Dying: A Book of Comfort
 

by Pat McNees (updated 9-10-26;  orig. published 11-11-15
Why are our medical bills so high? Why aren't drug prices regulated, as they are in other countries? Where is most of our health care budget spent? Where can we improve the system? Why do we overtreat the rich and undertreat the poor? Who is in charge, when a patient needs complex chronic care? Has our market-driven medical care system served us well or do we suffer from its perverse incentives? Ours is the most expensive health care system in the world but it is not delivering the most effective health care. What can we do? Here are links to key articles explaining the high cost of medical care in the United States -- and whether we're getting what we're paying for.

• Are Health Insurers to Blame for Our Health System Problems? (KFF video series, September 2026) This three-part video series from KFF considers this question and the complicated answer, exploring what’s driving rising insurance premiums, whether insurers provide value, and who we trust to decide what gets covered and at what price.Drawing on KFF analysis and polling, the videos build on a JAMA Forum article by Larry Levitt, Executive Vice President for Health Policy: Are Health Insurance Companies the Reason for Our Health System’s Ills?
• Part 1 or 3: What's Driving Rising Health Premiums? (KFF Health, 9-10-26)

    Costly health insurance premiums are straining employers and consumers alike. But, it's underlying health care spending, especially for hospital care, that's driving costs. The video looks at how hospital consolidation and employer demands for broad networks affect insurers' ability, and willingness, to control prices.
---Are Health Insurers Providing Good Value? (Part 2, KFF Health) Insurers take a cut of every premium dollar for overhead and profit. The question isn’t just whether they profit, but also whether we’re getting value in return. Larry Levitt breaks down how much goes to administrative costs and profit and how that varies across private insurance markets and Medicare, and considers what a Medicare-for-all system, which would be operated by the government, would address and what might be left unresolved.
---Is Prior Authorizaation a Blessing or a Curse (Part 3, KFF Health, 9-10-26) Deciding what health care gets covered largely falls to health insurers, and it’s not a role that wins them many fans. A KFF poll finds prior authorization is the single biggest burden insured adults say they face beyond cost. Larry Levitt weighs insurers’ role as a check on care that lacks medical evidence against the impact that delays and denials have on patient care and health care providers.
---Are the Tradeoffs from Prior Authorization Worth It? (Drew Altman, KFF, 3-16-26) Chart: Four in Ten Insured Adults With a Chronic Condition Say Prior Authorization Is Their Single Biggest Health Care Burden Beyond Costs. There is some disagreement about whether prior authorization review reduces costs for payers and protects quality by denying unnecessary services or shifting care to equally effective, lower-cost services, or whether it increases costs and leads to adverse outcomes over time by delaying or denying needed care, and studies are available to support either claim. However, it adds to the complexity of our health system, frustrates patients and providers, and drives up administrative costs.
---Doing More and Defying Labels in New Mexico (Drew Altman, KFF, ) The one place where leaders have avoided labels and have done more than perhaps any other is New Mexico. Dr. Drew Altman, KFF’s Founding President and CEO, discusses how New Mexico made childcare universal and became the only state to fully replace lost enhanced ACA tax credits while its leaders avoided polarizing labels like “progressive or “socialist.”

• Pharma is showering Congress with cash, even as drug makers race to fight the coronavirus (Lev Facher and Kaitlyn Bartley , STAT, 8-10-2020) according to a new STAT analysis. It’s a barrage of contributions that accounts for roughly $11 million in campaign giving, distributed via roughly 4,500 checks from the political action committees affiliated with the companies. The drug industry has a clear stake in keeping the Senate in Republican hands — and its political spending in 2020 reflects that priority. Lots of details on who gets and supports what (or not).
• The Health Insurance Hustle: Why Your Health Insurer Doesn’t Care About Your Big Bills

  Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank. (Marshall Allen, ProPublica, 5-25-18)
• Hospitals’ Trauma Care Prices Differed Wildly In 2023: Study (KFF Health News)

One study found prices were so unpredictable between hospitals that some insured patients needing trauma care even ended up with more bills than uninsured people did. Stat, meanwhile, covers tech startups who are making money out of hospital price transparency rules.
• A small group of patients account for a whole lot of spending (Drew Altman, Kaiser Family Foundation, 7-29-19)

"Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year. A very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high....

    They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care....Prescription drugs account for about 40% of this group’s costs, not counting rebates — compared with just 10% for the country as a whole. Their bills just for prescription drugs average out to about $34,000 per year. That’s much more than the average premium for family coverage. These are exactly the people our insurance system is failing. They have insurance and a major illness, but still struggle with their medical bills as deductibles and other out-of-pocket costs keep rising faster than wages. One solution might be to exempt this small group of high spenders with serious illnesses from drug or other copays, and limit their deductibles."
• Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You. (Marshall Allen, ProPublica and Vox, 7-19-19)

Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
• What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud (Marshall Allen, ProPublica, 7-19-19)

Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate:

Check to see whether people getting federal ID numbers that allow them to bill insurers have valid licenses.

Require insurance companies to verify that the people they are paying are licensed medical providers.

Require insurance companies to report cases of suspected fraud to state and federal regulators.

Audits and the potential for fines may be needed to spur the insurers to file the reports.
• Outrageous medical bills (examples, explained--but not justified!)
• Pulling back the curtain on surprise medical bills
• What you can do to challenge excessive medical bills
• Government efforts to protect against wrongful medical billing
• Hospital Financial Analysis: True Cost of Healthcare (David Belk MD, True Cost of Healthcare). What do the carefully researched numbers reveal? "The revenue for any health insurance company is tied directly to its expenses. In other words, the more a health insurance company spends each year, the more revenue they can earn (through premium increases the next year). Therefore, the last thing any health insurance company would want is for their overall expenses to drop. If their expenses were to drop, they couldn’t justify raising (or even maintaining) the amount they charge policy holders in premiums. That would be a disaster for them.
Since hospital utilization has been declining overall, it would be hard for private health insurance companies to continue to show an increase in their costs each year unless they deliberately overpaid hospitals, so that’s exactly what they do. Hospitals don’t mind being overpaid, so they’re not complaining. Since hospital bills always show enormous discounts from the insurance companies (due to persistent over-billing) most people wouldn’t suspect what the insurance companies are really doing. This way, both sides can work together to profit from our ignorance."

 

• Marshall Allen Unearths Waste in Health Care ( Rachel Zamzow, Open Notebook, 2-13-18)

    "In 2012, ProPublica reporter Marshall Allen came across a staggering statistic: The U.S. health care system wastes an estimated $765 billion each year....Last year, Allen decided to root out the sources of squandered funds within the system—an investigation that culminated in a series called Wasted Medicine. Allen discovered how hospitals discard unused medical supplies, how some drug expiration dates are meaningless, and how drug companies knowingly make oversized eyedrops—a story that prompted a group of U.S. senators to introduce legislation to reduce wasteful packaging of medicines.

• Wasted Medicine: Squandered Health Care Dollars (ProPublica Series). Includes

---A Hospital Charged $1,877 to Pierce a 5-Year-Old’s Ears. This Is Why Health Care Costs So Much. (Marshall Allen, ProPublica and NPR's Shots blog, 11-28-17). When a surgeon doing surgery on a child offers to throw in ear piercing as well, think twice about accepting.
--Paying Till It Hurts In her series on the cost of health care, Elisabeth Rosenthal interviews patients, physicians, economists, hospital and industry officials to examine the high price of health care. Buy her book: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back .

