Monday Morning Musings

A new week; a clean slate; starting over.  All good things.  Let's see about the news:

If the Supreme Court strikes down the individual mandate, what will states do?   Some states -- the states that are already working on Exchanges and implementing other aspects of health reform -- may well enact their own individual mandates.  Surely, insurers will be pressing this issue if they are still required to cover people with pre-existing conditions since adding young, healthy people to the pool is necessary to spread the cost of insuring those with pre-existing conditions. 

I'm really upset about this one.  Nonprofit hospitals are paid by the federal government to provide charity care to the poor.  However, the hospitals are getting increasingly aggressive.  Here's one example of a woman who probably was eligible for charity care, but instead, the hospital sent her claim to collections, threatened to garnish her wages, and threatened to sue her over $1800.  These hospitals don't pay taxes because they are supposed to be operating for the public good.  The hospital says they try to determine whether the patient is eligible for charity care, but blames the patient for not providing all the necessary information or otherwise not following the rules.  At the very least, hospitals who do this should lose their tax exempt status.

Years ago, we learned that the company that was responsible for reporting "usual and customary" rates to insurers for calculating out of network reimbursement was owned by UnitedHealth Group -- a clear conflict of interest that was stopped by a settlement agreement with the NY Attorney General.  Now, as insurers continue to diversify, we have to look for these conflicts carefully.   For example, EHR is supposed to help hospitals and other providers fight with insurers to make sure they pay sufficiently and timely.  But EHR was purchased by UnitedHealth Group.  As diversification flourishes, we have to be careful to look for these sorts of problems.

Service dogs are helping soldiers returning from Iraq with PTSD.  We've been learning a lot about service dogs lately; we have a client who's autistic who uses a service dog to keep him calm and focused.  The article linked here is about service dogs who help Iraq veterans who use service dogs to keep them calm when triggers arise that previously would have freaked them out.  These are not your usual dogs; they are highly trained and serve a very specific purpose, depending on the patient's needs.  The more I learn about the use of service dogs, the more respect I have for them and for those who train them. 

Type 2 diabetes is increasing in America's children, associated with obesity and much harder to treat than in adults.  This type of diabetes is new in children -- rarely seen before 1990.  Although it's still rare, it's growing.  And although adults with type 2 diabetes usually get by with oral medications, kids end up needing injections of insulin.  And they're looking at a lifetime of disease.  We need to figure out why this is happening and stop it before it happens.  All of the pediatric patients studied were obese.  So take your kids outside to play.  Don't reward them with high-calorie snacks.  Make food about fuel rather than pleasure.  I know these things only because my parents did everything wrong when it came to my weight.  Be smarter.

Connecticut Children's Medical Center and Athem Blue Cross Blue Shield of CT cannot come to agreement on reimbursement rates.  So children enrolled in Anthem cannot get their insurance to cover their CCMC doctors.  This is disastrous for these kids.  If you are in this situation, contact the Office of the Health care Advocate at 866-466-4446.  They're keeping track of the problems, although none of us are sure what can be done.  I hope the parties can reach a compromise.  It's about the kids; don't forget that. 

Have a great day -- or try to.  Jennifer

This Pisses Me Off

The House passed a bill that would pay for reducing student loan interest by cutting preventive health care.  Speaker Boehner calls the Prevention and Public Health Fund a "slush fund."  These are funds for cancer screening, child immunization, smoking cessation and nutrition.  In particular, the cancer screening funds are primarily for women -- breast and cervical cancer.  When did our health and the health of our children become "slush" that is expendable?  If the GOP wants to convince us that the "war on women" is a figment of the liberal media, perhaps they should stop targeting programs for women and children.  Are you not outraged?  You should be.  Jennifer

Finally Friday Edition

I do so love Fridays.  But today is bittersweet.  Our Administrative Assistant, Echo Kendall, is leaving us today.  She's about to give birth to a baby boy, and will be able to spend her time with him after he's born, not working, at least for the time being.  Although we are thrilled with her replacement, Jillian Szymanski, it's always sad when someone who's been a part of this organization for a good long time leaves, even if for the best of reasons.  But we are going to have a fun day today -- a little send-off with all of our love and best wishes.  Life moves on, but love remains.  I've known Echo since she was an infant; to have been able to spend her pregnancy with her has been a great gift that means so much to me.  I can't wait to meet her son!  Echo, we love you and will miss you -- and you'd better come visit once in awhile!

Okay -- wipe away the tears now -- here are a few of today's health highlights:

Remember medical loss ratios?  That's the percentage of premium dollars that go to paying for health care.  Under health reform, insurers must spend 80 or 85 percent of premium dollars on health care.  If they don't make that target, they have to pay rebates to their insureds.  Well guess what?  Insurers are expected to refund about $1.3 billion that will be coming this summer.  Still against health reform?  Still think it does nothing to control premium prices?  I bet you'll like that check when it shows up in your mailbox!

According to a new General Accountability Office report, as many as 112 million Americans have pre-existing conditions.  So if health reform falls, those people will be locked into their current insurance -- or if they lose that, they will not be able to get insurance at all.  Still against health reform?

After yesterday's story about debt collectors planted in emergency rooms trying to get money from people before they even receive care, Congressman Pete Stark has asked the Centers for Medicare and Medicaid Services (CMS) to investigate. Clearly, someone needs to look into this.  I'm glad to see it being taken seriously. 

As you know, Dr. Pauline Chen's pieces are among my favorites.  Today, she asks: Does medicine encourage gay doctors?  It appears, from her anecdotes, that the answer is no -- there's blatant discrimination against gay doctors, according to her experience.  While this information is anecdotal only, it's a poignant and sad reality.  We are grateful to Dr. Chen for talking about this issue.

Health care is changing to emphasize quality of life.  Give patients real life goals like being able to work or go to dinner with friends instead of focusing only on blood sugar levels or other scientific measures that are harder for patients to connect with.  This helps patients be able to measure their progress in between doctor appointments, and engages them in a more active role, managing their own care.  This is so totally right.

And that's what grabbed me today in my perusal of the papers.  Have a great day and a great week-end!  Jennifer

Thursday's Thoughts

I hadn't planned on spending next week interviewing candidates for our staff attorney position, but if chronic illness teaches us anything, it's that life is not predictable.  Our only choice is to roll with the punches.  So I'm rolling.

I find this to be interesting.  There's supposedly a lot of opposition to health reform, but two conservative Dems in Pennsylvania lost their party's primaries to two liberals, and the story is that it's largely due to the fact that the incumbents voted against health reform.  Early on in the polling about health reform, the questions were specific enough so that we know that a lot of people who were opposed did not think the law went far enough in the absence of single payer or a public option.  I wonder if that's still the case, so the polling against the law is not all from health reform opponents.  I'm not sure how else to explain these primary results -- and it makes sense to me, since it's quite clear that the law, in fact, does not go as far as it really should if we were trying to control costs as well as achieve near universal coverage.  The best way to keep costs down would have been to have a public option against which the commercial plans would have had to compete.  A lot of people on the left are still upset about that loss.  So is some of the opposition to health reform coming from the left?  Maybe so.

