SMOKINCHOICES (and other musings)

July 31, 2012

Food-illness still a threat

Food-illness fight isn’t being won

Rates held steady, CDC study shows


WASHINGTON — Little progress has been made in combating many types of food-borne illnesses in recent years, according to new federal data, an outcome that food-safety advocates say underscores the need to put into place the landmark food-safety bill signed by President Barack Obama more than a year ago.

The most-recent figures from the Centers for Disease Control and Prevention show that the rates of infections linked to four of five key pathogens it tracks — salmonella, vibrio, campylobacter and listeria — remained relatively steady or increased from 2007 through 2011. The exception is a strain of E. coli, which was tied to fewer illnesses in the same time frame.

The results frustrated consumer advocates, who, along with industry groups, pushed for passage of the Food Safety Modernization Act, which empowers the Food and Drug Administration to prevent food-borne illnesses instead of simply reacting to them. Obama signed the legislation in January 2011 after a string of food-borne outbreaks shook consumer confidence in the nation’s food supply.

But the administration has not met the deadlines for releasing draft rules needed to implement key provisions of the law, including one that would mandate that food imported into this country meet the same safety standards as food produced domestically.

  • “Everyone was hoping that this new food-safety law would be in place and we’d start seeing improvements by now,” said Erik Olson, a director at the Pew Health Group. “What these CDC numbers show is that, unless new protections are put into place, millions of Americans are going to continue to get sick from contaminated food.”

The data are based on infections diagnosed by 10 state laboratories.

(Why can’t someone find the time and just get the job done.    Why not enlist Michele?   She was a powerful woman who knew how to get things done, and I’ll bet she could put a little effort into something as important as this.

Either we have standards or we don’t.    And at present – – we don’t.   Jan))

OH’s Poorest left off ins.


State’s poorest could be left out


If Gov. John Kasich decides against expanding the state’s Medicaid program, more than 600,000 of the poorest Ohioans could remain without health insurance while those with slightly higher incomes would qualify for subsidies and tax credits to buy private coverage.

The potential gap was created last month when the U.S. Supreme Court, while upholding most of the federal health-care law, tossed a requirement that states expand Medicaid or face federal sanctions.

The health-care overhaul was designed to cover about half of uninsured Americans through Medicaid by expanding eligibility to those earning up to 138 percent of the federal poverty level — largely childless adults with incomes under $15,000 a year.

The rest would be required to purchase private coverage starting in 2014 — a mandate upheld by a majority of the justices — with subsidies and tax credits for those earning 100 to 400 percent of the poverty level.

That means those under the federal poverty level — in the absence of a Medicaid expansion — would get no state coverage and no help buying private insurance. In Ohio, an estimated 789,000 uninsured were to be covered through a Medicaid expansion, including 627,000 with incomes under the poverty level.

Kasich, like many governors, is on the fence, considering his options. (Not on the fence.  Kasich and Lt Gov Mary Taylor do NOT want to do this and have so stated.  State simply can’t afford it, they say.    Jan)

Although the federal government will pay expansion costs the first three years and at least 90 percent after that, the added expense down the road for states already struggling to pay budget-gobbling Medicaid tabs will be weighed against leaving the poorest without health insurance.  (So, the solution is. . . . ?  No one discusses that.  )

  • “If we don’t expand (Medicaid), those under the federal poverty level will not be able to utilize tax credits,” said Maureen Corcoran, former Ohio Medicaid director and president of Vorys Health Care Advisors in Columbus.

“The poorest will be shut out.”

With the national health-care debate showing no sign of letting up before November’s presidential election, Corcoran and other observers predict that most states won’t make a decision until afterward.

“You don’t have to do it by a certain date,” Corcoran said. “Over the next year or two, states will be re-evaluating their financial situations and deciding what they can or cannot do.”

The Kasich administration expects to decide in the coming months as it puts together a two-year state budget starting July 1, 2013.

“It’s not just about costs,” said Ohio Medicaid Director John McCarthy, noting that unlike several other states, Ohio did not rule out expanding Medicaid after the Supreme Court ruling.

“The governor is concerned about individuals below 100 percent of the federal poverty level,” McCarthy said. “We are going through and analyzing options now that this group is optional.”

Amy Rohling McGee, president of the Ohio Health Policy Institute, said states will have to weigh the cost against policy implications for the poor.

“Do we want to have this gap between the poorest and those who will be eligible for subsidies to purchase private coverage?” she asked.

There are also questions for federal regulators about possible alternatives for states to provide coverage to the “optional group,” McCarthy said. For instance, could states expand Medicaid for a smaller number and have others utilize subsidies offered through the exchange?

  • The debate comes as a new report found that fewer people died when states expanded their Medicaid programs. The study by the   New England Journal of Medicine found a 6 percent drop in the adult death rates in states that recently expanded coverage for the poor.

