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"content": "\u003cp>\u003cstrong>By Mina Kim, KQED\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_8897\" class=\"wp-caption alignleft\" style=\"max-width: 248px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/couch0409.jpg\">\u003cimg class=\"size-full wp-image-8897\" title=\"A sofa may contain up to two pounds of flame retardants. (Dan Buczynski/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/couch0409.jpg\" alt=\"A sofa may contain up to two pounds of flame retardants. (Dan Buczynski/Flickr)\" width=\"248\" height=\"140\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A sofa may contain up to two pounds of flame retardants. (Dan Buczynski/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A new study finds flame retardants -- chemicals used to make household items more fire resistant -- are linked to lower IQs and poorer coordination in children.\u003c/p>\n\u003cp>The\u003ca href=\"http://ehp.niehs.nih.gov/2012/11/1205597/\" target=\"_blank\"> UC Berkeley study\u003c/a> focuses on the effects of Polybrominated Diphenyl Ethers (PBDEs). That's a class of chemicals that was widely used in California in furniture, baby products and electronics, until they were phased out in 2004 out of concerns they were toxic.\u003c/p>\n\u003cp>Still, the flame retardant continues to leech out of older household products said the study's lead author Brenda Eskanazi. She's a professor of maternal and child health at UC Berkeley.\u003c/p>\n\u003cp>“The couch that I own was purchased before 2004,” Eskanazi said. “As the foam in the couch disintegrates, the PBDEs will enter into the dust particles, and if I had a child that was crawling on the floor, that child will be exposed to that dust.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Eskanzi recommends mopping, vacuuming and washing hands frequently to help reduce exposure to PBDEs.\u003c/p>\n\u003cp>Today's research comes from the \u003ca href=\"http://cerch.org/research-programs/chamacos/\" target=\"_blank\">CHAMACOS study\u003c/a> -- a study based in Salinas Valley of hundreds of pregnant women and their children, born since 1999. For the flame retardants study, researchers took blood samples of more than 270 children when they were in their mothers' wombs and again seven years later. The children received a battery of tests to gauge their attention span, fine motor skills and IQ.\u003c/p>\n\u003cp>“What we saw was that children had more problems in relationship to the amount of PBDEs in their mothers' or their (own) blood,” Eskanazi said.\u003c/p>\n\u003cp>Officials with the American Chemistry Council which represents the chemical industry said in a statement that they “will need time to more thoroughly analyze the findings” and noted that a link is not clear evidence of a cause-and-effect relationship.\u003c/p>\n\u003cp>The study appears in Thursday’s issue of the journal \u003ca title=\"http://ehp.niehs.nih.gov\" href=\"http://ehp.niehs.nih.gov\" target=\"_blank\">Environmental Health Perspectives\u003c/a>, published by the National Institute of Environmental Health Sciences, part of the NIH.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to Mina Kim's story:\u003c/strong>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201211150850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201211150850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"content": "\u003cp>By Alice Daniel, KQED\u003c/p>\n\u003cfigure id=\"attachment_6253\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_.gif\">\u003cimg class=\"size-full wp-image-6253\" title=\"Farming in California's Central Valley is a source of smog, a major contributor to the region's high asthma rates. (Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_.gif\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_.gif 300w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_-32x32.gif 32w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_-64x64.gif 64w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_-96x96.gif 96w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_-128x128.gif 128w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/CentralValleyPollution_Smog_Getty_-75x75.gif 75w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Farming in California's Central Valley is a source of smog, a major contributor to the region's high asthma rates. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The latest new thing in social policy circles is the social impact bond, and now Fresno is set to become the first city in the nation to test the idea of using this social bond idea to improve the health of the community.\u003c/p>\n\u003cp>Municipal bonds allow investors to put money into building roads or constructing schools. Health impact bonds aren’t much different, says Kevin Hamilton of the Fresno nonprofit health agency Clinica Sierra Vista. Instead of infrastructure, the investment is in public health, in this case asthma prevention.\u003c/p>\n\u003cp>\"There’s no reason to think of the public health in any different way than you do the public transportation system or the public school system,\" Hamilton says, \"all of which are things that have benefited from bond issues over time. No reason not to think of this in the same fashion.\"\u003c/p>\n\u003cp>The California Endowment is paying for Fresno's pilot project. The concept was developed by a Connecticut firm called Collective Health. The goal is to show that a systematic asthma prevention program can save enough money to entice private investors. One in six Fresno residents suffers from asthma. Hamilton says about 20 asthma patients go to the ER every day and of those, three are hospitalized.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"In this situation the return on investment comes from the health insurance companies who make money when people are well and lose money when they’re sick,\" Hamilton says. \"So you have that same sort of incentive to invest.\"\u003c/p>\n\u003cp>Starting in January, Clinica Sierra Vista will work with 200 low-income asthma patients on asthma intervention. Studies already show that symptoms are reduced with indoor air filters, clean or removed carpets and safe cleaning agents like vinegar and baking soda. But clinicians will also work with the patients to make sure they are using their medications correctly and keeping medical appointments. Cost savings will be documented by public and private insurers, says Hamilton.\u003c/p>\n\u003cp>On average, these 200 patients rack up costs of about $16,000 a year for ER visits and hospital stays. The goal is trim those costs by close to $8,000 by educating and training patients to manage asthma correctly.\u003c/p>\n\u003cp>\"It’s a way for a health insurance company to continue to make money, survive as an entity, and yet put money back into people’s health in a really, really positive way that has a chance of really changing their lives significantly,\" Hamilton says.\u003c/p>\n\u003cp>The pilot project hopes to save about a million dollars in the first year and cut ER visits by 30 percent. If it’s successful, investors would provide intervention funding for about 1100 patients the following year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Daniel's story:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201211140850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201211140850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"In this situation the return on investment comes from the health insurance companies who make money when people are well and lose money when they’re sick,\" Hamilton says. \"So you have that same sort of incentive to invest.\"\u003c/p>\n\u003cp>Starting in January, Clinica Sierra Vista will work with 200 low-income asthma patients on asthma intervention. Studies already show that symptoms are reduced with indoor air filters, clean or removed carpets and safe cleaning agents like vinegar and baking soda. But clinicians will also work with the patients to make sure they are using their medications correctly and keeping medical appointments. Cost savings will be documented by public and private insurers, says Hamilton.\u003c/p>\n\u003cp>On average, these 200 patients rack up costs of about $16,000 a year for ER visits and hospital stays. The goal is trim those costs by close to $8,000 by educating and training patients to manage asthma correctly.\u003c/p>\n\u003cp>\"It’s a way for a health insurance company to continue to make money, survive as an entity, and yet put money back into people’s health in a really, really positive way that has a chance of really changing their lives significantly,\" Hamilton says.\u003c/p>\n\u003cp>The pilot project hopes to save about a million dollars in the first year and cut ER visits by 30 percent. If it’s successful, investors would provide intervention funding for about 1100 patients the following year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Daniel's story:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201211140850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201211140850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_8862\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Antibiotics_DavidKalsbeek_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8862\" title=\"Antibiotics_DavidKalsbeek_Flickr\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Antibiotics_DavidKalsbeek_Flickr-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David Kalsbeek/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>More than two dozen American health organizations -- including the Centers for Disease Control and the American Academy of Pediatrics for starters -- are banding together to fight the overuse of antibiotics. In new research, \u003ca href=\"http://www.extendingthecure.org\" target=\"_blank\">Extending the Cure\u003c/a>, a DC-based policy group aiming to reduce inappropriate use or antibiotics, found prescribing rates dropped 17 percent nationally -- and 24 percent here in California -- from 1999 to 2010.\u003c/p>\n\u003cp>For a refresher: remember that antibiotics fight bacterial infections; they are useless the common cold or influenza -- those are caused by viruses.\u003c/p>\n\u003cp>Those lower prescribing rates make a difference, not just in avoiding medicines that won't help you -- or could even hurt you. All drugs have side effects, after all. Reduced use of antibiotics means reduced creation of superbugs. \"For many pathogens,\" said \u003cspan style=\"font-family: arial, helvetica, sans-serif\">Ramanan Laxminarayan, director of Extending the Cure, \"resistance rates are lower in California than other states.\"\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>In other words, avoiding that unnecessary antibiotic not only helps you, but it helps your community as a whole. There are regional variations. Laxminarayan says that western states tend to have less inappropriate use across the board, and many southern states tend to have higher rates. He says at least part of the explanation lies in the funding and sophistication of public health efforts.\u003c/p>\n\u003cp>\"(It's) the same sort of thing that explains why there's high rates of obesity and smoking,\" he told me. \"There's a clustering of behaviors that reflect less penetration of public health, perhaps poorer-funded public health departments. We don't know exactly why there's more antibiotic use in southern states, and it hasn't changed. That's troubling.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Yet it is possible to change and improve, he stressed. While there were some states with only a two percent decline, one state, Florida, had a 33 percent decline.\u003c/p>\n\u003cp>Extending the Cure does not track antibiotics use in livestock, but Laxminarayan says it's an \"important determinant and river of antibiotic resistance in humans.\" This year has seen new government regulations about the use of antibiotics in livestock. A \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm299802.htm\" target=\"_blank\">new FDA rule \u003c/a>requires that farmers now get a prescription for an antibiotic before administering it to animals.\u003c/p>\n\u003cp>In an era of cost-consciousness in health care, reducing inappropriate use of antibiotics can drive savings beyond the cost of the prescription itself. Laxminarayan called it a \"no-brainer.\"\u003c/p>\n\u003cp>\"You'll have fewer ER visits from side effects of the antibiotics, you'll save money on resistance,\" he said. \"When people have resistance, you need more expensive antibiotics, it costs more money.\"\u003c/p>\n\u003cp>Most importantly, tens of thousands of people die every year from drug-resistant infections. One sure way to help prevent the development of superbugs is to avoid overuse of antibiotics.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/news/story/2012/11/13/111095/health_officials_laud_decrease_in_antibiotic_prescriptions?category=bay+area\" target=\"_blank\">Listen to more on KQED radio\u003c/a>\u003c/p>\n\n",
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"excerpt": "More than two dozen American health organizations -- including the Centers for Disease Control and the American Academy of Pediatrics for starters -- are banding together to fight the overuse of antibiotics. In new research, Extending the Cure, a DC-based policy group aiming to reduce inappropriate use or antibiotics, found prescribing rates dropped 17 percent nationally -- and 24 percent here in California -- from 1999 to 2010.\r\n\r\nFor a refresher: remember that antibiotics fight bacterial infections; they are useless the common cold or influenza -- those are caused by viruses.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8862\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Antibiotics_DavidKalsbeek_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8862\" title=\"Antibiotics_DavidKalsbeek_Flickr\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Antibiotics_DavidKalsbeek_Flickr-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David Kalsbeek/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>More than two dozen American health organizations -- including the Centers for Disease Control and the American Academy of Pediatrics for starters -- are banding together to fight the overuse of antibiotics. In new research, \u003ca href=\"http://www.extendingthecure.org\" target=\"_blank\">Extending the Cure\u003c/a>, a DC-based policy group aiming to reduce inappropriate use or antibiotics, found prescribing rates dropped 17 percent nationally -- and 24 percent here in California -- from 1999 to 2010.\u003c/p>\n\u003cp>For a refresher: remember that antibiotics fight bacterial infections; they are useless the common cold or influenza -- those are caused by viruses.\u003c/p>\n\u003cp>Those lower prescribing rates make a difference, not just in avoiding medicines that won't help you -- or could even hurt you. All drugs have side effects, after all. Reduced use of antibiotics means reduced creation of superbugs. \"For many pathogens,\" said \u003cspan style=\"font-family: arial, helvetica, sans-serif\">Ramanan Laxminarayan, director of Extending the Cure, \"resistance rates are lower in California than other states.\"\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>In other words, avoiding that unnecessary antibiotic not only helps you, but it helps your community as a whole. There are regional variations. Laxminarayan says that western states tend to have less inappropriate use across the board, and many southern states tend to have higher rates. He says at least part of the explanation lies in the funding and sophistication of public health efforts.\u003c/p>\n\u003cp>\"(It's) the same sort of thing that explains why there's high rates of obesity and smoking,\" he told me. \"There's a clustering of behaviors that reflect less penetration of public health, perhaps poorer-funded public health departments. We don't know exactly why there's more antibiotic use in southern states, and it hasn't changed. That's troubling.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Yet it is possible to change and improve, he stressed. While there were some states with only a two percent decline, one state, Florida, had a 33 percent decline.\u003c/p>\n\u003cp>Extending the Cure does not track antibiotics use in livestock, but Laxminarayan says it's an \"important determinant and river of antibiotic resistance in humans.\" This year has seen new government regulations about the use of antibiotics in livestock. A \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm299802.htm\" target=\"_blank\">new FDA rule \u003c/a>requires that farmers now get a prescription for an antibiotic before administering it to animals.\u003c/p>\n\u003cp>In an era of cost-consciousness in health care, reducing inappropriate use of antibiotics can drive savings beyond the cost of the prescription itself. Laxminarayan called it a \"no-brainer.\"\u003c/p>\n\u003cp>\"You'll have fewer ER visits from side effects of the antibiotics, you'll save money on resistance,\" he said. \"When people have resistance, you need more expensive antibiotics, it costs more money.\"\u003c/p>\n\u003cp>Most importantly, tens of thousands of people die every year from drug-resistant infections. One sure way to help prevent the development of superbugs is to avoid overuse of antibiotics.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/news/story/2012/11/13/111095/health_officials_laud_decrease_in_antibiotic_prescriptions?category=bay+area\" target=\"_blank\">Listen to more on KQED radio\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "After the Election: A Consumer Q&A on the Health Care Law",
