The “Feel the Love” Foreign Policy Debate

October 24, 2012

By Melissa Bynes Brooks

On Monday night, Gov. Romney endorsed several of President Obama’s foreign policies and agreed to do exactly what President Obama is doing now, only better, during the third presidential debate on foreign policy. Each candidate discussed ideas and strategies vis-à-vis existential national security issues, America’s role in the world, unrest in the Middle East, and international trade policies with China in the global economy.

According to a national survey by the Pew Research Center mostly based on telephone interviews conducted October 4-7, 2012, nearly six-in-ten Americans (57%) do not believe the changes in the Middle East will lead to lasting improvements for people living in the affected countries, up sharply from 43% in April 2011. And a majority of Americans (54%) continue to say it is more important to have stable governments in the Middle East, even if there is less democracy in the region. Just 30% say democratic governments are more important, even if there is less stability.

Both candidates displayed solidarity about standing with Israel if they are attacked. Their timeline was the same for U.S. troop withdrawals from Afghanistan in 2014. Gov. Romney supported the ongoing maintenance of an “as well as can be expected” relationship with Pakistan while endorsing the current use of strong economic sanctions against Iran, as well as the use of military drones to fight terrorism.

President Obama’s current military innovation policy entails a defense strategy that would expand the U.S. military presence in Asia while decreasing the overall size of the force as the Pentagon seeks to reduce spending by nearly half a trillion dollars after a decade of war, thus allowing for nation building here at home. Cyber warfare and unmanned drones would continue to grow in priority, countering attempts by China and Iran to block U.S. power projection capabilities in areas like the South China Sea and the Strait of Hormuz. The shift in focus to Asia is the result of increasing concerns at the Pentagon over China’s strategic goals as it begins to field a new generation of weapons that American officials fear are designed to prevent U.S. naval and air forces from projecting power into the Far East.

When it comes to China, 49% of Americans want the U.S. to get tougher with China on economic issues, compared with 42% who say it is more important to build a stronger relationship. In March 2011, the balance of opinion was the reverse: 53% said building a stronger relationship was more important while 40% advocated tougher policies.

Independents and Republicans now are much more supportive of getting tougher with China than they were a year and a half ago. Nearly half of independents (47%) now say it is more important to get tougher with China on economic issues, up from just 30% in March 2011. The percentage of Republicans favoring a tougher stance has increased by 11 points (from 54% to 65%) over this period.

There has been less change in opinions among Democrats, and more Democrats continue to prioritize building stronger economic relations with China (53%) over getting tough with China (39%).

This partisan divide is reflected in the vastly different views of Obama and Romney voters. By 51% to 42%, Obama voters favor building a stronger economic relationship with China. By contrast, Romney voters say it is more important to get tough with China on economic issues, by 67% to 26%.

In the book China’s Search for Security (Columbia University Press, 2012), authors Andrew Nathan and Andrew Scobell wrote that China is not going to rule the world unless the U.S. withdraws from it. China’s rise will be a threat to the United States and the world only if the United States allows it to become one. The right China strategy begins at home. The United States must resume robust growth, continue to support a globally preeminent higher education sector, and continue to discover new technologies. U.S. policy should protect intellectual property from espionage and theft, deepen trade relations with other economies, sustain military innovation and renewal, and nurture relationships with allies and other cooperating powers.

These ideals were underscored by President Obama during the debate.

 “If we don’t have the best education system in the world, if we don’t continue to put money into research and technology that will allow us to — to create great businesses here in the United States, that’s how we lose the competition,” said President Obama.

Now, as a case in point, the U.S. consumes nearly 20 million barrels of oil each day, and nearly half of that oil is imported. Domestic biofuels are one way to reduce our dependence on imported oil and increase our nation’s energy security. In 2009, with transformational and breakthrough technologies in mind, President Obama launched the Energy Department’s Advanced Research Projects Agency-Energy (ARPA-E). ARPA-E selections seeks out technologies that are too risky for private sector investment while focusing on accelerating innovations in clean technology while advancing breakthroughs in biofuels, thermal storage, grid controls, and solar power electronics, increasing America’s competitiveness in rare earth alternatives.

