Several weeks ago, the Center on Budget and Policy Priorities analyzed the latest budget outlook from the Congressional Budget Office, and found that Medicare’s projected spending between 2010 and 2020 had dropped by over $500 billion since CBO’s projections in 2010.

This was effectively free deficit reduction: no spending had to be cut or policies changed. Health care markets simply shifted in an unexpected way that slowed the growth of health care costs — and what Medicare is projected to spend to buy health care for seniors slowed accordingly.

The big question is whether this slow down is temporary or long-term. David Cutler and Nikhil Sahni took a closer look and found that CBO’s numbers assume the slow down is temporary. If that assumption is wrong, then Medicare could see $363 billion in additional savings by 2023.

Cutler and Sahni constructed the graph below using CBO data. The blue line shows CBO’s 2010 forecast of Medicare’s “excess” annual spending growth. (The increase in spending per beneficiary minus the increase in gross domestic product per capita.) The green line shows CBO’s 2013 forecast. As you can see, while the growth projected in 2013 undercuts what was projected in 2010, the lines re-converge after 2018:

Basically, CBO is projecting that excess spending growth will jump back from its recent average of -2.9 percent to 1.4 percent after 2018.

Cutler and Sahni raise several reasons why this projection could be mistaken, and why the changes we’ve seen will stick: Medicare and Medicaid are moving to reduce reimbursement rates; digital record-keeping and new business models are lowering administrative costs; more low-cost generic drugs are becoming available as patents end, allowing for low-cost generics); we’re turning to expensive and overused procedures less often; and many health care organizations are restructuring to deliver care more efficiently.

This is important because Medicare is the primary driver of CBO’ long-term debt projections. As a result, predicting our future debt levels is a very tricky business, something the Beltway would do well to remember as it’s been gripped by debt panic. Changes in health care markets may have quietly lowered Medicare’s future spending by levels that rival the deficit reduction in either the “fiscal cliff” deal or 2011 Budget Control Act — all without lawmakers reducing any of Medicare’s benefits.

Equally important, we may very well owe many of those market changes — especially lower reimbursement rates, digitized records, and delivery system efficiency — to the reforms and incentives built into Obamacare. If true, that would make the health care reform law a far larger deficit reducer than anyone, including the CBO, has given it credit for.

Mayor Michael Bloomberg’s (I) public health initiative to ban the sale of sugary drinks larger than 16 ounces was set to begin on Tuesday — but after a state judge struck down the initiative on Monday, New Yorkers won’t have to relinquish their supersize sodas anytime soon.

The news will likely come as a relief to the New Yorkers who were already preparing to circumvent the city’s ban. Even if the new regulation had gone into effect, there would still have been several ways for soda lovers to get their super size fix — by going to any local convenience store (which wouldn’t have been subjected to the rule because they’re regulated by the state), by crossing state lines into New Jersey, or simply buying several smaller-sized sodas at once.

The judge’s opinion cites those loopholes as one his primary reasons for striking down the law, since he believed the “uneven enforcement” throughout the city rendered the regulation ineffective. But even though Bloomberg’s proposal wasn’t perfect, it was on the right track.

As an increasing body of research has tied the consumption of sugary drinks to obesity, public efforts like Bloomberg’s represent one small step toward reorienting a culture where portion sizes have continued to spiral out of control. Restaurants’ portion sizes are more than four times larger now than they were in the 1950s — and that culture of excess is making its way into Americans’ homes, too, where meals are also getting bigger. Soft drinks sizes specifically have seen one of the largest increases, ballooning by over 50 percent since the mid-1970s. And research suggests that larger portion sizes do lead people to consume more than they would have otherwise, since we tend to estimate calories with our eyes rather than our stomachs.
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A new study on mental health in war-ravaged Afghanistan conducted by researchers at the Washington University in St. Louis comes to a jarring conclusion: socioeconomic indicators such as poverty and social vulnerability are more telling risk factors for mental illness than even exposure to warfare. While the study in question is centered on Afghans’ mental health outlooks in the waning years of the Afghan war, its lessons — and implications — are just as applicable to another group in the region that has been living with a decade’s worth of violent and traumatic experiences: the enlisted men and women of the United States military.

The report is quick to point out that it’s not claiming that warfare isn’t a significant contributor to mental health concerns. But as an issue of systemic public health risk, underlying socioeconomic insecurity in the Afghan people was found to be a more significant and lasting indicator of mental wellness:

“War exposure is undisputedly a factor of mental distress and anxiety, but other predictors, such as poverty and vulnerability, are stronger and probably more persistent risk factors that have not received deserved attention in policy decisions,” says Jean-Francois Trani, PhD, assistant professor at the Brown School at Washington University and lead author of a new study published in the online first edition of Transcultural Psychiatry.

“Political unrest and violence is fueled by despair and frustrations often associated with mental distress,” Trani says. “A lack of resources or inability to find work make it impossible to assume one’s social status. That, in turn, leads to distress that can conduct to young men choosing a path of violent opposition to authorities and an international presence.”

