Why imposing Medicaid-style rebates in Part D is a bad idea

We’ve talked a lot about how repealing the non-interference clause in Medicare Part D would negatively impact beneficiaries. But there are other proposals to fundamentally alter the structure of Part D that would cause just as much harm to beneficiaries. Today, let’s look at one: Imposing mandatory Medicaid-style rebates on low-income utilization in Part D.

Imposing Medicaid-style government price setting in Part D would raise beneficiary premiums and could limit access to needed medicines through higher cost sharing and narrower formularies. It could even curtail investment in research and development needed to discover new treatments, costing jobs that are supported by the biopharmaceutical industry. The nonpartisan Congressional Budget Office found that a Medicaid-style rebate in Part D would reduce incentives to create new medicines, “particularly drugs for which a large share of users would be Medicare beneficiaries.” This could stifle potential breakthrough discoveries to treat Parkinson’s, arthritis, osteoporosis and other diseases that disproportionately affect the elderly.
Those who support this policy frequently overlook the robust competition and negotiation that already exists in the program. Evidence shows that Part D plans receive an average 35.3 percent discount from manufacturer list prices in key therapeutic areas, including supply chain discounts and negotiations with Part D plans. On top of that, the Medicare Trustees consistently confirm that rebates negotiated for brand medicines in Part D are substantial and that average rebate levels have increased each year of the program.
In case you missed it, nearly 400 groups across the health care industry sent a letter to Congress last session opposing this exact proposal.

Since its creation, Part D has provided beneficiaries with affordable access to comprehensive prescription drug coverage. Undermining the program’s competitive structure and increasing costs for beneficiaries would be a step in the wrong direction. 

5 of the best exercises you can ever do

If you're not an athlete or serious exerciser — and you just want to work out for your health or to fit in your clothes better — the gym scene can be intimidating and overwhelming. What are the best exercises for me? How will I find the time?
Just having to walk by treadmills, stationary bikes, and weight machines can be enough to make you head straight back home to the couch.
Yet some of the best physical activities for your body don't require the gym or ask you to get fit enough to run a marathon. These "workouts" can do wonders for your health. They'll help keep your weight under control, improve your balance and range of motion, strengthen your bones, protect your joints, prevent bladder control problems, and even ward off memory loss.
No matter your age or fitness level, these activities are some of the best exercises you can do and will help you get in shape and lower your risk for disease:

1. Swimming

You might call swimming the perfect workout. The buoyancy of the water supports your body and takes the strain off painful joints so you can move them more fluidly. "Swimming is good for individuals with arthritis because it's less weight-bearing," explains Dr. I-Min Lee, professor of medicine at Harvard Medical School.
Research has found that swimming can also improve your mental state and put you in a better mood. Water aerobics is another option. These classes help you burn calories and tone up.

2. Tai chi

This Chinese martial art that combines movement and relaxation is good for both body and mind. In fact, it's been called "meditation in motion." Tai chi is made up of a series of graceful movements, one transitioning smoothly into the next. Because the classes are offered at various levels, tai chi is accessible — and valuable — for people of all ages and fitness levels. "It's particularly good for older people because balance is an important component of fitness, and balance is something we lose as we get older," Dr. Lee says.
Take a class to help you get started and learn the proper form. You can find tai chi programs at your local YMCA, health club, community center, or senior center.

3. Strength training

If you believe that strength training is a macho, brawny activity, think again. Lifting light weights won't bulk up your muscles, but it will keep them strong. "If you don't use muscles, they will lose their strength over time," Dr. Lee says.
Muscle also helps burn calories. "The more muscle you have, the more calories you burn, so it's easier to maintain your weight," says Dr. Lee. Similar to other exercise, strength training may also help preserve brain function in later years.
Before starting a weight training program, be sure to learn the proper form. Start light, with just one or two pounds. You should be able to lift the weights 10 times with ease. After a couple of weeks, increase that by a pound or two. If you can easily lift the weights through the entire range of motion more than 12 times, move up to slightly heavier weight.

