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			Wednesday, August 12, 2009 News Clipping Archives *Maryland / Regional* Schools prepare for flu, hope to avoid closings (Catonsville Times) Uncertainty remains with next round of state budget cutbacks (Annapolis Capital) Md. health care meeting packed but controlled (Salisbury Daily Times) Pharmacy groups mull options in Del. Lawsuit (Salisbury Daily Times) Food bank providing summer meals for teens (Baltimore Sun) Shriver remembered in Carroll (Carroll County Times) State to spray Dorchester Co. for mosquitos Thursday (Salisbury Daily Times) About 30 animals seized from Virginia home (USA Today) Va day care center loses license over boy's death (USA Today) One-Woman Argument For Drug Treatment (Washington Post) *National / International* Bartering for health care is growing (Daily Record) Survey Finds High Fees Common in Medical Care (New York Times) Swine Flu Cases Climb Among U.S. Soldiers in Iraq (Washington Post) *Opinion* Don't Forget the Bacterial Threat (Wall Street Journal Commentary) Credit Sen. Cardin for willingness to listen (Hagerstown Herald-Mail Letter to the Editor) *Maryland / Regional* Schools prepare for flu, hope to avoid closings By Jay R. Thompson Catonsville Times Wednesday, August 12, 2009 With the 2009-10 school year less than three weeks away, faculty and staff at Baltimore County Public Schools have more to worry about than leaving summer behind and dusting off lesson plans. After all, swine flu is still out there. On its Web site, the Maryland Department of Health and Mental Hygiene has a large graphic with the words "H1N1 Influenza Virus" as its visual centerpiece. Its prominence leaves little doubt that health officials still harbor concern about the virus, perhaps with good reason: Four people died in Maryland over the summer due to the virus. "It's highly contagious, just like seasonal flu," said David Paulson, a spokesman for the Department of Health and Mental Hygiene. "Children and young adults seem to be a population that has little resistance," he said. Given the virus's communicability and young people's vulnerability, state and local health officials have focused on what will happen when young people are suddenly in close proximity with hundreds of their peers in public schools. "The variabilities are so many and there's so much that we don't know," Paulson said. Speaking about the virus in general, Paulson added, "We do expect, like seasonal flu, that there will be more deaths." "We have had some meetings about it," said Charles Herndon, spokesman for Baltimore County Public Schools. "Ultimately, this is going to come from the state and the county." In an e-mail, Monique Lyle, spokeswoman for the county Department of Health, said the department is working with the school system to "establish procedures both to aid in the prevention of spread of influenza and to handle ... individual cases and situations where there are multiple cases at a given school in accordance with the most current Centers for Disease Control guidelines." The guidelines include that a student suspected of having H1N1 would be "isolated from other students until their parents can come pick them up," Lyle said. "They will be required to be kept out of school until fever free for 24 hours and off any antiviral medications," she said. The school system got a little practice handling a swine flu incident during last spring. In May, the county closed Millford Mill Academy for a few days when a student there was confirmed to have swine flu. Lyle said school closures remain an option, and the decision rests with the state Department of Health and Mental Hygiene and the state superintendent. "School principals will be kept informed about what the current thinking is about their particular situation and they will notify parents promptly as soon as any decision is made about school closure," Lyle said. Aside from suspected cases of H1N1, the county schools' Health Services office will be "closely monitoring" attendance data and school nurse reports for signs of swine flu, and will pass findings on to county health officials, Lyle said. The state's first H1N1-related death was June 23. A second Maryland death was attributed to the virus July 8, followed by another on July 15 and another July 23. The actual number of swine flu cases in the state is in the hundreds. "The last count that we did last week is 799 confirmed cases in Maryland," Paulson said Aug. 3. But, as of July 24, the Department of Health and Mental Hygiene, along with the CDC, is no longer tracking the number of swine flu cases because, Paulson said, numbers have become meaningless. "Part of the reason for a count is to find out where the flu is," Paulson said. At this point, health officials already know that swine flu is "virtually in every corner of the state," Paulson said. Additionally, health officials have concluded that their counts are limited in accuracy because most cases are never reported. "Most people who get the flu get treatment or recover without having the flu test confirmed as H1N1," Paulson said. Tips for flu prevention Paulson suggests frequent hand-washing, or the popular standby when a sink and soap are not readily available. "People can protect themselves by using hand-sanitizer throughout the day," Paulson said. "I have two or three bottles in my office," he said. The state Department of Health Mental Hygiene also advises people to cover their mouth and nose when they cough or sneeze to prevent spreading the virus. Paulson said that while it's a reflex for people to use their hands to cover their faces when sneezing or coughing, the proper way is to block the cough or sneeze with the inside of one's elbow -- a relatively harmless place not used for shaking hands or opening doors, both simple means of viral transmission. Health officials are working on a vaccine. A swine flu vaccine is almost ready and the University of Maryland Medical Center will be one of eight sites in the country participating in trials of the vaccine, Paulson said. The state Department of Health and Mental Hygiene expects to receive their