"title": "After the Election: A Consumer Q&A on the Health Care Law",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Mary Agnes Carey and Jenny Gold, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-health-law.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-health-law.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Consumer-Guide-300_KHN.jpg\">\u003cimg class=\"alignleft size-full wp-image-8816\" title=\"Consumer Guide 300_KHN\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Consumer-Guide-300_KHN.jpg\" alt=\"\" width=\"300\" height=\"199\">\u003c/a>Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track.\u003c/p>\n\u003cp>Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation. What is clear is that the law will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.\u003c/p>\n\u003cp>While some of the key features don't kick in until 2014, the law has already altered the health care industry and established a number of consumer benefits.\u003c/p>\n\u003cp>Here's a primer on parts of the law already up and running, what's to come and ways that provisions could still be altered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>I don't have health insurance. Under the law, will I have to buy it and what happens if I don’t?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>Today, you are not required to have health insurance. But beginning on January 1, 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.\u003c!--more-->\u003c/p>\n\u003cp>For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.\u003c/p>\n\u003cp>Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.\u003c/p>\n\u003cp>While some states, including most recently Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law.\u003c/p>\n\u003cp>\u003cstrong>I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?\u003c/strong>\u003c/p>\n\u003cp>If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.\u003c/p>\n\u003cp>You may have seen some law-related changes already. For example, most plans \u003ca href=\"http://www.healthcare.gov/law/features/costs/limits/\" target=\"_blank\">now ban\u003c/a> lifetime coverage limits and include a \u003ca href=\"http://www.healthcare.gov/law/features/choices/young-adult-coverage/\" target=\"_blank\">guarantee\u003c/a> that an adult child up to age 26 who can't get health insurance at a job can stay on her parents' health plan.\u003c/p>\n\u003cp>\u003cstrong>What other parts of the law are now in place?\u003c/strong>\u003c/p>\n\u003cp>You are likely to be eligible for \u003ca href=\"http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html\" target=\"_blank\">preventive services \u003c/a>with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.\u003c/p>\n\u003cp>Health plans \u003ca href=\"http://www.healthcare.gov/law/features/rights/cancellations/\" target=\"_blank\">can't cancel \u003c/a>your coverage once you get sick – a practice known as \"rescission\" – unless you committed fraud when you applied for coverage.\u003c/p>\n\u003cp>Children with \u003ca href=\"http://www.healthcare.gov/law/features/rights/childrens-pre-existing-conditions/\" target=\"_blank\">pre-existing conditions \u003c/a>cannot be denied coverage. This will apply to adults in 2014.\u003c/p>\n\u003cp>Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.\u003c/p>\n\u003cp>Some existing plans, if they haven't changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these \"\u003ca href=\"http://www.healthcare.gov/news/factsheets/2010/06/keeping-the-health-plan-you-have-grandfathered.html\" target=\"_blank\">grandfathered\" plans\u003c/a> can still charge beneficiaries part of the cost of preventive services.\u003c/p>\n\u003cp>If you're currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.\u003c/p>\n\u003cp>\u003cstrong>I want health insurance but I can’t afford it. What will I do?\u003c/strong>\u003c/p>\n\u003cp>Depending on your income, you might be eligible for Medicaid (in California, Medi-Cal). Currently, in most states nonelderly adults without minor children don't qualify for Medicaid. But beginning in 2014, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 133 percent of the federal poverty level, (which based on current guidelines would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid.\u003c/p>\n\u003cp>The Supreme Court, however, ruled in June that states cannot be forced to make that change. Republican governors in several states have said that they will refuse the expansion, though that may change now that Obama has been re-elected. California is moving forward with Medicaid expansion already.\u003c/p>\n\u003cp>\u003cstrong>What if I make too much money for Medicaid but still can't afford to buy insurance?\u003c/strong>\u003c/p>\n\u003cp>You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called \u003ca href=\"http://www.healthcare.gov/law/features/choices/exchanges/\" target=\"_blank\">exchanges\u003c/a>, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.\u003c/p>\n\u003cp>These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current guidelines).\u003c/p>\n\u003cp>\u003cstrong>Will it be easier for me to get coverage even if I have health problems?\u003c/strong>\u003c/p>\n\u003cp>Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.\u003c/p>\n\u003cp>\u003cstrong>I own a small business. Will I have to buy health insurance for my workers?\u003c/strong>\u003c/p>\n\u003cp>No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don't provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.\u003c/p>\n\u003cp>However, firms with \u003ca href=\"http://www.healthcare.gov/using-insurance/employers/small-business/\" target=\"_blank\">50 or fewer people\u003c/a> won't face any penalties.\u003c/p>\n\u003cp>In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.\u003c/p>\n\u003cp>\u003cstrong>I'm over 65. How does the legislation affect seniors?\u003c/strong>\u003c/p>\n\u003cp>The law is narrowing a gap in the Medicare Part D prescription drug plan known as the \"\u003ca href=\"http://www.healthcare.gov/blog/2010/08/donuthole.html\" target=\"_blank\">doughnut hole\u003c/a>.\" That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/February/11/doughnut-hole-FAQ.aspx\" target=\"_blank\">coverage gap\u003c/a> will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. So far, 5.6 million seniors have saved $4.8 billion on prescription drugs, according to the Department of Health and Human Services.\u003c/p>\n\u003cp>The law also expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor. HHS reports that during the first nine months of 2012, more than 20.7 million Medicare beneficiaries have received preventive services at no cost.\u003c/p>\n\u003cp>The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.\u003c/p>\n\u003cp>\u003cstrong>Will I have to pay more for my health care because of the law?\u003c/strong>\u003c/p>\n\u003cp>No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.\u003c/p>\n\u003cp>That said, there are some new taxes and fees. For example, starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/February/11/Medicare-premium-increases.aspx\" target=\"_blank\">will pay\u003c/a> a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.\u003c/p>\n\u003cp>Starting in 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a \"Cadillac\" tax because it hits the most generous plans.\u003c/p>\n\u003cp>In addition, the law also imposes \u003ca href=\"http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions\">taxes and fees\u003c/a> on several major health industries. Beginning in 2013, medical device manufacturers and importers must pay a 2.3 percent tax on the sale of any taxable medical device to raise $29 billion over 10 years. An annual fee for health insurers \u003ca href=\"http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471-hr6079.pdf\">is expected to raise\u003c/a> more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.\u003c/p>\n\u003cp>Those fees will likely be passed onto consumers in the form of higher premiums.\u003c/p>\n\u003cp>\u003cstrong>Has the law hit some bumps in the road?\u003c/strong>\u003c/p>\n\u003cp>Yes. For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. As of Aug. 31, \u003ca href=\"http://www.healthcare.gov/news/factsheets/2012/10/pcip10122012a.html\">86,072 people\u003c/a> had signed up for the high-risk pools, but the program, which began in June 2010, was initially expected to enroll between 200,000 and 400,000 people. The cost and the requirements have been difficult for some to meet.\u003c/p>\n\u003cp>Applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.\u003c/p>\n\u003cp>Enrollment has increased since the summer, after the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/31/high-risk-health-insurance-pools-hhs.aspx\" target=\"_blank\">premiums were lowered\u003c/a> in some states by as much as 40 percent and some states stepped up advertising.\u003c/p>\n\u003cp>A long-term care provision of the law is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/october/14/class-act-implementation-halted-by-obama-administration.aspx\" target=\"_blank\">effectively suspended \u003c/a>the program even before it was to begin, saying they could not find a way to make it work financially.\u003c/p>\n\u003cp>\u003cstrong>Are there more changes ahead for the law?\u003c/strong>\u003c/p>\n\u003cp>Some observers think there could be \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-health-law-deficit.aspx\" target=\"_blank\">pressure in Congress\u003c/a> to make some changes to the law as a larger package to reduce the deficit\u003cstrong>.\u003c/strong> Among those options is scaling back the subsidies that help low-income Americans buy health insurance coverage. The amount of the subsidies, and possibly the Medicaid expansion as well, could be reduced.\u003c/p>\n\u003cp>It’s also possible that some of the taxes on the health care industry, which help pay for the new benefits in the health law, could be rolled back. For example, legislation to repeal the tax on medical device manufacturers passed the House with support from 37 Democrats (it is not expected to receive Senate consideration this year). Nine House Democrats are co-sponsoring legislation to repeal the law’s annual fee on health insurers.\u003c/p>\n\u003cp>Meanwhile, the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/09/ipab-faq.aspx\" target=\"_blank\">Independent Payment Advisory Board\u003c/a> (IPAB), one of the most contentious provisions of the health law, is also under continued attack by lawmakers. IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Some Republicans argue that the board amounts to health care rationing and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. In March, the House voted to repeal IPAB.\u003c/p>\n\n",
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"description": "By Mary Agnes Carey and Jenny Gold, Kaiser Health News Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track. Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation.",
"title": "After the Election: A Consumer Q&A on the Health Care Law | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Mary Agnes Carey and Jenny Gold, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-health-law.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-health-law.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Consumer-Guide-300_KHN.jpg\">\u003cimg class=\"alignleft size-full wp-image-8816\" title=\"Consumer Guide 300_KHN\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/Consumer-Guide-300_KHN.jpg\" alt=\"\" width=\"300\" height=\"199\">\u003c/a>Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track.\u003c/p>\n\u003cp>Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation. What is clear is that the law will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.\u003c/p>\n\u003cp>While some of the key features don't kick in until 2014, the law has already altered the health care industry and established a number of consumer benefits.\u003c/p>\n\u003cp>Here's a primer on parts of the law already up and running, what's to come and ways that provisions could still be altered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>I don't have health insurance. Under the law, will I have to buy it and what happens if I don’t?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>Today, you are not required to have health insurance. But beginning on January 1, 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.\u003c!--more-->\u003c/p>\n\u003cp>For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.\u003c/p>\n\u003cp>Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.\u003c/p>\n\u003cp>While some states, including most recently Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law.\u003c/p>\n\u003cp>\u003cstrong>I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?\u003c/strong>\u003c/p>\n\u003cp>If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.\u003c/p>\n\u003cp>You may have seen some law-related changes already. For example, most plans \u003ca href=\"http://www.healthcare.gov/law/features/costs/limits/\" target=\"_blank\">now ban\u003c/a> lifetime coverage limits and include a \u003ca href=\"http://www.healthcare.gov/law/features/choices/young-adult-coverage/\" target=\"_blank\">guarantee\u003c/a> that an adult child up to age 26 who can't get health insurance at a job can stay on her parents' health plan.\u003c/p>\n\u003cp>\u003cstrong>What other parts of the law are now in place?\u003c/strong>\u003c/p>\n\u003cp>You are likely to be eligible for \u003ca href=\"http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html\" target=\"_blank\">preventive services \u003c/a>with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.\u003c/p>\n\u003cp>Health plans \u003ca href=\"http://www.healthcare.gov/law/features/rights/cancellations/\" target=\"_blank\">can't cancel \u003c/a>your coverage once you get sick – a practice known as \"rescission\" – unless you committed fraud when you applied for coverage.\u003c/p>\n\u003cp>Children with \u003ca href=\"http://www.healthcare.gov/law/features/rights/childrens-pre-existing-conditions/\" target=\"_blank\">pre-existing conditions \u003c/a>cannot be denied coverage. This will apply to adults in 2014.\u003c/p>\n\u003cp>Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.\u003c/p>\n\u003cp>Some existing plans, if they haven't changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these \"\u003ca href=\"http://www.healthcare.gov/news/factsheets/2010/06/keeping-the-health-plan-you-have-grandfathered.html\" target=\"_blank\">grandfathered\" plans\u003c/a> can still charge beneficiaries part of the cost of preventive services.\u003c/p>\n\u003cp>If you're currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.\u003c/p>\n\u003cp>\u003cstrong>I want health insurance but I can’t afford it. What will I do?\u003c/strong>\u003c/p>\n\u003cp>Depending on your income, you might be eligible for Medicaid (in California, Medi-Cal). Currently, in most states nonelderly adults without minor children don't qualify for Medicaid. But beginning in 2014, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 133 percent of the federal poverty level, (which based on current guidelines would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid.