Hospitals Question Medicare Rules on Readmissions
By REED ABELSON
It is no longer enough for hospitals to make patients healthy enough to leave. Now, as part of the Obama administration’s health care overhaul, they are spending millions of dollars to keep those patients from coming back, often acting like personal assistants to help them manage their post-hospital lives.
While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care.
“It’s consumed a lot of resources,” said Dr. J. Michael Henderson, who focuses on quality and patient safety for the Cleveland Clinic, which attributes its relatively high readmission rate to the fact that it successfully treats a high number of severely ill patients.
Under the new federal regulations, hospitals face hefty penalties for readmitting patients they have already treated, on the theory that many readmissions result from poor follow-up care.
It makes for cheaper and better care in the long run, the thinking goes, to help patients stay healthy than to be forced to readmit them for another costly hospital stay.
So hospitals call patients within 48 hours of discharge to find out how they are feeling. They arrange patients’ follow-up appointments with doctors even before a patient leaves. And they have redoubled their efforts to make sure patients understand what medicines to take at home.
But hospitals have also taken on responsibilities far outside the medical realm: they are helping patients arrange transportation for follow-up doctor visits, get safe housing or even find a hot meal, all in an effort to keep them healthy.
Healthcare law could raise premiums 30% for some Californians
Premiums for many middle-income residents who aren't covered by employer plans could go up an average of 30% next year, a report says. Lower-income consumers could save big.
By Chad Terhune, Los Angeles Times
6:24 PM PDT, March 28, 2013
Compared with what individual policies cost now, premiums are expected to rise an average of 30% for many middle-income residents who don't get their insurance through their employers.
Alternatively, lower-income consumers will reap the biggest savings and are projected to save as much as 84% off their coverage thanks to federal subsidies.
The figures were released Thursday by Covered California, the state agency charged with implementing the federal Affordable Care Act. They underscore the harsh reality that costs for some consumers will have to rise in order to carry out the biggest healthcare expansion in half a century.
"It's hard to design any change of this scale where everybody is a winner and no one is worse off," said Gerald Kominski, director of the UCLA Center for Health Policy Research and an expert on health insurance. "Some people will feel they are being unfairly targeted or penalized."
The threat of higher costs could alienate many of the policyholders the state needs to keep in the fold in order to offset the increased costs of covering sicker, poorer people who have been shut out of the system for years.
According to the state, about 1.3 million people who are middle-income or higher and already have coverage not through an employer will bear the brunt of the higher costs. These are individuals making more than $46,000 and families earning more than $94,000 annually. People below those income levels qualify for federal subsidies.
An estimated 3.6 million Californians who are either uninsured or low-income will benefit the most from these changes. They will gain from guaranteed access to health insurance for the first time, regardless of their medical history. And they will no longer face financial ruin from enormous medical bills.
Merger of three medical practices would be milestone in Maine
Posted March 29, 2013, at 2:32 p.m.
A proposed merger among three medical practices in Auburn and Greater Portland would mark the largest consolidation of independent physician practices in recent Maine history, according to those involved.
Central Maine Orthopaedics, a 12-physician practice in Auburn, and OA Centers for Orthopaedics, a 16-physician practice in Portland, announced plans late Thursday to explore a merger with the much larger Spectrum Medical Group. Based in South Portland, Spectrum employs more than 170 physicians in Maine and New Hampshire in a range of medical specialties.
The three organizations have signed a letter of intent to explore a possible merger, according to a release from the three groups. The Auburn and Portland practices jointly approached Spectrum after deciding that consolidating would best serve their patients, the release states.
Spectrum, which consists of nine divisions, is the largest independent medical practice in northern New England.
“Both OA and CMO have a strong focus on delivering high-quality orthopaedic care that will improve patients’ quality of life,” Michael Cox, chief executive officer of CMO, said in the release. “Under the Spectrum umbrella, we would be able to achieve our mission more effectively.”
Spectrum’s specialties include anesthesiology, critical care medicine, radiology, neurology, pathology, physical medicine and rehabilitation, radiation oncology and surgery. Integrating Central Maine Orthopaedics and OA Centers for Orthopaedics would create an orthopaedics division, bringing the total number of physicians to nearly 200.
The three practices expect to complete a merger by the end of 2013. The organizations plan to work with the state’s certificate of need unit and other government agencies to determine the scope of regulatory review that the proposed merger will require.
“It’s certainly the largest consolidation of independent, privately owned medical practices in the state in recent times,” said Gordon Smith, executive vice president of the Maine Medical Association.