first batch of vaccines this fall. "They're hoping mid-October," Paulson said. For information about swine flu, go to the state Department of Health and Mental Hygiene's Web site at www.dhmh.state.md.us. Copyright 2009 Catonsville Times. Uncertainty remains with next round of state budget cutbacks By Liam Farrell Annapolis Capital Wednesday, August 12, 2009 Gov. Martin O'Malley's administration is publicly revealing few details about its next round of budget cuts as legislators grapple with the continuing uncertainty of Maryland's revenue situation. Administration officials told the House Appropriations and Senate Budget and Taxation committees yesterday that talks with labor groups and county governments are ongoing, but offered few glimpses of the more than $400 million of proposed cuts that will be taken up by the Board of Public Works on Aug. 26. "No one wants to pick their poison," said Joe Bryce, the governor's chief legislative officer. "We are down to the point where we have to make tough decisions." Legislators unsuccessfully pressed for details about the second round of budget cuts needed to close a $700 million budget gap for this fiscal year, which began July 1. The board made about $280 million of spending reductions and transfers last month. "This isn't getting any easier," said Eloise Foster, the secretary of the Department of Budget and Management. The officials also did not specify at the hearing how many furlough days are under consideration, other than saying one goal would be to vary them based on salary. The plans still are being worked out, said Matthew Gallagher, O'Malley's deputy chief of staff, who declined to mention the specific number of days employees would take under the plan. But he said they will focus on making lower-paid employees take fewer furlough days than those with higher salaries. "I think that the furlough plan that was enacted in the last fiscal year gives some indication of the way that we want to go about doing it," he said. Gallagher said administration officials have met with labor negotiators six times in recent weeks to talk about the plan. "I would characterize those discussions as ongoing," Gallagher said. Analysts with the state Department of Legislative Services told the committees that 66 percent of the first round of cuts did not affect services, and only $89.7 million of those adjustments are certain to be ongoing. "What it represents is a start," said Warren Deschenaux, the chief analyst for DLS. "It doesn't make tremendous progress in working down the out-year expectations." Although one-time actions and federal stimulus money are providing some budget buoyancy, the fiscal 2011 deficit is projected to be more than $2 billion. Until September's updated revenue estimates, it is difficult to know whether the problem will worsen, Deschenaux said. "The revenue world has proven sufficiently volatile," he said. "I don't know that we are going to be rapidly climbing out of our present predicament." The broad brush from O'Malley and his aides in the next round of actions will include hits to local aid and employee compensation, and leave kindergarten through 12th grade funding alone. Sen. Richard Madaleno, D-Montgomery, noted that keeping education sacrosanct leaves few big pots of money to raid, besides aid for local roads and community colleges. He urged the administration to be more specific. "You have two weeks," he said. "We have to start talking about it." Others were more blunt about how sustainable O'Malley's goals may turn out to be. "I know education is a sacred cow, but sometimes they get eaten as well," said Del. Galen Clagett, D-Frederick. One option that is definitively not on the governor's agenda, however, is new taxes. When asked about the possibility of proposing higher revenue raisers, Bryce had a succinct answer. "No," he said. The Associated Press contributed to this story. Copyright 2009 Annapolis Capital. Md. health care meeting packed but controlled By David Dishneau Salisbury Daily Times Tuesday, August 12, 2009 HAGERSTOWN, Md. (AP) — U.S. Sen. Ben Cardin told an excitable, skeptical crowd in western Maryland on Wednesday that the federal government has a responsibility to provide affordable health care to all, and that duty need not add to the national debt. Critics of health care reform often interrupted the Maryland Democrat, forcing him to compete with chants of, "Just say no!" near the end of the 70-minute session. But Cardin also drew loud applause for saying he supports a Patients' Bill of Rights guaranteeing a process for appealing insurer decisions, and opposes age discrimination in access to care. "The objective is to make sure that we don't discriminate by age, ever, in our health care system," Cardin told an 11-year-old boy who asked if his grandfather's quality of care, if he got cancer, would be lower than for a younger person. Still, the loudest cheers were for audience members who said they see the Democrat-led effort to provide universal health insurance as an ill-advised federal takeover of the medical system. "This is really not about health care reform or insurance reform. It's a bill about government control," one man said to wild applause. Another questioner got a standing ovation when she declared, "Your government has lost the faith and trust of the American people." Some booed when Cardin responded that the Obama administration has started restoring trust in health care. He quickly calmed the crowd by pledging not to support any health care reform bill that would increase the federal deficit. People lined up in warm, humid weather hours before the meeting at Hagerstown Community College. About 500 remained outside after the auditorium was filled, said campus security chief Henry Gautney. The first in line was Carol Austin, 64, a Hagerstown antiques dealer who supports universal health care and said she showed up at 8 a.m. for the meeting. "I think we drastically need health care reform," she said. "Providing for the general welfare is part of our Constitution, and I think health care for all is part of that." The opposite view was expressed by most of the signs