We’re approaching the sad ninth anniversary of the September 11 attacks, and the Ground Zero site in lower Manhattan has been much in the news lately. But instead of talking about the controversies, let’s look at how the rebuilding of the World Trade Center site is progressing.

Many people around the country seem to think the Ground Zero site is still full of ashes and ruin. That was true for what seemed a very long time. In the months after the attacks, the recovery crew labored in what turned out to be a toxic soup of poisonous chemicals and asbestos. I’ve written before about former Ground Zero workers succumbing to cancer and other diseases. Asbestos cancer can take many years to develop, so the remaining, apparently healthy workers remain in danger.

Yet the work continued. The entire area was scooped down nearly to bedrock, and by 2006 Ground Zero was a 16-acre, 70-foot-deep hole.

Today, Ground Zero is a busy, and less dangerous, construction site. Work on the 1,776 feet tall World Trade Center One tower, also called the Freedom Tower, is well underway. The tower will be open to the public in 2013.

This week, the first 16 trees of a planned 400-tree “forest” were planted. The trees are swamp white oaks, 30 feet tall. They are expected to grow to as high as 80 feet. The trees came from New York, Pennsylvania and Washington, DC, the locations of the three September 11 attacks.

The many trees will be part of an eight-acre, landscaped Memorial Plaza that will surround two huge reflecting pools with water cascading down their sides. The pools are being built into the “footprints” of the destroyed towers. The names of the people lost in the terrorist attacks will be inscribed around the pools. The city plans to have this Memorial Plaza finished in time for the tenth anniversary of the attacks next year.

Beneath the plaza is a vast chasm. A memorial museum will go into this space, expected to open in 2013. People will not only be able to view interactive, educational exhibits and artifacts from the day; they also will be able to approach the original slurry wall and parts of the remaining foundations of the towers.

Also, the last steel column removed from the disaster site has been returned. The carefully preserved, 58-ton beam is already in the museum space. Eventually the “survivor’s staircase,” the remains of a granite staircase that served as an escape route for thousands of people, will be returned as well.

The remaining acreage of Ground Zero will be  filled with office space, retail stores, and other businesses. Barring unforeseen setbacks, I believe five years from now — maybe less — the space will be entirely built over.

On a personal note — I used to walk through the lower level of the World Trade Center every work day as part of my daily commute, and I can still see all the corridors and the shops and the people in my mind. I can’t tell you what a relief it will be to see that sad space filled with city life again.

– Barbara O’Brien

Let’s say your home has an old and inefficient heating system, and your utility bills are out of sight.  You do some research, and you figure out that if you invest in a new heating system it will lower your utility bills so much that the system would pay for itself in a couple of years. That makes buying the new heating system a smart purchase, right?

Conversely, just because you are paying smaller utility bills doesn’t necessarily mean you are getting less heat. With your new, improved heating system, you are getting the same amount of heat for less money. The same argument applies to how the health care reform law will save money in the Medicare program.

Over the next ten years, several billion dollars are scheduled to be cut from the Medicaid prorgram. Opponents of the bill claim this means seniors will be getting less health care. Medicare is a huge concern to most seniors, of course, including seniors diagnosed with mesothelioma cancer. Although it can strike people of any age, most mesothelioma patients are either retired or close to retirement age when the deadly lung cancer is diagnosed.

So will seniors have to sacrifice their health care because Medicare costs are cut? They shouldn’t have to, and here is why.

First, as I wrote a few days ago, the trustees of the Medicare program are predicting that the health care reform bill really is slowing the increase in health care costs. This means that over the next ten years the Medicare program will be less expensive overall than was anticipated even a year ago.

Second, there will be changes in the way Medicare pays for health care services. Before, doctors simply were reimbursed for every service they performed. But people watching health care costs began to notice that some doctors order a whole lot more tests and procedures than others without necessarily getting better results.

In the future, doctors and hospitals will receive one payment for treatment of a particular condition, such as an appendectomy or so many months of cancer treatment. Remarkably, studies have shown that paying doctors this way not only reduces costs, but it also results in better average health care outcomes, including lower mortality rates. This is possibly because doctors are less likely to order treatments that are not absolutely necessary if they aren’t going to be paid for them. (See “Bundled payments might cut hospital costs without reducing quality of care” by Manoj Jain in the March 9, 2010, Washington Post.)

