Broad Skepticism on Health Care Law
With the approach of the new year, when health insurance policies under President Obama’s new health care law are set to begin, there is wide skepticism among both the insured and uninsured about how the law will affect them and the nation as a whole, according to a New York Times/CBS News poll.
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The poll found that just one-third of uninsured Americans expect the law, the Affordable Care Act, to improve the nation’s health care system, while the same proportion think the law will help them personally, according to the poll.
Overall, there is no consensus among uninsured Americans on how the health care system will fare once the law takes effect. While one-third expect improvement, two-thirds anticipate either a worsening or no difference at all.
“It will hurt everybody in the long run,” said Cat Ping, 55, of Indianapolis in a follow-up interview. Ms. Ping, who does not have insurance, added: “I don’t care how they spin it, Obamacare is not affordable. It’s wrecking our total economy.”
On the whole, uninsured Americans expect to be personally affected by the Affordable Care Act more so than all adults nationwide. Among all adults, nearly half think the law will not affect them at all, while among uninsured adults, just over one-quarter say that. And while a nearly 4 in 10 plurality of uninsured Americans think the health care law will hurt them personally, they are twice as likely as the general public to say the law will help them.
- The poll found that just one-third of uninsured Americans expect the law, the Affordable Care Act, to improve the nation’s health care system, while the same proportion think the law will help them personally, according to the poll.Overall, there is no consensus among uninsured Americans on how the health care system will fare once the law takes effect. While one-third expect improvement, two-thirds anticipate either a worsening or no difference at all.“It will hurt everybody in the long run,” said Cat Ping, 55, of Indianapolis in a follow-up interview. Ms. Ping, who does not have insurance, added: “I don’t care how they spin it, Obamacare is not affordable. It’s wrecking our total economy.”On the whole, uninsured Americans expect to be personally affected by the Affordable Care Act more so than all adults nationwide. Among all adults, nearly half think the law will not affect them at all, while among uninsured adults, just over one-quarter say that. And while a nearly 4 in 10 plurality of uninsured Americans think the health care law will hurt them personally, they are twice as likely as the general public to say the law will help them.
A Disability, and a Mother’s Embrace
By SUSANNAH MEADOWS
Rachel Adams is an Upper West Side intellectual who gave birth to a boy with Down syndrome six years ago. In this era of advanced prenatal screening, the first question more than one friend asked her was: How could this have happened?
On the surface it seemed like an expression of concern. But what it meant was: How could this child have happened?
To Ms. Adams, the idea that her son’s very existence requires an explanation — that he is here because of some failure of medical science — is appalling. Her book is less a memoir about mothering a child with Down syndrome than it is her attempt to set people straight. The syndrome is a disability, as she makes clear, not an illness and certainly not a tragedy.
“Raising Henry” is an important, hopeful book for that reason alone, and it’s easy to be on Ms. Adams’s team. Sometimes, though, you wish she were a more effective captain.
A professor of English and American studies at Columbia, she seems most at home making an argument, drawing on research (especially her own), seeing connections. She observes that in the brainy circles in which she moves, everyone talks about diversity — but how much are differences really valued? “I wonder,” she writes, “whether my friends and colleagues would recognize the value of a child who was slower, less capable and more dependent.”
And while she makes many good points, she leaves her most compelling evidence, her case-closer, largely out of the picture: Henry himself. She writes that her son is separate from his diagnosis, but barely offers a sense of who he is.
One quick glimpse comes midway through the book, when she writes that no genetic test would have told her about the essence of Henry: “I couldn’t have known about his great sense of humor or the sound of his infectious laugh. Or the smell of his hair. The delight he gets from singing along with music or pouring bathwater from one cup to another. His weight on my lap when we’re reading a book together.”
That’s the stuff. Too bad there is so little of it. Comparisons with the vivid characters who populate the 2012 book “Far From the Tree,” Andrew Solomon’s magnificent study of disability and identity differences, are hard to avoid. People like the autistic child who tells his mother “I love you” shortly before she dies, or the woman who starts her own school to meet her deaf son’s needs, make Mr. Solomon’s weighty volume, implausibly, a page-turner.
Glaxo Says It Will Stop Paying Doctors to Promote Drugs
By KATIE THOMAS
The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest.
The announcement appears to be a first for a major drug company — although others may be considering similar moves — and it comes at a particularly sensitive time for Glaxo. It is the subject of a bribery investigation in China, where authorities contend the company funneled illegal payments to doctors and government officials in an effort to lift drug sales.
Andrew Witty, Glaxo’s chief executive, said in a telephone interview Monday that its proposed changes were unrelated to the investigation in China, and were part of a yearslong effort “to try and make sure we stay in step with how the world is changing,” he said. “We keep asking ourselves, are there different ways, more effective ways of operating than perhaps the ways we as an industry have been operating over the last 30, 40 years?”
For decades, pharmaceutical companies have paid doctors to speak on their behalf at conferences and other meetings of medical professionals, on the assumption that the doctors are most likely to value the advice of trusted peers.
But the practice has also been criticized by those who question whether it unduly influences the information doctors give each other and can lead them to prescribe drugs inappropriately to patients. All such payments by pharmaceutical companies are to be made public next year under requirements of the Obama administration’s health care law.
