A Messy, Exuberant Case Against Being Too Clean
By ABIGAIL ZUGER, M.D.
Never fall in love. Oh, well, go ahead, if you must, but make sure you fall for a living being. A romance with anything else, be it a pair of shoes or a scientific theory, is only asking for trouble, so seldom will the inanimate beloved live up to your besotted expectations.
The best scientists struggle with this prohibition daily, knowing that even the most seductive data may well disappoint. But premature enthusiasm is routine among others, patients and their doctors foremost among them, with journalists smelling a scoop not far behind.
Moises Velasquez-Manoff — a journalist and also, as it happens, a patient — has fallen hard for an idea known as the hygiene hypothesis, whose implications, if followed out along a widely branching chain of extended supposition, threaten to unravel much of what we think we know about health and disease.
This hypothesis argues that our modern obsession with eradicating germs has backfired into an explosion of disease, specifically all the “new” diseases that have replaced infections to undermine our health. The modern immune system, the idea holds, is stymied by the sudden absence of its customary microbial targets. With nothing constructive to do, it is crazily spinning its wheels, resulting in soaring rates of food allergies and asthma, arthritis, psoriasis, multiple sclerosis and diabetes, even heart disease and cancer — not to mention alopecia, the premature baldness from which Mr. Velasquez-Manoff suffers and which led him to the subject in the first place. (In an opinion article in The New York Times last month, he suggested that an immune disorder might account for many cases of autism.)
Clearly, if true, the hygiene hypothesis is the single greatest medical story of our time, undercutting a century of putative progress. Is it true? Probably some of it is. But Mr. Velasquez-Manoff’s ambitious compendium of data and supposition — a great dense fruitcake of a book whose 680 endnotes, the author notes apologetically, refer to only a minority of the 10,000 studies he consulted — spins it all out in the most positive possible way with an energy, eloquence and desire to believe that is both breathtaking and a little scary.
Did Maine's insurance fix work?
Under Maine's new health insurance law, some business premiums have fallen while others jumped, stirring disagreement on its value.
Lisa Burton, who owns Reel Pizza Cinerama in Bar Harbor with her husband, saw her health insurance rate jump 67 percent this year. That's on top of a 35 percent increase last year. In two years, premiums to cover her three full-time employees have doubled.
"I feel lucky that business is doing well enough that I can absorb it," she said. "Other small businesses aren't that lucky."Gilbert Buthlay, chief executive officer of BEK Inc., a computer network design and service company in Brunswick, saw his insurance premiums rise this year, too, but by only 3 percent for his 13 workers.
"Because of the makeup of our work force, we were able to take advantage of another option that costs less but is a better fit," Buthlay said. "Our increases had been 10 or 15 percent, so we'll take 3 percent. And my employees are happy."
The experiences of those two small businesses show how the state's health insurance reform law has created both winners and losers since it was passed last year.
Supporters say the law is doing what was intended by lowering premiums for some Mainers and small businesses -- mostly companies in southern Maine with younger, healthier employees -- through deregulation and increased market competition.
Critics counter that while insurance rates have decreased for some, they have jumped substantially for older Mainers and small businesses in rural Maine.
http://www.pressherald.com/news/did-fix-work__2012-09-14.html
Federal court rejects Maine's Medicaid complaint
Gov. LePage would like to remove 24,000 low-income parents, as well as some elderly and 19- and 20-year-olds in order to balance the budget.
BOSTON — A federal appeals court on Thursday rejected Maine's request to speed the federal government's decision on whether to allow $20 million in cuts to the state's Medicaid program.
Maine had filed what's known as a state plan amendment with the U.S. Department of Health and Human Services on Aug. 2 and requested a decision by Sept. 1 so that its proposed changes could be implemented immediately and balance the state budget.
The changes to MaineCare, the state's version of Medicaid, would eliminate health care benefits for 24,000 low-income parents, nearly 7,000 19- and 20-year-olds, and 1,800 Medicare recipients who receive additional benefits under MaineCare.