Note also that most of the cuts will be to the Medicare Advantage program, not to regular Medicare. The Medicare Advantage program pays private insurance companies to enroll seniors in managed care networks. This was supposed to save money, on the theory that private insurance companies would use the money more efficiently than a government bureaucracy. However, just the opposite proved to be true.

Medicare Advantage costs the government about 15 percent more per person than regular Medicare, mostly because 15 percent of each dollar our government pays to the Medicare Advantage insurers goes into profits, marketing, and corporate expenses. This “overage” is nearly 10 times the rate of traditional Medicare.

So, like the new heating system, it should be possible for seniors on Medicare to get the same amount of health care for less money.

I wrote recently that there’s good news about the future of Medicare. But what about Social Security?

Some politicians have been claiming that both Medicare and Social Security are in deep trouble and about to go broke. Medicare has indeed been getting closer and closer to insolvency until recently, when the trustees of the fund announced that the fund has a better outlook this year than it had last year.

However, recently the Congressional Budget Office announced that this year, for the first time, the Social Security fund will pay out more in benefits than it receives in payroll taxes. Earlier projections had said this wouldn’t happen before 2016.

Many, if not most, mesothelioma patients depend on Medicare and Social Security. Mesothelioma is a deadly lung cancer caused by exposure to asbestos, and this exposure most often happened on the job. But because the disease takes many years to develop, the diagnosis often comes later in life, when the patient is retired.

So is Social Security going broke, and if so, what can be done about it? The alarmists say the Social Security trust fund has been drained to pay for other government expenses, so if Social Security can’t collect enough money to pay benefits it will be broke in no time. Others say that the Social Security trust fund is holding about $2 trillion in interest-bearing securities. This should keep the program going to about 2037 even if nothing is done.

So who is right? The Social Security fund has been running surpluses for many years. The money not paid out is loaned to the federal government in exchange for interest-bearing securities. These securities are backed by the full faith and credit of the United States. If the securities are as worthless as some critics claim, then U.S. Treasury bonds and even the money in your wallet are worthless also.

That said, it is probably true that Congress has come to rely on borrowing from Social Security way more than is good for the program, and something needs to change. But what?

If you pay close attention, the people who are most alarmist about the future of Social Security usually suggest one of two ways to “fix” the problem. One “fix” is cutting benefits. Another is privatization.

Privatization was an idea pushed hard by the Bush Administration in 2005. Basically, privatization means diverting all or part of FICA taxes to Wall Street financial firms for investment rather than into the trust fund. After all that’s happened with those financial firms in recent years, I say anyone who still thinks that’s a good idea needs to have his head examined. But, remarkably, many Republicans in Congress and running for Congress are still suggesting at least part of Social Security be turned into a kind of private investment fund.

These days the most frequently discussed “fix” is raising the retirement age. The age at which one can begin to claim full benefits already has been raised from 65 to 66, and it is scheduled to go to 67. Some politicians want to raise the age to 70. That may be all right for people who work in office jobs, but it puts a terrible burden on blue collar workers.

The FICA tax rate currently is 12.4 percent (half paid by employers, half by employees), and no one seems to be talking about raising that rate. Many people want to raise the cap, however. Right now, Social Security taxes are paid only on the first $106,800 of income. Taxing income above the current cap would bring in more revenue without raising the rate, and this would go a long way toward keeping Social Security solvent for a very long time.  Naturally, people with high incomes think this is a terrible idea.

You may have heard politicians say that Medicare is going broke and will run out of money at some point in the next decade. True? Well, there is reason to be worried, but the trustees of the Medicare fund recently pushed the estimated day of reckoning back 12 years, from 2017 (last year’s estimate) to 2029.

In May 2009, the trustees were predicting that by 2017, the part of Medicare that pays hospital bills would be depleted, and Medicare would have to stop paying those bills. But last week, the same trustees projected that the hospital fund should able to pay all of its bills until 2029. Projected shortfalls over the next 75 years for the rest of Medicare — the parts that pay for office visits and prescription drugs — also were substantially reduced.

The pushback of the estimated Day of Doom came about because of the health care reform bill that became law earlier this year. Experts who have looked closely at all the data say that the reform really should slow the rate of increase in health care costs — what the experts call “bending the curve.” At his New York Times blog, economist Paul Krugman has a chart that shows how the “curve bending” works.

But they’re just guessing, you say. Yes, but they are very educated guesses.

Medicare is important to all of us, or at least it ought to be to everyone who expects his parents, and himself, to live past the age of 65. Medicare also is an important issue to people suffering from mesothelioma. This deadly asbestos cancer can take 20 to 50 years to develop after exposure to asbestos. It’s common for people who were exposed to asbestos at work to be diagnosed after they retire.

