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Wednesday, February 4, 2015

Health Care Reform Articles - February 4, 2015

The Super-Rich Can’t Hide From the Rest of Us

by
Michael Winship
My friend Craig Zobel just premiered his new movie at the Sundance Film Festival. Z for Zachariah is based on a young adult novel from the seventies about a post-apocalyptic world and a woman who lives on a farm in a remote valley. A geographic anomaly, the valley has been isolated and protected from the nuclear radiation that devastated the rest of humanity. But then a man arrives and, a while later, another. You’ll have to see it.
Craig’s movie is the latest in a long line of such stories about faraway, idyllic places trying to fend off human wrongdoing – from Aristophanes’ Cloud Cuckoo Land and the pre-serpent-and-apple Garden of Eden to the Shangri-La of James Hilton’s novel, Lost Horizon. In the classic, 1937 movie version, Shangri-La’s High Lama says to the hero, a British diplomat, “Look at the world today. Is there anything more pitiful? What madness there is! What blindness! What unintelligent leadership! A scurrying mass of bewildered humanity, crashing headlong against each other, propelled by an orgy of greed and brutality.” Sounds like a typical night at Fox News.
Z for Zachariah was filmed on New Zealand’s South Island, about as close to a distant Paradise on Earth as I’ve ever been. Which apparently is part of the reason why, according to former hedge fund director Robert Johnson, “I know hedge fund managers all over the world who are buying airstrips and farms in places like New Zealand because they think they need a getaway.”
And not just a getaway for a couple of weeks of vacation fun. No, the British newspaper The Guardian reports, “With growing inequality and the civil unrest from Ferguson and the Occupy protests fresh in people’s mind, the world’s super rich are already preparing for the consequences.”

Martin Luther King Jr. -- Health Care as a Moral Crisis

By John Geyman, M.D.
The Huffington Post, Jan. 30, 2015
On this occasion honoring the anniversary of the birthday of Martin Luther King 86-years-ago, coinciding with the release of the movie Selma, it is fitting to recall his leadership on moral principles toward equity of health care in this country. Among his many classic quotes about health care, he had this to say in 1966 in a speech to the Medical Committee for Human Rights:
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
Were he here today, Martin Luther King, Jr. would be appalled to see what Americans are facing, even five years after the passage of the Affordable Care Act.
Here's one patient vignette that puts a human face on the outcomes facing patients unfortunate enough to live in states that opted out of Medicaid expansion, as more than twenty states have done.
Charlene Dill was a 32-year-old mother of three who earned $11,000 a year cleaning houses and babysitting in Florida. That was too much to qualify for Medicaid, and too little to afford health insurance. The ACA would have provided subsidies for health insurance if her income was more than $23,550. When she developed a heart condition, and later, abscess on her legs, she did go to emergency rooms, but couldn't afford those bills or any other care.
This is not an isolated anecdote, but more the rule for many millions of Americans. Access to care has improved for some, especially in states that expanded Medicaid, but there are still more than 30 million uninsured and tens of millions underinsured. Lacking any mechanisms to rein in markets and contain costs or prices, the ACA has unleashed increasing consolidation and control by hospital systems and insurers.
Wall Street is happy, and health care stocks are soaring. Yet one-third of insured Americans cannot afford to pay their medical bills, often leading to bankruptcy. Meanwhile, our safety net continues to deteriorate. We can expect that to worsen in the months and years ahead if Republican governors impose more restrictions on Medicaid, and if the Republican-controlled Congress cuts spending for critical programs.
As Martin Luther King knew full well, health care is a moral issue. Virtually all advanced countries around the world recognized long ago that health care is a human right, not a privilege based on ability to pay. Dr. Edmund Pellegrino, leading medical ethicist for many years at Georgetown University's Center for Clinical Bioethics, summed up the issue this way at the Annual Meeting of Academic Health Centers in 2000:
Access to health care is a moral obligation of a good society.

