Maryland / Regional
Delaware
reports 20 more swine flu cases
(Annapolis Capital)
Rats
are loyal to neighborhoods, JHU study finds
(Baltimore Sun)
China Quarantines Teens,
Teachers From Md.(Washington
Post)
Health care
sub-sector activity
(Daily Record)
Youths escape from
Cullen Center
(Frederick News-Post)
Military
Intelligence - While we're waiting
(Frederick News-Post)
Cardin announces
earmark requests
(Frederick News-Post)
Intense
program helps get many off drugs
(Salisbury Daily Times)
Woman sentenced in
abuse case
(Salisbury Daily Times)
Comatose woman's guardians sue Va nursing home
(Salisbury Daily Times)
National / International
Uninsured cost families extra $1,000 in annual premiums
(Baltimore Sun)
‘Underlying Conditions’ May Add to Flu Worries
(New York Times)
Massachusetts, Model for Universal Health Care, Sees Ups and
Downs in Policy
(New York Times)
Governments’ Drug-Abuse Costs Hit $468 Billion, Study Says
(New York Times)
More Small Firms
Drop Health Care
(Wall Street Journal)
Study: Substance-abuse funding skimps on prevention
(USA Today)
3 cruise ship crewmembers catch swine flu off Australia
(USA Today)
Opinion
The Health Insurance
Labyrinth
(New York Times Letter to the Editor)
Maryland / Regional
Delaware
reports 20 more swine flu cases
Associated Press
Annapolis Capital
Thursday, May 28, 2009
DOVER, Del. (AP) — Delaware health officials say they have
confirmed 20 more cases of swine flu, bringing the state's total
to 105 confirmed cases.
Advertisement
Health officials say none of the new cases reported since May 20
have been hospitalized and all are recovering after experiencing
mild symptoms.
All but two of the new cases were reported in New Castle County.
The others were reported in Kent County. And all were between
the ages of 6 and 16 years old with the exception of a
41-year-old Kent County resident and a 25-year-old New Castle
County resident.
Copyright © 2009 Capital Gazette Communications, Inc.,
Annapolis, Maryland.
Rats
are loyal to neighborhoods, JHU study finds
Associated Press
Baltimore Sun
Thursday, May 28, 2009
Rats are loyal to their neighborhoods, a new study finds.
The Baltimore study, which appears this week in the journal
Molecular Ecology, found that rats rarely venture more than a
block from home.
To find out why rat numbers have not changed despite decades of
extermination efforts, researchers from the Johns Hopkins
University Bloomberg School of Public Health trapped nearly 300
rats in 11 areas and tested them to see how they were related.
They found that east side and west side rats separated by a city
waterway were not related and that rats live in neighborhoods
not much longer than the average city alley.
The researchers say studying rat migration may shed light on how
they spread disease and help eradication efforts.
Copyright 2009 Baltimore Sun.
China
Quarantines Teens, Teachers From Md.
By Daniel de Vise
Washington Post
Thursday, May 28, 2009
Twenty-one students and three teachers from a Silver Spring
private school who flew last week to China for a weeklong tour
have been confined to their hotel rooms, quarantined for
possible exposure to swine flu during their flight from the
United States.
The group arrived in Guizhou province in southwestern China on
Friday for an "extended study week," one of several such
excursions from the Barrie School, which stresses experiential
learning.
Government officials quarantined the students and chaperons at a
hotel in the city of Kaili because a passenger on the plane was
suspected of having swine flu. Students have been permitted to
converse through the open doors of their hotel rooms, to write
e-mails and to talk on room-to-room telephones, but not to
leave.
"This gives hanging out a new meaning," Mike Kennedy, head of
school, said yesterday.
School officials have been told the quarantine will end tomorrow
evening, leaving the students one day to tour China before their
return flight Sunday.
The students, all of high school age and apparently free of flu
symptoms, are being housed one or two to a room. Helen Wright,
16, has a room to herself. She told her parents in an e-mail
this week, "I'm okay, but I'm lonely and scared," according to
her mother, Deborah Wright.
"Physically, they are okay," Wright said. "They are being fed.
But I am concerned about the kids' mental state."
Parents and school officials said they learned Tuesday from U.S.
consular officials that the plane passenger with the high fever
did not have swine flu, raising hopes that the quarantine would
be lifted. But the students remained confined as of yesterday
evening.
"Their whole trip has been basically destroyed," Wright said.
Copyright 2009 Washington Post.
Health care sub-sector
activity
RESI
Daily Record
Thursday, May 28, 2009
Between the third quarters of 2007 and 2008, the Health Care
industry expanded at a rate of 2 percent as all industry
sub-sectors expanded during the time period.
The greatest rate of growth occurred in Social Assistance which
expanded at a 2.6 percent rate over the time period. Ambulatory
Health Care Services and Nursing and Residential Care Facilities
employment grew at 2.4 percent and 2.2 percent rates,
respectively. The Hospitals sub-sector posted a more modest
growth rate of 1.1 percent.
Copyright 2009 Daily Record.
Youths escape from
Cullen Center
14 juveniles captured after leaving Victor Cullen cottages; 7
people hurt
By Staff and Wire Reports
Frederick News-Post
Thursday, May 28, 2009
SABILLASVILLE -- A fight broke out among juveniles at the Victor
Cullen Center about 7:45 p.m. Wednesday and 14 left their
cottages only to be captured a short time later, according to
Maryland State Police and a Department of Juvenile Services
spokeswoman.
By 8:45 p.m., all were in back in custody, Spokeswoman Tammy
Brown said. Seven people were injured.
