Health for life

So, how bad is it?

While HHS Secretary Sebelius Affordable Care Act nostrums help the Obama Administrations muddling of policy and election year politics, CMS Chief Actuary Richard Foster has stepped forward (see page 277) with some blunt language about Medicares solvency.  As the Disease Management Care Blog understands it, official projections on just when the money runs out are based on current law. 

Thats the rub:  

"While the Part B projections.... are reasonable in their portrayal of future costs under current law, they are not reasonable as an indication of actual future costs. Current law would require a physician fee reduction of an estimated 30.9 percent on January 1, 2013—an implausible expectation."

"[W]hile the Affordable Care Act makes important changes..., there is a strong likelihood that certain of these changes will not be viable in the long range. Specifically, the [anticipated] annual price updates for most categories of non-physician health services will be adjusted downward each year by the growth in economy-wide productivity. The best available evidence indicates that most health care providers cannot improve their productivity to this degree—or even approach such a level—as a result of the labor-intensive nature of these services."

"Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services. By the end of the long-range projection period, Medicare prices for ... many services would be less than half of their level under the prior law. Medicare prices would be considerably below the current relative level of Medicaid prices, which have already led to access problems.... Well before that point, Congress would have to intervene to prevent the withdrawal of providers from the Medicare market.... "

"Finally, the economic outlook remains more uncertain than usual. Due to the sensitivity of HI trust fund operations to wage increases and unemployment, the current slow recovery from the recent recession adds a significant further element of uncertainty to the trust fund projections."

Written by the fabulous Leigh, Veggie Might is a weekly Thursday column about all things Vegetarian.

In healthy, vegetarian cooking—in any cooking really—there is a shade of difference between bland and subtle. Conventional wisdom holds that if food is good for you it has to taste like a craft project. Well, I like to keep my craft projects and cooking projects separate, unless Amy Sedaris issues a challenge.

That is why I am known to tweak all recipes, especially vegetarian ones, written before 2005. Vegetarian recipes are notoriously bland. I mean, y’all know. We’ve all tried to cook quinoa with spinach, mushrooms, and tofu for unsuspecting carnis, only to have it backfire on occasion.

So this week I was trying to get whittle down the abundance of kasha in my pantry. Kasha, in the U.S. anyway, is buckwheat. In my old Vegetarian Times Complete Cookbook, I found what I thought was the perfect recipe to start with: Kasha with Potatoes and Dill.

It uses the classic Eastern European flavors of onion and dill, which are a bit out of my usual comfort zone, i.e., no garlic, parsley, or cilantro, and it will challenge me to follow a recipe. When working with new flavors, I don’t experiment much.

Well. It turned out to be that textbook hippie food that turns people off of healthy cooking: bland, mushy, with the distinct flavor of Aleene’s Tacky Glue. My Charming Dinner Guest was so polite, adding extra salt and telling me that “No, really, it’s good.” But I knew.

And I was determined to make it good.

Back to the recipe, I was ready to up all the seasonings and adjust the kasha:veg ratio by adding a turnip. I did those things, but I also realized something very important. I screwed it up the first time.

Going through the instructions again, I discovered that I had cooked the kasha way too long the first time. I got paste because I overcooked the grain. The recipe was still light on the onion and dill, but my error took away the subtle, nutty flavor of the kasha, which absolutely makes the dish.

The second go-round was delicious—light and fluffy, with a hint of sweetness from the onion and a counterbalance of tang from the dill. This dish makes a lovely alternative to a potato side, and packs in way more nutrition with the high-fiber kasha giving it a boost.

That is not the first time my hubris in the kitchen has resulted in a grain FAIL. But it’s cool. These little experiments are how I learn. But next time, I won’t jump to blame the recipe before I check my work.

