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Plot
Arriving in a hail of musket fire, the Doctor unexpectedly finds himself in the highlands of Scotland, where the ruthless Black Donald and his band of rebels are fighting the Redcoats. But the highland warriors no longer fight for the Jacobite cause and the English officers answer only to the mysterious Overlord. What has happened to Scotland and why are its moors littered with advanced, oil-pumping technology?

Reunited with his faithful companion Jamie McCrimmon, the Doctor must venture into the sinister City of Spires to find the answers. But standing in his way is the deadly Red Cap…

Is it any good?
It could do with being a three-parter instead of a four-parter, since episodes three and four are more than a bit flabby in the pacing department, but it's okay. Disappointingly, the first three episodes are all mystery-building: what's happening, who are the aliens behind this all, why are the timelines messed up? – but the fourth episode doesn't answer many of the questions, leaving them to be answered by the rest of the trilogy.

For the most-part, this is mostly a standard run around, with the Sixth Doctor running around the highlands getting mistaken for Frenchmen and Americans, trying to avoid getting shot while working out why Jamie's lost his memory and why time is messed up. Along the way, he meets up with Georgia Moffett, who's looking for her missing French husband.

It's actually quite enjoyable, with Baker giving a very decent performance when he's not putting on an accent and Hines giving a perfectly acceptable, if a little subdued and a little English performance of his own. Moffett seems more interested with delivery, so while she sounds good, she never really delivers the required emotion when needed.

The script does have a lot of research and there's many a line where you think, “Oh, interesting turn of phrase. That's an interesting perspective.” But the aliens are distinctly unimpressive, practically inaudible at times and although a little surprising are more like something out of The Sunmakers than anything else, and Red Cap, the aliens' worker/grunt, is more comical than threatening.

Without knowing how the new two stories proceed, I can't tell you if the pay off for all this timeline disruption is going to be good or not. If you listen only to this play, you're going to be a little disappointed that all the interesting parts of it aren't resolved, leaving you with a pretty dull villain being sorted out and a Doctor/companion reunion where the companion is old and bitter and doesn't remember the Doctor.

Not one to buy by itself then, but we'll see if it's worth it as the first part of a trilogy in a couple of plays' time.

Price
Amazon CD: £14.97
Big Finish download: £12.99
Big Finish CD: £14.99

Cast
Colin Baker (The Doctor)
Frazer Hines (Jamie McCrimmon)
Georgia Moffett (Alice)
Richard Earl (Victor)
James Albrecht (Major Heyward)
Russell Floyd (Sergeant Rilke)
Sam Graham (Guthrie)
Charlie Ross (Rob)
John Banks (Red Cap)

Writer: Simon Bovey
Director: Nicholas Briggs

For the past four years, an elderly gentleman visited the offices of Dr. Ram Y. Gordon, a cardiologist. The details of the patient’s case weren’t remarkable, but what happened after the first visit was. He wrote a letter to his doctor.

“I value and trust and feel comfortable with you, professionally and personally,” the patient wrote, as he explained his reasons for not pursuing a recommended procedure. “I need to count on you for ongoing advice, expertise, help, and perspective. I will endeavor to be a good patient even though this decision will seem to you a mistake on my part.”

It was the first of many letters Dr. Gordon would receive from his patient, a story he recounts with loving detail in the “A Piece of My Mind” column published in this week’s Journal of the American Medical Association:

Mr M always wore a suit, even if our appointment was the only one on his agenda. His words were measured and he spoke in a deep baritone, as if he were giving a lecture. He had a long and distinguished career as an educator, teaching English at a local high school before becoming a nationally renowned advocate of teaching reform. He had published almost 20 books and had been featured in Time magazine. He reminded me of John Keating, the inspirational English teacher in the film “Dead Poets Society.” I looked forward to his appointments.

One day, he asked to learn more about me. I felt uncomfortable. He was my patient, not my friend. Our relationship, while cordial and warm, was one of physician and patient, and I was fairly certain that this line should not be crossed. But this request, from this particular patient, felt somehow different. On his next visit we discussed his stable cardiac disease and then spent 40 minutes talking about me. He was an expert interviewer and sought details of my life, my interests, and my choice of medicine as a career. I let him in.

To learn more about this unusual doctor and patient relationship, read the full essay in The Journal of the American Medical Association, “With Appreciation,” and share your thoughts below.

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We posted yesterday that Rock the Vote President Heather Smith would join Secretary of Health and Human Services Kathleen Sebelius in a conversation about the expansion of health care which now allows people to stay on their parents’ health care until the age of 26. Prior to the chat thousands of  people emailed or tweeted questions about the expansion to Secretary Sebelius and Heather, this video gives lots of answers to some of the questions asked.

Interesting…

Some House Democrats are not content with the transparency requirements in the health care overhaul and say they’re committed to trying to force hospitals, pharmaceutical companies and other industries to reveal their price tags.

Rep. Steve Kagen (D-Wis.), a physician, has introduced a bill that would require all health care providers — from hospitals to insurance companies — to disclose publicly all prices on a continual basis.

It would peel back the curtain on internal negotiations, such as those between a dentist and a dental device maker or a physician and a pharmaceutical company.

The bill’s backers say that consumer prices would be lower if companies had to disclose them publicly. It is unclear how likely it is that the bills would make it to the House floor this year, but similar pieces of legislation have been introduced by Republicans, signaling a chance for bipartisan support.

Democrats are lukewarm to the idea:

There are skeptics, including some Democrats and health industry trade groups, who call the bill overly broad.

“More transparency is just one component of a larger strategy of the health care system,” said Rep. Frank Pallone (D-N.J.), chairman of the health subcommittee of the Committee on Energy and Commerce. “We just have to make sure it’s done correctly.”

Pallone pointed to a 2008 Congressional Budget Office report that outlined the benefits of similar transparency requirements, as well as a potential disadvantage: In small markets, if vendors know their competitors’ prices, they’ll simply match them, making negotiations obsolete.

Here’s the question I have to ask: Why is it necessary for us to require the medical/medical coverage industries disclose their prices?

