August 24, 2009 at 12:09 pm by Jonathan Kantrowitz
Dan Malloy has announced a plan for addressing the crisis facing Connecticut’s non-profit community providers.
The plan lays out three points that Malloy says will put Connecticut on a path to securing a more sustainable system of providers that can serve as a safety net for Connecticut residents in need:
· Establishing a Community Non-Profit Human Services Cabinet, and creating a new, Commissioner-level position to head that cabinet.
· Reforming the procedures Connecticut uses to reimburse and fund non-profit community providers.
· Moving non-profit providers to the top of the list of recipients for funding from the federal stimulus.
“For decades Connecticut has underfunded the vital non-profit providers that the state’s most vulnerable citizens rely on for help with developmental disabilities, mental illness, substance abuse, domestic abuse and much more,” said Mayor Malloy. “The only answer for this crisis is for Connecticut to begin to implement smarter, more sustainable reforms. It’s past time that we, as a state, started helping those who help.”
“The non-profit community which provides many of our state’s public services is in financial crisis – the state must develop a plan to support non-profits that is thoughtful and cost-effective,” said State Representative David McCluskey, Deputy Speaker. “Dan Malloy is working with non-profits to eliminate ineffective, duplicative and costly red tape and to creatively use existing state and federal resources to assist the non-profits in the vital role they perform for Connecticut. I am glad someone who is exploring a run for Governor is tackling this important issue.”
“I am pleased to work with Dan Malloy to reform the way we, as a state, interact with the private provider community,” said State Rep. Deb Heinrich. “The people who provide services to the neediest and most vulnerable in our state are hanging on by a thread. It is a crisis that has been years in the making. I am thankful that Dan recognizes the importance of true reform and has the courage to embrace real solutions, not quick fixes and gimmicks. This is a real benefit to our state, the providers and most importantly to the clients they serve.”
Quite a few research reports published in the last 2 weeks focus on good and bad food choices. I try to avoid the bad foods, not always with success, but make up for it by eating lots of the good foods (not great for weight loss, however.)
Here’s a summary of food related research published in the last 2 weeks. Other interesting research from the same time period follows.
Oxycholesterol may pose greatest heart disease risk
High levels of total cholesterol and LDL cholesterol (the so-called “bad” cholesterol) can increase the risk of heart attacks. Now scientists are reporting that another form of cholesterol called oxycholesterol — virtually unknown to the public — may be the most serious cardiovascular health threat of all.
Fried and processed food, particularly fast-food, contains high amounts of oxycholesterol. Avoiding these foods and eating a diet that is rich in antioxidants, such as fresh fruits and vegetables, may help reduce its levels in the body, the researchers note.
Scientists have known for years that a reaction between fats and oxygen, a process termed oxidation, produces oxycholesterol in the body. Oxidation occurs, for instance, when fat-containing foods are heated, as in frying chicken or grilling burgers or steaks. Food manufacturers produce oxycholesterol intentionally in the form of oxidized oils such as trans-fatty acids and partially-hydrogenated vegetable oils. When added to processed foods, those substances improve texture, taste and stability. Until now, however, much of the research focused on oxycholesterol’s effects in damaging cells, DNA, and its biochemical effects in contributing to atherosclerosis. This is one of the first studies on oxycholesterol’s effects in raising blood cholesterol levels compared to non-oxidized cholesterol.
Snack foods like popcorn and many popular breakfast cereals contain “surprisingly large” amounts of healthful antioxidant substances called “polyphenols.”
Polyphenols are a major reason why fruits and vegetables — and foods like chocolate, wine, coffee, and tea — have become renowned for their potential role in reducing the risk of heart disease, cancer, and other diseases.
Until now, however, no one knew that commercial hot and cold whole grain cereals — regarded as healthful for their fiber content — and snack foods also were a source of polyphenols.