Now my pantry is nearly kasha-free, and my fridge is well full. My menu is set for the week.

~~~
If you like this recipe, you might enjoy

• Quinoa, Mushrooms, and Mustard Greens
• Beets and Greens Curry
• Miso Mashed Potatoes

~~~

Kasha with Root Vegetables and Dill
Adapted from Vegetarian Times Complete Cookbook.
Serves 6


1 medium potato (about 8 oz), chopped (peeled, optional)
1 medium turnip (about 8 oz), peeled and chopped
water to cover

1 cup kasha
2 cups water
1 tsp salt

1 1/2 large onion, chopped
1 tsp olive oil
1/4 to 1/2 cup water
1/4–1/2 cup fresh dill, finely chopped
1 tsp salt

1) In a small saucepan, cover chopped potatoes and turnips with water and bring to a boil. Reduce heat to a rolling simmer and cook for 5 minutes or until just tender. Remove from heat, drain, and rinse with cold water to stop the cooking. Set root vegetables aside.

2) In a skillet, toast kasha over medium high heat for 7–10 minutes or until you smell the roasted grain fragrance. Stir and toss regularly. Set aside kasha.

3) Bring the 2 cups of water and 1 tsp of salt to boil in a small saucepan. Stir in the kasha, cover, reduce heat, and simmer for 15 minutes. Fluff with a fork.

4) While your kasha is cooking, heat oil in a large skillet and add the onion. Cook until onion is soft, about 7–10 minutes. Add water as necessary if the onion starts to stick.

5) Once all your components are ready, combine in the skillet over medium heat. Add to the onion the kasha, root vegetables, dill, and salt to taste. Toss to combine.

6) Serve as a side with a hearty entrée and vegetables. This goes great as a potato alternative with Bean Burgers and a vegetable.

7) Marvel at the subtle flavors and your finely tuned palate.

Approximate Calories, Fat, Fiber, and Price per Serving
158 calories, 1.6g fat, 6g fiber, $.44

Calculations
1 medium potato: 164 calories, .15g fat, 5g fiber, $.15
1 medium turnip: 39 calories, 0g fat, 2g fiber, $0.37
1 cup kasha: 567 calories, 4g fat, 17g fiber, $.83
1 1/2 large onion: 136.5 calories, .5g fat, 75g fiber, $1.00
1 tsp olive oil: 40 calories, 4.7g fat, 0g fiber, $.03
1/2 cup fresh dill: 2 calories, 0g fat, 0g fiber, $.25
2 tsp salt: negligible calories, fat, fiber, and price per serving
Totals: 948.5 calories, 9.35g fat, 24.5g fiber, $2.63
Per serving (totals/6): 158 calories, 1.6g fat, 6g fiber, $.44

Many people with diabetes wonder if their blurred vision signals the beginning of diabetic retinopathy or perhaps another common cause of vision loss, macular degeneration.

While blurred vision occurs with both conditions, there are distinct differences between diabetic retinopathy and macular degeneration.

First, macular degeneration generally results in central vision loss while diabetic retinopathy results in dispersed areas of vision loss.

Heres a normal view:


Heres that same view through the eyes of someone with macular degeneration:


Heres that same view through the eyes of someone with diabetic retinopathy:


You may be able to turn your head to compensate for central vision loss. Compensation for dispersed loss from retinopathy is more challenging.

Another difference between the two is the age at which they develop.

Where age-related macular degeneration usually occurs in an older age group (60 years and older), diabetic retinopathy can and does strike a younger population.

The ADA states:

"After 20 years of diabetes, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have some degree of retinopathy."
- American Diabetes Association: Diabetic Retinopathy

The average age for diagnosis of type 2 diabetes has shifted from the 40s and 50s in recent years towards a younger population, occurring with troubling frequency in adolescents. Type 1 diabetes can occur in children as young as 2 years old.

Twenty years on from childhood or the teen years places someone with diabetes at risk of losing their eyesight at the height of midlife. The ADA says:

"Diabetic retinopathy is estimated to be the most frequent cause of new cases of blindness among adults aged 20–74 years."

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Photos of vision loss from NIH National Eye Institute via Wikipedia.