The ARPA-E’s Electrofuels program has the potential to create liquid transportation fuels that are cost competitive with traditional gasoline-based fuels and 10 times more efficient than existing biofuels thus impacting:

• Security: Cost-competitive Electrofuels would help reduce U.S. dependence on imported oil and increase the nation’s energy security.
• Environment: Widespread use of Electrofuels would help limit greenhouse gas emissions and reduce demands for land, water, and fertilizer traditionally required to produce biofuels.
• Economy: A domestic Electrofuels industry could contribute tens of billions of dollars to the nation’s economy. Widespread use of Electrofuels could also help stabilize gasoline prices—saving drivers money at the pump.
• Jobs: Electrofuels could create jobs in fuel production, distribution, and sales.

 

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

 

The Rx for Reducing Pharmacy Compounding Risks

October 16, 2012

By Melissa Bynes Brooks

According to the International Academy of Compounding Pharmacists (IACP), the compounding industry now makes up an estimated 1 to 3 percent of the U.S. prescription market, which is $300 billion overall.

The Food and Drug Administration (FDA) is aware of a number of product quality problems associated with compounded drugs including contamination, poor compounding processes, and product toxicity. Unlike commercial drug manufacturers, pharmacies aren’t required to report adverse events associated with compounded drugs. Recent deaths from fungal meningitis associated with epidural steroid injections on or outside the outermost membrane covering the spinal cord to relieve back pain have shined a light on the regulation or lack thereof, of pharmacy compounding.

Clinical meningitis is defined as having one or more symptoms (e.g., headache, fever, stiff neck, or photophobia-sensitivity to light) and cerebral spinal fluid (CSF) pleocytosis (more than five white blood cells per µL or microliter), adjusting for the presence of red blood cells, regardless of CSF protein and glucose levels.

On September 18, 2012, the Tennessee Department of Health was alerted by a clinician regarding a patient with culture-confirmed Aspergillus fumigatus meningitis diagnosed 46 days after an epidural steroid injection at a Tennessee ambulatory surgical center. An additional eight patients with clinically diagnosed, culture-negative meningitis were later identified.

Patients had received one or more epidural steroid injections used to treat both peripheral joint and back pain from three lots of single-dose vials (17,676 single vials) with preservative-free methylprednisolone acetate solution (MPA), compounded at New England Compounding Center (NECC) in Framingham, Massachusetts. On October 4, 2012, the Centers for Disease Control (CDC) and FDA recommended that all health care professionals cease use and remove from their pharmaceutical inventory any product produced by NECC.

The states below received injections:

California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia.

As of October 16, a multistate investigation led by CDC in collaboration with state and local health departments and the FDA have identified 233 cases and 15 deaths associated with this outbreak in 10 states, with 14,000 persons potentially exposed to medications from NECC.

Four categories of cases in patients who received an injection with MPA produced by NECC have been identified:

1) Fungal meningitis or nonbacterial and non-viral meningitis of subacute (recent) onset following epidural injection on or after May 21.

2) Basilar stroke following epidural injection on or after May 21, in a person from whom no cerebrospinal fluid (CSF) specimen was obtained.

3) Spinal osteomyelitis (inflammation of bone and bone marrow) or epidural abscess (pus-filled cavity) at the site of injection following epidural or sacroiliac injection on or after May 21.

4) Septic (infectious) arthritis or osteomyelitis of a peripheral (near the surface) joint (e.g., knee) diagnosed following injection of that joint on or after May 21.

What is pharmacy compounding?

Pharmacy compounding involves combining, mixing, or altering ingredients to create a customized medication. This is carried out by a state licensed pharmacist. It may involve taking an approved drug substance and making a new medicine when a traditional approved drug is not available to meet the medical needs of a specific patient as prescribed by a physician, veterinarian, or other prescribing practitioner. For these patients, customized medications are the only way to better health. For example, this may involve making a suspension or suppository dosage form for a child or elderly patient who has difficulty swallowing a tablet or a capsule. There is an increased need for pharmacy compounding due to drug shortages and the need to access drugs or dosage forms that have been withdrawn from the market.

Because traditional pharmacy compounding serves an important public health function, the FDA exercises enforcement discretion to allow legitimate forms of pharmacy compounding that is regulated under state laws governing the practice of pharmacy. Therefore, all pharmacies and pharmacists are licensed and strictly regulated at the state level.