displayed outside. "The Obama health plan sucks," read a sign stuck in the ground near the steps leading to the campus theater. Many wore signs or T-shirts identifying themselves as members of an "angry mob." Cardin told reporters before the meeting that those who portray the reform effort as a bid to legalize euthanasia and provide free health care for illegal immigrants are deliberately misleading the public, "and I don't think that furthers the debate." He disagreed with Democratic House Speaker Nancy Pelosi's claim, along with House Majority Leader Steny Hoyer, D-Maryland, that the disruptions at town hall meetings are "un-American." But Cardin said unruly behavior is better suited for demonstrations. "If people try to disrupt, that's not what you should be doing at a town hall meeting," he said. Copyright 2009 Salisbury Daily Times. Pharmacy groups mull options in Del. lawsuit Associated Press Salisbury Daily Times Wednesday, August 12, 2009 WILMINGTON, Del. (AP) — Two trade groups challenging a reduction in Medicaid reimbursements to Delaware pharmacies are weighing their options. A federal judge on Wednesday gave the National Association of Chain Drug Stores and the National Community Pharmacists Association two weeks to decide how to proceed in their lawsuit. The groups sued the state in June over a two-percent reduction in reimbursement rates. The lawsuit was filed after Walgreen Co. said its 66 stores serving Delaware patients would drop out of the Medicaid program. But Walgreen reached an agreement with the state this week, saying it will remain in the Medicaid program and is dropping out of the lawsuit. Attorneys for the trade groups said they need time to review Walgreen's settlement with the state. Copyright 2009 Salisbury Daily Times. Food bank providing summer meals for teens At PAL Center in Woodmoor, nightly free dinners with friends By Mary Gail Hare Baltimore Sun Wednesday, August 12, 2009 For about 35 teens, the PAL Center in Woodmoor doesn't just mean board games and billiards, basketball tournaments and the occasional movie; the children also get a free dinner with friends. Most walk to the center in Baltimore County, arriving about 4 p.m. weekdays and typically staying until the building closes at 8 p.m. Nearly all say they enjoy the simple cold supper served from a paper bag. "I like that we have different things for dinner every day and that I get to talk to my friends," said Amandi Alston, 15. "I would rather have soda, but I know that the juice and milk they give us are better for us." For students accustomed to free breakfast and lunch at school, summer can be a hungry time. The Maryland Food Bank is serving 1,600 children daily, including the Woodmoor teens, through its Summer Food Service Program. The food bank is assisting nearly twice the number of children in this second year of the program and in many cases is providing the younger children two meals a day. "These are solid, nutritious meals," said Shanna Yetman, a spokeswoman for the food bank. "For children in low-income areas, three meals a day can be a stretch for many parents, especially in this economy. Summer is a particularly hard time for these children." The federally funded program, administered through the Maryland State Department of Education's School and Community Nutrition Programs, has made the food bank the local sponsor. It provides meals through vendors at five sites in Baltimore County, seven in Anne Arundel, four in Baltimore, one in Cecil County and six on the Eastern Shore. Some centers see up to 80 children a day and serve three meals. "We identify and manage the sites," said John Shaia, the program director. "But we know the numbers of children who need this program are on the rise and we need to increase this program." According to the 2007 Census Update, 144,000 children younger than 18 live at or below the federal poverty level. Feeding America, a domestic hunger-relief charity and a partner of the Maryland Food Bank, puts that number at more than 200,000. "We are trying to feed as many children as we can this summer," Yetman said. At the Woodmoor location, the teens gather in the art room about 5 p.m. and engage in lively conversation as they eat sandwiches, fruit and dessert and drink a glass of milk and a cup of juice. "They are here hanging out at the center, and they just stay for dinner," said Sam Buppert, 20, the center's assistant manager. "A lot of them say they would not have dinner if we didn't have it for them here. These are all growing kids who need food." Jeriah Williams, 13, said the meals at the center are better than what he might have at home. Jasmen Jackson, 17, said she likes the chicken drumsticks best. Nija Parker, 14, likes having fresh fruit every day. "We are all like a big family here," Jasmen said. Copyright © 2009, The Baltimore Sun. Shriver remembered in Carroll By Bryan Schutt Carroll County Times Wednesday, August 12, 2009 The impact of Eunice Kennedy Shriver’s death resounded across the country Tuesday, including Carroll County. The wife of Carroll native Sargent Shriver, Eunice Shriver will be forever remembered as a leading activist for the mentally disabled. Eunice Shriver, the sister of President John F. Kennedy, founded the Special Olympics as part of her quest to improve the lives of millions of children and adults. “She was the light of our lives, a mother, wife, grandmother, sister and aunt who taught us by example and with passion what it means to live a faith-driven life of love and service to others,” the family said to The Associated Press. James Shriver, a volunteer and member of board of governors at the Union Mills Homestead, said Eunice Shriver frequently visited the homestead along with Sargent Shriver, who was a life member. “She was a very engaging and friendly person,” he said. “She was very attached to Sargent; they were very close. Both had a very strong sense of family.” James Shriver said Sargent Shriver is a direct descendant of the homestead’s founders, Andrew and David Shriver. James Shriver said he believes Andrew Shriver was Sargent Shriver’s great-great-grandfather. Sargent Shriver