Wednesday, February 29, 2012
As always, the Wishlist Foundation -- a Pearl Jam fan-based nonprofit foundation -- is organizing pre-parties with some AWESOME auctions for VIP packages, including a chance to play on stage with Mike and the band!!!
Tickets go on sale Friday, but the auction items are up on eBay. So don't delay! I'll be at the Los Angeles concert at the famed, historic Troubador. Hope to see you there! Jennifer
The benefits we've already seen from the law are so important. One million young adults are covered under their parents' policies; 50,000 people with pre-existing conditions have coverage; kids under age 19 can get insurance despite pre-existing conditions; seniors paying less for prescription drugs. This is what we stand to lose if we don't navigate past the Supreme Court case and the Presidential election. It worries me greatly that people who don't understand the law will be its downfall. That's why I keep writing this blog every single day. That's why we NEED people to understand.
The attacks on the legislation are often abetted by the fact that virtually no one in the general public understands what this legislation means to them and their families. In the absence of understanding, the radio talk show hosts have convinced many Americans across the economic and political spectrum that the ACA either has no relationship to them or, at worst, will deny them access to health care. Part of the problem is that the main provisions of the ACA don't kick in until 2014, so the tangible benefits are still in the future for most of us.
But it's also a fact that the manner in which the act was passed was primarily an "insider's game," convincing the major interests -- insurers, hospitals, doctors, and members of Congress -- that the act would not destabilize their interests. Very little effort was made to enlist broad-based public support for the act and now, as a consequence, there needs to be a broad-based education effort to get people to understand just what's at stake for them and their families.And the stakes are enormous. Already, in the Great Recession and its aftermath, 62 percent of personal bankruptcies are directly attributable to the inability to pay for health care. An estimated 50 million Americans lack health insurance, including the 9.3 million adults who lost health insurance due to the recession. Even under the compromises which led to the passage of the ACA, fully 95 percent of Americans would be covered by 2014. This would be an enormous help not only for the working poor, but for virtually everyone who isn't super wealthy.
Not only is there an unwarranted and largely false assault on the health reform law, but there's also an assault on women's health. It's not just about insurance coverage of contraceptives; it's also about mergers between religious hospitals and secular hospitals, which result in the religious hospitals' imposition of their viewpoint on the secular hospital, making it harder and harder for women to have access to contraceptives (not to mention abortions), with or without insurance coverage.
And there will be a vote in the Senate on a bill that would allow any employer to refuse to provide insurance coverage not just of abortion and contraception, but of ANY health care service that the employer finds to be morally objectionable. So not only will employers make decisions about our health insurance, but they could be given the right to decide what health care services we can and cannot have.
All the while, criminals are getting rich off of our health care system, exploiting homeless people to steal from Medicaid and Medicare. When we talk budget cuts, how much attention are we paying to finding the fraud and the waste that, if cut, would save us billions?
As if there were not already plenty of reasons to shed a tear or two without us humans compounding the basis for our despair. A growing number of Americans is having a hard time just buying food.
I spoke with a woman yesterday whose husband has severe liver disease. He's working as best he can -- he refuses to apply for disability -- but he has no health insurance. He takes home about $300 per week, and the cheapest insurance I can find for him costs $239 per month. We looked at free clinics, free meds, disability -- but in the end, we are a wealthy society with no answers for people like these. Or, I should say, no answers today. Because as of January 1, 2014, this family will be eligible for Medicaid under health reform. If only he lives long enough to see the day.
We dance on the knife's edge as politicians cut deals that appear to them to be numbers on a piece of paper, not lives hanging in the balance. Ultimately, this all comes down to what kind of society we have and want. We must never forget that, in the blink of an eye, we can become one of our society's needy.
Illness is devastating -- scary, painful, complicated. Must it also bring down our financial well-being and perhaps that of our economy? Can't we just prioritize? What good is the best health care in the world if only the very wealthy can afford it? Jennifer
There are 7000 rare diseases (that we know of). That's a lot of people -- 350 million, at least -- who have a rare disease or know and love someone with a rare disease. The challenges people with rare diseases face are extraordinary. Not only is diagnosis elusive, but without FDA approved treatments, insurers fight every step of the way.
So how can you help?
Go here and raise a hand; if you do, $1 will be donated.
Go here and learn how to contact key decisionmakers.
Or just wear jeans with the Global Genes Project. Like their Facebook page here. And become a partner here.
And if nothing else, please spend a few minutes today reflecting on what it must be like to have a disease nobody's ever heard of, for which there is no known treatment or cure. Look around you. You know someone with a rare disease. Have you ever thought of how tough it must be for them? Well, think of them today. And maybe give them a lift if you can. Jennifer
Tuesday, February 28, 2012
And now, the news:
At-risk patients get the attention of health insurers. One percent of patients are responsible for 25 percent of health care costs. Insurers are looking for ways to manage their care and control those costs.
The cost of having cancer -- even with insurance -- is extraordinary. Copays and coinsurance are huge, and then there are the things insurance doesn't cover. Treatment decisions are being made based on the ability to pay. I don't think this is true only of cancer.
Bank of America is accused of imposing unnecessary burdens on homeowners with disabilities. Really? Ugh.
The Senate is getting ready for a vote on a GOP bill that would restrict access to contraceptives by exempting all religious-affiliated employers from the requirement that contraceptives be covered.
Schools, day-care centers and restaurants are getting better about caring for kids with food allergies. About time.
Health insurance in the mall? Some insurers are trying to start a retail business. How interesting. Highmark in PA, BCBS of Florida, and UnitedHealthcare in New York have all opened stores.
More Americans are seeking dental treatment at emergency rooms, where it's insanely expensive. This surprises me -- it would never occur to me to go to an ER with a toothache.
Black women are heavier -- and happier -- than white women. They have more comfort in their bodies than do white women. Interesting.
Black children are diagnosed with autism later than white children. Parents need to learn the warning signs.
Ever feel like you're having a good old-fashioned nervous breakdown? Now, it's called something fancier -- PTSD, depression -- but it's still the same paralyzing weight on your chest. Get help before it becomes immobilizing.
