Obama makes final appeal ahead of healthcare vote

US President Barack Obama has rallied the support of Democratic lawmakers on Capitol Hill ahead of a crucial vote on sweeping healthcare reform.

Urging them to back the measure in a House vote expected in the coming hours, he said: "Let's get this done."

Democratic leaders have spent days working to get the 216 votes needed to pass the highly-contested bill.

Democratic House Majority Leader Steny Hoyer said he believed the party now had the necessary support.

Senior House Democrats have decided on a direct vote to pass a Senate version of the reform bill, rather than using a procedural measure that would have "deemed" it passed without a vote.

Is this the single most important step that we have taken on health care since Medicare? Absolutely US President Barack Obama Full text of speech Q&A: US healthcare reform Your views on healthcare reform

And Democratic Senate Majority Leader Harry Reid assured House lawmakers he had the "commitment of a significant majority" in the Senate to pass the next stage of the legislation, amending that bill with changes the House wants.

However, Democratic leaders can't be certain of victory, says the BBC's Mark Mardell in Washington.

If passed, the reforms will deliver on Mr Obama's top domestic priority by providing insurance to some 32 million of the Americans who currently lack coverage.

The Republicans are unanimously opposed to the legislation, which they say is unaffordable and represents a government takeover of a large part of the country's economy.

In the party's weekly radio address, House Republican leader John Boehner criticised what he said were tax increases and cuts in some benefits to pay for the bill, saying: "This is not reform."

Protesters opposed to the Democrats' proposals demonstrated outside the Capitol building in Washington, waving placards and chanting "kill the bill".

'Tough vote'

Speaking to Democrats in Washington, Mr Obama said the vote would be the single most important step taken on healthcare since Medicare, which helps the elderly, was passed four decades ago.

Obama is trying to work the old magic, the ability to connect, that made him think he could be president in the first place Mark Mardell BBC North America editor Read Mark's thoughts in full

He told lawmakers: "I know it's a tough vote."

But he said he was confident that doing the right thing for the American people would end up "being the smart thing to do politically".

"Don't do it for me, don't do it for the Democratic Party, do it for the American people. They're the ones looking for action right now," he said.

The president has held dozens of meetings and phone calls in recent days with Democratic House members wavering over whether to back the bill or not.

It remains unclear exactly how many votes the party can count on.

Some lawmakers have called for tighter language in the bill to make sure no federal money can be used for abortions, while others are concerned about cost or say its reforms do not go far enough.

If the House passes this the president will sign it in to law, although it would still go to the Senate for more changes.

Deficit reduction

The House of Representatives and the Senate adopted different versions of the bill in November and December.

Opponents of the reform bill say it represents a government takeover

The usual procedure would be for two versions of legislation to be combined into a single bill for President Obama to sign into law.

But after Senate Democrats lost the 60-seat majority required to defeat a filibuster by Republicans, Democratic leaders decided to use a controversial procedure to ensure the bill's passage.

Under the plan, the House will vote on a package of reconciliation "fixes" amending the Senate bill.

The Senate will then be able to make changes in a separate bill using a procedure known as reconciliation, which allows budget provisions to be approved with 51 votes - rather than the 60 needed to overcome blocking tactics.

According to Congressional Budget Office, the final version of the Democrats' healthcare plan will cut the federal deficit by $138bn over 10 years.

The non-partisan body said the proposed legislation would cost about $940bn over a decade.

The reforms would increase insurance coverage through tax credits for the middle class and expansion of the Medicaid programme for the poor.

If approved, they would represent the biggest change in the US healthcare system since the creation in the 1960s of Medicare, the government-run scheme for Americans aged 65 or over.

US HEALTHCARE AND WORLD COMPARISONS

US expenditure on healthcare is the equivalent of about 16.2% of GDP - nearly twice that of some other OECD countries.

US HEALTHCARE AND WORLD COMPARISONS

The US falls behind some OECD countries for life expectancy and has a higher rate of infant mortality. Almost 46m US citizens do not have health insurance.

