Finally Friday

Ahhhh.  A three-day week-end, and much needed.  But first, the news:

Paul Krugman on Ryan's Medicare plan.I'm not saying a word -- just read it.  And here's Ezra Klein on Ryan's claim that the health reform law is a "new entitlement we didn't even ask for."  Actually, President Obama promised it, we elected him, and so yeah, a whole lot of us did ask for it -- and it's not an entitlement program, either.  It's just a different way of buying health insurance.  And here's a Q & A on both parties' plans for Medicare.

50 million people are uninsured.  The state with the largest number of uninsureds is . . . TEXAS! I could have told you that.  I think we get more calls from Texas than anywhere else in the country. 

So the California Medical Association and some other providers sue Aetna because Aetna allegedly threatens patients who want to see out of network doctors.  Then Aetna refuses to negotiate rates with these doctors, saying it's sort of hard to negotiate with people who are suing you.  Meanwhile, patients are stuck in the middle and may even have to change doctors if Aetna and their doctors don't come to agreement on reimbursement rates.  These disputes are happening more and more. 

California Medicaid (called Medi-Cal) has a pilot program called Partners for Children, through which a child with a life-threatening illness is paired up with a liaison to manage medical care and insurance, and an assigned nurse available 24/7.  How wonderful.  Not only does it help the child and her family, but it also saves money.  This is what insurers need to do more of.

A gripping tale of what it's like to do heart transplants on children. Sometimes, when I'm working on a health insurance appeal that's life and death, I feel incredible pressure.  But I never actually have a person's heart in my hands.  The teams who do transplants -- especially on children -- are amazing.

The FDA approved a drug to ease constipation and irritable bowel syndrome.  So many people suffer from these ailments -- I hope this drug lives up to its promise.

Senators Blumenthal and Gillibrand held a hearing in Connecticut on Lyme disease yesterday.  Such a hard issue.  The published studies don't bear out the patients' clinical experience, and yet these patients clearly are sick.  But getting insurance to cover treatment exceeding 30 days of antibiotics  is nearly impossible.

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

Thursday Themes

Hurricane Isaac is battering the coast of Louisiana.  These folks have lived through Katrina.  I can only imagine what it must feel like to watch the waters rise again and know that there is nothing you can do -- until it's over, and then you face cleaning up, again.  I'm very sad for them.

The US tops France, Germany and the UK in potentially preventable deaths.  The lack of timely health care is the cause of this.  Yet more proof of the need for universal coverage.

President Obama and VP candidate Paul Ryan have very similar goals when it comes to controlling Medicare spending, but they would get there in very different ways.  You really should read this.  It's a clear choice between a voucher to help you buy health insurance, after which you're on your own, versus making cuts to reimbursement rates, more fraud investigations, eliminating waste, and so on.  Paul Ryan's speech last night also talked about health care, his determination to repeal health reform (leaving people with pre-existing conditions without insurance) -- here's a run down of what he said about health care and what he didn't.

Another installment from the NY Times blogger who's been going through a bone marrow transplant.  She's now undergoing chemotherapy.  This young woman's courage is remarkable.

Calorie limits might not extend your life, but you might be healthier, says a new study.  I'm sort of confused -- how does being healthier NOT extend your life?  Oh, well -- bottom line is that less is more when it comes to calories, at least for most of us.

In California, if you're on Medi-Cal (Medicaid in California), and if you want to keep attending adult day centers, you have to enroll in managed care.  This is sort of a "money or your life" proposition, if you ask me.

The number of West Nile cases is increasing.  This makes me nervous.  Especially for those of us with suppressed immune systems, if you start feeling sick, don't wait before seeking medical attention.

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

Hump Day Headlines

Sorry, but I'm constitutionally incapable of watching the GOP convention without having a major cardiac event.  I probably won't watch much of the Dem convention, either.  The truth is that, for me, politics is an end to a means -- we need the right people in office who won't repeal health reform so we get coverage of pre-existing conditions.  And there's good reason to believe that the GOP will cut Medicare and Medicaid if given the change.  Here's Politico's take on Paul Ryan's health care plans.  So sure, there are other reasons to vote or not vote for many people, but I'm a single-issue voter.  So don't expect much coverage of the conventions here.  Still, there's lots of other news (believe it or not).

Although you may question whether it's health-related, but hurricane Isaac is touching down pretty darn close to where Katrina hit.  I am so very sorry for the people who now have to go through this -- twice.  A storm surge has already surpassed one of the levees.  I can't imagine having to live through something like this twice.  Or even once.  Just awful. 

The health reform law broadens preventive care for women more than men. For example, there's free preventive care for women, including tubal ligation, but not for vasectomies.  STD testing also is for women and not men, which makes no sense whatsoever.  The justification is that women go to the doctor more -- at least annually for the gynecological exam -- and they tend to be the partner who focuses on STDs and contraception.

Many states are slashing Medicaid, including dental services for adults.  We all don't pay enough attention to oral health.  Meanwhile, when something goes wrong, it costs a mint.  If I didn't have a savings account, I would be walking around with empty holes in my mouth!  We should not see dental care as expendable.

A Medicare Advantage plan -- a private HMO that administers Medicare for people enrolled in the plan -- has been found to have bilked Medicare of millions.  SCAN Health agreed to pay $3.8 million for billing people with higher risk scores so they would get more reimbursement for them.  

Hundreds of families turned up at a free health fair in South LA last week-end.  Kids got the back-to-school immunizations -- a great event.

The American Academy of Pediatrics has come out in favor of circumcision.  They say the benefits far outweigh the risks of the procedure.

A federal court said the government can't force cigarette makers to post graphic photos on their packs to warn people of the harm of smoking.  It would violate the free speech rights of the cigarette makers.  Ugh.

The New York Attorney General is investigating energy drinks -- what's in them, do they really do as advertised?  These drinks are regulated less than soda, and there's concern about what's in them and how safe they really are.  Do you drink this stuff? 

The Gordon and Betty Moore Foundation is giving $500,000 to hospitals to try to stem the tide of hospital acquired infections.  On their list of things to avoid?  A loss of dignity.  Somebody in that family has been in the hospital and gets it.

