LUMBERTON, N.C. - Less than two weeks are left for Congress to prevent a cut to reimbursements for doctors who treat Medicare patients. The cuts stem from a formula Congress has used for 15 years to determine how much doctors are paid. This year, a potential 26-percent cut is looming.

Family physician Dr. Brian Kessler, Lumberton, says the system discourages doctors like him, who are trying to meet their own overhead costs and turn a profit.

"Practice costs have gone up, yet physicians are looking at a reduction in their Medicare reimbursements, so a lot of physicians are not going to opt to take on new Medicare patients."

Kessler and other doctors are pushing Congress to find a permanent solution to negotiate reimbursement rates and to do away with the current formula system that creates uncertainties almost every year. Some seniors in North Carolina are already reporting difficulty in finding doctors who will accept them as new patients, he warns.

Kessler points out that 10,000 Americans will turn 65 every day for the next 19 years, which will eventually double the number of people who use Medicare.

"We want to do the best for our patients. When you can't continue to provide adequate services because the cost of providing those services outweighs that payment, it just makes it more and more difficult."

The cost to fix the Medicare reimbursement problem will only increase. According to Kessler, in 2005, it would have cost less than $50 billion. This year the cost is an estimated $250 billion.




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Agribusiness has spent $500 million so far to lobby for changes to the next farm bill - in particular to invalidate a California law that bans extreme-confinement veal calves, breeding pigs and egg-laying chickens. Proposition 12, passed in 2018, also requires meat raised elsewhere but sold in California to meet that standard.

Sean Thomas, international director of investigations for the nonprofit Animal Equality, said the Farm Bill proposed by the House Agriculture Committee includes language similar to the EATS Act, which would repeal Prop 12.

"Prop 12, it was overwhelmingly passed in a democratic process by the majority of Californians, and the EATS Act seeks to undermine that and take away any state's ability to just have these most basic, basic standards for the welfare of animals," he said.

Supporters of the EATS Act argue that California's rules are hurting agriculture in other states. The meat industry also lobbies in favor of protein requirements in school lunches and subsidies for livestock operations and dairies. According to the website Open Secrets, meat companies have made more than $27 million in political contributions since 1990.

The government needs to conduct strong oversight of factory farms to guard against pollution in the air and water, Thomas contended.

"If we think of a large-scale industrial pig farm, the amount of waste that it produces is similar to that of a small city. These are farms that are so concentrated with animals that they have open-air lagoons that regularly leach chemicals of these waste products into groundwater," he continued.

The meat industry also funds training courses aimed at social media influencers and students that teach talking points on how to downplay the harms of industrial agriculture.


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Consumer advocates have long detailed how older adults struggle to manage the cost of their medications but hope is emerging in Minnesota and elsewhere with federal changes taking shape.

Under the Inflation Reduction Act, several provisions were established to address the skyrocketing costs of prescription drugs, with most of the efforts focused on Medicare enrollees.

Michael Cabonargi, regional director for the U.S. Department of Health and Human Services, visited Minneapolis this month to help outline some of the estimated savings. The Biden administration recently unveiled price reduction agreements for the first group of Medicare-covered drugs included in negotiations with manufacturers.

"This is the first 10 drugs, again, the most prescribed, most expensive for things like hypertension, diabetes, cardiovascular disease," Cabonargi explained. "We're going to be expanding that."

The first wave of price controls takes effect next year and in 2025, Medicare will select up to 15 additional drugs covered under Part D for negotiation. The group Protect Our Care Minnesota said over time, the federal law will save older Minnesotans more than $113 million. Drugmakers have criticized the policy changes, arguing they will hurt innovation.

Separately, AARP said out-of-pocket drug cost caps of $2,000, also beginning next year, will result in average savings of roughly $1,500 for those who qualify.

Cabonargi noted when you take a step back, it appears consumers are beginning to get a fair shake under the Inflation Reduction Act.

"It really is going to change the trajectory of health care expenses in this country," Cabonargi contended. "For seniors in particular, they're going to have money back in their pocket."

The federal moves have faced political headwinds, with Republican lawmakers facing calls from conservative groups and strategists to roll back provisions. Meanwhile, Protect Our Care said nearly 30,000 Minnesotans on Medicare who use insulin are now saving on average $672 annually under a monthly price cap.

