Thursday Themes

Oh, boy, is this a long week or what? I suppose, since I just worked 44 hours in 3 days, it's reasonable to feel that way. Thank goodness for President's Day and a 3 day week-end. But first, the news:

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