Monday, December 30, 2013

Sell Your Assets to Save Them

Low-income Americans are now eligible for expanded Medicaid, including a million or more who own homes, farms, small businesses, or other significant assets. People with incomes below 138% of the federal poverty line are not eligible for subsidies at and are being routed straight to Medicaid--but the federal website doesn't warn people over 55 that Medicaid is a healthcare loan, not health insurance. Federal law requires states to recover the costs of long-term care and related medical expenses from the estates of Medicaid recipients who die after the age of 55, and many states have expanded that rule to recover all Medicaid expenses. This means that many older, poorer Americans are poised to lose their farms, homes, or small businesses.

A farmer cannot pass his land on to the next generation, because Medicaid "looks back" five years to see if whether assets have been given away.  Mom and Pop can't deed the corner store to their daughter; Nana can't give the house to her son. Medicaid was designed to serve the truly poor, not to offer tax-funded benefits to people with assets. The problem older Americans now face is an "unexpected human-caused event" with no easy answers.

Some people have suggested that low-income seniors lie about their income to get above the Medicaid threshold. If people over 55 can qualify for the maximum subsidy, health insurance costs them almost nothing. Lying is no solution, however--not only does it involve perjury, it commits a fraud on the insurance companies, and the insurers have no obligation to provide (very expensive) care to people who lie to get their coverage. People who claim income they don't have are likely to lose everything.

There is one way to save these assets--sell them. To be more precise--sell an undivided interest in them. A 64-year-old individual in Maryland qualifies for maximum subsidies with an income of just $12,000 per year. Grandpa can sell the farm to his son over time for $1,000 per month. Nana can get a reverse mortgage on her home. Mom and Pop can take on a partner who will buy them out on an installment basis. Selling part of your property may be the only way to keep the rest.

Remember--Medicaid is not insurance. When you pay insurance premiums, some company assumes the risk that you will get sick and need care. When you sign up for Medicaid, the government effectively co-signs your medical loans. When you die, the government recoups as much of its investment as it can.

If you like your farm, you can keep it--by paying for insurance instead of Medicaid.

Saturday, December 28, 2013

My Medicaid Nightmare

Did you ever have that dream where you are screaming as loud as you can and no sound comes out? Medicaid's "estate recovery" rule has me screaming, but my super-partisan audience isn't listening.

The "estate recovery" rule says that states must recover the costs of long-term care and related Medicaid expenses from the estates of Medicaid recipients who die after the age of 55. This rule has been on the books for twenty years, and elder law attorneys specialize in helping older Americans pass on their assets to their children and grandchildren so that nobody has to lose the family farm or corner store because they get old and sick.

The problem is that half the states have expanded Medicaid without thinking about how this rule is going to affect their citizens. Before the changes to healthcare, Medicaid was hard to get onto and people had years to prepare. Now, anybody with income below 138% of the federal poverty line is eligible with no limits on the assets they may own. Many of the family farms in my county belong to people who are not eligible for federal subsidies because their incomes are too low. That means they are signing up for Medicaid without understanding the implications.

My nightmare is that partisan Republicans treat this as "merely" another monstrous failure of the new law, while partisan Democrats don't want to deal with it. The gridlock in Washington leaves families at risk, but since this particular time-bomb won't blow up for years, nobody cares. By the time the Washington Post tells how one family lost the farm they had tilled for six generations, tens of thousands of family farms will have become the collateral for billions of dollars worth of medical expenses they can never pay.

I hereby invite Americans of every political persuasion to help address this problem. If you are a true-blue Democrat who celebrates the Patient Protection and Affordable Care Act, please join me in protecting these patients. If you are a red-hot Republican who despises Obamacare, please help me warn the people most affected. If you don't belong to either party, this isn't political--it's neighbors helping neighbors get ready for an "unexpected human-caused event."

What can you do to help? Click two hyperlinks and send one email. Use this link to find an elder law attorney in your state, click that link to find their contact information, and paste this into an email:
How does Medicaid's estate recovery rule apply to expanded Medicaid under the Affordable Care Act? See:
With help from elder law attorneys across America, we can get the word out in time to save the family farm.

Friday, December 27, 2013

Iowa and the Medicaid Trap

Washington and Oregon have noted the "Medicaid Trap," which threatens sole proprietorships and family farms in states which have expanded Medicaid. I had hoped that Iowa, Arkansas, and Utah might dodge this bullet because those three states are trying to provide actual insurance for low income citizens rather than enroll them in Medicaid as such. I contacted the Iowa Department of Human Services to find out more.

Unfortunately, the news goes from bad to worse. First, Iowa's low-income citizen remain subject to Medicaid's estate recovery rule. Congress required every state to recover the costs of "long-term care and related Medicaid expenses" from the estates of Medicaid recipients who died after the age of 55, and Iowa's novel approach to providing coverage to low-income citizens does not get around that.

Unfortunately, Iowa recovers all medical expenses, not just "long term care" and expenses directly attributed to such care. According to a personal email I just received from DHS,
Estate recovery applies to those persons who receive assistance funded by Medicaid who are 55 years of age or older. Iowa law does not limit the recovery of Medicaid expenditures to long-term care and related Medicaid expenses, as Iowa applies this program equitably to all Medicaid members who meet the requirements of federal law.
What this means is that many family farms across Iowa are now threatened by any medical event. If Iowans had been given more time get ready, the new law might not affect them much, but federal law imposes a five-year "look back" rule to keep Medicaid recipients from hiding their assets. That means Grampa and Nana can't just deed the farm over to the next generation--they have to stay out of the hospital for five years if they want to keep the farm in the family.

Here's one silver lining for Iowa farmers. Iowa Senator Charles Grassley asked Senator Max Baucus to make sure that several well-established Christian healthcare sharing ministries could continue to operate, and 26 USC 5000A(d)(2)(b) expressly recognizes their right to exist. Samaritan Ministries, Christian Healthcare Ministries, and Medi-Share all help non-smoking, church-going Christians pay their bills by sharing medical costs among their members--and the cost of a monthly "share" is surprisingly low.

The next generation of Iowa farmers may choose to help Mom and Dad sign up for healthshare for the next five years. That way they may be able to pay their medical bills and keep the family farm!

Monday, December 16, 2013

Oregon Waives the Medicaid Death Tax

The federal government requires states to recover medical costs from the estates of Medicaid recipients who die after the age of 55. The Act Formerly Known as Obamacare expands Medicaid eligibility so dramatically that many Americans could now forfeit everything they own without even realizing it. When Oregon discovered this problem,  the Oregon Health Authority swiftly attempted to reassure its citizens:
For any coverage that starts October 1, 2013 or later, members of OHP [the Oregon Health Plan] who are not receiving long-term care services will not be subject to estate recovery. This policy change affects all current and future enrollees on OHP. 
Federal law requires all 50 states to attempt to recover the costs of long-term care and related Medicaid services, but the states have considerable leeway as to how they go about the task. Apparently, nobody considered exactly what would happen in states that chose to Medicaid to cover citizens with low incomes but significant assets. 

Oregon is the first state to officially address the "if you like your house you can keep your house" problem, but it won't be the last. Every state that has expanded Medicaid coverage will have to examine its own statutes, regulations, policies and procedures to make sure that citizens don't sign away their homes when they sign up for Medicaid. 

Sunday, December 15, 2013

If You Like Your House, You Can Keep Your House

President Obama recently help up a sign that said, "Get Covered: Because Nobody Should Go Broke Just Because They Get Sick." He wouldn't be smiling if he read DailyKos.

On October 17, Beverly Woods asked a disturbing question on the website. What happens to the assets of people who now meet the expanded criteria for Medicaid?  Medicaid was designed to ensure healthcare for the truly destitute, and existing state and federal laws, regulations, policies, and procedures are based on the assumption that people on Medicaid have essentially no disposable assets. The Act Formerly Known as Obamacare changes that.