MLK's Vision and the Right to Healthcare

By James Besante, MS4
Common Dreams, Jan. 25, 2015
This past week the world celebrated the life of Dr. Martin Luther King Jr.
Marches of remembrance also served as painful reminders of unhealed wounds along the lines of race in America, particularly the failure to realize equal access to health care for all.
In 1966, while addressing the second convention of the Medical Committee for Human Rights, King declared, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
The true magnitude of race-based health inequality is staggering: In his seminal paper “What If We Were Equal,” former Surgeon General David Satcher calculated approximately 83,000 excess deaths per year among African Americans, also known as the “black-white mortality gap.”
Despite progress in civil rights, housing, education, and employment from 1960 to 2000, this gap has remained. Shockingly, it has widened for infants and African American men over the age of 35.
The King holiday was a sobering day of reflection, but it was also the crescendo to the very audible justice movement loosely organized under the banner Black Lives Matter.
Activists marched in cities across the nation to bring attention to numerous highly publicized incidents of police violence. More broadly, organizers sought to underline the subversive elements of racism still deeply etched in our nation’s subconscious, and no doubt represented in unequal health outcomes for African Americans.
As a nation, we do not provide universal access to even the most basic medical services. This is not likely to change anytime soon since the Congressional Budget Office estimates that 27 million people will remain uninsured after the full implementation of Obamacare.
The absence of universal health care coverage sets the U.S. apart from all other developed countries. It is the only member of the elite G7—a group of nations accounting for 66 percent of net global wealth—without universal health insurance for its citizens.
Dr. Satcher proposed national health insurance as the evidenced-based remedy to finally close the racial mortality gap and address persistent health injustice in America.
Polls show most Americans also support universal health care. In fact, the majority of physicians agree the private health insurance industry should be replaced with a streamlined, publicly accountable system, like “single-payer,” also known as “improved Medicare for all.”
What is single-payer? It simply means the government pays for health care costs without routing money through private insurers who manufacture paperwork, billing complexity and profits. This is how traditional Medicare insurance is able to operate with overhead costs of 2 percent, which is far more efficient than private health insurance plans, with overhead costs of 15 to 25 percent.
Harvard researchers recently calculated the administrative savings of single-payer’s simplified financing structure to be $375 billion annually, nearly 15 percent of total health spending. This would help to lower the sky-high cost of our current system, which is approaching 18 percent of the gross domestic product.
Single-payer would free patients from out-of-pocket expenses, like co-payments and deductibles—proven barriers to care that are administratively unwieldy and unnecessary for cost containment.
National health insurance would also give patients free choice of providers without the narrow networks that are commonly encountered by insured Americans.
The comprehensive, high-quality care that is equitably accessible in a single-payer national health program stands in stark contrast to our current market-based system in which health care is rationed based on an individual’s ability to pay.
http://www.pnhp.org/print/news/2015/january/mlks-vision-and-the-right-to-healthcare


Onward, Christian Health Care?

By MOLLY WORTHEN

WHEN Theresa Bixby, 63, learned that she had breast cancer four years ago, she reacted as many Americans do. “One of my first thoughts was, ‘will they pay?’ ” she said. But she wasn’t talking about a conventional insurance plan. She lost hers when she left her full-time position for part-time work at her church in Greenville, S.C. She was worried about the program that she had joined six months earlier: Christian Healthcare Ministries.
Christian Healthcare Ministries is not an insurance company. It is a nonprofit “health care sharing ministry” based in Barberton, Ohio. The cost of membership is far lower than the rates of traditional insurance policies — $45 a month for the cheapest plan — but the ministry makes no guarantees of payment. Members send their monthly “gift” to an escrow account, which disburses payments for eligible medical bills, excluding costs like routine physicals, continuing treatment for pre-existing conditions or procedures that members have voted to exclude, like care for pregnancies outside wedlock.
Each time Ms. Bixby visited her hospital for tests or chemotherapy, she explained that she was a self-pay patient and a member of a cost-sharing ministry. Sometimes the receptionist nodded; sometimes she got a blank stare. The hospital never denied her treatment, but “I was getting a two-inch stack of bills every month, and threats that they would take me to collections,” she told me.
Christian Healthcare Ministries assigned her case to a “member advocate,” who negotiated discounts on her fees. These counted toward Ms. Bixby’s $5,000 deductible, so she paid out of pocket only for office visits. In the end, the ministry persuaded the hospital to lop $220,900 off a bill of $301,540 and reimbursed or paid directly the remaining $80,640.
Despite stories like this, organizations such as Christian Healthcare Ministries claim a modest membership. The four main cost-sharing ministries in the United States have about 340,000 members. Regulators in several states have raised concerns that these ministries offer the illusion of insurance while sidestepping the Affordable Care Act’s baseline standards of coverage and skirting requirements that apply to conventional insurance companies, like minimum cash reserves. Nonetheless, membership in the ministries has been growing, particularly since the act granted them an exemption as one of the only ways to avoid the law’s mandate to buy insurance without paying a fine.

