Health Care Reform Articles - December 13, 2014

U.S. Health Care Lags Worldwide for Those Over 65

By PAULA SPAN

 DECEMBER 12, 2014

The Commonwealth Fund has been publishing surveys comparing health care in industrialized countries since 1998, a continuing report card in which the United States has usually fared poorly because of its high proportion of uninsured people.

But its latest report – an early anniversary tribute to Medicare, which turns 50 next year – focuses on those over 65, the one segment of the American population with nearly universal coverage and access to care.

So we should look better this time, right? Our seniors’ health care will make the honor roll, compared with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom? 

Well, no.

“It’s definitely a better picture than when we look at the U.S. population generally; that’s a pat on the back for Medicare,” said Robin Osborn, director of the fund’s International Health Policy and Practice Innovations program and lead author of the study. Previous research has shown that “Medicare is more protective than all the different insurance plans people have under age 65,” she said.

But as the survey of 15,617 respondents – published in Health Affairs – reveals, we still have mortifying lapses and problems, despite spending more on health care than any other country in the world. Yet we do better than these 10 other countries on some measures, sometimes surprisingly. (You can read the fund’s summaries hereand here.)

The bad news first:

■ Our older population is sicker. We lead the list in the proportion of people over 65 who have two or more chronic diseases (68 percent report hypertension, heart disease, diabetes, cancer, etc.) and who take four or more prescription drugs (53 percent). Only a third of seniors in the United Kingdom have multiple chronic conditions. (The survey didn’t include residents of nursing homes or other care facilities.)

“One thing we know contributes to this is not having an ongoing, stable source of health insurance throughout your life,” Ms. Osborn said. Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care.

■ Older Americans still struggle to pay for health care. Nineteen percent said that in the past year, cost was a barrier that prevented their seeing a doctor, undergoing a recommended test or treatment or filling a prescription. In only one other surveyed nation (New Zealand, at 10 percent) did that proportion reach double digits. 

Among American seniors, 21 percent had out-of-pocket medical expenses that topped $2,000 and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.

“As good as Medicare is – it provides excellent coverage over all – it still isn’t as protective as the coverage people get in other countries,” Ms. Osborn said. Its deductibles and cost-sharing requirements still leave many Americans scrambling to afford drugs and doctors – which also cost more here. 

The other countries in the survey, note, represent a variety of health care approaches, including single-payer national systems and subsidized private insurance coverage. Their structures involve many different benefits, thresholds and exemptions. 

What they share (aside from doing a better job for their elders than the United States, at lower cost) is that their systems cover all ages. Their elders are less likely to arrive at 65 trying to catch up after years without adequate medical care.

http://newoldage.blogs.nytimes.com/2014/12/12/u-s-health-care-lags-worldwide-for-those-over-65/?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Don’t Homogenize Health Care

By SANDEEP JAUHARDEC. 10, 2014

IN American medicine today, “variation” has become a dirty word. Variation in the treatment of a medical condition is associated with wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from asthma to diabetes, from urinary incontinence to gout.

At some level, this makes sense. Some types of variation are unwarranted, even deadly. For example, we know that ACE inhibitor drugs improve quality of life and survival in heart-failure patients, but only two-thirds of American physicians prescribe these drugs to such patients. A study by the National Committee for Quality Assurance, a nonprofit organization focused on health care, reported that 57,000 Americans die each year because the care they get is not based on the best available evidence.

But the effort to homogenize health care presumes that we always know which treatments are best and should be applied uniformly. Unfortunately, this is not the case. The evidence for most treatments in medicine remains weak. In the absence of good evidence recommending one treatment over another, trying to stamp out variation in care is irrational.

Even in my field, cardiology, a paragon of evidence-based medicine, most treatment recommendations are based on expert opinions, not randomized controlled trials. Rarely is there one best option.

Patient preferences have to be taken into consideration, too. Medical decisions necessarily involve value judgments, and who better to make those decisions than the patient? If a fashion model doesn’t want curative surgery because it will scar her face, that may make sense in the context of her priorities. As a doctor, I may not agree with her, but I have to try to understand her reasoning and abide by her decision.

