be paid for. Recently released e-mails show that HHS was aware of the program's unsustainability and deliberately withheld the information (Health Policy Matters 9/16/11).
Simply repealing the program is, however, problematic, because removing the phantom savings achieved by front-loading the program with 5 years of revenue collection would add $86 billion to the deficit, according to the Congressional Budget Office's perverse scoring system (WallSt] 10/4/11).
Advocates for the program say they want to hear it from the President if it's really over. "They have the authority to move forward and twist this Rubik's Cube until a solution pops up," said Connie Garner of AdvanceClass (Bloomberg.com 10/14/11)..."
Now that Obama's CLASS Act has crashed and burned, you may be wondering what ever happened to his much-vaunted high-risk pools.
The administration has not been making much of it - a sure sign that it must be failing. And so it is. On October 14 it posted the enrollment data as of August 31, 2011. It turns out that 13 months after the pools went into effect, 33,958 people had enrolled, less than 10% of the 375,000 CMS predicted would be enrolled by the end of 2010.
It is not for lack of effort. In July of this year, CMS cut premiums "significantly" in the 24 states where the Feds run the programs to encourage enrollment, according to the official web site. Yet, curiously, of the 5 states with the largest enrollment - Pennsylvania (3,936), California (3,368), Texas (2,650). North Carolina (2,146), and New York (1,998), only Texas is federally run.
WASHINGTON (AP) -- The Drug Enforcement Administration says people turned in more than 188.5 tons of unwanted or expired prescription medications in the agency's third National Prescription Drug Take-Back Day on Oct. 29.
The DEA initiative that began 13 months ago has resulted in almost 500 tons of medications being taken out of circulation, with assistance from state, local and tribal law enforcement partners as well as community groups.
For the most recent collection day, 5,327 sites were set up around the country.
DEA Administrator Michele Leonhart says the amount of drugs collected during the three Take-Back Days held so far speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs, which could fall into the hands of abusers or pollute the environment.
A new study published by scientists who examined diabetes mellitus type 2, reproductive factors, and breast cancer found a statistically significant association showing a 2.86-fold increased breast cancer risk from one induced abortion.
The study, led by Lilit Khachatryan, included researchers from Johns Hopkins School of Public Health and the University of Pennsylvania. Khachatryan is from the Department of Public Health, American University of Armenia, Yerevan, Armenia; Robert Scharpfb is from the Johns Hopkins School of Public Health and Sarah Kagan is from the School of Nursing at the University of Pennsylvania.
The study, published in Taylor & Francis, also found that delaying a first full-term pregnancy, which is frequently done by women having abortions, also raises the breast cancer risk wheras giving birth resulted in a 64% reduced risk.
Khachatryan’s team reported a statistically significant 13% increased breast cancer risk for every one year delay of a first full term pregnancy (FFTP), with delayed FFTPs until ages 21-30 or after age 30 resulting in 2.21-fold and 4.95-fold increased risks respectively. On the other hand, women with FFTPs before age 20 did not see a comparable breast cancer risk.
They wrote: “Any birth was protective (adjusted OR = 0.36, 95% CI 0.20–0.66). Each year delay in first pregnancy increased risk (adjusted OR = 1.13, 95% CI 1.01–1.27) as did induced abortions (adjusted OR = 2.86, 95% CI 1.02–8.04).”
Karen Malec of the Coalition on Abortion/Breast Cancer said she is not surprised by the findings because, “Fifty-four of 67 epidemiological studies since 1957 report an abortion-breast cancer link (not counting biological and experimental evidence).”
The study was not without some problems, Malec said, as the authors only one severely criticized study (Melbye et al. 1997) to make a claim that they did not believe there was enough evidence to prove the abortion-breast cancer link. Although Melbye’s team found no overall increased risk, they reported a statistically significant 89% increased risk for those having abortions after 18 weeks gestation.
Malec also noted another problem.
“Khachatryan’s group cited recall bias as a possible limitation of their study, but tellingly provided no citations to support that claim. According to this hypothesis, the only reason that scientists find an ABC link is not because abortion really does raise risk. Rather, more women with breast cancer accurately report their past abortions than do healthy women,” she said.
“Similarly, authors of the Uzbekistan Health Examination Survey (which received financial and technical assistance through the US AID-funded MEASURE DHS+ program) said induced abortion is not negatively stigmatized in former Soviet states and that the collection of data is, therefore, successful,” she added.
“National Cancer Institute (NCI) branch chief Dr. Louise Brinton and her colleagues admitted in a 2009 study led by Jessica Dolle that abortion raises risk,” she said. “”They demonstrated that they know recall bias is a red herring used to prop up abortion. After Brinton and the NCI told women during the agency’s 2003 workshop to disregard retrospective studies because they were flawed due to recall bias, Brinton and Jessica Dolle and their colleagues subsequently used supposedly “flawed” data from their group’s 1994 and 1996 studies for their 2009 study.”
She notes that Dr. Joel Brind, one of the world’s foremost researchers on abortion and breast cancer, says, “The recall bias argument has been repeatedly disproved in the literature.”
Brind concluded that Khachatryan’s team “did not-and perhaps were not allowed to-characterize their findings honestly in the politically correct atmosphere of the U.S. and Europe. The good news is that they were able to report their findings in a prominent peer-reviewed journal at all.”
A new study provides what independent researchers call the best evidence yet that colonoscopy - perhaps the most unloved cancer screening test - prevents deaths. Although many people have assumed colonoscopy must save lives because it is so often recommended, strong evidence has been lacking until now.
