Health bill impacts on seniors
Some good and bad benefits for seniors
The massive health care bill President Obama signed March 23, 2010 will affect nearly all American families. The 2,407-page bill and its 153-page package of corrections, likely to gain final Senate approval soon, has something for just about everyone. Seniors will not be missed. Several items of impact for this group are good news, some bad, according to USA Today.
Medicare recipients gain drug coverage
AARP, the nation’s largest seniors watchdog organization, says most of their senior followers should benefit from a number of provisions. Some simple, some complex and some for the wealthy, some for the poor.
Seniors will gain additional prescription-drug coverage, closing the coverage gap on the notorious “doughnut hole,” the Medicare Part D out-of-pocket costs provisions. Created in the original program in 2006, seniors whose total drug costs reach $2,830 now must pay for all their drugs until they have spent $4,550. A provision in the new law will close that cost gap, and prevents them from having to pay thousands for these deductible costs.
The bill provides that seniors who reach the established coverage gap will now be eligible for a one-time, $250 rebate with future considerations too. Beginning 2011, brand-name drug prices are to be discounted 50% during their coverage gap time period. Each year until 2020, the drug discount will increase, finally reaching 75% of the cost.
Other seniors good benefits
Additional benefits for seniors are spelled out in the bill. Free preventive services such as cancer screenings, funding for all states to increase and improve community services for people with disabilities, and upping children’s age on policies. For those seniors who have children and insurance policies including them, the children will be able to remain on parents’ policies until they reach the age of 26.
Also, poor adult seniors will get Medicaid and Low-income senior families will receive federal subsidies to buy insurance. This will be a welcome assistance to those that decided or were thrust into to helping raise families in their later years.
Some senior bad benefits
On the other hand, those seniors who have Medicare Advantage plans — those select private plans combining hospital, physician and drug coverage — could watch premiums increase or have benefits diminished. The new law reduces Medicare payments to those plans and approximately 23% of all Medicare beneficiaries have those plans.
Also, seniors who still work or live off of investment income will see their capital gains taxes increase to help pay for the bill. Beginning in 2013,for the first time, the Medicare payroll tax will be applied to income from investment. The new 3.8 percent tax will impact seniors’ interest, dividends, capital gains and other investment income for those individuals earning more than $200,000 a year and couples making more than $250,000.
Medicare wage payroll taxes will increase for working seniors. The new health bill also would increase the Medicare payroll tax by a 0.9 percentage point to 2.35 percent, on wages above $200,000 for individuals and $250,000 for married couples filing jointly.
The new tax on investment income is higher than the 2.9 percent tax proposed by President Obama. “House Democratic leaders increased it so they could reduce the impact of a new tax on high-cost health insurance plans strongly opposed by labor unions. The 40 percent tax on health benefits would be delayed until 2018 and would apply only to premiums exceeding $10,200 a year for individuals and $27,500 for families,” according to FOX news.
Seniors of all ages, retired and those still working, will be impacted by the new health care bill, both good and bad. Only time will tell what the total costs to the country will be for them their children, and their grandchildren.
Climate Change Solutions Affect Public Health
How Reducing Greenhouse/Carbon Emissions can Improve Our Health
Recently, 192 countries met in Copenhagen in an effort to reduce greenhouse gas emissions and avert the adverse effects of climate change. Such effects include: species loss, disruption of ecosystems, population displacement, damaged livelihoods, altered agricultural productivity and economic imbalance on regional and local levels. Health professionals may be burdened with the fallout from increased frequency and intensity of heat waves, reduction in cold-related deaths, increased floods and droughts, changes of distribution in vector-borne diseases, changes in the risk of disasters and malnutrition. Logically then, mitigation strategies to reduce emissions should also have benefits on global public health. Unfortunately, these benefits have not received significant attention in international negotiations. This article intends to give a concise overview on the connection of several strategies with public health and to strengthen the case for mitigation.
Low Carbon Power Generation
A term that describes the use of zero carbon sources like wind, solar and geothermal, low carbon sources such as nuclear and natural gas, as well as carbon-limiting innovations such as carbon capture and storage.
