Health Headlines - January 21

Many Aging Boomers Struggle With Insurance Concerns

Many aging baby boomers not yet eligible for Medicare are suffering from debilitating chronic conditions, yet often lack the resources to pay for essential health care, a new report finds.

"This is basically a working group actively saving for retirement," said Sara Collins, a senior program officer with the Commonwealth Fund, and lead author of the study. "We wanted to see whether they had health coverage, where they got coverage, and what their out-of-pocket costs were like and what that meant for access to care."

"These findings are clearly consistent with findings elsewhere," added Carol Pryor, senior policy analyst with The Access Project in Boston. "They point to a common problem."

According to the study, growth in U.S. health care costs is far outpacing increases in workers' wages. Employees are also being required to assume a greater share of premium contributions, deductibles and co-payments. And that's if they have any coverage at all.

The report joins a veritable deluge of data assessing the state of health insurance in the United States.

The situation is taking a toll. An earlier report from the Commonwealth Fund found that an estimated 77 million Americans, or 2 in 5 working adults, had a medical debt problem in the previous year.

The new findings appear in a report titled New Evidence on Health Coverage for Aging Boomers, put out by the Commonwealth Fund. It was to be presented Friday at the annual conference of the National Academy of Social Insurance.

The report was based on a survey of 1,189 adults aged 50 to 64 who were not enrolled in Medicare, who were employed full-time or part-time or who had an employed spouse.

More than 60 percent of the adults surveyed had been diagnosed with at least one chronic condition such as arthritis, cancer, diabetes, heart disease, high cholesterol or high blood pressure.

At the same time, health coverage was often lacking, with one-fifth currently uninsured or remembering a time they were uninsured since they were 50.

About 6 percent of insured older adults were really "underinsured." About one-third of respondents reported medical bill problems or accrued medical debt. Nearly one-quarter said they had foregone needed medical care because of the cost.

People with moderate incomes, like those with low incomes, worried about the affordability of health insurance. More than half of those with incomes below $40,000 and 42 percent of those with incomes between $40,000 and $60,000 reported being very worried about this issue.

In addition, 54 percent of people sampled with incomes under $25,000 and one-third of those with incomes between $25,000 and $40,000 said they had at some point gone without health insurance.

"What's surprising is the instability of coverage across low and moderate incomes," Collins said. "There is a sense of some risk and some high cost burdens among both low- and moderate-income working households in this age group."

About half of respondents in households with incomes under $40,000 and 43 percent of those earning $40,000 to $60,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, the survey found.

Tax credits for people with low incomes so they can buy private insurance aren't likely to help, the authors said.

Pryor said: "One thing that jumps out at me is the inadequacy of many of the insurance products being sold. For people purchasing insurance on the individual market, their medical bill problems are really similar to people who are uninsured. Having these insurance policies is offering no protection at all."

"There's a big push to consumer-driven policies that would shift more of the costs to the individual," she continued. "You have to start asking yourself whether having this type of insurance provides any protection to people. For years, we have talked about the problem in terms of the uninsured. But if we cover more people with inadequate policies, we're really talking about the underinsured who are in as much jeopardy as the uninsured."

Some solutions?

Seventy-two percent of those polled, including a sizable number with higher incomes, said they would be interested in receiving Medicare before they turn 65. This could occur through some type of buy-in.

Another possibility would be a Medicare savings account, which would start accumulating before a person retires.

"Obviously, this is an age where chronic conditions start popping up," Collins said. "This raises concerns about people's ability to maintain their health as they move toward retirement and toward Medicare."

On-the-Job Stress Bad for the Heart

A British study strengthens the link between on-the-job stress and the risk of heart disease, stroke and other cardiovascular problems.

People who report that their job is stressful are more likely to develop metabolic syndrome, a collection of cardiovascular risk factors such as obesity, high blood pressure and high cholesterol levels, according to the report.

Previous reports have shown a link between work stress and heart disease, but "the biological processes underlying this association remained unclear," said Tarani Chandola, a senior lecturer in epidemiology and public health at University College London, and lead author of the new research. "The study shows that there is a dose-response association between exposure to work stress and the metabolic syndrome."

The findings appear in the Jan. 21 issue of the British Medical Journal.