In "Medicaid Estate Recovery+ACA: Unintended Consequences," Ms. Woods explains the problem:
We haven't had lots of people younger than 65 on Medicaid, because in most states simply earning less than the Federal Poverty Level did not qualify one for Medicaid.
And we haven't had many people with lots of assets on Medicaid, because in most places you have to have less than around $2400 to your name before Medicaid will cover you. You can keep your house and your car, but Medicaid reserves the right to put liens on them and take them when you die.
But now we have the Affordable Care Act, and its expectation that everyone in the lower tier of income will end up in the Medicaid system. To accomplish this, they have dropped  the asset test. So now we will have lots of people ages 55-64, who have assets but not a lot of income right now, for whatever reason, on Medicaid.
The kicker of it is, if you make the right amount to qualify for a subsidized health insurance plan, your costs are going to be shared and subsidized by the government. But if you go on Medicaid, you owe the entire amount that Medicaid spends on you from the day you turn 55.
As she ended her October 17 entry, Ms. Woods noted, "The fact that practically no one is talking about this makes me uneasy." Four days later, she was back, with "Estate Recovery: It's Worse Than You Thought." The bottom line: Medicaid is not insurance, it's a loan.

If you buy insurance, you pay a certain amount each month to protect yourself from bills too big to pay. If you don't have insurance but wind up in the hospital, you are stuck with the bills. If you can't pay them off before you die, your heirs are stuck. The executor of your will (if you have one) must sell off your assets (if you have any) to pay off your bills before anybody gets anything from your estate. Medicaid does not insure Americans against medical expenses--it loans them the money to pay expenses, and takes it all back when they die.

You could call it a "death tax," if that term hadn't been taken. Next year, Americans who die with more than five million dollars in assets will pay 40% in taxes. Americans who die on Medicaid will pay 100% of their Medicaid expenses before their heirs get one penny.

Family farm? Gone. Mom and Pop shop? Gone. Nana's house, with her snow-white picket fence around her prize-winning garden? Gone, gone, gone.

Is there a way around this problem? There is not supposed to be, for long-term care expenses. The system is designed to loan money to people who have no assets, and to recover as much government money as possible from people who do have assets. Lots of people have tried to hide their assets from the government, with limited success. In particular, parents may not deed their houses over to their children to evade their debts--if they do, and incur medical expenses any time during the next 60 months, the children will be required to pay Medicaid back.

Federal law requires states to recover the costs of long-term care and related Medicaid expenses, but left it up the states to implement that recovery. No state legislation was written with today's situation in mind, and every state that has expanded Medicaid must now review its laws and policies to protect seniors from unintended consequences. Oregon has taken the first step to assure its citizens that it only intends to collect money for "long-term care" and not for ordinary medical expenses.

The problem with Oregon's response to date is that "long-term care" does not just mean "putting granny in the nursing home." Any Medicaid patient who is in a hospital for three days becomes eligible for "long term care" in a "skilled nursing facility," and "long term care" is any stay over 30 days. Thus, a bad case of pneumonia could send a 60-year-old into the hospital, on to "skilled nursing," and into "long-term care."

The Act Formerly Known as Obamacare has just turned into a full-employment act for attorneys who specialize in "elder law" in the states that have expanded Medicaid. Citizens of limited means who are over 49 should run, not walk, to an expert who can help them shield their homes from the unintended consequences of this law.

Saturday, December 14, 2013

Healthcare D-Day or Dunkirk

Reading over my last few posts, one would think I hated our President. I apologize for giving that impression. I don't. I donated money to his primary campaign, wept at the thought of Martin Luther King, Jr's dream come true, and receive his daily emails. He and I went to law school together (for one brief year--we never met). I pray for him as sincerely as I have ever prayed for any president, and that's a lot.

But I have been pretty hard on him lately, for a reason. He turned something as big as D-Day into the Bay of Pigs. When General Eisenhower gave the orders to invade Europe, he wrote a speech to give if things went badly. President Obama didn't write that speech. He borrowed one from Sergeant Schultz:
"I was not informed directly that the website would not be working the way it was supposed to. I’m accused of a lot of things. I don’t think I’m stupid enough to go around saying this is going to be like shopping on Amazon or Travelocity a week before the website opens if I thought that it wasn’t going to work," Mr. Obama said during a press conference at the White House. "Clearly we, and I, did not have enough awareness about the problems with the website."
Two weeks before the new year, there is every reason to believe that the net result of all this will leave millions of previously insured Americans exposed to physical and financial ruin. Instead of D-Day, where the forces of freedom pushed tyranny back across a continent, we are re-enacting the Battle of Dunkirk, where the Allied armies lay trapped between Hitler's devils and the deep blue sea.

The soldiers trapped at Dunkirk were not saved by the invincible British Navy (because big ships couldn't get close enough to the beach), but by the astounding courage, ingenuity and sacrifice of ordinary Britons along the southern coast of England. If you don't know the story, I cannot do it justice here. Read "The Snow Goose," by Paul Gallico--a lovely little story that moves me to tears as I type.

There are millions of Americans "trapped on the beach" right now, and tens of millions more to come. As of this moment, there is no realistic hope that Republicans and Democrats will decide to paper over their differences to stop the suffering--the political war that got us into this situation is raging hotter than ever, and there is no reason to think it will be over before January, 2017, when a new President takes office. Between now and then, the best hope our suffering neighbors has will come from us.

That's why I'm promoting the Federal Health Union Act of 2014--a bill that does not replace or repeal the Act Formerly Known as Obamacare. It doesn't promise affordable care for all Americans--but it does offer affordable care for more Americans. It's a bill that lets neighbors help out neighbors until big business and big government can get their act together.

For more information on the FHUA, click here.  There's one man in Washington who could sponsor this bill and make it happen. If he agrees to take a look at it, I'll let you know. Until then, may God help those who can't help themselves tonight.

Obama's Science of Change

It wasn't supposed to be work like this. Obama "scientific approach" to change was glowingly featured in Time Magazine in 2009. (No access to Time's premium-content? Try "Obama's efforts to change us carry a clear political risk.") Here's his "science of change" in a nutshell:
  1. make it clear, 
  2. make it easy, 
  3. make it popular, 
  4. make it mandatory.
The "clear" part was,"If you like your plan, you can keep your plan. Period." As Albert Einstein famously noted, "Make everything as simple as possible, but no simpler." Obama is no Einstein--his oversimplification of the Act Formerly Known as Obamacare won him Politifact's "Lie of the Year."

The "easy" part was, "Just visit, and there you can compare insurance plans, side by side, the same way you’d shop for a plane ticket on Kayak or a TV on Amazon." (Barack Obama, Oct. 1, 2013.) Six weeks later, the same man admitted that "what we're also discovering is that insurance is complicated to buy." (Barack Obama, Nov. 14, 2013.)

The "popular" part was taken for granted. The assumption that the Act Formerly Known as Obamacare would be popular was why it was formerly known as Obamacare. All Obama needed to do was hold up a sign that says, "Get Covered Because Nobody Should Go Broke Just Because They Get Sick."

But "Obama holding a sign" was a punchline just waiting for its joke. Within ten minutes, the Senate's most outspoken Obamacare opponent "cruz-ified" the President's tweet:

The "mandatory" part was written into the law--and then written out of it by the same Supreme Court Justice who declared Obamacare constitutional. Military service in Vietnam was mandatory, and burning a draft card could send a healthy young man to jail... or Canada. Health insurance, by contrast, is no more mandatory than a solar hot water heater, for the consumer.  The government can "nudge" you to buy the one or buy the other, and raise (or lower) your taxes according to your choice, but it cannot put you in jail or drive you to Canada if you don't buy insurance.

Whether you agree with Obama or not, he had a four-point plan to "nudge" Americans into his new system. And whether you agree with Obama or not, that plan has now failed on all four points.  This has big implications for all Americans, especially Democrats. While Republicans may embrace "the fierce urgency of shutting up" for now, too many of our neighbors are in real distress for us to wait for a new President to offer us something different in January, 2017.

That's why I think we need the  Federal Health Union Act of 2014, and need it now!

