States could leave millions of low-income people uninsured

The new Medicaid “doughnut hole”

From the Washington Post –

For Gov. Rick Perry, saying �no� to the federal health care law could also mean turning away up to 1.3 million Texans, nearly half the uninsured people who could be newly eligible for coverage in his state.

Gov. Chris Christie not only would be saying �no� to President Barack Obama, but to as many as 245,000 uninsured New Jersey residents as well.

The Supreme Court�s recent ruling gave governors new flexibility to reject what some Republicans deride as �Obamacare.� But there�s a downside, too.

States that reject the law�s Medicaid expansion risk leaving behind many of their low-income uninsured residents in a coverage gap already being called the new �doughnut hole� � a reference to a Medicare gap faced by seniors.

Medicaid is a giant federal-state health insurance program for the poor, now mostly covering children, mothers and disabled people. The expansion in Obama�s health care overhaul was originally expected to add roughly 15 million uninsured low-income people, mainly adults without children, who currently are not eligible in most states. Washington would pick up the entire cost for the first three years, with the federal share then dropping to 90 percent. The Medicaid expansion accounts for about half the total number of uninsured people projected to get coverage under the law.

If every state were to reject that Medicaid expansion � as the Supreme Court ruling now allows � some low-income people would still be picked up by other coverage provisions meant to help the middle class.

But nearly 11.5 million uninsured people below the federal poverty line would be left behind in a new coverage gap, according to recent estimates from the Urban Institute. That brings to mind the infamous �doughnut hole� in the Medicare prescription drug benefit, in which seniors with high drug costs find themselves paying out of pocket much of the year.

Those who fall into the new gap would neither qualify for Medicaid in their states under current rules nor be eligible for subsidized private insurance in new state marketplaces that Obama�s law calls exchanges.

Low-income children and mothers would continue to have insurance through Medicaid. Then, starting in 2014, millions of people over the poverty line would have subsidized private coverage through the new exchanges. �And then this group in the middle has nothing,� said Matt Salo, executive director of the National Association of Medicaid Directors. His organization takes no position on what states should do.

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Truvada drug trials signal 'turning point' in AIDS epidemic

A trio of new studies highlights the promise and challenges of preventing the spread of HIV, the virus that causes AIDS: Giving anti-AIDS drugs to healthy but high-risk patients can dramatically reduce the risk of infection.

Two studies from Africa in heterosexual patients found that the drugs reduced the rate of HIV infection by 62% to 75%, a success rate that's comparable to results from studies of gay men, according to research in today's New England Journal of Medicine. A third study in African women at high risk of infection, however, was ended early after researchers saw the drugs had no effect on HIV rates, largely because fewer than 40% of study participants took their pills as instructed.

Overall, though, the results bolster the notion of giving anti-AIDS drugs to healthy but high-risk people before they're exposed to HIV, says Myron Cohen, a professor at the University of North Carolina-Chapel Hill and co-author of an accompanying editorial. The strategy, known as PREP, or pre-exposure prophylaxis, is one of several powerful new tools in preventing HIV infection, he says.

An advisory panel to the Food and Drug Administration in May recommended approving the drug used in the studies, sold commercially as Truvada, for prevention. Truvada, which combines the drugs tenofovir and emtricitabine, is already approved to treat the disease. In two of the studies, patients were randomly assigned to take either a placebo or Truvada. In the third study, patients were randomly assigned to take either a placebo, Truvada or tenofovir. In that study, both tenofovir and Truvada worked about equally well.

"We're at some sort of turning point in the AIDS epidemic," says Cohen, who will speak later this month at AIDS 2012, an international conference in Washington, D.C., focusing on science and policy. "It's not a single thing going on. It's the culmination of what's happened for 30 years. � Each of them is moving the political world to start thinking about an AIDS-free generation."

About 34 million people have HIV/AIDS, including 1.1 million in the USA, according to the Centers for Disease Control and Prevention. About 50,000 Americans are newly infected with HIV each year.

A key challenge to using these drugs will be finding ways to motivate patients to take them properly, Cohen says. Researchers should find out, for example, whether women stopped taking the pills because of side effects or simply underestimated their risk of getting HIV. In the study of African women, about 3% of women became infected with HIV during the study, whether they took placebos or active drugs.

Using pills to prevent HIV is itself controversial.

On one hand, the pills could help protect the healthy partners of HIV-positive patients, says Anthony Fauci of the National Institutes of Health. The pills could give people a way to protect themselves, even when their partners refuse to use condoms, a common problem in some countries.

But doctors have to be careful to test patients for HIV before prescribing Truvada. If someone already has HIV and doesn't take the pills faithfully, that person could develop and spread a resistant form of the AIDS virus, Cohen says.

Even AIDS activists are divided on the issue, says Guido Silvestri, a professor at the Emory University School of Medicine.

Some argue that the pills should be given to everyone at risk of HIV, especially those with high-risk lifestyles. Others worry that the pills could give people a false sense of security and lead them to stop using condoms, which reduce the risk not only of AIDS but of other sexually transmitted infections and pregnancy, Silvestri says.

A Warning on SCOTUS Healthcare Decision: Needs Still Unmet

The U.S. Supreme Court�s recent decision that the president�s health care law is constitutional caused a flurry of celebration on the part of proponents of reform and a vow on the part of Republicans and other on the right to deep six the plan, along with the president.

Proponents of reform see the decision as a step in the right direction and those who oppose taking control of U.S. health care out of the hands of the insurance companies and the pharmaceutical companies have vowed to work tirelessly to defeat the idea of universal health care.

Then, there is the other viewpoint, not necessarily in the middle, but a more objective view of the state of America�s health and the �system� that is, indeed, controlled by nameless, faceless bureaucrats out of Corporate America. Top Republicans in Congress, like Sen. Mitch McConnell and House Speaker John Boehner, are doing their best to see that corporate bureaucrats will continue to stand between patients and their doctors (or other health care practitioners). They have a lot of help.

That other viewpoint is from Physicians for a National Health Program (PNHP), a group formed 25 years ago for a single purpose, to help develop and pass a single-payer universal health plan for America.

When the Supreme Court released its decision, PNHP stated that so-called Obamacare �is not a remedy to our health care crisis.�

In short, the reasons: �(1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.�

The legislation, which President Obama spent the first half of his first term attempting to get passed with bi-partisan support, the Affordable Care Act (ACA), is full of shortcomings that will become obvious immediately and some that will take some time to recognize. But the main problem with the ACA, according to PNHP and many others, is that the act �perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers� bottom line; and it obstructs any serious effort to control costs.�

PNHP and its 18,000 members across the country have a remedy that is clear and simple. They have been advocating a piece of legislation that was introduced in the House of Representatives by Rep. John Conyers, D-Mich., years ago, HR 676. It also is called �Expanded and Improved Medicare for All.�

HR 676 would, literally, take the current Medicare program that provides health care for those who are 65 or older (with some exceptions like prescription drugs and dental, unless you have supplemental coverage) and provide that same care for all. That was not what was envisioned by Obama and the Democratic leadership at the beginning of the fight over a new health care law. When Nancy Pelosi took the speaker�s gavel in the House of Representatives, one of the first things she pronounced was, �Single payer health care is off the table.� Things went downhill from there.

On the stump in the early days of the Obama Administration, Democratic legislators held what were called town hall meetings with constituents. Nearly every meeting was disrupted by self-described Tea Party members, who plunged the meetings into chaos. Little was learned about the reform proposal. Possibly, not much more is known today, but one thing is certain. Those same Tea Party members, or people with the same inclinations, remain unalterably opposed to universal health care of any kind.

Right-wingers seem to believe that Mitt Romney, who is awaiting coronation as the 2012 Republican presidential candidate, is just as opposed as they are to the Supreme Court-blessed (by a 5-4 decision) ACA. Few of them seem to know that Romney�s legacy, as governor to the people of Massachusetts, is virtually the same health care program that Obama signed and the court has upheld.

This puts Romney foursquare at war with himself, but that�s not an unusual position for him to be in. He now has to say that he is opposed to the federal health care reform law, thus denouncing his own legacy in the Bay State. And, he doesn�t seem to be getting any better at keeping his foot out of his mouth.

For example, during the GOP presidential primaries, he responded to a member of the audience with this gem: �Corporations are people, too, my friend.� Although he seemed completely unaware of the lives of working men and women, he should have known that millions of Americans know that corporations are not people, that they have powerful control over their daily lives, and that the U.S. Supreme Court gave Corporate America the right of free speech that was intended to protect citizens, not corporations, in its Citizens United decision. That decision has loosed the power of unlimited money into the political system, polluting it beyond all reason. Romney does not know this.

The trouble with both his Massachusetts universal health care law and the one just upheld by the court is that both leave the power and the profit in the hands of Corporate America, more particularly, its constituent corporations of the insurance, pharmaceutical, and related �industries.� Their power is not curbed in very many ways under either law, one of the problems being that there is no control over premiums, which translate into obscene profits, obscene CEO salaries and benefits, and similar treatment for all of top management in a host of corporations connected to the medical care industry (for many, even the use of the term is distasteful).

