Europe poised for exponential growth in digitized medical imaging storage space

LONDON – Medical images are increasingly becoming digitized. However, the exponential growth of digitized medical images poses an immense challenge in terms of management, compression and retrieval.

It is essential that image archive storage solution providers, picture archiving and communication system vendors and image modality manufacturers become aware of the growing requirements of storage space.

New analysis from Frost & Sullivan, Strategic Outlook Into Archive Requirements For Image Management In Medical Imaging, finds that the total European storage requirement in 2007 was 106,044 terabytes (TB). In this research, Frost & Sullivan's expert analysts thoroughly examine medical image storage solutions markets in the UK, France, Spain, Germany, Scandinavia, Benelux and Italy.

"There is an increasing demand for digitizing medical images as opposed to the traditional film-based images," said Frost & Sullivan Research Analyst Shriram Shanmugham.

"Unlike film-based images, digital images do not decay over time and can easily be stored for longer periods of time. Digitized images require less inventory space and the same image can be accessed by multiple physicians simultaneously."

Moreover, the turn-around time from the initial meeting with the physician to availing complete diagnosis is reduced. As a result, patients can expect quicker appointments with physicians and they can have permanent access to the images from remote sites.

However, certain images are not DICOM compatible and require a service-oriented approach to be archived. This is primarily because evolving healthcare standards such as DICOM and HL7 are being updated at a much slower pace than image archiving and image modality technology.

Other challenges include ensuring interoperability with hospital-based information systems. Another issue is that diagnostic procedures such as echo and angiogram generate a high resolution, large file-size images, and their long retrieval times pose a concern for hospitals.

"Some PACS vendors provide their own unique solution to archiving images that are not DICOM compatible, while others think it is wise to work around the evolving healthcare standards so that, in the future, systems interoperability is streamlined," said Shanmugham. "This trend of providing solutions to images that are not DICOM compatible will be prevalent over the next five to seven years."

The digitized medical imaging archives market requires complete cooperation among the following three major industry participants: PACS vendors, image modality manufacturers and storage solution providers. Some PACS vendors have indicated that it would be convenient for them if image modality manufacturers provided them with test data before an image modality is released into the market. By having the test data before hand, PACS vendors affirmed that they could easily establish connectivity (interoperability) of their module with the image modality.

"Hospitals cannot afford to experience an image server downtime," said Shanmugham. "It is therefore essential that storage solution providers devise innovative technology that obviates the possibility of such server downtime."

Romney: Obama's Health Care Mandate Is A Tax

Republican presidential challenger Mitt Romney spent his July Fourth holiday marching in a New Hampshire parade, and backtracking statements a top adviser made about the individual mandate in the Obama health care law.

There was something for almost everybody in Wolfeboro's Independence Day parade: a local brass band, bonnet-wearing Daughters of the American Revolution, a Zumba instructor shimmying across the bed of a pickup truck, and even a Jimmy Durante impersonator, complete with prosthetic nose.

Romney, who has a house on Lake Winnipesaukee, was decidedly at ease as he marched down Wolfeboro's main street. He was joined by his wife, Ann, a pack of supporters wearing blue T-shirts and also about 20 family members, most of whom traveled the parade route in antique trolley cars. By and large, they and their family's patriarch got a warm welcome in this very Republican small town.

"We love Mitt. He's going to be great for America," says Jeff Bichard, who lives in Wolfeboro and manages a fleet of trucks for a lighting company.

Bichard is convinced Romney will invigorate the economy, and he plans to work hard to help Romney carry the state, where recent polls show the former Massachusetts governor and President Obama in a near dead heat.

"I am picking up a sign for my house," Bichard adds. "I am going to put it on my front lawn, and I'm going to get a T-shirt and I've got it on my hat. We love Mitt."

But love was by no means the only emotion at this parade. Pat Jones, a 70-year-old former postmaster, shaded her eyes and shook her head as she watched one Romney after another wave and smile from their wooden trolleys.

"Would you ask Mitt how much a loaf of bread costs, how much a gallon of gas is and how much heating oil is?" Jones asks. "He is so removed from all of this. His world is so different from the common man."

Her husband, John Paul Jones, was quick to utter the epithet that has dogged Romney for years: "He's a flip-flopper."

That's a message Democrats will be selling, and Romney gave them some fresh ammunition.

"The majority of the [Supreme] Court said it's a tax, and therefore it is a tax. They have spoken. There is no way around that. You can try and say you wished they had decided another way, but they didn't," Romney told CBS News regarding the requirement that all Americans have insurance.

The individual mandate is at the core of Obama's health insurance overhaul. It's also the linchpin of the health law Romney passed as Massachusetts governor.

Earlier this week, a top Romney adviser said Romney viewed the mandate in the federal health law the same way he saw it in the Massachusetts law, as a fee or a fine, and not a tax. Romney's remarks to CBS directly contradicted that. Romney's new stance made him sound more like the GOP leaders in Congress.

"The American people know that President Obama has broken the pledge he made; he said he wouldn't raise taxes on middle-income Americans," Romney said.

That's an accusation Romney may soon hear turned against him. But on this day, the fighting words were mostly left unsaid.

When Romney spoke at a brief rally in Wolfeboro, he never mentioned the president. He even took pains to compliment the behavior of Obama supporters he met during the parade.

"They were courteous and respectful and said, 'Good luck to you' and 'Happy Fourth of July.' This is a time for us to come together as a people," Romney said.

Romney also said he hopes to make America more like America. And while it's hard to know precisely what that means, it's a hard point to argue with on Independence Day.

More Answers To Your Questions About The Health Care Law

Adam Cole/NPR

The Affordable Care Act remains pretty much intact after its review by the Supreme Court. So what's in it anyway?

Now that the Supreme Court has upheld almost all of the Affordable Care Act, many Americans are scrambling to remember � or learn for the first time � what's in the law and how it works.

We asked for questions from our audiences online and on air. Here's are some, edited for clarity and length, and the answers:

 

Q: Will the penalty for not having health insurance affect people at all income levels, or will low-income people be spared?

A: The short answer is no, if you can't afford insurance you don't have to buy it.

Here is the slightly longer answer.

For starters, if you don't earn enough to have to file a federal tax return, you're exempt. In 2010 that was $9,350 for an individual, or $18,700 for a married couple.

You're also exempt if you would have to pay more than 8 percent of your household's income for health insurance, after whatever help you might get from an employer or subsidies from the federal government.

Q: If someone is only insured for six or seven months a year, will there still be a fine?

A: Possibly, but it would be prorated for only the months you didn't have insurance.

There is one exception. There's no penalty in the law for a single gap of less than three months in a year. That's because many employers impose a waiting period. There's also a separate provision in the health law that forbids employers from imposing waiting periods of longer than three months. So no one will have to pay a penalty specifically because a new employer makes them wait to qualify for coverage.

Q: I understand that businesses above a certain size have to provide a health care insurance option, but do they have to pay for it? Does the law require a certain contribution from the employer, or can the employer make the employees just pay, say, 99 percent of the premiums?

A: This is where the law seems a little bit tricky. It doesn't stipulate how much of the premiums employers have to pay, but it does say that overall, employers with more than 50 workers have to provide a plan that covers 60 percent of the covered expenses for a typical population. And that plan can't cost more than 9.5 percent of family income.

Q: How does the law affect Medicare recipients? I heard it cuts billions of dollars from the program. Does it have other effects?

A: Let's take these one at a time. Yes, the law does reduce Medicare spending by roughly $500 billion less than it would have been without the law. That's over 10 years, by the way, and Medicare will cost a little under $500 billion this year. But none of that comes out of benefits guaranteed under the law.

The biggest single chunk comes from reducing what had been overpayments to private HMOs and other health plans that serve about 20 percent of Medicare patients.

The next biggest chunk comes from hospitals and other providers of health care that hope to get that money back because more people will have insurance.

As to other changes to Medicare, there are actually some new benefits. The doughnut hole, that gap in coverage for prescription drugs, is being gradually closed. And Medicare patients are now getting new preventive screenings, like mammograms, without having to pay a deductible.

Q: My son lives overseas, where he is covered by the national health insurance plan. As an American citizen, would he be required to pay the fee for not being covered under an American plan?

A: No, only residents of the U.S. and its territories are subject to the insurance requirements.

Q: I am a veteran getting my medical care from Veterans Affairs. Am I correct that this counts as having insurance, when it comes to the requirement that everyone be covered or pay a penalty?

A: Yes, the VA counts. So does TRICARE and other military health plans. In fact, just about all government health care program, including Medicare and Medicaid, count as well. That's why the Urban Institute estimates that come 2014, only about 7 million people out of the U.S. population of well over 300 million will have to either purchase insurance or be subject to paying the penalty.

Q: If my current insurance policy does not meet the minimum requirements in the Affordable Care Act, and my insurer must raise the standards of my policy, can my insurer raise the premiums I pay?

