It seems impossible to believe that smoking is even more harmful to health than we had thought. Yet that is exactly what a large and authoritative study published last week has revealed.
The findings provide stark evidence that the need to reduce smoking is more important than ever. Some 42 million American adults, 15 percent of women and 21 percent of men, still smoke. On average, they die more than a decade before nonsmokers. Poor people and those with less formal education are most likely to smoke. 
For the past 50 years, the evidence about tobacco’s dangers has been mounting. The landmark surgeon general’s report in 1964 first declared that smoking caused lung and laryngeal cancer and chronic bronchitis. A succession of later reports by the surgeon general kept adding to the list of smoking-related diseases.
The latest surgeon general’s report in 2014 estimated that there are 480,000 deaths each year in the United States from 21 diseases caused by smoking, including 12 types of cancer, acute myeloid leukemia, diabetes, heart disease, stroke and atherosclerosis. 
Now comes evidence that the toll is actually much worse than that. A study by researchers at the American Cancer Society, the National Cancer Institute and four universities — published in The New England Journal of Medicine on Wednesday — adds several more diseases and 60,000 deaths a year to the total. The added diseases include kidney failure, infections, a rare intestinal disease caused by inadequate blood flow, and heart and lung ailments not previously attributed to tobacco. The study also found small increases in the risks of breast and prostate cancer among smokers, although more research will be required to establish their significance. 
One obvious imperative is for governments to ramp up their efforts to help smokers quit, including with programs like Medicaid. The Centers for Disease Control and Prevention reported last year that only seven states cover all approved cessation medications and in-person counseling, and that all states impose some barriers to getting these treatments. That is a disservice to smokers who want to quit or could be persuaded to quit.
For people who earn too much to be eligible for Medicaid, the Affordable Care Act requires most health insurance plans to cover preventive services, including tobacco cessation programs. That could help millions of Americans, but it is not clear how well these services are working so far. 
The new study followed more than 900,000 men and women, 55 years of age or older, for 10 years.
The 60,000 additional deaths a year from smoking that the researchers found could bring the total number of deaths caused by smoking each year in the United States to 540,000. And the researchers suspect that may be an underestimate because they didn’t count deaths from diseases like breast and prostate cancer where the evidence is compelling but not quite strong enough to be certain that smoking was the cause. Either way, this huge number of deaths provides ample reason to use every possible tool to help smokers quit.
http://mobile.nytimes.com/2015/02/15/opinion/sunday/the-smoking-toll-gets-much-worse.html?emc=edit_tnt_20150214&nlid=1311158&tntemail0=y&_r=1&referrer=

Denied an Insurance Claim? Consumers Get Federal Help Under ACA 

By  • FEB 13, 2015
RAYMOND, Maine - When it comes to having claims denied, consumers who buy insurance on the Affordable Care Act's online marketplace have to be savvy.

They have to understand things like premiums, deductibles, and co-pays - essentially become their own HR department. But the federal health law does provide help, making the complicated process of insurance appeals a little bit easier.
In 2013, Brian and Leigh Walker's teenage daughter required hospitalization for an ongoing medical problem. A week went by, and her doctors felt she needed further care. But the Walkers, of Raymond, received a phone call from their insurance company: They were told no further hospitalization would be covered.
"And I looked at my wife and said, 'So now what do we do?' At the time the decision was simple - we needed to make sure she was cared for," Brian Walker says.
About a week later, their daughter was discharged - and the Walkers' faced an $8,000 bill. Brian spent hours on the phone with the insurance company trying to resolve the denied claim.
"There were calls where I would literally be on hold for a long time, and then I'd end up in Georgia," he says. "And the people would say, 'What are you calling us for?' and I'd say, 'Well, I got forwarded here.' It was a really difficult situation."
"I don't think we could have done this on our own," says Brian's wife, Leigh Walker. "I mean, we would have had to at least get a lawyer directly to deal with it. I don't think as an independent person, unless you have medical knowledge and have the ability to go through your entire policy and pull out the relevant pieces that show that it is medically necessary, it's pretty difficult."