So can we stop worrying about Medicare? Not yet. The Medicare program’s chief actuary, Richard S. Foster, also believes the curve will bend, but not as much as the trustees project. Some of the savings depend on how well the new law is implemented, and Foster is skeptical that the implementation will be as efficient as the trustees hope.

The bigger danger to the rosy projection, however, is that Congress will repeal the health care reform bill before most of it is allowed to go into effect. Conservatives have been scaring people into opposing health care reform by claiming it will drive costs up and destroy Medicare, when just the opposite is true.

And to make their scare stories more credible, this year the Republicans in Congress were responsible for cutting doctors’ Medicare fee reimbursements by 21 percent. They want constituents to believe these cuts came about because of the health care reform bill, but in fact the cuts were part of separate legislation.

As explained in an earlier post, several years ago Congress established a fee schedule for Medicare that would gradually reduce the fees every year. However, for the past several years Congress voted to defer the reduction — until this year. This year Republicans refused to defer the cuts, and so all the cuts that were deferred for several years will go into effect at once. Democrats in the House were able to postpone these cuts until next year.

Rand Paul, Kentucky Republican candidate for U.S. Senate, thinks the federal government has no business regulating mine safety. Kentucky, it should be noted, is a major mining state that led the nation in mining deaths last year — six coal miners and one limestone quarry worker lost their lives on the job. Two more Kentucky coal miners died in mining accidents this past April.

But the would-be senator thinks the federal government should stay out of mine safety. This is from a recent profile in Details magazine:

“Is there a certain amount of accidents and unfortunate things that do happen, no matter what the regulations are?” Paul says at the Harlan Center, in response to a question about the Big Branch disaster. “The bottom line is I’m not an expert, so don’t give me the power in Washington to be making rules. You live here, and you have to work in the mines. You’d try to make good rules to protect your people here. If you don’t, I’m thinking that no one will apply for those jobs. I know that doesn’t sound…” Here he stumbles, trying to parse his words properly but only presaging his campaign misstep. “I want to be compassionate,” he concludes, “and I’m sorry for what happened, but I wonder: Was it just an accident?”

First, the idea that Americans won’t take dangerous jobs is, unfortunately, not true. Americans take dangerous jobs all the time, especially if the pay is better than what could be made in the fast food industry. Does Paul not notice that mines are dangerous? Does he not notice that men apply for jobs in mines anyway?

Maybe not. Paul is a self-employed ophthalmologist. I suspect he’s been sheltered from the reality of what workplaces can be like when the boss thinks death is the cost of doing business.

And, of course, some kinds of workplace dangers are not obvious. It should not be an employee’s responsibility to test for dangerous levels of toxins or asbestos in his workplace, for example. Many mesothelioma victims were unknowingly exposed to asbestos long after it was known by science to be dangerous.

But candidate Paul seems to think that workers should be able to trust their employers to maintain safety, in spite of long years of human history saying otherwise.

In the 19th century, before those pesky workplace safety regulations, the fatality rate in American Bituminous coal mines was 3.53 deaths per thousand workers per year. In 1912, the death rate in Colorado’s coal mines was 7.055 per 1,000 employees. According to the U.S. Department of Labor, “The deadliest year in U.S. coal mining history was 1907, when 3,242 deaths occurred.” That’s slightly more than the number of people killed in the World Trade Center collapse.

In the 20th century the federal government gradually became more involved in mine safety, but it was not until 1952 that the Bureau of Mines gained some modest enforcement powers to compel mine owners to comply with regulations. But the number of mining accidents fell significantly after passage of the Federal Mine Safety and Health Act of 1977. There were 18 coal mining deaths nationwide in 2009, which as tragic as that was, was an all-time low. Before the 1977 act, the annual death rate was in the hundreds, at least.

These days, a mine disaster such as in the Big Branch Mine of West Virginia, in which 29 miners were killed by an explosion last April, shock the nation. And afterward someone always pops out of the woodwork to declare that such disaster prove government regulations don’t work. But usually what it means is that a mine owner, somehow or another, was allowed to slide. The fact is, miners depend on federal regulators and inspectors to protect their lives, because too often the mine owners care more about quarterly profits than safety.

Nearly a year ago I wrote about how the September 11 first responders and volunteers were getting sick from the toxic fumes they breathed at Ground Zero (see “The Toxins of 9/11“). Firefighters, policemen, and others who worked in the burning rubble of the World Trade Center, finding bodies and clearing debris, were breathing levels of benzene, dioxin, and other poisons that were way above the danger zone.