In patients tracked for as long as 20 years, the death rate from colorectal cancer was cut by 53 percent in those who had the test and whose doctors removed precancerous growths, known as adenomatous polyps, researchers reported Wednesday in the New England Journal of Medicine. The test examines the inside of the intestine with a camera-tipped tube.
COLON CANCER DEATHS have dropped, researchers say, because polyps found during screening are removed before they can develop into cancer.Source: Centers for Disease Control and Prevention
OUR ELECTRONIC SYSTEM OF REGISTRATION AND VOTING IS FLAWED
From the Sacramento Bee 2/17/2012
U.S. voting systems are in a pitiful condition
Approximately 24 milion - one of every eight - active voter registrations in the United States are either invalid or significantly naccurate.
More than 1.8 million dead citizens are listed as active voters.
Approximately 2.75 million people are registered in more than one state.
These are just some of the disturbing findings researchers from the Pew Center on the States document in their latest report on the dismal state of the nation's voting system.
Authors of the report "Inaccurate, Costly, and Inefficient," argue convincingly that the voting system is a failed paper-based relic of the 19th century - but that it doesn't have to be. Some states and many other nations are using state-of-the art technology to register voters more accurately and update registration information when voters move or die in a more timely way - and at a much lower cost.
California is home to Silicon Valley, the high-tech wonder of the world, but when it comes to using sophisticated technological innovation to modernize its voting system, our state lags significantly behind all its Western neighbors. Oregon, Utah, Nevada, Arizona, Colorado and Washington all have online voter registration. California does not.
California is the only state in the union that has not yet created a valid statewide database that allows county registrars to compare voter registration data with voter information from other counties, or against death records and postal change of address data.
Such a system would allow easier and faster cleanup of deadwood. The system is not expected to be in place before 2015 or 2016, after another gubernatorial and possibly presidential election cycle.
This matters not just because the basic apparatus of democracy is flawed to an extent that public confidence in elections is diminished. Hundreds of millions of dollars in public funds are being squandered processing paper registrations at a time recession-battered counties and the state can least afford such waste.
Democracies that use modern technologies to register voters spend a fraction of what election officials in the United States spend.
For example, Pew found our nation's neighbor to the north, Canada, spends only 35 cents per active voter to create and maintain registration lists. By contrast, it costs Oregon $4.11 per active per active voter. Oregon is a model of efficiency when compared to California.
It has been a dozen years since the Florida presidential election debacle of 2000 exposed serious flaws in our voting system.
Billions have been spent to upgrade voting machines and registration systems and yet serious problems persist.
WASHINGTON - The discovery that a fake version of the widely used cancer medicine Avastin is circulating in the United States is raising new fears that the multibil-lion-dollar drug-counterfeiting trade is increasingly making inroads nationally.
The criminal practice has largely been relegated to poor countries with lax regulations. But with more medicines arid drug ingredients for sale in the United States being manufactured overseas, American authorities fear that more counterfeits will find their way into this country, putting patients' lives at risk. The Avastin discovery follows other recent instances here of counterfeiting, involving such drugs as Viagra, the cholesterol medicine Lipitor and the weight-loss pill Alli.
"We do know there are counterfeits continuing to try and make their way onto the U.S. supply chain," said Connie Jung, an associate director in the Food and Drug Administration's office of drug security.
The FDA said Tuesday that it is investigating fake vials of Avastin that were sold to at least 19 doctors and clinics, including 16 sites in California, two in Texas and one in Chicago.
Tests showed the vials did not contain the active ingredient in Avastin, which is given intravenously in hospitals, clinics and doctors' offices to treat several types of cancer. The contents of the vials are still being analyzed, and the FDA said it hasn't received any reports of patients who were harmed.FDA officials said the counterfeit Avastin was imported from Britain and distributed.
The FDA gave assurances Wednesday that the United States remains one of the most secure pharmaceutical markets in the world. But the news sent cancer doctors scrambling to check their records.
Mary Mathias, a nurse who orders drugs for one doctor on the FDA list - Dr. Phillip L Chatham of Granada Hills in Southern California - said her office stopped using the firm in question at least a year ago.
Because Avastin treatments are spaced one to two weeks apart, it is not likely that someone would get more than one infusion from the same vial. And because these are people facing a life-threatening disease, it is hard to say whether missing one treatment with the real drug would compromise their care.
Gauging harm from a counterfeit cancer treatment is nearly impossible, said Dr. Robert C. Young, ex-president of the Fox Chase Cancer Center in Philadelphia and now a consultant to cancer centers.
A colon cancer patient, for example, might get 18 to 20 Avastin infusions over six months. Missing a dose seems unlikely to have a dramatic effect on survival odds, but it's not provable either way because cancer's course and a patient's response to treatment are not predictable, he said.
Counterfeits have traditionally been more of a concern in developing regions like Asia and Latin America, where as many as 30 percent of drugs sold are fake, according to the World Health Organization. Counterfeiting has become more prevalent as pharmaceutical supply chains increasingly stretch across continents. Over 80 percent of the active ingredients used in U.S. Pharmaceuticals are now manufactured overseas, according to a recent congressional report, and experts say this has made it easier to move counterfeit products into this country.
DID PRESIDENT OBAMA BACK DOWN ON BIRTH CONTROL MANDATE?
