Tuesday, April 30, 2013

Caffeine-Laced Gum Has Energized The FDA

More From The Salt FoodCaffeine-Laced Gum Has Energized The FDAFoodWhy An Immigration Deal Won't Solve The Farmworker ShortageFoodMon Dieu! Fast Food Now Rules In FranceFoodIf TV's Your Cup Of Tea, Try A Character-Infused Blend

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Monday, April 29, 2013

As Health Law Changes Loom, A Shift To Part-Time Workers

April 29, 2013

Listen to the Story 4 min 39 sec Playlist Download Transcript   Enlarge image i

An employee serves customers at an Olive Garden restaurant in Naperville, Ill. In December, Darden Restaurants, the chain's parent company, said it won't rule out shifting full-time workers to part time to save on health care costs.

Scott Boehm/AP Images for Olive Garden

An employee serves customers at an Olive Garden restaurant in Naperville, Ill. In December, Darden Restaurants, the chain's parent company, said it won't rule out shifting full-time workers to part time to save on health care costs.

Scott Boehm/AP Images for Olive Garden

Nearly all of the remaining provisions of the new health care law go into effect next January, including one that requires businesses with 50 or more full-time employees to pay for their health care or pay a penalty.

Some businesses may already be making personnel changes to save money when that provision of the Affordable Care Act kicks in. One option on the table: shifting full-time workers to part time.

Duane Davis thinks that's what happened to him. He'd probably still be stocking clothing at the Juicy Couture store in New York City if he still got 30 to 40 hours a week of work like he used to. The work environment "was very cool," he says, and he liked his co-workers.

But Davis quit because he couldn't get enough hours. If he'd stayed and worked 30 or more hours a week, he would have been eligible for employer-paid health care starting next year. But earlier this year, Davis says, he was told he could work no more than 23 hours.

"If we were ever going over those hours, they'd tell us to go home. Because we were going over the amount of hours that we were given for the week," Davis says.

According to Davis, business wasn't down and there was plenty to do. But he says management seemed eager to shift its employee roster from majority full time to majority part time.

Davis has no proof, but he suspects it's because the company is preparing for the new health care law.

"It was crazy," Davis says of the hour limits. "I was always trying to understand � if you don't have hours to give out to part-time workers, why [are] you hiring new part-time workers?"

Shots - Health News Health Law Could Penalize Small Businesses With Part-Timers

For Employers, A Cost-Benefit Analysis

Shots - Health News Rising Health Costs Lead Companies To Drop Part-Time Benefits

Juicy Couture's parent company, Fifth & Pacific, didn't respond to requests for comment. But the Papa John's pizza chain and Darden Restaurants, which owns Red Lobster and Olive Garden, have both publicly stated they may reduce workers' hours to stay under the 30-hour-a-week limit.

Rob Wilson, president of the temp agency Employco, says he's observing similar shifts happening across his business.

"We're seeing it quite a bit," he says. "Instead of saying, 'I want one person for 40 hours a week,' [employers are saying], 'I'll take two people for 20 hours or 25 hours a week.'"

Wilson says the health care issue is also reshaping his own business. A typical temp working full time makes a gross profit of about $3,000 a year for Employco. But the cost to insure that person would come to $2,900.

That means just $100 in profit per employee before he advertises or pays his recruiters and his payroll department. "You can't survive on $100," Wilson says, "so you really have to pass that cost on."

In other words, Wilson will have to charge his clients more � if they are willing to pay. And from his perspective, this basic math adds up to a big labor market problem. "Your underemployed population in America is just going to go up dramatically," Wilson predicts.

But experts say it's not clear that this workforce shift is attributable to the health care law. Some say employers have been shifting employees more toward part time for years � especially in the retail and hospitality industries � to increase flexibility and minimize benefit costs.

Neil Trautwein, a vice president at the National Retail Federation, notes that the Affordable Care Act is just one of many cost considerations for employers. "The ACA doesn't become the determinative factor, but it does become a factor," he says.

A Shift With 'Hidden Costs'

Elise Gould, director of health policy research at the Economic Policy Institute, a liberal think tank, says the new provision won't affect most workers. But studies show about 2 million workers could potentially get fewer hours � and therefore remain without health insurance.

"Workforces that are based on part-time work, a lot of those workers already are not eligible," Gould says. But, she adds, "to the extent that they have some workers that are working, say, 32 hours a week, are they going to move them down? Absolutely. Those are the workers that are most at risk."

It's not clear that relying on more part-time workers to avoid health care costs is a financially sound tradeoff for employers. Carrie Gleason, executive director of the Retail Action Project, a worker advocacy group, says "there are tremendous hidden costs to having a large part-time workforce."

Scheduling workers will be a bigger headache if employers rely on more part-time workers, Gleason says. And there's more turnover, which increases a business's training and customer service costs.

"This is a massive growing retail sector. It's one of the few sectors that are actually creating jobs," Gleason says. "Yet it's creating this workforce that's really reliant on government support or going to the emergency room to get health care."

If employers get around paying for health care costs, Gleason says, it will simply shift the burden of cost elsewhere.