\u003c/p>\n\u003cp>The Supreme Court, however, ruled in June that states cannot be forced to make that change. Republican governors in several states have said that they will refuse the expansion, though that may change now that Obama has been re-elected. California is moving forward with Medicaid expansion already.\u003c/p>\n\u003cp>\u003cstrong>What if I make too much money for Medicaid but still can't afford to buy insurance?\u003c/strong>\u003c/p>\n\u003cp>You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called \u003ca href=\"http://www.healthcare.gov/law/features/choices/exchanges/\" target=\"_blank\">exchanges\u003c/a>, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.\u003c/p>\n\u003cp>These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current guidelines).\u003c/p>\n\u003cp>\u003cstrong>Will it be easier for me to get coverage even if I have health problems?\u003c/strong>\u003c/p>\n\u003cp>Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.\u003c/p>\n\u003cp>\u003cstrong>I own a small business. Will I have to buy health insurance for my workers?\u003c/strong>\u003c/p>\n\u003cp>No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don't provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.\u003c/p>\n\u003cp>However, firms with \u003ca href=\"http://www.healthcare.gov/using-insurance/employers/small-business/\" target=\"_blank\">50 or fewer people\u003c/a> won't face any penalties.\u003c/p>\n\u003cp>In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.\u003c/p>\n\u003cp>\u003cstrong>I'm over 65. How does the legislation affect seniors?\u003c/strong>\u003c/p>\n\u003cp>The law is narrowing a gap in the Medicare Part D prescription drug plan known as the \"\u003ca href=\"http://www.healthcare.gov/blog/2010/08/donuthole.html\" target=\"_blank\">doughnut hole\u003c/a>.\" That's when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/February/11/doughnut-hole-FAQ.aspx\" target=\"_blank\">coverage gap\u003c/a> will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. So far, 5.6 million seniors have saved $4.8 billion on prescription drugs, according to the Department of Health and Human Services.\u003c/p>\n\u003cp>The law also expanded Medicare's coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor. HHS reports that during the first nine months of 2012, more than 20.7 million Medicare beneficiaries have received preventive services at no cost.\u003c/p>\n\u003cp>The health law reduced the federal government's payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.\u003c/p>\n\u003cp>\u003cstrong>Will I have to pay more for my health care because of the law?\u003c/strong>\u003c/p>\n\u003cp>No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.\u003c/p>\n\u003cp>That said, there are some new taxes and fees. For example, starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/February/11/Medicare-premium-increases.aspx\" target=\"_blank\">will pay\u003c/a> a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.\u003c/p>\n\u003cp>Starting in 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a \"Cadillac\" tax because it hits the most generous plans.\u003c/p>\n\u003cp>In addition, the law also imposes \u003ca href=\"http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions\">taxes and fees\u003c/a> on several major health industries. Beginning in 2013, medical device manufacturers and importers must pay a 2.3 percent tax on the sale of any taxable medical device to raise $29 billion over 10 years. An annual fee for health insurers \u003ca href=\"http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471-hr6079.pdf\">is expected to raise\u003c/a> more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.\u003c/p>\n\u003cp>Those fees will likely be passed onto consumers in the form of higher premiums.\u003c/p>\n\u003cp>\u003cstrong>Has the law hit some bumps in the road?\u003c/strong>\u003c/p>\n\u003cp>Yes. For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. As of Aug. 31, \u003ca href=\"http://www.healthcare.gov/news/factsheets/2012/10/pcip10122012a.html\">86,072 people\u003c/a> had signed up for the high-risk pools, but the program, which began in June 2010, was initially expected to enroll between 200,000 and 400,000 people. The cost and the requirements have been difficult for some to meet.\u003c/p>\n\u003cp>Applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.\u003c/p>\n\u003cp>Enrollment has increased since the summer, after the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/31/high-risk-health-insurance-pools-hhs.aspx\" target=\"_blank\">premiums were lowered\u003c/a> in some states by as much as 40 percent and some states stepped up advertising.\u003c/p>\n\u003cp>A long-term care provision of the law is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials \u003ca href=\"http://www.kaiserhealthnews.org/stories/2011/october/14/class-act-implementation-halted-by-obama-administration.aspx\" target=\"_blank\">effectively suspended \u003c/a>the program even before it was to begin, saying they could not find a way to make it work financially.\u003c/p>\n\u003cp>\u003cstrong>Are there more changes ahead for the law?\u003c/strong>\u003c/p>\n\u003cp>Some observers think there could be \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/November/07/obama-health-law-deficit.aspx\" target=\"_blank\">pressure in Congress\u003c/a> to make some changes to the law as a larger package to reduce the deficit\u003cstrong>.\u003c/strong> Among those options is scaling back the subsidies that help low-income Americans buy health insurance coverage. The amount of the subsidies, and possibly the Medicaid expansion as well, could be reduced.\u003c/p>\n\u003cp>It’s also possible that some of the taxes on the health care industry, which help pay for the new benefits in the health law, could be rolled back. For example, legislation to repeal the tax on medical device manufacturers passed the House with support from 37 Democrats (it is not expected to receive Senate consideration this year). Nine House Democrats are co-sponsoring legislation to repeal the law’s annual fee on health insurers.\u003c/p>\n\u003cp>Meanwhile, the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/May/09/ipab-faq.aspx\" target=\"_blank\">Independent Payment Advisory Board\u003c/a> (IPAB), one of the most contentious provisions of the health law, is also under continued attack by lawmakers. IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some Republicans argue that the board amounts to health care rationing and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. In March, the House voted to repeal IPAB.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "No Matter Who Wins, We're Still Heading for A Cliff",
"title": "No Matter Who Wins, We're Still Heading for A Cliff",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cem>By Julie Rovner\u003c/em>,\u003ca title=\"http://capsules.kaiserhealthnews.org/index.php/2012/10/as-fiscal-cliff-looms-medicare-and-medicaid-face-uncertain-futures/\" href=\"http://capsules.kaiserhealthnews.org/index.php/2012/10/as-fiscal-cliff-looms-medicare-and-medicaid-face-uncertain-futures/\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8743\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Cliff_Edge_Su-Lin_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8743\" title=\"(Su-Lin: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Cliff_Edge_Su-Lin_Flickr-300x225.jpg\" alt=\"(Su-Lin: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Su-Lin: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Whatever the outcome on November 6th, officials in Washington will still have to deal with a looming “fiscal cliff” before the end of the year.\u003c/p>\n\u003cp>What’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.\u003c/p>\n\u003cp>As two of the largest spending items in the federal budget, the \u003ca href=\"http://www.cbpp.org/cms/index.cfm?fa=view&id=1258\">Medicare and Medicaid\u003c/a> health programs are expected to play a role in how the deal gets done. Under the provisions of the law that created the budget deal Congress will attempt to undo, Medicare is subject to a \u003ca href=\"http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2012/10/23/driving-off-the-fiscal-cliff-will-providers-be-there-after-the-crash-\">two percent cut\u003c/a> in provider payments, while Medicaid is exempt.\u003c/p>\n\u003cp>But two new studies and a proposed class action lawsuit settlement suggest a lot of dollar signs could change as lawmakers start to think about how to address the impending mess.\u003cimg title=\"More...\" src=\"http://blogs.kqed.org/election2012/wp-includes/js/tinymce/plugins/wordpress/img/trans.gif\" alt=\"\">\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A proposed settlement in a \u003ca href=\"http://www.nytimes.com/2012/10/23/us/politics/settlement-eases-rules-for-some-medicare-patients.html?_r=1&\">long-running dispute\u003c/a> between advocates for Medicare patients and the federal government is actually likely to increase Medicare spending -- although how much remains unclear.\u003c/p>\n\u003cp>The suit was brought by the \u003ca href=\"http://www.medicareadvocacy.org/hidden/highlight-improvment-standard/\">Center for Medicare Advocacy\u003c/a> on behalf of a class of patients with chronic conditions. these patients had been denied Medicare coverage for home care, nursing home care or other services on the grounds that the patients’ conditions were not expected to “improve” with care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.medicareadvocacy.org/wp-content/uploads/2012/10/Proposed-Settlement-Agreement.101612.pdf\">settlemen\u003c/a>t -- assuming it is approved by the judge in the case -- means that “the Medicare Benefit Policy Manual will be revised to correct any suggestion that continued coverage is dependent on the beneficiary improving,” said the organization in a statement. The change is expected to affect as many as tens of thousands of beneficiaries with conditions ranging from multiple sclerosis to Parkinson’s to diabetes, arthritis, and heart disease.\u003c/p>\n\u003cp>But while it will boost spending for Medicare by preventing many of those patients from spending themselves into poverty, it could well end up saving money for Medicaid, which is jointly financed by the federal government and the states.\u003c/p>\n\u003cp>A new survey from the Kaiser Family Foundation finds that after one of the \u003ca href=\"http://www.reuters.com/article/2011/12/13/us-usa-states-medicaid-idUSTRE7BC25420111213\">fastest growing years\u003c/a> for that program, Medicaid spending growth \u003ca href=\"http://www.kff.org/medicaid/medicaid102512nr.cfm\">slowed dramatically in 2012\u003c/a>.\u003c/p>\n\u003cp>Total state Medicaid spending grew by an average of two percent in fiscal 2012, “among the lowest rates of growth ever recorded,” according to the study. By contrast, spending in fiscal 2011 rose by 9.7 percent.\u003c/p>\n\u003cp>Part of the slowdown was due to a recovering economy, which made fewer additional people eligible for the program, the survey found. Part was also due to states imposing their own cost controls on the program, in part stemming from the \u003ca href=\"http://www.npr.org/2011/07/01/137536342/how-much-do-states-really-spend-on-medicaid\">end of additional temporary federal funding\u003c/a> that came as part of the 2009 stimulus law.\u003c/p>\n\u003cp>That spending could go down more – a lot more – if Mitt Romney is elected and implements his plan for Medicaid, according to \u003ca href=\"http://www.kff.org/medicaid/8185.cfm\">yet another study\u003c/a> out this week.\u003c/p>\n\u003cp>This one, commissioned by the Kaiser Family Foundation and done by researchers for the Urban Institute, looked at the potential impact of implementing the plan approved by the Republican-led House. That’s similar to the one \u003ca href=\"http://www.mittromney.com/issues/health-care\">Romney is proposing\u003c/a>.\u003c/p>\n\u003cp>The study found that the combination of repealing the Affordable Care Act (which calls for a major expansion of Medicaid) and limiting federal payments for Medicaid could together reduce federal Medicaid spending by $1.7 trillion from 2013 to 2022. That represents a 38 percent cut in federal funding for the program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study estimated a range of how many people would lose coverage, depending on how states react. The estimates, however, range from a low of 31.3 million fewer people being covered to 37.5 fewer million people being covered.\u003c/p>\n\n",
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"excerpt": "Whatever the outcome on November 6th, official Washington will still have to deal with a looming “fiscal cliff” before the end of the year.\r\n\r\nWhat’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.",
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"description": "Whatever the outcome on November 6th, official Washington will still have to deal with a looming “fiscal cliff” before the end of the year.\r\n\r\nWhat’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.",
"title": "No Matter Who Wins, We're Still Heading for A Cliff | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>By Julie Rovner\u003c/em>,\u003ca title=\"http://capsules.kaiserhealthnews.org/index.php/2012/10/as-fiscal-cliff-looms-medicare-and-medicaid-face-uncertain-futures/\" href=\"http://capsules.kaiserhealthnews.org/index.php/2012/10/as-fiscal-cliff-looms-medicare-and-medicaid-face-uncertain-futures/\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8743\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Cliff_Edge_Su-Lin_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8743\" title=\"(Su-Lin: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Cliff_Edge_Su-Lin_Flickr-300x225.jpg\" alt=\"(Su-Lin: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Su-Lin: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Whatever the outcome on November 6th, officials in Washington will still have to deal with a looming “fiscal cliff” before the end of the year.\u003c/p>\n\u003cp>What’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.\u003c/p>\n\u003cp>As two of the largest spending items in the federal budget, the \u003ca href=\"http://www.cbpp.org/cms/index.cfm?fa=view&id=1258\">Medicare and Medicaid\u003c/a> health programs are expected to play a role in how the deal gets done. Under the provisions of the law that created the budget deal Congress will attempt to undo, Medicare is subject to a \u003ca href=\"http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2012/10/23/driving-off-the-fiscal-cliff-will-providers-be-there-after-the-crash-\">two percent cut\u003c/a> in provider payments, while Medicaid is exempt.\u003c/p>\n\u003cp>But two new studies and a proposed class action lawsuit settlement suggest a lot of dollar signs could change as lawmakers start to think about how to address the impending mess.\u003cimg title=\"More...\" src=\"http://blogs.kqed.org/election2012/wp-includes/js/tinymce/plugins/wordpress/img/trans.gif\" alt=\"\">\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A proposed settlement in a \u003ca href=\"http://www.nytimes.com/2012/10/23/us/politics/settlement-eases-rules-for-some-medicare-patients.html?_r=1&\">long-running dispute\u003c/a> between advocates for Medicare patients and the federal government is actually likely to increase Medicare spending -- although how much remains unclear.\u003c/p>\n\u003cp>The suit was brought by the \u003ca href=\"http://www.medicareadvocacy.org/hidden/highlight-improvment-standard/\">Center for Medicare Advocacy\u003c/a> on behalf of a class of patients with chronic conditions. these patients had been denied Medicare coverage for home care, nursing home care or other services on the grounds that the patients’ conditions were not expected to “improve” with care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.medicareadvocacy.org/wp-content/uploads/2012/10/Proposed-Settlement-Agreement.101612.pdf\">settlemen\u003c/a>t -- assuming it is approved by the judge in the case -- means that “the Medicare Benefit Policy Manual will be revised to correct any suggestion that continued coverage is dependent on the beneficiary improving,” said the organization in a statement. The change is expected to affect as many as tens of thousands of beneficiaries with conditions ranging from multiple sclerosis to Parkinson’s to diabetes, arthritis, and heart disease.