Health - Florida Legislators Pass H.M.O. Plan for Medicaid |
- Florida Legislators Pass H.M.O. Plan for Medicaid
- Diagnosis: The Weakness That Wouldn’t Go Away
- Celebrating a Death: Ugly, Maybe, but Only Human
- Urban Athlete: Hop, Skip and a Jump to Fitness
- G.O.P. Rethinking Bid to Overhaul Medicare Rules
- Well: Going Crackers for Homemade Crackers
| Florida Legislators Pass H.M.O. Plan for Medicaid Posted: 06 May 2011 11:48 PM PDT MIAMI — In a sweeping overhaul of its $21 billion Medicaid program, the Florida Legislature approved a bill Friday to shift nearly three million Medicaid recipients into managed-care programs in the hope of saving money and improving services. “Medicaid has grown faster than any other part of our budget,” said State Senator Joe Negron, Republican of Stuart, who took the lead on the bill. “It is crowding out funding for education, economic development and other parts of the budget that are equally important.” If signed into law as expected, the bill will make Florida, with one of the largest number of Medicaid patients and a high rate of uninsured, one of the biggest states to jump almost entirely from a traditional Medicaid payment system into managed care. The wholesale shift would begin in July 2012. The bill, a compromise between the House and the Senate versions, would allow the state to decide how much to spend on Medicaid each year, share in the profits of managed-care companies if they exceed 5 percent and penalize networks that reneged on contracts. To help ensure better care for patients, the bill would also require plans to include specialists and provide higher reimbursement rates to doctors. Patients would be charged $10 monthly premiums and $100 if they showed up at the emergency room with a non-emergency. The state and managed-care companies would control which services to provide to Medicaid patients. In so doing, the legislation would do away with the existing fee-for-service system, in which the state pays providers for each service, a practice that has led to widespread fraud and inconsistent care. Reimbursement rates have dropped so low that many doctors choose not to treat Medicaid patients. The Legislature’s bill seeks to remedy those issues with the requirement that plans include specialists and the higher reimbursement rates to doctors. Another sweetener for doctors and hospitals is a provision that limits the amount they would have to pay out in malpractice damages for pain and suffering to $300,000 for each Medicaid claimant, unless the damages award is punitive. Senator Negron said the cap was appropriate because doctors who treat Medicaid patients are basically providing a public service and should be encouraged to do so. But Democrats said it would be unreasonable to charge poor patients fees and unjust to treat them differently in malpractice cases. “Why is it that their pain and suffering is devalued?” asked State Senator Arthenia L. Joyner, a Democrat of Tampa. Gov. Rick Scott, a wealthy former health care executive who made revamping Medicaid a priority, supports the legislation, which is projected to save $1.1 billion in its first year. But the proposed law cannot go into effect without the approval of the federal government, which pays more than half of Florida’s Medicaid tab. Last month, the federal government advised legislators to choose the payment system that would guarantee that a percentage of the money, in this case 90 percent, would go to patient services. Instead, the Legislature chose the other option: to share profits with managed-care companies. But Senator Negron said he was not worried. “We have given the federal government a hundred good reasons to approve our plan,” he said. “I think they will work with us because they have the same economic pressures that we have.” Democrats and patient advocates said that they worried profit would get in the way of care and that some people would not be able to pay premiums. They expressed alarm that the bill is based on a five-year-old pilot program in five Florida counties that had decidedly mixed results. At least seven managed-care companies pulled out of the program in Broward County, and many patients — most of whom are low-income children or pregnant women — fled to networks run by hospitals. Managed care is not new to Florida. About 60 percent of Medicaid patients are in some form of managed care but, outside of the pilot program, they must receive a mandated minimum level of benefits. The Medicaid overhaul also extends into long-term care. Nursing home residents would shift into managed care, but the bill provides a separate provision for them. Payments would go directly to the nursing homes, bypassing managed-care companies, so money would not be deducted for administrative fees. Savings would come by shifting more people into home- and community-based programs. Developmentally disabled people would be exempt from the managed care system for now. And each of the 11 managed-care regions in Florida would have to include a network run by a hospital or doctors. Those networks could continue to use the traditional payment system for three more years. Those who already have insurance and are eligible for Medicaid would receive a voucher from the state to apply to their policies. |