The answer is simple, and speaks to the root cause of run-away health care costs that nothing in the Democrat health care bill that was just crammed down our throats addresses. Namely, the fact that most Americans aren’t the customers for their health care. Or even their health care coverage.

Think about it. When most Americans go to the hospital to get health care they’re not directly responsible for the bill. At least, not most of it. And given that reality, why should they care about the price? And if the consumer doesn’t care about the price, what impetus does the health care provider have to make those prices public and transparent?

The same goes health insurance as most Americans aren’t the direct customer for their health insurance policies either. Their employers negotiate the plan, and they sign up for the plan when they’re hired. So, again, what impetus does the health coverage provider have to be transparent with prices when the end consumer isn’t the customer?

A price transparency bill is all well and good, but we’d be far better off promoting policies that make Americans individually responsible for their health care. Because in a free market filled with consumers who are responsible for buying their own care and coverage price transparency would be imperative for care/coverage providers.

Tags: cbo, frank pallone, Health Care, health insurance, steve kagen

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In late March, Fidelity Investments issued its annual Retiree Health Care Costs Estimate, which found that a 65-year-old couple retiring in 2010 would need $250,000 in the bank to pay for all future medical expenses. This amount was calculated assuming the couple will be eligible for Medicare but won’t be covered by employer-sponsored retiree medical benefits.

Amounts included in the estimate were premiums for Medicare Parts B and D, Medicare co-payments and deductibles, and any amounts not covered by Medicare. Not included were amounts for dental, vision, and long-term care expenses.

Let’s start with the bad news: This amount is larger than many retirees’ total 401(k) balances, which are supposed to cover all living expenses, not just medical expenses. (My prior post, Can’t Retire Yet? Don’t Despair, offers statistics on average 401(k) balances.)

But there’s good news, too. Fidelity’s reports from prior years showed a breakdown of the total amount needed:  Medicare premiums would make up 30 percent of the total, and all other expenses would make up 70 percent of the total. Thirty percent of this year’s total would be $75,000, the amount that’s been estimated you’ll need in the bank to pay for Medicare premiums over your lifetime. And you’ll pay this amount regardless of your health.

The $175,000 remaining (70 percent of $250,000) is what you’ll pay for Medicare co-payments and deductibles only when you get sick. Do all you can to stay healthy, and you can help control and even reduce these estimated costs.

This is just one more reason to make the lifestyle changes you probably already know you should be making. Eat the right amount and kinds of food, get adequate exercise, manage your stress, and quit bad habits such as smoking or excessive drinking. This could save you boatloads of money, and help you better enjoy your retirement years. There’s definitely a potential financial gain in taking care of your health, so why not start now in order to better enjoy your retirement years?

P.S. Want some inspiration to make these lifestyle changes? Here’s a story about Tao Porchon-Lynch, who’s still teaching yoga at age 91.

Teague ran as a populist, but what stands out most today is the fact that he’s the wealthy owner of a corporation that doesn’t provide health insurance for employees. Progressives aren’t going to vote for Pearce. But they might stay home on Election Day.

The first time I met Harry Teague, in December 2007 when he was running for Congress, he brought up the fact that he provided affordable health insurance to employees of his businesses.

In fact, he told me at the time that he was in the process of creating a clinic and hiring a nurse practitioner for the employees of his company. He said he could offer his employees basic services cheaper than other clinics, and he hoped it would also reduce his costs as an employer.

Before being elected in November 2008, Teague, a Democrat, talked about his companies’ health care benefits time and time again on the campaign trail.

So I was surprised to learn today, from an article published by Politico, that Teague’s companies have cut all health care benefits for their employees.

But first, something else I was surprised about:  They’re still Teague’s companies.

That’s interesting because three of the companies announced last year they were re-forming under the name Cavaloz Energy Inc., and Teague said he was divesting himself of all interests in the companies. As of last week, that hadn’t happened, Politico reported. Though Teague has given control of the companies over to his son, Teague still owns the majority interest in the companies.

I e-mailed Teague’s office to ask why, almost six months after it told me Teague was divesting himself of those interests, it hasn’t happened. I’ll let you know if I get a reply.

Cutting health insurance for employees

On to the health care. Politico reported that as the health care reform debate was “raging” in Washington (Teague twice voted against reform bills), his companies were eliminating health care for employees. From the article:

“On Dec. 21, 2009 — as the health care debate was raging in Congress — a human resources manager at Teague’s Cavaloz Energy sent a memo to 250 employees of Teague-affiliated companies:

“‘Please be aware that effective Feb. 28, Cavaloz Energy Inc., Teaco Energy Services Inc., ABC Rental Tool, Eunice Well Servicing, Teaco Drilling will no longer offer health insurance to employees. We would ask that all employees currently covered under the company’s insurance policy begin to seek an alternative solution.’

“‘We apologize for any inconvenience this may cause,’ the notice added. ‘Know that we value your employment here at Cavaloz.’”

Teague spokeswoman Kara Kelber was quoted by Politico as saying that Teague “thinks employers should provide health insurance coverage for employees — that’s what he did when he was running a company. But he also knows that the economic downturn has forced many small businesses to make tough choices to survive.”

“While he is not involved in day-to-day operations of the company anymore, he deeply regrets that the rising cost of health insurance forced the company to make this decision,” Politico quoted Kelber as saying. “Ultimately, it came down to cutting the high-cost benefit or cutting jobs.”

A political problem

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San Diego could be one of about a dozen American cities selected for a federal project to make more health pricing information public.

With little fanfare, U.S. Health and Human Services Secretary Michael Leavitt came into town and met with about 20 hand-picked San Diegans on April 19 at the University Club in Downtown San Diego.

At the closed-door meeting, Leavitt told hospital executives, doctors, some of the city’s largest employers and most prominent business leaders that the federal government will issue a request for proposals within weeks for a price transparency study to begin in 2007.

Attendees received word of the San Diego meeting only a day or two earlier.