On Aug. 31, the federal DHHS sent a letter to Gov. Paul LePage saying it needed more time to consider the state's request. Federal law allows 90 days, which means a decision could be issued as late as Oct. 31.
"I appreciate that your budget is predicated on the savings anticipated from ending the Medicaid coverage of the groups of individuals at issue in the proposed (plan), but your request raises issues that require careful consideration," Marilyn Tavenner, acting commissioner of the DHHS's Centers for Medicare and Medicaid Services, wrote in the letter to the state.
Maine Attorney General William Schneider, responding on behalf of the state's health and human services commissioner, Mary Mayhew, responded by filing a complaint in the U.S. 1st Circuit Court of Appeals in Boston on Sept. 5. He urged the court to require the Centers for Medicare and Medicaid Services to act sooner because Maine would "suffer irreparable injury" without a swift decision.
On Thursday, the three-judge appeals court summarily denied Maine's request, writing that "the facts do not warrant" an expedited review of its state plan amendment.
http://www.pressherald.com/politics/Appeals-court-rejects-complaint-over-MaineCare-waiver-delay.html
Court throws out LePage lawsuit seeking expedited approval for Medicaid cuts
Posted Sept. 13, 2012, at 3:32 p.m.
AUGUSTA, Maine — A federal court has thrown out the LePage administration’s lawsuit that sought to force federal health officials to expedite the approval of Maine’s request to make about $20 million in cuts to its Medicaid program.
In a one-page decision filed Thursday, a three-judge panel from the First Circuit Court of Appeals in Boston “summarily denied” Maine’s case, saying “the facts do not warrant” the state’s call for an expedited review of its request to amend its state Medicaid plan with cuts affecting coverage for about 36,000 low-income residents.
The decision came less than two weeks after Maine Attorney General William Schneider petitioned the court to force an expedited decision from the federal Centers for Medicare and Medicaid Services after the agency informed the LePage administration it wouldn’t rule on its request to cut Medicaid on the administration’s desired time frame.
The federal government had not yet filed a response in the case.
Spokeswomen for Schneider and for Gov. Paul LePage both declined comment Thursday afternoon. Schneider’s spokeswoman, Brenda Kielty, noted that a settlement conference for Maine and federal officials has been scheduled for the beginning of October at the Boston court.
Opponents of the Medicaid cuts cheered the decision.
“The fact that the First Circuit summarily denied the state of Maine’s petition for review goes to show it was without merit,” said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners, which had sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius in early August urging her to reject the state’s request to cut Medicaid coverage. “It means that Maine, just like any other state, needs to follow the law, which means they can’t cut coverage for thousands of Maine people.”
Rep. Emily Cain, the Democratic leader in the Maine House, praised the court for exercising “due diligence” in the case. “It’s not surprising since the request was purely political and a frivolous use of taxpayer dollars,” she said in a statement.
Schneider’s court filing was a response to a letter the federal government sent LePage on Aug. 31 to tell him the Centers for Medicare and Medicaid Services, or CMS, was still reviewing Maine’s request for an amendment to its Medicaid state plan, and that it wouldn’t meet LePage ’s Sept. 1 deadline the administration sought for a decision.
Which Medicaid waiver do you object to?
Posted Sept. 11, 2012, at 3:12 p.m.
At the end of the last session, the Maine Legislature passed a budget virtually along party lines that would roll back some eligibility requirements for MaineCare to the federal minimum. The Legislature also eliminated some redundancy regarding those who are eligible for both Medicare and Medicaid. Finally, Maine eliminated eligibility for childless adults aged 19 and 20, as has most every other state.
Such changes will require a waiver from the secretary of Health and Human Services, Kathleen Sebelius, as the actions undertaken seemingly violate provisions of the Affordable Care Act, which prohibits such Medicaid rollbacks by the states.
Gov. Paul LePage has written a letter to Sebelius requesting a rapid decision, as the state budget for fiscal year 2013 is contingent on an affirmative rapid decision. Recently, Maine Attorney General William Schneider petitioned the U.S. 1st District Court of Appeals to approve the MaineCare changes requested by the state. The governor’s intent in requesting this waiver is clear: We must roll back some eligibility and benefits so we can better serve the most needy among us.
