Dec 23, 2010

Another great Health Reform Timeline online

From Kaiser Family Foundation...this one is a year-by-year breakdown of each provision, some more important than others.  See KFF Timeline.

Dec 9, 2010

Best of the Best Citizen Portals

Over the past two years, I've posted links to web addresses to make your voice heard.  Here's a recap of the best:

How to contact the White House
How to contact your Senator or Congressman

Here are the very best sources of citizen information on issues of the day:

Summary of the Health Reform Act (with schedule)
Congressional Staff Salaries and Perks
How will the Coming US Debt Crisis Unfold?

Nov 16, 2010

Vitamin D and Leukemia progression

A Mayo Clinic study just reported in the journal Blood that people diagnosed with CLL who had insufficient Vitamin D (less than 25 ng at the time of diagnosis) were more likely to progress and to die than were those with "adequate" levels.  Read the press release. 

Nov 14, 2010

GE is the GM of the future!

Back in 1978, I had the misfortune to buy an Olds Cutlass, a classy looking car with the classic GM pre-planned burnout at 50K miles.  After that, I swore I would never buy another GM car (or American car, for that matter).  Hondas became my mainstay and they didn't disappoint with price points and reliability that surpassed my Oldsmobile.  In the mid-90's I relented, bought a Chrysler Grand Jeep Cherokee .. Just 50K miles later,  when the drive train faultered, I was back to Japan, and my Lexus rx300 is now on it's 115K th mile. 

So...now comes GE, the big mother of American major appliances.  Our 22 year old GE ovens are still going strong, but our 2-year old GE Profile microwave blew out (magnetron) and GE would not honor the 5-year warranty, because a lead wire had also blown. (Convenient, huh?).  This morning, our 8-year old GE Profile refrigerator blew out.  We'll pay for repair or replacement, of course, but 8 years is NOT a reasonable length of life for a major appliance!  I have resolved NEVER AGAIN to buy a GE appliance.   This despite the fact that I own some GE stock.  I'm also gradually selling the stock and realizing the substantial loss on the investment.  Nothing made by GE is made in the USA anyway... The microwave comes from Malaysia;  the refrigerator was made in Mexico. 
What's still working in our kitchen?  The VERY OLD GE oven;  the Kitchen-aid dishwasher (5 years old); the kitchen-aid garbage compactor (22 years old);  and the GE profile cooktop (1 year old).  Which one would you predict will fail first?

Nov 3, 2010

My prediction for 2012 Republican Presidential Ticket

One of the joys of having this little personal blog is that I can indulge my favorite hobby-- to be able to say "I said that this would happen."  This post is to go on record with my prognostication for the republican ticket in 2012.  That way I can say, "See?.."
or, more likely, "Well, I don't  know diddly about politics, and never said I did."  (That latter statement is true.)
Here goes:
Republican Nominee for President, 2012, Mitch Daniels, Governor of Indiana
Republican Nominee for Vice-President, 2012, Marc Rubio, newly elected Senator from Florida.
This prediction should in no way be considered an endorsement of the above.  I'm just having fun with my told-you-so hobby.  You, dear reader, may have been a recipient of such statements in the past regarding all manner of things, and you know that I live for the times when you say something to me like,  "Do you remember way back in 2007, Judy when you told me to sell my house now rather than to wait for the price to improve?"  Well, you were right!
Now, if you REALLY want to have fun with me, why don't you counter --in the comments -- with your own predictions.  And then we can compare our prescience in September 2012 (God willing).

Oct 16, 2010

Federal Employees Health Plan 2011 Premiums

The US Gov't OPM announced the new rates for 2011 for the FEHB plans. Here is the chart showing 2011 premiums for national plans. For HMOs and other plans available in your area, click on FEHB site page.

For those of you who hate federal workers, you can see what the premium subsidy is for federal employees and retirees. Before you explode and bloviate, however, remember that salary + benefits = total compensation, and in general total federal compensation is not out of line with the private sector. In my view, federal employees are generally more risk averse than private sector workers, or more dedicated to public service, or lucky to have found a safe federal job and aware they couldn't command the same salary in a more competitive system. (Or some combination thereof.) We're no angels, but we aren't total ripoff artists, either.

