Monday, March 30, 2009

Health Care and Taxing Benefits

According to the New York Times, the Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system. The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as “the largest middle-class tax increase in history.” Most Americans with insurance get it from their employers, and taxing workers for the benefit is opposed by union leaders and some businesses. The idea of taxing medical insurance benefits, according to the Detroit Free Press, has long worried many lawmakers concerned that new taxes could jeopardize the employer-based health system most Americans rely on. Even now, the idea is fiercely opposed by many in Congress and many in organized labor.

According to the Washington Post, a Senate plan to overhaul the nation's health system is likely to include a new tax on some employer-provided health benefits that exceed the value of the basic plan offered to federal employees, currently about $13,000 a year for a family of four, the chairman of the Senate Finance Committee reported this week. Democrat Max Baucus of Montana said he is drafting the health reform measure, which he expects to unveil next week. He told reporters that taxing employer-provided benefits is "perhaps the best way to raise money for an overhaul of the health-care system" and offered details about the form that tax is likely to take. Baucus said his proposal is likely to cap benefits at "a level higher than the actual benefit that members of Congress receive today." An employer-provided plan worth less than that level would remain tax-free, he said, while any benefit exceeding the cap would be taxed as ordinary income. Such a tax, if adopted, would be phased in over "several years," Baucus said. And it would be likely to "grandfather" in health benefits set as part of a collective-bargaining agreement, he said, allowing union plans to remain tax-free until new contracts can be negotiated. Baucus declined to say how much money the proposal would generate.

According to the Washington Post, the nonpartisan Joint Committee on Taxation estimates that taxing employer benefits above the value of the Federal Employees Health Benefit Plan, adjusted for inflation, would generate nearly $420 billion over the next 10 years -- a sizable chunk of the $1 trillion or more likely to be needed to expand coverage for the uninsured. A higher cap and exemptions for unions would make the tax more politically palatable but would diminish the amount of money it would raise. Baucus said the sums under discussion remain "significant" but added that he is looking at a variety of other money-raising options, including Obama's plan to limit the value of itemized deductions for families earning more than $250,000 a year. At a closed-door meeting of the Finance Committee last month, the Joint Committee on Taxation also provided estimates for repealing the tax deduction for certain large medical expenses ($180 billion over 10 years), a new tax on flexible savings accounts and health reimbursement accounts (about $70 billion over 10 years), a new 3-cent tax on sugary drinks (about $50 billion over 10 years) and higher taxes on alcohol (about $60 billion over 10 years). A more dramatic proposal -- taxing half of all employer-provided health premiums -- would generate $1.2 trillion over 10 years, according to a memo provided to Finance Committee members. Baucus's comments came after a lunchtime meeting of Senate Democrats at which lawmakers began hashing out the complex details of a health overhaul. "This is the first week of crunch time," said Sen. Charles E. Schumer (D-N.Y.). "This is the first day when, instead of looking at the car, we're starting to test-drive it."

Democratic leaders in both the House and Senate yesterday continued to trickle out details of proposals without saying how they would raise the money, according to the Washington Post. The Senate Health, Education, Labor and Pensions Committee released an outline that would require the vast majority of businesses to contribute to workers' health costs and would impose tight restrictions on the practices of insurance companies. Like a developing House plan, it would include government-sponsored insurance for people who have trouble finding coverage on the private market -- an idea adamantly opposed by Republicans.

If Democrats could tax the air we breath, they would do it. The new tax legislation proposed to cover this mandatory health insurance plan is a crushing blow to American tax payers and the health care industry. Punishing tax payers and consumers in general to pay for a gargantuan national government health care system is typical of how Democrats and some Republicans view the value of Americans and our economic system. The absurdity of the taxes proposed to cover this new initiative harkens back to the day when Americans were taxed for drinking tea, the soft drink beverage of choice in the 1700's. That didn't go over too well. How ridiculous to mandate a policy that in its affect will cause hugely detrimental economic injury to the nation--businesses will be forced to let employees go because they cannot afford to keep workers, and the plan will reduce the purchasing power of all Americans. Plus, who is going to pay for it? Tax payers, not only now, but in generations to come.

Americans need to wake up, and shake up their elected representatives to let them know that the current political mess brewing in Congress known as national health care should be canned--immediately.

Until next time. Let me know what you think.

Thursday, March 26, 2009

Health Care and Food Poisoning

Food poisoning is a common, usually mild, but sometimes deadly illness according to eMedicineHealth. Typical symptoms include nausea, vomiting, abdominal cramping, and diarrhea that occur suddenly (within 48 hours) after consuming a contaminated food or drink. Depending on the contaminant, fever and chills, bloody stools, dehydration, and nervous system damage may follow. These symptoms may affect one person or a group of people who ate the same thing (called an outbreak). The Centers for Disease Control and Prevention (CDC) estimates that in the United States, food poisoning causes about 76 million illnesses, 325,000 hospitalizations, and up to 5,000 deaths each year. One of the most common bacterial forms of infection, the salmonellae organisms, account for $1 billion in medical costs and lost work time. Worldwide, diarrheal illnesses are among the leading causes of death. Travelers to developing countries often encounter food poisoning in the form of traveler's diarrhea or "Montezuma’s revenge." Additionally, there are possible new global threats to the world's food supply through terrorist actions using food toxins as weapons.

More than 250 known diseases can be transmitted through food according to eMedicineHealth. The CDC estimates unknown or undiscovered agents cause 81% of all food-borne illnesses and related hospitalizations. Many cases of food poisoning are not reported because people suffer mild symptoms and recover quickly. Also, doctors do not test for a cause in every suspected case because it does not change the treatment or the outcome. The known causes of food poisoning can be divided into two categories: infectious agents and toxic agents.
--Infectious agents include viruses, bacteria, and parasites.
--Toxic agents include poisonous mushrooms, improperly prepared exotic foods (such as barracuda), or pesticides on fruits and vegetables.
Food usually becomes contaminated from poor sanitation or preparation. Food handlers who do not wash their hands after using the bathroom or have infections themselves often cause contamination. Improperly packaged food stored at the wrong temperature also promotes contamination.

According to the National Institute of Health (NIH), most cases of food poisoning are from common bacteria like Staphylococcus or E. coli. Food poisoning tends to occur at picnics, school cafeterias, and large social functions. These are situations where food may be left unrefrigerated too long or food preparation techniques are not clean. Food poisoning often occurs from eating undercooked meats, dairy products, or food containing mayonaise (like coleslaw or potato salad) that have sat out too long. Infants and elderly people have the greatest risk for food poisoning. You are also at higher risk if you have a serious medical condition, like kidney disease or diabetes, a weakened immune system, or you travel outside of the U.S. to areas where there is more exposure to organisms that cause food poisoning. Pregnant and breastfeeding women have to be especially careful. The symptoms from the most common types of food poisoning generally start within 2 to 6 hours of eating the food responsible. Botulism is a very serious form of food poisoning that can be fatal. It can come from improper home canning.

You will usually recover from the most common types of food poisoning within a couple of days according to the NIH. The goal is to make you feel better and avoid dehydration. Drink any fluid (except milk or caffeinated beverages) to replace fluids lost by diarrhea and vomiting. Children should be given an electrolyte sold in drugstores. Don't eat solid foods until the diarrhea has passed, and avoid dairy, which can worsen diarrhea. If you have diarrhea and are unable to drink fluids (for example, due to nausea or vomiting), you may need medical attention and intravenous fluids. This is especially true for young children. If you take diuretics, you need to manage diarrhea carefully. Talk to your doctor -- you may need to stop taking the diuretic while you have the diarrhea. Medications should NEVER be stopped or changed without discussing with your doctor and getting specific instructions. For the most common causes of food poisoning, your doctor would NOT prescribe antibiotics. Antibiotics can actually prolong diarrhea and keep the organism in your body longer. If you have eaten toxins from mushrooms or shellfish, you will need to be seen right away. The emergency room doctor will take steps to empty out your stomach and remove the toxin.