Patients develop chronic pain after hernia repair. Really? I've had 4 hernia repairs and no chronic pain as a result. Must be because my surgeon is the best on the planet.
When should you keep your sick child home from school?
Stents are no better for treating coronary artery disease than medical management, says a new study.
Hepatitis C surpasses AIDS in death rates. Some new drugs are in the pipeline, but until then .... Very tough.
Music for people with hearing aids. Love it!
Knee replacement may give you your life back.
Omega 3 fatty acids do help foster brain acuity as we get older.
Caffeine may have some positive effects. It may help with depression. I need espresso!
Was this autistic boy made to sit in a cardboard box in school, or did he seek refuge in the box on his own? Should we let a kid choose to sit in a cardboard box, even if it's his own choice? Teacher's on leave, but the right answer is harder than it may seem.
And that's it for this morning. Have a great day! Jennifer
Monday, February 27, 2012
The National Governors' Association health committee met this week-end. Governors are split on the effects of health reform. But they all agree that we need to do something about the cost of chronic illness if we are to get a handle on health care costs. Americans are split on health reform, too. The House GOP is planning a series of votes to gut health reform during the Supreme Court arguments beginning March 26.
Meanwhile, Republican-led states are putting off the task of building an Exchange in the hope that the Supreme Court will strike down the law and/or President Obama will lose the election and the health reform law will be repealed. Of course, having an Exchange -- a place where people can shop for and buy insurance -- isn't a bad idea even without federal health reform. And there's not a very strong chance that the Supreme Court will strike down the entire law. Indeed, by January 2013, the Obama Administration will decide whether a state is making good progress, and if not, they will start building a federal exchange. So inaction is a risky move.
Just to put this all in context, here's a history of our healthcare system that gives you an idea of how we got to be where we are today.
We're hearing stories like this every day, people with legitimate pain control needs who cannot get pain medication. There is a growing stigma attached to pain medication. Patients are blamed rather than helped. Maine is looking at capping pain meds in their Medicaid program to 45 days -- period. Washington state has made it so impossible to get pain meds that one of my clients has tried to commit suicide and now is inpatient detox. It's a terrible situation. I understand the urge to crack down on the use of pain meds as they are sold and used illegally. But what about the people who really are in pain?
Last week, we told you about a study that shows that colonoscopies help prevent colon cancer. But during the recession, the number of screening colonoscopies has decreased tremendously. Watch this to learn when colonoscopies are free under the health reform law.
California continues to try to find ways to cut the costs of Medicaid (Medi-Cal in California), but the feds appear inclined against allowing them to charge co-pays. Other states also are looking for federal waivers. But here's what happens when you cut Medicaid.
More about contraceptive coverage -- five Q & A's.
Want to know your life expectancy? Take the quiz. Mine's 77.1 years. I was sort of counting on not having that many years left!
Cachexia -- weight and energy loss, muscle wasting -- often accompanying cancer. There's a word for it, and soon, perhaps a drug for it.
Had tests done but haven't heard from your doctor? Here's what can happen when you don't stay on top of things.
The large hospital chain Prime Healthcare is under investigation for price gouging.
Scientists at Mass General have found that stem cells can generate human eggs -- a potential boon for infertility treatment.
Insurance for a cancer survivor or for cancer treatment -- I'm quoted in the response to the second question.
And that's it for today. Have a great day! Jennifer
Friday, February 24, 2012
Then, a month or so after her big surgery, George took his car in to be fixed. It was a Cadillac; George and Teresa had done well in life, and they drove big cars and lived in a big house. They were both professionals; he was a hospital executive. They thought they were set for life.
Anyway, the Cadillac dealership said the car was fixed, so he brought it home and put it in the garage. Then George smelled smoke. In the end, their $800,000 home was reduced to rubble and flames.
George filed a claim with his homeowner's insurance, but State Farm -- his insurer -- denied the claim. He got a lawyer, but somehow, State Farm got the judge to exclude all evidence about the Cadillac, the dealership, the repairs -- the source of the fire. The jury found against George. He is now trying to appeal, but he doesn't have the $9000 he needs to get the trial transcripts he needs to appeal.
The house is a pile of rubble, but George has tried to hang onto it. He promised Teresa that she would not die in the three room "cave" they live in now, where Teresa sleeps on a broken couch and George sleeps in a chair. They have no working kitchen -- no refrigerator or stove -- so they can't go to a food bank for food. They tried Meals on Wheels but they both got sick after three days, so they gave up on that. George hasn't eaten yet today.
George and Teresa had burial plots. He sold his about a year ago to pay Teresa's medical expenses. He won't sell Teresa's because she deserves a proper burial, he says.
Teresa is on Social Security disability -- their only income -- and she has Medicare, but doctors and radiologists and other health care providers won't treat her without payment of the 20% coinsurance up front unless she has a Medicare supplemental policy. Teresa's policy costs $420 per month. George doesn't have it this month. He doesn't know what he's going to do.
I spent an hour and a half going through all the resources I know about with George. He has 3 pages of names and phone numbers now, so he will be busy on Monday. And I will try to do some more work for him next week. At the very least, they ought to have a bed to sleep in, so I will try to find a bed or furniture store to donate one.
But there it is -- a picture of what can happen to any of us if we're hit with a health disaster, a house fire, a nasty insurance company, a bad lawyer, a judge who actually high-fived the insurance company's lawyer when the jury brought back its verdict against George. It can happen to any of us.
Every day we have a roof over our head, a hot meal, a bed to sleep in, we are so very fortunate.
I will take that with me into the week-end. I hope you will, as well. Jennifer
One of the stupider budget cuts was a relatively small amount to fund consumer assistance programs to help consumers with health insurance issues that was not renewed in the 2012 budget -- only about $30 million. Texas is closing its program in April. Considering the state of health care in Texas, this seems pretty foolish to me, on both the state and federal levels.