\u003c/p>\n\u003cp>But while it will boost spending for Medicare by preventing many of those patients from spending themselves into poverty, it could well end up saving money for Medicaid, which is jointly financed by the federal government and the states.\u003c/p>\n\u003cp>A new survey from the Kaiser Family Foundation finds that after one of the \u003ca href=\"http://www.reuters.com/article/2011/12/13/us-usa-states-medicaid-idUSTRE7BC25420111213\">fastest growing years\u003c/a> for that program, Medicaid spending growth \u003ca href=\"http://www.kff.org/medicaid/medicaid102512nr.cfm\">slowed dramatically in 2012\u003c/a>.\u003c/p>\n\u003cp>Total state Medicaid spending grew by an average of two percent in fiscal 2012, “among the lowest rates of growth ever recorded,” according to the study. By contrast, spending in fiscal 2011 rose by 9.7 percent.\u003c/p>\n\u003cp>Part of the slowdown was due to a recovering economy, which made fewer additional people eligible for the program, the survey found. Part was also due to states imposing their own cost controls on the program, in part stemming from the \u003ca href=\"http://www.npr.org/2011/07/01/137536342/how-much-do-states-really-spend-on-medicaid\">end of additional temporary federal funding\u003c/a> that came as part of the 2009 stimulus law.\u003c/p>\n\u003cp>That spending could go down more – a lot more – if Mitt Romney is elected and implements his plan for Medicaid, according to \u003ca href=\"http://www.kff.org/medicaid/8185.cfm\">yet another study\u003c/a> out this week.\u003c/p>\n\u003cp>This one, commissioned by the Kaiser Family Foundation and done by researchers for the Urban Institute, looked at the potential impact of implementing the plan approved by the Republican-led House. That’s similar to the one \u003ca href=\"http://www.mittromney.com/issues/health-care\">Romney is proposing\u003c/a>.\u003c/p>\n\u003cp>The study found that the combination of repealing the Affordable Care Act (which calls for a major expansion of Medicaid) and limiting federal payments for Medicaid could together reduce federal Medicaid spending by $1.7 trillion from 2013 to 2022. That represents a 38 percent cut in federal funding for the program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study estimated a range of how many people would lose coverage, depending on how states react. The estimates, however, range from a low of 31.3 million fewer people being covered to 37.5 fewer million people being covered.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>By Julie Appleby,\u003c/em> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/25/health-care-costs.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/25/health-care-costs.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>There is no one villain in the battle against rising health care costs.\u003c/p>\n\u003cp>Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole. Many factors -- and nearly everyone -- contributes to those increases.\u003c/p>\n\u003cp>Here are seven ways you or your medical providers play a role, based on a recent report from the \u003ca title=\"http://bipartisanpolicy.org/library/staff-paper/what-driving-us-health-care-spending\" href=\"http://bipartisanpolicy.org/library/staff-paper/what-driving-us-health-care-spending\" target=\"_blank\">Bipartisan Policy Center\u003c/a>, a think tank in Washington, D.C.\u003c/p>\n\u003cp>\u003cstrong>1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Most insurers -- including traditional Medicare -- pay doctors, hospitals and other medical providers under a fee-for-service system that reimburses for each test, procedure or visit. Coupled with a medical system that is not integrated, this encourages overtreatment, including repetitive tests, the report says. New efforts in the federal health law and among some private insurers aim to move payments toward a flat rate for a specific condition, such as a knee replacement, or for a patient's entire episode of care, in order to streamline costs. Medical systems and doctors are also looking to electronic medical records as a way to improve coordination and reduce unnecessary, repeated tests.\u003c/p>\n\u003cp>\u003cstrong>2. We're growing older, sicker and fatter.\u003c/strong>\u003c/p>\n\u003cp>As we get older, we tend to need more medical care. The baby boom generation is heading into retirement, with enrollment in Medicare set to grow by an average of 1.6 million people annually. Additionally, nearly half the U.S. population has one or more chronic conditions, among them asthma, heart disease or diabetes, which drive up costs. And two-thirds of adults are either overweight or obese, which can also lead to chronic illness and additional medical spending.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.28.55-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8723\" title=\"Screen Shot 2012-10-25 at 1.28.55 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.28.55-PM-620x407.png\" alt=\"\" width=\"620\" height=\"407\">\u003c/a>\u003cbr>\n\u003c!--more-->\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.31.36-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8724\" title=\"Screen Shot 2012-10-25 at 1.31.36 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.31.36-PM-620x445.png\" alt=\"\" width=\"620\" height=\"445\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>3. We want new drugs, technologies, services and procedures.\u003c/strong>\u003c/p>\n\u003cp>Medical advances can help us get well, avoid disease and delay death, but they also drive up spending. Much new technology comes on the market after being tested only for safety or whether the new treatment is comparable to existing ones or even placebos. Patients and doctors often demand the newest treatments, even if there is little or no evidence that they are better. Prices for newer treatments are often higher than for the products they replace.\u003c/p>\n\u003cp>\u003cstrong>4. We get tax breaks on buying health insurance -- and the cost to patients of seeking care is often low.\u003c/strong>\u003c/p>\n\u003cp>The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care.\u003c/p>\n\u003cp>\u003cstrong>5. We don't have enough information to make decisions on which medical care is best for us.\u003c/strong>\u003c/p>\n\u003cp>While medical journals, the Internet and the popular press are awash in health information and studies, professionals and patients find there is no broad standard for evaluating individual treatments, or how specific treatments compare with others. Even when evidence shows a treatment isn't effective, or is potentially harmful, it can take a long time for that information to actually change how doctors practice or what patients demand, the report says. Additionally, Americans vary widely in how they view end-of- life issues, with some desiring every possible medical intervention to stave off death in every situation, no matter how small the possibility of success.\u003c/p>\n\u003cp>\u003cstrong>6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.\u003c/strong>\u003c/p>\n\u003cp>While mergers or partnerships among medical providers or insurers may improve efficiency and help drive down prices, consolidation can also have the opposite effect, allowing near-monopolies in some markets and driving up prices, the report says. Increasingly, hospitals are buying up rivals and directly employing physicians, creating larger medical systems.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.32.10-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8725\" title=\"Screen Shot 2012-10-25 at 1.32.10 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.32.10-PM-620x385.png\" alt=\"\" width=\"620\" height=\"385\">\u003c/a>\u003cstrong> 7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.\u003c/strong>\u003c/p>\n\u003cp>Malpractice premiums and jury awards are part of what drives spending. A larger problem, although hard to quantify, is \"defensive medicine\" -- when doctors prescribe unnecessary tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing or unnecessary tests by medical providers seeking to \"game the system\" are another concern.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Finally, the report notes that state laws sometimes limit the ability of nurse practitioners or other medical professionals, who are paid less than doctors, to fully perform work for which they are trained. The U.S. faces a shortage of primary care doctors, so more advanced practice nurses and others will be needed to help care for patients who gain insurance coverage under the federal health law. Conversely, the U.S. has a higher ratio of specialists than other countries, which can serve to drive up spending. Specialists have more advanced training than primary care doctors, and are paid far more.\u003c/p>\n\n",
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"excerpt": "There is no one villain in the battle against rising health care costs.\r\n\r\nCurrently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole. Many factors -- and nearly everyone -- contributes to those increases.\r\n\r\nHere are seven ways you or your medical providers play a role, based on a recent report from the Bipartisan Policy Center, a think tank in Washington, D.C. \r\n\r\n1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>By Julie Appleby,\u003c/em> \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/25/health-care-costs.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/25/health-care-costs.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>There is no one villain in the battle against rising health care costs.\u003c/p>\n\u003cp>Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole. Many factors -- and nearly everyone -- contributes to those increases.\u003c/p>\n\u003cp>Here are seven ways you or your medical providers play a role, based on a recent report from the \u003ca title=\"http://bipartisanpolicy.org/library/staff-paper/what-driving-us-health-care-spending\" href=\"http://bipartisanpolicy.org/library/staff-paper/what-driving-us-health-care-spending\" target=\"_blank\">Bipartisan Policy Center\u003c/a>, a think tank in Washington, D.C.\u003c/p>\n\u003cp>\u003cstrong>1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Most insurers -- including traditional Medicare -- pay doctors, hospitals and other medical providers under a fee-for-service system that reimburses for each test, procedure or visit. Coupled with a medical system that is not integrated, this encourages overtreatment, including repetitive tests, the report says. New efforts in the federal health law and among some private insurers aim to move payments toward a flat rate for a specific condition, such as a knee replacement, or for a patient's entire episode of care, in order to streamline costs. Medical systems and doctors are also looking to electronic medical records as a way to improve coordination and reduce unnecessary, repeated tests.\u003c/p>\n\u003cp>\u003cstrong>2. We're growing older, sicker and fatter.\u003c/strong>\u003c/p>\n\u003cp>As we get older, we tend to need more medical care. The baby boom generation is heading into retirement, with enrollment in Medicare set to grow by an average of 1.6 million people annually. Additionally, nearly half the U.S. population has one or more chronic conditions, among them asthma, heart disease or diabetes, which drive up costs. And two-thirds of adults are either overweight or obese, which can also lead to chronic illness and additional medical spending.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.28.55-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8723\" title=\"Screen Shot 2012-10-25 at 1.28.55 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.28.55-PM-620x407.png\" alt=\"\" width=\"620\" height=\"407\">\u003c/a>\u003cbr>\n\u003c!--more-->\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.31.36-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8724\" title=\"Screen Shot 2012-10-25 at 1.31.36 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.31.36-PM-620x445.png\" alt=\"\" width=\"620\" height=\"445\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>3. We want new drugs, technologies, services and procedures.\u003c/strong>\u003c/p>\n\u003cp>Medical advances can help us get well, avoid disease and delay death, but they also drive up spending. Much new technology comes on the market after being tested only for safety or whether the new treatment is comparable to existing ones or even placebos. Patients and doctors often demand the newest treatments, even if there is little or no evidence that they are better. Prices for newer treatments are often higher than for the products they replace.\u003c/p>\n\u003cp>\u003cstrong>4. We get tax breaks on buying health insurance -- and the cost to patients of seeking care is often low.\u003c/strong>\u003c/p>\n\u003cp>The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care.\u003c/p>\n\u003cp>\u003cstrong>5. We don't have enough information to make decisions on which medical care is best for us.\u003c/strong>\u003c/p>\n\u003cp>While medical journals, the Internet and the popular press are awash in health information and studies, professionals and patients find there is no broad standard for evaluating individual treatments, or how specific treatments compare with others. Even when evidence shows a treatment isn't effective, or is potentially harmful, it can take a long time for that information to actually change how doctors practice or what patients demand, the report says. Additionally, Americans vary widely in how they view end-of- life issues, with some desiring every possible medical intervention to stave off death in every situation, no matter how small the possibility of success.\u003c/p>\n\u003cp>\u003cstrong>6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.\u003c/strong>\u003c/p>\n\u003cp>While mergers or partnerships among medical providers or insurers may improve efficiency and help drive down prices, consolidation can also have the opposite effect, allowing near-monopolies in some markets and driving up prices, the report says. Increasingly, hospitals are buying up rivals and directly employing physicians, creating larger medical systems.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.32.10-PM.png\">\u003cimg class=\"aligncenter size-large wp-image-8725\" title=\"Screen Shot 2012-10-25 at 1.32.10 PM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Screen-Shot-2012-10-25-at-1.32.10-PM-620x385.png\" alt=\"\" width=\"620\" height=\"385\">\u003c/a>\u003cstrong> 7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.\u003c/strong>\u003c/p>\n\u003cp>Malpractice premiums and jury awards are part of what drives spending. A larger problem, although hard to quantify, is \"defensive medicine\" -- when doctors prescribe unnecessary tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing or unnecessary tests by medical providers seeking to \"game the system\" are another concern.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Finally, the report notes that state laws sometimes limit the ability of nurse practitioners or other medical professionals, who are paid less than doctors, to fully perform work for which they are trained. The U.S. faces a shortage of primary care doctors, so more advanced practice nurses and others will be needed to help care for patients who gain insurance coverage under the federal health law. Conversely, the U.S. has a higher ratio of specialists than other countries, which can serve to drive up spending. Specialists have more advanced training than primary care doctors, and are paid far more.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>By Mina Kim\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_8703\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Esfandiar_MinaKim_10252012.jpg\">\u003cimg class=\"size-medium wp-image-8703\" title=\"66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Esfandiar_MinaKim_10252012-e1351184417392-300x276.jpg\" alt=\"66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\" width=\"300\" height=\"276\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Golden State Adult Day Health Care in San Francisco serves seniors primarily from Russia, Ukraine and other Eastern European countries. As I walked in, I saw immediately that I was underdressed. All around were seniors pushing walkers, and they were wearing glittering sweaters, fur hats or chiffon skirts.