I've been reading a lot of opinions on President's Bush's proposal to tax health care benefits. The one that's closest to my opinion is this one from the Wall Street Journal. "The Bush health insurance proposal would make insurance more affordable for most Americans than the current employer-sponsored health care system, which leads to inequities and insulates individuals from the real cost of their treatment decisions. The biggest problem with Mr. Bush's plan is that it wasn't offered two years ago, when it had a better chance to pass. Bush is finally offering a GOP reform based on market principles that these pages have encouraged for years.

Good advice to Legislators from the Washington Post, "The Bush health insurance proposal would improve progressivity and fairness and help contain health care costs. As written, the proposal has flaws, but those can be addressed -- if Democrats are willing to do more than hurl criticism. Congress should engage, not reflexively dismiss."

"If a liberal president proposed reforming the tax code to give working families a bigger tax break for health care than corporations and giving poor families direct assistance to buy health care to boot, the New York Times and the rest of the mainstream media would be choking back tears as it praised an initiative that was so bold in its compassion and desire for fairness. But you won't find the president's critics supporting his fair and compassionate plan. Instead, they support an expansion of Medicaid that is like forcing people into the medical equivalent of public housing. Washington Times

Study after study has confirmed that regular exercise, combined with modest weight loss and a healthy diet, can lower type 2 diabetes risk and improve outcomes once people have the disease. In one of the most persuasive, researchers from the Diabetes Prevention Program Research Group concluded that diet and regular exercise were more effective than one of the most widely prescribed drug treatments for preventing type 2 diabetes

Yet, only 39% of surveyed adults with diabetes engaged in regular physical activity, compared with 58% of adults who did not have the disease, according to a report in the February issue of Diabetes Care. And activity levels declined as risk factors for type 2 diabetes increased.

It's not surprising to find that those with diabetes were more sedentary than the general public, but it's particularly troubling to see so few at-risk people were physically active. It's difficult to be optimistic about addressing the twin epidemics of obesity and diabetes. The best way to prevent type 2 diabetes is to prevent obesity, but it is really hard to exercise once you are obese.

Until recently, when hospitals and physicians made errors when dealing with patients, the hospital risk managers and insurers generally recommended "defend and deny" policies.

A growing number of health care providers are adopting "disclosure and apology" policies for dealing with patients who have experienced a medical error. Several states have passed laws protecting doctors' apologies from being used at trial, and more hospitals are implementing policies requiring that doctors and nurses quickly reveal errors to patients and families when warranted.

The stance of risk managers and insurers has changed in part because of mounting evidence that disclosure and apology programs, which often include an upfront offer of a financial settlement, can sharply reduce malpractice costs.

Pennsylvania Gov. Ed Rendell announced a proposal that would expand access to health care services, improve quality and reduce the state's health costs. The "Prescription for Pennsylvania" proposal would phase in a requirement that state residents whose annual incomes exceed 300% of the federal poverty level obtain health insurance. Residents with lower incomes would not be required to obtain coverage but would have the option of buying it at reduced rates.

The proposal also would expand Cover All Kids -- a program that aims to provide affordable health coverage for children -- to create a new initiative called Cover All Pennsylvanians that would help uninsured adults and small businesses obtain basic coverage through private insurers. Premiums for the plans would be determined by a sliding scale based on income. Rendell's proposal would create financial penalties for businesses that do not offer health insurance coverage to employees. In addition, four-year colleges and universities would be required to guarantee that students are insured or have access to a health clinic. Rendell also plans to meet with other large purchasers of health care to develop a pay-for-performance program that would link payments for health care services to the quality of care.

The health insurance industry in California has been quick to voice its qualified support for a proposal announced last week by Gov. Arnold Schwarzenegger that would require all state residents to obtain health insurance.

Their reaction suggests how much the political momentum behind health care reform efforts has intensified and how health insurers plan to cope, or even benefit. The new proposal could expand the industry's market by four million to five million currently uninsured Californians something health plans have been unable to do despite heavily marketing new products to some segments.