And read the series here--including the readers' comments (from both patients and doctors).
• Part 1: Colonoscopy: A case study in high costs The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures (Elisabeth Rosenthal, Health, NY Times, 6-1-13) While the American medical system is famous for expensive drugs and heroic care at the end of life, a more significant factor in the nation’s annual health care bill may be the high price tag of ordinary services.
• Part 2. Pregnancy: Cash on delivery. American Way of Birth, Costliest in the World (Elisabeth Rosenthal, Health, NY Times, 6-30-13). Cash on delivery.
• Part 3. Joint replacement: A trip abroad. In Need of a New Hip, but Priced Out of the U.S. (Elisabeth Rosenthal, NY Times, 8-3-13)
• Part 4. Prescriptions. No room to negotiate. The Soaring Cost of a Simple Breath (Elisabeth Rosenthal, NY Times, 10-12-13)
• Part 5. E.R. Visit As Hospital Prices Soar, a Stitch Tops $500 (Elisabeth Rosenthal, NY Times, 12-2-13)
--- Think the E.R. Is Expensive? Look at How Much It Costs to Get There (Elisabeth Rosenthal, NY Times, 12-5-13) Ambulances, once free, are now generally run as businesses that contribute to America’s escalating medical bills.
• Part 6. Dermatology. The high earners. Patients’ Costs Skyrocket; Specialists’ Incomes Soar (Elisabeth Rosenthal, NY Times, 1-18-13) Check out reader responses on three questions: In your experience, do doctors and patients discuss cost as part of care, and, if so, how does that affect the doctor-patient relationship? When do costs influence care? If you are a provider, how have the financial incentives of the current payment system in the United States affected your practice? If you are a provider, how have the financial incentives of the current payment system in the United States affected your practice?
• Part 7. Chronic illnesses. Even Small Medical Advances Can Mean Big Jumps in Bills (Elisabeth Rosenthal, NY Times, 4-5-13)
• Health Care’s Road to Ruin (Elisabeth Rosenthal, NY Times, 12-21-13) There are ways to lower costs. Is there the will?

• Why do drug companies charge so much? Because they can. (Marcia Angell, Washington Post, 9-25-15) "Unlike every other advanced country, the United States permits drug companies to charge patients whatever they choose. ...Drug companies say high prices are necessary to cover their research and development costs" but most drugs "are invented not by the companies that sell them now but by someone else. Then, like big fish swallowing little fish, larger companies either buy small firms outright or license promising drugs from them. Very often, the original discovery occurs in a university lab with public funding from the National Institutes of Health (NIH), then licensed to a start-up company partly owned by the university and then to a large company. There is very little innovation at the big drug firms. Instead, their major creative output is trivial variations of top-selling medications that are already on the market (called “me-too drugs”), to cash in with treatments just different enough to justify new patents." Pharmaceutical companies are among the most profitable and "they spend more on marketing and administration than on R&D." ... "Congress has blocked Medicare from negotiating the price of drugs or creating a formulary for patients. It’s time that we, too, move to stop price-gouging by the pharmaceutical industry — even when no one notices."

• CVS Health Is Sued Over 'Clawbacks' of Prescription Drug Co-Pays (Jef Feeley and Jared S Hopkins, Bloomberg, 8-9-17) CVS Health Corp. was sued by a California woman who accused the drugstore operator of charging customers co-payments for certain prescription drugs that exceed the cost of medicines. CVS, the largest U.S. pharmacy chain, overbilled consumers who used insurance to pay for some generic drugs and wrongfully hid the fact that the medicines’ cash price was cheaper. Woman says she paid $166 for medicine that actually cost $92. Chains worked with benefit managers on billings, suits say.

• When the Patient Is a Gold Mine: The Trouble With Rare-Disease Drugs (Benjamin Elgin, Doni Bloomfield, and Caroline Chen, BloombergBusinessWeek, 3-24-17) With a flagship treatment that helps fewer than 11,000 people, how is Alexion making so much money? In the U.S., an orphan drug is defined as one that treats a disease affecting fewer than 200,000 people in the country. Orphan drugs accounted for a disproportionate share, 41 percent, of all medications brought to market in 2014. These drugs have helped millions of people...but have also caused a seismic shift in treatment costs....A fraction of a teaspoon of Soliris, administered in a single 35-minute treatment, costs more than $18,000, and patients might need 26 treatments a year for the rest of their lives. With this single drug accounting for almost all its revenue, Alexion has created enormous wealth out of an estimated 11,000 customers." This is an ugly story about drug company marketing practices".... History: "To address neglected research areas, Congress in 1983 passed the Orphan Drug Act, which gave drugmakers federal grants, tax incentives, and seven years of marketing exclusivity for new rare-disease treatments (vs. three to five years of exclusivity for a more common new drug). In the ensuing 34 years, more than 600 orphan drugs have been approved in the U.S., compared with 10 in the decade before the law was passed. But government-protected monopolies, combined with desperate patients, led to today’s prices." Do your homework. Read this article.
• Reducing Medical Costs Where to start.
Collusion between Hollywood script writers and pharmaceutical companies isn’t new. Nor is the call to regulate it. (Mary Chris Jaklevic, HealthNewsReview.org, 6-1-17) 'Plenty has been written about a recent “disease awareness” plotline in ABC’s General Hospital that indirectly promoted ruxolitinib, the only prescription drug approved to treat a rare blood cancer called polycythemia vera (PV). The drug’s manufacturer, Incyte, said in a news release that it “teamed up” with the show and actress Finola Hughes, whose character was diagnosed with PV, “to raise awareness and inspire patients and caregivers impacted by these under-recognized blood cancers.”
non-branded “disease awareness” campaigns aren’t regulated like traditional direct-to-consumer ads, which are subject to explicit requirements including balanced portrayals of a drug’s efficacy and risks. Coverage highlighted an opinion piece in the Journal of the American Medical Association, in which oncologists Vinay Prasad and Sham Mailankody said disease awareness efforts “can lead to unintended consequences, including wasteful diagnostic testing, overdiagnosis, and inappropriate therapy.” They said “attempts may be necessary to regulate disease awareness promotions” including “collaboration and input from the FDA regarding the content of advertisements or disease awareness campaigns.”
• What Broke My Father's Heart by Katy Butler (NY Times Magazine, 6-18-10). How putting in a pacemaker wrecked a family's life. Katy Butler's father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. She writes, of her parents: "I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims." Do read the whole article. Here's another excerpt: "Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace." You may also want to read Knocking on Heaven's Door: The Path to a Better Way of Death

• Pharmaceutical Product Hopping: A Proposed Framework For Antitrust Analysis (Michael Carrier and Steve Shadowen, Health Affairs blog, 6-1-17) One "reason for high prices has flown under the radar. When drug companies reformulate their product, switching from one version of a drug to another, the price doesn’t dramatically increase. Instead, it stays at a high level for longer than it otherwise would have without the switch. Although more difficult to discern than a price spike, this practice, when undertaken to prevent generic market entry, can result in the unjustified continuation of monopoly pricing, burdening patients, the government, and the health care system as a whole."
• The Healthcare Industry and the USSR (YouTube video, Jeanne Pinder's wonderful talk, Ignite Health Foo 2013). See also Taking the mystery out of health care prices and the wonderful stories about Clear Health Prices.
• Bitter Pill: Why Medical Bills Are Killing Us (Steven Brill, Time Magazine, Health & Family, 2-10-13). In the longest article Time has published, Brill tries to answer the question: “Why exactly are the bills so high?” Long but worth reading, on the outrageously excessive prices hospitals, pharmaceutical companies, doctors, and equipment manufacturers charge and how Medicare and other insurers deal with it, or not. See Steven Brill’s 26,000-word health-care story, in one sentence (Sarah Kliff, Wonkblog, Washington Post, 2-23-12). (The sentence: "The American health-care system does not use rate-setting." (In other countries, which set rates for what both private and public plans can charge for various procedures, health-care costs have not risen so much.) And don't ignore the Comments.