Here's another installment from the young woman undergoing a bone marrow transplant.  She's had the transplant, but she's in isolation to prevent infection because her immune system is essentially non-existent due to the chemo that preceded the transplant.  She's waiting for her brother's healthy cells to engraft in her bone marrow.  She's lost her hair and can't eat.  And she's a hero.  Everybody who fights that hard to live is a hero.  I can tell you for sure that I wouldn't do it.  After my last bout with life-threatening illness, I have never bounced back completely.  What I went through was grueling and life-altering.  I will never be the same.  And I will never do it again.  Everybody who chooses this kind of fight is more courageous than I will ever be.  I am in awe. 

The House Appropriations Committee has gone ahead and passed spending targets that change the deal they made last August.  Remember the fight over raising the debt ceiling?  Congress agreed that a super-committee would try to agree on $1.5 trillion in cuts, and if they couldn't, there were automatic triggers that would take effect in 2013.  Well, since the super-committee failed, the triggers are looming and the House GOP is unhappy with the deal they made.  So they want to change it -- and that's bound to lead to a very partisan battle this summer, with the threat of a government shut-down in October, right before the election.  Who will the voters blame for that, I wonder?  Ugh -- what a mess!

Meanwhile, the health reform law is being dragged into the fight over student loans.  Congress is debating a measure that would stop interest rates from increasing.  Speaker Boehner says he'd pay for that with health reform funding -- what he calls a "slush fund."  Yeah, because providing subsidies to help middle-income families afford health insurance is definitely a slush fund kind of expenditure.  I just don't get it.  What would the GOP do to fix the status quo in health care, with unaffordable premiums, the rise in high-deductible plans, and the number of people who can't get care due to cost?  Until they answer that question, they should not have a right to criticize the plan that's already in place.

Ever wonder how much doctors earn?  Well, here are some figures.  I suspect this is only income from their practice of medicine, without the extras for research, public speaking, and so on.  But I have to say it's less than I thought.  Interesting. 

The Connecticut House of Representatives has passed a bill legalizing medical marijuana.  I'm not sure what this is worth, though, in light of the continued federal crack-downs on medical marijuana use.  Too bad, though, that the feds are taking this position.  I'm entirely convinced that marijuana is an under-utilized weapon in the arsenal to treat chronic pain, nausea, and other symptoms.  And I don't understand the basis for prohibiting it.  But in great local news, the House also passed a bill that would add consumers to the Board of the Connecticut Health Insurance Exchange and make our Healthcare Advocate, Vicki Veltri, a voting member.  About time.  Now, the Senate needs to pass it -- soon. 

That's it for today.  Have a great one.  Jennifer

Wednesday Already?

So this really blows me away.  A Minnesota debt collector has placed employees in emergency rooms and demanding payment before the patient even receives treatment.  The New York Times suggests that this may be happening all over the country.  And it is an outrage.  The debt collectors had access to medical information, violating privacy rules.  They dress so that they are indistinguishable from hospital employees.  They may not have identified themselves as debt collectors, as required under the Fair Debt Collection Practices Act.  Maybe I'm just missing something, but since the federal government pays nonprofit hospitals millions of dollars to compensate them for uncompensated care, I'm not sure why the hospitals feel so squeezed.  But I do know that they have no place in treatment areas of hospitals -- period.

And here's an opinion piece that makes me really mad.  The article says that Social Security disability is a bad thing, that it's too easy to get benefits, that it takes people out of the job market prematurely and slows economic growth.  You know, I talk to a lot of people on disability -- and a lot of people who are trying to get disability.  It's certainly not easy to get -- that much is for sure.  The article also says we can fix this by making employers buy private disability insurance so that they feel the pain every time they drive an employee to disability.  Bosses would then provide rehab and improve working conditions.  Really?  I do agree that we need to find more ways for disabled people to work.  So many people could earn a living if they could work from home.  But in my experience, the companies who offer private disability insurance are no less likely to push people to disability.  The problem is far more complex than this -- for example, if we had better, more affordable health care, people wouldn't get so sick that they end up on disability.  How about stopping the trend to high deductible health insurance so people would get the care they need to stay healthy and employed?  Yes, there are answers, but the answer isn't making disability harder to get than it already is.

A new study shows that painkiller abusers start at home, getting drugs from family or friends.  Kids find drugs in medicine closets and experiment.  Okay, then.  It seems that this should be an easy enough fix.  Parents, lock your drugs up where they can't be found by your kids.  If you're on pain meds, don't share them.  But what I worry about most of all when I read articles like this is that the crack down on pain meds is hurting people with legitimate chronic pain who are finding it increasingly difficult to get the meds they need.  So the people who have pain meds legitimately have to take responsibility for their use if you want pain meds to be available when you need them.

Join Costco and buy Aetna health insurance?  Sort of interesting.  I think insurers are trying to use agents and brokers less because commissions go on the administrative side of the medical loss ratio formula (percentage of premium dollars spent on health care).  Avoiding paying commissions is one way to make more room for other administrative costs -- like salaries and bonuses.  Expect to see more retail selling of health insurance, I predict.

And those are the stories that interested me today.  What do you think?  Jennifer

Staff Attorney Needed

Advocacy for Patients with Chronic Illness, located in Farmington, Connecticut, is looking for a staff attorney.  Primary responsibility is to prepare very complex insurance appeals, as well as to represent clients in employment and school matters, help locate resources for people in need, and supervise student interns.  We are willing to train, but Bar membership is required.  The salary is $45,000, non-negotiable.  Must be in Connecticut; the job cannot be done long-distance. 

The work is great.  Every once in awhile, we save a life.  And it's great training for a young lawyer.  If you're interested, please email your resume to patient_advocate@sbcglobal.net.  Jennifer

Tuesday Tidbits

I have to start with the article on the front page of the New York Times about out of network benefits.  I'd be profiling this one even if I were not in it.  This is a very important issue for consumers.  If you have insurance that allows you to go out of network, your policy says it will cover 70 or 80 percent of the "allowed amount."  You may think that means they'll pay 80% of what your doctor legitimately charges, but you would be dead wrong.  It's 80 percent of what the insurance company thinks your doctor should have charged, not what they actually charge. 

It used to be that insurers paid 80 percent of "usual and customary" charges.  Back in 2009, the NY Attorney General reached a settlement with insurers that would stop them from using cost data they got from a company called Ingenix, which was a United Health Group subsidiary -- clearly not unbiased -- to determine what was "usual and customary."  Under the settlement, insurers no longer could use Ingenix data.  However, a nonprofit organization -- FAIR Health -- was formed to receive and update that data and make it available to payers, providers, and consumers.

The insurance industry, though, saw an opening.  Many of them have switched now, from usual and customary to "allowable amount," defined as pretty much whatever they say it is.  In my case, Anthem Blue Cross Blue Shield of Connecticut pays whatever the Blue Cross in the provider's state pays.  In this case, Empire Blue Cross uses 250 percent of Medicare -- and when you have an upper endoscopy on the same day as a colonoscopy, they only pay half of the allowable amount for the upper endoscopy, or $220 out of an $1800 bill.  You know what happens -- people stop having scopes as often as they should because they can't afford it.  So they wait.  Until they are sick and don't have a choice.  And by then, they need a lot more than just scopes.  It's a racket for the insurers -- and consumers need to know about it.  Which is why I gave the New York Times all of my explanations of benefits and let them run with it.  Hopefully, it will illustrate the point for many consumers who need to know how their insurance works before they go for care, not after. 

And here's a related piece on hospital pricing, which also is all over the map.  The cost of a simple appendectomy is all over the place -- and about one-third of the price differential cannot be accounted for based on any differences in the procedure itself. 