How does pharmacy compounding increase safety risks in the public healthcare system?

Although state boards are constantly updating their standards and regulations, the safety and effectiveness of compounded drugs is not proven or established by supporting data which the FDA requires for approving new drugs. Compounded drugs are considered to be unapproved new drugs by the FDA. It is estimated that one fifth of all prescriptions written for FDA-approved drugs are for uses, for which they were not specifically approved.

One caveat is that the risk of obtaining a product of less than desired quality outweighs the benefits of obtaining a compounded drug. Other issues include large-scale drug manufacturing under the deceptive appearance of pharmacy compounding; compounding products containing an active ingredient not approved by the FDA; copying compounded products for economic gains; and selling products removed from the market by the FDA for safety reasons.

Similar circumstances no doubt contributed to the observed fungal contaminated steroid shots made by NECC and confirmed by FDA direct microscopic examination of foreign matter taken from a sealed vial.

More than 200 adverse events involving 71 compounded products since 1990 have occurred resulting in devastating consequences. For example, three patients died of infections stemming from contaminated compounded solutions that are used to paralyze the heart during open-heart surgery. The FDA issued a warning letter in March 2006 to the firm that compounded the solutions.

On October 8, 2012, Senator Richard Blumenthal (D-Conn.) called for stronger federal oversight of pharmacy compounding which manufactures drugs without a patient prescription in a letter to the commissioner of the FDA.

In the meantime, the public healthcare system would be better served if compounding guidelines set forth in the United States Pharmacopeial Convention (USP) were implemented by all pharmacy compounding companies. The USP is a scientific nonprofit organization that sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the United States by the Food and Drug Administration, and these standards are developed and relied upon in more than 140 countries.

Validation from the independent Pharmacy Compounding Accreditation Board (PCAB) represents another gold standard benchmark. PCAB offers accreditation to compounding pharmacies that meet nationally accepted quality assurance, quality control, and quality improvement standards. When choosing a compounding pharmacy, PCAB suggests looking for the designation “PCAB Accredited® compounding pharmacy” or the PCAB Seal.

The PCAB evaluation includes:

• An assessment of the pharmacy’s system for assuring and maintaining staff competency.
• A review of facilities and equipment.
• Review of records and procedures required to prepare quality compounded medications.
• Verification that the pharmacy uses ingredients from FDA registered and or licensed sources.
• Review of the pharmacy’s program for testing compounded preparations.

The New England Compounding Center (NECC), the company supplying the epidural steroid injections which resulted in the fungal meningitis outbreak, was not accredited by PCAB.

Follow on Twitter @Mlbbrooks

Obamacare + 7.8%: Can Obama Recapture the Race at Debate #2

October 10, 2012

By Melissa Bynes Brooks

A decreased unemployment rate to 7.8 percent in September is the perfect backdrop for underscoring President Obama’s credibility and record during the second presidential debate on October 16, 2012. This will be another opportunity for President Obama to passionately state why his model for governing is the best investment in the long term sustainability in the future of America. The success of his polices may be measured by what they have accomplished in terms of growing the economy, creating jobs, supporting small businesses, providing affordable healthcare, and improving government efficiency.

Before President Obama took office, the economy was losing 800,000 jobs a month. Since then, there have been 31 consecutive months of job growth and 5.2 million new private sector jobs.

Current conditions point to a potential US manufacturing renewal: Industrial output has been slowly rising over the last three years. The US remains one of the world’s largest and most attractive marketplaces: Sales of autos and durable goods are up; factory orders have increased; and the housing market is improving, lifting related construction and retail sectors. The American Auto Industry is thriving again.

The US still boasts the most skilled, highly trained workforce in the world. To maintain that edge, government policies and private initiatives are being implemented. In summer 2011, the Obama administration outlined the expansion of an industry-led worker-training program, Skills for America’s Future, intended to improve partnerships with community colleges and create easier-to-understand, uniform job-training requirement standards for prospective manufacturing employees. They also launched the Advanced Manufacturing Partnership (AMP), an initiative to provide more than $500 million to encourage investments in promising technologies. The plan’s objective was to partner with industry to create high-quality, good-paying jobs for American workers.