Not Enough Carrot, Not Enough Stick

The Washington Post editorial board has weighed in on the Act Previously Known as Obamacare. Today's editorial, "Two Problems That Could Undermine the Affordable Care Act," can be summed up in six words:
  1. Not enough carrot
  2. Not enough stick
The article begins with an admission that "enrollment is lagging."
To work well, the law’s new insurance marketplaces need millions to sign up and enough healthy people paying into the system to offset the medical costs of the sick. But this week the Department of Health and Human Services admitted that enrollment is lagging. 
Calling this enrollment "lagging" libels laggards everywhere. We still don't have meaningful numbers of people who have searched for a plan on, found a plan, selected that plan, and sent their full first month's premium into the provider. We do know that the numbers are so far short of the Administration's definition of "success" (seven million people by March 31st) that we're reduced to hoping they are somewhere above "epic fail" (less Americans insured on Jan. 1st than before the law kicked in, including Medicaid signups).

In early November, after the website's first disastrous month, our President went before the cameras to explain, "Now, this is like having a really good product in the store and the cash registers don't work and there aren't enough parking spots and nobody can get through the door." By early December, Secretary Sebelius testified to the  effect that the doors now work and the parking lot is  open. The administration official who is actually in charge of the website, Henry Chao, admitted that the "cash registers" aren't just "not working"--they haven't been built yet. That's why nobody is using the number of paid-up, covered customers (the only number that might actually measure "success"). That's why what the Post calls "lagging" enrollment merely refers to the number of people who have put a product in their cart--whether they have paid or not.

If the product was good but the price was bad, people might put it in their cart while they dug around the couch for extra change. If the product was bad but the alternatives were nonexistent, people might put it in their cart while they search for something else. But if the product was good and the price was good and the cash register (or good-enough-for-government-work equivalent) actually worked, we'd see enrollment catching up to at least the number of people who lost their policies--five million and more.

Enrollment is so far below that mark that the only people who actually do know the numbers are begging insurance companies to cover people who haven't paid (yet). This product just isn't selling.

So--there isn't enough carrot. Which brings us to the Post's second criticism--there's not enough stick, either.

The "stick" (Penalty? Tax? Mandate? Suggestion? Ask a lawyer, accountant, or mystic--the answer depends on the problem Obama is trying to solve today!) is $95 or 1% of income for every unininsured person. That's $95 for the "young invincibles," the bungee-jumping, keg-standing party animals who got a free ride on their parents' policy until they turned 26 and now have to choose between actually paying premiums ("I thought Obamacare was free?!") and paying $95. Is that enough of a "stick" to get them to sign up?

Not yet.

The Post may be exactly right in its diagnosis, but what is its prescription? More gain? More pain? Given the irreconcilable differences between Republicans and Democrats between now and the 2014 elections, America may be doomed to suffer the worst of both worlds. That's why I think the Federal Health Union Act of 2014 is worth pursuing. Maybe I can get the Post to endorse it!

Friday, December 13, 2013

Exercise, Estrogen, Cancer, and... Jello?

Headlines across the country today announce, "Exercise Can Ease Pain from Breast Cancer Drugs" (USA Today), "Exercise Helps Women Tolerate Breast Cancer Drugs (Boston Globe), "Exercise Eases Common Breast Cancer Treatment Side Effect" (Huffington Post).  Dr. Jennifer Ligibel, at the Susan F. Smith for Women's Cancers at Dana-Farber, just presented her findings on exercise at a major breast cancer symposium. The study is good news for women with breast cancer or at high risk of cancer--and for Dr. Joel Brind, who has a double interest in the results.

The study explored whether regular, supervised exercise might help reduce the aches and pains that tempt so many breast cancer patients to stop taking the estrogen-blocking drugs they need to fight tumors. Women who exercised regularly claimed 20% less joint pain, while a control group that followed normal daily activities claimed 3% less pain. Less pain equals more gain for women whose lives may depend on their ability to gag down a drug that makes them ache all over.

The science behind these cancer drugs is simple--estrogen is the "gasoline" of female physiology. On the one hand, it's what keeps the human race alive--but it has its dangers. In particular, estrogen causes certain types of breast tissue to reproduce rapidly. Women with estrogen-sensitive tumors (as well as women who have no tumors yet but are at high risk of developing them) can be helped with drugs which the body from using estrogen (such as Tamoxifen) or that keep estrogen from being produced in the first place ("aromatase inhibitors" like Letrozole).

That is no surprise to Dr. Brind, who made headlines of his own in 1993 when he claimed that women who choose abortion are more likely to develop breast cancer. Abortion leaves women awash in the estrogen of early pregnancy without the protective effects of third-trimester hormones. (If estrogen is like gasoline, third-trimester hormones are like rain that puts out the fires.) Brind (a professor of human biology and endocrinology at Baruch College of the City University of New York) thought he was just doing science when he connected the dots between research on rats, research on humans, and increasing breast cancer rates around the world. To his dismay, the vast majority of endocrinologists, breast cancer researchers, and women's health advocates rejected his reasoning, even though study after study shows a modest increase in breast cancer risk after induced abortion.

Dr. Brind found himself back in the news recently when Chinese researchers reported a statistically significant 44% increase in breast cancer risk after one or more abortions. Dr.Yubei Huang's "meta-analysis" aggregated data from 37 different studies in China, and found a consistent "dose-response relationship" that greatly strengthens the importance of the findings. Pro-life groups spread the word to their audiences, but the report got little play in big media.

What mainstream coverage that there was downplayed the link, insisting that the Chinese team used a "notoriously misleading method" that depended on women's personal accounts of their abortion history instead of official abortion records. The "recall bias" argument claims that women with cancer are more likely to tell the truth about something as personal as abortion, whereas healthy women might be tempted to conceal their past. This hypothetical bias has been put to the test by Dr. Janet Daling, of Fred Hutchinson Cancer Research Center in Seattle, who included a "control group" of women with cervical cancer to find out whether they showed a link to abortion. If "recall bias" created a false association between abortion and breast cancer, it should create the same mirage with cervical cancer. Dr. Daling found no relationship between abortion and cervical cancer (proving that in her study, at least, healthy women were not lying about their abortions), and a 50% increase in breast cancer risk among young women who chose abortion.

That should have put the so-called "recall bias" argument to rest--but when it comes to abortion, science takes a back seat to politics. Brind was mocked, attacked, and eventually outvoted at a 2003 conference at the National Institute of Health. The abortion/breast cancer link was dead. The science was settled. Those who argue that abortion increases the risk of breast cancer are now in the same category as those who deny that humans cause global warming.

So--what does a professional endocrinologist do after the National Institute of Health tells him to sit down, shut up, and stop talking about the effect of estrogen on breast tissue? In Brind's case, he keeps on researching. Dr. Brind started studying amino acid metabolism and discovered that a single amino acid--glycine--has a big effect on aches and pains. As it turns out, chicken soup is good for more than the soul--the proteins in chicken broth are rich in glycine, and they really do relieve the symptoms of the common cold. Brind encourages people with chronic pain to eat more jello, drink more soup, or use "Sweetamine," his own glycine-based supplement.

Which brings us back to today's news. Several hours of exercise each week may help women take their cancer drugs because it reduces joint pain by 20%. What if a daily dose of sweetamine reduces joint pain even more? Exercise is good in its own right, but if it is only a means to the end of helping women tolerate their medication, sweetamine might be far better. It's easy to make sure women take their sweetamine each day. It's hard to crack the whip to make them exercise!

It should be obvious what the next research project ought to be. Somebody needs to compare three groups of women: some taking sweetamine, some who exercise, and a "control group" of women who do neither. If sweetamine reduces joint pain more than exercise does, it may well be prescribed along with the estrogen-blockers it enables women to take.

This world is a funny place. We might yet see the very experts who mocked Brind's claim that estrogen raises the risk of cancer prescribe his remedy for the aches caused by estrogen-blockers!

Wednesday, December 11, 2013

Affordable Care for More Americans

This blog has explored how Obamacare affects Americans with serious illnesses such as multiple sclerosis, end-stage kidney disease, and AIDS, and earlier discussed its effect on Medicaid recipients. I'm tired of complaining about what doesn't work. How about a post on what would?