Contrary to what politicians and their benefactors in Corporate America say about a single-payer system of health care, PNHP noted recently: �Research shows the savings in administrative costs alone under a single-payer plan would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending. The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to �wait and see� how this reform plays out, we�ve seen how comparable plans have worked in Massachusetts and other states. Those �reforms� have invariably failed our patients, foundering on the shoals of skyrocketing costs, even as the private insurers have continued to amass vast fortunes.�

Considering the savings, what does it mean that Mitt Romney, Republicans in general, and the right-wingers of every stripe are frothing at the mouth in their attempt to be the most rabidly against the so-called reform? It means that there is a simple choice in the minds of the GOP and all of those in full support of the status quo. They want nothing to interfere with the massive transfer of wealth to the corporations that are in control of the current health care non-system. If that means leaving tens of millions out of the system, with no access to health care, so be it. After all, these are the politicians� benefactors, those who pay their bills.

�The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access,� PNHP stated after the court�s decision was announced. �Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.�

What brought the country to accepting this pathetic �reform?� For starters, Barack Obama, Nancy Pelosi, and other Democratic leaders and operatives took off the table the only proposal (HR 676) that made sense, if there truly were to be reform. They went to the bargaining table with the Republicans, so to speak, giving them their last best offer as an opener. If the president had been a union bargainer and had made such a proposal at the opening session of contract talks, he would have been yanked from the bargaining committee as if by shepherd�s crook.

To those who say that we must move toward universal health care in America incrementally, it must be pointed out that that�s what Harry Truman must have thought, back in the late 1940s, when he mulled national health care. It was only 60 years ago, and we�re still debating whether we should provide health care for all.

If we leave it to Mitt Romney to provide universal health care in America, it may be another 60 years before it happens and, if we approach �reform� the way President Obama and the Democrats have done, it�ll give Romney�s timetable a big boost.

(For a PNHP fact sheet on HR 676, visit www.pnhp.org.)

BlackCommentator.com Columnist, John Funiciello, is a labor organizer and former union organizer. His union work started when he became a local president of The Newspaper Guild in the early 1970s. He was a reporter for 14 years for newspapers in New York State. In addition to labor work, he is organizing family farmers as they struggle to stay on the land under enormous pressure from factory food producers and land developers.

Fewer antibiotics prescribed for children

The number of antibiotic prescriptions for kids declined 14% from 2002 to 2010, but antibiotics remain the most frequently prescribed drugs for pediatric patients, a federal analysis finds.

Antibiotics accounted for about a quarter of all pediatric prescriptions; amoxicillin leads the list.

Overall, 263.6 million prescriptions were written for patients 17 and under in 2010, down 7% from 2002, finds the analysis of prescription claims databases by Food and Drug Administration researchers, published today in the journal Pediatrics. By comparison, 3.3 billion were dispensed for ages 18 and up, 22% more than in 2002.

The medical community has made "an enormous effort to decrease antibiotic use" for kids in the past decade "by educating parents about the futility of treating viral infections with antibiotics" and about antibiotic resistance, the FDA study says.

Those efforts "are succeeding to some extent," but this study and others show antibiotic overuse "is still a big problem," says Adam Hersh, assistant professor of pediatric infectious diseases at the University of Utah. He says overuse of azithromycin and other broad-spectrum antibiotics "is contributing to the epidemic of antibiotic-resistant infections."

Other drug categories down from 2002-2010 were allergy medications (61%); pain (14%); and cough/cold without expectorant (42%). But prescriptions increasing include corticosteroids for asthma (14%); contraceptives (up 93%, possibly because of secondary uses, such as acne) and attention deficit hyperactivity disorder (46%).

"It's good news that cough and cold prescriptions are down, given that they don't work and can have serious side effects," says Danny Benjamin, a professor of pediatric medicine at Duke University. In 2008, the FDA advised against them for the youngest children. But he says the rise in prescriptions for ADHD and off-label use of proton pump inhibitors for certain gastrointestinal disorders is worrisome. Safety of long-term ADHD drugs is unknown, he says. The study cites 358,000 outpatient prescriptions for lansoprazole (Prevacid) for infants, despite labeling that it is not effective in babies under 1 year.

Top Ten Enemies of Single Payer

Most people, when they arrive in Washington, D.C., see it for what it is – a cesspool of corruption.

Two reasonable reactions to the cesspool.

One, run away screaming in fear.

Two, stay and fight back and bring to justice those who have corrupted our democracy.

Unfortunately, many choose a third way – stay and be transformed.

Instead of seeing a cesspool, they begin seeing a hot tub.

The result – profits and wealth for the corporate elite – death, disease and destruction for the American people.

Nowhere does this corrupt, calculating transformation do more damage than in the area of health care.

Outside the beltway cesspool/hot tub, the majority of doctors, nurses, small businesses, health economists, and the majority of the American people – according to recent polls – want a Canadian-style, single payer, everybody in, nobody out, free choice of doctor and hospital, national health insurance system.

Inside the beltway cesspool/hot tub, the corrupt elite will have none of it.

They won’t even put single payer on the table for discussion.

Why not?

Because it will bring a harsh justice – the death penalty – to their buddies in the multi-billion dollar private health insurance industry.

The will of the American people is being held up by a handful of organizations and individuals who profit off the suffering of the masses.

And the will of the American people will not be done until this criminal elite is confronted and defeated.

(Remember, virtually the entire industrialized world – save for us, the U.S. – makes it a crime to allow for-profit health insurance corporations to make money selling basic health insurance.)

Before we confront and defeat the inside the beltway cesspool/hot tub crowd, we must first know who they are.

To wit, we present the Top Ten Enemies of Single Payer (listed here in alphabetical order):

American Association of Retired Persons (AARP). AARP, one of DC’s most powerful lobbying groups, has worked inside the beltway for years to defeat single payer. Why? AARP makes about a quarter of its money selling insurance through its affiliate, United Healthcare Group, the nation’s largest for-profit insurance company. AARP must defeat single payer – which if enacted, would wipe out that revenue stream.

America’s Health Insurance Plans (AHIP). The private health insurance industry. Public enemy number one. The health insurance corporations must die so that the American people can live. Of course, facing the death penalty, AHIP is the most aggressive opponent to single payer. No compromise with AHIP.

American Medical Association. With a shrinking base of doctors (only 25 percent of doctors nationwide belong) – the AMA is the most conservative of the doctors’ organizations. I just returned from a health care policy forum at the Center for American Progress. As usual, not one of the panelists mentioned single payer. Only during the question period did a self-identified patient/citizen ask the single payer question. And a pit bull-like Nancy Nielsen, president of the AMA, ripped into the questioner. “Sounds more like a statement than a question,” Nielsen said. “And clearly you have a point of view about that. And I don’t happen to share that point of view.” Clearly she doesn’t. But just as clearly, the majority of doctors, probably even a majority of doctors who belong to the AMA, support single payer. Nielsen is in denial and must be defeated.

Barack Obama. He was for it when he was a state Senator in Illinois. Now, ensconced in the corporate prison that is the White House, he says single payer is off the table. To get off the list, Obama needs to put single payer back on the table.

Business Roundtable. Dr. David Himmelstein, co-founder of Physicians for a National Health Program (PNHP), was at a health care forum a couple of years ago sponsored by the Business Roundtable. And the moderator asked the audience – made up primarily of representatives of big business – to indicate their preference of health care reforms. And the majority came out in favor of single payer. Why then is the Business Roundtable opposed? Himmelstein put it this way: “In private, they support single payer, but they’re also thinking – if you can take away someone else’s business – the insurance companies’ business – you can take away mine. Also, if workers go on strike, I want them to lose their health insurance. And it’s also a cultural thing – we don’t do that kind of thing in this country.”

Families USA. A major inside the beltway liberal foundation and long-time foe of single payer. It’s chief executive, Ron Pollack, was once an advocate for single payer. But no more. In November 1991, Pollack was at a Washington hotel debating Yale University professor Ted Marmor in front of then Arkansas Governor Bill Clinton. Marmor was making the argument for single payer. Pollack against. A November 1994 article in the Washington Monthly, co-authored by Marmor, reported the result this way: “After the two advocates finished, Clinton looked thoughtful, pointed to Marmor and said, �Ted, you win the argument.’ But gesturing to Pollack, Marmor recalls, the governor quickly added, �But we’re going to do what he says.’ Even considering the Canadian system, everyone in the room agreed, would prompt GOP cries of �socialized medicine’ – cries that the press would faithfully report.”

Health Care for America Now. The largest coalition of liberal groups promoting a choice between a public plan and private insurance companies. “They are saying – we can’t do single payer because Americans don’t want it,” said Kip Sullivan of the Minnesota chapter of PNHP. “That’s based on junk research conducted by Celinda Lake for the Herndon Alliance. It is bad enough to say we can’t do single payer because the insurance industry is too powerful to beat. But it is just plain insidious to say we can’t do single payer because the American people don’t want it. In fact, polling data indicates that two-thirds of Americans support a single payer system. And that level of support exists despite the fact that there is little public discussion about it.”