Piling On Work to Escape Gap in Health Law

By 

AUSTIN, Tex. — Alma Ramos, a soft-spoken prep cook at a Tex-Mex restaurant, was eager to sign up for health insurance through the new HealthCare.gov marketplace last year. But Ms. Ramos, a single mother of three, quickly hit a baffling hurdle.
Because of a wrinkle in the Affordable Care Act, Ms. Ramos made too little money to receive federal aid for buying private insurance — and too much to qualify for Medicaid, the government health care program for the poor. But she found a solution.
Encouraged by counselors at a storefront enrollment center here, she took on more work, busing tables at night and, more recently, cooking tamales to sell out of her tiny apartment. By raising her annual income to about $24,000, Ms. Ramos, 39, qualified for a subsidy that enabled her to buy insurance for just $20 a month.
“I want to be covered for my kids,” she said. “I’ll do whatever I need to do.”
Ms. Ramos is one of many low-income, working adults who are caught in what experts call the coverage gap, eligible for neither federal subsidies nor Medicaidbecause they live in states that have declined to expand Medicaid under the health care law. And like Ms. Ramos, many of those people are taking second jobs or working extra hours to increase their incomes, hoping to become eligible for assistance that will enable them to afford marketplace plans.
All told, four million adults in nearly two dozen states fall into the gap, and Texas has the most, nearly one million. Though it is impossible to know how many of these people are trying to bolster their incomes, enrollment counselors around the country say they routinely help people think through whether they can scrape together extra income to qualify for financial help.
“If they are self-employed and clean houses, we calculate how much do you get per house?” said Elizabeth Colvin, who runs an enrollment program through Foundation Communities, a nonprofit group here. “Could you do one extra house a month?”
“Sometimes they’re like, ‘I’m doing all I can; I can’t do any more,’ ” she said. “But then sometimes they’re like, ‘Yes, I’m actually looking for a part-time job right now.’ ”
The gap is a consequence of the 2012 Supreme Court decision upholding major pieces of the Affordable Care Act. The law was written with the expectation that all states would expand Medicaid to cover nearly all low-income adults, so those who make less than the federal poverty level are not eligible for subsidies. But the court allowed states to opt out of expanding Medicaid, and 22 states, most of them Republican-controlled, have done so.


A Discredited Vaccine Study’s Continuing Impact on Public Health

In the churning over the refusal of some parents to immunize their children against certain diseases, a venerable Latin phrase may prove useful: Post hoc, ergo propter hoc. It means, “After this, therefore because of this.” In plainer language: Event B follows Event A, so B must be the direct result of A. It is a classic fallacy in logic.
It is also a trap into which many Americans have fallen. That is the consensus among health professionals trying to contain recent spurts of infectious diseases that they had believed were forever in the country’s rearview mirror. They worry that too many people are not getting their children vaccinated, out of a conviction that inoculations are risky.
Some parents feel certain that vaccines can lead to autism, if only because there have been instances when a child got a shot and then became autistic. Post hoc, ergo propter hoc. Making that connection between the two events, most health experts say, is as fallacious in the world of medicine as it is in the field of logic.
An outbreak of measles several weeks ago at Disneyland in Southern California focused minds and deepened concerns. It was as if the amusement park had become the tragic kingdom. Dozens of measles cases have spread across California. Arizona and other nearby states reported their own eruptions of this nasty illness, which officialdom had pronounced essentially eradicated in this country as recently as 2000.
But it is back. In 2014, there were 644 cases in 27 states, according to the Centers for Disease Control and Prevention. Should the pace set in January continue, the numbers could go still higher in 2015. While no one is known to have died in the new outbreaks, the lethal possibilities cannot be shrugged off. If the past is a guide, one or two of every 1,000 infected people will not survive.
To explore how matters reached this pass, Retro Report, a series of video documentaries studying major news stories of the past and their consequences, offers this special episode. It turns on a seminal moment in anti-vaccination resistance. This was an announcement in 1998 by a British doctor who said he had found a relationship between the M.M.R. vaccine — measles, mumps, rubella — and the onset of autism.
Typically, the M.M.R. shot is given to infants at about 12 months and again at age 5 or 6. This doctor, Andrew Wakefield, wrote that his study of 12 children showed that the three vaccines taken together could alter immune systems, causing intestinal woes that then reach, and damage, the brain. In fairly short order, his findings were widely rejected as — not to put too fine a point on it — bunk. Dozens of epidemiological studies found no merit to his work, which was based on a tiny sample. The British Medical Journal went so far as to call his research “fraudulent.” The British journal Lancet, which originally published Dr. Wakefield’s paper, retracted it. The British medical authorities stripped him of his license.
Nonetheless, despite his being held in disgrace, the vaccine-autism link has continued to be accepted on faith by some. Among the more prominently outspoken is Jenny McCarthy, a former television host and Playboy Playmate, who has linked her son’s autism to his vaccination: He got the shot, and then he was not O.K. Post hoc, etc.

