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