However, health insurers have raised concerns about some parts of the proposal, such as a provision that would require insurers to spend 85 cents of every dollar in premiums on health care and a provision that would require insurers to sell policies to all California residents, regardless of whether they have medical conditions.

President Bush proposed sending federal money to help the states that are coming up with innovative ways to cover the uninsured. States would be free to come up with their own plans --as Massachusetts, California, and others are doing as long as they met certain standards. Instead of new spending, the White House plan would take federal money now used for charity care at hospitals and redirect it to the state initiatives.

In an interview this week, Tommy Thompson, who served as Health and Human Services Secretary during Bush's first term, endorsed using the states as "laboratories" for health reform, saying Congress has lacked the political courage to tackle the problem.

According to some state proposals for expanded coverage, companies will have to pay into a state fund if they don't provide health insurance for their employees. This has some smaller companies worried because they are more likely not to provide group health plans.

Some larger companies could benefit from the proposals because of a reduction in the number of uninsured residents should decrease health care costs. Companies cover some of the cost of uncompensated care for uninsured residents through higher reimbursement rates paid to hospitals and other health care providers.

The Bush administration has proposed federal tax deductions of $7,500 for individuals or $15,000 for families who acquire health insurance on their own or through an employer. The deduction would be available to all individuals and families who purchase health insurance, regardless of the value of their policies or whether they itemize deductions on their tax returns

For U.S. residents who receive employer-based health insurance, the deduction would be offset by the cost of their coverage. The proposal would for the first time levy an income tax on the value of employer-sponsored health insurance in some cases. Currently, employees are not taxed on the value of their employer-sponsored health insurance. Under the proposal, individuals and families with employer-sponsored health insurance plans worth more than the proposed allowable deductions would pay income taxes on the difference.

This proposal indeed levels the playing field regarding tax treatment and should motivate employees to select more spartan coverage to maximize their tax deductions.

American consumers and business leaders are ready to have a very bipartisan solution. Now everyone is on the same side saying, "We want universal coverage.' The only question is 'How?'" Clearly, there are states that are looking into this. Whether Washington will do more than talk about the problem remains to be seen.

California Gov. Arnold Schwarzenegger announced a proposal, based on a Massachusetts law enacted last year, that would require all state residents to obtain health insurance, and Pennsylvania Gov. Ed Rendell announced a similar proposal. More than six additional states also are "actively debating the idea. Governors in Colorado, Illinois and Kansas recently have called for universal health insurance for residents, and governors in Arizona, Indiana, New Mexico and New York have called for expanded coverage.

A coalition of 16 organizations last week announced a proposal that would provide health insurance to more than half of uninsured U.S. residents, and a bipartisan group of lawmakers last week introduced legislation that would provide grants to states to test health care reform proposals. In addition, Sens. Ron Wyden (D-Ore.) and Edward Kennedy (D-Mass.) and Rep. John Dingell (D-Mich.) also have said they will seek to pass legislation that would extend Medicare to all residents and allow them to select from health plans offered to federal lawmakers.

My golf buddy recently got shingles. I didn't know what it was. It turns out, most people don't know about shingles unless they know someone who has had shingles, or they develop it themselves. Shingles, a disease caused by the same virus as chickenpox, affects roughly one million Americans each year.

Shingles is nasty and very painful.The first signs of shingles may not be visually noticeable. People often experience tingling, burning, itching or pain. During the first few days of symptoms, fluid-filled blisters will break out in a rash, usually on one side of the body or face. Patients are usually given analgesics along with antiviral medications for treatment. If possible, treatment should begin within 72 hours of the onset of symptoms. The rash is often painful and will heal in two to four weeks, in most people.

After a person gets the chickenpox, most often during childhood, the inactivated virus can live on in certain nerve cells in the body. In healthy people, the body's immune system usually keeps the virus at bay. As people age or their immune system becomes compromised, the virus can reactivate and result in shingles. Thus the risk of shingles increases with age. One out of two people who live to the age of 85 will have had shingles.