No Case for Killing the Medical Device Tax

By 

In seeking to dismantle the Affordable Care Act piece by piece, congressional Republicans have placed a high priority on repealing a tax on medical devices that would raise some $29 billion over the next 10 years to help ensure that health reform will not increase the deficit. Repealing the tax is a terrible idea that has been given a veneer of respectability by support from liberal Democrats in states with large concentrations of device manufacturers. They include Senator Elizabeth Warren of Massachusetts, Senators Amy Klobuchar and Al Franken of Minnesota and Representative Ron Kind of Wisconsin, among others. President Obama ought to veto any bill that eliminates the tax.
The health reform law imposes a modest 2.3 percent tax on sales of medical devices, to be paid by the manufacturers or importers. It applies to such products as X-ray machines, M.R.I. scanners, pacemakers and artificial hip and knee joints but not to eyeglasses, contact lenses and hearing aids. The $29 billion to be raised from the device industry is less than the amounts to be raised from insurers and drug companies, all of which will benefit from increased business under the act and should pay their fair shares of the cost. If the lost revenues from a repeal of the device tax are offset by reduced spending on other health care programs, as they might well be, many patients could suffer medical or financial harm.
Trade groups say the tax has already caused a big loss of jobs, has reduced spending on research and will lead to a total loss of 195,000 jobs among manufacturers and suppliers and in the general economy over the next five years. They also say the tax will stifle innovation, drive up health care costs and provide an incentive for manufacturers to locate facilities overseas.
Independent analysts believe the industry’s dire forecasts are malarkey. The Congressional Research Service estimated that the tax would have “relatively modest” effects on jobs, research and company profits and a “negligible” effect on the price of health care. Some jobs would be lost, but they account for a tiny fraction of 1 percent of the industry’s work force. The C.R.S. said the tax should not affect decisions on where to locate production facilities because domestically produced devices and imported devices are subject to the same tax.

Medicare to transform how it pays doctors and hospitals


The Obama administration outlined ambitious new goals Monday to transform over the next four years the way that the gargantuan Medicare program pays doctors and hospitals, rewarding providers that achieve better outcomes for patients rather than those that just do more.
The move away from so-called fee-for-service medicine is a central, if little recognized, goal of the Affordable Care Act, which the president signed five years ago.
Most experts believe that this shift is crucial to improving the quality of care that patients receive, while also restraining costs at a time when millions of baby boomers will be entering the nation's primary insurance program for the elderly.
Under the goals announced Monday, Medicare will make 30% of its direct payments to doctors, hospitals and other providers through alternative payment models by next year, up from nearly nothing four years ago.
These models include bonuses for doctors to coordinate patients' care and programs that set a budget for patient care and reward physician practices, hospitals and others who deliver the care under budget while achieving good outcomes for patients.
By 2018, half of Medicare's direct payments to providers should be through such models, according to the federal Department of Health and Human Services.

How to Measure a Medical Treatment’s Potential for Harm


By  Aaron E. Carroll and Austin Frakt
As we wrote last week, many fewer people benefit from medical therapies than we tend to think. This fact is quantified in a therapy’s Number Needed to Treat, or N.N.T., which tells you the number of people who would need to receive a medical therapy in order for one person to benefit. N.N.T.s well above 10 or even 100 are common. But knowing the potential for benefit is not enough. We must also consider potential harms.
Not every person who takes a medication will suffer a side effect, just as not every person will see a benefit. This fact can be expressed by Number Needed to Harm (N.N.H.), which is the flip side of N.N.T.
For instance, the N.N.T. for aspirin to prevent one additional heart attack over two years is 2,000. Even though this means that you have less than a 0.1 percent chance of seeing a benefit, you might think it’s worth it. After all, it’s just an aspirin. What harm could it do?
But aspirin can cause a number of problems, including increasing the chance of bleeding in the head or gastrointestinal tract. Not everyone who takes aspirin will bleed. Moreover, some people will bleed whether or not they take aspirin.
Aspirin’s N.N.H. for such major bleeding events is 3,333. For every 3,333 people, just over two on average will have a major bleeding event, whether they take aspirin or not. About 3,330 will have no bleed regardless of what they do. But for every 3,333 people who take aspirin for two years, one additional person will have a major bleeding event. That’s an expression of the risk of aspirin, complementing the fact that one out of 2,000 will avoid a heart attack.
Granted, one out of 3,333 is a pretty tiny risk. But remember that the chance of benefit is pretty small, too.
Sometimes, though, the N.N.H. can be much lower, even lower than that of N.N.T., which suggests the chance of harm is greater than the potential benefit. Consider screening mammograms, which are considered so essential that they are the only screening tests specifically mentioned in the Affordable Care Act, and coverage for them with no cost sharing is required by the law.
If you look at the data for all randomized controlled trials of breast cancer screening, the N.N.T. for recommending screening to prevent one death from breast cancer after 13 years of follow-up is 1,477. But further analyses show that the one woman would have probably died of other causes anyway. There may be no benefit at all with respect to preventing death from all causes.
Screening with mammograms can cause harm, though. They lead to overdiagnosis, encouraging the provision of therapies that provide no benefits — but do carry risks, and therefore are considered harms.