To prevent food poisoning, according to the NIH, take the following steps when preparing food:
--Carefully wash your hands and clean dishes and utensils.
--Use a thermometer when cooking. Cook beef to at least 160°F, poultry to at least 180°F, and fish to at least 140°F.
--DO NOT place cooked meat or fish back onto the same plate or container that held the raw meat, unless the container has been thoroughly washed.
--Promptly refrigerate any food you will not be eating right away. Keep the refrigerator set to around 40°F and your freezer at or below 0°F. DO NOT eat meat, poultry, or fish that has been refrigerated uncooked for longer than 1 to 2 days.
--DO NOT use outdated foods, packaged food with a broken seal, or cans that are bulging or have a dent.
--DO NOT use foods that have an unusual odor or a spoiled taste.

The NIH also reports some other steps to take:
--If you take care of young children, wash your hands often and dispose of diapers carefully so that bacteria can't spread to other surfaces or people.
--If you make canned food at home, be sure to follow proper canning techniques to prevent botulism.
--DO NOT feed honey to children under 1 year of age.
--DO NOT eat wild mushrooms.
--When traveling where contamination is more likely, eat only hot, freshly cooked food. Drink water only if it's been boiled. DO NOT eat raw vegetables or unpeeled fruit.
--DO NOT eat shellfish exposed to red tides.
--If you are pregnant or have a weakened immune system, DO NOT eat soft cheeses, especially imported from countries outside the U.S.

The Mayo Clinic says to prevent food poisoning: Keep hot food hot and cold food cold. And keep everything — especially your hands — clean. If you follow these basic rules, you'll be less likely to become ill from food poisoning. And, according to the Center for Disease Control (CDC), a few simple precautions can reduce the risk of foodborne diseases:
1.) COOK meat, poultry and eggs thoroughly. Using a thermometer to measure the internal temperature of meat is a good way to be sure that it is cooked sufficiently to kill bacteria. For example, ground beef should be cooked to an internal temperature of 160o F. Eggs should be cooked until the yolk is firm.
2.) SEPARATE: Don't cross-contaminate one food with another. Avoid cross-contaminating foods by washing hands, utensils, and cutting boards after they have been in contact with raw meat or poultry and before they touch another food. Put cooked meat on a clean platter, rather back on one that held the raw meat.
3. CHILL: Refrigerate leftovers promptly. Bacteria can grow quickly at room temperature, so refrigerate leftover foods if they are not going to be eaten within 4 hours. Large volumes of food will cool more quickly if they are divided into several shallow containers for refrigeration.
4.) CLEAN: Wash produce. Rinse fresh fruits and vegetables in running tap water to remove visible dirt and grime. Remove and discard the outermost leaves of a head of lettuce or cabbage. Because bacteria can grow well on the cut surface of fruit or vegetable, be careful not to contaminate these foods while slicing them up on the cutting board, and avoid leaving cut produce at room temperature for many hours. Don't be a source of foodborne illness yourself. Wash your hands with soap and water before preparing food. Avoid preparing food for others if you yourself have a diarrheal illness. Changing a baby's diaper while preparing food is a bad idea that can easily spread illness.
5.) REPORT: Report suspected foodborne illnesses to your local health department. The local public health department is an important part of the food safety system. Often calls from concerned citizens are how outbreaks are first detected. If a public health official contacts you to find our more about an illness you had, your cooperation is important. In public health investigations, it can be as important to talk to healthy people as to ill people. Your cooperation may be needed even if you are not ill.

Food poisoning can be deadly. Make sure that you follow the common sense guidelines for keeping food safe so you don't have issues with food poisoning. It can be a huge interruption in your day if you get it, and recovery can take anywhere from a day or two, or more. Keep your hands clean before you eat, and store food in proper locations before and after cooking. Don't get sick.

Until next time. Let me know what you think.

Monday, March 23, 2009

Health Care and Stem Cell Research

Embryonic stem cell research is a hot topic among pro-life advocates because it involves the destruction of human embryos in order to obtain the stem cells needed, according to Culture and Media Institute. Until recently, federal monies were not available for funding research. A consensus exists that that such embryos are alive, according to They contain human DNA and are thus human life. The controversy over embryonic stem cell research centers on whether human life in the form of an embryo less than two weeks after conception is also a human person. If it is a person, then extracting stem cells constitutes first degree murder. If it is not a person, then removing stem cells is morally acceptable.

According to the UK Times Online, Embryonic stem cells are the body’s master cells. They were first isolated from animal embryos by a British scientist, Sir Martin Evans, in 1981. The first human embryonic stem cells were derived in 1998 by an American team led by Jamie Thomson, and scientists say these cells have the potential to provide replacement tissue to treat all manner of disorders. Some embryos are also created especially for research, and stem cells are generally extracted after five days’ growth. As embryonic stem cells divide indefinitely, a single embryo could provide the raw material for a colony or “line” of cells for use in treatment. Not every embryo produces a viable line so dozens are needed. Tissue from aborted fetuses is not used in embryonic stem-cell research, though it is used in other approaches to stem-cell medicine.

According to, stem cells are seen by many researchers as having virtually unlimited application in the treatment and cure of many human diseases and disorders including Alzheimer's, diabetes, cancer, strokes, etc. Stem cells come in three general types:
--Embryonic stem cells are a primitive type of cell that can be coaxed into developing into all of the 220 types of cells found in the human body (e.g. blood cells, heart cells, brain cells, nerve cells, etc). In the past, they have always been derived from human embryos in a process that causes the death of the embryos. However, new research is developing techniques to convert skin cells into Induced Pluripotent Stem Cells (iPS cells) that emulate embryonic stem cells.
--Adult stem cells bear some similarities to embryonic stem cells. Research using adult cells has a two decade head start on embryonic stem cells. Thus, potential treatments have already advanced to human trial stage. Unfortunately, adult cells are limited in flexibility, and are only capable of developing into a few of the cell types.
--Induced pluripotent stem cells are specially treated ordinary cells -- e.g. skin cells -- that are specially processed to exhibit some of the properties of embryonic stem cells. Research in this area is just beginning. However the process seems to offer the advantages of embryonic stem cells without the ethical and rejection problems.

Many pro-lifers believe that human life, in the form of an ovum and spermatozoon, becomes a human person at the time of fertilization according to They view the killing of any embryo in order to extract its stem cells to be a form of homicide. They are generally opposed to such research. Others disagree. They believe that an embryo has the potential to develop into a person, but is not a person itself. They note that an embryo is not sentient; it has no brain, sensory organs, ability to think, memory, awareness of its surroundings, consciousness, internal organs, arms, legs, head, etc. They feel that research using stem cells derived from embryos is ethical.

According to CNN online, Embryonic stem cells are blank cells found in four- to five-day-old embryos, which have the ability to turn into any cell in the body. However, when stem cells are removed, the embryo is destroyed -- which has made this one of the most controversial medical research fields in the past decade. Federal research funds were prohibited for embryonic stem-cell research until August 2001, when Bush approved spending for research using only already-existing cell lines. Scientists later discovered that fewer than two dozen of those lines were useful for research, but abortion opponents opposed any legislation that would lift Bush's restrictions, and Bush twice vetoed congressional efforts to roll back his rules. President Obama recently loosened the restrictions, which many researchers and advocates have complained severely set back work toward curing disease such as Alzheimer's, Parkinson's and diabetes. Federal regulators have cleared the way for the first human trials of human embryonic stem-cell research using federal tax monies.

Are there any alternatives? According to the UK Times Online many types of adult stem cell are being used in medical therapies: last year scientists reported the transplant of a whole organ, a section of windpipe, grown from these. Adult stem cells, however, are partially specialized, and so cannot provide every kind of tissue. Another option is to reprogram adult skin cells by manipulating genes, so they acquire the versatile properties of embryonic stem cells. These “induced pluripotent” stem cells have great potential, but many hurdles remain before they are ready for human trials.

Let’s talk about what embryonic stem cell research entails. According to CBS News online, the embryos are created in a lab through artificial insemination of an egg, usually for the purposes of in vitro fertilization. If this pre-implantation embryo is not used for fertilization, it can be used to create a stem cell “line.” This takes place within six days of insemination. Perhaps ten of those cells out of a clump of about 200 are used to create a stem cell line, which then – and this is crucial – can exist, in theory, forever, since the cells continue to split in perpetuity. The problem is that every time cell divides, there is a chance it accumulates defects – it’s not always a perfect copy of itself. Lines created prior to 2001, with the theory that they can perpetually split in perpetuity, are losing efficacy of use.