We've tried meeting America's health care needs through big business (any company that can insure millions against a risk as expensive as cancer is "big" by any definition). Now we're trying to meet America's needs through a loveless marriage between big business and big government--but the honeymoon is over and the bride is talking to her lawyer. Progressives who held their noses to support Obamacare are now pushing for big government to do the job alone, through a single-payer system. While that makes sense (to them) in theory, the latest polls suggest that putting it into practice could be impossible for the time being.

Those polls suggest that neither the Republicans nor Democrats will have a commanding majority before 2016, leaving Obamacare the law of the land no matter how many "glitches" affect how many Americans. Big goals (repeal and replace! Switch to single payer!) will fire up the base on the left and right, but that won't help middle-of-the-road, middle-class folks for the next three years. We aren't going to get anything that can guarantee affordable care for all Americans--so how about finding something that would provide affordable care for more Americans? Especially if all we have to do is find something that works and make it work better?

There is already something that works. Obamacare provides an explicit exemption for healthcare sharing ministries ("healthshares"). Senator Max Baucus of Montana included a provision that recognizes not-for-profit healthshares as a valid way to comply with the Patient Protection and Affordable Care Act. That provision, which can be found at 26 USC 5000A(d)(2)(b), allows certain tax-deductible charities to share the costs of medical care among people with shared religious or ethical beliefs. More than 170,000 families currently participate in the three groups that were intentionally grandfathered in (Medi-Share, Samaritan Ministries, and Christian Healthcare Ministries) and membership seems to be rising since the new law took effect.

Healthshares aren't big business or big government, but they have been successful at meeting needs for more than thirty years. Between what members share and donors give, they have paid the bills for hundreds of thousands of patients--despite the fact that they are prohibited by law from paying salesmen, setting specific underwriting amounts, or using many of the other tools that the insurance industry has developed to serve their customers. Healthshares have succeeded with no direct government assistance and without the tools that insurance companies use--because members helping members is a better way to pay.

The Secular Coalition for America opposed Senator Baucus' plan to include healthshares in the law--but not because they disagree with healthshares. They wrote:
For centuries, numerous mutual aid societies in the United States have sponsored insurance and social services organized around a shared ethnic background, occupation, geographical region or religion. For example, in 1787 African Americans released from slavery organized a nondenominational benefit society called the "Free African Society of Philadelphia." By stating that only people belonging to religious mutual aid societies can be exempt from mandated health insurance this provision privileges Christian Americans over non-Christian Americans.
I couldn't agree more. That's why we need a Federal Health Union Act, which would amend the language of 26 USC 5000A(d)(2)(b) to include any not-for-profit organization united by any shared interests with an objective effect on health. Under such a law, Vegans as well as Hindus could share the health savings of a meat-free diet, while smokers could band together to cover their care without paying the 50% penalty Obamacare imposes.

Expanding healthshares to Vegans and smokers would make the law more just, but to make it more effective we need two additional changes. First, healthshares need to be able to use the same tools that health insurance companies need without apologizing for it or dancing around state regulations. Healthshares need to be expressly exempt from state insurance regulations in the same way that federal credit unions are exempt from state banking regulations.

That is why the Federal Health Union Act would be directly modeled on the Federal Credit Union Act of 1934, which created federally-chartered not-for-profit credit unions during the banking crisis of the Great Depression. The National Credit Union Association has been able to keep credit unions serving customers for many years--and a National HealthShare Association could ensure financial stability and consumer protection for not-for-profit health cooperatives.

The problem with allowing healthshares to compete directly with for-profit plans is that insurance companies are now required to accept all comers, even those with pre-existing conditions. This drives up the cost of healthcare, but low-income Americans are offered subsidies to help them cover the cost of these "free-market plans." If healthshares don't have to pay for pre-existing conditions, they won't be competing with for-profit plans--they'll be taking advantage of them. On the other hand, if plans sold on the exchange get subsidies and healthshares don't, it's the insurance companies that are taking the advantage.

The Federal Health Union Act funds pre-existing conditions and low-income insurance without forcing anybody to buy anything they don't want or pay for anything they detest. It does so through a "matching-funds" approach to fund-raising. Taxpayers who donate money to a federally-chartered healthshare will be eligible for a 50% tax credit for their gift. This saves taxpayers money (it costs taxpayers 50 cents to subsidize the poor and sick) and takes the politics out of healthcare. The Susan G. Komen Foundation could raise a lot more money for breast cancer in a very short time--and so could patients with less politically-prominent diseases, like Lyme Disease and multiple sclerosis.

Changing the tax law is not a simple matter--but in this case, it would be worth it. Medicare is a financial time bomb, and Medicaid has even more problems. Among other things, changes to Medicaid are raising the demand for healthcare while cutting the supply. Tax credits for healthshares could move millions of people off Medicaid onto non-profit plans, especially if not-for-profit hospitals can operate their own healthshare. A hospital healthshare could dramatically reduce the number of uninsured patients in a service area, reducing the amount that other patients pay. With a 50-cent-on-the-dollar tax credit, local businesses would have every reason to build good will by helping out their neighbors.

That's all it takes to provide affordable care for more Americans, including the poor, sick, and elderly. All we have to do is (a) expand healthshares, (b) allow them to compete directly with for-profit insurers, and (c) save 50 cents on donated dollars. It's a plan that Americans can understand, politicians can support, and the President can sign.

I hope to share this with my Senator (Joe Manchin of West Virginia) and Congresswoman (Shelley Moore Capito) at the earliest opportunity. If you think your representative might be interested in co-sponsoring such legislation, leave a comment explaining why. If we all work hard and work together, we can help millions of our neighbors in distress.

Tuesday, December 10, 2013

Obamacare and AIDS

One would assume that if anybody should benefit from Obama's changes to the healthcare laws, it would be people with AIDS. HIV positive people have been lobbying for government assistance since the nature of the disease first became evident in the 1980s, and Democratic politicians have led the charge to find a cure--or at least a treatment--for a disease that now affects millions of people, heterosexual and homosexual alike, around the world.

So it comes as something of a shock to learn that AIDS advocates are unhappy with Obamacare, as the Washington Post notes today:
But people who expected the new plans to provide pharmaceutical coverage comparable with that of employer-sponsored plans have been disappointed. In recent years, employers have compelled workers to pick up a growing share of the costs, especially for brand-name drugs. But insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on “fail first” or “step therapy” protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice.
The disruption to the existing market leaves many AIDS patients who were covered worse off than they were before:
Paul Prince, 52, a former information technology manager from Houston, said he was surprised that some of the health plans in the new federal marketplace wouldn’t pay for one or more of his HIV medications. The policy that seemed to provide the best coverage, he said, would cover only about two-thirds of his monthly $2,400 drug tab, leaving him responsible for $840.
“There was no way I could pay that,” said Prince, who is studying to become a teacher after being laid off from his previous job and losing his insurance.
Insurers have responded Obamacare's prohibition against discrimination on the basis of pre-existing conditions by cutting costly benefits--like expensive drugs.  The Post cites a study by Avalere Health:
A new analysis of health plans sold in the federal exchange — which covers 36 states — and 14 state exchanges found that the benefits tend to be skimpier than in most other private insurance in the United States, with drug benefits a particular weak spot.
Right now, this only affects the 5% of Americans who get their insurance on the individual market, but the Post reports that many employers are already thinking about cutting costs the same way.
Dan Mendelson, Avalere’s chief executive, predicted that employers may soon adapt some of the benefit designs in the exchanges’ health plans. “We are already seeing interest,” he said, because they are less expensive for companies, shifting more of the expense to patients.
The Washington Post article makes it clear that (a) this problem affects a larger group of illnesses, including cancer, multiple sclerosis, rheumatoid arthritis and autoimmune disease and (b) AIDS activists are working hard to change the rules to solve the problem--for people with HIV.

If you care about someone with AIDS, read the Washington Post article and pass it on.

If you care about someone with cancer, multiple sclerosis, rheumatoid arthritis, autoimmune disease, or another disease that involves expensive medications, you may want to subscribe to this blog.

Healthcare and Kidney Failure

America is the most generous nation on earth. Of course, we are also the richest nation on earth, so we ought to be.  How about giving until hurts? How about giving something money can't buy--like a kidney?