Uncertainty about a Medicaid expansion is also a concern for Ohio hospitals that provide more than $1 billion a year in services to those without insurance. Expanding Medicaid would mean less uncompensated care, although it also could come with an increase in the franchise tax they pay the state to help cover Medicaid costs.

The Ohio Hospital Association has not taken a position on expanding Medicaid but will discuss it at the board’s August meeting, said Mary Yost, a spokeswoman for the association.

The federal law aimed to make health insurance available to all Americans by 2014, when most will be required to have coverage or pay a fine.

Under the law, the federal government will cover 100 percent of Medicaid expansion costs in 2014–16. After that, the federal share would decrease. Ohio’s cost of expanding Medicaid would be nothing from 2014–16, but state officials project the state’s cost to be $457 million in 2017 and 2018, with the federal government picking up the rest.


July 30, 2012

Kids getting “Adult Problems”


Kids Developing “Adult Problems”

Overweight and obese children face high cholesterol and blood pressure and diabetes


It’s a sad truth that many of today’s children are carrying the health problems of the middle-aged. High cholesterol, high blood pressure and diabetes all are linked to the nation’s high rates of overweight and obese children. With that in mind, the National Heart, Lung and Blood Institute said late last year that all children should have cholesterol tests. Earlier advice was to screen children believed to be at high risk.

The new recommendation was met in some circles with cheers and in others with concern about the possibility that doctors would be quick to prescribe adult medications to children, not knowing what the long-term effects might be.

What everyone agrees on is that high cholesterol in children is a concern and one that has been under-recognized in the past.    And experts say that screening for it likely will open the door to more-productive conversations about lifestyle changes for youngsters facing a future that could include illness and early death.

Reversing high cholesterol before children reach their teen years or early adulthood is imperative, said Dr. Robert Murray, a professor of human nutrition at Ohio State University.

“Pediatric cardiologists have been beating this drum for a while,” he said. “The obesity epidemic has become a big enough problem that we should be screening 10-year-olds.”

  • The new advice, part of broader guidelines on reducing cardiovascular disease in children, says that everyone should undergo screening once between 9 and 11 years old and once between 17 and 21 years old. It also provides other advice to doctors caring for children with cholesterol problems.

High cholesterol can increase the risk of cardiovascular disease, including heart attacks and stroke. That risk increases the longer a person lives with the problem, said Dr. Ihouma Eneli, the medical director of Nationwide Children’s Hospital’s Center for Healthy Weight and Nutrition.

Some children are born with genetic abnormalities that lead to extremely high cholesterol that can cause early heart attack and even death. In those cases, medication can be necessary, said Dr. Peter Vande Kappelle, a pediatric cardiologist at Akron Children’s Hospital.

But in children who have high cholesterol because of poor diet and inactivity, lifestyle changes are usually enough, he said.

“It’s pretty easy to make a few changes if they’re drinking sodas every day and juices and eating fast food all the time,” he said. “And exercise is the best way to bring up your good cholesterol.”

An LDL (bad cholesterol) level of 110 or higher is a red flag in children, Vande Kappelle said. When looking at total cholesterol, more than 170 is considered high. Triglycerides should ideally be less than 100, he said.

  • About a quarter of overweight children and about 4 in 10 obese children have high cholesterol, according to one recent study, Vande Kappelle said.

“We really are missing a lot of kids with cholesterol problems,” said Dr. Bryan Ghiloni, who practices with the Mount Carmel Medical Group in New Albany. Routine screening will give doctors more opportunity to talk about weight loss and how it relates to medical problems, Ghiloni said.

Murray said he often counsels pediatricians that they should be careful when discussing weight with parents. Just telling them their children are obese or overweight is not particularly useful without explaining how this contributes to disease that might stick with the children throughout their lives, he said. A doctor with a cholesterol number on hand might well have an easier time conveying that information and find the child’s parents more receptive.

One challenge is that insurance rarely pays for nutritional counseling.

In Ghiloni’s office, a nurse works with families trying to improve their child’s health through lifestyle changes, he said. He has not prescribed statins, cholesterol-lowering medications usually used for adults, to children, he said, and is unlikely to do that except in extreme circumstances.

Little is known about the long-term effects of high cholesterol that starts in childhood because the problem has become pervasive only in recent decades. It’s clearly damaging, Eneli said, but some argue that not enough is known about how severe the risk is.

Many of those arguments come from experts worried that doctors will be too quick to prescribe medications to children. Eneli said there are clear recommendations about when to consider statins in children, and it shouldn’t happen often.


Water for ‘fracking,’ sure. . .

State may sell water for ‘fracking’


FRED SQUILLANTE DISPATCH    State officials are considering a plan that would let shale-oil drilling companies pay to take water from streams and reservoirs in state parks and forests.

