Adderall, a Drug of Increased Focus for N.F.L. Players





The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht.




“ ‘You’ve got to get some of these,’ ” Becht recalled the player saying. “I was like, ‘What the heck is that?’ He definitely needed it. He said it just locks you in, hones you in. He said, ‘When I have to take them, my focus is just raised up to another level.’ ”


Becht said he did not give Adderall another thought until 2009, when he was playing in Arizona and his fellow tight end Ben Patrick was suspended for testing positive for amphetamines. The drug he took, Patrick said, was Adderall. Becht asked Patrick why he took it, and Patrick told Becht, and reporters, that he had needed to stay awake for a long drive.


Those two conversations gave Becht, now a free agent, an early glimpse at a problem that is confounding the N.F.L. this season. Players are taking Adderall, a medication widely prescribed to treat attention deficit hyperactivity disorder, whether they need it or not, and are failing drug tests because of it. And that is almost certainly contributing to a most-troubling result: a record-setting year for N.F.L. drug suspensions.


According to N.F.L. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall. That is a 75 percent increase over the 12 suspensions announced in 2011 and, with a month to go in 2012, it is the most in a year since suspensions for performance-enhancing drugs began in 1989.


At least seven of the players suspended this year have been linked in news media reports to Adderall or have publicly blamed the drug, which acts as a strong stimulant in those without A.D.H.D. The most recent examples were Tampa Bay cornerback Eric Wright and New England defensive lineman Jermaine Cunningham last week.


The N.F.L. is forbidden under the terms of the drug-testing agreement with the players union from announcing what substance players have tested positive for — the urine test does not distinguish among types of amphetamines — and there is some suspicion that at least a few players may claim they took Adderall instead of admitting to steroid use, which carries a far greater stigma. But Adolpho Birch, who oversees drug testing as the N.F.L.’s senior vice president for law and labor, said last week that failed tests for amphetamines were up this year, although he did not provide any specifics. The increase in Adderall use probably accounts for a large part of the overall increase in failed tests.


“If nothing else it probably reflects an uptick in the use of amphetamine and amphetamine-related substances throughout society,” Birch said. “It’s not a secret that it’s a societal trend, and I think we’re starting to see some of the effects of that trend throughout our league.”


Amphetamines have long been used by athletes to provide a boost — think of the stories of “greenies” in baseball clubhouses decades ago. That Adderall use and abuse has made its way to the N.F.L. surprises few, because A.D.H.D. diagnoses and the use of medication to control it have sharply increased in recent years.


According to Dr. Lenard Adler, who runs the adult A.D.H.D. program at New York University Langone Medical Center, 4.4 percent of adults in the general population have the disorder, of which an estimated two-thirds are men. Birch said the number of exemptions the N.F.L. has granted for players who need treatment for A.D.H.D. is “almost certainly fewer” than 4.4 percent of those in the league.


The rates of those with the disorder fall as people get older; it is far more prevalent in children and adolescents. A report from the Centers for Disease Control and Prevention, using input from parents, found that as of 2007, about 9.5 percent or 5.4 million children from ages 4 to 17 had A.D.H.D. at some point. That was an increase of 22 percent from 2003. Boys (13.2 percent) were more likely to have the disorder than girls (5.6 percent).


Of children who currently have A.D.H.D., 66.3 percent are receiving medication, with boys 2.8 times more likely to receive medication. Those 11 to 17 years old are more likely to receive medication than younger children.


But Adderall, categorized by the Drug Enforcement Administration as a Schedule II controlled substance because it is particularly addictive, is also used by college students and even some high school students to provide extra energy and concentration for studying or as a party drug to ward off fatigue.


Dr. Leah Lagos, a New York sports psychologist who has worked with college and professional athletes, said she had seen patients who have used Adderall. She said she believed the rise in its use by professional athletes mimicked the use by college students. Just a few years ago, she said, it was estimated that 1 in 10 college students was abusing stimulants like Adderall and Ritalin. That estimate, Lagos said, has almost doubled.


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Student scores may be used in LAUSD teacher ratings









After months of tense negotiations, leaders of the Los Angeles Unified School District and its teachers union have tentatively agreed to use student test scores to evaluate instructors for the first time, officials announced Friday.