MARGARET A. BENGS Special to The Sacramento Bee 215/2012
Obama's fig leaf on contraception fails to quell a religious firestorm Margaret A. Bengs is a former spokeswoman for state agencies and apolitical speechwriter who lives in CarmichaeL Email: peggybengs@hotmail.com
Pesident BarackObama's "retreat" last week on his administration's radical mandate that religious employers violate their beliefs or pay exorbitant fines is no retreat at all. It is but a fig leaf that will still force religious organizations to subsidize practices that violate their moral convictions.
On Jan. 20, the U.S. Department of Health and Human Services issued a ruling that under the 2010 Patient Protection and Affordable Care Act, religious-affiliated schools, hospitals and social service organizations must provide free abortion-inducing drugs, sterilization and other contraceptive services that violate church teaching in their health insurance policies, or pay millions of dollars in fines.
In a land settled by pilgrims fleeing religious persecution and whose founders established religious liberty as the first tenet of the Bill of Rights, this flagrant violation of religious freedom awakened a sleeping giant.
More than 170 bishops throughout the country attacked the mandate in letters read to parishioners.
"Unless this rule is overturned," Patrick J. McGrath, Bishop of San Jose, and other bishops wrote, "we Catholics will be compelled either to violate our consciences, or to drop health coverage for our employees (and suffer the penalties for doing so), which is also unconscionable..."
"This is an alarming matter," Sacramento Bishop Jaime Soto said, that "strikes at the fundamental right to religious liberty for all citizens of any faith."
The National Association of Evangelicals, the Union of Orthodox Jewish Congregations of America and many other faith organizations joined in vigorous opposition."
The firestorm forced Obama to back down. But d
d he? On Feb. 10, the president announced an "accommodation." Now, he said, "instead of religiousaffiliated organizations paying for the contraceptive services directly, the insurance companies they choose to cover their employees must pay instead."
But insurance companies won't just collect donations to provide free contraception and services. Costs will eventually be added to premiums, and the premiums will be paid by the religious employers.
So while not providing these services "directly," religious-affiliated employers will forced to subsidize them indirectly.
The bishops aren't buying this distinction without a difference. Not only, they said, would they still be effectively financing contraception coverage, the change does not protect the many religious employers who self-insure or other private employers who object. The bishops are calling for full rescission of the mandate and for Congressional legislation to protect conscience rights under the health care law.
Some critics of faith groups say that employers should not be able to "force their own religious beliefs" on their employees. But no employer is forcing any belief on anyone. Women are free to choose to work elsewhere or to obtain contraceptive services anywhere they like. It is about government coercion of employers based on their religious views.
In fact, the very same people who preach that religions should not impose their beliefs on others appear to be the first to demand that faith organizations bow to the ground the instant the government hands down an edict, as though it came directly from Mount Sinai.
Apparently in the view of those who worship at the altar of secularism, religions cannot intrude on the "wall of separation" between church and state, but the state can intrude on a church's teaching with no problem.
The White House points to states like California that already require contraceptive coverage, but California requires this only for employers who also pay for outpatient prescription drug benefits. And state mandates can be avoided by self-insuring prescription drug coverage or through other means not available under the federal mandate.
Indeed, Obama has done the country a favor by unmasking the truth about the dangers of a federal takeover of the health care system.
Remember, "If you like your health care plan, you can keep it, period." Remember "choice and competition?" Instead, Obama is using force, coercion and fines - jeopardizing faith-based charities, hospitals and schools and the poor, disabled and children they serve, in order to force his agenda.
Those who say this issue is a tempest in a teapot because many Catholic women practice contraception are blinded to the reality of what's at stake. At its core, this issue is not about contraception.
It is about religious freedom. It is about the constitutional limits on federal power.
In the end, it is not even about Obama or the "reproductive rights" zealots at HHS. It's about whether we will continue to believe the lie that government can solve all our problems without growing into an octopus that, at any moment, could snatch away our freedoms..."
STATE WILL APPEAL RULING, WHICH HITS BUDGET BUT HELPS PATIENTS, PROVIDERS
by kevin yamamura kyamamura@sacbee.eom
Federal health officials rejected California's bid to charge Medi-Cal co-payments for everything from drugs to hospital visits, dealing a new blow to the state budget but relief to low-income patients and their providers.
Gov. Jerry Brown and lawmakers relied on mandatory Medi-Cal co-payments to save $511 million in last year's state budget and presumed that the state would continue saving in future years.
The plan to charge low-income Medi-Cal patients and let doctors refuse care for nonpayment was unprecedented for a state on such a wide scale. The charges ranged from $3 for "preferred" drug prescriptions
to $5 for doctor visits and a maximum $200 on hospital visits. Medi-Cal serves about 8 million Californians, though patients also eligible for Medicare were exempt from co-payments.
The state was required to obtain approval from the Centers for Medicare & Medicaid Services (CMS) to implement its plan.
But CMS said in a letter Monday that it was "unable to identify the legal and policy support" for the change. Under the Social Security Act, a state must meet several tests in order to charge co-payments, which include "providing benefits to recipients of medical assistance which can reasonably be expected to be equivalent to the risks to the recipients."
Providers, such as physicians and dentists, and advocates for low-income Californians warned that a co-pay plan would hurt low-income patients by cutting access to health care. Providers felt it was a back-door cut in reimbursement rates, on top of a 10 percent reduction that a federal judge recently blocked, because the state put the burden on them to collect the co-pays or make the decision to refuse patients for nonpayment.
Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty, said Medi-Cal patients would have stopped using health care if faced with a payment requirement. She said research shows that underuse of preventive health care, rather than overuse of the system, drives up costs.
"When people with even a nominal co-pay are asked to pay $3 to $5, they're going to write off the health care system writ large," Cajina said.