The second story of the day is the economic outlook of Social Security and Medicare.  The Social Security trust fund will run out of money in 2033, and Medicare in 2024.  But the Social Security disability account will go broke in 2016 -- not so long from now.  Some how, we are going to have to reform these systems without changing their essential character.  That may mean a higher retirement age, to start with.  The Social Security disability system is so broken, though, that it needs a much bigger fix.  They have to find a better way to make disability determinations.  There are too many appeals -- but that's because too many righteous claims are being denied, so there are too many appeals, and the whole system is bogged down.  I wonder how much of their budget they spend on administration.  I bet they could do it a lot cheaper if they did it right.

What if the Supreme Court strikes down only part of the health reform law?  What then happens to the rest of it?  Will the Supreme Court wade through all 2700 pages and figure out what parts survive and which don't?  Or will they send it back to a lower court -- or leave it to Congress to fix it?  No matter what, if the  Court does anything other than uphold the law, there will be chaos.

And here's a piece on travel insurance.  But read the fine print.  It always excludes pre-existing conditions.

Finally, apparently the days of debtors' prisons has returned. Here's a hair-raising story about a breast cancer survivor who was jailed for a $280 medical bill that she didn't even actually owe.  Such an outrage.  Illinois -- where this woman lives -- is considering legislation to outlaw debtors' prisons.  Should have been done long ago. 

And that's it for today.  Have a great day!  Jennifer

A blog change

As you know, this blog has undergone some changes over the years.  It used to be a lot more personal.  More recently, it's become a news-reel with little commentary.  But you don't need me for that.  You can go to Kaiser Health News and get the health-related headlines. 

So I'm making another change.  Now, I'm going to pick just a couple of articles or issues each day and comment on them a bit more fully.  There will still be links to the day's papers, and I'll still bring you what I think are the most important things you should know in the health world that day, but rather than linking to every article I can find, I'm going to be a bit more selective.

We'll see how it goes.  Let me know what you think.  Jennifer

Advocacy for Patients in the NY Times

On the front page of today's New York Times, you will see an article about out of network rates.  If you scroll down, you'll see a small picture of me and a few paragraphs telling the story of what I had to pay for my out of network colonoscopy and upper endoscopy.  Check it out!  Jennifer

Welcome Back Edition!

Another Monday -- and a gloomy one here in CT, where we are getting soaked.  Had a good trip to Chicago, although this old body just doesn't like all that standing and walking and lifting and ... you know.  Anyway, I'm not going to do a full blog post, but there were a couple of things I saw over the week-end that I thought you'd be interested in. 

Here's an interview with Dr. Otis Brawley, who wrote a new book called How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.  He blames much of the failure of the system on the big players in the system, but also says patients are "gluttonous" about getting more care, more tests, more drugs -- and I'm just not sure I'm buying that.  I think most sick people are like me -- we'd like as little contact with the medical system as is humanly possible considering our illness.  Anyway, it's interesting and thought-provoking. 

And here's an intriguing article about Mitt Romney's health care plan -- the headline says it may be more revolutionary than President Obama's.   It's a move away from employer-sponsored health insurance to giving people tax credits to buy insurance.  Since insurance costs more than the tax credits, the expectation is that this plan would increase the number of uninsured Americans.  It also would convert Medicare to vouchers and Medicaid to block grants.  I suspect I don't have to tell you what I think about this.

Many states are delaying taking steps to implement health reform until after the Supreme Court rules.  However, by that time, most state legislatures will be out of session -- so they will be way behind in setting up Exchanges.  They're going to have to make fast decisions whether to run their own Exchange or allow the feds to do it for them.  A real quandry.

Some states are considering lowering the cost of physical, occupational and speech therapy.

And that's it for a quick, abbreviated recap.  Have a great day!  Jennifer

Finally Friday Edition!

I'm off today to speak at the Crohn's & Colitis Foundation's Midwest educational seminar in Chicago.  But before I go, here's the news:

48 million Americans had gaps in their health insurance last year, primarily due to job loss and job changes. That's 1 in 4 Americans.  The Affordable Care Act would change that for many.  But if we lose health reform, there will be no mechanism in place for changing this.

Guns vs. healthcare.  The House GOP's budget would eliminate subsidies to help people buy health insurance through the Exchanges, and convert Medicaid to block grants in order to avoid cuts to defense.  They agreed to those defense cuts when they negotiated the increase in the debt ceiling, but now that the trigger for those cuts is approaching, they want to renegotiate. 

Growth in health care costs declines as a result of fewer inpatient hospitalizations.

Two new pills taken in combination appear to be excellent treatment for hepatitis C, but since they're made by two different companies which are not collaborating, the combination may not make it onto the market.  That's completely pathetic.

The great Dr. Pauline Chen writes about third-year med students, who typically rotate in a series of month-long specializations that is grueling and impersonal.  Studies show that this results in a loss of empathy and compassion for patients.  Some med schools, though, are trying alternatives -- which, we hope -- will result in better doctors.

There was an increase in measles cases in 2011.  Low vaccination rates in other countries is the likely cause.  If you're traveling, make sure to have your vaccinations.

And that's all I have for you today -- a slow news day.  Watch the NY Times this week-end for a story in which yours truly is featured, photo and all, if all goes according to plan.  Meanwhile, have a great day and a great week-end.  Jennifer

Almost Friday (YAY) Edition!

One more day and I'm off to the Crohn's & Colitis Foundation's largest educational program in Chicago, where I will be giving two speeches -- one to parents about school law, and one to the large group, an overview of disability law.  But first, the news:

Conservative policy analysts are encouraging states not to create health insurance Exchanges.   Their goal is to destroy health reform even before it really gets started.  But the law says that, if a state doesn't create an Exchange, the federal government will do it for them.  The whole idea of Exchanges is to create a marketplace where consumers can shop for and buy health insurance, while also applying for Medicaid or subsidies to help cover the cost of private insurance.  Even if you drop the subsidies, though, how is it not a good thing to help consumers get accurate, reliable information so that they can make informed decisions about health insurance?  There's been an Exchange in Utah for years now -- not exactly a hotbed of political activism -- because it's just smart to help consumers make good purchases.  So even if you are against some aspects of reform -- the individual mandate primarily -- why not use the good pieces of it?

A new study shows that people remain unaware of key aspects of the health reform law.  

Once you become uninsured, you're likely to stay uninsured for awhile, says a new study.  31 percent of those surveyed say they can't find insurance due to a pre-existing condition.

Bills introduced in the House and the Senate would change the rules on generics, allowing manufacturers to update information on risks, and thereby allowing patients to sue generic manufacturers if something goes wrong. This would overturn a Supreme Court decision holding that makers of generics cannot be sued for product liability.

The health insurer WellPoint (Anthem BCBS parent company) is the focus of an aggressive demand for corporate disclosure of political activity, including large donations to the Chamber of Commerce.  In this case, it's members of WellPoint's Board of Directors who are demanding transparency.

Here's another installment of the journal of a young woman undergoing a bone marrow transplant for leukemia.   She's totally amazing, if you ask me.

New breast cancer classifications may help to design custom treatment that will, thus, be more likely to succeed in treating the disease.

The Department of Veterans' Affairs is increasing its mental health staff in response to a surge in need for mental health services among those returning from war.  About time.

Exercise lowers Alzheimer's risk. 