Because private creation of stem cell lines has continued since Mr. Bush’s decision, there are now roughly 1,000 stem cell lines in existence, according to CBS News online. (The exact number is nearly impossible to determine.) President Obama’s action means that federal funding can go to research on these 1,000 lines. The National Institutes Of Health, which accepts applications for research grants involving embryonic stem cell research, sets guidelines for the ethical use of these lines – ensuring, for example, that they were created with the proper consents. Many, however, still feel that the government is standing in the way of the full benefits of stem cell research. That’s because of something called the Dickey-Wicker amendment, which was first introduced in 1996 and is reintroduced every year. Dickey-Wicker makes it illegal to use federal funds for research “in which human embryos are created, destroyed, discarded, or knowingly be subjected to risk of injury or death greater than allowed for research on fetuses in utero.” In other words, even though federal funding can now go to the study of existing stem cell lines, government-funded scientists cannot create new lines, because they cannot create or destroy embryos. Because of the potential uproar inherent in not reintroducing Dickey-Wicker – it’s part of the appropriations bill each year – it is unlikely that Congress will elect to abandon the amendment.

According to CBS News online, there have also been breakthroughs with adult stem cells, which can theoretically be transformed into embryonic form – something embryonic stem-cell research opponents say means there is no longer a need to harvest stem cells from embryos. But while the research is promising, embryonic stem cell research backers say the adult cells are not an adequate substitute, and that embryonic stem cells are “absolutely the gold standard” for research purposes.

According to Focus on the Family online, embryonic stem cell research and the cloning of human embryos for research require the destruction of tiny, living humans – violating the sanctity of human life. Every human, in every condition from the single cell stage of development to natural death, is made in God's image and possesses inestimable worth. Our human nature – not our size, level of development, environment or functional capacity – gives us worth and dignity as human beings. Therefore, devaluing and destroying the life of a human embryo opens the door to the devaluing and destroying any human life. In addition to the moral problems, scientific concerns abound with embryonic stem cells. Embryonic stem cell research is often touted as the most promising option because these cells are a "blank slate" capable of changing into all of the body's cell types. However, less well known is that many types of adult stem cells have the same ability – often referred to as pluripotency. And now, with the advent of iPS cells (adult body cells reprogrammed to behave like embryonic stem cells), we have yet another source of flexible stem cells that do not require the destruction of young human life. Scientifically, embryonic stem cell research continues to hit research dead-ends. What was once hailed as the most promising option for curing a whole host of diseases (Alzheimer's, Parkinson's, diabetes) has yet to yield any human clinical trials. In fact, the only consistent news about embryonic stem cell research is overly hyped exclamations about great "breakthroughs." The status of stem cell research is clear. Morally problematic, life destroying embryonic stem cell research is losing ground as a possible option for treating disease. But ethical, scientifically sound non-embryonic stem cell research is providing real therapies and basic research.

Embryonic stem cell research will continue to be a hot button issue for years to come, especially when federal tax dollars are at stake. No one has the right to end human life no matter how disguised the explanation or excuse. Those who pursue the destruction of even the most basic of human creation have stepped onto a slippery slope toward the denial of life.

Until next time. Let me know what you think.

Thursday, March 19, 2009

Health Care and Health Information Technology

According to the Health & Human Services agency of the US federal government (HHS), health information technologies can be tools that help individuals maintain their health through better management of their health information. Health IT will help consumers gather all of their health information in one place so they can thoroughly understand it and share it securely with their health care providers so they get the care that best fits their individual needs. Health IT can help to improve public health one individual at a time by building partnerships between health care consumers and providers across the country.

Health information technology (Health IT), according to the HHS, allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:
--Improve health care quality;
--Prevent medical errors;
--Reduce health care costs;
--Increase administrative efficiencies;
--Decrease paperwork; and
--Expand access to affordable care.
Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including:
--Early detection of infectious disease outbreaks around the country;
--Improved tracking of chronic disease management; and
--Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.

However, according to, IT industry analysts widely agree that software implementations fail because of the customers. It’s too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer’s fault. In a recent survey, one group identified the following top reasons for IT implementation failures:
~40% attribute failure to poor planning and communication;
~20% cite mismanagement and rejection by end users; and
~15% blame overspending.
Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don’t want to use them, practice staff is stuck doing things “the old-fashioned way,” etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent. More detail is available online at about this issue and suggested steps to create a smooth, successful EMR implementation.

According to the Rand Organization, major issues exist with implementing HIT. Current market conditions place serious obstacles in the way of effective HIT implementation:
1.) Relatively few providers have access to HIT. Only about 20 to 25 percent of hospitals and 15 to 20 percent of physicians’ offices have a HIT system. Small hospitals and hospitals with half or more of their patients on Medicare are less likely to have HIT.
2.) Connectivity — the ability to share information from system to system — is poor. HIT implementation is growing, but there is little sharing of health information between existing systems. There is no market pressure to develop HIT systems that can talk to each other. The piecemeal implementation currently under way may actually create additional barriers to the development of a future standardized system because of the high costs of replacing or converting today’s non-standard systems.
3.) Finally, one of the most serious barriers is the disconnect between who pays for HIT and who profits from HIT. Patients benefit from better health, and payors benefit from lower costs; however, providers pay in both higher costs to implement HIT and lower revenues after implementation. Hospitals that use HIT to reduce adverse drug events also reduce bed-days — and reduced bed-days mean reduced hospital income.

Rand suggests that widespread adoption of HIT and related technologies, applied correctly, could greatly improve health and healthcare in America while yielding significant savings. A range of policy options could be used to speed the development of HIT benefits. They suggest that government action is needed; without such action, it may be impossible to overcome market obstacles. Their findings strongly suggest that it is time for government and other payors to aggressively promote the adoption of effective Health Information Technology. However, moving the American health care system forward to adopt HIT on a wholesale basis should be viewed primarily as a goal instead of a government mandate. Funding needs should come from both private and public resources to assist in the costs for this agenda.

According to the American Hospital Association (AHA), the work of hospitals is caring for patients. Every day America’s hospitals strive to improve the safety and quality of that care. Research has shown that certain kinds of information technology (IT) – such as computerized physician order entry (CPOE), computerized decision support systems, and bar-coding for medication administration – can limit errors and improve care. HIT also can be a tool for improving efficiency. While hospitals have been pioneers in harnessing HIT to improve patient care, quality and efficiency, the challenge now is to extend its use and integrate it into the routine care processes in all hospitals, big and small, in both rural and urban areas.

Increasingly, health information technology (HIT) is at the forefront of public and private sector efforts to improve healthcare safety, quality, and efficiency according to Clear and compelling evidence has emerged demonstrating that HIT can play a critical role in addressing the challenges faced by the U.S. healthcare system. The Federal government, a number of states, and private sector leaders at the national, state and regional level have responded with the introduction of a myriad of policies and strategies designed to improve the quality, safety and efficiency of healthcare through information technology. Congress is also playing a significant leadership role with bi-partisan support of the use of HIT to improve healthcare. The private sector has also demonstrated significant leadership with the emergence of several initiatives and programs designed to improve healthcare through HIT along with the rapid expansion in state, regional and community-based health information exchange organizations and initiatives. And, according to Science Daily, the federal government is poised to pour $19 billion into health information technology as part of the new economic stimulus package. has reported that HIT will be a primary focus in the following initiatives:
--Policy changes in the Medicare and Medicaid programs that will accelerate the adoption of HIT to address goals around healthcare quality, safety and efficiency;
--Policy goals and strategies introduced in a series of legislation introduced by Congress, and prospects and expectations of action during the remainder of the year;
--Financial incentives programs emerging in many parts of the U.S. which are sponsored by purchasers, business coalitions, health plans, and Medicare;
--Health plan, purchaser, and public sector payer experiences in leveraging HIT for chronic care and disease management programs;
--Strategies for HIT adoption utilized by state policy-makers in their role as purchaser, payer and regulator;
--Real-world experiences of leaders who are building multi-stakeholder collaborations in states, regions, and communities across the U.S. to speed adoption of HIT and health information exchange to support patient care.