If emissions are reduced, it is predicted that there would be a reduction in particulate air pollution and consequently, mortality. The largest effect would be in India, where particulate air pollution is the greatest, and the smallest in the EU, where electricity production from fossil fuels is quite clean. Studies predict significant reductions in mortality from acute lower respiratory tract infections (ALRI), chronic obstructive pulmonary disease (COPD), and ischemic heart disease (IHD). Costs of implementing low emission electricity production would be substantially offset by reduced pollution-related mortality, especially in China and India.
Efficient Household Energy
Residential energy use makes up a large part of our carbon emissions. High per head emissions countries like the UK and low per head emissions countries like India require different approaches. In the UK, focus would be on changes to insulation, ventilation control, fuel use, and occupant behaviors, whereas in India, where stoves are used for everything, a national program to introduce 150 million low-emission cookstoves would be appropriate.
Household energy interventions have greater potential to improve public health in low-income settings. If India’s cookstove program were completed, 87% of households would have clean combustion leading to less particulate air pollution and a reduction in mortality from ALRI, COPD and IHD. Benefits for ALRI’s in children would be immediate on introduction of the stoves whereas the benefits for IHD and COPD would only be seen later.
Alternative Urban Transport
Transport accounts for a quarter of global CO2 emissions and three quarters of that is from road traffic. Strategies include introduction of low-emission motor vehicles, increasing active transport (walking, cycling etc) and the creation of safe urban environments that facilitate active transport.
Lower-emission motor vehicles would reduce the health burden from urban outdoor air pollution, but a reduction in the distance travelled by motor vehicles could have a greater effect. Increase in the distances walked and cycled would lead to large health benefits. Largest gains would be from reductions in the prevalence of IHD, cerebrovascular disease (CVD), depression, dementia, and diabetes.
Reduced Livestock Production and Consumption
The agriculture sector contributes 10—12% of total greenhouse-gas emissions worldwide. Four fifths of these emissions come from livestock. A combination of technological improvements and reduction in production of foods from animal sources could provide an effective contribution to meet targets to reduce emissions.
A reduction in the intake of saturated fat from animal sources could lead to a reduction in IHD and CVD.
Efforts to mitigate climate change and reduce emissions can also have benefits towards public health. With low carbon power generation, more efficient household energy, alternative urban transport and a reduction in livestock production, reductions in the incidences of common diseases such as ischemic heart disease and chronic obstructive pulmonary disease are possible.
Nurses Take Top Honor Again
Nurses Have Lost Top Rank Only Once
Since 1999, when the nursing profession was added to the poll, nurses have ranked number one every year but one. That was 2001 when firefighters deservedly took the title in the poll which was held shortly after September 11.
Nurses play a key role in the health care team. It is essential for patients, caregivers and loved ones to trust nurses. Patient education is a major role for nurses and the success of patients outcomes depends on this level of trust. The fact that nurses continue to rank highest on this list year after year is a testament to the nursing profession.
The Nursing Shortage
Nursing is one of the most rewarding professions and yet it can be one of the most challenging both physically and emotionally. As the Baby Boom generation ages and begins to retire, a large portion of today’s nursing workforce will be lost. It is not being replaced at a pace necessary to keep up with this projected loss as well as the increasing need of an aging population.
It is important for young people to recognize the nursing profession as a career option and seriously consider a career in the nursing profession. This accolade helps to reinforce the opportunities and the recognition that nurses need and deserve.
Other Health Care Team Members
Other members of the health care field to be ranked fairly high were pharmacists (or druggists) who came in with a combined 70% of “high” or “very high” scores and medical doctors who had a combined “very high” and “high” score of 64%.
Bankers Take a Hit
The banking industry took a big hit in the poll this year with a 12 percent decline from 2007. Bankers fell from 35 to 23%. Given the state of the economy, this is not surprising. In 1988 during the savings and loan crisis, banker fell from 38% down to 26%. This is the first time bankers have fallen below 30% since 1996.
High school teachers ranked with a combined score of 65%; policemen and clergy each with 56%. Funeral directors scored 47%. On the lower end, journalists scored 25%, bankers 23%, building contractors came in at 22% and real estate agents at 17%. At the bottom of the list were telemarketers and lobbyists who scored in the “low” ranking from 60% and 64% of those polled respectively.
Alternative Treatment Under Scrutiny
Homeopathic Health Care Funding to Stop
In the current economic climate governments are looking to save money and eliminate wasteful expenditure. A recent report from the House of Commons Science and Technology Committee published findings and recommendations that could see the state funding of homeopathic health care treatment axed by the British government. Could this be evidence of good or poor financial management?