had a house in Willow Street in Westminster and frequented Union Mills even once he moved away, according to Shriver. He said that Sargent Shriver has a burial plot picked out in the St. John’s cemetery in Westminster, but couldn’t say if Eunice Shriver would be buried there. Westminster Police Chief Jeffrey Spaulding said he also had the opportunity to meet Eunice Shriver and was amazed by the woman. “She demonstrated what one person can do to change the minds and hearts of millions around the world,” he said. Spaulding, who organizes central Maryland’s law enforcement torch run for Special Olympics events, said he will serve as a Maryland law enforcement representative at her funeral on Friday. “She was very gracious, very sharp; it’s pretty amazing what she accomplished,” he said. Reach staff writer Bryan Schutt at 410-857-7886 or bryan.schutt@carrollcountytimes.com. Copyright 2009 Carroll County Times. State to spray Dorchester Co. for mosquitos Thursday Salisbury Daily Times Wednesday, August 12, 2009 CRAPO — The Maryland Department of Agriculture will spray parts of Dorchester County for mosquitos Thursday evening. The state will spray Lakesville, Crapo, Toddville, Wingate, Crocheron, Bishops Head, Andrews, Wesley and Robbins with a twin-engine white plane with red and blue stripes. Spraying will occur during the evening hours after sunset at about 300 to 500 feet from the ground. It is not necessary for people, pets or livestock to leave while the area is being treated. Copyright 2009 Salisbury Daily Times. About 30 animals seized from Virginia home Associated Press USA Today Wednesday, August 12, 2009 TIMBERVILLE, Va. (AP) — About 30 dogs, cats and other animals have been seized from a home in Rockingham County. Sheriff Don Farley says conditions inside the residence in Timberville were inhumane. The sheriff's office said in a news release that 25-year-old Ronald L. Adams and 20-year-old Tiffany K. Dimick, both of Harrisonburg, were charged Tuesday night with misdemeanor animal cruelty. Farley says deputies and animal control officers went to the home Monday and found 12 dogs chained outside with little or no food and water that was unfit to drink. Rabbits, guinea pigs, cats, a squirrel and a rat were found inside. Farley says some of the animals were dead. The animals were taken to the Rockingham County SPCA for treatment. Copyright 2009 The Associated Press. All rights reserved. Va day care center loses license over boy's death Associated Press USA Today Wednesday, August 12, 2009 RICHMOND, Va. (AP) — A Richmond day care center's license has been revoked in connection with the death of a toddler who was in the facility's care. The Virginia Department of Social Services' director of licensing revoked the license of the Yellow Brick Road Daycare and Learning Center on Wednesday. State regulators who investigated the death of 13-month-old Andrew Joseph Johnson had recommended the action. The day care can remain open while it appeals the decision. Johnson died of environmental heat exposure July 6 after he was left in a day care van for at least four hours. Valerot Whitlow, the day care's owner, was charged with felony child neglect charge earlier this month. Her son, 23-year-old Keishawn Whitfield, was charged with involuntary manslaughter. Whitfield was driving the van. Copyright 2009 The Associated Press. All rights reserved. One-Woman Argument For Drug Treatment By Courtland Milloy Washington Post Wednesday, August 12, 2009 After being hooked on drugs for nearly half her life, Rozetta Boggan, 56, has been drug-free for seven years. No more crack cocaine. No alcohol. No heroin. She has her own apartment in Alexandria and a job setting up displays at the Washington Convention Center. No more hanging out in crack houses, no more dealing to support her habit. For those who never had a problem with substance abuse, that might not seem like a big deal. But with billions of dollars being spent in a futile effort to stop the flow of drugs into the United States, Boggan and others like her have achieved a victory that's truly worth celebrating. "One night, I'd had enough," she told me recently. "I was just sick and tired of being sick and tired. Then, out of the blue I said, 'Lord, please get me off of drugs.' " In 2000, not long after that prayer for help, Boggan was convicted on a federal drug conspiracy charge and sent to the Alderson women's prison in West Virginia. She took advantage of the prison drug treatment program and regularly attended 12-step self-help meetings. "For the first time, I got honest with myself," she recalled. "I admitted that I was an addict and that I couldn't stop using on my own. I started listening to other people's stories about their battles with addiction. It gave me hope. Sometimes, when I'd call my girlfriends back home, they'd say, 'I've been clean for six months,' and, 'You know so-and-so is clean.' That would encourage me because I didn't want to be the oldest thing out there in the streets, 50-years-old and still on crack." None of that is to suggest that prison is a cure; the point is that drug treatment programs work -- wherever they may be. The only question is, why do so many nonviolent drug offenders have to go to a federal prison to get state of the art care? Boggan was a small-time street dealer who sold $20 to $50 bags of crack to feed her habit. The conspiracy case against her stemmed from her introducing a customer to a dealer who sold bags that weren't much larger -- $100 and up. Nevertheless, she was sentenced to 15 years in prison. That's far more than some dealers get for possessing and distributing pounds of powder cocain e . Boggan had a right to be peeved. But instead of showing self-righteous anger, she opted for peace of mind. She took responsibility for her role in the predicament and kept the focus on developing a set of principles by which she could live in harmony with others. Gratitude, not resentment, was her watchword. "I felt blessed," Boggan said. "I thanked God for sending me to prison." For good behavior and completing the drug treatment program, she was released after seven years. Neither