Spectrum has been active over the last year in bringing additional specialties into its fold, Smith said. Spectrum recently integrated two Bangor practices, Neurology Associates of Eastern Maine andPenobscot Surgical Care.
In announcing the merger plans, the three organizations underscored that remaining independent — while many other physician practices have been scooped up by hospitals — would allow them to deliver services more efficiently and at a lower cost.
“Independent practices offer physicians a collaborative work environment and an increased ability to directly influence initiatives that affect patient care,” Douglas Brown, president of OA, said in the release. “In a health system-dominated market, independent practices preserve choice for both patients and physicians.”
Many moderately sized physician practices have responded to the pressures of a changing health care landscape — including payment reforms and the adoption of electronic medical records — by joining forces, Smith said.
“These are practices that are very committed to continuing to practice independently owned,” he said.
Insurance and Freedom
By PAUL KRUGMAN
President Obama will soon release a new budget, and the commentary is already flowing fast and furious. Progressives are angry (with good reason) over proposed cuts to Social Security; conservatives are denouncing the call for more revenues. But it’s all Kabuki. Since House Republicans will block anything Mr. Obama proposes, his budget is best seen not as policy but as positioning, an attempt to gain praise from “centrist” pundits.
No, the real policy action at this point is in the states, where the question is, How many Americans will be denied essential health care in the name of freedom?
I’m referring, of course, to the question of how many Republican governors will reject the Medicaid expansion that is a key part of Obamacare. What does that have to do with freedom? In reality, nothing. But when it comes to politics, it’s a different story.
It goes without saying that Republicans oppose any expansion of programs that help the less fortunate — along with tax cuts for the wealthy, such opposition is pretty much what defines modern conservatism. But they seem to be having more trouble than in the past defending their opposition without simply coming across as big meanies.
Specifically, the time-honored practice of attacking beneficiaries of government programs as undeserving malingerers doesn’t play the way it used to. When Ronald Reagan spoke about welfare queens driving Cadillacs, it resonated with many voters. When Mitt Romney was caught on tape sneering at the 47 percent, not so much.
There is, however, an alternative. From the enthusiastic reception American conservatives gave Friedrich Hayek’s “Road to Serfdom,” to Reagan, to the governors now standing in the way of Medicaid expansion, the U.S. right has sought to portray its position not as a matter of comforting the comfortable while afflicting the afflicted, but as a courageous defense of freedom.
Insurers see way to dodge federal healthcare law next year
A little-known loophole in President Obama's landmark legislation enables health insurers to extend existing policies for nearly all of 2014.
By Chad Terhune, Los Angeles Times
4:00 AM PDT, April 2, 2013
That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.
At issue is a little-known loophole in President Obama's landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.
"Insurers are onto this, and the big question is how many will try to game the system," said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.
Some of the nation's biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers' renewal dates for the end of December. There's also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.
Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.
"This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges," said Christine Monahan, a senior analyst at Georgetown University's Health Policy Institute. "The health insurers can cherry-pick some healthy people and it raises prices for everyone else."
This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.
Many health insurers are still mulling over their options on how to handle these individual renewals.
"Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible," said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. "We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward."
State hires consumer group to help it review healthcare rates
The hiring of Consumer Watchdog prompts the health insurance industry to complain that the state has enlisted a longtime nemesis to scrutinize rate hikes.
By Chad Terhune, Los Angeles TimesApril 3, 2013
California Insurance Commissioner Dave Jones lashed out Tuesday at another double-digit rate hike for thousands of small businesses getting their health insurance from industry giant Anthem Blue Cross.
But this time Jones got some help from a surprising source. He has quietly tapped Consumer Watchdog, his political ally and the state's most outspoken industry critic, to help review health insurance rate increases under a one-year contract worth as much as $88,000.
The insurance industry expressed dismay that the state enlisted its longtime nemesis to help review rate increases, and some experts questioned whether it's necessary to further antagonize insurers at a time when state officials are trying to work closely with the industry to implement a massive healthcare expansion.
Public-policy experts also scoffed at the arrangement.
"Their very aggressive stance against insurance companies raises serious questions about a conflict of interest," said Jessica Levinson, a Loyola Law School professor and expert on government ethics. "You want an independent researcher."
Patrick Johnston, president of the insurance trade group California Assn. of Health Plans, said, "Any review of health plan rates should be conducted by independent, impartial consumer groups that do not have political conflicts of interest and financial motivations."
