Medicare could to be headed for an immediate crisis. According to a story aired today on National Public Radio, Congress has just a few days to stop a planned 21 percent cut in reimbursements to doctors who treat seniors and others covered by the massive program. Such a reduction could cause many physicians to stop accepting Medicare patients, says NPR.

As bad as things are now for the health system, they'll probably get worse as Baby Boomers age into retirement. Just how much will Medicare grow in California, currently home to the largest number of beneficiaries -- 4.5 million enrollees? A new report estimates that the state's elderly ppopulation (65+) will more than double by the year 2030. The RAND study, Medicare Facts and Figures Chartbook, is intended to provide health providers, policymakers and advocates with essential data on California's Medicare recipients. Major findings:

Medicare reimbursement for care delivered to California beneficiaries is higher than the national average -- about $600 more per beneficiary in 2006.

In 2004 and 2005, total annual medical payments per Medicare beneficiary in California averaged $11,326, of which $1,330 (11 percent) came out of the beneficiaries' own pockets.

A large percentage of Medicare beneficiaries suffer from multiple chronic illnesses. In 2005, 79 percent reported having two or more chronic conditions, and 37 percent reported four or more.

A new investigative journalism group debuted this week. It joins a growing number of online news efforts in the state that includes California Watch, Voice of San Diego and The Bay Citizen.

FairWarning is a nonprofit operation based in Sherman Oaks that specializes in health, safety and corporate conduct. Its "mission is to arm consumers and workers with valuable information, and to spotlight reckless business practices and lax oversight by government agencies." The site's first three investigations look at old GM pickup trucks that explode in crashes, gross undercounting and fudging of injury data at U.S. companies, and the growing number of accidents involving all-terrain vehicles.

Yesterday, even as the U.S. House of Representatives prepared to vote on health care reform, partisans on both sides of the issue continued to squabble mightily over the merits of the legislation. Is the plan a "government takeover of medicine"? Will it reduce the federal deficit? Will the bill destroy the American economy? The din of claims and counter-claims has been going for months, and the average person doesn't not know what to believe.

Fortunately there are credible, impartial fact-checkers who can judge the veracity of political assertions on health care. One is the Pulitizer-prize winning PolitiFact, a site (profiled here last August) that examines dozens of statements by "members of Congress, the president, cabinet secretaries, lobbyists, people who testify before Congress and anyone else who speaks up in Washington". PolitiFact then rates the statement with its Truth-O-Meter scale (True, Mostly True, Half True, Barely, False and Pants on Fire).

The web site has analyzed over 250 health-related claims going back to 2007. Recently it published the "Top 5 lies about health care" and "Top 10 facts to know about health care". The articles clearly and concisely explain the most contentious points in the current debate. Worth a look.

The Center for Retirement Research at Boston College just published a study that anyone planning their post-employment finances will find disturbing. The authors seek to answer the question: how much will the typical married couple at age 65 spend on uninsured health care costs during the remainder of their lives? According to the CRR, the total expense, including insurance premiums, out-of-pocket costs, and home health costs (excluding nursing home care) averages about $197,000. If you include spending on nursing home care, that typical total balloons to $260,000. Further, five percent of couples, says the study, will see their health expenses in retirement grow as much as $310,000. If you include nursing home payments in that, there's a five percent chance the total health care cost will hit $570,000.

[Hat tip to the New York Times Economix blog.]

A new data-rich report by the University of Wisconsin and the Robert Wood Johnson Foundation suggests that where you live impacts your health. County Health Rankings aggregates key indicators for every county in the nation. And it compares each county to others within its state. Indicators are grouped into several categories: mortality, morbidity, health behaviors, clinical care, social/economic factors and physical environment.

In California, Sacramento County ranks 32nd in health outcomes (as measured by factors such as premature death, sick days, fair-poor reported adult health status). Placer comes in 6th, El Dorado 10th and Yolo 12th.

The National Center for Health Statistics released yesterday Health, United States, 2009, the 33rd annual compendium of data on nation's health and health care system. This 574-page book contains 150 trend tables covering a variety of topics ranging from mortality and fertility to health resource utilization and expenditure. 

