Health care to all Americans...What's in, what's out in the nation's health plan

Six years ago, candidate Barack Obama stood before Iowa voters and unveiled a plan designed to extend health care to all Americans.

"We can do this," he said with confidence. "The time has come for universal, affordable health care in America."

Three years ago,
President Barack Obama signed into law a plan designed to extend coverage to more than 30 million uninsured people.

"This is what change looks like," he exulted.

Not so fast.

Obama's message now boils down to this: Be patient, not yet, adjust your expectations.

A look at how the scope of Obama's health-care plan has narrowed in recent years:

PUBLIC OPTION? Never mind.

Obama once trumpeted the idea of providing a public option in health care, in essence a government-run plan that would be one of many choices for people seeking affordable care. That idea, popular with liberals but opposed by conservatives and many moderates, never made it into the health-care law. In the quest for a workable compromise, Obama deemed it expendable.

LONG-TERM CARE INSURANCE? Buh-bye.

When the president signed his health-care plan into law, it included a proposal to provide basic long-term care insurance at an affordable cost. Before the program ever got off the ground, though, the administration ditched it last spring for fear it would turn into a financial drain. It could take be years before lawmakers to tackle the issue again.

COVERAGE FOR THE NEEDIEST? Not in every state.

The law envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. But the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan. Because of Republican opposition in many states, it looks like nearly 2 in 3 of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.

WHAT ABOUT WORKERS? A longer wait.

The law requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk a series of escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1, 2014. But now the administration is pushing that requirement back a year, citing the complexity of the undertaking. Most medium and large business already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.

WHAT'S LEFT? Plenty.

Starting next year individuals will be required to carry health insurance or face fines. People who are uninsured will be able to shop for affordable coverage through online marketplaces. Middle-class people who don't have coverage through their jobs will use the marketplace to apply for tax credits to help pay their premiums. Low-income people will be steered to the Medicaid expansion — if their state participates. Insurance companies will be required to accept people regardless of their medical problems. A number of other changes already have taken effect, including a provision that allows young adults to stay on their parents' insurance until age 26 and a ban on lifetime limits on insurance coverage.

MORE...

Even though some firms won't have to offer insurance next year, workers can still get it.

The sudden delay of a major part of President Obama's historic health-care overhaul is raising questions about other potential problems lurking in the homestretch.

The requirement that many employers provide coverage is just one part of a complex law. But its one-year postponement has taken administration allies and adversaries alike by surprise.

White House officials said Wednesday that the delay was firm and would not be extended after a year - and that the overhaul will still be fully implemented by the time Obama leaves office. But the officials, who were not authorized to discuss internal deliberations on the record and spoke only on condition of anonymity, wouldn't rule out delays or tweaks to other provisions.

The White House action means that some companies that would have offered health insurance next year to avoid fines will not do so now. They're mainly firms with many low-wage workers, such as restaurants, hotels and temporary staffing companies.

The workers, however, will still be able to get coverage. Many may qualify for subsidized insurance through new marketplaces to debut Oct. 1, less than three months away.

The fact that new problems are popping up at this late stage could be a sign of additional troublesome issues ahead. It underscores a recent warning by the Government Accountability Office that the "timely and smooth" rollout of the new insurance markets can't be guaranteed, partly because much of the technology to run them hasn't been fully tested.

The timing of the announcement was also widely mentioned.

"It's understandable that when you announce a change in the law just before the Fourth of July holiday, it raises questions," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "Critics will jump on it and use it as more ammunition against the law."

The foundation is a research group that has closely followed the evolution of the health law since it was signed in 2010.

The development was seen as noteworthy by both critics and allies of the new law.

"We are concerned that the delay further erodes the coverage that was envisioned," said Rich Umbdenstock, president of the American Hospital Association, which has supported the Affordable Care Act.

Just over a week ago, Health and Human Services Secretary Kathleen Sebelius officially launched the 100-day countdown to the new insurance markets. Uninsured Americans in all 50 states and Washington, D.C., will be able to shop online for health plans, and most will get government subsidies to pay their premiums for coverage that takes effect Jan. 1.