The study… shows that even in a time of war, mental health is influenced by a combination of demographic and socioeconomic characteristics linked to social exclusion mechanisms — factors that were in place before war began.

“The conflict magnifies factors that were already in place,” Trani says, “and are redefined in relation to the changing social, cultural and economic contexts.”

To state the obvious, the report was done in the context of Afghanistan, a country with a high level of unrest and generally weak institutions. But the trends outlined in the study may also resonate with Afghanistan war veterans — a group that skews younger and more racially diverse than the general population — considering the socioeconomic exclusions and insecurities that they face here in the U.S. after returning home from combat:

The National Coalition for Homeless Veterans estimates that some 1.5 million veterans are at risk of homelessness due to poverty, lack of support networks and dismal, overcrowded, living conditions. Veterans are much more likely than the population at large to suffer from homelessness, comprising 23 percent of the homeless population even though only 8 percent of the population at large can claim veteran status.

Afghanistan War veterans are particularly at risk because of their young age and their exposure to combat with its psychological effects. Some seventy percent of Iraq and Afghanistan veterans had exposure to combat. About 30,700 are expected to leave the military in each of the next four years as the military reduces its ranks. About 13 percent of homeless Afghan and Iraq war veterans are women, and almost 50 percent of all homeless veterans are African American.

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Scientists believe they may have discovered an unlikely weapon in the fight against the global HIV/AIDS epidemic: bee venom.

According to researchers at the Washington University School of Medicine in St. Louis, bee venom contains a powerful toxin called “melittin” that can effectively kill the HIV virus while leaving the surrounding cells unharmed. Now that they’ve isolated the toxin, they’re using it to develop a vaginal gel to prevent the spread of HIV — a new tool that will hopefully help stop the transmission of the virus in places with high rates of infection:

“Our hope is that in places where HIV is running rampant, people could use this gel as a preventive measure to stop the initial infection,” says Joshua L. Hood, MD, PhD, a research instructor in medicine. [...]

According to Hood, an advantage of this approach is that the nanoparticle attacks an essential part of the virus’ structure. In contrast, most anti-HIV drugs inhibit the virus’s ability to replicate. But this anti-replication strategy does nothing to stop initial infection, and some strains of the virus have found ways around these drugs and reproduce anyway.

“We are attacking an inherent physical property of HIV,” Hood says. “Theoretically, there isn’t any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus.”

Beyond prevention in the form of a vaginal gel, Hood also sees potential for using nanoparticles with melittin as therapy for existing HIV infections, especially those that are drug-resistant. The nanoparticles could be injected intravenously and, in theory, would be able to clear HIV from the blood stream.

Researchers haven’t yet explored all of melittin’s potential to be used for contraceptive purposes, but Hood pointed out that the gel could likely be adapted to target sperm as well as HIV — essentially creating a spermicide that could protect against both pregnancy and sexually transmitted infections. But as of now, the gel is safe for both sperm and vaginal cells, and may be particularly useful for HIV-positive individuals who want to safely conceive.

And, since melittin could also help combat viruses other than HIV, bee venom could have broader implications for public health efforts. Melittin may be able to similarly destroy the hepatitis B and C viruses.

Bee venom’s important toxin is just the latest unexpected breakthrough in HIV treatment and prevention efforts. Last week, scientists reported that they may have “functionally cured” a two-year-old child of her HIV infection by aggressively treating her infection from the time of her birth. Unfortunately, the automatic cuts that recently began taking effect as a result of the sequestration may hamper future HIV research, as scientists will now have fewer resources to invest in research projects focused on unlocking the keys to treating the epidemic.

They swap out bed pans, tend to wounds, and assist with every facet of day-to-day life — sometimes even living with their patients. They’re home health care aides, and they are a crucial resource in caring for America’s sick, elderly, and disabled — and they do it all for an average wage of $9.70 per hour, less than the mean hourly compensation for lifeguards, food servers, and dry cleaners.

That reality will continue to affect more and more Americans, as growth in this particular portion of the health care industry has been fast — and it’s only going to get faster. Job growth in the American health care sector doubled from January to February, led by strong gains in ambulatory care givers, hospital workers, and home health aides. And as CNN Money points out, an uptick in America’s elderly population — fueled by aging Baby Boomers — will lead to an explosion in demand for such workers’ services.

But due to a loophole in labor protection laws, home health aides often make less than minimum wage, earning about $20,000 per year. And that’s just the full-time workers. Part-time health aides, who make up most of the profession, make even less and don’t receive benefits — leading to a sadly ironic situation in which health workers are often forced to forgo their own health care and turn to government safety net programs:

Under these conditions, it’s no surprise then that about 40% of home aides rely on public assistance, such as Medicaid and food stamps, just to get by.

“What you have is a situation here where the people that we count on to care for our families cannot take care of their own, and that’s got to change,” said Ai-jen Poo, director of the National Domestic Workers Alliance. [...]