And that's today's early morning news.  Have a great day. Jennifer

More on Specialty Tiers

NBC in Connecticut ran a really great story on the burden people with chronic illnesses face as insurers expand the use of specialty tiers.  Specialty tiers are used by insurers to take a category of drugs -- usually, drugs that are expensive -- and apply a percentage coinsurance instead of a fixed copay.  So, for example, the woman profiled in this story would have had to spend over $11,000 per year for her medication.  Due to the expense, she has had to stop taking the drug and her symptoms have worsened.

This is a tough one.  The cost of many drugs is through the roof.  However, are we prepared as a society to allow insurers to make them completely unaffordable?  If not, who bears the cost -- insurers or society as a whole?  And if so, what about the cost of treating illnesses when drugs that would keep those illnesses in remission are out of reach of a lot of patients, so their health care costs end up skyrocketing when their condition spirals out of control?

Unfortunately, there appear not to be ready answers to those questions on the public policy level.  We'll keep at it, though.  Jennifer

Hump Day Headlines!

Neither Crohn's disease nor corneal abrasion nor major tooth pain can stop your intrepid reporter (me) from bringing you the news!

Today, we welcome FAIR Health to Connecticut to give a presentation to those of us who do a lot of work with health insurance.  I'm so pleased that they are willing to come and show us all of their great tools.  First, though, we have to get down to business!

Community health centers -- perhaps the most important health care delivery system for the poor -- are struggling to keep quality up as they fall short on vaccinations, diabetes control.  

Health reform has funded the creation of hundreds of jobs.  What happens if the Supreme Court strikes down the entire law?  The health care sector has remained strong despite the recession, but if health reform goes away, so will a whole lot of money and a whole lot of jobs.

Guess what?  Drug testing welfare recipients doesn't save a state any money.  Now, can we stop treating welfare recipients like criminals please?

There are two new, counter-intuitive studies that say that obesity is no worse in poor neighborhoods where it can be hard to get fruits and veggies.  These studies show that there is no connection between the type of food being sold in a neighborhood and childhood obesity rates.  Hmmm.

A new blood test may be able to diagnose depression.   A challenging diagnosis -- and we may be close to nailing it down.  Great news.

This comes as no surprise to me -- a positive outlook improves your health.  You have more control over what's going on with your body than you may realize. 

Working towards a new social contract in health care.  Getting the results of research out to treatment faster and better.  It's great that the research sector is thinking like this. 

Have you ever thought about going vegan?  It's a huge challenge -- unless, of course, you have a personal chef!

And that's it for this morning -- a light news day.  Then again, no news is good news, so I'm not complaining.  Have a great day!  Jennifer

WOOHOO!!! Edition

Good morning!  And a great morning it is.  Yes, one of my eyes still doesn't work right.  And yes, I had a tooth pulled and an implant implanted yesterday.  So I have plenty to bitch and moan about.  But I just heard that we won an insurance appeal to get a man a stem cell transplant.  The insurance company's doctor had recommended "observation," which was nothing short of a death sentence.  I pulled out all the stops -- and WE WON!!!  There is NO BETTER FEELING than the way you feel when you save a life.  I don't care how much my eye hurts or my mouth hurts -- as long as I can do this work, nothing else really matters.

And so here's today's news -- as if that weren't enough!

A focus on quality of life reduces health care spending.   Getting well isn't all about blood tests and CT scans.  No matter how sick you are on paper, quality of life can matter more.  Our friends at the University of Michigan Center for Managing Chronic Disease are behind this one -- so obvious, but overlooked by mainstream medicine.

Another conservative scholar says health reform is constitutional and should be upheld.  Let's hope the Court reads that column.  Meanwhile, a key piece of health reform is the provision of tax credits or subsidies to help people buy insurance. However, you won't be able to get a subsidy if you are offered employer sponsored insurance unless that insurance is "unaffordable" by federal standards.  But the federal standards only look at the cost of covering the employee, not the employee's whole family, which may well be far more expensive.  This rule could exclude people from having the option of buying insurance through their state's Exchange with the help of subsidies, and many advocates -- including us -- don't think that's what Congress intended.

According to the NY Times, a bunch of lawyers are finding violations of the Americans with Disabilities Act in the old architecture of NY City, and then they're going out and looking for a client in whose name they can bring a lawsuit.  That's not the way it's supposed to work -- you're supposed to have a client come to you for help.  But maybe it's a good thing that they're identifying problems that need fixing.  What do you think?  Scrupulous public service or ambulance chasing?

Out of network care comes at a very high -- and complicated -- price.   Our friends at FAIR Health can help you to predict what an out of network service is going to cost you, but insurers are doing all they can to try to keep us in network.  For those of us with unusual medical circumstances, who really need to go out of network for our health, it's going to hit your wallet hard.

The feds have nailed two insurers -- Assurant and Bedford Park (which I've never heard of before) -- for unreasonable premium rate hikes.  The federal government does not have the authority to stop these rate hikes from taking place, but they do have the authority to report that they are unreasonable -- and hopefully, the state insurance departments will do their job and take a very hard look at these rate increases.

Teenage prescription drug deaths are climbing.  This stuff is so hard.  When legislators react to a statistic like this by tightening up controls on narcotics, chronic pain patients suffer terribly.  Where to draw the line?  So far, we have no really good answer to this question.

Gay men have been barred from donating blood for years due to HIV/AIDS.  But should we reconsider that, allowing low-risk (i.e., monogamous) gay men to donate?

The FDA is tangling with medical app makers.  Stepping into a regulatory void, the FDA takes are harder look at these apps to ensure that they are legit.  Except that people who create apps for mobile phones and tablets aren't really used to working with the FDA -- and visa versa.  It will take some getting used to.

With the focus on health care costs, some advocate against all the tests we have done, some of which don't help promote health outcomes.  And when the doctor owns the lab, more biopsies for prostate cancer are tested.  

Eating disorders are being treated faster and better.  Clearly, this is positive, but it only tells half the story.  Try getting your insurer to pay for treatment long enough for you to really kick the problem.

A new study shows that Enbrel is not more effective in treating back pain than more standard (and less expensive) therapies.

There's a rise in retractions of medical journal articles, and this is worrisome since clinicians and insurers make decisions based on published medical literature.  

Sex ed is on the rise on college campuses to bridge the gap between bedroom and classroom.

Does exercise make you over eat?  Or does it suppress your appetite?  The answer is less clear than I thought it was.  And here are a bunch of myths about exercise -- are they true?  And what about indoor walking -- is it good for you?

Red meat not only increases the risk of disease, but it also increases the risk of death.

A lovely piece about helping a friend die, slowly.  I'd like to think I'll have friends like this around me when the time comes.

And that's this morning's news.  Have a GREAT day!  Jennifer

Jillian's First Day Edition!!!

Our new administrative assistant, Jillian Szymanski, starts today.  Welcome Jillian!  Today's news is dedicated to you! 

And as our outgoing administrative assistant and dear friend Echo Kendall gets ready to give birth to Malaqi, I post this article in her honor -- services for breast feeding moms!

It's hard as a consumer to get prices on health care so you can comparison shop.  In some states like California, hospitals disclose rates on websites.  Or you can use our friend FAIR Health's website.  But it's still the case that, while we can easily find prices of everything else we buy, health care is the one thing it's hard to shop around for.  But we have no choice but to become educated consumers.