Kaiser Family Foundation. One of the most prestigious liberal inside the beltway think tanks on health reform policy. Saul Friedman is a reporter for Newsday. In February, Friedman wrote an article for Newsday arguing that single payer is suffering from a conspiracy of silence. And he says Kaiser is the most culpable of the co-conpsirators. Kaiser, funded initially by insurance industry money, regularly keeps single payer off the table, Friedman says. When single payer advocates released a study in January asserting that Congressman John Conyers’ single payer bill (HR 676) could create 2.6 million new jobs and would cost far less than the private insurance currently paid for by individuals and employers, “the Kaiser Family Foundation’s daily online report on health care developments at kff.org didn’t mention it,” Friedman reported. “Nor has Kaiser, the most comprehensive online source of health care information, made any mention of single-payer or the Conyers bill since it was introduced in 2003, despite widespread support for such a plan according to Kaiser’s own polls.” After a number of insistent inquiries, Kaiser told Friedman that they would publish charts in March comparing the Stark and Conyers bills. They never did.

The Lewin Group. The go-to consulting firm for health reform studies. The most recent study, released last week and widely quoted in the press, of the public plan option, showed that the insurance industry would lose 32 million policy holders if a public plan is enacted. Lewin’s health reform policy guru, John Sheils, told the Associated Press: “The private insurance industry might just fizzle out altogether.” What the mainstream press didn’t report was that The Lewin Group is a wholly owned subsidiary of Ingenix, which is in turn owned by UnitedHealth Group, the nation’s largest health insurance corporation. Lewin Group has conducted studies on single payer at the state level – and their studies consistently show that single payer is the most efficient cost saving system. But Lewin Group has never done a study on HR 676 – which would create a single payer for the entire country and drive The Lewin Group’s parent – UnitedHealth Group- out of business. When asked why Lewin Group never has done a study on HR 676, Sheils said – “the President didn’t propose single payer, did he?” No, he didn’t. That’s why he too is on this list. (Sheils says The Lewin Group has studied national single payer. He points to a recent comparison of the different health reform proposals floating on Capitol Hill – including one by Congressman Pete Stark (D-California). Stark’s bill would give every American the option of opting into Medicare. But that’s not single payer, because it keeps the private insurance industry in the game. Sheils counters that he modeled the Stark bill as single-payer. “The employer coverage option under the Stark bill is made so unfavorable that no employer would do it. We have everyone in Medicare, with the resulting savings.” Sheils says that of all the plans studied, the Stark bill saves the most money.)

Pharmaceutical Research and Manufacturers Association of America (PHRMA). PHRMA chief executive Billy Tauzin says that under single payer, the government would become a “price fixer.” By which he means, the government, as a single payer, will have the power to negotiate drug prices downward, thus costing the drug corporations millions in excess profits. In recent years, PHRMA has infiltrated liberal sounding groups like America’s Agenda – Health Care for All. PHRMA’s Vice President for Government Affairs and Law, Jan Faiks, now sits on the board of America’s Agenda and PHRMA contributes money to the group – which has worked in recent years to undermine single payer at the state level. (America’s Agenda Mark Blum won’t say how much money PHRMA gives to his group.)

We have met the enemy.

And they ain’t us.

Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter. He is also founder of singlepayeraction.org.

Many chain stores now add a toy aisle for adults

Store shelves at supermarkets, pharmacies and supercenters across the USA are making room for sex toys once reserved for adults-only eyes.

CVS, Walgreens, Kroger, Safeway, Target and Walmart are among major national chains that now include vibrators on store shelves. These devices (also known as personal massagers or vibes) have been around a long time, but their availability on the mass market is relatively new. Condom makers Trojan and Durex are among brands that have expanded product lines to include vibrators, starting with small vibrating rings. Durex launched its first handheld vibrator in 2008, Trojan in 2010.

"We're talking about the Walgreens and CVSes of the world � not the dot-coms and sex shops and things of that nature," says Durex senior brand manager Alan Cheung of the U.S. headquarters in Parsippany, N.J.

So why isn't anyone blushing?

With the erotic Fifty Shades trilogy still topping best-selling book lists and a movie (Hysteria) about the invention of the vibrator opening across the USA this week, the summer is starting out steamy. Sexperts cite a combination of factors, including marketing that targets average women. They also trace societal changes to 1998, when a Sex and the City episode broached the subject of vibrators. And in the early 2000s, Tupperware parties gave way to parties selling vibrators and sex toys.

"People are more comfortable than ever talking about vibrators and the idea of having one," says Bruce Weiss, vice president of marketing for Trojan, based in Princeton, N.J.

Even the fact that vibrators are the focus of a feature film illustrates how times have changed. Hysteria is a period comedy set in 1880s London.

"Couples are less willing to tolerate lousy sex," says sex therapist and clinical psychologist David Schnarch of Evergreen, Colo. "People have much higher expectations."

Websites that sell an array of paraphernalia designed to enhance the sexual experience include Liberator Bedroom Adventure Gear, which looks rather like a sexual Bed, Bath and Beyond. The Fifty Shades books prominently feature a sex playroom with whips, handcuffs and other sex toys, and now websites including Pure Romance and Babeland sell Fifty Shades-inspired wares.

Vibrator sales are increasing, show exclusive data provided to USA TODAY by Trojan. The research is by Nielsen, which tracks UPC-coded items scanned at food, drug and mass retailers, including vibrator rings and handheld devices. First-quarter numbers for 2012 count 318,840 vibrators (all brands) sold at retail outlets, excluding Walmart. That's $4.4 million worth of vibrators sold, up about 14% over the first quarter last year, Nielsen says.

Vibrator makers say they are responding to customer demand. About 53% of women and 45% of men have ever used a vibrator, suggests a 2008 online survey of 2,056 women and 1,047 men, ages 18-60, by the Center for Sexual Health Promotion at Indiana University in Bloomington. Funded by Trojan, it has resulted in a handful of academic papers in peer-reviewed journals, including two 2010 papers in the Journal of Sex & Marital Therapy, on vibrator use in relationships.

"Introducing a vibrator into a sexual relationship is now much more common in the U.S. and much less fraught with protecting a man's precious ego than it might have been 15 or 20 years ago," Schnarch says.

When a Job Disappears, So Does the Health Care

ASHLAND, Ohio � As jobless numbers reach levels not seen in 25 years, another crisis is unfolding for millions of people who lost their health insurance along with their jobs, joining the ranks of the uninsured.

The crisis is on display here. Starla D. Darling, 27, was pregnant when she learned that her insurance coverage was about to end. She rushed to the hospital, took a medication to induce labor and then had an emergency Caesarean section, in the hope that her Blue Cross and Blue Shield plan would pay for the delivery.

Wendy R. Carter, 41, who recently lost her job and her health benefits, is struggling to pay $12,942 in bills for a partial hysterectomy at a local hospital. Her daughter, Betsy A. Carter, 19, has pain in her lower right jaw, where a wisdom tooth is growing in. But she has not seen a dentist because she has no health insurance.

Ms. Darling and Wendy Carter are among 275 people who worked at an Archway cookie factory here in north central Ohio. The company provided excellent health benefits. But the plant shut down abruptly this fall, leaving workers without coverage, like millions of people battered by the worst economic crisis since the Depression.

About 10.3 million Americans were unemployed in November, according to the Bureau of Labor Statistics. The number of unemployed has increased by 2.8 million, or 36 percent, since January of this year, and by 4.3 million, or 71 percent, since January 2001.

Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits. On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.

Expanding access to health insurance, with federal subsidies, was a priority for President-elect Barack Obama and the new Democratic Congress. The increase in the ranks of the uninsured, including middle-class families with strong ties to the work force, adds urgency to their efforts.

�This shows why � no matter how bad the condition of the economy � we can�t delay pursuing comprehensive health care,� said Senator Sherrod Brown, Democrat of Ohio. �There are too many victims who are innocent of anything but working at the wrong place at the wrong time.�

Some parts of the federal safety net are more responsive to economic distress. The number of people on food stamps set a record in September, with 31.6 million people receiving benefits, up by two million in one month.

Nearly 4.4 million people are receiving unemployment insurance benefits, an increase of 60 percent in the past year. But more than half of unemployed workers are not receiving help because they do not qualify or have exhausted their benefits.

About 1.7 million families receive cash under the main federal-state welfare program, little changed from a year earlier. Welfare serves about 4 of 10 eligible families and fewer than one in four poor children.

In a letter dated Oct. 3, Archway told workers that their jobs would be eliminated, and their insurance terminated on Oct. 6, because of �unforeseeable business circumstances.� The company, owned by a private equity firm based in Greenwich, Conn., filed a petition for relief under Chapter 11 of the Bankruptcy Code.

Archway workers typically made $13 to $20 an hour. To save money in a tough economy, they are canceling appointments with doctors and dentists, putting off surgery, and going without prescription medicines for themselves and their children.

Archway cited �the challenging economic environment� as a reason for closing.

�We have been operating at a loss due largely to the significant increases in raw material costs, such as flour, butter, sugar and dairy, and the record high fuel costs across the country,� the company said.