Under the plan, which Glaxo said would be completed worldwide by 2016, the company will no longer pay health care professionals to speak on its behalf about its products or the diseases they treat “to audiences who can prescribe or influence prescribing,” it said in a statement. It will also stop providing financial support directly to doctors to attend medical conferences, a practice that is prohibited in the United States through an industry-imposed ethics code but that still occurs in other countries. In China, the authorities have said Glaxo compensated doctors for travel to conferences and lectures that never took place.
Mr. Witty declined to comment on the investigation because he said it was still underway.
http://www.nytimes.com/2013/12/17/business/glaxo-says-it-will-stop-paying-doctors-to-promote-drugs.html?pagewanted=2&hp&pagewanted=print
Fewer deals for doctors to market drugs, but more trust
People in Maine’s medical industry are pleased that a major pharmaceutical company will stop paying physicians to push its brands.
WASHINGTON — Representatives of Maine’s medical industry welcomed news this week that one of the largest pharmaceutical companies will stop paying doctors to promote its brand drugs to other physicians.
“I think it is another indication that times are changing and that these relationships will be kept at arm’s length, as they should be,” said Gordon Smith, executive director of the Maine Medical Association.
On Monday, the pharmaceutical giant GlaxoSmithKline announced plans to stop paying doctors to deliver speeches to other physicians on behalf of the company’s prescription drugs. The company, which makes such big-name drugs as Advair, Flonase and Zantac, plans to halt the practice by 2016.
“We recognize that we have an important role to play in providing doctors with information about our medicines, but this must be done clearly, transparently and without any perception of conflict of interest,” Sir Andrew Witty, CEO of GlaxoSmithKline, said in a prepared statement.
The company is the first major drug manufacturer to take such a step, although the industry as a whole has scaled back its use of doctors to promote specific drugs as scrutiny of drug industry-doctor relationships has increased. Broad, mandatory disclosure rules are set to take effect next year as part of the Affordable Care Act.
“I think the announcement is part of a longer-term change in drug industry marketing,” said Dr. Daniel Carlat, director of The Pew Charitable Trusts’ prescription project, which examines transparency and conflict-of-interest issues in the industry.
“What we have been seeing is, companies are re-evaluating how they are spending their marketing dollars and they have become very sensitive to (concerns) about paying doctors to give lectures to other doctors,” Carlat said. “So the drug companies have been getting a lot of push-back.”
A Gap in the Affordable Care Act
By CATHERINE SAINT LOUIS
The Affordable Care Act mandated that insurers cover dental care for children. Indeed, it was one of the 10 essential health benefits meant to set the bar for adequatehealth insurance.
But pediatric dental care is handled differently from coverage of other essential benefits on federal and state exchanges. These plans are often sold separately from medical insurance, and dental coverage for children is optional. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it.
Now experts are warning that the flawed implementation of this benefit on the exchanges could leave millions of children without access to dental care.
“It’s letting kids down in my mind, and it is clearly inconsistent with congressional intent,” said Dr. Paul Reggiardo, the chair of the American Academy of Pediatric Dentistry’s Council on Dental Benefit Programs. “The intent was to include all children. Now it only includes some.”
Tooth decay is the most common chronic childhood disease. Fourteen percent of children age 6 to 19 have untreated cavities, which can cause pain and, in rare cases, death. But the percentage of uninsured children who see a dentist annually declined to 25.2 percent in 2011 from 31.5 percent in 2003, according to the American Dental Association.
Had pediatric dental insurance remained a mandatory purchase on the new insurance exchanges, as originally envisioned, roughly three million children would have gained coverage this way by 2018, according to an analysis by the dental association. Pediatric dental coverage “has gone from a guarantee to a quote-unquote guarantee,” said Andrew Snyder, a program manager at the National Academy for State Health Policy.
On the state and federal exchanges, children’s dental coverage generally comes in two forms. It may be “embedded” in medical insurance plans or sold separately in “stand-alone” plans.
Both options are not available on every exchange, though they often coexist. State exchanges in New York and Massachusetts, and most of those run by the federal government, offer a choice of health plans with or without embedded pediatric dental benefits and stand-alone dental plans.
Generally, it is the stand-alone dental plans that worry policy experts and deter consumers on the exchanges.
Should We Toss Our Vitamin Pills?
By RONI CARYN RABIN
One in two adults takes a daily vitamin pill, and Americans spend tens of billions of dollars each year on supplements. Now, a small coterie of physicians writing in a leading medical journal has offered this blunt advice: “Stop wasting money.”
In an unusually direct opinion piece, the five authors say that for healthy Americans worried about chronic disease, there’s no clear benefit to taking vitamin and mineral pills. And in some instances, they may even cause harm.
The authors make an exception for supplemental vitamin D, which they say needs further research. Even so, widespread use of vitamin D pills “is not based on solid evidence that benefits outweigh harms,” the authors wrote. For other vitamins and supplements, “the case is closed.”
“The message is simple,” the editorial continued. “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”
“We have so much information from so many studies,” Dr. Cynthia Mulrow, senior deputy editor of Annals of Internal Medicine and an author of the editorial, said in an interview. “We don’t need a lot more evidence to put this to bed.”
Officials with the Natural Products Association, a trade organization that represents supplement suppliers and retailers, said they were shocked by what they termed “an attack” on their industry, pointing to a study published last year that found a modest reduction in overall cancers in a long, randomized, controlled trial of 15,000 male doctors.
