Fifth of July

We took the long week-end off and it was sublime, if too short. Back to the grind today, though. Starting with a reality check -- the news:

The Obama Administration is proposing cuts in Medicaid and Medicare in exchange for tax increases. Supposedly, the cuts will come from the payments to providers, but will not reduce benefits to beneficiaries. I don't buy that for a second. Cutting payments to providers makes fewer providers willing to take Medicare and Medicaid -- already a huge problem. And the Medicaid cuts would shift the burden to the states, which are broke, and which will pass them on to beneficiaries. They better get serious tax increases for the wealthy or a lot of people are going to be very unhappy. Here's a guide to the health care industries that are at risk in the debt talks. But the Tea Party is pushing Senator McConnell to demand a balanced budget amendment, which is not going to pass the Senate. The Tea Party is split -- some want no increase to the debt ceiling and some want to cut a deal. Some Dems want to continue the lower payroll taxes currently in place, but aren't we failing to fund Social Security by doing this? But the Bush tax cuts are not central in the talk; the taxes the President wants to increase are more focused on things like closing loopholes for corporate jets. Bill Clinton says Obama should stand firm. So do I. Except I think the Bush tax cuts should be rolled back. I think we have already taken more than enough from the poor and elderly to bring down debt. Now it's time for the wealthy, corporations to take a hit. And those financial institutions that brought about this recession? I am still waiting for someone to stop them from paying huge bonuses on the backs of the American taxpayers.

Premiums for the Pre-existing Condition Insurance Plan were reduced effective July 1. This remains a great alternative for people who have been without insurance for 6 months. Plans in 17 states and the District of Columbia saw premiums decrease this week-end.

Now, this is a scary trend. Insurers buying physician groups and practice management companies so that they can exert more control over the health care you get -- and don't. But there's also an increase in medical homes, which are patient-centered and ensure you get the care you need.

Poverty and other social factors can kill just like smoking and obesity. And yet we keep slashing services for the poor.

We know how hard it is to get treated for chronic pain. Part of the problem is that doctors have no way to tell what's real and what's not, or to measure pain. Some make patients sign contracts and even drug test them. Others refuse to write prescriptions for pain medication. What's the right answer? Big, big problem.

More employers are offering on-site medical care. I wonder if this will help sick workers in that they will get care without leaving the building and taking significant time off, or hurt them by allowing their employers to know their health care business?

We have a major problem with medication adherence in America, with people not taking their meds as directed. But what if medication was standardized, so you only had to take it 2 or 3 times per day, all at once?

A medical reason why heart disease disproportionately affects African-Americans.

The wonderful Dr. Pauline Chen tells us how important a good medical receptionist can be.

And that's the start of the day. Have a great one! Jennifer