of Boggan's parents drank or smoked. None of her siblings got mixed up in drugs. But that doesn't matter when it comes to drug addiction. Boggan, for whatever reason, was just different. "I just started drinking when I was 14 and progressed from one drug to the next," she recalled. "I also liked the street life. It was very fascinating to me. I was around a lot of older women in the streets, and I looked up to them. I had strong women in my family, all positive role models. I knew right from wrong, but I just chose to do wrong." With her life on the line, Boggan could not afford to wait for the country to win a war on drugs. She had to accept help where she found it, whether in a treatment program in prison or 12-step fellowship meetings once she got out. "I sometimes go to jails and tell my story to other women who are addicted to drugs and perform a praise dance to let them know how fortunate I am," Boggan said. "Each morning, I wake up, armor up with a prayer and make a conscious decision to stay clean -- one day at a time." That way, victory is assured. Copyright 2009 Washington Post. *National / International* Bartering for health care is growing Associated Press Daily Record Wednesday, August 12, 2009 Cash, check or a cord of wood for that doctor visit? As health care costs climb, old-fashioned bartering has seen brisk growth since the economy soured. Robert Josefs, a New Jersey resident, traded his Web site designing skills for nearly $1,000 in dental work last year when he had no insurance, and many other patients are learning that health care debts don't always have to be settled with sometimes-precious cash. Health care bartering has risen dramatically since the recession began, as people lose their health insurance and consumer spending drops, said Allen Zimmelman, a spokesman for the Bellevue, Wash.-based trade exchange ITEX Corp. ITEX Corp. has seen its health care business rise 45 percent over the past year. The exchange, which has 24,000 members, now fosters about $1 million a month in health care bartering. The popular online classified Web site Craigslist says overall bartering posts have more than doubled over the past year as the recession took hold. People who barter for health care say the practice allows them to stretch their resources or receive care they couldn't afford. But bartering can be tricky, and not every health care provider will consider it. Some doctors are open to bartering directly with patients. Others do their trading through an exchange like ITEX. These exchanges allow people to trade goods and services with other exchange members generally for barter dollars. They can then use those dollars to pay a health care provider who also belongs to the exchange. There are about 400 exchanges in the United States, Zimmelman said. The Web site barternews.com offers state-by-state listings. These exchanges charge membership and transaction fees, and they also help members deal with tax implications of bartering. Hotel rooms, restaurant meals and services like plumbing are among the more popular items traded. Direct bartering depends on the patient having a service or good the doctor needs. That's a wide range at The Barter Clinic on the edge of the Blue Ridge Mountains in Floyd, Va. Johanna Nichols barters produce from her organic vegetable farm with Susan Osborne, an osteopathic physician. Nichols, a Floyd resident, said she barters less than $600 in care every growing season to help offset a high-deductible insurance plan that covers her family. "We still are paying our health insurance premiums every month," she said. "It's just kind of an extra way to stretch our dollars." Osborne's Barter Clinic also accepts clothing, firewood and has counted violin lessons and child care among other unorthodox forms of payment. About 10 percent of her patients pay by alternative means from time to time. People will suggest a trade, and her office does research to figure the local prices for the proposed barter before deciding whether to accept it. Josefs, the Web site designer, found quick acceptance for his services. A dentist about an hour from his New Jersey home responded a few days after he posted a notice last year on Craigslist. He had chipped a dental veneer, but he had no insurance at the time. "There's a lot of out-of-pocket expenses that I was really just hoping not to pay," he said. Josefs had bartered successfully once before — by doing some Web design work for a sushi restaurant he and his wife frequent — and decided to try again. After calling an insurer to make sure his barter partner was an actual dentist, Josefs got about $900 in work in return for designing a Web site for the dental practice. He and the dentist hashed out a price after Josefs showed some sample Web sites and explained their cost. Web design is a popular bartering tool, but sometimes a specific skill isn't necessary. New Sharon, Maine, resident Anita Allen is spending part of her summer volunteering at nearby Franklin Memorial Hospital to help trim her uninsured grandson's medical debt. Allen, 72, works in the hospital's kitchen and gift shop under its Contract for Care program, which pays her by reducing the debt, which she figures may be around $8,000. She said her grandson took two trips to the emergency room for car and snowmobile accidents. He suffered no serious injuries, but the ambulance rides and exams that followed were pricey. "It sure helps to give time and pay off a bill because those bills run up quite fast," she said. Florida resident Steve Armstrong said his wife is getting a $6,000 dental implant paid by barter dollars he piled up through his business, Steve's Termite & Pest Control. Armstrong earns barter dollars by doing a few days of work each month for fellow members of International Barter Exchange. "Then the word of mouth from them goes to cash-buying customers too," he said. "It's like free advertising." Bartering to pay health care bills is generally limited to specialties like dentistry or smaller doctor practices that are less bureaucratic, said Andrew Whinston, a University of Texas at Austin professor who has studied