A: In a word, yes. That was part of the goal of the law, not just to get people without insurance to have it, but to get people with what was considered substandard insurance up to par. This is controversial, and it's the part that leads to claims that the government is interfering in the private insurance market, which in this case it is. But it's in the law because Congress heard about lots and lots and lots of cases where people who had insurance nevertheless ended up bankrupt because the insurance didn't cover what they thought it did. So will this make healthy people who have to spend more unhappy? Yes. But will it protect people better when they do get sick? Yes, it will do that, too. And will the arguments about it continue? Yes, undoubtedly.

Medicare. For All. For Life. Everywhere.

When the Medicare for All bus gets stuck, a neighborhood shows its true spirit

After spending the past month on the California Nurses Association ‘Medicare for All’ bus tour in California, I am more confident than ever about the prospects of winning guaranteed healthcare for all under an improved Medicare model. Cradle to grave. For life. In California. Everywhere.

Our wonderful videographer, Erin Fitzgerald, has been traveling with us and capturing the stories Californians have shared along the way. In advance of our two stops in Santa Monica Wednesday, July 11, at the Unitarian Universalist Community Church at 1260 18th Street (3-6 p.m. health screenings and 6:30-8 p.m. town hall) and tomorrow at the West Covina City Hall (same times and events), Erin captured images from our stops so far and shared them in this video piece:

At West Covina City Hall, 1444 W Garvey Ave South, Thursday evening at 6:30 p.m., July 12, Reggie Cervantes, 9/11 responder, and Dawnelle Keys, mom whose beautiful toddler Mychelle died because an out-of-network hospital wouldn�t treat her, will join me for a mini-SiCKO reunion. Join us as we talk about why Medicare for all for life would have been the only thing that might have saved us from been fodder for Michael Moore�s 2007 film.

There is no question that Californians want guaranteed healthcare for all. Only a small percentage of those we have reached out to have rejected the call. And those few seem fixed on their own isolated �I-have-mine-and-I-don�t �care-about-you� mindset. Those few folks are often turned around when medical crisis strikes, and though I never wish that on anyone else, I know that in an instant life as you know it can change and leave you utterly dependent on others for our lives.

So it was perhaps fitting that last night in South L.A. when we were just getting ready to pull out of our stop at the S.C.O.P.E. offices after the screenings and town hall, our bus got stuck. One wheel perched high in the air, we were straddling the whole of Florence Avenue and going nowhere. Within seconds, traffic started to back up and people in the neighborhood jumped to try to help us. One man tried to shove wood planks under the airborne wheel to give traction but the driver feared that with any additional pressure, that wood might fly out from under the wheel and hurt or kill someone. It didn�t work. So many good people tried to help, but it just didn�t work at all.

Finally, after quite some time, a police officer stuck his head in our bus and said, �What are you all doing in the ghetto?� That seemed an odd question to ask on many levels, but perhaps speaks to where we are in terms of our shared humanity and perceptions of that humanity. The police officer facilitated getting a huge wrecker to the site to pull the bus forward and, after significant effort, return our bus to the road.

It was interesting to me to see first the pulling together of community and then the intervention of publicly paid law enforcement personal and others to fix the problem. There was no consideration given to just letting us sit forever in that precarious spot. Seems like the right way to handle it when any one of us faces crisis outside our control. Could the bus driver have taken that turn and curb one degree or two differently and avoided the problem? Maybe. We�ll never know that, and that didn�t really matter. What mattered was that when confronted with a stuck bus and its stranded occupants, the local community came together to help.

I�ve been on a bus for Medicare for All that caught fire on the side of a highway in rural West Virginia. I have been on the SiCKO buses that traveled around the country with nurses educating people about the broken healthcare system and their demand for one single standard of high quality care for all. And now I�ve been on a bus that was stuck in South Los Angeles in a neighborhood where many people choose to avoid, but where the people who live there are both generous and equal in their shared need for healthcare.

Bus tours are grueling and we sometimes wonder about the costs and the challenges that come along with them. But always there are the amazing moments of clarity that come from being present with one another in ways that are so personal and direct. I have spent six months of the past five years on a bus fighting for Medicare for All for life. And I am so very lucky to have done so. But now, if you don�t mind, I�d like us to pull this together and win. And as the young father says at the end of Erin�s video, �Why not healthcare for the world?� Why not, California? We can do it.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

New imaging management solution eyes orthopedics

CHICAGO – A new comprehensive imaging solution is now available for orthopedics. Merge Healthcare officials announced Thursday the release of Merge OrthoPACS, an imaging management and digital templating solution that allows orthopedic surgeons and specialists to securely access images taken from virtually any location. 

Officials say the technology provides real-time study list updates, which ultimately delivers faster results to physicians. Physicians can also access archived images from their iPhones, iPads and other mobile devices with no software download required. 

"Merge's OrthoPACS solution successfully demonstrates our large investment and commitment to the orthopedic market," said Jeff Surges, CEO of Merge Healthcare. "We've combined new and innovative functionality with proven underlying technology to deliver a truly unified orthopedic-specific PACS solution. Additionally, we're excited to now offer OrthoPACS in a subscription model that will address clients' requirements for pricing that more closely aligns with their long-term operating plans."

"We've already begun upgrading our practice to Merge OrthoPACS," said Bradley Dick, chief information officer at Resurgens Orthopaedics, Georgia's largest orthopedic practice. "With Merge OrthoPACS, we'll migrate from a legacy product to true DICOM archive technology which will make it easier to share and manage images across our 21 offices in metro Atlanta."

Merge officials say orthopedic surgeons will find that the new solution integrates into and enhances their current workflow. For example:

Orthopedic-specific workflows are built into Merge OrthoPACS, from clinic use to the operating room.The Merge OrthoPACS zero-footprint client viewer can be the sole viewer for an orthopedic practice, meaning that reading images will be no different whether a surgeon reads from their workstation or any mobile device. The Merge OrthoPACS viewer also provides access to pre-surgical templating, including advanced measurements and automated hip templating. 

Americans need to try harder to eat fruits, vegetables

No one said eating enough fruits and vegetables was going to be a piece of cake � even if you're giving it your best shot.

The majority of Americans say they've been trying to eat more fruits and vegetables over the past year, according to a poll of 1,057 adults for the International Food Information Council Foundation.

But most people are consuming less than half of what the government recommends. Kids and adults eat an average of a little more than a cup of vegetables a day and a little more than half a cup of fruit, according to the latest data from the NPD Group, a market research firm. Those numbers don't count french fries but do include other types of potatoes, such as baked and mashed.

How much is enough?

How many cups you should eat is based on your calorie intake, according to the government's dietary guidelines. Anyone who consumes 2,000 calories a day is supposed to eat 2� cups of vegetables and two cups of fruit a day. A person who takes in about 1,400 calories a day should have about 1� cups of fruits and the same amount of vegetables.

"Children 2 through 12 and their parents are inching up in the amount they consume, but unfortunately, teens and the elderly are bringing the averages down," says Elizabeth Pivonka, president and CEO of the Produce for Better Health Foundation, a non-profit nutrition education group.

The Flexitarian Diet

To eat enough fruits and vegetables, Dawn Jackson Blatner, a registered dietitian in Chicago and author of The Flexitarian Diet, recommends trying to incorporate a fruit or vegetable into every meal and snack.

For instance, here�s one way to consume two cups of fruit and 2� cups of vegetables a day.

Breakfast: One cup or one piece of fruit, plus whole-grain toast and cottage cheese with cinnamon

Morning snack: � cup to cup of vegetables such as carrot sticks or broccoli spears with hummus

Lunch: One cup vegetables such as Greek salad stuffed into a whole-grain pita.

Afternoon or evening snack: One piece or cup of fruit with string cheese.

Dinner: One cup of vegetables such as cooked green beans with brown rice and barbecue chicken.

The reason for the push for an increased intake of fruits and vegetables is they are loaded with vitamins, minerals, fiber, antioxidants and other compounds that help fight disease, she says.

But can anyone really eat three to 4� cups from these two food groups each day?

Pivonka says every little bit counts: raisins in cereal, frozen berries in smoothies, vegetables in soup, tomato sauce on spaghetti, beans in chili, veggies on sandwiches, 100% fruit juices.

In general, one cup of raw or cooked vegetables or vegetable juice, or two cups of raw leafy greens, counts as one cup from the vegetable group. One cup (or one piece) of fruit or 100% fruit juice, or half a cup of dried fruit, is considered one cup from the fruit group. So if you eat an apple or banana, that counts as one cup of fruit for the day; a medium side salad could equal about one cup of vegetables.

An easy way to reach the recommended amount is to make half your plate fruits and vegetables at every meal, as suggested by the government's MyPlate icon (choosemy plate.gov), says Rachel Begun, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, formerly the American Dietetic Association: "This is a visual that's easy to remember."

Do the shopping

To eat enough from these two food groups, you need to make sure your fridge and freezer are well-stocked, which may mean grocery shopping one or two times a week, says Dawn Jackson Blatner, a registered dietitian in Chicago.