Oct 12, 2010

Vitamin D status & elective orthopedic surgery

At last, dear reader, the orthopedic surgeons have come around to the realization that cutting into people's bones without testing their Vitamin D status is neanderthal. Here is a report of a speech by a leading orthopedic surgeon at the Hospital for Special Surgery in NYC. Soon, I predict, it will constitute poor quality, if not outright malpractice, for elective procedures such as hip, knee or shoulder surgery to proceed without a vitamin D lab test and appropriate corrective D therapy.
I learned my lesson on D and elective orthopedic surgery the hard way. Maybe a fundamental understanding of the importance of vitamin d status to bone healing will quickly infiltrate the profession. Can't wait for my next follow up visit to find out whether my own orthopedic practice has evolved.

Oct 11, 2010

Medicare Premiums for 2011

Our CBO-Alumni den mother Kathy R sent the attached table around as a first look at what to expect for Medicare premiums in 2011. She took it from a report published September 23 by the National Health Policy Forum. I'm reproducing the table from that report here.

If you're in the "holdharmless" group, it's because you're not new to Medicare in 2011, and your income (modified AGI in 2009) is no more than $85,000. Otherwise, you're in another column. Note the income break points in the table. It makes sense to micro-manage your income if your AGI falls close to a breakpoint.
For example, make $85,001 (if you made only $85,000 in the previous year) and that extra dollar will net you about $58 per month, or about $700 per year, in extra Medicare Part B premium compared with the hold-harmless premium. That's a marginal tax rate of 78,000% on the last dollar (at least I think it is...it's hard for me to calculate high percentages.)

Sep 21, 2010

Great summary of the Health Reform Act

The Kaiser Family Foundation has published a very readable Summary of the Health Reform Act in plain English, except for pesky abbreviations such as FPL (=federal poverty level). Some, possibly critical, details have been left out. For example, if you are going to be eligible for Medicaid, due to low income on your IRS tax form, will the State be able to place you in their managed care program, or will you have to go fee-for-service Medicaid? This is important, because at present most doctors don't accept Medicaid and you'll have trouble finding a provider. Little unimportant details like that.
Otherwise, it's a great place to start.

Sep 15, 2010

Embarrassing quotes by those in the public eye

ProPublica, my favorite investigative journalism website, has started a new site where people (like us) can upload from their smart phones (not like us, cause we don't have one) snippets of speeches or public statements by politicians, business leaders, lobbyists, etc., that are worthy of at least a raised eyebrow.
It's called "Officials say the darndest things!" Check it out, and maybe you, too, can catch a pol in a stupid remark. On the other hand, I say stupid things every three minutes, but I'm genuine. Maybe there's an inverse relationship between stupid statements and genuineness.

Aug 30, 2010

Checking up on Charities

Here are 2 great websites for checking into how your charitable dollars are spent. One of my accounting gurus, who knows about these things, says that these are not perfect, as charities have ways of manipulating these numbers that can't be audited, but it's a start.

Charity Navigator - I like this one best. Has great info.

Better Business Bureau - worth a look.

Aug 24, 2010

New Evidence on Vitamin D's role in autoimmune diseases

This news article in Science Daily about a genomic study done at Oxford University and just published in Genome Research, suggests that Vitamin D deficiency is causal, not just a co-traveller with autoimmune diseases. All the more reason for those of us with autoimmune diseases to take it seriously.

Jul 27, 2010

Jane Brody (NY Times) weighs in on Vitamin D

Jane Brody's article on Vitamin D in the NY Times seems to come a bit late to the table, and it does not seem to reflect the NCI's latest take on the literature linking low Vitamin D to cancer. But, she does have a way of summarizing issues, so it's worth reading. Bottom line: what we knew already. Vitamin D is good for you. You should take at least 1000 to 2000 IU, depending on your stage in life. Most important: get tested.

Jul 15, 2010

How to compare hospitals on quality measures

Here is a great site, from the Commonwealth Fund, Why Not the Best? that allows you to compare hospital scores on a range of quality measures. I just did it for Georgetown University Hospital, a bit late for my surgery that took place earlier this year, but I was gratified to learn that GU has a high quality rating. (Whew!)