Consumer Watchdog was hired to supplement the state Insurance Department's own review of rates.
In its first report Tuesday, the Santa Monica group accused Anthem of padding its profits and overcharging small-business customers by about $17 million. Jones echoed that theme at a Sacramento news conference, but he didn't mention Consumer Watchdog's new role.
Jones criticized Anthem Blue Cross for raising rates on about 7,000 small businesses as much as 23% and said the company rejected his request for lower rates. Anthem said its average rate increase of nearly 11% for these 45,000 employees and their dependents was necessary to cover rising medical costs.
http://www.latimes.com/business/la-fi-0403-insurance-critic-hired-20130403,0,2957282,print.story
Healthcare an obstacle as Republicans court Latinos
As GOP members of Congress seek to repeal the Affordable Care Act, they risk undermining outreach efforts among the law's biggest supporters.
By Noam N. Levey, Washington Bureau6:11 PM PDT, March 31, 2013
WASHINGTON — As Republican leaders try to woo Latino voters with a new openness to legal status for the nation's illegal immigrants, the party remains at odds with America's fastest-growing ethnic community on another key issue: healthcare.
Latinos, who have the lowest rates of health coverage in the country, are among the strongest backers of President Obama's healthcare law. In a recent national poll, supporters outnumbered detractors by more than 2 to 1. Latinos also overwhelmingly see guaranteeing healthcare as a core government responsibility, surveys show.
Yet congressional Republicans continue to make repeal of the 2010 Affordable Care Act a top agenda item and have renewed calls for deep cuts in health programs such as Medicaid, which are very popular with Latinos.
"Obamacare is a colossal mistake for our country," Senate Minority Leader Mitch McConnell (R-Ky.) said recently in a speech on the Senate floor. "It needs to be pulled out by its roots."
Republican National Committee spokeswoman Alexandra Franceschi expressed confidence that Latinos would ultimately recognize that the law raises costs and burdens businesses. "We're going to do a better job explaining why this law is negatively affecting all Americans, including the Hispanic community," she said.
At the same time, however, attacking the law risks undermining the RNC's planned minority outreach campaign, which party leaders said in a recent strategy blueprint must convince Latinos "we care about them."
"This is going to hurt Republicans," said Matt Barreto, cofounder of Latino Decisions, a nonpartisan national polling firm. "When Republicans keep saying they will repeal the health law, Latinos hear the party is going to take away their healthcare."
Health law holds costly edicts for some companies
Full time will be defined as 30 hours, and businesses with 50 such workers face new requirements or penalties.
By Nathan Burgess nburgess@pressherald.com
Staff writer
Staff writer
If Doug Newman of Richmond-based Newman Concrete wants a full staff next year, he may have to shoulder some additional costs, or pay a penalty.
Newman's family-run company pours concrete at job sites around Maine, and has between 50 and 100 workers on staff during summers.
Most of those workers don't currently qualify for employer-paid health insurance from Newman's company, but because of the way the Affordable Care Act, the 2010 federal health reform law, is written, those workers could mean thousands of dollars in penalties if Newman doesn't provide health insurance.
A provision in the law states that employers with more than 50 full-time workers must provide health insurance to many of those employees or face penalties if even one worker has to draw federal subsidies in order to buy health insurance.
"That 50th employee is going to be the most expensive employee you ever put on payroll," Newman said.
The penalties go into effect in January. For a 70-employee company, the penalty will be $2,000 per full-time employee, minus the first 30 employees, or $80,000.
According to the Maine Department of Labor, 3,755 of Maine's 46,295 employers have between 20 and 99 employees. That's a small chunk, but one among many sectors of Maine employers who are facing challenges under the new law.
"I've actually heard of employers stopping projects and not hiring employees," said Joel Allumbaugh, CEO of the National Worksite Benefit Group, an employee benefits consultant. "Say if they've got 48 employees, maybe they don't do an expansion, and just try to stay where they are rather than take on the next project," he said.
Big Pharma Pockets $711 Billion in Profits by Robbing Seniors, Taxpayers
Here's an outrage that must be changed: Big Pharma has been systematically price-gouging the Medicare program for seniors and people with disabilities -- and raking in billions in excessive profits. The 11 largest global drug companies made an astonishing $711 billion in profits over the 10 years ending in 2012, and they got a turbo-charged boost when the Medicare Part D prescription drug program started in 2006, according to an analysis of corporate filings by Health Care for America Now (HCAN).