White House senior adviser Valerie Jarrett wrote in her blog that the administration is "on target" to open the new health insurance markets and it's "full steam ahead."

What Are The Benefits Of Vitamin D?What Is Vitamin D?

Vitamin D is a steroid vitamin, a group of fat-soluble prohormones, which encourages the absorption and metabolism of calciumand phosphorous. People who are exposed to normal quantities of sunlight do not need vitamin D supplements because sunlight promotes sufficient vitamin D synthesis in the skin. 

Five forms of vitamin D have been discovered, vitamin D₁, D₂, D₃, D₄, D₅. The two forms that seem to matter to humans the most are vitamins D₂ (ergocalciferol) and D₃(cholecalciferol). 

Researchers at the University of Minnesota found that Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success, suggesting a possible role for vitamin D in weight loss.

Data collected from the National Health and Nutrition Examination Survey (NHANES), USA found that 9% (7.6 million) of children across the USA were vitamin D deficient (defined as less than 15 ng/mL of blood), while another 61 percent, or 50.8 million, were vitamin D insufficient (15 to 29 ng/mL) (reference "We expected the prevalence of vitamin D deficiency would be high, but the magnitude of the problem nationwide was shocking," says lead author Juhi Kumar, M.D., M.P.H., a fellow in pediatrics at Children's Hospital at Montefiore Medical Center, The University Hospital and Academic Medical Center for Albert Einstein College of Medicine. 

Vitamin D for humans is obtained from sun exposure, food and supplements. It is biologically inert and has to undergo two hydroxylation reactions to become active in the body. The active form of vitamin D in the body is called Calcitriol (1,25-Dihydroxycholecalciferol). 

Calcitriol promotes the absorption of calcium and phosphorus from food in the gut and reabsorption of calcium in the kidneys - this increases the flow of calcium in the bloodstream. This is essential for the normal mineralization of bone and preventing hypocalcemic tetany. Hypocalcemic tetany is a low calcium condition in which the patient has overactive neurological reflexes, spasms of the hands and feet, cramps and spasms of the voice box (larynx). Calcitriol also plays a key role in the maintenance of many organ systems.

Various forms of vitamin D

We know about 5 forms of vitamin D, of which vitamins D₂ and D₃ are the major forms as far as humans are concerned. They are known collectively as calciferol.

• Vitamin D₁, molecular compound of ergocalciferol with lumisterol.


• Vitamin D₂, ergocalciferol (made from ergosterol).
  
  It is produced by invertebrates (animals without a spine, vertebral column), fungus and plants in response to sunlight (UV irradiation). Humans and other vertebrates do not produce vitamin D₂. We don't know much about what vitamin D₂ does in invertebrates. We know that ergosterol is a good absorber of ultraviolet radiation which can damage DNA, RNA and protein; consequently many scientists believe it may serve as a sunscreen that protects organisms from sunlight damage.


• Vitamin D₃, cholecalciferol (made from 7-dehydrocholesterol).
  
  Vitamin D₃ is made in the skin when 7-dehydrocholesterol reacts with ultraviolet light at 270-300 nm wavelengths - peak vitamin D₃ production occurs between 295-297 nm. It is only when the UV index is greater than 3 that these UVB wavelengths are present.
  
  A UV index of more than 3 occurs every day in the tropics, every day during some of spring, all of summer, and parts of autumn in temperate areas, and hardly ever at all in the arctic circles. Temperate regions are all regions outside the tropics and arctic circles. The number of days of the year when the UV index is greater than 3 become fewer the further you move away from the tropics.
  
  A human requires ten to fifteen minutes of sun exposure at least twice a week on the face, arms, hands, or back without sunscreen with a greater than 3 UV index for adequate amounts of vitamin D₃. Longer exposure results in the extra vitamin supply being degraded as fast as it is generated.


• Vitamin D₄, 22-dihydroergocalciferol.