Drilling companies’ growing thirst for water to “frack” Utica shale wells could soon be quenched in Ohio’s parks and forests.

  • Ohio Department of Natural Resources officials are weighing plans that would grant drillers access to state-held reservoirs, lakes and streams. For a price.

Agency records and emails obtained by The Dispatch show that officials have been discussing the issue since at least April. Natural Resources manages state parks and forests and regulates the drilling industry.

  • “Access to rivers: Can we charge and how much?” states one undated memo circulated among agency officials. “Access to scenic rivers: Can we do this?”

Drilling companies require use as much as 5 million gallons of water to frack a single shale well. The water is mixed with sand and chemicals, and is pumped underground to fracture the shale and free trapped oil and gas.    Companies can take water from Ohio streams and pay to draw water from privately owned ponds. Several companies have signed contracts with cities, paying them for access to drinking-water reservoirs.

  • The demand for water will grow. The state estimates that by the end of 2015, there will be 2,250 shale wells.

The use of public water for fracking is a growing issue across eastern Ohio. Environmental groups say that fracking could strain sources for drinking water, boating and wildlife.

  • “These streams and watercourses are our playgrounds and our drinking water,” said Cheryl Johncox, director of the Buckeye Forest Council. “I see this sell-off of our state resources as incredibly shortsighted.”
  • Those concerns led the Muskingum Watershed Conservancy District to announce on June 7 that it won’t sell water from six reservoirs until a water-availability study is completed.

Nine state parks and two forests that feature reservoirs, lakes or central streams are located within a 16-county region of eastern Ohio where shale drilling is the most active. Natural Resources officials looking to lease state lands for drilling named the area “Tier 1” because of the intense interest from energy companies.

Carlo LoParo, a Natural Resources spokesman, said the agency’s water plans are still being developed.    “Our goal is to develop a plan that will allow for the use of water if, based on a detailed analysis, withdrawal of that water does not cause a negative impact to navigation, recreation or wildlife,” LoParo said.

Records include a draft copy of a water-leasing policy dated April 16 that quotes a state law granting the authority to sell water from state-held lands when it is “advantageous.

  • Where reservoirs are concerned, the law bars sales that would hinder recreation or wildlife.

Officials also questioned how much money the state could make. “One company paid 1 penny per gallon or $10 per 1,000 gallons,” according to the undated memo.

Muskingum Watershed Conservancy officials have asked the U.S. Geological Survey for a study of its Atwood, Clendening and Leesville reservoirs.    Greg Koltun, a hydrologist in the Geological Survey’s Columbus office, said results should be available by the end of the year.    The survey will focus on water that’s discharged from each reservoir’s dam. Koltun said the analysis will subtract what’s needed to maintain drinking-water supplies and downstream wildlife to calculate the amount of “excess” water.

Lea Harper, a member of the Southeast Ohio Alliance to Save Our Water, questioned why conservancy districts would want to sell water. As many as a dozen oil and gas companies have asked to draw water from six district reservoirs.   “They should be working with us to help preserve and protect that water,” Harper said.

Darrin Lautenschleger, a conservancy district spokesman, said his agency includes industry among its “beneficial public uses” of water.

“Conservation involves the wise use of a natural resource, and that’s something we take very seriously,” he said.


Think Penn State gets it?

Penn State finally might gain perspective


In 1982, the president of the University of San Francisco, the Rev. John Lo Schiavo, suspended the university’s basketball team. The school had had a legendary basketball program — the great Bill Russell won two national championships as a player in the 1950s — but it had gotten out of control. Tutors were taking tests for players. Some were taking no-show jobs from boosters. The NCAA had twice put the university on probation.

By late 1981, as yet another scandal was erupting, Lo Schiavo had had enough.   He pulled the plug before the 1982 season. He said he did it because the basketball team didn’t reflect the values of the university. The school’s self-imposed “death penalty” lasted three seasons, and although USF was never again a basketball power, Lo Schiavo said he never regretted his decision. “We had to make the point,” he said years later, that “we intended to be good citizens.”

Early Monday, the day after Pennsylvania State University took down a statue of Joe Paterno that stood outside Beaver Stadium, the NCAA announced its sanctions against the school. For an organization that is usually as slow as molasses, it moved with astonishing speed; it was scarcely a week after the release of the Freeh report , which outlined in devastating detail the conspiracy at the top of Penn State that enabled Jerry Sandusky’s campaign of sexual abuse.  Perhaps it was motivated, as Mark Emmert, the NCAA president, claimed, by the unprecedented nature of the scandal.   Or perhaps it was because the organization needed to get this out of the way before the upcoming football season.

I had advocated that the NCAA impose the death penalty on Penn State, and that didn’t happen. I still think Penn State should stop playing football for a while — not so much to atone, but to remind its fans and its community that football had become too important at Penn State; that football had, in fact, corrupted Penn State. I wish Rodney Erickson, the Penn State president, were willing to follow Lo Schiavo’s footsteps.