According to a study by Kaiser Permanente as reported by Health Affairs, a comprehensive electronic health record can increase consumer convenience and satisfaction and provider efficiency while maintaining clinical quality, and that connecting patients directly with their care providers and giving online access to important medical information was critical in adoption of online tools. In addition to the convenience of fewer office visits and the benefits of faster resolution of health issues, e-mail messaging and scheduled telephone visits saved consumers the often overlooked out-of-pocket expenses for travel and parking, and time lost that would otherwise be spent at work or other pursuits. And, according to Science Daily, if implemented correctly, information technology (IT) systems -- including electronic health records -- have the potential to improve quality of care, increase efficiency and cost savings, reduce medical errors, and enhance continuity of care.

HIT is the wave of the future in medicine, but needs to be in place now. As more health care providers gear up for implementation, and the medical community moves toward using technology to reduce costs and improve the quality of care, consumers will benefit by experiencing lower costs and improved health care. Providers in the health care world will see better efficiencies and reduced liability, and insurance companies will experience more profitability as the cost to treat patients is reduced by decreased utilization and limiting unnecessary expenses. Although paper records will always be part of the equation, HIT will help eliminate the overabundance of duplicated hard copy files.

Until next time. Let me know what you think.

Tuesday, March 17, 2009

Health Care and Preemies

A group that tries to fight premature births and other problems in infants said that the cost of paying for one premature baby for a year is about the same as caring for 12 healthy, full-term babies as reported by Station KSBW in Santa Cruz, California. The March of Dimes, according to the report, said raising a healthy baby costs about $4,551 for the first year, including $3,800 paid for by insurance. A low birth-weight baby costs nearly $50,000, with insurance picking up $46,000. With about one in every eight babies born too soon in the U.S., the 543,000 preemies adds up to about $26 billion in spending each year.

According to the National Institute of Health (NIH), a premature infant is a baby born before 37 weeks gestation. The normal period for delivery is 40 weeks. At birth, a baby is classified as one of the following:
--Premature (less than 37 weeks gestation)
--Full term (37 to 42 weeks gestation)
--Post term (born after 42 weeks gestation)
1.) If a woman goes into labor before 37 weeks, it is called preterm labor. Often, the cause of preterm labor is unknown. Multiple pregnancy (twins, triplets, etc.) makes up about 15% of all premature births. The following health conditions and events in the mother may contribute to preterm labor:
--Heart disease
--Kidney disease
--Lack of prenatal care
--Poor nutrition
--Preeclampsia --the development of high blood pressure and protein in the urine after the 20th week of pregnancy
--Substance abuse
--Young age (a mother age younger than 18)
2.) A woman who has had any of the following is at increase risk of preterm labor:
--Premature rupture of the membranes or placenta previa
--Previous preterm delivery
--Problems with the uterus or cervix
--Unexplained high alpha-fetoprotein level in the second trimester
--Untreated disease or infection (such as urinary tract infection or infection of the amniotic membranes)

When premature labor develops and cannot be stopped medically, the health care team will prepare for a high-risk birth according to the NIH. The mother may be moved to a center that specifically cares for premature infants, for example, a neonatal intensive care unit (NICU). In some cases, medicines called steroids may be given to the mother in help the baby's lungs mature. When born, the baby is moved to a high-risk nursery. The infant is placed under a warmer or in an machine called an isolette, which controls the air temperature. Since infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation, your baby may have a feeding tube placed into the stomach. In very premature infants, nutrition may be given through a vein until the baby is stable enough to receive feedings by mouth. If the infant has breathing problems, a tube may be placed into the windpipe (trachea). A machine called a respirator will help the baby breathe. Oxygen is given. Nursery care is needed until the infant reaches a stable body weight and is able to feed by mouth and maintain body temperature. In very small infants, other problems may complicate treatment and a longer hospital stay may be needed.

According to, preemies have basic health needs:
1.) Warmth:
Premature babies lack the body fat necessary to maintain their body temperature, even when swaddled with blankets. Therefore, incubators or radiant warmers are used to keep the babies warm. Incubators are made of transparent plastic, and they completely surround an infant to keep him or her warm, decrease the chance of infection, and limit water loss. Radiant warmers are electrically warmed beds open to the air. These are used when the medical staff needs frequent access to the baby for care.
2.) Nutrition and Growth:
Premature babies have special nutritional needs because they grow at a faster rate than full-term babies and their digestive systems are immature. Neonatologists (pediatricians who specialize in the care of newborns) measure their weight in grams, not pounds and ounces. Full-term babies usually weigh more than 2,500 grams (about 5 pounds, 8 ounces), whereas premature babies weigh anywhere from about 500 to 2,500 grams. So, what are premature babies fed? Breast milk is an excellent source of nutrition, but premature infants are too immature to feed directly from the breast or bottle until they're 32 to 34 weeks gestational age. Most premature infants have to be fed slowly because of the risk of developing necrotizing enterocolitis (NEC), an intestinal infection unique to preemies. Breast milk can be pumped by the mother and fed to the premature baby through a tube that goes from the baby's nose or mouth into the stomach. Breast milk has an advantage over formula because it contains proteins that help fight infection and promote growth. Special fortifiers may be added to breast milk (or to formula if breastfeeding isn't desired), because premature infants have higher vitamin and mineral needs than full-term infants. Nearly all premature babies receive additional calcium and phosphorus either by adding fortifier to breast milk or directly through special formulas for preemies. The baby's blood chemicals and minerals, such as blood glucose (sugar), salt, potassium, calcium, phosphate, and magnesium, are monitored regularly, and the baby's diet is adjusted to keep these substances within a normal range.

According to the March of Dimes, preterm babies spend more time in the hospital than healthy babies do. Average length of hospital stays for a term infant for the first year of life in 2005: 2.3 days. Average length of hospital stays for a preterm infant in 2005: 14.2 days. Preemies also need more outpatient visits and prescriptions. Additionally, the emotional toll can be severe for the parents and all family members. When an infant arrives prematurely, the family faces a stressful new world. Often, the parents see the baby only for a moment before he or she is whisked away to the neonatal intensive care unit (NICU). Instead of taking home a healthy newborn, parents spend hours in the hospital, talking to all kinds of specialists. The medical equipment that is helping the baby is frightening. The doctors and nurses use clinical words that parents don't understand. And the busy, hectic atmosphere in the NICU is stressful. Often the mother, feeling lonely and sad, leaves the hospital before the baby does.Many preterm infants face life-threatening complications. Things can change very quickly. One day the baby appears to be doing well; the next, hope seems to be lost. Families with premature infants often refer to the NICU as a roller-coaster experience. Day-to-day life is completely disrupted. Parents spend hours in the NICU, away from their other children and their jobs. Sometimes the NICU stay can last for months, and often the facility is located miles from home. Families face financial stress as they struggle to pay the high NICU costs. Facing important decisions about their baby, families find that marriages and relationships are tested as never before. How do we share the time in the NICU? How do we manage the household? How do we find time for our other children and for ourselves? What do we tell others about the new baby? The baby's siblings may feel worried—and left out. How do we pay for all the expenses, and what about our insurance coverage? What about time off from work?

It's important to take your baby to your doctor's office soon after your preemie leaves the hospital, according to the American Association of Family Physicians (AAFP). Your doctor will check your baby's weight gain and find out how your baby is doing at home.Talk with your doctor about feeding your baby. Your doctor may recommend vitamins, iron and a special formula if the baby is bottle-fed. Vitamins are often given to premature babies to help them grow and stay healthy. Your baby also may need extra iron because premature babies often do not have as much iron stored in their bodies as full-term infants. After about 4 months of taking iron drops, your baby will have about the same amount of iron as a full-term baby. Your doctor may want your baby to take iron drops for a year or longer.Your baby may not grow at the same rate as a full-term baby for the first 2 years. Premature babies are usually smaller during this time. Sometimes they grow in bursts. They usually catch up with full-term babies in time. To keep a record of your baby's growth, your doctor can use special growth charts for premature babies. Your doctor will also want to know things like how active your baby is, when your baby sits up for the first time and when your baby crawls for the first time. These are things doctors want to know about all babies, not just premature babies.