Jul 8, 2010

Areas of agreement & disagreement on how to reduce federal deficit

The Committee for a Responsible Federal Budget just published the results of its on-line budget simulation project, where people could vote on which actions they would prefer to see the Federal government take. I'm amazed at how much agreement there is across parties on some things. Seems that it's likely the Social Security retirement age will be raised to 68, if lawmakers follow the will of the pople.

Jun 30, 2010

A succinct summary of the Evidence on Vitamin D and Cancer, from the NCI

This NCI summary of the evidence on the link (or lack of it) between Vitamin D and cancer incidence is an up-to-date for each cancer type. Bottom line: cancer prevention is not the strongest reason for taking Vitamin D, though its role may be clarified in the future.

Jun 28, 2010

Why Vitamin D recommendations are so low.

Here's a great article in the Financial Times about the politics of Vitamin D recommendations. With this issue, there are no bad guys, only policy makers and scientists with different mind-sets about what constitutes good evidence.

Jun 26, 2010

To tackle the federal deficit EVERYONE must suffer some.

Here's an analysis from the Committee for a Responsible Federal Budget which lays out how federal employees have fared over the past few years compared with employees in the private sector. In my view, federal employees should share in the pain to avoid an angry backlash from the American taxpayer in the future.
But, so should everyone else. AARP should take a leadership role here, but I'm not holding my breath.

Jun 22, 2010

Vitamin D & Cancer- Could it be just sunlight, and not Vitamin D?

New studies funded by NCI have checked out whether people with high circulating levels of Vitamin D have lower rates of certain rare cancers, and have come up with zilch. Vitamin D doesn't seem to be related to incidence of those cancers. For example, non-hodgkins lymphoma: not affected by Vitamin D. But, Non-hodgkins lymphoma IS inversely related to sun exposure. So, the authors of that study (available free-click here) speculate that there may be some other effect of sunlight on immune systems, not acting through Vitamin D, which protects against n-h lymphoma. Could such an effect be making Vitamin D look good across a variety of correlational studies? Maybe... we'll have to stay tuned to the research as it emerges.

Jun 14, 2010

Closing the Wall Street Tax Loophole: Citizen action needed now

You may have heard something about how private equity managers are able to shield most of their income from ordinary income taxes, instead paying the 15% capital gains tax. The original bill in the House eliminated that windfall and required them to declare income from investments in which they have no financial stake as ordinary income. Now, the financial reform bill is in Congress, and ALREADY compromises have been made. This morning's Washington Post editorial (strangely and stupidly not available on their web site right now) lays out the latest deal -- only 65% of the income will be taxed as ordinary income, leaving the remaining 35% to capital gains.

These guys (yes, they're mostly guys) make gazillions, and their lobbying efforts are paying off, with stupid arguments about how this will hurt their incentives to take risks. The only risks they take are with their human capital by choosing to work as private equity artists, and I betcha they couldn't make as much money -- even fully taxed -- had they invested their human capital for 15 years to become a brain surgeon!

Now is the time for those of you in swing states (alas, Maryland is full of democrats who will vote for whatever the leadership agrees to) to contact your congressman or senator and demand that these private equity firm managers pay their fair share of taxes. Click here for directions on how to find out who your congressman or senator is, and how to contact her or him.

May 27, 2010

State-level hospital infection rate comparison available

Not every state requires hospitals to report their rate of infections, but of those that do, I would choose to live in Washington State or Vermont, and not Maryland! Check the CDC report: First State-Specific Healthcare-Associated Infections Report (scroll down to page 10).

May 19, 2010

Make your own federal budget choices with this new on-line tool.