"I like to buy pre-washed containers of leafy greens, trays of assorted cut veggies and bags of frozen vegetables for later in the week when my fresh produce is gone."

She also likes to have leftover grilled veggies in the refrigerator in the spring and summer and roasted vegetables in the winter and fall.

Cooking vegetables, including grilling or roasting them, often helps bring out natural flavors and sweetness, Blatner says.

Consider the options

When people tell her they don't like vegetables, Pivonka tells them that there are hundreds of different fruits and vegetables that can be prepared in thousands of different ways. "My daughter was 10 years old before I discovered that she liked cooked carrots instead of raw carrots."

She says her group often hears from consumers who are concerned about cost. A government study showed you can eat the recommended daily amount of fruits and vegetables for $2 to $2.50 a day. "It's really a matter of priorities and how you spend your money," she says. "You can skip the soda when you eat out, and you've saved enough money to buy all your fruits and vegetables for the day."

When it comes to both price and taste, it's often best to eat produce that's in season, Begun says:

"There's a world of difference between a tomato from a local farm in late summer vs. one in January that was picked before its time and flown thousands of miles."

What's on Americans' minds? Increasingly, 'me'

An analysis of words and phrases in more than 750,000 American books published in the past 50 years finds an emphasis on "I" before "we" � showing growing attention to the individual over the group.

The study, published today in the online journal PLoS One, analyzes how often certain words and phrases appear in written language from year to year. Researchers say it is yet another indication that U.S. society since 1960 has become increasingly focused on the self.

"These trends reflect a sea change in American culture toward more individualism," says psychologist Jean Twenge of San Diego State University. "That can be both good and bad. Some people have argued that individualism has been on the rise in Western cultures for centuries, but that the increase accelerated after the late 1960s. These results suggest that's indeed the case."

Findings show nuances in different aspects of individualism, Twenge adds. "There's an emphasis on uniqueness and greatness, and things being personalized for the individual. But it's not about being independent and standing on your own two feet," she says.

"We got changes we expected in words like 'unique' or phrases like 'I love me.' We didn't get them in words and phrases more about independence. It shows the type of individualism that has increased."

Twenge and her co-authors did two studies using 20 words and 20 phrases describing both individualism and community. Examples: "independent" and "solo" for individualism, "communal" and "team" for groups. Phrases include "I am special" and "me against the world," "community spirit" and "it takes a village." Words and phrases used in the studies were chosen by an online panel.

Which words are on your mind?

Here are the top 20 individualistic and communal words and phrases:

Individualistic words:

Independent, individual, individually, unique, uniqueness, self, independence, oneself, soloist, identity, personalized, solo, solitary, personalize, loner, standout, single, personal, sole, singularity

Communal words:

Communal, community, commune, unity, communitarian, united, teamwork, team, collective, village, tribe, collectivization, group, collectivism, everyone, family, share, socialism, tribal, union

Individualistic phrases:

All about me, captain of my ship, focus on the self, I am special, I am the greatest, I can do it myself, I come first, I get what I want, I have my own style, I love me, I�m the best, looking out for number one, me against the world, me first, my needs, self love, self reliance, self sufficient, and there�s only one you, what's right for me

Communal phrases:

All in this together, band together, community goals, community spirit, common good, communal living, concern for the group, contribute to your community, it takes a village, sense of community, sharing of resources, strength through unity, the group is very important, the needs of all, together we are strong, united we stand, we are one, we can do it together, work as a team, working for the whole

Researchers used the Google Books Ngram Viewer, an online database released by Google in 2010 that contains the full texts of more than 5 million books scanned in from the 1500s through 2008, the most recent year completed.

The tool lets researchers compare usage trends in words and phrases over time, and shows their frequency for each year, compared with all words and phrases in the database.

Twenge's team analyzed all the books in the database in "American" English published between 1960 and 2008 � 766,513 books, says Google research manager Jon Orwant. Findings point to a progressive increase in words and phrases associated with individualism from 1960 on.

Not everyone buys the study's conclusions, however.

The words and phrases that were analyzed "are subjective choices. It's a little bit hazardous to make a leap from that to say this is a direction that American society is going," says linguistics professor Dennis Baron of the University of Illinois at Urbana-Champaign, who has seen the study and has used Google Ngram.

"People refer to themselves in the singular more than they do the plural, and it doesn't necessarily mean we're all individualists or egotists," he says. "It just means we have more occasions to refer to one form than the other."

Twenge says researchers began with 1960 because it was before the civil rights and women's movements would have affected language. It's possible the increase in some words may be the result of those social forces, she says, but it's clear the new focus on the self is not on "just being equal, but being better, and the best."

Single-payer system is the way to go

Millions of families are struggling with economic hardship. Health-care costs are weighing on more Americans, contributing to about a million bankruptcies a year, and are a major factor in many home foreclosures.

Distressed companies are struggling with the rising costs of providing health coverage for their employees, and there is evidence of poorer health outcomes for the uninsured. More deaths occur from lack of insurance than because of auto accidents, leading to more deaths from cancer and chronic diseases and worse outcomes from emergency care.

One in three families is now distressed by medical costs. Yet health-care costs continue to rise faster than inflation and squeeze both families and businesses.

We pay an estimated $50 billion for health care for the uninsured and an additional estimated $180 billion in lost productivity due to employee health problems. Yet with more than $10 trillion in national debt, but assets rated at only $1.5 trillion, how can we afford to reform this dysfunctional system?

Let me show how we must undertake this task.

For-profit insurance companies must go. Their mission is to make money, and they do this best by enrolling only people who are healthy and unlikely to need care. Then, when medical expenditures are called for, the health insurers benefit by denying tests or treatments. Enormous profits for their 1,500 companies and investors are possible in this way, but at highly expensive administrative effort and waste.

Since 1970, the number of administrative personnel in the health-care industry has increased 2,500 percent, while the number of physicians has only doubled. Some health-care CEOs have reaped salary and benefits of more than $1 billion a year. Profit and overhead in the U.S. health-care industry is now 31 percent, compared with less than half of that in most other industrialized countries.

Eliminating the insurance companies and replacing them with a single-payer system such as HR 676 proposes would save our country an estimated $350 billion a year, enough to provide comprehensive health care for all of us, including dental coverage, long-term care, full pharmacy and mental-health benefits � all with no co-pays or deductibles and at no additional cost to our country beyond what we now spend on health care.

The so-called mandate plans, of which the Barack Obama campaign proposal is representative, have been tried in a number of states and have never been sustainable or successful at covering the uninsured or controlling costs.

All were plagued by soaring cost increases and failed in just a few years.

Insurance works best when the largest possible number of individuals is covered in the same risk pool, so that the healthy individuals share in the cost of paying for treatment of the sick.

Any dividing up of the risk pool by for-profit insurance companies leaves those in sicker risk pools with rising costs, whether those pools are Medicaid or other insurers.

Currently, individuals tend to switch insurance plans an average of every two years, and continuity with one’s physicians gets disrupted. So there are no incentives for the insurer to practice preventive medicine, which, because of cost reduction, tends to pay off in the long run.

HR 676 is not socialized medicine, and it is not government-run medicine. Care would be provided by private physicians, and hospitals would continue to be private. Guidance for the single-payer plan would be through health planning boards on a regional basis, appointed by state legislators and advised by medical experts. Huge savings would be realized by having only one not-for-profit insurer for everyone.

Benefits beyond the financial would be realized by having a readily accessed database on what kind of health care works and levels of utilization on a national basis. Pilot programs like HR 676 have been hugely successful. A fine example is the national health insurance in Taiwan, with an overhead of less than 2 percent, functioning well since 1995 and covering 99 percent of the Taiwanese at less than half the per-capita health-care costs of the U.S. system. Medical bankruptcy is unheard of in those countries with national health insurance.

Our organization, Physicians for a National Health Program (www.PNHP.org) represents more than 15,000 physicians and many nonphysicians who are advocating for passage of HR 676.

Several additional members of Congress were elected on Nov. 4 who advocate for this position, including one U.S. senator, Mark Udall of Colorado. Surveys indicate about two-thirds of the public wants some form of national health insurance, and 59 percent of physicians favor this also, as well as more than half of our surveyed members of the Capital Medical Society who responded. Since it is the only comprehensive program that is affordable, can we get on about the business of passing HR 676 and let go of the idea that a private market of for-profit health insurers, with their exorbitant profits and administrative expenses, is in some way compatible with our interest?

This article is from www.tallahassee.com.

Coffee drinkers may live longer, study suggests

Coffee lovers are a loyal crowd. Most pour out their morning cup of java for the flavor, the aroma, and the accompanying jolt of energy, rather than the health perks.

So they may not mind if doctors debate new research suggesting that coffee lovers live longer.

According to an article in today's New England Journal of Medicine, those who drank coffee at the beginning of a 13-year study had a slightly lower risk of death than others, whether they chose decaf or full-strength.