Evidence Check on Homeopathic Treatment
The Committee has urged the government to withdraw NHS funding for homeopathic treatment and stop the Medicines and Healthcare Products Regulatory Agency licensing homeopathic treatments. The report states that there is a “mismatch between evidence and policy.”
The committee raised concerns that while the government recognises that there is no evidence that homeopathic treatment works beyond the placebo effect, it continues to fund homeopathic health care treatment through the National Health Service budget. The NSH currently funds four homeopathic hospitals in Scotland and England.
The report follows an evidence check questioning whether the government’s policies on homeopathy were based on sound evidence. Testimony was collected from the director of research at the Royal London Homeopathic Hospital, the chairman of the British Association of Homeopathic Manufacturers and the chief scientific adviser of the Royal Pharmaceutical Society of Great Britain.
Science and Technology Committee Conclusions
The committee concluded that the MHRA should not allow homeopathic product labels to make medical claims without evidence of efficacy. “As they are not medicines, homeopathic products should no longer be licensed by the MHRA,” the committee said.
Other concerns included the introduction of the National Rules Scheme in 2006 that allowed homeopathic treatments to make medical claims that were not based on randomised controlled trials, and the Department of Health’s willingness to spend public money on treatment that was “faith” based, rather than on a foundation of firm evidence.
The committee’s chairman, Liberal Democrat Phil Willis, said in a statement that “this was a challenging inquiry that provoked strong reactions. We were seeking to determine whether the government’s policies are evidence based on current evidence. They are not.”
“It sets an unfortunate precedent for the Department of Health to consider that the existence of a community which believes that homeopathy works is ‘evidence’ enough to continue spending public money on it,” Willis added. “This also sends out a confused message, and has potentially harmful consequences. We await the government’s response to our report with interest.”
It is no secret that the political party that wins the next British general election will implement severe cuts to public expenditure. The recent press reports on the wasteful purchase of unused swine flu vaccines by the British government, underscores the difficulty of doing business with large pharmaceutical corporations and raises questions about the government’s diligence. By comparison, the government’s expenditure on homeopathic health care seems like a drop in the ocean.
While the homeopathic community may seem like a soft target for financial cuts, there are others who may view the situation differently, and see yet more examples of government financial mismanagement on the run in to the next general election.
How to Deduct Medical Expenses on a Tax Return
Claiming Medical Costs Under The Income Tax Act
On a regular income tax return for Canadian citizens, medical expenses are calculated on line 330 and the refundable medical expense supplement is on line 452. There are several medical expenses that many individuals may not realize can be eligible for this deduction and there are other methods to maximize the benefit of claiming this expense.
Save Money By Combining Expenses on Income Tax Return
Combining medical expenses for the entire family and dependents and claiming this amount on the income tax return of the spouse with the higher income may help make this more beneficial. Medical expenses may also be claimed for any 12-month period ending in the year the return is for. If the end of last year and the beginning of this year contained a high amount of medical expenses, it may be more advantageous to wait to claim this amount for this year’s tax return.
What Can Be Claimed Under Medical Expenses?
Canada’s Income Tax Act currently allows prescription medications only to be deducted as a medical expense. Be sure to keep careful records of all prescriptions. Over the counter medications as well as natural and holistic vitamins, supplements and medications are currently not allowed to be deducted as a medical expense in Canada. If a large amount is spent on natural health and holistic products, an extended insurance plan that covers may be financially beneficial. Though the cost of insurance may increase, this amount is deductible on an income tax return and may actually help to save on income tax.
Other medical expenses that can be claimed include premiums paid through employment or university for extended health and dental plans, other extended health insurance plans such as Blue Cross, travel health insurance (even when purchased separately for each trip), and in some cases equipment purchased for home use and renovations done to your home to accommodate an illness or disability, however certain regulations and conditions apply.
Renovation Expenses for Medical Reasons
Renovation or construction expenses that are necessary to allow an individual with severe or prolonged mobility impairment or who suffers from abnormal physical or mental development, are allowable medical expenses under certain conditions. The costs incurred can be deducted minus any other renovation rebates such as for the goods and services tax or home renovation tax. Eligible renovations include those that would not normally be incurred by individuals without illness or impairment such as wheelchair ramps, safety rails, elevators, stair-lifters, lowering counters for easier access, widening doorways and others. For more information see the Revenue Canada site and line 368 in the General Income Tax and Benefit return.