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

Better Late Than Never

I made the mistake of taking yesterday off and returned to piles and piles -- hard to imagine how much could happen in one day.  So I'm off to a slow start today after having listened to voicemails and dealing with the mail, writing checks,etc.  So this will be a quickie today.

Is it a sign that there's a hurricane disrupting the GOP convention?  I'm not big on signs, but it must be terribly disappointing -- not to mention hard to change plane flights, hotels, network coverage -- what a mess.  It looks like Isaac will hit today right about where Katrina hit -- and that is a horrible tragedy, a region that hasn't yet been repaired and replenished yet, to take another hit -- I don't know how people will manage -- it's just too much.

More isn't always better.  Over-treatment is taking a huge toll.  What will that additional test tell you?  What would you do if it came back positive?  If the answer is nothing, then do you really need the test?  It's so hard to say no to a doctor -- they feel that you're questioning their authority.  But must we say yes to absolutely anything?

Early antibiotics may result in obesity.  Hmmm.  That could explain something in my family, for sure.

It started with a rash -- poison ivy, he thought.  But it blistered and spread to his face.  Super-potent medications like CellCept had no effect.  Skin biopsies said psoriasis, but the treatment didn't work.  It turned out to be a pancreatic tumor.  So too many tests are wasteful (see above), but not enough tests might have missed this rare diagnosis.  What's a patient to do?

Gotta go do a school conference.  Will try go get back here to finish later.  Sorry.  J

Finally Friday!

I'm particularly excited because I'm taking Monday off -- I'll have two 3-day week-ends in a row!  YAY!  But first, the news.

Should Lance Armstrong have given up his fight to prove that he wasn't doping?  He'll be stripped of all titles, medals, even prize money.  I want to believe that he's given up because the process was flawed, and not because he knew the evidence against him was overwhelming.  He's been an inspiration to many patients.  I read one opinion piece saying he'd have kept fighting if he was really innocent.  Very sad, either way.

A man walks into a hospital and puts a gun to his ailing wife's head and pulls the trigger.  Murder -- or mercy killing?  If it was a mercy killing, then I'm very sorry this man will spend the rest of his life in prison.  Married for 48 years, I can easily see how he thought he was doing the right thing, out of love.  What do you think?

The ever-wonderful Dr. Pauline Chen writes about doctor burn-out.  I get complaints all the time from patients whose doctors can't be bothered taking their inexplicable complaints seriously. I wonder if any of that has to do with the doctor's mental and physical status rather than simply not caring.  Burn-out affects primary care providers more than specialists -- doctors on the front lines, bombarded by demands on their time.  When they're burned out, they make mistakes, become detached, lose sight of why they wanted to be a doctor in the first place.  But what I want to know is what's a patient to do?

There was an outbreak of a deadly bug at the NIH hospital.  Six people died.  Eventually, the NIH figured out what it was and where it came from -- but while people were getting sick and dying, they didn't tell anybody.  Other patients in the hospital were exposed without their knowledge.  I think that's outrageous.

With the rise of West Nile virus, you should know what signs to look for.  Here's the low down.

Tattoo ink can be hazardous to your health.  Apparently, tattoo ink isn't required to be sterile, and several people have come down with nasty infections from it.  So if you're going to get inked, make sure it's in a shop that takes sterility seriously.

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

Thursday Themes

In the midst of the election season, the non-partisan Congressional Budget Office reports that if we don't do something to avoid the expiration of the Bush tax cuts and the automatic budget cuts that were put in place during the fight over raising the debt ceiling, we are headed towards a serious recession.  There's no chance Congress will reach an agreement on any of this, at least until after the election.  That means riding this wave of uncertainty right down to the last minute.

The campaigns have been talking non-stop about Medicare, but Ezra Klein reminds us that the big Romney-Ryan cuts are to programs for the poor, starting with Medicaid, food stamps, Pell grants -- and on and on.  It's a very fundamental disagreement about the role of government.  Since World War II, with the GI Bill and first time home-buyer supports and other programs, we built a middle class, later propping it up with Social Security, Medicaid and Medicare.  There was, in essence, a social compact, an agreement into which Americans entered to ensure that every American had an opportunity to grow and succeed.  The push towards small government doesn't help the middle class; it helps the wealthy.  And yet, so many middle class Americans favor the small government model.  It's completely baffling, if you ask me.

"Black and Latino children were more likely than white children to be obese, witness gun violence and ride in a car without a seat belt, according to a study released Wednesday."  There are widespread disparities in health status in African-American, Latino and white fifth graders in Houston, Birmingham, Alabama, and Los Angeles across many health indicators, from cigarette smoking to bike helmet use.  Many of these disparities increase the risk of health problems like diabetes and heart disease.

Here in Connecticut, Anthem Blue Cross Blue Shield, Aetna, and ConnectiCare have all submitted premium rate filings that would result in more than a 13% hike in premiums next year.  Consumers who would be affected by the rate hikes have an opportunity to comment.  I know we did.

We're seeing an alarming number of cases of West Nile virus this year.  With mosquito control district budgets being cut, we aren't really ready for this. 

Six ways to cope with cancer, from the NY Times blogger who's been writing throughout her bone marrow transplant.

A British man who had "locked-in syndrome" after a stroke, and who went to court for the right to assisted suicide, has died.  The court ruled against him and he refused to eat after that.  So sad. 

Children of older fathers appear to be more prone to autism, schizophrenia, as they transmit more DNA variations to their children.  Is this the male version of the biological clock?  Maybe.

Pulling an all-nighter to study for an exam is counter-productive since sleep deprivation greatly compromises comprehension and performance.  Go to bed!

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

Hump Day Headlines

More on the dueling Medicare fixes.  Today's report is that Romney's proposal to restore the $716 billion he claims President Obama "robbed" from Medicare would actually hasten Medicare's insolvency.  Of course, there's also the fact that Ryan's plan would have cut the same amount from Medicare, but instead of putting the savings toward providing health insurance for middle-income Americans, he would apply it to the deficit.  And the fact that Romney's proposal would cost seniors hundreds of additional dollars now, undermining his claim that his plan doesn't affect current seniors.  Experts cited by the NY Times such as John McDonough, the director of the Center for Public Health Leadership at Harvard, say either Romney/Ryan don't understand Medicare or they're deliberately not being candid with the American people.  I suspect we are going to be hit over the head on this issue pretty consistently between now and November.