Coffee drinkers also were a little less likely to die from specific causes: heart disease, respiratory problems, strokes, injuries and accidents, diabetes and infections. Coffee offered no protection against cancer.

Drinking two to three cups of coffee a day lowered the overall risk of death 10%, says the study, funded by the National Cancer Institute and AARP.

"It's interesting that coffee is more healthful than harmful," says Frank Hu, a professor at the Harvard School of Public Health, who has studied the health effects of coffee but wasn't involved in the new study.

Not so fast, says cardiologist Steve Nissen of the Cleveland Clinic, who also wasn't involved in the new research. Asking people about their coffee consumption only once in 13 years can be misleading, since drinking habits change. Nissen notes the study didn't include vital medical information that affects longevity, such as cholesterol or blood pressure levels.

"This study is not scientifically sound," Nissen says. "The public should ignore these findings."

Neal Freedman, the study's lead author, acknowledges that the design of his study prevents it from definitively proving that coffee affects longevity.

"We wouldn't recommend that anyone go out and drink coffee based on these results," Freedman says. But he says his study could provide some "reassurance" that coffee didn't seem to cut patients' lives short.

Scientists still have unanswered questions about coffee, which contains more than 1,000 compounds that can affect the risk of death, Freedman says.

Could Kaiser Permanente's Low-Cost Health Care Be Even Cheaper?

Enlarge Michel Euler/AP

George Halvorson, chairman and CEO of Kaiser Permanente, speaks during a session at the World Economic Forum in Davos, Switzerland, in 2009.

Michel Euler/AP

George Halvorson, chairman and CEO of Kaiser Permanente, speaks during a session at the World Economic Forum in Davos, Switzerland, in 2009.

Kaiser Permanente rose out of Henry J. Kaiser's utopian, industrialist dream.

During the 1930s and '40s, Kaiser wanted to make sure the workers at his Richmond, Calif., shipyard stayed healthy. Kaiser Permanente then opened its doors to the public in 1945.

That's a key difference from other providers: Kaiser Permanente owned its own hospitals and clinics and directly employed physicians. Other insurers had to negotiate with outside hospitals and doctors demanding ever-higher payments. Without those burdens, Kaiser could offer health coverage that was high-quality and less expensive than conventional insurers.

Today, it's a different story, says Mark Smith, head of the California HealthCare Foundation. The organization is no longer the bargain it used to be, he says, possibly because of what economists call "shadow pricing."

 

"If your competitor takes $4 to make a banana and it only takes you $2 to make a banana, you price your banana at $3.95 and you pocket the rest," Smith says.

It's difficult to discern just how Kaiser fares against other companies since negotiations between health plans and employers are largely confidential. Kaiser says its costs increase by about 5 percent each year. But some of Kaiser's biggest customers say their premiums have jumped much higher, in some cases 20 percent.

That's a charge Kaiser CEO George Halvorson denies. "We're at least 10 percent better everywhere. Sometimes we're 15 to 20 percent less expensive," he says.

Halvorson insists Kaiser's rates are based on how much it spends on patient care, not based on what other insurers are charging. And, he adds, Kaiser offers richer benefits than other plans.

But according to David Lansky, of the Pacific Business Group on Health, Kaiser Permanente has difficulty explaining how it sets its prices.

This may stem in part from the very trait that makes Kaiser Permanente so efficient: The health maintenance organization, unlike other providers, doesn't have a menu of fees.

Bob Kocher, a former health care adviser to President Obama, says Kaiser's model was at the back of policymakers' minds when they wrote what are essentially Kaiser look-alikes into the health overhaul law.

Kaiser hospitals have shown they can deliver top-shelf care for happy-hour prices. Recent Medicare data show all but one of Kaiser's hospitals cost significantly less than the national average. And the company's electronic medical record system is one of the most advanced in the world and has largely eliminated duplicative tests.

But Kocher suspects that as more doctors and hospitals band together into Kaiser Mini-Me's, Kaiser Permanente could face more competition.

Kaiser Permanente, meanwhile, is marching east. It's expanding in the Washington, D.C., area, as well as in Georgia. Some health policy experts assert that the company is setting its premiums, in part, to underwrite this expansion.

Halvorson says Kaiser Permanente spends its surplus to benefit its customers.

"We use our money to invest in our care system; we use our money to invest in our computer systems," he says. "We reinvest money in hospitals and clinics and that's the only use of the money."

Halvorson contends if all Americans got their care at Kaiser-like facilities, the U.S. would save hundreds of billions of dollars in health care costs. Others are less convinced. The cautionary tale of Kaiser Permanente, they say, is that even under the best circumstances, U.S. health care prices may still be untamable.

This story was supported in part by Kaiser Health News, which is not affiliated with Kaiser Permanente.

AMA thinking seriously about ICD-11

CHICAGO – ICD-10 proponents are not going to like this one bit.

Certainly not any more than they enjoyed my suggestion that the proposed ICD-10 deadline extension puts the U.S. healthcare industry into a strange time warp in which providers and payers will be finally implementing ICD-10 in the same one or two-year timeframe that ICD-11 is entering this world – and that being the case perhaps holding out for the 21st Century classification system that will be ICD-11, then moving aggressively to that is, well, at least worth considering.

Here it comes: The American Medical Association late Tuesday took up the ICD-11 cause.

Until now, it was a soft chant by rather disparate voices. If recent history with the proposed ICD-10 delay is any indication, though, the AMA can bellow loud enough to be heard in the highest of strongholds.

Potential alternative
The AMA voted on Tuesday to evaluate ICD-11 as a possible alternative to ICD-10 for replacing ICD-9 – saying that it will report back to delegates in 2013 with its findings.

“It is critical to evaluate alternatives to ICD-9 that will make for a less cumbersome transition and allow physicians to focus on their primary priority – patient care,” AMA president-elect Ardis Dee Hoven, MD, said in a statement. “The policy also asks stakeholders, such as the Centers for Medicare and Medicaid Services, to examine other options.”

Practicing the ‘it can’t hurt to ask’ methodology ostensibly worked for the AMA in getting ICD-10 delayed earlier this year. Two unrelated anonymous sources, both well-positioned vis a vis ICD-10, told me separately that even HHS Secretary Kathleen Sebelius was surprised when word came down – from the White House? – that her department was to postpone code set compliance. Take that as an unconfirmed rumor, please. But know that somebody, somewhere made the delay happen.

[See also: ICD-10 deadline do-over?.]

To be fair, the AMA could be in a time dimension all its own. HHS is likely to decide whether October 1, 2014 will be the new deadline, or not, well before 2013. Let’s hope. Unless HHS pushes ICD-10 further into the future, the AMA may be too late to start calling for ICD-11.

But the WHO in mid-May posted what it calls the beta drafting platform of ICD-11 – meaning work is underway though the process is undeniably nascent.

Not alone
The AMA is not the only one chanting for ICD-11. In a blind reader poll, Government Health IT asked its readers ‘Should the U.S. leapfrog ICD-10 and opt for ICD-11?’

Nearly one-quarter indicated “yes” while one-third weighed in with a firm “no.” Given the circumstances, which include the fact that ICD-11 is not yet ready for primetime, the more telling perspective is the 43 percent of a total 115 respondents who voted that “it’s worth considering.”

Matt Murray, MD, a pediatric emergency physician and self-described health IT advocate, contends in a May 17 blog post that CMS “prematurely dismisses the alternative option to forgo ICD-10 and implement ICD-11,” adding that he is “very concerned that this dismissal is published without a comparative analysis of the total costs of each option. And there is good reason to seriously consider implementing ICD-11.”

That’s a point very similar to one the MGMA has made – that before mandating ICD-10, CMS should conduct a comprehensive cost-benefit analysis, pilot ICD-10, and fully evaluate alternative approaches. Sounds only reasonable to me.

“Implementing ICD-10 has been compared to buying a Betamax instead of a VHS recorder in terms of pending obsolescence,” Dr. Murray wrote. “Informatics experts are in agreement that ICD-11 is superior to ICD-10 and that we need to get to it as soon as is tolerable.”

Continued next page.

Goold Health Systems partners with Unisys on Maine Medicaid deal

Goold Health Systems, a healthcare management company focusing on Medicaid services, has subcontracted with the Unisys Corporation to provide prior authorization, data management and mailroom services for Maine's Medicaid program.

The Cheyenne, Wyo.-based GHS will support the Unisys implementation of a new Medicaid management information system, Maine Integrated Health Management Solution (MIHMS), which is designed to ultimately bring down costs for beneficiaries.

"We are pleased to partner with Unisys on this important work, which is ultimately about designing a healthcare system that further positions Maine to provide affordable, appropriate and quality care to Maine Medicaid recipients," said Jim Clair, CEO of Goold Health Systems.

As part of Unisys' seven-year contract with Maine, Goold Health Systems will:

Capture all paper medical claims submitted for Medicaid benefits;Continue providing mailroom services for all incoming/outgoing processing;Capture all documents, such as correspondences, and make them available electronically to Unisys and state staff; andHandle medical prior authorizations processing and provide related clinical consultation during the implementation phase.