Further Information and List of Allowable Medical Deductions
See your Canada Revenue Agency Site for a complete list of allowable medical expenses. Most equipment , supplies and renovations require medical documentation or a prescription from a physician; be sure that deductions qualify before making purchases or claiming a deduction. Allowable medical expenses that are often overlooked include: laser eye surgery, ambulance costs, medical travel costs (in some cases), surgical hair transplants, allergy specific foods (with a prescription), prescription eyeglasses and contact lenses, dental and orthopedic costs.
Healthcare Costs Rising
The Effect of Exercise on the Healthcare Industry
Many exercise and diet recommendations, articles, and suggestions talk about the benefits of fitness. Some articles will offer tips to build bigger pecs, ways to lose 10 pounds in a week, or how to prepare for a marathon. On television, programming such as Oprah, Dr. Oz., morning talk shows, and infomercials churn out health and exercise related products, services, and information. Whether it is a “wonder pill” to decrease risk of cancer, a machine to get “ripped abs,” or a new exercise routine to “make the pounds melt away” the information is everywhere and endless. So what is the affect from the totality of multibillion dollar businesses, products, and advertising to promote healthy living? A $2.4 trillion price tag on healthcare expenditures in 2009, accounting for almost 16% of the total gross domestic product (GDP). At the current rate, by 2020 healthcare will account 20% of all dollars spent in the US.
Exercise and the Healthcare Economy
How does exercise affect the entire healthcare system? To answer that question it would take hundreds of pages just to scratch the surface. To understand the entire industry, examination of the 300+ million individuals in the United States is necessary. Although exercise, diet, and stress are a small components of the healthcare industry, completely ignoring them can have drastic consequences to the individual and the country. Consider this logical progression of a person diagnosed with type II diabetes:
- Individual does not maintain healthy lifestyle, including exercise and good diet, resulting in type II diabetes
- Diagnosis leads to increased visits to doctor, testing supplies, and medications
- Expenses of healthcare lead to increased pressure on finances
- Limited financial resources result in decreased vacations, participation in hobbies, and general funds for entertainment
- Concurrently, process of disease makes walking more difficult, wounds heal slower, and increases susceptibility to other diseases
- Declining health, having less money, tasty foods being labeled “bad,” and less opportunities to participate in enjoyable activities increases risk for depression
- Depression sets in motion lack of desire to “get better”
- Later stages of disease affects circulation and wound healing, resulting in leg amputation
- Leg amputation further progresses depression
- Individual continues to get worse, has less and less money, and puts tremendous pressure on the healthcare system
Struggling with Poor Health
In this particular example, the individual suffering this condition has less money, inability to participate in enjoyable activities, and overall declining health. Surrounding family and friends may also bear the burden for the loved one’s health complications. Poor health can make it difficult or impossible to perform some jobs, producing a risk of unemployment in very uncertain times. Hobbies and recreational activities also may suffer because of general poor health, only further progressing overall dissatisfaction with life. By ignoring health prevention measures an individual risks becoming more depressed, dependent, and financially vulnerable. As for healthcare the healthcare industry, the $2.4 trillion continues to rise without end in sight.
Simple Steps to Healthy Living
Diseases such as type II diabetes, heart disease, obesity, and arthrosclerosis often are born and progress from lifestyle choices. Simple interventions such as exercise, diet, and reducing daily stress levels can improve individual health but also benefit the overall economy. With a political climate in constant debate on how to “solve the healthcare problem,” the real resolution starts with millions of individuals. The entire healthcare spectrum may be too abstract to understand but the impact of personal health on individual health, personal satisfaction in life, and financial stability is tremendous. So how can a $2.4 trillion healthcare industry get going in the right direction? It starts with 300+ million people moving in the right direction.
Pandemic or Epidemic – What’s the Difference?
An epidemic is an outbreak of a virus or other illness that spreads easily from human to human but it is more confined to an area, region or even a country. It isn’t a global occurrence. Seasonal flu is an example of an epidemic.