A federal court of appeals has allowed Texas to cut off funding for Planned Parenthood as part of the Women's Health Program.  Planned Parenthood did not perform abortions as part of that Program.  Instead, they provided cancer screenings and other women's health services.

How do we control health care spending without rationing?  We hate that word, "rationing."  But we already provide more health care to those with insurance than those without, more to those who can afford it than those who can't.  And if you think insurance companies making decisions about what to cover isn't rationing, you're very wrong.  How can we reduce spending without inequity?  That, says this writer, is the question.

Montana's Senator Jon Tester has introduced legislation that would give states authority to review and block rate increases.  Some states already have such laws, but they aren't always applied vigorously.  Other states don't have such laws at all.  It's a very important idea whose time has come, as insurers keep raising rates as if there is no end to what they can charge.  Especially in states with limited competition because of the small number of insurers in the state, this is so important.  I knew there was a reason Pearl Jam is playing a concert for Senator Tester! 

The new Alzheimer's caregivers: men. Really, it's not just Alzheimer's, and there's nothing new about this.  My dad certainly was my mom's caregiver at the end of her life.  But we think of caregivers as women.  It's good to be reminded that they're men, too.

A few years of music lessons improves mental functioning, even years after you've stopped the lessons.  Yet another reason your kids should learn an instrument.

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

White House Disability Call on Friday

White House Monthly Disability Call

Hello everyone,

In order to help keep you more informed, we host monthly calls to update you on various disability issues as well as to introduce you to persons who work on disability issues in the Federal government. This month’s call will feature Senior Advisor to President Obama, Valerie Jarrett, and Director of the White House Domestic Policy Council, Cecilia Muñoz. Both will also take questions.

If you received this email as a forward but would like to be added to the White House Disability Group email distribution list, please visit our website at http://www.whitehouse.gov/disability-issues-contact and fill out the "contact us" form in the disabilities section, or you can email us at disability@who.eop.gov and provide your full name, city, state, and organization.

We strongly urge and ask that you distribute this email broadly to your networks and listservs so that everyone has the opportunity to learn this valuable information.

I would encourage you to call in about five minutes early due to the large volume of callers.
The conference call information is below.

• Date of Call: Friday, August 24, 2012
• Start Time: 2:00 p.m. EDT (dial in 5 minutes early)
• Dial in: (800) 762-7308  
• Code: White House Disability Call

For live captioning, at the start time of the event, please login by clicking on the link below. Please only use this feature if you are deaf or hard of hearing.
http://www.fedrcc.us//Enter.aspx?EventID=1998026&CustomerID=321

This call is off the record and not for press purposes. 

Tuesday Tidbits

The LA Times's David Lazarus says disabled people would be hurt most by the Ryan plan.  Shifting Medicare to vouchers would cost the disabled and elderly more.  For the disabled, this is especially hard because they have chronic health care problems that require ongoing care, and Social Security disability may be their only source of income.

The health reform law invested heavily in finding and eliminating Medicare fraud.  This is so right -- cutting fraud and waste are the best ways to cut savings without in any way affecting patient care.

Do you know how to choose a health plan?  Neither do most employees.  Come open enrollment time and they're confused and don't know how to make decisions.   Too bad this article doesn't have a sidebar that provides some guidance in choosing a plan.

Aetna's merger with Maryland-based Coventry reflects a change in the health insurance landscape, where bigger is better and money is to be made from privatization of Medicaid, Medicare and those poor enough to get government subsidies to buy insurance in an Exchange.

The US Preventive Services Task Force is poised to make HIV testing part of standard medical practice.  This is the body that, under health reform, decides what services should be provided for free (no deductibles, copays, coinsurance).  Why shouldn't HIV testing be standard?

Hospitals rate insurers as payers -- Wellpoint (Anthem) is their least favorite, whereas Cigna is their top choice.  Interesting to see how the consumer experience compares to that of hospitals.

More evidence of a rise in tuberculosis -- this time, in California, where there's a specialized ward to treat tuberculosis patients.

An interesting case against an ER doctor in California who used very aggressive collection efforts to try to get paid.  When she didn't like what the insurance company paid, she returned the payment and sued the patients, including attempting to take their homes.  California law requires doctors to accept managed care payments as payment in full for ER visits, but this doctor claims that the patients she's going after didn't have true emergencies.  Now, the state is suing the doctor, who has been ordered to stop these collection tactics.

Nearly half of all doctors report symptoms of burnout.  You know, I have to say that it seems to me that nearly half of all people report symptoms of burnout.  Not to take anything away from doctors, but I think we all struggle with this.  I know I do.

Planned Parenthood is dedicating $3 million to a breast health initiative.  About $1 million will go towards better diagnostic equipment, and the rest will go to outreach in underserved populations.

So you have life-saving heart surgery as a child.  Now you're an adult, and the fix is breaking down.  Another surgery?   What were thought to be cures don't last a lifetime.  And the doctors who really understand congenital heart problems are pediatricians - so where do these adult patients belong?  As medicine helps us keep people living longer, we face these sorts of quandries.

How well you sleep may hinge on your race?  Really?  Apparently.  Non-Latino whites tend to sleep best, with African-Americans sleeping worst.  Hmmm. 

Vitamin D may help ward off the common cold.  I take loads of prescription-strength vitamin D -- my gastroenterologist believes it helps IBD and it's helped me tremendously. 

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

I Really Hate Mondays

I didn't mind working until 9 pm on Friday because I knew I had the next two days off.  And when I say off, I mean really off -- pretty much spending my time resting, sleeping, watching mediocre TV that I've recorded over the past week(s), doing nothing more than checking email twice a day and going grocery shopping.  It feels so good to be able to stay in bed as long as I want to.  But then comes Monday, and although I'm running later than usual, were it up to me, I'd still be in bed, sleeping.  Unfortunately, I told several people to call me on Monday -- people who really need help, including one who really needs help quickly.  And so my conscience would not allow me to sleep in any later than I did.  And here I am, my first blog post for the week, but really, I'd love nothing more than to go back to bed.  WAKE UP! I attempt to command myself, but the pull to be prone is so strong.  Maybe the news will get my juices flowing.