Regardless of how one feels about the likelihood of the success of this waiver request, this is not the waiver about which I am most concerned. I am concerned about the waivers we have received for caring for our adults with developmental disabilities and those who have suffered traumatic brain injuries. Federal Social Security Law requires that we provide adequate and appropriate housing, shelter and services for these individuals. We have received waivers to allow us to house these individuals in group homes and shared living arrangements, with appropriate and often adaptive services and community supports, but we have never fully funded these investments. We are clearly in violation of federal law.
Currently, Maine has 717 developmentally disabled adults on a waiting list for Section 21 supports and housing. Of these severely disabled individuals, 185 are categorized as Priority 1, which means they will require substantial investments in their housing and services, often costing well in excess of $200,000 per year for life. There are another 532 individuals waiting for housing and supports who have lesser needs, but again the state does not have the funds to fulfill our legal requirement to take care of their health and welfare.
Some of the individuals on our Section 21 waiting list are also on the Section 29 waiting list, which means they are also eligible for community supports, more commonly known as a day program.
In Hancock County, Downeast Horizons operates such a program. These developmentally disabled individuals receive skills development, and such a program provides a de facto respite for their families. Providing a day program can be the advantage that keeps an individual from slipping into a Section 21 waiting list, where their needs become more intense and expensive. Often, day programming can be achieved for about 10 percent of the cost of Priority 1 Section 21 individuals.
Health insurance waivers show wrong priorities
Posted Sept. 13, 2012, at 2:57 p.m.
Gov. Paul LePage and Republican state lawmakers who voted to remove nearly 30,000 people from Medicaid need a waiver from the federal government to make many of these cuts. The debate over the waiver may sound like inside bureaucratic wrangling, but the consequences will have a real and devastating impact on thousands of Maine seniors, people with disabilities and working families.
A recent column by state Rep. Richard Malaby, R-Hancock, “Which Medicaid waiver do you object to?” (BDN, Sept. 11), argues that the state needs to make these cuts so we can help the “truly needy.” But this rhetoric does not match reality. The thousands of people they would like to take health care away from are truly needy. They include working parents, who are trying to make ends meet.
They include 19- and 20-year-olds with serious illnesses such as diabetes, cancer or severe mental health issues. They include seniors and people with disabilities who will have to choose between paying for their medicine and buying groceries.
Last year, Republicans forced through these health care cuts in a partisan budget after passing a huge tax cut for the rich. Seniors, people with disabilities and many Maine families will be asked to shoulder the burden so more money can go to people who don’t need it.
In times like these millionaires should be giving to charity, not getting it.
GOP and Medicare: Moving quickly, but in the wrong direction
By Jack Bernard
Ledger-Enquirer (Columbus, Ga.), Sept. 8, 2012
Ledger-Enquirer (Columbus, Ga.), Sept. 8, 2012
Rep. Paul Ryan (and, by extension, Mitt Romney) wants to start the process of getting the government out of our health care by going to a voucher program for Medicare. The problem is that the American people are clearly not with him or the GOP — my party — in this crusade.
August surveys by NBC/Wall Street Journal and the Pew Research Center confirm this fact. Pew finds that of the nearly three-fourths of Americans who have heard about the Ryan voucher plan, only 34 percent favor it while 49 percent oppose it. The NBC/WSJ survey finds that only 37 percent of the public believes Medicare needs a complete or major overhaul. When asked about the Ryan voucher concept, only 15 percent think it is a good idea, while 30 percent think it is bad. When asked do they favor Obama's position against or Romney's position for vouchers, 50 percent side with Obama as opposed to only 34 percent with Romney.
The response of the GOP to these polls has been to confuse the issue by accusing Obama of cutting $700 billion out of Medicare to fund Obamacare … which, while true, is very misleading. The Democrats have bumbled around, responding poorly to a surprisingly effective, although purposefully vague, Republican Medicare offensive.