Texas also has defied the federal government by excluding abortion providers from participating in the state's Medicaid program. We're not talking about Medicaid-funded abortions -- that's not happening. But we're talking about excluding a clinic that provides contraception, well-woman visits, pregnancy tests, breast cancer screenings -- and also abortions -- from providing NON-abortion services to poor women with few options. I apologize for all the Texans out there, but based on what I've learned about the State from clients, I can't figure out why anybody lives there.
The per person cost of the Pre-existing Condition Insurance Plan has been about double what was expected. About 50,000 people are enrolled nationwide. Each member will cost about $28,000 in 2012. Since there are no healthy people in the pool, there's no way to spread the risk, so this is the actual cost of care for a person with at least one chronic illness. I suspect my meds cost about that much.
Seven states have sued the Obama administration over its contraceptive coverage policy, alleging freedom of religion concerns. Nebraska, Florida, Michigan, Ohio, Oklahoma, South Carolina and Texas. Your tax dollars at work, folks. Um, guys, hasn't any of your lawyers told you that you can't sue to protect someone else's legal rights? It's called standing, and states don't have standing to sue to protect the Catholic church. This case should be dismissed. Of course, that assumes judges are not political creatures -- and that would be a very wrong assumption.
Meanwhile, the law student who wanted to testify at the contraceptive coverage hearing last week did finally give her testimony on the importance of contraception for women's health. She told about a classmate who needed birth control to treat ovarian cysts. When she no longer could afford the medication, she grew a cyst the size of a tennis ball and had to have surgery to remove her ovary. Where's the religious objection to birth control in that situation?
The federal government has awarded $26 million to Minnesota to create an insurance Exchange, a place where consumers can shop for and buy health care. But the state is split on health reform, so it's not clear what it will do with this money.
Some help for people with chronic fatigue syndrome? A push for drug repurposing -- using meds approved for something else to treat chronic fatigue. It's certainly worth a try.
There's a shift in elder care from nursing homes to managing care at home. It's because of money, but I think it's great for people to be able to stay in their own homes for as long as possible, and not to be warehoused in nursing homes. Here's a truly beautiful story of one family's journey.
A fitness program for the mentally ill -- very cool. It's giving people their lives back.
A broken heart really hurts. Not just mentally, but physically.
And that's today's news. Have a great day and a great week-end! Jennifer
Thursday, February 23, 2012
A new report finds that colonoscopies prevent cancer deaths. So please -- if you have symptoms, go to a doctor and get scoped. If you are age 50, start getting scoped regularly. I know it's no fun -- I've had more colonoscopies than most of you would have in three lifetimes. But if it saves your life? An easy call -- just do it.
The federal government awarded additional grants to states to create Exchanges where people will be able to shop for and buy health insurance. Ten states got these grants; four of them have Republican governors, including New Jersey, with the infamous Chris Christie.
Massachusetts, which has health reform very similar to the federal law, is beginning to lead the way on controlling costs.
A new federal program is focused on patient safety, but is it doing enough?
Like most states, California's budget problems has driven it to cut Medicaid (called Medi-
Cal in California) reimbursement rates to providers. Advocates in California sued, saying this would reduce access to health care for the poor. The US Court of Appeals for the 9th Circuit ruled for the advocates, blocking the cuts. But then, the Obama Administration approved the cuts, creating a disagreement between the courts and the federal government. Because of that, the Supreme Court ruled that the case had to go back to the 9th Circuit to consider the effects of the federal approval. For now, the state will continue to pay the higher reimbursement rates.
Meanwhile, in the private sector, California health insurers will be raising premiums from 8 to 14%. This way outpaces the cost of overall medical care, which has risen only 3.6% in the past year. So how do the insurers justify the rate hikes? We'll see.
In a ruling that echoes the fight going on in the country about contraceptive coverage, a judge in Washington State said the state can't require pharmacists to sell Plan B (the morning after pill) because it might infringe on their religious liberties. And what of women's right of access to health care?
Harnessing the power of the smart-phone for health monitoring -- the wave of the future. If patients are educated sufficiently and understand the readings they get -- and know when to call a doctor -- this could be a great advance.
An FDA panel has recommended approval of a new weight loss drug -- the first new one in many years.
Exercise fuels the brain, not only during exercise, but it helps with memory and concentration all the time.
And that's it for this morning. Have a great day! Jennifer
Wednesday, February 22, 2012
Last week, as you know, Congress held a hearing on birth control without considering the views of women. Well, the woman who was ready to testify but was not allowed to do so will testify at a hearing today about the importance of birth control to women's health. Will any GOPers even show up? Meanwhile, a Catholic university sues to block the administration's policy.
The Obama administration announced the first low-interest loans to groups that want to start non-profit health co-ops. These will be alternatives to traditional insurance and could be an exciting option.
Will nurse practitioners come to be the new primary care provider, as fewer doctors choose primary care and health reform (both the law and policy efforts, even by insurers) depends on primary care providers? They have the ability. Will Americans come to accept them?
Women are less likely to get immediate health care for a heart attack than men. One reason is that women don't get the same symptoms -- chest pain -- as men. Women feel fatigue -- and we have problems being taken seriously for that. To avoid heart disease, doctors should consider family history.
Here's a quiz to see how heart smart you are. I scored pretty well -- how did you do?
Hyperconnectivity in the brain is linked to depression. As best I can tell from the article, this means the depressed brain is less agile and versatile. Hmmm.
The FDA is allowing the import of cancer drugs amid shortages -- methotrexate and doxil.
Do you hate your body image? You may have body dysmorphic disorder.
Raw milk is more likely to cause dairy-related illness.
Sort of a light news day, but there it is. Have a great day! Jennifer
Tuesday, February 21, 2012
- Good phone skills
- Familiarity with Microsoft Word, Excel
- Comfort in a fast-paced but casual environment
- An appreciation for the burdens faced by vulnerable populations
- Neatness and organization
- A car in which to do errands (post office, bank)
Interested? Contact me at (860) 674-1370 or email@example.com.
In the midst of the debate over contraceptive coverage, here's a piece explaining that Catholic hospitals are on the rise, but there are strings -- like no contraception -- attached. And when a Catholic hospital merges with a secular hospital, the secular hospital has to stop providing abortion and contraception, too. This leaves people with nowhere to go.