But he’s not going to do that; even now, football remains too important in the Happy Valley. Nor, of course, did the NCAA impose the death penalty — Emmert claims it was, in part, because innocent bystanders would be hurt.   But that’s a silly excuse;   its sanctions invariably hurt players and others who have done nothing wrong. That is the nature of the beast.

Having said that, the sanctions were tougher than I thought they would be: a $60 million fine, a big reduction in athletic scholarships, a four-year postseason ban, a Soviet-style eradication of all victories since 1998, and more. Penn State players will be allowed to transfer to other schools without having to sit out a year. (Why every player at every school isn’t granted that basic right is a question for another day.)

On the one hand, the sanctions point to the degree to which the NCAA views college sports through the prism of money. The fine, Emmert said, was about equal to the annual revenue of the Penn State football team.The decision not to suspend football was, in part, a business decision — which only makes sense since college football is very big business. In effect, a moral transgression was being punished with economic sanctions . On the other hand, the sanctions ensure that Penn State will be awful for the foreseeable future. Its fans will have to find other things to do instead of investing their collective identity in Penn State football. That will be a useful discipline.

What was most galling about Emmert’s news conference was its sanctimony. He kept talking about the “values” that athletics was supposed to embody, about how college sports is supposed to be an integral part of academic life, and how it should never overwhelm the mission of the university. “Football will never again be placed ahead of educating, nurturing and protecting young people,” he said.

But at big-time sports schools, football always is placed ahead of everything else. The essential hypocrisy of college sports is that too many athletes are not real students — and no one cares. Coaches make millions and lose their jobs if they fail to win. Universities reap millions by filling stadiums and making attractive television deals. They serve as the minor leagues for the pros. Everybody knows this — including the NCAA. The notion that the Penn State case is going to change all of college sports is absurd. College football almost can’t help but corrode academic values. Nothing that happened Monday is going to change any of that.

Except, perhaps, at Penn State itself. Without question, the school has been shaken to its core by this scandal. It used to pretend it was better than other football programs. It can’t anymore. The combination of the scandal and the sanctions create, at least, the possibility that a school that once placed football above everything else may finally learn perspective.

Joe Nocera writes for The New York Times.

(I would love to comment, but the entire situation has been so painful and disturbing. . . .   .   what is there left to say?  All the abused boys,  I doubt there is much satisfaction for any of them – – some have all but been destroyed.  Then of course, the civil suits still yet to come.     Paterno, the sainted hero of the sport,  loved  and admired by so many, brought down and shamed for lack of  ethical, responsible behavior.  

Joe Nocera’s mind and shoulders are bigger and broader than mine – – glad he wrapped this up.  Jan)

July 28, 2012

Comm College – job portal

(This great story from Joe Nocera could outline the “leg-up” our young people are looking for to get the jobs they seek.    Jan)

Community colleges to the rescue


A man named Gerald Chertavian came by my office not long ago, and, by the time he left, I was filled with appreciation for the potential of community colleges to help stem the decline of the middle class. There are few more urgent tasks.

Chertavian runs a program, Year Up, which he founded, that makes it possible for poor high-school graduates to land good jobs. It does so, in part, by imparting important “soft skills” that members of the upper-middle-class take for granted, such as how to interact with colleagues in an office setting.

A second aspect of the program involves teaching marketable skills in such areas as computer support, say, or back-office work at financial firms. These are called middle-skill jobs; they require more than a high-school education but less than a four-year baccalaureate degree. Thirty years ago, said Chertavian, middle-skill jobs didn’t exist.    “There were jobs that required a college degree, and jobs that didn’t.    “Now,” he said, “up to a third of all jobs are middle-skill jobs.”

  • Almost universally, companies complain that they can’t find enough workers to fill those jobs.

As a result, Chertavian has had no trouble rounding up corporations such as General Electric and Bank of America to give internships to his charges; if all goes well — and it usually does — they wind up with a well-paying job. The entry-level pay can be as much as $40,000 a year.

The trouble with programs such as Chertavian’s is that they are akin to pebbles thrown in the ocean.  He has identified a sweet spot in the economy — matching motivated, but disadvantaged, young people with a genuine economic need. But Year Up, which operates in nine cities, can absorb only 1,400 students a year. What about the millions of others who don’t have access to such a program?

  • It was when I posed that question to Chertavian that he started talking about community colleges. He is a fierce believer in their transformative potential. All the students in Year Up also are required to be enrolled in a local community college, but, more recently, Chertavian has begun to affiliate more formally with community colleges. That would allow Year Up to reach many more students.

