Medicare, Social Security, Medicaid – All Discretionary Spending

 

George Will says all federal spending is ultimately “discretionary”

Members of Congress are actively working to cut the federal budget and bring down spending. But they’re steering clear of the politically difficult, big-ticket items such as Social Security, Medicare, Medicaid, interest on the debt and national defense.

“It’s not being debated because they say we’re only going to debate discretionary spending. We should ban that word,” said conservative commentator George F. Will on This Week with Christiane Amanpour.

“It’s all discretionary, other than interest on the national debt. Social Security is discretionary. We have the discretion to change the law. Same is true with Medicare and Medicaid,” Will said.

We thought Will’s statement was a provocative and interesting way to frame the debate. But was it true? We decided to check it out.

We’ll begin with a brief lesson on the terms Congress uses to describe the federal budget.

Discretionary spending means government spending that Congress sets every year through a process known as appropriations. It includes spending for most federal agencies, such as transportation and health. It includes foreign aid and defense spending. And it includes most grant programs administered by the federal government.

Non-discretionary spending, on the other hand, is spending that is controlled by legislation that sets eligibility criteria or spending formulas. It includes entitlement programs such as Medicare, Medicaid and Social Security in which you are legally entitled to benefits as long as you meet certain criteria. It also typically includes programs for which individuals automatically qualify, such as farm subsidies or military benefits. Sometimes non-discretionary spending is called mandatory spending or direct spending.

We ran Will’s comments by four experts on the federal budget. They all said that Will was essentially correct, that non-discretionary spending can be changed at any time by passing new legislation that changes the particular program.

A recent example of this is the health care law supported by President Obama and Democrats in Congress. The law made many changes to Medicare, to reduce its spending, in order to offer subsidies for health care insurance to the uninsured.

“There is no constitutional roadblock to Congress changing any spending at any time. In that sense, all spending is discretionary,” said Marc Goldwein, policy director for the nonpartisan Committee for a Responsible Federal Budget.

The reasons members of Congress are now so focused on discretionary spending is because it’s more politically difficult to change programs that affect benefits for so many voters.

“But you can’t stabilize the debt by focusing on only 12 percent of the budget,” Goldwein added. “Trying to do so is going to make the cuts far more painful than what would be necessary if we were to look more broadly.”

Both Medicare and Social Security were on the table in previous years when the budget needed adjustment, said the experts we consulted on both sides of the political aisle. Jim Horney of the left-leaning Center on Budget and Policy Priorities noted that “every major deficit reduction plan in the last 20 years has made significant changes to Medicare.” Brian Riedl of the conservative Heritage Foundation pointed out that Social Security was changed significantly in 1983 in a deal between Democrats in Congress and President Ronald Reagan.

Interest on the federal debt is a required payment unless the government is willing to default, a highly unlikely scenario. There are a few other contractually obligated payments the government has to make, typically for insurance programs such as mortgage insurance, flood insurance, and federal deposit insurance. But those payments are relatively small.

“I would add that even interest on the debt is in some way discretionary, because levels of debt can be changed by decisions to tax and spend and not run budget deficits,” said Josh Gordon, policy director of the Concord Coalition, a nonpartisan group that wants to eliminate deficits.

Will said that federal spending is “all discretionary, other than interest on the national debt. Social Security is discretionary. We have the discretion to change the law. Same is true with Medicare and Medicaid.” Will is making a broad statement here and leaves out a few details. But he’s largely correct, and we rate his statement True.

http://www.politifact.com/truth-o-meter/statements/2011/mar/15/george-will/george-will-says-all-federal-spending-ultimately-d/

Medigap on the Chopping Block

Medigap cuts. Georgia seniors on Medicare may see their Medigap insurance policies cover less and less if Washington get’s their way. Many are on a fixed income and are just barely making it, but Washington believe Georgia Medicare supplement plans are bad for Medicare.