Republican lawmakers hold the line against Obamacare at state level
As President Obama fights in Congress and the courts to preserve the nation's sweeping healthcare law, the Affordable Care Act faces still another threat to its viability: Republicans in statehouses, many bucking governors of their own party eager to accept its flow of federal dollars.
When a group of Republican governors filed suit to overturn Obama's signature achievement, Wyoming's Matt Mead was among them, arguing the legislation was a vast overreach that violated the Constitution and trampled the right of states to set their own policies.
But after the U.S. Supreme Court rejected that argument, Mead decided it would be foolhardy to pass up tens of millions of dollars the act provided to expand coverage for Wyoming's uninsured adults.
"We have fought the fight," Mead told lawmakers last month in his State of the State address. "We've done our best to find a fit for Wyoming. We are out of timeouts, and we need to address Medicaid expansion."
That argument failed to sway lawmakers in Wyoming's GOP-run Senate, which voted 19 to 11 to reject Mead's proposal; many of the opponents, said Phil Nicholas, the Senate president, had campaigned on a promise to block Medicaid expansion.
A similar dynamic is playing out in legislatures across the country, including Arizona, Florida and Utah, where conservative lawmakers remain a formidable hurdle to momentum building behind the Democratic goal of guaranteeing universal coverage.
Indeed, they have proved far more effective at thwarting the 2010 healthcare law than their Republican counterparts in Washington, who have voted more than 50 times to repeal all or part of the program many call Obamacare, largely to no avail.
Earlier this month, in Tennessee's GOP-led Senate, a committee rejected a proposal to extend Medicaid coverage despite a strong push by the state's Republican governor, Bill Haslam, and waivers from the Obama administration meant to allay conservative concerns.
"I said from the very beginning it would be difficult," Haslam told reporters after his plan was shot down. "I think what you saw today is a measure of just how difficult."

LePage wrongly blames ‘illegals’ for diseases in Maine

Blaming immigrants for local woes — they’re taking your jobs, they’re a drain on public assistance programs and making your taxes go up — has long been a staple of Republican campaigns. The new strategy is to blame illegal immigrants for disease outbreaks in America, when there is no evidence to support this.
In spontaneous remarks during his State of the State address last week, Gov. Paul LePage tied these immigrants to a costly uptick in hepatitis C, HIV and tuberculosis.
“But this is the problem with some of the illegals that are here today,” the governor said. “When a refugee comes here from a foreign country, they get a medical assessment and we know their health. But when they are here illegally, they don’t get medical assessments.
“And one thing that we don’t want to see is the uptick in hepatitis C, HIV and tuberculosis, but it is here. We are dealing with it. And it is very costly.” These remarks were not included in the written version of his speech. He made similar comments in October, days before the November election. “I have been trying to get the president to pay attention to illegals in our country,” LePage told reporters then. “Because there is a spike in hepatitis C, tuberculosis, HIV, and it is going on deaf ears.”
The governor is partially right about an uptick in some diseases, but there is no evidence that those who enter the United State illegally are responsible.
Data compiled by the Maine Center for Disease Controlshow that last year, there were 30 cases of acute hepatitis C in Maine, an increase from the five-year average of less than 10 per year. There was also an increase in HIV to 60 new cases last year.
A 2013 year-end report from the Maine CDC provides a more detailed look at disease rates for the prior decade. In 2013, there were eight people in Maine with acute hepatitis C, down from a high of 12 in 2011. The number of newly reported cases of chronic hepatitis C rose from 1,142 in 2010 (the first year the data is available) to 2,165 in 2013. The report provides no information about the nationality or birthplace of those infected but stresses that drug use is a major risk factor.
In 2013, there were 39 newly reported cases of HIV, the lowest during the previous decade. The 60 cases reported in 2014 are near the high of 64 reported in 2007.
Tuberculosis is a disease that is more prevalent among immigrants, particularly from Africa. These immigrants, however, are likely to be refugees or asylum seekers; they are not among those who entered the country illegally.
The number of new TB cases in Maine is small and varied widely by year from a low of eight in 2010 to a high of 20 in 2004; there were 15 new cases in 2013. Of these, seven were in people who were born in another country. There were also 433 cases of latent TB, with 82 percent of those infected born in another country, according to the CDC report. Those with latent TB cannot spread the disease to other people, and they show no symptoms of the disease. The most cases were found in people from Congo, Somalia, Burundi, Angola and Iraq. Three quarters of immigrants who enter the U.S. illegally come from Mexico, El Salvador, Guatemala and Honduras. These countries accounted for just three of the cases of latent TB in Maine reported in 2013.
Nationally, the number of cases of TB has declined dramatically, from more than 84,000 cases in 1953 to fewer than 10,000 in 2013. The number of cases has steadily dropped since 2000, even as the number of immigrants in the United States illegally has grown from about 8.5 million in 2000 to 11.4 million in 2012.
Infectious diseases are a concern in Maine, especially among the homeless and those with low incomes. Erroneously blaming these diseases on illegal immigrants doesn’t help solve the problem.

