A report found that LSU Interim Public Hospital found that per-patient costs are far above national standards, the nursing staff is top-heavy with administrators, operating rooms are under-used, and purchasing services are poorly managed.

BATON ROUGE -- The Interim LSU Public Hospital "lacks a broad vision and remains in a post-Katrina reactionary mode," according to a report that also found numerous management inefficiencies that add up to $66 million a year.

Among other things, the report found that per-patient costs are far above national standards, the nursing staff is top-heavy with administrators, operating rooms are under-used and purchasing services are poorly managed.

The conclusions are contained in a 161-page assessment by Alvarez & Marsal, the consulting firm that was brought on board in January to oversee the hospital's day-to-day operations and search for efficiencies.

If all the report's recommendations were to be implemented, the hospital could reduce costs by $66 million next year and take in $6.7 million in new revenue, for a total impact of $72 million, the report said.

LSU provided the March 23 report, along with a 27-page summary of the findings, to The Times-Picayune on Sunday in response to a public records request.

The report comes as the Senate prepares to start work on the $27 billion state budget, which includes $25 million in cuts to the seven LSU charity hospitals operated by the Health Care Services Division. Dr. Fred Cerise, who oversees health care operations for the LSU system, has said that nearly all the cost-cutting will be absorbed by the New Orleans operations.

Timing is delicate

The report comes at a delicate time for the university, which is hoping to replace the interim hospital with a $1.2 billion, 424-bed hospital in lower Mid-City and is trying to fend off an attempt by House Speaker Jim Tucker, R-Algiers, to transfer management of the New Orleans hospital operations to an independent board.

LSU officials have long acknowledged the need for the charity hospital system to become more efficient, and have said they plan to run the new hospital in a more efficient manner. Testifying last month before the House Appropriations Committee, Cerise said the New Orleans hospital was overstaffed and plans to shed about 300 jobs as part of $24 million in budget cuts.

Formerly known as University Hospital, the hospital was rebuilt with federal dollars after it was flooded in Hurricane Katrina; it reopened in November 2006 as the Interim LSU Public Hospital. With 2,500 staff members, 300 medical residents and fellows, and 400 nursing and allied health students, the hospital serves as the main training ground for the LSU Health Sciences Center in New Orleans.

Findings

Among the findings in the report:

• "The hospital's staff struggle with the effects of Hurricane Katrina and tend to think in 'recovery terms' instead of placing greater emphasis on operational efficiency and cost-effectiveness." The cost per patient per day, a key efficiency measurement, was $5,031 in New Orleans versus $2,794 at similarly sized teaching hospitals.

• The hospital has far more employees, particularly nurses, than dictated by national standards, and is overloaded with middle managers. According to the report, there are 8.2 full-time employees per occupied bed, compared to a national benchmark of six workers per bed.

• The report identified 126 nurses "with administrative titles and without routine patient care responsibilities" in an inpatient department that on an average day has 208 occupied beds.

"Higher than normal levels of nurse managers leads to role conflict and less accountability throughout all positions, with a significant cost to the organization," the report found.

• The New Orleans hospital has a 3-to-1 nurse/manager ratio; the report said the normal ratio, "even in heavily administrative organizations," should be 8-to-1.

• Simply adjusting overall employment levels to reflect the national standard would save $46 million a year in payroll costs, and also would lead to the elimination of 659 full-time positions. Reducing staffing to seven workers per occupied bed would save $25 million and eliminate 355 jobs.

• The hospital does not have a system in place to measure worker productivity, according to the report.

• The university's system for buying and tracking equipment supplies is "poorly organized, operates out of multiple locations, has cumbersome work flow processes and is minimally automated," the report found. Accountability often is lacking, and many department managers are unaware of how much money has been spent on supplies.

Proactive versus reactive

The report recommends closing the 63,480-square-foot, off-site supply warehouse, eliminating 20 jobs. According to the report, the state still has not made permanent repairs to the warehouse's electrical system, which failed during Katrina. Instead, power is being supplied by a rented diesel generator costing about $40,000 per month.

Similarly sized hospitals dedicate between 5,000 and 7,000 square feet for supply storage, according to the report, and have more than twice the inventory turnover rate. The slow turnover rate means some materials expire or become obsolete before they can be used, according to the report.

"It is apparent that the Materials Management staff are unable to apply basic supply chain practices, strategies, principles and concepts (i.e., identification of inventory turnover rate and ways to affect it) because the staff remain in a constant reactive mode addressing day-to-day needs," the report said.

• The hospital's top administrators should be more vigilant in monitoring contracts, with an eye to determining whether the services can be performed more efficiently in-house. As an example, the report cites a $2.6 million annual contract with an outside vendor, signed after Katrina, to have the floors cleaned. The report found that the same services, performed in-house, would cost $1 million per year.

• Although the report praises the dedication of operating room staff, it said the hospital does a poor job of making efficient use of its 12 operating rooms. The average use of the operating rooms during the prime-time hours of 7 a.m. to 3 p.m. was 55 percent, compared to an industry standard of 70 percent to 80 percent.

http://www.nola.com/news/index.ssf/2009/05/o_p103libbtop3_0518aaa01_the_h.html

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LSU hospital deserves a fresh start

The Times-Picayune | 05.17.09

Alice Paddison

I can understand preservationists wanting to preserve the old Charity Hospital building, which should be redeveloped for reuse. But what I cannot understand is how people think that by restoring Charity to a hospital, all the problems from the past will just disappear.

No one with insurance wanted to be taken to Charity unless they have a gunshot wound or severe injury. Once the person recovered enough they were immediately moved to Tulane, Touro, Baptist, Ochsner or East Jefferson. Is it fair to now require LSU to have some of these same entities on its board?

It is totally unrealistic to expect the paying public to be thrown into Charity Hospital with prisoners and psychiatric patients traipsing through public areas, which is the way Charity was set up. One has to wonder how many of the complainers were ever in the hospital as a patient.

Growing up in a medical family connected with LSU Medical Center has given me some insight into the problems with Charity. Going on rounds to area hospitals with my father and working at Charity for a summer gave me a different perspective. No one is addressing an important issue which is; would the paying public start to go to Charity if it were redone as a hospital?

In addition, the Charity footprint does not meet the needs of a growing, state of the art biomedical research center.

It is time to move forward and allow LSU to become an innovative economic engine for our city.

Alice Paddison

New Orleans

http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1242537608124210.xml&coll=1

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Local lawmakers split on governor’s budget

The Daily Comet | 05.15.09

Jeremy Alford

Capitol Correspondent

BATON ROUGE – Citing deep cuts to education and health care they say were avoidable, two lawmakers from the Terrebonne-Lafourche House delegation voted against Gov. Bobby Jindal’s $27 billion spending plan Thursday, while most of their colleagues rubberstamped the controversial budget without protest.

Editorial: State benefits from broader view

Opelousas Daily World | 05.18.09

There's plenty to gripe about when it comes to the current legislative session and Gov. Bobby Jindal's administration.

There are questions about budgeting priorities as we continue to target higher education and health care disproportionately in our recurring expenses.