Kaiser Health News reports:

As debt limit talks drag on, lawmakers are eying possible changes in Medicare supplemental plans – moves that could increase seniors’ out-of-pocket costs.

Traditional Medicare, the federal health program for the elderly and disabled, requires beneficiaries to pay hospital deductibles and a portion of the cost of tests and doctor visits.  To protect themselves from those out-of-pocket costs, about 17 percent of beneficiaries buy Medigap plans.   Another 34 percent get such coverage through a former employer.

But some health policy experts say such “first-dollar protection” drives up demand for Medicare services, costing the government money for what may be unnecessary care. One proposal would bar supplemental insurance from completely eliminating out-of-pocket costs – or charge enrollees a $530 a year extra if they want to keep such protection. That change could save up to $53 billion over 10 years, according to a chart used during the bipartisan talks led by Vice President Joe Biden.

What is Medigap and why do people buy it?

Unlike most job-based health insurance, traditional Medicare does not include “catastrophic” coverage, an annual maximum upper limit on the amount beneficiaries could pay. So enrollees can be liable for thousands of dollars each year, including: $1,132 per-episode deductible for hospital admissions; hundreds of dollars in daily charges for hospital stays of longer than 60 days; a $162-a-year deductible for doctor care, plus 20 percent of charges for office visits or equipment like wheelchairs.

Ten standardized types of Medicare supplement plans offered by private insurers – including AARP’s UnitedHealthcare policies  – cover all or most of such deductibles and copayments.  Some employers also pay all or part of such costs for their retirees.

What changes are under consideration?

It is not clear exactly what’s on the table in the negotiations between congressional leaders and the White House.  But the charts  released show that one such proposal under consideration would bar insurers from offering supplemental policies unless the policies came with an annual deductible. People who didn’t want a deductible could pay $530 a year in additional premium to ensure that they won’t be hit with costs before their coverage kicks in.

Is this a new idea?

No.  It is a subset of a larger discussion about spending on Medicare and other entitlements. In recent years, the National Commission on Fiscal Responsibility and Reform (The Bowles-Simpson Commission), the Debt Reduction Task Force, the Medicare Payment Advisory Commission and lawmakers, including Sen. Joe Lieberman, a Connecticut independent, and Sen. Tom Coburn, an Oklahoma Republican, have all suggested changing traditional Medicare.

Most of the ideas would create a single annual deductible – generally around $550 – after which beneficiaries would pay about 20 percent of medical costs up to a maximum annual cap, ranging from around $5,000 to more than $7,500.

Would changing supplemental coverage save money?

Some economists and policy experts say that supplemental coverage insulates beneficiaries from medical costs, driving up demand for unnecessary care. A study done for MedPAC in 2009 found that beneficiaries with supplemental insurance used more care and cost the program more money. The increased spending wasn’t for emergency hospitalizations, but for other services such as elective hospital admissions, preventive care, doctor office visits and some types of tests.

Supporters of the insurance say it shields seniors from unpredictable costs and reduces big-ticket expenses by encouraging them to seek help for medical problems before they become severe.

What else do people say about the idea?

Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says.

Still, Joe Antos of the conservative American Enterprise Institute says many of those people already pay large premiums for Medigap coverage – and would likely see those premiums decline if “first-dollar” protections are barred. Antos and Jonathan Gruber, an economist at MIT and consultant to Democrats, both think that if Congress were to change supplemental coverage – or the traditional program itself – that lawmakers would create exemptions for lower-income beneficiaries.

How would the proposal affect a Medigap policy I already own?

Congress would have to decide whether to impose restrictions only on new policies or include existing coverage.

What about people who don’t have a Medigap plan?

Only about 10 percent of seniors don’t have some sort of supplemental coverage. Some people have military/VA benefits, others are in Medicaid, and some have coverage through Medicare Advantage plans, which are insurance policies offered by private insurers as an alternative to traditional Medicare.

What are the chances that these ideas will be adopted by lawmakers?