Medicare is starting to report to doctors on how their patients are doing -- the first step in a move to tie doctors' pay to health outcomes.   But will this encourage doctors to withhold necessary care?  We don't know yet -- and we have to watch carefully.

In order to be sure there are enough doctors when Medicaid is expanded starting in 2014, health reform requires states to pay primary care providers in Medicaid the same fee they get in Medicare.  Is this sustainable?

A new vaccine is supposed to stop heroin use, but will it stop the underlying impulses that result in addiction?

A bit of a scandal as California hires the relatives of the state's consultant on mental health hospitals and then uses a controversial technique on patients.  This is pretty scary, if you ask me.

You have to keep your sense of humor no matter what, right?  Well, here's an Asperger's are Us comedy troupe.  You've gotta love it!

Connecticut Children's Medical Center is letting its contract with the state's largest insurer, Anthem Blue Cross Blue Shield of CT, lapse because the two cannot agree on reimbursement rates.  The people who suffer most will be the patients.  I hope the two sides can find a way to move forward.

And that's it for this morning.  Have a great day!  Jennifer

Finally Friday Edition

Long week -- emergency insurance appeal for stem cell transplant, corneal abrasion -- I'm pretty wiped out.  My eye is getting better, but because of the antibiotic ointment I have to put in it, I can't really see out of it, and my other eye is really straining.  So who knows what kind of typos I'm missing!!!  Anyway, here's the news for one last time this week:

Health reform is about real people. It's not just politics.  People with pre-existing conditions are holding their breath waiting for the Supreme Court decision, which threatens to derail the part of the law requiring insurers to cover people with pre-existing conditions.  Meanwhile, the Obama administration says it has no back-up plan in case the Court strikes down the law. 

After 6 years, how is health reform doing in Massachusetts?  There's still work to be done on cost control, and widely divergent views on how to move forward.  But they have nearly universal coverage, so now they are able to focus on cost, trying out various ideas in the search for ways to control cost without sacrificing quality health care.

If you get our newsletter (which you can sign up for here), you know that we've been focused on specialty tier legislation at the state level, trying to keep these medications in reach of the average patient.  So I'm glad to see some national press coverage of the issue.  I'm very concerned to learn that Aetna has launched specialty tiers in Connecticut.  If you're on Remicade, Humira or Cimzia for Crohn's, for example, you'll now pay a percentage coinsurance rather than a prescription drug copay.  It puts medication out of reach for too many patients.  And what gets me the most is that, if people can't get their meds, their disease gets out of control, and so they get sicker and far more expensive for the insurance company.  I don't know why they don't get that. 

Across the country, there are efforts to try to improve care for the most vulnerable -- people who are on Medicare due to disability and Medicaid due to poverty, known as "dual eligibles."  These tend to be the sickest of the sick and, thus, their health care costs -- borne by the government -- are especially high.  Connecticut it trying to work towards a plan that rewards health care providers for "shared savings" without eliminating care or making it unaffordable.  

New York's GOP blocked legislation to create an insurance exchange so Governor Cuomo has issued an executive order directing the state to do so.  

The CEO of Quest Diagnostics -- a huge laboratory operation with offices across the country -- says Americans aren't good consumers of health care.  We don't comparison shop, and price is not aligned with quality, he says. And most of all, since consumers don't want health care, health care consumption is not based on desire, as is consumption of most other services.  Interesting.


Women are less satisfied with their medical care than men. This doesn't shock me.  Women use more health care than men -- and women are taken less seriously by doctors, in my opinion and experience. 


Have you seen this video of a man with dementia in a nursing home who lights up when he's given music?  I love this! 


And that's it for this morning.  Have a great day and a great week-end!  Jennifer

Thursday One-Eyed Edition

I poked myself in the eye -- just carelessness -- and I have a major corneal abrasion.  I have to go back to the doctor today to make sure it's healing okay -- otherwise, I have to go to an eye doctor for more extensive treatment.  There are major nerve endings in the eye, so when I tell you this is painful, it's REALLY painful. 

But still, your trusty reporter, gladiator for the chronically ill, lets no small injury interfere with her duties!!!  If I can work from a hospital bed, I can work with one eye closed!  So here you go:

The Connecticut General Assembly has now passed a bill repealing the death penalty, and the Governor is expected to sign it.  This is a proud and historic day for our state; a step in the direction of human rights.

Health care reform in Massachusetts turned 6 yesterday. It's been a pretty good success, which bodes well for the federal health reform law.

Meanwhile, the struggle to get accurate information about health reform presses forward, with this latest detailed defense of the law by a Kentucky Congressman.  And there's also some second-guessing about the arguments made in the Supreme Court.

Here's the next installment in the NY Times series written by a young woman who is undergoing a bone marrow transplant for leukemia.  What a brave woman, to share this journey with all of us.

Vital signs by phones?  Doctor appointments scheduled using an app on your smartphone?  Is this the future of medicine?  I actually think this is very exciting.  Tools for monitoring chronic illnesses can only help us.

Johnson & Johnson has been fined $1.2 billion -- that's billion with a B -- for understating the risks associated with an antipsychotic medication, Risperdol. 

A link between quality sleep and diabetes.  Yet another indication that sleep is really critical to good health.

The World Health Organization says dementia cases are predicted to triple by 2050.

And that's it for today.  I apologize if I missed something -- the best I can do with only one eye open!  Have a great day!  Jennifer

Hump Day Headlines

Whew -- what a whirlwind yesterday was.  Today promises to be equally challenging.  So I'd better get right to the news.

A new poll says most Americans expect the Supreme Court Justices to vote their politics in the health reform case. And most people want at least the individual mandate to be stricken down.  I wonder whether those people would feel that way if they knew that we spend $43 billion to pay for care for people without insurance, that the "penalty" for not buying insurance is all of $95; and that we can't cover people with pre-existing conditions without an individual mandate.  But since nobody's teaching, people are listening to mainstream media and they don't understand.  I wish I knew how to reach them.  Meanwhile, the fuss about President Obama's comments on the case simply won't die. 

A jury awarded an elderly woman $34.3 million from a long-term care insurers in damages for not covering her stay in an assisted living facility.  Good for her!  Long-term care policies often take every possible opportunity to deny coverage.  Maybe now they'll think twice. 

The health cuts in the GOP budget approach $3 trillion!  You're not going to do that without depriving somebody of care.  It would turn Medicare into a voucher system, leaving seniors to find their own insurance and pay premiums that exceed their voucher, pay deductibles, copays and coinsurance -- a huge cost-shift to seniors.  Medicaid would become block grants, and health reform would be repealed.  Happy now? 

Meanwhile, more than 1 million Medicare beneficiaries are now enrolled in Accountable Care Organizations that stress care coordination, with resulting cost savings.  Twenty-seven applications have been approved.  To learn about Accountable Care Organizations, go here.

Drug shortages are plaguing hospitals.  Anethesia.  Cancer drugs.  Is this a real shortage, or are drug makers holding back to drive up prices?  I hate to think that. 

Colon cancer is one of the most treatable cancers.  But only if you catch it early.  So screenings are critical.  When doctors offer only colonoscopy, patients are less likely to get screened, but if offered options, they are more compliant. I can't blame anybody for hating colonoscopies.

Should the government pay for prenatal care for undocumented immigrants?  Nebraska's anti-abortion faction is split on this one.

Doctors learning how to cook?  I guess this is a way to teach them good nutrition, which benefits their patients.  So maybe this is a good thing?  Interesting. 