The pilot program could involve collecting pricing information from hospitals, health plans and the military. In March, at the same time the Bush administration announced Medicare would begin posting on its Web site the amount it pays to cover certain procedures, Leavitt had announced that there would likely be a pricing initiative to involve cities with higher than average health costs.

The issue of price transparency is of national importance as health costs rise and the actual cost of doctors’ services are masked by a chaotic entanglement of payers, including insurance companies, Medicare and Medicaid.

Jim Knight, the chief executive officer of San Diego-based Consumer Directed Healthcare, Inc., who attended the meeting, said Leavitt indicated he wanted to move very quickly on the pilot.

Leavitt stressed that collaboration among employers, health care providers and the military would be key to being selected, several attendees said.

The study would require hospitals to publicly share pricing information, though details about what information they would disclose and to whom were not announced.

Dr. Robert Hertzka, past president of the California Medical Association and an anesthesiologist at Sharp HealthCare, said Leavitt implied that some component of the project would involve employees with health savings accounts, or high deductible insurance plans, perhaps even requiring employers that participate to offer them as an option.

Leavitt could not be reached before press time, and San Diego County Health and Human Services officials said they did not receive an invitation to the meeting, nor did they have any knowledge of Leavitt’s visit.

Information about pricing is also fundamental to the decision making of consumers and providers with regard to HSAs, which are backed strongly by the Bush administration and Leavitt. The plans aim to encourage consumers to spend on health care more conservatively. Money left over, which is tax-free, can be used for purposes other than health care.

Political Agenda?

Some leaders at the meeting, such as Connect CEO Duane Roth, Sharp CEO Mike Murphy and others said they didn’t think HSAs were the motivation behind the federal pilot project on price transparency. Scripps Health CEO Chris Van Gorder said he thought the government was responding to advocacy groups.

“It’s a political issue more than a tactical issue at this point,” Van Gorder said. “What you are seeing is the government respond accordingly.”

Groups involved in organizing the meeting for Leavitt included the La Jolla-based California Healthcare Institute, a biomedical advocacy group; the Lincoln Club of San Diego County, a Republican club active in campaigns; and the San Diego Regional Chamber of Commerce.

Roth, an active member of all three groups, said he helped invite stakeholders to the meeting and will be organizing another meeting in the coming weeks to discuss how San Diego might collaborate on the pilot and how a response to HHS might be prepared.

Some attendees said Leavitt made San Diego’s chances to be part of the pilot seem almost certain. Roth said San Diego’s reputation for collaboration across industries would no doubt put the city in the running.

“It was clear that this was not being advertised,” said Roth, who said he never spoke with Leavitt directly.

Little Detail Provided

Van Gorder, who couldn’t change his schedule to be at the meeting on only a day’s notice, and Sharp’s Murphy said they support the idea of price transparency, but that they could not say if they would commit to the project since so few details were given about what it would require or how much money it could cost local hospitals, some of which already operate in the red.

Attendees at the meeting said Leavitt did not say how much money the community might receive to reimburse participants for costs associated with the project.

Neither Van Gorder nor Murphy would say if he foresaw obstacles to the pilot because, Van Gorder said, “It depends on what it is.”

“I don’t know that (Leavitt) has it totally figured out,” Murphy said, and added later, “It’s premature to say who exactly it could benefit.”

Since 2004, California law has required hospitals to disclose the prices of their 25 most common outpatient services. Some hospitals, including those in two of San Diego’s largest health systems, Sharp and Scripps, offer their entire fee schedules to the public upon request.

Van Gorder said only competing hospitals and advocacy groups have asked to see Scripps’ fee schedule, which he said is about the size of a telephone book.

“Patients never ask for it, which we find interesting,” Van Gorder said.

Hertzka said price disclosure could mean improved care.

“If you think you are doing the right thing, you have nothing to hide,” Hertzka said. “If someone else is doing something better, there’s more room for improvement.”

Attendees said Leavitt mentioned Rochester or Minneapolis/St. Paul, Minn., Salt Lake City and Indianapolis as other possible cities to be selected for the price transparency project.

A new study by the Rand Corporation finds that medical disparities experienced by poorer people and racial and ethnic minorities may increase with performance-based payments for primary care providers.

Pay-for-performance programs are an increasingly utilized strategy to improve the quality of medical care. The Patient Protection and Affordable Care Act signed into law by President Obama includes pay-for-performance pilot testing programs for certain Medicare providers.

"Paying for performance may have the unintended effect of diverting medical resources away from the communities that need these resources the most," said Dr. Mark Friedberg, the study's lead author and an associate natural scientist at RAND, a nonprofit research organization. "If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse."

The study, featured in the May 2010 issue of the journal of Health Affairs, simulates the impact of pay-for-performance programs that serve medically vulnerable communities—including minority communities—in which a health disparity currently exists.

In their simulation of primary care physicians in Massachusetts, researchers found that average-sized physician practices serving the highest proportion of vulnerable populations would receive about $7,100 less annually than other practices. That difference could be even larger if greater amounts of money are put at stake in future pay-for-performance programs.

This pay disparity is a leading indicator of potential increase in the disparity of the quality of care to medically vulnerable minority communities.

While pay-for–performance programs are new to the United States, they have been implemented in other countries, including the United Kingdom.

A similar U.K. study recorded the change in the health of diabetes patients both prior and post the implementation of a pay-for-performance program between 2000 and 2005. It was found in the study that the mean systolic and diastolic blood pressure and A1C hemoglobin levels decreased in the researcher's three main test groups, however, a disparity existed between white and black patients.

“I think those [pay-for-performance reforms] are important, but they're unlikely to transform health care by themselves. And they do run the risk of getting doctors and hospitals to teach to the test and be too specifically focused on the particular issues identified in the legislation,” said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution in an interview in the Washington Post about the Affordable Care Act.

The U.K. study, published in the journal Diabetes Care in December 2008 took into account age, gender, ethnicity, socioeconomic background, location, and medical practice variables.