On September 16, 2011, President Obama signed into law one of the most significant legislative reforms to the patent system in our Nation’s history. The America Invents Act  was passed with the President’s strong leadership last year, after nearly a decade of effort. A year later, the U.S. Patent and Trademark Office is implementing the legislation in a manner that makes it easier for American entrepreneurs and businesses to bring their inventions to the marketplace sooner, converting their ideas into new products and new jobs while avoiding costly delays and unnecessary litigation, letting them focus instead on innovation and job creation.

Outlays for Social Security and the major federal health care programs are projected to total 12.2 percent of GDP in 2020 under the alternative fiscal scenario, compared with an average of 7.3 percent over the past 40 years, placing increasing pressure on the federal budget. Obamacare reduces costs, manages risks, and improves efficiency in the healthcare delivery system. Contributing factors include a transition from a fee for services payment model to a bundle payment model, incentives for insurance providers and hospitals geared towards pay for performance and quality over quantity, and incentives for the use of health information technology which reduces medical errors. The estimated amount of deficit reduction under Obamacare will be $5 billion. Starting in 2014, insurance companies can no longer reject people with pre-existing conditions.

If Gov. Romney repeals Obamacare, he will add $109 billion to the federal budget deficits over the next 10 years and an estimated 60 million nonelderly people would be uninsured. His current plan would cover pre-existing conditions for people who had health insurance and continue to purchase it, as long as there’s no interruption in coverage of more than 63 days.

The Medicare Program is solvent for a period of 8 more years because President Obama cut $716 billion in wasteful spending from the fee-for-service sector (other than physicians’ services). Payment rates were set up in Medicare Advantage to provide low-income beneficiaries with a sufficient choice of plans without incurring a premium liability. There are reduced Medicare Disproportionate Share Hospital for state DSH payments which are more than the hospital’s eligible uncompensated care costs. Gov. Romney’s promise to restore $716 billion of wasteful spending back into the Medicare program is not congruent with his promise to decrease the federal deficit.

Who should bear the burden of proposed changes in spending cuts and tax increases?

A national survey by the Pew Research Center for the People & the Press, conducted July 12-15 shows the public supports President Obama on the issue of fairness and tax policies.  By two-to-one (44% to 22%), the public says that raising taxes on incomes above $250,000 would help the economy rather than hurt it, while 24% say this would not make a difference. Moreover, an identical percentage (44%) says a tax increase on higher incomes would make the tax system fairer, while just 21% say it would make the system less fair.

SCOTUS is also relevant to the fairness issue. The Supreme Court’s Impact on the 2012 Presidential Election, conducted on behalf of civil rights groups by Hart Research Associates, found that more than half of the 1,007 people surveyed online in late August, 54 percent, believe that the current Court majority “tends to side with corporations” as opposed to individuals. Thirty-six percent said the Court had struck a balance, and just 10 percent believe the Court favors individuals. Between the two candidates, 46 percent swing voters polled said they have “a great deal” or “a fair amount” of confidence that Obama would nominate good federal judges and Supreme Court justices if he wins. Only 35 percent of those swing voters said the same about Romney.

It is the role of government to ensure that organizations observe relevant laws and act ethically. Organizations must be legally, socially, and environmentally responsible. It is illegal to mislead consumers who purchase goods and services.

In February 2012, the Obama Administration oversaw the largest consumer financial protection bipartisan settlement in US history which provides $25 billion in relief to distressed mortgage borrowers. The historic joint state-federal settlement was with the country’s five largest mortgage servicers who routinely signed foreclosure related documents outside the presence of a notary public and without knowing whether the facts they contained were correct.  Both practices violate the law.  The mortgage servicers were Ally/GMAC, Bank of America, Citi, JPMorgan Chase, and Wells Fargo.

On January 29, 2009, President Obama signed the Lilly Ledbetter  Fair Pay Act of 2009 (“Act”).The Equal Pay Act requires that men and women in the same workplace be given equal pay for equal work. Compensation discrimination on the basis of race, color, religion, sex, national origin, age, or disability is illegal.

For the next debate, President Obama must ensure that voters understand and arrive at an implicit understanding of the role of government and public policy which can guide coordinated and measured change towards a stable outcome when the invisible hand fails to restore equilibrium.

There are no quick fixes.

 

Book Reference

Dixit, A. K. and Nalebuff, B. J. (2008). The Art of Strategy: A Game Theorist’s Guide to Success in Business and Life. New York, NY: W. W. Norton, Inc.