Most notably, it is about to begin operating at Miami Dade College, which has a staggering 174,000 students. Its president, Eduardo Padron, says that 90 percent of its students are minorities, 40 percent live in poverty and 60 percent require remedial education. Many are enrolled in four-year baccalaureate programs; although it remains primarily a community college, in recent years, it has begun offering four-year degrees. But most are not. They are looking to earn a certificate or an associate degree and acquire a skill that will lead to a good job.

“Community colleges are the great American invention in terms of education,” Padron said at a recent panel discussion I attended in Aspen, Colo. Their raison d’etre has always been to help grease the wheels of social mobility. But, in their earlier incarnation, they were primarily seen as a passageway to a university degree. Now with the skills gap such a pressing problem — and a high-school education so clearly inadequate for the modern economy — the task of teaching those skills is falling to community colleges.

Many state governments, unfortunately, have ravaged the budgets of their community-college systems, just as they have for many state university systems. In Florida, said Padron, community colleges have seen their state support drop by 21 percent in three years.

As a result, tuition at Miami Dade is $3,000 a year — a lot of money for people of little means.

In some states, such as Virginia and North Carolina, community colleges have become deeply connected with employers in the state. In others, they remain the stepchildren of the educational system. Graduation rates are low. Overcrowding is common.

“Yes, there are many institutions that need to do a much better job adapting to and connecting with labor markets,” Chertavian wrote in a follow-up email message to me.    But he remains hopeful.

  • “They are the mechanism that creates pathways to get young people into the economy,” he said.    Community colleges can be our salvation, if only we let them.

Joe Nocera writes for The New York Times

3rd Frontier stalled

Third Frontier stalled


FILE PHOTO    This small wind turbine at the Great Lakes Science Center is on the Lake Erie shore in Cleveland. A bid for $5 million in Ohio Third Frontier money to help create a wind farm in the lake was rejected.

Few investments approved as state retools it, reviews success measures

CLEVELAND —Supporters of Lake Erie windmills thought they offered the Third Frontier Commission an easy pitch to swing at.   They proposed raising several turbines off the coast of Cleveland and giving Ohio a foothold in a growing global industry, with the federal government picking up most of the tab.

They asked for $5 million to compete for a $50 million federal grant and get started on America’s first freshwater wind farm.

  • The commission denied the request with little explanation, to the dismay of many.

As some people questioned what the commission had against wind power, many more wondered what, if anything, the commission favors, and when it might start acting on its desires.

An initiative empowered to lead Ohio into new industries in the new economy appears to have lost its momentum and, some say, its sense of urgency. The program ended its fiscal year on June 30 having spent only about 20 percent of the $190 million available to invest in promising ideas and ventures. In a year of inaction, the nine-member commission endorsed few new ventures and did not make decisions on several key programs, including its commitment to entrepreneurship.

  • Former Ohio Gov. Bob Taft, who founded Ohio Third Frontier in 2002, said: “It’s hard to figure out what direction they’re taking it.”

Taft, who now teaches at the University of Dayton, said he worries that the administration of Gov. John Kasich, a fellow Republican, is impatient with a program designed to seed new, knowledge-based industries over time. “I hope it just doesn’t become a short-term business-attraction program,” Taft said. “That’s not what it was meant to be. It was designed to build up the Ohio economy through business-research partnerships.”

In 2006, Taft handed his creation over to Democratic Gov. Ted Strickland, who steered some Third Frontier money to other uses but left the program largely intact.

“I’m pleased it’s been sustained as long as it has been,” Taft said. “I just hope it doesn’t erode now.”

Leaders of the Kasich economic team insist that Third Frontier will not be allowed to erode on their watch. In fact, they say, they have been working behind the scenes to strengthen it with new strategies and programs.

“That has caused things to be put on hold, a bit of a pause, as they rolled out,” said Christiane Schmenk, director of the Ohio Department of Development and chairwoman of the Third Frontier Commission, which administers the program and distributes the money.

Schmenk said a critical review was overdue and should result in a more-efficient, cost-effective approach to job creation.

Still, it’s hard to fault skeptics who ask whether a year of opportunity has been lost.

Before the May 25 meeting, in which the pilot wind farm was one of the few investment prospects on a sparse agenda, the commission had not met with its advisory board of experts in nearly a year. The two bodies met again in June for the fiscal-year finale, where the commission left $150 million on the table.

The unspent millions will be rolled into the new year’s budget, and no money will be lost, Schmenk noted. But economic-development experts say there’s a cost to inaction, especially in the innovation economy.

Third Frontier money, generated by the sale of bonds, is largely intended to attract larger federal research grants and private investment.

  • The Cleveland software company OnShift illustrates the potential. After being awarded $800,000 in Third Frontier seed money in 2008, the startup attracted more than $7 million in private investment. Today, OnShift employs 42 in Cleveland and pays them an average of $79,000 a year.

“I firmly believe we really wouldn’t have a company without that assistance,” said chief executive Mark Woodka. “We had the software application, but we needed help to bring it to market.”