"We are pleased to be working with Goold Health Systems to help ensure that the state of Maine and its Medicaid providers consistently receive excellent service," said Teresa DiMarco, president of Unisys' health information management unit.

Maine's new Medicaid information system, MIHMS, is expected to go live in February 2010.

How Opponents Won The Health Care Messaging War

OK, so it's not exactly news that the Obama administration hasn't done the best job in the world selling the Affordable Care Act to the American public.

But now the Pew Research Center's Project for Excellence in Journalism has some statistics to demonstrate just how sorry that job has been. And it suggests that the media gets at least some of the blame.

It seems that during the pivotal period during which the legislation was being crafted (and the public was forming an opinion), from June 1, 2009, through March 31, 2010, nearly half the media coverage (49 percent) "focused on politics and strategy as well as the legislative process." How much focused on what the measure would actually do? Just 23 percent.

The study also measured how often media reports mentioned terms used by opponents of the bill, such as "government-run," or "rationing health care," compared to those used by supporters, such as "pre-existing conditions" or "more competition." It found that terms used by opponents "were far more present in media reports than terms associated with arguments supporting the bill."

Despite the success of opponents in messaging, however, the public remains largely split over the law, with most polls showing a majority of Democrats supporting it, and a somewhat larger majority of Republicans opposing it.

Legislation Introduced to Make Health Care a Right in New York State

Doctors, Nurses, Patients Advocates Applaud Updated Single Payer Medicare for All Legislation by Gottfried, Duane and 70 lawmakers

Doctors, nurses, patients, senior citizens, anti-poverty advocates, faith leaders and medical administrators joined Assemblymember Richard Gottfried and Senator Thomas Duane in unveiling an updated and revised single payer legislative proposal for New York State. More than 70 state lawmakers are cosponsors

Assemblymember Gottfried had initially drafted a single payer plan for New York in the early 90s. The revised legislation incorporates changes that have been made in the state’s oversight of health care in the interim, advances in how to provide medical services, and the recent federal changes in the health care system. The legislation builds upon the momentum from last May when Vermont became the first state to enact a universal health care system which the Governor plans to make a single payer system, where on programs pays all bills.

�The current system doesn�t work for patients or health care providers, or for the employers, individuals, and taxpayers who pay for care and coverage today,� said Assembly Health Committee Chair Richard N. Gottfried, author of the bill. �We can get better coverage, get all of us covered, and save billions by having New York provide publicly-sponsored, single-payer health coverage, like Medicare or Child Health Plus but for everyone.�

�Our current health insurance system is driven by uncertainty. Will my family have coverage? Can we afford it?,� said Senator Duane. �Single-payer is about removing that fear from peoples� lives. It will allow all New Yorkers the same comfort that our seniors get from Medicare, and that our veterans get from TRICARE. It will allow entrepreneurs to worry about product innovation, not health insurance costs. It is time for single-payer in New York.�

Joining Assemblymember Gottfried and Senator Duane at the press conference were Katie Robbins of Health-Care Now!, Vito Grasso, Executive Vice-President of the NYS Academy of Family Physicians, Dr. Asiya Tschannerl of Physicians for a National Health Program, Mark Dunlea of Single Payer NY / Hunger Action Network of NYS, Shaun Flynn of the NYS Nurses Association, and Rev. Bebb Stone.

Assemblymember Gottfried convinced lawmakers four years ago to fund a study of the most cost-effective way to provide health care to all New Yorkers. The answer was single payer, which would reduce overall health care expenditures in New York by $20 billion annually by 2019. The state study said that single payer would be $28 billion cheaper annually by 2019 than the insurance mandate enacted by Congress. In addition to saving money, single payer was the only plan that guaranteed that everyone would have access to health care services.

“The Presbyterian Church U.S.A. has called single payer health care reform ‘a moral imperative’ since 2008. If I want health care coverage for myself ( and I do), how can I not want it equally for my neighbor whom I am commanded to love as myself?” asked Rev. Bebb Stone. “We believe that the value of persons requires that each person have full access to essential services without regard to ability to pay and on terms that enhance the dignity of the individuals” according to the 2008 resolution.

The proposal would provide comprehensive health coverage for all New Yorkers. Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no premium, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc.

“Even if the recent federal health insurance mandates survives the legal challenges, it fails to provide health care coverage to everyone and is financially unsustainable. Tens of millions of Americans will discover that the insurance they are forced to buy fails to pay for the health services they will need. Everyone knows that there is a better solution – single payer, expanded and improved Medicare for all – and New York should be the first one to put it in place,” said Mark Dunlea, Executive Director of Hunger Action Network.

“The simplest and quickest way to reduce health care costs is to eliminate the money wasted on health insurance, its profits and administrative costs, and the bureaucratic barriers it presents to health providers and consumers. If we got rid of insurance companies nationally, the annual savings would be more than $400 billion,” added Dunlea, chair of the state legislative committee of Single Payer New York, an umbrella organization.

“As a physician working in the Bronx, I see every day the profound limits of medicine when patients must ration their care due to high copays and deductibles,” said Dr. Asiya S. Tschannerl with Physicians for a National Health Program. “And too many patients have told me that they earn just a few dollars too much to qualify for Medicaid, and are now facing the horrible dilemma of – “do I reduce my income? or go without insurance since I couldn’t afford it.” Enough is enough. We need a truly universal healthcare system like every other industrialized nation on this planet. Healthcare is a human right, not a privilege! A Single Payer expanded and improved Medicare for all would guarantee healthcare for all,” added Tschannerl, a member of Doctors for the 99% and Occupy Wall Street.

“We must end funding the waste, greed, and corruption of the health insurance companies, and move these resources to funding and providing actual healthcare. Insured or not, the Affordable Care Act pits people’s needs against profits for corporate-run healthcare. We can reverse this trend and recognize the right to healthcare by implementing the New York Health bill,” stated Katie Robbins of Healthcare-NOW! NYC.

“The Nurses Association firmly supports the establishment of a more equitable coverage system that directs scarce healthcare dollars towards providing universal access to high quality, cost-efficient health care for all New Yorkers – regardless of their age, income, health or employment status,” according to Deborah Elliott, RN, MBA, Deputy Executive Director, New York State Nurses Association.

Under the revised bill, health care would no longer be paid for by insurance companies charging a regressive �tax� � premiums, deductibles and co-pays � imposed regardless of ability to pay. Instead, New York Health would be paid for by assessments based on ability to pay, through a progressively-graduated payroll tax (paid 80% by employers and 20% by employees, and 100% by self-employed) and a surcharge on other taxable income. A specific revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor.

Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The �local share� of Medicaid funding � a major burden on local property taxes � would be ended.

Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents.

Assemblymember Gottfried, in his official sponsor memo, noted that “New Yorkers have experienced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured.

“Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated.”

Parents can build in 'special time' with kids this summer

The unofficial start of summer may have arrived already, but for many families, what once were the lazy days of summer have become the crazy days.

Parents and kids often find themselves racing to work, camps, swim meets and ballgames, plus answering cellphones, text messages and e-mails 24/7. So how can parents get more out of their time with their family?

They should consider setting aside an hour a week for "special time" with each child, says psychologist David Palmiter, author of Working Parents, Thriving Families and a public education coordinator for the American Psychological Association.

For that hour, each parent should focus totally on the child while doing something enjoyable, such as shooting baskets, playing a video game or drawing, he says.

Parents should keep in mind that the child should choose his activity, and many things he would choose will work, except for watching TV, Palmiter says.

He often spends special time with his own children, ages 11, 15 and 16, when they are going out for breakfast, taking a walk or shooting baskets.

Make kids the priority

Parents should really listen to what the child has to say and enjoy the child's company by living in the now, he says.

During special time, parents should avoid correcting behavior or ideas or directing the conversation, he says. That should be done at another time.

"Just focus on being with your child and enjoying him all that you can," Palmiter says.

And don't jump up to answer your cellphone or check your text messages, he says, "because that suggests to the kids that your iPhone is a higher priority than they are."

Special time with children is different from quality time in which parents divide their attention across fun family activities such as going to sporting events, fishing or riding roller coasters. Those serve a different purpose for enriching family life and building memories, he says.

Psychologist Mary Alvord, who has a private practice in Rockville, Md., and is the author of Resilience Builder Program for Children and Adolescents, says parents and kids can do simple things such as playing board games, bowling, playing miniature golf or cooking.

This hour can even be time in the car. "With teens, it's a nice time to talk with them because they're captive. Just make sure they're not texting."

So often parents and children do parallel activities such as sitting together to watch TV or going to the movies, and they're not conversing with each other, Alvord says.

"When you look at the research, kids' resilience is often based on time they spend with their parents, knowing they are appreciated by the family," she says. "Parents have to really listen to them. If you are always multitasking, it's not the same kind of listening."

Palmiter says that special hour each week can be used for all ages, including adult children, and it's important to have special time each week with your spouse or significant other. Even a dinner or a picnic can provide the opportunity to focus on your spouse, he says.