Researchers have found another reason to eat well: a healthy diet helps prevent kidney stones. Loading up on fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages is an effective way to ward off kidney stones. Because kidney stones are linked to higher rates of hypertension, diabetes, increased body weight, and other risk factors for heart disease, the findings have considerable health implications.
New research shows that high-fat diets are just as unhealthful in the short term as they are in the long term: an immediate decreased ability to exercise and significant short-term memory loss.
Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases. In an examination of the association between adherence to a Mediterranean-type diet and cognitive performance and risk of dementia, researchers found that high adherence to the diet was associated with slower decline in some measures of cognitive function.
Elderly individuals who had a diet that included higher consumption of fruits, vegetables, legumes, cereal and fish and was low in red meat and poultry and who were physically active had an associated lower risk of Alzheimer disease
A summary of earlier, but still relatively recent food research can be found here:
Meanwhile, from the last two weeks:
Healthy lifestyle = reduced risk of chronic disease
Four healthy lifestyle factors—never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet—together appear to be associated with as much as an 80 percent reduction in the risk of developing the most common and deadly chronic diseases.
Numerous studies demonstrate that regular aspirin use is associated with a lower risk of colorectal adenoma (a benign tumor) or cancer. According to a study in the August 12 issue of J o u r n a l o f t h e A m e r i c a n Medical Association..men and women who were diagnosed with colorectal cancer and began regular use of aspirin had a lower risk of overall and colorectal cancer death compared to patients not using aspirin. Details here:
Humans might not be walking on Earth today if not for the ancient fusing of two microscopic, single-celled organisms called prokaryotes, NASA-funded research has found.
By comparing proteins present in more than 3000 different prokaryotes — a type of single-celled organism without a nucleus — molecular biologist James A. Lake from the University of California at Los Angeles’ Center for Astrobiology showed that two major classes of relatively simple microbes fused together more than 2.5 billion years ago. Lake’s research reveals a new pathway for the evolution of life on Earth. These insights are published in the Aug. 20 online edition of the journal Nature.
This endosymbiosis, or merging of two cells, enabled the evolution of a highly stable and successful organism with the capacity to use energy from sunlight via photosynthesis. Further evolution led to photosynthetic organisms producing oxygen as a byproduct. The resulting oxygenation of Earth’s atmosphere profoundly affected the evolution of life, leading to more complex organisms that consumed oxygen, which were the ancestors of modern oxygen-breathing creatures including humans.
“Higher life would not have happened without this event,” Lake said. “These are very important organisms. At the time these two early prokaryotes were evolving, there was no oxygen in the Earth’s atmosphere. Humans could not live. No oxygen-breathing organisms could live.”
The genetic machinery and structural organization of these two organisms merged to produce a new class of prokaryotes, called double membrane prokaryotes. As they evolved, members of this double membrane class, called cyanobacteria, became the primary oxygen-producers on the planet, generating enough oxygen to alter the chemical composition of the atmosphere and set the stage for the evolution of more complex organisms such as animals and plants.
“This work is a major advance in our understanding of how a group of organisms came to be that learned to harness the sun and then effected the greatest environmental change Earth has ever seen, in this case with beneficial results,” said Carl Pilcher, director of the NASA Astrobiology Institute at NASA’s Ames Research Center in Moffett Field, Calif., which co-funded the study with the National Science Foundation in Arlington, Va.
Founded in 1998, the NASA Astrobiology Institute is a partnership between NASA, 14 U.S. teams and six international consortia. The institute’s goals are to promote, conduct, and lead interdisciplinary astrobiology research; train a new generation of astrobiology researchers; and share the excitement of astrobiology with learners of all ages.
The institute is part of NASA’s Astrobiology Program in Washington. The program supports research into the origin, evolution, distribution and future of life on Earth and the potential for life elsewhere.
In a commentary written for the Opinion section of the June 26, 2007 edition of The Wall Street Journal, Senators Ron Wyden (D-Oregon) and Bob Bennett (R-Utah) referred to The Lewin Group as “the gold standard of independent, health-care analysis.”