The juveniles left their cottages, Brown said. Ten were found
almost immediately in a maintenance building; four others were
found less than a quarter mile away. Six staff members and one
resident suffered minor injuries and were taken to a hospital.
Brown said she did not know how the escape occurred, and that
the events leading up to the escape were under investigation.
Nearly a year ago, two teens were captured within days of
escaping from the center.
On June 16, 2008, a 16-year-old and a 14-year-old escaped after
assaulting a staff member and scaling a razor wire fence
surrounding the facility.
The 14-year-old was captured two days later in Prince George's
County. The 16-year-old was captured June 20 in Baltimore.
The juvenile detention center reopened in July 2007 after being
closed for more than five years. It has a capacity of 48 boys.
Before it closed in 2002 amid allegations of abuse, the
state-owned, privately maintained campus housed more than 200
juvenile offenders.
At the time of the reopening, a state spokeswoman said security
was improved at the center with the addition of a no-climb mesh
security fence and camera and alarm systems. If an offender
escapes, area residents are to receive an automated phone call
alerting them.
Copyright 1997-09 Randall Family, LLC. All rights reserved.
Military
Intelligence - While we're waiting
Front Page
Frederick News-Post
Thursday, May 28, 2009
The National Academy of Sciences hasn't formed a committee yet
to review public health and safety issues associated with the
expansion of the Army's biolabs at Fort Detrick, but it should
shortly.
The academy has been told to expect the funding soon, a
spokeswoman said.
Once it has the money, it will begin soliciting nominations for
possible committee members from internal and external sources,
including the public.
In the meantime, the academy has started providing assistance
with creating a supplementary risk assessment for another
biocontainment lab in Boston.
Courts, and later the National Research Council, found the
Boston lab's original risk assessments lacked credibility.
Critics of the Fort Detrick expansion cited those problems as
part of their rationale for wanting more scrutiny of the local
project.
The academy expects to spend a total of 10 months working on the
new risk assessment for the Boston lab, from last month's start
date.
Under the terms of the budget language mandating the report, the
Fort Detrick review is supposed to be finished by March 1, 2010.
www.realwarriors.net
The Defense Department launched a website last week to
destigmatize mental health care for veterans, service members
and their families.
The website, www.realwarriors.net, is part of a
public-service marketing campaign including radio and television
ads.
The site includes articles on navigating the disability
evaluation system, preparing for deployment and returning to
civilian life.
The campaign is produced by the Defense Centers for Excellence
for Psychological Health and Traumatic Brain Injury.
The military and the Department of Veterans Affairs have been
expanding their mental health and suicide prevention efforts for
a few years. In July 2007, the VA launched a suicide prevention
hot line in partnership with the National Suicide Prevention
Lifeline.
Earlier this year, the Army gave all soldiers additional
training in how to recognize potentially suicidal behavior and
how to prevent suicide.
The Centers for Excellence for Psychological Health and
Traumatic Brain Injury outreach center can be reached by phone
at 1-866-966-1020.
The National Suicide Prevention Lifeline can be reached at
1-800-273-8255.
This week on post
From 11:30 a.m. to 1 p.m. Thursday at the Balfour Beatty
Community Center, the Being Away and Coming Back Home workshop
series continues with a workshop on tips for healthy family
reintegration.
Starting at noon Thursday, the Fort Detrick Toastmasters Club
meets in the Community Support Center.
From 6 to 10 p.m. Saturday, Child, Youth and School Services
will host an open mike night at Strough Auditorium. The cost is
$2 per attendee.
Copyright 1997-09 Randall Family, LLC. All rights reserved.
Cardin announces
earmark requests
By Meg Tully
Frederick News-Post
Thursday, May 28, 2009
U.S. Sen. Benjamin Cardin has asked congressional appropriators
to dole out $12.3 million for projects to benefit Frederick.
Cardin, a Maryland Democrat, released a list of $1.2 billion in
earmarks Wednesday.
Four projects are in the region, including a community college
health care program in Mount Airy, an international study of
stem cell research to be conducted in Frederick, and the
development of a model and plan for a green environment at Fort
Detrick.
He would also like to complete a 13.5-mile light rail or bus
rapid transit system in northern Montgomery County.
The Senate Appropriations Committee is expected to make a
decision on the requests this summer.
Senators were required for the first time this year to post all
of their earmark requests on their websites.
Cardin's announcement comes just after the deadline for those to
be posted. U.S. Sen. Barbara Mikulski, also a Democrat, posted
her list online but did not send out a comprehensive press
release announcing all the projects.
She listed only one project for Frederick -- a million-dollar
request toward the community college health care program that
Cardin also identified.
Cardin chose his earmarks from about $5.1 billion in submissions
from across the state, according to his office.
"I have carefully vetted every request for Fiscal Year 2010 to
ensure that they reflect our regional and national _priorities
and will help Maryland meet the challenges of the future,"
Cardin said in a statement.
"My appropriations requests focus on creating new jobs through
innovation and technology, improving our transportation
infrastructure, supporting health research, strengthening
homeland security, restoring the environment and lessening our
dependence on foreign energy."
U.S. Rep. Roscoe Bartlett, a Frederick Republican, also posted
earmark requests to his website earlier this year.
Please send comments to webmaster or contact us at 301-662-1177.
Copyright 1997-09 Randall Family, LLC. All rights reserved.
Intense
program helps get many off drugs
By Greg Latshaw
Salisbury Daily Times
Thursday, May 28, 2009
SALISBURY -- A few years ago, John Cole smoked crack cocaine.