4. Walking

Walking is simple, yet powerful. It can help you stay trim, improve cholesterol levels, strengthen bones, keep blood pressure in check, lift your mood, and lower your risk for a number of diseases (diabetes and heart disease, for example). A number of studies have shown that walking and other physical activities can even improve memory and resist age-related memory loss.
All you need is a well-fitting and supportive pair of shoes. Start with walking for about 10 to15 minutes at a time. Over time, you can start to walk farther and faster, until you're walking for 30 to 60 minutes on most days of the week.

5. Kegel exercises

These exercises won't help you look better, but they do something just as important — strengthen the pelvic floor muscles that support the bladder. Strong pelvic floor muscles can go a long way toward preventing incontinence. While many women are familiar with Kegels, these exercises can benefit men too.
To do a Kegel exercise correctly, squeeze the muscles you would use to prevent yourself from passing urine or gas. Hold the contraction for two or three seconds, then release. Make sure to completely relax your pelvic floor muscles after the contraction. Repeat 10 times. Try to do four to five sets a day.
Many of the things we do for fun (and work) count as exercise. Raking the yard counts as physical activity. So does ballroom dancing and playing with your kids or grandkids. As long as you're doing some form of aerobic exercise for at least 30 minutes a day, and you include two days of strength training a week, you can consider yourself an "active" person.


For additional information on this and other questions about getting started on a healthy exercise program, read Starting to Exercise, a Special Health Report from Harvard Medical School.

How Much Water Is in Your Diet?

How Much Water Is in Your Diet?

Drinking liquids isn't the only way to stay hydrated. You typically get about 20% of your water each day from food. You can get even more if you eat certain things. And there are benefits to taking in water through food: You absorb it more slowly and get nutrients along the way.

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Cucumbers

They’re 95% water and low in calories. They also may help fight inflammation and might even slow the aging process. They’re great in a salad or as an edible scoop for dips.

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Carrots

This one may be a surprise. Crunchy and dense, you wouldn’t think they’re full of water. But they are, around 90%. And they’re loaded with beta carotene and other antioxidants that protect you against cancer and keep your heart strong. Add them to a salad or have them as a snack.

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Zucchini

This green squash that grows like a weed in the South is 95% water. It has antioxidants -- things that help protect your cells from damage -- including two that are good for your eyes. It’s great grilled or roasted in the oven.

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Iceberg Lettuce

It’s 95% water, and while it has fewer nutrients than some other greens, it does give you a few things. Besides fiber -- which helps keep you regular -- it also delivers potassium, manganese, iron, calcium, magnesium, and phosphorous -- all essential minerals that can help keep you healthy.

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Spinach

Here’s a green leafy veggie that can be used raw in a salad or sauteed as a side dish. It doesn’t have quite as much water as iceberg lettuce, but it’s loaded with vitamin K, folate, manganese, and magnesium, plus antioxidants that help fight inflammation and cancer.

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Celery

It has a satisfying crunch and is still 95% water. It’s also low in calories and high in vitamin K, folate, and potassium. And celery is good for digestion because it has lots of fiber and helps prevent inflammation in your digestive system.

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Cauliflower

You may not have thought of this one, but it’s 92% water. It’s also rich in vitamin C, vitamin K, and other essentials. And it has other nutrients that may help lower cholesterol and protect you against cancer. But don’t boil it -- roast it to keep in the nutrients.

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Soup

No surprise here: The whole idea of soup is that it’s largely liquid. But it’s a great way to get fiber and nutrients as well -- and there’s one for every taste. Make broth from fish, chicken, or vegetables, and add almost anything to it, from beans to greens and meats -- even pasta. Homemade chicken soup is not only good for hydration, but it also might help fight the common cold.

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Tomatoes

They’re 95% water, and they can add flavor and sweetness to a sandwich or salad. They have lots of antioxidants, including one called lycopene that may help fight cancer. They also can help lower “bad” cholesterol (LDL) and may boost your overall heart health.

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Watermelon

This summer treat is a good way to stay hydrated when it’s hot. It’s sweet, but low in calories, and can quench your thirst, thanks to its 91% water content. Like tomatoes, it has lots of lycopene, an antioxidant that may protect your cells from sun damage and help your skin.