The financial sinkhole of health insurance complexity

By Jim Kahn, M.D., M.P.H.
KevinMD blog, Feb. 2, 2015
We all know that the U.S. system of paying for health care is tremendously complex and inefficient: a multitude of insurers, thousands of insurance plans, innumerable medical bills, countless incorrect and denied claims.
But just how much do we waste on this administrative morass?
I led a research team that recently reviewed all the available evidence and published our findings. The resulting numbers are staggering.
Compared with countries that have a single health insurer (i.e., the government), we waste more than $375 billion per year in excess paperwork to pay medical bills.
That’s $1 billion per day. That’s more than $1 trillion every three years. That’s 15 percent of all health spending — 1 in every 7 dollars spent on health care — on excess paperwork.
Let me put these big numbers into perspective. This waste equals $1,200 per year for each and every person in the United States. It represents 89 percent of total state and federal spending for Medicaid, our health insurance for the poor. It amounts to 2.3 percent of the U.S. economy.
And this striking toll doesn’t even count the effort expended by employers for their employees’ health insurance or time spent by patients and families dealing with insurance and bills.
What does this third of a trillion dollars each year pay for? It funds the endless detailed steps required in the “multi-payer” insurance system:  designing health plans, contracting between insurers and providers, marketing health insurance, signing up subscribers, checking insurance status at each medical visit, collecting copayments, creating bills, sending out bills, processing incoming payments, disputing insurance claims, collecting unpaid bills.
We call this “billing and insurance-related” administrative waste, or BIR. In the dead of our current winter, I pronounce it “brrr” because it reflects a frightfully chilling reality.
Imagine what we could do, as a nation, with more than $375 billion.
We could pay for everyone to have high-quality health care. The massive savings from lower paperwork would be enough to cover all Americans with minimal or no deductibles or copays.
Are we speculating? No, we’re summarizing solid empirical evidence, something sorely missing from most health care reform discussions.

What It's Like When You're An American Using Britain's NHS

By Jim Edwards
Business Insider, Jan. 29, 2015
I've spent half my life in the US and half of it in the UK, so I'm used to both countries' healthcare systems. I recently returned to London after 20 years in America, and after a few doctors' appointments I've come to see the NHS through American eyes.
The National Health Service is, as all Americans know and fear, a completely public "socialized medicine" system. It's dramatically different from the US's patchwork system of private providers and insurance companies.
My story isn't representative, of course. Healthcare delivery is different in the UK depending on where you live and which doctors and hospitals you use — just as it is in the US. But I've now used both systems for about two decades each, so I feel I have a pretty good handle on the main contrasts.
'This Rolls Royce isn't moving fast enough!'
The context here is that the NHS just released its most recent stats on accident and emergency room waiting times. The headline number is that 84% of patients are seen within four hours. In the UK, this is regarded as a huge failure — the standard the NHS is supposed to meet is 95% of patients in four hours. The UK media went into a fury about it, and some hospitals have begun postponing and rescheduling some non-emergency procedures in order to get those waiting times down.
In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. Bear in mind that within that four-hour period the NHS doctors are triaging patients: If you get hit by a bus, you're going to see someone instantly. If you broke a finger because you fell over while drunk at the pub, you're probably going to wait at the back of the line. It's not like people are literally bleeding to death while they wait for attention (although the British media loves it when it finds individual cases where that has happened).
So my overall impression is that currently, the Brits' complaints that the NHS isn't hitting that 95% mark is akin to saying, "This Rolls Royce isn't moving fast enough!"
Show up when you're told to -- or else
The first major difference from the patient's point of view is what happens when you call your doctor for a routine appointment. My specific health issue was that I thought I was going slightly deaf, and wanted it checked out.
I'm a dual US/UK citizen, so I qualify for NHS treatment. Here's what happened to me.
In America, you call your doctor and request an appointment when it's convenient for you. They might ask you what's wrong with you, presumably to make sure it's not something that requires immediate treatment. But basically, it's first come, first served, regardless of how important it is. Usually, you can pick an appointment time that's convenient for you if it is not an emergency.
In the UK, I was given an appointment whether I liked it or not. I called and leave a message. Within an hour or two a nurse practitioner called me back and asked me a few questions about my problem over the phone. (You've got to take the call in a private place if you don't want your office mates to hear.) Then they said: Come in at 9am on Thursday. There was no choice over appointment times — the assumption is that if you're ill, you're going to come to the doctor when they say.
At first I found this jarring. In America, I get to choose when I see the doctor! In Britain, I better show up when I'm told. But the appointment came quickly, as the local health authority in London has targets it needs to meet. Ultimately, I saw the logic of it: This is a public health system. It needs to manage its costs and services. If you're really sick, you'll show up. If you only want to show up when it's convenient for your schedule, then how sick are you, really?
America is worse at on-the-day care
In America, I've always had a long wait to see my doctor. I have read many a back issue of Newsweek in my primary care / general practitioner (GP) doctor's office. I've sat there for an hour playing with my phone while the doc sees patients in the order they were booked.
In the UK, I showed up at 9am and was seen instantly, at the Waterloo Health Centre. For an American, this was bizarre: My butt barely touched the seat in the waiting room before my name was called. Turns out my doc and her staff are serious about patient scheduling.
This was one reason I became convinced that the NHS way of scheduling is superior: You might not get the time or date that you want, but once you're in, you get seen super-quick.
The NHS actively discourages some patients -- for good reason