 

Is Getting too Little Sleep Making You Sick?

Fall 2012

http://www.browardhealthmagazine.com/BHMagOnline/index.html?page=12

REFERENCES

Centers for Disease Control and Prevention (2012). Adult Obesity Facts. Retrieved August 28, 2012, from
http://www.cdc.gov/obesity/data/adult.html

Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008). STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

Institute of Medicine. Sleep disorders and sleep deprivation: An unmet public health problem. 2006. Washington, D.C.: National Academies Press;

Jean-Philippe Chaput*, Jean-Pierre Després*,†, Claude Bouchard‡ and Angelo Tremblay* Short Sleep Duration is Associated with Reduced Leptin Levels and Increased Adiposity: Results from the Québec Family Study. Obesity (2007) 15, 253–261; doi:10.1038/oby.2007.512

Kryger MH: Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2000; 2:39–47

Lack of Sleep Found to be a New Risk Factor for Aggressive Breast Cancers (2012). Retrieved August 28, 2012, from
http://www.msnbc.msn.com/id/48802740/ns/local_news-peoria_il/

Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20: 392–8.

Sushmita Pamidi, Kristen Wroblewski, Josiane Broussard, Andrew Day, Erin C. Hanlon, Varghese Abraham, and Esra Tasali. Obstructive Sleep Apnea in Young Lean Men: Impact on insulin sensitivity and secretion Diabetes Care published ahead of print August 21, 2012, doi:10.2337/dc12-0841

Walters AS; Silvestri R; Zucconi M; Chandrashekariah R; Konofal E. Review of the Possible Relationship and Hypothetical Links Between Attention Deficit Hyperactivity Disorder (ADHD) and the Sim- ple Sleep Related Movement Disorders, Parasomnias, Hypersomnias, and Circadian Rhythm Disorders. J Clin Sleep Med 2008;4(6):591-600.

76% Say It’s Jobs But Millennials Are By No Means Provincial

August 26, 2012

By Melissa Bynes Brooks

Millennial voters are at a crossroads laden with a series of economic, social, and cultural issues to consider as they contemplate whether to vote for President Obama or Mitt Romney on Election Day.

More than three-quarters (76%) say jobs and unemployment represent critical issues facing the country according to a 2012 Millennial Values Survey conducted jointly by Public Religion Research Institute and Georgetown University’s Berkley Center for Religion, Peace, and World Affairs. Even though young people have been impacted the most during the recession, they remain the most optimistic about the recovery of the economy which has added jobs in a slower than desired pace.

From April to July 2012, the number of employed youth 16 to 24 years old rose 2.1 million to 19.5 million, the U.S. Bureau of Labor Statistics reported in August. This year, the share of young people employed in July was 50.2 percent. The number of unemployed youth in July 2012 was 4.0 million, a slight decrease from 4.1 million a year ago. The youth unemployment rate was 17.1 percent in July 2012. The unemployment rate for young men was 17.9 percent, in July 2012, and the rate for women was 16.2 percent. The jobless rate for whites was 14.9 percent, compared with 28.6 percent for blacks, 14.4 percent for Asians, and 18.5 percent for Hispanics.

The impact of past events on present circumstances has never been more apparent. Approximately 7.5 million jobs were lost in the eighteen months from the beginning of 2008 through the middle of 2009. This period was fully shaped by the Bush economic agenda. The takeaway, this is the same agenda Mitt Romney and Paul Ryan are campaigning on. Romney-Ryan would like to reinstate the same tax cuts and deregulation policies that resulted in the economic crisis. Romney-Ryan would also cut spending on roads, highways, and other physical infrastructure which would lower output in ways similar to the effects of cuts in private capital investment.

Over the most recent 18 months of the Obama administration, approximately 2.8 million jobs have been added. The average monthly job loss before President Obama’s policies took effect was 417,000. Over the last year-and-a-half, the average monthly job gain has been 155,000. When Congress failed to pass the American Jobs Act, President Obama announced a new initiative called Summer Jobs+ in January 2012. The Federal government and private sector came together to commit to creating nearly 180,000 employment opportunities for low-income youth in the summer of 2012, with a goal of reaching 250,000 employment opportunities by the start of summer. At least 100,000 were for placements in paid jobs and internships.

