Democrats warm to Medicare change that late Sen. Edward Kennedy opposed
The idea of affluence testing is not new — wealthy Medicare recipients already pay higher premiums for doctor visits and prescription drug coverage.
But negotiations to avoid the so-called "fiscal cliff" open the door to new measures that would make Medicare costs more progressive based on income.
Life Expectancy Rises Around the World, Study Finds
By SABRINA TAVERNISE
A sharp decline in deaths from malnutrition and diseases like measles and tuberculosis has caused a shift in global mortality patterns over the past 20 years, according to a new report, with far more of the world’s population now living into old age and dying from diseases more associated with rich countries, like cancer and heart disease.
The shift reflects improvements in sanitation, medical services and access to food throughout the developing world, as well as the success of broad public health efforts like vaccine programs. The results are dramatic: infant mortality has declined by more than half between 1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.
At the same time, chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just over half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.
But while developing countries made big strides – the average age of death in Brazil and Paraguay, for example, jumped to 63 in 2010, up from 28 in 1970 – the United States stagnated. American women registered the smallest gains in life expectancy of all high-income countries between 1990 and 2010. The two years of life they gained was less than Cyprus, where women gained 2.3 years of life and Canada, where women gained 2.4 years. The slow increase caused American women to fall to 36th place in the report’s global ranking of life expectancy, down from 22nd in 1990.
From Vermont, a Gruff Voice for Shielding Entitlements
By SHERYL GAY STOLBERG
WASHINGTON — When President Obama cut a deal with Congressional Republicans in December 2010 to extend tax cuts for the wealthy, Senator Bernard Sanders, the brusque Vermont independent who calls himself a socialist, decided it was time for a protest.
He had a cup of coffee and a bowl of oatmeal in a Senate cafeteria, marched into the chamber and began talking. He talked for so long — railing for 8 hours 37 minutes about economic justice, the decline of the middle class and “reckless, uncontrollable” corporate greed — that his legs cramped. So many people watched online that the Senate video server crashed.
Today the issue of tax cuts for the wealthy is once again front and center in Washington, as part of the debate over how to reduce the federal deficit. And Mr. Sanders is once again talking, carving out a place for himself as the antithesis of the Tea Party and becoming a thorn in the side to some Democrats and Mr. Obama, who he fears will cut Social Security, Medicare and Medicaid benefits as part of a deficit reduction deal.
A number of Congressional Democrats agree with Mr. Sanders that “no deal is better than a bad deal,” but he may be the most vocal.
He is emboldened by his recent re-election with more than 70 percent of the vote — “Seventy-one percent, but who’s counting?” Mr. Sanders said — and he appears to be making a little headway. Mr. Sanders has been pressing Mr. Obama to take Social Security off the negotiating table, and the White House now says changes to the retirement program should be considered on a “separate track” from a deficit deal.
“I think maybe he has learned something,” Mr. Sanders, 71, said of the president, who is 20 years his junior. “After four years he has gotten the clue that you can’t negotiate with yourself, you can’t come up with a modest agreement and hope the Republicans say, ‘That’s fair, you’re O.K., we’ll accept that.’ He’s reached out his hand, and they’ve cut him off at the wrist.”
Life Expectancy Rises Around the World, Study Finds
By SABRINA TAVERNISE
A sharp decline in deaths from malnutrition and diseases like measles and tuberculosis has caused a shift in global mortality patterns over the past 20 years,according to a new report, with far more of the world’s population now living into old age and dying from diseases more associated with rich countries, like cancer and heart disease.
The shift reflects improvements in sanitation, medical services and access to food throughout the developing world, as well as the success of broad public health efforts like vaccine programs. The results are dramatic: infant mortality has declined by more than half between 1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.
At the same time, chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just over half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.
But while developing countries made big strides – the average age of death in Brazil and Paraguay, for example, jumped to 63 in 2010, up from 28 in 1970 – the United States stagnated. American women registered the smallest gains in life expectancy of all high-income countries between 1990 and 2010. The two years of life they gained was less than in Cyprus, where women gained 2.3 years of life, and Canada, where women gained 2.4 years. The slow increase caused American women to fall to 36th place in the report’s global ranking of life expectancy, down from 22nd in 1990.