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Obama’s Checkup: One Month After, a Health Care Progress Report

May 08, 2010 6:01 AM

ABC News' Sunlen Miller Reports: “This is what change looks like,” President Obama touts in his weekly address, giving his administration a pat on the back, one month after health care reform was passed into law.

“It has now been a little over a month since I signed health insurance reform into law.  And while it will take some time to fully implement this law, reform is already delivering real benefits to millions of Americans.  Already, we are seeing a health care system that holds insurance companies more accountable and gives consumers more control.”

Mr. Obama says that there have been some “real, tangible benefits” already seen by the American people.

“After our administration demanded that Anthem Blue Cross justify a 39% premium increase on Californians, the company admitted the error and backed off its plan.  And this week, our Secretary of Health and Human Services, Kathleen Sebelius, wrote a letter to all states urging them to investigate other rate hikes and stop insurance companies from gaming the system.  To help states achieve this goal, we’ve set up a new Office of Consumer Information and Insurance Oversight, and will provide grants to states with the best oversight programs. “

The president touts that they are holding insurance companies more accountable as well in the last thirty days.

“But when we found out that an insurance company was systematically dropping the coverage of women diagnosed with breast cancer, my administration called on them to end this practice immediately.  Two weeks ago, the entire insurance industry announced that it would comply with the new law early and stop the perverse practice of dropping people’s coverage when they get sick. 

On Monday the administration will announce that they have asked insurance companies to not wait until September to comply with the  rule that allows young adults without insurance to say on their parents’’ plan until they’re 26 years old, to benefit this year’s graduating classes. And nest month, Obama says they’ll be putting in place a new patients’ bill of rights.

“I’ve said before that implementing health insurance reform won’t happen overnight, and it will require some tweaks and changes along the way,” Mr. Obama says, “But already, we are seeing how reform is improving the lives of millions of Americans.”

May 8, 2010

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With the American public still very much divided over the new health care law, President Obama trumpeted Saturday its initial impact, saying the overhaul had already helped millions of individuals and small businesses.

In his weekly national address, he reminded supporters that as of September the new law prevents insurance companies from dropping people when they get sick and allows children up to age 26 to stay on their on parents’ plan. (Some insurance companies have complied with this part of the law early and Mr. Obama is trying to get large employers to follow suit.)

“At long last, this is what health care reform is achieving,” Mr. Obama said. “This is what change looks like. And this is the promise we will keep as we continue to make this law a reality in the months and years to come.”

This year, 4 million small businesses benefited from health care tax cuts and seniors will receive a $250 check to help them cover the costs of prescriptions.

The administration is also drafting a “patients’ bill of rights” to educate consumers about their choices and rights and create an appeals process to enforce those rights, he said.

GOP Address: Republicans demanded today that the financial regulatory legislation senators are debating include a reform of Fannie Mae and Freddie Mac.

In the party’s weekly address, Senator Richard Shelby of Alabama, the ranking Republican on the Senate Banking Committee, said Republicans would focus their attacks on the government-backed housing agencies and Democrats’ proposed consumer protection agency.

“The Democrat bill fails to address, in any way, this central cause of the crisis,” Senator Shelby said. “It does, however, dramatically expand the reach of the federal government into parts of our economy that had nothing to do with the financial crisis.”

Republicans are trying to frame the debate over the bill in terms of government intervention as they have with Mr. Obama’s other major initiatives.

Republicans in Utah: Robert Bennett, the three-term Republican senator of Utah, may find he’s shut out of a fourth today at the state’s Republican Convention.

Senator Bennett will face seven challengers, the strongest of whom argue that he is not conservative enough. He must get the votes 40 percent of 3,500 state delegates to qualify for his party’s June primary, but that could be tough without the support of Tea Party activists and other leaders on the right.

Hickel Dead at 90: Walter J. Hickel, who served twice as governor of Alaska and as the secretary of the interior under former President Richard Nixon, died Friday night.

Mr. Hickel, once a member of the secessionist Alaskan Independence Party, “confounded critics by ricocheting from pro-business stalwart to ardent environmentalist and back again,” writes The Times’s Dennis Hevesi.

It was an ardor for Alaska’s vast wilderness — its craggy peaks, blue coastal ice sheets and rolling tundra carpeted by caribou herds, musk oxen, wolf packs, moose and millions of migratory birds — and a longing to tap into the oil and gas riches below the surface that propelled Mr. Hickel’s contradictory and sometimes quixotic quests.

Supreme Court Watch: The records of several of Mr. Obama’s top choices for the opening spot on the Supreme Court suggest the administration is on a collision course with the bench over the extent of executive power, The Times’s Charlie Savage writes.

Graduation Speech: Michele Obama will speak at the graduation at the University of Arkansas at Pine Bluff, once the only state-supported institution of higher education for African-Americans in Arkansas.

Politico notes that as the primary season approaches, Democratic candidates around the country will be seeking Mrs. Obama’s support. After her appearance at a Democratic National Convention fundraiser this week netted more than $1 million, she’s a hotter ticket than ever.

Food Drive: Food banks around Washington are holding the country’s biggest single-day food drive today. City letter carriers will collect non-perishable food donations left by residents outside mailboxes and inside post offices.

Embassy Tours: From 10 a.m. to 4 p.m., 27 European Union nations open their embassies for public tours and celebrations.

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Presidential Proclamation–National Women's Health Week

A PROCLAMATION

In recent decades, our Nation has made extraordinary progress in promoting women's health issues.  However, far too many women remain underserved and we must continue working to ensure all women can access medical services, receive fair treatment, and make healthy choices.  During National Women's Health Week, we recommit to breaking existing barriers and improving the health of American women for generations to come.

 Many American women face significant obstacles in caring for themselves and their families.  That is why my Administration fought tirelessly to pass the Affordable Care Act, which I recently signed into law.  This landmark legislation gives Americans greater control over their health care decisions and access to affordable and equitable insurance.  It lowers costs for women and prohibits insurance companies from overcharging because of gender or denying coverage due to a pre existing condition.  The Affordable Care Act also requires that new health care plans cover preventive care, routine screenings, and regular checkups, as well as basic pediatric services for children.  These services are vital to maintaining individual well being, and empower women when making choices for themselves and their families.  Visit HealthReform.gov to learn more about how the Affordable Care Act benefits Americans across the country.