The Entrepreneurial Signature Program is one of the sharper arrows in the Third Frontier quiver. It steers tens of millions to regional economic-development agencies such as Cleveland’s JumpStart Inc. that offer money and guidance to entrepreneurs.

All the entrepreneurial groups claim to generate many new jobs, but skeptics question some of their numbers. Last year, commissioners gave the ESP program a two-year, $40 million budget. But they also resolved to evaluate the programs and the criteria used to judge success. That review continues, and none of the $40 million has been awarded.

At its June 22 meeting, the commission voted to continue funding its entrepreneur programs at previous levels through January, in hopes of reaching consensus at an upcoming staff retreat.

The skepticism and critical review are healthy for a $2 billion program, many say.

“Every couple of years, we need to do this, especially after a change in administrations,” said Tom Waltermire, the chief executive of the northeastern Ohio business-attraction group Team NEO and a member of Third Frontier’s 11-member advisory board.

But Waltermire and other advisers express frustration with the pace of the critique, a lack of direction from state leaders, and a paucity of funds awarded in a year when companies are trying to pull out of a devastating recession.

“The ambiguity causes some angst in our investment community,” said John Huston, the founder of Ohio TechAngels and an advisory-board member from the Columbus area.

  • “The joke on the street is that surely Ohioans are not doing this to fellow Ohioans. It must be saboteurs from Michigan or Pennsylvania,” Huston said. “The point is, by delaying putting out the money, what really happens is, we become less competitive against our contiguous states, who are our real competitors.”

(Jan’s Comment:

One must question this lack of direction from state leaders as stated above and the paucity of funds awarded in a year when companies are trying to pull out of a devastating recession.  From all corners of our country  Republican  leaders are decrying Obama’s leadership for not doing more  to help the economy turn around.    All blame is piled on President Obama and his lack of “understanding” in how the economy works – – what it takes to get things done.

Nobody is fooling anybody.  This article illustrates rather graphically what is holding things up.  No matter what, we can’t allow things to get better until we get that “undeserving miscreant” out of the oval office.  Who does he think he is anyway?

It appears that President Obama is perhaps one of the most exceptional presidents this country has ever had.  Because he is black, he has been far more scrutinized  – microscopically so, than any other.  He has been forced to develop a dexterity that even he probably didn’t know that he had in order to dodge the slings and arrows WHILE performing his duties and getting things done.   Yes, he got things done, even as he frustrated highly organized and gigantically financed efforts of the few of the one percent at the top of the financial Mt Olympus whose desire is not in any way concerned about the ninety-nine percent beneath them.

The vows of the Republican “ins” to abstain from tax increases for any reason, no matter what is, it seems to me,  a dereliction of duty for it has stopped our government from its full function and responsibility. But, make no mistake – – this is exactly what those who control Congress desire – – to cripple and shrink government There is no ability to run a government without compromise and full discussion – – this is owed to the people who elected them and is their job which they are refusing to do.    I believe all who refuse to take up issues, discuss and vote them up or down, deserve pink slips, if not now – then most certainly in November.

Our great masses suffer; have had so much taken away and our youth are being deprived of the futures they deserve.  At the same time, our wealthiest companies and families have prospered beyond any recorded numbers at any time  on this planet. Yet the “ins” want ever MORE with no regard for the plight of the disadvantaged.  This isn’t just UNFAIR, its insane.

From one citizen to another, please – – exert the effort it takes to make sure that all whom you know or are acquainted with is Okay to vote.   They have whatever papers they need,   have transportation to get there and are registered in their area.  This election is so very important.  This is the easy thing to do.     Flat-out “revolutions” are painful and messy.  So, lets head it off at the pass and keep things neat and tidy and civilized.        Jan

July 27, 2012

Poor seeking ER, not abusing

Poor aren’t misusing ER, study finds

Medicaid holders usually seek more than routine care

By Susan Heavey REUTERS
WASHINGTON — Most people covered by U.S. government health insurance for the poor visit hospital emergency rooms for perceived emergencies, not for routine care, much like those with private insurance, according to a study released yesterday.

Researchers said the study helps dispel the notion that poorer patients are clogging hospitals for routine treatment — for a bad cold, for example — that others received at a lower cost in a clinic or doctor’s office.

Patients on Medicaid the insurance program for low-income people financed by the federal and state governments — do visit emergency rooms at twice the rate of privately insured patients, said the study by the nonpartisan Center for Studying Health Systems, reflecting ongoing challenges in finding alternative care.

But, like others, they go for urgent complaints of injuries and potentially serious problems such as high fevers and breathing trouble, especially in children, the study said.

One in 10 Medicaid patients used an emergency room for non-urgent care, compared with about 1 in 14 for patients with insurance through their employer or purchased on their own, the study showed.

