Canadians are ready for an adult conversation on Medicare
Canada's health-care system is ticking along nicely, Dr. Michael Rachlis says
By Michael Rachlis, M.D.The Toronto Star, Oct. 14, 2012
Over the past two years, Brian Mulroney, former Bank of Canada governor David Dodge and other prominent Canadians have called for an “adult conversation on medicare.” This month Globe and Mail columnist Jeffrey Simpson became the latest member of the Canadian chattering class to call for a mature deliberation about Canada’s favourite social program.
The analysis usually proceeds from a 30-second case for medicare’s unaffordability. Medicare might have been well-meant but health costs are rising faster than government revenues and the economy. Governments can’t fix medicare’s problems without raising taxes, which isn’t an option. The only hope is that Canadians will finally have a grown-up conversation about medicare and at least introduce more for-profit care if not dismantle it entirely.
This story is frequently told and easily understood. But it’s almost completely false.
Total health-care costs as a share of the economy did rise when the economy tanked in 2008-9 but they have been falling for two years. For the past two years, provincial government health costs have also fallen as a share of GDP and as a share of their overall spending. Far from hitting the forecast 70 per cent, or even 50 per cent of program expenditures, provincial health costs are less than 38 per cent of program spending and falling.
http://www.pnhp.org/print/news/2012/october/canadians-are-ready-for-an-adult-conversation-on-medicare
New Laws Add a Divisive Component to Breast Screening
By DENISE GRADY
In a move that has irked medical groups and delighted patient advocates, states have begun passing laws requiring clinics that perform mammograms to tell patients whether they have something that many women have never even heard of: dense breast tissue.
Women who have dense tissue must, under those laws, also be told that it can hide tumors on a mammogram, that it may increase the risk of breast cancer and that they should ask their doctors if they need additional screening tests, like ultrasound or M.R.I. scans.
The issue is pitting angry patients against the medical establishment. Advocates say women have a right to know, but medical groups argue that the significance of tissue density is uncertain and that reporting it may panic women and lead to an avalanche of needless screening tests and biopsies.
Laws requiring disclosure have been passed in Connecticut, Texas and Virginia, and most recently in California and New York, where they will take effect next year. A bill calling for a federal law has been introduced in the House.
The laws owe their existence mostly to Nancy M. Cappello, 59, of Woodbury, Conn. She was not told that she had dense breast tissue until after doctors found an advancedcancer that mammograms had missed. She took her story to legislators, and in 2009, Connecticut became the first state to require that women be told if they have dense breasts and that insurance companies cover ultrasound scans for those women.
“I want to help other women,” said Ms. Cappello, formerly the state’s chief of special education. “I can’t help myself. My cancer should have been detected at a much earlier stage.”
The Family Doctor, Minus the M.D.
By TINA ROSENBERG
The Family Health Clinic of Carroll County, in Delphi, Ind., and its smaller sibling about 40 minutes away in Monon provide full-service health care for about 10,000 people a year, most of them farmers or employees of the local pork production plant. About half the patients are Hispanic but there are also many German Baptist Brethren. Most of the patients are uninsured, and pay according to their income - the vast majority paying the $20 minimum charge for an appointment. About 30 percent are on Medicaid. The clinics, which are part of Purdue University's School of Nursing, offer family care, pediatrics, mental health and pregnancy care. Many patients come in for chronic problems: obesity, diabetes, hypertension, depression, alcoholism.
What these clinics don't offer are doctors. They are two of around 250 health clinics across America run completely by nurse practitioners: nurses with a master's degree that includes two or three years of advanced training in diagnosing and treating disease. A proposal endorsed by the American Association of Colleges of Nursing for 2015 would require nurse practitioners to have a doctorate of nursing practice, which would mean two or three more years of study. Nurse practitioners do everything primary care doctors do, including prescribing, although some states require that a physician provide review. Like doctors, of course, nurse practitioners refer patients to specialists or a hospital when needed.
America has a serious shortage of primary care physicians, and the deficit is growing. The population is aging - and getting sicker, with chronic disease ever more prevalent. Obamacare will bring 32 million uninsured people into the health system - and these newbies will need a lot of medical care. According to the American Association of Medical Colleges, the United States will be short some 45,000 primary care physicians by 2020.
The primary care physicians who do exist are badly distributed - 90 percent of internal medicine physicians, for example, work in urban areas. Some doctors go to work in rural areas or the poor parts of major cities, treating people who have Medicaid or no insurance. But they are few.
The Hunt for an Affordable Hearing Aid
By TRICIA ROMANO
The crackling noises coming from my left ear weren't a good sign.
Last year, when my decade-old analog hearing aid started making popping sounds, I knew I had to replace it. But because hearing aids are so costly and generally aren't covered by insurance, I had put it off. I soon learned that in the last 10 years, purchasing a hearing aid had become even more difficult and confusing than buying a new car - and almost as expensive.