The drug came first. Cole fell behind on paying rent and buying
food for his family. He'd sometimes steal from relatives to help
buy the drug.
It's a story Wicomico County addiction specialists know too
well. But instead of Cole ending up in prison after being
convicted of drug offenses in 2005, the Circuit Court directed
him into a new Drug Court program.
What followed were two years of intensive drug counseling that
went far beyond what he would receive in prison. He wasn't
behind bars, but he faced strict probationary controls.
Cole, 50, later became the first to graduate the Drug Court, and
Wednesday, he attended a special ceremony honoring the police
officers, health officials and businesses that made his
experience possible.
"It was a blessing," Cole said. "The lifestyle I'm living now,
one day at a time, I wouldn't trade if for a million bucks."
Twenty people have graduated from the Drug Court since it began
in 2005. Only one relapsed and was convicted again of a crime,
said Cherie T. Meienschein, the program coordinator.
That rate eclipses the national recidivism average of 75
percent. What's more, participants who are terminated from the
Drug Court program ultimately fare better than that national
recidivism average when they are released, Meienschein said.
"It's more than just keeping people out of jail. It's about
creating a better person," Judge Kathleen L. Beckstead told the
crowd of more than 50 people at Wednesday's ceremony.
The judge meets twice a month with the 26 people now enrolled in
the Drug Court. Beckstead said her reputation as a "no-nonsense
sentencer" made her hesitant to accept the program at first. But
she believes it gets results and is impressed with how strict
the program is.
Those who sign up for the Drug Court must first agree to waive
their Fourth Amendment rights. Police can search their homes at
random. Participants must wear GPS devices. They have a curfew.
They can't leave the county without permission. And, of course,
they must submit urine samples to be tested for drugs upon
request. Those who flunk out of Drug Court violate the terms of
their probation.
"If you think you're going to get away with something in this
program, then you've got another thing coming," Beckstead said.
Additionally, participants must work full-time and finish 100
hours of community service before they can be graduated from the
program. It typically takes two years to graduate, Meienschein
said.
"Where prison has failed, the Drug Courts have stepped in,
proving they can do a better job at providing treatment than
jail or probation," said Chris Deutsch, a spokesman with the
National Association of Drug Court Professionals in Alexandria,
Va.
Years ago, Congress declared May as National Drug Court Month.
There are more than 2,300 Drug Courts across the country,
including 41 in Maryland -- and the number is growing, according
to the NADCP.
Proponents say that Drug Courts also save money. Beckstead said
the county has saved about $2 million by putting people into the
program, rather than spending the money to incarcerate them.
Most important, however, is the personal impact.
Ask Cole, who said he is now drug-free. He works at Perdue Farms
and now puts his girlfriend's three grandchildren first. The
oldest child, Ramario Shuler, turns 5 next month.
"He is the motivation in my life," Cole said.
Copyright 2009 Salisbury Daily Times.
Woman sentenced in abuse
case
By Sharahn D. Boykin
Salisbury Daily Times
Thursday, May 28, 2009
SALISBURY -- A 61-year-old Salisbury woman was ordered to serve
nearly three months in the county detention center after she
pleaded guilty to adult abuse and neglect of a vulnerable adult
in Wicomico County Circuit Court on Wednesday.
The prosecutor called the case one of the most "appalling
sights" seen in her 22 years at the State's Attorney's Office.
However, the judge elected not to impose the maximum five-year
prison penalty, stating that she believed the defendant wouldn't
repeat the violations.
"It should be a humiliating situation to have that statement of
charges read to another human being," said Judge Kathleen
Beckstead.
Charges filed against Ruth May McCann include abuse and neglect
of a vulnerable adult family member, reckless endangerment and
vulnerable adult abuse resulting in physical injury, according
to court records.
The charges against McCann is one of the most recent cases
prosecuted by the new Wicomico County State's Attorney's Office
Protection of Adults Vulnerable or Elderly Unit.
"As a society, we have to begin a protection system to protect
the vulnerable," said Elizabeth Ireland, a Wicomico County
assistant state's attorney.
Prosecutors started the unit six months ago to focus on crimes
against the vulnerable and elderly, working with the local law
enforcement and the Department of Social Services.
In court Wednesday, the state dropped the three charges in
exchange for a guilty plea from McCann.
"I believe there should be some jail time, but not a lengthy
period," said Beckstead, who suspended all but 90 days of the
two-year sentence.
Police were called to Gateway Village Complex, a senior
apartment complex, after they received a report of elder abuse.
McCann was the designated caretaker for an 84-year-old
wheelchair-bound family member suffering from dementia, and she
lived in the one-bedroom apartment with the woman.
Police reported a strong odor of feces and urine in the home.
"The stench from the apartment was overwhelming," Ireland said.
Police found what they believed to be fecal matter and fecal
stains on the bedroom wall, headboard and on the victim's wheel
chair. Officers reported the victim appeared to have been
defecating and urinating in the bed.
"I knew the (expletive) was going to hit the fan," McCann said
during a conversation on her cell phone when police entered into
the apartment, Ireland told the judge.
Hospital personnel reported the victim had feces embedded in her
hair and nails, and believed the victim had not been bathed for
more than a month, according to court documents. As a result,
the victim's hair had to be cut short.
The victim's nails had grown long enough to penetrate her skin
and had to be surgically removed.
The victim was also hospitalized for five days and suffered from
a urinary tract infection, hypertension and hyperglycemia.
"I don't think she recognized the situation was as bad as it
was," said the defense attorney, Robert Marvel.
Marvel said he believed McCann was overwhelmed by the
responsibilities of being a caretaker.