The process is the point

For many families, the best way to have richer time together is to build on activities family members love, says psychologist Susan Linn, author of The Case for Make Believe. Parents can share the hobbies and activities they especially love with their children. That might be music, art, dance, woodworking, crafts, sewing, knitting, gardening or outdoor activities such as sports, fishing or hiking.

If parents are truly interested in what they're doing, they can pass that enthusiasm on to their children.

What's most important is that children enjoy the experience. So if you're making something with a child, perfectionism needs to go out the window. The process of doing it should be more important than the product, she says.

"One of my husband's most vivid childhood memories was hammering nails into a bench for fun at his father's picture-frame shop. He grew up to be an art restorer, and it all began with sitting hammering nails into the bench until the entire end of the bench was metal."

Parents also can share with their kids the games they played as a child. "I taught my grandchildren Mother May I, and they ask me to play it with them. We make up ridiculous steps.

"Parents have to keep in mind the importance of play for children � and for adults."

Healthcare IT stimulus funding: Show me where to put the money

NASHVILLE – Now that the $787 billion American Recovery and Reinvestment Act has been signed into law, what does it mean for the healthcare industry, particularly for healthcare IT?

Providers and other healthcare IT stakeholders should focus on five areas that will likely be targeted by healthcare IT funding, said John Tempesco, vice president of Client Services and Marketing for Informatics Corp. of America, or ICA.

Ready-to-go healthcare IT projects that prevent medical mistakes, provide better patient care, promote preventative care, evaluate the most cost-effective healthcare treatments and drive cost-savings efficiencies will not only provide ROI but create jobs as well, he said.

Vendors should encourage their customers to expand healthcare IT projects and get them in place to be "shovel ready" for when the funding becomes available, he said.

"Because the focus is shifting away from automating the business of medicine to the clinical practice of medicine, the emphasis is now on informatics," Tempesco said.

Congress and demonstration projects by the Centers for Medicare and Medicaid Services, or CMS, have been focusing on clinical results and how physicians use information in healthcare IT platforms to reduce errors, make better-informed clinical decisions and deliver workflow efficiencies, he pointed out.

As a result, clinical informatics will be an area of job creation, he said. With increased physician involvement in the selection and deployment of solutions, hospitals should strengthen the relationship between their clinical and IT staffs. That will require clinical application specialists and medical technicians to help train staff.

What's missing in the healthcare industry is the actual teaching and translation of how providers use healthcare IT solutions in their daily workflow to make incremental changes in their businesses, he said. "There are not enough clinical application specialists in most hospitals," he said.

Tempesco expects stimulus funding to flow to community projects. ICA is already seeing a lot of Requests for Proposals from states, including Kentucky, Mississippi and Louisiana, for statewide health information exchanges, or HIEs. "Any time you talk about HIEs, it requires vendors producing data inputs and outputs, and hospital staff doing integration, implementation and training," he said.

Tempesco has a word of caution for those giddy with the forthcoming healthcare IT funding. "My biggest fear is that we dump money into projects that don't have sustainability plans," he said, referring to the community health information networks, or CHINs, that received government funding but failed in the 1990s.

If initiatives stick to the five key areas, Tempesco said, those projects would glean value.
 

Oregon Activists Look to Grassroots Approach to Win Universal Health Care

With health care premiums rising three times faster than workers� income, more and more unions have come to see the existing health care system as unsustainable, despite their best efforts at the bargaining table.

In Oregon, activists are responding by rejuvenating a dormant campaign to win a health care system that covers everyone�and pays for it by cutting out the insurance companies. The concept is called �single payer.�

This isn’t the first time that Oregon activists have tried to win single payer. Ten years ago, they put an initiative on the ballot, but despite initially promising polls, the measure was trounced�victim of a flood of insurance company money and the sharp opposition of the Oregon AFL-CIO, which called it a threat to union health plans.

Times have changed.

When Portland Jobs with Justice began making the rounds of local union halls in 2008, urging support for national single-payer legislation sponsored by Representative John Conyers, the response was generally sympathetic. The national AFL-CIO has endorsed single payer on principle, and current state President Tom Chamberlain has been a consistent supporter.

The current focus isn�t just gaining endorsements, however.

Three activists from the Vermont Workers Center toured Oregon in December at the invitation of local Jobs with Justice chapters to spread the word on how they won landmark legislation laying the groundwork for a single-payer health care system in their state.

Their essential message: take it to the grassroots. Don�t split hairs over policy analysis. Don�t try to win over legislators who have heard all the arguments but haven�t felt the heat from their constituents. Don�t even use technical terms like �single payer,� unless you�re talking to people who already know what it means.

Instead, talk about health care as a human right�something everybody should have, regardless of the state of their bank account or their immigration papers, their medical condition, their job, their age, race, or gender, or whether some insurance underwriter thinks they�re a �good risk.� Seek out the people in all walks of life who have been burned by the health care system, get their stories, and turn them into effective activists and advocates.

For three years Vermonters built support in every corner of the state through one-on-one surveys, photo petitions, and public meetings where politicians were invited to hear testimony, comparable to the Workers� Rights Board hearings that are a standard part of the Jobs with Justice toolkit.

The Vermonters� tour made a tremendous impact, from metropolitan Portland to rural communities in eastern Oregon. Not everyone agreed with every aspect of the VWC approach, but everyone was talking about it. By the end of January, a new statewide coalition had convened to �create a comprehensive, affordable, publicly funded, universal health care system serving everyone in Oregon and the United States.�

By April, the coalition had a name�Health Care for All-Oregon�and close to 50 affiliates, including several statewide unions, immigrant rights groups, and community organizations ranging from the Rural Organizing Project to Elders in Action to Sisters of the Road (which advocates for the homeless).
Some, like Physicians for a National Health Program (PNHP) and the Mad as Hell Doctors (whose cross-country tour in 2009 brought the message to a host of new audiences), make single payer their main focus. The majority of affiliates have other priorities, but have come to understand that the collapse of our health care system threatens everything else on their agenda.

The Oregon Latino Health Coalition, which has labored tirelessly under the radar to secure medical services for the state�s 150,000 undocumented, recognized immediately that the Health Care for All human rights framework provides an opportunity for open advocacy without being isolated or marginalized. In voting to affiliate, the Representative Assembly of the Oregon Education Association noted that the skyrocketing cost of teachers� health benefits is draining money out of the classroom and has left the union increasingly vulnerable to attack.

State vs. National

For unions, perhaps the biggest sticking point has been the question of state vs. national legislation. When Congress passed the Affordable Care Act in spring 2010 and ended, for the time being, the prospect of any genuine national health care reform at the federal level, Portland Jobs with Justice made a strategic decision to pursue state legislation as a way to keep single payer before the public.

Working with state Representative Michael Dembrow (who is also a Teachers union officer and Jobs with Justice member), with activists from the 2002 initiative campaign, and with PNHP and the Mad as Hell Doctors, we drafted a bill that attracted a dozen legislative co-sponsors. In March 2011, supporters of the Dembrow bill staged a mass rally on the Capitol steps followed by a dramatic two-hour hearing before the House Health Care Committee. The legislation didn�t make it to the House floor, but it has more than proved its value as an organizing tool, energizing new activists across the state.

Some single-payer supporters question how far it can be implemented at the state level. They point to a host of federal laws and regulations that would need to be waived, and the difficulty of achieving the cost savings of a truly universal risk pool when the program stops at the state line.

This has in fact been a problem in Vermont, whose new law, while a giant step in the right direction, falls short of single payer. (Many Vermonters remain outside the risk pool, and funding, while administered by the state, still comes from multiple sources.) Unions with multi-employer Taft-Hartley health plans, which often cross state lines, worry that a statewide risk pool will not be viable enough to maintain the level of coverage they currently enjoy.

For this reason, Portland Jobs with Justice has made national legislation the ultimate objective, and has taken the position that the best union health plans set the standard by which any public plan should be assessed. Significantly, the �insurance exchange� provisions of the Affordable Care Act directly undermine Taft-Hartley trusts, by giving small employers a way to bypass unions and buy inferior, cut-rate insurance coverage for their workers. For unions, the Affordable Care Act is no solution: even if it survives the current Supreme Court challenge, its lack of cost controls and other internal contradictions will render it unworkable.

The challenge for us is to be ready with an alternative that has popular support, and the more states join Vermont in projecting such alternatives, the better.

Health Care for All-Oregon wants to bring everyone together to hammer out a strategy that works for all. The immediate task in Oregon, though, is not legislation but building the kind of mass base that changes the political climate in the state and makes legislation possible.

Efforts to pass single-payer bills in Vermont go back 20 years, but it was only after the Vermont Workers Center did three years of organizing around the principle of health care as a human right that they got results. Now that the Oregon coalition is up and running, we�ll see how much of Vermont�s game plan can be successfully exported.

Peter Shapiro is an organizer with Portland Jobs with Justice.