At this time of year, the Archway plant would usually be bustling as employees worked overtime to make Christmas cookies. This year the plant is silent. The aromas of cinnamon and licorice are missing. More than 40 trailers sit in the parking lot with nothing to haul.

In the weeks before it filed for bankruptcy protection, Archway apparently fell behind in paying for its employee health plan. In its bankruptcy filing, Archway said it owed more than $700,000 to Blue Cross and Blue Shield of Illinois, one of its largest creditors.

Richard D. Jackson, 53, was an oven operator at the bakery for 30 years. Mr. Jackson and his two daughters often used the Archway health plan to pay for doctor�s visits, imaging, surgery and medicines. Now that he has no insurance, he takes his Effexor antidepressant pills every other day, rather than daily, as prescribed.

Another former Archway employee, Jeffrey D. Austen, 50, said he had canceled shoulder surgery scheduled for Oct. 13 at the Cleveland Clinic because he had no way to pay for it.

�I had already lined up an orthopedic surgeon and an anesthesiologist,� Mr. Austen said.

In mid-October, Janet M. Esbenshade, 37, who had been a packer at the Archway plant, began to notice that her vision was blurred. �My eyes were burning, itching and watery,� Ms. Esbenshade said. �Pus was oozing out. If I had had insurance, I would have gone to an eye doctor right away.�

She waited two weeks. The infection became worse. She went to the hospital on Oct. 26. Doctors found that she had keratitis, a painful condition that she may have picked up from an old pair of contact lenses. They prescribed antibiotics, which have cleared up the infection.

Ms. Esbenshade has two daughters, ages 6 and 10, with asthma. She has explained to them why �we are not Christmas shopping this year � unless, by some miracle, Mommy goes back to work and gets a paycheck.�

She said she had told the girls, �I would rather you stay out of the hospital and take your medication than buy you a little toy right now because I think your health is more important.�

In some cases, people who are laid off can maintain their group health benefits under a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1986, known as Cobra. But that is not an option for former Archway employees because their group health plan no longer exists. And they generally cannot afford to buy insurance on their own.

Wendy Carter�s case is typical. She receives $956 a month in unemployment benefits. Her monthly expenses include her share of the rent ($300), car payments ($300), auto insurance ($75), utilities ($220) and food ($260). That leaves nothing for health insurance.

Ms. Darling, who was pregnant when her insurance ran out, worked at Archway for eight years, and her father, Franklin J. Phillips, worked there for 24 years.

�When I heard that I was losing my insurance,� she said, �I was scared. I remember that the bill for my son�s delivery in 2005 was about $9,000, and I knew I would never be able to pay that by myself.�

So Ms. Darling asked her midwife to induce labor two days before her health insurance expired.

�I was determined that we were getting this baby out, and it was going to be paid for,� said Ms. Darling, who was interviewed at her home here as she cradled the infant in her arms.

As it turned out, the insurance company denied her claim, leaving Ms. Darling with more than $17,000 in medical bills.

The latest official estimate of the number of uninsured, from the Census Bureau, is for 2007, when the economy was in better condition. In that year, the bureau says, 45.7 million people, accounting for 15.3 percent of the population, were uninsured.

M. Harvey Brenner, a professor of public health at the University of North Texas and Johns Hopkins University, said that three decades of research had shown a correlation between the condition of the economy and human health, including life expectancy.

�In recessions, with declines in national income and increases in unemployment,� Mr. Brenner said, �you often see increases in mortality from heart disease, cancer, psychiatric illnesses and other conditions.�

The recession is also taking a toll on hospitals.

�We have seen a significant increase in patients seeking assistance paying their bills,� said Erin M. Al-Mehairi, a spokeswoman for Samaritan Hospital in Ashland. �We�ve had a 40 percent increase in charity care write-offs this year over the 2007 level of $2.7 million.�

In addition, people are using the hospital less. �We�ve seen a huge decrease in M.R.I.�s, CAT scans, stress tests, cardiac catheterization tests, knee and hip replacements and other elective surgery,� Ms. Al-Mehairi said.

This article is from the New York Times.

Ohio runner with cerebral palsy, 11, becomes YouTube hit

COLUMBUS, Ohio(AP)�When John Blaine realized 11-year-old Matt Woodrum was struggling through his 400-meter race at school in central Ohio, the physical education teacher felt compelled to walk over and check on the boy.

"Matt, you're not going to stop, are you?" he encouragingly asked Woodrum, who has cerebral palsy.

"No way," said the panting, yet determined, fifth-grader.

Almost spontaneously, dozens of Woodrum's classmates � many who had participated earlier in the school's field day � converged alongside him, running and cheering on Woodrum as he completed his final lap under the hot sun.

The race on May 16, captured on video by Woodrum's mother, is now capturing the attention of strangers on the Internet, many who call the boy and his classmates an inspiration to be more compassionate toward each other. A nearly five-minute YouTube video posted this week by the boy's uncle has received more than 680,000 views.

Woodrum, who has spastic cerebral palsy that greatly affects his muscle movement, said he had a few moments where he struggled.

"I knew I would finish it," said the soft-spoken Woodrum, who attends Colonial Hills Elementary School in suburban Worthington. "But there were a couple of parts of the race where I really felt like giving up."

It was his fourth race of the day, and one he didn't have to run. Only a handful of students opted to give it a try, said Anne Curran, Woodrum's mother. She said her son doesn't exclude himself from anything, playing football and baseball with friends and his two brothers.

"He pushes through everything. He pushes through the pain, and he pushes through however long it may take to complete a task," she said. "He wants to go big or go home."

The sometimes shaky footage shows Woodrum beginning the race on a steady pace with his classmates, though he quickly lags. As several students pass him on their second lap around the grassy course, Blaine walks over to make sure Woodrum is OK.

"The kids will tell you that Matt never gives up on anything that he sets out to do," said Blaine, who has been Woodrum's teacher since kindergarten. "They knew he would cross that finish line, and they wanted to be a part of that."

During his second lap and with Blaine by his side, Woodrum is suddenly joined by classmates encouraging him to keep going. Clapping and running by his side, the group begins to yell in unison, "Let's go, Matt! Let's go!"

Woodrum said he was surprised by his classmates' kindness.

"It was really cool and encouraging," he said.

As Woodrum reaches the finish line, the video shows the dozens of students bursting into applause, some throwing their arms and fists into the air before giving him a round of high-fives. Some congratulate him, and at least one kid is heard in the video proudly telling another that Woodrum is his friend.

"They treat him like every other kid," Curran said. "They're very great with him and they're like a second family to him."

Curran said her son doesn't dwell on his condition.

"He's been a fighter since day one, and I didn't expect anything less."

Blaine said no one knew a video camera was recording the race that day.

"It was so fitting that we were all together," he said. "Matt was a huge part of that race, his classmates were a huge part of that race. It was a magic moment."

Tele-ICU initiative improves care, increases employee satisfaction

HIGH POINT, NC – High Point Regional Health System has seen big benefits from a three-year tele-ICU pilot with St. Louis-based Advanced ICU Care, officials say – improving care while alleviating clinicians' workload.

High Point's intensivist-led team is based in the Advanced ICU Care Monitoring Center and receives constant information on the patient’s condition through sophisticated software that notifies them of any change in the patient’s health that might require immediate intervention, officials say.

Two-way video in the patient’s room can be activated to conduct a conference between the bedside care team and the Advanced ICU Care team at any time of the day or night. This constant surveillance improves patient safety and health outcomes by avoiding complications and adverse situations with prompt, proactive interventions.

Key to the High Point collaboration is the strong alliance between its staff and the Advanced ICU Care team, officials say. During the three-year partnership, this team has successfully implemented quality care initiatives for better patient management and safety measures to avoid potential complications that can occur in an ICU, such as blood clots, deep vein thrombosis, gastric ulcers and sepsis. A significant achievement is the implementation of an innovative “patient cooling” process for people with cardiac arrest. Patients who have received this treatment have awakened after the arrest with no cognitive impairment.

“Three years ago, we partnered with Advanced ICU Care to bring around-the-clock intensivist care to ICU patients in our community,” said Greg Taylor, MD, High Point's COO. “From a seamless implementation to the quality enhancements we continue to achieve, the collaboration between our hospital staff and Advanced ICU Care has been a success. We are able to offer our patients the highest level of care available in the ICU today and to continue to improve on that level of care every day.”

Research has shown that patients in intensive care do better when they are monitored around-the-clock by intensivists, physicians specially trained in critical care medicine. Constant surveillance by these specialists is now the recommended standard of care for hospital ICUs.

But a severe shortage of intensivists means it’s simply not possible for most hospitals to meet this standard and have intensivists on staff at the hospital at all times. Advanced ICU Care, the nation’s largest independent provider of tele-ICU programs, helps hospitals overcome this barrier and achieve optimal care in the ICU through a tele-ICU program combining sophisticated telemedicine technology, 24-hour-monitoring by Board-certified intensivist physicians and continuous quality improvement initiatives.