A majority of Milennials report that education (54%) is another critical issue facing the nation.  President Obama signed an overhaul of the student loan program into law, increased funding for Pell Grants and allowed for direct student loans while preventing student loan interest rates from doubling. The American Recovery and Reinvestment Act invested heavily in education both as a way to provide jobs and lay the foundation for long-term prosperity. The Act provides $5 billion in competitive funds to spur innovation and chart ambitious reform to close the achievement gap and includes over $30 billion addressing college affordability and improving access to higher education.

Mitt Romney proposes tightening eligibility requirements for federal student financial aid and decreased funding for Pell grants. This may present a problem for lower income families by limiting their access to affordable higher education. He also opposes gainful employment regulations which help to prevent students from increasing their student debt while working towards degrees issued by sub-par schools. According to the Congressional Budget Office (CBO), Paul Ryan’s budget plan to cut federal spending for education such as loans or grants may lower productivity by reducing people skills.

Only 1-in-5 Milennials think social issues like abortion (22%) or same-sex marriage (22%) are critical issues. 53% think abortion should be legal, 43% do not, while 35% don’t know. One point of consideration is that the next president of the United States may have an opportunity to nominate a Supreme Court justice. This will be of particular interest for voters with concerns regarding women’s reproductive rights and the future of Roe v Wade. In 1973 the United States Supreme Court ruled that a right of privacy was protected by the Fourteenth Amendment under the Constitution and guaranteed a woman’s right to have an abortion under certain circumstances. Voters will determine whether to elect Obama- Biden who supports a woman’s right to choose or to elect Romney- Ryan, a team at odds on the issue. Romney opposes abortion with an exception for cases of rape, incest and risk to the mother’s life while Ryan objects to abortion in all circumstances except when the mother’s life is at risk. Paul Ryan, if he’s vice president, will literally be a heartbeat away from being the president so this makes his perspective relevant.

Access to affordable and preventive healthcare is important. Millennials broadly favored proposals that all Americans have insurance, that the government provides help for those unable to afford it, and supported a government health insurance plan to compete with private plans. A Pew Research Center poll taken via landlines and cellphones on September 22 through October 4, 2011 reflected that 56% of Millennials do not feel the government is doing enough for elderly Americans. They also feel more should be done to reduce the gap between the rich and the poor.

Millenials have an innate sense for tolerance and treating others fairly irrespective of class, race, gender, or sexual orientation and are more racially and ethnically diverse. Only 59% are white non-Hispanic. They are more open-minded than previous generations, suggests an analysis of studies by the Center for Information and Research on Civic Learning and Engagement, part of the University of Maryland’s School of Public Policy. They are also more inclined to support President Obama’s position of prosecutorial discretion when confronting illegal immigration and agree that the Defense of Marriage Act (DOMA) is unconstitutional. This generation is by no means provincial and there will be consequences, whatever the presidential choice.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

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Medicare and Obamacare: The Numbers Square

August 19, 2012

By Melissa Bynes Brooks

Despite the massive media hype portraying President Obama as being fiscally irresponsible, he has improved the solvency of the Medicare Program for beneficiaries while saving tax payers billions of dollars. He has also invested in the American people by expanding health care coverage for millions who are uninsured. The Affordable Care Act (ACA) has been a contributing factor to the Medicare program’s sustainability and enhanced financial outlook, albeit for a period of 8 more years. The Medicare debate is currently front and center in the upcoming presidential election. A  PEW Research Center poll conducted among registered voters in April 2012 shows that 74 percent of Americans rank health care as the fourth most important issue to their vote.

Output has exceeded input in the Social Security and Medicare trust funds. In 2011, 36 percent of federal spending was for Medicare and Social Security. The trend for rising costs is expected to continue due to the aging population of the baby boom generation coupled with decreasing population numbers in subsequent generations. According to the U.S. Census Bureau, life expectancy  has increased and people 90 and older now comprise 4.7 percent of the older population of people that are age 65 and older. This has increased from 2.8 percent in 1980 and is projected to be 10 percent in 2050.

