Category Archives: Moringa Oil

All about Moringa Oil

Moringa Oil For Better Skin And Hair

Generally utilized for food preparation and in other food preparations. Moringa oil has significant cosmetic value and is used in body and hair care as a moisturizer and skin conditioner. It can be used for perfume base as a fuel and for oiling machinery. Moringa oil can likewise be used to produce soap.

Post-summer hair makes me want to cry. Breakable, dry and split ends. My hair stylist wishes to cut it all off and make me start once again, however I can’t do it!

Fortunately, I’ve discovered a little bottle of happiness called Moringa Oil , which is also referred to as Ben Oil, and it’s working wonders on my hair!

Moringa oil is light and spreads quickly on the skin. You only require the smallest quantity. It is utilized for massage and aromatherapy applications.

Yes, you can also ingest it, and rub it on your face, which I’ve been doing this week too. My skin is SOFT and I feel RENEWED!

Moringa oil /Ben Oil is pressed from the seeds of Moringa oleifera , known variously as the horseradish tree, Ben Oil tree, or drumstick tree. The oil is characterized by an unusually long service life and a moderate, however enjoyable taste.

Moringa grows wild in India and Africa, but it is also being planted in plantations. It will grow in very poor soil in any temperate climate, so it can be grown in the Southern United States.

Moringa and its oil contains almost all of the Vitamins, minerals and amino acids that your body needs to survive and for that reason many feel that it could cure hunger and starvation worldwide.

I’m a Moringa oil believer!

Inside the new Dietary Guidelines: Fish and other seafood

There’s something, er, fishy about the new Dietary Guidelines for Americans 2010. Unlike the 2005 version, the newly updated edition of the federal government’s official guide to healthful eating lists increasing seafood intake among its key recommendations.

By “fishy,” I don’t mean suspicious. Besides being delicious, fish and shellfish, which together constitute “seafood,” can confer lasting health benefits.


How much?

8 oz. The amount of seafood most of us should eat each week. That’s two four-ounce servings, more than twice what most of us typically manage (3.5 ounces).

12 oz. The weekly amount recommended for women who are pregnant or breast-feeding.

4 oz. The amount of fish in a small can of tuna, which means an ordinary tuna sandwich gets you halfway to your weekly goal.


The benefits

Like red meat and poultry, fish provides the protein essential for maintaining healthy muscles and other tissues. Most of us get more than enough protein. What really makes fish worth eating are its omega-3 fatty acids. New research shows that these healthful fats may help prevent age-related macular degeneration, a disease that impairs vision. But their benefits extend far beyond that.

Heart health. Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), help prevent cardiovascular disease and sudden cardiac death. Penny Kris-Etherton, professor of nutrition at Penn State, says these healthful fats can reduce heart arrhythmia, the leading cause of sudden cardiac death. The effect can take hold mere weeks after a person adds more fish to his diet, she says. Omega-3s may also lower triglycerides and blood pressure and prevent blood clots that can cause stroke.

Child development. Omega-3 fatty acids contribute to fetal growth and brain development in early infancy, says Bethany Thayer, a spokeswoman for the American Dietetic Association. When women consume omega-3s – especially DHA – from at least eight ounces of seafood per week, the dietary guidelines say, their babies may have heightened visual and cognitive development.

Kris-Etherton adds that research shows kids who eat more fish may have slightly higher IQs than those who eat less. “A couple of IQ points, you question whether that can make a big difference,” she says. “But it might have some bearing on test-score results.”


How to eat more

Can it. For convenience, you can’t beat canned tuna and salmon (which also are good sources of Vitamin D and, if you buy the bone-in kind, calcium, Kris-Etherton says). Keep in mind, though, that if you limit yourself to these you’ll be getting more sodium than you need and missing out on the wide range of options in the fresh-seafood case.

Try milder fish.Don’t like fishy taste? Try mild-flavored fish such as cod, flounder, sole and tilapia, which take well to baking, poaching or steaming, Thayer says, more so than grilling. But she notes that these don’t deliver as big a dose of omega-3s as fattier fish.

Go beyond the fillet or steak. You can add fish to soups or salads, Thayer suggests. Get kids to eat more fish with homemade fish stripsor fish tacos. Or simply coat strips of cod or haddock in seasoned bread crumbs and bake them in the oven. Thayer herself is partial to salmon topped with fruit salsa. (You’ll notice that nobody suggests battering and frying, which adds unneeded calories and often unhealthful fat.)