 We have taken steps to provide access to high-quality, affordable health care, but individuals must also lead healthy lives and set a good example for their children.  From scheduling regular medical examinations to applying sunscreen, simple, everyday activities can make a positive impact on the lives of women.  Regular exercise, coupled with a nutritious diet, helps prevent heart disease, obesity, and other chronic conditions.  Visit WomensHealth.gov and GirlsHealth.gov for more information and resources on women's health issues.  I also encourage Americans to visit www.WhiteHouse.gov/Administration/EOP/CWG to learn about the White House Council on Women and Girls    a body I created to bring women's issues to the forefront, and to emphasize women's roles as full partners in shaping and implementing our Nation's policies.

 The health of American women and girls is not just a women's issue; all Americans have a vested interest.  Women are the foundation of many families, and by encouraging their wellness, we also promote the vitality of our children and our communities.  By standing firm in our commitment to improve women's health, we can give our daughters and granddaughters    and all Americans    a brighter future.

 NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 9-15, 2010, as National Women's Health Week.  I encourage all Americans to celebrate the progress we have made in protecting women's health and promote prevention, awareness, and educational activities that improve the health of all women.

 IN WITNESS WHEREOF, I have hereunto set my hand this seventh day of May, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fourth.

BARACK OBAMA

From Lori Ziganto’s latest article at RedState:

Shortly after the boondoggle known as the health care bill was passed, corporations discovered that the bill had a lot of detrimental factors to it, which, as Nancy Pelosi infamously said, we couldn’t find out until the bill was passed. As such, upon its passage, corporations began taking write-downs due to the elimination, by the new law, of many deductions they had previously been allowed to take.

This didn’t sit well with Representative Waxman, being utterly ignorant in the ways of business, and it got his rather unfortunate nose out of joint. He decided to use strong arm tactics, in his position as Chairman of the House Energy and Commerce Committee and demanded various things from corporations, including confidential memos. Egregious enough as that was, he didn’t stop there. Unfortunately for him and his fellow Democrats, there were unintended consequences of his strong arm tactics. They ended up revealing the intended consequences of the Health Care Bill:

No more employer-provided health care for you.

Read the rest here

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It is quite well known that global health care threatened by powerful trends – increasing demand, rising costs, uneven quality, inequitable distribution and misleading incentives. In India too, current healthcare systems will be unsustainable if unchanged over the next decade. If ignored, they will overwhelm health systems, creating massive financial burdens and devastating health problems for fellow Indians.

What makes a great health system, even as an ideal in India?

A) Universal access – through a fair distribution of healthcare products and services from a current ~ 30% of the population has access to modern medicine and quality health care.

2) An equitable sharing of the financial cost of access and a constant quest for improvements to a more equitable system.

3) Creation of easy accessibility to these services, combined with training and staffing personnel who deliver quality products and services.

4) Special attention to vulnerable groups such as children, women, disabled and elderly.

I’ve been surprised that despite knowing this, health has never taken its rightful place on the national agenda from the Government of India and even outside. The fact that diseases that affect more than one nation (HIV / AIDS, swine influenza, SARS, etc.) that afflict us have not even inspired a place on the global agenda. National States are still more likely to give security or commercial considerations take priority over health care. Healthcare, like climate change, is relegated to the sidelines.

The recently experienced a growing acceptance of the concept of health security. But there are big differences in the understanding and use of the term in different contexts. Politicians in developed countries stressed that their populations especially against external threats such as terrorism and pandemics, while health workers and politicians in developing countries think of the term in a broader framework for public health. Indeed, the concept is applied unevenly across the world. Divergent views of various states, combined with fears of hidden national security agendas, leading to a breakdown of mechanisms for global cooperation. So much so that some developing countries have begun to doubt that internationally shared health data is used in their best interest. Resolution of these incompatible understandings is a global priority.

This requires a global context of India’s largest and least used “weapons” – soft power.

Soft power has always been a central element in the diplomatic leadership. The power to attract, to get others to want what you want to frame the issues to set the agenda, is rooted in thousands of years of human experience. Skilled leaders have always understood that attractiveness comes from credibility and legitimacy. Power has never flowed solely from the barrel of a gun, even the most brutal dictators relied attraction and fear. India should exercise soft power to get himself some of the best technologies, products, services, talent and

Public Diplomacy is the chosen method of interaction between stakeholders involved in public health and policy for representation, cooperation, resolve conflicts, improving health and ensuring the right to health for vulnerable populations. Through health diplomacy, health priorities can take their rightful place at the national and international agenda. This will merge health expertise with diplomatic skills to alleviate suffering, bring peace, prepare for disasters and to help improve health systems throughout the world.

Role of health diplomacy will vary depending on the specific context and stakeholders. How global health will be a foreign policy issue for states, health diplomacy plays an important role in supplementing or assisting formal diplomatic channels of distribution. In cases where civil society or the private sector is engaged, health diplomacy assumes a leadership role in promoting or multilateral dialogue.

The global health burden that is placed on the international community’s demands effective transnational networks to provide sustainable solutions to the toughest challenges. Health diplomacy is a process and method that can help stakeholders to effectively pursue their interests, overcome obstacles to progress and take advantage of optimum benefit from international partnerships. In a world where the disease is everybody’s tragedy and everybody’s nightmare that is health diplomacy in everyone’s interest.

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It is quite well known that global health care threatened by powerful trends – increasing demand, rising costs, uneven quality, inequitable distribution and misleading incentives. In India too, current healthcare systems will be unsustainable if unchanged over the next decade. If ignored, they will overwhelm health systems, creating massive financial burdens and devastating health problems for fellow Indians.

What makes a great health system, even as an ideal in India?

A) Universal access – through a fair distribution of healthcare products and services from a current ~ 30% of the population has access to modern wine cheese medicine and quality health care.