\u003c/p>\n\u003cp>“This is mostly clothes from fifty years ago,” Center Director Katya Hope says. “But you look like you’re going to the opera because in fact, this is the major chance to socialize.”\u003c/p>\n\u003cp>Socializing is why 83-year-old Berta Vekhman says she loves it here.\u003c/p>\n\u003cp>“We cannot stay alone. When we are alone, we are dead,\" Vekhman says. “because we stay alone and nobody at home you cannot talk to somebody. You forget how to talk.”\u003c/p>\n\u003caside class=\"pullquote alignright\">The prospect of being home alone is hard on her. “I cry all day, all day.\"\u003c/aside>\n\u003cp>Vekhman suffers from diabetes, Parkinson’s Disease and needs help using the bathroom. She is prone to depression which she says has worsened since January. That's when state officials deemed her -- and 2,000 other seniors -- ineligible for services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Vekhman was receiving care through the Adult Day Health Care program. Through the program, independent centers, like Golden State, provided physical therapy, mental health treatment and a chance to socialize.\u003c!--more-->\u003c/p>\n\u003cp>In a budget balancing move last year, Gov. Jerry Brown tried to eliminate Adult Day Health Care entirely. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/14/how-lawsuits-can-stymie-some-budget-cuts/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/14/how-lawsuits-can-stymie-some-budget-cuts/\" target=\"_blank\">But advocates for the disabled sued\u003c/a>, and the result was a legal settlement that created Community Based Adult Services. It's a smaller program and has stricter eligibility requirements.\u003c/p>\n\u003cp>Vekhman has appealed her ineligibility. She feels lucky that Golden State is letting her continue to come for free. But the prospect of being home alone is hard on her. “I cry all day, all day,\" she says.\u003c/p>\n\u003cp>According to attorney Alice Ho the state is rejecting people who clearly qualify for the program. Ho and her colleagues at the law firm Ropes & Gray have handled the appeals of 14 of the seniors at Golden State Adult Day Health Care.\u003c/p>\n\u003cp>“These seniors had either Alzheimer’s or another form of dementia, issues like Parkinson’s disease, coronary artery disease, spinal meningiomas, other tumors,” Ho says. “Imagine older grandparents who’ve actually gotten really sick.”\u003c/p>\n\u003cp>What frustrates Ho is that all 14 seniors had initially been deemed eligible after face-to-face evaluations with state nurses last year. Officials with the Department of Healthcare Services overturned the nurses’ assessments, creating a lengthy appeals process -- that has resulted in all the seniors getting reinstated.\u003c/p>\n\u003cp>Golden State Adult Day Health Care has managed to keep providing services to seniors, even though the state is not reimbursing centers during the appeals process. But that's been the exception, not the rule.\u003c/p>\n\u003cp>At Grace Adult Day Health Care in Sunnyvale, an occupational therapist leads seniors through stretching exercises, giving instructions in both English and Farsi. At this center which serves seniors -- mostly from Iran and Afghanistan -- the state deemed nearly 80 of them ineligible for Community Based Adult Services.\u003c/p>\n\u003cp>“That's almost half the center,” Grace Adult Day's director Manooch Pouransari says. “And we think all of them are a mistake.”\u003c/p>\n\u003cp>The seniors here filed appeals earlier this year, but the state hasn't yet decided any of them. Pouransari says he tried to swallow the costs of caring for these seniors, but after three months, it became too much.\u003c/p>\n\u003cp>“It was a big blow financially to keep them here without the pay.” Pouransari says. “But with the state not responding, no news about hearings, we had to let them go.”\u003c/p>\n\u003cp>Pouransari says the seniors have suffered strokes, falls and broken hips.\u003c/p>\n\u003cp>Esfandiar Asbagh, 66, says he's had several falls while he's been home alone. Asbagh was stricken with polio as an infant and can't control the left side of his body.\u003c/p>\n\u003cp>“I have dizziness,” Asbagh struggles to say. “I'm very deep depression when I am alone.”\u003c/p>\n\u003cp>Asbagh says what keeps him going is the belief that the state will allow him back in to the program. “I believe 95 to 95 percent I'll win.”\u003c/p>\n\u003cp>State officials say delays in the appeals process stem from the program's legal battles and that the agency is now moving through the cases much faster. They say hearings are expected to be completed next month. Jane Ogle, Department of Health Care Services Deputy Director, says she stands behind the agency's eligibility determinations, including the ones that have overruled nurses' earlier assessments.\u003c/p>\n\u003cp>“With such a highly scrutinized program, we need to make sure that our decisions are fair and accurate and correct for each of the participants,” Ogle says. “That's why we put in a quality assurance review for each of these decisions”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>On November 8, state officials are expected to explain this in federal court. Advocates for the disabled say the state's eligibility reversals are illegal and are asking a judge to order that all seniors awaiting hearing decisions be reinstated.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>By Mina Kim\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_8703\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Esfandiar_MinaKim_10252012.jpg\">\u003cimg class=\"size-medium wp-image-8703\" title=\"66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Esfandiar_MinaKim_10252012-e1351184417392-300x276.jpg\" alt=\"66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\" width=\"300\" height=\"276\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">66-year-old Esfandiar Asbagh is waiting to learn if he is eligible for state adult day care services. (Mina Kim: KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Golden State Adult Day Health Care in San Francisco serves seniors primarily from Russia, Ukraine and other Eastern European countries. As I walked in, I saw immediately that I was underdressed. All around were seniors pushing walkers, and they were wearing glittering sweaters, fur hats or chiffon skirts.\u003c/p>\n\u003cp>“This is mostly clothes from fifty years ago,” Center Director Katya Hope says. “But you look like you’re going to the opera because in fact, this is the major chance to socialize.”\u003c/p>\n\u003cp>Socializing is why 83-year-old Berta Vekhman says she loves it here.\u003c/p>\n\u003cp>“We cannot stay alone. When we are alone, we are dead,\" Vekhman says. “because we stay alone and nobody at home you cannot talk to somebody. You forget how to talk.”\u003c/p>\n\u003caside class=\"pullquote alignright\">The prospect of being home alone is hard on her. “I cry all day, all day.\"\u003c/aside>\n\u003cp>Vekhman suffers from diabetes, Parkinson’s Disease and needs help using the bathroom. She is prone to depression which she says has worsened since January. That's when state officials deemed her -- and 2,000 other seniors -- ineligible for services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Vekhman was receiving care through the Adult Day Health Care program. Through the program, independent centers, like Golden State, provided physical therapy, mental health treatment and a chance to socialize.\u003c!--more-->\u003c/p>\n\u003cp>In a budget balancing move last year, Gov. Jerry Brown tried to eliminate Adult Day Health Care entirely. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/14/how-lawsuits-can-stymie-some-budget-cuts/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/14/how-lawsuits-can-stymie-some-budget-cuts/\" target=\"_blank\">But advocates for the disabled sued\u003c/a>, and the result was a legal settlement that created Community Based Adult Services. It's a smaller program and has stricter eligibility requirements.\u003c/p>\n\u003cp>Vekhman has appealed her ineligibility. She feels lucky that Golden State is letting her continue to come for free. But the prospect of being home alone is hard on her. “I cry all day, all day,\" she says.\u003c/p>\n\u003cp>According to attorney Alice Ho the state is rejecting people who clearly qualify for the program. Ho and her colleagues at the law firm Ropes & Gray have handled the appeals of 14 of the seniors at Golden State Adult Day Health Care.\u003c/p>\n\u003cp>“These seniors had either Alzheimer’s or another form of dementia, issues like Parkinson’s disease, coronary artery disease, spinal meningiomas, other tumors,” Ho says. “Imagine older grandparents who’ve actually gotten really sick.”\u003c/p>\n\u003cp>What frustrates Ho is that all 14 seniors had initially been deemed eligible after face-to-face evaluations with state nurses last year. Officials with the Department of Healthcare Services overturned the nurses’ assessments, creating a lengthy appeals process -- that has resulted in all the seniors getting reinstated.\u003c/p>\n\u003cp>Golden State Adult Day Health Care has managed to keep providing services to seniors, even though the state is not reimbursing centers during the appeals process. But that's been the exception, not the rule.\u003c/p>\n\u003cp>At Grace Adult Day Health Care in Sunnyvale, an occupational therapist leads seniors through stretching exercises, giving instructions in both English and Farsi. At this center which serves seniors -- mostly from Iran and Afghanistan -- the state deemed nearly 80 of them ineligible for Community Based Adult Services.\u003c/p>\n\u003cp>“That's almost half the center,” Grace Adult Day's director Manooch Pouransari says. “And we think all of them are a mistake.”\u003c/p>\n\u003cp>The seniors here filed appeals earlier this year, but the state hasn't yet decided any of them. Pouransari says he tried to swallow the costs of caring for these seniors, but after three months, it became too much.\u003c/p>\n\u003cp>“It was a big blow financially to keep them here without the pay.” Pouransari says. “But with the state not responding, no news about hearings, we had to let them go.”\u003c/p>\n\u003cp>Pouransari says the seniors have suffered strokes, falls and broken hips.\u003c/p>\n\u003cp>Esfandiar Asbagh, 66, says he's had several falls while he's been home alone. Asbagh was stricken with polio as an infant and can't control the left side of his body.\u003c/p>\n\u003cp>“I have dizziness,” Asbagh struggles to say. “I'm very deep depression when I am alone.”\u003c/p>\n\u003cp>Asbagh says what keeps him going is the belief that the state will allow him back in to the program. “I believe 95 to 95 percent I'll win.”\u003c/p>\n\u003cp>State officials say delays in the appeals process stem from the program's legal battles and that the agency is now moving through the cases much faster. They say hearings are expected to be completed next month. Jane Ogle, Department of Health Care Services Deputy Director, says she stands behind the agency's eligibility determinations, including the ones that have overruled nurses' earlier assessments.\u003c/p>\n\u003cp>“With such a highly scrutinized program, we need to make sure that our decisions are fair and accurate and correct for each of the participants,” Ogle says. “That's why we put in a quality assurance review for each of these decisions”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>On November 8, state officials are expected to explain this in federal court. Advocates for the disabled say the state's eligibility reversals are illegal and are asking a judge to order that all seniors awaiting hearing decisions be reinstated.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_8677\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr.jpg\">\u003cimg class=\"size-medium wp-image-8677\" title=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr-300x289.jpg\" alt=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If a medical study shows that a treatment has a big effect, how much should you trust it? According to a \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" target=\"_blank\">provocative report\u003c/a> published today, not very much.\u003c/p>\n\u003cp>A group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.\u003c/p>\n\u003cp>But here the rub: more than 90 percent of the time, those \"very large effects\" don't hold up after further research.\u003c/p>\n\u003cp>Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, \"Most of the time ... these very large effects largely evaporated, they became substantially smaller. It's not that they necessarily went away competely, but they were much, much smaller than the initial study.\"\u003c!--more-->\u003c/p>\n\u003cp>As the researchers say in the first line of their publication, \"Most effective interventions in health care confer modest, incremental benefits.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Of course, a modest benefit is not so bad, as Ioannidis quickly added. \"If you have several drugs or types of interventions and each of them could contribute some incremental benefit, that means we may have some room for ... progress in getting some better outcomes by using several of those interventions.\"\u003c/p>\n\u003cp>Still, when I pointed out that this news was likely to be a big bummer to lots of Americans used to the search for the silver bullet, he laughed softly and said, \"Yeah, too bad.\" He says that a belief in the silver bullet \"creates a vicious circle. It also creates an environment where claims for a silver bullet thrive against such overwhelming evidence.\"\u003c/p>\n\u003cp>There's room for more skepticism all around, Ioannidis asserts: from scientists, from patients, from the press and its readers, and from citizens. \"Whenever a very big discovery, or effect, or extraordinary finding is described,\" Ioannidis says, \"there should be some skepticism that it's not as huge, maybe it's not completely wrong, but it's not at that magnitude.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There was only one single case where Ioannidis and his colleagues identified an intervention that dramatically reduced death risk (a treatment for newborns with respiratory failure). Ioannidis admitted that some interventions likely to have big effects are never tested in randomized trials -- for ethical reasons. For example, if someone is bleeding profusely, doctors will always try to stop the bleeding. Scientists cannot randomize two groups to test a hypothesis around stopping bleeding.\u003c/p>\n\n",