The weaker a treatment recommendation, the more patient preferences should enter into medical decision making, and the more variation you should expect to see. This is a basic conflict in modern medicine: treatment uniformity, which aims to optimize population health, versus treatment variation, which aims to respect individual choice. There is no obvious solution to this conflict, but the resolution will determine what medical care is going to look like in 10 or 20 years.

http://www.nytimes.com/2014/12/11/opinion/dont-homogenize-health-care.html?mwrsm=Email&_r=0

Holiday injuries prompt ER doctors to warn of confusion over urgent care

By Jackie Farwell, BDN Staff

Posted Dec. 11, 2014, at 11:06 a.m.

As the holidays approach, emergency room physicians once again are girding for an influx of seasonal injuries. Falls from ladders while stringing lights, lacerations from broken glass ornaments and other holiday-related afflictions send about 250 patients a day to the hospital every November and December, according to the U.S. Consumer Product Safety Commission.

But some ER doctors worry too many patients are confused about whether to seek care at their local urgent care center or the hospital, according to a new poll by a major medical specialty society.

More than 75 percent of ER physicians harbor concerns patients with serious medical conditions will visit urgent care centers that are unequipped to treat them, according to the online poll conducted by the American College of Emergency Physicians. Ninety percent said patients are redirected to emergency departments because their medical conditions were more serious than urgent care centers could handle.

“It’s hard for patients to know two things: when is their problem more serious and the capabilities of the different places,” Dr. Charles Pattavina, head of the emergency department at St. Joseph Hospital in Bangor, said.

More than 2,800 emergency physicians responded to the poll, including 19 in Maine. The margin of error was 1.8 percent.

The poll adds a new twist to an ongoing move in health care toward greater reliance on urgent care centers. The facilities, along with clinics operated by retail chains including Wal-Mart and CVS, have gained popularity with consumers seeking to avoid long waits and limited hours at the doctor’s office and the high bills from emergency room visits.

Health advocates have encouraged their use as a way to stem the flow of patients who visit costly emergency rooms with less serious illnesses and injuries. The median cost of a visit to the ER is $1,233, 40 percent more than the typical American pays in monthly rent, a 2013 study found.

While urgent care centers save money by treating patients who otherwise would wind up in the ER, they also raise health care spending by diverting patients from their primary care doctors, according to a study by the Center for Studying Health System Change.

Urgent care centers in several states have siphoned patients from hospitals, competing for more lucrative insured patients, while hospitals continue serving uninsured populations that stress their bottom lines.

Just over half of ER physicians reported local urgent care centers market themselves as alternatives to the emergency department, the poll found.

http://bangordailynews.com/2014/12/11/health/holiday-injuries-prompt-er-doctors-to-warn-of-confusion-over-urgent-care/print/

Kaci Hickox among Ebola fighters, survivors named ‘Person of the Year’ by Time

By Julia Bayly, BDN Staff

FORT KENT, Maine — Kaci Hickox, the nurse who made national headlines recently when she defied Maine Gov. Paul LePage’s efforts to quarantine her after she returned from treating Ebola patients in Sierra Leone, is among those honored as Time Magazine’s 2014 “Person of the Year.”

The magazine named those fighting Ebola its 2014 “Person of the Year,” applauding the work of medical relief teams, doctors, nurses, ambulance drivers and burial teams working in western Africa, where an outbreak of the virus has killed thousands.

“For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time’s 2014 Person of the Year,” the magazine said in a statement.

Efforts to reach Hickox Wednesday were not successful.

But Hickox told the BDN last month, “There is no humanity in Ebola.”

Hickox was interviewed then at the Fort Kent home she shared with her boyfriend Ted Wilbur, a former University of Maine at Fort Kent nursing student, a few days before the couple moved to southern Maine.

While in west Africa, Hickox ran a 35-bed clinic in Bo, Sierra Leone, supervising a 50-member medical and support staff.