2) An equitable sharing of the financial cost of access and a constant quest for improvements to a more equitable system.

3) Creation of easy accessibility to these services, combined with training and staffing personnel who deliver quality products and services.

4) Special attention to vulnerable groups such as children, women, disabled and elderly.

I’ve been surprised that despite knowing this, health has never taken its rightful place on the national agenda from the Government of India and even outside. The fact that diseases that affect more wine cheese than one nation (HIV / AIDS, swine influenza, SARS, etc.) that afflict us have not even inspired a place on the global agenda. National States are still more likely to give security or commercial considerations take priority over health care. Healthcare, like climate change, is relegated to the sidelines.

The recently experienced a growing acceptance of the concept of health security. But there are big differences in the understanding and use of the term in different contexts. Politicians in developed countries stressed that their populations especially against external threats such as terrorism and pandemics, while health workers and red wine politicians in developing countries think of the term in a broader framework for public health. Indeed, the concept is applied unevenly across the world. Divergent views of various states, combined with fears of hidden national security agendas, leading to a breakdown of mechanisms for global cooperation. So much so that some developing countries have begun to doubt that internationally shared health data is used in their best interest. Resolution of these incompatible understandings is a global priority.

This requires a global context of India’s largest and least used “weapons” – soft power.

Soft power has always red wine been a central element in the diplomatic leadership. The power to attract, to get others to want what you want to frame the issues to set the agenda, is rooted in thousands of years of human experience. Skilled leaders have always understood that attractiveness comes from credibility and legitimacy. Power has never flowed solely from the barrel of a gun, even the most brutal dictators relied attraction and fear. India should exercise soft power to get himself some of the best technologies, products, services, talent and

Public Diplomacy is the chosen method of interaction between stakeholders involved in red wine public health and policy for representation, cooperation, resolve conflicts, improving health and ensuring the right to health for vulnerable populations. Through health diplomacy, health priorities can take their rightful place at the national and international agenda. This will merge health expertise with diplomatic skills to alleviate suffering, bring peace, prepare for disasters and to help improve health systems throughout the world.

Role of health diplomacy will vary depending on the specific context and stakeholders. How global health will be a foreign policy issue for states, health diplomacy plays an important role in supplementing or assisting formal diplomatic channels wine cheese of distribution. In cases where civil society or the private sector is engaged, health diplomacy assumes a leadership role in promoting or multilateral dialogue.

The global health burden that is placed on the international community’s demands effective transnational networks to provide sustainable solutions to the toughest challenges. Health diplomacy is a process and method that can help stakeholders to effectively pursue their interests, overcome obstacles to progress and take advantage of optimum benefit from international partnerships. In a world where the disease is everybody’s tragedy and everybody’s nightmare that is health diplomacy in everyone’s interest.

wine cheese Filed under: Uncategorized

With the American public still very much divided over the new health care law, President Obama trumpeted Saturday its initial impact, saying the overhaul had already helped millions of individuals and small businesses.

In his weekly national address, he reminded supporters that as of September the new law prevents insurance companies from dropping people when they get sick and allows children up to age 26 to stay on their on parents’ plan. (Some insurance companies have complied with this part of the law early and Mr. Obama is trying to get large employers to follow suit.)

“At long last, this is what health care reform is achieving,” Mr. Obama said. “This is what change looks like. And this is the promise we will keep as we continue to make this law a reality in the months and years to come.”

This year, 4 million small businesses benefited from health care tax cuts and seniors will receive a $250 check to help them cover the costs of prescriptions.

The administration is also drafting a “patients’ bill of rights” to educate consumers about their choices and rights and create an appeals process to enforce those rights, he said.

GOP Address: Republicans demanded today that the financial regulatory legislation senators are debating include a reform of Fannie Mae and Freddie Mac.

In the party’s weekly address, Senator Richard Shelby of Alabama, the ranking Republican on the Senate Banking Committee, said Republicans would focus their attacks on the government-backed housing agencies and Democrats’ proposed consumer protection agency.

“The Democrat bill fails to address, in any way, this central cause of the crisis,” Senator Shelby said. “It does, however, dramatically expand the reach of the federal government into parts of our economy that had nothing to do with the financial crisis.”

Republicans are trying to frame the debate over the bill in terms of government intervention as they have with Mr. Obama’s other major initiatives.

Republicans in Utah: Robert Bennett, the three-term Republican senator of Utah, may find he’s shut out of a fourth today at the state’s Republican Convention.

Senator Bennett will face seven challengers, the strongest of whom argue that he is not conservative enough. He must get the votes 40 percent of 3,500 state delegates to qualify for his party’s June primary, but that could be tough without the support of Tea Party activists and other leaders on the right.

Hickel Dead at 90: Walter J. Hickel, who served twice as governor of Alaska and as the secretary of the interior under former President Richard Nixon, died Friday night.

Mr. Hickel, once a member of the secessionist Alaskan Independence Party, “confounded critics by ricocheting from pro-business stalwart to ardent environmentalist and back again,” writes The Times’s Dennis Hevesi.

It was an ardor for Alaska’s vast wilderness — its craggy peaks, blue coastal ice sheets and rolling tundra carpeted by caribou herds, musk oxen, wolf packs, moose and millions of migratory birds — and a longing to tap into the oil and gas riches below the surface that propelled Mr. Hickel’s contradictory and sometimes quixotic quests.

Supreme Court Watch: The records of several of Mr. Obama’s top choices for the opening spot on the Supreme Court suggest the administration is on a collision course with the bench over the extent of executive power, The Times’s Charlie Savage writes.

Graduation Speech: Michele Obama will speak at the graduation at the University of Arkansas at Pine Bluff, once the only state-supported institution of higher education for African-Americans in Arkansas.

Politico notes that as the primary season approaches, Democratic candidates around the country will be seeking Mrs. Obama’s support. After her appearance at a Democratic National Convention fundraiser this week netted more than $1 million, she’s a hotter ticket than ever.

Food Drive: Food banks around Washington are holding the country’s biggest single-day food drive today. City letter carriers will collect non-perishable food donations left by residents outside mailboxes and inside post offices.