| Diagnosis: The Weakness That Wouldn’t Go Away Posted: 06 May 2011 06:57 AM PDT SYMPTOMS Related
THE EXAM Possible Diagnoses: Heart disease can manifest as weakness and fatigue, particularly in the elderly. The patient was referred to a cardiologist. An elevated white-blood-cell count was detected during the bleeding episode. She was sent to a hematologist. RESULTS ANOTHER SYMPTOM IN THE HOSPITAL A psychiatrist diagnosed hypomania and started the patient on several medications to stabilize her mood. The patient complained of severe weakness, which made minor chores difficult. A neurologist performed nerve-conduction tests, which revealed damage in the region where the nerves meet the muscle. He suggested that the injury might be a postviral neuropathy, an unusual reaction to a recent infection. He told her it should improve with time. The specialist sent her to physical therapy, but the weakness persisted. ADDITIONAL SYMPTOMS READERS’ RESPONSES Many readers thought there could be something wrong with her diet. Katherine of Cambridge, Mass., suggested that she might have a niacin (vitamin B3) deficiency, which could cause what doctors refer to as the four D’s: diarrhea, dermatitis (rash), dementia and death: “Could it be pellagra?” Patrick H. worried about the lack of a different B vitamin: “I will take a stab and go with B12 deficiency.” Iron and vitamin C were also among the suspects. Amy of Ohio read up on the patient’s symptoms: “I just learned that high iron deposits can decrease insulin secretion, and that, in turn, would elevate her glucose levels. . . . My diagnosis: iron poisoning.” Others focused on the timing of this illness. Diana of Long Island, N.Y., offered: “I’m going to go out on a limb here and say it may be due to chronic stress. It was mentioned that the patient just lost her mother, and she was her primary caregiver. Having helped my mother with my grandmother (who has Alzheimer’s), I know that stress can cause very odd symptoms and do major damage to the body.” Josie of St. Louis suggested: “[Her] mother’s death triggered depression, also eliminated need for treatment with high-blood-pressure medicine. Unneeded blood-pressure medicine aggravated psychosis and caused bleeding and skin spots.” The first correct answer came 54 minutes after the case was posted online. Elizabeth Neary, a pediatrician from Madison, Wisc., wrote, “Sounds like Cushing’s syndrome. . . . Rash looks like ecchymoses [bruises] — personality changes are common, as is weakness and edema.” By the time the answer was posted the next morning, 18 readers had nailed the diagnosis and five others were on the verge. The most commonly cited wrong diagnosis was porphyria — a group of inherited diseases that usually present with a combination of abdominal pain, psychiatric symptoms and skin findings. It was a thoughtful suggestion, although porphyrias usually show themselves by early adulthood. FINAL DIAGNOSIS
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| Celebrating a Death: Ugly, Maybe, but Only Human Posted: 07 May 2011 06:10 AM PDT Some Americans celebrated the killing of Osama bin Laden loudly, with chanting and frat-party revelry in the streets. Others were appalled — not by the killing, but by the celebrations. Stephen Crowley/The New York TimesCrowds celebrated early Monday outside of the White House after the announcement of Osama bin Laden's death. More Photos » MultimediaRelated
Joshua Bright for The New York TimesA crowd member dressed as Captain America joined the celebration at the World Trade Center site in New York early Monday morning. More Photos » “It was appropriate to go after Bin Laden, just to try to cut the head off that serpent, but I don’t think it’s decent to celebrate a killing like that,” said George Horwitz, a retired meat cutter and Army veteran in Bynum, N.C. Others were much more critical. “The worst kind of jingoistic hubris,” a University of Virginia student wrote in the college newspaper, The Cavalier Daily. In blogs and online forums, some people asked: Doesn’t taking revenge and glorying in it make us look just like the terrorists? The answer is no, social scientists say: it makes us look like human beings. In an array of research, both inside laboratories and out in the world, psychologists have shown that the appetite for revenge is a sensitive measure of how a society perceives both the seriousness of a crime and any larger threat that its perpetrator may pose. Revenge is most satisfying when there are strong reasons for exacting it, both practical and emotional. “Revenge evolved as a deterrent, to impose a cost on people who threaten a community and to reach into the heads of others who