“One of the difficulties in west Africa is there were not enough beds and definitely not enough beds in facilities equipped to take care of Ebola patients well,” she said. “We were a referral facility, so patients already diagnosed with Ebola were transferred to us.”

Every morning, Hickox said, she would get calls from health care workers at five other facilities telling her each had at least 10 Ebola patients they needed to send to her.

http://bangordailynews.com/2014/12/10/news/state/kaci-hickox-among-ebola-fighters-survivors-named-person-of-the-year-by-time/

Obama’s Health Law: Who Was Helped Most

By KEVIN QUEALY and MARGOT SANGER-KATZ OCT. 29, 2014

A new data set provides a clearer picture of which people gained health insurance under the Affordable Care Act.

We know that about 10 million more people have insurance coverage this year as a result of the Affordable Care Act. But until now it has been difficult to say much about who was getting that coverage — where they live, their age, their income and other such details.

Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas. The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon.

Each of these trends is going in the opposite direction of larger economic patterns. Young people have fared substantially worse in the job market than older people in recent years. Blacks and Hispanics have fared worse than whites and Asians. Rural areas have fallen further behind larger metropolitan areas.

Women are the one modest exception. They have benefited more from Obamacare than men, and they have received larger raises in recent years. But of course women still make considerably less money than men, so an economic benefit for women still pushes against inequality in many ways.

The Affordable Care Act was passed in 2010, but the law’s biggest insurance expansion provisions went into effect in January, when millions more people qualified for state Medicaid programs, and new subsidized insurance plans sold in state marketplaces kicked in.

http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?abt=0002&abg=0

Many Choose Not to Save in the Health Marketplace

By ABBY GOODNOUGHDEC. 11, 2014

PHOENIX — Steven Norton, recovering from a severe stroke, says he is renewing the health plan he got this year through the Affordable Care Act insuranceexchange. He will pay more in 2015 — $501 a month including his federal subsidy, up from $485. But for him, continuity matters more than price, so he has not logged on to HealthCare.gov to search for alternatives.

“If it’s working, why try to fix it?” said Mr. Norton, 51.

Nancy Allman, a retiree outside Tucson, sees things differently. Ms. Allman, 64, said she was surprised to learn her exchange plan would cost $235 a month next year after her subsidy, up from $158. Overwhelmed by her choices on HealthCare.gov, she called the customer service line and received help finding a plan from a different insurer that will cost only $77 a month. The plan has a smaller network of providers, but it includes her primary care doctor, and she is in good health.

“It was like a no-brainer to switch,” she said.

Across the nation, millions of people who bought insurance through the exchange in this inaugural year of coverage under the health care law must decide by Monday whether to switch plans for 2015 if they want a new plan starting Jan. 1. If they do nothing, most of the 6.7 million people who remained enrolled as of last month will automatically be re-enrolled in their current plans or similar ones. More often than not, the premiums for those in the most popular plans will increase, according to a New York Times analysis of data from the McKinsey Center for U.S. Health System Reform.

http://www.nytimes.com/2014/12/12/us/affordable-care-act-deadline-nears-many-not-seeking-cheaper-health-plan.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

The Punishing Cost of Cancer Care

By MIKKAEL A. SEKERES, M.D.

 DECEMBER 11, 2014

“I think it’s time to switch therapies,” I told my patient, as he and his wife sat next to each other by the wall of my exam room. 

He stared at me, unblinking, through his chipped, wire-rimmed glasses as his wife looked quickly down at the medication list she clutched in her hands. Her worn purse sat on the floor by her chair. “Switching therapies” was a euphemism for “your cancer is progressing,” a point I didn’t need to hammer home with them – they both knew the score.

“O.K.” he said, taking a deep breath. “What’s next?”

We had been navigating his cancer together for a year-and-a-half, balancing the most effective treatments we could devise with what his health insurance would cover, and what he could afford. The 90-mile drive to Cleveland was itself an economic strain, gas prices being what they were and their aging car becoming increasingly more finicky, particularly during the cold winter months.

“The next drug I’d suggest is a pill that you’d take every day. It can get you into a remission, and may even allow you to live a little longer. It’s the one we’ve talked about before,” I told him. He nodded, remembering.