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"excerpt": "If a medical study shows that a treatment has a big effect, how much should you trust it? According to a provocative report published today, not very much.\r\n\r\nA group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8677\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr.jpg\">\u003cimg class=\"size-medium wp-image-8677\" title=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr-300x289.jpg\" alt=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If a medical study shows that a treatment has a big effect, how much should you trust it? According to a \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" target=\"_blank\">provocative report\u003c/a> published today, not very much.\u003c/p>\n\u003cp>A group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.\u003c/p>\n\u003cp>But here the rub: more than 90 percent of the time, those \"very large effects\" don't hold up after further research.\u003c/p>\n\u003cp>Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, \"Most of the time ... these very large effects largely evaporated, they became substantially smaller. It's not that they necessarily went away competely, but they were much, much smaller than the initial study.\"\u003c!--more-->\u003c/p>\n\u003cp>As the researchers say in the first line of their publication, \"Most effective interventions in health care confer modest, incremental benefits.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Of course, a modest benefit is not so bad, as Ioannidis quickly added. \"If you have several drugs or types of interventions and each of them could contribute some incremental benefit, that means we may have some room for ... progress in getting some better outcomes by using several of those interventions.\"\u003c/p>\n\u003cp>Still, when I pointed out that this news was likely to be a big bummer to lots of Americans used to the search for the silver bullet, he laughed softly and said, \"Yeah, too bad.\" He says that a belief in the silver bullet \"creates a vicious circle. It also creates an environment where claims for a silver bullet thrive against such overwhelming evidence.\"\u003c/p>\n\u003cp>There's room for more skepticism all around, Ioannidis asserts: from scientists, from patients, from the press and its readers, and from citizens. \"Whenever a very big discovery, or effect, or extraordinary finding is described,\" Ioannidis says, \"there should be some skepticism that it's not as huge, maybe it's not completely wrong, but it's not at that magnitude.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There was only one single case where Ioannidis and his colleagues identified an intervention that dramatically reduced death risk (a treatment for newborns with respiratory failure). Ioannidis admitted that some interventions likely to have big effects are never tested in randomized trials -- for ethical reasons. For example, if someone is bleeding profusely, doctors will always try to stop the bleeding. Scientists cannot randomize two groups to test a hypothesis around stopping bleeding.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By Sarah Varney\u003c/strong>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/22/reagan-democrats-medicare.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/22/reagan-democrats-medicare.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8663\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Reagan_OpusPenguin_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8663\" title=\"(Opus Penguin: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Reagan_OpusPenguin_Flickr-300x254.jpg\" alt=\"(Opus Penguin: Flickr)\" width=\"300\" height=\"254\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Opus Penguin: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Of those voting this year, count in the so-called Reagan Democrats -- that group of once loyal left-leaners who crossed party lines in 1980 and helped the former California governor relocate to the White House.\u003c/p>\n\u003cp>Some of those Reagan Democrats were in their late 30s or early 40s then. Today, they’re older and on Medicare, a program that the GOP wants to alter dramatically. Do they fear for Medicare? Or do they still hold true to the Gipper’s smaller government ethos, even if it might mean big changes to the program for seniors and the disabled?\u003c/p>\n\u003cp>Kaiser Health News tracked down three Reagan Democrats, who have each landed in a different place on this question: Cheryl McNamara, John Crowe and Penny Lockhart.\u003c/p>\n\u003cp>Cheryl McNamara was 35 years old in 1980 and a registered Democrat. Asked what she remembers most about that period, she says the one thing that jumps to mind is inflation: \"I could see it was just killing my father, for example, who worked for a much smaller company and who couldn’t afford to raise their prices to match inflation. So he couldn’t afford to give the raises to people to match inflation, so the value of my father’s income was eroding.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>McNamara, now 67, lives in Willowbrook, Illinois and thinks she'll vote for Mitt Romney. She remembers thinking Reagan could put the brakes on inflation and stop the government from meddling with prices.\u003c!--more-->\u003c/p>\n\u003cp>It’s a message Jon Crowe, an undecided voter who is now 72 and living in Wardensville, West Virginia, remembers too.\u003c/p>\n\u003cp>\"My main lean with Reagan was basically budgetary,\" Crowe says. \"I found much more compatibility with Reagan's philosophy than I did with the Democratic philosophy.\"\u003c/p>\n\u003cp>But for both McNamara and Crowe, there were other ideas that were starting to take root then. McNamara says her belief that the country had enough money to do right by all of its citizens was starting to falter.\u003c/p>\n\u003cp>\"As I grew older and reality set in, I realized that there isn’t enough money in the world to spend it any which way you wanted to,\" McNamara says.\u003c/p>\n\u003cp>Crowe found himself at odds with both parties to a degree: \"At the time, my thinking about it was that the Democrats always wanted to get elected to give you something, and the Republicans wanted to get elected to reduce taxes. And I thought they were both wrong. I didn’t like a lot of the welfare policies. Although I thought people needed help, I thought Reagan had better ideas on that.\"\u003c/p>\n\u003cp>Penny Lockhart crossed over for Reagan's re-election in 1984. She was 39 years old, she recalls, \"Let’s see, my daughter was 5-years-old, and I had just gone to work part-time as bookkeeper.\"\u003c/p>\n\u003cp>Lockhart lives in the same modest home she lived in then, in the self-proclaimed garlic capital of the world, Gilroy, California.\u003c/p>\n\u003cp>\"My parents were both very active in Democratic politics,\" Lockhart says, \"so when I voted for Ronald Reagan it was a great shock to my family and actually my mother made me promise that I would not re-register as a Republican until she was dead.\"\u003c/p>\n\u003cp>Lockhart’s mother was a junior college teacher and her father managed a meat company. Lockhart starting doing accounting work for local farmers and welders whose businesses were in distress.\u003c/p>\n\u003cp>\"At that point I realized how hard it is to be a self-employed person and how important it is to give other people jobs,\" she says.\u003c/p>\n\u003cp>Lockhart, McNamara and Crowe don’t remember much about President Reagan and Medicare. The years they would need the program were, after all, still decades away. Reagan \u003cem>had \u003c/em>warned in a \u003ca href=\"http://www.mediaite.com/online/past-is-prologue-ronald-reagan-on-medicare-in-1961-sound-familiar\">1961 recording\u003c/a> for the American Medical Association that Medicare would usher in an age of totalitarianism: \"And pretty soon your son won’t decide when he’s in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do,\" he warned, ominously.\u003c/p>\n\u003cp>But by the time he became President, those fears seem to have subsided. Indeed, according to the Ronald Reagan Presidential Library, Reagan oversaw the expansion of Medicare to protect the elderly and disabled against what he called \"catastrophic\" health costs.\u003c/p>\n\u003cp>Lockhart is now 67 and on Medicare. It seems unlikely to Lockhart -- who plans to vote for Obama -- that Reagan would find much in common with the Romney-Ryan plan for premium support. That plan would give future Medicare beneficiaries a fixed amount of money to buy coverage from private health plans or traditional Medicare.\u003c/p>\n\u003cp>\"I do not believe that if Mr. Reagan were around today that he would be on the same page as Mr. Ryan,\" says Lockheart. \"I think he would want changes to be made so that things could continue as they were. I think of him as a really warm-hearted person and I find it hard to believe that he would want everything privatized.\"\u003c/p>\n\u003cp>For her part, Cheryl McNamara says she can get behind the Romney-Ryan Medicare plan. She says the Republican proposal is similar to the Medicare Advantage plans that exist today that give private insurers a set fee to care for patients.\u003c/p>\n\u003cp>\"I think it would be fine,\" says McNamara. \"There has to be a limit to how much the government paysfor this program, because price keeps going up, you have to spread that cost around.\"\u003c/p>\n\u003cp>John Crowe believes that the cost of Medicare needs to be addressed. He hasn’t decided who he is going to vote for, but he doesn’t trust the \"free market\" to look out for seniors’ best interests.\u003c/p>\n\u003cp>\"If you go to a voucher system, these insurance agents are gonna say, 'Whoa, we don’t need this guy who has a pre-existing condition' so they take the people with good health. So if they’re not stopped from that, the people who need the most are getting the least because they can’t afford the policy,\" says Crowe.\u003c/p>\n\u003cp>On the day he was interviewed, Crowe's wife was recovering from an operation, paid for by Medicare. With her safely at home, he sounded almost wistful about the man he helped elect many years ago. \"Reagan, he recognized the problem with government, the problem with Congress or bureaucracy,\" Crowe says. \"But he also felt there was a role that government should play and had to play and he was very proud of government.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Crowe says Reagan’s standard bearer is nowhere nearby.\u003c/p>\n\n",
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"excerpt": "Of those voting this year, count in the so-called Reagan Democrats -- that group of once loyal left-leaners who crossed party lines in 1980 and helped the former California governor relocate to the White House.\r\n\r\nSome of those Reagan Democrats were in their late 30s or early 40s then. Today, they’re older and on Medicare, a program that the GOP wants to alter dramatically. Do they fear for Medicare? Or do they still hold true to the Gipper’s smaller government ethos, even if it might mean big changes to the program for seniors and the disabled?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Sarah Varney\u003c/strong>, \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/22/reagan-democrats-medicare.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/22/reagan-democrats-medicare.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8663\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Reagan_OpusPenguin_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8663\" title=\"(Opus Penguin: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Reagan_OpusPenguin_Flickr-300x254.jpg\" alt=\"(Opus Penguin: Flickr)\" width=\"300\" height=\"254\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Opus Penguin: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Of those voting this year, count in the so-called Reagan Democrats -- that group of once loyal left-leaners who crossed party lines in 1980 and helped the former California governor relocate to the White House.\u003c/p>\n\u003cp>Some of those Reagan Democrats were in their late 30s or early 40s then. Today, they’re older and on Medicare, a program that the GOP wants to alter dramatically. Do they fear for Medicare? Or do they still hold true to the Gipper’s smaller government ethos, even if it might mean big changes to the program for seniors and the disabled?\u003c/p>\n\u003cp>Kaiser Health News tracked down three Reagan Democrats, who have each landed in a different place on this question: Cheryl McNamara, John Crowe and Penny Lockhart.\u003c/p>\n\u003cp>Cheryl McNamara was 35 years old in 1980 and a registered Democrat. Asked what she remembers most about that period, she says the one thing that jumps to mind is inflation: \"I could see it was just killing my father, for example, who worked for a much smaller company and who couldn’t afford to raise their prices to match inflation. So he couldn’t afford to give the raises to people to match inflation, so the value of my father’s income was eroding.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>McNamara, now 67, lives in Willowbrook, Illinois and thinks she'll vote for Mitt Romney. She remembers thinking Reagan could put the brakes on inflation and stop the government from meddling with prices.\u003c!--more-->\u003c/p>\n\u003cp>It’s a message Jon Crowe, an undecided voter who is now 72 and living in Wardensville, West Virginia, remembers too.\u003c/p>\n\u003cp>\"My main lean with Reagan was basically budgetary,\" Crowe says. \"I found much more compatibility with Reagan's philosophy than I did with the Democratic philosophy.\"\u003c/p>\n\u003cp>But for both McNamara and Crowe, there were other ideas that were starting to take root then. McNamara says her belief that the country had enough money to do right by all of its citizens was starting to falter.\u003c/p>\n\u003cp>\"As I grew older and reality set in, I realized that there isn’t enough money in the world to spend it any which way you wanted to,\" McNamara says.\u003c/p>\n\u003cp>Crowe found himself at odds with both parties to a degree: \"At the time, my thinking about it was that the Democrats always wanted to get elected to give you something, and the Republicans wanted to get elected to reduce taxes. And I thought they were both wrong. I didn’t like a lot of the welfare policies. Although I thought people needed help, I thought Reagan had better ideas on that.\"\u003c/p>\n\u003cp>Penny Lockhart crossed over for Reagan's re-election in 1984. She was 39 years old, she recalls, \"Let’s see, my daughter was 5-years-old, and I had just gone to work part-time as bookkeeper.\"\u003c/p>\n\u003cp>Lockhart lives in the same modest home she lived in then, in the self-proclaimed garlic capital of the world, Gilroy, California.\u003c/p>\n\u003cp>\"My parents were both very active in Democratic politics,\" Lockhart says, \"so when I voted for Ronald Reagan it was a great shock to my family and actually my mother made me promise that I would not re-register as a Republican until she was dead.\"\u003c/p>\n\u003cp>Lockhart’s mother was a junior college teacher and her father managed a meat company. Lockhart starting doing accounting work for local farmers and welders whose businesses were in distress.\u003c/p>\n\u003cp>\"At that point I realized how hard it is to be a self-employed person and how important it is to give other people jobs,\" she says.\u003c/p>\n\u003cp>Lockhart, McNamara and Crowe don’t remember much about President Reagan and Medicare. The years they would need the program were, after all, still decades away. Reagan \u003cem>had \u003c/em>warned in a \u003ca href=\"http://www.mediaite.com/online/past-is-prologue-ronald-reagan-on-medicare-in-1961-sound-familiar\">1961 recording\u003c/a> for the American Medical Association that Medicare would usher in an age of totalitarianism: \"And pretty soon your son won’t decide when he’s in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do,\" he warned, ominously.\u003c/p>\n\u003cp>But by the time he became President, those fears seem to have subsided. Indeed, according to the Ronald Reagan Presidential Library, Reagan oversaw the expansion of Medicare to protect the elderly and disabled against what he called \"catastrophic\" health costs.\u003c/p>\n\u003cp>Lockhart is now 67 and on Medicare. It seems unlikely to Lockhart -- who plans to vote for Obama -- that Reagan would find much in common with the Romney-Ryan plan for premium support. That plan would give future Medicare beneficiaries a fixed amount of money to buy coverage from private health plans or traditional Medicare.\u003c/p>\n\u003cp>\"I do not believe that if Mr. Reagan were around today that he would be on the same page as Mr. Ryan,\" says Lockheart. \"I think he would want changes to be made so that things could continue as they were. I think of him as a really warm-hearted person and I find it hard to believe that he would want everything privatized.\"\u003c/p>\n\u003cp>For her part, Cheryl McNamara says she can get behind the Romney-Ryan Medicare plan. She says the Republican proposal is similar to the Medicare Advantage plans that exist today that give private insurers a set fee to care for patients.\u003c/p>\n\u003cp>\"I think it would be fine,\" says McNamara. \"There has to be a limit to how much the government paysfor this program, because price keeps going up, you have to spread that cost around.\"\u003c/p>\n\u003cp>John Crowe believes that the cost of Medicare needs to be addressed. He hasn’t decided who he is going to vote for, but he doesn’t trust the \"free market\" to look out for seniors’ best interests.\u003c/p>\n\u003cp>\"If you go to a voucher system, these insurance agents are gonna say, 'Whoa, we don’t need this guy who has a pre-existing condition' so they take the people with good health. So if they’re not stopped from that, the people who need the most are getting the least because they can’t afford the policy,\" says Crowe.