How Medicare Was Made

BY 


Fifty years ago, Congress created Medicare and Medicaid and remade American health care. The number of elderly citizens lacking access to hospitals and doctors plummeted. Hospitals, physicians, and state and local governments came to depend on this federal funding. We have a tendency to forget the history of laws that extended the obligations and commitments of the federal government. But the passage of Medicare and Medicaid, which shattered the barriers that had separated the federal government and the health-care system, was no less contentious than the recent debates about the Affordable Care Act.


When Medicare was first proposed, in the late nineteen-fifties, national health insurance had been a losing cause for decades. In the thirties, Franklin Delano Roosevelt had chosen not to add health care to his Social Security proposal because he believed that it would be too controversial, and would damage the prospects of other programs. Whereas most Western democracies had adopted some form of national health-care program, the United States relied on a private system that revolved, as the sociologist Paul Starr has recounted, around a sacred understanding of the doctor-patient relationship. When liberals talked about giving the government a bigger role in health care, stakeholders in the existing system always fought back, protecting their authority and autonomy by warning that Washington would sever the ties between doctors and their patients. It was one thing to distribute old-age pensions but quite another to allow the government to intrude into intimate medical affairs. When one senator suggested in 1937 that President Franklin Delano Roosevelt was prepared to expand the government’s role in medicine if doctors did not do more to help the needy, Time magazine asked in its June cover story, “Nationalized Doctors?”
When President Harry Truman proposed national health insurance for every American in 1945, and again in 1949, as part of his effort to move forward with domestic policies that had been left out of the New Deal, he and allied liberals came to see why F.D.R. had avoided the issue of health care back in the nineteen-thirties. The American Medical Association conducted the most expensive lobbying effort to that date in opposition to Truman’s health-care plan, which it branded as “un-American” and “socialized medicine.” Charging that the Truman Administration consisted of “followers of the Moscow party line,” the A.M.A. worked closely with the conservative coalition in Congress to kill the measure in committee. By 1950, the proposal was dead.


Big Pharma's Pathetic Medical Bribes are Quite Profitable

Pharmaceutical companies are low-balling how much they pay doctors by misspelling the names of their drugs in their reports to the federal government.
By Charles Ornstein, Mike Tigas, Ryann Grochowski Jones /  Pro Publica

You'd think drug and medical device makers would know how to spell the names of their own products.
But when companies submitted data to the federal government last year on their payments to doctors, some got the product names wrong. Forest Laboratories misspelled its depression drug, Fetzima, as "Fetziima" 953 times — in more than one-third of all the reports on the drug. Medical device company Amedica Corp. sometimes called its Preference screw system "Preferance."
Amid much anticipation and after a lengthy delay, the government in September unveiled its Open Payments database, saying it would bring transparency to relationships between physicians and the drug and medical device industries. But this openness has been clouded by numerous errors that detract from its usefulness.
The database mistakes surfaced as we developed an app, rolled out this month with The Upshot, to identify the drugs and medical devices that were most heavily promoted to doctors in the last five months of 2013, the period covered by the data. We found that many of the drugs with the highest spending weren't cures or even medical breakthroughs, but rather "me-too" drugs that were little different than other drugs on the market.
As we tried to get accurate tallies of all payments associated with each drug and device, we encountered widespread problems with companies' submissions. We also learned that the Centers for Medicare and Medicaid Services, which administers the Open Payments database, doesn't double-check what companies submit.
"We are very committed to not altering data," said Shantanu Agrawal, director of the agency's Center for Program Integrity. "Our role is not to spell-check for the industry. The act of transparency also will improve the data itself."