But really, how did birth control get to be an election issue? This follows a bruising -- and, I like to think, embarrassing hearing on Capitol Hill last week, where a group of men argued that contraceptive coverage violates religious freedom. And here's a shock for you -- insurance companies don't want to pay for "free" (to insureds) birth control.
Get this --if you present to an emergency room for something that isn't an emergency, you may have to pay up front. Hospitals know insurers won't pay in some of these cases, so to be sure they get paid, they want money up front. Federal law requires that they see you, so they do screen to make sure there's no emergency, but if they don't think you have an emergency, it's pay or go home. Is this right?
A dialogue between a health care conservative and a health care liberal. Which side are you on? Next month, the Supreme Court will have to decide. Here's one possible way it could go. But I doubt it.
A push to train more primary care providers -- we need them for health care to work but the money is lousy, as are the hours. How do we get med students to choose such a hard road?
Counties in California are providing care for the uninsured. It's really impressive to see what they're doing. It's 47 counties and counting.
Two pharmacy distributors -- Cardinal and CVS Caremark -- ignored red flags that showed that two Florida pharmacies were ordering way more than their share of oxycodone.
Family history is a strong predictor of cardiac disease -- something your doctor should be looking at.
Tight clothes, high heels can be causing health problems. Duh.
Are doctors as curious as they ought to be? Or are they trying to fit us into well-expected categories? I'll tell you what -- were it not for the fact that my Crohn's expert is curious, I'd be dead.
We boomers are at risk for Hep C. And many of us don't know we have it.
Having problems at work? In bed? These are problems to discuss with your doctor in that they may be signs of medical problems.
Your eyes age, and that throws off the body's circadian rhythm -- and that may affect a host of medical issues that make us feel tired and lacking in energy.
Are signs of aging diseases we should treat, or should we just accept the natural aging process for what it is? Do you want to know how long you're likely to live? A new website predicts longevity.
Taking proton pump inhibitors (Nexium, Prevacid, Prilosec, etc.) may reduce absorption of calcium and result in bone loss, especially in older women.
How should we decide how to give out organs for transplant? In Israel, they are trying a new method, giving priority to people who have pledged to give their own organs. Fair?
Should you be stopping to eat during your work-out? Here are some other things that you should consider for running, biking.
The Obama administration is now pushing for changes to school vending machines -- foods kid eat outside of the cafeteria.
Omega 3 fatty acids reduce the risk of one kind of colon cancer, and only in women, a study says.
We all think about probiotics for gut ailments, but can they boost the immune system?
Is yoga good for you? Well, yes, but sometimes it's not. Read to learn which yoga poses may not be good for your body.
Fascinating. Syntesthesia blends the senses, so numbers have colors and emotions, and music has numbers and colors -- the senses get mixed up. And nobody's complaining.
A new book on heart health from the Cleveland Clinic -- get some free advice by reading the article.
Should we worry that, in a ferret study, swine flu appears to have the hallmarks of a pandemic?
And here in Connecticut, the state employees' health insurance pool is being opened to municipal employees now, with nonprofits (hopefully) to follow next year. The bigger the pool, the less expensive the premium, so this is good news as far as I'm concerned.
And that should get you started on your day. Have a great one. Jennifer
Friday, February 17, 2012
Contraceptive was the news of the day yesterday, as the House held a hearing on the President's policy requiring free coverage of contraceptives WITHOUT ANY INPUT FROM WOMEN! (Well, okay, two women testified against contraceptive coverage). The justification was that the hearing was about religious freedom, not about contraceptive coverage. But, of course, the issue involves a balancing of the two, and to ignore the importance of women's health was a sign that these guys just don't get it. The obvious wrongfulness of this led some Dems to walk out of the hearing. And then, to make things worse, later in the day, Rick Santorum's biggest donor and sometimes spokesman, Foster Friess, said he didn't know what all the fuss was about -- in his day, "gals" held an aspirin between their knees as birth control. Really? How'd that work for them? Some religious groups believe birth control is the same as abortion, although scientifically, this is not true, and this view is out of step with the majority of Americans -- and certainly, women. I assume no editorial comment is needed here since I imagine you groaning out loud as you read this.
Congress will vote on the package that extends the payroll tax, unemployment and Medicare reimbursement rates for doctors today, with the House voting early in the day and the Senate later. It's a bit of a nail-biter, but leadership seems to think they have the votes.
The Obama administration has concluded its review of 17 states' health reform waiver requests, denying Wisconsin's request for exemption from the medical loss ratio requirement (which requires 80 to 85 percent of premium dollars to be spent on health care), and partially granting a request from North Carolina. Waivers were to be granted if imposing the rule would substantially disrupt the insurance market in the state. The feds denied 10 requests and granted partial waivers to the remaining 7.
Okay-- hold onto your seats. An under-the-skin microchip delivers doses of medication. This could revolutionize treatment of illnesses that require constant delivery of meds -- starting with pain, and maybe even diabetes. Awesome. Here's more about how it works.
The FDA will reconsider a weight loss drug it previously rejected, recognizing that it's being used off-label and people are having great success with it.
Alabama is closing most hospitals for the mentally ill for budget reasons. And then we get calls from people who are going to out-of-network inpatient facilities because there are no in-network beds available -- and their insurance won't cover it because they went out-of-network. This country had better get its collective head on straight when it comes to mental health and substance abuse. Some people -- often young people, often suicidal -- need inpatient treatment on occasion. We can't make it impossible for them to get care.
And that's it for today. Have a great day and a great week-end. Jennifer
Thursday, February 16, 2012
We have a deal on the payroll tax, unemployment and Medicare reimbursement rates (the "doc fix"). The GOP will allow the payroll tax cut to continue without finding ways to pay for it. Unemployment benefits will now run a maximum of 73 weeks instead of 99, although this varies from state to state, and only 16 states ever had the maximum of 99. States are allowed to drug test people on unemployment -- but again, this is not new -- some states already do. And there will be changes to the pensions of new federal employees, who will have less of an employer contribution and more of an employee contribution. And we lost $5 billion from the public health and prevention fund that was established as part of health reform. They keep chipping away at this account, and that's a real problem. There are other health-related cuts as part of the deal. Finally, the huge reimbursement rate cuts for doctors participating in Medicare have been put off through the end of the year. All in all, not an outrageous resolution, but not ideal, either. The vote should come on Friday and it will be close.