Among the highlights in the report:

The birth rate among teenagers, 15-19, rose five percent between the years 2005 and 2007.

In 2007 life expectancy at birth rose to a record 77.9 years, up from 75.4 years in 1990.

In 2007, Americans visited doctors' offices, hospital outpatient and emergency rooms 1.2 billion times.

The percentage of people taking at least one prescription drug increased from 39 to 47 percent from 1988 to 2006.

There are also some state-level tables tracking multi-year trends on Medicare, Medicaid and the uninsured.

Anthem Blue Cross' big hike in individual health insurance premiums provoked strong reactions from U.S. Health and Human Services Secretary Kathleen Sebelius and State Insurance Commissioner Steve Poizner. It also reflects the relentless growth of health spending in the nation as a whole.

The same day the Anthem news broke, the journal Health Affairs published an article that projects health-related expenditures out to 2019. In several sobering tables, the authors estimate the aggregate cost, plus its proportion of GDP, of health care in the United States. They also break down the spending into key categories (hospital, dental, drugs, nursing home, public health, research, etc.).

The bottom line: the National Health Expenditure (NHE) will grow from $2.1 trillion in 2007 to $3.3 trillion in 2019 (in 2005 dollars). As a percentage of GDP, the NHE will increase from 15.9 to 19.3 percent over the same period. With baby boomers entering the Medicare system, public health care spending is expected to exceed private spending by 2012.

Bee data maven Phillip Reese has created a searchable database of license records for every registered nurse, licenses vocational nurse and certified nursing assistant in the state. You can call up the information by individual's name or place where practicing. What you get is a summary indicating the status of the license and whether the person has been disciplined. 

While we're on the subject of nurses, check out ProPublica's investigation of government regulation of nursing in California. The reporters found many instances where regulators failed to act against nurses whose misconduct had been verified. Sometimes the Board of Registered Nursing took more than three years to investigate and discipline licenses holders. That series ran last summer. Recently Propublica discovered that incompetent and impaired individuals often find their way into temp agencies supplying nurses to hospitals. Apparently these firms have been lax in their background checking.

The New York Times has produced two health reform infographics that deserve mention. The first summarizes the recent House vote on H.R. 3962, the Affordable Health Care for America Act. In addition to the complete tally of each house member's position, the accompanying map shows the geography of the vote with color-coding of each congressional district in the country. You get a good sense of where the Democrats who voted for and against the bill come from.

The other infographic is a well-illustrated NYT timeline of attempts at health reform legislation in the United States. It begins in 1912 with Theodore Roosevelt promising national health insurance while campaigning for President, and ends with the Oct. 7 House vote. (Presumably the chronology will grow with new developments.) Most of the timeline entries are supplemented with historic Times news clippings.

The recent death of a first-grader has prompted officals to close two Vacaville schools. Tests indicate the student had swine flu (H1N1), but the virus has not been confirmed as the cause of death.

The California Department of Health continues to update statistics on the H1N1 pandemic online. As of Oct. 17, there have been a total of 3,556 hospitalizations, ICU cases and fatalities in the state. There have been 233 California deaths. This table shows the extent of the disease in each county. Los Angeles County leads in number of hospitalizations and deaths, 331 and 33, respectively. Sacramento County comes in with 161 hospitalizations and eight deaths. Beginning Sept. 27, the Health Department committed to posting fresh stats every month.

Apparently not enough U.S. adults and adolescents heed their mothers' admonition to eat their vegetables. That's the conclusion of a new Centers for Disease Control survey which studied American diets to see if the country meets the national goal of at least 75 percent of Americans eating two or more servings of fruit a day and at least 50 percent of Americans eating three or more servings of vegetables a day.