There are questions about why we're trying to tackle so many things from mandatory helmets to guns on campus when the only thing that really matters is that looming budget deficit.

There is some sense of folks fiddling while Rome burns.

But, there's an interesting upside emerging this year, and it's an interesting year for it to be happening.

Even with money as tight as it is, the parochialism that has long haunted the halls of the state Capitol is being quietly snuffed out in favor of a bigger-picture approach to moving the state forward.

Take support for the Pennington Biomedical Research Center in Baton Rouge. Technically an arm of the LSU system, Pennington has received $70 million in one-time dollars since Jindal took office to upgrade its buildings and grow its campus. Pennington is a world-renowned research facility in nutrition, fitness, obesity and diabetes. It brings in hundreds of millions in research dollars and some of the world's top researchers in the field.

It's not just good for Baton Rouge or for LSU, it's good for the entire state, just as Lafayette's LITE Center or the New Iberia Research Center are good for the entire state. Jindal often has used LITE as a backdrop for his stops in Lafayette. That is not a coincidence. He has done the same at Pennington.

Focusing dollars on growing our academic and research capacity regardless of what part of the state it is in will be important to creating the economy of the future.

We only hope that Jindal will be able to carry this focus into budget talks with the state's institutions of higher education, which have the same mission. If the governor's intention is to force an end to parochialism in our colleges and universities by hoping higher education leaders build the same kind of priority system on quality rather than quantity, he may need to give more direction, not less. Otherwise, important research programs are at risk.

The state's waning parochialism has been given multiple tests this year, and in every case, the bigger picture has won out.

We saw it in $50 million to save a chicken-processing plant on one end of the state and $85 million to keep an NFL team on the other. Both projects are moving through swiftly, and legislators from both sides learned that questioning their brethren in need about priorities doesn't do much good when the end game is the same - to keep Louisianians working.

And most recently, we saw it when House members stopped any effort to strip money from coastal restoration projects to fund road projects in individual members' districts. If there is anything that defies parochialism, it is in coastal restoration and protection.

These are important steps forward. Now, it is incumbent on the governor to make clear what the big picture for the state really is and to ensure that every decision we're making is about that, not which part of the state can deliver the most votes.

http://www.dailyworld.com/article/20090518/OPINION01/905180306

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Editorial: Louisiana Governor Bobby Jindal and the Legislature are moving the state backward

The Times-Picayune | 05.16.09

Ted Jackson

Gov. Bobby Jindal wrote persuasively in a November 2007 essay about the need for a fresh start in Louisiana. He was newly elected and preparing to take office. His transition teams were beginning to craft the new administration's strategies.

The governor already had clear ideas of what needed to be accomplished. For one, he promised to toughen ethics laws and improve Louisiana's badly tarnished reputation. For another, he said his administration would make the state more attractive to businesses and invigorate the economy.

"Good jobs and exciting economic opportunities should exist for every citizen right here at home, and .¤.¤. Louisiana should become a much-sought-after destination instead of a point of departure for our best and brightest," he wrote.

His first special session as governor was devoted to ethics reform. His second focused on long-needed business tax cuts.

That was a good start. But the current legislative session is a different matter. This year he has given his blessing to a bill that will make Louisiana more hostile to businesses and to an array of legislation that makes the state seem narrow-minded and uninviting.

And while the governor's desire not to increase taxes on Louisianians is a worthy goal, cuts he is proposing for higher education could do long-term damage to the state's economic viability.

One of the most befuddling developments is Gov. Jindal's backing of legislation that would increase Louisiana's $75,000 homestead exemption. Even lawmakers seemed surprised when he gave his backing to House Bill 485, which would tie the exemption to the consumer price index going forward.

The exemption is already the most generous in the nation and raising it inevitably will lead to a bigger tax burden on businesses, which will mean fewer job opportunities for Louisianians. Increasing the exemption also would rob city and parish governments and school systems of property tax revenue, which could lead to reduced services or higher property tax rates or both.

As for state taxes, the Public Affairs Research Council is urging the Legislature to reverse or at least delay the elimination of the income tax reduction approved last year. Commissioner of Higher Education Sally Clausen also is arguing for the delay to ease the intense budget pressure.

They're right. Lawmakers shouldn't have voted last year to repeal the Stelly Plan, which raised income taxes on higher earners in exchange for a reduction in sales taxes. The loss of those revenues will result in a $360 million hit to the state budget next fiscal year.

Louisianians may be disappointed not to get the break this year, but making deep cuts in state services on the fly isn't smart -- and it isn't good for residents. Holding off on the Stelly repeal won't erase all of the budget shortfall, but it would be enough to lessen the pain.

"Slashing revenue without presenting specific proposals for cost-cutting . . . merely masquerades as a way to streamline government," PAR said.

But Gov. Jindal seems intent on sticking to his budget-cutting plan. His budget calls for $219 million in cuts to higher education, which university officials say will lead to layoffs, fewer class offerings and diminished support for sports and cultural programs like the Pulitzer Prize-winning LSU Press. The LSU System would have to cut $102 million, including the potential loss of 225 jobs at the University of New Orleans.

There is waste in higher education, no doubt, but such abrupt and extensive cuts give no assurance that needless programs will be eliminated and important ones will be saved. That needs to be done in a more deliberate manner than the current financial free fall will allow.

Fiscal woes aren't the only threat this year. Gov. Jindal's support of a bill to allow students and staff to carry concealed weapons on campus is misguided and could well discourage some parents from sending their children to college here.

Beyond the danger to individual students posed by the bill, the message it sends about Louisiana is the wrong one. So is the mean-spirited effort by some lawmakers to forbid gay adoptive parents from other states to get an updated birth certificate for children who are born here -- a measure that will hurt Louisiana children.

Gov. Jindal rightly focused in his campaign on creating a better image for Louisiana. His ethics session was a step toward that. His administration's professional handling of big business deals like the new Saints' agreement also is encouraging.

But increasing the homestead exemption, arming college students and making it difficult for children without parents to start a new life move us backwards. That may play well with some constituents and with a targeted national audience.

But it isn't good for Louisiana.

http://blog.nola.com/editorials/2009/05/editorial_louisiana_gov_bobby.html

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LSU researchers focus on infectious-disease fight

The Advocate | 05.16.09

By SANDY DAVIS

Advocate staff writer

Gus Kousoulas is quick to tell a visitor that LSU’s School of Veterinary Medicine is not just about treating a sick dog or horse — it’s also about finding treatments for infectious diseases in humans, including swine flu.

The School of Veterinary Medicine created the Division of Biotechnology and Molecular Medicine — BIOMMED — eight years ago to do that research, said Kousoulas, BIOMMED director.

“We’re a bona fide research center with a primary focus on infectious diseases,” he said. “We’re at the forefront of endemic diseases here.”

A lot of the infectious diseases they study are ones that an animal transmits to a human, such as swine flu, West Nile virus and Lyme disease.

Most recently, the center’s researchers focused on the H1N1 virus that recently threatened to become a pandemic.

“The reality is we cannot respond fast enough by getting a vaccine out there. It takes at least six months for that to happen,” Kousoulas said.