Under the breakthrough agreement, the nation's second-largest school district would join Chicago and a growing number of other cities in using test scores as one measure of how much teachers help their students progress academically in a year.


Alarm over low student performance, especially in impoverished and minority communities, has prompted the Obama administration and others to press school districts nationwide to craft better ways to identify struggling teachers for improvement.





The Los Angeles pact proposes to do that using a unique mix of individual and schoolwide testing data — including state standardized test scores, high school exit exams and district assessments, along with rates of attendance, graduation and suspensions.


But the tentative agreement leaves unanswered the most controversial question: how much to count student test scores in measuring teacher effectiveness. The school district and the union agreed only that the test scores would not be "sole, primary or controlling factors" in a teacher's final evaluation.


"It is crystal clear that what we're doing is historic and very positive," said L.A. Supt. John Deasy, who has fought to use student test scores in teacher performance reviews since taking the district's helm nearly two years ago. "This will help develop the skills of the teaching profession and hold us accountable for student achievement."


Members of United Teachers Los Angeles, however, still need to ratify the agreement. Many teachers have long opposed using test scores in their evaluations, saying test scores are unreliable measures of teacher ability.


The union characterized the agreement as a "limited" response to a Dec. 4 court-ordered deadline to show that test scores are being used in evaluations and said negotiations were continuing for future academic years. The deadline was imposed by Los Angeles County Superior Court Judge James C. Chalfant, who ruled this year that state law requires L.A. Unified to use test scores in teacher performance reviews.


In a statement, the teachers union also emphasized that the agreement rejected the use of the district's method of measuring student academic progress for individual instructors. That measure, called Academic Growth Over Time, uses a mathematical formula to estimate how much a teacher helps students' performance, based on state test scores and controlling for such outside factors as income and race. Under the agreement, however, schoolwide scores using this method, also known as a value-added system, will be used.


For individual teachers, the agreement proposes to use raw state standardized test score data. Warren Fletcher, teachers union president, said that data give teachers more useful information about student performance on specific skills.


Critics of using test scores in teacher reviews praised Los Angeles' proposed new system, saying it uses a wide array of data to determine a teacher's effect on student learning.


Deasy said he will be developing guidelines for administrators on how to use the mix of data in teacher reviews and has said in the past that test scores should not count for more than 25% of the final rating.


"This is a complex agreement and possibly the most sophisticated evaluation agreement that I have seen," said Diane Ravitch, an educational historian and vocal critic of the use of test scores in teacher evaluations. "It assures that test scores will not be overused, will not be assigned an arbitrary and inappropriate weight, will not be the sole or primary determinant of a teacher's evaluation."


Teacher Brent Smiley at Lawrence Middle School in Chatsworth said: "I will vote yes. I have no doubt that my union leaders negotiated the best they could, given the adverse set of circumstances they faced."


Labor-relations expert Charles Kerchner called the agreement "a shotgun wedding," but added, "I think it's unabashed good news."


He said it's notable that value-added measures and test scores have been accepted in some form by the teachers union.


"UTLA has moved beyond a strategy of just saying no to a strategy of trying to craft a useful agreement," said Kerchner, a professor at Claremont Graduate University.


The district is currently developing a new evaluation system that uses Academic Growth Over Time — along with a more rigorous classroom observation process, student and parent feedback and a teacher's contributions to the school community. The new observations were tested last year on a voluntary basis with about 450 teachers and 320 administrators; this year, every principal and one volunteer teacher at each of the district's 1,200 schools are expected to be trained.


The teachers union has filed an unfair labor charge against the district, arguing that the system is being unilaterally imposed without required negotiations.


Some teachers who have participated in the new observation process say it offers more specific guidance on how they can improve. Other educators — teachers and administrators alike — complain that it is too time-consuming.


The tentative agreement, acknowledging the extra time the new evaluations would take, would extend the time between evaluations from two to as long as five years for teachers with 10 or more years of experience.


Bill Lucia of EdVoice, the Sacramento-based educational advocacy group that brought the lawsuit, said he was "cautiously optimistic."


But he expressed dismay that the union did not reach agreement a few weeks earlier, which he said would have given L.A. Unified a shot at a $40-million federal grant. The district applied for the Race to the Top grant without the required teacher union support and was eliminated from the competition this week.