US HEALTHCARE AND WORLD COMPARISONS

Healthcare reform is a priority for Barack Obama. The US spends about $2.2tn a year on its system - which includes private, federal or employer schemes.

Blood pressure fluctuations 'warning sign for stroke'

Fluctuations in blood pressure could be more important than consistently high readings as a warning sign for stroke, researchers have said.

Current guidelines focus on the need to lower blood pressure levels to reduce the risk of stroke.

It means doctors should no longer ignore an occasional high reading and prescribe the drugs that produce the most steady blood pressure levels.

The Stroke Association called for national guidelines to be overhauled.

In the first of the series of studies, UK and Swedish researchers looked at the variability in blood pressure readings at doctors' checks.

What we're saying is, don't discount that one-off high blood pressure reading Professor Peter Rothwell, study leader

They found those with fluctuating readings at different GP visits had the greatest risk of future stroke regardless of what their average blood pressure reading was.

A review of previous trials also found that the differences in effectiveness of several blood pressure drugs could be explained by how well they kept blood pressure on an even keel.

Some drugs, in particular beta blockers, were shown in a separate study in The Lancet Neurology, to increase variation in a patient's blood pressure.

'Major implications'

Professor Peter Rothwell of the Department of Clinical Neurology at the University of Oxford, who led the research, said the findings have major implications for how GPs spot and treat people at high risk of stroke.

"At the moment, the guidelines for GPs say not to believe a one-off unusual reading, to bring the patient back and measure again, and as long as it's not consistently high, there is no need to treat.

"What we're saying is don't discount that one-off high blood pressure reading."

He added that GPs would also need to make sure they prescribe the most effective drug combinations - ideally one that lowers blood pressure but also stabilises it.

It is not know exactly why occasional spikes would increase a person's risk of stroke but it is thought it puts undue stress on the system.

We urge GPs to read this research to help them prescribe the best treatment for people at risk of stroke Joe Korner, Stroke Association

"If you get rapid fluctuations that can cause turbulent flow of blood which can cause damage and stiffening in the arteries," said Professor Rothwell.

He said anyone with high blood pressure who tests themselves at home might want to mention to their GP if they spot variations in their results.

The National Institute for Health and Clinical Excellence's guidelines on high blood pressure is in the process of being rewritten and these latest studies will be taken into account.

Joe Korner, director of communications at The Stroke Association said people who have occasional high blood pressure readings - known as episodic hypertension - are often not treated.

"With this new research it is now important that the clinical guidelines about treating high blood pressure are reviewed.

"In the meantime we urge GPs to read this research to help them prescribe the best treatment for people at risk of stroke."

Experts stressed that those already prescribed medication for high blood pressure should not worry or stop taking their pills.

Professor Peter Weissberg, medical director at the British Heart Foundation said: "Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use."

Low-fat, Mediterranean and low-carb diets 'help heart'

Fatty deposits in arteries iincrease the risk of stroke and heart disease Three diets - Mediterranean, low-fat and low-carbohydrate - are equally effective in helping reverse blocked arteries, say Israeli researchers. The study of 140 people, reported in the journal Circulation, found diet could reduce the fatty build up in arteries. The Ben-Gurion University team found that by the end of the two-year study, the arterial wall had been cut by 5%. Experts said the study was interesting, but diet was not a "magic bullet". Atherosclerosis is a progressive condition in which the arteries thicken with fatty deposits, increasing the risk of heart attacks and strokes. It was very interesting to see that these very different diets had a similar effect Iris Shai, study author The authors of this Israeli study, which was carried out in collaboration with researchers in the US, Canada and Germany, set out to see if this natural part of ageing can be reversed through diet. Volunteers followed one of three diets - a low-fat diet, a low-carbohydrate diet or a Mediterranean diet, which is based on eating lots of fruit and vegetables, and using olive oil as the main source of fat. They were asked to stick to the diet for two years, and record what they ate in food diaries. The study was carried out among overweight volunteers, mostly men, who were aged 40 to 65. Using three-dimensional imaging, the researchers measured the volume of the wall of the carotid artery, the large artery in the neck which takes blood up to the brain. This was done at the start of the study and again after two years. Clogged arteries Lead researcher Iris Shai said: "It was very interesting to see that these very different diets had a similar effect. "Some people suggest that low-carbohydrate diets are more likely to clog arteries, but we did not see that." The research paper suggested the link could be related to falling blood pressure caused by the change in diet. This study shows you can do something to reduce plaque build-up, even without pills Dr Charles Knight, British Cardiovascular Society The findings were welcomed by UK experts. Dr Charles Knight, secretary of the British Cardiovascular Society and a consultant cardiologist, said although the study was "relatively small" and was not able to follow through to find out how many people eventually had heart attacks or strokes, the results were nevertheless "very interesting". He pointed out that the study adds weight to the growing body of research that suggests that atherosclerosis is a modifiable disease. Ten to 15 years ago, it was thought that fatty build-up in the arteries was irreversible, but since then drugs trials have shown that it is possible for fatty deposits to be cut. "This study shows you can do something to reduce plaque build-up, even without pills," Dr Knight said. "It sends an effective message from a public health perspective." However, he warned that the scale of reduction in the volume of artery walls was relatively small and that changing diet, although helpful, was "no magic bullet".