“Our members market and sell their products in order to assist people to achieve a healthier lifestyle,” said John Shaw, executive director of the association, adding that he could not understand why the industry was being criticized “for trying to promote health and wellness.”
Demand for vitamin and mineral supplements has grown markedly in recent years, with domestic sales totaling some $30 billion in 2011. More than half of Americans used at least one dietary supplement from 2003-06, up from 42 percent from 1988-94, according to national health surveys conducted by the Centers for Disease Control and Prevention. The most popular products are multivitamin and mineral supplements, which are consumed by some 40 percent of men and women in the United States, according to data from the National Health and Nutrition Examination Survey.
Auto bailout could be harbinger for Obamacare
By Dana Milbank,
When will the criticism of Obamacare finally end?
I’ve done some research on the question, and by my calculations, judging from current trends, this will happen approximately . . . never.
I base this on the criticism of the auto bailout of early 2009. Almost five years later, the industry is healthy again and large swaths of the Midwest have been spared what would have been certain economic devastation. All this was achieved for a relatively modest sum: When the government’s last shares of General Motors were sold last week, the total cost to save GM and Chrysler came to about $12 billion. It would seem that the argument against the bailout has been settled. Yet opponents continue to argue their case — if anybody will listen.
On Monday, I resolved to listen. I went to the National Press Club, where the National Legal and Policy Center, a conservative group, was arguing that the GM bailout was a big mistake. When I arrived two minutes before the start of the news conference, I was the only reporter in the room; eventually, two others joined me.
Peter Flaherty, the group’s president, stared into a lone camera. “At its most fundamental level, the auto bailout is a failure,” he proclaimed. “There’s only been a modest culture change” at GM, he said, and “the bailout did not save jobs.” What’s more, he said, GM’s reorganization “was government-orchestrated theft.”
When Flaherty finished speaking, he asked for questions. Nobody stirred. Feeling pity, I asked if he really thought the auto bailout had no impact on U.S. employment.
“Yes,” he replied.
And the Troubled Assets Relief Program — which the auto bailout was part of — that returned a profit to taxpayers of $11 billion overall?
“I think it was a mistake,” he said.
Flaherty was offering a pre-buttal to GM’s chief executive, Dan Akerson, who spoke at the press club two hours later. Unlike Flaherty, Akerson had some concrete evidence to show why the bailout had been worth the cost: a $21.3 billion initial public offering for GM, 15 profitable quarters and total profits of nearly $30 billion, $10 billion invested in U.S. facilities (including $1.3 billion announced Monday), a return to an investment-grade rating for its bonds, and 26,000 jobs preserved.
Akerson — who is soon to be replaced by Mary Barra, GM’s chief of product development and the first woman to run a major industrial company — was a private-equity guy who joined the company after the bailout. But asked his opinion of the bailout decision, he cited a study by the Center for Automotive Research that concluded that overall it saved the government $36 billion to $38 billion in costs such as unemployment benefits, and that didn’t include $26 billion in pension liabilities that would have been dumped on taxpayers.
“The automotive industry in this country is somewhere between 3.5 and 4 percent of total GDP,” he said. “To have ceded that to foreign competition — in my opinion, as an American — would have been a serious mistake.”
The study Akerson cited calculated that the bailout saved 1.2 million to 2.6 million jobs in 2009 alone. But the National Legal and Policy Center’s Flaherty offered a breezy dismissal of that report: “Not surprising, in light of the fact that the center is substantially funded by the government.” (The Center for Automotive Research reports that 16 percent of its money comes from the government.)
Few people have heard of Flaherty or are likely to care what he thinks of the bailout. But his undiminished opposition to it, a position many conservatives share, is worth examining because there is apparently no pattern of facts that would change it. This, I suspect, is what Obamacare is up against.
U.S. ranks near bottom among industrialized nations in efficiency of health care spending
UCLA, McGill study also shows women fare worse than men in most countries.
A new study by researchers at the UCLA Fielding School of Public Health and McGill University in Montreal reveals that the United States health care system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives.
The study, which appears online Dec. 12 in the "First Look" section of theAmerican Journal of Public Health, illuminates stark differences in countries' efficiency of spending on health care, and the U.S.'s inferior ranking reflects a high price paid and a low return on investment.
For example, every additional hundred dollars spent on health care by the United States translated into a gain of less than half a month of life expectancy. In Germany, every additional hundred dollars spent translated into more than four months of increased life expectancy.
The researchers also discovered significant gender disparities within countries.
"Out of the 27 high-income nations we studied, the United States ranks 25th when it comes to reducing women's deaths," said Dr. Jody Heymann, senior author of the study and dean of the UCLA Fielding School of Public Health. "The country's efficiency of investments in reducing men's deaths is only slightly better, ranking 18th."
The study, which utilized data from 27 member countries of the Organization for Economic Cooperation and Development collected over 17 years (1991–2007), is the first-known research to estimate health-spending efficiency by gender across industrialized nations.
Who are the new uninsureds?
By Michael Hiltzik
3:45 PM PST, December 17, 2013
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It was always the case that the nation's medically uninsured were disproportionately non-white, poor and southern. These people were the prime targets of the Affordable Care Act, which aimed to bring them coverage in part by the federally-funded expansion of Medicaid.