Negotiations over the tentative pact, however, nearly fell apart. Earlier this week, the union pulled away from the deal on the table, L.A. Unified officials said. And the district discussed holding a Monday emergency school-board meeting to craft a formal response to the court order in anticipation that no deal would be reached. The options included adopting an evaluation system without the union's consent.


Some members of the Board of Education, who also will need to approve the pact, praised the agreement for taking student growth and achievement into account but gauging this growth through multiple measures. Steve Zimmer said that, just as important, this milestone was achieved through negotiation.


School board President Monica Garcia praised the tentative deal as "absolutely, by all accounts, better than what we have today."


teresa.watanabe@latimes.com


howard.blume@latimes.com





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Only in Vegas: Sprinting Santas and Run-Through Weddings











LAS VEGAS — Only in Sin City would the sight of 8,000 Santas running amok through the streets not raise an eyebrow. Even the Elvis Santas barely drew second glances in this town, where the King is as common as bad buffets and bad judgment.



But such things are par for the course when you’re running in a city where everything is just a bit more … weird, including the sports. The insanity returns this weekend with a zany fitness double feature that brings the 8th annual Great Santa Run and the Rock n’ Roll Las Vegas Marathon to town.


Part of what makes the Santa fun run so, well, fun, is everyone gets a brand-new five-piece Santa suit. I caught the action a few years back and seeing these photos still makes me smile.


As silly as that is — and it’s pretty freakin’ silly — it’s but a warmup to the Rock n’ Roll marathon. These things are held in cities around the world and they’re always lots of fun — well, fun if you’re capable of running 26.2 miles without dying — but the Vegas version is just a bit more so.


It isn’t the 40,000 people running down Las Vegas boulevard, or the live music, or even the celebrity impersonators — is that Celine Dion? — huffing and puffing down the Strip.


No, what makes this a distinctly Vegas experience is the run-through wedding service. That’s right. You and your dearly beloved can take a brief detour from the course and get hitched outside the Paris Las Vegas hotel and casino. Talk about an endurance race.


I’m still awaiting the addition of a run-through divorce court. Maybe next year.


All photos: Sol Neelman/Wired




Sol Neelman photographs the wonderful world of weird sports, from dog surfing to outhouse racing to underwater hockey. His book, "Weird Sports," is available now. If you've got a goofy game or silly sport you think he should cover, drop him a line.

Read more by Sol Neelman

Follow @solneelman on Twitter.



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Dolly Parton talks dreams, love, plastic surgery












NEW YORK (Reuters) – Although Dolly Parton has cemented her place in country and popular music, pop culture, and as an entrepreneur and philanthropist, she still, on occasion, gets nervous.


Her new book, “Dream More: Celebrate the Dreamer in You” encourages readers to overcome their fears, believe in their passions and keep taking risks.












The “I Will Always Love You” singer/songwriter, 66, who has written more than 3,000 songs and sold more than 100 million records, talked to Reuters about the message of the book, which was published this week.


Q. You say you put off writing this book?


A. “It’s just a simple little book. It’s not meant to save the world, or it’s not a complete book of how to be successful, but I think there is enough stuff in it for people to see kinda how I conduct my business and kinda what my thoughts are. And the good part is that all the money, if it sells good, goes to Imagination Library.”


Q. Right – your nonprofit quest to get kids to read?


A. “It’s one of the reasons I wanted to write this too, because I usually do concerts every year, for the foundation to make money to afford a lot of books, but I am not on tour now.”


Q. Talk about your 2009 commencement address at the University of Tennessee. Were you nervous?


A. “Well, yes, when I am out of my element doing things. I am not that educated and I didn’t go that far in school and I thought, ‘What am I going to say to these educated people, not just these kids who have just graduated college and are probably brilliant, but all these professionals and all these teachers?’ And I thought, ‘Oh, I am not smart enough’, but I thought, ‘Well, at least I am a hometown girl. At least they can see that in America, you can start from humble beginnings, that everybody can make it.”


Q. Which is one of the book’s messages, overcoming fears?


A. “Any time I am in a situation where I am just not comfortable, I am uneasy, but that doesn’t mean I won’t go on with it, just like the speech. And that I won’t be good at it, but there are just some things I would prefer not to do!”