Secondhand Smoke Exposure Drops, C.D.C. Reports

    By SABRINA TAVERNISE
    FEBRUARY 3, 2015
    Americans’ exposure to secondhand smoke declined by half over the past decade, federal health authorities reported Tuesday, as states and municipalities banned smoking in bars, restaurants and offices, and fewer Americans smoked inside their homes.
    The share of American nonsmokers exposed to secondhand smoke fell to 25 percent in 2012 from 53 percent in 2000, according to an analysis of federal health data by the Centers for Disease Control and Prevention. Exposure was determined by testing for cotinine, a marker of nicotine in the blood.
    There were many drivers of the decline. Around 700 towns and cities have banned smoking in public places over the past few decades, as have 26 states and the District of Columbia. The report also said that the share of American homes that forbade smoking stood at 83 percent in 2011, up from 43 percent in 1993. Finally, the smoking rate has declined, and smoking itself has become less acceptable in public.
    But even with the decline, a substantial share of American nonsmokers — one in four — were still exposed to secondhand smoke. Health experts estimated such exposure causes 41,000 deaths from lung cancer and heart disease and 400 deaths from sudden infant death syndrome every year. In all, there are more than 480,000 tobacco-related deaths annually — the single largest cause of preventable death.

    Measles: Perilous but Preventable


    By DENISE GRADY
    FEBRUARY 2, 2015

    Measles has been spreading in the United States at a rate that worries health officials, with 102 cases so far this year in at least 14 states.
    Most infections are linked to an outbreak that began in Disneyland in December, almost certainly started by someone who brought the disease in from another country. A “smattering” of other imported cases have also occurred, according to Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.
    Measles was eliminated from the United States in 2000, meaning that the infection no longer originates here. But worldwide, there are still about 20 million cases a year; in 2013, about 145,700 people died of measles. Travelers can bring the virus into the United States and transmit it to people who have not been vaccinated.
    Measles spreads through the air and is among the most contagious of all viruses; in past epidemics, it was not uncommon for one patient to infect 20 others. Some 90 percent of people exposed will get sick (unless they are immune because they have had measles already or have been vaccinated). The virus can hang suspended in the air for several hours, so it is possible to catch measles just by walking into a room where an infected person has recently spent time. Inhaling a tiny amount of viral particles is enough to cause illness.
    The disease is cause for particular concern because it can have severe complications, including pneumonia and encephalitis, which can be fatal. Those who survive encephalitis can wind up with brain damage. Measles can also cause deafness. And even without complications, the virus makes children very sick, with high fevers, a rash and sore eyes. Painful ear infections are also common.
    Here are some commonly asked questions about measles and the vaccine that prevents it.
    Q. Has the United States been particularly hard-hit?
    A. Many relatively wealthy countries are having worse outbreaks. Virtually all of continental Europe has been undergoing a large outbreak since 2008, with more than 30,000 cases in several years.
    France, which gets more tourists than any other country, had 15,000 measles cases in 2013, with at least six deaths. About 95 percent of the cases were in people who had never been vaccinated or had not had both recommended doses.
    http://mobile.nytimes.com/blogs/well/2015/02/02/measles-perilous-but-preventable/


    Maine Lawmakers to Weigh in on Vaccination Debate 

    By  • 15 HOURS AGO
    AUGUSTA, Maine - The recent measles outbreak that surfaced at Disneyland in California has fired up the debate over vaccinations, with high-profile politicians like U.S. House Speaker John Boehner and New Jersey Gov. Chris Christie weighing in on whether they should be mandatory.