Consumer concerns

Best for omega-3s. Some seafoods have more of these than others. The best are: salmon (wild and farmed) Pacific oysters, anchovies, herring, sardines, trout, and Atlantic and Pacific mackerel.

Mercury. Some people avoid fish for fear of consuming methyl mercury, which may harm the developing nervous system of an unborn baby or young child. Some fish contain more mercury than others, including large fish such as albacore tuna that “are great big and hang around the ocean a long time, eating smaller fish,” says Kris-Etherton.

Pregnant women in particular should steer clear of the top four mercury-containing fish: tilefish, shark, swordfish and king mackerel (also known as golden bass). As for tuna, the dietary guidelines say women who are pregnant or breast-feeding can eat any kind of tuna they like but should stick to no more than six ounces of white tuna per week because it contains more mercury.

Cholesterol. Shrimp is a “very lean source of protein,” Thayer says, but some people shy away because it is loaded with cholesterol. (It’s also lower in omega-3s than other seafood.) Thayer and Kris-Etherton agree that the science is fuzzy on how eating shrimp affects cholesterol levels in your body. American Heart Association guidelines call for consuming less than 300 mg per day of cholesterol; four ounces of shrimp deliver about 160 mg.

Safety and freshness. Cook fish until its internal temperature measures 145 degrees on a food thermometer, Thayer advises. Just checking to see if it’s flaky isn’t good enough. And the best way to tell whether fish is fresh is to give it a sniff. “If it smells fishy, it’s probably not fresh,” she says. “It should have just a faint smell of the sea.”

This column is part of a series about incorporating the Dietary Guidelines for Americans 2010 into your diet.

Type 2 diabetes surges in people younger than 20

Annie Snyder figured she’d be out of the pediatrician’s office in 30 minutes, tops. Then she’d head home, tuck the medical permission for YMCA summer camp in her bag and finish packing.

But that exam last summer wasn’t like any other she’d had in her 16-year, basically healthy life. Within minutes of learning the results from a urine test, she got two corroborating blood tests and was hustled off to Inova Fairfax Hospital. Lying on a gurney in the emergency room, she heard the word “diabetes” several times and knew from the urgent medical reaction that it was bad. Frightened and crying, she thought: “What have I done to myself?”

Doctors had discovered that Annie had Type 2 diabetes, a disease that is often linked to being overweight. She never made it to summer camp. By the time she came home from the hospital a week later, she knew how to inject herself with insulin and she knew that she’d have diabetes for the rest of her life.

As recently as the mid-1990s, Type 2 diabetes was almost exclusively a disease of adults. But apparently fueled by the childhood obesity epidemic, cases in people younger than 20 have ramped up from virtually zero to tens of thousands in the United States in little more than a decade. The children who have it are breaking new scientific ground: No one has any idea how they will fare over the course of a lifetime.

Annie says she was “most definitely overweight” at the time of her diagnosis, and she has already made major lifestyle changes to control the disease. By exercising and cutting back on carbohydrates, she has lost 12 pounds so far. She has reduced her need for insulin from several injections a day to just one each night, and she’s hoping that soon she’ll be able to put the needle aside and just use an oral drug, metformin.

Although she is the only person in her household with diabetes, Annie’s diagnosis triggered a family response. Her parents got rid of the dining room table and turned that space into an exercise room, complete with a bowl of apples and artfully arranged bottles of water at the door. Everyone exercises, including her 15-year-old brother, Stephen; everyone has given up sodas and snacks, everyone eats smaller portions.

“When I see my dad exercise, I know that I’ve helped get him motivated,” Annie says. “Before, exercise was a chore. I would sit and watch TV and eat snacks. Now, as soon as I come home, I put on my workout clothes.”


A disturbing trend

Today, about 3,700 Americans under the age of 20 receive a diagnosis annually of what used to be called “adult-onset” diabetes, according to the Centers for Disease Control and Prevention. That relatively small number makes it a rare disease in children, but it represents a trend with larger ramifications.

“In a little more than 10 years, the numbers went from nothing to something,” says Larry Deeb, a pediatric endocrinologist and past president of the medicine and science division of the American Diabetes Association. “And that’s something to worry about.”