"I would never harm her," a tearful McCann told the judge. "She
wouldn't let me do anything. She wouldn't let me bathe her ...
She would fuss and cuss."
According to the prosecutor, the victim is in a nursing home and
doing well.
Copyright ©2009 The Daily Times.
Comatose
woman's guardians sue Va nursing home
Associated Press
Salisbury Daily Times
Thursday, May 28, 2009
NORFOLK, Va. (AP) — A Chesapeake nursing home is being sued by
the guardians of a comatose woman who was sexually assaulted by
a male nurse while a patient there.
The lawsuit filed in Norfolk Circuit Court claims Chesapeake
Health and Rehabilitation Center should have known Mark S.
Albright's conduct would violate the woman's privacy and
dignity. It seeks $29 million in damages and also names Albright
as a defendant.
Center administrator Gregory Yanta declined to comment on the
lawsuit.
Albright formerly worked as a licensed practical nurse at the
nursing home. Police say another employee observed Albright with
his mouth on the woman's breast.
Albright pleaded guilty in November to aggravated sexual
battery. Last week, he was sentenced last week to six months in
prison, with another nine years and six months suspended.
Copyright 2009 The Associated Press. All rights reserved.
National / International
Uninsured cost families extra $1,000 in annual premiums
Associated Press
By Erica Werner
Baltimore Sun
Thursday, May 28, 2009
WASHINGTON - The average family with health insurance shells out
an extra $1,000 a year in premiums to pay for health care for
the uninsured, a new report finds.
And the average individual with private coverage pays an extra
$370 a year because of the cost-shifting, which happens when
someone without medical insurance gets care at an emergency room
or elsewhere and then doesn't pay.
The report was being released Thursday by advocacy group
Families USA, which said the findings -- which it calls a
"hidden tax" -- support its goal of extending coverage to all
the 50 million Americans who are now uninsured. Congress and the
Obama administration are working on a plan to do that.
Families USA contracted with independent actuarial consulting
firm Milliman Inc. to analyze federal data to produce the
findings.
"As more people join the ranks of the uninsured, the hidden
health tax is growing," said Ron Pollack, Families USA executive
director. "That tax hits America's businesses and insured
families hard in the pocketbook, and they therefore have a clear
financial stake in expanding health care coverage."
The report found that, in 2008, uninsured people received $116
billion in health care from hospitals, doctors and other
providers. The uninsured paid 37 percent of that amount out of
their own pockets, and government programs and charities covered
another 26 percent.
That left about $43 billion unpaid, and that sum made its way
into premiums charged by private insurance companies to
businesses and individuals, the report said.
The major government insurance programs -- Medicare for the
elderly and Medicaid for the poor -- are structured in a way
that doesn't easily allow payments to insurers to adjust upward.
And somebody has to pay.
Ronald A. Williams, chairman and chief executive of Aetna Inc.,
gave the example of a local community hospital that provides
care to someone without insurance who arrives at the emergency
room. When it's not paid for, the hospital has to raise its
rates to insurance companies, and they pass that on in higher
premiums, Williams said.
"Our members then say, 'Well, why is health insurance so
expensive?'" Williams said in an interview. "And the answer is
because you're paying for your own care as well as for the care
of some of the uninsured in the community."
Aetna was not involved in writing or funding the report but
Williams planned to appear at a news conference Thursday with
Families USA officials to release its findings.
Copyright 2009 Baltimore Sun.
‘Underlying Conditions’ May Add to Flu Worries
By Anemona Hartocollis
New York Times
Thursday, May 28, 2009
In announcing this week that swine flu had been implicated in
the deaths of two more New Yorkers, the city’s health
commissioner, Dr. Thomas R. Frieden, added a by-now familiar
caveat: Both of them, he said, had “underlying conditions.”
He went on to enumerate a list of conditions that could
aggravate the effects of swine flu and that characterize a large
portion of New York’s population: diabetes, asthma, heart
disease, lung disease, a weakened immune system and, possibly,
obesity.
He did not even mention three other risk factors that alone
apply to more than 1.2 million New Yorkers and 50 million
Americans: pregnancy, being younger than 2, or being older than
65.
Since the beginning of the swine flu outbreak, the phrase
“underlying medical condition” has been transformed from a
snippet of medical jargon into a household phrase. Mayor Michael
R. Bloomberg had fully absorbed the new vocabulary lesson by the
city’s second swine flu death on Sunday, that of a woman in her
50s. In an expression of empathy, he said his father had also
died in his 50s, “because of an underlying health condition.”
(In his autobiography, the mayor wrote, his father had heart
damage from childhood rheumatic fever.)
Dr. Frieden intended his warning, which he has applied to all
four New York deaths so far linked to the H1N1 virus, to be at
once helpful to those who might be more at risk for the disease
and reassuring to those who are not.
But it may apply to so many households that efforts to control
public fears by using the term may be having something of an
adverse effect. Even accounting for people who have more than
one condition, statistics suggest that the city’s long list of
red flags may encompass as many as one in three people.
“Many, many people share the same underlying causes that my
husband had, and if he’s at risk, many people are at risk,” said
Bonnie Wiener, the widow of Mitchell Wiener, 55, the first New
Yorker to die of swine flu, on May 17.
She disputed the city’s assertion that underlying conditions
were a factor in his death. “He was overweight and he was taking
medicine for high blood pressure,” she said. “How many people 50
and above don’t?”
About 50 percent of swine flu hospitalizations globally and
about 70 percent of those in the United States seem to involve
underlying conditions. Besides Dr. Frieden’s list, they include
anything that makes it difficult for patients to clear their
lungs, which can include some severe mental problems, seizure
disorders or neuromuscular disease.
