Before President Obama signed health care reform, Medicare beneficiaries first paid a deductible of $310 for online prescription drugs. Then Medicare pays 75 percent of charges up to $2,830. After that, coverage would stop cold until all of a senior’s out of pocket spending totalled $4,550. For those who reached this level of cost, which the government calls catastrophic, Medicare picked up again and covers 95 percent of the beneficiary’s drug bills.
The new health care reform law fills in the hole gradually between now and 2020. This year only, Medicare will send about 4 million people who reach the donut threshold a one-time rebate check of $250.
According to Peter Ashkenaz, a spokesperson for the federal Centers for Medicare and Medicaid Services, seniors will receive their checks about a month after they reach the donut hole.
Next year, Ashkenaz explained Medicare patients will receive a 50 percent discount on brand name drugs and a 7 percent discount generic drug brands. “If people need more, they could qualify for extra help and should talk to their state health insurance program and Social Security office to apply for extra help,” he said. The hole will be gradually filled a bit more each year after until it is completely closed over the course of the decade.
Medicare beneficiaries will receive a monthly mailing from Medicare showing how far along they are in spending.
A looming problem, Ashkenaz added, is that seniors need to be wary of scams. For instance, criminals have called seniors to say they are from Medicare and only need your Social Security number and bank information to deposit the $250 in your account.\
Political movers and shakers could not easily deny coverage to very sick people, so they agreed that Medicare should pay for medicine beyond amounts they said would be financially catastrophic for people. So instead of simply stopping coverage at a certain point, they ceased drug reimbursements at a midpoint and agreed to pick up spending again when people reach devastating amounts – amounts attained by a relatively small percentage of Medicare beneficiaries.
The insurance rules, all of which are set out in the new law, were put in the bill by the Obama administration and its Democratic allies to provide Americans with some early protections until the insurance market is completely overhauled in 2014.
The regulations, all of which were outlined in the original legislation, include:
• Barring insurance plans, with some exceptions, from denying coverage to children under 19 with preexisting medical conditions.
• Prohibiting insurers from rescinding coverage except in clear cases of fraud.
• Prohibiting insurance companies from imposing lifetime limits on what they will pay for care.
• Banning insurers from imposing annual limits of less than $750,000 on coverage of essential benefits including maternity care, emergency services and pharmaceuticals. (The minimum annual limit would rise to $2 million by 2014.)
• Prohibiting insurers from requiring that their customers get prior approval before getting emergency care outside the provider network.
With some exceptions, insurance plans starting after September will no longer be able to deny coverage to children under 19 with pre-existing medical conditions or to rescind coverage except in clear cases of fraud.
In all polls, independent voters are more disapproving of Obama and of the Democrats’ health legislation than not.
There have, though, been some instances where the influence of powerful corporate lobbies has been clear. They won obvious victories in defeating amendments on the floor or in committee on issues such as drug reimportation from abroad, bringing online generic drugs to market more quickly, and closing the so-called Medicare prescription drug “donut hole” (by which Medicare covers prescription costs up to $2,700 and over $6,154 but not in between).
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Scientists have for the first time identified the symptoms associated with what has been termed late-onset hypogonadism or 'male menopause' caused by a reduction in testosterone production in aging men.
But the researchers say that unlike the female menopause, which affects all women, the male menopause is relatively rare, affecting only 2% of elderly men, and is often linked to poor general health and obesity.
The findings, published in the New England Journal of Medicine, should provide new guidance to physicians prescribing male testosterone therapy, a practice that has increased by 400% in the United States, though not elsewhere, since 1999.
The University of Manchester researchers, working with colleagues at Imperial College London, UCL (University College London) and other European partners, measured the testosterone levels of 3,369 men between the ages of 40 and 79 years from eight European centres and asked details about their sexual health, physical and psychological health.
The team found that only nine of the 32 candidate symptoms were actually associated with low testosterone levels, the most important being the three sexual symptoms -- decreased frequency of morning erection, decreased frequency of sexual thoughts (sex drive), and erectile dysfunction.
The study concluded that the presence of all three sexual symptoms, together with low testosterone levels, was required to establish a diagnosis of late-onset hypogonadism, although other non-sexual symptoms may also be present.
These other symptoms included three physical symptoms -- an inability to engage in vigorous activity, such as running or lifting heavy objects, an inability to walk more than 1km, and an inability to bend, kneel or stoop -- and three psychological symptoms -- loss of energy, sadness, and fatigue. However, these non-sexual symptoms were only weakly related to low testosterone.
Additional symptoms often said to be associated with the male menopause but which the study was able to discount as not being testosterone related included changes in sleeping pattern, poor concentration, feeling worthless, nervousness or anxiety and difficulty getting up from a chair.