“If you picked a Medicaid recipient and a privately insured patient out of an (emergency department) waiting room and asked them both why they were there, the likelihood that they described symptoms we would call non-urgent is pretty similar,” said Emily Carrier, a researcher for the center.

The findings come shortly after the Supreme Court upheld President Barack Obama’s health-care overhaul but allowed states to opt out of the provision opening Medicaid up to more people.

Several governors already have refused to implement the law, including its Medicaid expansion. At the same time, some states are seeking ways to cut Medicaid costs, including discouraging unnecessary and costly emergency-room use in the face of ongoing budget crunches.

Researchers at the center combed government statistics from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics for 2008, the most-recent data available.

While some patients in emergency rooms initially reported serious symptoms, sometimes the diagnosis turned out to be minor, according to the study.

Among Medicaid patients 12 or younger, more than half of all visits were for injuries, serious breathing trouble, and common infections, the study said. Medicaid adults ages 18 to 64 also used the emergency room most for a range of ailments including digestive issues, mental disorders and injuries.

Our Foreign-policy Prez

Foreign-affairs record is pretty impressive


It won’t help him win many votes this year, but it should be noted that Barack Obama has been a good foreign-policy president.   He, Vice President Joe Biden, Secretary Hillary Clinton and the rest of his team have created a style of policy-making that is flexible, incremental and well-adapted to the specific circumstances of this moment.

Some eras call for bold doctrines, new global architecture and “Present at the Creation” moments. This is not one of those eras. Today, the world is like a cocktail party at which everybody is suffering from indigestion or some other internal ailment. People are interacting with each other, but they’re mostly focused on the godawful stuff going on inside. Europe has the euro mess. The Middle East has the Arab Spring. The U.S. has the economic stagnation and the debt. The Chinese have their perpetual growth and stability issues.

As a result, this is more of an age of anxiety than of straight-up conflict. Leaders are looking around warily at who might make their problems better and who might make them worse.

  • In this environment, you don’t need big, bold visionaries. You need leaders who will pay minute attention to the unique details and fleeting properties of each region’s specific circumstances. You need people who can improvise, shift and play it by ear. Obama, Clinton and the rest are well-suited to these sorts of tasks.

Obama has shown a good ability to combine a realist, power-politics mind-set with a warm appreciation of democracy and human rights. Early in his term, he responded poorly to the street marches in Tehran. But his administration has embraced a freedom agenda more aggressively since then, responding fairly well to the Arab Spring, rejecting those who wanted to stand by the collapsing dictatorships and using American power in a mostly successful humanitarian intervention in Libya.

Obama has also shown an impressive ability to learn along the way. He came into office trying to dialogue with dictators in Iran and North Korea. When that didn’t work, he learned his lesson and has been much more confrontational since. Early in his term, he tried nation-building in Afghanistan. When that, unfortunately, didn’t work, he scaled back that effort.

Obama has managed ambiguity well. This is most important in the case of China. When the Chinese military was overly aggressive, he stood up to China and reasserted America’s permanent presence in the Pacific. At the same time, it’s misleading to say there is a single China policy. There are myriad China policies on myriad fronts, some of which are confrontational and some of which are collaborative.

Obama also has dealt with uncertainty pretty well. No one knows what will happen if Israel or the U.S. strikes Iran’s nuclear facilities.   Confronted with that shroud of ignorance, Obama has properly pushed back the moment of decision-making for as long as possible, just in case anything positive turns up. This has meant performing a delicate dance — pressing Israelis to push back their timetable while, at the same time, embracing their goals. The period of delay may be ending, but it’s been useful so far.

Obama also has managed the tension between multilateral and unilateral action. No one can say he is hesitant to work with coalitions. Look at the Libyan action, or the Iranian sanctions. But when it comes to decimating al-Qaida, the U.S. has been quite willing to go it alone, continuing and expanding many policies of George W. Bush.

There have been failures on Obama’s watch, of course. Some of these flow from executive hubris. Obama believed that he could help resolve the Israeli-Palestinian dispute. He proceeded clumsily, pushed everybody into a corner and now peace is farther away than ever.

Some failures flow from excessive politicization. An inexcusable blunder by Obama was to announce the withdrawal date from Afghanistan at the same time he announced the surge into Afghanistan. That may have kept the Democratic base happy, but it sent thousands of soldiers and Marines on a mission that was doomed to fail.

  • Overall, though, the record is impressive. He has demonstrated that talk of American decline is hooey. The U.S. is still responsible for maintaining global order, for keeping people, goods and ideas moving freely.

And, partly as a result of his efforts, the world of foreign affairs is relatively uncontentious right now. Mitt Romney is having a great deal of trouble identifying profound disagreements. If that’s not a sign of success, I don’t know what is.

David Brooks writes for The New York Times.