They include chronic heart, liver and kidney disease; suppressed
immunity, whether caused by H.I.V. or drugs taken by cancer or
transplant patients; and blood diseases like sickle-cell anemia,
which lowers the blood’s ability to carry oxygen.
A similar list of conditions applies to any strain of flu.
About 400,000 New Yorkers have asthma, the city’s most common
chronic childhood illness; about 700,000, or 12.5 percent of
adults, have diabetes; about 100,000 have H.I.V.; about 17,000
women are pregnant at any time, a conservative estimate, and
about 900 people have tuberculosis, another risk factor,
according to 2008 city statistics.
There are about 1 million New Yorkers older than 65 (although
there is some evidence that people born before 1957 may have
antibodies to H1N1) and 228,000 younger than 2. Obesity — which
the federal Centers for Disease Control and Prevention suspect
may play a role because it can impede lung functioning and
immune responses — is practically epidemic. One-third of adult
Americans and more than 1 million adults and teenagers in New
York City are considered obese, but those with severe obesity
are considered more at risk.
“We were surprised by the frequency of obesity among the severe
cases that we’ve been tracking,” Dr. Anne Shuchat, the centers’
director of immunization and respiratory disease, said at a May
19 press conference.
The centers’ officials have said that pregnancy is a risk factor
because it suppresses the immune system to protect the fetus and
can decrease lung capacity.
Compounding the anxiety is that public health officials, citing
medical confidentiality, have refused to disclose not just the
identities of those who have died but even the most basic
information about their health conditions. (Mr. Wiener’s case
was widely known because of his long career in the school
system.)
Judy Trunnell, 33, a teacher from South Texas, was the first
American citizen to die of swine flu, in early May, after
delivering a healthy baby girl by Caesarean section. A Texas
Health Department spokeswoman said she had “chronic underlying
health conditions,” which her husband, Steven, later denied on
CNN.
More details came to light a week later through a routine
scientific study, a weekly “Morbidity and Mortality” report by
the federal disease centers. Without using her name, it said she
had a history of psoriasis (not considered an underlying
condition) and mild asthma, in addition to her pregnancy.
Warnings about underlying conditions appeared to be propelling
people toward bursting emergency rooms. At Maimonides Medical
Center in Brooklyn, Sally Maugeri, an unemployed kitchen worker
who had a cough, had brought in her nephew, Salvatore Soria, 10,
who had been sick with coughing, vomiting and diarrhea, and his
mother, Joanne Maugeri, 50, on Tuesday.
They had a trifecta of underlying conditions: Salvatore had a
history of asthma, while Sally Maugeri was nine months pregnant
and said that diabetes ran in her family. “The fact that he’s
sick and I’m pregnant, I wanted to come in to see if he has the
swine flu,” she said. “Because I have underlying symptoms, it
makes me more scared.”
Doctors diagnosed pneumonia in Salvatore and sent him home with
amoxicillin, an antibiotic.
On Wednesday, Shanaz Hossain brought in her son, Abir, 12, and
daughter, Zarin, 10. Abir had a fever of 103.6 at home, Mrs.
Hossain said, but her worries were aggravated by his asthma, the
dreaded underlying condition that she had heard about on the
television news. Abir’s private doctor had diagnosed strep
throat, but his mother took him to the emergency room for a
chest X-ray. “Of course I am still worried,” she said.
Such anxiety has been a headache for doctors. They say that
people with underlying conditions who have flu symptoms should
consult their doctors, but that visiting an emergency room full
of sick people may actually put them in more danger.
“Like the asthmatics, we’d really prefer that pregnant women
would stay away from the emergency departments,” said Dr. Steven
J. Davidson, the chairman of the hospital’s emergency medicine
department.
But City Councilman John C. Liu, who represents Flushing,
Queens, where the outbreak is widespread, said the Bloomberg
administration had failed to disclose enough information to a
jittery public. “The cloak of secrecy is not alleviating
anyone’s fears, whether they’re real or perceived,” he said.
But Dr. Scott Harper, a city epidemiologist, said that looking
at the conditions behind just a handful of deaths could give
people a false sense of security.
“This isn’t an issue of secrecy, it’s an issue of privacy,” Dr.
Harper said. “If you’re talking about two deaths in this size
population, to be able to make decisions about your personal
health knowing about medical details on those two deaths doesn’t
seem realistic. What does seem realistic is to look at things
that are published widely.”
Reporting was contributed by Jack Begg, David W. Chen, Ann
Farmer, Donald G. McNeil Jr. and Mathew R. Warren.
Copyright 2009 The New York Times Company.
Massachusetts, Model for Universal Health Care, Sees Ups and
Downs in Policy
By Kevin Sack
New York Times
Thursday, May 28, 2009
Despite a weakening economy, Massachusetts continued to measure
gains in the share of residents who reported having a steady
source of health care in 2008, its second year of near-universal
coverage, a new study has found.
But the annual survey, taken each fall since 2006, also raised
red flags regarding the ability of residents to actually use
that care, with growing numbers saying they could not afford
needed treatments and many reporting shortages of primary care
physicians.
The study’s authors wrote that there were lessons for
Washington, where Congressional committees are incorporating
much of the Massachusetts model into federal health care
legislation.
“Although major expansions in coverage can be achieved without
addressing health care costs, cost pressures have the potential
to undermine the gains,” wrote the researchers, Sharon K. Long
and Paul B. Masi of the Urban Institute.