Women who choose their own surgeon and hospital get better breast cancer care than those who rely on doctor or health plan referrals. That's because women who said they chose their own surgeon were twice as likely to see a highly experienced surgeon as were those referred by another doctor or by their health plan. The provider-based referral pathway was not associated with surgeon volume.

Steven Katz, MD, director of health services research at the University of Michigan Comprehensive Cancer Center reported the findings in the Jan. 20 issue of the Journal of Clinical Oncology.

Diminshing cognitive functions such as deterioration in memory, reduced ability to process information quickly, and reduced verbal fluency have been linked to risk of dementia in old age. Taking supplements of folic acid may significantly improve cognitive function in older men and women.

A group of 818 men and women over-50s were followed for three years. Some were given 800 micrograms of a synthetic form of folic acid per day, the rest took a placebo. The scientists found that the group who took the folic acid improved on all aspects of cognitive functioning compared to the group that took the placebo.

Some research studies have linked folic acid supplement taking with reductions in various age-related impairments such as hearing loss and Alzheimer's. Others are not so clear, but there seems to be consensus that it helps improve cognitive function in elderly people with high concentrations of the amino acid homocysteine in their blood, which could indicate increased riks of stroke, heart disease and Alzheimer's.

The study was led by Jane Durga from the Wageningen University in The Netherlands and is to be published in the Lancet.

Paper prescriptions are dangerous because of the risk for medical errors. The technology for electronic prescribing has existed for some time, yet fewer than 5% of practicing physicians in the U.S. currently use electronic prescribing. Many physicians are reluctant to adopt electronic prescribing largely because of the cost of the systems and a perception that the technology requires too much time to learn and install.

The National E-Prescribing Safety Initiative -- a coalition of technology and health care companies -- has launched an Internet-based electronic prescribing program that physicians can access at no cost. The software, called eRx NOW, is available free to any health care provider with legal authority to prescribe medication, and requires no download, no new hardware and minimal training. Health care information technology company Allscripts and Dell developed eRx NOW with contributions from Cisco Systems, Google and Microsoft. Other members of NEPSI include Aetna, Wellpoint, Sprint Nextel and SureScripts. The initiative will cost more than $100 million over five years.

The American Medical Association and the American Academy of Pediatrics have voiced concern over the trend to retail-based health clinics. Retail-based clinics, located in stores like Wal-Mart, Target and CVS, promise quick attention for routine visits with no appointments. The AMA opposes retail-based clinics as an appropriate source of medical care for infants, children and adolescents and strongly discourages their use.

Anne Pohnert, Washington, D.C.-area manager of operations for retail clinic chain MinuteClinic, said, "Many patients would like to get in to see their primary care physician, but when they call, there is no appointment available." She added, "We believe that a visit to MinuteClinic instead of an [emergency department] on a Friday evening for a five-minute strep test is a win-win for patients and insurers trying to save time and health care costs."

Rick Kellerman, president of the American Academy of Family Physicians, said, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." Kellerman said that physicians, who are concerned about retail clinics "encroaching on the economics of their business," already have begun adapting to the trend by expanding office hours, opening on weekends and offering online scheduling. AAFP also has launched a national project to test ways to improve patient care and "make primary care practices more welcoming to patients.

See full story at WashingtonPost.com, Is 'Quick' Enough?
Store Clinics Tap a Public Need, but Many Doctors Call the Care Inferior

Hundreds of thousands of toddlers and preschoolers in the U.S. get ear tubes each year, but a landmark study published in the Jan. 18 issue of The New England Journal of Medicine. shows that a most number may not need them for the purpose of avoiding future developmental problems.

Ear tubes are prescribed for fluid buildup, by itself is usually not painful, but it does affect hearing in the short term. The thinking has been that these early hearing problems could lead to long-term language and developmental impairment.

Early treatment with tubes was not shown to improve developmental outcomes, as measured by a battery of tests conducted throughout the children's lives, up to ages 9 to 11. The tests included checks of reading, spelling, writing, behavioral issues, social skills, and intelligence.

The report does not address the usefulness of tubes for the treatment of kids with repeated, painful ear infections. But it does show that tubes may not be an appropriate option for children who simply have persistent middle-ear fluid.