“The real expensive drug?” he asked.

This time I nodded. When I first suggested he take this pill as part of his chemotherapy regimen, I warned him about the possible cost, as this has become a part of my standard informed consent process. I review potential risks, benefits, alternative medications, the people involved in a patient’s care, and now economic risks. 

After checking with his insurance plan, which did not cover chemotherapy pills the way it did intravenous chemotherapy, I had the unpleasant task of telling my patient that the medication would cost him $5,000 per month. At the time he had laughed, a mixture of surprise and incredulity. He was too well-off to qualify for patient assistance, but too poor to afford the drug. His face was grave now.

“I won’t bankrupt my family for a month or two more time,” he said. “I have to leave them something.” His wife looked up briefly, about to interject, but remained quiet. This was ground they had already covered, and she would make her case for his taking the pill when I wasn’t present. They were private people, proud, and wouldn’t disagree with each other in front of someone who wasn’t family.

As the price of chemotherapy now routinely reaches $100,000 for a full treatment course, my patients are forced more and more into making the equivalent of Sophie’s Choice when it comes to treating their cancer: Spend down their savings for an improvement in survival that might amount to a few weeks, secretly hoping that they will be one of the lucky few at the “tail” of the survival curve – the handful of people who live years more; or decline the therapy and in so doing ensure that their families will be provided for after they have died.

I had to wonder whether anyone should be forced to make such a decision.

My patient and I discussed a couple of other treatment options, and ways that he might receive his therapy closer to home, a plan that made him visibly relax.

“Not that we don’t like seeing you,” he joked. His wife didn’t smile, though. Perhaps she wasn’t ready yet to let him go, or didn’t agree with his reasoning that she would be destitute if he chose the pill. Maybe she was incensed that hard-working people like themselves would be placed in such a quandary precisely at the time of their retirement, and in such a wealthy nation. The way she set her mouth, I guessed it was a combination of all three.

“I’ll miss seeing you,” I told them both as we all got up to leave. There was nothing else I could say – this was the part of cancer care I didn’t have the tools to fix.

http://well.blogs.nytimes.com/2014/12/11/the-punishing-cost-of-cancer-care/?mabReward=RI%3A7&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine

In Arizona, swings in Medicaid access show program's impact 

by Naom Levey

- LA Times

Bad timing turned Karen Slone's medical problem into a crisis.

Slone, 53, a former administrative assistant with diabetes, followed doctors' advice for years, getting regular checkups. Then, last year, she lost her job and her insurance, and stopped going to the doctor.

When she spotted a sore on her foot, a common complication of diabetes, Slone tried Neosporin and Band-Aids. By the time she went to an emergency room weeks later, she had a raging infection. Surgeons had to remove bones in two toes.

"It was awful," Slone recalled. "If I'd have been covered, I would have gone to the doctor sooner."

For low-income adults like Slone, Arizona was once a trailblazer in healthcare, providing broad access to Medicaid, the government health plan for the poor.

But during the last recession, Arizona cut coverage for tens of thousands of people. This year, the state expanded Medicaid again, although the decision faces a legal challenge.

Arizona's on-again, off-again approach makes it a useful place to look at the impact of a program that covers more than 1 in 5 Americans.

In 27 states, low-income adults are guaranteed Medicaid coverage through the Affordable Care Act, which provides billions of federal dollars to states to expand the program.

Poor adults are largely shut out of coverage in the remaining states, mostly in the South and interior West. These states declined federal aid, citing concerns about Medicaid's effectiveness and cost.

http://www.latimes.com/nation/la-na-healthcare-medicaid-swings-20141201-story.html#page=1

Virginia illogically denies Medicaid expansion as red states embrace it

By Editorial Board December 11 at 8:51 PM

TWO OF the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare.

The reasons are no mystery. Conservative governors and lawmakers in those states are acknowledging that it is profoundly illogical to deny the benefits they would reap — both budgetary and humanitarian — by accepting federal funding to provide health insurance for tens or hundreds of thousands of low-income residents.