Two surveys released Tuesday by the Kaiser Family Foundation show how the demographics of the uninsured will change, thanks to the ACA. More precisely, the surveys show how they will change as a result of inaction -- the failure of 25 states to expand Medicaid, which the ACA's drafters expected to address the coverage problems of the poor. One study examines the overall characteristics of the new uninsured, and the other focuses on their racial and ethnic backgrounds.
The short version is this: henceforth, America's uninsured population will be composed even more disproportionately of minorities, the poor and residents of the South.
What sticks out in these studies is that disdain for the problems of the medically uninsured is a continuum: the states whose policies or whose indifference have contributed to high levels of uninsured residents up to now are generally the states doing the least to improve their lot.
A few states plainly have taken the matter in hand. California, for instance, which historically has had a high percentage of uninsured residents (21% in 2012, ranking eighth), also has moved aggressively to take advantage of the provisions of the ACA. The states that have thus far scorned Medicaid expansion also tend to be those with the tightest Medicaid restrictions -- their average income eligiblity mark, measuring how poor you have to be to qualify for the program, is only 47% of the federal poverty line.
The South is the hotbed of resistance to Medicaid expansion: among the 14 states usually defined as the South, only Arkansas, Kentucky and West Virginia are expanding the program. That's despite the generosity of the federal government, which will cover 100% of the cost of the expansion for its first three years, and more than 90% through 2022.
That's unfortunate, because the region also has an especially large concentration of uninsured residents. Of the 17 states with percentages of uninsureds equal to or worse than the national average (18% in 2012), nine are southern states.
Consequently, the Medicaid "coverage gap" is largely a phenomenon of the South. The "gap" refers to the population segment earning less than 100% of the federal poverty line and more than their state's Medicaid eligibility ceiling. (Under the ACA, people earning more than the poverty line and not covered by the Medicaid expansion are eligible for federally-subsidized insurance premiums.) Of the more than 4.8 million Americans falling into the gap, 3.6 million live in the 11 southern states not expanding Medicaid.
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It was always the case that the nation's medically uninsured were disproportionately non-white, poor and southern. These people were the prime targets of the Affordable Care Act, which aimed to bring them coverage in part by the federally-funded expansion of Medicaid.
Two surveys released Tuesday by the Kaiser Family Foundation show how the demographics of the uninsured will change, thanks to the ACA. More precisely, the surveys show how they will change as a result of inaction -- the failure of 25 states to expand Medicaid, which the ACA's drafters expected to address the coverage problems of the poor. One study examines the overall characteristics of the new uninsured, and the other focuses on their racial and ethnic backgrounds.
The short version is this: henceforth, America's uninsured population will be composed even more disproportionately of minorities, the poor and residents of the South.
What sticks out in these studies is that disdain for the problems of the medically uninsured is a continuum: the states whose policies or whose indifference have contributed to high levels of uninsured residents up to now are generally the states doing the least to improve their lot.
A few states plainly have taken the matter in hand. California, for instance, which historically has had a high percentage of uninsured residents (21% in 2012, ranking eighth), also has moved aggressively to take advantage of the provisions of the ACA. The states that have thus far scorned Medicaid expansion also tend to be those with the tightest Medicaid restrictions -- their average income eligiblity mark, measuring how poor you have to be to qualify for the program, is only 47% of the federal poverty line.
The South is the hotbed of resistance to Medicaid expansion: among the 14 states usually defined as the South, only Arkansas, Kentucky and West Virginia are expanding the program. That's despite the generosity of the federal government, which will cover 100% of the cost of the expansion for its first three years, and more than 90% through 2022.
That's unfortunate, because the region also has an especially large concentration of uninsured residents. Of the 17 states with percentages of uninsureds equal to or worse than the national average (18% in 2012), nine are southern states.
Consequently, the Medicaid "coverage gap" is largely a phenomenon of the South. The "gap" refers to the population segment earning less than 100% of the federal poverty line and more than their state's Medicaid eligibility ceiling. (Under the ACA, people earning more than the poverty line and not covered by the Medicaid expansion are eligible for federally-subsidized insurance premiums.) Of the more than 4.8 million Americans falling into the gap, 3.6 million live in the 11 southern states not expanding Medicaid.
As food labels get closer look, ingredients vanish
Food and beverage companies understand that ingredients can become a liability once they fall out of favor with the public. Case in point: high-fructose corn syrup.
By Candice Choi
The Associated Press
NEW YORK — Take another look at that food label. An ingredient or two may have vanished.
As Americans pay closer attention to what they eat, food and beverage companies are learning that unfamiliar ingredients can invite criticism from online petitions and bloggers. The risk of damaging publicity has proven serious enough that some manufacturers have reformulated top-selling products to remove mysterious, unpronounceable components that could draw suspicion.
Earlier this year, for example, PepsiCo Inc. said it would stop using brominated vegetable oil in Gatorade and find a another way to evenly distribute color in the sports drink. Last year, Starbucks said it would stop using a red dye made of crushed bugs based on comments it received “through a variety of means,” including an online petition, and switch to a tomato-based extract. Kraft Foods plans to replace artificial dyes with colors derived from natural spices in select varieties of its macaroni and cheese, a nod to the feedback it’s hearing from parents.
Ali Dibadj, a Bernstein analyst who covers the packaged food and beverage industry, says the changes reflect a shift from “democratization to activism” by consumers.