Poverty in America brings with it a plague of what are called neglected tropical diseases -- dengue fever, cysticerosis, murine typhus and more.  These are diseases we expect to see in what we call developing countries.  But in the US, 2.8 million children live in households with income of less than $2 per person per day.  Poverty rates in Gulf Coast states of Mississippi, Louisiana and Alabama are as high as 20 percent.  In America, the richest country in the world.  We should be ashamed.  Sadly, only some of us are.

The Presidential campaigns won't talk about that, though.  Instead, Romney/Ryan will continue to accuse President Obama of raiding Medicare to fund health reform when, in fact (1) health reform does not reduce Medicare benefits -- it uses savings from lowering reimbursement rates for Medicare Advantage plans, private HMOs making a profit on Medicare, and slows the rate of growth of provider reimbursement; and (2) Ryan's budget would take the exact same amount of money from Medicare and use it to pay down the budget deficit.  Romney/Ryan are focusing on the fact that their plan would not affect anybody over age 55, so seniors needn't worry.  Meanwhile, the Obama campaign focuses on the savings seniors already have felt with the phase-out of the prescription drug doughnut hole.  Want the facts?  Try this piece from the non-partisan Kaiser Health News.

Maryland hospitals are looking to re-balance income, lowering prices for Medicare and Medicaid and raising prices for commercial insurance.  Apparently, Medicare and Medicaid pay more in Maryland than in most states, and private insurance pays less, so the hospitals are looking at correcting that trend.

Apps that play doctor?  Coming soon, apps you will be able to download to track things like blood glucose and heart rate.  The idea is that doctors will prescribe them and insurance companies will foot the bill.  Please don't ask me to appeal for you when your insurer denies coverage.  We're a long way from insurance covering an app.  But the FDA actually already approved one as a medical device, so maybe we're not as far from that as I would have thought.

If you have a defibrillator implanted, you need to check with your doctor about the brand and make sure it's not part of a recall of devices made by St. Jude's Medical that appear to be defective.  The FDA wants doctors to start x-raying patients to check their leads -- we're talking 80,000 patients -- but they won't necessarily do anything for patients with the defective leads except keep close watch on them.  Sounds like a mess to me -- but you should check with your doctor for more information.

A USA gold-medal soccer player comes out with her story of living with lupus -- and her goal of finding a cure for the disease.

And that's it for this Monday morning.  I'm no closer to being happy it's Monday, but I am wide awake now and ready to tackle the day.  Have a great one!  Jennifer

A Mom's Message to her Child

Carla Valentino suffers from RSD/CRPS (Reflex Sympathetic Dystrophy/ Chronic Regional Pain Syndrome), but that doesn’t define her. Instead, if you were to ask Carla what her proudest label is, she’d say “mom”.

In an effort to explain her condition to her own daughter, Valentino embarked on a journey to write a book specifically for children, on how to understand and cope with illness. When Can We Run, Dance, and Play Again is a colorful, touching and informative children’s story for kids of parents who are suffering from illness.

Valentino aims at presenting children with an illustration on how families deal with health issues, how to strengthen the family bond and how to use their imaginations.

For more on Valentino’s story, or for information on her book, visit her blog at http://carlavalentino.authorsxpress.com/.

I, for one, can't wait to read it myself!  Jennifer

Finally Friday!

More truth-telling on Medicare.  The health reform law does not cut benefits; the Ryan plan converts the whole program into a voucher system.  Which is better?  Here's one opinion, and here's the President's response to the claim that he "stole" $700 billion from Medicare and here's more about the Romney/Ryan position -- but in the end, you have to decide for yourself.  And here's more on Ryan's plan for Medicaid, which is even more dramatic.  You know, folks, the politicians are counting on you not doing your homework and buying whatever they're saying -- and I mean this about both sides of the aisle.  The only reasonable response for us voters is to take responsibility for learning the truth.  So you don't have to read me, but you do have to read and question and not just accept any one source.  Learn and think for yourself.  If, in fact, Medicare is even more important to voters than health reform, then you owe it to yourself to try to make sure you have the facts straight.

How to control health care costs -- set spending caps?  Some think so, and this scares me.  What happens to people who really need more than the average amount of care -- hemophiliacs, transplant patients?  We have to do something, but is this the best way to go? 

Dr. Pauline Chen writes this week about the problem we all have with these short doctor visits in which they tell us 10 things and maybe we remember one or two.  Should doctors focus more narrowly?  Should they give us a checklist in writing?  Always thoughtful, Dr. Chen gives us the doctor's perspective.

Imagine working in an ER in Aurora, Colorado on the night of the horrific shooting.  Here's what it was like -- and what it's like to live with the memories.

We're seeing an outbreak of West Nile Virus around Dallas.  They're now spraying pesticide to try to kill off the mosquitos.  Be careful, folks. 

The CDC says we should all be tested for hepatitis C.  Have you been tested?  If not, check with your doctor at your next visit.

Ann Romney talks about having MS on the campaign trail and not being able to keep up the crazy-fast pace.  Something all of us with chronic illnesses have to be mindful of.

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

Truth to Power

A lot of people are saying these days that President Obama took $716 billion from Medicare and used it to fund "Obamacare."  This is a lie.  President Obama cut payments to Medicare Advantage Plans -- private HMOs that administer Medicare -- because it was shown that the private insurers who run Medicare Advantage plans were making an unseemly profit on the system.  There was no reduction in the mandatory benefits that came with that.  President Obama also has tried to reduce inefficiencies and waste -- so they are cutting payments to hospitals with unacceptable readmission rates and they have stepped up fraud investigations.  In addition, President Obama has initiated a plan to coordinate the care of people who are on both Medicare and Medicaid, which will save some of the expense associated with these most expensive beneficiaries.  President Obama also included in the health reform law the phase-out of the Medicare Part D (drugs) doughnut hole, which already has saved seniors a bundle.  In fact, the changes President Obama has made to Medicare extended the life of the Medicare program.  You don't have to agree with me on health reform or on President Obama, but at least let the critique be truthful. 

Another installment from the NY Times blogger and cancer patient who's been undergoing a bone marrow transplant.  This time, she talks about how to talk about being sick -- something I best most of us with chronic illnesses have thought a lot about.