Being disingenuous will work for a while for my fellow Republicans, but eventually the Democrats will figure out how to better explain the substantial impact of the voucher proposal on the lives of the voters. The GOP will then lose this battle.
Americans will understand that making Medicare a voucher program is simply a budgetary maneuver proposed by a Washington wonk (Ryan) to shift the constantly increasing cost of health care from one payer (the federal government/Medicare) to another payer (the patient).
It does nothing to make the health care delivery system more efficient or effective, unless you buy into the dubious argument that an individual patient has more power to correct provider behavior than does the government through control of the payment mechanism.
A Single-Payer System Would Be Far More Efficient
By Robert Reich
Wall Street Pit, Sept. 13, 2012
Employer outlays for workers’ health insurance slowed from a 9 percent jump last year to less than half that — 4 percent — this year, according to a new survey from the Kaiser Foundation. Good news?
Our political class believes it is. The Obama administration attributes the drop to the new Affordable Care Act, which, among other things, gives states funding to review insurance rate increases.
Republicans agree it’s good news but blame Obamacare for the fact that employer health-care costs continue to rise faster than inflation. “The new mandates contained in the health care law are significantly increasing the cost of insurance” says Wyoming senator Mike Enzi, top Republican on the Senate health committee.
But both sides ignore one big reason for the drop: Employers are shifting healthcare costs to their workers. (The survey shows workers contributing an average of $4,316 toward the cost of family health plans this year, up from $4,129 last year. Many are receiving little or no employer-provided coverage at all.)
Score another win for American corporations — whose profits continue to be robust despite the anemic recovery — and another loss for American workers.
Those profits aren’t due to a surge in sales. Exports are down (Europeans, Japanese, and Chinese are all pulling in their belts) and American consumers don’t have the dough to buy more.
The profits are largely due to lower corporate costs, especially when it comes to their payrolls. Employer-provided health and pension contributions are shrinking, and the real median wage continues to drop.
High unemployment has given companies more bargaining leverage over their workers, who have to accept lower real pay and benefits or risk losing their jobs.
When it comes to health insurance, employees increasingly have to choose between health-insurance policies with sky-high premiums or with sky-high co-payments and deductibles. And since they can’t afford the former they’re opting for the big co-payments and deductibles – or no insurance at all.
http://www.pnhp.org/print/news/2012/september/a-single-payer-system-would-be-far-more-efficient
Wall Street Pit, Sept. 13, 2012
Employer outlays for workers’ health insurance slowed from a 9 percent jump last year to less than half that — 4 percent — this year, according to a new survey from the Kaiser Foundation. Good news?
Our political class believes it is. The Obama administration attributes the drop to the new Affordable Care Act, which, among other things, gives states funding to review insurance rate increases.
Republicans agree it’s good news but blame Obamacare for the fact that employer health-care costs continue to rise faster than inflation. “The new mandates contained in the health care law are significantly increasing the cost of insurance” says Wyoming senator Mike Enzi, top Republican on the Senate health committee.
But both sides ignore one big reason for the drop: Employers are shifting healthcare costs to their workers. (The survey shows workers contributing an average of $4,316 toward the cost of family health plans this year, up from $4,129 last year. Many are receiving little or no employer-provided coverage at all.)
Score another win for American corporations — whose profits continue to be robust despite the anemic recovery — and another loss for American workers.
Those profits aren’t due to a surge in sales. Exports are down (Europeans, Japanese, and Chinese are all pulling in their belts) and American consumers don’t have the dough to buy more.
The profits are largely due to lower corporate costs, especially when it comes to their payrolls. Employer-provided health and pension contributions are shrinking, and the real median wage continues to drop.
High unemployment has given companies more bargaining leverage over their workers, who have to accept lower real pay and benefits or risk losing their jobs.
When it comes to health insurance, employees increasingly have to choose between health-insurance policies with sky-high premiums or with sky-high co-payments and deductibles. And since they can’t afford the former they’re opting for the big co-payments and deductibles – or no insurance at all.
http://www.pnhp.org/print/news/2012/september/a-single-payer-system-would-be-far-more-efficient
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