In addition to quality patient care initiatives and protocols, staff satisfaction and working conditions have improved since the implementation of the tele-ICU program, and High Point has seen a reduction in nursing turnover, officials say.

“Our nurses have really embraced this program," said Cindy Stewart, RN, director of critical care and cardiovascular services at High Point Regional. "Being able to speak with Advanced ICU Care in the middle of the night has improved employee satisfaction among our nursing staff. We find that when we recruit, many nurses have heard of remote monitoring, and they’re excited to learn something new.”

Physicians at the hospital say they're comforted that their ICU patients have an intensivist-led team available when they are not in the hospital, making sure their care plans are followed and available should any situation arise that needs immediate attention.

“The Advanced ICU Care program relieves the pressure of having to perform around-the-clock ICU coverage by existing staff and avoids burnout,” said intensivist Peter Brath, MD, medical director of High Point’s Intensive Care Unit and Respiratory Therapy. “There are more doctors available to provide weekend and night backup coverage. From a quality of life standpoint, it’s wonderful.”

“High Point has been a great partner and we are very excited by the strong results that we have been able to achieve together,” said Mary Jo Gorman, MD, CEO of Advanced ICU Care. “We feel very confident the hospital will continue to see additional benefits stemming from our collaboration, from improved patient care to staff satisfaction.”

All Routine PSA Tests For Prostate Cancer Should End, Task Force Says

Jose Luis Magana/AP

Terry Dyroff, at home in Silver Spring, Md., got a PSA blood test that led to a prostate biopsy. The biopsy found no cancer, but it gave him a life-threatening infection.

There they go again � those 17 federally appointed experts at the U.S. Preventive Services Task Force are telling American doctors and patients to stop routinely doing lifesaving tests.

Or at least that's the way some people look at the task force's latest guidelines on prostate cancer screening, which say doctors should stop doing routine PSA tests on men of any age. (The task force earlier recommended an end to testing of men over 75.) You can find the screening guideline in that current issue of Annals of Internal Medicine, along with editorials for and against it.

The American Urological Association pronounced itself "outraged" at the task force edict.

"It really is too extreme for them to say that all PSA testing should stop," fumes Dr. William Catalona, a Northwestern University urologist and PSA testing pioneer. "If all PSA screening were to stop, there would be thousands of men who would unnecessarily suffer and die from prostate cancer."

Catalona insists the evidence suggests routine PSA screening prevents as many as 40 percent of prostate cancer deaths by catching the disease when it's early and curable.

No way, says Dr. Michael LeFevre, a task force member who is professor of family practice at the University of Missouri.

 

"We think the benefit is very small," LeFevre told Shots. "Our range is between zero and one prostate cancer death avoided for every thousand men screened." By comparison, he says, the lifesaving benefit from colorectal cancer screening is two to 10 times higher.

LeFevre doesn't deny PSA screening saves lives. It's just that the benefit is much smaller than screening advocates think, he says. His best case: Widespread PSA testing might avoid between 1,400 and 2,800 prostate cancer deaths among 28,000 US men who now die of the disease. That's 5 to 10 percent.

"I don't want to take lightly any one of those lives," he says. "And if prostate cancer screening was harmless and nobody suffered the consequences on the opposite side, then I'd say, 'Well, why not?' But unfortunately, that's not the case."

Unintended Consequences

The task force says up to 20 percent of men screened every year for 10 years will get a result that sends them to the biopsy suite. When cancer is found, nearly 90 percent will have surgery, radiation or hormone therapy, and up to one-third will end up with urinary incontinence, impotence or bowel problems.

Death from prostate cancer is a worse harm, for sure. But the task force says most of the men treated for cancer found through PSA screening would never have had a problem with the disease if it hadn't been found.

"A goodly proportion of men who have localized prostate cancer actually have a disease that will never kill them if left alone," says Dr. Otis Brawley, the American Cancer Society's chief medical officer. "More than a million men were needlessly cured of their prostate cancer over the last 20 years."

Brawley says this notion � experts call it "overdiagnosis" � is hard for most people to grasp, including cancer doctors (or perhaps especially cancer doctors). "What the Preventive Services Task Force is suggesting is contrary to all our prejudices," he told Shots. "We've all been taught that the way to deal with cancer is to find it early and cut it out."

He especially hopes the new guidelines will put a stop to mass PSA screening by mobile vans at shopping malls and hospital-sponsored "health fairs."

Brawley has been beating that drum since 1997, when an especially candid hospital marketing director bragged to him about the financial advantages of his institution's free PSA screening sessions. He recounts the story in his recently published book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.

"The marketing guy was really proud of his prostate-cancer-screening business plan," Brawley told Shots. "If they screened 1,000 men at the mall ... they got 135 guys coming in [to the hospital's clinics] to figure out why they had an abnormal test. And they would end up collecting an average of $3,000 per guy off of that."

From there, many biopsies would reveal prostate cancer, and nearly all of them would have surgery or radiation, he says. The ones who got radiation, the marketer told Brawley, "reimbursed at almost $80,000 a guy."

"I asked him, 'How many lives will you save if you screen a thousand guys?' " Brawley recalls. "And he took his glasses off and looked at me as if I was a fool and said, 'Don't you know, nobody knows if this stuff saves lives? I can't give you an estimate on that.' "

Brawley says some PSA screening fairs are sponsored by the makers of diapers for incontinent adults, apparently because they know many men with abnormal PSAs will eventually suffer treatment-related urinary problems. "I don't know if screening saves lives, but I sure know it sells diapers."

A Matter Of Semantics?

Brawley is himself an expert in prostate cancer treatment. And as opposed as he is to indiscriminate mass screening, he says he's not against PSA testing if doctors and patients go into it with open eyes, after a frank discussion of potential harms and benefits.

But while he thinks the Preventive Services Task Force "got it right," he says it needs to do a better job of explaining itself. As in the mammography screening controversy of 2009, the task force's analytical language leaves it open to the charge that it's unsympathetic to men's prostate cancer fears and diagnostic dilemma � coldhearted even.

"I wish the task force's wording were a little bit more user-friendly," Brawley says.

Instead of saying that doctors should stop doing PSA "routinely," he says, maybe it should have said they shouldn't do them "automatically."

That leaves the door open to a doctor-patient discussion about the pros and cons. And that's exactly what the task force says it wants to do.

Diabetes diagnosis motivates reporter to change his life

A mile into my workout at the gym and I start dreaming of cake.

Chocolate cake with buttercream frosting that's chilled but not frozen � cold enough so the cake and frosting are firm and rich and so sweet that you can get lost in the flavor.

And French fries, crinkle-cut and just snatched from the deep fryer, so crispy that they almost snap when you take a bite. With buckets of ketchup on the side and a Blue Moon beer with a slice of orange to wash them down.

I could eat these things.

Then I would die.

Not right away, but sooner than I want to.

Before my children are grown and settled into lives of their own.

Before my grandchildren are born.

Before I have time to enjoy growing old with my beloved.

Eight months ago, a very nice nurse from my doctor's office called with the news that something was wrong with the blood work from a routine physical.

A normal fasting blood sugar level, taken after not eating for eight hours, should be around 80.

My fasting blood sugar was 243, just below the level that requires a trip to the emergency room. My hemoglobin A1C test � which looks at blood sugar over a three-month period � should have been under 7. My score was over 12.

That blood sugar test meant that I � like about 25.3 million other Americans, according to the American Diabetes Association� had diabetes.

Even worse, the high blood sugar had begun affecting my kidneys, putting me at risk for kidney failure in the future.

My body had become a ticking time bomb.

I had known for months that something was wrong. I was ill-tempered and flew off the handle at the slightest frustration. Once, while driving home from the East Coast, I began screaming at my wife in the parking lot of a Dairy Queen after eating a mocha Blizzard. God only knows what my blood sugar was at that point.

My eyes would not focus when I tried to read a book. Sometimes it felt like my blood was literally on fire. Every negative emotion � anger, fear, frustration, anxiety � was amplified.

I was becoming someone that my children were afraid of � someone called Angry Bob, who flew off the handle without any warning.

A complete transformation

A preacher once told me that the New Testament Greek word "metanoia" � which my Bible translates as "repentance" � really refers to a complete transformation or metamorphosis.

He said that it literally means to stop walking in one direction, to turn around, and begin walking the opposite.

Diabetes for me has meant that kind of transformation.

I had lived for years on fast-food cheeseburgers, coffee with extra sugar, fries and pasta � those were my four main food groups, with a side order of garlic bread.

The only exercise I got was walking from my car in the parking lot to my desk at work or from the couch to the fridge.

Today all that has changed.

The fast-food burgers and garlic bread have been banished, replaced by yogurt and bananas, salads made of carrots and baby spinach and romaine lettuce and sometimes goat cheese, fresh asparagus and apples, along with plenty of whole-wheat tuna wraps.

Every day, rain or shine, I walk two or three miles, and at least twice a week I go to the gym and run about a mile and a half.

At the beginning of June, I was down to 212 pounds � 40 less than when I was diagnosed and more than 50 down from my all-time high.