may be contemplating similar behavior,” said Michael McCullough, a psychologist at the University of Miami and author of “Beyond Revenge: The Evolution of the Forgiveness Instinct” (Jossey-Bass, 2008). “In that sense it is a very natural response.” Many of the sources of the joyous outburst were obvious: A clear victory after so many drawn-out conflicts. A demonstration of American competence, and of consequences delivered. The public relations value of delivering a public blow to a worldwide terror network. And, it needs to be said, the timing: The news hit just as many bars were starting to clear out for the night. But this was much more than a simple excuse to party. “Pure existential release,” said Tom Pyszczynski, a social psychologist at the University of Colorado at Colorado Springs, who has studied reactions to 9/11. “Whether or not the killing makes any difference in the effectiveness of Al Qaeda hardly matters; defeating an enemy who threatens your worldview, the very values you believe are most protective, is the quickest way to calm existential anxiety.” After almost 10 years, the end was nothing if not final. “The emotions were so strong, I think, because the event was compacted: Bin Laden was found and killed, and it was done — done and over, just like that,” said Kevin Carlsmith, a social psychologist at Colgate University and the Center for Advanced Study in the Behavioral Sciences at Stanford. “We’re so used to people being brought in, held at Guantánamo, the trials, the appeals; it feels like justice is never done.” As a rule, people are far more forgiving than they might guess, studies find. After most betrayals, like being dumped by a love interest or insulted, the urge for revenge erodes around the same rate that certain memories do: sharply in the first few weeks, and much more slowly afterward. The same kind of pattern can follow even physical assaults, depending on the circumstances and the personality of the victim. “The intensity of the emotion falls off precipitously, simply because the body can’t carry such a giant load of outrage and function very well,” Dr. McCullough said. But the urge for payback — especially for a crime like the Sept. 11, 2001, attacks, which killed almost 3,000 civilians — never goes to zero. “There is a stubborn part of the memory that hangs on to the urge, to a little piece of it,” and the pain is refreshed every time the memory is recalled, Dr. McCullough said. It is easy to forget how much fear was in the air after the 9/11 attacks: the anthrax mailings, the airport lines, the color-coded terror alerts. Many of those celebrating late on Sunday and early Monday were teenagers during those years, young people who have lived much of their lives under the threat of terrorism — and this terrorist in particular — and who had the time and energy to hit the streets and share the moment. “For them this was a chance to be a part of history,” Dr. Pyszczynski said. In a long series of studies, psychologists have shown that when people are reminded that they will one day die, they fixate on attributes they consider central to their self worth. Those who are religious become more so; those who value strength or physical attractiveness intensify their focus on these qualities; and people generally become more patriotic, more supportive of aggressive military action. “Even subtle reminders of 9/11 have the same effect,” Dr. Pyszczynski said. The sight of Bin Laden’s face on television or a smartphone news feed might have been enough to move people from the sidelines into the streets, to cheer for the home team. Finally, people everywhere have a strong belief in “just desserts” punishment. In a 2002 study, psychologists at Princeton University had more than 1,000 participants evaluate specific crimes and give sentencing recommendations for each. The subjects carefully tailored each recommended sentence to the details of the infraction, its brutality and the record of the perpetrator. The drive to enforce those sentences varies widely from person to person. But in a crowd of like-minded people, the most intense drives for justice become the norm: People who may have felt a mix of emotions in response to the news can be swept up in the general revelry. Thus the natural urge for revenge — satisfied so suddenly, releasing a decade of background anxiety, stoked by peers — feeds on itself. Delight turns to chanting turns to climbing on lamp posts. |