Here are some recent examples of companies removing ingredients from products after complaints:
— Starbucks last year removed cochineal extract, a red dye made from crushed bugs, from its food and drinks after an online petition. The company says the decision was the result of customer feedback it received through "a variety of means."
— Earlier this year, PepsiCo removed brominated vegetable oil from Gatorade. An online petition had noted the ingredient's link to flame retardants. PepsiCo said the decision was the result of broader customer feedback.
— Kraft Foods says it will reformulate select varieties of its macaroni and cheese next year to use natural colors. A petition by a popular food blogger had asked the company to remove the artificial dyes. Kraft says the reformulation is a part of an ongoing push to improve the overall nutrition of its products.
— Chick-fil-A has been removing artificial dyes and high-fructose corn syrup from dressings and sauces. The company says people are becoming more aware of ingredients and that it expects to continue making change.
The Associated Press
FDA warns attention deficit drugs may cause prolonged erections
Posted Dec. 17, 2013, at 4:27 p.m.
A leading type of stimulant used to treat attention deficit disorder can cause rare cases of painful and long-lasting erections, the U.S. Food and Drug Administration warned on Tuesday.
The agency, in a notice on its website, said its review documented the problem, formally known as priapism, in males 8 to 33 years of age who took drugs containing methylphenidate. The chemical is the active ingredient of Novartis AG’s Ritalin and Johnson & Johnson’s Concerta. Generic forms of both drugs are also widely used.
Drug labels of such products will be updated to warn of the potential but rare danger, the FDA said.
“Younger males, especially those that have not yet reached puberty, may not recognize the problem or may be embarrassed to tell anyone if it occurs,” the FDA said.
The agency said patients developing erections lasting more than four hours should seek immediate medical attention to prevent permanent damage to the penis.
A non-stimulant drug also used to treat attention deficit hyperactivity disorder, Eli Lilly and Co’s Strattera, has also been linked to priapism in young children, teenagers and adults. Strattera, whose chemical name is atomoxetine, appears to pose a greater risk than methylphenidate products, the FDA said.
“Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine” products, the agency said.
Posted Dec. 17, 2013, at 4:27 p.m.
A leading type of stimulant used to treat attention deficit disorder can cause rare cases of painful and long-lasting erections, the U.S. Food and Drug Administration warned on Tuesday.
The agency, in a notice on its website, said its review documented the problem, formally known as priapism, in males 8 to 33 years of age who took drugs containing methylphenidate. The chemical is the active ingredient of Novartis AG’s Ritalin and Johnson & Johnson’s Concerta. Generic forms of both drugs are also widely used.
Drug labels of such products will be updated to warn of the potential but rare danger, the FDA said.
“Younger males, especially those that have not yet reached puberty, may not recognize the problem or may be embarrassed to tell anyone if it occurs,” the FDA said.
The agency said patients developing erections lasting more than four hours should seek immediate medical attention to prevent permanent damage to the penis.
A non-stimulant drug also used to treat attention deficit hyperactivity disorder, Eli Lilly and Co’s Strattera, has also been linked to priapism in young children, teenagers and adults. Strattera, whose chemical name is atomoxetine, appears to pose a greater risk than methylphenidate products, the FDA said.
“Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine” products, the agency said.
Free Portland clinic staves off closure, for now
Posted Dec. 17, 2013, at 1:23 p.m.
PORTLAND, Maine — One year after nearly being forced to close, the Portland Community Free Clinic is no longer on life support, but remains in serious condition.
The clinic, at 103 India St., provides no-cost medical care to more than 500 Cumberland County residents who can’t afford health insurance, but earn too much to qualify for Medicaid or other low-income health-care benefit programs.
With only a few employees, the clinic is staffed by 100 volunteer physicians, nurses, receptionists and others. But since its creation 20 years ago, it has also depended on external funding.
The clinic faced possible closure in December 2012 after losing financial support from Mercy Hospital and the city.
Mercy, which had been suffering financial difficulties of its own, stopped its annual contribution of about $200,000 in 2011. Emergency funding from the city dried up a year later.
Then, after a series of news reports, the Emanuel & Pauline A. Lerner Foundation pledged a challenge grant of $25,000 to keep the clinic open. In less than a month, a variety of gifts from charitable groups and individuals had brought the clinic more than $93,000, enough to remain in operation through this year.
Now the clinic’s prognosis has improved, slightly.
“I am confident that we can make our payroll and expectations until the first of July,” clinical programs director Dr. Caroline Teschke said last week.
Since last year’s crisis, Teschke said, the clinic has had “modest” success obtaining support through additional grants, individual donations, and fundraising events such as a holiday concert last Saturday at St. Ansgar Lutheran Church, in the Rosemont neighborhood. A charitable auction is planned for next March.
The clinic also continues to receive in-kind aid from the city, which provides office space and insurance coverage, and from Mercy, which helps out with free laboratory services.
In addition, the clinic has applied to become an independent nonprofit organization, a status that would provide tax and legal benefits. After receiving free help with the application process from Portland law firm Verrill Dana, Teschke said she expects to receive approval from the federal government sometime next year.
But meanwhile, the need for the clinic’s care “is in no way diminished,” she said. In fact, it may be increasing.
Unlike other public health clinics in the city, the Free Clinic specializes in caring for the working poor, a population that is overlooked amid the much-publicized debate over the federal Affordable Care Act, also known as “Obamacare.”