"The diagnosis of classical hypogonadism is corroborated by underlying diseases affecting the testes or pituitary gland, which controls testicular function, but this well-practiced diagnostic approach is frequently found wanting when dealing with the age-related decline of testosterone in elderly men who are prone to have a significant background of non-hormone-related complaints," said lead author Professor Fred Wu, from The University of Manchester's School of Biomedicine.
"Our findings have for the first time identified the key symptoms of late-onset hypogonadism and suggest that testosterone treatment may only be useful in a relatively small number of cases where androgen deficiency is suspected, since many candidate symptoms of classic hypogonadism were not associated with decreased testosterone levels in older men."
The research, part of the European Union-funded European Male Ageing Study, also identified the thresholds of testosterone below which certain symptoms become increasingly prevalent. Documentation of levels of testosterone below these thresholds is required to confirm the diagnosis of hypogonadism in symptomatic elderly men.
However, even with the nine rigorously selected symptoms, differences in testosterone levels between symptomatic and non-symptomatic men were marginal, highlighting the weak overall association between symptoms and testosterone levels.
Professor Wu added: "The long list of nonspecific symptoms that have a potential association with testosterone deficiency makes it difficult to establish a clear diagnosis of late-onset hypogonadism. This situation is further complicated when you consider that even the most specific sexual symptoms of androgen deficiency was relatively common among men with normal testosterone levels.
"It is therefore important to specify the presence of all three sexual symptoms of the nine testosterone-related symptoms we identified, together with low testosterone, in order to increase the probability of correctly diagnosing late-onset hypogonadism. The application of these new criteria should guard against the excessive diagnosis of hypogonadism and curb the unwise use of testosterone therapy in older men."
If some imaginative person had made a birthday cake for it, she – it would have had to be a she – might have put 100 million candles on it. For that represents the number of women around the world who start each day by swallowing it.
Yasmin is a birth control pill – known generically as the Pill – and many celebrated its 50th birthday on May 9th with justifiable gratitude and fanfare.
May 9, 1960, is one of those days that will shine bright in American history: it is the day that the U.S. Food and Drug Administration (FDA) approved the sale of the tiny pill that gave women control over their fertility. The FDA's "blessing" attested to the safety of hormonal contraception, or "birth control," in the words of Margaret Sanger. The Pill changed the world.
When it was approved, 500,000 women in the U.S. were already taking it, according to the recent Time cover story. This number would continue to swell rapidly, leading The
A recently released National Survey of Family Growth study found that the Pill is "the most popular method [of contraception] in the United States, used by 10.7 million women between the ages of 15 and 44. The Economist's crystal ball seems to be working well.
The early years in the life of the Pill were relatively easy ones. Millions of women "embraced" it, whatever the public arguments were for or against its use. It was an effective and convenient way to avoid pregnancy.
Most saw its promise in offering a different life beyond child rearing. More women were able to imagine a life that included both children and job. The results soon became plain: more companies, no longer afraid that women would leave as soon as they conceived a baby, eagerly opened their doors. Congress passed Title IX in 1972, ending not only discrimination in college athletics for female undergraduates, but also throwing open the doors of law, medical, and business schools to women.
But in the 1990s, the recent cover story in Time reported, when the Pill was about 20 years old, a backlash developed. The impetus for the counter-revolution started, or was ramped up, by organized religions and conservative political advocacy groups. The Catholic hierarchy consistently opposed the Pill from its inception, even though in 1970, "two-thirds of Catholic women were using birth control and more than a quarter were on the Pill." Many Evangelical Christian denominations followed suit, framing their disapproval in the context of what "God intends in marriage." Church leaders proclaimed that "using contraception can weaken the marital bond by separating sex from procreation."
On the eve of its 50th birthday, Katherine Spillar, Ms. magazine's executive editor, summed up the precarious situation in which the Pill currently finds itself: "We're still fighting those battles in Congress [like allowing hospital workers and pharmacists who have moral qualms about contraception to refuse to fill prescriptions]. To think that in 2010, 50 years after the birth control Pill, we still have to fight for access and effective family planning – it's painful."
If women gaining access to the Pill is painful in the U.S., it is infinitely more painful for women in the developing world. Investigative journalist Michelle Goldberg writes of this dilemma in her book, The Means of Reproduction: Sex, Power, and the Future of the World. In her concluding chapter, "Sex and Chaos," she paints a frightening picture of what will happen if we do not provide women in the developing world with the family-planning help many so desperately desire.
In developing countries overall, 15 percent of married women, and "seven percent of unmarried women have ... an unmet need for contraception," Goldberg writes. "This means they are sexually active, do not want to become pregnant, and yet are not using birth control." In sub-Saharan Africa, the number of unmarried women with an unmet need for online contraception is 24 percent and in many Latin American countries, "more than 40 percent of births were unwanted."