    Maine lawmakers will have a chance to weigh in on the controversy when they consider a number of vaccination bills this session.
    Democratic Rep. Ralph Tucker says he got the idea for his vaccine bill well before the measles outbreak at Disneyland, which has now grown to more than 100 infections spread across 14 states. "I put it in when I discovered that the rate of unvaccinated kids in our kindergarten in Maine went up to 5.5 percent of the entering kindergarteners," he says.
    It's one of the highest rates in the nation.  To reduce the number of unvaccinated kids, Tucker's bill would eliminate Maine's philosophical exemption from vaccines, while still allowing medical and religious exemptions.  
    Tucker says the majority of people who opt out do so on philosophical grounds. The problem with that, he says, is that the decision is not just a private matter for one's own family. He says it affects three other groups - first, infants who aren't old enough to get immunized.
    "The second group are the kids who, for one medical reason or another, can't get vaccinated," he says. "Currently these people are protected because almost everybody else is vaccinated, so they get this cushion around them.  The third group I'm concerned about are vaccinated children for whom the vaccine may not take."  
    Andrew MacLean, of the Maine Medical Association, says physicians are increasingly concerned about the rising number of Maine parents who take the philosophical exemption. "You start losing the benefits of herd immunity once you drop below about 95 percent of immunization.  
    The Maine Medical Association helped draft a different bill that also seeks to increase the number of vaccinated children.  Sponsored by Democratic Rep. Linda Sanborn, the bill would require parents to get consultation from a doctor before taking a philosophical exemption. Currently, parents must only give written notice to their child's school when they choose not to vaccinate.  


    Kaci Hickox blasts Christie again, this time over vaccines

    health policy, Home, public health
    By 
    Kaci Hickox is in the news yet again challenging New Jersey Gov. Chris Christie on his response to a public health issue. But this time the controversy centers around vaccines and measles, a much more pressing health threat to Americans than the Ebola virus.
    Hickox, as you may recall, grabbed headlines in late October when she was forced into quarantine near the airport in Newark, New Jersey, after returning from a tour treating Ebola patients in Sierra Leone with Doctors Without Borders. She went on to challenge a quarantine order in Maine.
    On Monday, Christie sparked controversy by saying parents need to have “some measure of choice” in vaccinating their children. Critics found his stance worryingly equivocal.
    Christie, speaking in London, also said his children had been vaccinated and that immunization was “an important part of being sure we protect their health and the public health.”
    The scientific consensus is clear that vaccines are safe and their benefits indisputable. Public health officials are stressing that immunization is critical to halting a measles outbreak that began in California and now has spread to 102 people in 14 states. The respiratory illness is highly contagious and can lead to dangerous complications, including pneumonia and brain swelling.


    Measles Outbreak Proves Delicate Issue to G.O.P. Field


    By JEREMY W. PETERS and RICHARD PÉREZ-PEÑA
    FEBRUARY 2, 2015

    WASHINGTON — The politics of medicine, morality and free will have collided in an emotional debate over vaccines and the government’s place in requiring them, posing a challenge for Republicans who find themselves in the familiar but uncomfortable position of reconciling modern science with the skepticism of their core conservative voters.
    As the latest measles outbreak raises alarm, and parents who have decided not to vaccinate their children face growing pressure to do so, the national debate is forcing the Republican Party’s 2016 presidential hopefuls to confront questions about whether it is in the public’s interest to allow parents to decide for themselves.
    Gov. Chris Christie’s trade mission to London was suddenly overshadowed on Monday after he was quoted as saying that parents “need to have some measure of choice” about vaccinating their children against measles. The New Jersey governor, who is trying to establish his credibility among conservatives as he weighs a run for the Republican nomination in 2016, later tried to temper his response. His office released a statement clarifying that “with a disease like measles there is no question kids should be vaccinated.”
    Senator Rand Paul of Kentucky, a physician, was less equivocal, telling the conservative radio host Laura Ingraham on Monday that parents should absolutely have a say in whether to vaccinate their children for measles.
    “While I think it’s a good idea to take the vaccine, I think that’s a personal decision for individuals,” he said, recalling his irritation at doctors who tried to press him to vaccinate his own children. He eventually did, he said, but spaced out the vaccinations over a period of time.
    http://mobile.nytimes.com/2015/02/03/us/politics/measles-proves-delicate-issue-to-gop-field.html

    Rwanda and Bangladesh Have Universal Healthcare -- Why Can't America?

    Some poor countries have shown that good basic healthcare for all can be provided at a very low cost.
    By Amartya Sen /  The Guardian