The drug companies hold the power to charge America's consumers whatever they want. Worse, Medicare -- the nation's largest purchaser of drugs -- is prohibited by law from seeking better prices. The result of this shortsighted policy is dramatic. In 2006, the first year of Medicare's prescription drug program, the combined profits of the largest drug companies soared 34 percent to $76.3 billion. And unlike other industries, such as Big Oil, drug companies get something even better than a tax subsidy -- they get a government program.
The drug companies hold the power to charge America's consumers whatever they want. Worse, Medicare -- the nation's largest purchaser of drugs -- is prohibited by law from seeking better prices. The result of this shortsighted policy is dramatic. In 2006, the first year of Medicare's prescription drug program, the combined profits of the largest drug companies soared 34 percent to $76.3 billion. And unlike other industries, such as Big Oil, drug companies get something even better than a tax subsidy -- they get a government program.
There is nothing wrong with a company making profits -- that's what they're supposed to do. But the drug industry's profits are excessive as a result of overcharging American consumers and taxpayers. We pay significantly more than any other country for the exact same drugs. Per capita drug spending in the U.S. is about 40 percent higher than in Canada, 75 percent greater than in Japan and nearly triple the amount spent in Denmark.
MaineHealth nears deal with New Hampshire hospital
Posted April 08, 2013, at 12:11 p.m.
PORTLAND, Maine — MaineHealth, the parent organization of Maine Medical Center in Portland, announced plans Monday to add its first out-of-state hospital to its system of health care facilities.
The MaineHealth board of trustees last week approved a membership agreement with the North Conway, N.H.,-based Memorial Hospital after nearly 18 months of talks between the organizations.
The addition of a New Hampshire institution to one of Maine’s largest health care networks is the latest in a string of new hospital alliances across the state’s medical landscape, as health care providers gravitate toward partnerships in an effort to create efficiencies and save money.
Earlier this year, after a deal to join the Massachusetts for-profit chain Steward Health Care System fell through, the Portland-based Mercy Health System of Maine agreed to join Eastern Maine Health Care Systems of Brewer.
The Lewiston-based Central Maine Healthcare is engaged in a prolonged — and currently stalled — effort to acquire Parkview Adventist Medical Center in Brunswick amid heavy competition in that town with nearby Mid Coast Hospital, which itself once absorbed Bath Memorial Hospital.
With Monday’s announcement, MaineHealth became the first of Maine’s health care families to plan expansion of its footprint out of state. MaineHealth President Bill Caron said the partnership made sense, as the 25-bed New Hampshire hospital “already has a strong relationship” with MaineHealth’s 606-bed Maine Medical Center, the state’s largest medical facility.
“We are pleased to have Memorial Hospital one step closer to joining our family of high-quality providers,” Caron said in a statement. “Approximately 90 percent of Memorial’s inpatient referrals and the vast majority of its outpatient ambulatory referrals go to Maine Medical Center.”
Memorial President and CEO Scott McKinnon said his hospital comes to the Maine system with sound finances. But he acknowledged that changes in medical technology and the uncertainties in hospital payment systems moving forward make it important for smaller institutions to partner with larger organizations, where costs can be dispersed and efficiencies found.
“We’ve achieved a positive operating margin over the last few years,” McKinnon said in the statement. “However, we feel strongly that Memorial can’t continue to go it alone. That’s why Memorial’s board of trustees has selected a strong partner that we believe is the best fit for Memorial strategically, and one that shares our values.”
After a public meeting on the proposed agreement on Thursday at Memorial Hospital, the deal will be forwarded to the New Hampshire attorney general’s office for review.
Since 1996, MaineHealth has brought eight hospitals, two home health agencies and a hospital support organization into its system. Most recently, it acquired Goodall Hospital in Sanford last fall.
Group holds teach-in on budget cut alternatives
ORONO, Maine (NEWS CENTER)-- While lawmakers debate budget cuts, residents are gathering to discuss how they can change the economy for the better. The Maine Alliance for the Common Good held a teach-in at the University of Maine Sunday. Attendees heard about alternatives to budget cuts and the problems they think need to be addressed. The message was simple, the road to changing our economy starts with the citizens.
Keynote speaker Doctor Margaret Flowers with It's Our Economy said, "Society tries to disempower people and tell them they cant create change and it's exactly the opposite. It's not about electing people to make change it's about we are the ones that could make that happen."