And that's it for this morning.  I'll be out much of the day -- wave if you see me whizzing by!  And have a great day!  Jennifere

Tuesday Tidbits

Running fast this morning, and extra early.  Working on an emergency insurance appeal, have a meeting outside the office from 9-11, so squeezing in a quick blog post for you today.  Today's Tuesday, so the biggest health news day of the week -- lots to tell you about, and much of it is really interesting. 

A new report written by a conservative economist says health reform will increase the debt.  That contradicts all previous reports, including the nonpartisan Congressional Budget Office, which says health reform helps cut the deficit -- and repeal would be a budget buster.  He says that, by extending the solvency of Medicare, health reform increases the deficit by increasing spending.  Huh?  So preventing Medicare from running out of money is a bad thing how?  I swear that's what he says.  Read it yourself!

The CT General Assembly's Government Administration and Elections Committee has voted out a bill that would add a consumer and a small business rep to the Board of Connecticut's Health Insurance Exchange.  Took them long enough.  The bill would also give CT's Healthcare Advocate, Vicki Veltri, a vote on the Board (she's currently a non-voting member).  Today's the first meeting of the Exchange Advisory Committees -- I'm on the Consumer Experience and Outreach Committee and the Health Plan Qualifications Committee, which meets tomorrow.

Equally importantly, food stamps helped reduce the rate of poverty during the recession.  What's more important to you -- the amount of the debt or the poverty rates?

Hackers somehow found their way into Utah's Medicaid records, exposing the personal information of about 780,000 patients. Why would someone want to steal data on poor people?  I can at least understand the desire to steal credit card numbers, but Medicaid recipients are poor, so why target them?  I'm sure there's some sick reasoning behind this one.

The CDC says the birthrate for US teens is the lowest ever.  Now, that's great news.  It comes as no surprise to me that the highest teen birthrate is in Mississippi. 

Fascinating story by our friend, Ariel Levin Becker, at the CT Mirror.  A study was done to see if imaging (CT scans, MRIs, etc.) is over-utilized or under-utilized.  It found that, in places where there is high unnecessary imaging, there's also high appropriate imaging; and where there's low unnecessary imaging, there's low imaging use.  If the places with inappropriate rates of imaging cut the inappropriate uses, it might risk losing some of the appropriate uses.  So what's the right answer?

Geriatric emergency rooms?  Why not?  Specialized emergency rooms for the elderly -- quiet, calm -- because of health reform's emphasis on patient satisfaction.  Yet another great outgrowth of health reform.  But here's a sad story about one elderly woman and the world around her.  Really, I'm not looking forward to old age at all.  But one good thing -- hearing aids are getting far better, although also far more expensive.  And depression in seniors can be treated.  And here are some life lessons from seniors.

Autism science is moving faster than ever.  Over $1 billion has been spent on research.  It may be linked to obesity during pregnancy.  With the rate of autism climbing, there's more pressure on researchers to figure out the cause.  It's great that progress is being made.

New research on how pets can enrich children's lives.  I don't know about kids, but I can tell you that, without my feline Emily, I would be the most alone person on the planet.  She's the best friend I could ever want and I honor her for her many gifts to me.

New treatment for sleep apnea, which contributes to everything from obesity to heart disease.  Standard treatment is this awful CPAP machine -- a mask over your face held in place by straps that go over and around your head.  I took one look at it and said "please take it away."  I couldn't stand the thought of it.  But this new device -- more expensive, of course -- just places a patch over your nose.  That, I think maybe I could live with.  I'm glad to hear they're working on options.

Do you review your medication regimen with your doctor periodically?  You should.  It might improve your health.

So interesting -- some people feel pain more than others -- and now, it appears, there may be a genetic link. Hmmm.

Depression and other mental health problems are as much diseases of the body as they are of the mind.

A new report says screening smokers for lung cancer would be a good value.

And that is today's news -- certainly enough to keep you busy while I get back to my real work!  Have a great day!  Jennifer

Monday Already?

Starting the week too tired.  Wishing my life away, hoping Friday comes quickly.  Meanwhile, the news:

The crisis in pain medication in Washington State is now (finally) making national news, but not with the spin I'd have put on it.  Sure, there are issues with doctors over-prescribing, but you can't just cut patients off cold-turkey, which is what many doctors out there have been doing.  I already had one client attempt suicide over it, and another has completely lost her mind. 

You hear people screaming about health reform using government funding to pay for illegal immigrants.  This is completely untrue.  But what do illegal immigrants who get sick here have to do in order to get health care?  Here's a harrowing story with a happy ending for one patient, but a cautionary tale for others. 

An important article about autism -- rates of autism are rising like mad, and there still are those who believe it's not real.  Can you imagine how hard this is for a parent to navigate?

Horrible news from New York, where advocates had won a court order requiring that mentally ill adults had to be moved out of institutions, only to have a court of appeals say that advocates lacked legal "standing"; in other words, they are not the right people to bring the lawsuit, so the case gets tossed.  What happens to the people who needed help in the first place?  What a sad mess.

A task force in California is seeking to change the mental health commitment law.  The law gave rights to people who previously could have been committed indefinitely and medicated involuntarily.  But they say it's not working very well.  The problem is that they don't have any good solutions, either.

Under health reform, preventive exams are covered without copay or coinsurance -- but it appears that the cost of these services varies widely, and that may mean higher costs borne entirely by insurance -- which, in turn, may mean increased insurance premiums.  They use colonoscopy as an example. In my experience -- and I've had a huge number of colonoscopies -- there's also a wide variety of quality.  You get what you pay for.  I'm not sure an $800 colonoscopy would be worth having.

Arizona got federal approval to expand health care to 22,000 children under the state's Medicaid program.

Here's a cautionary tale -- what happens when you think you're healthy enough to go without insurance.

And that's all I have this morning.  Have a great day!  Jennifer

The Answer to NY Times's Medical Puzzle

You know I love these "think like a doctor" puzzles run in the NY Times about once a month or so.  Anyway, this week's puzzle has been solved: adult onset Tay-Sachs disease.  Did any of my readers get it right?  I really thought I had this one, but I didn't.  Some day, though, I'm going to recognize something I've read in someone's medical chart! 

Anyway, have a nice week-end.  Jennifer

Finally Friday!

I have to be quick today -- I had a lot of complicated emails from overnight so I'm behind already this morning.  So here are the highlights:

Interesting to me how controversial the President's words about the Supreme Court have turned out to be. While it's true that he misspoke a bit, and it probably would have been better had he not commented, I can't imagine having your most important act as President be trashed like it was last week, especially when you know that it's politics rather than law that is driving things.  It's not as though he's the first President to criticize the Court.  I was really glad he spoke -- I needed to hear him voice his support for the law and for the right result from the Court.  When the GOP rants about activist judges, nobody reacts like this.  It's really somewhat remarkable. 

Ann Romney has MS and, as a result, she would not be able to buy insurance on the open market, or if she could, it would cost a mint.  Real people -- people who work for a living and aren't gazillionaires -- don't have the option of paying for their own care if they can't get insurance.This article compares Ms. Romney to another woman with MS who isn't quite so privileged.

The NY Times has launched a new series -- a young woman with leukemia who will be going through bone marrow transplant will write a column each week chronicling her experience.  She's introduced herself to us, and now we will follow her journey. 