The AAFP also recommends the following ways to care for your new preemie:
1.) Feeding schedule:
At first, most premature babies need 8 to 10 feedings a day. Don't wait longer than 4 hours between feedings, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to 8 wet diapers a day show that your baby is getting enough breast milk or formula. Premature babies often spit up after a feeding. This is normal, but you want to make sure that your baby is still gaining weight. Talk to your doctor if you think your baby has stopped gaining or is losing weight.
2.) Solid food:
Most doctors advise giving a premature baby solid food at 4 to 6 months after the baby's original due date (not the birth date). Premature babies are not as developed at birth as full-term babies are, so it may take them longer to develop their swallowing ability. If your baby has medical problems, a special diet may be helpful.
3.) Sleep Habits:
Although premature babies sleep more hours each day than full-term babies, they sleep for shorter periods of time. They wake up more often (and they wake you up more often!). All babies, including premature babies, should be put to bed on their backs, not on their stomachs. Use a firm mattress and no pillow. Sleeping on the stomach and sleeping on soft mattresses may increase your baby's risk of sudden infant death syndrome (SIDS), which is the sudden and unexplained death of an baby who is younger than 1 year old (usually while the infant is asleep, which is why it is also called "crib death").
4.) Vision and Hearing:
Crossed eyes are more common in premature babies than in full-term babies. The medical term for this condition is strabismus (say this: "straw-biz-mas"). Often, this problem goes away on its own as your baby grows and develops. Your doctor may want you to take your baby to an eye doctor if your baby has this problem. Some premature babies have an eye disease called retinopathy of prematurity (ROP), which is a condition in which the small blood vessels in the eye grow abnormally. ROP usually only occurs in babies who are born very early, at 32 weeks of pregnancy or earlier. If there's a chance your baby has ROP, your doctor will advise you to take the baby for regular check-ups by an eye doctor. ROP can be treated to help prevent vision loss.Premature babies are also more likely than full-term babies to have hearing problems. If you notice that your baby doesn't seem to hear you, tell your doctor so your baby can be checked for hearing problems. You can check your baby's hearing by making noises behind or to the side of the baby. If your baby doesn't turn his or her head, or jump at a loud noise, you should tell your doctor.
5.) Immunizations:
Immunizations (also called vaccines or shots) are given to premature babies at the same ages they are given to full-term babies. Your baby might be helped by getting a flu shot when she or he reaches 6 months of age. Premature babies might get sicker with the flu than full-term babies. Talk with your doctor about flu shots for your entire family. This can help protect your baby from catching the flu from someone in the family.

Premature babies require a huge commitment in time, care, expense, and love. They are very fragile in the first few hours and days and must be monitored around the clock for any health issues. Preemies need more attention than babies or children who have had a normal delivery. The premature baby is special and must be cared for with extra special devotion to their needs.

Until next time. Let me know what you think.

Monday, March 16, 2009

Health Care and COBRA

Employers will have to scramble to comply with federal legislation providing a federal subsidy of COBRA health insurance premiums to laid-off employees according to a recent report published by Workers who were laid off from Sept. 1, 2008, through Dec. 31, 2009, will be eligible for a 65% federal subsidy of their COBRA premiums under provisions in the massive economic stimulus bill.

According to the U.S. Department of Labor, the American Recovery and Reinvestment Act of 2009 (ARRA) provides for premium reductions and additional election opportunities for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. Eligible individuals pay only 35 percent of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider through a tax credit. The premium reduction applies to periods of health coverage beginning on or after February 17, 2009, and lasts for up to nine months for those eligible for COBRA during the period beginning September 1, 2008, and ending December 31, 2009, due to an involuntary termination of employment that occurred during that period. The TAA Health Coverage Improvement Act of 2009, enacted as part of ARRA, also made changes with regard to COBRA continuation coverage. More details about COBRA are available at .

According to, losing a job can be financially catastrophic. The impact of such a loss is often compounded by the concurrent loss of health coverage. Most people get their health coverage through the workplace: 61% of those under the age of 65 receive coverage through their jobs or through the job of a family member. As a result, when workers are laid off, they (and their families) often lose their health coverage as well. A recent study of multiple years of data from the U.S. Census Bureau regarding unemployment and insurance concluded
that, for each one percentage point rise in the unemployment rate, the number of uninsured
Americans rises by about 1.1 million. For unemployed workers and their families, lack of insurance can cause major problems. Many uninsured Americans delay or forgo needed medical care. As a result, uninsured adults are more likely than those with insurance to be diagnosed with diseases, such as breast cancer, when the diseases have reached an advanced stage. When uninsured Americans do get care, many end up with medical debt or have problems with medical bills. These problems include difficulty paying bills, being contacted by collection agencies, or having to change their way of life to pay medical bills. In fact, 61% of adults who were uninsured at some point in 2007 had medical debt or problems with medical bills.

According to, the American Recovery and Reinvestment Act of 2009 (the “Act”) defines eligible individuals as “Assistance Eligible Individuals” (AEI’s for short). AEI’s are employees (and their eligible dependents) who were/are involuntarily terminated for a reason other than gross misconduct between September 1, 2008 and December 31, 2009. The Act does not specify that an individual must have been a part of a Reduction in Force. AEI’s are NOT eligible if they are eligible for other group coverage (ex: through a spouse) or eligible for Medicare. Of those eligible for the subsidy:
--Current COBRA beneficiaries will become eligible for the subsidy on March 1, 2009.
--Current COBRA beneficiaries may also be given an opportunity to change to a lower cost plan if one is available to them through COBRA effective March 1, 2009, should the employer allow them to do so.
--COBRA qualified beneficiaries who have declined COBRA or who’s COBRA has ceased for non-payment will be given a one-time opportunity to elect COBRA with the subsidy for an effective date of March 1, 2009. However, coverage will not extend beyond what the original termination date would have been if COBRA had been elected as of the original qualifying event date.
--Must have a modified Adjusted Gross Income of less than $145,000 ($290,000 for joint filers).
--The subsidy is only available for the unpaid portion of the COBRA premium. Therefore, whatever is unpaid by the severance agreement will be subsidized 65% and the employee would pay the remaining 35%. If the employer as part of a severance agreement pays COBRA in full, the subsidy is not available.

According to the New York State Insurance Department, ARRA states that multi-employer plans and large employers with 20 or more employees will be responsible for paying the 65% subsidy. In such situations, the multi-employer plan or large employer will claim the payroll tax credit. In the case of small employers with fewer than 20 employees, the insurance company is responsible for paying the 65% subsidy. In such situations, the insurance company will claim the payroll tax credit. Eligible individuals can receive the subsidy for up to 9 months. The subsidy will end when the person is eligible for group coverage or Medicare, after 9 months of subsidy payments, or when the individual’s eligibility for COBRA coverage ends, whichever occurs first.
As soon as an individual receiving the subsidy is eligible for group health benefits, he or she must notify the entity administering the COBRA coverage of this or face a penalty equal to 110% of the subsidy amount. Individuals eligible for the subsidy will have sixty days from the date they receive notice of the subsidy to enroll in writing. Enrollment is not automatic. An individual must elect the subsidy.

When a worker loses health insurance through job loss, the option to pick up COBRA benefits has been cost prohibitive in most cases--especially if their is no new insurance coverage within the 18 months of availability to COBRA. The current administration has placed a huge burden on businesses to compensate 65% of the bill, although it does soften the blow for the ex-employee and his/her family. According to, business owners are warning that Obama administration efforts to help unemployed workers by subsidizing their COBRA health insurance premiums actually may harm their chances of getting what they need most: a job. Problematic COBRA regulations attached to the $787 billion stimulus plan now require businesses to “front” the cost for tens of millions in insurance premiums each month for workers who have lost their jobs. The growing controversy over the new rules may be only the first of many unintended consequences created by the Obama administration as it rapidly expands the size and scope of government.

Experts are warning that COBRA regulations intended to ease the burden on vast numbers of unemployed workers will also create more red tape and expenses for the very businesses that are expected to serve as the spawning ground for future U.S. job growth, according to Initially, the former employers of the laid-off workers are responsible for that other 65 percent. The federal government will reimburse employers for that 65 percent share, in the form of a tax credit deducted from payroll taxes that are due from employers each quarter. Companies will simply deduct the 65 percent owed to the government when they submit their payroll taxes. That might appear to be a win-win proposition. The early rumblings from the small-business community, however, suggest that it may hurt workers’ chances of finding new employment, by discouraging businesses from hiring. That’s because businesses will hire new workers knowing they may be required to pay 65 percent of workers’ health-insurance premiums, if they have to lay off the workers later. And the fact that the government will reimburse the 65 percent eventually isn’t sweetening the bitter medicine as much as the administration had no doubt expected.