Meanwhile, Virginia’s Republican-dominated legislature steadfastly refuses any plan, any approach or any modification to Medicaid that would do the same for the Old Dominion’s citizens.

Elsewhere, GOP leaders seek a workable compromise that would sling a safety net under many of their states’ most vulnerable residents. More than half of the states have gone ahead with the expansion. In Richmond, the subject goes all but unremarked — except when House Speaker William J. Howell (R-Stafford) deigns to repeatthat Virginia will stand pat.

Elsewhere, Republicans have given Medicaid expansion in their states a different name — the Healthy Indiana Plan, for instance — or rebranded it by including provisions that appeal to conservatives, such as work requirements for those who receive coverage or private insurance carriers. In Richmond, there is no sign that any influential Republicans are at work to fashion a means to help the state’s uninsured — even though expanding Medicaid would cover as many as 250,000 residents.

In other states, Republican leaders have managed to overcome their distaste for Obamacare simply because there is no rational justification, beyond partisan spite, for refusing federal funds that would help so many people.

http://www.washingtonpost.com/opinions/virginia-illogically-denies-medicaid-expansion-as-red-states-embrace-it/2014/12/11/3371f80a-8092-11e4-9f38-95a187e4c1f7_story.html

Unchecked superbugs could kill 10 million a year, cost $100 trillion

By Kate Kelland, Reuters

Posted Dec. 11, 2014, at 7:37 p.m.

LONDON — Drug-resistant superbugs could kill an extra 10 million people a year and cost up to $100 trillion by 2050 if their rampant global spread is not halted, according to a British government-commissioned review.

Such infections already kill hundreds of thousands of people a year and the trend is growing, the review said, adding: “The importance of effective antimicrobial drugs cannot be overplayed.”

Former Goldman Sachs chief economist Jim O’Neill, who led the work, noted that in Europe and the United States alone around 50,000 people currently die each year from infections caused by superbug forms of bacteria such as E.coli.

“Unless something is done by 2050, that number could become 10 million people losing their lives each year from then onwards,” he told a briefing in London.

Antimicrobials are a class of drugs that includes antibiotics, antivirals, antiparasitics and antifungals.

The Review of Antimicrobial Resistance (AMR) is based on analysis by two sets of researchers, RAND and KPMG, estimating the future impact of AMR under different scenarios for six common infections — three bacterial infections, plus malaria, HIV and tuberculosis.

But it excludes indirect effects of growing drug resistance which could “cast medicine back to the dark ages,” the review said, by making routine procedures more dangerous.

The problem posed by infectious microbes developing resistance to such drugs has been a feature of medicine since Alexander Fleming’s discovery of the first antibiotic, penicillin, in Britain in 1928.

But it has worsened in recent years as multi-drug-resistant bugs have developed and drug companies have reduced investment in an unprofitable field.

The World Health Organization has warned that a post-antibiotic era, where basic health care becomes far more dangerous due to risk of infection during routine operations, could arrive this century unless something drastic is done.

http://bangordailynews.com/2014/12/11/health/unchecked-superbugs-could-kill-10-million-a-year-cost-100-trillion/print/

Many States Will Be Unprepared if Court Weakens Health Law

by DEC. 11, 2014

Margot Sanger-Katz

A Supreme Court ruling this spring could upend health insurance markets in at least 34 states, eliminating the federal subsidies that make coverage affordable for millions of Americans.

State governments, theoretically, have ways to forestall this outcome. But few have taken action. If they wait until the court rules, it may already be too late for a state to get started on an exchange so that it is ready for 2016.

The case, called King v. Burwell, concerns whether subsidies can be given to consumers in every state in the country or only in those that have established their own state marketplaces as part of the Affordable Care Act. So far, more than a dozen states and the District of Columbia have such marketplaces. Should the high court rule that subsidies can be distributed only in states running their own exchanges, markets in the remaining states would be substantially disrupted. Prices for insurance plans would sharply rise. Millions of people would drop their coverage.