The collapse of the World Trade Center towers also released hundreds of tons of asbestos fibers into the air. Breathing asbestos can cause the deadly lung cancer mesothelioma. But the disease may not appear for 20 to 50 years after exposure, so workers and volunteers who are not sick yet are not out of danger.

Last week the House rejected a bill that would have provided medical support for the heroes of 9/11. The James Zadroga 9/11 Health and Compensation Act would have provided medical monitoring of the former Ground Zero workers, medical care for those who needed it, and a fund to compensate for lost income when sickened workers could no longer hold a job. The bill was to be paid by closing a tax loophole on foreign companies with U.S. subsidiaries, so that it would not have added to the federal budget deficit.

But last Thursday night, the bill failed to pass. House Republicans decided to protect the profits of foreign companies, not the 9/11 heroes. A GOP policy statement dismissed the bill as a “massive new entitlement program.”

Nine years ago politicians were tripping over each other praising the heroes of 9/11. Now they say the heroes are greedy parasites wanting an “entitlement.”

Rep. Lamar Smith (R-Texas) called the bill “a huge $8.4 billion slush fund paid by taxpayers that is open to abuse, fraud and waste.” As I explained, the bill would have been paid by closing a loophole on foreign companies doing business in the U.S., not by taxing U.S. citizens.

The bill was named for James Zadroga, a New York City policeman who died of respiratory illness attributed to the Ground Zero toxins. Zadroga was a healthy non-smoker in his early 30s on September 11, 2001. After the attacks he logged in 450 hours working at Ground Zero. Then he developed a persistent cough, grew weaker and weaker, and he died in 2006.

Today, James Fanelli of the New York Daily News reports that Ground Zero workers are refusing to sign a $625 million settlement with the City of New York. More than 10,000 firefighters, policement, and other Ground Zero workers had sued the city of New York, which had failed to provide adequate warnings and equipment for working in the toxic fumes. But many plaintiffs say the settlement isn’t enough. One retired NYPD officer said that the settlement would have provided him with only $4,700.

Approximately 50,000 people worked in the Ground Zero debris in the months following the September 11 attacks. Some came for just a few days, others worked there for several weeks. There is no way to anticipate the health problems these good people will face in the future.

In June 2009 the state of New York’s WTC Responder Fatalities Investigation had identified 817 people who worked at the WTC site who had since died.  Of these, 479 died of illnesses, including 270 cases of cancer. There seems to be no official tally of the number of sick and dying, however.

Texas governor Rick Perry thinks Texas has the best health care in the country, and it’s all because of tort reform. He said this recently on Bill Bennett’s syndicated radio program:

BENNETT: Thirty seconds on the doctors. You’ve got the best health care in the country, now I think, don’t you? Because of your tort law?

PERRY: We do, yes. I spoke with the doctors yesterday in San Antonio. We’ve got, you know, three of the great health care — well not — three of the great health care regions. When you think about the medical center in Houston, there are more doctors, nurses, researchers go to work there than any other place in the world, every day. You got UT Southwestern up in University of Texas Health Sciences Center, San Antonio, Scott & White. I mean these fabulous health care facilities.
[source]

However, according to the Commonweal Fund, Texas ranks 46th out of 51 — the 50 states plus the District of Columbia — in delivering health care to its citizens. I’d say Gov. Perry has lowered the bar for “best health care in the country” quite a bit.

For many years, Texas has led the nation in the percentage of uninsured citizens, including children. More than one in four Texans has no health insurance, and a large percentage of those with insurance have “junk” policies that cover very little. As a result, more Texans fail to see doctors when they need to than in any other state, plus DC.

Texas has enacted a number of draconian “tort reform” laws that make it extremely difficult for Texans to sue for damages, including malpractice. As a result, the number of malpractice suits filed in Texas every year has dropped significantly. And this was supposed to make health care more affordable and more accessible. But it didn’t.

The issues of tort — personal injury law — and health care are both of critical interest to people with mesothelioma cancer and other asbestos-related disease. Mesothelioma is a deadly disease caused by exp0sure to asbestos. Nearly all mesothelioma patients were exposed to asbestos on the job. “Tort reform” laws make it more difficult to file personal injury suits and also place caps on what juries can award in damages. Such laws punish the most vulnerable and injured people while protecting “perpetrators” from responsibility.