The ACA was touted as reducing the number of Americans without health coverage by expanding eligibility for Medicaid, and providing subsidies to help those who were ineligible to buy insurance through state-run health exchanges.
But the act doesn’t help many people in the middle: those who are ineligible for Medicaid, but for whom the subsidies aren’t enough. In Maine, this gap in coverage is compounded by the state’s refusal to participate in the optional expanded Medicaid coverage
You're Getting Too Much Healthcare
Extraneous tests and referrals increasingly set back the U.S. medical system, and our health. How to avoid unnecessary care.
Extraneous tests and referrals increasingly set back the U.S. medical system, and our health. How to avoid unnecessary care.
For people who had been awaiting the rollout of the Affordable Care Act in order to obtain health insurance for the first time, the major problem associated with American healthcare has been a lack of access to it. But for a surprising number of Americans, the greater problem may be exactly the opposite: They are receiving too much healthcare. And that’s not good news for either their wallets or their physical well-being.
The most recent estimate from the Institute of Medicine is that about 30 percent of total healthcare expenditures in America go toward unneeded care. Doctors, too, have acknowledged the problem: In a 2011 survey published in theArchives of Internal Medicine, 42 percent of American primary care physicianssaid that patients in their own practice were getting more care than necessary.
Are Nuts a Weight-Loss Aid?
For people who had been awaiting the rollout of the Affordable Care Act in order to obtain health insurance for the first time, the major problem associated with American healthcare has been a lack of access to it. But for a surprising number of Americans, the greater problem may be exactly the opposite: They are receiving too much healthcare. And that’s not good news for either their wallets or their physical well-being.
The most recent estimate from the Institute of Medicine is that about 30 percent of total healthcare expenditures in America go toward unneeded care. Doctors, too, have acknowledged the problem: In a 2011 survey published in theArchives of Internal Medicine, 42 percent of American primary care physicianssaid that patients in their own practice were getting more care than necessary.
Are Nuts a Weight-Loss Aid?
By MICHAEL MOSS
The following article is excellent. Health care is included in the general category "integrated social welfare system", but the point is made about universality as the basis for "social solidarity", a relationship that did not escape Otto Von Bismarck when he created the German state in the 19th century.
Is it reasonable to strive for that in the US? Who knows?
- SPC
WEST LAFAYETTE, Ind. — “Here are the nuts,” said Drew Sayer, a graduate student in nutrition science, before shoving me into the M.R.I. machine, flat on my back. “Chew them. Swallow them. And don’t move your head.”
I moved my head, which blurred the resulting images. But if all goes well in the coming weeks, researchers here at Purdue University will have stacks of brain scans with crystal-clear views inside the minds of their test subjects — while they were eating nuts. These images could help answer a timely question: Do nuts really merit the hype they’ve been getting as a guilt-free indulgence?
The reports about their many benefits have come thick and fast: studies finding that people who eat nuts (tree nuts like cashews, almonds and pistachios, along with their legume pal, the peanut) live longer and healthier lives, with less risk of chronic ailments like heart disease, respiratory problems and Type 2 diabetes.
But perhaps the most startling news is that nuts may help in maintaining a healthy weight. Research has found that people can snack on modest amounts of them without gaining pounds, and that nuts can even help in slimming down.
This dieting power is particularly hard to fathom when you consider that nuts pack 160 to 200 calories in each tiny ounce, not even a handful. And most of those calories come from fat. Ounce for ounce, cashews and pecans and walnuts are loaded with more calories than many of the processed foods being blamed for the surge in obesity. In the conventional wisdom, a dieter’s best friends are watery foods like celery and carrot sticks.
One of the country’s leading nutrition scientists, Richard Mattes of Purdue, has been exploring this seeming paradox and has some intriguing, if still uncertain, findings.
His current work on nuts is being funded by a marketing group, the Almond Board of California, which would normally raise concerns about bias. But Dr. Mattes has a record of biting the hands that feed science, and challenging presumptions about nutrition.
At a Philadelphia research center that gets some of its operating money from processed-food companies, he published a paper in 1991 showing that that industry, not the salt shakers on dinner tables, was largely responsible for the country’s vast consumption of sodium. He also helped establish that people are less able to detect calories in soda and other drinks than in solid foods, and so are less apt to put the brakes on overconsumption.
Nuts have several big things going for them, Dr. Mattes said. For starters, even a small amount can make you feel full. Scientists call this feeling satiety; it is a busy field in food research and marketing these days, given the way that snacking has become a sort of fourth meal, adding an estimated 580 calories to the average person’s daily consumption.
Why do nuts appease the appetite so well? Dr. Mattes pointed to several studies.
The following article is excellent. Health care is included in the general category "integrated social welfare system", but the point is made about universality as the basis for "social solidarity", a relationship that did not escape Otto Von Bismarck when he created the German state in the 19th century.
Is it reasonable to strive for that in the US? Who knows?
- SPC
Is the Safety Net Just Masking Tape?
By THOMAS B. EDSALL
“I don’t believe those two can exist without each other. Without a strong middle and working class you don’t have natural constituencies ready to fight and defend the implementation and maintenance of a safety net and public goods. The welfare state is one part, complimenting full employment, of empowering people and balancing power in a financial capitalist society.”