Health advocates go sour on sugar

The war on sugar is raging again.

This week, Walt Disney announced that it's going to stop advertising junk food to kids on its TV channels, radio station and website by 2015. It's eliminating ads for sugar-laden fruit drinks, candy and snack cakes.

Last week, New York Mayor Michael Bloomberg outlined a plan to ban large-size sugary beverages sold at the city's restaurants, movie theaters, sports venues and street carts. Some states and cities are working on "soda taxes" on sugary drinks. And in recent years, major health groups have discouraged the consumption of large amounts of added sugars.

The motivation is clear: The USA is in a full-fledged state of hand-wringing about overweight Americans who are among the most obese in the world and are heavier than they've ever been before.

It's a battle being waged on a number of front lines: Schools are beefing up their offering of fruits and vegetables, food and beverage marketers are being strong-armed to change how they market to kids and trans fats have been squeezed out of most processed foods.

Increasingly, the focus is being placed on sugar, the sweetener with a history that goes back 8,000 years.

Is something so sweet really that harmful to health? Or is it just being maligned as people look for a scapegoat for the obesity epidemic?

The American Heart Association says in a statement that research has tied a high intake of added sugars to many poor health conditions, including obesity, high blood pressure, type 2 diabetes and other risk factors for heart disease and stroke.

Diabetes educators often advise people with diabetes and pre-diabetes to watch their sugar intake, especially their consumption of sugary beverages. Nutritionists have said for years that sugar represents empty calories with no nutritional value.

The consumption of added sugars, especially from sugar-sweetened beverages, among some people in the country "is out of control," says Rachel Johnson, a spokeswoman for the American Heart Association and a nutrition professor at the University of Vermont.

Americans adults consume an average of 22 teaspoons a day, or about 355 calories, from added sugars, Johnson says. Every teaspoon has 15 to 16 calories.

You don't remember adding 22 teaspoons of sugar to your coffee or cereal?

Consider that sugar is used in everything from cakes, candy and cookies to muffins, jams, chocolates and ice cream.

People are downing table sugar, brown sugar, high-fructose corn syrup (in soda), maple syrup, honey, molasses and other caloric sweeteners. Added sugars make their way into many prepared and processed foods and beverages, from soda, sweet tea and lemonade to energy drinks and sports drinks.

One 16-ounce serving of regular soda, the proposed NYC cap, contains the equivalent of at least 12 teaspoons of sugar, says Cynthia Sass, a registered dietitian in New York City. "Many of my clients don't realize how much hidden sugar creeps into their diet, even in foods that don't seem sweet, like salad dressing, soups and crackers."

Sugar is "toxic" in the amount it's consumed by Americans, says pediatric endocrinologist Rob Lustig, a professor of pediatrics at the University of California-San Francisco and one of the country's most vocal critics of added sugars.

A little bit is OK, but it's the quantity that people are consuming that's harmful, Lustig says. "Everyone knows the dose determines the poison. I agree with that. There is a threshold, and right now we are way above that threshold."

The heart association recommends that most American women consume no more than 6 teaspoons a day, about 100 calories, from added sugars, Johnson says. For men, it's 9 teaspoons or about 150 calories. Kids should limit their intake to about the same amount, she says.

Others say not so fast. Added sugars have been "unfairly demonized" by some researchers, and "the reality is much more complicated," says James Rippe, a cardiologist who studies nutrition and fitness. He's worked with the food industry, including the Corn Refiners Association, which represents companies that make high-fructose corn syrup and other corn products. "Obesity is a bad problem, but to single out one component of the diet as a silver bullet to fix it is fantasy.

"And it distracts us from the serious multifaceted national commitment that we must have to solve this enormous public health problem of obesity," he says.

Sugar doesn't deserve to take the rap for the country's weight problem, says Andy Briscoe, president and CEO of the Sugar Association. "Sugar has been around for thousands of years. It's all natural. It's 15 calories (a teaspoon). It has been used safely by consumers by our grandmothers and our grandmothers' grandmothers."

What the research says

Research about the effects of excessive intake of sugary foods and drinks is coming out all the time, and there's not much that's reassuring, says Marion Nestle, a nutrition professor at New York University and co-author of Why Calories Count: From Science to Politics.

Johnson says recent studies show a link between high consumption of sugar-sweetened beverages and high blood pressure. So no surprise that when researchers conducted a study of people who reduced that consumption, their blood pressure dropped.

People with diabetes or pre-diabetes are often advised to watch their sugar intake. "The first thing we tell people to do for the prevention or management of diabetes is to not drink sugar-sweetened beverages," says Stephanie Dunbar, director of clinical affairs for the American Diabetes Association.

When someone with diabetes drinks a large quantity of sugary beverage, they get a huge dose of sugar at one time, she says. It hits their system quickly, raising blood glucose levels, she says.

That's not healthy for anyone, especially someone with diabetes or pre-diabetes, because high blood glucose causes damage to blood vessels, increasing risk of complications such as heart attacks, amputations and blindness, she says.

There are many kinds of studies that show sugared beverage consumption is linked to increased risk of obesity and type 2 diabetes, says Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity. There are a few studies showing no links, mainly funded by the beverage industry, but these stand against study after study showing that these beverages are having harmful health consequences, he says.

Is sugar to blame?

Much of the fuss about sugar comes because of questions about its role in a nation that has become way too heavy.

Thirty-six percent of adults in this country are obese, which is roughly 30 or more pounds over a healthy weight. About a third of children are overweight or obese. Obesity increases the risk of many chronic diseases including type 2 diabetes, heart disease and cancer.

Is sugar to blame for our bulging waistlines?

Overall, calorie intake has gone up since 1970, and about 16% to 17% of people's total daily calories come from added sugars, according to the U.S. Department of Agriculture's Economic Research Service.

Sugar is just one reason for obesity, but for many people, it's the big reason, Nestle says. "Some overweight kids drink 1,000 to 2,000 calories a day from sodas alone, and sweet desserts are a major source of calories in American diets."

The most important health concern about sugar intake is that it adds calories to the diet, which can be a ticket to weight gain and obesity, agrees Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. "The calories we consume in beverages that contain sugar do not make us feel as full as when we eat the same amount of calories in solid food, so consuming large amounts of sugar-sweetened beverages or fruit juices can pack on the pounds."

Klein, an expert on fatty liver disease, says that when you gain weight, fat can accumulate in your liver and reduce the effectiveness of insulin, the hormone that regulates blood sugar. Extra body fat affects the liver, and your pancreas works harder to try to keep blood sugar normal.

Whether or not you're overweight, consuming high amounts of sugar can increase triglycerides (blood fats) and increase fat production in your liver, he says. Possible explanations: High amounts of fructose, found in both sugar and high fructose corn syrup, can cause chemical reactions in the liver that lead to health problems, he says.

For many people, reducing the consumption of high-sugar beverages is a good first step for maintaining a proper body weight and improving their health, Klein says.

When it comes to added sugars' impact on health, including the liver, Rippe says, "this is some of the most complex biochemistry you can ever imagine. The literature on this is very mixed."

As for sugar's impact on obesity, Rippe says, "Americans are eating about 425 calories a day more than they were in 1970, according to the government statistics, but only 9% of those increased calories come from added sugars."

Briscoe adds: Most foods and beverages add calories to the diet and can lead to weight gain and obesity if overconsumed, "so we do not feel sugar should be singled out. We need to look at total caloric intake in the fight against obesity."

The addiction question

Studies on food and addiction show that sugar works on the brain very much like classic substances of abuse, Yale's Brownell says. He has researched the topic for an upcoming book, Food and Addiction: A Comprehensive Handbook. "Sugar doesn't have as strong of an effect on the brain as heroin or cocaine, or even alcohol or nicotine, but the addiction still exists. Sugar activates the same reward pathways of the brain."

When you are really addicted to something, your willpower goes out the window, he says. "If a kid gets off of the bus everyday and has to have a soda, is his brain hijacked by sugar?

"The question is: Is sugar addictive enough to create a public health menace? And I think the answer is yes."

Rippe says this theory "is very controversial." Most of that food-addiction research is based on work on animal brains, and animal brains are much different than human brains, he says.

"When we eat any food, the reward pathways light up. That's why we eat, because it's pleasurable," he says. "The scientific literature on this is very mixed and very inconclusive."

Charles Baker, chief science officer for the Sugar Association, says, "The same brain reward pathways are set in motion by any food a person happens to like. Unraveling the intricacies of the crosstalk within the brain and between the brain and digestive tract during eating, is still an evolving body of science. Reward pathways are simply one part of a multi-part system."

A matter of degree

Even nutritionists have a bit of a sweet tooth and don't want to come down too hard on something so tasty. Consuming some sugar is OK for many people, they say. "Even the staunchest anti-sugar advocates say it's a matter of degree," Nestle says. "Nobody worries about 10% of calories or less from sugar. It's only when the amounts go over that problems kick in."