One reason Texas lawmakers passed tort reform laws is that they believed protecting physicians and hospitals from malpractice suits would lower health care costs and make health care more accessible. However, it did not. And Gov. Perry refuses to acknowledge that tort reform didn’t deliver the promised rewards. In this he takes a cue from Mississippi governor Haley Barbour, who believes tort reform solved all of Mississippi’s health care problems. In fact, overall, Mississippi has the worst health care in the nation.

And the drop in malpractice suits hasn’t changed the fact that Texas has some of the most expensive health care markets in the country.

So it may be there are some fabulous medical centers in Texas, but large numbers of Texans don’t have access to those centers and are doing without even basic medical care.

Now, about having more medical personnel going to work in Houston than anywhere else in the world — I could not verify that, although I have a hard time believing there are more medical personnel in Houston than in, say, New York City. But according to the most recent data at the U.S. Census Bureau (which is from 2007), Texas comes out rather badly compared to other states in the ratio of physicians to population.

The state with the highest doctor-to-patient score is Massachusetts, with 469 physicians for every 100,000 residents. Texas comes in at #41, with 214.2 physicians for every 100,000 residents.

Incidentally, Mississippi is worse — 177.9 physicians for every 100,000 residents. But for once Mississippi is not rock bottom; it is only #48. Oklahoma and Idaho are #49 and #50, respectively.

For 45 years, most Americans aged 65 and over have depended on Medicare to pay for their health care. But there is growing concern that Medicare will become insolvent in a few years if the program isn’t changed. In this midterm election year, if you are concerned about the future of Medicare, please find out what candidates for Congress propose to do about Medicare before you vote. Some of the ideas being floated for “fixing” Medicare might surprise — and alarm — you.

Rep. Paul Ryan (R-WI) is the ranking Republican on the House Budget Committee and running for re-election. Ryan wants to eliminate the Medicare program and instead give vouchers to senior citizens that they can use to purchase private insurance policies. The value of the vouchers would not come close to the anticipated cost of the insurance.

I’d like to point out that insurance companies could refuse to accept senior citizens as policy holders until 2014. That’s when a provision in the new health care reform act kicks in that requires insurance companies to insure anyone who can pay the premiums, regardless of their pre-existing conditions. Rep. Ryan was opposed to the health care reform bill, of course, and he has said that repealing health care reform will be the first goal of a GOP Congress.

Think about this. The guy wants to eliminate Medicare and replace it with vouchers to buy private insurance. But if health care reform is repealed, there’s little chance private insurance companies will insure older people, vouchers or no vouchers.

Medicare is an important issue to people suffering from asbestos cancer. The cancer can take 20 to 50 years to develop after exposure to asbestos. It’s common for people who were exposed to asbestos at work to be diagnosed with mesothelioma after they retire.

Many candidates such as Ken Buck, Republican candidate for U.S. Senate from Colorado, make vague noises about health savings accounts somehow replacing Medicare. That’s, um, nuts. HSAs are special tax-free savings accounts in which you can save money to pay for medical expenses. These are combined with a high-deductible or “catastrophic” insurance policy as a safety net for major medical expenses. HSAs are a good deal for young and healthy people with high incomes who rarely need to see a doctor. For everyone else, they aren’t.

Sharron Angle, a Republican from Nevada running for the U.S. Senate, has similar ideas about Medicare. In a televised candidate debate last May, she said “We need to phase Medicare and Social Security out in favor of something privatized.” Later she elaborated on what she meant by that — in so many words, she thinks seniors should pay for their own health care out of retirement savings accounts. Lately she has been using the word “personalize” instead of “privatize,” but it means the same thing — you’re on your own.

The theory behind some of these cockamamie ideas is that the “free market” will find a way to make health care affordable if government just got out of the way. But before Medicare went into effect, 40 percent of people over age 65 had no medical insurance. Private policies were too expensive for many seniors, and insurance companies didn’t want to sell policies to seniors. There’s your “free market.” Medicare was a response to a problem the “free market” would not solve.

Recently President Obama appointed Dr. Donald Berwick to be Administrator of the Centers for Medicare and Medicaid. Dr. Berwick is a professor at Harvard Medical School and also President and CEO of the nonprofit Institute for Healthcare Improvement. Many mesothelioma patients are in their Medicare years when the first symptoms appear, so what happens to Medicare is a critical issue to people with the deadly asbestos cancer.