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Strawberries

They’re 91% water and also have lots of antioxidants, especially flavonoids -- chemicals that help your brain stay sharp and healthy. Eat them for dessert with a bit of whipped cream, or put them in a summer salad.

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Yogurt

It’s 85% water and a great source of protein and electrolytes that make your heart and other organs work the way they should. It also has bacteria (probiotics) that are good for digestion and help keep you regular. Have some with a few strawberries to get even more water in your afternoon snack.

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Oatmeal

Made with water or low-fat or skim milk, it can help keep you hydrated and give your heart a boost. It can lower your cholesterol levels and may even help ward off type 2 diabetes and breast cancer. It’s a healthy way to start the day -- as long as you watch the added sugar.

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Grapefruit

That sour bite can sure wake you up in the morning. Plus, at 90% water, it will help keep your body hydrated. It’s also full of fiber and nutrients, especially vitamin C, which helps your immune system and can protect your cells against damage. But it can cause problems if you take certain medications, so check with your doctor first if you take any prescription drugs.

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7 Nutrients Your Diet May Be Missing

Chances are, you need more of seven nutrients discussed here. Many adults don't get enough of them.
You can fix that problem by following these simple steps for each nutrient.

1. Calcium

Why It’s Good for You: Your bones need it. So do your heart and other muscles. Studies have shown a link between getting enough calcium and lower blood pressure, as well as weight control.
How Much You Need: You need more calcium as you age, according to the Institute of Medicine, the group of experts that sets nutrient quotas. Here's what you need every day:

• Ages 19 to 50: 1,000 milligrams
• Ages 51 and up: 1,200 mg

How to Get More of It: Three servings of low-fat dairy foods each day, as part of a balanced diet, provide you with the calcium you need. If you have a dairy allergy or lactose intolerance, you can get calcium from calcium-fortified products, dark green leafy vegetables, nuts, and seeds.
Some examples of foods that provide around 300 milligrams of calcium per serving include:

• 8 ounces nonfat milk or nonfat plain yogurt
• 8 ounces calcium-fortified orange juice
• 1 1/2 ounces hard cheese
• 8 ounces calcium-fortified soy milk, almond milk, or another milk alternative

2. Fiber

Why It’s Good for You: Fiber is good for your digestion, lowering cholesterol, and managing blood sugar levels. It's filling, and it's found in foods that are low in calories, so it helps you manage your weight. Fiber can also help lower your LDL, or bad cholesterol, which could lower your risk of heart disease.
How Much You Need:

• Men ages 19 to 50: 38 grams; ages 51 years and older: 30 grams
• Women ages 19 to 50: 25 grams; ages 51 years and older: 21 grams

How to Get More of It:

• Include fruits and vegetables and high-fiber whole grains at every meal and beans several times a week.
• Snack on whole-grain crackers, fruit, vegetables, nuts and seeds (including natural-style nut butters) or popcorn (a whole grain) instead of cookies, candy, or chips.
• Choose whole-grain breads and cereals, whole wheat pasta, and other whole grains, such as quinoa, millet, barley, cracked wheat, and wild rice.
• Look for breads with more than 3 grams of fiber per slice. Go for cereals with 5 or more grams of dietary fiber per serving.
• Start a meal with a bean soup, such as lentil or black bean.
• Add canned, rinsed chickpeas, kidney beans or black beans to salads, soups, eggs, and pasta dishes.
• Although food sources of fiber are best, fiber supplements can help you get the daily amount of fiber you need. Examples include psyllium, methylcellulose, wheat dextrin, and calcium polycarbophil. If you take a fiber supplement, increase the amount you take slowly. This can help prevent gas and cramping. It’s also important to drink enough liquids when you increase your fiber intake.