“It’s alarming just how little progress there has been for women in the United States,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation, a health research organization financed by the Bill and Melinda Gates Foundation at the University of Washington that coordinated the report. Rising rates of obesity among American women and the legacy of smoking, a habit women in this country formed later than men, are among the factors contributing to the stagnation, he said.
The World Health Organization issued a statement Thursday saying that some of the estimates in the report differ substantially from those done by United Nations agencies, though others are similar. All comprehensive estimates of global mortality rely heavily on statistical modeling because only 34 countries – representing about 15 percent of the world’s population – produce quality cause-of-death data.
Getting the runaround on long-term care insurance
An insurance company relies on corporate gibberish to build a smoke screen around a denial of benefits.
David Lazarus
5:14 PM PST, December 13, 2012
Yet now that she finds herself in a position to require such assistance, her insurer, Washington National Insurance Co., is denying her claims.
"She bought this insurance for the same reason anyone would," said Corwin's daughter, Leni, who has been representing her mother in their dealings with the company. "If you become disabled or need long-term care, it's just too expensive to pay for on your own."
As the baby boomers enter their sunset years, long-term care coverage represents an increasingly costly gamble for insurers. That's why Prudential stopped selling individual policies in March. MetLife exited the business in 2010.
About 70% of people over age 65 will require long-term care services during their lifetime, and more than 40% will need care in a nursing home, according to the U.S. Department of Health and Human Services
http://www.latimes.com/business/la-fi-lazarus-20121214,0,3947160,print.column
Blue Shield of California seeks rate hikes up to 20%
In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers. Consumer advocates say the firm should use its reserves to hold down rates.
By Chad Terhune, Los Angeles TimesDecember 13, 2012
Health insurer Blue Shield of California wants to raise rates as much as 20% for some individual policyholders, prompting calls for the nonprofit to use some of its record-high reserve of $3.9 billion to hold down premiums.
In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers, effective in March, with a maximum increase of 20%.
Some consumer advocates and healthcare economists say Blue Shield shouldn't be raising rates that high when it has stockpiled so much cash. The company's surplus is nearly three times as much as the Blue Cross and Blue Shield Assn. requires its member insurers to hold to cover future claims.
"Blue Shield is sitting on a huge surplus that is beyond what is required or necessary," said Laurie Sobel, a senior attorney for Consumers Union in San Francisco. "It should be used to hold down rate increases when it hits these extraordinary levels."
California officials can take into account an insurer's amount of surplus, among many other factors, when determining whether they think a rate increase is reasonable. Both the California insurance commissioner and the state Department of Managed Health Care are reviewing the company's proposed premiums, but neither agency has the authority to reject changes in rates.
Some other states limit how much surplus can be held by nonprofit health plans. Other regulators press nonprofit insurers to return more money to consumers and the community overall since their stated mission is to serve the public good. Washington's insurance commissioner has said the two big nonprofit Blue Cross and Blue Shield plans there hold enough surplus to allow a portion of it to be used to reduce rates.
http://www.latimes.com/business/la-fi-blue-shield-rates-20121213,0,87517,print.story
A shift in how healthcare is paid for
In Massachusetts, thousands of physicians receive more pay if their patients stay healthy and avoid costly medical care. It could become a national template.
By Noam N. Levey, Washington Bureau7:16 PM PST, December 12, 2012
CHELMSFORD, Mass. — It's hard work being one of Dr. Damian Folch's diabetic patients.
If a lab test shows high cholesterol, Folch is quick to call or email. No patient can leave the office without scheduling an annual eye exam, a key preventive test. A missed exam or an appointment leads to another call.
"We are a real pain in their necks," joked Folch, a primary care physician in suburban Boston. "We track them down."
That kind of attention has always been good medicine. For Folch, 59, it's now good business. He is among thousands of physicians in Massachusetts whose pay depends on how their patients fare, not just on how many times they see them. If patients stay healthy and avoid costly medical care, he gets more money.