Dr. Berwick was chosen for the job through what’s called a “recess appointment,” meaning the appointment was made while the Senate was in recess. Normally, an appointment to such a position requires the approval of the Senate, but the Constitution allows a president to use recess appointments to put someone in a position temporarily. The Senate would have to approve Dr. Berwick if he is to remain in the position beyond 2011.

Apparently the White House used the recess appointment because the president wanted to avoid a replay of the acrimonious health care debates, especially right before a midterm election. But of course nothing in Washington ever happens without a hitch. Senate Minority Leader Mitch McConnell denounced the recess appointment and said the president was trying  to “arrogantly circumvent the American people.”

Note that President George W. Bush made at least 171 recess appointments while he was president, and Sen. McConnell didn’t have a problem with those.

When complaining about the use of a recess appointment didn’t stir up enough outrage against Dr. Berwick, Republicans tried a different approach. They sifted through all of his past speeches and writings for incriminating evidence of something. This wasn’t easy, since Dr. Berwick’s appointment was endorsed by the American Hospital Association, the American Medical Association, the American Association of Family Physicians and pretty much the entire professional medical establishment in the U.S.

The best, or worst, opponents could find was a 2008 speech Dr. Berwick gave in Britain for the observance of the 60th anniversary of Britains’ National Health Service. Not too surprisingly, in this speech Dr. Berwick said nice things about the NHS. This revelation incited a chorus of hysterical shrieking that Dr. Berwick would establish an NHS-style health care system in the U.S., even though there is no way he could do such a thing even if he wanted to. Only Congress can change the Medicare and Medicaid programs into something else.

Then, they found an interview of Dr. Berwick from 2009 in which Berwick said, “We make these decisions [about how to use medical resources] all of the time. The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open. And right now, we are doing it blindly.” In other words, we already are rationing health care and doing a stupid job of it.

Many right-wing news outlets picked up this quote but chopped off the beginning and end, so that it became “The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open.” The quote was published under headlines screaming things like “ObamaCare Will be Rationed!”

Anti-reformers refuse to admit that health care already is rationed. It is rationed by insurance companies, which decide what they will and will not pay for, and it is rationed according to whether the patient has money or insurance at all. One of the reasons we have so needed health care reform is to stop rationing health care and just let people get the care they need. But this continues to be an uphill battle.

You may have heard that Medicare cuts are to blame for the shortage of primary care physicians in America. There’s some truth in that, but not in the way you probably think.

Most graduate medical education in the United States is funded, at least in part, by Medicare. Back in 1996, Medicare decided it would pay for no more than 100,000 medical residencies a year, and that number hasn’t changed since. This in turn has limited the number of medical school graduates who can complete residencies and become certified doctors.

Why did Medicare decide to limit  funding of residencies? Believe it or not, a few years back there were predictions the nation was educating too many doctors. Medical journals of the 1980s and 1990s warned that there would be a glut of doctors in America. Some doctors worried the competition would erode their income. The American Medical Association and other professional organizations actually lobbied for the cap on the number of funded residencies.

Now the shortage is so acute that the only reason many of us don’t have to wait many weeks for a doctor’s appointment is that so many Americans have been without medical insurance. But the new health care reform bill is expected to enable many millions of Americans to obtain insurance who don’t have it now.

Further, that other famous glut called the Baby Boom generation is getting older and will need more medical services in the years ahead.

And even further, of those doctors who do finish their residencies and become licensed to practice medicine, fewer and fewer are becoming family practice physicians. There are several reasons for the shortage of primary care doctors, but most of them boil down to the fact that primary care doctors work longer hours and get paid less for it than doctors in other areas of medicine.

What about cuts to the Medicare program you might have heard about? Medicare is a critical concern to people suffering from asbestos cancer, because the cancer can take decades after exposure to asbestos to develop. Many patients receiving mesothelioma treatment are on Medicare and are no doubt worried that their doctors will stop accepting Medicare.

First, understand that the recent cuts in Medicare payments to physicians were not part of the health care reform bill, although I’m sure many people believe otherwise. Here’s the real story:

Many years ago, Congress established a payment formula for Medicare that was supposed to keep costs under control.  Reimbursements to physicians were supposed to be trimmed a little every year. But beginning in 2003, Congress voted to defer those cuts every year — until this year.

And now all those deferred cuts are going to be imposed all at once. and Medicare fees are being cut by more than 21 percent. In June Democrats in Congress tried to pass “doc fix” legislation that would have prevented these cuts, but Republicans blocked it. And yes, if you are on Medicare, you should be concerned.