President Obama's compromise on contraceptive coverage has hit a snag that several of us already considered. The President's policy would require insurers rather than religious employers to offer free contraceptives. However, many religious employers self-insure, meaning they pay for the health care their employees get. If the employer IS the insurer, the President's compromise doesn't quite work. Hmmm.
There are fewer seniors in poverty, but the number of children in poverty continues to rise. There must be a way we can help them. Meanwhile, the elderly are not accessing all of the government benefits to which they are entitled. The elderly can see what benefits they're entitled to here. This is a great tool.
Home health agencies are fighting a Department of Labor rule that would require them to pay workers minimum wage. They claim this would cause them to cut workers' hours and be a burden on caregivers. Indeed, a gentleman on the White House disability call yesterday said he would no longer be able to work overtime, which would be a huge problems for him financially. But are low wages part of the reason there's such a high turnover in home health workers?
As many as 86 million people have benefited from health reform's free coverage of preventive care. And yet, next month, the Supreme Court will hear arguments in a case seeking to gut the law. Here's a preview of how that might go. Most Massachusetts residents are happy with their version of health reform, which is very similar to the federal law. If only Americans would give this a chance and let us get to 2014, when the big items kick in -- I'm willing to bet people would be pretty happy with it.
Should people be able to try drugs for unapproved uses (off-label uses)? The FDA approves a drug for the treatment of one disease, and then scientists find that the drug may work for another purpose. The safest course is to run clinical trials on the other use, but that takes time, and some patients in trials get placebos instead of the real thing. If you're very sick, you may not have that kind of time. In fact, this articles doesn't accurately portray how widespread off-label uses are. I take a medication that is FDA approved for traveler's diarrhea, but for me, it deals with bacterial overgrowth. Do we know it's safe over the long term without clinical trials? I don't know, but I do know that this one drug was the key to getting me back to full functioning, so I'm not sure I care. Most of our insurance appeals involve denials of coverage of off-label uses. Without off-label uses, many people with rare diseases would die.
Fake Avastin leads one to wonder if other injectibles also are attracting fakes.
Amelia Rivera may get her transplant. Her parents complained that she was being denied a transplant due to "mental retardation," but Children's Hospital of Philadelphia has clarified and said mental acuity is not a consideration for transplant. Amelia still has to undergo the full pre-transplant evaluation, but things are moving forward.
A 15 minute old newborn got a heart pacemaker. Amazing.
And that's today's news. Have a great day! Jennifer
Wednesday, February 15, 2012
We have a tentative deal that extends the payroll tax, unemployment compensation and the delay of the new Medicare reimbursement rates for the next 10 months. Unemployment will be shorter than 99 weeks -- there's some disagreement about how much shorter, but it looks like 73 weeks -- more than the 59 weeks the GOP wanted, and a significant concession from the Dems. However, that 73 weeks is for the hardest hit states; in many states, unemployment will run out after 63 weeks. And there are tweaks to Medicare (not to benefits) and to federal employee pensions.
However, they keep chipping away at the health care prevention fund established under health reform. Not only is it part of this deal, but it would be cut further by President Obama's 2013 budget. Short-sighted savings that will have long-term consequences.
Scientists are repurposing drugs that are FDA approved for one use but not another, trying to gain acceptance of off-label uses that can get drugs to new markets faster than the usual process.
For those of you against the individual mandate, here's its history. It was a Republican idea! That was before the Tea Party and before Barack Obama. Now, it's a war on religion. Really?
The roar over contraceptive coverage has died down, with many Catholics satisfied with the President's compromise -- but the Bishops still unhappy. But again, the Bishops don't want anybody to have access to contraceptives -- an extreme position that is not popular with the majority of Americans. You have to see Jon Stewart's take on this brouhaha.
Still, the GOP have introduced legislation that would allow any employer to exclude coverage of any service on grounds of conscience. Not just religious employers. Not just contraception. What a disaster that would be.
UnitedHealthcare has initiated a program that would allow doctors to share a patient's medical information over the internet. Good idea? Hmmm.
A study suggests that it might be best to skip an antibiotic for a sinus infection.
Johnson & Johnson made some bad artificial hips that the FDA rejected. So what did they do? They sold them overseas. That's just appalling to me. If they weren't good enough for Americans, why are they good enough for anybody?
A patient with Wegener's granulomatosis finds out that his mom is a match for a kidney donation, so he will have a transplant. I have a friend who had a liver transplant last night and I am praying that it was a success.
And that is today's news. Have a great day! Jennifer
Tuesday, February 14, 2012
On this Valentine's Day, WaPo examines love. It's a mystery, for sure, what makes us fall into and out of love, why we act sort of crazy around it. Some say it's all in our brains.
Well, well. The House GOP has decided to stop arguing about the payroll tax cut extension -- they're letting that move forward without knowing how it will be paid for, although negotiations still move on over extended unemployment benefits and putting off the reimbursement rate decrease for doctors in Medicare. Maybe this is a good thing -- or maybe this is a sign that they are not going to compromise over unemployment and Medicare reimbursement rates. Mostly, I think they just knew they could not raise taxes on the middle class as we head to the election. But Dems want to keep the three issues tied together, fearing they won't get the other two issues done if the payroll tax goes forward alone.
The President released his 2013 budget yesterday. The GOP was blasting it before it was even introduced. The President proposed increasing taxes on investment income and cutting military spending. He also would adopt the "Buffett rule," which would set a 30% income tax on income over $1 million. The budget includes $864 million to set up health insurance Exchanges, a core piece of health reform.
Meanwhile, the Department of Health and Human Services contributes $9 million in funding to encourage doctors to work in underserved areas.
The Pre-existing Condition Insurance Pool has attracted fewer people than anticipated, but states are still running through their allotted grants due to the extremely high health costs of people with pre-existing conditions.