Clostridium difficile -- affectionately known as c diff -- is a nasty infection that causes diarrhea, abdominal pain and bloating.  It shows up in hospitals a lot, although I've had it many times when I've had to take antibiotics.  What's news is that it kills about 30,000 Americans each year.  More can be done to stop it -- it's not even complicated if we just make it a priority.

A new AARP ad is reaching out to caregivers, acknowledging their burden and trying to provide them with some support.  This is so important -- we get so many calls from people who are calling on behalf of a child, a spouse, a parent, a sibling, trying to juggle caregiving with the rest of their many burdens.

Hundreds of thousands of Afghan veterans are suffering from a degenerative brain disease that has no known cause or cure.  It can cause angry outbursts, memory loss, problems walking and speaking, paranoia, and even suicide.  These may be invisible wounds that plague soldiers long after they return home. 

The entertainment industry is starting to portray mental illness in a more positive light as it makes its way into the lives of television characters.  It's no longer just the crazed gunman; it's Tony Soprano in therapy, Monk's OCD.  But there's still a long way to go.

And on that note, I bid you a great day!  Jennifer

Is This the Kind of World We Want?

We're working with a family with two boys with Duchenne muscular dystrophy (DMD).  One boy is enrolled in a clinical trial for a drug called eteplirsen, manufactured by a company called Sarepta Therapeutics and he's doing great.  However, the other boy is non-ambulatory, so he's not qualified for the clinical trial, and he continues to decline.  We've spoken to the drug company about a single-use IND, which the FDA gives for investigational drugs on a one-time basis.  However, they say they don't have enough of the drug available, and they have a lot of other families who want the drug.  The family is torn apart, happy about how one child is doing but devastated as they watch his brother decline knowing there's a drug out there that could help but the drug company won't allow it.  What a world we live in, where parents have to watch a child fade despite the fact that there's a ready solution.  You can read more about this family's courageous struggle here. 

In this world, hospitals find ways to profit for the private equity firms that bankroll them, even if it means bilking Medicare of millions of dollars, without regard for what's best for patients.  In this world, we have to keep fighting for health care for seniors -- a fight that should have ended decades ago.  In this world, political battles are fought with lies that do nothing but scare the American people.  Somehow, it's become completely okay to flat-out lie to the American people -- for example, this ad accuses the Independent Payment Advisory Board of rationing health care when, every single day, insurance companies already decide what care you're allowed to have. 

In this world, too many of us question our moral obligation to care for the very poor.  But we can't even have a civilized discussion about what kind of society we want to be -- it all just unravels into name-calling and baseless attacks.  Meanwhile, people suffer terribly -- children, who are poor through no fault of their own, who we abandon in the name of cutting budgets.

We need to have a serious discussion here in America.  People are hurting.  What obligation do the "haves" have to the "have nots?"  Is it fair to tax people who earn more at a higher rate?  Is it right to make sure everybody has access to health care, no matter their circumstances?  Are we willing to make sacrifices for the good of us all?  Or is it every man, woman and child for themselves?  You know my answer -- I'm willing to sacrifice my own interests for those of others.  It would be impossible to listen to the tales of loss and fear and illness that I hear every day and not be prepared to do whatever I can to help.  Is it just that those who are out for themselves don't have the same exposure to the tragedies that lurk in the shadows of America?  Because if that's the issue, I invite them to come sit in my chair for a day and see how they feel about the virtue of selfishness after that.  Jennifer

Tuesday -- Connecticut Primary Day!

Yes, I voted.  It was a tough one, though.  People I know and really like and even care about are running -- some up against some tough odds.  Do you vote for who you care about or who can win a general election?  I went with my heart rather than my head.  We'll see how pissed off my head is!  Now, onto the news:

With Romney's selection of Paul Ryan as his running mate, the future of Medicare has become a front and center issue in the upcoming campaign.  Ryan proposes giving seniors vouchers to buy private insurance rather than giving them Medicare.  That's an end of Medicare as we know it.  We already know that Medicare costs less than private insurance because of the relatively low administrative costs.  Vouchers will cost seniors big time -- and why give this gift to private insurance companies?  At least now, the choice is clear for the American people.  For those of us who worry about health care for the poor, as well, Ryan threatens Medicaid even more.  It's that Ayn Rand philosophy -- each to his own.

A number of consumer groups have issued a report with recommendations on how health reform should be implemented.  I haven't had a chance to read it all, but it looks very good.  Now, will the policy makers listen?

It's been about a month since Jesse Jackson Jr. left Washington and went into hiding, mysteriously.  First, it was "exhaustion."  Then it was depression and a gastrointestinal disorder.  Now, it's bipolar disorder.  Would it have taken a month for his family to announce his diagnosis if he had cancer or diabetes or Crohn's disease?  No.  The stigma attached to mental illness makes it something we hide as best we can. 

Binge eating among men is about as prevalent as among women.  This surprises me -- we never hear about eating disorders in men.  And it's true that anorexia and bulimia are far more prevalent in women, but binge eating affects men and women alike.  There aren't a lot of treatment options for men, though.  It's important to make the connection between binge eating and emotional distress.

Mississippi has the highest obesity rate and Colorado has the lowest.  Obesity can lead to diabetes, heart disease.  I'm not surprised about Mississippi -- they also seem to have horrendous health care, with not much of anything for the poor. 

Smart prosthetics?  Amazing technology allows you to adjust your prosthetic on your smart phone.  This is really something.  The world of medical devices is booming -- a t-shirt that you wear overnight instead of spending the night in a sleep lab.  Of course, getting an insurance company to pay for it is a whole other battle, but I think these developments are exciting.

White kids get more CT scans than African-American or Latino kids.  Why?  Is it insurance status?  Are white kids getting too much radiation?  We need to know the why of this to fix it, but the story doesn't tell us much.

Better care for premature infants raises questions about who to save and who not to.  I sure wouldn't want to be the one to make that decision.  Is it right to use all that medicine has to offer in every case?  We talk about this issue when it comes to the elderly, but less often when it comes to infants.

Do you want to know if you're likely to get Alzheimer's?  We should all make the plans we need to make no matter what.  I'm not sure it would help me to know how susceptible I am to Alzheimer's in particular.  What about you?

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

Monday Already?

Aw, c'mon.  Tell me it's really Sunday and I have another day off -- please?  Oh, well.  I guess I have to deal with the reality of Monday morning.  So here goes.