Over 600,000 Americans suffered from end stage kidney disease in 2008, and the number is rising. Kidneys are the body's toxic waste disposal units--a mission so critical that God gave us two of them. If one fails, the other is there for back-up. If both kidneys fail, the only option is to pipe the blood out of the body through a dialysis machine that does the filtering for them or get a kidney transplant.  More than 50,000 living people have given a kidney to save a life. I am proud to claim one of them in my own extended family.  My niece's brother-in-law has one less kidney and one more brother than he would have had without modern medicine. Thanks to that heroism, my nephew hopes to live as long as any other American.

With only 6,000 living donors each year and 10,000 kidneys from other sources, most end-stage kidney disease patients depend on dialysis. According to official figures reported in the New York Times, in 2008 over 380,000 Americans were receiving dialysis, at a cost of just under $40 billion.

Kidney failure is the only chronic disease that automatically qualifies an individual for Medicare, regardless of age. According to the American Kidney Fund, other Medicare patients can choose to continue their own private insurance as long as they are willing to pay for it, but dialysis patients are limited to 30 months of coverage under an employer-provided plan even if that plan offers better care than Medicare.

It gets worse for transplant patients. The American Kidney Fund reports:

Patients who receive a kidney transplant must take anti-rejection or immunosuppressive drugs for the life of their kidney transplant. However, Medicare will only pay for these drugs--which average $17,000 per year--for the first 36 months after a patient receives their transplant. Patients who are unable to pay for the medications are often forced to discontinue their use, resulting in kidney rejection and a return to Medicare-covered dialysis treatments at an annual cost of nearly $71,000 per patient.
That's rough on my nephew, but now there's Obamacare--or is there? Millions of Americans who were expecting more security and better care have been unsettled by the spectacular failure of  How does the new system work for kidney patients?

It isn't clear.

I visited to see whether kidney patients who are currently on Medicare can sign up for private insurance through the new exchanges. The online search tools told me all about Medicare and assured me that the new law would not take away my Medicare but had nothing to say about people who want off Medicare and on to private insurance that can no longer discriminate against people with pre-existing conditions.

So I called the 800 number and got the automated menu as I expected. One push of the "0" button broke me out of my robocall and I quickly got a very pleasant person who looked up the same articles I had been reading as she tried to figure out the answer with me. "Amanda" (not her real name) was able to tell me that it is illegal to sell insurance to somebody who is on Medicare (except for supplemental policies like Medicare Advantage). She figured out that a person who is eligible for Medicare (such as a kidney patient) is not eligible for any of the Obamacare subsidies. She couldn't say whether the system would allow a person who is currently on Medicare to pay their own way for a private plan. assures me that Obamacare won't take away my Medicare and offers me free colonoscopies. Their website indirectly alludes to $700 billion in cuts in Medicare through this optimistic paragraph:
The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.
Medicare's 800 number employs more robots than and insists that I type in my Medicare number. I could cheat and use my Mom's number, but that would be wrong. "If you do not have your Medicare number, you may wish to hang up." I hang up.

Searching for "Can Medicare patients choose Obamacare" gives me tons of hits--and they all promise me that I won't lose my Medicare. As far as I can tell, somebody at the very top made it clear that if you like your Medicare, you can keep your Medicare. (With so many people making the same promise, it sounds like this could turn into a post of its own, but that's for another day.)

How about Medicare supplemental insurance? That's usually the right answer for a person who wants more than Medicare. Now things get more troubling. According to "Beth" (not her real name), there are no options for "end of life treatment" for kidney failure in Minnesota. I'm hoping that doesn't mean what I think it means. Perhaps Beth got confused--it's a confusing situation. Fortunately, Beth's doctor in Saint Paul (who is as shocked as I am) is trying to find the answers. 

I hope there's a better answer for kidney patients than I've found yet. If you think I've stumbled onto the famous "death panels" here, you're wrong. Somebody is going to have to reduce the costs of all this care some time, and "death panels" may be the most accurate description of the body that tackles that terrible task, but this is just bureaucracy as usual. There should be a right answer to this question--we just haven't found it yet.

I appeal to readers from all points on the political spectrum to help out Beth. How does a patient with end-stage kidney disease take advantage of the new law? If Obamacare doesn't help them, are there private alternatives that do? Let's put our brains together, people, and make this world a better place!

Monday, December 9, 2013

Obamacare and Multiple Sclerosis

Obamacare was always expected to result in some "winners" and some "losers." The argument for the new law was that some people (especially the young and healthy) should pay a little more so that other people (the old and sick) could get the help they need. It's troubling to discover that some of the people who may get hurt the worst are those who are the sickest.

Approximately five percent of multiple sclerosis sufferers (those who were covered by individual insurance policies) have begun to discover how Obamacare affects them personally. Whitney Johnson had a policy that covered her medical bills even though they added up to $350,000 per year. Her existing insurance was cancelled and she was invited to pick a new policy from She had not been able to get what she needed through the Exchange, so she went directly to her insurer--only to discover that all her new options were unaffordable.  She writes:
I know I have five more IVIG treatments coming up over the next six months that cost $40,000 each. My insurance coverage ends in December, and I have to have these treatments. As a mother with a brand new baby, it’s a little unnerving to know that I may not be able to receive the care I need. It’s a little unnerving to know my health insurance that was working just fine for me was taken from me. The doctors I have used for years that have kept me this healthy will be taken from me.
Whitney is one of "small percentage" who have had their policies cancelled, but many more Americans with MS will be affected next November, when employer-provided policies must comply with the new law.  The Multiple Scerosis Association of America highlights the particular questions MS patients need to consider. These include:
  • Are my needed medications covered, and what are my costs?
  • Can I keep my doctor and are there restrictions on which doctors I can choose?
  • What plans can I afford and am eligible for?
  • Can I afford my deductible?
  • What are my expected out-of-pocket costs for equipment I may need?
  • Do I have to try lower-cost medications before I will be approved for the drugs I use now?

Forbes Magazine worked through the cost of MS medications in today's article, "No, You Can't Keep Your Drugs Either Under Obamacare."
Take, for example, the drug Copaxone for multiple sclerosis.
Someone on a bronze plan would be responsible for paying about 40% of the drug’s costs out of pocket, on average. That comes out to about $1,980 a month.
If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month.
But you’re probably better off with the cheaper bronze plan anyway. Since you’re going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesn’t count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can.
After all, the provider networks used by low cost bronze and high cost platinum plans are often the same. The only thing that varies between different “metal” plans is often the co-pay structure. The benefits are similar. So why pay higher premiums just to lower your co-pays when you know you’ll hit the out of pocket limits anyway.
By purchasing a costlier, gold or platinum plan, you typically can’t buy up the benefit much, if at all. What you’re doing is just prepaying the cost sharing.
That's assuming the drug you use is on the government's "formulary list, the list of drugs that are included in Obamacare. Even if it is on the government list, it may not be on your plan's list. Betaseron, for example, will not be available through ExpressScripts starting January 1. Forbes notes the out-of-pocket effects:
If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).
If you are an MS patient who has adequate employer-provided insurance today, don't wait until next November to find out how this works for you. Talk to your human resources department soon! If your employer is even thinking about changing your plan, call Washington! (All you need is your zipcode to find your Congressman, and you can find your Senators here.)

Not one single elected official wants you to lose coverage--but it's up to people with MS and the people who love them to help busy politicians understand the implications of this law. Whether you're Republican, Democrat, or terminally-turned-off by all things political, please speak out and spread the word!

Does Childbirth Cause Cancer?

There's no scientific debate on this one--women who give birth have an increased risk of breast cancer for the next fifteen years. Journals reporting this link include:

Why haven't you heard about this? First, because it's only temporary, and second, because the overall effect of childbirth is to reduce a women's lifetime risk. Young women have a very low risk of breast cancer, so a small increase in a very low risk is not a big problem. Older women have a much greater risk of breast cancer, so a long-term reduction in risk makes a big difference. That's why having children is generally associated with lower breast cancer risk.