The Pentagon wants to raise health insurance fees on some working retirees to help with the budget cuts. Vets say they will fight this.
The LA Times's David Lazarus says the birth control controversy shows the need to abandon employer-based health insurance. Interesting argument from a smart guy. What do you think? It may be that this is happening, like it or not; for the third straight year, employer-based insurance is on the decline.
The feds have recovered a record number of health care fraud judgments. For me, this is step one in how to control health care costs.
Soon there will be an app instead of a shrink! Scientists are at work on an app that will help deal with depression and anxiety. Just think of the money you would save on shrink bills! (*kidding* -- no app could ever substitute for my therapist).
Going to college with a chronic illness? Here are some survival tips from a Crohn's patient.
Do you like new things, crave taking risks? Novelty-seeking may be a predictor of well-being. This actually makes sense to me. I know how much energy I spend trying to fight change; I'd surely be better off if I could embrace it.
A little more on Jonathan Gruber's "comic book" that explains health reform. It's really good -- I wish it were free so everybody could read it.
Will a worm help us overcome autoimmune diseases? This theory has been floating around for several years -- you eat the eggs, the eggs hatch, and the worms do whatever they do so your immune system works better. It's been working in MS and Crohn's disease in small studies. I'm not sure I'm ready to try it yet, but hey -- whatever works!
Colon cancer risks can be cut greatly with prevention. HAVE THAT COLONOSCOPY.
A new study finds no benefits in B vitamins and omega-3 fatty acids in preventing cancer.
Scientists zap the brain to get with the flow. The "flow" is that term scientists use for that state of focus, when you're in the zone and everything's clicking. Can it be induced?
Ever think of going to a dental school for dental care? It's way less expensive.
An increasing number of women choose home birth, but will insurance cover it? It may save you money.
The relationship between soy and breast cancer is uncertain.
Stem cells regrow heart tissue in a small study.
High calorie intake is linked to mild memory lost in the elderly. Put down that muffin!
Are your kids getting enough sleep? What's enough?
And that's it for today's busy news day. Have a great day! Jennifer
Monday, February 13, 2012
It seems like a fitting start to ask what science knows about Adele's Someone Like You and why it produces tears.
Meanwhile, week-end talks about the payroll tax cut extension have gotten us nowhere. But President Obama is releasing his 2013 budget today, intended as an homage to the middle class. The budget includes a cut of $360 billion in health care -- mostly medicare provider cuts.
We're still focused on contraception. On Friday, President Obama announced a compromise that would allow religious employers to have no part in offering contraception to their employees -- but the Bishops are still not happy because they still have concerns about the overall policy. "[T]hey still had "grave" objections to the overall mandate, which includes the morning-after pill and sterilization." Read some more of their quotes. So then it wasn't about religious freedom, allowing religious employers a way out? It was about the Church trying to control women's bodies and choices? Yeah, I thought so. Despite the fact that there have been contraceptive coverage laws in many states for years, the GOP Senate Minority Leader Mitch McConnell says this is government meddling, and he pledges to reverse the President's policy of universal and free coverage of contraceptives.
Health reform cannot work without adding a whole lot of primary care providers. There's been talk about how to entice med students to primary care for a long time. There are increases, but not enough. How do we encourage med students to go for something that's against their financial interests?
Medicare finds that teaching hospitals are more prone to complications, although that study is disputed.
A shortage of methotrexate could spell disaster for a lot of people -- not just childhood leukemia, but plenty of IBD patients and, I'm sure, other off-label uses.
Hospitals with funding for charity care still pursue aggressive collections -- as we know.
Is it bad to be a workaholic even if you love your work?
And that's it for this morning. Have a great day. Jennifer
Friday, February 10, 2012
The GOP is warning that there may not be a payroll tax cut extension since Congress can't agree on anything. Unemployment extension hangs in the balance, too, as does Medicare reimbursement rates for doctors. A whole lot of people get hurt badly if this doesn't get resolved by the end of this month. Congress is now off for a 4 day week-end (isn't that nice for them?) and a recess is planned starting February 20. That doesn't leave a lot of time for a resolution, although reports are that staffers will work through the week-end to try to reach a deal.
Yesterday, the Obama Administration released the final regulations that require insurers to provide an easy to understand, uniform summary of benefits and coverage. It's not everything we wanted, but it's a big step forward towards consumers really being able to understand how their health insurance works. By using a uniform format, consumers will be able to compare plans to choose the one that best suits their needs, too. This has been a hard-fought battle against an industry that really didn't want any part of this. Although we didn't win on every point, this is progress. Here's more detail and illustrations of what parts of the forms will look like.
Attorneys General from Virginia and Massachusetts acted out the Supreme Court arguments in the health reform case yesterday. Don't miss the comments below the story.
United Healthcare is following Anthem and Aetna, changing the way they pay doctors, providing extra reimbursement for care coordination and chronic disease management.
The war over contraceptive coverage continues, helping the GOP to firm up its base. VP Biden says a compromise will be worked out. Senate Dems have called for compromise. It's a never ending battle between reproductive rights and religious freedom. The Senate GOP attempted to attach an amendment to the pending transportation bill that is full of jobs, and Majority Leader Harry Reid urged them to calm down.
What happens to a marriage when illness strikes? So tough.
And that's today's news. Have a great day and a great week-end! Jennifer
Thursday, February 9, 2012
The story of the day -- if you have out-of-network coverage under your insurance, you need to understand how it works. Your insurance covers a percentage of your out of network costs, right? But it's not a percentage of actual costs; it's a percentage of "usual and customary" or "allowable amount." The insurance companies have always had free reign over what's "usual and customary," and they have always low-balled patients. So, for example, if your policy pays 80% of out of network "usual and customary" and your doctor bills $1000, but the insurer only allows $800, the insurance covers 80% of $800, not 80% of $1000. So you pay your 20% of the $800 PLUS the $200 difference between the billed amount and the allowed amount. Now, insurers have a new game. Instead of basing usual and customary on actual commercial insurance claims data, they are starting to use Medicare rates, which are MUCH lower, leaving you with way more of the cost. You can challenge this by using payment data from FAIR Health, an organization that was created after the NY Attorney General cracked down on the data previously used by a UnitedHealthcare subsidiary called Ingenix, which was sold to most of the industry. But these are really tough fights. If you're having a problem and want to talk it through with us, feel free to get in touch. Note that yours truly is quoted in the article.