Diabetes can cause a litany of medical woes, including heart disease, kidney failure, limb amputations and blindness. It costs the U.S. health-care system $174 billion a year, according to the National Institutes of Health.

Those statistics are grim enough when patients are in their 60s. When the diagnosis is made decades earlier, new fears are raised: Will these children suffer heart attacks in their 20s, need kidney dialysis in their 30s or go blind before they see their own children graduate from high school?

Because about 80 percent of Type 2 diabetes patients are overweight or obese, it’s not surprising that patients such as Annie ask if they’ve done this to themselves. But there are other risk factors that no one can control: family history, ethnicity (blacks, Hispanics and American Indians have higher rates of diabetes), genetics or a mother who had diabetes during her pregnancy. Instead of wallowing in regret, doctors suggest that young patients and their parents seize the opportunity for a crash course on how to improve their health.

“I used to wear a button that said ‘Stamp Out Guilt,’ ” says Fran Cogen, director of the Child/Adolescent Diabetes Program at Children’s National Medical Center. “I try to tell people that no one caused their diabetes. I emphasize that they can make changes now.”

Alarm bells are going off among those who study diabetes in children because of what they know about the adult version of the illness. More than 25 million Americans have diabetes (more than 90 percent have Type 2), according to the National Institute of Diabetes and Digestive and Kidney Diseases – but an additional 79 million have a condition called pre-diabetes, in which blood sugar levels are higher than normal but not as high as in diabetes.

Pre-diabetes isn’t a disease requiring medical treatment – it’s a wake-up call. A large national study showed that adults with pre-diabetes who lost 7 percent of their body weight reduced their risk of diabetes by 58 percent.

Officials are concerned that the number of children already identified as having Type 2 diabetes is just the tip of the iceberg. In a national study of 2,000 eighth-grade students from communities at high risk for diabetes, more than half of the kids were overweight or obese. Only 1 percent had diabetes – but almost a third of them had pre-diabetes, according to Lori Laffel, chief of the Pediatric, Adolescent and Young Adult Section of the Joslin Diabetes Center in Boston and a principal investigator on the study.

It’s crucial, she says, to find those children before their condition progresses to diabetes so that it can be reversed by lifestyle changes, without medication.


Making progress

If there is any good news in childhood diabetes, it is that pediatricians are starting to look for it.

“It’s in the news, and all over the medical literature,” says Susan Conrad, a pediatric endocrinologist at Inova Fairfax Hospital. “Pediatricians are on top of it.”

For example, sometimes children whose bodies are beginning to have problems regulating insulin develop a telltale dark, velvety rash around their necks. A decade ago, such a child might have been referred to a dermatologist. In addition, CDC guidelines suggest that a child with a family history of diabetes, or one whose weight is above the 85th percentile for age and sex should be screened, with blood and urine tests, for diabetes.

Family experiences made John Perrone of Winchester, Va., aware of diabetes and its consequences. John’s mother, who developed gestational diabetes during all three of her pregnancies, now has Type 2 diabetes. His mother’s aunt had diabetes, and by the time she died in her 70s, she was on dialysis, in a wheelchair, legally blind and had suffered two strokes.

John got a diagnosis of Type 2 diabetes four years ago, and he has worked hard ever since to keep the disease under control. He says he’s gone from an overweight 11-year-old to a husky but fit 15-year-old. He has progressed from needing insulin injections to keeping his glucose under control with oral medication, combined with healthful eating and a lot of exercise.

He has learned enough to want to teach other kids with the disease. As an Eagle Scout project, he has developed a PowerPoint presentation aimed at youngsters. He has translated medical terms, such as glucose and glucometer, into words they understand, such as sugar and meter. He has also wanted to simplify for kids the basics of weight loss, which is so crucial for diabetes control.

“It’s all about in and out, what you eat, how much you exercise,” he says. “Maybe if kids understand it better, they can do it.”

This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente.

Parenting an overweight child can be difficult

When it comes to helping an overweight or obese child slim down, parents routinely blow it, pediatric obesity experts say. Some resort to nagging or coercion, others put the child on a restricted diet, and still others issue sweeping bans against foods containing sugar or fat – tactics that are, at best, ineffective and, at worst, damaging.