According to, one major objection is that it asks businesses to advance what could be a substantial amount of money at a time when credit is tight and businesses are desperate for capital. Companies that advise smaller firms on their health insurance needs say they’re already hearing stories about how some employers will use the federal subsidy to lower their insurance costs – essentially gaming the system to take advantage of government subsidies. Extra costs, they say, will inevitably shift from employers to the taxpayers, who probably don’t want to pay others’ insurance premiums. The new COBRA hits hardest those firms that are struggling the most. It is backdated to Sept. 1, 2008. So if you laid off 10 workers that month because you were barely able to make payroll, and each of them has a $1,000 monthly health insurance premium, your monthly overhead would increase $6,500 – at least until you receive reimbursement. That does not include the additional paperwork and administrative costs.

Additional reasons that this new legislation is onerous for small businesses is noted by NewsMax:
1.) Paperwork and administrative costs associated with the program will substantially increase. The reason is simple: With premium costs plunging to 35 percent, many more employees are expected to opt for the coverage. The employer will be expected to contact the employee to collect their 35 percent portion of the premium each month. That may be a small issue for major employers, it could eat up precious time for mom-and-pop stores. For small businesses that don’t have a dedicated HR department, it’s a burden. It’s that much more paperwork. They’ve got to track down employees each month, they’ve got to collect money from you each month. Any small business will tell you it’s a pain. Also, the program requires an additional tax report to be filed with the IRS.
2.) Small firms that employ a limited number of people will be tempted to game the system. A business run by a husband and wife may “lay off” a spouse, thereby cutting the spouse’s insurance cost by 65 percent. Taxpayers would underwrite that discount.
3.) Some small firms will save money by taking employees off the books. A firm paying $500 to $1,000 per month for an employee’s insurance might let the employee go. That way you’ll get 65 percent of your health insurance paid, and you can go collect unemployment compensation.
4.) State COBRA plans may exacerbate market distortions. Massachusetts officials, for example, are planning to add their state plan to the federal COBRA subsidy of 65 percent. This will reduce insurance costs for unemployed workers to just 7 percent of premiums – far less than ordinary workers.
5.) The federal subsidy is supposed to last for only nine months of unemployment. But with reports filed on a quarterly basis, it may be difficult to track if a worker remains on the program beyond nine months. The government may say the subsidy only lasts 9 months, but there can easily be people collecting it the whole 18 months.
6.) Businesses may react to the subsidy by discontinuing their voluntary efforts to aid workers. For example, many companies now pay laid-off employees’ COBRA premiums for a few months to help ease the transition for jobless workers. With the government now picking up 65 percent of the tab, they may no longer find that an economically rational practice – again, thereby shifting more of the healthcare cost to taxpayers.
7.) Companies with seasonal hiring patterns may be affected disproportionately. In the Northeast, for example, there’s not much work for pavers, painters, and landscapers in the winter. Companies in those sectors could face a deluge of COBRA premiums on a seasonal basis, which at the very least will wreak havoc with cash flows.
8.) Also, some firms could actually accumulate more tax credits than they would owe in payroll taxes. How long it would take them to receive a reimbursement from the federal government for the additional amount is unknown. There is a special form they must complete to request the refund.

Overall, the law is not positive for business, and it is very confusing and costly to administer. Small business drives the American economy. It is the engine of financial and economic progress. With businesses already wary of the administrative hurdles involved in hiring new employees, and the prediction in the business community, according to, is that the new COBRA law will absolutely discourage the hiring of new workers. The COBRA premiums are the money they need for capital to make things happen to keep the rest of the people busy. It is just one more burden that the government has deemed to force on the small businesses in America. The current administration is looking for ways to "help" the common man, but only punishes him in the end by creating a bureaucratic and financial nightmare for those companies who are looking to hire new workers.

Until next time. Let me know what you think.

Friday, March 13, 2009

Health Care and Fibromyalgia

You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia according to the Mayo Clinic. Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain. Fibromyalgia occurs in about 2% of the population in the United States. Women are much more likely to develop the disorder than are men, and the risk of fibromyalgia increases with age. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event.

According to YourTotalHealth at, Fibromyalgia can make everyday tasks difficult and can even cause insomnia and depression. While there is no cure for fibromyalgia, learning how to manage your pain and fatigue is the key to living a full and active life. Fibromyalgia is a chronic musculoskeletal syndrome in which the central nervous system translates normally nonpainful stimuli into pain. A range of symptoms may occur, including widespread and localized pain, fatigue, sleep problems, and mood disturbances such as depression. These symptoms vary in intensity and come and go over time. Certain conditions, such as poor sleep, physical activity and anxiety, may aggravate the symptoms. Though fibromyalgia is not a progressive or life-threatening condition, it impairs quality of life. Patients often have other conditions including migraines, irritable bowel syndrome, TMJ disorder, or restless leg syndrome. Fibromyalgia mainly affects women. Its cause or causes are not known. There are many theories, including abnormalities in brain chemicals, infections, trauma and genetics.

Laboratory and imaging tests cannot identify the condition according to YourTotalHealth. The American College of Rheumatology has established two criteria for diagnosis: widespread pain and the presence of 11 of 18 specified tender areas known as trigger points. There is no known cure for fibromyalgia, but the symptoms can be treated. The U.S. Food and Drug Administration has approved one medication, an anticonvulsant, specifically to treat fibromyalgia. Also, antidepressants and analgesics may also relieve symptoms. Nutrition, exercise and sleep therapy can help. Some patients benefit from complementary treatments such as massage, acupuncture, relaxation techniques, or biofeedback.

According to WebMD, symptoms of fibromyalgia include:
--Chronic muscle pain, muscle spasms or tightness, and leg cramps
--Moderate or severe fatigue and decreased energy
--Insomnia or waking up feeling just as tired as when you went to sleep
--Stiffness upon waking or after staying in one position for too long
--Difficulty remembering, concentrating, and performing simple mental tasks
--Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
--Tension or migraine headaches
--Jaw and facial tenderness
--Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
--Feeling anxious or depressed
--Numbness or tingling in the face, arms, hands, legs, or feet
--Increase in urinary urgency or frequency (irritable bladder)
--Reduced tolerance for exercise and muscle pain after exercise
--A feeling of swelling (without actual swelling) in the hands and feet
--Painful menstrual periods

According to the National Fibromyalgia Association, Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized American College of Rheumatology (ACR) criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations. It is estimated that it takes an average of five years for an FM patient to get an accurate diagnosis. Many doctors are still not adequately informed or educated about FM. Laboratory tests often prove negative and many FM symptoms overlap with those of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out an FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.

According to YourTotalHealth, physicians often use fibromyalgia as a classic example of a central pain state, in which the cause of the pain cannot be identified in the local pain site and most of the processes resulting in pain occur at the level of the spinal cord and brain. However, the pain is not “imagined” or psychological. Some form of input from the pain site is required – even if it is as common as a touch, light or sound. In patients with fibromyalgia, these stimuli are misinterpreted as painful events. Fibromyalgia is considered a benign condition. It is not degenerative or deforming, nor is it life-threatening. Though the pain may be severe and may significantly reduce quality of life, fibromyalgia causes no lasting tissue damage. The symptoms associated with fibromyalgia may seriously affect competitive employment. Though most patients remain in the workforce, some claim disability. Doing so can be difficult, even when physicians agree that symptoms are severe enough to warrant aid.

Although fibromyalgia has been recognized by the Social Security Administration as a medically determinable impairment, a general misunderstanding and lack of education regarding it may cause many organizations and individuals to disregard the condition. The Arthritis Foundation reports that disability rates among fibromyalgia patients may be as high as 44%, according to YourTotalHealth. Fibromyalgia is the second most common disorder seen by rheumatologists and among the most common causes of widespread, chronic pain. According to the Arthritis Foundation, fibromyalgia affects an estimated 2% of the United States population – about 3.5 million Americans. Men and women of all races and ages, including children and the elderly, may be affected, but fibromyalgia occurs most often in women over the age of 30. According to the American College of Rheumatology, about 80% to 90% of those affected by fibromyalgia are women. Though uncertainty remains regarding the underlying cause, diagnosis and optimal treatment exist for fibromyalgia. Many professionals and researchers are making efforts to improve the quality of life for patients with fibromyalgia. Better ways to diagnose and treat this condition are being researched. In addition, remaining active as much as possible is a must for fibromyalgia patients.