Because making any change that could be seen as a cut in Medicare benefits carries huge political risk, previous calls for changing the traditional Medicare program or limiting first-dollar coverage through supplemental insurance have not picked up support. But now, when failure to lift the debt ceiling could result in widespread economic problems, a middle-of-the night compromise between warring factions in Congress could put it back on the table.

“Normally, this would be dead on arrival. But this is such a dicey environment that these guys are going to cut some kind of deal at midnight either before or after Aug. 2 in such a hurry that they won’t be worried about the kinds of things people normally worry about when they cut senior benefits,” says Robert Laszewski, an Alexandria-Virginia-based consultant to the health care industry.

Antos is less sure. He says the potential savings of $53 billion over 10 years would be just a tiny slice of any deficit-reduction deal and might not be worth the political hit Congress would take from seniors.

“You can’t sugar coat it,” says Antos. “It would be much easier to do what lawmakers have always done in Medicare, which is lower payment rates (to doctors and hospitals) or restrict services in ways that are subtle and complicated. But to do something that looks like changing benefits, I don’t see it this time.”

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GERD and Orange Peel

Natural Supplements Like Orange Peel Extract Can Help Fight Heartburn

Author: Darrell Miller

If you think about how many prescription and over-the-counter heartburn medicines there are, you'd guess that everybody in American suffering from heartburn.

It is true. A Gallup Organization national survey discovered more than 60 million Americans experience heartburn symptoms every day. But, there is good news orange peel extract can work to relieve heartburn pain safely and effectively and without side effects. Many people tell about its great success in their lives.

What is heartburn?

Heartburn is the pain caused by the splashing up of fluids from the stomach into the esophagus. The stomach has a special lining to protect itself from the hydrochloric acid, the esophagus does not. At the bottom of the esophagus there is a circular muscle called lower esophageal sphincter (LES). When the LES opens to soon stomach acid travels from the stomach into the esophagus, this is what causes the burning pain.

What is the difference between heartburn and ulcers?

Stomach ulcers are sores usually caused by a bacterial infection or overuse of aspirin in the stomach. A stomach ulcer and heartburn are in the same family. They have mostly the same symptoms and treatments, and could eventually be a serious problem if left untreated.

What's the difference between heartburn and GERD?

Gastroesophageal reflux disease's (GERD) symptom is continual heartburn throughout an entire week. GERD can be a very serious disease because the hydrochloric acid can wear away the esophagus lining and develop scar tissue. Scar tissue causes problems with trying to swallow. GERD also can help cause asthma, pneumonia, hoarseness, chronic cough, and the erosion of teeth. Recently, doctors have found that GERD can be the cause for cancer of the larynx and pharynx.

What causes heartburn?

There are many causes for heartburn. The esophagus has an important function to allow humans to swallow. When we swallow, small muscle fibers contract creating a movement called peristalsis. The slowing down of esophageal peristalsis happens with age and heartburn can develop.

Overeating can also cause heartburn, because the food has overfilled the stomach which allows acid to come up. The acids can also cause heartburn when bending over, lying down, or lifting heavy objects.

Foods can cause the discomfort of heartburn. Foods and beverages such as: chocolate, tomatoes, raw onions, citrus fruits, garlic vinegar, black pepper, citrus juices, caffeine, carbon, and alcohol. Smokers are also more prone to heartburn because it relaxes the LES which opens to let the acid out.

Who else is prone to developing heartburn?

There are three major types of people who are more apt to having heartburn. People who are overweight get heartburn because their fat adds pressure to the abdomen. Also pregnant women get heartburn because of their pressure on the abdomen from the baby. Doctors also say that a woman's changing hormones can cause the muscle valve to relax. An overwhelming 25% of women have heartburn during their pregnancy.

Heartburn is also known to show up in people with hiatal hernias because in this condition, the stomach slides above the diaphragm, a thin muscle that keeps the stomach away from the chest. Food and the acid are now able to flow back into the esophagus, which causes heartburn.