In practice, Konczal writes, the political left has abandoned its quest for deep structural reform — full employment and worker empowerment — and instead has “doubled-down” on the safety net strategy. The result, in his view, is “a kind of pity-charity liberal capitalism.”
Konczal’s poignant description of the problem goes a long way towards explaining the current struggles of the left. The question is whether there is an effective worker empowerment strategy at a time of globalization, off-shoring and robotization.
Insofar as Democrats concentrate the bulk of their efforts on means-tested transfer programs (on the extension of long-term unemployment benefits, Medicaid and food stamps, for example), they leave the most needy and vulnerable to the vagaries of public opinion.
Survey data find that during hard times people become less altruistic and more inclined to see the poor as undeserving. They turn to the right, not the left, in periods of economic stress.
This argument is made by Benjamin Friedman, an economist at Harvard, in his book, “The Moral Consequences of Economic Growth,” as well as in a number of related publications. In a 2006 speech, which was printed in the American Economist, Friedman argued that:
“When a society is experiencing rising standards of living, broadly distributed across the population at large, that is precisely the circumstance under which it is likely also to make progress along a variety of dimensions that Western thinking has, at least since the eighteenth century, regarded not only as positive but as positive in explicitly moral terms.”
.
More of the High Costs of Complexity in healthcare
reform.
-SPC
It’s easy for liberals to explain away setbacks to programs and policies that they favor — ranging from infrastructure investment to food stamps to increased education budgets — as the result of the intransigence of the Republican Party, with its die-hard commitment to slashing government spending on nearly every front.
But that explanation is too facile.
Two years ago, Mike Konczal, a fellow at the Roosevelt Institute, opened a productive line of inquiry in a blog post called “Are We at the Completion of the Liberal Project?”
Konczal described two approaches to the liberal state. In the first, “you would have the government maintaining full employment, empowering workers and giving them more bargaining power.” In the second, “you would have a safety net for those who fell through the cracks.”
These two approaches, according to Konczal, should not be looked at as an either-or proposition, but as mutually reinforcing and interdependent:
“I don’t believe those two can exist without each other. Without a strong middle and working class you don’t have natural constituencies ready to fight and defend the implementation and maintenance of a safety net and public goods. The welfare state is one part, complimenting full employment, of empowering people and balancing power in a financial capitalist society.”
In practice, Konczal writes, the political left has abandoned its quest for deep structural reform — full employment and worker empowerment — and instead has “doubled-down” on the safety net strategy. The result, in his view, is “a kind of pity-charity liberal capitalism.”
Konczal’s poignant description of the problem goes a long way towards explaining the current struggles of the left. The question is whether there is an effective worker empowerment strategy at a time of globalization, off-shoring and robotization.
Insofar as Democrats concentrate the bulk of their efforts on means-tested transfer programs (on the extension of long-term unemployment benefits, Medicaid and food stamps, for example), they leave the most needy and vulnerable to the vagaries of public opinion.
Survey data find that during hard times people become less altruistic and more inclined to see the poor as undeserving. They turn to the right, not the left, in periods of economic stress.
This argument is made by Benjamin Friedman, an economist at Harvard, in his book, “The Moral Consequences of Economic Growth,” as well as in a number of related publications. In a 2006 speech, which was printed in the American Economist, Friedman argued that:
“When a society is experiencing rising standards of living, broadly distributed across the population at large, that is precisely the circumstance under which it is likely also to make progress along a variety of dimensions that Western thinking has, at least since the eighteenth century, regarded not only as positive but as positive in explicitly moral terms.”
.
More of the High Costs of Complexity in healthcarereform.
-SPC
California's health exchange botched letters to 114,000 households
By Chad Terhune
7:00 AM PST, December 18, 2013
advertisement
Adding to consumer confusion ahead of a major enrollment deadline, California's health insurance exchange sent flawed eligibility notices to nearly 114,000 households due to a computer error.
The Covered California exchange said the letters sent from Nov. 22 to Dec. 7 had blank spaces or missing information on people's eligibility for insurance or federal premium subsidies.
"The letters would say you are eligible for Covered California, but you are ineligible for blank," said exchange spokeswoman Anne Gonzales. "It seemed to contradict whether the enrollee was eligible. It was confusing to people."
Ben Amante of Costa Mesa received one of the letters last weekend and said he couldn't understand what it meant for his insurance application for himself and his daughter.
"One short paragraph said you're qualified and the next one says you're not qualified," Amante said. "Insurance companies are looking a lot better now after dealing with Covered California."
Gonzales said technical problems with the computer-generated letters have been fixed, and new notices are going out to the 113,847 affected households.
She urged people with questions about their application to check their account summary online at the coveredca.com website.
The inaccurate letters triggered increased calls to the state's three service centers, which are already straining to handle high volume. The average wait time topped 36 minutes at last count.
Consumers wanting coverage that starts Jan. 1 must enroll by Monday. The deadline for the first premium payment has been extended to Jan. 6.
To accommodate more applicants, the exchange's service centers will be open Sunday 8 a.m. to 8 p.m.
"We are definitely seeing a surge in interest," Gonzales said. "We are processing thousands of applications per day."