The California Insurance Commissioner is blasting Aetna's 8% rate hikes -- Connecticut approved the same rate hikes on April 4.  The California Commissioner is trying to get the legislature to give him authority to regulate premiums, so that probably accounts for the difference in their positions.  Connecticut's Commissioner already has that authority.  Indeed, Connecticut's Commissioner Leonardi just announced that the insurance companies will be sending consumers a notice of rate increases when the increases are filed so consumers have a chance to comment before the rate increase takes effect.  A small but dedicated group of advocates have been pushing for this for a long time, so we are very pleased to see this result, and we thank Commissioner Leonardi for his leadership.

Here's a nicely done piece on what to do if your insurance company refuses to pay for emergency room visits.

And that's it for this morning.  Have a great day!  Jennifer

We Did It: Connecticut Consumers to Receive Notices of Rate Incareses

STATE OF CONNECTICUT Insurance Department     Thomas B. Leonardi                                Commissioner

 

 

FOR IMMEDIATE RELEASE	CONTACT:	Donna Tommelleo
		860-297-3958
April 05th, 2012		Donna.Tommelleo@ct.gov

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Insurance Commissioner: Consumers To Receive

Timely Notice of Health Carriers’ Rate Filing

 

 

      Connecticut Insurance Commissioner Thomas B. Leonardi today announced that health insurance companies and HMOs will begin notifying their individual and small group policyholders each time they submit a rate request to the Insurance Department for review along with guidance on where to access the filing and submit comments.

 

      "Consumers have a right to know when their health carrier has filed for a new rate and the Department has worked closely with carriers to develop a letter on rate notification. Together with the Department’s postings, this letter is another important outreach resource that we can use to help educate policyholders about insurance rate procedures in Connecticut," Commissioner Leonardi said. "I appreciate the efforts and cooperation of the carriers to keep their customers well-informed every step of the rate process."

 

      The Commissioner said companies have agreed to mail out the notification letters at the same time they submit a rate filing to the Department.  The letters will go out consumers who have individual policies and, in the case of small group, will be mailed to the employer. The letter will direct consumers to the Health Insurance Rate Filing link on the Department’s Web site. The site includes the company’s rate request, correspondence with the Department, a section for public comment and a brief easy-to-understand summary of the entire filing. The letter also directs the policyholder to the Department’s e-Alert section.

 

      The Insurance Department uses several ways to notify the public each time a carrier files for rate change. Subscribers to e-Alerts get an e-mail with a link to the rate filing section. The Department also posts news of the filing on the cover of its Web site, on Facebook and on Twitter.

 

      The agreement drew praise from advocates, the industry and key state lawmakers:

 

      "I appreciate the Commissioner's efforts to secure this agreement with insurers, in lieu of legislation," said State Healthcare Advocate Victoria Veltri. "OHA has advocated for years for meaningful, advanced notice to consumers of proposed rate increases to allow consumers the option to shop for a new plan, prepare for a rate increase and/or provide comment to the Insurance Department on the insurer’s justification for the rate increase."

 

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      "This provision for direct notification of rate increase requests is an important part of the transparency and accountability we’ve been working toward in the state’s rate approval process – it’s gratifying to know consumers will now have more information available to them so they can participate more knowledgably in the proceedings," Senator Joseph J. Crisco, Jr. (D-Woodbridge), Senate chair of the legislature’s Insurance and Real Estate Committee, said.

 

      "As a regulated industry in the state of Connecticut it only follows the affected residents of the state ought to play a role in that regulation if they so desire. I commend Commissioner Leonardi for his responsiveness on this notification issue and remain grateful to my legislative colleagues and all those who helped revise our insurance rate review procedures," Senator Crisco added.

 

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      "For the sake of consumers, I am very happy with this announcement," said Rep. Robert Megna (D-New Haven), House chair of the legislature’s Insurance and Real Estate Committee."Informing consumers ahead of time of any potential rate increase will allow them flexibility in their financial planning."

 

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      "The process initiated by Commissioner Leonardi worked because everyone - the Department, legislators, interest groups and payers - have had the same goal in mind: putting the best possible information in the hands of consumers and encouraging them to participate in the Department's robust rate review process," said Keith Stover, spokesman for the Connecticut Association of Health Plans.  "We applaud the Commissioner's work and the Department's willingness to develop a sound, practical approach to a vital consumer issue."

Happy Birthday Mike McCready!!!

As many of you know, Mike McCready -- Pearl Jam guitarist -- and his wife Ashley O'Connor have supported Advocacy for Patients from day one.  Thus, when one of them has a birthday, we celebrate.  But how to celebrate on a blog?  I thought about only reporting good news today, but that would have left the blog blank.  So I'm just going to plow ahead and think of all of Mike's great guitar solos while I write!

Still more about health reform and the Supreme Court.  Here's an interesting piece on the ... let's call it "tension" between President Obama and Chief Justice Roberts about the role of the Supreme Court and whether the Court would be "activist" if it struck down health reform. However, when the President said that it would be unprecedented for the Court to strike down this law, he meant that, in the past 80 years, the Court has not struck down an Act of Congress based on the Commerce Clause.  Meanwhile, one report says that hospitals would be slammed if health reform were struck down.  It's so frustrating to know that health reform is such a great thing, but so many people are so misinformed that they continue to blast it. 

Here's a woman's story -- a cautionary tale of why health reform is so critical, and why the individual mandate is good policy.  Americans struggle with the cost of medical care; even those with insurance have cut back on doctor visits and medications due to copays they can't afford -- especially under Medicare Part D. 

But it's also true that patients really don't want more health care than they really need.  I've said this many times in response to the argument that patients will suck the system dry and have all kinds of unnecessary treatments as long as it's paid for by insurance.  The truth is that, if I never had to talk to another doctor again (besides my brother) that would be okay with me.

Here's a bit of a rant.  Mitt Romney claims that President Obama would end Medicare as we know it.   But he also supports Paul Ryan's budget, which would provide seniors with a voucher that they could use to purchase health insurance on their own -- greatly shifting costs to seniors and completely ending Medicare as we know it.  Romney's claim is based on the $500 billion cut in payments to Medicare Advantage Plans over 10 years.  That cut is simply a reduction in profits to Medicare Advantage Plans and not a cut in benefits to seniors, contrary to the GOP plan, which is a drastic cut to the Medicare program.  Do the facts just not matter to people when they say things like this?

GE is stepping up its investment in personalized medicine.  It appears that it may be possible to tailor treatment to individual patients based on their genetic make-up.  So GE is working on technology to tell us more about the biological traits of a cancer or other illness so that we can identify the treatment that is most likely to work.  Fascinating.

Meanwhile, the Senate HELP Committee is urging bipartisan support for an initiative that would get life-saving treatments through the FDA approval process and to patients faster.

Finally, Connecticut has taken a huge step towards abolishing the death penalty, as the state Senate passes the repeal bill.  The vote came at 2:05 am, after a long night of passionate debate.

In celebration of Mike, the NY Times has another one of its medical puzzles.  Can you guess the diagnosis?  The answer will be disclosed tomorrow.

And that's it for today!  Have a great day.  Jennifer

Hump Day Headlines

As you know, earlier this week, the President had a few choice words for the Supreme Court, warning them that judicial activism in the form of striking down the health reform law would undermine the Court's integrity.  Well, it seems a judge on the Court of Appeals for the Fifth Circuit was offended.  He demanded to know of a Justice Department lawyer whether the Justice Department recognizes that courts have the power to strike down Acts of Congress in appropriate cases -- and when she said yes, he ordered her to submit a letter brief, no shorter than 3 pages, analyzing the President's comments in light of the powers of the judicial branch.  I feel horrible for this poor lawyer, but it seems pretty clear to me that the key is "in appropriate cases."  Courts should strike down laws that are unconstitutional, not laws with which they do not agree.  The President toned down his remarks yesterday. 