The study is the first to examine the overall impact of the legislation on all stakeholders, and how the determination of who is eligible to participate in the “public exchange” made by the proposed Commissioner of Health Choices would affect premiums, coverage and spending for the federal government, state and local governments, private employers and consumers. Key findings, regardless of public exchange eligibility, include:
• The number of uninsured Americans would be reduced by 32.6 million;
• Hospitals that accept Medicare and public plan reimbursements would see payments for services reduced by an average 32 percent below what private insurers pay for the same treatment
• Likewise, payments for physician services would be reduced by an average 14 percent below what private insurers reimburse for the same treatment
• Premiums for a public plan would be an average of 20 percent less than private insurance premiums for families, and 25 percent less for individuals.
The analysis examined two scenarios that would result from a Commissioner’s determination of eligibility for the public plan option. In the first scenario, the Commissioner limits eligibility to individuals and employers with fewer than 20 workers. In the alternative scenario, the Commissioner permits all individuals and employers to enroll.
According to the report:
• Public plan enrollment would increase by 33.6 million (if the exchange was open only to small firms) to 103.4 million (if the exchange was open to all);
• Private plan enrollment would decrease by 34.9 million (if the exchange was open only to small firms) to 83.4 million (if the exchange was open to all);
• Between 2010 and 2019, if participation is limited to individuals and small firms, the legislation would cost the federal government $902.7 billion before tax increases and Medicare/Medicaid payment reforms, and $100 billion after those changes;
• If all Americans are permitted to participate in the public exchange, total cost to the federal government over the same ten year period, before offsets, would be $858 billion, and $55.3 billion after the changes;
• State and local governments would spend $67.8 billion less than they currently do if eligibility is limited to small firms, $158.3 billion less than they currently do if the exchange is open to all.
Rep. Raul Grijalva, D-Ariz., and Rep. Keith Ellison, D-Minn., both leaders of important House caucuses supporting a public insurance option, will join health care expert Jacob Hacker and Campaign for America’s Future co-director Roger Hickey on a conference call today to discuss a new report that details the reasons why growing blocs of House members refuse to support a health care bill without a public insurance option.
The report details how a strong public health insurance plan is critical to successfully achieving the goals of national health reform — lower costs, higher quality and guaranteed health security for all Americans. The paper evaluates the different proposals for health reform advancing through Congress for their potential to satisfy the president’s goals for health reform. Reps. Grijalva and Ellison will discuss efforts to secure a strong public health insurance plan. Hacker will discuss his new report, which details key elements of a strong public plan in the House and Senate bills and why an alternative proposal, insurance cooperative, are destined to fail.
August 19, 2009 at 11:34 am by Jonathan Kantrowitz
A group of some of the most distinguished health economists in the country has sent a letter to the President and Congress in support of the Administration’s proposal for the establishment of an independent board of doctors and health experts to guide Medicare policy. This Independent Medicare Advisory Council (IMAC) would make recommendations on Medicare reimbursement policy and other reforms – playing a critical role in allowing health care policy to adjust flexibly to a dynamic health care market, thereby helping contain costs and improve quality over time.
As the authors note, “a properly structured Independent Medicare Advisory Council (IMAC), with a congressional mandate and authority to do so, can reduce the rate of growth of health expenditures substantially.”
The signatories of this letter are household names to health policy wonks – Alan Garber, Jonathan Skinner, Joe Newhouse, and David Cutler to name just four – and they represent almost half of the Congressional Budget Office’s Panel of Health Advisers. Their support of the IMAC proposal underscores what most serious health analysts have recognized for some time: that moving toward a health system emphasizing quality rather than quantity will require continual effort, and that a key objective of legislation should be to put in place structures (like the IMAC) that facilitate such change over time. And ultimately, without a structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually rising health care costs will overwhelm the federal budget.