This simple shift in how healthcare is paid for — long seen as key to taming costs — has been occurring in pockets of the country. But nowhere is it happening more systematically than in Massachusetts, the state that blazed a trail in 2006 by guaranteeing its residents health insurance. Now Massachusetts, a model for President Obama's 2010 national healthcare law, may offer another template for national leaders looking to control health spending.
"There have been few greater periods of change in American medical history … and this is the epicenter," said Dr. Kevin Tabb, a former chief medical officer at Stanford Hospital and Clinics in Northern California who now heads Beth Israel Deaconess Medical Center, one of Boston's leading hospitals. "It is striking how different Massachusetts is from the rest of the nation."
In the last three years, commercial insurers in the state have moved nearly 1 million patients into health plans that reward doctors and hospitals that control costs while improving quality.
http://www.latimes.com/health/la-na-healthcare-cost-control-20121213,0,4417560,print.story
Editorial
Why not expand Medi-Cal in California?
The benefits to the public — including higher productivity, better health and fewer unpaid bills at county hospitals — more than justify the investment.
December 12, 2012California's Democratic-controlled Legislature has been an enthusiastic supporter of the 2010 federal healthcare reform law, but it has yet to take advantage of one of the most important provisions: the opportunity to offer Medi-Cal, the state's version of the Medicaid insurance program for the poor, to more Californians largely at the federal government's expense.
Gov. Jerry Brown hasn't committed mainly out of concern about the potential cost to the state. There's little doubt that the expansion would increase Medi-Cal costs over the long term, but the amount would be small in comparison to the state's total Medi-Cal budget — and to the billions of dollars in new federal aid flowing to doctors and hospitals. The benefits to the public — including higher productivity, better health and fewer unpaid bills at county hospitals — more than justify the investment.
As part of a multilayered effort to make healthcare more efficient and effective, the 2010 law sought to extend insurance to millions of Americans without coverage. To reach the poorest uninsured, it called on states to extend Medicaid at least to those earning up to 138%of the federal poverty line — including able-bodied adults without children, who'd previously been ineligible no matter how low their incomes — starting in 2014. The feds' share of the cost of the expansion would start at 100% for three years, then drop gradually to 90% by 2020. But as the federal Department of Health and Human Services announced Monday, that extra aid for any of the newly eligible would flow only if states expanded their Medicaid programs to the full extent called for by the 2010 law
http://www.latimes.com/health/la-ed-medi-cal-expansion-20121212,0,1716780,print.story
health clinic
Portland's mayor hopes other foundations will help keep the facility open to serve those who can't afford health insurance.
By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Staff Writer
PORTLAND — A Maine foundation has agreed to make a significant monetary contribution that will help keep the Portland Community Free Clinic open through next year, Mayor Michael Brennan said Thursday.
Brennan declined to name the foundation or say how much it will donate until details can be worked out. However, he said it's one of several Maine organizations he's tapped in the hope of saving a critical community resource that's in dire financial straits.
"I'm in discussions with a few foundations," Brennan said. "One foundation has stepped forward and made a sizable commitment. They'd like to see other foundations get involved and make matching gifts."
Brennan said he may share more details about the foundations on Friday.
The clinic at 103 India St. has enough cash to stay open until March, Brennan said. After that, it will need about $10,000 a month just to stay open through 2013, he said
Portland: Canadian drugs would save us millions
Maine AG William Schneider stopped the purchase of Canadian drugs because suppliers didn't have Maine licenses. But Portland plans to fight the law, which costs the city $3.2 million per year.
PORTLAND – City officials want Maine law changed to allow mail-order prescription drug purchases from Canada – a practice that saved Portland $3.2 million over an eight-year period before the state shut it down in the fall.
Prescription drug costs, and the potential for significant losses in education funding, emerged as the top legislative priorities Thursday morning during a meeting between the city officials and legislators who represent Portland.
It was the first such meeting since the elections Nov. 6, and nine of the 10 legislators attended to hear about the city's top concerns.