Epidemics usually result from a virus or subtype that is, or has been, circulating among humans. Therefore there is some immunity and the virus will not spread as rapidly. An epidemic can be very deadly, especially to the very young and very old as well as those with chronic illnesses. This is why, for example, flu vaccines are essential to help control the spread of the flu virus and to prevent deaths from complications such as pneumonia.
A pandemic occurs when a novel (or new) virus spreads easily among humans causing serious illness and death. Because it is usually a novel virus, humans have little or no immunity to it and the virus can spread rapidly. It usually causes many more deaths than an epidemic.
After the pandemic spreads, the virus will continue to circulate for several years. With the immunity that humans will have built up from exposure and illness and vaccines that have been developed from the strain, these viruses will not cause further pandemics.
Health care issues with a pandemic include:
- rapid transmission due to a highly mobile society
- antiviral medications and vaccines and antibiotics to treat secondary infections (such as pneumonia) would be used rapidly and supplies could become critically short
- it will take months to develop a vaccine against the novel virus
- medical facilities and personnel could become overwhelmed
- shortages of nurses and physicians could reach critical levels
- vital community services could be affected by a widespread outbreak
Plagues and outbreaks of cholera, small pox, typhus and influenza have caused pandemics throughout history. More recent pandemics include the 1918 Spanish flu which was originally thought to have been a swine flu or H1N1 Influenza A virus, but was not. In 1918, there were over 40 million deaths from the Spanish flu worldwide. What started out as a cough and achy muscles lead to a serious pandemic.
In 1957 the Asian flu pandemic hit and in 1968, the Hong Kong flu also became a pandemic. HIV/AIDS which began in the 1980’s and continues today is also considered a pandemic. The swine flu of 2009 is a pandemic, although with the rapid response worldwide, it is hoped to not be as severe as was originally thought.
Prevention is Key
It is important to understand that viruses can mutate and spread rapidly. Agencies such as WHO and the CDC monitor events and issue warnings as needed. Prevention is key. Handwashing is so low tech, but it can help prevent the spread of illness. Covering a cough or sneeze is not just polite; it is also essential to control the spread of germs. Social isolation as needed is an absolute.
Be Prepared for a Pandemic
Being prepared for any emergency is also an essential fact of life in the 21st century. Keeping a pantry stocked with provisions is vital. Maintaining at least a two week supply of prescription medications as well as a few essential OTC medications for cough, cold, and GI distress is also well advised. Be sure to renew any expired medications and store them according to the manufacturer’s label.
What is Palliative Care?
How is it Different From Hospice?
Many people confuse palliative care with hospice. Hospice uses palliative care to improve the quality of life in terminal illness, but palliative care is not always about end-of-life issues. The goal of palliative care is to improve the quality of life by relieving symptoms no matter what the prognosis.
In the face of any serious illness, controlling symptoms has been proven to be vital to successful outcomes. Some of the most difficult symptoms include pain, nausea and vomiting, insomnia, anorexia or lack of appetite, and shortness of breath.
Palliative care encompasses the use of Eastern and Western medicine and alternative treatments such as medications, oxygen, herbs, therapeutic massage, energy conservation, meditation, Reiki, acupuncture and acupressure, hypnosis and spiritual care. Some or all of these may be used to achieve the stress and symptom relief and control.
Better Able to Tolerate Curative Measures
When symptoms are well controlled, patients are better able to tolerate treatments necessary for curative measures such as chemotherapy and radiation. As a result, the curative treatments usually have a better chance of working than when the body is under stress and fighting the process. The quality of life is also improved tremendously for patients and their families.
Like hospice care, palliative care is provided by a team of health care professionals including doctors, nurses and social workers who have been trained in palliative care. The team may also include specially trained pharmacists, nutritionists, massage therapists, chaplains or other spiritual care providers all working together with the patient’s personal health care professionals to secure the best possible outcome.
Customized to Meet Patient’s Needs
Palliative care is customized to the needs of the patient and changes as the patient’s needs change. It is not a one-size-fits-all approach. What one patient requires for palliative treatment may be very different from another; even with the same diagnosis and treatments.
While palliative care can be very successful in helping patients achieve a cure or remission of their disease, in the event that the curative treatment is unsuccessful, or the patient wishes to discontinue treatment, the palliative team can help the patient transition to hospice care when the time is right.
Palliative care is most often provided in the hospital setting, but may be available from home health care agencies as well. It is a growing field that offers expanding opportunities to health care professionals and allied services as well.