Chandola and his colleagues questioned more than 10,000 British civil servants between the ages of 35 and 55 over a 14-year period, asking them four times during that period to say whether they felt stress on the job. Measurements of blood pressure, cholesterol and other metabolic syndrome components also were taken.

"There was a stepwise increase in the odds of the metabolic syndrome with increasing levels of exposure to work stress," Chandola said.

Men with chronic work stress were twice as likely to develop metabolic syndrome than those reporting no work stress. Women with work stress were also more likely to develop the syndrome, but there were only a few of them in the study.

People with metabolic syndrome were also more likely to have bad health habits, such as a poor diet with little consumption of fruits and vegetables. They also had a tendency to smoke, drink too much and not exercise enough, the researchers said.

Why should stress lead to metabolic syndrome, which has also been linked to type 2 diabetes? Chandola offered some thoughts.

Stress might affect the autonomic nervous system, which controls the activity of organs, blood vessels and glands, he said. Alternatively, stress might influence the production of hormones throughout the body. "We are currently investigating the effect of work stress on both systems," he said.

Steps need to be taken to help relieve stress, Chandola said. Previous reports found that civil servants who felt they were being treated fairly at work had a reduced risk of heart disease, while the risk was higher for those who felt they had little or no control over their work.

"Studies on workplace redesign to increase a worker's sense of control and participation at work have resulted in fewer sick days amongst workers in the experimental group," Chandola said.

On the individual level, counseling to modify a worker's sense of control might be helpful, he said.

Health Tip: 'Outgrowing' Asthma

Asthma is a chronic condition that can constrict the tubes carrying air in and out of your lungs.

The vast majority of asthma cases occur in childhood. Some children are diagnosed with it after having many coughs and colds in a relatively short period.

According to the U.S. National Heart, Lung, and Blood Institute, some children may outgrow asthma, but there is no way to predict who will and who won't. However, there are some indicators. Children with allergies, or a family history of asthma, are more likely to continue having asthma as they get older.

Some asthma is brought on by infection, while other causes include some types of exercise and allergens. Many children who have wheezing as a baby don't have asthma as they get older.

But other children continue to have asthma throughout their childhood.

Health Tip: When Knee Cartilage is Torn Beyond Repair

Sometimes, the cartilage in knee (meniscus) gets torn through exercise or injury, and the only alternative is to replace it with tissue taken from a donor.

The American Academy of Orthopaedic Surgeons says prime candidates for this procedure are usually physically active and under 55.

Usually, this is recommended only when half the meniscus is missing, either through injury or surgery or because of a a tear that can't be repaired.

When a meniscus is torn, it's usually treated by knee arthroscopy. By contrast, a meniscus transplant replaces the torn cartilage in a knee.

Other surgeries, such as ligament or cartilage repairs, may be performed at the time of the meniscus transplantation or with a separate surgery.

Food Fact:
Baker's treat.

Is the secret to delicious low-fat treats already be in your pantry? When used in baking, applesauce helps lower the overall fat content of some of your favorite muffins, bars, quick breads and cakes. When you're adapting a high-fat recipe to low-fat healthfulness, start by replacing two-thirds of the original's butter or margarine with unsweetened applesauce. Like fat, a fruit puree such as applesauce coats the starchy flour particles in baking. Without this step, gluten forms when the flour is moistened and stirred, making the end result tough.

Fitness Tip of the day:
Lose 5 lbs. a year without dieting.

One simple change in your daily routine can help you burn extra calories and shed excess pounds. Anything you do every day to burn an extra 50 calories will save you the equivalent of five extra pounds over the course of a year. It can be as easy as parking your car a mere five minutes further from your office each morning and then walk briskly to your desk and back again after work. That's easy weight loss in just 10 minutes a day!

FAQ of the day:
Can I eat red meat and still be healthy?

For most of us, being healthy does not mean you can never, ever take a bite of red meat, but there are a number of studies that suggest it makes sense to eat it less frequently. To take one example of the kinds of studies pointing in this direction, among Seventh Day Adventists, a religious group with a high percentage of vegetarians, men who ate beef at least three times a week were twice as likely to die of heart disease than men who did not. Red meat is very high in artery-clogging saturated fat; moderation and a balanced diet is a solid step toward good health.