Increased public attention to the problem of overweight – which affects one-third of Americans younger than 18 – has made more parents aware of the problem but has left them unsure of what to do. Should they intervene early, even in the preschool years, or keep quiet and practice a form of benign neglect, hoping that the baby fat will melt away as a child grows? At the same time, many parents are battling their own weight problems or hang-ups.

One Northern Virginia mother, who asked that her name be omitted because she wanted to protect her daughter’s privacy, said she found herself at a loss when her perenially chubby child grew visibly heavier than her middle school classmates. “I didn’t want to say the wrong thing and make her self-conscious, because she didn’t seem bothered by it. But I was definitely concerned this would be a problem, especially in high school,” the mother said.

“It’s not an easy place for parents to be at all,” said Eleanor Mackey, a clinical psychologist affiliated with the pediatric obesity clinic at Children’s National Medical Center in the District.

While some overweight children do slim down as they grow up, the likelihood decreases with age. An obese preschooler has an approximately 30 percent chance of becoming an obese adult, according to the Centers for Disease Control and Prevention, while an obese teenager has a 70 percent chance – 80 percent if one parent is obese.

Following are recommendations by pediatric obesity experts for parents concerned about what – and what not – to do.

The groundwork for obesity can be laid as early as infancy, said pediatrician Nazrat Mirza, who directs Children’s Hospital’s obesity clinic.

Many parents, she said, inadvertently overfeed infants, giving them six to eight ounces of formula or breast milk at a time, instead of the recommended three to four ounces. Others feed an infant every time the child cries – even though crying may be unrelated to hunger – or push food even after the baby has signaled he or she has had enough.

“People like fast-growing babies and regard a chubby baby as a healthy baby, but what they don’t realize is that they’re overriding innate metabolic cues,” Mirza said. Most babies and children younger than 4 or so instinctively know how much they need to eat. And insisting that children of any age finish everything on their plates can lead to habitual overeating, as can overly large portions.

Pediatrician Herschel Lessin, who practices in Poughkeepsie, N.Y., said that many parents misuse food as a reward or a bribe. “I have parents who buy their kids fast food five or six times a week,” said Lessin.

Adults, he said, commonly have skewed perceptions of children’s weight. “Parents worry way too much about a skinny kid and way too little about a fat kid,” Lessin observed.


Don’t focus on the scale

Too many parents zero in on the number on the scale – or proclaim that they want their child to lose a certain number of pounds – when they should be focusing on overall health.

“We really emphasize to the parents that the most important thing is to keep the focus on their child’s health, not their weight,” Mackey said. “The last thing we want is for parents to push weight dissatisfaction on kids and have kids feel bad about the way they look.” For a young child, these emotions, especially if combined with parental disapproval or disappointment, can be overwhelming.

Mackey said researchers have found that focusing specifically on weight loss rarely works for children and can trigger a vicious cycle in which distressed children turn to a reliable source of comfort: food.

Instead, she advises parents to say, “I really love you, and you have one body and one brain in this life, and I want you to take care of yourself,” and then discuss ways to be healthier, including an improved diet.

Hectoring a child can cause lasting harm. Mirza recalls the svelte mother who proclaimed, in front of her 5-year-old daughter, “She’s so obese.” The little girl burst into tears, lamenting that she was fat and ugly. “They had been hammering at her at home,” Mirza said.

Talking about a child’s weight in front of the child can “cause an over-focus on what the number means and on appearance,” said Washington nutritionist Elizabeth Davenport.

Davenport cautions that while parents need to be aware of a healthful weight, they shouldn’t overreact. Before a growth spurt or puberty, many children and preteens put on extra pounds, which come off as they mature. “It ends up evening out,” she said.


Forget special diets

Obesity experts see this often: An overweight child is put on a diet, while the rest of the family eats as it always did and high-calorie food remains in the house for thinner family members. Parents in such families sometimes protest that a skinny sibling should not be “penalized” by being denied chips or cookies or by having to drink nonfat milk, Mirza said.

But healthful eating is good for everyone, experts say, and should not be considered punishment.

“If it’s not adopted by the family, it’s not going to work” said Baltimore area pediatrician Daniel Levy, who founded the obesity task force of the Maryland chapter of the American Academy of Pediatrics. “You can’t ask a child to do something if you’re not willing to do it yourself.”