The CDC reports that nationally only 33 percent of adults and 32 percent of adolescents eat enough fruit. And only 27 percent of adults and 17 percent of adolescents eat enough vegetables. The survey includes state-level figures. No state has achieved the nutritional goal, but California scores pretty high in the fruit category (no surprise). Some 40.6 percent of California adults consume enough fruit (trailing the District of Columbia with 41.6 percent). On the vegetable side, California comes in around the middle with only 25.6 percent adults eating recommended amounts. (The District tops the list again with 30.0 percent.)

Last week U.S. Health and Human Services Secretary Kathleen Sebelius released state-level figures on the nation's uninsured. Nationally, the number of Americans living without health insurance climbed from 39.8 million in 2001 to 46.3 million in 2008. Every state in the country (except Massachucetts) has seen an increase over the seven year period. In California, the uninsured rose from 6.5 million in 2001 to 6.8 million in 2008. In percentage terms, that means non-elderly adults without insurance increased from 23.6 percent to 24.8 percent in the state. All these numbers do not include people who've lost their insurance in the recent recession or have had coverage gaps of shorter than a year.

The Bee's Anna Tong has reported on a new statewide study that provides fresh evidence of the link between obesity and consumption of soda and other sugared drinks. The California Center for Public Health Advocacy found that 24 percent of adults have one or more sodas a day, and these adults are 27 percent more likely to be overweight.

The U.S. Centers for Disease Control has aggregated a bunch of valuable information on obesity on its web site. Particularly disturbing are statistics showing the steady growth of the problem. Below is a chart tracking the percentage of U.S. and California adults who are considered obese (i.e. they have body mass indices greater than 30).

Year	U.S.	Calif.
1995	15.9	15.1
1996	16.8	14.6
1997	16.5	16.0
1998	18.3	17.3
1999	19.6	18.7
2000	20.0	19.9
2001	20.9	21.9
2002	21.9	19.2
2003	22.9	23.2
2004	23.2	22.2
2005	24.4	22.7
2006	25.1	23.3
2007	26.3	23.3
2008	26.7	24.3

The RAND Corporation says that just reducing sodium intake to recommended levels can save the nation as much as $18 billion a year in health costs. The RAND study, published in the American Journal of Health Promotion, estimates that meeting these guidelines could eliminate 11 million cases of hypertension in the United States. The Centers for Disease Control recommends that adults consume no more than 2,300 mg of sodium every day. However, three higher-risk groups -- people over 40, African Americans and those with high blood pressure -- should adhere to a 1,500 mg daily limit. A 2009 CDC study says 69 percent of U.S. adults fall into these three groups.

Most (77 percent) of the sodium we eat comes from processed and restaurant food. Not too long ago, The Bee reported on the Campbell company's decision to lower the sodium content of its tomato soup by 32 percent without altering its taste appreciably. Although the new formulation meets the government's "healthy" target of 480 mg sodium or less, Campbell's won't market the soup as "low-sodium". Apparently, the label is a consumer turnoff.

[Salt illustration by Elizabeth M. Smith, The Columbia (S.C.) State.]

Death panels, free sex-change surgeries, subsidized abortions -- these are some of the dubious assertions in the heated debate over health care. How does the average person distinquish between fact and fiction in the claims and counter-claims? You could consult official sources, such as the Obama Administration's HealthReform.gov web site or the Senate Republicans' Health Care Facts. But they have a partisan bias, of course.

So where do you go for impartial information? One place is PolitiFact, the Pulitizer Prize-winning fact-checking service of the St. Petersburg Times. PoliitFact began in the 2008 presidential election with the mission of examining "statements by members of Congress, the president, cabinet secretaries, lobbyists, people who testify before Congress and anyone else who speaks up in Washington." Times reporters and researchers then rate their accuracy on a "Truth-O-Meter:" True, Mostly True, Half True, Barely True and False. The most egregiously false statements earn the lowest rating of "Pants on Fire".

PolitiFact ratings are browseable by broad subject. The section on health not only addresses many of the controversial statements made during the current debate on health care legislation, it also covers claims made by presidential contenders during the primaries and post-convention campaigning.

Have suggestions for non-partisan, reality-based, fact-checking on health reform? Share them in the comments below.