bartering. Copyright 2009 Daily Record. Survey Finds High Fees Common in Medical Care By Gina Kolata New York Times Wednesday, August 12, 2009 A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629. The charges came out of a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008. The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that. But it said it did the survey in part to defend against efforts by the Obama administration to portray certain industry practices as a major part of the nation’s health care problems. The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online on Tuesday, explaining that they wanted to show that doctors’ fees are part of the health care problem. The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay. “It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth. The situation is so irrational, said Uwe E. Reinhardt, a health economist at Princeton, that it simply cannot go on. “We will not emerge out of this decade with this lunacy,” Dr. Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?” But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks. Karen M. Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying: “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.” Some of the health care legislation being considered by Congress would require insurers to increase their disclosure to patients of possible out-of-network costs. And President Obama has proposed changing how Medicare sets its payments to doctors and hospitals. But there are no specific proposals to control prices for out-of-network medical services. In the survey, patients were insured but saw doctors who were out of their networks of care providers. Those doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance. “That is what generally happens,” said Susan Pisano, a spokeswoman for the health insurers’ group. “The consumer is responsible.” The survey looked at 10 companies that insure patients in the 30 most populous states; the companies provided some of the highest bills from 2008. Researchers excluded two types of charges that were likely to be erroneous: those that were greater than 10,000 percent of Medicare’s fees for a procedure, or more than 2,000 percent of Medicare’s fees and also more than 50 percent higher than the next-highest bill for the same procedure. State laws protecting patients from getting stuck with medical bills in excess of their normal deductibles or co-payments vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy. And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks. In New York, patients with managed-care insurers cannot be asked to pay more than the applicable co-payment, deductible or co-insurance for an ambulance regardless of whether the provider is in or out of their network. In New Jersey, hospital emergency rooms treating Medicaid managed-care patients must accept Medicaid payments as payment in full and cannot bill patients extra. In Connecticut, a state law says it is “unfair trade practice” for medical providers to ask patients to pay more than a deductible or co-payment for services covered by their insurance. But in general, patients hit with high bills from out-of-network doctors and hospitals may have little recourse, said Leslie Moran, senior vice president of the New York Health Plan Association. “When patients dig in their heels and say, ‘No, I’m not going to pay it,’ it sometimes goes to collection,” she said. While there is no way of knowing how often doctors submit exorbitant bills, insurers tell America’s Health Insurance Plans that they see such bills “all the time, every day,” Ms. Pisano said. The New York Health Plan Association provided more examples. In testimony at a state hearing in October, it told of a Long Island surgeon who charged $23,500 for an emergency appendectomy. The patient’s insurer paid its out-of-network fee of $4,629. The surgeon demanded the balance or said he would force the patient to pay. The insurance company paid the bill. Patients who receive unexpected bills may not know what to do. That happened to Charles Bacchi’s mother. Mr. Bacchi, executive vice president of the California Association of Health Plans, said his mother was admitted to a hospital that had just dropped its association with her insurer. Mr. Bacchi’s mother, who spent less than a week in the hospital, received a bill for nearly $90,000 and was told that her plan would pay only a small part of it. Mr. Bacchi said she was terrified and hid the bill. “She thought the entire family savings would go up in smoke,” Mr. Bacchi said. When his mother finally told him about the bill, Mr. Bacchi intervened, and eventually the matter was settled by the hospital and the insurance company. No one intervened for Maria Davis, though, when her son fell and banged his mouth. Ms. Davis, a respiratory therapist in Miller Place on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot, and it looked like he had a bad cut on the inside of his mouth,” she said. After a long wait, she said, a doctor said he would put in stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Ms. Davis agreed. The plastic surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice, very gentle, very kind,” Ms. Davis said. He put in three stitches, and Ms. Davis assumed her insurer, UnitedHealthcare, would cover the bill. It did not. The bill was $6,000 — $300 for the emergency room consultation and $5,700 for putting in the stitches. The Davises paid their deductible of $350 and waited. After the insurer paid $2,024.80, Dr. Diehl cut his bill by $2,100 and billed the Davises for the balance, $1,525.20. He did not return calls to his office. So far, the Davises have not paid. “I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father. “We have gotten several letters, and they have gotten more than a little threatening,” Mr. Davis said. Had he known the doctor would charge $6,000, he said, “we may have looked for another doctor.” Copyright 2009 New York Times. Swine Flu Cases Climb Among U.S. Soldiers in Iraq Associated Press By Chelsea J. Carter Washington Post Wednesday, August 12, 2009 BAGHDAD -- The number of American troops