The problem with flu viruses, Kousoulas said, is they can change very quickly.

“If the avian flu and human flu infect a pig, the pig becomes a mixing vessel. The viruses mix in the pig, and a new virus comes out,” he said. “Because it changes so fast, it is highly possible that a new virus evolves that is highly virulent in humans.”

Companies that produce vaccines are now faced with a dilemma: should they produce vaccines for seasonal flu, swine flu or both, Kousoulas said.

“If we produce both vaccines, then we will have to produce much less of each, which means not everybody could be immunized,” he said.

Another fear is that swine flu will mutate so much that the new vaccine would be useless by fall, Kousoulas said.

“We’re really helpless in all of this,” he said. “We can only contain it partially through antiviral medicines and vaccines.”

There are only two antiviral medications on the market that work — Tamiflu and Relenza, Kousoulas said.

And flu viruses are known for becoming resistant to antiviral medications.

“These drugs are really not a panacea, they’re not an antibiotic that will cure you,” he said. “A lot of strains of the flu have become resistant to Tamiflu. Flu viruses become more resistant the more the medications are used.”

With summer beginning, the flu season is fading, Kousoulas said.

“Now we’re all holding our breath to see what happens in the Southern Hemisphere with the swine flu and what happens in the fall,” Kousoulas said.

One of the more interesting aspects of swine flu that BIOMMED is looking into is where did it actually originate.

“We think it actually began in either New Zealand or China,” Kousoulas said.

Beyond doing its own research, BIOMMED also does research for other companies that are developing treatments for infectious diseases.

Currently, they’re doing research for a company out of Norway that has extracted a compound from blue-green algae.

That extract was fed to mice infected with a more virulent strain of swine flu and the flu symptoms were relieved in about 20 to 30 percent of the mice, he said.

In addition to actual research work, he said BIOMMED was created as a catalyst to bring in large amounts of research funding from outside the state.

Apparently, that worked.

“Over the last five years, we have brought over $40 million of National Institutes of Health funding and we are poised to continue to do that over the next five years,” Kousoulas said.

About $10 million of the NIH funding was earmarked to create a center for experimental infectious disease research.

“What that means is we’re interested in every virus or bacterium that could infect animals or a human,” he said.

In the midst of these efforts, though, BIOMMED is facing budget cuts.

“If that happens, there will be a lot of us who will be looking for greener pastures,” Kousoulas said.

He said a highly competitive faculty brings a lot of funding to the state.

“I suspect we’re as good or better at bringing in out-of-state funding as Pennington,” Kousoulas added.

BIOMMED actually needs to hire new people, he said.

“But when you have cuts, what can you do?” Kousoulas asked. “We’re at a standstill which means we’re really behind.”

BIOMMED is also working on some of its own products.

“But we haven’t filed for patents yet,” Kousoulas said. “It’s very competitive between companies and scientists who are developing all of these things.”

In addition, BIOMMED has spun off a for-profit company, Thevac Biotech.

“The idea is to be able to produce (lab products) for research but also ultimately to produce vaccines and therapeutics in collaboration with the LSU School of Veterinary Medicine,” Kousoulas said.

He said the company is in its very early stages and one of the many pluses is it will provide employment for the scientists who graduate from LSU.

For now, Kousoulas is worried that with the budget cuts, some of the more talented researchers will leave.

“The high-end kind of research that we do should be preserved,” he said. “We need to be supported.”

http://www.2theadvocate.com/news/45194267.html

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Swine flu cases at 57 in Louisiana

The Times-Picayune | 05.16.09

The Associated Press

(AP) — BATON ROUGE, La. - Louisana health officials say the number of confirmed swine flu cases in the state has risen to 57.

The latest cases include seven confirmed Thursday in Plaquemines Parish and three from St. Charles Parish that were confirmed Thursday and Friday.

State health department spokesman Rene Milligan says the virus does not appear to be spreading rapidly within Louisiana. So far, about 2,800 specimens in Louisiana have been tested.

http://www.nola.com/newsflash/index.ssf?/base/national-16/1242493461235290.xml&storylist=louisiana

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Violent hazing at times in college band repertoire

The Associated Press | 05.16.09

By DOUG SIMPSON

BATON ROUGE, La. (AP) — When two first-year French horn players in Southern University's marching band were beaten so badly they had to be hospitalized in intensive care, it exposed a dirty secret: Hazing isn't reserved for fraternities.

At least one expert says the beatings are a growing problem at historically black colleges, where a spot in the marching band is coveted and the bands are revered almost as much as the sports teams for which they play their rousing fight songs.

"It's something that deserves more attention," said Walter Kimbrough, president of Philander Smith College in Little Rock, Ark., who has researched band hazing cases at historically black colleges nationwide and has been called as an expert witness in more than a dozen court cases involving hazing.

"And I'm just talking about violent cases — there could be a ton of those silent cases, the ones that could have been reported but weren't," he said.

Kimbrough estimated that 15 percent of the country's 80 historically black colleges have had violent hazings among band members over the past few years. He's found that brutal band hazings are not restricted to predominantly black schools but do crop up as a problem among bands that have cliques or subgroups that operate like fraternities — but without school authorization.

The victims at Southern apparently were seeking membership to "Mellow Phi Fellow," a fraternity-like subgroup of the French horn section, according to investigators.

The three told investigators that on Nov. 27, 2008 — two days before the band performed at Southern's annual Bayou Classic football game against Grambling State in the Louisiana Superdome — they gathered at the off-campus home of one of their bandmates, where they were blindfolded, doused with water and beaten with a board.

One of the victims elected to stop the ritual after being hit with a board more than 50 times and later identified the suspects, authorities said.

The other two kept going, and were beaten so badly they risked organ failure and were hospitalized for several days in intensive care. They are recuperating, District Attorney Hillar Moore said.

The University of Wisconsin-Madison last year briefly suspended its marching band after allegations that underclassmen were forced to drink huge amounts of alcohol.

One of the worst cases concluded when a former band member at historically black Florida A&M University in Tallahassee won a $1.8 million award in 2004 after suffering kidney damage because of a beating with a paddle. A jury found five former band members liable in that suit. The victim also settled with the school for an undisclosed amount.

Competition is intense among college bands, and Southern — with 190 members — in particular prides itself on the quality of its shows. There are tryouts for the band, known for its athleticism and synchronized dancing, which travels with the teams and performs around the country.

"What makes the football games ... is the band," said Angel Askew, 19, a Southern freshman from Mesa, Ariz. "A lot of people, to be honest, don't even watch the football games. They just wait for the next song the band's going to play."

Leslie Hicken, the director of bands at Furman University in Greenville, S.C., and a division president of the College Band Directors National Association, said hazing often occurs within sections of bands as new members seek approval from senior members who had been through the rituals in years past. New members are reluctant to report it, fearing they would lose their peers' respect, he said.

"The sections are encouraged by everyone to have their own kind of bonding experience," Hicken said. "I can see where, if not monitored, it could get out of control. We're talking about college students here — things are going to evolve on their own."