"These are children going in for checkups, elderly people going in for care management When you really start thinking about a person on Social Security or a mom on CalWORKs bringing in $800 a month, asking them to pay $5 is a much bigger chunk out of their budget than it would be for other folks."
The governor's latest budget, which estimates a $9.2 billion deficit, acknowledges the lost savings in 2011-12. But it is relying on $575 million to help balance next year's budget, according to Department of Finance spokesman H.D. Palmer. The administration will appeal Monday's ruling with Health and Human Services Secretary Kathleen Sebelius, Palmer said.
Call Kevin Yamamura, Bee Capitol Bureau, (916) 326-5548. Follow him on Twitter @kyamamura.
From the Director: In major nations I have visited, with government administered health care, co-pays proved very successful in curtailing the overuse and abuse , of the system, by the Medicaid patients.
This was started in the teaser article on WSJ on-line and I found it in full
on The Patriot Post · http://patriotpost.us." I'm not a Catholic but I say GO POPE!" by Peggy Noonan
A Battle the President Can't Win
By Peggy Noonan · Saturday, February 4, 2012
His decision on Catholic charities makes Romney's big gaffe look trivial.
What a faux pas, how inept, how removed from the essential realities of America. Yes, I'm referring to President Obama. But let's do Mitt Romney first.
He's taken heavy fire for his interview with CNN's Soledad O'Brien, in which he said, "I'm not concerned about the very poor."
Every criticism has been true. It was politically inept, playing into stereotypes about Republicans and about his own candidacy. It was Martian-like in its seeming remove from the concerns of everyday citizens. We're in a recession here! It was at odds both with longtime American tradition and with rising conservative concern over the growth and changing nature of what used to be called the underclass..."
So: inept..."
* * *
"...But the big political news of the week isn't Mr. Romney's gaffe, or even his victory in Florida. The big story took place in Washington. That's where a bomb went off that not many in the political class heard, or understood.
But President Obama just may have lost the election.
The president signed off on a Health and Human Services ruling that says that under ObamaCare, Catholic institutions -- including charities, hospitals and schools -- will be required by law, for the first time ever, to provide and pay for insurance coverage that includes contraceptives, abortion-inducing drugs and sterilization procedures. If they do not, they will face ruinous fines in the millions of dollars. Or they can always go out of business.
In other words, the Catholic Church was told this week that its institutions can't be Catholic anymore.
I invite you to imagine the moment we are living in without the church's charities, hospitals and schools. And if you know anything about those organizations, you know it is a fantasy that they can afford millions in fines.
There was no reason to make this ruling -- none. Except ideology.
The conscience clause, which keeps the church itself from having to bow to such decisions, has always been assumed to cover the church's institutions.
Now the church is fighting back. Priests in an estimated 70% of parishes last Sunday came forward to read strongly worded protests from the church's bishops. The ruling asks the church to abandon Catholic principles and beliefs; it is an abridgment of the First Amendment; it is not acceptable. They say they will not bow to it. They should never bow to it, not only because they are Catholic and cannot be told to take actions that deny their faith, but because they are citizens of the United States.
If they stay strong and fight, they will win. This is in fact a potentially unifying moment for American Catholics, long split left, right and center. Catholic conservatives will immediately and fully oppose the administration's decision. But Catholic liberals, who feel embarrassed and undercut, have also come out in opposition.
The church is split on many things. But do Catholics in the pews want the government telling their church to contravene its beliefs? A president affronting the leadership of the church, and blithely threatening its great institutions? No, they don't want that. They will unite against that.
The smallest part of this story is political. There are 77.7 million Catholics in the United States. In 2008 they made up 27% of the electorate, about 35 million people. Mr. Obama carried the Catholic vote, 54% to 45%. They helped him win.
They won't this year. And guess where a lot of Catholics live? In the battleground states.
There was no reason to pick this fight. It reflects political incompetence on a scale so great as to make Mitt Romney's gaffes a little bitty thing.
There was nothing for the president to gain, except, perhaps, the pleasure of making a great church bow to him.
Enjoy it while you can. You have awakened a sleeping giant..."
Studies find Alzheimer's spreads like virus in brain
By gina koiata
New York Times
Alzheimer's disease seems to spread like an infection from brain cell to brain cell, two new studies find. But instead of viruses or bacteria, what is being spread is a distorted protein known as tau.
The surprising finding answers a long-standing question and has immediate implications for developing treatments, researchers said. And, they said, they suspect other degenerative brain diseases, like Parkinson's, may spread in the brain in a similar way. Alzheimer's researchers have long known that dying, tau-filled cells first emerge in a small area of the brain where memories are made and stored. The disease then slowly moves outward .
Veterans disability claims rising along with backlogs
Washington Post
WASHINGTON - The Department of Veterans Affairs is facing a growing backlog of disability claims, fueled by veterans returning from Iraq and Afghanistan and a policy change making it easier for Vietnam veterans to file Agent Orange-related claims.
The number of pending claims before VA stood at 853,831 last week, an increase of nearly 100,000 from last year and nearly 500,000 from three years ago.
"Nearly 1 million veterans today are stuck in the backlog and more than half wait at least half a year to find out if their claim has been processed," said Rep. Jeff Miller, R-Fla., chairman of the House Veterans' Affairs Comittee.