• Equitable Access to Care — How the United States Ranks Internationally (Karen Davis and Jeromie Ballreich, New England Journal of Medicine, 10-23-14) "Notwithstanding Americans' impression that other countries ration care, for lower-income adults, obtaining timely primary care is a bigger problem in the United States than in other industrialized countries... even Americans with above-average income...are more likely than adults with above-average income elsewhere to report that during the past year, costs kept them from visiting the doctor for medical problems, from filling prescriptions or taking all recommended doses, or from getting recommended tests, treatment, or follow-up."

• Patenting the PKU Test — Federally Funded Research and Intellectual Property (Diane B. Paul, New England Journal of Medicine, 8-29-13). "Norms governing what should count as a freely available public good have fundamentally changed since 1965. The shift began in the 1970s, when an 'economic competitiveness agenda,' prompted by the oil crisis and concern about Japanese competition, began displacing narratives of science's role in fighting communism and defeating disease." " The Bayh–Dole Act was followed by other bills promoting the commercialization of publicly funded research, a phenomenon soon exported worldwide. Aggressive commercialization of university research has since become the norm, with universities embracing patenting as an efficient way to transform knowledge into products, generate new income sources, recoup product-development costs, and motivate scientists." " The key principles debated in the Guthrie case underlie the conflicts that remain to this day between political and economic imperatives to commercialize research and the social and moral imperatives to promote public health."

• Money-Driven Medicine: The Real Reason Health Care Costs So Much by Maggie Mahar. Among other points made: Today's market-driven medical system emerged over the past century thanks to trends that gradually stripped power from doctors and gave it to corporations, turning patients into profit centers.

• 5 Things I Didn't Know About Health Care (Until I Got Sick) (C. Coville, Cracked, 3-11-14) Three of them: The medical system is outdated, it doesn't allow for mental limits in the sick, if it doesn't understand your condition it will think you are crazy. "Sick people with potentially curable illnesses are shunted around between separate specialists who don't pay attention to anything except the body part they've been trained to focus on, a problem known as care fragmentation... Because of care fragmentation, sick people often have to coordinate their own care if they want to get treated correctly. But that's not as easy as it sounds, because ..."

• Lies, Damned Lies, and Medical Science (David H. Freeman, The Atlantic, 10-4-10). Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

• Home Alone: Family Caregivers Providing Complex Chronic Care (Susan C. Reinhard, Carole Levine, and Sarah Samis, AARP's Public Policy Institute, Oct. 2012) "In a fragmented health care system, it is often difficult to pinpoint individual or institutional responsibility for action. As a result, people with chronic conditions and their family caregivers too often move from the care of one professional to another or from one care setting to another without a clear sense of who is in charge. All too often, no one is in charge. Expecting family caregivers to perform the medical/nursing tasks described in this report without substantial professional involvement is unrealistic and unacceptable."

• The Diseases We Spend Our Health Dollars On (Drew Altman, WSJ, 3-3-15) An excellent chart breaking down our health spending dollar by disease. "The BEA found that spending for common illnesses such as a cold or strep throat grew faster than anything else over the 10-year period. Then came spending to treat endocrine disorders such as high cholesterol or diabetes. The bureau also found that the cost of treatment–-a combination of price and the complexity of services and technology used in treatment–-was the main culprit behind spending increases for diseases, not the number of cases treated."

• The Thousand-Dollar Pap Smear (Cheryl Bettigole, New England Journal of Medicine, 10-17-13). "The first time a patient called me to say that she'd been billed more than $600 for her Pap smear, I was sure it was a mistake. The second time, I was less sure, and these days I am no longer surprised to find laboratory charges of $1,000 or more for a test that until recently cost only $20 or $30. ... we physicians and our staff are responsible for ordering these unnecessary tests and hence responsible for the huge bills our patients are receiving. Yet we are not doing this alone. Laboratories have learned that one easy way to increase revenue is to make it easy for clinicians to order more tests" Do read this one!

• Treating vs. Healing: Understanding What Wellness Means to Patients (Johnny Hourmozoi,, Pacific Standard, 3-31-15) For those accustomed to Western medicine, it may seem crazy to refuse doctor-prescribed medicine. But to truly be a healer, doctors must understand what makes a patient feel well. "Evidence is the currency of contemporary Western medicine... In Iran, the emphasis is placed on healing, a concept intimately tied to notions of spirit and comfort—not morbidity and mortality."

• How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, a book by Otis Webb Brawley and Paul Goldberg, exposes the underbelly of healthcare today—the overtreatment of the rich, the undertreatment of the poor, the financial conflicts of interest that determine the care that physicians’ provide, insurance companies that don’t demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm.

• Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer by Shannon Brownlee. Our health care is staggeringly expensive, yet one in six Americans has no health insurance. We have some of the most skilled physicians in the world, yet one hundred thousand patients die each year from medical errors. Brownlee dissects what she calls “the medical-industrial complex” and lays bare the backward economic incentives embedded in our system.

• Medicine’s Top Earners Are Not the M.D.s (Elisabeth Rosenthal, NY Times, 5-17-13) "The biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine. The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries."

• U.S. Health Care Lags Worldwide for Those Over 65 (Paula Span, Caring and Coping, NY Times, 12-12-14) A Commonwealth Fund report card comparing health care in industrialized countries since 1998 shows "mortifying lapses and problems" in the U.S., "despite spending more on health care than any other country in the world." The U.S. Medicare system provides "excellent coverage" overall, provides good coverage for seniors, but what Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom "share (aside from doing a better job for their elders than the United States, at lower cost) is that their systems cover all ages. Their elders are less likely to arrive at 65 trying to catch up after years without adequate medical care....Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care."

• How much are U.S. doctors worth? Depends who you ask (Harris Meyer, Modern Healthcare 6-24-14). High U.S. physician pay is only a minor component of sky-high U.S. healthcare costs (and U.S. doctors face a higher cost of medical education and medical liability premiums than doctors elsewhere). "And other professionals in healthcare, notably hospital, health plan and pharmaceutical executives, generally make even more money."

• Why Are American Health Care Costs So High? (John Green on YouTube, 8-20-13) A little hyper, but worth a listen.

• Hospitals Fail To Protect Nursing Staff From Becoming Patients (Daniel Zwerdling, All Things Considered, NPR, 2-4-15) Most hospitals have not taken aggressive action to protect the nursing staff from back injuries from lifting patients. Only slowly, reluctantly are hospitals adopting patient-lifting equipment. (Part 1 of a series on injured nurses.) Part 2: Even 'Proper' Technique Exposes Nurses' Spines To Dangerous Forces (2-11-15). And Part 3: Hospital To Nurses: Your Injuries Are Not Our Problem

• Cost of medical school: USA vs France (Kevin Pho, KevinMD.com, 5-8-14) Visuals show dramatic differences. "If you want to pay me like a French doctor, also give me the French cost of medical school and the French medical malpractice system."

• The Malpractice Mess (Atul Gawande, Annals of Medicine, New Yorker, 11-14-05) Who pays the price when patients sue doctors? "General surgeons pay anywhere from thirty thousand to two hundred thousand dollars a year in malpractice-insurance premiums, depending on the litigation climate of the state they work in; neurosurgeons and obstetricians pay upward of fifty per cent more." Paying into an insurance fund for those actually harmed by doctors might mean fewer mammoth, random windfalls but under the current system in America most of those who are harmed are not compensated (except the lawyers).