\u003c/p>\n\u003cp>On the day he was interviewed, Crowe's wife was recovering from an operation, paid for by Medicare. With her safely at home, he sounded almost wistful about the man he helped elect many years ago. \"Reagan, he recognized the problem with government, the problem with Congress or bureaucracy,\" Crowe says. \"But he also felt there was a role that government should play and had to play and he was very proud of government.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Presidential Debate: Health Care Excerpts from Both Candidates",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>From\u003ca title=\"http://www.kaiserhealthnews.org/Multimedia/2012/October/town-hall-debate-obama-romney.aspx\" href=\"http://www.kaiserhealthnews.org/Multimedia/2012/October/town-hall-debate-obama-romney.aspx\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Even when the questions aren't about health care, many of the responses are. Here's what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. A transcript follows.\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashVars\" value=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cparam name=\"src\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"flashvars\" value=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"allowfullscreen\" value=\"true\">\u003cparam name=\"swliveconnect\" value=\"true\">\u003cparam name=\"allowscriptaccess\" value=\"always\">\u003cparam name=\"pluginspage\" value=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003cembed width=\"486\" height=\"412\" type=\"application/x-shockwave-flash\" src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" flashvars=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" seamlesstabbing=\"false\" allowfullscreen=\"true\" swliveconnect=\"true\" allowscriptaccess=\"always\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>BARACK OBAMA: Katherine, I just want to point out that when Gov. Romney's campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, \"I'll get back to you.\" And that's not the kind of advocacy that women need in any economy.\u003c!--more-->\u003c/p>\n\u003cp>Now, there are some other issues that have a bearing on how women succeed in the workplace: for example, their health care. A major difference in this campaign is that Gov. Romney feels comfortable having politicians in Washington decide the health care choices that women are making. I think that's a mistake. In my health care bill, I said insurance companies need to provide contraceptive coverage to everybody who is insured, because this is not just a health issue. It's an economic issue for women. It makes a difference. This is money out of that family's pocket.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Gov. Romney not only opposed it -- he suggested that, in fact, employers should be able to make the decision as to whether or not a woman gets contraception through her insurance coverage. That's not the kind of advocacy that women need. When Gov. Romney says that we should eliminate funding for Planned Parenthood, there are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care. They rely on it for mammograms, for cervical cancer screenings. That's a pocketbook issue for women and families all across the country.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>MITT ROMNEY: I'd just note that I don't believe that bureaucrats in Washington should tell someone whether they can use contraceptives or not, and I don't believe employers should tell someone whether they could have contraceptive care or not. Every woman in America should have access to contraceptives. And the president's statement of my policy is completely and totally wrong.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>And then let's take the last one, championing small business. Our party has been focused on big business too long. I came through small business. I understand how hard it is to start a small business. That's why everything I'll do is designed to help small businesses grow and add jobs. I want to keep their taxes down on small business. I want regulators to see their job as encouraging small enterprise, not crushing it.\u003c/p>\n\u003cp>And the thing I find most troubling about Obamacare -- well, it's a long list -- but one of the things I find most troubling is that when you go out and talk to small businesses and ask them what they think about it, they tell you it keeps them from hiring more people.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>BARACK OBAMA: You know, there are some things where Gov. Romney is different from George Bush. George Bush didn't propose turning Medicare into a voucher. George Bush embraced comprehensive immigration reform. He didn't call for self-deportation. George Bush never suggested that we eliminate funding for Planned Parenthood.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>But you should pay attention to this campaign, because Gov. Romney's made some commitments as well, and I suspect he'll keep those, too. You know, when members of the Republican Congress say, we're going to sign a no tax pledge so that we don't ask a dime from millionaires and billionaires to reduce our deficit so we can still invest in education and helping kids go to college, he said: me, too. When they said, we're going to cut Planned Parenthood funding, he said: me, too. When he said, we're going to repeal Obamacare, first thing I'm going to do -- despite the fact that it's the same health care plan that he passed in Massachusetts and is working well -- he said: me, too. That is not the kind of leadership that you need, but you should expect that those are promises he's going to keep.\u003c/p>\n\u003cp>And the choice in this election is going to be whose promises are going to be more likely to help you in your life, make sure your kids can go to college, make sure that you are getting a good-paying job, making sure that Medicare and Social Security will be there for you.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>MITT ROMNEY: I want to make sure that regulators see their job as encouraging small business , not crushing it. And there's no question but that Obamacare has been an extraordinary deterrent to enterprises of all kinds hiring people. My priority is making sure that we get more people hired. If we have more people hired, if we get back manufacturing jobs, if we get back all kinds of jobs into this country, then you're going to see rising incomes again.\u003c/p>\n\n",
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"excerpt": "Even when the questions aren't about health care, many of the responses are. Here's what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. \r\n\r\n \r\n\r\nA transcript follows.\r\n\r\n \r\n\r\nBARACK OBAMA: Katherine, I just want to point out that when Gov. Romney's campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, \"I'll get back to you.\" And that's not the kind of advocacy that women need in any economy.",
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"description": "Even when the questions aren't about health care, many of the responses are. Here's what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. \r\n\r\n \r\n\r\nA transcript follows.\r\n\r\n \r\n\r\nBARACK OBAMA: Katherine, I just want to point out that when Gov. Romney's campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, "I'll get back to you." And that's not the kind of advocacy that women need in any economy.",
"title": "Presidential Debate: Health Care Excerpts from Both Candidates | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>From\u003ca title=\"http://www.kaiserhealthnews.org/Multimedia/2012/October/town-hall-debate-obama-romney.aspx\" href=\"http://www.kaiserhealthnews.org/Multimedia/2012/October/town-hall-debate-obama-romney.aspx\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Even when the questions aren't about health care, many of the responses are. Here's what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. A transcript follows.\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashVars\" value=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cparam name=\"src\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"flashvars\" value=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"allowfullscreen\" value=\"true\">\u003cparam name=\"swliveconnect\" value=\"true\">\u003cparam name=\"allowscriptaccess\" value=\"always\">\u003cparam name=\"pluginspage\" value=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003cembed width=\"486\" height=\"412\" type=\"application/x-shockwave-flash\" src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" flashvars=\"videoId=1906061309001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" seamlesstabbing=\"false\" allowfullscreen=\"true\" swliveconnect=\"true\" allowscriptaccess=\"always\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>BARACK OBAMA: Katherine, I just want to point out that when Gov. Romney's campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, \"I'll get back to you.\" And that's not the kind of advocacy that women need in any economy.\u003c!--more-->\u003c/p>\n\u003cp>Now, there are some other issues that have a bearing on how women succeed in the workplace: for example, their health care. A major difference in this campaign is that Gov. Romney feels comfortable having politicians in Washington decide the health care choices that women are making. I think that's a mistake. In my health care bill, I said insurance companies need to provide contraceptive coverage to everybody who is insured, because this is not just a health issue. It's an economic issue for women. It makes a difference. This is money out of that family's pocket.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Romney not only opposed it -- he suggested that, in fact, employers should be able to make the decision as to whether or not a woman gets contraception through her insurance coverage. That's not the kind of advocacy that women need. When Gov. Romney says that we should eliminate funding for Planned Parenthood, there are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care. They rely on it for mammograms, for cervical cancer screenings. That's a pocketbook issue for women and families all across the country.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>MITT ROMNEY: I'd just note that I don't believe that bureaucrats in Washington should tell someone whether they can use contraceptives or not, and I don't believe employers should tell someone whether they could have contraceptive care or not. Every woman in America should have access to contraceptives. And the president's statement of my policy is completely and totally wrong.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>And then let's take the last one, championing small business. Our party has been focused on big business too long. I came through small business. I understand how hard it is to start a small business. That's why everything I'll do is designed to help small businesses grow and add jobs. I want to keep their taxes down on small business. I want regulators to see their job as encouraging small enterprise, not crushing it.\u003c/p>\n\u003cp>And the thing I find most troubling about Obamacare -- well, it's a long list -- but one of the things I find most troubling is that when you go out and talk to small businesses and ask them what they think about it, they tell you it keeps them from hiring more people.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>BARACK OBAMA: You know, there are some things where Gov. Romney is different from George Bush. George Bush didn't propose turning Medicare into a voucher. George Bush embraced comprehensive immigration reform. He didn't call for self-deportation. George Bush never suggested that we eliminate funding for Planned Parenthood.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>But you should pay attention to this campaign, because Gov. Romney's made some commitments as well, and I suspect he'll keep those, too. You know, when members of the Republican Congress say, we're going to sign a no tax pledge so that we don't ask a dime from millionaires and billionaires to reduce our deficit so we can still invest in education and helping kids go to college, he said: me, too. When they said, we're going to cut Planned Parenthood funding, he said: me, too. When he said, we're going to repeal Obamacare, first thing I'm going to do -- despite the fact that it's the same health care plan that he passed in Massachusetts and is working well -- he said: me, too. That is not the kind of leadership that you need, but you should expect that those are promises he's going to keep.\u003c/p>\n\u003cp>And the choice in this election is going to be whose promises are going to be more likely to help you in your life, make sure your kids can go to college, make sure that you are getting a good-paying job, making sure that Medicare and Social Security will be there for you.\u003c/p>\n\u003cp>…\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>MITT ROMNEY: I want to make sure that regulators see their job as encouraging small business , not crushing it. And there's no question but that Obamacare has been an extraordinary deterrent to enterprises of all kinds hiring people. My priority is making sure that we get more people hired. If we have more people hired, if we get back manufacturing jobs, if we get back all kinds of jobs into this country, then you're going to see rising incomes again.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Voucher Program Could Raise Medicare Premiums Across Country",
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"content": "\u003cp>\u003cstrong>If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" target=\"_blank\">By Jordan Rau, Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\">\u003cimg class=\"alignright size-full wp-image-8633\" title=\"OLYMPUS DIGITAL CAMERA\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\" alt=\"\" width=\"300\" height=\"215\">\u003c/a>The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.\u003c/p>\n\u003cp>If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).\u003c/p>\n\u003cp>The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.\u003c/p>\n\u003cp>The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated.\u003c!--more-->\u003c/p>\n\u003cp>Medicare spends vastly different amounts per beneficiary around the country, ranging from less than $500 a month per beneficiary in some places to more than $900 a month per beneficiary elsewhere. That’s often because people in some areas of the country are sicker and need more care; it’s also because providers in some places favor more interventions and more expensive ones. In those high-cost areas, beneficiaries would see significant monthly increases in premiums if they remained in traditional Medicare. The study found people in Los Angeles would have paid $260 more and people in Miami would have paid $492 more, for instance.\u003c/p>\n\u003cp>In other regions where Medicare costs were low—such as Alaska, Delaware, Hawaii, Wyoming and Washington, D.C.— people in traditional Medicare would not pay more, but people in many private Medicare Advantage plans would face higher premiums if they didn’t want to change to traditional Medicare. People in Portland, Ore., for instance, would have paid $211 more a month and people in Honolulu would have paid $254 a month to stay in their preferred private plan. About one in every four Medicare beneficiaries are now enrolled in these private plans, some of which are preferred provider organizations while others are HMOs.\u003c/p>\n\u003cp>Although the fight over premium support often has been characterized as a battle between defenders of traditional Medicare and proponents of private health plans, the study found that it could have a substantial impact on people who enrolled in Medicare Advantage plans. Nationwide, 88 percent of those beneficiaries would have paid more to stay in their plans, averaging $87 more per month, if it had been in place in 2010.\u003c/p>\n\u003cp>Of course, getting many beneficiaries to switch to less expensive plans is how the architects of premium support envision saving money. They say it will bring pressure on insurers, doctors and hospitals to offer lower prices. The study noted, however, that such shifts might mean significant changes in the type and quality of care for beneficiaries.