How to improve your Brain

Everyone can take steps to improve their memory, and with time and practice most people can gain the ability to memorize seemingly impossible amounts of information. Whether you want to win the World Memory Championships, ace your history test, or simply remember where you put your keys, this article can get you started. Scientists believe that exercising your brain can create a ‘cognitive reserve' that will help you stay sharp as you age. 1. Convince yourself that you do have a good memory that will improve. Too many people get stuck here and convince themselves that their memory is bad, that they are just not good with names, that numbers just slip out of their minds for some reason. Erase those thoughts and vow to improve your memory. Commit yourself to the task and bask in your achievements — it's hard to keep motivated if you beat yourself down every time you make a little bit of progress. 2. Keep your brain active. The brain is not a muscle, but regularly “exercisingâ€� the brain actually does keep it growing and spurs the development of new nerve connections that can help improve memory. By developing new mental skills—especially complex ones such as learning a new language or learning to play a new musical instrument—and challenging your brain with puzzles and games you can keep your brain active and improve its physiological functioning. 3. Exercise daily. Regular aerobic exercise improves circulation and efficiency throughout the body, including in the brain, and can help ward off the memory loss that comes with aging. Exercise also makes you more alert and relaxed, and can thereby improve your memory uptake, allowing you to take better mental “pictures.â€� 4. Reduce stress. Chronic stress, although it does not physically damage the brain, can make remembering much more difficult. Even temporary stresses can make it more difficult to effectively focus on concepts and observe things. Try to relax, regularly practice yoga or other stretching exercises, and see a doctor if you have severe chronic stress. 5. Eat well and eat right. There are a lot of herbal supplements on the market that claim to improve memory, but none have yet been shown to be effective in clinical tests (although small studies have shown some promising results for ginkgo biloba and phosphatidylserine) . A healthy diet, however, contributes to a healthy brain, and foods containing antioxidants— broccoli, blueberries, spinach, and berries, for example—and Omega-3 fatty acids appear to promote healthy brain functioning. Feed your brain with such supplements as Thiamine, Vitamin E, Niacin and Vitamin B-6. Grazing, eating 5 or 6 small meals throughout the day instead of 3 large meals, also seems to improve mental functioning (including memory) by limiting dips in blood sugar, which may negatively affect the brain. 6. Take better pictures. Often we forget things not because our memory is bad, but rather because our observational skills need work. One common situation where this occurs (and which almost everyone can relate to) is meeting new people. Often we don't really learn people's names at first because we aren't really concentrating on remembering them. You'll find that if you make a conscious effort to remember such things, you'll do much better. One way to train yourself to be more observant is to look at an unfamiliar photograph for a few seconds and then turn the photograph over and describe or write down as many details as you can about the photograph. Try closing your eyes and picturing the photo in your mind. Use a new photograph each time you try this exercise, and with regular practice you will find you're able to remember more details with even shorter glimpses of the photos. 7. Give yourself time to form a memory. Memories are very fragile in the short-term, and distractions can make you quickly forget something as simple as a phone number. The key to avoid losing memories before you can even form them is to be able to focus on the thing to be remembered for a while without thinking about other things, so when you're trying to remember something, avoid distractions and complicated tasks for a few minutes.