in Iraq diagnosed with swine flu has climbed to 67, making U.S. soldiers the largest group in the country to come down with the potentially deadly virus, Iraqi health officials said Wednesday. The figures were released by the Iraqi health ministry as it detailed steps being taken to control the spread of the virus, which last week claimed its first fatality in the southern holy city of Najaf. A 21-year-old Iraqi woman, who had visited the city's Shiite shrines, later died of swine flu. The health ministry has also confirmed that 23 Iraqis and six other foreigners have been diagnosed with the virus. Their nationalities were not disclosed. All the U.S. troops had either been treated or were undergoing treatment, said Dr. Amer al-Khuzai, the deputy health minister. There have been no fatalities among American forces, he said. The U.S. military did not immediately confirm the figures released by the Iraqis. But earlier this week, it said 51 soldiers had been diagnosed, while another 71 suspected cases were in isolation. "We think they have this many cases because they come through different countries to come here. They come from the United States. They come from Europe," al-Khuzai said. He said the U.S. military has been giving the ministry weekly updates about the number of swine flu cases diagnosed on American bases in Iraq. Col. Michael D. Eisenhauer, chief of clinical operations in Iraq, told The Associated Press in an e-mail earlier this week that the U.S. military had been completely open with the Iraqis on the cases of diagnosed Americans. The cases in American troops have been diagnosed over the last three months since the military actively began screening for the virus, he said. "There has not been a sudden outbreak," Eisenhauer added. Swine flu cases have been diagnosed at six U.S. bases in Iraq, the military said. In May, 18 soldiers on their way to Iraq were diagnosed in Kuwait with the virus. Troops are now screened for the virus before they leave the United States and again when the arrive in Iraq. Cases among Iraqis have been diagnosed in Baghdad and elsewhere. Ten were caught at Baghdad's International Airport, where health officials screen arriving passengers, said Dr. Sabah Karkukly, who oversees the ministry's swine flu program. The figures raise concern about Iraq's ability to control the virus' spread among millions of Shiites who visit the revered shrines in Najaf and another holy Shiite city, Karbala. Two cases of swine flu were diagnosed in Najaf, while three others were diagnosed in Karbala, said al-Khuzai, the deputy health minister. He cautioned Iraqis to take extra steps to protect themselves, such as avoiding crowded places where the virus can easily be transmitted. Iraq's Cabinet on Wednesday banned trips to Saudia Arabia's holy city of Mecca during the Muslim fasting month of Ramadan, which begins later this month. Iraq also joined other Arab health ministers in banning children, the elderly and the chronically ill from the annual hajj pilgrimage in late November. The World Health Organization, as of July 31, had tallied more than 162,000 swine flu cases worldwide. It counted at least 1,154 deaths, with more than 1,000 reported in the Americas, according to its Web site. Iraq's Cabinet also approved the purchase of $100 million worth of the anti-viral medicine Tamiflu, which is enough for a quarter of Iraq's population, Karkukly said. Associated Press Writer Hamid Ahmed contributed to this report. © 2009 The Associated Press. *Opinion* Don't Forget the Bacterial Threat Antibiotic resistance is a much bigger problem than swine flu. By Mitchell J. Schwaber and Yehuda Carmeli Wall Street Journal Commentary Wednesday, August 12, 2009 In March of this year an epidemic of H1N1 influenza virus, otherwise known as swine flu, began in Mexico. It spread to the United States within weeks and has since affected over 100 countries. Between the start of the outbreak and the end of July, a total of 1,154 people worldwide had died of the virus, about one-third of them in the U.S. The World Health Organization and other public-health agencies have responded to the epidemic with appropriate urgency. International organizations have disseminated information and guidelines and coordinated with public authorities across the globe to ensure an effective response. The pharmaceutical industry is developing antiviral agents and vaccines and producing them on a mass scale. The U.S. also has responded rapidly and forcefully. Just two weeks after the report of the first case on American soil, President Barack Obama asked Congress to allocate $1.5 billion to fight the virus. Compare this response to the scant media and political attention that have been given to several silent but no less deadly outbreaks of disease in recent years caused by antibiotic-resistant bacteria. Most such outbreaks are treated as the poor stepsisters of pandemic influenza, even while they have killed far more people than swine flu over the same period. Bacterial infections were once big killers. Before the advent of the antibiotic era some 70 years ago, pneumonia, meningitis, gangrene and bloodstream infection were almost uniformly fatal. But with antibiotics, they suddenly became treatable. Unfortunately, the era of easily treated infections is proving to be short-lived, as bacteria develop increasingly sophisticated mechanisms of resistance to antibiotics. Antibiotic-resistant bacteria typically do not threaten healthy people at first. Rather, they generally appear initially among hospitalized patients and only later spread to the community at large. But they are deadly. In the same period as the swine flu outbreak, antibiotic-resistant bacterial infections have killed thousands of people in the U.S. In contrast to the flu, most of these infections receive little or no public attention. The only exception has been methicillin-resistant Staphylococcus aureus (MRSA). This microbe is now receiving significant public attention—but this attention has come some three decades after its spread in the U.S. first began. That delay allowed MRSA to spread uncontrollably, and more than 18,000 