July 26, 2012

Doc should decide on C-sections

There’s a good reason for C-sections


In regard to the Bloomberg News article in last Saturday’s Dispatch, “Moms urged to pass on C-sections,” I would like to add perspective from the point of view of a physician who has practiced obstetrics and gynecology for 40 years. (That works for me – Jan)

The perception is that too many cesarean sections are being performed.   In 1970, the percentage of C-sections in central Ohio was 18 percent of total deliveries.    Recently, the percentage has risen to 31 percent. This article implies that the large number of these procedures is related to early delivery for the “convenience” of physician or patient.

  • More than three years ago,  all central Ohio maternity facilities adopted stringent regulations disallowing inductions and repeat C-sections before 39 weeks in an effort to decrease the alarming rate. These mandates are followed nationwide. Unfortunately, we have not seen the decrease we expected in the C-section rate.
  • Now, let’s look at why the rates climbed from 18 percent to 31 percent. In 1970, we did not have ultrasounds or any form of electronic fetal monitoring. We had no way to determine the oxygenation of the fetal blood or ways to monitor the fetus’ behavior and well-being.

These procedures now are all available at every maternal hospital in central Ohio. They warn us of problems occurring with the fetus that necessitate aggressive management, oftentimes a C-section, before the fetus is permanently damaged.

  • The landscape of obstetrics has changed dramatically since 1970. We rarely encountered the problems that are commonplace today — problems such as massive obesity, insulin-dependent diabetes, large numbers of toxemia and hypertensive patients, epidemic numbers of drug abusers and patients infected with sexually transmitted diseases that could harm a fetus with a vaginal birth. This is why the rate has jumped to 31 percent.

(A Clear matter of Priorities, it seems to me – Jan)

  • As obstetricians, we are entrusted to deliver a healthy baby. The insurance industry is entrusted to maintain a profit margin and now feels empowered to do so through coming between the patient and her doctor by “urging moms to pass on sections.”

What will be next? Will we be encouraged to pass on cardiac stents, knee replacements, chemotherapy? Once we let the insurance industry (and the government) dictate our health care, the list will be endless.

(Jan’s Comment:

I felt compelled to run this article-response to the other post I had put up [cited by the doctor].    Dr Carbanna has made an excellent platform for letting a doctor do what doctors do best – – manage patient care, based on knowledge and training. Few would choose to argue with this.

There is no question that patient care belongs in the hands of competent medically trained professionals.  I very much appreciate all the valuable points Dr Caranna has made regarding this issue and his specialty.    But I do not admire the sarcasm expressed in the last paragraph – it is beneath him. Nor the inference that insurance profits will rule the day.  The new Health Care law mandates a set percentage which is allowed and agreed upon.  Health discussions should reflect what we face – not hype.

The medical community has been deficient in the extreme in not being advisory with the millions upon millions of ill-informed people across our nation who are pathetically digging their own graves with every bite-full of food.  Most of the problems cited above are so easily monitored and corrected with diet alone.  But then, there is the problem – – right.  Our doctors don’t really know or care enough to lead in this un-necessary dilemma.  The toxemia, the diabetes, hypertension – – all able to be handled if some knowledgeable doctor would show them how.    They need help with answers and how-to’s, not chemicals with side effects

As to the stents for the heart patients – they are a temporary  “fix” and don’t correct anything or save lives.  But proper, corrective consumption of organic foods (primarily plant food) could completely turn lives around by restoring health and productivity (ala Bill Clinton) .  As far as I’m concerned, joint replacement falls in the same category.  Diet can correct most of these unhealthy conditions.  With our austerities facing us, we must be willing to make choices that are affordable and not simply picking from a menu choice like a kid in a candy store just because some doctor says it is available.  We are in this together and must look at the whole picture.  There is always gonna be the bigger, the newer or so-called “better”.  But is it?

Every single one of us understands that medicine in our nation is beyond reach and disproportionately high in cost.  We have a major problem.  We must say no to many “extra’s” IF WE ARE EVER TO PULL OUT OF THIS MALAISE.   We must learn to say no.  And ordinary folks MUST learn the essentials of how to eat and live and be healthy;  to make appropriate choices and not to simply indulge those taste buds.

If doctors refuse to get with the program by teaching their patients the necessities of healthful diet and life choices, then they  too are carving out their own demise – – because others will, are able to step in and share the wealth of the right things to do to be healthy.  There are literally thousands of sources for people – – blogs,  books and honest to God doctors who actually care and are doing it. 

My point [sorry, I always get carried away] is that we all must try to be practical, efficient and of course – – selective in choice.  Not one of us, if we set our mind to it will fall into a hole of stupidity, ignorance and futility – – not if we set our foot on any path and start to move in the direction of wholeness and health – we can’t help but get to a better place.. . . just sayin’  . . .   Jan)

Next Page »

%d bloggers like this: