Finally Friday Edition

And so, at last, it's Friday! Tomorrow is rest, Sunday is prep day, and Monday are scopes. But first, the news:

The GOP payroll tax cut plan is out. Despite President Obama's veto threat, it's tied to the Keystone Pipeline and rolling back environmental regulations, while paying for the tax cut with increases in Medicare premiums for the rich, shrink the size of the federal workforce, and end food stamps and unemployment for millionaires. And everybody knows it can't pass the Senate. Meanwhile, a Dem proposal, that would pay for the tax cut with a surcharge on incomes over $1 million also was rejected by the Senate. Can Congress get anything done before the end of the year? Speaker Boehner has a tough time getting the votes in the House without spending cuts. But eliminating government jobs in a jobs bill? Really? And there are Dems that support the Keystone pipeline (oil from Canada through the US). But does that belong in a jobs bill?

There's also the impending massive cut to Medicare's reimbursement rates if Congress doesn't act by the end of the year. The GOP has put together a deal to delay the cuts for 2 years by repealing unspecified portions of the health reform law and increasing Medicare premiums for high income seniors.

And then there's an extension of unemployment benefits, which also runs out at the end of the year. Protesters call on Senator Lieberman to make this happen.

Some GOPers are trying to force Justice Elena Kagan to recuse herself from hearing the challenge to the health reform law, which would all but guarantee that the law is struck down. They say she worked on the legal strategy for the law when she was Solicitor General, and they've demanded documents -- calendars, notes -- so they can comb through them for support. However, Attorney General Eric Holder says this violates separation of powers, and they should be requesting those documents as part of the court case rather than through the executive branch.

The Department of Health and Human Services rolls out $1.4 million in grants for school-based health clinics. However, states have cut Community Health Center funding -- critical safety net health care for the poor and uninsured.

The President defended Secretary Sebelius's decision to limit the sale of the morning after pill so that kids can't buy it without a prescription. Meanwhile, an FDA advisory panel recommends stronger warnings of blood clots for contraceptives Yaz and Yasmin. However, they back the overall benefits of these birth control pills.

The Pentagon opposes a mental health program for the National Guard. This is so despite an increase in suicide rates among the Guard.

Don Berwick's first speech after leaving the Centers for Medicare and Medicaid Services takes on his opponents, blasting the phony "death panel" accusations, and noting that those who say he favors rationing are also in favor of major cuts to Medicare and Medicaid. He says Republicans are the real rationers.

Which states spend the most on health care? Here's your answer.

The great Dr. Pauline Chen tells us about a web-based campaign to raise funds for cancer prevention using social media. Fabulous.

Night shift work may raise the risk of type 2 diabetes in women.

Right in the middle of a recession, Connecticut's Department of Social Services asks the feds for permission to cut Medicaid for low income adults -- because enrollment is expanding greatly. This would leave low income adults without access to health care.

And that, my friends, is the news. Look forward to a big deal post later in the day. In the meantime, have a great day! Jennifer

Thursday Themes

Brrrr. It's definitely winter in Connecticut this morning. Still, we have the news:

Politics is ruling the day on the payroll tax cut, as well as other year-end business, with leaders threatening to stay in session over the Christmas holidays if need be. But nobody's even pretending the that this is not about politics and the Presidential election. The President has warned that he will veto a bill that ties the payroll tax to the Keystone Pipeline. Indeed, he said any effort to tie the payroll tax to another, unrelated matter will be rejected. The President is meeting with House Dems today. He also has said he will forgo his Hawaii vacation if the issue is not resolved. Speaker Boehner says the GOP is working on their own proposal. Speaker Boehner is trying hard to find a solution that his own party can live with. Meanwhile, Congress is trying to finalize a deal on the 2012 budget; the current temporary funding measure expires on December 16.

Secretary of Health & Human Services Kathleen Sebelius rejected the FDA's recommendation to make the morning after pill available at any age. Right now, girls age 16 and 17 still need a prescription for it, while others do not. The FDA recommended lifting the age restriction. No HHS Secretary has every publicly overruled the FDA before. Meanwhile, the White House is still pondering a regulation that will provide an exception for religious objections to the requirement that contraceptives be provided for free -- should the exception cover any employer with any religious affiliation, or just churches?

Interesting patent case. Prometheus labs developed tests to help doctors calibrate the proper dose of 6 mercaptopurine (6MP) and azathioprine. Then the Mayo clinic came up with a test for the same thing. Prometheus says this is patent infringement. Mayo says this is medical research. The Supreme Court will decide.