people are now estimated to die each year in the U.S. from this bug, according to the Journal of the American Medical Association. Initially, MRSA was confined to hospital wards and affected primarily the elderly and chronically ill. It therefore remained outside of the headlines and off political agendas. MRSA entered the spotlight only after it began to affect healthy people living outside of hospitals. Have we learned our lesson? A more recent outbreak of resistant bacteria, widespread in New York City since the beginning of the decade, has now spread to areas outside of New York and even outside of the U.S. The bacteria involved are from the family of microbes that live in the human gut, called Enterobacteriaceae. They are the most frequently identified bacteria in human disease and are resistant to the carbapenem group of antibiotics, the drugs of last resort in combating resistant bacteria of this type. In the four-month period since it entered the U.S., swine flu has killed 436 people in this country. During this same period, more than 100 people are estimated to have succumbed to carbapenem-resistant Enterobacteriaceae in the New York City area alone, and more have undoubtedly died outside of New York. Yet the spread of these and other resistant bacteria has met with almost no coordinated effort to fight them in the U.S. Very few resources have been allocated to combat antimicrobial resistance. Last fiscal year, for example, the U.S. government budgeted just $16.9 million for the Centers for Disease Control and Prevention to spend fighting antibiotic resistance, about 1% of the total funding requested for swine flu. Can a campaign be effective in containing the spread of resistant bacteria? Yes. In England, national intervention has led to a greater than 50% decrease in MRSA bloodstream infections since 2004. Similarly, in Israel, where there has been a nationwide outbreak of a strain of carbapenem-resistant Enterobacteriaceae since 2006, a coordinated effort at every level of public health has succeeded in containing the spread of the bacteria. In both England and Israel, extensive media exposure led to widespread public awareness of the problem. That led the national government in both countries to make outbreak containment a top priority. England and Israel executed centralized, professionally-directed public health interventions that included setting targets, implementing new regulations, measuring outcomes, and accountability. These efforts successfully curtailed the outbreaks and demonstrate that the battle against infections with antibiotic-resistant bacteria can and should be waged. The ongoing spread of resistant bacteria must not be viewed as inevitable. The existence, extent and severity of the epidemic of antibiotic resistant bugs need to be immediately recognized by the government, the media and the public at large. The pharmaceutical industry should also be encouraged to develop new antibiotics to fight resistant bacteria. The response to the swine flu outbreak has been impressive. This response should be seen as a blueprint for how we fight other deadly outbreaks. Dr. Schwaber is director of the National Center for Infection Control of the Israel Ministry of Health. Dr. Carmeli is director of the Division of Epidemiology and Preventive Medicine at Tel Aviv Medical Center and is affiliated with the Division of Infectious Diseases at Beth Israel Deaconess Medical Center in Boston. Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Credit Sen. Cardin for willingness to listen Hagerstown Herald-Mail Letter to the Editor Wednesday, August 12, 2009 To the editor: Sen. Ben Cardin has agreed to hold a town hall meeting at Hagerstown Community College in order to explain the president’s health care reform program. I’m certain that many of your readers, like my wife and me, have serious questions about the bill that passed the House of Representatives, which is the only proposal currently on the table. Although (Speaker of the House) Nancy Pelosi believes that opponents of the bill have been hired by the pharmaceutical industry and Harry Reid thinks we are getting secret orders from Rush Limbaugh’s basement, the fact is we are not organized and this is the only way that I can communicate with those of you who think like us and want to have your voices heard. Sen. Cardin seems willing to listen. He told Fox News: “People have strong views about health care reform. The overwhelming majority of Americans want to participate. They want to know how it affects them, and what it will do with their health insurance through what it will do with their health care costs. Those are legitimate questions.” If the senator is willing to listen, it is important for those of us who oppose the current proposal to present our thoughts calmly and reasonably. The sponsors of this legislation already know that we are angry. There is no reason for us to show that anger. As a retired attorney, I have learned in a long career that if I wish to be heard I should speak in such a way as to make others wish to listen. Further, several left-wing groups are organizing their members to attend the Town Hall meetings to intimidate us. Let them get angry. The example of the Rev. Martin Luther King passively resisting when opponents became angry presented the world with visual images which turned the world against his opponents. Sweet reasonableness in the face of anger is the best way for us to achieve our objectives. Our reasons for opposing the current proposal are coherent and compelling. The reasons given by the sponsors of this proposal sound hollow and keep changing when it looks as though we aren’t buying it. Finally, if there are left-wing groups bringing their members to the town hall meeting we should not blame Sen. Cardin for this. Although I am a Republican and did not vote for him, he does deserve credit for showing a willingness to come and listen to our criticism of the proposal. Who knows? Maybe we can bring him over to our side. James H. Warner Hagerstown Copyright 2009 Hagerstown Herald-Mail. BACK TO TOP


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