Q. Success doesn’t equal happiness, yet you seem so hopeful and modest?


A. “I am always hopeful as a person, I have been since I was little…I really want things to be good. As I mention in the book, I wake up everyday expecting it to be good, and if it is not, then I try to set about changing it before I go to sleep at night.”


Q. Would you describe yourself as religious or spiritual?


A. “Just spiritual, I am not religious. Although I grew up in a very religious family, but…I am no fanatic by any stretch of the word, and I am no angel, believe me. I wrote a song called ‘The Seeker’ many, many years ago, and it says ‘I am a seeker, just a poor sinful creature, there is no one weaker than I am.’


“People say, ‘What do you regret?’ I say, ‘I can’t say that I regret anything because at the time I was doing it, whatever it was, it seemed to be the thing to be doing at the time.’


“I have a good friend base, I have a good husband. So I have a lot of things and people who help me and guide me. I have never had to go to a psychiatrist, but I would if I thought that I needed to.


Q. But we are in New York, Dolly! No psychiatrist?


A. “Well yes (laughs), I guess not. But I do that in my songs, I write my feelings out and then I have such a strong faith and then I have such good friends. I am very close to several of my sisters, and we just talk about everything and anything….And my best friend Judy, there is nothing I can’t tell her, even if it is the awful-est thing in the world.”


Q. You recently had to deny gay rumors. Who is your greatest love?


“My husband is my greatest love, I have been with him 48 years…He is my best buddy.”


Q. Why do you think people always wonder about him?


A. “They don’t think he really exists! When I was doing my show, we were thinking about having a different guy knock on the door every night, as my husband, and then one night he would be a midget, and one night he would be a black man, and one night he would be like a boxer or a wrestler, all these different things that people imagine what my husband looks like.”


Q. You say that looking so artificial works for you, as it lets you prove how real you are. Why all the plastic surgery?


A. “Because I need it. Why does anybody get it?”


Q. Why do you think you need it?


A. “Because I am in show business. I am not a natural beauty. And I am on camera all the time. And I just always see, like if I need – Oh take one of my chins off, at least! – Or whatever. I mean, I don’t go to extremes with it. I just do little bits and pieces, just to try and keep things touched up, just tweaking.”


(Reporting by Christine Kearney, editing by Jill Serjeant and Carol Bishopric)


Music News Headlines – Yahoo! News


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Supreme Court Takes Up Question of Gene Research



The case the court added to its docket concerns patents held by Myriad Genetics, a Utah company, on genes that correlate with increased risk of hereditary breast and ovarian cancer.


The patents were challenged by scientists and doctors who said that their research and ability to help patients had been frustrated. “Myriad and other gene patent holders have gained the right to exclude the rest of the scientific community from examining the naturally occurring genes of every person in the United States,” the plaintiffs told the Supreme Court in their petition seeking review. They added that the patents “prevent patients from examining their own genetic information” and “made it impossible to obtain second opinions.”


The legal question for the justices is whether isolated genes are “products of nature” that may not be patented or “human-made inventions” eligible for patent protection.


A divided three-judge panel of a federal appeals court in Washington ruled for the company. Each judge issued an opinion, and a central dispute was whether isolated genes are sufficiently different from ones in the body to allow them to be patented.


“The isolated DNA molecules before us are not found in nature,” wrote Judge Alan D. Lourie, who was in the majority. “They are obtained in the laboratory and are man-made, the product of human ingenuity.”


The company urged the justices not to hear the case, saying that the “isolated molecules” at issue “were created by humans, do not occur in nature and have new and significant utilities not found in nature.” It has long been settled, the company’s brief went on, that “the human ingenuity required to create isolated DNA molecules” is worthy of encouragement and that its fruits are worthy of protection.


The plaintiffs in the case, Association of Molecular Pathology v. Myriad Genetics, No. 12-398, were supported by friend-of-the-court briefs filed by the American Medical Association, AARP and women’s health groups.


The justices were also scheduled to consider on Friday 10 closely watched appeals in cases concerning same-sex marriage, but they gave no indications about which ones, if any, they will hear. It is not unusual for the justices to discuss petitions seeking their attention more than once, particularly when the cases present complex and overlapping issues.


The court is widely expected to agree to hear one or more cases on the constitutionality of the part of the federal Defense of Marriage Act of 1996 that forbids the federal government from providing benefits to same-sex couples married in states that allow such unions.