I am becoming, quite literally, a new man. I even started wearing my wedding band on the middle finger of my left hand so it doesn't fall off.

Before that call from the doctor's, I would not have believed that this kind of change was possible.

I felt terrible but was too overwhelmed with the pressures of life � work, raising a family, this never-ending recession � to do anything about it.

Getting diagnosed made the problem simple: Change now or die.

Walking every day

That change started with simple advice from my doctor, who told me to do three things.

Buy some comfortable shoes. Walk 20 minutes, three times a week. Pay attention to what you eat.

Those three small steps took what seemed to be an impossible task and put it into bite-size pieces.

I knew I couldn't change my life overnight. But even I could buy some shoes.

I did deviate a bit from the doctor's plan. Instead of three days a week, I walk every day, usually at lunch.

I mapped out a mile-and-a-half course from my office. Out the front door of The Tennessean, turn left on Broadway, left again on Seventh, up the hill, right on Charlotte, down the hill, left on 12th to the back door of the paper. On ambitious days, I can walk across the Cumberland on the pedestrian bridge and back to the office, for a two-mile route.

Three months in, my wife bought me some new pants and an iPod with a pedometer to keep track of how far I have walked. On June 10, I passed the million-step mark. I hope to log another million by the end of the year.

The hardest change to make was to take medication.

My doctor put me on an oral medication called Metformin. I started at 500 milligrams a day, then went up to 750 for three months. This past month, I went back down to 500 and hope to be medication-free at some point.

For now, if I don't take my medicine, Angry Bob comes back. And I don't want to be that guy anymore.

The great irony is that I feel better knowing I have diabetes than I did before my diagnosis, when I was sick and didn't know how near to death I was.

In the Old Testament book of Numbers, the people of Israel stand outside the Promised Land with their leader Joshua.

He gives them a choice: "This day I call heaven and earth as witnesses against you that I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live and that you may love the LORD your God, listen to His voice, and hold fast to Him."

So today I will choose life.

I will not eat cake.

Instead, I will wipe the sweat from my eyes and continue running as fast as I can into the future.

Contact Bob Smietana at 615-259-8228 or bsmietana@tennessean.com. Follow him on Twitter @bobsmietana.

Praying for Health Care Sanity

I admit it. I pray. I know there are intellectuals who are above such frivolity and for whom the showing of any belief in a power greater than one�s self and one�s intellect is the ultimate sign of weakness and inferiority. I don�t care. I am not weak, and just because I am not in the economic or intellectual class as some have identified that class does not mean my brain is inferior to anyone else�s.

I think a lot about cruelty and the power that the profit-making gods have over people in America today. And I work every day to support efforts to make the healthcare system less profit-driven and more humane. To do the work I do, I educated myself and have worked at least as hard intellectually and professionally as any of the elite class who hold so much power over the rest of us � not because they have earned that power, but because they have purchased it with cash, with cruelty and with blind ambition to control the lives of others.

Today, I pray. And for many American patients, prayer is one of the ways we try to steal ourselves against the traumas of an inhumane healthcare system run by the same profit-driven forces that control nearly every aspect of our lives every day. My insurance company has made my most recent cancer journey hell for me. For the past two months, the diagnostic efforts and now my treatment options have been second-guessed and delayed. But nothing else in life is delayed. So I pray. I pray my doctors have the wisdom and skill to work around Aetna�s demands (I am sure you could easily substitute your own insurance company�s name here), and I pray I can dance fast enough around all the other issues in life to keep everything steady through this process.

A few weeks ago I wrote that if this cancer ends up requiring some long, expensive fight for care and I will likely not be OK anyway, I will not spend the rest of my life fighting with an insurance company and begging for mercy. That has not changed. But I am not even yet to the point where I can make that decision � the insurance company has questioned every single test and every procedure though I have faithfully used their �preferred providers.�

I pray today, as many Americans patients do, that I wake up this afternoon and hear a good result, but that I won�t be left with hundreds or thousands in bills somehow. I pray, as many American patients do, that I won�t be seen in the wider world as damaged goods and unable to fulfill my other responsibilities. I pray, as many American patients do, not that I won�t hurt or die but that I won�t make others suffer because I couldn�t navigate the cruel system well enough even as I felt ill and needed help but didn�t dare ask for it.

Would this all be different if we had an improved, expanded, Medicare for all, for life, system? Of course it would. I would still pray. But I could stop praying for everything external to my healing and begin focusing all of my emotional, spiritual, and physical energy on fighting for health and well-being. And what a gift that would be.

So, you bet I pray today. I pray Aetna, cancer and those who think I am weak just get the hell out of the way. I pray for my doctors to help me heal, and I pray to just get on with my work. Oh, and I pray for small bills and that I�ll keep having the income I need to pay them. If we had Medicare for all for life, I�d be praying for strength and health. Simple prayers. Not too intellectual. Just me and my god, without interference from Aetna. Amen.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Vendor Notebook: AeroScout and Futura Mobility partner for RTLS

Futura Mobility has partnered with AeroScout to provide real-time location system (RTLS) technology to hospitals. With the partnership, officials say Futura Mobility will leverage AeroScout’s real-time asset management solutions that deliver location and status of mobile assets and equipment. Key components of the collaboration include temperature and humidity monitoring, patient flow and safety.

Allscripts announced that Summit Medical Group, the largest physician-owned multi-specialty practice in New Jersey, has signed a long-term contract for managed IT services. With Allscripts Managed Services, Summit will focus on its core mission of providing world class patient care while using IT to improve clinical, financial and operational outcomes, officials say.

HID Global announced the production release of its next generation EDGE EVO and VertX EVO controller platform that brings intelligence and decision-making to the door for advanced and highly customizable networked access control solutions. EDGE EVO and VertX EVO offer an open and scalable development platform for the deployment of a wide range of access control functionality, including remote management options, real-time monitoring, report generation and more.

triCerat unveiled the beta version of its Scanect software, a remote scanning technology for healthcare settings that speeds scanning without sacrificing quality or security.
 
SRS announced that Pittsburgh Bone & Joint Surgeons has selected the SRS EHR and PM to replace the system it originally purchased for its seven physicians. PBJS provides high-quality orthopaedic care to the Greater Pittsburgh area of Pennsylvania.

Allscripts announced that Evangelical Community Hospital, in Lewisburg, Pa., has selected its Sunrise EHR system. The hospital already uses Allscripts solutions for its outpatient electronic health record. The addition of the Allscripts Sunrise Clinical Manager solution will help the Hospital migrate its inpatient data and information to an electronic format and provide a seamless and integrated electronic information solution across the hospital, officials say.

Press Ganey Associates and the American Medical Group Association announced the launch of a survey designed to help accountable care organizations (ACOs) and high-performing health systems identify opportunities for improving both efficiency and quality. The AMGA-Press Ganey Coordinated Care Solution, assesses a patient’s entire episode of care and enables better management of population health to create positive patient outcomes and maximize shared savings.

Get Real Consulting announced the launch of the AARP Health Record. The application architected and developed by Get Real, is a secure web based solution designed to empower people over age 50 to manage and improve their own health. This application allows users to enter, store and edit their personal health information in a central location and to selectively share it with caregivers, family members, doctors and other healthcare providers.

InterSystems announced that it has entered into an agreement with Missouri Health Connection for InterSystems HealthShare to be the technology foundation for Missouri Health Connection’s (MHC) statewide health information network. MHC is the state-designated entity chartered to oversee development of Missouri’s statewide health information network.
 
Availity announced the launch of its suite of expanded clinical documentation capabilities, and that four major health plans, seven vendor partners, and multiple physician groups and hospitals are live and successfully utilizing these solutions across its network. The solution suite automates the costly, manual exchange of clinical information needed to support the revenue cycle, as well as emerging value-based payment models and quality improvement programs.

Outcomes Health Information Solutions announced the launch of MA365, a solution that actively drives quality results for Medicare Advantage plans year-round. Launched from a single data platform, MA365 is an integrated suite of solutions that identifies and resolves disparities in care for Medicare Advantage members with the goal of getting needed care for members while also impacting a Medicare Advantage health plan’s Star quality ratings.

MedeAnalytics announced the launch of its Employer Reporting Resource Center. As healthcare expenses have outpaced inflation and revenue growth, companies have struggled to understand the value of their relationships with full-service health plans. Created in response to growing interest by health plans looking to better serve their group and administrative services only (ASO) customers, this resource center has been created to serve as an educational service to the healthcare industry.

Pegasystems announced its next-generation product development and management solution that enables health plans to better meet industry and customer needs by reducing time to market for new insurance and wellness products amid growing healthcare complexity. Pega Product Composer System provides a customer-centric approach to developing and managing innovative healthcare products, supporting product design, approval, operational readiness and implementation.

New platform aims to make video easy for healthcare

SEATTLE, WA – Another cloud-based product made itself known to the healthcare industry on Wednesday. Experts say the platform will allow for efficient and affordable uploading, storing and distributing of videos on virtually any device. 

The product, dubbed mpx Essentials, was created by thePlatform, a video publishing company and independent subsidiary of Comcast. Previously focused on the entertainment industry, thePlatform is now extending its cloud-based product to the healthcare industry in hopes of procuring new success.