Although VA has processed nearly a million claims over the past year, another 1.3 million new claims were filed during the same period. Of the approximately 2.2 million veterans of the wars in Iraq and Afghanistan, 624,000 have filed disability claims and many more are ex
pected. In addition, more than 200,000 Vietnam War veterans have filed claims based on new regulations adopted in 2010 making it easier to get compensation for health problems caused by exposure to defoliants such as Agent Orange.
VA Secretary Eric K. Shin-seki launched a department-wide effort to break the backlog, according to agency officials. The Veterans Benefits Administration budget reached $2 billion in 2012, a 20 percent increase over the previous year, which VA says will accelerate services for veterans. But some members of congressional oversight committees question whether there is much to show for the additional money.
I barely fit into my examining room these days. There are several people in there with my patients — and more on the way. If they all showed up, I wouldn't be able to get through the door.
I've been in this business long enough to recall when only the doctor and the patient needed to be there, but lawsuits brought those days to an end. So, we had to make a place for a lawyer.
That makes three, right? Wrong. Four. The nurse has to be there, too; if there's a dispute, she referees.
Here in California, the insurance company that's going to pay the bill wants a spot, too. They say, "We're paying, so we're staying." Five.
Just when I thought we had it under control, some new government people came to town. They call themselves HCFA, CLIA and OSHA, and they all want seats. Eight.
Our President and his first lady like an idea they call an HCA (health-care alliance) and would set up an NMB (national medical board) to supervise the HCAs, HMOs, IPAs, PPOs and EPOs that see patients. They'll need seats, too.
Our first lady insists it's going to be better if the President gets his way.
SUPREME COURT WILL RULE ON OBAMA HEALTH CARE REFORM LAW
Tuesday, December 20, 2011 The Sacramento Bee A7
High court justices to take long look at health care law
by david G. savage
Tribune Washington Bureau
WASHINGTON - The Supreme Court announced Monday it will hear arguments over three days in late March to decide the constitutionality of President Barack Obama's health care overhaul, another sign the justices see the case as a once-in-a-generation test of the federal government's regulatory power.
The 5 hours of arguments are believed to be the most time devoted to a single case since the 1960s. In the 19th century, the justices often sat silently and listened to arguments over several days in one case. But in recent decades, one hour per case has been the norm, even when a major constitutional question is at issue.
But the health care case has been treated as extraordinary and deserving of an especially probing and thorough review. The court will decide whether the Constitution gave Congress the power to require all Americans to have health insurance by 2014.
The justices will focus on a single lawsuit that began in Florida. Lawyers for Florida and 25 other Republican-led states, joined by the National Federation of Independent Business, sued and asserted that the entire law passed by the Democratic-controlled Congress should be struck down.
The justices said last month they would debate and decide four separate questions that arose from the one suit.
On March 26, the court will consider an issue that could derail a decision for now. A 19th-century law known as the Anti-Injunction Act forbids judges from striking down taxes until the taxpayer has first paid the tax and then sought a refund. Under the health care law, a citizen who has no health insurance in 2014 will have to pay a "penalty" on his or her tax form that is due in April 2015. If this penalty is deemed a "tax," the Anti-Injunction Act says no judge could rule on it until 2015.
On March 27, the court will devote two hours of argument to what has been the main issue: Is the mandate that each individual have insurance a valid regulation of the health insurance market, or an unconstitutional burden on persons who do not want to buy insurance? On March 28, the court will debate if the entire statute should fall if one provision is struck down, or whether it can be "severed" so the rest of the law can stand
DOCTORS ASK: "WHAT AM I WORTH? NO ONE SEEMS TO KNOW"
"This country needs a health plan like the one in Canada and England. I believe that our Doctors are fighting such a plan because the government would determine their fees, not to mention the hospital costs."
A Letter to the Editor, my local newspaper. ______________________
Doctors make too much money, I've been told. Well don't they? I'm not sure and how could I know any way. Most people, even Doctors, don't discuss their incomes, and it isn't considered polite to ask. I feel that way, don't you?
Even so, magazines, newspapers and the other media tell people what I make. Where do they get those numbers? They're not correct, but, my patients and even some of my Colleagues think they are.
Anger is growing amongst us, I can feel it.
Well, how much should a Doctor make? What's it worth to go through all those years of school and then the training necessary to become a Doctor? I don't know and I don't know that anyone ever figured it out.
Nevertheless, it's accepted by many that I make too much money and it's high time that something be done about it.
My fees are being reduced and I see no end to it. That's what bothers me the most, if no one is sure what I'm worth, then who'd know where to stop, before we destroy the system that produced the greatest health care the world has ever known.
I've wondered. Is the public aware of how demanding a career in medicine can be? Do they realize that once we enter the Profession, we accept the responsibility for life long learning and commitment to life long service? Do they know that during all of those years our personal needs must remain secondary to these commitments, to the demands of those who choose us to be their Physicians?
Can they know that in the beginning our wives, husbands and children are proud, patient and understanding. Later, these feelings can give way to anger and frustration, the result of repeated personal and social disappointments, and the seemingly endless loneliness. The family's ego structure can be starving for nourishment while our lives are taken up with the needs of our patients....
Our families may disintegrate. Then, as we grow older, the ability and the willingness to be always correct and forever available becomes difficult to sustain. Guilt may follow. If so, mental depression, divorce, suicide, drugs or alcohol abuse can result.
When this happens, help for the healer in need may be limited, while criticism for those of us who falter, abounds.
"So, I ask again: What am I worth? No one seems to know and I've become afraid. Because, Once they saw me as a God now, I'm not sure. Perhaps... I should have warned them."
What do you think is the best hospital for ordinary abdominal surgery?" asked a woman who needed to have her gallbladder removed.