The first salesman I visited, in Los Angeles, looked at the hairline fracture on my wax-encrusted aid. He warned me that it could shatter in my ear and advised me to get a new one on the spot.
Alarmed, I visited Hearx, the national chain where I had bought my previous aids. There, a fastidious young man spread out a brochure for my preferred brand, Siemens, and showed me three models. The cheapest, a Siemens Motion 300, started at $1,600. The top-of-the-line model was more than $2,000 - for one ear. I gasped.
I've worn hearing aids for more than 30 years; I've had profound hearing loss in my right ear and moderate loss in the left ear, the one where I wear the aid, since I was 5. So I am probably savvier than most first-time customers, many of them elderly and scared of what might happen if they don't buy an expensive aid.
A hearing aid is basically just a microphone and amplifier in your ear. It isn't clear why it costs thousands of dollars.
But the digital era has ushered in new technology: Manufacturers boasted of Bluetooth, multiple settings, "channels" and "bands," which processed sound and fine-tuned it like a stereo's equalizer.
Settlement proposed to broaden Medicare coverage
The proposal would end Medicare's 'improvement standard,' making custodial and other care available for sick and disabled people whose conditions aren't expected to improve.
By Noam N. Levey, Washington Bureau
10:13 PM PDT, October 23, 2012
Europe’s Top Health Official Quits, and the Bloc Has a Mystery on Its Hands
By JAMES KANTER
BRUSSELS — The top health official for the European Union suddenly resigns. His plans to place marketing curbs on tobacco companies are put aside. The offices of antitobacco groups are burglarized. There is talk of cash payments of tens of millions of dollars by Big Tobacco.
The swirl of rumors here around events inevitably called “Tobaccogate” has a noirish tone that is unfamiliar in Brussels, the European Union capital better known for turgid debates about fish quotas. And much still remains mysterious and tangled in unproven accusations.
The one certainty: The fall from grace last week of John Dalli, the commissioner for health and consumer protection, was remarkably sudden. It came after investigators concluded that he had probably known about an attempt by a lobbyist to solicit a multimillion-dollar payoff in exchange for easing a ban on snus, a form of tobacco sold in small pouches and placed between the gum and lip.
In his latest public comments on the matter, Mr. Dalli denied the allegations on Wednesday, saying at a packed news conference that the European Commission president, José Manuel Barroso, had given him 30 minutes to resign.
Mr. Dalli said that he had requested 24 hours, so he could seek legal advice, and that resigning might have been an error because it suggested guilt. But Mr. Dalli insisted that he had to do so, because Mr. Barroso has the authority to dismiss any member of the commission.
Amid Cutbacks, Greek Doctors Offer Message to Poor: You Are Not Alone
By LIZ ALDERMAN
ATHENS — As the head of Greece’s largest oncology department, Dr. Kostas Syrigos thought he had seen everything. But nothing prepared him for Elena, an unemployed woman whose breast cancer had been diagnosed a year before she came to him.
By that time, her cancer had grown to the size of an orange and broken through the skin, leaving a wound that she was draining with paper napkins. “When we saw her we were speechless,” said Dr. Syrigos, the chief of oncology at Sotiria General Hospital in central Athens. “Everyone was crying. Things like that are described in textbooks, but you never see them because until now, anybody who got sick in this country could always get help.”
Life in Greece has been turned on its head since the debt crisis took hold. But in few areas has the change been more striking than in health care. Until recently, Greece had a typical European health system, with employers and individuals contributing to a fund that with government assistance financed universal care. People who lost their jobs received health care and unemployment benefits for a year, but were still treated by hospitals if they could not afford to pay even after the benefits expired.
Things changed in July 2011, when Greece signed a supplemental loan agreement with international lenders to ward off financial collapse. Now, as stipulated in the deal, Greeks must pay all costs out of pocket after their benefits expire.
About half of Greece’s 1.2 million long-term unemployed lack health insurance, a number that is expected to rise sharply in a country with an unemployment rate of 25 percent and a moribund economy, said Savas Robolis, director of the Labor Institute of the General Confederation of Greek Workers. A new $17.5 billion austerity package of budget cuts and tax increases, agreed upon Wednesday with Greece’s international lenders, will make matters only worse, most economists say.
Deeper Concerns About Drug Compounding
The more that reporters and regulators dig into the cause of the meningitis outbreak that has sickened more than 300 people in 18 states and killed 24, the worse it all looks. The Massachusetts pharmacy that produced the contaminated injectable steroid linked to the outbreak has a long, troubled history. But the issues of shoddy manufacturing practices and lax regulation go well beyond one company.
The New England Compounding Center in Framingham, Mass., has a record of violating state law by selling compounds in bulk without prescriptions for individual patients. It has also failed to follow standard procedures to keep its facility clean and its products sterile. In fact, it appears to have shipped the injectable steroid to some customers without even waiting for final sterility test results.
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