Speaker Boehner vows to fight against mandatory and free coverage of contraceptives. He's joined by many other Republicans. One woman Senator said that this is not a women's health issue; it's a religious liberty issue. I think it may be both. We have huge institutions run by the Catholic church -- hospitals, schools -- where hundreds of people work regardless of their faith. Should employees of those institutions lose out on a benefit that all other women will have? Or is this whole issue just a political tool, used by both sides to score points? This is why I'm so bad at politics. I keep thinking we're making decisions on the merits.
And in the never-ending effort to cut costs no matter the consequences, Connecticut's Governor Malloy has proposed changes to Medicaid, including counting assets of parents or guardians of anybody under age 26 to determine eligibility -- a move that would kick thousands of people off the program. The state is also looking to limit certain services like nursing home care, home health, medical equipment, and physician services. I'll say it again. When you stop people from accessing the care they need, they get sicker, end up in the hospital, lost their jobs, become disabled, and then we, the taxpayers, have no choice but to foot the bill. So wrong-headed.
Dr. Pauline Chen's column is about doctors' body language -- what doctors communicate even when they're not talking. So interesting.
Along similar lines, are doctors always honest with patients? Surely not. They give us good news even when it's not warranted, and they fail to disclose medical errors, a study shows.
A small study finds that electrical stimulation helps memory. Could this be the beginning of a real treatment for Alzheimer's?
Men's greater risk of heart disease may stem from a chromosome. Find the reason, find the treatment -- or so we hope.
A study shows that Tai Chi helps Parkinson's disease.
The benefits and hype of yoga -- is it for you? I'm trying to get into it, but starting is hard. After all, I write this blog at 6 am and work until 7 or 8 pm -- when is there time for me?!!! But that's a whole other story, isn't it?
And on that note, I wish you a great day! Jennifer
Wednesday, February 8, 2012
Talks on extending the payroll tax cut have stalled. We're going to go down to the wire yet again. WaPo says it's Groundhog Day again -- the same battle, over and over. The GOP wants to pay for it by, among other things, raising Medicare premiums and reducing subsidies under the health reform law (which doesn't take affect until 2014, so really, would this be paying for a tax cut now?). The Dems want a millionaire's tax. Worlds apart.
In light of the Catholic criticism President Obama's decision to make contraception a mandatory, free insurance benefit, the President now says he will try to come up with ways to accommodate faith-based objections to contraception. I'm biting my tongue.
You've heard of mindfulness meditation, right? How about mindful eating? I so totally believe in this -- although I just broke all the rules by scarfing down a bagel while writing this!
The Centers for Disease Control has said that it will focus on ending the Black HIV/AIDS epidemic. Good.
Did you know bread is the number one source of salt in our diets, more than potato chips? Good to know.
The Obama Administration has vowed to increase funding of Alzheimer's research.
A Pennsylvania college is dispensing the "morning after pill" in vending machines. Good idea?
There are new guidelines for how to avoid deep vein thrombosis on long plane flights.
Here are foods that boost your immune system. We could all use a little of that.
And for a bit of humor amidst all the serious stuff going on, here's Jimmy Fallon with the First Lady trying out her Let's Move initiative. Here's a longer clip. After all, laughter is the best medicine.
Have a great day! Jennifer
Tuesday, February 7, 2012
As you know, there are 3 issues Congress has to resolve by the end of the month: payroll tax cut, unemployment extension, and the cut to Medicare doctors' reimbursement rate. No surprise that they're not doing very well. The House and Senate are at an impasse on Medicare reimbursement rates, unable to agree on how to pay for it. As for the payroll tax, everybody agrees it needs to be extended, but how? Thousands of people are about to find out that unemployment now ends at 79 weeks, not 99. It's all a huge mess. Congress does have a recess planned for the end of the month, so if they don't make progress soon, we will have yet another nail-biter.
What's really on the line in the Supreme Court's health reform case is coverage of people with pre-existing conditions. The LA Times's David Lazarus explains that, without the individual mandate, driving healthy people into the market for health insurance, we'll never get coverage of people with pre-existing conditions at rates that anybody can afford. This is pretty much the same argument we made in our brief to the Supreme Court. Meanwhile, the States filed their brief against the law yesterday. Meanwhile, a new survey shows the state of our health -- especially that of the poor -- to be dismal. One-third of poor people haven't had insurance in 2 years. Half of families at 2 1/2 times the poverty level lack a regular source of care. Doesn't this trouble you? Don't we have a moral imperative to act?
Does it take surveillance cameras to get ICU staff to wash their hands? Apparently.
Cardiologists often pass up safe treatment with medication to go for the more expensive, high tech angioplasty and stenting. If, as studies show, the two treatments are equally effective, is it wrong to go with the less expensive alternative to save costs? And if this is okay with cardiology, what about the rest of medicine? A huge question that matters a whole lot. Meanwhile, if you want to eat heart healthy, here are some tips and myth-busters.
Consumer Reports says women are taking drugs unnecessarily.
Another piece about how important it can be to have blood pressure checked in both arms to diagnose peripheral vascular disease.
A high fiber diet may not protect against diverticulosis.
There's a push for family input to detect dementia.
Researchers are working on a test to figure out whether someone is dangerously fatigued so that they can predict and, thus, avoid "performance failure," like falling asleep when driving.
Should you be eating gluten? Apparently, those with Celiac disease aren't the only ones who should avoid it.
Is your doctor following ovarian cancer screening guidelines? Apparently, many are not.
The American Society of Clinical Oncology says advanced cancer patients should be given both cancer care and palliative care, making end of life decisions. It actually helps people with their treatment, and they live a little longer.