 That's good news. But it leaves us with two questions. Why does breast cancer risk go up after childbirth? Why does it go down again after 15 years?

Jose and Irma Russo, of Fox Chase Cancer Center in Philadelphia, have done countless studies on the physiology of breast tissue. They have demonstrated that breast tissue specializes during the latter stages of pregnancy, leaving mature tissue at a lower risk of cancer. The early stages of pregnancy, by contrast, are a time of rapid cell division. (Women who have had babies know about this--tender breasts are one of the earliest signs of pregnancy.) These rapidly-replicating cells are a higher risk of mutation.

The prime suspect for the transient risk after childbirth is estrogen.  Estrogen helps prepare a woman's body for birth. It is the "gasoline" that keeps the human race going--but gasoline can be dangerous. All it takes is a spark to create an explosion. If you add enough estrogen to just one abnormal breast cell you can grow a tumor.

The good news is that the hormones of later pregnancy may actually stop some tumors in their tracks. The research to date is consistent with research on rats which indicates that tumors which have already begun to grow are redirected into normal tissue. (If you enjoyed biology in high school, read this article--it spells out the mechanism by which stem cells of one type are converted to another, and zeroes in on the precise tissue types that are at risk in early pregnancy.) If estrogen is the "gasoline" that catches fire, the hormones of later pregnancy are "rain" that puts fires out.

These are plausible answers to our two questions (why does risk go up after childbirth? Why does it go down after 15 years?), but if they turn out to be correct, they lead directly to a third question. What happens if a woman's breast cancer risk is raised by early pregnancy without the protective effect of later pregnancy? What if there's gasoline but no rain?

Research on rats proves that an interrupted pregnancy confers no protective effect. How about humans? If women have an elevated risk after any pregnancy (not just a full-term pregnancy), then women who choose abortions should have an elevated risk for at least 15 years after the procedure, just like other women who were pregnant. Carefully designed studies of breast cancer in young women find exactly that. Dr. Janet Daling, of Seattle's Fred Hutchinson Cancer Research Center, found:
Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50% higher than among other women (95% CI = 1.2-1.9). While this increased risk did not vary by the number of induced abortions or by the history of a completed pregnancy, it did vary according to the age at which the abortion occurred and the duration of that pregnancy. Highest risks were observed when the abortion was done at ages younger than 18 years—particularly if it took place after 8 weeks' gestation—or at 30 years of age or older. 
To answer the question posed by the title: childbirth does not cause cancer. Pregnancy does--in the sense that it adds "gasoline" that can burst into flame. Full-term pregnancy is the rain that puts fires out and reduces the risk of fire thereafter.

Sunday, December 8, 2013

Chinese Breast Cancer Trends

The latest meta-analysis from China shows that breast cancer is 44% more likely among Chinese women who have had one or more abortions. Critics claim this study is flawed because it relies on "case-control studies" which match a woman with cancer to a woman without cancer. The "recall bias" theory holds that women with cancer tend to tell the truth about their abortion history, while healthy women tend to conceal their abortions--even in China, where abortion is anything but "a private matter between a woman and her doctor."

It is easy to put the recall bias theory to the test. China has traditionally had a low breast cancer rate (only one out of forty Chinese women expect to get the disease, a mere fraction of the American rate).  If abortion does not increase the risk of breast cancer, tens of millions of Chinese abortions should have no impact on cancer incidence in China. But breast cancer in China is rising, and rising rapidly, as this public service simulation from General Electric shows.

This could be mere coincidence. Logicians recognize the post hoc ergo propter hoc fallacy--"after something, therefore because of something." There could be other causes of China's rising cancer rate. Oral contraceptives are known to have carcinogenic effects--but less than 2% of Chinese women have access to the Pill.

Perhaps pollutants are causing the increase. When the pesticide DDT breaks down to DDE, it mimics some of the effects of estrogen, leading some researchers to suspect it as a cause of cancer. China used to use DDT extensively in agriculture. If DDT caused breast cancer, one would expect peasant women in China to have elevated rates, while urban women might be spared. If abortion increases the risk of cancer, the results should be the opposite, because urban women in China are more likely to abort than peasant women are. As it turns out, breast cancer rates are rising more rapidly among urban women in China than among peasants.

Something is causing Chinese breast cancer cases to rise. It isn't the Pill, and it isn't DDT. What, then?

The latest meta-analysis says that women who choose abortion are 44% more likely to get breast cancer than do those that don't. Multiply that small number by millions and you get exactly what China is now experiencing--a rise in breast cancer all over the country with the highest rates in the urban centers.

Friday, December 6, 2013

Chicken Soup Isn't Just Good for the Soul!

Mainstream medicine is provided by doctors who are nervous about malpractice suits and is funded by the government or insurance companies. That means most doctors have a good reason to suggest more tests while most patient have no good reason to say "no." Third-party payment of medical bills is not the only reason medical costs keep rising, but it is certainly part of the problem.

Self-pay patients (including those who participate in healthcare sharing ministries) are different. They want good health, but it comes out of their pockets--initially, at least--not some big company's. This should lead self-pay patients to work a little harder at staying healthy. They ought to eat chicken soup a little more often and Big Macs a little less.

Of course, eating chicken soup is just a metaphor for old-fashioned approaches to staying healthy. Nobody really believes chicken soup heals colds--or do they?

As it turns out, chicken soup really does help people get over colds. Chicken soup contains high levels of collagen, which is the richest source of glycine in the body, as collagen is 22% glycine by weight. Health-conscious people have so relied on lean, skinless, boneless meats lately that the average American diet is now lower in collagen than it used to be. Dr. Joel Brind writes in Chicken Soup, the Common Cold, and Proglyta,
...a research team at the Nebraska Medical Center in Omaha found that chicken soup actively inhibits inflammation. Specifically, they tested a standard laboratory model of neutrophils... in vitro, and found that a soluble substance in chicken soup ” significantly inhibited neutrophil migration and did so in a concentration-dependent manner.” And it is inflammation that is responsible for most of the symptoms of cold and flu.
 If you hate chicken soup, try Jello. It has the very same proteins. (Is this why Jello always seems to be on the hospital menu?) There's also "Sweetamine," a glycine-based supplement you can use like a sweetener.  It''s healthy choices that set self-pay patients apart!

Debate the Abortion/Breast Cancer Link

What scientific paper could possibly open up a subject as controversial as "death panels" or "global warming"? How about the latest Chinese research that finds a statistically significant 44% increase in breast cancer risk after induced abortions. For those who are new to the debate, here are the arguments for and against the Abortion/Breast Cancer link.

The Argument

  • Estrogen is to breast cancer what carbon dioxide is to global warming--with a twist.

    • CO2 is a "greenhouse gas" that traps heat, so anthropogenic global-warming ("AGW") theorists argue that the rise in temperatures around the world is the result of humans burning fossil fuels.

    • Steroidal estrogen is a recognized carcinogen. Pregnancy loads a woman's body with estrogen, but abortion interrupts the process before other hormones can mature breast tissues. Abortion/breast cancer ("ABC") theorists argue that this can explain the global epidemic of breast cancer since oral contraceptives and abortions became common.

  • The twist: people who question the AGW hypothesis are called "deniers" and are told "the science is settled." People who articulate the ABC hypothesis are called "fanatics" and are also told "the science is settled."

Research on Rats

  • Pro: Rat breast tissue is more susceptible to mutations in early pregnancy, which raises the risk of cancer. Fortunately, breast tissue becomes specialized in later pregnancy, which reduces the lifetime risk of cancer. Rats that give birth have a lower incidence of cancer, but research shows that interrupted pregnancies confer no protective effect. Although the A/BC link was first hypothesized in 1957, nobody has done a study on rats that is specifically designed to find out whether induced abortions raises the risk of cancer.

  • Con: Rats aren't people. The science is settled. We don't need more research.

Research on Pregnancy

  • Pro: The age at first live birth is a well-known risk factor for breast cancer. Earlier is better--the sooner a woman has a baby, the lower is her lifetime risk of breast cancer. This is true despite the fact that child-birth itself
    raises a woman's risk of breast cancer in the 15 years after birth. This transient risk is due to the impact of estrogen on breast tissue. Abortion leaves a woman with the worst of both worlds--all the elevated risks of pregnancy without the protective effects of birth.