The Bee just reported that officials have found the West Nile virus in a Yolo County chicken. The bird is part of a test flock used to monitor the spread of the disease. The find is significant because it suggests mosquitoes in that area are carrying the virus and could transmit it to humans.

The California Public Health Department, UC Davis and other agencies maintain WestNile.ca.gov, a robust web site loaded with information -- data, news, reports, FAQs, links and other resources -- on a disease which has killed 91 people since 2003. A West Nile summary (updated on a weekly) includes county-level statistics on mosquito pools, horses, dead birds, squirrels, monitor chickens, as well as human cases. You can also report a dead bird or squirrel on this site.

President Obama today signed tough new legislation aimed at curbing cigarette smoking by teenagers. Aside from empowering the U.S. Food and Drug Administration to regulate tobacco, the law will ban youth-focused marketing by manufacturers.

Tobacco use by teens has declined, but it's still a health problem. According to the Centers for Disease Control:

* 20% of high school students report current cigarette use.

* Every day, about 4,000 U.S. adolescents, aged 12-17, try their first cigarette.

* Fifty percent of high school students have tried cigarette smoking.

* Fourteen percent of high school students have smoked a whole cigarette before age 13.

* Nearly eight percent of high school students (13% of male and 2% of female students) have used smokeless tobacco.

 

House Democrats today unveiled a new health care reform plan intended to cover the 50 million people in the country who lack medical insurance. (See the 850-page draft bill here.)

The U.S. Census maintains statistics on the uninsured. The latest data (2006-2007) breaks down estimates by age, race, ethnicity, income, family and employment status. There's also a table showing the number and percentage of the uninsured population by state. Approximately 15.5 percent of Americans are without insurance. In California about 6.7 million people --18.5 percent -- are uninsured. That puts California seventh in a ranking of states. Texas is first with 24.8 percent. Massachusetts is last with 7.9 percent.

Another sign of the economic times: personal bankruptcy filings for the 12-month period ending March 31, 2009 are up 32.4 percent from 12-month period ending March 31, 2008 (1,153,412 up from 871,186 filings). That's according to the U.S. Courts web site, where you can find a load of bankruptcy stats broken out by region and chapter.

A new study of personal bankruptcies in 2007 by the American Journal of Medicine found that medical debts contributed to 62.1 percent of all filings. About 92 percent of these medical debtors owed over $5,000 in medical billls (or 10 percent of pretax family income). The study looks at the survey data in terms of age, income, family size, insurance status and other factors.

Childbearing by unmarried women -- which leveled off nine years ago -- has been rising steeply since 2002, according to a new report issued today by the U.S. Centers for Disease Control. Babies born to unmarried women totaled 1.7 million in 2007, about 26% more than in 2002. Nationally the percentage of all live births to unmarried mothers rose from 34.0 in 2002 to 39.7 in 2007. In March, the CDC provided state-level data on nonmarital childbearing in 2007. California ranked 27th among the states with 38.9 percent of births to unmarried women. Mississippi was tops with 53.7 percent. Utah ranked last with 19.6 percent.

Today President Obama lauded the health care industry's promise to curb costs by $2 trillion over the next ten years. Representatives of hospitals, insurance companies, drug makers and doctors told the Administration they would slow cost increases by 1.5 percentage points a year. That begs the question: just how much does the United States spend on medical care? And how fast have expenditures been rising?

The Centers for Medicare and Medicaid Services (a division of U.S. Health and Human Services) keeps track of the nation's health spending and makes this data available through its web site. In total, the National Health Expenditure (NHE) grew 6.1 percent to $2.2 trillion in 2007. The annual percent change in NHE is expected to be 6.2 percent in 2008 and average 6.1 over the next decade.

CMS also provides a bunch of historical and projected data analyzing the NHE by type of service, source of funds, age of patients, state, per capita spending, spending as a percent of GDP, etc. In California, for instance, estimated health care costs grew from $81 billion in 1991 to $166 billion in 2004. That's an annual average increase of 5.7 percent. In comparison, national spending over the same period grew from $669 billion to $1.5 trillion -- an annual average increase of 6.7 percent.