• Vitamin D₅, sitocalciferol (made from 7-dehydrositosterol).

Which is more important for humans, vitamins D₂ or D₃?

Both vitamins D₂ and D₃ are used in human nutritional supplements. Pharmaceutical forms include calcitriol (1alpha, 25-dihydroxycholecalciferol), doxercalciferol and calcipotriene. The majority of scientists state that D₂ and D₃ are equally effective in our bloodstream. However, some say that D₃ is more effective. Animal experiments, specifically on rats, indicate that D₂ is more effective than D₃.

What do we need vitamin D for?

• It is crucial for the absorption and metabolism of calcium and phosphorous, which have various functions, especially the maintenance of healthy bones.


• It is an immune system regulator.


• It may be an important way to arm the immune system against disorders like the common cold, say scientists from the University of Colorado Denver School of Medicine, Massachusetts General Hospital and Children's Hospital Boston.


• It may reduce the risk of developing multiple sclerosis. Multiple sclerosis is much less common the nearer you get to the tropics, where there is much more sunlight, according to Dennis Bourdette, chairman of the Department of Neurology and director of the Multiple Sclerosis and Neuroimmunology Center at Oregon Health and Science University, USA.


• Vitamin D may have a key role in helping the brain to keep working well in later life, according to a study of 3000 European men between the ages of 40 and 79.


• Vitamin D is probably linked to maintaining a healthy body weight, according to research carried out at the Medical College of Georgia, USA.


• It can reduce the severity and frequency of asthma symptoms, and also the likelihood of hospitalizations due to asthma, researchers from Harvard Medical School found after monitoring 616 children in Costa Rica.


• It has been shown to reduce the risk of developing rheumatoid arthritis in women.


• A form of vitamin D could be one of our body's main protections against damage from low levels of radiation, say radiological experts from the New York City Department of Health and Mental Hygiene.


• Various studies have shown that people with adequate levels of vitamin D have a significantly lower risk of developing cancer, compared to people with lower levels. Vitamin D deficiency was found to be prevalent in cancer patients regardless of nutritional status, in a study carried out by Cancer Treatment Centers of America.


• High vitamin D doses can help people recover from tuberculosis more rapidly, researchers reported in September 2012 in the Proceeding of the National Academy of Sciences (PNAS).


• An additional study published in September 2012 suggested that low levels of vitamin D may increase the risk of heart attack and early death.

A study published in JAMA in October 2012 found that vitamin C does not help reduce how often or how severely we catch colds.

Sunlight and vitamin D requirements

If you live in the tropics and can expose your unprotected skin to two sessions of 15 minutes of sunlight each week your body will naturally produce adequate amounts of vitamin D. The following factors may reduce your body's vitamin D synthesis:

• If you live far from the equator, your sunlight exposure will be less during many months of the year.
• Cloud cover
• Smog
• Sunscreens

If your body cannot produce enough vitamin D because of insufficient sunlight exposure you will need to obtain it from foods and perhaps supplements. Experts say that people with a high risk of vitamin D deficiency should consume 25 μg (1000 IU) of vitamin D each day so that there is a good level of 25-hydroxyvitamin D in the bloodstream. Elderly people, as well as people with dark skin should consume extra vitamin D for good health. 

Vitamin D levels in women in winter - women with arthritis, diabetes and some other chronic conditions are much more susceptible to drops in vitamin D levels during the winter months, researchers from Vanderbilt University Medical Center in Nashville, Tenn., reported at the 2012 American Society of Clinical Pathology Annual Meeting. They added that doctors should become aware of this and help these patients maintain adequate levels of vitamin D during the winter season.

How much vitamin D do I need?

The information below relates to people who do not have exposure to sunlight. 