The Committee for a Responsible Federal Budget, a group of gurus who fret about our future (don't we all these days?) has just published a great little tool/game you can use to look at how various spending and tax changes would affect our ability to reach a "sustainable" budget by the year 2020. Try the Budget Simulator.
My favorite among the choices is to increase the gas tax by 10 cents, but I would do a lot more than that! I would vary the gas tax inversely with the oil price to maintain an at-the-pump price of $3.50 (regular), rising gradually to $4.00 per gallon over the next 5 years. That would send the signal that the market needs for manufacturers to invest in energy-saving car models, and for consumers to favor conservation. A double win! Our dependence on foreign fuel would gradually stabilize itself, and some tax revenue would help with the deficit. (We could give some of it back to the working poor by exempting the first $10K of income from social security tax.) My wise environmental activist lawyer friend Ben says this approach would be dead on arrival in the Congress. I'm going to start my own oil-can party, or maybe I'll call it the "Can Oil"Party.

May 3, 2010

Congressional salaries, perks and earmarks available on-line

Legistorm has all sorts of information on the financial affairs of Congress members and their staffs. You can check out your own Congress person's gifts, travel, salary, and earmarks. This will just make you angrier, regardless of party, so I've filed this under the label "Citizen Portals" (see left), and you can always come back to it when you're feeling in need of a righteous citizen fix.

May 2, 2010

Vitamin D supplements and breast cancer risk

Here is information on a new study in American Journal of Clinical Nutrition that suggests (but does not prove) that vitamin d supplements may protect against breast cancer. Click here for news release.

Apr 26, 2010

Schedule for changes in the Medicare Part D benefit

If you want to know how your (or your loved-one's) Medicare Part D benefit will change over the next 10 years as a result of the health reform legislation, see this excellent and short summary from KFF: Key Changes to the Medicare Part D Coverage Gap. What the summary sheet doesn't tell you is what the changes mean for Part D premiums and government spending ... (up up up, of course). Still, if the benefit is out there for everyone else, we'd be stupid not to take our share, right?

Apr 24, 2010

How will the coming US debt crisis unfold?

Here is an interesting report from the Committee for a Responsible Federal Budget outlining several scenarios for how a debt crisis will occur if we don't do something to manage our fiscal deficits in the near future. It's worth reading to try to figure out what kinds of personal wealth management strategies would give you the best chance of riding out the crisis without losing everything (or almost everything.)

Mar 26, 2010

Health Care Reform Timetable

Here's a good summary, from the Kaiser Family Foundation, of what will happen when, as health care reform ramps up over the next few years. See Health Care Reform Timetable.

Mar 20, 2010

Hypocritical congress manipulates CBO esimtates.

An old theory states that regulated industries ultimately "capture" the relgulators and are able to mold the rules to their own advantage. Too bad the theory always seems to work in practice. Now we're seeing it in the manipulation of the CBO scoring process by the "regulated" Congress. Keith Hennessey posted an example of how the House has crafted a Medicaid provision in the reconciliation bill that requires states to pay doctors the same as Medicare pays them, and HAVE THE FEDERAL GOVERNMENT PICK UP THE TAB, without being charged with a $52 billion ten-year cost that CBO estimated for that provision in the original House Bill. The reconciliation bill limits the years in which those increased fees would apply to only two --- 2013 and 2014 -- which brings the cost down to only $8 billion over ten years.

Of course, everyone knows that once those increases go into effect, Congress will never let the fees go back to the old rules. Look what's happened to the physician fee reductions passed in 1997 for Medicare. Each year Congress passes an over-ride, and the reductions are "delayed" for another year. That's what will happen here. So, the health reform bill will effectively federalize Medicaid and add it to the Medicare fee-for-service system (the system that "works so well"). State leaders will love it. Less payout for Medicaid. Doctors will like it, and more of them will participate in Medicaid, which is good for poor people, and by extension the rest of us. Let's face it, though...our deficit hole will just grow and grow and grow.

CBO has no choice but to score the bill this way. It has to assume the law will operate as it says in the bill it's scoring at the time, not as it will play out in reality. This manipulation of legislative language by Congress has improved over time, so at this point the "CBO score" is largely a political football, with the majority using it to hide major new cost-raising changes.

This is just one of dozens of little "surprises" lurking in the bill -- which I admit I still have not read in full and probably never will. What I'm learning is from newspapers and internet. Keith Hennessey's blog is a jewel . I may not agree with him on priorities, but he's an excellent analyst of policy and politics. And he's not lazy. He actually read the reconcilation bill.