A decision in the court case is expected in June; a new marketplace would need to be ready for shoppers in October in order to sell health plans for 2016. If those states want to make sure that subsidies keep flowing to their residents, they can build their own marketplaces. But it won’t be easy.

Continue reading the main storyhttp://www.nytimes.com/2014/12/12/upshot/many-states-will-be-unprepared-if-court-weakens-health-law.html?_r=1&abt=0002&abg=0

Health care torch passed … to nobody

Next generation of Dems less visionary, more wonky.

By David Nather

Henry Waxman and George Miller spent nearly 40 years pushing universal health care. John Dingell — who helped pass the Medicare law in 1965 — fought for a vision of health care coverage for all Americans as far back as the Kennedy administration.

They’re all leaving Congress at the end of this month.

Who will be the new health care leaders for Democrats? Sens. Chris Murphy of Connecticut and Ben Cardin of Maryland want more delivery system reforms. Sen. Patty Murray of Washington wants better contraceptive coverage and more doctors. All three want to beef up mental health coverage. And Sen. Ron Wyden of Oregon and Rep. Frank Pallone of New Jersey aren’t even saying what’s on their agenda — they want the Republicans to go first. It’s all smaller bore stuff — a real comedown from the visions of the past.

The generational upheaval leaves the national health care debate in flux as a new Republican Congress takes control in January. There are no clear grand plans that can break the cycle of Obamacare fights, but the lack of big Democratic ideas — and defenders — leaves the health care law open to change. In fact, one of the most eagerly awaited proposals is actually coming from Republicans — a replacement for Obamacare that’s being developed by two possible GOP presidential candidates: Paul Ryan, who’s about to become the new House Ways and Means Committee chairman, and Sen. Marco Rubio of Florida. Rubio has described it, but neither one will say when it’s going to be released.

http://www.politico.com/story/2014/12/health-care-democrats-113379.html

Mitch McConnell’s Obamacare gambit

Behind closed doors, Republicans are plotting one last tilt at the Affordable Care Act.

By Jennifer Haberkorn and Manu Raju

In high-level strategy sessions on Capitol Hill, Republicans are going through reams of historical information and sitting through marathon slide show presentations, trying to figure out how to gut Obamacare through a complicated budget process that requires only a simple majority — a sign of how seriously they’re taking their best shot yet at dealing a long-term blow to the health care law.

Behind closed doors, Washington’s top budget experts have quietly met with Sen. Mitch McConnell, the incoming majority leader, and the Senate Republican Conference to detail options for action next year.

In a session with about a dozen senior GOP aides last month, the staff director for Republicans on the Senate Budget Committee privately laid out various scenarios that could occur when the Senate’s parliamentarian weighs in on the GOP’s Obamacare moves.

And the conservative Senate Steering Committee has put together three giant binders of information detailing the budget wars dating back to 1986, turning piles of data into a 28-page PowerPoint presentation being distributed to senators and staff laying out the kinds of procedural hurdles that could thwart their efforts. The process they are considering, known as “reconciliation,” has been used by Congress in the past to avoid a minority’s filibuster of controversial bills, including Obamacare itself.

While no one believes repealing the Affordable Care Act is feasible with President Barack Obama still in office, Republicans are eager to use a special procedure that might let them kill at least a large piece of the law — potentially the Medicaid expansion, subsidies for purchasing health insurance or even the individual mandate — with only a simple majority.

http://www.politico.com/story/2014/12/mitch-mcconnells-obamacare-gambit-113405.html#ixzz3LPEPHszJ

Americans Are Drowning in Uncollected Medical Debt, Report Says

Medical debt is hurting the creditworthiness of 43 million Americans, and the systems in place to collect and report this debt can be challenging for people, according to a new report released on Thursday by the Consumer Financial Protection Bureau (CFPB).