The difficulties in receiving care were severest among
low-income residents, who have gained the most from expanded
access under the state’s law, passed in 2006. It requires most
residents to have health insurance and provides state-subsidized
plans for the poor. Massachusetts now has the country’s lowest
percentage of the uninsured — 2.6 percent, compared with a
national average of 15 percent.
But the study, which was scheduled for publication Thursday in
the journal Health Affairs, found that increased demand for care
from the newly insured was confronting an insufficient supply of
willing physicians. One in five adults said they had been told
in the last 12 months that a doctor or clinic was not accepting
new patients or would not see patients with their type of
insurance. The rejection rates for low-income adults and those
with public insurance were double the rates for higher-income
residents and those with private coverage.
The authors concluded that the high rejection rates helped
explain another important finding: that there has been little
change in the use of emergency rooms for non-emergency
treatment. Among low-income residents — defined as those with
incomes of less than three times the federal poverty level, or
$66,150 for a family of four — 23 percent said their last trip
to an emergency room had been for a non-emergency, the same as
in 2006.
The report sets the stage for legislative recommendations
expected next month from a state commission that hopes to slow
the growth in health spending. The commission has already
drafted principles calling for a system of global payments to
networks of doctors, hospitals and other providers. The networks
would be paid for an individual’s ongoing care, rather than for
each procedure or office visit, providing an incentive to keep
patients healthy rather than merely treating their ailments.
The researchers found consistent yearly increases in the
percentage of residents who said they had a usual source of care
and who had seen a doctor or dentist in the past year. But they
concluded that initial gains in procuring needed care had begun
to erode by the fall of 2008.
For instance, the share of people from low-income families who
did not get needed care in the previous year because of cost
dropped to 17 percent in fall 2007 from 27 percent in fall 2006.
But it then jumped to 18 percent last year.
Copyright 2009 The New York Times Company.
Governments’ Drug-Abuse Costs Hit $468 Billion, Study Says
By Erik Eckholm
New York Times
Thursday, May 28, 2009
Government spending related to smoking and the abuse of alcohol
and illegal drugs reached $468 billion in 2005, accounting for
more than one-tenth of combined federal, state and local
expenditures for all purposes, according to a new study.
Most abuse-related spending went toward direct health care costs
for lung disease, cirrhosis and overdoses, for example, or for
law enforcement expenses including incarceration, according to
the report released Thursday by the National Center on Addiction
and Substance Abuse, a private group at Columbia University.
Just over 2 percent of the total went to prevention, treatment
and addiction research. The study is the first to calculate
abuse-related spending by all three levels of government.
“This is such a stunning misallocation of resources,” said
Joseph A. Califano Jr., chairman of the center, referring to the
lack of preventive measures. “It’s a commentary on the stigma
attached to addictions and the failure of governments to make
investments in the short run that would pay enormous dividends
to taxpayers over time.”
Beyond resulting in poor health and crime, addictions and
substance abuse — especially alcohol — are major underlying
factors in other costly social problems like homelessness,
domestic violence and child abuse.
Shifting money from hospitals and prisons to addiction treatment
and research has never been politically easy, and it is all the
harder now because the federal government and most states face
large budget deficits and are cutting many key services. But Mr.
Califano said that many preventive measures had rapid payoffs in
medical and other expenses.
The work of the center and of Mr. Califano, who was a secretary
of Health, Education and Welfare in the 1970s, have sometimes
drawn fire from conservatives who put more emphasis on law
enforcement than drug treatment and, on the other side, from
groups who advocate loosening some drug laws and using needle
exchanges and supervised addiction maintenance, as some European
countries do, to reduce the personal and societal costs.
Ethan Nadelmann, director of the Drug Policy Alliance, a
national group advocating legal reforms, said it was misleading
for the report to lump together direct costs of tobacco, alcohol
and drug abuse, like ill health, with expenses relating to
enforcement of marijuana laws and prison. Many of the criminal
justice costs, Mr. Nadelmann said, are not an inherent result of
drug use but rather of policy choices to criminalize it.
“Still, the punch line of their report, that society should
invest far more in prevention and treatment, makes total sense,”
Mr. Nadelmann said.
The new report cites the antismoking campaigns of the last
several decades as a promising model: education, higher taxes
and restrictions on smoking zones have cut the incidence of
smoking by close to half, saving billions in costs. It called
for similar efforts to curb under-age drinking and excess
alcohol consumption by adults, using higher taxes on beer, for
example.
Even with tobacco, far more could be done, according to the
report, which noted that only a small fraction of the more than
$200 billion the states have received since 1998 under the
Multi-State Tobacco Settlement had gone to prevention of
smoking.
Federal studies show that the best drug treatment programs pay
for themselves 12 times over, the report said, because patients
who succeed have quick improvements in health and behavior.
The Columbia center called for legislation to require broader
coverage of substance abuse treatment by health insurers. Mr.
Califano said that as the new Obama administration tried to rein
in spiraling health costs, deepening such coverage would be
vital.
Some insurance companies have opposed such a sweeping
requirement, arguing that the record of drug treatment is too
spotty.
Copyright 2009 The New York Times Company.
More Small Firms
Drop Health Care
By Dana Mattioli
Wall Street Journal
Wednesday, May 27, 2009
Accelerating health-care premiums and sharp revenue shortfalls
due to the recession are forcing some small companies to choose
between dropping health insurance or laying off workers -- or
staying in business at all.
Sheryl Weldon, owner of Commerce Welding & Manufacturing Co.,
saw health-insurance payments increase to more than $800 monthly
per employee from about $200 five years ago. With monthly
revenue down 10% since December, Ms. Weldon stopped providing
health coverage to employees, including one being treated for
prostate cancer, for the first time in the 64-year-history of
the Dallas sheet-metal company.