Mar 17, 2010

"But, Medicare works so well for me..."

That quote comes from one of my most devoted readers, whose name will go unmentioned. In my never-ending effort to convince him/her that it only works well until it doesn't work, for example, when one cannot find an endocrinologist who will accept a new Medicare patient, I am attaching an interesting article about a new trend among cardiologists -- charging an annual access fee to Medicare patients. This appears to be legal if carefully crafted, and I for one applaud it, provided that I will be able to afford it when my own internist decides it's time to do that same. My doc is worth it, because he does old-style actual communicating-type medicine, and I'd gladly pay extra for those phone calls and email access, etc. But, please, not too much extra $$, buddy, okay? Here's the article from the KFF Website, "As Medicare Pay Shrinks, Some Doctors..."

Mar 13, 2010

Vitamin D prevents Influenza A in Children-randomized trial results

The results of a double blind randomized trial, just published in the American Journal of Clinical Nutrition, is the first definitive evidence that vitamin D3 supplementation actually reduces the incidence of influenza A viruses in children. (H1N1 is influenza A, as is H5N1.) Especially so in kids with asthma.
Check out the abstract in the AJCN website, "Vitamin D".

Mar 10, 2010

What the Senate health reform bill would do for women...but not for men

It's been a long time since I've posted on anything, especially on health reform, because I've been so conflicted. I want to see universal health coverage, and I want to see a regulated health exchange. To me, the Republicans' proposals are insipid because they ignore the realities of the individual insurance market. In short, insurance companies can't offer insurance to all with community rating in the individual and small business markets so long as health insurance is not mandatory, or at least difficult to escape without penalty. So, I want to see reform, and I care about it a lot for my family and friends.
But, those Democrats! Here's a perfect example of the problem. My own Senator Mikulski, ultra-liberal from Maryland, introduced with much emotion (and a speech laden with either stupid inaccuracies or outright lies -- I think the former) a bill that would cover annual preventive visits to doctors for all women for free. Here is Mikulski's own summary of her amendment. The Amendment passed with 61 votes and is part of the final Senate bill.
CBO estimated that it would add about a billion to costs over 10 years. But that's the cost of only about 5 years of actual coverage, since the law wouldn't go into effect until 4 years down the line.
What galls me is the over-reach of the liberals in both the Senate and House, not to mention the recent White House sweeteners, to mandate a rich set of benefits, when what people really need is to be covered when they are sick and scared.
What also galls me in particular about Mikulski is her discrimination against men. And I'm not even one.
I don't trust the Republicans when they say that they want to "just start over", but I can't trust the Democrats not to lard up a bill with new spending.
Bottom line: I hope it passes. Then I hope that the bill will be amended to take out all the stupid stuff, and add to taxes to pay for it. These hopes are also stupid, I know. That's why I haven't been blogging recently.

Jan 18, 2010

Don't give to charities through credit cards!

Friend George is at it again, educating me about the ways of the world. It hadn't occurred to me that giving to Haiti relief, or any other charity for that matter, through my credit card means less for the relief agency and more for the card company and banks. Here's a NY Times article documenting the practice, and reporting that "some" card fees have been waived for Haiti relief.
Why not stay away from giving through credit cards altogether? I'm afraid I was lazy and ignorant this past holiday season and used credit cards to give to some of my favorite charities online. Now I'm reformed. It's direct checks from here on in, with my own postage attached. That has the added bonus of helping the struggling but vastly improved newly privatized US Postal Service stay solvent. (No, I'm not being sarcastic. Have you checked out how hard the USPS is trying these days? There's nothing like competition.)

Jan 11, 2010

Wellness Discounts in Health Reform a real problem

Having already admitted that I cannot read the 4000+ total pages of legislative language in the two final bills (House and Senate) without giving up all other aspects of my life, I'm depending on secondary sources to uncover aspects of one or the other bill that are problematical. Here is what Kaiser Family Foundation says about one provision that sounds discriminatory against those with "lifestyle" issues. This affects people with employer based health insurance. Read KFF News on Wellness Program.