SOURCES: Paradise, J.L. The New England Journal of Medicine, Jan. 18, 2007; vol 356: pp 248-261. Jack L. Paradise, MD, professor emeritus, University of Pittsburgh. Stephen Berman, MD, pediatrician, Children's Hospital, Denver; professor of pediatrics, University of Colorado School of Medicine.

Cervical cancer could be virtually eliminated if all females used the vaccine against the sexually transmitted Human Papillomavirus (HPV), the virus that causes cervical cancer. In June 2006 the FDA gave the go ahead to use the vaccine in females aged 9 to 26. Another HPV vaccine is due to come before the FDA for approval this year.

The types of HPV that the vaccines protect against account for 70 per cent of cervical cancer cases, so it is still important to push for screening to catch the other 30 per cent. Also, screening will be important for those women who may already have been exposed to the HPV types target by the vaccines, and for women who for whatever reason do not get vaccinated.

HPV is the most common sexually transmitted disease in America, where 6 million cases are diagnosed annually. The number of women in 2006 that will have been diagnosed with cervical cancer is estimated by the American Cancer Society (ACS) to reach 9,710, and 3,700 will have died of it.

Most primary care physicians say that they accommodate their patients' requests for drugs they have seen in TV ads, according to a survey published in the February issue of Consumer Reports. The survey questioned 335 doctors and 39,090 U.S. residents. It found that 78% of PCPs received patient requests for specific drugs they have seen advertised on television and that 67% reported they sometimes grant the requests.

In addition, the survey found that 41% of doctors feel patients are poorly informed. According to Robert Thompson, a professor of popular culture at Syracuse University, direct-to-consumer drug ads "have completely turned around the old relationship when the doctor was this godlike character and you used to go in there all deferentially." Consumer Reports urges readers to "ignore drug ads" and cautions that the drug industry "spends billions of dollars a year trying to get you to pester your doctor for expensive, new brand-name drugs".

Separately, health insurance carriers often point to direct-to-consumer drug ads s one of the significant causes of increased prescription drug costs.

See full story from Atlanta Journal-Constitution, TV drug ads influence doctors' orders

Powerful business interests that once teamed up to defeat Democratic healthcare plans now advocate extending medical insurance to millions of Americans. Among the champions of change is the trade group representing the nation's leading health insurance firms. That industry developed the "Harry and Louise" television ad campaign, which helped turn public opinion against the universal healthcare plan proposed by President Clinton and then-First Lady Hillary Rodham Clinton in 1994.

Today, the president of the Service Employees International Union will stand with the director of the Business Roundtable, which represents the nation's leading corporations, to announce one campaign to overhaul healthcare. On Thursday, private health insurance companies will join with doctors' organizations and health-activist groups on the left to announce a plan for universal coverage.

The two plans being announced this week — the details of which were not available — come in the wake of ambitious blueprints for universal health coverage put forward by two prominent Republicans: in California by Gov. Arnold Schwarzenegger and in Massachusetts under Gov. Mitt Romney, who has since left office and is a 2008 presidential candidate

Now, Democratic constituent groups, including labor and seniors' organizations, are joining with big business to demand a substantive response to the nation's healthcare problem, which has left 46 million people uninsured and has undermined American corporations' ability to compete internationally.

See full story in the L A Times, Unlikely allies advocate healthcare overhaul

Two Medicare recipients taking the same drugs but living in different states could face costs that differe by thousands of dollars - even if each had chosen the lowest-cost plan available to them. And within a state, the difference in a person's costs for the same drugs could top $10,000 a year or more, depending on which plan he or she chose. Such wide variation in prices demonstrates that Medicare prescription drug plans are substantially more affordable in some states than in others. The difference in plan costs appears to have little to do with the cost of living in different states. In fact, some of the states with the lowest cost-of-living-adjusted average incomes had some of the highest drug plan costs.