Should all children be screened for a condition marked by high cholesterol? An expensive option, and some say one that over-diagnoses. But is the cost worth it for the few who are helped?
A Georgia law seeking to curtail assisted suicide has been ruled unconstitutional because it would have prevented people from advocating for assisted suicide, making it a free speech violation.
A couple of years ago, scientists released a paper saying they found a virus that causes chronic fatigue syndrome. Then this study got discredited and then retracted, and patients were left dangling without answers.
And that's where we leave it for this morning. Have a great day! Jennifer
Monday, February 6, 2012
Notwithstanding, today, we filed our comments. Not quite 3 pages, but we did our best. In our view, Mercer's report is an excellent indication of what happens when people who do not have day-to-day interaction with consumers struggling to obtain or keep their health insurance make decisions in a vacuum.
Read our op-ed in CTNewsJunkie here. In it, we explain that:
The Mercer report shows even more clearly why it is imperative for the General Assembly to add several consumer voices to the Exchange Board. Not only should our Healthcare Advocate have a vote, but people who understand the obstacles consumers face should be at the table, with a vote, so that they can ensure that the Exchange addresses the needs of consumers. Without strong consumer voices at the table, we will have an Exchange that may work for State officials, that may work for insurance companies, but that will have put the needs of consumers last instead of first.
We who represent consumers who struggle to obtain and maintain access to health care have a different and valuable perspective on what obstacles patients face. In my case, not only do I have several serious, disabling chronic illnesses, but I also have represented thousands of people with chronic illness who are uninsured, or who have insurance that does not cover what they need, or who have insurance with high deductibles and copays that make actual access to treatment entirely unaffordable. Based on what I live and what I’ve learned, I have a perspective that many – from federal government agencies to nationwide insurance carriers – find to be revealing.
Against this background, it should come as no surprise that Connecticut’s systematic exclusion of strong consumer voices in the process of setting up the Connecticut Health Insurance Exchange would have dire consequences. We can begin to see that in the final report issued by the Exchange Board’s consultant, Mercer. Mercer’s report draws on information gathered from insurance carriers and companies like Ingenix and the Lewin Group that are wholly owned subsidiaries of UnitedHealthcare; no consumer advocates were consulted. As a result, Mercer’s report is fatally one-sided.
For example, Mercer advocates for innovations that would ease the costs to insurers by shifting costs to consumers, making treatment so expensive that it is inaccessible to most of us. This is best illustrated by Mercer’s advocacy for specialty tiers as part of pharmaceutical coverage plans. Most of us have insurance that requires a set dollar amount copay for a prescription; we pay a little more for brand names than we do for generics, and a little more for drugs not on our plan’s formulary. Specialty tiers, which already are in use in 25% of plans nationwide, require patients to pay a percentage of the cost of their medication. We know of one woman who, under her plan with specialty tiers, would have to come up with $3000 per month to pay for her medication – far more than most of us can afford. Yet, Mercer thinks specialty tiers are one of the innovations Connecticut should try – while other states like New York, Hawaii, Maine and Vermont are passing laws to ban specialty tiers, and Congress is considering an exceptions process under Medicare for people faced with these costs.
Some would say that the need to bring down health care costs is paramount, and if specialty tiers discourage patients from taking expensive medications, well, maybe that’s for the best. But what happens when patients cannot access the treatment they need is that they get sicker, their disease spirals out of control, they are absent from work and lose their jobs and their health insurance, they go on disability and Medicaid or Medicare – and guess what? We the taxpayers pay a far greater cost in the end by losing productive members of society to disabling illness that could have been avoided had care been affordable. It doesn’t take a genius to realize that the long-term costs of specialty tiers far exceed the cost of providing affordable care in the first instance. But without someone with experience dealing with patients faced with specialty tiers providing input, all of this was lost on Mercer – and, presumably, the Exchange Board.
This is one of many examples that are pointed out in our comments and the comments of many other consumer advocates to the Mercer report. The virtues of a Basic Health Program and forcing insurers to end discriminatory pricing, and the lack of consideration of the long-term positive effects of reform on health care costs are minimized or even entirely ignored. If there were strong consumer voices on the Exchange, these sorts of omissions could not occur.
Are you a Connecticut consumer? Make sure your voice is heard. Contact the Exchange Board's chair, Lieutenant Governor Nancy Wyman, here; the Governor's Special Advisor on Health Reform here; and the members of the Insurance Committee of the General Assembly here.
This is REALLY important, folks. This is going to dictate how you shop for and buy health insurance from 2014 onward. Please join us in making sure it gets done right. Jennifer
People with disabilities can be assets in the workplace. After all, we surmount challenges that most people never dream of. We just have to learn how to pitch ourselves -- and believe that we have something very special to offer.
The GOP is split on what to do about extending the payroll tax cut. And they only have a few weeks to get this done or you're going to see a decrease in your paycheck.
The states opposing health reform will file their briefs in the Supreme Court today. I'll be here to dispell the propoganda. My law school alma mater held a moot court on the health reform case.
New York City has been running a series of ads intended to scare us into being healthy. Is fear the best motivator?
Steps you can take to make your parents' -- or your -- home safer, keeping them out of nursing homes. And here are 10 Alzheimer's warning signs. How to talk to aging parents about changes. What to do if you suspect Alzheimer's. And Patti Davis, a daughter whose father, Ronald Reagan, was stricken.
Hospitals mine records to find "good" patients -- and then advertise with them in mind.
The head of Sloan Kettering is being sued for taking research that was funded through his former employer and using it to start up a valuable company.
An adopted child with fetal alcohol syndrome finds a friend in a golden retriever. Reminds me of one of our recent insurance appeals.
A new online site, HealthTap, allows you to ask medical questions and doctors answer, gaining points and climbing numbered levels. Check it out here.
Last week's NY Times puzzle is answered here. I was nowhere close.
What doctors can learn from musicians.
And here in Connecticut, the Governor will propose allowing unlicensed aides to give out medications. What's a few mistakes if you can save the state $28 million per year?
Check back a little later for news on the Connecticut Health Insurance Exchange.
And have a great day! Jennifer