The seven defendants in the Southern case originally faced felony charges of aggravated battery and "ritualistic acts" that carried prison sentences of up to 50 years. A plea deal was proposed this past week that would give the seven defendants — ranging in age from 20 to 23 — probation instead of prison time if they plead to lesser charges. Southern suspended all seven indefinitely.

"Hopefully this is just an isolated incident, and one that Southern surely wants to address, because they don't want this," Moore, the prosecutor, said.

Southern, with an enrollment of about 7,400, has forced every member of the 180-member "Human Jukebox" to reapply for their spots in the band and sign an anti-hazing pledge, said school spokesman Ed Pratt.

The university had no comment on the proposed plea agreement.

Danielle Winger, 21, a junior from New Orleans, said she has friends in the band and doubts violent hazing is widespread.

"I can honestly say, I've never seen someone walking around with black eyes, or broken arms," Winger said. "I think this was just boys being boys."

http://www.google.com/hostednews/ap/article/ALeqM5iQjYC5LJNQWDZvj2uZ60sQWfoIVgD986ROUG0

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Congress has little appetite for health care taxes

The Times-Picayune | 05.18.09

STEPHEN OHLEMACHER

The Associated Press

(AP) — WASHINGTON - It's the toughest question of all in the debate over revamping the health care system-how to pay for expanding coverage to nearly 50 million uninsured people.

Ask lawmakers about raising taxes and the responses range from emphatic opposition to noncommittal statements about "putting everything on the table."

Cutting costs is a popular idea, but few experts think enough savings can be wrung from the system to expand coverage to so many-despite pledges from medical providers.

Undaunted, Congress is forging ahead, but with no consensus in sight. Few of President Barack Obama's proposed tax increases have been well received on Capitol Hill, and there aren't many popular ideas coming from lawmakers, either.

Democrats, who have been fighting the tax-and-spend label for decades, are very much aware of what happened the last time a Democrat won the White House and a Democratic-controlled Congress voted to raise taxes. It was l993, and Republicans won control of Congress the following year.

"Ever since then they've been especially scared to deal with these difficult issues," said Eugene Steuerle, a Treasury official under former President Ronald Reagan.

Obama says his goals are to rein in costs, guarantee choice of health plans and doctors, and ensure that all Americans have access to affordable coverage. But guaranteeing coverage for all could cost $1.5 trillion over the next decade, which has some advocates concerned that Congress will pass a plan that falls short.

Medical providers have pledged to find $2 trillion in savings over the next decade, but much of that money will be needed to keep premiums from skyrocketing for those who already have coverage.

"So far, nothing tough has been done," said William Gale, co-director of the Tax Policy Institute, a Washington think tank whose research was often cited by Obama during the presidential campaign.

Rep. Charles Rangel, chairman of the tax-writing House Ways and Means Committee, said Congress "absolutely" has the will to raise taxes to pay for health care reform.

"Cut costs, raise revenue," the New York Democrat said. "Closing loopholes could be considered raising taxes, right?"

But Rangel is one of the few lawmakers to openly embrace tax increases. Today's Democratic Congress is, after all, very different from the one that helped former President Bill Clinton raise taxes in 1993 to reduce federal budget deficits. Democrats retook Congress in 2006 and expanded their majority in 2008 in part by electing moderates in Republican-leaning districts.

Many of those newly elected Democrats are wary of voting to raise taxes, especially when they are unlikely to get any Republican support.

"If you are a first- or second-term Democrat, why on earth would you want to vote in July or August 2009 for a tax increase that the president doesn't want to have take effect until 2011?" asked Clint Stretch, managing principal of tax policy at Deloitte Tax. "You've just handed your opponent an extra year to campaign that you're a big-tax Democrat."

House Speaker Nancy Pelosi has pledged to pass a health care reform bill this summer. Her take on taxes: "We're putting everything on the table."

Obama's proposal targets high-income families by reducing their tax deductions, including those for mortgage interest and charitable donations, for individuals making more than $200,000 and couples making more than $250,000.

The proposal would raise about $276 billion over 10 years as part of a "down payment" for health care reform, but key Democrats have said they worry it would hurt charitable organizations.

One critic has been Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee. Baucus has been working for months on a plan that would tax at least some health benefits provided by employers. Employer provided health insurance is currently untaxed.

Obama, however, opposed a similar plan offered by his rival in the presidential election, Sen. John McCain, R-Ariz. Baucus' plan is getting no better reaction from fellow Democrats in the House.

"I think it was a bad idea when John McCain proposed it and I think it's a bad idea today," said Rep. Mike Ross, D-Ark., who chairs the health care task force for the conservative "Blue Dog" Democrats.

A nutrition group has proposed a series of sin taxes to help pay for health care, including a tax on soft drinks that got a lot of attention at the Capitol. The group, the Center for Science in the Public Interest, said reducing soft drink consumption would "help slow the obesity epidemic."

The proposal prompted objections from the beverage industry, and even Clinton, who said in a broadcast interview that Congress should focus on containing costs rather than raising taxes.

Clinton, of course, remembers how hard it was to craft a massive health care overhaul when he was president. It went about as well as the 1994 elections did for the Democrats.

http://www.nola.com/newsflash/index.ssf?/base/national-2/1242637515108760.xml&storylist=health

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Study links cigarette changes to rising lung risk

The Times-Picayune | 05.18.09

LAURAN NEERGAARD

The Associated Press

(AP) — WASHINGTON - It may be riskier on the lungs to smoke cigarettes today than it was a few decades ago-at least in the U.S., says new research that blames changes in cigarette design for fueling a certain type of lung cancer.

Up to half of the nation's lung cancer cases may be due to those changes, Dr. David Burns of the University of California, San Diego, told a recent meeting of tobacco researchers.

It's not the first time that scientists have concluded the 1960s movement for lower-tar cigarettes brought some unexpected consequences. But this study, while preliminary, is among the most in-depth looks. And intriguingly it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia even though both countries switched to so-called milder cigarettes at the same time.

"The most likely explanation for it is a change in the cigarette," Burns said in an interview-and he cited a difference: Cigarettes sold in Australia contain lower levels of nitrosamines, a known carcinogen, than those sold in the U.S.

That's circumstantial evidence that requires more research, he acknowledged.

But anti-smoking advocates are citing the study as Congress considers whether the Food and Drug Administration should regulate tobacco, legislation that would give the agency power to decide such things as whether to set caps on certain chemicals in tobacco smoke.

Smokers once tended to get lung cancer in larger air tubes, particularly a type named "squamous cell carcinoma." Then doctors noticed a jump in adenocarcinoma, which grows in small air sacs far deeper in the lung. Initial studies blamed introduction of filtered, lower-tar cigarettes. When smokers switched, they began inhaling more deeply to get their nicotine jolt, pushing cancer-causing smoke deeper than before.

Burns' study, presented at a meeting of the Society for Research on Nicotine and Tobacco, took a closer look. He compared smoking behaviors of different age groups over four decades-how much they smoked, when they started, when they quit-and how cancer-risk changed.