Ms. Weldon and several of her 14 employees are going uninsured
and the third-generation business owner is struggling with the
emotional toll of the decision.
"I have a terrible time handling that I can't give them that
coverage," says Ms. Weldon, 52 years old. "How do you expect
someone to be at their job everyday and perform if they can't be
healthy?"
As the Obama administration wrestles with broader questions of
health-care overhaul, tough economic times are forcing more
businesses to grapple with stressful questions about
discontinuing coverage. Health-insurance premiums for single
workers rose 74% for small businesses from 2001 to 2008, the
latest year data are available, according to nonprofit research
group Kaiser Family Foundation.
About 10% of small businesses are considering eliminating
coverage over the next year, up from 3% in 2005, according to a
recent survey by National Small Business Association.
That follows earlier declines in coverage, with just 38% of
small businesses providing health insurance last year compared
to 61% in 1993, according to the trade group. In 2007, 41%
offered coverage. A Hewitt Associates survey found that 19% of
all companies plan to stop providing health-care benefits in the
next three to five years.
Assurant Health, a national health-insurance provider, has
recently seen more small businesses canceling coverage. Scott
Krienke, senior vice president of product lines, says premiums
typically increase 8% to 16% yearly for small businesses, with
the smallest firms particularly at risk for large rate
increases.
In March, after losing a large client that accounted for more
than 50% of revenue, Kelly Reeves canceled health insurance for
her three employees. Ms. Reeves, president of seven-year-old
public-relations firm KLR Communications, says she had to choose
between that and laying off an employee.
Ms. Reeves says turnover is a concern even in this slack job
market, but she has told her employees she understands if they
leave for a job with medical benefits. Should business pick up,
she plans to reinstate health insurance but provide less
expensive coverage.
"You want to attract good talent and benefits are important for
that," says Ms. Reeves.
Even small businesses that continue to provide benefits say the
question of dropping medical insurance is one of the most
difficult they face.
Shanahan Sound & Electronics Inc., a Lowell, Mass.-based sound-
and video-design firm, has seen a 50% decrease in monthly
revenue since last year. Health-insurance costs increased by 14%
this year to approximately $7,000 per month. Catherine Shanahan,
president of the 16-employee firm, refuses to cancel the plan.
"I really believe it would be the worst thing in the world I can
do for morale," she says.
Karen McLeese, vice president of employee benefit regulatory
affairs at business services firm CBIZ, has been steering
companies that consider dropping insurance to less costly
high-deductible plans and cost sharing.
"In today's environment, health insurance is extremely costly
and to shift that burden to individual employees when raises and
bonuses are trimmed really makes it a double whammy," says
Dennis J. Ceru, professor of entrepreneurship at the Babson
College Graduate School of Business near Boston.
Many of the employees losing insurance are priced out of private
plans. Mr. Ceru says the cost for a family on an private plan
can exceed $20,000 a year.
Dennis Morgan, a driver at Commerce who's being treated for
prostate cancer, worries about how he will pay for surgery
should he need it. The 60-year-old's $500-a-week salary makes
him eligible for a program at his hospital where he can receive
prescriptions at a low cost and pay between $5 and $10 for
doctors' visits. But he would be required to pay a percentage of
the cost of any medical procedure.
Mr. Morgan has looked into private health insurance but says he
can't afford it. At the same time, he understands Ms. Weldon's
decision to eliminate coverage.
"We needed to cut health care," says Mr. Morgan. "It's the only
thing left to cut."
Still, the decision rarely sits easy with those making it. "If I
think about it, I can't sleep," says Ms. Weldon, who says that
her father and grandfather had always covered 100% of
health-insurance expenses.
Dana Korey, president of San Diego organizing company Away With
Clutter, eliminated health insurance for her 15 employees in
January.
"It was incredibly painful, these people are like family to me
and I felt like I let them down," says Ms. Korey.
Amid the recession, many of her clients could no longer justify
organizing jobs, which typically range between $3,000 and
$7,000. Now Ms. Korey is changing her business strategy and
creating a DVD on organizing. She is using the savings from
canceling health insurance, roughly $5,500 monthly, to fund the
venture.
Alternatives to Eliminating Health Insurance
* Consider Cost Sharing: Companies that are paying
100% of employee health care may want to switch to a cost
sharing model where employees help defray the cost. Switching
from a 100% health plan to a 50/50 split can significantly free
up funds.
* Increase Charges: Dominic Morelli, an employee
benefits broker and consultant, says many companies are
increasing employee co-payments and deductibles.
* Shop Around: If your current provider is charging
you the maximum renewal rate each year, shop around for a new
provider. A health insurance broker can help manage your search,
or you can search for better rates online.
* Manage Your Prescription Drug Plan: Many employers
don't realize the amount of money they can save by requiring
employees to use generic versions of prescription drugs, says
Tim Stentiford of Hewitt Associates.
* Consider Wellness Plans: Fostering healthy eating
and exercising habits can save employers insurance money by
creating a healthier workforce.
Copyright 2009 Wall Street Journal.
Study: Substance-abuse funding skimps on prevention
By Jillian Berman
USA Today
Thursday, May 28, 2009
Most of the taxpayer money devoted to combating alcohol and drug
abuse goes to cleaning up its consequences, while only about 2%
of the funding is used for prevention, says a report from the
National Center on Addiction and Substance Abuse (CASA) at
Columbia University.
The study found that 96% of the $467.7 billion a year that
federal, state and local governments spend on substance abuse is
used to deal with consequences such as crime and homelessness.