In the past, my answer would have reflected my own personal opinion. It would not have been based on scientific evidence, and there are many hospitals - both good and bad - that I don't know much about.
Today there is good data that she can use to make her choice. The organization that accredits American hospitals - the Joint Commission for the Accreditation of Hospitals - recently released its list of the country's top 405 hospitals.
They represent 14 percent of the United States and each achieved at least 95 percent on their score card.
None of the biggies - UCLA, Johns Hopkins, Harvard, Columbia or Stanford - is on the list, but several smaller hospitals did exceptionally well.
You may wonder why this list is so different from lists like the "Top Hospitals" compiled by US News and World Report. The answer has to do with the way the lists are developed.The US News and World report asks doctors for their personal opinions on hospitals. Doctors rate hospitals based on reputation for unusual or complicated medical conditions,on the other hand, the Joint Commission's ranking is based on real hospital data related to common conditions like surgery, asthma care for children, heart attacks and pneumonia. So hospitals are ranked on such important things as giving the appropriate medicines to heart attack patients and starting antibiotics before surgery begins. Do these criteria really make a difference? You bet they do - in some cases they can be the difference between life and death.The Joint Commission deserves a great amount of credit for making this comparative information publicly available and for holding hospitals to new high standards. It seems to be making a real difference in the care people receive - most hospitals big and small are now scrambling
.to improve the care they provide.
Are these rankings perfect measures of quality? Of course not, and they need to be made better.
The prestigious hospitals with top-notch doctors still provide very good care, but they don't measure up on some of these important routine quality measures.
So, to the woman who is looking for the best place to have ordinary abdominal surgery, my advice is to pick a great doctor who practices at one of the top 405 hospitals.
See the report at: www.jointcommission.org/ 2011_annual_report.
The Joint Commission: Recent changes to Elements of Performance Effective July 2009, The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), implemented Elements of Performance (EP) regarding the use of physical restraint and seclusion. These changes were made to help align Joint Commission Standards more closely with CMS regulations, help clear up questions related to behavioral restraints and medical restraints, and dictate new requirements for a hospital’s documentation and policies and procedures regarding restraint and seclusion. Additionally, the Joint Commission EPs provide specific staff training.
Michael Wilkes, MJD., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.
From the Director: The Joint Commission is now a member of a Federal Government Agency--It was originated several years/decades/ ago by private practicing physicians.
The PSA test is under attack again, this time from the US. Preventive Services Task Force, which has gone out on a limb suggesting an end to routine PSA screening for prostate cancer. The recommendation, based on exhaustive research, concludes that the test does not generally save lives, and in fact, does more harm overall than good.
Unfortunately, while this recommendation underscores the inadequacy of the PSA test, it neglects to acknowledge that many men will die unnecessarily if they don't get screened. There is a middle road that clinicians and their patients can take that makes use of both routine screening and prostate biopsy to appropriately treat prostate cancer and reduce the chances of dangerous or unwanted side effects.
The task force has recommended that only men with highly suspicious symptoms undergo PSA screening. We know that once symptomatic, a patient with prostate cancer is often beyond cure. PSA screening was started to catch these cancers before they become incurable..."
_______________________________
"....well-meaning people clearly differ on how PSAs should be used; one member of the task force is an esteemed UC Davis colleague. But we cannot return to the 1980s, when men showed up to the clinic with largely incurable disease.
The Institute of Medicine has championed the role of patient-centered care, in which decisions are made jointly between the doctors and their well-informed patients. The task force recommendations in effect suggest that we cannot trust patients to weigh the pros and cons of PSA screenings and, after a balanced discussion with their doctor, decide on a course of treatment. This flies in the face of this best medical practice.
Until we have better tools to diagnose and stage prostate cancer, I recommend we follow the Institute of Medicine's guideline when it comes to PSA screening. Together with his physician, a well-informed patient has a much better chance
From the Director:An earlier HCREI Bulletin [search- Prostate Cancer] reports a new urine test ,when added to the PSA test, to be helpful in deciding who should be treated -- further research is intense concerning this disease.
MAJOR CHANGE IN OBAMA HEALTH CARE LAW
Obama drops long-term insurance from health law
by noam N. levey
Tribune Washington Bureaumn 10/15/2011
WASHINGTON...
WHO IS LIABLE WHEN HEALTH CARE IS DENIED? AAPS NEWS Letter 10/10/2011
Democrat congressional leaders Pelosi and Reid, and chairmen Baucus and Harkin filed an amicus brief in the U.S. Supreme Court in the Maxwell-Jolly cases, arguing that beneficiaries have a private right to sue states that cut Medicaid provider payments.
These same leaders enacted the ACA, in which §3403 denies both judicial and administrative review of decisions of the Independent Payment Advisory Board. The provision was added despite warnings from the Medicare actuary that cutting provider payments would likely cause severe access problems. That is "precisely the issue the Democrat leaders cited as providing justification for Medicaid beneficiaries to sue," writes Christopher Jennings, Health Policy Analyst, Republican Policy Committee.
Courts now struggle with finding managed-care organizations liable when utilization review denies care, if it might involve an eligibility rather than a medical decision. If the U.S. adopts a single -payor system, patients injured by denial or delay of care may have no recourse, writes Benjamin Saunier (IL&M, summer 2011).
"...People with eating disorders such as anorexia have opened up a new battleground in the insurance wars, testing the boundaries of laws mandating equivalent coverage for mental illnesses.