Imposing a special diet on one child, said Mackey, “is not sustainable. And children are very big into what’s fair.” Universal participation, she said, also “shows parents how hard it is.”

Parents who ban certain foods – sweets or french fries or pizza – are likely to find that the edict boomerangs. Such prohibitions can lead to hiding food or secret eating, which can mushroom into a full-blown eating disorder.

“These kids tend to go nuts when they’re around forbidden foods,” Mackey said. “One teenage girl told her mother, ‘I eat as much as I want when you’re not around because I never know when I’m going to get it again.’ ”


Learn basic nutrition

Endocrinologist David Ludwig, who directs the obesity clinic at Children’s Hospital Boston, said that many parents have major misconceptions about what constitutes a healthful diet.

“We regularly see parents who are well intentioned but have diets that have terrible nutritional quality,” said Ludwig, an associate professor at Harvard Medical School and author of a 2007 book entitled “Ending the Food Fight.” A surprising number of parents think that low-fat Twinkies or goldfish-shaped crackers and packaged macaroni and cheese are healthful, he said, even though they are laden with empty calories and minimal nutritional value. “There’s a lot of nutritional misunderstanding, much of it promoted by the food industry.”

Lessin, the Poughkeepsie pediatrician, cautions parents against giving their children juice (“sugar water”), soda (“a can a day is 15 pounds per year”) or fast food (“crack for toddlers”). If they want a child to lose weight, parents need to arm themselves with basic knowledge about proper nutrition, he said, adding, “There’s no magic.”


Emphasize activity

“A parent who says, ‘Go get some exercise’ while lying on the couch” is not likely to meet with success, Mirza said.

Kids are just as likely as adults to avoid exercise, but most value time with their parents, Davenport observed. So instead of telling a child to go out and play or get some exercise, do something together: Ride bikes, go for a walk or ice skating, or play ball.

“The first thing to do is to turn off the TV” and curb the widespread practice of putting a set in children’s bedrooms, Ludwig said. Studies have documented the common-sense observation that extended TV viewing and obesity are correlated. Kids who spend more than two hours per day watching TV or playing video games are more likely to be overweight than other children. And a 2009 report by the Kaiser Family Foundation found that nearly three-quarters of kids between 8 and 18 had a bedroom TV.


Don’t be the food police

“Do you really need another piece?”

It’s a question many parents have asked their overweight children; the desired answer is a foregone conclusion. Monitoring what an overweight child eats may be understandable, but it’s likely to ignite a battle for control.

Instead of saying, “That’s enough,” it’s preferable to ask a younger child, “Is there room in your stomach for more?” That teaches children to self-regulate and not rely on an external force that tells them to stop, Davenport noted.

In general it’s better for parents to refrain from commenting about how little – or how much – a child eats. Setting a good example, Mirza advised, is likely to be among the most effective anti-obesity strategies. “Small, sustainable change is our target,” she said.”Many times, we notice the child has become successful when the parents start to make changes.”

Surgeon general says obesity crisis should be addressed together

Since 1980, obesity rates have doubled in adults and more than tripled in children. The problem is even worse among black, Hispanic and Native American children. Nationwide, more than two-thirds of adults and more than one in three children are overweight or obese.

We see the sobering impact of these numbers in the high rates of chronic diseases such as diabetes, heart disease and other illnesses that are starting to affect our children. A study from the University of North Carolina School of Medicine reported that obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life.

Everyone has a role to play in the prevention and control of obesity. Mothers, fathers, teachers, business executives, child-care professionals, clinicians, politicians and government and community leaders: we must all commit to changes that promote the health and wellness of our families and our communities.

Change starts with the choices we make each day for ourselves and those around us. At the same time, there is a growing consensus that we, as a nation, need to create communities and environments where the healthy choices are the easy choices and the affordable choices.

The Surgeon General’s Vision for a Healthy and Fit Nation” is an attempt to change the national conversation from a negative one about obesity and illness to a positive one about being healthy and being fit. We need to stop bombarding Americans with what they can’t do and what they can’t eat. We need to begin to talk about what they can do to become healthy and fit.

For years now, we have encouraged Americans to eat more nutritiously, exercise regularly and maintain healthier lifestyles. But for people to do these things, Americans need to live and work in environments that support their efforts.