A scientific panel has found few environmental triggers for breast cancer. Meanwhile, two new breast cancer drugs are in the pipeline with promising results. These drugs, when used in combination with other drugs, appear to slow the progression of disease.

Crowded emergency rooms drive patients to thriving urgent care centers. This is a good thing; urgent care centers often can provide the help needed but for far less money.

California plans an overhaul of its mental health system.

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

Hump Day Headlines

Went out to dinner with a friend last night. The food definitely did not agree with me, which is why the news is a little late this morning. But here goes:

They're still bickering over the payroll tax cut. The GOP is split on what to do. Some say they this would worsen the deficit; others say the party that's been pushing cutting taxes for the rich can't deny a tax cut to the middle class. Here's a helpful graphic that shows the competing positions. The President gave a rousing speech yesterday in Kansas calling for a return to middle-class values. He said that income inequality is the defining issue of our time.

Among the issues that must be dealt with by the end of the year is the scheduled huge cut to Medicare physician reimbursement. The hope had been for a permanent "fix" rather than another delay, but the House GOP says no way.

Medicare enrollment is skyrocketing. The deadline for enrolling has been extended for anybody who contacts one of the organizations that enrolls people by the end of the day today. You can call 1-800-633-4227 or call the Medicare Rights Center at 1-800-333-4114. As long as you at least leave a voicemail by the end of today, you can still be enrolled until midnight on Saturday.

Contrary to the belief that the Presidency adds years onto your life, a new report says that Presidents live longer than most men of their age.

The FDA could decide today whether to lift age restrictions on the "morning after pill," which would mean bringing it from behind the counter to the public shelves of the pharmacy.

Believe it or not, that's all I have for you today. Not a whole lot of health news this week, it seems. Oh, well. Maybe that's a good thing. Anyway, have a great day! Jennifer

Health Reform at Work

A great story about the good health reform has done. But read the comments -- so hostile, so uneducated, so baseless. When are we going to learn to be more compassionate, not to mention informed? Jennifer

Tuesday Tidbits

This week already feels too long. I think it's anxiety about my scopes next Monday -- or more specifically, the prep on Sunday. But before that, the news:

A bipartisan proposal would extend the payroll tax cut and provide funding for roads and bridges -- the best way to create jobs in this economy. But will it pass? It's once again paid for by a tax surcharge on income over $1 million. This appears to be the only tax cut the GOP is against, although both Mitt Romney and Newt Gingrich support it. The GOP plans to offer their own proposal today, paying for the cut by cutting federal employee wages, cut Medicare for the wealthy. According to Politico, this is all posturing before the final push next week. Meanwhile, GOP Senator John Kyl says the only way we keep the payroll tax cut is if we renew the Bush tax cuts. Yup, those big tax cuts that favor the wealthy -- and that nobody has ever even tried to pay for.

Did you know that Medicare penalizes people who don't sign up when they first become eligible? It's really important to know how Medicare works if you're near eligibility. Also, Medicare is going to allow its data to be used to rate doctors and hospitals.

The health reform law is changing behavior - for the better. The Part D doughnut hole is a lot smaller. People are going for free preventive care. Meanwhile, a bill has been introduced that would allow cameras to broadcast the Supreme Court arguments on the health reform case.

A Senate panel today is hearing testimony on the proposed merger to ExpressScripts and Medco, two massive pharmacy benefit managers. Keep your eye on this one, folks -- this may dictate how you get your meds for the rest of your life.

A patient was removed from the liver transplant list because he uses medical marijuana. This is thoroughly outrageous! They say it's because marijuana might cause a problem post-transplant, but the drug counseling they want to force on the patient has nothing to do with mold; it's purely about treating medical marijuana -- prescribed by a physician -- as a street drug.

The shortage of nurses may be ending, as more nurses join the workforce.

Some employers base health insurance costs on salary -- you get paid more, you pay more. The wave of the future? Hmmm.

Understand the aging brain and take care of what you've got.

Should the "morning after pill" be available over the counter, on open shelves, so you don't have to discuss it with the pharmacist?

I'm not sure I buy this. This article says left-handed people have a greater chance of ADHD, mental illness. I know some pretty impressive left-handed people. Hmmm again.