Through claims and court cases, those with severe cases of anorexia or bulimia are fighting insurers to pay for stays in residential treatment centers, arguing that the centers offer around-the-clock monitoring so that patients do not forgo eating or purge their meals.
But in the past few years, some insurance companies have re-emphasized that they do not cover residential treatment for eating disorders or other mental or emotional conditions. The insurers consider residential treatments not only costly - sometimes reaching more than $1,000 a day - hut unproven and more akin to education than to medicine.
Even some doctors who treat eating disorders concede there are few studies proving that residential care is effective, although they believe it. ..."
The FixersThose entrepreneurs are part of the coalitions of experts trying to re-engineer the system. Their initiatives, which included global budgets and prospective payment (DRGs), were based on Roemer's Law, writes Greg Scandlen: Greedy doctors needlessly hospitalized innocent patients, and all could be set right through effective management of physicians by bureaucrats and business executives (http://tinyurl.com/3qoo3r8). Decades and tens of millions of dollars after the Robert Wood Johnson Foundation (RWJF) conference described by Scandlen, RWJF has announced still another "new" program, bragging about its 40 years of involvement in health systems reform (Business Wire 8/31/11). Its website, www.careaboutyourcare.org, has the familiar content: concerns about "gaps" (we need "Quality/Equality"), and calls for electronic records (we need public reports of "health care performance"), "value exchange," and "transformative change."
The fixers aim to go beyond the medical and public health models, to the "social determinants of health" model to enhance "population health," which "may require a wide range of strategies, including redistribution of wealth" (Robert H. Brook, JAMA 6/28/10). "Comparative effectiveness" research needs to include "behavioral economics and change" and "comprehensive inter-agency, multisectoral" strategies (JAMA 8/25/10).
To get doctors integrated into the program, UnitedHealth Groups, a huge player along with RWJF on the Clinton Task Force on Health Care Reform, is simply buying doctor groups. Deals are carefully structured to comply with government rules (WSJ 9/1/11). And if ObamaCare ACOs (see p 2) seem too difficult for physicians and hospitals, UnitedHealth ("United for Reform") is there with "value-based contracting strategies" to fill the gap (www.uhc.com).
At some point, doctors need to decide whether to head for a lifeboat, or keep their well-appointed state room while working on compliance with the deck-chair rearranging program. Maybe they will even jettison DRGs, CPT, ICD-10, ACOs, CER, and ACA.
THIS STUDY FINDS/SUGGESTS A CAUSE FOR PROSTATE CANCER
Sacramento Bee October 12, 2011 »
NATION
Vitamin E linked to cancer
STUDY: LARGE DOSES BOOST PROSTATE RISK
by rob stein Washington Post
Large daily doses of vitamin E, long touted as a virtual wonder drag that could protect against cancer, heart disease, dementia and other ailments, increase the risk for prostate cancer among middle-aged men, according to a large federal study released Tuesday.
The analysis of data from more than 35,000 healthy men concluded that those who took vitamin E every day at the relatively large dose levels commonly sold in drug, grocery and health food stores were 17 percent more likely to develop prostate cancer.
'You really have to question now how taking vitamin E will help someone," said Eric Klein, a Cleveland Clinic prostate cancer expert who led what had been hoped to be a cancer-prevention study. "Not only is it unlikely to help them, it apparently could hurt them."
The findings, published in the Journal of the American Medical Association, are the latest in a series of carefully designed experiments that have found that vitamins and other dietary supplements are useless or possibly dangerous. On Monday, the Archives of Internal Medicine published a paper that concluded that o
lder women might have a higher overall mortality rate if they take multivitamins, folic acid, iron, magnesium, copper or zinc.
"Just because ifs 'only a vitamin' or If s natural,' we assume it must be safe. But over and over again, we see thaf s not necessarily the case," said Howard Par-nes of the National Cancer Institute, which funded the prostate cancer study. "Not only isn't it the fountain of youth that some people said, it can be harmful."
About half of U.S. adults regularly take some kind of supplement, according to the latest federal data,
Americans spend more than $28 billion a year on vitamins, minerals and other substances that companies claim can reduce the risk for cancer, heart attacks, strokes, diabetes and Alzheimer's disease, among others, including about $340 million alone in 2010 for vitamin E, according to the Nutrition Business Journal.
Beta carotene might help slow a common form of blindness known as macu-lar degeneration. But virtually every other large, rigorous attempt to verify the benefits of a dietary supplement has failed, and in some cases produced evidence of harm.
The National Institutes of Health launched a $119 million project to study prostate cancer in 2001 after laboratory studies and some clinical data indicated that the anti-oxidant vitamin E and selenium might protect against prostate cancer, the second most common cancer among men.
The study followed more than 35,533 men ages 50 or older at 427 sites in the United States, Canada and Puerto Rico. The men were divided into four groups who took daily doses of 400 international units of vitamin E and 200 micro-grams of selenium; vitamin E and a placebo that looked like selenium; selenium and a placebo that looked like vitamin E; or two placebos.
An independent panel monitoring the experiment halted it in 2008 when it became clear there was no benefit and indications emerged the supplements might be increasing the risk for prostate cancer and diabetes.
The new analysis, which is based on additional data collected since the trial was halted, found the diabetes risk disappeared, but the prostate cancer risk reached statistical significance. There were 620 cases of prostate cancer among the men taking vitamin E alone, compared with 555 among those taking selenium and vitamin E, 575 among those taking selenium and 529 among men taking a placebo. Based on the findings, the researchers calculated that for every 1,000 men taking vitamin E alone, about 76 developed prostate cancer compared with 65 taking the placebo.