Local organizations and activists met to share
what they feel are the state's biggest issues and how they can band together and make a change.
what they feel are the state's biggest issues and how they can band together and make a change.
(Be sure to click on the video link in this article-SPC)
Waistlines expand in emerging markets as fast food takes hold
Posted April 08, 2013, at 10:27 a.m.
CHICAGO — Fast food and expanding waistlines are not just an American health concern.
Even as McDonald’s, Yum Brands and Domino’s Pizza work to placate anti-obesity advocates at home, they’re taking high-calorie offerings to other parts of the globe and hooking a new generation in emerging markets. Their target customers, often part of a rising middle class with a more sedentary lifestyle, are in turn putting on the pounds.
Eating less home cooking, and consuming more processed snacks and sugary drinks, the average man is gaining weight in Mexico, Brazil and Chile faster than the worldwide average, according to the Waistline Index compiled by Bloomberg. The women are too, except in Brazil, where they are holding to the global average. In all three countries, fast food is a relatively new option.
The foreign influx is in some ways similar to the one 300 years ago, when the conquistadors brought smallpox and measles to native civilizations in Central and South America, said Tim Lobstein, director of policy and programs at the International Association for the Study of Obesity in London.
“The parallel now is the big transnational corporations also setting foot in these remote areas and bringing non- communicable diseases,” such as obesity, diabetes and heart disease, Lobstein said in an interview.
Increases in these diseases, the rising cost of medical care and worries about childhood obesity may force the food companies to change some practices abroad and push them into new markets to achieve their desired growth. Already, legislators in Brazil are considering restrictions on marketing by fast-food companies.
Men in Mexico gained an average of more than 15 pounds from the opening of the first U.S. fast-food outlet in 1985 through 2010, while the nation’s women added more than 19 pounds, according to the research conducted by Bloomberg. In Chile, men have gained 14 pounds on average since the first American chain opened in 1989, while women’s weight has increased 18 pounds.
Those figures top the global average. Around the world, men gained about 11 pounds in the 30 years through 2010 and women about 10 pounds, according to the data.
Health problems related to changes in diet and lifestyle have been well documented. Death rates in Brazil and Mexico from cardiovascular disease and diabetes surpassed those in the U.S. in 2008, the most recent data available from the World Health Organization. Chile trails those two with a death rate from the diseases close to that of the U.S.
The diseases are also affecting Asian nations, though obesity rates are lower there. In China, where Yum has more than 5,200 locations, the rate of diabetes will surpass that of the United States by 2030, according to the International Diabetes Federation in Brussels. KFC, which sells a fried sausage burger and popcorn chicken in China, is expanding to smaller cities in the Asian nation.
“The science clearly links eating out with obesity,” said Margo Wootan, nutrition policy director at the Center for Science in the Public Interest, a Washington-based advocacy group. “Restaurants need to realize that eating out is a big part of people’s diets and they have an important role to play.”
Worries mount about enrolling consumers in federally-run insurance exchanges
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Posted April 08, 2013, at 9:22 a.m.
When President Lyndon B. Johnson wanted to enroll seniors for the new Medicare program he had just signed into law, the story goes that his administration sent out workers on dog sleds to reach people in the remote Alaskan tundra.
“The Forest Service even had rangers looking for hermits in the woods,” recalled the late Robert Ball, Johnson’s Social Security commissioner, in a documentary on Medicare’s 40th anniversary.
The plan to insure as many as 27 million Americans under the federal health law beginning this fall will be the biggest expansion of health coverage since that launch. Millions will be eligible to shop for insurance in the new online marketplaces, which open for enrollment Oct. 1 with the coverage taking effect Jan. 1.
But six months before the process begins, questions are mounting about the scope and adequacy of efforts to reach out to consumers – especially in the 33 states that defaulted to the federal government to run their marketplaces, also called exchanges. The Obama administration has said little about outreach plans for those states, and neither the money nor the strategy is apparent.
“I’m getting very worried,” says Stan Dorn, a senior fellow at the nonpartisan Urban Institute, who studies outreach and enrollment for health programs. “Most health coverage expansions have not reached their target populations very quickly.”
‘A Pittance’
Ron Pollack, executive director of the advocacy group Families USA, and an administration ally, says he is hearing that as little as $40 million to $50 million in federal grants may be available to hire nonprofit groups to work directly with consumers in the states with federally-run marketplaces – a number the administration declined to confirm.
“That’s a pittance compared to what’s needed to make the application process work,” Pollack says. “It doesn’t even scratch the surface” — even in tandem with privately funded efforts.