And that's today's news -- another slow news day. Have a great one. Jennifer

Medi-Cal to Provide Enhanced Mental Health Services

For Immediate Release Monday, December 5, 2011 Contact: Vincent Eng +1 703 981 6636 media@healthlaw.org Settlement Puts Community-Based Mental Health Services for Foster Care Children on the Medi-Cal Menu of Services Agreement in Katie A. will provide mental health services to California children in, or at risk of entering, nation's largest child welfare system

Los Angeles, CA - Federal District Court Judge A. Howard Matz today approved a landmark agreement between advocates and the state of California that will provide intensive home- and community-based mental health services for children in foster care or at risk of removal from their families. The agreement in the class-action suit Katie A. v. Bonta comes nine years after the case was first filed. Under the ground-breaking settlement, California will make two types of mental health services, "Intensive Home-Based Services" and "Intensive Care Coordination," available to certain children under Medicaid. The state will also determine what parts of "Therapeutic Foster Care" services are covered under Medicaid and provide that service to certain class members. "These services will ensure that thousands of Medicaid-eligible children obtain access to the mental health services they need to live in a family and succeed in school and later life," said Robert Newman, attorney for the plaintiffs, from the Western Center for Law and Poverty. The settlement also requires California to improve its system of care for providing mental health services to foster youth by coordinating decision-making among state and local agencies, improving guidance to mental health care providers, and developing a consistent team approach to meeting the needs of eligible children and youth and their families. "This agreement will improve children's access to mental health care and lower government costs. But, the hard work of doing what is promised in the Agreement remains," stated Patrick Gardner, an attorney with the National Center for Youth Law. Implementation of the Agreement must be achieved within 3 years, a relatively short period of time for such a large statewide system. "We commend the state for agreeing to an accelerated schedule for getting these services in place," said Kimberly Lewis, an attorney with the National Health Law Program. "We will be doing what we can to ensure that the state is successful in meeting its deadlines." Judge Matz also noted the aggressive timetable, and made a commitment to assure that deadlines would be met "without any extension." The first milestone in the Agreement is completion of an implementation plan within 6 months. "The settlement brings California into line with modern mental health practice," stated Ira Burnim, of the Bazelon Center for Mental Health Law. "We are delighted to see the process begin that will put into place a system that will address the mental health needs of thousands of California's most vulnerable children." The children in the plaintiff class are represented by the Western Center on Law and Poverty, the National Center for Youth Law, Bazelon Center for Mental Health Law, Disability Rights California, the American Civil Liberties Union of Southern California, and the National Health Law Program. The Settlement Agreement can be found here. Judge Matz's Stipulated Judgment Order can be found here. ### Founded in 1969, the National Health Law Program works with and on behalf of limited-income people, people with disabilities, and children to improve their access to quality health care and to enforce their legal rights to health. NHeLP works with courts, government agencies, and Congress to ensure quality health care for the most vulnerable members of our society. www.healthlaw.org

Monday Musings Already?

Monday already? Oh, boy -- another long and busy week ahead. But first, the news:

Congrats to our friend Mike McCready for running the Las Vegas half marathon to benefit Crohn's disease and ulcerative colitis.

On his way out of office (see Friday's post), Don Berwick said 20 to 30 percent of health spending is wasteful. We have to find a way to get that under control.

Rumor has it that Senate Majority Leader Harry Reid will announce a compromise on the payroll tax cut extension today that will pay for the tax "in a serious way," whatever that means. John Boehner may make his own proposal -- and there may be a package that includes extending unemployment and further delaying the huge cut to physician reimbursement rates under Medicare.

A health reform lawsuit plaintiff has her case mooted out, meaning she's no longer a small business owner and instead, she'd be eligible for subsidies to help her pay for health insurance, thereby negating her claim that she'd somehow be harmed by the law.

Juan Williams says neither Mitt nor Newt can get away with claiming they were against a health insurance mandate. It would be interesting if we had a GOP presidential candidate who favored the mandate, no?

HHS did not change the medical loss ratio (percentage of premium dollars spent on health care) despite the National Association of Insurance Commissioners' vote to shift agents/brokers to the health care side instead of administration. This is great news. The final rule also requires public disclosure of how health care dollars are spent.

Can strep cause an illness characterized by tics and obsessive-compulsive disorder, called PANDAS? I have 3 insurance appeals pending involving PANDAS, so I say yes.

Cancer patients who are obese or have type 2 diabetes have a worse prognosis than others.

More exercise means better sleep.

Med students wash their hands, but the habit decreases as they get more experience.

A patient safety expert has his own brush with the medical establishment -- and was pleased.

And that's it for today -- a light start to the news week. Have a great day. Jennifer