The Congressional Budget Office (CBO) analyzed proposals to shift more decision-making out of politics and toward a body like the Independent Medicare Advisory Council (IMAC) put forward by the Administration. CBO noted that this type of approach could lead to significant long-term savings in federal spending on health care and that the available evidence implies that a substantial share of spending on health care contributes little, if anything, to the overall health of the nation. This supports what President Obama has said all along: we can reduce waste and unnecessary spending without reducing quality of care and benefits.
CBO suggested that the proposal, with several specific tweaks that would strengthen its operations, could generate significant savings. (The potential modifications included items such as providing mandatory funding for the council, rather than having the council rely on the annual appropriations cycle, and requiring independent verification of the expected reductions in program spending rather than relying only on the Medicare actuaries for such verification, along with other suggestions, such as including an across-the-board reduction in payments as a fallback mechanism if the council did not produce proposals that generated adequate savings.) And if you look back at recent history, one can see why an empowered advisory council would be useful. For example, for the better part of this decade, MedPAC has recommended reducing overpayments to insurance companies for Medicare Advantage plans – to equate those payments with the cost of covering the same beneficiary under traditional Medicare. Yet, nothing happened, costing taxpayers tens of billions of dollars. We can’t afford that type of inertia.
The bottom line is that it is very rare for CBO to conclude that a specific legislative proposal would generate significant long-term savings so it is noteworthy that, with some modifications, CBO reached such a conclusion with regard to the IMAC concept.
August 19, 2009 at 10:21 am by Jonathan Kantrowitz
The health insurance purchasing co-ops proposed by Sen. Kent Conrad (D-ND) and a number of Senate conservatives have been tested and largely failed throughout the United States. History shows they would not have the market clout to leverage discounts and good policy choices with health insurers. Such co-ops could even become a path to gutting state consumer protection laws, according to the non-partisan Consumer Watchdog.
Co-ops have largely failed to provide health care savings for small businesses and the self-employed because they could not amass enough purchasing power to leverage better prices from the health insurance industry.(1) Health insurers, hostile to co-ops, have been free to ignore them and refuse to sell coverage.(2) Insurers’ hostility and neglect also prevented co-ops from offering a sufficient variety of plans with good benefits to attract a large enough group of members.
As described by Sen. Kent Conrad, the chief proponent of co-ops, state-based or regional co-op health plans would remain beholden to for-profit insurance companies for provision of coverage. Conversely, the proposed “public option” would allow business and individuals and small businesses to bypass the private insurance market altogether, if they chose, and avoid wasteful administrative costs and profits that are ten times greater than administrative costs of public health plans like Medicare.(3)
According to proponents, a health co-op would need 25,000 members to be financially viable, and at least 500,000 members to negotiate effectively with health care providers.(4) A 2002 report by the Commonwealth Fund described various reasons for the failure of previous co-op experiments, all related to lack of clout:(5)
The Florida Community Health Purchasing Alliances enrolled 92,000 people when enrollment peaked in 1998, had increasing difficulty attracting any but the smallest employers and gradually found themselves losing health insurers. As a consequence, enrollment also fell, and the purchasing alliance ceased operations in 2000.
The Texas Insurance Purchasing Alliance, begun in 1994, never reached the enrollment levels of the Florida effort, covering only about 1,000 firms and 13,000 people at its height. Difficulty in attracting employers led to the withdrawal of insurers, and the Alliance governing board ultimately decided that the operation was not viable and closed it down.
The Alliance in Colorado was the most recent failure. Established in 1995, the Alliance closed in the summer of 2002 after one of its three health plans withdrew from the state small-group market, a second capped enrollment, and the last decided to stop participating.
Wolf in Sheep’s Clothing: Eliminating State Insurance Regulation
Some lawmakers, led by Senator Mike Enzi (R-Wyo.), see co-ops as not just a weak pseudo-reform but as the insurance companies’ top prize: a vehicle to avoid state insurance regulation.