According to the Food Nutrition Board at the Institute of Medicine of The National Academies, which created the Dietary Reference Intakes (DRIs), people should be intaking the following amounts of vitamin D if nothing is being synthesized (no sunlight exposure):

• Children up to 13 years - 5 mcg (200 IU)
• 14-18 years - 5 mcg (200 IU)
• 19-50 years - 5mcg (200 IU)
• 51-70 years - 10 mcg (400 IU)
• 71+ years - 15 mcg (600 IU)

The American Academy of Pediatrics recommends that exclusively or partially breastfed babies should receive supplements of 400 UI per day shortly after birth, and when they are weaned they should consume a minimum of 1,000 mL/day of vitamin D fortified formula or whole milk. Non-breastfed infants consuming less than 1,000 mL/day of vitamin D-fortified formula or milk should receive a vitamin D supplement of 400 IU per day. It also recommends that older children and adolescents who do not get 400 IU per day through vitamin D fortified milk and foods should take a 400 IU vitamin supplement each day.

Vitamin D and nutrition

Over the last few hundred years human lifestyles have changed. The industrial revolution resulted in more indoor work and less exposure to sunlight. Many societies around the world wore more clothing over the centuries, further reducing skin exposure to sunlight. These changes have brought with them a significant reduction in the natural production of vitamin D and subsequent diseases. 

Countries responded to these changes by fortifying some foods with vitamins D2 and D3, examples include breakfast cereals, bread, pastries, oil spreads, margarine, milk and other dairy products. Initially, some scientists complained that nutritional fortification and recommended supplementation doses were not making up for the shortfall. These people were ignored, and sometimes ridiculed - however, over the last few years studies indicate that they may have been right after all. 

Not that many foods contain vitamin D. Some fish, such as salmon, tuna and mackerel, as well as fish liver oils are considered to be the best sources. Some vitamin D is also present in beef liver, cheese and egg yolks. Most of these are Vitamin D3. Some mushrooms provide variable amounts of vitamin D2.

Most of the food sourced vitamin D in the western diet comes from fortified foods - where vitamin D is artificially added. Most US milk is fortified with 100 IU/cup of vitamin D. In the 1930s milk was fortified in many countries to combat rickets, which was a major health problem then.

Vitamin D levels in pregnancy protects mother but not baby from MS

Pregnant women, and women in general, have a lower risk of developing MS (multiple sclerosis) if their vitamin D levels are high. Researchers from Umeå University Hospital added that the developing fetus does not appear to receive the same protection if the mother's vitamin D levels are high. They reported their findings in the journal Neurology.

Study author, neurologist Jonatan Salzer, MD said:

Food and Nutrition

we all need adequate food and nourishment. Food, which is essential for survival and growth of human beings, can also lead us to many health risks if not chosen properly. But, before we discuss its beneficiaries and functions, let us define what is Food and Nutrition?

Food is made up of any substance, composed of carbohydrates, water, proteins, and fats either eaten or drunk by any animal, including humans to give energy or help build up the body for growth.

Nutrition is the process in which you consume food or nourishing liquids, digest and absorb them and use them for health and growth.
Also, Nutrition can be defined as a three-part process i.e. consumption, digestion and circulation of the food. The origin of the word ‘nutrition’ is linked to the Latin words ‘nutritionem and nutrire,’ meaning ‘’a nourishing’’ or ‘’to nourish, suckle.’’

As the saying goes, `we are what we eat, ` good nutrition plays a vital role in our wellbeing, helping to keep the mind and the body fit.

10 Healthy Eating Habits for the Holidays

Half of Americans' annual weight gain occurs during the holiday period? And despite our New Year's resolutions, studies show that some of that weight sticks around forever. I'd never tell you not to indulge on Thanksgiving and other special holidays, but don't throw out your healthy eating habits and let the next six weeks turn into a free-for-all. These tips on eating sensibly can help you savor holiday delicacies but still fit into your clothes come 2013.