What side effects do many heartburn medications have?

No medications can cure heartburn, but they can relieve the pain for a period of time. Some medications are known to impede some vitamins and calcium absorption, as well as interfere with digestion and stomach secretions.

Heartburn medications work for some people most of the time, but for some they lack a consistent relief. This allows for many people to switch brands to find the one that will work the best for their body.

Antacids use substances to neutralize stomach acid, but now the hydrochloric acid can not do its vital functions, like digesting food, inhibiting bacterial growth, and absorbing vitamins and nutrients. Also, when the acid is neutralized, our body reacts by creating even more, which would cause even greater heartburn. This cycle is known as "acid rebound."

Antacids also have many side effects. Food poisoning is more apt to happening because bacteria can survive longer with the antacids.

Proton pump inhibitors (PPIs) restrain the acid from creating. Actually, it practically shuts down the stomach's ability to produce acid.

The most common heartburn medications, such as Nexium, Prilosec, and Prevacid are actually supposed to be used short-time, but people are using them as a long-term medication. Using the orange peel extract is a safe alternative because it has no side effects.

How does orange peel extract work?

Orange peel extract is being researched and there are several possibilities as to how it stops heartburn. Some believe that it helps food move through the stomach, forbidding food to stay in the esophagus for a long period of time. This minimizes the chance for heartburn. It can also work as a surfactant, which reduces the surface tension of a liquid and would decrease the potential for the hydrochloric acid to splash.

How much orange peel extract should I take?

It is recommended that 1,000 mg be taken every other day, which was used in the scientific studies. Look for a product with 98.5% purity of d-limonene, found in the orange peel extract.

How does orange peel extract cure heartburn?

Almost 90% of the participants in the studies said that their heartburn was happening less after two weeks and about one-third said that they had a resolution of the heartburn after about two days. Even better, participants said that although they stopped take the orange peel extract, two weeks after they hadn't felt heartburn. On a scale of 1-10 (10= mild and 1= severe), the study participants had an average rating of 7.8 and two weeks after the end of taking the orange peel extract they stopped having any heartburn. Seldom, some people felt heartburn after eating the foods that they previously avoided, but a single orange peel extract pill solved the problem.

Is orange peel extract safe?

It is an all-natural product, which makes it safe for many people. You should always follow the directions on the bottle.

You shouldn't take it if you are pregnant or nursing or if you have an ulcer. Ulcers will create a burning irritating sensation. Children shouldn't be given the orange peel extract because it has not been tested on them yet. Orange peel extract has been used in cancer studies for many years, and scientists haven't found any adverse effects.

Does orange peel extract affect cancer?

Research has discovered that orange peel extract has prevented cancer activity by inhibiting the way cancer cells divide and grow. Some cancers that the orange peel extract has prevented are breast, skin, liver, lung, pancreatic, colon, and stomach cancers, in laboratory studies.

One study had 32 cancer patients take the orange peel extract, and no toxicity was observed. Blood analysis revealed that the orange peel extract was absorbed in to their bodies very well. More research is needed on orange peel extract and cancer.

Some important last notes

Frequent heartburn could mean a more serious condition and if this is you, you should consult a professional health physician.

Conclusion

Heartburn can be very serious. It happens to millions of Americans who spend billions of dollars on medications. Orange peel extract is an inexpensive and safe way to relieve heartburn pain. Orange Peel Extract can be found at any health food store.

Article Source: http://www.articlesbase.com/medicine-articles/natural-supplements-like-orange-peel-extract-can-help-fight-heartburn-91394.html

About the Author
Visit VitaNet Health Foods at http://vitanetonline.com/ VitaNet sells high quality supplements like HeartBurn Free Orange Peel Extract. Please link to this site when using this article.

Heartburn Drugs Safe?