8. Create vivid, memorable images. You remember information more easily if you can visualize it. If you want to associate a child with a book, try not to visualize the child reading the book – that's too simple and forgettable. Instead, come up with something more jarring, something that sticks, like the book chasing the child, or the child eating the book. It's your mind – make the images as shocking and emotional as possible to keep the associations strong. 9. Repeat things you need to learn. The more times you hear, see, or think about something, the more surely you'll remember it, right? It's a no-brainer. When you want to remember something, be it your new coworker's name or your best friend's birthday, repeat it, either out loud or silently. Try writing it down; think about it. 10. Group things you need to remember. Random lists of things (a shopping list, for example) can be especially difficult to remember. To make it easier, try categorizing the individual things from the list. If you can remember that, among other things, you wanted to buy four different kinds of vegetables, you'll find it easier to remember all four.

11. Organize your life. Keep items that you frequently need, such as keys and eyeglasses, in the same place every time. Use an electronic organizer or daily planner to keep track of appointments, due dates for bills, and other tasks. Keep phone numbers and addresses in an address book or enter them into your computer or cell phone. Improved organization can help free up your powers of concentration so that you can remember less routine things. Even if being organized doesn't improve your memory, you'll receive a lot of the same benefits (i.e. you won't have to search for your keys anymore). 12. Try meditation. Research now suggests that people who regularly practice “mindfulness� meditation are able to focus better and may have better memories. Mindfulness (also known as awareness or insight meditation) is the type commonly practiced in Western countries and is easy to learn. Studies at Massachusetts General Hospital show that regular meditation thickens the cerebral cortex in the brain by increasing the blood flow to that region. Some researchers believe this can enhance attention span, focus, and memory. 13. Sleep well. The amount of sleep we get affects the brain's ability to recall recently learned information. Getting a good night's sleep – a minimum of seven hours a night – may improve your short-term memory and long-term relational memory, according to recent studies conducted at the Harvard Medical School. 14. Build your memorization arsenal. Learn pegs, memory palaces, and the Dominic System. These techniques form the foundation for mnemonic techniques, and will visibly improve your memory. 15. Venture out and learn from your mistakes. Go ahead and take a stab at memorizing the first one hundred digits of pi, or, if you've done that already, the first one thousand. Memorize the monarchs of England through your memory palaces, or your grocery list through visualization. Through diligent effort you will eventually master the art of memorization.

Job for Doctor-Health Insurance

Job Title: Assistant Manager – Health Insurance (MBBS Doctor)

Location: Head Office-Lahore

Age: Preferably up to 30 years

Experience: 1 to 3 years after house job in reputable hospitals

Education: MBBS

Skills: He/She should be well verse with commonly used software like MS Office with excellent skills in MS Excel & MS Word. Moreover, he/she should be goal oriented, hard working and a committed team player. Good communication skills (written and verbal) and pleasant personality is also desirable.

Job description: Principal duties will include the following:

Attend to insured member’s queries in respect to their policy coverage, benefits, limits and exclusions; and assist them in obtaining required medical services.

To ensure direct assistance to the medical providers with respect to policy terms and conditions, exclusions and limit of coverage and attend their inquiries to clarify on any raised problem.

To monitor regional in-patient cases and treatments,

To assist in the claims management, medical underwriting and other activities assigned from time to time.

Apply to: Please email your latest CV before 15th March 2010 at

health@alfalahinsurance.com

OR send by post at

Health Insurance Department

Alfalah Insurance Company Limited
5-Saint Mary Park
Gulberg-III

Lahore

Special Notes: Health Insurance is one of the fastest growing segments of insurance industry in the country. We are eager to strengthen our team and have a vacancy for medical doctor who wishes to make a career in this new exciting field which offers great opportunities in years to come. Excellent emoluments and training possibilities await the successful candidate.