| Urban Athlete: Hop, Skip and a Jump to Fitness Posted: 05 May 2011 11:30 PM PDT MY wedding day almost nine years ago was one of the most joyous days of my life. Gaining 15 pounds two years into the marital journey, however, was less than thrilling. Through a friend, I heard about Exude Fitness, a company in New York City that helps clients lose weight by jumping rope. Desperate to remove the evidence of too many overindulgent, albeit romantic meals, I scheduled a session with the company’s founder, Edward Jackowski. Blog ArtsBeatThe latest on the arts, coverage of live events, critical reviews, multimedia extravaganzas and much more. Join the discussion. In a few meetings he showed me how to skip rope properly and created a workout that I could do on my own. I started with a basic jump, two feet at a time, and eventually graduated to fancier moves. It turned out that a child’s idea of playground fun could be an effective fitness tool for an adult: after two months of jumping several times a week, I was lighter than I had been before my wedding. Mr. Jackowski, who also wrote the book “Jump Into Fitness,” describes jumping rope as an intensive cardiovascular workout that has one-fifth the impact on the back and the knees as running and burns more calories in less time. “Jumping rope for 10 minutes at 150 turns per minute is equal to 30 minutes of running between six and seven miles per hour,” he said. Exude offers one-on-one sessions at your home or at one of its eight locations in the city, but there are other places to jump in a group setting. Aerospace, a boutique gym in the meatpacking district, incorporates ropes in many of its classes, including boxing and sculpting. It also has a dedicated class called Aerojump offered in 30- and 60-minute sessions. Classes start with two-foot jumps and progress to jumping jacks, arm crossovers, forward and back steps, jumping on one foot and making double turns that require exercisers to jump up and spin the rope twice before landing. The only short breaks involve the use of light weights for upper- and lower-body work. Classes, for 10 to 15 participants, take place in a spacious room. Michael Olajide, the former boxer who teaches the classes, said that skippers of all levels were welcome and that there was no pressure to do every move. “It’s natural to start slow and take breaks,” he said. “But eventually you will build up your endurance enough to be able to do the whole class.” Jeremy Abelson, a 30-year-old from the West Village who works in finance, said that he had been attending twice a week for the past two years and that the program had transformed his body. “I lost more than 15 pounds right away and went from undefined abs to an eight-pack,” he said. The Sports Center at Chelsea Piers offers two rope-heavy classes for aspiring jumpers: the hourlong Interval Box intersperses five to seven skipping sets with boxing moves, like punching in different directions, and the 30-minute High Velocity features constant skipping with stops for a few exercises for the arms, abs and legs. The instructor of both, Pamela Carton, said that she blared house music and turned out the lights to simulate the feeling of a nightclub. Those touches make the workout less painful, said Dana Morgenstern, 32, a fashion designer who lives in Chelsea. “The time goes by so fast that I don’t realize how hard I’ve worked until it’s over,” she said. As for me, I still swear by my plastic purple jump rope. It helped me slim down seven years ago and has even inspired my husband, Mahir, to start skipping. After all, we want to add years to our marriage, not pounds to our frames. |
| G.O.P. Rethinking Bid to Overhaul Medicare Rules Posted: 06 May 2011 05:22 PM PDT WASHINGTON — House Republicans signaled Thursday that they were backing away from the centerpiece of their budget plan — a proposal to overhaul Medicare — in a decision that underscored both the difficulties and political perils of addressing the nation’s long-term fiscal problems. Stephen Crowley/The New York TimesVice President Joseph R. Biden Jr. has been representing the administration in the talks with Republicans and Democrats. Related
Related in Opinion
Blogs The CaucusThe latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. Stephen Crowley/The New York TimesSenator Jon Kyl leaving Blair House after the budget talks. While top Republicans insisted that they remained committed to the Medicare initiative, which had become the target of intense attacks by Democrats and liberal groups in recent weeks, the lawmaker who would have to turn the proposal into legislation said he had no plans to do so any time soon. The lawmaker, Representative Dave Camp, Republican of Michigan and chairman of the Ways and Means Committee, said that while he still supports the party’s Medicare approach, opposition from Democrats made it pointless to proceed. “I’m not interested in talking about whether the House is going to pass a bill that the Senate shows no interest in,” Mr. Camp said in an appearance at the National Press Club. “I’m not interested in laying down more markers. I am interested in solutions.” Coupled with remarks by other House Republican leaders, his statement suggested that the party’s Medicare proposal had been shelved, even though the party’s lawmakers had taken a risky vote to pass the budget in the House just last month, and in the past two weeks had attempted to sell it to constituents in often-stormy town hall meetings. Republicans suggested that they would