Heartburn drugs OK for short term, but risks remain

Mar 25, 2011 12:46 PM
CRHL0510 PrilosecEquate thumb 240xauto 85 Heartburn Drugs Safe?
 
 

The over-the-counter drugs Prilosec and Prevacid are safe when taken short term, according to an annoucement this week from the U.S. Food and Drug Administration. But many people take the drugs long-term, increasing their risk of fractures.

The FDA said that OTC proton-pump inhibitors don't pose a fracture risk when they're taken for less than 14 days, three times a year. However, taking the drugs longer or more often does increase those risks, especially when taken for a year or longer.

That's why we say consumers should exercise caution when using the drugs to treat heartburn orgastroesophageal reflux disease (GERD).

Over-the-counter doses of PPI medicines should be:

 

  • Omeprazole (found in Prilosec OTC and others) — 20 mg tablet (Once a day for no more than 14 days. The 14-day course may repeated every 4 months.)
  • Lansoprazole (Prevacid 24HR) — 15 mg tablet (Once a day for no more than 14 days. The 14-day course may repeated every 4 months.)

New COPD Drug

FDA Approves New Drug to Treat COPD

Daliresp Will Be Sold in Pill Form to Treat Chronic Obstructive Pulmonary Disease
By Bill Hendrick
WebMD Health News
Reviewed by Laura J. Martin, MD

 

69x75 new drug copd 02 New COPD Drug

March 1, 2011 — The FDA has approved a new treatment for people with worsening symptoms of severe chronic obstructive pulmonary disease (COPD), a lung disorder that makes breathing difficult.

The drug, roflumilast — carrying the trade name Daliresp — will be sold in pill form, unlike some other medications for COPD, which are inhaled.

The FDA says roflumilast, a new drug class for COPD treatment, is an inhibitor of an enzyme called phosphodiesterase type 4 (PDE-4).

The pill is recommended for people with severe COPD to treat symptoms of cough and excess mucus linked to bronchitis. It is not intended to treat another form of COPD, which involves primary emphysema.

The FDA’s approval was announced even though the agency’s advisory panel voted 10-5 on April 7, 2010, not to recommend approval of the once-daily pill.  At the time the panel members decided the drug had too many adverse effects to offset what the FDA called a “modest” increase in lung function attributable to roflumilast.

The FDA approval of roflumilast requires a medication guide informing patients of the potential risks of mental health problems, including changes in mood, thinking, or behavior, as well as unexplained weight loss.

 

COPD Symptoms

Symptoms of COPD include breathlessness, chronic cough, and excessive phlegm.

An exacerbation can last up to several weeks and result in a decline in lung function and increased risk of death, and it may be associated with severe anxiety, the FDA says.

Cigarette smoking is the leading cause of COPD.

“COPD is a serious disease that gets worse over time,” Curtis Rosebraugh, MD, MPH, of FDA, says in a news release.

“New treatment options that reduce frequency of flare-ups or exacerbations are important in helping patients with COPD associated with chronic bronchitis and a history of exacerbations in managing this debilitating disease,” says Rosebraugh, director of the office of drug evaluation in the FDA’s Center for Drug Evaluation and Research.

Side Effects

The FDA says in a news release that the safety and effectiveness of roflumilast was demonstrated in two phase III clinical trials that included more than 1,500 patients 40 and older.

The federal agency says that those treated had a history of COPD associated with chronic bronchitis and had experienced an exacerbation of the disease during the 12 months prior to beginning treatment.

The FDA says roflumilast should not be used to treat sudden breathing problemsand is not recommended for people younger than 18.

The most common side effects include diarrhea, nausea, headacheinsomniaback pain, decreased appetite, and dizziness.

The medication is marketed by St. Louis-based Forest Pharmaceuticals, a subsidiary of Forest Laboratories.

http://www.webmd.com/lung/copd/news/20110301/fda-approves-new-drug-to-treat-copd?src=RSS_PUBLIC