3. Vitamin A : Essential Nutrient for Eyes

Why It’s Good for You: You need vitamin A for your vision, genes, immune system, and many other things.
How Much You Need: Vitamin A comes in two forms: as retinol (which is ready for the body to use) and carotenoids, the raw materials the body converts to vitamin A.
How to Get More of It: Make your diet colorful. Top picks include:

• Carrots
• Sweet potatoes
• Pumpkin
• Spinach
• Cantaloupe
• Sweet red pepper
• Broccoli
• Tomato

4. Potassium: Essential Nutrient for Nerves and Muscles

Why It’s Good for You: Potassium is present in every cell of your body. It plays a key role in maintaining muscles, nerves, and fluid balance. Potassium also promotes strong bones, and you need it for energy production. Getting enough potassium also hedges against high blood pressure.
How Much You Need: Men and women age 19 and older need 4,700 milligrams of potassium every day.

If you have high blood pressure, check with your doctor or pharmacist about the medications you take to control it. Some drugs, including certain diuretics, make you lose potassium, so you need to compensate for the loss.
How to Get More of It: These potassium-packed foods will help you meet your daily quota:

• 1 cup canned kidney beans: 607 milligrams
• 2 cups raw spinach: 839 mg
• Medium sweet potato, cooked: 694 mg
• 1 cup Greek yogurt: 240 mg
• 1 cup orange juice: 496 mg
• 1 cup cooked broccoli: 457 mg
• 1 cup cantaloupe: 431 mg
• 1 medium banana: 422 mg

5. Folic Acid

Why It’s Good for You: If there's a chance you'll become pregnant or are pregnant, this is particularly important. Folic acid is the synthetic form of the B vitamin folate. Once you conceive, folic acid and folate, the natural form, help protect your baby against neural tube defects (and possibly cleft lip or palate) during the first 30 days.

How Much You Need: Getting the recommended 400 micrograms of folic acid every day from supplements is a must for women who may become pregnant. (Many prenatal vitamins have as much as 800mcg.) Folate is important throughout pregnancy, too. It's involved in cell production and guards against a certain type of anemia. Pregnant women need 600 mcg.
How to Get More of It: In addition to taking a folic acid supplement, women who could become pregnant should eat folate-rich foods including:

• Breakfast cereals: 1 ounce equals 100-400 micrograms of folic acid
• Enriched spaghetti: 1 cup cooked equals 80 mcg folic acid
• Enriched bread: 2 slices equals 86 mcg folic acid
• Lentils: 1 cup cooked equals 358 mcg folate
• Spinach: 1 cup cooked equals 139 mcg folate
• Broccoli: 1 cup cooked equals 168 mcg folate
• Orange juice: 3/4 cup equals 35 mcg folate

6. Iron

Why It’s Good for You: Iron is responsible for transporting oxygen to cells and tissues throughout the body. It's important for women to get enough iron before and during pregnancy. Pregnancy is a drag on your iron supply and may cause iron-deficiency anemia in a new mom.
How Much You Need: Men need 8 milligrams per day of iron. Women need 18 milligrams per day from ages 19 to 50 (27 grams if they're pregnant) and 8 milligrams from age 51 on (because they are no longer losing iron through menstruation).
How to Get More of It: Animal sources of iron include:

• 3 ounces cooked beef: 3 milligrams
• 3 ounces cooked dark-meat turkey: 2 mg
• 3 ounces cooked light-meat turkey: 1 mg
• 3 ounces cooked chicken thigh: 1.1 mg
• 3 ounces cooked chicken breast: 0.9 mg
• 1 large hardboiled egg: 0.9 mg

Plant-based iron sources include:

• 1 cup fortified instant oatmeal: 10 milligrams
• 1 cup cooked soybeans: 8 mg
• 1 cup boiled kidney beans: 4 mg
• 1 cup edamame, cooked from frozen: 3.5 mg

Spinach, raisins, and beans are also good sources of iron. So are whole-grain cereals that have been enriched with iron. Keep in mind that the iron absorption rate from plant sources is lower than with animal sources of iron.

7. Vitamin D

Why It’s Good for You: Your skin makes vitamin D in response to sunlight, but its ability to do that depends on your age, skin color, and where you live. Some experts recommend getting vitamin D from your diet instead of relying on the sun.
How Much You Need: Current recommendations call for adults ages 19-70 to get 600 international units of vitamin D per day, and 800 IU per day starting at age 71.