    Twenty-five hundred years ago, the young Gautama Buddha left his princely home, in the foothills of the Himalayas, in a state of agitation and agony. What was he so distressed about? We learn from his biography that he was moved in particular by seeing the penalties of ill health – by the sight of mortality (a dead body being taken to cremation), morbidity (a person severely afflicted by illness), and disability (a person reduced and ravaged by unaided old age). Health has been a primary concern of human beings throughout history. It should, therefore, come as no surprise that healthcare for all – “universal healthcare” (UHC) – has been a highly appealing social objective in most countries in the world, even in those that have not got very far in actually providing it.
    The usual reason given for not attempting to provide universal healthcare in a country is poverty. The United States, which can certainly afford to provide healthcare at quite a high level for all Americans, is exceptional in terms of the popularity of the view that any kind of public establishment of universal healthcare must somehow involve unacceptable intrusions into private life. There is considerable political complexity in the resistance to UHC in the US, often led by medical business and fed by ideologues who want “the government to be out of our lives”, and also in the systematic cultivation of a deep suspicion of any kind of national health service, as is standard in Europe (“socialised medicine” is now a term of horror in the US).
    One of the oddities in the contemporary world is our astonishing failure to make adequate use of policy lessons that can be drawn from the diversity of experiences that the heterogeneous world already provides. There is much evidence of the big contributions that UHC can make in advancing the lives of people, and also (and this is very important) in enhancing economic and social opportunities – including facilitating the possibility of sustained economic growth (as has been firmly demonstrated in the experience of south-east Asian countries, such as Japan, South Korea, Taiwan, Singapore and, more recently, China).
    Further, a number of poor countries have shown, through their pioneering public policies, that basic healthcare for all can be provided at a remarkably good level at very low cost if the society, including the political and intellectual leadership, can get its act together. There are many examples of such success across the world. None of these individual examples are flawless and each country can learn from the experiences of others. Nevertheless, the lessons that can be derived from these pioneering departures provide a solid basis for the presumption that, in general, the provision of universal healthcare is an achievable goal even in the poorer countries. An Uncertain Glory: India and its Contradictions, my book written jointly with Jean Drèze, discusses how the country’s predominantly messy healthcare system can be vastly improved by learning lessons from high-performing nations abroad, and also from the contrasting performances of different states within India that have pursued different health policies.

    If not Obamacare, what healthcare reform do Americans actually want?


    The US supreme court will decide on Thursday whether or not to uphold fully, uphold partially, or reject the healthcare bill passed by Congress and signed by President Obama in 2010. Much has been made of public opinion polls showing that the majority of Americans oppose the bill.
    But can these polls be trusted? What do Americans really believe on the issue of healthcare?
    Most Americans may not like Obamacare as a whole, but they seem to like it as long as it doesn't include the mandate. Only 34% of respondents in the CBS poll approved of Obamacare as a whole, but 51% either wanted the bill kept intact or only wanted the mandate eliminated. A Fox News poll similarly discovered that only 40% of Americans favored the healthcare bill as a whole, but 51%, again, wanted to keep either the whole law or most of the law minus the mandate. 
    You might believe that those opposed to Obama's Affordable Care Act are against it because it goes too far, but an examination of those opposed to his healthcare reform law reveals a more complex picture: 43% of Americans favored Obama's healthcare bill in a recent CNN/ORC poll, while 51% opposed it. Yet, only 34% of the general population opposes Obamacare because it goes too far; 13% of Americans asked actually oppose it because it is too timid. When you combine those who oppose it for not going far enough with those who favor it, a majority, 56%, actually wants Obama's healthcare bill or something more far-reaching. Similar findings have been made in polls done by CBS, Kaiser, and Reuters/Ipsos. 

    Lawsuit Seeks to Legalize Doctor-Assisted Suicide for Terminally Ill Patients in New York

    By 
    A group of doctors and terminally ill patients are asking New York courts to declare that doctor-assisted suicide is legal and not covered by the state’s prohibition on helping people take their own lives.
    Under longtime interpretations of state law, a doctor who helps a terminally ill patient die by providing a fatal dose of medication can be prosecuted under the manslaughter statute, which covers anyone who “intentionally causes or aids another person to commit suicide.”
    The lawsuit, to be filed Wednesday in State Supreme Court in Manhattan, contends that the law was intended to prevent someone from, for instance, helping a lovesick teenager commit suicide, but not to stop a doctor from helping a mentally competent, terminally ill patient die.
    The plaintiffs also argue that because doctors are already allowed to help terminally ill patients die in some circumstances, such as when they remove life support, the fact that they cannot hasten death for other terminally ill patients violates the equal protection clause of the State Constitution.
    “What we will be helping the court to see is there are many instances where patients under existing law in medicine can invite medical conduct which precipitates death,” Kathryn L. Tucker, lead counsel in the case and executive director for the Disability Rights Legal Center, said this week. “Yet it is somewhat random whether any given patient will fall into that category.”

    House G.O.P. Again Votes to Repeal Health Care Law

    By 
    WASHINGTON — The House passed a bill on Tuesday to repeal the Affordable Care Act for the first time in the new Congress, but Democrats appeared to show more zeal in defending the law than Republicans did in trying to get rid of it.
    The measure goes now to the Senate, where the majority leader, Mitch McConnell, Republican of Kentucky, has said that the chamber will vote on legislation repealing the health law but has not announced a schedule.
    Republicans in both chambers are divided over how to replace the law and how to respond if the Supreme Court upholds a challenge to insurance subsidies now being provided to millions of people under the law.
    The House vote, 239 to 186, generally followed party lines. No Democrats voted for repeal. Three Republicans — Representatives Robert Dold of Illinois, John Katko of upstate New York and Bruce Poliquin of Maine — voted against the bill.


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