Making Yourself Indispensable At Work

Scared of losing your job? Are you living in constant fear of being unemployed owing to the current economic crisis and the ensuing downsizing? Then you are among the millions of employees worldwide, who are living under this continuous threat and wish they could somehow make sure that they were truly indispensable for the company. While it is true that no one is completely indispensable, there are certain things that you can do to make yourself a valuable employee so that the company managers have to think twice before letting you go. Here are some tips that you can incorporate in your daily routine to lessen the chances of you getting fired in the next downsizing:

Take more initiative

The most important thing in a workplace is taking initiative, not only because of the downsizing, but also because of the constantly changing job conditions. Nobody appreciates an employee who sits around waiting to be told what to do next and then accomplishes only the given task. Be active and take every opportunity that comes your way.

Work hard

When you are being paid to do something, you are supposed to give it your maximum effort. In order to become indispensable you must make sure that you are doing your work well and are meeting the required standards. Not only that, to prove to your employers that you are a worthy asset; you have to excel in your work and go beyond the expected standards. Moreover, if you do not know how to do something, instead of making it an excuse, go and find out how to go about that specific task and finish it efficiently.

Take responsibility

In order to become an asset for your company you will have to go beyond your job description and start viewing your department as a company, and yourself as the sole owner of the company. You must consider the pros and cons of every decision you make. At the end of the day, you must think of ways to improve the output of your department in order to impress the superiors with your productivity.

Positive attitude

Whatever happens, try to stay calm and focused. Maintaining a positive attitude in workplace is essential in proving your worth. An employee, who gets panicked easily and starts messing things up, is not an indispensable asset. If you can accomplish your tasks on a rough day with a smile on your face, you will definitely get noticed by your superiors and will certainly make a good impression.

Be a team player

Make sure that you are a valuable team player by always supporting your superiors and your entire team. Moreover, you have should remain careful and steer clear of petty politics and other unprofessional stuff that can retard the pace of work and harm the ongoing projects. Choose to be an integral part of any team and be responsible for the work allotted to you. Work in such a manner that your team and your managers start depending on you and start considering you indispensable.

Avoid politics

No matter which company you work for, office politics will follow you and getting involved means getting into trouble. So, the best option is to avoid taking sides whenever such a situation arises in the workplace. You never know what the consequences of such actions might be. Just be neutral and try to get along well with everyone. Moreover, do not indulge in gossip under any circumstances and distance yourself from such conversations regarding rumors about the company. It is important that you have a clean reputation and are not regarded as a tale-bearer in the eyes of your superiors. Remember, no one wants to have a gossiping employee or a team mate, who can’t keep things confidential.

Improve your skills

In order to make yourself indispensable in the eyes of your managers, you should focus on the specific skills that you possess. While it is important that you possess a specialized skill, what is more important is how effectively you utilize this skill. Make sure that you let your superiors know that you are willing and available to help whenever your expertise is needed. This will make you a valuable resource, and an indispensable person within the organization.

Improve your visibility

While it is vital that you do your work with honesty and dedication, it is more important that you make people aware of your achievements and expertise without being ostentatious. Keep your superiors apprised of your efforts and hard work in terms of benefiting the company.

Be prepared to volunteer

Make sure that whenever you get the chance, you volunteer to do extra work in order to save your employer money and time. Nothing is more crucial for the managers than saving time and money. By volunteering to do extra projects, you can impress more people in the office with your capabilities and talent.

Be flexible

Make sure that you can be flexible enough to adapt changes smoothly. Due to the ongoing economic crisis many companies are constantly making integral changes in their organization to save resources and be more productive. If you cannot go with the changes and do your best to ensure a smooth transition, sooner or later your superiors will start considering you a burden for the team and you will be replaced.

Be cost effective

Nowadays cutting costs has become a major concern for most organizations, which means that as a valuable employee you should concentrate on finding ways to help lower the cost in your company. Make a note of the cost savings you have achieved and make sure to keep the management informed about your efforts in this regards.