Tim Sale, director of technical sales and program leader of mpx Essentials, said he expects the product will take off, partly due to the increasingly ubiquitous nature of health information technology these days. 

“What we’re seeing is that healthcare providers are using video for a variety things, from virtual facility tours to patient education programs,” Sale said. “We think it will continue to expand,” because the product allows healthcare facilities to “provide a really high-end experience to their customers on any device – without requiring IT and without requiring a developer."

The product was created in response to the growing demand for cloud-based platforms, a technology catching like wildfire in the healthcare industry.

“More and more organizations are using video to communicate with their customers, employees and stakeholders, and their needs are rapidly evolving,” said Ian Blaine, CEO of thePlatform. 

Sale said he sees this product as a “business tool” for the healthcare industry without the need for web developers or IT professionals. “It’s not generally the focus of a healthcare service or provider to be in the business of managing video content or developing video players, so we think this product frees up resources to do other things and really simplifies how much time you spend on the service.”

Key features of mpx Essentials include: 

Ease of use: A Web-based console, with consistent blade-based navigation and customizable shortcuts; Increased video views: Mix and match play-lists with generated video lineups; Improve search and discoverability with metadata toolset and other features; Search-optimized feeds for Google and Bing, as well as a Connector for auto-publishing to a YouTube account;Custom video player designs: Choose dimensions, skins, colors, layers, social media integration (such as Facebook and Twitter), closed captioning support, and other third-party plugins; Playback across devices: Smart video players provide video playback on PCs, Macs, smartphones, tablets and other internet-connected devices;   Support: 24X7 customer support and content delivery network (CDN) services for storage and multi-bitrate streaming.

Ore. company recalls tainted lettuce amidst listeria concern

PORTLAND, Ore.(AP)�A Portland produce distributor announced it is voluntarily recalling bagged lettuce that could be tainted with listeria.

The Pacific Coast Fruit Co. said the lettuce was sold to Fred Meyer stores in the Northwest, and also distributed to a pair of companies that stock vending machines.

Pacific Coast Fruit bought the lettuce from River Ranch Fresh Foods of Salinas, Calif., which issued a nationwide recall on Monday.

No known illnesses have been linked to the recall that has also prompted stores to pull deli sandwiches.

Symptoms of listeria infection include high fever, headache and neck stiffness.

A press release on the U.S. Food and Drug Administration website (http://is.gd/WofHmX ) includes a list of the lettuce products recalled by Pacific Coast Fruit.

Coffee drinkers may live longer, study suggests

Coffee lovers are a loyal crowd. Most pour out their morning cup of java for the flavor, the aroma, and the accompanying jolt of energy, rather than the health perks.

So they may not mind if doctors debate new research suggesting that coffee lovers live longer.

According to an article in today's New England Journal of Medicine, those who drank coffee at the beginning of a 13-year study had a slightly lower risk of death than others, whether they chose decaf or full-strength.

Coffee drinkers also were a little less likely to die from specific causes: heart disease, respiratory problems, strokes, injuries and accidents, diabetes and infections. Coffee offered no protection against cancer.

Drinking two to three cups of coffee a day lowered the overall risk of death 10%, says the study, funded by the National Cancer Institute and AARP.

"It's interesting that coffee is more healthful than harmful," says Frank Hu, a professor at the Harvard School of Public Health, who has studied the health effects of coffee but wasn't involved in the new study.

Not so fast, says cardiologist Steve Nissen of the Cleveland Clinic, who also wasn't involved in the new research. Asking people about their coffee consumption only once in 13 years can be misleading, since drinking habits change. Nissen notes the study didn't include vital medical information that affects longevity, such as cholesterol or blood pressure levels.

"This study is not scientifically sound," Nissen says. "The public should ignore these findings."

Neal Freedman, the study's lead author, acknowledges that the design of his study prevents it from definitively proving that coffee affects longevity.

"We wouldn't recommend that anyone go out and drink coffee based on these results," Freedman says. But he says his study could provide some "reassurance" that coffee didn't seem to cut patients' lives short.

Scientists still have unanswered questions about coffee, which contains more than 1,000 compounds that can affect the risk of death, Freedman says.

Health Insurance Cutbacks Squeeze The Insured

Hide caption Amber Cooper lives in Modesto, Calif., with her son, Jaden, 5, and her husband, Kevin. She had a liver transplant when she was 10 years old and needs daily medication so her body won't reject her liver. Previous Next Deanne Fitzmaurice for NPR Hide caption When Amber's employer changed health care plans, she could no longer afford the blood tests that monitor her liver. She also had trouble paying for her medication. A charity, Healthwell Foundation, stepped up to help pay her health care costs. Previous Next Deanne Fitzmaurice for NPR Hide caption Jaden climbs into a kitchen cabinet, removing the food from the shelves so he can fit. Amber says she can't afford to buy him new shoes or clothes because of her health care expenses. Previous Next Deanne Fitzmaurice for NPR Hide caption After coming home from his job, Kevin works on a fence he is building around their home. The Coopers have stopped taking trips, eating out and spending money on anything else they don't need. Previous Next Deanne Fitzmaurice for NPR Hide caption Amber waits for her monthly blood test at a lab in Modesto. For several months she couldn't afford the tests, but then her company changed insurance again and she was able to resume them. Previous Next Deanne Fitzmaurice for NPR Hide caption The family tries to find entertainment at home � like letting Jaden play in the sprinklers and walking to a neighborhood park � to save money. Previous Next Deanne Fitzmaurice for NPR

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Amber Cooper and her husband were doing OK. They had jobs, a healthy 5-year-old son, a house in Riverbank, Calif., and health insurance from her job in the accounting department of a small manufacturing company.

Then one day everything changed.

"We were in a conference room ... and I had heard rumors but didn't know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in. It was devastating for me," Cooper said.

Devastating because the rumors � her worst fears � had come true. She was in that conference room for a meeting about her health insurance.

Cooper had a liver transplant when she was 10. She takes a drug twice a day so her body won't reject her liver.

 

"Every year my company changes the insurance. And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage," she said.

Cooper was stunned. Her anti-rejection medicine costs way more than she could afford on her own � more than $1,000 a month.

Cooper, 30, started a frantic search for help. Finally, she found the HealthWell Foundation, which was willing to pay for her medication. But she still couldn't afford the $300 blood test she needs every month to make sure she's not rejecting her liver.

"It is scary because the only way to tell if you're going to go into rejection is by the blood work. Your numbers will be a little bit crazy, and then the doctors will be like, 'OK, you need to get in and we need to check you out and make sure you're OK.' So I really took a risk not getting that blood work done. But I couldn't afford to get it done. I really couldn't," she said.

What happened to Cooper is happening more and more these days.

Health insurance has been changing dramatically "beneath the surface," said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. "In plain language, it's becoming skimpier and skimpier and less and less comprehensive."

Paul Fronstin of the Employee Benefit Research Institute says that is the trend nationally.

"Deductibles have gone up. Copays have gone up. You see cost-sharing for out-of-network services have gone up," Fronstin said. "It seems to have accelerated in the last few years. Health care is just continuing to take a bigger bite out of take-home pay."

So even people with insurance are paying thousands of dollars out of pocket before their insurance kicks in. And even when it does, insurance picks up less than it used to � often a lot less.

More than 1 in 5 Americans had a problem getting insurance to pay for a hospital, doctor or other health care in the past year, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Altman says this comes as many families are struggling to get by.

"This affects not only how people seek health care � they're more reluctant to get it if they can put it off. But it also affects family budgets in a very real way, especially as we're still coming out of recession and families are still crunched by a weak economy," Altman said.

Cooper's family has stopped taking trips, eating out, fixing up their house or spending money on anything else they don't have to. Their son gets by with hand-me-downs, she said.

"He's 5 and growing out of everything. I haven't been able to buy him any clothes and shoes. Those are things I haven't been able to purchase because of the increase in the health care," she said.

And Fronstin says the weak economy is driving more and more companies to cut back on coverage because of simple math: It's the only way they can keep up with rising health care costs.

"Employers are trying to manage those costs. They're trying to keep those cost increases as close to inflation as possible. And they're doing everything they can to get their workers so that they think twice about the health care that they are using," Fronstin said.

Cooper is just grateful she's getting her drugs every month. And she started those monthly blood tests again when her company changed insurance again this year. But it's still not as good as it used to be. So she and her husband don't go to the doctor when they get sick if they can avoid it. The same goes for their son.

"There were a couple of times where he got sick where I just tried to do the best I could with what I had, whether it was children's ibuprofen or cooling him down with cool rags and that sort of thing," she said.

She can't help but worry about the next company meeting about her family's health plan.

"It changes every year, so I really have no clue what's going to happen next year and with them making that change, I really don't know what to expect every year," she said.

List of top children's hospitals is guide to quality care

U.S. News & World Report says its ranking of best children's hospitals, out Tuesday, puts an emphasis on institutions with top care in at least one of 10 specialties. A total of 80 hospitals excelled in at least one area, but its honor roll focuses on a dozen that ranked high in at least three specialties.