1. Prepare for the office onslaught. Most American offices will be filled with boxes of chocolates and gift basket goodies over the coming weeks, so if you work in one, arm yourself with alternative healthy food options. "Stash your own snacks in your desk or the office fridge so you won't be tempted to grab a handful of holiday candy when hunger strikes," says Tanya Zuckerbrot, RD, author of The Miracle Carb Diet and founder ofthe F-Factor Diet. "Dried fruits and nuts, or a piece of string cheese or carrots are all healthy choices."
2. Remember, "If it's Thick, it will Stick." Zuckerbrot suggests you keep this mantra in mind—it's those high calorie condiments like gravy, butter and heavy dressings that can really jack up the calorie counts of holiday meals.
3. Load up on bod-friendly food first. When at a party or celebratory meal, fill up on healthy food options that are high in fiber before moving onto the more decadent eats. "For example, hover over the vegetable sticks, fruit, plain chicken pieces, and things like that. Then move on to some of the less healthy, but yummy, offerings," says Zuckerbrot. "You will be less likely to overindulge on these foods if you have already filled up on some of the healthier items." Same goes for Thanksgiving and other big holiday dinners: Make sure you've eaten plenty of salad and veggie sides before you go for a second helping of mashed potatoes.
4. Make red wine your drink of choice. If you like to toast the holidays with something stronger than seltzer, do it with red wine. Not only do piles of studies show that red wine is good for cardiovascular health, one released earlier this year found that (very moderate)red wine consumption may even help prevent breast cancer (this is major good news for wine-lovers like me, since women are usually told that any alcohol consumption raises breast cancer risk). But whatever you drink, keep in mind that alcoholic beverages usually contain about 150 calories per glass, and "avoid drinks made from mixes and frozen cocktails, like margaritas and daiquiris, and definitely say no to the eggnog," says Zuckerbrot.
5. Load up on spicy food. "Spices such as cinnamon, ginger, cayenne pepper, garlic, hot peppers, mustards and chili sauce are known to spike thermogenesis, the heat-producing effect of calories that raises metabolism," says Zuckerbrot. "Ginger for example, can boost metabolism by up to 20%, making pumpkin bread and gingerbread cookies great holiday treats."
6. Don't nibble while you cook. Too much "sampling" of food while you're preparing it can mean eating a whole meal's worth of calories before the big meal even starts!  This "Thanksgiving Cook Calorie Guide" slideshow over at CookingLight.com vividly shows how it can happen. 
7. Favor low-carb apps: "Instead of pigs in a blanket, which are 460 calories per serving, look for appetizers like chicken or beef kabobs, chicken satay or lean turkey meatballs, which are all less than 200 calories per serving," says Zuckerbrot. Similarly, approach the cheese plate by trying thin slices of firm cheese on their own rather than smearing brie onto slices of baguette. Crudites are always a good option, as long as you go easy on the dip. Shrimp cocktail is a better choice than crab cakes, points out Zuckebrot, since crab cakes contain fattening fillers and are often fried.
8. Stay trim with the right turkey. "White meat is lower in calories and saturated fat than dark meat, and provides a great source of lean protein," says Zuckerbrot.
9. Have a filet mignon feast.  Filet mignon is a leaner cut of beef than prime rib. "If prime rib is a holiday tradition in your home, it might just be time to start a new one. This cut of beef comes from the fattiest part of the cow, and one piece packs in a whopping 750 calories and 45 grams of fat," says Zuckerbrot.  "Instead, try filet mignon—a 4 ounce steak is only 180 calories and 8 grams of fat."
10. Pick pumpkin over pecan. I love me some pecan pie, but can't deny that pumpkin is a better choice for your bod.  "At 500 calories and 37 grams of fat, pecan tops the list of worst pies out there," says Zuckerbrot. While the nuts do contain some heart-healthy monounsaturated fat, the filling is chock full of butter and corn syrup. "Pumpkin pie has 316 calories and 14 gram fat per slice, plus pumpkin is a good source of fiber and vitamins A and C," she says.

But perhaps the most important tip on eating healthy at the holidays is this: When you've overindulged at a celebration, do NOT make it an excuse to go into a downward spiral of gluttony that lasts for days or weeks. Resume your healthy eating habits starting at breakfast the next morning, and look forward to indulging a little at the next special occasion.