For example, the 78-year-old woman might pay $4,113 out of her own pocket each year for her four medicines if she chose the lowest-cost plan available in Michigan, while the same drugs would cost her $16,856 if she lived just over the border in Ohio and had chosen the lowest-cost plan there. On average across the United States, her plan costs would be $8,146.

This shows just how high the stakes can be when a senior is deciding which plan to choose, or deciding whether or not to switch plans. It is extremely important that Medicare beneficiaries use the online cost calculator or get other assistance as they choose their plans because choosing a plan based on a familiar name may not lead to the lowest costs for a person's medicines.

The results, published in the January Journal of General Internal Medicine, online at http://www.springerlink.com/content/7177637783wu21wj/

A new study published in the Annals of Internal Medicine has indicated that not only does growth hormone (GH) not help you live longer, but it comes with a substantial potential for adverse side effects, such as diabetes, carpel tunnel syndrome and swollen joints. Growth hormones have been promoted for years as wonder products that can prevent, even reverse, the aging process.

Researchers from the University of Stanford looked at 31 studies. The study looked at a total of 220 participants - average age was 69 - who received growth hormone. The researchers found that growth hormones did bring about a slight reduction in body weight and a slight increase in muscle. They did not detect, however, any change in the patients' cholesterol levels, aerobic capacity or bone density.

The researchers did find that there was an increase in developing soft tissue edema (swelling), arthralgias, carpal tunnel syndrome and gynecomastia. They were also more likely to experience the onset of diabetes mellitus and impaired fasting glucose.

Dr Hau Liu, team leader, said "There is certainly no data out there to suggest that giving growth hormone to an otherwise healthy person will make him or her live longer. We did find, however, that there was substantial potential for adverse side effects. In short, the studies provided no real evidence that the therapy resulted in increased fitness."

Annals of Internal Medicine
16 January 2007, "Systematic Review: The Safety and Efficacy of Growth Hormone in the Healthy Elderly"

A study in Norway examined delivery records over a six-month period. According to the study, 5.2% of infants delivered by planned vaginal deliveries were transferred to neonatal intensive care units, compared with 9.8% of infants delivered by planned c-section. About 0.8% of the infants in the vaginal delivery group experienced lung disorders, compared with 1.6% in the c-section group.

"For the child, the stress of vaginal delivery seems superior to elective caesarean delivery in many situations," the researchers write, adding, "Therefore, we emphasize the importance of limiting planned caesarean deliveries to cases with proven benefit for the mother and/or child".

American Journal of Obstetrics and Gynecology, 16 Jan 2007

WellPoint, the largest U.S. health insurer, on Monday announced a proposal to reduce the number of uninsured residents. Under the proposal, WellPoint will lobby states to expand their health insurance programs to children in families with annual incomes of as much as 300% of the federal poverty level. WellPoint also will lobby states to expand their health insurance programs to parents in families with annual incomes of as much as 200% of the federal poverty level and childless adults with annual incomes of as much as $10,000.

WellPoint said that states could use funds from increased cigarette taxes to help cover the cost of expanded health insurance programs. In addition, WellPoint will establish new health plans that target large populations of uninsured residents, such as young adults, early retirees and Hispanics and will promote public-private partnerships to provide health insurance for those who do not qualify for public programs. WellPoint will spend $30 million over three years to support local programs nationwide that seek to improve health care access .

Walgreen has opened 50 in-store clinics in five markets since last year and plans to operate 250 nationwide by August. They have 5,584 stores nationwide. "The clinics over time will help lower health care costs," CEO Jeffrey Rein said.

Walgreen hopes the in-store clinics, which offer treatment for minor ailments and are operated by nurse practitioners, will boost prescription drug sales and encourage customer loyalty. Walgreen is moving forward carefully with the expansion in an effort to avoid alienating doctors.

CVS, Wal-Mart and Target in the past three years also have opened in-store clinics. I applaud this trend given the growing shortage of Family Practice physicians.

California Governor Schwartzenneger wants to require everybody in California to carry health insurance. That means illegal immigrants too. No way, say most Californians. Not for people who sneaked into the state illegally.