The court has also been asked to hear cases about Proposition 8, the ballot initiative that banned same-sex marriage in California, and an Arizona measure that withdrew state benefits from both gay and straight domestic partners.


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A slick stereotype: L.A. drivers unable to handle the rain













A wet walk on the pier


Far removed from the many SigAlerts and traffic accidents caused by the rain, umbrella-toting pedestrians stroll on the Huntington Beach Pier before dawn on Thursday.
(Mark Boster / Los Angeles Times / November 29, 2012)































































You know what they say: L.A. drivers can't handle the rain.


Many motorists didn't disprove the stereotype Thursday as rain slickened roadways and snarled the morning commute. The California Highway Patrol reported more than three times as many accidents (294) between 12:01 a.m. and 4:30 p.m. Thursday than in the same time period a week ago (90), on Thanksgiving.


Although there were some morning crashes that shut down area freeways — including a jackknifed big rig on the 5 Freeway in Glendale and a fatal crash on the 134 in Toluca Lake — CHP Officer Ed Jacobs said most were single-car spinouts.





"People are driving too fast for the roadway," Jacobs said. "Slow down. It's really simple. There is no other thing to do."


Of the many jokes about the storm shared via social media, many focused on traffic.


"Los Angeles + rain = Carmageddon," @Nick_Favorite wrote.


"The only thing worse than LA drivers? LA drivers in the rain," @LiliannaEvelyn said.


But drivers, beware. More wet weather is in store for California through the weekend. Forecasters said scattered showers should persist as a series of storms passes through the area, the strongest of which should hit Sunday afternoon and evening.


Jacobs called the number of reported accidents "huge" but said it was typical for a rainy day in Los Angeles.


But is it proof L.A. drivers can't handle the rain?


"You'll have to draw your own conclusion on that one," Jacobs said.


kate.mather@latimes.com






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New Camera Snaps All-Sky Auroras in Full Color











Capturing a multicolored, all-sky image of the auroras that decorate Earth’s polar skies is now possible.


Normally, studying these shimmering phenomena means taking multiple images of an aurora, using different filters that block or image different wavelengths. Now, a camera with tunable liquid crystal filters can capture many colors at once, a team of space-weather researchers reports Nov. 29 in Optics Express.


Called NORUSCA II, the camera also takes pictures of the entire sky. Scientists are hoping that such precision aurora-imaging will help them better understand and classify the celestial light shows.


The team tested the sky-gazing camera at the Kjell Henriksen Observatory in Svalbard, Norway, during the auroral season of 2011 and 2012. On Jan. 24, 2012, an enormous solar flare flung a blob of charged particles in Earth’s direction. The skies over Svalbard lit up as the particles struck Earth’s atmosphere, producing a bright green aurora and intense geomagnetic storm.



Charged particles colliding with different gases in Earth’s atmosphere produce the multicolored auroras. For example, oxygen atoms can glow green or red, depending on their altitude. Hydrogen and helium high in the ionosphere can produce shimmering blue or purple. Nitrogen? Red, violet, or blue.


The new camera captured these swirling lights using many different wavelength channels; individual frames from the Jan. 24 event have been stitched together in the video above. And the camera is sensitive enough to see daytime auroras, like the reddish lights flickering across the sky on Dec. 29, 2011 (video below).



Videos: Optics Express, Vol. 20, Issue 25.









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Adkins explains Confederate flag earpiece












NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.


Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.












But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.


He noted he’s a descendant of Confederate soldiers and says he did not intend offense by wearing it.


Adkins — on a USO tour in Japan — also called for the preservation of America’s battlefields and an “honest conversation about the country’s history.”


___


Online:


http://www.traceadkins.com


Entertainment News Headlines – Yahoo! News


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Medicare Is Faulted in Electronic Medical Records Conversion





The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.







Mike Spencer/Wilmington Star-News, via Associated Press

Celeste Stephens, a nurse, leads a session on electronic records at New Hanover Regional Medical Center in Wilmington, N.C.







Centers for Medicare and Medicaid Services

Marilyn Tavenner, acting administrator for Medicare.






The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.


But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.


Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.


The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.


Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”


The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.


Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.


“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.


Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.


House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.


In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.