Finding the right physician is crucial in treating fibromyalgia according to YourTotalHealth. An empathetic physician who understands the diagnosis and treatment of fibromyalgia and is willing to listen to and work with the patient is important. A family physician may send a fibromyalgia patient to a rheumatologist. Patients’ self-education is a key to better results. Individuals are encouraged to keep communication with their physicians open. It may help to make a list of everything that needs to be discussed and bring it along to appointments. All treatment options, including those individuals can do on their own, should be discussed with a physician. Also, proper exercise has been shown to decrease symptoms of fibromyalgia and reduce severity of symptoms. Striving for restful sleep is important in the treatment of fibromyalgia. Patients are advised to consult their physician before considering any complementary or alternative therapy.
Many fibromyalgia patients have trouble coping with their disorder. There are many means to help an individual cope with fibromyalgia or any other chronic illness. Psychological counseling may also help. Additionally, Fibromyalgia support groups can provide important information, encouragement and positive feelings.

Although Fibromyalgia is not life-threatening, it does interrupt and affect the quality of life when someone suffers from its symptoms. Getting the correct diagnosis by a medical provider can help assist in dealing with FM, and learning more about how to cope with it can be beneficial. Understanding how Fibromyalgia affects your body can alert you to a greater awareness of treatment options and lifestyle changes that will help ease the pain.

Until next time. Let me know what you think.

Wednesday, March 11, 2009

Health Care and Artificial Sweeteners

More than ever, people are consuming large amounts of sugar as part of their daily diet according to the Mayo Clinic. But in excess, sugar can take its toll. Eating large amounts of sugar adds extra calories, which can cause weight gain. So many people opt for artificial sweeteners — also referred to as sugar substitutes or low-calorie sweeteners — as a way to enjoy their favorite foods without as many calories.

According to eDocAmerica, Saccharin (Sweet 'N Low) was the first, and is perhaps the most controversial of the artificial sweeteners. In 1977, the FDA actually proposed banning saccharin because of studies indicating that it caused cancer in animals. The case for continuing its use was successfully argued in Congress and it was allowed to be used as long as products containing saccharin had a warning label. Saccharin then underwent additional study, and while a link with cancer in rodents was still evident, this link was felt to be related to a mechanism that wasn't relevant to humans. In May 2000, the U.S. Department of Health and Human Services removed saccharin from its list of cancer-causing chemicals. Currently, the warning label on saccharin-containing products is not required. The Center for Science in the Public Interest, however, considers it "highly imprudent" to remove saccharin from the list of potential carcinogens. In their opinion, additional study is necessary to confirm the safety of a product potentially affecting "tens of millions" human beings.

Aspartame (Equal, NutraSweet) is another artificial sweetener according to eDocAmerica. Like several other artificial sweeteners, aspartame has been suspected of having links to cancer. In the mid-1990's a concern was expressed that aspartame may be responsible for a rise in the incidence of brain cancer in the United States. The National Toxicological Program of the U.S. Department of Health and Human Services conducted animal studies to investigate this concern and found no link between aspartame and cancer. Later, in 2005, a European group reported that aspartame was responsible for causing leukemia and lymphoma in laboratory rats. Following a re-evaluation of the data, the European Food Safety Authority (EFSA) refuted this conclusion. In a 2006 study, U.S. National Cancer Institute researchers studied a large number of adults 50 to 69 years of age over a five-year period and found no evidence that aspartame posed any risk. At this time, the Food and Drug Administration considers aspartame to be safe. The watch dog group, Center for Science in the Public Interest, however, isn't so convinced. They have recommended additional study to evaluate its safety.

According to eDocAmerica, Acesulfame-K (Sweet One, Sunette, and Sweet 'n Safe) Although ascesulfame-K is approved by the FDA, the jury seems to be out in regard to the safety of this sweetener. Most of the studies evaluating its potential for causing cancer have been criticized because of methodological flaws. Two studies involving laboratory rats, however, did suggest that the additive could cause cancer. This compelled the Center for Science in the Public to urge the FDA to require better testing before permitting the use of acesulfame-K. Its manufacturer, Hoechst, a German chemical company, points out that almost 100 studies have been conducted on acesulfame-K and that it has consistently been shown to be safe for human consumption. It is currently being used in more than 5,000 food, beverage and pharmaceutical products in over 100 countries around the world. Neotame, the sweetest of all the artificial sweeteners, is used much less than the others. It was approved by the U.S. FDA in 2002. Neotame is produced by the same manufacturer of aspartame (NutraSweet Co.) and is chemically similar. One important difference between the two is that since it is not metabolized into phenylalanine, it is considered to be safe for those with pheylketonuria (PKU). While the Center for Science in the Public Interest gave its cousin, aspartame an "avoid" rating, perhaps because only tiny amounts of neotame are needed to sweeten foods, it has received a "safe" rating.

Sucralose (Splenda), according to eDocAmerica, is another artificial sweetener. At one time, its manufacturer (McNeil Nutritionals) used the slogan "made from sugar, so it tastes like sugar" to market sucralose. In its production, the sugar used is so chemically altered, however, that the US Sugar Association was able to require them to stop using this slogan. While artificial, and in spite of concerns posted on the internet, the Center for Science in the Public Interest considers it to be safe. Perhaps the most concerning aspect of sucralose is that it contains chlorine, a known carcinogen. Despite this, no studies to date have demonstrated a link between sucralose and cancer. The FDA reviewed studies related to sucralose and determined that it does not pose carcinogenic, reproductive, or neurological risk to human beings. A number of symptoms including bloating, diarrhea, nausea, hives, wheezing, cough and depression have been attributed to sucralose ingestion, but again, none of these have been confirmed in scientific studies. Its safety may, to some degree, be due to the fact that less than a quarter of the sucralose consumed is actually absorbed through the gastrointestinal tract. From available data, sucralose appears to be the safest of the available artificial sweeteners.

According to the Mayo Clinic, artificial sweeteners are chemicals or natural compounds that offer the sweetness of sugar without as many calories. Because the substitutes are much sweeter than sugar, it takes a much smaller quantity to create the same sweetness. Products made with artificial sweeteners have a much lower calorie count than do those made with sugar. Artificial sweeteners are often used as part of a weight-loss plan or as a means to control weight gain.
People with diabetes may use artificial sweeteners because they make food taste sweet without raising blood sugar levels. But keep in mind that if you do have diabetes, some foods containing artificial sweeteners, such as sugar-free yogurt, can still affect your blood sugar level due to other carbohydrates or proteins in the food. Some foods labeled "sugar-free" — such as sugar-free cookies and chocolates — may contain sweeteners, such as sorbitol or mannitol, which contain calories and can affect your blood sugar level. Some sugar-free products may also contain flour, which will raise blood sugar levels. Also, remember that foods containing sugar substitutes may also contain calories that may undermine your ability to lose weight and control blood sugar.

Artificial sweeteners, according to the Mayo Clinic, are often the subject of stories, presented in the popular press and on the Internet, claiming that they cause a variety of health problems, including cancer. According to the National Cancer Institute, however, there's no scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer. And numerous studies confirm that artificial sweeteners are safe for the general population. Aspartame does carry a cautionary note, however. It isn't safe for people who have the rare hereditary disease phenylketonuria (PKU). Products that contain aspartame must carry a PKU warning on the label.