Schwartzenneger puts it this way, "Let me be clear about this one issue … the debate over covering undocumented or illegal immigrants. I don't think it is a question or a debate if they ought to be covered…. A federal law requires us to treat everyone who shows up at an emergency room and needs care….Therefore, the decision that [we] made was not should we treat them…. The question really is, how can we treat them in the most cost-effective way? Because right now they go into an emergency room, and that means sometimes thousands of dollars are being rung up. But in the meantime, we can do it cheaper by sending them just to a doctor…. We are trying to be realistic here and not live in denial."

Read full story in Los Angeles Times, Part of Schwarzenegger's health plan faces tough sell to public

Weight loss, or bariatric, surgery was nine times more common in 2004 than in 1998 in the U.S. - 121,055 in 2004 - most of those operations were gastric bypass surgeries.

"This report shows that more Americans are turning to obesity surgery and that an increasing number of younger people are undergoing these procedures," says AHRQ Director Carolyn Clancy in an AHRQ news release.

"As the rate of obesity continues to climb, the health care system needs to be prepared for continued escalation in the rate of this surgery and its potential complications," Clancy says.

Bariatric surgery can have complications, but the report shows a drop in the hospital inpatient death rate. In 2004, 230 patients died in hospital stays in which bariatric surgery was performed, down nearly 80% from 1998.

Consumer Reports conducted the survey in three phases last year. The survey of about 39,000 patients and 335 primary care doctors appears in the February edition of Consumer Reports.

These tips from Consumer Reports might get you better care:

Get referrals. Friends, co-workers, or relatives can provide recommendations.

Research carefully. When gathering health information, consider the quality of the source.

Make an agenda. Before your appointment, set priorities about what you want to discuss with your doctor.

Ask about email. If you don't have time to cover everything in your appointment, ask if you can follow up by email.

Bring someone with you. A friend or relative can help you get your questions answered and remember what the doctor tells you.

Tell it like it is. Be frank, honest; and don't be shy. Bring up any conditions bothering you.

Follow your doctor's advice. For example, don't stop taking medications without talking with your doctor.

Be persistent. Work with your doctor to find the right treatment.

Switch doctors, if necessary. Not happy with your doctor? There are others out there.

Keep drug ads in perspective. If you ask your doctor for a drug you saw advertised, understand he may or may not agree its the right drug for you.

The Texas Legislature will consider two bills that would require girls entering the sixth grade to receive the human papillomavirus vaccine Gardasil - shown in clinical trials to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases.

The FDA approved the vaccine in July 2006 for sale and marketing to girls and women ages nine to 26, and the CDC voted unanimously to recommend that girls ages 11 and 12 receive the vaccine.

California's proposal to mandate health insurance covrage for all demonstrates that with Congress stalled on enacting comprehensive health care reform, the states are beginning to take matters into their own hands. Schwarzenegger said, "If you can't afford it, the state will help you buy it, but you must be insured".

Karen Davis, president of the Commonwealth Fund, said, "This is a very significant proposal. It is not just children he is talking about. It is really dealing with the whole problem of the uninsured, with concrete positions to raise revenues to pay for that coverage and the philosophy of shared responsibility."

Diane Rowland, executive vice president of the Kaiser Family Foundation, said, "Health care for the uninsured is back on the agenda," adding, "The governors are trying to lead the way, but it's also going to take national action to try to address this problem"

Some states - like New York and New Jersey - already promote individual coverage by requiring insurers to offer it to all comers through what are known as "guarantee-issue" laws. Studies show guaranteed issue can price people out of the market, and, as public policy, it achieves the opposite goal of getting more people insured. In New York and New Jersey individual health insurance rates are much higher than most other states. Consequently, only those who really need it (the sick and those needing medical treatment or procedures) buy health insurance.

In California, Gov. Schwarzenegger has said he favors requiring individuals to obtain health insurance in the same way drivers must carry automobile coverage. He certainly knows that such a mandate won't work if insurers are allowed to exclude all but the healthiest customers as current law in most states allows.