The risk of squamous cell carcinoma stayed about the same over those years, Burns found. But adenocarcinoma rose. It makes up 65 percent to 70 percent of newly occurring U.S. lung cancer cases, but no more than 40 percent of Australia's lung cancer, he said.

While the nation's total lung cancer cases have inched down as the number of smokers has dropped in recent years, the study suggests an individual smoker's risk of getting cancer is higher.

It's well known that cigarettes differ from country to country, because of different tobacco crops grown locally and smokers' varying tastes. Nitrosamines are a byproduct of tobacco processing and levels vary for several reasons, including differences in curing practices.

Australian cigarettes contain about 20 percent of the nitrosamine content of U.S. cigarettes, making the chemical a prime suspect, concluded Burns, who has been scientific editor of several surgeon general reports on tobacco.

That doesn't rule out a role for deeper inhaling, cautioned Dr. Michael Thun of the American Cancer Society: "There's several strong suspects in the lineup. They may have acted in combination."

Philip Morris USA spokesman David Sutton called the study speculative and hard to evaluate until it's published in a medical journal, something Burns plans to do.

Still, Philip Morris, which supports FDA tobacco regulation, began taking steps with its growers in 2000 that have yielded "significantly lower" nitrosamine levels in recent years' supplies, Sutton said.

Be careful in assuming lower-nitrosamine cigarettes are less lethal, said Dr. Neal Benowitz of the University of California, San Francisco, a well-known tobacco expert. Lung cancer is only one of tobacco's many risks-it causes heart disease and other killer diseases, too.

"If you reduce someone's (lung cancer) risk by 10 percent, that's not really meaningful for an individual," he said. "The goal still is to get them to stop."

http://www.nola.com/newsflash/index.ssf?/base/national-16/1242637613108760.xml&storylist=health

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Mental health: What you can do and where you can go

WWLTV | 05.18.09

Watch video: http://www.wwltv.com/video/featured-index.html?nvid=362563

Medical expert Dr. Brobson Lutz talks about what New Orleanians can do if they have mental health questions as the state talks about cutting budgets, including in the health industry.

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Clearer Vision After Cataracts

The New York Times | 05.18.09

By PETER JARET

In Brief:

Cataracts occur when the eye’s natural lens becomes cloudy with age.

Cataracts don’t harm the eye but can progressively impair vision.

Cloudy lenses can be removed and replaced with artificial lenses designed to correct a range of vision problems.

With a variety of new replacement lenses on the market, it’s wise to talk to your eye doctor about your options.

Like bum knees and crow’s feet, cataracts are the price we pay for getting older. Cataracts form when the normally transparent lens of the eye turns cloudy. At least three out of five people over age 60 will eventually develop them. Today, thanks to a steady march of advances, cataract replacement surgery often gives people better vision than they’ve had in years.

Progress in the field has been nothing short of astonishing, experts say, starting with the development of artificial lenses about 30 years ago.

“In the early days, all we could do was remove the cataractous lens,” said Dr. Peter R. Egbert, director of the Cataract Service at Stanford University. “Patients ended up with no lens in their eye to focus and had to wear very thick glasses to see. Nobody was happy with the results.”

Patients can now choose from a wide range of artificial lenses. The most common are monofocal lenses, which focus vision at a single distance, the way a pair of standard glasses does. Before surgery, ophthalmologists test the eyes to choose the best prescription for the artificial lens, based on whether patients are nearsighted or farsighted or have normal vision.

Multifocal lenses, designed to focus both up close and at a distance, are a newer option. They are particularly appealing because by the time people develop cataracts, usually starting in their 60s, most suffer from presbyopia and require reading glasses. Presbyopia occurs when the body’s natural lens stiffens with age and eye muscles can no longer focus it for close vision.

Techniques to insert the new lenses have also been refined. In the past, doctors had to make a relatively large incision in the clear capsule that contains the natural lens. Now a technique called phacoemulsification breaks up the damaged lens so it can be removed in fragments through a much smaller opening. Replacement lenses are made of a material pliable enough to be rolled up and inserted through the opening. Once inside, they unfold to fill the capsule. The entire procedure usually takes less than 30 minutes and is typically performed using an anesthetic eye drop.

Monofocal lenses, which have long been in use and are covered by insurance, remain the most common choice of replacement lens. But multifocal lenses are growing in popularity.

A variety of multifocal brands are available, but they all work in one of two basic ways. One design presents two images to the retina, one focused close and the other at a distance. The brain then chooses which one to “see.” The second design, called an accommodating lens, incorporates a kind of hinge that allows eye muscles to focus the lens either near or far.

“For people who wear bifocals, the new lenses can mean being much less reliant on glasses, and in some cases eliminate the need for them entirely,” said Dr. David F. Chang, a clinical professor of ophthalmology at the University of California, San Francisco.

Because these so-called premium lenses are not considered medically necessary, they aren’t covered by Medicare or private insurance. The additional cost can run up to $3,000 per eye.

Another new artificial lens design, called a toric lens, corrects astigmatism, which is caused by an abnormal curvature of the cornea. Like multifocal lenses, they are considered premium lenses and aren’t covered by most insurance plans.

Joan Gallien, 68, of San Jose, Calif., is among the many patients who have paid the extra money for premium lenses. She said she “couldn’t be happier” about no longer needing to rely on glasses for distance or reading.

But there are drawbacks. Patients sometimes complain about seeing haloes around lights at night. In addition, multifocal lenses designed to present two images to the retina can decrease contrast, making it more difficult to see in dim light.

“The haloes are definitely there, especially around traffic lights and headlights,” Ms. Gallien said. “They’re kind of frustrating. I try not to drive at night.”

Some doctors believe the drawbacks outweigh the benefits, especially because the majority of patients end up having to wear reading glasses for very fine print.

“I definitely tell my patients about multifocal lenses, but I don’t recommend them myself,” Dr. Egbert said. “The fact is, I wouldn’t want one in my eye.”

Other specialists are more enthusiastic.

“Occasionally people do notice decreased contrast and rings around lights at night,” said Dr. Marian Macsai, professor and vice chairman of the department of ophthalmology at Northwestern University Feinberg School of Medicine. “But in the hundreds and hundreds of patients who’ve opted for these lenses, I haven’t had anyone ask me to take them out. They’re very happy with the results.”

How well the lenses work depends in part on how healthy the eye is, said Dr. David M. Brown, assistant professor of ophthalmology at The Methodist Hospital, Weill College of Medicine in Houston, where he specializes in retinal surgery.

“Since many multifocal lenses cut down on the amount of light reaching the retina, they aren’t recommended for people with macular degeneration or diabetic retinopathy, which already make it difficult to see in low light,” Dr. Brown said. “People with a family history of macular degeneration or diabetes should be informed that should they develop macular disease, they may have more difficulties functioning with multifocal lenses.”

Like presbyopia, retinal problems become more common with age, limiting the number of candidates for multifocal lenses.

Most eye specialists expect multifocal lens designs to improve. One approach under development is a plastic gel that would be injected into the capsule that held the original lens and would form a highly pliable new lens.

Monofocal lenses, meanwhile, are already so refined that the results for many patients are dramatic.

