Medicare abuses aren't just at the hospice

The New York Times reported today that hospice care in the U.S. is getting abused at an increasing rate. The government dished out $12 billion in 2009 for hospice care compared to $2.9 billion in 2000. Four out of 10 Medicare patients now use hospice for end-of-life treatment, which is what hospice is there for. But what's largely going overlooked, or rather underreported, is why this abuse has been increasing and how to actually fix it.

Briefly, the NY Times reporter cites that patients are deciding to avoid life-support treatments in the hospital for pain-relieving medication through hospice care, which can be at a nursing home or privately in your own home. This still doesn't answer why, however. Hospice is for patients who are expected to live no more than six months, but with mental diseases and autoimmune diseases increasing in the American population -- where often proper lifestyle changes and reduced stress can increase life expectancy -- many of these patients are living longer than the six months expected.

In other topics on Medicare and Medicaid, the abuse doesn't stop at hospice care. Recently, I reported in Automative Fleet magazine on how Medicaid van services can largely go overlooked, despite the hustle of contractors to oversee these services. When picking up Medicaid riders is a main source of income for a service fleet, it might be easy to report a higher number, as reported by some fleet contractors.

While the health care reform will work to curb some of these abuses, legislators aren't necessarily informed and educated enough on all these gaps to make effective change. What America needs is a nonpartisan committee to find these holes in government medical services to help prevent waste. As well, this could open other questions for legislation, such as why more and more people are bypassing life-prolongment treatment for a more peaceful end through hospice care. And also this raises questions to the medical community: What defines a terminally ill patient? Maybe the attention and personal services given through hospice care were all that were needed to make the illness not so terminal.

FIFA needs to let groups hand out condoms at World Cup stadiums

Participating at the World Cup in South Africa, HIV/AIDS awareness groups will be located at health centers where condoms and other sex education materials will be available. Originally, however, these South African AIDS organization asked to dispense the condoms and goods at the stadiums, according to VOA News. FIFA, the International Federation of Association Football, refuses to let these groups into the stadiums and has isolated them to the health centers that will be located with other vendors.

Rhulani Lehloka, communications manager for the AIDS Consortium in Braamfontein, told VOA News that, “The (HIV) prevalence rate in our country is the highest in the world. And we have the interests of the visitors at heart, but we’re also having the interests of the people of South Africa at heart.” All of the groups consider the passing out of condoms to be a “holistic” approach to HIV/AIDS awareness and prevention.

According to the World Health Organization, in 2008, the latest solid statistics, approximately 33.4 million people are currently living with HIV, 2.7 million of which were newly infected in 2008. Deaths in 2008 alone attributed to AIDS/HIV, was around 2 million people worldwide.

While the yearly number of people infected with HIV is decreasing, and has by almost 1 million in the last 10 years, transmission is still easy on continents like Africa where socioeconomics, poor health access and malnutrition all play an underlying role in the transmission of HIV/AIDS. The prevalence of AIDS is not lowering in Africa, but is rising. Of the 33.4 million living with AIDS, about 23 million of those live in Africa. As of 2009, in South Africa, 16.9 percent of the population is living with AIDS, the fifth highest percentage in all of Africa (Swaziland, 25.9 percent; Botswana, 25 percent; Lesotho, 23.4 percent; and Zimbabwe, 19.1 percent).

Apparently, FIFA needs HIV awareness, and should allow these groups to distribute condoms and information. What is the harm?

Land important in studying economics and culture, but not only factor

Ancient centres of origin of plant and animal domestication — the nine homelands of food production — are indicated by the orange-shaded areas on the map. The most agriculturally productive areas of the modern world, as judged by cereals and major staples, are indicated by the yellow-shaded areas. Note that there is almost no overlap between the areas highlighted, except that China appears on both distributions, and that the most productive areas of the central United States today approach areas of the eastern United States where domestication originated. The reason why the two distributions are so different is that agriculture arose in areas to which the wild ancestors of the most valuable domesticable crops and animals were native, but other areas proved much more productive when those valuable domesticates reached them.

Source: "Evolution, consequences and future of plant and animal domestication"

Jared Diamond. Nature 418, 700-707(8 August 2002) doi:10.1038/nature01019

In studying humans, a variation of aspects is used to understand behavior and the empirical world we’ve created. In a recent article by ScienceNOW, information originally used to track moth development was refined and retooled to see how humans used the land. Looking at several aspects of climate and soil, the simulation looked at how the four main subsistence types (farming, sedentary animal husbandry, nomadic wandering, and hunting and gathering) had played out in reality to what the soil and climate could supposedly bear. The study had an error of about one-third, with modern day culture coinciding with a majority of their findings.


This plays along with many theories about the development of agriculture and its effect on human “advancement.” Jared Diamond, for example, in “Guns, Germs and Steel: The Fates of Human Societies,” describes the importance of geography in cultural and even genetic change. Lands on the East-West axis (i.e. Eurasia) versus the North-South axis (i.e. Africa) would have quicker advancements and population booms because of the availability of domesticable plants and animals. This holds true when compared to how many plants and animals have been domesticated in these regions historically. These areas have shifted slightly to other more hospitable climates as it has changed, such as from eastern United States to western. But it does show an implication of why we see technological, economical and agricultural development in the patterns that we do.

One large problem, however, is that the article claims the finding, “may help explain why some regions are more prone to violence than others.” It is one thing to assert that the environment was a large contributing factor to how cultures developed their subsistence strategies and technologies across the world. However, in no way does this assert that violence would occur less on the East-West axis – a formidable study would need to be done because this assumes geography is a superior factor to the formation of culture. This is called geographical determinism. Violence cannot be understood from geography alone or as the determining device, and it would absurd to think competition for resources can be reduced to the sole reason for the world’s problems. Backing up to the fact that the study failed to present current land uses with what the model projected one-third of the time is evidence that biology, culture and psychology are also triggering reasons for human behavior.

Thankfully, the researchers of the study acknowledged this in their study, however, headlines led readers a different direction. At the very end of the study, the researchers write: “[W]e know that human societies and economies went through historical development, so ignoring history may not always be the best strategy to understand causalities. … Nevertheless, our ‘null model’ will be a useful tool in identifying regions that require further investigation to understand additional processes that shape the distribution and performance of human economic traits.