Medicare’s costs under the Trustees’ current-law assumptions rise from their current level of 3.7 percent of GDP to 6.0 percent in 2040 and 6.7 percent in 2085. If the Sustainable Growth Rate (SGR) restraint were overridden, Medicare costs would rise to 6.5 percent of GDP in 2040 and 7.8 percent in 2085. Under the full scenario, in which adherence to the ACA cost-saving measures also erodes, costs would rise to 7.0 percent of GDP in 2040 and 10.3 percent in 2085. The SGR system compares the accumulated amount of actual physician- related spending to a specified target level.

The Affordable Care Act decreases Medicare spending in the following ways:

• It permanently reduces Medicare payment updates for most categories of providers by the increase in economy-wide multifactor productivity. “Multifactor productivity” is a measure of real output per combined unit of labor and capital, reflecting the contributions of all factors of production. There are reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services) which will decrease Medicare spending by $415 billion. Physicians’ services are based on a fee schedule, which reflects the relative level of time and effort required for each service and its relative complexity. Relative factors per service are translated into dollar payment amounts through a conversion factor, which is updated each calendar year based on the SGR. Medicare payment rates for physician services are scheduled to be reduced by approximately 31 percent in 2013.
• The ACA Reduces Medicare Advantage payment benchmarks and permanently extends the authority to adjust for coding intensity. A new mechanism for setting payment rates in the Medicare Advantage program will decrease Medicare spending by $156 billion. A Medicare Advantage Plan is a type of health plan offered by a private company that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Premium subsidy amounts will be calculated for low-income beneficiaries to help ensure that the premium subsidy in each Part D region, provides low-income beneficiaries with a sufficient choice of plans for which they would incur no premium liability.
• The ACA Reduces Medicare Disproportionate Share Hospital (DSH) payments and refines imaging payments. DSH adjustment payments provide additional help to those hospitals that serve a significantly disproportionate number of low-income patients. States receive an annual DSH allotment to cover the costs of DSH hospitals that provide care which is not paid by other payers, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or other health insurance. Federal Financial Participation (FFP) is limited and is not available for state DSH payments that are more than the hospital’s eligible uncompensated care cost. Unnecessary DSH spending will be decreased by $56 billion.

The estimated amount of deficit reduction from penalty payments and other effects on tax revenues under the ACA will be $5 billion.

Under Mitt Romney’s and Paul Ryan’s Medicare Plan, the CBO estimates that costs for senior citizens could increase by as much as $6,000.00 a year. Low-income beneficiaries who are not eligible for both Medicare and Medicaid would receive a medical savings account (MSA). This account will be used to pay premiums, co-pays, and other out-of-pocket costs. Low-income seniors would be offered the same range of plan options offered to other seniors. Whether they will be able to afford it is another issue since eligibility levels for low income beneficiaries are unspecified. Additionally, there are no price controls for out of pocket expenses for the coverage of essential benefits and unspecified prescription drug coverage. The specificities have not been clarified and senior citizens have expressed their concerns regarding the information provided or lack thereof.

“Our plan is very simple.  Which is, that for people 55 years of age and older there’s no change,” said Mitt Romney during an interview with ABC Green Bay affiliate, WBAY . “The only change I’d mention is we’d restore the $817 billion President Obama took out of the Medicare trust fund.  We’d restore it to Medicare.” 

I beg to differ. 

Mitt Romney’s plan to repeal Obamacare will be much more complicated. Several of the Medicare benefits and payments enacted by ACA will not be able to be retroactively adjusted. There are negotiated contracted payment rates and subsidized benefits in the Medicare Advantage program and the Part D prescription drug program. Likewise the Internal Revenue Service may not be able to collect revenues retroactively; relevant to provisions that have already been provided as new or increased tax benefits. If Mitt Romney repeals Obamacare, he will contribute to increasing federal budget deficits by $109 billion over the 2013–2022 periods. 

Clearly, Mitt Romney’s plan for healthcare is to transfer its ownership, finances, and accountability from the public sector to private enterprises. Read the fine print. The Romney- Ryan policies have the potential to fail to protect the poorest and most vulnerable citizens from social-economic injustices. Nothing happens by coincidence and efforts may be underway at this very moment, to promote their agenda by silencing the voices of those who will be impacted the most, with voter suppression laws. 