“You can have someone who’s very nearsighted, who basically can’t see until they reach for their glasses in the morning,” said Dr. Stuart McKinnon, director of ophthalmology and neurobiology at Duke University School of Medicine. “You do cataract surgery and afterwards they can see perfectly. We’ll do surgery on one eye, and afterwards they come and say, “I never realized. Let’s get the other eye done.’ ”

http://health.nytimes.com/ref/health/healthguide/esn-cataracts-ess.html?ref=health

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New York Reports Its First Swine Flu Death

The New York Times | 05.17.09

By ANEMONA HARTOCOLLIS

An assistant principal at a New York City public school died of complications from swine flu in an intensive care unit of a Queens hospital on Sunday night, the first death in New York State of the flu strain that has swept across much of the world since it was first identified in April.

Hours before the death of the assistant principal, Mitchell Wiener, city officials announced that five more Queens schools had closed.

On Friday, Dr. Daniel Jernigan, head of flu epidemiology for the federal Centers for Disease Control and Prevention, said there had been 173 hospitalizations and 5 deaths reported to the agency. But he emphasized that most cases in the United States — possibly “upwards of 100,000” — were mild.

In Japan, the number of swine flu cases soared over the weekend, and authorities closed more than 1,000 schools and kindergartens .

Mr. Wiener’s death, which came five days after he entered the hospital and three days after his school, Intermediate School 238 in Hollis, Queens, was shut down by health officials, raised the level of concern among the public, especially parents, but health officials played down the significance of the death to public policy.

Health officials said Sunday that the death was not surprising, since even in a normal flu season, thousands of victims die of complications from the disease.

Mr. Wiener had a history of medical problems that may have put him at greater risk, the officials said. His family said that he had suffered from gout but that it was under control with medication.

The city’s health commissioner, Dr. Thomas R. Frieden, called the death “terribly tragic,” and said, “Our heart goes out to the family and to the community.”

“We are now seeing a rising tide of flu in many parts of New York City,” Dr. Frieden said. But he added: “Nothing we’ve seen so far suggests that it’s more dangerous to someone who gets it than the flu that comes every year. We should not forget that the flu that comes every year kills about 1,000 New Yorkers.”

Mr. Wiener, 55, had been “overwhelmed” by the illness, despite beginning a course of treatment with an experimental drug, Ribavirin, after he failed to respond to other antiviral drugs, according to Ole Pedersen, a spokesman for Flushing Hospital Medical Center, where Mr. Wiener had been a patient since Wednesday.

After an early period of high alert when the virus was first detected in New York City, officials had more recently toned down their concern, leading Mr. Wiener’s family to lash out on Friday.

His wife, Bonnie, a reading teacher, blamed the city for failing to act sooner to close the school where she and her husband both worked. “I know we have a duty to educate the children of New York,” Ms. Wiener, who is not sick, said on Friday. But, she added, “something just doesn’t fit right.”

Late last week, the city closed five schools in Queens and one in Brooklyn, after five cases of swine flu were confirmed, including that of Mr. Wiener.

The city said on Sunday that it was closing the five additional schools because of the large number of children coming down with flulike symptoms like fever and coughing. That brought the number of schools closed in New York City to 11 since Thursday and to at least 15 since the virus was identified in April.

Jessica Scaperotti, a spokeswoman for the New York City Department of Health and Mental Hygiene, said that there were no more confirmed cases of swine flu but that the department had decided to close the schools because of “unusually high and increasing levels of influenzalike illness.”

A total of 105 students were documented with flulike illness at Middle School 158 in Bayside, Our Lady of Lourdes in Queens Village and a building in Flushing that houses three schools with a total of 1,320 students, including Intermediate School 25. All of the schools will be closed beginning Monday for at least five days, the department said.

“We are evaluating the situation and looking at all schools in New York City and making decisions on a case-by-case basis,” Ms. Scaperotti said.

In a statement, Mayor Michael R. Bloomberg asked New Yorkers to keep Mr. Wiener’s family “in their thoughts and prayers.” The mayor added, “He was a well-liked and devoted educator, and his death is a loss for our schools and our city.”

Ernest A. Logan, president of the principals’ union, called Mr. Wiener “the truest kind of educational leader, unsung, yet absolutely dedicated to his students, his teachers and fellow administrators.”

Chancellor Joel I. Klein and Randi Weingarten, president of the teachers’ union, were among the many officials who offered condolences. Ms. Weingarten said the death was a reminder of the need to monitor schools for flu outbreaks.

Mr. Wiener was hired as a teacher at Intermediate School 238 in September 1978, after working as a substitute teacher in the city six months. He became assistant principal of the school in July 2007.

Several former students of Mr. Wiener’s gathered outside I.S. 238 on Sunday to remember him. They left flowers and candles on the steps and wrote “RIP Mr. Wiener” in black marker on the door.

“He knew every kid’s name” said Byron Lopez, 32, a former student who is now a commercial real estate appraiser. He recalled his teacher’s constant refrain: “Get to class, Byron. You’re going to be late.” He said he had stayed close to his teacher since leaving the school after eighth grade.

Mr. Lopez still lives in the neighborhood, where he said many people believed the city waited too long to close the school.

In one shift in the way the city was responding to the disease, hours before Mr. Wiener’s death, the health department issued a statement urging New Yorkers who suffered from underlying health issues like emphysema, diabetes or asthma and who were exposed to the flu to see their doctors to determine whether they should take antiviral drugs as a precaution.

Dr. Frieden said Sunday that city officials did not expect to stop the flu from spreading at this point. But he said that the school closings and the warnings to people with underlying health conditions were an attempt to keep people from getting seriously ill, as Mr. Wiener had.

“At this point our goal is not to stop the spread of flu, because that’s like stopping the tide from coming in or going out,” Dr. Frieden said. “We have been concerned by the emergence of a novel virus, and for people with underlying conditions, it’s very important to get treated promptly.”

On Friday, Dr. Frieden was named by President Obama to head the federal Centers for Disease Control and Prevention, where he will have to make critical decisions about how to deal with the spread of the disease. He starts in June. He has urged the federal government to mount a Manhattan Project-type effort to develop a vaccine.

One of Mr. Wiener’s three sons, Adam, said about an hour after his death that the family was too devastated to talk. “Out of respect to my family, not right now,” Adam Wiener said. “We can’t talk about this right now.”

Dr. Scott A. Harper, a medical epidemiologist with the health department’s Bureau of Communicable Disease, said that since swine flu was detected in New York, there have been 178 confirmed cases, with a vast majority of cases going undiagnosed. “The first hint that it was here was in a school, so we’re not surprised to see activity in schools continuing,” he said.

At Flushing Hospital Sunday night, Mary S. Meguerditchian, 60, whose husband has been recovering from a stroke on the same floor as Mr. Wiener, said the family had seemed optimistic about Mr. Wiener’s chances on Saturday. But on Sunday Ms. Wiener had told her that a “special vaccination” had been administered to Mr. Wiener, “but it didn’t work,” Ms. Meguerditchian said.