As you know, Mitt Romney chose Paul Ryan as his VP choice.  Kaiser Health News put out a special Saturday edition in their honor, so here are the health care basics of Paul Ryan's views.  The big deal is how he proposes to change Medicare to a voucher system.  More here.  And for me, here's the most important take-away.  Paul Ryan is a fan of Ayn Rand's -- as WaPo says, the virtue of selfishness.  In many ways, the coming election will be about selfishness vs. compassion.  Are we a country that cares for its most vulnerable, or is it every man (I use the masculine deliberately) for himself?  Here's an essay that looked at Romney's view of the poor even before the Ryan pick.  It's a stark contrast that will say a lot about our country.  For the sake of those who call me with nothing less than tragic circumstances, I hope this comes out right. 

This is a little complicated but since I try to keep you informed, let's see how it goes.  The health reform law says you can buy insurance -- with subsidies -- through the exchange unless you have "affordable" insurance through your employer.  The IRS interprets "affordable" to mean individual insurance, not family insurance.  So if your self-only coverage is "affordable," you have to buy it, even if your family coverage is not.  Members of Congress are appealing to the administration to fix this in regulation.  This could leave people without an affordable option. 

Laws permitting assisted suicide in Oregon and Washington were opposed on the ground that poor people would be forced to kill themselves, depressed people would kill themselves prematurely -- that all kinds of wrong decisions would be made.  It's turned out to be quite the opposite.  The assisted suicide laws have been used properly and sparingly, and mostly by white, educated, and financially comfortable. 

Is gun violence a social disease?  Yes, say doctors, and we need to approach it like a public health problem.  Host factors -- what makes someone more likely to shoot?  Product features -- what makes which guns the most dangerous?  Environmental risk factors -- what conditions allow for or give rise to shootings?  Disease patterns -- how does the problem spread?  Why not ask these questions about guns?

More than 2200 hospitals will be penalized by Medicare for unacceptably high rates of readmissions.  The point here is that hospitals have to do a better job of discharge planning to make sure patients have the care they need when they leave the hospital so they won't be readmitted.  Hospitals that serve the poor will be hardest hit.  Do the community-based resources exist for the poor? 

That's it for this morning.  Have a great day, even if it is Monday.  Jennifer

And the answer is................

Lyme carditis!  Did any of you get it right?  Jennifer

Half Day, Half Blog

Hi. I'm playing hooky this morning, taking a few hours of down time.  But there are a couple of stories in today's papers that I don't want you to miss.

Our friend Nina Bernstein writes about the rebates people are -- or are not -- getting if their insurer spent more than 80 or 85 percent of premium dollars on health care. If you get your insurance through an employer and you are due for a rebate, you got a letter in the mail, but the check went to your employer.  Employers have some options -- pay you the rebate, apply the rebate to future premiums -- so if you're wondering where your rebate is, read this article before you start asking so you'll understand the way it's supposed to work.

One of our favorites, Dr. Pauline Chen, writes about bullying in medical school and efforts that are underway to change that. 

That's all for now.  Have a great day.  I'm going to relax for a bit before heading to the office.  Later.  Jennifer

Thursday Themes

My favorite!  A NY Times diagnosis puzzle.  Some day, it's going to be one of the rare diseases we've learned about from doing insurance appeals and I'm gonna win!  Maybe today is your day!

You couldn't undergo a bone marrow transplant without confronting insurance issues.  And so, the NY Times blogger describes what the financial aspects of being sick felt like to her.  "If you have a chronic illness in America, there’s a good chance you also hold a degree in Health Insurance 101, whether you want to or not," she says.  Absolutely.  You should read this -- it will ring true with many of you.

Paid sick leave may reduce workplace injuries, a new study says. There's not much explanation why, but they do make the point that fewer injuries means lower worker's comp premiums, so paid sick leave may not be as expensive as some think.

Promising results from a clinical trial of a prenatal test that will be better are predicting genetic abnormalities like autism and mental retardation.  Sounds like a good thing until you read that the test won't tell you if a small abnormality will actually be harmful, so this leaves the parents with great uncertainty and anxiety. 

Cholesterol levels in kids are down significantly -- good news in the midst of all the chatter about increased obesity and diabetes rates.  But blue collar workers are the least healthy due to higher rates of obesity and smoking.

Surprisingly, in the very old, high blood pressure may be a good thing.  Apparently, several studies have shown that high blood pressure may signify longer life.  Hmmm.  And here's another head-scratcher -- type 2 diabetes patients who were normal weight succumbed to the disease more often than those who were obese.  The theory on that one is that doctors probably treat obese patients more aggressively. 

And that's the health news today.  It's a hot and muggy one -- stay cool and have a great day!  Jennifer

Hump Day Headlines

And here we go.  Remember the fight over raising the debt ceiling, when Congress punted to a super-committee, which itself punted to automatic spending cuts that have to be put in place pretty soon?  Nobody's happy about it -- and now, President Obama has to begin to outline what cuts he's going to make.  Half of the cuts are supposed to be to defense spending, which has the GOP -- who pushed us into this mess -- very unhappy.  This is going to be massively painful.  The Bush tax cuts are about to expire.  Add huge spending cuts and we're destabilizing an already wobbly economy.  No matter what President Obama does, somebody's going to be upset.  It's a horrible position to be in two months before the election.

Students with disabilities are more likely to be suspended from school, with African-American disabled students being disciplined most often.  Instead of providing accommodations and supports, schools punish and exclude these kids.  It's truly a travesty.

A fascinating innovation led by Washington-based Group Health, a nonprofit health insurance plan, in which researchers inform clinical practice -- and clinical practice informs research.  One of the things we see in our insurance appeals is insurance company coverage policies that are academic-minded rather than practical.  For example, Aetna will not pay for a test called fecal calprotectin.  It costs about $200.  They say in their coverage policy that it's experimental as a predictor of IBD relapse.  But clinicians don't use it to predict relapse; they use it to determine whether symptoms are due to IBD or IBS.  Aetna's preferred alternative is colonoscopy, which costs ten times as much and is more invasive and risky.  Clinicians use fecal calprotectin routinely, but the people who write the coverage policy at Aetna aren't listening to them; they're just reading medical journals.  So this interaction between research and clinical is a really important step that may bridge this divide, finally. 