  • Con: Women don't care about raising their risk of cancer when
    they're considering terminating their pregnancy, and doctors shouldn't
    tell them about it. It would only confuse and distress them.

Research on Estrogen

  • Pro: The suspected link between abortion and breast cancer is based on the high levels of estrogen during pregnancy. Estrogen has been tied to breast cancer time after time.  Hormone replacement therapy is a recognized breast cancer risk. Steroidal estrogen is a recognized carcinogen.  Injectable contraceptives appear to raise breast cancer risk. Studies on oral contraceptives have been more controversial, but the World Health Organization identifies estrogen-containing oral contraceptives as a "Class 1 carcinogen."

  • Con: Only Catholics object to oral contraceptives. This is just another case of religion hiding behind the mask of "science."

Research on Populations

  • Pro: Breast cancer is rising around the world, especially in
    populations that have begun to use oral contraceptives or induced
    abortion. Breast cancer incidence is elevated in every group that tends
    to choose abortion: (i.e., young black women, more educated women,
    higher status women, etc) and lower in most groups that tend to avoid
    abortion (older black women, more religious women, Hispanic women in
    Hispanic neighborhoods, etc.).

  • Con: Claims of a "global epidemic" of breast cancer have been
    overblown. Most of the alleged increase in breast cancer in the United
    States is simply the result of better publicity and longer lifespans.

Breast Cancer Studies:

Case-Control Studies: Matching women with breast cancer to otherwise-identical women 

  • Pro: Study after study finds a modest increase in breast cancer risk. The studies that distinguish women who had abortions from women who took the Pill are consistent with an increase in risk of 3% per week of terminated pregnancy. Studies designed to correct for the possibility of "recall bias" fail to find any.

  • Con: Any apparent increase can be explained by "recall bias," which holds that women who get sick tell the truth while women who are healthy tend to maintain their privacy.

Cohort Studies: Following large groups of previously-identified women over time

  • Pro: Cohort studies, which track large groups of women over
    time, necessarily fail to address the multiple variables that affect
    breast cancer risk. Studies funded by big drug companies should be
    scrutinized as carefully as studies by tobacco companies.

  • Con: Cohort studies are the most reliable because they are the largest and are not subject to recall bias.

Recall Bias: Do Healthy Women Conceal Abortions?

  • Pro: Janet Daling, of Seattle's Fred Hutchinson Cancer Research Institute, is personally pro-choice but is even more anti-cancer. Her research on the abortion/breast cancer link was elegantly designed to detect any evidence of recall bias. She included three groups of women in her study: some with breast cancer, some with cervical cancer, and some who were healthy. The recall bias theory suggests that women with cancer (whether breast cancer or cervical cancer) would tell the truth, while healthy women might be shy. She found no evidence of an increase in risk among women with cervical cancer, but a statistically significant increase among women who chose abortion.

  • Con: Recall bias explains all the apparent increase in risk.

Hypothesis Or Theory?

  • Pro: Before the National Institute of Health convened its panel to discuss this issue in 2003, almost every paper on the topic concluded with "more research is needed." The research done since then is consistent with a modest, transient increase in breast cancer risk after induced abortion as long as one recognizes the confounding effect of oral contraceptives. With the latest meta-analysis from China, it's time to stop calling this the "abortion/breast cancer hypothesis" and recognize it as a valid scientific theory.

  • Con: The hypothesis has been disproved. The science is settled. The continuing obsession about this is just more right-wing, anti-choice obfuscation.


The link between abortion and breast cancer has been so vigorously and officially denied that many people have decided it simply must be false. Talking about abortion and breast cancer these days is like insisting that Obamacare will create "death panels" or denying global warming.

That's why the new Chinese research matters. It's time for open-minded people to review the arguments and make up their own minds. This page is a place to begin the discussion.

Thursday, December 5, 2013

Chinese Abortions and American Health

In 1981, Dr. Malcolm Pike studied 163 Los Angeles breast cancer patients under the age of 33 and found that women who had used oral contraceptives were significantly more likely to get breast cancer than women who did not. The "relative risk" for women who had taken the Pill for six years of more was 2.2--which means they were twice as likely to get breast cancer as were women who did not take the Pill... with one exception. Women who had abortions (instead of relying on oral contraceptives) were even more likely to get breast cancer.

Pike did not zero in on abortions and the Pill because he disapproved of them on religious grounds, but because both of them expose a woman to estrogen. Estrogen has a well-documented impact on breast cancer risk. The Pill artificially adds estrogen to a woman from the outside, while pregnancy adds estrogen from the inside. Estrogen raises the risk of breast cancer in the 15 years after a normal birth, but the final stages of pregnancy mature the breast tissue so much that the overall effect of childbirth is to lower a woman's lifetime risk. Abortion leaves women with all the elevated risks of early pregnancy and none of the protective effects of third-trimester maturation.

The women in Pike's study were all under 32 when they got cancer. That's how many years have passed since Pike first published his findings. What has happened since then? Wikipedia lists 113 references on its "abortion/breast cancer hypothesis" page, and many of them show an elevated risk after abortion. The elevated risk is small, as these things go--a transient increase in risk of about 3% per week of terminated pregnancy. It takes a big study to turn something that small into a significant finding, and most of the big studies have been funded by big organizations, such as governments  and/or pharmaceutical companies.

To date, none of the studies funded by drug companies separate women who take oral contraceptives from women who have abortions. Imagine a tobacco company comparing lung cancer risks among pipe smokers to non-pipe-smokers without ever asking about cigarettes. That's what you get when a drug company simplistically compares women who terminated their pregnancy to women who avoided pregnancy... somehow. You have to ask about the Pill!

Not all studies have been funded by big drug companies, however, resulting in a steady drip of studies with elevated breast cancer risks after abortion. How can scientists ignore this? The answer is something called "recall bias." Abortion is such a private matter that healthy woman don't usually want to disclose it. All that changes when a woman gets cancer, however. If all the healthy women "forget" their abortions and all the sick women remember them, it would look like sick women had had more abortions even if they didn't really.

Between small numbers, recall bias, oral contraceptives, and the red-hot politics of abortion, all this can be confusing. Reasonable scientists have been able to disagree about the abortion/cancer link, and, as a result, American women have been choosing abortion for the last 32 years without finding out about this issue. But the latest research from China clears away the confusion.

Time Magazine reports that only 1.2% of Chinese women take the Pill, resulting in a lot of pregnancies. With China's "one-child per couple" policy, that has led to 13 million abortions every year. Unlike America, where these abortions are a "private matter between a woman and her doctor," Chinese data on abortions are kept by the same government agencies that conduct the procedures. With such huge numbers, official government data, and virtually no oral contraceptives, Chinese research on the abortion/breast cancer link should be as solid as research on living human beings can ever ethically be.

And the latest research devastates the claim that there is no link between abortion and breast cancer. The newest study from China perfectly matches the evidence from earlier studies suggesting that each week of a terminated pregnancy raises a woman's transient risk by approximately 3%. For a single abortion at 15-weeks, one would expect a 45% increase in risk. The meta-analysis reports a 44% rise. A second abortion would add more exposure, adding more risk. Two abortions in China leads to a 76% increase in risk. A third abortion would raise the risk even more--and Chinese women with three abortion had an average increased risk of 89%. This kind of "dose-response relationship" is very persuasive to open-minded researchers... especially when the "dose" is something with such a clear-cut relationship to breast cancer as estrogen.

Do you think this is going to change any medical minds? It will--but not in America any time soon. But that no longer matters. China has too many women and too many scientists to wait around for American "researchers" any longer.

Why Some Secularists Hate Christian Healthshares

One self-proclaimed "secularist" discovered Christian healthshares some years ago--and hates them. This article is a now dated (the author predicted that Catholics would jump on the healthshare bandwagon if Obama got reelected, and they haven't--yet), and it includes some information about legal challenges that are now ancient history, but it you can stand the snarkiness, it's well worth reading. Here's a sample:
What an incredibly sweet deal for these three outfits. There’s only one way in the whole law for right-wingers to evade Obama’s Commie individual insurance mandate, and they own it — without any fear of competition! All three just happen to be evangelical Christian — equal protection of the laws is such an outdated notion. 