"It's hard for consumers to navigate the medical debt maze and come out with a clean credit report on the other side," said CFPB director Richard Cordray in a statement. "Getting medical care should not make your credit report sick." The CFPB study concluded that the process of billing for medical care can be confusing and the system for reporting overdue medical debt is haphazard. This could explain why half of all overdue debt on credit reports is now for medical expenses. The report says one out of five credit reports now contains a black mark from overdue medical debt. The major credit reporting agencies will now be required to provide the bureau with regular reports about how consumer disputes are being handled. They will also be expected to investigate companies that have abnormally high dispute rates and do something about it. The CFPB has information on how to deal with medical debt, both before it goes on a credit report and after

http://www.nbcnews.com/business/personal-finance/americans-are-drowning-uncollected-medical-debt-report-says-n266201

Another Baseless Attack on Health Law

By THE EDITORIAL BOARDDEC. 12, 2014

The opponents of the Affordable Care Act have filed another long-shot lawsuit that could undermine health care reform and force many consumers to pay more for health insurance if the suit succeeds.

The Supreme Court has already agreed to hear a separate case, filed by anti-reform forces, that seeks to prevent the payment of tax credit subsidies to help people buy insurance in 36 states where the federal government has established health care exchanges because the state chose not to. If that case succeeds, low- and middle-income people in those states will have to pay a lot more of their insurance premiums.

The new suit, filed late last month by the Republican-dominated House, aims to block another important subsidy: federal payments to insurance companies to keep deductibles, co-payments and other cost-sharing low for the poor. The Affordable Care Act specifies the maximum amounts people will have to pay in cost-sharing based on their incomes, and federal subsidies make up the rest.

If the government is blocked from reimbursing insurers for the subsidies, the insurers will have to absorb the costs. But companies might well raise their premiums for everyone else in the individual market to recoup the loss. The House lawsuit argues that no money was appropriated to reimburse insurers for cost-sharing and that the administration could not use money from a separate account that subsidizes premiums.

The Affordable Care Act authorized these cost-sharing subsidies when it was enacted in 2010 and the administration at one point requested an appropriation, but Congress failed to provide it. The House suit argues that it was unconstitutional for the administration to tap the separate fund to pay cost-sharing subsidies that are expected to total $175 billion over a 10-year period.

http://www.nytimes.com/2014/12/13/opinion/another-baseless-attack-on-health-law.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region&_r=0

How Social Status Affects Your Health

DEC. 12, 2014

WHAT is the relationship between social status and health?

This is a tricky question. In modern industrialized societies, health certainly improves as you move up the socioeconomic ladder, but much of that trend is a result of health care and lifestyle factors (diet, physical activity) that are associated with income — not relative social position per se.

If you want to see how status affects health, you have to isolate status from material wealth. How to do that? The easiest way is to observe a society in which there is minimal material wealth to contest and where there are limited avenues for status competition.

So that is what my colleagues and I did. For several years, we studied the Tsimane forager-horticulturalists of Amazonian Bolivia, a small, preindustrial, politically egalitarian society in which status confers no formal privileges (such as coercive authority). As we report in a recent article in the journal Evolution, Medicine, and Public Health, we found that even among the Tsimane, higher status was associated with lower levels of stress and better health.

Along the banks of the Maniqui River and in adjacent forests, the Tsimane people hunt, fish and plant plantains, rice and sweet manioc. They live in villages that range in size from 30 to 700 people. During village meetings, decision making is consensus-based. No individual has the right to coerce anyone else.

But that doesn’t mean there are no status distinctions. When you attend a Tsimane village meeting, you soon notice that the opinions of certain men are more influential during the consensus-building process. These same men are often solicited to mediate disputes or to represent villagers’ interests with outsiders. (Many Tsimane women have a voice in community affairs, but it is rare in such small-scale societies for women to have equal status, on average, with men.)

My colleagues and I measured the social status of all the men from four Tsimane villages (nearly 200 men between the ages of 18 and 83), by asking them to evaluate one another on their informal political influence. The men also provided urine samples and received medical examinations from physicians associated with the Tsimane Health and Life History Project.

We found that Tsimane men with less political influence had higher levels of the stress hormone cortisol, which has many important physiological functions. This result persisted after controlling for other factors that might affect stress levels, including age, body size and personality.

In addition, we found that the less influential Tsimane men had a higher risk of respiratory infection, the most common cause of sickness and death in their society. Stress may contribute to this disparity in infection risk; when chronic, stress can dampen immune function.