Of that money, according to the report, governments spend the
most on health care costs associated with substance abuse (58%)
followed by the costs of prosecuting and jailing the offenders
(13.1%).
"The killer finding is that we are spending 96 cents of every
dollar we spend on substance abuse and addiction to shovel up
the human wreckage," says Joseph Califano Jr., founder and
chairman of CASA. "We're making this really tiny investment in
prevention and treatment when we have enough experience to know
that prevention and treatment can reduce the shoveling-up
burden."
Researchers determined spending amounts by analyzing federal,
state and local budgets for the year 2005, the most recent year
that complete data were available, Califano says.
"These governments have it backwards," he says. "They're wasting
billions of dollars of taxpayers' money and not making some
relatively simple investments that could sharply reduce the
consequences of drug and alcohol addiction."
Califano says the main reason that federal and state governments
aren't ready to change priorities is because there is a stigma
attached to alcohol and drug addiction.
To reduce the amount spent on substance abuse, Califano says,
the government needs to "mount major prevention programs," with
a focus on kids.
He adds that increasing taxes on alcohol and training doctors to
talk to patients about their substance use also will help
decrease associated costs.
"This is a problem we can deal with. We know a lot more about it
than we knew years ago," Califano says.
Copyright 2009 USA Today.
3 cruise ship crewmembers catch swine flu off Australia
Associated Press
USA Today
Thursday, May 28, 2009
CANBERRA, Australia (AP) — A cruise ship with 2,000 passengers
aboard has cut short a voyage and will head to an Australian
port for medical help after three crewmembers were diagnosed
Thursday with swine flu, a health official said.
The interrupted vacation left passengers disappointed and
fearing for the health of their families.
Health Minister Nicola Roxon also announced that Australia had
ordered enough swine flu vaccination for 10 million people —
almost half Australia's population. That comes as the number of
swine flu cases in the country jumped from 67 Wednesday to 103
by mid-Thursday.
Elsewhere in Asia, Singapore confirmed its first swine flu
infection Wednesday, a 22-year-old woman who reported symptoms
after visiting New York. South Korea confirmed four more cases
of the disease, bringing the total there to 33. And in the
Philippines, tests confirmed four more cases of the virus in
guests who attended a wedding in the country, raising the
country's total to 10.
The virus has sickened more than 13,000 people in 48 countries
and been linked to more than a 100 deaths worldwide, with the
majority of the fatalities in Mexico.
Hours after the disease was confirmed aboard the Pacific Dawn,
the luxury liner diverted toward the Queensland state tourist
hub of Airlie Beach to allow a 4-year-old girl who needed
medical treatment for a broken arm to disembark, the state
government said.
Her father, Bevan Wagstaff, said he was desperate to get his
daughter Tamsyn and pregnant wife Venessa away from the virus
threat.
"The only word I could use at the moment would be devastation,"
Wagstaff told Nine Network news by telephone from the ship of
his reaction to the crewmembers' diagnoses.
"My wife is midway through her pregnancy; she is absolutely
distraught," he added.
The state health department said the family did not have flu
symptoms, but will be kept in isolation on shore for up to a
week as a precaution.
The three swine flu cases were the ship's second flu outbreak in
as many consecutive cruises from Sydney to Australia's
northeastern tropical waters.
An outbreak of 24 cases of the virus have been reported among
passengers and crew of the first cruise that ended in Sydney on
Monday.
The ship had been allowed to sail again from Sydney that same
day on its current 10-day cruise with 2,000 new passengers on
board before the first swine flu case from the previous cruise
was confirmed.
Roxon said that three crewmembers had tested positive for the
virus Thursday from swabs sent to a laboratory in the east coast
city of Brisbane.
Two sick passengers had also been tested and cleared of swine
flu, she said.
Roxon said the infected crew had been isolated from passengers
since early in the cruise and had been treated with antiviral
medication.
"It may not be necessary for there to be a quarantine
arrangement," Roxon told reporters.
The ship will dock Saturday in the Brisbane, where passengers
will be examined by public health experts and some will leave
the ship. It will continue south to Sydney by Monday, three days
ahead of schedule.
Passenger David Gair told Australian Broadcasting Corp. radio by
telephone that the mood on board was disappointment, but no one
challenged the decision to turn the ship around.
"Everyone on board's very disappointed that we're not stopping
at our proposed destinations, but obviously the threat has
escalated and they don't want to take any risks," he said.
Roxon said the government has ordered 10 million courses of
swine flu vaccine from Australian vaccines developer CSL Ltd.,
which could be available within months.
Clinical trials of the experimental new vaccine were underway,
she said.
Copyright 2009 The Associated Press. All rights reserved.
Opinion
The Health Insurance
Labyrinth
New York Times Letter to the Editor
Thursday, May 28, 2009
To the Editor:
As a family physician for 47 years, I totally agree with Paul
Krugman’s May 22 column, “Blue Double Cross.” Health care
insurers are more bureaucratic than any government agency. They
often deny choice of doctor, and refuse to pay for care.
My experience with the government programs, Medicare and
Medicaid, is that the reimbursement for services may be low, but
there is one uniform set of rules to follow.
Each health care insurer has a different set of rules. The
reimbursement for services varies widely and the doctor
sometimes doesn’t know where to send the patient for laboratory
or other tests. Furthermore, the physician often doesn’t know
whether the prescriptions he or she writes will be covered.
As Mr. Krugman reports, insurance companies are still bad for
your health.
Melvin H. Kirschner
Granada Hills, Calif., May 22, 2009
Copyright 2009 New York Times.
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