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Wednesday, April 24, 2013

Beyond Obamacare

How a Single-Payer System Can Save US Health Care

As Minnesota�s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans� administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system�s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation�s economy�twice that of other wealthy democracies�48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans�which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate �job lock,� in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system�up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

The Minnesota model

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for �state innovation waivers� to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont�s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

In Minnesota, two advocacy organizations�Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program�are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans�inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

This article originally appeared in the April 2013 issue of Minnesota Medicine.

Tuesday, April 16, 2013

Boston Doctors Compare Marathon Bomb Injuries To War Wounds

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Monday, April 15, 2013

Pretending To Be A 'Good Nurse,' Serial Killer Targeted Patients

April 15, 2013

Listen to the Story 30 min 40 sec Playlist Download Transcript   The Good Nurse

A True Story of Medicine, Madness, and Murder

by Charles Graeber

Hardcover, 307 pages | purchase

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In 2003, police in Somerset County, N.J., arrested a hospital nurse named Charlie Cullen who was suspected of injecting patients with lethal doses of a variety of medications. Cullen would turn out to be one of the nation's most prolific serial killers, murdering dozens, perhaps hundreds of people in nine hospitals over a 16-year period.

Journalist Charles Graeber spent six years investigating the Cullen case, and is the only reporter to have spoken with Cullen in prison. In his new book, The Good Nurse, Graeber pieces together the elements of Cullen's story.

"We'll never know how many people Charlie Cullen ultimately killed," Graeber tells Fresh Air's Dave Davies. "Charlie Cullen doesn't know how many people he killed. He initially could recall 40 and also said there was a large part of his life that was a fog during which he would have no ability to recall. But during that fog � those fogs lasted years � he said there were probably multiples a week."

Graeber � who has written for Wired, GQ and New York Magazine, among other publications � focuses not only on Cullen's tortured life and crimes, but on why Cullen wasn't stopped for so long, despite plenty of evidence he was harming patients. In case after case, Graeber writes, hospital staff believed Cullen was harming patients and pressured him to leave, but failed to alert state regulators or take other steps that might have ended his killing spree. Graeber has his suspicions of why the hospitals failed to report Cullen to the police, but stops short of directly pointing fingers.

He says that in writing the book he has tried "[to lay] it out so that a reader can see the facts laid side by side and decide for themselves the culpability of the hospitals, what they knew, when they knew, what they should have done; and certainly laws have changed in the wake of this."

One of the reasons that Cullen's crimes were so difficult to pinpoint is that human error and death are simply part of the hospital experience.

"Other incidents such as medication errors that are more routine, he had a lot of those as well," says Graeber, "and it's again difficult to sort out which ones were legitimate mistakes and which were simply the M.O. of murder. And more of those should have been reported; very few were, and the question time after time is, 'Should more have been reported?' Yes, absolutely. And you have to go hospital-by-hospital, case-by-case and really look at which incidents should have been reported."

Interview Highlights

On the actions of the hospitals

"The first actions you see time and time again at these hospitals is a legal action rather than an effective investigative reaction. And oftentimes, you'll find that what becomes � certainly in retrospect � to be a real burden of evidence against one guy ... when it starts to really look like this guy is dirty, that's the time he gets moved on one way or the other. He's pushed out or pressured out. So do the hospitals know? That's a question a reader needs to ask, and I think I provide enough evidence that they'll be able to draw that conclusion. But certainly he should have been stopped before he was, and because he wasn't, he killed a lot more people."

Medical student turned journalist Charles Graeber has written about science, crime and business for The New Yorker, Wired and New York Magazine, among other publications.

Gabrielle V. Allen/Twelve Books

On Cullen's troubled childhood, possible sexual abuse and his first attempt at murder

"When asked directly about abuse of that sort in the house he gets very angry. He has gotten very angry with family members, with ex-wives, when they've tried to get him to seek counseling, when they've tried to take him aside, because the pattern � it certainly seems to fit the pattern. He won't say, but he felt unsafe. There were strange men in and out of that house. He had a brother-in-law that came to live with one of his sisters when his sister was pregnant. There was a lot of domestic abuse surrounding that. Exactly what happened to the child is not clear. Eventually the sister ran away, but the brother-in-law stayed, and he and Charlie had a tortured relationship that Charlie had reported to at least one � if not two � of his later lovers that he'd tried to poison that brother's drink. He'd put lighter fluid in the vodka, which is sort of an early example of what would become his pattern for life: a way of passively dealing with things."

On Cullen's narcissism

"His thinking is circular, narcissistic and then the question is how far does that narcissism go? Is it sociopathic? And the answer to that lies somewhere in, well, you have to ask yourself, 'What sort of a person can kill someone and be there as they die and not have it seem to really affect their day at all, or in fact affect their future behavior in any negative fashion for 16 years?'"

On Cullen's hero complex

"Sometimes that's what worked for him. He knew what was wrong with a patient when no one else did. He could be the first to go in there. The other residents remember him jumping on the chest of a patient in just � the sort of � the most dramatic fashion. They appreciated his enthusiasm and his passion, but it seemed a little over the top. But the truth was he did what others could not do, and he did receive praise for that. It did elevate his status, and so there was absolutely an element of ego in the murders."