Although the highest ranked centers, Boston's Children's Hospital and Children's Hospital of Philadelphia, also topped last year's chart, the criteria were a bit different in the list's fifth year.

Health rankings editor Avery Comarow says reputation still factors into which centers rank best, but it's a shrinking role. He says "for reasons that may or may not be justified," the most esteemed hospitals tended to overshadow less recommended centers that still offered top care.

"It's important to remember that these rankings are not for routine pediatric care," he says. "They're for kids who just need the ultimate in care and I think that most parents are willing to travel at least some distance for that."

Gillian Ray, the Children's Hospital Association public relations director, says the list is informative. However, parents shouldn't assume they can only receive quality care at one of the 12 top-tier hospitals.

"Before you think you have to travel across the country for the top care, make sure you know what's in your own backyard," Ray says. "There are children's hospitals in most major areas and most kids are within two or three hours of a children's hospital."

Ray says parents could ensure their local hospital can care for young patients by asking about staff (for instance, whether there are surgeons trained in pediatric care), and such medical equipment as kid-sized intubation tubes and needles.

Comarow says the list should provide parents with a starting point. If a hospital tells a family they do "a lot of work" in a difficult heart surgery, they should still ask for a full picture.

"You have to say, 'Well, what does that mean? What is a lot of work, who's the best person there and what success rate does she have? What's the death rate and what are the complications?' " Comarow says. "It's important to find the person who can give your child what he or she needs and there's no getting around the fact that that takes work and there's no shortcuts."

The full rankings and methodology can be read at www.usnews.com/childrenshospitals.

Docs adopt and adapt, yet still cling to old ways

ATLANTA – The technology takeover has begun, and physicians nationwide are acclimating one step at a time, a new physician survey reveals. Laptop, smartphone and iPad usage is increasingly common among U.S. physicians, but the report finds old-fashioned methods of communication continuing to stand their ground.

The second annual National Physicians Survey, conducted by the little blue book and Sharecare, polled 1,190 U.S. practitioners representing more than 75 medical specialties. It reveals physicians' perceptions about the ongoing changes in the healthcare system and how those changes are impacting their daily practices as well as their ability to provide optimal patient care. 

Two out of three physicians (66 percent) say the integration of electronic medical records (EMRs) is among their practice challenges. Despite that, most doctors (66 percent) acknowledge EMRs will at least improve or have a neutral effect on their future business.

Almost one out of three doctors (30 percent) are using laptops regularly for e-prescribing, EMRs and more. Almost a quarter (20 percent) are using smartphones, and 12 percent use iPads, for clinical needs.

Additional survey highlights:

Peer-to-peer communication is occurring via email – despite not being a "secure channel."Thirty-four percent of physicians communicate with other clinicians via email – not defined as a "secure channel" by HIPAA.Telephone (95 percent) and fax (63 percent) are still the primary forms of communication.A dinosaur in most other office environments today, the fax is still king with physicians, supporting hand-written notes, insurance forms and lab test result transmissions.Fifty-eight percent of doctors communicate with peers in person.Five percent use social networking sitesDoctor-to-patient communication remains fairly traditional, with some online inroads.The majority of physicians (91 percent) talk with patients via phone, 84 percent in person, 20 percent via email, 8 percent via personal health records (PHRs) and 6 percent via text.Few physicians are opting for solo practices these days -- a good portion are "employed" by hospitals, large practices or accountable care organizations (ACOs).Twenty-two percent of physicians are in ACO talks, up from 12 percent last yearOf those who said they were aware of ACOs, 37 percent stated that they would participate as a member of a group practice, 27 percent as a member of a physician-hospital organization, 10 percent as a hospital-employed physician.Only 17 percent of the respondents were unfamiliar with the ACO term, down from 45 percent last year.

Doctors say new patients find them via:

Word of mouth (71 percent)Practice networks referrals (33 percent)Print directories (29 percent)Internet searches (22 percent)

Despite an onslaught of healthcare regulations and requirements and shrinking practice margins, physicians are finding some advocates.

Forty-one percent say their state medical organization/society advocates for them. Thirty-nine percent say their national medical organization/society does.But 40 percent report "no one."

Still, overwhelmingly burdened by obtaining reimbursements from insurers (81 percent) and patient approvals (77 percent), most doctors (71 percent) believe the quality of healthcare will deteriorate over the next five years.

Fifty-five percent fear they aren't spending adequate time with each patient.Thirty-eight percent are concerned they aren't seeing enough patients in a day.

"Physicians today are practicing in a healthcare environment that they never could have predicted much less prepared for," said Keith Steward, MD, senior vice president of medical affairs at Sharecare. "This year's National Physicians Survey provides valuable insight into the frustrations and opportunities of the day-to-day management of practices, administration tools doctors use, and how communication with both colleagues and patients is evolving.

"Arming doctors with innovative solutions to ease administrative burdens is a top priority for the healthcare industry," he adds. "Doctors need to get back to what they were trained to do – provide their patients with the best care possible."

[See also: Docs believe EHRs safer than paper, but patients still ambivalent.]

Woman battling flesh-eating bacteria upgraded to 'good' condition

AUGUSTA, Ga. -- The medical condition of the Georgia woman suffering from a flesh-eating bacteria has been upgraded to "good," Aimee Copeland's doctors announced Monday.

The upgrade means that the University of West Georgia graduate student's vital signs are stable, that she is conscious and comfortable, and that her indicators are excellent, said Barclay Bishop, media relations manager for Doctors Hospital in Augusta, Ga.

The upgrade is another victory for Copeland, 24, who has been hospitalized since May 1, battling kidney failure and other organ damage after she began exhibiting symptoms related to the necrotizing fasciitis, or flesh-eating bacteria. She contracted the bacteria through a gash in her leg while riding on a homemade zipline over the Lower Tallapoosa River.

Copeland lost her hands, left leg and right foot to the disease. She was upgraded from "serious" to "good" condition less than two weeks after being upgraded from "critical" to "serious."

Copeland's recovery has attracted nationwide attention.

Andy Copeland, Aimee's father, told WXIA-TV on Monday that his family is encouraged by the many milestones his daughter has recently achieved. He said that Aimee even went outside in her wheelchair for the first time over the weekend.

In Aimee Copeland's case, the necrotizing fasciitis was caused by bacteria known as Aeromonas hydrophila, found in warm rivers and streams. Many people exposed to the bacteria don't get sick. Only a handful of necrotizing fasciitis infections caused from that strain of bacteria have been reported in medical journals in recent decades.

Flesh-eating bacteria emit toxins that destroy muscle, fat and skin tissue. The federal Centers for Disease Control and Prevention estimates that 550 to 1,000 cases of necrotizing fasciitis occur each year. About 1 in 4 patients dies.

In this week’s Health Wonk Review:

The June 22 edition of Health Wonk Review is posted now at Managed Care Matters, and�features columns from healthinsurance.org bloggers Maggie Mahar, Harold Pollack, and Henry J. Aaron.

They discuss the pending Supreme Court decision on the constitutionality of the Affordable Care Act and its individual mandate, the 2012 elections and what both will mean to the health reform law.

Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog.

In this week’s Health Wonk Review:

The June 22 edition of Health Wonk Review is posted now at Managed Care Matters, and�features columns from healthinsurance.org bloggers Maggie Mahar, Harold Pollack, and Henry J. Aaron.

They discuss the pending Supreme Court decision on the constitutionality of the Affordable Care Act and its individual mandate, the 2012 elections and what both will mean to the health reform law.

Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog.

Mayo Clinic partners with Benefitfocus on health and wellness

ROCHESTER, MN – Mayo Clinic announced Monday that its products and services would be made available through HR InTouch, a benefit management and employee communication portal developed by Charleston, S.C.-based Benefitfocus.

Through this alliance, Mayo Clinic and Benefitfocus will help employers create a more informed and healthy workforce by providing access to more than 3,500 content pieces and articles, newsletters and a 24/7 nurse line staffed by registered nurses, officials say.

In addition, employers can access the Mayo Clinic EmbodyHealth portal, an online tool combining smart Web technology with proven behavior change methods to improve lifestyle habits and reduce health risks for employees.

Officials say these new offerings will allow employers to manage the entire benefits lifecycle in one place, and provide employees seamless access to quality health information and tools.

"Our patients have told us they want a more convenient way to access Mayo Clinic care and expertise," said Paul Limburg, MD, medical director of Mayo Clinic Global Business Solutions. "As a result of this relationship with Benefitfocus, we will be able to reach out in a new way and potentially help many more people who could benefit from Mayo Clinic expertise in the medical and behavioral sciences."

"The demand for employee health and wellness programs continues to skyrocket as employers search for the most effective employee engagement tools," said Shawn Jenkins, Benefitfocus president and CEO. "Wellness programs that are designed and implemented properly can have a strong impact on controlling an organization's healthcare costs and improving employee health. The relationship with Mayo Clinic gives our clients the expert resources and proven methods needed to engage employees, promote healthy lifestyle choices and support long-term behavior change."