• When Health Costs Harm Your Credit (Elisabeth Rosenthal, NY Times, 3-8-14)

• Benefits Questioned in Tax Breaks for Nonprofit Hospitals (Elisabeth Rosenthal, NY Times, 12-17-13) Cities still reeling from the recession are challenging the billions of dollars in tax breaks granted to the nation’s nonprofit hospitals.

• When Doctors Sell Out, Hospitals Cash In (Community Oncology Alliance, 7-8-13) Everything was the same about Mike Rosenberg’s routine visit to Atlanta Cancer Care in February – everything, that is, but the bill. Rosenberg went to the same office and saw the same staff to get the same blood work and the same medication he gets every month. But the cost difference was remarkable: Rosenberg’s out-of-pocket charge increased from $20 to $212. What his insurer had to pay exploded from $2,735 to $5,661.

• New Analysis Shows Many 340B Hospitals Provide Minimal Charity Care; Small Percentage of 340B Hospitals Provide More (Community Oncology Alliance, 3-25-14)

• Health Plans Seek Leverage When Physicians Submit Extremely High Bills (Joseph Burns, Managed Care, Aug 2011). One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation. Aetna sued several New Jersey physicians over medical bills for out-of-network care, bills Aetna said were unconscionable.

• How Doctors Are Paid Now, And Why It Has to Change (John Carroll, Managed Care, Dec. 2007). Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn’t had much effect on its use. warped the way medicine is practiced, devaluing vital services such as doctor-patient discussions while pumping up rewards for expensive procedures and bigger volumes.

• Patents, Profits, and the American People — The Bayh–Dole Act of 1980 (Howard Markel, N Engl J Med 2013; 369:794-796, August 29, 2013, DOI: 10.1056/NEJMp1306553). It's time for Congress to recalibrate Bayh–Dole. "When the Bayh–Dole Act was written, its aim was primarily to stimulate economic growth by more efficiently mining the untapped scientific riches of hospitals, laboratories, and universities. Much has changed since then.... Profits and patents can be powerful incentives for scientists, businesspeople, and universities, but new and ongoing risks — including high prices that limit access to lifesaving technologies, reduced sharing of scientific data, marked shifts of focus from basic to applied research, and conflicts of interests for doctors and academic medical centers — should be mitigated or averted through revisions of the law. All Americans should be able to share in the bounties of federally funded biomedical research."

• Data uncover nation’s top Medicare billers ( Peter Whoriskey, Dan Keating and Lena H. Sun, Washington Post, 4-9-14). "Jonathan S. Skinner, a Dartmouth economist..."there are people who are operating in the gray area of health care who are causing Medicare to spend enormous amounts on health care that may be harmful to their patients.'”'

• The top 10 Medicare billers explain why they charged $121M in one year (Jason Millan, Wonkblog, 4-9-14) "Some doctors said they were just passing through the payment to drug companies. But the Medicare payment system also incentivizes physicians to choose more expensive drugs, since they’re reimbursed for the average price of the drug plus 6 percent." See comments section for links to articles about pending big changes in Medicare payments to providers.

• Manufactured Medicare outrage (Charles Lane, Opinion, Wash Post, 3-18-15) "Last fall, the Department of Health and Human Services released a comprehensive analysis showing that MA costs grew faster than they would have under fee-for-service between 2004 and 2013 — and that only upcoding, not patient demographics or other neutral factors, could explain this.

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• Maintaining mobility and preventing disability are key to living independently as we age

   (National Instititution on Aging, NIH)

   Mobility — the ability to move or walk freely and easily — is critical for functioning well and living independently. As we age, we may experience changes to our mobility.

    There are many reasons for these changes, including changes in gait (how we walk), balance, and physical strength. All of these can increase the number and severity of falls and make it harder for older adults to go out and visit with friends and family and continue doing their activities independently.

     Older adults who lose their mobility are less likely to remain living at home; have higher rates of disease, disability, hospitalization, and death; and have poorer quality of life. In today’s health care environment, improving health largely falls outside of health care facilities.

     People with functional limitations and chronic conditions are four times more likely than the general population to be among the five percent costliest users of health services. And yet, function is rarely addressed in medical visits.

• The MyMobility Plan for Older Adult Drivers (CDC)

    The MyMobility Plan can help you stay safe, mobile, and independent as you age. CDC developed this planning tool to help older adults plan for future mobility changes that might increase their risk for motor vehicle crashes and falls.

 

• MyMobility Tool (CDC) Download this informational tool to help older adults maintain their mobility and independence as they age.

• Falls-free checkup (National Council on Aging)
    Answer 13 simple questions to get your falls risk score and resources to prevent falls.

    Falls and motor vehicle crashes are the leading causes of injury and injury death in older adults. There are many negative outcomes for older adults if they stop driving or fall, including potential decreases in their health, social interaction, and the ability to get around. CDC developed this planning tool, using available scientific evidence, to help older adults plan for future mobility changes that might increase their risk for motor vehicle crashes and falls.

• The Extreme Sport Helping Some Older Adults Navigate Ups and Downs (ad in Nice News)

Have you heard of parkour? The activity involves jumping over ledges, climbing fences, and running over obstacles to get from Point A to Point B. A coach named Tan Shie Boon is harnessing the activity to help adults aged 50 to 70 in Singapore improve their balance, build strength, and learn how to fall safely.

    “In parkour, you’re falling all the time. You make a mistake when you jump, you fall,” he told Reuters. “But when you fall, you learn how to fall better next time.”

    My friend Jeanne B and I are testing the exercises with an expert in Maryland whose wonderful gym is full of children who have been enthusiastically learning to climb and fall safely. We hope to do the same.

• Mobility Resources for Older Adult Drivers (CDC)

• Medicine Risk Task Sheet

   https://www.cdc.gov/older-adult-drivers/media/pdfs/Medicine-Fact-Sheet.pdf

   Scroll to bottom of that page for medications that may be problematic for falling and for auto crashes.

   Medications can be linked to injuries as we age. Three out of every four older adults take at least one medication commonly linked to falls or crashes.

• CAPABLE National Center (888-352-9062)
---Frequently asked questions (CAPABLE website)

Examples (for in case tips disappear from online)

    How the CAPABLE team leverages home modifications to increase function and independence.

    Examples include:

 The handy worker lowered the cabinets so Mrs. R can reach items and organize her spices using less energy.

    The handy worker installed an above stove mirror so Mrs. R can see food in pots and pans while seated.

    A reacher gives Mrs. R better control to pick up items.

The handy worker added an extended chain to her light and switched the bulb to an LED.

    Mrs. R can now operate the light safely without her husband’s help and she can read the sheet music better.

    Wearing arthritis compression gloves and a back brace decreases her pain.

    The handy worker constructed a higher bench to prevent back pain when playing the piano.

---Beyond Grab Bars case study (Capable)

• Older People Will Need Much Better Transit (Laura Bliss, City Lab, 8-4-17)

    Transit agencies, take note: For the growing number of Americans over 65, mobility can’t wait.

    A TransitCenter report makes the case that healthy aging hinges on better mass transportation. Good transit can ease isolation, can connect to medical care, is safer than driving, means a safer way to walk, and current options just aren't cutting it.

    "Most transit systems, especially those built prior to the Americans with Disabilities Act, don’t respond adequately to these limitations. Buses that lack accessible seating, stations without shade or benches, and connections that require crossing dangerous roads discourage elderly users. So do, for example, the 362 out of 472 subway stations in New York City that aren’t accessible to wheelchair users."