One health plan believes that private insurers ought to share the risk and that selective underwriting ought to be abolished. "We think it's a bad system," said David Seldin, a spokesman for Blue Shield of California. "We operate the same way as everybody else in the marketplace does, using the same actuarial data that everyone else in the marketplace does, because it's the only way to remain economically viable," he said. "But we would really like to see the system changed."

I'll admit it. I fell for one of those weight control scammers. About two years ago, I threw away about $100 on CortiSlim tablets. Their incessant radio ads appealed to me because they were spoken by a principal of the company, Dr. Somethimgorother, in a low-key, matter-of-fact pseudoscientific presentation that made me call their 800 number. The pills produced no noticable result and I moved on.

This week the FDA fined CortiSlim and three other weight control con artists (Xenadrine EFX, TrimSpa, One-A-Day WeightSmart) $25 million in false advertising claims. The common theme in these cases is the marketers made claims that their products contain new, breakthrough ingredients which are proven to cause weight loss or control weight. But the claims aren't supported by sound science.

A new federal database makes public for first time statistical data that compares health insurance costs among the nation’s largest cities and other geographical areas. A warning: this is a government website so user friendly it is not.

Some highlights from the new data for the 20 largest metro areas:

Average premiums for family coverage were highest in New York ($11,244) and lowest ($8,521) in the Riverside, California metro area, which includes San Bernardino and Ontario.

Premiums for single coverage were highest in San Francisco ($4,185) and lowest in Riverside, ($3,012).

The data include statistical averages from the following cities and surrounding areas: New York, Los Angeles, Chicago, Philadelphia, Dallas-Fort Worth, Miami, Houston, Washington, DC, Atlanta, Detroit, Boston, San Francisco, Riverside, Phoenix, Seattle, Minneapolis, San Diego, St. Louis, Baltimore and Tampa.

The estimates, which are from AHRQ’s Medical Expenditure Panel Survey for 2004 -- the most current data -- show large geographical variations in how much Americans pay for family coverage and individual coverage as well as how much employers contribute to workers’ health insurance premiums. We already know that the quality of health care can vary significantly according to geography. These new data highlight local cost variations.

This is all part of the US Department of Health and Human Services drive for health care transparency. Looks like they are getting some traction.

Kaiser Foundation Health Plan Inc.is working with state regulators to develop standards to protect its members from unfair cancellations of health insurance, a move that hopefully will lead to industrywide reforms. The move comes amid a growing controversy over the insurance industry's cancellation of individual policies - the type people without employer-based group coverage buy for themselves. Kaiser said its proposed standards would include the requirement that it consult with policyholders before deciding whether to rescind their coverage. Such a consultation would help the HMO determine whether policyholders intentionally submitted inaccurate information about their health conditions in order to obtain coverage.

Kaiser embraces a standard for cancellation pushed by consumer advocates. Other health plans, are fighting regulators and former policyholders for the right to rescind coverage when medical information relevant to the policy-granting decision is left out of an application — even if the omission is an honest mistake.

Amy Dobberteen, enforcement chief for the Department of Managed Health Care, said Kaiser's plan to talk to policyholders first was a shift in the right direction. "Other plans have pointed out to us endlessly that that's not required by law," Dobberteen said. "For goodness sake, if you are consumer-friendly, why wouldn't you contact the consumer? … A health plan does have the moral responsibility to pursue [this information] when they are about to wipe out from under them their entire health security blanket."

The new protocol Kaiser is developing would require the HMO to contact policyholders and gather their input before making a rescission decision, said James Larreta-Moylan, Kaiser's business line manager for individual plans in California. "In the past, when we had investigated, if we had enough documentation, we would rescind and give them an opportunity to appeal," he said. "So now we're actually going to seek their input. We've flipped it around."

See full story by Lisa Girion of the Los Angeles Times, Kaiser to push for standards on health plans

Pharmacies are allowed to make and sell their own drugs. The practice, known as compounding, has long been accepted as a way for physicians to tailor drug therapies to individual patients—say, by instructing a pharmacist to turn pills into liquids for someone who has trouble swallowing. Such products can be sold without FDA approval, provided the pharmacist has a prescription from a doctor. But once a compounding pharmacy starts mass-marketing its own recipes, via the Web or other means, the FDA can regulate it as if the pharmacy were a commercial drug manufacturer.

