Medical Care

The Environmental Protection Agency on Wednesday declared its first public health emergency, saying the federal government would funnel $6 million to provide medical care for people sickened by asbestos from a mine in Montana. The declaration applies to the towns of Libby and Troy, where for decades workers dug for vermiculite, a mineral used in insulation.

Lawmakers on Thursday sharply criticized a federal program that relies on private insurance companies to provide medical care and benefits to civilians injured while working in support of the U.S. military effort in Iraq and Afghanistan. Members of a House subcommittee charged that the insurance firms had exploited the taxpayer-supported program to reap enormous profits while shortchanging workers. "We've got to straighten out this mess and we're going to do that," said Rep. Elijah E.

Millions of Americans who are self-employed, working for small businesses or -- increasingly in this economy -- jobless, are facing the difficult and expensive task of buying health insurance on the open market. The options are dizzying, with premiums, deductibles and co-payments that vary widely among plans and costs that are not always obvious. People who are older may pay more, as may those who have children and women who are of child-bearing age.

Widowed and HIV-positive, Beatrice Acheing had no money to have her baby delivered in a hospital. But she admitted herself anyway to reduce the risk of transmitting the virus during childbirth. To her relief, the boy was born HIV-negative. But their ordeal had just begun. Hours after labor, both mother and baby were shunted into a locked, guarded room with other indigent patients. They were given one meal, sometimes two, a day, but no clothes or diapers for the infants.

A homeless man spent the night camped outside the Forum, hoping to finally get glasses to help him see better. An unemployed grocery clerk waited in desperate need of root canal surgery. A former auto mechanic came with an aching back. One by one, about 1,500 people made their way through the Inglewood sports arena, where dozens of volunteer doctors, dentists, nurses and other healthcare professionals are providing free medical services this week. Remote Area Medical Foundation is a trailer-equipped service that has staged health clinics in rural parts of the United States, Mexico and South America.

Taxing tobacco is cowardly. When politicians do it, they mostly hit the poor and the powerless. I've written that for a decade and I'm still writing it. That acknowledged, I believe it's time to raise the tobacco tax. Raise it by a hefty amount. Be a bully. It's cowardly because smokers are sitting ducks -- unlike billionaires, big corporations, labor brotherhoods and other political investors, er, campaign contributors. But there's no stomach for raising broad-based taxes -- income, sales, vehicle -- at least among Gov. Arnold Schwarzenegger, Republican legislators and apparently the voters.

At first glance, this city of 45,000 looks like so many others, a spiral of ranch homes, shopping centers and chain stores. But to healthcare reformers, Grand Junction, Colo., is the land of innovation -- a place that provides high-quality healthcare at a fraction of the regular price. The local HMO offers prenatal care to all women in the county. Doctors evaluate themselves partly on the cost-effectiveness of treatments they prescribe. Nurses often check on patients home from the hospital to help prevent relapses.

A Torrance hospital held a baby shower this week for an unlikely addition: A 7-pound robotic baby named Simantha. The $35,000 baby "born" May 30 will serve as an educational tool for students and staff members in the clinical skills lab at Torrance Memorial Medical Center. Simantha joins three robotic adults: Stan D. Ardman (a play on the phrase "standard man"), Brittnay and Jake, who is called Jessica when staff members use her as a female. John Edwards, the clinical skills simulation technician who runs the lab and maintains the robots, was beaming like a proud father at the baby shower, he said.

An implantable device that shocks an erratically beating heart and works to keep both ventricles beating synchronously reduced hospitalizations for heart failure by 41%, according to results reported Tuesday at the European Society of Cardiology Congress in Barcelona, Spain. The results, reported online in the New England Journal of Medicine, were significantly better than preliminary results announced in June, when the trial was halted prematurely because of its success. "This is a real breakthrough" for patients with mild to moderate heart disease, said Dr. Leslie Saxon, a cardiologist at USC's Keck School of Medicine, one of the study sites.

Not all sick patients are expensive. At 82, Bettie Lowden is about as chronically ill as they come. In addition to heart failure, she has diabetes and a history of heart attacks and strokes. Yet Medicare spends less than $1,000 a month on her care, or about half the agency's outlay for the average congestive heart failure patient for hospitalizations alone. Lowden belongs to Cerritos-based CareMore Health Plan Inc., a private Medicare Advantage contractor. Medicare pays CareMore a set monthly fee of $700 to $950 per patient.