Patients with diabetes may be misdiagnosed with Type 1 when it's really Type 2, which determines the correct treatment.  Type 1 is an autoimmune disease that requires insulin; Type 2 stems from inactivity and obesity and often can be treated with diet and exercise.  If you have diabetes and are doing what your doctor told you to do but still aren't feeling better, maybe it's time for a second opinion.

Morning is prime time for self-improvement, says USA Today.  It's also the time IBD patients spend in the bathroom, and rheumatoid arthritis patients spend trying to get themselves moving for the day.  For us, the morning routine is critical to making it through the day. 

That's all for today -- a light health news day.  Since no news is usually good news, I don't mind!  Have a great day.  Jennifer

Tuesday Tidbits

More news about the consequences of states refusing to set up health insurance Exchanges -- the feds are doing it for them, and that may mean the feds have more say over insurance matters than they normally would.  I wonder when the states will realize that the Exchanges are good for consumers and admit that at least this one piece of health reform is a really positive step.

Here's an interesting little wrinkle.  The health reform law requires that kids up to age 26 be kept on their parents' policy.  However, because dependent policies are not covered by the Pregnancy Discrimination Act, those policies may not cover maternity care.  Hmmm.

Texas Governor Rick Perry says Texas won't participate in the Medicaid expansion -- but he wants to end the Texas Women's Health Program in order to de-fund Planned Parenthood -- and he says this won't hurt women because they'll be covered by -- you guessed it -- the Medicaid expansion!  Hmmm.

Does your doctor take the time for wellness measures?  Make sure you're up to date on immunizations, provide counseling about preventive care, talk about diet, exercise?  You're entitled to these services now for free.  So Consumer's Reports says you should insist on them.

HCA --  a large hospital chain -- has discovered that it has been performing unnecessary procedures, including cardiac catheterizations, to the tune of millions of dollars.  It appears to be more than just a couple of rogue doctors.  The company discovered it and didn't tell anybody, but the US Attorney's Office in Miami is looking into it.  This appears to have happened in Florida hospitals, although HCA has hospitals in many states.  Even worse, they settled a fraud case with the federal government in 2000 and were supposed to take measures to make sure things like this never happened again.  I can't imagine finding out I'd had such an invasive test done unnecessarily.  Wow.

Is there a racial divide in end of life decisionmaking?  African-Americans are more likely to pursue aggressive treatment and refuse DNR orders.  Partly due to strong religious faith, partly due to lack of trust in the medical system -- but when everything is explained to them in a caring and informative way, they are able to cross that racial divide and choose DNR orders more often. 

Bacteria are becoming antibiotic-resistant.  There may come a day, sooner than later, when we don't have drugs to fight super-infections.  Having had MRSA (drug resistant staph) several times, this doesn't seem that implausible.

The CDC says the graphic anti-smoking ads are working.  Calls to the CDC's smoking-cessation hotline doubled in the 12 weeks they ran the ads. 

A treatment for drug-resistant depression: repetitive transcranial magnetic stimulation.  Some patients swear by it, but it's not covered by most insurance, so be prepared to pony up.

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

Another Monday

Another horrible shooting. I can't help but feel that the politics of hate in this country have contributed.  It's not all guns; it's words, too.  The Westboro Baptist protests at funerals (and tweeted after the Sikh attack in Wisconsin "God sent another shooter.").  The birthers.  The all-out hatred (not just disagreement) of our President.  The extremes on the health reform law.  The harsh words about gay marriage.  It's as if hatred has become an accepted part of our culture.  We have to stop.

Since about half of the states have not moved towards setting up an Exchange (a marketplace where you can shop for and buy insurance), the federal government finds itself in the unexpected position of building exchanges in the remaining states.  In Missouri, there's a ballot referendum that would prohibit the state from setting up an Exchange.  I really don't get this.  All the Exchange is is a place where consumers can compare, shop for and buy health insurance, while also enrolling in Medicaid and applying for subsidies.  The insurance sold on the Exchange is private insurance, just like we have now. 

And once again, the GOP wants to replace insurance coverage of pre-existing conditions with grants to states to create or shore up high risk pools.  Once again, treat us as different, as pariahs.  Once again, force us to pay twice as much for health insurance -- which is the same as offering nothing to many people -- and wait 6 months without insurance to get coverage.  Once again, we would have lifetime limits on benefits while the rest of America would not.  I could go on.  This is not a tenable option, as they would know if they ever seriously listened to people with pre-existing conditions.

A study shows that lying can harm your health.  Both mental and physical health declined when study participants lied.  Hmmm.

A colon cancer patient explains the genetic link to colon cancer in his family.  Should your family be tested?  Check it out.

Swine flu is being passed from pigs to humans.  This is no joke.  Think before attending that state fair this summer.

Jesse Jackson Jr. is hospitalized due to depression.  I've been interested in the coverage of his now 7 week absence from his job.  First, several of his colleagues -- Dems -- demanded to know what was going on.  Now, we hear that he collapsed at his home due to debilitating depression -- and I want to know what makes one depressed person able to put one foot in front of the other and somehow cope while another collapses?  And I marvel at the difference between how we react to physical illness and how we react to mental illness.  If he'd had appendicitis and surgery, I doubt we'd be reading much more than a litle blurb about it.

Remember my experience with US Airways?  Well apparently, Alaska Airlines refused to accommodate a patient with Parkinson's disease.  They claim he never said he was disabled.  I very definitely said I was disabled, and in my case, that was considered a behavior problem by a fight attendant and by the passenger next to me, who said "maybe you shouldn't travel." 

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

Finally Friday!

As unemployment runs out, tragedy abounds for over 1 million people who've been out of work for the long term.  This article tells the story of an office manager who was laid off two years ago and hasn't been able to find work.  She's spent her savings and even used candlelight to save on electricity bills. If she doesn't find a job in the next month, she will be evicted and homeless.  Now, add to that a serious chronic illness and no way to pay for health care.  Those are the calls I get.  That is why health reform's Medicaid expansion is so important. 

A month or so ago, it seemed like health reform would be a hot button issue throughout the presidential campaign.  However, both campaigns have gone silent on health reform. Is it because Romney can't really attack the law since he signed the same plan into law in Massachusetts?  That and the fact that the President doesn't want to highlight it too much due to opposition.  It's still a big issue in Congressional races, but the presidential campaigns aren't talking about it -- at least for now.  I'm sure it will come back during the debates.