A recent study by the Institute for Women’s Policy Research estimates immigrants make up 28% of home health care workers, and of those, one in five are undocumented.

The Census Bureau has found that 53% of home health aides are minorities. By their calculations, it is the single most common job for black women, who alone represent nearly a third of the entire profession.

This is part of the reason workers are undervalued and underpaid, say worker advocates like Eileen Boris, a professor of feminist studies at the University of California, Santa Barbara.

The fact that the populations who are already disproportionately affected by poverty and poor access to essential services are turning to such low-wage, low-benefit jobs is a sad reflection on both America’s economic recovery and holes in the social safety net. In fact, most of the jobs added to the U.S. economy since the recession ended pay low wages.

Under Obamacare, home health aides will serve as essential foot soldiers in the fight to make America’s health care system more efficient. The Obama Administration has been pushing to revamp labor protections for home health aides, but that effort has not enjoyed much success so far.

Over the past year, Texas officials have attacked women’s health resources from all angles — slashing funding from family planning programs, cutting off funds to the Planned Parenthood affiliates in the state, and attempting to shut down dozens of abortion clinics. Those decisions have jeopardized thousands of low-income women’s access to affordable health care, and faith leaders are praying for Texas to reverse its course.

Religious leaders in Texas joined together last week to emphasize that women’s health is a religious issue. Jewish and Christian leaders prayed for increased access to preventative health services, like family planning programs and birth control, in a state that has become increasingly hostile to women’s health care:

Gathered in the rotunda of the Texas Capitol Extension, leaders from Christian and Jewish faiths voiced frustration with funding for women’s health care services. Their prayer included a plea to state lawmakers to restore the $73 million cut from family planning services during 2011 and to make contraception more readily available to low-income women.

“For us this is part of our faith commitment that cares for all of God’s creation, all of God’s people,” said Larry Bethune, pastor of University Baptist Church in Austin. “Particularly for the stability of families and for the care of women and their health.”

“We believe that women should have and families should have the opportunity to make choices about when they’re going to have children and how many children they’re going to have,” said Bethune. “Women need to have access to health care, to good counsel and to clinics that can provide that health care before, during and after pregnancy.”

The faith leaders criticized Texas officials for targeting Planned Parenthood in their ongoing crusade against abortion — a crusade that has had far-reaching implications for the poor women in the state who must now search for new doctors. Planned Parenthood is the state’s largest health care provider for low-income women, but Texas Republicans have been so focused on cutting ties with the national organization that they have forced the closure of dozens of unaffiliated health clinics and have ultimately eliminated $30 million in federal funding for women’s health services.

“I think the abortion issue, it’s just part of a continuing culture war,” Rabbi Neal Katz told a local ABC News affiliate. “But I do believe that it’s a distraction from the issue that we’re trying to focus on, which is women having access to good health care, to family planning, to birth control.”

Despite the Religious Right’s attempt to use abortion as a wedge issue, reproductive rights are not actually incompatible with faith communities. Most religious groups support women’s right to legal abortion services under Roe v. Wade, and many people of faith — including Catholics and evangelicals — support expanding women’s access to birth control.

South Dakota Gov. Dennis Daugaard (R) has approved a measure to extend the state’s abortion waiting period, which is already one of the longest in the country. Under the new law, weekends and holidays won’t count toward the 72-hour waiting period required for women seeking abortions — which means that some women may be forced to wait up to six days if they seek abortion services before a three-day weekend.

Mandatory waiting periods are a popular tactic among abortion opponents. Designed to shame women out of their decision to terminate a pregnancy, waiting periods require women to seek counseling and repeatedly verify their consent before proceeding with the voluntary medical procedure. South Dakota’s law — which has thus far been tied up in court as women’s health advocates challenge its provisions — actually requires women to visit a biased, anti-abortion “crisis pregnancy center” (CPC). Proponents of the new law claim it will help ensure that women have enough time to schedule an appointment with a CPC during their business hours.

But there’s no reason to force women to wait longer to access legal abortion services. Waiting periods and forced “counseling” sessions don’t actually change women’s minds about whether they want to have an abortion. And waiting periods actually cause emotional and financial hardships for women.

According to a new study that surveyed the effects of mandatory 24-hour waiting periods, forcing women to put off an abortion — denying them the bodily autonomy to decide when they want to terminate a pregnancy — negatively effects most women’s emotional well-being. When women are required to make multiple trips to a clinic, they also end up having to pay for extra transportation and child care on top of the cost of the abortion procedure. Of course, South Dakota’s law is even more stringent than the 24-hour waiting period that provided the subject for that study.

And now that South Dakota will also exclude weekends and holidays from its unnecessary waiting period, the women seeking reproductive care will face an even bigger burden. No other state limits its waiting period to business hours simply to accommodate the schedules of right-wing CPCs — but South Dakota Republicans have made it clear they would rather prioritize their anti-abortion agenda over women’s health.