Open enrollment as part of the Affordable Care Act continues through March 31. Covered California said it has enrolled more than 156,000 people in private health plans through Dec. 7 and thousands more have started the application process.
http://www.latimes.com/business/healthcare/news/la-fi-mo-california-exchange-mail-mistake-20131217,0,3997097,print.story
By Chad Terhune
7:00 AM PST, December 18, 2013
| advertisement |
Adding to consumer confusion ahead of a major enrollment deadline, California's health insurance exchange sent flawed eligibility notices to nearly 114,000 households due to a computer error.
The Covered California exchange said the letters sent from Nov. 22 to Dec. 7 had blank spaces or missing information on people's eligibility for insurance or federal premium subsidies.
"The letters would say you are eligible for Covered California, but you are ineligible for blank," said exchange spokeswoman Anne Gonzales. "It seemed to contradict whether the enrollee was eligible. It was confusing to people."
Ben Amante of Costa Mesa received one of the letters last weekend and said he couldn't understand what it meant for his insurance application for himself and his daughter.
"One short paragraph said you're qualified and the next one says you're not qualified," Amante said. "Insurance companies are looking a lot better now after dealing with Covered California."
Gonzales said technical problems with the computer-generated letters have been fixed, and new notices are going out to the 113,847 affected households.
She urged people with questions about their application to check their account summary online at the coveredca.com website.
The inaccurate letters triggered increased calls to the state's three service centers, which are already straining to handle high volume. The average wait time topped 36 minutes at last count.
Consumers wanting coverage that starts Jan. 1 must enroll by Monday. The deadline for the first premium payment has been extended to Jan. 6.
To accommodate more applicants, the exchange's service centers will be open Sunday 8 a.m. to 8 p.m.
"We are definitely seeing a surge in interest," Gonzales said. "We are processing thousands of applications per day."
Open enrollment as part of the Affordable Care Act continues through March 31. Covered California said it has enrolled more than 156,000 people in private health plans through Dec. 7 and thousands more have started the application process.
http://www.latimes.com/business/healthcare/news/la-fi-mo-california-exchange-mail-mistake-20131217,0,3997097,print.story
Obamacare in perspective, after the death of a husband
Posted Dec. 18, 2013, at 10:45 a.m.
In the spirit of the season, I am grateful every day that I live and work in Maine in a community that thrives on integrity, friendship and love.
And I give thanks every day that I have my health. I have routine physicals, referrals to specialists and excellent care at my local medical center. I give thanks that, because of my work, I have health insurance that covers the cost of my medical care.
It was not always so.
My husband Frank and I were self-employed during the last years of our marriage and could not afford to buy health insurance. Like so many of our hardworking neighbors, we crossed our fingers that nothing would send us to the hospital for appointments, tests or pills we could not afford.
We looked into paying for our own health insurance, but paying $1,100 a month for the two of us was impossible. So we chose to go without. When self-employed family members talked about the high costs of premiums, we remained quiet. We did not want others, even our families, to know we could not afford insurance.
We did not go to doctors, and we never spoke about our health. When we caught colds, we drank orange juice and waited it out. We figured we could save money if we did not spend, say, $110 for a single visit to the doctor. Hoping our incomes would improve, we thought we were saving even more if we did not have to pay for prescription drugs.
We pressed our luck and took chances. One of us lost.
Nearly two years ago, my husband Frank lost a painful battle with pancreatic cancer. I miss him every day. His absence left a hole in my heart, a void in our community and in my world.
I cannot help but think that if he had gone to a doctor in the years before his diagnosis in 2010, he might be here with me today.
A doctor might have found indications that his blood counts were amiss from an emerging cancer. He or she probably would have admonished Frank about the red meat he ate every night and all that fried food he loved. Frank might have made lifestyle changes and gotten preventive care that could have stalled the progress of the cancer. And I would have had a few more years with my husband and best friend.
Posted Dec. 18, 2013, at 10:45 a.m.
In the spirit of the season, I am grateful every day that I live and work in Maine in a community that thrives on integrity, friendship and love.
And I give thanks every day that I have my health. I have routine physicals, referrals to specialists and excellent care at my local medical center. I give thanks that, because of my work, I have health insurance that covers the cost of my medical care.
It was not always so.
My husband Frank and I were self-employed during the last years of our marriage and could not afford to buy health insurance. Like so many of our hardworking neighbors, we crossed our fingers that nothing would send us to the hospital for appointments, tests or pills we could not afford.
We looked into paying for our own health insurance, but paying $1,100 a month for the two of us was impossible. So we chose to go without. When self-employed family members talked about the high costs of premiums, we remained quiet. We did not want others, even our families, to know we could not afford insurance.
We did not go to doctors, and we never spoke about our health. When we caught colds, we drank orange juice and waited it out. We figured we could save money if we did not spend, say, $110 for a single visit to the doctor. Hoping our incomes would improve, we thought we were saving even more if we did not have to pay for prescription drugs.
We pressed our luck and took chances. One of us lost.
Nearly two years ago, my husband Frank lost a painful battle with pancreatic cancer. I miss him every day. His absence left a hole in my heart, a void in our community and in my world.
I cannot help but think that if he had gone to a doctor in the years before his diagnosis in 2010, he might be here with me today.
A doctor might have found indications that his blood counts were amiss from an emerging cancer. He or she probably would have admonished Frank about the red meat he ate every night and all that fried food he loved. Frank might have made lifestyle changes and gotten preventive care that could have stalled the progress of the cancer. And I would have had a few more years with my husband and best friend.
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