The House GOP challenges the IRS on interpreting the health reform law to allow subsidies to be paid through federal exchanges where states refuse to create their own exchange.  The IRS says this was its best interpretation of the law.  I suspect this one's going to court.

And a liberal think tank has come out with a second generation health reform law -- this one focusing on controlling cost.  As I said earlier in the week, the Massachusetts plan was always intended to involve two steps -- first, get everyone covered; then, focus on costs.  To a large extent, that was the model of the federal law, too.  But we need to deal with costs -- and we need all the ideas we can muster.  This one is interesting in that it avoids cutting entitlement programs in way that would affect health care quality, moving away from fee for service to an umbrella payment per patient to take care of that patient's care.  I worry that this would incentivize providers to provide fewer services, but if you figure that each provider would have some healthy people and some sick people, maybe it balances out.  We surely have to try something new.

Speaking of controlling costs, Vermont has created a Green Mountain Board, which is controlling health care pricing in the state as they transition to a single-payer system.  Now, if hospitals want to raise rates more than 3.7%, they need approval.  Another interesting experiment.

The horror of being shot is compounded by the cost of care, the inability to work -- a bullet, a chronic illness -- random things that change lives forever. 

There's a nursing shortage, so you'd expect nursing schools to be booming -- but apparently, they're having a hard time finding professors.  Hmm.  I think of teaching as such a desirable profession, especially at the graduate level.  This surprises me.

A new report says Medicaid providers who owe thousands in back taxes still were paid for providing services to Medicaid beneficiaries.  Apparently, the IRS has no authority to garnish Medicaid payments to providers who owe federal taxes.  That's one loophole I'd get rid of really quickly. 

HHS is awarding $2.3 million in grants to help veterans become physician's assistants. This is so smart -- we need more primary care providers and they don't all have to be doctors.  Veterans need jobs (as do all of the unemployed).  Why not kill two birds with one stone, designing a program to address both needs?  We should be doing more of this. 

Important discovery -- the reason cancer comes back after chemotherapy is that chemo doesn't kill the stem cells that fuel the cancer.  Now, researchers can focus on finding ways to kill the errant stem cells -- a whole new territory to explore.

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

Thursday Themes

Congressional leaders reached a budget deal that ensures that there will be no threat of a government shut-down through the election season.  That doesn't mean there won't be bitter partisan battles, though.  The GOP-led House has voted to extend the Bush tax cuts for everybody, including the very wealthy -- a vote that cannot be duplicated in the Senate, and that the President has threatened to veto.  And there's still the threat of $110 billion in automatic budget cuts linked to last year's horrible deal to increase the debt limit.  Members of Congress are looking to point the finger of blame at each other for this ridiculous deal that was made at the 11th hour when compromise proved impossible.  They don't seem to get that it's this kind of nonsense that's making Americans turn off to all of them, regardless of party affiliation.

Kaiser Health News -- a nonpartisan news service -- has a profile of Mitt Romney's positions on health care.  I offer it to you without comment; you already know what I think, and you all need to decide for yourselves.  All I ask is that you make educated choices -- so read! 

Rebates resulting from the medical loss ratio -- a limit on the percentage of premium dollars that can be spent on administration as opposed to health care -- should be in the mail.  In California alone, the rebates total nearly $74 million.

To save money, though, look to insurers creating more hoops to jump through before they will authorize care -- more prior authorizations, smaller networks.  We've noticed that the appeals we're getting these days are far more complex and challenging.  Not sure what exactly explains that. But I'd expect to see more of this grab for control over health care spending as insurers looks for ways to increase profits while complying with the health reform law.

But health reform will transform decisionmaking for young people, who will be able to get affordable insurance (with subsidies) on the exchange and, thus, will no longer have to choose a job solely based on whether health insurance is offered.  Gee -- wonder what this will mean for Starbucks (one of the companies that offers health insurance to low-paid workers).

Group Health Cooperative -- a nonprofit health plan in Washington state -- is teaming with a Catholic hospital system to create a larger medical home-type system.  This should be very interesting to watch -- can health plans and providers come together to provide better care, more  care coordination, more patient-centered care, at less cost?  We'll see.

You know how you can never sleep in the hospital?  Well, it turns out that less hospital noise improves your health -- so hospitals are looking to see how they can reduce noise.  About time.  But then again, they're still going to wake you to take your vitals every few hours!

What's the connection between psychology and obesity?  This will be one of the issues addressed at the American Psychological Association's annual meeting in Orlando starting today.  We talk about what to eat and how to exercise, but there's a psychological component that drives the decision of what to put in your mouth.  After all, obesity really is an eating disorder; we don't treat it as such, but perhaps we should.

Home health providers will be part of a get out the vote drive this year.  They say the goal is not political -- it's about getting people to participate in the democratic process.  But it's also calculated to increase the political clout of the home health industry.

Consumer health apps are a growing sector of the health care industry.  Will consumers use them?  Should be interesting to watch.

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

Hump Day Headlines

Free preventive care starts today.   Not only the controversial coverage of birth control, but eight services aimed at protecting women's health.  Screenings for gestational diabetes and HPV, services for victims of domestic violence, breastfeeding support, counseling on STDs -- all free.  A great move in the right direction.

Congressional leaders reached a tentative deal to fund the government for 6 months, until after the election, to avoid an embarrassing impasse in the run up to the election.

Massachusetts passed a law that is aimed at controlling the growth of health care spending.  Health care costs will not be allowed to grow at a rate faster than the state's economy, and a state agency will monitor and enforce these spending limits.  An important experiment that may help us nationally if it works.  Here's some more on this important effort.

The medical loss ratio rebates should be out now.  If you got a rebate, you know you got your money's worth out of your insurance last year.  If you didn't get a rebate, you know your insurer is spending 80-85% of premium dollars on health care.  Either way, consumers win!

In store clinics -- a growing trend, and possibly a way to address the doctor shortage as 30 million people join the market for health care in 2014.  For simple problems -- a cold, the flu -- this may be a good option.

Brian Mansfield has colon cancer, and is writing about his experience fighting it.  Very well done.  And a strong reminder to have that colonoscopy.

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