    The basics of transit haven't changed much. Microtransit could be a game-changer for seniors savvy with smartphones.

    Cities are also experimenting with subsidized ride-hailing services to get elderly residents around.

    And retiree-filled Altamonte Springs, Florida, has been straight-up subsidizing Uber rides for everyone.

    Riders of all ages value frequency and speed in their transit options most, and older riders also "emphasize accessibility and comfort, with shelter and seating ranking high among their priorities."

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See also
Evola vaccine
Evola virus (under Medical Mysteries)

  
Ebola disease: Key facts

    (World Health Organization)
• Ebola disease is a severe, often fatal illness in humans.
• Three different viruses are known to cause large Ebola disease outbreaks: Ebola virus, Sudan virus and Bundibugyo virus.
• The average Ebola disease case fatality rate is around 50%. Case fatality rates have varied from 25–90% in past outbreaks.
• Early intensive supportive care with rehydration and the treatment of symptoms improves survival.
• Approved vaccines and treatments are only available for one of the viruses (Ebola virus) and are under development for the others.
• Outbreak control relies on a package of interventions including intensive supportive care of patients, infection prevention and control, disease surveillance and contact tracing, laboratory services, safe and dignified burials, vaccination if relevant, and social mobilization.

• How Bad Could the Ebola Outbreak Get? Here Are 5 Key Factors.

(Stephanie Nolen, Samuel Granados, Amy Schoenfeld Walker, Carl Zimmer and Apoorva Mandavilli, NY Times interacctive, 6-23-26)

How widespread is testing? Limited testing meant missed cases early on, though things are improving.

   An early failure to identify the Bundibugyo virus, the species responsible for the outbreak, followed by a lack of testing equipment, led to major delays in identifying infected people. That has made current case counts almost certainly lower than reality.

Can infected people be traced and isolated? More Ebola exposures are being tracked, but blind spots remain. Experts think most contacts have not even been identified.

When will vaccines and treatment become available? Testing and approving vaccines and treatments could take several months or more. For now, the only treatment that the W.H.O. recommends is supportive care. That can include IV fluids, antibiotics for bacterial infections and management of organ failure and other complications.

How far might the infection travel? Global spread appears very unlikely. Spread within the highly mobile affected region is much more likely.

How deadly is the virus? It’s not clear yet, but this Ebola species may be less deadly than others.

• HHS confirms Americans with high-risk Ebola exposures will have access to experimental therapy

(Helen Branswell, STAT News, 6-4-26)

Antibody treatment has been developed by Mapp Biopharmaceuticals

• Crisis in the Hot Zone

   (Richard Preston, New Yorker, 10-19-91)

Lessons from an outbreak of Ebola. Note the year: 1991.

Like all viruses, Ebola and its cousin Marburg are parasites. They can copy themselves only inside a cell. Viruses need to use a cell’s equipment to reproduce.

• The Ebola Wars

   (Richard Preston, New Yorker, 10-20-2014)

As an epidemic widens, the virus is mutating. Geneticists are racing to keep up.

• Is Ebola Evolving Into a Deadlier Virus?

    (Richard Preston, New Yorker, 8-7-19)

The virus that has infected thousands in the Democratic Republic of the Congo has been replicating itself every eighteen hours for more than a year.

    Right now, there may be around six hundred people in eastern Congo who have Kivu Ebola particles replicating in their bodies. As Ebola re-creates itself, many of the resulting particles are deformed duds and can’t replicate further. The ones that can copy themselves are infective. The Kivu swarm, with its three new lineages of Ebola, may amount to about one or two quadrillion infective particles of the virus. If these particles were collected in one place, they would fill three teaspoons and would weigh about fifteen grams.

    That small space contains numberless genetic possibilities. The longer the outbreak is allowed to continue, the greater the chances that Ebola will mutate, get better at spreading in humans, and vastly enlarge its circle of victims.

• Ebola outbreak may be spreading faster than first thought, WHO doctor warns

    (BBC News, video, 3.37 minutes, 5-20-26)

• WHO chief concerned over ‘scale and speed’ of Ebola outbreak as Congo reports 134 dead

   (AP News, via MedPage Today, 5-19-26)

The director-general of the World Health Organization voiced concerns about the "scale and speed" of an outbreak of a rare Ebola variant in the Congo, where authorities reported a sharp rise to at least 131 suspected deaths and more than 500 suspected cases.

• Ebola Fast Facts (CNN)

• With no approved vaccine for Ebola outbreak, experts weigh testing a long shot

(Helen Branswell, STAT News, 5-18-26)

   While there is no vaccine for this type of Ebola, animal study suggests Merck’s Ervebo, designed for another strain of the virus, might offer some protection.

• Flawed tests and funerals allowed Ebola to spread undetected, sources say

   (Reuters, 5-18-26)

Local funeral practices helped the virus spread before any alarm was raised, diagnostic tests in a local laboratory were calibrated for the wrong strain of Ebola, and samples sent to Kinshasa were not stored or shipped properly, the officials said.
     Experts say the resulting delays risk hobbling efforts to contain the outbreak, which the World Health Organization at the weekend declared a public health emergency of international concern.
     "It's just a scattered mess right now. I don't think we have anything close to a real idea of how many cases there are," said Craig Spencer, an emergency physician and public health professor at Brown University.

• Ebola virus

   Background on ebola virus, in section on medical mysteries.
• Ebola vaccine

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• Lung Diseases (National Lung, Heart, and Blood Disorders Institute, NIH)

The National Heart, Lung, and Blood Institute (NHLBI) conducts and supports research that expands our understanding of lung biology and how lung diseases start and progress, as well as studies and clinical trials that lead to new and improved ways to diagnose, treat, and prevent lung diseases.

---All health topics covered by NHLBI  (a huge list, in alphabetical order)

• Lung Infections, Illustrated (Lung Cancer Center)

• Lung Infections (Lung Cancer Center) A lung infection (pulmonary infection) occurs when microbes like bacteria, viruses, or fungi enter the lungs, causing inflammation and fluid accumulation, such as in pneumonia or bronchitis.

    The most common causes are viral (including COVID-19 and influenza) or bacterial, though fungi can also be responsible.

    Common symptoms include a persistent cough (producing yellow, green, or rusty mucus), chest pain, fever, shortness of breath, and fatigue.

Common types of lung infection:

    Pneumonia (infection of the air sacs, or alveoli)

    Acute Bronchitis (inflammation of the airways, or bronchial tubes)

    Walking Pneumonia (a mild form of pneumonia).

 

SERIOUS LUNG DISEASE:

• Lung disease (Cleveland Clinic)
 Lung disease is a general term for health conditions that affect your airways or lung tissue.

 Common lung diseases include asthma and COPD (chronic obstructive pulmonary disease), pulmonary fibrosis, pneumonia, and lung cancer. 

 Cardiovascular diseases that affect your lungs — like pulmonary hypertension and pulmonary embolism — are also sometimes considered lung diseases.    

 

Lung disease can cause symptoms like shortness of breath and chronic cough.

Treatment depends on the type of lung disease you have. 
Most lung diseases are long-term (chronic).

You may be born with one (like cystic fibrosis) or you might develop one later in life (like COPD).

A few lung diseases, such as infections, are short-term and can be cured.