How to Get More of It: Natural sources of vitamin D include fish and egg yolk. Vitamin D-fortified foods include milk, yogurt, some orange juice products, and some breakfast cereals. You may need a mixture of both food and supplements to get the vitamin D your body requires.

Choosing the Right Vitamins

Even with the best dietary intentions, we often fall short of meeting all our nutritional needs. One answer is a daily multivitamin, which is safe, effective, and can go a long way toward correcting any nutritional deficiencies.
Of course, the ideal way to get your nutrients is still from food. Food not only supplies vitamins and minerals, but also gives us fiber and a host of other healthy compounds, like phytochemicals and antioxidants, that interact with each other in ways that supplements can't.
The scientific community used to believe that a varied, healthful diet would provide all the vitamins and minerals we need. But recent surveys show that most American diets fall short of satisfying the minimum daily requirements for several vitamins and minerals. (Still, we rarely see actual deficiencies in the U.S., simply because we eat plenty of food.)

The culprit? Often, it's life in the fast lane -- chowing down on too much fast food and not enough fruits, veggies, whole grains, and low-fat dairy. Researchers have concluded that a single daily multivitamin/mineral pill may be the answer for achieving optimum health and preventing chronic diseases.

At the WebMD Weight Loss Clinic, we encourage everyone to take a daily multivitamin. This is especially important for people whose calorie prescription is less than 1,500 per day.
Under certain conditions -- for example, if you're pregnant or following a strict vegetarian diet -- you may need additional supplements. Check with your doctor or a registered dietitian for more information.

Nutritional Insurance

Approximately 40% of Americans take supplements, according to the third U.S. National Health Examination Survey. And the most popular supplement is the multivitamin.

One important point: a daily multivitamin supplements your diet; it's not intended to correct a bad diet. The benefit of a daily multi is that it can make up for minor deficiencies in your diet that could eventually help lead to chronic disease. In fact, a study published in the August 2003 Journal of Nutrition found that men and women who took multivitamins significantly reduced their risk for a first heart attack.
The body needs roughly 40 vitamins and minerals each day for good health, and it's not always easy to get all of those from food. Taking a daily multivitamin certainly won't hurt, even if your diet is already chock full of vitamins and minerals.

Too Much of a Good Thing

Taking individual vitamin or mineral supplements can be a bad idea; it's easy to overdose on certain nutrients that can be toxic in large amounts.
To help guide consumers, the government sets safe upper limits for most vitamins and minerals. So always read the label on the package, and keep in mind the food that you eat also contributes vitamins and minerals.
Keep in mind that some supplements you can find on the shelves contain herbs or other unnecessary ingredients that can be potentially harmful. Unlike drugs, supplements aren't required to undergo rigorous testing or get government approval, leaving the safety of these products up to the manufacturers.

The simplest and best way to meet your nutritional needs is to take one multi each day, unless your doctor prescribes specific vitamins or minerals. If you are taking more than a daily multi, discuss it with your doctor, just as you would any medication.

Choosing a Multivitamin

The easy part is deciding that a daily multivitamin is right for you; the challenge is selecting one from among the hundreds that line the drugstore shelves.
So before you buy, do a little comparison shopping. Bring along your reading glasses, and take a few minutes to review the percent of Daily Values (DV) for each nutrient the supplement contains.

To find the least expensive multivitamin supplement that still provides all the vitamins and minerals you need, keep these tips in mind:

• Avoid supplements that provide more than 100% of the DV for any vitamin or mineral.
• Choose a supplement with no more than 3,000-3,500 International Units (IUs) of retinol or vitamin A.
• Men and postmenopausal women should choose multivitamins with 50% or less of the DV for iron.
• Don't expect to find 100% of the DV for calcium or magnesium in a multivitamin. Adding these would make the pills very large.
• Look for the USP (United States Pharmacopeia) symbol, a mark of a quality product.
• Most additives, such as herbs, are unnecessary and just drive up the price of the supplement.
• Supplements designed for certain age groups or sexes tend to be pricier. You can usually find a similar formula in a generic brand.