15-Minute Asian Tuna - Healthy Food Tip and Recipe

healthy food tip and recipe

Today's Recipe

If you don't know what to serve for dinner tonight ...

Our Quick Broil method of cooking is perfect for preparing seared tuna as tuna tastes best when not cooked through. The combination of tuna, shiitake mushrooms, and seasonings adds a wonderful Asian flavor to your Healthiest Way of Eating.

15-Minute Asian Tuna

Prep and Cook Time: 15 minutes

Ingredients:

4 6 oz tuna steaks

1 TBS fresh lemon juice

1 cup minced scallion

3 medium cloves garlic, pressed

1 TBS minced fresh ginger

2 cups thickly sliced fresh shiitake mushrooms (remove stems)

1 TBS chicken broth

1 cup fresh squeezed orange juice

2 TBS soy sauce

2 TBS chopped cilantro

salt and white pepper to taste

Directions:

Preheat the broiler on high and place an all stainless steel skillet (be sure the handle is also stainless steel) or cast iron pan about 5 inches from the heat for about 10 minutes to get it very hot.

Press garlic and let sit for 5 minutes to bring out its health-promoting benefits.

Rub tuna with lemon juice and season with a little salt and white pepper. Set aside.

Heat 1 TBS broth in a 10-12 inch stainless steel skillet on the stovetop. Healthy Sauté scallion, garlic, ginger, and mushrooms in broth for about 2 minutes, stirring constantly over medium heat.

Add orange juice and cook for another 2 minutes. Add soy sauce and cilantro.

Using a hot pad, pull out broiler pan and place tuna in hot pan and return pan to broiler. Keep in mind it is cooking rapidly on both sides, so it is done very quickly, usually in 2-3 minutes, depending on thickness.

Place tuna on plates and pour mushroom sauce over each piece. Or you can lay a bed of mushroom sauce on each plate and place tuna on top.

Serves 4

Serve with

Napa Cabbage Salad

Seaweed Rice..

Healthy Food Tip

If shellfish are bottom feeders and contain toxic chemicals, why do you include them among the World's Healthiest Foods?

In The World's Healthiest Foods book and WHFoods website, we have tried to limit the analysis of foods and food benefits to factors that have been documented in peer-reviewed, Western science research studies. I don't believe that's the only way to evaluate food, but it's the approach we were most comfortable with in constructing the list of the World's Healthiest Foods. When we looked at the published research on shellfish, we came to the conclusions that are presented in the book and on the website.

I'm especially concerned at the present time about the potential toxic residues found in virtually all fish and shellfish. But from a Western science research standpoint, there are also some well-documented benefits from shellfish. For example, the mineral selenium — so often deficient in the diet of American adults — is provided by shrimp in a concentration difficult to obtain from many other foods.

One type of shellfish that raises special concerns for me is shrimp. As of 2003, almost 90% of all shrimp consumed in the United States were imported from Asia and Latin America, with China, Vietnam, and Thailand serving as the three top suppliers. These shrimp imports totaled about 1.5 billion pounds! U.S. shrimp farms produce approximately 12 million pounds of shrimp each year, but that amount is less than 1% of the total shrimp imports. This huge imbalance between imported and domestically produced shrimp can be problematic due to problems with contamination in certain Asian fish farming operations and also with lack of sustainable practices on the part of many fish farming operations.

One website I like for identifying high-quality shrimp retailers and shrimp-serving restaurants is the Monterey Bay Aquariums' Seafood Watch. Their website address is: http://www.montereybayaquarium.org/cr/seafoodwatch.aspx. You can use their Seafood Guides and Visit our Restaurant Partners links to locate high-quality fish in the U.S., including shrimp and other commonly eaten shellfish. When it comes to purchasing shellfish — and all types of fish well — I also encourage you to ask your grocers, or fishmongers, or whoever is responsible for providing your fish, as many questions as necessary to get an idea about its overall quality and sustainability.