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By Tim Marema for The Daily Yonder.
Broadcast version by Mike Moen for Wisconsin News Connection for the Public News Service/Daily Yonder Collaboration

Rural residents are less likely to be worried about the health risks of drinking unpasteurized milk, but they are just as likely as other Americans to understand the effectiveness of pasteurization to kill germs without changing milk’s taste or nutritional value.

A public opinion survey conducted by the University of Pennsylvania’s Annenberg Public Policy Center found that only a third of rural respondents thought raw milk was less safe to drink than pasteurized milk. Of urban respondents, about half said raw milk is less safe. The difference between urban and rural respondents was significant when researchers controlled for other factors such as age and education.

But the study found there was no statistical difference between rural and urban respondents’ knowledge that pasteurization eliminates milk-borne bacteria and viruses without affecting taste or nutrition.

“We did find that people living in rural areas thought that raw milk was safer overall than people living in the suburbs or in urban environments,” said Shawn Patterson Jr., a research analyst with the public policy center in a Daily Yonder interview.

Patterson said the center will conduct more research to see if they can pin down the cause of the different attitudes toward pasteurization. 

One possibility is that rural people understand the process of pasteurization but think raw milk is safer because they are more aware of managing livestock and milk production, he said. Or they might feel more confident about raw milk because they are closer to the milk source or raise the milk-producing animals themselves.

Patterson said he was not aware of studies that confirmed that consumers could mitigate the risks associated with drinking raw milk if they were more aware of where it came from. “But what we do know is that [raw milk] is still significantly less safe than pasteurized milk.”

A 2017 study found that unpasteurized milk was responsible for nearly all reported illnesses and hospitalizations linked to milk-borne infections. While under 4% of the U.S. drinks raw milk and under 2% eats cheese made with raw milk, those consumers experienced 96% of the illnesses caused by contaminated milk, the study showed.

Bird Flu and Raw Milk

While reported milk-related illnesses are low compared to other diseases (an average of 760 reported illnesses a year and 22 hospitalizations, the 2017 study said), milk safety has been in the news since an outbreak of bird flu H5N1 was reported in U.S. dairy cattle earlier this year. 

Infected cows can shed H5N1 into their milk, the CDC reported, and mice that consumed infected milk showed signs of developing the flu. This has led to fear that raw milk from infected cows could transmit H5N1 flu to humans. 

Currently, this influenza is not transmittable between humans. Out of 14 reported cases of H5N1 flu in humans this year, four were among dairy workers and nine were among poultry workers.

The Food and Drug Administration prohibits the inter-state sale of unpasteurized milk. States make their own rules for milk that doesn’t cross state lines. 

Pasteurization has been the norm for a century. But Patterson said there has been an uptick in demand for unpasteurized milk in recent years. He said that social media could be one reason and that future research would test that hypothesis.

Beth Ann Mayer in Healthline reported in June that profit motives from social media producers are part of the push for raw milk. 

Unpasteurized milk can transmit pathogens such as listeria, campylobacter, salmonella, and E. coli. People who are pregnant or have weakened immune systems are especially vulnerable to such infections, according to the FDA.

Mainstream scientists have found no evidence that pasteurization alters the nutritional value of milk, but myths persist that it does, Patterson said. 

“Pasteurization doesn’t change the nutritional value of milk; it doesn’t significantly change the taste of milk,” he said. “And so the risks really don’t outweigh any of the benefits.”

Other key findings in the public opinion poll on the safety of raw milk were the following:

• People over 65 were more likely than other age groups to think raw milk was less safe than pasteurized milk.


• Awareness of the health risks associated with unpasteurized milk increased as education levels increased. 


• Men were more likely than women to think raw milk was less safe than pasteurized milk. 


• Democrats were more likely than Republicans or independents to think raw milk was less safe.


• White, non-Hispanics were more likely than Hispanics or Blacks to think raw was less safe. 

The poll was conducted in June 2024 using the SRSS Opinion Panel. Rural was defined as respondents who lived in a nonmetropolitan county, based on the Office of Management and Budget Metropolitan Statistical Area system.




Tim Marema wrote this article for The Daily Yonder.


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