A pharmacy called Med4Home advertises on the Internet and TV. They target Medicare recipiants, promising to deliver medications to the door and file their Medicare claims for them. But what Med4Home actually delivers are reformulated versions of the brand-name medicines. Med4Home's parent company, home health-care provider Lincare Holdings Inc., (LNCR ) is being investigated by the Food & Drug Administration. In August 2006, the agency sent a warning letter to another Lincare affiliate that makes the drugs Med4Home delivers. The FDA blasted the affiliate, Reliant Pharmacy Services, for making drugs at "ineffective or dangerous dosage levels," maintaining poor quality-control practices, and in some cases sending patients non-FDA-approved copies of commercially available drugs without getting clearance from their physicians.

See full story at BusinessWeek.com, Is Your Medicine The Real Deal?

It's difficult to get insured if you don't belong to an employer group. In California, 20% of people who applied for individual coverage were turned away or charged a higher premium because of preexisting conditions. California carriers turn people away or charge them higher premiums for conditions that range from the catastrophic to the common. Cancer, epilepsy and AIDS make the list, along with breast implants, ear infections, varicose veins and sleep apnea.

According to regulators' postings, rejection letters and interviews with brokers, conditions that can lead to outright rejection or a higher premium include: AIDS, allergies, arthritis, asthma, attention deficit disorder, autism, bed-wetting, breast implants, cancer, cerebral palsy, chronic bronchitis, chronic fatigue syndrome, chronic sinusitis, cirrhosis, cystitis, diabetes, ear infections, epilepsy, gender reassignment, heart disease and hemochromatosis (a common genetic disorder that causes the body to absorb too much iron).

Other conditions are hepatitis, herpes, high blood pressure, impotence, infertility, irritable bowel syndrome, joint sprain, kidney infections, lupus, mild depression, muscular dystrophy, migraines, miscarriage, pregnancy, "expectant fatherhood," planned adoption, psoriasis, recurrent tonsillitis, renal failure, ringworm, severe mental disorders, sleep apnea, stroke, ulcers and varicose veins.

Lisa Girion, a staff writer for the Los Angeles Times, published a comprehensive story on this subject, published Sunday, Dec. 31, 2006, Healthy? Insurers don't buy it I strongly recommend it.

How many people do you know who take vitamin C and echinacea to prevent colds, melatonin for insomnia, or St. John's wort for depression? More than 60% of Americans use herbal and dietary supplements, yet the Food & Drug Administration (FDA) has virtually no authority over these so-called safe and natural wares. Reputable study after study has failed to show that these remedies are effective. The only supplements with unqualified support are calcium and vitamin D for women at risk of osteoporosis, folate for pregnant women, and fish oil, containing omega-3 fatty acids, for lowering cholesterol and blood pressure. Multivitamins, taken by more than half of all adult Americans, have been largely dismissed by the National Institutes of Health.

A new book just published by author, Dan Hurley, Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry, is an angry and detailed exposé of the largely unregulated field of natural remedies. Hurley has gathered considerable data on the steady flow of deaths, disfigurements, and injuries linked to this $21 billion-a-year business.

A gene variation that helps people live into their 90s and beyond also protects their memories and ability to think and learn new information, according to a study published in the December 26, 2006, issue of Neurology, the scientific journal of the American Academy of Neurology.

The study examined 158 people, who were 95 years old or older. Those who had the gene variant were twice as likely to have good brain function compared to those who did not have the gene variant. The researchers also validated these findings in a group of 124 who were between age 75 and 85 and found similar results.

“It’s possible that this gene variant also protects against the development of Alzheimer’s disease,” said study author Nir Barzilai, MD, the director of the Institute for Aging Research at Albert Einstein College of Medicine in Bronx, NY. Work is being done to develop drugs that can mimic the effect of this gene variation, Barzilai said.