continue to press to rein in the growing costs of Medicare, even if not through the current proposal, which would transform the program into one in which the federal government subsidized the purchase of private health insurance coverage by Americans 65 and older. Putting aside the proposal would remove one of the biggest points of contention between the parties as they address both the nation’s long-term budget problems and the more immediate need for an agreement on raising the federal debt limit. The development came as Vice President Joseph R. Biden Jr. held a first negotiating session with members of both parties to try to find a deal that would allow Congress to raise the debt ceiling this year. Republicans are demanding spending cuts and other measures to reduce the budget deficit as the price of support for raising the debt ceiling. The Republican Medicare plan was never likely to be adopted as part of any deal on the debt limit. But the decision by Republicans to pull back the proposal was a tacit acknowledgment that the politics of entitlement reform remain so volatile that pressing ahead in the face of intense Democratic opposition could cost the party dearly at the polls. As they rolled out their budget last month, Republicans hailed the Medicare plan as a bold attempt to address chronic deficits. All but four House Republicans voted for the budget proposal, which was developed by Representative Paul D. Ryan of Wisconsin, chairman of the House Budget Committee. President Obama and Congressional Democrats quickly went on the attack, condemning the Republican plan. Mr. Camp’s statement on Medicare was in sync with similar comments by other top Republicans, including Representatives Eric Cantor of Virginia, the majority leader, and Mr. Ryan. They said Republicans recognized that they were unlikely to win approval of their sweeping Medicare overhaul in the debt-reduction talks that began at Blair House on Thursday. “The reality is this president has excoriated our budget plan and the Medicare proposal in the plan,” Mr. Cantor told reporters. The negotiators, who agreed to meet next on Tuesday, are combing their respective budget proposals to find common ground. But given the parties’ differences and the short time frame for negotiations before Congress must increase the debt limit, both sides have indicated that any compromise is likely to be based less on specific policy changes than on proposals setting deficit-reduction targets for coming years. Those targets would be combined with triggers to make automatic cuts in spending — and tax increases, in Democrats’ view — if the targets are exceeded. While Mr. Cantor outlined the House-passed Ryan budget as Republicans’ opening bid in the Blair House negotiations, he said little about the Medicare proposals, participants said. “He didn’t need to talk about it in that room,” said one participant. “Everyone knows it’s dead.” Still, the leadership comments surprised many Republican lawmakers, who said they had expected to move forward on the plan. Some members — especially freshmen from districts with steep re-election hills to scale — were upset to hear that the plan could be scotched after they had voted for the budget proposal and then invested so much hard work trying to sell it back home over the spring recess. “I would be very disappointed if we didn’t follow through,” said Representative Joe Walsh, whose district lies in the Chicago suburbs. “We have spent, gosh, a month or two now trying to educate the American people to a pretty good reception. I appreciate the chairman’s notion, but I would continue to respectfully challenge him to get this thing through committee.” Representative Bobby Schilling of Illinois said backing down now would be giving in “to lies and deceit told by the other side.” “We’ve just got to address this problem,” he said. “Is it going to be perfect? No, but it needs to be addressed.” The House speaker, John A. Boehner, said Thursday that the party was not backing away from the Medicare overhaul. But he said Mr. Camp’s view was a recognition of the “political realities that we face.” Democrats said it did not matter if Republicans decided to jettison their Medicare plan because they had already voted for it as part of the budget. “The Republicans are slowly realizing their plan to privatize Medicare is a political disaster,” said Senator Charles E. Schumer of New York, the No. 3 Democrat. “But until they renounce their vote for it, they are still going to own it.” Mr. Ryan said he believed the future of the Medicare proposal would be decided in next year’s elections. “At the end of the day, I think 2012 is going to make the decision,” Mr. Ryan said at a budget forum Thursday, predicting voters would back the plan he said protects Medicare from insolvency. “The people are ahead of the political class.” |
| Well: Going Crackers for Homemade Crackers Posted: 06 May 2011 12:24 PM PDT |
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