Embassy Tours: From 10 a.m. to 4 p.m., 27 European Union nations open their embassies for public tours and celebrations.

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With the American public still very much divided over the new health care law, President Obama trumpeted Saturday its initial impact, saying the overhaul had already helped millions of individuals and small businesses.

In his weekly national address, he reminded supporters that as of September the new law prevents insurance companies from dropping people when they get sick and allows children up to age 26 to stay on their on parents’ plan. (Some insurance companies have complied with this part of the law early and Mr. Obama is trying to get large employers to follow suit.)

“At long last, this is what health care reform is achieving,” Mr. Obama said. “This is what change looks like. And this is the promise we will keep as we continue to make this law a reality in the months and years to come.”

This year, 4 million small businesses benefited from health care tax cuts and seniors will receive a $250 check to help them cover the costs of prescriptions.

The administration is also drafting a “patients’ bill of rights” to educate consumers about their choices and rights and create an appeals process to enforce those rights, he said.

GOP Address: Republicans demanded today that the financial regulatory legislation senators are debating include a reform of Fannie Mae and Freddie Mac.

In the party’s weekly address, Senator Richard Shelby of Alabama, the ranking Republican on the Senate Banking Committee, said Republicans would focus their attacks on the government-backed housing agencies and Democrats’ proposed consumer protection agency.

“The Democrat bill fails to address, in any way, this central cause of the crisis,” Senator Shelby said. “It does, however, dramatically expand the reach of the federal government into parts of our economy that had nothing to do with the financial crisis.”

Republicans are trying to frame the debate over the bill in terms of government intervention as they have with Mr. Obama’s other major initiatives.

Republicans in Utah: Robert Bennett, the three-term Republican senator of Utah, may find he’s shut out of a fourth today at the state’s Republican Convention.

Senator Bennett will face seven challengers, the strongest of whom argue that he is not conservative enough. He must get the votes 40 percent of 3,500 state delegates to qualify for his party’s June primary, but that could be tough without the support of Tea Party activists and other leaders on the right.

Hickel Dead at 90: Walter J. Hickel, who served twice as governor of Alaska and as the secretary of the interior under former President Richard Nixon, died Friday night.

Mr. Hickel, once a member of the secessionist Alaskan Independence Party, “confounded critics by ricocheting from pro-business stalwart to ardent environmentalist and back again,” writes The Times’s Dennis Hevesi.

It was an ardor for Alaska’s vast wilderness — its craggy peaks, blue coastal ice sheets and rolling tundra carpeted by caribou herds, musk oxen, wolf packs, moose and millions of migratory birds — and a longing to tap into the oil and gas riches below the surface that propelled Mr. Hickel’s contradictory and sometimes quixotic quests.

Supreme Court Watch: The records of several of Mr. Obama’s top choices for the opening spot on the Supreme Court suggest the administration is on a collision course with the bench over the extent of executive power, The Times’s Charlie Savage writes.

Graduation Speech: Michele Obama will speak at the graduation at the University of Arkansas at Pine Bluff, once the only state-supported institution of higher education for African-Americans in Arkansas.

Politico notes that as the primary season approaches, Democratic candidates around the country will be seeking Mrs. Obama’s support. After her appearance at a Democratic National Convention fundraiser this week netted more than $1 million, she’s a hotter ticket than ever.

Food Drive: Food banks around Washington are holding the country’s biggest single-day food drive today. City letter carriers will collect non-perishable food donations left by residents outside mailboxes and inside post offices.

Embassy Tours: From 10 a.m. to 4 p.m., 27 European Union nations open their embassies for public tours and celebrations.

“We don't know what the impacts are going to be yet,” said Dave Bary, an EPA spokesman in Dallas. “We don't know in what direction this oil will go.”

The potential for unhealthy air quality depends on a variety of factors, particularly the speed and direction of winds that could disperse fumes and determine where they go, said Jonathan Ward, an environmental toxicology professor at the University of Texas Medical Branch at Galveston.

With the leaky Gulf well some 50 miles offshore, Ward said much of the oil vapor likely wouldn't reach land, although the potential for air pollution from the slick will remain as long as the leak continues.

Public health agencies in Alabama, Louisiana and Mississippi advised people near the coast who experience nausea, headaches or other smell-related ailments to stay inside, turn on air conditioners and avoid exerting themselves outdoors.

In addition to air pollution, officials also were guarding against health problems from tainted drinking water and seafood.

Some communities, including New Orleans, get their supplies from the Mississippi River. Its southerly currents will prevent oil from drifting upstream to city intake pipes, and the Coast Guard is making sure that any ships with oil-coated hulls are scrubbed down before proceeding up the river, Guidry said.

Even so, the state health department has ordered testing of municipal water systems near the Gulf for signs of oil.

“It's next to impossible that a high amount would get in,” Guidry said. “Even if some got through, more than likely the treatment system would eliminate it.”

The department this week began taking samples at seafood processing plants. Officials have ordered a temporary moratorium on fishing in federal waters from the Mississippi River to the Florida Panhandle, but sampling will provide benchmarks enabling scientists to track any increases in contaminant levels once fishing is allowed to resume.

Louisiana health officials said they believe fish, shrimp and other Gulf delicacies already on the market are safe.

“If we see increases in hydrocarbons or other contaminants, we'd stop the flow of seafood,” Levine said.

Oil has compounds that have been linked to cancer. But they break down in the body and are excreted, so there's little chance of getting cancer from tainted seafood even if people ate it for many years, said LuAnn White, director of Tulane Universisty's Center for Applied Environmental Public Health.

The telltale smell likely would deter consumers from eating oily seafood, White said, but if people did eat it, they might get gastrointestinal sickness.

The U.S. Centers for Disease Control and Prevention is working with epidemiologists in the Gulf states to develop studies of health repercussions from the oil spill, Guidry said.

Yet another hazard is direct contact with oil-saturated water – particularly for cleanup crews and volunteers involved in animal rescue operations.