Ex-Maine insurance chief to head to DC health exchange
Posted Dec. 13, 2012, at 1:44 p.m.
Mila Kofman, Maine’s former top insurance regulator, has been appointed to oversee the District of Columbia’s health insurance exchange.
A Georgetown University professor, Kofman was named executive director of the D.C. Health Benefit Exchange in a unanimous vote, the exchange’s board announced in a Wednesday press release.
Beginning on Jan. 2, Kofman will manage the exchange’s operations leading up to its scheduled launch in 2014.
Kofman was appointed as superintendent of Maine’s Bureau of Insurance in 2008 by Gov. John Baldacci. She announced her resignation in May 2011, citing philosophical differences with Gov. Paul LePage.
During her tenure in Maine, Kofman was known as a consumer-oriented regulator. In 2009, she garnered national attention for disallowing built-in profits in rate increases in individual plans marketed by Anthem Blue Cross and Blue Shield of Maine.
In February, the Maine Supreme Court rejected Anthem’s appeal of Kofman’s decision to slash by nearly half a rate increase affecting about 11,000 Mainers covered by the company’s individual health insurance policies.
Before coming to Maine, Kofman served in the U.S. Labor Department from 1997-2001 and later as a professor at Georgetown’s Health Policy Institute. She returned to the Georgetown faculty after her stint in Maine, and has advised states on the implementation of the federal health reform law.
Wellness care: An alternative to more drugs and worsening health
Posted Dec. 13, 2012, at 6:04 p.m.
Wellness care may be best understood by contrasting it against our present health care system. Their underlying principles are quite different, but it’s common to miss these differences and to see wellness as a watered-down version of medical care.
I’ll be exploring these differences in several columns about wellness that I hope you find interesting and educational. I’m a chiropractic physician with 30 years of experience, and have also had training in acupuncture, nutrition and lifestyle changes.
In our current system, when a patient goes to a doctor with an illness or a complaint, the doctor takes over the healing process. If the patient has inflammation, they are given a drug to stop it; if they have an infection, they are given drugs to kill the bacteria. If the patient’s thyroid is not producing enough hormone, more is given in pill form; if the thyroid makes too much hormone, the gland can be partially damaged to reduce its output. If an organ is very diseased, it can be removed and sometimes replaced.
These approaches can be described as “attacking the disease.”
I am all in favor of using aggressive treatments to attack diseases, when necessary. But there seems to be no limit to America’s appetite for prescription drugs. According to Medical News Today, Americans filled more than four billion prescriptions in 2011. In 2003, we consumed more than 25 million pills an hour, every hour, for a staggering total of 600 million pills a day.
This reliance on medications has its costs — every year an estimated 2.2 million people suffer “serious drug-induced diseases.” One and a half million of these people had to be hospitalized due to the seriousness of the reaction. The 100,000 deaths caused each year by adverse reactions to prescription drugs is the fifth-leading cause of death in the U.S. today.
Medications can be lifesaving, but today most medications are given for diseases of lifestyle. Lack of exercise, a diet high in processed and “fast” foods, and constant low-grade stress are huge contributors to all of the major “diseases of civilization”— heart disease, chronic pain, diabetes, obesity, high blood pressure, stroke and cancer.
We are conditioned to think we have little or no control over our health, and that we need our medications to help ease the inevitable decline as we age. This is not true, and research has shown this over and over again. Our health is determined far more by our lifestyles than by our genetics, and when we do get sick, these problems are better treated naturally, with wellness care.
Maine ranks ninth healthiest state
BANGOR, Maine — Maine has been ranked has the ninth healthiest state in the country, according to rankings on americashealthrankings.org.
Vermont checked in as the country’s healthiest state for the sixth consecutive year, with Mississippi and Louisiana tying for last place.
Nationwide, nearly 28 percent of the general population is obese while 26 percent get no exercise.
Maine’s ranking moved up one spot from 10th in 2011, with strengths including low violent crime rate, low rate of uninsured population and low prevalence of low birthweight.
Maine’s challenges included a high prevalence of chain smoking and high rate of cancer deaths.
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