Ms. Meguerditchian said she heard Ms. Wiener cry out from inside the Wiener family’s special waiting room as doctors told them that Mr. Wiener had died.

“I was crying too,” Ms. Meguerditchian said. “It’s like my family because I was with them the whole time. I feel very bad. It’s very hard for the wife and for the kids.”

She said that being exposed to the family of a swine flu victim had left her and her family frightened for their own health.

“Every minute we wash our hands,” she said.

The swine flu outbreak in New York was first reported to city health officials on April 23 by a school nurse, Mary Pappas, at St. Francis Preparatory School in Fresh Meadows, Queens. Over the next few days, hundreds of students became ill as the flu spread rapidly among students and teachers at the school, which was closed for about a week. An investigation by the city’s health department traced the likely origin of the illness to several students who had visited Cancún, Mexico, the center of the virus, during spring break.

Reporting was contributed by Russ Buettner, David W. Chen, Javier C. Hernandez, A. G. Sulzberger, Rebecca White and Karen Zraick.

http://www.nytimes.com/2009/05/18/nyregion/18swine.html?_r=1&ref=health

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CDC seeing more regular flu cases now

The Associated Press | 05.16.09

By MARILYNN MARCHIONE, AP Medical Writer

U.S. health officials are seeing a surprisingly high number of cases of ordinary, seasonal flu at a time when the flu season typically peters out.

About half of people recently testing positive for the flu have the new swine flu virus, Dr. Daniel Jernigan of the Centers for Disease Control and Prevention in Atlanta said Friday.

The rest have seasonal flu, which is still causing widespread or regional illness in about two dozen states, "something that we would not expect at this time," he said. "We would be expecting the season to be slowing down or almost completely stopped."

The higher numbers of seasonal flu cases do not seem to be just because health officials are looking harder this year because of worries about swine flu, Jernigan said. A network of doctors who track how many patients are coming in with flulike symptoms, plus evidence from school outbreaks and lab testing, points to more flu — not just more reporting, he said.

In the United States, there are now more than 4,700 probable and confirmed cases of swine flu, and 173 hospitalizations and four deaths, Jernigan said. The tally doesn't include a fifth death that Texas officials said Friday was due to swine flu.

"The H1N1 virus is not going away," Jernigan said. The virus "appears to be expanding throughout the United States" and poses "an ongoing public health threat," he said.

Swine flu continues to affect more younger people — those ages 5 to 24 — and CDC is still seeing relatively few cases in older people.

"That may be just a matter of time" until the virus spreads to that population, or it may prove to be a difference in the virus or its effect on various groups, he said.

Officials are still monitoring the situation in Mexico, where the outbreak began. However, the CDC's quarantine chief, Dr. Martin Cetron, said the agency was downgrading its warnings about travel to Mexico. The CDC had urged people to avoid nonessential travel to that country, but that was changed Friday to just a precaution for people at high risk of flu complications.

The fifth U.S. death attributed to swine flu was reported Friday in a 33-year-old Texas man who died May 5 or May 6 after becoming sick a few days earlier. Corpus Christi-Nueces County Health District's Dr. William Burgin Jr. said the man had medical conditions, including heart problems, that made it tougher for him to fight a viral illness. The victim's name was not released.

It was the third swine flu death in Texas. Other deaths occurred in Washington and Arizona.

In New York City, three public schools in the borough of Queens were closed after hundreds of children were sent home sick this week, and a city official said Friday that three more schools would be shut down after students developed flu symptoms. At one school, Susan B. Anthony middle school, there were five confirmed cases of swine flu, including a 55-year-old assistant principal hospitalized in critical condition.

Outgoing City Health Commissioner Dr. Thomas Frieden said Friday that the large clusters of apparent swine flu cases at the schools were "a little surprising," but added: "So far it doesn't appear to be causing more severe illness than seasonal influenza."

"We don't know how far it will spread, how wide it will spread, how long it will spread," said Frieden, who on Friday was named director of the CDC.

As he spoke, maintenance workers at the schools scrubbed desks, floors and door handles Friday. At one middle school, where 241 children were out with flulike symptoms Thursday, a worker in a mask was seen mopping down the cafeteria.

Addressing criticism that the schools should have been closed sooner, Mayor Michael Bloomberg said, "We have to make decisions on each school individually. ... Our children need more time in school, not less."

New York City's first swine flu outbreak occurred when hundreds of teenagers at a Roman Catholic high school began falling ill following the return of several students from vacations in Mexico.

http://news.yahoo.com/s/ap/20090516/ap_on_he_me/us_med_swine_flu_us;_ylt=AlQqiRO2wKBVrEqEG61qbDDVJRIF

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Buying Health Insurance Begins With Homework

The New York Times | 05.15.09

By LESLEY ALDERMAN

OH, the glory of being your own boss: the freedom, the creativity, the jeans-only dress code. And then there’s the dreary stuff — like finding and paying for your own health insurance.

Denise Spatafora, an author and career and life coach who has been self-employed for 20 years, says it used to be that “dealing with insurance was just part of what it meant to be an entrepreneur.”

But when Ms. Spatafora had to find a new policy this year for herself and her family, she was shocked. “Prices are through the roof,” she said, “and all the doctors I love don’t take insurance anymore.”

She lives in Manhattan, and people in New York State pay some of the highest health insurance premiums in the country, increasing by 13 to 15 percent annually for nearly a decade.

Fortunately for Ms. Spatafora, because she is a sole proprietor she is eligible for plans that cost considerably less than an individual would pay in New York. With the help of a broker, Aaron Lindskog, Ms. Spatafora found a family plan from Emblem Health that comes with a relatively high deductible of $5,000, but costs just $487 a month.

“My family is healthy,” says Ms. Spatafora, who is the author of “Better Birth” (Wiley, 2009). “This coverage is just for emergencies.”

But strategies suitable for New York do not necessarily work in other states. Some places, like Florida, allow a “group” to consist of just one person. That means sole proprietors can buy insurance in the small-group market without being screened for health issues. But it also means that small-group insurance in Florida may be more expensive than individual plans that can provide a price break for good health.

“When you’re self-employed, you’re straddling two distinct markets: the individual and the group market,” notes Janet Trautwein, chief executive of the National Association of Health Underwriters, an organization of health insurance agents, brokers and consultants.

Those two markets vary depending on where you live. And so, if you are self-employed and in the market for a new plan, or you need to upgrade an old one, you should learn about the rules in your state. (You can find a link to your state’s insurance department at the National Association of Insurance Commissioners site, www.naic.org/state_web_map.htm.)

Then consider the following, before you make a choice:

ASSOCIATION PLANS Professional organizations and local chambers of commerce typically offer good options for the self-employed — especially in expensive markets like New York.

When Larry Smith left his full-time job in 2005 to start SMITHMag.net, an online magazine, he called dozens of insurers. “The options were lousy and outrageously expensive,” recalled Mr. Smith, who lives in Brooklyn. “Clearly, I had to find a way to replicate the advantages of being part of a larger whole.”