Although cases of swine flu has yet to be confirmed, public health and Catholic church officials have closed the St. Mel School where 40 students are ill, four with ful-like symptons. A sample from one student was sent to the Centers for Disease Control, the nation's top public health facility.

The CDC has posted a helpful set of pages reporting the latest stats and news on the outbreak. As of 10 a.m today, 40 U.S. cases of swine flu have been reported (seven in California). The CDC also provides information for professionals, reports and publications, press briefings and travel notices.

For an international perspective, browse on over to the World Health Organization's epidemic and pandemic alert page. There you'll find fairly up-to-date news on swine flu, as well as an archive of news releases about disease outbreaks going back to 1996.

To get a national perspective on child abuse and the efforts of local government agencies to prevent it, take a look the recent report, Child Maltreatment 2007, prepared by the U.S. Department of Health and Human Services, Administration for Children and Families. The 162-page document is filled with statistics derived from data collected by CPS agencies across the country. Among the national findings for fiscal 2007:

* An estimated 794,000 children were determined to be victims of abuse or neglect. Of these 1,760 died (a rate of 2.35 deaths per 100,000).

* Of the estimated 3.2 million referrals to government (involving the maltreatment of 5.8 million children), 61.7 percent of cases were screened for investigation/assessment by CPS agencies.

* Nearly 80 percent of perpetrators were parents and another 6.6 percent were other relatives of the victim. Female perpetrators outnumber male ones by 56.5 percent.

Can you trust your doctor? That question will be addressed by an expert panel at a town hall meeting tonight at the McGeorge School of Law. The program "gets to the heart of the relationship and opens the door to a discussion that will demystify medical care and answer questions about how your physician makes decisions. In the end, you'll feel empowered to talk to your doctor and be more confident in your medical care." Capital Public Radio and The Bee are the sponsers and Bee Columnist Dr. Michael Wilkes is the moderator.

Trust is an essential aspect of medicine. So it's good to know there's a place to find out if your doctor has ever been disciplined. The California Medical Board provides a free online database where you can see any board actions or citations, hospital discipline, felonies or malpractice settlements over $30,000. Note that complaints to the board, board investigations, or misdemeanors not resulting in board action, are not included in the database. In addition, the record also shows the doctor's medical school, year graduated, and whether his/her license is valid.

Incidentally, the American Medicial Association has a web directory where you can browse doctors by name or specialty. DoctorFinder includes most licensed medical and osteopathic physicians in the United States and its possessions. You can narrow searches to a specific city or ZIP code. The resulting record shows office address, phone, specialty and any specialty certifications. 

Steroid use in sports continues to be a concern in the wake of Alex Rodriguez's admission and the release last year of George Mitchell's Report to the Baseball Commissioner on the illegal use of performance-enhancing substances by players.

Such revelations renew fears about the example steroid use by professional athletes sets for teenagers. The U.S. Centers for Disease Control tracks performance drug use in high schools, as part of its ongoing Youth Risk Behavior Surveillance System (YRBSS). The survey covers a range of activities including sexuality, tobacco, alcohol, illegal drugs, injuries, violence, exercise, and diet. It also estimates the percentage of students who have taken steroid pills or shots without a doctor's prescription one or more times during their life. The latest national figures (2007) say 3.9 percent of students reported they illegally used steroids at least once. The data goes back to 1991, and the Healthy Youth! web site lets you slice data by gender, race, grade and reporting year.

GKI Foods, a Michigan candy maker, is recalling all its products containing peanuts. That's the latest in the salmonella outbreak tied to peanut butter and peanut paste made by the Peanut Corporation of America at its Georgia plant. PCA doesn't sell directly to consumers but its potentially contaminated peanuts are used by more than 100 companies in the manufacture of food products, such as cookies, crackers, cereal, candy and ice cream.

The U.S. Food and Drug Administration has created a helpful web site filled with up-to-date news and other information on the salmonella situtation. For consumers there's a concise FAQ on the disease and the current recalls. You'll also find a searchable database with which you can find recalled products by brand name, UPC code or generic food type (e.g., crackers, brownies, etc.). You can also browse and sort the complete recall list with this Excel spreadsheet.