 

Types of lung disease (examples) include:

---Asthma, a condition that causes inflammation and narrows your airways

---Bronchiectasis, a condition where your airways widen and form pouches

---Chronic obstructive pulmonary disease (COPD, including emphysema), airway damage that makes it hard to breathe

---Cystic fibrosis, a pancreatic disease that affects your lungs

---Emphysema

---Infections like pneumonia and tuberculosis

---Pulmonary fibrosis and other types of interstitial lung disease, conditions that damage your lung tissue and can get worse over time

---Lung cancers, like non-small cell lung cancer, small cell lung cancer, and mesothelioma

---Lymphangioleiomyomatosis (LAM), a disease that causes cysts in your lungs.

• Rare Lung Diseases (Cleveland Clinic)

   Click on this link: Cleveland Clinic (not discussed on this blog post)

    Often called orphan lung diseases.

 

• Management and Treatments for Lung Diseases (Cleveland Clinic) 

Brief descriptions of: 

  Corticosteroids

  Inhaled medications (bronchodilators)

  Oxygen therapy

  Smoking cessation programs

  Anti-fibrotic and cytotoxic drugs (medications that can slow down lung scarring caused by certain types of lung disease)

  Biologic drugs (medications like rituximab that are sometimes used to treat autoimmune diseases and other causes of lung disease)

  Clinical trials (tests of new treatments to see if they are effective)

  Positive airway pressure (a BiPAP machine to help you breathe)

  Pulmonary rehabilitation (an exercise and education program to strengthen your lungs and help you manage certain lung diseases).

 

Smoking is the leading cause of preventable death worldwide, responsible for over 480,000 deaths annually in the U.S. alone.

It causes roughly 90% of lung cancer deaths and 80% of COPD deaths.

Cigarette smoke contains over 7,000 chemicals, with at least 69 known to cause cancer, affecting nearly every organ in the body.

Nicotine is highly addictive, reaching the brain within 10 seconds of the first puff.

Smoking damages airways, decreases immune system efficiency, and harms fertility in both men and women.

It causes accelerated aging of the skin, stained teeth, and severe gum disease

Cigarettes are the most littered item on Earth.

Tobacco kills up to half of its users who don't quit

Second hand smoke causes accelerated aging of the skin, stained teeth, and severe gum disease

 

• The Dirty Dozen: 12 Myths That Undermine Tobacco Control

1. People have free choice whether or not to smoke

2. Everyone knows how bad smoking is.

3. Just a few cigarettes a day can't hurt.

4. "Light" cigarettes are less harmful.

5. It's easy to stop smoking. If people want to quit, they will.

6. Cessation medications don't work.

7. Once a smoker, always a smoker.

8. Smokers may die earlier, but all they lose are a couple of bad years at the end of life.

9. Environmental smoke may be a nuisance, but it isn't deadly.

10. Tobacco is good for the economy.

11. We've already solved the tobacco problem.

12. The tobacco industry no longer markets to kids or undermines public health efforts.

 

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"This remarkable collection, coming from personal experience and wide reading, will help many find the potential of growth through loss."  ~Dame Cicely Saunders, OM, DBE, FRCP,  founder of the hospice movement  

 

"This is a special gem of a resource for those contending with dying,death, and bereavement. Through its expertly chosen material, Dying, A Book of Comfort informs, guides, and gently enables healthy grief and mourning. I recommend it heartily. 

    ~ Therese A. Rando, author of How to Go On Living When Someone You Love Dies

“Seldom have I read a book that exudes such comfort, such an embrace of genuine insight, care and support....The book’s gift, and it is a rich treasure for the reader, is that it embraces who we are.... The book can be read cover to cover, or just pick out a page. Something will leap off the page, a story, a quote, a reading, narrative couplings of diverse themes colorfully worded by the author/scribe, to give you the needed word or embrace....This book needs wide circulation. The bereaved deserve this, and the book will help all of us.”  ~ Rev. Richard B. Gilbert, director, World Pastoral Care Center, in Resources Hotline

 

"It is by far the best book of its kind that I have come across (and, over the years, I have come across many). It has passages from so many of the writers that I know and have taught and Pat McNees has such good judgment."

                    ~ Carol Brown

“The subject of death is so rife with terror that it takes a calm and sure hand like Pat McNees’s to soothe, help us understand, and finally, rejoice in life. This is an important and very dear book.”  ~ Sherry Suib Cohen, author of  Secrets of a Very Happy Marriage

“A remarkable collection (331 pages) of quotations of comfort.” ~ Ernest Morgan, Dealing Creatively with Death

"For those who face the lonely reality of death, this book provides understanding and much-needed solace.

      ~ Claire Berman, author of Caring for Yourself While Caring for Your Aging Parents

“McNees has provided a remarkable anthology of insights, comforting words, stories, reassurance, and guidance for the journey of dying and grieving. Fourteen chapters delve artfully and compassionately into a full range of dying, death, and bereavement topics. An index by author ‘Names’ and another by ‘Titles and Selected First Lines’ make it possible to return and savor the many rich offerings she has gathered.”

"Dying, A Book of Comfort is THE book to press into the hands of those you love, read out loud in the company of others, and reflect on after they have all gone home. Pat McNees gently guides us as we reluctantly explore the far side of forever."

                       ~ Lynne Lamberg, author of The Body Clock Guide to Better Health

In process of revising the order page so that it works!
Buy Now - Dying: A Book of Comfort

Please read this at least once before this situation arises!

• Call 911 for heart attack or stroke symptoms, or just drive to the ER? What doctors say you should do (American Heart Association News, 4-15-25)

 

Meanwhile, assuming you've read that article and are back to leisure reading, one of my most reliable friends/editors asked me to share this advice (yes, I know, I wondered what 1 and 2 were also, but they were clearly in the nature of throat-clearing): 

 

Suppose you might be having a heart attack:

 

3. Suddenly you start experiencing severe pain in your chest that starts to drag out into your arm and up in to your jaw. You are only about five km from the hospital nearest your home.

4. Unfortunately you don't know if you'll be able to make it that far.

5. You have been trained in CPR, but the guy who taught the course did not tell you how to perform it on yourself.

6. HOW TO SURVIVE A HEART ATTACK WHEN ALONE? Since many people are alone when they suffer a heart attack without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

7. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.

8. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

• How to tell the difference between a heart attack and panic attack (Catherine S. Williams, American Heart Association News, 7-13-22)

• 7 things to know about how stroke is different for women (American Heart Association News, 5-22-24)

 

Happy birthday, Dad, wherever you are!

 

• Kennedy Flips Food Pyramid to Emphasize Red Meat and Whole Milk (Alice Callahan and Dani Blum, NY Times, 1-7-26)
   "After years of being advised to avoid eating too much red meat and foods high in fats, Americans are now being told to embrace them. The Trump administration released new dietary guidelines on Wednesday, pushing Americans to prioritize protein and cut back on added sugars and processed foods.
   "For months, Mr. Kennedy and Dr. Marty Makary, the Food and Drug Administration commissioner, had said that the new guidelines would end the so-called “war” on saturated fats, prompting consumer health groups and nutrition experts to worry that the new guidelines would recommend that people consume more saturated fats. That move would put people’s health at risk, experts said, since saturated fats have been shown to raise cholesterol levels and the risk of cardiovascular disease.
   "The administration kept the saturated fat recommendation unchanged, suggesting that no more than 10 percent of daily calories should come from the fats.
   "But the guidelines also include the contradictory advice to prioritize foods that are high in saturated fats, such as red meat, full-fat dairy products and butter and beef tallow. Consuming one eight-ounce rib-eye steak, for example, would put many people over their daily saturated fat limit."

     

While research suggests that getting more of your protein from plant rather than animal sources can reduce risks of cardiovascular disease and earlier death, the new guidelines don't steer people toward plant proteins.

 

Would you take nutritional advice from Donald Trump?