He found a good proxy by joining MediaBistro.com, a New York-based organization for media professionals. For a $55 annual fee, he was able to join an Oxford plan that charges $333 a month for individual coverage. Considering that the average monthly rate for an individual in New York is $900, according to the New York State department of insurance, Mr. Smith scored a good deal.

MediaBistro.com offers well-priced individual or family coverage through a group plan to New Yorkers and discounted plans to those outside the state (www.mediabistro.com/insurance). The Freelancers Union (www.freelancersunion.org/insurance) also offers insurance to independent workers, but you must earn income in one of their approved industries.

Beware, though, of organizations that are created simply to sell insurance, Ms. Trautwein said. “Each year we come across dozens of scams,” she said. “Make sure it’s a bona fide association, and there is a decent insurer in the background.”

HEALTH INSURANCE BROKERS An independent broker represents several insurers and can match you with the company that offers the best rate and coverage. An experienced broker can help you figure out your priorities (H.M.O.? P.P.O.? high-deductible plan?) and explain what is available in your locale. A broker can also provide continuing support after you purchase the policy.

Having trouble with a claim or confused by out-of-network rules? Your broker can decode the arcane lingo and help you settle disputes. What’s more, because brokers earn their fees from insurers, they don’t charge you.

To find a broker in your area use the Find an Agent feature on the National Association of Health Underwriters site (www.nahu.org).

Once you have a few names, quiz them about their expertise and whether they serve multiple carriers. The best broker for you is one that is familiar with your situation, knows about various plans, and is not just a shill for a couple of companies.

If you want to take a do-it-yourself approach, try an Internet brokerage site like ehealthinsurance.com, which can help you compare policies and prices in your area.

CONSIDER A PART-TIME JOB If you are an entrepreneur working 70-hour weeks, this may not make sense for you. But if you are a painter or novelist with more time than money, or you have a health condition that makes it difficult to find affordable coverage, a part-time job can keep you out of debt.

Nearly 80 percent of large companies offer benefits to their part-time employees, according to the consulting firm Hewitt Associates. Employees at Starbucks who work 20 hours or more a week, for example, are entitled to health care coverage that includes prescription drug and mental health benefits, as well as other perks. Trader Joe’s and Barnes and Noble are among other companies offering health coverage to part-timers.

DISABILITY INSURANCE Health insurance can protect you only so far. If you become ill and cannot work, you will need insurance to help replace your lost income — especially if you are the main breadwinner.

“If I were starting out today,” says Mickey Lyons, owner of The Medical Link, a benefits consulting firm in Manhattan, “I’d get a high-deductible health plan and a disability plan that replaced 50 percent of my income.”

Mr. Lyons is in the business of selling insurance, of course, but his point makes sense. After you have spent years building up your business, you do not want a broken arm or a bout with cancer to derail your efforts.

http://www.nytimes.com/2009/05/16/health/16patient.html?ref=health

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Health Plans Would Add to Controls on Insurers

The New York Times | 05.15.09

By ROBERT PEAR

WASHINGTON — The government could rein in aggressive marketing practices of health insurance companies, regulate their premiums and allow workers to drop out of group health plans to seek a better deal on their own under legislation being developed by leading Democratic senators.

The Senate proposals, which emerged this week, are broadly similar to ones being drafted by the chairmen of three House committees. Democrats in both houses would vastly expand federal regulation of insurance to guarantee that all Americans have access to affordable coverage, a top priority of President Obama.

Lawmakers have not figured out how to pay for their proposals, which could easily cost more than $1 trillion over a decade. And they have not resolved the politically explosive question of whether to create a public insurance program, to compete with private insurers.

But after a week of intense discussions, in which members of the House and the Senate immersed themselves in the details of health care, Democrats began to line up in favor of several basic ideas.

Under the Senate proposals, everyone would be required to carry insurance. The requirement would take effect in 2013, but exemptions would be allowed for illegal immigrants and people with religious objections.

In addition, most employers would be required to offer insurance to their full-time workers, or else pay a special tax. The government would set minimum standards for benefits, including doctors’ services, hospital care and prescription drugs. All insurers would have to offer four levels of coverage: lowest, low, medium and high.

Insurers “could not include lifetime limits on coverage or annual limits on any benefits,” a detailed options paper from the Finance Committee says.

Under the Senate plans, the federal government would regulate the marketing of commercial insurance to families and employers, just as it regulates sales of managed care plans to Medicare beneficiaries by companies like Aetna, Humana and UnitedHealth.

While the House has not made as much progress as the Senate, House Democrats agree with their Senate colleagues that the government should establish a national health insurance exchange, or marketplace, where people could buy coverage, using standard application forms. All insurers would have to participate in the exchange, and the government would post “quality ratings” on a Web site.

Consumers could sign up for insurance at hospitals, schools, Social Security offices and state departments of motor vehicles.

Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, said the exchange would “make purchasing health insurance easier and more understandable.”

Under the Democratic proposals, the government would offer tax credits to help people buy insurance. The credit would be available to people with incomes up to four times the poverty level ($88,200 for a family of four).

The government would also provide tax credits to help small businesses buy insurance for employees. The credit would be available to businesses with up to 25 employees, and businesses with the lowest-wage workers would get more aid.

Under the Senate proposals, the government would regulate not only insurance products, but also the marketing of insurance and sales commissions paid to insurance agents and brokers.

The Democrats would “ensure compliance” with the new requirements in several ways.

Taxpayers would have to report their health insurance coverage on their federal income tax returns. Under the main Senate proposal, the penalty for not being insured would be an excise tax, which could be as high as 75 percent of the premium for the lowest-cost health plan available in the area where a person lives.

Under the proposal, all employers with more than $500,000 in total payroll would have to offer insurance to full-time workers or “pay an assessment,” in the form of a new excise tax.

An employer offering insurance would have to pay at least 50 percent of the premium. An employer not offering insurance would have to pay the excise tax, which would increase with a company’s payroll, so the largest employers might pay $500 per employee per month.

More than 160 million Americans receive health insurance through employers, the principal source of coverage for people under 65.

One of the most notable features of the Senate proposals is that workers could drop out of an employer’s group health plan and buy private insurance on their own, outside the workplace. The employer’s normal contribution for a worker would be paid to the insurance exchange.

Democrats said that people dropping out of employer plans would, in many cases, be eligible for tax credits to defray their premiums.

Employers worry that this feature would destabilize the health plans they provide to employees.

“If people can opt out of employer-sponsored insurance and get a tax credit, that will lead to a death spiral for employer-sponsored plans,” said James P. Gelfand, senior manager of health policy at the United States Chamber of Commerce.

“People who are sick will stay in employer plans, and many young, healthy people will opt out,” Mr. Gelfand said.

The Democratic proposals would expand Medicaid to cover additional low-income families with children. And the federal government would require states to increase Medicaid payment rates for doctors and hospitals, which are often much lower than rates paid by Medicare and commercial insurers.

Democrats said they had not decided on the precise income limits, and they are still trying to figure out whether Medicaid recipients could buy coverage through the insurance exchange.

http://www.nytimes.com/2009/05/16/health/policy/16health.html?ref=health

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Please email questions and comments to lsuhospitals@lsuhsc.edu.