When the container ship Cosco Busan hit a bridge and released 53,000 gallons of highly toxic bunker fuel into San Francisco Bay in November 2007, officials managing the cleanup ordered volunteers to wear protective suits, gloves and masks that later were discarded at a hazardous waste dump. Some oil fouled beaches, which were closed to prevent danger to the public.

People working around the Gulf spill should be equipped with respirator devices and wear heavy-duty gloves and protective clothing to guard against painful skin rashes, said Gina Solomon, an associate professor at the University of California-San Francisco medical school and a senior scientist with the Natural Resources Defense Council who has treated patients exposed to oil fumes.

“The workers absolutely need to be protected,” Solomon said.

___

Associated Press Writer Jason Dearen contributed to this story from San Francisco.

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The health savings account is a type of account that an individual can set up with many different financial institutions. Here are the basics of the health savings account.

Health Savings Account

The health savings account is a type of account that individuals can use to pay for qualified medical expenses. Individuals are allowed to make pretax contributions into their health savings accounts. You can contribute as much as $5000 per year to this type of account. You will then be able to deduct the amount of money that you contribute from your taxable income at the end of the year.

Eligibility

Not everyone is eligible to set up a health savings account. In order to be eligible, you have to be enrolled in a high-deductible health insurance plan. This means that your deductible has to be more than $1000 before you can sign up.

Qualified Expenses

You can use the funds from your health savings account for a variety of purposes. For example, you can use the money to pay for medical treatment up to your deductible amount. You can also use it for things like dental care, vision care, chiropractic care, prescriptions, and other medical treatments.

Let’s face it – men and women have many differences!  Because they are physically different, their fitness and nutritional needs also differ.  Both men and women would benefit from regular exercise and a healthy diet.  Yet, the male body responds more favorably to certain types of exercises and foods.

Nutrition for Men

The male body has a higher percentage of muscle tissue than the female body.  To support lean muscle tissue, especially in active men, eating adequate amounts protein is essential.  In fact, men who want to build muscle mass might benefit from slightly increasing the daily recommendation of protein in their diets.  A diet that is built around lean cuts of meat, fish, eggs, poultry, and low-fat dairy products may better encourage muscle growth.

Although too little protein in the diet can cause muscles to shrink, eating too much protein may actually stimulate weight loss.  (The body burns more calories digesting protein than it does digesting carbs.)  If you’re trying to shed excess weight, a high-protein diet could be the way to go.  Nevertheless, it’s a good idea to increase your protein intake only a little if you’re trying to gain lean weight and build muscle.

According to Men’s Health.com, “protein has qualities that help weight loss and may curtail weight gain…The best weight-gain strategy is to focus on calories first, protein second.  You should make sure you’re eating at least 2 grams of protein per kilogram (2.2 pounds) of muscle mass.”

In addition to protein, the male body also needs adequate amounts of vitamins and minerals.  Nutrient-rich diets help keep men healthy.  Vitamins (including plenty of antioxidants) and minerals are essential for preventing oxidative damage to the cells in the body.  These nutrients are necessary for maintaining healthy tissue, protecting the immune system, preventing bone loss (yes, even men need calcium), and protecting from loss of vision.

Exercises for Men

The types of exercises that are most beneficial to a man depend upon his fitness goals.  Does he want to lose weight?  Does he want to bulk up?  Does he want to improve his endurance and speed?

Cardiovascular exercise is one of the best ways to burn fat and calories.  There are many kinds of great cardio workouts, such as jogging outdoors or on a treadmill, training on an elliptical machine, bicycling, and interval training.  Ideally, men should try to get a minimum of 30 minutes of cardio exercise at least three times per week.

Interval training is one of the most efficient ways to burn calories, improve endurance and speed, and strengthen and tone muscles.  Such training involves alternating high and low intensity exercises, as well as start-and-stop motions.  Intensity levels may be increased as fitness improves.

Men who wish to build muscle should engage in resistance and strength training no less than twice per week for 30 minutes or more each session.  To bulk up fast, exercise routines should focus mainly on strengthening the hamstrings, chest, back, and quadriceps.  Bench presses, weighted squats, pushups, bicep curls, tricep extensions, lunges, crunches, and seated rowing are examples of resistance and strength training exercises.

Those whose ultimate fitness goal is to bulk up should engage primarily in strength training routines.  For optimal results and to avoid strain and injury, vary the workouts and target a different area of the body each day.  For instance, you might work the lower body one day and the upper body the next.  Muscles need time to repair after each intense training session, and they respond better when they are given a day or so to rest between workouts.

To lose weight AND build muscle, a balanced routine that includes both cardio and strength training often works best.  Such routines should target the total body and should include at least one exercise for each muscle group.  Spending just a few minutes on each area of the body when performing resistance exercises can still produce noticeable results.  Challenge your body even further by regularly changing your workout routines.  Most importantly, engage in exercises that you enjoy and that motivate you to reach your fitness goals.

Workout Routine for Men

Men who are just beginning a fitness program may need a little help getting started.  Hiring a personal trainer is always an option.  However, there are also numerous workout videos and online resources available.

Ian Lee, a fitness specialist with AskMen.com, has presented a three-day workout routine for men who have busy schedules and limited time to exercise.  According to Lee, this workout plan gives you a total body workout over the course of three different exercise sessions.

“The trick to getting a complete workout is to be efficient,” said Ian Lee.

Below is an example of the three-day workout routine:

Day One – Work on chest, back, and abs, and do 30 minutes of cardio exercise. Day Two – Rest Day Three – Focus on shoulders, abs, and legs and perform 30 minutes of cardiovascular exercise. Day Four – Rest Day Five – Work biceps, triceps, and abdominals, and do 30 minutes of cardio. Days Six and Seven – Rest

Choose the specific types of exercises for this 3-day routine based on available equipment, preferences, and level of fitness.  Each exercise session should be completed within an hour and a half or less, including the cardio segment of the workout.

Through proper nutrition and exercise, men can reach their fitness goals as they improve their health and overall well-being.