Wednesday, July 16, 2008

More Republicans Defect on Medicare Veto Override

By Ben Persing - Capitol Briefings - Tuesday, July 15, 2008
UPDATE 7:05 PM: The Senate has now also voted to override the veto, 70-26. Four Republicans switched from voting against the measure previously to voting in favor of the override today: Kit Bond (Mo.), Thad Cochran (Miss.), Roger Wicker (Miss.) and Richard Lugar (Ind.).

The House had voted to override President Bush's veto of a bill to block cuts in payments to doctors under Medicare, and the caravan of Republicans moving away from the president on the issue turned into a stampede.

The chamber voted 383-41 to override the veto, with 153 Republicans joining all 230 Democrats present to vote "aye." That's an increase of 24 Republicans in favor since the bill's original passage last month. The administration and GOP leaders did their best in both the House and Senate to prevent the measure from passing the first time around, urging their members to vote "no" so they could try to negotiate a better bill, but many rank-and-file Republicans didn't listen. Even more ignored Bush's wishes today.

The Senate vote to override is scheduled to happen within the hour.
Read more in the Federal Insider

Medicare Advantage: Congress rightly overrides President Bush's veto of a bill that levels the playing field between health-care providers

By Washington Post - Wed., July 16, 2008
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.

Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.

How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.

The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.

Read more in the Washington Post

Monday, July 14, 2008

Fibromyalgia: Little understood, often frustrating

By Judy Fortin - CNN Medical Correspondent - Monday, July 14, 2008

ATLANTA, Georgia (CNN) -- You wouldn't know it by looking at her, but at any given moment Dana Poole hurts all over.

"It's kind of like a burning, but an ache. It's almost like you have the flu," said Poole, 31, a receptionist from Canton, Georgia.

Poole is one of almost 6 million Americans who suffer from a chronic condition called fibromyalgia.

In addition to widespread pain, patients may complain about fatigue and sleep disturbances, depression, headaches, irritable bowel syndrome and heightened sensitivity.

"Dana is typical of a lot of fibromyalgia patients," said Dr. Jefrey Lieberman, an Atlanta, Georgia-based rheumatologist. "She came into my office complaining of a lot of diffuse pain all over her body and fatigue. She really didn't know why she was getting it."

That's part of the frustration of having fibromyalgia. Experts aren't sure what causes it, but many believe many factors are involved.

Some think the condition, which is not progressive or life-threatening, may be triggered by an emotional or traumatic event.

Lieberman believed it is related to a disordered sleep pattern and poor exercise. "It appears to be more of a neuro-chemical process," he said. "In other words, there really is no inflammation in patients with fibromyalgia." Health Minute: More on identifying fibromyalgia »

Getting a proper diagnosis can sometimes be just as frustrating as finding out what's behind the disease.

"Fibromyalgia is to some extent a diagnosis of exclusion," Lieberman said. "There are lot of things it can be confused with such as thyroid disorders, metabolic disorders and certain rheumatologic inflammatory conditions."

For almost five years, Poole jumped from doctor to doctor trying to figure out what was causing her symptoms. "They were constantly saying I'm a tall, thin female. 'You're getting older -- your body is going to change,' and it was frustrating."

Lieberman understood Poole's frustration. "Sometimes fibromyalgia is used as a wastebasket term if a patient has pain and they don't know what it is from," he said. "It is frequently misdiagnosed. In fact, it is overdiagnosed and it is underdiagnosed."

Specialists such as Lieberman can make a proper diagnosis based on criteria set by the American College of Rheumatology.

"Those criteria are diffuse pain in three or more quadrants of the body and the presence of what are called tender points in the body," Lieberman explained. "There are 18 total tender points, and by definition we like to see 11 of those tender points being present."

It's estimated that up to 90 percent of patients are women. Most of them start feeling symptoms in early and middle adulthood.

Poole remembered that the pain first started when she was 20. It wasn't until she met Lieberman about five years ago that she got some relief.

She took part in a drug study for Cymbalta, one of two medications approved for the management of fibromyalgia. The other drug is called Lyrica.

"Both of them are geared toward the patient's well-being as well as improving their pain," Lieberman said.

He also encouraged Poole to control her condition through a healthy diet, stress reduction, getting enough sleep and regular low-impact exercise.

"We think that aerobic exercise helps to stimulate endorphins and enkephlins from the body which are your own natural pain relievers," Lieberman said.

The doctor is quick to point out that even with proper medication and adequate exercise, fibromyalgia has no cure.

Although Lieberman said some of his patients report the symptoms tapering off in their mid-50s and -60s, others are faced with years of managing the condition.

"For most of my patients, I tell them that I can get you 50 to 75 percent better and many of those patients will jump at that," he said.

Poole is one of them, but knowing that she'll need to follow a careful daily regimen can be daunting, she said. "It wears you out, mentally, physically and emotionally."



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