People fear what they don't understand. Or, in this case, people who oppose Christianity fear what they do understand. Now we just need to make sure more Christians understand the power of healthshares.

Wednesday, December 4, 2013

Health and Wealth

James 2:5 says, "Listen, my beloved brothers, has not God chosen those who are poor in the world to be rich in faith and heirs of the kingdom, which he has promised to those who love him?"

I have been to Rome three times, and vividly remember my first visit. I was on a bus tour that took us to the Vatican in the morning and the catacombs in the afternoon. I was overwhelmed by the magnificence of St. Peter's--an awe-inspiring display that was designed (around the time of the Reformation) to remind faithful Catholics of the magnificence of the One True Church. As a Protestant, I was duly impressed--but not converted (even though I did catch a glimpse of the Pope and even though some of my faithful Catholic friends were praying God would use that trip to bring me home to Rome).

What moved me, that day, was my visit to the catacombs. There, in those ancient corridors carved out of living rock, I saw hand-painted symbols of my faith. I visited the tombs of some of the very first bishops of Rome--the earliest popes--and I did feel "at home." These were my brothers. This was my church.

This is not to say that rich Christians aren't Christians and poor Christians are. It's just that what Christians need isn't more money, but more of Christ. That's true even when we're talking about really expensive propositions like healing the sick or feeding the hungry.

Let's talk about feeding the hungry first. Mark 6 tells how five thousand men (not counting women and children) got so hungry that Christ's disciples begged Him to send them home. Jesus answered them, You give them something to eat.” 

Some theologians think the "miracle of the loaves and fishes" wasn't a "violation of the laws of physics." They suggest that people started sharing the little they had hoarded for themselves and it turned out there was more than enough for all. Without taking any theological position on how the loaves and fishes worked, it's clear that healthcare needs might be met if many Christians shared the little they have with others in need.

Jesus didn't need a billion dollars or a government program to feed the hungry. He doesn't need a corporation or federal agency to heal the sick. He does need followers who actually follow Him, however--and that means us.

Tuesday, December 3, 2013

The Hobby Lobby Case

The government's contempt for Catholics is on display in Sebelius v. Hobby Lobby, Inc., which pits America's most prominent supporter of partial birth abortion,  Kathleen Sebelius, Secretary of Health and Human Services, against devout Roman Catholic business owners.

 The Religious Freedom Restoration Act ("RFRA") explicitly safeguards religious freedom from Acts of Congress. My old boss, Mike Farris, co-chaired the group that drafted RFRA , and he knew what he was doing. Having fought for religiously motivated homeschoolers in courts all over the country, Mike crafted the strongest protections Congress would consider--and got it passed.

Unfortunately, the government now insists that religious liberty does not apply to corporations--even if those corporations are closely held by people who share the same beliefs.  That's hard on Catholics, who have used the corporate form of ownership to accomplish a vast variety of enterprises, from building not-for-profit hospitals to growing business like Hobby Lobby, Inc. According to Kathleen Sebelius, Catholic business owners now have the choice of selling their companies or denying their faith. Instead, they have gone to court.

If Hobby Lobby wins, some corporations will be exempt from some of Obamacare's most objectionable mandates. But coerced contraceptives today (and abortions tomorrow?) are just the tip of the iceberg. Healthcare sharing ministries ("healthshares") are a legal, affordable, Christian alternative to the kind of insurance Hobby Lobby objects to. Healthshares are a better mousetrap. This blog exists to beat a path to their door so that individuals, churches, and, corporations don't have to compromise their convictions.

Oral Contraceptives and Cancer

The National Cancer Institute admits there is some evidence that women who use oral contraceptives face an increased risk of breast cancer for several years. That is no surprise, since the Pill delivers estrogen to a woman's body, and increased exposure to estrogen is associated with elevated breast cancer risk. The mystery is not that oral contraceptives raise breast cancer risk, but that they don't appear to raise the risk anywhere near enough to account for the global epidemic of breast cancer since they became widely available in the 1960s.

What the National Cancer Institute won't tell you is that oral contraceptives are just one way a woman can get an abnormal exposure to estrogen. Pregnancy also delivers "sudden and dramatic increases in estrogen." There's nothing abnormal about pregnancy, of course, but doctors are well aware of a "transient" increase in breast cancer risk after birth. A full-term pregnancy matures and specializes breast tissue, reducing a woman's lifetime risk of breast cancer--but only after an elevated risk for the fifteen years after birth.

If a full-term pregnancy raises risk in the short term but lowers risk overall, what about an interrupted pregnancy? Miscarriages, which are often associated with insufficient estrogen levels, don't seem to have a measurable effect on breast cancer risk, but interrupting a viable pregnancy seems to produce the worst of both worlds--elevated short-term risk (due to estrogen) without the long-term benefit of mature, milk-producing tissue. In other words, it would seem that abortion must increase the risk of breast cancer in young women.

How come you don't hear that from the National Cancer Institute? The reason may disturb you. Study after study has been published on the abortion/breast cancer link, with varying results. Some, such as the most recent meta-analyis from China, find an elevated risk of cancer after abortion.
A systematic review and meta-analysis of 36 Chinese studies by Dr. Yubei Huang and his colleagues in the prestigious journal, Cancer Causes Control, last week reported a significant 44% increased breast cancer risk among women with at least one induced abortion...

Others find no increase in risk--but those studies simply compare women who have abortions to women who don't have abortions. That's like comparing pipe smokers to non-pipe-smokers instead of comparing pipe smokers to cigarette smokers to non-smokers. If estrogen is what elevates the risk of breast cancer, it makes no sense to compare one group of women with elevated estrogen levels (pill takers) to another group of women with elevated estrogen levels (whose pregnancies were terminated by induced abortions).

Once you include all sources of elevated estrogen, the "global epidemic" of breast cancer suddenly makes sense. Breast cancer is on the rise among all groups that routinely use oral contraceptives or choose abortion, while it tends to remain at normal levels among women without an artificially high exposure to estrogen.

If this is true, why isn't everybody talking about it? First of all, in our ultra-politicized world, anybody who mentions the abortion/breast cancer link is instantly marginalized--just like Sarah Palin was when she claimed Obamacare would lead to death panels. (If you haven't noticed, the mainstream media finally admits that death panels are real.)  Second, many of the biggest (and most questionable) studies on abortion and breast cancer have been funded by the same drug companies that produce the Pill. And finally, the political and legal implications of an abortion/breast cancer link are overwhelming. At a minimum, Planned Parenthood would be bankrupted by malpractice suits, and Roe v. Wade itself would have to be reconsidered in light of a genuine medical danger. The stakes in America are too high to let science be science.

But that can't be all there is to it! Science is science, and even the tobacco industry had to hide the evidence that smoking led to cancer. How can drug companies hide the evidence of an abortion/breast cancer link? The answer is, they don't. They just attribute it to "recall bias," arguing that women who choose abortion tend to be ashamed of their choice, and so don't tell the truth about their own medical history until they get cancer--at which point, life trumps privacy. With this approach, study after study that shows an elevated risk can be ignored every time. Without direct experiments on living human beings (which violates every principle of medical ethics), indirect evidence of increased risk gets ignored time after time.

Except in China. Abortion there has none of the personal stigma that it has in the United States, and medical records on abortions are easily available. With nearly a billion people and a state-mandated one-child per couple policy, China is the next best thing to a laboratory for conducting direct experimentation on living human beings. This makes it especially significant that Chinese researchers are pointing out the consistent elevated risk after abortion.

Convinced?  Then tell a friend--or ten. Forward this link to folks who need to know.

Skeptical? I haven't scratched the surface of the evidence for this link. Post your questions or critiques in the comment section below and I'll respond to them as time permits.

Angry?  That's what the comments are for--but please keep it clean, or I'll delete it, whether you're roasting me or toasting me. This blog is intended for the whole family, with a zero tolerance policy on profanity.