Manage your time

Make sure that you get to work on time and don’t be the first one to rush out the door as soon as your time ends. This is the way your employers and managers assess your dedication and commitment to your job. Any company will value an employee who shows up for work punctually and exhibits concern over his job. Moreover, keep in mind that your employers will also know if you are just wasting time by sitting idle at your work station, only to spend extra time in office to impress the boss. So whatever you do, make sure that your work output is in balance with the time you spend at the office.

Managed Health Care Plans

What is managed health care?

It’s a system that controls the financing and delivery of health services to members who are enrolled in a specific type of healthcare plan.

The goals of managed health care are to ensure that...

• providers deliver high-quality care in an environment that manages or controls costs.
• the care delivered is medically necessary and appropriate for the patient’s condition.
• care is rendered by the most appropriate provider.
• care is rendered in the most appropriate, least-restrictive setting.

What are the major types of managed care plans?

• Health Maintenance Organizations (HMO)
• Preferred Provider Organizations (PPO)
• Point-of-Service (POS) plans

Each of these systems has distinctive features or characteristics.

Health Maintenance Organizations (HMO)

• An HMO enters into contractual arrangements with healthcare providers (e.g., physicians, hospitals and other healthcare professionals) who together form a “provider network.” In simple terms, a contracted provider is one who provides services to health plan members at discounted rates in exchange for receiving health plan referrals.
• Members are required to see only providers within this network to have their healthcare paid for by the HMO. If the member receives care from a provider who isn’t in the network, the HMO won’t pay for care unless it was pre-authorized by the HMO or deemed an emergency.
• Members select a Primary Care Physician (PCP), often called a “gatekeeper,” who provides, arranges, coordinates and authorizes all aspects of the member’s health care. PCPs are usually family doctors, internal medicine doctors, general practitioners and obstetricians/gynecologists.
• Members can only see a specialist (e.g., cardiologist, dermatologist, rheumatologist) if this is authorized by the PCP. If the member sees a specialist without a referral, the HMO won’t pay for the care.
• HMOs are the most restrictive type of health plan because they give members the least choice in selecting a health care provider. However, HMOs typically provide members with a greater range of health benefits for the lowest out-of-pocket expenses, such as either no or a very low copayment (the amount of money a member is required to pay the provider in addition to what the HMO pays. It often must be paid prior to services being rendered).

Preferred Provider Organizations (PPO)

• PPOs are similar to HMOs in that they enter into contractual arrangements with healthcare providers (e.g., physicians, hospitals and other healthcare professionals) who together form a “provider network.”
• Unlike an HMO, members don’t have a PCP (“gatekeeper”) nor do they have to use an in-network provider for their care. However, PPOs offer members "richer" benefits as financial incentives to use network providers. The incentives may include lower deductibles, lower co-payments and higher reimbursements. For example, if you see an in-network family physician for a routine visit, you may only have a small co-payment or deductible. If you see a non-network family physician for a routine visit, you may have to pay as much as 50 percent of the total bill.
• PPO members typically don’t have to get a referral to see a specialist. However, as mentioned above, there’s a financial incentive to use a specialist on the PPO’s provider network.
• PPOs are less restrictive than HMOs in the choice of health care provider. However, they tend to require greater "out-of-pocket" payments from the members.

Point-Of-Service Plans (POS)

• A POS plan is often called an HMO/PPO hybrid or an “open-ended” HMO. The reason it’s called “point-of-service” is that members choose which option – HMO or PPO – they will use each time they seek health care.
• Like an HMO and a PPO, a POS plan has a contracted provider network.
• POS plans encourage, but don’t require, members to choose a primary care physician (PCP). As in a traditional HMO, the PCP acts as a “gatekeeper” when making referrals. Members who choose not to use their PCPs for referrals (but still seek care from an in-network provider) still receive benefits but will pay higher copays and/or deductibles than members who use their PCPs.
• POS members also may opt to visit an out-of-network provider at their discretion. If so, a member copays, and coinsurance and deductibles are substantially higher.
• POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.