What not to do with plastic products.  (revised 10-25-25)

 • Microplastics are everywhere. You can do one simple thing to avoid them. (Shannon Osaka, Washington Post, 10-13-25)

Microplastics, studies increasingly show, are released from exposure to heat.

“Heat makes it easier for microplastics to leach out from packaging materials.”

    Stop putting anything plastic in the microwave.

    Don't pour hot water or hot tea into plastic containers.

    Avoid exposing plastic to heat.
    The effect was even stronger in plastics that are older and degraded. Hot coffee prepared in an eight-year-old home coffee machine with plastic components had twice as many microplastics as coffee prepared in a machine that was only six months old.
    The same effect has been shown in studies looking at how laundry produces microplastics: Higher washing temperatures, scientists have found, lead to more tiny plastics released from synthetic clothing.

    Keeping your plastic away from heat is a low-hanging fruit that can substantially lower your exposure.

 

• The plastic problem isn't your fault, but you can be part of the solution (Rebecca Davis, Audrey Nguyen, Life Kit, NPR,7-12-21)

    "I'm talking about the stuff that comes with food and bottled drinks, cosmetics, carryout containers, bags and wrappers — more than 40% of all plastic made is packaging, which is used only once or twice before being thrown away. Don't we feel at least a little guilty when we toss one plastic snack wrapper or coffee cup after another into the trash?"
    "It's estimated that only about 9% of plastic waste generated in the U.S. is recycled and that the rest ends up in landfills, incinerators and, unfortunately, marine environments such as rivers and oceans. And there, according to the National Oceanic and Atmospheric Administration, it will remain for hundreds of years."

   

• Recycling plastic is practically impossible — and the problem is getting worse (Laura Sullivan, All Things Considered, NPR, 10-24-22)

    "The vast majority of plastic that people use, and in many cases put into blue recycling bins, is headed to landfills, or worse, according to a report from Greenpeace on the state of plastic recycling in the U.S.
    "Greenpeace found that no plastic — not even soda bottles, one of the most prolific items thrown into recycling bins — meets the threshold to be called "recyclable" according to standards set by the Ellen MacArthur Foundation New Plastic Economy Initiative. Plastic must have a recycling rate of 30% to reach that standard; no plastic has ever been recycled and reused close to that rate.'

• Ocean plastics: How much do rich countries contribute by shipping their waste overseas? (Hannah Ritchie, Our World in Data, 10-5-23)
Nearly one-quarter of the world’s plastic waste is mismanaged or littered. Around 82 million tonnes. This means it’s not stored in secure landfills, recycled or incinerated.
    One-quarter of that – 19 million tonnes – is leaked to the environment. 13 million tonnes to terrestrial environments, and 6 million tonnes to rivers or coastlines.
     1.7 million tonnes of this is then transported to the ocean: 1.4 million tonnes from rivers, and 0.3 million tonnes from coastlines. The rest of the plastic waste that was leaked into aquatic environments accumulated in rivers and lakes.

 

  The Myth of Plastic Recycling (Laura Sullivan, Emily Kwong, Rebecca Ramirez, NPR, 12-08-22)

   "Only a small fraction of plastic is ultimately recycled.     

   A recent Greenpeace report found that people may be putting plastic into recycling bins — but the amount of plastic transformed into new items in the U.S. is at a new roughly 5-6% low.
    "The plastic industry has spent tens of millions of dollars promoting the benefits of plastic, a product that, for the most part, was buried, was burned or, in some cases, wound up in the ocean. The problem has existed for decades. In all that time, less than 10 percent of plastic has ever been recycled."

• Plastic-Free July Every piece of plastic that’s ever been created still exists in our world. Single-use plastic is the worst culprit. It’s manufactured to last forever, yet it’s often used for only a few minutes before being thrown away. So what can we do to turn the tide on one of the most urgent issues of our time?

• How to live without plastics for a month, according to the founder of a global movement (Claire Murashima, NPR, 7-2-24)

• Advancing Sustainable Materials Management: 2018 Fact Sheet (EPA, 2018)

• Where does the plastic in our oceans come from?(Hannah Ritchie, Our World in Data, 5-1-21)

   Which countries and rivers emit the most plastic to the ocean? Around 0.5% of plastic waste ends up in the ocean. Most of it stays close to the shoreline. What does this mean for solutions to tackle plastic pollution?  

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Pruritus (proo-RIE-tus) is the medical term for itchiness. The condition causes you to feel the need to scratch your skin to get relief. There are several possible causes for pruritus that include an underlying medical condition, contact with an irritant or a reaction to a medication.

 

Look for entries about the following diseases and conditions on Cleveland Clinic, Mayo Clinic,  Medline Plus, National Institutes of Health (NIH), WebMD, etc.

• How to relieve itching (Medical News Today, Charlotte Lillis, 12-21-23) Common causes of itchy skin include insect bites, allergies, stress, and skin conditions such as eczema and psoriasis.

   Itchy skin, also known as pruritus, can be uncomfortable and frustrating. Some home remedies may help remedy itchy skin, including applying essential oils, wet wraps, and colloidal oatmeal 

   Applying menthol (an essential oil found in plants of the mint family).

   Cooling the itch. Wet wrap therapy (applying water-soaked fabric wraps made of gauze or surgical netting to areas of itchy skin).

   Colloidal oatmeal ("finely ground oatmeal that a person can dissolve in water. The resulting solution forms a protective barrier on the surface of the skin, which helps to seal in moisture. See Yareli Colloidal Oatmeal Powder for psoriasis

    Apple cider vinegar.

    Moisturizing. (Moisturizers, such as creams and lotions, can help hydrate the outermost layer of the skin. They are essential for managing skin conditions that cause itching and dryness.)

    Baking soda. (The NEA recommends adding one-quarter of a cup of baking soda to a warm bath. An alternative option is to mix the baking soda with a little water to form a paste, which a person can apply directly to itchy areas.)

    Avoiding irritants. Possible irritants include: Hot water. Temperature and humidity changes. Fragranced skin care products. Wool and synthetic fabrics. Stress (try yoga and mindfulness meditation).

    Can apple cider vinegar help with eczema? (Medical News Today) Some people use apple cider vinegar to improve the symptoms of eczema. However, it can irritate the skin and may not be suitable for everyone.

 

•  Itching (MedLine Plus) Itching is an irritating sensation that makes you want to scratch your skin. Sometimes it can feel like pain, but it is different. Often, you feel itchy in one area in your body, but sometimes you may feel itching all over. Along with the itching, you may also have a rash or hives. A succinct guide to resources for various subtopics and possible remedies.

     A mini-encyclopedia on itching and itching-related terms. Among possible remedies listed: Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness.

•  The primary NIH organization for research on Itching is the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

• A Visual Guide to Viral Rashes (Paul Frerythema infectiosum, Skin Problems and Treatments, WebMD, 11-22-22) 

Excellent photos of skin conditions for chicken pox, shingles, Molluscum contagiosum, fifth disease (erythema infectiosum), cold sores, genital herpes, hand-foot-and-mouth disease, rubella, measles, roseola (sixth disease), Colorado tick fever, HIV rash, Acrodermatitis (Gianotti-Crosti Syndrome), Mononucleosis, and Zika
---Skin Problems & Treatments Resource Center (WebMD)
---Plantar warts and palmar warts (Web MD)
---Psoriasis
---Cold sores (fever blisters)
---Rosacea
---Vitiligo and loss of skin color Vitiligo is a long-lasting condition that causes a loss of color in patches on the skin. It happens when the body's immune system mistakenly attacks and destroys the skin cells that make color or pigment (melanocytes), turning the affected skin milky white.