For example, children should be playing and having fun. However, we have to provide safe environments for them, such as clean and well-lighted parks, recreational facilities, community centers, and walking and bike paths. Healthy foods should be affordable and accessible. Increased consumer knowledge and awareness about healthy nutrition and physical activity will foster a growing demand for healthy food products and exercise options, dramatically influencing marketing trends.

We should remember that individuals are more likely to change their behavior if they have a meaningful reward – something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, can enjoy and can celebrate.

The real reward is optimal health, which allows people to embrace each day and live their lives to the fullest – without disease, disability or lost productivity.

We have an opportunity to make a difference in this public-health crisis of obesity and overweight. Working together, we can become a healthy and fit nation. Today I would like to ask for your help.

Benjamin, a family physician, is the surgeon general of the United States.

Doctors try new models to push health insurers aside

Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs. Now some medical practices are sidelining health insurers entirely, instead charging patients a moderate membership fee each month. The approach gets a nod in the health-care overhaul law. But not everyone agrees it’s the right way to go.

Seattle-based Qliance Medical Management’s three clinics typically charge a patient about $65 a month for unlimited access to the practice’s 12 physicians and nurse practitioners. (Fees vary depending on the level of service and the patient’s age.) Office appointments last up to an hour, and clinics have evening and weekend hours, with e-mail and phone access to clinicians as well. Routine preventive care and many in-office procedures are free; patients pay for lab work and other outside services “at or near” cost, and they get discounts on many medications.

The average $700 to $800 per patient that Qliance receives annually in membership fees is up to three times more than a doctor in a standard insurance-based practice might make per patient, says Norm Wu, the company’s president and chief executive. “So we can have a third the number of patients and get the same revenue per clinician, but with much less overhead,” he says. The approach, he says, allows Qliance to funnel more money into the care itself – through longer office hours, for example, or better diagnostic equipment.

Bruce Henderson joined Qliance when its first clinic opened in 2007. Although at the time he had health insurance through his job, Henderson, now 63, was soon laid off. Now he pays Qliance $79 a month for primary care and carries a catastrophic medical plan with a $10,000 deductible, for which he pays $225 a month.

Henderson has high blood pressure, high cholesterol and Type 2 diabetes. Working with his Qliance doctor, he switched to lower-cost medications and reduced his monthly out-of-pocket costs from $500 to $100. He goes in regularly for blood work and exams to keep his diabetes in check. Periodically he also has early skin cancers removed and last month was in three times for a cyst removal. “The doctors will sit there with you as long as you need them to,” he says. “They don’t rush in and out.”

A 2007 Washington state law encourages “innovative arrangements between patients and providers,” such as direct-pay primary care.

There are 15 other direct-pay practices in Washington state, according to a 2010 report to the legislature from the state’s insurance commissioner. Some are more conventional “concierge” practices, which are aimed at well-to-do patients, charging as much as $850 a month for personalized, high-touch services. But the biggest growth is in practices that charge fees in the $85 to $135 range, according to the report.

Although Washington state may be a hotbed of direct-pay activity, primary-care physicians in many other states are offering similar services. At Access Healthcare in Apex, N.C., for example, members pay $39 a month plus $20 per visit for unlimited primary-care services, says the practice’s founder, Brian Forrest. Having run the subscription-based practice for 10 years, he is now expanding and expects the first franchises to open this summer.

Forrest, a physician, says that half of his clients have insurance, with their typical copayments for primary-care visits averaging $35 to $50. “For lots of insured patients, it’s actually cheaper for them to see us,” he says.

Washington state’s representatives in Congress and its governor, Chris Gregoire (D), successfully pushed to involve direct-pay practices in the federal health-care overhaul. Under a provision in that law, insurers selling plans on the state-based insurance exchanges that will open in 2014 will be allowed to “provide coverage through a qualified direct primary care medical home plan . . . .”

As envisioned by Qliance, direct-pay practices like the one it operates will link to custom “wraparound” health insurance policies that would pick up where Qliance leaves off, providing specialist care, hospitalization and the like.

“What we’re inventing here is a new relationship between primary care and insurance,” says Garrison Bliss, chief medical officer for Qliance Medical Management. Patients would essentially have two monthly health-care fees: one that they’d pay to a doctor’s office for their primary care and another they’d pay to an insurer for all their other care. Providing better primary care should reduce insurance claims for emergency care and hospitalization down the road, Qliance’s Wu says.