BROWN ALSO SIGNS BILL BARRING CHILDREN FROM TANNING BOOTHS
by david siders
dsiders@sacbee.com
Gov. Jerry Brown has signed legislation allowing children 12 and older to seek medical care for the prevention of sexually transmitted diseases without parental consent, including vaccinations against human papillomavi-rus, or HPV, which can cause cervical cancer.
Brown also announced Sunday that he has signed legislation prohibiting minors from using tanning beds, a first-in-the-nation law.
The signatures came as Brown, a Democrat, finished acting on hundreds of bills sent to him by the Legislaturem this fall. The Democratic governor released decisions on dozens of bills ahead of a Sunday night deadline.
The health care bill, Assembly Bill 499, by Assemblywoman Toni Atkins, D-San Diego, pitted public health officials against parental-rights advocates, vaccination opponents and religious and conservative groups. Existing law allows minors to consent to diagnosis and treatment, but not prevention, of sexually transmitted diseases. Advocates said the bill would provide children access to potentially life-saving care.
Randy Thomasson, president of the conservative Save California.com, said in a prepared statement that Brown "obviously doesn't care about informed consent for patients or parental consent for dads and moms."
He said the bill gives girls "a false sense of security that they can have all the sexual activity they want without risking developing cervical cancer or a raft of other negative consequences."
The issue gained attention after flaring in the Republican presidential race, with Texas Gov. Rick Perry taking criticism from fellow Republicans for signing an executive order in 2007, since overturned, mandating an HPV vaccine for sixth-grade girls but including an "opt out" provision for parents who objected. The law Brown signed does not mandate such a vaccine; it only allows children to seek care without parental consent
The tanning bed bill, Senate Bill 746, by Sen. Ted Lieu, D-Torrance, was supported by doctors, nurses and the American Cancer Society, which said ultraviolet tanning beds increase skin cancer risk
"If everyone knew the true dangers of tanning beds, they'd be shocked," Lieu said in a prepared statement.
The tanning industry argued current law requiring pa
rental consent for children between age 14 and 18 was sufficient, and it said the bill would hurt business. According to a legislative analysis, the Indoor Tanning Association estimated teenagers under age of 18 represent 5 percent to 10 percent of a tanning business's customer base.
The law takes effect Jan. 1.
Ann Haas, a Sacramento dermatologist and past president of the California Society of Dermatology & Dermato-logic Surgery, was among those pushing for the ban.
"If s been a long time coming," she said.
Call David Siders, Bee Capitol Bureau, (916)321-1215. Follow him on Twitter @davidsiders.
MORE BILL ACTION
• Also Sunday, GoV. Jerry Brown signed^ bill giving farmworkers greater protections in labor organizing disputes, and another one on autism treatment. The Bee wraps up some of the other action the governor took Sunday. A4
CAPITOL ALERT BLOG
Track the news of bill signings and vetoes. sacbee.com/capitolalert
GALLERY
Keep up on the 22 most-watched bills on Gov. Jerry Brown's desk.
FAILURE TO VACCINATE CHILDREN CREATING PUBLIC HEALTH PROBLEMS
From the Sacramento Bee 10/8/2011
Vaccination refusal endangers all of us PUBLIC, SCHOOLS NEED TO BE VIGILANT
California is the "epicenter of vaccine refusal" in the United States, Dr. Blaise. Congeni of Akron Children's Hospital in Ohio told ABC News That became an issue with last year's whooping cough epidemic -with 9,143 reported cases, the most in 50 years. Lawmakers acted appropriately, passing a law requiring all seventh- to 12th-graders to get vaccinated starting this school year.
The Bee has reported, however, that some districts, such as Folsom Cordova Unified, were defying the law by allowing unvaccinated students to come to school. Others, such as Natomas Unified, were allowing unvaccinated students to get separate instruction in the gym.
The Legislature needs to revisit the law to ensure that districts that do not enforce the law suffer consequences. Allowing large numbers of students to attend school without being vaccinated puts the community at risk
This isn't just about whooping cough. It also is about other serious or potentially fatal diseases - smallpox, diphtheria, tetanus, polio, measles, mumps, rubella and meningitis.
An important issue is that California has a very loose "personal belief exemption," an opt-out for parents that need not be based on religion or medical necessity. Legislators ought to revisit that law, too.
Overall, the "opt-out" rate is about 2 percent, not a big problem. When a large enough percentage of the population is vaccinated, that protects everybody - including new-borns, people with cancer undergoing chemotherapy and others who cannot be vaccinated. When a small number of parents refuse vaccination, their children are protected as "free riders."
But when a large percentage is intentionally unvaccinated, that puts the larger community at risk - undermining "community immunity." A review of California Department of Public Health data shows that we have clusters of schools in that category. That*s a concern.
Of 280 schools in Sacramento County serving kindergartners, 46 had exemption rates greater than 5 percent last year.
Eight schools had opt-out rates of 20 percent or greater: Golden Valley Charter School of Orangevale and Visions in Education of Carmichael at 57 percent, Sacramento Waldorf at 50 percent, Community Outreach Academy of McClellan at 35 percent, Alice Birney Waldorf at 32 percent, California Montessori Project and Camellia Waldorf at 21 percent and Folsom Community Charter at 20 percent
The public and public health professionals should raise the vaccination issue at these hot spots with principals and PTAs. When parents at these schools make a choice for their child not to get vaccines, they're also making a choice to put others at risk.
The bottom line: Kids need to get their vaccinations to protect us all.
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