Our innate desire for sweetness may be interfering with our ability to judge right from wrong according to MedicineNet. There is nothing in our diet that we can consume without a cost. The cost can be excess calories, fat, protein, or carbohydrates. It's even possible to consume excess water. We see calorie- and sugar-free sweeteners and believe that there isn't a cost, but maybe there is. Unfortunately, the research that has been done is failing us. With two sides battling over the safety of these sweeteners, it's imperative that we get the answers from the "gold standard" of research studies: independent, randomized, double-blinded, placebo-controlled studies. It's our responsibility to be aware of what we are consuming and to protect our safety. Acceptable Daily Intakes have been set for each nonnutritive sweetener for a reason; we can't ingest unlimited quantities of these additives. If you believe that you are experiencing any of the symptoms from the consumption of a nutritive or nonnutritive sweetener, then eliminating them from your diet is the best way to determine if it's so. Sweeteners are not essential nutrients in our diet, so they exist to nurture our sweet tooth, not our bodies.

Artificial sweeteners, when used in moderation, are an acceptable substitute for sugar or other types of natural sweeteners. However, like anything else, when abused they can cause symptoms that are detrimental to a healthy lifestyle. Be sensitive to your body's needs when you are ingesting foods or beverages that use artificial sweeteners. Learn to use these food additives in moderation. Be careful with the types and amounts of artificial sweeteners you use in cooking and consumption of foods and drinks.

Until next time. Let me know what you think.

Thursday, March 5, 2009

Health Care and Insurance Premiums

Health insurance premiums by 2016 are undoubtedly going to take a big jump. The US Public Interest Research Group has predicted that costs for employer sponsored family health insurance will increase from $11,381 (2006 figure) to $24,291 by 2016. The Group sees inappropriate, ineffective and uncoordinated care as a driver of this rise, along with excessive administrative costs and drug/device marketing costs. Currently, they assert, that one healthcare dollar in three goes to administration and marketing-totaling $730 billion.

Did you know that almost 20% of working Americans have no health insurance? MSNBC reports, according to, the rising cost of healthcare premiums in the workplace is taking its toll. In fact, the numbers may be even worse than this, because this report was based on a census taken in 2007. Given the present state of the economy, the number of uninsured workers is bound to increase. What does this mean for people with chronic pain? Well, it means that they are far less likely to go to the doctor for anything other than an emergency. This potentially means that breakthrough pain or other short-term illnesses that may cause pain to increase will go untreated. It also means that prescription drugs may become too expensive to pay for out of pocket. In short, these people will not get adequate care for their chronic pain condition. It seems unfair that so many people might have to make the choice between buying groceries or paying for their chronic pain medication.

According to Medical News Today, an increased number of employees in 2009 will pay more for health insurance -- and receive less coverage in some cases -- as employers "grapple with the financial fallout of rising medical expenses and diminished revenue and profits" during the current economic recession, the Washington Post reports. The recession "is making it more difficult for many employers to subsidize health care costs at previous levels," and in 2009 "benefit packages contain the biggest increases for workers since the recession of 2001," according to the Post. In 1999, employers covered about 90% of the cost of health insurance for employees, compared with 73% today, and the percentage likely will decrease to 70% over the next few years. A recent Mercer survey found that 44% of almost 2,000 large employers plan to increase the share of health insurance premiums paid by employees in 2009, compared with 40% in 2008. In addition, according to a recent Corporate Executive Board survey, one-fourth of 350 large employers increased health insurance deductibles by an average of 9% in 2008, and 30% plan to increase deductibles by an average of 14% in 2009. In an effort to reduce costs, an increased number of employers have begun to offer high-deductible health plans linked with health savings accounts and focus on wellness programs "aimed at keeping workers healthy through diet and exercise," the Post reports.

Rising health care costs – and the steps employers are taking to cope with them – are worsening the income gap in the U.S., according to McKinsey Global Institute researchers as reported by the Wall Street Journal. Rising health-insurance premiums are accounting for a disproportionate share of the lowest-paid employees’ compensation compared to higher-income employees. The researchers found that the ratio of employer-paid health-insurance premiums to total household income was 20% for those who were insured in the lowest-income group. Of that group, which earned $14,800 a year on average, only 22% were covered at all. That 20% stands in stark contrast to the 3.3% health - insurance - premium - to - income ratio for the highest income group, which averaged $210,000 annually. Nine out of 10 of those workers are insured. The disparities in income and coverage are also reaching workers’ out-of-pocket expenses. As the highest-earners’ salaries increased over the years, so did their health care benefits and the types of services that were covered. As a result they paid very few additional health - care costs. A similar trend took place with higher-middle and lower-middle income groups, but at a slower rate, meaning their out of pocket costs grew a bit. As for the lowest income group, “incomes have been stagnant, and their employers are less likely to pay for their health insurance. This group is finding any health care difficult, if not impossible, to afford,” the researchers concluded. Using the most recent data from 1966 to 2005, the researchers noted that health insurance premiums grew 5% a year. And as premiums rose, enrollment in the employer-sponsored plans has dropped or remained the same, especially in regard to the middle class. “Some employers are offering more comprehensive benefits to attract and retain better workers. At the same time, some companies have been prompted to withdraw the offer of employee health care benefits altogether; others have had to limit the number of employees eligible for benefits…Put another way, employers are spending more on health care per employee but for fewer employees.”

According to Towers Perrin, data from a recent survey indicates that the business and social impacts of rising health care costs still loom large, but also that leading companies are successfully mitigating that threat through a variety of health-focused management techniques that are paying off in significant ways—and point toward broader solutions to the cost crisis. The most striking result of the survey is the contrast between the high- and low-performing companies. The high performers will pay, on average, 14% less in 2009 a differential that quickly adds up to millions of dollars in annual savings for companies and for their employees. While high-performing companies spend almost $1,500 less per employee overall, $350 of those savings, on average, are shared with employees in the form of lower contributions. This shared 'health dividend' also creates important workforce performance advantages, as reported by these organizations such as high employee engagement. Overall, the high performers are reaping a health dividend that can be a source of true competitive advantage and a model for the health care reform debate." According to Towers Perrin's annual Health Care Cost Survey, the average corporate health benefit expenditure in 2009 will be $9,660 per employee-an increase of 6% over 2008 figures. The 6% growth rate will make 2009 the fifth consecutive year of single-digit percentage increases. However, many companies and their employees will still face record-high dollar costs in 2009, which is sure to deepen concerns about affordability, particularly for lower-wage workers and pre-65 retirees. Underscoring the growing affordability gap, the Towers Perrin survey database shows that total health care costs have increased by 33% since 2004, with the employee share increasing by 42% during the same period.

As in previous years, the survey indicates that employers will shoulder the lion's share of the 2009 cost burden, subsidizing, on average, 78% of premium costs and asking employees to cover the remaining 22%, plus usage-based copays, deductibles and coinsurance, according to Towers Perrin. However, while the employee percentage share has held steady in the last few years, the actual dollar burden has grown due to the ever-increasing cost base and the added impact of benefit design-related increases in out-of-pocket costs. Analyzing the 2009 data by coverage level, the average reported cost of medical coverage for active employee-only coverage is $4,860 per year and, for family coverage, $14,244 per year. While these numbers are impressive in themselves, the impact of current health care costs and cost increases is starkly evident when compared with wage increases over the past eight to 10 years an analysis that reveals a growing affordability gap and significant erosion over time in compensation values and employee purchasing power. And even though employees at high-performing companies are doing better overall, they are still feeling the legacy impact of years of rising costs, despite the best efforts of their employers today to keep costs down. Much more detail can be found at .

Fifty-nine percent of U.S. businesses in 2009 intend to increase employees' deductibles, copayments or out-of-pocket spending limits, according to preliminary data of a national survey released on Thursday by Mercer, the AP/Houston Chronicle reports. The preliminary results included the responses of about half of the 3,000 large companies surveyed who responded. The survey found that health care costs for workers and employers will increase by an estimated 5.7% in 2009, the same rate as this year. According to Mercer, health care cost growth has been about 6% since 2005, and while the rate is lower than the double-digit increases in previous years, it still is growing at a faster rate than inflation or workers' wages, noted by EMaxHealth.

Overall, health insurance premiums are going up, and they go up every year. Some years the increase is greater than the year before, and some years the increase is not as bad. The costs, though, continue to increase each year regardless of the net gain in price. As part of your employee compensation each year, you should discuss this issue with your HR Director to find ways that will help you contain the costs you must bear for coverage. It's a smart idea to research this issue in advance of each new year before open enrollment. After that, it's too typically too late to change the price until the next year unless you have a qualifying event.

Until next time. Let me know what you think.