In his Dec. 6 radio address, President-elect Barack Obama laid out key elements of his plan to revive the U.S. economy. One of these is to modernize the health care system by ensuring "that every doctor's office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year."

Coincidentally, the National Center for Health Statistics released this month its latest estimates of the use of electronic medical records (EMR) by office-based physicians. Relying on a mail survey conducted this year, the NCHS found that "38.4 percent of the physicians reported using full or partial EMR systems, not including billing records, in their office-based practices. About 20.4 percent reported using a system described as minimally functional and including the following features: orders for prescriptions, orders for tests, viewing laboratory or imaging results, and clinical notes."

A comparable 2006 survey reported that 29.2 percent of the doctors were using full or partial EMR, and 12.4 percent of them had minimally functional systems.  

Just in time for the holiday eating season, the Centers for Disease Control released results of a survey estimating the percentage of adults who engage in the minimum amount of aerobic exercise "required to produce substantial health benefits". The study used U.S. Department of Health and Human Services 2008 exercise guidelines as a benchmark. Survey respondents are considered sufficiently active if they do at least "150 minutes of moderate-intensity activity per week, or 75 minutes of vigorous-intensity activity per week, or an equivalent combination of moderate- and vigorous-intensity physical activity".

So how did the nation do? Overall, 64.5% of U.S. adults met the guidelines in 2007, including 68.9% of men and 60.4% of women. The percent varies with such factors as age, race, education, region and body mass.

Incidentally, the HHS web site, Physical Activity Guidelines for Americans, provides some practical, non-intimidating advice on ways adults can get healthier by ramping up their exercise.

Today is the 33rd Great American Smokeout, the American Cancer Society's annual effort to encourage smokers to quit for a day. The ACS says it's never been a better time to stop smoking because of all the resources and help available. That includes the Quitline (1-800-227-2345), a free telephone service where smokers can get confidential counseling from trained advisers.

Just how many smokers are there in the country? According to the federal Centers for Disease Control, about 43.4 million (or one in five) adults currently smoke. The CDC provides a detailed statistical portrait of smokers broken down by gender, age, race, education and poverty status. The agency also reports that smoking and exposure to tobacco smoke result in about 443,000 premature deaths in the United States every year. Check out this sobering table showing annual deaths attributed to a variety of smoking-related diseases. It also shows years of potential life lost and the economic productivity lost for each of the diseases. 

The state Medical Board licenses and regulates some 125,000 doctors and surgeons in California. It's also charged with disclosing facts about physician malpractice and disciplinary action to the public. Is the board doing an adequate job in this regard?

The California Research Bureau doesn't think so. In its recent report, "Physician Misconduct and Public Disclosure Practices at the Medical Board of California," the CRB concludes that state regulators could be doing much more to inform the public. Consumers would greatly benefit, say the authors, by knowing more details of disciplinary actions (citiations, fines and enforcement actions), as well as malpractice payout histories (judgments, arbitration awards and settlements). The CRB recommends that MBC significantly expand the professional profiles contained in its searchable database of licensed physicians.

Cynthia Hubert's recent story on elder suicide reported the sobering statistic that older people, 65 and older, have the highest rate of suicide of any age group.

The Centers for Disease Control compiles national data on mortality and leading causes of death, including suicide. Should you need to track the number of suicides by such factors as place, age, gender, race, Hispanic origin and suicide method, the CDC provides an interactive web database for customizing queries for this information. All leading causes of death are covered so you can compare various illnesses with intentional and unintentional deaths. Plus the database has annual figures (1999-2005) for each state and the country as a whole.

Overall, is there a difference between men and women regarding method of suicide?  If you search the CDC database by gender (all ages, all races), firearms emerge as the leading method for males (followed by suffocation, poisoning and cutting/piercing). That's in contrast to poisoning (followed by firearms, suffocation and cutting/piercing) as the top method for females.