This idea raises a host of questions, policy experts say, including how direct-pay primary-care practices could charge monthly fees for preventive care services that under the new law are supposed to be provided free.

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn’t work very well, Robert Berenson, a fellow at the Urban Institute, says “it doesn’t make any sense” to provide primary care outside the health insurance system. “This is not going to work for a lot of patients who can’t afford the out-of-pocket subscriptions.”

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail questions@kaiserhealthnews.org

Medigap supplemental coverage can be too pricey for younger Medicare beneficiaries

One night three years ago, Joe Hobson finished reading a book, went to sleep and woke up blind. The problem, caused by a rare hereditary disease, forced him to give up his 20-year communications job, along with its generous health insurance. Now 63, the Arlington man is covered by Medicare, the federal program for elderly and disabled Americans.

Like many people with Medicare, Hobson would like to buy supplemental, or Medigap, insurance to help cover his out-of-pocket costs, such as co-payments and deductibles. But Medigap prices can be prohibitive for disabled beneficiaries younger than 65. The cheapest plan for such people in Northern Virginia costs $338 a month, according to Brad Rothermel, an Annandale insurance agent who has helped Hobson look for a policy. That’s three times the premium of a plan with much better benefits that is available to a 65-year-old. And the private insurers that offer Medigap policies are free to reject Hobson or charge him extra because of his preexisting health conditions.

Federal Medigap rules generally prohibit insurers from rejecting applicants or charging them higher premiums because of preexisting conditions, as long as they apply within six months of turning 65 and getting Medicare coverage for doctor visits and other outpatient services, says Peter Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Services. However, when Congress created this protection in 1992, he says, it exempted disabled Medicare beneficiaries under 65, a group that now totals 8 million people.

“There’s something not right here,” says Hobson, whose living expenses consume all of the income he receives under the Social Security program for disabled people.

People such as Hobson have good reason to be concerned, says Bonnie Burns, a policy specialist with California Health Advocates, a nonprofit organization. She is also a member of a federally established working group that updates Medigap rules when Congress makes changes.

Because there is no annual cap on Medicare out-of-pocket costs, Burns says, there’s no limit to how much beneficiaries might be required to pay if they get very sick or have a very expensive medical condition. “It makes sense to buy Medigap insurance to mitigate that possibility,” she says.

Last year’s federal health-care overhaul does not address this issue. A provision to provide disabled Medicare beneficiaries better coverage was dropped from the legislation during congressional negotiations because it would have increased Medicare costs, according to a House Democratic congressional aide.

In the absence of federal rules, 29 states, including Maryland, require insurers to sell at least one kind of Medigap plan to anyone who applies. (Virginia and the District do not.) Of the states that guarantee Medigap plans, most allow companies to charge higher rates to disabled applicants younger than 65. But if such people apply for a Medigap policy when they turn 65, insurers cannot charge higher premiums based on preexisting health conditions.

“When you are disabled and 65, you’re the same as any other Medicare beneficiary,” says Leta Blank, the Montgomery County director of Maryland’s Senior Health Insurance Assistance Program.

As for Hobson, he isn’t easily discouraged. A volunteer with the National Federation of the Blind, he has helped organize the Virginia chapter’s convention. He is passionate about “talking” computers and other adaptive technology for blind people.

Last fall, Hobson sought help from John Glowacky and Cedar Dvorin, counselors at the Virginia Insurance Counseling Assistance Project, a program for Virginians with Medicare. Hobson’s income and assets disqualify him for Medicaid, the insurance program for low-income people, Glowacky says.

He could get a Medicare Advantage policy, but these private, managed-care plans require patients to go to health-care providers who are part of the plan’s network or pay extra for out-of-network care. Glowacky says most of his clients are reluctant to end a long-term relationship with a doctor.

Hobson could go without additional insurance, “but if something catastrophic happens, you’re on the hook,” Glowacky says. “You don’t buy homeowners insurance the day your house burns down.”

Hobson decided to take that gamble and hope for the best, until his 65th birthday in July 2012. “When I turn 65,” he says, “I will be able to get a Medicare supplemental plan with a simple phone call.”

This article was produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.