\u003c/p>\n\u003cp>In some regions, the low cost plans might be HMOs, which have tightly controlled networks of doctors and hospitals. If beneficiaries switched from traditional Medicare to HMOs, they might not be able to keep seeing their regular doctors or go to their preferred hospital. In other areas, beneficiaries –perhaps people in private plans that coordinate care – might not like shifting into less costly traditional Medicare.\u003c/p>\n\u003cp>\"Beneficiaries' preferences and plan choices are not purely driven by premiums, and some beneficiaries may not view the low-cost plan, whether a private plan or traditional Medicare, as optimal for meeting their individual needs and circumstances,\" wrote the authors, led by analyst Gretchen Jacobson.\u003c/p>\n\u003cp>Other studies have found that only a small portion of Medicare beneficiaries switch their Part D prescription drug or Medicare Advantage plans each year, even when doing so could save them money. \"There are tradeoffs involved in making changes and we know from Part D and Medicare Advantage that people don’t really change very often,\" said Tricia Neuman, who oversees the foundation’s Medicare analyses.\u003c/p>\n\u003cp>In addition, the new study noted that some low-cost plans might not be able to handle an influx of new beneficiaries. A particularly glaring example is in Los Angeles County, where fewer than 10,000 beneficiaries are enrolled in one of the two lowest-cost plans, while more than 900,000 beneficiaries are enrolled in traditional Medicare or other plans\u003c/p>\n\u003cp>The study did not estimate how much money the plan would have saved Medicare. In a statement, the Romney campaign said: \"As the authors stress, this is not a study of the Romney-Ryan plan. Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare.\" The Obama campaign trumpeted the study, saying it \"demonstrates how hollow\" is Romney’s claim that the elderly would retain the option of enrolling in traditional Medicare under their plan.\u003c/p>\n\u003cp>Joe Antos, a health care expert at the American Enterprise Institute, said that the study is \"the best technical study so far of this sort,\" although he expected a premium support market would be much more competitive than the current Medicare Advantage market is, since the latter is guaranteed a certain payment by the federal government.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"The competition would be even more intense,\" he said, especially since most Medicare beneficiaries would not be able to afford anything more expensive than the benchmark plan, and thus insurers would compete to meet those prices. \"You just can't have high costs if people can’t pay it,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/October/15/premium-support-medicare-study.aspx\" target=\"_blank\">By Jordan Rau, Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\">\u003cimg class=\"alignright size-full wp-image-8633\" title=\"OLYMPUS DIGITAL CAMERA\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/SeniorWalking_KaiserHealthNews.jpg\" alt=\"\" width=\"300\" height=\"215\">\u003c/a>The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.\u003c/p>\n\u003cp>If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).\u003c/p>\n\u003cp>The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.\u003c/p>\n\u003cp>The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated.\u003c!--more-->\u003c/p>\n\u003cp>Medicare spends vastly different amounts per beneficiary around the country, ranging from less than $500 a month per beneficiary in some places to more than $900 a month per beneficiary elsewhere. That’s often because people in some areas of the country are sicker and need more care; it’s also because providers in some places favor more interventions and more expensive ones. In those high-cost areas, beneficiaries would see significant monthly increases in premiums if they remained in traditional Medicare. The study found people in Los Angeles would have paid $260 more and people in Miami would have paid $492 more, for instance.\u003c/p>\n\u003cp>In other regions where Medicare costs were low—such as Alaska, Delaware, Hawaii, Wyoming and Washington, D.C.— people in traditional Medicare would not pay more, but people in many private Medicare Advantage plans would face higher premiums if they didn’t want to change to traditional Medicare. People in Portland, Ore., for instance, would have paid $211 more a month and people in Honolulu would have paid $254 a month to stay in their preferred private plan. About one in every four Medicare beneficiaries are now enrolled in these private plans, some of which are preferred provider organizations while others are HMOs.\u003c/p>\n\u003cp>Although the fight over premium support often has been characterized as a battle between defenders of traditional Medicare and proponents of private health plans, the study found that it could have a substantial impact on people who enrolled in Medicare Advantage plans. Nationwide, 88 percent of those beneficiaries would have paid more to stay in their plans, averaging $87 more per month, if it had been in place in 2010.\u003c/p>\n\u003cp>Of course, getting many beneficiaries to switch to less expensive plans is how the architects of premium support envision saving money. They say it will bring pressure on insurers, doctors and hospitals to offer lower prices. The study noted, however, that such shifts might mean significant changes in the type and quality of care for beneficiaries.\u003c/p>\n\u003cp>In some regions, the low cost plans might be HMOs, which have tightly controlled networks of doctors and hospitals. If beneficiaries switched from traditional Medicare to HMOs, they might not be able to keep seeing their regular doctors or go to their preferred hospital. In other areas, beneficiaries –perhaps people in private plans that coordinate care – might not like shifting into less costly traditional Medicare.\u003c/p>\n\u003cp>\"Beneficiaries' preferences and plan choices are not purely driven by premiums, and some beneficiaries may not view the low-cost plan, whether a private plan or traditional Medicare, as optimal for meeting their individual needs and circumstances,\" wrote the authors, led by analyst Gretchen Jacobson.\u003c/p>\n\u003cp>Other studies have found that only a small portion of Medicare beneficiaries switch their Part D prescription drug or Medicare Advantage plans each year, even when doing so could save them money. \"There are tradeoffs involved in making changes and we know from Part D and Medicare Advantage that people don’t really change very often,\" said Tricia Neuman, who oversees the foundation’s Medicare analyses.\u003c/p>\n\u003cp>In addition, the new study noted that some low-cost plans might not be able to handle an influx of new beneficiaries. A particularly glaring example is in Los Angeles County, where fewer than 10,000 beneficiaries are enrolled in one of the two lowest-cost plans, while more than 900,000 beneficiaries are enrolled in traditional Medicare or other plans\u003c/p>\n\u003cp>The study did not estimate how much money the plan would have saved Medicare. In a statement, the Romney campaign said: \"As the authors stress, this is not a study of the Romney-Ryan plan. Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare.\" The Obama campaign trumpeted the study, saying it \"demonstrates how hollow\" is Romney’s claim that the elderly would retain the option of enrolling in traditional Medicare under their plan.\u003c/p>\n\u003cp>Joe Antos, a health care expert at the American Enterprise Institute, said that the study is \"the best technical study so far of this sort,\" although he expected a premium support market would be much more competitive than the current Medicare Advantage market is, since the latter is guaranteed a certain payment by the federal government.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_8606\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Soda_Flickr_Tessek.jpg\">\u003cimg class=\"size-medium wp-image-8606\" title=\"(Tessek: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Soda_Flickr_Tessek-300x223.jpg\" alt=\"(Tessek: Flickr)\" width=\"300\" height=\"223\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Tessek: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>My KQED colleague Mina Kim \u003ca title=\"http://blogs.kqed.org/election2012/2012/10/12/can-a-penny-an-ounce-soda-tax-curb-obesity/\" href=\"http://blogs.kqed.org/election2012/2012/10/12/can-a-penny-an-ounce-soda-tax-curb-obesity/\" target=\"_blank\">produced a great piece\u003c/a> examining whether higher soda prices leads to weight loss -- and the health benefits that come with it. She profiled a 17-year-old football player from Tracy -- Jorge Cota, who at 5'11\" weighed 321 pounds. He had high blood pressure and may have had heart and kidney problems. That was a year ago.\u003c/p>\n\u003cp>While Cota since has made many diet changes, the first thing he did was cut out his drink of choice, Dr. Pepper. He had been drinking two or three cans or bottles a day.\u003c/p>\n\u003cp>He's since lost 70 pounds, Kim reports.\u003c/p>\n\u003cp>Still, Cota told Kim that he doubts a penny-per-ounce soda tax would make a difference in soda consumption. After all, a 20-ounce soda would go up only 20 cents.\u003c/p>\n\u003cp>Kim turned to Kelly Brownell, head of the Rudd Center for Food Policy and Obesity at Yale. As she reports:\u003c/p>\n\u003cblockquote>\u003cp>His group has studied how pricing changes affect consumer behavior.\u003c/p>\n\u003cp>“The penny-per-ounce, which is the level of tax being discussed the most around the country, is enough to affect consumption, somewhere between 10 or 20 percent or so,” Brownell says. “[That] would be enough to not make it a terrible burden on consumers, but would affect consumption of the product enough to reduce health care costs.”\u003c/p>\n\u003cp>More importantly, Brownell says, passage of the tax would give a big boost to the national trend away from sugary drinks that’s already begun in school districts and communities where demand for fresh local food is growing.\u003c!--more-->\u003c/p>\n\u003cp>“When the beverage industry claims that this really won’t affect consumption patterns, then why in the world are they fighting it so hard?” Brownell asks.\u003c/p>\u003c/blockquote>\n\u003cp>\u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/01/09/soda-tax-what-can-a-penny-do/\" href=\"http://ww2.kqed.org/stateofhealth/2012/01/09/soda-tax-what-can-a-penny-do/\" target=\"_blank\">As State of Health reported earlier this year,\u003c/a> not only does the reduced consumption reduce health care costs, researchers say, it can also save lives. Reduced consumption equals modest weight loss, which reduces risk of diabetes, and over 10 years researchers estimated 26,000 lives would be saved (or \"premature deaths\" avoided).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Last December, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/07/could-richmond-be-first-california-city-to-tax-soda/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/07/could-richmond-be-first-california-city-to-tax-soda/\" target=\"_blank\">when the Richmond City Council was debating\u003c/a> whether to investigate putting a soda tax on the ballot, I talked to Harold Goldstein of the California Center for Public Health Advocacy. As I reported then:\u003c/p>\n\u003cblockquote>\u003cp>Goldstein \u003ca title=\"http://cwh.berkeley.edu/sites/default/files/primary_pdfs/Sweetened_Bevs_Obesity_Epidemic_PHN_2010_0.pdf\" href=\"http://cwh.berkeley.edu/sites/default/files/primary_pdfs/Sweetened_Bevs_Obesity_Epidemic_PHN_2010_0.pdf\" target=\"_blank\">cites a study\u003c/a> from UC Berkeley Center for Weight and Health which looked at average daily caloric consumption from 1977-2001 and found the average American was eating 278 more calories each day. Almost half of those calories were from sweetened drinks. “The results were mind-blowing,” he said, but added, “I realize in my adult lifetime, the beverage industry has changed dramatically. It used to be one little glass with ice. If you wanted more, you had to pay more. Every restaurant now provides free refills. What comes out of the vending machine has gone from 12 ounces to 20 ounces.”\u003c/p>\u003c/blockquote>\n\u003cp>And all of those ounces come with calories.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People may oppose a soda tax for all kinds of reasons. Indeed Kim closes her piece with discussions from opponents who say it will drive people away from local businesses, that the tax flows into the general fund and is not mandated to be spent on anti-obesity programs (although voters can approve a non-binding measure to direct the money to sports fields and the like), but one thing is certain: sugary beverages are getting the national attention public health advocates have been pushing for.\u003c/p>\n\n",
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"excerpt": "My KQED colleague Mina Kim produced a great piece examining whether higher soda prices leads to weight loss -- and the health benefits that come with it. She profiled a 17-year-old football player from Tracy -- Jorge Cota, who at 5'11\" weighed 321 pounds. He had high blood pressure and may have had heart and kidney problems. That was a year ago.\r\n\r\nWhile Cota since has made many diet changes, the first thing he did was cut out his drink of choice, Dr. Pepper. He had been drinking two or three cans or bottles a day.\r\n\r\nHe's since lost 70 pounds, Kim reports.",
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"description": "My KQED colleague Mina Kim produced a great piece examining whether higher soda prices leads to weight loss -- and the health benefits that come with it. She profiled a 17-year-old football player from Tracy -- Jorge Cota, who at 5'11" weighed 321 pounds. He had high blood pressure and may have had heart and kidney problems. That was a year ago.\r\n\r\nWhile Cota since has made many diet changes, the first thing he did was cut out his drink of choice, Dr. Pepper. He had been drinking two or three cans or bottles a day.\r\n\r\nHe's since lost 70 pounds, Kim reports.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last December, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/07/could-richmond-be-first-california-city-to-tax-soda/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/07/could-richmond-be-first-california-city-to-tax-soda/\" target=\"_blank\">when the Richmond City Council was debating\u003c/a> whether to investigate putting a soda tax on the ballot, I talked to Harold Goldstein of the California Center for Public Health Advocacy. As I reported then:\u003c/p>\n\u003cblockquote>\u003cp>Goldstein \u003ca title=\"http://cwh.berkeley.edu/sites/default/files/primary_pdfs/Sweetened_Bevs_Obesity_Epidemic_PHN_2010_0.pdf\" href=\"http://cwh.berkeley.edu/sites/default/files/primary_pdfs/Sweetened_Bevs_Obesity_Epidemic_PHN_2010_0.pdf\" target=\"_blank\">cites a study\u003c/a> from UC Berkeley Center for Weight and Health which looked at average daily caloric consumption from 1977-2001 and found the average American was eating 278 more calories each day. Almost half of those calories were from sweetened drinks. “The results were mind-blowing,” he said, but added, “I realize in my adult lifetime, the beverage industry has changed dramatically. It used to be one little glass with ice. If you wanted more, you had to pay more. Every restaurant now provides free refills. What comes out of the vending machine has gone from 12 ounces to 20 ounces.”\u003c/p>\u003c/blockquote>\n\u003cp>And all of those ounces come with calories.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People may oppose a soda tax for all kinds of reasons. Indeed Kim closes her piece with discussions from opponents who say it will drive people away from local businesses, that the tax flows into the general fund and is not mandated to be spent on anti-obesity programs (although voters can approve a non-binding measure to direct the money to sports fields and the like), but one thing is certain: sugary beverages are getting the national attention public health advocates have been pushing for.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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