Studying the same individuals over a four-year period, we also found that for men whose influence declined over time, greater declines were correlated with higher levels of cortisol and respiratory illness. Downward mobility is harmful, it seems, even in an egalitarian society.

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Why might low status cause such stress for the Tsimane? One possibility is that status offers a greater sense of control. Another is that status acts as a form of social insurance. Influential Tsimane men have more allies and food-production partners, who can be helpful in mitigating conflict, sickness and food shortage. The relative lack of such support may cause psychosocial stress.

Our study is limited to adults, yet further studies might examine if childhood and adolescence are important periods in Tsimane society for establishing the social ties that beget status and regulate stress. Recent studies in industrialized societies have found that adults who experience low socioeconomic status in childhood show heightened cortisol responses as adults, regardless of their current socioeconomic status.

It is interesting that even in industrialized societies, the status comparisons most consequential for psychosocial stress are often among individuals who live near one another or occupy the same social network, not individuals at opposite ends of the socioeconomic spectrum. Those living just above the poverty line may resent welfare for those living just below it, and a millionaire may envy a multimillionaire more than he envies a billionaire.

http://www.nytimes.com/2014/12/14/opinion/sunday/how-social-status-affects-your-health.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region

Whooping cough on the rise in parts of Maine

By Abigail Curtis, BDN Staff

Posted Dec. 12, 2014, at 2:22 p.m.

BELFAST, Maine — Whooping cough has been on the rise during the last few months in several Maine counties, according to the Maine Center for Disease Control and Prevention.

Since September, the highly contagious respiratory infection has hit Piscatquis County the hardest, at a rate of 122 cases per 100,000 residents, 10 times the statewide average. Two other counties also reported high rates of the disease this autumn, including Waldo County, at 64 cases per 100,000 residents and Somerset County, with 60 cases per 100,000 residents.

Dr. Sheila Pinette, director of the Maine CDC, said Thursday that pertussis generally begins with symptoms of a common cold, then often develops into a severe cough after a few weeks. The cough can last for several weeks, and the disease is most dangerous to infants because it can rob them of oxygen, leading to brain damage and even death.

“Any time you have a child under a year of age, they don’t cough as well,” she said. “Oftentimes, small children under the age of 6 months require hospitalization.”

She said that as of Dec. 10, Maine had a total of 453 cases since the beginning of the year. While that is significantly more than the 332 recorded in 2013, it does not approach the spike of 737 cases amid a national outbreak in 2012 — the highest in at least 50 years.

“Once school started, we started seeing larger numbers across the board,” Pinette said.

Other counties have had much lower pertussis infection rates since September, with very few or zero confirmed cases in Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Washington, Cumberland and York counties. Slightly higher rates were recorded in Penobscot County, where 18 cases per 100,000 were recorded; Androscoggin, 17; Sagadahoc, 14; and Aroostook, 11.

In June and July of this year, an outbreak sickened a number of children in Washington County and several other counties in northern and eastern Maine. The numbers dropped before they started to rise again in October and November, according to figures from the CDC.

“We need to immunize and practice good hand-washing and respiratory etiquette,” Pinette told the BDN in August.

Parents should call their physicians if they are unsure whether their children are fully vaccinated, she said Thursday.

Maine is among the top 10 states with the highest vaccine opt-out rates , according to figures from the U.S. Centers for Disease Control and Prevention. More than 4 percent of Maine kindergartners, or 620 students, were exempted from required vaccines in 2012-13, including the vaccine for pertussis. In the majority of cases, parents cited philosophical objections to vaccines instead of medical or religious reasons.

Some parents are hesitant to see their infants and young children stuck with needles numerous times and argue not enough research has been done on the cumulative health effects from so many shots. While some choose to spread their children’s immunizations out over a longer period, medical professionals say vaccines are purposefully timed to be administered when children are most at risk for certain diseases.

http://bangordailynews.com/2014/12/12/health/whooping-cough-on-the-rise-in-parts-of-maine/print/