This article has been revised to reflect the following correction:

Correction: November 30, 2012

An article on Thursday about a federal report critical of Medicare’s performance in assuring accuracy as doctors and hospitals switch to electronic medical records misstated, in some copies, the timing of a statement from a Medicare spokesman in response to the report. The statement was released late Wednesday, not late Thursday.



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Most Americans Face Lower Tax Burden Than in the 80s




What Is Fair?:
Taxes are still a hot topic after the presidential election. But as a country that spends more than it collects in taxes, are we asking the right taxpayers to pay the right amounts?







BELLEVILLE, Ill. — Alan Hicks divides long days between the insurance business he started in the late 1970s and the barbecue restaurant he opened with his sons three years ago. He earned more than $250,000 last year and said taxes took more than 40 percent. What’s worse, in his view, is that others — the wealthy, hiding in loopholes; the poor, living on government benefits — are not paying their fair share.







Kirsten Luce for The New York Times

"I don't have the answer of where to pull back. I want the state parks to stay open. I want, I want, I want. I want Big Bird, I think it's beautiful. What don't I want? I don't know," said Anita Thole, a safety supervisor for a utility contractor.






“It feels like the harder we work, the more they take from us,” said Mr. Hicks, 55, as he waited for a meat truck one recent afternoon. “And it seems like there’s an awful lot of people in the United States who don’t pay any taxes.”


These are common sentiments in the eastern suburbs of St. Louis, a region of fading factory towns fringed by new subdivisions. Here, as across the country, people like Mr. Hicks are pained by the conviction that they are paying ever more to finance the expansion of government.


But in fact, most Americans in 2010 paid far less in total taxes — federal, state and local — than they would have paid 30 years ago. According to an analysis by The New York Times, the combination of all income taxes, sales taxes and property taxes took a smaller share of their income than it took from households with the same inflation-adjusted income in 1980.


Households earning more than $200,000 benefited from the largest percentage declines in total taxation as a share of income. Middle-income households benefited, too. More than 85 percent of households with earnings above $25,000 paid less in total taxes than comparable households in 1980.


Lower-income households, however, saved little or nothing. Many pay no federal income taxes, but they do pay a range of other levies, like federal payroll taxes, state sales taxes and local property taxes. Only about half of taxpaying households with incomes below $25,000 paid less in 2010.


The uneven decline is a result of two trends. Congress cut federal taxation at every income level over the last 30 years. State and local taxes, meanwhile, increased for most Americans. Those taxes generally take a larger share of income from those who make less, so the increases offset more and more of the federal savings at lower levels of income.


In a half-dozen states, including Connecticut, Florida and New Jersey, the increases were large enough to offset the federal savings for most households, not just the poorer ones.


Now an era of tax cuts may be reaching its end. The federal government depends increasingly on borrowed money to pay its bills, and many state and local governments are similarly confronting the reality that they are spending more money than they collect. In Washington, debates about tax cuts have yielded to debates about who should pay more.


President Obama campaigned for re-election on a promise to take a larger share of taxable income above roughly $250,000 a year. The White House is now negotiating with Congressional Republicans, who instead want to raise some money by reducing tax deductions. Federal spending cuts also are at issue.


If a deal is not struck by year’s end, a wide range of federal tax cuts passed since 2000 will expire and taxes will rise for roughly 90 percent of Americans, according to the independent Tax Policy Center. For lower-income households, taxation would spike well above 1980 levels. Upper-income households would lose some but not all of the benefits of tax cuts over the last three decades.


Public debate over taxes has typically focused on the federal income tax, but that now accounts for less than a third of the total tax revenues collected by federal, state and local governments. To analyze the total burden, The Times created a model, in consultation with experts, which estimated total tax bills for each taxpayer in each year from 1980, when the election of President Ronald Reagan opened an era of tax cutting, up to 2010, the most recent year for which relevant data is available.


The analysis shows that the overall burden of taxation declined as a share of income in the 1980s, rose to a new peak in the 1990s and fell again in the 2000s. Tax rates at most income levels were lower in 2010 than at any point during the 1980s.


Governments still collected the same share of total income in 2010 as in 1980 — 31 cents from every dollar — because people with higher incomes pay taxes at higher rates, and household incomes rose over the last three decades, particularly at the top.


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