Meanwhile, here's a list of 15 consumer protections that we would lose if the health reform law was struck down. Republicans are starting to think about what to do if the health reform law is struck down -- they always said repeal and replace, so what if they get to the "replace" part of things?  Predictable answer: toss the goal of universal coverage and substitute cost cutting instead.  I can feel my blood pressure rising as I write this.  Obstacles to people getting care cost us money because people without insurance wait until they are very ill, end up in an ER, and when they can't pay the bill, it's your tax dollars that cover it.  So failing to provide universal coverage increases costs -- period.  They'll let people by insurance across state lines (which means eliminating state coverage mandates), offer tax deductions for people who buy individual insurance, pass malpractice reform.  As if any of that makes a dent in this huge problem we have. 

Meanwhile, panels of doctors -- professional societies, not government "death panels" -- are recommending that certain tests not be performed in certain circumstances -- things they consider to be wasteful.  This is good if the result is really to eliminate waste; it's bad if it's used by insurance companies to limit treatment options.  What works for one person may not work for others, and doctors should be free to tailor their practices to the individual patient's needs.  The problem will not be these consensus protocols; it will be how they are applied.  But note that this is NOT something that is mandated under health reform; this is something the medical profession realizes it needs to address.  The hope is that this will empower patients to ask their doctors why they are ordering certain tests -- do I really need this, doc?  From that standpoint, this can be a great thing.  This is all part of a project called Choosing Wisely.  Check out their website -- it's pretty interesting.

Nearly 90,000 poor children in Pennsylvania were kicked off of Medicaid in an effort to control the state's budget.  The Governor says he's cleaning house, eliminating people whose paperwork is not in order.  It's just just Pennsylvania; lots of states are trying to cut back. Colorado is using a lottery to see which 10,000 of 50,000 eligibles will get benefits.  Hawaii tried to limit adults to 10 days in the hospital per year, but the feds wouldn't agree.  This is horrendous.  If we do not find a way to get a handle on health care costs without leaving people with no care -- who, again, get sicker and end up in ERs and cost us even more money -- our country's economy will not be sustainable.  People have to get this.  Something has to change.  The question, from my standpoint, is how we can control costs without depriving people of care they need.  For example, there are many proposals for revamping Medicare.  We don't have to go with a GOP plan that converts Medicare to a voucher system designed to make private insurance companies rich.  But we do have to do something.

On that note, I'm off to try to do my little part in this massive struggle for the civil rights of people with chronic illnesses.  Have a great day.  Jennifer

If you thought "Obamacare" was bad...

The General Accountability Office -- a nonpartisan government agency -- has released a report that says that the national debt would skyrocket if the health reform law was struck down.  Don't believe me?  The report is here.  Read it yourself if you like.  It says what it says -- if the planned changes to Medicaid and Medicare do not happen, the national debt will explode. 

Sorry I'm a bit cranky.  I'm so sick of writing about this law over and over and having people write me back to tell me crazy stories about all the insane things that they believe are part of this law.  Why would you believe someone who hasn't read the law as opposed to someone who has (i.e., me)?  Responses to today's newsletter have been wacky.  One woman told me her doctor told her there are death panels, and, well, since he's her doctor, she believes him.  Another woman called to get my mailing address so she can send me "proof" that the United States is joining the European Union in 2014!!! 

I have no problem with people disagreeing with me as a matter of opinion.  But when people state AS FACT things that are so clearly untrue, it makes me sort of nuts.  Jennifer

How's Your County's Health

A new app will tell you the state of your county's health -- and how education and economic status directly relate to health status.  You can try it out here.  It's pretty interesting.  Not only does it tell you how things are today, but it also shows you how things can be in the future if education and income in your county increase.  Check it out!  Jennifer

Tuesday Tidbits

Tuesday's the big day for health news, so let's dive right in.

Yesterday was World Autism Awareness Day and I didn't post about it -- no excuses, I just blew it. Let's see if I can make up for it today. Researchers are hard at work to find a cause. Autism is far more common than we thought -- 1 in 88 kids has it. Early diagnosis can make a huge difference. But treatments fall short.

We learned some things about the Supreme Court last week. The banter -- almost comedic at times -- showed a less serious side, but nine sharp intellects (well, Justice Thomas doesn't speak, so we can't really say about him) were on full display. Meanwhile, President Obama thinks the Court will rule in favor of the law. Although his comments could be taken as a bit of a warning forecasting what he will say about the Court if they strike down the law, that the Court's reputation for integrity is at stake, that only an activist Court would strike down health reform. Which is true. A majority of Americans, though, say last week's arguments didn't change their view on health reform. Then again, since most Americans probably didn't listen to or read the arguments, that makes sense. But people whose views were changed were more negative of both the law and the Court. Again, no surprise based on the tone and slant of the arguments. Meanwhile, insurers are moving ahead with reforms regardless of what the Court decides. Of course, that story is mostly about Cigna, which doesn't sell much individual health insurance, and it's the companies that do sell to individuals who we have to watch to see what they will do about covering pre-existing conditions. It's hard to imagine that they will do so voluntarily.

Should the FDA think politically, or should it respond solely to health issues? Apparently, the FDA and the White House don't always agree. When they don't, it gets a bit tense. The FDA isn't an independent agency, but should it be?

The Federal Trade Commission has blocked the merger of two hospitals in Toledo, Ohio. Why do we care? The trend right now is mergers and growth. If the FTC is going to step in, that may change that trend and have an effect on how health care providers respond to the health care crisis in America. But the FTC did approve the merger of Medco and Express Scripts -- creating one huge mail order pharmacy company that may well drive prices upwards. When you look at these two decisions side-by-side, it's hard to make sense of them.

Americans are living longer -- and those who do so are apt to have more education, says a new study. Is education a predictor because the more you know, the healthier your lifestyle? Or is education tied to class, making money the predictor rather than a college education? One thing we now know is that DNA is less of a predictor than we thought it was. A study on twins shows less of a connection than had been anticipated.

Sleep disturbances -- even if not as severe as sleep apnea -- are related to depression. That explains a lot! However, the elderly have lower rates of depression than we might have guessed, but part of that is because it's not being diagnosed. That may change, though, now that, under health reform, an annual depression screening is free. I'm all for screening for depression, but I hope this doesn't just mean a lot more people on anti-depressants. We need to get to the bottom of the cause of the depression -- or, at least, that's what I think.

And then again, maybe we just have too many studies. Here's one that really gets me. Too much happiness can make you unhappy. Too much cheerfulness can make you gullible, insensitive, less successful. Really? And even so, do we care? And mammograms may mean we treat tumors that otherwise would have done no harm. That doesn't tell you how many lives have been saved due to mammograms. And then there's fish. Eating it helps you get nutritional essentials, but it also contains contaminants. Sometimes it seems like all these studies just cancel each other out -- maybe we should just do what we like. But then you read that body mass index has been under-reporting our obesity epidemic, and you know that these studies are reminders of things we do need to know and act upon.

And that's it for this morning. Have a great day. Jennifer