Read an excerpt of The Good Nurse

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Thursday, April 11, 2013

Rate of employer-based health insurance keeps dropping

From USA Today –

The availability of employer-sponsored insurance has fallen by about 10% over the past decade, which has spurred an increase in the overall number of Americans without health insurance, according to a report released today.

“This documents that in virtually every state across the country, there has been a steady decline in employers that provide coverage over the past 10 years,” said Andrew Hyman, director of the Robert Wood Johnson Foundation’s health care coverage team. “It would be a real stretch to say this was caused by anticipation of the Affordable Care Act,” President Obama’s 2010 health care law.

The universal coverage requirement and the state health insurance exchanges needed to make it work will start Jan. 1. Some employers have said they may drop health insurance because it would be cheaper to pay a $2,000 fine and have employees buy insurance through the exchanges instead of paying an average of $15,000 to buy that employee health insurance.

Other employers have said they will drop employees’ hours below 30 a week to avoid the requirement to provide insurance or pay a fee.

If so, employers would be following a trend that started before the health care law passed in 2010. The new study found that employer-sponsored coverage dropped from 69% to 60% between 1999 and 2010. The amount each employee paid annually for insurance more than doubled in that period from $435 to $1,056 for an individual and from $1,526 to $3,842 for a family.

The Johnson foundation’s State Health Access Data Assistance Center conducted the research.

Coverage also varied from state to state, based on state law, regional employment rates and average employer size.

Hyman said the steady decline in coverage has come in spite of changes in the economy and employment rates throughout the decade.

“So now we’re all wondering how it will change with the implementation of the ACA,” he said. The “silver lining,” he said, is that with the new law, even those who don’t receive coverage through their employer will be able to get a plan through the health exchange system.

Predictions vary on the law’s effects. The Congressional Budget Office says between 3 million and 5 million fewer people will have employer-subsidized insurance. A Towers Watson survey of more than 500 companies with more than 1,000 employees found none of the companies plan to drop insurance because of the law. A House Ways and Means Committee study found that 71 Fortune 100 companies said they could save $28.6 billion by dropping health insurance and paying the $2,000-per-employee fine.

However, health insurance brokers say their business clients are “staying the course” on their current health plans, said John Torinus, co-founder of Successful Entrepreneur Investors and who has served on several health care reform task forces. As a former CEO, he said he considered health coverage a benefit not just to the employee, but also to the employer.

In a presentation to the World Health Care Congress Wednesday, Torinus said corporations have the power to turn the tide of rising health care costs. Consumer-driven plans, as well as employers who help employees make good decisions about spending and lifestyle, are a better answer than dropping employees’ insurance. Healthy employees are more productive, take less time off and are happier.

He said more employers are offering health care at the workplace so they can ensure employees receive preventive checks to keep them healthy, the employer isn’t saddled with unnecessary referrals and procedures and the employee goes to a less-expensive, better-quality specialist when there are several options from which to choose.

Kent Bradley, senior vice president and chief medical officer of grocery store giant Safeway, proposed that employers could address the rising costs of Medicare by pushing back the time in a person’s life that he or she starts being unhealthy.

Employers are better able to provide incentives � employees at Safeway pay premiums based on their behaviors, and they can save up to $760 per person � as well as a supportive workplace to help people make healthy lifestyle choices. So rather than having a population of seniors dealing with chronic disease from obesity, such programs could stave off illness until a population turns 75 or older, he said.

Hyman said he expects employers to continue to offer insurance.

“I think, frequently, employers are thinking and projecting based on one or two factors,” he said. “But it will be interesting to see what they do with a range of considerations.”

Seniors In The South Are More Apt To Be Prescribed Risky Drugs

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Wednesday, April 10, 2013

Obama Budget to Include Cuts to Programs in Hopes of Deal

From the New York Times –

President Obama next week will take the political risk of formally proposing cuts to Social Security and Medicare in his annual budget in an effort to demonstrate his willingness to compromise with Republicans and revive prospects for a long-term deficit-reduction deal, administration officials say.

In a significant shift in fiscal strategy, Mr. Obama on Wednesday will send a budget plan to Capitol Hill that departs from the usual presidential wish list that Republicans typically declare dead on arrival. Instead it will embody the final compromise offer that he made to Speaker John A. Boehner late last year, before Mr. Boehner abandoned negotiations in opposition to the president�s demand for higher taxes from wealthy individuals and some corporations.

Congressional Republicans have dug in against any new tax revenues after higher taxes for the affluent were approved at the start of the year. The administration�s hope is to create cracks in Republicans� antitax resistance, especially in the Senate, as constituents complain about the across-the-board cuts in military and domestic programs that took effect March 1.

Mr. Obama�s proposed deficit reduction would replace those cuts. And if Republicans continue to resist the president, the White House believes that most Americans will blame them for the fiscal paralysis.

Continue reading…

With Plan B Ruling, Judge Signs Off On Years Of Advocacy

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Wednesday, April 3, 2013

The Hidden Limitations Of Health Savings Accounts

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