Johnson agrees: "Sugar is not the root of all dietary evil. A little bit of sugar adds to the taste of foods. But we've lost sight of moderation because of the gigantic portion sizes. You have to be so vigilant about portion sizes to avoid overconsuming.

"We have to be careful not to demonize one ingredient in the diet," she says. "We did that with fat, and it backfired because then low-fat products came on the market that were low in fat but high in sugar.

"It didn't lead people to an overall healthier diet which is one that is rich in fruits, vegetables, whole grains, non-fat dairy and lean protein."

Premier makes big connect with big data

CHARLOTTE, NC – The Premier healthcare alliance will connect more than 100,000 healthcare provides in what Premier calls the world’s largest healthcare community to share knowledge, data, best practices and decision support.

The alliance’s PremierConnect technology platform will make it possible for clinicians, supply chain leaders, hospital executives and other healthcare providers nationwide to connect as one in communities of common interest, officials say.

[See also: Premier to bring meaning to disparate data]

Premier, which describes itself as a performance improvement alliance, includes more than 2,600 U.S. hospitals and 84,000-plus other healthcare sites.

PremierConnect will connect data, knowledge and people in ways that support evolving care delivery models and accelerate the pace of performance improvement, say Premier officials. The virtual community allows alliance members to instantly share knowledge, data and strategies based on thousands of patient outcomes that can be used to benefit treatment anywhere, an ability that has been a missing link in care delivery to date.

"Health systems today need an integrated look into utilization, costs, efficiency and quality," said Michael D. Connelly, president and CEO of Catholic Health Partners. "With this information we can further build out the predictive capabilities that will help us find opportunities and enact corrective actions before they affect patients. This initiative is a critical foundational piece to our mission and the mission of the Premier alliance to improve the health of our communities."

[See also: Premier comparative effectiveness program seeking applicants]

PremierConnect supports new ways to deliver care that are required by health reform, including accountable care organizations (ACOs), which emphasize more clinical integration and healthier outcomes. Individual health systems can use it to connect care across all of their sites – hospitals, physician offices, outpatient clinics and more. These population analytic capabilities provide insight into how to manage populations for improved outcomes.

"Leaders of healthcare systems will be able to easily make data-driven, evidence-based decisions that improve performance while making their communities healthier places to live,” said Premier President and CEO Susan DeVore. “They'll know which patients are driving undesirable outcomes, which physicians have the highest costs or the poorest performance, and why these scenarios are occurring.

"Patients will have confidence that their care is based on proven innovations and best practices from top-performing clinical leaders nationwide," DeVore added. "And their providers will understand everything about their care – what drugs they're taking or allergic to, what procedures they've had recently and more."

PremierConnect will integrate Premier's clinical, financial and operational comparative databases, containing one in four patient admissions and close to $43 billion in annual purchasing data. This information is updated every 30 days to ensure it is current. It will also continuously integrate real-time electronic health record data from over 325 hospitals. Premier's quality, safety, labor and supply chain applications will be easily accessible in PremierConnect, helping providers make decisions based on a combination of quality, safety and cost information – not each individually.

"What we've built mirrors what we're trying to do in healthcare – build a system that is coordinated and integrated, where communication is dramatically improved and we aren't unnecessarily repeating work," said Keith J. Figlioli, Premier's senior vice president of healthcare informatics. "It will help eliminate unnecessary care that can compromise safety and add to already expensive bills for both consumers and health systems. It's a new, better approach to care delivery, with a truly efficient way to treat patients and keep people healthy."

PremierConnect is powered by IBM information management, business analytics, enterprise content management, social business, Rational, Tivoli and WebSphere software, as well as IBM Power Systems hardware to provide insights from vast amounts of data.

[See also: Premier develops industry IT standards for ACOs]

VA awards $4.9M contract to support open source tech

WASHINGTON – The Department of Veterans Affairs has awarded Ray Group International of Tampa, Fla., a $4.9 million contract to support the open source community that is contributing software code to the VA and Defense Department integrated electronic health record system.

RGI, a service-disabled veteran-owned small business that provides software engineering support services, will perform operations to continue the development and establishment of the Open Source Electronic Health Record Agent (OSEHRA) over the next six months, according to a June 21 announcement  in Federal Business Opportunities.

[See also: VA a good model for EHR systems and implementation]

With the contract in place, OSEHRA will be able to recruit necessary staff and deploy accounting capability and other business systems to ultimately make the OSEHRA software development community operationally self-sufficient, according to the notice. RGI will provide project management, analysis, configuration management and testing services. 

OSEHRA will enable federal agencies, industry and academia to contribute software code to create applications and tools for the iEHR, to improve and modernize VA's VistA electronic health record system, and eventually to certify code through testing.

DOD recently said thatit has contributed the software code of the theater version of its AHLTA clinical information system into the open source community. OSEHRA started with the VistA code.

[See also: VA and DoD interoperability program needs better management, GAO says]

The custodial agent for the open source community must approve software code for integration into the evolving VistA code base and interoperability of complimentary software.

Q&A: Be careful with your supplement regimen

So should you or shouldn't you take calcium and vitamin D supplements? Some recent developments may have left consumers confused.

The U.S. Preventive Services Task Force said Tuesday that healthy postmenopausal women should not take daily low doses of vitamin D and calcium to prevent bone fractures because they slightly increase risk for kidney stones. In its draft recommendation, the panel also said existing research is insufficient to assess the risks or benefits of taking vitamin D to prevent cancer.

A recent study found calcium supplements may raise some people's risk for heart attacks.

Yet for years, experts have touted both calcium and vitamin D as key nutrients for bone health.

The Institute of Medicine, which provides independent advice, recommends 600-800 international units (IU) of vitamin D daily and 700-1,300 milligrams of calcium, depending on your age.

Many foods are rich in calcium and fortified with vitamin D. Sunlight triggers production of vitamin D in the skin and is a major source.

But nutrition experts say many people still may need to fine-tune their diets to get enough.

Endocrinologist Bess Dawson-Hughes, director of the Bone Metabolism Laboratory at the USDA's Human Nutrition Research Center on Aging at Tufts University in Boston, answers questions about the new recommendations.

How much calcium?

Here are the current recommendations
for calcium intake based on age group,
in milligrams per day:

Children ages 1-3: 700

Children 4-8: 1,000

Adolescents 9-18: 1,300

All adults 19-50: 1,000

Men 51-70: 1,000

Women 51+: 1,200

Men 71+: 1,200

To get this amount of calcium in food, children and adults would need to consume at least three servings a day of calcium-rich foods such as low-fat milk, yogurt or fortified orange juice. Teens need four servings. A cup of milk has about 300 milligrams of calcium.

Source: Institute of Medicine,
USA TODAY research

Q: Why are calcium and vitamin D so critical?

A: They are both essential for the development and maintenance of healthy bones. Older people with adequate vitamin D levels have fewer falls than those with lower D levels. The U.S. Preventive Services Task Force said that.

Low levels of vitamin D have been associated with a range of chronic diseases, such as diabetes, hypertension, heart disease, some cancers, infections and autoimmune problems. These early findings warrant further investigation.

The National Institutes of Health is currently funding some very large trials to define the effects of vitamin D on the burden of many of these chronic diseases.

Q: Can people get enough vitamin D and calcium in their diets, or do they need to take supplements to meet the recommendations?

A: Many adults are not getting quite enough calcium in their diets. They have two choices. My first recommendation is to modify their food intake to include one more calcium-rich food a day. We have lots of foods to choose from, and calcium has been added to many foods, including orange juice and cereal.

If you can't get it through foods, then use supplements to bring your intake up to the 1,000 to 1,200 milligrams a day, the amount recommended for adults.

You need to get up into the recommended intake level of calcium, but there is no point in exceeding that level because there is no benefit. And there are potential risks, however low they might be, that there would be adverse consequences to exceeding those levels. So why spend more money and take more risks?

Vitamin D is more complicated, because we get it from sun exposure and from food. It's not easy to get 600 to 800 IU of vitamin D daily from food sources. You'd have to be eating a lot of wild salmon, and you'd have to do it every day. � If you're not getting any sun contribution, you are going to need a supplement.

Q: Is there is an increased risk of heart attack from taking calcium supplements?

A: I don't think we have a conclusive answer to that yet. There is certainly enough of a suggestion that high-dose calcium supplements may be detrimental. I recommend avoiding high-dose calcium supplement use, such as exceeding the institute recommendations for calcium by 500 to 1,000 milligrams a day.

People should use calcium supplements only as necessary to reach the institute requirements.

Q: If postmenopausal women are taking vitamin D and calcium supplements to prevent osteoporosis, do you think they should stop, based on this panel's advice?

A: You should estimate how much calcium and vitamin D you are getting through food, and if you are below the Institute of Medicine requirement, you should increase it with food if you can. If you can't, then you should take a supplement that fills in the gap.

Q: Any other advice?

A: We need to encourage food sources of calcium, vitamin D and all other nutrients. It's an old message, but it's timely again because we are getting a backlash on supplements.