 

• Parvovirus B19 and Fifth Disease (CDC) Fifth disease is caused by the human parvovirus. It is most prevalent in the winter and spring and is usually seen in school-aged children.

 

• What Makes Us Itch? (American Academy of Allergy, Asthma, and Immunology)

   "Itching can be caused by many different things including allergies, insect bites, dry skin or illness.
    "While most itches are merely bothersome or uncomfortable, excessive scratching can damage your skin’s protective barrier and expose your body to germs and infection.
    "Itch and pain are closely linked in the brain. The reflex to pain is to withdraw. The reflex to itch is to scratch. This reflex is a protective response developed to help animals remove parasites from their skin. That’s why even a slight movement of hairs is enough to make you want to scratch.
    "Itching is often triggered by histamine, a chemical in the body associated with immune responses. It causes the itch and redness you see with insect bites, rashes and skin dryness or damage.
    "Histamine is released by the body during allergic reactions, such as those to pollen, food, latex and medications." [And more. Worth a read.]

 

• Atopic Dermatitis (NIAMS)

    "Atopic dermatitis, often referred to as eczema, is a chronic (long-lasting) disease that causes inflammation, redness, and irritation of the skin. It is a common condition that usually begins in childhood; however, anyone can get the disease at any age. Atopic dermatitis is not contagious, so it cannot be spread from person to person.
     "Atopic dermatitis causes the skin to become extremely itchy. Scratching leads to further redness, swelling, cracking, “weeping” clear fluid, crusting, and scaling. In most cases, there are periods of time when the disease is worse, called flares, followed by periods when the skin improves or clears up entirely, called remissions.
     "Researchers do not know what causes atopic dermatitis, but they do know that genes, the immune system, and the environment play a role in the disease. Depending on the severity and location of the symptoms, living with atopic dermatitis can be hard. Treatment can help control symptoms. For many people, atopic dermatitis improves by adulthood, but for some, it can be a lifelong illness."

• Bathing and Eczema (National Aleczema Organization)
    "Establishing a bathing routine that works for your skin is important for daily eczema management and care....

    "People with eczema, especially atopic dermatitis, tend to have very dry skin in general. A skin barrier that is inflamed or dry is vulnerable to bacteria and allergens, which can make eczema symptoms worse.

    Taking a bath or shower is helpful for eczema. Whether you have mild or severe eczema, a regular bathing and skincare routine can strengthen your skin barrier and help you retain moisture."

• How I Came To Terms With My Eczema Links to several WebMD blog posts about atopic dermatitis.

• Scratching and allergic skin inflammation (NIH Research Matters, 2-25-25) Researchers found how scratching can worsen allergic skin symptoms but also protect from infection. The findings could explain why the instinct to scratch an itch might have evolved in the first place. Targeting mast cells or the neurons that promote their activation could prove to be a promising approach for treating itchy inflammatory diseases like dermatitis and eczema.

 

• Itchy Skin (pruritis) (Mayo Clinic)

• Neuropathic Itch (NIH) Itching is a tingling or irritation of the skin that makes you want to scratch the area. Itching may occur all over the body or only in one location. (Prose academic.)
• Common neuropathic itch syndromes (Anne Louise Oaklander, PubMed) "Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves."

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• 10 Things to Know About Medicaid (Alice Burns, Elizabeth Hinton, Robin Rudowitz, and Maiss Mohamed, KFF, 2-18-25) Whether subsidies expire at the end of this year or in two or three years, their expiration would result in the steepest increase in out-of-pocket premium payments most enrollees in this market have seen. Because the Inflation Reduction Act extends the enhanced subsidies for three years and not permanently, future Marketplace enrollees may see steep premium increases when the subsidies eventually expire.
    Among potential changes to Medicaid through executive actions (under Trump!), this brief highlights ten key things to know about Medicaid (go to the source for full copy).

1. Nationally, one in five people have Medicaid, but this varies across the states (see map).

2. Medicaid is a key source of coverage for certain populations (see chart).

3. Medicaid is jointly financed by the federal government and states (see map).

4. Medicaid accounts for one fifth of all health care spending, and over half of spending on long-term care (see chart).

5. People who qualify for Medicaid based on age or disability account for more than half of spending I (see chart).

6. Flexibility to administer Medicaid results in variation in per enrollee costs across states (see map).

7. Three-quarters of all Medicaid enrollees receive care through comprehensive, risk-based MCOs. 8. Medicaid coverage facilitates access to care, improves health outcomes, and provides financial protection from medical debt.

9. Section 1115 demonstration waivers reflect changing priorities across presidential administrations.

10. The majority of the public holds favorable views of Medicaid.

    In the most recent KFF tracking poll, more than three-fourths (77%) of Americans held favorable views of Medicaid, including six in ten Republicans (63%), and at least eight in ten independents (81%) and Democrats (87%) (Figure 10). Medicaid is also viewed favorably by a majority of voters who say they voted for President Trump in the 2024 election (62%). Nearly half of the public (46%) say the federal government doesn’t spend enough on the Medicaid program, with another third (33%) saying it spends “about the right amount,” and around one in five (19%) saying it spends “too much.”

    With possible changes to government health programs, seven in ten (72%) say they are worried about the level of benefits that will be available to people covered by Medicaid in the future

Topics Medicaid Uninsured Tags Medicaid's Future Access to Care Maternal and Child Health Children Children's Health Insurance Program (CHIP) Disability Also of Interest Medicaid: What to Watch in 2025 Medicaid Financing: The Basics 10 Things to Know About Medicaid Managed Care
• Medicaid: What to Watch in 2025

• ACA Marketplace Enrollees Will See Steep Increases in Premium Payments in 2026 if Enhanced Subsidies Expire (KFF, 7-6-24) Enrollees in 12 HealthCare.gov states would see their annual payments at least double on average without enhanced subsidies 

• Where ACA Marketplace Enrollment Is Growing the Fastest, and Why (Cynthia Cox and Jared Ortaliza, KFF, 5-16-24) The five states with the fastest growth in Marketplace enrollment since 2020 – Texas (212%), Mississippi (190%), Georgia (181%), Tennessee (177%), and South Carolina (167%) – have certain characteristics in common: They all started off with high uninsured rates before the enhanced subsidies rolled out, they have not expanded Medicaid under the ACA, and they all use the Healthcare.gov enrollment platform.
• What Does the Federal Government Spend on Health Care? (Juliette Cubanski, Alice Burns, and Cynthia Cox, Medicaid, KFF, 2-24-25)
The federal government spent $1.9 trillion on health care programs and services in fiscal year (FY) 2024, 27% of all federal outlays in that year, and collectively the largest category of federal spending.
     Forgone tax revenues to the federal government resulting from tax subsidies for employer sponsored insurance coverage (ESI) and a portion of the Affordable Care Act (ACA) premium tax credits together totaled $398 billion in FY 2024.
     Over 80% of all federal support for health programs and services, including spending and tax subsidies, goes to programs that provide or subsidize health insurance coverage, with

---36% going to Medicare,

---25% going to Medicaid and CHIP,

---17% going to employment-based health coverage, and

---5% going to subsidies for Affordable Care Act (ACA) coverage.
     Discretionary spending is a relatively small component of overall federal support for health programs and services. Over half (52% or $128 billion) of discretionary health spending paid for hospital and medical care for veterans. Discretionary health spending also provides funding for agencies such as the National Institutes of Health (NIH, 19% of discretionary health spending) and the Centers for Disease Control and Prevention (CDC, 4%), as well as global health (4%).