That pot of money will cover grants to hire people to help consumers in 33 states with federally-run exchanges, including Texas and Florida, which have some of the nation’s highest uninsured rates. Just for comparison, California has budgeted more than $50 million for ‘in person’ help for consumers this year and next, and another $200 million for outreach and education.
Officials at The Centers for Medicare & Medicaid Services declined requests to discuss their outreach budget or strategy in the marketplaces run by the federal government. In a written statement, the agency says it is “coordinating with federal agencies, states and external partners to educate consumers and motivate them to enroll.”
Enrolling people under a law that few know anything about was always going to be challenging. Three years after the law’s passage, polls show widespread ignorance about its provisions.
“It’s not hard to get sick people to sign up for health insurance,” says Bob Laszewski, a Virginia-based consultant and former insurance executive. “But it’s really hard to get healthy people to sign up. If we don’t get a healthy cross-section, the financial structure of the [Affordable Care Act] unravels,” and premiums will skyrocket.
Red meat’s fat and cholesterol aren’t the only dangers for heart health
Posted April 08, 2013, at 11:59 a.m.
The fat and cholesterol found in a steak may not be the only components bad for the heart, according to researchers who have found another substance in red meat that can clog the arteries.
The substance is called carnitine, and as bacteria in the gut breaks it down, it turns into a compound known to harden arteries, according to a study published Sunday in the journal Nature Medicine. What’s more, people who eat a lot of meat allow more of the bacteria that converts carnitine to the harmful compound to grow, increasing its effect.
Previous research has shown that high levels of meat-eating are linked to cardiovascular risk, due in part to the saturated fats and cholesterol in meat. However, the higher levels of these ingredients aren’t enough to explain the difference in heart disease between meat eaters and vegans or vegetarians. This study, which takes into account the differences in the stomach’s inhabitants, may begin to explain the difference.
“The bacteria living in our digestive tracts are dictated by our long-term dietary patterns,” said study author Stanley Hazen, the section head of Preventive Cardiology and Rehabilitation at Cleveland Clinic, in a statement. “A diet high in carnitine actually shifts our gut microbe composition to those that like carnitine, making meat eaters even more susceptible.”
The study followed 2,595 people and measured carnitine levels, as well as those of its byproduct, TMAO. Omnivores produced more TMAO than vegetarians and vegans after eating carnitine, the researchers found.
Although carnitine is also found in fish, poultry, wheat and some vegetables, its main food source is red meat, especially lamb, according to the University of Maryland. Because vegetarians and vegans eat fewer foods that contain it, their gut bacteria doesn’t process it as easily, which may explain some of the health benefits of meatless diets.
After feeding mice diets that would produce high levels of TMAO, researchers found that animals had higher levels of hardened arteries. However, if the researchers suppressed the bacteria living in the mouse’s guts, the effects dissipated.
Angus King answers BDN and reader questions, from guns to his mustache
Check out the second video link in this article to get Angus' views about health care.
=SPC
'Bitter Pill' misses the target on solutions to the U.S. medical crisis
Brill glosses over the real solution to the cost of medical bills: a single-payer system which forces hospitals to be more efficient
By Jack Bernard
Time magazine, Letters, Feb. 23, 2013
Time magazine, Letters, Feb. 23, 2013
As someone who has worked on all sides of the health care field (regulator, non-profit, for-profit) for 30 years, I was intrigued by the Steven Brill piece, “Bitter Pill: Why Medical Bills Are Killing Us.” On the analysis of the problem, Brill was mainly on target, but he missed the mark on most of his proposed solutions.
For example, hospital competition is not the answer to getting lower prices and never has been. For instance, coordination of services among hospitals within a region is a far more cost-effective way to minimize duplicative purchases of expensive technology. Furthermore, group purchases of supplies, pharmaceuticals and capital equipment by large hospital systems has been shown to drive down vendor prices by up to 20 percent versus pricing given to small independent hospitals.
Brill glosses over the real solution to the cost of medical bills: a single-payer system which forces hospitals to be more efficient. Medicare For All, incorporating quality measures, would eliminate all the “chargemaster” game-playing. The inefficient providers would be paid the same as the effective ones. With higher costs, they would be driven out. Likewise for the ones with poor quality. Plus, the 20+ percent administrative marketing costs currently charged by private insurance companies — versus just 3 percent with Medicare — could be put back into direct care where it belongs.
Jack Bernard resides in Monticello, Ga.
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