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

 

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“Obamacare: Win-Win for the Economy”

August 1, 2012

By Melissa Bynes Brooks

Theoretically, the cost of healthcare should decrease as the demand for products and services increase because the healthcare industry is the exception to the “basic economic” model of supply and demand. It is more complex. Health insurance costs are lower when larger groups of people are involved in the consumer pool thus increasing demand and lessening the costs of unhealthy or risky individuals with healthy or less risky individuals.

Despite looming promises of repeal by Republicans, the Affordable Care Act (ACA) is an essential component for cost containment and strengthening of the U.S. economy. This is especially true when 17 percent of the nation’s GDP is spent on health care with a GDP growth rate of only 1.5 percent.

Further analysis by the CBO, after the Supreme Court ruled that the ACA is constitutional, indicates that repealing the law would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, adding $109 billion to federal budget deficits over that period. Additionally, an estimated 60 million nonelderly people would be uninsured.

Regulatory requirements have not eluded corporate leaders currently brainstorming and investing in new strategies and innovative technologies to position their companies for competition in a market place projected to expand health insurance coverage, to an estimated 14 million people by 2014, and 30 million people by the latter part of the coming decade.

Business mergers are forming between companies directly impacted by the ACA.

In early July, the first major health care sector merger occurred when health care giant WellPoint said it will buy Amerigroup, a managed health care company with 4.5 million customers of state sponsored health care programs, for $4.9 billion or $92 a share in cash.

“We believe that this combination will create an industry leader in the government sector serving Medicaid and Medicare enrollees,” said WellPoint CEO Angela Braly in a statement. Braly added that the merger, which focuses on Medicaid recipients like the poor and the elderly, is an opportunity to “position our companies for future growth as the health insurance industry changes and as we prepare for health insurance exchanges.”

Amerigroup shares increased 40 percent, to over $89.84 a share following news of the merger. WellPoint shares increased 3 percent, to $61.64 a share. Shares for both companies had decreased in value after the Supreme Court decision in June.

The ACA presents broad economies of scale for health information technology (HIT) companies specializing in the provision of secure platforms for accessing and sharing patient data through the installation of electronic health records (EHR), telemedicine, and mobile health applications. 88 percent of physicians said they would like their patients to track their health information and 40 percent of individuals said they would buy a personal health-monitoring device or pay for a monthly subscription to send health information to their providers.

Authentidate Holding Corp. provides secure web-based software applications and telehealth products and services that enable healthcare organizations to coordinate care for patients and enhance related administrative and clinical workflows.

Their alliance with hospitals, physicians, and consumers generated revenues for the quarter ending on March 31, 2012 of approximately $764,000, compared to $729,000 for the prior year period. Revenues were mostly from telehealth products and services. For the third quarter of fiscal year 2012, revenues increased approximately 16 percent compared to the second quarter of fiscal year 2012, due to higher telehealth revenues for the current period.

There are an estimated 5.9 billion mobile-cellular subscriptions. Mobile-broadband subscriptions have grown 45 percent annually over the last four years. PwC estimates the U.S. mHealth market opportunities will be $6.5 billion by 2017, for remote mobile-enabled services used to monitor symptoms and manage chronic conditions like high blood pressure and diabetes. Growth is expected to be driven in part by the ACA objectives of providing cost effective preventative care.

Administration of the U.S. health system alone accounts for 7 percent of total spending. ACA has established regulations to rein in costs. Health insurance providers are now required to decrease administrative costs. They must spend 80 to 85 percent of premium dollars on medical care and health care quality improvement or they will be required to provide rebates to their customers. This year an estimated nine million Americans may be eligible for rebates worth up to $1.4 billion.

There are reimbursement incentives for hospitals and healthcare providers busy implementing certified EHR technology to meet the Centers for Medicare & Medicaid Services’ (CMS) and Office of the National Coordinator’s (ONC) requirements for meaningful use by 2015. Health systems will see a decrease in their Medicare and Medicaid reimbursements if they are not able to demonstrate meaningful use relevant to e-prescribing, the electronic exchange of health information to improve quality care, and the submission of clinical quality and other measures.

Love it or hate it, the Affordable Care Act appears to be a win-win for the economy and healthcare industry stakeholders consisting of consumers, health systems, providers, and technology business enterprises.

“When you eliminate the impossible whatever remains however improbable must be the truth!”

-Sir Arthur Conan Doyle, Scottish author and creator of Sherlock Holmes.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

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