Under a similar plan authored by Enzi in 2006, state co-ops would have been exempted from state consumer protection laws. As a result, consumers would lose benefits such as a woman’s right to visit an OB/GYN, screenings for cervical and prostate cancers, newborn care, bans on “drive thru” deliveries, and guarantees of independent medical review if an insurer denies coverage for a medically necessary treatment. The plan would have also extended the Employee Retirement Income Security Act (ERISA) exemption from state common law to any company that sells these bare bones plans. If health insurers inappropriately denied claims, policyholders would be unable to collect damages. Enzi’s measure, S. 1995–the so-called “Association Health Plan” legislation–failed in the Senate in 2006, but Enzi continues to show strong interest in reviving it.
Enzi’s bill (S.1955), like Conrad’s co-ops, was touted as a way to insure more people but would in fact have eroded existing coverage for those who already had health insurance. Under it, any HMO or insurer could ignore state patient protections, courts and regulators to sell “junk” health insurance.
Shifting the Burden to the Middle Class
All of the bills being considered in Congress require Americans to buy private insurance policies. The fragmented co-ops, with a few possible large-state exceptions like California, would not be capable of protecting their customers from the worst insurance company abuses, including double-digit premium increases and other steady cost-shifting onto the middle class. Any effort by states to band together in regional alliances would raise a demand by insurers to be exempted from any state patient protections or controls.
Only a national public option would have the clout to bargain with providers and bypass the insurance companies altogether.
(1) See Elliot K. Wicks, Health Insurance Purchasing Cooperatives, Issue Brief, The Commonwealth Fund, November 2002, page 3-4.
(2) Id.
(3) Jacob S. Hacker, Ph.D., Case for Public Plan Choice in National Health Reform, Institute for America’s Future & U.C. Berkeley School of Law, December 2008, page 5.
(4) Robert Pear and Gardiner Harris, Alternate Plan as Health Option Muddies Debate, New York Times, August 17, 2009.
August 19, 2009 at 10:15 am by Jonathan Kantrowitz
Critics of health care reform argue that it would raise costs, reduce choice and lead to the rationing of care. But when it comes to end of life care which will account for increasing billions of the country’s health care dollars in the decades ahead as the baby boomers age rationing may not be as arbitrary and cruel as it sounds.
An amazing portion of a person’s life-time medical expenses are spent in the last 90 days if life, often on useless procedures, that at best will prolong a life that has no meaning. These procedures are provided out of habit, as a result of financial incentives, or through our failure to accept that death is a natural end to life.
“As the President stated in March, ‘The thinking on the public option has been that it gives consumers more choices and it helps keep the private sector honest, because there’s some competition out there.’
“We agree with the President that a public option will keep insurance companies honest and increase competition.
“There is strong support in the House for a public option. In the House, all three of our bills contain a public option, as does the bill from the Senate HELP Committee.
“A public option is the best option to lower costs, improve the quality of health care, ensure choice and expand coverage.
“The public option brings real reform to lower costs over the 10-year period of the bill.”
John D. Rockefeller IV (W.Va.) said that a public option, as the plan has become known, is “a must.” Sen. Russell Feingold (Wis.) said that “without a public option, I don’t see how we will bring real change to a system that has made good health care a privilege for those who can afford it.”
White House press secretary Robert Gibbs insisted Monday that there has been no change in President Barack Obama’s desire to see a public health insurance option be part of a healthcare bill.
Gibbs pushed back hard at reports the administration had abandoned its support for a public option one day after he and another official appeared to signal a shift.
The White House on Monday sought to allay concerns by emphasizing that President Obama still supported a so-called public option and had not decided whether to drop that concept to make legislation more palatable to moderate Democrats. The president will avoid committing to either path until at least next month, aides said, in hopes of keeping the issue from overtaking the entire health care debate…
David Axelrod, a senior adviser to Mr. Obama, said the president had “absolutely not” concluded that it would be impossible for a bill including a public plan to pass Congress. With lawmakers in recess and the president preparing for his own vacation at the end of the month, Mr. Axelrod said he expected discussions to resume in September.
